A randomized controlled trial of alternative modes of service provision toyoung children with cerebral palsy in Bangladesh

Objective: To compare the efficacy of an outreach program for young childre n with cerebral palsy with center-based and "minimal intervention" control groups. Design: Randomized controlled tial conducted in a group of 85 children betw een the ages of 1.5 and 5 years. Urban children were allocated to a daily c enter-based mother-child group or to monthly training of their parents alon g with a pictorial guidance manual. Rural children were allocated either to parent training or health advice. Outcome measures were changes in childre n's adaptive skills, maternal stress and adaptation to the child, satisfact ion with social support, and knowledge of handling a physically disabled ch ild. Results: Fifty-eight children were successfully followed up. The pattern of change in children's adaptive skills was as predicted (ie, least progress in the health advice group). positive effects of intervention also included increased maternal knowledge and perceived helpfulness of support from for mal sources, However, maternal adaptation increased most in the health advi ce group with minimal intervention. When children had attended a program at least 4 times, their skills improved, and mothers' adaptation did increase . Conclusions: Outreach training for mothers in Bangladesh can help them to i mprove the skills of their young children with cerebral palsy and is percei ved as helpful.