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Pham VM, Hoang TL, Hoang KC, Nguyen NM, DeLuca SC, Coker-Bolt P. The effect of constraint-induced movement therapy for children with hemiplegic cerebral palsy in Vietnam. Disabil Rehabil 2024:1-7. [PMID: 38828697 DOI: 10.1080/09638288.2024.2360060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Pediatric constraint-induced movement therapy (CIMT) is an evidence-based treatment that has a long history of demonstrating efficacy for children with hemiparesis. The purpose of this study is to determine the effectiveness of a culturally responsive CIMT program for children with hemiplegic cerebral palsy (CP) developed for the Vietnam healthcare system. METHODS Thirty children with hemiplegic CP (mean age = 2.88 years, age range: 1 to 8 yrs, 60% male) were recruited to a CIMT program (7.5 h/week, 4 weeks) developed for the cultural context of Vietnam. Motor abilities of the affected arm and participation in daily activities were evaluated at 3 time points (one-week prior to CIMT (baseline), one-week before (pre) and after (post) CIMT) using the Quality of Upper Extremity Skill Test (QUEST) and Pediatric Motor Activity Log-Revised (PMAL-R). Individual goals were measured using the Goal Attainment Scale (GAS). RESULTS There were significant increases in the "How often scale" and "How Well" scales of the PMAL-R (0.75 and 0.75, p < 0.00)). Score of Grasp and Dissociated Movement items on the QUEST increased significantly (6.47 and 7.63, p < 0.001). Group GAS T-Scores were 52.19 indicating that children met individual goals. CONCLUSIONS A model of CIMT was successfully developed and delivered within the Vietnamese healthcare system. Future studies should explore the optimal model for CIMT in various regions of world where the delivery of rehabilitation services may vary.
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Affiliation(s)
- Van Minh Pham
- Rehabilitation Department, Ha Noi Medical University, Hanoi, Vietnam
- Ha Noi Rehabilitation Hospital, Hanoi, Vietnam
| | - Thi Lien Hoang
- Rehabilitation Department, Ha Noi Medical University, Hanoi, Vietnam
- Ha Noi Rehabilitation Hospital, Hanoi, Vietnam
| | - Khanh Chi Hoang
- Rehabilitation Department, Ha Noi Medical University, Hanoi, Vietnam
- Ha Noi Rehabilitation Hospital, Hanoi, Vietnam
| | - Ngoc-Minh Nguyen
- Rehabilitation Department, Nursing and Medical Technology Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium
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Merino-Andrés J, López-Muñoz P, Carrión RP, Martín-Casas P, Ruiz-Becerro I, Hidalgo-Robles Á. Is more always better? Effectiveness of constraint-induced movement therapy in children with high-risk or unilateral cerebral palsy (0-6 years): Systematic review and meta-analysis. Child Care Health Dev 2024; 50:e13262. [PMID: 38606885 DOI: 10.1111/cch.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/30/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND While constraint-induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint-induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis. METHODS This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration's tool. RESULTS Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents' perception of how effectively children use their affected upper limb. CONCLUSIONS Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent's perception.
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Affiliation(s)
- Javier Merino-Andrés
- PedPT Research Lab, Toledo, Spain
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- Toledo Physiotherapy Research Group (GIFTO), Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain
| | - Purificación López-Muñoz
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- Research in Pediatric Physiotherapy and Neurology Group, ImproveLab, Toledo, Spain
| | - Rocío Palomo Carrión
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- Research in Pediatric Physiotherapy and Neurology Group, ImproveLab, Toledo, Spain
| | - Patricia Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Álvaro Hidalgo-Robles
- PedPT Research Lab, Toledo, Spain
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- International University of La Rioja, Logroño, Spain
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McGloon K, Humanitzki E, Brennan J, Summers P, Brennan A, George MS, Badran BW, Cribb AR, Jenkins D, Coker-Bolt P. Pairing taVNS and CIMT is feasible and may improve upper extremity function in infants. Front Pediatr 2024; 12:1365767. [PMID: 38415207 PMCID: PMC10896996 DOI: 10.3389/fped.2024.1365767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
In this study we combined non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) with 40 h of constraint induced movement therapy (CIMT) in infants. All infants completed the full intervention with no adverse events. Therapists were able to maintain high treatment fidelity and reported high ratings for ease of use and child tolerance. Preliminary results show promising gains on motor outcomes: Mean QUEST increase 19.17 (minimal clinically important difference, MCID 4.89); Mean GMFM increase 13.33 (MCID 1%-3%). Infants also exceeded expectations on Goal Attainment Scores (+1). Early data is promising that taVNS paired with intensive motor CIMT is feasible, reliable, and safe in young infants with hemiplegia, and may help harness activity-dependent plasticity to enhance functional movement.
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Affiliation(s)
- Kelly McGloon
- Department of Rehabilitation Science, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Elizabeth Humanitzki
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Julia Brennan
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Philip Summers
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Alyssa Brennan
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Mark S. George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Bashar W. Badran
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Anne R. Cribb
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Dorothea Jenkins
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Patricia Coker-Bolt
- Department of Rehabilitation Science, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
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Ferron A, Robert MT, Fortin W, Bau O, Cardinal MC, Desgagné J, Saussez G, Bleyenheuft Y, Levac D. Virtual Reality and Active Video Game Integration within an Intensive Bimanual Therapy Program for Children with Hemiplegia. Phys Occup Ther Pediatr 2023; 44:410-426. [PMID: 37846035 DOI: 10.1080/01942638.2023.2259462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
AIMS To describe the nature of custom and non-custom virtual reality and active video game (VR/AVG) implementation within a Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention program for children with hemiplegia. METHODS Six children aged 8-11 years participated in a 10-day HABIT-ILE intervention (65 h; 6.5 planned VR/AVG hours). VR/AVG implementation details were recorded daily and summarized with descriptive statistics; active motor engagement was quantified as minutes of active game participation. Post-intervention interviews with interventionists were analyzed with qualitative content analysis. RESULTS On average, participants received 79% of the planned VR/AVG dosage (314/400 planned minutes, range 214-400 min), of which the per-session active motor engagement average was 68% (27 min, SD 12 min). Participation involved equivalent amounts of custom (49%) and non-custom (51%) VR/AVG system use. Material and verbal adaptations facilitated alignment with HABIT-ILE principles. Interventionists identified type of task (gross versus fine motor), children's perceived motivation, and VR/AVG attributes as factors influencing active motor engagement and alignment with HABIT-ILE principles. CONCLUSIONS Describing individual and technological challenges of VR/AVG integration within HABIT-ILE can advance knowledge about VR/AVG use in intensive interventions and identify directions for subsequent research.
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Affiliation(s)
- Audrey Ferron
- Centre Hospitalier Universitaire Sainte-Justine - Research Center, Montreal, Canada
| | | | - William Fortin
- Centre Hospitalier Universitaire Sainte-Justine - Research Center, Montreal, Canada
| | - Odette Bau
- Centre Hospitalier Universitaire Sainte-Justine - Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Marie-Claude Cardinal
- Centre Hospitalier Universitaire Sainte-Justine - Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Julie Desgagné
- Centre Hospitalier Universitaire Sainte-Justine - Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Geoffroy Saussez
- Institute of Neuroscience, Université catholique de Louvain, Louvain, Belgium
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Louvain, Belgium
| | - Danielle Levac
- Centre Hospitalier Universitaire Sainte-Justine - Research Center, Montreal, Canada
- Faculty of Medicine, University of Montreal, Montreal, Canada
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Tang H, Pan J, Xu Y, Liu L, Yang X, Huang S, Peng T, Huang Y, Zhao Y, Fu C, Zhou H, Chen Z, Wang W, He L, Xu K. Constraint therapy promotes motor cortex remodeling and functional improvement by regulating c-Jun/miR-182-5p/Nogo - A signals in hemiplegic cerebral palsy mice. Ann Anat 2023; 250:152136. [PMID: 37506776 DOI: 10.1016/j.aanat.2023.152136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Our previous study has confirmed that constraint-induced movement therapy (CIMT) could promote neural remodeling in hemiplegic cerebral palsy (HCP) mice through Nogo-A/NgR/RhoA/ROCK signaling, however, the upstream mechanism was still unclear. Therefore, the present study aimed to further explore the mechanism of CIMT regulating the expression of Nogo-A in HCP mice. METHOD HCP mice were well established through ligating the left common carotid artery of 7-day-old pups and being placed in a hypoxic box which was filled with a mixture of 8% oxygen and 92% nitrogen. CIMT intervention was conducted by taping to fix the entire arm of the contralateral side (left) to force the mice to use the affected limb (right). Bioinformatics prediction and luciferase experiment were performed to confirm that miR-182-5p was targeted with Nogo-A. The beam test and grip test were applied to examine the behavioral performance under the intervention of c-Jun and CIMT. Also, immunofluorescence, Golgi staining, and transmission electron microscopy were conducted to show that the lenti-expression of c-Jun could increases the expression of myelin, and downregulates the expression of Nogo-A under the CIMT on HCP mice. RESULT (1) The beam walking test and grip test experiment results showed that compared with the control group, the HCP + nCIMT group's forelimb grasping ability and balance coordination ability were decreased (P < 0.05). (2) The results of Golgi staining, and transmission electron microscopy showed that the thickness of myelin sheath and the density of dendritic spines in the HCP + nCIMT group were lower than those in the control group (P < 0.05). Compared with the HCP + nCIMT group, the cerebral cortex myelin sheath thickness, dendrite spine density and nerve filament expression were increased in HCP + CIMT group (P < 0.05). (3) Immunofluorescence staining showed that the expression of Nogo-A in the cerebral cortex of the HCP + nCIMT group was higher than that of the HCP + CIMT group (P < 0.05). Compared with the HCP + CIMT group, the expression of Nogo-A in the HCP + LC + CIMT group was decreased and, in the HCP, + SC + CIMT group was significantly increased (P < 0.05). Compared with the HCP + nCIMT group, the expression of c-Jun in the control, HCP + CIMT, HCP + LC + nCIMT and HCP + LC + CIMT groups was significantly increased, and in the HCP + SC + CIMT was decreased (P < 0.05). (4) Real-time quantitative polymerase chain reaction (RT-qPCR) results showed that the expression level of miR-182-5p in the HCP + LC + CIMT group was more increased than that in the HCP + nCIMT group (P < 0.05). The expression level of miR-182-5p in the HCP + LC + CIMT group was higher than that in the HCP + LC + nCIMT group and the HCP + SC + CIMT group (P < 0.05). CONCLUSION These data identified that CIMT might stimulate the remodeling of neurons and myelin in the motor cortex by partially inhibiting the c-Jun/miR-182-5p/Nogo-A pathway, thereby facilitating the grasping performance and balance function of HCP mice.
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Affiliation(s)
- Hongmei Tang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Pan
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yunxian Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liru Liu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xubo Yang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shiya Huang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tingting Peng
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuan Huang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yiting Zhao
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chaoqiong Fu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hongyu Zhou
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhaofang Chen
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wenda Wang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lu He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
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Scott K, Sakzewski L, Ziviani J, Heathcock JC, Boyd R. Fidelity of Delivery in a Multisite Randomized Clinical Trial of Intervention Efficacy for Infants With Unilateral Cerebral Palsy. Pediatr Phys Ther 2023; 35:458-466. [PMID: 37747982 PMCID: PMC10703014 DOI: 10.1097/pep.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
PURPOSE To investigate the reliability of a measure of fidelity of therapist delivery, quantify fidelity of delivery, and determine factors impacting fidelity in the Rehabilitation EArly for Congenital Hemiplegia (REACH) clinical trial. METHODS Ninety-five infants (aged 3-9 months) with unilateral cerebral palsy participated in the REACH clinical trial. The Therapist Fidelity Checklist (TFC) evaluated key intervention components. Video-recorded intervention sessions were scored using the TFC. RESULTS Inter- and intrarater reliability was percentage agreement 77% to 100%. Fidelity of delivery was high for 88.9% of sessions and moderate for 11.1% of sessions. Sessions with moderate scores included infants receiving infant-friendly bimanual therapy and occurred at the intervention midpoint or later. No significant relationships were found for TFC scores and infant age, manual ability, or parent engagement. CONCLUSIONS Fidelity of delivery was high for the REACH trial in most intervention sessions. Standardized therapist training with intervention manuals and monthly peer-to-peer support likely contributed to these results.
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Affiliation(s)
- Kimberley Scott
- Department of Physical Therapy, Creighton University, Omaha, Nebraska, United States
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jill C. Heathcock
- Division of Physical Therapy, The Ohio State University, Columbus, Ohio, United States
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Lennon N, Church C, Shields T, Kee J, Henley JD, Salazar-Torres JJ, Niiler T, Shrader MW, Ty JM. Can the Shriners Hospital Upper Extremity Evaluation (SHUEE) Detect Change in Dynamic Position and Spontaneous Function of the Upper Limb in People With Hemiplegic Cerebral Palsy? J Pediatr Orthop 2023; 43:e471-e475. [PMID: 36952245 DOI: 10.1097/bpo.0000000000002403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND The Shriners Hospital Upper Extremity Evaluation (SHUEE) is a video-based measure designed to assess upper extremity function in people with cerebral palsy (CP). The SHUEE completes both dynamic positional analysis (DPA; position during functional activities) and spontaneous functional analysis (spontaneous use of the involved limb). Although the SHUEE has been suggested as a measure for planning upper limb interventions and evaluating outcomes, limited evidence of its ability to detect change exists. Thus, this study aimed to describe responsiveness of the SHUEE to detect change after orthopaedic surgery. METHODS In this Institutional Review Board-approved retrospective cohort study, we identified children with CP who were administered SHUEE on≥2 encounters. We formed pairs of initial and follow-up visits between temporally adjacent visits. Pairs were assigned to a surgery or non-surgery group based on intervening upper limb orthopaedic surgery. We compared differences in baseline SHUEE scores between groups and differences in temporally adjacent SHUEE scores within groups using Welch unequal variances t tests and paired t tests, respectively. RESULTS Nineteen people (7 female) with hemiplegic CP had≥2 SHUEE assessments; Manual Ability Classification System levels I (3), II (8), III (7), IV (1); Gross Motor Function Classification System levels I (10), II (7), IV (2); mean age at baseline 11.9 (5.1 to 19.1) years; and follow-up at 13.4 (5.5 to 19.7) years. Six people had≥2 visits leading to 14 surgical pairs and 10 non-surgical pairs. At baseline, DPA of the wrist and forearm were significantly lower in the surgical group ( P <0.05). At follow-up, no significant difference between the groups existed in DPA measures ( P >0.05). After surgical intervention, there was a significant change in overall and wrist DPA ( P <0.05). CONCLUSIONS The DPA measures demonstrated responsiveness to expected positional changes in the arm after orthopaedic surgery in people with CP. The SHUEE was useful in identifying abnormal segmental alignment pre-surgically and documenting changes in alignment postoperatively. As orthopaedic surgery does not address limb neglect or bimanual ability, spontaneous functional analysis scores were as expected-unchanged. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Nancy Lennon
- Department of Orthopaedics, Nemours Children's Health, Wilmington, DE
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DeLuca SC, Trucks MR, Wallace D, Ramey SL. Evidence for Using ACQUIRE Therapy in the Clinical Application of Intensive Therapy: A Framework to Guide Therapeutic Interactions. Behav Sci (Basel) 2023; 13:484. [PMID: 37366736 DOI: 10.3390/bs13060484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Intensive therapies have become increasingly popular for children with hemiparesis in the last two decades and are specifically recommended because of high levels of scientific evidence associated with them, including multiple randomized controlled trials and systematic reviews. Common features of most intensive therapies that have documented efficacy include: high dosages of therapy hours; active engagement of the child; individualized goal-directed activities; and the systematic application of operant conditioning techniques to elicit and progress skills with an emphasis on success-oriented play. However, the scientific protocols have not resulted in guiding principles designed to aid clinicians with understanding the complexity of applying these principles to a heterogeneous clinical population, nor have we gathered sufficient clinical data using intensive therapies to justify their widespread clinical use beyond hemiparesis. We define a framework for describing moment-by-moment therapeutic interactions that we have used to train therapists across multiple clinical trials in implementing intensive therapy protocols. We also document outcomes from the use of this framework during intensive therapies provided clinically to children (7 months-20 years) from a wide array of diagnoses that present with motor impairments, including hemiparesis and quadriparesis. Results indicate that children from a wide array of diagnostic categories demonstrated functional improvements.
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Affiliation(s)
- Stephanie C DeLuca
- The Fralin Biomedical Research Institute's Neuromotor Clinic, Roanoke, VA 24016, USA
- The School of Neuroscience, Virginia Tech, Blacksburg, VA 24061, USA
- The Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA
| | - Mary Rebekah Trucks
- The Fralin Biomedical Research Institute's Neuromotor Clinic, Roanoke, VA 24016, USA
| | - Dorian Wallace
- The Fralin Biomedical Research Institute's Neuromotor Clinic, Roanoke, VA 24016, USA
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Xu Y, Tang Q, Ding N, Zhang T, Luo H. Ferroptosis-associated gene CISD2 suppresses colon cancer development by regulating tumor immune microenvironment. PeerJ 2023; 11:e15476. [PMID: 37304867 PMCID: PMC10249621 DOI: 10.7717/peerj.15476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Background Despite the association of ferroptosis with various tumors, the specific mechanism by which it influences colon adenocarcinoma (COAD) microenvironmental equilibrium remains elusive. This study aims to elucidate how ferroptosis affects COAD microenvironmental homeostasis and its potential impact on COAD research. Objective By employing genetic screening and single-cell analysis of tumor data, we investigated the role of ferroptosis genes in COAD microenvironmental homeostasis. The genes were correlated with immune cell infiltration in tissue samples and patient outcomes. Methods Ferroptosis-associated genes were initially identified through the FerrDb database. Utilizing the tidyverse and Seurat packages, genes with substantial expression differences were extracted, and clustering analysis was performed on the single-cell data. A Venn diagram depicted shared differential genes for ferroptosis and tumors. To screen key ferroptosis genes, further enrichment analysis and immune cell infiltration analysis were conducted. Lastly, human COAD cell lines were employed to overexpress CDGSH iron sulfur domain 2 (CISD2) through cellular assays to validate its function in COAD. Results Following screening of The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases, 414 COAD patient samples and 341 normal samples were included. Through the FerrDb database, 259 ferroptosis genes were identified. Clustering the single-cell data revealed 911 tumor marker genes, of which 18 were ferroptosis genes. Analysis of variance (ANOVA) and univariate regression analysis determined that only CISD2 was statistically significantly associated with clinical outcomes. Additionally, CISD2 was found to positively correlate with activated memory T cells and negatively correlate with regulatory T cells (Tregs) and plasma cells in COAD, as well as being significantly associated with several immune-related and cancer-related pathways. CISD2 expression was elevated in most tumors, likely due to cell cycle regulation and immune system activation. Moreover, CISD2 upregulation inhibited COAD cell proliferation and enhanced 5-fluorouracil (5-FU) sensitivity. Our findings indicate, for the first time, that CISD2 governs the cell cycle and stimulates the immune system to impede COAD progression. Conclusion By modulating the cell cycle and mediating immune infiltration, CISD2 may inhibit COAD development by influencing tumor immune microenvironment equilibrium, providing valuable insights into the relevance and potential impact of the research results on the COAD research field.
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Affiliation(s)
- Yuanyuan Xu
- Department of Anorectal Surgery, Chenzhou No. 1 People's Hospital, Chenzhou, China
| | - Qingzhu Tang
- Department of Anorectal Surgery, Chenzhou No. 1 People's Hospital, Chenzhou, China
| | - Ning Ding
- Hunan University of Chinese Medicine, Hunan, China
| | - Tao Zhang
- Hunan University of Chinese Medicine, Hunan, China
| | - Hongbiao Luo
- Department of Anorectal Surgery, Chenzhou No. 1 People's Hospital, Chenzhou, China
- Hunan University of Chinese Medicine, Hunan, China
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Felling RJ, Jordan LC, Mrakotsky C, deVeber G, Peterson RK, Mineyko A, Feldman SJ, Shapiro K, Lo W, Beslow LA. Roadmap for the Assessment and Management of Outcomes in Pediatric Stroke. Pediatr Neurol 2023; 141:93-100. [PMID: 36805967 DOI: 10.1016/j.pediatrneurol.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Neurological morbidity is common after pediatric stroke, with moderate to severe deficits that can significantly impact education and social function. Care and recovery occur in phases distinguished by the time interval after stroke onset. These phases include the hyperacute and acute periods in which the focus is on cerebral reperfusion and prevention of neurological deterioration, followed by the subacute and chronic phases in which the focus is on secondary stroke prevention and mitigation of disability through rehabilitation, adaptation, and reintegration into the community. In this article, a multidisciplinary group of pediatric stroke experts review the stages of recovery after pediatric stroke with an emphasis on critical assessment time points. Our goal is to encourage increased standardization of outcome assessment to facilitate future clinical trials comparing various treatment and intervention options and advance optimized care for children with stroke.
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Affiliation(s)
- Ryan J Felling
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christine Mrakotsky
- Departments of Psychiatry & Neurology, Center for Neuropsychology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabrielle deVeber
- Child Health Evaluative Sciences Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Rachel K Peterson
- Neuropsychology Department, Kennedy Krieger Institute, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Aleksandra Mineyko
- Section of Neurology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Samantha J Feldman
- Neurosciences and Mental Health Research Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Kevin Shapiro
- Cortica Healthcare, Westlake Village, California; Division of Neurology, Children's Hospital Lost Angeles, Los Angeles, California
| | - Warren Lo
- Departments of Pediatrics and Neurology, The Ohio State University Nationwide Children's Hospital, Columbus, Ohio
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Adams RJ, Lunsford CD, Stevenson RD, Ellington AL, Lichter MD, Patrie JT. Concurrent Validity of Measures of Upper Extremity Function Derived from Videogame-Based Motion Capture for Children with Hemiplegia. Games Health J 2023. [PMID: 36944143 DOI: 10.1089/g4h.2022.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Objective: Pediatric hemiplegia is associated with wide-ranging deficits in arm and hand motor function, neg-atively impacting participation in daily occupations and quality of life. This study investigated whether performance measures generated during therapy videogame play by children with hemiplegia can be valid indicators of upper extremity motor function. Materials and Methods: Ten children with hemiplegia used a custom therapy game system alternatively using their affected and non-affected hand to provide motion capture data that spans a wide range of motor function status. The children also completed a series of standardized outcome measure assessments with each hand, including the Quality of Upper Extremity Skills Test, the Jebsen Taylor Hand Function Test, and the Wolf Motor Function Test. Results: Statistical analysis using the nonparametric Spearman rank correlation revealed high and significant correlation between videogame-derived motion capture measures, characterizing the speed and smoothness of movements, and the standardized outcome measure assessments. Conclusion: The results suggest that a low-cost motion capture system can be used to monitor a child's motor function status and progress during a therapy program.
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Affiliation(s)
| | | | - Richard D Stevenson
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Allison L Ellington
- Department of Occupational Therapy, Mary Baldwin University, Staunton, Virginia, USA
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12
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Tezcan S, Çankaya T. The effect of modified constraint-induced movement therapy in children with hemiparetic cerebral palsy. Consecutive or intermittent days? Disabil Rehabil 2022; 44:7500-7507. [PMID: 34775897 DOI: 10.1080/09638288.2021.2002441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate effect of modified constraint-induced movement therapy (mCIMT) administered on consecutive or intermittent days on upper limb function in children with hemiparetic cerebral palsy (CP). MATERIALS AND METHODS Thirty-three children (age range 5-18 y) with hemiparetic CP separated into three groups: consecutive mCIMT group (n = 11), intermittent mCIMT group (n = 11), control group (n = 11). The outcome measures consist of Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Pediatric Balance Scale (PBS), Modified Tardieu Scale (MTS), Jebsen-Taylor Hand Function Test (JTHFT), Children's Hand Use Experience Questionnaire (CHEQ), Abilhand Kids Questionnaire, surface Electromyography (sEMG). The evaluations were made baseline, 10 days after, 5 weeks after the treatment. RESULTS Improvements were achieved in all groups. The use of upper extremities in daily life activities (p < 0.01), speed of performing the activities (p < 0.001), grasping efficiency (p < 0.001), the amount of a decrease in the children's sense of discomfort while performing activities (p < 0.001) on the affected side in both mCIMT groups were better than the control group. The gain levels in mCIMT groups were similar (p > 0.05). CONCLUSIONS Administration of mCIMT on intermittent days facilitate the adaptation of a child, it was concluded to be a more tolerable method and could be more effective.Implications for rehabilitationmCIMT is more effective than low-dose conventional therapeutic interventions in improving paretic upper limb functions in children with hemiparetic CP.The application of mCIMT in the child's natural environment increases the motivation to participate in the treatment.The application of mCIMT on intermittent days will be more easily tolerated in paediatric individuals and will increase participation in the treatment.
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Affiliation(s)
- Sezen Tezcan
- Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Tamer Çankaya
- Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
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13
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Ramey SL, DeLuca SC, Stevenson RD, Conaway M, Darragh AR, Lo W. Constraint-Induced Movement Therapy for Cerebral Palsy: A Randomized Trial. Pediatrics 2021; 148:peds.2020-033878. [PMID: 34649982 DOI: 10.1542/peds.2020-033878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of constraint-induced movement therapy (CIMT) to usual customary treatment (UCT). METHODS CHAMP randomly assigned 118 2- to 8-year-olds with hemiparetic cerebral palsy to one of 5 treatments with assessments at baseline, end of treatment, and 6 months posttreatment. Primary blinded outcomes were the assisting hand assessment; Peabody Motor Development Scales, Second Edition, Visual Motor Integration; and Quality of Upper Extremity Skills Test Dissociated Movement. Parents rated functioning on the Pediatric Evaluation of Disabilities Inventory-Computer Adaptive Test Daily Activities and Child Motor Activity Log How Often scale. Analyses were focused on blinded and parent-report outcomes and rank-order gains across all measures. RESULTS Findings varied in statistical significance when analyzing individual blinded outcomes. parent reports, and rank-order gains. Consistently, high-dose CIMT, regardless of constraint type, produced a pattern of greatest short- and long-term gains (1.7% probability of occurring by chance alone) and significant gains on visual motor integration and dissociated movement at 6 months. O'Brien's rank-order analyses revealed high-dose CIMT produced significantly greater improvement than a moderate dose or UCT. All CIMT groups improved significantly more in parent-reported functioning, compared with that of UCT. Children with UCT also revealed objective gains (eg, 48% exceeded the smallest-detectable assisting hand assessment change, compared with 71% high-dose CIMT at the end of treatment). CONCLUSIONS CHAMP provides novel albeit complex findings: although most individual blinded outcomes fell below statistical significance for group differences, high-dose CIMT consistently produced the largest improvements at both time points. An unexpected finding concerns shifts in UCT toward higher dosages, with improved outcomes compared with previous reports.
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Affiliation(s)
| | - Stephanie C DeLuca
- Fralin Biomedical Research Institute, Virginia Tech, Blacksburg, Virginia
| | - Richard D Stevenson
- Department of Pediatrics and Division of Neurodevelopmental Behavioral Pediatrics, UVA Children's, Charlottesville, Virginia
| | - Mark Conaway
- Department of Pediatrics and Division of Neurodevelopmental Behavioral Pediatrics, UVA Children's, Charlottesville, Virginia
| | - Amy R Darragh
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Warren Lo
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio.,Departments of Neurology and Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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14
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Smith AE, Aravamuthan B. Optimizing Constraint-Induced Movement Therapy for Children With Cerebral Palsy. Pediatrics 2021; 148:peds.2021-053121. [PMID: 34649981 DOI: 10.1542/peds.2021-053121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alyssa E Smith
- St Louis Children's Hospital and Department of Neurology, Washington University, St Louis, Missouri
| | - Bhooma Aravamuthan
- St Louis Children's Hospital and Department of Neurology, Washington University, St Louis, Missouri
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15
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Walker C, Shierk A, Roberts H. Constraint Induced Movement Therapy in Infants and Toddlers with Hemiplegic Cerebral Palsy: A Scoping Review. Occup Ther Health Care 2021; 36:29-45. [PMID: 34339315 DOI: 10.1080/07380577.2021.1953206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cerebral Palsy (CP) is the leading cause of motor disability in childhood. Recent studies have investigated the effectiveness of constraint induced movement therapy (CIMT) as an early intervention for infants and toddlers with hemiplegic CP. This scoping review aims to identify current evidence for CIMT protocols for children 3 months to 5 years 11 months as well as clinical applications for practice and gaps in research. Selected databases and additional studies were searched and reviewed with 10 studies were selected for review. Results show CIMT for infants and toddlers is a feasible and effective treatment consisting of caregiver coaching, treatment in the child's typical environment, and just right activities. Future research is needed to determine the effects of different dosages in early CIMT, and the long term developmental effects throughout childhood.
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Affiliation(s)
- Casey Walker
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
| | - Angela Shierk
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
| | - Heather Roberts
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
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16
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Graser JV, Bastiaenen CHG, Gut A, Keller U, van Hedel HJA. Contextual interference in children with brain lesions: a pilot study investigating blocked vs. random practice order of an upper limb robotic exergame. Pilot Feasibility Stud 2021; 7:135. [PMID: 34172085 PMCID: PMC8228977 DOI: 10.1186/s40814-021-00866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/03/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Evidence about contextual interference in children with brain lesions when practising motor tasks is lacking. Our main objective was to evaluate the feasibility of a randomised controlled trial (RCT) comparing blocked with random practice order of an upper limb robotic exergame to improve reaching in children with neuromotor disorders with a pilot trial. Methods We recruited children with brain lesions and impaired upper limb functions who underwent a 3-week schedule that consisted of baseline assessments, intervention period (participants were randomised to a blocked or random order group), and follow-up assessment. We evaluated ten feasibility criteria, including the practicability of the inclusion/exclusion criteria, recruitment rate, feasibility of randomisation, scheduling procedure, and the participants’ programme adherence. Results The inclusion/exclusion criteria were not completely feasible as patients who were not able to perform the exergames were included. Twelve participants were recruited, and six datasets were used for analysis. The scheduling and randomisation procedures were generally feasible, but the procedure was only partially feasible for the participants, as some sessions were aborted due to lack of motivation and fatigue. Conclusion An RCT following this study protocol is not feasible. We formulated suggestions for future studies that aim to investigate contextual interference as in this pilot study. Trial registration ClinicalTrials.gov Identifier: NCT02443857, registered on May 14, 2015 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00866-4.
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Affiliation(s)
- Judith V Graser
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland. .,Children's Research Centre CRC, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Research Group Function, Participation and Rehabilitation CAPHRI, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
| | - Caroline H G Bastiaenen
- Research Group Function, Participation and Rehabilitation CAPHRI, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Anja Gut
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland.,Children's Research Centre CRC, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Urs Keller
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland.,Children's Research Centre CRC, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland.,Children's Research Centre CRC, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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17
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Kanitkar A, Parmar ST, Szturm TJ, Restall G, Rempel G, Naik N, Gaonkar N, Sepehri N, Ankolekar B. Reliability and validity of a computer game-based tool of upper extremity assessment for object manipulation tasks in children with cerebral palsy. J Rehabil Assist Technol Eng 2021; 8:20556683211014023. [PMID: 34123406 PMCID: PMC8175827 DOI: 10.1177/20556683211014023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction A computer game-based upper extremity (CUE) assessment tool is developed to quantify manual dexterity of children with Cerebral Palsy (CP). The purpose of this study was to determine test-retest reliability of the CUE performance measures (success rate, movement onset time, movement error, and movement variation) and convergent validity with the Peabody Developmental Motor Scale version 2 (PDMS-2) and the Quality of Upper Extremity Skills Test (QUEST). Methods Thirty-five children with CP aged four to ten years were tested on two occasions two weeks apart. Results CUE performance measures of five chosen object manipulation tasks exhibited high to moderate intra-class correlation coefficient (ICC) values. There was no significant difference in the CUE performance measures between test periods. With few exceptions, there was no significant correlation between the CUE performance measures and the PDMS-2 or the QUEST test scores. Conclusions The high to moderate ICC values and lack of systematic errors indicate that the CUE assessment tool has the ability to repeatedly record reliable performance measures of different object manipulation tasks. The lack of a correlation between the CUE and the PDMS-2 or QUEST scores indicates that performance measures of these assessment tools represent distinct attributes of manual dexterity.
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Affiliation(s)
- Anuprita Kanitkar
- Department of Applied Health Sciences, University of Manitoba, Winnipeg, Canada
- Anuprita Kanitkar, University of Manitoba 771 McDermot Avenue, Winnipeg, MB Manitoba R3E 0T6 Canada 204 789-3897.
| | - Sanjay T Parmar
- SDM College of Physiotherapy, Shri Dharamshala Manjunatheshwara University, Dharwad, India
| | - Tony J Szturm
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Gayle Restall
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Gina Rempel
- Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | - Nilashri Naik
- Department of Physiotherapy, Ushas School for Exceptional Children, Hubli, India
| | | | - Nariman Sepehri
- Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
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18
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Kanitkar A, Parmar ST, Szturm TJ, Restall G, Rempel G, Sepehri N. Parents' Perspectives on a Computer Game-Assisted Rehabilitation Program for Manual Dexterity in Children With Cerebral Palsy: Qualitative Analysis of Expectations, Child Engagement, and Benefits. JMIR Rehabil Assist Technol 2021; 8:e24337. [PMID: 34057424 PMCID: PMC8204242 DOI: 10.2196/24337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/20/2020] [Accepted: 04/11/2021] [Indexed: 12/04/2022] Open
Abstract
Background Children with motor impairments affecting the upper extremity benefit from task-specific therapy, such as constraint-induced movement therapy. However, there is a need to improve engagement and compliance with task-specific exercise programs that target manual dexterity for children with cerebral palsy (CP). A computer game–based rehabilitation (GRP) platform was developed that combines fine manipulation and gross movement exercises with engaging game activities appropriate for young children with CP. Objective The objectives of this qualitative analysis were to compare parents’ perspectives and opinions about expectations, challenges, and benefits between 2 interventions. Methods A mixed methods, randomized controlled trial (RCT) was conducted to examine the feasibility and estimate the effect size of 2 exercise programs for rehabilitation of manual dexterity of children with CP using either GRP or conventional therapy. Parents of 26 of the children who completed the GRP program (n=33) and parents of 15 of the children who completed the conventional therapy program (n=27) participated in the interviews. A general conductive approach was used to analyze the data recorded during the parents’ interviews. Results Five themes captured the range of the parent’s experiences, viewpoints, and ideas: (1) parents’ expectations, (2) child’s engagement with therapy, (3) positive effects of the interventions, (4) challenges, and (5) improving the protocol. Conclusions Parents from both groups recognized that their expectations related to improving children’s object handling and manipulation skills including participation in activities of daily life were addressed during the 16-week therapy program. Parents perceived a change in the children’s level of independence in their daily tasks at home, school, and leisure activities. Trial Registration ClinicalTrials.gov NCT02728375; https://clinicaltrials.gov/ct2/show/NCT02728375
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Affiliation(s)
| | | | | | | | - Gina Rempel
- University of Manitoba, Winnipeg, MB, Canada
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