Conductive education for children with cerebral palsy: effects on hand motor functions relevant to activities of daily living.
OBJECTIVE
To study the effects of conductive education, a combined educational and therapeutic task-oriented approach for children with cerebral palsy (CP), on their hand motor functions and activities of daily living (ADLs).


METHODS
Individual cohort study (B-A-B design).


METHODS
Ambulatory, referral center.


METHODS
Sixty-four children with CP, severity Gross Motor Function Classification System levels II through IV, ages 3 to 6 years.


METHODS
Phases B: a 4.5-month period of special education, including 2 hours of individual physiotherapy or occupational therapy per week (special education). Phase A: during a 9-month period, conductive education was administered in 3 blocks of 4 weeks (7 hours daily from Monday through Friday); between the blocks, special education was applied as in the B phases.


METHODS
Transformed sum scores (0.00-1.00) for coordinative (eg, force-movement synergy during object manipulation, aiming) and for elementary hand functions (eg, maximum grip force, tapping), based on kinetic and kinematic measures; standardized parent questionnaire to measure ADL competence scores from 0.00 (dependence) to 1.00 (independence). Outcome parameters were changes in these parameters during phase A (intervention) compared with average changes during the B phases (pre- and postintervention). Student t tests were used for dependent samples.


RESULTS
Conductive education improved coordinative hand functions by 20% to 25% from baseline, compared with no improvement during special education; the preferred hand improved from .38 to .48 (mean, .10; 95% confidence interval [CI], .086-.114) and the nonpreferred hand improved from .39 to .47 (mean, .08; 95% CI, .034-.116). There were no changes in elementary hand motor functions. ADL competence improved by .11 (95% CI, .070-.149), from .50 to .61 ( approximately 20%), compared with no significant improvement under special education.


CONCLUSIONS
Conductive education improved coordinative hand functions and ADLs in children with CP. There was no effect on elementary hand functions.
Blank
Rainer
R
Institute of Social Pediatrics and Adolescent Medicine, Child Center Munich, Ludwig Maximilians University, Munich, Germany. rjblank@gmx.de
von Kries
Rüdiger
R
Hesse
Stefan
S
von Voss
Hubertus
H
D000203:Activities of Daily Living; D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000193:education / Q000534:rehabilitation*; D004519:Education, Special / Q000379:methods*; D005260:Female; D006225:Hand / Q000502:physiology*; D006801:Humans; D008297:Male; D009048:Motor Skills; D009788:Occupational Therapy / Q000379:methods; D026741:Physical Therapy Modalities; D016896:Treatment Outcome