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Alotaibi A, Ibrahim A, Ahmed R, Abualait T. Effectiveness of Partial Body Weight-Supported Treadmill Training on Various Outcomes in Different Contexts among Children and Adolescents with Cerebral Palsy: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 11:9. [PMID: 38275430 PMCID: PMC10813858 DOI: 10.3390/children11010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
The efficiency of partial body weight-supported treadmill training (PBWSTT) for treating various conditions in children and adolescents with cerebral palsy (CP) in diverse contexts of rehabilitation, households, or schools is unknown. The major objective of this systematic review and meta-analysis was to analyze the effectiveness of PBWSTT on various outcomes in different contexts among children and adolescents with CP. We incorporated full-text, randomized controlled trial studies that specifically assessed the effects of PBWSTT walking, motor function, stride, balance, and endurance in children and adolescents aged 3 to 18 years with CP. The literature search was carried out using Google Scholar, PubMed, Web of Science, CINAHL Plus, Scopus, PEDro, and ResearchGate databases. The methodological quality was evaluated using a Cochrane risk of bias instrument. A meta-analysis of pooled data from 10 studies with 255 participants demonstrated that PBWSTT for 4-12 weeks in rehabilitation (mean difference [MD] = 1.94, 95% confidence interval [CI] = 1.40-2.48, p < 0.0001), at home or in a school context (MD = 13.5, 95% CI = 13.9-16.0, p < 0.0001), was significantly effective for treating various conditions in children and adolescents suffering with CP. The period of 4-12 weeks of PBWSTT in rehabilitation and at-home/school settings is effective on various outcomes in children or adolescents with CP.
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Affiliation(s)
- Abdulmajeed Alotaibi
- Department of Physical Therapy, Children’s Hospital, Ministry of Health, Taif 26514, Saudi Arabia
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (A.I.); (R.A.); (T.A.)
| | - Alaa Ibrahim
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (A.I.); (R.A.); (T.A.)
| | - Raafat Ahmed
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (A.I.); (R.A.); (T.A.)
| | - Turki Abualait
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (A.I.); (R.A.); (T.A.)
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Soares EG, Gusmão CHV, Souto DO. Efficacy of aerobic exercise on the functioning and quality of life of children and adolescents with cerebral palsy: A systematic review and meta-analysis. Dev Med Child Neurol 2023; 65:1292-1307. [PMID: 36895173 DOI: 10.1111/dmcn.15570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/11/2023]
Abstract
AIM To investigate the efficacy of aerobic exercise on the functioning (participation, activities, and body functions and structures) and quality of life (QoL) of children and adolescents with cerebral palsy (CP). METHOD A systematic review with meta-analysis was performed. A comprehensive search of articles was performed using the electronic databases Embase, PubMed, PEDro, and CINAHL. Methodological quality and certainty of evidence were evaluated with the PEDro and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scales respectively. The effects of aerobic exercise on functioning were assessed using meta-analytic techniques. However, given the broad nature of outcomes related to functioning and QoL, different instruments can be used to measure them; this made it impossible to synthesize results in a meta-analysis for some of the outcomes. RESULTS Fifteen randomized controlled trials with 414 participants with CP were included. Analysis of the methodological quality of the studies revealed a low risk of bias. The effect of aerobic exercise compared to usual care or other interventions was significant for aerobic capacity (standardized mean difference [SMD] = 0.81; 95% confidence interval [CI] = 0.16-1.47; p < 0.002; I2 = 68%), gross motor function (SMD = 0.70; 95% = CI 0.21-1.19; p = 0.005; I2 = 49%), mobility (SMD = 0.53; 95% CI = 0.05-1.05; p = 0.03; I2 = 27%), balance, and participation (SMD = 0.74; 95% CI = 0.10-1.39; p = 0.02; I2 = 0%). Aerobic exercise was not effective for muscle strength, spasticity, gait parameters, and QoL (p > 0.05). The certainty of evidence for most comparisons was moderate to low. INTERPRETATION This review provides the most up-to-date evidence on the efficacy of aerobic exercise on the functioning and QoL of children and adolescents with CP. WHAT THIS PAPER ADDS Aerobic exercise improves gross motor function but not gait parameters in cerebral palsy (CP). It improves participation but not quality of life in children and adolescents with CP. It is more effective than usual care or other interventions in improving mobility, aerobic capacity, and balance in CP. It is no more effective than usual care or other interventions in improving muscle strength and spasticity.
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Affiliation(s)
- Esther G Soares
- Department of Physiotherapy, College of Santa Luzia, Santa Luzia, Brazil
| | - Cláudio H V Gusmão
- Department of Physiotherapy, College of Santa Luzia, Santa Luzia, Brazil
| | - Deisiane O Souto
- Department of Physiotherapy, College of Santa Luzia, Santa Luzia, Brazil
- Graduate Program in Rehabilitation Sciences, Physical Therapy Department, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Qian G, Cai X, Xu K, Tian H, Meng Q, Ossowski Z, Liang J. Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis. Front Neurol 2023; 13:1005485. [PMID: 36703638 PMCID: PMC9871496 DOI: 10.3389/fneur.2022.1005485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Background A vital objective to treat people with cerebral palsy (CP) is to increase gait velocity and improve gross motor function. This study aimed to evaluate the relative effectiveness of gait training interventions for persons with CP. Methods Studies published up to October 26, 2022 were searched from four electronic databases [including Medline (via PubMed), Web of Science, Embase and Cochrane]. Studies with randomized controlled trials (RCTs), people with CP, comparisons of different gait training interventions and outcomes of gait velocity and gross motor function measures (GMFM) were included in this study. The quality of the literature was evaluated using the risk of bias tool in the Cochrane Handbook, the extracted data were analyzed through network meta-analysis (NMA) using Stata16.0 and RevMan5.4 software. Results Twenty RCTs with a total of 516 individuals with CP were included in accordance with the criteria of this study. The results of the NMA analysis indicated that both external cues treadmill training (ECTT) [mean difference (MD) = 0.10, 95% confidence interval CI (0.04, 0.17), P < 0.05] and partial body weight supported treadmill training (BWSTT) [MD = 0.12, 95% CI (0.01, 0.23), P < 0.05] had better gait velocity than over ground gait training (OGT), BWSTT [MD = 0.09, 95%CI(0.01,0.18), P < 0.05] had a better gait velocity than robot-assisted gait training (RAGT), BWSTT [MD = 0.09, 95% CI (0.06, 0.13) P < 0.05] had a better gait velocity than treadmill training (TT), and BWSTT [MD = 0.14, 95% CI (0.07, 0.21), P < 0.05] had a better gait velocity than conventional physical therapy (CON). The SUCRA ranking indicated that BWSTT optimally improved the gait velocity, and the other followed an order of BWSTT (91.7%) > ECTT (80.9%) > RAGT (46.2%) > TT (44%) > OGT (21.6%) > CON (11.1%). In terms of GMFM, for dimension D (GMFM-D), there was no statistical difference between each comparison; for dimension E (GMFM-E), RAGT [MD = 10.45, 95% CI (2.51, 18.40), P < 0.05] was significantly more effective than CON. Both SUCRA ranking results showed that RAGT improved GMFM-D/E optimally, with rankings of RAGT (69.7%) > TT (69.3%) > BWSTT (67.7%) > OGT (24%) > CON (20.3%), and RAGT (86.1%) > BWSTT (68.2%) > TT (58%) > CON (20.1%) > OGT (17.6%) respectively. Conclusion This study suggested that BWSTT was optimal in increasing the gait velocity and RAGT was optimal in optimizing GMFM in persons with CP. Impacted by the limitations of the number and quality of studies, randomized controlled trials with larger sample sizes, multiple centers, and high quality should be conducted to validate the above conclusion. Further studies will be required to focus on the total duration of the intervention, duration and frequency of sessions, and intensity that are optimal for the promotion of gait ability in this population. Systematic review registration https://doi.org/10.37766/inplasy2022.10.0108, identifier: INPLASY2022100108.
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Affiliation(s)
- Guoping Qian
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Xiaoye Cai
- Department of General Education, Shanghai Normal University Tianhua College, Shanghai, China
| | - Kai Xu
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland,Department of Art and Sports, Huanghe Science and Technology University, Zhengzhou, Henan, China
| | - Hao Tian
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland,Department of Physical Education and Humanities, Nanjing Sport Institute, Nanjing, China
| | - Qiao Meng
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Zbigniew Ossowski
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland,*Correspondence: Zbigniew Ossowski ✉
| | - Jinghong Liang
- Department of Maternal and Child Health, School of Public Health, Medical College of Sun Yat-sen University, Guangzhou, China,Jinghong Liang ✉
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Ochandorena-Acha M, Terradas-Monllor M, Nunes Cabrera TF, Torrabias Rodas M, Grau S. Effectiveness of virtual reality on functional mobility during treadmill training in children with cerebral palsy: a single-blind, two-arm parallel group randomised clinical trial (VirtWalkCP Project). BMJ Open 2022; 12:e061988. [PMID: 36328390 PMCID: PMC9639079 DOI: 10.1136/bmjopen-2022-061988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Treadmill training and virtual reality have been investigated in children with cerebral palsy. However, few studies have assessed the effectiveness of the combination of both treatments on children's functional and balance activities. The project aims to compare the effects of treadmill training with and without virtual reality on walking endurance and speed, static and dynamic balance, gross motor function, functional independence, quality of life and occupational participation in children with spastic cerebral palsy between the ages of 4 and 12 years classified at levels I, II and III of the Gross Motor Function Classification System. METHODS AND ANALYSIS This study is a single-blind, two-arm parallel group, randomised, controlled clinical trial. Participants will be recruited at the Pediatric Department of the Vic Hospital Consortium, and the research will be conducted at the University of Vic - Central University of Catalonia. The participants will be randomly allocated into two groups: (1) the experimental group, which will receive the treadmill training at the same time as the virtual reality; and (2) the control group, which will undertake treadmill gait training alone. The training will be provided in 10 sessions over 2 weeks with 30 min for each session. Assessments will be performed on three occasions: 1 week before the intervention, 1 week following the intervention and 1 month after the end of the intervention. The evaluations will involve the 6 min walk test, stabilometry, the Berg Balance Scale, the 10 m walk test, the Gross Motor Function Measure, the Functional Independence Measure, the paediatric quality of life inventory and the Children Participation Questionnaire. For between-within group comparison, a mixed-effect linear model will be used. ETHICS AND DISSEMINATION The study has been approved by the Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (2021061). Results will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT05131724.
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Affiliation(s)
- Mirari Ochandorena-Acha
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), C.Sagrada Família, 7, 08500 Vic, Spain
- Neurology department, Sant Joan de Deu Barcelona Children's Hospital, Barcelona, Catalonia, Spain
| | - Marc Terradas-Monllor
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), C.Sagrada Família, 7, 08500 Vic, Spain
- Pain Medicine Section, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Tania Fabiola Nunes Cabrera
- Neurology department, Sant Joan de Deu Barcelona Children's Hospital, Barcelona, Catalonia, Spain
- Pediatric Department, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
| | | | - Sergi Grau
- Faculty of Science and Technology, University of Vic - Central University of Catalonia, Vic, Spain
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Fang Y, Orekhov G, Lerner ZF. Adaptive ankle exoskeleton gait training demonstrates acute neuromuscular and spatiotemporal benefits for individuals with cerebral palsy: A pilot study. Gait Posture 2022; 95:256-263. [PMID: 33248858 PMCID: PMC8110598 DOI: 10.1016/j.gaitpost.2020.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait abnormalities from neuromuscular conditions like cerebral palsy (CP) limit mobility and negatively affect quality of life. Increasing walking speed and stride length are essential clinical goals in the treatment of gait disorders from CP. RESEARCH QUESTION How does over-ground gait training with an untethered ankle exoskeleton providing adaptive assistance affect mobility-related spatiotemporal outcomes and lower-extremity muscle activity in people with CP? METHODS A diverse cohort of individuals with CP (n = 6, age 9-31, Gross Motor Function Classification System Level I - III) completed four over-ground training sessions (98 ± 17 min of assisted walking) and received pre- and post-training assessments. On both assessments, participants walked over-ground with and without the exoskeleton while we recorded spatiotemporal outcomes and muscle activity. We used two-tailed paired t-tests to compare all parameters pre- and post-training, and between assisted and unassisted conditions. RESULTS Following training, walking speed increased 0.24 m/s (p = 0.006) and stride length increased 0.17 m (p = 0.013) during unassisted walking, while walking speed increased 0.28 m/s (p = 0.023) and stride length increased 0.15 m (p = 0.002) during exoskeleton-assisted walking. Exoskeleton training improved stride-to-stride repeatability of soleus and vastus lateralis muscle activation by up to 51 % (p ≤ 0.046), while the amount of integrated stance-phase muscle activity was similar across visits and conditions. Relative to baseline, post-training walking with the exoskeleton resulted in a soleus activity pattern that was 39 % more similar to the typical pattern from unimpaired individuals (p < 0.001). SIGNIFICANCE This study demonstrates acute spatiotemporal and neuromuscular benefits from over-ground training with adaptive ankle exoskeleton assistance, and provides rationale for completion of a longer randomized controlled training protocol.
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Affiliation(s)
- Ying Fang
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Greg Orekhov
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Zachary F. Lerner
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA,Department of Orthopedics, the University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
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Selph SS, Skelly AC, Wasson N, Dettori JR, Brodt ED, Ensrud E, Elliot D, Dissinger KM, McDonagh M. Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury. Arch Phys Med Rehabil 2021; 102:2464-2481.e33. [PMID: 34653376 DOI: 10.1016/j.apmr.2021.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI). DATA SOURCES Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020). STUDY SELECTION Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI. DATA EXTRACTION We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant. DATA SYNTHESIS No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT. CONCLUSIONS Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.
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Affiliation(s)
- Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.
| | | | - Ngoc Wasson
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Erik Ensrud
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Diane Elliot
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Kristin M Dissinger
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
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Kilgour G, Adair B, Stott NS, Steele M, Hogan A, Imms C. Do physical activity interventions influence subsequent attendance and involvement in physical activities for children with cerebral palsy: a systematic review. Disabil Rehabil 2021; 44:1682-1698. [PMID: 34097836 DOI: 10.1080/09638288.2021.1909151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate if children with cerebral palsy have sustained attendance and involvement in physical activities after completing physical activity interventions. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Seven databases were searched for the period 2001-2020 with hand-searching of pertinent reference lists. Criteria for study inclusion were participants aged 0-18 years and ≥50% with cerebral palsy; follow-up ≥1 month beyond completion of the physical activity intervention; and measurement of attendance and/or involvement in any physical activity post-intervention. Study selection, data extraction, and risk of bias assessments (Physiotherapy Evidence Database (PEDro) or tool for non-randomised studies) were completed independently by paired reviewers. Results were compiled by narrative synthesis. RESULTS Thirteen studies were included (11 randomised controlled trials (RCTs), two non-randomised case series; intervention sample sizes: 6-34). All study participants had cerebral palsy and were aged 4-16.7 years. PEDro scores for the RCTs ranged from 5 to 10; 10 did not blind one or more therapist, participant, or assessor. Two case series showed high risk of bias. Twelve studies reported on attendance, with positive changes in three studies. At 4-14 weeks post-intervention, two studies demonstrated positive changes were maintained. Four studies included involvement outcomes; one reporting positive changes in physical activity involvement four weeks after intervention completion. CONCLUSIONS Physical activity attendance may be influenced by physical activity interventions in the short term, but more robust research designs are required to investigate whether gains can be sustained. Activity involvement, which may influence ongoing participation, is under-researched.Implications for RehabilitationPositive changes in attendance and involvement following physical activity interventions appear short term at best.Physical activity interventions should have longer follow-up periods to determine the effect on sustained physical activity participation.Careful selection and reporting of attendance and involvement outcome measures is required.The optimal physical activity intervention to increase attendance or involvement in physical activities remains uncertain.
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Affiliation(s)
- Gaela Kilgour
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Brooke Adair
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | - Amy Hogan
- Cerebral Palsy Society, Auckland, New Zealand
| | - Christine Imms
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Hornáček K, Kujawa J, Varela Donoso E, Dincer F, Ilieva E, Takáč P, Petronic Markovic I, Votava J, Vetra A, Nikolic D, Christodoulou N, Zampolini M, Kiekens C. Evidence Based Position Paper on Physical and Rehabilitation Medicine professional practice for persons with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:1020-1035. [PMID: 33861040 DOI: 10.23736/s1973-9087.21.06983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. AIM The aim of this study was to improve Physical and Rehabilitation Medicine physician´s professional practice for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. MATERIAL AND METHODS A systematic review of the literature including an eighteen-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. RESULTS As the result of a Consensus Delphi procedure process 74 recommendations are presented together with the systematic literature review. CONCLUSIONS The PRM physician´s role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM programme developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients´ health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions.
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Affiliation(s)
- Karol Hornáček
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Jolanta Kujawa
- Department of Physical and Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University of School of Medicine, Madrid, Spain
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Peter Takáč
- Department of Physical and Rehabilitation Medicine, L. Pasteur University Hospital, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic -
| | - Ivana Petronic Markovic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jiří Votava
- Faculty of Health Studies, University of J. E. Purkyně, Ústí nad Labem, Czech Republic
| | - Anita Vetra
- Rehabilitation Department, Riga Stradins University, Riga, Latvia
| | - Dejan Nikolic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Zampolini
- Department of Rehabilitation, Foligno Hospital, USL Umbria 2, Perugia, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola Bologna, Italy
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Vali Noghondar N, Saberi Kakhki A, Sohrabi M, Alirezaei Noghondar F. Variability and coordination patterns of walking with different speeds in active and non-active children with Down syndrome: A cross-sectional case-control study. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:723-731. [PMID: 36210898 PMCID: PMC9542406 DOI: 10.1080/20473869.2021.1893923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 06/16/2023]
Abstract
Purpose: Children with Down syndrome (DS) have multiple difficulties in gait pattern. So, the effect of the activity level and speed on the gait coordination and variability was investigated. Methods: In this case-control observational study, 24 participants in three groups of active and non-active children with DS, and the control group without intellectual disability were asked to walk on a treadmill with two speeds of 0.8 and 1.2 m/s. Continuous Relative Phase (CRP) and variability of CRP in thigh-leg and leg-foot coupling were assessed. Results: CRP and variability of CRP in the leg-foot coupling in the control group were significantly higher than active and non-active groups with DS. Speed led to increase the CRP of leg-foot in the active group with DS and increase the variability of this coupling in non-active group with DS. Conclusion: In this study, the activity level provided the compatibility with speed changes of walking in CRP of leg-foot in children with DS.
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Affiliation(s)
| | | | - Mehdi Sohrabi
- Department of Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
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Chiu HC, Ada L, Bania TA. Mechanically assisted walking training for walking, participation, and quality of life in children with cerebral palsy. Cochrane Database Syst Rev 2020; 11:CD013114. [PMID: 33202482 PMCID: PMC8092676 DOI: 10.1002/14651858.cd013114.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cerebral palsy is the most common physical disability in childhood. Mechanically assisted walking training can be provided with or without body weight support to enable children with cerebral palsy to perform repetitive practice of complex gait cycles. It is important to examine the effects of mechanically assisted walking training to identify evidence-based treatments to improve walking performance. OBJECTIVES To assess the effects of mechanically assisted walking training compared to control for walking, participation, and quality of life in children with cerebral palsy 3 to 18 years of age. SEARCH METHODS In January 2020, we searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers. We handsearched conference abstracts and checked reference lists of included studies. SELECTION CRITERIA Randomized controlled trials (RCTs) or quasi-RCTs, including cross-over trials, comparing any type of mechanically assisted walking training (with or without body weight support) with no walking training or the same dose of overground walking training in children with cerebral palsy (classified as Gross Motor Function Classification System [GMFCS] Levels I to IV) 3 to 18 years of age. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 17 studies with 451 participants (GMFCS Levels I to IV; mean age range 4 to 14 years) from outpatient settings. The duration of the intervention period (4 to 12 weeks) ranged widely, as did intensity of training in terms of both length (15 minutes to 40 minutes) and frequency (two to five times a week) of sessions. Six studies were funded by grants, three had no funding support, and eight did not report information on funding. Due to the nature of the intervention, all studies were at high risk of performance bias. Mechanically assisted walking training without body weight support versus no walking training Four studies (100 participants) assessed this comparison. Compared to no walking, mechanically assisted walking training without body weight support increased walking speed (mean difference [MD] 0.05 meter per second [m/s] [change scores], 95% confidence interval [CI] 0.03 to 0.07; 1 study, 10 participants; moderate-quality evidence) as measured by the Biodex Gait Trainer 2™ (Biodex, Shirley, NY, USA) and improved gross motor function (standardized MD [SMD] 1.30 [postintervention scores], 95% CI 0.49 to 2.11; 2 studies, 60 participants; low-quality evidence) postintervention. One study (30 participants) reported no adverse events (low-quality evidence). No study measured participation or quality of life. Mechanically assisted walking training without body weight support versus the same dose of overground walking training Two studies (55 participants) assessed this comparison. Compared to the same dose of overground walking, mechanically assisted walking training without body weight support increased walking speed (MD 0.25 m/s [change or postintervention scores], 95% CI 0.13 to 0.37; 2 studies, 55 participants; moderate-quality evidence) as assessed by the 6-minute walk test or Vicon gait analysis. It also improved gross motor function (MD 11.90% [change scores], 95% CI 2.98 to 20.82; 1 study, 35 participants; moderate-quality evidence) as assessed by the Gross Motor Function Measure (GMFM) and participation (MD 8.20 [change scores], 95% CI 5.69 to 10.71; 1 study, 35 participants; moderate-quality evidence) as assessed by the Pediatric Evaluation of Disability Inventory (scored from 0 to 59), compared to the same dose of overground walking training. No study measured adverse events or quality of life. Mechanically assisted walking training with body weight support versus no walking training Eight studies (210 participants) assessed this comparison. Compared to no walking training, mechanically assisted walking training with body weight support increased walking speed (MD 0.07 m/s [change and postintervention scores], 95% CI 0.06 to 0.08; 7 studies, 161 participants; moderate-quality evidence) as assessed by the 10-meter or 8-meter walk test. There were no differences between groups in gross motor function (MD 1.09% [change and postintervention scores], 95% CI -0.57 to 2.75; 3 studies, 58 participants; low-quality evidence) as assessed by the GMFM; participation (SMD 0.33 [change scores], 95% CI -0.27 to 0.93; 2 studies, 44 participants; low-quality evidence); and quality of life (MD 9.50% [change scores], 95% CI -4.03 to 23.03; 1 study, 26 participants; low-quality evidence) as assessed by the Pediatric Quality of Life Cerebral Palsy Module (scored 0 [bad] to 100 [good]). Three studies (56 participants) reported no adverse events (low-quality evidence). Mechanically assisted walking training with body weight support versus the same dose of overground walking training Three studies (86 participants) assessed this comparison. There were no differences between groups in walking speed (MD -0.02 m/s [change and postintervention scores], 95% CI -0.08 to 0.04; 3 studies, 78 participants; low-quality evidence) as assessed by the 10-meter or 5-minute walk test; gross motor function (MD -0.73% [postintervention scores], 95% CI -14.38 to 12.92; 2 studies, 52 participants; low-quality evidence) as assessed by the GMFM; and participation (MD -4.74 [change scores], 95% CI -11.89 to 2.41; 1 study, 26 participants; moderate-quality evidence) as assessed by the School Function Assessment (scored from 19 to 76). No study measured adverse events or quality of life. AUTHORS' CONCLUSIONS Compared with no walking, mechanically assisted walking training probably results in small increases in walking speed (with or without body weight support) and may improve gross motor function (with body weight support). Compared with the same dose of overground walking, mechanically assisted walking training with body weight support may result in little to no difference in walking speed and gross motor function, although two studies found that mechanically assisted walking training without body weight support is probably more effective than the same dose of overground walking training for walking speed and gross motor function. Not many studies reported adverse events, although those that did appeared to show no differences between groups. The results are largely not clinically significant, sample sizes are small, and risk of bias and intensity of intervention vary across studies, making it hard to draw robust conclusions. Mechanically assisted walking training is a means to undertake high-intensity, repetitive, task-specific training and may be useful for children with poor concentration.
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Affiliation(s)
- Hsiu-Ching Chiu
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Lidcombe, Australia
| | - Theofani A Bania
- Department of Physiotherapy, School of Health Rehabilitation Science, University of Patras, Myrtia, Greece
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11
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Klobucká S, Klobucký R, Kollár B. Effect of robot-assisted gait training on motor functions in adolescent and young adult patients with bilateral spastic cerebral palsy: A randomized controlled trial. NeuroRehabilitation 2020; 47:495-508. [PMID: 33136072 DOI: 10.3233/nre-203102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robot-assisted gait training (RAGT) allows an intensive gait training in patients with cerebral palsy (CP). There are few evidences on the effectiveness of RAGT in adults with CP. OBJECTIVE To assess the effect of RAGT on gross motor function in adolescent and adult patients with bilateral spastic CP and to compare the effect of RAGT with conventional kinesiotherapy. METHODS Forty-seven patients (mean age 21.2±5.33 years) with bilateral spastic CP were divided into two groups. Twenty-one patients underwent 20 therapeutic units of RAGT and 26 patients underwent 20 therapeutic units of conventional therapy/training (CON). The following parameters were evaluated before (V1) and after the therapy (V2): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). In patients in the experimental RAGT group, these parameters were also evaluated 3-4 months later (V3). RESULTS Comparing the mean improvements in endpoints in both groups (RAGT vs. CON) after 20 TUs, we observed the statistically significant difference (p < 0.001) and large effect size in all GMFM dimensions and total GMFM improvement in favour of the RAGT group. In RAGT patients, the improvement persisted even 3-4 months after RAGT (p < 0.001). CONCLUSION We demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP.
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Affiliation(s)
| | - Robert Klobucký
- Slovak Academy of Sciences, Institute for Sociology, Bratislava, Slovakia
| | - Branislav Kollár
- 1st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
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12
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Lopes JBP, Miziara IM, Galli M, Cimolin V, Oliveira CS. Effect of Transcranial Direct Current Stimulation Combined With Xbox-Kinect Game Experience on Upper Limb Movement in Down Syndrome: A Case Report. Front Bioeng Biotechnol 2020; 8:514. [PMID: 32548102 PMCID: PMC7273846 DOI: 10.3389/fbioe.2020.00514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/30/2020] [Indexed: 11/28/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique used to enhance local synaptic efficacy and modulate the electrical activity of the cortex in neurological disorders. Researchers have sought to combine this type of stimulation with well-established therapeutic modalities, such as motor training involving Xbox Kinect games, which has demonstrated promising results. Thus, this study aimed to determine whether tDCS can enhance upper limb motor training in an eight-year-old child with Down Syndrome (DS) (cognitive age: five years, based on the Wechsler Intelligence Scale for Children). The evaluations consisted of three-dimensional analysis of upper limb kinematics during a reaching task performed before, after10 session, and one month after the intervention. The intervention protocol involved 1 20-min sessions of tDCS over the primary motor cortex at an intensity of 1 mA during Xbox Kinect game training involving an upper limb motor task. The analysis of the kinematic data revealed that in the pre-intervention evaluation, the dominant limb executed the task slowly and over a long path. These aspects improved at the post-intervention and follow-up evaluations, as demonstrated by the shorter total movement duration (3.05 vs. 1.58 vs. 1.52 s, respectively). Similar changes occurred with the non-dominant upper limb; a significant increase in movement velocity at the post-intervention and follow-up evaluations was observed (0.53 vs. 0.54 vs. 0.85 m/s, respectively). The present case report offers preliminary data from a protocol study, and the results confirm the notion that anodal tDCS combined with upper limb motor training leads to improvements in different kinematic variables.
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Affiliation(s)
- Jamile Benite Palma Lopes
- Health Sciences Program, Faculty of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil
- Undergraduate Department, Faculty of Taquaritinga - FTGA, Taquaritinga, Brazil
| | - Isabela Marques Miziara
- Undergraduate Department, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
- Undergraduate Department, Faculty of Electrical and Biomedical Engineering, Federal University of Pará, Belém, Brazil
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Claudia Santos Oliveira
- Program in Human Movement and Rehabilitation Center of Anápolis, Anápolis, Brazil
- Master's and Doctoral Program in Health Sciences, São Paulo Santa Casa School of Medical Sciences, São Paulo, Brazil
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13
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Han YG, Yun CK. Effectiveness of treadmill training on gait function in children with cerebral palsy: meta-analysis. J Exerc Rehabil 2020; 16:10-19. [PMID: 32161730 PMCID: PMC7056486 DOI: 10.12965/jer.1938748.374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/30/2020] [Indexed: 11/22/2022] Open
Abstract
The purpose of this review was to analysis the effects of treadmill training on gait function in children with cerebral palsy. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science were searched. Investigating the effects of treadmill training on gait endurance, gait speed, limb support time, cadence, and step length in children with cerebral palsy. Similar outcomes were pooled by calculating the standardized mean difference. Of the eight studies, 179 participants were included. The average PEDro score was 6.25/10. The results of the sensitivity test for bias evaluation using the duval and tweedie's trim and fill method showed low publication bias. The test regarding the effect of treadmill training on overall gait function yielded a moderate effect size of 0.53, which was a statistically significant effect as its confidence interval did not include. The overall effect size of gait endurance was 0.85. The overall effect size of gait speed and limb support time were 0.52 and 0.73. The overall effect size of cadence and step length were 0.14 and 0.21, indicating a nonsignificant improvement. These findings suggested that treadmill training on cerebral palsy was effective for gait endurance, gait speed and limb support time than cadence and step length.
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Affiliation(s)
- Yong-Gu Han
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Gyeongsan, Korea
| | - Chang-Kyo Yun
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Gyeongsan, Korea
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14
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Corsi C, Santos MM, Moreira RFC, Dos Santos AN, de Campos AC, Galli M, Rocha NACF. Effect of physical therapy interventions on spatiotemporal gait parameters in children with cerebral palsy: a systematic review. Disabil Rehabil 2019; 43:1507-1516. [PMID: 31588810 DOI: 10.1080/09638288.2019.1671500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To investigate the effect of physical therapy interventions on spatiotemporal gait parameters in children with cerebral palsy. METHODS Six databases were searched: PubMed, Embase, Web of Science, Science Direct, Lilacs, and Scopus. Two independent reviewers worked on primary study selection based on titles, abstracts, and full text reading. We included randomized controlled trials investigating the role of therapeutic interventions on gait kinematics in children with cerebral palsy. The independent reviewers extracted information about study population, intervention type, main outcomes, and methodological quality according to PEDro Scale. The body of evidence was synthesized through GRADE. RESULTS Twenty-six studies were found addressing the following treatment categories: functional electrical stimulation, transcranial stimulation, gait training, muscular strengthening, vibratory platform training, and serial casting. A moderate level of evidence was identified for vibratory platform training, gait training, transcranial stimulation (positive effect), and isolated muscle strengthening (negative effect) in relation to gait velocity. Electrical stimulation showed a moderate level of evidence regarding stride length. The evidence for other outcomes was of low or very low quality. CONCLUSION Vibratory platform, gait training, electrical stimulation, and transcranial stimulation were effective to improve spatiotemporal gait parameters, especially velocity in children with cerebral palsy.Implication for rehabilitationImprovement and maintenance of gait of children with cerebral palsy is a great challenge to rehabilitation professionalsVibratory platform, gait training, electrical stimulation, and transcranial stimulation improve gait parameters.Isolated strength training was not effective to improve gait parameters in Cerebral Palsy.Long-term effect of most techniques on gait parameters until unclear.
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Affiliation(s)
- Carolina Corsi
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.,Bioengineering Department, Politecnico di Milano, Milan, Italy
| | - Mariana M Santos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Roberta F C Moreira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Adriana N Dos Santos
- Department of Physical Therapy, Federal University of Santa Catarina, Araranguá, Brazil
| | - Ana C de Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Manuela Galli
- Bioengineering Department, Politecnico di Milano, Milan, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele di Pisana, Rome, Italy
| | - Nelci A C F Rocha
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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15
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Gómez-Pérez C, Font-Llagunes JM, Martori JC, Vidal Samsó J. Gait parameters in children with bilateral spastic cerebral palsy: a systematic review of randomized controlled trials. Dev Med Child Neurol 2019; 61:770-782. [PMID: 30484877 DOI: 10.1111/dmcn.14108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
Abstract
AIM To identify the gait parameters used to assess gait disorders in children with bilateral spastic cerebral palsy (CP) and evaluate their responsiveness to treatments. METHOD A systematic search within PubMed, Web of Science, and Scopus (in English, 2000-2016) for randomized controlled trials of children with bilateral spastic CP who were assessed by instrumented gait analysis (IGA) was performed. Data related to participants and study characteristics, risk of bias, and outcome measures were collected. A list of gait parameters responsive to clinical interventions was obtained. RESULTS Twenty-one articles met the inclusion criteria. Eighty-nine gait parameters were identified, 56 of which showed responsiveness to treatments. Spatiotemporal and kinematic parameters were widely used compared to kinetic and surface electromyography data. The majority of responsive gait parameters were joint angles at the sagittal plane (flexion-extension). INTERPRETATION The IGA yields responsive outcome measures for the gait assessment of children with bilateral spastic CP. Spatiotemporal and kinematic (at sagittal plane) parameters are the gait parameters used most frequently. Further research is needed to establish the relevant gait parameters for each clinical problem. WHAT THIS PAPER ADDS Fifty-six responsive gait parameters for children with bilateral spastic cerebral palsy were identified. Most responsive gait parameters belong to joint angles time-series at sagittal plane. Spatiotemporal and kinematic parameters are widely used compared to kinetic and surface electromyography parameters.
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Affiliation(s)
- Cristina Gómez-Pérez
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences, Faculty of Health Science and Welfare, Centre for Health and Social Care Research, University of Vic - Central University of Catalonia, Vic, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain.,Biomedical Engineering, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group, Department of Economics and Business, Faculty of Business and Communication Studies, University of Vic - Central University of Catalonia, Vic, Spain
| | - Joan Vidal Samsó
- Institut Guttmann, Neurorehabilitation Institute, Badalona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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16
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Bjornson KF, Moreau N, Bodkin AW. Short-burst interval treadmill training walking capacity and performance in cerebral palsy: a pilot study. Dev Neurorehabil 2019; 22:126-133. [PMID: 29658831 PMCID: PMC7894036 DOI: 10.1080/17518423.2018.1462270] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To examine the effect of short-burst interval locomotor treadmill training (SBLTT) on walking capacity and performance in cerebral palsy (CP). METHODS Twelve children with spastic diplegic CP (average 8.6 years) across Gross Motor Function Classification System levels II (8) and III (4) were randomized to 20 SBLTT sessions over 4 or 10 weeks. SBLTT consisted of alternating 30 seconds of slow and fast walking for 30 minutes/session. Outcomes included the 10 m walk test, one-minute walk test (1MWT), and timed-up-and go (TUG) (capacity) and StepWatch (performance) collected at baseline, post, and 6 weeks post. RESULTS Fast speed (+.11, p = .04; +.11 m/s, p = .006), 1MWT (+11.2; +11.7 m, p = .006) and TUG (-1.7; -1.9 seconds, p = .006) improved post SBLTT and 6 weeks, respectively. Walking performance increased: average strides/day (+948; +1712, p < .001) and percent time in high strides rates (+0.4, p = 0.07; +0.2, p = .008). CONCLUSIONS Pilot study suggests SBLTT may improve short-term walking capacity and performance.
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Affiliation(s)
- Kristie F. Bjornson
- Seattle Children’s Research Institute, University of Washington, Seattle, WA, United States of America
| | - Noelle Moreau
- Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Amy Winter Bodkin
- Physical Medicine and Rehabilitation, University of Colorado, Denver, CO, United States of America
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17
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Fauzi AA, Khayat MM, Sabirin S, Haron N, Mohamed MNA, Davis GM. Structured home-based exercise program for improving walking ability in ambulant children with cerebral palsy. J Pediatr Rehabil Med 2019; 12:161-169. [PMID: 31227664 DOI: 10.3233/prm-180538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate outcomes after 8 weeks of a structured home-based exercise program (SHEP) for improving walking ability in ambulant children with cerebral palsy (CP). METHOD Eleven children participated in this study (7 males and 4 females, mean age 10 years 3 months, standard deviation (SD) 3y) with Gross Motor Function Classification System (GMFCS) I-III. This study used a prospective multiple assessment baseline design to assess the effect of SHEP upon multiple outcomes obtained in three different phases. Exercise intensity was quantified by OMNI-RPE assessed by caregivers and children. Outcome assessments of walking speed, GMFM-66 and physiological cost index (PCI) were measured four times at pre-intervention (Phase 1) and at 3-weekly intervals over eight weeks during intervention (Phase 2). Follow-up assessments were performed at one month and three months after intervention (Phase 3). Statistical analyses were repeated measures ANOVA and Wilcoxon signed-rank test. RESULTS SHEP improved walking ability in children with CP, particularly for their walking speed (p= 0.01, Cohen's d= 1.9). The improvement of GMFM-66 scores during Phase 2 and Phase 3 had a large effect size, with Cohen's d of 1.039 and 1.054, respectively, compared with that during Phase 1 (p< 0.017). No significant change of PCI was observed (Cohen's d= 0.39). CONCLUSION SHEP can be a useful intervention tool, given as a written, structured, and practical exercise program undertaken at home to achieve short term goals for improving walking ability when added to standard care.
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Affiliation(s)
- Aishah Ahmad Fauzi
- Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Masyitah Mohammad Khayat
- Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Sakinah Sabirin
- Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Norazah Haron
- Department of Rehabilitation Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Nahar Azmi Mohamed
- Department of Sports Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Glen M Davis
- Clinical Exercise and Rehabilitation Unit, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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18
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Ahmadi M, O’Neil M, Fragala-Pinkham M, Lennon N, Trost S. Machine learning algorithms for activity recognition in ambulant children and adolescents with cerebral palsy. J Neuroeng Rehabil 2018; 15:105. [PMID: 30442154 PMCID: PMC6238270 DOI: 10.1186/s12984-018-0456-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/06/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common physical disability among children (2.5 to 3.6 cases per 1000 live births). Inadequate physical activity (PA) is a major problem effecting the health and well-being of children with CP. Practical, yet accurate measures of PA are needed to evaluate the effectiveness of surgical and therapy-based interventions to increase PA. Accelerometer-based motion sensors have become the standard for objectively measuring PA in children and adolescents; however, current methods for estimating physical activity intensity in children with CP are associated with significant error and may dramatically underestimate HPA in children with more severe mobility limitations. Machine learning (ML) models that first classify the PA type and then predict PA intensity or energy expenditure using activity specific regression equations may be more accurate than standalone regression models. However, the feasibility and validity of ML methods has not been explored in youth with CP. Therefore, the purpose of this study was to develop and test ML models for the automatic identification of PA type in ambulant children with CP. METHODS Twenty two children and adolescents (mean age: 12.8 ± 2.9 y) with CP classified at GMFCS Levels I to III completed 7 activity trials while wearing an ActiGraph GT3X+ accelerometer on the hip and wrist. Trials were categorised as sedentary (SED), standing utilitarian movements (SUM), comfortable walking (CW), and brisk walking (BW). Random forest (RF), support vector machine (SVM), and binary decision tree (BDT) classifiers were trained with features extracted from the vector magnitude (VM) of the raw acceleration signal using 10 s non-overlapping windows. Performance was evaluated using leave-one-subject out cross validation. RESULTS SVM (82.0-89.0%) and RF (82.6-88.8%) provided significantly better classification accuracy than BDT (76.1-86.2%). Hip (82.7-85.5%) and wrist (76.1-82.6%) classifiers exhibited comparable prediction accuracy, while the combined hip and wrist (86.2-89.0%) classifiers achieved the best overall performance. For all classifiers, recognition accuracy was excellent for SED (94.1-97.9%), good to excellent for SUM (74.0-96.6%) and brisk walking (71.5-86.0%), and modest for comfortable walking (47.6-70.4%). When comfortable and brisk walking were combined into a single walking class, recognition accuracy ranged from 90.3 to 96.5%. CONCLUSIONS ML methods provided acceptable classification accuracy for detection of a range of activities commonly performed by ambulatory children with CP. The resultant models can help clinicians more effectively monitor bouts of brisk walking in the community. The results indicate that 2-step models that first classify PA type and then predict energy expenditure using activity specific regression equations are worthy of exploration in this patient group.
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Affiliation(s)
- Matthew Ahmadi
- Institute of Health and Biomedical Innovation at QLD Centre for Children’s Health Research, School of Exercise and Nutrition Sciences, Queensland University of Technology, 62 Graham St, South Brisbane, QLD 4101 Australia
| | - Margaret O’Neil
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, 1601 Cherry St., Philadelphia, PA USA
| | | | - Nancy Lennon
- Gait Analysis Laboratory, AI DuPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE USA
| | - Stewart Trost
- Institute of Health and Biomedical Innovation at QLD Centre for Children’s Health Research, School of Exercise and Nutrition Sciences, Queensland University of Technology, 62 Graham St, South Brisbane, QLD 4101 Australia
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Booth ATC, Buizer AI, Meyns P, Oude Lansink ILB, Steenbrink F, van der Krogt MM. The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:866-883. [PMID: 29512110 DOI: 10.1111/dmcn.13708] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/28/2022]
Abstract
AIM The aim of this systematic review was to investigate the effects of functional gait training on walking ability in children and young adults with cerebral palsy (CP). METHOD The review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Web of Science) for relevant literature published between January 1980 and January 2017. Included studies involved training with a focus on actively practising the task of walking as an intervention while reporting outcome measures relating to walking ability. RESULTS Forty-one studies were identified, with 11 randomized controlled trials included. There is strong evidence that functional gait training results in clinically important benefits for children and young adults with CP, with a therapeutic goal of improved walking speed. Functional gait training was found to have a moderate positive effect on walking speed over standard physical therapy (effect size 0.79, p=0.04). Further, there is weaker yet relatively consistent evidence that functional gait training can also benefit walking endurance and gait-related gross motor function. INTERPRETATION There is promising evidence that functional gait training is a safe, feasible, and effective intervention to target improved walking ability in children and young adults with CP. The addition of virtual reality and biofeedback can increase patient engagement and magnify effects. WHAT THIS PAPER ADDS Functional gait training is a safe, feasible, and effective intervention to improve walking ability. Functional gait training shows larger positive effects on walking speed than standard physical therapy. Walking endurance and gait-related gross motor function can also benefit from functional gait training. Addition of virtual reality and biofeedback shows promise to increase engagement and improve outcomes.
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Affiliation(s)
- Adam T C Booth
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Department of Clinical Applications and Research, Motek Medical BV, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Pieter Meyns
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Faculty of Medicine and Life Sciences, REVAL Rehabilitation Research Center - BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Irene L B Oude Lansink
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Frans Steenbrink
- Department of Clinical Applications and Research, Motek Medical BV, Amsterdam, the Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Takahashi K, Mutsuzaki H, Mataki Y, Yoshikawa K, Matsuda M, Enomoto K, Sano K, Kubota A, Mizukami M, Iwasaki N, Yamazaki M. Safety and immediate effect of gait training using a Hybrid Assistive Limb in patients with cerebral palsy. J Phys Ther Sci 2018; 30:1009-1013. [PMID: 30154591 PMCID: PMC6110229 DOI: 10.1589/jpts.30.1009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to determine the safety and immediate effect of a single
training session with the Hybrid Assistive Limb (CYBERDYNE) on walking ability in patients
with cerebral palsy. [Participants and Methods] This study included 20 patients with
cerebral palsy (15 males, 5 females, mean age 15.0 ± 6.3 years; 19 with spastic cerebral
palsy, 1 with athetoid cerebral palsy; Gross Motor Function Classification System level I:
4, II: 3, III: 9, and IV: 4). Participants completed a single 20-minute gait training
session using the Hybrid Assistive Limb. The safety and immediate effect were evaluated.
The immediate outcomes were gait speed and mean step length, and cadence before and after
training. [Results] Two participants were excluded because they were not tall enough to
use the Hybrid Assistive Limb. Eighteen participants performed the training. There were no
serious adverse events during the training. Since 14 participants were able to walk on
their own, walking evaluations were performed before and after training. Statistically
significant improvements were observed in gait speed and mean step length. [Conclusion]
Gait training using the Hybrid Assistive Limb is safe for patients with cerebral palsy and
can produce immediate effects on walking ability in ambulatory patients with cerebral
palsy.
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Affiliation(s)
- Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hirotaka Mutsuzaki
- Center of Medical Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan.,Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Mayumi Matsuda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Keiko Enomoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kumiko Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Aoi Kubota
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Nobuaki Iwasaki
- Center of Medical Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan.,Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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21
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Multimodale Komplexbehandlungen und Funktionstherapien für Kinder und Jugendliche mit Zerebralparese. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-018-0382-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Bizama F, Medley A, Trudelle-Jackson E, Csiza L. The Effect of Visual Environmental Distraction on Gait Performance in Children. Phys Occup Ther Pediatr 2018; 38:64-73. [PMID: 28394674 DOI: 10.1080/01942638.2017.1297987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Identify the effect of visual distraction on gait parameters in children and describe the role of walking experience (WE) in the management of visual distraction. METHODS Forty-two typically developing children, mean age 43.2 months (SD = 22.9) participated and were divided into three groups according to WE: early walkers (6-11 months of WE), preschool walkers (12-37 months of WE), and experienced walkers (38-79 months of WE). Gait parameters measured under two conditions (no visual distraction and with visual distraction) included: velocity, step length, step width, and double limb support percentage (DLS%) of gait cycle. Multivariate analysis of variance assessed differences in gait between groups (effect of WE) and within groups (effect of condition). RESULTS Significant main effects of WE group F(8,74) = 5.300, p ≤.001 and visual distraction condition F(4,36) = 2.586, p = 0.053 were found. Visual environmental distraction significantly affected gait performance in children regardless of walking experience. Velocity decreased from 110.04 to 97.73 cm/sec (p = 0.003) while DLS% of gait cycle increased from 18.29% to 20.39% (p = 0.025). CONCLUSIONS Results suggest physical therapists need to consider attentional requirements when assessing gait; even in children with more WE. If attention to task is a limiting factor for performance or learning of a motor task, it may need to be addressed directly as part of the treatment plan.
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Affiliation(s)
- F Bizama
- a Children's Health System of Texas , Dallas , Texas , USA
| | - A Medley
- b School of Physical Therapy, Texas Woman's University , Dallas , Texas , USA
| | - E Trudelle-Jackson
- b School of Physical Therapy, Texas Woman's University , Dallas , Texas , USA
| | - L Csiza
- b School of Physical Therapy, Texas Woman's University , Dallas , Texas , USA
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23
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Hoffman RM, Corr BB, Stuberg WA, Arpin DJ, Kurz MJ. Changes in lower extremity strength may be related to the walking speed improvements in children with cerebral palsy after gait training. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 73:14-20. [PMID: 29245044 DOI: 10.1016/j.ridd.2017.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 11/28/2017] [Accepted: 12/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cerebral palsy (CP) has a high probability of resulting in lower extremity strength and walking deficits. Numerous studies have shown that gait training has the potential to improve the walking abilities of these children; however, the factors governing these improvements are unknown. AIMS This study aimed to evaluate the relationship between change in lower extremity strength, walking speed and endurance of children with CP following gait training. METHODS AND PROCEDURES Eleven children with CP (GMFCS levels=II-III) completed a gait training protocol three days a week for six weeks. Outcome measures included a 10m fast-as-possible walk test, 6min walking endurance test and lower extremity strength. OUTCOMES AND RESULTS The group results indicated there were improvements in walking speed, walking endurance and lower extremity strength. In addition, there was a positive correlation between percent change in lower extremity strength and walking speed and a negative correlation between the percent change in lower extremity strength and the child's age. CONCLUSIONS Our results imply that changes in lower extremity strength might be related to the degree of the walking speed changes seen after gait training. Younger children may be more likely to show improvements in lower extremity strength after gait training.
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Affiliation(s)
- Rashelle M Hoffman
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA
| | - Bradley B Corr
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA
| | - Wayne A Stuberg
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA
| | - David J Arpin
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA
| | - Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA.
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24
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Valentín‐Gudiol M, Mattern‐Baxter K, Girabent‐Farrés M, Bagur‐Calafat C, Hadders‐Algra M, Angulo‐Barroso RM. Treadmill interventions in children under six years of age at risk of neuromotor delay. Cochrane Database Syst Rev 2017; 7:CD009242. [PMID: 28755534 PMCID: PMC6483121 DOI: 10.1002/14651858.cd009242.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development. OBJECTIVES To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay. SEARCH METHODS In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population. DATA COLLECTION AND ANALYSIS Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model. MAIN RESULTS This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45). AUTHORS' CONCLUSIONS This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.
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Affiliation(s)
- Marta Valentín‐Gudiol
- Universitat Internacional de CatalunyaDepartment of Physical TherapyBarcelonaSpain
- Ramon Llull UniversityBlanquerna School of Health SciencesBarcelonaSpain
| | - Katrin Mattern‐Baxter
- California State UniversityDepartment of Physical Therapy6000 J StSacramentoCaliforniaUSA95819
| | - Montserrat Girabent‐Farrés
- Universitat Internacional de CatalunyaDepartment of Physical Therapy, Biostatistics UnitC/ Josep trueta, s/nSant Cugat del VallèsBarcelonaSpain08195
| | | | - Mijna Hadders‐Algra
- University of Groningen, University Medical Center Groningen, Department of PaediatricsHanzeplein 1GroningenNetherlands9713 GZ
| | - Rosa Maria Angulo‐Barroso
- University of BarcelonaDepartment of Health and Applied Sciences, National Institute of Physical EducationAve. de L'Estadi 12‐22BarcelonaBarcelonaSpain08036
- California State UniversityDepartment of KinesiologyNorthridgeCaliforniaUSA
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A Home-Based Body Weight-Supported Treadmill Program for Children With Cerebral Palsy: A Pilot Study. Pediatr Phys Ther 2017; 29:223-229. [PMID: 28654490 DOI: 10.1097/pep.0000000000000406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this pilot study was to explore the effect and feasibility of a home-based body weight-supported treadmill training (BWSTT) program on walking capacity and functional mobility in children with cerebral palsy (CP). METHODS A within-subjects, repeated-measures design was used. Ten children with CP ages 6 to 16 years participated in pre- and postintervention testing sessions, an initial home training session, and a 12-week home-based BWSTT program conducted 3 to 4 times per week by a parent or caregiver for up to 20 minutes each session. Multiple outcome measures for walking capacity and functional mobility were used. RESULTS As a group, participants demonstrated significant improvements in walking capacity and functional mobility at the completion the 12-week intervention program. CONCLUSIONS Additional research regarding home-based BWSTT programs in children with CP is warranted and should focus on identifying specific parameters that promote achievement of optimal functional outcomes.
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Abstract
BACKGROUND Cerebral palsy (CP) is a neurodevelopmental disorder resulting from an injury to the developing brain. It is the most common form of childhood disability with prevalence rates of between 1.5 and 3.8 per 1000 births reported worldwide. The primary impairments associated with CP include reduced muscle strength and reduced cardiorespiratory fitness, resulting in difficulties performing activities such as dressing, walking and negotiating stairs.Exercise is defined as a planned, structured and repetitive activity that aims to improve fitness, and it is a commonly used intervention for people with CP. Aerobic and resistance training may improve activity (i.e. the ability to execute a task) and participation (i.e. involvement in a life situation) through their impact on the primary impairments of CP. However, to date, there has been no comprehensive review of exercise interventions for people with CP. OBJECTIVES To assess the effects of exercise interventions in people with CP, primarily in terms of activity, participation and quality of life. Secondary outcomes assessed body functions and body structures. Comparators of interest were no treatment, usual care or an alternative type of exercise intervention. SEARCH METHODS In June 2016 we searched CENTRAL, MEDLINE, Embase, nine other databases and four trials registers. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of children, adolescents and adults with CP. We included studies of aerobic exercise, resistance training, and 'mixed training' (a combination of at least two of aerobic exercise, resistance training and anaerobic training). DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and potentially relevant full-text reports for eligibility; extracted all relevant data and conducted 'Risk of bias' and GRADE assessments. MAIN RESULTS We included 29 trials (926 participants); 27 included children and adolescents up to the age of 19 years, three included adolescents and young adults (10 to 22 years), and one included adults over 20 years. Males constituted 53% of the sample. Five trials were conducted in the USA; four in Australia; two in Egypt, Korea, Saudi Arabia, Taiwan, the Netherlands, and the UK; three in Greece; and one apiece in India, Italy, Norway, and South Africa.Twenty-six trials included people with spastic CP only; three trials included children and adolescents with spastic and other types of CP. Twenty-one trials included people who were able to walk with or without assistive devices, four trials also included people who used wheeled mobility devices in most settings, and one trial included people who used wheeled mobility devices only. Three trials did not report the functional ability of participants. Only two trials reported participants' manual ability. Eight studies compared aerobic exercise to usual care, while 15 compared resistance training and 4 compared mixed training to usual care or no treatment. Two trials compared aerobic exercise to resistance training. We judged all trials to be at high risk of bias overall.We found low-quality evidence that aerobic exercise improves gross motor function in the short term (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.02 to 1.04, N = 65, 3 studies) and intermediate term (mean difference (MD) 12.96%, 95% CI 0.52% to 25.40%, N = 12, 1 study). Aerobic exercise does not improve gait speed in the short term (MD 0.09 m/s, 95% CI -0.11 m/s to 0.28 m/s, N = 82, 4 studies, very low-quality evidence) or intermediate term (MD -0.17 m/s, 95% CI -0.59 m/s to 0.24 m/s, N = 12, 1 study, low-quality evidence). No trial assessed participation or quality of life following aerobic exercise.We found low-quality evidence that resistance training does not improve gross motor function (SMD 0.12, 95% CI -0.19 to 0.43, N = 164, 7 studies), gait speed (MD 0.03 m/s, 95% CI -0.02 m/s to 0.07 m/s, N = 185, 8 studies), participation (SMD 0.34, 95% CI -0.01 to 0.70, N = 127, 2 studies) or parent-reported quality of life (MD 12.70, 95% CI -5.63 to 31.03, n = 12, 1 study) in the short term. There is also low-quality evidence that resistance training does not improve gait speed (MD -0.03 m/s, 95% CI -0.17 m/s to 0.11 m/s, N = 84, 3 studies), gross motor function (SMD 0.13, 95% CI -0.30 to 0.55, N = 85, 3 studies) or participation (MD 0.37, 95% CI -6.61 to 7.35, N = 36, 1 study) in the intermediate term.We found low-quality evidence that mixed training does not improve gross motor function (SMD 0.02, 95% CI -0.29 to 0.33, N = 163, 4 studies) or gait speed (MD 0.10 m/s, -0.07 m/s to 0.27 m/s, N = 58, 1 study) but does improve participation (MD 0.40, 95% CI 0.13 to 0.67, N = 65, 1 study) in the short-term.There is no difference between resistance training and aerobic exercise in terms of the effect on gross motor function in the short term (SMD 0.02, 95% CI -0.50 to 0.55, N = 56, 2 studies, low-quality evidence).Thirteen trials did not report adverse events, seven reported no adverse events, and nine reported non-serious adverse events. AUTHORS' CONCLUSIONS The quality of evidence for all conclusions is low to very low. As included trials have small sample sizes, heterogeneity may be underestimated, resulting in considerable uncertainty relating to effect estimates. For children with CP, there is evidence that aerobic exercise may result in a small improvement in gross motor function, though it does not improve gait speed. There is evidence that resistance training does not improve gait speed, gross motor function, participation or quality of life among children with CP.Based on the evidence available, exercise appears to be safe for people with CP; only 55% of trials, however, reported adverse events or stated that they monitored adverse events. There is a need for large, high-quality, well-reported RCTs that assess the effectiveness of exercise in terms of activity and participation, before drawing any firm conclusions on the effectiveness of exercise for people with CP. Research is also required to determine if current exercise guidelines for the general population are effective and feasible for people with CP.
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Affiliation(s)
- Jennifer M Ryan
- Brunel University LondonInstitute of Environment, Health and SocietiesKingston LaneUxbridgeMiddlesexUKUB8 3PH
| | | | - Stephen G Noorduyn
- McMaster UniversityCanChild Centre for Childhood Disability Research1280 Main Street West, Rm. 2C1McMaster UniversityHamiltonONCanadaL8S 4L8
| | - Neil E O'Connell
- Brunel UniversityDepartment of Clinical Sciences/Health Economics Research Group, Institute of Environment, Health and SocietiesKingston LaneUxbridgeMiddlesexUKUB8 3PH
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27
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Bleyenheuft Y, Ebner-Karestinos D, Surana B, Paradis J, Sidiropoulos A, Renders A, Friel KM, Brandao M, Rameckers E, Gordon AM. Intensive upper- and lower-extremity training for children with bilateral cerebral palsy: a quasi-randomized trial. Dev Med Child Neurol 2017; 59:625-633. [PMID: 28133725 DOI: 10.1111/dmcn.13379] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 11/26/2022]
Abstract
AIM An approach that simultaneously engages both the upper and lower extremities, hand-arm bimanual intensive therapy including lower extremity (HABIT-ILE), has recently demonstrated improvements in upper and lower extremities in children with unilateral cerebral palsy (CP). It is not known whether children with bilateral CP would benefit from this approach. The aim of this study was to examine the efficacy of HABIT-ILE in children with bilateral CP. METHOD A quasi-randomized trial design was used, whereby 20 participants (age 6-15y, Gross Motor Function Classification System levels II-IV, Manual Ability Classification System levels I-III) were assigned to a treatment (HABIT-ILE) or a comparison group in the order in which they were enrolled. Children in the HABIT-ILE group were assessed before and after 84 hours of intervention over 13 days, as well as at 3 months' follow-up. Children in the comparison group were assessed at the same time points. Children in both groups were assessed using the Gross Motor Function Measure (GMFM-66) and ABILHAND-Kids (primary measures), and six secondary measures. RESULTS A group×test session interaction indicated significant improvements in the HABIT-ILE group as assessed by the GMFM-66, lower-extremity performance (6-Minute Walk Test; Pediatric Balance Scale), functional upper-extremity abilities (ABILHAND-Kids/Pediatric Evaluation of Disability Inventory), and the dexterity of the less affected upper extremity. CONCLUSION HABIT-ILE is efficacious for improving both upper- and lower-extremity function in children with bilateral CP.
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Affiliation(s)
- Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Bhavini Surana
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Julie Paradis
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Alexis Sidiropoulos
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Anne Renders
- Physical and Rehabilitation Medicine Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Kathleen M Friel
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.,Burke-Cornell Medical Research Institute, White Plains, NY, USA
| | - Marina Brandao
- Departamento de Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eugene Rameckers
- Research in Function and Rehabilitation, Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands.,Center of Expertise, Adelante Rehabilitation, Hoensbroek, the Netherlands.,Avans Plus, Breda, the Netherlands
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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28
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Kenyon LK, Westman M, Hefferan A, McCrary P, Baker BJ. A home-based body weight supported treadmill training program for children with cerebral palsy: A case series. Physiother Theory Pract 2017; 33:576-585. [PMID: 28557625 DOI: 10.1080/09593985.2017.1325956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Contemporary approaches to the treatment of cerebral palsy (CP) advocate a task-specific approach that emphasizes repetition and practice of specific tasks. Recent studies suggest that body-weight-supported treadmill training (BWSTT) programs may be beneficial in clinical settings. The purposes of this case series were to explore the outcomes and feasibility of a home-based BWSTT program for three children with CP. CASE DESCRIPTION Three children with CP at Gross Motor Function Classification System (GMFCS) Levels III or IV participated in this case series. Examination included the Functional Assessment Questionnaire (FAQ), the 10-meter walk test, the Gross Motor Function Measure (GMFM-66), and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). A harness system was used to conduct the BWSTT program over an 8-12 week period. OUTCOMES All of the families reported enjoying the BWSTT program and found the harness easy to use. Participant 2 increased from a 2 to a 4 on the FAQ, while Participant 3 increased from a 6 to a 7. DISCUSSION Two of the participants demonstrated post-intervention improvements in functional mobility. In addition to mobility outcomes, future research should explore the potential health benefits of a home-based BWSTT program.
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Affiliation(s)
- Lisa K Kenyon
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
| | - Marci Westman
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
| | - Ashley Hefferan
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
| | - Peter McCrary
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
| | - Barbara J Baker
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
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29
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Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis. Phys Ther 2016; 96:1938-1954. [PMID: 27313240 PMCID: PMC5131187 DOI: 10.2522/ptj.20150401] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 06/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Children with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear. PURPOSE The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP. DATA SOURCES MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014. STUDY SELECTION The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure. DATA EXTRACTION Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded. DATA SYNTHESIS Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=-0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category. LIMITATIONS Gait speed was the only outcome measure analyzed. CONCLUSIONS Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.
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30
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Nikityuk IE, Moshonkina TR, Gerasimenko YP, Vissarionov SV, Baindurashvili AG. [The regulation of balance in the children presenting with severe cerebral palsy following the treatment with the use of the locomotor training in combination with the electrical stimulation of leg muscles and spinal cord]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2016; 93:23-27. [PMID: 27801408 DOI: 10.17116/kurort2016523-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of the cerebral palsy (CP) symptoms is the impairment of the ability to maintain upright standing. The objective of the present study was to investigate the effect of the locomotor training combined with electrical transcutaneous spinal cord stimulation (TSCS) and functional electrical stimulation (FES) of the muscles to facilitate the restoration of the vertical posture function in the children presenting with cerebral palsy. PATIENTS AND METHODS This article is designed to present the results of the study that included 19 patients at the age from 6 to 12 years. The severity of the CP clinical manifestations was estimated to be around 3 in accordance with The Gross Motor Function Classification System (GMFCS). All the patients underwent 15 half-hour daily sessions of robotic mechanotherapy with the use of a locomotor training device. In 8 patients from the main group, each locomotor training session was accompanied by the TSCS and FES procedures. The patients of the control group underwent the locomotor training alone. RESULTS The dynamics of regaining the standing posture regulation was evaluated by stabilometry that has revealed a significant increase of postural stability in the children of the main group in comparison with those in the control group. It was apparent as a statistically significant (p<0.05) reduction of the length and the area of the center of pressure (COP) projection with open eyes (the 167 mm and 112 mm2 decrease of the median, respectively). In addition, the tendency toward the normalization of the COP projection in the sagittal plane was documented. CONCLUSION The present study has demonstrated the normalization of the impaired balance control system in the children presenting with the severe form of cerebral palsy under the influence of the combined treatment with the use of transcutaneous spinal cord stimulation and functional electrical stimulation of legs muscles supplemented by the locomotor training.
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Affiliation(s)
- I E Nikityuk
- The Turner Scientific Research Institute for Children̓s Orthopedics under the Ministry of Health of Russian Federation, Pushkin, Saint Peterburg, Russia
| | - T R Moshonkina
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Peterburg, Russia; 'Kosyma' Ltd., Moscow, Russia
| | - Yu P Gerasimenko
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Peterburg, Russia; 'Kosyma' Ltd., Moscow, Russia
| | - S V Vissarionov
- The Turner Scientific Research Institute for Children̓s Orthopedics under the Ministry of Health of Russian Federation, Pushkin, Saint Peterburg, Russia
| | - A G Baindurashvili
- The Turner Scientific Research Institute for Children̓s Orthopedics under the Ministry of Health of Russian Federation, Pushkin, Saint Peterburg, Russia
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Comparison of a robotic-assisted gait training program with a program of functional gait training for children with cerebral palsy: design and methods of a two group randomized controlled cross-over trial. SPRINGERPLUS 2016; 5:1886. [PMID: 27843743 PMCID: PMC5084143 DOI: 10.1186/s40064-016-3535-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 10/13/2016] [Indexed: 01/21/2023]
Abstract
Background Enhancement of functional ambulation is a key goal of rehabilitation for children with cerebral palsy (CP) who experience gross motor impairment. Physiotherapy (PT) approaches often involve overground and treadmill-based gait training to promote motor learning, typically as free walking or with body-weight support. Robotic-assisted gait training (RAGT), using a device such as the Lokomat®Pro, may permit longer training duration, faster and more variable gait speeds, and support walking pattern guidance more than overground/treadmill training to further capitalize on motor learning principles. Single group pre-/post-test studies have demonstrated an association between RAGT and moderate to large improvements in gross motor skills, gait velocity and endurance. A single published randomized controlled trial (RCT) comparing RAGT to a PT-only intervention showed no difference in gait kinematics. However, gross motor function and walking endurance were not evaluated and conclusions were limited by a large PT group drop-out rate. Methods/design In this two-group cross-over RCT, children are randomly allocated to the RAGT or PT arm (each with twice weekly sessions for eight weeks), with cross-over to the other intervention arm following a six-week break. Both interventions are grounded in motor learning principles with incorporation of individualized mobility-based goals. Sessions are fully operationalized through manualized, menu-based protocols and post-session documentation to enhance internal and external validity. Assessments occur pre/post each intervention arm (four time points total) by an independent assessor. The co-primary outcomes are gross motor functional ability (Gross Motor Function Measure (GMFM-66) and 6-minute walk test), with secondary outcome measures assessing: (a) individualized goals; (b) gait variables and daily walking amounts; and (c) functional abilities, participation and quality of life. Investigators and statisticians are blinded to study group allocation in the analyses, and assessors are blinded to treatment group. The primary analysis will be the pre- to post-test differences (change scores) of the GMFM-66 and 6MWT between RAGT and PT groups. Discussion This study is the first RCT comparing RAGT to an active gait-related PT intervention in paediatric CP that addresses gait-related gross motor, participation and individualized outcomes, and as such, is expected to provide comprehensive information as to the potential role of RAGT in clinical practice. Trial registration ClinicalTrials.gov NCT02196298 Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-3535-0) contains supplementary material, which is available to authorized users.
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Wiart L, Rosychuk RJ, Wright FV. Evaluation of the effectiveness of robotic gait training and gait-focused physical therapy programs for children and youth with cerebral palsy: a mixed methods RCT. BMC Neurol 2016; 16:86. [PMID: 27255908 PMCID: PMC4890515 DOI: 10.1186/s12883-016-0582-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 04/29/2016] [Indexed: 12/31/2022] Open
Abstract
Background Robot assisted gait training (RAGT) is considered to be a promising approach for improving gait-related gross motor function of children and youth with cerebral palsy. However, RAGT has yet to be empirically demonstrated to be effective. This knowledge gap is particularly salient given the strong interest in this intensive therapy, the high cost of the technology, and the requirement for specialized rehabilitation centre resources. Methods This is a research protocol describing a prospective, multi-centre, concurrent mixed methods study comprised of a randomized controlled trial (RCT) and an interpretive descriptive qualitative design. It is a mixed methods study designed to determine the relative effectiveness of three physical therapy treatment conditions (i.e., RAGT, a functional physical therapy program conducted over-ground (fPT), and RAGT + fPT) on gait related motor skills of ambulatory children with cerebral palsy. Children with cerebral palsy aged 5–18 years who are ambulatory (Gross Motor Function Classification System Levels II and III) will be randomly allocated to one of four treatment conditions: 1) RAGT, 2) fPT, 3) RAGT and fPT combined, or 4) a maintenance therapy only control group. The qualitative component will explicate child and parent experiences with the interventions, provide insight into the values that underlie their therapy goals, and assist with interpretation of the results of the RCT. Discussion n/a. Trial Registration NCT02391324 Registered March 12, 2015.
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Affiliation(s)
- Lesley Wiart
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-60 Corbett Hall, Edmonton, Alberta, T5G 2G4, Canada. .,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada.
| | - Rhonda J Rosychuk
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Edmonton Clinic Health Academy (ECHA), Rm 3-524, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada
| | - F Virginia Wright
- Bloorview Children's Hospital Foundation, Bloorview Research Institute, Rm4W-270, 150 Kilgour Rd, Toronto, Ontario, M4G 1R8, Canada.,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Swe NN, Sendhilnnathan S, van Den Berg M, Barr C. Over ground walking and body weight supported walking improve mobility equally in cerebral palsy: a randomised controlled trial. Clin Rehabil 2015; 29:1108-16. [DOI: 10.1177/0269215514566249] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/06/2014] [Indexed: 11/17/2022]
Abstract
Objective: To assess partial body weight supported treadmill training versus over ground training for walking ability in children with mild to moderate cerebral palsy. Design: Randomised controlled trial. Setting: A Special Needs school in Singapore. Subjects: Thirty children with cerebral palsy, aged 6-18, with a Gross Motor Function Classification System score of II-III. Interventions: Two times 30 minute sessions of walking training per week for 8 weeks, progressed as tolerated, either over ground (control) or using partial body weight supported treadmill training (intervention). Main measures: The 10 metre walk test, and the 6 minute walk test. Secondary measures were sub-sections D and E on the Gross Motor Function Measure. Outcomes were assessed at baseline, and after 4 and 8 weeks of training. Results: There was no effect of group allocation on any outcome measure, while time was a significant factor for all outcomes. Walking speed improved significantly more in the intervention group by week 4 (0.109 (0.067)m/s vs 0.048 (0.071)m/s, P=0.024) however by week 8 the change from baseline was similar (intervention 0.0160 (0.069)m/s vs control 0.173 (0.109)m/s, P=0.697). All gains made by week 4 were significantly improved on by week 8 for the 10 metre walk test, 6 minute walk test, and the gross motor function measure. Conclusions: Partial body weight supported treadmill training is no more effective than over ground walking at improving aspects of walking and function in children with mild to moderate cerebral palsy. Gains seen in 4 weeks can be furthered by 8 weeks.
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Affiliation(s)
- Ni Ni Swe
- Department of Rehabilitation Aged and Extended Care, Flinders University, Australia
- Cerebral Palsy Alliance Singapore, Singapore
| | | | - Maayken van Den Berg
- Department of Rehabilitation Aged and Extended Care, Flinders University, Australia
| | - Christopher Barr
- Department of Rehabilitation Aged and Extended Care, Flinders University, Australia
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Emara HAMAH. Effect of a new physical therapy concept on dynamic balance in children with spastic diplegic cerebral palsy. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2015. [DOI: 10.1016/j.ejmhg.2014.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bleyenheuft Y, Arnould C, Brandao MB, Bleyenheuft C, Gordon AM. Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) in Children With Unilateral Spastic Cerebral Palsy: A Randomized Trial. Neurorehabil Neural Repair 2014; 29:645-57. [PMID: 25527487 DOI: 10.1177/1545968314562109] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intensive bimanual training results in more improvement in hand function in children with unilateral spastic cerebral palsy (USCP) than lower intensity conventional interventions. However, it is not known whether combined upper and lower extremity training in an intensive protocol is more efficacious for upper and lower functional abilities than conventional therapies provided in usual customary care. OBJECTIVE To determine the efficacy of Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) for children with USCP. METHODS Twenty-four children with USCP were randomized into 2 groups: an immediate HABIT-ILE group (IHG, initially receiving HABIT-ILE, 10 days = 90 hours), and a delayed HABIT-ILE group (DHG), which continued their conventional/ongoing treatment for an intended total duration of 90 hours. In phase 2, children in the DHG were crossed over to receive HABIT-ILE and children of the IHG were followed in their ongoing conventional therapy. Children were assessed using the Assisting Hand Assessment (AHA, primary outcome), the ABILHAND-Kids, and the Pediatric Evaluation of Disability Inventory. Dexterity (Box and Blocks Test [BBT]) and pinch strength were also measured. Locomotor abilities were assessed with Six-Minute Walk Test (6MWT, primary outcome) and ABILOCO-kids. Social participation was measured with the Assessment of Life-HABITs. RESULTS A 2 (groups) × 3 (test sessions) analysis of variance indicated significant improvements for primary outcomes (AHA, P < .001; 6MWT, P = .002) and all secondary assessments except BBT, step length and bodyweight distribution following HABIT-ILE, but not conventional therapy. CONCLUSION The findings suggest that combined upper and lower extremity in an intensive training protocol may be efficacious for improving both upper and lower extremity function in children with USCP.
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Affiliation(s)
- Yannick Bleyenheuft
- Institue of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Carlyne Arnould
- Physical and Occupational Therapy Department, Paramedical Category, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium
| | - Marina B Brandao
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Corrine Bleyenheuft
- Institue of Neuroscience, Université catholique de Louvain, Brussels, Belgium CHU Mont-Godinne, Yvoir, Belgium
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Bleyenheuft Y, Gordon AM. Hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) for children with cerebral palsy. Phys Occup Ther Pediatr 2014; 34:390-403. [PMID: 25271469 DOI: 10.3109/01942638.2014.932884] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hand-arm bimanual intensive therapy and constrained-induced movement therapy have shown evidence of effectiveness in improvement of upper extremity use in children with unilateral spastic cerebral palsy (CP). The effectiveness of interventions that are based on intensive practice of activities that combine UE and LE functions has not been reported. We propose that bimanual UE activities that simultaneously require trunk and LE postural adaptations uniquely address motor control limitations of children with unilateral spastic CP. The aim of this perspective is to present such an approach Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE). HABIT-ILE is unique in selection of tasks and activities that require simultaneous control and coordination of UE and LE movements. It is a motor-learning-based approach using problem solving and highly structured practice. During the intervention, activities and tasks are progressively graded toward more complex bimanual coordination for the UE and increasing demands of the LE. HABIT-ILE is provided in small groups for 90 hr using a camp model. Future research (randomized controlled trial) is needed to determine the effectiveness of HABIT-ILE.
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Schroeder AS, Homburg M, Warken B, Auffermann H, Koerte I, Berweck S, Jahn K, Heinen F, Borggraefe I. Prospective controlled cohort study to evaluate changes of function, activity and participation in patients with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy. Eur J Paediatr Neurol 2014; 18:502-10. [PMID: 24821475 DOI: 10.1016/j.ejpn.2014.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Robot-enhanced therapies are increasingly being used to improve gross motor performance in patients with cerebral palsy. AIM To evaluate gross motor function, activity and participation in patients with bilateral spastic cerebral palsy (BS-CP) after Robot-enhanced repetitive treadmill therapy (ROBERT) in a prospective, controlled cohort study. METHODS Participants trained for 30-60 min in each of 12 sessions within a three-week-period. Changes in Gross Motor Function Measure (GMFM 66) scores, standardized walking distance, self-selected and maximum walking speed (ICF domain "Activity"), and Canadian Occupational Performance Measure (COPM; "Participation") were measured. Outcome measures were assessed three weeks in advance (V1), the day before (V2) as well as the day after, and 8 weeks after ROBERT (V3 + V4). RESULTS 18 patients with BS-CP participated; age 11.5 (mean, range: 5.0-21.8) years, body weight 36.4 (15.0-72.0) kg. GMFCS levels I-IV were: n = 4; 5; 8; 1. There was no significant difference comparing V1 and V2. GMFM 66 (total +2.5 points, Dimension D +3.8 and E +3.2) and COPM (Performance +2.1 points, Satisfaction +1.8 points) showed statistically significant improvements for V3 or V4 compared to V1 or V2 representing clinically meaningful effect sizes. Age, GMFCS level, and repeated ROBERT blocks correlated negatively with GMFM improvement, but not with COPM improvement. INTERPRETATION Following ROBERT, this prospective controlled cohort study showed significant and clinically meaningful improvements of function in ICF domains of "activity" and "participation" in patients with BS-CP. Further assessment in a larger cohort is necessary to allow more specific definition of factors that influence responsiveness to ROBERT program.
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Affiliation(s)
- A S Schroeder
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany.
| | - M Homburg
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - B Warken
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - H Auffermann
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - I Koerte
- Institute of Clinical Radiology, University of Munich, Germany
| | - S Berweck
- Specialist Centre for Paediatric Neurology, Epilepsy Centre for Children and Adolescents, Vogtareuth, Germany
| | - K Jahn
- German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany
| | - F Heinen
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - I Borggraefe
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany
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Grecco LAC, E Mendonça M, Duarte NAC, Zanon N, Fregni F, Oliveira CS. Transcranial Direct Current Stimulation Combined with Treadmill Gait Training in Delayed Neuro-psychomotor Development. J Phys Ther Sci 2014; 26:945-50. [PMID: 25013302 PMCID: PMC4085227 DOI: 10.1589/jpts.26.945] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/08/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of the present study was to describe the results of transcranial direct current stimulation combined with treadmill training in a child with delayed neuro-psychomotor development. [Subject and Methods] Transcranial direct current stimulation (intensity: 1 mA) was applied over the primary motor cortex for 20 minutes during simultaneous treadmill training (2.5 km/h) in ten sessions. [Results] Clinically significant improvement was found in motor development (fine motor subscale, 23 to 25; gross motor subscale, 32 to 41). Reductions in mean oscillation of the center of pressure were found in the anteroposterior (239.2 to 146.5 mm) and mediolateral (177.4 to 149.2 mm) directions. Increases occurred in cadence (106 to 123 steps/minute), step length (0.16 to 0.23 m), step width (0.09 to 0.14 m) and gait velocity with support (0.3 to 0.7 m/s). [Conclusion] After treatment, the child was able to initiate the standing position for the first time and walk without support.
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Affiliation(s)
| | - Mariana E Mendonça
- Neurosciences and Behavior, Psychology Institute,
University of São Paulo, Brazil
| | | | - Nelci Zanon
- Pediatric Neurosurgery, University Federal de São Paulo,
Brazil
| | - Felipe Fregni
- Neurosciences and Behavior, Psychology Institute,
University of São Paulo, Brazil
- Rehabilitation Sciences, University Nove de Julho,
Brazil
- Pediatric Neurosurgery, University Federal de São Paulo,
Brazil
- Department of Physical Medicine and Rehabilitation,
Spaulding Rehabilitation Hospital, USA
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Hassani S, Krzak JJ, Johnson B, Flanagan A, Gorton G, Bagley A, Õunpuu S, Romness M, Tylkowski C, Oeffinger D. One-Minute Walk and modified Timed Up and Go tests in children with cerebral palsy: performance and minimum clinically important differences. Dev Med Child Neurol 2014; 56:482-9. [PMID: 24843890 DOI: 10.1111/dmcn.12325] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This prospective multicenter study assessed performance and changes over time, with and without surgical intervention, in the modified Timed Up and Go (mTUG) and One-Minute Walk tests (1MWT) in children with bilateral cerebral palsy (CP). Minimum clinically important differences (MCIDs) were established for these tools. METHOD Two hundred and nineteen participants with bilateral spastic CP (Gross Motor Function Classification System [GMFCS] levels I–III) were evaluated at baseline and 12 months follow-up. The non-surgical group (n=168; 54 females, 114 males; mean age 12y 11mo, [SD 2y 7mo], range 8y 1mo–19y) had no surgical interventions during the study. The surgical group (n=51; 19 females, 32 males; mean age 12y 10mo [SD 2y 8mo] range 8y 2mo–17y 5mo) underwent soft-tissue and/or bony procedures within 12 months from baseline. The mTUG and 1MWT were collected and MCIDs were established from the change scores of the non-surgical group. RESULTS Dependent walkers (GMFCS level III) required more time to complete the mTUG (p≤0.01) than independent walkers (GMFCS levels I and II). For the 1MWT, distance walked decreased with increasing impairment (p≤0.01). 1MWT and mTUG change scores were not significantly different at any GMFCS level for either the surgical or non-surgical groups (p≤0.01). INTERPRETATION Children with varying levels of function (GMFCS level) perform differently on the 1MWT and mTUG. The data and MCID values can assist clinicians in interpreting changes over time and in assessing interventions.
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Affiliation(s)
- Sahar Hassani
- Shriners Hospitals for Children - Chicago; Chicago IL USA
| | - Joseph J Krzak
- Shriners Hospitals for Children - Chicago; Chicago IL USA
| | - Barbara Johnson
- Shriners Hospitals for Children - Salt Lake City; Salt Lake City UT USA
| | - Ann Flanagan
- Shriners Hospitals for Children - Chicago; Chicago IL USA
| | - George Gorton
- Shriners Hospitals for Children - Springfield; Springfield MA USA
| | - Anita Bagley
- Shriners Hospitals for Children - Northern California; Sacramento CA USA
| | - Sylvia Õunpuu
- Connecticut Children's Medical Center; Hartford CT USA
| | | | | | - Donna Oeffinger
- Shriners Hospitals for Children - Lexington; Lexington KY USA
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Chrysagis N, Skordilis EK, Koutsouki D. Validity and clinical utility of functional assessments in children with cerebral palsy. Arch Phys Med Rehabil 2013; 95:369-74. [PMID: 24239880 DOI: 10.1016/j.apmr.2013.10.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/21/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the validity and clinical utility of functional assessments (1-minute walk test, 10-meter walk test, Timed Up & Go [TUG] test, Timed Up and Down Stairs [TUDS] test, sit-to-stand [STS] test, and lateral step-up [LSU] test). DESIGN Cross-sectional study. SETTING Four special schools for adolescents with physical disabilities. PARTICIPANTS Adolescents with spastic tetraplegia and diplegia (at levels I-III) were selected through convenience sampling (N=35; mean age, 14.97±2.03y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES GMFM-88 (dimensions D and E), 1-minute walk, 10-meter walk, TUG, TUDS, STS, and LSU tests. Data were analyzed using Pearson intercorrelations, multiple regression analysis, and multivariate analysis of variance (MANOVA). RESULTS Significant moderate to high intercorrelations were found. Three significant positive predictors emerged (1-minute walk, 10-meter walk, and LSU) with the following regression equation: YGMFM-88 (dimensions D and E) = 5.708 + .402 × X1-minute walk + .920 × XLSU + .404 × X10-meter walk The MANOVA was significant (Λ=.163, F=14.732, P<.001, η(2)=.596), and post hoc comparisons revealed significant differences across Gross Motor Function Classification System Expanded and Revised levels in all paired comparisons for the 1-minute walk and LSU tests. For the 10-meter walk test, significant differences were evident in the level I versus level III and level II versus level III comparisons. No significant differences were found in the 10-meter walk test between levels I and II. CONCLUSIONS These functional assessments (1-minute walk, LSU, and 10-meter walk tests) are simple to administer, quick, low cost, and user-friendly. Although these assessments are not a substitute for the criterion standard (GMFM-88), they may be used for a quick assessment in adolescents with cerebral palsy (levels I-III) either at school or during rehabilitation, especially when time is limited.
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Affiliation(s)
- Nikolaos Chrysagis
- Department of Physical Therapy, Technological Educational Institute of Athens, Athens, Greece; Laboratory of Adapted Physical Activity/Developmental and Physical Disabilities, Athens, Greece
| | - Emmanouil K Skordilis
- Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece.
| | - Dimitra Koutsouki
- Laboratory of Adapted Physical Activity/Developmental and Physical Disabilities, Athens, Greece; Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Grecco LAC, Duarte NDAC, de Mendonça ME, Pasini H, Lima VLCDC, Franco RC, de Oliveira LVF, de Carvalho PDTC, Corrêa JCF, Collange NZ, Sampaio LMM, Galli M, Fregni F, Oliveira CS. Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial. BMC Pediatr 2013; 13:168. [PMID: 24112817 PMCID: PMC3852945 DOI: 10.1186/1471-2431-13-168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. METHODS/DESIGN A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. DISCUSSION This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. TRIAL REGISTRATION ReBEC RBR-9B5DH7.
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Affiliation(s)
- Luanda André Collange Grecco
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Rua Diogo de Faria 775, Vila Mariana, CEP 04037-000 São Paulo, SP, Brazil
| | | | | | - Hugo Pasini
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Vânia Lúcia Costa de Carvalho Lima
- Master’s and Doctoral Programs in Communication disordes: Speech area, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Renata Calhes Franco
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | | | | | - João Carlos Ferrari Corrêa
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Nelci Zanon Collange
- 4th Pediatric Neurosurgery, University of São Paulo and the Federal Pediatric Neurosurgical Center (CENEPE), São Paulo, Brazil
| | - Luciana Maria Malosá Sampaio
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Manuela Galli
- Associate professor of Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Felipe Fregni
- Laboratory of Neuromodulation & Center of Clinical Research Learning, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Claudia Santos Oliveira
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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Grecco LAC, Zanon N, Sampaio LMM, Oliveira CS. A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial. Clin Rehabil 2013; 27:686-96. [PMID: 23503736 DOI: 10.1177/0269215513476721] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Compare the effects of treadmill training and training with overground walking (both without partial weight support) on motor skills in children with cerebral palsy. DESIGN Randomized controlled clinical trial. SETTING Physical therapy clinics. SUBJECTS Thirty-six children with cerebral palsy (levels I-III of the Gross Motor Functional Classification System) randomly divided into two intervention groups. INTERVENTIONS Experimental group (17 children) submitted to treadmill training without partial weight support. Overground walking group (18 children) submitted to gait training on a fixed surface (ground). Training was performed for seven consecutive weeks (two sessions per week), with four subsequent weeks of follow-up. RESULTS Both groups demonstrated improvements on the 6-minute walk test (experimental group from 227.4 SD 49.4 to 377.2 SD 93.0; overground walking group from 222.6 SD 42.6 to 268.0 SD 45.0), timed up-and-go test (experimental group from 14.3 SD 2.9 to 7.8 SD 2.2; overground walking group from 12.8 SD 2.2 to 10.5 SD 2.5), Pediatric Evaluation Disability Inventory (experimental group from 128.0 SD 19.9 to 139.0 SD 18.4; overground walking group from 120.8 SD 19.0 to 125.8 SD 12.2), Gross Motor Function Measure-88 (experimental group from 81.6 SD 8.7 to 93.0 SD 5.7; overground walking group from 77.3 SD 7.0 to 80.8 SD 7.2), Berg Balance Scale (experimental group from 34.9 SD 8.5 to 46.7 SD 7.6; overground walking group from 31.9 SD 7.0 to 35.7 SD 6.8) after treatment. The experimental group demonstrated greater improvements than the overground walking group both after treatment and during follow up (p < 0.05). CONCLUSION Treadmill training proved more effective than training with overground walking regarding functional mobility, functional performance, gross motor function and functional balance in children with cerebral palsy.
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Burdea GC, Cioi D, Kale A, Janes WE, Ross SA, Engsberg JR. Robotics and gaming to improve ankle strength, motor control, and function in children with cerebral palsy--a case study series. IEEE Trans Neural Syst Rehabil Eng 2013; 21:165-73. [PMID: 22773059 PMCID: PMC4228314 DOI: 10.1109/tnsre.2012.2206055] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of this study was to investigate the feasibility of game-based robotic training of the ankle in children with cerebral palsy (CP). The design was a case study, 12 weeks intervention, with no follow-up. The setting was a university research laboratory. The participants were a referred sample of three children with cerebral palsy, age 7-12, all male. All completed the intervention. Participants trained on the Rutgers Ankle CP system for 36 rehabilitation sessions (12 weeks, three times/week), playing two custom virtual reality games. The games were played while participants were seated, and trained one ankle at-a-time for strength, motor control, and coordination. The primary study outcome measures were for impairment (DF/PF torques, DF initial contact angle and gait speed), function (GMFM), and quality of life (Peds QL). Secondary outcome measures relate to game performance (game scores as reflective of ankle motor control and endurance). Gait function improved substantially in ankle kinematics, speed and endurance. Overall function (GMFM) indicated improvements that were typical of other ankle strength training programs. Quality of life increased beyond what would be considered a minimal clinical important difference. Game performance improved in both games during the intervention. This feasibility study supports the assumption that game-based robotic training of the ankle benefits gait in children with CP. Game technology is appropriate for the age group and was well accepted by the participants. Additional studies are needed however, to quantify the level of benefit and compare the approach presented here to traditional methods of therapy.
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Affiliation(s)
- Grigore C Burdea
- Tele-Rehabilitation Institute, Rutgers University, Piscataway, NJ 08854, USA.
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Treadmill training following orthopedic surgery in lower limbs of children with cerebral palsy. Pediatr Phys Ther 2013; 25:187-92; discussion 193. [PMID: 23542199 DOI: 10.1097/pep.0b013e3182888495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the effect of treadmill training on gross motor function and functional mobility in children with cerebral palsy (CP) receiving physical therapy following orthopedic surgery for the lower limbs. METHODS Children with CP between 8 and 15 years of age participated and were divided into 2 groups: those having undergone soft tissue surgery and those having undergone both soft tissue and bone surgery. The program consisted of 12 weeks of treadmill training without partial weight support at a frequency of one 30-minute session per week. RESULTS Significant improvements were found on the gross motor function measure-88 after treadmill training; distance traveled on the 6 meter walk test; and time tolerated on the treadmill. CONCLUSIONS Treadmill training during physical therapy is beneficial for children with CP who undergo orthopedic surgery in the lower limbs.
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