1
|
Srinivasan S, Amonkar N, Kumavor PD, Bubela D, Morgan K. Joystick-Operated Ride-On Toy Navigation Training for Children With Hemiplegic Cerebral Palsy: A Pilot Study. Am J Occup Ther 2024; 78:7804185070. [PMID: 38836619 DOI: 10.5014/ajot.2024.050589] [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: 06/06/2024] Open
Abstract
IMPORTANCE Children with hemiplegic cerebral palsy (HCP) require intensive task-oriented training to make meaningful gains in affected upper extremity (UE) motor function. OBJECTIVE To evaluate the acceptability and utility of single joystick-operated ride-on toy (ROT) navigation training incorporated into a modified constraint-induced movement therapy (CIMT) camp for children with HCP. DESIGN Single group pretest-posttest design. SETTING Three-wk structured CIMT camp. PARTICIPANTS Eleven children with HCP between ages 3 and 14 yr. INTERVENTION Children received group-based CIMT for 6 hr/day, 5 days/wk, for 3 wk. As part of camp activities, children also received ROT navigation training for 20 to 30 min/day, 5 days/wk, for 3 wk. OUTCOMES AND MEASURES We assessed children's acceptance of ROT training by monitoring adherence and evaluating child engagement (affect and attention) during training sessions. The effects of ROT training combined with other camp activities on children's affected UE motor function were also assessed with the standardized Quality of Upper Extremity Skills Test (QUEST) and training-specific measures of ROT maneuvering accuracy. RESULTS Children demonstrated high levels of training adherence, positive affect, and task-appropriate attention across weeks. Positive engagement during ROT sessions was correlated with independent navigation. We also found medium- to large-sized improvements in QUEST scores and toy-maneuvering capabilities after the combined program. CONCLUSIONS AND RELEVANCE Our pilot data support the use of joystick-operated ROTs as child-friendly therapy adjuncts that can be incorporated into intensive UE training programs to improve adherence and motivation in therapy programs, boost treatment dosing, and promote affected UE motor function in children with HCP. Plain-Language Summary: This pilot study offers promising evidence that supports the use of modified single joystick-operated ride-on toys (ROTs) for children with hemiplegic cerebral palsy (HCP). The study used ROTs as one of several interventions that were part of a constraint-induced movement therapy (CIMT) camp program for children with HCP. The ROTs boosted children's motivation, their engagement with and adherence to training, and their practice in using their affected upper extremity (UE) for goal-directed activities in their natural settings. ROTs are accessible, age-appropriate, and easy-to-use devices for both occupational therapy clinicians and families to encourage children to use their affected UEs by challenging their perceptual, motor-planning, problem-solving, and movement-control skills in an enjoyable and engaging way. ROTs can be used within and outside conventional rehabilitation settings.
Collapse
Affiliation(s)
- Sudha Srinivasan
- Sudha Srinivasan, PT, PhD, is Assistant Professor, Physical Therapy Program, Department of Kinesiology; Affiliate, Institute for Collaboration on Health, Intervention, and Policy; and Affiliate, The Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs;
| | - Nidhi Amonkar
- Nidhi Amonkar, PT, is Graduate Student, Physical Therapy Program, Department of Kinesiology; Affiliate, Institute for Collaboration on Health, Intervention, and Policy; and Affiliate, The Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs
| | - Patrick D Kumavor
- Patrick D. Kumavor, PhD, is Associate Professor in Residence, Biomedical Engineering Department, University of Connecticut, Storrs
| | - Deborah Bubela
- Deborah Bubela, PT, PhD, is Emeritus Associate Professor in Residence, Physical Therapy Program, Department of Kinesiology; Affiliate, Institute for Collaboration on Health, Intervention, and Policy; and Affiliate, The Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs
| | - Kristin Morgan
- Kristin Morgan, PhD, is Assistant Professor, Biomedical Engineering Department, University of Connecticut, Storrs
| |
Collapse
|
2
|
Shahane V, Kumavor PD, Morgan K, Srinivasan S. Fast and Fun: A Pilot Feasibility Study Using Dual Joystick-Operated Ride-on Toys for Upper Extremity Rehabilitation in Children with Hemiplegia. Phys Occup Ther Pediatr 2024; 44:844-864. [PMID: 38863174 DOI: 10.1080/01942638.2024.2360462] [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: 12/10/2023] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/13/2024]
Abstract
AIM Our study investigates the feasibility and utility of implementing a dual joystick-operated ride-on-toy navigation training (RNT) program within a 3-week intensive camp based on principles of modified constraint-induced movement therapy and bimanual training, to improve upper extremity (UE) function in children with unilateral cerebral palsy (UCP). METHODS We employed a single-group pretest posttest, mixed methods study design. Eleven 4-to-10-year-old children with UCP received RNT as part of camp activities. Sessions required children to use both arms together for navigation and completing gross and fine motor UE challenges. We collected exit questionnaires from children, caregivers, and clinicians to assess the feasibility, acceptance, enjoyment, and perceived efficacy of RNT. Videos of training sessions were coded using Datavyu behavioral coding software to assess children's facial expressions and affective states, indicative of their level of engagement during intervention sessions. RESULTS We found high levels of child engagement during RNT sessions based on video data and stakeholder feedback. The RNT program was smoothly integrated into the camp. Stakeholders acknowledged the highly motivating nature of RNT. When combined with other camp activities, the program led to stakeholder-reported improvements in bimanual skills and spontaneous daily use of the affected UE. CONCLUSIONS Our pilot study provides promising evidence for using joystick-operated ride-on toys as engaging therapy adjuncts. Our findings call for future studies to systematically assess the efficacy of these devices in improving UE function among children with UCP.
Collapse
Affiliation(s)
- Vaishnavi Shahane
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT, USA
| | - Patrick D Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, USA
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, USA
| | - Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT, USA
| |
Collapse
|
3
|
Tobaiqi MA, Albadawi EA, Fadlalmola HA, Albadrani MS. Application of Virtual Reality-Assisted Exergaming on the Rehabilitation of Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7091. [PMID: 38002703 PMCID: PMC10672287 DOI: 10.3390/jcm12227091] [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: 09/27/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Rehabilitation programs for children with cerebral palsy (CP) aim to improve their motor and cognitive skills through repeated and progressively challenging exercises. However, these exercises can be tedious and demotivating, which can affect the effectiveness and feasibility of the programs. To overcome this problem, virtual reality VR-assisted exergaming has emerged as a novel modality of physiotherapy that combines fun and motivation with physical activity. VR exergaming allows children with CP to perform complex movements in a secure and immersive environment, where they can interact with virtual objects and scenarios. This enhances their active engagement and learning, as well as their self-confidence and enjoyment. We aim to provide a comprehensive overview of the current state of research on VR exergaming for CP rehabilitation. The specific objectives are: To identify and describe the existing studies that have investigated the effects of VR exergaming on motor function and participation outcomes in children with CP. In addition, we aim to identify and discuss the main gaps, challenges, and limitations in the current research on VR exergaming for CP rehabilitation. Finally, we aim to provide recommendations and suggestions for future research and practice in this field. METHODS In June 2023, we conducted a systematic search on Scopus, Web of Science, PubMed, Cochrane, and Embase for randomized trials and cohort studies that applied VR-assisted exergaming to rehabilitating patients with CP. The inclusion criteria encompassed the following: (1) Randomized controlled trials (RCTs) and cohort studies involving the rehabilitation of children with CP; (2) the application of VR-based exergaming on the rehabilitation; (3) in comparison with conventional rehabilitation/usual care. The quality of the selected RCTs was evaluated using Cochrane's tool for risk of bias assessment bias includes. Whereas the quality of cohort studies was assessed using the National Institutes of Health (NIH) tool. RESULTS The systematic search of databases retrieved a total of 2576 studies. After removing 863 duplicates, 1713 studies underwent title and abstract screening, and 68 studies were then selected as eligible for full-text screening. Finally, 45 studies were involved in this review (n = 1580), and 24 of those were included in the quantitative analysis. The majority of the included RCTs had a low risk of bias regarding study reporting, participants' attrition, and generating a random sequence. Nearly half of the RCTs ensured good blinding of outcomes assessors. However, almost all the RCTs were unclear regarding the blinding of the participants and the study personnel. The 2020 retrospective cohort study conducted at Samsung Changwon Hospital, investigating the effects of virtual reality-based rehabilitation on upper extremity function in children with cerebral palsy, demonstrated fair quality in its methodology and findings. VR-assisted exergaming was more effective than conventional physiotherapy in improving the Gross Motor Function Measurement (GMFM)-88 score (MD = 0.81; 95% CI [0.15, 1.47], p-value = 0.02) and the GMFM walking and standing dimensions (MD = 1.45; 95% CI [0.48, 2.24], p-value = 0.003 and MD = 3.15; 95% CI [0.87, 5.42], p-value = 0.007), respectively. The mobility and cognitive domains of the Pediatric Evaluation of Disability Inventory score (MD = 1.32; 95% CI [1.11, 1.52], p-value < 0.001) and (MD = 0.81; 95% CI [0.50, 1.13], p-value < 0.0001) were also improved. The Canadian Occupational Performance Measure performance domain (MD = 1.30; 95% CI [1.04, 1.56], p-value < 0.001), the WeeFunctional Independence Measure total score (MD = 6.67; 95% CI [6.36, 6.99], p-value < 0.0001), and the Melbourne Assessment of Unilateral Upper Limb Function-2 score (p-value < 0.001) improved as well. This new intervention is similarly beneficial as conventional therapy in improving other efficacy measures. CONCLUSIONS Our findings suggest that VR-assisted exergaming may have some advantages over conventional rehabilitation in improving CP children's functioning and performance in daily life activities, upper and lower limb mobility, and cognition. VR-assisted exergaming seems to be as effective as conventional physiotherapy in the other studied function measures. With its potential efficacy, better feasibility, no reported side effects, and entertaining experience, VR-assisted exergaming may be a viable complementary approach to conventional physiotherapy in rehabilitating children with CP.
Collapse
Affiliation(s)
- Muhammad Abubaker Tobaiqi
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia
| | - Emad Ali Albadawi
- Department of Anatomy, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia;
| | - Hammad Ali Fadlalmola
- Department of Community Health Nursing, Nursing College, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia;
| | - Muayad Saud Albadrani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia
| |
Collapse
|
4
|
Kanitkar A, Parmar ST, Szturm TJ, Restall G, Rempel GR, Sepehri N, Naik N. Evaluation of a computer game-assisted rehabilitation program for manual dexterity of children with cerebral palsy: Feasibility randomized control trial. PM R 2023; 15:1280-1291. [PMID: 36655404 DOI: 10.1002/pmrj.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is a need for innovation to improve the engagement and compliance of rehabilitation programs for children with upper extremity (UE) motor impairments due to cerebral palsy (CP); a computer games-based rehabilitation platform (GRP) was developed to address this need. The GRP provides engaging task-specific exercises targeting manual dexterity (object handling and manipulation). OBJECTIVE To evaluate the therapeutic value and treatment effect size of an exercise program using the GRP in children with CP. METHODS A total of 63 children with CP, aged 4 to 10 years, were recruited. The Peabody Developmental Motor Scale-2 (PDMS-2) Grasp and Visual-Motor Integration (VMI) subscores and Computer game-based Upper Extremity (CUE) assessment of manual dexterity were used to assess participants before and after a 16-week intervention program, delivered three times per week. The experimental group (XG) received a computer games-based exercise program targeting object manipulation tasks. The active control arm (CG) consisted of task-specific training similar to the tasks used in constrained induced movement therapy. RESULTS There were only a few dropouts during the 16-week program, and compliance was high. Both groups showed significant improvements with medium to large effect sizes. Improvements in the PDMS-2 Grasp and VMI subscores observed in the XG were significantly greater than that in the CG. There were significant improvements (p < .01) in PDMS-2 grasp and VMI subscores for XG with moderate to large effect sizes (0.5-0.8). For CG, the Grasp and VMI subscores did improve but these changes were not statistically significant. There was a significant improvement observed in the majority of CUE object manipulation test scores for XG (p < .01) with moderate to large effect sizes (0.50-1.2) Although CG did show improvements in all CUE object manipulation test scores, the changes did not reach statistical significance (p < .01). CONCLUSION This study demonstrates the utility of the GRP to practice a broad range of object manipulation tasks in children with CP. The present findings are positive and support further research and development. The long-term effects of the GRP program in children with CP will need to be confirmed in a future randomized controlled trial. In addition to measures of structure and function, future trials should also include outcome measures such as health-related quality of life and level of participation to validate the findings.
Collapse
Affiliation(s)
- Anuprita Kanitkar
- College of rehabilitation sciences, University of Manitoba, Winnipeg, Canada
| | | | - Tony Joseph Szturm
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Gayle Restall
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Gina Ruth Rempel
- Max Rady College of Medicine, Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Nariman Sepehri
- Faculty of Engineering, University of Manitoba, Winnipeg, Canada
| | - Nilahri Naik
- Ushas' School for Exceptional Children, Hubli, India
| |
Collapse
|
5
|
Saussez G, Bailly R, Araneda R, Paradis J, Ebner-Karestinos D, Klöcker A, Sogbossi ES, Riquelme I, Brochard S, Bleyenheuft Y. Efficacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial. J Neuroeng Rehabil 2023; 20:98. [PMID: 37516873 PMCID: PMC10385889 DOI: 10.1186/s12984-023-01218-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 07/13/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND The implementation of virtual devices can facilitate the role of therapists (e.g., patient motivation, intensity of practice) to improve the effectiveness of treatment for children with cerebral palsy. Among existing therapeutic devices, none has been specifically designed to promote the application of principles underlying evidence-based motor skill learning interventions. Consequently, evidence is lacking regarding the effectiveness of virtual-based sessions in motor function rehabilitation with respect to promoting the transfer of motor improvements into daily life activities. We tested the effectiveness of implementing a recently developed virtual device (REAtouch®), specifically designed to enable the application of therapeutic motor skill learning principles, during a Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention. METHODS Forty children with unilateral cerebral palsy (5-18 years; MACS I-III; GMFCS I-II) were randomly assigned to a control group or a "REAtouch®" experimental group for a 90-h HABIT-ILE day-camp intervention (two weeks). Children in the REAtouch® group spent nearly half of their one-on-one therapeutic time using the REAtouch®. Participants underwent three testing sessions: the week before (T1), after intervention (T2), and at three months follow-up (T3). The primary outcome was the Assisting Hand Assessment (T3-T1; blinded). Secondary outcomes measured uni-bimanual hand function, stereognosis, gait endurance, daily life abilities, and functional goals. Accelerometers and a manual report of daily activities served to document therapeutic dosage and treatment characteristics. We used one-way RMANOVA to compare the efficacies of the two interventions, and non-inferiority analyses to contrast changes in the "REAtouch®" group versus the "HABIT-ILE" control group. RESULTS We found significant improvements in both groups for most of the outcome measures (p < 0.05). There was significant non-inferiority of changes in the REAtouch® group for upper extremities motor function, functional goals attainment, and abilities in daily life activities (p < 0.05). CONCLUSIONS Use of the REAtouch® device during HABIT-ILE showed non-inferior efficacy compared to the conventional evidence-based HABIT-ILE intervention in children with unilateral cerebral palsy. This study demonstrates the feasibility of using this virtual device in a high dosage camp model, and establishes the possibility of applying the therapeutic principles of motor skill learning during specifically designed virtual-based sessions. TRIAL REGISTRATION Trial registration number: NCT03930836-Registration date on the International Clinical Trials Registry Platform (ICTRP): June 21th, 2018; Registration date on NIH Clinical Trials Registry: April 29th, 2019. First patient enrollment: July 3rd, 2018.
Collapse
Affiliation(s)
- G Saussez
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium.
- Motor Sciences department, FfH Lab, CeREF Santé, HELHa, Rue Trieu Kaisin, 136, 6061, Montignies-Sur-Sambre, Belgium.
| | - R Bailly
- Fondation Ildys, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France
| | - R Araneda
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - J Paradis
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - D Ebner-Karestinos
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - A Klöcker
- Haute Ecole Leonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - E S Sogbossi
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - I Riquelme
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
| | - S Brochard
- Fondation Ildys, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France
| | - Y Bleyenheuft
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
| |
Collapse
|
6
|
Choi JY, Yi SH, Shim D, Yoo B, Park ES, Rha DW. Home-based virtual reality-enhanced upper limb training system in children with brain injury: a randomized controlled trial. Front Pediatr 2023; 11:1131573. [PMID: 37274815 PMCID: PMC10233002 DOI: 10.3389/fped.2023.1131573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
Background Rehabilitation of upper limb function can be challenging in children with brain lesion. Recent virtual reality (VR) rehabilitation may be an additional treatment option in pediatric rehabilitation. Objectives To assess the feasibility and effectiveness of a home-based VR-enhanced rehabilitation program with wearable multi-inertial measurement unit (IMU) sensors on upper limb functions in children with brain injury. Methods This multicenter single blind randomized controlled trial included 40 children with cerebral palsy (CP) or static brain injury. Subjects were randomized 1:1 to experimental and control group. Both the groups maintained the same therapeutic content and dose of occupational therapy during the intervention period. The experimental group performed additional training at home using the VR-enhanced program for at least 30 min/day, 5 days/week, for 6 weeks. VR training consisted of daily activities or games promoting wrist and forearm articular movements using wearable IMU sensors. The Melbourne Assessment of Unilateral Upper Limb Function-version 2 (MA2), Upper Limb Physician's Rating Scale (ULPRS), Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT), computerized 3D motion analysis, and user satisfaction survey were performed. Mann-Whitney U test was used to compare treatment effects between groups, and Friedman and Wilcoxon signed-rank tests were used to compare pre and post intervention. Results Overall 35 children (15 in VR group and 20 in control group) completed the protocol. In the experimental group, an average VR training time was 855 min. The accuracy of motion measured by MA2, segmental movements by ULPRS, daily living capability and social cognitive function by PEDI-CAT, movement time and shoulder movement pattern by motion analysis showed significant improvements. However, there were no significant differences in any of the functional outcome measures compared to the control group. All the children and parents reported positive experiences. Conclusions Home-based VR training though it had limited impact on improving upper limb function, it could help improve social cognitive function, movement pattern, and efficiency in children with brain injury and could be an effective means of extending clinical therapy to the home. Clinical Trial Registration CRIS.nih.go.kr: identifier KCT0003172.
Collapse
Affiliation(s)
- Ja Young Choi
- Department of Physical and Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sook-hee Yi
- Department of Physical and Rehabilitation Medicine, Seoul Rehabilitation Hospital, Seoul, Republic of Korea
| | - Dain Shim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beomki Yoo
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Sook Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
7
|
Srinivasan S, Amonkar N, Kumavor P, Morgan K, Bubela D. Outcomes Associated with a Single Joystick-Operated Ride-on-Toy Navigation Training Incorporated into a Constraint-Induced Movement Therapy Program: A Pilot Feasibility Study. Behav Sci (Basel) 2023; 13:bs13050413. [PMID: 37232651 DOI: 10.3390/bs13050413] [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: 03/16/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Our research aims to evaluate the utility of joystick-operated ride-on-toys (ROTs) as therapeutic adjuncts to improve upper extremity (UE) function in children with hemiplegic cerebral palsy (HCP). This study assessed changes in affected UE use and function following a three-week ROT navigation training incorporated into an existing constraint-induced movement therapy (CIMT) camp in 11 children (3-14 years old) with HCP. We report changes in scores on the standardized Shriners Hospital Upper Extremity Evaluation (SHUEE) from pretest-to-posttest and changes from early-to-late sessions in percent time spent by the affected arm in: (a) "moderate-to-vigorous activity", "light activity" and "no activity" bouts based on accelerometer data and (b) "independent", "assisted", and "no activity" bouts based on video data. We also explored relationships between standardized measures and training-specific measures of affected UE activity. We found small-to-medium improvements in the SHUEE scores. Between 90 and 100% of children also showed medium-to-large improvements in affected UE activity from early-to-late sessions using accelerometers and small improvements via video-based assessments. Exploratory analyses suggested trends for relationships between pretest-posttest and training-specific objective and subjective measures of arm use and function. Our pilot data suggest that single joystick-operated ROTs may serve as motivating, child-friendly tools that can augment conventional therapies such as CIMT to boost treatment dosing, promote affected UE movement practice during real-world navigation tasks, and ultimately improve functional outcomes in children with HCP.
Collapse
Affiliation(s)
- Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06268, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06268, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06268, USA
| | - Nidhi Amonkar
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06268, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06268, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06268, USA
| | - Patrick Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA
| | - Deborah Bubela
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06268, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06268, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06268, USA
| |
Collapse
|
8
|
Shahane V, Kumavor P, Morgan K, Friel KM, Srinivasan SM. A protocol for a single-arm interventional study assessing the effects of a home-based joystick-operated ride-on-toy navigation training programme to improve affected upper extremity function and spontaneous use in children with unilateral cerebral palsy (UCP). BMJ Open 2023; 13:e071742. [PMID: 37160396 PMCID: PMC10173997 DOI: 10.1136/bmjopen-2023-071742] [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: 05/11/2023] Open
Abstract
INTRODUCTION Children with unilateral cerebral palsy (UCP) face significant limitations in upper extremity (UE) function and require effective interventions that promote intensive goal-directed practice while maximising motivation and adherence with therapy. This study builds on our past work and will assess the effects of a 6-week researcher-caregiver codelivered, home-based ride-on-toy navigation training (RNT) programme in young children with UCP. We hypothesise that the RNT programme will be acceptable, feasible to implement, and lead to greater improvements in unimanual and bimanual function when combined with conventional therapy, compared with conventional therapy provided alone. METHODS AND ANALYSIS 15 children with UCP between 3 and 8 years will be recruited. During the 6-week control phase, participants will receive treatement-as-usual alone. During the subsequent 6-week intervention phase, in addition to conventional therapy, RNT will be provided 4-5 times/week (2 times by researchers, 2-3 times by caregivers), 30-45 min/session. We will assess UE function using standardised tests (Quality of Upper Extremity Skills Test and Shriner's Hospital Upper Extremity Evaluation), reaching kinematics, wrist-worn accelerometry, caregiver-rated ABILHAND-Kids questionnaire, and training-specific measures of movement control during RNT. Programme feasibility and acceptance will be assessed using device use metrics, child and caregiver exit questionnaires, training-specific measures of child engagement, and the Physical Activity Enjoyment Scale. All assessments will be conducted at pretest, following the control phase (midpoint), and after completion of the intervention phase (post-test). ETHICS AND DISSEMINATION The study is approved by the Institutional Review Board of the University of Connecticut (# H22-0059). Results from this study will be disseminated through peer-reviewed manuscripts in scientific journals in the field, through national and international conferences, and through presentations to parent advocacy groups and other support organisations associated with CP. TRIAL REGISTRATION NUMBER NCT05559320.
Collapse
Affiliation(s)
- Vaishnavi Shahane
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, Connecticut, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
| | - Patrick Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, Connecticut, USA
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, Connecticut, USA
| | - Kathleen M Friel
- Burke Neurological Institute, White Plains, New York, USA
- Brain Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Sudha Madhav Srinivasan
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, Connecticut, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
| |
Collapse
|
9
|
Shih TY, Wang TN, Shieh JY, Lin SY, Ruan SJ, Tang HH, Chen HL. Comparative effects of kinect-based versus therapist-based constraint-induced movement therapy on motor control and daily motor function in children with unilateral cerebral palsy: a randomized control trial. J Neuroeng Rehabil 2023; 20:13. [PMID: 36703170 PMCID: PMC9880374 DOI: 10.1186/s12984-023-01135-6] [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: 04/30/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Constraint-induced movement therapy (CIMT) is a prominent neurorehabilitation approach for improving affected upper extremity motor function in children with unilateral cerebral palsy (UCP). However, the restraint of the less-affected upper extremity and intensive training protocol during CIMT may decrease children's motivation and increase the therapist's workload and family's burden. A kinect-based CIMT program, aiming to mitigate the concerns of CIMT, has been developed. The preliminary results demonstrated that this program was child-friendly and feasible for improving upper extremity motor function. However, whether the kinect-based CIMT can achieve better or at least comparable effects to that of traditional CIMT (i.e., therapist-based CIMT) should be further investigated. Therefore, this study aimed to compare the effects of kinect-based CIMT with that of therapist-based CIMT on upper extremity and trunk motor control and on daily motor function in children with UCP. METHODS Twenty-nine children with UCP were recruited and randomly allocated to kinect-based CIMT (n = 14) or therapist-based CIMT (n = 15). The intervention dosage was 2.25 h a day, 2 days a week for 8 weeks. Outcome measures, namely upper extremity and trunk motor control and daily motor function, were evaluated before and after 36-h interventions. Upper extremity and trunk motor control were assessed with unimanual reach-to-grasp kinematics, and daily motor function was evaluated with the Revised Pediatric Motor Activity Log. Between-group comparisons of effectiveness on all outcome measures were analyzed by analysis of covariance (α = 0.05). RESULTS The two groups demonstrated similar improvements in upper extremity motor control and daily motor function. In addition, the kinect-based CIMT group demonstrated greater improvements in trunk motor control than the therapist-based CIMT group did (F(1,28) > 4.862, p < 0.036). CONCLUSION Kinect-based CIMT has effects comparable to that of therapist-based CIMT on UE motor control and daily motor function. Moreover, kinect-based CIMT helps decrease trunk compensation during reaching in children with UCP. Therefore, kinect-based CIMT can be used as an alternative approach to therapist-based CIMT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02808195. Registered on 2016/06/21, https://clinicaltrials.gov/ct2/show/NCT02808195 .
Collapse
Affiliation(s)
- Tsai-Yu Shih
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tien-Ni Wang
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan ,grid.412094.a0000 0004 0572 7815Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jeng-Yi Shieh
- grid.412094.a0000 0004 0572 7815Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Yu Lin
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shanq-Jang Ruan
- grid.45907.3f0000 0000 9744 5137Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Hsien-Hui Tang
- grid.45907.3f0000 0000 9744 5137Department of Design, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Hao-Ling Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
10
|
de Matos MA, Souto DO, Soares BA, de Oliveira VC, Leite HR, Camargos ACR. Effectiveness of Physical Therapy Interventions in Children with Brachial Plexus Birth Injury: A Systematic Review. Dev Neurorehabil 2023; 26:52-62. [PMID: 35848401 DOI: 10.1080/17518423.2022.2099995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIM To systematically review the effectiveness of physical therapy interventions in infants, children and adolescents with brachial plexus birth injury (BPBI). METHODS Systematic review of randomized controlled trials including patients under 18 years old with BPBI was conducted on Medline, Cochrane, Embase, Amed and Pedro databases. Methodological quality was assessed by the PEDro score and quality of evidence by the GRADE system. The primary outcomes measured were range of motion, muscle strength and bone mineral density. RESULTS Seven studies were included, two in infant and 5 in children, of 932 title and abstracts screened. The interventions, characteristics of the participants and outcomes were diverse. The largest effect was found when other intervention was combined with conventional physical therapy in the primary outcomes, with low quality of evidence. CONCLUSION Physical therapy interventions alone or in combination with other treatment modalities are effective in improving short-term disabilities in children with BPBI.
Collapse
Affiliation(s)
- Mariana Aguiar de Matos
- Physical Therapy Department, Faculdade Sete Lagoas (FACSETE), Sete Lagoas, Minas Gerais, Brasil
| | - Deisiane Oliveira Souto
- Physical Therapy Department, Faculdade de Santa Luzia (UNIESP S.A), Santa Luzia, Minas Gerais, Brasil.,Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruno Alvarenga Soares
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vinícius Cunha de Oliveira
- Graduate Program in Rehabilitation and Functional Performance, Faculty of Biological and Health Science Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Diamantina, Minas Gerais, Brazil
| | - Hércules Ribeiro Leite
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Resende Camargos
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
11
|
Bingol H, Kerem Gunel M, Alkan H. The Efficacy of Two Models of Intensive Upper Limb Training on Health-Related Quality of Life in Children with Hemiplegic Cerebral Palsy Mainstreamed in Regular Schools: A Double-Blinded, Randomized Controlled Trial. Physiother Theory Pract 2023; 39:10-25. [PMID: 34743663 DOI: 10.1080/09593985.2021.1999355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Children with hemiplegic cerebral palsy (CP) are at risk of reduced upper limb function and poorer quality of life than their typically developing peers. Although upper limb impairments have potential negative impact on the health-related quality of life (HRQOL) in children with hemiplegic CP, the efficacy of upper limb rehabilitation approaches aiming to improve upper limb impairments on HRQOL has not been adequately investigated. OBJECTIVE This study compares the efficacy of two modes of activity-based upper limb rehabilitation (modified constraint-induced movement therapy [mCIMT] and bimanual training [BIM]) on HRQOL outcomes in children with hemiplegic CP mainstreamed in regular schools. METHODS Thirty children with hemiplegic CP aged between 7 and 11 years (mean age 8.53 ± 1.54 years) who had functional ability levels of I-III according to the Manual Ability Classification System (MACS), Gross Motor Classification System (GMFCS), and Communication Function Classification System (CFCS) were randomly assigned to receive mCIMT or BIM training. Result: Both mCIMT and BIM yielded statistically significant improvements in all HRQOL domains immediately after the 10-week interventions (P < .001), which were retained at 16 weeks. CONCLUSION While there were some differences in the intervention effects, both of these upper limb rehabilitation approaches based on intensive unimanual or bimanual activity may be beneficial for improving perceived life satisfaction related to physical activity, general mood, family, friends, and school among children with hemiplegic CP mainstreamed in regular schools.
Collapse
Affiliation(s)
- Hasan Bingol
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Mus Alparslan University, 49250-Güzeltepe/Mus, Turkey.,Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, 06100-Samanpazarı/Ankara, Turkey
| | - Mintaze Kerem Gunel
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, 06100-Samanpazarı/Ankara, Turkey
| | - Halil Alkan
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100-Samanpazarı/Ankara, Turkey.,Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Mus Alparslan University, 49250-Güzeltepe/Mus, Turkey
| |
Collapse
|
12
|
Effects of Eight Weeks of Selected Virtual-Assisted Montessori-Based Games on Motor Proficiency and Perceived Self-Control in Children with Spastic Hemiplegia during the Coronavirus Outbreak. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5792094. [DOI: 10.1155/2022/5792094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/15/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
This study is aimed at examining the effect of eight weeks of selected virtual-assisted games based on Montessori pedagogical principal on the motor proficiency and perceived self-control in the children with spastic hemiplegia during the coronavirus outbreak. In this quasi-experimental study, the children (
) with hemiplegia were randomly selected and assigned to either the experimental group or the control group. In the pretest, motor skills and self-controlling were evaluated using 36-item Lincoln-Oseretsky Motor Development Scale and Children’s Perceived Self-Control Scale (CPSC) (ss, 1982), respectively. The experimental group then engaged in three 45-minute sessions of virtual game play over the course of eight weeks. 24 hours following the last practice session, the posttest was given on the same day as the pretest. After ensuring the normal distribution of collected data with Shapiro-Wilk test, the data were analyzed using Analysis of Covariance test (ANCOVA). Results showed that the experimental group compared to the control group was better in the motor proficiency and perceived self-control after performing selected virtual-assisted Montessori games can significantly improve motor proficiency and perceived self-control (
). This pattern of data revealed that the virtual-assisted intervention based on Montessori pedagogical principles may increase motor proficiency and self-control in children with hemiplegia, particularly when confronted with the limitations imposed on by the coronavirus epidemic.
Collapse
|
13
|
Tezcan S, Çankaya T. The effect of modified constraint-induced movement therapy in children with hemiparetic cerebral palsy. Consecutive or intermittent days? Disabil Rehabil 2022; 44:7500-7507. [PMID: 34775897 DOI: 10.1080/09638288.2021.2002441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate effect of modified constraint-induced movement therapy (mCIMT) administered on consecutive or intermittent days on upper limb function in children with hemiparetic cerebral palsy (CP). MATERIALS AND METHODS Thirty-three children (age range 5-18 y) with hemiparetic CP separated into three groups: consecutive mCIMT group (n = 11), intermittent mCIMT group (n = 11), control group (n = 11). The outcome measures consist of Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Pediatric Balance Scale (PBS), Modified Tardieu Scale (MTS), Jebsen-Taylor Hand Function Test (JTHFT), Children's Hand Use Experience Questionnaire (CHEQ), Abilhand Kids Questionnaire, surface Electromyography (sEMG). The evaluations were made baseline, 10 days after, 5 weeks after the treatment. RESULTS Improvements were achieved in all groups. The use of upper extremities in daily life activities (p < 0.01), speed of performing the activities (p < 0.001), grasping efficiency (p < 0.001), the amount of a decrease in the children's sense of discomfort while performing activities (p < 0.001) on the affected side in both mCIMT groups were better than the control group. The gain levels in mCIMT groups were similar (p > 0.05). CONCLUSIONS Administration of mCIMT on intermittent days facilitate the adaptation of a child, it was concluded to be a more tolerable method and could be more effective.Implications for rehabilitationmCIMT is more effective than low-dose conventional therapeutic interventions in improving paretic upper limb functions in children with hemiparetic CP.The application of mCIMT in the child's natural environment increases the motivation to participate in the treatment.The application of mCIMT on intermittent days will be more easily tolerated in paediatric individuals and will increase participation in the treatment.
Collapse
Affiliation(s)
- Sezen Tezcan
- Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Tamer Çankaya
- Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| |
Collapse
|
14
|
Feasibility of Using Joystick-Operated Ride-on-Toys to Promote Upper Extremity Function in Children With Cerebral Palsy: A Pilot Study. Pediatr Phys Ther 2022; 34:508-517. [PMID: 36044637 DOI: 10.1097/pep.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the feasibility of implementation, acceptance, and perceived efficacy of a joystick-operated ride-on-toy intervention to promote upper extremity (UE) function in 3- to 14-year-old children with hemiplegic cerebral palsy. METHODS Exit questionnaires were collected from children, caregivers, and clinicians/camp staff following a 3-week ride-on-toy training program incorporated within a summer camp for children with hemiplegic cerebral palsy. Training encouraged children to use their affected UE to maneuver the ride-on-toy. Questionnaires included Likert scale and open-ended questions to assess enjoyment, acceptance, feasibility, and perceived efficacy of the training. RESULTS All stakeholder groups indicated that the training was enjoyable. Clinicians/staff and caregivers indicated that the training increased children's motivation to use their affected UE and reported perceived improvements in UE movement control and function following training. CONCLUSIONS Our promising preliminary findings call for future research to systematically assess the efficacy of ride-on-toys to promote UE control and function in children with hemiplegic cerebral palsy.Supplemental Digital Content 1 video abstract, available at: http://links.lww.com/PPT/A404.
Collapse
|
15
|
Roostaei M, Raji P, Kalantari KK, Faghihzadeh E, Fragala-Pinkham M. Effect of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. Dev Neurorehabil 2022; 25:281-288. [PMID: 34971522 DOI: 10.1080/17518423.2021.2020351] [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: 10/19/2022]
Abstract
PURPOSE To compare the effects of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. MATERIALS AND METHODS Twelve children with hemiplegic cerebral palsy and 12 typically developing children ages 5 to 12 years (GMFCS I-II) were evaluated with the Timed Up and Go (TUG) and Biodex Balance System during three upper extremity (UE) conditions: 1) Free UEs (no constraints), 2) Simple UE constraint (unaffected/dominant UE constrained with a sling), and 3) Difficult UE constraint (Simple constraint plus the other UE holding cup of water). RESULTS The UE condition had significant effects on Overall Stability Index (OSI) (F(2,44) = 24.899, p < .001), Medial-Lateral Stability Index (MLSI) (F(2,44) = 4.380, p = .018), Anterior-Posterior Stability Index (F(2,44) = 6.187, p = .004), and TUG scores (F(2,44) = 113.372, p < .001). Group was significant for OSI (F(1,22) = 7.906, p = .010), MLSI (F(1,22) = 13.113, p = .002), and TUG (F(1,22) = 36.282, p < .001). CONCLUSIONS The upper extremity appears to have a role in maintaining functional balance and postural stability in children with hemiplegic cerebral palsy and should be considered during intervention programs.
Collapse
Affiliation(s)
- Meysam Roostaei
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Raji
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi Kalantari
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Faghihzadeh
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maria Fragala-Pinkham
- Department of Physical Therapy and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
16
|
Taghizadeh A, Webster KE, Bhopti A, Carey L, Hoare B. Are they really motor learning therapies? A scoping review of evidence-based, task-focused models of upper limb therapy for children with unilateral cerebral palsy. Disabil Rehabil 2022; 45:1536-1548. [PMID: 35468016 DOI: 10.1080/09638288.2022.2063414] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify the specific motor learning (ML) theories underpinning evidence-based, task-focused upper limb models of therapy for children with unilateral cerebral palsy; and to document the strategies used in the operationalisation of these theories. MATERIAL AND METHOD This scoping review searched for relevant studies using eight electronic databases. A list of 68 ML strategies and accompanying definitions was developed for data extraction. Three classifications; adequate, inadequate or not described were used to rate the description of ML strategies. A corresponding colour-coding system was used to provide a visual summary. RESULTS There is a limited description of the ML theories and strategies used to operationalise these theories in existing models of evidence-based upper limb therapy. Of 103 therapy protocols included, only 24 explicitly described the guiding ML theory. When described, there was significant variation in the underlying theories, leading to significantly different focus and content of therapy. Of the 68 ML strategies, only three were adequately described. CONCLUSIONS To support treatment fidelity and the implementation of evidence-based, task-focused models of upper limb therapy in clinical practice, future research needs to provide explicit details about the underlying theories and strategies used in the operationalisation of these theories.Implications for rehabilitationEvidence-based models of upper limb therapy purport to be based on motor learning theory, however, most provide a very limited description of the theories and strategies used.Dosage of practice is only one element that is specific to a therapy approach and other elements guided by the principles of type of task and type of feedback should be considered.To support the implementation of evidence-based approaches in clinical practice, and improve treatment fidelity, it is important for researchers to define the theories that guide therapy approaches and explicitly describe the strategies used to operationalise these theories.
Collapse
Affiliation(s)
- Atefeh Taghizadeh
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Kate E Webster
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Anoo Bhopti
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Leeanne Carey
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Brian Hoare
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| |
Collapse
|
17
|
Saiote C, Sutter E, Xenopoulos-Oddsson A, Rao R, Georgieff M, Rudser K, Peyton C, Dean D, McAdams RM, Gillick B. Study Protocol: Multimodal Longitudinal Assessment of Infant Brain Organization and Recovery in Perinatal Brain Injury. Pediatr Phys Ther 2022; 34:268-276. [PMID: 35385465 PMCID: PMC9200232 DOI: 10.1097/pep.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Perinatal brain injury is a primary cause of cerebral palsy, a condition resulting in lifelong motor impairment. Infancy is an important period of motor system development, including development of the corticospinal tract (CST), the primary pathway for cortical movement control. The interaction between perinatal stroke recovery, CST organization, and resultant motor outcome in infants is not well understood. METHODS Here, we present a protocol for multimodal longitudinal assessment of brain development and motor function following perinatal brain injury using transcranial magnetic stimulation and magnetic resonance imaging to noninvasively measure CST functional and structural integrity across multiple time points in infants 3 to 24 months of age. We will further assess the association between cortical excitability, integrity, and motor function. DISCUSSION This protocol will identify bioindicators of motor outcome and neuroplasticity and subsequently inform early detection, diagnosis, and intervention strategies for infants with perinatal stroke, brain bleeds, and related diagnoses.
Collapse
Affiliation(s)
- Catarina Saiote
- Waisman Center (Drs Saiote, Sutter, Dean, and Gillick), Department of Pediatrics (Drs Dean, McAdams, and Gillick), and Department of Medical Physics (Dr Dean), University of Wisconsin-Madison, Madison, Wisconsin; Department of Rehabilitation Medicine (Dr Sutter and Ms Xenopoulos-Oddsson), Department of Pediatrics (Drs Rao and Georgieff), and Division of Biostatistics (Dr Rudser), University of Minnesota, Minneapolis, Minnesota; Department of Physical Therapy and Human Movement Sciences, Department of Pediatrics (Dr Peyton), Northwestern University, Chicago, Illinois
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Gordon AM, Ferre CL, Robert MT, Chin K, Brandao M, Friel KM. HABIT+tDCS: a study protocol of a randomised controlled trial (RCT) investigating the synergistic efficacy of hand-arm bimanual intensive therapy (HABIT) plus targeted non-invasive brain stimulation to improve upper extremity function in school-age children with unilateral cerebral palsy. BMJ Open 2022; 12:e052409. [PMID: 35190424 PMCID: PMC8860006 DOI: 10.1136/bmjopen-2021-052409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Unilateral spastic cerebral palsy (USCP) is characterised by movement deficits primarily on one body side. The best available upper extremity (UE) therapies are costly and intensive. Thus, there is an urgent need for better, more efficient and thus more accessible therapies. Transcranial direct current stimulation (tDCS) is non-invasive and may enhance physical rehabilitation approaches. The aim of this study is to determine whether tDCS targeted to the hemisphere with corticospinal tract (CST) connectivity enhances the efficacy of UE training in children with USCP. Our central hypothesis is that hand-arm bimanual intensive therapy (HABIT) combined with a tDCS montage targeting the hemisphere with CST connectivity to the impaired UE muscles will improve UE function more than HABIT plus sham stimulation. We will test this by conducting a randomised clinical trial with clinical and motor cortex physiology outcomes. METHODS AND ANALYSES 81 children, aged 6-17 years, will be randomised to receive 2 mA anodal tDCS targeted to the affected UE motor map, 2 mA cathodal tDCS to the contralesional motor cortex or sham tDCS during the first 20 min of each HABIT session (10 hours: 2 hours/day for 5 days). Primary outcomes will be Box and Blocks Test, Assisting Hand Assessment and motor cortex excitability, determined with single-pulse transcranial magnetic stimulation. Secondary outcomes include ABILHAND-Kids, Canadian Occupational Performance Measure, Cooper Stereognosis, Dimension of Mastery Questionnaire and Participation and Environment Measure-Children and Youth. All measures will be collected before, immediately and 6 months after treatment. A group × test session Analysis of Variance will test differences among groups on all measures. ETHICS AND DISSEMINATION The study has been approved by the BRANY Institutional Review Board (#18-10-285-512). We will leverage our subject and family relationships to maximise dissemination and share results with the academic and patient/family advocacy groups. TRIAL REGISTRATION NUMBER NCT03402854.
Collapse
Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
| | - Claudio L Ferre
- Burke Neurological Institute, White Plains, New York, USA
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
| | - Maxime T Robert
- Department of Rehabilitation, Laval University, Quebec City, Quebec, Canada
| | - Karen Chin
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
- Burke Neurological Institute, White Plains, New York, USA
| | - Marina Brandao
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | |
Collapse
|
19
|
From Hemispheric Asymmetry through Sensorimotor Experiences to Cognitive Outcomes in Children with Cerebral Palsy. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent neuroimaging studies allowed us to explore abnormal brain structures and interhemispheric connectivity in children with cerebral palsy (CP). Behavioral researchers have long reported that children with CP exhibit suboptimal performance in different cognitive domains (e.g., receptive and expressive language skills, reading, mental imagery, spatial processing, subitizing, math, and executive functions). However, there has been very limited cross-domain research involving these two areas of scientific inquiry. To stimulate such research, this perspective paper proposes some possible neurological mechanisms involved in the cognitive delays and impairments in children with CP. Additionally, the paper examines the ways motor and sensorimotor experience during the development of these neural substrates could enable more optimal development for children with CP. Understanding these developmental mechanisms could guide more effective interventions to promote the development of both sensorimotor and cognitive skills in children with CP.
Collapse
|
20
|
Sicari M, Longhi M, D'Angelo G, Boetto V, Lavorato A, Cocchini L, Beatrici M, Battiston B, Garbossa D, Massazza G, Titolo P. Modified constraint induced movement therapy in children with obstetric brachial plexus palsy: a systematic review. Eur J Phys Rehabil Med 2022; 58:43-50. [PMID: 34747579 PMCID: PMC9980490 DOI: 10.23736/s1973-9087.21.06886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Obstetric brachial plexus palsy (OBPP) is a flaccid paralysis occurring in the upper limb during birth. The OBPP includes mild lesions with complete spontaneous recovery and severe injuries with no regain of arm function. Among the most promising rehabilitation treatments aimed at improving upper extremity motor activities in individuals with neurological dysfunctions, there is the modified constraint-induced movement therapy (mCIMT). The aim of this systematic review is to assess and synthesize the critical aspects of the use of mCIMT in children with OBPP. EVIDENCE ACQUISITION This systematic review has been carried out according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis). A comprehensive search of the literature was conducted using PubMed, MEDLINE and Evidence Based Medicine Reviews, databases. We enclosed experimental and original articles, case reports and book chapters. Four articles were finally included. EVIDENCE SYNTHESIS One case report tested the feasibility of mCIMT to encourage use of the affected arm in a child with Erb-Duchenne palsy and documented the clinical changes observed. A case series had the purpose to determine if mCIMT in combination with botulinum toxin (BTX-A) improved arm function in 2 children with OBPP. A cohort study compared the use of mCIMT in 19 OBPP and 18 unilateral Cerebral Palsy. A prospective single-blind RCT described mCIMT versus conventional therapy in a group of 39 children with OBPP. CONCLUSIONS This systematic review on the use of mCIMT in children with OBPP shows that there is unanimous agreement that a program should last 2 weeks at least. However, there is no scientific evidence supporting a single common mCIMT protocol in the management of OBPP because of a considerable heterogeneity. Further high methodological studies regarding the application of mCIMT for OBPP and based on larger patients' sample should have the potential to optimize the appropriateness of care provided to infants with OBPP and, therefore, their quality of life.
Collapse
Affiliation(s)
- Monica Sicari
- Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Maria Longhi
- Unit of Rehabilitation Medicine, Department of Neuroscience, University Hospital of Modena, Modena, Italy -
| | - Giulia D'Angelo
- Division of Physical Medicine and Rehabilitation, ASLTO3, Turin, Italy
| | - Valentina Boetto
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Lavorato
- Unit of Neurosurgery, Department of Neuroscience "Rita Levi Montalcini, " University of Turin, Turin, Italy
| | - Lorella Cocchini
- Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Maurizio Beatrici
- Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Bruno Battiston
- Unit of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Diego Garbossa
- Unit of Neurosurgery, Department of Neuroscience "Rita Levi Montalcini, " University of Turin, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Titolo
- Unit of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| |
Collapse
|
21
|
Bingöl H, Günel MK. Comparing the effects of modified constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy mainstreamed in regular school: A randomized controlled study. Arch Pediatr 2022; 29:105-115. [PMID: 35039189 DOI: 10.1016/j.arcped.2021.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/07/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to compare the effects of modified constraint-induced movement therapy (mCIMT) and bimanual training (BIT) based on the International Classification of Functioning, Disability, and Health, Children and Youth (ICF-CY) conceptual framework. RESEARCH METHOD A total of 32 children (mean age 10.43 years [SD 2.9 years]; 15 girls, 17 boys) whose functional motor and communication levels, according to the Manual Ability Classification System, Gross Motor Function Classification System, and Communication Function Classification System, changed between level I and III were randomly distributed to one of the mCIMT or BIT groups with equivalent dosing frequencies and intensities (10 weeks, 3 days/week, 2.5 h/day). Upper extremity body function outcomes (handheld dynamometer), activity outcomes (Quality of Upper Extremity Skills Test, The Children's Hand-use Experience Questionnaire, ABILHAND-Kids, Pediatric Upper Extremity Motor Activity Log), and participation outcomes (Child and Adolescent Scale of Participation) were assessed before and after treatment, and at 16 weeks postintervention. The clinical trial number of the study is NCT04577391. RESULTS mCIMT resulted in more significant improvements in all outcomes than BIT at the immediate postintervention period (T2), which were maintained in the mCIMT group throughout the 16-week postintervention period (p<0.001; dmCIMT > dBIT). CONCLUSION The potential advantage of mCIMT versus BIT is the larger short-term effect sizes (ESs) and the more sustainable improvements.
Collapse
Affiliation(s)
- Hasan Bingöl
- Department of Therapy and Rehabilitation, Vocational School of Health Service, Muş Alparslan University, 49250-Güzeltepe, Mus, Turkey; Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, 06100-Samanpazarı, Ankara, Turkey.
| | - Mintaze Kerem Günel
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100-Samanpazarı, Ankara, Turkey.
| |
Collapse
|
22
|
Chen HL, Lin SY, Yeh CF, Chen RY, Tang HH, Ruan SJ, Wang TN. Development and Feasibility of a Kinect-Based Constraint-Induced Therapy Program in the Home Setting for Children With Unilateral Cerebral Palsy. Front Bioeng Biotechnol 2021; 9:755506. [PMID: 34765593 PMCID: PMC8576521 DOI: 10.3389/fbioe.2021.755506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cerebral palsy (CP) is the leading cause of childhood-onset physical disability. Children with CP often have impaired upper limb (UL) function. Constraint-induced therapy (CIT) is one of the most effective UL interventions for children with unilateral CP. However, concerns about CIT for children have been repeatedly raised due to frustration caused by restraint of the child’s less-affected UL and lack of motivation for the intensive protocol. Virtual reality (VR), which can mitigate the disadvantages of CIT, potentially can be used as an alternative mediator for implementing CIT. Therefore, we developed a VR-based CIT program for children with CP using the Kinect system. Aims: The feasibility of the Kinect-based CIT program was evaluated for children with unilateral CP using a two-phase study design. Materials and Methods: In phase 1, ten children with unilateral CP were recruited. To confirm the achievement of the motor training goals, maximal UL joint angles were evaluated during gameplay. To evaluate children’s perceptions of the game, a questionnaire was used. In phase 2, eight children with unilateral CP were recruited and received an 8 weeks Kinect-based CIT intervention. Performance scores of the game and outcomes of the box and block test (BBT) were recorded weekly. Results: In phase 1, results supported that the design of the program was CIT-specific and was motivational for children with unilateral CP. In phase 2, game performance and the BBT scores began showing stable improvements in the fifth week of intervention. Conclusion: It suggested the Kinect-based CIT program was beneficial to the motor function of the affected UL for children with unilateral CP. According to the results of this feasibility study, larger and controlled effectiveness studies of the Kinect-based CIT program can be conducted to further improve its clinical utility. Clinical Trial Registration: ClinicalTrials.gov, NCT02808195; Comparative effectiveness of a Kinect-based unilateral arm training system vs. CIT for children with CP
Collapse
Affiliation(s)
- Hao-Ling Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Szu-Yu Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Fu Yeh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ren-Yu Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Hui Tang
- Department of Industrial and Commercial Design, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Shanq-Jang Ruan
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Tien-Ni Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
23
|
Modified constraint-induced movement therapy during hospitalization in children with perinatal brachial plexus palsy: A randomized controlled trial. J Hand Ther 2021; 33:418-425. [PMID: 32151503 DOI: 10.1016/j.jht.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 09/29/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective single-blind, randomized controlled study. INTRODUCTION Children with perinatal brachial plexus palsy (PBPP) have motion limitations in the affected upper extremity. Modified constraint-induced movement therapy (mCIMT) is one of the treatment options used for the improvement of the function of the affected limb. PURPOSE OF THE STUDY The purpose of this study was to compare the effect of mCIMT and conventional therapy in improving active range of motion (ROM) and functional use of the affected upper extremity in children with PBPP with injuries to upper and middle trunks in the hospital environment. MATERIALS 26 patients received conventional rehabilitation program (control group) and 13 patients participated in a mCIMT program (study group). Children had a mean age 56.3 months (range 4-10 years). The mCIMT included 1 hour therapy sessions emphasizing the affected arm use for 14 consecutive days during hospitalization. Their normal arm was also constrained for 6 hour per day. All the patients were assessed at the baseline, one day, one month, and three months after completion of therapy using active ROM, active movement scale, hand dynamometer, box and blocks test. RESULTS The mCIMT group improved more than the control group in shoulder internal rotation, forearm supination, elbow flexion active ROMs, hand grip strength, and in upper extremity function. CONCLUSION mCIMT has a potential to promote functional gains for children with PBPP; this approach should be widely applied within routine clinical practice.
Collapse
|
24
|
Friel KM, Ferre CL, Brandao M, Kuo HC, Chin K, Hung YC, Robert MT, Flamand VH, Smorenburg A, Bleyenheuft Y, Carmel JB, Campos T, Gordon AM. Improvements in Upper Extremity Function Following Intensive Training Are Independent of Corticospinal Tract Organization in Children With Unilateral Spastic Cerebral Palsy: A Clinical Randomized Trial. Front Neurol 2021; 12:660780. [PMID: 34012418 PMCID: PMC8127842 DOI: 10.3389/fneur.2021.660780] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background/Objectives: Intensive training of the more affected upper extremity (UE) has been shown to be effective for children with unilateral spastic cerebral palsy (USCP). Two types of UE training have been particularly successful: Constraint-Induced Movement Therapy (CIMT) and Bimanual training. Reorganization of the corticospinal tract (CST) early during development often occurs in USCP. Prior studies have suggested that children with an ipsilateral CST controlling the affected UE may improve less following CIMT than children with a contralateral CST. We tested the hypothesis that improvements in UE function after intensive training depend on CST laterality. Study Participants and Setting: Eighty-two children with USCP, age 5 years 10 months to 17 years, University laboratory setting. Materials/Methods: Single-pulse transcranial magnetic stimulation (TMS) was used to determine each child's CST connectivity pattern. Children were stratified by age, sex, baseline hand function and CST connectivity pattern, and randomized to receive either CIMT or Bimanual training, each of which were provided in a day-camp setting (90 h). Hand function was tested before, immediately and 6 months after the intervention with the Jebsen-Taylor Test of Hand Function, the Assisting Hand Assessment, the Box and Block Test, and ABILHAND-Kids. The Canadian Occupational Performance Measure was used to track goal achievement and the Pediatric Evaluation of Disability Inventory was used to assess functioning in daily living activities at home. Results: In contrast to our hypothesis, participants had statistically similar improvements for both CIMT and Bimanual training for all measures independent of their CST connectivity pattern (contralateral, ipsilateral, or bilateral) (p < 0.05 in all cases). Conclusions/Significance: The efficacy of CIMT and Bimanual training is independent of CST connectivity pattern. Children with an ipsilateral CST, previously thought to be maladaptive, have the capacity to improve as well as children with a contralateral or bilateral CST following intensive CIMT or Bimanual training. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02918890.
Collapse
Affiliation(s)
- Kathleen M Friel
- Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York, NY, United States
| | - Claudio L Ferre
- Burke Neurological Institute, White Plains, NY, United States.,Teachers College, Columbia University, New York, NY, United States
| | - Marina Brandao
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hsing-Ching Kuo
- Teachers College, Columbia University, New York, NY, United States
| | - Karen Chin
- Burke Neurological Institute, White Plains, NY, United States.,Teachers College, Columbia University, New York, NY, United States
| | - Ya-Ching Hung
- Queens College, City University of New York, New York, NY, United States
| | - Maxime T Robert
- Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York, NY, United States
| | | | - Ana Smorenburg
- Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York, NY, United States
| | | | - Jason B Carmel
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, United States
| | - Talita Campos
- Burke Neurological Institute, White Plains, NY, United States.,Teachers College, Columbia University, New York, NY, United States
| | - Andrew M Gordon
- Teachers College, Columbia University, New York, NY, United States
| |
Collapse
|
25
|
Lee GK, Pascual M, Rethlefsen SA. A hybrid model of modified constraint induced movement therapy to improve upper extremity performance in children with unilateral upper extremity paresis: Retrospective case series. Br J Occup Ther 2021. [DOI: 10.1177/0308022620936873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The study aims were to assess impact of an intensive camp-based intervention using a hybrid model of modified constraint induced movement therapy with bimanual therapy in children with upper extremity impairment, and to see if improvements persisted over time. Method Twenty subjects participated. Eight subjects attended camp 2 years in a row, and 12 subjects attended camp only 1 year. The Assisting Hand Assessment and Children’s Hand-use Experience Questionnaire were administered before and after camp. Assisting Hand Assessment and Children’s Hand-use Experience Questionnaire scores were compared between assessments using linear mixed effects models, adjusting for covariates (age and Manual Ability Classification System level) and the repeated measures within subjects. Results Assisting Hand Assessment score improved during the intervention phase for subjects at all Manual Ability Classification System levels ( p ≤ 0.0001). Improvement was maintained long-term at 1 year post. Children’s Hand-use Experience Questionnaire scores for grasp efficacy and time taken were significantly improved during intervention but not maintained at 1 year post. The feeling bothered dimension showed no significant change over time. Conclusion A hybrid model of modified constraint induced movement therapy and bimanual therapy was effective in improving bimanual function for children with varying levels of neurologic hemiparesis, with changes maintained long-term.
Collapse
Affiliation(s)
- Gina Kim Lee
- Division of Rehabilitation Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Marielle Pascual
- Division of Rehabilitation Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Susan A Rethlefsen
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
26
|
Demers M, Fung K, Subramanian SK, Lemay M, Robert MT. Integration of Motor Learning Principles Into Virtual Reality Interventions for Individuals With Cerebral Palsy: Systematic Review. JMIR Serious Games 2021; 9:e23822. [PMID: 33825690 PMCID: PMC8060861 DOI: 10.2196/23822] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/06/2020] [Accepted: 03/13/2021] [Indexed: 01/08/2023] Open
Abstract
Background Increasing evidence supports the use of virtual reality systems to improve upper limb motor functions in individuals with cerebral palsy. While virtual reality offers the possibility to include key components to promote motor learning, it remains unclear if and how motor learning principles are incorporated into the development of rehabilitation interventions using virtual reality. Objective The objective of this study was to determine the extent to which motor learning principles are integrated into virtual reality interventions targeting upper limb function in individuals with cerebral palsy. Methods A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was performed in 10 databases using a combination of keywords related to cerebral palsy, virtual reality, video games, and rehabilitation. Studies were divided into 2 categories: commercial video game platforms and devices and custom virtual reality systems. Study quality was assessed using the modified Downs and Black checklist. Results The initial search yielded 1497 publications. A total of 26 studies from 30 publications were included, with most studies classified as “fair” according to the modified Downs and Black checklist. The majority of studies provided enhanced feedback and variable practice and used functionally relevant and motivating virtual tasks. The dosage varied greatly (total training time ranged from 300 to 3360 minutes), with only 6 studies reporting the number of movement repetitions per session. The difficulty progression and the assessment of skills retention and transfer were poorly incorporated, especially for the commercial video games. Conclusions Motor learning principles should be better integrated into the development of future virtual reality systems for optimal upper limb motor recovery in individuals with cerebral palsy. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020151982; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151982
Collapse
Affiliation(s)
- Marika Demers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Karen Fung
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Sandeep K Subramanian
- Department of Physical Therapy, School of Health Professions, UT Health San Antonio, San Antonio, TX, United States
| | - Martin Lemay
- Centre de Réadaptation Marie Enfant, Centre de Recherche du CHU Sainte Justine, Montreal, QC, Canada.,Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montreal, QC, Canada
| | - Maxime T Robert
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| |
Collapse
|
27
|
Sidiropoulos AN, Santamaria V, Gordon AM. Continuous inter-limb coordination deficits in children with unilateral spastic cerebral palsy. Clin Biomech (Bristol, Avon) 2021; 81:105250. [PMID: 33378717 DOI: 10.1016/j.clinbiomech.2020.105250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Continuous inter-limb coordination and the ability to offset perturbations to a movement pattern (i.e., stability) are important factors in efficient motor performance. Patients with movement disorders often show deficits in coordination and stability, although little is known about these features in children with cerebral palsy. The purpose of this study was to identify the continuous inter-limb coordination and stability deficits in children with cerebral palsy and determine if improvement occurs with upper extremity intervention. METHODS Children with cerebral palsy participated in bimanual or unimanual intensive therapy. Continuous inter-limb coordination between the arms and between the more-affected arm and leg was evaluated using relative phase analysis during four gross motor tasks, including in-place marching and standing with asymmetric and symmetric arm swing. A control group of children with cerebral palsy and a group of typically developing children were also evaluated. FINDINGS Children with cerebral palsy displayed coordination deficits compared to typically developing children (p<0.01), yet both groups presented similarly poor levels of stability (p=0.39). Compared to standing, adding legs to the task negatively impacted the coordination (p<0.01) and stability (p<0.01) of all children. Both groups improved coordination between the arms post-intervention (p<0.05 for all cases), however neither group improved stability (p>0.05 for all cases). INTERPRETATION Relative phase analysis successfully provided a sensitive measurement of coordination and stability in pathologic and non-pathologic populations. Findings indicate that all children have difficulty producing consistent movement patterns and suggest that both bimanual and unimanual interventions can improve continuous coordination in children with cerebral palsy.
Collapse
Affiliation(s)
- Alexis N Sidiropoulos
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 W 120(th) St., New York, NY 10027, USA.
| | - Victor Santamaria
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 W 120(th) St., New York, NY 10027, USA
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 W 120(th) St., New York, NY 10027, USA
| |
Collapse
|
28
|
Roberts H, Shierk A, Clegg NJ, Baldwin D, Smith L, Yeatts P, Delgado MR. Constraint Induced Movement Therapy Camp for Children with Hemiplegic Cerebral Palsy Augmented by Use of an Exoskeleton to Play Games in Virtual Reality. Phys Occup Ther Pediatr 2021; 41:150-165. [PMID: 32892679 DOI: 10.1080/01942638.2020.1812790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To determine the acceptability and effects of a pediatric constraint induced movement therapy (P-CIMT) camp for children with hemiplegic cerebral palsy (hCP) augmented by use of an exoskeleton to play games in virtual reality (VR). METHOD 31 children with hCP attended a P-CIMT camp 6 hours per day for 10 days over 2 successive weeks (60 hours) that included 30 minutes of unilateral training with the Hocoma Armeo®Spring Pediatric that combines the assistance of an exoskeleton and VR games. The primary outcome measure was the Assisting Hand Assessment (AHA); secondary outcome measures were the Melbourne Assessment of Uni-lateral Hand Function (MUUL), and the Canadian Occupational Performance Measure (COPM). Assessments were completed at pre-intervention, post-intervention, and 6 months following intervention. RESULTS Participants demonstrated clinically and statistically significant improvement in bimanual performance (AHA) (p < .001) and COPM Performance (p < .001) and Satisfaction with performance (p < .001). Improvement in unilateral performance (MUUL) was statistically (p < .001) but not clinically significant. CONCLUSIONS A P-CIMT camp augmented by the Hocoma Armeo®Spring Pediatric was feasible and accepted by participants. Bimanual hand function and occupational performance improved immediately following intervention, and the treatment effects persisted 6 months following intervention.
Collapse
Affiliation(s)
- Heather Roberts
- Scottish Rite Hospital for Children, Texas Woman's University, Denton, Texas, USA
| | - Angela Shierk
- Scottish Rite Hospital for Children, Texas Woman's University, Denton, Texas, USA
| | - Nancy J Clegg
- Research Department, Scottish Rite for Children, Dallas, Texas, USA
| | - Deborah Baldwin
- Research Department, Scottish Rite for Children, Dallas, Texas, USA
| | - Linsley Smith
- Research Department, Scottish Rite for Children, Dallas, Texas, USA
| | - Paul Yeatts
- Department of Neurology, Texas Woman's University, Denton, Texas, USA
| | - Mauricio R Delgado
- Department of Neurology, Scottish Rite for Children, Dallas, Texas, USA.,The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| |
Collapse
|
29
|
Modified Constraint-Induced Movement Therapy at Home-Is It Possible? Families and Children's Experience. CHILDREN-BASEL 2020; 7:children7110248. [PMID: 33266393 PMCID: PMC7700425 DOI: 10.3390/children7110248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
Abstract
Modified constraint-induced movement therapy (mCIMT) is efficient at improving upper limb non-use. The experiences of families and children with mCIMT could allow researchers to understand how it influences their day-to-day life and to improve the function of the affected upper limb without altering family life and avoiding frustration. In this qualitative study, we aimed to collect the experiences of parents and their children (aged 4-8 years) who did mCIMT at home regarding the application of low-intensity modified constraint-induced movement therapy to improve the affected upper limb functionality in infantile hemiplegia with moderate manual ability. Individual semi-structured interviews were performed to obtain insights into their experience with mCIMT. The experiences of parents and children were described in thematic sections. Eight children with hemiplegia (six years, standard deviation, SD: 1.77) and their parents were asked about their experiences after applying 50 h of mCIMT at home. Three main themes emerged from the children's interview data: (1) the experience of wearing the containment in the modified constraint-induced movement therapy (CIMT) intervention, (2) the reaction to performing the therapy at home with his/her family, and (3) learning of the affected upper limb. In the parents' interview data, there were two main themes: (1) the difficulty of executing an intensive therapy protocol (mCIMT: 50 h) at home and (2) the feeling of not wanting to finish the intervention. The experiences of the parents and their children regarding mCIMT allowed us to understand the facilitators and barriers that affect the execution of mCIMT at home, and this understanding allows us to improve its future application.
Collapse
|
30
|
Ouyang RG, Yang CN, Qu YL, Koduri MP, Chien CW. Effectiveness of hand-arm bimanual intensive training on upper extremity function in children with cerebral palsy: A systematic review. Eur J Paediatr Neurol 2020; 25:17-28. [PMID: 31902688 DOI: 10.1016/j.ejpn.2019.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 11/08/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To systematically review the effectiveness of Hand-Arm Bimanual Intensive Training (HABIT) on upper limb function in children with cerebral palsy. METHODS Six databases (MEDLINE, CINAHL, PubMed, Embase, Cochrane Library, and PsycINFO) were searched for HABIT-related studies published in English between 2007 and 2017. The methodological quality of the included studies was classified based on the Levels of Evidence of the American Occupational Therapy Association guidelines. If the included studies were randomized controlled trials (RCTs), the methodological quality was evaluated using the Revised Cochrane risk of bias tool. Cohen's d effect sizes were computed and synthesized to assess the effectiveness. RESULTS Among 646 studies, 15 fulfilled the inclusion criteria. Eleven studies were RCTs, 64% of which were rated as having a high risk of bias; one was a quasi-RCT, one was a retrospective study, and two were longitudinal studies. Nearly half of the included studies used HABIT for 6 h a day for three consecutive weeks (totaling 90 h), and some studies used different doses/schedules or added training components to HABIT. Synthesis of the results demonstrated a significantly small effect size (d = 0.36, P = 0.017) for improving upper limb function immediately after the interventions, and the improvements were maintained at follow-up. Similarly, significantly moderate or large effect sizes were found for self-care function (d = 0.52, P = 0.003) and goal improvements (d = 1.78-2.28, P < 0.001). CONCLUSION This review supports the effectiveness of HABIT as an intervention for improving upper limb function in children with cerebral palsy.
Collapse
Affiliation(s)
- Rang-Ge Ouyang
- Department of Rehabilitation, Xiangya Hospital, Central South University, Hunan, China
| | - Chieh-Ning Yang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Ya-Lan Qu
- School of Communication Sciences, The Beijing Language and Culture University, Beijing, China.
| | - Manohar Prasad Koduri
- Department of Mechanical, Materials, and Aerospace, School of Engineering, University of Liverpool, Liverpool, Harrison Hughes Building, Liverpool, L69 3GH, UK; International Intercollegiate Ph.D. Program, National Tsing Hua University, No. 101, Section 2, Guangfu Road, East District, Hsinchu City, Taiwan R.O.C
| | - Chi-Wen Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| |
Collapse
|
31
|
Zielinski IM, van Delft R, Voorman JM, Geurts ACH, Steenbergen B, Aarts PBM. The effects of modified constraint-induced movement therapy combined with intensive bimanual training in children with brachial plexus birth injury: a retrospective data base study. Disabil Rehabil 2019; 43:2275-2284. [PMID: 31814455 DOI: 10.1080/09638288.2019.1697381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In children with Brachial Plexus Birth Injury, a non-use of the affected upper limb despite sufficient capacity, is sometimes observed, called developmental disregard. The combination of modified constraint-induced-movement-therapy with bimanual training is frequently applied to overcome developmental disregard in unilateral Cerebral Palsy. In the current study the effects of the combination of modified constraint-induced-movement-therapy with bimanual training are investigated in children with Brachial Plexus Birth Injury in comparison to children with unilateral Cerebral Palsy. We hypothesize that the combination of modified constraint-induced-movement-therapy with bimanual training is effective in Brachial Plexus Birth Injury. METHODS Data of 19 children with Brachial Plexus Birth Injury (Mage: 4.1 years) and 18 with unilateral Cerebral Palsy (Mage: 4.5 years) were compared. The effects of modified constraint-induced-movement-therapy with bimanual training (54 h modified constraint-induced-movement-therapy, 18 h bimanual training, 8-10 weeks) was investigated by assessing spontaneous affected-upper-limb-use ("Assisting Hand Assessment"), manual abilities ("ABILHAND-kids") and subjective performance and satisfaction of problematic bimanual activities ("Canadian Occupational Performance Measure") at three time points (pre-treatment, post-treatment, follow-up). This data was analyzed using repeated-measures analysis. RESULTS Children with Brachial Plexus Birth Injury showed significant improvements on all outcome measures following modified constraint-induced-movement-therapy with bimanual training. These results were comparable to those observed in the group of children with unilateral Cerebral Palsy. DISCUSSION These results suggest that modified constraint-induced-movement-therapy with bimanual training is effective in Brachial Plexus Birth Injury. They indicate a comparable improved bimanual performance in children with Brachial Plexus Birth Injury than in unilateral Cerebral Palsy and suggests that both groups of children have affectively overcome their developmental disregard.IMPLICATIONS FOR REHABILITATIONChildren with Brachial Plexus Birth Injury frequently experience difficulties in activities of daily living.It has recently been suggested that children with Brachial Plexus Birth Injury may also show a non-use of the affected upper limb despite sufficient capacity, called developmental disregard.Children with Brachial Plexus Birth Injury and developmental disregard might therefore benefit from intensive therapies aimed at overcoming developmental disregard, originally developed for children with unilateral Cerebral Palsy.A combination of modified Constrained-Induced Movement Therapy with intensive Bimanual Training has shown to be affective in children with unilateral Cerebral Palsy.In a small sample, this study shows that a combination of modified Constrained-Induced Movement Therapy with intensive bimanual training is effective in children with Brachial Plexus Birth Injury, comparable and even more than in unilateral Cerebral Palsy.
Collapse
Affiliation(s)
- Ingar M Zielinski
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.,Department of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Renske van Delft
- Merem Rehabilitation Centre De Trappenberg, Huizen, The Netherlands
| | | | - Alexander C H Geurts
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands.,Donders Centre for Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.,School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Pauline B M Aarts
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| |
Collapse
|
32
|
Şahin S, Köse B, Aran OT, Bahadır Ağce Z, Kayıhan H. The Effects of Virtual Reality on Motor Functions and Daily Life Activities in Unilateral Spastic Cerebral Palsy: A Single-Blind Randomized Controlled Trial. Games Health J 2019; 9:45-52. [PMID: 31335174 DOI: 10.1089/g4h.2019.0020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: This study was designed to investigate the effects of virtual reality (VR) through Kinect on both gross and fine motor functions and independence in daily living activities in children with unilateral spastic cerebral palsy (USCP). Materials and Methods: This study was designed as a single-blind, randomized, controlled trial. Sixty children with USCP were randomized and split equally between the VR intervention group (10 females and 20 males with a mean age of 10.5 ± 3.62 years) and the traditional occupational therapy (TOT) intervention group (13 females and 17 males with a mean age of 10.06 ± 3.24 years). Both groups were evaluated in terms of motor functioning via the Bruininks-Oseretsky Test of Motor Proficiency-Short Form (BOTMP-SF) and were assessed in accordance with independence in daily activities via the WeeFunctional Independence Measure (WeeFIM). Interventions were conducted for 8 weeks with the main objective of improving motor functions and independence in daily activities. Results: Total motor functions and total independence in daily lives in both groups improved after 8 weeks of intervention. A comparison between groups revealed significantly greater improvements in both gross and fine motor functions and daily activities in the VR group than in the TOT group (P < 0.001). Conclusion: The Kinect-based VR intervention approach is important to improving motor functions and independence in daily activities of children with USCP.
Collapse
Affiliation(s)
- Sedef Şahin
- Department of Occupational Therapy, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Barkın Köse
- Department of Occupational Therapy, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Orkun Tahir Aran
- Department of Occupational Therapy, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Zeynep Bahadır Ağce
- Department of Occupational Therapy, Üsküdar University Faculty of Health Sciences, İstanbul, Turkey
| | - Hülya Kayıhan
- Department of Occupational Therapy, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| |
Collapse
|
33
|
Hoare BJ, Wallen MA, Thorley MN, Jackman ML, Carey LM, Imms C. Constraint-induced movement therapy in children with unilateral cerebral palsy. Cochrane Database Syst Rev 2019; 4:CD004149. [PMID: 30932166 PMCID: PMC6442500 DOI: 10.1002/14651858.cd004149.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Unilateral cerebral palsy (CP) is a condition that affects muscle control and function on one side of the body. Children with unilateral CP experience difficulties using their hands together secondary to disturbances that occur in the developing fetal or infant brain. Often, the more affected limb is disregarded. Constraint-induced movement therapy (CIMT) aims to increase use of the more affected upper limb and improve bimanual performance. CIMT is based on two principles: restraining the use of the less affected limb (for example, using a splint, mitt or sling) and intensive therapeutic practice of the more affected limb. OBJECTIVES To evaluate the effect of constraint-induced movement therapy (CIMT) in the treatment of the more affected upper limb in children with unilateral CP. SEARCH METHODS In March 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PEDro, OTseeker, five other databases and three trials registers. We also ran citation searches, checked reference lists, contacted experts, handsearched key journals and searched using Google Scholar. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs or clinically controlled trials implemented with children with unilateral CP, aged between 0 and 19 years, where CIMT was compared with a different form of CIMT, or a low dose, high-dose or dose-matched alternative form of upper-limb intervention such as bimanual intervention. Primarily, outcomes were bimanual performance, unimanual capacity and manual ability. Secondary outcomes included measures of self-care, body function, participation and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts to eliminate ineligible studies. Five review authors were paired to extract data and assess risk of bias in each included study. GRADE assessments were undertaken by two review authors. MAIN RESULTS We included 36 trials (1264 participants), published between 2004 and 2018. Sample sizes ranged from 11 to 105 (mean 35). Mean age was 5.96 years (standard deviation (SD) 1.82), range three months to 19.8 years; 53% male and 47% participants had left hemiplegia. Fifty-seven outcome measures were used across studies. Average length of CIMT programs was four weeks (range one to 10 weeks). Frequency of sessions ranged from twice weekly to seven days per week. Duration of intervention sessions ranged from 0.5 to eight hours per day. The mean total number of hours of CIMT provided was 137 hours (range 20 to 504 hours). The most common constraint devices were a mitt/glove or a sling (11 studies each).We judged the risk of bias as moderate to high across the studies. KEY RESULTS Primary outcomes at primary endpoint (immediately after intervention)CIMT versus low-dose comparison (e.g. occupational therapy)We found low-quality evidence that CIMT was more effective than a low-dose comparison for improving bimanual performance (mean difference (MD) 5.44 Assisting Hand Assessment (AHA) units, 95% confidence interval (CI) 2.37 to 8.51).CIMT was more effective than a low-dose comparison for improving unimanual capacity (Quality of upper extremity skills test (QUEST) - Dissociated movement MD 5.95, 95% CI 2.02 to 9.87; Grasps; MD 7.57, 95% CI 2.10 to 13.05; Weight bearing MD 5.92, 95% CI 2.21 to 9.6; Protective extension MD 12.54, 95% CI 8.60 to 16.47). Three studies reported adverse events, including frustration, constraint refusal and reversible skin irritations from casting.CIMT versus high-dose comparison (e.g. individualised occupational therapy, bimanual therapy)When compared with a high-dose comparison, CIMT was not more effective for improving bimanual performance (MD -0.39 AHA Units, 95% CI -3.14 to 2.36). There was no evidence that CIMT was more effective than a high-dose comparison for improving unimanual capacity in a single study using QUEST (Dissociated movement MD 0.49, 95% CI -10.71 to 11.69; Grasp MD -0.20, 95% CI -11.84 to 11.44). Two studies reported that some children experienced frustration participating in CIMT.CIMT versus dose-matched comparison (e.g. Hand Arm Bimanual Intensive Therapy, bimanual therapy, occupational therapy)There was no evidence of differences in bimanual performance between groups receiving CIMT or a dose-matched comparison (MD 0.80 AHA units, 95% CI -0.78 to 2.38).There was no evidence that CIMT was more effective than a dose-matched comparison for improving unimanual capacity (Box and Blocks Test MD 1.11, 95% CI -0.06 to 2.28; Melbourne Assessment MD 1.48, 95% CI -0.49 to 3.44; QUEST Dissociated movement MD 6.51, 95% CI -0.74 to 13.76; Grasp, MD 6.63, 95% CI -2.38 to 15.65; Weightbearing MD -2.31, 95% CI -8.02 to 3.40) except for the Protective extension domain (MD 6.86, 95% CI 0.14 to 13.58).There was no evidence of differences in manual ability between groups receiving CIMT or a dose-matched comparison (ABILHAND-Kids MD 0.74, 95% CI 0.31 to 1.18). From 15 studies, two children did not tolerate CIMT and three experienced difficulty. AUTHORS' CONCLUSIONS The quality of evidence for all conclusions was low to very low. For children with unilateral CP, there was some evidence that CIMT resulted in improved bimanual performance and unimanual capacity when compared to a low-dose comparison, but not when compared to a high-dose or dose-matched comparison. Based on the evidence available, CIMT appears to be safe for children with CP.
Collapse
Affiliation(s)
- Brian J Hoare
- Monash Children's HospitalVictorian Paediatric Rehabilitation Service246 Clayton RdClaytonVictoriaAustralia3168
| | - Margaret A Wallen
- Australian Catholic UniversitySchool of Allied Health, Faculty of Health SciencesNorth SydneyAustralia
| | - Megan N Thorley
- Royal Children's HospitalRehabilitationHerston RoadBrisbaneQueenslandAustralia4006
| | - Michelle L Jackman
- John Hunter Children's HospitalPaediatric Occupational TherapyLambton RoadNew LambtonNew South WalesAustralia2310
| | - Leeanne M Carey
- Florey Institute of Neuroscience and Mental Health, The University of MelbourneNeurorehabilitation and Recovery, Stroke DivisionMelbourneVictoriaAustralia3081
| | - Christine Imms
- Australian Catholic UniversityCentre for Disability & Development ResearchLevel 2, Daniel Mannix Building17 Young StreetMelbourneVictoriaAustralia3065
| | | |
Collapse
|
34
|
Ferrante R, Hendershot S, Baranet K, Barbosa G, Carey H, Maitre N, Lo W, Pan J, Heathcock J. Daily and Weekly Rehabilitation Delivery for Young Children With Gross Motor Delay: A Randomized Clinical Trial Protocol (the DRIVE Study). Pediatr Phys Ther 2019; 31:217-224. [PMID: 30865149 PMCID: PMC7029804 DOI: 10.1097/pep.0000000000000594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The proposed project tests the principle that frequency of rehabilitation is an important regulator of therapeutic response in infants. METHODS We will randomize 75 infants with cerebral palsy, 6 to 24 months of age and/or Gross Motor Function Classification System levels III to V (higher severity), to determine the short-term and long-term effects of 3 dosing protocols consisting of an identical number of 2-hour sessions of the same motor learning-based therapy applied over a different total number of calendar weeks. RESULTS AND CONCLUSIONS The results will inform clinicians, families, and scientists about dosing and will provide needed recommendations for frequency of rehabilitation to optimize motor function and development of young children with cerebral palsy.
Collapse
Affiliation(s)
- Rachel Ferrante
- Nationwide Children's Hospital (Drs Ferrante, Hendershot, Baranet, Maitre, and Lo), Columbus, Ohio; The Ohio State University (Drs Barbosa, Pan, and Heathcock), Columbus, Ohio; Kettering College (Dr Carey), Kettering, Ohio
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Sidiropoulos AN, Chen S, Kaminski TRM, Gordon AM. Modulation of gait inter-limb coordination in children with unilateral spastic cerebral palsy after intensive upper extremity intervention. Exp Brain Res 2019; 237:1409-1419. [PMID: 30888460 DOI: 10.1007/s00221-019-05501-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/25/2019] [Indexed: 11/26/2022]
Abstract
Motor function difficulties associated with unilateral spastic cerebral palsy (USCP) impact gait inter-limb coordination between the upper and lower extremities. Two motor learning based, upper extremity treatments, Constraint Induced Movement Therapy (CIMT) and Hand Arm Bimanual Therapy (HABIT), have resulted in improvements in coordination and function between the arms in children with USCP. However, no study has investigated whether coordination between the upper and lower extremities improves after either intervention during a functional task, such as walking. Gait analysis was performed before and after participation in intensive (3 weeks, 90 h total) CIMT and HABIT interventions to determine if intensive upper extremity treatment can improve inter-limb coordination between the upper and lower extremities of children (n = 20, 6-17 years old) with USCP. While upper extremity clinical evaluations indicated hand function improvements, there were no changes in lower extremity parameters for either treatment. However, we found that 10 out of 11 children with a 2:1 arm swing-to-stride ratio at pre-test improved to a 1:1 ratio at post-test. Temporal synchronicity of contralateral limbs, swing displacement of the more affected arm, and arm swing side symmetry unexpectedly decreased. Positive changes in coordination were observed in children who demonstrated poor coordination during walking at pre-test, yet the changes were not robust. Principle component analysis did not indicate changes in limb coupling. While more coordinated, gross-motor training of the upper and lower extremity may reveal greater changes, lower extremity gait patterns were not improved in high functioning children with USCP.
Collapse
Affiliation(s)
- Alexis N Sidiropoulos
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 W 120th St., New York, NY, 10027, USA.
| | - Siyun Chen
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 W 120th St., New York, NY, 10027, USA
| | - Terry R M Kaminski
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 W 120th St., New York, NY, 10027, USA
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 W 120th St., New York, NY, 10027, USA
| |
Collapse
|
36
|
Chen YL, Chen HL, Shieh JY, Wang TN. Preliminary Efficacy of a Friendly Constraint-Induced Therapy (Friendly-CIT) Program on Motor and Psychosocial Outcomes in Children with Cerebral Palsy. Phys Occup Ther Pediatr 2019; 39:139-150. [PMID: 29912601 DOI: 10.1080/01942638.2018.1484407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIMS Constraint-induced therapy (CIT) is effective, but concerns have been repeatedly raised regarding the generalizability, feasibility, and potentially intrusive nature of restraining a child's unimpaired upper limb. We examined the feasibility and efficacy of friendly-CIT, which uses home-based model, a caregiver-determined schedule, and gentle restraint, in children with cerebral palsy. METHODS In a one-group pre-post intervention trial, 15 children (median of age = 8 years, 4 months) participated in 8 weeks of friendly-CIT (36 hours). Motor and psychosocial outcomes were investigated. RESULTS Participants showed significant improvement on the manual dexterity subtest of the Bruininks-Oseretsky Test of Motor Proficiency (p = 0.004); the how often (p = 0.01) and how well (p = 0.02) scales of the Revised Pediatric Motor Activity Log; and the functional skills score on the Chinese version of the Pediatric Evaluation of Disability Inventory (p = 0.002). For psychosocial outcomes, children with CP consistently demonstrated high engagement and increased playfulness (p < 0.0001) during the 8-week intervention. Parents showed no change in stress status and high satisfaction with friendly-CIT. CONCLUSION Friendly-CIT is feasible and promising for improving a child's motor and psychosocial outcomes without increasing parental stress.
Collapse
Affiliation(s)
- Yu-Lun Chen
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Hao-Ling Chen
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
| | - Jeng-Yi Shieh
- b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
| | - Tien-Ni Wang
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
| |
Collapse
|
37
|
Chamudot R, Parush S, Rigbi A, Horovitz R, Gross-Tsur V. Effectiveness of Modified Constraint-Induced Movement Therapy Compared With Bimanual Therapy Home Programs for Infants With Hemiplegia: A Randomized Controlled Trial. Am J Occup Ther 2018; 72:7206205010p1-7206205010p9. [DOI: 10.5014/ajot.2018.025981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We examined the effectiveness of modified constraint-induced movement therapy (mCIMT) in treating infants with hemiplegic cerebral palsy and compared therapy outcomes with a nonconstraining bimanual therapy (BIM) of equal intensity.
METHOD. In a single-blinded randomized controlled trial, 33 infants with hemiplegia (mean corrected age = 11.1 mo, standard deviation = 2.2) received either mCIMT (n = 17) or BIM (n = 16). Both interventions included home programs encouraging the use of the affected hand during daily 1-hr play sessions for 8 wk. Outcome measures were administered pre- and posttreatment and included the Mini-Assisting Hand Assessment for babies and the Functional Inventory. At baseline, parents also filled out the Dimensions of Mastery Questionnaire.
RESULTS. Both groups demonstrated a significantly large and equal improvement in hand and gross motor function posttreatment (p < .001) and high treatment compliance.
CONCLUSION. mCIMT and BIM are equally effective methods for treating infants with hemiplegia.
Collapse
Affiliation(s)
- Rena Chamudot
- Rena Chamudot, PhD, OT, is Lecturer, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Occupational Therapy Director, Dvorah Agmon Pre-School Development Center, Jerusalem, Israel. At the time of the study, she was Doctoral Student, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Israel;
| | - Shula Parush
- Shula Parush, PhD, OT, is Professor Emeritus, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amihai Rigbi
- Amihai Rigbi, PhD, is Senior Lecturer, Faculty of Education, and Research Authority, Beit Berl Academic College, Kfar-Sava, Israel
| | - Roni Horovitz
- Roni Horovitz, MSc, OTR/L, is OTD Candidate, Boston University, Boston, MA. At the time of the study, she was Graduate Student, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Varda Gross-Tsur
- Varda Gross-Tsur, PhD, MD, is Professor of Pediatrics, Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel, and the Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
38
|
Somatosensory Plasticity in Pediatric Cerebral Palsy following Constraint-Induced Movement Therapy. Neural Plast 2018; 2018:1891978. [PMID: 30532772 PMCID: PMC6250030 DOI: 10.1155/2018/1891978] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 09/16/2018] [Indexed: 01/15/2023] Open
Abstract
Cerebral palsy (CP) is predominantly a disorder of movement, with evidence of sensory-motor dysfunction. CIMT1 is a widely used treatment for hemiplegic CP. However, effects of CIMT on somatosensory processing remain unclear. To examine potential CIMT-induced changes in cortical tactile processing, we designed a prospective study, during which 10 children with hemiplegic CP (5 to 8 years old) underwent an intensive one-week-long nonremovable hard-constraint CIMT. Before and directly after the treatment, we recorded their cortical event-related potential (ERP) responses to calibrated light touch (versus a control stimulus) at the more and less affected hand. To provide insights into the core neurophysiological deficits in light touch processing in CP as well as into the plasticity of this function following CIMT, we analyzed the ERPs within an electrical neuroimaging framework. After CIMT, brain areas governing the more affected hand responded to touch in configurations similar to those activated by the hemisphere controlling the less affected hand before CIMT. This was in contrast to the affected hand where configurations resembled those of the more affected hand before CIMT. Furthermore, dysfunctional patterns of brain activity, identified using hierarchical ERP cluster analyses, appeared reduced after CIMT in proportion with changes in sensory-motor measures (grip or pinch movements). These novel results suggest recovery of functional sensory activation as one possible mechanism underlying the effectiveness of intensive constraint-based therapy on motor functions in the more affected upper extremity in CP. However, maladaptive effects on the less affected constrained extremity may also have occurred. Our findings also highlight the use of electrical neuroimaging as feasible methodology to measure changes in tactile function after treatment even in young children, as it does not require active participation.
Collapse
|
39
|
Kuo HC, Zewdie E, Ciechanski P, Damji O, Kirton A. Intervention-Induced Motor Cortex Plasticity in Hemiparetic Children With Perinatal Stroke. Neurorehabil Neural Repair 2018; 32:941-952. [DOI: 10.1177/1545968318801546] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Hsing-Ching Kuo
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Ephrem Zewdie
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Patrick Ciechanski
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada
| | - Omar Damji
- Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Adam Kirton
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada
- University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
40
|
Fonseca Jr. PR, Calhes Franco de Moura R, Galli M, Santos Oliveira C. Effect of physiotherapeutic intervention on the gait after the application of botulinum toxin in children with cerebral palsy: systematic review. Eur J Phys Rehabil Med 2018; 54:757-765. [DOI: 10.23736/s1973-9087.17.04940-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
41
|
Schnackers M, Beckers L, Janssen-Potten Y, Aarts P, Rameckers E, van der Burg J, de Groot I, Smeets R, Geurts S, Steenbergen B. Home-based bimanual training based on motor learning principles in children with unilateral cerebral palsy and their parents (the COAD-study): rationale and protocols. BMC Pediatr 2018; 18:139. [PMID: 29669522 PMCID: PMC5907414 DOI: 10.1186/s12887-018-1110-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Home-based training is considered an important intervention in rehabilitation of children with unilateral cerebral palsy. Despite consensus on the value of home-based upper limb training, no evidence-based best practice exists. Promoting compliance of children to adhere to an intensive program while keeping parental stress levels low is an important challenge when designing home-based training programs. Incorporating implicit motor learning principles emerges to be a promising method to resolve this challenge. METHODS Here we describe two protocols for home-based bimanual training programs, one based on implicit motor learning principles and one based on explicit motor learning principles, for children with unilateral spastic cerebral palsy aged 2 through 7 years. Children receive goal-oriented, task-specific bimanual training in their home environment from their parents for 3.5 h/week for 12 weeks according to an individualized program. Parents will be intensively coached by a multidisciplinary team, consisting of a pediatric therapist and remedial educationalist. Both programs consist of a preparation phase (goal setting, introductory meetings with coaching professionals, design of individualized program, instruction of parents, home visit) and home-based training phase (training, video-recordings, registrations, and telecoaching and home visits by the coaching team). The programs contrast with respect to the teaching strategy, i.e. how the parents support their child during training. In both programs parents provide their child with instructions and feedback that focus on the activity (i.e. task-oriented) or the result of the activity (i.e. result-oriented). However, in the explicit program parents are in addition instructed to give exact instructions and feedback on the motor performance of the bimanual activities, whereas in the implicit program the use of both hands and the appropriate motor performance of the activity are elicited via manipulation of the organization of the activities. DISCUSSION With the protocols described here, we aim to take a next step in the development of much needed evidence-based home-based training programs for children with unilateral cerebral palsy.
Collapse
Affiliation(s)
- Marlous Schnackers
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Laura Beckers
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands
| | - Yvonne Janssen-Potten
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands
| | - Pauline Aarts
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Eugène Rameckers
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands
- Master of Specialized Physical Therapy, AVANS Plus, Breda, the Netherlands
| | - Jan van der Burg
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
- School of Pedagogical and Educational sciences, Radboud University, Nijmegen, the Netherlands
| | - Imelda de Groot
- Department of Rehabilitation, Donders Centre for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Libra Rehabilitation and Audiology, Eindhoven, Weert the Netherlands
| | - Sander Geurts
- Department of Rehabilitation, Donders Centre for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- School of Psychology, Australian Catholic University, Melbourne, Australia
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, Vic Australia
| |
Collapse
|
42
|
Moon JH, Jung JH, Hahm SC, Cho HY. The effects of task-oriented training on hand dexterity and strength in children with spastic hemiplegic cerebral palsy: a preliminary study. J Phys Ther Sci 2017; 29:1800-1802. [PMID: 29184291 PMCID: PMC5684012 DOI: 10.1589/jpts.29.1800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/11/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of task-oriented
training (TOT) on hand dexterity and strength in children with spastic hemiplegic cerebral
palsy. [Subjects and Methods] Twelve children with spastic hemiplegic cerebral palsy were
randomly assigned to either the TOT group (n=6) or the control group (n=6). In both
groups, conventional occupational therapy was performed 40-min/day, 2 times a week, for 4
weeks. In the TOT group, TOT was additionally performed for 20 min, and the control group
received usual care. The box and block test (BBT) was performed to assess hand dexterity.
Hand strength was also assessed using hand dynamometer. [Results] After intervention, the
TOT group showed a significant improvement of hand dexterity. In the control group, BBT
and grip strength were not significantly improved after intervention. [Conclusion] In
clinical settings, we suggest that TOT may be used as an intervention to improve hand
dexterity in children with spastic hemiplegic cerebral palsy.
Collapse
Affiliation(s)
- Jong-Hoon Moon
- Department of Occupational Therapy, Graduate School, Gachon University, Republic of Korea
| | - Jin-Hwa Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea.,Department of Occupational Therapy, Graduate School, Gachon University, Republic of Korea
| | - Suk-Chan Hahm
- Department of Rehabilitation Standard and Policy, National Rehabilitation Research Institute, National Rehabilitation Center: 58 Samgaksan-ro, Gangbuk-gu, Seoul 01022, Republic of Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, Gachon University: 191 Hambangmoe-ro, Yeonsu-gu, Incheon 406-799, Republic of Korea
| |
Collapse
|
43
|
Comparing Unimanual and Bimanual Training in Upper Extremity Function in Children With Unilateral Cerebral Palsy. Pediatr Phys Ther 2017; 29:288-306. [PMID: 28953170 DOI: 10.1097/pep.0000000000000438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This systematic review compared intensive bimanual therapy (IBT) and modified constraint-induced movement therapy (mCIMT) in upper limb function in children with unilateral cerebral palsy (CP). METHODS Four electronic databases were searched from 2009 through October 2015 for randomized control trials comparing IBT with mCIMT. RESULTS Eight articles met the inclusion criteria; 5 randomized clinical trials with 221 participants with unilateral CP, ages 1.5 to 16 years, who received the intervention in a day camp, clinical, or preschool setting were included. The IBT group performed bimanual motor activities; the mCIMT group performed unilateral motor activities. CONCLUSION There was a strong, nonspecific recommendation for either approach to improve quality of unimanual movement, bimanual capacity, and movement efficiency. There was a weak, specific recommendation for IBT in improving movement quality and a specific but weak recommendation favoring IBT to improve the child's performance on parent-reported outcomes.
Collapse
|
44
|
Saussez G, Brandão MB, Gordon AM, Bleyenheuft Y. Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials. Front Neurol 2017; 8:495. [PMID: 29018400 PMCID: PMC5622919 DOI: 10.3389/fneur.2017.00495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/04/2017] [Indexed: 11/13/2022] Open
Abstract
Hand-Arm Bimanual Intensive Therapy (HABIT) promotes hand function using intensive practice of bimanual functional and play tasks. This intervention has shown to be efficacious to improve upper-extremity (UE) function in children with unilateral spastic cerebral palsy (USCP). In addition to UE function deficits, lower-extremity (LE) function and UE-LE coordination are also impaired in children with USCP. Recently, a new intervention has been introduced in which the LE is simultaneously engaged during HABIT (Hand-Arm Bimanual Intensive Therapy Including Lower Extremities; HABIT-ILE). Positive effects of this therapy have been demonstrated for both the UE and LE function in children with USCP. However, it is unknown whether the addition of this constant LE component during a bimanual intensive therapy attenuates UE improvements observed in children with USCP. This retrospective study, based on multiple randomized protocols, aims to compare the UE function improvements in children with USCP after HABIT or HABIT-ILE. This study included 86 children with USCP who received 90 h of either HABIT (n = 42) or HABIT-ILE (n = 44) as participants in previous studies. Children were assessed before, after, and 4-6 months after intervention. Primary outcomes were the ABILHAND-Kids and the Assisting Hand Assessment. Secondary measures included the Jebsen-Taylor Test of Hand Function, the Pediatric Evaluation of Disability Inventory [(PEDI); only the self-care functional ability domain] and the Canadian Occupational Performance Measure (COPM). Data analysis was performed using two-way repeated-measures analysis of variance with repeated measures on test sessions. Both groups showed similar, significant improvements for all tests (test session effect p < 0.001; group × test session interaction p > 0.05) except the PEDI and COPM. Larger improvements on these tests were found for the HABIT-ILE group (test session effect p < 0.001; group × test session interaction p < 0.05). These larger improvements may be explained by the constant simultaneous UE-LE engagement observed during the HABIT-ILE intervention since many daily living activities included in the PEDI and the COPM goals involve the LE and, more specifically, UE-LE coordination. We conclude that UE improvements in children with USCP are not attenuated by simultaneous UE-LE engagement during intensive intervention. In addition, systematic LE engagement during bimanual intensive intervention (HABIT-ILE) leads to larger functional improvements in activities of daily living involving the LE.
Collapse
Affiliation(s)
- Geoffroy Saussez
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, United States
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
45
|
Fonseca Junior PR, Filoni E, Setter CM, Berbel AM, Fernandes AO, Moura RCDF. Constraint-induced movement therapy of upper limb of children with cerebral palsy in clinical practice: systematic review of the literature. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/17425124032017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The purpose of the present study was to perform a systematic review of the literature to investigate how and with what modifications or adaptations constraint-induced movement therapy has been employed in clinical practice for therapeutic interventions in children with cerebral palsy. Searches were conducted of the CAPES (Brazilian fostering agency) periodical portal, Pubmed, Bireme, Science Direct, Scielo and PEDro databases for relevant articles published between January 2010 and May 2016. The articles retrieved were evaluated, scored and qualified by two blinded reviewers using the Physical therapy Evidence Database Scale. The searches led to the retrieval of 102 articles, 12 of which were included in the present systematic review. A table was created containing information on the study groups, inclusion criteria, intervention, intervention frequency, difficulties encountered, evaluations and outcomes. Considerable variety was found in the therapeutic intervention models. The findings of the present review demonstrate that constraint-induced movement therapy in pediatric clinical practice is not employed in its original form. Although the studies analyzed did not have a common methodology regarding the use of this type of therapy, the method has been adapted with considerable flexibility, providing promising, positive results regarding the therapeutic intervention of the paretic upper limb in children with cerebral palsy.
Collapse
Affiliation(s)
| | - Eduardo Filoni
- Universidade de Mogi das Cruzes, Brazil; Universidade Cruzeiro do Sul, Brazil
| | | | | | | | | |
Collapse
|
46
|
Reifenberg G, Gabrosek G, Tanner K, Harpster K, Proffitt R, Persch A. Feasibility of Pediatric Game-Based Neurorehabilitation Using Telehealth Technologies: A Case Report. Am J Occup Ther 2017; 71:7103190040p1-7103190040p8. [PMID: 28422630 DOI: 10.5014/ajot.2017.024976] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This case report is the first in a series of reports designed to determine the feasibility of implementing game-based neurorehabilitation using telehealth technologies (GbN+TT) for children with cerebral palsy, evaluate the responsiveness of relevant outcome measures to changes in motor impairment and activity participation after intervention, and identify technological challenges associated with implementation of GbN+TT. The participant completed more than 56 hr of game-based neurorehabilitation over 8 wk using the Timocco platform in his home. The primary measures of motor impairment (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition) and function (Pediatric Motor Activity Log) were both sensitive to change. Results indicate that it is feasible to administer GbN+TT to a child with cerebral palsy and monitor outcomes using standardized assessments.
Collapse
Affiliation(s)
- Grace Reifenberg
- Grace Reifenberg, BS, is Student Research Assistant, Child & Adolescent Health, Rehabilitation, & Evaluation (CAHRE) Lab, The Ohio State University, Columbus
| | - Gabrielle Gabrosek
- Gabrielle Gabrosek, BA, is Student Research Assistant, CAHRE Lab, The Ohio State University, Columbus
| | - Kelly Tanner
- Kelly Tanner, PhD, OTR/L, is Director of Occupational Therapy Research, Nationwide Children's Hospital, Columbus, OH
| | - Karen Harpster
- Karen Harpster, PhD, OTR/L, is Director of Occupational Therapy Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia
| | - Andrew Persch
- Andrew Persch, PhD, OTR/L, BCP, is Director, CAHRE Lab, and Assistant Professor, Division of Occupational Therapy, The Ohio State University, Columbus;
| |
Collapse
|
47
|
Cohen-Holzer M, Sorek G, Kerem J, Katz-Leurer M. The impact of combined constraint-induced and bimanual arm training program on the perceived hand-use experience of children with unilateral cerebral palsy. Dev Neurorehabil 2017; 20:355-360. [PMID: 27739919 DOI: 10.1080/17518423.2016.1238017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess change in perceived hand-use experience following a combined bimanual with constraint intervention and to examine its relationship regarding objective hand-function among children with unilateral cerebral palsy (UCP). METHODS Twenty-six children with UCP received 6 hours of combined intervention daily for 10 days. The Children's Hand-use Experience Questionnaire (CHEQ), Assisting Hand Assessment (AHA), and the Jebsen-Taylor Test of Hand Function (JTTHF) assessed independence and experience, bimanual and unimanual function at baseline and 3-months post-intervention. RESULTS Significant improvement over time was noted in AHA and in JTTHF scores. No significant difference was noted on the CHEQ. Although significant associations were noted between JTTHF and AHA results and CHEQ at 3-months post-intervention, no significant associations were noted between changed scores over time. CONCLUSIONS Although measured hand-function and performance improved, this may not be reflected in the hand-use experience during bimanual performance following a combined program. Children's experience merits treatment strategy implementation and investigation.
Collapse
Affiliation(s)
- Marilyn Cohen-Holzer
- a Department of Occupational Therapy , Alyn Hospital, Pediatric and Adolescent Rehabilitation Center , Jerusalem , Israel
| | - Gilad Sorek
- a Department of Occupational Therapy , Alyn Hospital, Pediatric and Adolescent Rehabilitation Center , Jerusalem , Israel
| | - Julie Kerem
- a Department of Occupational Therapy , Alyn Hospital, Pediatric and Adolescent Rehabilitation Center , Jerusalem , Israel
| | - Michal Katz-Leurer
- a Department of Occupational Therapy , Alyn Hospital, Pediatric and Adolescent Rehabilitation Center , Jerusalem , Israel.,b Physical Therapy Department, School of Health Professions, Faculty of Medicine , Tel Aviv University , Ramat Aviv , Israel
| |
Collapse
|
48
|
Charles J. Upper extremity muscle activation in children with unilateral cerebral palsy during an auditory cued repetitive task: Effects on bimanual coordination. J Pediatr Rehabil Med 2017; 10:19-26. [PMID: 28339407 DOI: 10.3233/prm-170407] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this exploratory study was to investigate mirror muscle activation in the upper limbs of children with unilateral cerebral palsy during an auditory-cued repetitive squeezing task and to compare upper limb muscle activation patterns to typically developing peers engaged in the same task. METHODS A convenience sample of six children with unilateral cerebral palsy and six typically developing peers (7-17 y) participated in the study. Muscle activity was measured using a 16 channel Zerowire EMG system (Noraxon, USA Inc. Scottsdale, AZ) in the anterior deltoid, biceps brachii, extensor carpi radialis, flexor carpi radialis, and lateral triceps muscles bilaterally as children squeezed a pediatric bulb dynamometer to 3 pounds per square inch (PSI) for a one second duration, 10 times in one minute. Squeezing activity was cued by a computer generated auditory beep. Between hand differences in muscle onset times and onset amplitude for each muscle were determined using paired t-tests. Two group by two hand ANOVA measured between group differences. RESULTS Results supported increased later muscle onset and lack of significant differences in onset amplitude bilaterally when the dominant hand was working in the CP population. CONCLUSIONS There are differences in motor control mechanisms of muscle activation between populations.
Collapse
|
49
|
Sakzewski L, Reedman S, Hoffmann T. Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:417-427. [PMID: 27736712 DOI: 10.1016/j.ridd.2016.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Incomplete reporting of components of interventions limits uptake of evidence into clinical practice. AIMS To evaluate the completeness of reporting of research and control interventions in randomised trials of upper limb therapies for children with unilateral cerebral palsy. METHODS AND PROCEDURES Sixty randomized trials were included, encompassing 60 research and 68 control interventions. Using the 12-item Template for Intervention Description and Replication (TIDieR) checklist, two reviewers independently rated intervention and control descriptions. OUTCOMES AND RESULTS When using 50% of studies as the benchmark, five of the 12 TIDieR items for the research intervention, eight of the 12 items for the control intervention and 11 of 12 items for "usual care" interventions were inadequately reported. Procedures used to deliver the research intervention were adequately reported for 63% of studies. Materials were used in 94% of research interventions, yet only 27% provided details to access/replicate materials. Training materials for interventionists were used in 38% of trials, 10 (17%) had procedure manuals, yet only 3 reported details to access materials. The location where the research intervention was provided was detailed in 65% of studies. Reporting of all items was poorer for the control intervention. CONCLUSIONS No study adequately reported all elements on the TIDieR checklist. Details crucial for replication of interventions and interpretation of results were missing. Authors, reviewers, and editors all have a responsibility to improve the quality of intervention reporting in published trials. The TIDieR guide is a potential solution, helping to structure accounts of interventions.
Collapse
Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| |
Collapse
|
50
|
Cohen-Holzer M, Sorek G, Kerem J, Schless S, Freedman R, Rotem H, Schweitzer M, Katz-Leurer M. The Influence of Intense Combined Training on Upper Extremity Function in Children With Unilateral Cerebral Palsy: Does Initial Ability Matter? Phys Occup Ther Pediatr 2016; 36:376-87. [PMID: 26734890 DOI: 10.3109/01942638.2015.1108379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To examine whether level of manual ability modifies the response to an intensive program combining modified constraint and bimanual training on arm functioning children with unilateral cerebral palsy (UCP). METHODS Thirty-four children aged 6-11 years, with Manual Ability Classification System (MACS) levels I-III (I:8, II:15, III:11), participated in a 2-week program, combining an hour of modified constraint with 5 hr of bimanual practice daily. The Assisting Hand Assessment (AHA) and the Jebsen-Taylor Test of Hand Function (JTTHF) were done pre-, post-, and 3-months post-intervention. RESULTS Mean AHA logits unit scores increased overtime (F2;50 = 5, p = 0.01). There was no significant difference in AHA logits units change score between MACS levels (F4;56 = 1.4, p = 0.22). JTTHF scores did not change for either the affected or less-affected hand, although a significant interaction of time and MACS level was found in the less-affected side (F4;58 = 6.5, p < 0.01). Children in MACS levels I and II improved by similar degrees, in comparison to children at MACS level III who demonstrated significantly greater change over time. CONCLUSION While a similar trend of improvement was found in the bimanual abilities of children at all MACS levels, only children at MACS level III had improved performance in unilateral abilities in the less-affected side following intervention.
Collapse
Affiliation(s)
- Marilyn Cohen-Holzer
- a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel
| | - Gilad Sorek
- a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel
| | - Julie Kerem
- a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel
| | - Simon Schless
- a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel
| | - Rachel Freedman
- a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel
| | - Hemda Rotem
- a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel
| | - Maayan Schweitzer
- a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel
| | - Michal Katz-Leurer
- a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel.,b Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine , Tel-Aviv University , Ramat Aviv, Israel
| |
Collapse
|