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Development of Segmental Intensive Trunk Training for Children with Cerebral Palsy GMFCS IV-V

Surana, Bhavini Krunalkumar

Postural control is essential for maintaining an upright sitting position. However, children with Cerebral Palsy (CP) Gross Motor Function Classification System (GMFCS) IV-V present with impaired postural control, often limiting their daily function and environmental interaction. Most interventions targeting postural dysfunction in CP consider the trunk as a single biomechanical segment and are challenging to use in the GMFCS IV-V population.

The aim of this study was to develop the Segmental Intensive Trunk Training (SITT), which uses the segmental model of trunk control. The motor learning framework was chosen for structuring SITT to be an intensive approach, with a dosage of 2hrs/day, 3days/week for 4 weeks (24 hours). The development process included the test of feasibility and the initial evidence of effects, using a single subject research design (SSRD). An A-B-A design was used, where the first phase A included 4 baseline assessments, and phase B included the 4 weeks of SITT intervention.

The second phase A was the withdrawal period including an immediate posttest, post 1 week test and a 3 month follow up evaluation. Postural control and reaching behavior were assessed during all 3 phases, using the Segmental Assessment of Trunk Control (SATCO) and Seated Postural and Reaching Control Test (SP&R-co). Hand dexterity and function was measured using the Box and Block test, and ABILHAND-kids questionnaire. Gross motor function was measured using the Gross Motor Function Measure Item Set (GMFM-IS). Performance on functional goals was assessed using the Canadian Occupational Performance Measure (COPM). Data analysis was descriptive, including visual analysis and the two standard deviation band method. One participant (11 years, GMFCS V) participated in the study with a 100% completion rate and 88% participation rate. SITT was a feasible approach for training segmental postural control and reaching behavior in children with CP GMFCS V.

The improvements in postural control were associated with an improvement in manual dexterity, gross motor function, functional goal performance, and performance-related satisfaction. The gains in static control and COPM performance and satisfaction were retained at 3 months. These improvements were seen in the areas of body structure and function, and activity domains. Progress in motor performance in response to SITT was established at an individual level; however, more evidence is needed to establish the external validity of the approach.

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More About This Work

Academic Units
Biobehavioral Sciences
Thesis Advisors
Gordon, Andrew Michael
Degree
Ed.D., Teachers College, Columbia University
Published Here
March 8, 2021