Early Intervention in Cerebral Palsy: Perception-Action vs Neurodevelopmental Therapy
Efficacy of the Perception-Action Approach Versus Neurodevelopmental Therapy in Early Intervention for Children With Cerebral Palsy: A Randomized Controlled Trial
The goal of this clinical trial is to compare two different physiotherapy approaches used in early intervention for children with cerebral palsy. These approaches are the Perception-Action Approach and Neurodevelopmental Therapy (Bobath). The study aims to understand which approach is more effective in supporting neurodevelopmental outcomes in early childhood in Cerebral Palsy.
The main questions this study aims to answer are:
How does the Perception-Action Approach affect motor function in young children with cerebral palsy? How does Neurodevelopmental Therapy (Bobath) affect motor function in young children with cerebral palsy? Are there differences in outcomes between these two approaches?
Researchers will compare these two approaches to see which one better supports motor development.
Participants will:
Be children aged 0 to 36 months with cerebral palsy or at high risk Be assigned to one of the two therapy groups Receive one therapy session per week for 12 weeks Be assessed before and after the intervention using standardized tests
The results of this study may help therapists and families choose the most effective early intervention approach for children with cerebral palsy.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Type d'étude
Inscription (Estimé)
Phase
- N'est pas applicable
Contacts et emplacements
Coordonnées de l'étude
- Nom: Tuba D Doğan, PT, MSc, PhD(c)
- Numéro de téléphone: +905324090941
- E-mail: tubaderyadogan@gmail.com
Sauvegarde des contacts de l'étude
- Nom: Turgay Altunalan, PHd
- Numéro de téléphone: +90 506 593 88 82
- E-mail: turgay.altunalan@ktu.edu.tr
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
- Enfant
Accepte les volontaires sains
La description
Inclusion Criteria:
- Diagnosis of Cerebral Palsy
- Being at high risk for Cerebral Palsy (based on MRI or cranial ultrasound findings and neurological examination)
- Age between 0-36 months (using corrected age for preterm infants)
- Parental agreement to participate in the study and attend all assessment and therapy sessions; signed informed consent form from the parent(s) or legal guardian(s)
Exclusion Criteria:
- Presence of severe visual or hearing impairment that would prevent full participation in therapy sessions
- Uncontrolled seizures
- Receipt of botulinum toxin injection or orthopedic surgery within the last 6 months
- Diagnosis of an additional neurometabolic, genetic, or other neurological disorder
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Expérimental: Perception-Action Approach (PA)
The Perception-Action Approach is grounded in ecological, dynamic systems, and neural group selection theories, emphasizing perception-action coupling and supporting the child's overall development through self-initiated actions. The intervention promotes variability, adaptability, and exploration in an enriched environment. Therapists primarily structure the environment to encourage independent discovery of functional solutions rather than using hands-on facilitation. Activities are individualized to support variability, adaptability, and functional problem-solving. Informational touch may be used as task-consistent input to enhance perception of the relationship between the body and environment, inviting new movement possibilities without guiding movement. Variability and adaptability are prioritized over a single ideal movement pattern, and errors are considered part of learning. Sessions are conducted once weekly for 12 weeks (45 minutes each). |
A physiotherapy intervention based on the Perception-Action Approach, emphasizing active exploration, self-initiated movement, and variability within meaningful tasks.
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Comparateur actif: Neurodevelopmental Therapy (NDT-Bobath)
Participants receive physiotherapy based on Neurodevelopmental Therapy (Bobath), a holistic and individualized approach to neurorehabilitation. The intervention focuses on the analysis and facilitation of functional movement within meaningful activities to improve participation. Assessment and treatment are closely integrated, with therapy continuously adapted based on the child's responses. Active participation of the child is emphasized. Therapists may use hands-on facilitation, including key points of control, to support alignment, postural organization, and the regulation of muscle tone, aiming to improve the quality of movement during functional tasks. Activities are individualized and embedded in functional contexts, with assistance adapted to the child's needs. Sessions are conducted once weekly for 12 weeks (45 minutes each). |
A physiotherapy intervention based on Neurodevelopmental Therapy (Bobath), using therapeutic handling and facilitation to support alignment, postural organization, and movement quality during functional activities.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Gross Motor Function Measure-66 (GMFM-66)
Délai: Baseline (pre-intervention) and after 12 weeks of intervention
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The GMFM-66 is a standardized observational assessment used to evaluate changes in gross motor function in children with cerebral palsy.
It provides interval-level measurement of motor abilities and is sensitive to changes over time.
|
Baseline (pre-intervention) and after 12 weeks of intervention
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III)
Délai: Baseline (pre-intervention) and after 12 weeks of intervention
|
The Bayley-III is a standardized and widely used developmental assessment tool that evaluates cognitive, language (receptive and expressive), and motor (fine and gross) development in infants and young children.
It provides composite scores that allow for the assessment of overall developmental functioning.
|
Baseline (pre-intervention) and after 12 weeks of intervention
|
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Infant Motor Profile (IMP)
Délai: Baseline (pre-intervention) and after 12 weeks of intervention
|
The IMP is a video-based, standardized assessment that evaluates the quality of motor behavior in infants.
It assesses domains including variation, adaptability, symmetry, and performance, providing insight into motor development beyond milestone achievement.
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Baseline (pre-intervention) and after 12 weeks of intervention
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Pediatric Evaluation of Disability Inventory (PEDI)
Délai: Baseline (pre-intervention) and after 12 weeks of intervention
|
The PEDI is a standardized assessment that evaluates functional performance in children across the domains of self-care, mobility, and social function.
It is typically based on caregiver report and provides information about a child's capability and performance in daily life activities.
|
Baseline (pre-intervention) and after 12 weeks of intervention
|
Autres mesures de résultats
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
The Parental Stress Scale (PSS)
Délai: Baseline (pre-intervention) and after 12 weeks of intervention
|
The Parental Stress Scale (PSS-18), developed by Berry and Jones, is an 18-item self-report questionnaire designed to measure the level of stress associated with parenting.
It assesses both positive and negative aspects of the parent-child relationship, and total scores indicate overall parental stress.
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Baseline (pre-intervention) and after 12 weeks of intervention
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Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Directeur d'études: Dilek Çokar, PHd, Istinye University
Publications et liens utiles
Publications générales
- Hadders-Algra M, Boxum AG, Hielkema T, Hamer EG. Effect of early intervention in infants at very high risk of cerebral palsy: a systematic review. Dev Med Child Neurol. 2017 Mar;59(3):246-258. doi: 10.1111/dmcn.13331. Epub 2016 Dec 7.
- Damiano DL, Longo E. Early intervention evidence for infants with or at risk for cerebral palsy: an overview of systematic reviews. Dev Med Child Neurol. 2021 Jul;63(7):771-784. doi: 10.1111/dmcn.14855. Epub 2021 Apr 6.
- Pick, H. L. (1994). Eleanor J. Gibson: Learning to perceive and perceiving to learn. In A century of developmental psychology (pp. 527-544). American Psychological Association. https://doi.org/10.1037/10155-018
- Harbourne RT, Willett S, Kyvelidou A, Deffeyes J, Stergiou N. A comparison of interventions for children with cerebral palsy to improve sitting postural control: a clinical trial. Phys Ther. 2010 Dec;90(12):1881-98. doi: 10.2522/ptj.2010132. Epub 2010 Oct 21.
- Butler C, Darrah J. Effects of neurodevelopmental treatment (NDT) for cerebral palsy: an AACPDM evidence report. Dev Med Child Neurol. 2001 Nov;43(11):778-90. doi: 10.1017/s0012162201001414. No abstract available.
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Estimé)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 2026/55
Plan pour les données individuelles des participants (IPD)
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Informations sur les médicaments et les dispositifs, documents d'étude
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