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Liu Y, Li H. Electrical Stimulation for Children with Cerebral Palsy: A Meta-analysis for Randomized Controlled Trials. Neuropediatrics 2023; 54:381-387. [PMID: 37100402 DOI: 10.1055/a-2081-1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Different types of electrical stimulation (ES) showed diverse effects on children with cerebral palsy (CP). Previous studies reported inconsistent results for effects of ES on children with CP. The present study aimed to conduct a meta-analysis to summarize these diverse results. METHODS We searched for studies exploring effects of ES on children with CP in databases (PubMed and Web of Science) from their inception until December 2022. Standard mean differences (SMDs) and 95% confidence intervals (CIs) were computed using STATA 12.0 software. RESULTS The meta-analysis included 19 randomized controlled trials (including 265 CP patients in test group and 263 CP patients in corresponding control group). The study showed an increased improvement in gross motor function, walking speed, step length, and daily living activities in ES group compared with corresponding control group with random effects models (gross motor function: SMD = 2.04, 95% CI = 1.43-2.65; walking speed: SMD = 3.71, 95% CI = 1.49-5.92; step length: SMD = 1.89, 95% CI = 0.65-3.13; daily living activities: SMD = 5.18, 95% CI = 3.04-7.31), whereas the study showed no significant difference in change of muscle strength between ES group and the corresponding control group with a random effects model (SMD = 0.42, 95% CI = -0.12 to 0.97). CONCLUSION The study demonstrated that ES might be used as therapy to improve gross motor function, gait, and daily living activities in children with CP.
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Affiliation(s)
- Yu Liu
- Department of Pediatrics, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China
| | - Hongzhi Li
- Department of Pediatrics, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China
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Sanchez C, Lerma-Lara S, Garcia-Carmona R, Urendes E, Laccourreye P, Raya R. Studying the Research-Practice Gap in Physical Therapies for Cerebral Palsy: Preliminary Outcomes Based on a Survey of Spanish Clinicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14535. [PMID: 36361414 PMCID: PMC9657953 DOI: 10.3390/ijerph192114535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this work is to study the gap between the research evidence and the clinical practice in the physical rehabilitation of people with cerebral palsy. A review process was performed to (1) identify physical therapies to improve postural control in children with cerebral palsy and (2) determine the scientific evidence supporting the effectiveness of those therapies. A Likert-based survey addressing a total of 43 healthcare professionals involved in pediatric physical therapy departments in Spain was carried out. The discussion was mainly supported by studies of level I or II evidence (according to the Oxford scale). The search process yielded 50 studies reporting 16 therapies. A strong positive correlation between the most used treatments and elevated levels of satisfaction was found. Some well-known but not often used techniques, such as hippotherapy, were identified. The treatment with the highest degree of use and satisfaction-neurodevelopment therapy (Bobath)-and some emerging techniques, such as virtual reality, were also identified. The fact that there is a meaningful gap between clinical practice and the scientific evidence was confirmed. The identified gap brings a certain degree of controversy. While some classic and well-known therapies had poor levels of supporting evidence, other relatively new approaches showed promising results.
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Affiliation(s)
- Cristina Sanchez
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, 28668 Madrid, Spain
| | - Sergio Lerma-Lara
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - Rodrigo Garcia-Carmona
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, 28668 Madrid, Spain
| | - Eloy Urendes
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, 28668 Madrid, Spain
| | - Paula Laccourreye
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, 28668 Madrid, Spain
| | - Rafael Raya
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, 28668 Madrid, Spain
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Kolit Z, Ekici G. Effect of the cognitive orientation to daily occupational performance (CO-OP) approach for children with cerebral palsy: A randomized controlled trial. J Pediatr Rehabil Med 2022; 16:59-70. [PMID: 36314226 DOI: 10.3233/prm-210085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The study aimed to examine the effects of "Cognitive Orientation to daily Occupational Performance" (CO-OP) approach in terms of performance and satisfaction as well as functional status in children with cerebral palsy (CP) receiving neurodevelopmental treatment (NDT) and determine the parents' satisfaction level. METHODS Thirty-two children with CP were randomized to experimental (n = 16) or control (n = 16) groups, with n = 2 dropouts. Therapy was applied twice a week for five weeks. The experimental group received a CO-OP plus NDT, while the control group received only NDT. RESULTS No baseline differences existed, except for years of schooling, which was higher in the experimental group. After treatment, there were statistically significant and clinically meaningful improvements in occupational performance and function, favouring children who received 5-weeks of CO-OP plus NDT over NDT alone (p < 0.05). CONCLUSION CO-OP is expected to be beneficial if incorporated into CP rehabilitation.
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Affiliation(s)
- Zeynep Kolit
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Gamze Ekici
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Mooney JA, Rose J. A Scoping Review of Neuromuscular Electrical Stimulation to Improve Gait in Cerebral Palsy: The Arc of Progress and Future Strategies. Front Neurol 2019; 10:887. [PMID: 31496986 PMCID: PMC6712587 DOI: 10.3389/fneur.2019.00887] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Neuromuscular deficits of children with spastic cerebral palsy (CP) limits mobility, due to muscle weakness, short muscle-tendon unit, spasticity, and impaired selective motor control. Surgical and pharmaceutical strategies have been partially effective but often cause further weakness. Neuromuscular electrical stimulation (NMES) is an evolving technology that can improve neuromuscular physiology, strength, and mobility. This review aims to identify gaps in knowledge to motivate future NMES research. Methods: Research publications from 1990- July 20th 2019 that investigated gait-specific NMES in CP were reviewed using the PubMed and Google Scholar databases. Results were filtered by the National Institute of Neurological Disorder and Stroke common data elements guidelines for CP. The Oxford Centre for Evidence Based Medicine guidelines were used to determine levels of evidence for each outcome. Gait-specific NMES research protocols and trends are described, with implications for future research. Results: Eighteen studies met inclusion criteria, reporting on 212 participants, 162 of whom received NMES while walking, average age of 9.8 years, GMFCS levels I–III. Studies included 4 randomized control trials, 9 cohort studies and 5 case studies. A historical trend emerged that began with experimental multi-channel NMES device development, followed by the commercial development of single-channel devices with inertial sensor-based gait event detection to facilitate ankle dorsiflexion in swing phase. This research reported strong evidence demonstrating improved ankle dorsiflexion kinematics in swing and at initial contact. Improved walking speed, step length, and muscle volume were also reported. However, improvements in global walking scores were not consistently found, motivating a recent return to investigating multi-channel gait-specific NMES applications. Conclusions: Research on single-channel gait-specific NMES found that it improved ankle motion in swing but was insufficient to address more complex gait abnormalities common in CP, such as flexed-knee and stiff-knee gait. Early evidence indicates that multi-channel gait-specific NMES may improve gait patterns in CP, however significantly more research is needed. The conclusions of this review are highly limited by the low level of evidence of the studies available. This review provides a historical record of past work and a technical context, with implications for future research on gait-specific NMES to improve walking patterns and mobility in CP.
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Affiliation(s)
- Jake A Mooney
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States.,Motion & Gait Analysis Lab, Lucile Packard Children's Hospital, Stanford Children's Health, Stanford, CA, United States
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States.,Motion & Gait Analysis Lab, Lucile Packard Children's Hospital, Stanford Children's Health, Stanford, CA, United States
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Vova JA, Eggebrecht EM. Utilizing Functional Electrical Stimulation and Exoskeletons in Pediatrics: a Closer Look at Their Roles in Gait and Functional Changes in Cerebral Palsy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00215-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Moll I, Vles JSH, Soudant DLHM, Witlox AMA, Staal HM, Speth LAWM, Janssen-Potten YJM, Coenen M, Koudijs SM, Vermeulen RJ. Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review. Dev Med Child Neurol 2017; 59:1230-1236. [PMID: 28815571 DOI: 10.1111/dmcn.13501] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Abstract
AIM To assess the effect of functional electrical stimulation (FES) of ankle dorsiflexors in children and adolescents with spastic cerebral palsy (CP) during walking. METHOD A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched for studies applying interventions to patients aged younger than 20 years. Outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF). RESULTS Seven hundred and eighty abstracts were found, 35 articles were fully screened, and 14 articles were used for analysis. Only five articles (three studies) were of level I to III evidence. At ICF participation and activity level, there is limited evidence for a decrease in self-reported frequency of toe-drag and falls. At ICF body structure and function level, there is clear evidence (I-III) that FES increased (active) ankle dorsiflexion angle, strength, and improved selective motor control, balance, and gait kinematics, but decreased walking speed. Adverse events include skin irritation, toleration, and acceptation issues. INTERPRETATION There are insufficient data supporting functional gain by FES on activity and participation level. However, evidence points towards a role for FES as an alternative to orthoses in children with spastic CP. WHAT THIS PAPER ADDS Effects of functional electrical stimulation (FES) point towards a potential role as an alternative to orthoses for patients with spastic cerebral palsy (CP). Some evidence for a decrease in self-reported frequency of toe-drag and falls with the use of FES in spastic CP. Limited evidence for improvements in activity and participation in patients with spastic CP using FES.
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Affiliation(s)
- Irene Moll
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johannes S H Vles
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dan L H M Soudant
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Adhiambo M A Witlox
- Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Heleen M Staal
- Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lucianne A W M Speth
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.,Adelante, Pediatric Rehabilitation, Valkenburg, the Netherlands
| | - Yvonne J M Janssen-Potten
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.,Adelante, Pediatric Rehabilitation, Valkenburg, the Netherlands
| | - Marcel Coenen
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.,Adelante, Pediatric Rehabilitation, Valkenburg, the Netherlands
| | - Suzanne M Koudijs
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
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Pool D, Elliott C, Bear N, Donnelly CJ, Davis C, Stannage K, Valentine J. Neuromuscular electrical stimulation-assisted gait increases muscle strength and volume in children with unilateral spastic cerebral palsy. Dev Med Child Neurol 2016; 58:492-501. [PMID: 26555148 DOI: 10.1111/dmcn.12955] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/26/2022]
Abstract
AIM To determine if neuromuscular electrical stimulation (NMES) applied to the ankle dorsiflexors during gait improves muscle volume and strength in children with unilateral spastic cerebral palsy (CP). METHOD Thirty-two children (15 females, 17 males; mean age 10y 8mo, age range 5y 5mo-18y 1mo) with unilateral spastic CP and a Gross Motor Function Classification System of level I or level II were randomly assigned to either the 8-week daily NMES treatment group or control group (usual or conventional treatments). Outcomes at week 8 (post-NMES) and week 14 (carryover) included magnetic resonance imaging for muscle volumes (tibialis anterior, anterior compartment, and gastrocnemius), strength (hand-held dynamometry for isometric dorsiflexion strength and heel raises for functional strength), and clinical measures for lower limb selective motor control. RESULTS At week 8, the treatment group demonstrated significantly (p<0.05) increased muscle volumes for tibialis anterior, anterior compartment, medial and lateral gastrocnemius, and dorsiflexion strength not only when compared to their baseline values but also when compared to the control group at week 8. At week 14, both tibialis anterior and lateral gastrocnemius volumes in the treatment group remained significantly increased when compared to their baseline values. However, only lateral gastrocnemius volumes had significantly greater values when compared to the control group at week 14. There were no between group differences in the clinical measures for lower limb selective motor control at week 8 and 14. INTERPRETATION Eight weeks of daily NMES-assisted gait increases muscle volume and strength of the stimulated ankle dorsiflexors in children with unilateral spastic CP. These changes are use-dependent and do not carry over after the 8-week treatment period. Gastrocnemius volume also increased post-treatment with carryover at week 14.
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Affiliation(s)
- Dayna Pool
- Department of Physiotherapy and Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Sport Science Exercise and Health, The University of Western Australia, Perth, WA, Australia
| | - Catherine Elliott
- Faculty of Health Science, Curtin University of Technology, Perth, WA, Australia
| | - Natasha Bear
- Department of Physiotherapy and Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Cyril J Donnelly
- School of Sport Science Exercise and Health, The University of Western Australia, Perth, WA, Australia
| | - Caroline Davis
- School of Sport Science Exercise and Health, The University of Western Australia, Perth, WA, Australia
| | - Katherine Stannage
- Department of Orthopaedics, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Jane Valentine
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
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