Physiotherapy - Theses
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ItemBike skills training for children with cerebral palsy( 2019)Training targeted towards goals that are meaningful to children with cerebral palsy (CP) and their families is needed to improve function and support participation in physical activities in this population. Riding a two-wheel bike is a common goal for ambulant children with CP, yet little specific evidence exists to guide clinicians and families. This thesis developed and tested a task-specific approach to training bike skills in this population through three studies: 1) a systematic review, 2) a practice survey, and 3) a randomised controlled trial (RCT). Each study used the International Classification of Functioning, Health and Disability (ICF) as a framework. While strong evidence exists for task-specific training (TST) for improved upper limb (UL) function in this population, prior to this thesis the literature regarding TST for gross motor skills, including bike riding, in ambulant children with CP had not been systematically appraised. Thus, Study 1 aimed to systematically evaluate the effectiveness of task-specific gross motor skills training for improving activity and participation outcomes in ambulant school-aged children with CP. This review involved 13 studies of low-to-moderate overall quality and found effects of TST were positive for participation-related outcomes, and mixed for specific skill performance and functional skills, while little or negative effects were found for general gross motor skills. This study identified the need for higher quality studies and reporting that enables evidence synthesis. Given the importance of understanding current practice when designing effectiveness studies, Study 2 involved a survey of 95 physiotherapists (PTs) and occupational therapist (OTs) in Australia about their practices when training two-wheel bike skills in children with CP. This study found that while functional approaches to training and goal-based assessment and evaluation were predominant, overall practices appear highly variable. Moreover, the need to develop and test bike-specific measures and interventions in this population was highlighted. The findings from Studies 1 and 2 informed the design of Study 3. This multi-site assessor-blind RCT aimed to determine if a task-specific approach was more effective than a parent-led home program for attaining individualised two-wheel bike riding goals in ambulant children with CP. Sixty-two children were randomly allocated to either the task-specific approach (n=31) or home program (n=31). The primary finding was that the task-specific program was more effective than the home program for goal attainment at one week post-intervention. Greater odds of goal attainment were retained at three months and evidence of better outcomes following the task-specific program were found for some outcomes related to participation in bike riding, physical activity and self-perception. In addition, there was evidence of mixed effects for functional skills, and little difference in bike skills and health-related quality of life. While each of these studies provides an original contribution to the literature, together they form a significant foundation for evidence on training bike skills in ambulant children with CP. Use of the ICF across the thesis meant findings could be synthesised and enhanced the clinical relevance of the research. Given that an effective approach for attaining two-wheel bike riding goals in this population now exists, training for clinicians to optimise knowledge translation should be developed. Future research should seek to understand relationships between bike skills training and a broader range of ICF domains and levels of function in CP, tailor interventions to individuals and determine longer-term outcomes.