A Physical Therapy Intervention to Advance Cognitive and Motor Skills: A Single Subject Study of a Young Child With Cerebral Palsy.
Stacey C Dusing, Reggie T Harbourne, Michele A Lobo and 7 others
PMID 31568380WHAT IT FOUND
A single child with severe cerebral palsy showed faster gains in motor and problem-solving skills during a parent-led physical therapy intervention that combined sitting and reaching with cognitive play.
The mother changed how she played, but the study cannot prove the therapy caused the improvement.
Key findings
01The child's gross motor skills improved on 100% of outcome assessments immediately post-intervention and at follow-up.
02The mother changed her interaction style after the intervention, incorporating toys into problem-solving activities rather than just using them to motivate passive movement.
03The rate of cognitive skill gain increased during the three-month intervention compared to the ten-month baseline period, but slowed after the intervention ended.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study included only one child, so the results cannot be generalized to other children with cerebral palsy. There was no control group or reversal phase, so it is impossible to determine if the improvements were due to the intervention or natural development. The mother continued some intervention activities after the formal sessions ended, which means the 'baseline' behavior was not fully restored, confounding the follow-up results. The number of data points on the primary outcome (Bayley-III) was limited, making statistical analysis difficult. The child had severe motor impairments (GMFCS IV), and the assessment tools may not have fully captured her cognitive potential due to her physical limitations.
Declared interests
The authors report no conflicts of interest. The study was supported by non-U.S. government funding.
The easy way to misread this
Do not interpret the improvement in this single child as evidence that the START-Play intervention works. Without a control group or reversal, it is impossible to distinguish the effect of the therapy from the child's natural developmental trajectory or the placebo effect of increased parental engagement.