rehabilitation for the cerebral palsied children should be given thought a team work 
 including parents as a model refers to patient centered treatment regimens1,2,3 .
this idea encourages considering parent s opinions about physiotherapy and rehabilitation 
 for their children with cp . for this reason , health providers , especially physiotherapists 
 ( pts )
, should talk with the parents of a disabled child before planning a specific treatment 
 or intervention in order to establish the most suitable program for the child4,5,6,7 .
the parents of disabled children seek to learn all details , both positive and negative 
 aspects , about a physiotherapy and rehabilitation program that will be applied to their 
 children .
this is necessary for the parents to understand the mission and goal of the 
 program .
moreover , the pts and mother ( m ) or father of a disabled child should evaluate the 
 child together so that they can define the needs of the child .
for this reason , the parents 
 of children with cp should also be included in making decisions in the rehabilitation 
 process4 , 5 , 
 8 , 9 the purposes of this research were ( 1 ) to understand perceptions of ms and pts regarding 
 the rehabilitation programs their children receive and ( 2 ) to report the current knowledge 
 of ms and pts , highlighting consensus and disagreement .
one hundred and thirty children ( 75 
 boys , 55 girls ) who were being treated in special education centers in different parts of 
 turkey and their ms and 130 pts who were treating them were included in the study .
informed consent was obtained from ms and pts , written approval was obtained for the study 
 from the managers of the schools , and the study was completed in accordance with the 
 principles of the helsinki declaration .
the inclusion criteria were as follows : all participants agreed to participate , the 
 children had been diagnosed with cp by a pediatric neurologist , and the caregivers of the 
 children had to be ms .
demographic data of children , ms , and psts were recorded . the gross motor function classification system ( gmfcs )
was used to determine the functional 
 level appropriate for the age of the child and score it between 1 and 5 .
while a score of 1 
 indicates that the child may easily achieve indoor ambulation without the need for 
 adjunctive mobilization devices , a score of 5 indicates that the child is totally dependent 
 for mobilization .
the reliability and validity of the classification system have been 
 determined for children aged between 2 months and 12  years , and studies have also been done 
 for adults with cp10 , 11 .
the questionnaire form was composed of 6 open - ended questions asking about the expectations 
 and opinions of the ms and pts with regard to the physiotherapy and rehabilitation programs 
 being used .
the questionnaire form was created by experienced pts who were working in the 
 pediatric rehabilitation units of university hospitals and special education rehabilitation 
 centers . in the present study ,
power analysis revealed that 90% power would be obtained with a 
 reliability of 95% if 130 people were included in the study .
characteristics of the children with cp , ms , and pts are presented as mean  
 standard deviation , numbers , and percentages .
the 
 kappa coefficient ( k ) was used to analyze agreement with regard to the views of the pts and 
 ms .
a kappa coefficient for two values of 
 between 0.0 and 0.20 was considered to indicate statistically insignificant concordance , and 
 one between 0.21 and 0.40 was considered to indicate statistically moderate concordance .
the mean age of the children who participated in the study ( 75 boys , 55 girls ) was 
 89.8052.05 months , and the mean duration of treatment was 73.6242.11 months .
the mean age of the pts was 28.077.28  years , and their mean 
 number of working years was 6.847.51 .
of the ms , 83.1% had 12  years or less of education , 
 14.6% had 12 or more years of education and 2.3% were illiterate ( table 1table 1
. characteristics of the children with cp , ms , and ptschildren with cpxsdmin  maxage ( months)89.8052.0518300treatment period ( months)73.6242.1118240gendern%boys7557.70girls5542.30motherxsdmin - maxage ( years)35.475.792349physiotherapistxsdmin - maxage ( years)28.077.282251length of service ( years)6.847.51130education level of mothern%12 years or less10883.112 years or more1914.6illiterate32.3clinical types of the children with cpn%spastic11185.4dyskinetic75.4ataxic64.6hypotonic43.1mixed type21.5gmfcslevel 1107.7level 22116.2level 33829.2level 43627.7level 52519.2 ) .
the distribution of clinical types of cp cases and levels according to the 
 gmfcs are shown in table 1 . according to the results of the questionnaire that asked about the opinions of the ms and 
 pts , while 33.1% ( n=43 ) of the pts and 32.3% ( n=42 ) of the ms defined the health status of 
 the children as  good  , the concordance was found to be 13.1% .
in addition , while 38.5% 
 ( n=50 ) of the pts and 39.2% ( n=51 ) of the ms defined the health status of the children as 
  moderate  , the concordance was found as 18.5% .
statistically insignificant correlation was 
 found ( k=0.129 and p=0.015 ) ( table 2table 2 .
description of the health of the children with cp , awareness about the received 
 treatments , and views about the appropriateness of the treatmentsphysiotherapistmother physiotherapist- mother agreement description of the health of the children with cp*n%n%n%perfect43.132.310.8very good129.21310.010.8good4333.14232.31713.1moderate5038.55139.22418.5bad2116.22116.275.4awareness about the received therapies*bobath11386.95240.04736.2vojta21.543.110.8special education53.85038.543.1reflexology53.843.121.5botox32.321.5 - -i have no idea21.51813.8 - -views about the appropriateness of the 
 treatment**yes12394.610883.110782.3no32.396.932.3i have no idea43.11310.021.5*statistically significant ( p < 0.05 ) , kappa coefficient ; * * statistically 
 significant ( p < 0.01 ) , kappa coefficient ) . * statistically significant ( p < 0.05 ) , kappa coefficient ; * * statistically 
 significant ( p < 0.01 ) , kappa coefficient when the awarenesses of the ms and pts about the therapies the children received were 
 analyzed , 86.9% ( n= 113 ) of the pts and 40% ( n=52 ) of the ms stated that the children were 
 receiving bobath therapy , and the concordance was found to be 36.2% .
statistically 
 insignificant concordance was found between the ms and pts ( k=0.077 and p=0.016 ) ( table 2 ) .
while 94.6% ( n=123 ) of the pts and 83.1% ( n=108 ) of the ms stated that they found the 
 therapy appropriate , the concordance was found to be 82.3% .
moderate concordance was found 
 between the pts and ms when all answers about the appropriateness of therapy were evaluated 
 ( k=0.338 and p=0.0001 ) ( table 2 ) . when asked about the ability to walk with / without help ,
31.5% ( n= 41 ) of the pts and 38.5% 
 ( n=50 ) of the ms stated that they wanted the children with cp to walk with / without help , and 
 the concordance was found to be 17.7% .
statistically insignificant concordance was found 
 between the pts and ms when all expectations were evaluated ( k=0.187 and p=0.0001 ) ( table 3table 3 .
the views of the physiotherapists and the mothers about the expectations from 
 the treatment the children with cp receive , additional therapies and effectiveness of 
 the physiotherapy and rehabilitation programphysiotherapistmotherphysiotherapist - mother agreementexpectations from the treatment**n%n%n%walking with / without help4131.55038.52317.7standing with / without help1511.586.243.1sitting with / without help3123.81310.086.2independency in daily life activities2015.44635.486.2increased balance and postural control2317.71310.053.8additional therapies**not necessary2418.54232.386.2speech therapy3426.23728.51410.8water exercise2317.72418.596.9special education and psychosocial support2015.41410.864.6reflexology129.253.821.5vojta32.332.3 - -surgical53.832.3 - -sensory  perception motor education96.921.5 - -effectiveness of the physiotherapy and rehabilitation 
 program**perfect1310.0129.232.3very good3325.44030.81310.0good6953.15945.43526.9moderate107.7118.521.5bad53.886.232.3**statistically significant ( p < 0.01 ) , kappa coefficient ) . * * statistically significant ( p < 0.01 ) , kappa coefficient when asked about additional therapy , 18.5% ( n=24 ) of the pts and 32.3% ( n=42 ) of the ms 
 stated that it was not necessary .
statistically 
 insignificant concordance was found between the pts and ms with regard to additional 
 therapies ( k=0.136 and p=0.001 ) ( table 3 ) . finally ,
when questioned about the efficacy of the physiotherapy and rehabilitation 
 programs , 25.4% ( n=33 ) of the pts and 30.8% ( n=40 ) of the ms defined the applied therapy as 
  very good  , and the concordance was found to be 10.0% .
statistically insignificant 
 concordance was found between the pts and ms in terms of opinions about the efficacy of the 
 programs ( k=0.141 and p=0.009 ) ( table 3 ) .
the results of our study showed that while statistically insignificant concordance 
 ( k=0.00.20 ) was found between the pts and ms regarding the definition of the health 
 statuses of the children , treatment methods applied to the children , required additional 
 therapies , and appropriateness of the rehabilitation programs , statistically moderate 
 concordance was found regarding the appropriateness of the therapies ( k=0.210.40 ) . for families with a disabled child , it is quite difficult to accept the disability and 
 rearrange lifestyles to adapt to the child s condition12,13,14 .
ms who are the primary caregivers of disabled children and interact more often with them 
 represent a risk group for mental health due to anxiety and worries about the problems of 
 their disabled child15 , 16 .
the significance of participation of the family in 
 treatment and education of a disabled child is emphasized in the literature17,18,19 .
it has been emphasized that early application of physiotherapy to a child with cp are 
 important for motor development of the child and that the mother perceives the condition of 
 the child20 .
considering that all 
 rehabilitation processes should be realized in the natural environment of the child , 
 involving the family in this process is inevitable . informing the family
about the care and 
 rehabilitation of the child and providing help are as effective as directly educating the 
 child21 . according to the results of 
 our study
, we consider that it is necessary to increase the contribution of mothers to 
 treatment , to educate them in order to apply the therapies at home and to better understand 
 their children , and to increase the cooperation with pts . in a study of karaduman
families graded the treatment methods applied to their 
 children as special education , physiotherapy , speech therapy , drug therapy , and surgical 
 therapies , respectively22 . in our study
, the mothers stated that bobath therapy and special education treatment were 
 the most appropriate and most beneficial treatment types for their children .
low concordance 
 was found between pts and ms in terms of the therapies applied to the children and degree of 
 benefit from treatment . in the study of karaduman et al . , the outcomes expected by families from treatment were 
 attainment of the most efficient level of the disability or total elimination of the 
 disability22 . in our study ,
38.5% of ms 
 wanted their children to walk with / without help , and 35.4% wanted their children to perform 
 daily activities independently .
high concordance was found between pts and ms in terms of expectations from therapies . 
 however , 67.72% of the ms and 81.5% of the pts considered alternative treatment methods to 
 be necessary ( table 3 ) .
the importance of a high education level of families for adequate care and treatment of a 
 disabled child is known . in studies investigating the relations between families and health 
 teams in early and later periods ,
ms stated that they did not understand the explanations 
 their child s disease23 , 24 . in our study ,
83.1% of ms had 12  years of education or 
 less ( table 1 ) .
we consider that this resulted from the fact that families are not sufficiently 
 informed about their child s health and treatments or that they can not understand enough of 
 the information they are given .
emphasized that having enough knowledge about the condition of the child is 
 important for adaptation to the child and care , education , and rehabilitation of the 
 child25 .
one of the most important factors that positively affects the ability to cope with 
 difficulties is education26 . in the study 
 of singer et al .
conducted with families of disabled children , families with a higher 
 education level reportedly cared for their children better ; in other words , awareness about 
 the disease was higher27 . in our study , 
 the concordance between ms and pts regarding the appropriateness of therapy was 82.3% , and 
 it was found to be 36.2% for treatment awareness .
these concordance rates show the 
 importance of informing and educating the mothers of children with cp . in conclusion ,
participation of the ms in the treatment program and awareness about the 
 treatment are important .
we consider that health staff involved in the care of disabled 
 children should consider the opinions of the ms about the therapy when determining the most 
 appropriate and most beneficial treatment .
we consider that ms should cooperate with pts in the course of rehabilitation and receive 
 education about the condition of their children in order to increase their awareness of 
 their child s disease , find the most appropriate treatment option , practice the therapy at 
 home in the most effective and most appropriate way , and obtain better results from 
 rehabilitation programs .
   [ purpose ] the aim of this study was to examine the agreement between physiotherapists 
 ( pts ) and mothers ( ms ) about the treatment of children with cerebral palsy ( cp ) who 
 received treatment in special education and rehabilitation centers . [ subjects ] ms of 130 
 children with cp ( 75 boys , 55 girls ) and 130 pts who applied rehabilitation programs were 
 interviewed . 
 [ methods ] clinical types and gross motor function levels of the children were 
 recorded . a questionnaire consisting of 6 open - ended questions 
 was used to describe the 
 expectations and views of the pts and ms about the physiotherapy and rehabilitation 
 programs for the children . 
 [ results ] the mean age of the children was 89.8052.05 months . 
 
 the mean treatment period for the children was 73.6242.11 months . 
 the mean age of the 
 mothers was 35.475.79  years , and the mean age of the pts was 28.077.28  years . 
 we found a 
 statistically moderate level of agreement between the pts and ms regarding the 
 appropriateness of the treatment provided to the children . 
 there was statistically 
 insignificant agreement regarding the applied treatment methods and the appropriateness of 
 the applied rehabilitation programs . 
 [ conclusion ] we believe that the views and 
 expectations of the ms should be taken into account by the pts when preparing a treatment 
 program for children with cp . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION