Current occupational therapy and physiotherapy services for children with cerebral palsy in India: A survey on focus and gaps

Abstract

Background: Cerebral palsy (CP) is a common cause of chronic childhood disability and constitutes a substantial portion of paediatric occupational therapy (OT) and physical therapy (PT) practices. An analysis of current rehabilitation practices is necessary to use more recent, evidence-based, and effective treatment modalities. This study intends to explore the current rehabilitation trends in assessing and planning interventions for children with CP in India and finding the focus and gaps in treatment. Objectives: To describe the focus of therapy practices in OT and PT for children with CP and better understand whether it is congruent with recommended practices. Study Design: A cross-sectional survey. Methods: An India-wide web-based survey on “Rehabilitation services for children with CP: A survey of what we do and how we individualize treatment for different children” (self-designed questionnaire) was completed by 50 occupational and 12 physical therapists to identify assessments and treatment interventions based on their clinical practice. Data were coded using the International Classification of Functioning, Disability, and Health (ICF) definitions for “body functions and structure,” “activity and participation,” and “environment.” Descriptive and quantitative statistics were used to identify the focus and gaps. Results: Both professions focused primarily on body structure and function assessment (OT: 28 [56%] and PT: 8 [66.7%]) when assessing and intervening. “Activity and participation” related assessment was focussed more by physiotherapists 4 (33.3%) than occupational therapists 15 (30%). Majority 44 (71.09%) of the therapists chose interventions that came under the ICF category: Activity and participation. While the percentage of therapists focussing on body structure and function and contextual factors interventions were 28 (45.02%) and 32 (52.27%), respectively. Attention, however, was mainly directed toward task-oriented activities such as activities of daily living and mobility 49 (79%). Participation in leisure or community-based activities received comparatively least attention 35 (56.5%). The environment received limited attention for assessments, although it was an important focus of intervention (environment modifications: 47 [75.8%]).OTs focused more on sensory components (U = 173.000, P = 0.019, 95% confidence interval [CI]: 0.017 to 0.022, mdn = 1.00) and, PTs focused more on gait (U = 192.000, P = 0.046, 95% CI: 0.0.039 to 0.047, mdn = 2.00) and trunk impairment (U = 129.000, P = 0.001, 95% CI: 0.0.000 to 0.001, mdn = 1.00). Conclusion: While body functions and structure are well-addressed, other ICF elements, specifically participation, are poorly integrated into practice. The emerging focus on the environment in therapy intervention, by modifying the context rather than changing aspects of the child, is consistent with current approaches and evidence. Knowledge translation implementation initiatives are recommended to bridge identified gaps.