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Goikoetxea-Sotelo G, van Hedel HJA. Reporting Completeness of Intensity-, Dose-, and Dosage-Related Items in Active Pediatric Upper Limb Neurorehabilitation Trials: A Systematic Review. Arch Phys Med Rehabil 2024; 105:1784-1792. [PMID: 38160897 DOI: 10.1016/j.apmr.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To analyze the reporting completeness of the TIDieR items 8-12, in particular intensity, dose, and dosage, in active pediatric upper limb neurorehabilitation trials. DATA SOURCES We searched PubMed Central, Scopus, CINAHL, OTseeker, and Web of Science for eligible publications. STUDY SELECTION We included publications analyzing active pediatric upper limb neurorehabilitation interventions and assessed the reporting completeness of 11 items for each intervention and control group. DATA EXTRACTION Two raters independently screened titles and abstracts and selected the publications using the RYYAN platform. We unblinded the results after the raters had completed their selection and resolved the disagreements by discussion. We used the same procedures to review the full texts. DATA SYNTHESIS We included 52 randomized controlled trials with 65 intervention and 48 control groups. Authors did not report all 11 items in any of the study groups. The overall reporting completeness varied between 1% (intensity) to 95% (length of the intervention). The reporting completeness of the TIDieR items ranged from 2% (modifications) to 64% (when and how much). We found no significant differences in the reporting completeness between the intervention and control groups. CONCLUSIONS Information essential for dose-response calculations is often missing in randomized controlled trials of pediatric upper limb neurorehabilitation interventions. Reporting completeness should be improved, and new measures to accurately quantify intensity should be discussed and developed.
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Affiliation(s)
- Gaizka Goikoetxea-Sotelo
- Swiss Children's Rehab, University Children's Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Javvaji CK, Vagha JD, Meshram RJ, Taksande A. Assessment Scales in Cerebral Palsy: A Comprehensive Review of Tools and Applications. Cureus 2023; 15:e47939. [PMID: 38034189 PMCID: PMC10685081 DOI: 10.7759/cureus.47939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Cerebral palsy (CP) is a complex neurological condition characterized by motor dysfunction affecting millions worldwide. This comprehensive review delves into the critical role of assessment in managing CP. Beginning with exploring its definition and background, we elucidate the diverse objectives of CP assessment, ranging from diagnosis and goal setting to research and epidemiology. We examine standard assessment scales and tools, discuss the challenges inherent in CP assessment, and highlight emerging trends, including integrating technology, personalized medicine, and neuroimaging. The applications of CP assessment in clinical diagnosis, treatment planning, research, and education are underscored. Recommendations for the future encompass standardization, interdisciplinary collaboration, research priorities, and professional training. In conclusion, we emphasize the importance of assessment as a compass guiding the care of individuals with CP, issuing a call to action for improved assessment practices to shape a brighter future for those affected by this condition.
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Affiliation(s)
- Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Surkar SM, Willson JD, Cassidy JM, Kantak S, Patterson CG. Remote ischaemic conditioning combined with bimanual task training to enhance bimanual skill learning and corticospinal excitability in children with unilateral cerebral palsy: a study protocol of a single centre, phase II randomised controlled trial. BMJ Open 2023; 13:e076881. [PMID: 37770277 PMCID: PMC10546168 DOI: 10.1136/bmjopen-2023-076881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/22/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Children with unilateral cerebral palsy (UCP) have difficulty in bimanual coordination that restricts the child's independence in daily activities. Although several efficacious interventions to improve bimanual coordination exist, these interventions often require higher training doses and have modest effect sizes. Thus, there is a critical need to find an effective priming agent that, when paired with task-specific training, will facilitate neurobiological processes to enhance the magnitude of training effects and subsequently improve functional capabilities of children with UCP. The aim of this study is to determine the effects of a novel priming agent, remote ischaemic conditioning (RIC), combined with bimanual training on bimanual skill learning and corticospinal excitability in children with UCP. METHODS AND ANALYSES 46 children, aged 8-16 years, will be randomly assigned to receive RIC or sham conditioning combined with 5 days of bimanual skill (cup stacking) training (15 trials per session). RIC or sham conditioning will be performed with a standard conditioning protocol of five cycles of alternative inflation and deflation of a pressure cuff on the affected arm with the pressure of at least 20 mm Hg above systolic blood pressure for RIC and 25 mm Hg for sham conditioning. Primary outcomes will be movement time and corticospinal excitability measures determined with a single-pulse transcranial magnetic stimulation (TMS). Secondary outcomes include Assisting Hand Assessment, spatio-temporal kinematic variables and paired pulse TMS measures. All measures will be conducted before and immediately after the intervention. A mixed model analysis of variance will test the group×time interaction for all outcomes with group (RIC and sham) as between-subject and time (preintervention, postintervention) as within-subject factors. ETHICS AND DISSEMINATION The study has been approved by the University Medical Centre Institutional Review Board (UMCIRB #21-001913). We will disseminate the study findings via peer-reviewed publications and presentations at professional conferences. TRIAL REGISTRATION NUMBER NCT05777070.
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Affiliation(s)
- Swati M Surkar
- Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - John D Willson
- Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - Jessica M Cassidy
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shailesh Kantak
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
- Department of Rehabilitation Medicine, Moss Rehabilitation Research Institute, Philadelphia, PA, USA
| | - Charity G Patterson
- Department of Physical Therapy and School of Health and Rehabilitation Sciences Data Center, University of Pittsburgh, Pittsburgh, PA, USA
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Han Y, Park S. Effectiveness of virtual reality on activities of daily living in children with cerebral palsy: a systematic review and meta-analysis. PeerJ 2023; 11:e15964. [PMID: 37667752 PMCID: PMC10475275 DOI: 10.7717/peerj.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
Background No meta-analysis has been conducted on the effect of specific virtual reality (VR) treatment modes on activities of daily living (ADL) in children with cerebral palsy (CP). Therefore, this study aimed to confirm whether VR therapy is effective in improving ADL in children with CP according to subgroups. Methodology Literature published in the Cumulated Index to Nursing and Allied Health Literature (CINAHL), Embase, the Physiotherapy Evidence Database (PEDro), and PubMed was reviewed, and Risk of Bias 2.0 (RoB 2) was used to evaluate the quality of the literature. A funnel plot was visually observed to confirm publication bias, supplemented with Egger's regression test. Data analysis was performed using R version 4.2.1. Subgroup analysis was performed according to the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), treatment minutes per week, treatment period, age, and RoB. Results Eleven of 2,978 studies were included, and the overall effect size was 0.37 (95% confidence interval = 0.17-0.57). Regarding GMFCS, effect sizes of 0.41 and 0.33 was observed for the low- and high-function groups, respectively. For MACS, 0.27 and 0.43 were observed for the low and high-function groups. Regarding treatment minutes per week, the values were 0.22, 0.44, and 0.27 in the 1-100, 101-200, and 201-300 min groups, respectively. In the classification according to age, 0.29 was observed for school-age children and 0.98 for preschool children. Lastly, in the classification according to the RoB, 0.52, -0.01, and 0.23 indicated studies with low risk, some concern, and high risk, respectively. Conclusions The highest effect was observed when VR was applied within 6 weeks of 101-200 per week. Therefore, it is suggested that if the results of this review are applied to children with cerebral palsy in the community, it will be an effective intervention method. Systematic review registration PROPEROS (registration number CRD42023409801).
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Affiliation(s)
- YongGu Han
- Department of Physical Therapy, Yonsei University, Wonju, Kangwondo, South Korea
| | - SunWook Park
- Department of Physical Therapy, Kangwon National University, Samchuk, Kangwondo, South Korea
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Ragni LB, Dlugacz SK, Sadowsky C, Cammarata G, Sala DA, Bill V, Sukhov R, Chu A. Design and Use of a 3D-Printed Dynamic Upper Extremity Orthosis for Children With Cerebral Palsy and Severe Upper Extremity Involvement: A Pilot Study. Am J Occup Ther 2023; 77:7704205060. [PMID: 37611318 DOI: 10.5014/ajot.2023.050095] [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: 08/25/2023] Open
Abstract
IMPORTANCE Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses. OBJECTIVE To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V. DESIGN Pilot study. Assessments were performed pretreatment and immediately posttreatment. SETTING Hospital-based outpatient occupational therapy department. PARTICIPANTS Five patients, ages 13 to 17 yr, with CP and unilateral UE involvement MACS Levels III to V. INTERVENTION Custom forearm thumb opponens orthosis and the DUEO were designed and fabricated by a multidisciplinary team for use during eight 1-hr occupational therapy sessions targeting bimanual UE training. OUTCOMES AND MEASURES Pretreatment and posttreatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), and the Pediatric Quality of Life Inventory: CP Module (PedsQL:CP). RESULTS All participants had higher posttreatment scores on at least one measure. Four had minimal clinically important differences (MCID) on the AHA. Three met MCID criteria on MA-2 subtests (one negative change). Four demonstrated improvement on the PMAL-R (one participant achieved an MCID score), and three reported improvements in more than one PedsQL:CP domain. CONCLUSIONS AND RELEVANCE This novel 3D-printed device, in combination with occupational therapy, shows promising evidence that children who score in lower MACS levels can show gains in UE function. What This Article Adds: This study demonstrates that a customized, 3D-printed dynamic orthosis, in combination with occupational therapy intervention, can facilitate UE function in children with severe hand impairment.
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Affiliation(s)
- Lori B Ragni
- Lori B. Ragni, MS, OTR/L, BCP, is Supervisor, Pediatric Occupational Therapy, Rusk Rehabilitation, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Stacy Kirsch Dlugacz
- Stacy Kirsch Dlugacz, MS, OTR/L, C/NDT, is Clinical Specialist, Pediatric Occupational Therapy, Rusk Rehabilitation, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Cali Sadowsky
- Cali Sadowsky, MS, OTR/L, is Senior Occupational Therapist, Pediatric Occupational Therapy, Rusk Rehabilitation, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Gabriella Cammarata
- Gabriella Cammarata, MS, is Studio Research Coordinator, Tandon School of Engineering, New York University, Brooklyn, NY
| | - Debra A Sala
- Debra A. Sala, MS, PT, is Research Coordinator, Division of Pediatric Orthopedics, Hassenfeld Children's Hospital, NYU Langone Health, New York, NY
| | - Victoria Bill
- Victoria Bill, MS, is Director, MakerSpace, and Adjunct Professor, Tandon School of Engineering, New York University, Brooklyn, NY
| | - Renat Sukhov
- Renat Sukhov, MD, is Clinical Research Associate Professor of Rehabilitation Medicine, NYU Langone Health, New York, NY
| | - Alice Chu
- Alice Chu, MD, is Associate Professor of Orthopedic Surgery and Chief, Division of Pediatric Orthopedics, Rutgers New Jersey Medical School, Newark, NJ;
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Ortega-Martínez A, Palomo-Carrión R, Varela-Ferro C, Bagur-Calafat MC. Feasibility of a Home-Based Mirror Therapy Program in Children with Unilateral Spastic Cerebral Palsy. Healthcare (Basel) 2023; 11:1797. [PMID: 37372915 DOI: 10.3390/healthcare11121797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Children with Unilateral Spastic Cerebral Palsy (US CP) have motor and somatosensory impairments that affect one side of their body, impacting upper limb functioning. These impairments contribute negatively to children's bimanual performance and quality of life. Intensive home-based therapies have been developed and have demonstrated their feasibility for children with US CP and their parents, especially when therapies are designed with the proper coaching of families. Mirror Therapy (MT) is being studied to become an approachable intensive and home-based therapy suitable for children with US CP. The aim of this study is to analyze the feasibility of a five-week home-based program of MT for children with US CP that includes coaching by the therapist. Six children aged 8-12 years old performed the therapy for five days per week, 30 min per day. A minimum of 80% of compliance was required. The feasibility included compliance evaluations, total dosage, perceived difficulty of the exercises, and losses of follow-ups. All children completed the therapy and were included in the analysis. The total accomplishment was 86.47 ± 7.67. The perceived difficulty of the exercises ranged from 2.37 to 4.51 out of 10. In conclusion, a home-based program of Mirror Therapy is a safe, cost-efficient, and feasible therapy for children with US CP when the therapist is involved as a coach during the entire program.
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Affiliation(s)
- Anna Ortega-Martínez
- Physiotherapy Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- Physiotherapy Department, Fundació Aspace Catalunya, 08038 Barcelona, Spain
| | - Rocío Palomo-Carrión
- Physiotherapy Department, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
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Ou CH, Shiue CC, Kuan YC, Liou TH, Chen HC, Kuo TJ. Neuromuscular Electrical Stimulation of Upper Limbs in Patients With Cerebral Palsy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Phys Med Rehabil 2023; 102:151-158. [PMID: 35687763 DOI: 10.1097/phm.0000000000002058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of the study is to assess the effects of neuromuscular electrical stimulation on the upper limbs of patients with cerebral palsy. DESIGN We searched PubMed, Cochrane, Embase, and Scopus databases for randomized controlled trials examining the effects of neuromuscular electrical stimulation on the upper limbs of children with cerebral palsy. RESULTS Eight randomized controlled trials ( N = 294) were included in the meta-analysis. Compared with traditional physical therapy, sensorimotor training and task-oriented training, constraint-induced movement therapy, dynamic bracing, and conventional robot-assisted therapy, neuromuscular electrical stimulation in combination with these therapies resulted in significantly greater functional scale scores (standardized mean difference = 0.80; 95% confidence interval = 0.54 to 1.06), muscle strength of upper limbs (standardized mean difference = 0.57; 95% confidence interval = 0.25 to 0.88), and spasticity of upper limbs (relative risk = 2.53; 95% confidence interval = 1.46 to 4.39; standardized mean difference = -0.18; 95% confidence interval = -0.29 to -0.06) but did not improve the wrist range of motion (standardized mean difference = 0.43; 95% confidence interval = -0.04 to 0.91). In addition, the effect of neuromuscular electrical stimulation on functional scale scores remained after 3-mo follow-up (standardized mean difference = 0.68; 95% confidence interval = 0.16 to 1.2). CONCLUSIONS Neuromuscular electrical stimulation effectively improved hand function, muscle strength, and spasticity in patients with cerebral palsy.
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Affiliation(s)
- Chih-Hung Ou
- From the Division of Physical Therapy, Department of Rehabilitation, En Chu Kong Hospital, New Taipei City, Taiwan (C-HO); Department of Rehabilitation, En Chu Kong Hospital, New Taipei City, Taiwan (C-CS); Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (Y-CK); Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (Y-CK); Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (Y-CK, H-CC); Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan (Y-CK, T-HL, H-CC, T-JK); Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (T-HL, H-CC, T-JK); and Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (T-HL, H-CC)
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Bono GLP, Achermann P, Rückriem B, Lieber J, van Hedel HJA. Goal-Directed Personalized Upper Limb Intensive Therapy (PULIT) for Children With Hemiparesis: A Retrospective Analysis. Am J Occup Ther 2022; 76:23966. [DOI: 10.5014/ajot.2022.049008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Importance: Children with hemiparesis experience limitations in activities of daily living (ADLs) as a result of upper limb impairments. To address these limitations, we developed a group-based Personalized Upper Limb Intensive Therapy (PULIT) program combining modified constraint-induced movement therapy, bimanual intensive therapy, and exergame-based robotics.
Objective: To determine the effectiveness of PULIT in helping children with upper limb impairments achieve individually set goals and enable transfer of the attained motor skills into ADLs.
Design: Retrospective analysis.
Setting: Day camp at a pediatric rehabilitation clinic in Switzerland.
Participants: Twenty-three children with upper limb impairment (unilateral cerebral palsy, n = 16; acquired brain injury, n = 7); 13 boys and 10 girls (M age = 7 yr, 8 mo, SD = 2 yr, 1 mo; Manual Ability Classification System Level I–IV).
Intervention: Thirty hours of PULIT over the course of 8 days.
Outcomes and Measures: Goal attainment scaling (GAS) was assessed on the first and last day of intervention. The Canadian Occupational Performance Measure (COPM) and dexterity tests, such as the Box and Block Test (BBT), were administered 3 wk before and 3 wk after the intervention.
Results: Total goal achievement was 85.7%. GAS, parent- and child-rated COPM Performance and Satisfaction, and the BBT of the affected and dominant upper limb improved significantly.
Conclusions and Relevance: PULIT effectively increases children’s dexterity of the impaired and dominant upper limb, improves ADL performance, and achieves individual goals. This retrospective analysis could serve as a basis for a future randomized trial.
What This Article Adds: This article informs occupational therapy practitioners about a therapy program that includes conventional and rehabilitation technology interventions and enables children with hemiparesis of the upper limb to improve relevant ADL tasks in 8 days’ time.
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Affiliation(s)
- Géraldine L. P. Bono
- Géraldine L. P. Bono, MD, is Doctoral Candidate, Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland, and Resident Physician, Department of Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Prisca Achermann
- Prisca Achermann, OT, is Occupational Therapist, Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
| | - Bärbel Rückriem
- Bärbel Rückriem, MScOT, is Head of Occupational Therapy, Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
| | - Jan Lieber
- Jan Lieber, MScOT, is Deputy Head of Occupational Therapy, Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
| | - Hubertus J. A. van Hedel
- Hubertus J. A. van Hedel, PhD, PT, is Head of Research, Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland, and Professor of Neurorehabilitation, Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland;
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Bania TA, Taylor NF, Chiu HC, Charitaki G. What are the optimum training parameters of progressive resistance exercise for changes in muscle function, activity and participation in people with cerebral palsy? A systematic review and meta-regression. Physiotherapy 2022; 119:1-16. [PMID: 36696699 DOI: 10.1016/j.physio.2022.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/11/2022] [Accepted: 10/13/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the effect of progressive resistance exercise (PRE) on impairment, activity and participation of people with cerebral palsy (CP). Also, to determine which programme parameters provide the most beneficial effects. DATA SOURCES Electronic databases searched from the earliest available time. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) implementing PRE as an intervention in people with cerebral palsy were included. STUDIES APPRAISAL & SYNTHESIS METHODS Methodological quality of trials was assessed with the PEDro scale. Meta-analysis and meta-regression were completed. RESULTS We included 20 reports of 16 RCTs (n = 504 participants). Results demonstrated low certainty evidence that PRE improved muscle strength (pooled standardised mean difference (SMD)= 0.59 (95%CI: 0.16-1.01; I²=70%). This increase in muscle strength was maintained an average of 11 weeks after training stopped. Τhere was also moderate certainty evidence that it is inconclusive whether PRE has a small effect on gross motor function (SMD= 0.14 (95%CI: -0.09 to 0.36; I²=0%) or participation (SMD= 0.26 (95%CIs: -0.02 to 0.54; I²=0%). When PRE was compared with other therapy there were no between-group differences. Meta-regression demonstrated no effect of PRE intensity or training volume (frequency x total duration) on muscle strength (p > 0.5). No serious adverse events were reported. There is lack of evidence of the effectiveness of PRE in adults and non-ambulatory people with CP. CONCLUSIONS PRE is safe and increases muscle strength in young people with CP, which is maintained after training stops. The increase in muscle strength is unrelated to the PRE intensity or dose. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Theofani A Bania
- Department of Physiotherapy, University of Patras, Ktirio B', Rio, 26504 , Greece.
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University; and Allied Health Clinical Research Office, Eastern Health, Australia.
| | - Hsiu-Ching Chiu
- Department of Physical Therapy, I-Shou University, Xuecheng Road, Dashu District, Kaohsiung 82445 Taiwan.
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A Review on Recent Advances of Cerebral Palsy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2622310. [PMID: 35941906 PMCID: PMC9356840 DOI: 10.1155/2022/2622310] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 12/04/2022]
Abstract
This narrative review summarizes the latest advances in cerebral palsy and identifies where more research is required. Several studies on cerebral palsy were analyzed to generate a general idea of the prevalence of, risk factors associated with, and classification of cerebral palsy (CP). Different classification systems used for the classification of CP on a functional basis were also analyzed. Diagnosis systems used along with the prevention techniques were discussed. State-of-the-art treatment strategies for CP were also analyzed. Statistical distribution was performed based on the selected studies. Prevalence was found to be 2-3/1000 lives; the factors that can be correlated are gestational age and birth weight. The risk factors identified were preconception, prenatal, perinatal, and postnatal categories. According to the evidence, CP is classified into spastic (80%), dyskinetic (15%), and ataxic (5%) forms. Diagnosis approaches were based on clinical investigation and neurological examinations that include magnetic resonance imaging (MRI), biomarkers, and cranial ultrasound. The treatment procedures found were medical and surgical interventions, physiotherapy, occupational therapy, umbilical milking, nanomedicine, and stem cell therapy. Technological advancements in CP were also discussed. CP is the most common neuromotor disability with a prevalence of 2-3/1000 lives. The highest contributing risk factor is prematurity and being underweight. Several preventions and diagnostic techniques like MRI and ultrasound were being used. Treatment like cord blood treatment nanomedicine and stem cell therapy needs to be investigated further in the future to apply in clinical practice. Future studies are indicated in the context of technological advancements among cerebral palsy children.
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Cacioppo M, Lempereur M, Marin A, Rauscent H, Crétual A, Brochard S, Bonan I. Motor patterns of the impaired upper limb in children with unilateral cerebral palsy performing bimanual tasks. Clin Biomech (Bristol, Avon) 2022; 97:105710. [PMID: 35763887 DOI: 10.1016/j.clinbiomech.2022.105710] [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] [Received: 12/14/2021] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Upper limb movement patterns have not yet been identified in bimanual conditions despite the difficulties children with unilateral cerebral palsy have performing bimanual activities. The aim was to identify specific motor patterns from kinematic deviations during bimanual tasks in this population. METHODS Twenty children with unilateral cerebral palsy and 20 age-matched, typically developing children performed the five tasks of a 3D bimanual protocol. To evaluate upper limb kinematic deviations, 10 Arm Variable Scores were calculated for the affected /non-dominant upper limb of each participant for each task. Sparse K-means cluster analysis was applied to the 50 Arm Variable Scores of all the children to identify motor patterns and determining variables. Clinical tests of impairment (muscle strength, selectivity, spasticity) and function (Assisting hand assessment, Abilhand-Kids) were compared between the clusters obtained. FINDINGS Three different motor patterns were identified using the data from all the children: mild, proximal-distal and proximal-distal with trunk. The most important cluster determinants were the Arm Variable Scores for pronation-supination and wrist extension. In the cerebral palsy group, scores of impairments (p < .01) and function (Assisting Hand Assessment [p < .001] and Abilhand-Kids [p = .004]) differed for each motor pattern. Supination and wrist extension deviations differed significantly between the groups (p < .001). INTERPRETATION During performance of bimanual tasks, children with unilateral cerebral palsy used distinct motor patterns that each corresponded to a specific clinical profile. Elbow-wrist deviations were the largest and most decisive and were specific to the cerebral palsy group: they should be the target of interventions to enhance bimanual function. CLINICALTRIALS gov identifier: NCT03888443.
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Affiliation(s)
- Marine Cacioppo
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; Pediatric Rehabilitation Department, Fondation ILDYS, 29200 Brest, France.
| | - Mathieu Lempereur
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France
| | - Antoine Marin
- M2S laboratory (Mouvement Sport Santé), Rennes 2 University - ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France
| | - Hélène Rauscent
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35000 Rennes, France
| | - Armel Crétual
- M2S laboratory (Mouvement Sport Santé), Rennes 2 University - ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France
| | - Sylvain Brochard
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; Pediatric Rehabilitation Department, Fondation ILDYS, 29200 Brest, France
| | - Isabelle Bonan
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35000 Rennes, France; Unité Empenn (ex-Visages) U1228 INSERM-INRIA, IRISA UMR CNRS 6074, Campus de Beaulieu, 35042 Rennes Cedex, France
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12
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Lieber J, Dittli J, Lambercy O, Gassert R, Meyer-Heim A, van Hedel HJA. Clinical utility of a pediatric hand exoskeleton: identifying users, practicability, and acceptance, and recommendations for design improvement. J Neuroeng Rehabil 2022; 19:17. [PMID: 35148786 PMCID: PMC8832660 DOI: 10.1186/s12984-022-00994-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children and adolescents with upper limb impairments can experience limited bimanual performance reducing daily-life independence. We have developed a fully wearable pediatric hand exoskeleton (PEXO) to train or compensate for impaired hand function. In this study, we investigated its appropriateness, practicability, and acceptability. METHODS Children and adolescents aged 6-18 years with functional limitations in at least one hand due to a neurological cause were selected for this cross-sectional evaluation. We characterized participants by various clinical tests and quantified bimanual performance with the Assisting Hand Assessment (AHA). We identified children whose AHA scaled score increased by ≥ 7 points when using the hand exoskeleton and determined clinical predictors to investigate appropriateness. The time needed to don each component and the number of technical issues were recorded to evaluate practicability. For acceptability, the experiences of the patients and the therapist with PEXO were evaluated. We further noted any adverse events. RESULTS Eleven children (median age 11.4 years) agreed to participate, but data was available for nine participants. The median AHA scaled score was higher with PEXO (68; IQR: 59.5-83) than without (55; IQR: 37.5-80.5; p = 0.035). The Box and Block test, the Selective Control of the Upper Extremity Scale, and finger extensor muscle strength could differentiate well between those participants who improved in AHA scaled scores by ≥ 7 points and those who did not (sensitivity and specificity varied between 0.75 and 1.00). The median times needed to don the back module, the glove, and the hand module were 62, 150, and 160 s, respectively, but all participants needed assistance. The most critical failures were the robustness of the transmission system, the electronics, and the attachment system. Acceptance was generally high, particularly in participants who improved bimanual performance with PEXO. Five participants experienced some pressure points. No adverse events occurred. CONCLUSIONS PEXO is a safe exoskeleton that can improve bimanual hand performance in young patients with minimal hand function. PEXO receives high acceptance. We formulated recommendations to improve technical issues and the donning before such exoskeletons can be used under daily-life conditions for therapy or as an assistive device. Trial registration Not appropriate.
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Affiliation(s)
- Jan Lieber
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Jan Dittli
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008, Zurich, Switzerland
| | - Andreas Meyer-Heim
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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13
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Gerard A, Toussaint-Thorin M, Mohammad Y, Letellier G, Fritot S, Masson S, Duhamel A, Donskoff C, Zagame Y, Beghin L, Gottrand L. PROPENSIX: pressure garment therapy using compressive dynamic Lycra ® sleeve to improve bi-manual performance in unilateral cerebral palsy: a multicenter randomized controlled trial protocol. Trials 2022; 23:117. [PMID: 35123557 PMCID: PMC8817585 DOI: 10.1186/s13063-022-06041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/19/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Upper limb impairment affects activity and participation in children with unilateral cerebral palsy (UCP). Pressure garment therapy (PGT) using compressive dynamic Lycra® garments is an innovative intervention proposed for the management of cerebral palsy consequences. The PROPENSIX study aims to evaluate the efficacy of a therapy using a Lycra® sleeve as compared to a placebo sleeve to improve bi-manual performance measured by the Assisting Hand Assessment (AHA) in children with unilateral cerebral palsy. METHODS The PROPENSIX trial is a multicenter, prospective, placebo-controlled, double-blinded, randomized study. One hundred children with UCP, aged from 5 to 10, are randomly assigned as soon as they are recruited in a 1:1 ratio to perform usual daily activities, especially activities involving bimanual performances, with Lycra® sleeve or placebo sleeve during 6 months. The primary endpoint is the change in bimanual performance from inclusion to 6 months, evaluated by AHA. The secondary endpoints evaluate changes from inclusion to 6 months in other dimensions of the International Classification of Functioning (ICF), upper limb movement capacity assessed by Quality of Upper Extremity Skill Test (QUEST), and health-related quality of life evaluated by Pediatric Quality of Life Inventory 3.0 Cerebral Palsy Module (PedsQLTM 3.0 CP Module) and in body structures and functions domain assessed by neuro-orthopedic examination and somatosensory evoked potentials (SEP). DISCUSSION The PROPENSIX study is the largest randomized controlled trial (RCT) aiming to evaluate the efficacy of a PGT using compressive dynamic Lycra® sleeve in UCP. Enhancement of children's bimanual performance at the end of the 6 months wear of the Lycra® sleeve should improve evidence regarding this type of treatment and expand discussion about their recommendation in clinical practice. Data from secondary outcomes assessments should bring interesting arguments to discuss the Lycra® sleeve action on mobility, tonus, and sensory impairments in children with unilateral cerebral palsy. TRIAL REGISTRATION ClinicalTrials.gov NCT02086214 . Retrospectively registered on March 13, 2014 TRIAL STATUS: Study start data: December 2012. Recruitment status: completed. Primary completion date: April 2021. Estimated study completion date: December 2022. Protocol version 10 (date: February 2018).
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Affiliation(s)
- A. Gerard
- Service de Soins de Suites et Réadaptation pédiatrique, CHU Reims, AMH 47 Rue Cognacq-Jay, F-51092 Reims, France
| | - M. Toussaint-Thorin
- Service de Soins de Suites et Réadaptation pédiatrique, CHU Reims, AMH 47 Rue Cognacq-Jay, F-51092 Reims, France
| | - Y. Mohammad
- Service d’Éducation et de Soins Spécialisés à Domicile APF, 50 Square Frédéric Chopin, F-60175 Creil, France
- Maison de rééducation et d’autonomie, 20 Rue Anatole France, F-95260 Beaumont-sur-Oise, France
| | - G. Letellier
- Établissement de Santé pour Enfants et Adolescents de la région Nantaise, 58 Rue des Bourdonnières, F-44200 Nantes, France
| | - S. Fritot
- Médecine Physique et de Réadaptation Pédiatrique, CHU Amiens, 1 Rue du Professeur Christian Cabrol, F-80054 Amiens, France
| | - S. Masson
- Établissement de Soins de Suite et Réadaptation Pédiatrique Marc Sautelet APF, 10 Rue du Petit Boulevard, F-59650 Villeneuve-d’Ascq, France
| | - A. Duhamel
- CHU Lille, ULR 2694-Metrics: évaluation des technologies de santé et des pratiques médicales, University of Lille, 2 Avenue Oscar Lambret, F-59000 Lille, France
| | - C. Donskoff
- Service de Soins de Suite et de Réadaptation Pédiatrique, Centre Paul Dottin, 26 Avenue Tolosane, F-31522 Ramonville-Saint-Agne, France
| | - Y. Zagame
- Medical Z, 14 Rue Georges Cuvier, F-37550 Saint-Avertin, France
| | - L. Beghin
- CHU Lille, CIC1403 - Clinical Investigation Center, University of Lille, 2 Avenue Oscar Lambret, F-59000 Lille, France
| | - L. Gottrand
- Établissement de Soins de Suite et Réadaptation Pédiatrique Marc Sautelet APF, 10 Rue du Petit Boulevard, F-59650 Villeneuve-d’Ascq, France
- Institut d’Éducation Motrice pour enfants et adolescents Christian Dabbadie APF, 64 Rue de la Liberté, F-59650 Villeneuve-d’Ascq, France
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14
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Kuroda MM, Iwasaki N, Yoshikawa K, Takeuchi R, Mataki Y, Nakayama T, Nakayama J, Ohguro H, Tokeji K, Mutsuzaki H. Voluntary-assisted Upper Limb Training for Severe Cerebral Palsy Using Robotics Devices and Neuromuscular Electrical Stimulation: Three Case Reports. Prog Rehabil Med 2022; 7:20220050. [PMID: 36188138 PMCID: PMC9475054 DOI: 10.2490/prm.20220050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 08/23/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Constraint-induced movement therapy (CIMT) improves the motor function of paralyzed
upper limbs of adults after stroke. However, in patients with severe spastic cerebral
palsy (CP), the use of CIMT is not warranted. Our aim was to investigate the feasibility
and effectiveness of repetitive voluntary-assisted upper limb training (VAUT) for three
patients with severe CP using a combination of robotics [Hybrid Assistive Limb (HAL)]
and functional electrical stimulation [Integrated Volitional Control Electrical
Stimulation (IVES)]. Case: Three patients with CP were enrolled. Patients 1, 2, and 3 were 8-, 19-, and
18-year-old males, respectively. Patient 1 had spastic hemiplegia, while patients 2 and
3 had spastic quadriplegia. VAUT using single-joint HAL was performed for 1 or 2
sessions/month for 50 min/session over an 8-month period for 9–13 sessions in total. One
patient’s voluntary hand movement was insufficient, affecting his upper limb exercise
performance; therefore, IVES was required in addition to HAL. Outcome measures included
motor function of the upper limbs and use of paralyzed hands, which were measured before
and after intervention. No adverse events were observed during VAUT. After intervention,
the Action Research Arm Test scores showed improvements in all three patients. The
Children’s Hand-use Experience Questionnaire showed improvements in two patients. Discussion: The use of VAUT, together with new systems such as HAL and IVES, for severe CP is safe
and may be effective. Our study suggested that upper limb function can be improved for
patients with severe CP.
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Affiliation(s)
- Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Nobuaki Iwasaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yuki Mataki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Tomohiro Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Junko Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Haruka Ohguro
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kayo Tokeji
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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15
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Grampurohit N, Bell A, Duff SV, Mulcahey MJ, Thielen CC, Kaplan G, Marino RJ. Highlighting gaps in spinal cord injury research in activity-based interventions for the upper extremity: A scoping review. NeuroRehabilitation 2021; 49:23-38. [PMID: 33967071 DOI: 10.3233/nre-210042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders three months post onset/injury. RESULTS The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI.
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Affiliation(s)
- Namrata Grampurohit
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Bell
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susan V Duff
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA, USA
| | - M J Mulcahey
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Gary Kaplan
- Scott Memorial Library, Academic Commons, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph J Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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16
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Steel KA, Anderson DI, Smith CA, Ellem E, Liu KPY, Morrison-Gurza A, Dune T, Fairley LH. Potential Value of Customized Video Self-Modelling for Motor Skill Learning in Individuals with Cerebral Palsy: A Case-Study Approach. Percept Mot Skills 2021; 128:1464-1484. [PMID: 33892615 DOI: 10.1177/00315125211012810] [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: 11/17/2022]
Abstract
Cerebral Palsy (CP) is a common physical disability that is managed with a variety of strategies. One non-invasive intervention for people living with CP is a type of video self-modelling (VSM) referred to as positive self-review (PSR). PSR involves watching a video of oneself performing only the best examples of a desired task; this technique has been associated with improved performance and learning for people without disabilities and for those in various clinical populations, including children with spina bifida and stroke patients. PSR may have similar benefits for people living with CP. In this study we examined the effectiveness of PSR for improving a self-selected movement task among individuals living with CP. In this case study approach, eight participants completed a pre-, post-, and second post-test measuring and recording well-being, movement self-consciousness and tendency to consciously monitor movements. Results were mixed, with some participants improving their movement time, well-being ratings and tendency toward self-consciousness and conscious monitoring of movements and others showing no changes or regressions. The effectiveness of VSM appears to depend upon the match between type of task and disability and/or the length of practice. More study is needed.
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Affiliation(s)
- Kylie A Steel
- Western Sydney University, Sydney, Australia.,The MARCS Institute, Sydney, Australia
| | - David I Anderson
- San Francisco State University, San Francisco, California, United States
| | - Caroline A Smith
- Western Sydney University, Sydney, Australia.,National Institute of Complementary Medicine, Sydney, Australia
| | | | | | | | - Tinashe Dune
- Western Sydney University, Sydney, Australia.,Translational Health Research Institute, Sydney, Australia
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17
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Immersive Virtual Environments and Wearable Haptic Devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study. J Neuroeng Rehabil 2020; 17:144. [PMID: 33115487 PMCID: PMC7594483 DOI: 10.1186/s12984-020-00771-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
Background The past decade has seen the emergence of rehabilitation treatments using virtual reality. One of the advantages in using this technology is the potential to create positive motivation, by means of engaging environments and tasks shaped in the form of serious games. The aim of this study is to determine the efficacy of immersive Virtual Environments and weaRable hAptic devices (VERA) for rehabilitation of upper limb in children with Cerebral Palsy (CP) and Developmental Dyspraxia (DD). Methods A two period cross-over design was adopted for determining the differences between the proposed therapy and a conventional treatment. Eight children were randomized into two groups: one group received the VERA treatment in the first period and the manual therapy in the second period, and viceversa for the other group. Children were assessed at the beginning and the end of each period through both the Nine Hole Peg Test (9-HPT, primary outcome) and Kinesiological Measurements obtained during the performing of similar tasks in a real setting scenario (secondary outcomes). Results All subjects, not depending from which group they come from, significantly improved in both the performance of the 9-HPT and in the parameters of the kinesiological measurements (movement error and smoothness). No statistically significant differences have been found between the two groups. Conclusions These findings suggest that immersive VE and wearable haptic devices is a viable alternative to conventional therapy for improving upper extremity function in children with neuromotor impairments. Trial registration ClinicalTrials, NCT03353623. Registered 27 November 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03353623
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18
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Plasschaert VFP, Vriezekolk JE, Aarts PBM, Geurts ACH, Van den Ende CHM. Interventions to improve upper limb function for children with bilateral cerebral palsy: a systematic review. Dev Med Child Neurol 2019; 61:899-907. [PMID: 30632139 PMCID: PMC6850353 DOI: 10.1111/dmcn.14141] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 01/19/2023]
Abstract
AIM To systematically review the efficacy of interventions on upper limb function in children 0 to 19 years of age with bilateral cerebral palsy on the basis of outcome measures of upper limb function and measures of activities and/or participation according to the International Classification of Functioning, Disability and Health. METHOD Cochrane, PubMed, Embase, CINAHL, and Web of Science were searched from inception to September 2017. Methodological quality and strength of evidence were analysed by two independent raters using Sackett's level of evidence and the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines. RESULTS Fifteen studies with a large variety of interventions and heterogeneity in outcome measures met the inclusion criteria. Twelve studies provided level IV evidence according to AACPDM guidelines. For three small randomized controlled trials the level of evidence was II. Only one of these trials showed strong methodological quality: a study on hand-arm bimanual intensive therapy including lower extremities. INTERPRETATION We identified a large variety of interventions, heterogeneity in outcome measures, and generally weak to moderate methodological quality for most studies. We recommend further research specifically aimed at bimanual-intensive, goal-directed, and task-specific training programmes for the upper limb in children with bilateral cerebral palsy, using either high-quality (multicentre) trials or well-designed single-case trials. WHAT THIS PAPER ADDS There is a large variety of interventions on upper limb function in children with bilateral cerebral palsy. Heterogeneity of outcome measures and interventions impeded firm conclusions about intervention efficacy. Most studies had low-level evidence and weak to moderate methodological quality. The strongest evidence from a small randomized controlled trial was for hand-arm bimanual intensive therapy including lower extremities.
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Affiliation(s)
- Véronique F P Plasschaert
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands,Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenthe Netherlands
| | | | - Pauline B M Aarts
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands,Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenthe Netherlands
| | - Cornelia H M Van den Ende
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands,Department of RheumatologySint MaartenskliniekNijmegenthe Netherlands
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