Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline

Modified sports interventions for children and adolescents with disabilities: A scoping review

AIM

To establish the scope of the literature on modified sports interventions for children and adolescents with disabilities.

METHOD

For this scoping review, articles were screened and the characteristics of studies were extracted. The modified sports interventions were described in terms of their structure, using the items of the Template for Intervention Description and Replication. Components of intervention treatment were described by using the language of the Rehabilitation Treatment Specification System. Results were analysed and validated by a group of professionals, using the Public and Patient Involvement strategy.

RESULTS

Twelve studies were eligible for inclusion, investigating interventions for children with autism spectrum disorder, cerebral palsy, and other conditions. Most studies presented a moderate level of evidence. Active ingredients were repeated sports-related motor training and introduction to the sport through a 'learning by action' mechanism. The intervention target was gross motor skills performance, and intervention aims (indirect outcomes) were physical activity participation and different body functions.

INTERPRETATION

The inclusion of stakeholders in this review helped to validate our findings about the characteristics and structure of modified sports interventions, to identify research gaps, and to provide a step process for clinical implementation. Future investigations are warranted of the effectiveness of modified sports investigations with better quality studies, including participation outcomes and studies with non-ambulant children.

WHAT THIS PAPER ADDS

Modified sports interventions target sport-related skills performance and aim to achieve physical activity participation and body functions. These interventions included group-based, sports-related motor skills training and introduction to sports in real-world environments. They are offered mostly for ambulant children with autism spectrum disorder and cerebral palsy. Most studies of modified sports interventions presented moderate level of evidence.

Intervenções de esportes modificados para crianças e adolescentes com deficiência: Uma revisão de escopo

As intervenções de esportes modificados visam o desempenho de habilidades relacionadas ao esporte e visam alcançar a participação em atividades físicas e funções corporais Essas intervenções incluíram treinamento de habilidades motoras relacionadas ao esporte em grupo e introdução ao esporte em ambientes do mundo real Eles são oferecidos principalmente para crianças ambulantes com transtorno do espectro do autismo e paralisia cerebral A maioria dos estudos de intervenção de esportes modificados apresentou nível de evidência moderado Resumo gráfico: Intervenções de esportes modificados para crianças e adolescentes com deficiência: Uma revisão de escopo. https://onlinelibrary.wiley.com/doi/10.1111/dmcn.15952.

Practices of Physical Therapists Who Assist People With Cerebral Palsy in Brazil: A National Survey

PURPOSE

To describe the practices of pediatric physical therapists (PTs) working with children and adolescents with cerebral palsy (CP) in Brazil.

METHODS

PTs working with children and adolescents with CP were invited to participate via social media and email campaigns to complete an online survey containing 46 questions.

RESULTS

In total, 373 PTs participated. Most PTs reported searching in scientific databases (96.8%) and on social media (71%). The main barrier to information reported was limited access to full-text articles (44%). Among the PTs, 58.4% and 84% reported using the International Classification of Functioning, Disability and Health (ICF) and family centered practice models, respectively. Regarding tools and interventions, there was little focus on the domains of contextual factors and participation.

CONCLUSIONS

This survey points to some important advances. However, strategies are still needed to promote knowledge translation and evidence-based practices among pediatric PTs in Brazil.

Relato Familiar da Motricidade Grossa: Refinamento e avaliação das propriedades psicométricas

Objetivo

Refinar o Relato Familiar da Motricidade Grossa (GM‐FR) utilizando a contribuição dos pais e avaliar as suas propriedades psicométricas.

Método

Neste estudo metodológico, 12 pais de crianças e adolescentes com paralisia cerebral (PC), com idade entre 2 e 18 anos, classificados em todos os níveis do Sistema de Classificação da Função Motora Grossa (GMFCS), foram entrevistados sobre sua experiência na conclusão do GM‐FR (validade de conteúdo). O feedback dos pais foi usado para refinar o instrumento que foi então preenchida por 146 famílias para avaliar a consistência interna, e a validade discriminativa e concorrente. 46 pais completaram o GM‐FR novamente, 7 a 30 dias depois, para avaliar a confiabilidade teste‐reteste.

Resultados

A pontuação do GM‐FR, as imagens, as descrições e o número total de itens foram revisados com base no feedback dos pais. O GM‐FR versão 2.0 demonstrou alta consistência interna (α de Cronbach = 0,99), ausência de efeitos piso/teto e excelente confiabilidade teste‐reteste (coeficiente de correlação intraclasse = 0,99). Os escores do GM‐FR discriminaram entre os níveis do GMFCS (p < 0,05) e foram fortemente correlacionados negativamente com o nível do GMFCS (r = −0,92; p < 0,001). Os escores do GM‐FR correlacionaram‐se de forma positiva e forte com o Gross Motor Function Measure‐66 (r = 0,94; p < 0,001) e com o domínio de mobilidade do Pediatric Evaluation of Disability Inventory – Computer Adaptive Test (r = 0,93; p < 0,001).

Interpretação

A participação ativa das famílias no desenvolvimento do GM‐FR facilitou a criação de um instrumento amigável à família. Este estudo fornece fortes evidências de confiabilidade e validade para apoiar o uso do GM‐FR na prática clínica e em pesquisas para avaliar o desempenho motor grosso de crianças e adolescentes com PC.

Programa domiciliar individualizado via telessaúde para crianças com paralisia cerebral durante a pandemia de COVID-19

Objetivo

Analisar os efeitos de um programa domiciliar individualizado via telessaúde no desempenho de objetivos funcionais de crianças e adolescentes com paralisia cerebral (PC) durante a pandemia de COVID‐19.

Método

Um estudo de intervenção prospectivo de único grupo com crianças/adolescentes com PC (n = 144; idade mediana = 92 meses [Q1 = 44.0, Q3 = 148.8]; 74 meninos, 70 meninas), representando todos os níveis do Sistema de Classificação da Função Motora Grossa (GMFCS), participaram de um programa domiciliar de 4 meses no Brasil. Equipes interdisciplinares encorajaram famílias a escolher um objetivo funcional a ser treinado. A Medida Canadense de Desempenho Ocupacional (COPM) foi usada no período pré‐intervenção (T1), pós‐intervenção (T2) e 3 meses de follow‐up (T3). As diferenças nos escores da COPM em T1, T2 e T3 foram avaliadas usando o teste de Friedman. O tamanho de efeito foi calculado usando o teste d de Cohen. Análise univariada foi incluída.

Resultado

Melhoras significativas foram observadas após a intervenção, com manutenção dos escores após 3 meses (p < 0.001; ddesempenho = 1.33; dsatisfação = 1.31). Nenhuma das variáveis testadas (habilidades das crianças, idade, nível educacional do cuidador, percepção de centrado na família e tipo de objetivo) foram significativamente relacionados às mudanças nos escores.

Interpretação

O programa domiciliar individualizado via telessaúde pode ser uma intervenção potencial, especialmente para crianças classificadas nos níveis IV e V do GMFCS. Além disso, essa intervenção forneceu uma possível solução para ajudar crianças e suas famílias no desempenho de objetivos funcionais prioritários durante o período de pandemia.

Building independence in self-care and household tasks: a qualitative study with adolescents with cerebral palsy and their caregivers

PURPOSE

Adolescents with cerebral palsy (CP) may experience limitations in self-care and household tasks. The aim of the study was to understand the process of building independence in self-care and household tasks from the perspective of adolescents and their caregivers.

MATERIALS AND METHODS

We conducted a qualitative study with a phenomenological approach with 10 adolescents (15-17 years old) and 11 caregivers from a transition service in Brazil. Semistructured, remote interviews were conducted with each participant. The interviews were recorded for transcription and content analysis.

RESULTS

Two thematic categories emerged: (1) "Thinking about independence" and (2) "Possible ways to foster independence." The first category was divided into three subcategories: "Expectations and the desire to be independent," "Obstacles to independence," "Concerns about the future." The second category was divided into four subcategories: "People and places," "Opportunities for practice," "Personal attitude" and "Adaptations that facilitate."

CONCLUSION

Adolescents' independence in several everyday activities involves physical, socioemotional and environmental aspects. Enabling opportunities for practice, an adapted environment, support from rehabilitation services and developing collaborative relationships with caregivers are elements that may favor the independence of adolescents with CP.

Individualized telehealth home programme for children with cerebral palsy during the COVID-19 pandemic

AIM

To analyse the effects of an individualized telehealth home programme on the performance of functional goals of children and adolescents with cerebral palsy (CP) during the COVID-19 pandemic.

METHOD

A prospective single-group intervention study with children/adolescents with CP (n = 144; median age = 92 months [Q1 = 44.0, Q3 = 148.8]; 74 males, 70 females), representing all Gross Motor Function Classification System (GMFCS) levels participated in a 4-month home programme in Brazil. An interdisciplinary team encouraged families to choose a functional goal to be trained. The Canadian Occupational Performance Measure (COPM) was used at pre-intervention (T1), post-intervention (T2), and 3-month follow-up (T3). The differences in COPM scores at T1, T2, and T3 were evaluated using Friedman's test. The effect size was calculated using Cohen's d. Univariate analysis was included.

RESULTS

Significant improvements were observed after the intervention, with maintenance of scores after 3 months (p < 0.001, dperformance = 1.33; dsatisfaction = 1.31). None of the tested variables (child's abilities, age, caregiver's educational level, perception of family-centredness, and type of goal) were significantly related to the change scores.

INTERPRETATION

The individualized remote telehealth home programme can be a potential intervention, especially for children with CP classified in GMFCS levels IV and V. Also, this intervention provided a possible solution to help some children and their families in performing prioritized functional goals during the pandemic period.

Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study

This single-participant case study examines the feasibility of using custom virtual reality (VR) gaming software in the home environment for low-dose Hand Arm Bimanual Intensive Training (HABIT). A 10-year-old with right unilateral cerebral palsy participated in this trial. Fine and gross motor skills as well as personal goals for motor outcomes were assessed before and after the intervention using the Box and Blocks Test, Nine-Hole Peg Test, and Canadian Occupational Performance Measure. Movement intensities collected via the VR hardware accelerometers, VR game scores, and task accuracy were recorded via the HABIT-VR software as indices of motor performance. The child and family were instructed to use the HABIT-VR games twice daily for 30 minutes over a 14-day period and asked to record when they used the system. The child used the system and completed the 14-hour, low-dose HABIT-VR intervention across 22 days. There was no change in Box and Blocks Test and Nine-Hole Peg Test scores before and after the intervention. Canadian Occupational Performance Measure scores increased but did not reach the clinically relevant threshold, due to high scores at baseline. Changes in motor task intensities during the use of VR and mastery of the VR bimanual tasks suggested improved motor efficiency. This case study provides preliminary evidence that HABIT-VR is useful for promoting adherence to HABIT activities and for the maintenance of upper extremity motor skills in the home setting.

Defining paediatric neurorehabilitation: You cannot improve what you cannot characterize

Neurorehabilitation is the primary therapy for neurological impairment in children, yet its potential to achieve change remains incompletely understood and probably underestimated. Understanding 'the difference neurorehabilitation can make' against a background of neurological repair and recovery as well as ongoing neurological development is an enormous challenge, exacerbated to no small extent by the lack of a 'common currency' for the description and measurement of the neurorehabilitation services a child is receiving. This review addresses attempts to parse neurorehabilitation treatment content in theoretically and mechanistically valid ways that might help address this challenge.

Tendon transfer in spastic cerebral palsy upper limb

Cerebral palsy (CP) in upper limb produces functional, aesthetic and hygienic issues, and is not always amenable to surgical procedures. We are reporting a single-center, long follow-up experience with tendon transfer in wrist and forearm CP. The CP cases who had undergone tendon transfer in hand, wrist and forearm in a 14-year period were evaluated for change in motion, function and cosmetic appearance and also assessed by Manual Ability Classification System (MACS), and Dash (Disability of Arm, Shoulder, Hand) scores. Forty-two spastic CP patients with a mean age of 19.81 (10-34 years, SD: 5.36) years with a mean follow-up of 5.5 (2-14) years, entered the study. 24 cases were GMFCS I or II and 18 were III or IV. Supination beyond neutral was seen in 48.5%, and improvement in MACS scores in all the cases. Improved 'grasp' and 'release' and keyboard use was seen in 50%, 71% and 87% respectively. The satisfaction from appearance and improved function of 83-96% correlated positively with GMFSC, MACS and DASH scores. Noticeable improvement in personal hygienic care was seen in only 52% of cases. Tendon transfer in well-selected spastic upper extremity CP cases results in long-time improved function, and limb appearance - correlating with initial GMFCS and MACS scores.

Embracing complexity to find simplicity in designing and assessing rehabilitation interventions

This commentary is on the invited review by Forsyth and Whyte on pages 1123–1132 of this issue.

Identificação de ingredientes de intervenções não invasivas para crianças deambuladoras com paralisia cerebral usando as minhas palavras favoritas: uma revisão de escopo

Objetivo

Mapear os ingredientes das intervenções não invasivas fornecidas às crianças deambuladoras com Paralisia Cerebral (PC).

Método

Os artigos foram selecionados e as características dos estudos extraídas. Os ingredientes das intervenções foram descritos em termos do Sistema de Especificação de Taxonomia de Reabilitação (RTSS) e vinculados às minhas palavras favoritas. Os resultados foram interpretados e validados por meio da abordagem de Envolvimento de pacientes e do Publico em Pesquisa (EPP).

Resultados

Sessenta e um artigos foram incluídos, dos quais 55,5% foram classificados como ensaios clínicos randomizados. Os estudos selecionados incluíram um total de 2187 crianças (a idade média variou de 3 meses a 5,9 anos), a maioria de países desenvolvidos. Os estudos incluídos investigaram um total de 27 intervenções, que juntas apresentaram ingredientes representando todas as minhas palavras favoritas, na seguinte ordem de frequência: “Saúde” (ex., treinamento de força e resistência), “Funcionalidade” (ex., prática ativa e repetitiva de uma tarefa), “Família” (ex., terapia focada no contexto), “Diversão” (ex., inclusão de atividades amistosas para crianças), “Amigos” (ex., atividades em grupo) e “Futuro” (ex., compartilhamento de informações didáticas). Assim, os ingredientes relacionados à palavra “Futuro” foram os relatados com menos frequência.

Interpretação

Terapeutas e famílias precisam estar cientes da correspondência mais apropriada entre as metas elencadas por meio das minhas palavras favoritas e os objetivos, ingredientes e alvos das intervenções. Finalmente, “Diversão”, “Amigos” e “Futuro” devem ser abordadas como desfechos potenciais em estudos futuros.

Effects of various exercise interventions on motor function in cerebral palsy patients: a systematic review and network meta-analysis

PURPOSE

A network meta-analysis was utilized to compare the rehabilitative effectiveness of different exercise interventions on motor function in cerebral palsy(CP) patients.

METHODS

Computer searches were conducted across 9 databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase, and others, to identify randomized controlled trials focusing on different exercise interventions aimed at enhancing motor function in CP patients. The search spanned from the inception of the databases to January 31, 2024.

RESULTS

20 articles, encompassing 570 patients and evaluating three types of exercise interventions, were included in the analysis. Results showed that aerobic training, resistance training, and mixed training exhibited superior outcomes compared to the control group, as evidenced by improvements in Gross Motor Function Measure scores, muscle strength, gait speed, and 10-Meter Walk Test scores (P < 0.05). Furthermore, the network meta-analysis revealed that resistance training ranked highest in enhancing gross motor function and gait speed among CP patients, while mixed training was deemed most effective in improving muscle strength and 10-Meter Walk Test scores.

CONCLUSION

Exercise interventions have been shown to significantly improve motor function in CP patients. Among these, resistance training and mixed training stand out for their effectiveness in enhancing walking capabilities. Resistance training is specifically aimed at improving gross motor function, while mixed training focuses on increasing muscle strength.

F-words ingredients of non-invasive interventions for young ambulant children with cerebral palsy: A scoping review

AIM

To map the ingredients of non-invasive interventions provided to young ambulant children with cerebral palsy.

METHOD

Articles were screened and each study's characteristics extracted. The intervention ingredients were described in terms of the Rehabilitation Treatment Specification System and linked to the 'F-words'. Results were interpreted and validated by a patient and public involvement group.

RESULTS

Sixty-one papers were included, of which 55.5% were classified as randomized controlled trial design studies. The selected studies included a total of 2187 children (mean age range 3 months to 5 years 11 months), most from high-income countries. The included studies investigated a total of 27 interventions, which together presented ingredients representing all F-words, in the following order of frequency: 'fitness' (e.g. strength and endurance training), 'functioning' (e.g. active and repetitive practice of a task), 'family' (e.g. context-focused therapy), 'fun' (e.g. inclusion of child-friendly activities), 'friends' (e.g. group activities), and 'future' (e.g. didactic information sharing). Thus, ingredients related to the F-word 'future' were the most infrequently reported.

INTERPRETATION

Therapists and families need to be aware of the most appropriate match between the F-word goals, ingredients, and targets. Finally, 'fun', 'friends', and 'future' should be addressed as potential outcomes in future studies.

Effects of exercise intervention on balance function in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To determine the effectiveness of exercise intervention on postural balance, gait parameters, and muscle strength in children with cerebral palsy by quantifying the information from randomized controlled trials (RCTs).

METHODS

We conducted a systematical search for RCTs from the databases, including PubMed, ISI Web of Science, and Scopus using a between-group design involving children with cerebral palsy and assessing the effect of exercise intervention on postural balance, gait parameters, and muscle strength. The specified inclusion criteria were determined by the PICOS tool. The outcomes of included studies were evaluated by meta-analysis, and subgroup and sensitivity analyses were conducted to analyze the observed heterogeneities using Review Manager 5.4 and Stata version 18.0. The revised Cochrane risk of bias tool for randomized trials (RoB 2) was used to evaluate the risk of bias and quality of the included studies.

RESULTS

Twenty-four studies were included in this meta-analysis, with 579 children with cerebral palsy. Exercise intervention showed a statistically significant favorable effect on gross motor function (SMD = 0.32; 95%CI [0.03 to 0.61]; I2 = 16%), anteroposterior stability index (SMD = -0.93; 95%CI [-1.69 to -0.18]; I2 = 80%), and mediolateral stability index (SMD = -0.60; 95%CI [-1.16 to -0.03]; I2 = 73%) compared to control group among children with cerebral palsy. None of the above meta-analyses exhibited publication bias, as indicated by Egger's test with p-values greater than 0.05 for all.

CONCLUSIONS

Exercise is effective in improving gross motor function and balance in children with cerebral palsy. Due to the lack of studies examining the efficacy of each exercise type, we are unable to provide definitive training recommendations.

ボバースフレームワーク:をむのにするシステマチックサイエンスのアプローチ

現在、発達領域で推奨されているボバース臨床推論フレームワーク(Bobath Clinical Reasoning Framework: BCRF)によるボバース実践を、システム科学のレンズによって概念化し、小児期発症の障害に関連する様々な変数の相互関係・相関依存に対する全人的観点を提供する。BCRFはICFの各領域間の関係性を理解し、それぞれがどのように影響を与え、どのように影響を受けるのかを理解する助けとなる臨床推論の詳細なフレームワークである。BCRFは介入計画へとつながる観察に基づく学際的なシステムであり、実践的な推論のアプローチである。BCRFにより脳性麻痺(Cerebral Palsy: CP)などの障害における複雑な状況を全人的に理解し、神経学的障害がある人々の生涯にわたるマネジメントおよびハビリテーションの基盤を持つことができる。BCRFが用いる臨床推論は、個々人およびその社会的環境、とくに家族単位で見られる重要な文脈的要因を重視している。定型発達・非定型発達、病態生理(感覚運動・認知・行動)、神経科学の相互関連性、および、心身機能・身体構造レベルの構成要素がどのように活動・参加レベルに影響を与えるのか、BCRFはその理解に根差している。BCRFにとって不可欠なシステム科学system science※1)のモデルはCPの複雑性を理解および対応を進める有用な方法であり、何よりも大切な目標とはあらゆる文脈であらゆる個々人の生きた経験を最適化することである。.

Le cadre de raisonnement clinique Bobath: un modèle de science des systèmes pour aborder la complexité des troubles neurodéveloppementaux, y compris la paralysie cérébrale

La pratique Bobath actuelle telle qu'elle est recommandée dans le cadre du Bobath Clinical Reasoning Framework (BCRF) se base sur une application clinique de la science des systèmes. Elle offre une perspective holistique des relations entre les variables qui sont associées à l'apparition d'un handicap chez l'enfant. Le BCRF est un cadre de raisonnement clinique qui peut aider à comprendre les relations entre les domaines de la Classification Internationale du Fonctionnement, du Handicap et de la Santé. C'est un système d'observation transdisciplinaire de raisonnement pratique qui vise à proposer un plan d'intervention. Plus généralement, le BCRF permet une compréhension holistique de la complexité des situations associées à des troubles tels que la paralysie cérébrale et indique des choix d'adaptation et de prise en charge tout au long de la vie des personnes vivant avec des troubles neurologiques. Ce raisonnement clinique se base sur les facteurs contextuels importants de l'individu et de son environnement social, principalement la cellule familiale, et sur une compréhension des relations entre le développement typique et atypique, la physiopathologie (sensorimotrice, cognitive, comportementale) et les neurosciences, ainsi que sur l'impact des fonctions et des structures corporelles sur les activités et la participation. Le modèle de la science des systèmes du BCRF permet d'aborder la complexité de la paralysie cérébrale, avec l'objectif global d'optimiser l'expérience vécue par chaque individu dans chaque contexte.

El marco de razonamiento clínico de Bobath: Un modelo de ciencia de sistemas para abordar la complejidad de los trastornos del neurodesarrollo incluida la parálisis cerebral

La actual práctica de desarrollo Bobath recomendada dentro del Marco de Razonamiento Clínico Bobath (BCRF) puede conceptualizarse utilizando la visión de la ciencia de los sistemas. Proporciona, así, una perspectiva holística de la interrelación e interconexión de las variables asociadas con la discapacidad aparecida durante la infancia. El BCRF se define como un marco exhaustivo de razonamiento clínico que puede aplicarse para ayudar a comprender las relaciones entre los dominios de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud, cómo se puede influir en esos dominios y cómo influyen entre sí. El BCRF es un sistema de observación transdisciplinario y de razonamiento práctico que da lugar a un plan de intervención. Esto proporciona una comprensión holística de la complexidad de las situaciones asociadas a trastornos como la parálisis cerebral (PC) y la base para la gestión y habilitación a lo largo de la vida de personas que viven con trastornos neurológicos. El razonamiento clínico utilizado por el BCRF se basa en los importantes factores contextuales del individuo y su entorno social, principalmente la unidad familiar. Se basa en la comprensión de las interrelaciones entre el desarrollo típico y atípico, la fisiopatología (sensoriomotora, cognitiva, conductual) y la neurociencia, así como el impacto de funciones y estructuras corporales sobre la actividad y la participación. El modelo de ciencia de sistemas del BCRF es una forma útil de comprender y responder a la complejidad de la parálisis cerebral, con el objetivo global de optimizar la experiencia vivida de todo individuo en cualquier contexto.

O Quadro de Raciocínio Clínico Bobath: Uma abordagem de ciência de sistemas para a complexidade das condições do neurodesenvolvimento, incluindo a paralisia cerebral

Esta revisão descreve um modelo de prática pediátrica recomendada do Bobath, o Quadro de Raciocínio Clínico Bobath (QRCB), e explica como esse conhecimento contribui para a área de habilitação em distúrbios pediátricos. A ciência de sistemas proporciona uma nova maneira de concetualizar a paralisia cerebral como uma condição complexa. Ela foi aplicada ao QRCB para ilustrar uma perspetiva holística sobre a inter-relação e interconexão das variáveis associadas à PC. O modelo de ciência de sistemas adotado pelo QRCB é uma forma promissora de construir uma estrutura abrangente que engloba a complexidade da PC e possibilitará pesquisas mais robustas.

Bobath Klinik Gerekçelendirme Çerçevesi: Serebral palsi dahil nörogelişimsel durumların karmaşıklığında sistemler bilimi yaklaşımı

Bobath Klinik Gerekçelendirme Çerçevesi (BKGÇ) içerisindeki önerilen güncel gelişimsel Bobath uygulaması sistemler bilimi merceği kullanılarak kavramsallaştırılabilir ve bunu çocukluk çağı engelliliği ile ilişkilendirilen değişkenlerin birbirine bağlılığı ve etkileşimine bütüncül bir bakış açısıyla sağlar. BKGÇ, İşlevsellik, Yetiyitimi ve Sağlığın Uluslararası Sınıflandırması (ICF)’nın alt boyutları arasındaki ilişkiyi ve bu alt boyutların birbirini nasıl etkilediğini anlamak için uygulanabilen derinlemesine bir klinik gerekçelendirme çerçevesi olarak tanımlanmaktadır. BKGÇ, bir tedavi planı ile sonuçlanan klinik gerekçelendirme ve transdisipliner gözlemsel bir sistemdir. Bu sistem ise, serebral palsi (SP) gibi bozuklukların karmaşıklığını anlamak için bütüncül bir anlayış sunar ve nörolojik bozukluğu olan bireylerin yaşam boyu tedavisi ve rehabilitasyonu için temel oluşturur. BKGÇ tarafından kullanılan klinik gerekçelendirme, başta aile birimi olmak üzere bireyin ve sosyal çevresinin önemli bağlamsal faktörlerine dayanmaktadır. Tipik ve atipik gelişim, patofizyoloji (sensorimotor, bilişsel, davranışsal) ve sinirbilim arasındaki karşılıklı ilişkilerin ve bu vücut yapı ve fonksiyonlarının aktivite ve katılım üzerindeki etkisinin anlaşılmasına dayanır. BKGÇ'nin ayrılmaz bir parçası olan sistemler bilimi modeli, SP'nin karmaşıklığını anlamak ve buna yanıt vermek için yararlı bir yoldur; kapsayıcı hedef, herhangi bir bağlamda herhangi bir bireyin yaşadığı deneyimi optimize etmektir.

Benefits of robotic gait assistance with ATLAS 2030 in children with cerebral palsy

Objective

This study aims to assess the impact of integrating ATLAS 2030 into the conventional therapy regimen for children with Cerebral Palsy (CP) compared to conventional therapy alone regarding gross motor function, range of motion (ROM) and spasticity.

Design

A non-randomized controlled trial conducted in outpatient rehabilitation settings and special education schools, following the recommendations by the Consolidated Standards of Reporting Trials (CONSORT) statement.

Participants

Thirty children with CP divided into intervention and control groups.

Intervention

The intervention group received three months of therapy (twice per week) with the ATLAS 2030 device in addition to their standard therapy, while the control group underwent standard therapy alone.

Main outcome measure

Gross motor function assessed using the Gross Motor Function Measure of 88 items (GMFM-88).

Secondary outcomes

Spasticity, measured by the Modified Ashworth Scale (MAS), and ROM of the lower limbs.

Results

Statistically significant differences were observed between groups, in favour the intervention group, in both the GMFM-88 total score and dimension A, B and D. Similar findings were noted for spasticity and ROM, demonstrating significant improvements in the intervention group.

Conclusion

ATLAS 2030 proves to be a safe and valuable tool for the rehabilitation of children with CP, showing improvements in motor function, spasticity and ROM.

Analysis of YouTube-Based Therapeutic Content for Children with Cerebral Palsy

BACKGROUND/OBJECTIVES

Cerebral palsy (CP) causes movement and posture challenges due to central nervous system damage, requiring lifelong management. During the COVID-19 pandemic, there was limited access to facility-based treatments, which increased the demand for home-based therapies and digital resources. We analyzed the qualitative and quantitative aspects of YouTube videos focusing on CP therapy for children.

METHODS

A total of 95 videos were evaluated for content quality using the modified DISCERN (mDISCERN) tool and Global Quality Scale (GQS). The therapeutic program efficacy was assessed via the International Consensus on Therapeutic Exercise and Training (i-CONTENT) tool, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Consensus on Exercise Reporting Template (CERT), and popularity was measured by the video power index (VPI).

RESULTS

YouTube-based therapeutic videos for children with CP generally exhibit reliability in video content and effectiveness in therapeutic programming, and no correlations were found between video popularity and quality. However, the qualitative analysis reveals insufficient mention of uncertainty in the treatment principles within the video content as well as a lack of detailed treatment descriptions encompassing aspects such as intensity, frequency, timing, setting, outcome measurement during and post-treatment, and safety considerations within therapeutic programs. In particular, this tendency was consistent regardless of the uploader's expertise level and the classification of the neuromotor therapy type in contrast to that of the exercise type.

CONCLUSIONS

YouTube-based content for CP children still has significant limitations in how substantive viewers, such as caregivers, can acquire tailored information and apply practical information to their exercise and treatment programs.

Joystick-Operated Ride-On Toy Navigation Training for Children With Hemiplegic Cerebral Palsy: A Pilot Study

IMPORTANCE

Children with hemiplegic cerebral palsy (HCP) require intensive task-oriented training to make meaningful gains in affected upper extremity (UE) motor function.

OBJECTIVE

To evaluate the acceptability and utility of single joystick-operated ride-on toy (ROT) navigation training incorporated into a modified constraint-induced movement therapy (CIMT) camp for children with HCP.

DESIGN

Single group pretest-posttest design.

SETTING

Three-wk structured CIMT camp.

PARTICIPANTS

Eleven children with HCP between ages 3 and 14 yr.

INTERVENTION

Children received group-based CIMT for 6 hr/day, 5 days/wk, for 3 wk. As part of camp activities, children also received ROT navigation training for 20 to 30 min/day, 5 days/wk, for 3 wk.

OUTCOMES AND MEASURES

We assessed children's acceptance of ROT training by monitoring adherence and evaluating child engagement (affect and attention) during training sessions. The effects of ROT training combined with other camp activities on children's affected UE motor function were also assessed with the standardized Quality of Upper Extremity Skills Test (QUEST) and training-specific measures of ROT maneuvering accuracy.

RESULTS

Children demonstrated high levels of training adherence, positive affect, and task-appropriate attention across weeks. Positive engagement during ROT sessions was correlated with independent navigation. We also found medium- to large-sized improvements in QUEST scores and toy-maneuvering capabilities after the combined program.

CONCLUSIONS AND RELEVANCE

Our pilot data support the use of joystick-operated ROTs as child-friendly therapy adjuncts that can be incorporated into intensive UE training programs to improve adherence and motivation in therapy programs, boost treatment dosing, and promote affected UE motor function in children with HCP. Plain-Language Summary: This pilot study offers promising evidence that supports the use of modified single joystick-operated ride-on toys (ROTs) for children with hemiplegic cerebral palsy (HCP). The study used ROTs as one of several interventions that were part of a constraint-induced movement therapy (CIMT) camp program for children with HCP. The ROTs boosted children's motivation, their engagement with and adherence to training, and their practice in using their affected upper extremity (UE) for goal-directed activities in their natural settings. ROTs are accessible, age-appropriate, and easy-to-use devices for both occupational therapy clinicians and families to encourage children to use their affected UEs by challenging their perceptual, motor-planning, problem-solving, and movement-control skills in an enjoyable and engaging way. ROTs can be used within and outside conventional rehabilitation settings.

Harnessing Mobility: A Medically Complex Child's Home Program Utilizing an In-Home Body Weight Support System

PURPOSE

To describe a home program for a child with medical complexity using an over-ground body weight support (BWS) system.

SUMMARY OF KEY POINTS

Children with medical complexity often use home programs due to challenges with regular therapy attendance. In this case, effective home program components including child centered design, family leadership, and best practice principles were prioritized around the PUMA (portable mobility aid for children). This BWS system was to be used for 1 hour per day to support mobility and active play.

STATEMENT OF CONCLUSIONS

The CMC and family demonstrated high adherence, using over-ground BWS 87% of the 135 days it was accessible with an average daily usage of 59 min spread across 1-3 bouts per day. The average daily fun index during usage was 7/10.

RECOMMENDATIONS FOR CLINICAL PRACTICE

This home program demonstrated over-ground BWS technology as a feasible, fun platform for functional mobility and socialization in a child with significant medical and physical limitations.

Effects of a 12 week community-based high-level mobility programme on sustained participation in physical activity by adolescents with cerebral palsy: a single subject research design study

PURPOSE

To assess if a high-level mobility programme (HLMP) can promote sustained participation in physical activity by adolescents with cerebral palsy.

METHODS

Eight adolescents with cerebral palsy, Gross Motor Function Classification System levels I-II, 11-16 years, participated in 24 community-based group HLMP sessions across 12 weeks. Participants set attendance, involvement, and physical performance goals, completed activity diaries over 58 weeks and undertook physical capacity tests. Measures of activity frequency and diversity (attendance) and involvement level were collected weekly across baseline (4-6 weeks), intervention (12 weeks), and nine months follow-up (including Covid lockdown).

RESULTS

Median attendance was 23 of 24 HLMP sessions. Attendance goal/s attainment was highest during COVID lockdown. Involvement goals were consistently attained throughout all phases. Physical performance goal/s attainment was highest during intervention phase but reduced during nine months follow-up. Frequency of participation in physical activities varied greatly across study phases (range 0-33 episodes/week) with stable variety of activities and generally high 'involvement.' During the intervention, seven participants improved physical capacity and six maintained, or increased, the gains six months later.

CONCLUSION

Most participants improved physical capacity post-intervention but only some had sustained attendance and involvement in physical activity, highlighting the complexity of physical activity participation.

Percepções dos pais sobre uma intervenção de esportes modificados para crianças com paralisia cerebral

O Sports Stars Brasil tem como objetivo promover a participação em atividades de lazer. O Sports Stars foi uma intervenção agradável, de curto prazo, com dosagem pequena, focada na participação. Os pais dos participantes do Sports Stars Brasil perceberam benefícios em todas as "minhas palavras favoritas". Esta intervenção de esportes modificados foi capaz de integrar todas as "minhas palavras favoritas".

Parents' perceptions of a modified sports intervention for children with cerebral palsy

AIM

To explore the perceptions of parents of children with cerebral palsy (CP) participating in a modified sports intervention, Sports Stars Brazil.

METHOD

Parents of children with CP (n = 15, 6-12 years old, nine males, six females), classified in Gross Motor Function Classification System levels I and II, who participated in the Sports Stars Brazil intervention, were recruited for this descriptive qualitative study. Children received the 8-week (1 hour per week) modified sports intervention. After the intervention, parents participated in a focus group. The F-word (fitness, family, fun, functioning, friends, and future) interpretation of the International Classification of Functioning, Disability and Health was used to guide the discussion. Participants were invited to report their experience of participating in the intervention using the F-words for a childhood disability model. Transcripts were coded using content analysis.

RESULTS

Parents reported positive experiences of the Sports Stars Brazil intervention, including a decrease in sedentarism (fitness), improvement of motor skills (functioning), greater connection between child and family (family), better socialization (friends), increased participation in pleasurable activities (fun), and awareness of the importance of physical activity (future). All positive experiences were interconnected.

INTERPRETATION

This study presents the ability of the Sports Stars Brazil intervention to integrate all aspects of functioning and supports its role as an engaging and promising intervention option for ambulant children with CP.

WHAT THIS PAPER ADDS

The parents of children participating in Sports Stars Brazil perceived benefits across all F-words. This modified sports intervention integrated all F-words into one concept.

Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus

Children functioning at Gross Motor Function Classification System (GMFCS) levels IV-V cannot maintain an aligned standing position or take steps without support. Upright positioning and mobility devices have psycho-social significance for these children and their families, enhancing use of vision, communication, functioning and emotional well-being. Standers and supported stepping devices facilitate opportunities for biomechanical loading, potentially helping to build and maintain muscle and bone integrity, and they promote physical development. However, families are often required to choose between these two devices for their young child. This study aims to synthesize evidence for use and benefits of both supported standing and stepping devices through the lens of two contemporary theoretical frameworks to support clinical reasoning and implementation. The F-words for childhood development (functioning, family, fitness, fun, friends, future) and the interdependence-Human Activity Assistive Technology (iHAAT) models were combined to illustrate the complex interactions between the child, family, caregivers, peers and contextual factors when implementing standing and stepping devices with children at GMFCS levels IV and V. Supported standing and stepping devices provide complementary benefits, and both may be necessary starting at 9-15 months. We propose they both be included ON-Time, along with other age-appropriate positioning and mobility devices, to promote more equitable developmental opportunities for children with non-ambulant cerebral palsy.

Child-led goal setting and evaluation tools for children with a disability: A scoping review

AIM

To examine child-led goal setting and evaluation tools and approaches for children with a disability or developmental delay.

METHOD

Six databases were searched for studies that included population (children aged less than 18 years with disability or developmental delay); construct (child-led goal setting tool or approach); and context (developmental therapy or rehabilitation). The utility of tools and approaches across the goal setting and evaluation process was investigated using abductive content analysis.

RESULTS

Fifty articles met the inclusion criteria. Three approaches and four tools for child-led goal setting and evaluation were identified. No studies reported the clinimetric properties of tools specifically for child self-respondents. Qualitative analysis revealed six distinct goal phases in which tools and approaches were used, which were synthesized into a new framework for child-led goal setting and evaluation titled DECIDE: Direct children to goal setting; Elicit goal topics and priorities; Construct a goal statement; Indicate baseline goal performance; Develop an action plan to address the goal; and Evaluate goal progress after the intervention.

INTERPRETATION

Children actively participated in goal setting and evaluation across six DECIDE goal phases. Further clinimetric information is required to support use of goal setting and evaluation tools with child self-respondents. Future research should emphasize the development of multi-phase goal setting tools and approaches for diverse populations of children.

The Bobath Clinical Reasoning Framework: A systems science approach to the complexity of neurodevelopmental conditions, including cerebral palsy

The current recommended developmental Bobath practice within the Bobath Clinical Reasoning Framework (BCRF) can be conceptualized using the lens of systems science, thereby providing a holistic perspective on the interrelatedness and interconnectedness of the variables associated with childhood-onset disability. The BCRF is defined as an in-depth clinical reasoning framework that can be applied to help understand the relationships between the domains of the International Classification of Functioning, Disability and Health, how those domains can be influenced, and how they impact each other. The BCRF is a transdisciplinary observational system and practical reasoning approach that results in an intervention plan. This provides a holistic understanding of the complexity of situations associated with disorders such as cerebral palsy (CP) and the basis for the lifelong management and habilitation of people living with neurological disorders. The clinical reasoning used by the BCRF draws on the important contextual factors of the individual and their social environment, primarily the family unit. It is rooted in an understanding of the interrelationships between typical and atypical development, pathophysiology (sensorimotor, cognitive, behavioural), and neuroscience, and the impact of these body structure and function constructs on activity and participation. The systems science model integral to the BCRF is a useful way forward in understanding and responding to the complexity of CP, the overarching goal being to optimize the lived experience of any individual in any context.

The SPORTS Participation Framework: illuminating the pathway for people with disability to enter into, participate in, and excel at sport

BACKGROUND

Sports participation for people with disabilities exists at the intersection of health, sport, and education sectors. However, no common framework and language exist to describe the stages of sports participation.

OBJECTIVE

To present the background to the SPORTS Participation Framework, and how it can be used to illuminate the path that people with disability may travel to enter into, participate in, and enjoy and excel at all levels of sport.

METHOD

The SPORTS Participation Framework includes six stages drawn from mainstream sports pathways and models used to classify barriers to sports participation for people with disabilities: (S) Screening, goal setting and individual preparation, (P) Practitioner led, peer-group sports interventions, (O) Organised junior entry-point sports programs, (R) Recreational sport (non-competitive), (T) Team competition (school/club representation), and (S) State, National, and International competition.

RESULTS

For each stage, this paper describes the content of sports activities, the context in which they are performed, key stakeholders, barriers to participation, available evidence, and case studies.

CONCLUSIONS

The SPORTS Participation Framework presents a structure to navigate the stages of introducing and promoting lifelong sports participation for people with disabilities. It scaffolds clear communication, governance, and policy across health, sport, and education sectors, and supports clinicians and researchers to address barriers to participation at each stage to improve individual and population-wide participation in sport for people with disabilities.

The Bobath Clinical Reasoning Framework: Open to debate

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.

The effects of postural control and upper extremity functional capacity on functional Independence in preschool-age children with spastic cerebral palsy: a path model

PURPOSE

To investigate the effects of postural control and upper extremity functional capacity on functional independence and identify whether quality of upper extremity skills mediates the effects of postural control on functional independence in preschool-age children with spastic cerebral palsy (CP).

METHODS

106 children with CP -mean age 43.4 ± 11.3 (24-71 months)- were included in this cross-sectional study. Postural control, upper extremity functional capacity, and functional independence in activities of daily living were evaluated using the Early Clinical Assessment of Balance (ECAB), Quality of Upper Extremity Skills Test (QUEST), and the Functional Independence Measure of Children (WeeFIM), respectively. A path model was used to evaluate the total, direct, and indirect effects.

RESULTS

According to the path model, ECAB (direct effect; r = 0.391, p < 0.01, indirect effect; r = 0.398) and QUEST (direct effect; r = 0.493, p < 0.01) had an impact on WeeFIM. In addition, QUEST had mediating effects on the relationship between ECAB and WeeFIM. The path model explained 71% of the variation in functional independence of the participants.

CONCLUSION

In the management of CP in preschool-age children, the focus should be on improving not only upper extremity capacity but also postural control to help improve functional independence in activities of daily living.

Is more always better? Effectiveness of constraint-induced movement therapy in children with high-risk or unilateral cerebral palsy (0-6 years): Systematic review and meta-analysis

BACKGROUND

While constraint-induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint-induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis.

METHODS

This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration's tool.

RESULTS

Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents' perception of how effectively children use their affected upper limb.

CONCLUSIONS

Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent's perception.

Cross-cultural adaptation, validity and reliability of the Japanese version of ABILHAND-kids for children with cerebral palsy using Rasch measurement model

PURPOSE

The aim of this study was to develop the Japanese version of the ABILHAND-Kids and to examine its psychometric properties for Japanese children with cerebral palsy (CP).

METHODS

The experimental version of 75 items was developed using forward-backward translation method. Parents of 137 children with CP answered it. Their responses were analyzed to successive items, and psychometric properties of the final version were investigated through the Rasch measurement model.

RESULTS

The Japanese version of the ABILHAND-Kids contained 22 items. It showed valid item-patient targeting, no significant floor and ceiling effects, and no differential item functioning for demographic and clinical subgroups. All items contributed to the definition of one-dimensional measure. For internal consistency, the person separation index was 0.94. For test-retest reliability, the intraclass correlation coefficients were 0.96 (95% CI: 0.92-0.98). The minimal detectable difference was calculated with a logit score of 0.79 and a total raw score of 4.50. The logit score showed a strong correlation with the Manual Ability Classification System level (ρ= -0.70) and the Gross Motor Function Classification System level (ρ= -0.62).

CONCLUSIONS

The Japanese version of the ABILHAND-Kids was found to be valid and reliable. It appears to be a good tool for assessing manual abilities in daily activities in children with CP.

Inspiratory Training for Improving Respiratory Strength, Pulmonary Function, and Walking in Cerebral Palsy: A Meta-Analysis

PURPOSE

To investigate the effects of inspiratory strength training on respiratory muscle strength, pulmonary function, and walking capacity in children with cerebral palsy, with Gross Motor Function Classification System I to III.

METHODS

Searches were conducted in CINAHL, LILACS, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases. The outcomes of interest were respiratory muscle strength, pulmonary function, and walking capacity. The quality was assessed by PEDro Scale. The Grading of Recommendations Assessment, Development, and Evaluation system was used to summarize the quality of evidence.

RESULTS

Inspiratory strength training increased the strength of inspiratory muscles and may increase the strength of the expiratory muscles. No changes were observed in pulmonary function or walking capacity.

CONCLUSIONS

This systematic review provides moderate-quality evidence that inspiratory strength training is effective for increasing inspiratory muscle strength in children with cerebral palsy. Benefits may be carried over to improving expiratory muscle strength but were not observed on pulmonary function or walking capacity.

A Pilot Feasibility Study on the Use of Dual-Joystick-Operated Ride-on Toys in Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy

Children with unilateral cerebral palsy (UCP) require task-oriented practice several hours per week to produce meaningful gains in affected upper extremity (UE) motor function. Clinicians find it challenging to provide services at the required intensity and sustain child engagement. This pilot study assessed the acceptance and utility of a child-friendly program using dual-joystick-operated ride-on toys incorporated into an intensive UE rehabilitation camp. Eleven children with UCP between four and 10 years received ride-on-toy navigation training for 20-30 min/day, five days/week, for three weeks as part of camp programming. We report session adherence and percent time children spent in task-appropriate attention/engagement across sessions. The overall effects of camp programming on children's motor function were assessed using the Shriner's Hospital Upper Extremity Evaluation (SHUEE) from pretest to posttest and using training-specific measures of bimanual UE use and navigational accuracy. Children showed excellent adherence and sustained task-appropriate engagement across sessions. The combined program led to improved navigational accuracy (p-values ≤ 0.007) as well as spontaneous affected UE use during bimanual activities outside the training context (p < 0.001). Our pilot study provides promising evidence for using modified, commercially available ride-on toys to incentivize rehabilitation and boost repetitive, task-oriented UE practice among children with UCP.

Sports Activities in Children with Cerebral Palsy: A Narrative Review

Physical exercise is known to have beneficial effects on psychosocial well-being and cognitive performance. Children with cerebral palsy (CP) showed lower levels of physical activity (PA) than healthy children; this fact, in addition to the basic clinical condition, increased the sedentary habit with a psychological impact and motor impairment of these children. Furthermore, children and adolescents with CP are less committed to sports activities than typically developing children of the same age. The aim of the present narrative review was to increase the amount of knowledge regarding the effectiveness and importance of specific and individualized sports in children with CP. A comprehensive search of MED-LINE and EMBASE databases was performed, including specific search terms such as "cerebral palsy" combined with "sport", "physical activity", and the names of different sports. No publication date limits were set. We included studies with an age range of 0-18 years. The main results pointed out that most of the sports improved motor function, quality of life, and coordination in children and adolescents with CP. Physicians, therapists, and parents should become aware of the benefits of sports activities for this population of patients. Specific sports activities could be included as a usual indication in clinical practice in addition to rehabilitation treatment.

"From All, To All": Implementing a collaborative online conference to reflect on the daily living of individuals with cerebral palsy

BACKGROUND

Translating knowledge to improve paediatric rehabilitation has become a research area of interest. This study describes the development and evaluation of an online conference that brought together perspectives of individuals with cerebral palsy (CP), families, health care professionals, and researchers to discuss the daily living of individuals with CP.

METHODS

We anchored the development and implementation of the online conference in the action cycle of the Knowledge to Action Framework. To develop the meeting, we included representatives from each stakeholder group in the programme committee. The conference programme was designed having the lifespan perspective of individuals with CP, from birth to adulthood, as its central core, with themes related to daily living (e.g., self-care, mobility, and continuing education). Participants' satisfaction with the conference was assessed using an anonymized online survey sent to all participants.

RESULTS

The conference had 1656 attendees, of whom 675 answered the online satisfaction survey. Most participants rated the structure of the conference (i.e., quality of the technical support, audio and video, and online platform) and discussed topics (i.e., relevance, content, discussion, speakers, and available time) positively.

CONCLUSION

Collaborative conferences that include stakeholders throughout the planning and implementation are a viable, effective knowledge translation strategy that allows for sharing experiences and disseminating knowledge among families and individuals with CP, health care professionals, and researchers.

The effect of structured supportive approach based on Kolcaba's comfort theory applied to parents of children with cerebral palsy on child's comfort, quality of life, and parent's self-efficacy: A randomised controlled trial

AIM

This study aims to assess how a structured supportive approach applied to the parents of children living with cerebral palsy according to how the Theory of Comfort affects the child's comfort, quality of life, and parent's self-efficacy.

DESIGN

A single-blind, randomised, controlled experimental trial.

METHODS

The study was conducted with parents of children with cerebral palsy aged between 8 and 16 years who presented to the rehabilitation centers between October 2021 and November 2022. The sample consisted of a total of 73 parents from the experimental (n = 35) and control (n = 38) groups. While a care programme based on the Theory of Comfort was applied to the intervention group, the practises included in the routines of the centres were applied to the control group. The researcher collected data using the Comfort Behaviours Checklist (CBCL), the Parent Form of the Quality-of-Life Scale for Children (QoLC), and the Self-Efficacy Scale.

RESULTS

The children in the intervention group had significantly higher CBCL and QoLC mean scores and the parents in the intervention group had significantly higher self-efficacy mean scores of parents when compared to the control group.

CONCLUSIONS

The structured supportive approach based on the Theory of Comfort enhanced children's comfort and quality of life and increased parents' self-efficacy.

RELEVANCE TO CLINICAL PRACTICE

It is recommended to implement the structured supportive approach applied according to the Theory of Comfort with the parents of children with cerebral palsy in special training and rehabilitation centres. Paediatric nurses can perform preventive and rehabilitative nursing management with a holistic approach to meet the needs of children with cerebral palsy and their families.

The provision and impact of rehabilitation provided by physiotherapists in children and young people with congenital heart disease following cardiac surgery: a scoping review

INTRODUCTION

Children with congenital heart disease (CHD) are at risk of delayed motor development with increased risk for those requiring cardiac surgical intervention. We conducted a scoping review to identify the provision and impact of physiotherapy-delivered rehabilitation in children and young people with CHD following cardiac surgery.

METHODS

CINAHL, EMBASE, PUBMED, AHMED, EMCARE, Cochrane Database of Systematic Reviews, NHS Evidence databases were searched (2000-2022). Included studies were published in full, in English and reported the use of physiotherapy in CHD (participants 0-18years) post-surgical procedure. Articles were screened by title and abstract and through full-text review with results structured in accordance with the PAGER framework and PRISMA- ScR checklist.

RESULTS

Seven full text peer reviewed papers published 2014-2021 were identified from 5747 papers screened. Included papers were predominantly non-randomised cohort studies with a sample size of between one and 247. Study participants ranged from eight days to 16 years, with a variety of congenital heart defects and surgical procedures. The provision of physiotherapy varied with a range of rehabilitation formats and physiotherapeutic interventions utilised. Physiotherapy provision appeared to have a positive impact on functional/ developmental outcomes and muscle strength.

DISCUSSION

Assessing the impact and provision of physiotherapy in CHD post-surgical intervention is challenging based on the published literature, due to small sample sizes, lack of control groups, heterogeneous demographics and variable intervention and formats delivered. Further research is required to identify the optimum format of physiotherapy provision and establish the potential impact of physiotherapy delivered rehabilitation on motor function and development. CONTRIBUTION OF THE PAPER.

Serious Game with Electromyography Feedback and Physical Therapy in Young Children with Unilateral Spastic Cerebral Palsy and Equinus Gait: A Prospective Open-Label Study

The clinical effects of a serious game with electromyography feedback (EMGs_SG) and physical therapy (PT) was investigated prospectively in children with unilateral spastic cerebral palsy (USCP). An additional aim was to better understand the influence of muscle shortening on function. Thirty children with USCP (age 7.6 ± 2.1 years) received four weeks of EMGs_SG sessions 2×/week including repetitive, active alternating training of dorsi- and plantar flexors in a seated position. In addition, each child received usual PT treatment ≤ 2×/week, involving plantar flexor stretching and command strengthening on dorsi- and plantar flexors. Five-Step Assessment parameters, including preferred gait velocity (normalized by height); plantar flexor extensibility (XV1); angle of catch (XV3); maximal active ankle dorsiflexion (XA); and derived coefficients of shortening, spasticity, and weakness for both soleus and gastrosoleus complex (GSC) were compared pre and post treatment (t-tests). Correlations were explored between the various coefficients and gait velocities at baseline. After four weeks of EMGs_SG + PT, there was an increase in normalized gait velocity from 0.72 ± 0.13 to 0.77 ± 0.13 m/s (p = 0.025, d = 0.43), a decrease in coefficients of shortening (soleus, 0.10 ± 0.07 pre vs. 0.07 ± 0.08 post, p = 0.004, d = 0.57; GSC 0.16 ± 0.08 vs. 0.13 ± 0.08, p = 0.003, d = 0.58), spasticity (soleus 0.14 ± 0.06 vs. 0.12 ± 0.07, p = 0.02, d = 0.46), and weakness (soleus 0.14 ± 0.07 vs. 0.11 ± 0.07, p = 0.005, d = 0.55). At baseline, normalized gait velocity correlated with the coefficient of GSC shortening (R = -0.43, p = 0.02). Four weeks of EMGs_SG and PT were associated with improved gait velocity and decreased plantar flexor shortening. A randomized controlled trial comparing EMGs_SG and conventional PT is needed.

Bone Deformities through the Prism of the International Classification of Functioning, Disability and Health in Ambulant Children with Cerebral Palsy: A Systematic Review

(1) Aim: The aim of this study was to determine the relationship between lower limb bone deformities and body functions, activity, and participation in ambulant children with CP and whether changing bone morphology affects outcomes in these domains. (2) Methods: A systematic literature search (PROSPERO CRD42020208416) of studies reporting correlations between measures of lower limb bone deformities and measures of body function, activity or participation, or post-surgical outcomes in these domains was conducted from 1990 to 2023 in Medline, Scopus, and Cochrane Library. We assessed study quality with the Checklist for Case Series (CCS) and a quality assessment developed by Quebec University Hospital. Meta-analysis was not possible; therefore, descriptive synthesis was performed. (3) Results: A total of 12 of 3373 screened articles were included. No studies evaluated the relationships between bone deformities and activity or participation, or the effect of isolated bone surgery on these domains. Correlations between bone deformities and body functions were poor-to-moderate. Internal hip rotation during gait improved after femoral derotation osteotomy. (4) Conclusions: A shift in paradigm is urgently required for the research and management of bone deformities in children with CP to include the activity and participation domains of the ICF, as well as consider more psychological aspects such as self-image.

Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder

Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.

The upper limb in children with cerebral palsy. Evaluation and treatment

Management of the upper limb in children with cerebral palsy is often complex and must be carried out by a team experienced in this field. Several clinical parameters must be taken into consideration, such as higher functions, visual problems, overall upper limb function, motor control, sensitivity, presence of hemineglect or synkinesis, limb position at rest and during walking. And last but not least, a complete analysis of the upper limb is required. It is only after this exhaustive assessment - which often includes occupational therapy, physiotherapy and in some cases, video and electromyography evaluations - that a treatment indication can be discussed with the patient's family. Other than baseline treatment consisting of rehabilitation, occupational therapy and bracing, botulinum toxin injections could be an option, targeting specific muscle groups. Surgical treatments, which are often indicated in severe forms with contractures, are proposed after the patient's case is presented at a multidisciplinary meeting. These include selective neurotomy, muscle-tendon release, transfer or lengthening, and procedures on bone and joints (osteotomy, arthrodesis). LEVEL OF EVIDENCE: Expert opinion.

Gait and sEMG characteristics of lower limbs in children with unilateral spastic cerebral palsy during walking

BACKGROUND

Children with unilateral spastic cerebral palsy (USCP) have muscle hypertonia, balance, and coordination defects that affect gross motor skills, especially walking. Understanding the gait characteristics and lower limb muscle activation patterns of USCP children can provide an objective and quantitative basis for patient assessment and treatment plan formulation.

OBJECTIVE

This study compared the gait and lower limb muscle activation characteristics of children with USCP and with typical development (TD) during walking.

METHODS

We recorded gait and sEMG data of 20 children with USCP, and 20 with typical development. sEMG signals were acquired from the bilateral tibialis anterior (TA) and lateral gastrocnemius muscles (LG) during walking. The root mean square (RMS) value, integrated electromyographic (iEMG) value and co-contraction ratio (CR) were used to evaluate muscle activity. Student's t Test and non-parametric rank sum Test were used to compare the differences between the data groups (significance level of 0.05).

RESULTS

The stance time, step length, speed, single leg support time ratio, ground impact, pre-swing angle, and muscle strength of the affected side were significantly decreased compared to those of the unaffected side in children with USCP (P < 0.05), while the swing phase, muscle tonus of LG were significantly prolonged (P < 0.05). Compared with TD children, children with USCP exhibited reduced bilateral walking ability, particularly noticeable in their smaller pre-swing angle(P < 0.05), diminished muscle strength of the TA and LG, as well as LG spasms(P < 0.05).

SIGNIFICANCE

Children with USCP have decreased ambulatory gait stability. Step length, pull acceleration, pre-swing angle, and CR can be used as sensitive indicators for gait assessment. Strengthening the TA muscle and reducing ankle spasm may help improve gait and postural stability in children with USCP.

F-words e ingredientes das intervenções precoces para crianças com paralisia cerebral não deambuladoras: uma revisão de escopo

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.

F-words and early intervention ingredients for non-ambulant children with cerebral palsy: A scoping review

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.

F-Wörter und Interventionsinhalte in der Frühförderung nicht gehfähiger Kinder mit Cerebralparese: eine umfangreiche Literaturübersicht

Ziel

Untersuchung 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.

Methode

Recherche 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.

Ergebnisse

87 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.

Interpretation

Viele 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.

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