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Adiguzel H, Kirmaci ZIK, Gogremis M, Kirmaci YS, Dilber C, Berktas DT. The effect of proprioceptive neuromuscular facilitation on functional skills, muscle strength, and trunk control in children with cerebral palsy: A randomized controlled trial. Early Hum Dev 2024; 192:106010. [PMID: 38653163 DOI: 10.1016/j.earlhumdev.2024.106010] [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: 03/22/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Proprioceptive neuromuscular facilitation (PNF) is generally used for the lower limbs in children with Cerebral Palsy (CP). This study aimed to determine the effect of PNF and Neurodevelopmental Therapy (NDT) on functional abilities, muscle strength, and trunk control in children with CP. METHODS Thirty spastic CP children classified as either level I-II in the Gross Motor Function Classification System (GMFCS) or level I-II in the Manual Ability Classification System (MACS) were included. The PNF (n = 15) and the NDT group (n = 15) had physiotherapy for six weeks. The ABILHAND-Kids scale, the Purdue Pegboard Test (PBPT), the Nine-Hole Peg Test (9-HPT), and the Jebson-Taylor Hand Function Test (JTHFT) were employed. Pinch meters, Jamar handheld dynamometers, and digital muscular strength assessments were used. RESULTS The PNF group increased shoulder flexion (p < 0.05), adduction (p < 0.05), elevation (p < 0.05), scapular abduction (p < 0.05), elbow extension (right) (p < 0.05), grip (p < 0.05), and pinch strengths (left p < 0.05, right p < 0.05). The PNF group had significantly lower 9-HPT (p < 0.05), JTHFT (card turning), JTHFT (simulated feeding), JTHFT (lifting light cans), and JTHFT (lifting weight cans) durations (p < 0.05), and significantly higher PBPT (right-left) PBPT (bimanual), PBPT (assembly). (p < 0.05), ABILHAND (p < 0.05), and TCMS total scores (p < 0.001). While JTHFT (simulated feeding-left), JTHFT (stacking checkers-left), JTHFT (lifting light cans-left), and JTHFT (lifting weight cans-right/left) (p < 0.05) durations decreased in the NDT group, PBPT (right) (p < 0.05) had an increase in duration. CONCLUSION PNF improves trunk control, upper extremity functional skills, selective proximal muscle strength, and distal upper extremity muscle and grip strength.
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Affiliation(s)
- Hatice Adiguzel
- Kahramanmaras Sutcu Imam University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 46100 Dulkadiroglu, Kahramanmaras, Turkey.
| | - Zekiye Ipek Katirci Kirmaci
- Gaziantep Islamic Science and Technology University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 27010 Sahinbey, Gaziantep, Turkey
| | - Mehmet Gogremis
- Kahramanmaras Sutcu Imam University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 46100 Dulkadiroglu, Kahramanmaras, Turkey
| | - Yusuf Sinasi Kirmaci
- Kahramanmaras Sutcu Imam University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 46100 Dulkadiroglu, Kahramanmaras, Turkey
| | - Cengiz Dilber
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Child Health and Diseases, 46040 Onikisubat, Kahramanmaras, Turkey
| | - Deniz Tuncel Berktas
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Neurology, 46040 Onikisubat, Kahramanmaras, Turkey
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Burgess A, Oftedal S, Boyd RN, Reedman S, Trost SG, Ware RS, Sakzewski L. Construct Validity of the Both Hands Assessment Using Wrist-Worn Accelerometers. Phys Occup Ther Pediatr 2023; 44:42-55. [PMID: 37183420 DOI: 10.1080/01942638.2023.2207635] [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: 11/15/2022] [Accepted: 04/24/2023] [Indexed: 05/16/2023]
Abstract
AIM The aim of this study was to evaluate the construct validity of the Both Hands Assessment (BoHA) using activity of the upper limbs as detected by accelerometry in children with bilateral cerebral palsy (CP). METHODS Observational study of children with CP (n = 44, n = 27 boys, aged 9.1 ± 1.6 years; Manual Ability Classification Scale I: n = 15, II: n = 22, III: n = 7) completing a BoHA assessment while wearing a triaxial accelerometer on each wrist. BoHA Each-Hand sub-scores, BoHA percentage difference between hands, BoHA Units, mean activity for each hand, mean activity asymmetry index and total mean activity were calculated. Linear regressions were used to analyze associations between measures. RESULTS There were significant, positive associations between BoHA Units and total mean activity (B = 0.86, 95%CI: 0.32, 1.40), BoHA Percentage difference between hands and mean activity asymmetry index (B = 0.95, 95%CI: 0.75,1.15), and BoHA Each-Hand sub-score and mean activity for the non-dominant hand (B = 1.71, 95%CI: 1.16, 2.28), but not the dominant hand (B = 0.50, 95%CI: -0.45, 1.45). CONCLUSIONS This study provides further evidence for the construct validity of the BoHA as a measure of upper limb performance. Wearable wrist sensors such as accelerometers capture and quantify gross upper limb movement in children with CP but cannot measure fine finger movements captured by the BoHA. CLINICAL TRIALS REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12616001488493 and ACTRN12618000164291).
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Affiliation(s)
- Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Stewart G Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Moulaei K, Sheikhtaheri A, Haghdoost AA, Nezhadd MS, Bahaadinbeigy K. A data set for the design and implementation of the upper limb disability registry. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:130. [PMID: 37397108 PMCID: PMC10312779 DOI: 10.4103/jehp.jehp_721_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/14/2022] [Indexed: 07/04/2023]
Abstract
BACKGROUND If the data elements needed for patient registries are not identified, designing and implementing them can be very challenging. Identifying and introducing a Data Set (DS) can help solve this challenge. The aim of this study was to identify and present a DS for the design and implementation of the upper limb disability registry. MATERIALS AND METHODS This cross-sectional study was conducted in two phases. In the first phase, to identify the administrative and clinical data elements required for registry, a comprehensive study was conducted in PubMed, Web of Science, and Scopus databases. Then, the necessary data elements were extracted from the studies and a questionnaire was designed based on them. In the second phase, in order to confirm the DS, the questionnaire was distributed to 20 orthopedic, physical medicine and rehabilitation physicians and physiotherapists during a two-round Delphi. In order to analyze the data, the frequency and mean score of each data element were calculated. Data elements that received an agreement more than 75% in the first or two-round Delphi were considered for the final DS. RESULTS A total of 81 data elements in five categories of "demographic data", "clinical presentation", "past medical history", "psychological issues", and "pharmacological and non-pharmacological treatments" were extracted from the studies. Finally, 78 data elements were approved by experts as essential data elements for designing a patient registry for upper limb disabilities. CONCLUSION In this study, the data elements necessary for the design and implementation of the upper limb disability registry were suggested. This DS can help registry designers and health data administrators know what data needs to be included in the registry system in order to have a successful design and implementation. Moreover, this standardized DS can be effective for integrating and improving the information management of people with upper limb disabilities and used to accurately gather the upper limb disabilities data for research and policymaking purposes.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali A. Haghdoost
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour S. Nezhadd
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Elvrum AKG, Johansen GO, Vik T, Krumlinde-Sundholm L. External validity of the Both Hands Assessment for evaluating bimanual performance in children with bilateral cerebral palsy. Dev Med Child Neurol 2022; 64:586-592. [PMID: 34907525 DOI: 10.1111/dmcn.15127] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 09/11/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate the external validity of the Both Hands Assessment (BoHA), a new test evaluating bimanual performance in children with bilateral cerebral palsy (CP), by analysing its relationship to established measurements of hand function and self-care skills. METHOD In this cross-sectional study, we recruited children with bilateral CP and manual ability corresponding to Manual Ability Classification System (MACS) levels I to III attending three habilitation units in Norway. All participants completed the BoHA. Unimanual capacity was assessed using the Bimanual Fine Motor Function (BFMF) classification, the Box and Block Test (BBT), and the Melbourne Assessment 2 (MA2). Self-care skills were assessed with the Pediatric Evaluation of Disability Inventory (PEDI). RESULTS Thirty-nine children (19 males, 20 females; mean age 8y 2mo, SD 2y 8mo; age range 2y 8mo-12y 6mo) were included. Spearman's correlation coefficient (ρ) suggested high correlation between the BoHA and MACS (p=0.89; 95% confidence interval [CI] 0.79-0.94), BFMF classification (p=0.84; 95% CI 0.71-0.91), and BBT for the non-dominant (p=0.85; 95% CI 0.68-0.95) and dominant hand (p=0.72; 95% CI 0.53-0.85). The Spearman's ρ between the BoHA and the MA2 subscales varied between 0.48 and 0.83, while the PEDI's ρ was 0.51 (95% CI 0.33-0.67). INTERPRETATION The BoHA provides valid measures of hand use as suggested by its high correlation with other activity-based measures of hand function.
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Affiliation(s)
- Ann-Kristin G Elvrum
- Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gøril Okkenhaug Johansen
- Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Vik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lena Krumlinde-Sundholm
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Leite HR, Queiroz IP, Santos JG, Barroso de Souza FL, Scheidt Figueiredo PH, de Cordoba Lanza F, Ângelo de Deus F, Cunha Neves CD, Soares BA, Tsopanoglou SP, Lima VP. Measurement properties of the six-minute pegboard and ring test (6PBRT) in healthy adolescents. J Bodyw Mov Ther 2021; 28:56-61. [PMID: 34776196 DOI: 10.1016/j.jbmt.2021.08.002] [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: 02/11/2021] [Revised: 07/13/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the cardiorespiratory responses to the 6-min pegboard and ring test (6PBRT) and to assess its reproducibility in healthy adolescents. METHODS It was a cross-sectional study with 52 healthy adolescents (11-18 years old of both genders). The 6PBRT was performed twice on two different days by the same examiner. Intra-rater reliability, percentage of the minimal difference chance (MDC%) and agreement of the number of moving rings were analyzed. Also, cardiopulmonary parameters were collected before and after tests. RESULTS Intraclass correlation coefficient (ICC) for the number of rings moved was 0.87 (95%CI 0.69-0.93). The mean number of moved rings during the second test was higher. The MDC% with a 95 % confidence interval was greater than acceptable values. Bland-Altman analysis did not show agreement between measurements (bias = 30.1); with upper and lower limits of agreement of -67.8 to 127.9, respectively. There was a significant increase in dyspnea, fatigue and HR values at the end of the tests (p < 0.0001). In both tests, participants reached HR equivalent to 48 % of the maximum predicted. CONCLUSION Together, the results suggest that the 6PBRT is not a reliable measure for a population of healthy adolescents, which indicates the necessity to perform more than one test. The 6PBRT is suggested to be a submaximal test for this population.
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Affiliation(s)
- Hércules Ribeiro Leite
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus JK, Alto da Jacuba, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO), Universidade Federal de Minas Gerais (UFMG), Av. Antônio Carlos, Pampulha, Belo Horizonte, Brazil
| | - Ilkilene Pinheiro Queiroz
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus JK, Alto da Jacuba, Minas Gerais, Brazil
| | - Júlia Gonçalves Santos
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus JK, Alto da Jacuba, Minas Gerais, Brazil
| | - Fernanda Lorena Barroso de Souza
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus JK, Alto da Jacuba, Minas Gerais, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus JK, Alto da Jacuba, Minas Gerais, Brazil
| | - Fernanda de Cordoba Lanza
- Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO), Universidade Federal de Minas Gerais (UFMG), Av. Antônio Carlos, Pampulha, Belo Horizonte, Brazil
| | - Franciele Ângelo de Deus
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus JK, Alto da Jacuba, Minas Gerais, Brazil
| | | | - Bruno Alvarenga Soares
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus JK, Alto da Jacuba, Minas Gerais, Brazil
| | - Sabrina Pinheiro Tsopanoglou
- Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO), Universidade Federal de Minas Gerais (UFMG), Av. Antônio Carlos, Pampulha, Belo Horizonte, Brazil
| | - Vanessa Pereira Lima
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus JK, Alto da Jacuba, Minas Gerais, Brazil.
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MacDermid JC. ICF Linking and Cognitive Interviewing Are Complementary Methods for Optimizing Content Validity of Outcome Measures: An Integrated Methods Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:702596. [PMID: 36188847 PMCID: PMC9397968 DOI: 10.3389/fresc.2021.702596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/10/2021] [Indexed: 12/18/2022]
Abstract
Content validity is a fundamental requirement of outcome measures. After reviewing operational needs and existing definitions, content validity we as defined as: the extent to which a measure provides a comprehensive and true assessment of the key relevant elements of a specified construct or attribute across a defined range, clearly and equitably for a stated target audience and context. ICF linkage rules from 2002, 2005, and 2019 have provide increasingly clear processes for describing and evaluating content of outcome measures. ICF Core Sets provide international reference standards of the core constructs of importance for different health conditions. Both are important as reference standards during content validation. To summarize their use as reference standards, the following summary indicators were proposed: (1) Measure to ICF linkage, (2) Measure to (Brief or Comprehensive) Core Set Absolute Linkage, (3) Measure to (Brief or Comprehensive) Core Set Unique Linkage, (4) Core Set Representation, and (5) Core Set Unique Disability Representation. Methods to assess how respondents engage with content are needed to complement ICF-linking. Cognitive interviewing is an ideal method since it used to explore how respondents interpret and calibrate response to individual items on an outcome measure. We proposed a framework for classifying these responses: Clarity/Comprehension, Relevance, Inadequate response definition, Reference Point, Perspective modification, and Calibration Across Items. Our analysis of 24 manuscripts that used ICF linking for content validation since updated linking rules were published found that authors typically used linking to validate existing measures, involved multiple raters, used 2005 linking rules, summarized content at a concept level (e.g., impairment, activity, participation) and/or use core sets as a reference standard. Infrequently, ICF linking was used to create item pools/conceptual frameworks for new measures, applied the full scope of the 2019 linking rules, used summary indicators, or integrated ICF-linking with qualitative methods like cognitive interviews. We conclude that ICF linkage is a powerful tool for content validity during development or validation of PROM. Best practices include use of updated ICF linking rules, triangulation of ICF linking with participant assessments of clarity and relevance preferably obtained using cognitive interview methods, and application of defined summary indicators.
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Affiliation(s)
- Joy C. MacDermid
- Department of Surgery, School of Physical Therapy, Western University, London, ON, Canada
- Hand and Upper Limb Centre, St. Joseph's Health Centre, London, ON, Canada
- *Correspondence: Joy C. MacDermid
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Burgess A, Boyd RN, Chatfield MD, Ziviani J, Sakzewski L. Hand Function in 8- to 12-Year-Old Children with Bilateral Cerebral Palsy and Interpretability of the Both Hands Assessment. Phys Occup Ther Pediatr 2021; 41:358-371. [PMID: 33334218 DOI: 10.1080/01942638.2020.1856286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To describe bimanual performance in a sample of Australian children with bilateral cerebral palsy (CP) and, examine the qualitative meaning (or interpretability) of scores on the Both Hands Assessment (BoHA). METHODS Children with bilateral CP aged 8-12 years (n = 54) classified Manual Ability Classification System (MACS) level I = 20, II = 18, III = 16 were examined using the BoHA. RESULTS Bimanual performance was significantly different across MACS levels I-III (p < 0.001). Mean (95%CI) BoHA-unit for each MACS level were I = 85 (81-89), II = 72 (68-76) and III = 53 (49-56). Children with asymmetrical hand use (≥ 20% difference between upper limbs, n = 10) were classified MACS levels II and III and had a mean (95%CI) BoHA-unit of 56 (51-62). Children with symmetrical hand use were classified in MACS level I-III and had a mean (95%CI) BoHA-unit of 74 (70-79). CONCLUSIONS The BoHA quantified observations of bimanual performance for children with bilateral CP, differentiated between MACS levels I-III and provided clinically meaningful information. The BoHA may facilitate tailoring of upper limb intervention. Future research is recommended to examine inter-rater and intra-rater reliability and responsiveness of the BoHA, as well as longitudinal studies of bimanual hand skill development in children with bilateral CP.
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Affiliation(s)
- Andrea Burgess
- The University of Queensland, Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Centre, South Brisbane, Australia
| | - Roslyn Nancy Boyd
- The University of Queensland, Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Centre, South Brisbane, Australia
| | - Mark David Chatfield
- The University of Queensland, Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Centre, South Brisbane, Australia
| | - Jenny Ziviani
- The University of Queensland, Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Centre, South Brisbane, Australia
| | - Leanne Sakzewski
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
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da Silva TD, Fontes AMGG, de Oliveira-Furlan BS, Roque TT, Lima AII, de Souza BMM, Alberissi CADO, Silveira AC, de Moraes ÍAP, Collett J, Silva RP, Airoldi MJ, Ribeiro-Papa DC, Dawes H, Monteiro CBDM. Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial. Front Neurol 2020; 11:953. [PMID: 32982950 PMCID: PMC7492207 DOI: 10.3389/fneur.2020.00953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms. Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4–14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS. Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP. Trial Registration:ClinicalTrials.gov, NCT04044677. Registered on 05 August 2019.
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Affiliation(s)
- Talita Dias da Silva
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Departamento de Medicina (Cardiologia), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil.,Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | | | - Barbara Soares de Oliveira-Furlan
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Tatiane Tedeschi Roque
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Ana Izabel Izidório Lima
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Bruna Mayara Magalhães de Souza
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Camila Aparecida de Oliveira Alberissi
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Ana Clara Silveira
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Íbis Ariana Peña de Moraes
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Johnny Collett
- Institute of Nursing and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom.,Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Roger Pereira Silva
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Marina Junqueira Airoldi
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Denise Cardoso Ribeiro-Papa
- Departamento de Medicina (Cardiologia), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Helen Dawes
- Institute of Nursing and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom.,Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Carlos Bandeira de Mello Monteiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
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