Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 2 , Pages 251-259, February 2008

Conductive Education for Children With Cerebral Palsy: Effects on Hand Motor Functions Relevant to Activities of Daily Living

  • Rainer Blank, MD, PhD

      Affiliations

    • Institute of Social Pediatrics and Adolescent Medicine, Child Center Munich, Ludwig Maximilians University, Munich, Germany
    • Corresponding Author InformationReprint requests to Rainer Blank, MD, PhD, Child Center Maulbronn, Knittlinger Steige 21, D 75433 Maulbronn, Germany
    • ,
  • Rüdiger von Kries, MD

      Affiliations

    • Institute of Social Pediatrics and Adolescent Medicine, Child Center Munich, Ludwig Maximilians University, Munich, Germany
    • ,
  • Stefan Hesse, MD

      Affiliations

    • Department of Neurological Rehabilitation, Klinik Berlin, Charité University Medicine, Berlin, Germany.
    • ,
  • Hubertus von Voss, MD

      Affiliations

    • Institute of Social Pediatrics and Adolescent Medicine, Child Center Munich, Ludwig Maximilians University, Munich, Germany

Abstract 

Blank R, von Kries R, Hesse S, von Voss H. Conductive education for children with cerebral palsy: effects on hand motor functions relevant to activities of daily living.

Objective

To study the effects of conductive education, a combined educational and therapeutic task-oriented approach for children with cerebral palsy (CP), on their hand motor functions and activities of daily living (ADLs).

Design

Individual cohort study (B-A-B design).

Setting

Ambulatory, referral center.

Participants

Sixty-four children with CP, severity Gross Motor Function Classification System levels II through IV, ages 3 to 6 years.

Interventions

Phases B: a 4.5-month period of special education, including 2 hours of individual physiotherapy or occupational therapy per week (special education). Phase A: during a 9-month period, conductive education was administered in 3 blocks of 4 weeks (7 hours daily from Monday through Friday); between the blocks, special education was applied as in the B phases.

Main Outcome Measures

Transformed sum scores (0.00–1.00) for coordinative (eg, force-movement synergy during object manipulation, aiming) and for elementary hand functions (eg, maximum grip force, tapping), based on kinetic and kinematic measures; standardized parent questionnaire to measure ADL competence scores from 0.00 (dependence) to 1.00 (independence). Outcome parameters were changes in these parameters during phase A (intervention) compared with average changes during the B phases (pre- and postintervention). Student t tests were used for dependent samples.

Results

Conductive education improved coordinative hand functions by 20% to 25% from baseline, compared with no improvement during special education; the preferred hand improved from .38 to .48 (mean, .10; 95% confidence interval [CI], .086−.114) and the nonpreferred hand improved from .39 to .47 (mean, .08; 95% CI, .034–.116). There were no changes in elementary hand motor functions. ADL competence improved by .11 (95% CI, .070–.149), from .50 to .61 (≈20%), compared with no significant improvement under special education.

Conclusions

Conductive education improved coordinative hand functions and ADLs in children with CP. There was no effect on elementary hand functions.

Key Words: Activities of daily living, Cerebral palsy, Education, Hand, Locomotor activity, Rehabilitation, Task performance

 

 Supported by the Verband der Deutschen Angestelltenkrankenkassen und des Arbeiterersatzkassenverbandes (Association of the German Health Insurances for Employees and Workers) with its member insurance companies: Barmer Ersatzkasse, Deutsche Angestelltenkrankenkasse, Techniker Krankenkasse, Kaufmännische Krankenkasse, Hamburg-Münchner Krankenkasse, Hanseatische Krankenkasse, Handelskrankenkasse, Schäbisch Gmünder Ersatzkasse, Gärtnerkrankenkasse, Brühler Krankenkasse, Buchdrucker-Krankenkasse, Krankenkasse für Bau- und Holfzberufe, Krankenkasse “Eintracht.”No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(07)01642-5

doi:10.1016/j.apmr.2007.08.138

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 2 , Pages 251-259, February 2008

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