Wheelchair Positioning and Breathing in Children with Cerebral Palsy: Study Methods and Lessons Learned

Effects of routine physical therapy with and without kinesio taping in improving gross motor function in sitting and standing in spastic diplegic cerebral palsy children

OBJECTIVE

To determine the effectiveness of Kinesio taping along with routine physical therapy on improving gross motor function in sitting and standing among spastic diplegic Cerebral Palsy children.

DESIGN

Randomized controlled trial.

SETTINGS

University Teaching Hospital University of Lahore, Lahore.

PARTICIPANTS

53 participants with diagnosed spastic diplegic cerebral palsy were randomly allocated in control and experimental groups.

INTERVENTION

26 Participants were treated by kinesio taping which was applied in a criss-cross manner along with routine physical therapy program while the control group (n = 27) received NDT exercise program that comprises of stretching, functional reaching, weight-bearing exercises and walking.

OUTCOME MEASURE

Gross motor function was assessed using 2 components of Gross Motor Function Classification System (GMFCS-88), i.e., sitting as well as standing at the base line and after every 3rd week for 12 weeks follow up.

RESULTS

In study and control group the mean score of gross motor function for sitting at baseline was 33.96 ± 3.11 and 31.50 ± 3.32 respectively. After intervention, it changed to 47.70 ± 5.46 and 43.46 ± 1.81 respectively. Mean score for Gross Motor Function calculated at base line in study and control group for standing was 27.37 ± 1.14 and 26 ± 3.01 respectively. At the end of intervention, the score improved to 36.55 ± 4.27 and 33.69 ± 2.46 respectively.

CONCLUSION

In comparison to control group, significant increase in gross motor function of intervention group was seen after the 12 weeks of intervention. In this way, over back muscles the application of kinesio tape in a Criss-Cross manner may be helpful. Also it can be used as an additional approach along with routine physical therapy to improve standing and sitting in spastic diplegic children.

Seating arrangements for children with insufficient head control: lessons from trials using the i2i head & neck positioning & support system

[Purpose] An insufficient head control is the most troublesome condition for children with impaired mobility who require optimal seating. [Subjects and Methods] We report on the clinical trial of the newly developed i2i head & neck positioning & support system called i2i for locomotively disabled children with periventricular leukomalacia (PVL). [Results] Two major advantages of the i2i were observed in the trial. The first was its favorable effect on the alignment of the spine to prevent scoliosis and to provide stable breathing and optimal seating, which resulted in improvement of the children’s activities of daily living (ADL). The second was its direct application of force to the head rather than indirectly to the pelvis in a conventional seat arrangement. The conventional way of head support is based on stabilization of the trunk which is based on stabilization of the pelvis by some seating arrangement. [Conclusion] The trial of the i2i device demonstrated its usefulness in helping PVL children with insufficient head control develop their abilities while preventing secondary disability.

Two Seating Systems' Effects on an Adolescent With Cerebral Palsy and Severe Scoliosis

BACKGROUND AND PURPOSE

To compare physiological functioning, communication switch activation, and response accuracy in a 19-year-old young man with quadriplegic cerebral palsy and neurological scoliosis using 2 seating systems within the school setting.

METHODS

Prospective single-subject alternating treatment design with 2 conditions: baseline phase with standard planar inserts (A1), custom-molded back with original seat (B), and return to baseline (A2). Measures included oxygen saturation (SaO2), heart rate (HR), respiration rate (RR), body temperature (BT), processing time to activate switches, and response accuracy.

RESULTS

SaO2 levels increased from "distressed" to "normal"; variability decreased. HR, RR, and BT fluctuations decreased with the custom-molded back. Processing time decreased with increased variability, affected by subject's motivation; accuracy improved slightly. Reported social approachability and student-initiated communication increased.

CONCLUSIONS

SaO2 increased and HR, RR, and BT fluctuations decreased with a custom-molded back. Graphing data may help determine seating effect with complex clients.

Wheelchair components and pulmonary function in children with cerebral palsy

OBJECTIVE

This study investigates the effects of four individual wheelchair components (upper extremity supports, lateral trunk supports, anterior pelvic belt, and 30 degree posterior seat tilt), on pulmonary function in prepubertal children with cerebral palsy (CP).

METHODS

Participants who range in age from 5-10 years were evaluated using four wheelchair components in six configurations (conditions 1-6) using a planar seating simulator. The Respironics Non Invasive Cardiac Output monitor (NICO) and MasterScreen Impulse Oscillometry System (IOS) measured pulmonary function parameters. Repeated measures ANOVA was used to analyze effect of wheelchair conditions on total airway resistance (R(AW)).

RESULTS

Eight participants completed the protocol. R(AW) and minute ventilation (MV) varied with wheelchair condition. Lowest R(AW) was seen with two upper extremity supports or two lateral trunk supports. Differences were not significant (p = 0.253).

CONCLUSIONS

The NICO and IOS, independent of participant effort, measured R(AW) and MV, which varied by wheelchair seating condition. More research is needed with a larger sample to determine seating components' impact on pulmonary function. These methods objectively measured pulmonary function of young children with CP in wheelchairs and could facilitate further research into benefits of wheelchair postural support components.