Children with moderate to severe cerebral palsy may not benefit from stochastic vibration when developing independent sitting

The effects of postural control and upper extremity functional capacity on functional Independence in preschool-age children with spastic cerebral palsy: a path model

PURPOSE

To investigate the effects of postural control and upper extremity functional capacity on functional independence and identify whether quality of upper extremity skills mediates the effects of postural control on functional independence in preschool-age children with spastic cerebral palsy (CP).

METHODS

106 children with CP -mean age 43.4 ± 11.3 (24-71 months)- were included in this cross-sectional study. Postural control, upper extremity functional capacity, and functional independence in activities of daily living were evaluated using the Early Clinical Assessment of Balance (ECAB), Quality of Upper Extremity Skills Test (QUEST), and the Functional Independence Measure of Children (WeeFIM), respectively. A path model was used to evaluate the total, direct, and indirect effects.

RESULTS

According to the path model, ECAB (direct effect; r = 0.391, p < 0.01, indirect effect; r = 0.398) and QUEST (direct effect; r = 0.493, p < 0.01) had an impact on WeeFIM. In addition, QUEST had mediating effects on the relationship between ECAB and WeeFIM. The path model explained 71% of the variation in functional independence of the participants.

CONCLUSION

In the management of CP in preschool-age children, the focus should be on improving not only upper extremity capacity but also postural control to help improve functional independence in activities of daily living.

Physical therapy interventions to improve sitting ability in children with or at-risk for cerebral palsy: a systematic review and meta-analysis

AIM

To conduct a systematic review and meta-analysis on the effectiveness of physical therapy interventions to improve sitting ability in young children with or at risk for cerebral palsy (CP).

METHOD

A systematic literature search was performed using five databases. Study selection criteria were randomized controlled trials published in English on physical therapy interventions targeting sitting, reporting developmental or functional sitting outcomes, and focused on young children with or at risk for CP (mean age ≤5y). Risk of bias (ROB) was assessed using the Cochrane ROB 2.0 tool.

RESULTS

Twelve unique studies met the inclusion criteria and were categorized into one of two categories: (1) comparison of two physical therapy interventions or (2) physical therapy plus adjunct versus physical therapy alone. The combined pooled effect size (g) for the 10 studies included in meta-analysis was large (g=0.78) but non-significant. Pooled effect for category 1 was small (g=-0.06) and non-significant. Interventions in category 2 showed a large and significant effect (g=1.90, p=0.022).

INTERPRETATION

There is a lack of strong evidence for physical therapy interventions targeting sitting in young children with or at-risk for CP due to limitations in methodological rigor and sample sizes. Components of impairment remediation combined with functional balance training should be explored to improve sitting in children diagnosed with CP. Given the benefits of early achievement of sitting, strong evidence-based research is needed.

WHAT THIS PAPER ADDS

Strong evidence is lacking for physical therapy interventions to improve sitting ability in young children with/at risk for cerebral palsy (CP). Kinesio-taping may be an effective adjunct to conventional physical therapy in improving sitting ability in children with spastic bilateral CP. Task-specific, intensive, and child-initiated intervention components show promise for improving sitting in young infants at risk for CP.

Visual and somatosensory contributions to infant sitting postural control

There are a limited number of studies that have investigated sitting posture during infancy and the contribution of the sensory systems. The goal of this study was to examine the effects of altered visual and somatosensory signals on infant sitting postural control. Thirteen infants (mean age ± SD, 259.69 ± 16.88 days) participated in the study. Initially, a single physical therapist performed the Peabody Developmental Motor Scale to determine typical motor development. Then the child was placed onto a force platform under four randomized conditions: (a) Control (C) - sat independently on the force plate, (b) Somatosensory (SS) - Sat independently on a foam pad (low density), (c) Visual (VS) - sat independently on the force plate while the lights were turned off creating dim lighting, and (d) Combination of b and c (NVSS). Center of pressure (COP) data from both the anterior-posterior (AP) and the medial-lateral (ML) directions were acquired through the Vicon software at 240 Hz. The lights off conditions, both VS and NVSS, lead to increased Root Mean Square (RMS) and Range values in the AP direction, as well as increased Lyapunov Exponent (LyE) values in the ML direction. Altered visual information lead to greater disturbances of sitting postural control in typically developing infants than altered somatosensory information. The lights off conditions (VS and NVSS), unveiled different control mechanisms for AP and ML direction during sitting. Thus, the present findings confirm the dominance of vision during the early acquisition of a new postural accomplishment.

Stochastic resonance stimulation improves balance in children with cerebral palsy: a case control study

Background

Stochastic Resonance (SR) Stimulation has been used to enhance balance in populations with sensory deficits by improving the detection and transmission of afferent information. Despite the potential promise of SR in improving postural control, its use in individuals with cerebral palsy (CP) is novel. The objective of this study was to investigate the immediate effects of electrical SR stimulation when applied in the ankle muscles and ligaments on postural stability in children with CP and their typically developing (TD) peers.

Methods

Ten children with spastic diplegia (GMFCS level I- III) and ten age-matched TD children participated in this study. For each participant the SR sensory threshold was determined. Then, five different SR intensity levels (no stimulation, 25, 50, 75, and 90% of sensory threshold) were used to identify the optimal SR intensity for each subject. The optimal SR and no stimulation condition were tested while children stood on top of 2 force plates with their eyes open and closed. To assess balance, the center of pressure velocity (COPV) in anteroposterior (A/P) and medial-lateral (M/L) direction, 95% COP confidence ellipse area (COPA), and A/P and M/L root mean square (RMS) measures were computed and compared.

Results

For the CP group, SR significantly decreased COPV in A/P direction, and COPA measures compared to the no stimulation condition for the eyes open condition. In the eyes closed condition, SR significantly decreased COPV only in M/L direction. Children with CP demonstrated greater reduction in all the COP measures but the RMS in M/L direction during the eyes open condition compared to their TD peers. The only significant difference between groups in the eyes closed condition was in the COPV in M/L direction.

Conclusions

SR electrical stimulation may be an effective stimulation approach for decreasing postural sway and has the potential to be used as a therapeutic tool to improve balance. Applying subject-specific SR stimulation intensities is recommended to maximize balance improvements. Overall, balance rehabilitation interventions in CP might be more effective if sensory facilitation methods, like SR, are utilized by the clinicians.

Trial registration

ClinicalTrials.gov identifier NCT02456376; 28 May 2015 (Retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT02456376.