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Gefen N, Weiss PL, Rigbi A, Rosenberg L. Lessons learned from a pediatric powered mobility lending program. Disabil Rehabil Assist Technol 2024; 19:2250-2259. [PMID: 37897432 DOI: 10.1080/17483107.2023.2276232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE To evaluate children's characteristics and impact of a powered wheelchair lending program including comparisons of diagnostic sub-groups, and validation of a predictive model of powered mobility proficiency. METHODS AND MATERIALS This retrospective study included 172 children who participated in the ALYN powered mobility lending program from 3/2009-7/2022. Demographics and functional levels were measured via questionnaires; driving proficiency was evaluated when the wheelchair was returned, and parents and children were interviewed following their participation in the program. RESULTS Two diagnostic groups were identified: cerebral palsy (CP) (n = 136, median = 9.75 yrs) and other neuromuscular diseases (NMD) (n = 30, median = 5.83 yrs). They differed significantly in the age they commenced PM training, the male/female ratio, walking ability and access mode. Fifty-seven percent of the participants with CP achieved powered mobility proficiency, a rate that was significantly lower than the 73% proficiency found for the NMD group. Four significant predictors were identified: communication, manual wheelchair operation, access mode and go-stop upon request. They predicted proficiency in approximately 80% of cases. Overall feedback from the parents and children indicated that their personal and family's quality of life improved as a result of their child's ability to use a powered wheelchair. CONCLUSIONS A lending program provides children with opportunities to improve mobility skills in an appropriate powered wheelchair. Children who can communicate verbally, propel a manual wheelchair, use a joystick and go-stop upon request are significantly more likely to become proficient drivers; however, many who were unable to complete these tasks also improved and even became proficient drivers.
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Affiliation(s)
- Naomi Gefen
- ALYN Hospital, Jerusalem, Israel
- PARC Research Center, ALYN Hospital, Jerusalem, Israel
| | - Patrice L Weiss
- PARC Research Center, ALYN Hospital, Jerusalem, Israel
- Dept. of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Amihai Rigbi
- Faculty of Education, Beit Berl College, Kfar-Sava, Israel
| | - Lori Rosenberg
- School of Occupational Therapy, Hebrew University, Israel
- Ilanot Special Education School, Jerusalem, Israel
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2
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Romin E, Lindgren A, Rodby-Bousquet E, Cloodt E. Sit-to-stand performance in children with cerebral palsy: a population-based cross-sectional study. BMC Musculoskelet Disord 2024; 25:460. [PMID: 38862936 PMCID: PMC11165808 DOI: 10.1186/s12891-024-07557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Sit-to-stand (STS) is one of the most commonly performed functional movements in a child's daily life that enables the child to perform functional activities such as independent transfer and to initiate walking and self-care. Children with cerebral palsy (CP) often have reduced STS ability. The aim of this study was to describe STS performance in a national based total population of children with CP and its association with age, sex, Gross Motor Function Classification System (GMFCS) level, and CP subtype. METHODS This cross-sectional study included 4,250 children (2,503 boys, 1,747 girls) aged 1-18 years from the Swedish Cerebral Palsy Follow-Up Program (CPUP). STS performance was classified depending on the independence or need for support into "without support," "with support," or "unable." "With support" included external support from, e.g., walls and furniture. Physical assistance from another person was classified as "unable" (dependent). Ordinal and binary logistic regression analyses were used to identify associations between STS and age, GMFCS level, and CP subtype. RESULTS 60% of the children performed STS without support, 14% performed STS with support, and 26% were unable or needed assistance from another person. STS performance was strongly associated with GMFCS level and differed with age and subtype (p < 0.001). For all GMFCS levels, STS performance was lowest at age 1-3 years. Most children with GMFCS level I (99%) or II (88%) performed STS without support at the age of 4-6 years. In children with GMFCS level III or IV, the prevalence of independent STS performance improved throughout childhood. CP subtype was not associated with STS performance across all GMFCS levels when adjusted for age. CONCLUSIONS Independent STS performance in children with CP is associated with GMFCS level and age. Children with CP acquire STS ability later than their peers normally do. The proportion of children with independent STS performance increased throughout childhood, also for children with GMFCS level III or IV. These findings suggest the importance of maintaining a focus on STS performance within physiotherapy strategies and interventions for children with CP, including those with higher GMFCS level.
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Affiliation(s)
- Elinor Romin
- Habilitation Centre Child and Youth, Region Kronoberg, Växjö, Sweden
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
- Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
| | - Erika Cloodt
- Habilitation Centre Child and Youth, Region Kronoberg, Växjö, Sweden.
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.
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3
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Kiernan D, Malone A. Age related progression of lower limb coordination during gait in children with cerebral palsy without a history of surgical intervention. J Biomech 2024; 171:112206. [PMID: 38941841 DOI: 10.1016/j.jbiomech.2024.112206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
Walking requires precise movement between body segments, referred to as intersegmental coordination, which is an important factor in efficient motor performance. For children with cerebral palsy (CP), who often demonstrate an impaired neuromuscular system, intersegmental coordination has been shown to be different when compared to their typically developed (TD) peers. However, how intersegmental coordination changes over time in these children is unclear. The aim of this study was to quantify age-related changes in intersegmental coordination in children with bilateral CP without a history of surgical intervention and to compare to control groups of children with TD of similar age, weight, and height. A retrospective analysis of 162 children with bilateral CP who had a baseline and follow-up 3D gait assessment, and no history of surgical intervention, was conducted. Two age, weight, and height control groups of children with TD were included. A full 3-dimensional kinematic analysis was performed, and continuous relative phase analysis of the thigh-shank and shank-foot, while walking at a self-selected walking speed, was used to measure intersegmental coordination. Differences were present for children with CP compared to children with TD at baseline for thigh-shank intersegmental coordination. However, children with CP demonstrated a change over time with a move towards TD patterns at follow-up assessment. This study provides insights into the acquisition and stabilisation of intersegmental coordination between children with CP and TD.
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Affiliation(s)
- Damien Kiernan
- Movement Analysis Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - Ailish Malone
- School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St. Stephen's Green Dublin 2, Ireland
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4
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Kim C, Kim S, Kim H, Hwang J, Kim SH, Yang M, Ahn SY, Sung SI, Chang YS. Long-term impact of late pulmonary hypertension requiring medication in extremely preterm infants with severe bronchopulmonary dysplasia. Sci Rep 2024; 14:8705. [PMID: 38622180 PMCID: PMC11018761 DOI: 10.1038/s41598-024-58977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
This study investigated whether late pulmonary hypertension (LPH) independently increases the risk of long-term mortality or neurodevelopmental delay (NDD) in extremely preterm infants (EPIs) with severe bronchopulmonary dysplasia (BPD). Using prospectively collected data from the Korean Neonatal Network, we included EPIs with severe BPD born at 22-27 weeks' gestation between 2013 and 2021. EPIs having severe BPD with LPH (LPH, n = 124) were matched 1:3 with those without pulmonary hypertension (PH) as controls (CON, n = 372), via propensity score matching. LPH was defined as PH with the initiation of medication after 36 weeks' corrected age (CA). Long-term mortality after 36 weeks' CA or NDD at 18-24 months' CA was analyzed. NDD was assessed using composite scores based on various neurodevelopmental assessment modalities. LPH had significantly higher long-term mortality or NDD (45.2% vs. 23.1%, P < 0.001), mortality (24.2% vs. 4.84%, P < 0.001), and NDD (68.4% vs. 37.8%, P = 0.001), respectively than CON, even after adjusting for different demographic factors. Multivariable regression demonstrated that LPH independently increased the risk of mortality or NDD (adjusted odds ratio, 1.95; 95% confidence intervals, 1.17-3.25). When LPH occurs in EPIs with severe BPD, special monitoring and meticulous care for long-term survival and neurodevelopment are continuously needed.
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Affiliation(s)
- Chan Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
| | - Sumin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Hanna Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
| | - Jieun Hwang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
| | - Seung Hyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
| | - Misun Yang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea.
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
- Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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Lidbeck C, Häbel H, Martinsson C, Pettersson K, Löwing K. Motor Development in Children with Cerebral Palsy in Sweden-A Population-Based Longitudinal Register Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1864. [PMID: 38136066 PMCID: PMC10741609 DOI: 10.3390/children10121864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
The aim was to explore longitudinal motor development in children with cerebral palsy (CP) in Sweden with respect to the Gross Motor Function Classification System (GMFCS). In this national CP registry-based study, 2138 children aged 0.5-19 years participated (42% girls). The distribution with respect to GMFCS was I: 49%, II: 16%, III: 10%, IV: 14%, and V: 11%. In total, 5538 assessments (mean 2.7, min-max: 1-9) with the Gross Motor Function Measure-66 were included. Data were analysed using non-linear mixed-effects regression models, and the Stable Limit Model was selected to fit data. Five distinct curves of predicted gross motor development with respect to GMFCS levels were obtained. The achieved motor development was maintained over time. The estimated average GMFM-66 limit and the average age when 90% of the expected limits were reached were at GMFCS I: 88 at age 4.5; GMFCS II: 71 at age 4.2; GMFCS III: 54 at age 3.1; GMFCS IV: 38 at age 2.6, and at GMFCS V: 18 at age 0.9. In conclusion, this is the first national population-based study following motor development in CP. Five distinct curves reported in previous controlled research studies were confirmed. Our study adds knowledge about motor development captured in children's everyday context.
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Affiliation(s)
- Cecilia Lidbeck
- Division of Paediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden;
- Astrid Lindgren Childrens Hospital, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Henrike Häbel
- Medical Statistics Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | | | - Katina Pettersson
- Centre for Clinical Research, Uppsala University—Region Västmanland, 721 89 Västerås, Sweden;
| | - Kristina Löwing
- Division of Paediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden;
- Astrid Lindgren Childrens Hospital, Karolinska University Hospital, 171 76 Stockholm, Sweden
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6
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Jeon GW, Ahn SY, Kim SM, Yang M, Sung SI, Sung JH, Oh SY, Roh CR, Choi SJ, Chang YS. Antenatal Magnesium Sulfate Is Not Associated With Improved Long-Term Neurodevelopment and Growth in Very Low Birth Weight Infants. J Korean Med Sci 2023; 38:e350. [PMID: 37967876 PMCID: PMC10643250 DOI: 10.3346/jkms.2023.38.e350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Though antenatal magnesium sulfate (MgSO4) is widely used for fetal neuroprotection, suspicions about the long-term neuroprotection of antenatal MgSO4 have been raised. METHODS We investigated short- and long-term outcomes of antenatal MgSO4 use for 468 infants weighing < 1,500 g with a gestational age of 24-31 weeks. RESULTS Short-term morbidities and the risk of developmental delay, hearing loss, and cerebral palsy at a corrected age of 18-24 months and 3 years of age did not decrease in the MgSO4 group (infants who were exposed to MgSO4 for any purpose) or neuroprotection group (infants who were exposed to MgSO4 for fetal neuroprotection) compared with the control group (infants who were not exposed to MgSO4). The z-scores of weight, height, and head circumference did not increase in the MgSO4 group or neuroprotection group compared with the control group. CONCLUSION Antenatal MgSO4 including MgSO4 for neuroprotection did not have beneficial effects on long-term neurodevelopmental and growth outcomes.
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Affiliation(s)
- Ga Won Jeon
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Min Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Misun Yang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Samsung Medical Center, Seoul, Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Samsung Medical Center, Seoul, Korea.
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7
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Erkek S, Çekmece Ç. Investigation of the Relationship between Sensory-Processing Skills and Motor Functions in Children with Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1723. [PMID: 38002814 PMCID: PMC10670370 DOI: 10.3390/children10111723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/12/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023]
Abstract
The main purpose of this study is to examine the relationship between sensory-processing skills and gross motor functions, bimanual motor functions, and balance in children with cerebral palsy (CP). A total of 47 patients between the ages of 3 and 10, diagnosed with CP, who received or applied for treatment in our physical therapy and rehabilitation unit were included in the study. Sensory profiling (SP), assisting hand assessment (AHA), the Gross Motor Function Measure-66 (GMFM-66), and the Pediatric Berg Balance Scale (PBBS) were used in the evaluation of the children with CP who participated in the study. The Gross Motor Function Classification System (GMFCS) was used to classify the children based on functional abilities and limitations, and the Manual Ability Classification System (MACS) was used to classify the children based on manual dexterity. The SP parameters were compared with AHA, GMFM-66, and PBBS results, and with GMFCS and MACS levels. Statistically significant relationships were found between AHA and SP, PBBS, and SP and between GMFM-66 and SP (p < 0.05). Our study shows that there are some disorders in sensory processing in children with CP. We think that sensory evaluations should be included in the CP rehabilitation program.
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Affiliation(s)
- Serhat Erkek
- Department of Occupational Therapy, Yalova State Hospital, Baglarbası, Yalova 77100, Turkey;
| | - Çiğdem Çekmece
- Section of Occupational Therapy, Department of Therapy and Rehabilitation, Vocational School of Kocaeli Health Services, Kocaeli University, Umuttepe Campus, Izmit 41380, Turkey
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8
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Algabbani MF, Almass BA, Shaheen AAM, Alhusaini A, Almurdi MM, Alqabbani S. Psychometric properties of the Obstacles and Curb tests and their discriminative ability across functional levels in ambulatory children with spastic cerebral palsy. Int J Rehabil Res 2023; 46:178-186. [PMID: 37042182 PMCID: PMC10155681 DOI: 10.1097/mrr.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 04/13/2023]
Abstract
The Obstacles and Curb tests are timed walking assessments that have emerged from the Spinal Cord Injury Functional Ambulation Profile and have been modified for children; however, their psychometric properties have not been adequately investigated. The aim of this research was to examine the psychometric properties of the Obstacles and Curb tests for children with cerebral palsy (CP). This cross-sectional study included 68 children aged 6-12 years; there were 34 children with CP and 34 age- and sex-matched typically developing children. Validity was examined by correlation with the 10-m Walk Test (10-MWT), Modified Time Up and Go test (mTUG), and Pediatric Balance Scale (PBS). Differences in the Obstacle and Curb test scores were calculated between children with CP and typically developing children and within different Gross Motor Function Classification System (GMFCS) levels. Children with CP completed the tests twice within a 30-min interval in the same session. The tests showed significant strong to very strong correlations with the 10-MWT, mTUG, and PBS. The within-session reliability was excellent, typically developing children were significantly faster than children with CP with high sensitivity and specificity, and the time differed significantly within the GMFCS level. Thus, the Obstacles and Curb tests can be considered valid, reliable, and sensitive walking tests for ambulatory children with CP.
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Affiliation(s)
- Maha F. Algabbani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
| | - Banan A. Almass
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Afaf A. M. Shaheen
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
- Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Adel Alhusaini
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
| | - Muneera M. Almurdi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
| | - Samiah Alqabbani
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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9
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Bania TA, Taylor NF, Chiu HC, Charitaki G. What are the optimum training parameters of progressive resistance exercise for changes in muscle function, activity and participation in people with cerebral palsy? A systematic review and meta-regression. Physiotherapy 2022; 119:1-16. [PMID: 36696699 DOI: 10.1016/j.physio.2022.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/11/2022] [Accepted: 10/13/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the effect of progressive resistance exercise (PRE) on impairment, activity and participation of people with cerebral palsy (CP). Also, to determine which programme parameters provide the most beneficial effects. DATA SOURCES Electronic databases searched from the earliest available time. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) implementing PRE as an intervention in people with cerebral palsy were included. STUDIES APPRAISAL & SYNTHESIS METHODS Methodological quality of trials was assessed with the PEDro scale. Meta-analysis and meta-regression were completed. RESULTS We included 20 reports of 16 RCTs (n = 504 participants). Results demonstrated low certainty evidence that PRE improved muscle strength (pooled standardised mean difference (SMD)= 0.59 (95%CI: 0.16-1.01; I²=70%). This increase in muscle strength was maintained an average of 11 weeks after training stopped. Τhere was also moderate certainty evidence that it is inconclusive whether PRE has a small effect on gross motor function (SMD= 0.14 (95%CI: -0.09 to 0.36; I²=0%) or participation (SMD= 0.26 (95%CIs: -0.02 to 0.54; I²=0%). When PRE was compared with other therapy there were no between-group differences. Meta-regression demonstrated no effect of PRE intensity or training volume (frequency x total duration) on muscle strength (p > 0.5). No serious adverse events were reported. There is lack of evidence of the effectiveness of PRE in adults and non-ambulatory people with CP. CONCLUSIONS PRE is safe and increases muscle strength in young people with CP, which is maintained after training stops. The increase in muscle strength is unrelated to the PRE intensity or dose. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Theofani A Bania
- Department of Physiotherapy, University of Patras, Ktirio B', Rio, 26504 , Greece.
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University; and Allied Health Clinical Research Office, Eastern Health, Australia.
| | - Hsiu-Ching Chiu
- Department of Physical Therapy, I-Shou University, Xuecheng Road, Dashu District, Kaohsiung 82445 Taiwan.
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10
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Tousignant-Laflamme Y, Houle C, Cook C, Naye F, LeBlanc A, Décary S. Mastering Prognostic Tools: An Opportunity to Enhance Personalized Care and to Optimize Clinical Outcomes in Physical Therapy. Phys Ther 2022; 102:6535136. [PMID: 35202464 PMCID: PMC9155156 DOI: 10.1093/ptj/pzac023] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/19/2021] [Accepted: 02/21/2022] [Indexed: 12/14/2022]
Abstract
UNLABELLED In health care, clinical decision making is typically based on diagnostic findings. Rehabilitation clinicians commonly rely on pathoanatomical diagnoses to guide treatment and define prognosis. Targeting prognostic factors is a promising way for rehabilitation clinicians to enhance treatment decision-making processes, personalize rehabilitation approaches, and ultimately improve patient outcomes. This can be achieved by using prognostic tools that provide accurate estimates of the probability of future outcomes for a patient in clinical practice. Most literature reviews of prognostic tools in rehabilitation have focused on prescriptive clinical prediction rules. These studies highlight notable methodological issues and conclude that these tools are neither valid nor useful for clinical practice. This has raised the need to open the scope of research to understand what makes a quality prognostic tool that can be used in clinical practice. Methodological guidance in prognosis research has emerged in the last decade, encompassing exploratory studies on the development of prognosis and prognostic models. Methodological rigor is essential to develop prognostic tools, because only prognostic models developed and validated through a rigorous methodological process should guide clinical decision making. This Perspective argues that rehabilitation clinicians need to master the identification and use of prognostic tools to enhance their capacity to provide personalized rehabilitation. It is time for prognosis research to look for prognostic models that were developed and validated following a comprehensive process before being simplified into suitable tools for clinical practice. New models, or rigorous validation of current models, are needed. The approach discussed in this Perspective offers a promising way to overcome the limitations of most models and provide clinicians with quality tools for personalized rehabilitation approaches. IMPACT Prognostic research can be applied to clinical rehabilitation; this Perspective proposes solutions to develop high-quality prognostic models to optimize patient outcomes.
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Affiliation(s)
| | - Catherine Houle
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada,Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Chad Cook
- Physical Therapy Division, Duke University, Durham, North Carolina, USA,Department of Population Health Sciences, Duke University, Durham, North Carolina, USA,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Florian Naye
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada,Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Simon Décary
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada,Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
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11
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Baird G, Chandler S, Shortland A, Will E, Simonoff E, Scrutton D, Fairhurst C. Acquisition and loss of best walking skills in children and young people with bilateral cerebral palsy. Dev Med Child Neurol 2022; 64:235-242. [PMID: 34410016 DOI: 10.1111/dmcn.15015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/24/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore factors predicting acquisition and loss of best walking ability in young people with bilateral cerebral palsy (CP). METHOD In our population cohort (Study of Hips And Physical Experience) of 338 children (201 males, 137 females) with bilateral CP, age at achieving walking was recorded and walking ability predicted from early motor milestones. Walking was assessed at 5 to 8 years (mean 7y) and in 228 of 278 survivors at 13 to 19 years (mean 16y). Parent carers reported their view of any loss of best achieved walking. Factors potentially associated with loss of best achieved walking were explored: severity and type of motor disorder; intellect and communication; manipulative skill; general health and comorbidity; pain; orthopaedic surgery; musculoskeletal spine and lower limb deformity; weight; fatigue; mood; and presence of regular exercise regime. RESULTS The ability to walk independently was reliably predicted by the motor milestone 'getting to sit and maintain sitting' by the age of 36 months (without aids) and 55 months (with aids). Forty-five per cent of the cohort never walked 10 steps independently. Not all who achieved walking without aids were still doing so by a mean age of 16 years, which was associated with later age at achieving walking and the degree of musculoskeletal deformity, as was the parent carers' report of loss of best walking. INTERPRETATION In this study, development of musculoskeletal deformity was a significant factor in not maintaining best achieved walking by mean age 16 years, which is most likely to occur in young people whose walking ability is with aids over short distances or in therapy only. Prediction of future walking ability in a child with bilateral CP can be made from early motor milestones.
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Affiliation(s)
- Gillian Baird
- Newcomen Neurodevelopmental Service, Paediatric Neurosciences, Guy's & St Thomas' NHS Trust, King's Health Partners, Evelina London Children's Hospital, London, UK
| | - Susie Chandler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Adam Shortland
- Biomedical Engineering & Imaging Science, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Elspeth Will
- Newcomen Neurodevelopmental Service, Paediatric Neurosciences, Guy's & St Thomas' NHS Trust, King's Health Partners, Evelina London Children's Hospital, London, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Scrutton
- Newcomen Neurodevelopmental Service, Paediatric Neurosciences, Guy's & St Thomas' NHS Trust, King's Health Partners, Evelina London Children's Hospital, London, UK
| | - Charlie Fairhurst
- Newcomen Neurodevelopmental Service, Paediatric Neurosciences, Guy's & St Thomas' NHS Trust, King's Health Partners, Evelina London Children's Hospital, London, UK
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Definitions of bronchopulmonary dysplasia and long-term outcomes of extremely preterm infants in Korean Neonatal Network. Sci Rep 2021; 11:24349. [PMID: 34934085 PMCID: PMC8692520 DOI: 10.1038/s41598-021-03644-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022] Open
Abstract
New definitions for bronchopulmonary dysplasia (BPD) have recently been suggested, and an accurate diagnosis, including severity classification with proper definition, is crucial to identify high-risk infants for appropriate interventions. To determine whether recently suggested BPD definitions can better predict long-term outcomes of BPD in extremely preterm infants (EPIs) than the original BPD definition, BPD was classified with severity 1, 2, and 3 using three different definitions: definition A (original), National Institute of Child Health and Human Development (NICHD) definition in 2001; definition B, the modified NICHD 2016 definition (graded by the oxygen concentration and the respiratory support at 36 weeks’ postmenstrual age [PMA]); and definition C, the modified Jensen 2019 definition (graded by the respiratory support at 36 weeks’ PMA). We evaluated 1050 EPIs using a national cohort. Whereas EPIs with grade 2 or 3 BPD as per definition A did not show any increase in the risk, EPIs with BPD diagnosed by definition B and C showed significantly increased risk for poor outcomes, such as respiratory mortality and morbidities, neurodevelopmental delay, and growth restriction at 18–24 months of corrected age. The recently suggested definition and severity grading better reflects long-term childhood morbidities than the original definition in EPIs.
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Pavão SL, Dos Santos AN, Cicuto Ferreira Rocha NA. Sex and age influence on postural sway during sit-to-stand movement in children and adolescents: Cross-sectional study. Int J Dev Neurosci 2021; 81:520-528. [PMID: 34091944 DOI: 10.1002/jdn.10134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 11/09/2022] Open
Abstract
We investigated the influence of sex and age in postural sway during sit-to-stand (STS) in children and adolescents of 5-15 years. We evaluated sway during STS in 86 typical participants. STS was divided into three phases: preparation, rising, and stabilization. We calculated for each phase: area, anterior-posterior, and medial-lateral velocity of center-of-pressure sway. We applied a stepwise multiple linear regression model to determine if age and sex might be predictors of postural sway during STS. Only age was associated with sway, accounting for between 6.5% and 14.6% of the variability in sway during STS. The age of the subject influences postural sway during STS, but in a small amount. This variable should be taken into account as a variable of control in the assessment of dynamic postural control. Moreover, postural stability during STS was not associated with the sex of the participants.
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Affiliation(s)
- Silvia Leticia Pavão
- Department of Prevention and Rehabilitation in Physiotherapy, Federal University of Paraná, Curitiba, Brazil
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14
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Pavão SL, Lima CRG, Rocha NACF. Association between sensory processing and activity performance in children with cerebral palsy levels I-II on the gross motor function classification system. Braz J Phys Ther 2021; 25:194-202. [PMID: 32540329 PMCID: PMC7990726 DOI: 10.1016/j.bjpt.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 04/20/2020] [Accepted: 05/20/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Investigating the influence of sensory processing disorders on the level of function of children with cerebral palsy (CP) may help therapists identify specific impairments that impact activity and participation in these children. This may provide direction on selection of interventions to improve function and quality of life. OBJECTIVES To investigate if sensory processing disorders in children with CP levels I and II on the Gross Motor Function Classification System (GMFCS) are associated with activity performance. METHODS Sensory processing and activity performance of 28 children with CP between 5 and 15 years (mean ± standard deviation; 9.9 ± 3.2 years) were evaluated using the Sensory Profile (SP) and Pediatric Evaluation of Disability Inventory (PEDI), respectively. Associations between the components of the SP and PEDI were assessed with Spearman correlation coefficients. Multiple linear regression analysis using backward stepwise method was used to determine the variables of sensory processing that are associated with activity performance on the PEDI. RESULTS The category of Behavioral Outcomes of Sensory Processing was the only variable associated with Functional Abilities in self-care and social function (r2 = 0.30 and r2 = 0.39, respectively) and Caregiver Assistance (r2 = 0.36 and r2 = 0.37, respectively), (p < 0.05). CONCLUSION Sensory processing in children with CP levels I-II on the GMFCS is associated with their ability to perform daily living activities and in their social interaction with the environment.
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Affiliation(s)
- Sílvia Leticia Pavão
- Department of Physical Therapy, Neuropediatrics Section, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Departament Prevention and Rehabilitation in Physiotherapy, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Camila Resende Gâmbaro Lima
- Department of Physical Therapy, Neuropediatrics Section, Universidade Federal de São Carlos, São Carlos, SP, Brazil
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van Tittelboom V, AlemdaroĞlu-GÜrbÜz I, Hanssen B, Plasschaert F, Heyrman L, Feys H, Desloovere K, Calders P, Van den Broeck C. Reliability of functional tests of the lower limbs and core stability in children and adolescents with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:738-746. [PMID: 33470579 DOI: 10.23736/s1973-9087.21.06627-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Muscle weakness in children and adolescents with cerebral palsy (CP) can affect daily life activities, even more if functional capabilities are poor. Also core stability plays an important role in distal force generation. AIM The main purpose of this study was to investigate the reliability of functional tests of the lower limbs and the core stability in children and adolescents with bilateral spastic CP with Gross Motor Function Classification System (GMFCS) levels II and III. Secondary, associations within the functional tests and between the functional tests and gait capacity were analyzed. DESIGN Cross sectional study. SETTING CP reference center *blinded for reviewers*, pediatric physiotherapists and schools for children and adolescents with motor impairments. POPULATION Twenty-four children and adolescents with CP (11.4±2.5 yrs, GMFCS II/III:13/11) participated in this study. METHODS Functional tests of the lower limbs (GMFCS II: Sit-To-Stand (STS), Lateral Step-Up (LSU), bilateral heel rise (BHR), high jump (HJ), long jump (LJ); GMFCS III: STS, LSU) and core stability (bridging and Rolling Like a Ball (RLB)) were tested twice. On the second test occasion, gait capacity (1-Minute Walk Test (1MWT) and modified Timed Up and Go (mTUG)) were also assessed. RESULTS Relative reliability of the functional tests ranged from good to excellent (Intraclass Correlation Coefficients (ICC), 0.88 - 0.96). Absolute reliability showed large variability with acceptable results for the BHR, HJ, LJ and RLB (Minimal Detectable Change % (MDC %) < 40%). Strong associations were found of the RLB test and the mTUG with the BHR, HJ and LJ tests. CONCLUSIONS The functional tests of the lower limbs and core stability were found reliable. To measure change over time, the BHR, the HJ and LJ can be used for children and adolescents with GMFCS level II. The RLB test can be used for both GMFCS levels. Associations between the BHR, HJ and LJ tests in particular showed strong associations with the RLB test and with the mTUG. CLINICAL REHABILITATION IMPACT this study highlighted the importance of developing functional tests for children and adolescents with lower motor function capacities and to integrate core stability tests in routine clinical assessments.
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Affiliation(s)
- Vanessa van Tittelboom
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium - .,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium -
| | | | - Britta Hanssen
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Frank Plasschaert
- Department of Orthopedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lieve Heyrman
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Lidbeck C, Bartonek Å. Motor function at increasing postural demands in children with bilateral cerebral palsy. Eur J Phys Rehabil Med 2021; 57:731-737. [PMID: 33393279 DOI: 10.23736/s1973-9087.20.06662-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Among children with cerebral palsy (CP) some choose to be mobile by crawling or walking on their knees despite some bipedal walking ability. This motor behaviour raises questions and we wanted to enhance understanding of the child's choice of mobility. AIM To explore gross motor abilities in positions with various postural demands focusing on floor mobility among children with CP. DESIGN A cross-sectional observational study was performed at the neuropediatric outpatient department at Karolinska University Hospital. POPULATION Thirty-six children with bilateral CP, median age 11.2 years, functioning at Gross Motor Function Classification System (GMFCS) level I-IV. METHODS Motor skills using the Gross Motor Function Measure (GMFM-88), and lower leg muscles strength in hip flexors, knee extensors, ankle dorsiflexors and plantarflexors with a hand-held dynamometer were assessed. A Kruskal-Wallis Test with post hoc Bonferroni corrections were used to compare GMFM percentage (%) scores and muscle strength between the GMFCS levels. RESULTS GMFM-88 (%) scores in Walking (E) and Standing (D) dimensions were significantly higher at GMFCS levels I and II, compared to levels III and IV. In Crawling & Kneeling (C) level I achieved higher score than levels III and IV, and in Sitting (B) than level IV. Muscle strength values in the plantarflexors were significantly higher at GMFCS level I compared to level II. CONCLUSIONS As expected the children at GMFCS III performed less than those at GMFCS II at high postural demands in GMFM dimensions including standing and walking. Identical GMFM-scores in dimension C confirm similar motor function in items including kneeling and knee walking. Since lower limb muscle strength was similar, the difference in postural behaviour between the groups at high level motor activities may be associated with sensorimotor disturbances along with the children's motor disorder. CLINICAL REHABILITATION IMPACT The GMFM-88, in particular dimension C, including kneeling and walking items can be used as an identification of preference of floor mobility in children with CP. Awareness and understanding of how postural positions affect movement is of importance for prognosis, and physiotherapy.
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Affiliation(s)
- Cecilia Lidbeck
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden -
| | - Åsa Bartonek
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Mattern-Baxter K. Analysis of a Group-Based Treadmill Program for Children with Neuromotor Delay Who Are Pre-Ambulatory. Phys Occup Ther Pediatr 2021; 41:271-283. [PMID: 33086909 DOI: 10.1080/01942638.2020.1834055] [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: 10/23/2022]
Abstract
PURPOSE To analyze data from a prospective cohort study, a group-based treadmill program, administered twice weekly for 14 weeks, in regard to gross motor skills related to walking and walking attainment in young children with neuromotor delay who are pre-ambulatory. METHODS Seventy children (F = 29), mean age 25.6 (SD 10.1) months participated in the program 2×/week for 14 weeks. The Gross Motor Function Measure-88 Dimensions D and E (GMFM D/E), Functional Mobility Scale for 5, 50, and 500 meters (FMS 5, 50, 500), the timed 10-m walk test (10MWT), and the Pediatric Evaluation of Disability Inventory Caregiver Mobility Scale (PEDI) were administered before and after the program. RESULTS Statistically significant improvements were found in the GMFM D, GMFM E, FMS 5, 50, 500 and PEDI, but not in 10MWT. CONCLUSIONS A group-based treadmill program was associated with improvements in motor skills related to walking in young children when administered in adjunct to ongoing physical therapy.
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Brugnaro BH, Oliveira MFP, de Campos AC, Pavão SL, Rocha NACF. Postural control in Down syndrome and relationships with the dimensions of the International Classification of Functioning, Disability and Health - a systematic review. Disabil Rehabil 2020; 44:2207-2222. [PMID: 33049152 DOI: 10.1080/09638288.2020.1830439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Postural control assessment in children with Down syndrome (DS) may contribute to understanding the impact of impairments in Body Structures and Functions on Activities and Participation, providing a biopsychosocial approach to support clinical practice. The present study aimed to systematically review the literature addressing postural control in children and adolescents with Down syndrome, with a focus in the interactions among the components of the International Classification of Functioning (ICF). METHODS We conducted a tailored search in PubMed; Web of Science, SCOPUS and Science Direct databases. RESULTS We identified 20 full-texts that fulfilled the inclusion and exclusion criteria. Children and adolescents with DS showed lower postural stability across studies. The ICF components most commonly addressed were Body Structure and Function and Activity. Although the studies measured these components, they did not analyze the interrelationships of components when describing the determinants of postural control in this population. CONCLUSIONS Overall, the studies indicate that children and adolescents with DS show decreased postural stability and greater vulnerability to sensory changes than their typical peers. There is a lack of studies using the biopsychosocial approach. Only few studies have related the activity level of the participants with the variables of postural control. None of them addressed components of Participation and Environmental Factors. The poor methodological quality of the included studies limits the translation of results to clinical practice. Further studies addressing children with disabilities, such as DS, should utilize the ICF framework, thus providing a biopsychosocial approach of health in these individuals.IMPLICATIONS FOR REHABILITATIONChildren with Down syndrome show decreased postural stability and greater vulnerability to sensory changes than their typical peers.In clinical practice, when assessing postural control of individuals with DS, rehabilitation professionals should not only address components of Body Structures and Functions, but also investigate their impact on Activity and Participation.Training of postural control should address strategies that include natural environments and participation situations.The biopsychosocial approach provided by the ICF framework should be implemented in clinical practice.
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Affiliation(s)
- Beatriz Helena Brugnaro
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Maria Fernanda Pauletti Oliveira
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Ana Carolina de Campos
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Silvia Letícia Pavão
- Departament of Prevention and Rehabilitation in Physical Therapy, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Nelci Adriana Cicuto Ferreira Rocha
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
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Impact of dual task on postural sway during sit-to-stand movement in children with unilateral cerebral palsy. Clin Biomech (Bristol, Avon) 2020; 78:105072. [PMID: 32562882 DOI: 10.1016/j.clinbiomech.2020.105072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/14/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND To verify the effect of dual-task on postural oscillation during sit-to-stand movement in children with Cerebral Palsy. METHODS 17 children with spastic unilateral cerebral palsy and 20 typically-developing children, aged 5 to 12 years, performed the following tasks: Simple task: sit-to-stand with arms crossed against the chest; bimanual dual-task: sit-to-stand while carrying a tray; unimanual dual-task: sit-to-stand while holding a plastic cup with one hand. For data analysis, sit-to-stand was divided in three phases: preparation (phase 1), rising (phase 2), and stabilization (phase 3). Postural control was measured using a force plate, and the variables analyzed were: area, anterior-posterior and medial-lateral velocity, and STS duration. Analysis of variance was applied to test the effects of group; task conditions and interactions. FINDINGS Children with cerebral palsy presented higher values of postural oscillation when compared to their typical pairs. Bimanual and Unimanual dual tasks presented greater postural oscillation values in sit-to-stand phase 1 compared to simple task. In bimanual dual-task, children with cerebral palsy presented lower values of velocity in phases 3, and greater postural oscillation and duration of the task when compared to single-task and unimanual dual-tasks. I. INTERPRETATION The insertion of a secondary task seems to interfere differently children with cerebral palsy, depending on the specific demands of each task. Thus, the importance of inserting dual tasks in the interventions is emphasized, considering that they are executed extensively in the day to day, and can act as facilitators or challenge in the execution of functional tasks.
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Aertssen W, Smulders E, Smits-Engelsman B, Rameckers E. Functional strength measurement in cerebral palsy: feasibility, test-retest reliability, and construct validity. Dev Neurorehabil 2019; 22:453-461. [PMID: 30207812 DOI: 10.1080/17518423.2018.1518963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: No instrument exists that measures functional strength in both lower and upper extremities in children with cerebral palsy (CP). Therefore, the functional strength measurement (FSM) was tested for feasibility, test-retest reliability and validity in CP. Methods: Thirty-seven children with CP (aged 4-10 years, Gross Motor Function Classification System I and II) participated. The most common compensations for CP were described; new item descriptions were standardized, and one item was removed. Test-retest reliability was examined. To measure convergent validity, correlations between the FSM-CP and isometric muscle strength measured with the handheld dynamometer (HHD) were determined. Results: Test-retest reliability was considered high for all items (intra-class correlation coefficient 0.79-0.95). Significant correlations between the HHD and FSM-CP ranged from r = 0.36 to 0.75. Conclusion: The FSM-CP is feasible, reliable, and valid to use in children with CP. The FSM-CP can be considered as a helpful tool in clinical practice of physical examination of children with CP.
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Young J, Jackson S. Improved motor function in a pre-ambulatory child with spastic bilateral cerebral palsy, using a custom rigid ankle-foot orthosis-footwear combination: A case report. Prosthet Orthot Int 2019; 43:453-458. [PMID: 31165679 DOI: 10.1177/0309364619852239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankle-foot orthoses may be used in pre-ambulatory children with cerebral palsy; however, their effect on the acquisition of walking is unknown. This case report aims to evaluate the effect of an ankle-foot orthosis-footwear combination on the acquisition of walking in a single subject with cerebral palsy. CASE DESCRIPTION AND METHODS This study reports the orthotic management of a single child with spastic bilateral cerebral palsy over a 15-month period, during which time the ability to independently stand and walk was acquired. Custom rigid ankle-foot orthoses were prescribed. Gait speed and Edinburgh Visual Gait Score were assessed with and without the orthoses. FINDINGS AND OUTCOMES The subject developed the ability to stand and walk using an ankle-foot orthosis-footwear combination with a walker frame, and to a limited extent without a walker frame. The subject remained unable to take independent steps unless wearing the ankle-foot orthosis-footwear combination. Clinically significant differences in gait speed and Edinburgh Visual Gait Score were observed. CONCLUSION An ankle-foot orthosis-footwear combination may aid the development of independent walking in some children with cerebral palsy. Further research on the effects of orthoses on the acquisition of walking ability in children with cerebral palsy is needed. CLINICAL RELEVANCE Custom rigid ankle-foot orthoses combined with footwear may aid the development of independent standing and walking in some children with bilateral spastic cerebral palsy. This intervention may be considered in clinical practice and future research in this patient group.
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Affiliation(s)
- Joshua Young
- 1 St George's University Hospitals NHS Foundation Trust, Douglas Bader Rehabilitation Centre, Queen Mary's Hospital, London, UK
| | - Sally Jackson
- 2 Hounslow and Richmond Community Healthcare NHS Trust, Ham Clinic, London, UK
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Soares LMDS, Rozane JMSG, Carvalho RDP. Motor performance of children with cerebral palsy in anterior reach. Clin Biomech (Bristol, Avon) 2019; 68:158-162. [PMID: 31212211 DOI: 10.1016/j.clinbiomech.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/30/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with cerebral palsy perform small displacements during the anterior reach movement from standing position without loss of balance. There are two possible reasons for their decreased performance: the difficulty to stabilize their lower limbs during forward body inclination to reach greater distances or to control the movement of forward reaching. The objective of this study is to identify and compare the motor performance of children with CP and typically developing children, during anterior reach. METHODS This is a cross-sectional study, composed of 28 children, 14 with spastic cerebral palsy and 14 typical children, who were all evaluated by the Pediatric Reach Test and three-dimensional motion analysis. FINDINGS The decreased performance was shown by the lower movement control by children with cerebral palsy. The bilateral and unilateral cerebral palsy children showed lower range of motion of shoulder and trunk than typical children. INTERPRETATION Children with cerebral palsy show lower anterior displacement and movement control and difficulty bending the trunk and flexing shoulders while reaching forward, suggesting poor postural balance.
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Affiliation(s)
| | | | - Raquel de Paula Carvalho
- Department of Human Movement Science, Federal University of São Paulo, Rua Silva Jardim, 136 - Vila Mathias, Santos, SP 11015-020, Brazil.
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Abstract
OBJECTIVE The purpose of this study was to explore the practices physical therapists and occupational therapists use in early intervention (EI) for infants with or at risk for cerebral palsy (CP). METHODS A survey was disseminated nationally to EI providers using an online anonymous link. RESULTS Two hundred sixty-nine therapists completed at least 50% of the survey. Four percent of therapists use the General Movement Assessment to predict CP, 57% reported infants at risk for CP receive therapy once a week, 89% identified parents' goals as the most important factor in customizing the EI program, and 75% provide parents with home programs. However, 73% never or rarely use outcome measures to prioritize parents' goals; 31% provide parents with individualized home program and more than 60% never assess environmental enrichment. CONCLUSION Therapists do not incorporate sufficient strategies for goal-oriented interventions, comprehensive parent education, and optimum environmental enrichment.
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Pena GM, Pavão SL, Oliveira MFP, Godoi D, de Campos AC, Rocha NACF. Dual-task effects on postural sway during sit-to-stand movement in children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:576-586. [PMID: 30687997 DOI: 10.1111/jir.12599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cognitive and postural tasks require common cognitive mechanisms, resulting in conflicts when both tasks are simultaneously performed. The presence of neuromotor dysfunctions, such as Down syndrome, may impair coordination processes required to perform dual-tasks. The objective of this study was to investigate the dual-task effects on postural sway during sit-to-stand movements in typical children and children with Down syndrome in a cross-sectional study. METHODS Twenty six typical children (10.2 ± 2.4 years) and 21 with Down syndrome (10.3 ± 2.3 years) performed sit-to-stand in the following conditions: (1) simple task; (2) dual-task bimanual activity (DT-Bim): sit-to-stand while carrying a tray using both hands; (3) dual-task unimanual dominant activity (DT-Uni-Dom): sit-to-stand while holding a plastic cup simulating water using the dominant hand; (4) dual-task unimanual non-dominant activity (DT-Uni-Nondom): sit-to-stand movement while holding a plastic cup simulating water. For data analysis, sit-to-stand was divided into three phases: preparation (phase 1), rising (phase 2), and stabilisation (phase 3). The following variables were calculated for each phase: anterior-posterior and medial-lateral amplitude of centre-of-pressure displacement, anterior-posterior and medial-lateral velocity of centre-of-pressure sway and area of centre-of-pressure sway. RESULTS Children with Down syndrome showed greater sway than typical children in all sit-to-stand phases. Typical children showed greater anterior-posterior amplitude in phase 2 of sit-to-stand during DT-Uni Nondom compared with DT-Uni Dom. Children with Down syndrome during simple task condition showed greater and faster values sway in phases 2 and 3 of sit-to-stand movement than in DT-Bim activity, DT-Uni Dom activity and DT-Uni Nondom activity. During the condition of DT-Bim activity, these children showed lower anterior-posterior velocity of sway in phase 2 than during DT-Uni Dom activity. CONCLUSIONS Children with Down syndrome showed greater postural sway during sit-to-stand than typical children. The addition of a concurrent motor task to sit-to-stand impacted postural sway in different intensities and in different ways across groups. Dual-tasks increased body sway in typical children in the DT-Uni Nondom condition compared with dominant one. In children with Down syndrome, dual-tasks decreased body sway, apparently resulting in a postural strategy of stiffness.
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Affiliation(s)
- G M Pena
- Physical Therapy Department, Neuropediatrics Sector, Federal University of São Carlos, São Carlos, Brazil
| | - S L Pavão
- Physical Therapy Department, Neuropediatrics Sector, Federal University of São Carlos, São Carlos, Brazil
| | - M F P Oliveira
- Physical Therapy Department, Neuropediatrics Sector, Federal University of São Carlos, São Carlos, Brazil
| | - D Godoi
- Department of Physical Education, Federal University of São Carlos - UFSCar, São Carlos, Brazil
| | - A C de Campos
- Physical Therapy Department, Neuropediatrics Sector, Federal University of São Carlos, São Carlos, Brazil
| | - N A C F Rocha
- Physical Therapy Department, Neuropediatrics Sector, Federal University of São Carlos, São Carlos, Brazil
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Abstract
PURPOSES To present the history and aims of the STEP conferences; describe the interdependence of prevention, prediction, plasticity, and participation; reflect on where we stand today regarding those 4 Ps; and discuss how future neurorehabilitation should look for individuals with movement disorders. KEY POINTS Physical therapists have focused primarily on tertiary prevention, emphasizing primary/secondary prevention far less. Predicting optimal response to intervention is essential for primary prevention. Research examining neurorehabilitation effects mediated by brain plasticity is evolving from an emphasis on impairment outcomes toward examination of participation outcomes. CLINICAL PRACTICE RECOMMENDATIONS:: (1) Capitalize on primary and secondary prevention. (2) Administer simple, environmentally relevant predictive measures. (3) Partner with researchers to examine exercise-induced brain plasticity effects via neuroimaging. (4) Encourage physical activity to promote secondary prevention of lifestyle-related diseases and enhance participation. (5) Integrate psychological/social sciences with physiological sciences to move forward with advances in mindful health and patient-centered practices.
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Bania T, Chiu HC, Billis E. Activity training on the ground in children with cerebral palsy: Systematic review and meta-analysis. Physiother Theory Pract 2018; 35:810-821. [PMID: 29659303 DOI: 10.1080/09593985.2018.1460647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To systematically review the evidence about whether activity training on the ground is effective on activity or participation in children with cerebral palsy. Methods: Randomized controlled trials (RCTs) were searched in databases using relevant keywords. RCTs were included with children (≤18 years) with cerebral palsy who received activity training on the ground only or activity training on the ground combined with another type of physiotherapy. Outcome measures classified as measures of activity or participation according to the International Classification of Functioning, Disability, and Health were analyzed. Results: Nine RCTs (257 participants) were included in this review. Individual studies resulted in conflicting results when activity training on the ground was compared to no intervention. Based on meta-analysis, activity training on the ground was not more effective than no intervention (standardized mean difference [SMD]: 0.18; confidence interval [CI]: -1.49 to 1.86) or other therapies (SMD: -0.09; CI: -0.86 to 0.69) (I2 > 75%) on improving activity or participation. Results from a single study demonstrated that activity training on the ground combined with other physiotherapy intervention was not more effective than no intervention (SMD: -0.18 CI: -0.89 to 0.54). Conclusions: The available evidence shows little effect of activity training on the ground on activity or participation in children with cerebral palsy, suggesting that rigorous trials with larger samples and larger "dosage" of activity training on the ground are needed in the future.
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Affiliation(s)
- Theofani Bania
- a Department of Physiotherapy , TEI of Western Greece , Aigio , Greece
| | - Hsiu-Ching Chiu
- b Department of Physical Therapy , I-Shou University , Kaohsiung City , Taiwan
| | - Evdokia Billis
- a Department of Physiotherapy , TEI of Western Greece , Aigio , Greece
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Are postural adjustments during reaching related to walking development in typically developing infants and infants at risk of cerebral palsy? Infant Behav Dev 2017; 50:107-115. [PMID: 29268105 DOI: 10.1016/j.infbeh.2017.12.004] [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] [Received: 10/01/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In typical development, postural adjustments during reaching change in the second half of infancy, including increasing rates of direction-specific adjustments. These changes are absent or different in infants at risk of cerebral palsy (CP). To discover whether these changes are related to acquisition of independent walking, we studied postural adjustments during reaching in infants before and after they learned to walk. METHODS Ten typically developing (TD) infants and 11 infants at very high risk (VHR) of CP were assessed before and after they learned to walk. Reaching movements were elicited during supported sitting, while surface electromyography was recorded of arm, neck, and trunk muscles. Percentages of direction-specific adjustments (first level of control), and recruitment patterns and anticipatory activation (second level of control) were calculated. RESULTS In both groups, postural adjustments during reaching were similar before and after acquisition of independent walking. Direction-specificity increased with age in typically developing infants but not in VHR-infants. CONCLUSION Increasing age rather than the transition to independent walking is associated with increasing direction-specificity of TD-infants during reaching while sitting, while infants at very high risk of CP show no increase in direction-specificity, suggesting that they gradually grow into a postural deficit.
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28
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Harris SR, Winstein CJ. The Past, Present, and Future of Neurorehabilitation: From NUSTEP Through IV STEP and Beyond. Pediatr Phys Ther 2017; 29 Suppl 3:S2-S9. [PMID: 28654472 DOI: 10.1097/pep.0000000000000376] [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: 11/25/2022]
Abstract
PURPOSES To present the history and aims of the STEP conferences; describe the interdependence of prevention, prediction, plasticity, and participation; reflect on where we stand today regarding those 4 Ps; and discuss how future neurorehabilitation should look for individuals with movement disorders. KEY POINTS Physical therapists have focused primarily on tertiary prevention, emphasizing primary/secondary prevention far less. Predicting optimal response to intervention is essential for primary prevention. Research examining neurorehabilitation effects mediated by brain plasticity is evolving from an emphasis on impairment outcomes toward examination of participation outcomes. CLINICAL PRACTICE RECOMMENDATIONS:: (1) Capitalize on primary and secondary prevention. (2) Administer simple, environmentally relevant predictive measures. (3) Partner with researchers to examine exercise-induced brain plasticity effects via neuroimaging. (4) Encourage physical activity to promote secondary prevention of lifestyle-related diseases and enhance participation. (5) Integrate psychological/social sciences with physiological sciences to move forward with advances in mindful health and patient-centered practices.
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Affiliation(s)
- Susan R Harris
- Department of Physical Therapy (Dr Harris), Faculty of Medicine, University of British Columbia, Vancouver, Canada; and Division of Biokinesiology & Physical Therapy, and Department of Neurology, Keck School of Medicine (Dr Winstein), and Motor Behavior & Neurorehabilitation Laboratory, Ostrow School of Dentistry, University of Southern California, Los Angeles
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29
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Qiu A, Yang Z, Li Z. Recent perspectives of cerebral palsy in children. Minerva Pediatr 2017; 71:297-303. [PMID: 28353322 DOI: 10.23736/s0026-4946.17.04880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The movement and posture disorder of cerebral palsy (CP) is presumed to mainly be a consequence of the motor disorder, but accompanying disturbances with sensations and perception have also been suggested to influence motor function. The heterogeneous condition of CP is caused by an injury to the immature brain affecting movement and posture development. The attainment of standing and walking can be difficult and an assistive device to accomplish the tasks may be required for some children with CP. In this review, we enlightened the role of possible sensory and perceptual disturbances for standing difficulties in children with CP.
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Affiliation(s)
- Aizhen Qiu
- Department of Rehabilitation, Xuzhou Children's Hospital, Xuzhou, China
| | - Zhongxiu Yang
- Department of Rehabilitation, Xuzhou Children's Hospital, Xuzhou, China -
| | - Zhilin Li
- Department of Rehabilitation, Xuzhou Children's Hospital, Xuzhou, China
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30
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Keeratisiroj O, Thawinchai N, Siritaratiwat W, Buntragulpoontawee M, Pratoomsoot C. Prognostic predictors for ambulation in children with cerebral palsy: a systematic review and meta-analysis of observational studies. Disabil Rehabil 2016; 40:135-143. [DOI: 10.1080/09638288.2016.1250119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Orawan Keeratisiroj
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Nuanlaor Thawinchai
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Wantana Siritaratiwat
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
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