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|Title:||Current Evidence and Future Directions for Physiotherapy Intervention in Cerebral Palsy: Physical Activity and Physical Fitness|
|Authors:||Girling-Butler, Jane M|
|Publisher:||University of Sydney|
|Abstract:||The aim of this thesis was to examine the evidence for physiotherapy intervention for children with cerebral palsy. Cerebral palsy is the most common activity limiting disability in children and adolescents with the incidence being approximately 2-3 per 1,000 live births worldwide. The severity of cerebral palsy is highly variable, but inevitably results in some degree of activity limitation due to motor impairment. However, from the physiotherapist’s point of view the presence of motor impairments – and the subsequent effect that these impairments have on a child’s activity and participation – is the most relevant for intervention. Therefore, determining the most effective form of physiotherapy intervention to address motor impairment, to promote physical activity and enable community participation is an important issue. Four studies were undertaken in this thesis. The first study was a summary of systematic reviews of physiotherapy intervention for children with cerebral palsy and was conducted in order to identify the evidence located on electronic databases. This study found evidence for six physiotherapy interventions – casting, physiotherapy intervention in conjunction with botulinum toxin type-A, electrical stimulation, constraint-induced movement therapy, strength training and cardiorespiratory training. However, the evidence for the effect of intervention was equivocal due to the small numbers of randomised controlled trials, poor reporting of data in the trials and inconclusive results. Since there were a number of trials examining cardiorespiratory training in children with cerebral palsy, which is also an important focus in other areas of physiotherapy intervention, it was decided to investigate this further. In the second study, a systematic review was conducted to examine the evidence for improving cardiorespiratory fitness in children with cerebral palsy. This review showed that it was possible to increase cardiorespiratory fitness in these children. However, the improved fitness did not carry over into their everyday activity. This raised the question of whether there was a relationship between cardiorespiratory fitness and activity and led to the third study. The third study was a feasibility study which examined whether cardiorespiratory fitness or walking capacity influenced the amount of physical activity undertaken by children with cerebral palsy who had mild impairment and were able to walk. This study found that children with cerebral palsy had low cardiorespiratory fitness levels compared to reported values in typically-developing children. However, as there was a moderate correlation between peak heart rate and oxygen uptake during the progressive exercise test, these children demonstrated that they had a normal cardiorespiratory response to exercise of increasing intensity. To control for environmental influences, the children with cerebral palsy were compared to a matched group of siblings to examine the amount of their physical activity. The results revealed that the children with cerebral palsy were performing as much daily physical activity as their age-matched siblings, but that this activity was less than recommended guidelines for both groups. Overall, no relation was found between the cardiorespiratory fitness or walking capacity of the children with cerebral palsy, and the amount of their physical activity. Given that the amount of activity was not determined by the child’s physical characteristics (cardiorespiratory fitness or walking capacity), the fourth study was undertaken in order to identify whether there were barriers which were preventing the child performing activities. Parents were asked to indicate what they saw as being the barriers which were either preventing their child from performing an activity, or which were influencing how frequently their child performed the activity. This study found that these children were regularly engaged in physical activities which are fairly representative of typically-developing children. However, parents perceived cost as being the largest barrier to their child’s activities. Of concern, was that cost was preventing the child from being engaged in activities which could be performed frequently. Generally, children with cerebral palsy just want to engage in activities alongside their typically-developing peers. For children who are ambulant and capable of physical activity, it is important that they are given the opportunity to engage in regular activity which is performed at a moderate to vigorous level. Furthermore, identifying the barriers which are preventing physical activity means that there is a greater chance that children with cerebral palsy will have a more active lifestyle.|
|Rights and Permissions:||The author retains copyright of this thesis.|
|Type of Work:||PhD Doctorate|
|Appears in Collections:||Sydney Digital Theses (Open Access)|
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