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Gatica-Rojas V, Cartes-Velásquez R, Soto-Poblete A, Lizama LEC. Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: Protocol for a clinical trial. PLoS One 2023; 18:e0268163. [PMID: 37590295 PMCID: PMC10434878 DOI: 10.1371/journal.pone.0268163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/22/2022] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE To establish the feasibility and effectiveness of a rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral palsy-spastic hemiplegia. It also aims to compare the effectiveness of this programme under two delivery modalities, telerehabilitation (TR) and face-to-face (FtF). METHODS This is a registered randomized controlled clinical trial protocol (ACTRN12621000117819). Eighteen sessions of low-cost virtual reality therapy will be provided through both, FtF and TR modalities using a Nintendo Wii balance board. Each programme will last for 6 weeks and will consist of 3 sessions per week of 25 minutes each. Twenty patients diagnosed with cerebral palsy-spastic hemiplegia will be recruited for each group: FtF or TR (n = 40). Participants will be assessed at baseline, by the end of weeks 2, 4, and 6, and at weeks 8 and 10 (post-intervention follow-ups). The primary outcome will be the Center of Pressure sway area (CoParea); secondary outcomes will be standard deviation and velocity of the CoP in the mediolateral and anterior-posterior directions; tertiary outcomes will include the Modified-Modified Ashworth Scale for lower limbs, Modified Ashworth Scale for upper limbs, timed up-and-go tests, the timed one-leg standing and 6-minute walk test. RESULTS This study provides an assessment of the feasibility and effectiveness of an affordable rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral palsy. CONCLUSION The designed rehabilitation programme using low-cost virtual reality may improve postural control in children with cerebral palsy-spastic hemiplegia. The TR modality is likely to be as effective as the FtF modality. The TR programme has been designed to overcome access barriers to physiotherapy services for children with cerebral palsy in low-resource settings, remote areas, and in restricted mobility contexts.
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Affiliation(s)
- Valeska Gatica-Rojas
- Tele-rehabilitation Technology Center and Neurosciences in Human Movement, Faculty of Health Sciences, Universidad de Talca, Talca, Chile
| | | | - Alex Soto-Poblete
- Institute of Mathematics and Physics, Universidad de Talca, Talca, Chile
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Mohammed AH, El-Serougy HR, Karim AEA, Sakr M, Sheha SM. Correlation between Selective Motor Control of the Lower Extremities and Balance in Spastic Hemiplegic Cerebral Palsy: a randomized controlled trial. BMC Sports Sci Med Rehabil 2023; 15:24. [PMID: 36872326 PMCID: PMC9987100 DOI: 10.1186/s13102-023-00636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) have motor deficits caused by spasticity, weakness, contractures, diminished selective motor control (SMC), and poor balance. The purpose of the current study was to evaluate the influence of mirror feedback on lower extremity selective motor control and balance in children with hemiplegic cerebral palsy. Understanding the relationship between SMC and balance will help children with hemiplegic CP receive more appropriate therapies. METHODS Forty-seven children of both sexes diagnosed with hemiplegic CP participated in the study. Group1 (Gr1 - control group) received conventional physical therapy training while group 2 (Gr2 - intervention group) received conventional physical therapy training in addition to bilateral lower extremity mirror therapy (MT). The primary outcome measure used was Selective Control Assessment of Lower Extremity scale (SCALE), while the secondary outcome measure was the Pediatric Balance Scale (PBS). RESULTS There were significant differences in Selective Control Assessment of Lower Extremity Scale (SCALE) and Pediatric Balance Scale (PBS) between both groups in favor of Gr2. After treatment, both groups improved significantly, yet Gr2 outperformed Gr1 by a large margin. CONCLUSION Mirror therapy may be a useful addition to home-based motor interventions for children with hemiplegic CP due to its relative simplicity, low cost, and high patient adherence. Additionally, it may help children improve their selective motor skills and balance. TRIAL REGISTRATION Current Controlled Trials using African Clinical Trials Registry website with ID number PACTR202105604636415 retrospectively registered on 21/01/202.
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Affiliation(s)
- Amira H Mohammed
- Department of Physical Therapy for Pediatric and its Surgery, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
| | - Hager R El-Serougy
- Department of Physical Therapy for Neuromuscular Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, Giza, Egypt.
| | - Amel E Abdel Karim
- Department of Physical Therapy for Pediatric Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, 77, Giza, Egypt
| | - Mohamad Sakr
- Department of Neurology, College of Medicine, Misr University for Science and Technology, 77, Giza, Egypt
| | - Samah M Sheha
- Department of Physical Therapy for Pediatric Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, 77, Giza, Egypt
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Beltramin RZ, Martimbianco ALC, Gonçalves MLL, Rocha MM, Silva SM, Horliana ACRT, Santos EM, Turcio KH, Mesquita-Ferrari RA, Fernandes KPS, Motta LJ, Bussadori SK. Abnormal Activity of Masticatory Muscles in Patients with Diagnosis of Cerebral Palsy. A Systematic Review and Meta-Analysis of Observational Studies. Phys Occup Ther Pediatr 2023; 43:548-563. [PMID: 36760123 DOI: 10.1080/01942638.2023.2173038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 01/05/2023] [Accepted: 01/14/2023] [Indexed: 02/11/2023]
Abstract
AIMS to map and synthesize the results from studies that assessed whether individuals diagnosed with cerebral palsy (CP) have abnormal masseter and temporal muscles activation during the masticatory cycle. METHODS Six databases were searched for comparative observational studies assessing masticatory muscles activation in individuals with CP through electromyography analysis. Methodological quality was evaluated using the Joanna Briggs Critical Appraisal Checklist. Outcome data were combined in meta-analysis using the Review Manager software. RESULTS We included five cross-sectional studies with an overall low risk of bias. Meta-analyses showed no difference between CP and healthy individuals regarding maximum voluntary isometric contraction: right masseter (Standard mean difference [SMD] - 0.95; 95% CI -2.03 to 0.13); left masseter (SMD -0.92; 95% CI -1.93 to 0.09); right temporal (SMD -0.72; 95% CI -1.63 to 0.18); and left temporal (SMD -0.68; 95% CI -1.76 to 0.40). Electrical activity amplitude in the inactive period was superior in the CP group, and maximum bite pressure presented higher values in the control group (Mean difference [MD] - 17.38; CI 95% -26.62 to -10.15). CONCLUSIONS Based on observational studies with a lower level of evidence, individuals with CP seem to present difficulties activating masticatory muscles. Future prospective cohort studies with rigorous methodology are still necessary to support these findings. PROSPERO register CRD42020208444.
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Affiliation(s)
- Rafael Zaratin Beltramin
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Marcela Leticia Leal Gonçalves
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Dentistry College, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Monise Mendes Rocha
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Soraia Micaela Silva
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Elaine Marcílio Santos
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Dentistry College, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Karina Helga Turcio
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), School of Dentistry - Aracatuba, São Paulo, Brazil
| | | | | | - Lara Jansiski Motta
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Dentistry College, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
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El-Shamy SM, El Kafy EMA. Effect of functional electrical stimulation versus TheraTogs on gait and balance in children with hemiplegic cerebral palsy: a randomized controlled trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Children with cerebral palsy exhibit postural restrictions and gait problems as a result of both primary and secondary brain damage impairments. One of the main goals of cerebral palsy rehabilitation is to improve gait and balance. As a result, the purpose of this study was to compare the effects of FES and TheraTogs on gait and balance in children with hemiplegic CP. A randomized controlled study was conducted on 30 children with hemiplegic CP (18 boys and 12 girls) between the ages of 8 and 12 years. The children were divided into two equal groups. In addition to the traditional physical treatment program, the FES group received functional electrical stimulation (pulse width 300 μs, frequency 33 Hz, 2 h/day, 3 days/week, 3 months). The TheraTogs group, on the other hand, received the TheraTogs strapping system as well as the same traditional program for the same time period. The 3-D motion analysis and the Biodex balance system were used to analyze gait parameters and postural stability at baseline and 3 months after the intervention.
Results
When comparing the mean values of the gait parameters and postural stability indices of children in both groups before and after treatment, a significant improvement was reported. Furthermore, the FES group showed a greater improvement in all of the measured outcomes (P < 0.001).
Conclusion
Functional electrical stimulation improves gait pattern and postural stability in children with hemiplegic cerebral palsy significantly more than TheraTogs strapping systems.
Clinical trial registration
This study was registered in the ClinicalTrial.gov PRS (NCT05020834).
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Hanssen B, Peeters N, Vandekerckhove I, De Beukelaer N, Bar-On L, Molenaers G, Van Campenhout A, Degelaen M, Van den Broeck C, Calders P, Desloovere K. The Contribution of Decreased Muscle Size to Muscle Weakness in Children With Spastic Cerebral Palsy. Front Neurol 2021; 12:692582. [PMID: 34381414 PMCID: PMC8350776 DOI: 10.3389/fneur.2021.692582] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Muscle weakness is a common clinical symptom in children with spastic cerebral palsy (SCP). It is caused by impaired neural ability and altered intrinsic capacity of the muscles. To define the contribution of decreased muscle size to muscle weakness, two cohorts were recruited in this cross-sectional investigation: 53 children with SCP [median age, 8.2 (IQR, 4.1) years, 19/34 uni/bilateral] and 31 children with a typical development (TD) [median age, 9.7 (IQR, 2.9) years]. Muscle volume (MV) and muscle belly length for m. rectus femoris, semitendinosus, gastrocnemius medialis, and tibialis anterior were defined from three-dimensional freehand ultrasound acquisitions. A fixed dynamometer was used to assess maximal voluntary isometric contractions for knee extension, knee flexion, plantar flexion, and dorsiflexion from which maximal joint torque (MJT) was calculated. Selective motor control (SMC) was assessed on a 5-point scale for the children with SCP. First, the anthropometrics, strength, and muscle size parameters were compared between the cohorts. Significant differences for all muscle size and strength parameters were found (p ≤ 0.003), except for joint torque per MV for the plantar flexors. Secondly, the associations of anthropometrics, muscle size, gross motor function classification system (GMFCS) level, and SMC with MJT were investigated using univariate and stepwise multiple linear regressions. The associations of MJT with growth-related parameters like age, weight, and height appeared strongest in the TD cohort, whereas for the SCP cohort, these associations were accompanied by associations with SMC and GMFCS. The stepwise regression models resulted in ranges of explained variance in MJT from 29.3 to 66.3% in the TD cohort and from 16.8 to 60.1% in the SCP cohort. Finally, the MJT deficit observed in the SCP cohort was further investigated using the TD regression equations to estimate norm MJT based on height and potential MJT based on MV. From the total MJT deficit, 22.6–57.3% could be explained by deficits in MV. This investigation confirmed the disproportional decrease in muscle size and muscle strength around the knee and ankle joint in children with SCP, but also highlighted the large variability in the contribution of muscle size to muscle weakness.
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Affiliation(s)
- Britta Hanssen
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ines Vandekerckhove
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Nathalie De Beukelaer
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Medicine, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Guy Molenaers
- Department of Development and Regeneration, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | - Marc Degelaen
- Department of Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium.,Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.,University Hospital, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
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Conner BC, Schwartz MH, Lerner ZF. Pilot evaluation of changes in motor control after wearable robotic resistance training in children with cerebral palsy. J Biomech 2021; 126:110601. [PMID: 34332214 DOI: 10.1016/j.jbiomech.2021.110601] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/12/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
Cerebral palsy (CP) is characterized by deficits in motor function due to reduced neuromuscular control. We leveraged the guiding principles of motor learning theory to design a wearable robotic intervention intended to improve neuromuscular control of the ankle. The goal of this study was to determine the neuromuscular and biomechanical response to four weeks of exoskeleton ankle resistance therapy (exo-therapy) in children with CP. Five children with CP (12 - 17 years, GMFCS I - II, two diplegic and three hemiplegic, four males and one female) were recruited for ten 20-minute sessions of exo-therapy. Surface electromyography, three-dimensional kinematics, and metabolic data were collected at baseline and after training was complete. After completion of training and with no device on, participants walked with decreased co-contraction between the plantar flexors and dorsiflexors (-29 ± 11%, p = 0.02), a more typical plantar flexor activation profile (33 ± 13% stronger correlation to a typical soleus activation profile, p = 0.01), and increased neural control complexity (7 ± 3%, p < 0.01 measured via muscle synergy analysis). These improvements in neuromuscular control led to a more mechanically efficient gait pattern (58 ± 34%, p < 0.05) with a reduced metabolic cost of transport (-29 ± 15%, p = 0.02). The findings from this study suggest that ankle exoskeleton resistance therapy shows promise for rapidly improving neuromuscular control for children with CP, and may serve as a meaningful rehabilitative complement to common surgical procedures.
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Affiliation(s)
- Benjamin C Conner
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Michael H Schwartz
- James R. Gage Center for Gait & Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, MN, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Zachary F Lerner
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA; Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA.
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