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Teshome MS, Bekele T, Verbecque E, Mingels S, Granitzer M, Abessa TG, Lema TB, Rameckers E. Body composition and associated factors among 5-7-year-old children with moderate acute malnutrition in Jimma town in southwest Ethiopia: A comparative cross-sectional study. Matern Child Nutr 2024:e13655. [PMID: 38661055 DOI: 10.1111/mcn.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
Acute malnutrition affects not only the growth and development but also the body composition of children. However, its specific effects have not yet been characterized. This study aims to compare the body composition of 5-7-year-old children with moderate acute malnutrition (MAM) to that of their well-nourished (WN) peers and identify associated factors. A school-based comparative cross-sectional study was conducted from June to July 2022 in Jimma town, southwest Ethiopia. The study participants were selected from eight kindergartens and eight primary schools using a simple random sampling technique based on the proportional allocation of the sample to the size of the population in the respective school. Descriptive statistics and multivariable linear regression analyses were used to assess the mean differences and associations between variables and isolate independent predictors of body composition, respectively. The statistical significance was determined using ß-coefficients with 95% confidence intervals and a p value of ≤ 0.05. Data were captured from 388 (194 MAM and 194 WN) children with a response rate of 97.9%. The mean fat-free mass of WN children was significantly higher compared with those with MAM (p < 0.001). The mean (SD) of fat mass of MAM children was 4.23 ± 0.72 kg, 4.36 ± 0.88 kg and 4.08 ± 0.89 kg for 5, 6 and 7-year-olds, respectively. For WN children, the mean (SD) of fat mass was 4.92 ± 0.88 kg for 5 years old, 5.64 ± 1.01 kg for 6 years old and 5.75 ± 1.26 kg for 7 years old (p < 0.001). On the multivariable linear regression analysis after controlling for background variables, WN children exhibited 1.51 times higher fat-free mass compared with MAM children (β = 1.51, p = 0.003). A unit increase in age of the study participants was associated with a 1.37 increment in fat-free mass (β = 1.37, p < 0.001). WN children had 1.07 times higher fat mass compared with children with MAM (β = 1.07, p < 0.001). A unit increase in the age of the child resulted in 0.15 times increment in fat mass (β = 0.15, p = 0.020), and being female was associated with a 0.37 increase in fat mass (β = 0.37, p < 0.001). The results showed that the mean fat mass and fat-free mass were significantly lower among moderately acute malnourished children than in WN children showing the loss of both body compartments due to malnutrition. The body mass index for age, age of the child and sex of the child were significantly linked to both fat-free mass and fat mass.
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Affiliation(s)
- Melese Sinaga Teshome
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Diepenbeek, Belgium
| | - Tamirat Bekele
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Evi Verbecque
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Diepenbeek, Belgium
| | - Sarah Mingels
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Diepenbeek, Belgium
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, Leuven, Belgium
| | - Marita Granitzer
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Diepenbeek, Belgium
| | - Teklu Gemechu Abessa
- Department of Special Needs and Inclusive Education, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew Lema
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
| | - Eugene Rameckers
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Diepenbeek, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
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Velghe S, Rameckers E, Meyns P, Johnson C, Hallemans A, Verbecque E, Klingels K. Effects of a highly intensive balance therapy camp in children with developmental coordination disorder - An intervention protocol. Res Dev Disabil 2024; 147:104694. [PMID: 38382234 DOI: 10.1016/j.ridd.2024.104694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Children with Developmental Coordination Disorder (DCD) often (<87 %) experience postural control problems, impacting all levels of the International Classification of Functioning, Disability and Health (ICF) including their daily participation, self-esteem and mental health. Due to the multisystemic nature of postural control, comprehensive therapy should target all systems which is currently not the case. Highly intensive therapy is effective and commonly used in pediatric populations, but has not been explored yet to train postural control in children with DCD. AIMS To investigate the effects of a highly intensive functional balance therapy camp at all ICF levels in children with DCD. METHODS AND PROCEDURES The effects on postural control, muscle activity, brain alterations, self-perceived competence, self-identified goals, gross motor activities and participation are evaluated. Participants are assessed pre- and post-intervention, including a 3 months follow-up. Forty-eight children with DCD, aged 6-12 years old, receive 40 h of comprehensive balance training. This intervention is fun, individually tailored, targets all postural control systems, implements different motor learning strategies and includes both individual and group activities. CONCLUSION Novel insights into the effects of a highly intensive comprehensive balance therapy camp designed for children with DCD will be gained at all levels of the ICF.
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Affiliation(s)
- Silke Velghe
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
| | - Eugene Rameckers
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation research line, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, the Netherlands
| | - Pieter Meyns
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Charlotte Johnson
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Research group MOVANT, University of Antwerp, Antwerp, Belgium
| | - Ann Hallemans
- Research group MOVANT, University of Antwerp, Antwerp, Belgium
| | - Evi Verbecque
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Katrijn Klingels
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Teshome MS, Lema TB, Abessa TG, Mingels S, Granitzer M, Rameckers E, Verbecque E. Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis. J Nutr Sci 2024; 12:e130. [PMID: 38179261 PMCID: PMC10765019 DOI: 10.1017/jns.2023.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Moderate acute malnutrition (MAM) is defined by a weight-for-height Z-score (WHZ) between -3 and -2 of the WHO reference or by a mid-upper arm circumference (MUAC) of ≥11⋅5 and <12⋅5 cm. This study aimed to synthesise the evidence for the effectiveness of Ready-to-Use Supplementary Food (RUSF) compared to other dietary interventions or no intervention on functioning at different levels of the International Classification of Functioning, Disability, and Health (ICF) among children with MAM between 2 and12 years old. Three databases (PubMed, Scopus, and Web of Science) were systematically searched (last update: 20 November 2022). Pooled estimates of effect were calculated using random-effects meta-analyses. The level of evidence was estimated with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. Seven studies were included. RUSF had a significant small-sized better effect (pooled mean: 0⋅38; 95 % CI = [0⋅10, 0⋅67], P = 0⋅01, I² = 97 %) on different anthropometric measurements compared to other dietary interventions among MAM children (n 6476). Comparing RUSF with corn-soy blend Plus Plus (CSB++) showed that RUSF had a small-sized but significantly better effect on the children's anthropometric measures compared to children who received CSB++ (pooled mean: 0⋅16; 95 % CI = [0⋅05, 0⋅27], P = 0⋅01; I2 = 35 %). MAM children treated with RUSF had a better recovery rate compared to those treated with CSB++ (pooled risk difference: 0⋅11; 95 % CI = [0⋅06, 0⋅11], P < 0⋅001; I2 = 0 %). The RUSF intervention seems promising in improving MAM children's nutritional outcomes and recovery rate compared to other dietary interventions.
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Affiliation(s)
- Melese Sinaga Teshome
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
| | - Tefera Belachew Lema
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
| | - Teklu Gemechu Abessa
- Department of Special Needs and Inclusive Education, Jimma University, Jimma, Ethiopia
| | - Sarah Mingels
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, Leuven 3000, Belgium
| | - Marita Granitzer
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
| | - Eugene Rameckers
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Evi Verbecque
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
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Geijen M, Bastiaenen C, Gordon A, Smeets R, Rameckers E. Exploring relevant parameters and investigating their reproducibility of task-oriented unimanual strength measurement in children with unilateral cerebral palsy. Disabil Rehabil 2024; 46:180-186. [PMID: 36794727 DOI: 10.1080/09638288.2023.2178677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE To explore relevant parameters and investigate their test-retest reliability within the scope of the push button task of the Task-oriented Arm-hAnd Capacity (TAAC) measured in children with unilateral Cerebral Palsy (CP). METHODS 118 children diagnosed with unilateral CP, aged between 6 and 18 years, participated in this study. Thetest-retest reliability of the force generated during the push button task of the TAAC was investigated using an intraclass correlation (ICC) two-way random model with absolute agreement. The ICCs were calculated across the whole age group and for two separate age subgroups (6-12 and 13-18 years). RESULTS Test-retest reliability of the parameters "mean peak force of all attempts", "overshoot of force", "number of successful attempts" and "time to complete four successful attempts" were moderate to good (ICC range 0.667-0.865; 0.721-0.908; 0.733-0.817, respectively). CONCLUSIONS The results showed moderate to good test-retest reliability for all parameters. The parameters "mean peak force" and "number of successful attempts" are the most relevant parameters, as these parameters are task-specific and the most functional for clinical practice.Implications for RehabilitationClinical relevant information about the use of task-oriented strength during the performance of daily activity has been added to strength measurements in children with Cerebral Palsy.The Task-oriented Arm-hAnd Capacity instrument is a reliable, objective and simple instrument to measure task-oriented strength during daily activity and is ready for use in a clinical setting.The Task-oriented Arm-hAnd Capacity instrument is both a capacity and performance-based test.The measurement with the push button task showed moderate to good test-retest reliability.
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Affiliation(s)
- Mellanie Geijen
- Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
| | - Caroline Bastiaenen
- Department of Epidemiology, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
| | - Andrew Gordon
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, NY, USA
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
| | - Eugene Rameckers
- Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands
- Rehabilitation Science, Pediatric Physical Therapy, Hasselt University, Hasselt, Belgium
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Pelckmans M, Nijmolen P, Bloemen M, Kuijpers E, Meershoek A, Rameckers E. Barriers and Facilitators to the Acceptance of eHealth Interventions by Dutch Pediatric Physical Therapists in Times of the COVID-19 Pandemic: A Mixed-Methods Approach. Pediatr Phys Ther 2023; 35:243-250. [PMID: 36722830 PMCID: PMC10035549 DOI: 10.1097/pep.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic created an urgent need for eHealth as the relevance of infection control and social distancing continues. Evidence describing the acceptability of implementing eHealth into pediatric physical therapy services is limited. PURPOSE To investigate the determinants of eHealth acceptance by Dutch pediatric physical therapists during the COVID-19 pandemic. METHODS A mixed-methods approach was used. It included a quantitative exploratory questionnaire of 154 pediatric physical therapists and qualitative in-depth interviews of 16 pediatric physical therapists. RESULTS The eHealth interventions were beneficial for collaboration between health care professionals and face-to-face therapy. eHealth interventions were, however, found to be unsuitable especially in the diagnostic phase. Barriers to more extensive application include costs, technical difficulties, and a perceived negative attitude of children. CONCLUSION Pediatric physical therapists used eHealth interventions extensively in times of the COVID-19 pandemic. However, the acceptance of eHealth interventions is dependent on the pediatric physical therapist's perception of usefulness in private practice, rehabilitation setting, or clinical hospital.
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Affiliation(s)
- Maud Pelckmans
- Correspondence: Maud Pelckmans, MSc, Emmahof 5, 5141DA Waalwijk, the Netherlands ()
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Brauers L, Smeets R, Feys P, Gordon AM, Janssen-Potten Y, Ortibus E, Feys H, Rameckers E, Klingels K. Children With Cerebral Palsy Show Higher Static-But Not Higher Dynamic-Motor Fatigability in Grip and Pinch Tasks Than Children With Typical Development Do. Phys Ther 2023; 103:pzac155. [PMID: 37104625 PMCID: PMC10071583 DOI: 10.1093/ptj/pzac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/16/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate differences in static and dynamic motor fatigability during grip and pinch tasks between children with unilateral spastic cerebral palsy (USCP) and children with typical development (TD) and between preferred and nonpreferred hands. METHODS Fifty-three children with USCP and 53 age-matched children with TD (mean = 11 years 1 month; SD = 3 years 8 months) participated in 30-second maximum exertion sustained and repeated grip and pinch tasks. For sustained tasks, the Static Fatigue Index and the ratio of mean force between the first and last thirds of the curve were calculated. For repeated tasks, the ratio of mean force and the ratio of numbers of peaks between the first and last thirds of the curve were calculated. RESULTS Higher Static Fatigue Index scores for grip and pinch were found with USCP in both hands and between hands in both groups. Dynamic motor fatigability showed inconsistent results, with higher levels of fatigability in children with TD than in children with USCP for grip in the ratio of mean force between the first and last thirds of the curve in nonpreferred hands and in the ratio of number of peaks between the first and last thirds of the curve in preferred hands. CONCLUSION Higher motor fatigability in children with USCP than in children with TD was found for static but not dynamic grip and pinch. Underlying mechanisms may play different roles in static and dynamic motor fatigability. IMPACT These results highlight that static motor fatigability in grip and pinch tasks should be part of a comprehensive upper limb assessment and that this could be the target of individualized interventions.
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Affiliation(s)
- Lieke Brauers
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Peter Feys
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Yvonne Janssen-Potten
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
- Center of Expertise, Adelante Rehabilitation Center, Valkenburg, the Netherlands
| | - Els Ortibus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hilde Feys
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Eugene Rameckers
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
- Center of Expertise, Adelante Rehabilitation Center, Valkenburg, the Netherlands
| | - Katrijn Klingels
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium
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Brauers L, Smeets R, Feys P, Gordon AM, van der Leij-Roelofsen B, Bastiaenen C, Rameckers E, Klingels K. Test-Retest Reliability of a Static and Dynamic Motor Fatigability Protocol Using Grip and Pinch Strength in Children With Cerebral Palsy. Phys Ther 2022; 102:6632290. [PMID: 35793460 DOI: 10.1093/ptj/pzac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/03/2021] [Accepted: 01/02/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the test-retest reliability, measurement error, and interpretability of new motor fatigability outcomes of grip and pinch strength for children with unilateral cerebral palsy (UCP). METHODS Motor fatigability during grip and pinch strength was measured twice (within 48 hours) in both hands of 50 children (mean age = 11 years 2 months; 14, 31, and 5 children with Manual Ability Classification System levels I, II, and III, respectively) using a 30-second static and dynamic maximum exertion protocol. For static motor fatigability, the Static Fatigue Index (SFI) and mean force (Fmean) in the first (Fmean1) and last (Fmean3) 10 seconds were calculated. For dynamic motor fatigability, Fmean1, Fmean3, and the number of peaks in the first and last 10 seconds were calculated. RESULTS For static motor fatigability, the intraclass correlation coefficients (ICCs) were moderate to high for Fmean1 and Fmean3 (0.56-0.88), and the SFI showed low to moderate reliability (ICC = 0.32-0.72). For dynamic motor fatigability, the ICCs were moderate to high for all outcomes (0.54-0.91). The standard error of measurement agreement and the smallest detectable difference agreement were large in all outcomes, except for the SFI in static motor fatigability. Details per age group are provided. In general, younger children (6-11 years old) showed lower reliability than older children (12-18 years old). CONCLUSION Most outcome measures for static and dynamic motor fatigability of grip and pinch strength show moderate to high reliability in children with UCP, indicating that these tests can be used reliably to investigate the presence of motor fatigability in UCP, especially in older children. Standard error of measurement agreement and smallest detectable difference agreement indicated that these outcome measures should be interpreted with caution when evaluating change. IMPACT Most of the proposed outcome measures for static and dynamic motor fatigability of grip and pinch are reliable in children with UCP and can be used for discriminative purposes.
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Affiliation(s)
- Lieke Brauers
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Peter Feys
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York
| | | | - Caroline Bastiaenen
- Department of Epidemiology, Research Line: Function, Participation and Rehabilitation, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Eugene Rameckers
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - Katrijn Klingels
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Aranceta-Garza A, Ross K, Buhler M, Rameckers E. A Comparative Study of Efficacy and Functionality of Ten Commercially Available Wrist-Hand Orthoses in Healthy Females: Wrist Range of Motion and Grip Strength Analysis. Front Rehabilit Sci 2021; 2:687554. [PMID: 34286314 PMCID: PMC7611306 DOI: 10.3389/fresc.2021.687554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Wrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength. Design: Randomised comparative functional study of the wrist/hand with and without WHOs. Participants: Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks. Main outcome measures: The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained. Results: From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4). Conclusion: WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users' needs.
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Affiliation(s)
| | - Karyn Ross
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
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Geijen M, Rameckers E, Bastiaenen C, Gordon A, Smeets R. Construct Validity of a Task-Oriented Bimanual and Unimanual Strength Measurement in Children With Unilateral Cerebral Palsy. Phys Ther 2020; 100:2237-2245. [PMID: 32936866 PMCID: PMC7720643 DOI: 10.1093/ptj/pzaa173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 05/14/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purposes of this study were to (1) investigate aspects of construct validity of peak force measurements of crate-and-pitcher tasks using the Task-oriented Arm-hAnd Capacity (TAAC), an instrument designed to measure task-oriented arm and hand strength for cross-sectional and evaluation purposes, and (2) compare TAAC measurements with those of comparative measures using COSMIN guidelines. METHODS In this cross-sectional validity study, participants were 105 children (mean age = 12 years 10 months; number of boys = 66) diagnosed with unilateral cerebral palsy (UCP). Ten a priori hypotheses were formulated with peak force of the TAAC as index measure and compared with measures on body functions and structure and activity level of the International Classification of Functioning, Disability and Health for Children and Youth. Strength and direction of the relationship between the TAAC and comparative measures were investigated by calculating Pearson correlation coefficients (r). RESULTS On body functions and structures level, low-to-moderate positive correlations (0.493-0.687) were found. On activity level, low negative and positive correlations (-0.271 to 0.387) were found. CONCLUSION The construct of peak force measurement of the TAAC is in line with the a priori hypotheses with comparators on body function and structures and activity level, indicating a partial overlap of the construct of the TAAC with both International Classification of Functioning levels. The TAAC appears to be valuable, as it measures functional strength that differs from the constructs of the comparators. More research with a larger population and more comparators is needed. IMPACT Clinically relevant information is lacking about the use of strength and strength measurement during daily activities in children with UCP. This study shows that the TAAC provides unique information about functional strength in children with UCP.
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Affiliation(s)
| | - Eugene Rameckers
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University; Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands; and Rehabilitation Science, Pediatric Physical Therapy, Hasselt University, Hasselt, Belgium
| | | | - Andrew Gordon
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University
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Brauers L, Rameckers E, Severijns D, Feys P, Smeets R, Klingels K. Measuring Motor Fatigability in the Upper Limbs in Individuals With Neurologic Disorders: A Systematic Review. Arch Phys Med Rehabil 2020; 101:907-916. [DOI: 10.1016/j.apmr.2019.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 01/21/2023]
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Geijen M, Ketelaar M, Sakzewski L, Palisano R, Rameckers E. Defining Functional Therapy in Research Involving Children with Cerebral Palsy: A Systematic Review. Phys Occup Ther Pediatr 2020; 40:231-246. [PMID: 31554456 DOI: 10.1080/01942638.2019.1664703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: To review definitions and elements of interventions in studies, which used the word "functional" to describe their intervention for children with cerebral palsy (CP), and to determine whether definitions and elements are similar to criteria of functional therapy described in the Dutch Guidelines.Methods: Systematic review of intervention studies, which used the word "functional" to describe interventions for children with CP. We described criteria of functional therapy that were used to describe the intervention, and whether criteria were described similarly to the descriptions used in the Dutch Guidelines.Results: Of the 27 included studies, criteria "based on the activities/participation level of the ICF-CY", "goal-directed" and "context-specific" were referred to the most (40-59.3%). Descriptions of these criteria were less comparable to the suggested definition (43.8-69.2%). The remaining three criteria ("active involvement", "task-specific", and "focused on functionality instead of normality") were referred to less frequently (18.5-33.3%). The descriptions reported for these criteria were, however, the most comparable with the suggested definitions (80-100%).Conclusions: The included studies, in general have not used criteria of functional therapy. Future studies have to describe the elements of interventions in detail. Moreover, it is important to reach consensus on the definition and elements of functional therapy.
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Affiliation(s)
- Mellanie Geijen
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Leanne Sakzewski
- dQueensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Robert Palisano
- eDepartment of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Eugene Rameckers
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands.,fCentre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,gDepartment of Pediatric Physical Therapy, Hasselt University, Biomed, Hasselt, Belgium
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Aertssen W, Smulders E, Smits-Engelsman B, Rameckers E. Functional strength measurement in cerebral palsy: feasibility, test-retest reliability, and construct validity. Dev Neurorehabil 2019; 22:453-461. [PMID: 30207812 DOI: 10.1080/17518423.2018.1518963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: No instrument exists that measures functional strength in both lower and upper extremities in children with cerebral palsy (CP). Therefore, the functional strength measurement (FSM) was tested for feasibility, test-retest reliability and validity in CP. Methods: Thirty-seven children with CP (aged 4-10 years, Gross Motor Function Classification System I and II) participated. The most common compensations for CP were described; new item descriptions were standardized, and one item was removed. Test-retest reliability was examined. To measure convergent validity, correlations between the FSM-CP and isometric muscle strength measured with the handheld dynamometer (HHD) were determined. Results: Test-retest reliability was considered high for all items (intra-class correlation coefficient 0.79-0.95). Significant correlations between the HHD and FSM-CP ranged from r = 0.36 to 0.75. Conclusion: The FSM-CP is feasible, reliable, and valid to use in children with CP. The FSM-CP can be considered as a helpful tool in clinical practice of physical examination of children with CP.
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Dekkers K, Janssen-Potten Y, Gordon AM, Speth L, Smeets R, Rameckers E. Reliability of maximum isometric arm, grip and pinch strength measurements in children (7–12 years) with unilateral spastic cerebral palsy. Disabil Rehabil 2019; 42:1448-1453. [DOI: 10.1080/09638288.2018.1524522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Koen Dekkers
- Revant Rehabilitation Centres, Breda, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, The Netherlands
| | - Yvonne Janssen-Potten
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Andrew M. Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Lucianne Speth
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Libra Rehabilitation and Audiology, Eindhoven/Weert, The Netherlands
| | - Eugene Rameckers
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Faculty of Medicine & Health Science, Pediatric Rehabilitation, Biomed, Hasselt University, Hasselt, Belgium
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Geijen M, Rameckers E, Schnackers M, Bastiaenen C, Gordon A, Speth L, Smeets R. Reproducibility of Task-Oriented Bimanual and Unimanual Strength Measurement in Children with Unilateral Cerebral Palsy. Phys Occup Ther Pediatr 2019; 39:420-432. [PMID: 30422038 DOI: 10.1080/01942638.2018.1527426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: To examine reproducibility of the arm-hand strength measured while performing the bimanual crate task and the unimanual pitcher task. Methods: 105 children diagnosed with unilateral Cerebral Palsy, aged between 6 and 18 years, participated in this study. The test-retest reliability of the force generated during bimanual crate task and unimanual pitcher task of the Task-oriented Arm-hAnd Capacity instrument was investigated using intraclass correlation two-way random model with absolute agreement. The intraclass correlations were calculated for two age groups (6-12 and 13-18 years old). Results: The results showed good test-retest reliability for the crate and pitcher task with the non-affected hand for both age groups. The results of the pitcher task for the affected hand showed moderate test-retest reliability for both age groups. Conclusion: The Task-oriented Arm-hAnd Capacity instrument has moderate to good test-retest reliability. It is a simple and objective instrument to assess task-oriented strength in children with unilateral cerebral palsy.
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Affiliation(s)
- Mellanie Geijen
- a Research School CAPHRI, Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands
| | - Eugene Rameckers
- a Research School CAPHRI, Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,b Centre of Expertise in Rehabilitation and Audiology , Adelante , Hoensbroek , The Netherlands
| | - Marlous Schnackers
- a Research School CAPHRI, Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,c Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands
| | - Carolien Bastiaenen
- d Research School CAPHRI, Department of Epidemiology , Maastricht University , Maastricht , The Netherlands
| | - Andrew Gordon
- e Department of Biobehavioral Sciences , Teachers College Columbia University , New York , NY , USA
| | - Lucianne Speth
- b Centre of Expertise in Rehabilitation and Audiology , Adelante , Hoensbroek , The Netherlands
| | - Rob Smeets
- a Research School CAPHRI, Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,f Libra Rehabilitation and Audiology , Eindhoven/Weert , The Netherlands
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Salavati M, Rameckers E, Waninge A, Krijnen W, van der Schans C, Steenbergen B. Evaluating the outcome of an individual functional therapy program focused on children with cerebral palsy and cerebral visual impairment: a multiple case study. European Journal of Physiotherapy 2018. [DOI: 10.1080/21679169.2017.1374455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Masoud Salavati
- Royal Dutch Visio, Center of Expertise for Blind and Visually Impaired People, Haren, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Eugene Rameckers
- 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, Valkenburg and Hoensbroek, The Netherlands
- AVANSplus, University for Professionals for Paediatric Physical Therapy, Breda, The Netherlands
| | - Aly Waninge
- Royal Dutch Visio, Center of Expertise for Blind and Visually Impaired People, Haren, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Wim Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Cees van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
- School of Psychology, Australian Catholic University, Melbourne, Australia
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16
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Bonney E, Rameckers E, Ferguson G, Smits-Engelsman B. "Not just another Wii training": a graded Wii protocol to increase physical fitness in adolescent girls with probable developmental coordination disorder-a pilot study. BMC Pediatr 2018; 18:78. [PMID: 29471799 PMCID: PMC5822519 DOI: 10.1186/s12887-018-1029-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/29/2018] [Indexed: 02/01/2023] Open
Abstract
Background Adolescents with low motor competence participate less in physical activity and tend to exhibit decreased physical fitness compared to their peers with high motor competence. It is therefore essential to identify new methods of enhancing physical fitness in this population. Active video games (AVG) have been shown to improve motor performance, yet investigations of its impact on physical fitness are limited. The objective of this study was to examine the impact of the graded Wii protocol in adolescent girls with probable Developmental Coordination Disorder (p-DCD). Methods A single-group pre-post design was conducted to assess the impact of a newly developed Wii protocol in adolescent girls attending school in a low income community of Cape Town, South Africa. Sixteen participants (aged 13-16 years) with p-DCD (≤16th percentile on the MABC-2 test) were recruited. Participants received 45 min Wii training for 14 weeks. Outcome measures included the six-minute walk distance and repeated sprint ability. Information on heart rate, enjoyment and perceived exertion ratings were also collected. Results Significant improvements in aerobic and anaerobic fitness were observed. The participants reported high enjoyment scores and low perceived exertion ratings. The graded Wii protocol was easily adaptable and required little resources (space, equipment and expertise) to administer. Conclusions The findings provide preliminary evidence to support the use of the graded Wii protocol for promoting physical fitness in adolescent girls with p-DCD. Further studies are needed to confirm these results and to validate the clinical efficacy of the protocol in a larger sample with a more robust design.
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Affiliation(s)
- Emmanuel Bonney
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Department of Physiotherapy, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana.
| | - Eugene Rameckers
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands.,Department of Functioning and Rehabilitation, Maastricht University, Maastricht, the Netherlands
| | - Gillian Ferguson
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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17
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van Vulpen LF, de Groot S, Rameckers E, Becher JG, Dallmeijer AJ. Improved Walking Capacity and Muscle Strength After Functional Power-Training in Young Children With Cerebral Palsy. Neurorehabil Neural Repair 2017; 31:827-841. [DOI: 10.1177/1545968317723750] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background. Strength training programs for children with cerebral palsy (CP) showed inconclusive evidence for improving walking, despite improvements in strength. Recent studies have suggested that strength training with high movement velocity is more effective for improving walking than traditional resistance training. Objective. The purpose of this study was to evaluate the effect of functional high-velocity resistance training (power-training) to improve muscle strength and walking capacity of children with CP. Method. Twenty-two children with spastic CP participated (13 bilateral, Gross Motor Function Classification System [GMFCS] level I [n = 10] and II [n = 12], 7.5 years [SD 1.8, range 4-10 years]). Within-subjects changes in a 14-weeks usual care period were compared with changes in a 14-week functional power-training period (in groups, 3×/wk). Outcome measures were the muscle power sprint test (MPST), 1-minute walk test (1MWT), 10-m shuttle run test (SRT), gross motor function (GMFM-66), isometric strength of lower-limb muscles and dynamic ankle plantar flexor strength. Results. Changes during the training period were significantly larger than changes in the usual care period for all outcome measures ( P < .05). Large improvements were found during the training period for walking capacity (ΔMPST [mean]: 27.6 W [95%CI 15.84-39.46, 83% increase], Δ1MWT: 9.4 m [95% CI 4.17-14.68, 13%], ΔSRT: 4.2 [95%CI 2.57-5.83, 56%], ΔGMFM-66: 5.5 [95% CI 3.33-7.74, 7%]) and muscle strength (18%-128%), while outcomes remained stable in the usual care period. Conclusions. The results indicate that functional power-training is an effective training for improving walking capacity in young children with cerebral palsy.
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Affiliation(s)
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
- University of Groningen, University Medical Center Groningen, the Netherlands
| | - Eugene Rameckers
- School for Public Health and Primary Care (CAPHRI), Maastricht University, the Netherlands
- University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, the Netherlands
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18
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Bleyenheuft Y, Ebner-Karestinos D, Surana B, Paradis J, Sidiropoulos A, Renders A, Friel KM, Brandao M, Rameckers E, Gordon AM. Intensive upper- and lower-extremity training for children with bilateral cerebral palsy: a quasi-randomized trial. Dev Med Child Neurol 2017; 59:625-633. [PMID: 28133725 DOI: 10.1111/dmcn.13379] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 11/26/2022]
Abstract
AIM An approach that simultaneously engages both the upper and lower extremities, hand-arm bimanual intensive therapy including lower extremity (HABIT-ILE), has recently demonstrated improvements in upper and lower extremities in children with unilateral cerebral palsy (CP). It is not known whether children with bilateral CP would benefit from this approach. The aim of this study was to examine the efficacy of HABIT-ILE in children with bilateral CP. METHOD A quasi-randomized trial design was used, whereby 20 participants (age 6-15y, Gross Motor Function Classification System levels II-IV, Manual Ability Classification System levels I-III) were assigned to a treatment (HABIT-ILE) or a comparison group in the order in which they were enrolled. Children in the HABIT-ILE group were assessed before and after 84 hours of intervention over 13 days, as well as at 3 months' follow-up. Children in the comparison group were assessed at the same time points. Children in both groups were assessed using the Gross Motor Function Measure (GMFM-66) and ABILHAND-Kids (primary measures), and six secondary measures. RESULTS A group×test session interaction indicated significant improvements in the HABIT-ILE group as assessed by the GMFM-66, lower-extremity performance (6-Minute Walk Test; Pediatric Balance Scale), functional upper-extremity abilities (ABILHAND-Kids/Pediatric Evaluation of Disability Inventory), and the dexterity of the less affected upper extremity. CONCLUSION HABIT-ILE is efficacious for improving both upper- and lower-extremity function in children with bilateral CP.
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Affiliation(s)
- Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Bhavini Surana
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Julie Paradis
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Alexis Sidiropoulos
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Anne Renders
- Physical and Rehabilitation Medicine Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Kathleen M Friel
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.,Burke-Cornell Medical Research Institute, White Plains, NY, USA
| | - Marina Brandao
- Departamento de Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eugene Rameckers
- Research in Function and Rehabilitation, Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands.,Center of Expertise, Adelante Rehabilitation, Hoensbroek, the Netherlands.,Avans Plus, Breda, the Netherlands
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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19
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Speth L, Janssen-Potten Y, Rameckers E, Defesche A, Winkens B, Becher J, Smeets R, Vles H. Effects of botulinum toxin A and/or bimanual task-oriented therapy on upper extremity activities in unilateral Cerebral Palsy: a clinical trial. BMC Neurol 2015; 15:143. [PMID: 26286662 PMCID: PMC4544795 DOI: 10.1186/s12883-015-0404-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study reports on the effects of botulinum toxin A (BoNT-A) injections in the upper extremity (UE) in children with unilateral Cerebral Palsy (uCP) combined with bimanual task-oriented therapy (BITT) or either treatment modality performed separately. Bimanual activities were measured with the Assisting Hand Assessment (AHA), the ABILHand-Kids questionnaire (AK), the Observational Skills Assessment Score (OSAS). Goal achievement was measured with Goal Attainment Scaling (GAS), using blind video assessment, and the Canadian Occupational Performance Measure (COPM). METHODS Thirty-five children, mean age 7.14 years (SD 2.63), 11 Manual Ability Classification Score (MACS) I, 15 MACS II and 9 MACS III, participated. The trial started with four study groups: BoNT-A-only (n = 5), BITT-only (n = 11), BoNT-A + BITT (n = 13), and control (n = 6). Twenty-two children were randomised, 13 children received their parents' preferred treatment: BoNT-A + BITT or BITT-only. Three comparisons were analysed: BITT (BoNT-A + BITT and BITT-only; n = 24) versus no BITT (BoNT-A-only and control; n = 11), BoNT-A (BoNT-A-only and BoNT-A + BITT; n = 18) versus no BoNT-A (BITT-only and control; n = 17), and the additional effect of BoNT-A (BoNT-A + BITT versus BITT-only). Follow-up time: 24 weeks. RESULTS No significant differences between the groups were found on the AHA. The amount of use of both hands on the OSAS was significantly better in the BoNT-A group in the beading and sandwich-making task. The BoNT-A group also showed significant improvement in the quality scores of the OSAS: the wrist position during grasping and holding, especially in the younger children. The BITT group improved significantly on the AK and significantly more on the performance and satisfaction scores of the COPM at 12 and 24 weeks regarding several goals. BoNT-A showed a significant negative effect at 12 and 24 weeks in the most important goal. BITT, more than BoNT-A + BITT, showed positive effects on the GAS score at 12 (significant), 18 and 24 weeks. CONCLUSIONS BoNT-A has a positive effect on quality of movement and amount of use of the affected UE during the 3 months' working time. BoNT-A has no additional effect on bimanual performance and goal achievement. BITT has a positive effect on goal achievement and bimanual performance, even up to 6 weeks after therapy had stopped. TRIAL REGISTRATION Current Controlled Trials ISRCTN69541857.
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Affiliation(s)
- Lucianne Speth
- Adelante, Paediatric Rehabilitation, Onderstestraat 29, 6301 , KA, Valkenburg, The Netherlands. .,Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 , CC, Hoensbroek, The Netherlands.
| | - Yvonne Janssen-Potten
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 , CC, Hoensbroek, The Netherlands. .,Department of Rehabilitation Medicine, Maastricht University, Research School CAPHRI, PO Box 616, 6200 , MD, Maastricht, The Netherlands.
| | - Eugene Rameckers
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 , CC, Hoensbroek, The Netherlands. .,Department of Rehabilitation Medicine, Maastricht University, Research School CAPHRI, PO Box 616, 6200 , MD, Maastricht, The Netherlands.
| | - Anke Defesche
- Adelante, Paediatric Rehabilitation, Onderstestraat 29, 6301 , KA, Valkenburg, The Netherlands.
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Research School CAPHRI, Maastricht, The Netherlands.
| | - Jules Becher
- Department of Rehabilitation Medicine, Free University Medical Centre, De Boelelaan 1118, 1081 , HZ, Amsterdam, The Netherlands.
| | - Rob Smeets
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 , CC, Hoensbroek, The Netherlands. .,Department of Rehabilitation Medicine, Maastricht University, Research School CAPHRI, PO Box 616, 6200 , MD, Maastricht, The Netherlands. .,Department of Rehabilitation Medicine, Maastricht University Medical Centre, PO Box 5200, 6202 , AZ, Maastricht, The Netherlands.
| | - Hans Vles
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands. .,Department of Neurology, Maastricht University, Research School GROW, Maastricht, The Netherlands.
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20
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Speth L, Janssen-Potten Y, Leffers P, Rameckers E, Defesche A, Winkens B, Becher J, Smeets R, Vles JSH. Effects of botulinum toxin A and/or bimanual task-oriented therapy on upper extremity impairments in unilateral Cerebral Palsy: an explorative study. Eur J Paediatr Neurol 2015; 19:337-48. [PMID: 25661064 DOI: 10.1016/j.ejpn.2015.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 11/11/2014] [Accepted: 01/11/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study reports on the effects of botulinum toxin A (BoNT-A) injections in the upper extremity (UE) of children with unilateral Cerebral Palsy (uCP) combined with bimanual task oriented therapy (BITT) or either treatment modality performed separately on UE range of motion (ROM), spasticity and (functional) strength. METHODS Thirty-five children, mean age 7.14 years (SD 2.63) of whom 11 had a Manual Ability Classification Score (MACS) I, 15 MACS II and 9 MACS III, participated. The trial started with four study groups: BoNT-A-only (n = 5), BITT-only (n = 11), BoNT-A + BITT (n = 13), and control (n = 6). Twenty-two children were randomized and, due to recruitment problems 13 children received their parents' preferred treatment: BoNT-A + BITT or BITT-only. Three comparisons were analysed: BITT (BoNT-A + BITT and BITT-only; n = 24) versus no BITT (BoNT-A-only and control; n = 11), BoNT-A (BoNT-A-only and BoNT-A + BITT; n = 18) versus no BoNT-A (BITT-only and control; n = 17), and the additional effect of BoNT-A (BoNT-A + BITT versus BITT-only). RESULTS BoNT-A significantly decreased key grip strength and finger flexion tone, had a clinically relevant (additional) positive effect on active thumb abduction and supination and a significantly negative effect on unilateral functional strength. BITT + BoNT-A significantly increased active supination. BITT reduced elbow flexor tone and BITT-only resulted in more improvement than BoNT-A + BITT in functional unimanual and, to a lesser extent, in bimanual grip strength. CONCLUSIONS In comparison with BoNT-A + BITT, BITT-only gives more improvement on functional grip strength and, therefore, could possibly increase bimanual performance. In this case, the (additional) role of BoNT-A may be an increase in active supination and thumb abduction.
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Affiliation(s)
- Lucianne Speth
- Adelante, Paediatric Rehabilitation Centre, Onderstestraat 29, 6301 KA Valkenburg, The Netherlands; Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.
| | - Yvonne Janssen-Potten
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands; Maastricht University, Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht, The Netherlands
| | - Pieter Leffers
- Maastricht University, Department of Epidemiology, Maastricht, The Netherlands
| | - Eugene Rameckers
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands; Maastricht University, Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht, The Netherlands
| | - Anke Defesche
- Adelante, Paediatric Rehabilitation Centre, Onderstestraat 29, 6301 KA Valkenburg, The Netherlands
| | - Bjorn Winkens
- Maastricht University, Department of Methodology and Statistics, Maastricht, The Netherlands
| | - Jules Becher
- Free University Medical Centre, Department of Rehabilitation Medicine, Amsterdam, The Netherlands
| | - Rob Smeets
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands; Maastricht University, Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht, The Netherlands; Maastricht University Medical Centre, Department of Rehabilitation Medicine, Maastricht, The Netherlands
| | - J S H Vles
- Maastricht University Medical Centre, Department of Neurology, Maastricht, The Netherlands; Maastricht University, Research School GROW, Department of Neurology, Maastricht, The Netherlands
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Eliasson AC, Krumlinde-Sundholm L, Gordon AM, Feys H, Klingels K, Aarts PBM, Rameckers E, Autti-Rämö I, Hoare B. Guidelines for future research in constraint-induced movement therapy for children with unilateral cerebral palsy: an expert consensus. Dev Med Child Neurol 2014; 56:125-37. [PMID: 24266735 DOI: 10.1111/dmcn.12273] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 01/22/2023]
Abstract
AIM The aim of this study was to provide an overview of what is known about constraintinduced movement therapy (CIMT) in children with unilateral cerebral palsy (CP), to identify current knowledge gaps, and to provide suggestions for future research. METHOD Nine experts participated in a consensus meeting. A comprehensive literature search was conducted and data were summarized before the meeting. The core model produced by the European network for Health Technology Assessment was used as a framework for discussion and to identify critical issues for future research. RESULTS All models of CIMT have demonstrated improvements in the upper limb abilities of children with unilateral CP. A consensus was reached on 11 important questions to be further explored in future studies. The areas of highest priority included the effect of dosage, the effect of repeated CIMT, and the impact of predictive factors, such as age, on the response to CIMT. Consensus suggestions for future study designs and the use of validated outcome measures were also provided. INTERPRETATION The CIMT construct is complex, and much remains unknown. It is unclear whether a specific model of CIMT demonstrates superiority over others and whether dosage of training matters. Future research should build upon existing knowledge and aim to provide information that will help implement CIMT in various countries with different healthcare resources and organizational structures.
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Affiliation(s)
- Ann Christin Eliasson
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Lena Krumlinde-Sundholm
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Andrew M Gordon
- Department of Biobehavioral Sciences; Teachers College; Columbia University; New York NY USA
| | - Hilde Feys
- Department of Rehabilitation Sciences; Katholieke Universiteit; Leuven Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences; Katholieke Universiteit; Leuven Belgium
| | - Pauline B M Aarts
- Department of Paediatric Rehabilitation; Sint Maartenskliniek; Nijmegen The Netherlands
| | - Eugene Rameckers
- Adelante Rehabilitation Center; Valkenburg The Netherlands
- Rehabilitation Medicine CAPHRI; University Maastricht; Maastricht The Netherlands
- Master of Specialised Physical Therapy; AVANSplus; Breda the Netherlands
| | - Ilona Autti-Rämö
- Research Department; Social Insurance Institution; Helsinki Finland
- Department of Child Neurology; Helsinki University Hospital; Helsinki Finland
| | - Brian Hoare
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Monash Children's Hospital; Clayton Vic. Australia
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Speth L, Janssen-Potten Y, Leffers P, Rameckers E, Defesche A, Geers R, Smeets R, Vles H. Observational skills assessment score: reliability in measuring amount and quality of use of the affected hand in unilateral cerebral palsy. BMC Neurol 2013; 13:152. [PMID: 24139170 PMCID: PMC3853931 DOI: 10.1186/1471-2377-13-152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Observational Skills Assessment Score (OSAS) measures amount and quality of use of the affected hand in children with unilateral Cerebral Palsy (CP) in bimanual activities and could therefore be a valuable addition to existing assessment tools. The OSAS consists of tasks that are age appropriate and require use of the affected hand. METHODS To measure the agreement and reliability of the OSAS a convenience sample of two groups of 16 children with unilateral spastic CP (2.5-6 and 12-16 years old), performed age specific bimanual tasks in 2 measurement sessions. Three experienced raters took part in testing and 8 in scoring. Intra class correlation (ICC) values for intra- and inter-rater reliability, and the mean and standard deviation of the differences between measurements were calculated. For test-retest reliability beside ICC scores, Smallest Detectable Differences (SDDs) were calculated in 16 older and 10 younger children. RESULTS Generally, there seems to be good agreement between repeated measurements of the OSAS, as indicated by the small SDDs on most scales for quality of movement, compared to the range of their scales. This indicates potentially good sensitivity to change if used for patient evaluation purposes. The exceptions were the 'quality of reach' score for all tasks, and all quality scores for the stacking blocks task for the young children. As used in the present study, the OSAS has good discriminative capacity within patient populations as indicated by the high ICCs for most quality scores. Measuring the amount of use does not seem to be useful for either discrimination or evaluation. CONCLUSION In general, the OSAS seems to be a reliable tool for assessing the quality of use of the affected hand in bimanual activities in younger and older children with unilateral CP. Some modifications may improve its usefulness and efficiency.
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Affiliation(s)
- Lucianne Speth
- Adelante, Paediatric Rehabilitation, Onderstestraat 29, 6301 KA, Valkenburg, the Netherlands.
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Engelbert R, Scheper M, Rameckers E, Verbunt J, Remvig L, Juul-Kristensen B. AB0800 Children with generalized joint hypermobility and musculoskeletal complaints: state of the art on diagnostics, clinical characteristics and treatment. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Speth L, Vles J, Rameckers E. Additional Effect of Botulinum Toxin A Treatment on Upper Limb Functional Skills in Children with Hemiparetic Cerebral Palsy. Neuromodulation 2005; 8:191-2. [DOI: 10.1111/j.1525-1403.2005.05237-8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Increasingly in the developed world, patients expect to be partners in the management of their healthcare. Several recent studies show that the patient perspective differs from the perspective of the healthcare provider. Patients usually focus on the impact of their condition on their lifestyle, while clinicians may tend to focus on simple objective measures. Like other people, patients with chronic disease such as allergy and asthma want to live as normal a life as possible, and the ability to do so is influenced by the level of disease control, by environmental factors and by social factors. Healthcare managers need to be aware of the patient perspective to ensure that it is taken into account in decision-making.
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Affiliation(s)
- E Rameckers
- European Federation of Asthma and Allergy Associations, Slenaken, The Netherlands
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