Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy

Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder

Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.

Clinical Outcomes of an Intensity Program for Children With Movement Challenges

PURPOSE

Physical therapists at an outpatient pediatric facility developed and implemented an Intensity Program for children with movement challenges. The program was initiated on the basis of best evidence, parent advocacy, and clinician expertise. The purpose of this investigation is to analyze outcome data gathered from the program since 2012 to determine the effect of the program along with any specific child characteristics that were more likely to lead to positive outcomes.

METHODS

A variety of outcome data were analyzed to compare preprogram performance with postprogram performance.

RESULTS

Program participants made statistically significant and clinically important improvement in most outcome measures. Parents were highly satisfied with the program, including 98% of respondents who indicated that they would like to repeat their participation in the program.

CONCLUSIONS

The results of this investigation suggest that many children with movement challenges are likely to benefit from participation in an Intensity Program.

Application of Space Technologies Aimed at Proprioceptive Correction in Terrestrial Medicine in Russia

Space technologies greatly contributed not only to space medicine but also to terrestrial medicine, which actively involves these technologies in everyday practice. Based on the existing countermeasures, and due to similarities of sensorimotor alterations provoked by the weightlessness with various neurological disorders, a lot of work has been dedicated to adaptation and introduction of these countermeasures for rehabilitation of patients. Axial loading suit and mechanical stimulation of the soles' support zones are used in mitigation of stroke and traumatic brain injury consequences. They are also applied for rehabilitation of children with cerebral palsy. Complex application of these proprioceptive correction methods in neurorehabilitation programs makes it possible to effectively treat neurological patients with severe motor disturbances and significant brain damage.

Neurodevelopmental Therapy for Cerebral Palsy: A Meta-analysis

BACKGROUND AND OBJECTIVE

Bobath therapy, or neurodevelopmental therapy (NDT) is widely practiced despite evidence other interventions are more effective in cerebral palsy (CP). The objective is to determine the efficacy of NDT in children and infants with CP or high risk of CP.

METHODS

Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, and Medline were searched through March 2021. Randomized controlled trials comparing NDT with any or no intervention were included. Meta-analysis was conducted with standardized mean differences calculated. Quality was assessed by using Cochrane Risk of Bias tool-2 and certainty by using Grading of Recommendations Assessment, Development, and Evaluation.

RESULTS

Of 667 records screened, 34 studies (in 35 publications, 1332 participants) met inclusion. Four meta-analyses were conducted assessing motor function. We found no effect between NDT and control (pooled effect size 0.13 [-0.20 to 0.46]), a moderate effect favoring activity-based approaches (0.76 [0.12 to 1.40]) and body function and structures (0.77 [0.19 to 1.35]) over NDT and no effect between higher- and lower-dose NDT (0.32 [-0.11 to 0.75]). A strong recommendation against the use of NDT at any dose was made. Studies were not all Consolidated Standards of Reporting Trials-compliant. NDT versus activity-based comparator had considerable heterogeneity (I2 = 80%) reflecting varied measures.

CONCLUSIONS

We found that activity-based and body structure and function interventions are more effective than NDT for improving motor function, NDT is no more effective than control, and higher-dose NDT is not more effective than lower-dose. Deimplementation of NDT in CP is required.

SPIDER as A Rehabilitation Tool for Patients with Neurological Disabilities: The Preliminary Research

(1) Background and purpose: SPIDER (Strengthening Program for Intensive Developmental Exercises and activities for Reaching health capability) is dedicated for patients suffering from Cerebral Palsy, Sclerosis Multiplex, Spinal Bifida, Spinal Muscular Atrophy and strokes. Authors proposed a computer model for the evaluation patient's condition and the rehabilitation progress. (2) Methods: The 2-year-old and 76-year-old patients with neurological problems, who underwent individual therapy included balancing and coordination practising with SPIDER device. The model comparing the forces, which act during the therapy process, such as the expander and gravity forces, was worked out using Matlab software. (3) Results: The model allowed controlling the changes into the patients centre of gravity forces continuous adjustment and postural stability during any patient's movement. After rehabilitation sessions, lasted for 28 days during which patients received the progress information and the therapist got the numeric data, regarding the period of the therapy. (4) Conclusions: The first patient was able to move, dramatically improved the ability to balance and coordination. The second one presented change in gait, improvement in mobility, motor function and decreased fall risk. The proposed computer model gives information about the forces acting to the patient body. The physiotherapist can evaluate the progress of patient verticalization and receive information, in the form of numbers and charts.

Exercise and Physical Therapy Interventions for Children with Ataxia: A Systematic Review

The effectiveness of exercise and physical therapy for children with ataxia is poorly understood. The aim of this systematic review was to critically evaluate the range, scope and methodological quality of studies investigating the effectiveness of exercise and physical therapy interventions for children with ataxia. The following databases were searched: AMED, CENTRAL, CDSR, CINAHL, ClinicalTrials.gov, EMBASE, Ovid MEDLINE, PEDro and Web of Science. No limits were placed on language, type of study or year of publication. Two reviewers independently determined whether the studies met the inclusion criteria, extracted all relevant outcomes, and conducted methodological quality assessments. A total of 1988 studies were identified, and 124 full texts were screened. Twenty studies were included in the review. A total of 40 children (aged 5-18 years) with ataxia as a primary impairment participated in the included studies. Data were able to be extracted from eleven studies with a total of 21 children (aged 5-18 years), with a range of cerebellar pathology. The studies reported promising results but were of low methodological quality (no RCTs), used small sample sizes and were heterogeneous in terms of interventions, participants and outcomes. No firm conclusions can be made about the effectiveness of exercise and physical therapy for children with ataxia. There is a need for further high-quality child-centred research.

Development Through the Lens of a Perception-Action-Cognition Connection: Recognizing the Need for a Paradigm Shift in Clinical Reasoning

Clinical assessment of movement and posture guides the decision-making process in designing interventions for infants and children with movement disorders. Clinical reasoning is influenced by the therapist's understanding of developmental processes. The views of development grounded in perception-action, dynamic systems, and neuronal group selection theories are well recognized in current literature and supported by a large body of research. Based on the available evidence, intervention must be task-specific, repetitive, and highly salient to the child. Furthermore, it must honor spontaneous exploration and active problem-solving, enhance the child's ability to perceive environmental affordances, and target optimal variability and adaptability of movement and posture. However, a neuromaturational approach to developmental assessment and intervention that relies on "teaching" motor milestones and emphasizes the importance of correcting movement patterns in infants and children developing atypically is still prevalent in the clinic. This perspective paper will: (1) examine evidence in support of a paradigm shift from neuromaturational views toward bringing the concepts of grounded cognition, variability, complexity, and adaptability to the forefront of clinical reasoning; and (2) introduce the Perception-Action Approach as a method of assessment and intervention that may serve as an agent of such a shift by augmenting knowledge translation for the clinician.

The clinical aspects and effectiveness of suit therapies for cerebral palsy: A systematic review

OBJECTIVES

The aim of this review to evaluate the clinical aspects and effectiveness of suit therapy for patients with cerebral palsy (CP).

MATERIALS AND METHODS

A literature search was performed in the PubMed, SCOPUS, Web of Science, and PEDro databases within the period from the establishment of the relevant database to July 2018. The articles were categorized according to their study design. We included studies published in peer-review journals focusing on the efficacy of suit therapies for CP and excluded review articles, duplications, non-related articles. A narrative synthesis approach was used, as it was not possible to classify extracted and analyzed data, and the overall effect size was unable to be calculated. Data regarding study subjects (number, age, CP type, Gross Motor Function Classification System [GMFCS] level), suit type, intervention including dose of suit therapy, outcome measurements, outcomes, adverse effects, and funding were extracted. The method introduced by Furlan, Pennick, Bombardier, and van Tulder was used to evaluate the risk of bias for the assessment of methodological quality of randomized-controlled trials (RCTs).

RESULTS

A total of 29 studies were included of which 10 were Class I, eight were Class II-III, and 11 were Class IV studies. Studies were heterogenous in design, sample size, study population, and outcomes measured. The methodological quality score of RCTs varied between 4 and 10. The results of the high-quality RCTs showed that wearing the suit along with conventional therapy improved proximal stability, gross motor function, and gait. The Class II-III and IV studies supported the findings of the Class I studies.

CONCLUSION

The major improvements from the RCTs were seen in proximal stability, gross motor function and gait, although grading was unable to be done due to the heterogeneity of included studies. In order to obtain gains in the function, it is important to carefully consider intended use, patient selection criteria, and suit type.

Why orthotic devices could be of help in the management of Movement Disorders in the young

Background

Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities. Nowadays, the general management of patients with MD is based on rehabilitation, pharmacological treatments, surgery, and traditional splints. Although some attempts have been made to devise specific orthoses for the rehabilitation of patients affected by MD, especially the younger ones, those devices have received limited attention.

Main body

This paper will principally discuss the case of upper limb rehabilitation in Childhood Dyskinesia (CD), a complex motor disease that affects paediatric patients. Through a critical review of the present solutions and a discussion about the neurophysiological characteristics of the disease, the study will lead to the formulation of desirable features of a possible new upper-limb orthosis.

Conclusions

Design principles will be derived to provide specialised orthoses for the dynamic control of posture and the stabilisation of voluntary movements: those include using biomechanical actions and enhanced proprioception to support the sensorimotor rehabilitation of the children affected by CD. A similar approach could be advantageously applied in other MD-related conditions, especially with hyperkinetic and/or hypertonic traits.

The effects of vest type dynamic elastomeric fabric orthosis on sitting balance and gross manual dexterity in children with cerebral palsy: a single-blinded randomised controlled study

Purpose: To evaluate the effects of vest type dynamic elastomeric fabric orthosis on posture and balance during sitting and gross manual dexterity and to compare the efficacy of daily wearing time of 2 h versus 6 h.Method: Twenty-four children with cerebral palsy (CP) aged 3-9 years with GMFCS levels III and IV were randomised to either of three groups: (i) a control group who received only conventional exercise therapy, (ii) dynamic elastomeric fabric orthosis 2 h group who wore the orthosis for 2 h during therapy and dynamic elastomeric fabric orthosis 6 h group who wore the orthosis for 4 h in addition to the 2 h of wear along with therapy during hospital inpatient stay for 2 weeks. Children continued to use dynamic elastomeric fabric orthosis during the post-discharge period. The primary outcome measure was the Sitting Assessment Scale. The secondary outcome measurements were the sitting dimension of Gross Motor Function Measure, Box and Block Test and Parent Satisfaction Survey. Assessments were made before treatment, at post-treatment, at 1-month post-treatment, and at 3-months post-treatment. Sitting Assessment Scale and Box and Block Test were also assessed when immediately after wearing the orthosis. This trial is registered with Clinicaltrials.gov, under number NCT03191552.Results: All groups showed similar improvements except the control group which showed less improvement in Sitting Assessment Scale scores compared to the dynamic elastomeric fabric orthosis groups. Dynamic elastomeric fabric orthosis groups showed greater improvements compared to the control group in the Sitting Assessment Scale but not in the sitting dimension of Gross Motor Function Measure and Box and Block Test at post-treatment, at 1-month post-treatment and at 3-months post-treatment. When the dynamic elastomeric fabric orthosis groups (2 h versus 6 h) were compared, there were no significant differences in any of the assessments. The Sitting Assessment Scale and Box and Block Test scores also improved immediately after the patients put on the orthosis. At 1-month post-treatment, parents of children in the control group reported less satisfaction than parents of the children in dynamic elastomeric fabric orthosis groups.Conclusions: Dynamic elastomeric fabric orthosis vest has an immediate effect on the sitting balance and gross manual dexterity. It also provides improvements in posture and balance during sitting. Wearing dynamic elastomeric fabric orthosis vest for 2 h during therapy is as much effective as wearing it for 6 h in children with CP in addition to therapy to improve sitting balance.Implications for rehabilitationDynamic elastomeric fabric orthosis vest provides improvements in sitting balance when used in addition to conventional therapy in children with cerebral palsy.Wearing dynamic elastomeric fabric orthosis for 2 h and wearing dynamic elastomeric fabric orthosis vest for 6 h resulted in similar clinical outcomes.Dynamic elastomeric fabric orthosis vest has an immediate effect on sitting balance and gross manual dexterity in children with cerebral palsy.

Effects of Suit-Orthosis on Postural Adjustments During Seated Reaching Task in Children With Cerebral Palsy

AIM

To investigate suit-orthosis effects on postural sway during anticipatory and compensatory postural adjustments (APA and CPA, respectively) in a seated reaching task performed by children with cerebral palsy (CP).

METHODS

Twenty-nine children were divided according to Manual Ability Classification System (MACS) I and II-III. Participants were instructed to reach forward toward an object both in a no-suit condition and in a suit-orthosis condition.

RESULTS

Using the suit-orthosis, children at MACS II-III decreased velocity of center-of-pressure (CoP) sway during APA, whereas children at MACS I increased the anterior-posterior CoP displacement during CPA.

CONCLUSION

Suit-orthosis improved postural stability in children at MACS II-III during APA. The suit may assist with arm function control during postural sway when preparing to reach for objects.

CLINICAL IMPLICATIONS

Suit-orthoses in therapy should be individually prescribed considering the intended activity and person's motor impairment.

Effects of interventions with therapeutic suits (clothing) on impairments and functional limitations of children with cerebral palsy: a systematic review

BACKGROUND

Therapeutic suits or clothing whether associated with intensive protocols or not, became popular in the rehabilitation of children with cerebral palsy. Studies have reported positive effects of these suits on children's posture, balance, motor function and gait. A summary of current literature may help guide therapeutic actions.

OBJECTIVE

To evaluate the available evidence on the effects of interventions based on the use of therapeutic suits in the treatment of impairments and functional limitations of children with cerebral palsy.

METHOD

Three independent reviewers searched for experimental studies on MEDLINE, SciELO, BIREME, LILACS, PEDro and CENTRAL databases, between October and December 2015 and updated in May 2016. The reviewers evaluated the methodological quality of selected studies using the Checklist for Measuring Quality. The Grading of Recommendations Assessment, Development and Evaluation was used to synthesize the quality of evidence and strength of recommendation.

RESULTS

From the 13 studies, two evaluated the Full Body Suit, two tested the Dynamic Elastomeric Fabric Orthose, three evaluated TheraTogs and six tested the TheraSuit/AdeliSuit protocols. The quality of evidence for the Full Body Suit, the Dynamic Elastomeric Fabric Orthose and the TheraSuit/AdeliSuit protocols was very low for body structure and function outcomes, while the evidence for TheraTogs was low quality. Regarding the activity outcomes, the Full Body Suit and TheraSuit showed very low quality evidence while the evidence for TheraSuit/AdeliSuit protocols were of low quality.

CONCLUSION

Enthusiasm with new therapeutic approaches that argue modifications in the neuromusculoskeletal impairments and functional limitations of children with cerebral palsy need to be guided by scientific evaluation. The low quality of evidence suggests caution in recommending the use of these therapeutic suits. New studies could change the findings of this review.

Clinical usefulness of Adeli suit therapy for improving gait function in children with spastic cerebral palsy: a case study

[Purpose] The purpose of this study was to determine the effects of Adeli suit therapy (AST) on gross motor function and gait function in children with cerebral palsy. [Subjects and Methods] Two participants with spastic cerebral palsy were recruited to undergo AST. AST was applied in 60-minute sessions, five times per week, with 20 sessions total over 4 weeks. Assessments of gross motor function, spatiotemporal parameters, and functional ambulation performance for gait were conducted. [Results] Gross motor function, cadence, and functional ambulation performance improved after the intervention in both cases. [Conclusion] Although additional follow-up studies are required, the results demonstrated improved gross motor function and functional ambulation performance in the children with cerebral palsy. These findings suggest a variety of applications for conservative therapeutic methods that require future clinical trials in children with cerebral palsy.

Efficacy of suit therapy on functioning in children and adolescents with cerebral palsy: a systematic review and meta-analysis

AIM

This systematic review and meta-analysis presents an overview of the efficacy of suit therapy on functioning in children and adolescents with cerebral palsy (CP).

METHOD

A systematic review with meta-analysis was conducted. A comprehensive search of peer-reviewed articles was performed on electronic databases, from their inception to May 2014. Studies included were rated for methodological quality using the Physiotherapy Evidence Database scale. Effects of suit therapy on functioning were assessed using meta-analytic techniques.

RESULTS

From the 46 identified studies, four met the inclusion criteria and were included in the meta-analysis. Small, pooled effect sizes were found for gross motor function at post-treatment (g=0.46, 95% confidence interval [CI] 0.10-0.82) and follow-up (g=0.47, 95% CI 0.03-0.90).

INTERPRETATION

The small number of studies, the variability between them, and the low sample sizes are limitations of this review. Findings suggest that to weigh and balance benefits against harms, clinicians, patients, and families need better evidence to examine and prove the effects of short intensive treatment such as suit therapy on gross motor function in children and adolescents with CP. Therefore, more research based on high-quality studies focusing on functioning in all dimensions of the International Classification of Functioning, Disability and Health perspective is necessary to clarify the impact of suit therapy.

Effects of combined Adeli suit and neurodevelopmental treatment in children with spastic cerebral palsy with gross motor function classification system levels I and II

Background:

Children with cerebral palsy (CP) exhibit diverse gait patterns depending on their neurological deficits and musculoskeletal problems. The Adeli suit treatment (AST) has been proposed as an intensive exercise protocol in the management of CP.

Objectives:

The aim of this study was to compare the effects of a 6-week programme of combined AST and neurodevelopment treatment (NDT) with those of NDT alone on Gross Motor Function Measure (GMFM), balance, and gait in children with CP.

Methods:

Twenty children with CP of Gross Motor Function Classification System levels I and II were randomly assigned to one of the following two groups: (1) NDT or (2) AST/NDT. The participants were assessed using the GMFM, Pediatric Balance Scale (PBS), Timed Up and Go (TUG) test, and spatiotemporal gait parameters.

Results:

The GMFM, PBS, and TUG test for both groups showed a statistically significant increase (p < 0.05). Three children were excluded. Compared to the NDT group (n = 9), the AST/NDT group (n = 8) demonstrated a significant increase in spatiotemporal gait parameters (p < 0.05).

Conclusion:

These results provide evidence for the greater effectiveness of combined AST/NDT than NDT alone in improving spatiotemporal gait parameters but not GMFM, PBS, and TUG test.

Short-term, intensive neurodevelopmental treatment program experiences of parents and their children with disabilities

PURPOSE

Parents' perspectives on intervention and functional changes in children were investigated following an intensive neurodevelopmental treatment (NDT) program of 1 to 2 weeks (5 consecutive days per week; 2-4 h/d).

METHODS

Thirteen parents and their children (aged 1-17 years) with neuromotor conditions participated in a short-term, intensive program conducted by NDT certified pediatric therapists. A mixed-method design was used: a qualitative phenomenological approach of inquiry for parent perspectives and a pre/posttest quasi-experimental design for weekly intervention changes using Goal Attainment Scaling and the Canadian Occupational Performance Measure.

RESULTS

Through interviews, parents reported positive experiences with the intensive NDT program. Child participants demonstrated significant improvements in Goal Attainment Scaling (P < .001) and Canadian Occupational Performance Measure (P < .001) scores pre- to postintervention.

CONCLUSIONS

A short-term, intensive NDT program was perceived by parents as beneficial and supported functional improvements. Valued were expert, compassionate therapists; collaboration; objective goals; home programming; and individualized intervention. Scheduling, financial support, and fatigue were difficulties.

Effect of Adeli suit treatment on gait in a child with cerebral palsy: a single-subject report

The purpose of this research report is to investigate the long-term effect of Adeli suit treatment (AST) in a child with cerebral palsy (CP) on spatial-temporal gait parameters, 10-meter walking speed, gross motor functional measure (GMFM) and performance on the pediatric balance scale (PBS). An eight-year-old girl with spastic diplegia classified as level III on the Gross Motor Function Classification System participated in this single-subject A-B design study, with a baseline and an intervention phase. The baseline phase was collected at one-week intervals for six weeks and then the AST intervention phase was carried out with 18 AST sessions, 50 min per session, once a week for an 18-week period. Spatial-temporal gait parameters significantly improved after the completion of 18 sessions. Furthermore, 10-meter walking speed, GMFM and PBS changed significantly from the baseline measurement (p < 0.05). In conclusion, the AST was effective in improving gait, gross motor function and balance in a child with diplegic CP. Clinically, neuro-rehabilitation with AST provided a complementary and alternative treatment for lower extremity rehabilitation in this child with CP. These findings provide preliminary evidence supporting the effectiveness of AST in children with spastic CP, and thus underscore the need for additional research in this area.

Mechanical efficiency and balance in adolescents and young adults with cerebral palsy

Mechanical efficiency (ME) during stair-climbing measures ambulation ability. This study investigated the relationship between ME and age, anthropometric, functional walking, and balance parameters in 52 adolescents with cerebral palsy (CP), age 13.5-23.3 yrs, who participated in an intervention study to improve walking. Measurements included ME, 6-min and 10-m walk tests and the Berg balance scale (BBS). Walk test measures correlated significantly with ME, as expected, as did BBS (r=0.68) and age (r=0.51). The multiple correlation coefficient with both age and BBS increased to 0.80. The measurements were divided into two groups of low (<40, n=19) and high (>40, n=33) BBS scores. Repeating regression analyses, demonstrated that in the low BBS group ME was significantly related to BBS, but not age, in contrast to opposite results in the high BBS group. Regressions were calculated for each of the 14 items of the BBS with ME. For the whole group, 12 items correlated significantly, but only three in the high BBS group (one leg standing, reach while standing and tandem standing). In the low BBS group 10 of the items correlated significantly, with the former three ranking near the top. Balance is an important component of ambulation in children with CP. Mobility in those scoring>40 is related to age, but in those more deficient in balance (<40) mobility is more closely associated with balance than age. Effective therapy to improve walking in younger children might incorporate more balance-focused exercises, similar to those related to BBS items strongly associated with ME.

Description of the Pediasuit ProtocolTM

INTRODUCTION: PediaSuit ProtocolTM is an intensive therapy with a holistic approach to the treatment of individuals with neurological disorders like cerebral palsy (CP), developmental delays, traumatic brain injuries, autism and other conditions which affect a child's motor and/or cognitive functions. OBJECTIVE: The aim of the present work is to describe the PediaSuit ProtocolTM. METHODS: The authors team remained two months observing the care provided in a clinic with physical therapists trained by the PediaSuit ProtocolTM team (USA). RESULTS: The PediaSuitTM is a therapeutic protocol which uses a suit combined with intensive physical therapy and consists of up to four hours of therapy a day, five days a week, during three or four weeks. The PediaSuit ProtocolTM is customized to fit the needs of each child, with specific functional goals, and usually involves an intensive rehabilitation program. It combines the best elements of various techniques and methods, and has a sound rationale based on exercise physiology. CONCLUSION: This protocol anticipates results obtained only with long periods of conventional physical therapy.

Improving quality of life of children with cerebral palsy: a systematic review of clinical trials

OBJECTIVE

To systematically review the impact of different interventions on quality of life (QoL) for children with cerebral palsy.

METHODS

English articles were sought from five major English databases from inceptions until March 2010. Keywords used consisted of four components (and their variants): (i) clinical condition: cerebral palsy; (ii) outcome measures: quality of life, well-being; (iii) study design: clinical trials; and (iv) target population: people aged 0-18.

RESULTS

Eight studies satisfied the inclusion criteria, all of which are of good to excellent quality (a Jadad score of 4 or above). The Pediatric Evaluation of Disability Inventory, the Pediatric Quality of Life Inventory, the TNO-AZL Children's Health-Related Quality of Life and the Caregiver Priorities and Child Health Index of Life with Disabilities were used to measure QoL. Significant positive results were reported by two studies using medicinal interventions (diazepam and intrathecal baclofen therapy, effect sizes 5.9, 9.1 respectively) and two studies employing motor control approach training (strength training and exercise training, former effect size being 3.8).

CONCLUSION

Current review suggests that positive effect was shown in medicinal and motor control interventions on QoL. However, no single interventional approach can demonstrate a consistent positive impact on QoL across different studies. Future studies are recommended to (i) provide a clear definition of QoL, and investigate the relationship between symptoms' severity and QoL; (ii) measure outcome at different time points to capture real effects of interventions; and (iii) make more use of valid outcome instruments, either self-report or parent/caregiver proxy reports.

Effects of Modified Adeli Suit Therapy on Improvement of Gross Motor Function in Children with Cerebral Palsy

Objective

This study aimed to investigate the effects of the Modified Adeli suit therapy (MAST) on improvement of gross motor function in children with cerebral palsy (CP).

Methods

Thirty-six children with CP assigned by match pairs to three equal groups such as the MAST, the AST, and the Neurodevelopmental Treatment. They were treated for 4 weeks, 2 hr/d, 5 d/wk. All children were tested by the Gross Motor Function Measure (GMFM) at baseline, immediately before and 16 weeks after treatments.

Results

All groups had improvement in the GMFM after treatment (p < .01) and there were significant differences among groups (p < .01). In the follow-up study, no significant improvement in the GMFM was seen within groups (p > .05), but again there were significant differences among groups (p < .01).

Conclusion

The MAST was more effective than using either the AST or the Neurodevelopmental treatment on improvement of gross motor function in children with CP after treatment and at follow-up.

Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome

This quasi-experimental study compared the effect of standard occupational therapy (SOT) and virtual reality using Wii gaming technology (VRWii) on children with Down syndrome (DS). Children (n = 105) were randomly assigned to intervention with either SOT or VRWii, while another 50 served as controls. All children were assessed with measures of sensorimotor functions. At post-intervention, the treatment groups significantly outperformed the control group on all measures. Participants in the VRWii group had a greater pre-post change on motor proficiency, visual-integrative abilities, and sensory integrative functioning. Virtual reality using Wii gaming technology demonstrated benefit in improving sensorimotor functions among children with DS. It could be used as adjuvant therapy to other proven successful rehabilitative interventions in treating children with DS.

The effect of suit wear during an intensive therapy program in children with cerebral palsy

PURPOSE

To examine the effects of suit wear during an intensive therapy program on motor function among children with cerebral palsy.

METHOD

Twenty children were randomized to an experimental (TheraSuit) or a control (control suit) group and participated in an intensive therapy program. The Pediatric Evaluation of Disability Inventory (PEDI) and Gross Motor Function Measure (GMFM)-66 were administered before and after (4 and 9 weeks). Parent satisfaction was also assessed.

RESULTS

No significant differences were found between groups. Significant within-group differences were found for the control group on the GMFM-66 and for the experimental group on the GMFM-66, PEDI Functional Skills Self-care, PEDI Caregiver Assistance Self-care, and PEDI Functional Skills Mobility. No adverse events were reported.

CONCLUSIONS

Children wearing the TheraSuit during an intensive therapy program did not demonstrate improved motor function compared with those wearing a control suit during the same program.

Effectiveness of motor learning coaching in children with cerebral palsy: a randomized controlled trial

Objective: To evaluate effectiveness of motor learning coaching on retention and transfer of gross motor function in children with cerebral palsy.

Design: Block randomized trial, matched for age and gross motor function.

Setting: Coordinated, multinational study (Israel, Jordan and Palestinian Authority) in schools and rehabilitation centers.

Subjects: 78 children with spastic cerebral palsy, gross motor functional levels II and III, aged 66 to 146 months.

Interventions: 1 hr/day, 3 days/week for 3 months treatment with motor learning coaching or neurodevelopmental treatment: two groups.

Main measures: Gross motor function Measure (GMFM-66), stair-climbing mechanical efficiency (ME) and parent questionnaire rating their child’s mobility. Immediate treatment effects were assessed after 3 months and retention determined from follow-up measurements 6 months after treatment.

Results: GMFM-66, ME and parent questionnaires were obtained from 65, 31 and 64 subjects, respectively. Although both groups increased GMFM-66 score over 3 months, measurements 6 months later indicated retention was significantly superior by 2.7 in the motor learning coaching children of level-II. Similar retention trend was evident for ME, increasing 6 months after motor learning coaching by 1.1% and declining 0.3% after neurodevelopmental treatment. Mobility performance in the outdoors and community environment increased 13% from 3 to 9 months after motor learning coaching and decreased 12% after neurodevelopmental treatment. Minor group differences occurred in children of level-III.

Conclusions: In higher functioning children with cerebral palsy, the motor learning coaching treatment resulted in significantly greater retention of gross motor function and transfer of mobility performance to unstructured environments than neurodevelopmental treatment.

Unethical prescriptions: alternative therapies for children with cerebral palsy

The US National Center for Complementary and Alternative Medicine (CAM) defines CAM as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." The problem with said therapies is that, for the most part, their effectiveness is questionable and their side effect profile is essentially unknown. Furthermore, as stated by Rosenbaum, many CAM treatments are based on "at best, anecdotal evidence and at times rather unusual ideas about the biology of the conditions to which they are being applied." In spite of the data shortage,Americans are forecasted to spend more than $42 billion on CAM during 2009. Using a patient for illustration purposes, the author presents 3 CAM treatments that have been advocated for children with cerebral palsy. The current scientific literature on these remedies and their purported benefit is reviewed. The article ends with a discussion on the reasons why prescribing said therapies is contrary to the concept of evidence-based medicine and the tenets of medical ethics.

Parent and therapist perceptions of an intense model of physical therapy

PURPOSE

The purpose of this study was to determine parent and therapist perceptions regarding the effect of an intense model of physical therapy for children with cerebral palsy.

METHODS

Informants included 5 parents, 5 therapists, and 5 children with cerebral palsy who previously participated in an intense program (ie, strengthening and functional activities 4 hours/day, 5 days/week for 3 weeks). Parents and therapists were interviewed, and children were observed. Data were collected and analyzed using qualitative methodology.

RESULTS

Five common themes emerged, based on perceptions: (1) improvement in motor function, (2) improvement in confidence and independence, (3) stress during the program but a time of no therapy between sessions, (4) increased participation in the community, and (5) fatigue during the program but perceived rapid attainment of goals.

CONCLUSIONS

The constructs identified should be considered by clinicians in program development and by researchers for further study.

Changes in two children with cerebral palsy after intensive suit therapy: a case report

PURPOSE

The purpose of this case report was to investigate effects of intensive suit therapy on gait, functional skills, caregiver assistance, and gross motor ability in children with cerebral palsy.

CASE DESCRIPTION

Two children with spastic diplegia classified at level III on the Gross Motor Function Classification System participated. Outcomes were assessed using dimensions D and E of the Gross Motor Function Measure, the Pediatric Evaluation of Disability Inventory, and instrumented gait analysis.

INTERVENTION

Each child participated in the Therasuit Method, 4 hours a day, 5 days a week for 3 weeks.

OUTCOMES

Very small improvements in function were noted in dimension D of the Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory Self-care Domain with decreased function in other areas. Improved walking speed, cadence, symmetry, joint motion, and posture were found with gait analysis.

CONCLUSION

Further investigation is needed of the suit itself, and intensive therapy programs in children with cerebral palsy.

Complementary and alternative methods in cerebral palsy

There are no published studies specifically addressing complementary and alternative treatments in adults with cerebral palsy (CP). However, national surveys of adults with chronic disabilities document that a majority of them use such treatments, that they are willing to pay out of pocket, if necessary, and that they believe that pursuing such treatment relieves pain, reduces stress and anxiety, and leads to improved feelings of fitness and well-being. Individuals enjoy taking charge of their own health care decisions, and frequently feel more in control with these therapies than with more traditional methods. In contrast to adults, there is some information on complementary and alternative methods (CAM) in children with CP. This article discusses some of the CAM used in children that may be carried over into adulthood, as well as the pitfalls for patients and conventional physicians as they try to sort out what might be helpful and what might be harmful in this arena. Practitioners of both conventional and CAM therapies believe that exercise can be beneficial; accordingly, activities such as recreational sports, yoga, and hippotherapy may be continued from childhood into adulthood. General treatments for stress and anxiety, through such activities as yoga and meditation, though not directed at CP per se, may be more popular for adults than children. Research in this area should first identify what methods are being utilized and then subject these methods to well-designed outcome studies that take into account any associated risks.

Management of motor problems in cerebral palsy: a critical update for the clinician

Currently there is no specific treatment for the brain insults leading to motor dysfunction in cerebral palsy. The available symptomatic therapeutic options place cerebral palsy among the costliest chronic childhood conditions. Therefore, it is necessary to make well-informed decisions in an effort to match cost-effectiveness with patient and family needs. This presentation aims to analyze the efficacy of rehabilitation therapy, orthoses, oral medications, botulinum toxin, intrathecal baclofen, complementary or alternative treatments and discuss guidelines for a goal oriented approach. Despite insufficient reporting of trials, physiotherapy has shifted from traditional to goal oriented approaches, based on principles of motor learning, strength and fitness training. Correct choice and use of orthoses is stressed, yet evidence from primary studies is limited. Pharmacological treatments of spasticity (oral agents, botulinum toxin, intrathecal baclofen) may be alternatives or supplements to orthopaedic surgery. There is evidence that botulinum toxin combined with conservative treatments reduces the number of complex orthopaedic interventions. Intrathecal baclofen effectively reduces spasticity; criteria describing the ideal candidate are needed. Complementary or alternative treatment use is widespread; research needs to determine what factors make these modalities desirable and effective in cerebral palsy. It is concluded that the introduction of new therapies facilitates an individualized management plan. Multimodal treatment is optimized with a multidisciplinary team. Outcome measurement according to the World Health Organization's new International Classification of Functioning, Disability and Health is emphasized.

Rehabilitative therapies in cerebral palsy: the good, the not as good, and the possible

In the past decade, growing recognition of the importance of motor activity for the development and maintenance of central nervous system pathways and for recovery of function post injury has provided new avenues for rehabilitation. Physical therapy is likely to have a prominent role in stimulating neuroplastic changes in damaged developing nervous systems that may finally alter the natural history of these disorders, which has not yet been possible. In this article, we discuss the scientific evidence for various physical therapy treatment options for children with cerebral palsy. Newer, more intense, and task-related exercise programs show the strongest level of evidence. Traditional approaches and newer ''packaged'' approaches have failed to provide evidence of superiority. Their continued prevalence among clinicians is puzzling and disconcerting, as evidence supporting other approaches continues to accumulate.

Fostering locomotor behavior of children with developmental disabilities: An overview of studies using treadmills and walkers with microswitches

This paper provides an overview of studies using programs with treadmills or walkers with microswitches and contingent stimulation to foster locomotor behavior of children with developmental disabilities. Twenty-six studies were identified in the period 2000-2008 (i.e., the period in which research in this area has actually taken shape). Twenty-one of the studies involved the use of treadmills (i.e., 13 were aimed at children with cerebral palsy, 6 at children with Down syndrome, and 2 at children with Rett syndome or cerebellar ataxia). The remaining five studies concerned the use of walkers with microswitches and contingent stimulation with children with multiple disabilities. The outcomes of the studies tended to be positive but occasional failures also occurred. The outcomes were analyzed considering the characteristics of the approaches employed, the implications of the approaches for the participants' overall functioning situation (development), as well as methodological and practical aspects related to those approaches. Issues for future research were also examined.

The effects of femoral derotation osteotomy in children with cerebral palsy: an evaluation using energy cost and functional mobility

BACKGROUND

The effect of femoral derotation osteotomy (FDO) in children with cerebral palsy (CP) has hitherto been examined using various outcome measures including range of motion of lower extremity joints and gait parameters. However, functional ambulation following this procedure has been scarcely investigated.

OBJECTIVE

To evaluate the effect of FDO on energy cost during stair climbing and functional mobility in children with CP.

METHOD

A prospective case series study was conducted on 18 children with CP, 11 at Gross Motor Functional Classification System (GMFCS) II and 7 with GMFCS III, aged 8.5 +/- 1.24 years (range, 6.9-11 years) who underwent FDO to correct hip internal rotation. The energy cost was measured using the heart beat cost index (HBCI) during stair climbing test, whereas functional mobility was assessed using the Gillette Functional Assessment Questionnaire (FAQ). Tests were administered before surgery (P0), 6 months (P1), and at approximately a year postoperatively (P2).

RESULTS

Compared with P0, significant changes in hip rotation were observed at P1 and P2. There was a significant improvement in HBCI from P0 to P2, whereas FAQ improved significantly from P1 to P2. A moderate correlation was found between HBCI and GMFCS at all times (r = 0.61-0.78). Negative correlations were found between the HBCI and FAQ and between GMFCS and FAQ at all times (r = -0.5).

CONCLUSION

This study indicates that children with CP may benefit functionally from FDO as judged by HBCI and functional mobility rating.

Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review

BACKGROUND

To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP).

METHODS

A search was made in Medline, Cinahl, PEDro and the Cochrane library for the period 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Twenty-two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited due to low methodological quality and the statistically insignificant results of the studies.

CONCLUSION

Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well-designed trials are needed especially for focused PT interventions.

Prediction of mechanical efficiency from heart rate during stair-climbing in children with cerebral palsy

Measuring mechanical efficiency (ME) is potentially useful to assess motor performance in individuals with physical disabilities. The purpose of this study was to determine the accuracy of predicting ME from heart rate (HR) during a self-paced stair-climbing test in children with a range of motor abilities. The participants were 12 normally developed children (ND) and 24 with cerebral palsy (CP), ranging in age from 5 to 15 years (mean: 8 years). Five were at level II, 11 at level III and 8 at level IV according to the gross motor function classification system. ME was calculated as the ratio of external work to O(2) uptake (VO(2) ml/min) measured or predicted from HR. The absolute values of VO(2) and HR during stair-climbing were not significantly correlated. However, the correlation between values above resting (dVO(2) and dHR) was significant (r=0.61). Furthermore, when including body weight as a second variable the prediction of dVO(2) was significantly improved (r=0.85). This resulted in a high correlation (r=0.96) between measured and predicted net ME (ME(net)). Predicted ME(net) for 25 stair-climbing tests repeated after an average of 6 months resulted in an r-value of 0.92 with predicted ME(net) of the first test. This study demonstrates that ME(net) during stair-climbing can be predicted in children with a broad range of motor abilities from dHR and may be a simple tool to help define developmental stages or evaluating intervention efficacy.

Cerebral palsy

Cerebral palsy (CP) is the leading cause of childhood disability. This article reviews common presentations of CP and its possible causes. The management of common problems seen in affected children is discussed in a system-based approach. Many treatment options are available for CP, with varying degrees of evidence and acceptance. As individuals who have CP transition into adulthood, they face unique issues that are not well recognized in the medical community. This article briefly reviews the psychosocial impact of this chronic disease on individuals and their caregivers and family.

Nonoperative management of spasticity in children

Central to the longitudinal management of childhood hypertonia are nonsurgical treatments. These include physical and occupational therapy, electrical stimulation, orthotics, botulium toxin, and drugs. This manuscripts reviews these treatment modalities as well as evaluation tools available to assess their impact on a child's hypertonia.

Promoting foot–leg movements in children with multiple disabilities through the use of support devices and technology for regulating contingent stimulation

The present study assessed the possibility of promoting pre-ambulatory foot-leg movements in children with multiple disabilities by motivating their action through contingent stimulation combined with a support device. Two children aged 10 and 8 years participated. Microswitch technology (i.e., pressure sensors under the shoes or optic sensors at the front-inner side of the shoes) served for detecting the foot-leg movements and providing contingent stimulation on their occurrence. Sensor activation produced 5 s of stimulation during intervention. Data showed that both children had significant increases in foot-leg movements during the intervention phases. Implications of the data in terms of skill acquisition and further intervention prospects are discussed.

Use of complementary and alternative medicine for the treatment of children with cerebral palsy

The use of complementary and alternative medicine for the treatment of patients with cerebral palsy is more prevalent than one might anticipate. Using the classification of complementary and alternative medicine developed by the National Center for Complementary and Alternative Medicine, this article reviews the different treatments that are used by patients with this condition.