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Xie P, Nie Z, Zhang T, Xu G, Sun A, Chen T, Lv Y. FNIRS based study of brain network characteristics in children with cerebral palsy during bilateral lower limb movement. Med Phys 2024; 51:4434-4446. [PMID: 38683184 DOI: 10.1002/mp.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/23/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Motor dysfunctions in children with cerebral palsy (CP) are caused by nonprogressive brain damage. Understanding the functional characteristics of the brain is important for rehabilitation. PURPOSE This paper aimed to study the brain networks of children with CP during bilateral lower limb movement using functional near-infrared spectroscopy (fNIRS) and to explore effective fNIRS indices for reflecting functional brain activity. METHODS Using fNIRS, cerebral oxygenation signals in the bilateral prefrontal cortex (LPFC/RPFC) and motor cortex (LMC/RMC) were recorded from fifteen children with spastic CP and seventeen children with typical development (CTDs) in the resting state and during bilateral lower limb movement. Functional connectivity matrices based on phase-locking values (PLVs) were calculated using Hilbert transformation, and binary networks were constructed at different sparsity levels. Network metrics such as the clustering coefficient, global efficiency, local efficiency, and transitivity were calculated. Furthermore, the time-varying curves of network metrics during movement were obtained by dividing the time window and using sparse inverse covariance matrices. Finally, conditional Granger causality (GC) was used to explore the causal relationships between different brain regions. RESULTS Compared to CTDs, the connectivity between RMC-RPFC (p = 0.017) and RMC-LMC (p = 0.002) in the brain network was decreased in children with CP, and the clustering coefficient (p = 0.003), global efficiency (p = 0.034), local efficiency (p = 0.015), and transitivity (p = 0.009) were significantly lower. The standard deviation of the changes in global efficiency of children with CP during motion was also greater than that of CTDs. Using GC, it was found that there was a significant increase in causal strength from the RMC to the RPFC (p = 0.04) and from the RMC to the LMC (p = 0.042) in children with CP during motion. Additionally, there were significant negative correlations between the PLV of LMC-RMC (p = 0.002) and the Gross Motor Function Classification System (GMFCS) and between the GMFCS and the clustering coefficient (p = 0.01). CONCLUSIONS During rehabilitation training of the lower limbs, there were significant differences in brain network indices between children with CP and CTDs. The indicators proposed in this paper are effective at evaluating motor function and the real-time impact of rehabilitation training on the brain network and have great potential for application in guiding clinical motor function assessment and planning rehabilitation strategies.
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Affiliation(s)
- Ping Xie
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Institute of Electric Engineering, Yanshan University, Qinhuangdao, Hebei, China
| | - Zichao Nie
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Institute of Electric Engineering, Yanshan University, Qinhuangdao, Hebei, China
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Tengyu Zhang
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Gongcheng Xu
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Aiping Sun
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Tiandi Chen
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Nanchang City Key Laboratory of Integrated Medical and Industrial Technology, Nanchang university, Nanchang, China
| | - Yan Lv
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Institute of Electric Engineering, Yanshan University, Qinhuangdao, Hebei, China
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
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Savas-Kalender D, Kurt-Aydin M, Acarol FO, Tarsuslu T, Yis U. Dual task impact on functional mobility and interaction of functional level and balance in patients with Duchenne muscular dystrophy. Gait Posture 2024; 108:282-288. [PMID: 38171184 DOI: 10.1016/j.gaitpost.2023.12.010] [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: 09/07/2023] [Revised: 11/14/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Dystrophin, a protein crucial for various brain regions governing higher-order functions like learning and memory is notably absent in individuals with Duchenne muscular dystrophy (DMD). This absence of dystrophin in the brain is believed to underlie cognitive challenges in DMD. Cognitive and motor challenges observed in DMD could potentially hinder the execution of dual tasks. RESEARCH QUESTION Is there a significant correlation between dual-task performance, functional mobility, and balance in children with DMD? METHOD The study included 28 participants (14 DMD, 14 typical development). Timed Up and Go (TUG) test results were recorded for single and dual-task conditions (motor-motor, cognitive-motor). Functional level was assessed using Motor Function Measurement-32 (MFM-32), Brooke Upper Extremity Scale, and Vignos Scale. Balance was evaluated using Balance Master System and Pediatric Functional Reach Test (PFRT). RESULTS Significant differences in TUG test scores across conditions were observed in both DMD and typical development groups (p < 0.05). Children with DMD exhibited longer completion times compared to typical development children (p < 0.05). Among children with DMD, there was a significant correlation between TUG scores in different task conditions and balance assessment (p < 0.05, r = 0.571 to -0.819). Lower MFM-32 scores in DMD children were correlated with worse TUG performance across conditions (p < 0.05, r = 0.586 to -0.868). SIGNIFIANCE This study sheds light on the multifaceted nature of dual-tasking challenges in individuals with DMD, thereby contributing to a deeper understanding of the implications for rehabilitation strategies.
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Affiliation(s)
| | - Merve Kurt-Aydin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | | | - Tulay Tarsuslu
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkiye
| | - Uluc Yis
- Department of Pediatric Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkiye
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Rubsam M, Girolami GL, Bhatt T. Heterogeneity of Tasks and Outcome Measures in Dual Tasking Studies in Children With Cerebral Palsy: A Scoping Review. Phys Ther 2024; 104:pzad151. [PMID: 37941469 DOI: 10.1093/ptj/pzad151] [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: 09/05/2023] [Revised: 06/22/2023] [Accepted: 08/30/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The aims of this scoping review are to examine the available literature regarding dual tasking in children with cerebral palsy (CP) and to identify and categorize both the motor and cognitive tasks and outcome measures used primarily through the International Classification of Functioning, Disability, and Health model. METHODS Five electronic databases were searched. Studies were included if they: (1) were published in English; (2) included at least 1 group of children or adolescents with a diagnosis of CP; (3) assessed dual tasking as part of the study; (4) reported the method for performing the dual task; and (5) reported the outcome measures utilized. RESULTS Twenty-three studies with 439 children with CP were included. All studies utilized motor activities as the primary task, including walking, balance, and a functional transition. Motor secondary tasks occurred in 10 studies, cognitive secondary tasks in 12 studies, and 1 study used both. Forty-one outcome measures over 23 studies assessed the body structure and function domain, 7 measures over 6 studies assessed activity limitations, and 2 outcomes over 2 studies assessed participation. CONCLUSION The 23 included studies demonstrated heterogeneity in the age and function of participants, secondary tasks, and outcome measures. Future studies on dual tasking in children with CP should consider the difficulty of the primary motor or cognitive task and compare secondary tasks to establish this contribution to motor performance. Studies should incorporate activity and participation measures to assess meaningful functional outcomes. IMPACT Children with CP experience challenges when exposed to dual task situations. This scoping review highlights the importance of considering multiple factors when designing dual tasking studies involving children with CP to facilitate results translation, improved participation, and enhanced function. Similarly, studies should utilize activity and participation outcomes to assess quality of life.
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Affiliation(s)
- Meaghan Rubsam
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA
- PhD Program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Gay L Girolami
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA
- PhD Program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA
- PhD Program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA
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Martínez-Zarzuela M, González-Alonso J, Antón-Rodríguez M, Díaz-Pernas FJ, Müller H, Simón-Martínez C. Multimodal video and IMU kinematic dataset on daily life activities using affordable devices. Sci Data 2023; 10:648. [PMID: 37737210 PMCID: PMC10516922 DOI: 10.1038/s41597-023-02554-9] [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: 03/06/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
Human activity recognition and clinical biomechanics are challenging problems in physical telerehabilitation medicine. However, most publicly available datasets on human body movements cannot be used to study both problems in an out-of-the-lab movement acquisition setting. The objective of the VIDIMU dataset is to pave the way towards affordable patient gross motor tracking solutions for daily life activities recognition and kinematic analysis. The dataset includes 13 activities registered using a commodity camera and five inertial sensors. The video recordings were acquired in 54 subjects, of which 16 also had simultaneous recordings of inertial sensors. The novelty of dataset lies in: (i) the clinical relevance of the chosen movements, (ii) the combined utilization of affordable video and custom sensors, and (iii) the implementation of state-of-the-art tools for multimodal data processing of 3D body pose tracking and motion reconstruction in a musculoskeletal model from inertial data. The validation confirms that a minimally disturbing acquisition protocol, performed according to real-life conditions can provide a comprehensive picture of human joint angles during daily life activities.
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Affiliation(s)
| | | | | | | | - Henning Müller
- University of Applied Sciences and Arts Western Switzerland (HES-SO) Valais-Wallis, Sierre, Switzerland
- Medical faculty, University of Geneva, Geneva, Switzerland
| | - Cristina Simón-Martínez
- University of Applied Sciences and Arts Western Switzerland (HES-SO) Valais-Wallis, Sierre, Switzerland
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Zhang T, Xu G, Huo C, Li W, Li Z, Li W. Cortical hemodynamic response and networks in children with cerebral palsy during upper limb bilateral motor training. JOURNAL OF BIOPHOTONICS 2023; 16:e202200326. [PMID: 36602536 DOI: 10.1002/jbio.202200326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/05/2022] [Accepted: 12/28/2022] [Indexed: 05/17/2023]
Abstract
Understanding the characteristics of functional brain activity is important for motor rehabilitation of children with cerebral palsy (CP). Using the functional near-infrared spectroscopy (fNIRS) technology, the cortical response and networks of prefrontal (PFC) and motor cortices (MC) were analyzed for children with CP and typical development (CTD). Compared with CTD, the resting cortical response of dominant MC in children with CP increased, and the functional connectivity between cerebral areas decreased. In the motor state of children with CP, the coupling strength started from dominant MC increased compared with resting state, and the hemispherical autonomy index (HAI) of the dominant MC was higher than that in the CTD, which reflected the leading role of dominant MC in brain regulation during motor. The functional connectivity between bilateral MC was positively correlated with motor performance. This study provided effective indices for evaluating the motor function and real-time impact of motor on brain networks.
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Affiliation(s)
- Tengyu Zhang
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Gongcheng Xu
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Congcong Huo
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wenhao Li
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- School of Rehabilitation Engineering, Beijing College of Social Administration, Beijing, China
| | - Zengyong Li
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, China
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Laatar R, Kachouri H, Borji R, Ben Waer F, Rebai H, Sahli S. Dual-task affects postural balance performance in children with intellectual disability. Somatosens Mot Res 2023; 40:33-38. [PMID: 36524595 DOI: 10.1080/08990220.2022.2157389] [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: 12/23/2022]
Abstract
BACKGROUND Dual-task designs have been used to study the degree of automatic and controlled processing involved in postural balance. The aim of the present study was to explore postural balance performance during dual-task condition in children with intellectual disability compared to those with typical development. METHODS Fifteen children with intellectual disability aged from 7 to 12 years old and fifteen age-matched children with typical development participated in this study. Participants were asked to maintain static balance on a force platform during a baseline condition (single task) and while performing the Picture Recognition Memory Test (dual-task condition). RESULTS The results showed that dual-task similarly affects postural performance of both typically developing children and those with intellectual disability (p < .001). CONCLUSIONS Children with intellectual disability and children with typical development have difficulties in maintaining their balance when carrying out a concurrent cognitive task. Intellectual disability did not lead to a more strongly compromised balance performance in dual-task situation.
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Affiliation(s)
- Rabeb Laatar
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Hiba Kachouri
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Rihab Borji
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Ben Waer
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Haithem Rebai
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Sahli
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
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Wist S, Carcreff L, Bruijn SM, Allali G, Newman CJ, Fluss J, Armand S. Gait stability in ambulant children with cerebral palsy during dual tasks. PLoS One 2022; 17:e0270145. [PMID: 35731795 PMCID: PMC9216605 DOI: 10.1371/journal.pone.0270145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Aim
The aim of this cross-sectional study was to measure the effect of dual tasks on gait stability in ambulant children with cerebral palsy (CP) compared to typically developing (TD) children.
Methods
The children of the CP (n = 20) and TD groups (n = 20) walked first without a dual task, then while counting forward and finally while alternatively naming fruits and animals (DTf/a). They then completed the same cognitive exercises while sitting comfortably. We calculated the distance between the foot placement estimator (FPE) and the real foot placement in the anterior direction (DFPEAP) and in the mediolateral direction (DFPEML) as a measure of gait stability, in a gait laboratory using an optoelectronic system. Cognitive scores were computed. Comparisons within and between groups were analysed with linear mixed models.
Results
The dual task had a significant effect on the CP group in DFPEAP and DFPEML. The CP group was more affected than the TD group during dual task in the DFPEML. Children in both groups showed significant changes in gait stability during dual tasks.
Interpretation
The impact of dual task on gait stability is possibly due to the sharing of attention between gait and the cognitive task. All children favoured a ‘posture second’ strategy during the dual task of alternatively naming animals and fruits. Children with CP increased their mediolateral stability during dual task.
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Affiliation(s)
- Sophie Wist
- Zürcher Hochschule für Angewandte Wissenschaften, ZHAW, Institut für Physiotherapie, Winterthur, Switzerland
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Lena Carcreff
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Sjoerd M. Bruijn
- Department of Human Movement Sciences, Vrije University Amsterdam, Amsterdam, Netherlands
| | - Gilles Allali
- Department of Neurology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christopher J. Newman
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joel Fluss
- Pediatric Neurology Unit, Children’s Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Laatar R, Ben Waer F, Borji R, Rebai H, Sahli S. Cognitive-Motor Interference during Dual Tasks in Blind Children. J Mot Behav 2022; 54:736-743. [PMID: 35538018 DOI: 10.1080/00222895.2022.2074956] [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: 10/18/2022]
Abstract
The aim of the present study was to compare the dual-task (DT) performance in blind children with sighted ones while concurrently performing a motor task (upright standing) with cognitive (Letter fluency (LF) or Category fluency (CF)) tasks. The Center of pressure mean velocity (CoPVm) and the cognitive performances were recorded during single (ST) and DT conditions. Results showed that, for both groups, CoPVm values increased significantly (p < 0.05) in the DT compared to ST condition. The CoPVm values were significantly (p < 0.001) higher in blind children, compared to controls only in the DT-CF condition. In conclusion, balance performance of blind and typically developed children is affected by dual tasking. Interference between motor and cognitive tasks has more pronounced effects on balance performance in blind children, compared to controls. This difference was observed only when performing the CF task concurrently with the postural balance task.
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Affiliation(s)
- Rabeb Laatar
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Ben Waer
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Rihab Borji
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Haithem Rebai
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Sahli
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
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Okur EO, Arik MI, Okur I, Gokpinar HH, Gunel MK. Dual-task training effect on gait parameters in children with spastic diplegic cerebral palsy: Preliminary results of a self-controlled study. Gait Posture 2022; 94:45-50. [PMID: 35247824 DOI: 10.1016/j.gaitpost.2022.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) may have difficulties under dual-task conditions. Spatiotemporal gait parameters have deteriorated with concurrent tasks in children with CP. However, how dual-task training affects gait parameters in children with spastic diplegic CP has not been clarified. RESEARCH QUESTION How does dual-task training program effect gait, functional skills, and health-related quality of life in children with spastic diplegic CP? METHODS Eleven children with spastic diplegic CP (median age 11 y, range 7-16 y; 4 female; 7 male) Gross Motor Function Classification System level 1-2 and obtained 27 and higher scores from Modified Mini Mental Test included in the study. The study was planned as a self-controlled clinical research design. Children were recruited to conventional physiotherapy program for 8 weeks and dual-task training program added to conventional physiotherapy program for following 8 weeks. Children were evaluated at baseline, after conventional physiotherapy program, and after dual-task training program. Children's gait was evaluated with Zebris™ FDM-2 device and Edinburgh Visual Gait Score, functional mobility skills with 1 min Walk Test (1MWT), and health-related quality of life with the Pediatric Quality of Life Inventory (PedsQL) - CP module. RESULTS The difference in step length, step time, stride time, cadence and gait speed of spatiotemporal parameters of gait during dual-task performance were found statistically significant in children with spastic diplegic CP, after dual-task training program (p < 0,05). After dual-task training, statistically significant gains were found in 1MWT, movement and balance subtitle of PedsQL-CP module Parent Form (p < 0,05). SIGNIFICANCE Dual-task training program added to a conventional physiotherapy program provides more gains in terms of functionality of children with spastic diplegic CP will contribute to the improvement of the motor functional level.
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Affiliation(s)
- Eda Ozge Okur
- Kutahya Health Sciences University, Faculty of Health Sciences, Department of Occupational Therapy, Kutahya, Turkey,.
| | - Meltem Isintas Arik
- Kutahya Health Sciences University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kutahya, Turkey
| | - Ismail Okur
- Kutahya Health Sciences University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kutahya, Turkey
| | | | - Mintaze Kerem Gunel
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Samanpazari, Ankara, Turkey
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Szturm T, Parmar ST, Mehta K, Shetty DR, Kanitkar A, Eskicioglu R, Gaonkar N. Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22030761. [PMID: 35161508 PMCID: PMC8838424 DOI: 10.3390/s22030761] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 05/16/2023]
Abstract
The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children's experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant's experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.
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Affiliation(s)
- Tony Szturm
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB R3E0T6, Canada;
- Correspondence: (T.S.); (S.T.P.)
| | - Sanjay Tejraj Parmar
- SDM College of Physiotherapy, Dharwad 580009, India;
- Correspondence: (T.S.); (S.T.P.)
| | - Kavisha Mehta
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB R3E0T6, Canada;
| | | | - Anuprita Kanitkar
- Department of Applied Health Sciences, University of Manitoba, Winnipeg, MB R3E0T6, Canada;
| | - Rasit Eskicioglu
- Computer Sciences, University of Manitoba, Winnipeg, MB R3E0T6, Canada;
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Nemkova S, Boldyrev V. Complex diagnostics and treatment of cognitive dysfunctions in cerebral palsy. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:51-61. [DOI: 10.17116/jnevro202212209251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Piitulainen H, Kulmala JP, Mäenpää H, Rantalainen T. The gait is less stable in children with cerebral palsy in normal and dual-task gait compared to typically developed peers. J Biomech 2021; 117:110244. [PMID: 33493716 DOI: 10.1016/j.jbiomech.2021.110244] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/21/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
There is limited evidence about gait stability and its alteration by concurrent motor and cognitive tasks in children with cerebral palsy (CP). We examined gait stability and how it is altered by constrained cognitive or motor task in CP and their typically developed (TD) controls. Gait kinematics were recorded using inertial-measurement units (IMU) from 18 patients with hemiplegia (13.5 ± 2.4 years), 12 with diplegia (13.0 ± 2.1 years), and 31 TD controls (13.5 ± 2.2 years) during unconstrained gait, and motor (carrying a tray) and cognitive (word naming) task constrained gait at preferred speed (~400 steps/task). Step duration, its standard deviation and refined-compound-multiscale entropy (RCME) were computed independently for vertical and resultant horizontal accelerations. Gait complexity was higher for patients with CP than TD in all tasks and directions (p < 0.001-0.01), being pronounced in vertical direction, cognitive task and for diplegic patients (p < 0.05-0.001). The gait complexity increased more (i.e. higher dual-task cost) from the unconstrained to the constrained gait in CP compared to TD (p < 0.05). Step duration was similar in all groups (p > 0.586), but its variation was higher in CP than TD (p < 0.001-0.05), and during the constrained than unconstrained gait in all groups (p < 0.01-0.001). The gait in children with CP was more complex and the dual-task cost was higher primarily for children with diplegic CP than TD during cognitive task, indicating that attentional load hinders their gait more. This raises the hypothesis that more attention and cortical resources are needed to compensate for the impaired gait in children with CP.
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Affiliation(s)
- Harri Piitulainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Motion Analysis Laboratory, Helsinki University Hospital and University of Helsinki, Children and Adolescents, Helsinki, Finland.
| | - Juha-Pekka Kulmala
- Motion Analysis Laboratory, Helsinki University Hospital and University of Helsinki, Children and Adolescents, Helsinki, Finland
| | - Helena Mäenpää
- Motion Analysis Laboratory, Helsinki University Hospital and University of Helsinki, Children and Adolescents, Helsinki, Finland
| | - Timo Rantalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Roostaei M, Raji P, Morone G, Razi B, Khademi-Kalantari K. The effect of dual-task conditions on gait and balance performance in children with cerebral palsy: A systematic review and meta-analysis of observational studies. J Bodyw Mov Ther 2020; 26:448-462. [PMID: 33992282 DOI: 10.1016/j.jbmt.2020.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 10/29/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
Dual-task conditions are commonly experienced in daily routines. The aim of the present systematic review is to investigate the effect of dual-task conditions on gait and balance performance in children with cerebral palsy (CP) and to perform meta-analyses where applicable. Five databases, "ProQuest", "PubMed", "OTSeeker", "Scopus", and "PEDro" from the incipient date of databases up to Aug 24, 2020 were searched for studies focusing on the effects of dual-task conditions on gait and balance performance in children with CP. After removing irrelevant articles and applying inclusion and exclusion criteria, nine articles were included in the present systematic review and meta-analysis. The results of the meta-analysis showed that walking speed was slower during dual-task conditions compared to single-task conditions in children with CP (WMD = -0.29 m/s, 95% CI = -0.34, -0.24, P ≤ 0.001) and walking speed decreased in children with CP during dual-task conditions in comparison with the typical development (TD) control group (WMD = -0.19 m/s, 95% CI = -0.23 to -0.15, P ≤ 0.001). The results of subgroup analysis based on the type of task indicated that adding concurrent tasks to walking degrades walking speed under varied dual-task conditions. Additionally, theoretical synthesis of the literature demonstrated that other gait and balance variables are changed by performing cognitive and motor secondary tasks differently. Although these changes may be compensatory strategies to retain their stability, there was not sufficient evidence to reach a firm conclusion. Research gaps and recommendations for future studies are discussed.
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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.
| | | | - Bahman Razi
- Department of Hematology, School of Medicine, Tarbiat Modares University, Tehran, Iran.
| | - Khosro Khademi-Kalantari
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Fluss J, Lidzba K. Cognitive and academic profiles in children with cerebral palsy: A narrative review. Ann Phys Rehabil Med 2020; 63:447-456. [DOI: 10.1016/j.rehab.2020.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/11/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
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Surkar SM, Hoffman RM, Harbourne R, Kurz MJ. Cognitive-Motor Interference Heightens the Prefrontal Cortical Activation and Deteriorates the Task Performance in Children With Hemiplegic Cerebral Palsy. Arch Phys Med Rehabil 2020; 102:225-232. [PMID: 32976843 DOI: 10.1016/j.apmr.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/07/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare the prefrontal cortex (PFC) activation and task performance during single- and dual-task conditions between typically developing (TD) children and children with hemiplegic cerebral palsy (HCP). DESIGN A prospective, comparative design. SETTING Research laboratory. PARTICIPANTS Participants (N=21) included 12 TD children (age, 6.0±1.1y) and 9 children with HCP (age, 7.2±3.1). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES PFC activation was assessed by measuring the concentration of oxygenated hemoglobin while the children performed a shape-matching task with their more affected arm while sitting on a stable (single task) vs dynamic surface (dual task). The task performance was assessed with the total number of shapes matched, dual-task cost, and reaction time (RT). RESULTS For both conditions, the children with HCP exhibited greater PFC activation, matched a fewer shapes, and had slower RT than the TD children. These differences were accentuated during the dual-task condition and the dual-task cost was greater. An increase in the PFC activation during the dual-task condition was tightly correlated with a higher dual-task cost in children with HCP (r=0.77, P=.01). CONCLUSIONS Children with HCP appear to have a heightened amount of PFC activity while performing a dual task. The greater cortical activity may be a result of the finite attentional resources that are shared between both the motor as well as cognitive demands of the task. The cognitive-motor interference is likely exacerbated in children with HCP because of the structural and functional brain changes as a result of an insult to the developing brain.
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Affiliation(s)
- Swati M Surkar
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina; Department of Physical Therapy, Munroe Meyer Institute of Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska
| | - Rashelle M Hoffman
- Department of Physical Therapy, Munroe Meyer Institute of Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska
| | - Regina Harbourne
- Department of Physical Therapy John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania
| | - Max J Kurz
- Department of Physical Therapy, Munroe Meyer Institute of Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska; Cognitive Neuroscience of Development & Aging (CoNDA) Center, University of Nebraska Medical Center, Omaha, Nebraska.
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Carcreff L, Gerber CN, Paraschiv-Ionescu A, De Coulon G, Aminian K, Newman CJ, Armand S. Walking Speed of Children and Adolescents With Cerebral Palsy: Laboratory Versus Daily Life. Front Bioeng Biotechnol 2020; 8:812. [PMID: 32766230 PMCID: PMC7381141 DOI: 10.3389/fbioe.2020.00812] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022] Open
Abstract
The purpose of this pilot study was to compare walking speed, an important component of gait, in the laboratory and daily life, in young individuals with cerebral palsy (CP) and with typical development (TD), and to quantify to what extent gait observed in clinical settings compares to gait in real life. Fifteen children, adolescents and young adults with CP (6 GMFCS I, 2 GMFCS II, and 7 GMFCS III) and 14 with TD were included. They wore 4 synchronized inertial sensors on their shanks and thighs while walking at their spontaneous self-selected speed in the laboratory, and then during 2 week-days and 1 weekend day in their daily environment. Walking speed was computed from shank angular velocity signals using a validated algorithm. The median of the speed distributions in the laboratory and daily life were compared at the group and individual levels using Wilcoxon tests and Spearman's correlation coefficients. The corresponding percentile of daily life speed equivalent to the speed in the laboratory was computed and observed at the group level. Daily-life walking speed was significantly lower compared to the laboratory for the CP group (0.91 [0.58-1.23] m/s vs 1.07 [0.73-1.28] m/s, p = 0.015), but not for TD (1.29 [1.24-1.40] m/s vs 1.29 [1.20-1.40] m/s, p = 0.715). Median speeds correlated highly in CP (p < 0.001, rho = 0.89), but not in TD. In children with CP, 60% of the daily life walking activity was at a slower speed than in-laboratory (corresponding percentile = 60). On the contrary, almost 60% of the daily life activity of TD was at a faster speed than in-laboratory (corresponding percentile = 42.5). Nevertheless, highly heterogeneous behaviors were observed within both populations and within subgroups of GMFCS level. At the group level, children with CP tend to under-perform during natural walking as compared to walking in a clinical environment. The heterogeneous behaviors at the individual level indicate that real-life gait performance cannot be directly inferred from in-laboratory capacity. This emphasizes the importance of completing clinical gait analysis with data from daily life, to better understand the overall function of children with CP.
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Affiliation(s)
- Lena Carcreff
- Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Corinna N. Gerber
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Anisoara Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Geraldo De Coulon
- Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Pediatric Orthopedics, Geneva University Hospitals, Geneva, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Christopher J. Newman
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Stéphane Armand
- Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Sremakaew M, Sungkarat S, Treleaven J, Uthaikhup S. Effects of tandem walk and cognitive and motor dual- tasks on gait speed in individuals with chronic idiopathic neck pain: a preliminary study. Physiother Theory Pract 2019; 37:1210-1216. [PMID: 31671008 DOI: 10.1080/09593985.2019.1686794] [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: 10/25/2022]
Abstract
Introduction: Gait impairment has been associated with neck pain. It is relevant to understand the possible influence of narrow-based walk and an attention-demanding secondary task on gait performance in neck pain.Purpose: To investigate the effects of tandem walk and cognitive and motor dual-tasks on gait speed in persons with chronic idiopathic neck pain (CINP) compared with controls.Methods: A cross-sectional study. Thirty participants with CINP and 30 asymptomatic controls participated in the study. Gait speed was assessed using a timed 10-m walk test at a comfortable pace under four conditions: (1) comfortable walk (as reference); (2) tandem walk (single task); (3) cognitive dual-task walking; and (4) motor dual-task walking. Dual-task interference was calculated.Results: There was no difference in comfortable gait speed between groups (p= 0.40). The CINP group had slower gait speed during the tandem walk than controls (p= 0.02). The dual-task interference on gait speed was not different between groups (p = 0.67 for cognitive, p = 0.93 for motor).Conclusion: Participants with CINP had impaired gait stability during tandem walk. An attention-demanding secondary task did not influence gait speed in individuals with CINP compared to controls. The study suggests that tandem walk could be considered as an assessment tool and part of rehabilitation for neck pain.
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Affiliation(s)
- Munlika Sremakaew
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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