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Gözaçan Karabulut D, Maden Ç, Karabulut Y, Aslan M. Effects of Video-Based Exercises and Conventional Physiotherapy on Upper Extremity Functionality, Selective Motor Control, and Proprioception in Unilateral Cerebral Palsy: A Randomized Controlled Trial. Games Health J 2024; 13:305-312. [PMID: 39069879 DOI: 10.1089/g4h.2024.0044] [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] [Indexed: 07/30/2024] Open
Abstract
Objective: The present study was conducted to evaluate the effects of video-based exercises added to conventional physiotherapy (CPT) on upper extremity functionality, selective motor control, and proprioception in individuals with unilateral cerebral palsy (UCP). Materials and Methods: Thirty patients with UCP were randomized into two groups: the intervention group (15 individuals with a mean age of 9.2 ± 3.8 years) and the control group (15 individuals with a mean age of 8.3 ± 4.1 years). The intervention group received 8 weeks of video-based exercises, and the control group received 8 weeks of conventional physiotherapy. Upper extremity functional abilities, upper extremity selective motor control, proprioception, and entertainment levels were evaluated before and after the intervention for all groups. Results: While a significant change was observed in the mean scores of the ABILHAND-Kids, Selective Control of the Upper Extremity Scale right-left scores, shoulder flexion, shoulder abduction, and elbow flexion proprioception angles after the video-based exercises in the intervention group (P < 0.05), a significant change was observed only in the 60-degree flexion angle in the control group (P = 0.001). In the comparison between the groups, there were significant differences in post-intervention value only in shoulder flexion and abduction angles, whereas there was no difference between the groups in elbow flexion angles (P > 0.05). Conclusion: Incorporating video-based exercises into the upper extremity rehabilitation processes of individuals with UCP is beneficial in terms of upper extremity functionality, selective motor control, and proprioception.
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Affiliation(s)
- Demet Gözaçan Karabulut
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gaziantep Islam Science and Technology University, Gaziantep, Turkey
| | - Çağtay Maden
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gaziantep Islam Science and Technology University, Gaziantep, Turkey
| | - Yalçın Karabulut
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Mehmet Aslan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
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Taş SA, Çankaya T. Effects of structured training on spinal posture and selective motor control in children with unilateral spastic cerebral palsy. Gait Posture 2024; 109:22-27. [PMID: 38244393 DOI: 10.1016/j.gaitpost.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/09/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Children with Unilateral Spastic Cerebral Palsy (USCP) have an asymmetrical postural pattern. Although functional limitations are less, deteriorations in spinal posture are observed. RESEARCH QUESTION What is the effect of structured training on spinal posture and selective motor control of upper extremity? METHODS Forty five children with USCP were included in the study. Participants were children ages 3-18 with GMFCS levels 1 and 2. Spinal posture and mobility was assessed by Spinal Mouse (SM) and the Spinal Alignment and Range of Motion Measure (SAROMM), and selective motor control of upper extremity was evaluated by the Selective Control of the Upper Extremity Scale (SCUES). Children were divided into two groups: structured training group (STG) (n = 22) and conventional physiotherapy group (CPG) (n = 23). Groups received treatment sessions lasting 45 min, 2 days a week for 8 weeks. Evaluations were made baseline and after treatment. RESULTS In sagittal plane, there was a significant decrease in the degree of thoracic kyphosis after treatment in the STG (p = 0.004). A significant difference was found in total spine angulation (p = 0.015) and mobility from flexion to extension in the STG group. There was a difference in total spine angulation (p = 0.014) in the CPG group, but no difference in spinal mobility. Post-training differences were found in thoracic angulation (p = 0.006) and lateral flexion mobility to the affected side in the STG in thoracic (p = 0.020), lumbar (p = 0.035) and total spine (p = 0.008) in the frontal plane. When SCUES-shoulder, elbow, wrist, total scores changes was significant in CPG (p < 0.001), SCUES-forearm (p = 0.002) and fingers (p = 0.007) changes was significant in STG. SIGNIFICANCE This study showed that although children with USCP are more mildly affected, there are adverse effects on their selective motor control and spinal posture. This study reveals the contribution of structured training in terms of selective movement, spinal smoothness and mobility in children.
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Affiliation(s)
- Seda Ayaz Taş
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Bolu, Turkey
| | - Tamer Çankaya
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Bolu, Turkey
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Boz Sönmez D, Giray E, Atıcı A, Illeez ÖG, Akpınar P, Ünlü Özkan F, Aktaş I. Validity and reliability of selective control of upper extremity scale (SCUES) in patients with chronic stroke. Disabil Rehabil 2023:1-13. [PMID: 38140918 DOI: 10.1080/09638288.2023.2291551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE The aim of this study is to investigate the validity and reliability of the Selective Control of Upper Extremity Scale (SCUES) in patients with stroke. MATERIALS AND METHODS Forty-two patients with stroke aged 18-75 years, were included in the study. Patients were video-recorded while SCUES was administered. The videos were scored to determine the intrarater and inter-rater reliability. Fugl Meyer Assessment of Upper Extremity (FMA-UE), Box and Block test (BBT) and Brunnstrom Stages of Motor Recovery were measured to evaluate validity of SCUES. Spearman correlation analysis was used to assess the validity of SCUES. Intraclass correlation coefficient (ICC), Kappa (κ) and weighted Kappa (κw) were calculated to determine intrarater and inter-rater reliability. RESULTS There were significant positive high correlations between SCUES and FMA-UE and BBT and Brunnstrom upper extremity proximal and distal values (rho = 0.944, p = 0.01; rho = 0,875, p = 0.01; rho = 0.84, p = 0.01, rho = 0.82, p = 0.01; respectively) showing validity of SCUES. The ICC value of inter-rater reliability of SCUES was 0,99 (%95 CI: 0,989-0,997, p = 0,001) showing excellent reliability. κ and κ w values for inter-rater and intrarater reliability of individual SCUES items were above 0.7 indicating excellent reliability. ICC of SCUES and FMA-UE indicated excellent intrarater reliability (ICC = 0,99; %95 CI: 0,989-0,997, p = 0,001; ICC = 0.943; %95 CI: 0.9-0.97, p = 0,0001, consecutively). CONCLUSIONS SCUES showed similar validity and reliability with FMA-UE and SCUES can be used in the evaluation of upper extremity selective motor control in patients with stroke.
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Affiliation(s)
- Didem Boz Sönmez
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
| | - Arzu Atıcı
- Physical Medicine and Rehabilitation Clinic, University of Health Sciences Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Türkiye
| | - Özge Gülsüm Illeez
- Physical Medicine and Rehabilitation Clinic, University of Health Sciences Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Türkiye
| | - Pınar Akpınar
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
| | - Feyza Ünlü Özkan
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
| | - Ilknur Aktaş
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
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Tunçdemir M, Üneş S, Karakaya J, Kerem Günel M. Reliability and validity of the Turkish version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy. Disabil Rehabil 2023; 45:106-110. [PMID: 34994671 DOI: 10.1080/09638288.2021.2022783] [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: 12/31/2022]
Abstract
PURPOSE This study aims to translate the Selective Control Assessment of the Lower Extremity (SCALE) into Turkish language, assess its reliability and validity in children with spastic cerebral palsy. MATERIALS AND METHODS Fifty-two children with CP (mean age 9 years 8 months, range 4-18 years) included in this cross-sectional study. Intra- and interrater reliability was assessed by intraclass correlation coefficient (ICC). The SCALE was correlated with the Gross Motor Function Classification System (GMFCS), the Physician's Rating Scale (PRS), and Gross Motor Function Measurement (GMFM) to assess validity. RESULTS Intra- and interrater reliability of the SCALE were excellent (ICC > 0.75). SCALE and GMFCS (r = -0.786, p < 0.001), SCALE and PRS (r = 0.761, p < 0.001), SCALE and GMFM (r = 0.863, p < 0.001) were highly correlated. SCALE scores differed significantly between GMFCS levels and between types of spastic CP. CONCLUSIONS The Turkish version of the SCALE appears to be a valid and reliable tool to assess selective voluntary motor control of the lower limbs in children with spastic CP.IMPLICATIONS FOR REHABILITATIONThe Turkish version of the Selective Control Assessment of the Lower Extremity is a valid and reliable assessment for children with spastic CP.The SCALE scores differed significantly between Gross Motor Function Classification System levels I versus II and levels II versus III as well as between types of spastic CP.The current study suggests that the SCALE is a quick and easy outcome measure to assess selective motor control in patients with spastic CP.
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Affiliation(s)
- Merve Tunçdemir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Sefa Üneş
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem Günel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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He W, Huang Y, He L, Liu L, Zeng P, Qiu H, Wang X, Zhou H, Chen Z, Xu Y, Zhao J, Wang W, Tang H, Xu K. Safety and effects of transcranial direct current stimulation on hand function in preschool children with hemiplegic cerebral palsy: A pilot study. Front Behav Neurosci 2022; 16:925122. [PMID: 36160682 PMCID: PMC9500382 DOI: 10.3389/fnbeh.2022.925122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has shown a promising prospect in improving function and spasticity in school-aged children with cerebral palsy, but little is known in preschool children. The aim of this study was to explore the safety and effects of tDCS on hand function in preschool children (aged 3–6 years) with hemiplegic cerebral palsy (HCP). We designed a crossover, single-blind, sham-controlled study in 30 preschool children with HCP, who were recruited to receive one session of sham and one session of active anodal tDCS (1.5 mA, 20 min) on the primary motor cortex of the affected hemisphere, with a 24-h interval between the two sessions. Questionnaire was completed by each participant and their attendants immediately, 90 min, and 24 h after each session to monitor common adverse events of tDCS, such as skin irritation, skin erythema, burning sensation, headache, dizziness, etc. Box and Block Test, Selective Control of the Upper Extremity Scale, Modified Ashworth Scale, and Melbourne Assessment 2 were conducted at baseline, immediately, and 90 min after each session. No severe adverse event occurred during the study and only a few of them felt transient and slight discomfort. Results also showed that all participants performed better at Box and Block Test of the hemiplegic hand immediately after a single anodal tDCS (P < 0.05) and this improvement lasted at least 90 min and more than 24 h. However, there was no significant improvement in Selective Control of the Upper Extremity Scale of both hands, Box and Block Test of the non-hemiplegic hand, Modified Ashworth Scale, and Melbourne Assessment 2 of the hemiplegic upper limb (P > 0.05). Shortly, this study supported the safety and effects of a single anodal tDCS on improving the manual dexterity of the hemiplegic hand for preschool children with HCP. Further researches with larger samples about the optimal dose and treatment cycle of tDCS for preschool children with HCP are warranted. This study gained the approval of ethics committee of the organization and was registered at chictr.org (ChiCTR2000031141).
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Affiliation(s)
- Wenjie He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuan Huang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Lu He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liru Liu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Peishan Zeng
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Qiu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoyue Wang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongyu Zhou
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhaofang Chen
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yi Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jingyi Zhao
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenda Wang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongmei Tang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Hongmei Tang
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Kaishou Xu
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Wu Q, Peng T, Liu L, Zeng P, Xu Y, Yang X, Zhao Y, Fu C, Huang S, Huang Y, Zhou H, Liu Y, Tang H, He L, Xu K. The Effect of Constraint-Induced Movement Therapy Combined With Repetitive Transcranial Magnetic Stimulation on Hand Function in Preschool Children With Unilateral Cerebral Palsy: A Randomized Controlled Preliminary Study. Front Behav Neurosci 2022; 16:876567. [PMID: 35449560 PMCID: PMC9017424 DOI: 10.3389/fnbeh.2022.876567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Constraint-induced movement therapy (CIMT) combined with repetitive transcranial magnetic stimulation (rTMS) have shown great potential in improving function in schoolchildren with unilateral cerebral palsy attributed to perinatal stroke. However, the prospect of application in preschool children with unilateral cerebral palsy (UCP) attributed to various brain disorders remains unclear. In this prospective, assessor-blinded, randomized controlled study, 40 preschool children with UCP (aged 2.5–6 years) were randomized to receive 10 days of CIMT combined with active or sham rTMS. Assessments were performed at baseline, 2 weeks, and 6 months post-intervention to investigate upper limb extremity, social life ability, and perceived changes by parents and motor-evoked potentials. Overall, 35 participants completed the trial. The CIMT plus active stimulation group had greater gains in the affected hand function (range of motion, accuracy, and fluency) than the CIMT plus sham stimulation group (P < 0.05), but there was no significant difference in muscular tone, social life ability, and perceived changes by parents between the two groups (P > 0.05). In addition, there was no significant difference in hand function between children with and without motor-evoked potential (P > 0.05). No participants reported severe adverse events during the study session. In short, the treatment of CIMT combined with rTMS is safe and feasible for preschool children with UCP attributed to various brain disorders. Randomized controlled studies with large samples and long-term effects are warranted.
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Affiliation(s)
- Qianwen Wu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tingting Peng
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liru Liu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Peishan Zeng
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yunxian Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xubo Yang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yiting Zhao
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chaoqiong Fu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shiya Huang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuan Huang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Hongyu Zhou
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yun Liu
- Department of Rehabilitation, Kunming Children's Hospital, Kunming, China
| | - Hongmei Tang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lu He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Lu He
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Kaishou Xu ; orcid.org/0000-0002-0639-3488
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Assessment of Manual Abilities Using the Box and Block Test in Children with Bilateral Cerebral Palsy. Occup Ther Int 2022; 2022:9980523. [PMID: 35281716 PMCID: PMC8888044 DOI: 10.1155/2022/9980523] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 11/27/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to determine the correlation between manual dexterity evaluated with the Box and Block Test (BBT) and the performance of daily activities in children with bilateral cerebral palsy (CP). Methods The BBT was applied to 162 children with cerebral palsy of bilateral distribution aged 6 to 13 years. The level of performance was evaluated according to the Manual Ability Classification System (MACS), Gross Motor Function Classification System (GMFCS), and Pediatric Evaluation of Disability Inventory (PEDI) in the domains of self-care, mobility, and social function. Correlations between the findings of the BBT and the PEDI were determined, and additionally, some specific toileting tasks of the PEDI were evaluated. Results The results of the BBT were lower in the lowest functional levels of the MACS (p ≤ 0.001). The BBT showed a strong correlation with the domains' self-care (r = 0.8), mobility (r = 0.7), and social function (r = 0.6) of the PEDI. The BBT was different between children who were able and children who were not able to perform the toileting tasks that were evaluated. A lower capacity in the BBT obtained in children with functional status GMFCS III, IV, and V was associated with poor performance in toileting tasks evaluated in the PEDI. Conclusion The results of the BBT are correlated with the activities of daily living of children with bilateral CP. The data obtained from this test is used to predict the performance of daily activities of these patients in settings such as school and home and helps to identify contextual factors that influence the level of independence in children with bilateral CP.
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Lieber J, Dittli J, Lambercy O, Gassert R, Meyer-Heim A, van Hedel HJA. Clinical utility of a pediatric hand exoskeleton: identifying users, practicability, and acceptance, and recommendations for design improvement. J Neuroeng Rehabil 2022; 19:17. [PMID: 35148786 PMCID: PMC8832660 DOI: 10.1186/s12984-022-00994-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children and adolescents with upper limb impairments can experience limited bimanual performance reducing daily-life independence. We have developed a fully wearable pediatric hand exoskeleton (PEXO) to train or compensate for impaired hand function. In this study, we investigated its appropriateness, practicability, and acceptability. METHODS Children and adolescents aged 6-18 years with functional limitations in at least one hand due to a neurological cause were selected for this cross-sectional evaluation. We characterized participants by various clinical tests and quantified bimanual performance with the Assisting Hand Assessment (AHA). We identified children whose AHA scaled score increased by ≥ 7 points when using the hand exoskeleton and determined clinical predictors to investigate appropriateness. The time needed to don each component and the number of technical issues were recorded to evaluate practicability. For acceptability, the experiences of the patients and the therapist with PEXO were evaluated. We further noted any adverse events. RESULTS Eleven children (median age 11.4 years) agreed to participate, but data was available for nine participants. The median AHA scaled score was higher with PEXO (68; IQR: 59.5-83) than without (55; IQR: 37.5-80.5; p = 0.035). The Box and Block test, the Selective Control of the Upper Extremity Scale, and finger extensor muscle strength could differentiate well between those participants who improved in AHA scaled scores by ≥ 7 points and those who did not (sensitivity and specificity varied between 0.75 and 1.00). The median times needed to don the back module, the glove, and the hand module were 62, 150, and 160 s, respectively, but all participants needed assistance. The most critical failures were the robustness of the transmission system, the electronics, and the attachment system. Acceptance was generally high, particularly in participants who improved bimanual performance with PEXO. Five participants experienced some pressure points. No adverse events occurred. CONCLUSIONS PEXO is a safe exoskeleton that can improve bimanual hand performance in young patients with minimal hand function. PEXO receives high acceptance. We formulated recommendations to improve technical issues and the donning before such exoskeletons can be used under daily-life conditions for therapy or as an assistive device. Trial registration Not appropriate.
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Affiliation(s)
- Jan Lieber
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Jan Dittli
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008, Zurich, Switzerland
| | - Andreas Meyer-Heim
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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Tunçdemir M, Karakaya J, Kerem-Günel M. Reliability and Validity of the Turkish Version of the Selective Control of the Upper Extremity Scale in Children with Cerebral Palsy. Phys Occup Ther Pediatr 2022; 42:99-112. [PMID: 34030602 DOI: 10.1080/01942638.2021.1928809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To investigate the psychometric properties of the Selective Control of the Upper Extremity Scale (SCUES). METHODS Fifty-two children (27 females and 25 males; mean age 9.8 ± 4.4 years) with spastic type of cerebral palsy (CP) participated in the study. Psychometric analyses included reliability, concurrent validity, construct validity, and discriminant validity. Upper Limb Physician's Rating Scale (ULPRS), Modified Ashworth Scale (MAS), Quality of Upper Extremity Skills Test (QUEST) were used for concurrent validity. Manual Ability Classification System (MACS) was used for construct validity. Differences in SCUES scores were determined between participants categorized according to their limb distribution and MACS levels. RESULTS Intra-rater reliability (intraclass correlation coefficient [ICC] = 0.98) of the SCUES was excellent. SCUES and ULPRS (r = 0.87, p < 0.001), SCUES and MAS (r=-0.93, p < 0.001), SCUES and QUEST (r=0.81, p < 0.001) were highly correlated. SCUES and MACS (r=-0.67, p < 0.001) was moderately correlated. SCUES scores differed significantly between children classifed as MACS levels I versus II and III and between children with hemiparetic and diparetic CP. CONCLUSION The SCUES appears to be a valid and reliable tool to assess selective voluntary motor control of the upper extremities in children with spastic CP, which may be useful in selecting and planning interventions.
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Affiliation(s)
- Merve Tunçdemir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem-Günel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Fahr A, Kläy A, Coka LS, van Hedel HJA. Game-based training of selective voluntary motor control in children and youth with upper motor neuron lesions: protocol for a multiple baseline design study. BMC Pediatr 2021; 21:505. [PMID: 34763681 PMCID: PMC8582135 DOI: 10.1186/s12887-021-02983-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Impairments of selective control of joint movements can have consequences for many activities of daily life, but there are only a few interventions to improve selective voluntary motor control (SVMC). We have developed a treatment option to specifically enhance SVMC exploiting the advantages of interactive computer play technology. It targets SVMC by training selective activation of a muscle or a selective joint movement while it provides immediate feedback about involuntary muscle activations/movements at an (unwanted) joint. This study aims to investigate the effectiveness of this game-based intervention to enhance SVMC in children and youth with upper motor neuron lesions. Methods We will conduct a randomized, non-concurrent, multiple baseline design study. Patients aged between 6 and 20 years with reduced SVMC due to an upper motor neuron lesion will be included. During the baseline phase of random length, participants will attend their regular intensive rehabilitation program, and in the intervention phase, they will additionally complete 10 therapy sessions (à 40 min) of the game-based SVMC training. The primary outcome will be a short SVMC assessment conducted repeatedly throughout both phases, which quantifies movement accuracy and involuntary movements. Changes in clinical SVMC measures, muscle strength, cortical excitability, motor control of the inhibited/unwanted movement, and functional independence will be assessed as secondary outcomes. We will use a mixed-effect model to determine the change in the course of the primary outcome when the intervention is introduced, and we will compare changes between phases for secondary outcomes with paired tests. Discussion This study will provide first evidence whether SVMC can be improved with our game-based training. The single-case design takes into account the individualization required for this intervention, and it can help to address the challenges of intervention trials in our setting. Trial registration German Clinical Trials Register: DRKS00025184, registered on 28.04.2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02983-8.
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Affiliation(s)
- Annina Fahr
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zürich, Switzerland. .,Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
| | - Andrina Kläy
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zürich, Switzerland
| | - Larissa S Coka
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zürich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zürich, Switzerland
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11
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Keller JW, Fahr A, Lieber J, Balzer J, van Hedel HJA. Impact of Upper Extremity Impairment and Trunk Control on Self-Care Independence in Children With Upper Motor Neuron Lesions. Phys Ther 2021; 101:pzab112. [PMID: 34464449 PMCID: PMC8407597 DOI: 10.1093/ptj/pzab112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/19/2021] [Accepted: 03/15/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the relative importance of different approaches to measure upper extremity selective voluntary motor control (SVMC), spasticity, strength, and trunk control for explaining self-care independence in children affected by upper motor neuron lesions. METHODS Thirty-one patients (mean [SD] age = 12.5 [3.2] years) with mild to moderate arm function impairments participated in this observational study. Self-care independence was evaluated with the Functional Independence Measure for children (WeeFIM). Upper extremity SVMC was quantified with the Selective Control of the Upper Extremity Scale (SCUES), a similarity index (SISCUES) calculated from simultaneously recorded surface electromyography muscle activity patterns, and an accuracy and involuntary movement score derived from an inertial-measurement-unit-based assessgame. The Trunk Control Measurement Scale was applied and upper extremity spasticity (Modified Ashworth Scale) and strength (dynamometry) were assessed. To determine the relative importance of these factors for self-care independence, 3 regression models were created: 1 included only upper extremity SVMC measures, 1 included upper extremity and trunk SVMC measures (overall SVMC model), and 1 included all measures (final self-care model). RESULTS In the upper extremity SVMC model (total variance explained 52.5%), the assessgame (30.7%) and SCUES (16.5%) were more important than the SISCUES (4.5%). In the overall SVMC model (75.0%), trunk SVMC (39.0%) was followed by the assessgame (21.1%), SCUES (11.0%), and SISCUES (4.5%). In the final self-care model (82.1%), trunk control explained 43.2%, upper extremity SVMC explained 23.1%, spasticity explained 12.3%, and strength explained 2.3%. CONCLUSION Although upper extremity SVMC explains a substantial portion of self-care independence, overall trunk control was even more important. Whether training trunk control and SVMC can translate to improved self-care independence should be the subject of future research. IMPACT This study highlights the importance of trunk control and selective voluntary motor control for self-care independence in children with upper motor neuron lesions.
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Affiliation(s)
- Jeffrey W Keller
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Annina Fahr
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Jan Lieber
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Julia Balzer
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- European University of Applied Sciences (EU | FH)/Erft GmbH, Applied Health Science, Rostock, Germany
| | - Hubertus J A van Hedel
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
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12
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Fahr A, Kläy A, Keller JW, van Hedel HJA. An Interactive Computer Game for Improving Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Development and Preliminary Feasibility Study. JMIR Serious Games 2021; 9:e26028. [PMID: 34319236 PMCID: PMC8367178 DOI: 10.2196/26028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/30/2021] [Accepted: 05/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Computer game–based interventions are emerging in pediatric neurorehabilitation, as they can provide two key elements for motor learning—motivating environments that enable long-term compliance, which is particularly relevant for children, and augmented feedback for improving movement performance. Objective The overall aim of this study is to develop an interactive computer play for children with upper motor neuron lesions to train selective voluntary motor control and give particular attention to motivation and feedback. We also aim to determine features that make games engaging, investigate which sensory feedback modality is noticed the fastest during play, develop an interactive game, and evaluate its feasibility. Methods We identified engaging game features by interviewing 19 children and adolescents undergoing rehabilitation. By using a test version of the game, we determined the response times of 10 patients who had to react to visual, auditory, or combined feedback signals. On the basis of the results of these two subprojects, we developed and designed a game environment. Feasibility was studied in terms of the practicability and acceptability of the intervention among 5 children with upper motor neuron lesions. Results The game features deemed the most important by pediatric patients were strategic gameplay (13/29, 45% of answers) and choice (6/29, 21%). While playing the game, an acoustic alarm signal (reaction time: median 2.8 seconds) was detected significantly faster (P=.01) than conditions with other feedback modalities (avatar velocity reduction: median 7.8 seconds; color desaturation: median 5.7 seconds). Most children enjoyed playing the game, despite some technical issues. Conclusions The careful identification of game features that increase motivation and feedback modalities that inform children quickly led to the development of an interactive computer play for training selective voluntary motor control in children and adolescents with upper motor neuron lesions.
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Affiliation(s)
- Annina Fahr
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern a.A., Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andrina Kläy
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern a.A., Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jeffrey W Keller
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern a.A., Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern a.A., Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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13
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Keller JW, Fahr A, Balzer J, Lieber J, van Hedel HJA. Validity and reliability of an electromyography-based upper limb assessment quantifying selective voluntary motor control in children with upper motor neuron lesions. Sci Prog 2021; 104:368504211008058. [PMID: 33871293 PMCID: PMC10454990 DOI: 10.1177/00368504211008058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Current clinical assessments evaluating selective voluntary motor control are measured on an ordinal scale. We combined the Selective Control of the Upper Extremity Scale (SCUES) with surface electromyography to develop a more objective and interval-scaled assessment of selective voluntary motor control. The resulting Similarity Index (SI) quantifies the similarity of muscle activation patterns. We aimed to evaluate the validity and reliability of this new assessment named SISCUES (Similarity Index of the SCUES) in children with upper motor neuron lesions. Thirty-three patients (12.2 years [8.8;14.9]) affected by upper motor neuron lesions with mild to moderate impairments and 31 typically developing children (11.6 years [8.5;13.9]) participated. We calculated reference muscle activation patterns for the SISCUES using data of 33 neurologically healthy adults (median [1st; 3rd quantile]: 32.5 [27.9; 38.3]). We calculated Spearman correlations (ρ) between the SISCUES and the SCUES and the Manual Ability Classification System (MACS) to establish concurrent validity. Discriminative validity was tested by comparing scores of patients and healthy peers with a robust ANCOVA. Intraclass correlation coefficients2,1 and minimal detectable changes indicated relative and absolute reliability. The SISCUES correlates strongly with SCUES (ρ = 0.76, p < 0.001) and moderately with the MACS (ρ = -0.58, p < 0.001). The average SISCUES can discriminate between patients and peers. The intraclass correlation coefficient2,1 was 0.90 and the minimal detectable change was 0.07 (8% of patients' median score). Concurrent validity, discriminative validity, and reliability of the SISCUES were established. Further studies are needed to evaluate whether it is responsive enough to detect changes from therapeutic interventions.
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Affiliation(s)
- Jeffrey W Keller
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Annina Fahr
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Julia Balzer
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland
| | - Jan Lieber
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Hubertus JA van Hedel
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
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14
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Fahr A, Keller JW, Balzer J, Lieber J, van Hedel HJA. Quantifying age-related differences in selective voluntary motor control in children and adolescents with three assessments. Hum Mov Sci 2021; 77:102790. [PMID: 33798928 DOI: 10.1016/j.humov.2021.102790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurophysiological development of selective voluntary motor control (SVMC) is assumed but has not been quantified objectively. We assessed SVMC with (i) clinical assessments, (ii) a combination of these assessments with surface electromyography (sEMG) and, (iii) a playful computer game. The aim of this study was to describe and compare age-related differences in SVMC, quantified with these tools, in neurologically intact children, adolescents, and adults. METHODS We measured upper and lower extremity SVMC with three assessments in 31 children and adolescents. A sample of 33 and 31 adults provided reference values for the upper and lower extremity assessments, respectively. The Selective Control of the Upper Extremity Scale (SCUES) or the Selective Control Assessment of the Lower Extremity (SCALE) were combined with simultaneous sEMG recordings. We quantified SVMC by a similarity index that compared an individual's muscle activation pattern with those of an adult reference group. The SVMC Assessgame required isolated joint movements to steer an avatar and quantified the accuracy of the selective movement and the extent of involuntary movements occurring in not involved joints. RESULTS Results from the conventional clinical assessments correlated low to moderately with age (SCUES: r = 0.55, p = 0.013; SCALE: r = 0.44, p = 0.001), while the correlation between the sEMG based similarity index and age was negligible (r ≤ 0.25). The outcomes of the Assessgame correlated highly with age (r ≥ 0.80, p ≤ 0.001). Older children and adolescents performed movements more accurately and with fewer involuntary movements compared to younger participants. CONCLUSIONS The tools assess and quantify SVMC differently, affecting the way they capture age-related differences in SVMC. Some assessments require reference values from neurologically intact children and adolescents to correctly classify impairments of SVMC in patients with neuromotor disorders.
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Affiliation(s)
- Annina Fahr
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910 Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland; ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland.
| | - Jeffrey W Keller
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910 Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland; Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, University of Zurich Dean's Office Office of the Board of Directors of the Academic Medicine Zurich (UMZH), Pestalozzistrasse 3/5, 8091 Zurich, Switzerland.
| | - Julia Balzer
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910 Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland.
| | - Jan Lieber
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910 Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland.
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910 Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland.
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15
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Lieber J, Gartmann T, Keller JW, van Hedel HJA. Validity and reliability of the Selective Control of the Upper Extremity Scale in children with upper motor neuron lesions. Disabil Rehabil 2021; 44:3694-3700. [PMID: 33577357 DOI: 10.1080/09638288.2021.1881171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE We evaluated the validity and intra-, inter-, and test-retest reliability of the Selective Control of the Upper Extremity Scale (SCUES) sum and item scores in patients with upper motor neuron lesions. METHODS Thirty-one boys and 15 girls (mean age ± SD: 11 years 1 month ± 3 years 9 month) with upper motor neuron lesions participated. We correlated SCUES scores with the range of motion items of the Melbourne Assessment 2 (MA2) and Box and Block Test (BBT) to establish concurrent validity and compared scores between the more and less affected side for discriminative validity. Intra-class correlation coefficients (ICC) and smallest detectable changes (SDC) indicated relative and absolute reliability. RESULTS For the more affected side, SCUES sum scores correlated well with MA2 (ρ = 0.83) and BBT (ρ = 0.77), and reliability proved high for intra-rater (ICC = 0.93, SDC = 2.55), inter-rater (ICC = 0.86, SDC = 3.58), and test-retest (ICC = 0.98, SDC = 1.41) reliability. Reliability of single items varied from 0.64 (inter-rater elbow) to 0.98 (intra-rater elbow). Limb and item scores were lower for the more affected side. CONCLUSION The SCUES limb and item scores seem valid and reliable in children with upper motor neuron lesions. While future studies should evaluate the responsiveness of the SCUES, we recommend that the same rater should score a patient twice.Implications for rehabilitationThe SCUES assesses selective voluntary motor control and appears valid and reliable in patients with upper motor neuron lesions.Test-retest reliability of the SCUES seems excellent.SCUES single item scores show concurrent validity and acceptable reliability.Limb and item scores are significantly lower for the more affected side.
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Affiliation(s)
- Jan Lieber
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Gartmann
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Donau-Universität Krems, Fakultät für Gesundheit und Medizin, Krems, Austria
| | - Jeffrey W Keller
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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16
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Shams FE, Amini M, Mehraban AH, Zarei MA, Kalani D. Development and psychometric evaluation of performance-based upper extremity motor control test (PB-UE-MCT) for people with cerebral palsy. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2021. [DOI: 10.1590/2526-8910.ctoao21567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Upper extremity disorders limits the performance in the activities of daily living, especially, in bilateral (two-handed) activities. Objective This study was designed to develop a performance-based upper extremity motor control test (PB-UE-MCT) and to measure its psychometric properties (including, convergent validity, intrarater reliability, and interrater reliability) for people with cerebral palsy (CP). Method The PB-UE-MCT was developed in three phases, including planning, construction, and psychometric evaluation. The participants included 50 people with CP with an age range of 6 to 18 years. To measure internal consistency, Cronbach's alpha was run (n=50). Intrarater and interrater reliability was measured for 25 participants. To assess convergent validity, the correlations of the PB-UE-MCT with the Manual Ability Classification System (MACS) and with the Selective Control Upper Extremity Scale (SCUES) were calculated. Results The values obtained for Cronbach's alpha (.90 to .96) indicated the excellent internal consistency of the PB-UE-MCT. The ICC values for intrarater reliability and interrater reliability were between .84 and .99 and between .89 and .99, respectively. The correlation coefficients obtained for the items of the PB-UE-MCT and those of the MACS were between .51 and .73. The correlation coefficients of the items of the PB-UE-MCT with those of the SCUES were in the range of .67 to .98, which proves the PB-UE-MCT's good to excellent levels of convergent validity. Conclusion The results confirm that the PB-UE-MCT is a valid and reliable tool for evaluating the upper extremity performance of people with CP through task analysis.
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Yildiz A, Yildiz R, Celik HI, Manzak OF, Elbasan B. Construct and discriminative validity and reliability of the Selective Control of the Upper Extremity Scale (SCUES) in children with unilateral cerebral palsy. Physiother Theory Pract 2020; 38:919-927. [DOI: 10.1080/09593985.2020.1805832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ayse Yildiz
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Ramazan Yildiz
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Halil Ibrahim Celik
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Omer Faruk Manzak
- Defne Duru Special Education and Rehabilitation Center, Ankara, Turkey
| | - Bulent Elbasan
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Keller JW, Fahr A, Balzer J, Lieber J, van Hedel HJA. Validity and reliability of an accelerometer-based assessgame to quantify upper limb selective voluntary motor control. J Neuroeng Rehabil 2020; 17:89. [PMID: 32660569 PMCID: PMC7358929 DOI: 10.1186/s12984-020-00717-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Current clinical assessments measure selective voluntary motor control (SVMC) on an ordinal scale. We introduce a playful, interval-scaled method to assess SVMC in children with brain lesions and evaluate its validity and reliability. METHODS Thirty-one neurologically intact children (median [1st-3rd quartile]: 11.6 years [8.5-13.9]) and 33 patients (12.2 years [8.8-14.9]) affected by upper motor neuron lesions with mild to moderate impairments participated. Using accelerometers, they played a movement tracking game (assessgame) with isolated joint movements (shoulder, elbow, lower arm [pro-/supination], wrist, and fingers), yielding an accuracy score. Involuntary movements were recorded simultaneously and resulted in an involuntary movement score. Both scores were normalized to the performance of 33 neurologically intact adults (32.5 years [27.9; 38.3]), which represented physiological movement patterns. We correlated the assessgame outcomes with the Manual Ability Classification System, Selective Control of the Upper Extremity Scale, and a therapist rating of involuntary movements. Furthermore, a robust ANCOVA was performed with age as covariate, comparing patients to their healthy peers at the age levels of 7.5, 9, 10.5, 12, and 15 years. Intraclass correlation coefficients and smallest real differences indicated relative and absolute reliability. RESULTS Correlations (Kendall/Spearman) for the accuracy score were τ = 0.29 (p = 0.035; Manual Ability Classification System), ρ = - 0.37 (p = 0.035; Selective Control of the Upper Extremity Scale), and ρ = 0.64 (p < 0.001; therapist rating). Correlations for the involuntary movement metric were τ = 0.37 (p = 0.008), ρ = - 0.55 (p = 0.001), and ρ = 0.79 (p < 0.001), respectively. The robust ANCOVAs revealed that patients performed significantly poorer than their healthy peers in both outcomes and at all age levels except for the dominant/less affected arm, where the youngest age group did not differ significantly. Robust intraclass correlation coefficients and smallest real differences were 0.80 and 1.02 (46% of median patient score) for the accuracy and 0.92 and 2.55 (58%) for involuntary movements, respectively. CONCLUSION While this novel assessgame is valid, the reliability might need to be improved. Further studies are needed to determine whether the assessgame is sensitive enough to detect changes in SVMC after a surgical or therapeutic intervention.
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Affiliation(s)
- Jeffrey W Keller
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland. .,Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Annina Fahr
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Julia Balzer
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland
| | - Jan Lieber
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Santamaria V, Rachwani J, Saussez G, Bleyenheuft Y, Dutkowsky J, Gordon AM, Woollacott MH. The Seated Postural & Reaching Control Test in Cerebral Palsy: A Validation Study. Phys Occup Ther Pediatr 2020; 40:441-469. [PMID: 31900006 PMCID: PMC7250729 DOI: 10.1080/01942638.2019.1705456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: Children with moderate-severe cerebral palsy (CP) show postural control deficits that affect their daily activities, like reaching. The Seated Postural and Reaching Control test (SP&R-co) was developed to address the need for clinical measures that objectively identify dimensions of postural imbalance and corresponding reaching limitations in children with CP.Methods: SP&R-co documentation was designed for test validity and rater training. Rater and internal consistency were examined using Cronbach's α. Reference SP&R-co score sheets of children and rater's scores were used for absolute item-by-item, average inter-rater, and intra-rater reliability. Motor classification systems and performance tests were used for construct and concurrent validity.Results: The SP&R-co scoring showed acceptable-good consistency (α = 0.76-0.84). Interrelatedness of SP&R-co items was good-excellent (α = 0.82-0.97). The raters demonstrated fair, good, and excellent item-by-item reliability (ICC = 0.41-0.92). Inter-rater and intra-rater reliability of SP&R-co dimensions were good-excellent (ICC = 0.68-0.86 and ICC = 0.64-0.95, respectively). Construct and concurrent validity showed moderate-excellent correlations (r = 0.49-0.88).Conclusions: Results provide evidence that the SP&R-co is a reliable and valid test for therapists to objectively examine and quantify seated postural and reaching control in children with CP.
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Affiliation(s)
- Victor Santamaria
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Jaya Rachwani
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Geoffroy Saussez
- Institute of Neuroscience, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Joseph Dutkowsky
- Department of Orthopedic Surgery, Weinberg Cerebral Palsy Center: Columbia Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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Keller JW, Balzer J, Fahr A, Lieber J, Keller U, van Hedel HJA. First validation of a novel assessgame quantifying selective voluntary motor control in children with upper motor neuron lesions. Sci Rep 2019; 9:19972. [PMID: 31889062 PMCID: PMC6937339 DOI: 10.1038/s41598-019-56495-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/09/2019] [Indexed: 11/09/2022] Open
Abstract
The question whether novel rehabilitation interventions can exploit restorative rather than compensatory mechanisms has gained momentum in recent years. Assessments measuring selective voluntary motor control could answer this question. However, while current clinical assessments are ordinal-scaled, which could affect their sensitivity, lab-based assessments are costly and time-consuming. We propose a novel, interval-scaled, computer-based assessment game using low-cost accelerometers to evaluate selective voluntary motor control. Participants steer an avatar owl on a star-studded path by moving the targeted joint of the upper or lower extremities. We calculate a target joint accuracy metric, and an outcome score for the frequency and amplitude of involuntary movements of adjacent and contralateral joints as well as the trunk. We detail the methods and, as a first proof of concept, relate the results of select children with upper motor neuron lesions (n = 48) to reference groups of neurologically intact children (n = 62) and adults (n = 64). Linear mixed models indicated that the cumulative therapist score, rating the degree of selectivity, was a good predictor of the involuntary movements outcome score. This highlights the validity of this assessgame approach to quantify selective voluntary motor control and warrants a more thorough exploration to quantify changes induced by restorative interventions.
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Affiliation(s)
- Jeffrey W Keller
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland. .,Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Julia Balzer
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland
| | - Annina Fahr
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jan Lieber
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Urs Keller
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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21
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Giray E, Karali‐Bingul D, Akyuz G. The Effectiveness of Kinesiotaping, Sham Taping or Exercises Only in Lateral Epicondylitis Treatment: A Randomized Controlled Study. PM R 2019; 11:681-693. [DOI: 10.1002/pmrj.12067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/04/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Esra Giray
- Department of Physical Medicine and RehabilitationMarmara University School of Medicine Istanbul Turkey
| | - Duygu Karali‐Bingul
- Department of Physical Medicine and RehabilitationMarmara University School of Medicine Istanbul Turkey
| | - Gulseren Akyuz
- Department of Physical Medicine and Rehabilitation and Division of Pain MedicineMarmara University School of Medicine Istanbul Turkey
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22
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McNish RN, Chembrammel P, Speidel NC, Lin JJ, López-Ortiz C. Rehabilitation for Children With Dystonic Cerebral Palsy Using Haptic Feedback in Virtual Reality: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11470. [PMID: 31344678 PMCID: PMC6682270 DOI: 10.2196/11470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common developmental motor disorder in children. Individuals with CP demonstrate abnormal muscle tone and motor control. Within the population of children with CP, between 4% and 17% present dystonic symptoms that may manifest as large errors in movement tasks, high variability in movement trajectories, and undesired movements at rest. These symptoms of dystonia typically worsen with physical intervention exercises. OBJECTIVE The aim of this study is to establish the effect of haptic feedback in a virtual reality (VR) game intervention on movement outcomes of children with dystonic CP. METHODS The protocol describes a randomized controlled trial that uses a VR game-based intervention incorporating fully automated robotic haptic feedback. The study consists of face-to-face assessments of movement before, after, and 1 month following the completion of the 6-session game-based intervention. Children with dystonic CP, aged between 7 and 17 years, will be recruited for this study through posted fliers and laboratory websites along with a group of typically developing (TD) children in the same age range. We anticipate to recruit a total of 68 participants, 34 each with CP and TD. Both groups of children will be randomly allocated into an intervention or control group using a blocked randomization method. The primary outcome measure will be the smoothness index of the interaction force with the robot and of the accelerometry signals of sensors placed on the upper limb segments. Secondary outcomes include a battery of clinical tests and a quantitative measure of spasticity. Assessors administering clinical measures will be blinded. All sessions will be administered on-site by research personnel. RESULTS The trial has not started and is pending local institutional review board approval. CONCLUSIONS Movement outcomes will be examined for changes in muscle activation and clinical measures in children with dystonic CP and TD children. Paired t tests will be conducted on movement outcomes for both groups of children independently. Positive and negative results will be reported and addressed. TRIAL REGISTRATION ClinicalTrials.gov NCT03744884; https://clinicaltrials.gov/ct2/show/NCT03744884 (Archived by WebCite at http://www.webcitation.org/74RSvmbZP). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/11470.
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Affiliation(s)
- Reika Nicole McNish
- Department of Kinesiology and Community Health, Neuroscience Program, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Chamapign, Urbana, IL, United States
| | - Pramod Chembrammel
- Health Care Engineering Systems Center, College of Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | | | - Julian Jwchun Lin
- Children's Hospital of Illinois, OSF Saint Francis Medical Center, OSF Illinois Neurological Institute, Peoria, IL, United States
| | - Citlali López-Ortiz
- Department of Kinesiology and Community Health, Department of Dance, Neuroscience Program, Illinois Informatics Institute, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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McLean B, Blakeman M, Carey L, Ward R, Novak I, Valentine J, Blair E, Taylor S, Bear N, Bynevelt M, Basc E, Rose S, Reid L, Pannek K, Angeli J, Harpster K, Elliott C. Discovering the sense of touch: protocol for a randomised controlled trial examining the efficacy of a somatosensory discrimination intervention for children with hemiplegic cerebral palsy. BMC Pediatr 2018; 18:252. [PMID: 30064388 PMCID: PMC6069953 DOI: 10.1186/s12887-018-1217-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 07/09/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Of children with hemiplegic cerebral palsy, 75% have impaired somatosensory function, which contributes to learned non-use of the affected upper limb. Currently, motor learning approaches are used to improve upper-limb motor skills in these children, but few studies have examined the effect of any intervention to ameliorate somatosensory impairments. Recently, Sense© training was piloted with a paediatric sample, seven children with hemiplegic cerebral palsy, demonstrating statistically and clinically significant change in limb position sense, goal performance and bimanual hand-use. This paper describes a protocol for a Randomised Controlled Trial of Sense© for Kids training, hypothesising that its receipt will improve somatosensory discrimination ability more than placebo (dose-matched Goal Directed Therapy via Home Program). Secondary hypotheses include that it will alter brain activation in somatosensory processing regions, white-matter characteristics of the thalamocortical tracts and improve bimanual function, activity and participation more than Goal Directed Training via Home Program. METHODS AND DESIGN This is a single blind, randomised matched-pair, placebo-controlled trial. Participants will be aged 6-15 years with a confirmed description of hemiplegic cerebral palsy and somatosensory discrimination impairment, as measured by the sense©_assess Kids. Participants will be randomly allocated to receive 3h a week for 6 weeks of either Sense© for Kids or Goal Directed Therapy via Home Program. Children will be matched on age and severity of somatosensory discrimination impairment. The primary outcome will be somatosensory discrimination ability, measured by sense©_assess Kids score. Secondary outcomes will include degree of brain activation in response to a somatosensory task measured by functional MRI, changes in the white matter of the thalamocortical tract measured by diffusion MRI, bimanual motor function, activity and participation. DISCUSSION This study will assess the efficacy of an intervention to increase somatosensory discrimination ability in children with cerebral palsy. It will explore clinically important questions about the efficacy of intervening in somatosensation impairment to improve bimanual motor function, compared with focusing on motor impairment directly, and whether focusing on motor impairment alone can affect somatosensory ability. TRIAL REGISTRATION This trial is registered with the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12618000348257. World Health Organisation universal trial number: U1111-1210-1726.
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Affiliation(s)
- Belinda McLean
- School of Adolescent and Child Health, University of Western Australia, Perth, WA Australia
- Kids Rehab Department, Perth Children’s Hospital, Perth, WA Australia
| | - Misty Blakeman
- Kids Rehab Department, Perth Children’s Hospital, Perth, WA Australia
| | - Leeanne Carey
- Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC Australia
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC Australia
| | - Roslyn Ward
- School of Occupational Therapy and Social Work, Curtin University, Perth, WA Australia
| | - Iona Novak
- Cerebral Palsy Alliance, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW Australia
| | - Jane Valentine
- School of Adolescent and Child Health, University of Western Australia, Perth, WA Australia
- Kids Rehab Department, Perth Children’s Hospital, Perth, WA Australia
| | - Eve Blair
- Telethon Kids Institute, University of Western Australia, Perth, WA Australia
| | - Susan Taylor
- Kids Rehab Department, Perth Children’s Hospital, Perth, WA Australia
- School of Occupational Therapy and Social Work, Curtin University, Perth, WA Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Child and Adolescent Health Services, Perth, WA Australia
| | - Michael Bynevelt
- Kids Rehab Department, Perth Children’s Hospital, Perth, WA Australia
- Sir Charles Gairdner Hospital, Perth, WA Australia
| | - Emma Basc
- Consumer Representative, Perth, WA Australia
| | - Stephen Rose
- Australian e-Health Research Centre, CSIRO, Brisbane, Queensland Australia
| | - Lee Reid
- Australian e-Health Research Centre, CSIRO, Brisbane, Queensland Australia
| | - Kerstin Pannek
- Australian e-Health Research Centre, CSIRO, Brisbane, Queensland Australia
| | - Jennifer Angeli
- School of Adolescent and Child Health, University of Western Australia, Perth, WA Australia
- Kids Rehab Department, Perth Children’s Hospital, Perth, WA Australia
| | - Karen Harpster
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio USA
| | - Catherine Elliott
- School of Occupational Therapy and Social Work, Curtin University, Perth, WA Australia
- Department of Clinical Research and Education, Child and Adolescent Health Services, Perth, WA Australia
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SUKAL-MOULTON THERESA, GAEBLER-SPIRA DEBORAH, KROSSCHELL KRISTINJ. The validity and reliability of the Test of Arm Selective Control for children with cerebral palsy: a prospective cross-sectional study. Dev Med Child Neurol 2018; 60:374-381. [PMID: 29383702 PMCID: PMC5867232 DOI: 10.1111/dmcn.13671] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/30/2022]
Abstract
AIM This study examined the reliability and validity of the Test of Arm Selective Control (TASC) to examine upper extremity selective voluntary motor control in children and adolescents with all types of spastic cerebral palsy (CP). METHOD Fifty-six participants with CP, ranging in age from 5 years 9 months to 18 years 11 months (average 11y 7mo, SD 3y 9mo; 25 males, 31 females), participated in this prospective cross-sectional study. They were evaluated using the TASC and several clinical measures. RESULTS TASC and Manual Ability Classification System (r=-0.529, p<0.001), TASC and ABILHAND-Kids (r=0.596, p<0.001), and TASC and affected extremities (r=-0.486, p=0.001) were moderately correlated. There was a weak correlation between the TASC and Gross Motor Function Classification System (r=-0.363, p=0.006) and no correlation between the TASC and age (p=0.366) or rater (p=0.713). Interrater reliability for upper extremity total score (intraclass correlation coefficient [ICC]=0.92-0.94) and upper extremity limb scores (ICC=0.92-0.96) was high for two independent rater groups (p≤0.001). Average time to administer was 16 minutes, 18 seconds. INTERPRETATION The TASC is a reliable and valid tool for objective assessment of selective voluntary motor control. Clinically this measure may guide the selection of medical, surgical, or therapy interventions and may improve outcome prognosis. WHAT THIS PAPER ADDS The Test of Arm Selective Control (TASC) demonstrates a high degree of reliability and multiple aspects of validity when assessing upper extremity selective control in those with cerebral palsy. The TASC is an upper limb companion to the Selective Control Assessment of the Lower Extremity.
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Affiliation(s)
- THERESA SUKAL-MOULTON
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - DEBORAH GAEBLER-SPIRA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL,Rehabilitation Institute of Chicago, Chicago, IL
| | - KRISTIN J KROSSCHELL
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Roldan A, Sabido R, Barbado D, Caballero C, Reina R. Manual Dexterity and Intralimb Coordination Assessment to Distinguish Different Levels of Impairment in Boccia Players with Cerebral Palsy. Front Neurol 2017; 8:582. [PMID: 29176957 PMCID: PMC5686082 DOI: 10.3389/fneur.2017.00582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/18/2017] [Indexed: 11/13/2022] Open
Abstract
Background Boccia is a paralympic sport played by athletes with severe neurological impairments affecting all four limbs. Impaired manual dexterity (MD) and intralimb coordination (ILC) may limit individuals’ ability to perform certain activities such as grasping, releasing, or manipulating objects, which are essential tasks for daily life or to participate in para sports such as boccia. However, there are currently no specific instruments available to assess hand–arm coordination in boccia players with severe cerebral palsy (CP). Purpose To design new sport-specific coordination tests to assess impaired MD and ILC in boccia players; afterward, quantify to what extent their coordination is impaired compared to a control group (CG) without neurological impairments. Methods Seventy-three recreational boccia players with severe CP (BC1: age = 34.01 ± 16.43 years; BC2: age = 33.97 ± 14.29 years), and 19 healthy adults (age = 27.89 ± 7.08 years) completed the test battery. The Box and Block test (BBT) and Box and Ball test (BBLT) were used to assess MD and four tapping tests to assess upper ILC. Results Both MD tests were able to discriminate between sport classes. Boccia players obtained better scores in the BBLT in comparison to the BBT, showing that the BBLT had more appropriate testing features. On the other hand, only one of the ILC tests was able to discriminate between sport classes, displaying the highest practical significance (d = −1.12). Participants with CP scored significantly worse in all the coordination tests compared to the CG. Conclusion Using sport-specific equipment facilitated grasp function during the MD assessment. Regarding the ILC, the type of movement (continuous vs. discrete) seems to be more relevant for classification than the movement direction (vertical vs. horizontal) or the presence of a ball.
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Affiliation(s)
- Alba Roldan
- Miguel Hernández University, Sport Research Center, Elche, Alicante, Spain
| | - Rafael Sabido
- Miguel Hernández University, Sport Research Center, Elche, Alicante, Spain
| | - David Barbado
- Miguel Hernández University, Sport Research Center, Elche, Alicante, Spain
| | - Carla Caballero
- Rutgers University, The State University of New Jersey, New Brunswick, NJ, United States
| | - Raúl Reina
- Miguel Hernández University, Sport Research Center, Elche, Alicante, Spain
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Mailleux L, Jaspers E, Ortibus E, Simon-Martinez C, Desloovere K, Molenaers G, Klingels K, Feys H. Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy. PLoS One 2017; 12:e0180196. [PMID: 28671953 PMCID: PMC5495347 DOI: 10.1371/journal.pone.0180196] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/12/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The clinical application of upper limb (UL) three-dimensional movement analysis (3DMA) in children with unilateral cerebral palsy (uCP) remains challenging, despite its benefits compared to conventional clinical scales. Moreover, knowledge on UL movement pathology and how this relates to clinical parameters remains scarce. Therefore, we investigated UL kinematics across different manual ability classification system (MACS) levels and explored the relation between clinical and kinematic parameters in children with uCP. PATIENTS AND METHODS Fifty children (MACS: I = 15, II = 26, III = 9) underwent an UL evaluation of sensorimotor impairments (grip force, muscle strength, muscle tone, two-point discrimination, stereognosis), bimanual performance (Assisting Hand Assessment, AHA), unimanual capacity (Melbourne Assessment 2, MA2) and UL-3DMA during hand-to-head, hand-to-mouth and reach-to-grasp tasks. Global parameters (Arm Profile Score (APS), duration, (timing of) maximum velocity, trajectory straightness) and joint specific parameters (angles at task endpoint, ROM and Arm Variable Scores (AVS)) were extracted. The APS and AVS refer respectively to the total amount of movement pathology and movement deviations of wrist, elbow, shoulder, scapula and trunk. RESULTS Longer movement durations and increased APS were found with higher MACS-levels (p<0.001). Increased APS was also associated with more severe sensorimotor impairments (r = -0.30-(-0.73)) and with lower AHA and MA2-scores (r = -0.50-(-0.86)). For the joint specific parameters, stronger movement deviations distally were significantly associated with increased muscle weakness (r = -0.32-(-0.74)) and muscle tone (r = 0.33-(-0.61)); proximal movement deviations correlated only with muscle weakness (r = -0.35-0.59). Regression analysis exposed grip force as the most important predictor for the variability in APS (p<0.002). CONCLUSION We found increased movement pathology with increasing MACS-levels and demonstrated the adverse impact of especially muscle weakness. The lower correlations suggest that 3DMA provides additional information regarding UL motor function, particularly for the proximal joints. Integrating both methods seems clinically meaningful to obtain a comprehensive representation of all aspects of a child's UL functioning.
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Affiliation(s)
- Lisa Mailleux
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- * E-mail:
| | - Ellen Jaspers
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Els Ortibus
- KU Leuven–University of Leuven, Department of Development and Regeneration, Leuven, Belgium
| | | | - Kaat Desloovere
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University Hospitals Leuven, Clinical Motion Analysis Laboratory, Leuven, Belgium
| | - Guy Molenaers
- KU Leuven–University of Leuven, Department of Development and Regeneration, Leuven, Belgium
- University Hospitals Leuven, Department of Orthopaedic Medicine, Leuven, Belgium
| | - Katrijn Klingels
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- UHasselt–Hasselt University, BIOMED, Rehabilitation Research Center (REVAL), Diepenbeek, Belgium
| | - Hilde Feys
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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van Hedel HJA, Häfliger N, Gerber CN. Quantifying selective elbow movements during an exergame in children with neurological disorders: a pilot study. J Neuroeng Rehabil 2016; 13:93. [PMID: 27769301 PMCID: PMC5073824 DOI: 10.1186/s12984-016-0200-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is difficult to distinguish between restorative and compensatory mechanisms underlying (pediatric) neurorehabilitation, as objective measures assessing selective voluntary motor control (SVMC) are scarce. METHODS We aimed to quantify SVMC of elbow movements in children with brain lesions. Children played an airplane game with the glove-based YouGrabber system. Participants were instructed to steer an airplane on a screen through a cloud-free path by correctly applying bilateral elbow flexion and extension movements. Game performance measures were (i) % time on the correct path and (ii) similarity between the ideal flight path and the actually flown path. SVMC was quantified by calculating a correlation coefficient between the derivative of the ideal path and elbow movements. A therapist scored whether the child had used compensatory movements. RESULTS Thirty-three children with brain lesions (11 girls; 12.6 ± 3.6 years) participated. Clinical motor and cognitive scores correlated moderately with SVMC (0.50-0.74). Receiver Operating Characteristics analyses showed that SVMC could differentiate well and better than clinical and game performance measures between compensatory and physiological movements. CONCLUSIONS We conclude that a simple measure assessed while playing a game appears promising in quantifying SVMC. We propose how to improve the methodology, and how this approach can be easily extended to other joints.
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Affiliation(s)
- Hubertus J. A. van Hedel
- Rehabilitation Center Affoltern am Albis, University Children’s Hospital Zurich, Mühlebergstrasse 104, CH-8910 Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Nadine Häfliger
- Rehabilitation Center Affoltern am Albis, University Children’s Hospital Zurich, Mühlebergstrasse 104, CH-8910 Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Corinna N. Gerber
- Rehabilitation Center Affoltern am Albis, University Children’s Hospital Zurich, Mühlebergstrasse 104, CH-8910 Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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28
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Gordon AM. What does selective motor control of the upper extremity in cerebral palsy tell us? Dev Med Child Neurol 2016; 58:536-7. [PMID: 26773326 DOI: 10.1111/dmcn.13028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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