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Published online September 21, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. e606-e614 (doi:10.1542/peds.2009-0288)
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ARTICLE

Occupational Therapy Home Programs for Cerebral Palsy: Double-Blind, Randomized, Controlled Trial

Iona Novak, PhDa, Anne Cusick, PhDb, Natasha Lannin, PhDc

a Cerebral Palsy Institute, School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
b College of Health and Science, University of Western Sydney, Sydney, Australia
c Rehabilitation Studies Unit, Faculty of Medicine, Royal Rehabilitation Centre, University of Sydney, Sydney, Australia

OBJECTIVE: The goal was to assess the effectiveness of an occupational therapy home program (OTHP), compared with no OTHP, with respect to function and parent satisfaction with child function, participation, goal attainment, and quality of upper limb skill in school-aged children with cerebral palsy.

METHODS: Thirty-six children with cerebral palsy (mean age: 7.7 years; male: 69%; Gross Motor Function Classification System: level I, 47%; level II, 14%; level III, 16%; level IV, 7%; level V, 16%; spasticity, 85%; dyskinesia, 14%; ataxia, 3%) were randomly and equally assigned to OTHPs for 8 or 4 weeks or to no OTHP. The primary end point was Canadian Occupational Performance Measure scores 8 weeks after baseline. Secondary measures were recorded at 4 and 8 weeks.

RESULTS: Eight weeks of OTHP produced statistically significant differences in function and parent satisfaction with function, compared with no OTHP. Parents in the 4-week OTHP group did not discontinue use at 4 weeks, as instructed, and continued for 8 weeks; results demonstrated statistically significant differences, compared with no OTHP. There was no difference in primary or secondary end point measures between intervention groups.

CONCLUSION: Pediatricians can advise families that OTHPs developed with a collaborative, evidence-based approach and implemented by parents at home were clinically effective if implemented 17.5 times per month for an average of 16.5 minutes per session.

Key Words: home program • cerebral palsy • occupational therapy • randomized • controlled trial • double-blind • effectiveness • outcomes • Canadian Occupational Performance Measure • function

Abbreviations: COPM—Canadian Occupational Performance Measure • COPM-P—Canadian Occupational Performance Measure-Performance • COPM-S—Canadian Occupational Performance Measure-Satisfaction • CAPE—Children's Assessment of Participation and Enjoyment • CI—confidence interval • GAS—Goal Attainment Scale • QUEST—Quality of Upper Extremity Skills Test • OT—occupational therapy • OTHP—occupational therapy home program

Accepted May 29, 2009.


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