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Forsyth R, Whyte J. Defining paediatric neurorehabilitation: You cannot improve what you cannot characterize. Dev Med Child Neurol 2024; 66:1123-1132. [PMID: 38666455 DOI: 10.1111/dmcn.15919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/16/2024] [Accepted: 03/04/2024] [Indexed: 08/03/2024]
Abstract
Neurorehabilitation is the primary therapy for neurological impairment in children, yet its potential to achieve change remains incompletely understood and probably underestimated. Understanding 'the difference neurorehabilitation can make' against a background of neurological repair and recovery as well as ongoing neurological development is an enormous challenge, exacerbated to no small extent by the lack of a 'common currency' for the description and measurement of the neurorehabilitation services a child is receiving. This review addresses attempts to parse neurorehabilitation treatment content in theoretically and mechanistically valid ways that might help address this challenge.
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Affiliation(s)
- Rob Forsyth
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
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Tanner K, Reader B, O'Rourke S, Byars M, Fallieras K, Brunelle A, Bailes A. Spreading Standardized Documentation of Pediatric Occupational and Physical Therapy Dose: A Quality Improvement Initiative. Am J Occup Ther 2024; 78:7804205050. [PMID: 38836792 DOI: 10.5014/ajot.2024.050576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
IMPORTANCE Clinicians and researchers can leverage clinical documentation of therapy services for quality improvement and research purposes. However, documentation is often institution specific and may not adequately capture the dose of therapy delivered, thus limiting collaboration. OBJECTIVE To implement documentation of pediatric occupational and physical therapy dose from one institution to another institution. Dose documentation includes the frequency, intensity, time, and type of interventions delivered (FITT Epic® Flowsheet) at each session. DESIGN Prospective time-series quality improvement study. SETTING Two large urban pediatric hospitals. PARTICIPANTS Occupational and physical therapy staff members. INTERVENTION Staff training and feedback loops utilizing existing groups. OUTCOMES AND MEASURES The process measure (number of available staff trained and using the FITT Epic Flowsheet over time) and the outcome measure (percentage of FITT Epic Flowsheets used for treatment visits each month) were analyzed using a statistical process control chart. The balancing measure (percentage of notes closed before 7 p.m. on the same day as the encounter) was analyzed using mean per month across three time periods. RESULTS Fifty-seven staff members (68%) attended formal training. On average, clinicians documented 90% of sessions using the FITT Epic Flowsheet after implementation. There was no change observed in the balancing measure. CONCLUSIONS AND RELEVANCE Documentation of dose was spread from one institution to another. Shared documentation will facilitate future collaboration for quality improvement and research purposes. Occupational therapy practitioners and leaders should consider implementing documentation with common dose elements. Plain-Language Summary: Occupational therapy documentation is often institution specific and may not adequately capture the dose of therapy (frequency, intensity, time) or types of interventions that were delivered, thus limiting opportunities for collaboration between institutions. This article adds to the literature on administrative supports for clinical and quality improvement research by illustrating a specific example of how documentation of dose can be shared from one institution to another. The data show that clinicians at one institution started using a new style of documentation using the FITT Epic® Flowsheet and shared discrete dose elements with another institution, creating new opportunities for collaboration. Shared documentation can facilitate future collaboration for quality improvement and research purposes.
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Affiliation(s)
- Kelly Tanner
- Kelly Tanner, PhD, OTR/L, BCP, is Research Scientist, Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH;
| | - Ben Reader
- Ben Reader, PT, DPT, is Research Scientist, Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | - Sara O'Rourke
- Sara O'Rourke, MOT, OTR/L, BCP, is Clinical Therapies Program Manager, Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | - Michelle Byars
- Michelle Byars, PT, is Clinical Therapies Homecare Program Manager, Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | - Kristin Fallieras
- Kristin Fallieras, PT, is Performance Improvement Coordinator, Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | - Amy Brunelle
- Amy Brunelle, is Senior Epic Analyst, Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | - Amy Bailes
- Amy Bailes, PT, PhD, is Physical Therapist III, Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, and Associate Professor, Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, Cincinnati, OH
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Goikoetxea-Sotelo G, van Hedel HJA. Defining, quantifying, and reporting intensity, dose, and dosage of neurorehabilitative interventions focusing on motor outcomes. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1139251. [PMID: 37637933 PMCID: PMC10457006 DOI: 10.3389/fresc.2023.1139251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023]
Abstract
Introduction Determining the minimal amount of therapy needed for positive neurorehabilitative outcomes is important for optimizing active treatment interventions to improve motor outcomes. However, there are various challenges when quantifying these relationships: first, several consensuses on the definition and usage of the terms intensity, dose, and dosage of motor interventions have been proposed, but there seems to be no agreement, and the terms are still used inconsistently. Second, randomized controlled trials frequently underreport items relevant to determining the intensity, dose, and dosage of the interventions. Third, there is no universal measure to quantify therapy intensity accurately. This "perspectives" paper aims to increase awareness of these topics among neurorehabilitation specialists. Defining quantifying and reporting We searched the literature for definitions of intensity, dose, and dosage and adapted the ones we considered the most appropriate to fit the needs of neurorehabilitative interventions. Furthermore, we suggest refining the template for intervention description and replication (TIDieR) to enhance the reporting of randomized controlled trials. Finally, we performed a systematic literature search to provide a list of intensity measures and complemented these with some novel candidate measures. Discussion The proposed definitions of intensity, dose, and dosage could improve the communication between neurorehabilitation specialists and the reporting of dose and dosage in interventional studies. Quantifying intensity is necessary to improve our understanding of the minimal intensity, dose, and dosage of therapy needed to improve motor outcomes in neurorehabilitation. We consider the lack of appropriate intensity measures a significant gap in knowledge requiring future research.
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Affiliation(s)
- Gaizka Goikoetxea-Sotelo
- Swiss Children’s Rehab, University Children’s Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Hubertus J. A. van Hedel
- Swiss Children’s Rehab, University Children’s Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
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Schreiber J, Wenskovitch J, Belt J, O'Donnell A, Wolf D. Clinical Outcomes of an Intensity Program for Children With Movement Challenges. Pediatr Phys Ther 2023:00001577-990000000-00053. [PMID: 37071878 DOI: 10.1097/pep.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE Physical therapists at an outpatient pediatric facility developed and implemented an Intensity Program for children with movement challenges. The program was initiated on the basis of best evidence, parent advocacy, and clinician expertise. The purpose of this investigation is to analyze outcome data gathered from the program since 2012 to determine the effect of the program along with any specific child characteristics that were more likely to lead to positive outcomes. METHODS A variety of outcome data were analyzed to compare preprogram performance with postprogram performance. RESULTS Program participants made statistically significant and clinically important improvement in most outcome measures. Parents were highly satisfied with the program, including 98% of respondents who indicated that they would like to repeat their participation in the program. CONCLUSIONS The results of this investigation suggest that many children with movement challenges are likely to benefit from participation in an Intensity Program.
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Affiliation(s)
- Joseph Schreiber
- Doctor of Physical Therapy Program (Dr Schreiber) and Health Informatics Program (Dr Wolf), Chatham University, Pittsburgh, Pennsylvania; Computer Science Program (Dr Wenskovitch), Virginia Tech, Blacksburg, Virginia; Independent Contractor Working in Early Intervention (Ms Belt); The Children's Institute of Pittsburgh (Dr O'Donnell), Pittsburgh, Pennsylvania
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Inpatient Physical Therapy After Orthopedic Lower Extremity Surgery in Children With Cerebral Palsy. Pediatr Phys Ther 2023; 35:57-64. [PMID: 36638029 DOI: 10.1097/pep.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To characterize and examine the variability in receipt of inpatient (IP) physical therapy after lower extremity (LE) orthopedic surgery for individuals with cerebral palsy (CP) across hospital-level (region, bed size) and individual characteristics (gender, age, race/ethnicity, insurance type, technology dependency, and surgical burden). METHODS We retrospectively analyzed physical therapy billing data of children with CP who had LE orthopedic surgery from October 1, 2015, through September 30, 2017, from the Pediatric Health Information Services (PHIS) database. RESULTS Seventy-five percent of individuals received IP physical therapy during the hospital stay. Individuals from the South and West and those who were technology dependent were less likely to receive IP therapy. Those at large hospitals, aged 11 to 14 years, and with a high surgical burden were more likely to receive therapy. CONCLUSIONS Results provide a starting point for future research on the discrepancies of acute physical therapy services in children diagnosed with CP. (Supplemental digital content video abstract available at: http://links.lww.com/PPT/A420).
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6
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Bonarrigo K, McGuire M, Dorich JM, Bolger A, Lambert J, Horn PS, Tian C. Use of supported standing in males with Duchenne muscular dystrophy: Individual and family perspectives. J Pediatr Rehabil Med 2023; 16:553-569. [PMID: 36617765 DOI: 10.3233/prm-220026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study aimed to explore stander use in individuals with Duchenne Muscular Dystrophy (DMD). METHODS This mixed method research study employed a survey with categorical and open-ended questions related to stander use. Categorical responses were analyzed quantitatively. Qualitative analysis of open-ended responses was linked to the International Classification of Function. Qualitative and quantitative results were merged to derive meta-inferences. RESULTS Of 147 respondents, 28.6% (n = 42) reported stander use. Equipment used included sit-to-stand stander (n = 27), power standing feature in a wheelchair (n = 13), and unspecified equipment (n = 2). Economic services were the most common barrier to stander obtainment. Age of loss of ambulation (LOA) and age of start of stander use were positively correlated (r = 0.61, p < 0.0001, n = 36), with 59.5% initiating stander use after LOA. Twenty-nine respondents reported standing less than the recommended dose of 60-90 minutes at least five days a week, with frequency directionally less than five days per week (p = 0.06) and time significantly less than 60-90 minutes (p = 0.002). Respondents' total dose was significantly lower than the recommended 300 minutes (p = 0.02). Lack of time and presence of contractures contributed to decreased duration of use. CONCLUSION This study provides a greater understanding of stander use among individuals with DMD and can assist with decision making about stander use prior to complications of disease progression to promote optimal health despite reported barriers.
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Affiliation(s)
- Kelly Bonarrigo
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michelle McGuire
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jenny M Dorich
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ashlee Bolger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Divisionof Rehabilitation Medicine, Cincinnati Children's Hospital MedicalCenter, Cincinnati, OH, USA
| | - Joshua Lambert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cuixia Tian
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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7
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Prosser LA, Skorup J, Pierce SR, Jawad AF, Fagg AH, Kolobe THA, Smith BA. Locomotor learning in infants at high risk for cerebral palsy: A study protocol. Front Pediatr 2023; 11:891633. [PMID: 36911033 PMCID: PMC9995839 DOI: 10.3389/fped.2023.891633] [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] [Received: 03/08/2022] [Accepted: 01/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background Physical disability in individuals with cerebral palsy (CP) creates lifelong mobility challenges and healthcare costs. Despite this, very little is known about how infants at high risk for CP learn to move and acquire early locomotor skills, which set the foundation for lifelong mobility. The objective of this project is to characterize the evolution of locomotor learning over the first 18 months of life in infants at high risk for CP. To characterize how locomotor skill is learned, we will use robotic and sensor technology to provide intervention and longitudinally study infant movement across three stages of the development of human motor control: early spontaneous movement, prone locomotion (crawling), and upright locomotion (walking). Study design This longitudinal observational/intervention cohort study (ClinicalTrials.gov Identifier: NCT04561232) will enroll sixty participants who are at risk for CP due to a brain injury by one month post-term age. Study participation will be completed by 18 months of age. Early spontaneous leg movements will be measured monthly from 1 to 4 months of age using inertial sensors worn on the ankles for two full days each month. Infants who remain at high risk for CP at 4 months of age, as determined from clinical assessments of motor function and movement quality, will continue through two locomotor training phases. Prone locomotor training will be delivered from 5 to 9 months of age using a robotic crawl training device that responds to infant behavior in real-time. Upright locomotor training will be delivered from 9 to 18 months of age using a dynamic weight support system to allow participants to practice skills beyond their current level of function. Repeated assessments of locomotor skill, training characteristics (such as movement error, variability, movement time and postural control), and variables that may mediate locomotor learning will be collected every two months during prone training and every three months during upright training. Discussion This study will develop predictive models of locomotor skill acquisition over time. We hypothesize that experiencing and correcting movement errors is critical to skill acquisition in infants at risk for CP and that locomotor learning is mediated by neurobehavioral factors outside of training.Project Number 1R01HD098364-01A1.ClinicalTrials.gov Identifier: NCT04561232.
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Affiliation(s)
- Laura A Prosser
- Division of Rehabilitation Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Julie Skorup
- Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Samuel R Pierce
- Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Abbas F Jawad
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Andrew H Fagg
- Department of Computer Science, University of Oklahoma, Norman, OK, United States.,Institute for Biomedical Engineering, Science and Technology, University of Oklahoma, Norman, OK, United States
| | - Thubi H A Kolobe
- Department of Rehabilitation Science, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
| | - Beth A Smith
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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8
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Sargent B, Harbourne R, Moreau NG, Sukal-Moulton T, Tovin M, Cameron JL, Stevenson RD, Novak I, Heathcock J. Research Summit V: Optimizing Transitions From Infancy to Early Adulthood in Children With Neuromotor Conditions. Pediatr Phys Ther 2022; 34:411-417. [PMID: 35653258 PMCID: PMC9250600 DOI: 10.1097/pep.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of this executive summary is to review the process and outcomes of the Academy of Pediatric Physical Therapy Research Summit V, "Optimizing transitions from infancy to young adulthood in children with neuromotor disabilities: biological and environmental factors to support functional independence." SUMMARY OF KEY POINTS An interdisciplinary group of researchers, representatives from funding agencies, and individuals with neuromotor disabilities and their parents participated in an intensive 2.5-day summit to determine research priorities to optimize life transitions for children with neuromotor disabilities. Recommended priorities for research included (1) promoting self-determination and self-efficacy of individuals with neuromotor disabilities and their families, (2) best care at the right time: evidence-based best practice care, led and navigated by families seamlessly across the lifespan, (3) strengthening connections between developmental domains to enhance function and participation, and (4) optimal dosing and timing to support adaptive bone, muscle, and brain plasticity across the lifespan.
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Affiliation(s)
- Barbara Sargent
- University of Southern California, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Los Angeles, California, USA
| | - Regina Harbourne
- Duquesne University, Rangos School of Health Sciences, Department of Physical Therapy, Pittsburgh, Pennsylvania, USA
| | - Noelle G. Moreau
- Louisiana State University Health Sciences Center – New Orleans, Department of Physical Therapy, School of Allied Health, New Orleans, Louisiana USA
| | - Theresa Sukal-Moulton
- Northwestern University, Departments of Physical Therapy and Human Movement Sciences and Pediatrics, Feinberg School of Medicine, Chicago, IL, USA
| | - Melissa Tovin
- Nova Southeastern University, Department of Physical Therapy, Fort Lauderdale, FL, USA
| | - Judy L. Cameron
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania, USA
| | - Richard D. Stevenson
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, VA, USA
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jill Heathcock
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, Columbus, OH, USA
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Inamdar K, Khurana S, Dusing SC. Effect of Contingency Paradigm-Based Interventions on Developmental Outcomes in Young Infants: A Systematic Review. Pediatr Phys Ther 2022; 34:146-161. [PMID: 35184076 DOI: 10.1097/pep.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this systematic review was to identify controlled trials evaluating the efficacy of contingency paradigm-based interventions to improve feeding, motor, or cognitive outcomes during the first year of life. SUMMARY OF KEY POINTS Seventeen studies, including 10 randomized controlled trials, incorporating contingency paradigm-based interventions were identified. Three of 3 trials reported improvements in nutritive sucking using pacifier-activated lullaby in preterm infants before term age. Seven of 12 trials reported improvements in reaching, manual exploration, and kicking behaviors in term and preterm infants; and 6 of 10 trials reported gains in early cognition using sticky mittens and contingent toys. CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE Contingency paradigm-based interventions can improve feeding outcomes in the neonatal intensive care unit in very preterm infants, and increase reaching, and perceptual-cognitive behaviors in term infants. Future research is needed to establish contingency paradigms as an effective early intervention strategy. WHAT THIS ADDS TO THE EVIDENCE This review synthesizes a body of literature on contingency paradigm-based interventions and highlights its potential paradigm-based interventions to improve developmental outcomes in infants.
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Affiliation(s)
- Ketaki Inamdar
- Department of Physical Therapy (Ms Inamdar), Rehabilitation and Movement Science Program, Motor Development Lab, Virginia Commonwealth University, Richmond, Virginia; Department of Physical Therapy (Dr Khurana), Motor Development Lab, Virginia Commonwealth University, Richmond, Virginia; Division of Biokinesiology and Physical Therapy (Dr Dusing), Motor Development Lab, University of Southern California, Los Angeles, California
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10
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Regional Differences in School-Based Physical Therapy Practice for Students Who Made Progress on 2 Outcome Measures. Pediatr Phys Ther 2022; 34:46-54. [PMID: 34958332 DOI: 10.1097/pep.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study examined whether regional differences exist in the provision of school-based physical therapy services for students who achieved positive progress and explored relationships between student outcomes and school-based physical therapy. METHODS Physical therapists developed student goals using Goal Attainment Scaling (GAS) and administered the School Function Assessment (SFA). Therapists documented activities, interventions, and type of service delivery provided weekly. Students were assigned to regions for analysis. RESULTS Student GAS goal attainment and progress on the SFA did not vary significantly among regions. The dosage of school-based physical therapy services, interventions, and activities varied. CONCLUSIONS There were regional differences that did not impact goal achievement. Further research is needed to identify the most efficient and effective interventions and dosage to support student outcomes.
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Gmelig Meyling C, Verschuren O, Rentinck IR, Engelbert RHH, Gorter JW. Physical rehabilitation interventions in children with acquired brain injury: a scoping review. Dev Med Child Neurol 2022; 64:40-48. [PMID: 34309829 PMCID: PMC9292549 DOI: 10.1111/dmcn.14997] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
AIM To synthesize the evidence about the characteristics (frequency, intensity, time, type) and effects of physical rehabilitation interventions on functional recovery and performance in daily functioning in children and young people with acquired brain injury (ABI), including traumatic brain injuries (TBI) and non-TBI, during the subacute rehabilitation phase. METHOD Using scoping review methodology, a systematic literature search was performed using four databases. Articles were screened by title and abstract and data from eligible studies were extracted for synthesis. RESULTS Nine of 3009 studies were included. The results demonstrated a variety of intervention characteristics: frequency varied between 1 and 7 days per week; time of intervention varied between 25 minutes and 6 hours a day; intervention types were specified in seven studies; and none of the included studies reported details of intensity of intervention. All studies reported positive results on the International Classification of Functioning, Disability and Health: Children and Youth (ICF-CY) levels of body function and activities after the intervention period, with study designs of included studies being cohort studies without concurrent controls (n=7) or case reports (n=2). INTERPRETATION Inconsistency in results hampers generalizability to guide clinical practice. Physical interventions during subacute rehabilitation have potential to improve functional recovery with intervention characteristics as an important factor influencing its effectiveness. Future well-designed studies are indicated to gain knowledge and optimize rehabilitation practice in paediatric ABI and high-quality research including outcomes across all ICF-CY domains is needed.
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Affiliation(s)
- Christiaan Gmelig Meyling
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtthe Netherlands,Department of Pediatric RehabilitationDe Hoogstraat RehabilitationUtrechtthe Netherlands
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtthe Netherlands
| | - Ingrid R Rentinck
- Department of Pediatric RehabilitationDe Hoogstraat RehabilitationUtrechtthe Netherlands
| | - Raoul H H Engelbert
- Department of RehabilitationAmsterdam Movement SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands,Faculty of HealthCentre of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamthe Netherlands,Department of PediatricsAmsterdam UMCEmma Children’s HospitalUniversity of AmsterdamAmsterdamthe Netherlands
| | - Jan Willem Gorter
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtthe Netherlands,Department of PediatricsCanChild Centre for Childhood Disability ResearchMcMaster UniversityHamiltonONCanada
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DAMIANO DIANEL, LONGO EGMAR. Early intervention evidence for infants with or at risk for cerebral palsy: an overview of systematic reviews. Dev Med Child Neurol 2021; 63:771-784. [PMID: 33825199 PMCID: PMC9413025 DOI: 10.1111/dmcn.14855] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 12/15/2022]
Abstract
AIM To perform an overview of systematic reviews and more recent randomized controlled trials (RCTs) on early motor interventions in infants aged 0 to 3 years with or at risk of cerebral palsy to inform current clinical and research efforts and provide a benchmark to assess future interventions ideally initiated within the first 6 months. METHOD Standardized searches of the PubMed, Embase, Scopus, and Web of Science databases were conducted for systematic reviews (2009-2020) and RCTs (2015-2020). RESULTS From 840 unique records, 31 full texts were reviewed, yielding three systematic reviews encompassing 46 studies, 16 with comparison groups, and six additional RCTs that met the criteria. Two enrichment- and activity-based approaches had medium effect sizes on motor development, only one with low risk of bias; two others had large task-specific effect sizes but some bias concerns; and three enriched environment studies with some bias concerns had medium effect sizes on cognitive development. Most had small or no effect sizes, bias concerns, and uncertain diagnostic determinations. INTERPRETATION Data synthesis revealed limited data quantity and quality, and suggest, although not yet confirmed, greater benefit from early versus later intervention. Research efforts with greater early diagnostic precision and earlier intervention are accelerating, which may transform future outcomes and practices. What this paper adds For over 50% of trials within the reviews, the intervention was compared to standard care with only two showing efficacy. Similar to results in older children, constraint-induced movement therapy (CIMT) emerged as efficacious with high effect sizes. CIMT was not superior to similarly intense bimanual training or occupational therapy. Goals-Activity-Motor Enrichment intervention initiated before 5 months of age was superior to equally intense standard care. Several other enriched environment strategies promoted cognitive and/or motor development.
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Affiliation(s)
| | - EGMAR LONGO
- Health of Children, Federal University of Rio Grande do Norte/Faculty of Health Sciences of Trairi-UFRN/FACISA, Santa Cruz, Brazil
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13
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Bailes AF, Greve K, Long J, Kurowski BG, Vargus-Adams J, Aronow B, Mitelpunkt A. Describing the Delivery of Evidence-Based Physical Therapy Intervention to Individuals With Cerebral Palsy. Pediatr Phys Ther 2021; 33:65-72. [PMID: 33770793 PMCID: PMC10141519 DOI: 10.1097/pep.0000000000000783] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize by evidence grades and examine variation in type of physical therapy intervention delivered in routine clinical care in individuals with cerebral palsy (CP). METHODS Retrospective data collection from the electronic record over 1 year at a tertiary care pediatric outpatient therapy division. RESULTS Four hundred sixty-five individuals with CP received 28 344 interventions during 4335 treatment visits. Sixty-six percent of interventions were evidence-based interventions (EBIs). Significant variation was demonstrated across Gross Motor Function Classification System levels, with children classified as level V receiving the least and level III the most. The most frequent EBIs delivered were caregiver education, motor control, functional strengthening, ankle-foot orthoses, treadmill training, and fit of adaptive equipment. CONCLUSIONS Further work is needed to determine whether amount of EBI is related to better outcomes. Combining this information with other aspects of dose (intensity, time, and frequency) may elucidate the contribution of each with outcomes.
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Affiliation(s)
- Amy F Bailes
- Division of Occupational Therapy and Physical Therapy (Drs Bailes, Greve, and Long), Division of Orthopaedic Surgery Motion Analysis Laboratory (Dr Long), and Division of Biomedical Informatics (Drs Aronow and Mitelpunkt), Cincinnati Children's Hospital, Cincinnati, Ohio; Department of Rehabilitation Science (Dr Bailes), University of Cincinnati, Cincinnati, Ohio; Division of Pediatric Rehabilitation Medicine (Drs Kurowski and Vargus-Adams), Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Sackler Faculty of Medicine (Dr Mitelpunkt), Tel Aviv University, Tel Aviv, Israel
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Ragni LB, Zlotolow DA, Daluiski A, Kim G. Combined clinic and home-based therapeutic approach for the treatment of bilateral radial deficiency for a young child with Holt-Oram syndrome: A case report. J Hand Ther 2021; 35:670-677. [PMID: 33947614 DOI: 10.1016/j.jht.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/17/2020] [Accepted: 03/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Holt-Oram syndrome (HOS) is a rare, genetic condition characterized by the combination of congenital heart defect and hypoplasia in one or both upper extremities. Children with HOS commonly present with varied joint and limb involvement including radial longitudinal deficiency impacting hand function. Evidence-based guidelines regarding orthotic wear and therapeutic techniques are lacking. PURPOSE The aim of this case report was to present the results of a long-term occupational therapy program for a patient with HOS pre and postpollicization. STUDY DESIGN Case report. METHODS A 4-month-old patient with bilateral radial longitudinal deficiencies began outpatient occupational therapy for custom orthosis fabrication and treatment which included long term clinic and home-based intervention. Techniques included passive range of motion, orthosis wear, therapeutic taping, and modified constraint induced movement therapy. Longitudinal assessment of musculoskeletal alignment and functional hand use was performed using goniometry for passive and active range of motion, the Assisting Hand Assessment (AHA), and The Thumb Grasp and Pinch Assessment (T-GAP). RESULTS Improvement in passive and active range of motion was achieved as well as improved activity level function as measured by the AHA and T-GAP postpollicization and intervention. CONCLUSIONS A combined clinic and home-based therapeutic approach can be effective for children with HOS to improve alignment and function pre and postpollicization to further enhance hand function. Comprehensive, long-term assessment is necessary to fully evaluate and communicate improvement.
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Affiliation(s)
- Lori B Ragni
- NYU Langone Health Rusk Rehabilitation, New York, NY, USA.
| | | | | | - Grace Kim
- NYU Langone Health Rusk Rehabilitation, New York, NY, USA.
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Galvão FR, Silvestre MC, Gomes CL, Pereira NK, Nóbrega VT, Lima WS, Gondim AL, Cacho EW, Cacho RO. Group-based constraint-induced movement therapy in the rehabilitation of chronic poststroke patients. Medicine (Baltimore) 2021; 100:e24864. [PMID: 33663110 PMCID: PMC7909176 DOI: 10.1097/md.0000000000024864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to describe the effects of a 90-minute group-based constraint-induced movement therapy protocol (CIMT) on upper extremity (UE) rehabilitation in poststroke patients. METHOD The study was a case series clinical study with 6 patients with chronic stroke admitted to the institutional integrated clinic. Ten 90-minute CIMT sessions were administered, based on the principles of the original therapy. On completion of the protocol, participants underwent group care once a week, for 1 hour a day. For comparison purposes, the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM) were applied on admission, shortly after completing the protocol, and 3 months after completion. In addition, the MAL and shaping tasks were applied daily. RESULTS There was a statistically significant difference only in the MAL Amount of Use Scale applied daily between the 2nd (3.56) and 9th (3.31) and 2nd and 10th days (4.49) (P = .004), with a moderate effect size (d' = 0.46), and in the average value of shaping repetitions between the 1st (16.10) and 2nd (6.00) and 1st and 10th tasks (7.00) (P = .014), with a moderate effect size (d' = 0.35). CONCLUSION The 90-minute CIMT protocol resulted in significant improvements in use of the more affected arm in activities of daily living during the 2-week protocol. Additional research with a larger sample and a control group is needed to confirm its effectiveness.
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Rahlin M, Duncan B, Howe CL, Pottinger HL. How does the intensity of physical therapy affect the Gross Motor Function Measure (GMFM-66) total score in children with cerebral palsy? A systematic review protocol. BMJ Open 2020; 10:e036630. [PMID: 32690525 PMCID: PMC7371020 DOI: 10.1136/bmjopen-2019-036630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Intensive physical therapy (PT) interventions administered to children with cerebral palsy (CP) have received a significant amount of attention in published literature. However, there is considerable variability in therapy intensity among studies and notable lack of information on optimal intervention dosing. This makes it difficult for clinicians to use evidence to inform practice. Many studies use the Gross Motor Function Measure (GMFM-66) to assess functional progress in children with CP. The purpose of this systematic review will be to identify the GMFM-66 change score reported in published studies, with outcomes based on intervention intensity. Whether the type of PT intervention, child's age, and Gross Motor Function Classification System level influence the GMFM-66 scores will be also assessed. METHODS AND ANALYSIS This systematic review protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 checklist. In March 2018, nine databases (PubMed, Ovid MEDLINE, Cochrane Library, Embase, Scopus, Web of Science, CINAHL, ClinicalTrials.gov, and REHABDATA) were searched for controlled clinical trials and single-subject design studies of PT interventions of any kind and intensity that used the GMFM-66 as an outcome measure for children with CP, age up to 18 years. Two authors independently reviewed the titles and abstracts and arrived at consensus on paper selection for a full-text review. The same process was used for a full-text article screening based on further detailed inclusion criteria, with a final selection made for those suitable for data extraction. Prior to commencement of data extraction, all searches will be updated, and new results re-screened. ETHICS AND DISSEMINATION This study will involve a systematic review of published articles and no primary data collection. Therefore, no ethical approval will be necessary. Results will be disseminated in a peer-reviewed publication and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42020147669.
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Affiliation(s)
- Mary Rahlin
- Department of Physical Therapy, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Burris Duncan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Carol L Howe
- Health Sciences Library, University of Arizona, Tucson, Arizona, USA
| | - Heidi L Pottinger
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Ravault L, Darbois N, Pinsault N. Methodological Considerations to Investigate Dosage Parameters of Intensive Upper Limb Rehabilitation in Children with Unilateral Spastic Cerebral Palsy: A Scoping Review of RCTs. Dev Neurorehabil 2020; 23:309-320. [PMID: 31710245 DOI: 10.1080/17518423.2019.1687599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSES To identify and synthesize RCTs on the isolated effect of dosage parameters of upper limb Intensive Motor Rehabilitation Treatments (IMRT) of children with Unilateral Spastic Cerebral Palsy (USCP); to identify the most frequent methodological weaknesses. METHODS Searches were conducted until September 2018 in gray and published literature databases and supplemented by exploring the identified studies' references. Inclusion criteria applied: RCT; children aged 1.5 to 19 years with USCP; upper limb IMRT differing only from ≥1/4 dosage parameters between groups. Literature analyses conducted: qualitative and descriptive. RESULTS We identified 461 studies. Seventeen were included: three presented a rehabilitation dosage distinction between groups in Frequency-Time, four in Intensity-Progressivity, three in Intensity-Restraint, two in Intensity-Environment and five presented ≥3 distinctions above. CONCLUSIONS Inconsistencies were noted between USCP lifelong issues, and the short follow-ups and lack of participation assessments. Confounding factors and misstatements in Intent To Treat (ITT) analyses were identified. A meta-analysis was considered irrelevant. ABBREVIATIONS USCP, CP: Unilateral Spastic Cerebral Palsy, Cerebral Palsy; RCT: Randomized Controlled Trial; IMRT: Intensive Motor Rehabilitation Treatment.
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Affiliation(s)
- Lucas Ravault
- Grenoble Alps University Hospital , Grenoble, France
| | | | - Nicolas Pinsault
- Grenoble Alps University Hospital , Grenoble, France.,Grenoble Alps University , Grenoble, France.,ThEMAS team, TIMC-IMAG Laboratory, UMR CNRS-UGA 5525 , Grenoble, France
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18
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Jackman M, Lannin N, Galea C, Sakzewski L, Miller L, Novak I. What is the threshold dose of upper limb training for children with cerebral palsy to improve function? A systematic review. Aust Occup Ther J 2020; 67:269-280. [DOI: 10.1111/1440-1630.12666] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle Jackman
- Paediatric Occupational Therapy Department John Hunter Children’s Hospital Newcastle NSW Australia
| | - Natasha Lannin
- Occupational Therapy Department La Trobe University (School of Allied Health)The Alfred Prahran Vic Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Child and Adolescent HealthThe University of Sydney Frenchs Forest NSW Australia
| | - Leanne Sakzewski
- Centre for Children’s Health ResearchQueensland Cerebral Palsy and Rehabilitation Research CentreThe University of Queensland South Brisbane Qld Australia
| | - Laura Miller
- Australian Catholic University Banyo Qld Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Child and Adolescent HealthThe University of Sydney Frenchs Forest NSW Australia
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Abstract
Objective To apply practice-based evidence to clinical management of cerebral palsy (CP). The process of establishing purpose, structure, logistics, and elements of a multi-institutional registry and the baseline characteristics of initial enrollees are reported. Design A consensus-building process among consumers, clinicians, and researchers used a participatory action process. Setting Community, hospitals, and universities. Participants More than 100 clinicians, researchers, and consumers and more than 1858 enrollees in the registry. Main Outcome Measures Not applicable. Results Consensus was that the purpose of registry was to (1) quantify practice variation, (2) facilitate quality improvement (QI), and (3) perform comparative effectiveness research (CER). Collecting data during routine clinical care using the electronic medical record was determined to be a sustainable plan for data acquisition and management. Clinicians from multiple disciplines defined salient characteristics of individuals and interventions for the registry elements. The registry was central to the clinical research network, and a leadership structure was created. A leading electronic health record platform adopted the registry elements. Twenty-four sites have initiated the data collection process and agreed to export data to the registry. Currently 12 are collecting data. Number of enrollees and characteristics were similar to other population registers. Conclusions This is the first multi-institutional CP registry that contains the patient and treatment characteristics needed for QI and CER. The Cerebral Palsy Research Network registry elements are implemented in a versatile electronic platform and minimize burden to clinicians. The resultant registry is available for any institution to participate and is growing rapidly.
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Key Words
- CDE, common data element
- CER, comparative effectiveness research
- CP, cerebral palsy
- CPRN, Cerebral Palsy Research Network
- Cerebral palsy
- Comparative effectiveness research
- EHR, electronic health record
- GMFCS, Gross Motor Function Classification System
- HCRN, Hydrocephalus Clinical Research Network
- IRB, Institutional Review Board
- LFEP, Learn from Every Patient
- NCH, Nationwide Children’s Hospital
- NINDS, National Institute of Neurological Disorders and Stroke
- OT, occupational therapy
- PT, physical therapy
- QI, quality improvement
- Quality improvement
- REDCap, Research Electronic Data Capture
- Rehabilitation
- SLP, speech language pathology
- VON, Vermont Oxford Network
- registries
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21
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Dumas HM. Quantifying motor learning strategies can translate to physiotherapy dose for children with cerebral palsy. Dev Med Child Neurol 2019; 61:996. [PMID: 30761519 DOI: 10.1111/dmcn.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Helene M Dumas
- Medical/Rehabilitation Research Center, Franciscan Children's Hospital, Boston, MA, USA
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22
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Documenting Physical Therapy Dose for Individuals With Cerebral Palsy: A Quality Improvement Initiative. Pediatr Phys Ther 2019; 31:234-241. [PMID: 31206504 DOI: 10.1097/pep.0000000000000614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the quality improvement (QI) activities used to improve treatment dose documentation for individuals with cerebral palsy (CP) and to discuss insights gained from this project. METHODS Global and smart aims were established and interventions were tested from January 2017 through February 2018 using Plan-Do-Study-Act cycles. Performance was tracked overtime using run and control charts. RESULTS The QI initiative resulted in a sustainable increase in percentage of dose elements present in the electronic medical record from 78% to 94%. Key drivers of improvement included (1) knowledge and awareness of dose, (2) clinician buy-in, (3) effective engagement of child and parent, (4) therapist knowledge of evidence-based treatments, (5) transparent and reliable documentation system, and (6) audit and clinician feedback. CONCLUSIONS QI methods provided the tools to improve workflow and increase dose documentation for individuals with CP.
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Ferrante R, Hendershot S, Baranet K, Barbosa G, Carey H, Maitre N, Lo W, Pan J, Heathcock J. Daily and Weekly Rehabilitation Delivery for Young Children With Gross Motor Delay: A Randomized Clinical Trial Protocol (the DRIVE Study). Pediatr Phys Ther 2019; 31:217-224. [PMID: 30865149 PMCID: PMC7029804 DOI: 10.1097/pep.0000000000000594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The proposed project tests the principle that frequency of rehabilitation is an important regulator of therapeutic response in infants. METHODS We will randomize 75 infants with cerebral palsy, 6 to 24 months of age and/or Gross Motor Function Classification System levels III to V (higher severity), to determine the short-term and long-term effects of 3 dosing protocols consisting of an identical number of 2-hour sessions of the same motor learning-based therapy applied over a different total number of calendar weeks. RESULTS AND CONCLUSIONS The results will inform clinicians, families, and scientists about dosing and will provide needed recommendations for frequency of rehabilitation to optimize motor function and development of young children with cerebral palsy.
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Affiliation(s)
- Rachel Ferrante
- Nationwide Children's Hospital (Drs Ferrante, Hendershot, Baranet, Maitre, and Lo), Columbus, Ohio; The Ohio State University (Drs Barbosa, Pan, and Heathcock), Columbus, Ohio; Kettering College (Dr Carey), Kettering, Ohio
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24
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Pottinger HL, Rahlin M, Voigt J, Walsh ME, Fregosi CM, Duncan BR. Feasibility of an intensive outpatient Perception-Action Approach intervention for children with cerebral palsy: a pilot study. Physiother Theory Pract 2018; 36:973-988. [PMID: 30198809 DOI: 10.1080/09593985.2018.1517847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this pilot study was (1) to evaluate feasibility of attendance and parent satisfaction with an intensive outpatient physical and occupational therapy program for young children with spastic cerebral palsy (CP) and (2) to examine changes in motor function. Methods: Sixteen children with CP, age range 18-36 months (mean 24.3 ± 6.3 months), received physical and occupational therapy sessions (30 minutes each) 5 days per week for 12 weeks. Attendance rates and parent satisfaction were assessed. Change in motor function using a one-group pre-post design was evaluated using the Gross Motor Function Measure-66 (GMFM-66), Quality of Upper Extremity Skills Test, and Pediatric Evaluation of Disability Inventory. GMFM-66 outcomes were also compared with expected outcomes using previously published normative developmental trajectories of children receiving standard therapies. Results: An average of 82% of scheduled outpatient physical and occupational therapies for 16 children were completed and the 11 parents who completed the Hills and Kitchen's Physiotherapy Outpatient Satisfaction Questionnaire were satisfied with the therapies and with their child's progress. Participants showed notable, statistically significant improvement across all activity-related measures. Conclusion: An intensive protocol of outpatient therapies utilizing Perception-Action Approach was feasible for most families of young children with spastic CP to attend at the outpatient clinic location. As this was not an experimental study, no reliable conclusions related to efficacy can be made, but the promising results suggest that further research into the effectiveness of intensive protocols is worthwhile.
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Affiliation(s)
- Heidi L Pottinger
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona , Tucson, AZ, USA
| | - Mary Rahlin
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science , North Chicago, IL, USA
| | - Jessiemarie Voigt
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona , Tucson, AZ, USA
| | - Michele E Walsh
- Department of Family Studies and Human Development, Norton School of Family and Consumer Sciences, University of Arizona , Tucson, AZ, USA
| | - Charlene M Fregosi
- Tucson Medical Center, Outpatient Therapies and Audiology , Tucson, AZ, USA
| | - Burris R Duncan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona , Tucson, AZ, USA
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Brandão MB, Mancini MC, Ferre CL, Figueiredo PRP, Oliveira RHS, Gonçalves SC, Dias MCS, Gordon AM. Does Dosage Matter? A Pilot Study of Hand-Arm Bimanual Intensive Training (HABIT) Dose and Dosing Schedule in Children with Unilateral Cerebral Palsy. Phys Occup Ther Pediatr 2018; 38:227-242. [PMID: 29240518 DOI: 10.1080/01942638.2017.1407014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 hours) and two schedules of the same dose (90 vs. 2 × 45 hours) on hand and daily functioning. METHOD Eighteen children with unilateral cerebral palsy were randomized to receive 6 hours of daily training over 3 weeks, totaling 90 hours (Group 90, n = 9) or receive 6 hours of daily training over 1.5 weeks, totaling 45 hours (Group 2 × 45, n = 9). After 6 months, Group 2 × 45 received an additional 45 hours. Hand (Jebsen-Taylor Test of Hand Function, Assisting Hand Assessment) and daily functioning tests (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory) were administered before, immediately after, and 6 months after interventions. RESULTS Both groups demonstrated significant improvements in hand and daily functioning after 90 hours (Group 90) or the first 45 hours (Group 2 × 45), without differences between groups. However, more children from Group 90 obtained smallest detectable differences in the Assisting Hand Assessment. The addition of the second bout of 45 hours (Group 2 × 45) did not lead to further improvements. CONCLUSIONS As this study was powered to test for large differences between groups, future investigations on larger samples will be needed to compare differences at the two dosage levels.
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Affiliation(s)
- Marina B Brandão
- a Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Marisa C Mancini
- a Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Claudio L Ferre
- b Burke-Cornell Medical Research Institute , White Plains , New York , USA
| | | | - Rachel H S Oliveira
- a Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | | | - Miriam C S Dias
- d Occupational Therapist , Belo Horizonte , Minas Gerais , Brazil
| | - Andrew M Gordon
- e Department of Biobehavioral Sciences , Teachers College, Columbia University , New York , New York , USA
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Gee BM, Gerber LD, Butikofer R, Covington N, Lloyd K. Exploring the parameters of intensity, frequency, and duration within the constraint induced movement therapy published research: A content analysis. NeuroRehabilitation 2018; 42:167-172. [PMID: 29562553 DOI: 10.3233/nre-172233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurological rehabilitation specialists must determine appropriate dosage, consisting of frequency, intensity, and duration of specified treatments. OBJECTIVE The objective of this study was to perform a content analysis of the current literature related to dosage (duration, frequency and intensity) for constraint-induced movement therapy (CIMT) in the adult population. METHODS A content analysis was conducted which yielded 62 scholarly articles. RESULTS The frequency of CIMT ranged from 1 to 7 days per week with the average frequency being 4.98 days. The duration of CIMT, ranged from 2 to 10 weeks with the average duration 3.14 weeks. All three components of dosage were reported collectively in outcomes studies conducted in inpatient settings and rehabilitation clinics. CONCLUSIONS The findings provide a groundwork for evidence based practice for clinician in the application of CIMT dosage with consideration of settings and CIMT components.
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Affiliation(s)
- Bryan M Gee
- Department of Physical and Occupational Therapy, Idaho State University, Pocatello, ID, USA
| | - L Derek Gerber
- Department of Physical and Occupational Therapy, Idaho State University, Pocatello, ID, USA
| | - Rebecca Butikofer
- Department of Physical and Occupational Therapy, Idaho State University, Pocatello, ID, USA
| | - Nicole Covington
- Department of Physical and Occupational Therapy, Idaho State University, Pocatello, ID, USA
| | - Kimberly Lloyd
- Department of Physical and Occupational Therapy, Idaho State University, Pocatello, ID, USA
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Cope S, Mohn-Johnsen S. The effects of dosage time and frequency on motor outcomes in children with cerebral palsy: A systematic review. Dev Neurorehabil 2017. [PMID: 28632463 DOI: 10.1080/17518423.2017.1282053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Provide an updated review regarding treatment dosage for children with cerebral palsy (CP) by examining the variables of type, time, frequency, and intensity. METHODS A systematic review was performed with 30 articles meeting the inclusion criteria. Two authors independently extracted data including information about risk of bias. Ten articles were included in the review. RESULTS Eight studies manipulated time, two studies manipulated frequency, and three studies manipulated both variables. No studies investigated intensity. Findings suggest that manipulating time and/or frequency may result in better motor function for higher total dosing; however, benefits were not consistent across studies and few showed clinically significant improvements. CONCLUSION This most current evidence regarding the effect of dosage on motor function for children with CP suggests that there is insufficient evidence to support implementing high-dosage therapy. Further research is needed to clarify the relationship between dosage variables on motor function for children with CP.
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Affiliation(s)
- Steven Cope
- a Department of Occupational Therapy , The College of St. Scholastica , Duluth , MN , USA
| | - Samantha Mohn-Johnsen
- b Department of Physical Therapy , The College of St. Scholastica , Duluth , MN , USA
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28
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Valentín‐Gudiol M, Mattern‐Baxter K, Girabent‐Farrés M, Bagur‐Calafat C, Hadders‐Algra M, Angulo‐Barroso RM. Treadmill interventions in children under six years of age at risk of neuromotor delay. Cochrane Database Syst Rev 2017; 7:CD009242. [PMID: 28755534 PMCID: PMC6483121 DOI: 10.1002/14651858.cd009242.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development. OBJECTIVES To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay. SEARCH METHODS In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population. DATA COLLECTION AND ANALYSIS Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model. MAIN RESULTS This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45). AUTHORS' CONCLUSIONS This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.
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Affiliation(s)
- Marta Valentín‐Gudiol
- Universitat Internacional de CatalunyaDepartment of Physical TherapyBarcelonaSpain
- Ramon Llull UniversityBlanquerna School of Health SciencesBarcelonaSpain
| | - Katrin Mattern‐Baxter
- California State UniversityDepartment of Physical Therapy6000 J StSacramentoCaliforniaUSA95819
| | - Montserrat Girabent‐Farrés
- Universitat Internacional de CatalunyaDepartment of Physical Therapy, Biostatistics UnitC/ Josep trueta, s/nSant Cugat del VallèsBarcelonaSpain08195
| | | | - Mijna Hadders‐Algra
- University of Groningen, University Medical Center Groningen, Department of PaediatricsHanzeplein 1GroningenNetherlands9713 GZ
| | - Rosa Maria Angulo‐Barroso
- University of BarcelonaDepartment of Health and Applied Sciences, National Institute of Physical EducationAve. de L'Estadi 12‐22BarcelonaBarcelonaSpain08036
- California State UniversityDepartment of KinesiologyNorthridgeCaliforniaUSA
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Gannotti ME. Coupling Timing of Interventions With Dose to Optimize Plasticity and Participation in Pediatric Neurologic Populations. Pediatr Phys Ther 2017; 29 Suppl 3:S37-S47. [PMID: 28654476 PMCID: PMC5488702 DOI: 10.1097/pep.0000000000000383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this article is to propose that coupling of timing of interventions with dosing of interventions optimizes plasticity and participation in pediatric neurologic conditions, specifically cerebral palsy. Dosing includes frequency, intensity, time per session, and type of intervention. Interventions focus on body structures and function and activity and participation, and both are explored. Known parameters for promoting bone, muscle, and brain plasticity and evidence supporting critical periods of growth during development are reviewed. Although parameters for dosing participation are not yet established, emerging evidence suggests that participation at high intensities has the potential for change. Participation interventions may provide an additional avenue to promote change through the life span. Recommendations for research and clinical practice are presented to stimulate discussions and innovations in research and practice.
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Affiliation(s)
- Mary E Gannotti
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut
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Bailes AF, Gannotti M, Fenchel M. Using the electronic medical record to study the association of child and environmental characteristics on the type of physical therapy services delivered to individuals with cerebral palsy. Physiother Theory Pract 2017; 33:644-652. [DOI: 10.1080/09593985.2017.1328717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amy F. Bailes
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Mary Gannotti
- Department of Rehabilitation Sciences, University of Hartford, Hartford, CT, USA
| | - Matthew Fenchel
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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31
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Charles J. Hand-arm bimanual intensive therapy: a new direction. Dev Med Child Neurol 2017; 59:569. [PMID: 28272737 DOI: 10.1111/dmcn.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jeanne Charles
- Physical Therapy Department, University of New England - Portland Campus, Portland, ME, USA
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32
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Hadders-Algra M, Boxum AG, Hielkema T, Hamer EG. Effect of early intervention in infants at very high risk of cerebral palsy: a systematic review. Dev Med Child Neurol 2017; 59:246-258. [PMID: 27925172 DOI: 10.1111/dmcn.13331] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 01/18/2023]
Abstract
AIM First, to systematically review the evidence on the effect of intervention applied during the first postnatal year in infants with or at very high risk of cerebral palsy (CP) on child and family outcome. Second, to assess whether type and dosing of intervention modify the effect of intervention. METHOD Relevant literature was identified by searching the PubMed, Embase, and CINAHL databases. Selection criteria included infants younger than 12 months corrected age with or at very high risk of CP. Methodological quality including risk of bias was scrutinized. RESULTS Thirteen papers met the inclusion criteria. Seven studies with moderate to high methodological quality were analysed in detail; they evaluated neurodevelopmental treatment only (n=2), multisensory stimulation (n=1), developmental stimulation (n=2), and multifaceted interventions consisting of a mix of developmental stimulation, support of parent-infant interaction, and neurodevelopmental treatment (n=2). The heterogeneity precluded conclusions. Yet, two suggestions emerged: (1) dosing may be critical for effectiveness; (2) multifaceted intervention may offer best opportunities for child and family. INTERPRETATION The literature on early intervention in very high-risk infants with sufficient methodological quality is limited, heterogeneous, and provides weak evidence on the effect. More studies are urgently needed. Suggestions for future research are provided.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
| | - Anke G Boxum
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
| | - Tjitske Hielkema
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, the Netherlands
| | - Elisa G Hamer
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.,Radboud University Medical Center, Department of Neurology, Nijmegen, the Netherlands
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33
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Audu O, Daly C. Standing activity intervention and motor function in a young child with cerebral palsy: A case report. Physiother Theory Pract 2017; 33:162-172. [PMID: 28071965 DOI: 10.1080/09593985.2016.1265621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE There is limited evidence to fully justify the use of standing interventions for children with cerebral palsy (CP). This case report describes the impact of an 8-week standing program on motor function in a child with severe CP living in western Africa. METHODS The subject was diagnosed with ischemic - hypoxic encephalopathy shortly after birth and with CP at 12 months of age. Gross Motor Function Classification of CP was level IV. Early attempts at physical therapy were interrupted by limited access to medical services. At 18 months, a standing program using a locally constructed standing frame was initiated. The standing intervention was completed at home 5 times a week for 8 weeks. Motor skills were assessed at baseline and post-intervention using the Gross Motor Function Measure (GMFM-66). RESULTS Scores on the GMFM-66 increased from 28 at baseline to 37.4 in 8 weeks. Improvements in motor function included improved head control, improved upper extremity function, and increased sitting ability. CONCLUSIONS Implementation of a home-based standing program may have contributed to improved motor skills for this child. Further research is needed to determine the effect of standing interventions on functional motor development for children with severe CP.
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Affiliation(s)
- Olukemi Audu
- a Physical Therapy Department, School of Health Professions and Studies , University of Michigan-Flint , Flint , MI , USA
| | - Carol Daly
- a Physical Therapy Department, School of Health Professions and Studies , University of Michigan-Flint , Flint , MI , USA
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Coker-Bolt P, Downey RJ, Connolly J, Hoover R, Shelton D, Seo NJ. Exploring the feasibility and use of accelerometers before, during, and after a camp-based CIMT program for children with cerebral palsy. J Pediatr Rehabil Med 2017; 10:27-36. [PMID: 28339408 DOI: 10.3233/prm-170408] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this pilot study was to determine the feasibility and use accelerometers before, during, and after a camp-based constraint-induced movement therapy (CIMT) program for children with hemiplegic cerebral palsy. METHODS A pre-test post-test design was used for 12 children with CP (mean = 4.9 yrs) who completed a 30-hour camp-based CIMT program. The accelerometer data were collected using ActiGraph GT9X Link. Children wore accelerometers on both wrists one day before and after the camp and on the affected limb during each camp day. Three developmental assessments were administered pre-post CIMT program. RESULTS Accelerometers were successfully worn before, during, and directly after the CIMT program to collect upper limb data. Affected upper limb accelerometer activity significantly increased during the CIMT camp compared to baseline (p< 0.05). Significant improvements were seen in all twelve children on all assessments of affected upper limb function (p< 0.05) measuring capacity and quality of affected upper limb functioning. CONCLUSION Accelerometers can be worn during high intensity pediatric CIMT programs to collect data about affected upper limb function. Further study is required to determine the relationship between accelerometer data, measure of motor capacity, and real-world performance post-CIMT.
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Affiliation(s)
- Patty Coker-Bolt
- Department of Health Professions, Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC, USA.,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Ryan J Downey
- Department of Health Professions, Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC, USA
| | - Jacqueline Connolly
- Department of Health Professions, Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC, USA
| | - Reagin Hoover
- Department of Health Professions, Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel Shelton
- Department of Health Professions, Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC, USA
| | - Na Jin Seo
- Department of Health Professions, Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC, USA.,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
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Maitre NL, Chorna O, Romeo DM, Guzzetta A. Implementation of the Hammersmith Infant Neurological Examination in a High-Risk Infant Follow-Up Program. Pediatr Neurol 2016; 65:31-38. [PMID: 27765470 PMCID: PMC5395423 DOI: 10.1016/j.pediatrneurol.2016.09.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND High-risk infant follow-up programs provide early identification and referral for treatment of neurodevelopmental delays and impairments. In these programs, a standardized neurological examination is a critical component of evaluation for clinical and research purposes. METHODS To address primary challenges of provider educational diversity and standardized documentation, we designed an approach to training and implementation of the Hammersmith Infant Neurological Examination with precourse materials, a workshop model, and adaptation of the electronic medical record. CONCLUSIONS Provider completion and documentation of a neurological examination were evaluated before and after Hammersmith Infant Neurological Examination training. Standardized training and implementation of the Hammersmith Infant Neurological Examination in a large high-risk infant follow-up is feasible and effective and allows for quantitative evaluation of neurological findings and developmental trajectories.
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Affiliation(s)
- Nathalie L Maitre
- Center for Perinatal Research at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics at Nationwide Children's Hospital, Columbus, Ohio.
| | - Olena Chorna
- Center for Perinatal Research at Nationwide Children's Hospital, Columbus, OH
| | | | - Andrea Guzzetta
- Stella Maris Infant Laboratory for Early Intervention, Department of Developmental Neuroscience, Stella Maris Scientific Institute, University of Pisa, Italy,Department of Clinical and Experimental Medicine, University of Pisa, Italy
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36
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Affiliation(s)
- Amy F Bailes
- Cincinnati Childrens Hospital Medical Center - Division of Occupational Therapy, Physical Therapy and Therapeutic Recreation, Cincinnati, OH, USA
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37
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Gee BM, Lloyd K, Devine N, Tyrrell E, Evans T, Hill R, Dineen S, Magalogo K. Dosage Parameters in Pediatric Outcome Studies Reported in 9 Peer-Reviewed Occupational Therapy Journals from 2008 to 2014: A Content Analysis. Rehabil Res Pract 2016; 2016:3580789. [PMID: 26949547 PMCID: PMC4754491 DOI: 10.1155/2016/3580789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/28/2015] [Accepted: 12/31/2015] [Indexed: 11/17/2022] Open
Abstract
Occupational therapists determine the dosage when establishing the plan of care for their pediatric clients. A content analysis was conducted using 123 pediatric occupational therapy outcomes studies from 9 scholarly international occupational therapy journals. The parameters of dosage were calculated using descriptive statistics in order to obtain a representation of dosage available within the current collage of pediatric occupational therapy outcomes studies. The results revealed that most studies reported portions of dosage parameters within the published studies. The average findings for the subcomponents related to dosage were session length (minutes) M = 58.7, duration of plan of care (weeks) M = 12.1, session frequency (per week) M = 3.4, and total hours of therapy (hours) M = 18.1. This first attempt at describing and calculating dosage related to pediatric occupational therapy practice indicates that evidence is lacking within the published literature to adequately guide OT dosage decisions. Further research related to dosage in pediatric occupational therapy practice is needed.
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Affiliation(s)
- Bryan M. Gee
- Department of Physical and Occupational Therapy, Idaho State University, Campus Mail Box 8045, Pocatello, ID 83201-8045, USA
| | - Kimberly Lloyd
- Department of Physical and Occupational Therapy, Idaho State University, Campus Mail Box 8045, Pocatello, ID 83201-8045, USA
| | - Nancy Devine
- Department of Physical and Occupational Therapy, Idaho State University, Campus Mail Box 8045, Pocatello, ID 83201-8045, USA
| | - Erin Tyrrell
- Idaho State University, Pocatello, ID 83201-8045, USA
| | - Trisha Evans
- Idaho State University, Pocatello, ID 83201-8045, USA
| | - Rebekah Hill
- Idaho State University, Pocatello, ID 83201-8045, USA
| | - Stacee Dineen
- Idaho State University, Pocatello, ID 83201-8045, USA
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Effects of a Group-Based Treadmill Program on Children With Neurodevelopmental Impairment Who Are Not Yet Ambulating. Pediatr Phys Ther 2016; 28:312-9. [PMID: 27008580 DOI: 10.1097/pep.0000000000000250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the effects of a group-based treadmill program on gross motor skills related to walking and the amount of support needed for ambulation in children with neuromotor impairment who are not yet walking. METHODS Twelve children (mean age, 30.4 months; standard deviation, 7.9) participated in the program twice per week for 14 weeks. The Gross Motor Function Measure-88 Dimensions D and E (GMFM-88 D/E), the Functional Mobility Scale (FMS), the timed 10-m walk test, and the Pediatric Evaluation of Disability Inventory Mobility Scale (PEDI) were administered before and at the conclusion of the program. Data were analyzed using paired the t test and Wilcoxon matched-pairs signed rank test. RESULTS Statistically significant improvements were found between pre- and posttests in the GMFM-88 D (P = .0005) and E (P = .001), in FMS scores (P = .039), and the PEDI (P = .001). CONCLUSIONS A group-based treadmill program leads to positive changes in walking ability in children with neuromotor impairment.
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Comparative Effectiveness Research and Children With Cerebral Palsy: Identifying a Conceptual Framework and Specifying Measures. Pediatr Phys Ther 2016; 28:58-69. [PMID: 27088688 DOI: 10.1097/pep.0000000000000203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE A step toward advancing research about rehabilitation service associated with positive outcomes for children with cerebral palsy is consensus about a conceptual framework and measures. METHODS A Delphi process was used to establish consensus among clinicians and researchers in North America. RESULTS Directors of large pediatric rehabilitation centers, clinicians from large hospitals, and researchers with expertise in outcomes participated (N = 18). Andersen's model of health care utilization framed outcomes: consumer satisfaction, activity, participation, quality of life, and pain. Measures agreed upon included Participation and Environment Measure for Children and Youth, Measure of Processes of Care, PEDI-CAT, KIDSCREEN-10, PROMIS Pediatric Pain Interference Scale, Visual Analog Scale for pain intensity, PROMIS Global Health Short Form, Family Environment Scale, Family Support Scale, and functional classification levels for gross motor, manual ability, and communication. CONCLUSIONS Universal forms for documenting service use are needed. Findings inform clinicians and researchers concerned with outcome assessment.
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40
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Technology for Children With Brain Injury and Motor Disability: Executive Summary From Research Summit IV. Pediatr Phys Ther 2016; 28:483-9. [PMID: 27661249 DOI: 10.1097/pep.0000000000000317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advances in technology show promise as tools to optimize functional mobility, independence, and participation in infants and children with motor disability due to brain injury. Although technologies are often used in adult rehabilitation, these have not been widely applied to rehabilitation of infants and children. In October 2015, the Academy of Pediatric Physical Therapy sponsored Research Summit IV, "Innovations in Technology for Children With Brain Insults: Maximizing Outcomes." The summit included pediatric physical therapist researchers, experts from other scientific fields, funding agencies, and consumers. Participants identified challenges in implementing technology in pediatric rehabilitation including accessibility, affordability, managing large data sets, and identifying relevant data elements. Participants identified 4 key areas for technology development: to determine (1) thresholds for learning, (2) appropriate transfer to independence, (3) optimal measurement of subtle changes, and (4) how to adapt to growth and changing abilities.
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Gagliardi C, Brenna V, Romaniello R, Arrigoni F, Tavano A, Romani M, Valente EM, Borgatti R. Cognitive rehabilitation in a child with Joubert Syndrome: Developmental trends and adaptive changes in a single case report. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 47:375-384. [PMID: 26489806 DOI: 10.1016/j.ridd.2015.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 06/05/2023]
Abstract
We report the clinical and rehabilitative follow up of M, a female child carrying a compound heterozygous pathogenic mutations in the TCTN1 gene and affected by Joubert Syndrome (JS). JS is a congenital cerebellar ataxia characterized by "the molar tooth sign" on axial MRI, a pathognomonic neuroradiological malformation involving the cerebellum and brainstem. JS presents with high phenotypic/cognitive variability, and little is known about cognitive rehabilitation programs. We describe the therapeutic settings, intensive rehabilitation targets and outcome indexes in M's cognitive development. Using a single case evidence-based approach, we attempt to distinguish the effectiveness of the intervention from the overall developmental trend. We assume that an adequate amount of focused, goal directed treatment in a relative short period of time can be at least as effective as one provided in longer time, and much less interfering with the child's everyday life. We conclude by discussing specific issues in cognitive development and rehabilitation in JS and, more broadly, in cerebellar malformations.
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Affiliation(s)
- Chiara Gagliardi
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
| | - Viola Brenna
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Romina Romaniello
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Filippo Arrigoni
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Alessandro Tavano
- Department of Neuroscience, Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany
| | - Marta Romani
- IRCCS Casa Sollievo della Sofferenza, Mendel Laboratory, San Giovanni Rotondo, Italy
| | - Enza Maria Valente
- Section of Neurosciences, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Renato Borgatti
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
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Implementing treatment frequency and duration guidelines in a hospital-based pediatric outpatient setting: administrative case report. Phys Ther 2015; 95:678-84. [PMID: 25573762 DOI: 10.2522/ptj.20130360] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/21/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Determining treatment frequency and duration of physical therapist services is an important component of outpatient pediatric physical therapist practice, yet there is little research available to inform these decisions. Treatment frequency guidelines (TFG) can assist decision making in guiding pediatric physical therapy. The purpose of this project was to examine the feasibility and application of implementing TFG in hospital-based pediatric outpatient physical therapy. PROJECT DESCRIPTION Previously developed TFG were modified for use in our pediatric outpatient physical therapy department to include duration and were referred to as treatment frequency and duration guidelines (TFDG). In order to successfully implement the TFDG, there were 2 phases to the project. In phase 1, the staff were provided the guidelines and procedures in a staff meeting and via email using a PowerPoint presentation. Phase 2 was initiated due to the poor response of the staff in implementing the guidelines in their practice after phase 1. The format was changed to include formal re-education via small-group and one-on-one education sessions (phase 2). Chart reviews were completed to assess therapists' adherence to using TFDG. OUTCOMES Therapists' adherence to use of TFDG increased following re-education: phase 1 (n=225 charts, 31% adherence) and phase 2 (n=197 charts, 90% adherence). DISCUSSION Treatment frequency and duration guidelines may assist in guiding frequency and duration decisions in pediatric physical therapy. Education via in-person meetings may improve adherence among staff.
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Basu AP, Pearse J, Kelly S, Wisher V, Kisler J. Early intervention to improve hand function in hemiplegic cerebral palsy. Front Neurol 2015; 5:281. [PMID: 25610423 PMCID: PMC4285072 DOI: 10.3389/fneur.2014.00281] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/09/2014] [Indexed: 01/29/2023] Open
Abstract
Children with hemiplegic cerebral palsy often have marked hand involvement with excessive thumb adduction and flexion and limited active wrist extension from infancy. Post-lesional aberrant plasticity can lead to progressive abnormalities of the developing motor system. Disturbances of somatosensory and visual function and developmental disregard contribute to difficulties with hand use. Progressive soft tissue and bony changes may occur, leading to contractures, which further limit function in a vicious cycle. Early intervention might help to break this cycle, however, the precise nature and appropriateness of the intervention must be carefully considered. Traditional approaches to the hemiplegic upper limb include medications and botulinum toxin injections to manage abnormalities of tone, and surgical interventions. Therapist input, including provision of orthoses, remains a mainstay although many therapies have not been well evaluated. There has been a recent increase in interventions for the hemiplegic upper limb, mostly aimed outside the period of infancy. These include trials of constraint-induced movement therapy (CIMT) and bimanual therapy as well as the use of virtual reality and robot-assisted therapy. In future, non-invasive brain stimulation may be combined with therapy. Interventions under investigation in the infant age group include modified CIMT and action observation therapy. A further approach which may be suited to the infant with thumb-in-palm deformity, but which requires evaluation, is the use of elastic taping. Enhanced cutaneous feedback through mechanical stimulation to the skin provided by the tape during movement has been postulated to modulate ongoing muscle activity. If effective, this would represent a low-cost, safe, widely applicable early intervention.
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Affiliation(s)
- Anna Purna Basu
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK ; Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Janice Pearse
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK ; Paediatric Physical Therapy, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Susan Kelly
- Paediatric Physical Therapy, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Vicki Wisher
- Paediatric Physical Therapy, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Jill Kisler
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK ; Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
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The scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities. Pediatr Phys Ther 2015; 27:2-15. [PMID: 25521261 DOI: 10.1097/pep.0000000000000098] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this report is to discuss the scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities. SUMMARY OF KEY POINTS Evidence is provided that supports integration of health promotion and fitness strategies in physical therapy clinical management. Physical therapists' roles in community-based adapted sports and fitness interventions and reimbursement considerations are discussed. CONCLUSIONS Physical therapists are in a unique position to provide expertise in the design and implementation of health promotion and fitness programs for youth with disabilities. These programs are important to promote active, healthy lifestyles and reduce comorbidities associated with sedentary behaviors and unhealthy weight, which are often seen in youth with disabilities. RECOMMENDATIONS FOR CLINICAL PRACTICE Pediatric physical therapists should incorporate health promotion and fitness strategies into practice.
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Abstract
PURPOSE To describe a daily physical therapy (PT) intervention program and outcomes for 2 young children with spastic quadriplegia, Gross Motor Function Classification System (GMFCS) level V, and to evaluate the feasibility of using a daily program in an urban children's hospital outpatient setting. SUMMARY OF KEY POINTS Two young children, GMFCS level V, received 2 hours of PT intervention based on motor learning principles 5 days a week for 4 consecutive weeks. Gross Motor Functional Measure (GMFM-66, GMFM-88) and the Bayley Scales of Infant Development, Third Edition, were used as pre- and postoutcome measures. The daily, high intensity intervention was well tolerated. Improvements in motor function, language, and cognitive skills were found. STATEMENT OF CONCLUSION A daily PT program appears feasible and may improve overall development in young children with cerebral palsy in GMFCS level V.
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