The Role of Regular Physical Therapy on Spasticity in Children With Cerebral Palsy

F-words e ingredientes das intervenções precoces para crianças com paralisia cerebral não deambuladoras: uma revisão de escopo

Cuidados centrados na família (incluindo coaching e intervenções fornecidas pelo cuidador) e treinamento parental formal são estratégias eficazes para crianças nos níveis IV e V do GMFCS. Os ingredientes de tecnologia assistiva podem promover várias F-words (funcionalidade, saúde, família, diversão, amigos e futuro). O menor nível de evidência foi encontrado para diversão, amigos e futuro. Outros fatores (prestação de serviços, treinamento profissional, dose de terapia, modificações ambientais) são relevantes para crianças pequenas nos níveis IV e V do GMFCS. Esta revisão de escopo identificou os ingredientes de intervenções precoces para crianças com paralisia cerebral em risco de não serem deambuladoras, e os mapeou-os de acordo com a estrutura das F-words. O treinamento formal dos pais e a tecnologia assistiva se destacaram como estratégias para abordar com várias F-words.

F-words and early intervention ingredients for non-ambulant children with cerebral palsy: A scoping review

AIM

To explore the ingredients of early interventions provided to young children with cerebral palsy (CP) who are classified in Gross Motor Function Classification System (GMFCS) levels IV and V, and to identify the 'F-words' addressed by the interventions.

METHOD

Searches were completed in four electronic databases. Inclusion criteria were the original experimental studies that fitted the following PCC components: population, young children (aged 0-5 years, at least 30% of the sample) with CP and significant motor impairment (GMFCS levels IV or V, at least 30% of the sample); concept, non-surgical and non-pharmacological early intervention services measuring outcomes from any of the International Classification of Functioning, Disability and Health domains; and context, studies published from 2001 to 2021, from all settings and not limited to any specific geographical location.

RESULTS

Eighty-seven papers were included for review, with qualitative (n = 3), mixed-methods (n = 4), quantitative descriptive (n = 22), quantitative non-randomized (n = 39), and quantitative randomized (n = 19) designs. Fitness (n = 59), family (n = 46), and functioning (n = 33) ingredients were addressed by most experimental studies, whereas studies on fun (n = 6), friends (n = 5), and future (n = 14) were scarce. Several other factors (n = 55) related to the environment, for example, service provision, professional training, therapy dose, and environmental modifications, were also relevant.

INTERPRETATION

Many studies positively supported formal parent training and use of assistive technology to promote several F-words. A menu of intervention ingredients was provided, with suggestions for future research, to incorporate them into a real context within the family and clinical practice.

WHAT THIS PAPER ADDS

Family-centred care (including coaching and caregiver-delivered interventions) and formal parental training are effective strategies for children in GMFCS levels IV and V. Assistive technology ingredients (power, mobility, supported, sitting, stepping, and standing) may promote several 'F-words' (functioning, fitness, family, fun, friends, and future). The lowest level of evidence was found for fun, friends, and future. Other factors (service provision, professional training, therapy dose, environmental modifications) are relevant for young children in GMFCS levels IV and V.

F-Wörter und Interventionsinhalte in der Frühförderung nicht gehfähiger Kinder mit Cerebralparese: eine umfangreiche Literaturübersicht

Ziel

Untersuchung der Inhalte von Frühfördermaßnahmen für Kleinkinder mit Cerebralparese (CP) mit Gross Motor Function Classification System (GMFCS) Level IV und V und die Identifikation von „F‐Wörtern“, die von den Maßnahmen adressiert werden.

Methode

Recherche in vier elektronischen Datenbanken. Einschlusskriterien: experimentelle Originalstudien, die die folgenden PCC‐Komponenten erfüllten: Population: Kleinkinder (im Alter von 0–5 Jahre, mindestens 30% der Stichprobe) mit CP und erheblicher motorischer Beeinträchtigung (GMFCS‐Levels IV oder V, mindestens 30% der Stichprobe); Konzept: nicht‐chirurgische und nicht‐pharmakologische Leistungen der Frühförderung, die Ergebnisse aus einem der Bereiche der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) messen; und Kontext: Studien, die zwischen 2001 und 2021 veröffentlicht wurden, in allen Konstellationen und nicht auf einen bestimmten geografischen Ort beschränkt.

Ergebnisse

87 Studien wurden in dieser Literaturübersicht berücksichtigt, mit qualitativen (n = 3), Mixed Methods (n = 4), quantitativ deskriptiven (n = 22), quantitativ nicht‐randomisierten (n = 39) und quantitativ randomisierten (n = 19) Designs. Die meisten experimentellen Studien befassten sich mit Fitness (n = 59), Familie (n = 46) und Funktion (n = 33), während es nur wenige Studien zu den Bereichen Spaß (n = 6), Freunde (n = 5) und Zukunft (n = 14) gab. Verschiedene Umweltfaktoren (n = 55) waren ebenfalls bedeutsam, z. B. das Angebot an Dienstleistungen, Berufsausbildung, Therapiedosis und Umweltanpassungen.

Interpretation

Viele Studien unterstützen Elternschulungen und den Einsatz assistiver Technologien zur Förderung verschiedener F‐Wörter. Ein „Menü“ von Inhalten der Frühförderung wurden ermittelt, mit Vorschlägen für weitere Forschung, um diese in der klinischen Praxis mit Familien umzusetzen.

Was dieser Artikel beiträgt

F-words e ingredientes de las intervenciones tempranas dirigidas a niños no ambulantes con parálisis cerebral: Una revisión exploratoria

La atención centrada en la familia (incluyendo coaching e intervenciones realizadas por los cuidadores) y el entrenamiento formal de los padres son estrategias efectivas para los niños con niveles IV y V de la GMFCS. Los ingredientes de la tecnología de apoyo pueden promover varias "F-words" (funcionamiento, estado físico, familia, diversión, amigos y futuro). Se encontró el nivel más bajo de evidencia para diversión, amigos y futuro. Otros factores (provisión de servicios, formación profesional, dosis de terapia, modificaciones del entorno) son relevantes para los niños pequeños con niveles IV y V de la GMFCS. Ingredientes de la intervención y F-words en intervenciones tempranas dirigidas a niños no ambulantes con parálisis cerebral.

HIPPOTHERAPY IN CEREBRAL PALSY - SURVEY RESEARCH

OBJECTIVE

The aim: To assess the effects of a one-year hippotherapy programme on the physical and mental functioning of children with cerebral palsy.

PATIENTS AND METHODS

Materials and methods: The study included 15 children with cerebral palsy whose mean age was 9 years. The children participated in hippotherapy ses¬sions at the Rehabilitation Centre in Rusinowice (one-year observation). The clinical presentation was dominated by manifestations of motor and postural abnormalities caused by central nervous system damage. A survey questionnaire was used in the study to collect information about problems associated with everyday life and functioning.

RESULTS

Results: The results obtained in this study showed that spastic CP was the most common form of the disorder, affecting 8 out of 15 children (53%). It was followed by mixed CP (40%, 6 children). Among the respondents, 67% (10 people) were already familiar with hippotherapy whereas 33% did not know this method.

CONCLUSION

Conclusions: There was a strong correlation between being familiar with effects of hippotherapy and the level of education of the parent/guardian. This result had a moderate influence on the frequency of hippotherapy sessions. Systematic hippotherapy sessions helped improve physical fitness and everyday functioning in children with cerebral palsy.

Does ultrasound imaging of the spastic muscle have an additive effect on clinical examination tools in patients with cerebral palsy?: A pilot study

Objective

The Modified Ashworth Scale, the Modified Tardieu Scale, and measuring the passive range of motion is commonly preferred examination tools for spasticity in cerebral palsy (CP). Ultrasonography has become increasingly used to provide relevant insight into spastic muscle morphology and structure recently. It was aimed to reveal associations between the clinical and ultrasonographic parameters of gastrocnemius medialis (GM) and lateralis muscles in this population.

Methods

Thirty-four children with spastic CP aged between 4 and 12 years who did not have botulinum neurotoxin A intervention within 6 months or had no previous history of any orthopedic or neurological surgery were included. The spasticity of GM and lateralis was evaluated firstly by the Modified Ashworth Scale, Modified Tardieu Scale, and ankle passive range of motion. Then, the cross-sectional area (CSA), muscle thickness (MT), qualitative and quantitative echo intensity (EI) values of both muscles were measured from their ultrasonographic images.

Results

The CSA of GM, and qualitative EI of both muscles were found to be mild-to-moderately correlated to all clinical examination tools (p<0.01), whereas the CSA of gastrocnemius lateralis was mildly related to Modified Ashworth Scale (p=0.009). The MT and quantitative EI of both muscles were not associated with any of the clinical tools (p>0.05).

Conclusion

Ultrasonographic measurements of GM and lateralis partially reflect ankle spasticity in children with CP. Ultrasonography can be used as an alternative tool in this patient population where the clinical evaluation can not perform ideally.

Need to Perform Rehabilitation Exercises at Home by Parents of Children with Neurological Diseases to Maintain Performance During COVID-19 Lockdown

With the outbreak of the novel pandemic coronavirus disease 2019 worldwide, numerous pediatric rehabilitation clinics have closed to support social and physical distancing, and therapists similar to other individuals are staying at their homes. There is a common concern of parents and caregivers that how and with what quality children's rehabilitation exercises should proceed. Most children with neurological diseases have problems, such as muscle spasticity, range of motion (ROM) limitation, muscle shortening, balance loss, and mobility and movement impairments. The normalization of muscle tone, preservation of ROM, muscle stretch, and improvement of fine and gross motor skills and balance are essential activities that need to be considered. Therefore, this study aimed to summarize the necessities of a home-based rehabilitation exercise program during the quarantine period.