Capturing and characterizing the variability in physical therapy dose after orthopedic multi-level surgery in ambulatory children with Cerebral Palsy

Project Summary
Ambulatory children with cerebral palsy (CP) can have profound impairments of the lower
extremities including physical deformities, loss of motor function, and resultant poor quality of
life. Orthopedic multi-level surgery (MLS) is standard of care to address lower extremity
impairments and children experience a decrease in function requiring extensive physical
therapy (PT) for up to two years to regain function. Evidence for post-surgical PT best practices
is vastly unknown. This application proposes a pilot project to obtain preliminary data examining
the variation in PT frequency and type of intervention delivered during usual care across
settings to ambulatory children with CP following MLS, and describe the relationship between
type of intervention and recovery of gait at 6 months. Participants will be recruited from two
large academic centers where MLS surgery is performed. Sixteen ambulatory children with CP
that undergo MLS, consisting of at least one bony and any number of soft tissue procedures,
will be recruited and evaluated at baseline before surgery and 6 months post-surgery. Using a
published path model for studying dose in CP, comprehensive details about therapy frequency
and type will be captured via our successful EHR implemented flowsheet for children treated at
the two academic sites, and via REDCap surveys, with identical fields to the flowsheet, from
outpatient community therapists. This study will capture details on all types of PT intervention
delivered with specific interest in the five types delivered to children with CP following MLS, with
the most recent evidence (in children that have not undergone surgery), to improve gait. These
five types include mobility training, treadmill training, partial body weight supported treadmill
training, fitness training and ankle foot orthoses (AFOs). We will count the total number of PT
Interventions to improve Gait (PTIG) delivered and describe the relationship between PITGs to
the recovery of gait at six months post-surgery. We hypothesize that children seen by academic
therapists for post-surgical PT will have greater frequency of therapy sessions and higher count
of PTIGS than children seen by community outpatient therapists. We also hypothesize that the
count of PTIGs delivered will have a positive relationship with gait measured in two ways; self-
selected walking speed and walking performance (steps/day). The proposed research is
innovative and will guide development of precision rehabilitation approaches that are
translatable to clinical practice. The proposed research is significant because findings will inform
future work to determine the most effective strategies to improve health and motor outcomes for
children with CP after MLS.

Grant Number: 1R03HD111717-01A1
NIH Institute/Center: NIH
Principal Investigator: Amy Bailes