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Shierk A, Roberts H, Habeeb Y, Dursun N, Cekmece C, Bonikowski M, Pyrzanowska W, Carranza J, Granados Garcia G, Clegg N, Delgado MR. Development of GO Move: A Website for Children With Unilateral Cerebral Palsy. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:589-596. [PMID: 38281146 DOI: 10.1177/15394492231225141] [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] [Indexed: 01/30/2024]
Abstract
It is unknown if an online tool is wanted by therapists and parents of individuals with unilateral cerebral palsy (UCP) to support implementation of goal-directed home programs, and if wanted, the recommended features for the tool. The objective was to explore the experiences of therapists and parents who have implemented home programs, seek guidance on translating a paper-based home program toolbox into a mobile website, and develop the website. Qualitative descriptive methodology guided data collection using semi-structured interviews and thematic analysis, validated with field notes and member checking. A team science, iterative approach was used to integrate the themes into the development of the mobile website. Five primary themes including recommendations for the functionality, features, content, and naming of the mobile website were identified. Parents and therapists value home programs. Participants provided recommendations regarding content and features, and the GO Move mobile website was developed based on the recommendations.
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Affiliation(s)
- Angela Shierk
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Heather Roberts
- Scottish Rite for Children, Dallas, TX, USA
- Texas Woman's University, Denton, USA
| | | | | | | | | | | | | | | | | | - Mauricio R Delgado
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Gehringer JE, Woodruff Jameson A, Boyer H, Konieczny J, Thomas R, Pierce Iii J, Cunha AB, Willett S. Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study. JMIR Form Res 2024; 8:e57588. [PMID: 39241226 DOI: 10.2196/57588] [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: 02/20/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 09/08/2024] Open
Abstract
This single-participant case study examines the feasibility of using custom virtual reality (VR) gaming software in the home environment for low-dose Hand Arm Bimanual Intensive Training (HABIT). A 10-year-old with right unilateral cerebral palsy participated in this trial. Fine and gross motor skills as well as personal goals for motor outcomes were assessed before and after the intervention using the Box and Blocks Test, Nine-Hole Peg Test, and Canadian Occupational Performance Measure. Movement intensities collected via the VR hardware accelerometers, VR game scores, and task accuracy were recorded via the HABIT-VR software as indices of motor performance. The child and family were instructed to use the HABIT-VR games twice daily for 30 minutes over a 14-day period and asked to record when they used the system. The child used the system and completed the 14-hour, low-dose HABIT-VR intervention across 22 days. There was no change in Box and Blocks Test and Nine-Hole Peg Test scores before and after the intervention. Canadian Occupational Performance Measure scores increased but did not reach the clinically relevant threshold, due to high scores at baseline. Changes in motor task intensities during the use of VR and mastery of the VR bimanual tasks suggested improved motor efficiency. This case study provides preliminary evidence that HABIT-VR is useful for promoting adherence to HABIT activities and for the maintenance of upper extremity motor skills in the home setting.
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Affiliation(s)
- James E Gehringer
- Virtual Reality Laboratory, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Physical Therapy, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Anne Woodruff Jameson
- Department of Physical Therapy, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Hailey Boyer
- Department of Physical Therapy, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jennifer Konieczny
- Department of Occupational Therapy, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ryan Thomas
- Virtual Reality Laboratory, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Physical Therapy, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
| | - James Pierce Iii
- Virtual Reality Laboratory, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Physical Therapy, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Andrea B Cunha
- Department of Physical Therapy, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Sandra Willett
- Department of Physical Therapy, Munroe-Meyer Insitute, University of Nebraska Medical Center, Omaha, NE, United States
- Physical Therapy Program, Department of Kinesiology, Colorado Mesa University, Grand Junction, CO, United States
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Delfing D, Chin K, Hentrich L, Rachwani J, Friel KM, Santamaria V, Imms C, Gordon AM. Assessing engagement in rehabilitation: development, validity, reliability, and responsiveness to change of the Rehabilitation Observation Measure of Engagement (ROME). Disabil Rehabil 2024; 46:1888-1897. [PMID: 37161867 DOI: 10.1080/09638288.2023.2208379] [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: 10/11/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE We describe the development of an observational video coding tool, the Rehabilitation Observation Measure of Engagement (ROME), to quantify engagement in rehabilitative settings at the person (internal state of an individual) and between-system (interaction between individuals) level. METHODS Forty-nine children with unilateral spastic cerebral palsy (29 males; Age: M = 9.28 yrs, SD = 3.08 yrs) and their interventionists were videotaped during different activities. Construct validity was examined by correlating the ROME with the Engagement vs. Disaffection with Learning Survey and the Pediatric Rehabilitation Intervention Measure of Engagement - Observation questionnaire. Inter- and intra-rater reliability were examined using two independent raters. The ROME's responsiveness to change was examined by comparing scores across activities. RESULTS For construct validity, results showed a positive correlation for person-level engagement (r = 0.444, p = 0.003). No relationship was found between-system-level engagement. High intrarater (91.8%) and interrater (96.1%) reliability was found. The ROME's responsiveness to change was supported by children exhibiting lower engagement scores during repetitive shaping activities. CONCLUSION These findings provide evidence that the ROME is a reliable tool to objectively examine the construct of engagement within rehabilitation and is valid for quantifying person-level engagement. It provides information that cannot be extracted from questionnaires and can help guide intervention decisions.
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Affiliation(s)
- Dalina Delfing
- Department of Biobehavioral Sciences, Teachers College, Columbia University, NY, NY, United States
| | - Karen Chin
- Department of Biobehavioral Sciences, Teachers College, Columbia University, NY, NY, United States
| | - Larissa Hentrich
- Department of Biobehavioral Sciences, Teachers College, Columbia University, NY, NY, United States
| | - Jaya Rachwani
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, United States
| | - Kathleen M Friel
- Burke Neurological Institute, Weill Cornell Medicine, White Plains, NY, United States
| | - Victor Santamaria
- Department of Physical Therapy, New York Medical College, NY, United States
| | - Christine Imms
- Healthy Trajectories: A Child and Youth Disability Research Hub, Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, NY, NY, United States
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Grajales López V, Hernández Suárez OI, Pinzón Bernal MY, Salamanca Duque LM. [Effectiveness of early motor interventions in children with cerebral palsy between 3 to 5years of age: Systematic review]. Rehabilitacion (Madr) 2024; 58:100832. [PMID: 38141422 DOI: 10.1016/j.rh.2023.100832] [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: 04/10/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/25/2023]
Abstract
Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary.
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Au KLK, Knitter JL, Morrow-McGinty S, Campos TC, Carmel JB, Friel KM. Combining Unimanual and Bimanual Therapies for Children with Hemiparesis: Is There an Optimal Delivery Schedule? Behav Sci (Basel) 2023; 13:490. [PMID: 37366742 DOI: 10.3390/bs13060490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Constraint-induced movement therapy (CIMT) and bimanual therapy (BT) are among the most effective hand therapies for children with unilateral cerebral palsy (uCP). Since they train different aspects of hand use, they likely have synergistic effects. The aim of this study was to examine the efficacy of different combinations of mCIMT and BT in an intensive occupational therapy program for children with uCP. Children (n = 35) participated in intensive modified CIMT (mCIMT) and BT, 6 weeks, 5 days/week, 6 h/day. During the first 2 weeks, children wore a mitt over the less-affected hand and engaged in functional and play activities with the affected hand. Starting in week 3, bimanual play and functional activities were added progressively, 1 hour/week. This intervention was compared to two different schedules of block interventions: (1) 3 weeks of mCIMT followed by 3 weeks of BT, and (2) 3 weeks of BT followed by 3 weeks of mCIMT. Hand function was tested before, after, and two months after therapy with the Assisting Hand Assessment (AHA), Pediatric Evaluation of Disability Inventory (PEDI), and Canadian Occupational Performance Measure (COPM). All three groups of children improved in functional independence (PEDI; p < 0.031), goal performance (COPM Performance; p < 0.0001) and satisfaction (COPM Satisfaction; p < 0.0001), which persisted two months post-intervention. All groups showed similar amounts of improvement, indicating that the delivery schedule for mCIMT and BT does not significantly impact the outcomes.
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Affiliation(s)
- Ka Lai K Au
- Blythedale Children's Hospital, Valhalla, NY 10595, USA
| | | | | | - Talita C Campos
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jason B Carmel
- Weinberg Family Cerebral Palsy Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Kathleen M Friel
- Burke Neurological Institute, White Plains, NY 10605, USA
- Brain Mind Research Institute, Weill Cornell Medical College, New York, NY 10021, USA
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Yang FA, Lee TH, Huang SW, Liou TH, Escorpizo R, Chen HC. Upper limb manual training for children with cerebral palsy: A systematic review and network meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:516-533. [PMID: 36330696 DOI: 10.1177/02692155221137698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are different upper limb manual training protocols, namely constraint-induced movement therapy, modified constraint-induced movement therapy, hand-arm bimanual intensive training, hand-arm bimanual intensive training including lower extremity, action observation training, and mirror therapy, available for improving functional outcomes in children with cerebral palsy. However, the effect and priority of these strategies remain unclear. DATA SOURCES We searched the PubMed, Cochrane Library, and Embase databases for relevant articles from inception to October 12, 2022. REVIEW METHODS To assess the effect and priority of different strategies of upper limb manual training protocols through a systematic review and network meta-analysis of randomized controlled trials. RESULTS We included 22 randomized controlled trials in this network meta-analysis. The ranking probability and standard mean differences with 95% credible intervals of the comparison between placebo and other forms of upper limb manual training were as follows: mirror therapy = 2.83 (1.78, 3.88), hand-arm bimanual intensive training including the lower extremity = 0.53 (0.09, 0.96), constraint-induced movement therapy = 0.44 (0.18, 0.71), hand-arm bimanual intensive training = 0.41 (0.15, 0.67), modified constraint-induced movement therapy = 0.39 (0.03, 0.74), and action observation training = 0.18 ( - 0.29, 0.65). No significant inconsistency was noted between the results of direct and indirect comparisons. CONCLUSION We suggest that mirror therapy could be the upper limb manual training protocol of choice for improving functional outcomes in patients with cerebral palsy.
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Affiliation(s)
- Fu-An Yang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ting-Hsuan Lee
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, College of Nursing and Health Sciences, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan
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Nawge S, Karthikbabu S. Does bimanual task training benefit manual ability and hand function of children with bilateral spastic cerebral palsy? J Pediatr Rehabil Med 2022; 16:49-57. [PMID: 36373302 DOI: 10.3233/prm-210109] [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: 11/10/2022] Open
Abstract
PURPOSE Sixty percent of children with bilateral cerebral palsy have impaired hand function. The study's purpose was to examine the benefits of bimanual task practice on the manual ability and hand function of children with bilateral spastic cerebral palsy. METHODS In this pre-post study design, 18 children with bilateral spastic cerebral palsy with an average age of 11.5 (+/-1.9) years, Manual Ability Classification System levels I-III and Bimanual Fine Motor Function levels I-III participated in bimanual task practice of upper extremities. The task practice included clay activities, paper manipulation and activities of daily needs. The children underwent 45-minute training sessions 3 times a week over 6 weeks. The outcome measures were ABILHAND-Kids, Quality of Upper Extremity Skills Test and grip strength. RESULTS Post-training, a mean change of 6.44 logits in ABILHAND-Kids, 11 points on the Quality of Upper Extremity Skills Test, and 3.3 and 3.1 kilograms grip strength in the dominant and nondominant hands respectively were observed with a statistical significance (p < 0.05). CONCLUSION Bimanual task training might be beneficial in improving manual ability, hand function and grip strength in children with bilateral spastic cerebral palsy.
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Affiliation(s)
- Surabhi Nawge
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Hospital, Bangalore campus, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Suruliraj Karthikbabu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Hospital, Bangalore campus, Manipal Academy of Higher Education, Manipal, Karnataka, India.,KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust, Coimbatore, The Tamil Nadu Dr M.G.R. Medical University, Chennai, India
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Gordon AM, Ferre CL, Robert MT, Chin K, Brandao M, Friel KM. HABIT+tDCS: a study protocol of a randomised controlled trial (RCT) investigating the synergistic efficacy of hand-arm bimanual intensive therapy (HABIT) plus targeted non-invasive brain stimulation to improve upper extremity function in school-age children with unilateral cerebral palsy. BMJ Open 2022; 12:e052409. [PMID: 35190424 PMCID: PMC8860006 DOI: 10.1136/bmjopen-2021-052409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Unilateral spastic cerebral palsy (USCP) is characterised by movement deficits primarily on one body side. The best available upper extremity (UE) therapies are costly and intensive. Thus, there is an urgent need for better, more efficient and thus more accessible therapies. Transcranial direct current stimulation (tDCS) is non-invasive and may enhance physical rehabilitation approaches. The aim of this study is to determine whether tDCS targeted to the hemisphere with corticospinal tract (CST) connectivity enhances the efficacy of UE training in children with USCP. Our central hypothesis is that hand-arm bimanual intensive therapy (HABIT) combined with a tDCS montage targeting the hemisphere with CST connectivity to the impaired UE muscles will improve UE function more than HABIT plus sham stimulation. We will test this by conducting a randomised clinical trial with clinical and motor cortex physiology outcomes. METHODS AND ANALYSES 81 children, aged 6-17 years, will be randomised to receive 2 mA anodal tDCS targeted to the affected UE motor map, 2 mA cathodal tDCS to the contralesional motor cortex or sham tDCS during the first 20 min of each HABIT session (10 hours: 2 hours/day for 5 days). Primary outcomes will be Box and Blocks Test, Assisting Hand Assessment and motor cortex excitability, determined with single-pulse transcranial magnetic stimulation. Secondary outcomes include ABILHAND-Kids, Canadian Occupational Performance Measure, Cooper Stereognosis, Dimension of Mastery Questionnaire and Participation and Environment Measure-Children and Youth. All measures will be collected before, immediately and 6 months after treatment. A group × test session Analysis of Variance will test differences among groups on all measures. ETHICS AND DISSEMINATION The study has been approved by the BRANY Institutional Review Board (#18-10-285-512). We will leverage our subject and family relationships to maximise dissemination and share results with the academic and patient/family advocacy groups. TRIAL REGISTRATION NUMBER NCT03402854.
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Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
| | - Claudio L Ferre
- Burke Neurological Institute, White Plains, New York, USA
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
| | - Maxime T Robert
- Department of Rehabilitation, Laval University, Quebec City, Quebec, Canada
| | - Karen Chin
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
- Burke Neurological Institute, White Plains, New York, USA
| | - Marina Brandao
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Palomo-Carrión R, Lirio-Romero C, Ferri-Morales A, Jovellar-Isiegas P, Cortés-Vega MD, Romay-Barrero H. Combined intensive therapies at home in spastic unilateral cerebral palsy with high bimanual functional performance. What do they offer? A comparative randomised clinical trial. Ther Adv Chronic Dis 2021; 12:20406223211034996. [PMID: 34408823 PMCID: PMC8366120 DOI: 10.1177/20406223211034996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Children with unilateral spastic cerebral palsy (USCP) receive different treatments, including the application of modified constraint induced movement therapy (mCIMT) or bimanual intensive therapy (BIT) to increase affected upper limb functionality. The aim of this study was to compare the effectiveness of two protocols with different proportions and orders of mCIMT/BIT within combined intensive home-therapy in children with USCP (6–8 years old) with high bimanual functional performance, applied by the family. Methods: The protocols were performed on 20 children with an average age of 7.12 years [standard deviation (SD): 0.70], allocated to two different combined therapies. The protocols were designed by 100 h of dose for 10 weeks: 80 h of mCIMT followed by 20 h of BIT (mCIMT-B group) and 80 h of BIT followed by 20 h of mCIMT (BIT-mCI group). Bimanual functional performance was measured with Assisting Hand Assessment Scale (AHA) and the affected upper limb-use experience with Children’s Hand-use Experience Questionnaire (CHEQ). Parent satisfaction and expectations with therapy were measured using a specific questionnaire. There were five assessment timepoints (week 0, week 4, week 8, week 10 and week 34). Results: There were no statistically significant (p > 0.05) inter- and intra-group changes in the bimanual functional performance of both groups. The affected upper limb-use experience obtained significant changes in BIT-mCI group, with statistically significant differences in the pairwise comparisons between week 0–10 and week 4–10 (p = 0.028) for use of the affected hand and the use of the affected hand to grasp between week 4 and week 8 (p = 0.028). Grasp efficacy and discomfort acquired statistically significant differences only in the BIT-mCI group for pairwise comparisons week 0–week 10/week 4–week 10 (p = 0.035). Although task execution time compared with a typically developing child of the same age obtained statistically significant differences only in the group mCIMT-B for pairwise comparisons week 0–week 8 (p = 0.03), week 0–week 10 (p = 0.03), week 4–week 8 (p = 0.04) and week 4–week 10 (p = 0.03). Family satisfaction and expectations acquired an increase between week 0 and week 10 (p ⩽ 0.02). Conclusion: Applying 80 h of BIT for 8 weeks in children with high bimanual functional performance USCP (6–8 years old), executed at home with family involvement would be sufficient to obtain improvements in affected upper limb-use experience, without the need to use combined protocols of 100 h. However, no statistically significant increase in bimanual functional performance would be obtained, with the basal situation of the child being a factor to consider for the execution of mCIMT and BIT. Registration number and name of trial registry: [ClinicalTrials.gov identifier: NCT03465046]
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Affiliation(s)
- Rocío Palomo-Carrión
- University of Castilla-La Mancha, Toledo, Spain GIFTO, Physiotherapy Research Group of Toledo, Spain
| | - Cristina Lirio-Romero
- University of Castilla-La Mancha, Avda. Carlos III. s/n, Toledo, 45071, Spain GIFTO, Physiotherapy Research Group of Toledo, Spain
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Hornáček K, Kujawa J, Varela Donoso E, Dincer F, Ilieva E, Takáč P, Petronic Markovic I, Votava J, Vetra A, Nikolic D, Christodoulou N, Zampolini M, Kiekens C. Evidence Based Position Paper on Physical and Rehabilitation Medicine professional practice for persons with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:1020-1035. [PMID: 33861040 DOI: 10.23736/s1973-9087.21.06983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. AIM The aim of this study was to improve Physical and Rehabilitation Medicine physician´s professional practice for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. MATERIAL AND METHODS A systematic review of the literature including an eighteen-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. RESULTS As the result of a Consensus Delphi procedure process 74 recommendations are presented together with the systematic literature review. CONCLUSIONS The PRM physician´s role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM programme developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients´ health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions.
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Affiliation(s)
- Karol Hornáček
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Jolanta Kujawa
- Department of Physical and Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University of School of Medicine, Madrid, Spain
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Peter Takáč
- Department of Physical and Rehabilitation Medicine, L. Pasteur University Hospital, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic -
| | - Ivana Petronic Markovic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jiří Votava
- Faculty of Health Studies, University of J. E. Purkyně, Ústí nad Labem, Czech Republic
| | - Anita Vetra
- Rehabilitation Department, Riga Stradins University, Riga, Latvia
| | - Dejan Nikolic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Zampolini
- Department of Rehabilitation, Foligno Hospital, USL Umbria 2, Perugia, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola Bologna, Italy
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Feitosa AM, Mancini MC, Silvério APM, Gordon AM, Brandão MB. "Help Me to Improve my Own Priorities!": A Feasibility Study of an Individualized Intensive Goal Training for Adolescents with Cerebral Palsy. Phys Occup Ther Pediatr 2021; 41:601-619. [PMID: 33653225 DOI: 10.1080/01942638.2021.1891186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To investigate the feasibility and the preliminary effects of an individualized intensive goal training for adolescents with cerebral palsy (CP). METHODS Twelve adolescents with CP (12-17 years old, MACS II-III, GMFCS I-IV) identified functional goals to be practiced three hours/day, five days/week, for two weeks. The feasibility aspects included the participant's adherence (i.e., daily logs), the adequacy of the instruments used, and the participant's satisfaction with the intervention (i.e., structured questionnaire). Outcome measures included the Canadian Occupational Performance Measure (COPM), Pediatric Evaluation of Disability Inventory (PEDI) (self-care; mobility), Children Helping Out: Responsibilities, Expectations and Supports (CHORES), Participation and Environment Measure-Children and Youth (PEM-CY) (home) and Box and Blocks Test (BBT). Assessments were conducted one month and two days before the intervention, immediately and three months after the intervention. Friedman tests were used to test time-related differences in the outcome measures. RESULTS All adolescents completed and reported satisfaction with the proposed intervention. Significant improvements were observed in performance and satisfaction (COPM), in functional skills and caregiver assistance in self-care and in the performance of household tasks. There were no significant differences in mobility skills, independence in mobility or household tasks, home participation, or manual dexterity. CONCLUSION The intensive training was feasible and promoted improvements in functional goals and daily functioning of adolescents with CP.
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Affiliation(s)
- Aline M Feitosa
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marisa C Mancini
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Paula M Silvério
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Marina B Brandão
- Graduate Program in Rehabilitation Sciences, Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Keller-Ross ML, Chantigian DP, Nemanich S, Gillick BT. Cardiovascular Effects of Transcranial Direct Current Stimulation and Bimanual Training in Children With Cerebral Palsy. Pediatr Phys Ther 2021; 33:11-16. [PMID: 33337767 PMCID: PMC7755053 DOI: 10.1097/pep.0000000000000762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the influence of combined transcranial direct current stimulation (tDCS) to the motor cortex (M1) and bimanual training on cardiovascular function in children with cerebral palsy (CP). METHODS Mean arterial pressure (MAP), heart rate (HR), and HR variability (HRV) were measured immediately before and after 20 minutes of cathodal tDCS to contralesional M1 and bimanual training on days 1, 6, and 10 of a 10-day trial in 8 participants (5 females, 7-19 years). RESULTS Baseline MAP and HR were similar across days (93 ± 10 mm Hg and 90 ± 10 bpm, P > .05). MAP was similar from baseline to postintervention across all 3 days. Systolic pressure, diastolic pressure, nor HR significantly changed. HRV was not influenced by the 10-day intervention. CONCLUSIONS Combined cathodal tDCS to M1 and bimanual training does not influence autonomic and cardiovascular function in children with CP due to perinatal stroke.
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Affiliation(s)
- Manda L Keller-Ross
- Division of Rehabilitation Science (Drs Keller-Ross and Gillick and Mr Chantigian) and Division of Physical Therapy (Drs Keller-Ross, Nemanich, and Gillick), Department of Rehabilitation, Medical School, University of Minnesota, Minneapolis, Minnesota
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13
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Ouyang RG, Yang CN, Qu YL, Koduri MP, Chien CW. Effectiveness of hand-arm bimanual intensive training on upper extremity function in children with cerebral palsy: A systematic review. Eur J Paediatr Neurol 2020; 25:17-28. [PMID: 31902688 DOI: 10.1016/j.ejpn.2019.12.017] [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: 12/09/2018] [Revised: 11/08/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To systematically review the effectiveness of Hand-Arm Bimanual Intensive Training (HABIT) on upper limb function in children with cerebral palsy. METHODS Six databases (MEDLINE, CINAHL, PubMed, Embase, Cochrane Library, and PsycINFO) were searched for HABIT-related studies published in English between 2007 and 2017. The methodological quality of the included studies was classified based on the Levels of Evidence of the American Occupational Therapy Association guidelines. If the included studies were randomized controlled trials (RCTs), the methodological quality was evaluated using the Revised Cochrane risk of bias tool. Cohen's d effect sizes were computed and synthesized to assess the effectiveness. RESULTS Among 646 studies, 15 fulfilled the inclusion criteria. Eleven studies were RCTs, 64% of which were rated as having a high risk of bias; one was a quasi-RCT, one was a retrospective study, and two were longitudinal studies. Nearly half of the included studies used HABIT for 6 h a day for three consecutive weeks (totaling 90 h), and some studies used different doses/schedules or added training components to HABIT. Synthesis of the results demonstrated a significantly small effect size (d = 0.36, P = 0.017) for improving upper limb function immediately after the interventions, and the improvements were maintained at follow-up. Similarly, significantly moderate or large effect sizes were found for self-care function (d = 0.52, P = 0.003) and goal improvements (d = 1.78-2.28, P < 0.001). CONCLUSION This review supports the effectiveness of HABIT as an intervention for improving upper limb function in children with cerebral palsy.
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Affiliation(s)
- Rang-Ge Ouyang
- Department of Rehabilitation, Xiangya Hospital, Central South University, Hunan, China
| | - Chieh-Ning Yang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Ya-Lan Qu
- School of Communication Sciences, The Beijing Language and Culture University, Beijing, China.
| | - Manohar Prasad Koduri
- Department of Mechanical, Materials, and Aerospace, School of Engineering, University of Liverpool, Liverpool, Harrison Hughes Building, Liverpool, L69 3GH, UK; International Intercollegiate Ph.D. Program, National Tsing Hua University, No. 101, Section 2, Guangfu Road, East District, Hsinchu City, Taiwan R.O.C
| | - Chi-Wen Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
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Mallory K, Barton K, Woodhouse J, Bernstein J, Greenspoon D, Reed N. Occupational Performance Issues of Children with Hemiplegia after Acquired Brain Injury. Phys Occup Ther Pediatr 2020; 40:279-293. [PMID: 31608806 DOI: 10.1080/01942638.2019.1675845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: This retrospective, exploratory study aimed to examine the categories and frequency of occupational performance issues (OPIs) identified by children (or their caregivers), who participated in a two-week, group-based modified constraint induced movement therapy program, Helping Hand. The effect of participant age on the OPIs identified was also explored.Methods: OPIs were identified using the Canadian Occupational Performance Measure for 46 Helping Hand participants, prior to program participation. Descriptive statistics including the frequency of identified OPIs were used to categorize the 236 OPIs into occupational areas. Descriptive statistics were also used to determine how the categories of OPIs and relative frequencies differed based on participant age.Results: The identified OPIs were diverse, and differed in frequency of identification and level of specificity. The OPIs identified varied based on participant age, with age groups showing developmentally appropriate differences in OPIs.Conclusions: Identification of OPIs should balance client-centredness with probing for specificity, in order for OPIs to be understood by clinicians. This will guide future program development and interventions that target age-appropriate occupational priorities.
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Affiliation(s)
- Kylie Mallory
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Barton
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Janet Woodhouse
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Janet Bernstein
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Dayna Greenspoon
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Bloorview Research Institute, Toronto, Ontario, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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Shum LC, Valdes BA, Hodges NJ, Van der Loos HFM. Error Augmentation in Immersive Virtual Reality for Bimanual Upper-Limb Rehabilitation in Individuals With and Without Hemiplegic Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng 2019; 28:541-549. [PMID: 31841417 DOI: 10.1109/tnsre.2019.2959621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
With more readily available commercial immersive virtual reality (VR) technologies, the potential of new feedback strategies as tools to facilitate motor rehabilitation should be investigated. Augmented feedback or error augmentation (EA) can easily be shown in a virtual environment. Here, visual EA provided via immersive VR was tested for its effectiveness to improve bimanual symmetry in a reaching task. A single-session crossover design was used to test two training cases, with or without EA. With EA, the distance between hands in the forward direction was augmented. Participants were recruited from typically developing (TD) populations (n = 12, ages 13-21) and performed in an adapted environment with an initial asymmetry between limbs. Also, five participants with hemiplegic cerebral palsy (CP) (ages 14-21, MACS I-III) completed the study. Among TD participants, a significantly larger change in symmetry in the adapted environment was shown after EA than training without EA (F (1, 10) = 9.64, p = 0.01). Each participant in the CP group also improved more after EA training (8.8-103.7)%, such that they achieved lower symmetry error after training with EA. As participants in both groups adapted more symmetrically with EA, beneficial changes from this training method could be evaluated in future studies for longer-term functional changes.
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Hoare BJ, Wallen MA, Thorley MN, Jackman ML, Carey LM, Imms C. Constraint-induced movement therapy in children with unilateral cerebral palsy. Cochrane Database Syst Rev 2019; 4:CD004149. [PMID: 30932166 PMCID: PMC6442500 DOI: 10.1002/14651858.cd004149.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Unilateral cerebral palsy (CP) is a condition that affects muscle control and function on one side of the body. Children with unilateral CP experience difficulties using their hands together secondary to disturbances that occur in the developing fetal or infant brain. Often, the more affected limb is disregarded. Constraint-induced movement therapy (CIMT) aims to increase use of the more affected upper limb and improve bimanual performance. CIMT is based on two principles: restraining the use of the less affected limb (for example, using a splint, mitt or sling) and intensive therapeutic practice of the more affected limb. OBJECTIVES To evaluate the effect of constraint-induced movement therapy (CIMT) in the treatment of the more affected upper limb in children with unilateral CP. SEARCH METHODS In March 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PEDro, OTseeker, five other databases and three trials registers. We also ran citation searches, checked reference lists, contacted experts, handsearched key journals and searched using Google Scholar. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs or clinically controlled trials implemented with children with unilateral CP, aged between 0 and 19 years, where CIMT was compared with a different form of CIMT, or a low dose, high-dose or dose-matched alternative form of upper-limb intervention such as bimanual intervention. Primarily, outcomes were bimanual performance, unimanual capacity and manual ability. Secondary outcomes included measures of self-care, body function, participation and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts to eliminate ineligible studies. Five review authors were paired to extract data and assess risk of bias in each included study. GRADE assessments were undertaken by two review authors. MAIN RESULTS We included 36 trials (1264 participants), published between 2004 and 2018. Sample sizes ranged from 11 to 105 (mean 35). Mean age was 5.96 years (standard deviation (SD) 1.82), range three months to 19.8 years; 53% male and 47% participants had left hemiplegia. Fifty-seven outcome measures were used across studies. Average length of CIMT programs was four weeks (range one to 10 weeks). Frequency of sessions ranged from twice weekly to seven days per week. Duration of intervention sessions ranged from 0.5 to eight hours per day. The mean total number of hours of CIMT provided was 137 hours (range 20 to 504 hours). The most common constraint devices were a mitt/glove or a sling (11 studies each).We judged the risk of bias as moderate to high across the studies. KEY RESULTS Primary outcomes at primary endpoint (immediately after intervention)CIMT versus low-dose comparison (e.g. occupational therapy)We found low-quality evidence that CIMT was more effective than a low-dose comparison for improving bimanual performance (mean difference (MD) 5.44 Assisting Hand Assessment (AHA) units, 95% confidence interval (CI) 2.37 to 8.51).CIMT was more effective than a low-dose comparison for improving unimanual capacity (Quality of upper extremity skills test (QUEST) - Dissociated movement MD 5.95, 95% CI 2.02 to 9.87; Grasps; MD 7.57, 95% CI 2.10 to 13.05; Weight bearing MD 5.92, 95% CI 2.21 to 9.6; Protective extension MD 12.54, 95% CI 8.60 to 16.47). Three studies reported adverse events, including frustration, constraint refusal and reversible skin irritations from casting.CIMT versus high-dose comparison (e.g. individualised occupational therapy, bimanual therapy)When compared with a high-dose comparison, CIMT was not more effective for improving bimanual performance (MD -0.39 AHA Units, 95% CI -3.14 to 2.36). There was no evidence that CIMT was more effective than a high-dose comparison for improving unimanual capacity in a single study using QUEST (Dissociated movement MD 0.49, 95% CI -10.71 to 11.69; Grasp MD -0.20, 95% CI -11.84 to 11.44). Two studies reported that some children experienced frustration participating in CIMT.CIMT versus dose-matched comparison (e.g. Hand Arm Bimanual Intensive Therapy, bimanual therapy, occupational therapy)There was no evidence of differences in bimanual performance between groups receiving CIMT or a dose-matched comparison (MD 0.80 AHA units, 95% CI -0.78 to 2.38).There was no evidence that CIMT was more effective than a dose-matched comparison for improving unimanual capacity (Box and Blocks Test MD 1.11, 95% CI -0.06 to 2.28; Melbourne Assessment MD 1.48, 95% CI -0.49 to 3.44; QUEST Dissociated movement MD 6.51, 95% CI -0.74 to 13.76; Grasp, MD 6.63, 95% CI -2.38 to 15.65; Weightbearing MD -2.31, 95% CI -8.02 to 3.40) except for the Protective extension domain (MD 6.86, 95% CI 0.14 to 13.58).There was no evidence of differences in manual ability between groups receiving CIMT or a dose-matched comparison (ABILHAND-Kids MD 0.74, 95% CI 0.31 to 1.18). From 15 studies, two children did not tolerate CIMT and three experienced difficulty. AUTHORS' CONCLUSIONS The quality of evidence for all conclusions was low to very low. For children with unilateral CP, there was some evidence that CIMT resulted in improved bimanual performance and unimanual capacity when compared to a low-dose comparison, but not when compared to a high-dose or dose-matched comparison. Based on the evidence available, CIMT appears to be safe for children with CP.
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Affiliation(s)
- Brian J Hoare
- Monash Children's HospitalVictorian Paediatric Rehabilitation Service246 Clayton RdClaytonVictoriaAustralia3168
| | - Margaret A Wallen
- Australian Catholic UniversitySchool of Allied Health, Faculty of Health SciencesNorth SydneyAustralia
| | - Megan N Thorley
- Royal Children's HospitalRehabilitationHerston RoadBrisbaneQueenslandAustralia4006
| | - Michelle L Jackman
- John Hunter Children's HospitalPaediatric Occupational TherapyLambton RoadNew LambtonNew South WalesAustralia2310
| | - Leeanne M Carey
- Florey Institute of Neuroscience and Mental Health, The University of MelbourneNeurorehabilitation and Recovery, Stroke DivisionMelbourneVictoriaAustralia3081
| | - Christine Imms
- Australian Catholic UniversityCentre for Disability & Development ResearchLevel 2, Daniel Mannix Building17 Young StreetMelbourneVictoriaAustralia3065
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Chen YL, Chen HL, Shieh JY, Wang TN. Preliminary Efficacy of a Friendly Constraint-Induced Therapy (Friendly-CIT) Program on Motor and Psychosocial Outcomes in Children with Cerebral Palsy. Phys Occup Ther Pediatr 2019; 39:139-150. [PMID: 29912601 DOI: 10.1080/01942638.2018.1484407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIMS Constraint-induced therapy (CIT) is effective, but concerns have been repeatedly raised regarding the generalizability, feasibility, and potentially intrusive nature of restraining a child's unimpaired upper limb. We examined the feasibility and efficacy of friendly-CIT, which uses home-based model, a caregiver-determined schedule, and gentle restraint, in children with cerebral palsy. METHODS In a one-group pre-post intervention trial, 15 children (median of age = 8 years, 4 months) participated in 8 weeks of friendly-CIT (36 hours). Motor and psychosocial outcomes were investigated. RESULTS Participants showed significant improvement on the manual dexterity subtest of the Bruininks-Oseretsky Test of Motor Proficiency (p = 0.004); the how often (p = 0.01) and how well (p = 0.02) scales of the Revised Pediatric Motor Activity Log; and the functional skills score on the Chinese version of the Pediatric Evaluation of Disability Inventory (p = 0.002). For psychosocial outcomes, children with CP consistently demonstrated high engagement and increased playfulness (p < 0.0001) during the 8-week intervention. Parents showed no change in stress status and high satisfaction with friendly-CIT. CONCLUSION Friendly-CIT is feasible and promising for improving a child's motor and psychosocial outcomes without increasing parental stress.
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Affiliation(s)
- Yu-Lun Chen
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Hao-Ling Chen
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
| | - Jeng-Yi Shieh
- b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
| | - Tien-Ni Wang
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
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Hines A, Bundy AC, Black D, Haertsch M, Wallen M. Upper Limb Function of Children with Unilateral Cerebral Palsy After a Magic-Themed HABIT: A Pre-Post-Study with 3- and 6-Month Follow-Up. Phys Occup Ther Pediatr 2019; 39:404-419. [PMID: 30648457 DOI: 10.1080/01942638.2018.1505802] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: To examine changes in upper limb function, and performance in everyday tasks, for children with unilateral cerebral palsy who participated in a magic-themed hand-arm bimanual intensive therapy (HABIT). Methods: Twenty-eight children participated; mean age 10 y 6 mo (SD 2 y 2 mo), n = 15 male and n = 13 female. Using a single group, pre-and post-test design, the magic-themed HABIT was delivered for 60 hours over 10 days. Bimanual and unimanual hand function were measured using the Assisting Hand Assessment (AHA) and Box and Blocks Test (BBT). Occupational performance was rated using the Canadian Occupational Performance Measure (COPM). Two parent questionnaires explored change in bimanual hand use in everyday activities; ABILHAND-Kids and Children's Hand-use Experience Questionnaire (CHEQ). Assessments were completed pre-, immediately post, 3 months and 6 months after the intervention. Results: Friedman's ANOVA revealed a significant improvement for COPM and CHEQ grasp subscale. Repeated measures ANOVA revealed a significant improvement in BBT, and ABILHAND-Kids, and no significant change for AHA. Conclusions: Children who participated in the magic-themed HABIT experienced improved occupational performance, unimanual skills, and parent ratings of performance in challenging everyday tasks.
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Affiliation(s)
- A Hines
- a Faculty of Health Sciences, The University of Sydney, Sydney, NSW , Australia
| | - A C Bundy
- a Faculty of Health Sciences, The University of Sydney, Sydney, NSW , Australia.,b Occupational Therapy, Colorado State University, Fort Collins, CO , USA
| | - D Black
- a Faculty of Health Sciences, The University of Sydney, Sydney, NSW , Australia
| | - M Haertsch
- c Arts Health Institute, Newcastle, NSW , Australia
| | - M Wallen
- a Faculty of Health Sciences, The University of Sydney, Sydney, NSW , Australia.,d School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW , Australia.,e Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW , Australia
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Transcranial Direct Current Stimulation (tDCS) Paired with Occupation-Centered Bimanual Training in Children with Unilateral Cerebral Palsy: A Preliminary Study. Neural Plast 2018; 2018:9610812. [PMID: 30627151 PMCID: PMC6304908 DOI: 10.1155/2018/9610812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/18/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022] Open
Abstract
Objective We investigated the preliminary efficacy of cathodal transcranial direct current stimulation (tDCS) combined with bimanual training in children and young adults with unilateral cerebral palsy based on the principle of exaggerated interhemispheric inhibition (IHI). Methods Eight participants with corticospinal tract (CST) connectivity from the lesioned hemisphere participated in an open-label study of 10 sessions of cathodal tDCS to the nonlesioned hemisphere (20 minutes) concurrently with bimanual, goal-directed training (120 minutes). We measured the frequency of adverse events and intervention efficacy with performance (bimanual-Assisting Hand Assessment (AHA)-and unimanual-Box and Blocks), self-report (Canadian Occupational Performance Measure (COPM), ABILHAND), and neurophysiologic (motor-evoked potential amplitude, cortical silent period (CSP) duration, and motor mapping) assessments. Results All participants completed the study with no serious adverse events. Three of 8 participants showed gains on the AHA, and 4 of 8 participants showed gains in Box and Blocks (more affected hand). Nonlesioned CSP duration decreased in 6 of 6 participants with analyzable data. Cortical representation of the first dorsal interosseous expanded in the nonlesioned hemisphere in 4 of 6 participants and decreased in the lesioned hemisphere in 3 of 4 participants with analyzable data. Conclusions While goal achievement was observed, objective measures of hand function showed inconsistent gains. Neurophysiologic data suggests nonlinear responses to cathodal stimulation of the nonlesioned hemisphere. Future studies examining the contributions of activity-dependent competition and cortical excitability imbalances are indicated.
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Brandão MB, Mancini MC, Ferre CL, Figueiredo PRP, Oliveira RHS, Gonçalves SC, Dias MCS, Gordon AM. Does Dosage Matter? A Pilot Study of Hand-Arm Bimanual Intensive Training (HABIT) Dose and Dosing Schedule in Children with Unilateral Cerebral Palsy. Phys Occup Ther Pediatr 2018; 38:227-242. [PMID: 29240518 DOI: 10.1080/01942638.2017.1407014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 hours) and two schedules of the same dose (90 vs. 2 × 45 hours) on hand and daily functioning. METHOD Eighteen children with unilateral cerebral palsy were randomized to receive 6 hours of daily training over 3 weeks, totaling 90 hours (Group 90, n = 9) or receive 6 hours of daily training over 1.5 weeks, totaling 45 hours (Group 2 × 45, n = 9). After 6 months, Group 2 × 45 received an additional 45 hours. Hand (Jebsen-Taylor Test of Hand Function, Assisting Hand Assessment) and daily functioning tests (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory) were administered before, immediately after, and 6 months after interventions. RESULTS Both groups demonstrated significant improvements in hand and daily functioning after 90 hours (Group 90) or the first 45 hours (Group 2 × 45), without differences between groups. However, more children from Group 90 obtained smallest detectable differences in the Assisting Hand Assessment. The addition of the second bout of 45 hours (Group 2 × 45) did not lead to further improvements. CONCLUSIONS As this study was powered to test for large differences between groups, future investigations on larger samples will be needed to compare differences at the two dosage levels.
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Affiliation(s)
- Marina B Brandão
- a Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Marisa C Mancini
- a Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Claudio L Ferre
- b Burke-Cornell Medical Research Institute , White Plains , New York , USA
| | | | - Rachel H S Oliveira
- a Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | | | - Miriam C S Dias
- d Occupational Therapist , Belo Horizonte , Minas Gerais , Brazil
| | - Andrew M Gordon
- e Department of Biobehavioral Sciences , Teachers College, Columbia University , New York , New York , USA
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Comparing Unimanual and Bimanual Training in Upper Extremity Function in Children With Unilateral Cerebral Palsy. Pediatr Phys Ther 2017; 29:288-306. [PMID: 28953170 DOI: 10.1097/pep.0000000000000438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This systematic review compared intensive bimanual therapy (IBT) and modified constraint-induced movement therapy (mCIMT) in upper limb function in children with unilateral cerebral palsy (CP). METHODS Four electronic databases were searched from 2009 through October 2015 for randomized control trials comparing IBT with mCIMT. RESULTS Eight articles met the inclusion criteria; 5 randomized clinical trials with 221 participants with unilateral CP, ages 1.5 to 16 years, who received the intervention in a day camp, clinical, or preschool setting were included. The IBT group performed bimanual motor activities; the mCIMT group performed unilateral motor activities. CONCLUSION There was a strong, nonspecific recommendation for either approach to improve quality of unimanual movement, bimanual capacity, and movement efficiency. There was a weak, specific recommendation for IBT in improving movement quality and a specific but weak recommendation favoring IBT to improve the child's performance on parent-reported outcomes.
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Gordon AM. Impaired Voluntary Movement Control and Its Rehabilitation in Cerebral Palsy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 957:291-311. [PMID: 28035572 DOI: 10.1007/978-3-319-47313-0_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Cerebral palsy is caused by early damage to the developing brain, as the most common pediatric neurological disorder. Hemiplegia (unilateral spastic cerebral palsy) is the most common subtype, and the resulting impairments, lateralized to one body side, especially affect the upper extremity, limiting daily function. This chapter first describes the pathophysiology and mechanisms underlying impaired upper extremity control of cerebral palsy. It will be shown that the severity of impaired hand function closely relates to the integrity of the corticospinal tract innervating the affected hand. It will also shown that the developing corticospinal tract can reorganize its connectivity depending on the timing and location of CNS injury, which also has implications for the severity of hand impairments and rehabilitation. The mechanisms underlying impaired motor function will be highlighted, including deficits in movement execution and planning and sensorimotor integration. It will be shown that despite having unimanual hand impairments, bimanual movement control deficits and mirror movements also impact function. Evidence for motor learning-based therapies including Constraint-Induced Movement Therapy and Bimanual Training, and the possible pathophysiological predictors of treatment outcome and plasticity will be described. Finally, future directions for rehabilitations will be presented.
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Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, New York, Box 93, 10027, USA.
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Fonseca Junior PR, Filoni E, Setter CM, Berbel AM, Fernandes AO, Moura RCDF. Constraint-induced movement therapy of upper limb of children with cerebral palsy in clinical practice: systematic review of the literature. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/17425124032017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The purpose of the present study was to perform a systematic review of the literature to investigate how and with what modifications or adaptations constraint-induced movement therapy has been employed in clinical practice for therapeutic interventions in children with cerebral palsy. Searches were conducted of the CAPES (Brazilian fostering agency) periodical portal, Pubmed, Bireme, Science Direct, Scielo and PEDro databases for relevant articles published between January 2010 and May 2016. The articles retrieved were evaluated, scored and qualified by two blinded reviewers using the Physical therapy Evidence Database Scale. The searches led to the retrieval of 102 articles, 12 of which were included in the present systematic review. A table was created containing information on the study groups, inclusion criteria, intervention, intervention frequency, difficulties encountered, evaluations and outcomes. Considerable variety was found in the therapeutic intervention models. The findings of the present review demonstrate that constraint-induced movement therapy in pediatric clinical practice is not employed in its original form. Although the studies analyzed did not have a common methodology regarding the use of this type of therapy, the method has been adapted with considerable flexibility, providing promising, positive results regarding the therapeutic intervention of the paretic upper limb in children with cerebral palsy.
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Affiliation(s)
| | - Eduardo Filoni
- Universidade de Mogi das Cruzes, Brazil; Universidade Cruzeiro do Sul, Brazil
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Tervahauta MH, Girolami GL, Øberg GK. Efficacy of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy: a systematic review. Clin Rehabil 2017; 31:1445-1456. [PMID: 29050511 DOI: 10.1177/0269215517698834] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review the evidence on the effect of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy. DATA SOURCES Seven electronic databases (Cinahl, Cochrane Library, EMBASE, Ovid MEDLINE, PEDro, PsycINFO, PubMed) were searched from database inception through December 2016. METHODS A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Standardised mean differences (effect sizes) were calculated for each study and outcome. RESULTS Nine studies met the eligibility criteria. All studies provided level II evidence. Methodological quality was high in two studies, moderate in four studies and low in three studies. The methodology, participant and intervention characteristics were heterogeneous. The participants' ages ranged from 1.5 to 16 years. Their initial hand function ranged from Manual Ability Classification System Level I to Level III. The total intervention dose ranged from 24 to 210 hours and duration from one week to ten weeks. The studies measured outcomes assessing unimanual and bimanual hand and arm function, participation and attainment of individualised goals. Overall, the effect sizes did not favour one of the interventions at short- or long-term follow-up. The 95% confidence intervals were broad, indicating inaccurate precision of the effect sizes. Pooling of the data for a meta-analysis was judged to be of little clinical value owing to heterogeneity. CONCLUSION It is not possible to conclude whether constraint-induced movement therapy or bimanual intensive training is more effective than the other in children with unilateral cerebral palsy.
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Affiliation(s)
- M H Tervahauta
- 1 Department of Paediatric Habilitation, Stavanger University Hospital, Stavanger, Norway
| | - G L Girolami
- 2 Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - G K Øberg
- 3 Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Norway
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Beckers LWME, Schnackers MLAP, Janssen-Potten YJ, Kleijnen J, Steenbergen B. Feasibility and effect of home-based therapy programmes for children with cerebral palsy: a protocol for a systematic review. BMJ Open 2017; 7:e013687. [PMID: 28237960 PMCID: PMC5337681 DOI: 10.1136/bmjopen-2016-013687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Given the promising advantages of upper extremity home-based programmes in children with cerebral palsy (CP), a systematic review of the available literature on this topic is warranted. The purpose of the systematic review described in this protocol is to investigate currently available home-based occupational therapy and physiotherapy programmes regarding both their feasibility and effect. METHODS AND ANALYSIS This protocol describes a systematic review, developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015. Studies will be included in which primary data are collected, participants are children aged <18 years with any type of CP and the intervention of interest is a home-based occupational therapy or physiotherapy intervention. Comparators of interest are: no therapy, care as usual, centre-based occupational therapy or physiotherapy, an alternative home-based programme and a medical intervention. Studies will be included that report either on feasibility (ie, acceptability, demand, implementation, practicality, adaptation, expansion or integration) or on efficacy/effectiveness (ie, child-related upper extremity outcomes within all International Classification of Functioning, Disability and Health levels or parent-related/caregiver-related outcomes on the psychological and social domain). Relevant studies will be identified by searching the databases MEDLINE, EMBASE, CINAHL, PsycINFO, PEDro, OTSeeker and CPCI-S as well as the trial registers ICTRP and CENTRAL, the reference lists of included records and by circulating a bibliography of the included records to authors of included studies. There will be no restrictions on language or year of publication. The search strategy consists of terms related to the population and intervention. Data will be extracted in duplicate using a digital data extraction form. ETHICS AND DISSEMINATION The proposed study does not involve collection of primary data. Accordingly, no ethical approval is required. The authors will disseminate the findings of this systematic review through publication in a peer-reviewed journal and conference presentation(s). TRIAL REGISTRATION NUMBER CRD42016043743; pre-results.
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Affiliation(s)
- L W M E Beckers
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Adelante, Center of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - M L A P Schnackers
- Radboud University Nijmegen, Behavioural Science Institute, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Y J Janssen-Potten
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Adelante, Center of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - J Kleijnen
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Kleijnen Systematic Reviews Ltd, York, UK
| | - B Steenbergen
- Radboud University Nijmegen, Behavioural Science Institute, Nijmegen, The Netherlands
- Australian Catholic University, School of Psychology, Melbourne, Australia
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Chiu HC, Ada L. Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review. J Physiother 2016; 62:130-7. [PMID: 27323932 DOI: 10.1016/j.jphys.2016.05.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/30/2016] [Accepted: 05/23/2016] [Indexed: 11/17/2022] Open
Abstract
QUESTIONS Does constraint-induced movement therapy improve activity and participation in children with hemiplegic cerebral palsy? Does it improve activity and participation more than the same dose of upper limb therapy without restraint? Is the effect of constraint-induced movement therapy related to the duration of intervention or the age of the children? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS Children with hemiplegic cerebral palsy with any level of motor disability. INTERVENTION The experimental group received constraint-induced movement therapy (defined as restraint of the less affected upper limb during supervised activity practice of the more affected upper limb). The control group received no intervention, sham intervention, or the same dose of upper limb therapy. OUTCOME MEASURES Measures of upper limb activity and participation were used in the analysis. RESULTS Constraint-induced movement therapy was more effective than no/sham intervention in terms of upper limb activity (SMD 0.63, 95% CI 0.20 to 1.06) and participation (SMD 1.21, 95% CI 0.41 to 2.02). However, constraint-induced movement therapy was no better than the same dose of upper limb therapy without restraint either in terms of upper limb activity (SMD 0.05, 95% CI -0.21 to 0.32) or participation (SMD -0.02, 95% CI -0.34 to 0.31). The effect of constraint-induced movement therapy was not related to the duration of intervention or the age of the children. CONCLUSIONS This review suggests that constraint-induced movement therapy is more effective than no intervention, but no more effective than the same dose of upper limb practice without restraint. REGISTRATION PROSPERO CRD42015024665. [Chiu H-C, Ada L (2016) Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review.Journal of Physiotherapy62: 130-137].
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Affiliation(s)
- Hsiu-Ching Chiu
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan (ROC)
| | - Louise Ada
- Discipline of Physiotherapy,The University of Sydney, Sydney, Australia
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Shierk A, Lake A, Haas T. Review of Therapeutic Interventions for the Upper Limb Classified by Manual Ability in Children with Cerebral Palsy. Semin Plast Surg 2016; 30:14-23. [PMID: 26869859 DOI: 10.1055/s-0035-1571256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this literature review was to assemble an inventory of intervention strategies utilized for children diagnosed with cerebral palsy (CP) based on the Manual Ability Classification System (MACS). The purpose of the inventory is to guide physicians and therapists in intervention selection aimed at improving upper limb function in children with CP. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, ERIC (Educational Research Information Center), Google Scholar, OTSeeker (Occupational Therapy Systematic Evaluation of Evidence), OVID (Ovid Technologies, Inc.), and PubMed. Inclusion criteria were whether the study (1) identified MACS levels of participants, and (2) addressed the effectiveness of intervention on upper limb function. Overall, 74 articles met the inclusion criteria. The summarized data identified 10 categories of intervention. The majority of participants across studies were MACS level II. The most frequently cited interventions were constraint-induced movement therapy (CIMT), bimanual training, and virtual reality and computer-based training. Multiple interventions demonstrated effectiveness for upper limb improvement at each MACS level. However, there is a need for additional research for interventions appropriate for MACS levels IV and V. To fully develop an intervention inventory based on manual ability, future studies need to report MACS levels of participants, particularly for splinting and therapy interventions used in combination with surgery.
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Affiliation(s)
- Angela Shierk
- Occupational Therapy, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Amy Lake
- Occupational Therapy, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Tara Haas
- Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, Texas
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Gee BM, Lloyd K, Devine N, Tyrrell E, Evans T, Hill R, Dineen S, Magalogo K. Dosage Parameters in Pediatric Outcome Studies Reported in 9 Peer-Reviewed Occupational Therapy Journals from 2008 to 2014: A Content Analysis. Rehabil Res Pract 2016; 2016:3580789. [PMID: 26949547 PMCID: PMC4754491 DOI: 10.1155/2016/3580789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/28/2015] [Accepted: 12/31/2015] [Indexed: 11/17/2022] Open
Abstract
Occupational therapists determine the dosage when establishing the plan of care for their pediatric clients. A content analysis was conducted using 123 pediatric occupational therapy outcomes studies from 9 scholarly international occupational therapy journals. The parameters of dosage were calculated using descriptive statistics in order to obtain a representation of dosage available within the current collage of pediatric occupational therapy outcomes studies. The results revealed that most studies reported portions of dosage parameters within the published studies. The average findings for the subcomponents related to dosage were session length (minutes) M = 58.7, duration of plan of care (weeks) M = 12.1, session frequency (per week) M = 3.4, and total hours of therapy (hours) M = 18.1. This first attempt at describing and calculating dosage related to pediatric occupational therapy practice indicates that evidence is lacking within the published literature to adequately guide OT dosage decisions. Further research related to dosage in pediatric occupational therapy practice is needed.
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Affiliation(s)
- Bryan M. Gee
- Department of Physical and Occupational Therapy, Idaho State University, Campus Mail Box 8045, Pocatello, ID 83201-8045, USA
| | - Kimberly Lloyd
- Department of Physical and Occupational Therapy, Idaho State University, Campus Mail Box 8045, Pocatello, ID 83201-8045, USA
| | - Nancy Devine
- Department of Physical and Occupational Therapy, Idaho State University, Campus Mail Box 8045, Pocatello, ID 83201-8045, USA
| | - Erin Tyrrell
- Idaho State University, Pocatello, ID 83201-8045, USA
| | - Trisha Evans
- Idaho State University, Pocatello, ID 83201-8045, USA
| | - Rebekah Hill
- Idaho State University, Pocatello, ID 83201-8045, USA
| | - Stacee Dineen
- Idaho State University, Pocatello, ID 83201-8045, USA
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Kuo HC, Gordon AM, Henrionnet A, Hautfenne S, Friel KM, Bleyenheuft Y. The effects of intensive bimanual training with and without tactile training on tactile function in children with unilateral spastic cerebral palsy: A pilot study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:129-139. [PMID: 26698408 PMCID: PMC4871715 DOI: 10.1016/j.ridd.2015.11.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
Children with unilateral spastic cerebral palsy (USCP) often have tactile impairments. Intensive bimanual training improves the motor abilities, but the effects on the sensory system have not been studied. Here we compare the effects of bimanual training with and without tactile training on tactile impairments. Twenty children with USCP (6-15.5 years; MACS: I-III) were randomized to receive either bimanual therapy (HABIT) or HABIT+tactile training (HABIT+T). All participants received 82 h of standardized HABIT. In addition 8 sessions of 1h were provided to both groups. The HABIT+T group received tactile training (without vision) using materials of varied shapes and textures. The HABIT group received training with the same materials without tactile directed training (full vision). Primary outcomes included grating orientation task/GOT and stereognosis. Secondary outcomes included two-point discrimination/TPD, Semmes-Weinstein monofilaments/SWM. The GOT improved in both groups after training, while stereognosis of the more-affected hand tended to improve (but p=0.063). No changes were found in the TPD and the SWM. There were no group×test interactions for any measure. We conclude tactile spatial resolution can improve after bimanual training. Either intensive bimanual training alone or incorporation of materials with a diversity of shapes/textures may drive these changes.
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Affiliation(s)
- Hsing-Ching Kuo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Box 93, New York, NY 10027, USA.
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Box 93, New York, NY 10027, USA.
| | - Aline Henrionnet
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
| | - Sylvie Hautfenne
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
| | - Kathleen M Friel
- Burke-Cornell Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY 10605, USA; Brain-Mind Research Institute, Weill Cornell Medical College, 1300 York Ave, New York, NY 10021, USA.
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
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Bleyenheuft Y, Dricot L, Gilis N, Kuo HC, Grandin C, Bleyenheuft C, Gordon AM, Friel KM. Capturing neuroplastic changes after bimanual intensive rehabilitation in children with unilateral spastic cerebral palsy: A combined DTI, TMS and fMRI pilot study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 43-44:136-49. [PMID: 26183338 PMCID: PMC4871716 DOI: 10.1016/j.ridd.2015.06.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/25/2015] [Accepted: 06/29/2015] [Indexed: 05/25/2023]
Abstract
Intensive rehabilitation interventions have been shown to be efficacious in improving upper extremity function in children with unilateral spastic cerebral palsy (USCP). These interventions are based on motor learning principles and engage children in skillful movements. Improvements in upper extremity function are believed to be associated with neuroplastic changes. However, these neuroplastic changes have not been well-described in children with cerebral palsy, likely due to challenges in defining and implementing the optimal tools and tests in children. Here we documented the implementation of three different neurological assessments (diffusion tensor imaging-DTI, transcranial magnetic stimulation-TMS and functional magnetic resonance imaging-fMRI) before and after a bimanual intensive treatment (HABIT-ILE) in two children with USCP presenting differential corticospinal developmental reorganization (ipsilateral and contralateral). The aim of the study was to capture neurophysiological changes and to document the complementary relationship between these measures, the potential measurable changes and the feasibility of applying these techniques in children with USCP. Independent of cortical reorganization, both children showed increases in activation and size of the motor areas controlling the affected hand, quantified with different techniques. In addition, fMRI provided additional unexpected changes in the reward circuit while using the affected hand.
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Affiliation(s)
- Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
| | - Laurence Dricot
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Nathalie Gilis
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Hsing-Ching Kuo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA
| | - Cécile Grandin
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Radioloy Service, Clinques Universitaires Saint-Luc, Brussels, Belgium
| | - Corinne Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Physical Medicine and Rehabilitation Service, CHU Mont-Godinne, Yvoir, Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA
| | - Kathleen M Friel
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA; Burke-Cornell Medical Research Institute, White Plains, NY, USA
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Geerdink Y, Aarts P, van der Burg J, Steenbergen B, Geurts A. Intensive upper limb intervention with self-management training is feasible and promising for older children and adolescents with unilateral cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 43-44:97-105. [PMID: 26164301 DOI: 10.1016/j.ridd.2015.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/24/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
This study explored the feasibility and preliminary effectiveness of a short (one week) intensive intervention combining Constraint Induced Movement Therapy (CIMT) and bimanual training (BiT) to improve upper limb capacity and bimanual performance guided by individual goal setting in children and adolescents with unilateral cerebral palsy aged 8-18 years. Self-management training was added to the intervention to maximize the effect of training and to empower the participants in self-monitoring the effective use of their affected hand. Functional goals (Canadian Occupational Performance Measure), unimanual capacity (Box and Block Test), bimanual performance (ABILHAND-Kids, Children's Hand-use Experience Questionnaire (CHEQ)) and amount of use (Video Observation Aarts and Aarts - determine developmental disregard (VOAA-DDD-R)) were measured at baseline, one week and four months post intervention. Twenty children (mean age 9.5 years) participated. Repeated measures ANOVA was used to measure effects over time. Compared to baseline, there were significant improvements on all outcome measures. The largest effect sizes were found for the COPM-performance and COPM-satisfaction (Cohen's d=2.09 and d=2.42, respectively). The effect size was large for the ABILHAND-Kids (d=0.86), moderate for the CHEQ (d=0.70) and Box and Block Test (d=0.56), and small for the VOAA-DDD-R (d=0.33). All effects were retained at the four months post intervention assessment. The results of this study indicate that one-week (36h) intensive CIMT-BiT combined with self-management training is a feasible and promising intervention for improving the capacity of the upper limb and its use in bimanual activities in older children and adolescents with unilateral CP.
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Affiliation(s)
- Yvonne Geerdink
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands.
| | - Pauline Aarts
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands.
| | - Jan van der Burg
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands.
| | - Bert Steenbergen
- Radboud University, Behavioural Science Institute, Postbus 9104, 6500 HE Nijmegen, The Netherlands; Australian Catholic University, School of Psychology, Melbourne, Australia.
| | - Alexander Geurts
- Radboud University Medical Centre, Donders Centre for Neuroscience (DCN), Department of Rehabilitation, 898, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Lobo M, Galloway J, Heathcock J. Characterization and intervention for upper extremity exploration & reaching behaviors in infancy. J Hand Ther 2015; 28:114-24; quiz 125. [PMID: 25835251 PMCID: PMC4424113 DOI: 10.1016/j.jht.2014.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/23/2014] [Accepted: 12/03/2014] [Indexed: 02/03/2023]
Abstract
This article aims to: 1) highlight general exploration, reaching, and object exploration behaviors as key activities of daily living in infancy, 2) describe how knowledge of early warning signs for these behaviors may improve early assessment, and 3) discuss interventions that may advance performance of these behaviors. Early intervention should focus on improving performance of these behaviors because: a) these early, interrelated upper extremity behaviors serve an integral role in global learning and development in infancy, b) among at-risk populations, differences have been observed in the quantity and quality of performance of these behaviors and, in many cases, these differences are associated with related perceptual-motor and cognitive delays. This article highlights how early assessment and intervention can target these key early behaviors in populations at risk for upper extremity disabilities, such as those born preterm, with Down syndrome, brachial plexus palsy, or arthrogryposis multiplex congentia.
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Affiliation(s)
- M.A. Lobo
- Physical Therapy Department, University of Delaware, 540 South College Ave., Newark, DE 19713, USA
| | - J.C. Galloway
- Physical Therapy & Psychology Departments, University of Delaware, 540 South College Ave., Newark, DE 19713, USA
| | - J.C Heathcock
- Physical Therapy Department, 516 Atwell Hall, The Ohio State University, 453 West tenth Avenue, Columbus, OH 43210, USA
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Gelkop N, Burshtein DG, Lahav A, Brezner A, Al-Oraibi S, Ferre CL, Gordon AM. Efficacy of constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy in an educational setting. Phys Occup Ther Pediatr 2015; 35:24-39. [PMID: 24983295 DOI: 10.3109/01942638.2014.925027] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We examined the efficacy of modified constraint-induced movement therapy (CIMT) and hand-arm bimanual intensive therapy (HABIT) in a special education preschool/kindergarten in Israel. Twelve children (1.5-7 years) with congenital hemiplegic cerebral palsy were randomized to receive modified CIMT (n = 6) or HABIT (n = 6). Occupational and physical therapists administered usual and customary care for 8 weeks; children then crossed over to receive CIMT or HABIT 2 hr/day, 6 days/week for 8 weeks from their occupational therapist. The Assisting Hand Assessment and Quality of Upper Extremity Skills Test were administered 2 months prior to the intervention, immediately before, immediately after intervention, and 6 months after the first baseline assessment. Both groups demonstrated no change during baseline and comparable improvement following CIMT and HABIT (p < .001), which was maintained at 6-month follow-up. Results suggest that modified CIMT and HABIT provided in school-based settings can lead to improvements in quality of bimanual skill and movement patterns.
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Bleyenheuft Y, Arnould C, Brandao MB, Bleyenheuft C, Gordon AM. Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) in Children With Unilateral Spastic Cerebral Palsy: A Randomized Trial. Neurorehabil Neural Repair 2014; 29:645-57. [PMID: 25527487 DOI: 10.1177/1545968314562109] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intensive bimanual training results in more improvement in hand function in children with unilateral spastic cerebral palsy (USCP) than lower intensity conventional interventions. However, it is not known whether combined upper and lower extremity training in an intensive protocol is more efficacious for upper and lower functional abilities than conventional therapies provided in usual customary care. OBJECTIVE To determine the efficacy of Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) for children with USCP. METHODS Twenty-four children with USCP were randomized into 2 groups: an immediate HABIT-ILE group (IHG, initially receiving HABIT-ILE, 10 days = 90 hours), and a delayed HABIT-ILE group (DHG), which continued their conventional/ongoing treatment for an intended total duration of 90 hours. In phase 2, children in the DHG were crossed over to receive HABIT-ILE and children of the IHG were followed in their ongoing conventional therapy. Children were assessed using the Assisting Hand Assessment (AHA, primary outcome), the ABILHAND-Kids, and the Pediatric Evaluation of Disability Inventory. Dexterity (Box and Blocks Test [BBT]) and pinch strength were also measured. Locomotor abilities were assessed with Six-Minute Walk Test (6MWT, primary outcome) and ABILOCO-kids. Social participation was measured with the Assessment of Life-HABITs. RESULTS A 2 (groups) × 3 (test sessions) analysis of variance indicated significant improvements for primary outcomes (AHA, P < .001; 6MWT, P = .002) and all secondary assessments except BBT, step length and bodyweight distribution following HABIT-ILE, but not conventional therapy. CONCLUSION The findings suggest that combined upper and lower extremity in an intensive training protocol may be efficacious for improving both upper and lower extremity function in children with USCP.
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Affiliation(s)
- Yannick Bleyenheuft
- Institue of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Carlyne Arnould
- Physical and Occupational Therapy Department, Paramedical Category, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium
| | - Marina B Brandao
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Corrine Bleyenheuft
- Institue of Neuroscience, Université catholique de Louvain, Brussels, Belgium CHU Mont-Godinne, Yvoir, Belgium
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Tinderholt Myrhaug H, Østensjø S, Larun L, Odgaard-Jensen J, Jahnsen R. Intensive training of motor function and functional skills among young children with cerebral palsy: a systematic review and meta-analysis. BMC Pediatr 2014; 14:292. [PMID: 25475608 PMCID: PMC4265534 DOI: 10.1186/s12887-014-0292-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young children with cerebral palsy (CP) receive a variety of interventions to prevent and/or reduce activity limitations and participation restrictions. Some of these interventions are intensive, and it is a challenge to identify the optimal intensity. Therefore, the objective of this systematic review was to describe and categorise intensive motor function and functional skills training among young children with CP, to summarise the effects of these interventions, and to examine characteristics that may contribute to explain the variations in these effects. METHODS Ten databases were searched for controlled studies that included young children (mean age less than seven years old) with CP and assessments of the effects of intensive motor function and functional skills training. The studies were critically assessed by the Risk of bias tool (RoB) and categorised for intensity and contexts of interventions. Standardised mean difference were computed for outcomes, and summarised descriptively or in meta-analyses. RESULTS Thirty-eight studies were included. Studies that targeted gross motor function were fewer, older and with lower frequency of training sessions over longer training periods than studies that targeted hand function. Home training was most common in studies on hand function and functional skills, and often increased the amount of training. The effects of constraint induced movement therapy (CIMT) on hand function and functional skills were summarised in six meta-analyses, which supported the existing evidence of CIMT. In a majority of the included studies, equal improvements were identified between intensive intervention and conventional therapy or between two different intensive interventions. CONCLUSIONS Different types of training, different intensities and different contexts between studies that targeted gross and fine motor function might explain some of the observed effect variations. Home training may increase the amount of training, but are less controllable. These factors may have contributed to the observed variations in the effectiveness of CIMT. Rigorous research on intensive gross motor training is needed. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42013004023.
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Affiliation(s)
- Hilde Tinderholt Myrhaug
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, St. Olavs plass, Postbox 4, 0130, Oslo, Norway.
- Primary Health Care Unit, Norwegian Knowledge Centre for the Health Services, St. Olavs plass, Postbox 7004, 0130, Oslo, Norway.
| | - Sigrid Østensjø
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, St. Olavs plass, Postbox 4, 0130, Oslo, Norway.
| | - Lillebeth Larun
- Primary Health Care Unit, Norwegian Knowledge Centre for the Health Services, St. Olavs plass, Postbox 7004, 0130, Oslo, Norway.
| | - Jan Odgaard-Jensen
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, St. Olavs plass, Postbox 7004, 0130, Oslo, Norway.
| | - Reidun Jahnsen
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, St. Olavs plass, Postbox 4, 0130, Oslo, Norway.
- Department of Clinical Neuroscience for Children, Oslo University Hospital, Rikshospitalet, Postbox 4950, Nydalen, 0424, Oslo, Norway.
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Friel KM, Williams PTJA, Serradj N, Chakrabarty S, Martin JH. Activity-Based Therapies for Repair of the Corticospinal System Injured during Development. Front Neurol 2014; 5:229. [PMID: 25505443 PMCID: PMC4241838 DOI: 10.3389/fneur.2014.00229] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/22/2014] [Indexed: 01/29/2023] Open
Abstract
This review presents the mechanistic underpinnings of corticospinal tract (CST) development, derived from animal models, and applies what has been learned to inform neural activity-based strategies for CST repair. We first discuss that, in normal development, early bilateral CST projections are later refined into a dense crossed CST projection, with maintenance of sparse ipsilateral projections. Using a novel mouse genetic model, we show that promoting the ipsilateral CST projection produces mirror movements, common in hemiplegic cerebral palsy (CP), suggesting that ipsilateral CST projections become maladaptive when they become abnormally dense and strong. We next discuss how animal studies support a developmental “competition rule” whereby more active/used connections are more competitive and overtake less active/used connections. Based on this rule, after unilateral injury the damaged CST is less able to compete for spinal synaptic connections than the uninjured CST. This can lead to a progressive loss of the injured hemisphere’s contralateral projection and a reactive gain of the undamaged hemisphere’s ipsilateral CST. Knowledge of the pathophysiology of the developing CST after injury informs interventional strategies. In an animal model of hemiplegic CP, promoting injured system activity or decreasing the uninjured system’s activity immediately after the period of a developmental injury both increase the synaptic competitiveness of the damaged system, contributing to significant CST repair and motor recovery. However, delayed intervention, despite significant CST repair, fails to restore skilled movements, stressing the need to consider repair strategies for other neural systems, including the rubrospinal and spinal interneuronal systems. Our interventional approaches harness neural activity-dependent processes and are highly effective in restoring function. These approaches are minimally invasive and are poised for translation to the human.
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Affiliation(s)
- Kathleen M Friel
- Department of Neurology, Brain and Mind Research Institute, Weill Cornell Medical College , New York, NY , USA ; Burke Medical Research Institute , White Plains, NY , USA
| | - Preston T J A Williams
- Department of Physiology, Pharmacology and Neuroscience, City College of the City University of New York , New York, NY , USA
| | - Najet Serradj
- Department of Physiology, Pharmacology and Neuroscience, City College of the City University of New York , New York, NY , USA
| | - Samit Chakrabarty
- School of Biomedical Sciences, Faculty of Biology, University of Leeds , Leeds , UK
| | - John H Martin
- Department of Physiology, Pharmacology and Neuroscience, City College of the City University of New York , New York, NY , USA ; The Graduate Center of the City University of New York , New York, NY , USA
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Chen YP, Pope S, Tyler D, Warren GL. Effectiveness of constraint-induced movement therapy on upper-extremity function in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2014; 28:939-53. [DOI: 10.1177/0269215514544982] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To systematically examine the research literature on the effectiveness of constraint-induced movement therapy on improving arm function in children with cerebral palsy, and to assess the association between the study effect size and the characteristics of the patients and intervention protocol. Data sources: A systematic literature search was conducted in PubMed, PsycINFO, Cochrane, CINAHL, Web of Science, and TRIP Database up to May 2014. Review methods: Studies employing randomized controlled trial design, children with cerebral palsy, comparing constraint-induced movement therapy with another intervention with a focus on arm function, and upper-extremity measures were included in this review. Methodological quality was evaluated using the Physiotherapy Evidence-based Database (PEDro) scale. Results: The literature search resulted in 27 randomized controlled trial studies with good methodological quality that compared constraint-induced movement therapy with other intervention therapy. Overall, constraint-induced movement therapy provided a medium beneficial effect ( d = 0.546; p < 0.001) when compared with conventional therapy. For the subgroup analyses, presence of a dose-equivalent comparison group, intervention location, and time of follow-up were significant factors. Studies examining constraint-induced movement therapy effect without a dose-equivalent comparison group showed a large effect in children with cerebral palsy, but studies with a dose-equivalent group only showed a small effect. Children who received home-based constraint-induced movement therapy had a better improvement in arm function than those who received constraint-induced movement therapy elsewhere. Conclusion: The research literature supports constraint-induced movement therapy as an effective intervention to improve arm function in children with cerebral palsy.
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Affiliation(s)
- Yu-ping Chen
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Stephanie Pope
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Dana Tyler
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Gordon L Warren
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
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Sakzewski L, Gordon A, Eliasson AC. The state of the evidence for intensive upper limb therapy approaches for children with unilateral cerebral palsy. J Child Neurol 2014; 29:1077-90. [PMID: 24820334 DOI: 10.1177/0883073814533150] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/03/2014] [Indexed: 11/16/2022]
Abstract
Children with unilateral cerebral palsy experience difficulties with unimanual and bimanual upper limb function, impacting independence in daily life. Targeted upper limb therapies such as constraint-induced movement therapy, bimanual training, and combined approaches have emerged in the last decade. This article reviews the scientific rationale underpinning these treatments and current evidence to improve upper limb outcomes and goal attainment. Intensive models of therapy achieved modest to strong effects to improve upper limb function compared to usual care. Dose-matched comparisons of bimanual and unimanual training demonstrated similar gains in upper limb outcomes. The optimum timing, dose and impact of repeat episodes of intensive upper limb therapies require further investigation. Characteristics of children who achieve clinically meaningful outcomes remain unclear. Key components of intervention include collaborative goal setting with families and intensive repetitive, incrementally challenging, task practice. Choice of treatment approach should be governed by child/family goals and preferences, individual, and contextual factors.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, University of Queensland, Queensland, Australia
| | - Andrew Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Kreider CM, Bendixen RM, Huang YY, Lim Y. Review of occupational therapy intervention research in the practice area of children and youth 2009-2013. Am J Occup Ther 2014; 68:e61-73. [PMID: 24581415 PMCID: PMC5362028 DOI: 10.5014/ajot.2014.011114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE. We conducted a systematic review examining the extent to which pediatric intervention research recently published in the American Journal of Occupational Therapy reflects occupational therapy's holistic occupation-based tenets. METHOD. We surveyed 10 systematic reviews and analyzed 38 single effectiveness studies for intervention approach, type, level of environmental targeting, level of occupational task and participation practice, and measures used. RESULTS. Of the 38 single effectiveness studies, 12 (32%) explicitly incorporated both environmental targets of intervention and practice of complex or in vivo occupational tasks, with steady increases during the 2009-2013 time frame. CONCLUSION. In the area of children and youth, occupational therapy is making steady gains in reflecting and demonstrating the effectiveness of the profession's holistic, occupation-based tenets. Occupational therapy researchers must be mindful to ensure that despite the reductionist nature of intervention research, interventions reflect the profession's holistic understanding of the interplay between the child, environment, and occupations.
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Affiliation(s)
- Consuelo M Kreider
- Consuelo M. Kreider, PhD, OTR/L, is Research Assistant Professor, Department of Occupational Therapy, University of Florida, PO Box 100164, Gainesville, FL 32610-0164;
| | - Roxanna M Bendixen
- Roxanna M. Bendixen, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA. At the time of the study, she was Research Assistant Professor, Department of Occupational Therapy, University of Florida, Gainesville
| | - Yu Yun Huang
- Yu Yun Huang, MS, OTR, is Doctoral Student, Department of Occupational Therapy, University of Florida, Gainesville
| | - Yoonjeong Lim
- Yoonjeong Lim, MS, OT, is Doctoral Student, Department of Occupational Therapy, University of Florida, Gainesville
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Sakzewski L, Ziviani J, Boyd RN. Efficacy of upper limb therapies for unilateral cerebral palsy: a meta-analysis. Pediatrics 2014; 133:e175-204. [PMID: 24366991 DOI: 10.1542/peds.2013-0675] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children with unilateral cerebral palsy present with impaired upper limb (UL) function affecting independence, participation, and quality of life and require effective rehabilitation. This study aims to systematically review the efficacy of nonsurgical upper limb therapies for children with unilateral cerebral palsy. METHODS Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, the Cochrane Central Register of Controlled Trials, and PubMed were searched to December 2012. Randomized controlled or comparison trials were included. RESULTS Forty-two studies evaluating 113 UL therapy approaches (N = 1454 subjects) met the inclusion criteria. Moderate to strong effects favoring intramuscular injections of botulinum toxin A and occupational therapy (OT) to improve UL and individualized outcomes compared with OT alone were identified. Constraint-induced movement therapy achieved modest to strong treatment effects on improving movement quality and efficiency of the impaired UL compared with usual care. There were weak treatment effects for most outcomes when constraint therapy was compared with an equal dose (amount) of bimanual OT; both yielded similar improved outcomes. Newer interventions such as action observation training and mirror therapy should be viewed as experimental. CONCLUSIONS There is modest evidence that intensive activity-based, goal-directed interventions (eg, constraint-induced movement therapy, bimanual training) are more effective than standard care in improving UL and individualized outcomes. There is little evidence to support block therapy alone as the dose of intervention is unlikely to be sufficient to lead to sustained changes in UL outcomes. There is strong evidence that goal-directed OT home programs are effective and could supplement hands-on direct therapy to achieve increased dose of intervention.
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Affiliation(s)
- Leanne Sakzewski
- BOcc Thy, Queensland Cerebral Palsy and Rehabilitation Research Centre, Level 7, Block 6, Royal Brisbane Hospital, Herston Rd, Herston QLD 4029, Australia.
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Brandão MB, Ferre C, Kuo HC, Rameckers EAA, Bleyenheuft Y, Hung YC, Friel K, Gordon AM. Comparison of Structured Skill and Unstructured Practice During Intensive Bimanual Training in Children With Unilateral Spastic Cerebral Palsy. Neurorehabil Neural Repair 2013; 28:452-61. [PMID: 24376067 DOI: 10.1177/1545968313516871] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Background High-intensity training aims to improve hand function in children with unilateral spastic cerebral palsy (USCP). However, the extent to which skill training is required is not known. Objectives To compare the effects of intensive bimanual training with and without structured progression of skill difficulty, on manual dexterity, bimanual hand use, daily functioning, and functional goals in children with USCP. Method Twenty-two children were randomized to structured practice group (SPG) or unstructured practice group (UPG), and received 6 h/d training during 15 days. Children from the SPG were engaged in fine and gross motor bimanual activities, with skill progression and goal training. Children from UPG performed the same activities without skill progression or goal training. Participants were evaluated before, immediately and 6 months after training by a physical therapist blinded to group allocation. The primary outcomes were the Jebsen-Taylor Test of Hand Function (JTTHF) and Assisting Hand Assessment (AHA). Secondary outcomes included the Canadian Occupational Performance Measure (COPM), Pediatric Evaluation of Disability Inventory (PEDI), and ABILHAND-Kids. Results Both groups showed similar improvements in the JTTHF, AHA, ABILHAND-Kids, COPM-satisfaction, and PEDI (P < .05). A significant interaction in the COPM-performance scale (P = .03) showed superior improvements of the SPG immediately, but not 6 months, after the intervention. CONCLUSIONS Children from both groups demonstrated improvements in dexterity and functional hand use. This suggests that for intensive bimanual approaches, intensive training at such high doses may not require structured practice to elicit improvements. However, there may be immediate added benefit of including goal training.
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Affiliation(s)
- Marina B Brandão
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Claudio Ferre
- Teachers College, Columbia University, New York, NY, USA
| | | | - Eugene A A Rameckers
- Maastricht University, Maastricht, Netherlands University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, Netherlands
| | | | - Ya-Ching Hung
- Queens College, City University of New York, Flushing, NY, USA
| | - Kathleen Friel
- Burke-Cornell Medical Research Institute, White Plains, NY, USA
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Abstract
Abstract
We reviewed 11 articles, including efficacy and effectiveness studies, addressing intervention effectiveness for children and youth published in 2012 in the American Journal of Occupational Therapy and organized them by level and type of research according to a framework adapted from the International Classification of Functioning, Disability and Health. Compared with articles published in previous years, these studies showed improvement in their ability to guide practitioners to make evidence-based decisions by increasing understanding of the intervention’s pragmatic relevance and the extent to which it promotes participation in childhood and adolescent occupations. Studies’ evidence levels have increased along with efforts to increase scientific rigor. Intervention fidelity was included in several of the studies, but not consistently. Siblings and other family members were not examined, and none of the articles reviewed described longitudinal studies. Measures of client acceptability and cost–benefit analysis need more attention in future studies.
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Affiliation(s)
- Rondalyn Whitney
- Rondalyn Whitney, PhD, OT/L, is Assistant Professor, Department of Occupational Therapy, University of the Sciences, Philadelphia
| | - Claudia List Hilton
- Claudia List Hilton, PhD, MBA, OTR/L, SROT, FAOTA, is Assistant Professor, Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555; . At the time of the study, she was Assistant Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
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Brogren Carlberg E, Löwing K. Does goal setting in activity-focused interventions for children with cerebral palsy influence treatment outcome? Dev Med Child Neurol 2013; 55 Suppl 4:47-54. [PMID: 24237280 DOI: 10.1111/dmcn.12307] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 11/28/2022]
Abstract
Today, treatment for children with cerebral palsy predominantly aims at improving the children's possibilities to perform everyday activities in their natural environment. The activities in focus for intervention are often expressed as specific goals, frequently defined in a collaborative goal-setting process between professionals and parents. The role of goal setting to improve the outcome of the intervention has not been shown in the literature so far. Thus, the aim of this systematic review was to explore if goal setting has an impact on treatment outcome assessed by standardized measures. CINAHL and MEDLINE were searched from January 2000 to October 2012, resulting in a final selection of 13 articles, six of which were randomized controlled trials. Methodological quality was assessed and study characteristics were analysed descriptively. Subject characteristics, type of intervention/s, frequency, and intensity of therapy varied largely. Outcome was assessed by standardized outcome measures as well as evaluated through aspects of goal attainment. Most studies showed robust within-group changes according to study-appropriate standardized measures, whereas the between-group comparisons exhibited less consistent differences in outcome. The review does not provide support for a positive effect of goal setting per se on treatment outcome. Studies that specifically measure the effect of goal setting on treatment outcome are needed.
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Affiliation(s)
- Eva Brogren Carlberg
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Universitetssjukhuset, Stockholm, Sweden
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Andersen JC, Majnemer A, O'Grady K, Gordon AM. Intensive upper extremity training for children with hemiplegia: from science to practice. Semin Pediatr Neurol 2013; 20:100-5. [PMID: 23948684 DOI: 10.1016/j.spen.2013.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
For children with hemiplegic cerebral palsy, bimanual abilities are central to independent function. Over the last decade, considerable attention has been given to 2 forms of extended practice therapy for the upper limb, constraint-induced movement therapy and intensive bimanual training. This article reviews the varying nature of these 2 approaches and the existing scientific rationale supporting them. Comparisons between these 2 intensive upper extremity training approaches indicate similar improvements in unimanual capacity and bimanual performance outcomes; however, when considering participant and caregiver goal achievement, evidence favors a bimanual approach. Careful selection of either therapy for this population requires consideration of individual and contextual factors in relation to treatment goals. The key ingredients and dose responses remain unknown. Treatment intensity, intrinsic motivation, and individualization of treatment are hypothesized as requisite in either approach.
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Affiliation(s)
- John C Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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