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EVALUATING THE EVIDENCE

The therapeutic methods, frequency and duration of service, setting in which the service is delivered, and service delivery system vary. Evaluating the efficacy and effectiveness of therapy for motor dis-ability is difficult, because treatment is not a standardized, readily quantifiable process that can be prescribed in discrete, consistent units. Individualized therapy programs vary in many parameters and incorporate subjective as well as objective elements. Clear documentation of efficacy related to the variable parameters of therapy continues to be elusive. This problem may in part reflect difficult methodologic issues including the measurement of treatment-related change on a background of develop-mental maturation, the establishment of appropriate outcome criteria, heterogeneity of the populations involved, and the complex nature of the interventions.

A recent review of the evidence to support the effectiveness of neurodevelopmental treatment for children with cerebral palsy indicates that this popular method of intervention does not confer an ad-vantage over the alternatives with which it has been compared in altering abnormal motor responses, slowing or preventing contractures, or facilitating more normal motor development or functional mo-tor activities, nor does more intensive neurodevelopmental treatment result in greater benefit. Physical therapy alone was found in 1 well-designed study to be less effective in improving motor development after 1 year than the therapy incorporating develop-mentally appropriate play and learning skills for children younger than 3 years with motor impairment.

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