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Elkholi SM, Awad SS, Alotaibi MH. Neglect of Psychological Care for Children with Cerebral Palsy and Their Families and Its Impact on Their Occupational Engagement in Saudi Arabia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1216. [PMID: 39202497 PMCID: PMC11356549 DOI: 10.3390/medicina60081216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Many children with (CP) and their families in Saudi Arabia struggle emotionally. Unfortunately, there have not been many studies conducted on how to help them with these challenges. This research aims to bring attention to this gap and to explore how a lack of proper mental health care might affect these children's ability to participate in everyday activities. Materials and Methods: In this cross-sectional descriptive study, a survey was conducted between August and October 2023. A total of 300 parents of CP children from Saudi Arabia participated in the study. The impact of psychological care negligence on the occupational engagement of CP children and their families was assessed by designing a valid questionnaire. Results: A total of 300 parents of children with CP participated in this study. The majority of the sample, 71% of parents, said that their children did not receive any psychological care, and 59.7% of the participants said that their children did not even receive a referral to a psychologist. However, 60.3% of parents of children noticed a significant decline in the occupational performance of their children, and 65.7% predicted an improvement in their children's performance with future psychological care. Conclusions: It is clear that there is a lack of awareness about the importance of mental health care for children with CP in Saudi Arabia. This lack of care hinders these children and their families' occupational engagement and social participation.
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Affiliation(s)
- Safaa M. Elkholi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | | | - Madawi H. Alotaibi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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Livingstone RW, Paleg GS, Field DA. Supported standing and stepping device use in young children with cerebral palsy, gross motor function classification system III, IV and V: A descriptive study. Assist Technol 2024; 36:264-274. [PMID: 37988126 DOI: 10.1080/10400435.2023.2283461] [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: 11/19/2022] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
This study described and compared use of supported-standing and stepping devices by young children with cerebral palsy, Gross-Motor Function Classification System (GMFCS) levels III-V following power mobility introduction. Data was collected at two time-points, 5-6 months apart, for 42 participants, aged 18-80 months, using the Home Use of Technology for CHildren (HUTCH). Supported-standing and stepping device choice and time in each device remained stable over 6 months. Associations between device use and three functional classifications were examined. Children with more impaired motor, postural and manual abilities were more likely to use a supine stander rather than a prone/upright stander or no stander. Children at GMFCS V tended to use hands-free stepping devices, while support-arms stepping devices were more common for children at GMFCS IV. Only children at GMFCS III used convertible stepping devices. Using power mobility, standers and supported-stepping devices was feasible and 19/34 classified at GMFCS IV/V used all three devices over 6 months. A key finding was that introduction of power mobility did not reduce use of supported-stepping devices at any GMFCS level. Use of multiple upright positioning and mobility devices may assist children with limited mobility to be actively engaged and participate in daily life.
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Affiliation(s)
- Roslyn W Livingstone
- Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Occupational Therapist II, Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
- Investigator, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Ginny S Paleg
- Physical Therapist, Montgomery County Infants and Toddlers Program, Rockville, Maryland, USA
| | - Debra A Field
- Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Occupational Therapist II, Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
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3
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LaForme Fiss A, Chiarello LA, Hsu LY, McCoy SW. Adaptive behavior and mastery motivation in children with physical disabilities. Physiother Theory Pract 2024; 40:1616-1627. [PMID: 36847241 DOI: 10.1080/09593985.2023.2181118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/30/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Adaptive behavior consists of conceptual, social, and practical skills and describes the ability of individuals to manage environmental demands, interact with others, and engage in activities to meet ones needs. Mastery motivation is an intrinsic characteristic that enables persistence when attempting to master a skill. Children with physical disabilities often demonstrate less effective adaptive behaviors and lower mastery motivation than their peers without disabilities, which may subsequently impact development and participation in daily activities. Therefore, it may be beneficial for pediatric rehabilitation practitioners to focus intentionally on facilitating effective adaptive behaviors in children with physical disabilities as they aim to support child development and function. OBJECTIVE This perspective paper highlights the importance of adaptive behavior for children with physical disabilities, discusses methods of assessment, and illustrates intervention principles and strategies to support the development of appropriate adaptive behaviors across childhood. Key intervention principles include: 1) engage children and address motivation; 2) collaborate with others; 3) support real-life meaningful experiences; 4) scaffold the just-right challenge; and 5) guide children in discovering solutions.
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Affiliation(s)
| | - Lisa A Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA USA
| | - Lin-Ya Hsu
- Department of Rehabilitative Medicine, University of Washington, Seattle, WA USA
| | - Sarah Westcott McCoy
- Department of Rehabilitative Medicine, University of Washington, Seattle, WA USA
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Shetty T, Ganesan S, Johari A, Mullerpatan R. Gross motor function profile of children with cerebral palsy in a low-resource setting: A call for reflection on the model of care. J Pediatr Rehabil Med 2023; 16:211-218. [PMID: 36872801 DOI: 10.3233/prm-220039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
PURPOSE The current study aimed to explore Gross Motor Function Measure (GMFM) profiles among children with cerebral palsy (CP) at various Gross Motor Function Classification System (GMFCS) levels in a low-resource setting. Seventy-one ambulatory children with CP (61% males), were studied after signed informed consent was obtained from parents and assent from children older than 12 years. METHODS Ambulatory capacity of children with CP was classified using GMFCS levels. Functional ability of all participants was measured using GMFM-88. RESULTS Children with CP in a low-resource setting had 12-44% lower GMFM scores in dimensions of standing, walking, running, and jumping with reference to children from high-resource settings with similar ambulatory capacity reported previously. The most affected components across various GMFCS levels were 'sitting on a large and small bench from floor,' 'arm-free squatting,' 'half-kneeling,' 'kneel-walking,' and 'single-limb hop'. CONCLUSION Knowledge of GMFM profiles can guide clinicians and policymakers in low-resource settings for strategic rehabilitation planning and extend the focus of rehabilitation from restoration of body structure and function to the wider domain of social participation in leisure, sport, work, and the community at large. Additionally, providing tailored rehabilitation based on a profile of motor function can ensure an economically, environmentally, and socially sustainable future.
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Affiliation(s)
- Triveni Shetty
- Department of Neurophysiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Sailakshmi Ganesan
- Department of Neurophysiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | | | - Rajani Mullerpatan
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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Relative contribution of sensory and motor impairments to mobility limitations in children with cerebral palsy: an observational study. Sci Rep 2023; 13:3229. [PMID: 36828863 PMCID: PMC9957987 DOI: 10.1038/s41598-023-30293-9] [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: 09/27/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
The purpose of this study was to determine the relative contribution of sensory and motor impairments to mobility limitations in cerebral palsy. An observational study was carried out in 83 children with all types of cerebral palsy with a mean age of 10.8 years (SD 1.2). Five impairments (coordination, strength, spasticity, contracture, proprioception) and three aspects of mobility (standing up from a chair, short and long distance walking) were measured. Standard multiple regression was used to determine the relative contribution of impairments to mobility as well as the relative contribution of strength of individual muscle groups (dorsiflexors, plantarflexors, knee extensors, hip abductors and hip extensors) to mobility. Five impairments accounted for 48% of the variance in overall mobility (p < 0.001): coordination independently accounted for 9%, contracture for 4% and strength for 3% of the variance. Five muscle groups accounted for 53% of the variance in overall mobility (p < 0.001): hip extensors independently accounted for 9%, knee extensors for 4%, dorsiflexors for 4% and plantarflexors for 3% of the variance. Our findings demonstrate that the impairments making a significant independent contribution to mobility in pre-adolescent cerebral palsy were loss of coordination, loss of strength and contracture.
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Klenø AN, Stisen MB, Cubel CH, Mechlenburg I, Nordbye-Nielsen K. Prevalence of knee contractures is high in children with cerebral palsy in Denmark. Physiother Theory Pract 2023; 39:200-207. [PMID: 34809532 DOI: 10.1080/09593985.2021.2007558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a neurological disease occurring in children at early gestation, often resulting in pronounced functional limitations. A Swedish cross-sectional study (Cloodt, et al., 2018) discovered that 22% of children with CP had a knee contracture, which was associated with higher levels of Gross Motor Function Classification System (GMFCS), higher age, and higher levels of spasticity measured by the Modified Ashworth Scale (MAS). The current study investigated these associations in a Danish population. METHODS This is a cross-sectional study including 1,163 children with CP aged 0-15 years, registered in the Danish National Cerebral Palsy Registry between 2017 and 2019. Prevalence of knee contracture was estimated, and logistic regression analysis was applied with results presented as odds ratio (OR) with 95% confidence intervals (CI). RESULTS A total of 511 children with CP had knee contracture resulting in a prevalence of 44%. Age groups 4-6 years (OR: 1.73, CI: 1.19; 2.52), 7-9 years (OR: 1.85, CI: 1.29; 2.66) and 10-12 years (OR: 2.12, CI: 1.39; 3.24) were significantly associated with a higher prevalence of knee contractures compared to age group 0-3 years. Knee contractures were significantly more frequent at GMFCS levels IV (OR: 1.9, CI: 1.21; 2.97) and V (OR: 3.62, CI: 2.36; 5.55) compared to level I. Knee contractures were not associated with higher levels of MAS. CONCLUSIONS Knee contractures are highly prevalent and significantly associated with high levels of GMFCS and increased age until 12 years, but not with high levels of spasticity in children with CP in Denmark.
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Affiliation(s)
- André Nis Klenø
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark
| | - Martin Bækgaard Stisen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark
| | - Claes Høgh Cubel
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Kirsten Nordbye-Nielsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus N, Denmark.,CP North: Living Life with Cerebral Palsy in the Nordic Countries, Aarhus University Hospital, Aarhus N, Denmark
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Inoue T, Izumi H, Nishibu H, Himuro N. Reliability, validity, and minimal clinically important differences of the Japanese version of the early clinical assessment of balance in children with cerebral palsy. Disabil Rehabil 2022; 44:7283-7289. [PMID: 34541984 DOI: 10.1080/09638288.2021.1977859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE We aimed to translate the Early Clinical Assessment of Balance (ECAB) from English to Japanese and examine the content validity, inter-rater reliability, intra-rater reliability, construct validity, and minimal clinically important difference (MCID) for children with cerebral palsy (CP). METHODS The ECAB was translated into Japanese per international standards. The study included 106 children with CP and, aged 1.5-12 years. The ECAB, the Gross Motor Function Classification System (GMFCS), and the Gross Motor Function Measure 66 Basal & Ceiling (GMFM-66-B&C) were measured. The content and construct validity were examined based on therapist feedback and correlations between the ECAB and GMFM-66-B&C. The inter-rater reliability and the intra-rater reliability were examined by the intra-class correlation coefficient (ICC). The MCID was calculated by the anchor-based method with the GMFM-66-B&C. RESULTS High content validity (more than 80% agreement), inter-rater and intra-rater reliability (ICC = 0.99 & 0.99, respectively), and construct validity (r = 0.96) were demonstrated, with MCID values of 7.39, 5.32, and 6.88 observed for the GMFCS I/II, III, and IV/V, respectively. CONCLUSION The Japanese version of the ECAB is a reliable and valid measure of balance ability in children with CP. Furthermore, the MCID of the ECAB was established, appears to be useful in helping to provide rehabilitation.Implications for RehabilitationThe Japanese version of the Early Clinical Assessment of Balance is easy, safe, and low-cost, and has high reliability and validity for assessing balance ability in children with cerebral palsy.The use of the Japanese version of the Early Clinical Assessment of Balance is beneficial for determining the therapeutic effect, appropriate treatment, and prediction of prognosis regarding balance ability in children with cerebral palsy.The minimal detectable change of the Japanese version of the ECAB suggest that a score exceeding 6 is a true change and the minimal clinically important difference of the Japanese version of the ECAB suggest that the scores exceeding 8, 6, and 7 for the GMFCS I/II, III, and IV/V, respectively, is a clinically useful change.
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Affiliation(s)
- Takahito Inoue
- Division of Rehabilitation Medicine, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Hiroto Izumi
- Division of Rehabilitation Medicine, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Hisato Nishibu
- Division of Rehabilitation Medicine, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Nobuaki Himuro
- Department of Public Health, School of Medicine, Sapporo Medical University, Sapporo, Japan
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Sheu J, Cohen D, Sousa T, Pham KLD. Cerebral Palsy: Current Concepts and Practices in Musculoskeletal Care. Pediatr Rev 2022; 43:572-581. [PMID: 36180545 DOI: 10.1542/pir.2022-005657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebral palsy is a neurologic disorder characterized by a spectrum of motor and cognitive deficits resulting from insults to the developing brain. The etiologies are numerous and likely multifactorial; an increasing portion of cases may be attributable to genetic causes, although the exact mechanisms responsible remain poorly understood. Major risk factors include intrauterine stroke and prematurity and neonatal infection, trauma, and hypoxia, which may occur in the prenatal, perinatal, or postnatal period. The Gross Motor Function Classification System (GMFCS) is a widely used tool to establish a child's level of function and to guide treatment; however, additional metrics are necessary to formulate long-term prognoses. Goals of care are to maximize function and independence, which directly correlate with overall quality of life, and family participation is key to establishing goals early in treatment. Nonpharmaceutical treatments include physical, occupational, and speech therapy, as well as bracing, equipment, and technology. There is a breadth of medical interventions for managing hypertonia, including medications, botulinum toxin injections, intrathecal baclofen pumps, and selective dorsal rhizotomy. Orthopedic interventions are indicated for symptomatic or progressive musculoskeletal sequelae. Treatments for dysplastic hips and/or hip instability range from soft tissue releases to bony procedures. Neuromuscular scoliosis is managed with posterior spinal fusion because bracing is ineffective against these rapidly progressive curves. The degree of care varies considerably depending on the child's baseline GMFCS level and functional capabilities, and early screening, diagnosis, and appropriate referrals are paramount to initiating early care and maximizing the child's quality of life.
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Affiliation(s)
- Jonathan Sheu
- Department of Orthopedic Surgery, McLaren Flint Regional Hospital, Flint, MI
| | - Dorian Cohen
- Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Ted Sousa
- Department of Orthopedic Surgery, Shriners Hospital for Children, Spokane, WA
| | - Kelly L D Pham
- Department of Physical Medicine and Rehabilitation, Pediatric Rehabilitation Medicine, Reach Pediatric Rehab, Vienna, VA
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Changing the Paradigm of School-Based Physical Therapist Service Delivery: Using Evidence to Support Intensive Intervention. Pediatr Phys Ther 2022; 34:73-80. [PMID: 34958336 DOI: 10.1097/pep.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article is to highlight the paradigm shift away from the typical model of direct service delivery of consistent frequency and duration in the school setting to accommodate an intensive progressive resistive exercise intervention. School-based physical therapists describe how they applied an evidence-based intensive intervention with multiple students in an urban public school district. SUMMARY OF KEY POINTS The school-based physical therapists had to modify the typical service delivery model and overcome other challenges to implement this intensive intervention approach. Substantial improvements in strength and functional activities were observed in multiple students and measured across several months. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE An intensive intervention model appears effective and feasible in the school setting. Evidence-based intervention approaches should be considered when the student could benefit. VIDEO ABSTRACT For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A339.
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Krarup LH, Kristensen PK, Strand L, Bredtoft SL, Mechlenburg I, Nordbye‐Nielsen K. Ankle contractures are frequent among children with cerebral palsy and associated with lower gross motor function and degree of spasticity. Acta Paediatr 2021; 110:2171-2178. [PMID: 33565134 DOI: 10.1111/apa.15804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 01/14/2023]
Abstract
AIM To estimate yearly prevalence of ankle contractures among children with cerebral palsy (CP). Moreover, to investigate whether age, gross motor function or spasticity are associated with ankle contracture. METHODS We examined yearly prevalence of ankle contractures among 933 children based on data from a national clinical quality database from 2012 to 2019. We used the Gross Motor Function Classification System (GMFCS) and the Modified Ashworth Scale (MAS) to assess gross motor function and spasticity in the plantar flexors. Ankle contracture was defined as dorsiflexion with an extended knee equal to or below 0 degrees. Associations between age, GMFCS, spasticity and ankle contractures were analysed using multivariable regression and presented as odds ratios (OR) with 95% confidence intervals (95%CI). RESULTS The prevalence of ankle contracture was 32% and did not change with calendar year. GMFCS IV-V compared to I-III (40.6% vs. 28.9%, OR = 1.5 (95%CI: 1.07-2.11) and MAS 2-4 compared to 0 (44.6% vs. 24.4%, OR = 2.5 (95%CI: 1.59-3.91) were associated with a higher prevalence of ankle contracture. Age was not associated with ankle contracture. CONCLUSION Ankle contractures are frequent among children with CP. Lower gross motor function and severe spasticity were associated with ankle contracture.
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Affiliation(s)
| | | | - Louise Strand
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark
| | | | - Inger Mechlenburg
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Kirsten Nordbye‐Nielsen
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark
- CPNorth: Living Life With Cerebral Palsy in the Nordic Countries Aarhus Denmark
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Hornáček K, Kujawa J, Varela Donoso E, Dincer F, Ilieva E, Takáč P, Petronic Markovic I, Votava J, Vetra A, Nikolic D, Christodoulou N, Zampolini M, Kiekens C. Evidence Based Position Paper on Physical and Rehabilitation Medicine professional practice for persons with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:1020-1035. [PMID: 33861040 DOI: 10.23736/s1973-9087.21.06983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. AIM The aim of this study was to improve Physical and Rehabilitation Medicine physician´s professional practice for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. MATERIAL AND METHODS A systematic review of the literature including an eighteen-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. RESULTS As the result of a Consensus Delphi procedure process 74 recommendations are presented together with the systematic literature review. CONCLUSIONS The PRM physician´s role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM programme developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients´ health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions.
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Affiliation(s)
- Karol Hornáček
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Jolanta Kujawa
- Department of Physical and Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University of School of Medicine, Madrid, Spain
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Peter Takáč
- Department of Physical and Rehabilitation Medicine, L. Pasteur University Hospital, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic -
| | - Ivana Petronic Markovic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jiří Votava
- Faculty of Health Studies, University of J. E. Purkyně, Ústí nad Labem, Czech Republic
| | - Anita Vetra
- Rehabilitation Department, Riga Stradins University, Riga, Latvia
| | - Dejan Nikolic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Zampolini
- Department of Rehabilitation, Foligno Hospital, USL Umbria 2, Perugia, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola Bologna, Italy
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Bartlett DJ. Advancing the Evidence Base of Pediatric Physical Therapy: "Sincerely, From the Heart". Pediatr Phys Ther 2020; 32:172-179. [PMID: 32604355 DOI: 10.1097/pep.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To share reflections on themes that have become important to me as a developing pediatric physical therapy researcher contributing to knowledge generation in our field. KEY POINTS The themes are: select strong mentors, assemble a research team with diverse perspectives and strengths, be family-centered, be rigorous in approaches to study design to match the research question, mentor the next generation, and engage in knowledge translation and exchange. CONCLUSIONS I encourage everyone to reflect on who has been or could be your mentors or mentees, and on how you can be a part of an effective, family-centered research team, by encouraging a breadth of research designs to answer the many research questions that remain and by assisting in the implementation of knowledge to practice. CLINICAL RELEVANCE Outcomes for children and families receiving pediatric physical therapy services are enhanced through the use of evidence-based knowledge.
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Affiliation(s)
- Doreen J Bartlett
- School of Physical Therapy, Western University, London, Ontario, Canada
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13
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Lewis J, Scott K, Pan X, Heathcock J. The Relationship between Parent-reported PEDI-CAT Mobility and Gross Motor Function in Children with Cerebral Palsy: Brief Report. Dev Neurorehabil 2020; 23:140-144. [PMID: 31726912 DOI: 10.1080/17518423.2019.1687601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The PEDI-CAT mobility domain (PEDI-mob) is a parent-reported measure of mobility for children up to 21 years of age. The purpose of this research is to investigate the relationship between the PEDI-mob and Gross Motor Function Measure (GMFM)-66 and Gross Motor Function Classification Scale (GMFCS) levels.Methods: Fifty-seven children (N = 57), ages 2-8.8 years participated. PEDI-mob and GMFM were administered and GMFCS was confirmed during the same session. A Pearson correlation coefficient was calculated for PEDI-mob and GMFM-66 scores to evaluate the association between these two measures. An ANOVA was used to analyze PEDI-mob across GMFCS levels.Results: Large, statistically significant correlation was found between PEDI-mob and GMFM-66 scores (r = 0.894, p-value<0.001). Differences in PEDI-mob scores were found across GMFCS levels (p-value <0.001), where patients with higher GMFCS levels had lower PEDI-mob scores.Conclusion: These results support a strong relationship between parent-reported and clinically measured motor function.
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McCoy SW, Palisano R, Avery L, Jeffries L, Laforme Fiss A, Chiarello L, Hanna S. Physical, occupational, and speech therapy for children with cerebral palsy. Dev Med Child Neurol 2020; 62:140-146. [PMID: 31353456 DOI: 10.1111/dmcn.14325] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 12/12/2022]
Abstract
AIM To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP). METHOD We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal graphs for each GMFCS level, depicting change across time using centiles. Using multinomial models, we analyzed the relationship between therapies (amount, focus, family-centeredness, and the extent therapies met children's needs) and whether change in balance, walking endurance, and participation was 'more than' and 'less than' the reference of 'as expected'. RESULTS Children were more likely to progress 'more than expected' when participating in recreation when therapies were family-centered, met children's needs, and focused on structured play/recreation. A focus on health and well-being was positively associated with participation and self-care. The amount of therapy did not predict outcomes. INTERPRETATION Therapy services that are family-centered, consider the needs of the child, and focus on structured play/recreational activities and health/well-being may enhance the development of children with CP. WHAT THIS PAPER ADDS Family-centered rehabilitation therapies were positively associated with greater participation in family/recreation activities and walking endurance. Parental perception that rehabilitation therapies met children's needs was associated with greater participation in family/recreation activities. Structured play, recreational activities, and health/well-being are important for self-care and participation when planning rehabilitation therapy. The amount of rehabilitation therapy was not related to developmental outcomes.
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Affiliation(s)
- Sarah Westcott McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Robert Palisano
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Lisa Avery
- Avery Information Services, Orillia, Ontario, Canada
| | - Lynn Jeffries
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Lisa Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Steve Hanna
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Abstract
PURPOSE This project aimed to determine whether change occurs over time for impairments of balance, range of motion, endurance, and strength of children with cerebral palsy, by Gross Motor Function Classification System (GMFCS) levels. METHODS Measurements were completed in 77 children at 2 sessions (T1, T2) on average 5.8 years apart. Mean ages were 2.9 years (SD = 0.9) and 8.7 years (SD = 1.1) at T1 and T2, respectively. RESULTS There were significant differences from T1 to T2 for some children (GMFCS levels I, II, and III/IV: balance increased; GMFCS levels I and II: strength increased; and GMFCS levels III/IV and V: range of motion decreased). Endurance scores were not different and did not change. CONCLUSIONS Longitudinal changes in most impairments occurred in children with cerebral palsy. Monitoring and targeted interventions should support each child's development.
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Gontijo APB, Starling JMP, Oliveira GD, Meier D, Mancini MC. CULTURAL ADAPTATION AND RELIABILITY ANALYSIS OF THE EARLY CLINICAL ASSESSMENT OF BALANCE. REVISTA PAULISTA DE PEDIATRIA 2019; 37:325-331. [PMID: 31090845 PMCID: PMC6868562 DOI: 10.1590/1984-0462/;2019;37;3;00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/10/2018] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective: To translate the Early Clinical Assessment of Balance (ECAB), an assessment scale developed specifically for children and adolescents with cerebral palsy into Brazilian Portuguese, evaluate semantic, idiomatic, experiential and conceptual equivalences, and to examine the face validity and the reliability within and between examiners of the Brazilian version. Methods: The following steps were done: translation by two independent translators; synthesis of translations; back translation into English; analysis of back-translations by a multidisciplinary committee and the author of the test to develop the final version of the test; test application training; administration of the translated version of ECAB (videotaped) in 60 children and adolescents with cerebral palsy; intra and inter-examiner reliability assessment. Reability was assessed by intraclass correlation coefficient (CCI). Results: The discrepancies found were related mainly to semantic equivalence and, therefore, there was no need to make cultural adaptations in any of the 13 items on the scale. The rate of agreement was greater than 90% and the reliability of the ECAB-Portuguese total score was excellent both for the intra-rater test (CCI=1.00) and for the inter-rater test (CCI=0.998). Likewise, the reliability evaluation of each of the scale items was also excellent. Conclusions: The translated version of the ECAB into Portuguese provides a tool for the evaluation of the specific balance for children and adolescents with cerebral palsy with different levels of functioning.
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Stretching and Progressive Resistance Exercise in Children With Cerebral Palsy: A Randomized Controlled Trial. Pediatr Phys Ther 2019; 31:264-271. [PMID: 31220010 DOI: 10.1097/pep.0000000000000616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effect of stretching and progressive resistance exercise on range of motion and muscle strength in children with cerebral palsy. METHODS Thirty-seven children with spastic bilateral cerebral palsy and Gross Motor Function Classification System levels I to III were randomized to an intervention and a comparison group. The intervention included stretching of hamstrings and progressive resistance exercise, targeting the lower extremities for 16 weeks, followed by a 16-week maintenance program. Passive and active popliteal angle and muscle strength were evaluated at 0, 16, and 32 weeks. RESULTS After 16 weeks nonsignificant improvements were found in passive, active popliteal angle and quadriceps and hamstrings strength. CONCLUSION A 16-week stretching and progressive resistance exercise program followed by a 16-week maintenance program showed nonsignificant improvements in passive, active popliteal angle and muscle strength for the intervention group.
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Chiarello LA, Bartlett DJ, Palisano RJ, McCoy SW, Jeffries L, Fiss AL, Wilk P. Determinants of playfulness of young children with cerebral palsy. Dev Neurorehabil 2019; 22:240-249. [PMID: 29746800 DOI: 10.1080/17518423.2018.1471623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To identify child, family, and service determinants of playfulness of young children with cerebral palsy. METHODS Participants were 429 children, 18-60 months. Children were divided into two groups, Gross Motor Function Classification System levels I-II and III-V. Therapists collected data on body functions and gross motor function; parents provided information about children's health conditions and adaptive behavior, family life, and services. One year after the beginning of the study, therapists assessed children's playfulness. Data were analyzed using structural equation modeling. RESULTS Higher gross motor function was associated with higher playfulness for both groups. Greater impact of health conditions on daily life was associated with lower playfulness for children in levels I-II. More effective adaptive behavior was associated with higher playfulness, and higher parent perception of therapists' family-centeredness was associated with lower playfulness for children in levels III-V. CONCLUSION Supporting gross motor function, health, and adaptive behavior may foster playfulness.
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Affiliation(s)
- Lisa A Chiarello
- a Department of Physical Therapy and Rehabilitation Sciences , Drexel University , Philadelphia , PA , USA
| | - Doreen J Bartlett
- b School of Physical Therapy , Western University , London , Ontario , Canada
| | - Robert J Palisano
- a Department of Physical Therapy and Rehabilitation Sciences , Drexel University , Philadelphia , PA , USA
| | - Sarah Westcott McCoy
- c Department of Rehabilitation Medicine , University of Washington , Seattle , Washington , USA
| | - Lynn Jeffries
- d Department of Rehabilitation Sciences , The University of Oklahoma Health Sciences Centre , Oklahoma City , Oklahoma , USA
| | | | - Piotr Wilk
- f Department of Epidemiology and Biostatistics , Western University , London , Ontario , Canada
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Jeffries LM, LaForme Fiss A, Westcott McCoy S, Bartlett D, Avery L, Hanna S. Developmental Trajectories and Reference Percentiles for Range of Motion, Endurance, and Muscle Strength of Children With Cerebral Palsy. Phys Ther 2019; 99:329-338. [PMID: 30602008 DOI: 10.1093/ptj/pzy160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/13/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Children with cerebral palsy (CP) frequently present with secondary impairments in spinal alignment and extremity range of motion, endurance for activity, and muscle strength. Creation of developmental trajectories for these impairments will help guide clinical decision-making. OBJECTIVE For children in each level of the Gross Motor Function Classification System (GMFCS) this study aimed to: (1) create longitudinal developmental trajectories for range of motion (Spinal Alignment and Range of Motion Measures [SAROMM]), endurance (Early Activity Scale for Endurance [EASE]), and functional strength (Functional Strength Assessment [FSA]); and (2) develop age-specific reference percentiles and amount of change typical over 1 year for these outcomes. DESIGN This study used a longitudinal cohort design. METHODS Participants comprised 708 children with CP across GMFCS levels, aged 18 months up to the 12th birthday, and their families. In 2 to 5 assessments every 6 months over 2 years, trained therapists performed the SAROMM and FSA, and parents completed the EASE questionnaire. For children in each GMFCS level, longitudinal trajectories using linear and nonlinear mixed-effects models from all visits, and reference percentiles using quantile regression from the first, 12-month, and 24-month visits were created for each measure. RESULTS Longitudinal trajectories and percentile graphs for SAROMM, FSA, and EASE were primarily linear, with different performance scores among GMFCS levels. There was much variability in both longitudinal trajectories and percentiles within GMFCS levels. LIMITATIONS Limitations included a convenience sample and varying numbers of participants assessed at each visit. CONCLUSIONS The longitudinal trajectories and percentile graphs have application for monitoring how children with CP are performing and changing over time compared with other children with CP. The resources presented allow therapists and families to collaboratively make decisions about intervention activities targeted to children's unique needs.
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Affiliation(s)
- Lynn M Jeffries
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117 (USA)
| | | | | | - Doreen Bartlett
- School of Physical Therapy, Elborn College, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Lisa Avery
- Avery Information Services Ltd, Orillia, Ontario, Canada
| | - Steven Hanna
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
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LaForme Fiss A, McCoy SW, Bartlett D, Avery L, Hanna SE. Developmental Trajectories for the Early Clinical Assessment of Balance by Gross Motor Function Classification System Level for Children With Cerebral Palsy. Phys Ther 2019; 99:217-228. [PMID: 30715490 PMCID: PMC6339982 DOI: 10.1093/ptj/pzy132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 06/18/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Children with cerebral palsy (CP) characteristically present with impairments in balance. Currently, the pattern and timing of the development of balance ability have not been described for children with CP of varying Gross Motor Function Classification System (GMFCS) levels. OBJECTIVE The purpose of this study was to document longitudinal developmental trajectories in a measure of balance, the Early Clinical Assessment of Balance (ECAB) scores, along with age-specific reference percentiles and the amount of change typical over a 1-year period for children within different GMFCS levels. DESIGN The design was a longitudinal cohort study. METHODS Participants included 708 children with CP, aged 18 months through their 12th birthday, and their families. Children participated in 2 to 5 assessments using the GMFCS and ECAB. RESULTS Longitudinal trajectories describing the average change in the ECAB score with respect to age were created by fitting separate nonlinear mixed-effect models for children in each GMFCS level. Reference percentiles were constructed using quantile regression of ECAB data from the first visit (baseline) and 12-month and 24-month visits. Using these reference points, the amount of change in percentiles was calculated for all children by subtracting the baseline percentile score from the 12-month percentile score. Children whose percentile changes are within the 80% limits can usually be described as "developing as expected" for their age and GMFCS levels. LIMITATIONS Limitations of this study included use of a convenience sample, a ceiling effect of the ECAB for some children in GMFCS levels I and II, and the use of both a 12-month and 24-month study protocol that impacted the number of children available for each assessment session. CONCLUSIONS When used appropriately to monitor development and change over time for children with CP, the ECAB longitudinal trajectories, reference percentiles, and the associated change scores presented here should assist therapists and families in collaborative interaction to proactively plan services and interventions relative to balance ability.
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Affiliation(s)
- Alyssa LaForme Fiss
- Department of Physical Therapy, Mercer University, Atlanta, GA 30341 (USA),Address all correspondence to Dr LaForme Fiss at:
| | | | - Doreen Bartlett
- School of Physical Therapy, Elborn College, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Lisa Avery
- Avery Information Services Ltd, Orillia, Ontario, Canada
| | - Steven E Hanna
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Developmental Trajectories and Reference Percentiles for the 6-Minute Walk Test for Children With Cerebral Palsy. Pediatr Phys Ther 2019; 31:51-59. [PMID: 30557281 DOI: 10.1097/pep.0000000000000552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purposes of this study were to document longitudinal developmental trajectories in 6-minute walk test (6MWT) distances and to develop age-specific reference percentiles for children across different Gross Motor Function Classification System (GMFCS) levels. METHODS A TOTAL OF: 456 children with cerebral palsy ages 3 to 12 years of, GMFCS levels I to III participated. Children's motor function was classified on the GMFCS, and children completed the 6MWT 2 to 5 times in 2 years. RESULTS Longitudinal developmental trajectories support that 6MWT distances increase with age followed by a tapering, as children approach their functional limit relative to their GMFCS level. Reference percentile graphs were created to monitor change over time. CONCLUSIONS The 6MWT longitudinal developmental trajectories, reference percentiles, and interpretation of percentile change should assist collaborative and proactive intervention planning relative to functional walking capacity for children with cerebral palsy.
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Størvold GV, Jahnsen RB, Evensen KAI, Bratberg GH. Is more frequent physical therapy associated with increased gross motor improvement in children with cerebral palsy? A national prospective cohort study. Disabil Rehabil 2018; 42:1430-1438. [PMID: 30444146 DOI: 10.1080/09638288.2018.1528635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose: To investigate the association between physical therapy frequency and gross motor improvement in children with cerebral palsy (CP).Materials and methods: This is a prospective cohort study of 442 children aged 2-12 years, Gross Motor Function Classification System levels I-V, from the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Outcome was change in reference percentiles for the Gross Motor Function Measure (GMFM-66) between two subsequent assessments (N = 1056) analyzed in a linear mixed model.Results: It was a dose response association between physical therapy frequency and gross motor improvement. Mean change was 4.2 (95% CI: 1.4-7.1) percentiles larger for physical therapy 1-2 times per week and 7.1 (95% CI: 2.6-11.6) percentiles larger for physical therapy >2 times per week, compared to less frequent physical therapy when analyzed in a multivariable model including multiple child and intervention factors. The only statistically significant confounder was number of contractures which was negatively associated with gross motor improvement.Conclusions: When gross motor improvement is a goal for children with CP, more frequent physical therapy should be considered.Implications for rehabilitationIn general, the gross motor development of Norwegian children with cerebral palsy was as expected according to the reference percentiles for the GMFM-66.When gross motor improvement is a goal for children with cerebral palsy, high-frequency physical therapy should be considered.Contractures should be addressed in order to optimize gross motor improvement for children with cerebral palsy.
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Affiliation(s)
- Gunfrid V Størvold
- Habilitation Centre, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Reidun B Jahnsen
- Department of Clinical Neuroscience for Children, CPOP, Oslo University Hospital, Oslo, Norway.,CHARM, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kari Anne I Evensen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Physiotherapy, Trondheim Municipality, Trondheim, Norway
| | - Grete H Bratberg
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Faculty of Nursing and Health Science, Nord University, Levanger, Norway
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Mccoy SW, Effgen SK, Chiarello LA, Jeffries LM, Villasante Tezanos AG. School-based physical therapy services and student functional performance at school. Dev Med Child Neurol 2018; 60:1140-1148. [PMID: 29603734 DOI: 10.1111/dmcn.13748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2018] [Indexed: 11/27/2022]
Abstract
AIM We explored relationships of school-based physical therapy to standardized outcomes of students receiving physical therapy. METHOD Using a practice-based evidence research design, School Function Assessment (SFA) outcomes of 296 students with disabilities (mean age 7y 4mo [standard deviation 2y]; 166 males, 130 females), served by 109 physical therapists, were explored. After training, therapists completed 10 SFA scales on students at the beginning and end of the school year. Therapists collected detailed weekly data on services (activities, interventions, types, student participation) using the School-Physical Therapy Interventions for Pediatrics (S-PTIP) system. Stepwise linear regressions were used to investigate S-PTIP predictors of SFA outcomes. RESULTS Predictors of SFA section outcomes varied in strength, with the coefficient of determination (R2 ) for each outcome ranging from 0.107 to 0.326. Services that correlated positively with the SFA outcomes included mobility, sensory, motor learning, aerobic/conditioning, functional strengthening, playground access interventions, and higher student participation during therapy (standardized β=0.11-0.26). Services that correlated negatively with the SFA outcomes included providing services within student groups, within school activity, with students not in special education, during recreation activities, and with positioning, hands-on facilitation, sensory integration, orthoses, and equipment interventions (standardized β=-0.14 to -0.22). INTERPRETATION Consideration of outcomes is prudent to focus services. Overall results suggest we should emphasize active mobility practice by using motor learning interventions and engaging students within therapy sessions. WHAT THIS PAPER ADDS No specific interventions predicted positively on all School Function Assessment (SFA) outcomes. Active movement practice seems related to overall better SFA outcomes. Active mobility practice improved SFA participation, mobility, recreation, and activities of daily living. Engaging students in therapy activities and interventions improved outcomes.
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Affiliation(s)
- Sarah Westcott Mccoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Susan K Effgen
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Lisa A Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Lynn M Jeffries
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
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Bartlett DJ, McCoy SW, Chiarello LA, Avery L, Galuppi B. A Collaborative Approach to Decision Making Through Developmental Monitoring to Provide Individualized Services for Children With Cerebral Palsy. Phys Ther 2018; 98:865-875. [PMID: 29982806 DOI: 10.1093/ptj/pzy081] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 07/02/2018] [Indexed: 02/09/2023]
Affiliation(s)
- Doreen J Bartlett
- Professor Emerita, School of Physical Therapy, Western University, 1588 Elborn College, London, Ontario, Canada N6G 1H1
| | - Sarah W McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Lisa A Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, Pennsylvania
| | - Lisa Avery
- Statistical Consultant, Avery Information Services, Orillia, Ontario, Canada
| | - Barbara Galuppi
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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Gupta M, Rajak BL, Bhatia D, Mukherjee A. Neuromodulatory effect of repetitive transcranial magnetic stimulation pulses on functional motor performances of spastic cerebral palsy children. J Med Eng Technol 2018; 42:352-358. [PMID: 30175934 DOI: 10.1080/03091902.2018.1510555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Neuromodulation is emerging as a new therapeutic field towards treatment of neurological disorders through advances in medical devices. Repetitive Transcranial Magnetic Stimulation (rTMS) is one such neuromodulatory device that has received increasing interest as a tool for modulating cortical excitability that influence motor activity in both normal and diseased population. However, the therapeutic effect of rTMS varies depending on stimulation frequency, intensity, pulse trains, duration, etc. Our previous studies had already demonstrated that higher frequency of 10 Hz was effective in improving the motor activity of spastic CP patients. OBJECTIVE This study was aimed to evaluate the effect of different rTMS pulses on gross motor performance of spastic CP patients. METHOD Thirty spastic CP patients were divided equally into three groups P1500, P2000 and P2500 with mean age (in years) 7.7 ± SD4.4, 6.8 ± SD5.3 and 7.2 ± SD5.1 respectively. Gross Motor Function Measure (GMFM) was employed as an outcome measure to assess the motor performance. Constant rTMS frequency of 10 Hz was delivered to each participant but the number of stimulation pulse varied according to the groups; which were 1500, 2000 and 2500 pulses for P1500, P2000 and P2500 group respectively. rTMS therapy of 15 minutes duration was followed by physical therapy of 30 minutes daily for 20 days. RESULT Statistical analysis of pre versus post GMFM scores of different groups revealed significant result (p < .001) and the improvement in functional motor activity was 2.33% in P1500, 3.58% in P2000 and 5.17% in P2500 group. INTERPRETATION The result demonstrated modulatory effect of rTMS pulse by improving motor function of spastic CP patients.
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Affiliation(s)
- Meena Gupta
- a Department of Biomedical Engineering , North Eastern Hill University , Shillong , India
| | - Bablu Lal Rajak
- a Department of Biomedical Engineering , North Eastern Hill University , Shillong , India
| | - Dinesh Bhatia
- a Department of Biomedical Engineering , North Eastern Hill University , Shillong , India
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Jeevanantham D, Bartlett D. Subgrouping children with cerebral palsy from a broader perspective using two methods. Physiother Theory Pract 2018; 34:453-463. [PMID: 29400608 DOI: 10.1080/09593985.2017.1422163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose was to develop two versions of a body function index in cerebral palsy (BFI-CP I and BFI-CP II) using two methods to explore the relationship and differences among them and the Gross Motor Function Classification System (GMFCS) and to explore the differences among subsets of the classifications that do not correspond to the ordinal levels of the GMFCS. Data on various measures from 405 children with CP between 18 months and 5 years of age were extracted from the Move & PLAY Study. The BFI-CP I was developed using a summing technique and the BFI-CP II was developed using cluster analysis. There was a strong correlation between the BFI-CP I and the GMFCS (r = 0.92), between the BFI-CP II and the GMFCS (r = 0.93), and between the BFI-CP I and II (r = 0.92) all (p < 0.001). There was also a significant difference between the BFI-CP I and the GMFCS (χ2 = 670.49, df = 16, p < 0.001) and between the BFI-CP II and the GMFCS (χ2 = 685.57, df = 16, p < 0.001). The findings of this study indicate that the two versions of the BFI-CP could be used as complementary methods in describing children with CP.
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Affiliation(s)
- Deepa Jeevanantham
- a Health and Rehabilitation Sciences Program , Western University , London , Ontario , Canada
| | - Doreen Bartlett
- b School of Physical Therapy , Western University , London , Ontario , Canada
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Curtis DJ, Woollacott M, Bencke J, Lauridsen HB, Saavedra S, Bandholm T, Sonne-Holm S. The functional effect of segmental trunk and head control training in moderate-to-severe cerebral palsy: A randomized controlled trial. Dev Neurorehabil 2018; 21:91-100. [PMID: 28045553 DOI: 10.1080/17518423.2016.1265603] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine whether segmental training is more effective in improving gross motor function in children and young people with moderate-to-severe cerebral palsy than conventional physiotherapy. METHODS Twenty-eight participants were randomized to a segmental training or control group. Outcomes were Gross Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory (PEDI), Segmental Assessment of Trunk Control (SATCo), and postural sway at baseline, at primary endpoint (6 months), and at follow-up (12 months). RESULTS There were no significant differences in either GMFM, PEDI, or SATCo scores at primary endpoint or follow-up. There were significant reductions in anterior-posterior head angular sway and trunk sway in the segmental training group at primary endpoint but not at follow-up. CONCLUSION Segmental training was not superior to usual care in improving GMFM. Improvements in head and trunk sway were greater in the segmental training group at primary endpoint but not at follow-up.
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Affiliation(s)
- Derek John Curtis
- a The Gait Analysis Laboratory, Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark.,b Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen, Denmark.,c Institute for Physical and Occupational Therapy, The Faculty of Health and Technology , Metropolitan University College , Copenhagen
| | | | - Jesper Bencke
- a The Gait Analysis Laboratory, Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark
| | - Hanne Bloch Lauridsen
- a The Gait Analysis Laboratory, Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark
| | - Sandy Saavedra
- e Department of Rehabilitation Sciences College of Education , Nursing & Health Professions, University of Hartford , Hartford , CT, USA
| | - Thomas Bandholm
- b Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen, Denmark.,f Department of Physical and Occupational Therapy , Hvidovre University Hospital , Copenhagen , Denmark.,g Clinical Research Centre, Hvidovre University Hospital , Copenhagen , Denmark
| | - Stig Sonne-Holm
- a The Gait Analysis Laboratory, Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark.,h Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark
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Størvold GV, Jahnsen RB, Evensen KAI, Romild UK, Bratberg GH. Factors Associated with Enhanced Gross Motor Progress in Children with Cerebral Palsy: A Register-Based Study. Phys Occup Ther Pediatr 2018; 38:548-561. [PMID: 29714626 DOI: 10.1080/01942638.2018.1462288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM To examine associations between interventions and child characteristics; and enhanced gross motor progress in children with cerebral palsy (CP). METHODS Prospective cohort study based on 2048 assessments of 442 children (256 boys, 186 girls) aged 2-12 years registered in the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Gross motor progress estimates were based on repeated measures of reference percentiles for the Gross Motor Function Measure (GMFM-66) in a linear mixed model. Mean follow-up time: 2.9 years. RESULTS Intensive training was the only intervention factor associated with enhanced gross motor progress (mean 3.3 percentiles, 95% CI: 1.0, 5.5 per period of ≥3 sessions per week and/or participation in an intensive program). Gross motor function was on average 24.2 percentiles (95% CI: 15.2, 33.2) lower in children with intellectual disability compared with others. Except for eating problems (-10.5 percentiles 95% CI: -18.5, -2.4) and ankle contractures by age (-1.9 percentiles 95% CI: -3.6, -0.2) no other factors examined were associated with long-term gross motor progress. CONCLUSIONS Intensive training was associated with enhanced gross motor progress over an average of 2.9 years in children with CP. Intellectual disability was a strong negative prognostic factor. Preventing ankle contractures appears important for gross motor progress.
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Affiliation(s)
- Gunfrid V Størvold
- a Habilitation Centre, Nord-Trøndelag Hospital Trust , Levanger , Norway
| | - Reidun B Jahnsen
- b Department of Clinical Neuroscience for Children , Oslo University Hospital , Oslo , Norway
| | - Kari Anne I Evensen
- c Department of Clinical and Molecular Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| | - Ulla K Romild
- d Department of Knowledge Development , Public Health Agency of Sweden , Østersund , Sweden
| | - Grete H Bratberg
- e Department of Research, Nord-Trøndelag Hospital Trust, Levanger , Norway and Faculty of Nursing and Health Sciences, Nord University , Levanger , Norway
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Eken MM, Harlaar J, Dallmeijer AJ, de Waard E, van Bennekom CAM, Houdijk H. Squat test performance and execution in children with and without cerebral palsy. Clin Biomech (Bristol, Avon) 2017; 41:98-105. [PMID: 28040656 DOI: 10.1016/j.clinbiomech.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 10/31/2016] [Accepted: 12/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knowledge on lower extremity strength is imperative to informed decision making for children with cerebral palsy (CP) with mobility problems. However, a functional and clinically feasible test is not available. We aimed to determine whether the squat test is suitable for this purpose by investigating test performance and execution in children with cerebral palsy and typically developing (TD) peers. METHODS Squat test performance, defined by the number of two-legged squats until fatigue (max 20), was assessed in twenty children with bilateral CP (6-19years; gross motor function classification system I-III) and sixteen TD children (7-16years). Muscle fatigue was assessed from changes in electromyography (EMG). Joint range-of-motion and net torque were calculated for each single squat, to investigate differences between groups and between the 2nd and last squat. FINDINGS Fifteen children with CP performed <20 squats (median=13, IQR=7-19), while all TD children performed the maximum of 20 squats. Median EMG frequency decreased and amplitude increased in mm. quadriceps of both groups. Ankle and knee range-of-motion were reduced in children with CP during a single squat by 10 to 15°. No differences between 2nd and last squat were observed, except for knee range-of-motion which increased in TD children and decreased in children with CP. INTERPRETATION Squat test performance was reduced in children with CP, especially in those with more severe CP. Muscle fatigue was present in both children with CP and TD peers, confirming that endurance of the lower extremity was tested. Minor execution differences between groups suggest that standardized execution is important to avoid compensation strategies. It is concluded that the squat test is feasible to test lower extremity strength in children with CP in a clinically meaningful way. Further clinimetric evaluation is needed before clinical implementation.
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Affiliation(s)
- M M Eken
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Heliomare Rehabilitation, Research and Development, Wijk aan Zee, The Netherlands.
| | - J Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - A J Dallmeijer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - E de Waard
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - C A M van Bennekom
- Heliomare Rehabilitation, Research and Development, Wijk aan Zee, The Netherlands; Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H Houdijk
- Heliomare Rehabilitation, Research and Development, Wijk aan Zee, The Netherlands; Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
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Rodby-Bousquet E, Paleg G, Casey J, Wizert A, Livingstone R. Physical risk factors influencing wheeled mobility in children with cerebral palsy: a cross-sectional study. BMC Pediatr 2016; 16:165. [PMID: 27724880 PMCID: PMC5057439 DOI: 10.1186/s12887-016-0707-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 10/05/2016] [Indexed: 11/20/2022] Open
Abstract
Background There is a lack of understanding of the factors that influence independent mobility and participation in meaningful activities. The purpose of this study was to analyse physical factors influencing independent use of manual and power wheelchairs in a total population of children with cerebral palsy (CP). Methods A cross-sectional study based on the most recent examination of all children with CP, born 2002–2013, reported into the Swedish cerebral palsy registry (CPUP), from January 2012 to June 2014. There were 2328 children (58 % boys, 42 % girls), aged 0–11 years, at all levels of gross motor function and hand function. Hazard ratios adjusted for age and sex were used to calculate the risk for not being able to self-propel based on Gross Motor Function Classification System (GMFCS) levels, upper extremity range of motion and hand function including Manual Ability Classification System (MACS), House functional classification system, Thumb-in-palm deformity, Zancolli (spasticity of wrist/finger flexors) and bimanual ability. Results In total 858 children used wheelchairs outdoors (692 manual, 20 power, 146 both). Only 10 % of the 838 children self-propelled manual wheelchairs, while 90 % were pushed. In contrast 75 % of the 166 children who used power mobility outdoors were independent. Poor hand function was the greatest risk factor for being unable to self-propel a manual wheelchair, while classification as GMFCS V or MACS IV-V were the greatest risk factors for not being able to use a power wheelchair independently. Conclusions The majority of children with CP, aged 0–11 years did not self-propel manual wheelchairs regardless of age, gross motor function, range of motion or manual abilities. Power mobility should be considered at earlier ages to promote independent mobility for all children with CP who require a wheelchair especially outdoors.
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Affiliation(s)
- Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, Vestmanland County Hospital, SE-721 89, Västerås, Sweden. .,Department of Clinical Sciences Lund, Orthopaedics, Lund University, University Hospital, Lund, Sweden.
| | - Ginny Paleg
- Montgomery County Infants & Toddlers Program, Maryland, USA
| | - Jackie Casey
- Institute of Nursing and Health Research, School of Health Sciences, University of Ulster, Coleraine, Northern Ireland
| | - Alicja Wizert
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, University Hospital, Lund, Sweden
| | - Roslyn Livingstone
- Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
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Vos RC, Becher JG, Voorman JM, Gorter JW, van Eck M, van Meeteren J, Smits DW, Twisk JW, Dallmeijer AJ. Longitudinal Association Between Gross Motor Capacity and Neuromusculoskeletal Function in Children and Youth With Cerebral Palsy. Arch Phys Med Rehabil 2016; 97:1329-37. [PMID: 27085848 DOI: 10.1016/j.apmr.2016.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/22/2016] [Accepted: 03/20/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine associations over longitudinal measurements between neuromusculoskeletal function and gross motor capacity in children and youth with cerebral palsy (CP). DESIGN A prospective cohort study. SETTING Rehabilitation departments of university medical centers and rehabilitations centers. PARTICIPANTS A sample (N=327) consisting of 148 children (aged 5-9y) and 179 youth (aged 11-20y) with CP, Gross Motor Function Classification System level I (n=180), level II (n=44), level III (n=36), level IV (n=34), and level V (n=33). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gross motor capacity was assessed with the Gross Motor Function Measure-66 over a period of 2 to 4 years in different age cohorts. Neuromusculoskeletal function included selective motor control (SMC), muscle strength, spasticity, and range of motion (ROM) of the lower extremities. RESULTS Multilevel analyses showed that SMC was significantly associated with gross motor capacity in children and youth with CP, showing higher values and a more favorable course of gross motor capacity in those with better SMC. Strength was only associated with gross motor capacity in youth. Reduced ROM of hip (children) and knee extension (youth) and spasticity of the hip adductors (youth) were additionally-but more weakly-associated with lower values and a less favorable course of gross motor capacity. CONCLUSIONS Results indicate that children and youth with more severely impaired SMC and youth with reduced muscle strength have a less favorable course of gross motor capacity, while spasticity and reduced ROM are less determinative.
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Affiliation(s)
- Rimke C Vos
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jan Willem Gorter
- CanChild Center for Childhood Disability Research, McMaster University, Hamilton, Canada; Partner of NetChild, Network for Childhood Disability Research, Utrecht, The Netherlands
| | - Mirjam van Eck
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jetty van Meeteren
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dirk-Wouter Smits
- Partner of NetChild, Network for Childhood Disability Research, Utrecht, The Netherlands; Rudolf Magnus Institute of Neuroscience, Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Jos W Twisk
- Department of Biostatistics and Methodology, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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O'Connor B, Kerr C, Shields N, Imms C. A systematic review of evidence-based assessment practices by allied health practitioners for children with cerebral palsy. Dev Med Child Neurol 2016; 58:332-47. [PMID: 26645152 DOI: 10.1111/dmcn.12973] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/16/2022]
Abstract
AIM The routine use of psychometrically robust assessment tools is integral to best practice. This systematic review aims to determine the extent to which evidence-based assessment tools were used by allied health practitioners for children with cerebral palsy (CP). METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols 2015 was employed. A search strategy applied the free text terms: 'allied health practitioner', 'assessment', and 'cerebral palsy', and related subject headings to seven databases. Included articles reported assessment practices of occupational therapists, physiotherapists, or speech pathologists working with children with CP aged 0 to 18 years, published from the year 2000. RESULTS Fourteen articles met the inclusion criteria. Eighty-eight assessment tools were reported, of which 23 were in high use. Of these, three tools focused on gross motor function and had acceptable validity for use with children with CP: Gross Motor Function Measure, Gross Motor Function Classification System, and goniometry. Validated tools to assess other activity components, participation, quality of life, and pain were used infrequently or not at all. INTERPRETATION Allied health practitioners used only a few of the available evidence-based assessment tools. Assessment findings in many areas considered important by children and families were rarely documented using validated assessment tools.
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Affiliation(s)
- Bridget O'Connor
- School of Allied Health, Australian Catholic University, Fitzroy, Vic., Australia
| | - Claire Kerr
- Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Vic., Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Nora Shields
- School of Allied Health, La Trobe University, Bundoora, Vic., Australia.,Northern Centre for Health Education and Research, Epping, Vic., Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Vic., Australia
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Chiarello LA, Bartlett DJ, Palisano RJ, McCoy SW, Fiss AL, Jeffries L, Wilk P. Determinants of participation in family and recreational activities of young children with cerebral palsy. Disabil Rehabil 2016; 38:2455-68. [DOI: 10.3109/09638288.2016.1138548] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lisa A. Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | | | - Robert J. Palisano
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Sarah Westcott McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Lynn Jeffries
- Department of Rehabilitation Sciences, The University of Oklahoma Health Sciences Centre, Oklahoma, OK, USA
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Bartlett DJ, Galuppi B, Palisano RJ, McCoy SW. Consensus classifications of gross motor, manual ability, and communication function classification systems between therapists and parents of children with cerebral palsy. Dev Med Child Neurol 2016; 58:98-9. [PMID: 26767662 DOI: 10.1111/dmcn.12933] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Barbara Galuppi
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Robert J Palisano
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Sarah Westcott McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Abstract
PURPOSE We describe primary and secondary impairments in young children with cerebral palsy (CP); report differences in impairments on the basis of Gross Motor Function Classification System (GMFCS), age, and sex; and examine the extent that individual impairments account for the construct of primary and secondary impairments. METHODS Participants included 429 children with CP (242 [56%] male; 1½ to 5 years) representing all GMFCS levels. Reliable assessors collected primary and secondary impairment data using clinical measures. Analyses included descriptive statistics, comparisons among GMFCS, age, and sex, and factor analysis. RESULTS Young children with CP present with primary and secondary impairments. Significant differences in impairments occur among some GMFCS levels and age groups but not sex groups. Postural stability contributed most to primary impairments and strength to secondary impairments. CONCLUSION Young children with CP across GMFCS levels may have already developed secondary impairments that should be addressed within therapy services.
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Giannasi LC, Matsui MY, Freitas SRB, Caldas BF, Grossmann E, Amorim JBO, dos Santos IDR, Oliveira LVF, Oliveira CS, Gomes MF. Effects of Neuromuscular Electrical Stimulation on the Masticatory Muscles and Physiologic Sleep Variables in Adults with Cerebral Palsy: A Novel Therapeutic Approach. PLoS One 2015; 10:e0128959. [PMID: 26247208 PMCID: PMC4527754 DOI: 10.1371/journal.pone.0128959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 03/31/2015] [Indexed: 12/02/2022] Open
Abstract
Cerebral palsy (CP) is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair orapharygeal muscle tone, leading to a compromised chewing function and to sleep disorders (such as obstructive sleep apnea). Thirteen adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES) therapy. The effects on the masticatory muscles and sleep variables were evaluated using electromyography (EMG) and polysomnography (PSG), respectively, prior and after 2 months of NMES. EMG consisted of 3 tests in different positions: rest, mouth opening and maximum clenching effort (MCE). EMG values in the rest position were 100% higher than values recorded prior to therapy for all muscles analyzed (p < 0.05); mean mouth opening increased from 38.0 ± 8.0 to 44.0 ± 10.0 cm (p = 0.03). A significant difference in MCE was found only for the right masseter. PSG revealed an improved in the AHI from 7.2±7.0/h to 2.3±1.5/h (p < 0.05); total sleep time improved from 185 min to 250 min (p = 0.04) and minimun SaO2 improved from 83.6 ± 3.0 to 86.4 ± 4.0 (p = 0.04). NMES performed over a two-month period led to improvements in the electrical activity of the masticatory muscles at rest, mouth opening, isometric contraction and sleep variables, including the elimination of obstructive sleep apnea events in patients with CP.
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Affiliation(s)
- Lilian Chrystiane Giannasi
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
- Rehabilitation Sciences Master and PhD Program, Nove de Julho University-UNINOVE, São Paulo, Brazil
- * E-mail:
| | - Miriam Yumi Matsui
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
| | | | - Bruna F. Caldas
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
| | - Eduardo Grossmann
- Anatomy Laboratory, Federal University of Rio Grande do Sul- UFRGS, Porto Alegre, RS, Brazil
| | - José Benedito O. Amorim
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
| | | | | | - Claudia Santos Oliveira
- Rehabilitation Sciences Master and PhD Program, Nove de Julho University-UNINOVE, São Paulo, Brazil
| | - Monica Fernandes Gomes
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
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Curtis DJ, Butler P, Saavedra S, Bencke J, Kallemose T, Sonne-Holm S, Woollacott M. The central role of trunk control in the gross motor function of children with cerebral palsy: a retrospective cross-sectional study. Dev Med Child Neurol 2015; 57:351-7. [PMID: 25412902 DOI: 10.1111/dmcn.12641] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 01/21/2023]
Abstract
AIM Improvement of gross motor function and mobility are primary goals of physical therapy in children with cerebral palsy (CP). The purpose of this study was to investigate the relationship between segmental control of the trunk and the corresponding gross motor function in children with CP. METHOD This retrospective cross-sectional study was based on 92 consecutive referrals of children with CP in Gross Motor Function Classification System (GMFCS) levels I to V, 39 females, 53 males (median age 4y [range 1-14y]), and 77, 12, and 3 with spastic, dyskinetic, and ataxic CP respectively. The participants were tested using the Gross Motor Function Measure (GMFM), the Pediatric Evaluation of Disability Inventory (PEDI), and the Segmental Assessment of Trunk Control (SATCo). RESULTS Linear regression analysis showed a positive relationship between the segmental level of trunk control and age, with both gross motor function and mobility. Segmental trunk control measured using the SATCo could explain between 38% and 40% of variation in GMFM and between 32% and 37% of variation in PEDI. INTERPRETATION This study suggests a strong association between segmental trunk postural control and gross motor function and mobility with significant clinical implications for the treatment of children with CP.
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Affiliation(s)
- Derek John Curtis
- Department of Physical and Occupational Therapy, Hvidovre University Hospital, Copenhagen, Denmark; Gait Analysis Laboratory, Department of Orthopedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark; Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Forsyth R, Basu A. The promotion of recovery through rehabilitation after acquired brain injury in children. Dev Med Child Neurol 2015; 57:16-22. [PMID: 25200439 DOI: 10.1111/dmcn.12575] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 12/12/2022]
Abstract
A degree of motor recovery is typically seen after acquired brain injury in children. The extent to which rehabilitation efforts can claim credit for this is disputed. Strong correlations between late impairment outcomes and early severity and impairment indices are seen both in adults and children. These correlations have been interpreted by some as evidence that recovery is largely intrinsic and that any additional rehabilitation effects are small. Such views are belied by published animal studies demonstrating the possibility of large rehabilitation effects. Animal models suggest that to achieve similar rehabilitation treatment effect sizes in clinical practice, rehabilitation 'doses' should be greater, rehabilitation efforts should start sooner, and premature accommodation of impairment should be avoided.
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Affiliation(s)
- Rob Forsyth
- Institute of Neuroscience, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, Newcastle, UK
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Lobo MA, Kokkoni E, Cunha AB, Galloway JC. Infants born preterm demonstrate impaired object exploration behaviors throughout infancy and toddlerhood. Phys Ther 2015; 95:51-64. [PMID: 25169919 PMCID: PMC4295084 DOI: 10.2522/ptj.20130584] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 08/24/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Object exploration behaviors form the foundation for future global development, but little is known about how these behaviors are exhibited by infants born preterm. OBJECTIVE The study objective was to longitudinally compare a comprehensive set of object exploration behaviors in infants born preterm and infants born full-term from infancy into toddlerhood. DESIGN Twenty-two infants born full-term and 28 infants born preterm were monitored as they interacted with objects throughout their first 2 years. METHODS Infants were provided up to 30 seconds to interact with each of 7 objects across 9 visits. Experimenters coded videos of infants' behaviors. Growth modeling and t tests were used to compare how much infants exhibited behaviors and how well they matched their behaviors to the properties of objects. RESULTS Infants born preterm explored objects less in the first 6 months, exhibited less visual-haptic multimodal exploration, displayed reduced variability of exploratory behavior in a manner that reflected severity of risk, and were less able to match their behaviors to the properties of objects in a manner that reflected severity of risk. Infants born preterm with significant brain injury also had impaired bimanual abilities. LIMITATIONS There was a limited sample of infants born preterm with significant brain injury. CONCLUSIONS Infants born preterm have impaired abilities to interact with objects even in the first months of life. This impairment likely limits the knowledge they acquire about objects and about how they can act on them; this limited knowledge may, in turn, impair their early learning abilities. These results highlight the need for assessment and intervention tools specific for object exploration in young infants.
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Affiliation(s)
- Michele A Lobo
- M.A. Lobo, PT, PhD, Department of Physical Therapy, University of Delaware, 210K STAR, 540 South College Ave, Newark, DE 19713 (USA).
| | - Elena Kokkoni
- E. Kokkoni, MSc, Department of Physical Therapy, University of Delaware
| | - Andrea Baraldi Cunha
- A.B. Cunha, PT, PhD, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - James Cole Galloway
- J.C. Galloway, PT, PhD, Department of Physical Therapy, University of Delaware
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Bartlett DJ, Chiarello LA, McCoy SW, Palisano RJ, Jeffries L, Fiss AL, Wilk P. Determinants of self-care participation of young children with cerebral palsy. Dev Neurorehabil 2014; 17:403-13. [PMID: 24725221 DOI: 10.3109/17518423.2014.897398] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To test a model of child, family and service determinants of self-care participation of children with cerebral palsy (CP), grouped by Gross Motor Function Classification System levels (I-II and III-V). METHODS Participants were a convenience sample of 429 children (242 males) with CP, aged 18-60 months. Data on impairments and gross motor function were collected by reliable therapists; parents provided information about children's health conditions and adaptive behaviour. Seven months later parents reported on family life and services received. One year after study onset, parents documented children's self-care participation. Data from two groups of children were analysed using structural equation modelling. RESULTS The model explained a significant proportion of the variance of self-care participation, with higher motor function, fewer health conditions and higher levels of adaptive behaviour being associated with greater self-care participation. CONCLUSION Supporting children's gross motor function, health and adaptive behaviour may optimize self-care participation.
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Affiliation(s)
- Doreen J Bartlett
- School of Physical Therapy, Western University , London, ON , Canada
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Kruijsen-Terpstra AJA, Ketelaar M, Verschuren O, Smits DW, Jongmans MJ, Gorter JW. Determinants of Developmental Gain in Daily Activities in Young Children with Cerebral Palsy. Phys Occup Ther Pediatr 2014; 35:265-279. [PMID: 25232647 DOI: 10.3109/01942638.2014.957429] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT The aim of this study was to examine which child and family characteristics at the child's age of 2 years are determinants of development of self-care and mobility activities over a period of 2 years in young children with cerebral palsy (CP). Longitudinal data of 92 children, representing all levels of the Gross Motor Function Classification System (GMFCS), were analyzed. Children's self-care and mobility activities were assessed with the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory. Development of self-care and mobility activities was related to several child determinants but no family determinants. GMFCS, type of CP, intellectual capacity, and epilepsy were related to the development of self-care and mobility activities, while manual ability and spasticity were related to development of mobility activities. Multivariate analysis indicated that GMFCS and intellectual capacity were the strongest determinants of development of self-care activities, and GMFCS was the strongest determinant of development of mobility activities. The change in self-care and mobility activities was less favorable in severely affected children with severe disability. Knowledge of GMFCS level and intellectual capacity is important in anticipating change over time and goal setting in young children with CP.
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Affiliation(s)
- Anne J A Kruijsen-Terpstra
- 1Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Affiliation(s)
- Eva Beckung
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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