Original Work Progress Assessment #2 

 
 
Date: ​April, 2, 2018 
 
Subject: ​Neurology 
 
MLA Citation: ​Song, Chiang-Soon. “Relationships between Physical and Cognitive 
Functioning and Activities of Daily Living in Children with Cerebral Palsy.” ​Journal 
of Physical Therapy Science​, The Society of Physical Therapy Science, May 2013, 
www.ncbi.nlm.nih.gov/pmc/articles/PMC3804975/. 
 
Introduction: 
 
Due to the fact that I will be beginning my two-week observership session in 
the very near future, it is vital for me to continue expanding my knowledge, as it 
related to Cerebral Palsy. Dr. Thomas expressed her interest in me creating a 
clinical case study regarding Cerebral Palsy and its cognitive effects, so I found a 
case report, published in 2013, by Chiang-Soon Song about the effects of Cerebral 
Palsy on daily activities. This case study will not only be a great resource for future 
reference (when I begin to write my clinical case study) but also help me gain a 
better idea of how I can make my report more unique. The report was published in 
the Journal of Physical Therapy Science. 
 
Comparisons Made Between Clinical Tests:  
 
In the case study, three main tests are used to garner data and also make 
comparisons: the Gross Motor Function Measure (GMFM), the Bayley Infant 
Development Screening Test 2 (BSID-2), and the Wee Functional Independence 
Measure (WeeFIM). Overall, the results from the GMFM positively correlated with 
the those of the BSID-2, but not with the WeeFIM. Before discussing examples, it is 
important to state that the study was evaluating the effects of age, types of CP, and 
the ability to stand with/without assistance on physical/cognitive functions and 
activities of daily living (ADL).  
 
One example of how the WeeFIM scores differed from the other two tests is 
found in the fact that WeeFIM scores differed “significantly” with CP type, but the 
other two tests did not. Each of the tests were described in the report and all three 
were seemingly reliable, as shown through their inter-rater reliability (degree of 
agreement among raters) and test-retest reliability (how accurately the test could 
be repeated). Although I have a few questions on how Song came to his conclusions, 
his results state that physical and cognitive functions differed significantly between 
standing with assistance and standing without assistance, which means that he 
went with the results from the GMFM and BSID-2 tests. However, he states that 
ADL are affected by type of CP, but not by age or standing independence, which 
signifies that ADL were determined by the WeeFIM test, while physical and 
cognitive functions were determined by GMFM and BSID-2. Overall, using these 
three tests, it is clear that physical functioning and cognitive functioning are 
strongly related in CP. 
 
Classifications of Data:  
 
Because the study had a total of 68 children with CP. it is very important to 
identify strict classifications. The inclusion criteria and exclusion criteria were both 
defined, and many of the seemingly more severe cases of CP were discluded from 
the study. In order to properly delineate the spread of data, the general 
characteristics of the subjects were listed in a table, including age, gender, types of 
CP, and standing independence, with percentages for each. Therefore, in the case 
the my study includes many subjects, it will important for me to create a table in 
order to represent the types of subjects involved in the study. In addition, there 
were not any significant outliers in the study, which serves to increase the validity 
of the results presented. 
 
Moreover, with the large number of subjects, the subjects must be assessed 
under the same conditions. For instance, in this particular study, all of the 
assessments were conducted in a “quiet, uncluttered therapy room.” Song even 
mentions the qualifications of the therapists, in that the three therapists 
conducting the tests all have 10 years or more worth of experience. It is also 
important to note that all of the measurements were completed in 10 days in order 
to ensure that the children would not develop any further while the measurements 
were being taken. Given that most of the data will already be presented to me for 
my own case study, it is very likely that I will have to create a table that organizes 
the data for the subjects. In addition, it is possible that I will describe the tests used 
to assess each child, depending on if there is a certain uniformity of assessments 
performed on the subjects.  
 
Development of Physical and Cognitive Functions:  
 
 The general purpose of the case study was to evaluate the relationship 
between physical function, cognitive function, and ADL in children with CP; 
however, this may be difficult due to the fact that balanced development of physical 
and cognitive functioning is “rare” in children with CP. The rarity of balanced 
development can be further explained by the fact that if children with CP do not 
function normally in a specific domain, then they will not show normal overall 
development, which lessens the likelihood of balanced development. According to 
the study, most studies of children with neurological disorders tend to focus on the 
physical impacts. However, it is also important to consider the cognitive 
impairment caused by neurological disorder such as CP. Cognitive impairments can 
affect the child’s functional activities and integration in social settings, both of 
which impact overall development.  
 
Because there is a lack of study on the true relationship between physical 
and cognitive functioning in children with CP, this study is unique, in a sense; such 
is the function of the discussion. In regards to physical functioning specifically, it is 
important to recognize that, due to the results about standing independence, 
children who move more actively will score higher in physical and cognitive tests. 
From this, Song propounds that therapists should look into active movement and 
its effect on physical and cognitive functioning. Because of the positive correlation 
between physical and cognitive functioning in children with CP, more study must 
be done in order to fully ascertain this relationship. Lastly, there was not a 
clear-cut correlation between ADL and physical/cognitive functioning, so more 
research will have to be done on this relationship as well. 
 
Conclusion: 
 
Overall, this study was useful in demonstrating the relationship between 
physical and cognitive functions in children with CP, which will hopefully help 
guide me my case study in the right direction. I will make sure to look specifically 
for cognitive functions when I begin to observe under Dr. Thomas, as well as 
looking for the imbalance in cognitive and physical development. Although I am 
unsure of how to look for ADL, I will try my best to deduce from my own 
judgements, as well as discussions with Dr. Thomas. From here on out, I will 
continue looking for case studies on PubMed that I will potentially cite in my case 
study.