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Performance Following Ability-Focused Physical Therapy Intervention in Individuals With Severely Limited Physical and Cognitive Abilities

DA Brown, PhD, PT, PCS, is Assistant Professor, Department of Physical Therapy, University of New England, Marcil Hall, Room 106, 11 Hills Beach Rd, Biddeford, ME 04005-9599 (dbrown@mailbox.une.edu)
SK Effgen, PhD, PT, is Professor and Director, Pediatric Physical Therapy Program, Allegheny University of the Health Sciences (formerly The Medical College of Pennsylvania and Hahnemann University), Philadelphia, Pa.
RJ Palisano, ScD, PT, is Professor and Director, Program in Movement Science, Allegheny University of the Health Sciences. He is also Co-Investigator, Neurodevelopmental Clinical Research Unit, McMaster University, Hamilton, Ontario, Canada.
This research was completed in partial fulfillment of the requirements of Dr Brown's doctoral studies in pediatric physical therapy at The Medical College of Pennsylvania and Hahnemann University.

Background and Purpose. Do individuals with severely limited physical and cognitive abilities improve their gross motor abilities when given physical therapy intervention, and does improvement transfer to nontreatment settings? Subjects. The subjects were 24 individuals (10 female, 14 male), aged 3 to 30 years (=20.1, SD=8.1), who were nonambulatory and had limited adaptive behavior. Methods. Change in gross motor ability during 18 weeks of twice-weekly therapy was measured using goal attainment scaling (GAS). Three gross motor goals were developed for each subject based on individual or caregiver needs, with one goal randomly selected as a control. Physical impairments were treated, and behavioral management principles, low-level communication approaches, high-repetition practice of goals, and a progressive reduction of both physical assistance and multisensory cues were used. An independent rater scored goal level from randomly ordered videotapes recorded during therapy and in recess and home settings. Results. Mean GAS T scores were higher for treatment goals (=45.6, SD=10.5) compared with control goals (=34.6, SD=11.8). When the expected goal level (50) was met during therapy, mean GAS T scores in recess settings (=35.9, SD=11.5) and home settings (=42.2, SD=12.2) were lower. At the conclusion of therapy, there were no differences in goal levels between treatment and control goals in both the recess and home settings. Conclusion and Discussion. The subjects demonstrated improvement of gross motor abilities practiced during therapy. Level of ability during therapy, however, did not consistently transfer to the recess and home settings.

Key Words: Ability-focused physical therapy • Generalization • Goal attainment scaling • Motor learning • Severe physical and cognitive disability • Transfer

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