ArticleFrontiers in pediatrics2026
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.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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; 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.
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