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Oliveira RHS, Mancini MC, Figueiredo PRP, Abrahão LC, Reis EA, Gordon AM, Brandão MB. Individualized telehealth home programme for children with cerebral palsy during the COVID-19 pandemic. Dev Med Child Neurol 2024. [PMID: 39240105 DOI: 10.1111/dmcn.16072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 07/16/2024] [Accepted: 07/29/2024] [Indexed: 09/07/2024]
Abstract
AIM To analyse the effects of an individualized telehealth home programme on the performance of functional goals of children and adolescents with cerebral palsy (CP) during the COVID-19 pandemic. METHOD A prospective single-group intervention study with children/adolescents with CP (n = 144; median age = 92 months [Q1 = 44.0, Q3 = 148.8]; 74 males, 70 females), representing all Gross Motor Function Classification System (GMFCS) levels participated in a 4-month home programme in Brazil. An interdisciplinary team encouraged families to choose a functional goal to be trained. The Canadian Occupational Performance Measure (COPM) was used at pre-intervention (T1), post-intervention (T2), and 3-month follow-up (T3). The differences in COPM scores at T1, T2, and T3 were evaluated using Friedman's test. The effect size was calculated using Cohen's d. Univariate analysis was included. RESULTS Significant improvements were observed after the intervention, with maintenance of scores after 3 months (p < 0.001, dperformance = 1.33; dsatisfaction = 1.31). None of the tested variables (child's abilities, age, caregiver's educational level, perception of family-centredness, and type of goal) were significantly related to the change scores. INTERPRETATION The individualized remote telehealth home programme can be a potential intervention, especially for children with CP classified in GMFCS levels IV and V. Also, this intervention provided a possible solution to help some children and their families in performing prioritized functional goals during the pandemic period.
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Affiliation(s)
- Rachel H S Oliveira
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marisa C Mancini
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Priscilla R P Figueiredo
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Associação Mineira de Reabilitação, Belo Horizonte, Minas Gerais, Brazil
| | - Leonardo C Abrahão
- Associação Mineira de Reabilitação, Belo Horizonte, Minas Gerais, Brazil
| | - Edna A Reis
- Departamento de Estatística-LabEst/CECiDa, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Marina B Brandão
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Chan-Víquez D, Fernández-Huertas H, Montserrat-Gonzalez C, Khan A, Fehlings D, Munce S, Wright FV, Biddiss E. Feasibility of a home-based home videogaming intervention with a family-centered approach for children with cerebral palsy: a randomized multiple baseline single-case experimental design. J Neuroeng Rehabil 2024; 21:151. [PMID: 39227911 PMCID: PMC11373410 DOI: 10.1186/s12984-024-01446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/13/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Worldwide, children with cerebral palsy (CP) living in underserved communities face barriers to accessing motor therapy services. This study assessed the implementation and effectiveness of an 8-week, upper limb (UL) home-based intervention with a movement-tracking videogame (Bootle Blast) in Costa Rican children with CP. METHODS Children established a weekly playtime goal and two UL activities of daily living (ADLs) that they would like to improve on. A multiple-baseline, single-case experimental design, was used with the Performance Quality Rating Scale (PQRS) as the repeated measure to track changes in performance of the selected ADLs between the baseline (usual care) and intervention (Bootle Blast) phases. The Canadian Occupational Performance Measure (COPM), the Box and Blocks Test (BBT) and the Children's Hand-Use Experience Questionnaire (CHEQ) were collected before and after the intervention. Technical barriers were documented during weekly video calls with a monitoring therapist. Treatment effect size, slope changes and percentage of non-overlapping data were identified for the PQRS. Descriptive statistics summarized results for the BBT, CHEQ, videogame logs (e.g., playtime) and technical barriers. RESULTS Fifteen children participated and 13 completed the intervention. Both participants who dropped out did so after completing baseline assessments, but before experiencing Bootle Blast. Children's mean active playtime (i.e., mini-games targeting the UL) across the 8-weeks was 377 min, while mean total time spent engaging with Bootle Blast (active + passive play time [e.g., time navigating menus, reviewing rewards]) was 728 min. In total, eight technical issues (from five children) were reported, and all but three were resolved within 48 h. Partial effectiveness was associated with the intervention. Specifically, 85% of participants improved on the PQRS and 69% achieved clinically important improvements ≥ 2 points in performance on the COPM. Children improved by 1.8 blocks on average on the BBT, while on the CHEQ, five children had a clinically important increase of 10% of the total number of UL activities performed with both hands. CONCLUSION Bootle Blast is a feasible and effective option to facilitate access and engage children with cerebral palsy in UL home rehabilitation. Trial registration Trial registration number: NCT05403567.
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Affiliation(s)
- Daniela Chan-Víquez
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | | | - Ajmal Khan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Sarah Munce
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada.
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Goikoetxea-Sotelo G, van Hedel HJA. Reporting Completeness of Intensity-, Dose-, and Dosage-Related Items in Active Pediatric Upper Limb Neurorehabilitation Trials: A Systematic Review. Arch Phys Med Rehabil 2024; 105:1784-1792. [PMID: 38160897 DOI: 10.1016/j.apmr.2023.12.007] [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: 06/29/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To analyze the reporting completeness of the TIDieR items 8-12, in particular intensity, dose, and dosage, in active pediatric upper limb neurorehabilitation trials. DATA SOURCES We searched PubMed Central, Scopus, CINAHL, OTseeker, and Web of Science for eligible publications. STUDY SELECTION We included publications analyzing active pediatric upper limb neurorehabilitation interventions and assessed the reporting completeness of 11 items for each intervention and control group. DATA EXTRACTION Two raters independently screened titles and abstracts and selected the publications using the RYYAN platform. We unblinded the results after the raters had completed their selection and resolved the disagreements by discussion. We used the same procedures to review the full texts. DATA SYNTHESIS We included 52 randomized controlled trials with 65 intervention and 48 control groups. Authors did not report all 11 items in any of the study groups. The overall reporting completeness varied between 1% (intensity) to 95% (length of the intervention). The reporting completeness of the TIDieR items ranged from 2% (modifications) to 64% (when and how much). We found no significant differences in the reporting completeness between the intervention and control groups. CONCLUSIONS Information essential for dose-response calculations is often missing in randomized controlled trials of pediatric upper limb neurorehabilitation interventions. Reporting completeness should be improved, and new measures to accurately quantify intensity should be discussed and developed.
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Affiliation(s)
- Gaizka Goikoetxea-Sotelo
- Swiss Children's Rehab, University Children's Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Svensson K, Eliasson AC, Sundelin H, Holmqvist KL. Parents in the Driver's Seat-Experiences of Parent-Delivered Baby-mCIMT Coached Remotely. J Clin Med 2024; 13:4864. [PMID: 39201006 PMCID: PMC11355282 DOI: 10.3390/jcm13164864] [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: 07/05/2024] [Revised: 08/11/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Recent guidelines on early intervention in children at high risk of cerebral palsy (CP) recommend parental involvement and family-centered home-based interventions with parents as primary trainers. Therapist coaching by home visitation is resource demanding, and telerehabilitation is a viable option for remote intervention and coaching. This study aims to describe parents' experiences of engaging in Baby-mCIMT coached remotely. Their infants are at high risk of unilateral cerebral palsy and the parents have been the primary trainers in regard to home-based intervention, optimizing the use of the affected hand. Methods: A qualitative approach involving semi-structured interviews with eight parents was employed. Data were analyzed using qualitative content analysis. Results: The overarching theme "Parents in the driver's seat-learning through remote coaching to create conditions to enhance the child's motor skills" describes parents' experiences as primary training providers. The following three underlying categories with subcategories were identified: (1) Baby-mCIMT coached remotely in an everyday context-practical and technical prerequisites; (2) the child's response and the therapists' coaching supports active parental learning; (3) capability and sense of control-strengthening and demanding aspects. Conclusions: Our findings revealed that Baby-mCIMT coached remotely empowered the parents as primary trainers, which provided them with opportunities for understanding and learning about their child and their development. The findings underscore the importance of responsive professional guidance and a strong therapist-parent relationship to succeed with the Baby-mCIMT program coached remotely and to manage the digital coaching format.
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Affiliation(s)
- Katarina Svensson
- Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Linkoping University, 58183 Linkoping, Sweden;
- Crown Princess Victoria’s Children Hospital, 58185 Linkoping, Sweden
| | - Ann-Christin Eliasson
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institute, 17177 Stockholm, Sweden;
- Neuropaediatric Research Unit, Astrid Lindgren Children’s Hospital, 17176 Stockholm, Sweden
| | - Heléne Sundelin
- Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Linkoping University, 58183 Linkoping, Sweden;
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institute, 17177 Stockholm, Sweden;
- Neuropaediatric Research Unit, Astrid Lindgren Children’s Hospital, 17176 Stockholm, Sweden
| | - Kajsa Lidström Holmqvist
- University Health Care Research Center, Department of Neurology and Rehabilitation Medicine, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden;
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Faccioli S, Sassi S, Pagliano E, Maghini C, Perazza S, Siani MF, Sgherri G, Farella GM, Foscan M, Viganò M, Sghedoni S, Bai AV, Borelli G, Ferrari A. Care Pathways in Rehabilitation for Children and Adolescents with Cerebral Palsy: Distinctiveness of the Adaptation to the Italian Context. CHILDREN (BASEL, SWITZERLAND) 2024; 11:852. [PMID: 39062302 PMCID: PMC11275177 DOI: 10.3390/children11070852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND In 2020, a multiprofessional panel was set up in collaboration with the Italian FightTheStroke Foundation family association to produce evidence-based recommendations for the management and neuromotor rehabilitation of persons with cerebral palsy aged 2-18 years to implement in clinical practice in Italy. METHODS The recommendations of these care pathways were developed according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for Care Pathways Development and the Grading of Recommendations Assessment Development and Evaluation working group for adoption, adaptation, or de novo development of recommendations from high-quality guidelines (GRADE-ADOLOPMENT). RESULTS Four strong positive recommendations were developed regarding comprehensive management, and twenty-four addressed neuromotor treatment. CONCLUSIONS A holistic, individualized approach was affirmed in terms of both multidimensional patient profile and interdisciplinary management in a network with the school where children and adolescents are integrated. It was defined that all motor rehabilitation approaches must be individually tailored considering age and developmentally appropriate activities as interventions and goals, in light of the reference curves addressing prognosis for Gross Motor Function and Manual Ability Classification Systems. Intervention must be structured with adaptations of the task and/or of the context (objects and environment) based on the analysis of the child's skills to support motivation and avoid frustration.
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Affiliation(s)
- Silvia Faccioli
- Paediatric Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (S.S.); (S.P.); (S.S.); (G.B.); (A.F.)
- PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Silvia Sassi
- Paediatric Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (S.S.); (S.P.); (S.S.); (G.B.); (A.F.)
| | - Emanuela Pagliano
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.P.); (M.F.); (M.V.)
| | - Cristina Maghini
- Functional Rehabilitation Unit, IRCCS E. Medea, Associazione La Nostra Famiglia, 23842 Bosisio Parini, Italy;
| | - Silvia Perazza
- Paediatric Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (S.S.); (S.P.); (S.S.); (G.B.); (A.F.)
| | - Maria Francesca Siani
- Physical Medicine and Rehabilitation Unit, S. Maria delle Croci Hospital, Azienda Unità Sanitaria Locale Romagna, 48121 Ravenna, Italy;
| | - Giada Sgherri
- Developmental Neuroscience Clinical Department, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (G.S.); (A.V.B.)
| | | | - Maria Foscan
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.P.); (M.F.); (M.V.)
| | - Marta Viganò
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.P.); (M.F.); (M.V.)
| | - Silvia Sghedoni
- Paediatric Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (S.S.); (S.P.); (S.S.); (G.B.); (A.F.)
| | - Arianna Valeria Bai
- Developmental Neuroscience Clinical Department, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (G.S.); (A.V.B.)
| | - Giulia Borelli
- Paediatric Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (S.S.); (S.P.); (S.S.); (G.B.); (A.F.)
| | - Adriano Ferrari
- Paediatric Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (S.S.); (S.P.); (S.S.); (G.B.); (A.F.)
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Srinivasan S, Amonkar N, Kumavor PD, Bubela D, Morgan K. Joystick-Operated Ride-On Toy Navigation Training for Children With Hemiplegic Cerebral Palsy: A Pilot Study. Am J Occup Ther 2024; 78:7804185070. [PMID: 38836619 DOI: 10.5014/ajot.2024.050589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
IMPORTANCE Children with hemiplegic cerebral palsy (HCP) require intensive task-oriented training to make meaningful gains in affected upper extremity (UE) motor function. OBJECTIVE To evaluate the acceptability and utility of single joystick-operated ride-on toy (ROT) navigation training incorporated into a modified constraint-induced movement therapy (CIMT) camp for children with HCP. DESIGN Single group pretest-posttest design. SETTING Three-wk structured CIMT camp. PARTICIPANTS Eleven children with HCP between ages 3 and 14 yr. INTERVENTION Children received group-based CIMT for 6 hr/day, 5 days/wk, for 3 wk. As part of camp activities, children also received ROT navigation training for 20 to 30 min/day, 5 days/wk, for 3 wk. OUTCOMES AND MEASURES We assessed children's acceptance of ROT training by monitoring adherence and evaluating child engagement (affect and attention) during training sessions. The effects of ROT training combined with other camp activities on children's affected UE motor function were also assessed with the standardized Quality of Upper Extremity Skills Test (QUEST) and training-specific measures of ROT maneuvering accuracy. RESULTS Children demonstrated high levels of training adherence, positive affect, and task-appropriate attention across weeks. Positive engagement during ROT sessions was correlated with independent navigation. We also found medium- to large-sized improvements in QUEST scores and toy-maneuvering capabilities after the combined program. CONCLUSIONS AND RELEVANCE Our pilot data support the use of joystick-operated ROTs as child-friendly therapy adjuncts that can be incorporated into intensive UE training programs to improve adherence and motivation in therapy programs, boost treatment dosing, and promote affected UE motor function in children with HCP. Plain-Language Summary: This pilot study offers promising evidence that supports the use of modified single joystick-operated ride-on toys (ROTs) for children with hemiplegic cerebral palsy (HCP). The study used ROTs as one of several interventions that were part of a constraint-induced movement therapy (CIMT) camp program for children with HCP. The ROTs boosted children's motivation, their engagement with and adherence to training, and their practice in using their affected upper extremity (UE) for goal-directed activities in their natural settings. ROTs are accessible, age-appropriate, and easy-to-use devices for both occupational therapy clinicians and families to encourage children to use their affected UEs by challenging their perceptual, motor-planning, problem-solving, and movement-control skills in an enjoyable and engaging way. ROTs can be used within and outside conventional rehabilitation settings.
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Affiliation(s)
- Sudha Srinivasan
- Sudha Srinivasan, PT, PhD, is Assistant Professor, Physical Therapy Program, Department of Kinesiology; Affiliate, Institute for Collaboration on Health, Intervention, and Policy; and Affiliate, The Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs;
| | - Nidhi Amonkar
- Nidhi Amonkar, PT, is Graduate Student, Physical Therapy Program, Department of Kinesiology; Affiliate, Institute for Collaboration on Health, Intervention, and Policy; and Affiliate, The Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs
| | - Patrick D Kumavor
- Patrick D. Kumavor, PhD, is Associate Professor in Residence, Biomedical Engineering Department, University of Connecticut, Storrs
| | - Deborah Bubela
- Deborah Bubela, PT, PhD, is Emeritus Associate Professor in Residence, Physical Therapy Program, Department of Kinesiology; Affiliate, Institute for Collaboration on Health, Intervention, and Policy; and Affiliate, The Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs
| | - Kristin Morgan
- Kristin Morgan, PhD, is Assistant Professor, Biomedical Engineering Department, University of Connecticut, Storrs
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Sabet A, Galloway JC. Harnessing Mobility: A Medically Complex Child's Home Program Utilizing an In-Home Body Weight Support System. Pediatr Phys Ther 2024; 36:347-352. [PMID: 39023763 DOI: 10.1097/pep.0000000000001112] [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: 07/20/2024]
Abstract
PURPOSE To describe a home program for a child with medical complexity using an over-ground body weight support (BWS) system. SUMMARY OF KEY POINTS Children with medical complexity often use home programs due to challenges with regular therapy attendance. In this case, effective home program components including child centered design, family leadership, and best practice principles were prioritized around the PUMA (portable mobility aid for children). This BWS system was to be used for 1 hour per day to support mobility and active play. STATEMENT OF CONCLUSIONS The CMC and family demonstrated high adherence, using over-ground BWS 87% of the 135 days it was accessible with an average daily usage of 59 min spread across 1-3 bouts per day. The average daily fun index during usage was 7/10. RECOMMENDATIONS FOR CLINICAL PRACTICE This home program demonstrated over-ground BWS technology as a feasible, fun platform for functional mobility and socialization in a child with significant medical and physical limitations.
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Affiliation(s)
- Andrina Sabet
- Go Baby Go, Mobility Matters, LLC, Cleveland, Ohio (Ms Sabet); Go Baby Go, University of Delaware, Newark, Delaware Physical Therapy, Baylor University, Waco, Texas (Dr Galloway)
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Chan-Víquez D, Fernández-Huertas H, Chacón-Vargas F, Montserrat-Gonzalez C, Fehlings D, Munce S, Virginia Wright F, Biddiss E. Family expectations and demand for home-based videogaming therapy in children with cerebral palsy in Costa Rica: a mixed methods study. Disabil Rehabil 2024:1-12. [PMID: 38946018 DOI: 10.1080/09638288.2024.2362952] [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: 12/03/2023] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE To understand the expectations and demand for a movement-tracking videogame (Bootle Blast) for home-based, upper limb (UL) rehabilitation among Costa Rican children with cerebral palsy (CP). METHODS Data were collected via telephone screening (demand) and child-parent dyads Zoom interviews (expectations). Descriptive statistics and data transformation were used to report on demand success criteria (i.e., recruitment rate, having an appropriate screen and space to play, setting a weekly play time goal (PTG) ≥45 min, identifying one UL therapy goal). The DEPICT model for collaborative qualitative analysis was used in the thematic analysis of interview data. RESULTS Fifteen dyads participated (1.6 ± 1 recruited/month). All had a flat-screen TV in a suitable location to play, were able to set a UL therapy goal, and established PTGs ranging from 45-120 min per week. Identified themes were: 1) Socio-cultural factors heighten demand, 2) Feelings of hope prevail for the intervention, and 3) Collaborative goal setting supports realistic expectations for Bootle Blast. CONCLUSIONS Dyads had positive and realistic expectations about implementing the proposed videogaming intervention. This study provides insights on tailoring a family-centered, therapy gaming intervention to improve access to motor rehabilitation for children with CP in rural/remote settings and low-middle income countries.
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Affiliation(s)
- Daniela Chan-Víquez
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | | | | | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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Niyonsenga J, Uwingeneye L, Musabyemariya I, Sagahutu JB, Cavallini F, Caricati L, Eugene R, Mutabaruka J, Jansen S, Monacelli N. The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: A systematic review. PLoS One 2024; 19:e0305432. [PMID: 38865337 PMCID: PMC11168686 DOI: 10.1371/journal.pone.0305432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Involving parents of children with cerebral palsy (C-CP) in home exercise programmes (HEP) is globally practiced strategy closely linked to improved physical performance and functional outcomes for the child. Nevertheless, non-adherence to HEP is increasing at an alarming rate, and little is known about the factors influencing adherence to HEP (AHEP) especially in parents of C-CP. This systematic review aimed to identify the factors enhancing AHEP among parents of C-CP to reinforce the efficacy of rehabilitation practices proposed by health professionals, researchers, and educators. MATERIALS AND METHODS We conducted searches in PubMed, Scopus, CINHAL, PsycINFO, and Embase for articles published up to March 2023, that investigated the factors influencing AHEP among parents of C-CP. A narrative synthesis was conducted using the search results and pertinent material from other sources. RESULTS Overall, non-adherence rates to HEP were moderate to high, ranging from 34% to 79.2%. Strong evidence suggests that factors enhancing AHEP fall into three categories: child-related (such as younger age and better gross motor function [GMF]), the caregiver-related (including high self-efficacy and knowledge, strong social support, low levels of depression, anxiety and stress symptoms, and a low perception of barriers), and the physiotherapist-related. For the latter category, the parent's perception of a supportive and collaborative relationship with the therapist is one of the conditions most favourably influences AHEP. CONCLUSION Our findings highlight that factors influencing AHEP are multifactorial. Some, such as GMF or the economic and social conditions of the family, are challenging to change. However, the relationship between therapist and parent is an aspect that can be strengthened. These results underscore the importance of substantial training and psychosocial support for therapists to enhance their awareness and competence in building supportive relationship with parents.
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Affiliation(s)
- Japhet Niyonsenga
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Social Sciences and Humanities, University of Parma, Parma, Italy
| | - Liliane Uwingeneye
- Department of Business Administration, College of Business and Economics, University of Rwanda, Kigali, Rwanda
| | - Inès Musabyemariya
- Department of Physiotherapy, International Committee of the Red Cross–ICRC, Tinduf, Algeria
| | - Jean Baptiste Sagahutu
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Francesca Cavallini
- Department of Social Sciences and Humanities, University of Parma, Parma, Italy
| | - Luca Caricati
- Department of Social Sciences and Humanities, University of Parma, Parma, Italy
| | - Rutembesa Eugene
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Mutabaruka
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stefan Jansen
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Petrevska M, Wright FV, Khan A, Munce S, Fehlings D, Biddiss E. Evaluating the impact of movement tracking feedback on engagement with home exercise programmes of children with cerebral palsy using a new therapy app: a protocol for a mixed-methods single-case experimental design with alternating treatments. BMJ Open 2024; 14:e082761. [PMID: 38503423 PMCID: PMC10952875 DOI: 10.1136/bmjopen-2023-082761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology. METHODS AND ANALYSIS In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6-12 years, Gross Motor Function Classification System levels I-II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays. ETHICS AND DISSEMINATION Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER NCT05998239; pre-results.
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Affiliation(s)
- Marina Petrevska
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ajmal Khan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Shierk A, Roberts H, Habeeb Y, Dursun N, Cekmece C, Bonikowski M, Pyrzanowska W, Carranza J, Granados Garcia G, Clegg N, Delgado MR. Development of GO Move: A Website for Children With Unilateral Cerebral Palsy. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492231225141. [PMID: 38281146 DOI: 10.1177/15394492231225141] [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: 01/30/2024]
Abstract
It is unknown if an online tool is wanted by therapists and parents of individuals with unilateral cerebral palsy (UCP) to support implementation of goal-directed home programs, and if wanted, the recommended features for the tool. The objective was to explore the experiences of therapists and parents who have implemented home programs, seek guidance on translating a paper-based home program toolbox into a mobile website, and develop the website. Qualitative descriptive methodology guided data collection using semi-structured interviews and thematic analysis, validated with field notes and member checking. A team science, iterative approach was used to integrate the themes into the development of the mobile website. Five primary themes including recommendations for the functionality, features, content, and naming of the mobile website were identified. Parents and therapists value home programs. Participants provided recommendations regarding content and features, and the GO Move mobile website was developed based on the recommendations.
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Affiliation(s)
- Angela Shierk
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Heather Roberts
- Scottish Rite for Children, Dallas, TX, USA
- Texas Woman's University, Denton, USA
| | | | | | | | | | | | | | | | | | - Mauricio R Delgado
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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12
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Wang Z, He K, Sui X, Yi J, Yang Z, Wang K, Gao Y, Bian L, Jiang J, Zhao L. The Effect of Web-Based Telerehabilitation Programs on Children and Adolescents With Brain Injury: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e46957. [PMID: 38145485 PMCID: PMC10775025 DOI: 10.2196/46957] [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: 03/03/2023] [Revised: 05/02/2023] [Accepted: 10/11/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Acquired brain injury (ABI) in children and adolescents can lead to motor and executive impairments that often require long-term treatment. The implementation of web-based telerehabilitation therapy at home is a method to improve the functional status of patients. Therefore, we performed a systematic review of the effects of web-based telerehabilitation programs on functional outcomes in children and adolescents with brain injury and supplemented the findings with a meta-analysis. OBJECTIVE This study evaluated the therapeutic effect of web-based telerehabilitation training on children and adolescents with brain injury to determine whether web-based telerehabilitation therapy improved motor function, executive function, physical activity level, lower limb strength, hand and upper limb function, visual processing skills, and occupational functional performance in children and adolescents with brain injury. METHODS PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for randomized controlled trials on web-based telerehabilitation programs in children and adolescents with brain injury until December 2022, and the risk of bias was evaluated using the Cochrane Collaboration Tool. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software. RESULTS Overall, 17 studies involving 848 patients were included. Web-based telerehabilitation therapy improved the motor function (standardized mean difference [SMD] 0.29, 95% CI 0.01-0.57; P=.04), physical activity level (SMD 0.42, 95% CI 0.11-0.73; P=.007), lower limb strength (SMD 0.52, 95% CI 0.13-0.90; P=.009), and visual processing skills (SMD 0.26, 95% CI 0.02-0.50; P=.04) of children and adolescents with brain injury. It also improved executive function in letter-number sequencing (SMD 1.26, 95% CI 0.26-2.26; P=.01), attention (SMD 0.38, 95% CI 0.09-0.66; P=.009), and symbol search (SMD 1.18, 95% CI 0.43-1.93, P=.002). CONCLUSIONS Web-based telerehabilitation therapy improved motor function, physical activity level, lower limb strength, letter-number sequencing, attention, and symbol search, which improved the quality of life in children and adolescents with brain injury. Web-based telerehabilitation programs provide great convenience for children and adolescents with ABI who need long-term treatment and allow them to exercise at home for rehabilitation training. The widespread implementation of remote interventions also provides children and adolescents in remote areas with better access to rehabilitation services. This review provides evidence for the effectiveness of web-based telerehabilitation therapy, but there was heterogeneity in some of the results because of different disease types and intervention programs. Future studies can expand the sample size according to disease type and increase follow-up time according to different exercise prescriptions to further refine the long-term effects of this intervention on various functions of children and adolescents with ABI. TRIAL REGISTRATION PROSPERO CRD42023421917; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421917.
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Affiliation(s)
- Zeyu Wang
- School of Nursing, Jilin University, Changchun, China
| | - Kang He
- School of Nursing, Jilin University, Changchun, China
| | - Xin Sui
- School of Nursing, Jilin University, Changchun, China
| | - Jiang Yi
- The Second Hospital of Jilin University, Jilin University, Changchun City, China
| | - Zhaoyun Yang
- School of Nursing, Jilin University, Changchun, China
| | - Kai Wang
- School of Nursing, Jilin University, Changchun, China
| | - Yan Gao
- School of Nursing, Jilin University, Changchun, China
| | - Linfang Bian
- School of Nursing, Jilin University, Changchun, China
| | - Junjie Jiang
- The Second Hospital of Jilin University, Jilin University, Changchun City, China
| | - Lijing Zhao
- School of Nursing, Jilin University, Changchun, China
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Reidy TG, Andrejow NW, Naber E, Carney J. Hybrid Telehealth Pediatric Constraint Induced Movement Therapy Compared to In-person Intervention: A Case Series. Int J Telerehabil 2023; 15:e6567. [PMID: 38162938 PMCID: PMC10754234 DOI: 10.5195/ijt.2023.6567] [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] [Indexed: 01/03/2024] Open
Abstract
Constraint induced movement therapy is an established, evidence-based intervention for children with hemiplegia. This case series describes the feasibility and clinical opportunities of using a hybrid telehealth and onsite model to deliver pediatric constraint induced movement therapy during the COVID-19 pandemic. These cases support that a hybrid model had a similar effect on upper extremity improvement compared to a traditional, in-person model and may be an option when access to in-person care is not available.
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Affiliation(s)
| | | | - Erin Naber
- Specialized Transition Program, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Joan Carney
- Specialized Transition Program, Kennedy Krieger Institute, Baltimore, MD, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Johnson RW, White BK, Gibson N, Gucciardi DF, Williams SA. A Mixed-Methods Feasibility Study of a Gamified Therapy Prescription App for Children with Neurodisability. Phys Occup Ther Pediatr 2023; 44:586-603. [PMID: 37814984 DOI: 10.1080/01942638.2023.2263576] [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: 01/16/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
AIM Determine the feasibility of a gamified therapy (occupational therapy, physiotherapy, speech pathology) prescription app developed for children with neurodisability for delivering school and home therapy programs (the Zingo app). METHOD A mixed-methods feasibility study was conducted with children (and their parents, therapists, and teachers) with neurodisability (n = 8, female= 5) who were prescribed a 4-week individualized therapy program by their usual treating therapist using Zingo. Primary outcome measures were program adherence, engagement, app quality, and user experience, collected with quantitative and qualitative methods. RESULTS Mean adherence to the program was 58.0% (SD 27.2). Our combined Engagement Index (EI) score was 74.4% (SD 11.7). App quality measured using Mobile Application Rating Scale- User version was 4.6/5 (SD 0.7, n = 6) for parents, 4.6/5 (SD 0.5, n = 5) for teachers, and 4.4/5 (SD 0.6, n = 6) for therapists. Thematic analysis of semi-structured interviews yielded a primary theme of "app as motivator" for therapy. CONCLUSIONS Adherence findings were affected by COVID-19 outbreak however remain comparable with other studies in this cohort. EI findings compared favorably with other studies. The findings are supportive of the feasibility of Zingo for delivering home and school therapy programs for children with neurodisability and was found to motivate therapy program completion.
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Affiliation(s)
- Rowan W Johnson
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Therapy Services, Ability WA, Perth, Australia
| | - Becky K White
- Curtin School of Population Health, Curtin University, Perth, Australia
- Reach Health Promotion Innovations, Perth, Australia
| | - Noula Gibson
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Department of Physiotherapy, Perth Children's Hospital, Perth, Australia
| | - Daniel F Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Sîan A Williams
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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15
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Gatica-Rojas V, Cartes-Velásquez R, Soto-Poblete A, Lizama LEC. Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: Protocol for a clinical trial. PLoS One 2023; 18:e0268163. [PMID: 37590295 PMCID: PMC10434878 DOI: 10.1371/journal.pone.0268163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/22/2022] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE To establish the feasibility and effectiveness of a rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral palsy-spastic hemiplegia. It also aims to compare the effectiveness of this programme under two delivery modalities, telerehabilitation (TR) and face-to-face (FtF). METHODS This is a registered randomized controlled clinical trial protocol (ACTRN12621000117819). Eighteen sessions of low-cost virtual reality therapy will be provided through both, FtF and TR modalities using a Nintendo Wii balance board. Each programme will last for 6 weeks and will consist of 3 sessions per week of 25 minutes each. Twenty patients diagnosed with cerebral palsy-spastic hemiplegia will be recruited for each group: FtF or TR (n = 40). Participants will be assessed at baseline, by the end of weeks 2, 4, and 6, and at weeks 8 and 10 (post-intervention follow-ups). The primary outcome will be the Center of Pressure sway area (CoParea); secondary outcomes will be standard deviation and velocity of the CoP in the mediolateral and anterior-posterior directions; tertiary outcomes will include the Modified-Modified Ashworth Scale for lower limbs, Modified Ashworth Scale for upper limbs, timed up-and-go tests, the timed one-leg standing and 6-minute walk test. RESULTS This study provides an assessment of the feasibility and effectiveness of an affordable rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral palsy. CONCLUSION The designed rehabilitation programme using low-cost virtual reality may improve postural control in children with cerebral palsy-spastic hemiplegia. The TR modality is likely to be as effective as the FtF modality. The TR programme has been designed to overcome access barriers to physiotherapy services for children with cerebral palsy in low-resource settings, remote areas, and in restricted mobility contexts.
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Affiliation(s)
- Valeska Gatica-Rojas
- Tele-rehabilitation Technology Center and Neurosciences in Human Movement, Faculty of Health Sciences, Universidad de Talca, Talca, Chile
| | | | - Alex Soto-Poblete
- Institute of Mathematics and Physics, Universidad de Talca, Talca, Chile
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16
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Chan-Víquez D, Khan A, Munce S, Fehlings D, Wright FV, Biddiss E. Understanding a videogame home intervention for children with hemiplegia: a mixed methods multi-case study. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1217797. [PMID: 37502272 PMCID: PMC10368996 DOI: 10.3389/fmedt.2023.1217797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Access to rehabilitation therapies is a salient and growing issue for children with cerebral palsy (CP) and their families, motivating interest in home-based interventions. Bootle Blast is a low-cost, movement-tracking videogame that can be used at home to encourage upper limb (UL) functional exercise tailored to each child's abilities and therapy goals. The study objectives were to: 1) Establish the extent to which children achieve their self-directed play-time goal over a 12-week intervention, 2) Measure changes in UL motor outcomes, and 3) Explore participants' experiences of using Bootle Blast at home. Methods Mixed methods case series study of four children with hemiplegic cerebral palsy (HCP), each with a participating parent. Participants played Bootle Blast at home for 12 weeks. Study assessments occurred at baseline, post-intervention and four week follow up. A post-intervention interview explored participants' experiences. Game-logs provided play time and progress data. Results Three of four participants (8-13 yrs., Manual Ability Classification Level I-II) completed the intervention. One dropped out at week 6. Play-time goals were achieved in most weeks, with two of four children surpassing their overall intervention goals. Outcomes varied across the three participants, however consistent improvements were observed on the Canadian Occupational Performance Measure and the Box and Blocks Test. Inductive analysis generated four main themes: 1) Intrinsic motivators fostered play engagement, 2) Virtual play for real-world gains, 3) Therapy on demand (at home), and 4) Shifting the onus from the parent to the game. Integration of qualitative and quantitative data was important for interpreting play patterns/usage and clinical outcomes. Discussion This mixed methods study describes a novel videogaming intervention designed for home-rehabilitation for children with HCP and provides preliminary evidence to guide future study design and research. Clinical Trial Registration [https://clinicaltrials.gov/ct2/show/NCT04009031?recrs=h&cond=Cerebral+Palsy&cntry=CA&city=Toronto&draw=2&rank=1], identifier [NCT04009031].
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Affiliation(s)
- Daniela Chan-Víquez
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Ajmal Khan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Ortega-Martínez A, Palomo-Carrión R, Varela-Ferro C, Bagur-Calafat MC. Feasibility of a Home-Based Mirror Therapy Program in Children with Unilateral Spastic Cerebral Palsy. Healthcare (Basel) 2023; 11:1797. [PMID: 37372915 DOI: 10.3390/healthcare11121797] [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: 04/30/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Children with Unilateral Spastic Cerebral Palsy (US CP) have motor and somatosensory impairments that affect one side of their body, impacting upper limb functioning. These impairments contribute negatively to children's bimanual performance and quality of life. Intensive home-based therapies have been developed and have demonstrated their feasibility for children with US CP and their parents, especially when therapies are designed with the proper coaching of families. Mirror Therapy (MT) is being studied to become an approachable intensive and home-based therapy suitable for children with US CP. The aim of this study is to analyze the feasibility of a five-week home-based program of MT for children with US CP that includes coaching by the therapist. Six children aged 8-12 years old performed the therapy for five days per week, 30 min per day. A minimum of 80% of compliance was required. The feasibility included compliance evaluations, total dosage, perceived difficulty of the exercises, and losses of follow-ups. All children completed the therapy and were included in the analysis. The total accomplishment was 86.47 ± 7.67. The perceived difficulty of the exercises ranged from 2.37 to 4.51 out of 10. In conclusion, a home-based program of Mirror Therapy is a safe, cost-efficient, and feasible therapy for children with US CP when the therapist is involved as a coach during the entire program.
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Affiliation(s)
- Anna Ortega-Martínez
- Physiotherapy Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- Physiotherapy Department, Fundació Aspace Catalunya, 08038 Barcelona, Spain
| | - Rocío Palomo-Carrión
- Physiotherapy Department, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
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Faccioli S, Pagliano E, Ferrari A, Maghini C, Siani MF, Sgherri G, Cappetta G, Borelli G, Farella GM, Foscan M, Viganò M, Sghedoni S, Perazza S, Sassi S. Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review. Front Neurol 2023; 14:1171224. [PMID: 37305763 PMCID: PMC10248244 DOI: 10.3389/fneur.2023.1171224] [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: 02/21/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Evidence regarding the management of several aspects of cerebral palsy improved in recent years. Still, discrepancies are reported in clinical practice. Italian professionals and stakeholders expressed the need of setting up updated, evidenced-based, shared statements, to address clinical practice in cerebral palsy rehabilitation. The objective of the present study was to provide an updated overview of the state of knowledge, regarding the management and motor rehabilitation of children and young people with cerebral palsy, as the framework to develop evidence-based recommendations on this topic. Methods Guidelines and systematic reviews were searched, relative to evidence-based management and motor treatment, aimed at improving gross motor and manual function and activities, in subjects with cerebral palsy, aged 2-18 years. A systematic search according to the Patients Intervention Control Outcome framework was executed on multiple sites. Independent evaluators provided selection and quality assessment of the studies and extraction of data. Results Four guidelines, 43 systematic reviews, and three primary studies were included. Agreement among guidelines was reported relative to the general requirements of management and motor treatment. Considering the subject's multidimensional profile, age and developmentally appropriate activities were recommended to set individual goals and interventions. Only a few approaches were supported by high-level evidence (i.e., bimanual therapy and constraint-induced movement therapy to enhance manual performance). Several task-specific active approaches, to improve gross motor function and gait, were reported (mobility and gait training, cycling, backward gait, and treadmill), based on low-level evidence. Increasing daily physical activity and countering sedentary behavior were advised. Based on the available evidence, non-invasive brain stimulation, virtual reality, action-observation therapy, hydrotherapy, and hippotherapy might be complementary to task or goal-oriented physical therapy programs. Conclusion A multiple-disciplinary family-centered evidence-based management is recommended. All motor rehabilitation approaches to minors affected by cerebral palsy must share the following fundamental characteristics: engaging active involvement of the subject, individualized, age and developmentally appropriate, goal-directed, skill-based, and preferably intensive and time-limited, but suitable for the needs and preferences of the child or young person and their family, and feasible considering the implications for themselves and possible contextual limitations.
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Affiliation(s)
- Silvia Faccioli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Ph.D. Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuela Pagliano
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Adriano Ferrari
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Maghini
- Functional Rehabilitation Unit, IRCCS E. Medea, Associazione La Nostra Famiglia, Bosisio Parini, Italy
| | - Maria F. Siani
- Physical Medicine and Rehabilitation Unit, S. Maria delle Croci Hospital, Azienda Unità Sanitaria Locale Romagna, Ravenna, Italy
| | - Giada Sgherri
- Developmental Neuroscience Clinical Department, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Gina Cappetta
- Physical Medicine and Rehabilitation Unit, Infermi Hospital, Azienda Unità Sanitaria Locale Romagna, Rimini, Italy
| | - Giulia Borelli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina M. Farella
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Foscan
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marta Viganò
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Sghedoni
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Perazza
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Sassi
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Choi JY, Yi SH, Shim D, Yoo B, Park ES, Rha DW. Home-based virtual reality-enhanced upper limb training system in children with brain injury: a randomized controlled trial. Front Pediatr 2023; 11:1131573. [PMID: 37274815 PMCID: PMC10233002 DOI: 10.3389/fped.2023.1131573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
Background Rehabilitation of upper limb function can be challenging in children with brain lesion. Recent virtual reality (VR) rehabilitation may be an additional treatment option in pediatric rehabilitation. Objectives To assess the feasibility and effectiveness of a home-based VR-enhanced rehabilitation program with wearable multi-inertial measurement unit (IMU) sensors on upper limb functions in children with brain injury. Methods This multicenter single blind randomized controlled trial included 40 children with cerebral palsy (CP) or static brain injury. Subjects were randomized 1:1 to experimental and control group. Both the groups maintained the same therapeutic content and dose of occupational therapy during the intervention period. The experimental group performed additional training at home using the VR-enhanced program for at least 30 min/day, 5 days/week, for 6 weeks. VR training consisted of daily activities or games promoting wrist and forearm articular movements using wearable IMU sensors. The Melbourne Assessment of Unilateral Upper Limb Function-version 2 (MA2), Upper Limb Physician's Rating Scale (ULPRS), Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT), computerized 3D motion analysis, and user satisfaction survey were performed. Mann-Whitney U test was used to compare treatment effects between groups, and Friedman and Wilcoxon signed-rank tests were used to compare pre and post intervention. Results Overall 35 children (15 in VR group and 20 in control group) completed the protocol. In the experimental group, an average VR training time was 855 min. The accuracy of motion measured by MA2, segmental movements by ULPRS, daily living capability and social cognitive function by PEDI-CAT, movement time and shoulder movement pattern by motion analysis showed significant improvements. However, there were no significant differences in any of the functional outcome measures compared to the control group. All the children and parents reported positive experiences. Conclusions Home-based VR training though it had limited impact on improving upper limb function, it could help improve social cognitive function, movement pattern, and efficiency in children with brain injury and could be an effective means of extending clinical therapy to the home. Clinical Trial Registration CRIS.nih.go.kr: identifier KCT0003172.
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Affiliation(s)
- Ja Young Choi
- Department of Physical and Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sook-hee Yi
- Department of Physical and Rehabilitation Medicine, Seoul Rehabilitation Hospital, Seoul, Republic of Korea
| | - Dain Shim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beomki Yoo
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Sook Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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20
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Shahane V, Kumavor P, Morgan K, Friel KM, Srinivasan SM. A protocol for a single-arm interventional study assessing the effects of a home-based joystick-operated ride-on-toy navigation training programme to improve affected upper extremity function and spontaneous use in children with unilateral cerebral palsy (UCP). BMJ Open 2023; 13:e071742. [PMID: 37160396 PMCID: PMC10173997 DOI: 10.1136/bmjopen-2023-071742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION Children with unilateral cerebral palsy (UCP) face significant limitations in upper extremity (UE) function and require effective interventions that promote intensive goal-directed practice while maximising motivation and adherence with therapy. This study builds on our past work and will assess the effects of a 6-week researcher-caregiver codelivered, home-based ride-on-toy navigation training (RNT) programme in young children with UCP. We hypothesise that the RNT programme will be acceptable, feasible to implement, and lead to greater improvements in unimanual and bimanual function when combined with conventional therapy, compared with conventional therapy provided alone. METHODS AND ANALYSIS 15 children with UCP between 3 and 8 years will be recruited. During the 6-week control phase, participants will receive treatement-as-usual alone. During the subsequent 6-week intervention phase, in addition to conventional therapy, RNT will be provided 4-5 times/week (2 times by researchers, 2-3 times by caregivers), 30-45 min/session. We will assess UE function using standardised tests (Quality of Upper Extremity Skills Test and Shriner's Hospital Upper Extremity Evaluation), reaching kinematics, wrist-worn accelerometry, caregiver-rated ABILHAND-Kids questionnaire, and training-specific measures of movement control during RNT. Programme feasibility and acceptance will be assessed using device use metrics, child and caregiver exit questionnaires, training-specific measures of child engagement, and the Physical Activity Enjoyment Scale. All assessments will be conducted at pretest, following the control phase (midpoint), and after completion of the intervention phase (post-test). ETHICS AND DISSEMINATION The study is approved by the Institutional Review Board of the University of Connecticut (# H22-0059). Results from this study will be disseminated through peer-reviewed manuscripts in scientific journals in the field, through national and international conferences, and through presentations to parent advocacy groups and other support organisations associated with CP. TRIAL REGISTRATION NUMBER NCT05559320.
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Affiliation(s)
- Vaishnavi Shahane
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, Connecticut, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
| | - Patrick Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, Connecticut, USA
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, Connecticut, USA
| | - Kathleen M Friel
- Burke Neurological Institute, White Plains, New York, USA
- Brain Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Sudha Madhav Srinivasan
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, Connecticut, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
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21
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McConkey R, O’Hagan P, Corcoran J. Parental Perceptions of Family-Centred Supports for Children with Developmental Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4205. [PMID: 36901214 PMCID: PMC10001732 DOI: 10.3390/ijerph20054205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Family-centred interventions have long been advocated in paediatric practice and in public health, but their implementation is rarer with children experiencing developmental disabilities. Moreover, the uptake is lower in families from more socially deprived backgrounds. Yet there is robust evidence that such interventions bring benefits to the family caregivers as well as to the affected children. The present study emerged from a support service that had been located in a rural county in Ireland in which nearly 100 families of children with intellectual and developmental disabilities had participated. Using a qualitative research methodology, interviews were conducted with 16 parents who had taken part in the service with the aim of gaining insights into the ways a family-centred service had been of value to them. The themes identified in their responses were validated in two ways. All parents were given the opportunity to provide their perceptions using a self-completion questionnaire, and nearly 50% responded. In addition, seven health and social care staff who had referred families to the project were asked their views through personal interviews. The core theme to emerge was the focus placed on family engagement by the service, with four subthemes emerging: parental confidence boosted; children developed; community connections were made; and supportive staff. These insights should help existing health and social care services to become more family-centred and inform the development of new support services in response to the high levels of unmet needs among marginalized families in even the most affluent countries.
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Affiliation(s)
- Roy McConkey
- Institute of Nursing and Health Research, Ulster University, Belfast BT1 6DN, Northern Ireland, UK
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22
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Electromyographic biofeedback-driven gaming to alter calf muscle activation during gait in children with spastic cerebral palsy. Gait Posture 2023; 102:10-17. [PMID: 36870265 DOI: 10.1016/j.gaitpost.2023.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/20/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Children with cerebral palsy often show deviating calf muscle activation patterns during gait, with excess activation during early stance and insufficient activation during push-off. RESEARCH QUESTION Can children with cerebral palsy improve their calf muscle activation patterns during gait using one session of biofeedback-driven gaming? METHODS Eighteen children (6-17 y) with spastic cerebral palsy received implicit game-based biofeedback on electromyographic activity of the calf muscle (soleus or gastrocnemius medialis) while walking on a treadmill during one session. Biofeedback alternately aimed to reduce early stance activity, increase push-off activity, and both combined. Early stance and push-off activity and the double-bump-index (early stance divided by push-off activity) were determined during baseline and walking with feedback. Changes were assessed at group level using repeated measures ANOVA with simple contrast or Friedman test with post-hoc Wilcoxon signed rank test, as well as individually using independent t-tests or Wilcoxon rank sum tests. Perceived competence and interest-enjoyment were assessed through a questionnaire. RESULTS Children successfully decreased their electromyographic activity during early stance feedback trials (relative decrease of 6.8 ± 12.2 %, P = 0.025), with a trend during the combined feedback trials (6.5 ± 13.9 %, P = 0.055), and increased their electromyographic activity during push-off feedback trials (8.1 ± 15.8 %, P = 0.038). Individual improvements were seen in twelve of eighteen participants. All children experienced high levels of interest-enjoyment (8.4/10) and perceived competence (8.1/10). SIGNIFICANCE This exploratory study suggests that children with cerebral palsy can achieve small within-session improvements of their calf muscle activation pattern when provided with implicit biofeedback-driven gaming in an enjoyable manner. Follow-up gait training studies can incorporate this method to assess retention and long-term functional benefits of electromyographic biofeedback-driven gaming.
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23
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The Impact of a Family-Centred Intervention for Parents of Children with Developmental Disabilities: A Model Project in Rural Ireland. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020175. [PMID: 36832304 PMCID: PMC9954624 DOI: 10.3390/children10020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
The greater risk of poor mental health and social isolation, experienced by parents of children with developmental disabilities, is compounded by family circumstances and living in rural settings. Often parents receive little personal support. Family-centred interventions have been recommended internationally for promoting children's development, as well as boosting parental wellbeing. Yet, in many countries, current service provision is predominately child-focused and clinic-centred. An innovative, family-centred support service was designed and evaluated in a rural county of Ireland. Support staff visit the family home every month for around one year with regular check-ins by phone. The service aims included setting developmental goals for the child that were agreed with parents, alongside actions to address the personal needs of parents and siblings. In addition, community activities are identified or created to promote the social inclusion of the child and family in local communities, as well as locating opportunities for social activities for mothers. To date, 96 families with 110 children have been involved and three monthly reviews have been undertaken of each child's progress. Baseline measures on parents' mental health and social isolation were gathered and repeated when parents had completed their involvement with the project, along with qualitative information regarding the parents' experiences. Most children attained their learning targets, alongside those selected as personal goals by parents; in particular, parents reported their child's greater involvement in community activities, increased knowledge and skills, and with more confidence and resilience. Significant increases in parental well-being scores were reported, but there was a limited impact on their social participation and that of their child. This evidence-based model of provision is an example of how current social care provision for families who have a child with developmental disabilities could be cost-effectively re-envisioned even in rural areas.
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24
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Palomo-Carrión R, Romay-Barrero H, Lirio-Romero C, Arroyo-Fernádez R, M-Guijarro-Herraiz M, Ferri-Morales A. Feasibility of family-directed home-based bimanual intensive therapy combined with modified constraint induced movement therapy (h-BITmCI) in very low and low bimanual functional level: A brief report. Dev Neurorehabil 2023; 26:63-70. [PMID: 35833864 DOI: 10.1080/17518423.2022.2099993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the feasibility of a home-based hybrid Bimanual-Intensive-Therapy combined with modified Constraint-Induced-Movement-Therapy (h-BITmCI) in children with spastic unilateral cerebral palsy (SUCP) with low and very low bimanual functional level. METHODS A single-group of 10 children aged 5-8 years old, performed the hybrid home Bimanual-Intensive-Therapy (BIT, 80 hours) combined with modified Constraint-Induced-Movement-Therapy (mCIMT, 20 hours): h-BITmCI. Thus, Bimanual Functional Performance (BFP), Quality of Life (QoL) and expectations from families were measured through the Assisting Hand Assessment, (AHA), Pediatric Quality of Life Inventory, for Cerebral Palsy, (PedsQLTM v. 3.0, CP) and a specific questionnaire for families for baseline period (week 0), during the treatment phase (week 4 and week 8) and after the intervention (week 10). Repeated measures ANOVA analysis (with post hoc test correction) was used for the BFP and QoL, with a confidence interval (CI) of 95% and with p value <.008 considered statistically significant. RESULTS Ten children completed the study with an average of 77-hours-BIT and 17-hours-mCIMT. None of the participants dropped out of the study during the follow-up process, and the parents' expectations were fulfilled, indicating high caregiver compliance. During the first 80 hours of BIT, a mean increase of 3.7 AHA units was obtained for the BFP (p = 1.00) and 1.64 points in the QoL (p = 1.00). Clinically relevant changes were observed in the last two weeks (20 hours mCIMT) with a mean increase of 10.6 AHA units in BFP and 6.29 points in QoL (p < .001). CONCLUSIONS h-BITmCI protocol is feasible to be performed at home with the family's involvement, obtaining the greatest improvements after 100 hours of both therapies. Thus, mCIMT would be a relevant condition to increase the affected upper limb functionality, rather than the dosage used to obtain clinically relevant changes.
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Affiliation(s)
- Rocío Palomo-Carrión
- Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy, University of Castilla-La Mancha, Toledo, Spain.,Group of research in Physiotherapy, Faculty of Physiotherapy and Nursing, Toledo, Spain
| | - Helena Romay-Barrero
- Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy, University of Castilla-La Mancha, Toledo, Spain
| | - Cristina Lirio-Romero
- Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy, University of Castilla-La Mancha, Toledo, Spain.,Group of research in Physiotherapy, Faculty of Physiotherapy and Nursing, Toledo, Spain
| | - Rubén Arroyo-Fernádez
- Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy, University of Castilla-La Mancha, Toledo, Spain
| | - Marta M-Guijarro-Herraiz
- Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Cuenca, Spain
| | - Asunción Ferri-Morales
- Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy, University of Castilla-La Mancha, Toledo, Spain
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25
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Roldán-Pérez P, Abuín-Porras V, Buesa-Estéllez A, Ortiz-Lucas M. Functional Splinting efficacy in a Specific Task Home Program for Children with Cerebral Palsy. A Randomized Controlled Trial. Dev Neurorehabil 2022; 25:469-478. [PMID: 35822931 DOI: 10.1080/17518423.2022.2099027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The purpose of this study is to investigate whether wearing a functional hand splint adds benefit to carrying out a task-specific home program. METHODS Thirty-three children were randomly assigned to the Specific Task and Splint Group or to a comparison group. Participants were evaluated before and after 6 weeks of intervention and at 14 weeks of follow-up. RESULTS Both groups improved on the Assisting Hand Assessment and the Children's Hand-use Experience Questionnaire (AHA Units p = .000; CHEQ bimanual tasks p = .000; CHEQ grasp efficacy p = .000 and CHEQ time utilization p = .018). No differences were found between the groups after the intervention or after the follow-up. CONCLUSIONS Hand skills improved in both groups who received a task-specific home program. Wearing a functional hand splint did not appear to improve effectiveness in addition to the home program. This study is registered in ClinicalTrials.gov (NCT03282422).
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Affiliation(s)
- Patricia Roldán-Pérez
- Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego , Spain.,MOTUS Research group-San Jorge University, Villanueva de Gállego, Spain
| | - Vanesa Abuín-Porras
- Universidad Europea de Madrid, Villaviciosa de Odón, Spain.,Fundación DACER, Spain
| | - Almudena Buesa-Estéllez
- Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego , Spain.,MOTUS Research group-San Jorge University, Villanueva de Gállego, Spain
| | - María Ortiz-Lucas
- iPhysio Research group-San Jorge University, Villanueva de Gállego, Spain
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26
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Alwhaibi RM, Omer AB, Khan R. Factors Affecting Mothers' Adherence to Home Exercise Programs Designed for Their Children with Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10792. [PMID: 36078507 PMCID: PMC9517889 DOI: 10.3390/ijerph191710792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Cerebral palsy is a common motor disorder that results in long-term impairment. The purpose of this study was to find out what factors influence Saudi mothers' compliance with their Children with Cerebral Palsy (C-CP) Home Exercise Program (HEP). A self-administered online questionnaire was used to perform this qualitative research study on a group of 113 mothers who had children with CP. The study included mothers with children from birth to 12 years old who had received a HEP prescription from a physiotherapist. The measuring instrument tool was a questionnaire with two sections: demographic characteristics and a questionnaire about the parents' adherence to the HEP. The questionnaire utilized in this study was subjected to a reliability analysis, and the derived Cronbach's alpha was found to be 0.814 for the questionnaire (which had 17 phrases). These results imply that the questionnaire is reliable. A total of 113 responses were received, with 4 incomplete responses being eliminated. The majority of mothers (66.1%) did not follow the HEP, according to the findings of this survey. The demographics of the mothers revealed that 20-25-year-old mothers were more adherent than the other age groups. The findings of this study demonstrated that the physical therapist's treatment of the mother influenced exercise compliance.
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Affiliation(s)
- Reem M. Alwhaibi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Asma B. Omer
- Department of Basic Health Sciences, Deanship of Preparatory Year for the Health Colleges, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Ruqaiyah Khan
- Department of Public Health, Athar Institute of Health and Management Studies, New Delhi 110049, India
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27
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FarmDay: A Gamified Virtual Reality Neurorehabilitation Application for Upper Limb Based on Activities of Daily Living. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with upper limb disorders are limited in their activities of daily living and impose an important healthcare burden due to the repetitive rehabilitation they require. A way to reduce this burden is through home-based therapy using virtual reality solutions, since they are readily available, provide immersion, and enable accurate motion tracking, and custom applications can be developed for them. However, there is lack of guidelines for the design of effective VR rehabilitation applications in the literature, particularly for bimanual training. This work introduces a VR telerehabilitation system that uses off-the-shelf hardware, a real-time remote setup, and a bimanual training application that aims to improve upper extremity motor function. It is made of six activities and was evaluated by five physiotherapists specialised in (1) neuromotor disorders and (2) functional rehabilitation and (3) occupational therapy. A descriptive analysis of the results obtained from the System Usability Scale test of the application and a collection of qualitative assessments of each game have been carried out. The application obtained a mean score of 86.25 (±8.96 SD) in the System Usability Scale, and the experts concluded that it accurately reproduces activities of daily living movements except for wrist and finger movements. They also offer a set of design guidelines.
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28
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Verhaegh AP, Nuijen NB, Aarts PB, Nijhuis-van der Sanden MWG, Willemsen MA, Groen BE, Vriezekolk JE. Parents' experiences with a home-based upper limb training program using a video coaching approach for infants and toddlers with unilateral cerebral palsy: a qualitative interview study. BMC Pediatr 2022; 22:380. [PMID: 35768858 PMCID: PMC9245237 DOI: 10.1186/s12887-022-03432-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Although early home-based upper limb training programs are promising, in-depth understanding of parents’ experiences with these programs is still limited. We developed an early home-based upper limb training program for infants and toddlers (8–36 months) with or at risk of unilateral cerebral palsy using video coaching for parents. The aim of this qualitative study was to evaluate parents’ experiences with the home-based training program using a video coaching approach in order to optimize implementation strategies. Methods We held semi-structured interviews with parents of 13 children with unilateral cerebral palsy, who participated in our program in the period from 2014 – 2017. On average, parents had delivered two training periods of the program at the time of the interviews. Interviews were analyzed using inductive thematic content analysis. Results We identified three overarching interacting themes that shaped the experiences of parents with the program: 1) Parental learning comprising the subthemes parents’ training competencies and the facilitative and reinforcing role of video coaching, 2) Parental load comprising the subthemes flexibility of the program, supportive network, competing demands, and child’s mood and functional capacities, and 3) Parental perseverance comprising the subthemes beliefs and expectancies and seeing child’s functional improvements. Conclusions For successful implementation of an early home-based upper limb training program using video coaching, support in delivering home-training from a therapist or from others within parents’ social network, is needed to relieve parental load. Seeing functional improvements of their child on the videos increased parents’ motivation to continue with the training. Positively phrased feedback from an occupational therapist stimulated parents’ perseverance and training competency. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03432-w.
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Affiliation(s)
- Anke Pm Verhaegh
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands. .,IQ Healthcare, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Nienke B Nuijen
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Pauline Bm Aarts
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Research and Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- IQ Healthcare, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michèl Aap Willemsen
- Department of Pediatric Neurology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brenda E Groen
- Department of Research and Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna E Vriezekolk
- Department of Research and Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands
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29
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Chaovalit S, Dodd KJ, Taylor NF. Caregivers' Perceptions of a High Repetition Sit-To-Stand Exercise Program for Children with Cerebral Palsy Who Have Mobility Limitations. Phys Occup Ther Pediatr 2022; 42:566-578. [PMID: 35350951 DOI: 10.1080/01942638.2022.2057208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS To explore caregiver perceptions about the outcomes and feasibility of a high repetition sit-to-stand home-based exercise program on themselves and their children with cerebral palsy who have mobility limitations. METHODS Face-to-face semi-structured interviews were conducted with 19 caregivers (17 women, mean age 39 y 6 mo (SD 8 y 4 mo) of 19 children with cerebral palsy (10 males, mean age 7 y 2 mo (SD 2 y 1 mo) classified as level III (n = 8) or IV (n = 11) on the Gross Motor Function Classification System. The children had completed a 6-week task-specific sit-to-stand exercise program. Each week a physical therapist and caregivers supervised the program: twice by the physical therapist and three times by the caregivers. Interviews were completed immediately after program completion, and transcripts were analyzed using a process of inductive thematic analysis within an interpretive description framework. RESULTS Themes were: (1) caregivers saw positive changes in their children from completing the program, (2) seeing positive changes gave caregivers hope that their child could develop with further training, and (3) the program was feasible to complete. CONCLUSIONS Caregivers perceived positive changes in their children and expressed increased hope for their child's future after a high repetition sit-to-stand exercise program, suggesting the program is feasible with caregiver supervision.
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Affiliation(s)
- Sirawee Chaovalit
- School of Allied Health, Human Services and Sport; College of Science, Health and Engineering, La Trobe University, Australia
| | - Karen J Dodd
- School of Allied Health, Human Services and Sport; College of Science, Health and Engineering, La Trobe University, Australia.,College of Health and Biomedicine, Victoria University, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport; College of Science, Health and Engineering, La Trobe University, Australia.,Allied Health Clinical Research Office, Eastern Health, Australia
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Outcome of Community-Based Early Intervention and Rehabilitation for Children with Cerebral Palsy in Rural Bangladesh: A Quasi-Experimental Study. Brain Sci 2021; 11:brainsci11091189. [PMID: 34573210 PMCID: PMC8469407 DOI: 10.3390/brainsci11091189] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 02/01/2023] Open
Abstract
We evaluated the outcome of a community-based early intervention and habilitation for children with cerebral palsy (CP) in Bangladesh. Children registered on the Bangladesh CP Register (BCPR) were recruited in two groups for this study: Group A received a comprehensive six-month long community-based caregiver-led intervention program at the “Shishu Shorgo” (Bengali title, which translates to ‘Children’s Heaven’) Early Intervention and Rehabilitation Centres developed to support participants from the BCPR. Group B received standard care. A quasi-experimental study was conducted. Data were obtained at baseline, at the end of the program (i.e., 6 months), and at a 12-month follow-up. Outcome measures for children included gross motor functional measure (GMFM-66), Communication Function Classification System (CFCS), and Viking Speech Scale (VSS) and, for adult caregivers, the depression, anxiety, and stress scale (DASS 21). Between October 2016 and March 2017, 156 children with CP were recruited (77 in Group A and 79 in Group B). The total score of GMFM-66, CFCS level, and VSS level significantly improved statistically in Group A (p < 0.05 for all) and deteriorated in Group B (p < 0.001, p = 0.095, p = 0.232). The intervention showed promising outcomes particularly for children with CP under five years of age. There is a need for caregiver-led community-based programs for children with CP in LMICs.
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31
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Palomo-Carrión R, Lirio-Romero C, Ferri-Morales A, Jovellar-Isiegas P, Cortés-Vega MD, Romay-Barrero H. Combined intensive therapies at home in spastic unilateral cerebral palsy with high bimanual functional performance. What do they offer? A comparative randomised clinical trial. Ther Adv Chronic Dis 2021; 12:20406223211034996. [PMID: 34408823 PMCID: PMC8366120 DOI: 10.1177/20406223211034996] [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: 03/19/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Children with unilateral spastic cerebral palsy (USCP) receive different treatments, including the application of modified constraint induced movement therapy (mCIMT) or bimanual intensive therapy (BIT) to increase affected upper limb functionality. The aim of this study was to compare the effectiveness of two protocols with different proportions and orders of mCIMT/BIT within combined intensive home-therapy in children with USCP (6–8 years old) with high bimanual functional performance, applied by the family. Methods: The protocols were performed on 20 children with an average age of 7.12 years [standard deviation (SD): 0.70], allocated to two different combined therapies. The protocols were designed by 100 h of dose for 10 weeks: 80 h of mCIMT followed by 20 h of BIT (mCIMT-B group) and 80 h of BIT followed by 20 h of mCIMT (BIT-mCI group). Bimanual functional performance was measured with Assisting Hand Assessment Scale (AHA) and the affected upper limb-use experience with Children’s Hand-use Experience Questionnaire (CHEQ). Parent satisfaction and expectations with therapy were measured using a specific questionnaire. There were five assessment timepoints (week 0, week 4, week 8, week 10 and week 34). Results: There were no statistically significant (p > 0.05) inter- and intra-group changes in the bimanual functional performance of both groups. The affected upper limb-use experience obtained significant changes in BIT-mCI group, with statistically significant differences in the pairwise comparisons between week 0–10 and week 4–10 (p = 0.028) for use of the affected hand and the use of the affected hand to grasp between week 4 and week 8 (p = 0.028). Grasp efficacy and discomfort acquired statistically significant differences only in the BIT-mCI group for pairwise comparisons week 0–week 10/week 4–week 10 (p = 0.035). Although task execution time compared with a typically developing child of the same age obtained statistically significant differences only in the group mCIMT-B for pairwise comparisons week 0–week 8 (p = 0.03), week 0–week 10 (p = 0.03), week 4–week 8 (p = 0.04) and week 4–week 10 (p = 0.03). Family satisfaction and expectations acquired an increase between week 0 and week 10 (p ⩽ 0.02). Conclusion: Applying 80 h of BIT for 8 weeks in children with high bimanual functional performance USCP (6–8 years old), executed at home with family involvement would be sufficient to obtain improvements in affected upper limb-use experience, without the need to use combined protocols of 100 h. However, no statistically significant increase in bimanual functional performance would be obtained, with the basal situation of the child being a factor to consider for the execution of mCIMT and BIT. Registration number and name of trial registry: [ClinicalTrials.gov identifier: NCT03465046]
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Affiliation(s)
- Rocío Palomo-Carrión
- University of Castilla-La Mancha, Toledo, Spain GIFTO, Physiotherapy Research Group of Toledo, Spain
| | - Cristina Lirio-Romero
- University of Castilla-La Mancha, Avda. Carlos III. s/n, Toledo, 45071, Spain GIFTO, Physiotherapy Research Group of Toledo, Spain
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Cheng M, Anderson M, Levac DE. Performance Variability During Motor Learning of a New Balance Task in a Non-immersive Virtual Environment in Children With Hemiplegic Cerebral Palsy and Typically Developing Peers. Front Neurol 2021; 12:623200. [PMID: 33790848 PMCID: PMC8005528 DOI: 10.3389/fneur.2021.623200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Motor impairments contribute to performance variability in children with cerebral palsy (CP) during motor skill learning. Non-immersive virtual environments (VEs) are popular interventions to promote motor learning in children with hemiplegic CP. Greater understanding of performance variability as compared to typically developing (TD) peers during motor learning in VEs may inform clinical decisions about practice dose and challenge progression. Purpose: (1) To quantify within-child (i.e., across different timepoints) and between-child (i.e., between children at the same timepoint) variability in motor skill acquisition, retention and transfer in a non-immersive VE in children with CP as compared to TD children; and (2) To explore the relationship between the amount of within-child variability during skill acquisition and learning outcomes. Methods: Secondary data analysis of 2 studies in which 13 children with hemiplegic CP and 67 TD children aged 7-14 years undertook repeated trials of a novel standing postural control task in acquisition, retention and transfer sessions. Changes in performance across trials and sessions in children with CP as compared to TD children and between younger (7-10 years) and older (11-14 years) children were assessed using mixed effects models. Raw scores were converted to z-scores to meet model distributional assumptions. Performance variability was quantified as the standard deviation of z-scores. Results: TD children outperformed children with CP and older children outperformed younger children at each session. Older children with CP had the least between-child variability in acquisition and the most in retention, while older TD children demonstrated the opposite pattern. Younger children with CP had consistently high between-child variability, with no difference between sessions. Within-child variability was highest in younger children, regardless of group. Within-child variability was more pronounced in TD children as compared to children with CP. The relationship between the amount of within-child variability in performance and performance outcome at acquisition, retention and transfer sessions was task-specific, with a positive correlation for 1 study and a negative correlation in the other. Conclusions: Findings, though preliminary and limited by small sample size, can inform subsequent research to explore VE-specific causes of performance variability, including differing movement execution requirements and individual characteristics such as motivation, attention and visuospatial abilities.
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Affiliation(s)
- Minxin Cheng
- Rehabilitation Games and Virtual Reality Laboratory, Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
| | - Michael Anderson
- Department of Biology, Macalester College, St. Paul, MN, United States
| | - Danielle E Levac
- Rehabilitation Games and Virtual Reality Laboratory, Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
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