This seminal paper represents one of the earliest attempts to determine the effect of physical therapy upon three types of cerebral palsy—spastic hemiparesis, spastic tetraparesis, and extrapyramidal. The groups studied were drawn from 1821 patients with cerebral palsy known to Children's Hospital of Boston between 1930 and 1950, and formed the basis for the follow-up study of Drs Bronson Crothers and Richmond Paine. The patients were divided into two cohorts, one untreated, the other receiving intensive therapy with stratification into a mild group and a severe group. Other considerations were taken into account.
The data regarding the 177 cerebral palsy patients were previously included in the above-mentioned follow-up study, thus reasonable and detailed information were available to the type, intensity, and duration of physical therapy and similar treatment. These patients were followed until at least age 14 years. Seventy-four were accidentally or intentionally untreated, and the status of this group at follow-up examination was compared with the 103 subjected to intensive therapy, with or without bracing and orthopedic surgery. Original and serial motion pictures were available from 132 patients. The original makeup of the treated and untreated cohorts was similar as to type and severity of involvement, with mild and severe cases being evaluated separately. Cohorts were stated to be comparable as to intelligence, but the untreated group contained a higher percentage of mentally defective patients.
The patients with mild spastic hemiparesis developed a better quality of motion with or without therapy. The treated group with moderate or severe hemiparesis had a relatively better gait and fewer contractures.
Those with spastic tetraparesis had a poorer prognosis than those with hemiparesis. The authors felt that the quality of gait might have been improved and contractures lessened by physical therapy.
The gait and hand function of those treated of the extrapyramidal types were not that different from the untreated.
The physical therapy rendered was heterogeneous, using stretching exercises, “muscle training,” attempts to teach patterns of movement and range of motion of individual joints, and also functional training. It was mentioned that perhaps with more modern therapies these patients might have done better.
Of importance is Paine's noting that the tendency of children to improve in coordination and function with increasing age must be distinguished from the effects of treatment.
This paper, written in 1962, opened a new era of encouragement for clinical trial studies to determine the effectiveness of therapy for cerebral palsy. Since this paper was published, neurodevelopmental pediatricians who focus on the interdisciplinary evaluation, diagnosis, and management of chronic encephalopathies have engaged in clinical trial studies not only to determine therapy effectiveness in cerebral palsy, but also the wide array of developmental disorders (cerebral palsy, mental retardation, learning disabilities spectrum [attention deficit disorder, attention deficit hyperactivity disorder], autism, deafness, and the visually impaired). This paper not only encouraged clinical trials of physical therapy but also challenged academicians and practitioners to use other methods of treatment for improvement of motor function of children with cerebral palsy. Since that time, neurosurgery, along with orthopedic surgeons has devised newer methods of treatment using baclofen, oral and intrathecal botulinum toxin, and rhizotomies. Newer methods of physical therapy have been also devised, such as, neurodevelopmental therapy for enhancing the functioning of these children.
Therapy studies should continue to receive high priority in the subspecialty of neurodevelopmental disabilities. The goal of such studies should be the continued clinical benefit of children with motor dysfunction.