Children, Youth, Families & Schools, Nebraska Center for Research on


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Stuyvenberg, C.L.; Brown, S.E.; Inamdar, K.; Evans M.; Hsu, L.- y.; Rolin, O.; Harbourne, R.T.; Westcott McCoy, S.; Lobo, M.A.; Koziol, N.A.; et al. Targeted Physical Therapy Combined with Spasticity Management Changes Motor Development Trajectory for a 2- Year-Old with Cerebral Palsy. J. Pers. Med. 2021, 11, 163. 10.3390/jpm11030163


© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons. org/licenses/by/4.0/).


Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7–16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader STARTPlay intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The followup data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and STARTPlay, further research is needed to generalize these findings.