Outcomes of adherence to play therapy in children with cerebral palsy: a clinical trial.

Abstract

Background: Cerebral palsy (CP)is an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development. Play is an occupation of childhood. Through play children improve performance skills. Research shows that play therapy has a positive effect on improving motor skills in children. Games in a way stimulate the nervous system and make the child active, they create vitality and nerve readiness which cause excitement and interaction of sensory and perceptual parts and decision making in children.

Objective: The primary objective was to determine adherence to a structured play-therapy program in children with CP. The secondary objective was to explore changes in hand/upper-extremity function following the program.

Methods: This pilot, single-arm clinical trial recruited 12 children (5-13 years) with hemiplegic or diplegic CP from Sneha Kiran Spastic Society, Mysore. The intervention comprised institution-based play therapy (45 minutes/day, 5 days/week for 6 weeks) with a home component (2 days/week). Adherence was calculated as the percentage of prescribed sessions completed, with ≥75% predefined as adherent. Upper-extremity function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the program.

Results: Institutional adherence ranged from 59% to 96% (mean 86.4%); 11/12 children met the ≥75% adherence threshold. Home adherence was lower (0%-83%). QUEST scores increased from 47.65 ± 14.47 (pre) to 48.51 ± 14.61 (post), with a statistically significant pre-post change on Wilcoxon signed-rank testing (Z = -1.992, p = 0.046).

Conclusion: There was good adherence to play therapy (84.6%) in children with hemiplegic and diplegic cerebral palsy with age group of 6 to 12 years. There was significant improvement in hand function after 6 weeks of play therapy. Therefore, play therapy can be implemented in children with cerebral palsy. Larger controlled studies are warranted to confirm effectiveness and to address barriers to home adherence.