1
|
Zhao Y, Ying D, Ouyang C, Li X, Xiong Z, Liao Z, Lu W, Zhong Y, Feng Z. Enhancing motor function in children with cerebral palsy: A Comparative study of pediatric tuina and conventional rehabilitation. J Bodyw Mov Ther 2025; 41:1-7. [PMID: 39663073 DOI: 10.1016/j.jbmt.2024.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 08/07/2024] [Accepted: 10/13/2024] [Indexed: 12/13/2024]
Abstract
OBJECTIVE This study explores the impact of combining Pediatric Tuina (PT) with conventional rehabilitation on motor function in children diagnosed with cerebral palsy (CP). METHODS This controlled trial involved 115 CP-affected children aged 1 month to 13 years. They were allocated into an experimental group (n = 57) receiving PT and conventional rehabilitation, and a control group (n = 58) receiving only conventional rehabilitation for three months. The GMFM-88 scale was employed for evaluating motor function at the start and end of the treatment period. RESULTS Compared to the conventional rehabilitation group, the combination of PT and standard rehabilitation therapy showed significant improvement in motor function among children with CP after 3 months. There were no significant differences in baseline characteristics between the two groups. Children in the PT combined with the standard rehabilitation therapy group exhibited more prominent improvements in motor function (supine and rolling: experimental group 47.88 ± 5.02 vs control group 42.86 ± 10.30; sitting: experimental group 45.16 ± 18.52 vs control group 35.59 ± 18.97; total score: experimental group 147.88 ± 75.59 vs control group 118.90 ± 77.87; P = 0.045). Furthermore, there was a significant increase in scores for children after the combination therapy (pre-treatment 105.39 ± 85.76 vs post-treatment 147.88 ± 75.59; P = 0.045). CONCLUSION PT, when used in conjunction with conventional rehabilitation methods, significantly enhances motor function in children with CP. The study advocates for further extensive research to validate and understand the broader implications of PT in CP treatment.
Collapse
Affiliation(s)
- Yue Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China.
| | - Dexia Ying
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Chengfeng Ouyang
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Xunxin Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Zhichao Xiong
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Ziqin Liao
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Wenhui Lu
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Yingjun Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China.
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| |
Collapse
|
2
|
Brennan N, Hood E, Badman A. Anterior chain activation and high intensity gait training to improve walking in an adult with cerebral palsy: a case report. Physiother Theory Pract 2024:1-7. [PMID: 39676330 DOI: 10.1080/09593985.2024.2441974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 12/09/2024] [Accepted: 12/09/2024] [Indexed: 12/17/2024]
Abstract
BACKGROUND AND PURPOSE Adults living with Cerebral Palsy (CP) who are non-ambulatory are at increased risk for falls, contractures, reduced bone density, and pain. There is limited evidence for core strength training, anterior chain activation exercises, or high intensity gait training (HIGT) to improve gait function in adults with CP. The purpose of this case report is to describe the use of anterior chain muscle activation and HIGT to improve walking in a non-ambulatory adult male with quadriplegic CP. CASE DESCRIPTION The participant was a 26 y.o. male living with spastic quadriplegic CP with a goal to cross the finish line of an adaptive triathlon while ambulating. The outpatient physiotherapy protocol emphasized anterior chain activation exercises and HIGT to improve strength, gait, and mobility at a frequency of 1-2 times a week for 8 months. OUTCOMES The minimal detectable change of 19 points was achieved on the Function in Sitting Test (FIST). The original ambulation goal was exceeded to a maximum of 76 meters overground. The participant was able to walk across the finish line using a gait trainer while supervised at an adaptive triathlon. CONCLUSIONS Focusing on anterior chain exercises and HIGT was effective to minimize extensor spasticity by strengthening body flexors allowing improved mobility and gait.
Collapse
Affiliation(s)
- Nicole Brennan
- Department of Physical Therapy, Good Shepherd Rehabilitation Network, Allentown, PA, USA
| | - Ethan Hood
- Doctor of Physical Therapy Program, DeSales University, Center Valley, PA, USA
| | - Allyson Badman
- Doctor of Physical Therapy Program, DeSales University, Center Valley, PA, USA
| |
Collapse
|
3
|
Rosenberg L, Zecharia S, Gilboa Y, Golos A. Managing the move from assisted to independent living: an inclusive qualitative study among adults with cerebral palsy. Disabil Rehabil 2024; 46:6402-6409. [PMID: 38591970 DOI: 10.1080/09638288.2024.2339535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To understand aspects important to adults with severe cerebral palsy (CP) as they prepare to move from assisted to independent living and to create an appropriate intervention. MATERIALS AND METHODS An inclusive qualitative study was conducted together with adults with severe CP (Gross Motor Function Classification Scale 4-5) preparing to move to independent living. It included semi-structured interviews which were recorded, transcribed, and analyzed by two occupational therapists to create themes. The themes were reviewed and adjusted by the partners in a group context. RESULTS Seven partners aged 23-47 years (median= 35 years, standard deviation = 10; 4 female) participated. Four themes arose with sub-themes: (1) house management (finances, meals, maintenance, and housework), (2) interactions and boundaries (with a caregiver, family, friends, and romantic partners), (3) schedules (work, leisure, volunteering, education, and health management), and (4) "my way" (autonomy, independence, and self-advocacy; emotions and group power). These themes expressed the concerns of the partners and formed the basis of a group intervention before their move from assisted to independent living. CONCLUSIONS The inclusive research revealed themes the partners raised that expressed their concerns; these became the basis for a group intervention to prepare for their move from assisted to independent living.
Collapse
Affiliation(s)
- Lori Rosenberg
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Occupational Therapy Department, Beit Finger of the Gravsky Rehabilitation Centre, Jerusalem, Israel
| | - Shira Zecharia
- Occupational Therapy Department, Beit Finger of the Gravsky Rehabilitation Centre, Jerusalem, Israel
| | - Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Anat Golos
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| |
Collapse
|
4
|
Jaster M, Schneider J, Metz C, Walch E, Kaindl AM. Relationship between cerebral palsy severity and cognition, aids and education. Minerva Pediatr (Torino) 2024; 76:728-734. [PMID: 35142453 DOI: 10.23736/s2724-5276.22.06357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cerebral palsy (CP) refers to a non-progressive permanent lesion of the developing brain, which can manifest with motor function disability and various comorbidities and complications. However, there is little data on the correlation between motor and mental function in CP, as cognitive assessments are rarely the main focus of studies on children with CP. METHODS We studied a large cohort of 381 children and adolescents with CP. We analyzed the relationship between severity of CP and the presence of developmental disturbances (motor, motor-linguistic, global) including cognition, the number of aids and education. RESULTS We found a strong correlation between the severity of CP according to the Gross Motor Function Classification System (GMFCS) and developmental disturbances. In line with this finding, the number of aids per individual also correlated significantly with CP severity and the extent of developmental disturbance. Going beyond the number of aids most patients already received special education in kindergarten. Later, the type of schooling correlated significantly with severity of CP and developmental disturbance. While developmental disturbance and cognition correlated, this was not the case for CP severity and cognition. The latter indicates a wide range in individual manifestation and resources. CONCLUSIONS Our data underline that cognition does not necessarily correlate with CP severity. Thus, in addition to the evaluation and treatment of motor deficits, cognitive assessment should be offered early-on to improve patient-centered counselling and support with respect to appropriate education.
Collapse
Affiliation(s)
- Monika Jaster
- Department of Pediatric Neurology, Charité University of Medicine, Berlin, Germany
- Center for Chronically Sick Children (SPZ), Charité University of Medicine, Berlin, Germany
| | - Joanna Schneider
- Department of Pediatric Neurology, Charité University of Medicine, Berlin, Germany
- Center for Chronically Sick Children (SPZ), Charité University of Medicine, Berlin, Germany
| | - Charlotte Metz
- Department of Pediatric Neurology, Charité University of Medicine, Berlin, Germany
- Center for Chronically Sick Children (SPZ), Charité University of Medicine, Berlin, Germany
| | - Elisabeth Walch
- Department of Pediatric Neurology, Charité University of Medicine, Berlin, Germany
- Center for Chronically Sick Children (SPZ), Charité University of Medicine, Berlin, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité University of Medicine, Berlin, Germany -
- Center for Chronically Sick Children (SPZ), Charité University of Medicine, Berlin, Germany
- Institute for Cell Biology and Neurobiology, Charité University of Medicine, Berlin, Germany
| |
Collapse
|
5
|
Baltieri S, Wajnsztejn R. Impact of Health Access on Hospitalization of Children and Youth with Cerebral Palsy and Paralytic Syndromes in Brazilian Regions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1286. [PMID: 39457259 PMCID: PMC11507291 DOI: 10.3390/ijerph21101286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 09/15/2024] [Accepted: 09/23/2024] [Indexed: 10/28/2024]
Abstract
In 2021, 28.16% of Brazilians were aged 0-19 years, highlighting the critical need for medical care in diagnosing and treating cerebral palsy (CP). In developing countries, CP prevalence reaches 7/1000 live births, emphasizing the importance of healthcare access, which influences diagnosis and prognosis. This study aimed to analyze the correlation between health infrastructure across different Brazilian regions and its impact on hospitalization and mortality rates among children with CP and other paralytic syndromes. An ecological time-series design was used, analyzing secondary population-based data from DATASUS, covering January 2018 to December 2021. The data included healthcare facilities, physicians, hospitalizations, and deaths for individuals aged 0-19 years, with analysis conducted using Microsoft Excel. The results revealed significant disparities in healthcare infrastructure, particularly in the northern and northeastern regions. A notable correlation was found between healthcare inequalities and hospitalizations and mortality rates, with the northern region showing significant results (p = 0.03 for hospitalizations and p = 0.02 for mortalities). This study underscores significant regional disparities in healthcare access in Brazil, contributing to variations in hospitalization rates for children and adolescents, especially in the northern region.
Collapse
Affiliation(s)
| | - Rubens Wajnsztejn
- Scientific Writing Laboratory, Specialized Learning Center, Graduate Program in Health Sciences, ABC Medical School, Santo André CEP 09060-650, SP, Brazil;
| |
Collapse
|
6
|
Poncet F, Cherriere C, Beaudry L, Fortin S, Lemay M. Co-Construction of a Dance Class Adapted for Adolescents with Cerebral Palsy. Phys Occup Ther Pediatr 2024:1-21. [PMID: 39262227 DOI: 10.1080/01942638.2024.2400623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 08/24/2024] [Accepted: 08/31/2024] [Indexed: 09/13/2024]
Abstract
AIM To co-construct a dance class adapted for adolescents with cerebral palsy (CP). METHOD A three phase co-construction process with study collaborators was used to (1) define the objectives and the obstacles and opportunities related to offering a dance class in the community through three focus groups with adolescents, their parents and study partners; (2) co-create the dance class based on the results of step 1, the expertise of the research team and the logic model of the dance class; and (3) test the dance class to evaluate its effects in relation to the defined objectives. RESULTS Three objectives were identified: to have fun, promote movement, and social interaction. A weekly dance class (60 min./10 wk) was continuously tested on the adolescents and adapted by the dance facilitators. CONCLUSION To improve practices and support the implementation of dance classes for young people with CP, eight recommendations are proposed relating to the creation of adapted classes and the evaluation of their desired effects.
Collapse
Affiliation(s)
- Frédérique Poncet
- Centre de réadaptation Lethbridge-Layton-Mackay, CIUSSS Centre-Ouest-de-l'ile-de-Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, Canada
| | - Claire Cherriere
- Laboratoire du mouvement et de la cognition (MOCO) au centre de réadaptation Marie Enfant du Centre Hospitalier Universitaire de Ste Justine, Montréal, Canada
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Lucie Beaudry
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, Canada
- Département de danse, Université du Québec à Montréal, Montréal, Canada
| | - Sylvie Fortin
- Département de danse, Université du Québec à Montréal, Montréal, Canada
| | - Martin Lemay
- Département des sciences de l'activité physique, Université du Québec à Montréal, Montréal, Canada
| |
Collapse
|
7
|
Nie X, Cheng R, Hao P, Guo Y, Chen G, Ji L, Jia L. MicroRNA-128-3p Affects Neuronal Apoptosis and Neurobehavior in Cerebral Palsy Rats by Targeting E3 Ubiquitin-Linking Enzyme Smurf2 and Regulating YY1 Expression. Mol Neurobiol 2024:10.1007/s12035-024-04362-7. [PMID: 39102109 DOI: 10.1007/s12035-024-04362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 07/09/2024] [Indexed: 08/06/2024]
Abstract
This study was dedicated to investigating the effects of microRNA-128-3p (miR-128-3p) on neuronal apoptosis and neurobehavior in cerebral palsy (CP) rats via the Smurf2/YY1 axis.In vivo modeling of hypoxic-ischemic (HI) CP was established in neonatal rats. Neurobehavioral tests (geotaxis reflex, cliff avoidance reaction, and grip test) were measured after HI induction. The HI-induced neurological injury was evaluated by HE staining, Nissl staining, TUNEL staining, immunohistochemical staining, and RT-qPCR. The expression of miR-128-3p, Smurf2, and YY1 was determined by RT-qPCR and western blot techniques. Moreover, primary cortical neurons were used to establish the oxygen and glucose deprivation (OGD) model in vitro, cell viability was detected by CCK-8 assay, neuronal apoptosis was assessed by flow cytometry and western blot, and the underlying mechanism between miR-128-3p, Smurf2 and YY1 was verified by bioinformatics analysis, dual luciferase reporter assay, RIP, Co-IP, ubiquitination assay, western blot, and RT-qPCR.In vivo, miR-128-3p and YY1 expression was elevated, and Smurf2 expression was decreased in brain tissues of hypoxic-ischemic CP rats. Downregulation of miR-128-3p or overexpression of Smurf2 improved neurobehavioral performance, reduced neuronal apoptosis, and elevated Nestin and NGF expression in hypoxic-ischemic CP rats, and downregulation of Smurf2 reversed the effects of downregulation of miR-128-3p on neurobehavioral performance, neuronal apoptosis, and Nestin and NGF expression in hypoxic-ischemic CP rats, while overexpression of YY1 reversed the effects of Smurf2 on neurobehavioral performance, neuronal apoptosis, and Nestin and NGF expression in hypoxic-ischemic CP rats. In vitro, downregulation of miR-128-3p effectively promoted the neuronal survival, reduced the apoptosis rate, and decreased caspase3 protein expression after OGD, and overexpression of YY1 reversed the ameliorative effect of downregulation of miR-128-3p on OGD-induced neuronal injury. miR-128-3p targeted to suppress Smurf2 to lower YY1 ubiquitination degradation and decrease its expression.Inhibition of miR-128-3p improves neuronal apoptosis and neurobehavioral changes in hypoxic-ischemic CP rats by promoting Smurf2 to promote YY1 ubiquitination degradation and reduce YY1 expression.
Collapse
Affiliation(s)
- Xiaoqi Nie
- Department of Neurosurgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Rui Cheng
- Department of Neurosurgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Pengfei Hao
- Department of Neurosurgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
- Shanxi Medical University, Taiyuan, 030607, Shanxi, China
| | - Yuhong Guo
- Department of Neurosurgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Gang Chen
- Department of Neurosurgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Lei Ji
- Department of Neurosurgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China.
| |
Collapse
|
8
|
Dertli S, Aydin Yilmaz AS, Gunay U. Care burden, perceived social support, coping attitudes and life satisfaction of mothers with children with cerebral palsy. Child Care Health Dev 2024; 50:e13297. [PMID: 38895968 DOI: 10.1111/cch.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
AIM This study's aim is to determine the relationship between care burden, perceived social support, coping attitudes and life satisfaction of mothers with children with cerebral palsy (CP). METHODS This descriptive study was conducted in Turkey between March and June 2022 to determine the relationship between caregiving burden, perceived social support, coping attitudes and life satisfaction of 122 mothers with CP children. Path analysis was used to evaluate the data. RESULTS Correlation analysis showed a positive relationship between mothers' social support perceptions and life satisfaction and coping attitudes, a positive relationship between their life satisfaction and coping attitudes (p < .001). The path analysis showed that the social support perceived by the mothers significantly affected their coping attitudes (β = .257; p < .001) and life satisfaction (β = .081; p < .001). Mothers' care burden (β = .169; p < .001) and coping attitudes (β = .071; p < .05) also had a significant effect on their life satisfaction. CONCLUSIONS It is an important finding of this study that mothers' perceptions of social support and coping attitudes have a positive effect on their life satisfaction. Long-term care can cause physical and psychological problems for mothers. Mothers' strong coping strategies and high levels of social support may reduce the occurrence of these problems. Drawing attention to this issue in mothers and revealing the effects of these variables is important in terms of indirectly supporting child outcomes.
Collapse
Affiliation(s)
- Semiha Dertli
- Faculty of Health Sciences, Department of Child Health and Disease Nursing, Firat University, Elazig, Turkey
| | | | - Ulviye Gunay
- Faculty of Nursing, Department of Child Health and Disease Nursing, Inonu University, Malatya, Turkey
| |
Collapse
|
9
|
Miskiewicz MJ, Parsa S, Magruder M, Abdelgawad A. Reoperation, Readmission, and Postoperative Bleeding in Pediatric Cerebral Palsy Patients Undergoing Spinal Arthrodesis. Cureus 2024; 16:e62520. [PMID: 39022514 PMCID: PMC11253555 DOI: 10.7759/cureus.62520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Background Cerebral palsy (CP) is one of the most common neuromuscular disorders in children, and spinal abnormalities are vastly more common in people with CP compared to the general population. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative complications. This study aims to investigate (1) whether pediatric CP patients have higher rates of postoperative complications after spinal fusion and (2) risk factors for postoperative bleeding, readmission, and reoperation. Methodology The 2019 American College of Surgeons National Surgical Quality Improvement Program Pediatric database was used for this study. Chi-square tests were used to compare patient demographics, frequency of comorbidities, intraoperative factors, and postoperative complications between CP and non-CP patients. Multivariable logistic regression modeling was conducted to determine if CP was an independent risk factor for the composite variable that included postoperative bleeding, readmission, and reoperation. Results A total of 4,445 patients were included in the study, with 606 CP and 3,839 non-CP patients. Several comorbidities were more prevalent in the CP cohort, most notably asthma, gastrointestinal disease, previous cardiac surgery, and hematologic disorders. Multivariable logistic regression modeling revealed that CP, older age, non-Caucasian race, American Society of Anesthesiologists (ASA) class of 3 or higher, posterior surgical approach, previous cardiac surgery, and ostomy were significantly correlated with higher postoperative complications. Conclusions This study demonstrates that CP, older age, non-Caucasian race, ASA class of 3 or higher, posterior approach, previous cardiac surgery, and ostomy are independent risk factors for postoperative complications, including readmission, reoperation, and postoperative bleeding requiring transfusions. Consequently, there is a pressing need for additional research to establish perioperative strategies that reduce postoperative risks for these patients. Spine surgeons should consider the findings of this study when communicating the potential risks of spinal fusion surgery with patients and their families.
Collapse
Affiliation(s)
| | - Shabnam Parsa
- Department of Surgery, Stony Brook University, Stony Brook, USA
| | - Matthew Magruder
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, USA
| | - Amr Abdelgawad
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, USA
| |
Collapse
|
10
|
Mushta SM, Alghamdi R, Almalki H, Waqas S, Alawwadh A, Barasheed O, Garnan M, McIntyre S, Rashid H, Badawi N, Khandaker G. Saudi Cerebral Palsy Register (SCPR): Protocol on the Methods and Technical Details. J Epidemiol Glob Health 2024; 14:453-461. [PMID: 38358616 PMCID: PMC11176122 DOI: 10.1007/s44197-024-00198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
This protocol presents a comprehensive proposal for the establishment of the Saudi Cerebral Palsy Register (SCPR), a crucial project for investigating and addressing the prevalence, etiology, and management of cerebral palsy (CP) in Saudi Arabia. The SCPR will not only provide a robust database for ongoing research and analysis but will also serve as a platform for investigating the causes of CP, implementing preventative strategies, and improving the quality of care and outcomes for people with CP and their families in Saudi Arabia. Detailed case definitions, inclusion/exclusion criteria, and data collection protocols are discussed to ensure the integrity and comparability of the data. The plan also outlines strategic funding, institutional and government endorsement, sustainability considerations, potential challenges and proposed solutions, and expected outcomes and impact. These include creating research and educational opportunities, fostering regional and international collaborations, and significantly contributing to CP prevention strategies. Overcoming anticipated obstacles, such as stigma, institutional policies, and collaborations, and securing both necessary funding and endorsements are highlighted as critical for the success of the SCPR. The project is not only aligned with promote prevention of health risks, a target of Vision 2030 in Saudi Arabia, but is also expected to have a substantial impact on the health and quality of life of people with CP and their families in Saudi Arabia, serving as inspiration for similar efforts worldwide.
Collapse
Affiliation(s)
- Sami Mukhdari Mushta
- Public Health Authority (PHA), 13351, Riyadh, Saudi Arabia.
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.
| | - Riyad Alghamdi
- Public Health Authority (PHA), 13351, Riyadh, Saudi Arabia
| | - Hani Almalki
- Public Health Agency, Ministry of Health, 12382, Riyadh, Saudi Arabia
| | - Saadia Waqas
- King Fahad Center, Children with Disability Association (CDA), 12273, Riyadh, Saudi Arabia
| | - Adel Alawwadh
- Khamis Mushayt Maternity and Children Hospital (KMMCH), 62454, Khamis Mushayt, Saudi Arabia
| | - Osamah Barasheed
- The Executive Administration of Research and Innovation, King Abdullah Medical City in Holy Capital (KAMC-HC), 24246, Makkah, Saudi Arabia
| | - Mohammad Garnan
- Public Health Administration, Asir Health, 62523, Abha, Saudi Arabia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Harunor Rashid
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2050, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network (SCHN), Westmead, NSW, 2145, Australia
| | - Gulam Khandaker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, 4700, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, 4701, Australia
| |
Collapse
|
11
|
Demeco A, Molinaro A, Ambroggi M, Frizziero A, Fazzi E, Costantino C, Buccino G. Cognitive approaches in the rehabilitation of upper limbs function in children with cerebral palsy: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2024; 60:445-457. [PMID: 38512713 PMCID: PMC11255880 DOI: 10.23736/s1973-9087.24.08288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/31/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Cerebral palsy (CP) is the predominant cause of children disability. It is characterized by motor, sensory, and postural deficits due to a non-progressive injury to the developing central nervous system. In recent years, new rehabilitation techniques targeting the central representations of motor patterns have been introduced: the most used are action observation therapy (AOT), motor imagery (MI), and mirror therapy (MT). Aim of this study is to assess the effectiveness of these cognitive strategies on the recovery of upper limb motor functions in children with CP. EVIDENCE ACQUISITION This study was designed as a systematic review and meta-analysis, registered in PROSPERO (CRD42023403794). For the report and methodological definitions of this study, the recommendations of the PRISMA protocol and the Cochrane collaboration, were followed. A total of 3 electronic databases (PubMed, Scopus, and Web of Science) were searched for relevant Randomized Control Trials (RCT) using the combinations of terms "cerebral palsy" AND "action observation" OR "motor imagery" OR "mirror therapy" OR "cognitive therapy." A meta-analysis was carried out to compare cognitive and conventional approaches and combine direct and indirect effects. A random-effects meta-analysis model was used to derive pooled effect estimates. EVIDENCE SYNTHESIS Out of 328 records, 12 RCTs were analyzed in this systematic review published from 2012 to 2022, and included 375 children, of whom 195 received cognitive therapies, and 180 underwent conventional rehabilitation. AOT was the most investigated (RCTs N.=7), and showed significant results in the recovery of upper limb motor functions, albeit the meta-analysis demonstrated a non-significant difference in Melbourne Unilateral Upper limb Scale (MUUL) (95% CI: -7.34, 12); in Assisting Hand Assessment (AHA) (95% CI: -4.84, 10.74), and in AbilHand-Kids Questionnaire (95% CI: -1.12, 1.45). Five RCTs investigated MT showing significant improvements in grip and dexterity; none used MI as intervention therapy. CONCLUSIONS Cognitive therapies provided with encouraging results in the recovery of upper limb motor functions, although not a clinical effect in bimanual or unimanual performance; they could represent a valid therapeutic solution integrated to conventional rehabilitation in the treatment of upper limb motor impairment in children with CP.
Collapse
Affiliation(s)
- Andrea Demeco
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Anna Molinaro
- Unit of Child Neurology and Psychiatry, Department of Clinical and Experimental Sciences, University of Brescia ASST Ospedali Civili of Brescia, Brescia, Italy
| | - Martina Ambroggi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elisa Fazzi
- Unit of Child Neurology and Psychiatry, Department of Clinical and Experimental Sciences, University of Brescia ASST Ospedali Civili of Brescia, Brescia, Italy
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy -
| | - Giovanni Buccino
- IRCCS Istituto Scientifico San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
12
|
Zhang Y, Hui Z, Qi W, Zhang J, Wang M, Zhu D. Clinical study on the safety and feasibility of AiWalker-K for lower limbs exercise rehabilitation in children with cerebral palsy. PLoS One 2024; 19:e0303517. [PMID: 38776339 PMCID: PMC11111022 DOI: 10.1371/journal.pone.0303517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/24/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Robotic-assisted gait training (RAGT) devices are effective for children with cerebral palsy (CP). Many RAGT devices have been created and put into clinical rehabilitation treatment. Therefore, we aimed to investigate the safety and feasibility of a new RAGT for children with CP. METHODS This study is a cross-over design with 23 subjects randomly divided into two groups. The occurrence of adverse events and changes in heart rate and blood pressure were recorded during each AiWalker-K training. Additionally, Gross Motor Function Measure-88 (GMFM-88), Pediatric Balance Scale (PBS), 6 Minutes Walking Test (6MWT), Physiological Cost Index, and Edinburgh Visual Gait Score (EVGS) were used to assess treatment, period, carry-over, and follow-up effects in this study. RESULTS Adverse events included joint pain, skin pain, and injury. Heart rate and blood pressure were higher with the AiWalker-K compared to the rest (P < 0.05), but remained within safe ranges. After combined treatment with AiWalker-K and routine rehabilitation treatment, significant improvements in 6MWT, GMFM-88 D and E, PBS, and EVGS were observed compared to routine rehabilitation treatment alone (P < 0.05). CONCLUSIONS Under the guidance of experienced medical personnel, AiWalker-K can be used for rehabilitation in children with CP.
Collapse
Affiliation(s)
- Yi Zhang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhichong Hui
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weihang Qi
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiamei Zhang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingmei Wang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dengna Zhu
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
13
|
Anderson JT, Toolan C, Coker E, Singer H, Pham D, Jackson N, Lord C, Wilson RB. A novel dance intervention program for children and adolescents with developmental disabilities: a pilot randomized control trial. BMC Sports Sci Med Rehabil 2024; 16:109. [PMID: 38745176 PMCID: PMC11092010 DOI: 10.1186/s13102-024-00897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Organized physical activity programs have been shown to provide wide benefits to participants, though there are relatively few studies examining the impact of these programs for individuals with developmental disabilities. This pilot study was conducted to determine the feasibility and impact of an undergraduate-led dance intervention program for children and adolescents with developmental disabilities. We evaluated the impact of the dance program on motor ability and social skills. METHODS The study design was a waitlist control clinical trial in which participants were randomized to active and control groups. Eligible participants included male and female children and adolescents between the ages of 4 and 17 years with neurodevelopmental disabilities. The Motor Assessment Battery for Children Checklist and the Social Responsiveness Scale were used to assess change in motor and social skills, respectively. After gathering baseline data, the active group completed 1 h of online dance classes per week for 10 weeks, while the control group entered a 10-week waiting period. All participants then returned for a follow-up visit. Pre- and post-intervention data were analyzed using linear mixed-effects modeling adjusting for age and class attendance with subject random intercept. RESULTS We recruited and randomized 43 participants with neurodevelopmental disabilities (mean age = 8.63, SD = 2.98), of which 30 participated in dance classes. The attendance rate was 82.6% for the active group and 61.7% for the control group. The active group demonstrated a significant improvement in motor skills in an unpredictable environment, as indicated on the Motor Assessment Battery for Children Checklist (n = 21, p = 0.05). We also observed positive trends in social skills that did not reach significance. CONCLUSIONS Our results indicate that it is feasible to develop and implement a fully digital dance intervention program for individuals with developmental disabilities. Further, we find that change in motor skills can be detected after just 10 h of low-intensity participation. However, a lack of significant change in social skills coupled with limitations in study implementation suggests further research is needed to determine the full impact of this dance program. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration System: Protocol ID 20-001680-AM-00005, registered 17/2/2021 - Retrospectively Registered, https://clinicaltrials.gov/study/NCT04762290 .
Collapse
Affiliation(s)
- Jeffrey T Anderson
- University of California, Los Angeles, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | | | - Emily Coker
- Stanford School of Medicine, Stanford, CA, USA
| | - Hannah Singer
- University of California, Los Angeles, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Derek Pham
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Catherine Lord
- University of California, Los Angeles, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Rujuta B Wilson
- University of California, Los Angeles, Los Angeles, CA, USA.
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
| |
Collapse
|
14
|
Hussain SA, Hadian DMR, Hassan Z, Shadmehr A, Talebian S, Kiyani MM, Mir SM. The Effects of Whole-Body Vibration Therapy in Weight-Bearing and Non-Weight-Bearing Positions for Upper and Lower Extremities on Balance and Function in Cerebral Palsy Children: A Randomized Controlled Trial. Cureus 2024; 16:e61404. [PMID: 38947699 PMCID: PMC11214666 DOI: 10.7759/cureus.61404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Background and objective Cerebral palsy (CP) is one of the most prevalent neurological conditions affecting children; it is characterized by poor motor control, restricted range of motion (ROM), and poor balance. While whole-body vibration therapy (WBVT) has been used to treat these symptoms, its efficacy in different configurations remains unexplored. Hence, this study aimed to determine and compare the effects of WBVT applied to either the upper extremities, lower extremities, or both upper and lower extremities in weight-bearing and non-weight-bearing positions on ROM (shoulders, elbows, wrists, hips, knees, and ankle joints), balance, and function in children with spastic hemiplegic CP. Methods This randomized clinical trial involved 60 hemiplegic spastic CP children aged 5-15 years. After randomization, all the participants were divided into six groups of equal size based on the WBVT application for upper extremities, lower extremities, or both in weight-bearing or non-weight-bearing positions. The therapy was applied three times per week for four consecutive weeks. The outcome measures were ROM, hand grip strength, balance quantification score using My Fitness Trainer (MFT) 2.0, and timed up and go (TUG) scores. Results While all the groups were homogenous before treatment, after treatment, it was observed that all the ranges improved significantly in all groups. The same was observed for hand grip strength, balance score, and TUG test scores (p<0.05). The post-hoc analysis revealed that the weight-bearing position for the upper and lower extremities combined showed the highest level of improvement. Conclusions Based on our findings, WBVT in weight-bearing positions produces more significant results than in non-weight-bearing positions. We also observed that when WBVT is applied to the upper extremities, it can improve the function of the lower extremities and vice versa.
Collapse
Affiliation(s)
- Syed Ali Hussain
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | | | - Zainab Hassan
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Azadeh Shadmehr
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Saeed Talebian
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Mubin Mustafa Kiyani
- Shifa College of Medical Technology, Shifa Tameer e Millat University, Islamabad, PAK
| | - S Mohsen Mir
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| |
Collapse
|
15
|
Zhang Q, Qiu Z. Therapeutic effects of repetitive transcranial magnetic stimulation in patients with cerebral palsy: a systematic review and network meta-analysis. Neurol Sci 2024; 45:1953-1967. [PMID: 38117402 DOI: 10.1007/s10072-023-07235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
The purpose of this study was to systematically evaluate the efficacy of repetitive transcranial magnetic stimulation in children with cerebral palsy and to compare the differences in efficacy of different treatment parameters. Computer searches of PubMed, Embase, Cochrane Library, Scopus, Web of Science, China Knowledge Network, Wanfang Data Knowledge Service Platform, Vipshop and China Biomedical Literature Database were conducted to collect randomized controlled trials (RCTs) of TMS to improve function in children with cerebral palsy. The search period was from the establishment of the database to April 2023. Two researchers independently screened the literature and extracted data information, and the risk of bias was assessed for the included studies using the Cochrane Systematic Evaluation Manual 5.1.0. Statistical analysis was performed using RevMan 5.4 and Stata software. A total of 18 studies containing 1675 patients with cerebral palsy were included, and r-TMS did not differ significantly from other treatments in improving language function [MD = 2.80, 95% CI (-1.51, 7.11), Z = 1.27, P = 0.20] after treatment. The results of the reticulated meta-analysis showed the best probability ranking of the effect of three different frequencies of r-TMS on motor function scores in children with cerebral palsy: combined LF-rTMS + HF-rTMS (49.8%) > LF-rTMS (45.6%) > HF-rTMS (4.6%) > conventional rehabilitation (0%). Publication bias showed no significant asymmetry in the inverted funnel plot, but the possibility of publication bias could not be excluded. The results of this study showed that r-TMS was not statistically significant in improving language function in children with cerebral palsy compared to conventional treatment. r-TMS was almost unanimously significantly effective in motor function in children with cerebral palsy according to current literature data, and the combined high- and low-frequency transcranial magnetic therapy was better than low-frequency transcranial magnetic therapy.
Collapse
Affiliation(s)
- Qian Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China.
| | - Zhengang Qiu
- Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
- Department of Rehabilitation Medicine, University City Hospital, Shandong University of Traditional Chinese Medicine, Jinan, 250300, Shandong, China
| |
Collapse
|
16
|
Keough JR, Irvine B, Kelly D, Wrightson J, Comaduran Marquez D, Kinney-Lang E, Kirton A. Fatigue in children using motor imagery and P300 brain-computer interfaces. J Neuroeng Rehabil 2024; 21:61. [PMID: 38658998 PMCID: PMC11040843 DOI: 10.1186/s12984-024-01349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Brain-computer interface (BCI) technology offers children with quadriplegic cerebral palsy unique opportunities for communication, environmental exploration, learning, and game play. Research in adults demonstrates a negative impact of fatigue on BCI enjoyment, while effects on BCI performance are variable. To date, there have been no pediatric studies of BCI fatigue. The purpose of this study was to assess the effects of two different BCI paradigms, motor imagery and visual P300, on the development of self-reported fatigue and an electroencephalography (EEG) biomarker of fatigue in typically developing children. METHODS Thirty-seven typically-developing school-aged children were recruited to a prospective, crossover study. Participants attended three sessions: (A) motor imagery-BCI, (B) visual P300-BCI, and (C) video viewing (control). The motor imagery task involved an imagined left- or right-hand squeeze. The P300 task involved attending to one square on a 3 × 3 grid during a random single flash sequence. Each paradigm had respective calibration periods and a similar visual counting game. Primary outcomes were self-reported fatigue and the power of the EEG alpha band both collected during resting-state periods pre- and post-task. Self-reported fatigue was measured using a 10-point visual analog scale. EEG alpha band power was calculated as the integrated power spectral density from 8 to 12 Hz of the EEG spectrum. RESULTS Thirty-two children completed the protocol (age range 7-16, 63% female). Self-reported fatigue and EEG alpha band power increased across all sessions (F(1,155) = 33.9, p < 0.001; F = 5.0(1,149), p = 0.027 respectively). No differences in fatigue development were observed between session types. There was no correlation between self-reported fatigue and EEG alpha band power change. BCI performance varied between participants and paradigms as expected but was not associated with self-reported fatigue or EEG alpha band power. CONCLUSION Short periods (30-mintues) of BCI use can increase self-reported fatigue and EEG alpha band power to a similar degree in children performing motor imagery and P300 BCI paradigms. Performance was not associated with our measures of fatigue; the impact of fatigue on useability and enjoyment is unclear. Our results reflect the variability of fatigue and the BCI experience more broadly in children and warrant further investigation.
Collapse
Affiliation(s)
- Joanna Rg Keough
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brian Irvine
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dion Kelly
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James Wrightson
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Comaduran Marquez
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eli Kinney-Lang
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
17
|
Uysal İ, Özden F, Tümtürk İ, İmerci A. The effectiveness of dual task exercise training on balance, mobility, physical performance, and quality of life in children with cerebral palsy: a single-blind randomized controlled trial. Ir J Med Sci 2024; 193:813-821. [PMID: 37777679 DOI: 10.1007/s11845-023-03530-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Most activities of daily living require more than one activity, including motor-motor or motor-cognitive task. Few studies have investigated the effects of dual-task training in children with cerebral palsy (CP). AIMS This study was aimed at investigating the effectiveness of motor-cognitive dual-task exercise training in children with cerebral palsy (CP). METHODS A single-blind randomized controlled trial was conducted with thirty children with CP. Participants were randomized into dual group training group (DTG) and control group (CG). Children were evaluated before the intervention and after 12 weeks of treatment with Gross Motor Function Classification Scale (GMFCS), Pediatric Berg Balance Test (PBBS), Single Leg Stance Test (SLST), Timed Up and Go Test (TUG), 3 Meter Backwards Walk Test (3-MBWT), 6 Meter Walk Test (6-MWT), and General Children's Quality of Life Measure (KINDL). RESULTS DTG demonstrated significantly improved all KINDL scores (p < 0.01). In comparisons between groups adjusted analysis, results showed a better improvement of all KINDL scores in-favor-of DTG (p < 0.01). Significant improvements were found in all SLST scores and PBS in DTG (p < 0.01). Adjusted analysis results proved there was a significant improvement in all balance scores on behalf of DTG (p < 0.01). Significant improvement was observed in DTG for TUG, 3MBWT, and 6MWT scores (p = 0.001). An improvement in-favor-of DTG was found for all performance tests in the adjusted analysis (p < 0.001). CONCLUSION The results of this randomized controlled trial highlighted the advantage of dual-task training on balance, physical performance, and quality of life in children with CP.
Collapse
Affiliation(s)
- İsmail Uysal
- Fethiye Vocational School of Health Services, Department of Health Care Services, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Fatih Özden
- Department of Health Care Services, Köyceğiz Vocational School of Health Services, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - İsmet Tümtürk
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Süleyman Demirel University, Isparta, Turkey
| | - Ahmet İmerci
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Muğla Sıtkı Koçman University, Muğla, Turkey
| |
Collapse
|
18
|
Lai B, Oster RA, Davis D, Bright L, Fisher G, Wilroy J, Kim Y, Young R, Wright A, Sinha T, Rimmer JH. Telehealth Movement-to-Music With Arm-Based Sprint-Intensity Interval Training to Improve Cardiometabolic Health and Cardiorespiratory Fitness in Children With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56499. [PMID: 38441939 PMCID: PMC10951837 DOI: 10.2196/56499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Children with mobility disabilities, including those with cerebral palsy, have limited options and limited time to exercise to manage their cardiometabolic health and cardiorespiratory fitness. Regular cardiovascular exercise during childhood is a critical health behavior for preventing health decline in adulthood. Thus, there is an urgent need for accessible, age-appropriate, convenient exercise modalities in this group. Sprint-intensity interval training (SIT), combined with telehealth procedures, may be ideal for children with disabilities. SIT includes repetitive bouts of maximal exercise effort combined with rest periods, which can be effective in eliciting comparable results to moderate-exercise training with very short training durations. OBJECTIVE This phase 1 pilot feasibility randomized controlled trial aims to investigate the potential effects of a 12-week SIT program on indicators of cardiorespiratory fitness and cardiometabolic health among children with cerebral palsy. An ancillary aim is to evaluate the feasibility of the program through several process feasibility metrics. METHODS This study uses a 2-armed parallel group design. A total of 50 physically inactive children with cerebral palsy (aged 6-17 years) will be randomly allocated into 1 of 2 groups: a 12-week SIT or a waitlist control group that continues habitual activity for 12 weeks. The SIT prescription includes 3 tele-supervised sessions per week with 30 repeated sequences of 4 seconds of maximal arm exercise, with active recovery, warm-up, and cooldown periods (for an approximately 20-minute total session). SIT includes guided videos with child-themed arm routines and music. The exercise sessions will be remotely supervised through a web-based videoconference application and include safety monitoring equipment. Outcomes are measured at pre- and postintervention (weeks 0 and 13, respectively). Health outcome measures include peak oxygen consumption (VO2 peak), measured by a graded exercise test; high-sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, and cholesterol using a finger stick dried blood spot test; blood pressure, using a sphygmomanometer; and body composition (total mass, total lean mass, tissue % lean, and tissue % fat) using dual x-ray absorptiometry. Feasibility will be evaluated by the following metrics: adverse events or problems experienced throughout the intervention related to participant safety; perceived enjoyment; and recruitment, enrollment, and attrition rates. RESULTS Recruitment procedures started in November 2023. All data are anticipated to be collected by February 2025. Full trial results are anticipated to be analyzed and submitted for publication by March 2025. Secondary analyses of data will be subsequently published. CONCLUSIONS This trial tests an accessible and low-cost exercise program that leverages principles of high-intensity exercise to provide a convenient program for children with physical disabilities. Knowledge obtained from this study will inform the development of a larger trial for improving the cardiometabolic health, cardiorespiratory fitness, and well-being of children with physical disabilities. TRIAL REGISTRATION ClinicalTrials.gov NCT05619211; https://clinicaltrials.gov/study/NCT05619211. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56499.
Collapse
Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert A Oster
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Drew Davis
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Larsen Bright
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gordon Fisher
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jereme Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yumi Kim
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Raven Young
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ashley Wright
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tanvee Sinha
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H Rimmer
- Dean's Office, School of Health Professions, National Center on Health, Physical Activity and Disability, Birmingham, AL, United States
| |
Collapse
|
19
|
Elnaggar RK, Ramirez-Campillo R, Azab AR, Alrawaili SM, Alghadier M, Alotaibi MA, Alhowimel AS, Abdrabo MS, Elbanna MF, Aboeleneen AM, Morsy WE. Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics. CHILDREN (BASEL, SWITZERLAND) 2024; 11:243. [PMID: 38397355 PMCID: PMC10887404 DOI: 10.3390/children11020243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12-18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability-LoS), balance, and mobility (Community Balance and Mobility Scale-CB&M; Functional Walking Test-FWT; Timed Up and Down Stair test-TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP.
Collapse
Affiliation(s)
- Ragab K. Elnaggar
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
| | - Alshimaa R. Azab
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Saud M. Alrawaili
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mshari Alghadier
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mazyad A. Alotaibi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Ahmed S. Alhowimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mohamed S. Abdrabo
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Mohammed F. Elbanna
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahmed M. Aboeleneen
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Walaa E. Morsy
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| |
Collapse
|
20
|
Heiden GS, Andrade RVS, de Mattos de Araujo BM, da Silva-Neto UX, Baratto-Filho F, Zeigelboim BS, de Castro Corrêa C, Taveira KVM, de Araujo CM. Prevalence of orofacial injuries resulting from trauma in individuals with cerebral palsy: A systematic review and meta-analysis. Dent Traumatol 2024; 40:111-120. [PMID: 37605544 DOI: 10.1111/edt.12879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023]
Abstract
Individuals with cerebral palsy (CP) may have cognitive, sensitive, behavioral, communicative, and convulsive disorders. Because defensive reflexes are reduced by CP, the risk of orofacial trauma is greater in these individuals. This study aimed to evaluate the prevalence of orofacial injuries resulting from trauma in patients with CP. This review was reported according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO-CRD42022293570). The search was performed for articles published until January 2023 in Embase, Latin American and Caribbean Literature on Health Sciences (LILACS), PubMed/Medline, Scopus, and Web of Science databases. Gray literature was also consulted through Google Scholar, OpenGrey, ProQuest Dissertations, and Theses. Studies in which orofacial injuries due to trauma were prevalent in individuals with CP were included. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Additionally, a random-effects meta-analysis was conducted. Twelve studies were included in the synthesis, of which nine presented a low risk of bias and three presented a moderate risk. When considering the general prevalence of orofacial injuries in patients with CP, a prevalence of 34% [95% CI = 18%-52%; I2 = 98%] was observed, with enamel and dentin fractures being the most common orofacial injuries. Approximately one in three patients with CP showed at least one type of orofacial injury involving dental trauma. There is a lack of literature assessing the prevalence of these traumas in soft tissues and the evidence for this outcome remains uncertain.
Collapse
Affiliation(s)
| | | | | | | | - Flares Baratto-Filho
- Department of Endodontics, Tuiuti University of Paraná, Paraná, Brazil
- Undergraduate Department of Dentistry, University of the Region of Joinville (Univille), Santa Catarina, Brazil
| | | | - Camila de Castro Corrêa
- Department of Speech Therapy and Audiology, Centro Universitário Planalto do Distrito Federal, Brasília, Brazil
| | | | | |
Collapse
|
21
|
Tao J, Hao R, Guo Y, Zhang W. Characteristics of Visual Function in Children With Cerebral Palsy and Intellectual Disabilities in Urban Beijing. Transl Vis Sci Technol 2024; 13:7. [PMID: 38334704 PMCID: PMC10867668 DOI: 10.1167/tvst.13.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
Objective To investigate ocular development and the characteristics of visual function among children with cerebral palsy (CP) and intellectual disabilities in Beijing's Chaoyang District schools. Methods A total of 160 children (320 eyes) with CP and intellectual disabilities, including 86 males and 74 females aged between 6 and 18 years old (median, 13.5 years), were included in this study. A total of 214 healthy children aged 6 to 18 years (median, 10 years) were recruited as a control group for visual function, including 116 males and 98 females. Subjective far vision, objective vision (electrophysiological sweep visual evoked potential), corrected vision, near stereopsis, ametropia, the anterior segment, and the fundus were examined. Results A total of 232 eyes (76.32%) were ametropic among 304 eyes that could cooperate; 200 eyes (65.79%) were astigmatic, 16 eyes (5.26%) were hyperopic, and 120 eyes (39.47%) were myopic. A total of 64 children had strabismus (40%), and 24 had nystagmus (15%). The near stereopsis test showed that 72 children (64.29%) demonstrated 100″ and less. A total of 214 healthy children aged 6 to 18 years were recruited as a control group for visual function. There was a significant difference in visual functions between children with intellectual disabilities and those without (Z = -10.370; P < 0.001). Conclusions The prevalence of abnormal visual function in children with CP and intellectual disability was significantly higher than that in healthy children. Among them, myopia is the main refractive error, and the correction rate was low. Translational Relevance The electrical signals generated by stimulating the retina with black and white stripes are transmitted to the brain. Scanning electrophysiological devices can capture the activity of the cerebral cortex and convert it into an electroencephalogram. Scanning electrophysiological electrooculography is used to examine the objective vision of children with cerebral palsy.
Collapse
Affiliation(s)
- Jun Tao
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University affiliated Eye Hospital, Tianjin, China
- Beijing Chaoyang District Maternal and Child Health care Hospital, Beijing, China
| | - Rui Hao
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University affiliated Eye Hospital, Tianjin, China
| | - Yatu Guo
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University affiliated Eye Hospital, Tianjin, China
| | - Wei Zhang
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University affiliated Eye Hospital, Tianjin, China
| |
Collapse
|
22
|
Su TY, Huang YC, Ko JY, Hsin YJ, Yu MY, Hung PL. Therapeutic effects of extracorporeal shock wave therapy on patients with spastic cerebral palsy and Rett syndrome: clinical and ultrasonographic findings. Orphanet J Rare Dis 2024; 19:6. [PMID: 38172891 PMCID: PMC10763338 DOI: 10.1186/s13023-023-03010-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) is reportedly effective for improving spasticity and motor function in children with cerebral palsy (CP). Because late-stage Rett syndrome has a similar presentation, this study aimed to investigate the effects of ESWT on these two diseases. MATERIAL AND METHODS Patients diagnosed with spastic CP and Rett syndrome received 1500 impulses of ESWT at 4 Hz and 0.1 mJ/mm2, on their spastic legsonce weekly for a total of 12 weeks. Outcomes were assessed before and 4 and 12 weeks after ESWT. Clinical assessments included the Modified Ashworth Scale (MAS), passive range of motion (PROM), and Gross Motor Function Measure 88 (GMFM-88). Ultrasonographic assessments included muscle thickness, acoustic radiation force impulse (ARFI), and strain elastography. RESULTS Fifteen patients with CP and six with Rett syndrome were enrolled in this study. After ESWT, patients with CP showed significant clinical improvement in the MAS (P = 0.011), ankle PROM (P = 0.002), walking/running/jumping function (P = 0.003), and total function (P < 0.001) of the GMFM-88. The patients with Rett syndrome showed improved MAS scores (P = 0.061) and significantly improved total gross motor function (P = 0.030). Under ARFI, patients with CP demonstrated decreased shear wave speed in the gastrocnemius medial head (P = 0.038). Conversely, patients with Rett syndrome show increased shear-wave speeds after ESWT. CONCLUSION Our study provides evidence that a weekly course of low-dose ESWT for 12 weeks is beneficial for children with both CP and Rett syndrome, with the clinical effects of reducing spasticity and improving the gross motor function of the lower limbs. The ARFI sonoelastography reveals improvement of muscle stiffness in patients with CP after ESWT, but deteriorated in patients with Rett syndrome. The diverse therapeutic response to ESWT may be caused by the MECP2 mutation in Rett syndrome, having a continuous impact and driving the pathophysiology differently as compared to CP, which is secondary to a static insult. Trial registration IRB 201700462A3. Registered 22March 2017, https://cghhrpms.cgmh.org.tw/HRPMS/Default.aspx .
Collapse
Affiliation(s)
- Ting-Yu Su
- Department of Pediatric Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Jih-Yang Ko
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yi-Jung Hsin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Min-Yuan Yu
- Department of Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Pi-Lien Hung
- Department of Pediatric Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan.
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
| |
Collapse
|
23
|
Barmouz M, Uribe LV, Ai Q, Azarhoushang B. Design and fabrication of a novel 4D-printed customized hand orthosis to treat cerebral palsy. Med Eng Phys 2024; 123:104087. [PMID: 38365340 DOI: 10.1016/j.medengphy.2023.104087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 02/18/2024]
Abstract
This research study is dedicated to additive manufacturing of the shape memory polymer hand orthosis to treat patients with cerebral palsy. The treatment process for cerebral palsy is a step-by-step process that needs different adjustments for the spastic hand to stretch it towards a normal posture, whereas meeting these requirements using conventional methods or complicated mechanisms is expensive, less flexible, time-consuming, and less practical. A comprehensive investigation was conducted to design and fabricate novel thermally actuated customized hand orthosis via digital light processing (DLP). The highly precise scanning device was used to derive the hand model, and subsequently, the Blender software was used to design the customized orthosis. The results showed that fabricated orthosis could represent a strong potential to become an alternative treatment for cerebral palsy. The shape memory actuation of the orthosis indicated that 100 % shape recovery is achievable in different actuating conditions with recovery temperatures higher than 55°C. Besides, it was found that the response time and shape recovery percentage could be tailored in the range of 5 to 40 s and 45 to 100%, respectively, by adjusting programming and actuation temperatures. Further, the repeatability of the shape memory effects in the printed orthosis was investigated as well, which proved that until 17 repetitions, 100 % shape recovery was achievable.
Collapse
Affiliation(s)
- Mohsen Barmouz
- Institute of Precision Machining (KSF), Furtwangen University, Germany.
| | | | - Qingfeng Ai
- Institute of Precision Machining (KSF), Furtwangen University, Germany
| | | |
Collapse
|
24
|
Tuncay S, Sarman A. The relationship of spiritual orientation and caregiver burden of caregiver mothers with a child with cerebral palsy in Turkey. Child Care Health Dev 2024; 50:e13141. [PMID: 37309022 DOI: 10.1111/cch.13141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/29/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This study aims to examine the association between spiritual orientation and the caregiving burden experienced by mothers of children with cerebral palsy. METHODS Parents of 181 children with cerebral palsy, aged 0-18, participated in this cross-sectional-descriptive study. "Sociodemographic Form," "Spiritual Orientation Scale," "Zarit Caregiver Burden Scale," and "Gross Motor Function Classification System" were used to collect data. RESULTS The mothers who participated in the study had a mean age of 35.74 ± 5.94 years. The study showed that 17.1% of children with cerebral palsy did not receive special education, and 92.8% of them were born with a disability. Additionally, 62.4% of the children were found to be undernourished, 48.6% had irregular oral care, 43.1% had semi-active activity, 65.7% had irregular sleeping patterns, and 50.8% only partially understood what was stated. The study discovered that as mothers' ages increased, their spiritual orientation decreased, and their burden of caring increased. Furthermore, the mothers of children with severe disabilities had an increasing burden of care, as indicated by the gross motor classification. CONCLUSIONS The study found that mothers with higher spiritual orientation scores perceived less care burden. These findings suggest the need for implementing activities to provide moral support to mothers.
Collapse
Affiliation(s)
- Suat Tuncay
- Faculty of Health Science, Department of Pediatric Nursing, Bingol University, Bingol, Turkey
| | - Abdullah Sarman
- Faculty of Health Science, Department of Pediatric Nursing, Bingol University, Bingol, Turkey
| |
Collapse
|
25
|
Seltzer RA, Langner JL, Javier NM, Kaur J, Shafau AL, Ezeonu T, Bryson X, Hastings K, Tileston K, Vorhies JS. Cannabidiol Use Patterns and Efficacy for Children Who Have Cerebral Palsy. Orthopedics 2024; 47:52-56. [PMID: 37216564 DOI: 10.3928/01477447-20230517-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cannabidiol (CBD)-containing supplements are used by children with cerebral palsy (CP), but the prevalence and efficacy of their use have not been studied. We sought to describe CBD use patterns and perceived efficacy in the pediatric population with CP, evaluating any association between CBD use and health-related quality of life. Patients with CP were prospectively enrolled, and caregivers were offered the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) Questionnaire and a survey assessing CBD use. Of 119 participants, 20 (16.8%) endorsed CBD use (CBD+) and 99 (83.2%) denied it (CBD-). Participants in the CBD+ group had worse functional status (85% Gross Motor Function Classification System level IV-V for CBD+ vs 37.4% for CBD-, P<.001) and lower health-related quality of life (mean CPCHILD score of 49.3 for CBD+ vs 62.2 for CBD-, P=.001). Spasticity was the rationale most cited for CBD use (29%), followed by pain and anxiety (both 22.6%). CBD was perceived to be most effective for improving emotional health, spasticity, and pain. Fifty percent of the patients in the CBD+ group underwent surgery in the previous 2 years and most endorsed a general benefit in the postoperative setting. The most common side effects noted were fatigue and increased appetite (both 12%). Most participants endorsed no side effects (60%). CBD may serve as a useful adjunct for some children with CP, especially those with worse disease severity. Caregivers perceive CBD as offering some benefits, particularly in the domains of emotional health, spasticity, and pain. We found no evidence of severe adverse events in our small cohort. [Orthopedics. 2024;47(1):52-56.].
Collapse
|
26
|
Dlamini MD, Chang YJ, Nguyen TTB. Caregivers' experiences of having a child with cerebral palsy. A meta-synthesis. J Pediatr Nurs 2023; 73:157-168. [PMID: 37690430 DOI: 10.1016/j.pedn.2023.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
AIM To synthesize qualitative research findings of caregiver experiences and challenges in caring for and raising a child with cerebral palsy. DESIGN A systematic review and meta-synthesis. METHODS Four electronic databases: CINAHL, Embase, OVID Medline, and Cochrane, were systematically searched for qualitative research papers published before December 2022. Two independent reviewers assessed eligibility and further appraised the quality of methodology using the Critical Appraisal Skills Program (CASP) tool for qualitative research. A content thematic analysis approach was used to synthesize the qualitative research findings, construct core subthemes, and synthesize themes. RESULTS Sixty-seven findings were extracted from the 12 included studies. The findings were grouped into eleven sub-themes and then into five synthesized themes. The synthesized themes are 1. Need for convenient healthcare facilities, therapeutic services, and accessible public places, 2. Need for healthcare information and financial aid, 3. Psychological, and physical constraints, 4. Societal rejection and stigma, and 5. Overwhelming caring burden. CONCLUSION Caregivers face many challenges in adjusting their lifestyles to meet the needs of the child with cerebral palsy. Some adjustments reported included giving up full-time jobs and businesses to be full-time caregivers, giving up leisure activities, and confinement to one place.
Collapse
Affiliation(s)
- Maggie Dumsile Dlamini
- Department of Nursing, College of Medicine, National Cheng Kung University, No1 University Road, Tainan 70101, Taiwan; Department of Nursing, Eswatini Christian Medical University, Lomkiri Portion 69 of Farm 73, Zone 4, Mbabane, Hhohho, Swaziland
| | - Ying-Ju Chang
- Professor, Institute of Allied Health Sciences & Department of Nursing, College of Medicine, National Cheng Kung University, No 1 University Road, Tainan 70101, Taiwan; Director, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Tram Thi Bich Nguyen
- Department of Nursing, College of Medicine, National Cheng Kung University, No1 University Road, Tainan 70101, Taiwan; Medical Simultaion Center, Duy Tan University, 254 Nguyen Van Linh, Da Nang, Viet Nam.
| |
Collapse
|
27
|
Naaris M, Bekteshi S, Aufheimer M, Gerling K, Hallez H, Ortibus E, Konings M, Monbaliu E. Effectiveness of wheeled mobility skill interventions in children and young people with cerebral palsy: A systematic review. Dev Med Child Neurol 2023; 65:1436-1450. [PMID: 37021407 DOI: 10.1111/dmcn.15597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 04/07/2023]
Abstract
AIM To systematically review the effectiveness of wheeled mobility interventions in children and young people with cerebral palsy (CP). METHOD A systematic literature search was performed in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, EBSCO, PEDro, and Web of Science using database-specific concepts such as 'child' and 'wheelchair'. Studies focusing on wheeled mobility skill interventions with participants aged 6 to 21 years with CP were included. RESULTS Twenty studies with 203 participants were included. The impact of wheeled mobility skill interventions was assessed on mobility skills (n = 18), activity and participation (n = 10), and quality of life (n = 3). No studies reported effects on stress, fatigue, and motivational aspects. Interventions included power wheelchair skill training (n = 12), computer-based training (n = 5), smart wheelchair training (n = 2), and manual wheelchair training (n = 1), showing positive wheeled mobility intervention effects. Study quality based on the Methodological Index for Non-Randomized Studies scale was 9 out of 16 and 14 out of 24 for non-comparative and comparative studies respectively. Risk of bias was serious-to-critical on the Risk of Bias in Non-Randomized Studies of Interventions. INTERPRETATION Wheeled mobility interventions showed promising beneficial effects on wheeled mobility, activity and participation, and quality of life for children and young people with CP. Future studies with structured and standardized training programmes and assessment tools are warranted to further accelerate the wheeled mobility skill acquisition process in this population. WHAT THIS PAPER ADDS Wheeled mobility interventions improve wheeled mobility skills in individuals with cerebral palsy. The mobility skill acquisition process benefits from structured and standardized training. Knowledge of the intervention effects on participation and quality of life is limited. Most studies had moderate quality of evidence because of methodological limitations.
Collapse
Affiliation(s)
- Mari Naaris
- Department of Rehabilitation Sciences, Neurorehabilitation Technology Lab, Katholieke Universiteit Leuven, Bruges, Belgium
| | - Saranda Bekteshi
- Department of Rehabilitation Sciences, Neurorehabilitation Technology Lab, Katholieke Universiteit Leuven, Bruges, Belgium
| | - Maria Aufheimer
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kathrin Gerling
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hans Hallez
- Department of Computer Sciences, Mechatronics Research Group, Katholieke Universiteit Leuven, Bruges, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marco Konings
- Department of Rehabilitation Sciences, Neurorehabilitation Technology Lab, Katholieke Universiteit Leuven, Bruges, Belgium
| | - Elegast Monbaliu
- Department of Rehabilitation Sciences, Neurorehabilitation Technology Lab, Katholieke Universiteit Leuven, Bruges, Belgium
| |
Collapse
|
28
|
Expósito D, Morales-Suarez MM, Soriano JM, Soler C. Tools for Nutrition Assessment of Adults with Cerebral Palsy: Development of a Gold Standard. Curr Nutr Rep 2023; 12:545-553. [PMID: 37486592 DOI: 10.1007/s13668-023-00485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW Cerebral palsy (CP) is a group of disorders caused by non-stabilized cerebral lesions. Individuals with this disorder are at a higher risk of suffering from malnutrition and other related detrimental effects to their quality of life. For this reason, accurate methods of nutritional assessment are vital for people suffering from this condition. While assessment of nutritional status in children with CP has been extensively studied, very few studies have been carried out on adults. These limitations are due to the great anatomical-functional variability characteristic of this syndrome. Difficulties that derive from this variability in adult patients with CP mean that there remains an urgent need for certain standards of nutritional assessment for this population. The objective of this review is to compile the latest trends in nutritional assessment in adults with CP to guide the development of a conceptual framework for future research. RECENT FINDINGS With this aim, relevant studies have been identified. The most commonly used technique to evaluate nutritional status is the BMI because of its ease-of-use. However, its well-known limitations fail to adequately estimate the nutritional status in this population, with measurements of patients with CP yielding results that are much less accurate than those that already exist in the general population. Although more studies are needed, kinanthropometry is considered one of the most reliable techniques; nevertheless, the anatomical limitation characteristic of CP plays a limiting factor.
Collapse
Affiliation(s)
- D Expósito
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain.
- Department of Basic Medical Sciences, Universidad Católica de Valencia, 46001, Valencia, Spain.
- Department of Nutrition, Universidad Católica de Valencia, 46001, Valencia, Spain.
| | - M M Morales-Suarez
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100, Burjassot, Valencia, Spain
- CIBER Epidemiologia Y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - J M Soriano
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain
- Joint Research Unit On Endocrinology, Nutrition and Clinical Dietetics, UV-IIS La Fe, 46012, Valencia, Spain
| | - C Soler
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain
- Joint Research Unit On Endocrinology, Nutrition and Clinical Dietetics, UV-IIS La Fe, 46012, Valencia, Spain
| |
Collapse
|
29
|
Viswanath M, Jha R, Gambhirao AD, Kurup A, Badal S, Kohli S, Parappil P, John BM, Adhikari KM, Kovilapu UB, Sondhi V. Comorbidities in children with cerebral palsy: a single-centre cross-sectional hospital-based study from India. BMJ Open 2023; 13:e072365. [PMID: 37429681 DOI: 10.1136/bmjopen-2023-072365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To describe the comorbidities in children with cerebral palsy (CP) and determine the characteristics associated with different impairments. DESIGN Cross-sectional study. SETTING Tertiary care referral centre in India. PATIENTS Between April 2018 and May 2022, all children aged 2-18 years with a confirmed diagnosis of CP were enrolled by systematic random sampling. Data on antenatal, birth and postnatal risk factors, clinical evaluation and investigations (neuroimaging and genetic/metabolic workup) were recorded. MAIN OUTCOME MEASURES Prevalence of the co-occurring impairments was determined using clinical evaluation or investigations as indicated. RESULTS Of the 436 children screened, 384 participated (spastic CP=214 (55.7%) (spastic hemiplegic=52 (13.5%); spastic diplegia=70 (18.2%); spastic quadriplegia=92 (24%)), dyskinetic CP=58 (15.1%) and mixed CP=110 (28.6%)). A primary antenatal/perinatal/neonatal and postneonatal risk factor was identified in 32 (8.3%), 320 (83.3%) and 26 (6.8%) patients, respectively. Prevalent comorbidities (the test used) included visual impairment (clinical assessment and visual evoked potential)=357/383(93.2%), hearing impairment (brainstem-evoked response audiometry)=113 (30%), no understanding of any communication (MacArthur Communicative Development Inventory)=137 (36%), cognitive impairment (Vineland scale of social maturity)=341 (88.8%), severe gastrointestinal dysfunction (clinical evaluation/interview)=90 (23%), significant pain (non-communicating children's pain checklist)=230 (60%), epilepsy=245 (64%), drug-resistant epilepsy=163 (42.4%), sleep impairment (Children's Sleep Habits Questionnaire)=176/290(60.7%) and behavioural abnormalities (Childhood behaviour checklist)=165 (43%). Overall, hemiparetic and diplegic CP and Gross Motor Function Classification System ≤3 were predictive of lesser co-occurring impairment. CONCLUSION CP children have a high burden of comorbidities, which increase with increasing functional impairment. This calls for urgent actions to prioritise opportunities to prevent risk factors associated with CP and organise existing resources to identify and manage co-occurring impairments. TRIAL REGISTRATION NUMBER CTRI/2018/07/014819.
Collapse
Affiliation(s)
- Maya Viswanath
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ruchika Jha
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Arjun Kurup
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sachendra Badal
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sarvesh Kohli
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Parvathi Parappil
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Biju M John
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Uday Bhanu Kovilapu
- Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vishal Sondhi
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
| |
Collapse
|
30
|
Mikuluk B, Guttoo P, Anderson A, Skeens M. Certified Child Life Specialist role in implementation of individualized coping plans for children receiving botulinum toxin injections. J SPEC PEDIATR NURS 2023:e12413. [PMID: 37354039 DOI: 10.1111/jspn.12413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/28/2022] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this paper is to describe the implementation of evidence-based, individualized coping plans and to compare the rates of child anxiety, child cooperation, and parent anxiety before and after implementation of these coping plans for children receiving recurring BoNT-A injections emphasizing the role of Certified Child Life Specialists (CCLSs) within the interdisciplinary team approach. DESIGN AND METHODS A retrospective chart review was conducted for children receiving BoNT-A injections at a Physical Medicine clinic pre- and post-implementation of the coping plan. Descriptive statistics were used to evaluate care plan implementation, child cooperation, child anxiety, and parent anxiety. RESULTS Post-implementation of coping care plans, children experienced improved cooperation during BoNT-A injections. Parental anxiety decreased once coping plans were implemented. Documentation improved after the implementation of coping plans specific to areas involving cooperation, child's anxiety and distress, and parental anxiety and distress. It was also noted that there was an increase in child anxiety assessments within documentation. PRACTICE IMPLICATIONS CCLS were able to utilize their expertise to collaboratively create individualized coping care plans to increase child's cooperation and decrease parental anxiety during BoNT-A injections.
Collapse
Affiliation(s)
- Brittany Mikuluk
- Department of Family and Volunteer Services, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Parishma Guttoo
- The Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Avery Anderson
- Professional Development, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Micah Skeens
- The Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
31
|
Alrashidi M, Wadey CA, Tomlinson RJ, Buckingham G, Williams CA. The efficacy of virtual reality interventions compared with conventional physiotherapy in improving the upper limb motor function of children with cerebral palsy: a systematic review of randomised controlled trials. Disabil Rehabil 2023; 45:1773-1783. [PMID: 35575755 DOI: 10.1080/09638288.2022.2071484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/06/2022] [Accepted: 04/24/2022] [Indexed: 01/16/2023]
Abstract
PURPOSE Cerebral palsy (CP) is the commonest motor disability affecting children. This study reviewed the evidence for virtual reality (VR) intervention compared with conventional physiotherapy in upper limb function of children with CP. METHODS Searches were undertaken in MEDLINE, EMBASE, PEDro, CENTRAL, Web of Science, CINAHL, ERIC, ICTRP, EU-CTR, ClinicalTrials.gov and EThOS databases. Only randomised-controlled trials (RCTs) were included. Two reviewers independently screened the search results, assessed full-text articles, extracted data and appraised the methodological quality by using the Cochrane collaboration's risk of bias (RoB2) tool. Albatross plots were used to synthesise the data. RESULTS Seven RCTs, examining motor function in a total of 202 children with CP, included. Four trials used the Quality of Upper Extremity Skills Test (QUEST) as an outcome measure, and three trials used grip strength. These outcome measures were utilised to develop two Albatross plots. Data from the plots showed contradictory findings of the included studies. CONCLUSIONS The effect of VR in the upper limb rehabilitation of children with CP remains unclear. All included studies used commercial non-immersive VR games. Future high-quality clinical research is needed to explore the extent to which non-immersive and immersive VR is feasible and effective with children and adolescents.IMPLICATIONS FOR REHABILITATIONThe current evidence supporting the use of VR as a rehabilitative tool is weak and uncertain.The current use of VR relies only on commercial non-immersive VR (off-shelf) games, which are not adjustable to meet the demands and goals of therapy programmes.Future research is needed to study the therapeutic feasibility of immersive VR with children and adolescents.
Collapse
Affiliation(s)
- Mohammed Alrashidi
- Children's Health and Exercise Research Centre, Sport & Health Sciences, University of Exeter, Exeter, UK
- Sport and Health Sciences, University of Exeter, Exeter, UK
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, Taibah University, Madina, KSA
| | - Curtis A Wadey
- Children's Health and Exercise Research Centre, Sport & Health Sciences, University of Exeter, Exeter, UK
| | | | | | - Craig A Williams
- Children's Health and Exercise Research Centre, Sport & Health Sciences, University of Exeter, Exeter, UK
| |
Collapse
|
32
|
Hou X, Yan Y, Zhan Q, Wang J, Xiao B, Jiang W. Unsupervised machine learning effectively clusters pediatric spastic cerebral palsy patients for determination of optimal responders to selective dorsal rhizotomy. Sci Rep 2023; 13:8095. [PMID: 37208393 DOI: 10.1038/s41598-023-35021-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/11/2023] [Indexed: 05/21/2023] Open
Abstract
Selective dorsal rhizotomy (SDR) can reduce the spasticity in patients with spastic cerebral palsy (SCP) and thus improve the motor function in these patients, but different levels of improvement in motor function were observed among patients after SDR. The aim of the present study was to subgroup patients and to predict the possible outcome of SDR based on the pre-operational parameters. A hundred and thirty-five pediatric patients diagnosed with SCP who underwent SDR from January 2015 to January 2021 were retrospectively reviewed. Spasticity of lower limbs, the number of target muscles, motor functions, and other clinical parameters were used as input variables for unsupervised machine learning to cluster all included patients. The postoperative motor function change is used to assess the clinical significance of clustering. After the SDR procedure, the spasticity of muscles in all patients was reduced significantly, and the motor function was promoted significantly at the follow-up duration. All patients were categorized into three subgroups by both hierarchical and K-means clustering methods. The three subgroups showed significantly different clinical characteristics except for the age at surgery, and the post-operational motor function change at the last follow-up in these three clusters was different. Three subgroups clustered by two methods could be identified as "best responders", "good responders" and "moderate responders" based on the increasement of motor function after SDR. Clustering results achieved by hierarchical and K-means algorithms showed high consistency in subgrouping the whole group of patients. These results indicated that SDR could relieve the spasticity and promote the motor function of patients with SCP. Unsupervised machine learning methods can effectively and accurately cluster patients into different subgroups suffering from SCP based on pre-operative characteristics. Machine learning can be used for the determination of optimal responders for SDR surgery.
Collapse
Affiliation(s)
- Xiaobin Hou
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China
| | - Yanyun Yan
- Department of Operating Room, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qijia Zhan
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China
| | - Junlu Wang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China
| | - Bo Xiao
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China
| | - Wenbin Jiang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China.
| |
Collapse
|
33
|
Wang L, Zhang N, Fang L, Cui Z, Niu H, Lv F, Hu D, Wu D. Effect of hip CPM on gross motor function and development of the hip joint: a single-center randomized controlled study on spastic cerebral palsy children with hip dysplasia. Front Pediatr 2023; 11:1090919. [PMID: 37228431 PMCID: PMC10203473 DOI: 10.3389/fped.2023.1090919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Objective To investigate the effectiveness of hip continuous passive motion (hCPM) on hip development at skeletal maturity and gross motor function for spastic cerebral palsy children with hip dysplasia. Methods Prospective case-control research of hCPM with goal-directed training versus merely goal-directed training. On the basis of goal-directed training, the hCPM group used the hip joint CPM instrument (the external fixator was connected to the power device to make the hip joint carry out continuous passive movement) for 40-60 min, twice a day, and five times a week, and received continuous training for 8 weeks simultaneously. The control group received only goal-directed training for 8 weeks. Functional outcomes pertaining to the affected hip joints were assessed via gross motor function measure (GMFM), migration percentage (MP), acetabular index (AI), and Harris hip functional score (HHS) at the time of enrollment and the end of the intervention. Results The case-control research included 65 participants (mean age = 46.20 months, SD = 17.09 months; Gross Motor Function Grading System level: III = 41, IV = 24) who were randomly selected to either the hCPM (n = 45) or the control group (n = 20). No differences were found in baseline (acquisition phase) GMFM, MP, AI, or HHS (t = -1.720, P = 0.090; t* = 1.836, P* = 0.071; t# = -1.517, P# = 0.139; t* = -1.310, P* = 0.195; t# = -1.084, P# = 0.097; t = -1.041, P = 0.301). At the 8-week follow-up, GMFM, MP, AI, and HHS significantly improved over baseline in the hCPM group (hCPM group: t = 18.59, 20.172*, 40.291#, 16.820*, 32.900#, 28.081; P < 0.001). Between-group differences at 8-week follow-up times points favored the hCPM group for GMFM (t = -2.637, P = 0.011), MP (t* = 2.615, P* = 0.014; t# = 3.000, P# = 0.006), AI (t* = 2.055, P* = 0.044; t# = 2.223, P# = 0.030), HHS (t = -4.685, P < 0.001) (*: left side; #: right side). Conclusion Spastic cerebral palsy children with hip dysplasia achieved meaningful functional improvement after 8 weeks of goal-directed training with hCPM therapy.
Collapse
Affiliation(s)
- Lulu Wang
- Pediatric Neurological Rehabilitation Center, Pediatric Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Nuochen Zhang
- Pediatric Neurological Rehabilitation Center, Pediatric Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liwei Fang
- Pediatric Neurological Rehabilitation Center, Pediatric Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhenzhen Cui
- Pediatric Neurological Rehabilitation Center, Pediatric Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huihui Niu
- Pediatric Neurological Rehabilitation Center, Pediatric Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fuli Lv
- Pediatric Neurological Rehabilitation Center, Pediatric Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dayong Hu
- Department of Pediatrics, Anhui Hefei Southeast Surgical Hospital
| | - De Wu
- Pediatric Neurological Rehabilitation Center, Pediatric Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Pediatrics, Anhui Hefei Southeast Surgical Hospital
| |
Collapse
|
34
|
Kumar D, Kumar R, Mudgal SK, Ranjan P, Kumar S. The Effects of Botulinum Toxin and Casting in Spastic Children With Cerebral Palsy: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e36851. [PMID: 37123757 PMCID: PMC10142340 DOI: 10.7759/cureus.36851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Cerebral palsy (CP) is a neurological disorder that affects muscle tone, movement, and motor skills in children. One of the most common symptoms of cerebral palsy is spasticity, which is characterised by involuntary muscle contractions and stiffness. Both botulinum toxin and casting have been used as standalone treatments for spasticity in cerebral palsy, but which is better is still unclear. The aim of the present meta-analysis was to compare the effects on spasticity of serial casting and/or botulinum toxin type A (BoNT-A) in conjunction with or as independent therapies. Studies up to February 2022 were identified in four separate databases. The inclusion criteria were randomised controlled trials (RCTs) that compared different therapies (Botulinum toxin A, or BoNT-A, and casting) and assessed spasticity improvement in children with spastic cerebral palsy who were younger than 18 years old and were published in English. With a 95% confidence interval (CI), the standardised mean difference (SMD) was utilised to calculate treatment effects. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was followed to undertake the current study. The search for relevant literature in four databases generated 147 results. After the abstract and full-text screening, five publications with a total of 190 cerebral palsy patients were included in this systematic review and meta-analysis. In patients with cerebral palsy, both methods - botulinum toxin and casting- apply globally; our systematic review tries to find out the most effective treatment between the two but does not show any significant difference in these methods. As we know, botulinum toxin is expensive, and the casting method is time-consuming and poorly accepted by patients. There is a need for an excellent study to examine the impact of casting and botulinum toxin type A.
Collapse
|
35
|
Pekeles H, Al Amrani F, Perez-Morgui M, Wintermark P, Shevell M. Characteristics of Children With Cerebral Palsy in the Post-Therapeutic Hypothermia Era. J Child Neurol 2023; 38:130-136. [PMID: 36872628 DOI: 10.1177/08830738231159162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Objectives: To explore the profile of children with cerebral palsy secondary to intrapartum asphyxia treated with therapeutic hypothermia after birth and to compare characteristics of children treated with therapeutic hypothermia with mild vs severe cerebral palsy outcome. Study Design: We identified all children treated with therapeutic hypothermia for intrapartum asphyxia in a single-center tertiary-level neonatal intensive care unit from 2008 to 2018 with a cerebral palsy outcome. We collected perinatal and outcome measures from patient charts. We searched the literature for characteristics of children with cerebral palsy prior to therapeutic hypothermia (historical cohort) to compare to our cohort. We subdivided our cohort into mild vs severe cerebral palsy and compared neonatal characteristics to identify predictors of severe phenotype. Results: Thirty of 355 cooled neonates (8%) developed cerebral palsy. More children had spastic quadriparesis and epilepsy, and fewer had visual impairment in the post-therapeutic hypothermia era compared to the historical cohort, but had similar Gross Motor Function Classification System scores. In our cohort, more children had severe (19 of 30, 63%) compared to mild cerebral palsy (11 of 30, 37%). The severe group had higher mean birth weight, lower 5- and 10-minute Apgar scores, and more often white matter injury with associated deep gray matter injury or near-total injury pattern (P < .05). Conclusions: Our data demonstrated more infants with severe rather than mild cerebral palsy in our cohort treated with therapeutic hypothermia. Birthweight, 5- and 10-minute Apgar scores, and magnetic resonance imaging (MRI) findings were significantly different between mild and severe phenotype groups. Our findings can guide clinicians how to better weigh these factors, when counseling parents in the neonatal period.
Collapse
Affiliation(s)
- Heather Pekeles
- Division of Pediatric Neurology, 10040Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Fatema Al Amrani
- Pediatric Neurology Unit, Department of Child Health, 194179Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | - Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, 5620McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, 5620McGill University, Montreal, QC, Canada
| | - Michael Shevell
- Departments of Pediatrics and Neurology/Neurosurgery, 5620McGill University, Montreal, QC, Canada
| |
Collapse
|
36
|
Abstract
PURPOSE To summarize and update the current knowledge on the effectiveness of hippotherapy on postural control in children with cerebral palsy. METHODS Using a systematic review methodology, the electronic databases PubMed, Virtual Health Library, PEDro, Scielo, Embase, and Web of Science were searched for eligible articles from 2011 up to September 2021. Quality assessment of eligible studies was performed using the PEDro scale. RESULTS There were 239 identified studies. Eight clinical trials were selected. The total sample consisted of 264 individuals, with 134 allocated to the experimental group (hippotherapy) and 130 individuals to the control group (conventional therapy). Most studies had moderate to high methodological quality. CONCLUSIONS Hippotherapy can be an effective intervention to improve several aspects related to postural control, such as static balance (especially in the sitting posture), dynamic balance, and alignment (body posture) in children aged 3 to 16 years, particularly with spastic hemiplegia or diplegia. WHAT THIS ADDS TO THE EVIDENCE This review summarizes studies that explore potential effects of hippotherapy on postural control in children with cerebral palsy.
Collapse
|
37
|
Jakobsson T, Lauruschkus K, Tornberg ÅB. An evaluation of data processing when using the ActiGraph GT3X accelerometer in non-ambulant children and adolescents with cerebral palsy. Clin Physiol Funct Imaging 2023; 43:85-95. [PMID: 36373707 PMCID: PMC10099771 DOI: 10.1111/cpf.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate vertical acceleration, vector magnitude, non-wear time, valid day classifications, and valid period classifications in the data processing phase when using the ActiGraph GT3X accelerometer in non-ambulant children and adolescents with cerebral palsy (CP). MATERIAL AND METHODS Accelerometer data retrieved from 33 non-ambulant children and adolescents (4-17 years) with CP were analysed. Comparisons of (i) vertical acceleration versus vector magnitude, (ii) two different non-wear times, (iii) three different settings to classify a day as valid and (iv) two different settings to classify a period as valid were made. RESULTS AND CONCLUSIONS Vector magnitude and a non-wear time of at least 90 consecutive minutes statistically significantly increased minutes recorded per day, especially for sedentary time. There was a statistically significant difference in numbers of valid days depending on time criteria set to determine a valid day, whereas there was no statistically significant difference in valid periods using 3 compared to 4 days. This study suggests using the pre-settings in ActiLife; vector magnitude, non-wear time of 90 consecutive minutes, 500 min recorded per day with periods of at least 3 valid days when assessing physical activity objectively by the ActiGraph GT3X accelerometer in non-ambulant children and adolescents with CP.
Collapse
Affiliation(s)
- Trille Jakobsson
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Katarina Lauruschkus
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Åsa B Tornberg
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
38
|
Brauers L, Smeets R, Feys P, Gordon AM, Janssen-Potten Y, Ortibus E, Feys H, Rameckers E, Klingels K. Children With Cerebral Palsy Show Higher Static-But Not Higher Dynamic-Motor Fatigability in Grip and Pinch Tasks Than Children With Typical Development Do. Phys Ther 2023; 103:pzac155. [PMID: 37104625 PMCID: PMC10071583 DOI: 10.1093/ptj/pzac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/16/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate differences in static and dynamic motor fatigability during grip and pinch tasks between children with unilateral spastic cerebral palsy (USCP) and children with typical development (TD) and between preferred and nonpreferred hands. METHODS Fifty-three children with USCP and 53 age-matched children with TD (mean = 11 years 1 month; SD = 3 years 8 months) participated in 30-second maximum exertion sustained and repeated grip and pinch tasks. For sustained tasks, the Static Fatigue Index and the ratio of mean force between the first and last thirds of the curve were calculated. For repeated tasks, the ratio of mean force and the ratio of numbers of peaks between the first and last thirds of the curve were calculated. RESULTS Higher Static Fatigue Index scores for grip and pinch were found with USCP in both hands and between hands in both groups. Dynamic motor fatigability showed inconsistent results, with higher levels of fatigability in children with TD than in children with USCP for grip in the ratio of mean force between the first and last thirds of the curve in nonpreferred hands and in the ratio of number of peaks between the first and last thirds of the curve in preferred hands. CONCLUSION Higher motor fatigability in children with USCP than in children with TD was found for static but not dynamic grip and pinch. Underlying mechanisms may play different roles in static and dynamic motor fatigability. IMPACT These results highlight that static motor fatigability in grip and pinch tasks should be part of a comprehensive upper limb assessment and that this could be the target of individualized interventions.
Collapse
Affiliation(s)
- Lieke Brauers
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Peter Feys
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Yvonne Janssen-Potten
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
- Center of Expertise, Adelante Rehabilitation Center, Valkenburg, the Netherlands
| | - Els Ortibus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hilde Feys
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Eugene Rameckers
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
- Center of Expertise, Adelante Rehabilitation Center, Valkenburg, the Netherlands
| | - Katrijn Klingels
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium
| |
Collapse
|
39
|
Dere T, Serel Arslan S, Alemdaroğlu-Gürbüz İ. Validity and reliability of the turkish version of the early activity scale for endurance in preschool children with cerebral palsy. Dev Neurorehabil 2023; 26:101-108. [PMID: 36628489 DOI: 10.1080/17518423.2023.2166616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study presented the Turkish translation of the Early Activity Scale for Endurance (T-EASE) which was developed to evaluate the endurance for physical activity of preschool children with Cerebral Palsy (CP), and its validity and reliability. Fifty-five children with CP aged between 2 and 5 years were included in the study. The Gross Motor Function Classification Scale (GMFCS) and Pediatric Outcomes Data Collection Instrument (PODCI) were used to determine motor function levels and quality of life of the study population. The T-EASE had good test-retest reliability (ICC = 0.996), internal consistency (α = 0.903), higher construct validity approved by confirmatory factor analysis, and criterion validity supported by the weak-to-strong correlations between T-EASE and GMFCS, and PODCI. The T-EASE scores were significantly different between GMFCS levels (p < .05). The T-EASE was found to be valid and reliable to determine the endurance for physical activity of Turkish pre-school children with CP with the sensitivity to changes in motor function levels.
Collapse
Affiliation(s)
- Tuğba Dere
- Sarıkaya School of Physiotherapy and Rehabilitation, Yozgat Bozok University, Yozgat, Turkey
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | | |
Collapse
|
40
|
Adverse effects following botulinum toxin A injections in children with cerebral palsy. J Pediatr Orthop B 2023:01202412-990000000-00085. [PMID: 36723611 DOI: 10.1097/bpb.0000000000001055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The study aimed to analyze the adverse events associated with botulinum toxin A (BoNT-A) injections in children with cerebral palsy (CP). The literature search was completed using the Medline, PubMed, Google Scholar, Scopus, and Cochrane Library databases from the earliest date possible up to December 2021. Search terms included 'botulinum toxin', 'cerebral palsy', 'spasticity', 'adverse effects', 'side effects', 'undesirable effects', 'complications', 'lower limb', 'upper limb', and 'children' including combinations of index and free-text terms. Fifty-five studies were included in the study. Data on 6333 pediatric patients and more than 14 080 BoNT-A injections were collected. Respiratory symptoms and respiratory tract infections were the most frequently registered adverse events (AEs). Other common AEs included procedural/focal AEs, flu-like symptoms, and asthenia. Sentinel events including four cases of death were reported. AEs were more frequent and severe in high-dose patients; however, the capacity of BoNT-A to spread systemically remains unclear. Since severe adverse events are not common, further research is needed to collect more definitive clinical and homogeneous data to support the findings of the present research and clarify the safety profile of BoNT-A, especially regarding the incidence of respiratory issues and complications in GMFCS IV or V patients.
Collapse
|
41
|
Asante E, Lymn JS, Diver C. Stories of restitution: Family experiences of diagnosis and help-seeking for a child with cerebral palsy. J Pediatr Nurs 2023; 69:e73-e79. [PMID: 36635113 DOI: 10.1016/j.pedn.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The experience of living with children with CP is dominated by the voice of the mother while others are rarely reported. Incorporation of the voices of other family members is important for a holistic understanding. METHODS Drawing on the philosophical perspectives of pragmatism, generic qualitative methodology, and Frank's narratives, this article highlights how restitution was constructed by 30 family members. FINDINGS They constructed restitution by hoping for a cure through either biomedical and/or alternative models of treatment, followed by intransitive and transcendent restitution. DISCUSSION This appears to be the first time that restitution has been extended to families living with children with chronic illnesses. APPLICATION TO PRACTICE This would mean that paediatric nursing professionals and other health professionals dealing with family members living with children with CP could attend to their stories in an open and focused manner to honour and validate their stories as well as their experiences.
Collapse
Affiliation(s)
- Emmanuel Asante
- Faculty of Health, Psychology and Social Care, University of Derby, School of Health Sciences, University of Nottingham, United Kingdom.
| | - Joanne S Lymn
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.
| | - Claire Diver
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.
| |
Collapse
|
42
|
Kuliński W, Gryl E. HIPPOTHERAPY IN CEREBRAL PALSY - SURVEY RESEARCH. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:897-906. [PMID: 37326068 DOI: 10.36740/wlek202305102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: To assess the effects of a one-year hippotherapy programme on the physical and mental functioning of children with cerebral palsy. PATIENTS AND METHODS Materials and methods: The study included 15 children with cerebral palsy whose mean age was 9 years. The children participated in hippotherapy ses¬sions at the Rehabilitation Centre in Rusinowice (one-year observation). The clinical presentation was dominated by manifestations of motor and postural abnormalities caused by central nervous system damage. A survey questionnaire was used in the study to collect information about problems associated with everyday life and functioning. RESULTS Results: The results obtained in this study showed that spastic CP was the most common form of the disorder, affecting 8 out of 15 children (53%). It was followed by mixed CP (40%, 6 children). Among the respondents, 67% (10 people) were already familiar with hippotherapy whereas 33% did not know this method. CONCLUSION Conclusions: There was a strong correlation between being familiar with effects of hippotherapy and the level of education of the parent/guardian. This result had a moderate influence on the frequency of hippotherapy sessions. Systematic hippotherapy sessions helped improve physical fitness and everyday functioning in children with cerebral palsy.
Collapse
Affiliation(s)
- Włodzisław Kuliński
- DEPARTMENT OF REHABILITATION, MILITARY INSTITUTE OF MEDICINE, NATIONAL RESEARCH INSTITUTE, WARSAW, POLAND
| | - Emilia Gryl
- COLLEGIUM MEDICUM, JAN KOCHANOWSKI UNIVERSITY, KIELCE, POLAND
| |
Collapse
|
43
|
Rhodes JT, Tagawa A, Moore L, Holcomb A, Carry P, Skinner A, Miller S, De S, Carollo J. Rectus femoris transfers with and without a hamstring lengthening will not change hip kinematics in children with cerebral palsy. Gait Posture 2023; 99:119-123. [PMID: 36410181 DOI: 10.1016/j.gaitpost.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND A rectus femoris transfer (RFT) surgery with and without a hamstring lengthening (HSL) is used to treat stiff-knee gait in children with cerebral palsy (CP). While current literature has reported that a RFT surgery improves the kinematics at the knee, little is known about the kinematic changes at the hip. RESEARCH QUESTION Does a RFT surgery change hip joint kinematics in children with CP? METHODS This retrospective study included children (<18 years old) diagnosed with CP, who underwent a RFT procedure, and who were seen at our institution's accredited clinical motion laboratory. Patients with both pre- and post-operative gait analysis were identified and comparison between those analyses were performed to identify kinematic differences at the hip and knee. A total of 66 legs from 46 children (mean age: 11.1 ± 3.6) met the inclusion criteria. RESULTS Overall results revealed that a RFT did not change kinematics at the hip [p > 0.05], however, a RFT did increase the maximum knee flexion during the swing period [Mean Difference Post - Pre: 8.3°, 95% CI: 4.9-11.8, p < 0.0001]. Additionally, it was found that changes in hip extension during the terminal stance phase were significantly different between the combined RFT and HSL compared to solely an RFT. The results of this study also revealed that children whose stiff-knee gait did not improve, tended to have increased hip external rotation during terminal stance and swing and greater hip extension during terminal stance, compared to children whose stiff-knee gait did improve. SIGNIFICANCE Overall, a RFT with and without a HSL surgery improves hip and knee kinematics in the sagittal plane, however, improvements at the hip were not clinically significant. As a result, a RFT or a combined RFT with HSL should not be used to change hip kinematics in children with CP.
Collapse
Affiliation(s)
- Jason T Rhodes
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, USA; Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA; Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO, USA.
| | - Alex Tagawa
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA; Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO, USA
| | - Lucas Moore
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA; Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO, USA
| | - Amy Holcomb
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA; Colorado State University, Fort Collins, CO, USA
| | - Patrick Carry
- Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO, USA
| | - Austin Skinner
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA; Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO, USA; Kansas City University College of Osteopathic Medicine, Joplin, MO, USA
| | - Scott Miller
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA; Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO, USA
| | - Sayan De
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, USA; Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA; Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO, USA
| | - James Carollo
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, USA; Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA; Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO, USA
| |
Collapse
|
44
|
Lentzari L, Misouridou E, Karkou V, Paraskeva M, Tsiou C, Govina O, Kalogianni A, Parissopoulos S. The Experience of Dancing Among Individuals with Cerebral Palsy at an Inclusive Dance Group: A Qualitative Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:443-456. [PMID: 37581818 DOI: 10.1007/978-3-031-31986-0_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Art practices such as dance have the potential to support people with disabilities. It is possible that through dancing, bodies that may be regarded as "deficient" can be strengthened while enhancing their personal and cultural identities. It is also possible that inclusive group dance classes can enable the integration of people with disabilities in their social context. However, there is limited research on how these potential benefits are experienced by participants. AIM The purpose of this research is to describe the experience of people with cerebral palsy participating in regular dance classes. METHODS Semi-structured interviews were conducted with six participants with cerebral palsy who participated in an inclusive dance group that was informed by the creative approach of Laban. The interviews were transcribed, coded, and analyzed according to the thematic analysis of Braun and Clarke. The qualitative analysis software program ATLAS.TI version 8 was used for organizing and data analysis. FINDINGS The six interviews were analyzed and codified in four main categories: (1) the experience of cerebral palsy (the body does not help); (2) dance as a form of relationship with myself and the other; (3) the value of dancing and; (4) the dancer. These categories led to the creation of two subthemes: (a) the "unlocking" concerning the therapeutic effect of dance and (b) the "acquisition of a dancer's identity" by engaging with dance as an artform. An overall theme also emerged, "the passage from darkness to light." CONCLUSIONS Individuals with cerebral palsy, while taking the risk of being physically "exposed" in dance classes and dance group performances, managed to unlock their bodies, develop connections with others, acquire the identity of a dancer, and move from "darkness" to "light."
Collapse
Affiliation(s)
- Lydia Lentzari
- Department of Nursing, MSc "Neurological Disorders - Evidence Based Practice", University of West Attica, Athens, Greece.
| | - Evdokia Misouridou
- Department of Nursing, MSc "Neurological Disorders - Evidence Based Practice", University of West Attica, Athens, Greece
| | - Vicky Karkou
- Research Center for Arts and Wellbeing, Edge Hill University, Ormskirk, UK
| | | | - Chrysoula Tsiou
- Department of Nursing, MSc "Neurological Disorders - Evidence Based Practice", University of West Attica, Athens, Greece
| | - Ourania Govina
- Department of Nursing, MSc "Neurological Disorders - Evidence Based Practice", University of West Attica, Athens, Greece
| | - Antonia Kalogianni
- Department of Nursing, MSc "Neurological Disorders - Evidence Based Practice", University of West Attica, Athens, Greece
| | - Stelios Parissopoulos
- Department of Nursing, MSc "Neurological Disorders - Evidence Based Practice", University of West Attica, Athens, Greece
| |
Collapse
|
45
|
Almasri NA, Alquaqzeh FA. Determinants of Quality of Life of Children and Adolescents with Cerebral Palsy: A Systematic Review. Phys Occup Ther Pediatr 2023:1-22. [PMID: 36588347 DOI: 10.1080/01942638.2022.2162358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To summarize research findings on the determinants of Quality of Life (QoL) in children with cerebral palsy based on the International Classification of Functioning, Disability, and Health (ICF). METHODS The protocol of the review was registered in the International Prospective Register of The Systematic Reviews PROSPERO (CRD42021261966). A PubMed, Web of Science, MEDLINE complete, and CINAHL Plus search was conducted between January 2020 and October 2021 to identify studies that examined determinants of QoL. Inclusion criteria for the studies were children between the ages of birth and 20 years with cerebral palsy. The data extraction and quality evaluation of studies were carried out independently by two reviewers. RESULTS A total of 664 studies were identified in the search, of which 23 studies were included in the review. The majority of the studies were conducted in high-income countries. According to the ICF, 48% of the studies examined body function determinants, 52% examined activities determinants, and 26% examined environmental determinants. In contrast, 13% of the studies examined determinants related to participation and 13% examined determinants related to personal factors. CONCLUSIONS Based on our findings, most of the determinants identified in the literature are related sequentially to functional activities, body functions and structures, and environmental factors. Researchers should focus on assessing the determinants of QoL related to participation and personal characteristics for children with cerebral palsy in order to improve their QoL.
Collapse
Affiliation(s)
- Nihad A Almasri
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Fatima Alzahra Alquaqzeh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| |
Collapse
|
46
|
Guérin M, Sijobert B, Zaragoza B, Cambon F, Boyer L, Patte K. Combining intensive rehabilitation with a non-functional isokinetic strengthening program in adolescents with cerebral palsy: a study protocol for a randomized controlled trial. JMIR Res Protoc 2022; 12:e43221. [PMID: 36790338 DOI: 10.2196/43221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common brain injury in the pediatric population. CP patients present different affectations such as decreased muscle strength, gait deviations, impaired proprioception, and spasticity. Isokinetic strengthening programs combined with an intensive rehabilitation may improve muscle strength and therefore gait efficiency. Clinical Trials: The protocol has been accepted by the French National Ethics Committee (IDRCB: 2022-A00431-42). OBJECTIVE The primary aim of this randomized controlled trial is to compare the effect of an intensive rehabilitation combined with a non-functional isokinetic progressive strengthening program to an intensive rehabilitation alone on gait parameters and muscle strength in CP patients. Another goal of the current study is to determine whether adding an isokinetic program to an intensive rehabilitation is more effective than an intensive reha-bilitation alone on decreasing spasticity and improving joint position sense in CP patients. METHODS Thirty adolescents with spastic diplegia CP (GMFCS level I to III) will be randomized, by an independent researcher, into a 3-week intensive rehabilitation and isokinetic pro-gressive strengthening group or an intensive rehabilitation control group. Gait param-eters, muscle strength, spasticity and knee joint position sense will be assessed. These variables will be evaluated at baseline (T0) and at the end of the intervention (T1). The intensive rehabilitation will consist of physiotherapy sessions twice a day and hydro-therapy and virtual reality gait training once a day. The isokinetic training group will have a total of 9 supervised isokinetic strength training focusing on knee flexors and extensors with different execution speeds. RESULTS The protocol has been accepted by the French National Ethics Committee in October 2022. Inclusion of patients will start in November 2022. CONCLUSIONS The combination of an intensive rehabilitation with an isokinetic program on knee flexors and extensors have not been studied yet. The findings of this study may determine if an isokinetic strength training program of knee flexors and extensors is benefic to improve gait parameters, muscle strength, spasticity, and joint position sense in adolescents with spastic diplegia. CLINICALTRIAL The protocol has been accepted by the French National Ethics Committee (IDRCB: 2022-A00431-42).
Collapse
Affiliation(s)
- Mathias Guérin
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Benoit Sijobert
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Benjamin Zaragoza
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Flore Cambon
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Laurence Boyer
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Karine Patte
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| |
Collapse
|
47
|
Legouez L, Le Dieu-Lugon B, Feillet S, Riou G, Yeddou M, Plouchart T, Dourmap N, Le Ray MA, Marret S, Gonzalez BJ, Cleren C. Effects of MgSO 4 Alone or Associated with 4-PBA on Behavior and White Matter Integrity in a Mouse Model of Cerebral Palsy: A Sex- and Time-Dependent Study. Int J Mol Sci 2022; 23:ijms232415947. [PMID: 36555591 PMCID: PMC9788405 DOI: 10.3390/ijms232415947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Cerebral palsy (CP) is defined as permanent disorders of movement and posture. Prematurity and hypoxia-ischemia (HI) are risk factors of CP, and boys display a greater vulnerability to develop CP. Magnesium sulfate (MgSO4) is administered to mothers at risk of preterm delivery as a neuroprotective agent. However, its effectiveness is only partial at long term. To prolong MgSO4 effects, it was combined with 4-phenylbutyrate (4-PBA). A mouse model of neonatal HI, generating lesions similar to those reported in preterms, was realized. At short term, at the behavioral and cellular levels, and in both sexes, the MgSO4/4-PBA association did not alter the total prevention induced by MgSO4 alone. At long term, the association extended the MgSO4 preventive effects on HI-induced motor and cognitive deficits. This might be sustained by the promotion of oligodendrocyte precursor differentiation after HI at short term, which led to improvement of white matter integrity at long term. Interestingly, at long term, at a behavioral level, sex-dependent responses to HI were observed. This might partly be explained by early sex-dependent pathological processes that occur after HI. Indeed, at short term, apoptosis through mitochondrial pathways seemed to be activated in females but not in males, and only the MgSO4/4-PBA association seemed to counter this apoptotic process.
Collapse
Affiliation(s)
- Lou Legouez
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Bérénice Le Dieu-Lugon
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Shérine Feillet
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Gaëtan Riou
- INSERM U1234 “Pan’Ther”, Flow Cytometry Core—IRIB, 76000 Rouen, France
| | - Melissa Yeddou
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Thibault Plouchart
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Nathalie Dourmap
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Marie-Anne Le Ray
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Stéphane Marret
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
- Department of Neonatal Paediatrics and Intensive Care-Neuropediatric, CHU, Rouen Hospital, 76000 Rouen, France
| | - Bruno J. Gonzalez
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Carine Cleren
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
- Correspondence:
| |
Collapse
|
48
|
Hu J, Wang X, Liu X, Xia T, Liu Q, Zhang X, Hu Y. Effectiveness and safety of acupuncture for children with cerebral palsy: An overview of systematic reviews. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
49
|
Robinson KG, Marsh AG, Lee SK, Hicks J, Romero B, Batish M, Crowgey EL, Shrader MW, Akins RE. DNA Methylation Analysis Reveals Distinct Patterns in Satellite Cell-Derived Myogenic Progenitor Cells of Subjects with Spastic Cerebral Palsy. J Pers Med 2022; 12:jpm12121978. [PMID: 36556199 PMCID: PMC9780849 DOI: 10.3390/jpm12121978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Spastic type cerebral palsy (CP) is a complex neuromuscular disorder that involves altered skeletal muscle microanatomy and growth, but little is known about the mechanisms contributing to muscle pathophysiology and dysfunction. Traditional genomic approaches have provided limited insight regarding disease onset and severity, but recent epigenomic studies indicate that DNA methylation patterns can be altered in CP. Here, we examined whether a diagnosis of spastic CP is associated with intrinsic DNA methylation differences in myoblasts and myotubes derived from muscle resident stem cell populations (satellite cells; SCs). Twelve subjects were enrolled (6 CP; 6 control) with informed consent/assent. Skeletal muscle biopsies were obtained during orthopedic surgeries, and SCs were isolated and cultured to establish patient-specific myoblast cell lines capable of proliferation and differentiation in culture. DNA methylation analyses indicated significant differences at 525 individual CpG sites in proliferating SC-derived myoblasts (MB) and 1774 CpG sites in differentiating SC-derived myotubes (MT). Of these, 79 CpG sites were common in both culture types. The distribution of differentially methylated 1 Mbp chromosomal segments indicated distinct regional hypo- and hyper-methylation patterns, and significant enrichment of differentially methylated sites on chromosomes 12, 13, 14, 15, 18, and 20. Average methylation load across 2000 bp regions flanking transcriptional start sites was significantly different in 3 genes in MBs, and 10 genes in MTs. SC derived MBs isolated from study participants with spastic CP exhibited fundamental differences in DNA methylation compared to controls at multiple levels of organization that may reveal new targets for studies of mechanisms contributing to muscle dysregulation in spastic CP.
Collapse
Affiliation(s)
- Karyn G. Robinson
- Nemours Children’s Research, Nemours Children’s Health System, Wilmington, DE 19803, USA
| | - Adam G. Marsh
- Center for Bioinformatics and Computational Biology, University of Delaware, Newark, DE 19716, USA
| | - Stephanie K. Lee
- Nemours Children’s Research, Nemours Children’s Health System, Wilmington, DE 19803, USA
| | - Jonathan Hicks
- Center for Bioinformatics and Computational Biology, University of Delaware, Newark, DE 19716, USA
| | - Brigette Romero
- Medical and Molecular Sciences, University of Delaware, Newark, DE 19716, USA
| | - Mona Batish
- Medical and Molecular Sciences, University of Delaware, Newark, DE 19716, USA
| | - Erin L. Crowgey
- Nemours Children’s Research, Nemours Children’s Health System, Wilmington, DE 19803, USA
| | - M. Wade Shrader
- Department of Orthopedics, Nemours Children’s Hospital Delaware, Wilmington, DE 19803, USA
| | - Robert E. Akins
- Nemours Children’s Research, Nemours Children’s Health System, Wilmington, DE 19803, USA
- Correspondence: ; Tel.: +1-302-651-6779
| |
Collapse
|
50
|
Zai W, Xu N, Wu W, Wang Y, Wang R. Effect of task-oriented training on gross motor function, balance and activities of daily living in children with cerebral palsy: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31565. [PMID: 36343029 PMCID: PMC9646623 DOI: 10.1097/md.0000000000031565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To systematically evaluate task-oriented training (TOT) on the improvement of gross motor function, balance and activities of daily living in children with cerebral palsy (CP). METHODS A number of randomized controlled trials (RCTs) of TOT in children with CP were searched from Pubmed, Cochrane Library, Web of Science, EmBase, China National Knowledge Infrastructure, Chinese Biology Medicine, Chinese Scientific Journals Database and Wanfang data from the establishment of database to March 2022. The methodological quality of the included studies was evaluated, and meta-analysis was performed by RevMan5.4 software. RESULTS A total of 16 studies were included in the systematic review (n = 893). Meta-analysis showed that the gross motor function measure (GMFM) (MD = 11.05, 95%CI [8.26, 13.83], P < .00001), dimension D (MD = 3.05, 95%CI [1.58, 4.53], P < .0001) of the GMFM, dimension E (MD = 7.36, 95%CI [5.88, 8.84], P < .00001) of the GMFM, the Berg Balance Scale (BBS) (MD = 6.23, 95%CI [3.31, 9.15], P < .0001), the pediatric evaluation of disability inventory (PEDI) mobile function (MD = 6.44, 95%CI [3.85, 9.02], P < .00001) score improved significantly in the TOT group compared with the control group. CONCLUSIONS Current evidence shows that TOT could effectively improve gross motor function, balance and activities of daily living in children with CP. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.
Collapse
Affiliation(s)
- Weiyi Zai
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ning Xu
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- * Correspondence: Ning Xu, School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, China (e-mail: ) and Wei Wu, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China (e-mail: )
| | - Wei Wu
- Qilu Hospital of Shandong University, Jinan, Shandong, China
- * Correspondence: Ning Xu, School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, China (e-mail: ) and Wei Wu, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China (e-mail: )
| | - Yueying Wang
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Runfang Wang
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| |
Collapse
|