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Shah S, Avery A, Bailey R, Bell B, Coulson N, Luke R, McLaughlin J, Logan P. The everydayness of falling: consequences and management for adults with cerebral palsy across the life course. Disabil Rehabil 2024:1-9. [PMID: 38994847 DOI: 10.1080/09638288.2024.2376346] [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: 08/22/2023] [Accepted: 06/29/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE To explore the cause, influences and consequences of falling for adults with cerebral palsy (CP) across their life course, and how this is managed. MATERIALS AND METHODS We used interview data from a multimethod UK study exploring the effects of ageing with CP and healthcare across the life course. Twenty-six participants were recruited and interviewed using various digital platforms to maximise inclusive participation in the UK. Follow-up email semi-structured interviews were conducted to further explore experiences of falls. Transcribed interviews were analysed thematically. RESULTS Falling and fear of falling (FoF) is problematic for over half of the participants in the sample. They perceived falls and FoF as limiting their participation, autonomy and independence in employment, social and cultural activities. Participants used their own management strategies, due to limited specialist interventions or practitioner knowledge to manage or prevent falls. Practices, such as the use of a wheelchair or avoiding activities prompted changes to relationships and identity. CONCLUSIONS Falling for adults with CP happens earlier in life compared to the general population. Adults with CP may benefit from specialist falls prevention services to help maintain muscle strength and balance. Research is needed to evaluate effective interventions for people with CP.
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Affiliation(s)
- Sonali Shah
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Avery
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth Bailey
- Faculty of Arts & Social Science, Open University, UK
| | - Brian Bell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Coulson
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
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Sansare A, Arcodia M, Lee SCK, Jeka J, Reimann H. Individuals with cerebral palsy show altered responses to visual perturbations during walking. Front Hum Neurosci 2022; 16:977032. [PMID: 36158616 PMCID: PMC9493200 DOI: 10.3389/fnhum.2022.977032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with cerebral palsy (CP) have deficits in processing of somatosensory and proprioceptive information. To compensate for these deficits, they tend to rely on vision over proprioception in single plane upper and lower limb movements and in standing. It is not known whether this also applies to walking, an activity where the threat to balance is higher. Through this study, we used visual perturbations to understand how individuals with and without CP integrate visual input for walking balance control. Additionally, we probed the balance mechanisms driving the responses to the visual perturbations. More specifically, we investigated differences in the use of ankle roll response i.e., the use of ankle inversion, and the foot placement response, i.e., stepping in the direction of perceived fall. Thirty-four participants (17 CP, 17 age-and sex-matched typically developing controls or TD) were recruited. Participants walked on a self-paced treadmill in a virtual reality environment. Intermittently, the virtual scene was rotated in the frontal plane to induce the sensation of a sideways fall. Our results showed that compared to their TD peers, the overall body sway in response to the visual perturbations was magnified and delayed in CP group, implying that they were more affected by changes in visual cues and relied more so on visual information for walking balance control. Also, the CP group showed a lack of ankle response, through a significantly reduced ankle inversion on the affected side compared to the TD group. The CP group showed a higher foot placement response compared to the TD group immediately following the visual perturbations. Thus, individuals with CP showed a dominant proximal foot placement strategy and diminished ankle roll response, suggestive of a reliance on proximal over distal control of walking balance in individuals with CP.
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Affiliation(s)
- Ashwini Sansare
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Maelyn Arcodia
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Samuel C. K. Lee
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - John Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
- *Correspondence: Hendrik Reimann,
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El-Kafy EMA, El-Shamy SM. The impact of conservative soft orthotic intervention with strapping on thoracic kyphotic posture and spinal mobility in children with cerebral palsy: a randomized control trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-021-00068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study mainly aimed to evaluate the influences of Thera Togs orthotic undergarment with its strapping system on dorsal kyphotic posture and spinal mobility in children with spastic diplegic cerebral palsy. The study also investigated the impact of the modulation of thoracic kyphosis on balance and risk of falls in these children.
Study design
This study was a randomized control trial.
Participants
Forty children with diplegic cerebral palsy, aged from 8 to 10 years were met the inclusion criteria and participated in this study. Only 38 children completed the study.
Methods
The children in the control group received 2 h of conventional exercise protocol aiming for modulating thoracic kyphotic posture. The treatment program was conducted 3 times/week, for 12 successive weeks. Children in the study group wore TheraTogs orthoses with the strapping system for 8 h every day in combination with the conventional exercise program.
Outcome measures
For both groups, the primary outcome measures (thoracic kyphotic angle, and thoracic flexion and extension range of motion), and the secondary outcomes (the overall stability index of fall risk test, and the pediatric balance scale score) were recorded at baseline and after completion of the treatment. T test was used to compare the changes within-and between-groups in all measured variables, at baseline and immediately after 12 weeks of treatment.
Results
Children in the study group showed significant improvements in the scores of all primary and secondary measures post-treatment compared to the control group (P < 0.05).
Conclusion
Conservative treatment composed of TheraTogs orthotic system with conventional exercise treatment is effective in modulating thoracic kyphosis and improving dorsal range of motion in children with spastic diplegic cerebral palsy. This improvement has a positive influence on postural balance performance and reduces the risk of fall in these children.
Trial registration
The ClinicalTrial.gov PRS (NCT05063175). 30 September 2021—retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05063175
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Kinect V2-Based Gait Analysis for Children with Cerebral Palsy: Validity and Reliability of Spatial Margin of Stability and Spatiotemporal Variables. SENSORS 2021; 21:s21062104. [PMID: 33802731 PMCID: PMC8002565 DOI: 10.3390/s21062104] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/15/2021] [Accepted: 03/13/2021] [Indexed: 12/17/2022]
Abstract
Children with cerebral palsy (CP) have high risks of falling. It is necessary to evaluate gait stability for children with CP. In comparison to traditional motion capture techniques, the Kinect has the potential to be utilised as a cost-effective gait stability assessment tool, ensuring frequent and uninterrupted gait monitoring. To evaluate the validity and reliability of this measurement, in this study, ten children with CP performed two testing sessions, of which gait data were recorded by a Kinect V2 sensor and a referential Motion Analysis system. The margin of stability (MOS) and gait spatiotemporal metrics were examined. For the spatiotemporal parameters, intraclass correlation coefficient (ICC2,k) values were from 0.83 to 0.99 between two devices and from 0.78 to 0.88 between two testing sessions. For the MOS outcomes, ICC2,k values ranged from 0.42 to 0.99 between two devices and 0.28 to 0.69 between two test sessions. The Kinect V2 was able to provide valid and reliable spatiotemporal gait parameters, and it could also offer accurate outcome measures for the minimum MOS. The reliability of the Kinect V2 when assessing time-specific MOS variables was limited. The Kinect V2 shows the potential to be used as a cost-effective tool for CP gait stability assessment.
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Tracy JB, Petersen DA, Pigman J, Conner BC, Wright HG, Modlesky CM, Miller F, Johnson CL, Crenshaw JR. Dynamic stability during walking in children with and without cerebral palsy. Gait Posture 2019; 72:182-187. [PMID: 31226600 PMCID: PMC6684400 DOI: 10.1016/j.gaitpost.2019.06.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/22/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cerebral palsy (CP) is associated with a high risk of falling during walking. Many gait abnormalities associated with CP likely alter foot placement and center of mass (CoM) movement in a way that affects anterior or lateral dynamic stability, in turn influencing fall risk. RESEARCH QUESTION Do children with CP demonstrate altered anterior or lateral dynamic stability compared to typically-developing (TD) children? METHODS In this case-control, observational study, we measured gait kinematics of two groups of children (15 CP, 11 GMFCS level I, 4 GMFCS level II; 14 TD; age 5-12) in walking conditions of a preferred speed, a fast speed, and a preferred speed while completing a cognitive task. For dominant and non-dominant limbs, the margin of stability (MoS), a spatial measure of dynamic stability, was calculated as the distance between the edge of the base of support and the CoM position after accounting for scaled velocity. Statistical comparisons of were made using mixed factorial ANOVAs. Post hoc comparisons were Sidak adjusted. RESULTS The anterior MoS before foot strike and at mid-swing differed between each condition but not between groups. Based on the minimum lateral MoS, children with CP had more stability when bearing weight on their non-dominant limb compared to TD children. These differences were not apparent when on the dominant limb. SIGNIFICANCE This high-functioning group of children with CP exhibited a more conservative lateral stability strategy during walking when bearing weight with the non-dominant limb. This strategy may be protective against lateral falls. We observed no between-group differences in anterior stability. Because CP has been previously associated with impaired anterior balance reactions, and there was no observed compensation in anterior gait stability, this lack of group differences could contribute to a higher risk of falling in that direction.
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Affiliation(s)
- James B Tracy
- 540 S College Ave, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Drew A Petersen
- 245 North 15th Street, MS 502, Department of Physical Therapy, Drexel University, Philadelphia, PA, USA
| | - Jamie Pigman
- 540 S College Ave, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Benjamin C Conner
- 550 E Van Buren St, College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Henry G Wright
- 540 S College Ave, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | | | - Freeman Miller
- 540 S College Ave, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; 1600 Rockland Rd, Department of Orthopedics, Nemours A.I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Curtis L Johnson
- 150 Academy Street, Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Jeremy R Crenshaw
- 540 S College Ave, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
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Fearon K. ‘Have you ever talked to any women with Turner syndrome?’ Using universal design and photo elicitation interviews in research with women with mild cognitive impairment. METHODOLOGICAL INNOVATIONS 2019. [DOI: 10.1177/2059799119841933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A growing body of methodological research literature demonstrates the importance of adapting research design to address the specific needs of participants from minority groups. The aim is to treat participants more respectfully during the research process and to enhance participation, ensuring the findings more closely reflect participants’ views and experience. However, there is an absence of work examining the needs of research participants with Turner syndrome, a chromosome disorder linked with mild cognitive impairment and its potential impact on research interviews. This article draws on a study of reproductive decision-making in women with Turner Syndrome and mothers of girls with Turner syndrome to consider ways to improve research access and to make methodological adaptations for this group of participants. There is little qualitative research on the experience of living with Turner syndrome or its associated experience of infertility. Most of the small number of studies that exist do not describe whether the research method was adapted to accommodate the psychosocial features of Turner syndrome. Yet, these features, which include social cognition issues and anxiety, may have an impact on women’s ability to participate fully in a research interview and consequently on the quality of the data. This article fills a gap in research describing the use of adaptions with women with Turner syndrome, which may be of use to researchers and practitioners working with this group. It describes how a novel approach to research adaptations, universal design, was used to identify and incorporate adaptions into the research design, both through the choice of photo elicitation interviews as a research method and through adjustments made at each stage of the research process. It discusses how adaptions worked to overcome barriers to participation and how effective this was, concluding with suggestions for applying this approach in future research.
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Affiliation(s)
- Kriss Fearon
- Centre for Reproduction Research, De Montfort University, Leicester, UK
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Alemdaroğlu E, Özbudak SD, Mandiroğlu S, Biçer SA, Özgirgin N, Uçan H. Predictive Factors for Inpatient Falls among Children with Cerebral Palsy. J Pediatr Nurs 2017; 32:25-31. [PMID: 27633845 DOI: 10.1016/j.pedn.2016.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/09/2016] [Accepted: 08/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Inpatient falls are of significant concern. The aim of this prospective study was to determine the predictors of inpatient falls among children with cerebral palsy in a rehabilitation hospital. DESIGN AND METHODS A total of 93 patients with cerebral palsy were assessed based on history, physical findings, the Selective Motor Control Test, the Gross Motor Functional Classification System, the Berg Balance Scale and the Manual Ability Classification System. Previous history of falls/frequent falls, and any falls which occurred during hospitalization, were recorded. RESULTS Of all 93 patients, 25 (27%) fell and 68 (73%) did not fall. The mean age of the fallers (6.3±2.0 years) was lower than that of the non-fallers (8.1±3.9 years). Behavioral problems according to the mother's statement (OR 26.454), not being able to maintain a long sitting position (OR 10.807), ability to balance on knees without support (OR 9.810), a history of frequent falls (OR 4.893) and a negative Thomas test (OR 4.192 fold) were found to increase the risk of inpatient falls. CONCLUSIONS In these children with cerebral palsy, behavioral problems according to the mother's statement, a history of frequent falls, not being able to maintain a long sitting position, a negative Thomas test, and able to balance on knees without support were associated with the risk of inpatient falls. Children with cerebral palsy may experience inpatient falls. Further studies are required in order to develop prevention programs. PRACTICE IMPLICATIONS For patients diagnosed with cerebral palsy, these results may help identify possible inpatient fallers on hospital admission.
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Affiliation(s)
- Ebru Alemdaroğlu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara (Alemdaroğlu, Özbudak Demir, Mandıroğlu, Alakoç, Girgin, Uçan), Turkey
| | - Sibel Demir Özbudak
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara (Alemdaroğlu, Özbudak Demir, Mandıroğlu, Alakoç, Girgin, Uçan), Turkey.
| | - Sibel Mandiroğlu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara (Alemdaroğlu, Özbudak Demir, Mandıroğlu, Alakoç, Girgin, Uçan), Turkey
| | - Seda Alakoç Biçer
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara (Alemdaroğlu, Özbudak Demir, Mandıroğlu, Alakoç, Girgin, Uçan), Turkey
| | - Neşe Özgirgin
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara (Alemdaroğlu, Özbudak Demir, Mandıroğlu, Alakoç, Girgin, Uçan), Turkey
| | - Halil Uçan
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara (Alemdaroğlu, Özbudak Demir, Mandıroğlu, Alakoç, Girgin, Uçan), Turkey
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Xu Y, Schick JM, Wang K, Xin K, de la Vega A, Seabrooke A, Ruiz MJ, Ainechi A, Hoon A, DeCroes B, Johnson T, Allen R. GaitAssist: A Novel Technology to Mitigate Scissoring Gait in Cerebral Palsy Patients1. J Med Device 2016. [DOI: 10.1115/1.4033762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yu Xu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Jacob M. Schick
- Department of Biology, Johns Hopkins University, Baltimore, MD 21218
| | - Kaiyuan Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Kevin Xin
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Alexander de la Vega
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD 21218
| | - Andie Seabrooke
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Michael J. Ruiz
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Ana Ainechi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Alexander Hoon
- Phelps Center for Cerebral Palsy and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD 21205
| | - Brittany DeCroes
- Department of Outpatient Physical Therapy, Kennedy Krieger Institute, Baltimore, MD 21205
| | - Tara Johnson
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD 21205
| | - Robert Allen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD 21218
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