A randomized controlled trial of alternative modes of service provision to young children with cerebral palsy in Bangladesh

Abstract

Objective: To compare the efficacy of an outreach program for young children with cerebral palsy with center-based and “minimal intervention” control groups. Design: Randomized controlled trial conducted in a group of 85 children between the ages of 1.5 and 5 years. Urban children were allocated to a daily center-based mother-child group or to monthly training of their parents along with a pictorial guidance manual. Rural children were allocated either to parent training or health advice. Outcome measures were changes in children’s adaptive skills, maternal stress and adaptation to the child, satisfaction with social support, and knowledge of handling a physically disabled child. Results: Fifty-eight children were successfully followed up. The pattern of change in children’s adaptive skills was as predicted (ie, least progress in the health advice group). Positive effects of intervention also included increased maternal knowledge and perceived helpfulness of support from formal sources. However, maternal adaptation increased most in the health advice group with minimal intervention. When children had attended a program at least 4 times, their skills improved, and mothers’ adaptation did increase. Conclusions: Outreach training for mothers in Bangladesh can help them to improve the skills of their young children with cerebral palsy and is perceived as helpful. (J Pediatr 2000;137:769-76)