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Andersen M, Krarup LH, Rolving N, Holsgaard-Larsen A, Pawlowski C, Rasmussen HM, Hubeishy MH. Healthcare Professionals' Perspectives on the Use of Standing Frames for Children Diagnosed With Cerebral Palsy: An Explanatory Mixed Methods Study. Child Care Health Dev 2024; 50:e13320. [PMID: 39143846 DOI: 10.1111/cch.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Standing frames are commonly used by healthcare professionals in their practice with children with cerebral palsy (CP) who do not have an independent standing function. A better understanding of healthcare professionals' attitudes and experiences with standing frames may impact practice and rehabilitation. Therefore, this study aimed to investigate the standing frame practice among healthcare professionals and expand their attitude and experience with the use of standing frames for children with CP. METHODS This is an explanatory sequential mixed methods study. A cross-sectional survey was conducted, providing quantitative data on 210 healthcare professionals' use of standing frames. The quantitative data were descriptively analysed. Subsequently, the results from the survey were followed up with five focus group interviews of healthcare professionals (n = 14). The qualitative data were analysed using thematic analysis, enabling integration between the quantitative and qualitative data. RESULTS When quantitative and qualitative data are integrated, expansion between the two datasets occurred. The quantitative dataset emphasised the use of GMFCS levels as a guideline for recommending standing frames, whereas the qualitative data showed that the healthcare professionals' recommendations were based on individual needs. Furthermore, the healthcare professionals expanded the quantitative data, showing that the healthcare professionals' considerations regarding age and dosage were based on clinical experience, and saw the standing frame as having many benefits. CONCLUSION The healthcare professionals had a child-centred approach, where the child's need for using a standing frame was assessed based on the functional level, stage of development, cognitive level and clinical assessment. All of these considerations showed that the use of standing frames for children with CP was individualised, thereby making it difficult to make unified descriptions.
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Affiliation(s)
| | - Lærke Hartvig Krarup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
- R82 A/S, Gedved, Denmark
| | - Nanna Rolving
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Holsgaard-Larsen
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Pawlowski
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Helle Mätzke Rasmussen
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maja Husted Hubeishy
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Regional Hospital Central Jutland, Odense, Denmark
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Fonvig CE, Troelsen J, Halekoh U, Holsgaard-Larsen A. Limited associations between passive range of motion and gross motor function in ambulant/semi-ambulant children and adolescents with cerebral palsy: A cross-sectional study. J Bodyw Mov Ther 2024; 39:170-175. [PMID: 38876622 DOI: 10.1016/j.jbmt.2024.02.030] [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: 11/28/2022] [Revised: 12/12/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND AND AIM Cerebral palsy (CP) is the most common childhood motor disability, and the Cerebral Palsy Follow-Up Program (CPUP) in Nordic countries uses a traffic light system for passive range of motion (ROM) assessment to aid interpretation and guide decisions regarding interventions. However, the arbitrary chosen ROM threshold values and their potential clinical impact are uncertain. We investigated whether lower extremity ROM values were positively associated with gross motor function and whether gross motor function scores differ between the CPUP ROM thresholds. METHODS This was a cross-sectional analysis of CPUP data for 841 ambulatory children and adolescents with CP, at a mean (SD) age of 9 (3). Regression analyses were employed to explore the relationship between gross motor capacity and performance (using the Gross Motor Function Measure (GMFM-66) and the Functional Mobility Scale (FMS) 5/50/500 m, respectively) and lower extremity ROM, measured with a goniometer. ROM was assessed both as continuous and categorical variables. RESULTS We found that two out of ten continuous ROM measures were positively associated with gross motor function. Limited differences in gross motor function between the ROM thresholds were seen for seven out of ten ROM measures. The CPUP traffic light thresholds primarily differentiated gross motor function between the red and green categories, predominantly for the subgroup of participants with bilateral spastic CP. CONCLUSION Limited associations between passive ROM and gross motor function in children and adolescents with CP were observed, indicating that there is more to consider than ROM when identifying whether interventions are needed.
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Affiliation(s)
- Christina Esmann Fonvig
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Jens Troelsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ulrich Halekoh
- Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Denmark
| | - Anders Holsgaard-Larsen
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hurd CL, Barnes M, Diot CM, Condliffe EG, Alazem H, Pritchard L, Zwicker JD, McCormick A, Watt MJ, Andersen J, Kirton A, Yang JF. Parent-therapist partnership to ELEVATE gross motor function in children with perinatal stroke: protocol for a mixed methods randomized controlled trial. BMC Pediatr 2022; 22:480. [PMID: 35948896 PMCID: PMC9364526 DOI: 10.1186/s12887-022-03525-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is increasing evidence for early, active rehabilitation to enhance motor function following early brain injury. This is clear for interventions targeting the upper extremity, whereas passive treatment approaches for the lower extremity persist. The purpose of this trial is to evaluate the effectiveness of early, intensive rehabilitation targeting the lower extremity and delivered in a parent-therapist partnership model for children with perinatal stroke. Methods We describe a protocol for a waitlist-control, single-blind, mixed methods effectiveness randomized controlled trial, with an embedded qualitative study using interpretative description. Participants are children with perinatal stroke aged eight months to three years with signs of hemiparesis. Participants will be randomly allocated to an immediate ELEVATE (Engaging the Lower Extremity Via Active Therapy Early) intervention group, or a waitlist-control group, who will receive usual care for six months. The ELEVATE intervention involves one hour of training four days per week for 12 weeks, with a pediatric therapist and a parent or guardian each delivering two sessions per week. The intervention targets the affected lower extremity by progressively challenging the child while standing and walking. The primary outcome measure is the Gross Motor Function Measure-66. Secondary outcomes include the Pediatric Quality of Life Inventory™, Young Children's Participation and Environment Measure, and an instrumented measure of spasticity. A cost-effectiveness analysis and qualitative component will explore benefit to costs ratios and parents’ perspectives of early, intensive rehabilitation, and their role as a partner in the rehabilitation, respectively. Discussion This study has the potential to change current rehabilitation for young children with perinatal stroke if the ELEVATE intervention is effective. The parent interviews will provide further insight into benefits and challenges of a partnership model of rehabilitation. The mixed methods design will enable optimization for transfer of this collaborative approach into physical therapy practice. Trial registration ClinicalTrials.gov NCT03672864. Registered 17 September 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03525-6.
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Affiliation(s)
- Caitlin L Hurd
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Michelle Barnes
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | | | - Elizabeth G Condliffe
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Hana Alazem
- Department of Pediatrics, University of Ottawa, and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lesley Pritchard
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Jennifer D Zwicker
- School of Public Policy and Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Man-Joe Watt
- Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Adam Kirton
- Department of Pediatrics and Department of Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jaynie F Yang
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
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Svane C, Forman CR, Rasul A, Nielsen JB, Lorentzen J. Muscle Contractures in Adults With Cerebral Palsy Characterized by Combined Ultrasound-Derived Echo Intensity and Handheld Dynamometry Measures. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:694-701. [PMID: 35065812 DOI: 10.1016/j.ultrasmedbio.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
We used ultrasound-derived echo intensity and hand-held dynamometry to characterize plantar flexor muscle contractures in adults with cerebral palsy (CP). Eleven adults with CP (aged 41 ± 12 y, Gross Motor Function Classification System I-II) and 11 neurologically intact adults (aged 35 ± 10 y) participated in the study. Echo intensity was measured from the medial gastrocnemius muscle using brightness mode ultrasound. Hand-held dynamometry was used to quantify plantar flexor passive muscle stiffness and ankle joint passive range of motion (pROM). Echo intensity correlated with both passive muscle stiffness (r = 0.57, p = 0.006) and pROM (r = -0.56, p = 0.006). Ultrasound echo intensity (p = 0.02, standardized mean difference [SMD] = 1.13) and passive muscle stiffness (p < 0.001, SMD = 1.99) were higher and ankle joint pROM (p < 0.001, SMD = 2.69) was lower in adults with CP than in neurologically intact adults. We conclude that combined ultrasound-derived echo intensity and hand-held dynamometry may be used to provide an objective characterization of muscle contractures.
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Affiliation(s)
- Christian Svane
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark.
| | - Christian Riis Forman
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark
| | - Aqella Rasul
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark
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