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A Multivariate Model of Determinants of Motor Change for Children With Cerebral Palsy

DJ Bartlett, PT, PhD, is Assistant Professor, School of Physical Therapy, Faculty of Health Sciences, The University of Western Ontario, 1588 Elborn College, London, Ontario, Canada N6G 1H1 (d.bartlett{at}uwo.ca). She is also an Associate Member, CanChild, Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada. Address all correspondence to Dr Bartlett at the first address
RJ Palisano, PT, ScD, is Professor, Department of Rehabilitation Sciences, MCP Hahnemann University, Philadelphia, Pa. He is also Co-investigator, CanChild, Centre for Childhood Disability Research, McMaster University

The purpose of this article is to describe the development of a theory-and data-based model of determinants of motor change for children with cerebral palsy. The dimensions of human functioning proposed by the World Health Organization, general systems theory, theories of human ecology, and a philosophical approach incorporating family-centered care provide the conceptual framework for the model. The model focuses on relationships among child characteristics (eg, primary and secondary impairments, personality), family ecology (eg, dynamics of family function), and health care services (eg, availability, access, intervention options). Clarification of the complex multivariate and interactive relationships among the multiple child and family determinants, using statistical methods such as structural equation modeling, is necessary before determining how physical therapy intervention can optimize motor outcomes of children with cerebral palsy. We propose that the development and testing of multivariate models is also useful in physical therapy research and in the management of complex chronic conditions other than cerebral palsy. Testing of similar models could provide physical therapists with support for: (1) prognostic discussions with clients and their families, (2) establishment of realistic and attainable goals, and (3) interventions to enhance outcomes for individual clients with a variety of prognostic attributes.

Key Words: Cerebral palsy • Motor outcomes • Prognostic model • Structural equation modeling

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