1
|
Moen RD, Østensjø S. Understanding the use and benefits of assistive devices among young children with cerebral palsy and their families in Norway: a cross-sectional population-based registry study. Disabil Rehabil Assist Technol 2024; 19:1454-1462. [PMID: 37026592 DOI: 10.1080/17483107.2023.2198563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Assistive technology intervention has become an important strategy in enhancing function in young children with cerebral palsy. This study aimed to provide an in-depth knowledge of the use of assistive devices by describing their purposes, the environments in which they are used, frequency of use and perceived benefits from the caregiver's perspective. MATERIAL AND METHODS This is a cross-sectional population-based study using data from national cerebral palsy registers in Norway. Of a total of 202 children, 130 participated (mean age 49.9 months, SD 14.0 months). RESULTS The 130 children and their families used a median of 2.5 assistive devices (range 0-12) to support positioning, mobility, self-care and training, stimulation and play. Devices most commonly had one or two main purposes and were used both at home and in kindergarten/school. The usage rate varied from less than twice a week to several times a day. The majority of parents reported significant benefits for caregiving and/or the child's functioning. Total use increased in accordance with the level of the child's gross motor limitations and was associated with restrictions imposed by housing concerns. CONCLUSIONS The frequent use of a wide range of devices, and the intended and perceived benefits, demonstrates that early provision of assistive devices can be an effective function-enhancing strategy in young children with cerebral palsy. However, the findings also indicate that factors others than the child's motor abilities must be considered when integrating the use of devices into the child's daily routines and activities.
Collapse
Affiliation(s)
- Rikke Damkjær Moen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Medical Manager, Made for Movement, Skien, Norway
| | - Sigrid Østensjø
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
2
|
Field DA, Borisoff J, Chan FHN, Livingstone RW, Miller WC. Standing power wheelchairs and their use by children and youth with mobility limitations: an interrupted time series. Disabil Rehabil Assist Technol 2024; 19:454-464. [PMID: 35943726 DOI: 10.1080/17483107.2022.2096933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/27/2022] [Indexed: 10/15/2022]
Abstract
Standing power wheelchairs (PWSDs) expand positioning and mobility options for individuals with motor impairments. Although more available, little is known about how PWSDs are used in everyday life. PURPOSE to describe children's use of PWSDs in the first three months post-wheelchair delivery and the impacts on satisfaction with participation in daily life. MATERIALS AND METHODS An interrupted time series of purposefully sampled children aged 5-18 years who were receiving a PWSD. The Wheelchair Outcome Measure for Young People (WhOM-YP) documented satisfaction with patient-reported meaningful participation outcomes. Data loggers objectively measured wheelchair mobility outcomes including distance travelled, bouts of mobility, and duration. Data were measured over two sessions pre-wheelchair-delivery and at one week, one month and three months post-wheelchair-delivery. RESULTS Six children aged 7-18 years participated, four diagnosed with cerebral palsy, two with spina bifida. Analyses of individual data illustrated positive change in overall WhOM-YP satisfaction scores after PWSD provision though change varied across time, as did, distance, bouts of mobility and duration of use. Participants identified 14 in-home and 16 out-of-home unique participation outcomes, although several commonalities existed. CONCLUSION PWSDs hold promise for increasing children's satisfaction with participation in daily life, in addition to possibly increasing mobility outcomes. IMPLICATIONS FOR REHABILITATIONFor children with mobility limitations, PWSDs may promote participation in daily life and increased mobility.Data logger technology provides valuable information about children's PWSD use and how this varies over time.Benefits and challenges exist with implementing PWSD and data logger technologies.When implementing PWSD use, it is critical to consider context, training and support needs of clients and caregivers.
Collapse
Affiliation(s)
- Debra A Field
- Clinical Associate Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia (UBC); Occupational Therapist, Sunny Hill Health Centre for Children, Vancouver, Canada
| | - Jaimie Borisoff
- International Collaboration on Repair Discoveries (ICORD) and Principal Investigator Adjunct Faculty, Department of Occupational Science & Occupational Therapy, UBC; 'Director, MAKE+ and the Rehabilitation Engineering Design Laboratory, British Columbia Institute of Technology, Vancouver, Canada
| | - Franco H N Chan
- Rehabilitation Research Engineer, ICORD, UBC, Vancouver, Canada
| | - Roslyn W Livingstone
- Clinical Assistant Professor, Department of Occupational Science and Occupational Therapy; and Investigator, British Columbia Children's Hospital Research Institute, UBC; former Occupational Therapist, Sunny Hill Health Centre for Children, Vancouver, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, UBC, Principal Investigator, Rehabilitation Research Program, GF Strong Rehabilitation Centre and ICORD, UBC, Vancouver, Canada
| |
Collapse
|
3
|
Vlčkova B, Halámka J, Müller M, Sanz-Mengibar JM, Šafářová M. Can Clinical Assessment of Postural Control Explain Locomotive Body Function, Mobility, Self-Care and Participation in Children with Cerebral Palsy? Healthcare (Basel) 2024; 12:98. [PMID: 38201004 PMCID: PMC10779062 DOI: 10.3390/healthcare12010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/23/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Trunk control may influence self-care, mobility, and participation, as well as how children living with cerebral palsy (CP) move around. Mobility and Gross Motor performance are described over environmental factors, while locomotion can be understood as the intrinsic ontogenetic automatic postural function of the central nervous system, and could be the underlying element explaining the relationship between these factors. Our goal is to study the correlation among Trunk Control Measurement Scale (TCMS) and Pediatric Evaluation of Disability Inventory (PEDI) domains, as well as Locomotor Stages (LS). METHODS A feasibility observational analysis was designed including 25 children with CP who were assessed with these scales. RESULTS The strong correlation confirms higher levels of trunk control in children with better self-care, mobility and participation capacities. Strong correlations indicate also that higher LS show better levels of PEDI and TCMS domains. CONCLUSIONS Our results suggest that more mature LS require higher levels of trunk control, benefitting self-care, mobility and social functions.
Collapse
Affiliation(s)
- Blanka Vlčkova
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (B.V.); (J.H.); (M.Š.)
| | - Jiří Halámka
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (B.V.); (J.H.); (M.Š.)
| | - Markus Müller
- Physiotherapy Department, Evangelisches Krankenhaus Düsseldorf Sozialpädiatrisches Zentrum, 40217 Düsseldorf, Germany;
| | - Jose Manuel Sanz-Mengibar
- Queen Square Centre for Neuromuscular Diseases, University College London and National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Marcela Šafářová
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (B.V.); (J.H.); (M.Š.)
| |
Collapse
|
4
|
Bingol H, Kerem Gunel M. Exploration of the relationship between functional motor and communication performance levels and amount of use of the more affected upper extremity based on the caregivers' perceptions in children with hemiplegic cerebral palsy: A cross-sectional study. Rehabilitacion (Madr) 2023; 57:100784. [PMID: 36739683 DOI: 10.1016/j.rh.2023.100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Accepted: 12/08/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate relationships between amount of use of the more affected upper extremity and functional motor and communication performance classification systems. MATERIAL AND METHODS The study comprised 95 children with congenital hemiplegic cerebral palsy (CP) aged 6-15 years (52 males, 43 females; mean age 9.53, SD 3.1) and their parents/caregivers. The amount of use of the more affected upper extremity was assessed using Pediatric Motor Activity Log-Revised-How Often subscale (PMAL-R HO). Functional levels of the enrolled children were defined by the parents/caregivers using Manual Ability Classification System (MACS), Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R), and Communication Function Classification System (CFCS). RESULTS A strong and negative correlation was found between PMAL-R HO subscale score and MACS (r=-0.819), suggesting that children with lower MACS levels are more likely to use their more affected upper extremity spontaneously. Additionally, negative and moderate associations between PMAL-R HO subscale score and GMFCS and CFCS were revealed (r1=-0.549 and r2=-0.567). CONCLUSION The amount of use of the more affected upper extremity is more sensitive to MACS than GMFCS-E&R and CFCS. Children with a given MACS level had a wide range of PMAL-R HO subscale score. In addition to MACS, a score on the PMAL-R HO subscale related to the more affected upper extremity should be included as an inclusion criterion in clinical trials to avoid misleading effects of intervention approaches aimed at improving the amount of use of the more affected upper extremity in children with congenital hemiplegic CP.
Collapse
Affiliation(s)
- H Bingol
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Mus Alparslan University, Mus, Turkey.
| | - M Kerem Gunel
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Sıhhiye, Ankara, Turkey
| |
Collapse
|
5
|
Ericson A, Bartonek Å, Tedroff K, Lidbeck C. Responses to Sensory Events in Daily Life in Children with Cerebral Palsy from a Parent Reported Perspective and in a Swedish Context. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1139. [PMID: 37508634 PMCID: PMC10378633 DOI: 10.3390/children10071139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
The motor disorders of cerebral palsy (CP) are often accompanied by sensory disturbances, but knowledge of their relationship to motor functioning is sparse. This study explored responses to sensory events in relation to spastic subtype and motor functioning in children with CP. Parents of 60 children with CP (unilateral: 18, bilateral: 42) with GMFCS levels I:29, II:13, III:15 and IV:3 of mean age 12.3 years (3.7 SD) participated. The parents (n = 55) rated their children´s responses with the norm-referenced questionnaire Child Sensory Profile-2© (CSP-2©), Swedish version, incorporating nine sections and four sensory processing patterns/quadrants, and replied (n = 57) to two additional questions. On the CSP-2©, thirty (55%) of the children were reported to have responses "much more than others" (>2 SD) in one or more of the sections and/or quadrants and 22 (40%) in the section of Body Position, overrepresented by the children with bilateral CP. The additional questions revealed that a greater proportion of children at GMFCS levels III-IV compared to level I frequently were requested to sit/stand up straight (14/17 versus 6/26, p < 0.001) and were sound sensitive at a younger age (14/17 versus 10/26, p = 0.005). The findings of this study highlight the sensory aspects of motor functioning in children with spastic CP.
Collapse
Affiliation(s)
- Annika Ericson
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, S-171 76 Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, S-171 76 Stockholm, Sweden
| | - Cecilia Lidbeck
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, S-171 76 Stockholm, Sweden
| |
Collapse
|
6
|
Hou X, Qiu H, Liu L, Li Y, He L, Li J, Tang H, Xu K. Reliability and validity of the East Asian children's version of mini-MACS in children with cerebral palsy. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:997221. [DOI: 10.3389/fresc.2022.997221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022]
Abstract
BackgroundMini-Manual Ability Classification System (Mini-MACS) was developed for children with cerebral palsy aged 1–4 years, but its validity and reliability in different cultures are unavailable yet. This study was to determine the reliability and validity of Mini-MACS in East Asian children with cerebral palsy and investigate the correlation between Mini-MACS and Gross Motor Function Classification System.MethodsOne hundred and four East Asian children with cerebral palsy aged 12–48 months were classified by one of their parents, an occupational therapist, and a physical therapist with Mini-MACS. The results were analyzed for inter-rater reliability by using intraclass correlation coefficient (ICC). The Nine-hole Peg Test was used for the criterion-related validity analysis, and parents retested their children after 2 weeks to evaluate test–retest reliability. Gross Motor Function Classification System levels were also collected to investigate the correlation with Mini-MACS.ResultsGood inter-rater reliability among the occupational therapist, physical therapist, and parents was found [ICC = 0.984 (95% confidence interval, CI, 0.976–0.989), 0.973 (95% CI 0.960–0.982), and 0.966 (95% CI 0.950–0.977), respectively; p < 0.01]. The test–retest reliability in parents was almost perfect [ICC = 0.985 (95% CI 0.977–0.990), p < 0.01]. Mini-MACS had consistency with the Nine-hole Peg Test (r = 0.582, 0.581, and 0.566, respectively; p < 0.01). A correlation was found between Gross Motor Function Classification System and Mini-MACS (r = 0.626, 0.596, and 0.598, respectively; p < 0.01).ConclusionThe Mini-MACS demonstrates evidence that it is a valid and reliable tool to classify manual ability in East Asian children with cerebral palsy and is also positively related to the Gross Motor Function Classification System.
Collapse
|
7
|
Muacevic A, Adler JR. The Greek Version of Mini-Manual Ability Classification System (Mini-MACS): Translation and Reliability Study. Cureus 2022; 14:e30073. [PMID: 36381925 PMCID: PMC9639793 DOI: 10.7759/cureus.30073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The Mini-Manual Ability Classification System (Mini-MACS) is an adaptation of the MACS for children with cerebral palsy (CP) aged 1-4 years, which classifies children's performance to handle objects that are relevant to their age and development. The availability of a reliable Mini-MACS in Greek would allow for using it safely and properly in the clinical and research context of Greece. Therefore, the purpose of this study was to translate the original English version into Greek and examine its test-retest and interrater reliability. MATERIAL AND METHODS The English Mini-MACS was translated into Greek using the "forward-backward" method. Sixty-three children with CP, Gross Motor Function Classification System (GMFCS) levels I-V, aged 12 -50 months were included in the reliability study. Test-retest and interrater reliability were assessed using the interclass correlation coefficient (ICC). The association between Mini-MACS and GMFCS level ratings was also assessed using Spearman's rho correlation coefficient (ρ). RESULTS The translated version was easy to understand and use. The Greek Mini-MACS was found to have excellent test-retest reliability (ICC > 0.96) for both parents and therapists, good interrater reliability (ICC=0.89) between therapists and parents, and moderate-to-strong correlation with the GMFCS (ρ = 0.56-0.64, p < 0.0001). CONCLUSION The Greek Mini-MACS constitutes a user-friendly and reliable scale for use in the Greek population.
Collapse
|
8
|
Unes S, Tuncdemir M, Ozal C, Cankaya O, Seyhan Biyik K, Delioglu K, Gunbey C, Kerem Gunel M, Anlar B. Relationship among four functional classification systems and parent interpredicted intelligence level in children with different clinical types of cerebral palsy. Dev Neurorehabil 2022; 25:410-416. [PMID: 35301928 DOI: 10.1080/17518423.2022.2051629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the relationships between four functional classification systems in children with cerebral palsy (CP) and parent-interpredicted intelligence level, and the functional status in clinical types of CP. METHODS Two hundred and twenty-five children with CP ages between 2 and 18 (mean age 6.5 ± 4.4) years included using the Surveillance of CP in Europe (SCPE) database in Turkey. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Classification System (EDACS) levels were classified by clinical observation, and intelligence quotient (IQ) was determined by parent reports. RESULTS Correlations were found between all functional levels; the strongest were between GMFCS-MACS (r = 0.784, p < .001), CFCS-EDACS (r = 0.772, p < .001). Strong correlations were found for the IQ-CFCS (r = 0.762, p < .001) and IQ-EDACS (r = 0.634, p < .001). Correlations were stronger in children with bilateral CP and IQ level <70. CONCLUSIONS Taken together, these four classification systems and reported IQ levels can adequately describe overall functioning for children with CP. Our results can guide clinicians in the rehabilitation of children with CP.
Collapse
Affiliation(s)
- Sefa Unes
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Merve Tuncdemir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cemil Ozal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ozge Cankaya
- Departmant of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kütahya Health Sciences University, Kütahya, Turkey
| | - Kübra Seyhan Biyik
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Kıvanc Delioglu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ceren Gunbey
- Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem Gunel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Banu Anlar
- Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
9
|
Abu-Dahab SMN, Almasri NA, Saleh M, Malkawi SH. Determinants of Manual Abilities of Children with Cerebral Palsy: A National Registry-Based Study. Dev Neurorehabil 2022; 25:145-150. [PMID: 33852816 DOI: 10.1080/17518423.2021.1914761] [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: 10/21/2022]
Abstract
PURPOSE This cross-sectional study aimed to identify determinants of manual abilities of children with cerebral palsy (CP), as measured by the Manual Ability Classification System (MACS), in terms of intrinsic (child-related) and extrinsic (service-related) variables. METHODS The participants were 106 children with a confirmed diagnosis of CP (aged 4-16 years). Two ordinal logistic regression models were conducted to identify intrinsic and extrinsic determinants of manual abilities. RESULTS Four child-related (intrinsic) variables were found to be significant determinants of manual abilities: bimanual ability, ability to maintain and assume chair sitting, presence of seizures, and gross motor function, and only one service-related (extrinsic) significant variable was identified, which was receiving spasticity medications. DISCUSSION The results highlight several determinants that should be considered when assessing and intervening to improve manual abilities of children with CP. The findings are discussed in relation to the intervention approach, contextual modification, and assistive device prescription.
Collapse
Affiliation(s)
- Sana M N Abu-Dahab
- Department of Occupational Therapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Nihad A Almasri
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Maysoun Saleh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Somaya H Malkawi
- Department of Occupational Therapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| |
Collapse
|
10
|
Morel D. Special Needs Insurance: More Stability for a Growing Family's Budget. J Insur Med 2021; 49:1-31. [PMID: 34788842 DOI: 10.17849/insm-49-s1-1-31.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE.— To propose an insurance product called special needs insurance. The insurance will pay parents a lump sum up to $100,000 if they have a child that is born with or develops a special needs condition such as Down syndrome, cerebral palsy or autism. BACKGROUND.— Raising a child is expensive; raising a child with a special need can be hundreds of thousands of dollars more expensive. These additional costs include direct costs that are not covered by health insurance and indirect costs such as the loss of earnings when a working parent must tend to a special needs child. METHOD.— We analyze a gamut of birth and early childhood disabilities, both physical and cognitive, from the medico-actuarial perspective. We describe each condition using relevant medical literature and calculate prevalence rates from epidemiological studies (appendix A1-A15). After accounting for multiple births, we develop a final premium. RESULTS.— We find that physical impairments are sufficiently well understood to guarantee a fixed payout, whereas cognitive impairments such as autism are less understood, and so for these we propose a cognitive fund that does not guarantee a fixed payout. We find that an average single premium of $4,600 allows the insurer to profitably pay out the proposed benefits. CONCLUSIONS.— Raising a special needs child can put a significant strain on the affected family's budget. We propose an insurance product that provides relief through a large lump sum payout. Although no new insurance product can be guaranteed success, our analysis of this product gives an interested insurer reasonable justification to take on this new risk.
Collapse
|
11
|
Rosenberg L, Maeir A, Gilboa Y. Evaluating a Therapeutic Powered Mobility Camp for Children with Severe Cerebral Palsy. The Canadian Journal of Occupational Therapy 2021; 88:294-305. [PMID: 34435918 PMCID: PMC8640274 DOI: 10.1177/00084174211034938] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. Children and youth with severe cerebral palsy (CP) have limited independent mobility, which affects opportunities for overall development. Purpose. To examine the effectiveness of Power Fun, a therapeutic powered mobility summer camp. Methods. A quasi-experimental, repeated-measure design was used, with participants acting as their own control. Twenty-four participants with severe CP (aged 7-20 years) attended Power Fun for three weeks, five days/week. Assessments of powered mobility skills and functional mobility goals were conducted three weeks before the camp (T1), at baseline (T2), postintervention (T3), and at three-week follow-up (T4). Findings. An analysis of variance results indicated significant improvements in powered mobility skills (F(1,22) = 56.61, p < 0.001, η2p = 0.74) and functional mobility goals (F(1,58) = 80.17, p < 0.001, η2p = 0.74), with 70% of goals achieved postintervention. A descriptive analysis revealed three learning profiles. Implications. This study provides initial evidence supporting the effectiveness of Power Fun as an intervention promoting powered mobility for children with severe CP, across a range of abilities.
Collapse
Affiliation(s)
- Lori Rosenberg
- Lori Rosenberg, School of Occupational Therapy, 1 Churchill Blvd, PO Box 24026, Jerusalem, Israel.
| | | | | |
Collapse
|
12
|
Chen KL, Huang CY, Chen CT, Chow JC, Chou W. Development of the computerized adaptive test of motor development (MD-CAT) adopting multidimensional Rasch analysis. Arch Phys Med Rehabil 2021; 102:2185-2192.e2. [PMID: 34245683 DOI: 10.1016/j.apmr.2021.06.007] [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: 08/13/2020] [Revised: 05/06/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to develop the computerized adaptive test of motor development (MD-CAT) in preschool children based on multidimensional Rasch analysis. DESIGN A retrospective study with cross-sectional design SETTING: A medical center PARTICIPANTS: 1,738 children INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: MD-CAT RESULTS: Multidimensional Rasch analysis was used to develop the item bank of the MD-CAT. The item bank of the MD-CAT contained 74 items, with 44 and 30 items respectively for the subscales of gross and fine motor skills. High correlation existed between the two subscales (r = 0.96). Three stopping rules were set for the MD-CAT: (1) the person reliability achieved 0.95 or the limited reliability increased by < 0.01, (2) at least 3 items were assessed in each dimension, and (3) the number of items used for assessment reached 16. Based on the three stopping rules, the MD-CAT had high correlations with its total test length (r =0.87 to 0.98 for the two dimensions), indicating sufficient construct validity. The MD-CAT also had adequate diagnostic validity (area under the curve = 0.72-0.93) and efficiency (an average of 3 to 6 items used for the assessment). CONCLUSION The MD-CAT has high precision and efficiency, good construct validity and high diagnostic validity. The results of our study indicate that the MD-CAT can be useful in clinical practice and in research as a diagnostic measure.
Collapse
Affiliation(s)
- Kuan-Lin Chen
- Department of Occupational Therapy, College of Medicine, National Cheng Kung, University, No. 1, University Rd., Tainan City 701, Taiwan (R.O.C.); Department of Physical Medicine and Rehabilitation, National Cheng Kung, University Hospital, College of Medicine, National Cheng Kung University, No. 1, University Rd., Tainan City 701, Taiwan (R.O.C.); Institute of Allied Health Sciences, College of Medicine, National Cheng Kung, University, No. 1, University Rd., Tainan City 701, Taiwan (R.O.C.)
| | - Chien-Yu Huang
- School of Occupational Therapy, College of Medicine, I-Shou University, No. 8, Yida Rd., Kaohsiung City 82445, Taiwan (R.O.C.)
| | - Cheng-Te Chen
- Department of Educational Psychology and Counseling, National Tsing Hua, University, No. 101, Section 2, Kuang-Fu Rd., Hsinchu, Taiwan (R.O.C)
| | - Julie Chi Chow
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan (R.O.C.); School of Medicine, Kaohsiung Medical University, Kaohsiung (R.O.C.)
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical Center, Taiwan (R.O.C.); Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Taiwan (R.O.C.).
| |
Collapse
|
13
|
Papadimitriou I, Dalivigka Z, Outsika C, Scarmeas N, Pons R. Dystonia assessment in children with cerebral palsy and periventricular leukomalacia. Eur J Paediatr Neurol 2021; 32:8-15. [PMID: 33743389 DOI: 10.1016/j.ejpn.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/15/2021] [Accepted: 03/02/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the frequency, motor phenotype, clinical patterns and functional consequences of dystonia in patients with cerebral palsy (CP) in the setting of periventricular leukomalacia. METHODS Retrospective analysis of a cohort of 31 patients with CP and periventricular leukomalacia. Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were used to classify functional ability. Spasticity was rated using the Modified Ashworth Scale. Presence of dystonia was assessed by reviewing video recordings, and its severity by using the Burke-Fahn-Marsden Dystonia Rating Scale. RESULTS All patients showed evidence of dystonia involving upper and/or lower limbs, neck, trunk, mouth and eyes in order of frequency. In 29% of patients dystonia involved only the limbs and in 71% it was multifocal. Dystonia severity ranged from slight to severe. Severity and distribution of dystonia did not correlate with gender, age, weeks of gestation or duration of neonatal unit stay. GMFCS and MACS correlated with dystonia but not with spasticity. CONCLUSIONS Severity of dystonia, but not spasticity is associated with the severity of motor functional disability in CP patients with periventricular leukomalacia and demonstrates the key role of dystonia in the motor function of these patients.
Collapse
Affiliation(s)
- Ioanna Papadimitriou
- 1st Department of Pediatrics, Aghia Sofia Children's Hospital, National and Kapodistrian University of Athens, Thivon and Levadias, Athens, 11527, Greece
| | - Zoi Dalivigka
- Pediatric Rehabilitation Unit, Pan & Aglaia's Kyriakou Children's Hospital, Leof. Andrea Siggrou 290, Kallithea, 17673, Greece.
| | - Chrysa Outsika
- 1st Department of Pediatrics, Aghia Sofia Children's Hospital, National and Kapodistrian University of Athens, Thivon and Levadias, Athens, 11527, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Leof. Vasilissis Sofias 72, Athens, 11528, Greece; Department of Neurology, Columbia University, New York, 710 W 168th St, New York, NY, 10032, USA.
| | - Roser Pons
- 1st Department of Pediatrics, Aghia Sofia Children's Hospital, National and Kapodistrian University of Athens, Thivon and Levadias, Athens, 11527, Greece.
| |
Collapse
|
14
|
Eek MN, Lidman G. Arm Muscle Strength in Children with Bilateral Spastic CP. Phys Occup Ther Pediatr 2021; 41:529-539. [PMID: 33487084 DOI: 10.1080/01942638.2021.1872757] [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: 10/22/2022]
Abstract
AIMS To assess arm-muscle strength related to motor function in children with bilateral spastic cerebral palsy, 5-15 years old. METHODS Muscle strength was measured for shoulder abductors, elbow extensors and flexors, wrist extensors, and grip strength. The children were grouped according to the Manual Ability Classification Scale (MACS). RESULTS Forty-two children were included. The majority of the children at MACS levels I-II were within the normal range; shoulder abductors were weakest (mean 60-80% of predicted value), and variation was greatest for wrist extensors.Children at MACS level II showed lower values than children at level I, with significant differences for shoulder abductors (p=.028) and wrist extensors (p<.001). Differences between the dominant and non-dominant side was greater in children at MACS level II and statistically significant for wrist extensors (p=.024).Of 15 children tested for grip strength, nine were within the 2 SD range. The three children at MACS level II, all walking with a walker, had a higher mean value than those at MACS level I. CONCLUSIONS Muscle strength was lower and differences were greater between sides in children at MACS level II. Wrist extensors showed a decreasing trend with age as compared with normal development.
Collapse
Affiliation(s)
- Meta N Eek
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Git Lidman
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Rehabilitation Centre, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
15
|
Haberfehlner H, Bonouvrié LA, Boeschoten K, Fleuren S, Monbaliu E, Becher JG, Vermeulen RJ, Buizer AI. Use of the Dyskinesia Impairment Scale in non-ambulatory dyskinetic cerebral palsy. Dev Med Child Neurol 2020; 62:494-499. [PMID: 31784988 PMCID: PMC7079134 DOI: 10.1111/dmcn.14415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 12/01/2022]
Abstract
AIM To assess the responsiveness, concurrent validity, and feasibility of the Dyskinesia Impairment Scale (DIS) in non-ambulatory patients with dyskinetic cerebral palsy (CP). METHOD The study is a secondary analysis of data collected in the IDYS trial, a randomized controlled trial on the effects of intrathecal baclofen (ITB). The DIS and Barry-Albright Dystonia Scale (BADS) were conducted at baseline and after 3 months of ITB or placebo treatment. Responsiveness was assessed by comparing the effect sizes and correlation of change after treatment between the DIS and BADS. Concurrent validity was evaluated by assessing the correlations between scales. Feasibility was evaluated for each DIS item by the number of participants who successfully accomplished the item. RESULTS Thirty-three non-ambulatory patients (9 females, 24 males) with dyskinetic CP (ITB-treated: n=17, mean [SD] age: 14y 1mo [4y 1mo]; placebo-treated: n=16, mean [SD] age: 14y 7mo [4y]) were included in the study. The effect sizes for BADS and DIS were similar in The ITB-treated group (-0.29 and -0.22 respectively). Changes after treatment on the DIS dystonia subscale correlated with changes on the BADS (r=0.64; p<0.001). The DIS dystonia subscale and BADS correlated at baseline and follow-up (r=0.78; p<0.001 and r=0.79; p<0.001). Not all DIS activity items could be performed in this sample of patients. INTERPRETATION For non-ambulatory patients with dyskinetic CP, the responsiveness of the DIS equalled the responsiveness of BADS. Concurrent validity was adequate. Feasibility for activity items was restricted in patients with severe dyskinetic CP. WHAT THIS PAPER ADDS The Dyskinesia Impairment Scale (DIS) and Barry-Albright Dystonia Scale showed similar responsiveness in non-ambulatory patients with dyskinetic cerebral palsy (CP). No floor or ceiling effect was observed for DIS in non-ambulatory participants. The concurrent validity of DIS was adequate in non-ambulatory participants. Patients with dyskinetic CP in Gross Motor Function Classification System levels IV and V could not perform all DIS activity items.
Collapse
Affiliation(s)
- Helga Haberfehlner
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamthe Netherlands
| | - Laura A Bonouvrié
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamthe Netherlands
| | - Karin Boeschoten
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamthe Netherlands
| | - Sabine Fleuren
- Department of NeurologySection of Pediatric NeurologyMaastricht UMC+Maastrichtthe Netherlands
| | - Elegast Monbaliu
- Department of Rehabilitation SciencesKU Leuven Campus BruggeBruggeBelgium
| | - Jules G Becher
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamthe Netherlands
| | - R Jeroen Vermeulen
- Department of NeurologySection of Pediatric NeurologyMaastricht UMC+Maastrichtthe Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamthe Netherlands
| |
Collapse
|
16
|
Haberfehlner H, Goudriaan M, Bonouvrié LA, Jansma EP, Harlaar J, Vermeulen RJ, van der Krogt MM, Buizer AI. Instrumented assessment of motor function in dyskinetic cerebral palsy: a systematic review. J Neuroeng Rehabil 2020; 17:39. [PMID: 32138731 PMCID: PMC7057465 DOI: 10.1186/s12984-020-00658-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 02/13/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In this systematic review we investigate which instrumented measurements are available to assess motor impairments, related activity limitations and participation restrictions in children and young adults with dyskinetic cerebral palsy. We aim to classify these instrumented measurements using the categories of the international classification of functioning, disability and health for children and youth (ICF-CY) and provide an overview of the outcome parameters. METHODS A systematic literature search was performed in November 2019. We electronically searched Pubmed, Embase and Scopus databases. Search blocks included (a) cerebral palsy, (b) athetosis, dystonia and/or dyskinesia, (c) age 2-24 years and (d) instrumented measurements (using keywords such as biomechanics, sensors, smartphone, and robot). RESULTS Our search yielded 4537 articles. After inspection of titles and abstracts, a full text of 245 of those articles were included and assessed for further eligibility. A total of 49 articles met our inclusion criteria. A broad spectrum of instruments and technologies are used to assess motor function in dyskinetic cerebral palsy, with the majority using 3D motion capture and surface electromyography. Only for a small number of instruments methodological quality was assessed, with only one study showing an adequate assessment of test-retest reliability. The majority of studies was at ICF-CY function and structure level and assessed control of voluntary movement (29 of 49) mainly in the upper extremity, followed by assessment of involuntary movements (15 of 49), muscle tone/motor reflex (6 of 49), gait pattern (5 of 49) and muscle power (2 of 49). At ICF-CY level of activities and participation hand and arm use (9 of 49), fine hand use (5 of 49), lifting and carrying objects (3 of 49), maintaining a body position (2 of 49), walking (1 of 49) and moving around using equipment (1 of 49) was assessed. Only a few methods are potentially suitable outside the clinical environment (e.g. inertial sensors, accelerometers). CONCLUSION Although the current review shows the potential of several instrumented methods to be used as objective outcome measures in dyskinetic cerebral palsy, their methodological quality is still unknown. Future development should focus on evaluating clinimetrics, including validating against clinical meaningfulness. New technological developments should aim for measurements that can be applied outside the laboratory.
Collapse
Affiliation(s)
- Helga Haberfehlner
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, PO Box 7057, Amsterdam, 1007MB, The Netherlands.
| | - Marije Goudriaan
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, PO Box 7057, Amsterdam, 1007MB, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Laura A Bonouvrié
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, PO Box 7057, Amsterdam, 1007MB, The Netherlands
| | - Elise P Jansma
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, PO Box 7057, Amsterdam, 1007MB, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Section of Pediatric Neurology, Maastricht UMC+, Maastricht, The Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, PO Box 7057, Amsterdam, 1007MB, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, PO Box 7057, Amsterdam, 1007MB, The Netherlands
| |
Collapse
|
17
|
Epidemiology of Cerebral Palsy in Adulthood: A Systematic Review and Meta-analysis of the Most Frequently Studied Outcomes. Arch Phys Med Rehabil 2020; 101:1041-1052. [PMID: 32059945 DOI: 10.1016/j.apmr.2020.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/13/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the epidemiology of health status, impairments, activities and participation in adults with cerebral palsy (CP). DATA SOURCES Embase, MEDLINE, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane, and Google Scholar were searched for 3 themes ("cerebral palsy," "adult," and "outcome assessment") in literature published between January 2000 and December 2018. STUDY SELECTION Full-article peer-reviewed English journal articles on descriptive, observational, or experimental studies describing the most studied outcomes in adults with CP (n≥25, age≥18y) were included. Studies were included in the analyses if frequently studied outcomes were described in at least 3 studies using similar methods of assessment. DATA EXTRACTION Data were extracted independently by 2 authors from 65 articles (total N=28,429) using a standardized score sheet. DATA SYNTHESIS Meta-analyses revealed that overall, on average 65.1% (95% confidence interval [CI], 55.1-74.5) of adults with CP experienced pain, 57.9% (95% CI, 51.1-64.6) were ambulant, 65.5% (95% CI, 61.2-69.7) had little or no limitation in manual ability, 18.2% (95% CI, 10.6-27.2) had tertiary education, 39.2% (95% CI, 31.5;47.1) were employed, and 29.3% (95% CI, 9.0-55.3) lived independently. In adults without intellectual disability, proportions of individuals who were ambulant (72.6% [95% CI, 58.8-84.5]) and lived independently (90.0% [95% CI, 83.8-94.9]) were higher (P=.014 and P<.01, respectively). The Fatigue Severity Scale score was 4.1 (95% CI, 3.8-4.4). Epilepsy (28.8% [95% CI, 20.1-38.4]) and asthma (28.3% [95% CI, 18.7-38.9]) were especially prevalent comorbidities. CONCLUSIONS The present systematic review and meta-analysis on the epidemiology of adults with CP provided state-of-the-art knowledge on the most frequently studied outcomes. On average, adults with CP are fatigued, and a majority experience pain, are ambulant, and have little or no difficulty with manual ability. On average, 40% are employed and 30% live independently. More uniformity in assessment and reports is advised to improve knowledge on epidemiology and gain insight in more outcomes.
Collapse
|
18
|
Bahrampour M, Downes M, Boyd RN, Scuffham PA, Byrnes J. Using Rasch and factor analysis to develop a Proxy-Reported health state classification (descriptive) system for Cerebral Palsy. Disabil Rehabil 2020; 43:2647-2655. [DOI: 10.1080/09638288.2019.1709565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Mina Bahrampour
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children’s Health Research, The University of Queensland, Brisbane, Australia
| | - Paul A. Scuffham
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| |
Collapse
|
19
|
Farr WJ, Green D, Bremner S, Male I, Gage H, Bailey S, Speller S, Colville V, Jackson M, Memon A, Morris C. Feasibility of a randomised controlled trial to evaluate home-based virtual reality therapy in children with cerebral palsy. Disabil Rehabil 2019; 43:85-97. [PMID: 31131641 DOI: 10.1080/09638288.2019.1618400] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Evidence is increasing for effective virtual reality therapy for motor rehabilitation for children with Cerebral Palsy. We assessed the feasibility of a virtual reality therapy mode of intervention, appropriateness of measures, and potential cost-effectiveness. METHODS A 12-week, 2-group, parallel-feasibility trial (ISRCT 17624388) using Nintendo Wii FitTM at home. Children aged 5-16, with ambulatory Cerebral Palsy, who were able to follow simple instructions were randomised to two groups; one supported by physiotherapists (individualised activity programme), the other unsupported with children having free choice (control). Children were assessed in clinic at baseline, week 6, and week 12 by blinded assessors. Feasibility of the intervention was assessed via recruitment, adherence, and usefulness of measurement tools. RESULTS Forty-four children were eligible (out of 48 approached): 31 consented, 30 were randomised, 21 completed the study; 10 in the supported group and 11 in the unsupported group. Nine children discontinued from tiredness, after-school activities, homework, surgery, technical difficulties or negative system feedback. The supported group completed 19 of 36 (IQR 5-35) possible sessions; the unsupported group 24 of 36 sessions (IQR 8-36). Gross Motor Function Measure scores varied by Cerebral Palsy severity after the intervention. There were no adverse events. CONCLUSION Virtual reality therapy offers potential as a therapeutic adjunct for children with Cerebral Palsy, warranting substantive confirmatory study. Gross Motor Function Measure, with modifications to improve sensitivity, appeared appropriate as a primary measure, with Timed up and Go test secondary. The intervention was inexpensive costing £20 per child. An explanatory trial to evaluate the clinical/cost-effectiveness of commercial system virtual reality therapy is feasible with minor methodological adaptation. Implications for rehabilitation Home-based interactive computer gaming was feasible, safe and cost effective as a therapy adjunct. Discontinue if additional pressures are present: imminent surgery, family resilience to technical difficulties, negative system feedback, after-school activities. Change in Gross Motor Function Measurement scores varied by severity of Cerebral Palsy.
Collapse
Affiliation(s)
- William J Farr
- Research and Innovation, Sussex Community NHS Trust, Brighton, England.,Brighton and Sussex Medical School, Brighton, England
| | - Dido Green
- Department of Rehabilitation, Oxford Brookes University, Oxford, England
| | | | - Ian Male
- Research and Innovation, Sussex Community NHS Trust, Brighton, England.,Brighton and Sussex Medical School, Brighton, England
| | - Heather Gage
- School of Economics, University of Surrey, Guildford, England
| | - Sarah Bailey
- Medical School, University of Exeter, Exeter, England
| | - Sandra Speller
- Research and Innovation, Sussex Community NHS Trust, Brighton, England
| | - Valerie Colville
- Parent partnership advisors Sussex Community NHS Trust, Brighton, England
| | - Mandy Jackson
- Parent partnership advisors Sussex Community NHS Trust, Brighton, England
| | - Anjum Memon
- Brighton and Sussex Medical School, Brighton, England
| | | |
Collapse
|
20
|
Milton YM, Dunford C, Newby KV. Occupational therapy home programmes for children with cerebral palsy: A national survey of United Kingdom paediatric occupational therapy practice. Br J Occup Ther 2019. [DOI: 10.1177/0308022619830263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yvonne M Milton
- Faculty of Health and Life Sciences, Coventry University, UK
- Adoptionplus, Buckinghamshire, UK
| | - Carolyn Dunford
- Department of Clinical Sciences, Brunel University London, UK
| | - Katie V Newby
- Centre for Advances in Behavioural Science, Coventry University, UK
| |
Collapse
|
21
|
Jeon I, Bang MS, Lim JY, Shin HI, Leigh JH, Kim K, Kwon BS, Jang SN, Jung SH. Sarcopenia among Adults with Cerebral Palsy in South Korea. PM R 2019; 11:1296-1301. [PMID: 30729753 DOI: 10.1002/pmrj.12134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/31/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Most adults with cerebral palsy encounter newly developing physical health problems and premature functional decline with aging. These physical and functional losses along with the characteristic symptoms of cerebral palsy may heighten the risk of sarcopenia. OBJECTIVE To determine the prevalence of sarcopenia among a selected group of adults with cerebral palsy and to identify the factors associated with their sarcopenia among them. DESIGN Cross-sectional study. SETTING University hospitals and communities for persons with disabilities. PARTICIPANTS A total of 80 adults with cerebral palsy (46 men and 34 women with mean age of 42.8 ± 8.86 years) were included. METHOD Muscle mass, strength, and physical performance were measured to diagnose sarcopenia. Participants also completed a structured questionnaire for physical, psychological, or socioeconomic attributes and health-related quality of life. MAIN OUTCOME MEASURES Prevalence of sarcopenia in adults with cerebral palsy. RESULTS The prevalence of sarcopenia was 47.9%. Sarcopenia was significantly associated with sex, the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), body mass index (BMI), and trunk fat. Male, higher GMFCS and lower BMI were significant risk factors of sarcopenia. Sarcopenic adults with cerebral palsy showed significantly lower health-related quality of life. CONCLUSION The prevalence of sarcopenia in adults with cerebral palsy was higher than that of general population despite the young age of the selected group. Modifiable risk factor was a low BMI. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Inpyo Jeon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Incheon St.Mary's Hospital, Incheon, Republic of Korea
| | - KeeWon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University College of Medicine, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of KoreaDisclosure: nothing to disclose
| |
Collapse
|
22
|
Piscitelli D, Vercelli S, Meroni R, Zagnoni G, Pellicciari L. Reliability of the gross motor function classification system and the manual ability classification system in children with cerebral palsy in Tanzania. Dev Neurorehabil 2019; 22:80-86. [PMID: 28692325 DOI: 10.1080/17518423.2017.1342710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) are broadly studied in high-income countries, but data concerning their functioning are lacking in developing countries. Therefore, we analyzed their reliability and sensitivity to change in children with cerebral palsy in Tanzania. METHODS GMFCS and MACS are two ordinal grading systems used to assess motor functions while observing children's performances. Forty-nine children were classified by two independent physiotherapy students at baseline, after one month and after one year. Reliability and sensitivity to change were analyzed using intraclass correlation coefficient (ICC), effect size (ES), standard response mean (SRM), standard error of measurement (SEM), and minimal detectable change (MDC). RESULTS Inter- (ICC = 0.97/0.95 for GMFCS/MACS) and intra-rater reliability (ICC = 0.98/0.96 GMFCS/MACS) were excellent. Sensitivity to change was small (ES = -0.14/0.11, SRM = -0.24;/0.24 GMFCS/MACS). SEM was 0.2 points, resulting in MDC = 0.5/0.7 for GMFCS/MACS, respectively. CONCLUSIONS GMFCS and MACS demonstrated excellent reliability, but not sensitivity to change.
Collapse
Affiliation(s)
- Daniele Piscitelli
- a PhD Program in Neuroscience, School of Medicine and Surgery , University of Milano-Bicocca , Monza , Italy.,b Nyumba Ali Organization , Bologna , Italy
| | - Stefano Vercelli
- c Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Division of Physical Medicine and Rehabilitation , Salvatore Maugeri Foundation - IRCCS, Scientific Institute of Veruno , Novara , Italy
| | - Roberto Meroni
- d School of Medicine and Surgery, Program in Physical Therapy , University of Milano-Bicocca , Milan , Italy
| | - Giulia Zagnoni
- b Nyumba Ali Organization , Bologna , Italy.,e School of Medicine, Program in Physical Therapy , University of Bologna , Bologna , Italy
| | - Leonardo Pellicciari
- f PhD Program in Advanced Sciences and Technologies in Rehabilitation Medicine and Sports, Department of Clinical Sciences and Translational Medicine , Tor Vergata University of Rome , Rome , Italy
| |
Collapse
|
23
|
Kim DS, Kim ED, Kim GW, Won YH, Ko MH, Seo JH, Park SH. Motor Evoked Potentials in the Upper Extremities of Children with Spastic Hemiplegic Cerebral Palsy. BRAIN & NEUROREHABILITATION 2019. [DOI: 10.12786/bn.2019.12.e10] [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)
- Da-Sol Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
| | - Eu-Deum Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jeon-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| |
Collapse
|
24
|
Socioeconomic Status Influences Functional Severity of Untreated Cerebral Palsy in Nepal: A Prospective Analysis and Systematic Review. Clin Orthop Relat Res 2019; 477:10-21. [PMID: 30179955 PMCID: PMC6345316 DOI: 10.1097/corr.0000000000000476] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cerebral palsy (CP) comprises a heterogeneous group of disorders whose clinical manifestations and epidemiologic characteristics vary across socioeconomic and geographic contexts. The functional severity of untreated CP in low-income countries has been insufficiently studied; a better understanding of how these children present for care in resource-constrained environments is important because it will better characterize the natural history of CP, guide clinical decision-making, and aid in the prognostication of children with untreated CP. QUESTIONS/PURPOSES The purposes of this study were (1) to determine the etiologies, motor subtypes, topographic distributions, and functional classifications of a large cohort of Nepali children with untreated CP presenting to a large pediatric rehabilitation center in Nepal; and (2) to compare the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) scores of a subset of patients with spastic CP in the Nepali cohort with control subjects from high-income countries. METHODS A cross-sectional study was conducted at the Hospital and Rehabilitation Centre for Disabled Children in Nepal. Two hundred six consecutive Nepali children (76 girls; median age 4.0 years [interquartile range {IQR}, 2.5-9.0 years]) were evaluated to determine the demographic, clinical, and functional characteristics of a cohort of Nepali children with untreated CP. A systematic review of the Medline and Cochrane databases was then performed to obtain reference classification scores from high-income countries. Cross-sectional, noninterventional studies reporting at least one functional classification system with a sample size of at least 50 participants were included. Only studies of patients with spastic CP were included to allow for compatible comparisons with a subset of our study sample with spastic CP. A random-effects analysis was used to pool functional scores from participants in the included studies. Among the 206 children in our sample, 102 had spastic CP (35 girls; median age 5.5 years [IQR, 3.5-9.0 years]). Functional scores from these children were compared with pooled scores obtained from the systematic review by assessing the proportions of children in each sample with GMFCS, MACS, and CFCS score categories of I or II versus III to V. RESULTS Children with spastic hemiplegia from high-income countries were more likely to have a GMFCS score of I or II (96% [95% confidence interval {CI}, 92%-99%] versus 78% [95% CI, 62%-89%]) and a MACS score of I or II (83% [95% CI, 77%-88%] versus 50% [95% CI, 32%-68%]) relative to those from Nepal, but they were less likely to have a CFCS score of I or II (67% [95% CI, 51%-80%] versus 97% [95% CI, 87%-99%]). No differences were seen in children with spastic diplegia or quadriplegia. CONCLUSIONS Children in Nepal with hemiplegic CP display less difficulty in communicating and social engagement (CFCS) despite more-severe upper- and lower-extremity impairments in gross motor function (GMFCS) and manual ability (MACS) than do children with hemiplegic CP from high-income countries. Targeted interventions, including perhaps simple orthopaedic interventions to treat soft-tissue contractures, may therefore provide more-substantial improvements in function and quality of life to Nepali children than could be achieved for the same deployment of resources in more-affluent settings. LEVEL OF EVIDENCE Level II, prognostic study.
Collapse
|
25
|
Gilard V, Chadie A, Ferracci FX, Brasseur-Daudruy M, Proust F, Marret S, Curey S. Post hemorrhagic hydrocephalus and neurodevelopmental outcomes in a context of neonatal intraventricular hemorrhage: an institutional experience in 122 preterm children. BMC Pediatr 2018; 18:288. [PMID: 30170570 PMCID: PMC6119335 DOI: 10.1186/s12887-018-1249-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) is a frequent complication in extreme and very preterm births. Despite a high risk of death and impaired neurodevelopment, the precise prognosis of infants with IVH remains unclear. The objective of this study was to evaluate the rate and predictive factors of evolution to post hemorrhagic hydrocephalus (PHH) requiring a shunt, in newborns with IVH and to report their neurodevelopmental outcomes at 2 years of age. METHODS Among all preterm newborns admitted to the department of neonatalogy at Rouen University Hospital, France between January 2000 and December 2013, 122 had an IVH and were included in the study. Newborns with grade 1 IVH according to the Papile classification were excluded. RESULTS At 2-year, 18% (n = 22) of our IVH cohort required permanent cerebro spinal fluid (CSF) derivation. High IVH grade, low gestational age at birth and increased head circumference were risk factors for PHH. The rate of death of IVH was 36.9% (n = 45). The rate of cerebral palsy was 55.9% (n = 43) in the 77 surviving patients (49.4%). Risk factors for impaired neurodevelopment were high grade IVH and increased head circumference. CONCLUSION High IVH grade was strongly correlated with death and neurodevelopmental outcome. The impact of an increased head circumference highlights the need for early management. CSF biomarkers and new medical treatments such as antenatal magnesium sulfate have emerged and could predict and improve the prognosis of these newborns with PHH.
Collapse
Affiliation(s)
- Vianney Gilard
- Neurosurgery Department, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
| | - Alexandra Chadie
- Paediatrics Department, Rouen University Hospital, 76000, Rouen, France
| | | | | | - François Proust
- Neurosurgery Department, Strasbourg University Hospital, 67000, Strasbourg, France
| | - Stéphane Marret
- Paediatrics Department, Rouen University Hospital, 76000, Rouen, France
| | - Sophie Curey
- Neurosurgery Department, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| |
Collapse
|
26
|
Almasri NA, Saleh M, Abu-Dahab S, Malkawi SH, Nordmark E. Functional profiles of children with cerebral palsy in Jordan based on the association between gross motor function and manual ability. BMC Pediatr 2018; 18:276. [PMID: 30131063 PMCID: PMC6103966 DOI: 10.1186/s12887-018-1257-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 08/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background Cerebral palsy (CP) is the most common cause of physical disability in childhood. A major challenge for delivering effective services for children with CP is the heterogeneity of the medical condition. Categorizing children into homogeneous groups based on functional profiles is expected to improve service planning. The aims of this study were to (1) to describe functional profiles of children with CP based on the Gross Motor Function Classification System-Expanded & Revised (GMFCS-E & R) and the Manual Ability Classification System (MACS); and (2) to examine associations and agreements between the GMFCS-E & R and the MACS for all participants then for subgroups based on subtypes of CP and chronological age of children. Methods A convenience sample of 124 children with CP (mean age 4.5, SD 2.9 years, 56% male) participated in the study. Children were classified into the GMFCS-E & R and the MACS levels by research assistants based on parents input. Research assistants determined the subtypes of CP. Results Thirty six percent of the participants were able to ambulate independently (GMFCS-E & R levels I-II) and 64% were able to handle objects independently (MACS levels I-II). The most common functional profile of children with CP in our study is the “manual abilities better than gross motor function”. An overall strong correlation was found between the GMFCS-E & R and the MACS (rs = .73, p < .001), the correlations vary significantly based on subtypes of CP and chronological age of children. A very strong correlation was found in children with spastic quadriplegia (rs = .81, p < .001), moderate with spastic diplegia (rs = .64, p < .001), and weak with spastic hemiplegia (rs = .37, p < .001). Conclusions The GMFCS- E & R and the MACS provide complementary but distinctive information related to mobility and manual abilities of children with CP. Subtypes of CP and chronological age differentiated functional profiles. Functional abilities of children with CP in Jordan have similar patterns to children with CP in other countries. Functional profiles can inform clinicians, researchers, and policy makers.
Collapse
Affiliation(s)
- Nihad A Almasri
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Queen Rania Al Abdallah St, Amman, 11942, Jordan.
| | - Maysoun Saleh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Queen Rania Al Abdallah St, Amman, 11942, Jordan
| | - Sana Abu-Dahab
- Department of occupational therapy, School of Rehabilitation Sciences, The University of Jordan, Queen Rania Al Abdallah St, Amman, 11942, Jordan
| | - Somaya H Malkawi
- Department of occupational therapy, School of Rehabilitation Sciences, The University of Jordan, Queen Rania Al Abdallah St, Amman, 11942, Jordan
| | - Eva Nordmark
- Faculty of Medicine, Lund university, P.0. 157, SE-221 00, Lund, Sweden
| |
Collapse
|
27
|
Guedin N, Fluss J, Thevenot C. Dexterity and Finger Sense: A Possible Dissociation in Children With Cerebral Palsy. Percept Mot Skills 2018; 125:718-731. [DOI: 10.1177/0031512518779473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Both hand and finger sensory perception and motor abilities are essential for the development of skilled gestures and efficient bimanual coordination. While finger dexterity and finger sensory perception can be impaired in children with cerebral palsy (CP), the relationship between these two functions in this population is not clearly established. The common assumption that CP children with better sensory function also demonstrate better motor outcomes has been recently challenged. To study these questions further, we assessed both finger dexterity and finger gnosia, the ability to perceive one’s own fingers by touch, in groups of 11 children with unilateral (i.e., hemiplegic CP) and 11 children with bilateral spastic CP (i.e., diplegic CP) and compared them with typical children. In our sample, children with hemiplegia exhibited finger dexterity deficit in both hands and finger gnosia deficit only in their paretic hand. In contrast, children with diplegia exhibited finger gnosia deficits in both hands and finger dexterity deficit only in their dominant hand. Thus, our results indicated that children with spastic hemiplegia and diplegia present different sensory and motor profiles and suggest that these two subgroups of CP should be considered separately in future experimental and clinical research. We discuss the implications of our results for rehabilitation.
Collapse
Affiliation(s)
| | - Joel Fluss
- Pediatric Neurology Unit, Pediatric Subspecialties Service, Children’s Hospital of Geneva, Switzerland
| | | |
Collapse
|
28
|
Lee BH. Relationship between gross motor function and the function, activity and participation components of the International Classification of Functioning in children with spastic cerebral palsy. J Phys Ther Sci 2017; 29:1732-1736. [PMID: 29184279 PMCID: PMC5684000 DOI: 10.1589/jpts.29.1732] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/26/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to evaluate the relationship between gross motor function, measured using the Gross Motor Function Measure (GMFM), Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Functional Independence Measure for Children (WeeFIM), and Function, and Activity and Participation components of the International Classification of Functioning, Disability, and Health-Child and Youth Check List (ICF-CY) in children with spastic cerebral palsy (CP). [Subjects and Methods] Seventy-seven children with spastic CP participated in the study. The GMFM, GMFCS, MACS, and WeeFIM were administered in their entirety to patients without orthoses or mobility aids. The ICF-CY was used to evaluate the degree of disability and health. [Results] The score of the ICF component of Activity and Participation had a significantly strong correlation with the scores of GMFM, GMFCS, MACS, WeeFIM, and ICF component of Function. [Conclusion] When establishing a treatment plan for children with spastic CP, the children's physical abilities, and their limitation in activity, performance, and participation, which would be measured using the ICF-CY, should be taken into consideration.
Collapse
Affiliation(s)
- Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University: 815 Hwarang-ro, Nowon-gu, Seoul 01795, Republic of Korea
| |
Collapse
|
29
|
Pons R, Vanezis A, Skouteli H, Papavasiliou A, Tziomaki M, Syrengelas D, Darras N. Upper Limb Function, Kinematic Analysis, and Dystonia Assessment in Children With Spastic Diplegic Cerebral Palsy and Periventricular Leukomalacia. J Child Neurol 2017; 32:936-941. [PMID: 28776460 DOI: 10.1177/0883073817722451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Assessment of upper limb function, kinematic analysis, and dystonia in patients with spastic diplegia cerebral palsy and periventricular leukomalacia. Seven children with spastic diplegia cerebral palsy and 8 controls underwent upper limb kinematics. Movement duration, average and maximum linear velocity, index of curvature, index of dystonia, and target accuracy and stability were analyzed. In the patients with spastic diplegia, Gross Motor Function and Manual Ability Classification Systems were determined, and spasticity and dystonia were rated using the Modified Ashworth and the Burke-Fahn-Marsden Dystonia scales respectively. Children with spastic diplegia demonstrated a tendency toward higher index of dystonia reflecting overflow, higher index of curvature, lower velocities, and poor target accuracy and stability. All patients showed clinical evidence of dystonia in the upper limbs. Dystonia scores correlated with the Manual Ability Classification System (r = 0.86, P = .01) and with the index of dystonia (r = 0.82, P = .02). Children with spastic diplegia cerebral palsy present dystonia in the upper limbs. This is functionally relevant and can be measured with kinematic analysis.
Collapse
Affiliation(s)
- Roser Pons
- 1 First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Vanezis
- 2 Gait and Motion Analysis Center, ELEPAP-Rehabilitation for the Disabled, Athens, Greece
| | - Helen Skouteli
- 2 Gait and Motion Analysis Center, ELEPAP-Rehabilitation for the Disabled, Athens, Greece
| | | | - Magda Tziomaki
- 2 Gait and Motion Analysis Center, ELEPAP-Rehabilitation for the Disabled, Athens, Greece
| | - Dimitris Syrengelas
- 4 Department of Pediatric Physical Therapy, Agia Sofia Children's Hospital, Athens, Greece
| | - Nikolaos Darras
- 2 Gait and Motion Analysis Center, ELEPAP-Rehabilitation for the Disabled, Athens, Greece
| |
Collapse
|
30
|
Yim SY, Yang CY, Park JH, Kim MY, Shin YB, Kang EY, Lee ZI, Kwon BS, Chang JC, Kim SW, Kim MO, Kwon JY, Jung HY, Sung IY. Korean Database of Cerebral Palsy: A Report on Characteristics of Cerebral Palsy in South Korea. Ann Rehabil Med 2017; 41:638-649. [PMID: 28971049 PMCID: PMC5608672 DOI: 10.5535/arm.2017.41.4.638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To introduce the Korean Database of Cerebral Palsy (KDCP) and to provide the first report on characteristics of subjects with cerebral palsy (CP). Methods The KDCP is a nationwide database of subjects with CP, which includes a total of 773 subjects. Characteristics such as demography, birth history, onset and type of CP, brain magnetic resonance imaging (MRI) findings, functional ability and accompanying impairments, were extracted and analyzed. Results Preterm delivery and low birth weight were found in 59.51% and 60.28% of subjects, respectively. Postnatally acquired CP was 15.3%. The distribution of CP was 87.32%, 5.17%, and 1.81% for spastic, dyskinetic, and ataxic types, respectively. Functional ability was the worst in dyskinetic CP, as compared to other types of CP. Speech-language disorder (43.9%), ophthalmologic impairment (32.9%), and intellectual disability (30.3%) were the three most common accompanying impairments. The number of accompanying impairments was elevated in subjects with preterm birth and low birth weight. Brain MRI showed normal findings, malformations, and non-malformations in 10.62%, 9.56%, and 77.35% of subjects, respectively. Subjects with normal MRI findings had better functional ability than subjects with other MRI findings. MRI findings of a non-malformation origin, such as periventricular leukomalacia, were more common in subjects with preterm birth and low birth weight. Conclusion The KDCP and its first report are introduced in this report, wherein the KDCP established agreement on terminologies of CP. This study added information on the characteristics of subjects with CP in South Korea, which can now be compared to those of other countries and ethnicities.
Collapse
Affiliation(s)
- Shin-Young Yim
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon Korea
| | - Chung-Yong Yang
- Rehabilitation Institute of Chicago, Chicago, IL, USA and The Seum Hospital, Jeonju, Korea
| | - Joo Hyun Park
- Department of Physical Medicine and Rehabilitation, The Catholic University of Korea, Seoul, Korea
| | - Min Young Kim
- Department of Physical Medicine and Rehabilitation, CHA University, Seongnam, Korea
| | - Yong-Beom Shin
- Department of Physical Medicine and Rehabilitation, Pusan National University School of Medicine, Busan, Korea
| | - Eun-Young Kang
- Department of Physical Medicine and Rehabilitation, Kwangju Christian Hospital, Gwangju, Korea
| | - Zee-Ihn Lee
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Daegu, Korea
| | - Bum-Sun Kwon
- Department of Physical Medicine and Rehabilitation, Dongguk University College of Medicine, Goyang, Korea
| | - Ji Chan Chang
- Department of Physical Medicine and Rehabilitation, Hanmaeum Hospital, Jeju, Korea
| | - Seong Woo Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Myeong-Ok Kim
- Department of Physical Medicine and Rehabilitation, Inha University School of Medicine, Incheon, Korea
| | - Jeong-Yi Kwon
- Department of Physical Medicine and Rehabilitation, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Han-Young Jung
- Department of Physical Medicine and Rehabilitation, Inha University School of Medicine, Incheon, Korea
| | - In Young Sung
- Department of Physical Medicine and Rehabilitation, University of Ulsan College of Medicine, Seoul, Korea
| | | |
Collapse
|
31
|
Westbom L, Rimstedt A, Nordmark E. Assessments of pain in children and adolescents with cerebral palsy: a retrospective population-based registry study. Dev Med Child Neurol 2017; 59:858-863. [PMID: 28509356 DOI: 10.1111/dmcn.13459] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Abstract
AIM To explore pain screening in CPUP, a follow-up surveillance programme for people with cerebral palsy (CP), specifically to describe reported pain prevalence, localizations, patterns of distribution; to compare with studies using psychometrically sound assessment instruments; and to assess agreement between pain documented in CPUP and medical records. METHOD Registry study of a population with CP, born 1993 to 2008, living in Skåne, Sweden in 2013. Descriptive data, cross-tabulations, and chi-square tests to characterize and compare the study groups. Kappa analysis to test the concordance between register and medical record reports on pain. RESULTS Pain was reported by 185 out of 497 children (37%; females 40%, males 35%). Level V in both Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) was associated with highest prevalence of pain (50% and 54%), and level I with lowest prevalence of pain (30% and 32%). Pain was most frequent in dyskinetic CP (46%) and least frequent in unilateral spastic CP (33%). Feet and knees were the dominant localizations. Fair-moderate agreement (kappa 0.37, prevalence-adjusted bias-adjusted kappa [PABAK] 0.44) was found between documented pain in CPUP and medical records, although more seldom recognized in medical records. INTERPRETATION The distribution of pain between CP subtypes, functional levels, sex, and age in CPUP is concordant with previous population-based studies, indicating the validity of the CPUP pain screening. Despite this, further clinical evaluation with extended pain assessments and pain management were largely neglected in children reporting chronic pain.
Collapse
Affiliation(s)
- Lena Westbom
- Faculty of Medicine, Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden.,Department of Paediatrics, Skåne University Hospital, Lund, Sweden
| | | | - Eva Nordmark
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| |
Collapse
|
32
|
Elvrum AKG, Beckung E, Sæther R, Lydersen S, Vik T, Himmelmann K. Bimanual Capacity of Children With Cerebral Palsy: Intra- and Interrater Reliability of a Revised Edition of the Bimanual Fine Motor Function Classification. Phys Occup Ther Pediatr 2017; 37:239-251. [PMID: 27563732 DOI: 10.1080/01942638.2016.1185507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To develop a revised edition of the Bimanual Fine Motor Function (BFMF 2), as a classification of fine motor capacity in children with cerebral palsy (CP), and establish intra- and interrater reliability of this edition. METHODS The content of the original BFMF was discussed by an expert panel, resulting in a revised edition comprising the original description of the classification levels, but in addition including figures with specific explanatory text. Four professionals classified fine motor function of 79 children (3-17 years; 45 boys) who represented all subtypes of CP and Manual Ability Classification levels (I-V). Intra- and inter-rater reliability was assessed using overall intra-class correlation coefficient (ICC), and Cohen's quadratic weighted kappa. RESULTS The overall ICC was 0.86. Cohen's weighted kappa indicated high intra-rater (кw: >0.90) and inter-rater (кw: >0.85) reliability. CONCLUSIONS The revised BFMF 2 had high intra- and interrater reliability. The classification levels could be determined from short video recordings (<5 minutes), using the figures and precise descriptions of the fine motor function levels included in the BFMF 2. Thus, the BFMF 2 may be a feasible and useful classification of fine motor capacity both in research and in clinical practice.
Collapse
Affiliation(s)
- Ann-Kristin G Elvrum
- a Department of Clinical Services , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway.,b Department of Laboratory Medicine , Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway
| | - Eva Beckung
- c Department of Physiotherapy , Institute of Neuroscience and Physiology, Sahlgrenska, Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Rannei Sæther
- b Department of Laboratory Medicine , Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway.,d Department of Paediatrics , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
| | - Stian Lydersen
- e Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway
| | - Torstein Vik
- b Department of Laboratory Medicine , Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway
| | - Kate Himmelmann
- f Department of Pediatrics , Institute of Clinical Sciences, Queen Silvia Children's, Hospital, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| |
Collapse
|
33
|
Kamonseki DH, Cedin L, Clemente AF, Peixoto BDO, Zamunér AR. Translation, cross-cultural adaptation and validation of the ABILHAND-Kids for the Brazilian Portuguese. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/16856024022017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
ABSTRACT This study aimed to translate, to adapt cross-culturally and to validate the ABILHAND-Kids for the Brazilian Portuguese. ABILHAND-Kids was translated to Brazilian Portuguese and translated back by two certified translators in each phase. After the expert committee approval, the pre-test version was applied in 40 parents of children with cerebral palsy in order to verify item comprehension. Twenty-one volunteers were enrolled in the psychometric properties analysis. Reproducibility was verified by interrater and intrarater reliability and the validity was tested by investigating Box and Block Test, Purdue Pegboard Test and grip strength correlations. ABILHAND-Kids showed strong intrarater (ICC=0.91) and interrater (ICC=0.97) reliability and high internal consistency (Cronbach’s alfa: 0.99). ABILHAND-Kids showed significant correlations with Box and Block Test (performed by dominant upper extremity), Purdue Pegboard Test and grip strength. The Brazilian Portuguese version of ABILHAND-Kids is a reliable tool to measure upper extremities function of children with cerebral palsy, based on the perception of their parents.
Collapse
|
34
|
Johari S, Rassafiani M, Dalvand H, Ahmadi Kahjoogh M, Daemi M. Effects of maternal handling training at home, on development of fine motor skills in the children with cerebral palsy: A randomized clinical trial. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2016. [DOI: 10.1080/19411243.2016.1220342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
|
35
|
Milton Y, Roe S. Occupational therapy home programmes for children with unilateral cerebral palsy using bimanual and modified constraint induced movement therapies: A critical review. Br J Occup Ther 2016. [DOI: 10.1177/0308022616664738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The home context is considered a good location for children with cerebral palsy to practise meaningful occupations. The aim of this critical review was to gain a deeper understanding of how bimanual therapy and modified constraint induced movement therapy or constraint induced movement therapy methods are used within occupational therapy home programmes from an occupational perspective. Method A literature search was conducted using electronic databases for health research; five studies met the inclusion criteria. These were critically appraised and were analysed according to the relevant supports and barriers of the person–environment–occupation conceptual model of practice. Findings Family collaboration, strategic use of outcome measures, construction of the programme within the home environment and occupation-focused goals and activities emerged as commonly used methods. Enhanced descriptions of intervention context, the child’s voice in defining goals and challenges in optimising occupational balance surfaced as gaps in the programmes. Conclusion The methods used in implementing these approaches within occupational therapy home programmes requires combining motor and non-motor approaches, core occupational therapy skills, working within individual contexts and valuing family preferences. Using child-specific goal-setting instruments would strengthen the child’s voice and promote participation within a wider range of occupations.
Collapse
Affiliation(s)
- Yvonne Milton
- Senior Lecturer in Occupational Therapy, Coventry University, UK; Clinician, Adoptionplus, Milton Keynes, UK
| | - Sarah Roe
- Associate Head of School/Principal Lecturer in Occupational Therapy, Coventry University, UK
| |
Collapse
|
36
|
Ryalls BO, Harbourne R, Kelly-Vance L, Wickstrom J, Stergiou N, Kyvelidou A. A Perceptual Motor Intervention Improves Play Behavior in Children with Moderate to Severe Cerebral Palsy. Front Psychol 2016; 7:643. [PMID: 27199868 PMCID: PMC4853430 DOI: 10.3389/fpsyg.2016.00643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/18/2016] [Indexed: 11/30/2022] Open
Abstract
For children with moderate or severe cerebral palsy (CP), a foundational early goal is independent sitting. Sitting offers additional opportunities for object exploration, play and social engagement. The achievement of sitting coincides with important milestones in other developmental areas, such as social engagement with others, understanding of spatial relationships, and the use of both hands to explore objects. These milestones are essential skills necessary for play behavior. However, little is known about how sitting and play behavior might be affected by a physical therapy intervention in children with moderate or severe CP. Therefore, our overall purpose in this study was to determine if sitting skill could be advanced in children with moderate to severe CP using a perceptual motor intervention, and if play skills would change significantly as sitting advanced. Thirty children between the ages of 18 months and 6 years who were able to hold prop sitting for at least 10 s were recruited for this study. Outcome measures were the sitting subsection of the Gross Motor Function Measure (GMFM), and the Play Assessment of Children with Motor Impairment play assessment scale, which is a modified version of the Play in Early Childhood Evaluation System. Significant improvements in GMFM sitting scores (p < 0.001) and marginally significant improvement in play assessment scores (p = 0.067) were found from pre- to post-intervention. Sitting change explained a significant portion of the variance in play change for children over the age of 3 years, who were more severely affected by CP. The results of this study indicate that advances in sitting skill may be a factor in supporting improvements in functional play, along with age and severity of physical impairment.
Collapse
Affiliation(s)
| | | | | | | | - Nick Stergiou
- University of Nebraska at Omaha, OmahaNE, USA
- College of Public Health, University of Nebraska Medical Center, OmahaNE, USA
| | | |
Collapse
|
37
|
Surender S, Gowda VK, Sanjay KS, Basavaraja GV, Benakappa N, Benakappa A. Caregiver-reported health-related quality of life of children with cerebral palsy and their families and its association with gross motor function: A South Indian study. J Neurosci Rural Pract 2016; 7:223-7. [PMID: 27114652 PMCID: PMC4821929 DOI: 10.4103/0976-3147.178657] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: In children, health-related quality of life (HRQOL) includes parental impact and family functioning along with concepts of illness, functional status, mental health, and comfort. We are focusing on the impact of cerebral palsy (CP) on children's HRQOL and their families, and its relationship with gross motor dysfunction. Subjects and Methods: CP children aged 3–10 years under regular neurology follow-up were enrolled. The HRQOL and motor severity were prospectively assessed using lifestyle assessment questionnaire-CP and gross motor function classification systems, respectively. Results: One hundred children participated in this study. Thirty-three percent of children had good, 22% had mildly affected, whereas 45% had moderately to severely affected HRQOL. A significant association is present between gross motor function classification system and HRQOL. Conclusion: HRQOL in CP and their caregivers is highly impaired. The degree of impairment is associated with physical independence, mobility, clinical burden, and social integration dimensions. Therapies targeting these dimensions and associated comorbidities will improve the HRQOL. Gross motor function classification system is a good indicator of HRQOL.
Collapse
Affiliation(s)
- S Surender
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Vykuntaraju K Gowda
- Department of Paediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - K S Sanjay
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - G V Basavaraja
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Naveen Benakappa
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Asha Benakappa
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| |
Collapse
|
38
|
Sanz Mengibar JM, Santonja-Medina F, Sanchez-de-Muniain P, Canteras-Jordana M. Can Clinical Assessment of Locomotive Body Function Explain Gross Motor Environmental Performance in Cerebral Palsy? J Child Neurol 2016; 31:474-80. [PMID: 26294341 DOI: 10.1177/0883073815599264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Abstract
Gross Motor Function Classification System has discriminative purposes but does not assess short-term therapy goals. Locomotion Stages (LS) classify postural body functions and independent activity components. Assessing the relation between Gross Motor Function Classification System level and Locomotion Stages will make us understand if clinical assessment can explain and predict motor environmental performance in cerebral palsy. A total of 462 children were assessed with both scales. High reliability and strong negative correlation (-0.908) for Gross Motor Function Classification System and Locomotion Stages at any age was found. Sensitivity was 83%, and specificity and positive predictive value were 100% within the same age range. Regression analysis showed detailed probabilities for the realization of the Gross Motor Function Classification System depending on the Locomotion Stages and the age group. Postural body function measure with Locomotion Stages is reliable, sensitive, and specific for gross motor function and able to predict environmental performance.
Collapse
|
39
|
Elze MC, Gimeno H, Tustin K, Baker L, Lumsden DE, Hutton JL, Lin JPSM. Burke-Fahn-Marsden dystonia severity, Gross Motor, Manual Ability, and Communication Function Classification scales in childhood hyperkinetic movement disorders including cerebral palsy: a 'Rosetta Stone' study. Dev Med Child Neurol 2016; 58:145-53. [PMID: 26616635 DOI: 10.1111/dmcn.12965] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
AIM Hyperkinetic movement disorders (HMDs) can be assessed using impairment-based scales or functional classifications. The Burke-Fahn-Marsden Dystonia Rating Scale-movement (BFM-M) evaluates dystonia impairment, but may not reflect functional ability. The Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) are widely used in the literature on cerebral palsy to classify functional ability, but not in childhood movement disorders. We explore the concordance of these three functional scales in a large sample of paediatric HMDs and the impact of dystonia severity on these scales. METHOD Children with HMDs (n=161; median age 10y 3mo, range 2y 6mo-21y) were assessed using the BFM-M, GMFCS, MACS, and CFCS from 2007 to 2013. This cross-sectional study contrasts the information provided by these scales. RESULTS All four scales were strongly associated (all Spearman's rank correlation coefficient rs >0.72, p<0.001), with worse dystonia severity implying worse function. Secondary dystonias had worse dystonia and less function than primary dystonias (p<0.001). A longer proportion of life lived with dystonia is associated with more severe dystonia (rs =0.42, p<0.001). INTERPRETATION The BFM-M is strongly linked with the GMFCS, MACS, and CFCS, irrespective of aetiology. Each scale offers interrelated but complementary information and is applicable to all aetiologies. Movement disorders including cerebral palsy can be effectively evaluated using these scales.
Collapse
Affiliation(s)
- Markus C Elze
- Department of Statistics, University of Warwick, Coventry, UK.,Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Hortensia Gimeno
- Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, UK
| | - Kylee Tustin
- Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lesley Baker
- Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Daniel E Lumsden
- Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane L Hutton
- Department of Statistics, University of Warwick, Coventry, UK
| | - Jean-Pierre S-M Lin
- Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
40
|
Montero Mendoza S, Gómez-Conesa A, Hidalgo Montesinos MD. Association between gross motor function and postural control in sitting in children with Cerebral Palsy: a correlational study in Spain. BMC Pediatr 2015; 15:124. [PMID: 26376627 PMCID: PMC4571109 DOI: 10.1186/s12887-015-0442-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/04/2015] [Indexed: 11/10/2022] Open
Abstract
Background Cerebral palsy (CP) is one of the causes of physical disability in children. Sitting abilities can be described using the Level of Sitting Scale (LSS) and the Gross Motor Function Classification System (GMFCS). There is growing interest in the sitting posture of children with CP owing to a stable sitting position allows for the development of eye-hand coordination, functions of the upper extremities and functional skills. Besides, in recent years researchers have tried to develop a new terminology to classify the CP as performed by the Surveillance of Cerebral Palsy in Europe (SCPE), in order to improve the monitoring of the frequency of the PC, providing a framework for research and service planning. The aim of this study was to analyse the relationship between GMFCS and LSS. The second purpose was to describe how the SCPE relates to sitting abilities with the GMFCS and LSS. Methods The study involved 139 children with CP (range 3–18 years) from 24 educational centres. Age, gender, CP classification according to SCPE, GMFCS and LSS levels were recorded by an experienced physiotherapist. Results A significant inverse relationship between GMFCS and LSS score levels was found (rs = −0.86, p = 0.00). 45.3 % of the children capable of leaning in any direction and of re-erecting the trunk (level VIII on the LSS) could walk without limitation (level I on the GMFCS). There were differences in the distribution of the GMFCS (χ2(4):50.78) and LSS (χ2(7): 37.15) levels and CP according to the distribution of the spasticity (p <0.01). Conclusions There was a negative correlation between both scales and a relation between sitting ability and the capacity to walk with or without technical devices. GMFCS and the LSS are useful tools for describing the functional abilities and limitations of children with CP, specially sitting and mobility. Classification based on the distribution of spasticity and the gross motor function provides clinical information on the prognosis and development of children with CP.
Collapse
Affiliation(s)
- Sergio Montero Mendoza
- Research Group in Physiotherapy and Health Promotion, Regional Campus of International Excellence "Campus Mare Nostrum", Murcia University, Murcia, Spain. .,Department of Physiotherapy, Faculty of Medicine, University of Murcia, 30100, Espinardo-Murcia, Spain.
| | - Antonia Gómez-Conesa
- Research Group in Physiotherapy and Health Promotion, Regional Campus of International Excellence "Campus Mare Nostrum", Murcia University, Murcia, Spain.
| | - María Dolores Hidalgo Montesinos
- Research Group in Physiotherapy and Health Promotion, Regional Campus of International Excellence "Campus Mare Nostrum", Murcia University, Murcia, Spain.
| |
Collapse
|
41
|
Bhinde SM, Patel KS, Kori VK, Rajagopala S. Management of spastic cerebral palsy through multiple Ayurveda treatment modalities. Ayu 2015. [PMID: 26195914 PMCID: PMC4492036 DOI: 10.4103/0974-8520.159044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is a leading cause of childhood disability affecting function and development. The global incidence of CP is 2:1000. It has been reported that children with CP and their caretaker have impaired health-related quality of life (QOL). Of the many types and subtypes of CP, none has any known cure. For a detailed description of the disease CP, though, there is no one to one correlation in Ayurvedic classics; it can be taken as Vata Vyadhi as far as its etiology and symptomatology are concerned. AIM To assess the effect of certain Panchakarma procedures in the management of CP. MATERIALS AND METHODS Total 8 patients were registered and treated with 5 days of Udvartana, 5 days of Abhyanga followed by Sarvanga Swedana and then 8 days of Yoga Basti. The same course of treatment has been repeated for 3 times with an interval of 14 days. Ashtanga Ghrita was given during whole procedures as internal medication. Results of treatment were assessed with anthropometrical measurement, developmental milestone, Modified Ashworth Scale, spasm scale, reflex scale, and muscle power grading. RESULT This Ayurvedic management shows good result in CP patients, especially by improving growth (height, weight, chest circumference) and development (head holding and sitting), reducing spasticity of left upper limb and muscle spasm. CONCLUSION Multisystem approach is needed to improve the condition of the patient. Panchakarma along with internal medication should be given to improve all the facets of spastic CP. Yoga Basti acts by their own mode of action and can be used freely for such disease conditions.
Collapse
Affiliation(s)
- Sagar M Bhinde
- Department of Kaumarbhritya, GJ Patel Institute of Ayurvedic Studies and Research, New Vallabha Vidyanagar, Anand, India
| | - Kalpana S Patel
- Department of Kaumarbhritya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
| | - Virendra Kumar Kori
- Department of Kaumarbhritya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
| | - S Rajagopala
- Department of Kaumarbhritya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
| |
Collapse
|
42
|
Gillick BT, Krach LE, Feyma T, Rich TL, Moberg K, Menk J, Cassidy J, Kimberley T, Carey JR. Safety of primed repetitive transcranial magnetic stimulation and modified constraint-induced movement therapy in a randomized controlled trial in pediatric hemiparesis. Arch Phys Med Rehabil 2015; 96:S104-13. [PMID: 25283350 PMCID: PMC4380609 DOI: 10.1016/j.apmr.2014.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the safety of combining a 6-Hz primed low-frequency repetitive transcranial magnetic stimulation (rTMS) intervention in the contralesional hemisphere with a modified constraint-induced movement therapy (mCIMT) program in children with congenital hemiparesis. DESIGN Phase 1 randomized, double-blinded, placebo-controlled pretest/posttest trial. SETTING University academic facility and pediatric specialty hospital. PARTICIPANTS Subjects (N = 19; age range, 8-17 y) with congenital hemiparesis caused by ischemic stroke or periventricular leukomalacia. No subject withdrew because of adverse events. All subjects included completed the study. INTERVENTIONS Subjects were randomized to 1 of 2 groups: either real rTMS plus mCIMT (n = 10) or sham rTMS plus mCIMT (n = 9). MAIN OUTCOME MEASURES Adverse events, physician assessment, ipsilateral hand function, stereognosis, cognitive function, subject report of symptoms assessment, and subject questionnaire. RESULTS No major adverse events occurred. Minor adverse events were found in both groups. The most common events were headaches (real: 50%, sham: 89%; P = .14) and cast irritation (real: 30%, sham: 44%; P = .65). No differences between groups in secondary cognitive and unaffected hand motor measures were found. CONCLUSIONS Primed rTMS can be used safely with mCIMT in congenital hemiparesis. We provide new information on the use of rTMS in combination with mCIMT in children. These findings could be useful in research and future clinical applications in advancing function in congenital hemiparesis.
Collapse
Affiliation(s)
- Bernadette T Gillick
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN.
| | - Linda E Krach
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN; Gillette Children's Specialty Healthcare, St Paul, MN
| | - Tim Feyma
- Gillette Children's Specialty Healthcare, St Paul, MN
| | - Tonya L Rich
- Gillette Children's Specialty Healthcare, St Paul, MN
| | - Kelli Moberg
- Gillette Children's Specialty Healthcare, St Paul, MN
| | - Jeremiah Menk
- University of Minnesota Clinical and Translational Science Institute Biostatistical Design and Analysis Center, Minneapolis, MN
| | - Jessica Cassidy
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN
| | - Teresa Kimberley
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN
| | - James R Carey
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN
| |
Collapse
|
43
|
Lee JW, Chung E, Lee BH. A comparison of functioning, activity, and participation in school-aged children with cerebral palsy using the manual ability classification system. J Phys Ther Sci 2015; 27:243-6. [PMID: 25642083 PMCID: PMC4305573 DOI: 10.1589/jpts.27.243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/19/2014] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of this study was to evaluate the functioning, extent of activity,
and participation of school-aged children with cerebral palsy (CP) using the Manual
Ability Classification System (MACS). [Subjects and Methods] The Subjects were 57
school-aged children (7–12 years old) with CP. The MACS, Gross Motor Function Measure
(GMFM), International Classification of Functioning, Disability and Health for Children
and Youth (ICF-CY) Checklist, and a questionnaire were used to measure children’s
functioning, activity, and participation. [Results] GMFM scores differed significantly
across the MACS levels. The following differed significantly according to MACS level when
assessed with the ICF-CY function section: mental functions; sensory function and pain;
voice and speech functions; functions of the digestive, metabolic, and endocrine systems;
genitourinary and reproductive function; and neuromusculoskeletal and movement related
function. The data from the activities and participation section of the ICF-CY also showed
statistically significant differences across MACS levels. [Conclusion] These results
suggest that the functioning, activity, and participation of school-aged children with CP
depend on their MACS level and that the functioning of children with CP affects their
activities and participation.
Collapse
Affiliation(s)
- Jae-Won Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - EunJung Chung
- Department of Physical Therapy, Andong Science College, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| |
Collapse
|
44
|
Emilsson L, Lindahl B, Köster M, Lambe M, Ludvigsson JF. Review of 103 Swedish Healthcare Quality Registries. J Intern Med 2015; 277:94-136. [PMID: 25174800 DOI: 10.1111/joim.12303] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES In the past two decades, an increasing number of nationwide, Swedish Healthcare Quality Registries (QRs) focusing on specific disorders have been initiated, mostly by physicians. Here, we describe the purpose, organization, variables, coverage and completeness of 103 Swedish QRs. METHODS From March to September 2013, we examined the 2012 applications of 103 QRs to the Swedish Association of Local Authorities and Regions (SALAR) and also studied the annual reports from the same QRs. After initial data abstraction, the coordinator of each QR was contacted at least twice between June and October 2013 and asked to confirm the accuracy of the data retrieved from the applications and reports. RESULTS About 60% of the QRs covered ≥80% of their target population (completeness). Data recorded in Swedish QRs include aspects of disease management (diagnosis, clinical characteristics, treatment and lead times). In addition, some QRs retrieve data on self-reported quality of life (EQ5D, SF-36 and disease-specific measures), lifestyle (smoking) and general health status (World Health Organization performance status, body mass index and blood pressure). CONCLUSION Detailed clinical data available in Swedish QRs complement information from government-administered registries and provide an important source not only for assessment and development of quality of care but also for research.
Collapse
Affiliation(s)
- L Emilsson
- Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | | | | | | |
Collapse
|
45
|
Boyaci A, Akal A, Tutoglu A, Kandemir H, Koca I, Boyraz I, Celen E, Ozkan U. Relationship among Ocular Diseases, Developmental Levels, and Clinical Characteristics of Children with Diplegic Cerebral Palsy. J Phys Ther Sci 2014; 26:1679-84. [PMID: 25435676 PMCID: PMC4242931 DOI: 10.1589/jpts.26.1679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/28/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to evaluate the relationships among vision problems, developmental levels, upper extremity functions, and qualities of life of children with cerebral palsy (CP). [Subjects] The study included 32 children, aged 4-15 years, diagnosed with diplegic type CP. [Methods] Hand function was evaluated using the Manual Ability Classification System (MACS) and the Bimanual Fine Motor Function (BFMF) scale, and the severity of CP was assessed using the Gross Motor Function Classification System (GMFCS). The developmental and mental capabilities of the children were evaluated using the Ankara Developmental Screening Inventory (ADSI) or the WISC-R test. An oculomotor examination was conducted for all patients. [Results] Positive correlations were found between GMFCS and BFMF, GMFCS and MACS, and MACS and BFMF scores (r=0.636; r=0.553; r=0.718, respectively). Significant correlations were found between upper extremity function, the severity of CP, the quality of life, and the general developmental level. There was no significant correlation between ocular disorders and clinical characteristics. [Conclusion] GMFCS, MACS, and BFMF may be useful for defining the functional status of children with CP, as they are easy, practical, and simple classification scales that conform to each other.
Collapse
Affiliation(s)
- Ahmet Boyaci
- Department of Physical Medicine and Rehabilitation, Harran
University Medical School, Turkey
| | - Ali Akal
- Department of Ophthalmology, Harran University Medical
School, Turkey
| | - Ahmet Tutoglu
- Department of Physical Medicine and Rehabilitation, Harran
University Medical School, Turkey
| | - Hasan Kandemir
- Child and Adolescent Psychiatry, Harran University Medical
School, Turkey
| | - Irfan Koca
- Department of Physical Medicine and Rehabilitation,
Gaziantep University Medical School, Turkey
| | - Ismail Boyraz
- Department of Physical Medicine and Rehabilitation, Abant
Izzet Baysal University Medical School, Turkey
| | - Esra Celen
- Department of Physical Medicine and Rehabilitation, Harran
University Medical School, Turkey
| | - Ufuk Ozkan
- Department of Ophthalmology, Harran University Medical
School, Turkey
| |
Collapse
|
46
|
Compagnone E, Maniglio J, Camposeo S, Vespino T, Losito L, De Rinaldis M, Gennaro L, Trabacca A. Functional classifications for cerebral palsy: correlations between the gross motor function classification system (GMFCS), the manual ability classification system (MACS) and the communication function classification system (CFCS). RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2651-2657. [PMID: 25062096 DOI: 10.1016/j.ridd.2014.07.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/02/2014] [Indexed: 06/03/2023]
Abstract
This study aimed to investigate a possible correlation between the gross motor function classification system-expanded and revised (GMFCS-E&R), the manual abilities classification system (MACS) and the communication function classification system (CFCS) functional levels in children with cerebral palsy (CP) by CP subtype. It was also geared to verify whether there is a correlation between these classification systems and intellectual functioning (IF) and parental socio-economic status (SES). A total of 87 children (47 males and 40 females, age range 4-18 years, mean age 8.9±4.2) were included in the study. A strong correlation was found between the three classifications: Level V of the GMFCS-E&R corresponds to Level V of the MACS (rs=0.67, p=0.001); the same relationship was found for the CFCS and the MACS (rs=0.73, p<0.001) and for the GMFCS-E&R and the CFCS (rs=0.61, p=0.001). The correlations between the IQ and the global functional disability profile were strong or moderate (GMFCS and IQ: rs=0.66, p=0.001; MACS and IQ: rs=0.58, p=0.001; CFCS and MACS: rs=0.65, p=0.001). The Kruskal-Wallis test was used to determine if there were differences between the GMFCS-E&R, the CFCS and the MACS by CP type. CP types showed different scores for the IQ level (Chi-square=8.59, df=2, p=0.014), the GMFCS-E&R (Chi-square=36.46, df=2, p<0.001), the CFCS (Chi-square=12.87, df=2, p=0.002), and the MACS Level (Chi-square=13.96, df=2, p<0.001) but no significant differences emerged for the SES (Chi-square=1.19, df=2, p=0.554). This study shows how the three functional classifications (GMFCS-E&R, CFCS and MACS) complement each other to provide a better description of the functional profile of CP. The systematic evaluation of the IQ can provide useful information about a possible future outcome for every functional level. The SES does not appear to affect functional profiles.
Collapse
Affiliation(s)
- Eliana Compagnone
- Scientific Institute I.R.C.C.S. "Eugenio Medea", "La Nostra Famiglia", Neurorehabilitation Unit 1 (Developmental Neurology and Functional Rehabilitation), Brindisi Research Centre, Brindisi, Italy
| | - Jlenia Maniglio
- Scientific Institute I.R.C.C.S. "Eugenio Medea", "La Nostra Famiglia", Neurorehabilitation Unit 1 (Developmental Neurology and Functional Rehabilitation), Brindisi Research Centre, Brindisi, Italy
| | - Serena Camposeo
- Scientific Institute I.R.C.C.S. "Eugenio Medea", "La Nostra Famiglia", Neurorehabilitation Unit 2 (Developmental Psychopathology), Brindisi Research Centre, Brindisi, Italy
| | - Teresa Vespino
- Scientific Institute I.R.C.C.S. "Eugenio Medea", "La Nostra Famiglia", Neurorehabilitation Unit 1 (Developmental Neurology and Functional Rehabilitation), Brindisi Research Centre, Brindisi, Italy
| | - Luciana Losito
- Scientific Institute I.R.C.C.S. "Eugenio Medea", "La Nostra Famiglia", Neurorehabilitation Unit 1 (Developmental Neurology and Functional Rehabilitation), Brindisi Research Centre, Brindisi, Italy
| | - Marta De Rinaldis
- Scientific Institute I.R.C.C.S. "Eugenio Medea", "La Nostra Famiglia", Neurorehabilitation Unit 1 (Developmental Neurology and Functional Rehabilitation), Brindisi Research Centre, Brindisi, Italy
| | - Leonarda Gennaro
- Scientific Institute I.R.C.C.S. "Eugenio Medea", "La Nostra Famiglia", Neurorehabilitation Unit 1 (Developmental Neurology and Functional Rehabilitation), Brindisi Research Centre, Brindisi, Italy
| | - Antonio Trabacca
- Scientific Institute I.R.C.C.S. "Eugenio Medea", "La Nostra Famiglia", Neurorehabilitation Unit 1 (Developmental Neurology and Functional Rehabilitation), Brindisi Research Centre, Brindisi, Italy.
| |
Collapse
|
47
|
Golubović Š, Slavković S. Manual ability and manual dexterity in children with cerebral palsy. Hippokratia 2014; 18:310-314. [PMID: 26052196 PMCID: PMC4453803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Manual ability and performance of dexterity tasks require both gross and fine hand motions and coordination. The aim of this study was to determine the level of manual dexterity (capacity) and investigate its relationship with manual ability (performance) in children with cerebral palsy. METHOD This study was designed as a cross-sectional study of 30 children with cerebral palsy (aged 8-15 years). In order to assess gross manual dexterity the Box and Block Test was used. Manual ability was assessed according to Manual Ability Classification System (MACS). RESULTS A relationship between the level of manual ability impairment and performance on manual dexterity tasks was expressed. Participants at MACS level IV demonstrated slowest times and transferred the smallest number of blocks (p<0.01). This study also found that correlation between Gross Motor Function Classification Scale (GMFCS) and MACS is statistically significant (p<0.001). All hand skills were more impaired in the non-dominant hand compared to the dominant hand but there were no statistically significant difference (p=0.06). CONCLUSION The results suggest that gross manual dexterity is a good predictor of manual abilities in children with cerebral palsy. These results provide better understanding of the relationship between manual dexterity and activity limitations and lend credibility to the use of these classification systems and assessments in order to optimize treatment planning and evaluate interventions and progress. Hippokratia 2014; 18 (4): 310-314.
Collapse
Affiliation(s)
- Š Golubović
- Department of Special Rehabilitation and Education, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - S Slavković
- Department of Special Rehabilitation and Education, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
48
|
Rosenbaum P, Eliasson AC, Hidecker MJC, Palisano RJ. Classification in childhood disability: focusing on function in the 21st century. J Child Neurol 2014; 29:1036-45. [PMID: 24810083 DOI: 10.1177/0883073814533008] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 11/16/2022]
Abstract
Classification systems in health care are usually based on current understanding of the condition. They are often derived empirically and adopted applying sound principles of measurement science to assess whether they are reliable (consistent) and valid (true) for the purposes to which they are applied. In the past 15 years, the authors have developed and validated classification systems for specific aspects of everyday function in people with cerebral palsy--gross motor function, manual abilities, and communicative function. This article describes the approaches used to conceptualize each aspect of function, develop the tools, and assess their reliability and validity. We report on the utility of each system with respect to clinical applicability, use of these tools for research, and the uptake and impact that they have had around the world. We hope that readers will find these accounts interesting, relevant, and applicable to their daily work with children and youth with disabilities.
Collapse
Affiliation(s)
- Peter Rosenbaum
- CanChild Centre, McMaster University, Hamilton, Ontario, Canada
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | | | - Robert J Palisano
- Physical Therapy and Rehabilitation Sciences Department, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
49
|
Lundh D, Coleman S, Riad J. Movement deviation and asymmetry assessment with three dimensional gait analysis of both upper- and lower extremity results in four different clinical relevant subgroups in unilateral cerebral palsy. Clin Biomech (Bristol, Avon) 2014; 29:381-6. [PMID: 24670612 DOI: 10.1016/j.clinbiomech.2014.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 01/22/2014] [Accepted: 02/27/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND In unilateral cerebral palsy, movement pattern can be difficult to define and quantify. The aim was to assess the degree of deviation and asymmetry in upper and lower extremities during walking. METHODS Forty-seven patients, 45 Gross Motor Function Classification Scale (GMFCS) I and 2 patients GMFCS II, mean age 17.1 years (range 13.1 to 24.0) and 15 matched controls were evaluated. Gait profile score (GPS) and arm posture score (APS) were calculated from three-dimensional gait analysis (GA). Asymmetry was the calculated difference in deviation between affected and unaffected sides. FINDINGS The GPS was significantly increased compared to the control group on the affected side (6.93 (2.08) versus 4.23 (1.11) degrees) and on the unaffected side (6.67 (2.14)). The APS was also significantly increased on the affected side (10.39 (5.01) versus 5.52 (1.71) degrees) and on the unaffected side (7.13 (2.23)). The lower extremity asymmetry increased (significantly) in comparison with the control group (7.89 (3.82) versus 3.90 (1.01)) and correspondingly in the upper extremity (9.75 (4.62) versus 5.72 (1.84)). The GPS was not different between affected and unaffected sides, however the APS was different (statistically significant). INTERPRETATION We calculated deviation and asymmetry of movement during walking in unilateral CP, identifying four important clinical groups: close to normal, deviations mainly in the leg, deviations mainly in the arm and those with deviation in the arm and leg. This method can be applied to any patient group, and aid in diagnosing, planning treatment, and prognosis.
Collapse
Affiliation(s)
- Dan Lundh
- University of Skövde, Box 408, 541 28 Skövde, Sweden.
| | - Scott Coleman
- Motion and Sports Lab, Baylor University Medical Center, 411 N. Washington Ave Suite 2100, Dallas, TX 752 46, USA
| | - Jacques Riad
- Orthopaedic Department, Skaraborg Hospital Skövde, 541 85 Skövde, Sweden; Women's and Children's Health, Karolinska Institute, 171 76 Stockholm, Sweden
| |
Collapse
|
50
|
GAJEWSKA E, SOBIESKA M, SAMBORSKI W. Associations between Manual Abilities, Gross Motor Function, Epilepsy, and Mental Capacity in Children with Cerebral Palsy. IRANIAN JOURNAL OF CHILD NEUROLOGY 2014; 8:45-52. [PMID: 24949051 PMCID: PMC4058065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 01/24/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate gross motor function and hand function in children with cerebral palsy to explore their association with epilepsy and mental capacity. MATERIAL & METHODS The research investigating the association between gross and fine motor function and the presence of epilepsy and/or mental impairment was conducted on a group of 83 children (45 girls, 38 boys). Among them, 41 were diagnosed with quadriplegia, 14 hemiplegia, 18 diplegia, 7 mixed form, and 3 athetosis. A neurologist assessed each child in terms of possible epilepsy and confirmed diagnosis in 35 children. A psychologist assessed the mental level (according to Wechsler) and found 13 children within intellectual norm, 3 children with mild mental impairment, 18 with moderate, 27 with severe, and 22 with profound. Children were then classified based on Gross Motor Function Classification System and Manual Ability Classification Scale. RESULTS The gross motor function and manual performance were analysed in relation to mental impairment and the presence of epilepsy. Epilepsy was found to disturb conscious motor functions, but also higher degree of mental impairment was observed in children with epilepsy. CONCLUSION The occurrence of epilepsy in children with cerebral palsy is associated with worse manual function. The occurrence of epilepsy is associated with limitations in conscious motor functions. There is an association between epilepsy in children with cerebral palsy and the degree of mental impairment. The occurrence of epilepsy, mainly in children with hemiplegia and diplegia is associated with worse mental capacities.
Collapse
Affiliation(s)
- Ewa GAJEWSKA
- Chair for Physiotherapy, Department,, Rheumatology and Rehabilitation University of Medical Sciences, Poznań, 28 Czerwca 1956r. 135/147 61-545, Poznań, Poland
| | - Magdalena SOBIESKA
- Chair for Physiotherapy, Department,, Rheumatology and Rehabilitation University of Medical Sciences, Poznań, 28 Czerwca 1956r. 135/147 61-545, Poznań, Poland
| | - Włodzimierz SAMBORSKI
- Chair for Physiotherapy, Department,, Rheumatology and Rehabilitation University of Medical Sciences, Poznań, 28 Czerwca 1956r. 135/147 61-545, Poznań, Poland
| |
Collapse
|