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Haddon M, West L, Elliott C, Walmsley C, Valentine J, Bear N, Pool D. Kindy Moves: the feasibility of an intensive interdisciplinary programme on goal and motor outcomes for preschool-aged children with neurodisabilities requiring daily equipment and physical assistance. BMJ Open 2023; 13:e068816. [PMID: 37169503 DOI: 10.1136/bmjopen-2022-068816] [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: 05/13/2023] Open
Abstract
OBJECTIVES To determine the feasibility of an intensive interdisciplinary programme in improving goal and motor outcomes for preschool-aged children with non-progressive neurodisabilities. The primary hypothesis was that the intervention would be feasible. DESIGN A single group feasibility study. SETTING An Australian paediatric community therapy provider. PARTICIPANTS Forty children were recruited. Inclusion criteria were age 2-5 years with a non-progressive neurodisability, Gross Motor Function Classification System (GMFCS) levels III-V or equivalent, and goals relating to mobility, communication and upper limb function. Exclusion criteria included orthopaedic surgery in the past 6 months, unstable hip subluxation, uncontrolled seizure disorder or treadmill training in the past month. INTERVENTION A goal-directed programme of three 2-hour sessions per week for 4 weeks (24 hours total). This consisted of treadmill and overground walking, communication practice, and upper limb tasks tailored by an interdisciplinary team. PRIMARY AND SECONDARY OUTCOME MEASURES Limited-efficacy measures from preintervention (T1) to postintervention (T2) and 4-week follow-up (T3) included the Goal Attainment Scaling (GAS), Canadian Occupational Performance Measure (COPM), Gross Motor Function Measure (GMFM-66) and 10-Metre Walk Test (10MWT). Acceptability, demand, implementation and practicality were also explored. RESULTS There were improvements at T2 compared with T1 for all limited-efficacy measures. The GAS improved at T2 (mean difference (MD) 27.7, 95% CI 25.8 to 29.5) as well as COPM performance (MD 3.2, 95% CI 2.8 to 3.6) and satisfaction (MD 3.3, 95% CI 2.8 to 3.8). The GMFM-66 (MD 2.3, 95% CI 1.0 to 3.5) and 10MWT (median difference -2.3, 95% CI -28.8 to 0.0) improved at T2. Almost all improvements were maintained at T3. Other feasibility components were also demonstrated. There were no adverse events. CONCLUSIONS An intensive interdisciplinary programme is feasible in improving goal and motor outcomes for preschool children with neurodisabilities (GMFCS III-V or equivalent). A randomised controlled trial is warranted to establish efficacy. TRIAL REGISTRATION NUMBER ACTRN12619000064101.
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Affiliation(s)
- Matthew Haddon
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Loren West
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Catherine Elliott
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Corrin Walmsley
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Jane Valentine
- Telethon Kids Institute, Perth, Western Australia, Australia
- Paediatric Rehabilitation, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Dayna Pool
- The Healthy Strides Foundation, Perth, Western Australia, Australia
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Demont A, Gedda M, Lager C, de Lattre C, Gary Y, Keroulle E, Feuillerat B, Caudan H, Sancelme Z, Isapof A, Viehweger E, Chatelin M, Hochard M, Boivin J, Vurpillat P, Genès N, de Boissezon X, Fontaine A, Brochard S. Evidence-based, Implementable Motor Rehabilitation Guidelines for Individuals With Cerebral Palsy. Neurology 2022; 99:283-297. [PMID: 35750497 DOI: 10.1212/wnl.0000000000200936] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/19/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cerebral palsy is a life-long condition that causes heterogeneous motor disorders. Motor rehabilitation interventions must be adapted to the topography of the symptoms, ambulatory capacity and age of the individual. Current guidelines do not differentiate between the different profiles of individuals with cerebral palsy, which limits their implementation. OBJECTIVES To develop evidence-based, implementable guidelines for motor rehabilitation interventions for individuals with cerebral palsy according to the age, topography of the cerebral palsy and ambulatory capacity of the individual, and to determine a level of priority for each intervention. METHODS We used a mixed methods design that combined a systematic review of the literature on available motor rehabilitation interventions with expert opinions. Based on the French National Authority for Health methodology, recommendations were graded as strong, conditional or weak. Interventions were then prioritized by the experts according to both the evidence and their own opinions on relevance and implementability to provide a guide for clinicians. All recommendations were approved by experts who were independent from the working group. RESULTS Strong recommendations as first-line treatments were made for gait training, physical activities and hand-arm bimanual intensive therapy for all children and adolescents with cerebral palsy. Moderate recommendations were made against passive joint mobilizations, muscle stretching, prolonged stretching with the limb fixed, and neurodevelopmental therapies for all children and adolescents with cerebral palsy. Strong recommendations as first-line treatments were made for gait training for all adults with cerebral palsy and moderate recommendations as moderate importance interventions for strengthening exercises and ankle-foot orthoses for motor impairment of the feet and the ankles. DISCUSSION These guidelines, which combine research evidence and expert opinion, could help individuals with cerebral palsy and their families to co-determine rehabilitation goals with health professionals, according to their preferences.
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Affiliation(s)
- Anthony Demont
- French National Authority for Health, Saint-Denis, France .,University of Paris, ECEVE, Inserm, U1123, Paris, France
| | - Michel Gedda
- French National Authority for Health, Saint-Denis, France.,University of Paris, ECEVE, Inserm, U1123, Paris, France
| | - Céline Lager
- Occupational therapy Clinic, Mouans Sartoux, France
| | | | - Yann Gary
- Bourgès Clinic, Castelnau-le-lez, France
| | - Elisabeth Keroulle
- Société d'études et de soins pour les enfants paralysés et polymalformés, Antony, France
| | | | | | | | - Arnaud Isapof
- Neuropediatrics Department, Hôpital Armand Trousseau, CRMR Neuromuscular pathologies, APHP, Paris, France
| | - Elke Viehweger
- Orthopedic department, Neuro-orthopedics Unit and Movement Analysis Center, Université Bâle, Suisse
| | | | | | | | | | | | - Xavier de Boissezon
- Physical and Rehabilitation Medicine Department, Neurosciences, CHU, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | | | - Sylvain Brochard
- Physical and medical rehabilitation department, CHRU Brest, Brest, France.,Paediatric physical and medical rehabilitation department, Fondation ILDYS, Brest, France.,University of Western Brittany, Laboratory of medical information processing, Inserm U1101, Brest, France
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