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Abstract of Higher Degree Thesis
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Abstract of Higher Degree Thesis A full list of Fellowship and higher degree dissertations and theses is available from Samantha Molloy in the Information Unit of the CSP Education Department. Those housed at the CSP may be viewed by appointment or borrowed by post - please contact the
Information Unit for further details. For access to dissertations or theses housed elsewhere please contact the institution concerned. (They are not normally available for loan.)
The Impact of Prehension and Fine Motor Development on Gross Motor Activity in Children With Cerebral Palsy Philippa Margaret Hallam PhD MSc MCSP PhD thesis, University of Liverpool, 1996
This dissertation considers the effect of a novel form of physiotherapy which concentrates on prehensile function and the normal development of grip. Conventional physiotherapy for children with cerebral palsy (CP) concentrates on the improvement of gross motor functions such as balance, crawling, sitting, standing and walking. There is evidence to suggest that concentrating on fine motor skills such as grasping and finger movements may have an effect on general development. This study examined the hypothesis that, if efforts are made to maintain the development of prehensile skills as near normal as possible from the age of 18 months, motor disability may be less severe than would otherwise have been the case and general development may be improved. This study was designed as a randomised controlled trial. One hundred infants were recruited from ten h o s p i t a l u n i t s w i t h i n t h e N o r t h W e s t Region. Children were randomly allocated to one of three groups a n d offered different t r e a t m e n t regimes. Group 1 (N = 34) received traditional physiotherapy, group 2 (N = 33) received traditional physiotherapy plus one extra session per week of therapy based on the traditional method, and group 3 (N = 33) received traditional physiotherapy augmented by one extra session per week of therapy based entirely on enhancing prehensile skills and manual dexterity. All the children were assessed a t 18 and 24 months of age using the Griffiths Mental Development Scales by two paediatricians blinded as to which group the children were in. Analysis of the Griffiths Developmental Score results showed t h a t t h e g r e a t e s t improvement i n motor development occurred in those children who had an extra session of general physiotherapy, followed by those who had a n extra session of hand therapy. The children in the treatment control group maintained their level of motor function but did not improve on it. A dynamometer was specifically designed and built to measure and record the pressure exerted by a child’s grip. It was designed by t h e author and developed
Physiotherapy, August 1997, vol83, no 8
in collaboration with t h e University of Liverpool’s Health Physics Department. Validation of the instrument was carried out by independent bio-engineers based in the Research and Development Division of the Welsh Development Agency. The tool was constructed to enable the author to measure small variations in grip strength and produce ‘grip profiles’ for t h e duration of a two-second grip phase, thereby detecting abnormalities in fine motor activity. The dynamometer was used to produce normative data with five able-bodied children and then used to compare the performance of left and right sides in children with CP. The results demonstrated differences in strength for the left and right sides of the body not only for children with tetraplegia but also for those with diplegia. Children with hemiplegia also showed marked muscle weakness on their ‘good’ sides. This confirms the presence of abnormal neurological signs in the ‘good’ hands, often thought to be unaffected by CP.
A questionnaire was given to all t h e parents after their children had completed their 24-month developmental assessment. The purpose of this was to evaluate their response to research in general as well as this particular study. Children with CP form a wellresearched, if not over-researched, population group. Many families had participated in previous clinical trials and it was important to establish whether the research process was becoming a burden to them. It was returned by 44% of the parents, and the majority of t h e comments were positive a n d encouraging. Thirty-five of the parents who responded said they would be willing to allow their children to take part in further research projects, the other nine respondents said it would be a possibility. The outcome measure used to evaluate the results (Griffiths Developmental Assessment) found that the extra hand therapy had no significant affect on locomotor outcome; therefore the hypothesis was rejected. The group of children who received extra general neuro-developmental t h e r a p y demonstrated the greatest improvement in physical ability during the six-month treatment. This point raises an important issue and a possible future hypothesis. The study demonstrated t h a t increasing physiotherapy treatment sessions significantly improved motor ability. To. validate these results a protocol could be designed to evaluate t h e optimum duration a n d frequency of physiotherapy for children with CP.
Abstract of Higher Degree Thesis A full list of Fellowship and higher degree dissertations and theses is available from Samantha Molloy in the Information Unit of the CSP Education Department. Those housed at the CSP may be viewed by appointment or borrowed by post - please contact the
Information Unit for further details. For access to dissertations or theses housed elsewhere please contact the institution concerned. (They are not normally available for loan.)
The Impact of Prehension and Fine Motor Development on Gross Motor Activity in Children With Cerebral Palsy Philippa Margaret Hallam PhD MSc MCSP PhD thesis, University of Liverpool, 1996
This dissertation considers the effect of a novel form of physiotherapy which concentrates on prehensile function and the normal development of grip. Conventional physiotherapy for children with cerebral palsy (CP) concentrates on the improvement of gross motor functions such as balance, crawling, sitting, standing and walking. There is evidence to suggest that concentrating on fine motor skills such as grasping and finger movements may have an effect on general development. This study examined the hypothesis that, if efforts are made to maintain the development of prehensile skills as near normal as possible from the age of 18 months, motor disability may be less severe than would otherwise have been the case and general development may be improved. This study was designed as a randomised controlled trial. One hundred infants were recruited from ten h o s p i t a l u n i t s w i t h i n t h e N o r t h W e s t Region. Children were randomly allocated to one of three groups a n d offered different t r e a t m e n t regimes. Group 1 (N = 34) received traditional physiotherapy, group 2 (N = 33) received traditional physiotherapy plus one extra session per week of therapy based on the traditional method, and group 3 (N = 33) received traditional physiotherapy augmented by one extra session per week of therapy based entirely on enhancing prehensile skills and manual dexterity. All the children were assessed a t 18 and 24 months of age using the Griffiths Mental Development Scales by two paediatricians blinded as to which group the children were in. Analysis of the Griffiths Developmental Score results showed t h a t t h e g r e a t e s t improvement i n motor development occurred in those children who had an extra session of general physiotherapy, followed by those who had a n extra session of hand therapy. The children in the treatment control group maintained their level of motor function but did not improve on it. A dynamometer was specifically designed and built to measure and record the pressure exerted by a child’s grip. It was designed by t h e author and developed
Physiotherapy, August 1997, vol83, no 8
in collaboration with t h e University of Liverpool’s Health Physics Department. Validation of the instrument was carried out by independent bio-engineers based in the Research and Development Division of the Welsh Development Agency. The tool was constructed to enable the author to measure small variations in grip strength and produce ‘grip profiles’ for t h e duration of a two-second grip phase, thereby detecting abnormalities in fine motor activity. The dynamometer was used to produce normative data with five able-bodied children and then used to compare the performance of left and right sides in children with CP. The results demonstrated differences in strength for the left and right sides of the body not only for children with tetraplegia but also for those with diplegia. Children with hemiplegia also showed marked muscle weakness on their ‘good’ sides. This confirms the presence of abnormal neurological signs in the ‘good’ hands, often thought to be unaffected by CP.
A questionnaire was given to all t h e parents after their children had completed their 24-month developmental assessment. The purpose of this was to evaluate their response to research in general as well as this particular study. Children with CP form a wellresearched, if not over-researched, population group. Many families had participated in previous clinical trials and it was important to establish whether the research process was becoming a burden to them. It was returned by 44% of the parents, and the majority of t h e comments were positive a n d encouraging. Thirty-five of the parents who responded said they would be willing to allow their children to take part in further research projects, the other nine respondents said it would be a possibility. The outcome measure used to evaluate the results (Griffiths Developmental Assessment) found that the extra hand therapy had no significant affect on locomotor outcome; therefore the hypothesis was rejected. The group of children who received extra general neuro-developmental t h e r a p y demonstrated the greatest improvement in physical ability during the six-month treatment. This point raises an important issue and a possible future hypothesis. The study demonstrated t h a t increasing physiotherapy treatment sessions significantly improved motor ability. To. validate these results a protocol could be designed to evaluate t h e optimum duration a n d frequency of physiotherapy for children with CP.