Conductive Education for Children With Cerebral Palsy: Effects on Hand Motor Functions Relevant to Activities of Daily Living
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.
aInstitute of Social Pediatrics and Adolescent Medicine, Child Center Munich, Ludwig Maximilians University, Munich, Germany
bDepartment of Neurological Rehabilitation, Klinik Berlin, Charité University Medicine, Berlin, Germany.
Reprint requests to Rainer Blank, MD, PhD, Child Center Maulbronn, Knittlinger Steige 21, D 75433 Maulbronn, Germany
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.
ABSTRACT