The Effect of TOAP in Children With CP

This study employed an interventional crossover desing to evaluate the effects of a task-oriented aquatherapy program (TOAP) on occupational performance, participate and motivation in children with cerebral palsy. The intervention was grounded in occupational therapy principles and structured according to the Person-Environment-Occupation (PEO) model with an emphasis on meaningful, child-selected occupations performed in an aquatic environment.

Individualized intervention goals were determined prior to the intervention using occupations prioritized by each participant through the Canadian Occupational Performance Measure (COPM). Based on these prioritized occupations, a structured TOAP was developed for each child. The program incorporated task-oriented aquatic activities designed to support functional movement, postural control, balance and engagement while emphasizing active participation and motivation during therapy sessions.

The study consisted of two consecutive 16-week intervention periods. During the first period, one group received the TOAP intervention while the comparison group received conventional rehabilitation exercises commonly used in pediatric neurorehabilitation. Following completion of the first period, the groups crossed over and received the alternate intervention in the second period. This crossover, structure allowed each participant to serve as their own control, thereby reducing inter-individual variability.

All intervention sessions were conducted twice weekly, with each sessions lasting 40 minutes. Interventions were delivered by trained clinicians in an aquatic therapy setting. Outcome assessments were conducted at baseline and at the end of the each intervention period to evaluate changes associated with each treatment condition.

The study protocol was desinged to examine whether a personalized, task-oriented aquatic intervention grounded in meaningful occupations could enhance occupational performance, participation and motivation in children with cerebral palsy and to inform the development of structured aquatic intervention approaches applicable to clinical practice.

Inclusion criteria

• Children with CP classified as GMFCS levels 1-3 and MACS levels 1-3.
• Children and caregivers who voluntarily agreed to participate

Exclusion criteria

• Severe intellectual disability
• MAS levels 3-4
• Surgery or botulinum toxin injection within the past 6 months
• Significant hearing or vision impairment interfering with assessment
• Medical conditions preventing exercise (e.g., cardiovascular failure)
• Conditions preventing aquatic exercise (e.g., infection, open wound, incontinence)