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Kesar T. The Effects of Stroke and Stroke Gait Rehabilitation on Behavioral and Neurophysiological Outcomes:: Challenges and Opportunities for Future Research. Dela J Public Health 2023; 9:76-81. [PMID: 37701480 PMCID: PMC10494801 DOI: 10.32481/djph.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Stroke continues to be a leading cause of adult disability, contributing to immense healthcare costs. Even after discharge from rehabilitation, post-stroke individuals continue to have persistent gait impairments, which in turn adversely affect functional mobility and quality of life. Multiple factors, including biomechanics, energy cost, psychosocial variables, as well as the physiological function of corticospinal neural pathways influence stroke gait function and training-induced gait improvements. As a step toward addressing this challenge, the objective of the current perspective paper is to outline knowledge gaps pertinent to the measurement and retraining of stroke gait dysfunction. The paper also has recommendations for future research directions to address important knowledge gaps, especially related to the measurement and rehabilitation-induced modulation of biomechanical and neural processes underlying stroke gait dysfunction. We posit that there is a need for leveraging emerging technologies to develop innovative, comprehensive, methods to measure gait patterns quantitatively, to provide clinicians with objective measure of gait quality that can supplement conventional clinical outcomes of walking function. Additionally, we posit that there is a need for more research on how the stroke lesion affects multiple parts of the nervous system, and to understand the neuroplasticity correlates of gait training and gait recovery. Multi-modal clinical research studies that can combine clinical, biomechanical, neural, and computational modeling data provide promise for gaining new information about stroke gait dysfunction as well as the multitude of factors affecting recovery and treatment response in people with post-stroke hemiparesis.
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Affiliation(s)
- Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine
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Sporns PB, Fullerton HJ, Lee S, Kim H, Lo WD, Mackay MT, Wildgruber M. Childhood stroke. Nat Rev Dis Primers 2022; 8:12. [PMID: 35210461 DOI: 10.1038/s41572-022-00337-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/09/2023]
Abstract
Stroke is an important cause of neurological morbidity in children; most survivors have permanent neurological deficits that affect the remainder of their life. Stroke in childhood, the focus of this Primer, is distinguished from perinatal stroke, defined as stroke before 29 days of age, because of its unique pathogenesis reflecting the maternal-fetal unit. Although approximately 15% of strokes in adults are haemorrhagic, half of incident strokes in children are haemorrhagic and half are ischaemic. The causes of childhood stroke are distinct from those in adults. Urgent brain imaging is essential to confirm the stroke diagnosis and guide decisions about hyperacute therapies. Secondary stroke prevention strongly depends on the underlying aetiology. While the past decade has seen substantial advances in paediatric stroke research, the quality of evidence for interventions, such as the rapid reperfusion therapies that have revolutionized arterial ischaemic stroke care in adults, remains low. Substantial time delays in diagnosis and treatment continue to challenge best possible care. Effective primary stroke prevention strategies in children with sickle cell disease represent a major success, yet barriers to implementation persist. The multidisciplinary members of the International Pediatric Stroke Organization are coordinating global efforts to tackle these challenges and improve the outcomes in children with cerebrovascular disease.
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Helen Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Center for Cerebrovascular Research, University of California at San Francisco, San Francisco, CA, USA
| | - Warren D Lo
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
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Lange ML, Crane B, Diamond FJ, Eason S, Presperin Pedersen J, Peek G. RESNA position on the application of dynamic seating. Assist Technol 2021:1-11. [PMID: 34516360 DOI: 10.1080/10400435.2021.1979383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Dynamic Seating is an intervention used as a part of a manual or power wheelchair to provide movement against resistance in response to client force. This technology can be used for various clinical applications including preventing client injury and equipment breakage; dissipating extensor forces; providing movement for sensory input, calming, and increased alertness; increasing muscle strength, trunk and head control; and other medical benefits. The purpose of this RESNA Position Paper is to provide a definition for this technology in relation to other seating and wheeled mobility technologies as well as present clinical indicators for this seating intervention including literature to substantiate these claims. Although more recent and stronger evidence is needed, existing research does support the application of dynamic seating in numerous clinical scenarios.
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Affiliation(s)
| | - Barbara Crane
- School of Health Professions, Plymouth State University, Plymouth, Hampshire, USA
| | | | | | | | - Greg Peek
- Seating Dynamics , Centennial, Colorado, USA
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Gama GL, Ramos de Amorim MM, Alves da Silva Júnior R, Cristina de Sousa Santos A, Assunção PL, de Sales Tavares J, de Sales Regis T, de Sales Tavares J, Melo A. Effect of Intensive Physiotherapy Training for Children With Congenital Zika Syndrome: A Retrospective Cohort Study. Arch Phys Med Rehabil 2020; 102:413-422. [PMID: 33007306 DOI: 10.1016/j.apmr.2020.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the effect of intensive physiotherapy training on the motor function of children with congenital Zika syndrome (CZS). DESIGN A retrospective cohort study. SETTING A support center for children with microcephaly. PARTICIPANTS Children (N=7) aged 14 to 18 months old who were diagnosed with CZS and previously monitored more than 1 year. INTERVENTIONS A 2-stage protocol repeated uninterruptedly for 1 year. In the first stage, the children were submitted to 1 hour of conventional physiotherapy and 1 hour of suit therapy 5 times a week for 4 weeks. The second stage consisted of 1 hour of suit therapy 3 times a week for 2 weeks. MAIN OUTCOME MEASURES Gross motor function measure (GMFM) and body weight. RESULTS Six evaluations were conducted approximately 3 months apart. An increase in the overall GMFM score was observed between the first and second (P=.046), first and third (P=.018), first and fourth (P=.018), first and fifth (P=.043), and first and sixth evaluations (P=.018). Differences in the scores of the individual GMFM dimensions were found only for dimension A (lying and rolling) between the first and fourth evaluations (P=.027) and for dimension B (sitting) between the first and third (P=.018), first and fourth (P=.046), and first and sixth evaluations (P=.027). No difference was found in body weight between the first and sixth evaluations (P=.009). During follow-up, only 1 child required hospitalization, and another had increased irritability. CONCLUSIONS Children with CZS were able to perform 2 hours of motor physiotherapy daily with no serious complications, resulting in an increase or stabilization in GMFM scores.
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Affiliation(s)
- Gabriela Lopes Gama
- Professor Joaquim Amorim Neto Research Institute (IPESQ), Campina Grande, Paraíba, Brazil; UNIFACISA University Center, Campina Grande, Paraíba, Brazil
| | | | | | | | - Paula Lisiane Assunção
- Professor Joaquim Amorim Neto Research Institute (IPESQ), Campina Grande, Paraíba, Brazil
| | | | | | | | - Adriana Melo
- Professor Joaquim Amorim Neto Research Institute (IPESQ), Campina Grande, Paraíba, Brazil; UNIFACISA University Center, Campina Grande, Paraíba, Brazil.
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Graessle E. Infant crawling orthosis and home program to strengthen a neurologically impaired upper extremity. J Hand Ther 2019; 31:411-415. [PMID: 28673444 DOI: 10.1016/j.jht.2017.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Eileen Graessle
- Department of Occupational Therapy, Rehabilitation Services, Shriners Hospitals for Children-St. Louis, St. Louis, MO, USA.
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Walmsley C, Taylor S, Parkins T, Carey L, Girdler S, Elliott C. What is the current practice of therapists in the measurement of somatosensation in children with cerebral palsy and other neurological disorders? Aust Occup Ther J 2017; 65:89-97. [DOI: 10.1111/1440-1630.12431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Corrin Walmsley
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
| | - Susan Taylor
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
- Department of Paediatric Rehabilitation; Princess Margaret Hospital for Children; Perth Australia
| | - Timothy Parkins
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
| | - Leeanne Carey
- Neurorehabilitation and Recovery; The Florey Institute of Neuroscience and Mental Health; Melbourne Australia
- Occupational Therapy; School of Allied Health; La Trobe University; Melbourne Australia
| | - Sonya Girdler
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
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Cope S, Mohn-Johnsen S. The effects of dosage time and frequency on motor outcomes in children with cerebral palsy: A systematic review. Dev Neurorehabil 2017. [PMID: 28632463 DOI: 10.1080/17518423.2017.1282053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Provide an updated review regarding treatment dosage for children with cerebral palsy (CP) by examining the variables of type, time, frequency, and intensity. METHODS A systematic review was performed with 30 articles meeting the inclusion criteria. Two authors independently extracted data including information about risk of bias. Ten articles were included in the review. RESULTS Eight studies manipulated time, two studies manipulated frequency, and three studies manipulated both variables. No studies investigated intensity. Findings suggest that manipulating time and/or frequency may result in better motor function for higher total dosing; however, benefits were not consistent across studies and few showed clinically significant improvements. CONCLUSION This most current evidence regarding the effect of dosage on motor function for children with CP suggests that there is insufficient evidence to support implementing high-dosage therapy. Further research is needed to clarify the relationship between dosage variables on motor function for children with CP.
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Affiliation(s)
- Steven Cope
- a Department of Occupational Therapy , The College of St. Scholastica , Duluth , MN , USA
| | - Samantha Mohn-Johnsen
- b Department of Physical Therapy , The College of St. Scholastica , Duluth , MN , USA
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Ting LH, Chiel HJ, Trumbower RD, Allen JL, McKay JL, Hackney ME, Kesar TM. Neuromechanical principles underlying movement modularity and their implications for rehabilitation. Neuron 2015; 86:38-54. [PMID: 25856485 DOI: 10.1016/j.neuron.2015.02.042] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Neuromechanical principles define the properties and problems that shape neural solutions for movement. Although the theoretical and experimental evidence is debated, we present arguments for consistent structures in motor patterns, i.e., motor modules, that are neuromechanical solutions for movement particular to an individual and shaped by evolutionary, developmental, and learning processes. As a consequence, motor modules may be useful in assessing sensorimotor deficits specific to an individual and define targets for the rational development of novel rehabilitation therapies that enhance neural plasticity and sculpt motor recovery. We propose that motor module organization is disrupted and may be improved by therapy in spinal cord injury, stroke, and Parkinson's disease. Recent studies provide insights into the yet-unknown underlying neural mechanisms of motor modules, motor impairment, and motor learning and may lead to better understanding of the causal nature of modularity and its underlying neural substrates.
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Affiliation(s)
- Lena H Ting
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA; Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA 30322, USA.
| | - Hillel J Chiel
- Department of Biology, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Neurosciences, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Randy D Trumbower
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA; Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA 30322, USA
| | - Jessica L Allen
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - J Lucas McKay
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Madeleine E Hackney
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA 30033, USA; Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, GA 30322, USA
| | - Trisha M Kesar
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA; Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA 30322, USA
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Abstract
Safer and more effective interventions have been invented for children with cerebral palsy, but the rapid expansion of the evidence base has made keeping up-to-date difficult. Unfortunately, outdated care is being provided. The aims were to survey the questions parents asked neurologists and provide evidence-based answers, using knowledge translation techniques. Parents asked the following questions: (1) what's wrong with my baby? An algorithm for early diagnosis was proposed. (2) What is cerebral palsy and what online resources are current? Reputable information websites were sourced and hyperlinks provided. (3) The prognosis? Prognostic data from meta-analyses were summarized in an infographic. (4) What interventions offer the most evidence-supported results? Systematic review data about the most effective interventions was mapped into a bubble chart infographic. Finally, (5) What can we expect? Predictors and facilitators of good outcomes were summarized. This article provides an overview of the most up-to-date diagnostic practices and evidence-based intervention options.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, University of Notre Dame, Australia
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Leonardi M, Sattin D, Raggi A. An Italian population study on 600 persons in vegetative state and minimally conscious state. Brain Inj 2013; 27:473-84. [DOI: 10.3109/02699052.2012.750758] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Kesar TM, Sawaki L, Burdette JH, Cabrera MN, Kolaski K, Smith BP, O'Shea TM, Koman LA, Wittenberg GF. Motor cortical functional geometry in cerebral palsy and its relationship to disability. Clin Neurophysiol 2011; 123:1383-90. [PMID: 22153667 DOI: 10.1016/j.clinph.2011.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 10/31/2011] [Accepted: 11/06/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate motor cortical map patterns in children with diplegic and hemiplegic cerebral palsy (CP), and the relationships between motor cortical geometry and motor function in CP. METHODS Transcranial magnetic stimulation (TMS) was used to map motor cortical representations of the first dorsal interosseus (FDI) and tibialis anterior (TA) muscles in 13 children with CP (age 9-16 years, 6 males.) The Gross Motor Function Measure (GMFM) and Melbourne upper extremity function were used to quantify motor ability. RESULTS In the hemiplegic participants (N = 7), the affected (right) FDI cortical representation was mapped on the ipsilateral (N = 4), contralateral (N = 2), or bilateral (N = 1) cortex. Participants with diplegia (N = 6) showed either bilateral (N = 2) or contralateral (N = 4) cortical hand maps. The FDI and TA motor map center-of-gravity mediolateral location ranged from 2-8 cm and 3-6 cm from the midline, respectively. Among diplegics, more lateral FDI representation locations were associated with lower Melbourne scores, i.e. worse hand motor function (Spearman's rho = -0.841, p = 0.036). CONCLUSIONS Abnormalities in TMS-derived motor maps cut across the clinical classifications of hemiplegic and diplegic CP. The lateralization of the upper and lower extremity motor representation demonstrates reorganization after insults to the affected hemispheres of both diplegic and hemiplegic children. SIGNIFICANCE The current study is a step towards defining the relationship between changes in motor maps and functional impairments in CP. These results suggest the need for further work to develop improved classification schemes that integrate clinical, radiologic, and neurophysiologic measures in CP.
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Affiliation(s)
- T M Kesar
- Dept of Physical Therapy, University of Delaware, Newark, DE, United States
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Aarts PB, van Hartingsveldt M, Anderson PG, van den Tillaar I, van der Burg J, Geurts AC. The Pirate Group Intervention Protocol: Description and a Case Report of a Modified Constraint-induced Movement Therapy Combined with Bimanual Training for Young Children with Unilateral Spastic Cerebral Palsy. Occup Ther Int 2011; 19:76-87. [DOI: 10.1002/oti.321] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 03/23/2011] [Accepted: 03/28/2011] [Indexed: 12/19/2022] Open
Affiliation(s)
- Pauline B. Aarts
- Sint Maartenskliniek; Department of Pediatric Rehabilitation; Nijmegen The Netherlands
- Sint Maartenskliniek; Department of Research, Development and Education; Nijmegen The Netherlands
| | - Margo van Hartingsveldt
- Radboud University Nijmegen Medical Centre; Department of Occupational Therapy; Nijmegen The Netherlands
| | - Patricia G. Anderson
- Sint Maartenskliniek; Department of Research, Development and Education; Nijmegen The Netherlands
| | | | - Jan van der Burg
- Sint Maartenskliniek; Department of Pediatric Rehabilitation; Nijmegen The Netherlands
| | - Alexander C. Geurts
- Radboud University Nijmegen Medical Centre; Department of Rehabilitation; Nijmegen The Netherlands
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