1
|
Merino-Andrés J, López-Muñoz P, Carrión RP, Martín-Casas P, Ruiz-Becerro I, Hidalgo-Robles Á. Is more always better? Effectiveness of constraint-induced movement therapy in children with high-risk or unilateral cerebral palsy (0-6 years): Systematic review and meta-analysis. Child Care Health Dev 2024; 50:e13262. [PMID: 38606885 DOI: 10.1111/cch.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/30/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND While constraint-induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint-induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis. METHODS This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration's tool. RESULTS Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents' perception of how effectively children use their affected upper limb. CONCLUSIONS Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent's perception.
Collapse
Affiliation(s)
- Javier Merino-Andrés
- PedPT Research Lab, Toledo, Spain
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- Toledo Physiotherapy Research Group (GIFTO), Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain
| | - Purificación López-Muñoz
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- Research in Pediatric Physiotherapy and Neurology Group, ImproveLab, Toledo, Spain
| | - Rocío Palomo Carrión
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- Research in Pediatric Physiotherapy and Neurology Group, ImproveLab, Toledo, Spain
| | - Patricia Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Álvaro Hidalgo-Robles
- PedPT Research Lab, Toledo, Spain
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- International University of La Rioja, Logroño, Spain
| |
Collapse
|
2
|
Svensson K, Sundelin H, Eliasson AC. Outcomes of a Parent-Delivered Baby-mCIMT Model for Infants at High Risk of Unilateral Cerebral Palsy Using Remote Coaching in Telerehabilitation. CHILDREN (BASEL, SWITZERLAND) 2024; 11:101. [PMID: 38255414 PMCID: PMC10814714 DOI: 10.3390/children11010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
There is growing evidence of the positive effects of constraint-induced movement therapy (CIMT) for infants at high risk of unilateral cerebral palsy (UCP) when provided by parents with in-person coaching/supervision from occupational therapists during home visits. The aim of this study is to investigate whether Baby-mCIMT (modifiedCIMT) can be as effective if parents are coached/supervised remotely. In this case-control study, we recruited 20 infants and re-used 18 controls, 4-8-month-old infants in both groups at high risk of UCP. The same protocol regarding inclusion criteria, data collection, and training volume was used in both groups. The training was conducted for two 6-week periods, separated by a 6-week break, consisting of daily 30 min sessions conducted by parents, supported by therapist coaching once a week. The primary outcome was measured using the Hand Assessment for Infants (HAI). There was no difference in the change of HAI units (p = 0.803) or that of the affected-hand raw score (p = 0.942) between the two groups. The remote coaching method was well received by parents. In conclusion, this demonstrates that remote coaching/supervision is as effective as the in-person approach, requiring less time and effort for both families and healthcare providers.
Collapse
Affiliation(s)
- Katarina Svensson
- Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Linkoping University, 58183 Linkoping, Sweden;
- Crown Princess Victoria’s Children Hospital, 58185 Linkoping, Sweden
| | - Heléne Sundelin
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institute, 17177 Stockholm, Sweden;
- Neuropaediatric Research Unit, Astrid Lindgren Children’s Hospital, 17176 Stockholm, Sweden
| | - Ann-Christin Eliasson
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institute, 17177 Stockholm, Sweden;
| |
Collapse
|
3
|
Araneda R, Ebner-Karestinos D, Paradis J, Klöcker A, Saussez G, Demas J, Bailly R, Bouvier S, Carton de Tournai A, Herman E, Souki A, Le Gal G, Nowak E, Sizonenko SV, Newman CJ, Dinomais M, Riquelme I, Guzzetta A, Brochard S, Bleyenheuft Y. Changes Induced by Early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities in Young Children With Unilateral Cerebral Palsy: A Randomized Clinical Trial. JAMA Pediatr 2024; 178:19-28. [PMID: 37930692 PMCID: PMC10628844 DOI: 10.1001/jamapediatrics.2023.4809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/10/2023] [Indexed: 11/07/2023]
Abstract
Importance Intensive interventions are provided to young children with unilateral cerebral palsy (UCP), classically focused on the upper extremity despite the frequent impairment of gross motor function. Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) effectively improves manual dexterity and gross motor function in school-aged children. Objective To verify if HABIT-ILE would improve manual abilities in young children with UCP more than usual motor activity. Design, Setting, and Participants This prospective randomized clinical trial (November 2018 to December 2021), including 2 parallel groups and a 1:1 allocation, recruitment took place at European university hospitals, cerebral palsy specialized centers, and spontaneous applications at 3 sites: Brussels, Belgium; Brest, France; and Pisa, Italy. Matched (age at inclusion, lesion type, cause of cerebral palsy, and affected side) pairs randomization was performed. Young children were assessed at baseline (T0), 2 weeks after baseline (T1), and 3 months after baseline (T2). Health care professionals and assessors of main outcomes were blinded to group allocation. At least 23 young children (in each group) aged 12 to 59 months with spastic/dyskinetic UCP and able to follow instructions were needed. Exclusion criteria included uncontrolled seizures, scheduled botulinum toxin injections, orthopedic surgery scheduled during the 6 months before or during the study period, severe visual/cognitive impairments, or contraindications to magnetic resonance imaging. Interventions Two weeks of usual motor activity including usual rehabilitation (control group) vs 2 weeks (50 hours) of HABIT-ILE (HABIT-ILE group). Main Outcomes and Measures Primary outcome: Assisting Hand Assessment (AHA); secondary outcomes: Gross Motor Function Measure-66 (GMFM-66), Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), and Canadian Occupational Performance Measure (COPM). Results Of 50 recruited young children (26 girls [52%], median age; 35.3 months for HABIT-ILE group; median age, 32.8 months for control group), 49 were included in the final analyses. Change in AHA score from T0 to T2 was significantly greater in the HABIT-ILE group (adjusted mean score difference [MD], 5.19; 95% CI, 2.84-7.55; P < .001). Changes in GMFM-66 (MD, 4.72; 95% CI, 2.66-6.78), PEDI-CAT daily activities (MD, 1.40; 95% CI, 0.29-2.51), COPM performance (MD, 3.62; 95% CI, 2.91-4.32), and satisfaction (MD, 3.53; 95% CI, 2.70-4.36) scores were greater in the HABIT ILE group. Conclusions and Relevance In this clinical trial, early HABIT-ILE was shown to be an effective treatment to improve motor performance in young children with UCP. Moreover, the improvements had an impact on daily life activities of these children. Trial registration ClinicalTrials.gov Identifier: NCT04020354.
Collapse
Affiliation(s)
- Rodrigo Araneda
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - Daniela Ebner-Karestinos
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - Julie Paradis
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Anne Klöcker
- Haute Ecole Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - Geoffroy Saussez
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Forme et Fonctionnement Humain Unit, Department of Motor Sciences, CeREF - Haute Ecole Louvain en Hainaut, Belgium
| | - Josselin Demas
- Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) – EA7315 F-49000 France
- Instituts de formation du Centre Hospitalier de Laval, Laval, France
| | - Rodolphe Bailly
- INSERM UMR 1101, LaTIM, Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Sandra Bouvier
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
- Western Brittany University, Brest, France
| | | | - Enimie Herman
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Grégoire Le Gal
- University Hospital of Brest, Brest, France
- INSERM CIC 1412, Brest, France
| | - Emmanuel Nowak
- University Hospital of Brest, Brest, France
- INSERM CIC 1412, Brest, France
| | - Stephane V. Sizonenko
- Division of Child Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - Christopher J. Newman
- Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mickael Dinomais
- Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) – EA7315 F-49000 France
- CHU Angers, Département de Médecine Physique et de Réadaptions, CHU Angers-Capucins, F- 49933, France
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy and Research Institute on Health Sciences (UINICS-Idisba), University of the Balearic Islands, Palma de Mallorca, Spain
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sylvain Brochard
- INSERM UMR 1101, LaTIM, Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
- Western Brittany University, Brest, France
- University Hospital of Brest, Brest, France
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
4
|
Reidy TG, Andrejow NW, Naber E, Carney J. Hybrid Telehealth Pediatric Constraint Induced Movement Therapy Compared to In-person Intervention: A Case Series. Int J Telerehabil 2023; 15:e6567. [PMID: 38162938 PMCID: PMC10754234 DOI: 10.5195/ijt.2023.6567] [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] [Indexed: 01/03/2024] Open
Abstract
Constraint induced movement therapy is an established, evidence-based intervention for children with hemiplegia. This case series describes the feasibility and clinical opportunities of using a hybrid telehealth and onsite model to deliver pediatric constraint induced movement therapy during the COVID-19 pandemic. These cases support that a hybrid model had a similar effect on upper extremity improvement compared to a traditional, in-person model and may be an option when access to in-person care is not available.
Collapse
Affiliation(s)
| | | | - Erin Naber
- Specialized Transition Program, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Joan Carney
- Specialized Transition Program, Kennedy Krieger Institute, Baltimore, MD, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
DeLuca SC, Trucks MR, Wallace D, Ramey SL. Evidence for Using ACQUIRE Therapy in the Clinical Application of Intensive Therapy: A Framework to Guide Therapeutic Interactions. Behav Sci (Basel) 2023; 13:484. [PMID: 37366736 DOI: 10.3390/bs13060484] [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: 05/09/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Intensive therapies have become increasingly popular for children with hemiparesis in the last two decades and are specifically recommended because of high levels of scientific evidence associated with them, including multiple randomized controlled trials and systematic reviews. Common features of most intensive therapies that have documented efficacy include: high dosages of therapy hours; active engagement of the child; individualized goal-directed activities; and the systematic application of operant conditioning techniques to elicit and progress skills with an emphasis on success-oriented play. However, the scientific protocols have not resulted in guiding principles designed to aid clinicians with understanding the complexity of applying these principles to a heterogeneous clinical population, nor have we gathered sufficient clinical data using intensive therapies to justify their widespread clinical use beyond hemiparesis. We define a framework for describing moment-by-moment therapeutic interactions that we have used to train therapists across multiple clinical trials in implementing intensive therapy protocols. We also document outcomes from the use of this framework during intensive therapies provided clinically to children (7 months-20 years) from a wide array of diagnoses that present with motor impairments, including hemiparesis and quadriparesis. Results indicate that children from a wide array of diagnostic categories demonstrated functional improvements.
Collapse
Affiliation(s)
- Stephanie C DeLuca
- The Fralin Biomedical Research Institute's Neuromotor Clinic, Roanoke, VA 24016, USA
- The School of Neuroscience, Virginia Tech, Blacksburg, VA 24061, USA
- The Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA
| | - Mary Rebekah Trucks
- The Fralin Biomedical Research Institute's Neuromotor Clinic, Roanoke, VA 24016, USA
| | - Dorian Wallace
- The Fralin Biomedical Research Institute's Neuromotor Clinic, Roanoke, VA 24016, USA
| | | |
Collapse
|
6
|
Abstract
Early childhood affords rapid brain development and advancement of the motor system. In High-Risk Infant Follow-Up programs, watchful waiting and monitoring of infants at high risk is shifting toward active surveillance and early diagnosis, followed by immediate targeted very early interventions. Infants with delayed motor skills benefit from developmental care, NIDCAP, and generic or specific motor training. Infants with cerebral palsy benefit from enrichment, targeted skills interventions, and task-specific motor training at high intensity. Infants with degenerative conditions benefit from enrichment but also require accommodations such as powered mobility.
Collapse
Affiliation(s)
- Lynda McNamara
- The Children's Hospital Westmead Clinical School, The University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia.
| |
Collapse
|
7
|
Chen Z, Huang Z, Li X, Deng W, Gao M, Jin M, Zhou X, Du Q. Effects of traditional Chinese medicine combined with modern rehabilitation therapies on motor function in children with cerebral palsy: A systematic review and meta-analysis. Front Neurosci 2023; 17:1097477. [PMID: 36845424 PMCID: PMC9944433 DOI: 10.3389/fnins.2023.1097477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
Objective Traditional Chinese Medicine (TCM) has considerable experience in the treatment of cerebral palsy (CP), but little evidence shows the effect of a combination of TCM and modern rehabilitation therapies on CP. This systematic review aims to evaluate the effect of integrated TCM and modern rehabilitation therapies on motor development in children with CP. Methods We systematically searched five databases up to June 2022, including PubMed, the Cumulative Index to Nursing and Allied Health, Cochrane Library, Embase, and Web of Science. Gross motor function measure (GMFM) and Peabody Development Motor Scales-II were the primary outcomes to evaluate motor development. Secondary outcomes included the joint range of motion, the Modified Ashworth scale (MAS), the Berg balance scale, and Activities of Daily living (ADL). Weighted mean differences (WMD) and 95% confidence intervals (CIs) were used to determine intergroup differences. Results A total of 2,211 participants from 22 trials were enrolled in this study. Among these, one study was at a low risk of bias and seven studies showed a high risk of bias. Significant improvements were found in GMFM-66 (WMD 9.33; 95% CI 0.14-18.52, P < 0.05, I 2 = 92.1%), GMFM-88 (WMD 8.24; 95% CI 3.25-13.24, P < 0.01, I 2 = 0.0%), Berg balance scale (WMD 4.42; 95% CI 1.21-7.63, P < 0.01, I 2 = 96.7%), and ADL (WMD 3.78; 95% CI 2.12-5.43, P < 0.01, I 2 = 58.8%). No adverse events were reported during the TCM intervention in the included studies. The quality of evidence was high to low. Conclusion Integrated TCM and modern rehabilitation therapies may be an effective and safe intervention protocol to improve gross motor function, muscle tone, and the functional independence of children with CP. However, our results should be interpreted carefully because of the heterogeneity between the included studies. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022345470.
Collapse
Affiliation(s)
- Zhengquan Chen
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zefan Huang
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Li
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Deng
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Miao Gao
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mengdie Jin
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuan Zhou
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,*Correspondence: Xuan Zhou,
| | - Qing Du
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Chongming Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China,Qing Du,
| |
Collapse
|
8
|
Effectiveness of Mechanical Horse-Riding Simulator-Based Interventions in Patients with Cerebral Palsy-A Systematic Review and Meta-Analysis. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9120790. [PMID: 36550996 PMCID: PMC9774556 DOI: 10.3390/bioengineering9120790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mechanical horse-riding simulator (HRS) exercises are a type of therapy based on the use of robotic or mechanical devices that produces movement similar to a real horse with the aim of simulating hippotherapy. This review analyses the effectiveness of HRS therapies in patients with cerebral palsy (CP). METHODS A systematic review and a meta-analysis were carried out by searching studies in PubMed Medline, SCOPUS, Web of Science, CINAHL, PEDro and SciELO up until October 2022. We selected clinical trials that assessed the effectiveness of HRS therapy, compared to other interventions, in patients with CP. The main variables were gross motor function (its global score and dimensions, such as sitting ability), functional balance, spasticity, hip range of motion (ROM), posturographic balance and satisfaction. The risk of bias was assessed using the Cochrane Risk of Bias Tool. The pooled effect was calculated using Cohen's Standardized Mean Difference (SMD) for a 95% confidence interval (95% CI). RESULTS Twelve studies were included in the systematic review, and 10 were included in the meta-analysis, providing data from 343 patients with spastic diplegic CP. Our findings revealed that HRS plus physiotherapy is more effective than physiotherapy in improving the total gross motor function (SMD 0.98; 95% CI 0.35-1.62), sitting ability of the gross motor function (SMD 0.84; 95% CI 0.32-1.36) and functional balance (SMD 0.6; 95% CI 0.1-1.08), and HRS therapy is better than sham to improve pelvic abduction ROM (SMD 0.79; 95% CI 0.21-1.37). CONCLUSIONS Horse-riding simulator-based therapy is an effective therapy to improve gross motor function, functional balance and abduction pelvic ROM in children with CP, in comparison to physiotherapy or sham.
Collapse
|