Can rebound therapy improve gross motor skills and participation in children with cerebral palsy?

Background and Purpose Rebound therapy, i.e. the therapeutic use of the trampoline, is widely used in a community physiotherapy service to help children with cerebral palsy (CP) develop gross motor skills and participation in physical play. Not only is there very little evidence to demonstrate the effectiveness of rebound therapy in these outcomes but the most recent study has a number of limitations (Witham et al. 2012): non-validated outcome measures, participants with different diagnoses, and use of outcomes that do not measure activity and participation (as per the International Classification of Functioning, Disability and Health model) (Rosenbaum & Stewart 2004). This study aimed to address these limitations. Specifically, this feasibility study aimed to explore whether an intensive 3 week rebound therapy intervention improves gross motor skills and participation in physical play and satisfaction in children with CP. Methods A repeated measures (within-subject) experimental design was used. A convenience sample (n=7) was selected based on the criteria: diagnosis of CP, Gross Motor Function Classification System (GMFCS) level I-II. Participants followed a rebound therapy programme with pre-determined progressions: two 20 minute sessions per week for 3 weeks. Gross Motor Function Measure (GMFM) was administered 6 weeks before intervention, immediately before intervention, and immediately after 3 weeks of rebound therapy. Canadian Occupational Performance Measure (COPM) was administered immediately before and 6 weeks after intervention. Data were analysed using SPSS. Wilcoxon signed rank test was used for all comparisons. Results Children’s COPM scores improved after rebound therapy; this was statistically significant (p<0.046). There was no change in GMFM (p<0.463). Conclusions Rebound therapy may improve participation of children with mild CP. The effect on gross motor skills is inconclusive, possibly due to the ceiling effects of the GMFM. GMFM may not be sufficiently sensitive to detect change in the study population. Further research is required to investigate the mechanisms involved and effectiveness of rebound therapy.