Exploring Physiotherapists' Use of Motor Learning Strategies in Gait-Based Interventions for Children with Cerebral Palsy.
Jennifer L Ryan, F Virginia Wright, Danielle E Levac
PMID 31154883WHAT IT FOUND
Eight physiotherapists said child characteristics and each child's response drove their gait-strategy choices.
They adapted cues and task progression during sessions, but used inconsistent language for the same strategies.
Key findings
01Child characteristics were the strongest influence on therapists' motor learning strategy decisions, and strategies were adapted during sessions based on each child's response.
02Therapists used motor learning language inconsistently; the term 'motor learning' was mentioned nine times by three of eight therapists, and they often described verbal, tactile and visual cues instead.
03Many motor learning strategies were used similarly across gym and Lokomat sessions, but Lokomat machine guidance changed how therapists used physical guidance and allowed more verbal instruction and feedback.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only eight physiotherapists were interviewed, all women, from one hospital team, so the findings may not represent wider practice. The study was nested inside Lokomat clinical trials, and the first author was a treating physiotherapist and interviewer who knew some participants, which may have shaped responses and interpretation. The trial setting included shorter 30-minute sessions, which may have limited strategies needing more explanation, such as education or mental practice. Open-ended questioning was used to reduce bias, but it may have caused therapists to overlook strategies they did not mention. No patient outcomes or treatment effects were measured; the study reports therapists' perceptions and descriptions.
Declared interests
The authors reported no potential conflict of interest.
The easy way to misread this
Do not conclude that the Lokomat or gym-based motor learning strategies improve walking. The study reports how eight physiotherapists described their decisions and language; it measured no patient outcomes.