Type and Distribution of Gross Motor Activity During Physical Therapy in Young Children With Cerebral Palsy.

Objective: Physical therapists routinely deliver and prescribe motor practice to improve function. The ability to select optimal practice regimens is limited by a current lack of detail in the measurement of motor practice. The objective of this study was to quantify the type, amount, and timing of gross motor practice during physical therapist sessions.

Methods: A secondary video coding analysis of physical therapist sessions from the iMOVE clinical trial (NCT02340026) in young children with cerebral palsy (CP) was conducted. The 37 children who completed the treatment phase were included (mean age = 22.1 months). Children could initiate pulling to stand but were unable to walk. Videos of randomly selected therapy sessions were coded for gross motor activity (422 videos total). The 10 gross motor activity codes included lying, sitting, four point, crawling, kneeling, knee walking, standing, walking, transitions between floor postures, and transitions to/from an upright posture. Twenty percent of each video was double coded for reliability. Time per session, number of bouts, and median time per bout were calculated for each gross motor activity and for 2 aggregate measures: movement time and upright time.

Results: Participants spent more than half of therapy time in sitting and standing combined (60.3%). Transitions occurred more frequently than any other motor activity (49.3 total transitions per session). Movement time accounted for 16.3% of therapy time. Upright time accounted for 53.3% of therapy time.

Conclusions: Critical practice time to gain motor skill is not equivalent to chronological time or time spent in therapy. Toddlers with CP spent a small amount of therapy time moving. Future work should explore the relations between motor practice and rehabilitation outcomes.

Impact: Physical therapists are ideally suited to detail the content of motor practice and ultimately to prescribe optimal patterns of motor practice. We report the characteristics of gross motor practice during therapy in children with CP.