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Chen YT, Wang ZC, Xie YM, Wang X, Huang J, Wang J. Stapled hemorrhoidopexy for hemorrhoids: A overview of systematic reviews and meta-analysis. Asian J Surg 2024:S1015-9584(24)01223-5. [PMID: 39009485 DOI: 10.1016/j.asjsur.2024.06.006] [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: 03/22/2024] [Revised: 06/01/2024] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
Stapled hemorrhoidopexy has been used for years to treat hemorrhoids. Despite numerous systematic reviews and meta-analyses on the topic, inconsistent conclusions have left people uncertain about its effectiveness and raised doubts about the quality of these reviews.In order to provide reliable evidence for clinical practice, it is crucial to conduct an overview to assess the quality of MAs/SRs regarding the efficacy and complications of SH.A comprehensive search was performed across seven databases to identify MAs/SRs on the efficacy and complications of SH from inception to October 2023. The selected MAs/SRs were then assessed using three well-established tools: AMSTAR-2, PRISMA 2020and GRADE. These assessments provide a robust evaluation of the quality and reliability of the included MAs/SRs.We removed overlapping randomized controlled trials (RCTs) and conducted a new meta-analysis of the outcomes. The overview included 23 meta-analyses.In AMSTAR-2, three reviews were deemed moderate quality, nine reviews were classified as low quality, and eleven reviews were evaluated as critically low quality.In PRISMA 2020,certain deficiencies were exhibited, such as abstracts (0/23:0 %),final retrieval date (0/23:0 %), sensitivity analysis (6/23:26.09 %),publication bias assessment (11/23:47.83 %), the quality of evidence (2/23:8.70 %) and so on.In GRADE,twenty-six items were rated as moderate quality (27.96 %),forty-one items were rated as low quality (44.09 %) and twenty-six items were rated as critically low quality (27.96 %).SH has been found to be an effective intervention for reducing postoperative pain, shortening procedure time, and promoting wound healing. The re-analysis indicated that SH can reduce postoperative pain in hemorrhoid patients (odds ratio = 0.28, 95 % confidence interval [0.15,0.55], p = 0.0002; I2 = 74 %, p < 0.00001). But SH is associated with a higher risk of postoperative bleeding and recurrence of prolapse.Given that the reviews included in this overview were rated as low quality, caution should be exercised when interpreting the findings.
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Affiliation(s)
- Yang-Tao Chen
- Department of Anorectal Surgery, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China
| | - Zhao-Chu Wang
- Department of Anorectal Surgery, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China
| | - Ya-Meng Xie
- Department of Anorectal Surgery, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China
| | - Xun Wang
- Department of Anorectal Surgery, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China
| | - Juan Huang
- Department of Anorectal Surgery, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China
| | - Jing Wang
- Department of Anorectal Surgery, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China.
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Jun K, Park D, Eo H, Woo S, Koo WM, Kim JM, Lee BJ, Chang MC. Association between Cognitive Abilities before the Age of 3 Years and Those at Least 1 Year Later in Children with Developmental Delay. Neuropediatrics 2024. [PMID: 38897233 DOI: 10.1055/a-2349-1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE This study investigated whether early cognitive assessment in children with developmental delay (DD) predicts cognitive development. We investigated the correlation between cognitive and language development in children with DD, cerebral palsy (CP), and autism spectrum disorder (ASD). METHODS Data were collected from children diagnosed with DD who visited the hospital between 2015 and 2023. The assessments included the Korean Bayley Scales of Infant and Toddler Development Second Edition (K-BSID-II) and the Korean Wechsler Preschool Primary Scale of Intelligence Fourth Edition (K-WPPSI-IV). Language development was evaluated using the Sequenced Language Scale for Infants (SELSI) and Preschool Receptive-Expressive Language Scale (PRES). The statistical analysis involved a correlation analysis. RESULTS Among 95 children in the study, a significant correlation was discovered between early cognitive assessments (the Mental Developmental Index from the K-BSID-II) and later cognitive development (the Full-Scale Intelligence Quotient from the K-WPPSI-IV) in the DD and CP groups, but not in the ASD group. The DD and CP groups exhibited significant correlations in language development between the SELSI and PRES, whereas the ASD group did not. CONCLUSION Early cognitive assessments can predict later cognitive development in children with DD and CP, but not in those with ASD, according to this study. There was a strong correlation between language and cognitive development in the DD and CP groups, highlighting the importance of early intervention and assessment for these children. Further investigation is necessary to address these limitations and refine demographic data.
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Affiliation(s)
- Kwangohk Jun
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Daegu, Korea
| | - Donghwi Park
- Seoul Spine Rehabilitation Clinic, Ulsan-si, Korea
| | - Hyoshin Eo
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Daegu, Korea
| | - Seongho Woo
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Daegu, Korea
| | - Won Mo Koo
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Daegu, Korea
| | - Jong Min Kim
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Daegu, Korea
| | - Byung Joo Lee
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Daegu, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
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Lewis SA, Ruttenberg A, Iyiyol T, Kong N, Jin SC, Kruer MC. Potential clinical applications of advanced genomic analysis in cerebral palsy. EBioMedicine 2024; 106:105229. [PMID: 38970919 DOI: 10.1016/j.ebiom.2024.105229] [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: 02/15/2024] [Revised: 04/26/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024] Open
Abstract
Cerebral palsy (CP) has historically been attributed to acquired insults, but emerging research suggests that genetic variations are also important causes of CP. While microarray and whole-exome sequencing based studies have been the primary methods for establishing new CP-gene relationships and providing a genetic etiology for individual patients, the cause of their condition remains unknown for many patients with CP. Recent advancements in genomic technologies offer additional opportunities to uncover variations in human genomes, transcriptomes, and epigenomes that have previously escaped detection. In this review, we outline the use of these state-of-the-art technologies to address the molecular diagnostic challenges experienced by individuals with CP. We also explore the importance of identifying a molecular etiology whenever possible, given the potential for genomic medicine to provide opportunities to treat patients with CP in new and more precise ways.
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Affiliation(s)
- Sara A Lewis
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States; Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Andrew Ruttenberg
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Tuğçe Iyiyol
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Nahyun Kong
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States; Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States; Programs in Neuroscience and Molecular & Cellular Biology, School of Life Sciences, Arizona State University, Tempe, AZ, United States.
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Panda S, Singh A, Kato H, Kokhanov A. Cerebral Palsy: A Current Perspective. Neoreviews 2024; 25:e350-e360. [PMID: 38821909 DOI: 10.1542/neo.25-6-e350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 06/02/2024]
Abstract
Cerebral palsy (CP) is the most common cause of motor disability in children. Insults to the brain at different times lead to diverse injuries. As a result, CP is an extremely heterogeneous clinical diagnosis, presenting differently in each individual and at various ages. With improving survival rates of preterm newborns, increasing active resuscitation of extremely preterm newborns, and widespread availability of extensive genetic testing soon after birth, it is imperative to focus on earlier diagnosis and long-term outcomes of CP. CP is primarily classified into 4 categories based on type of motor impairment, functional ability, distribution, and etiology. As the understanding of CP has evolved significantly in the last 2 decades, the methods of early detection of CP have consequently advanced. Appropriate diagnosis is essential for proper education and counseling of affected families, and introduction of therapeutic interventions as early as possible. In this review, we focus on early brain development and provide an overview of the etiology, classification, diagnosis, early therapeutic options, and prognosis of CP.
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Affiliation(s)
- Sanjeet Panda
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Ajay Singh
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Houston, TX
| | - Hugo Kato
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Artemiy Kokhanov
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
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Souza RFA, Leite HR, Lucena R, Carvalho A. Early Detection and Intervention for Children with High Risk of Cerebral Palsy: A Survey of Physical Therapists and Occupational Therapists in Brazil. Phys Occup Ther Pediatr 2024:1-15. [PMID: 38764324 DOI: 10.1080/01942638.2024.2353124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
AIMS The purpose of this study was to assess the current clinical practice of physiotherapists and occupational therapists on early detection and early intervention for children with cerebral palsy (CP) in Brazil. METHODS This was a cross-sectional study. A purpose-developed electronic survey was disseminated across the country to physiotherapists and occupational therapists working with young children with or at risk of CP. RESULTS A total of 205 anonymous respondents were included. Most participants (64.4%) agree that the diagnosis of CP can be made before 6 months of age. General Movements Assessment (26.8%) and Hammersmith Infant Neurological Examination (37.1%) were used infrequently. Infants at risk for CP receive therapy twice a week or more by 58.5% of therapists, 93.2% identified parents' goals as the most important factor in customizing the early intervention program. The most frequent intervention strategies for this age group were active stimulation of the child (n = 182), family training (n = 161), strategies to optimize the environment (n = 143), and neurodevelopmental treatment/Bobath (n = 99). CONCLUSIONS Currently, pediatric physiotherapists and occupational therapists in Brazil do not fully incorporate best practice tools for early identification of children with CP, nor sufficient best evidence-based interventions.
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Affiliation(s)
- Rosiane F A Souza
- SARAH Network of Rehabilitation Hospitals, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Hércules R Leite
- School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rita Lucena
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Banaru D, Boyd D, Halevy M, Oliver A, Orsat-Parker K, Brien M, Krishna D, Coutinho F, Ogourtsova T. Social capital of families of children with neurodevelopmental disabilities in South India. Dev Med Child Neurol 2024. [PMID: 38698550 DOI: 10.1111/dmcn.15949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/05/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024]
Abstract
AIM To investigate the social capital of families with children with neurodevelopmental disabilities in South India receiving a community-based early intervention (Enabling Inclusion®) program and to explore determinants and associations between social capital and program duration, socio-demographic factors, family empowerment, and caregiver burden. METHOD Using purposive sampling in a cross-sectional study design, 217 families (n = 71 received short Enabling Inclusion [<5 months]; n = 146 received long Enabling Inclusion [>9 months]) were recruited and completed the Short Adapted Social Capital Tool (SASCAT: cognitive, structural), measures of family empowerment, and caregiver strain. Descriptive statistics, regression, and correlations were used for analyses. RESULTS In 52.1% of participants, low cognitive and structural social capital was observed. Higher odds of low structural social capital were observed for mothers with primary versus secondary education (adjusted odds ratio [OR] = 0.35; 95% confidence interval [CI] 0.13-0.90; p = 0.029); and caregivers of children with cerebral palsy versus autism (OR = 4.66; 95% CI 1.02-21.21; p = 0.046). Significant associations were found between structural social capital, the child's age, and support group membership (χ2 = 6.29; 4.70; degrees of freedom [df] = 2; 1; p = 0.04; p = 0.02 respectively), as well as between cognitive social capital and other disability in the family (χ2 = 4.62, df = 1, p = 0.03). INTERPRETATION While program duration was not found to mediate social capital, mother's education and child's diagnosis emerged as key influential factors, warranting their consideration in interventions supporting families of children with neurodevelopmental disabilities in low- and-middle-income countries and elsewhere.
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Affiliation(s)
- Diana Banaru
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Dana Boyd
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Melanie Halevy
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Angel Oliver
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Kayla Orsat-Parker
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Marie Brien
- Enabling Inclusion Program, Amar Seva Sangam, Ayikudi, Tamil Nadu, India
| | - Dinesh Krishna
- Enabling Inclusion Program, Amar Seva Sangam, Ayikudi, Tamil Nadu, India
| | - Franzina Coutinho
- Enabling Inclusion Program, Amar Seva Sangam, Ayikudi, Tamil Nadu, India
- Jewish Rehabilitation Hospital, Research Center - RESI ALLIANT KID Laboratory, site of Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC, Canada
| | - Tatiana Ogourtsova
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital, Research Center - RESI ALLIANT KID Laboratory, site of Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC, Canada
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Wu J, Bai C, Hu M, Guan Q, Li J, Luan X, Yan B. Efficacy of cervical perivascular sympathectomy in improving upper limb motor function in children with cerebral palsy and construction of a predictive model. Clin Neurol Neurosurg 2024; 240:108273. [PMID: 38608351 DOI: 10.1016/j.clineuro.2024.108273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/23/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The effectiveness of cervical perivascular sympathectomy (CPVS) in enhancing upper limb motor function in children with cerebral palsy is unclear, and the factors that influence the effectiveness of the surgery have not been documented. OBJECTIVE To investigate the effectiveness of CPVS in enhancing upper limb motor function in children with cerebral palsy and develop a predictive chart for potential associated adverse outcomes METHODS: The study included 187 children with cerebral palsy who underwent CPVS at the Cerebral Palsy Center, Second Affiliated Hospital of Xinjiang Medical University, between January 2018 and January 2022. Patients were categorized into two groups based on prognostic outcomes: those with adverse and favorable prognoses. Demographic and laboratory data were collected and analyzed from both groups. To identify independent predictors of poor post-CPVS upper limb motor function outcomes, statistical techniques, including univariate analysis and binary logistic regression, were applied. Subsequently, these predictors were integrated to formulate a comprehensive predictive model. RESULTS In this cohort of 187 children with cerebral palsy undergoing CPVS, 68 (36.36%) exhibited a favorable prognosis for upper limb motor function and 119 (63.64%) demonstrated an adverse prognosis. Age, motor function, and serum albumin levels were identified as significant prognostic factors via logistic regression analysis. To develop the model, we divided the sample into a training set (70%, n = 131) and a validation set (30%, n = 56). Employing motor function, serum albumin levels, and age as variables, we crafted a predictive model. The model's performance, reflected by the area under the curve was 0.813 (0.732, 0.894) in the training set and 0.770 (0.647, 0.892) in the validation set, demonstrating its robust predictive capability for post-CPVS adverse outcomes. Furthermore, the consistency curve and Hosmer-Lemeshow test (χ2 = 8.808, p = 0.359) illustrated a strong concordance between the model's predictions of poor prognosis and the actual incidence rate. CONCLUSION CPVS has been shown to be effective in improving upper limb motor function in patients with cerebral palsy. Independent prognostic factors identified encompass motor function, age, and serum albumin levels. The composite predictive model shows potential for clinical applications.
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Affiliation(s)
- Junjie Wu
- Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang 830063, China
| | - Chao Bai
- Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang 830063, China
| | - Mingbo Hu
- Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang 830063, China
| | - Qi Guan
- Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang 830063, China
| | - Jianglong Li
- Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang 830063, China
| | - Xinping Luan
- Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang 830063, China
| | - Baofeng Yan
- Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang 830063, China.
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Mayston M, Saloojee G, Foley S. The Bobath Clinical Reasoning Framework: Open to debate. Dev Med Child Neurol 2024; 66:671-672. [PMID: 38343029 DOI: 10.1111/dmcn.15881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 04/04/2024]
Abstract
This letter to the editor is a response to the letters to the editor by Blomme, Damiano et al., and Coughlan et al. on pages 667, 668, and 669–670 respectively.
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Sharma N. Comparing the Pre-writing Skills of Diplegic Cerebral Palsy Children to Those of Normal Children. Cureus 2024; 16:e61352. [PMID: 38947676 PMCID: PMC11214161 DOI: 10.7759/cureus.61352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION The pencil grasp and drawing patterns are specific to different age levels. So, if one knows a certain pattern for that particular age, it will guide the intervention plan for children with cerebral palsy (CP). The chances of improvement in diplegic CP are possible with the help of early intervention; therefore, early intervention is only possible if one knows the areas of delay and the age at which the intervention should be started. MATERIAL AND METHODS It was a cross-sectional, case-control study. A total of 60 children were selected for the study, of which 30 (50%) were normal and 30 (50%) had diplegic cerebral palsy. A convenient sampling method is used for evaluation. RESULTS The t-value for pencil grasp between the two groups, i.e., normal and CP diplegic, was 3.515 (P=0.001), revealing a significant difference in the grasp pattern of the two groups. Similarly, the t-value for drawing patterns between the two groups, i.e., normal and CP diplegic, was 5.796 (P = 0.001). A significant difference was found in the drawing patterns of both groups. CONCLUSION Our study found that diplegic CP children performed lower on the Erhardt Developmental Prehension Assessment (EDPA) and showed larger variation in the pencil grasp and drawing than the normal children.
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Affiliation(s)
- Nirvi Sharma
- Pediatrics, New York City Department of Education, Jersey City, USA
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Mulqueeney A, Battin M, McKillop A, Stott NS, Allermo-Fletcher A, Williams SA. A prospective assessment of readiness to implement an early detection of cerebral palsy pathway in a neonatal intensive care setting using the PARIHS framework. Implement Sci Commun 2024; 5:46. [PMID: 38654322 PMCID: PMC11036598 DOI: 10.1186/s43058-024-00581-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Early detection of cerebral palsy (CP) is possible through targeted use of assessment tools. Changes in practice are needed to facilitate this shift towards earlier diagnosis of CP in New Zealand. The aim of this study was to prospectively evaluate readiness to implement an early detection of CP pathway within a level 3 neonatal intensive care unit (NICU) setting prior to any implementation taking place. The PARIHS (Promoting Action on Research Implementation in Health Services) framework was engaged to assess readiness by highlighting determinants that influence implementation outcomes as either barriers or enablers. METHODS A mixed methods approach was used. Firstly, an online staff survey assessed PARIHS sub-elements using Likert scores and free text with the intent to develop a baseline understanding of staff views. Secondly, focus groups were conducted to gain deeper understanding of barriers and enablers to implementation. Participants included health professionals involved in the first 6 months of life. Data were analysed to outline the barriers and enablers of implementation under the Evidence and Context constructs of the PARIHS framework. RESULTS Twenty-seven participants completed the survey, and 20 participants participated in eight focus groups and two individual interviews. Quantitative (survey) findings found 65% agreement around the usefulness of research evidence on early CP detection; however, ≤ 45% felt current resources (i.e. human, financial and IT) were sufficient for implementation. Qualitative findings (survey and focus groups) highlighted key staff concerns around resources, family impact (creating unnecessary stress), and equity (barriers to participation). Staff wanted information regarding how international evidence translates to the local context and availability of timely follow-up services. Sub-elements within the Evidence and Context constructs were rated as either mixed or low (except for Evidence - Research, rated as high), overall indicating that Auckland NICU is at the early stages of readiness to implement the early CP detection pathway. CONCLUSION This work may resonate with other neonatal services preparing to implement CP early detection pathways. Resourcing has a major role in facilitating implementation of pathways and uncertainty about resources is a barrier to implementation. Ongoing focus on building consensus and funding is required to ensure optimal uptake.
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Affiliation(s)
- Amy Mulqueeney
- Newborn Services, Starship Child Health, Te Toka Tumai - Auckland, Te Whatu Ora, Auckland, New Zealand
| | - Malcolm Battin
- Newborn Services, Starship Child Health, Te Toka Tumai - Auckland, Te Whatu Ora, Auckland, New Zealand.
- Faculty of Medical and Health Sciences, Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
| | - Ann McKillop
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Sîan A Williams
- School of Allied Health, Curtin University, Perth, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
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See MSN, Ereno IL, Teh WY, Baral VR, Vaughan RD, Yeo CL. Agreement between Hammersmith Neonatal Neurological Examination (HNNE) and Test of Infant Motor Performance (TIMP) in neurodevelopmental assessment of preterm infants <32 weeks' gestation at term corrected age. Early Hum Dev 2024; 190:105973. [PMID: 38377881 DOI: 10.1016/j.earlhumdev.2024.105973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To determine the agreement between HNNE and TIMP at TCA for preterm infants born <32+0 weeks' gestation, and to evaluate their correlation to PDMS-2 at 12-month corrected age (CA). METHODS Infants born between November 2013 to June 2022 who had both HNNE and TIMP performed at TCA of 37+0-41+6 weeks gestation, and motor outcome assessed using the PDMS-2 at 12-month old were enrolled. The HNNE and 12-month PDMS-2 findings were categorized as optimal vs sub-optimal. TIMP was categorized as typical vs atypical. Cohen's kappa was used to determine the agreement between HNNE and TIMP. Sensitivity analysis and Receiver Operating Characteristic (ROC) curves were used to evaluate the predictive values of HNNE and TIMP on motor outcome at CA of 12-months. RESULTS HNNE and TIMP done on 125 infants at TCA do not show reliable agreement. HNNE demonstrated slight and fair agreement with the 12-month Total Motor Quotient (TMQ) and Fine Motor Quotient (FMQ) of the PDMS-2 respectively. TIMP at TCA demonstrated fair agreement with all sub-domains of motor function on PDMS-2 at 12-months. In comparison with TIMP, HNNE at TCA is more sensitive at predicting suboptimal total, gross and fine motor outcomes at 12-month CA with sensitivity of 68.4 %, 51.9 %, and 83.3 % vs 44.4 %, 31.8 % and 53.3 % respectively. Atypical TIMP at TCA is more specific for suboptimal total, gross and fine motor outcomes at 12-month CA with specificity of 90.3 %, 89 % and 90.5 % respectively. Neurobehavioral assessments at TCA using HNNE and TIMP were predictive of suboptimal fine motor quotient at CA of 12-months with AUC of 0.760 (p = 0.011) and 0.718 (p = 0.032) respectively. The difference in AUC between the 2 instruments of 0.042 was not statistically significant (p = 0.741). CONCLUSIONS While the HNNE and TIMP done at TCA did not demonstrate significant agreement, suboptimal HNNE and atypical TIMP at TCA were predictive of suboptimal FMQ on PDMS-2 at 12-month CA.
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Affiliation(s)
| | - Imelda Lustestica Ereno
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wan Ying Teh
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Vijayendra Ranjan Baral
- Duke-NUS Medical School, Singapore; Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, National Technological University of Singapore, Singapore
| | | | - Cheo Lian Yeo
- Duke-NUS Medical School, Singapore; Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, National Technological University of Singapore, Singapore.
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Carton de Tournai A, Herman E, Gathy E, Ebner-Karestinos D, Araneda R, Dricot L, Macq B, Vandermeeren Y, Bleyenheuft Y. Baby HABIT-ILE intervention: study protocol of a randomised controlled trial in infants aged 6-18 months with unilateral cerebral palsy. BMJ Open 2024; 14:e078383. [PMID: 38367973 PMCID: PMC10875549 DOI: 10.1136/bmjopen-2023-078383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/31/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Research using animal models suggests that intensive motor skill training in infants under 2 years old with cerebral palsy (CP) may significantly reduce, or even prevent, maladaptive neuroplastic changes following brain injury. However, the effects of such interventions to tentatively prevent secondary neurological damages have never been assessed in infants with CP. This study aims to determine the effect of the baby Hand and Arm Bimanual Intensive Therapy Including Lower Extremities (baby HABIT-ILE) in infants with unilateral CP, compared with a control intervention. METHODS AND ANALYSIS This randomised controlled trial will include 48 infants with unilateral CP aged (corrected if preterm) 6-18 months at the first assessment. They will be paired by age and by aetiology of the CP, and randomised into two groups (immediate and delayed). Assessments will be performed at baseline and at 1 month, 3 months and 6 months after baseline. The immediate group will receive 50 hours of baby HABIT-ILE intervention over 2 weeks, between first and second assessment, while the delayed group will continue their usual activities. This last group will receive baby HABIT-ILE intervention after the 3-month assessment. Primary outcome will be the Mini-Assisting Hand Assessment. Secondary outcomes will include behavioural assessments for gross and fine motricity, visual-cognitive-language abilities as well as MRI and kinematics measures. Moreover, parents will determine and score child-relevant goals and fill out questionnaires of participation, daily activities and mobility. ETHICS AND DISSEMINATION Full ethical approval has been obtained by the Comité d'éthique Hospitalo-Facultaire/Université catholique de Louvain, Brussels (2013/01MAR/069 B403201316810g). The recommendations of the ethical board and the Belgian law of 7 May 2004 concerning human experiments will be followed. Parents will sign a written informed consent ahead of participation. Findings will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT04698395. Registered on the International Clinical Trials Registry Platform (ICTRP) on 2 December 2020 and NIH Clinical Trials Registry on 6 January 2021. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT04698395?term=bleyenheuft&draw=1&rank=7.
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Affiliation(s)
| | - Enimie Herman
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Estelle Gathy
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Neurology Department, Stroke Unit/Motor Learning Lab, CHU UCL Namur, Yvoir, Belgium
| | - Daniela Ebner-Karestinos
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andrés Bello, Santiago, Chile
| | - Rodrigo Araneda
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andrés Bello, Santiago, Chile
| | - Laurence Dricot
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Louvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Benoît Macq
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTM), Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Yves Vandermeeren
- Neurology Department, Stroke Unit/Motor Learning Lab, CHU UCL Namur, Yvoir, Belgium
- Louvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Louvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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Maitre NL. Early cerebral palsy motor therapies research: Hope springs and science matters. Dev Med Child Neurol 2024; 66:145-146. [PMID: 37697819 DOI: 10.1111/dmcn.15752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
This commentary is on the original article by Prosser et al. on pages 233–243 of this issue.
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Affiliation(s)
- Nathalie L Maitre
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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De Campos AC, Hidalgo-Robles Á, Longo E, Shrader C, Paleg G. F-words e ingredientes das intervenções precoces para crianças com paralisia cerebral não deambuladoras: uma revisão de escopo. Dev Med Child Neurol 2024; 66:e12-e22. [PMID: 37491829 DOI: 10.1111/dmcn.15717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 07/27/2023]
Abstract
Cuidados centrados na família (incluindo coaching e intervenções fornecidas pelo cuidador) e treinamento parental formal são estratégias eficazes para crianças nos níveis IV e V do GMFCS. Os ingredientes de tecnologia assistiva podem promover várias F-words (funcionalidade, saúde, família, diversão, amigos e futuro). O menor nível de evidência foi encontrado para diversão, amigos e futuro. Outros fatores (prestação de serviços, treinamento profissional, dose de terapia, modificações ambientais) são relevantes para crianças pequenas nos níveis IV e V do GMFCS. Esta revisão de escopo identificou os ingredientes de intervenções precoces para crianças com paralisia cerebral em risco de não serem deambuladoras, e os mapeou-os de acordo com a estrutura das F-words. O treinamento formal dos pais e a tecnologia assistiva se destacaram como estratégias para abordar com várias F-words.
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Affiliation(s)
| | | | - Egmar Longo
- Departamento de Fisioterapia em Pediatria, Universidade Federal da Paraíba, PB, Brasil
| | - Claire Shrader
- HMS School for Children with Cerebral Palsy, Philadelphia, PA, USA
| | - Ginny Paleg
- Montgomery County Infants and Toddlers Program, Rockville, MD, USA
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De Campos AC, Hidalgo-Robles Á, Longo E, Shrader C, Paleg G. F-words and early intervention ingredients for non-ambulant children with cerebral palsy: A scoping review. Dev Med Child Neurol 2024; 66:41-51. [PMID: 37381598 DOI: 10.1111/dmcn.15682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023]
Abstract
AIM To explore the ingredients of early interventions provided to young children with cerebral palsy (CP) who are classified in Gross Motor Function Classification System (GMFCS) levels IV and V, and to identify the 'F-words' addressed by the interventions. METHOD Searches were completed in four electronic databases. Inclusion criteria were the original experimental studies that fitted the following PCC components: population, young children (aged 0-5 years, at least 30% of the sample) with CP and significant motor impairment (GMFCS levels IV or V, at least 30% of the sample); concept, non-surgical and non-pharmacological early intervention services measuring outcomes from any of the International Classification of Functioning, Disability and Health domains; and context, studies published from 2001 to 2021, from all settings and not limited to any specific geographical location. RESULTS Eighty-seven papers were included for review, with qualitative (n = 3), mixed-methods (n = 4), quantitative descriptive (n = 22), quantitative non-randomized (n = 39), and quantitative randomized (n = 19) designs. Fitness (n = 59), family (n = 46), and functioning (n = 33) ingredients were addressed by most experimental studies, whereas studies on fun (n = 6), friends (n = 5), and future (n = 14) were scarce. Several other factors (n = 55) related to the environment, for example, service provision, professional training, therapy dose, and environmental modifications, were also relevant. INTERPRETATION Many studies positively supported formal parent training and use of assistive technology to promote several F-words. A menu of intervention ingredients was provided, with suggestions for future research, to incorporate them into a real context within the family and clinical practice. WHAT THIS PAPER ADDS Family-centred care (including coaching and caregiver-delivered interventions) and formal parental training are effective strategies for children in GMFCS levels IV and V. Assistive technology ingredients (power, mobility, supported, sitting, stepping, and standing) may promote several 'F-words' (functioning, fitness, family, fun, friends, and future). The lowest level of evidence was found for fun, friends, and future. Other factors (service provision, professional training, therapy dose, environmental modifications) are relevant for young children in GMFCS levels IV and V.
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Affiliation(s)
- Ana Carolina De Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos-, SP, Brazil
| | | | - Egmar Longo
- Department of Physical therapy in Pediatrics, Federal University of Paraíba, João Pessoa-, PB, Brazil
| | - Claire Shrader
- HMS School for Children with Cerebral Palsy, Philadelphia, PA, USA
| | - Ginny Paleg
- Montgomery County Infants and Toddlers Program, Rockville, MD, USA
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De Campos AC, Hidalgo-Robles Á, Longo E, Shrader C, Paleg G. F-Wörter und Interventionsinhalte in der Frühförderung nicht gehfähiger Kinder mit Cerebralparese: eine umfangreiche Literaturübersicht. Dev Med Child Neurol 2024; 66:e23-e34. [PMID: 37740649 DOI: 10.1111/dmcn.15756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
AbstractZielUntersuchung der Inhalte von Frühfördermaßnahmen für Kleinkinder mit Cerebralparese (CP) mit Gross Motor Function Classification System (GMFCS) Level IV und V und die Identifikation von „F‐Wörtern“, die von den Maßnahmen adressiert werden.MethodeRecherche in vier elektronischen Datenbanken. Einschlusskriterien: experimentelle Originalstudien, die die folgenden PCC‐Komponenten erfüllten: Population: Kleinkinder (im Alter von 0–5 Jahre, mindestens 30% der Stichprobe) mit CP und erheblicher motorischer Beeinträchtigung (GMFCS‐Levels IV oder V, mindestens 30% der Stichprobe); Konzept: nicht‐chirurgische und nicht‐pharmakologische Leistungen der Frühförderung, die Ergebnisse aus einem der Bereiche der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) messen; und Kontext: Studien, die zwischen 2001 und 2021 veröffentlicht wurden, in allen Konstellationen und nicht auf einen bestimmten geografischen Ort beschränkt.Ergebnisse87 Studien wurden in dieser Literaturübersicht berücksichtigt, mit qualitativen (n = 3), Mixed Methods (n = 4), quantitativ deskriptiven (n = 22), quantitativ nicht‐randomisierten (n = 39) und quantitativ randomisierten (n = 19) Designs. Die meisten experimentellen Studien befassten sich mit Fitness (n = 59), Familie (n = 46) und Funktion (n = 33), während es nur wenige Studien zu den Bereichen Spaß (n = 6), Freunde (n = 5) und Zukunft (n = 14) gab. Verschiedene Umweltfaktoren (n = 55) waren ebenfalls bedeutsam, z. B. das Angebot an Dienstleistungen, Berufsausbildung, Therapiedosis und Umweltanpassungen.InterpretationViele Studien unterstützen Elternschulungen und den Einsatz assistiver Technologien zur Förderung verschiedener F‐Wörter. Ein „Menü“ von Inhalten der Frühförderung wurden ermittelt, mit Vorschlägen für weitere Forschung, um diese in der klinischen Praxis mit Familien umzusetzen.Was dieser Artikel beiträgt
Familienzentrierte Angebote (einschließlich Beratung von und Intervention durch die Bezugspersonen) und strukturiertes Elterntraining sind wirksame Strategien für Kinder in den GMFCS‐Levels IV und V.
Hilfsmittel (Elektromobilität, unterstütztes Sitzen, Stehen und Gehen) können verschiedene „F‐Wörter“ fördern (Funktion, Fitness, Familie, Spaß, Freunde und Zukunft).
Die geringste Menge an Evidenz wurde für Spaß, Freunde und Zukunft gefunden.
Andere Faktoren (Angebot an Dienstleistungen, Berufsausbildung, Therapiedosis, Umweltanpassungen) sind relevant für Kleinkinder der GMFCS‐Levels IV und V.
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Affiliation(s)
- Ana Carolina De Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | | | - Egmar Longo
- Department of Physical therapy in Pediatrics, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Claire Shrader
- HMS School for Children with Cerebral Palsy, PA, Philadelphia, USA
| | - Ginny Paleg
- Montgomery County Infants and Toddlers Program, Early Childhood Services, MD, Rockville, USA
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de Campos AC, Hidalgo-Robles Á, Longo E, Shrader C, Paleg G. F-words e ingredientes de las intervenciones tempranas dirigidas a niños no ambulantes con parálisis cerebral: Una revisión exploratoria. Dev Med Child Neurol 2024; 66:e1-e11. [PMID: 37491808 DOI: 10.1111/dmcn.15716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
La atención centrada en la familia (incluyendo coaching e intervenciones realizadas por los cuidadores) y el entrenamiento formal de los padres son estrategias efectivas para los niños con niveles IV y V de la GMFCS. Los ingredientes de la tecnología de apoyo pueden promover varias "F-words" (funcionamiento, estado físico, familia, diversión, amigos y futuro). Se encontró el nivel más bajo de evidencia para diversión, amigos y futuro. Otros factores (provisión de servicios, formación profesional, dosis de terapia, modificaciones del entorno) son relevantes para los niños pequeños con niveles IV y V de la GMFCS. Ingredientes de la intervención y F-words en intervenciones tempranas dirigidas a niños no ambulantes con parálisis cerebral.
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Affiliation(s)
- Ana Carolina de Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, -SP, Brazil
| | | | - Egmar Longo
- Department of Physical therapy in Pediatrics, Federal University of Paraíba, João Pessoa, -PB, Brazil
| | - Claire Shrader
- HMS School for Children with Cerebral Palsy, Philadelphia, PA, USA
| | - Ginny Paleg
- Montgomery County Infants and Toddlers Program, Rockville, MD, USA
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Ayupe KMA, Dias IMBC, Cazeiro APM, de Campos AC, Longo E. Rehabilitation Practices Delivered by Physical and Occupational Therapists to Brazilian Children With Congenital Zika Syndrome: A Cross-Sectional Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300219. [PMID: 38123996 PMCID: PMC10749651 DOI: 10.9745/ghsp-d-23-00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Congenital Zika syndrome (CZS) is a health condition that has affected the development of thousands of children in Brazil. Because it is a new condition, its understanding is an ongoing process. Therefore, it is important to know the rehabilitation interventions being delivered to improve the functioning of these children. We aimed to describe the practices of physical therapists (PTs) and occupational therapists (OTs) who provide follow-up care for children with CZS in Brazil. METHODS This cross-sectional study included PTs and OTs who assist children with CZS in Brazil. An online questionnaire was used to verify the participants' personal characteristics and professional work environment, as well as the rehabilitation programs they implemented in Brazil for children with CZS. Data were analyzed using descriptive statistics. RESULTS A total of 116 professionals (79 PT and 37 OT) who work mainly in public health services (81.9%) participated in the study. Of these, 24.1% plan interventions based on reading scientific articles, 66.4% did not report using the biopsychosocial model, 52.6% do not perform any assessments before starting an intervention, 31.9% use neurodevelopmental treatment, and 22.4% use sensorimotor stimulation interventions. The majority of the interventions are delivered 1 to 2 times a week, lasting up to 1 hour. CONCLUSIONS Professional training and knowledge translation strategies are needed to implement evidence-based practices and improve the quality of rehabilitation programs for Brazilian children with CZS.
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Affiliation(s)
- Kennea Martins Almeida Ayupe
- Department of Integrated Health Education, Center for Health Sciences, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
| | - Ianka Maria Bezerra Cunha Dias
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Faculty of Health Sciences of Trairi, Santa Cruz, Rio Grande do Norte, Brazil
| | | | - Ana Carolina de Campos
- Postgraduate Program in Physical Therapy, Universidade Federal do São Carlos, São Carlos, São Paulo, Brazil
| | - Egmar Longo
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Faculty of Health Sciences of Trairi, Santa Cruz, Rio Grande do Norte, Brazil
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McLeod KL, Thorley M, Reedman SE, Chatfield MD, Sakzewski L. Effect of Active Motor Learning Interventions on Gross Motor Function and Mobility in Children Aged 2 to 6 Years With Bilateral Cerebral Palsy: A Systematic Review and Meta-analysis. Pediatr Phys Ther 2023; 35:412-428. [PMID: 37656984 DOI: 10.1097/pep.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE The purpose of this systematic review is to identify evidence-based interventions to promote active motor learning in children aged 2 to 6 years with bilateral cerebral palsy. SUMMARY OF KEY POINTS Seven randomized clinical trials of active motor learning interventions targeting gross motor function and mobility were included. Two studies compared context-focused therapy to child-focused therapy. Five studies compared active motor therapy to usual care. Context-focused therapy, child-focused therapy, and active motor therapy were comparable to usual care to improve functional mobility and gross motor function. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE There are limited active intervention studies targeting gross motor function for young children with bilateral cerebral palsy. The authors recommend consideration of the clinical good practice guidelines, dosage parameters, and improved reporting methods when implementing active motor learning interventions targeting gross motor function and mobility for children with cerebral palsy.
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Affiliation(s)
- Kate L McLeod
- Faculty of Medicine (Ms McLeod, Drs Reedman and Sakzewski, and Mr Chatfield), Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia; Queensland Paediatric Rehabilitation Service (Ms McLeod and Dr Thorley), Queensland Children's Hospital, Brisbane, Queensland, Australia
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Deng W, Anastasopoulos S, deRegnier RA, Pouppirt N, Barlow AK, Patrick C, O’Brien MK, Babula S, Sukal-Moulton T, Peyton C, Morgan C, Rogers JA, Lieber RL, Jayaraman A. Protocol for a randomized controlled trial to evaluate a year-long (NICU-to-home) evidence-based, high dose physical therapy intervention in infants at risk of neuromotor delay. PLoS One 2023; 18:e0291408. [PMID: 37725613 PMCID: PMC10508609 DOI: 10.1371/journal.pone.0291408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Developmental disabilities and neuromotor delay adversely affect long-term neuromuscular function and quality of life. Current evidence suggests that early therapeutic intervention reduces the severity of motor delay by harnessing neuroplastic potential during infancy. To date, most early therapeutic intervention trials are of limited duration and do not begin soon after birth and thus do not take full advantage of early neuroplasticity. The Corbett Ryan-Northwestern-Shirley Ryan AbilityLab-Lurie Children's Infant Early Detection, Intervention and Prevention Project (Project Corbett Ryan) is a multi-site longitudinal randomized controlled trial to evaluate the efficacy of an evidence-based physical therapy intervention initiated in the neonatal intensive care unit (NICU) and continuing to 12 months of age (corrected when applicable). The study integrates five key principles: active learning, environmental enrichment, caregiver engagement, a strengths-based approach, and high dosage (ClinicalTrials.gov identifier NCT05568264). METHODS We will recruit 192 infants at risk for neuromotor delay who were admitted to the NICU. Infants will be randomized to either a standard-of-care group or an intervention group; infants in both groups will have access to standard-of-care services. The intervention is initiated in the NICU and continues in the infant's home until 12 months of age. Participants will receive twice-weekly physical therapy sessions and caregiver-guided daily activities, assigned by the therapist, targeting collaboratively identified goals. We will use various standardized clinical assessments (General Movement Assessment; Bayley Scales of Infant and Toddler Development, 4th Edition (Bayley-4); Test of Infant Motor Performance; Pediatric Quality of Life Inventory Family Impact Module; Alberta Infant Motor Scale; Neurological, Sensory, Motor, Developmental Assessment; Hammersmith Infant Neurological Examination) as well as novel technology-based tools (wearable sensors, video-based pose estimation) to evaluate neuromotor status and development throughout the course of the study. The primary outcome is the Bayley-4 motor score at 12 months; we will compare scores in infants receiving the intervention vs. standard-of-care therapy.
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Affiliation(s)
- Weiyang Deng
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | | | - Raye-Ann deRegnier
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nicole Pouppirt
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ann K. Barlow
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Cheryl Patrick
- Division of Rehabilitative Services, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Megan K. O’Brien
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
| | - Sarah Babula
- Pathways.org, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John A. Rogers
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Departments of Materials Science and Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, United States of America
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Richard L. Lieber
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Jessie Brown Jr., Hines V.A. Medical Center, Hines, Illinois, United States of America
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Tanner K, O'Rourke S, Cunningham K, Duffin V, Maitre N. Implementing Parent Coaching in Hospital-Based Pediatric Occupational Therapy: A Multisite Quality Improvement Project. Am J Occup Ther 2023; 77:7705205120. [PMID: 37756516 DOI: 10.5014/ajot.2023.050243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
IMPORTANCE Parent coaching (PC) is a best practice for young children with, or at high risk for, cerebral palsy (CP). Occupational therapy practitioners in outpatient settings encounter barriers to implementing PC. OBJECTIVE To increase the documented use of PC in outpatient occupational therapy visits for children younger than age 2 yr with, or at high risk for, CP from 0% to 80%. DESIGN Multicenter quality improvement (QI) initiative with a time-series design. SETTING Three pediatric tertiary-care institutions, each with multiple outpatient occupational therapy clinics. PARTICIPANTS Practitioners in the outpatient clinics and patients <2 yr old with, or at high risk for, cerebral palsy. INTERVENTION Plan-do-study-act cycles included interventions packaged as a toolkit: education sessions, quick references, electronic medical record (EMR) supports, and site-specific strategies. OUTCOMES AND MEASURES The primary outcome measure was the use of PC in outpatient sessions. Process measures included pre- and posteducation practitioner knowledge scores and an EMR checklist. Balancing measures (ensuring that changes do not cause problems in other areas) of parent satisfaction/experience and practitioner productivity were measured pre- and postintervention. RESULTS The primary outcome measure goal (80% documented use of PC in sessions) was attained in the seventh month of the study, sustained for 4 mo, and settled at 79.1% for the remaining 6 mo. Practitioner knowledge scores increased from 83.1% to 87.9% after initial education sessions, t[56] = 3.289, p = .001. Parent satisfaction/experience and practitioner productivity scores did not change. CONCLUSIONS AND RELEVANCE QI methodology can support PC implementation in pediatric outpatient practice. What This Article Adds: This multisite QI initiative shows that outpatient occupational therapy practitioners can implement PC as a best practice with the use of a toolkit. Results suggest that education alone does not result in changes to practitioner behavior and that QI methods can help when implementing best practices in a clinical setting.
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Affiliation(s)
- Kelly Tanner
- Kelly Tanner, PhD, OTR/L, BCP, is Clinical Therapies Research Scientist, Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH;
| | - Sara O'Rourke
- Sara O'Rourke, MOT, OTR/L, BCP, is Outpatient Occupational Therapy Program Manager, Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | - Kristin Cunningham
- Kristin Cunningham, MS, OTR/L, BCP, is Clinical Specialist, Occupational Therapy Department, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Valerie Duffin
- Valerie Duffin, MOT, OTR/L, is Rehab Manager, Primary Children's Rehab, Primary Children's Hospital, Salt Lake City, UT
| | - Nathalie Maitre
- Nathalie Maitre, MD, PhD, is Professor and Director of Early Development and Cerebral Palsy Research, Division of Neonatology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
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22
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Verhage CH, Gorter JW, Takken T, Benders MJNL, de Vries LS, van der Aa NE, Wagenaar N. Detecting Asymmetry of Upper Limb Activity with Accelerometry in Infants at Risk for Unilateral Spastic Cerebral Palsy. Phys Occup Ther Pediatr 2023; 44:1-15. [PMID: 37318108 DOI: 10.1080/01942638.2023.2218478] [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: 09/06/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
AIMS To examine whether accelerometry can quantitate asymmetry of upper limb activity in infants aged 3-12 months at risk for developing unilateral spastic cerebral palsy (USCP). METHOD A prospective study was performed in 50 infants with unilateral perinatal brain injury at high risk of developing USCP. Triaxial accelerometers were worn on the ipsilateral and contralesional upper limb during the Hand Assessment for Infants (HAI). Infants were grouped in three age intervals (3-5 months, 5-7.5 months and 7.5 until 12 months). Each age interval group was divided in a group with and without asymmetrical hand function based on HAI cutoff values suggestive of USCP. RESULTS In a total of 82 assessments, the asymmetry index for mean upper limb activity was higher in infants with asymmetrical hand function compared to infants with symmetrical hand function in all three age groups (ranging from 41 to 51% versus - 2-6%, p < 0.01), while the total activity of both upper limbs did not differ. CONCLUSIONS Upper limb accelerometry can identify asymmetrical hand function in the upper limbs in infants with unilateral perinatal brain injury from 3 months onwards and is complementary to the Hand Assessment for Infants.
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Affiliation(s)
- Cornelia H Verhage
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Willem Gorter
- Pediatric Rehabilitation Medicine, Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Takken
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nienke Wagenaar
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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23
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Jawed A, Mowry M. Strengthening Equitable Access to Care and Support for Children with Cerebral Palsy and Their Caregivers. CHILDREN (BASEL, SWITZERLAND) 2023; 10:994. [PMID: 37371227 DOI: 10.3390/children10060994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Cerebral palsy is one of the most prevalent groups of motor disorders affecting children and adults across the world. As increasingly more children with cerebral palsy are living longer into adulthood, it is ever more crucial to ensure access to timely and needed early intervention from the onset of diagnosis, on a continuum, to optimize medical, developmental, socio-emotional, and academic outcomes for these children over time. The American Academy of Pediatrics (AAP), in collaboration with the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM), substantially revised the clinical practice guidelines for cerebral palsy in 2022, after their prior publication of the guidelines in 2006. The revised guidelines account for a range of considerations that are in line with the biopsychosocial, risk and resilience, and family-centered care models as well as promote a more strengths-based approach to care. Furthermore, there is increased emphasis in the guidelines on promoting equitable access to care as part of contributing towards health equity for all children with cerebral palsy. In addition, the 2022 guidelines clearly present recommendations for earlier diagnosis of cerebral palsy, potentially as early as infancy, as the basis for activating access to early intervention services for children that can bolster their neuroplasticity and global development from an earlier age onward. We consolidate the existing literature on caregiver perceptions, beliefs and concerns surrounding earlier diagnosis of cerebral palsy and connect them to the recommendations in the revised guidelines. We also delineate several considerations surrounding education for healthcare providers and caregivers of children in navigating the chronicity of cerebral palsy in both community and healthcare contexts. There is a scant amount of literature on cerebral palsy across traditional and nontraditional sources of media in published studies, which we also review. Lastly, we present a wealth of recommendations for further research and practice that account for the revised 2022 guidelines, caregiver preferences and acceptability of care, and health equity as the bases for strengthening equitable access to care for children with cerebral palsy on a continuum as they transition into adulthood.
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Affiliation(s)
- Aysha Jawed
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Social Work, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
| | - Michelle Mowry
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Nursing, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
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24
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Haddon M, West L, Elliott C, Walmsley C, Valentine J, Bear N, Pool D. Kindy Moves: the feasibility of an intensive interdisciplinary programme on goal and motor outcomes for preschool-aged children with neurodisabilities requiring daily equipment and physical assistance. BMJ Open 2023; 13:e068816. [PMID: 37169503 DOI: 10.1136/bmjopen-2022-068816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES To determine the feasibility of an intensive interdisciplinary programme in improving goal and motor outcomes for preschool-aged children with non-progressive neurodisabilities. The primary hypothesis was that the intervention would be feasible. DESIGN A single group feasibility study. SETTING An Australian paediatric community therapy provider. PARTICIPANTS Forty children were recruited. Inclusion criteria were age 2-5 years with a non-progressive neurodisability, Gross Motor Function Classification System (GMFCS) levels III-V or equivalent, and goals relating to mobility, communication and upper limb function. Exclusion criteria included orthopaedic surgery in the past 6 months, unstable hip subluxation, uncontrolled seizure disorder or treadmill training in the past month. INTERVENTION A goal-directed programme of three 2-hour sessions per week for 4 weeks (24 hours total). This consisted of treadmill and overground walking, communication practice, and upper limb tasks tailored by an interdisciplinary team. PRIMARY AND SECONDARY OUTCOME MEASURES Limited-efficacy measures from preintervention (T1) to postintervention (T2) and 4-week follow-up (T3) included the Goal Attainment Scaling (GAS), Canadian Occupational Performance Measure (COPM), Gross Motor Function Measure (GMFM-66) and 10-Metre Walk Test (10MWT). Acceptability, demand, implementation and practicality were also explored. RESULTS There were improvements at T2 compared with T1 for all limited-efficacy measures. The GAS improved at T2 (mean difference (MD) 27.7, 95% CI 25.8 to 29.5) as well as COPM performance (MD 3.2, 95% CI 2.8 to 3.6) and satisfaction (MD 3.3, 95% CI 2.8 to 3.8). The GMFM-66 (MD 2.3, 95% CI 1.0 to 3.5) and 10MWT (median difference -2.3, 95% CI -28.8 to 0.0) improved at T2. Almost all improvements were maintained at T3. Other feasibility components were also demonstrated. There were no adverse events. CONCLUSIONS An intensive interdisciplinary programme is feasible in improving goal and motor outcomes for preschool children with neurodisabilities (GMFCS III-V or equivalent). A randomised controlled trial is warranted to establish efficacy. TRIAL REGISTRATION NUMBER ACTRN12619000064101.
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Affiliation(s)
- Matthew Haddon
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Loren West
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Catherine Elliott
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Corrin Walmsley
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Jane Valentine
- Telethon Kids Institute, Perth, Western Australia, Australia
- Paediatric Rehabilitation, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Dayna Pool
- The Healthy Strides Foundation, Perth, Western Australia, Australia
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25
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Shahane V, Kumavor P, Morgan K, Friel KM, Srinivasan SM. A protocol for a single-arm interventional study assessing the effects of a home-based joystick-operated ride-on-toy navigation training programme to improve affected upper extremity function and spontaneous use in children with unilateral cerebral palsy (UCP). BMJ Open 2023; 13:e071742. [PMID: 37160396 PMCID: PMC10173997 DOI: 10.1136/bmjopen-2023-071742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION Children with unilateral cerebral palsy (UCP) face significant limitations in upper extremity (UE) function and require effective interventions that promote intensive goal-directed practice while maximising motivation and adherence with therapy. This study builds on our past work and will assess the effects of a 6-week researcher-caregiver codelivered, home-based ride-on-toy navigation training (RNT) programme in young children with UCP. We hypothesise that the RNT programme will be acceptable, feasible to implement, and lead to greater improvements in unimanual and bimanual function when combined with conventional therapy, compared with conventional therapy provided alone. METHODS AND ANALYSIS 15 children with UCP between 3 and 8 years will be recruited. During the 6-week control phase, participants will receive treatement-as-usual alone. During the subsequent 6-week intervention phase, in addition to conventional therapy, RNT will be provided 4-5 times/week (2 times by researchers, 2-3 times by caregivers), 30-45 min/session. We will assess UE function using standardised tests (Quality of Upper Extremity Skills Test and Shriner's Hospital Upper Extremity Evaluation), reaching kinematics, wrist-worn accelerometry, caregiver-rated ABILHAND-Kids questionnaire, and training-specific measures of movement control during RNT. Programme feasibility and acceptance will be assessed using device use metrics, child and caregiver exit questionnaires, training-specific measures of child engagement, and the Physical Activity Enjoyment Scale. All assessments will be conducted at pretest, following the control phase (midpoint), and after completion of the intervention phase (post-test). ETHICS AND DISSEMINATION The study is approved by the Institutional Review Board of the University of Connecticut (# H22-0059). Results from this study will be disseminated through peer-reviewed manuscripts in scientific journals in the field, through national and international conferences, and through presentations to parent advocacy groups and other support organisations associated with CP. TRIAL REGISTRATION NUMBER NCT05559320.
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Affiliation(s)
- Vaishnavi Shahane
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, Connecticut, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
| | - Patrick Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, Connecticut, USA
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, Connecticut, USA
| | - Kathleen M Friel
- Burke Neurological Institute, White Plains, New York, USA
- Brain Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Sudha Madhav Srinivasan
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, Connecticut, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
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26
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Caesar RA, Boyd RN, Cioni G, Ware RS, Doherty J, Jackson MP, Salthouse KL, Colditz PB. Early detection of developmental delay in infants born very preterm or with very low birthweight. Dev Med Child Neurol 2023; 65:346-357. [PMID: 37017185 PMCID: PMC10952560 DOI: 10.1111/dmcn.15381] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/19/2022]
Abstract
AIM This study aimed to identify early clinical biomarkers from birth to 16 weeks corrected age to predict typical outcome and developmental delay in infants born very preterm or with very low birthweight. METHOD A prospective cohort of infants on the Sunshine Coast, Australia, was assessed using the Premie-Neuro Examination, the General Movement Assessment (GMA), the Alberta Infant Motor Scale, and the Infant Sensory Profile 2. At 24 months corrected age, delay was identified using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and Neurosensory Motor Developmental Assessment (NSMDA). RESULTS One hundred and four infants were recruited; 79 completed outcome assessments (43 females, 36 males; mean gestational age 30 weeks [SD 1 week 6 days], mean birthweight 1346 g [SD 323]). The incidence of developmental delay (motor or cognitive) was 6.3%. Suboptimal quality of fidgety general movements (temporal organization) at 16 weeks corrected age demonstrated the best predictive accuracy (Bayley-III motor: sensitivity 100% [95% confidence interval {CI} 3-100], specificity 75% [95% CI 63-84], area under the curve [AUC] 0.87); Bayley-III cognitive: sensitivity 100% [95% CI 3-100], specificity 75% [95% CI 64-84], AUC 0.88); NSMDA motor: sensitivity 100% [95% CI 40-100], specificity 81% [95% CI 70-90], AUC 0.91 [95% CI 0.86-0.95]). GMA trajectories that combined abnormal writhing general movements at 4 to 5 weeks corrected age with suboptimal quality of fidgety movement at 16 weeks corrected age were strongly predictive of developmental delay, superior to all other clinical tools, and perinatal and demographic variables investigated (p = 0.01, Akaike information criterion method 18.79 [score corrected for small sample size], accounting for 93% of the cumulative weight). INTERPRETATION Only the GMA had sufficient predictive validity to act as a biomarker for both conditions: typical outcome and developmental delay (motor or cognitive). GMA trajectories that assessed both writhing general movements at 4 to 5 weeks corrected age and quality of fidgety movement at 16 weeks corrected age predicted adverse neurodevelopmental outcome, accurately differentiating between infants with typical outcomes and those at increased risk for motor or cognitive delay.
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Affiliation(s)
- Rebecca A. Caesar
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of MedicineThe University of Queensland, Child Health Research CentreBrisbaneAustralia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of MedicineThe University of Queensland, Child Health Research CentreBrisbaneAustralia
| | - Giovanni Cioni
- Department of Developmental NeuroscienceIRCCS Fondazione Stella MarisPisaItaly
| | - Robert S. Ware
- Griffith University, Menzies Health Institute QueenslandGold CoastAustralia
| | - Julie Doherty
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
| | - Maxine P. Jackson
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
| | - Kaye L. Salthouse
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
| | - Paul B. Colditz
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of MedicineThe University of Queensland, Child Health Research CentreBrisbaneAustralia
- The University of Queensland Centre for Clinical Research, Faculty of MedicineThe University of Queensland, Royal Brisbane and Women's HospitalBrisbaneAustralia
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27
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Abstract
Early childhood affords rapid brain development and advancement of the motor system. In High-Risk Infant Follow-Up programs, watchful waiting and monitoring of infants at high risk is shifting toward active surveillance and early diagnosis, followed by immediate targeted very early interventions. Infants with delayed motor skills benefit from developmental care, NIDCAP, and generic or specific motor training. Infants with cerebral palsy benefit from enrichment, targeted skills interventions, and task-specific motor training at high intensity. Infants with degenerative conditions benefit from enrichment but also require accommodations such as powered mobility.
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Affiliation(s)
- Lynda McNamara
- The Children's Hospital Westmead Clinical School, The University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia.
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28
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Santos Sampaio SS, de Amorim Rodrigues NA, Moura JR, de Lima-Alvarez CD, Pereira SA. Effects of Prone Positioning on Head Control in Preterm Infants: Randomized and Controlled Clinical Trial Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2375. [PMID: 36767742 PMCID: PMC9915948 DOI: 10.3390/ijerph20032375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE The primary aim will be to assess the effects of prone positioning (tummy time) on cervical extension (angular kinematics and time) in preterm infants. The secondary aim will be to assess the effects of tummy time on gross motor function. METHODS This randomized, controlled clinical trial will include 40 preterm infants weighing less than 2500 g, randomly allocated into control or experimental group (n = 20) and followed up from birth to six months of corrected age by the team of the neonatal follow-up clinic. Caregivers will be routinely guided on bonding, developmental milestones, and how to perform the tummy time for 30 min throughout the day (experimental group). An illustrative booklet will be provided as support material. The hypothesis will be tested using inferential analysis, considering an alpha of 5%. DISCUSSION We expect tummy time to strengthen cervical muscles needed to overcome gravity, master motor skills, and stimulate the integration between family activity and environmental experiences, considerable challenges to which preterm infants are exposed. TRIAL REGISTRATION Registered in the Brazilian Registry of Clinical Trials (identifier RBR-2nwkr47) on 17 February 2022.
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Affiliation(s)
- Sabrinne Suelen Santos Sampaio
- Post-Graduation Program of Physiotherapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil
| | | | - Julia Raffin Moura
- Post-Graduate Program in Sciences of Rehabilitation, Universidade de Brasília (UNB), Brasília 72220-275, Distrito Federal, Brazil
| | - Carolina Daniel de Lima-Alvarez
- Departament of Physiotherapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil
| | - Silvana Alves Pereira
- Post-Graduation Program of Physiotherapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil
- Departament of Physiotherapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil
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29
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Longo E, Monteiro R, Hidalgo-Robles Á, Paleg G, Shrader C, De Campos AC. Assigning F-words as ingredients of interventions for children with cerebral palsy functioning at GMFCS IV and V: A scoping review protocol. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1110552. [PMID: 36873816 PMCID: PMC9978822 DOI: 10.3389/fresc.2023.1110552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/12/2023] [Indexed: 02/18/2023]
Abstract
Introduction Children with Cerebral Palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) levels IV and V require "on time" identification and intervention. Interventions offered continue to be a challenge, in high-, but even more so in middle-, and low-income countries. Aim To describe the methods developed to explore the ingredients of published studies on early interventions in young children with cerebral palsy (CP) at highest risk of being non-ambulant based on the "F-words for child development framework" and the design of a scoping review exploring these ingredients. Method An operational procedure was developed through expert panels to identify ingredients of published interventions and related F-words. After sufficient agreement among researchers was reached, a scoping review was designed. The review is registered in the Open Science Framework database. The "Population, Concept and Context" framework was used. Population: young children (0-5 years with CP and at highest risk for being non-ambulant (GMFCS levels IV or V); Concept: non-surgical and non-pharmacological early intervention services measuring outcomes from any ICF domain; Context: studies published from 2001 to 2021. After duplicated screening and selection, data will be extracted and quality will be assessed with the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) and Mixed Methods Appraisal (MMAT) tools. Results We present the protocol to identify the explicit (directly measured outcomes and respective ICF domains) and implicit (intervention features not explicitly intended or measured) ingredients. Conclusion Findings will support the implementation of the F-words in interventions for young children with non-ambulant CP.
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Affiliation(s)
- E Longo
- Department of Physical Therapy, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - R Monteiro
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Á Hidalgo-Robles
- Facultad de Educación, Universidad Internacional de La Rioja, Logroño, La Rioja, Spain
| | - G Paleg
- Montgomery County Infants and Toddlers Program, Rockville, MD, USA
| | - C Shrader
- HMS School for Children with Cerebral Palsy, Philadelphia, PA, USA
| | - A C De Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
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30
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Palomo-Carrión R, Pinero-Pinto E, Romay-Barrero H, Escobio-Prieto I, Lillo-Navarro C, Romero-Galisteo RP. Shall we start? Ready, set, go! Toward early intervention in infants with unilateral cerebral palsy. A randomized clinical trial protocol. Ther Adv Chronic Dis 2022; 13:20406223221136059. [PMID: 36420043 PMCID: PMC9676300 DOI: 10.1177/20406223221136059] [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: 06/01/2022] [Accepted: 10/14/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND It is crucial to start an early intervention in unilateral cerebral palsy. Intensive therapies are focused on training based on activities. OBJECTIVE The objective of the study was to study the changes in the bimanual functional performance (BFP) after early intensive therapies at home compared with standard care in children with unilateral cerebral palsy from 9 to 18 months of age. DESIGN A single-blind comparative effectiveness study will be conducted. METHODS AND ANALYSIS Children will be randomized into four groups: infant-mCIMT, infant-BIT, infant-hybrid, and infant standard therapy (control group, CG). Each early intensive protocol will last 50 h and will be applied throughout a 10-week period with the family involvement at home. The main outcomes are BFP measure with mini-Assisting Hand Assessment (mini-AHA) scale, functional goals measure with Goal Attainment Scale (GAS), and satisfaction and expectations on intensive therapy from parents measure through specific questionnaire. Baseline characteristics between groups will be compared using independent t test and Fisher's exact test. Pre- and post-treatment outcomes of standard assessments will be compared using analysis of variance (ANOVA) for parametric and Kruskal-Wallis test for non-parametric variables. The Bonferroni correction is applied for multiple comparisons. An alpha level of p ⩽ 0.05 is considered significant. DISCUSSION In relation to other studies that have analyzed intensive therapies, although with fewer intervention groups, it seems that the application of any of the intensive interventions is effective with the applied dose to obtain changes in BFP and increase the spontaneous use of the affected upper limb. REGISTRATION ClinicalTrials.gov Identifier: NCT04642872.
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Affiliation(s)
- Rocío Palomo-Carrión
- Faculty of Physiotherapy and Nursing, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla- La Mancha (UCLM), Toledo, Spain
- GIFTO Group, Group of researching in Physiotherapy, Toledo, Spain
| | - Elena Pinero-Pinto
- Faculty of Nursery, Physiotherapy and Podiatry, Department of Physiotherapy, University of Seville, Avicena Street, S/N, 41009 Seville, Spain
| | - Helena Romay-Barrero
- Faculty of Physiotherapy and Nursing, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla- La Mancha (UCLM), Toledo, Spain
- GIFTO Group, Group of researching in Physiotherapy, Toledo, Spain
| | - Isabel Escobio-Prieto
- Faculty of Nursery, Physiotherapy and Podiatry, Department of Physiotherapy, University of Seville, Seville, Instituto de Biomedicina de Sevilla (IBIS), Spain
| | - Carmen Lillo-Navarro
- Department of Pathology and Surgery and Center for Translational Research in Physical Therapy (CEIT), University Miguel Hernández, Alicante, Spain
| | - Rita-Pilar Romero-Galisteo
- Faculty of Health Sciences. Department of Physiotherapy, University of Málaga, Institute of Biomedicine of Málaga (IBIMA), Málaga, Spain
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31
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Chen D, Wu Y, Li H, Pan X, Zhou J. Treatment on patients with spastic cerebral palsy in the past 30 years: A systematic review and bibliometric analysis. Medicine (Baltimore) 2022; 101:e30535. [PMID: 36397367 PMCID: PMC9666139 DOI: 10.1097/md.0000000000030535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the past 30 years, treatments from different disciplines have been applied to spastic cerebral palsy (SCP). However, few bibliometric studies have been conducted to date. This study explored the knowledge base, emerging hotspots, and future trends related to SCP treatment research using bibliometric analysis. METHODS Publications on SCP treatment included in the Web of Science Core Collection database between 1990 and 2020 were retrieved, and Medical Subject Headings terms were extracted from PubMed. Online bibliometric analysis website (http://bibliometric.com/), 2 pieces of software called "CiteSpace" and "VOSViewer" were used for quantitative analysis and knowledge map establishment. RESULTS A total of 1668 papers were retrieved from 1990 to 2020. The number of publications has increased annually. Developmental Medicine and Child Neurology is the most productive and the highest co-cited journal. The United States has been the largest contributor. Vrije Universiteit Amsterdam ranked first in the number of papers published among institutions that have conducted correlational research. Becher JG and Graham HK should be considered scholars who have made outstanding contributions. The knowledge base of the SCP treatment research field is thoughtfully constructed to promote understanding of the field. CONCLUSION This bibliometric study identified global achievements, research hotspots, and trends of SCP treatment. They provide insights into the research field and valuable information for future scientific research and clinical treatment.
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Affiliation(s)
- Dingfang Chen
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Yuefeng Wu
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - HaiYing Li
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Xue Pan
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Jin Zhou
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Jin Zhou, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China (e-mail: )
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32
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Lima CRG, Abreu RWFD, Verdério BN, Brugnaro BH, Santos MMD, Dos Santos AN, Morgan C, Rocha NACF. Early Intervention Involving Specific Task-Environment-Participation (STEP) Protocol for Infants at Risk: A Feasibility Study. Phys Occup Ther Pediatr 2022; 43:303-320. [PMID: 36329671 DOI: 10.1080/01942638.2022.2142084] [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: 11/06/2022]
Abstract
Aims: To verify the feasibility and preliminary effects of the STEP protocol, an intervention based on specific motor skills, environmental factors and participation, in infants at biological risk.Methods: Twenty-eight at-risk infants (STEP Protocol = 14; Standard Intervention = 14), aged 3-9 months and at risk for developmental delay. The following outcomes were assessed: motor skills (Alberta Infant Motor Scale-AIMS); frequency and involvement of participation (Young Children's Participation and Environment Measure-YC-PEM), and home environment opportunities (Affordances in the Home Environment for Motor Development-AHEMD-IS). For both groups, interventions were provided by parents. The intervention for group was based on the following principles: (1) standard intervention: stimulation of motor skills; (2) STEP: stimulation of motor skills, participation, mother-infant interaction, environmental enrichment. A mean comparison test was applied to verify difference between groups after the intervention.Results: The protocol showed good retention and recruitment rates. The STEP group had significantly higher outcomes after intervention on the AIMS (p = 0.014); frequency (p = 0.02) and engagement (p = 0.03) in participation, when compared to standard intervention.Conclusions: The results showed that the STEP protocol is feasible, and presents better results compared to the standard intervention, which reinforces the importance of promoting participation, specific motor skills and family involvement.
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Affiliation(s)
- Camila Resende Gâmbaro Lima
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, São Carlos-SP, Brazil
| | | | - Bruna Nayara Verdério
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, São Carlos-SP, Brazil
| | - Beatriz Helena Brugnaro
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, São Carlos-SP, Brazil
| | - Mariana Martins Dos Santos
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, São Carlos-SP, Brazil
| | | | - Catherine Morgan
- School of Medicine, Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
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Baker A, Niles N, Kysh L, Sargent B. Effect of Motor Intervention for Infants and Toddlers With Cerebral Palsy: A Systematic Review and Meta-analysis. Pediatr Phys Ther 2022; 34:297-307. [PMID: 35671383 PMCID: PMC9574888 DOI: 10.1097/pep.0000000000000914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To conduct a systematic review and meta-analysis on the effect of motor intervention on motor function of infants and toddlers with cerebral palsy (CP). METHODS Four databases were searched for randomized controlled trials (RCTs) of motor interventions for children with or at high risk of CP younger than 36 months. Studies were excluded if less than 50% of children developed CP. RESULTS Eleven RCTs included 363 children; 85% diagnosed with CP. Very low-quality evidence supports that: (1) task-specific motor training was more effective than standard care for improving motor function (small effect), (2) constraint-induced movement therapy (CIMT) may be more effective than bimanual play or massage for improving function of the more affected hand (moderate effect), and high-intensity treadmill training is no more effective than low-intensity for improving walking. CONCLUSIONS Very low-quality evidence supports that task-specific motor training and CIMT may improve motor function of infants and toddlers with CP.The Supplemental Digital Content Video Abstract is available at: http://links.lww.com/PPT/A382 .
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Affiliation(s)
- Aubrey Baker
- Children’s Hospital of Los Angeles, Division of
Pediatric Rehabilitation Medicine, 4650 Sunset Blvd., Los Angeles, California
- University of Southern California, Division of
Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Los Angeles,
California
| | - Natalie Niles
- Children’s Hospital of Los Angeles, Division of
Pediatric Rehabilitation Medicine, 4650 Sunset Blvd., Los Angeles, California
- University of Southern California, Division of
Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Los Angeles,
California
| | - Lynn Kysh
- Children’s Hospital of Los Angeles, Institute for
Nursing and Interprofessional Research, 4650 Sunset Blvd., Los Angeles,
California
| | - Barbara Sargent
- University of Southern California, Division of
Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Los Angeles,
California
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Dusing SC, Harbourne RT, Hsu LY, Koziol NA, Kretch K, Sargent B, Jensen-Willett S, McCoy SW, Vanderbilt DL. The SIT-PT Trial Protocol: A Dose-Matched Randomized Clinical Trial Comparing 2 Physical Therapist Interventions for Infants and Toddlers With Cerebral Palsy. Phys Ther 2022; 102:6566428. [PMID: 35421222 PMCID: PMC9291380 DOI: 10.1093/ptj/pzac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/09/2022] [Accepted: 03/07/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Although early intervention for infants at risk for cerebral palsy is routinely recommended, the content of intervention is poorly described, varies widely, and has mixed supporting evidence. The purpose of this study was to compare efficacy of 2 interventions grounded in differing domains of the International Classification of Functioning, Disability and Health on developmental outcomes of infants with or at high risk of cerebral palsy. METHODS Infants who meet inclusion criteria will be randomized into either Sitting Together and Reaching To Play or Movement, Orientation, Repetition, Exercise Physical Therapy groups. Both groups will receive intervention twice weekly for 3 months and follow-up at 3, 6, 9, and 12 months from baseline. The primary objectives compare changes over time and between groups in sitting, gross motor, and cognitive development. The setting is the infant's home unless the caregiver requests otherwise. One hundred and fifty infants between 8 and 24 months of age will be enrolled in 3 geographically, racially, and ethnically diverse sites: Los Angeles, California; Omaha, Nebraska; and Seattle, Washington. Enrolled infants will demonstrate motor delays, emerging sitting skills, and signs of neurologic impairment. Sitting Together and Reaching To Play targets activities including sitting, reaching, and motor-based problem solving to improve global development. In contrast, Movement, Orientation, Repetition, Exercise Physical Therapy focuses on strengthening and musculoskeletal alignment while encouraging repeated movement practice. Outcome measures include the Gross Motor Function Measure, Bayley Scales of Infant Development-IV, Assessment of Problem Solving in Play, and a Parent Child Interaction assessment. Enrolled children will maintain usual intervention services due to ethical concerns with intervention withdrawal. IMPACT This will be the first study, to our knowledge, comparing efficacy of early physical therapy with dose-matched interventions and well-defined key principles. The outcomes will inform selection of key principle of intervention in this population.
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Affiliation(s)
- Stacey C Dusing
- Address all correspondence to Dr Dusing at: ; Follow the author(s): @motordevlab
| | - Regina T Harbourne
- Rangos School of Health Sciences, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Lin-Ya Hsu
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Natalie A Koziol
- College of Education and Human Sciences, Nebraska Center for Research on Children, Youth, Families and Schools, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Kari Kretch
- Ostrow School of Dentistry, Division of Physical Therapy and Biokinesiology, University of Southern California, Los Angeles, California, USA
| | - Barbara Sargent
- Ostrow School of Dentistry, Division of Physical Therapy and Biokinesiology, University of Southern California, Los Angeles, California, USA
| | - Sandra Jensen-Willett
- Munroe-Meyer Institute, Department of Physical Therapy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sarah Westcott McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Douglas L Vanderbilt
- Developmental-Behavioral Pediatrics Section, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California, USA
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Forssberg H, Damiano DL, Armstrong R. 'Better Together': achieving a global professional network for childhood disability. Dev Med Child Neurol 2022; 64:277-278. [PMID: 35120265 DOI: 10.1111/dmcn.15145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
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Maitre NL, Byrne R, Duncan A, Dusing S, Gaebler-Spira D, Rosenbaum P, Winter S. "High-risk for cerebral palsy" designation: A clinical consensus statement. J Pediatr Rehabil Med 2022; 15:165-174. [PMID: 35275579 DOI: 10.3233/prm-220030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nathalie L Maitre
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Stacey Dusing
- University of Southern California, Los Angeles, CA, USA
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Karadag-Saygi E, Kenis-Coskun Ö, Unalan PC, Evkaya-Acar A, Giray E, Akgulle AH. Pros and cons of botulinum toxin injection therapy in cerebral palsy: A qualitative study exploring caregivers' perspective. Child Care Health Dev 2022; 48:150-158. [PMID: 34623695 DOI: 10.1111/cch.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/16/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To describe and understand the experiences and beliefs of caregivers of children with cerebral palsy following botulinum toxin injection. METHODS A descriptive case study approach with focus group interviews was employed. A semi-structured questionnaire was conducted to collect data. Twenty-one caregivers of children (3-13 years old) with cerebral palsy were recruited with a maximum variation sampling strategy to gain insight through different perspectives. Qualitative analysis with verbatim transcripts was analysed using a thematic approach. FINDINGS Four themes emerged from qualitative analyses: acceptance of diagnosis, perceptions about treatment, caregivers' experiences with the health environment, and feelings and thoughts after the treatment. CONCLUSIONS This study highlights caregivers' requests for information about the possible long-term effect of botulinum toxin, as well as information and support to provide the best rehabilitation programme immediately after injection.
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Affiliation(s)
- Evrim Karadag-Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Özge Kenis-Coskun
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Pemra C Unalan
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayca Evkaya-Acar
- Department of Physiotherapy and Rehabilitation, Istanbul Medeniyet University Faculty of Health Science, Istanbul, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Hamdi Akgulle
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
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Basu AP. Early intervention for infants at high risk for cerebral palsy: evidently important, but where's the evidence? Dev Med Child Neurol 2021; 63:762. [PMID: 33825191 DOI: 10.1111/dmcn.14875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Anna Purna Basu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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