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Araneda R, Ebner-Karestinos D, Paradis J, Klöcker A, Saussez G, Demas J, Bailly R, Bouvier S, Carton de Tournai A, Herman E, Souki A, Le Gal G, Nowak E, Sizonenko SV, Newman CJ, Dinomais M, Riquelme I, Guzzetta A, Brochard S, Bleyenheuft Y. Changes Induced by Early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities in Young Children With Unilateral Cerebral Palsy: A Randomized Clinical Trial. JAMA Pediatr 2024; 178:19-28. [PMID: 37930692 PMCID: PMC10628844 DOI: 10.1001/jamapediatrics.2023.4809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/10/2023] [Indexed: 11/07/2023]
Abstract
Importance Intensive interventions are provided to young children with unilateral cerebral palsy (UCP), classically focused on the upper extremity despite the frequent impairment of gross motor function. Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) effectively improves manual dexterity and gross motor function in school-aged children. Objective To verify if HABIT-ILE would improve manual abilities in young children with UCP more than usual motor activity. Design, Setting, and Participants This prospective randomized clinical trial (November 2018 to December 2021), including 2 parallel groups and a 1:1 allocation, recruitment took place at European university hospitals, cerebral palsy specialized centers, and spontaneous applications at 3 sites: Brussels, Belgium; Brest, France; and Pisa, Italy. Matched (age at inclusion, lesion type, cause of cerebral palsy, and affected side) pairs randomization was performed. Young children were assessed at baseline (T0), 2 weeks after baseline (T1), and 3 months after baseline (T2). Health care professionals and assessors of main outcomes were blinded to group allocation. At least 23 young children (in each group) aged 12 to 59 months with spastic/dyskinetic UCP and able to follow instructions were needed. Exclusion criteria included uncontrolled seizures, scheduled botulinum toxin injections, orthopedic surgery scheduled during the 6 months before or during the study period, severe visual/cognitive impairments, or contraindications to magnetic resonance imaging. Interventions Two weeks of usual motor activity including usual rehabilitation (control group) vs 2 weeks (50 hours) of HABIT-ILE (HABIT-ILE group). Main Outcomes and Measures Primary outcome: Assisting Hand Assessment (AHA); secondary outcomes: Gross Motor Function Measure-66 (GMFM-66), Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), and Canadian Occupational Performance Measure (COPM). Results Of 50 recruited young children (26 girls [52%], median age; 35.3 months for HABIT-ILE group; median age, 32.8 months for control group), 49 were included in the final analyses. Change in AHA score from T0 to T2 was significantly greater in the HABIT-ILE group (adjusted mean score difference [MD], 5.19; 95% CI, 2.84-7.55; P < .001). Changes in GMFM-66 (MD, 4.72; 95% CI, 2.66-6.78), PEDI-CAT daily activities (MD, 1.40; 95% CI, 0.29-2.51), COPM performance (MD, 3.62; 95% CI, 2.91-4.32), and satisfaction (MD, 3.53; 95% CI, 2.70-4.36) scores were greater in the HABIT ILE group. Conclusions and Relevance In this clinical trial, early HABIT-ILE was shown to be an effective treatment to improve motor performance in young children with UCP. Moreover, the improvements had an impact on daily life activities of these children. Trial registration ClinicalTrials.gov Identifier: NCT04020354.
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Affiliation(s)
- Rodrigo Araneda
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - Daniela Ebner-Karestinos
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - Julie Paradis
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Anne Klöcker
- Haute Ecole Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - Geoffroy Saussez
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Forme et Fonctionnement Humain Unit, Department of Motor Sciences, CeREF - Haute Ecole Louvain en Hainaut, Belgium
| | - Josselin Demas
- Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) – EA7315 F-49000 France
- Instituts de formation du Centre Hospitalier de Laval, Laval, France
| | - Rodolphe Bailly
- INSERM UMR 1101, LaTIM, Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Sandra Bouvier
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
- Western Brittany University, Brest, France
| | | | - Enimie Herman
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Grégoire Le Gal
- University Hospital of Brest, Brest, France
- INSERM CIC 1412, Brest, France
| | - Emmanuel Nowak
- University Hospital of Brest, Brest, France
- INSERM CIC 1412, Brest, France
| | - Stephane V. Sizonenko
- Division of Child Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - Christopher J. Newman
- Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mickael Dinomais
- Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) – EA7315 F-49000 France
- CHU Angers, Département de Médecine Physique et de Réadaptions, CHU Angers-Capucins, F- 49933, France
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy and Research Institute on Health Sciences (UINICS-Idisba), University of the Balearic Islands, Palma de Mallorca, Spain
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sylvain Brochard
- INSERM UMR 1101, LaTIM, Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
- Western Brittany University, Brest, France
- University Hospital of Brest, Brest, France
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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Janssen-Potten YJM, Roks L, Roijen R, Vermeulen RJ, Rameckers EEA. Effectiveness of functional intensive therapy on mobility and self-care activities in children and adolescents with cerebral palsy - a prospective clinical study. Disabil Rehabil 2023; 45:3529-3538. [PMID: 36226733 DOI: 10.1080/09638288.2022.2130445] [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: 03/15/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Cerebral palsy (CP) is a major cause of childhood disability. Children with CP often lack motor skills to effectively perform activities of daily living. The aim is to assess the effectiveness of a functional intensive therapy program focused on improving individual goals in the domain of mobility and self-care in children and adolescents with CP. MATERIAL AND METHODS Thirty-five CP patients, aged 11-19 years, GMFCS I-IV, received daily 6-7 h of functional therapy for 15 days. Outcomes were assessed at baseline, immediately after the program and at three months follow-up. RESULTS Significant post-intervention improvement was seen on all primary and secondary outcome measures; personal goals (GAS score; COPM performance and COPM satisfaction), daily activities (ACTIVLIM), hand function (ABILHAND-Kids), mobility (ABILOCO-Kids; GMFM-66-IS score). There was no loss to follow up during the program and after three months. At follow-up, improvements were retained except for ABILOCO and GMFM-66-IS. CONCLUSIONS Functional intensive therapy appears feasible and seems to be effective in improving treatment goals focused on mobility and self-care, even in older and more severely affected children and adolescents with CP. After three months, these possible effects were still present.Implications for rehabilitationShort intensive functional training is feasible and showing no loss to follow up in the older and more severely affected children and adolescents with cerebral palsy (CP).Short intensive functional training appears effective in improving individual goals in children and adolescents with CP and improvements endorse three months.Short intensive functional training seems to be effective on both mobility and self-care domains of the ICF-CY.
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Affiliation(s)
- Yvonne J M Janssen-Potten
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Lars Roks
- Department of Quality & Safety, Zuyderland Medical Centre, Sittard, The Netherlands
| | - Ruud Roijen
- Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Research School MHeNS, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eugène E A Rameckers
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Pediatric Rehabilitation, BIOMED, Hasselt University, Hasselt, Belgium
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3
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Brandão MB, Coster WJ, Figueiredo PRP, Amaral MF, Gordon AM, Mancini MC. Assisting hand use and self-care bimanual performance of children with unilateral spastic cerebral palsy. Dev Med Child Neurol 2023; 65:385-392. [PMID: 35866562 DOI: 10.1111/dmcn.15362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
AIM To examine the relationship between assisting hand use in bimanual activities and children's self-care activities and task performance. METHOD We retrospectively analysed daily functioning (Pediatric Evaluation of Disability Inventory [PEDI]) and bimanual performance (Assisting Hand Assessment [AHA]) data from the assessment of 112 children (mean age: 8 years 10 months [SD 2 years 1 month], range 3 years 7 months-17 years 4 months; 66 males, 46 females) with unilateral spastic cerebral palsy (CP). We used Rasch analysis to examine the relationship between individual item scores from the AHA and the self-care items (functional skills, caregiver assistance) from the PEDI. RESULTS Most self-care functional skills and caregiver-assisted tasks were located on the middle of the unidimensional continuum. These items showed similar levels of difficulty as the items from the AHA related to the effective coordination of two hands, appropriate pace, and use of the assisting hand to stabilize and release objects, as well as variations in arm movements. INTERPRETATION The distribution of the PEDI self-care and AHA items along the unidimensional continuum illustrates the relationship between assisting hand use and self-care bimanual performance. Interpretation of the items' locations on the hierarchical unidimensional continuum may be helpful to therapists' clinical reasoning and suggest intervention goals to improve the hand function and daily functioning of children with unilateral spastic CP. Such an application needs further investigation.
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Affiliation(s)
- Marina B Brandão
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Wendy J Coster
- Department of Occupational Therapy, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA, USA
| | - Priscilla R P Figueiredo
- Universidade Federal de Minas Gerais; Associação Mineira de Reabilitação, Belo Horizonte, Brazil
| | - Maíra F Amaral
- Department of Occupational Therapy, Universidade Federal do Triângulo Mineiro, Uberaba, Brazil
| | - Andrew M Gordon
- Movement Science Program, Columbia University, New York, NY, USA
| | - Marisa C Mancini
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Brandão MB, Coster WJ, Figueiredo PRP, Amaral MF, Gordon AM, Mancini MC. Uso da mão de assistência e o desempenho bimanual no autocuidado de crianças com paralisia cerebral unilateral espástica. Dev Med Child Neurol 2023; 65:e1-e8. [PMID: 35903015 DOI: 10.1111/dmcn.15368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marina B Brandão
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Wendy J Coster
- Department of Occupational Therapy, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA, USA
| | - Priscilla R P Figueiredo
- Universidade Federal de Minas Gerais; Associação Mineira de Reabilitação, Belo Horizonte, Brasil
| | - Maíra F Amaral
- Departamento de Terapia Ocupacional, Universidade Federal do Triângulo Mineiro, Uberaba, Brasil
| | - Andrew M Gordon
- Movement Science Program, Columbia University, New York, NY, USA
| | - Marisa C Mancini
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Liu W, Hu Y, Li J, Chang J. Effect of Virtual Reality on Balance Function in Children With Cerebral Palsy: A Systematic Review and Meta-analysis. Front Public Health 2022; 10:865474. [PMID: 35548088 PMCID: PMC9081327 DOI: 10.3389/fpubh.2022.865474] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
Virtual Reality (VR) therapy is popular in treating children with Cerebral Palsy (CP) as a new technology for rehabilitation. Nevertheless, no substantial evidence supporting VR therapy promotion has been developed to date. This study aimed to investigate the effects of VR therapy on balance in children with CP. We conducted a systematic search in PubMed and Web of Science (updated to December 30, 2021). The systematic review and meta-analysis included all randomized controlled trials that included children with CP. A total of 18 RCT studies were eligible for inclusion in the systematic review, and meta-analysis was performed on 16 of them. Results showed that the VR intervention was beneficial for balance (SMD 0.47 [95% CI, SD 0.28, 0.66]). We concluded that VR therapy interventions for children with CP have positive effects. However, cautious implementation is needed in clinical applications.
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Affiliation(s)
- Wei Liu
- School of Physical Education, Xuzhou Kindergarten Teachers College, Xuzhou, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Yuanyan Hu
- School of Mathematics and Statistics, Yunlin Normal University, Yunlin, China
| | - Junfeng Li
- Ministry of Sports, Shandong Technology and Business University, Yantai, China
- *Correspondence: Junfeng Li
| | - Jindong Chang
- Institute of Motor Quotient, Southwest University, Chongqing, China
- Jindong Chang
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Gordon AM, Ferre CL, Robert MT, Chin K, Brandao M, Friel KM. HABIT+tDCS: a study protocol of a randomised controlled trial (RCT) investigating the synergistic efficacy of hand-arm bimanual intensive therapy (HABIT) plus targeted non-invasive brain stimulation to improve upper extremity function in school-age children with unilateral cerebral palsy. BMJ Open 2022; 12:e052409. [PMID: 35190424 PMCID: PMC8860006 DOI: 10.1136/bmjopen-2021-052409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Unilateral spastic cerebral palsy (USCP) is characterised by movement deficits primarily on one body side. The best available upper extremity (UE) therapies are costly and intensive. Thus, there is an urgent need for better, more efficient and thus more accessible therapies. Transcranial direct current stimulation (tDCS) is non-invasive and may enhance physical rehabilitation approaches. The aim of this study is to determine whether tDCS targeted to the hemisphere with corticospinal tract (CST) connectivity enhances the efficacy of UE training in children with USCP. Our central hypothesis is that hand-arm bimanual intensive therapy (HABIT) combined with a tDCS montage targeting the hemisphere with CST connectivity to the impaired UE muscles will improve UE function more than HABIT plus sham stimulation. We will test this by conducting a randomised clinical trial with clinical and motor cortex physiology outcomes. METHODS AND ANALYSES 81 children, aged 6-17 years, will be randomised to receive 2 mA anodal tDCS targeted to the affected UE motor map, 2 mA cathodal tDCS to the contralesional motor cortex or sham tDCS during the first 20 min of each HABIT session (10 hours: 2 hours/day for 5 days). Primary outcomes will be Box and Blocks Test, Assisting Hand Assessment and motor cortex excitability, determined with single-pulse transcranial magnetic stimulation. Secondary outcomes include ABILHAND-Kids, Canadian Occupational Performance Measure, Cooper Stereognosis, Dimension of Mastery Questionnaire and Participation and Environment Measure-Children and Youth. All measures will be collected before, immediately and 6 months after treatment. A group × test session Analysis of Variance will test differences among groups on all measures. ETHICS AND DISSEMINATION The study has been approved by the BRANY Institutional Review Board (#18-10-285-512). We will leverage our subject and family relationships to maximise dissemination and share results with the academic and patient/family advocacy groups. TRIAL REGISTRATION NUMBER NCT03402854.
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Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
| | - Claudio L Ferre
- Burke Neurological Institute, White Plains, New York, USA
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
| | - Maxime T Robert
- Department of Rehabilitation, Laval University, Quebec City, Quebec, Canada
| | - Karen Chin
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
- Burke Neurological Institute, White Plains, New York, USA
| | - Marina Brandao
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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McCall JV, Ludovice MC, Elliott C, Kamper DG. Hand function development of children with hemiplegic cerebral palsy: A scoping review. J Pediatr Rehabil Med 2022; 15:211-228. [PMID: 34864699 DOI: 10.3233/prm-200714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Hemiplegic cerebral palsy (hCP) typically impacts sensorimotor control of the hand, but comprehensive assessments of the hands of children with hCP are relatively rare. This scoping review summarizes the development of hand function for children with hCP. METHODS This scoping review focused on the development of hand function in children with hCP. Electronic databases (PubMed, PEDro, Web of Science, CINAHL, and SpringerLink) were searched to identify studies assessing hand function in children with hCP. The search was performed using keywords (e.g., "hemiplegia"). An iterative approach verified by two authors was used to select the studies. Articles which reported quantitative data for children with hCP on any items of a specified set of hand evaluations were included. Measures were sorted into three categories: quantitative neuromechanics, clinical assessments, and clinical functional evaluations. RESULTS Initial searches returned 1536 articles, 131 of which were included in the final review. Trends between assessment scores and age were examined for both hands. CONCLUSION While several studies have evaluated hand function in children with hCP, the majority relied on clinical scales, assessments, or qualitative descriptions. Further assessments of kinematics, kinetics, and muscle activation patterns are needed to identify the underlying impairment mechanisms that should be targeted for treatment.
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Affiliation(s)
- James V McCall
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Miranda C Ludovice
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,Child and Adolescent Health Services, Perth Children's Hospital, Perth, Australia
| | - Derek G Kamper
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Friel KM, Ferre CL, Brandao M, Kuo HC, Chin K, Hung YC, Robert MT, Flamand VH, Smorenburg A, Bleyenheuft Y, Carmel JB, Campos T, Gordon AM. Improvements in Upper Extremity Function Following Intensive Training Are Independent of Corticospinal Tract Organization in Children With Unilateral Spastic Cerebral Palsy: A Clinical Randomized Trial. Front Neurol 2021; 12:660780. [PMID: 34012418 PMCID: PMC8127842 DOI: 10.3389/fneur.2021.660780] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background/Objectives: Intensive training of the more affected upper extremity (UE) has been shown to be effective for children with unilateral spastic cerebral palsy (USCP). Two types of UE training have been particularly successful: Constraint-Induced Movement Therapy (CIMT) and Bimanual training. Reorganization of the corticospinal tract (CST) early during development often occurs in USCP. Prior studies have suggested that children with an ipsilateral CST controlling the affected UE may improve less following CIMT than children with a contralateral CST. We tested the hypothesis that improvements in UE function after intensive training depend on CST laterality. Study Participants and Setting: Eighty-two children with USCP, age 5 years 10 months to 17 years, University laboratory setting. Materials/Methods: Single-pulse transcranial magnetic stimulation (TMS) was used to determine each child's CST connectivity pattern. Children were stratified by age, sex, baseline hand function and CST connectivity pattern, and randomized to receive either CIMT or Bimanual training, each of which were provided in a day-camp setting (90 h). Hand function was tested before, immediately and 6 months after the intervention with the Jebsen-Taylor Test of Hand Function, the Assisting Hand Assessment, the Box and Block Test, and ABILHAND-Kids. The Canadian Occupational Performance Measure was used to track goal achievement and the Pediatric Evaluation of Disability Inventory was used to assess functioning in daily living activities at home. Results: In contrast to our hypothesis, participants had statistically similar improvements for both CIMT and Bimanual training for all measures independent of their CST connectivity pattern (contralateral, ipsilateral, or bilateral) (p < 0.05 in all cases). Conclusions/Significance: The efficacy of CIMT and Bimanual training is independent of CST connectivity pattern. Children with an ipsilateral CST, previously thought to be maladaptive, have the capacity to improve as well as children with a contralateral or bilateral CST following intensive CIMT or Bimanual training. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02918890.
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Affiliation(s)
- Kathleen M Friel
- Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York, NY, United States
| | - Claudio L Ferre
- Burke Neurological Institute, White Plains, NY, United States.,Teachers College, Columbia University, New York, NY, United States
| | - Marina Brandao
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hsing-Ching Kuo
- Teachers College, Columbia University, New York, NY, United States
| | - Karen Chin
- Burke Neurological Institute, White Plains, NY, United States.,Teachers College, Columbia University, New York, NY, United States
| | - Ya-Ching Hung
- Queens College, City University of New York, New York, NY, United States
| | - Maxime T Robert
- Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York, NY, United States
| | | | - Ana Smorenburg
- Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York, NY, United States
| | | | - Jason B Carmel
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, United States
| | - Talita Campos
- Burke Neurological Institute, White Plains, NY, United States.,Teachers College, Columbia University, New York, NY, United States
| | - Andrew M Gordon
- Teachers College, Columbia University, New York, NY, United States
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Hornáček K, Kujawa J, Varela Donoso E, Dincer F, Ilieva E, Takáč P, Petronic Markovic I, Votava J, Vetra A, Nikolic D, Christodoulou N, Zampolini M, Kiekens C. Evidence Based Position Paper on Physical and Rehabilitation Medicine professional practice for persons with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:1020-1035. [PMID: 33861040 DOI: 10.23736/s1973-9087.21.06983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. AIM The aim of this study was to improve Physical and Rehabilitation Medicine physician´s professional practice for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. MATERIAL AND METHODS A systematic review of the literature including an eighteen-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. RESULTS As the result of a Consensus Delphi procedure process 74 recommendations are presented together with the systematic literature review. CONCLUSIONS The PRM physician´s role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM programme developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients´ health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions.
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Affiliation(s)
- Karol Hornáček
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Jolanta Kujawa
- Department of Physical and Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University of School of Medicine, Madrid, Spain
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Peter Takáč
- Department of Physical and Rehabilitation Medicine, L. Pasteur University Hospital, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic -
| | - Ivana Petronic Markovic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jiří Votava
- Faculty of Health Studies, University of J. E. Purkyně, Ústí nad Labem, Czech Republic
| | - Anita Vetra
- Rehabilitation Department, Riga Stradins University, Riga, Latvia
| | - Dejan Nikolic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Zampolini
- Department of Rehabilitation, Foligno Hospital, USL Umbria 2, Perugia, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola Bologna, Italy
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Feitosa AM, Mancini MC, Silvério APM, Gordon AM, Brandão MB. "Help Me to Improve my Own Priorities!": A Feasibility Study of an Individualized Intensive Goal Training for Adolescents with Cerebral Palsy. Phys Occup Ther Pediatr 2021; 41:601-619. [PMID: 33653225 DOI: 10.1080/01942638.2021.1891186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To investigate the feasibility and the preliminary effects of an individualized intensive goal training for adolescents with cerebral palsy (CP). METHODS Twelve adolescents with CP (12-17 years old, MACS II-III, GMFCS I-IV) identified functional goals to be practiced three hours/day, five days/week, for two weeks. The feasibility aspects included the participant's adherence (i.e., daily logs), the adequacy of the instruments used, and the participant's satisfaction with the intervention (i.e., structured questionnaire). Outcome measures included the Canadian Occupational Performance Measure (COPM), Pediatric Evaluation of Disability Inventory (PEDI) (self-care; mobility), Children Helping Out: Responsibilities, Expectations and Supports (CHORES), Participation and Environment Measure-Children and Youth (PEM-CY) (home) and Box and Blocks Test (BBT). Assessments were conducted one month and two days before the intervention, immediately and three months after the intervention. Friedman tests were used to test time-related differences in the outcome measures. RESULTS All adolescents completed and reported satisfaction with the proposed intervention. Significant improvements were observed in performance and satisfaction (COPM), in functional skills and caregiver assistance in self-care and in the performance of household tasks. There were no significant differences in mobility skills, independence in mobility or household tasks, home participation, or manual dexterity. CONCLUSION The intensive training was feasible and promoted improvements in functional goals and daily functioning of adolescents with CP.
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Affiliation(s)
- Aline M Feitosa
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marisa C Mancini
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Paula M Silvério
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Marina B Brandão
- Graduate Program in Rehabilitation Sciences, Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Ravault L, Darbois N, Pinsault N. Methodological Considerations to Investigate Dosage Parameters of Intensive Upper Limb Rehabilitation in Children with Unilateral Spastic Cerebral Palsy: A Scoping Review of RCTs. Dev Neurorehabil 2020; 23:309-320. [PMID: 31710245 DOI: 10.1080/17518423.2019.1687599] [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: 10/25/2022]
Abstract
PURPOSES To identify and synthesize RCTs on the isolated effect of dosage parameters of upper limb Intensive Motor Rehabilitation Treatments (IMRT) of children with Unilateral Spastic Cerebral Palsy (USCP); to identify the most frequent methodological weaknesses. METHODS Searches were conducted until September 2018 in gray and published literature databases and supplemented by exploring the identified studies' references. Inclusion criteria applied: RCT; children aged 1.5 to 19 years with USCP; upper limb IMRT differing only from ≥1/4 dosage parameters between groups. Literature analyses conducted: qualitative and descriptive. RESULTS We identified 461 studies. Seventeen were included: three presented a rehabilitation dosage distinction between groups in Frequency-Time, four in Intensity-Progressivity, three in Intensity-Restraint, two in Intensity-Environment and five presented ≥3 distinctions above. CONCLUSIONS Inconsistencies were noted between USCP lifelong issues, and the short follow-ups and lack of participation assessments. Confounding factors and misstatements in Intent To Treat (ITT) analyses were identified. A meta-analysis was considered irrelevant. ABBREVIATIONS USCP, CP: Unilateral Spastic Cerebral Palsy, Cerebral Palsy; RCT: Randomized Controlled Trial; IMRT: Intensive Motor Rehabilitation Treatment.
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Affiliation(s)
- Lucas Ravault
- Grenoble Alps University Hospital , Grenoble, France
| | | | - Nicolas Pinsault
- Grenoble Alps University Hospital , Grenoble, France.,Grenoble Alps University , Grenoble, France.,ThEMAS team, TIMC-IMAG Laboratory, UMR CNRS-UGA 5525 , Grenoble, France
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12
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Jackman M, Lannin N, Galea C, Sakzewski L, Miller L, Novak I. What is the threshold dose of upper limb training for children with cerebral palsy to improve function? A systematic review. Aust Occup Ther J 2020; 67:269-280. [DOI: 10.1111/1440-1630.12666] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle Jackman
- Paediatric Occupational Therapy Department John Hunter Children’s Hospital Newcastle NSW Australia
| | - Natasha Lannin
- Occupational Therapy Department La Trobe University (School of Allied Health)The Alfred Prahran Vic Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Child and Adolescent HealthThe University of Sydney Frenchs Forest NSW Australia
| | - Leanne Sakzewski
- Centre for Children’s Health ResearchQueensland Cerebral Palsy and Rehabilitation Research CentreThe University of Queensland South Brisbane Qld Australia
| | - Laura Miller
- Australian Catholic University Banyo Qld Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Child and Adolescent HealthThe University of Sydney Frenchs Forest NSW Australia
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13
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Ouyang RG, Yang CN, Qu YL, Koduri MP, Chien CW. Effectiveness of hand-arm bimanual intensive training on upper extremity function in children with cerebral palsy: A systematic review. Eur J Paediatr Neurol 2020; 25:17-28. [PMID: 31902688 DOI: 10.1016/j.ejpn.2019.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 11/08/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To systematically review the effectiveness of Hand-Arm Bimanual Intensive Training (HABIT) on upper limb function in children with cerebral palsy. METHODS Six databases (MEDLINE, CINAHL, PubMed, Embase, Cochrane Library, and PsycINFO) were searched for HABIT-related studies published in English between 2007 and 2017. The methodological quality of the included studies was classified based on the Levels of Evidence of the American Occupational Therapy Association guidelines. If the included studies were randomized controlled trials (RCTs), the methodological quality was evaluated using the Revised Cochrane risk of bias tool. Cohen's d effect sizes were computed and synthesized to assess the effectiveness. RESULTS Among 646 studies, 15 fulfilled the inclusion criteria. Eleven studies were RCTs, 64% of which were rated as having a high risk of bias; one was a quasi-RCT, one was a retrospective study, and two were longitudinal studies. Nearly half of the included studies used HABIT for 6 h a day for three consecutive weeks (totaling 90 h), and some studies used different doses/schedules or added training components to HABIT. Synthesis of the results demonstrated a significantly small effect size (d = 0.36, P = 0.017) for improving upper limb function immediately after the interventions, and the improvements were maintained at follow-up. Similarly, significantly moderate or large effect sizes were found for self-care function (d = 0.52, P = 0.003) and goal improvements (d = 1.78-2.28, P < 0.001). CONCLUSION This review supports the effectiveness of HABIT as an intervention for improving upper limb function in children with cerebral palsy.
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Affiliation(s)
- Rang-Ge Ouyang
- Department of Rehabilitation, Xiangya Hospital, Central South University, Hunan, China
| | - Chieh-Ning Yang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Ya-Lan Qu
- School of Communication Sciences, The Beijing Language and Culture University, Beijing, China.
| | - Manohar Prasad Koduri
- Department of Mechanical, Materials, and Aerospace, School of Engineering, University of Liverpool, Liverpool, Harrison Hughes Building, Liverpool, L69 3GH, UK; International Intercollegiate Ph.D. Program, National Tsing Hua University, No. 101, Section 2, Guangfu Road, East District, Hsinchu City, Taiwan R.O.C
| | - Chi-Wen Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
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Hung YC, Spingarn A, Friel KM, Gordon AM. Intensive Unimanual Training Leads to Better Reaching and Head Control than Bimanual Training in Children with Unilateral Cerebral Palsy. Phys Occup Ther Pediatr 2020; 40:491-505. [PMID: 31942818 DOI: 10.1080/01942638.2020.1712513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS To quantify the changes in joint movement control and motor planning of the more-affected upper extremity (UE) during a reach-grasp-eat task in children with Unilateral Spastic Cerebral Palsy (USCP) after either constraint-induced movement therapy (CIMT) or hand-arm bimanual intensive therapy (HABIT). METHODS Twenty children with USCP (average age 7.7; MACS levels I-II) were randomized into either a CIMT or HABIT group. Both groups received intensive training 6 h a day for 15 days. Children performed a reach-grasp-eat task before and after training with their more-affected hand using 3D kinematic analysis. RESULTS Both groups illustrated shorter movement time during reaching, grasping, and eating phases after training (p < 0.05). Additionally, both intensive training approaches improved joint control with decreased trunk involvement, greater elbow, and wrist excursions during the reaching phase, and greater elbow excursion during the eating phase (p < 0.05). However, only the CIMT group decreased hand curvature during reaching, lowered hand position at grasp, and decreased head rotation during the eating phase (p < 0.05). CONCLUSIONS The current findings showed that both CIMT and HABIT improved UE joint control, but there were greater effects of CIMT on the more-affected UE motor planning and head control for children with USCP.
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Affiliation(s)
- Ya-Ching Hung
- Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, Flushing, NY, USA
| | - Aryeh Spingarn
- Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, Flushing, NY, USA
| | - Kathleen M Friel
- Neuroscience, Burke Medical Research Institute, Weill Cornell Medicine, White Plains, NY, USA
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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15
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Ferrante R, Hendershot S, Baranet K, Barbosa G, Carey H, Maitre N, Lo W, Pan J, Heathcock J. Daily and Weekly Rehabilitation Delivery for Young Children With Gross Motor Delay: A Randomized Clinical Trial Protocol (the DRIVE Study). Pediatr Phys Ther 2019; 31:217-224. [PMID: 30865149 PMCID: PMC7029804 DOI: 10.1097/pep.0000000000000594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The proposed project tests the principle that frequency of rehabilitation is an important regulator of therapeutic response in infants. METHODS We will randomize 75 infants with cerebral palsy, 6 to 24 months of age and/or Gross Motor Function Classification System levels III to V (higher severity), to determine the short-term and long-term effects of 3 dosing protocols consisting of an identical number of 2-hour sessions of the same motor learning-based therapy applied over a different total number of calendar weeks. RESULTS AND CONCLUSIONS The results will inform clinicians, families, and scientists about dosing and will provide needed recommendations for frequency of rehabilitation to optimize motor function and development of young children with cerebral palsy.
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Affiliation(s)
- Rachel Ferrante
- Nationwide Children's Hospital (Drs Ferrante, Hendershot, Baranet, Maitre, and Lo), Columbus, Ohio; The Ohio State University (Drs Barbosa, Pan, and Heathcock), Columbus, Ohio; Kettering College (Dr Carey), Kettering, Ohio
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16
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Brandão MB, Mancini MC, Ferre CL, Figueiredo PRP, Oliveira RHS, Gonçalves SC, Dias MCS, Gordon AM. Does Dosage Matter? A Pilot Study of Hand-Arm Bimanual Intensive Training (HABIT) Dose and Dosing Schedule in Children with Unilateral Cerebral Palsy. Phys Occup Ther Pediatr 2018; 38:227-242. [PMID: 29240518 DOI: 10.1080/01942638.2017.1407014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 hours) and two schedules of the same dose (90 vs. 2 × 45 hours) on hand and daily functioning. METHOD Eighteen children with unilateral cerebral palsy were randomized to receive 6 hours of daily training over 3 weeks, totaling 90 hours (Group 90, n = 9) or receive 6 hours of daily training over 1.5 weeks, totaling 45 hours (Group 2 × 45, n = 9). After 6 months, Group 2 × 45 received an additional 45 hours. Hand (Jebsen-Taylor Test of Hand Function, Assisting Hand Assessment) and daily functioning tests (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory) were administered before, immediately after, and 6 months after interventions. RESULTS Both groups demonstrated significant improvements in hand and daily functioning after 90 hours (Group 90) or the first 45 hours (Group 2 × 45), without differences between groups. However, more children from Group 90 obtained smallest detectable differences in the Assisting Hand Assessment. The addition of the second bout of 45 hours (Group 2 × 45) did not lead to further improvements. CONCLUSIONS As this study was powered to test for large differences between groups, future investigations on larger samples will be needed to compare differences at the two dosage levels.
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Affiliation(s)
- Marina B Brandão
- a Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Marisa C Mancini
- a Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Claudio L Ferre
- b Burke-Cornell Medical Research Institute , White Plains , New York , USA
| | | | - Rachel H S Oliveira
- a Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | | | - Miriam C S Dias
- d Occupational Therapist , Belo Horizonte , Minas Gerais , Brazil
| | - Andrew M Gordon
- e Department of Biobehavioral Sciences , Teachers College, Columbia University , New York , New York , USA
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17
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Hung YC, Gordon AM. Virtual reality training for children with unilateral cerebral palsy. Dev Med Child Neurol 2018; 60:334-335. [PMID: 29442357 DOI: 10.1111/dmcn.13699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ya-Ching Hung
- Queens College, City University of New York, Flushing, NY, USA
| | - Andrew M Gordon
- USA Teachers College, Columbia University, New York, NY, USA
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18
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Unilateral forelimb sensorimotor cortex devascularization disrupts the topographic and kinematic characteristics of hand movements while string-pulling for food in the rat. Behav Brain Res 2018; 338:88-100. [DOI: 10.1016/j.bbr.2017.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 02/06/2023]
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Branjerdporn N, Ziviani J, Sakzewski L. Goal-directed occupational therapy for children with unilateral cerebral palsy: Categorising and quantifying session content. Br J Occup Ther 2017. [DOI: 10.1177/0308022617743458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nataya Branjerdporn
- Occupational Therapy Honours Student, School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Jenny Ziviani
- Conjoint Professor, School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Conjoint Professor, Children’s Allied Health Research, Children’s Health Queensland, Australia
| | - Leanne Sakzewski
- Senior Postdoctoral Research Fellow, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Australia
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20
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Saussez G, Brandão MB, Gordon AM, Bleyenheuft Y. Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials. Front Neurol 2017; 8:495. [PMID: 29018400 PMCID: PMC5622919 DOI: 10.3389/fneur.2017.00495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/04/2017] [Indexed: 11/13/2022] Open
Abstract
Hand-Arm Bimanual Intensive Therapy (HABIT) promotes hand function using intensive practice of bimanual functional and play tasks. This intervention has shown to be efficacious to improve upper-extremity (UE) function in children with unilateral spastic cerebral palsy (USCP). In addition to UE function deficits, lower-extremity (LE) function and UE-LE coordination are also impaired in children with USCP. Recently, a new intervention has been introduced in which the LE is simultaneously engaged during HABIT (Hand-Arm Bimanual Intensive Therapy Including Lower Extremities; HABIT-ILE). Positive effects of this therapy have been demonstrated for both the UE and LE function in children with USCP. However, it is unknown whether the addition of this constant LE component during a bimanual intensive therapy attenuates UE improvements observed in children with USCP. This retrospective study, based on multiple randomized protocols, aims to compare the UE function improvements in children with USCP after HABIT or HABIT-ILE. This study included 86 children with USCP who received 90 h of either HABIT (n = 42) or HABIT-ILE (n = 44) as participants in previous studies. Children were assessed before, after, and 4-6 months after intervention. Primary outcomes were the ABILHAND-Kids and the Assisting Hand Assessment. Secondary measures included the Jebsen-Taylor Test of Hand Function, the Pediatric Evaluation of Disability Inventory [(PEDI); only the self-care functional ability domain] and the Canadian Occupational Performance Measure (COPM). Data analysis was performed using two-way repeated-measures analysis of variance with repeated measures on test sessions. Both groups showed similar, significant improvements for all tests (test session effect p < 0.001; group × test session interaction p > 0.05) except the PEDI and COPM. Larger improvements on these tests were found for the HABIT-ILE group (test session effect p < 0.001; group × test session interaction p < 0.05). These larger improvements may be explained by the constant simultaneous UE-LE engagement observed during the HABIT-ILE intervention since many daily living activities included in the PEDI and the COPM goals involve the LE and, more specifically, UE-LE coordination. We conclude that UE improvements in children with USCP are not attenuated by simultaneous UE-LE engagement during intensive intervention. In addition, systematic LE engagement during bimanual intensive intervention (HABIT-ILE) leads to larger functional improvements in activities of daily living involving the LE.
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Affiliation(s)
- Geoffroy Saussez
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, United States
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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21
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Gordon AM. Impaired Voluntary Movement Control and Its Rehabilitation in Cerebral Palsy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 957:291-311. [PMID: 28035572 DOI: 10.1007/978-3-319-47313-0_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Cerebral palsy is caused by early damage to the developing brain, as the most common pediatric neurological disorder. Hemiplegia (unilateral spastic cerebral palsy) is the most common subtype, and the resulting impairments, lateralized to one body side, especially affect the upper extremity, limiting daily function. This chapter first describes the pathophysiology and mechanisms underlying impaired upper extremity control of cerebral palsy. It will be shown that the severity of impaired hand function closely relates to the integrity of the corticospinal tract innervating the affected hand. It will also shown that the developing corticospinal tract can reorganize its connectivity depending on the timing and location of CNS injury, which also has implications for the severity of hand impairments and rehabilitation. The mechanisms underlying impaired motor function will be highlighted, including deficits in movement execution and planning and sensorimotor integration. It will be shown that despite having unimanual hand impairments, bimanual movement control deficits and mirror movements also impact function. Evidence for motor learning-based therapies including Constraint-Induced Movement Therapy and Bimanual Training, and the possible pathophysiological predictors of treatment outcome and plasticity will be described. Finally, future directions for rehabilitations will be presented.
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Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, New York, Box 93, 10027, USA.
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22
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Bleyenheuft Y, Gordon AM, Rameckers E, Thonnard JL, Arnould C. Measuring changes of manual ability with ABILHAND-Kids following intensive training for children with unilateral cerebral palsy. Dev Med Child Neurol 2017; 59:505-511. [PMID: 27896811 DOI: 10.1111/dmcn.13338] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 01/31/2023]
Abstract
AIM ABILHAND-Kids is a parent-reported questionnaire measuring manual ability in children with cerebral palsy (CP). Its psychometric properties have been established, with the exception of responsiveness, which is examined here. METHOD In this cohort study, 98 children (46 males, 52 females; range 6-19y, mean 11y, standard deviation [SD] 3.3y) with unilateral CP underwent three assessments of upper extremity function: at baseline (T1); after 80 to 90 hours of intensive training (T2); and at follow-up (T3). The responsiveness was analyzed using global, group (based on age and on Manual Ability Classification System [MACS] level), and individual approaches during two time periods (T1-T2 and T2-T3). Effect size was used to quantify magnitude of changes. RESULTS The global approach showed significant improvements between T1 and T2 (p<0.001) but not between T2 and T3 (p=0.222). In the group analyses, effect size and SRM demonstrated large changes in younger children (6-12y, n=52, mean change=1.06 logit, effect size >0.8) and small changes in the older children (13-19y, n=46, mean change=0.71 logit, effect size >0.4). Children in MACS level II demonstrated larger changes than children in MACS level I or III. INTERPRETATION The ABILHAND-Kids exhibited responsiveness in detecting changes after intensive training. Therefore, this scale is potentially useful in assessing the functional status of children with unilateral CP in clinical trials.
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Affiliation(s)
- Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Eugène Rameckers
- Rehabilitation Science, Maastricht University, Maastricht, the Netherlands.,Center of Expertise, Adelante Rehabilitation, Hoensbroek, the Netherlands
| | - Jean-Louis Thonnard
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Carlyne Arnould
- Physical and Occupational Therapy Departments, Paramedical Category, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium
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Ferre CL, Brandão M, Surana B, Dew AP, Moreau NG, Gordon AM. Caregiver-directed home-based intensive bimanual training in young children with unilateral spastic cerebral palsy: a randomized trial. Dev Med Child Neurol 2017; 59:497-504. [PMID: 27864822 DOI: 10.1111/dmcn.13330] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/30/2022]
Abstract
AIM To examine the efficacy of caregiver-directed, home-based intensive bimanual training in children with unilateral spastic cerebral palsy (USCP) using a randomized control trial. METHOD Twenty-four children (ages 2y 6mo-10y 1mo; 10 males, 14 females) performed home-based activities directed by a caregiver for 2 hours per day, 5 days per week, for 9 weeks (total=90h). Cohorts of children were age-matched into groups and randomized to receive home-based hand-arm bimanual intensive therapy (H-HABIT; n=12) or lower-limb functional intensive training (LIFT-control; n=12). Caregivers were trained before the intervention and supervised remotely via telerehabilitation. Dexterity and bimanual hand function were assessed using the Box and Blocks test (BBT) and the Assisting Hand Assessment (AHA) respectively. Caregiver perception of functional goals was measured using the Canadian Occupational Performance Measure (COPM). RESULTS H-HABIT showed greater improvement on the BBT compared to LIFT-control and no improvement on the AHA. H-HABIT demonstrated significant improvement in COPM-Performance compared to LIFT-control and both groups showed equal improvement in COPM-Satisfaction. INTERPRETATION H-HABIT improved dexterity and performance of functional goals, but not bimanual performance, in children with USCP compared to a control group receiving intervention of equal intensity/duration that also controlled for increased caregiver attention. Home-based models provide a valuable, family-centered approach to achieve increased treatment intensity.
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Affiliation(s)
- Claudio L Ferre
- Burke-Cornell Medical Research Institute, White Plains, NY, USA.,Biobehavioral Sciences Department, Teachers College, Columbia University, New York, NY, USA
| | - Marina Brandão
- Occupational Therapy Department, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bhavini Surana
- Biobehavioral Sciences Department, Teachers College, Columbia University, New York, NY, USA
| | - Ashley P Dew
- Department of Rehab Services, Ochsner Health System, New Orleans, LA, USA
| | - Noelle G Moreau
- Department of Physical Therapy, School of Allied Health Professions, LSU Health Sciences, New Orleans, LA, USA
| | - Andrew M Gordon
- Biobehavioral Sciences Department, Teachers College, Columbia University, New York, NY, USA
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24
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Hung YC, Brandão MB, Gordon AM. Structured skill practice during intensive bimanual training leads to better trunk and arm control than unstructured practice in children with unilateral spastic cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 60:65-76. [PMID: 27912104 DOI: 10.1016/j.ridd.2016.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/25/2016] [Accepted: 11/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Recently, intensive practice showed good efficacy in improving upper extremity function for children with unilateral spastic cerebral palsy (USCP). However, little is known about the significance of skill progression frequently used during intensive practice. AIMS We evaluate the importance of skill progression during intensive bimanual practice on movement coordination. METHODS AND PROCEDURES Twenty children with USCP (average age: 8.5; MACS levels: I-III) participated in the study. Ten children were randomly allocated to a structured practice group (SPG) with skill progression, and the other 10 children randomized to an unstructured practice group (UPG) without skill progression. Both groups practiced bimanual activities 6h a day for 15days. Children were asked to perform a bimanual drawer-opening task before and after intensive practice using 3-D kinematic analyses. OUTCOMES AND RESULTS Both groups showed improved temporal bimanual coordination with increased normalized movement overlap of the two hands (p=0.005) and decreased goal synchronization time (p=0.002). However, only the SPG showed decreased trunk involvement (p=0.01) and increased elbow joint excursion (p=0.017) with decreased variability (p=0.015 and 0.048 respectively). CONCLUSIONS AND IMPLICATIONS The results highlighted the importance of skill progression for intensive practice to improve upper extremity and trunk movement control and consistency for children with USCP.
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Affiliation(s)
- Ya-Ching Hung
- Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, 65-30 Kissena Blvd, Flushing, NY 11367, USA.
| | - Marina B Brandão
- Departamento de Terapia Ocupacional, Universidade Federal de Minas Gerais, Av. Pres. Antonio Carlos, 6627, Belo Horizonte, MG, 31270901, Brazil
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Box 93, New York, NY 10027, USA
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Kuo H, Ferre CL, Carmel JB, Gowatsky JL, Stanford AD, Rowny SB, Lisanby SH, Gordon AM, Friel KM. Using diffusion tensor imaging to identify corticospinal tract projection patterns in children with unilateral spastic cerebral palsy. Dev Med Child Neurol 2017; 59:65-71. [PMID: 27465858 PMCID: PMC5215687 DOI: 10.1111/dmcn.13192] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
Abstract
AIM To determine whether diffusion tensor imaging (DTI) can be an independent assessment for identifying the corticospinal tract (CST) projecting from the more-affected motor cortex in children with unilateral spastic cerebral palsy (CP). METHOD Twenty children with unilateral spastic CP participated in this study (16 males, four females; mean age 9y 2mo [standard deviation (SD) 3y 2mo], Manual Ability Classification System [MACS] level I-III). We used DTI tractography to reconstruct the CST projecting from the more-affected motor cortex. We mapped the motor representation of the more-affected hand by stimulating the more- and the less-affected motor cortex measured with single-pulse transcranial magnetic stimulation (TMS). We then verified the presence or absence of the contralateral CST by comparing the TMS map and DTI tractography. Fisher's exact test was used to determine the association between findings of TMS and DTI. RESULTS DTI tractography successfully identified the CST controlling the more-affected hand (sensitivity=82%, specificity=78%). INTERPRETATION Contralateral CST projecting from the lesioned motor cortex assessed by DTI is consistent with findings of TMS mapping. Since CST connectivity may be predictive of response to certain upper extremity treatments, DTI-identified CST connectivity may potentially be valuable for determining such connectivity where TMS is unavailable or inadvisable for children with seizures.
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Affiliation(s)
- Hsing‐Ching Kuo
- Department of Biobehavioral SciencesTeachers CollegeColumbia UniversityNew YorkNYUSA
| | | | - Jason B Carmel
- Burke‐Cornell Medical Research InstituteWhite PlainsNYUSA,Brain Mind Research Institute and Department of NeurologyWeill Cornell Medical CollegeNew YorkNYUSA,Department of PediatricsWeill Cornell Medical CollegeNew YorkNYUSA
| | - Jaimie L Gowatsky
- New York State Psychiatric InstituteColumbia UniversityNew YorkNYUSA
| | | | - Stefan B Rowny
- New York State Psychiatric InstituteColumbia UniversityNew YorkNYUSA
| | - Sarah H Lisanby
- Division of Translational ResearchNational Institutes of HealthRockvilleMDUSA
| | - Andrew M Gordon
- Department of Biobehavioral SciencesTeachers CollegeColumbia UniversityNew YorkNYUSA
| | - Kathleen M Friel
- Burke‐Cornell Medical Research InstituteWhite PlainsNYUSA,Brain Mind Research Institute and Department of NeurologyWeill Cornell Medical CollegeNew YorkNYUSA
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Sakzewski L, Reedman S, Hoffmann T. Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:417-427. [PMID: 27736712 DOI: 10.1016/j.ridd.2016.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Incomplete reporting of components of interventions limits uptake of evidence into clinical practice. AIMS To evaluate the completeness of reporting of research and control interventions in randomised trials of upper limb therapies for children with unilateral cerebral palsy. METHODS AND PROCEDURES Sixty randomized trials were included, encompassing 60 research and 68 control interventions. Using the 12-item Template for Intervention Description and Replication (TIDieR) checklist, two reviewers independently rated intervention and control descriptions. OUTCOMES AND RESULTS When using 50% of studies as the benchmark, five of the 12 TIDieR items for the research intervention, eight of the 12 items for the control intervention and 11 of 12 items for "usual care" interventions were inadequately reported. Procedures used to deliver the research intervention were adequately reported for 63% of studies. Materials were used in 94% of research interventions, yet only 27% provided details to access/replicate materials. Training materials for interventionists were used in 38% of trials, 10 (17%) had procedure manuals, yet only 3 reported details to access materials. The location where the research intervention was provided was detailed in 65% of studies. Reporting of all items was poorer for the control intervention. CONCLUSIONS No study adequately reported all elements on the TIDieR checklist. Details crucial for replication of interventions and interpretation of results were missing. Authors, reviewers, and editors all have a responsibility to improve the quality of intervention reporting in published trials. The TIDieR guide is a potential solution, helping to structure accounts of interventions.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Smorenburg ARP, Gordon AM, Kuo HC, Ferre CL, Brandao M, Bleyenheuft Y, Carmel JB, Friel KM. Does Corticospinal Tract Connectivity Influence the Response to Intensive Bimanual Therapy in Children With Unilateral Cerebral Palsy? Neurorehabil Neural Repair 2016; 31:250-260. [PMID: 27856938 DOI: 10.1177/1545968316675427] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reorganization of the corticospinal tract (CST) can occur in unilateral spastic cerebral palsy (USCP). The affected hand can be controlled via (1) typical contralateral projections from the lesioned hemisphere, (2) ipsilateral projections from the nonlesioned hemisphere, and (3) a combination of contralateral and ipsilateral projections (ie, bilateral). Intensive bimanual therapy and constraint-induced movement therapy (CIMT) improve hand function of children with USCP. Earlier it was suggested that the CST connectivity pattern may influence the efficacy of CIMT. OBJECTIVE To examine whether CST projection pattern influences the efficacy of intensive bimanual therapy in children with USCP. PARTICIPANTS Thirty-three children with USCP (age 8.9 ± 2.6 years, 16 females). METHODS Bimanual therapy was provided in a day-camp setting (90 hours). Participants were involved in different bimanual play and functional activities actively engaging both hands. Hand function was tested before and after the intervention with the Jebsen-Taylor Test of Hand Function, Assisting Hand Assessment, ABILHAND-Kids, and the Canadian Occupational Performance Measure. Single-pulse transcranial magnetic stimulation (TMS) was used to determine each child's CST projection pattern (ie, ipsilateral, contralateral, or bilateral). RESULTS Children whose affected hand was controlled only by ipsilateral CST projections had worse Jebsen-Taylor Test of Hand Function and Assisting Hand Assessment scores than children in the contralateral group at baseline. Bimanual hand use and functional hand use was independent of CST projection pattern. After bimanual therapy, improvements on all outcome measures were observed, and these improvements were independent of the CST connectivity pattern. CONCLUSION The efficacy of bimanual therapy on hand function in children with USCP appears to be independent of CST connectivity pattern.
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Affiliation(s)
| | | | - Hsing-Ching Kuo
- 1 Burke-Cornell Medical Research Institute, White Plains, NY, USA.,2 Teachers College, Columbia University, New York, NY, USA
| | - Claudio L Ferre
- 1 Burke-Cornell Medical Research Institute, White Plains, NY, USA.,2 Teachers College, Columbia University, New York, NY, USA
| | - Marina Brandao
- 3 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Jason B Carmel
- 1 Burke-Cornell Medical Research Institute, White Plains, NY, USA.,5 Weill Cornell Medical College, New York, NY, USA
| | - Kathleen M Friel
- 1 Burke-Cornell Medical Research Institute, White Plains, NY, USA.,5 Weill Cornell Medical College, New York, NY, USA
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Friel KM, Kuo HC, Fuller J, Ferre CL, Brandão M, Carmel JB, Bleyenheuft Y, Gowatsky JL, Stanford AD, Rowny SB, Luber B, Bassi B, Murphy DLK, Lisanby SH, Gordon AM. Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy. Neurorehabil Neural Repair 2016; 30:834-44. [PMID: 26867559 DOI: 10.1177/1545968315625838] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intensive bimanual therapy can improve hand function in children with unilateral spastic cerebral palsy (USCP). We compared the effects of structured bimanual skill training versus unstructured bimanual practice on motor outcomes and motor map plasticity in children with USCP. Objective We hypothesized that structured skill training would produce greater motor map plasticity than unstructured practice. Methods Twenty children with USCP (average age 9.5; 12 males) received therapy in a day camp setting, 6 h/day, 5 days/week, for 3 weeks. In structured skill training (n = 10), children performed progressively more difficult movements and practiced functional goals. In unstructured practice (n = 10), children engaged in bimanual activities but did not practice skillful movements or functional goals. We used the Assisting Hand Assessment (AHA), Jebsen-Taylor Test of Hand Function (JTTHF), and Canadian Occupational Performance Measure (COPM) to measure hand function. We used single-pulse transcranial magnetic stimulation to map the representation of first dorsal interosseous and flexor carpi radialis muscles bilaterally. Results Both groups showed significant improvements in bimanual hand use (AHA; P < .05) and hand dexterity (JTTHF; P < .001). However, only the structured skill group showed increases in the size of the affected hand motor map and amplitudes of motor evoked potentials (P < .01). Most children who showed the most functional improvements (COPM) had the largest changes in map size. Conclusions These findings uncover a dichotomy of plasticity: the unstructured practice group improved hand function but did not show changes in motor maps. Skill training is important for driving motor cortex plasticity in children with USCP.
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Affiliation(s)
- Kathleen M Friel
- Burke-Cornell Medical Research Institute, White Plains, NY, USA Teachers College, Columbia University, New York, NY, USA Weill Cornell Medical College, New York, NY, USA
| | | | - Jason Fuller
- Burke-Cornell Medical Research Institute, White Plains, NY, USA New York University, New York, NY, USA
| | | | - Marina Brandão
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jason B Carmel
- Burke-Cornell Medical Research Institute, White Plains, NY, USA Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | | | - Bruce Bassi
- Columbia University Medical Center, New York, NY, USA
| | | | - Sarah H Lisanby
- Division of Translational Research, National Institutes of Health, Bethesda, MD, USA
| | - Andrew M Gordon
- Teachers College, Columbia University, New York, NY, USA Columbia University Medical Center, New York, NY, USA
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Kuo HC, Gordon AM, Henrionnet A, Hautfenne S, Friel KM, Bleyenheuft Y. The effects of intensive bimanual training with and without tactile training on tactile function in children with unilateral spastic cerebral palsy: A pilot study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:129-139. [PMID: 26698408 PMCID: PMC4871715 DOI: 10.1016/j.ridd.2015.11.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
Children with unilateral spastic cerebral palsy (USCP) often have tactile impairments. Intensive bimanual training improves the motor abilities, but the effects on the sensory system have not been studied. Here we compare the effects of bimanual training with and without tactile training on tactile impairments. Twenty children with USCP (6-15.5 years; MACS: I-III) were randomized to receive either bimanual therapy (HABIT) or HABIT+tactile training (HABIT+T). All participants received 82 h of standardized HABIT. In addition 8 sessions of 1h were provided to both groups. The HABIT+T group received tactile training (without vision) using materials of varied shapes and textures. The HABIT group received training with the same materials without tactile directed training (full vision). Primary outcomes included grating orientation task/GOT and stereognosis. Secondary outcomes included two-point discrimination/TPD, Semmes-Weinstein monofilaments/SWM. The GOT improved in both groups after training, while stereognosis of the more-affected hand tended to improve (but p=0.063). No changes were found in the TPD and the SWM. There were no group×test interactions for any measure. We conclude tactile spatial resolution can improve after bimanual training. Either intensive bimanual training alone or incorporation of materials with a diversity of shapes/textures may drive these changes.
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Affiliation(s)
- Hsing-Ching Kuo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Box 93, New York, NY 10027, USA.
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Box 93, New York, NY 10027, USA.
| | - Aline Henrionnet
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
| | - Sylvie Hautfenne
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
| | - Kathleen M Friel
- Burke-Cornell Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY 10605, USA; Brain-Mind Research Institute, Weill Cornell Medical College, 1300 York Ave, New York, NY 10021, USA.
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
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Abstract
PURPOSE To describe a daily physical therapy (PT) intervention program and outcomes for 2 young children with spastic quadriplegia, Gross Motor Function Classification System (GMFCS) level V, and to evaluate the feasibility of using a daily program in an urban children's hospital outpatient setting. SUMMARY OF KEY POINTS Two young children, GMFCS level V, received 2 hours of PT intervention based on motor learning principles 5 days a week for 4 consecutive weeks. Gross Motor Functional Measure (GMFM-66, GMFM-88) and the Bayley Scales of Infant Development, Third Edition, were used as pre- and postoutcome measures. The daily, high intensity intervention was well tolerated. Improvements in motor function, language, and cognitive skills were found. STATEMENT OF CONCLUSION A daily PT program appears feasible and may improve overall development in young children with cerebral palsy in GMFCS level V.
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Bleyenheuft Y, Arnould C, Brandao MB, Bleyenheuft C, Gordon AM. Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) in Children With Unilateral Spastic Cerebral Palsy: A Randomized Trial. Neurorehabil Neural Repair 2014; 29:645-57. [PMID: 25527487 DOI: 10.1177/1545968314562109] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intensive bimanual training results in more improvement in hand function in children with unilateral spastic cerebral palsy (USCP) than lower intensity conventional interventions. However, it is not known whether combined upper and lower extremity training in an intensive protocol is more efficacious for upper and lower functional abilities than conventional therapies provided in usual customary care. OBJECTIVE To determine the efficacy of Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) for children with USCP. METHODS Twenty-four children with USCP were randomized into 2 groups: an immediate HABIT-ILE group (IHG, initially receiving HABIT-ILE, 10 days = 90 hours), and a delayed HABIT-ILE group (DHG), which continued their conventional/ongoing treatment for an intended total duration of 90 hours. In phase 2, children in the DHG were crossed over to receive HABIT-ILE and children of the IHG were followed in their ongoing conventional therapy. Children were assessed using the Assisting Hand Assessment (AHA, primary outcome), the ABILHAND-Kids, and the Pediatric Evaluation of Disability Inventory. Dexterity (Box and Blocks Test [BBT]) and pinch strength were also measured. Locomotor abilities were assessed with Six-Minute Walk Test (6MWT, primary outcome) and ABILOCO-kids. Social participation was measured with the Assessment of Life-HABITs. RESULTS A 2 (groups) × 3 (test sessions) analysis of variance indicated significant improvements for primary outcomes (AHA, P < .001; 6MWT, P = .002) and all secondary assessments except BBT, step length and bodyweight distribution following HABIT-ILE, but not conventional therapy. CONCLUSION The findings suggest that combined upper and lower extremity in an intensive training protocol may be efficacious for improving both upper and lower extremity function in children with USCP.
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Affiliation(s)
- Yannick Bleyenheuft
- Institue of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Carlyne Arnould
- Physical and Occupational Therapy Department, Paramedical Category, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium
| | - Marina B Brandao
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Corrine Bleyenheuft
- Institue of Neuroscience, Université catholique de Louvain, Brussels, Belgium CHU Mont-Godinne, Yvoir, Belgium
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Friel KM, Williams PTJA, Serradj N, Chakrabarty S, Martin JH. Activity-Based Therapies for Repair of the Corticospinal System Injured during Development. Front Neurol 2014; 5:229. [PMID: 25505443 PMCID: PMC4241838 DOI: 10.3389/fneur.2014.00229] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/22/2014] [Indexed: 01/29/2023] Open
Abstract
This review presents the mechanistic underpinnings of corticospinal tract (CST) development, derived from animal models, and applies what has been learned to inform neural activity-based strategies for CST repair. We first discuss that, in normal development, early bilateral CST projections are later refined into a dense crossed CST projection, with maintenance of sparse ipsilateral projections. Using a novel mouse genetic model, we show that promoting the ipsilateral CST projection produces mirror movements, common in hemiplegic cerebral palsy (CP), suggesting that ipsilateral CST projections become maladaptive when they become abnormally dense and strong. We next discuss how animal studies support a developmental “competition rule” whereby more active/used connections are more competitive and overtake less active/used connections. Based on this rule, after unilateral injury the damaged CST is less able to compete for spinal synaptic connections than the uninjured CST. This can lead to a progressive loss of the injured hemisphere’s contralateral projection and a reactive gain of the undamaged hemisphere’s ipsilateral CST. Knowledge of the pathophysiology of the developing CST after injury informs interventional strategies. In an animal model of hemiplegic CP, promoting injured system activity or decreasing the uninjured system’s activity immediately after the period of a developmental injury both increase the synaptic competitiveness of the damaged system, contributing to significant CST repair and motor recovery. However, delayed intervention, despite significant CST repair, fails to restore skilled movements, stressing the need to consider repair strategies for other neural systems, including the rubrospinal and spinal interneuronal systems. Our interventional approaches harness neural activity-dependent processes and are highly effective in restoring function. These approaches are minimally invasive and are poised for translation to the human.
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Affiliation(s)
- Kathleen M Friel
- Department of Neurology, Brain and Mind Research Institute, Weill Cornell Medical College , New York, NY , USA ; Burke Medical Research Institute , White Plains, NY , USA
| | - Preston T J A Williams
- Department of Physiology, Pharmacology and Neuroscience, City College of the City University of New York , New York, NY , USA
| | - Najet Serradj
- Department of Physiology, Pharmacology and Neuroscience, City College of the City University of New York , New York, NY , USA
| | - Samit Chakrabarty
- School of Biomedical Sciences, Faculty of Biology, University of Leeds , Leeds , UK
| | - John H Martin
- Department of Physiology, Pharmacology and Neuroscience, City College of the City University of New York , New York, NY , USA ; The Graduate Center of the City University of New York , New York, NY , USA
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Bleyenheuft Y, Gordon AM. Hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) for children with cerebral palsy. Phys Occup Ther Pediatr 2014; 34:390-403. [PMID: 25271469 DOI: 10.3109/01942638.2014.932884] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hand-arm bimanual intensive therapy and constrained-induced movement therapy have shown evidence of effectiveness in improvement of upper extremity use in children with unilateral spastic cerebral palsy (CP). The effectiveness of interventions that are based on intensive practice of activities that combine UE and LE functions has not been reported. We propose that bimanual UE activities that simultaneously require trunk and LE postural adaptations uniquely address motor control limitations of children with unilateral spastic CP. The aim of this perspective is to present such an approach Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE). HABIT-ILE is unique in selection of tasks and activities that require simultaneous control and coordination of UE and LE movements. It is a motor-learning-based approach using problem solving and highly structured practice. During the intervention, activities and tasks are progressively graded toward more complex bimanual coordination for the UE and increasing demands of the LE. HABIT-ILE is provided in small groups for 90 hr using a camp model. Future research (randomized controlled trial) is needed to determine the effectiveness of HABIT-ILE.
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