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

Effects of motor and cognitive dual tasks on walking and balance in children with diparetic cerebral palsy

This study investigates the effects of motor and cognitive dual tasks on walking and balance in Children with diparetic cerebral palsy. The subjects of this study were 12 children (experimental group n = 6, control group n = 6) who were medical diagnosed with diparetic cerebral palsy. They aged 8-12 years. Experimental group was administered treatment for 30 min, 2 times a week for 8 weeks, with the experimental group performing motor and cognitive dual task, while the control group did not have such a training. Wilcoxon signed-rank test was performed to analyze changes in balance, gross motor function in the group, and the Mann-Whitney test was conducted to compare the differences between the two groups before and after intervention. In This study, the mean time for completing the Timed Up and Go Test in single and dual tasks and mean cognitive responses, there was a significant difference between the two groups (P < 0.05). Conclusion: Considering that many activities in daily life are dual tasks, these difficulties they experience in performing dual tasks show that children's daily lives are also affected. Therefore, dual task evaluations are very important for individuals to be independent in daily life.

The effectiveness of dual task exercise training on balance, mobility, physical performance, and quality of life in children with cerebral palsy: a single-blind randomized controlled trial

BACKGROUND

Most activities of daily living require more than one activity, including motor-motor or motor-cognitive task. Few studies have investigated the effects of dual-task training in children with cerebral palsy (CP).

AIMS

This study was aimed at investigating the effectiveness of motor-cognitive dual-task exercise training in children with cerebral palsy (CP).

METHODS

A single-blind randomized controlled trial was conducted with thirty children with CP. Participants were randomized into dual group training group (DTG) and control group (CG). Children were evaluated before the intervention and after 12 weeks of treatment with Gross Motor Function Classification Scale (GMFCS), Pediatric Berg Balance Test (PBBS), Single Leg Stance Test (SLST), Timed Up and Go Test (TUG), 3 Meter Backwards Walk Test (3-MBWT), 6 Meter Walk Test (6-MWT), and General Children's Quality of Life Measure (KINDL).

RESULTS

DTG demonstrated significantly improved all KINDL scores (p < 0.01). In comparisons between groups adjusted analysis, results showed a better improvement of all KINDL scores in-favor-of DTG (p < 0.01). Significant improvements were found in all SLST scores and PBS in DTG (p < 0.01). Adjusted analysis results proved there was a significant improvement in all balance scores on behalf of DTG (p < 0.01). Significant improvement was observed in DTG for TUG, 3MBWT, and 6MWT scores (p = 0.001). An improvement in-favor-of DTG was found for all performance tests in the adjusted analysis (p < 0.001).

CONCLUSION

The results of this randomized controlled trial highlighted the advantage of dual-task training on balance, physical performance, and quality of life in children with CP.

Effects of Task Interference on Kinematics and Dual-Task Cost of Running in Early Childhood

Children aged 3-8 are in a critical period for motor development and postural control. Running is a basic motor skill that children need to master in early childhood. While running, children are prone to dangerous events such as falls. This study investigates the kinematic characteristics of running by children associated with different interference tasks, i.e., normalized running, cognitive dual-tasks, and obstacle crossing tasks, and provides a theoretical foundation for the interference mechanism of children's dynamic postural control and for screening of motor disorders. Two hundred children aged 3-8 were recruited. The BTS Bioengineering infrared motion capture system was used to collect spatiotemporal and kinematic running data under three tasks. Repeated measures of variance analysis were used to compare the effects of different interference tasks and ages on children's running signs. The main and interaction effect tests were compared by the Bonferroni method. The results and conclusions are as follows: (1) Running characteristics of early childhood are influenced by interference tasks and age. With interference tasks, the overall characteristics of running by children aged 3-8 showed an increasing trend in running cycle time and a decreasing trend in stride length, step length, cadence, and speed. (2) Both cognitive and obstacle crossing tasks had costs, and cognitive task costs were greater than obstacle crossing costs. Children adopted a "task first" running strategy with different interference tasks. When facing cognitive tasks, their overall joint motion decreased, and they reduced joint motions to promote task completion. When facing obstacle crossing tasks, because of the characteristics of the task itself, children increased joint motions to cope with interference. (3) In terms of age, the running characteristics showed a nonlinear development trend in various indicators, with a degree of recurrence and high variability in adjacent age groups. (4) The dual-task interference paradigm of "postural-cognition" can be used as a motor intervention tool to promote the development of basic motor skills in early childhood.

Heterogeneity of Tasks and Outcome Measures in Dual Tasking Studies in Children With Cerebral Palsy: A Scoping Review

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.

Effects of a multi-component virtual reality program on motor skills and functional postural control in children with hemiplegic cerebral palsy

Background

Pediatric neurorehabilitation has recently employed virtual reality (VR) technologies as a platform to design and implement novel modalities.

Aims

To evaluate the feasibility of a multi-component VR-based program on motor skills and functional postural control for children with hemiplegic cerebral palsy (HCP).

Methods

A single-case-experimental design was conducted on eight children with HCP (12.33 ± 4.71 years and GMFCS= II, I). The VR-based program consisted of 3 sessions per week for four weeks. Timed Up and Go (TUG) test, Functional Reach Test (FRT), Pediatric Balance Scale (PBS), Activities Scale for Kids (ASK), ABILHAND-Kids, and Box and Block Test (BBT) were used to evaluate functional changes.

Outcomes and results

Statistical analysis showed that improvements in functional postural control were significant on at least one balance measure for seven out of eight participants during the intervention phase. For all participants, a significant increase was observed in the BBT scores. Before-after intervention analysis revealed statistically significant improvements in PBS (z = -2.52, p ≤ 0.01), ABILHAND-Kids (z = -2.25, p ≤ 0.01), and ASK (z = -2.38, p ≤ 0.01).

Conclusions and implications

This study provided early evidence of the effectiveness of the multi-component VR-based program in children with HCP. However, future studies with randomized controlled trial design are needed to evaluate the long-term effects and compare them with conventional rehabilitation practice.

Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review

Background

Evidence regarding the management of several aspects of cerebral palsy improved in recent years. Still, discrepancies are reported in clinical practice. Italian professionals and stakeholders expressed the need of setting up updated, evidenced-based, shared statements, to address clinical practice in cerebral palsy rehabilitation. The objective of the present study was to provide an updated overview of the state of knowledge, regarding the management and motor rehabilitation of children and young people with cerebral palsy, as the framework to develop evidence-based recommendations on this topic.

Methods

Guidelines and systematic reviews were searched, relative to evidence-based management and motor treatment, aimed at improving gross motor and manual function and activities, in subjects with cerebral palsy, aged 2-18 years. A systematic search according to the Patients Intervention Control Outcome framework was executed on multiple sites. Independent evaluators provided selection and quality assessment of the studies and extraction of data.

Results

Four guidelines, 43 systematic reviews, and three primary studies were included. Agreement among guidelines was reported relative to the general requirements of management and motor treatment. Considering the subject's multidimensional profile, age and developmentally appropriate activities were recommended to set individual goals and interventions. Only a few approaches were supported by high-level evidence (i.e., bimanual therapy and constraint-induced movement therapy to enhance manual performance). Several task-specific active approaches, to improve gross motor function and gait, were reported (mobility and gait training, cycling, backward gait, and treadmill), based on low-level evidence. Increasing daily physical activity and countering sedentary behavior were advised. Based on the available evidence, non-invasive brain stimulation, virtual reality, action-observation therapy, hydrotherapy, and hippotherapy might be complementary to task or goal-oriented physical therapy programs.

Conclusion

A multiple-disciplinary family-centered evidence-based management is recommended. All motor rehabilitation approaches to minors affected by cerebral palsy must share the following fundamental characteristics: engaging active involvement of the subject, individualized, age and developmentally appropriate, goal-directed, skill-based, and preferably intensive and time-limited, but suitable for the needs and preferences of the child or young person and their family, and feasible considering the implications for themselves and possible contextual limitations.

Effect of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy

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.

An Accessible Training Device for Children With Cerebral Palsy

Walking and balance capabilities can be improved upon using repetitive ankle dorsiflexion exercises. Here we developed two types of pedal switches incorporated with training devices to improve their walking and balance performance of children with cerebral palsy. The first type of pedal switch can be used to operate a home appliance, while the second type of pedal switch can connect them to web games. Pedal switches can be used for home rehabilitation. This randomized controlled trial included patients in the intervention (n = 24) and control (n = 24) groups who completed 15 weeks of ankle training. The experimental group performed ankle dorsiflexion using a pressure-activated pedal switch connected to the web games. The control group performed ankle dorsiflexion exercises using a pedal switch that operated a home appliance (a fan). Standing balance and walking performance were estimated using the Zebris FDM system, a pressure force platform, the Pediatric Balance Scale score, and the 1-minute walk test. The pre- and posttest data were analyzed using analysis of variance and analysis of covariance, which revealed that the intervention group had more significant improvements in sway patterns and balance and walking. The developed facility of a modified pedal switch integrated with web games can achieve better exercise adherence to promote balance and walking performance than that with home appliances. Maintaining motivation in children with cerebral palsy plays a very important role in the rehabilitation process.