The pediatric Cogni-Famille protocol: family-mediated manual therapy achieves comparable outcomes at one-eighth cost in children with cerebral palsy-a franco-Cameroonian comparative study.

BACKGROUND

Cerebral palsy (CP) remains the leading childhood motor disorder worldwide, yet rehabilitation access is severely limited across sub-Saharan Africa due to resource scarcity, workforce shortages, and profound cultural stigmatization. Family-mediated approaches offer a promising pathway to bridge this gap. To our knowledge, this study represents the first evaluation of a pediatric adaptation of the Cogni-Famille protocol - originally developed for adult post-stroke rehabilitation - applied to children with spastic CP across two dramatically different resource environments.

METHODS

Twenty-one children with confirmed spastic CP (GMFCS levels I-III, ages 5-12) completed a 12-week family-mediated manual therapy (FMMT) intervention: 9 in institutional settings (France) and 12 in home-based care (Cameroon). Caregivers received progressive training in five manual therapy modules emphasizing ecological plasticity principles, delivered through twice-weekly therapist-supervised sessions (45-60 min each) complemented by daily home practice of 2-3 h. Primary outcome was change in Gross Motor Function Measure (GMFM-66). Secondary outcomes included spasticity (Modified Ashworth Scale), exploratory cost comparison, and qualitative social impact assessment. Statistical comparisons used Mann-Whitney U tests for continuous variables and Fisher's exact test for categorical variables.

RESULTS

Both cohorts achieved clinically significant GMFM-66 improvements (France: +15.2 ± 3.8 points; Cameroon: +13.8 ± 4.2 points; p = 0.28), exceeding the minimal clinically important difference by 8-fold. Spasticity decreased comparably across settings (Modified Ashworth: France -1.3 ± 0.4; Cameroon -1.1 ± 0.5; p = 0.33). Exploratory cost comparison revealed the Cameroonian model cost one-eighth that of France (38€ vs. 320€ monthly) while achieving equivalent clinical outcomes. Qualitative interviews documented profound social impacts: 11 of 12 Cameroonian families reported reduced stigmatization and improved community integration. Three Cameroonian children died during follow-up from complications unrelated to the intervention, reflecting the significant health vulnerabilities faced by children with disabilities in resource-limited settings.

CONCLUSIONS

Family-mediated manual therapy produces substantive motor improvements at dramatically reduced cost when culturally contextualized, while simultaneously addressing social exclusion. This approach demonstrates five innovative mechanisms - ecological plasticity, therapeutic motherhood, sequential micro-learning, community anchoring, and functional dignity restoration - offering a scalable and replicable model for addressing Africa's rehabilitation gap.