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Physical Therapists' Perceptions of Factors Influencing the Acquisition of Motor Abilities of Children With Cerebral Palsy: Implications for Clinical Reasoning

DJ Bartlett, PT, PhD, is Assistant Professor, School of Physical Therapy, Faculty of Health Sciences, 1588 Elborn College, The University of Western Ontario, London, Ontario, Canada N6G 1H1 (djbartle{at}uwo.ca), and 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, Programs in Rehabilitation Sciences, MCP Hahnemann University, Philadelphia, Pa, and Co-Investigator, CanChild, Centre for Childhood Disability Research, McMaster University

Background and Purpose. Evidence supporting factors predicting motor change for children with cerebral palsy is minimal. A consensus exercise using focus groups and survey methods was conducted to identify factors perceived to affect the acquisition of basic motor abilities among children with cerebral palsy from the time of diagnosis to 7 years of age. Subjects. Fifty-seven physical therapists participated in one of 12 focus groups, and 60 physical therapists participated in a follow-up questionnaire survey via mail. Methods. The nominal group technique was used to conduct the focus groups. Results. Participants reached consensus about 12 factors in 4 constructs, which we called: (1) primary impairments (muscle tone/movement patterns, distribution of involvement, balance, and sensory impairment), (2) secondary impairments (range of motion/joint alignment, force production, health, and endurance), (3) personality characteristics (motivation), and (4) family factors (support to child, family expectations, and support to family). Discussion and Conclusion. The recognition of potential determinants of motor change could assist in the clinical reasoning that physical therapists use when planning interventions for children with cerebral palsy. Participants identified a set of variables, some of which are found in the literature, that can provide foundation knowledge for decision making and research on factors that bring about change in motor ability among children with cerebral palsy.

Key Words: Cerebral palsy • Clinical reasoning • Consensus • Motor outcomes • Prognosis

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