Thursday, November 4, 2010

Motor Learning Versus Neurodevelopmental Treatment

A recent article in Clinical Rehabilitation compared two groups of children with cerebral palsy. Seventy eight children (ages 66-146 months) with spastic cerebral palsy (gross motor functional levels II and III) were divided into two groups. One group received motor learning coaching for 3x/week, one hour sessions, over three months. The other group received the same 3x/week, 1 hour sessions for three months of neurodevelopmetnal treatment (NDT). After the three months and at 6 months, the Gross Motor Function Measure (GMFM-66) was performed along with parent questionnaire and stair climbing was assessed.

The results showed the following:
  • both groups showed increased scores in GMFM-66 at 3 months
  • at 6 months retention was significantly better in the motor learning group level II children
  • stair climbing also showed improved retention after 6 months in the motor learning group (increased by 1.1% compared to a decreased of 0.3% in the NDT group)
  • mobility improved by 13% for the motor learning coaching group and decreased by 12% with the NDT group

The researchers concluded that motor learning coaching resulted in significantly better results in gross motor function and mobility for higher level functioning children with cerebral palsy.

Reference: Simona Bar-Haim et. al. Effectiveness of motor learning coaching in children with cerebral palsy: a randomized controlled trial Clin Rehabil November 2010 vol. 24 no. 11 1009-1020

5 comments:

TherExtras said...

Whoa. Big slam on NDT.

I think parsing by technique is useful up to a point, but PT should NOT be specific to a single technique. PT - implemented by a thinking-person - should include both motor learning coaching with appropriately used NDT concepts.

Looking for that study that shows the difference between groups - some get therapy/some not or some get much less (typical dosage of 2x/week) vs intensive dosage. Barbara

Your Therapy Source Inc said...

I agree a good therapist combines many techniques - NDT, motor learning, SI, etc.

Are you thinking of the intensive group therapy study posted at Group Therapy?

TherExtras said...

Not exactly, Margaret. I'm thinking that study has not been done yet. So long as PT is thought of as single technique (pill or pharmaceutical) then we are relegated being technicians of techniques instead of thinking professionals. Barbara

Your Therapy Source Inc said...

I think PT's now are thinking professionals. The problem is we sometimes "think" on our own based on our own experiences and depth of knowledge. These studies that look closely at different techniques and dosages are important to base our professional judgement on.

That being said, this is why more research should focus on the dynamic systems theory approach when working with children. There is much greater variability in children's development and our current system of 1-2x/week is not the most efficient nor beneficial to the child.

TherExtras said...

Looks like we agree. Good point about treatment frequency (dosage). Barbara