Evidence-Based Management of Postural Control in a Child with Cerebral Palsy

The Mechanism of Hip Dislocation Related to the Use of Abduction Bar and Hip Compression Bandage in Patients With Spastic Cerebral Palsy

OBJECTIVE

The aims of the study were to identify the differences of forces in the hip adductors between with or without the abduction bar and to evaluate the effect of hip compression bandage on the spasticity of the adductor muscles.

DESIGN

Thirty-three patients with cerebral palsy (Gross Motor Functional Classification System IV and V) were prospectively included. Surface electromyography was taken by attaching electromyography on the adductor and abductor muscles. Theraband was used as hip compression bandage. Surface electromyography were taken when spasticity provoked with and without abduction bar, as well as with both abduction bar and hip compression bandage. Root mean square values were measured.

RESULTS

Root mean square values were significantly increased with abduction bar in the adductor longus, adductor magnus, and tensor fascia lata muscles. Adductor Sum and Net Adduction Index showed significant increases after the use of abduction bar. After applying hip compression bandage, the Net Adduction Index was significantly decreased.

CONCLUSIONS

Our results showed significant changes in the adductor muscles' amplitude, Adduction Sum, and Net Adduction Index. These results indicate that forces that worsen hip dislocation may develop, and therefore, abduction bar should either not be used for spastic cerebral palsy patients or should only be used with hip compression wrapping in place as well.

Dual-task effects in children with neuromotor dysfunction: a systematic review

INTRODUCTION

Based on the assumption that motor actions result from the interaction between cognitive, perceptual, mechanical and neurological mechanisms, neuromotor dysfunctions are expected to impair central coordination processes required to perform dual-tasks. The aim of the present work was to systematically review the literature concerning the effects of dual-task in the activities performed by children with neuromotor dysfunctions.

EVIDENCE ACQUISITION

A tailored search strategy in relevant databases was conducted by two independent reviewers in August 2018 seeking for online articles published in English evaluating dual-task (motor-motor, cognitive-cognitive or cognitive-motor) effects on activities in subjects with neuromotor dysfunctions younger than 18 years. The following data were extracted: category of dual-task paradigm (motor-motor; cognitive-cognitive; cognitive-motor), primary and secondary tasks, study methods, methodological quality of the studies, and research gaps in the literature.

EVIDENCE SYNTHESIS

We identified 13 full-text reports that fulfilled the predefined inclusion and exclusion criteria.

CONCLUSIONS

There are a few high-quality studies addressing dual-task effects on activities performed by children with neuromotor dysfunctions. These children show greater susceptibility to dual-task costs than typical ones. There is a lack of studies addressing children with CP and Down Syndrome, which are highly prevalent and commonly seen in clinical settings. Thus, dual-task effects in children with neuromotor dysfunctions remain a wide research field, with need for further studies to fill in the existing gaps.