A preliminary report on the effectiveness of trunk targeting in achieving independent sitting balance in children with cerebral palsy

Abstract

Objective: To assess the potential of Targeted Training in initiating or accelerating improved movement control of the trunk and hip joints in children with cerebral palsy so that independent sitting balance without specialized seating could be achieved. Design: Six single case studies. Setting: Assessment and review were undertaken in a specialized centre with intervention in the subjects' home or school. Subjects: Children between the ages of two years five months and seven years five months (mean four years seven months) with an established diagnosis of cerebral palsy. None had independent sitting balance at the start of the study. Intervention: Targeted Training using specialized equipment was directed at the appropriate few joints of the trunk as determined by initial testing and progressed when control at those joints had become automatic. The equipment provided support and challenged control learning. Periods of no intervention and placebo intervention, when the equipment was inappropriately set up, were also used. Two of the children ceased their traditional physiotherapy input while Targeted Training or placebo training took place. Main outcome measure: A new test was devised and validated to determine the most caudal extent of control of the vertical posture. In addition, a functional test of independent sitting balance was defined. Results: All six children showed an increase in movement control and all gained independent sitting balance within 12–25 weeks (mean 16 weeks). This was irrespective of the continuation or cessation of traditional physiotherapy. Conclusion: These preliminary findings suggest that Targeted Training may be an effective means of promoting movement control and functional ability. Confirmation of these findings by other investigators would be of value.