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Flores MB, Ardolino EM, J Manella K. Current Trends for Children With Spina Bifida: A Survey of Pediatric Physical Therapists. Pediatr Phys Ther 2024; 36:307-314. [PMID: 38830058 DOI: 10.1097/pep.0000000000001107] [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: 06/05/2024]
Abstract
PURPOSE To describe contemporary physical therapy practice and management of children with spina bifida (SB) in the context of the International Classification of Functioning, Disability, and Health (ICF) framework. METHODS A descriptive, cross-sectional electronic survey was sent to US pediatric physical therapy clinics and posted in the American Physical Therapy Association Pediatrics newsletter. Data were analyzed using content analysis. Codes were compared, refined, and condensed into categories. RESULTS A total of 163 participants were included. Most assessments evaluated the ICF Activity component. Most frequently reported ICF components: impairments = decreased strength (17.9%), activity limitations = limited walking (22.5%), and participation restrictions = restricted socializing/playing with peers or siblings (22.6%). The most prevalent intervention was strength training. CONCLUSIONS Physical therapists (PTs) in the United States are performing assessments and interventions supported by available evidence; however, knowledge translation and more research are needed to support best practices in PT management of children with SB.
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Affiliation(s)
- Megan B Flores
- Department of Physical Therapy (Drs Flores and Ardolino), Baylor University, Waco, Texas; Doctor of Physical Therapy Program (Manella), Nova Southeastern University - Tampa Bay Regional Campus, Clearwater, Florida
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Silva T, Tobelem DDC, Malavazzi TCDS, Mendonça JFBD, Andreo L, Chavantes MC, Tempestini Horliana ACR, Turcio KHL, Gomes AO, Deana AM, Fernandes KPS, Motta LJ, Mesquita-Ferrari RA, Brugnera A, Nammour S, Bussadori SK. Effect of Photobiomodulation Combined with Physiotherapy on Functional Performance in Children with Myelomeningo-Cele-Randomized, Blind, Clinical Trial. J Clin Med 2023; 12:jcm12082920. [PMID: 37109256 PMCID: PMC10142114 DOI: 10.3390/jcm12082920] [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: 02/05/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the electrical activity of the rectus femoris, tibialis anterior, and lateral gastrocnemius muscles during the sit-to-stand task and functional mobility after a neurofunctional physiotherapy protocol associated with PBM. METHODS Twenty-five children were randomly allocated to either Active PBM + physiotherapy (n = 13) or PBM sham + physiotherapy (n = 12). PBM was carried out with a LED device (850 nm, 25 J, 50 s per point and 200 mW) at four points over the area with absence of a spiny process. Both groups completed a twelve-week supervised program with two weekly 45-60 min sessions. Pre-training and post-training assessments involved the Pediatric Evaluation of Disability Inventory (PEDI). Muscle activity was assessed using portable electromyography (BTS Engineering) and the electrodes were positioned on the lateral gastrocnemius, anterior tibialis, and rectus femoris muscles. The RMS data were recorded and analyzed. RESULTS After 24 sessions of the treatment protocol, improvements were found in the PEDI score. The participants presented greater independence in performing the tasks, requiring less assistance from their caregivers. More significant electrical activity was found in the three muscles evaluated between the rest period and execution of the sit-to-stand tasks, both in the more compromised or less compromised lower limbs. CONCLUSION Neurofunctional physiotherapy with or without PBM improved functional mobility and electrical muscle activity in children with myelomeningocele.
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Affiliation(s)
- Tamiris Silva
- University Nove de Julho (UNINOVE), São Paulo 01525-000, SP, Brazil
| | | | | | | | - Lucas Andreo
- University Nove de Julho (UNINOVE), São Paulo 01525-000, SP, Brazil
| | | | | | | | | | | | | | | | | | - Aldo Brugnera
- Physics Institute of São Carlos, University of the São Paulo, São Paulo 11330-900, SP, Brazil
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Andrzejewska M, Hap K, Biernat K, Sutkowska E, Demczyszak I, Marciniak D, Kuciel N. Factors affecting rehabilitation of infants with Central Coordination Disorders during a three-month-long observation. BMC Pediatr 2021; 21:579. [PMID: 34922477 PMCID: PMC8684221 DOI: 10.1186/s12887-021-03066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Central coordination disorders (CCD) encompass various abnormalities observed in infants but early therapy may have an impact on their condition. The aim was to seek factors that may affect the early results of therapy of infants with CCD. Methods We analyzed the outcomes of a three-month period of rehabilitation of infants living with CCD. Children were treated at Non-public Specialist Healthcare Institution Medi-Reh in Kalisz in the period from 1 Jan 2014 to 31 Nov 2019. In our retrospective study results of three-month therapy of infants, aged 1 to 6 months, with CCD were analysed regards to the effectiveness and the potential impact of different factors. Therapy and assessment of children were conducted with the use of the Vojta method, which was performed during the first visit (WW) and the follow-up visit (after 3 months- 1WK). The analysis of the influence of various factors on the effect of therapy included: mother's age at the time of delivery, duration of breastfeeding, child APGAR, gestational age in which the child was born, sex of the child, birth weight, age of the child at WW, type of delivery, craniosacral therapy as an additive treatment. Results Based on the examination results from 66 medical records it was demonstrated that after active period of the therapy, improvement was observed in 54 (81.81%) (p=0.48) children (condition during WW versus 1WK among the group). The sole factor impacting improvement after 3 months was the age of the child at WW, when the child started therapy. This factor significantly (p=0.002) increased the chance of achieving improvement - by 3.2 times (OR= 3,2; CI= 95). No statistically significant differences were shown for the other studied factors. Conclusions Prompt implementation of rehabilitation in children with CCD provides a better chance of improving their motor function. The rehabilitation should be started as soon as possible after the diagnosis is constituted.
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Affiliation(s)
| | - Katarzyna Hap
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland.
| | - Karolina Biernat
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland
| | - Edyta Sutkowska
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland
| | - Iwona Demczyszak
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland
| | - Dominik Marciniak
- Department of Drugs Form Technology, Wroclaw Medical University, Wroclaw, Poland
| | - Natalia Kuciel
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland
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Silva T, de Queiroz JR, Turcio KHL, Tobelem DDC, Araújo TR, Coutinho KSL, Chavantes MC, Horliana ACRT, Deana AM, da Silva DDFT, Castelo PM, Fernandes KPS, Motta LJ, Mesquita-Ferrari RA, Kalil Bussadori S. Effect of photobiomodulation combined with physical therapy on functional performance in children with myelomeningocele: A protocol randomized clinical blind study. PLoS One 2021; 16:e0253963. [PMID: 34613973 PMCID: PMC8494316 DOI: 10.1371/journal.pone.0253963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/30/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Myelomeningocele is a severe type of spina bifida, resulting from improper closure of the neural tube. This condition drastically affects the structures of the spinal cord resulting in deficiencies. The combination of these deficiencies results in an overall decrease in mobility and functional participation amongst this population. Physiotherapy plays an essential role in rehabilitating people with MMC. The current literature shows that resources such as photobiomodulation (PBM) may support the rehabilitation of neurological conditions. The aim of the proposed study is to evaluate the effects of photobiomodulation (PBM) combined with physical therapy on functional performance in children with low lumbosacral myelomeningocele. MATERIALS AND METHODS This is a protocol randomized clinical blind study, that will include 30 individuals of both sexes, aged between 5 to 8 years, diagnosed with low and sacral lumbar myelomeningocele and capable of performing the sit-to-stand task. The participants will be randomly assigned into two treatment groups: PBM + physiotherapeutic exercises and sham PBM + physiotherapeutic exercises. Irradiation will be carried out with light emitting diode (LED) at a wavelength of 850 nm, energy of 25 J per point, 50 seconds per point and a power of 200 mW. The same device will be used in the placebo group but will not emit light. Muscle activity will be assessed using a portable electromyograph (BTS Engineering) and the sit-to-stand task will be performed as a measure of functioning. Electrodes will be positioned on the lateral gastrocnemius, tibialis anterior and rectus femoris muscles. The Pediatric Evaluation of Disability Inventory will be used to assess functional independence. Quality of life will be assessed using the Child Health Questionnaire-Parent Form 50. Changes in participation will be assessed using the Participation and Environment Measure for Children and Youth. The data will be analyzed with the aid of GraphPad PRISM. DISCUSSION The results of this study can contribute to a better understanding of the effectiveness of PBM on functioning and quality of life in children with myelomeningocele. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04425330.
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Affiliation(s)
- Tamiris Silva
- Universidade Nove de Julho, UNINOVE, São Paulo, SP, Brazil
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Rizzo R, Knight SP, Davis JRC, Newman L, Duggan E, Kenny RA, Romero-Ortuno R. SART and Individual Trial Mistake Thresholds: Predictive Model for Mobility Decline. Geriatrics (Basel) 2021; 6:geriatrics6030085. [PMID: 34562986 PMCID: PMC8482118 DOI: 10.3390/geriatrics6030085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
The Sustained Attention to Response Task (SART) has been used to measure neurocognitive functions in older adults. However, simplified average features of this complex dataset may result in loss of primary information and fail to express associations between test performance and clinically meaningful outcomes. Here, we describe a new method to visualise individual trial (raw) information obtained from the SART test, vis-à-vis age, and groups based on mobility status in a large population-based study of ageing in Ireland. A thresholding method, based on the individual trial number of mistakes, was employed to better visualise poorer SART performances, and was statistically validated with binary logistic regression models to predict mobility and cognitive decline after 4 years. Raw SART data were available for 4864 participants aged 50 years and over at baseline. The novel visualisation-derived feature bad performance, indicating the number of SART trials with at least 4 mistakes, was the most significant predictor of mobility decline expressed by the transition from Timed Up-and-Go (TUG) < 12 to TUG ≥ 12 s (OR = 1.29; 95% CI 1.14–1.46; p < 0.001), and the only significant predictor of new falls (OR = 1.11; 95% CI 1.03–1.21; p = 0.011), in models adjusted for multiple covariates. However, no SART-related variables resulted significant for the risk of cognitive decline, expressed by a decrease of ≥2 points in the Mini-Mental State Examination (MMSE) score. This novel multimodal visualisation could help clinicians easily develop clinical hypotheses. A threshold approach to the evaluation of SART performance in older adults may better identify subjects at higher risk of future mobility decline.
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Affiliation(s)
- Rossella Rizzo
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Correspondence:
| | - Silvin Paul Knight
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - James R. C. Davis
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Louise Newman
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Eoin Duggan
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St. James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St. James’s Hospital, D08 NHY1 Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
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Mendoza MJ, Gollob SD, Lavado D, Koo BHB, Cruz S, Roche ET, Vela EA. A Vacuum-Powered Artificial Muscle Designed for Infant Rehabilitation. MICROMACHINES 2021; 12:971. [PMID: 34442593 PMCID: PMC8400328 DOI: 10.3390/mi12080971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
The majority of soft pneumatic actuators for rehabilitation exercises have been designed for adult users. Specifically, there is a paucity of soft rehabilitative devices designed for infants with upper and lower limb motor disabilities. We present a low-profile vacuum-powered artificial muscle (LP-VPAM) with dimensions suitable for infants. The actuator produced a maximum force of 26 N at vacuum pressures of -40 kPa. When implemented in an experimental model of an infant leg in an antagonistic-agonist configuration to measure resultant knee flexion, the actuator generated knee flexion angles of 43° and 61° in the prone and side-lying position, respectively.
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Affiliation(s)
- Mijaíl Jaén Mendoza
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru; (M.J.M.); (D.L.)
| | - Samuel Dutra Gollob
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (S.D.G.); (B.H.B.K.)
| | - Diego Lavado
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru; (M.J.M.); (D.L.)
| | - Bon Ho Brandon Koo
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (S.D.G.); (B.H.B.K.)
| | - Segundo Cruz
- Instituto Nacional de Salud del Niño de San Borja, Lima 15037, Peru;
| | - Ellen T. Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (S.D.G.); (B.H.B.K.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Emir A. Vela
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru; (M.J.M.); (D.L.)
- Research Centre in Bioengineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru
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Ferreira FR, Bexiga FP, Martins VVDM, Favero FM, Sartor CD, Artilheiro MC, Voos MC. Independência funcional de crianças de um a quatro anos com mielomeningocele. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17006325022018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A mielomeningocele é causada por defeito no fechamento do tubo neural. A doença representa a segunda causa de deficiência crônica no aparelho locomotor em crianças. A independência funcional depende do nível da lesão medular e sua avaliação é importante para a determinação de abordagens terapêuticas adequadas. O objetivo foi descrever a independência funcional e o nível de lesão de 15 crianças de seis meses a quatro anos com lesão medular completa causada por mielomeningocele. Foi realizado um estudo observacional do tipo transversal nas Universidades Ibirapuera e Santa Cecília. O Inventário de Avaliação Pediátrica de Incapacidade (Pediatric Evaluation of Disability Inventory - PEDI) foi aplicado com os pais, para avaliação da independência funcional nas atividades de vida diária das crianças. A escala de Padrões Internacionais para Classificação Neurológica de Lesão da Medula Espinhal da Associação Americana de Lesão Medular (International Standards for Neurological Classification of Spinal Cord Injury of the American Spinal Injury Association) foi utilizada para determinar o nível motor e sensitivo da lesão. Foram avaliados seis meninos e nove meninas (27,0±11,8 meses de idade). Três crianças apresentaram lesão torácica, nove apresentaram lesão lombar alta, duas apresentaram lesão lombar baixa e uma apresentou lesão sacral. As pontuações na PEDI variaram de 15 a 60% no domínio autocuidado, de 10 a 15% no domínio mobilidade e de 19 a 58% no domínio função social. Houve grande variabilidade no desempenho funcional de crianças com mielomeningocele, detectada pelos domínios autocuidado e função social da PEDI. As crianças apresentaram grande prejuízo no domínio mobilidade.
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