Goal-directed occupational therapy for children with unilateral cerebral palsy: Categorising and quantifying session content

Introduction There is strong evidence that goal-directed occupational therapy achieves improvements in motor and self-care outcomes for children with unilateral cerebral palsy. This pilot study aimed to describe collaborative goals set in occupational therapy sessions, develop categories to describe session content and determine the percentage of in-session time spent addressing goal practice for children with unilateral cerebral palsy. Method Videos of 10 therapy sessions with 10 unique child-therapist dyads were analysed. Session content was categorised into goal practice (goal-directed therapy, meaningful goal-supporting activity) and other activity (non-goal-related, child engagement and behavioural support, parent engagement, transition). Descriptive statistics determined the percentage of in-session time spent in goal practice. Results Forty-three goals were set and 41 (95%) were activity focused. Mean percentage of time spent in-session on goal practice was 47.5% (SD 31.1%, range 0%-88.1%). Child behavioural support (4.9%), engaging parents (3.2%), transitioning between activities (6.7%) and non-goal-related activity (45.3%) comprised the remaining session time. Conclusion Less than half of session time was spent in goal practice, despite being conducted under a goal-directed framework. Non-goal-related activities comprised nearly half of in-session time. Therapists need to consider how to maximise time spent in goal practice during therapy sessions.