Effect of sensorimotor groups on gross motor acquisition for young children with Down syndrome

A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study

The pilot study assessed the utility of a training program using modified, commercially available dual-joystick-operated ride-on toys to promote unimanual and bimanual upper extremity (UE) function in children with cerebral palsy (CP). The ride-on-toy training was integrated within a 3-week, intensive, task-oriented training camp for children with CP. Eleven children with hemiplegia between 4 and 10 years received the ride-on-toy training program 20-30 min/day, 5 days/week for 3 weeks. Unimanual motor function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the camp. During ride-on-toy training sessions, children wore activity monitors on both wrists to assess the duration and intensity of bimanual UE activity. Video data from early and late sessions were coded for bimanual UE use, independent navigation, and movement bouts. Children improved their total and subscale QUEST scores from pretest to post-test while increasing moderate activity in their affected UE from early to late sessions, demonstrating more equal use of both UEs across sessions. There were no significant changes in the rates of movement bouts from early to late sessions. We can conclude that joystick-operated ride-on toys function as child-friendly, intrinsically rewarding tools that can complement conventional therapy and promote bimanual motor functions in children with CP.

The Uses and Effectiveness of Occupational Therapy Physical Activity Interventions in Young Children with Developmental Disabilities: A Systematic Review

BACKGROUND

Physical activity (PA) is often used to support the development of young children (<5 years) with disabilities. The effectiveness of PA as an occupational therapy (OT) treatment approach in this population has not yet been systematically examined.

AIMS

This research aimed to explore the uses and effectiveness of OT PA interventions on developmental indicators in young children with developmental disabilities.

METHODS

A systematic review of peer-reviewed publications (from 2000 onward) across six electronic databases was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess study quality. Narrative synthesis (vote counting and structured reporting of effects) was employed to summarize the findings.

RESULTS

Eight studies with heterogenous interventions were included. Evidence demonstrated positive trends of participation in the PA interventions on physical, cognitive, and social-emotional indicators, with significance varying. There was no association between interventions and communication indicators or negative effects related to participation in the interventions. Overall, the studies were low-quality when judged by GRADE.

CONCLUSIONS

PA may be a promising avenue for OT interventions among young children with developmental disabilities. Rigorous research is needed to determine the magnitude of effect PA has on developmental indicators.

Systematic review: Need for high-quality research on occupational therapy for children with intellectual disability

BACKGROUND

Enabling participation in everyday life and supporting development are essential goals in occupational therapy of children and young people with intellectual disabilities (ID).

OBJECTIVE

To gather and evaluate evidence of the effectiveness of occupational therapy interventions for children with ID in terms of participation in everyday life.

MATERIAL AND METHODS

A literature search conducted using electronic databases (CINAHL, Cochrane Library, PubMed and EMBASE) from January 2000 to May 2020. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Quality of evidence was critically appraised with the GRADE.

RESULTS

The search yielded 4741 records, of which 15 studies met the inclusion criteria: 3 randomized controlled trials, 3 case-control studies, 2 case series and 7 case reports. The studies were diverse in quality. The evidence is inconclusive because of the limited amount of methodologically robust studies.

CONCLUSIONS AND SIGNIFICANCE

Results support the notion that occupational therapy in daily environments for children with ID may enhances participation in everyday activities. Further research with appropriate study designs and outcome measurements is needed. Although the research evidence was limited, the results encourage focussing on occupational therapy for children with ID to enhance participation in school and home environments.

Combined sensory integration therapy plus neurodevelopmental therapy (NT) versus NT alone for motor and attention in children with Down syndrome: a randomized controlled trial

In this study, we aimed to analyze the incremental effects of sensory integration therapy (SIT) plus neurodevelopmental therapy (NT) versus NT alone on the attention and motor skills in children with Down syndrome (DS). We randomly assigned into experimental (i.e. SIT + NT; n = 21) and control (i.e. NT alone; n = 21) groups. While NT was applied to both groups for six weeks, SIT was applied simultaneously to the experimental group for six weeks. Participants' motor functions (Bruininks-Oseretsky Test of Motor Proficiency-Short form (BOT-2 SF)) and attention skills (Stroop TBAG (Turkish Scientific and Technological Research Association) Form) were evaluated before and after treatment (6 weeks later). Stroop TBAG and BOT-2 SF scores of the groups were similar at the baseline (p > 0.05). Significant improvement from baseline was observed in both BOT-2 SF, and Stroop TBAG results in both groups (p < 0.05). In addition, the improvement in both BOT-2 SF and Stroop TBAG results was found to be greater in the experimental group compared to the control group (p < 0.01). There were clear advantages to adding SIT to NT alone when seeking to improve motor and attention skills in children with DS.

Current Trends in Pediatric Physical Therapy Practice for Children With Down Syndrome

BACKGROUND

Physical therapists (PTs) have a broad range of approaches to the management of Down syndrome (DS).

PURPOSE

To examine the breadth of physical therapy practice for children with DS.

METHODS

A survey was distributed to 1000 randomly selected members of the Academy of Pediatric Physical Therapy.

DATA ANALYSIS

Responses were categorized into 13 thematic subcategories and 3 International Classification of Functioning, Disability and Health (ICF) subcategories.

RESULTS AND DISCUSSION

One hundred eight PTs participated. Joint stability and alignment were the most common physical therapy-related problem. Functional movement was the most common physical therapy intervention. Most clinicians identified and treated at the ICF level of body functions and structure. Multiple assessment tools were used and tended to include norm-referenced tests. There was diversity of interventions with varying amounts of supporting evidence.

CONCLUSIONS

PTs manage children with DS for a wide variety of needs with a variety of interventions.

Effect of Group-Task-Oriented Training on Gross and Fine Motor Function, and Activities of Daily Living in Children with Spastic Cerebral Palsy

Aims: To determine the effects of group-task-oriented training (group-TOT) on gross and fine motor function, activities of daily living (ADL) and social function of children with spastic cerebral palsy (CP).Methods: Eighteen children with spastic CP (4-7.5 years, gross motor function classification system level I-III) were randomly assigned to the Group-TOT (9 children received group-TOT for 1 hour, twice a week for 8 weeks) or the comparison group (9 children received individualized traditional physical and occupational therapy). The Gross Motor Function Measure (GMFM)-88, the Bruininks-Oseretsky Test of Motor Proficiency 2^nd edition (BOT-2), and the Pediatric Evaluation of Disability Inventory (PEDI) were administered before and after the intervention, and in the Group-TOT, 16 weeks after the intervention.Results: Children in the Group-TOT showed significant improvements in the GMFM-88 standing and walking/running/jumping subscales, the BOT-2 manual dexterity subscale, and the PEDI social function subscale (p < 0.05); changes were maintained 16 weeks after the intervention ended. In contrast, the comparison group improved in only the BOT-2 fine motor integration subscale (p < 0.05).Conclusions: The findings provide evidence of effectiveness of group-TOT in improving gross and fine motor function, and social function in children with CP.

Description of School-Based Physical Therapy Services and Outcomes for Students with Down Syndrome

Students with Down syndrome (DS) receive school-based physical therapy (SBPT), however little data exists regarding services and outcomes. Using a prospective observational cohort study our aim was to explore SBPT activities and interventions, and students' goal achievement of 46 students with DS, tracked by 17 physical therapists (PTs). PTs provided on average 24.0 min/week direct service and 11.6 min/week services on behalf of the student. The most frequent activities employed were physical education/recreation, mobility, and sitting/standing/transitions. The most frequent interventions implemented were neuromuscular, mobility, and musculoskeletal. Although students individually met 69.5% of their primary outcome goals, their achievement could not be explained by total minutes of either direct and minutes on behalf of SBPT, nor minutes spent in most frequent activity.

Interventions to improve sensory and motor outcomes for young children with central hypotonia: A systematic review

OBJECTIVE

To evaluate evidence supporting physical and occupational therapy interventions used to improve sensory and motor outcomes for children 0-6 years with central hypotonia.

METHODS

Four electronic databases were searched from 1996 to March 2017. Level of evidence and study conduct was evaluated using American Academy of Cerebral Palsy and Developmental Medicine criteria. Traffic lighting classification identified interventions that were green (proven effective), yellow (possibly effective) or red (proven ineffective or contraindicated).

RESULTS

Thirty-seven articles were included. Nine studies measured orthotic interventions while four distinct studies published over nine articles measured treadmill interventions. Remaining studies measured impact of compression garments, massage, motor and sensori-motor interventions, positioning and mobility interventions.

CONCLUSIONS

Green light evidence supports treadmill training (to promote ambulation and gait characteristics) and massage (to positively affect muscle tone, motor development and use of vision) for infants with Down syndrome. These interventions are considered Yellow (possibly effective) for other populations. Green light evidence supports impact of orthoses on foot alignment for ambulatory children with hypotonia, while impact on gait characteristics is Yellow light and motor development may be negatively impacted (Red light) in pre-ambulatory children. All other interventions rated Yellow (possibly effective) and therapists should monitor using sensitive outcome measures.

Effect of Group Setting on Gross Motor Performance in Children 3-5 Years Old with Motor Delays

AIMS

The purpose of this study was to evaluate differences in gross motor performance of children 3-5 years of age with motor delays when assessed individually compared to assessment in a group setting among peers with typical development (TD).

METHODS

Twenty children with motor delays and 42 children with TD were recruited from a preschool program. A within-subject repeated measures design was used; each child with delay was tested both in an individual setting and in a group setting with two to four peers with TD. Testing sessions were completed 4-8 days apart. Ten different motor skills from the Peabody Developmental Motor Scales-2 were administered. Performance of each item was videotaped and scored by a blinded researcher.

RESULTS

Overall gross motor performance was significantly different (p < .05) between the two settings, with 14 of 20 children demonstrating better performance in the group setting. In particular, children performed better on locomotion items (p < .05).

CONCLUSIONS

The higher scores for locomotion in the group setting may be due to the influence of competition, motivation, or modeling. Assessing a child in a group setting is recommended as part of the evaluation process.

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.

Did waiting times really decrease following a service reorganization? Results from a retrospective study in a pediatric rehabilitation program in Québec

PURPOSE

To examine changes in waiting times and types of services received before, during and after a pediatric rehabilitation service reorganization including new admission procedures; To compare waiting time data available in the program's administrative database and children's medical files.

METHOD

Waiting time was defined as the time elapsed between referral and accessing a service provided by any clinician in the program (program waiting time) or by any clinician within a discipline (discipline-specific waiting time). Services were categorized as individual, group treatment, or other. ANOVAs and χ(2) tests were used to examine changes in waiting times and type of services, respectively. Paired T-tests compared the program waiting times from the two databases.

RESULTS

Data were collected on 188 children (mean age: 4 years and 1 month). The program and occupational therapy waiting times were shorter following the service reorganization. For two disciplines, the proportion of children receiving individual treatment diminished over time, while group and other types of interventions increased. Program waiting times calculated using the two data sources did not differ significantly but differences in the available data highlighted administrative issues.

CONCLUSIONS

Service reorganization can decrease waiting times and change the type of services offered over time.

Increasing the use of group interventions in a pediatric rehabilitation program: perceptions of administrators, therapists, and parents

OBJECTIVES

To explore perceptions related to increased utilization of group interventions as a part of the service reorganization within a pediatric rehabilitation program.

METHODS

Individual interviews with program administrators (n = 13) and focus groups with therapists (n = 19) and parents of children with disabilities (n = 5) were conducted. Data were analyzed using a coding grid inspired by the organized action systems theory.

RESULTS

Administrators and therapists identified several issues including the need to improve the referral process for groups and the coordination across services. Groups considerably modified practice and required substantial efforts from therapists. Administrators felt groups contributed to increased service accessibility. Although therapists had some doubts about service quality in groups, especially in regard to the reduced attention to individual needs, they reported positive benefits on children's social participation. Generally, parents were satisfied with group interventions.

CONCLUSION

Groups appear to be a promising method of service delivery, but organizational-related issues should be considered.

Aerobic exercise training programmes for improving physical and psychosocial health in adults with Down syndrome

BACKGROUND

Although physical fitness has been suggested to improve physical and psychosocial health for a variety of population profiles, there is a lack of information about the safety and effectiveness of aerobic exercise for adults with Down syndrome.

OBJECTIVES

To evaluate the effectiveness and safety of aerobic exercise training programmes for physiological and psychosocial outcomes in adults with Down syndrome.

SEARCH STRATEGY

The following electronic databases were searched: The Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 1); MEDLINE (1966 to August 2009); EMBASE (1980 to August 2009); CINAHL (1982 to August 2009); LILACS (1982 to August 2009); PsycINFO (1887 to August 2009); ERIC (1966 to August 2009); Current Controlled Trials (August 2009); and Campbell Collaboration's Social, Psychological, Educational and Criminological Register (C2- SPECTR) (to August 2009). Information about ongoing clinical trials was sought by searching ClinicalTrials.gov (http://clinicaltrials.gov) (accessed August 2009), and the National Research Register (NRR) (2009 Issue 1).

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials using supervised aerobic exercise training programmes with behavioral components accepted as co-interventions.

DATA COLLECTION AND ANALYSIS

Two reviewers selected relevant trials, assessed methodological quality and extracted data. Where appropriate, data were pooled using meta-analysis with a random-effects model. Positive values favour the intervention group, while negative values favour the control group.

MAIN RESULTS

Three studies included in this systematic review used different kinds of aerobic activity: walking/jogging and rowing training and included participants with a broad age range (17 to 65 years). They were conducted in the USA, Portugal and Israel. In the meta-analyses, only maximal treadmill grade was improved after aerobic exercise training programmes (4.26 grades (%) [95% CI 2.06, 6.45]). Other variables relative to work performance that could not be combined in a meta-analysis were also improved in the intervention group (maximal test time P=0.0003), total turns of fan wheel (P=0.02), resistance of ergometer (p=0.003), power knee extension and flexion (p<0.00001), and timed up and go test (p=0.008). Thirty other outcomes measured in this review including, oxidative stress and body composition variables, could not be combined in the meta-analysis. Apart from work performance, trials reported no statistically significant improvements.

AUTHORS' CONCLUSIONS

There is insufficient evidence to demonstrate that there is improvement in physical or psychosocial outcomes of aerobic exercise in adults with Down syndrome. Although evidence exists to support improvements in physiological and psychological aspects from strategies using mixed physical activity programmes, well-conducted research examining long-term physical outcomes, adverse effects, psychosocial outcomes and costs is required before informed practice decisions can be made.