Change the environment, not the child


[img_inline align=”right” src=”” caption=”Mary Law, professor in McMaster’s School of Rehabilitation Science, has found that treatment for children with cerebral palsy focused on the child’s environment is just as effective as treatment focused on the child. File photo.”]A successful new rehabilitation approach to treating children with cerebral palsy puts its
focus on where a child lives and plays, not just improving the child's balance, posture
and movement skills.

Researchers reports that the new approach, called a “context-focused intervention”, is
just as beneficial as traditional child-focused therapy, offering parents an additional
treatment option for children with the congenital disorder.

The McMaster study, in conjunction with researchers at the University of Alberta, is the
first randomized trial to examine the effects of therapy focused on changing a child's
task or environment rather than the child.

Context-focused and child-focused therapies were evaluated in a randomized
controlled trial of 128 children with cerebral palsy ranging in age from one year to
almost six years old. The children, from 19 different rehabilitation centres in Ontario
and Alberta, received one of the two approaches for six months. Therapy was provided
by occupational therapists and physical therapists. Between assessments at six and nine
months, they returned to their regular therapy schedule.

Researchers found that while both groups improved significantly over the study, there
were “no significant differences in daily functioning” between the two treatment groups,
reported lead author Mary Law, professor in McMaster's School of Rehabilitation Science
and co-founder of the University's CanChild Centre for Childhood Disability Research.

Cerebral palsy is caused by damage in the brain before or just after birth and results in
problems with muscle tone and movement, and impacts ability to perform everyday
activities. More than 50,000 Canadians have cerebral palsy, which occurs in about two
of 1,000 babies.

During the study, parents in both groups received general information and education
about their child's disability as well as specific strategies to practice at home.

In the child-focused approach, therapists identified the underlying impairment – tone,
posture, range of motion – and provided therapy to improve the child's skills and

Emphasis in the context therapy approach was on changing the task or environment.
For example, one parent's goal was for their child to finger-feed himself Cheerios. The
therapist experimented with putting peanut butter on the tips of his fingers so that the
Cheerios would stick to it. The child was successful in one intervention session, even
though he did not have the fine grasp to pick them up without it. Having experienced
success, the child went on to be able to finger-feed Cheerios by himself.

“This study provides evidence that each intervention approach yields equivalent
important change after a six-month intervention,” Law said. “We also found no
difference between the therapy approaches for the outcome of parent empowerment.”

If both approaches are equally effective, Law said therapists and families are able to
discuss the treatment approach that best fits the intervention goals for their child and
their family situation.

Law is co-author in a second article describing the context-focused approach with lead
author Johanna Darrah, a professor of physical therapy in the Faculty of Rehabilitation
Medicine at the University of Alberta. Darrah said the experience with context therapy
was positive: “The benefits of working in the child's natural environment were striking.”

Darrah added researchers found this approach was more challenging with children who
have a severe disability, as some therapists felt that by not providing hands-on
treatment, the approach is not true therapy. However, the study found that the context
approach was equally effective for children with mild or severe cerebral palsy.

The study was supported by a grant from the National Institutes of Health in the United
States and the Alberta Centre for Child Family and Community Research. Mary Law holds
the John and Margaret Lillie Chair in Childhood Disability Research.

The research was published in the medical journal Developmental Medicine and Child