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Flux E, Mooijekind B, Bar-On L, van Asseldonk EHF, Buizer AI, van der Krogt MM. Relation between stretch and activation of the medial gastrocnemius muscle during gait in children with cerebral palsy compared to typically developing children. J Electromyogr Kinesiol 2024; 79:102921. [PMID: 39303491 DOI: 10.1016/j.jelekin.2024.102921] [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: 01/12/2024] [Revised: 05/22/2024] [Accepted: 08/20/2024] [Indexed: 09/22/2024] Open
Abstract
Stretch hyperreflexia is often a target for treatment to improve gait in children with spastic cerebral palsy (CP). However, the presence of stretch hyperreflexia during gait remains debated. Therefore, we assessed the relation between gastrocnemius medialis muscle-tendon stretch and muscle activation during gait in children with CP compared to typically developing (TD) children. 3D gait analysis including electromyography (EMG) and dynamic ultrasound was carried out to assess, respectively gastrocnemius medialis activation and fascicle, belly, and tendon stretch during treadmill walking. Musculotendon-unit stretch was also estimated using OpenSim. Ratios of EMG/peak lengthening velocities and accelerations were compared between CP and TD. Velocity and acceleration peaks prior to EMG peaks were qualitatively assessed. EMG/velocity and EMG/acceleration ratios were up to 500% higher for CP (n = 14) than TD (n = 15) for most structures. Increased late swing muscle activation in CP was often preceded by fascicle and musculotendon-unit peak lengthening velocity, and early stance muscle activation by peaks in multiple structures. Increased muscle activation in CP is associated with muscle-tendon stretch during gait. Concluding, late swing muscle activation in CP appears velocity-dependent, whereas early stance activation can be velocity- and acceleration-dependent. These insights into stretch reflex mechanisms during gait can assist development of targeted interventions.
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Affiliation(s)
- Eline Flux
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Babette Mooijekind
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands; Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium
| | - Lynn Bar-On
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands; Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium
| | | | - Annemieke I Buizer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands; Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
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Bradley SS, de Holanda LJ, Chau T, Wright FV. Physiotherapy-assisted overground exoskeleton use: mixed methods feasibility study protocol quantifying the user experience, as well as functional, neural, and muscular outcomes in children with mobility impairments. Front Neurosci 2024; 18:1398459. [PMID: 39145294 PMCID: PMC11322617 DOI: 10.3389/fnins.2024.1398459] [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: 03/09/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Background Early phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm. Methods This protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) pre-post intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents. Discussion This will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention. Clinical trial registration https://clinicaltrials.gov, identifier NCT05463211.
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Affiliation(s)
- Stefanie S. Bradley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Tom Chau
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Nourizadeh M, Shadgan B, Abbasidezfouli S, Juricic M, Mulpuri K. Methods of muscle spasticity assessment in children with cerebral palsy: a scoping review. J Orthop Surg Res 2024; 19:401. [PMID: 38992701 PMCID: PMC11238363 DOI: 10.1186/s13018-024-04894-7] [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: 05/06/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Evaluating muscle spasticity in children with cerebral palsy (CP) is essential for determining the most effective treatment strategies. This scoping review assesses the current methods used to evaluate muscle spasticity, highlighting both traditional and innovative technologies, and their respective advantages and limitations. METHODS A search (to April 2024) used keywords such as muscle spasticity, cerebral palsy, and assessment methods. Selection criteria included articles involving CP children, assessing spasticity objectively/subjectively, comparing methods, or evaluating method effectiveness. RESULTS From an initial pool of 1971 articles, 30 met our inclusion criteria. These studies collectively appraised a variety of techniques ranging from well-established clinical scales like the modified Ashworth Scale and Tardieu Scale, to cutting-edge technologies such as real-time sonoelastography and inertial sensors. Notably, innovative methods such as the dynamic evaluation of range of motion scale and the stiffness tool were highlighted for their potential to provide more nuanced and precise assessments of spasticity. The review unveiled a critical insight: while traditional methods are convenient and widely used, they often fall short in reliability and objectivity. CONCLUSION The review discussed the strengths and limitations of each method and concluded that more reliable methods are needed to measure the level of muscle spasticity more accurately.
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Affiliation(s)
- Mehdi Nourizadeh
- Implantable Biosensing Laboratory, ICORD, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Babak Shadgan
- Implantable Biosensing Laboratory, ICORD, Vancouver, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
| | - Samin Abbasidezfouli
- The Heart and Lung Innovation Centre, Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Maria Juricic
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Kishore Mulpuri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
- Department of Orthopaedic Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
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Cloodt E, Lindgren A, Rodby-Bousquet E. Knee and ankle range of motion and spasticity from childhood into adulthood: a longitudinal cohort study of 3,223 individuals with cerebral palsy. Acta Orthop 2024; 95:200-205. [PMID: 38708569 PMCID: PMC11072397 DOI: 10.2340/17453674.2024.40606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND AND PURPOSE Reduced range of motion (ROM) and spasticity are common secondary findings in cerebral palsy (CP) affecting gait, positioning, and everyday functioning. These impairments can change over time and lead to various needs for intervention. The aim of this study was to analyze the development path of the changes in hamstring length, knee extension, ankle dorsiflexion, and spasticity in hamstrings and gastrosoleus from childhood into adulthood in individuals with CP at the Gross Motor Function Classification System (GMFCS) levels I-V. METHODS A longitudinal cohort study was undertaken of 61,800 measurements in 3,223 individuals with CP, born 1990-2017 and followed for an average of 8.7 years (range 0-26). The age at examination varied between 0 and 30 years. The GMFCS levels I-V, goniometric measurements, and the modified Ashworth scale (MAS) were used for repeated assessments of motor function, ROM, and spasticity. RESULTS Throughout the follow-up period, knee extension and hamstring length exhibited a consistent decline across all individuals, with more pronounced decreases evident in those classified at GMFCS levels III-V. Ankle dorsiflexion demonstrated a gradual reduction from 15° to 5° (GMFCS I-IV) or 10° (GMFCS V). Spasticity levels in the hamstrings and gastrosoleus peaked between ages 5 and 7, showing a propensity to increase with higher GMFCS levels. CONCLUSION Passive ROM continues to decrease to 30 years of age, most pronouncedly for knee extension. Conversely, spasticity reached its peak at a younger age, with a more notable occurrence observed in the gastrosoleus compared with the hamstrings. Less than 50% of individuals had spasticity corresponding to MAS 2-4 at any age.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; Department of Research and Development, Region Kronoberg, Växjö.
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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Willaert J, Desloovere K, Van Campenhout A, Ting LH, De Groote F. Identification of Neural and Non-Neural Origins of Joint Hyper-Resistance Based on a Novel Neuromechanical Model. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1435-1444. [PMID: 38526884 PMCID: PMC11032725 DOI: 10.1109/tnsre.2024.3381739] [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] [Indexed: 03/27/2024]
Abstract
Joint hyper-resistance is a common symptom in neurological disorders. It has both neural and non-neural origins, but it has been challenging to distinguish different origins based on clinical tests alone. Combining instrumented tests with parameter identification based on a neuromechanical model may allow us to dissociate the different origins of joint hyper-resistance in individual patients. However, this requires that the model captures the underlying mechanisms. Here, we propose a neuromechanical model that, in contrast to previously proposed models, accounts for muscle short-range stiffness (SRS) and its interaction with muscle tone and reflex activity. We collected knee angle trajectories during the pendulum test in 15 children with cerebral palsy (CP) and 5 typically developing children. We did the test in two conditions - hold and pre-movement - that have been shown to alter knee movement. We modeled the lower leg as an inverted pendulum actuated by two antagonistic Hill-type muscles extended with SRS. Reflex activity was modeled as delayed, linear feedback from muscle force. We estimated neural and non-neural parameters by optimizing the fit between simulated and measured knee angle trajectories during the hold condition. The model could fit a wide range of knee angle trajectories in the hold condition. The model with personalized parameters predicted the effect of pre-movement demonstrating that the model captured the underlying mechanism and subject-specific deficits. Our model may help with the identification of neural and non-neural origins of joint hyper-resistance and thereby opens perspectives for improved diagnosis and treatment selection in children with spastic CP, but such applications require further studies to establish the method's reliability.
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Banky M, Tirosh O, Davey R, Mentiplay BF, Clark RA, Olver JH, Williams G. Controlling modified Tardieu scale assessment speeds to match joint angular velocities during walking impacts spasticity assessment outcomes. Clin Rehabil 2023; 37:1684-1697. [PMID: 37431534 DOI: 10.1177/02692155231187203] [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: 07/12/2023]
Abstract
OBJECTIVE To investigate whether tailoring the speed of the Modified Tardieu Scale to reflect an individual's joint angular velocity during walking influences spasticity assessment outcomes. DESIGN Observational trial. SETTING Inpatient and outpatient neurological hospital department. SUBJECTS Ninety adults with lower-limb spasticity. INTERVENTIONS N/A. MAIN MEASURES The Modified Tardieu Scale was used to assess the gastrocnemius, soleus, hamstrings and quadriceps. The V1 (slow) and V3 (fast) movements were completed as per standardised testing. Two additional assessments were completed, reflecting joint angular velocities during walking based on (i) a healthy control database (controlled velocity) and (ii) the individual's real-time joint angular velocities during walking (matched velocity). The agreement was compared using Cohen's and Weighted Kappa statistics, sensitivity and specificity. RESULTS There was poor agreement when rating trials as spastic or not spastic at the ankle joint (Cohen's Kappa = 0.01-0.17). Trials were classified as spastic during V3 and not spastic during the controlled conditions in 81.6-85.1% of trials when compared to stance phase dorsiflexion angular velocities and 48.0-56.4% when compared to swing phase dorsiflexion angular velocities. The severity of muscle reaction demonstrated poor agreement at the ankle (Weighted Kappa = 0.01-0.28). At the knee, there was a moderate-excellent agreement between the V3 and controlled conditions when rating a trial as spastic or not spastic (Cohen's Kappa = 0.66-0.84) and excellent agreement when comparing severity (Weighted Kappa = 0.73-0.94). CONCLUSION The speed of assessment impacted spasticity outcomes. It is possible that the standardised protocol may overestimate the impact spasticity has on walking, especially at the ankle.
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Affiliation(s)
- Megan Banky
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Oren Tirosh
- School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Rebecca Davey
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Ross A Clark
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia
| | - John H Olver
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Gavin Williams
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
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Willaert J, Ting LH, Van Campenhout A, Desloovere K, De Groote F. Reduced reciprocal inhibition during clinical tests of spasticity is associated with impaired reactive standing balance control in children with cerebral palsy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.07.23298160. [PMID: 37986791 PMCID: PMC10659464 DOI: 10.1101/2023.11.07.23298160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Joint hyper-resistance is a common symptom in cerebral palsy (CP). It is assessed by rotating the joint of a relaxed patient. Joint rotations also occur when perturbing functional movements. Therefore, joint hyper-resistance might contribute to reactive balance impairments in CP. Aim To investigate relationships between altered muscle responses to isolated joint rotations and perturbations of standing balance in children with CP. Methods & procedures 20 children with CP participated in the study. During an instrumented spasticity assessment, the ankle was rotated as fast as possible from maximal plantarflexion towards maximal dorsiflexion. Standing balance was perturbed by backward support-surface translations and toe-up support-surface rotations. Gastrocnemius, soleus, and tibialis anterior electromyography was measured. We quantified reduced reciprocal inhibition by plantarflexor-dorsiflexor co-activation and the neural response to stretch by average muscle activity. We evaluated the relation between muscle responses to ankle rotation and balance perturbations using linear mixed models. Outcomes & results Co-activation during isolated joint rotations and perturbations of standing balance was correlated across all levels. The neural response to stretch during isolated joint rotations and balance perturbations was not correlated. Conclusions & implications Reduced reciprocal inhibition during isolated joint rotations might be a predictor of altered reactive balance control strategies.
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Affiliation(s)
- Jente Willaert
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Lena H. Ting
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven – UZ Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven – UZ Leuven, Leuven, Belgium
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He J, Luo A, Yu J, Qian C, Liu D, Hou M, Ma Y. Quantitative assessment of spasticity: a narrative review of novel approaches and technologies. Front Neurol 2023; 14:1121323. [PMID: 37475737 PMCID: PMC10354649 DOI: 10.3389/fneur.2023.1121323] [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: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Spasticity is a complex neurological disorder, causing significant physical disabilities and affecting patients' independence and quality of daily lives. Current spasticity assessment methods are questioned for their non-standardized measurement protocols, limited reliabilities, and capabilities in distinguishing neuron or non-neuron factors in upper motor neuron lesion. A series of new approaches are developed for improving the effectiveness of current clinical used spasticity assessment methods with the developing technology in biosensors, robotics, medical imaging, biomechanics, telemedicine, and artificial intelligence. We investigated the reliabilities and effectiveness of current spasticity measures employed in clinical environments and the newly developed approaches, published from 2016 to date, which have the potential to be used in clinical environments. The new spasticity scales, taking advantage of quantified information such as torque, or echo intensity, the velocity-dependent feature and patients' self-reported information, grade spasticity semi-quantitatively, have competitive or better reliability than previous spasticity scales. Medical imaging technologies, including near-infrared spectroscopy, magnetic resonance imaging, ultrasound and thermography, can measure muscle hemodynamics and metabolism, muscle tissue properties, or temperature of tissue. Medical imaging-based methods are feasible to provide quantitative information in assessing and monitoring muscle spasticity. Portable devices, robotic based equipment or myotonometry, using information from angular, inertial, torque or surface EMG sensors, can quantify spasticity with the help of machine learning algorithms. However, spasticity measures using those devices are normally not physiological sound. Repetitive peripheral magnetic stimulation can assess patients with severe spasticity, which lost voluntary contractions. Neuromusculoskeletal modeling evaluates the neural and non-neural properties and may gain insights into the underlying pathology of spasticity muscles. Telemedicine technology enables outpatient spasticity assessment. The newly developed spasticity methods aim to standardize experimental protocols and outcome measures and enable quantified, accurate, and intelligent assessment. However, more work is needed to investigate and improve the effectiveness and accuracy of spasticity assessment.
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Affiliation(s)
- Jian He
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Anhua Luo
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Jiajia Yu
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Chengxi Qian
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Dongwei Liu
- School of Information Management and Artificial Intelligence, Zhejiang University of Finance and Economics, Hangzhou, China
| | - Meijin Hou
- National Joint Engineering Research Centre of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopaedics and Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, China
| | - Ye Ma
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
- National Joint Engineering Research Centre of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopaedics and Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, China
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White H, Barney B, Augsburger S, Miller E, Iwinski H. AFOs Improve Stride Length and Gait Velocity but Not Motor Function for Most with Mild Cerebral Palsy. SENSORS (BASEL, SWITZERLAND) 2023; 23:569. [PMID: 36679366 PMCID: PMC9860799 DOI: 10.3390/s23020569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Ankle-foot orthoses (AFOs) are prescribed to children with cerebral palsy (CP) in hopes of improving their gait and gross motor activities. The purpose of this retrospective study was to examine if clinically significant changes in gross motor function occur with the use of AFOs in children and adolescents diagnosed with CP (Gross Motor Function Classification System levels I and II). Data from 124 clinical assessments were analyzed. Based on minimum clinically important difference (MCID), 77% of subjects demonstrated an increase in stride length, 45% of subjects demonstrated an increase in walking velocity, and 30% demonstrated a decrease in cadence. Additionally, 27% of the subjects demonstrated increase in gait deviation index (GDI). Deterioration in gait was evident by decreases in walking speed (5% of subjects), increases in cadence (11% of subjects), and 15% of subjects demonstrated decreases in gait deviation index. Twenty-two percent of subjects demonstrated no change in stride lengths and one participant demonstrated a decrease in stride length. However, AFOs improved Gross Motor Function Measure (GMFM) scores for a minority (10%) of children with mild CP (GMFCS level I and II), with 82-85% of subjects demonstrating no change in GMFM scores and 5-7% demonstrating decrease in GMFM scores.
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Affiliation(s)
- Hank White
- Shriners Children’s Lexington, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Brian Barney
- Division of Physical Therapy, College of Health Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536, USA
| | - Sam Augsburger
- Shriners Children’s Lexington, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Eric Miller
- Pediatric Orthotic & Prosthetic Services—Midwest, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Henry Iwinski
- Shriners Children’s Lexington, 110 Conn Terrace, Lexington, KY 40508, USA
- Department of Orthopaedic Surgery, University of Kentucky, 740 S Limestone St., Room K423, Lexington, KY 40536, USA
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Klenø AN, Stisen MB, Cubel CH, Mechlenburg I, Nordbye-Nielsen K. Prevalence of knee contractures is high in children with cerebral palsy in Denmark. Physiother Theory Pract 2023; 39:200-207. [PMID: 34809532 DOI: 10.1080/09593985.2021.2007558] [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
INTRODUCTION Cerebral palsy (CP) is a neurological disease occurring in children at early gestation, often resulting in pronounced functional limitations. A Swedish cross-sectional study (Cloodt, et al., 2018) discovered that 22% of children with CP had a knee contracture, which was associated with higher levels of Gross Motor Function Classification System (GMFCS), higher age, and higher levels of spasticity measured by the Modified Ashworth Scale (MAS). The current study investigated these associations in a Danish population. METHODS This is a cross-sectional study including 1,163 children with CP aged 0-15 years, registered in the Danish National Cerebral Palsy Registry between 2017 and 2019. Prevalence of knee contracture was estimated, and logistic regression analysis was applied with results presented as odds ratio (OR) with 95% confidence intervals (CI). RESULTS A total of 511 children with CP had knee contracture resulting in a prevalence of 44%. Age groups 4-6 years (OR: 1.73, CI: 1.19; 2.52), 7-9 years (OR: 1.85, CI: 1.29; 2.66) and 10-12 years (OR: 2.12, CI: 1.39; 3.24) were significantly associated with a higher prevalence of knee contractures compared to age group 0-3 years. Knee contractures were significantly more frequent at GMFCS levels IV (OR: 1.9, CI: 1.21; 2.97) and V (OR: 3.62, CI: 2.36; 5.55) compared to level I. Knee contractures were not associated with higher levels of MAS. CONCLUSIONS Knee contractures are highly prevalent and significantly associated with high levels of GMFCS and increased age until 12 years, but not with high levels of spasticity in children with CP in Denmark.
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Affiliation(s)
- André Nis Klenø
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark
| | - Martin Bækgaard Stisen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark
| | - Claes Høgh Cubel
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Kirsten Nordbye-Nielsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark.,CP North: Living Life with Cerebral Palsy in the Nordic Countries, Aarhus University Hospital, Aarhus N, Denmark
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van der Velden LL, Onneweer B, Haarman CJW, Benner JL, Roebroeck ME, Ribbers GM, Selles RW. Development of a single device to quantify motor impairments of the elbow: proof of concept. J Neuroeng Rehabil 2022; 19:77. [PMID: 35864498 PMCID: PMC9306071 DOI: 10.1186/s12984-022-01050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background For patients with post-stroke upper limb impairments, the currently available clinical measurement instruments are inadequate for reliable quantification of multiple impairments, such as muscle weakness, abnormal synergy, changes in elastic joint properties and spasticity. Robotic devices to date have successfully achieved precise and accurate quantification but are often limited to the measurement of one or two impairments. Our primary aim is to develop a robotic device that can effectively quantify four main motor impairments of the elbow. Methods The robotic device, Shoulder Elbow Perturbator, is a one-degree-of-freedom device that can simultaneously manipulate the elbow joint and support the (partial) weight of the human arm. Upper limb impairments of the elbow were quantified based on four experiments on the paretic arm in ten stroke patients (mean age 65 ± 10 yrs, 9 males, post-stroke) and the non-dominant arm in 20 healthy controls (mean age 65 ± 14 yrs, 6 males). The maximum strength of elbow flexor and elbow extensor muscles was measured isometrically at 90-degree elbow flexion. The maximal active extension angle of the elbow was measured under different arm weight support levels to assess abnormal synergy. Torque resistance was analyzed during a slow (6°/s) passive elbow rotation, where the elbow moved from the maximal flexion to maximal extension angle and back, to assess elastic joint properties. The torque profile was evaluated during fast (100°/s) passive extension rotation of the elbow to estimate spasticity. Results The ten chronic stroke patients successfully completed the measurement protocol. The results showed impairment values outside the 10th and 90th percentile reference intervals of healthy controls. Individual patient profiles were determined and illustrated in a radar figure, to support clinicians in developing targeted treatment plans. Conclusion The Shoulder Elbow Perturbator can effectively quantify the four most important impairments of the elbow in stroke patients and distinguish impairment scores of patients from healthy controls. These results are promising for objective and complete quantification of motor impairments of the elbow and monitoring patient prognosis. Our newly developed Shoulder Elbow Perturbator can therefore in the future be employed to evaluate treatment effects by comparing pre- and post-treatment assessments. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01050-2.
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Affiliation(s)
- Levinia Lara van der Velden
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. .,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands.
| | - Bram Onneweer
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | | | - Joyce Lisanne Benner
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Marij Eugenie Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | - Gerard Maria Ribbers
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | - Ruud Willem Selles
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
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12
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Aloraini SM, Alyosuf EY, Aloraini LI, Aldaihan MM. Assessment of spasticity: an overview of systematic reviews. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2059942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Saleh M. Aloraini
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Saudi Arabia
| | - Emtenan Y. Alyosuf
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Saudi Arabia
| | - Lamya I. Aloraini
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Saudi Arabia
| | - Mishal M. Aldaihan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
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13
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Leister I, Mittermayr R, Mattiassich G, Aigner L, Haider T, Machegger L, Kindermann H, Grazer-Horacek A, Holfeld J, Schaden W. The effect of extracorporeal shock wave therapy in acute traumatic spinal cord injury on motor and sensory function within 6 months post-injury: a study protocol for a two-arm three-stage adaptive, prospective, multi-center, randomized, blinded, placebo-controlled clinical trial. Trials 2022; 23:245. [PMID: 35365190 PMCID: PMC8973563 DOI: 10.1186/s13063-022-06161-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background The pathological mechanism in acute spinal cord injury (SCI) is dual sequential: the primary mechanical lesion and the secondary injury due to a cascade of biochemical and pathological changes initiated by the primary lesion. Therapeutic approaches have focused on modulating the mechanisms of secondary injury. Despite extensive efforts in the treatment of SCI, there is yet no causal, curative treatment approach available. Extracorporeal shock wave therapy (ESWT) has been successfully implemented in clinical use. Biological responses to therapeutic shock waves include altered metabolic activity of various cell types due to direct and indirect mechanotransduction leading to improved migration, proliferation, chemotaxis, modulation of the inflammatory response, angiogenesis, and neovascularization, thus inducing rather a regeneration than repair. The aim of this clinical study is to investigate the effect of ESWT in humans within the first 48 h after an acute traumatic SCI, with the objective to intervene in the secondary injury phase in order to reduce the extent of neuronal loss. Methods This two-arm three-stage adaptive, prospective, multi-center, randomized, blinded, placebo-controlled study has been initiated in July 2020, and a total of 82 patients with acute traumatic SCI will be recruited for the first stage in 15 participating hospitals as part of a two-armed three-stage adaptive trial design. The focused ESWT (energy flux density: 0.1–0.19 mJ/mm2, frequency: 2–5 Hz) is applied once at the level of the lesion, five segments above/below, and on the plantar surface of both feet within the first 48 h after trauma. The degree of improvement in motor and sensory function after 6 months post-injury is the primary endpoint of the study. Secondary endpoints include routine blood chemistry parameters, the degree of spasticity, the ability to walk, urological function, quality of life, and the independence in everyday life. Discussion The application of ESWT activates the nervous tissue regeneration involving a multitude of various biochemical and cellular events and leads to a decreased neuronal loss. ESWT might contribute to an improvement in the treatment of acute traumatic SCI in future clinical use. Trial registration ClinicalTrials.govNCT04474106 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06161-8.
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Affiliation(s)
- Iris Leister
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelus Medical University, Salzburg, Austria. .,Spinal Cord Injury Center, Clinical Research Unit, BG Trauma Center Murnau, Murnau, Germany. .,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria. .,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria.
| | - Rainer Mittermayr
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Meidling, Vienna, Austria
| | - Georg Mattiassich
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Department of Orthopedics and Trauma Surgery, Klinik Diakonissen Schladming, Schladming, Austria
| | - Ludwig Aigner
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelus Medical University, Salzburg, Austria.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Thomas Haider
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas Machegger
- Division of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, Steyr, Austria
| | | | - Johannes Holfeld
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Schaden
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Meidling, Vienna, Austria
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14
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Hyun C, Kim K, Lee S, Ko N, Lee IS, Koh SE. The Short-term Effects of Hippotherapy and Therapeutic Horseback Riding on Spasticity in Children With Cerebral Palsy: A Meta-analysis. Pediatr Phys Ther 2022; 34:172-178. [PMID: 35184078 PMCID: PMC8959353 DOI: 10.1097/pep.0000000000000880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We systematically reviewed the short-term effects of hippotherapy and therapeutic horseback riding (THR) on lower-limb muscle spasticity in children with cerebral palsy (CP). METHODS PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched for relevant quantitative studies. Treatment effects were coded using the Ashworth scale (AS) or modified Ashworth scale (MAS) in pre- and posttreatment evaluations. Of the 73 studies identified initially, 7 met the inclusion criteria. RESULTS Treatment was associated with positive effects on lower-limb muscle spasticity, as supported by the AS or MAS scores. However, repeated trials did not show a statistically significant difference from a single trial (Q = 2.95, P = .086). CONCLUSION Hippotherapy and THR can be used to treat lower-limb muscle spasticity in children with CP. However, repeated sessions did not show a better effect in reducing spasticity. WHAT THIS ADDS TO THE EVIDENCE This is the first meta-analysis to confirm that hippotherapy or THR can reduce lower-limb muscle spasticity in children with CP in the short term, but long-term effects on function still require further studies.
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Affiliation(s)
- Cheolhwan Hyun
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Seoul, Korea
| | - Kyungmin Kim
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Seoul, Korea
| | - Soolim Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Seoul, Korea
| | - Nayeon Ko
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Seoul, Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Seoul, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Seoul, Korea
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15
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Shu X, McConaghy C, Knight A. Validity and reliability of the Modified Tardieu Scale as a spasticity outcome measure of the upper limbs in adults with neurological conditions: a systematic review and narrative analysis. BMJ Open 2021; 11:e050711. [PMID: 34952873 PMCID: PMC8712979 DOI: 10.1136/bmjopen-2021-050711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate published evidence on the Modified Tardieu Scale (MTS) as a tool to assess spasticity in the upper limbs of adults with neurological conditions. DATA SOURCES A systematic search of six electronic databases (PubMed/MEDLINE, CINAHL, EMBASE, the Cochrane Library, Web of Science and Physiotherapy Evidence Database) from inception to 31 December 2020. A search strategy was developed using key elements of the research question: population, intervention (action), outcome. STUDY ELIGIBILITY CRITERIA Inclusion criteria: (1) adult participants with neurological conditions; (2) upper limb muscles/joints as tested elements; (3) studies testing the MTS and (4) reliability or validity reported. EXCLUSION CRITERIA (1) non-English articles; (2) non-empirical articles and (3) studies testing the Tardieu Scale. STUDY APPRAISAL Evidence quality was evaluated using the US National Heart, Lung, Blood Institute quality assessment tool for observational cohort and cross-sectional studies. RESULTS Six reliability studies met the inclusion criteria. Overall, most articles reported good-to-excellent levels of inter-rater, intrarater and test-retest reliability. However, limitations, such as study design weaknesses, statistical misuses and reporting biases, undermine confidence in reported conclusions. The validity of the MTS also remained questionable based on the results of one study. CONCLUSIONS AND IMPLICATIONS This review did not find sufficient evidence to either support or reject the use of the MTS in assessing spasticity in the upper limbs of adults with neurological conditions. Despite the paucity of research evidence, the MTS may still remain a clinically useful tool to measure the motor aspect of spasticity. Future research would benefit from a focus on test standardisation, while the wider field would require the development of a consensual definition of spasticity.
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Affiliation(s)
- Xiaoyi Shu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Ciara McConaghy
- Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alec Knight
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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16
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Silva SM, Martins RARC, Ribeiro TR. Bruxism in children and adolescents with cerebral palsy. ABCS HEALTH SCIENCES 2021. [DOI: 10.7322/abcshs.2020110.1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This study aims to summarize the existing evidence from primary studies in order to answer the following question: "are children and adolescents with cerebral palsy (CP) frequently affected by bruxism?". For such, databases Web of Science, Medline (via PubMed), Lilacs, SciELO, Scopus and Wiley Online Library were used, with the keywords “Cerebral Palsy” and “Bruxism” alone and in combination, without the restriction of the publication date. The search included all articles published until May 2020. A total of 229 publications were found, of which 12 were selected, after careful analysis. Retrospective data analyses, cross-sectional studies and observational case-control studies published in English and with samples composed of children and/or adolescents were included. Case reports, literature reviews and studies whose sample consisted of adults-only were excluded. In the evaluated studies, bruxism was present in all samples with cerebral palsy. However, oral signs and symptoms resulting from this parafunction were reported only in three studies, in which the presence of dental wear and pain was evaluated. Therefore, bruxism in children and adolescents with cerebral palsy is a frequent oral condition, however, knowledge about the associated and risk factors for the occurrence of this problem in these patients remains limited.
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17
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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: 0] [Impact Index Per Article: 0] [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
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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
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18
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Cabrita JP, Quaresma MC, Bizarra MDF. Prevalence of bruxism in adults with cerebral palsy institutionalized in Lisbon. SPECIAL CARE IN DENTISTRY 2021; 42:155-159. [PMID: 34547111 DOI: 10.1111/scd.12650] [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: 07/29/2021] [Revised: 08/19/2021] [Accepted: 09/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the prevalence of bruxism in individuals with cerebral palsy (CP) and evaluating the various factors associated METHODS: One hundred and ten adults diagnosed with CP were selected from six institutions for people with special needs. Data were collected through oral examinations using the diagnostic criteria proposed by the American Academy of Sleep Medicine and the modified scale of Asworth RESULTS: Of the total sample, spastic tetraplegia was the most common type and half of the population presents severe intellectual disability. The prevalence of bruxism was 74,5%. Wear facets were observed in 67.9% of the sample, 59.1% of which were brilliant. There was a positive association between mixed bruxism (MB) and the spasticity classification. Through a logistic regression it was found that the risk of having MB and general bruxism (GB) is greater in individuals who have shiny wear facets. CONCLUSIONS In the present study the high prevalence of GB indicates there is an urgent need for treatment options in people with CP. More studies are needed with standardized diagnostic protocols and representative samples to evaluate the factors that influence the presence of bruxism in this population and to establish an appropriate treatment planning.
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Affiliation(s)
- Joana P Cabrita
- School of Dental Medicine, University of Lisbon, Lisboa, Portugal
| | - Maria Carlos Quaresma
- Oral Rehabilitation Department, School of Dental Medicine, University of Lisbon, Lisboa, Portugal
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19
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Effects of Ankle Continuous Passive Motion on Soleus Hypertonia in Individuals with Cerebral Palsy: A Case Series. Biomed J 2021; 45:708-716. [PMID: 34332162 PMCID: PMC9486241 DOI: 10.1016/j.bj.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Continuous passive motion device (CPM) provides repetitive movement over extended periods of time for those who have low functional ability. The purpose of this research was to evaluate the effects of a four-week program of continuous passive motion of the ankle joint on the changes in soleus hypertonia in individuals with cerebral palsy who suffered from life-long hypertonia. Methods A single group, repeated-measures study was conducted. Eight individuals (7 males and 1 female with a mean age of 21.8 ± 8.5 years) with spastic cerebral palsy underwent bilateral ankle CPM for 1 h a day, 5 days a week, for 4 weeks. The outcome measures included the Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle, the ratio of maximum H reflex to maximum soleus M-response (H/M ratio), and post-activation depression (PAD). All outcomes were measured before and after the intervention. A paired t-test was used to examine treatment effects pre-versus post-intervention. Results Paired t-tests showed that the CPM program significantly decreased the MAS score (p = 0.006), decreased the maximum H/M ratio (p=0.001), improved PAD (p = 0.003, p = 0.040, and p = 0.032 at 0.2 Hz, 1 Hz, and 2 Hz, respectively), and increased the passive ankle range of motion (p = 0.049). Conclusion Ankle CPM not only reduced soleus hypertonia but also improved the PROM in individuals with cerebral palsy. The results of this study show ankle CPM to be an effective intervention for individuals with cerebral palsy.
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20
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Cooney NJ, Minhas AS. Humanoid Robot Based Platform to Evaluate the Efficacy of Using Inertial Sensors for Spasticity Assessment in Cerebral Palsy. IEEE J Biomed Health Inform 2021; 26:254-263. [PMID: 34115599 DOI: 10.1109/jbhi.2021.3088133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Spasticity is commonly present in individuals with cerebral palsy (CP) and manifests itself as shaky movements, muscle tightness and joint stiffness. Accurate and objective measurement of spasticity is investigated using inertial measurement unit (IMU) sensors. However, use of current IMU-based devices is limited to clinics in urban areas where experienced and trained health professionals are available to collect spasticity data. Designing these devices based on the wearable internet of things based architectures with edge computing will expand their use to home, aged care or remote clinics enabling less-experienced health professionals or care givers to collect spasticity data. However, these new designs require rigorous testing during their prototyping stage and collection of supporting data for regulatory approvals. This work demonstrates that a humanoid robot can act as an accurate model of the movements of CP individuals performing pendulum test during their spasticity assessment. Utilizing this model, we present a robust platform to evaluate new designs of IMU-based spasticity measurement devices.
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21
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Rigot SK, Boninger ML, Ding D, McKernan G, Field-Fote EC, Hoffman J, Hibbs R, Worobey LA. Toward Improving the Prediction of Functional Ambulation After Spinal Cord Injury Though the Inclusion of Limb Accelerations During Sleep and Personal Factors. Arch Phys Med Rehabil 2021; 103:676-687.e6. [PMID: 33839107 DOI: 10.1016/j.apmr.2021.02.029] [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: 10/10/2020] [Revised: 01/21/2021] [Accepted: 02/07/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine if functional measures of ambulation can be accurately classified using clinical measures; demographics; personal, psychosocial, and environmental factors; and limb accelerations (LAs) obtained during sleep among individuals with chronic, motor incomplete spinal cord injury (SCI) in an effort to guide future, longitudinal predictions models. DESIGN Cross-sectional, 1-5 days of data collection. SETTING Community-based data collection. PARTICIPANTS Adults with chronic (>1 year), motor incomplete SCI (N=27). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Ambulatory ability based on the 10-m walk test (10MWT) or 6-minute walk test (6MWT) categorized as nonambulatory, household ambulator (0.01-0.44 m/s, 1-204 m), or community ambulator (>0.44 m/s, >204 m). A random forest model classified ambulatory ability using input features including clinical measures of strength, sensation, and spasticity; demographics; personal, psychosocial, and environmental factors including pain, environmental factors, health, social support, self-efficacy, resilience, and sleep quality; and LAs measured during sleep. Machine learning methods were used explicitly to avoid overfitting and minimize the possibility of biased results. RESULTS The combination of LA, clinical, and demographic features resulted in the highest classification accuracies for both functional ambulation outcomes (10MWT=70.4%, 6MWT=81.5%). Adding LAs, personal, psychosocial, and environmental factors, or both increased the accuracy of classification compared with the clinical/demographic features alone. Clinical measures of strength and sensation (especially knee flexion strength), LA measures of movement smoothness, and presence of pain and comorbidities were among the most important features selected for the models. CONCLUSIONS The addition of LA and personal, psychosocial, and environmental features increased functional ambulation classification accuracy in a population with incomplete SCI for whom improved prognosis for mobility outcomes is needed. These findings provide support for future longitudinal studies that use LA; personal, psychosocial, and environmental factors; and advanced analyses to improve clinical prediction rules for functional mobility outcomes.
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Affiliation(s)
- Stephanie K Rigot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Dan Ding
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Gina McKernan
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Edelle C Field-Fote
- Crawford Research Institute, Shepherd Center, Atlanta, GA; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; Program in Applied Physiology, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
| | - Jeanne Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Rachel Hibbs
- Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Lynn A Worobey
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
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22
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Goo M, Tucker K, Johnston LM. A profile of reference data for shear modulus for lower limb muscles in typically developing children. Clin Biomech (Bristol, Avon) 2021; 83:105254. [PMID: 33740498 DOI: 10.1016/j.clinbiomech.2020.105254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 12/10/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Shear wave elastography can measure shear wave speed in muscles, which is used to estimate shear modulus. Normative values and standardized methodology are needed for children. Study aims were to: estimate shear modulus behavior of lower limb muscles of typically developing children; and establish a profile of reference data and recommendations for clinical assessment. METHODS Forty-one typically developing children (mean 9.7 y, SD 1.9 y) completed assessment of resting shear modulus of rectus femoris, biceps femoris, gastrocnemius lateralis and tibialis anterior at short and long lengths using shear wave elastography. Effects of muscle length, age, sex and BMI were examined. Then, our data and data from a scoping review for typical individuals were collated according to Net-Longitudinal Tension Angle (net proximal and distal joint angles). FINDINGS Shear modulus was: higher at long versus short muscle lengths for all four muscles (P < 0.001); correlated with increasing age for tibialis anterior at short (r = 0.39) and long lengths (r = 0.42) (both P = 0.01); but not related to sex or BMI. Shear modulus: tended to increase with increasing Net-Longitudinal Tension Angle for 18 lower limb muscles; and was higher for children than adults for some muscles (e.g. tibialis anterior and gastrocnemius lateralis, both P < 0.001). INTERPRETATION In typically developing children, shear modulus of lower limb muscles increases with increasing Net-Longitudinal Tension Angle. Recommendations enable comparison of values across different test positions and populations. Some relation between shear modulus and age was identified, but more research is needed.
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Affiliation(s)
- Miran Goo
- The University of Queensland, School of Biomedical Sciences, Brisbane, QLD 4072, Australia
| | - Kylie Tucker
- The University of Queensland, School of Biomedical Sciences, Brisbane, QLD 4072, Australia
| | - Leanne M Johnston
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD 4072, Australia.
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Bowal N, Nettel-Aguirre A, Ursulak G, Condliffe E, Robu I, Goldstein S, Emery C, Ronsky JL, Kuntze G. Associations of hamstring and triceps surae muscle spasticity and stance phase gait kinematics in children with spastic diplegic cerebral palsy. J Biomech 2021; 117:110218. [PMID: 33486260 DOI: 10.1016/j.jbiomech.2020.110218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/08/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
Clinical decisions on interventions to improve function in children with cerebral palsy (CP) are based, in part, on hypothesized interactions amongst physical signs of CP and functional deficits. However, a knowledge gap exists regarding associations between spasticity and gait function. This study quantified associations of hamstring and triceps surae spasticity with hip, knee and ankle CP gait patterns. This is a cohort study of children and adolescents [n = 51; 31 male; 20 female; spastic diplegia; Gross Motor Function Classification System I (n = 23) and II (n = 28)] who participated in a clinical consult including gait (Motion Analysis, USA) and modified Tardieu scale (MTS) testing (hamstrings, triceps surae). Shape-based clustering was performed on stance phase sagittal hip, knee and ankle patterns using z-normalized and non-normalized data. Linear regression (R, v3.5.0, R Core Team, Austria) was conducted to assess associations between MTS measures and data clusters (α = 0.05). Shape-clustering revealed two hip and three knee and ankle clusters for z-normalized and non-normalized data. Significant associations of hamstring spasticity and joint patterns were observed for z-normalized knee clusters (CKnee A p = 0.002; CKnee B p = 0.006) and interactions amongst non-normalized hip and knee clusters (CHipA:CKnee B p = 0.033). Trends were observed for soleus spasticity and gastrocnemius range of motion angle and non-normalized ankle clusters (CAnkle B p = 0.051; CAnkle B p = 0.053 respectively). Significant associations of early knee extension and hamstring spasticity, observed using shape-clustering of z-normalized data, provide unique information that may inform the identification of individuals most likely to benefit from spasticity management and targets for spasticity management assessment.
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Affiliation(s)
- N Bowal
- Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - A Nettel-Aguirre
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - G Ursulak
- C.H. Riddell Movement Assessment Center, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - E Condliffe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - I Robu
- C.H. Riddell Movement Assessment Center, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - S Goldstein
- Section of Pediatric Orthopaedic Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - C Emery
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada; Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - J L Ronsky
- Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada; Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - G Kuntze
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
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Use of Vitamin D Bolus in Fortified Juice for Improving Vitamin D Status in Children with Cerebral Palsy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1339:257-264. [DOI: 10.1007/978-3-030-78787-5_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Marsico P, Frontzek-Weps V, van Hedel HJA. Velocity dependent measure of spasticity: Reliability in children and juveniles with neuromotor disorders. J Pediatr Rehabil Med 2021; 14:219-226. [PMID: 33998556 DOI: 10.3233/prm-200704] [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: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to create a clear, standardized test description to rate spasticity severity into four categories according to the definition given by Lance [1], referred to as the Velocity Dependent Measure of Spasticity (VDMS). METHOD Muscle groups of the upper and lower limbs of children with neuromotor disorders were evaluated on their response to passive movement in a fast-versus slow-velocity test condition. The interrater and test-retest reliability were assessed using Gwet's alpha one (95%-CI) and the percentage agreement. RESULTS Two physiotherapists independently assessed 45 children and youths (age 4-19 years). The interrater reliability of the VDMS was substantial to almost perfect (Gwet's alpha one: 0.66-0.99, n= 45) while the test-retest reliability was almost perfect as well (Gwet's alpha one: 0.83-1.00, n= 42). CONCLUSION The VDMS can be recommended as a reliable assessment with a standardized procedure to assess spasticity of the extremities in children with neuromotor disorders.
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Affiliation(s)
- Petra Marsico
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center CRC, University Children's Hospital Zurich, Zurich, Switzerland.,Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland
| | - Victoria Frontzek-Weps
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center CRC, University Children's Hospital Zurich, Zurich, Switzerland.,Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Hubertus J A van Hedel
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center CRC, University Children's Hospital Zurich, Zurich, Switzerland.,Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland
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26
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Lundkvist Josenby A, Westbom L. No support that early selective dorsal rhizotomy increase frequency of scoliosis and spinal pain - a longitudinal population-based register study from four to 25 years of age. BMC Musculoskelet Disord 2020; 21:782. [PMID: 33246436 PMCID: PMC7697382 DOI: 10.1186/s12891-020-03782-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at 4 years of age. Variables associated with scoliosis at 20 years of age were explored. Method In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990–2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at 4 years of age and were included; 36 had undergone SDR at a median age of 4.0 years (range 2.5–6.6 years), and 113 had not. Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at 4 years of age were used for stratification. Result Frequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p = 0.004). Frequency of spinal pain did not differ between the groups (p- levels > 0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age. Conclusion Frequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03782-5.
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Affiliation(s)
- Annika Lundkvist Josenby
- Children's Hospital, Skåne University Hospital, Lund, Sweden. .,Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden.
| | - Lena Westbom
- Children's Hospital, Skåne University Hospital, Lund, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
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Pennington M, Summers J, Coker B, Eddy S, Kartha MR, Edwards K, Freeman R, Goodden J, Powell H, Verity C, Peacock JL. Selective dorsal rhizotomy; evidence on cost-effectiveness from England. PLoS One 2020; 15:e0236783. [PMID: 32776949 PMCID: PMC7416930 DOI: 10.1371/journal.pone.0236783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/15/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Selective dorsal rhizotomy (SDR) has gained interest as an intervention to reduce spasticity and pain, and improve quality of life and mobility in children with cerebral palsy mainly affecting the legs (diplegia). We evaluated the cost-effectiveness of SDR in England. Methods Cost-effectiveness was quantified with respect to Gross Motor Function Measure (GMFM-66) and the pain dimension of the Cerebral Palsy Quality of Life questionnaire for Children (CPQOL-Child). Data on outcomes following SDR over two years were drawn from a national evaluation in England which included 137 children, mean age 6.6 years at surgery. The incremental impact of SDR on GMFM-66 was determined through comparison with data from a historic Canadian cohort not undergoing SDR. Another single centre provided data on hospital care over ten years for 15 children undergoing SDR at a mean age of 7.0 years, and a comparable cohort managed without SDR. The incremental impact of SDR on pain was determined using a before and after comparison using data from the national evaluation. Missing data were imputed using multiple imputation. Incremental costs of SDR were determined as the difference in costs over 5 years for the patients undergoing SDR and those managed without SDR. Uncertainty was quantified using bootstrapping and reported as the cost-effectiveness acceptability curve. Results In the base case, the incremental cost-effectiveness ratios (ICERs) for SDR are £1,382 and £903 with respect to a unit improvement in GMFM-66 and the pain dimension of CPQOL-Child, respectively. Inclusion of data to 10 years indicates SDR is cheaper than management without SDR. Incremental costs and ICERs for SDR rose in sensitivity analysis applying an alternative regression model to cost data. Conclusions Data on outcomes from a large observational study of SDR and long-term cost data on children who did and did not receive SDR indicates SDR is cost-effective.
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Affiliation(s)
- Mark Pennington
- Kings Health Economics, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, United Kingdom
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- * E-mail:
| | - Jennifer Summers
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Bola Coker
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Saskia Eddy
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Muralikrishnan R. Kartha
- Kings Health Economics, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, United Kingdom
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Karen Edwards
- The Robert Jones & Agnes Hunt Hospital, Oswestry, United Kingdom
| | - Robert Freeman
- The Robert Jones & Agnes Hunt Hospital, Oswestry, United Kingdom
| | - John Goodden
- Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom
| | - Helen Powell
- National Institute for Health and Care Excellence, Manchester, United Kingdom
| | | | - Janet L. Peacock
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
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28
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Hegazy FA, Aboelnasr EA, Salem YT. Effect of lidocaine iontophoresis combined with exercise intervention on gait and spasticity in children with spastic hemiplegic cerebral palsy: A randomized controlled trial. NeuroRehabilitation 2020; 47:133-141. [PMID: 32716326 DOI: 10.3233/nre-203152] [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: 11/15/2022]
Abstract
BACKGROUND Gait deviations and spasticity are common impairments seen in children with cerebral palsy (CP) and may interfere with functional performance and effective walking pattern. Lidocaine iontophoresis is effective for reducing muscle spasticity in adults. PURPOSE To investigate the effect of lidocaine epinephrine iontophoresis combined with exercises on gait and spasticity in children with spastic hemiplegic cerebral palsy (HCP). METHODS Thirty children with spastic HCP aged 4-6 (5.20±0.32) years were randomly assigned to the experimental group (n = 15) and control group (n = 15). Children in both groups received one hour of exercises, three times a week for three months. Children in the experimental group received 2% lidocaine iontophoresis immediately before the exercises. The lidocaine iontophoresis was delivered for 20 minutes (1mA/min). Spatio-temporal gait parameters were assessed within one week before and after the intervention using 3D motion analysis. Surface electromyography was used to assess muscle tone using H/M ratio of the soleus muscle. ANOVA was used to investigate the differences between experimental and control groups. Statistical significance was set at P value less than 0.05. RESULTS There was no difference between groups at baseline. Post-intervention, the experimental group showed significant improvements when compared to the control group for gait speed (p = 0.03), stride length (p = 0.04), cadence (p = 0.0001), cycle time (p = 0.0001), and H/M ratio (p = 0.02). CONCLUSION Lidocaine iontophoresis combined with exercises was effective in improving gait spatiotemporal parameters and reducing spasticity in children with CP.
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Affiliation(s)
- Fatma A Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | | | - Yasser T Salem
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt.,Department of Physical Therapy, University of North Texas Health Science Center, Texas, USA
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29
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The utility of shear wave elastography in the evaluation of muscle stiffness in patients with cerebral palsy after botulinum toxin A injection. J Med Ultrason (2001) 2020; 47:609-615. [PMID: 32705628 DOI: 10.1007/s10396-020-01042-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The first aim of this study was to evaluate changes in the stiffness of the medial gastrocnemius muscle (GM) after a botulinum toxin A (BoNT-A) injection in children with cerebral palsy (CP) using shear wave elastography (SWE). We also wanted to investigate the usability of SWE for evaluating spasticity in a clinical setting. The second aim of this study was to show how treatment of the gastrocnemius muscle spasticity caused a change in the elasticity of the anterior tibial (TA) muscle. METHODS Twenty-four pediatric patients diagnosed with a spastic type of CP, who were scheduled to receive a BoNT-A injection in the gastrocnemius muscle, were included in the study. There was a total of 43 lower extremities to evaluate, and muscle stiffness was measured before the injection and a month post injection using SWE. The physiatrist evaluated muscle spasticity using the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale at about the same time. RESULTS SWE values of the GM (pre-BoNT-A: 45.9 ± 6.5 kPa, post-BoNT-A: 25.0 ± 5.7 kPa) decreased significantly post BoNT-A injection (P < 0.01). SWE measurements of the GM had positive correlations with MAS, V1X, V3X, and R2-R1 (P < 0.01); and negative correlations with R2 and R1 (P < 0.05). SWE values of the TA muscle (pre: 36.9 ± 7.9 kPa, post: 28.4 ± 5.2 kPa) decreased significantly (P < 0.01). CONCLUSION Quantitative measurement of muscle stiffness using SWE may provide important information for the evaluation of spasticity and treatment efficiency in pediatric CP patients.
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Johnston K, Danchenko N, Hansen R, Dinet J, Liovas A, Armstrong A, Bains S, Sullivan SD. Cost effectiveness and impact on quality of life of abobotulinumtoxinA and onabotulinumtoxinA in the treatment of children with lower limb spasticity in Canada. J Med Econ 2020; 23:631-640. [PMID: 31985313 DOI: 10.1080/13696998.2020.1722138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Injectable botulinum neurotoxins are a mainstay of treatment for pediatric spasticity. AbobotulinumtoxinA and onabotulinumtoxinA are both injectable toxin therapies used to treat pediatric lower limb (PLL) spasticity in Canada. The objective of this study was to assess the cost-effectiveness of abobotulinumtoxinA vs. onabotulinumtoxinA in the treatment of PLL spasticity in Canada.Methods: A probabilistic Markov cohort model with a 2-year time horizon was developed, with health states defined by response to therapy, as characterized by the goal attainment scale (GAS). Based on randomized controlled trial evidence, response to therapy was similar or higher for abobotulinumtoxinA relative to onabotulinumtoxinA; uncertainty was incorporated into model parameters, however, as the two therapies have not been compared head-to-head. Canadian resource use and cost data were incorporated.Results: In the base case, abobotulinumtoxinA generated 1.48 quality-adjusted life years over the model time horizon, compared to 1.47 for onabotulinumtoxinA. AbobotulinumtoxinA was associated with cost savings of $123 CAD, reflecting lower costs in both medication acquisition and health services. The estimated improvement to quality of life and reduced costs result in an estimate of economic dominance for abobotulinumtoxinA over onabotulinumtoxinA. This dominant result persisted across probabilistic and scenario analyses.Key points for decision makersBased on a review of available clinical evidence, abobotulinumtoxinA was found to have significant and/or numerical efficacy benefits to onabotulinumtoxinA on functional outcomes (Goal Attainment Scale) and tone (Modified Ashworth Scale) and in the treatment of pediatric lower limb spasticityIn this cost-effectiveness analysis, abobotulinumtoxinA was found to be associated with greater quality-adjusted life years and lower costs than onabotulinumtoxinA (economically dominant)A limitation of this analysis was the uncertainty around key parameters. Specifically, the lack of head-to-head comparison data for the two therapies, and variable data regarding likely onabotulinumtoxinA dosing in PLL in clinical practice. However, across a range of plausible scenarios, the economic dominant result remained.
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Affiliation(s)
- Karissa Johnston
- Broadstreet Health Economics and Outcomes Research, Vancouver, Canada
| | | | - Ryan Hansen
- Choice Institute, University of Washington, Seattle, WA, USA
| | - Jerome Dinet
- Ipsen Biopharmaceuticals Canada, Mississauga, Canada
| | - Anna Liovas
- Ipsen Biopharmaceuticals Canada, Mississauga, Canada
| | - Ava Armstrong
- Ipsen Biopharmaceuticals Canada, Mississauga, Canada
| | | | - Sean D Sullivan
- Choice Institute, University of Washington, Seattle, WA, USA
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31
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Kim JY, Park G, Lee SA, Nam Y. Analysis of Machine Learning-Based Assessment for Elbow Spasticity Using Inertial Sensors. SENSORS 2020; 20:s20061622. [PMID: 32183281 PMCID: PMC7146614 DOI: 10.3390/s20061622] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 11/16/2022]
Abstract
Spasticity is a frequently observed symptom in patients with neurological impairments. Spastic movements of their upper and lower limbs are periodically measured to evaluate functional outcomes of physical rehabilitation, and they are quantified by clinical outcome measures such as the modified Ashworth scale (MAS). This study proposes a method to determine the severity of elbow spasticity, by analyzing the acceleration and rotation attributes collected from the elbow of the affected side of patients and machine-learning algorithms to classify the degree of spastic movement; this approach is comparable to assigning an MAS score. We collected inertial data from participants using a wearable device incorporating inertial measurement units during a passive stretch test. Machine-learning algorithms-including decision tree, random forests (RFs), support vector machine, linear discriminant analysis, and multilayer perceptrons-were evaluated in combinations of two segmentation techniques and feature sets. A RF performed well, achieving up to 95.4% accuracy. This work not only successfully demonstrates how wearable technology and machine learning can be used to generate a clinically meaningful index but also offers rehabilitation patients an opportunity to monitor the degree of spasticity, even in nonhealthcare institutions where the help of clinical professionals is unavailable.
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Affiliation(s)
- Jung-Yeon Kim
- ICT Convergence Rehabilitation Engineering Research Center, Soonchunhyang University, Asan 31538, Korea;
| | - Geunsu Park
- Department of ICT Convergence Rehabilitation Engineering, Soonchunhyang University, Asan 31538, Korea;
| | - Seong-A Lee
- Department of Occupational Therapy, Soonchunhyang University, Asan 31538, Korea;
| | - Yunyoung Nam
- Department of Computer Science and Engineering, Soonchunhyang University, Asan 31538, Korea
- Correspondence: ; Tel.: +82-41-530-1282
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Fosdahl MA, Jahnsen R, Pripp AH, Holm I. Change in popliteal angle and hamstrings spasticity during childhood in ambulant children with spastic bilateral cerebral palsy. A register-based cohort study. BMC Pediatr 2020; 20:11. [PMID: 31914961 PMCID: PMC6947838 DOI: 10.1186/s12887-019-1891-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Muscle contractures are developing during childhood and may cause extensive problems in gait and every day functioning in children with cerebral palsy (CP). The aim of the present study was to evaluate how the popliteal angle (PA) and hamstrings spasticity change during childhood in walking children with spastic bilateral CP. METHODS The present study was a longitudinal register-based cohort study including 419 children (1-15 years of age) with spastic bilateral CP, gross motor function classification system (GMFCS) level I, II and III included in the Norwegian CP Follow-up Program (CPOP). From 2006 to 2018 a total of 2193 tests were performed. The children were tested by trained physiotherapists yearly or every second year, depending on GMFCS level and age. The PA and the hamstrings spasticity (Modified Ashworth scale (MAS)) were measured at every time point. Both legs were included in the analysis. RESULTS There was an increase in PA with age for all three GMFCS levels with significant differences between the levels from 1 up to 8 years of age. At the age of 10 years there was no significant difference between GMFCS level II and III. At the age of 14 years all three GMFCS levels had a mean PA above 40° and there were no significant differences between the groups. The hamstrings spasticity scores for all the three GMFCS levels were at the lower end of the MAS (mean < 1+), however they were significantly different from each other until 8 years of age. The spasticity increased the first four years in all three GMFCS levels, thereafter the level I and II slightly increased, and level III slightly decreased, until the age of 15 years. CONCLUSION The present study showed an increasing PA during childhood. There were significantly different PAs between GMFCS level I, II and III up to 8 years of age. At the age of 14 years all levels showed a PA above 40°. The spasticity increased up to 4 years of age, but all the spasticity scores were at the lower end of the MAS during childhood.
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Affiliation(s)
- Merete Aarsland Fosdahl
- Department of Clinical Neuroscience for Children, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway. .,Medical Faculty, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.
| | - Reidun Jahnsen
- Department of Clinical Neuroscience for Children, The Cerebral Palsy Follow-up Program (CPOP), Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Medical Faculty, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Inger Holm
- Division of Orthopaedic Surgery, Department of Research and Development, Oslo University Hospital, Oslo, Norway.,Medical Faculty, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
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Sousa KTD, Ferreira GB, Santos AT, Nomelini QSS, Minussi LODA, Rezende ÉRMDA, Nonato IL. ASSESSMENT OF NUTRITIONAL STATUS AND FREQUENCY OF COMPLICATIONS ASSOCIATED TO FEEDING IN PATIENTS WITH SPASTIC QUADRIPLEGIC CEREBRAL PALSY. REVISTA PAULISTA DE PEDIATRIA 2020; 38:e2018410. [PMID: 32401853 PMCID: PMC7219035 DOI: 10.1590/1984-0462/2020/38/2018410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 05/28/2019] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective: To correlate the nutritional status with variables associated to the type of diet and feeding route of children and adolescents with spastic quadriplegic cerebral palsy (CP). Methods: This cross-sectional study included 28 patients aged ≤13 years old who presented a diagnosis of spastic quadriplegic CP and were followed by the nutrition team of the Outpatient Clinic for Special Patients of Hospital de Clínicas de Uberlândia - Universidade Federal de Uberlândia (HC-UFU), between July/2016 and January/2017. Consent forms were signed by the legal guardians. The nutritional status was evaluated and data on dietary complications food route and type of diet were collected. For the description of data, average and median values were used. Correlation was tested with Spearman’s index. Significance was set at p<0.05. Results: 75% of patients used alternative feeding routes (nasoenteral, catheter or gastrostomy), 57% were eutrophic. The most frequent complications were oropharyngeal dysphagia, reflux and intestinal constipation. No correlation was found between the occurrence of complications and the nutritional status. There was a positive correlation between the diet received and the patient’s nutritional status (0.48; p=0.01), i.e. individuals with adequate caloric and macronutrients intake had a better nutritional status. Conclusions: The results reinforce the need for continued nutritional guidance for the children’s parents/caregivers, as well as the choice of an adequate rout of feeding to each child by the multi-professional team, in order to contribute to improved nutritional status and adequate dietary intake.
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Luo Z, Lo WLA, Bian R, Wong S, Li L. Advanced quantitative estimation methods for spasticity: a literature review. J Int Med Res 2019; 48:300060519888425. [PMID: 31801402 PMCID: PMC7607521 DOI: 10.1177/0300060519888425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Post-stroke spasticity seriously affects patients’ quality of life. Spasticity is
considered to involve both neural and non-neural factors. Current clinical
scales, such as the Modified Ashworth Scale and the Modified Tardieu Scale, lack
reliability and reproducibility. These scales are also unable to identify the
neural and non-neural contributions to spasticity. Surface electromyography and
biomechanical and myotonometry measurement methods for post-stroke spasticity
are discussed in this report. Surface electromyography can provide neural
information, while myotonometry can estimate muscular properties. Both the
neural and non-neural contributions can be estimated by biomechanical
measurement. These laboratory methods can quantitatively assess spasticity. They
can provide more valuable information for further study on treatment and
rehabilitation than clinical scales.
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Affiliation(s)
- Zichong Luo
- Department of Electromechanical Engineering, Faculty of Science
and Technology, University of Macau, Macau, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruihao Bian
- Department of Rehabilitation Medicine, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sengfat Wong
- Department of Electromechanical Engineering, Faculty of Science
and Technology, University of Macau, Macau, China
| | - Le Li
- Department of Rehabilitation Medicine, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, China
- Le Li, Department of Rehabilitation
Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou,
China.
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35
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Chen X, Wu Q, Tang L, Cao S, Zhang X, Chen X. Quantitative assessment of lower limbs gross motor function in children with cerebral palsy based on surface EMG and inertial sensors. Med Biol Eng Comput 2019; 58:101-116. [PMID: 31754980 DOI: 10.1007/s11517-019-02076-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
Abstract
Taking advantage of motion sensing technology, a quantitative assessment method for lower limbs motor function of cerebral palsy (CP) based on the gross motor function measurement (GMFM)-24 scale was explored in this study. According to the motion analysis on GMFM-24 scale, we translated the assessment problem of GMFM-24 scale into a detection problem of different motion modes including static state, fall, step, turning, alternating gait, walking, running, lifting legs, kicking balls, and jumping. The surface electromyography (sEMG) electrodes and inertial sensors were adopted to capture motion data, and a framework integrating a series of detection algorithms was presented for the assessment of lower limbs gross motor function. Two groups of participants including 8 healthy adults and 14 CP children were recruited. A self-developed data acquisition equipment integrating 24 sEMG electrodes and 9 inertial units was adopted for data acquisition. A platform based on two laser beam sensors was used to perform cross-border detection. The parameters/thresholds of motion detection algorithms were determined by the data from healthy adults, and the lower limbs gross motor function evaluation was conducted on 14 CP children. The experimental results verified the feasibility and effectiveness of the proposed quantitative assessment method. Compared to the clinical assessment score based on GMFM-24 scale, 90.1% accuracy was obtained for evaluation of 303 tasks in 14 CP children. The objective motor function assessment method proposed has potential application value for the quantitative assessment of lower limbs motor function of CP children in clinical practice. Graphical abstract The algorithm framework for the assessment of lower limbs gross motor function. Using the GMFM-24 scale as the evaluation standard, a quantitative evaluation program for the lower limbs gross motor function of CP children based on motion sensing technology was proposed.
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Affiliation(s)
- Xiang Chen
- Department of Electronic Science and Technology, University of Science and Technology of China (USTC), Hefei, China.
| | - Qi Wu
- Department of Electronic Science and Technology, University of Science and Technology of China (USTC), Hefei, China
| | - Lu Tang
- Department of Electronic Science and Technology, University of Science and Technology of China (USTC), Hefei, China
| | - Shuai Cao
- Department of Electronic Science and Technology, University of Science and Technology of China (USTC), Hefei, China
| | - Xu Zhang
- Department of Electronic Science and Technology, University of Science and Technology of China (USTC), Hefei, China
| | - Xun Chen
- Department of Electronic Science and Technology, University of Science and Technology of China (USTC), Hefei, China
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What causes increased passive stiffness of plantarflexor muscle–tendon unit in children with spastic cerebral palsy? Eur J Appl Physiol 2019; 119:2151-2165. [DOI: 10.1007/s00421-019-04208-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/06/2019] [Indexed: 01/31/2023]
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37
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Lumsden DE, Crowe B, Basu A, Amin S, Devlin A, DeAlwis Y, Kumar R, Lodh R, Lundy CT, Mordekar SR, Smith M, Cadwgan J. Pharmacological management of abnormal tone and movement in cerebral palsy. Arch Dis Child 2019; 104:775-780. [PMID: 30948360 DOI: 10.1136/archdischild-2018-316309] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The evidence base to guide the pharmacological management of tone and abnormal movements in cerebral palsy (CP) is limited, as is an understanding of routine clinical practice in the UK. We aimed to establish details of motor phenotype and current pharmacological management of a representative cohort across a network of UK tertiary centres. METHODS Prospective multicentre review of specialist motor disorder clinics at nine UK centres, collecting data on clinical features and pharmacological management of children and young people (CYP) with CP over a single calendar month. RESULTS Data were collected from 275 CYP with CP reviewed over the calendar month of October 2017. Isolated dystonia or spasticity was infrequently seen, with a mixed picture of dystonia and spasticity ± choreoathetosis identified in 194/275 (70.5%) of CYP. A comorbid diagnosis of epilepsy was present in 103/275 (37.4%). The most commonly used medications for abnormal tone/movement were baclofen, trihexyphenidyl, gabapentin, diazepam and clonidine. Medication use appeared to be influenced separately by the presence of dystonia or spasticity. Botulinum toxin use was common (62.2%). A smaller proportion of children (12.4%) had undergone a previous neurosurgical procedure for tone/movement management. CONCLUSIONS CYP with CP frequently present with a complex movement phenotype and comorbid epilepsy. They have multiple therapy, medical and surgical management regimens. Future trials of therapeutic, pharmacological or surgical interventions in this population must adequately encompass this complexity in order to be translatable to clinical practice.
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Affiliation(s)
- Daniel E Lumsden
- Paediatric Neurosciences, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Belinda Crowe
- The Neurodisability Service, Great Ormond Street Hospital for Children, London, UK
| | - Anna Basu
- Paediatric Neurology, Royal Victoria Infirmary, Newcastle, UK
| | - Sam Amin
- Paediatric Neurology, University Hospitals Bristol, Bristol, UK
| | - Anita Devlin
- Department of Paediatric Neurology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Yasmin DeAlwis
- Paediatric Neurology, Royal Victoria Infirmary, Newcastle, UK
| | - Ram Kumar
- Paediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Rajib Lodh
- Paediatric Neurorehabilitation, Leeds Children's Hospital, Leeds, UK
| | - Claire T Lundy
- Paediatric Neurodisability, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Santosh R Mordekar
- Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Martin Smith
- Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Jill Cadwgan
- Paediatric Neurosciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Tirosh O, Rutz E. Quantifying the velocity-dependent muscle response during gait of children with Cerebral Palsy. J Electromyogr Kinesiol 2019; 48:76-83. [PMID: 31252283 DOI: 10.1016/j.jelekin.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 04/04/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022] Open
Abstract
A new method is introduced quantifying the velocity-dependent muscle response during gait in spastic muscles of children with Cerebral Palsy. The velocity-dependent muscle activation Index is calculated during a 3-dimensional gait analysis using segment angular velocity and the Instantaneous Mean Frequency calculated from surface electromyography. Typical developed children (n = 11) and children with hemiplegia (n = 11) aging from 8 to 19 years participated in the study. The rectus femoris and the medial gastrocnemius were assessed by calculating the velocity dependent muscle activation Index and the modified Ashworth Scale. Greater velocity-dependent muscle activation Index values for both medial gastrocnemius and rectus femoris muscles were associated with greater Ashworth Scale. Post hoc analysis revealed significant lower velocity-dependent muscle activation Index means in the Typical developed group compared with Ashworth Scale scores of 1, 2, 3, and 5. In addition, velocity-dependent muscle activation Index for Ashworth Scale 0, 1, and 2 were significantly lower than for Ashworth Scale 3 and 5. The velocity dependent muscle activation Index showed negative low correlation with walking speed and cadence. Findings show that spastic muscles can be quantified during dynamic functional task such as walking. Future studies should investigate the reliability of the velocity-dependent muscle activation Index that may be used for the assessment of spasticity management such as Botulinum toxin A interventions.
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Affiliation(s)
- Oren Tirosh
- Department of Health and Medical Science, Swinburne University of Technology, Melbourne, Australia.
| | - Erich Rutz
- Department of Orthopedic Surgery, University Children's Hospital Basel, Spitalstrasse 33, 4056 Basel, Switzerland; Murdoch Children's Research Institute, Melbourne, Australia
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Lee H, Kim EK, Son DB, Hwang Y, Kim JS, Lim SH, Sul B, Hong BY. The Role of Regular Physical Therapy on Spasticity in Children With Cerebral Palsy. Ann Rehabil Med 2019; 43:289-296. [PMID: 31311250 PMCID: PMC6637053 DOI: 10.5535/arm.2019.43.3.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/30/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the effect of physical therapy (PT) intervention on spasticity in patients with cerebral palsy (CP), and to assess the degree of deterioration of spasticity when regular PT is interrupted in those patients. METHODS We recruited 35 children with spastic CP who visited our hospital for PT, and whose Modified Tardieu Scale (MTS) scores were serially recorded including before and after a 10-day public holiday time frame period. The outcome measures were the angle of range of motion (ROM) of dorsiflexion of the ankle joint (R1 and R2) in the knee flexion and extension positions as assessed using the MTS. RESULTS The range of dorsiflexion of the ankle joint (R1 and R2) after the holiday period was significantly decreased as compared with that measured ROM noted before the holiday period, regardless of the knee position, age, or gross motor function. The dynamic component of the MTS (R2-R1) showed a slight decrease in the knee flexion position. CONCLUSION Interruption of regular PT aggravated spasticity and decreased ankle joint ROM in children with spastic CP. Our findings suggest that regular PT in the care continuum for children with CP is crucial for the maintenance of ROM in the spastic ankle joints.
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Affiliation(s)
- Heewon Lee
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Eun Kyung Kim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Dong Baek Son
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Youngdeok Hwang
- Department of Statistics, Sungkyunkwan University, Seoul, Korea
| | - Joon-Sung Kim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bomi Sul
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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40
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Lindén O, Hägglund G, Rodby-Bousquet E, Wagner P. The development of spasticity with age in 4,162 children with cerebral palsy: a register-based prospective cohort study. Acta Orthop 2019; 90:286-291. [PMID: 30907682 PMCID: PMC6534199 DOI: 10.1080/17453674.2019.1590769] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Spasticity is often regarded as a major cause of functional limitation in children with cerebral palsy (CP). We analyzed the spasticity development with age in the gastrosoleus muscle in children with CP. Children and methods - This is a longitudinal cohort study of 4,162 children (57% boys) with CP born in 1990-2015, monitored using standardized follow-up examinations in the Swedish surveillance program for CP. The study is based on 57,953 measurements of spasticity of the gastrosoleus muscle assessed using the Ashworth scale (AS) in participants between 0 and 15 years of age. The spasticity was analyzed in relation to age, sex, and Gross Motor Function Classification System (GMFCS) levels using a linear mixed model. Development of spasticity with age was modeled as a linear spline. Results - The degree of spasticity increased in most children over the first 5 years of life. At 5 years of age, 38% had an AS level of ≥ 2. The spasticity then decreased for 65% of the children during the remaining study period. At 15 years of age only 22% had AS ≥ 2. The level of spasticity and the rate of increase and decrease before and after 5.5 years of age were higher in children at GMFCS IV-V. Interpretation - The degree of spasticity of the gastrosoleus muscle often decreases after 5 years of age, which is important for long-term treatment planning and should be considered in spasticity management.
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Affiliation(s)
- Olof Lindén
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden;; ,Correspondence:
| | - Gunnar Hägglund
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden;;
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden;; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden
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41
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Wu YN, Park HS, Chen JJ, Ren Y, Roth EJ, Zhang LQ. Position as Well as Velocity Dependence of Spasticity-Four-Dimensional Characterizations of Catch Angle. Front Neurol 2018; 9:863. [PMID: 30416478 PMCID: PMC6212511 DOI: 10.3389/fneur.2018.00863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022] Open
Abstract
We investigated the muscle alterations related to spasticity in stroke quantitatively using a portable manual spasticity evaluator. Methods: Quantitative neuro-mechanical evaluations under controlled passive elbow stretches in stroke survivors and healthy controls were performed in a research laboratory of a rehabilitation hospital. Twelve stroke survivors and nine healthy controls participated in the study. Spasticity and catch angle were evaluated at 90°/s and 270°/s with the velocities controlled through real-time audiovisual feedback. The elbow range of motion (ROM), stiffness, and energy loss were determined at a slow velocity of 30°/s. Four-dimensional measures including joint position, torque, velocity and torque change rate were analyzed jointly to determine the catch angle. Results: The catch angle was dependent on the stretch velocity and occurred significantly later with increasing velocity (p < 0.001), indicating position dependence of spasticity. The higher resistance felt by the examiner at the higher velocity was also due to more extreme joint position (joint angle) since the spastic joint was moved significantly further to a stiffer elbow position with the higher velocity. Stroke survivors showed smaller ROM (p < 0.001), higher stiffness (p < 0.001), and larger energy loss (p = 0.005). Compared to the controls, stroke survivors showed increased reflex excitability with higher reflex-mediated torque (p < 0.001) and at higher velocities (p = 0.02). Conclusion: Velocity dependence of spasticity is partially due to joint angle position dependence with the joint moved further (to a stiffer position where higher resistance was felt) at a higher velocity. The “4-dimensional characterization” including the joint angle, velocity, torque, and torque change rate provides a systematic tool to characterize catch angle and spasticity quantitatively.
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Affiliation(s)
- Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korean Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jia-Jin Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yupeng Ren
- Rehabtek LLC, Glenview, IL, United States
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, Department of Orthopaedics, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
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42
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Hwang J, Shin Y, Park JH, Cha YJ, You JSH. Effects of Walkbot gait training on kinematics, kinetics, and clinical gait function in paraplegia and quadriplegia. NeuroRehabilitation 2018; 42:481-489. [PMID: 29660947 DOI: 10.3233/nre-172226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population. OBJECTIVE The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia. METHODS Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program. RESULTS Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P < 0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities. CONCLUSIONS These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.
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Affiliation(s)
- Jongseok Hwang
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
| | - Yongil Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea
| | - Ji-Ho Park
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
| | - Young Joo Cha
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
| | - Joshua Sung H You
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
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Brændvik SM, Elkamil AI, Klund-Hansen SL, Roeleveld K. Physiological responses during clinical spasticity evaluation in elbow flexors in children with cerebral palsy. Physiother Theory Pract 2018; 36:691-700. [PMID: 30028217 DOI: 10.1080/09593985.2018.1491079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Tardieu test is often used to identify and evaluate the severity of spasticity for clinical decision-making and treatment evaluation in cerebral palsy (CP). Objective: The study's objective was to gain further insight into the construct validity of clinical spasticity evaluation in children with CP. Methods: The kinematics and neuromuscular response of the biceps brachii (BB) during passive elbow extension were studied when performing the Tardieu test with its corresponding clinical interpretation. Fifteen children with unilateral spastic CP and 15 typically developing (TD) peers 15 (median/interquartile range age; 13/4 and 12/5 years, respectively) participated. Results: A clinical catch was detected in 9 of the 15 children with CP. During fast passive elbow extension, the CP group had higher BB activation (p = 0.041), lower fast maximal angular velocity (p = 0.001), and decelerated earlier in the extension movement (p = 0.001). Discussion: On average, the CP group without a clinical detected catch were closer to TD for all those variables, but this only reached statistical 20 significance in the latter variable (p = 0.018). This inconsistency also shows in possibly one false positive and three false negative catch observations. Conclusion: The Tardieu test should be carried out with caution on individual level and more studies including kinematic and neuromuscular measures are necessary.
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Affiliation(s)
- Siri Merete Brændvik
- Faculty of Medicine and Health, Department of Neuromedicine and Movement Science , Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Clinical Services, St. Olavs University Hospital , Trondheim, Norway
| | - Areej I Elkamil
- Faculty of Medicine and Health, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU , Trondheim, Norway
| | - Sandra Linnea Klund-Hansen
- Faculty of Medicine and Health, Department of Neuromedicine and Movement Science , Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Sunnaas Rehabilitation Hospital, Nesodden , Norway
| | - Karin Roeleveld
- Faculty of Medicine and Health, Department of Neuromedicine and Movement Science , Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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44
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Goo M, Tucker K, Johnston LM. Muscle tone assessments for children aged 0 to 12 years: a systematic review. Dev Med Child Neurol 2018; 60:660-671. [PMID: 29405265 DOI: 10.1111/dmcn.13668] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 01/10/2023]
Abstract
AIM The aim of this study was to identify and examine the psychometric properties of muscle tone assessments for children aged 0 to 12 years. METHOD Four electronic databases were searched to identify studies that included assessments of resting and/or active muscle tone. Methodological quality and overall psychometric evidence of studies were rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. RESULTS Twenty-one assessments were identified from 97 included studies. All assessments were broad developmental assessments that included muscle tone items or subscales. Most assessments (16/21) were designed for young children (<2y). Four assessments measured resting and active tone and demonstrated at least moderate validity or reliability: the Amiel-Tison Neurological Assessment (ATNA) at term, Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS), Premie-Neuro for newborn infants, and the Hammersmith Infant Neurological Examination (HINE) for infants aged 2 months to 2 years. For children over 2 years, the Neurological Sensory Motor Developmental Assessment (NSMDA) assesses resting and active tone but has limited validity. INTERPRETATION The ATNA at term, NNNS, Premie-Neuro, HINE, and NSMDA can assess resting and active tone in infants and/or children. Further psychometric research is required to extend reliability, validity, and responsiveness data, particularly for older children. WHAT THIS PAPER ADDS This is the first review of muscle tone assessments for children aged 0 to 12 years. Twenty-one assessments contain muscle tone items and 16 are for children under 2 years. Four assessments are reliable or valid to measure both resting and active tone.
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Affiliation(s)
- Miran Goo
- School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Kylie Tucker
- School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne M Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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45
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A novel sensor-based assessment of lower limb spasticity in children with cerebral palsy. J Neuroeng Rehabil 2018; 15:45. [PMID: 29866177 PMCID: PMC5987429 DOI: 10.1186/s12984-018-0388-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 05/14/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To provide effective interventions for spasticity, accurate and reliable spasticity assessment is essential. For the assessment, the Modified Tardieu Scale (MTS) has been widely used owing to its simplicity and convenience. However, it has poor or moderate accuracy and reliability. METHODS We proposed a novel inertial measurement unit (IMU)-based MTS assessment system to improve the accuracy and reliability of the MTS itself. The proposed system consists of a joint angle calculation algorithm, a function to detect abnormal muscle reaction (a catch and clonus), and a visual biofeedback mechanism. Through spastic knee and ankle joint assessment, the proposed IMU-based MTS assessment system was compared with the conventional MTS assessment system in 28 children with cerebral palsy by two raters. RESULTS The results showed that the proposed system has good accuracy (root mean square error < 3.2°) and test-retest and inter-rater reliabilities (ICC > 0.8), while the conventional MTS system has poor or moderate reliability. Moreover, we found that the deteriorated reliability of the conventional MTS system comes from its goniometric measurement as well as from irregular passive stretch velocity. CONCLUSIONS The proposed system, which is clinically relevant, can significantly improve the accuracy and reliability of the MTS in lower limbs for children with cerebral palsy.
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Cai Y, Zhang CS, Ouyang W, Li J, Nong W, Zhang AL, Xue CC, Wen Z. Electroacupuncture for poststroke spasticity (EAPSS): protocol for a randomised controlled trial. BMJ Open 2018; 8:e017912. [PMID: 29487073 PMCID: PMC5855476 DOI: 10.1136/bmjopen-2017-017912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Spasticity is a common complication of stroke. Current therapies for poststroke spasticity (PSS) have been reported to be associated with high costs, lack of long-term benefit and unwanted adverse events (AEs). Electroacupuncture (EA) has been used for PSS, however, its efficacy and safety is yet to be confirmed by high-quality clinical studies. This study is designed to evaluate the add-on effects and safety profile of EA when used in combination with usual care (UC). METHODS AND ANALYSIS This study is a parallel group randomised controlled trial. A total of 136 participants will be included and randomly assigned to either the treatment group (EA plus UC) or the control group (UC alone). Prior to the main trial, a pilot study involving 30 participants will be conducted to assess the feasibility of the trial protocol. EA will be administered by registered acupuncturists for 20min to 30 min, three times per week for 4 weeks. The primary outcome measure (Modified Ashworth Scale) and secondary outcome measures (Fugl-Meyer Assessment and Barthel Index) will be evaluated at baseline, the end of treatment (week 4) and the end of follow-up (week 8). AEs will be monitored, recorded and reported, and their causality will be explored. ETHICS AND DISSEMINATION Ethics approval was obtained from the ethics committees of Guangdong Provincial Hospital of Chinese Medicine and RMIT University in December 2016. The results will be disseminated in a peer-reviewed journal, and PhD theses and might be presented at international conferences. TRIAL REGISTRATION NUMBER ChiCTR-IOR-16010283; Pre-results.
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Affiliation(s)
- Yiyi Cai
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Claire Shuiqing Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Wenwei Ouyang
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jianmin Li
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenheng Nong
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Charlie Changli Xue
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Zehuai Wen
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Marques IA, Silva MB, Silva AN, Luiz LMD, Soares AB, Naves ELM. Measurement of post-stroke spasticity based on tonic stretch reflex threshold: implications of stretch velocity for clinical practice. Disabil Rehabil 2017; 41:219-225. [PMID: 28969434 DOI: 10.1080/09638288.2017.1381183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The most commonly used method for the clinical evaluation of spasticity is the modified Ashworth scale (MAS), which is subjective. In this regard, the spasticity assessment through the tonic stretch reflex threshold, which is an objective method, has emerged as an alternative. It is based on the value of the dynamic stretch reflex threshold, which is measured at different stretch velocities. However, by this definition, it is not possible to define the speed at which passive stretches should be performed during evaluation. OBJECTIVE This study aimed to evaluate whether the speed-variation sequence used to acquire the dynamic stretch reflex threshold influences the tonic stretch reflex threshold (TSRT) and, consequently, the estimation of spasticity by this method. METHODS Three forms of stretching-variation speed were adopted, i.e., increasing, decreasing, and randomised. The study was performed using 10 post-stroke patients. RESULTS AND CONCLUSIONS The results showed that the stretch protocols were not all the same and that the method of increasing was most suitable for performing manual passive stretches to evaluate TSRT in these patients. Another analysis was the correlation between MAS and tonic stretch reflex threshold; a weak correlation was observed between the increasing and decreasing methods, and moderate correlation was observed between the random methods. Implications for Rehabilitation We demonstrated that the protocol of execution of passive stretches influences in the measurement of the tonic stretch reflex threshold (TSRT). We recommend the method of increasing velocity for performing manual passive stretches. We also build software with a reliable biological data acquisition system, which makes acquisition and processing of data in real time. In this way, the TSRT is a promising quantitative measure to assess post-stroke spasticity, calculated automatically. We also we provided the use of portable instruments to facilitate the assessment of spasticity in clinical practice.
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Affiliation(s)
- Isabela Alves Marques
- a Faculty of Electrical Engineering , Assistive Technologies Group, Federal University of Uberlandia , Uberlandia , Brazil
| | - Maristella Borges Silva
- a Faculty of Electrical Engineering , Assistive Technologies Group, Federal University of Uberlandia , Uberlandia , Brazil
| | - Andrei Nakagawa Silva
- a Faculty of Electrical Engineering , Assistive Technologies Group, Federal University of Uberlandia , Uberlandia , Brazil
| | - Luiza Maire David Luiz
- a Faculty of Electrical Engineering , Assistive Technologies Group, Federal University of Uberlandia , Uberlandia , Brazil
| | - Alcimar Barbosa Soares
- a Faculty of Electrical Engineering , Assistive Technologies Group, Federal University of Uberlandia , Uberlandia , Brazil
| | - Eduardo Lázaro Martins Naves
- a Faculty of Electrical Engineering , Assistive Technologies Group, Federal University of Uberlandia , Uberlandia , Brazil
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Lotfian M, Mirbagheri MM, Kharazi MR, Dadashi F, Nourian R, Irani A, Mirbagheri A. Pendulum test measure correlates with gait parameters in children with cerebral palsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:1708-1711. [PMID: 28268656 DOI: 10.1109/embc.2016.7591045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Individuals with cerebral palsy (CP) usually suffer from different impairments including gait impairment and spasticity. Spastic hypertonia is a defining feature of spasticity and manifests as a mechanical abnormality. The objective of this study was to determine the relationship between spastic hypertonia and gait impairments in spastic children with CP, addressing an important controversial issue. Spastic hypertonia was quantified using the pendulum test. The gait impairments were evaluated using the motion capture system in a gait laboratory. Our results showed significant correlations among gait parameters; i.e. walking speed, step length, and the pendulum test measures. This indicates that neuromuscular abnormalities are associated with spasticity and may contribute to gait impairments. The clinical implication is that the impaired gait in children with CP may be improved with the treatment of neuromuscular abnormalities.
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Auvichayapat P, Aree-uea B, Auvichayapat N, Phuttharak W, Janyacharoen T, Tunkamnerdthai O, Boonphongsathian W, Ngernyam N, Keeratitanont K. Transient Changes in Brain Metabolites after Transcranial Direct Current Stimulation in Spastic Cerebral Palsy: A Pilot Study. Front Neurol 2017; 8:366. [PMID: 28824525 PMCID: PMC5534437 DOI: 10.3389/fneur.2017.00366] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 07/12/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Muscle spasticity is a disability caused by damage to the pyramidal system. Standard treatments for spasticity include muscle stretching, antispastic medications, and tendon release surgeries, but treatment outcomes remain unsatisfactory. Anodal transcranial direct current stimulation (tDCS) in patients with muscle spasticity is known to result in significant improvement in spastic tone (p < 0.001). However, the mechanism of action by which tDCS treatment affects spasticity remains unclear. This pilot study aimed to investigate the effect of anodal tDCS upon brain metabolites in the left basal ganglia and ipsilateral primary motor cortex (M1) in children with spastic cerebral palsy (CP). MATERIALS AND METHODS This study consisted of three steps: a baseline evaluation, a treatment period, and a follow-up period. During the treatment period, patients were given 20 min of 1 mA anodal tDCS over the left M1 for five consecutive days. Outcomes were compared between pre- and immediate posttreatment in terms of brain metabolites, Tardieu scales, and the quality of upper extremity skills test. RESULTS Ten patients with spastic CP were enrolled. Following tDCS, there were significant increases in the ratio of N-acetylaspartate (NAA)/creatine (Cr) (p = 0.030), choline (Cho)/Cr (p = 0.043), and myoinositol (mI)/Cr (p = 0.035) in the basal ganglia. Moreover, increased glutamine-glutamate (Glx)/Cr ratio in the left M1 (p = 0.008) was found. In addition, we also observed improvements in the extent of spasticity and hand function (p = 0.028). CONCLUSION Five consecutive days of anodal tDCS over the left M1 appeared statistically to reduce the degree of spasticity and increase NAA, Cho, mI, and Glx. Future research studies, involving a larger sample size of spastic CP patients undergoing tDCS is now warranted.
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Affiliation(s)
- Paradee Auvichayapat
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Benchaporn Aree-uea
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narong Auvichayapat
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Warinthorn Phuttharak
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Taweesak Janyacharoen
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Orathai Tunkamnerdthai
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Niran Ngernyam
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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van den Noort JC, Bar-On L, Aertbeliën E, Bonikowski M, Braendvik SM, Broström EW, Buizer AI, Burridge JH, van Campenhout A, Dan B, Fleuren JF, Grunt S, Heinen F, Horemans HL, Jansen C, Kranzl A, Krautwurst BK, van der Krogt M, Lerma Lara S, Lidbeck CM, Lin JP, Martinez I, Meskers C, Metaxiotis D, Molenaers G, Patikas DA, Rémy-Néris O, Roeleveld K, Shortland AP, Sikkens J, Sloot L, Vermeulen RJ, Wimmer C, Schröder AS, Schless S, Becher JG, Desloovere K, Harlaar J. European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch. Eur J Neurol 2017; 24:981-e38. [DOI: 10.1111/ene.13322] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 04/06/2017] [Indexed: 12/27/2022]
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