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Zade A, Sharath HV, Gangwani N. Pediatric Rehabilitation for Walking Difficulty and Calf Muscle Pain in a 13-Year-Old Male With Spastic Diplegic Cerebral Palsy and Clubfoot Deformity: A Case Report. Cureus 2024; 16:e55697. [PMID: 38586773 PMCID: PMC10998005 DOI: 10.7759/cureus.55697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Cerebral palsy (CP) manifests as atypical muscle tone, posture, and movement, and is classified into four main types: extrapyramidal (dyskinetic), spastic quadriplegia, spastic hemiplegia, and spastic diplegia. Patients with CP might move awkwardly because of this since it indicates that their muscles are tense. We report the case of a 13-year-old child who complained of soreness in his right calf muscle and trouble walking over the previous two years. His condition is recognized as spastic diplegic CP. This report aims to understand the impact of neurophysiotherapy procedures in the context of CP. Physical therapy employs various therapeutic techniques to help patients become more independent in carrying out their everyday tasks and enhance their quality of life, including stretching, proprioceptive neuromuscular facilitation, limb strengthening exercises, and gait training. Early rehabilitation aids in treating various motor functions, such as balance, posture, oral motor functioning, fine motor skills, gross motor skills, muscle control, muscle tone, reflexes, and body movement. It also helps children with CP reach their full potential for physical independence and fitness and enhances the quality of life for both the child and the family. Pediatric rehabilitation yields significant benefits in alleviating walking difficulty and calf muscle pain in individuals with spastic diplegic CP and clubfoot deformity.
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Affiliation(s)
- Aakanksha Zade
- Department of Pediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| | - H V Sharath
- Department of Pediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| | - Nikita Gangwani
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
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Mufti A, Gulati S, Kochhar KP, Alam I, Wadhwa S, Sikka K, Saxena R, Jain S. Novel Therapeutic Strategies of Non-Invasive Brain Stimulation and Nanomedicine in Pediatric Cerebral Palsy Patients. Neurol India 2024; 72:248-257. [PMID: 38691468 DOI: 10.4103/ni.ni_953_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/05/2023] [Indexed: 05/03/2024]
Abstract
Infantile central palsy (CP) is caused due to damage to the immature developing brain usually before birth, leading to altered topography and biochemical milieu. CP is a life-limiting disorder, which causes changes in sensory, motor, cognitive, and behavioral functioning. Understanding its pathophysiology is complex, and current therapeutic modalities, oral medication, surgical treatment, physical therapy, and rehabilitation provide minimal relief. As the brain is plastic, it has an inherent capacity to adapt to altered activity; thus, non-invasive brain stimulation (NIBS) strategies, like repetitive transcranial magnetic stimulation, which can modulate the neuronal activity and its function, may lead to recovery in CP patients. Further, in recent years, nanomedicine has shown a promising approach in pre-clinical studies for the treatment of central nervous system disorder because it can cross the blood-brain barrier, improve penetration, and provide sustained release of the drug. The review focuses on the principles and mechanisms of various NIBS techniques used in CP. We have also contemplated the effect of rehabilitation and nanomedicine in CP children, which will definitely lead to advancing our diagnostic as well as therapeutic abilities, in a vulnerable group of little ones.
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Affiliation(s)
- Aliya Mufti
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Kanwal P Kochhar
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Iqbal Alam
- Department of Physiology Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sanjay Wadhwa
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Kapil Sikka
- Department of ENT, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Rohit Saxena
- Department of Rajendra Prasad Centre, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Suman Jain
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
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Tobaiqi MA, Albadawi EA, Fadlalmola HA, Albadrani MS. Application of Virtual Reality-Assisted Exergaming on the Rehabilitation of Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7091. [PMID: 38002703 PMCID: PMC10672287 DOI: 10.3390/jcm12227091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Rehabilitation programs for children with cerebral palsy (CP) aim to improve their motor and cognitive skills through repeated and progressively challenging exercises. However, these exercises can be tedious and demotivating, which can affect the effectiveness and feasibility of the programs. To overcome this problem, virtual reality VR-assisted exergaming has emerged as a novel modality of physiotherapy that combines fun and motivation with physical activity. VR exergaming allows children with CP to perform complex movements in a secure and immersive environment, where they can interact with virtual objects and scenarios. This enhances their active engagement and learning, as well as their self-confidence and enjoyment. We aim to provide a comprehensive overview of the current state of research on VR exergaming for CP rehabilitation. The specific objectives are: To identify and describe the existing studies that have investigated the effects of VR exergaming on motor function and participation outcomes in children with CP. In addition, we aim to identify and discuss the main gaps, challenges, and limitations in the current research on VR exergaming for CP rehabilitation. Finally, we aim to provide recommendations and suggestions for future research and practice in this field. METHODS In June 2023, we conducted a systematic search on Scopus, Web of Science, PubMed, Cochrane, and Embase for randomized trials and cohort studies that applied VR-assisted exergaming to rehabilitating patients with CP. The inclusion criteria encompassed the following: (1) Randomized controlled trials (RCTs) and cohort studies involving the rehabilitation of children with CP; (2) the application of VR-based exergaming on the rehabilitation; (3) in comparison with conventional rehabilitation/usual care. The quality of the selected RCTs was evaluated using Cochrane's tool for risk of bias assessment bias includes. Whereas the quality of cohort studies was assessed using the National Institutes of Health (NIH) tool. RESULTS The systematic search of databases retrieved a total of 2576 studies. After removing 863 duplicates, 1713 studies underwent title and abstract screening, and 68 studies were then selected as eligible for full-text screening. Finally, 45 studies were involved in this review (n = 1580), and 24 of those were included in the quantitative analysis. The majority of the included RCTs had a low risk of bias regarding study reporting, participants' attrition, and generating a random sequence. Nearly half of the RCTs ensured good blinding of outcomes assessors. However, almost all the RCTs were unclear regarding the blinding of the participants and the study personnel. The 2020 retrospective cohort study conducted at Samsung Changwon Hospital, investigating the effects of virtual reality-based rehabilitation on upper extremity function in children with cerebral palsy, demonstrated fair quality in its methodology and findings. VR-assisted exergaming was more effective than conventional physiotherapy in improving the Gross Motor Function Measurement (GMFM)-88 score (MD = 0.81; 95% CI [0.15, 1.47], p-value = 0.02) and the GMFM walking and standing dimensions (MD = 1.45; 95% CI [0.48, 2.24], p-value = 0.003 and MD = 3.15; 95% CI [0.87, 5.42], p-value = 0.007), respectively. The mobility and cognitive domains of the Pediatric Evaluation of Disability Inventory score (MD = 1.32; 95% CI [1.11, 1.52], p-value < 0.001) and (MD = 0.81; 95% CI [0.50, 1.13], p-value < 0.0001) were also improved. The Canadian Occupational Performance Measure performance domain (MD = 1.30; 95% CI [1.04, 1.56], p-value < 0.001), the WeeFunctional Independence Measure total score (MD = 6.67; 95% CI [6.36, 6.99], p-value < 0.0001), and the Melbourne Assessment of Unilateral Upper Limb Function-2 score (p-value < 0.001) improved as well. This new intervention is similarly beneficial as conventional therapy in improving other efficacy measures. CONCLUSIONS Our findings suggest that VR-assisted exergaming may have some advantages over conventional rehabilitation in improving CP children's functioning and performance in daily life activities, upper and lower limb mobility, and cognition. VR-assisted exergaming seems to be as effective as conventional physiotherapy in the other studied function measures. With its potential efficacy, better feasibility, no reported side effects, and entertaining experience, VR-assisted exergaming may be a viable complementary approach to conventional physiotherapy in rehabilitating children with CP.
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Affiliation(s)
- Muhammad Abubaker Tobaiqi
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia
| | - Emad Ali Albadawi
- Department of Anatomy, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia;
| | - Hammad Ali Fadlalmola
- Department of Community Health Nursing, Nursing College, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia;
| | - Muayad Saud Albadrani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia
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Warutkar VB, Kovela RK, Samal S. Effectiveness of Sensory Integration Therapy on Functional Mobility in Children With Spastic Diplegic Cerebral Palsy. Cureus 2023; 15:e45683. [PMID: 37868525 PMCID: PMC10590061 DOI: 10.7759/cureus.45683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Background A set of non-progressive brain abnormalities and nervous system dysfunctions are referred to as cerebral palsy (CP). Due to this, the child's mobility, eyesight, learning, and thought processes are affected. It can evolve before, through birth, or the first year of a child's life. The activity through which the brain organizes and analyses external sensations like touch, motion, body awareness, vision, hearing, and gravity is indicated as sensory integration. The use of sensory integration therapy (SIT) necessitates that the sensorimotor exercises target the specific parts of difficulties that the child experiences daily. This study aims to study the effectiveness of SIT on functional mobility in children with spastic diplegic CP. Methods In this study, 40 children of CP with spastic diplegic who met the inclusion and exclusion criterion were enlisted and were separated into two groups, with Group A (n=20) receiving SIT for 25 minutes along with conventional physiotherapy for 20 minutes, and Group B (n=20) were given conventional physiotherapy for 45 minutes. A four-week therapy plan was followed. Short sensory profile (SSP) and Gross Motor Function Classification System (GMFCS), Pediatric mini-mental state examination (MMSE), and Modified Ashworth Scale were taken as outcome measures. Results SIT along with traditional treatment is described in the study protocol which aids CP children to improve themselves. Following a four-week protocol, combined therapy of SIT and conventional physiotherapy show an effect on the motor function of the children. After therapy, scores in GMFCS and SSP improved. By using Student's paired t-test, a statistically significant difference was found in GMFCS score at pre and post-test treatment in group A (7.28, p=0.0001) and group B (4.48, p=0.0001), in SSP score at pre and post-test treatment in group A (27.91, p=0.0001) and group B (11.31, p=0.0001), in MMSE score at pre- and post-test treatment in group A (6.89, p=0.0001) and group B (6.32, p=0.0001). The significance threshold was p<0.0001. Conclusion Under the study's experimental conditions, both groups showed substantial improvements in the functional mobility of children. When the efficacy of SIT along with conventional physiotherapy was examined, the impact resulted in a significantly greater improvement in the functional mobility of spastic diplegic CP children.
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Affiliation(s)
- Vaishnavi B Warutkar
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Rakesh K Kovela
- Physiotherapy, Nitte Institute of Physiotherapy, Nitte (Deemed to be University), Mangalore, IND
| | - Snehal Samal
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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Crebbin K, Grisbrook T, Elliott C, Thornton A. The Use of Serious Gaming to Improve Sensorimotor Function and Motivation in People with Cerebral Palsy: A Systematic Review. Games Health J 2023; 12:169-197. [PMID: 36161972 DOI: 10.1089/g4h.2022.0112] [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: 11/13/2022] Open
Abstract
The aim of this systematic review was to review the evidence for serious gaming interventions in improving sensorimotor function in children and adults with cerebral palsy (CP). Seven databases were searched with terms related to serious gaming and CP. Articles were evaluated according to the Downs and Black rating scale and important principles of serious gaming defined by Whyte et al. Extracted data included the population, intervention, serious gaming elements, outcomes, and authors' conclusions. Fifty-seven articles were identified for inclusion. Participants' ages ranged from 3 to 57 years. Interventions tested included commercial videogames as well as specially designed games. Most interventions had themed content, short-term goals, rewards, feedback, and multiple games. Outcome measures and study designs were inconsistent between studies. Sensorimotor function results of noncomparative studies were positive or neutral overall, but results of comparative studies were more mixed. We concluded that serious gaming interventions may be a useful adjunct to treatment as they are noninvasive, were not associated with deterioration in most cases, and may improve compliance. More comparative studies need to be completed to assess compliance and treatment outcomes. Future games should also aim to adhere more closely to the principles of serious gaming.
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Affiliation(s)
- Kayley Crebbin
- UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Tiffany Grisbrook
- UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Catherine Elliott
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Ashleigh Thornton
- UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
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Kumar D, Kumar R, Mudgal SK, Ranjan P, Kumar S. The Effects of Botulinum Toxin and Casting in Spastic Children With Cerebral Palsy: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e36851. [PMID: 37123757 PMCID: PMC10142340 DOI: 10.7759/cureus.36851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Cerebral palsy (CP) is a neurological disorder that affects muscle tone, movement, and motor skills in children. One of the most common symptoms of cerebral palsy is spasticity, which is characterised by involuntary muscle contractions and stiffness. Both botulinum toxin and casting have been used as standalone treatments for spasticity in cerebral palsy, but which is better is still unclear. The aim of the present meta-analysis was to compare the effects on spasticity of serial casting and/or botulinum toxin type A (BoNT-A) in conjunction with or as independent therapies. Studies up to February 2022 were identified in four separate databases. The inclusion criteria were randomised controlled trials (RCTs) that compared different therapies (Botulinum toxin A, or BoNT-A, and casting) and assessed spasticity improvement in children with spastic cerebral palsy who were younger than 18 years old and were published in English. With a 95% confidence interval (CI), the standardised mean difference (SMD) was utilised to calculate treatment effects. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was followed to undertake the current study. The search for relevant literature in four databases generated 147 results. After the abstract and full-text screening, five publications with a total of 190 cerebral palsy patients were included in this systematic review and meta-analysis. In patients with cerebral palsy, both methods - botulinum toxin and casting- apply globally; our systematic review tries to find out the most effective treatment between the two but does not show any significant difference in these methods. As we know, botulinum toxin is expensive, and the casting method is time-consuming and poorly accepted by patients. There is a need for an excellent study to examine the impact of casting and botulinum toxin type A.
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A pilot study on lengthening potentials and biomechanical effects of double and triple hemisection on tendon with slide lengthening. Sci Rep 2023; 13:3922. [PMID: 36894616 PMCID: PMC9998391 DOI: 10.1038/s41598-023-30791-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
The current study explored the slide-lengthening potentials of double and triple hemisections and the biomechanical effects of different inter-hemisection distances. Forty-eight porcine flexor digitorum profundus tendons were divided into double- and triple-hemisection groups (Groups A and B) and a control group (Group C). Group A was divided into Group A1 (distance between hemisections were the same as Group B) and Group A2 (distance between hemisections corresponded to the greatest distance between hemisections in Group B). Biomechanical evaluation, motion analysis, and finite element analysis (FEA) were performed. Failure load of intact tendon was significantly highest among groups. When the distance was 4 cm, the failure load of Group A increased significantly. When the distance between the hemisections was 0.5 or 1 cm, the failure load of Group B was significantly lower than Group A. Tendon elongation and failure load of Group B were significantly lower than those in Group A when the greatest distance between hemisections was the same. Consequently, Double hemisections had a similar lengthening ability to that of triple hemisections with the same distance, but better when the distances between extreme hemisections matched. However, the driving force for the initiation of lengthening may be greater.
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Rafiei Milajerdi H, Ordooiazar F, Dewey D. [Formula: see text]Is active video gaming associated with improvements in social behaviors in children with neurodevelopmental disorders: a systematic review. Child Neuropsychol 2023; 29:1-27. [PMID: 35236234 DOI: 10.1080/09297049.2022.2046721] [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: 10/18/2022]
Abstract
Active video gaming (AVG) is a way that children with neurodevelopmental disorders can participate in social play and could be associated with improvements in social behaviors. However, limited research has investigated if AVG is associated with improvements in social behaviors in children and adolescents with neurodevelopmental disorders. A systematic literature search was conducted in Medline, Embase, Psycinfo, Cinahl, and Eric, Web of Science, and Scopus. Three main concepts were searched: exergaming, neurodevelopmental disorders, and social behaviors. Keywords and subject headings were used for each concept. 3080 articles were identified in the initial search in 2019; in January 2021, 167 additional articles were identified. Of these, 8 studies with 242 children with autism spectrum disorder, cerebral palsy, or developmental coordination disorder were included in this review. Six studies reported that participation in AVG was associated with improved social functioning, social interaction, emotional well-being, and social/emotional skills in children with ASD, CP, and DCD. In contrast, two studies that included children diagnosed with ASD did not find any association between AVG participation and social behaviors. The findings of this systematic review suggest that participation in an AVG intervention may be associated with improved social behaviors in children and adolescents with ASD, CP, and DCD. However, due to the limited number of studies included, this finding must be interpreted with caution. Future research is needed that examines the treatment fidelity of AVG in improving social behavior skills in children with neurodevelopmental disorders and the generalizability of these skills to real-life social situations.
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Affiliation(s)
| | | | - Deborah Dewey
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Botulinum Toxin Intervention in Cerebral Palsy-Induced Spasticity Management: Projected and Contradictory Effects on Skeletal Muscles. Toxins (Basel) 2022; 14:toxins14110772. [PMID: 36356022 PMCID: PMC9692445 DOI: 10.3390/toxins14110772] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged muscle contraction. The persistent resistance of spastic muscles to stretching is often followed by structural and mechanical changes in musculature. This leads to functional limitations at the respective joint. Focal injection of botulinum toxin type-A (BTX-A) is effectively used to manage spasticity and improve the quality of life of the patients. By blocking acetylcholine release at the neuromuscular junction and causing temporary muscle paralysis, BTX-A aims to reduce spasticity and hereby improve joint function. However, recent studies have indicated some contradictory effects such as increased muscle stiffness or a narrower range of active force production. The potential of these toxin- and atrophy-related alterations in worsening the condition of spastic muscles that are already subjected to changes should be further investigated and quantified. By focusing on the effects of BTX-A on muscle biomechanics and overall function in children with CP, this review deals with which of these goals have been achieved and to what extent, and what can await us in the future.
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Hurd CL, Barnes M, Diot CM, Condliffe EG, Alazem H, Pritchard L, Zwicker JD, McCormick A, Watt MJ, Andersen J, Kirton A, Yang JF. Parent-therapist partnership to ELEVATE gross motor function in children with perinatal stroke: protocol for a mixed methods randomized controlled trial. BMC Pediatr 2022; 22:480. [PMID: 35948896 PMCID: PMC9364526 DOI: 10.1186/s12887-022-03525-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is increasing evidence for early, active rehabilitation to enhance motor function following early brain injury. This is clear for interventions targeting the upper extremity, whereas passive treatment approaches for the lower extremity persist. The purpose of this trial is to evaluate the effectiveness of early, intensive rehabilitation targeting the lower extremity and delivered in a parent-therapist partnership model for children with perinatal stroke. Methods We describe a protocol for a waitlist-control, single-blind, mixed methods effectiveness randomized controlled trial, with an embedded qualitative study using interpretative description. Participants are children with perinatal stroke aged eight months to three years with signs of hemiparesis. Participants will be randomly allocated to an immediate ELEVATE (Engaging the Lower Extremity Via Active Therapy Early) intervention group, or a waitlist-control group, who will receive usual care for six months. The ELEVATE intervention involves one hour of training four days per week for 12 weeks, with a pediatric therapist and a parent or guardian each delivering two sessions per week. The intervention targets the affected lower extremity by progressively challenging the child while standing and walking. The primary outcome measure is the Gross Motor Function Measure-66. Secondary outcomes include the Pediatric Quality of Life Inventory™, Young Children's Participation and Environment Measure, and an instrumented measure of spasticity. A cost-effectiveness analysis and qualitative component will explore benefit to costs ratios and parents’ perspectives of early, intensive rehabilitation, and their role as a partner in the rehabilitation, respectively. Discussion This study has the potential to change current rehabilitation for young children with perinatal stroke if the ELEVATE intervention is effective. The parent interviews will provide further insight into benefits and challenges of a partnership model of rehabilitation. The mixed methods design will enable optimization for transfer of this collaborative approach into physical therapy practice. Trial registration ClinicalTrials.gov NCT03672864. Registered 17 September 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03525-6.
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Affiliation(s)
- Caitlin L Hurd
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Michelle Barnes
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | | | - Elizabeth G Condliffe
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Hana Alazem
- Department of Pediatrics, University of Ottawa, and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lesley Pritchard
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Jennifer D Zwicker
- School of Public Policy and Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Man-Joe Watt
- Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Adam Kirton
- Department of Pediatrics and Department of Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jaynie F Yang
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
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Cabezas-López M, Bernabéu-Brotóns E. The effects of Bobath therapy on children with cerebral palsy: a systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Despite its broad application in paediatric care, the effectiveness of therapy based on the Bobath concept has not been systematically researched. The aim of this review was to explore whether there is scientific evidence regarding the validity of the Bobath concept as an effective therapy for children with cerebral palsy. Methods A search was conducted between March and December 2020, of research databases (Cochrane, PEDro, PubMed, Web of Science), selecting randomised controlled trials published since 2015, which compared Bobath therapy with other therapies in terms of their effect on the gross motor functions of children with cerebral palsy. Results Applying the eligibility criteria, four randomised controlled trials were selected, three of which found Bobath therapy to be more effective than other therapies as a therapeutic method, while one found no difference between Bobath therapy and another therapy. No study that met the inclusion criteria found Bobath therapy to be less effective than another therapy. Conclusions The principal limitation of this review has been the small number of randomised controlled trials found and so the results must be interpreted with caution. Nonetheless, studies showed that therapy based on Bobath therapy improves the gross motor function of children with cerebral palsy.
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Karadag-Saygi E, Kenis-Coskun Ö, Unalan PC, Evkaya-Acar A, Giray E, Akgulle AH. Pros and cons of botulinum toxin injection therapy in cerebral palsy: A qualitative study exploring caregivers' perspective. Child Care Health Dev 2022; 48:150-158. [PMID: 34623695 DOI: 10.1111/cch.12915] [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] [Received: 05/13/2021] [Revised: 09/16/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To describe and understand the experiences and beliefs of caregivers of children with cerebral palsy following botulinum toxin injection. METHODS A descriptive case study approach with focus group interviews was employed. A semi-structured questionnaire was conducted to collect data. Twenty-one caregivers of children (3-13 years old) with cerebral palsy were recruited with a maximum variation sampling strategy to gain insight through different perspectives. Qualitative analysis with verbatim transcripts was analysed using a thematic approach. FINDINGS Four themes emerged from qualitative analyses: acceptance of diagnosis, perceptions about treatment, caregivers' experiences with the health environment, and feelings and thoughts after the treatment. CONCLUSIONS This study highlights caregivers' requests for information about the possible long-term effect of botulinum toxin, as well as information and support to provide the best rehabilitation programme immediately after injection.
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Affiliation(s)
- Evrim Karadag-Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Özge Kenis-Coskun
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Pemra C Unalan
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayca Evkaya-Acar
- Department of Physiotherapy and Rehabilitation, Istanbul Medeniyet University Faculty of Health Science, Istanbul, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Hamdi Akgulle
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
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13
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Gercek N, Tatar Y, Uzun S. Alternative exercise methods for children with cerebral palsy: effects of virtual vs. traditional golf training. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:933-942. [PMID: 36568621 PMCID: PMC9788717 DOI: 10.1080/20473869.2021.1926853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 06/17/2023]
Abstract
Aim: Sport activities can increase the number of motor tasks performed by children with disabilities, helping to motivate these children to sustain life-long exercise. The aim of this study was to investigate the effects of virtual and traditional golf training on balance, muscle strength, lower extremity flexibility and aerobic endurance in children with cerebral palsy. Methods: 19 children with unilateral cerebral palsy were divided into two groups, each of them received either virtual (n = 9) or traditional (n = 10) golf training, for over 12 weeks with three days of a 60-minute session/day. The effect of golf training was assessed with the Gross Motor Function Measure-88, the Modified Ashworth Scale and Lateral Step Up, Curl Up, Six-Minute Walk, Sit and Reach, Modified Thomas, and balance tests. Results: Both training methods were associated with improved lower extremity flexibility and muscle strength, aerobic endurance and Gross Motor Function Measure-88 compared with the pre-training baseline values (p < 0.05). There was no difference found between virtual and traditional golf training groups except for balance and lateral step up tests (p > 0.05). Conclusions: Both virtual and traditional golf training applied for 12 weeks on children with unilateral cerebral palsy improved lower extremity functions and physical performance. The use of virtual and traditional training as a complementary application to reduce motor problems in children with cerebral palsy could enhance the sustainability of this type of training because of its edutainment features. Virtual golf has an important advantage over traditional golf in that (a) the latter can be expensive and inaccessible for people with disabilities, and (b) making virtual golf a safer activity.
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Affiliation(s)
- Nejla Gercek
- Sport Health Sciences Department, Faculty of Sports Sciences, University of Marmara, Istanbul, Turkey
| | - Yasar Tatar
- Sport Health Sciences Department, Faculty of Sports Sciences, University of Marmara, Istanbul, Turkey
| | - Selda Uzun
- Sport Health Sciences Department, Faculty of Sports Sciences, University of Marmara, Istanbul, Turkey
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14
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Lee NY, Lee EJ, Kwon HY. The effects of dual-task training on balance and gross motor function in children with spastic diplegia. J Exerc Rehabil 2021; 17:21-27. [PMID: 33728285 PMCID: PMC7939989 DOI: 10.12965/jer.2142032.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/31/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to investigate changes in dynamic balance and gross motion function when dual-task training was performed on an unstable support surface by children with spastic diplegia. The subjects of this study were 14 children (experimental group n=7, control group n=7) who were medical diagnosed with spastic diplegia. Both groups were administered treatment for 30 min, 2 times a week for 8 weeks, with the experimental group performing dual-task exercise in which cognitive tasks related to daily living were performed while maintaining balance on an unstable surface, and the control group being administered neurodevelopmental treatment. Balance and gross motor function Assessments were conducted before intervention and after 8 weeks of intervention. Wilcoxon signed-rank test was performed to analyze changes in balance, gross motor function in the group, and the Mann–Whitney test was conducted to compare the differences between the two groups before and after intervention. The results showed that there was a statistically significant difference in both groups when balance in a sitting position and gross motor function (P<0.05). There was a statistically significant difference between the two groups in balance and gross motor function assessment (P<0.05). Based on the results of this study, it was confirmed that dual-task training improves balance, gross motor function in children with spastic diplegia. Therefore, dual-task training may be considered as an effective method of intervention method in the functional aspect of children with spastic diplegia.
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Affiliation(s)
- Na-Yun Lee
- Ulsan Community Rehabilitation Center, Ulsan, Korea.,Department of Biomedical Health Science, Graduate School, Dong-Eui University, Busan, Korea
| | - Eun-Jung Lee
- Ulsan Community Rehabilitation Center, Ulsan, Korea.,Department of Biomedical Health Science, Graduate School, Dong-Eui University, Busan, Korea
| | - Hae-Yeon Kwon
- Department of Physical Therapy, College of Nursing and Healthcare Science, Dong-Eui University, Busan, Korea
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15
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Samsir MS, Zakaria R, Razak SA, Ismail MS, Rahim MZA, Lin CS, Osman NMFN, Asri MA, Mohd NH, Ahmad AH. Six Months Guided Exercise Therapy Improves Motor Abilities and White Matter Connectivity in Children with Cerebral Palsy. Malays J Med Sci 2020; 27:90-100. [PMID: 33154705 PMCID: PMC7605833 DOI: 10.21315/mjms2020.27.5.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/23/2020] [Indexed: 01/22/2023] Open
Abstract
Background Diffusion magnetic resonance imaging (dMRI) provides the state of putative connectivity from lesioned areas to other brain areas and is potentially beneficial to monitor intervention outcomes. This study assessed the effect of a 6 months guided exercise therapy on motor abilities and white matter diffusivity in the brains of cerebral palsy (CP) children. Methods This is a single arm pre-and post-test research design involving 10 spastic CP children, aged 8–18 years and whose Gross Motor Function Classification System Expanded and Revised (GMFCS-E & R) at least Level 21 with the ability to ambulate independently. They were recruited from Paediatric Neurology Clinic, Hospital Universiti Sains Malaysia (HUSM) from December 2015–December 2016. All participants underwent 6 months of therapist-guided exercise session comprising progressive strength training at a frequency of twice a week, 1 h duration per session. The effect of exercise on motor abilities was assessed using the Gross Motor Function Measures (GMFM)-88. Six out of the 10 children consented for dMRI. Probabilistic tractography of the corticospinal tract (CST) was performed to determine the connectivity index of the tracts pre-and post-intervention. Results All the participants displayed statistically significant increment in GMFM-88 scores pre-to post-exercise intervention. This improvement was concurrent with increased connectivity index in the CST of upper limbs and lower limbs in the brain of these children. Conclusion Our findings demonstrated that 6 months guided exercise therapy improves motor abilities of CP children concurrent with strengthening the connectivities of the motor pathways in the brain.
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Affiliation(s)
- Md Safwan Samsir
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Faculty of Psychology and Education, Universiti Malaysia Sabah, Malaysia
| | - Rahimah Zakaria
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Salmi Abdul Razak
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohamed Saat Ismail
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - Chia-Shu Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Nik Mohammad Faez Nik Osman
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohammad Afiq Asri
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nor Haslina Mohd
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Asma Hayati Ahmad
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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16
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Morscher MA, Thomas MD, Sahgal S, Adamczyk MJ. Onabotulinum toxin type A injection into the triceps unmasks elbow flexion in infant brachial plexus birth palsy: A retrospective observational cohort study. Medicine (Baltimore) 2020; 99:e21830. [PMID: 32846828 PMCID: PMC7447388 DOI: 10.1097/md.0000000000021830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Brachial plexus birth palsy (BPBP) is a neurologic injury that can result in mild to full paralysis of the affected upper extremity. In severe cases, nerve surgery is often performed before age 1 year. Several studies report gains in elbow flexion with onabotulinum toxin type A (OBTT-A) injections to the triceps; however, its use in infants is not widely reported. The purpose of this study is to present our experience using these injections before 6 months of age to therapeutically unmask elbow flexion and diagnostically guide surgical decision making.This is a retrospective observational cohort study. The cohort included infants with BPBP who received OBTT-A injection to the triceps before age 6 months. Indications for the injections include trace elbow flexion and palpable co-contraction of the biceps and triceps. Elbow flexion was evaluated using the Toronto Test score. Therapeutic success was defined as an increase in post-injection scores. These scores were then used diagnostically as an indication for surgery if the infant did not achieve full elbow flexion by 8 months. A treatment algorithm for OBTT-A triceps injection was developed based on all treatment options offered to infants with elbow flexion deficits seen in the clinic.Of the 12 infants that received OBTT-A triceps injections, 10 (83%) had improved Toronto test elbow flexion scores post-injection. Gains in elbow flexion once attained were maintained. Of the 9 OBTT-A infants with at least 2 years follow-up, 4 achieved full elbow flexion without surgery; the remainder after surgery. No complications with OBTT-A injections were noted and patients were followed on average 6 years. The average age at time of injection was 4 months (range: 2-5 months). Compared to other treatments given, OBTT-A infants tended to present with more elbow flexion than the 4 infants requiring immediate surgical intervention and less elbow flexion than the 16 infants treated conservatively.OBTT-A injection to the triceps in infants with BPBP before 6 months of age therapeutically improved elbow flexion and diagnostically guided surgical decisions when full elbow flexion was not achieved by 8 months of age with no known complications.
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Affiliation(s)
| | | | - Suneet Sahgal
- Rehabilitation Services, The Children's Center Rehabilitation Hospital, Bethany, OK
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17
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Leal AF, da Silva TD, Lopes PB, Bahadori S, de Araújo LV, da Costa MVB, de Moraes ÍAP, Marques RH, Crocetta TB, de Abreu LC, Monteiro CBDM. The use of a task through virtual reality in cerebral palsy using two different interaction devices (concrete and abstract) - a cross-sectional randomized study. J Neuroeng Rehabil 2020; 17:59. [PMID: 32349752 PMCID: PMC7191706 DOI: 10.1186/s12984-020-00689-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/16/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cerebral Palsy (CP) is characterised by variable difficulties in muscular action, resulting in inability of the individual to perform functional movement. An option to provide functionality to the individual with CP is the use of computer innovation. The aim of this paper was to verify if there was any performance improvement in a task performed in a virtual environment and if there was transfer to the task performed in the real environment and vice versa in this population. METHODS A computer program was developed comprising a motor task, but with two possibilities of user interaction: a) concrete interface (with physical contact): in which the individual touches the computer screen to finish the task and b) abstract interface (no physical contact): in which the individual performs a hand movement in front of the Kinect device. Participants were split into two groups. The experimental group consisted of 28 individuals with CP within the ages of 6 and 15 years old. The control group included 28 typically developing individuals mirroring the age and sex of the experimental group. RESULTS Individuals from both groups were able to improve task performance and retain acquired information. The CP group presented worse performance than the control group in all phases of the study. Further findings showed that the CP group presented better performance in the abstract interface than in the concrete interface, whereas, in the control group, the opposite occurred: their best performance was in the concrete. CONCLUSIONS Motor tasks performed by individuals with CP through an interface with a more virtual environment feature (abstract interface: Kinect) provided better performance when compared to an interface with a more real characteristic (concrete interface: Touchscreen). TRIAL REGISTRATION ClinicalTrials.gov Identifier - NCT03352440; Date of registration - November 17, 2017.
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Affiliation(s)
- Andréa Fernanda Leal
- Laboratório de Desenho e Escrita Científica, Departamento de Ciências Básicas, Faculdade de Medicina do ABC, Santo André, SP, Brazil
- Departamento de Cardiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Talita Dias da Silva
- Departamento de Cardiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação, Escola de Artes, Ciências e Humanidades - EACH - Universidade de São Paulo, São Paulo, SP, Brazil.
- Faculdade de Medicina, Universidade Cidade de São Paulo - UNICID, São Paulo, SP, Brazil.
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 15, São Paulo, SP, CEP: 05360-160, Brazil.
| | - Priscila Bianchi Lopes
- Departamento de Cardiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Shayan Bahadori
- Orthopaedic Research Institute, Bournemouth University, Executive Business Centre, Holdenhurst Road, Bournemouth, BH8 8EB, UK
| | - Luciano Vieira de Araújo
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação, Escola de Artes, Ciências e Humanidades - EACH - Universidade de São Paulo, São Paulo, SP, Brazil
| | - Murillo Vinicius Brandão da Costa
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação, Escola de Artes, Ciências e Humanidades - EACH - Universidade de São Paulo, São Paulo, SP, Brazil
| | - Íbis Ariana Peña de Moraes
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação, Escola de Artes, Ciências e Humanidades - EACH - Universidade de São Paulo, São Paulo, SP, Brazil
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 15, São Paulo, SP, CEP: 05360-160, Brazil
| | | | - Tania Brusque Crocetta
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação, Escola de Artes, Ciências e Humanidades - EACH - Universidade de São Paulo, São Paulo, SP, Brazil
- Secretaria de Tecnologia da Informação e Comunicação, Universidade do Estado de Santa Catarina - UDESC, Florianópolis, SC, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Desenho e Escrita Científica, Departamento de Ciências Básicas, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Carlos Bandeira de Mello Monteiro
- Laboratório de Desenho e Escrita Científica, Departamento de Ciências Básicas, Faculdade de Medicina do ABC, Santo André, SP, Brazil
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação, Escola de Artes, Ciências e Humanidades - EACH - Universidade de São Paulo, São Paulo, SP, Brazil
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 15, São Paulo, SP, CEP: 05360-160, Brazil
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18
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Daoud MI, Alhusseini A, Ali MZ, Alazrai R. A Game-Based Rehabilitation System for Upper-Limb Cerebral Palsy: A Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2020; 20:E2416. [PMID: 32344557 PMCID: PMC7219503 DOI: 10.3390/s20082416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022]
Abstract
Game-based rehabilitation systems provide an effective tool to engage cerebral palsy patients in physical exercises within an exciting and entertaining environment. A crucial factor to ensure the effectiveness of game-based rehabilitation systems is to assess the correctness of the movements performed by the patient during the game-playing sessions. In this study, we propose a game-based rehabilitation system for upper-limb cerebral palsy that includes three game-based exercises and a computerized assessment method. The game-based exercises aim to engage the participant in shoulder flexion, shoulder horizontal abduction/adduction, and shoulder adduction physical exercises that target the right arm. Human interaction with the game-based rehabilitation system is achieved using a Kinect sensor that tracks the skeleton joints of the participant. The computerized assessment method aims to assess the correctness of the right arm movements during each game-playing session by analyzing the tracking data acquired by the Kinect sensor. To evaluate the performance of the computerized assessment method, two groups of participants volunteered to participate in the game-based exercises. The first group included six cerebral palsy children and the second group included twenty typically developing subjects. For every participant, the computerized assessment method was employed to assess the correctness of the right arm movements in each game-playing session and these computer-based assessments were compared with matching gold standard evaluations provided by an experienced physiotherapist. The results reported in this study suggest the feasibility of employing the computerized assessment method to evaluate the correctness of the right arm movements during the game-playing sessions.
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Affiliation(s)
- Mohammad I. Daoud
- Department of Computer Engineering, German Jordanian University, Amman 11180, Jordan; (A.A.); (R.A.)
| | - Abdullah Alhusseini
- Department of Computer Engineering, German Jordanian University, Amman 11180, Jordan; (A.A.); (R.A.)
| | - Mostafa Z. Ali
- Department of Computer Information Systems, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Rami Alazrai
- Department of Computer Engineering, German Jordanian University, Amman 11180, Jordan; (A.A.); (R.A.)
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19
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Maharaj SS, White TL, Kaka B. Does the physiotherapy management of children with cerebral palsy differ between urban and rural public hospitals in KwaZulu-Natal? A physiotherapist’s perspective. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2018.1536892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sonill S. Maharaj
- Department of Physiotherapy, School of Health Sciences, University of Kwa-Zulu Natal, Durban, South Africa
| | - Tracey-Lee White
- Department of Physiotherapy, School of Health Sciences, University of Kwa-Zulu Natal, Durban, South Africa
| | - Bashir Kaka
- Department of Physiotherapy, School of Health Sciences, University of Kwa-Zulu Natal, Durban, South Africa
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20
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Oudenhoven LM, van Vulpen LF, Dallmeijer AJ, de Groot S, Buizer AI, van der Krogt MM. Effects of functional power training on gait kinematics in children with cerebral palsy. Gait Posture 2019; 73:168-172. [PMID: 31344605 DOI: 10.1016/j.gaitpost.2019.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/25/2019] [Accepted: 06/28/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle weakness is one of the most prevalent symptoms in children with cerebral palsy (CP). Although recent studies show that functional power training can improve strength and functional capacity in young children with CP, effects on specific gait parameters have not previously been reported. RESEARCH QUESTION What are the effects of functional power training on gait in children with CP? Specifically, we investigated effects of training on gait kinematics and spatiotemporal parameters, and whether these were dependent on walking speed. METHODS Ten children with CP (age 5-10 years, GMFCS I-II) participated in a functional power training program. At the start and end of the program, children underwent 3D gait analysis on a treadmill at a gradual range of walking speeds (70-175% of their comfortable walking speed). Multilevel (linear mixed model) analysis was used to evaluate effects pre-post training at different walking velocities. RESULTS Although children's self-chosen comfortable walking speed improved (0.71 ± 0.25 to 0.85 ± 0.25 m/s, p < .05), effects on gait kinematics at similar speed were limited and only exceeded statistical and clinically meaningful thresholds when children walked at higher walking speed. At fast speeds, improvements up to 5° were found in knee and hip extension during stance (p < .01). SIGNIFICANCE This study demonstrates that gait kinematics can improve after functional power training, but the magnitude of effects is dependent on walking speed. In this light, improvements are underestimated when evaluating gait at pre-training comfortable walking speed only.
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Affiliation(s)
- Laura M Oudenhoven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
| | - Liesbeth F van Vulpen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands.
| | - Annet J Dallmeijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, the Netherlands.
| | - Annemieke I Buizer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
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21
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Alkhateeb AM, Daher NS, Forrester BJ, Martin BD, Jaber HM. Effects of adjustments to wheelchair seat to back support angle on head, neck, and shoulder postures in subjects with cerebral palsy. Assist Technol 2019; 33:326-332. [PMID: 31339811 DOI: 10.1080/10400435.2019.1641167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A wheelchair is usually a source of mobility for people with moderate to severe cerebral palsy, who are unable to walk. They spend long periods of time sitting in their wheelchair, which can affect their head and neck alignment. Opening the seat to back support angle of the wheelchair can modify realignment of body segments and improve posture. Aims: To examine the effect of seat to back support angle adjustments on head, neck, and shoulder postural alignment in people with cerebral palsy. Methods: Nine participants with cerebral palsy who use a wheelchair for mobility sat in a research wheelchair. Sagittal head angle (SHA), cervical angle (CVA), and shoulder angle (SA) from photographs were examined using the Coach's Eye device during three different seat to back support angles of the wheelchair (90°, 100°, 110°). Results: There were significant differences in mean SHA and CVA among the different seat to back support angles (p < .001). However, there was no significant difference in mean SA. Conclusion: Head (SHA) and (CVA) alignment was closest to neutral posture with seat to back support angles set at 110°. Thus, adjusting the wheelchair back support to a 110º would provide the most appropriate sagittal head and cervical angle for this population.
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Affiliation(s)
- Afnan M Alkhateeb
- a Physical Therapy Department, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University , Jeddah , Kingdom of Saudi Arabia.,b Department of Physical Therapy, School of Allied Health Professions, Loma Linda University , Loma Linda , California , USA
| | - Noha S Daher
- c Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University , Loma Linda , California , USA
| | - Bonnie J Forrester
- b Department of Physical Therapy, School of Allied Health Professions, Loma Linda University , Loma Linda , California , USA
| | - Bradford D Martin
- b Department of Physical Therapy, School of Allied Health Professions, Loma Linda University , Loma Linda , California , USA
| | - Hatem M Jaber
- b Department of Physical Therapy, School of Allied Health Professions, Loma Linda University , Loma Linda , California , USA
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22
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Firouzeh P, Sonnenberg LK, Morris C, Pritchard-Wiart L. Ankle foot orthoses for young children with cerebral palsy: a scoping review. Disabil Rehabil 2019; 43:726-738. [PMID: 31248284 DOI: 10.1080/09638288.2019.1631394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To describe research on outcomes associated with early Ankle Foot Orthosis (AFO) use, AFO use patterns, and parent and clinician perspectives on AFO use among young children with cerebral palsy. METHOD Arksey and O'Malley's five-stage method was used to conduct a scoping review. MEDLINE (Ovid), PubMed, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, PEDro, Web of Science and Scopus were searched for studies evaluating AFO use with children under the age of six years. Descriptive information was extracted and outcomes categorized according to the International Classification of Functioning, Disability and Health (ICF). Quality assessments were conducted to evaluate methodological rigor. RESULTS Nineteen articles were included in the review; 14 focused on body functions and structures, seven on activity level outcomes and no studies addressed participation outcomes. Evaluations of the effects of AFOs on gross motor skills other than gait were limited. Overall, the body of evidence is comprised of methodologically weak studies with common threats to validity including inadequate descriptions of study protocols, AFO construction, and comparison interventions. CONCLUSION Research evaluating the effects of AFOs on age-appropriate, functional outcomes including transitional movements, floor mobility and participation in early childhood settings is needed to inform practice regarding early orthotic prescription. Implications for rehabilitationLack of rigorous evidence about the effects of AFOs in young children limits the ability of research to guide practice in pediatric rehabilitation.More rigorous research that evaluates a broader range of age-appropriate outcomes, including those focused on participation in meaningful activities, could further inform clinical practice.While clinicians often discuss expectations and goals with individual families, qualitative research that provides more insight into the experiences of families could guide AFO prescription and monitoring practices.
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Affiliation(s)
- Pegah Firouzeh
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Lyn K Sonnenberg
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Glenrose Rehabilitation Hospital, Edmonton, Canada
| | - Christopher Morris
- PenCRU, University of Exeter Medical School, University of Exeter, Exeter, UK
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23
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Kara OK, Sahin S, Yardimci BN, Mutlu A. The role of the family in early intervention of preterm infants with abnormal general movements. ACTA ACUST UNITED AC 2019; 24:101-109. [PMID: 31056541 PMCID: PMC8015461 DOI: 10.17712/nsj.2019.2.20180001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives: To determine the effect of family-based intervention on motor function in preterm infants. Methods: This study was designed as a randomized controlled trial between August 2015 and September 2016. Forty-two preterm infants were randomized and split equally between the family-based intervention group, composed of a physiotherapeutic and a familial component (8 males, 8 females; mean age 91±3.09 days), and the traditional early intervention group (8 females, 8 males, mean age: 91.06±2.4 days). Both groups received a treatment program based on a neurodevelopmental approach during 3- to 12-months-old. The groups were evaluated at corrected ages of the third, sixth, ninth, twelfth, and 24th months using the Bayley Scale of Infant and Toddler Development, Third Edition (Bayley-III). Results: Within-group changes over time were statistically significant using multivariate tests of fine motor (Multivariate analysis of variance (MANOVA); F=1515.27, p<0.001) and gross motor (MANOVA; F=1950.59, p=0.001) development. However, there was no interaction between groups in fine (MANOVA; F=0.027, p=0.872) and gross motor development (MANOVA; F=0.022, p=0.883). Conclusion: The early intervention approaches might support fine and gross motor function development in preterm infants in the first year of life.
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Affiliation(s)
- Ozgun K Kara
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey. E-mail:
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Raji P, Mehraban AH, Ahmadi M, Schiariti V. Assessment priorities in cerebral palsy using ICF core set by Iranian occupational therapists. The Canadian Journal of Occupational Therapy 2019; 86:289-298. [PMID: 31046435 DOI: 10.1177/0008417419833400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. International Classification of Functioning, Disability and Health (ICF) core set for cerebral palsy allows for the description of the levels of functioning in cerebral palsy. It is not exactly clear which of these levels is more important for evaluation from the perspective of occupational therapists in Iran. By identifying these priorities, we can establish a better plan for intervention. PURPOSE. This study defines assessment priorities in children with cerebral palsy (<6 years). METHOD. Sixty-two Iranian occupational therapists studied the priorities of assessment based on the Iranian ICF core set. The therapists were asked to rate the code categories from 1 to 3. The results are presented as mean values. FINDINGS. Occupational therapists first focus on body functions assessment, then activities/participation, and ultimately, environmental factors. IMPLICATIONS. Occupational therapists in Iran have a bottom-up approach toward clients with cerebral palsy. It may be necessary to revise the educational curriculum, prepare a training course, and provide more supervision for practising occupational therapists.
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Abstract
BACKGROUND In children, cerebral palsy (CP) is one of the most common causes of irreversible neurological sequelae. Acupotomy, a modernized acupuncture form combining the effects of microsurgery and conventional acupuncture, may show specific benefits in the treatment of CP, especially with respect to spasticity. The aim of this review was to evaluate the efficacy of acupotomy for CP. METHODS Eleven databases were comprehensively searched from their inception dates to November 27, 2018. Randomized controlled trials (RCTs) or quasi-RCTs evaluating acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment for CP were included. The methodological quality of included studies was assessed using the risk of bias tool. The quality of evidence for each main outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analysis was performed, and the pooled data were presented as mean difference (MD) with 95% confidence interval (CI) for continuous outcomes and as risk ratio (RR) with 95% CI for dichotomous outcomes. RESULTS Eight studies involving 530 participants were included. In 1 study, acupotomy was associated with significantly higher total effective rate (TER) compared with Bobath (P < .01). Acupotomy combined with rehabilitation was associated with significantly higher TER (RR 1.24, 95% CI 1.01-1.52, I = 77%) and gross motor function measure score (MD 12.62, 95% CI 11.75-13.49, I = 54%), and significantly lower muscle tone of gastrocnemius measured by the Ashworth scale or the modified Ashworth scale (MD -0.97, 95% CI -1.07 to -0.88, I = 0%) compared with rehabilitation alone. No studies reported the incidence of adverse events. The methodological quality of the included studies and quality of evidence for the main finding were generally low. CONCLUSION Current evidence shows that acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment might have benefits in the treatment of CP. However, due to the small number of studies included, the lack of sample size, poor methodological qualities, and low quality of evidence, the findings of this review should be interpreted with caution. Larger and more rigorous, high-quality RCTs should be performed on this topic. PROSPERO REGISTRATION NUMBER CRD42018105891.
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Affiliation(s)
- Chan-Young Kwon
- Chung-Yeon Central Institute, Gwangju
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Boram Lee
- Department of Pediatrics of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Republic of Korea
| | - Gyu Tae Chang
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
- Department of Pediatrics of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Republic of Korea
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Ahrens-Nicklas R, Schlotawa L, Ballabio A, Brunetti-Pierri N, De Castro M, Dierks T, Eichler F, Ficicioglu C, Finglas A, Gaertner J, Kirmse B, Klepper J, Lee M, Olsen A, Parenti G, Vossough A, Vanderver A, Adang LA. Complex care of individuals with multiple sulfatase deficiency: Clinical cases and consensus statement. Mol Genet Metab 2018; 123:337-346. [PMID: 29397290 PMCID: PMC6856873 DOI: 10.1016/j.ymgme.2018.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022]
Abstract
Multiple sulfatase deficiency (MSD) is an ultra-rare neurodegenerative disorder that results in defective sulfatase post-translational modification. Sulfatases in the body are activated by a unique protein, formylglycine-generating enzyme (FGE) that is encoded by SUMF1. When FGE is absent or insufficient, all 17 known human sulfatases are affected, including the enzymes associated with metachromatic leukodystrophy (MLD), several mucopolysaccharidoses (MPS II, IIIA, IIID, IVA, VI), chondrodysplasia punctata, and X-linked ichthyosis. As such, individuals demonstrate a complex and severe clinical phenotype that has not been fully characterized to date. In this report, we describe two individuals with distinct clinical presentations of MSD. Also, we detail a comprehensive systems-based approach to the management of individuals with MSD, from the initial diagnostic evaluation to unique multisystem issues and potential management options. As there have been no natural history studies to date, the recommendations within this report are based on published studies and consensus opinion and underscore the need for future research on evidence-based outcomes to improve management of children with MSD.
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Affiliation(s)
- Rebecca Ahrens-Nicklas
- Division of Human Genetics and Metabolism, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Lars Schlotawa
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK; Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Germany.
| | - Andrea Ballabio
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Nicola Brunetti-Pierri
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy; Department of Translational Medicine, Federico II University of Naples, Italy
| | - Mauricio De Castro
- United States Air Force Medical Genetics Center, 81st Medical Group, Keesler AFB, MS, USA
| | - Thomas Dierks
- Faculty of Chemistry, Biochemistry I, Bielefeld University, Bielefeld, Germany
| | - Florian Eichler
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Can Ficicioglu
- Division of Human Genetics and Metabolism, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jutta Gaertner
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Germany
| | - Brian Kirmse
- Department of Pediatrics, Genetic and Metabolism, University of Mississippi Medical Center, USA
| | - Joerg Klepper
- Department of Pediatrics and Neuropediatrics, Children's Hospital, Klinikum Aschaffenburg-Alzenau, Germany
| | - Marcus Lee
- Division of Pediatric Neurology, Children's of Mississippi, University of Mississippi Medical Center, Biloxi, MS, USA
| | | | - Giancarlo Parenti
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy; Department of Translational Medicine, Federico II University of Naples, Italy
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adeline Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura A Adang
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Efficacy of Armeo® Robotic Therapy Versus Conventional Therapy on Upper Limb Function in Children With Hemiplegic Cerebral Palsy. Am J Phys Med Rehabil 2018; 97:164-169. [DOI: 10.1097/phm.0000000000000852] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Adang LA, Sherbini O, Ball L, Bloom M, Darbari A, Amartino H, DiVito D, Eichler F, Escolar M, Evans SH, Fatemi A, Fraser J, Hollowell L, Jaffe N, Joseph C, Karpinski M, Keller S, Maddock R, Mancilla E, McClary B, Mertz J, Morgart K, Langan T, Leventer R, Parikh S, Pizzino A, Prange E, Renaud DL, Rizzo W, Shapiro J, Suhr D, Suhr T, Tonduti D, Waggoner J, Waldman A, Wolf NI, Zerem A, Bonkowsky JL, Bernard G, van Haren K, Vanderver A. Revised consensus statement on the preventive and symptomatic care of patients with leukodystrophies. Mol Genet Metab 2017; 122:18-32. [PMID: 28863857 PMCID: PMC8018711 DOI: 10.1016/j.ymgme.2017.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/18/2017] [Accepted: 08/19/2017] [Indexed: 12/21/2022]
Abstract
Leukodystrophies are a broad class of genetic disorders that result in disruption or destruction of central myelination. Although the mechanisms underlying these disorders are heterogeneous, there are many common symptoms that affect patients irrespective of the genetic diagnosis. The comfort and quality of life of these children is a primary goal that can complement efforts directed at curative therapies. Contained within this report is a systems-based approach to management of complications that result from leukodystrophies. We discuss the initial evaluation, identification of common medical issues, and management options to establish a comprehensive, standardized care approach. We will also address clinical topics relevant to select leukodystrophies, such as gallbladder pathology and adrenal insufficiency. The recommendations within this review rely on existing studies and consensus opinions and underscore the need for future research on evidence-based outcomes to better treat the manifestations of this unique set of genetic disorders.
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Affiliation(s)
- Laura A Adang
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Omar Sherbini
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura Ball
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA; Department of Physical Medicine and Rehabilitation, Children's National Medical Center, Washington, DC, USA
| | - Miriam Bloom
- Department of Pediatrics, Children's National Medical Center, Washington, DC, USA; Complex Care Program, Children's National Medical Center, Washington, DC, USA
| | - Anil Darbari
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's National Medical Center, Washington, DC, USA
| | - Hernan Amartino
- Servicio de Neurología Infantil, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Donna DiVito
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Florian Eichler
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Escolar
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sarah H Evans
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA; Department of Physical Medicine and Rehabilitation, Children's National Medical Center, Washington, DC, USA
| | - Ali Fatemi
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jamie Fraser
- Rare Disease Institute, Children's National Medical Center, Washington, DC, USA
| | - Leslie Hollowell
- Complex Care Program, Children's National Medical Center, Washington, DC, USA
| | - Nicole Jaffe
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher Joseph
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Mary Karpinski
- Pediatric Multiple Sclerosis Center, Women and Children's Hospital, Buffalo, NY, USA
| | - Stephanie Keller
- Division of Pediatric Neurology, Emory University, Atlanta, GA, USA
| | - Ryan Maddock
- Department of Pediatrics, Children's National Medical Center, Washington, DC, USA
| | - Edna Mancilla
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bruce McClary
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jana Mertz
- Autism Spectrum Disorders Center, Women and Children's Hospital, Buffalo, NY, USA
| | - Kiley Morgart
- Psychiatric Social Work Program, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Thomas Langan
- Hunter James Kelly Research Institute, Buffalo, NY, USA
| | - Richard Leventer
- Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Sumit Parikh
- Neurogenetics, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy Pizzino
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Prange
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Deborah L Renaud
- Division of Child and Adolescent Neurology, Departments of Neurology and Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - William Rizzo
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jay Shapiro
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | | | | | - Davide Tonduti
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole I Wolf
- Department of Child Neurology, VU University Medical Centre and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Joshua L Bonkowsky
- Department of Pediatrics, Division of Pediatric Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Genevieve Bernard
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada; Department of Pediatrics, McGill University, Montreal, Canada; Department of Medical Genetics, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada; Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Keith van Haren
- Department of Neurology, Lucile Packard Children's Hospital and Stanford University School of Medicine, Stanford, CA, USA
| | - Adeline Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Translational Science, Children's National Medical Center, Washington, DC, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
Hypertonia is the abnormal increase in muscle tone as a result of upper motor neuron lesions. There are three following clinical types: spasticity, dystonia, and rigidity. Management of hypertonia is individualized and should be directed by the patient and/or family׳s goals of care as well as the underlying cause of the hypertonia. Treatment options include stretching, strengthening, positioning, oral medications, botulinum toxin injections, phenol injections, as well as surgical procedures. Without effective management, hypertonia can result in muscle imbalance, abnormal movement patterns, pain, joint contracture, joint deformity, and ultimately negatively impact a patient׳s function. This discussion serves as an overview of hypertonia, focusing on spasticity and dystonia, in the pediatric population by examining the causes and epidemiology, elucidating its symptoms, discussing available treatment and management options, and clarifying why this all matters.
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Affiliation(s)
- Sarah Helen Evans
- Pediatric Rehabilitation Medicine, Children׳s National Health System, Washington, DC
| | - Mark William Cameron
- Pediatric Rehabilitation Medicine, Children׳s National Health System, Washington, DC
| | - Justin Michael Burton
- Pediatric Rehabilitation Medicine, Children׳s National Health System, Washington, DC
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Reliability of center of pressure measures for assessing the development of sitting postural control through the stages of sitting. Gait Posture 2017; 56:8-13. [PMID: 28477560 PMCID: PMC5511624 DOI: 10.1016/j.gaitpost.2017.04.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 04/12/2017] [Accepted: 04/26/2017] [Indexed: 02/02/2023]
Abstract
Cerebral palsy (CP) impairs an individual's ability to move and control one's posture. Unfortunately, the signs and symptoms of CP may not be apparent before age two. Evaluating sitting posture is a potential way to assess the developing mechanisms that contribute to CP. The purpose of this project was to determine the reliability of linear and nonlinear measures, including inter- and intrastage reliability, when used to analyze the center of pressure (COP) time series during the stages of sitting development in children with typical development (TD) and with/at-risk for cerebral palsy (CP). We hypothesized that nonlinear tools would be more reliable than linear tools in assessing childrens' sitting development, and reliability would increase with development. COP data was recorded for three trials at eight sessions. Linear parameters used were root mean square, range of sway for the anterior-posterior (AP) and medial-lateral (ML) directions, and sway path. Nonlinear parameters used were Approximate Entropy, the largest Lyapunov Exponent, and Correlation Dimension for the AP and ML direction. Participants consisted of 33 children with TD and 26 children with/at-risk for CP. Our results determined that COP is a moderately reliable method for assessing the development of sitting postural control in stages in both groups. Thus, clinicians may be able to use measures from COP data across stages to assess the efficacy of therapeutic interventions that are intended to improve sitting postural abilities in children with/at-risk for CP.
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Adolfsson M, Johnson E, Nilsson S. Pain management for children with cerebral palsy in school settings in two cultures: action and reaction approaches. Disabil Rehabil 2017; 40:2152-2162. [DOI: 10.1080/09638288.2017.1327987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Margareta Adolfsson
- CHILD, Jönköping University, Jönköping, Sweden
- School of Education and Communication, Jönköping University, Jönköping, Sweden
- Swedish Institute of Disability Research, Jönköping University, Jönköping, Sweden
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Stefan Nilsson
- CHILD, Jönköping University, Jönköping, Sweden
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Kassee C, Hunt C, Holmes MWR, Lloyd M. Home-based Nintendo Wii training to improve upper-limb function in children ages 7 to 12 with spastic hemiplegic cerebral palsy. J Pediatr Rehabil Med 2017; 10:145-154. [PMID: 28582885 DOI: 10.3233/prm-170439] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This pilot study compared a Nintendo Wii intervention to single-joint resistance training for the upper limb in children ages 7 to 12 with spastic hemiplegic cerebral palsy (CP). Children were randomized to Wii training (n= 3), or resistance training (n= 3) and trained at home for 6 weeks. Pre, post and 4-week follow-up measures were collected. Outcome measures were the Melbourne Assessment (MA2), and ABILHAND-Kids, and grip strength. Compliance, motivation and feasibility of each intervention was explored using daily logbook responses and questionnaires. Descriptive statistics were used. Three children improved in the MA2, two of which were in the Wii training group. Improvements in the ABILHAND-Kids were minimal for all participants. Grip strength improvements were observed in 3 participants, two of which were in the resistance training group. The Wii training group reported higher compliance and more consistently positive responses to motivation and feasibility questions. Therefore, Wii training may be an effective home-based rehabilitation strategy, and is worth exploring in a larger trial. Implications of Wii training in the context of motivation theory are discussed.
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Affiliation(s)
- Caroline Kassee
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Carolyn Hunt
- Medical Services, Grandview Children's Centre, Oshawa, ON, Canada
| | | | - Meghann Lloyd
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
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Shin JW, Song GB, Ko J. The effects of neck and trunk stabilization exercises on cerebral palsy children's static and dynamic trunk balance: case series. J Phys Ther Sci 2017; 29:771-774. [PMID: 28533628 PMCID: PMC5430291 DOI: 10.1589/jpts.29.771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/18/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this case series was to examination the effects of trunk and
neck stabilization exercise on the static, dynamic trunk balance abilities of children
with cerebral palsy. [Subjects and Methods] The study included 11 school aged children
diagnosed with paraplegia due to a premature birth. Each child engaged in exercise
treatments twice per week for eight weeks; each treatment lasted for 45 minutes. After
conducting a preliminary assessment, exercise treatments were designed based on each
child’s level of functioning. Another assessment was conducted after the eight weeks of
treatment. [Results] The Trunk Control Measurement Scale evaluation showed that the
exercise treatments had a significant effect on static sitting balance, selective movement
control, dynamic reaching, and total Trunk Control Measurement Scale scores. [Conclusion]
The results indicate that neck and trunk stabilization exercises that require children’s
active participation are helpful for improving static and dynamic balance ability among
children diagnosed with cerebral palsy.
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Affiliation(s)
- Ji-Won Shin
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Gui-Bin Song
- Department of Physical Therapy, Yeungnam University College, Republic of Korea
| | - Jooyeon Ko
- Department of Physical Therapy, Daegu Health College, Republic of Korea
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Mansouri M, Birgani PM, Kharazi MR, Lotfian M, Naeimipoor M, Mirbagheri MM. Estimation of gait parameter using sonoelastography in children with cerebral palsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:1729-1732. [PMID: 28268660 DOI: 10.1109/embc.2016.7591050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We aimed to study the relationship between neuromuscular abnormalities associated with spasticity and gait impairments in spastic children with hemiplegia cerebral palsy (CP). Neuromuscular abnormalities of the tibialis anterior and medial gastrocnemius muscles of the spastic ankle were quantified using sonoelastography with two major features; i.e. entropy and histogram ratio of sonoelastography images. Gait impairments were evaluated in the gait laboratory using motion capture system, and the spatial and temporal features were extracted. The correlation analysis showed a significant relation between both the entropy and histogram ratio of sonoelastography images with walking speed and step time. The findings demonstrate that the neuromuscular abnormalities associated with spasticity may contribute to gait impairments in children with CP.
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Basu AP, Pearse JE, Baggaley J, Watson RM, Rapley T. Participatory design in the development of an early therapy intervention for perinatal stroke. BMC Pediatr 2017; 17:33. [PMID: 28114899 PMCID: PMC5259952 DOI: 10.1186/s12887-017-0797-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal stroke is the leading cause of unilateral (hemiparetic) cerebral palsy, with life-long personal, social and financial consequences. Translational research findings indicate that early therapy intervention has the potential for significant improvements in long-term outcome in terms of motor function. By involving families and health professionals in the development and design stage, we aimed to produce a therapy intervention which they would engage with. METHODS Nine parents of children with hemiparesis and fourteen health professionals involved in the care of infants with perinatal stroke took part in peer review and focus groups to discuss evolving therapy materials, with revisions made iteratively. The materials and approach were also discussed at a meeting of the London Child Stroke Research Reference Group. Focus group data were coded using Normalisation Process Theory constructs to explore potential barriers and facilitators to routine uptake of the intervention. RESULTS We developed the Early Therapy in Perinatal Stroke (eTIPS) program - a parent-delivered, home-based complex intervention addressing a current gap in practice for infants in the first 6 months of life after unilateral perinatal stroke and with the aim of improving motor outcome. Parents and health professionals saw the intervention as different from usual practice, and valuable (high coherence). They were keen to engage (high cognitive participation). They considered the tasks for parents to be achievable (high collective action). They demonstrated trust in the approach and felt that parents would undertake the recommended activities (high collective action). They saw the approach as flexible and adaptable (high reflexive monitoring). Following suggestions made, we added a section on involving the extended family, and obtained funding for a website and videos to supplement written materials. CONCLUSIONS Focus groups with parents and health professionals provided meaningful feedback to iteratively improve the intervention materials prior to embarking on a pilot study. The intervention has a high potential to normalize and become a routine part of parents' interactions with their child following unilateral perinatal stroke.
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Affiliation(s)
- Anna Purna Basu
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK. .,Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK.
| | - Janice Elizabeth Pearse
- Therapy Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Jessica Baggaley
- Medical Sciences Graduate School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Rose Mary Watson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
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Jung SH, Song SH, Kim DR, Kim SG, Park YJ, Son YJ, Lee G. Effects of kinesio taping on the gait parameters of children with cerebral palsy: a pilot study. ACTA ACUST UNITED AC 2016. [DOI: 10.14474/ptrs.2016.5.4.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sun-Hye Jung
- JungWoo Children Development Center, Changwon, Republic of Korea
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - Sun-Hae Song
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - Da-Rye Kim
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - Seul-Gi Kim
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - Ye-Jin Park
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - Yeon-Jung Son
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
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Shin JW, Song GB. The effects of neck and trunk stabilization exercises on upper limb and visuoperceptual function in children with cerebral palsy. J Phys Ther Sci 2016; 28:3232-3235. [PMID: 27942155 PMCID: PMC5140835 DOI: 10.1589/jpts.28.3232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/19/2016] [Indexed: 12/19/2022] Open
Abstract
[Purpose] The present study aimed to investigate the effects of neck and trunk
stabilization exercises on upper limb and visuoperceptual function in children with
cerebral palsy. The Jebson-Taylor hand function test and the Korean Developmental Test of
Visual Perception-2 (K-DTVP-2) test were utilised. [Subjects and Methods] The study
subjects were 11 schoolchildren who had paraplegia caused by premature birth, and who had
been diagnosed with periventricular leukomalacia. Kinesitherapy was implemented in
individual children for eight weeks, twice a week, for 45 minutes at a time. After a
preliminary evaluation, kinesitherapy, including neck and trunk stabilization exercises
common to all the children, was implemented for eight weeks according to the functioning
and level of each child. A post evaluation was performed after the eight weeks of
kinesitherapy. [Results] The intervention showed a significant effect in five
subcategories of the Jebson-Taylor hand function test, as well as according to the
K-DTVP-2 test. [Conclusion] Because neck and trunk stabilization exercises requiring
positive participation by the children included fundamental elements of daily living
motion, the exercises might have had a positive effect on upper limb and visuoperceptual
function.
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Affiliation(s)
- Ji-Won Shin
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Gui-Bin Song
- Department of Physical Therapy, Yeungnam University College, Republic of Korea
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Eldridge F, Lavin N. How effective is stretching in maintaining range of movement for children with cerebral palsy? A critical review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.8.386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Fleur Eldridge
- Graduate physiotherapist, University of Bradford, Bradford, UK
| | - Nicole Lavin
- Physiotherapy lecturer, Division of Allied Health Professions and Sport, Faculty of Health Studies, University of Bradford, Bradford, UK
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Surender S, Gowda VK, Sanjay KS, Basavaraja GV, Benakappa N, Benakappa A. Caregiver-reported health-related quality of life of children with cerebral palsy and their families and its association with gross motor function: A South Indian study. J Neurosci Rural Pract 2016; 7:223-7. [PMID: 27114652 PMCID: PMC4821929 DOI: 10.4103/0976-3147.178657] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: In children, health-related quality of life (HRQOL) includes parental impact and family functioning along with concepts of illness, functional status, mental health, and comfort. We are focusing on the impact of cerebral palsy (CP) on children's HRQOL and their families, and its relationship with gross motor dysfunction. Subjects and Methods: CP children aged 3–10 years under regular neurology follow-up were enrolled. The HRQOL and motor severity were prospectively assessed using lifestyle assessment questionnaire-CP and gross motor function classification systems, respectively. Results: One hundred children participated in this study. Thirty-three percent of children had good, 22% had mildly affected, whereas 45% had moderately to severely affected HRQOL. A significant association is present between gross motor function classification system and HRQOL. Conclusion: HRQOL in CP and their caregivers is highly impaired. The degree of impairment is associated with physical independence, mobility, clinical burden, and social integration dimensions. Therapies targeting these dimensions and associated comorbidities will improve the HRQOL. Gross motor function classification system is a good indicator of HRQOL.
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Affiliation(s)
- S Surender
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Vykuntaraju K Gowda
- Department of Paediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - K S Sanjay
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - G V Basavaraja
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Naveen Benakappa
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Asha Benakappa
- Department of Paediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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Low birth weight, very low birth weight and extremely low birth weight in African children aged between 0 and 5 years old: a systematic review. J Dev Orig Health Dis 2016; 7:408-15. [DOI: 10.1017/s2040174416000131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Low birth weight (LBW<2500), very low birth weight (VLBW<1500), extremely low birth weight (ELBW<1500) infants are at high risk for growth failure that result in delayed development. Africa is a continent that presents high rates of children born with LBW, VLBW and ELBW particularly sub-Saharan Africa. To review the existing literature that explores the repercussions of LBW, VLBW and ELBW on growth, neurodevelopmental outcome and mortality in African children aged 0–5 years old. A systematic review of peer-reviewed articles using Academic Search Complete in the following databases: PubMed, Scopus and Scholar Google. Quantitatives studies that investigated the association between LBW, VLBW, ELBW with growth, neurodevelopmental outcome and mortality, published between 2008 and 2015 were included. African studies with humans were eligible for inclusion. From the total of 2205 articles, 12 articles were identified as relevant and were subsequently reviewed in full version. Significant associations were found between LBW, VLBW and ELBW with growth, neurodevelopmental outcome and mortality. Surviving VLBW and ELBW showed increased risk of death, growth retardation and delayed neurodevelopment. Post-neonatal interventions need to be carried out in order to minimize the short-term effects of VLBW and ELBW.
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Simon ADS, do Pinho AS, Grazziotin Dos Santos C, Pagnussat ADS. Facilitation handlings induce increase in electromyographic activity of muscles involved in head control of cerebral palsy children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2547-2557. [PMID: 25010566 DOI: 10.1016/j.ridd.2014.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/14/2014] [Accepted: 06/19/2014] [Indexed: 06/03/2023]
Abstract
This study aimed to investigate the electromyographic (EMG) activation of the main cervical muscles involved in the head control during two postures widely used for the facilitation of head control in children with Cerebral Palsy (CP). A crossover trial involving 31 children with clinical diagnosis of CP and spastic quadriplegia was conducted. Electromyography was used to measure muscular activity in randomized postures. Three positions were at rest: (a) lateral decubitus, (b) ventral decubitus on the floor and (c) ventral decubitus on the wedge. Handlings for facilitating the head control were performed using the hip joint as key point of control in two postures: (a) lateral decubitus and (b) ventral decubitus on wedge. All children underwent standardized handlings, performed by the same researcher with experience in the neurodevelopmental treatment. EMG signal was recorded from muscles involved in the head control (paraspinal and sternocleidomastoid muscles) in sagittal, frontal and transverse planes, at the fourth cervical vertebra (C4), tenth thoracic vertebra (T10) and sternocleidomastoid muscle (SCM) levels. The results showed a significant increase in muscle activation when handling was performed in the lateral decubitus at C4 (P<0.001), T10 (P<0.001) and SCM (P=0.02) levels. A significant higher muscle activation was observed when handling was performed in lateral decubitus when compared to ventral decubitus at C4 level (P<0.001). Handling in ventral decubitus also induced an increase in EMG activation at T10 (P=0.018) and SCM (P=0.004) levels but not at C4 level (P=0.38). In conclusion, handlings performed in both positions may induce the facilitation of head control, as evaluated by the activity of cervical and upper trunk muscles. Handling performed in lateral decubitus may induce a slightly better facilitation of head control. These findings contribute to evidence-based physiotherapy practice for the rehabilitation of severely spastic quadriplegic CP children.
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Affiliation(s)
- Anelise de Saldanha Simon
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Alexandre Severo do Pinho
- Departamento de Fisioterapia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Camila Grazziotin Dos Santos
- Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | - Aline de Souza Pagnussat
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Departamento de Fisioterapia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Programa de Pós Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
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Bonnechère B, Jansen B, Omelina L, Degelaen M, Wermenbol V, Rooze M, Van Sint Jan S. Can serious games be incorporated with conventional treatment of children with cerebral palsy? A review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1899-1913. [PMID: 24794289 DOI: 10.1016/j.ridd.2014.04.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/03/2014] [Accepted: 04/08/2014] [Indexed: 06/03/2023]
Abstract
The use of video games in rehabilitation is becoming more popular to clinicians. These games are embedded in off-the-shelf commercial entertainment applications or especially-developed for clinical purposes. Treatment of cerebral palsy (CP) children is a challenging task for clinicians. Lack of motivation and progress monitoring are two important factors clinicians need to deal with. The use of serious games (SG), sometimes referred to as Virtual Rehabilitation (VR), could therefore be an interesting adjuvant to conventional treatment for these patients. This is however a new discipline and many scientific issues remain to be solved. The aim of this paper is to describe available conventional treatment for CP children together with the level of evidence of each approach. A systematic review of the use of SG in rehabilitation is then conducted. 31 papers (7 randomized clinical trials, 16 cohort studies and 8 single-cases studies) were selected and analyzed, and their level of evidence compared to the conventional treatment. These studies reported outcomes for 352 patients. In summary, this review shows that it is difficult to compare those studies despite the large amount of patients. This is due to the lack of standardization in patient rehabilitation strategy and to the use of various clinical scales and scores. This non-standardization in patient follow-up between previously-published works make evidence-based conclusions difficult to obtain in order to support these techniques objectively. The use of SG for rehabilitation purposes currently meets similar issues. This paper proposes standardization strategies in order to improve treatment comparison and SG use in rehabilitation.
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Affiliation(s)
- B Bonnechère
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, Belgium.
| | - B Jansen
- Department of Electronics and Informatics - ETRO, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium; iMinds, Department of Future Media and Imaging (FMI), Gaston Crommenlaan 8 (Box 102), B-9050 Ghent, Belgium
| | - L Omelina
- Department of Electronics and Informatics - ETRO, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - M Degelaen
- Rehabilitation Hospital Inkendaal, Centrum voor bewegingsanalyse, Vlezenbeek, Belgium; Centre d'analyse du Mouvement, Hôpital Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - V Wermenbol
- Department of Paediatric Neurology - Hôpital Erasme, Belgium
| | - M Rooze
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, Belgium
| | - S Van Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, Belgium
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Oliveira A, Jácome C, Marques A. Physical fitness and exercise training on individuals with spina bifida: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1119-1136. [PMID: 24612860 DOI: 10.1016/j.ridd.2014.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/01/2014] [Accepted: 02/03/2014] [Indexed: 06/03/2023]
Abstract
Spina Bifida (SB) is characterized by several physical impairments; however, data on physical fitness and on the benefits of exercise training in individuals with SB are dispersed in the literature. Thus, this systematic review aimed to describe (i) physical fitness components (cardiorespiratory endurance, muscle strength, body composition, flexibility and neuromotor) and (ii) exercise training effects on the physical fitness of individuals with SB. CINAHL, MEDLINE and EMBASE were searched from January to March 2013 and updated in December 2013. Twenty-three studies were included. A summary of the results was performed using a best-evidence synthesis. Participants with SB had lower cardiorespiratory endurance (-32 to 54% in VO2 peak) and muscle strength (-58 to 90%) and higher body fat (159%) than their healthy peers. Mobility restrictions were present in 26.3-61% of participants. No data on neuromotor fitness were found. Aerobic and strength training improved participants' cardiorespiratory endurance (effect sizes 0.78-1.4) and muscle strength (effect sizes 0-0.59). Individuals with SB have impaired cardiorespiratory endurance, muscle strength, body composition and flexibility when compared to healthy peers. Exercise training seems to improve two of these fitness components (cardiorespiratory endurance and muscle strength). Nevertheless, the heterogeneity of the studies' designs, methods and instruments used limits the establishment of firm conclusions and highlights the need for further research.
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Affiliation(s)
- Ana Oliveira
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal.
| | - Cristina Jácome
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal.
| | - Alda Marques
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal; Unidade de Investigação e Formação sobre Adultos e Idosos (UniFAI), 4050-313 Porto, Portugal.
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Nikaina I, Papavasiliou A. Potential of Botulinum toxin A to treat upper extremity spasticity in children with cerebral palsy. TOXIN REV 2014. [DOI: 10.3109/15569543.2014.896020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Factors related to psychosocial quality of life for children with cerebral palsy. Int J Pediatr 2014; 2014:204386. [PMID: 24678321 PMCID: PMC3941960 DOI: 10.1155/2014/204386] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Current health services interventions focus on the treatment of the musculoskeletal impairments of cerebral palsy (CP). The goal of this study was to explore whether the severity of physical symptoms correlates with psychosocial quality of life (QOL) among pediatric patients with CP. Methods. A sample of 53 caregivers of children with CP was surveyed and health status information was extracted from patient medical records. Descriptive analysis explored the association between the main outcome variable, psychosocial QOL (CP QOL-child), and patient demographics, comorbidity (e.g., visual, hearing and feeding impairments, language delays, and epilepsy), CP severity (GMFCS), and the receipt of family centered care (MPOC-20). Results. Child psychosocial QOL decreased with increasing comorbidity but was not associated with CP symptom severity or any measured demographic factors. Reporting high levels of family centered care (FCC) was associated with higher psychosocial QOL in univariate analysis but was not significant when controlling for comorbidities. Conclusion. There is no clear connection between symptom severity and psychosocial QOL in children with CP. Comorbidity however is strongly associated with psychosocial QOL. Focusing on reducing CP comorbidities could have a positive impact on psychosocial QOL.
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Dhiman N, Chi A, Pawlik TM, Efron DT, Haut ER, Schneider EB, Hashmi ZG, Scott VK, Hui X, Ali MT, Haider AH. Increased complications after appendectomy in patients with cerebral palsy: Are special needs patients at risk for disparities in outcomes? Surgery 2013; 154:479-85. [DOI: 10.1016/j.surg.2013.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/28/2013] [Indexed: 11/29/2022]
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Quality of life in youngsters with cerebral palsy after single-event multilevel surgery. Eur J Paediatr Neurol 2013; 17:401-6. [PMID: 23481663 DOI: 10.1016/j.ejpn.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 12/24/2012] [Accepted: 02/01/2013] [Indexed: 11/22/2022]
Abstract
UNLABELLED A single event-multilevel surgery (SEMLS) is today a well-established modality of treatment in children with cerebral palsy (CP). It comprises muscle lengthening/transfers and correction of bony deformities in a single surgical session. Functional improvements after SEMLS have been examined thoroughly, however little is known about the impact of SEMLS on the quality of life (QOL) of children with CP. This study reports on the QOL of children/adolescents with CP after SEMLS. Forty patients underwent SEMLS and were classified according GMFCS levels II-V, age and time span between surgery and questioning. The Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child) and an author developed questionnaire were completed to evaluate QOL. Overall, children/adolescents reported high quality of life scores after SEMLS on the CP QOL-Child. For all the domains of the CP QOL-Child the children reported significant higher scores than their parents (p < 0.05). Significant differences (p < 0.05) were found for the functional-related domains of the CP QOL-Child between GMFCS level III and levels IV-V, but not for the socio-emotional domains. Older children at the moment of surgery (15y0m-18y11m) reported significantly less 'pain and feeling about disability' than children who were younger when operated on (10y0m-14y11m). Almost all aspects included in the author developed questionnaire improved for the majority of the children after SEMLS. CONCLUSION After SEMLS, children with CP report high quality of life, significantly higher than their parents perceived. Function and age may influence specific aspects of QOL after SEMLS.
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Silva GFD, Teles MC, Santos SA, Ferreira FO, Almeida KM, Camargos ACR. Avaliação de um programa de aplicação de toxina botulínica tipo A em crianças do Vale do Jequitinhonha com paralisia cerebral. CIENCIA & SAUDE COLETIVA 2013; 18:2075-84. [DOI: 10.1590/s1413-81232013000700023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 07/18/2012] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi avaliar os efeitos de um programa público de aplicação de toxina botulínica tipo A (TBA) na espasticidade muscular, amplitude de movimento, qualidade da marcha, independência funcional e qualidade de vida de crianças e adolescentes com paralisia cerebral (PC). Foi realizado um estudo quase experimental que avaliou os efeitos do emprego da TBA, aplicada três vezes, com intervalos de três meses, em 14 crianças com PC. Estas foram avaliadas através da Escala Modificada de Ashworth, Goniometria Manual, Physician Rating Scale, Inventário de Avaliação Pediátrica de Incapacidade (PEDI) e Questionário do Cuidador da Criança (QCC). Foi observada redução da espasticidade, aumento da amplitude de movimento, melhora das habilidades funcionais de autocuidado e mobilidade do PEDI e das áreas de cuidado pessoal, conforto e interação/comunicação do QCC. O programa de aplicação de TBA em crianças e adolescentes com PC, realizado em um núcleo de reabilitação público do Vale do Jequitinhonha, foi efetivo para a população beneficiada.
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Papavasiliou AS, Nikaina I, Foska K, Bouros P, Mitsou G, Filiopoulos C. Safety of botulinum toxin A in children and adolescents with cerebral palsy in a pragmatic setting. Toxins (Basel) 2013; 5:524-36. [PMID: 23482250 PMCID: PMC3705276 DOI: 10.3390/toxins5030524] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 02/20/2013] [Accepted: 03/04/2013] [Indexed: 11/16/2022] Open
Abstract
This retrospective study aimed to examine the safety of botulinum toxin A (BoNT-A) treatment in a paediatric multidisciplinary cerebral palsy clinic. In a sample of 454 patients who had 1515 BoNT-A sessions, data on adverse events were available in 356 patients and 1382 sessions; 51 non-fatal adverse events were reported (3.3% of the total injections number, 8.7% of the patients). On five occasions, the adverse reactions observed in GMFCS V children were attributed to the sedation used (rectal midazolam plus pethidine; buccal midazolam) and resulted in prolongation of hospitalization. Of the reactions attributed to the toxin, 23 involved an excessive reduction of the muscle tone either of the injected limb(s) or generalized; others included local pain, restlessness, lethargy with pallor, disturbance in swallowing and speech production, seizures, strabismus, excessive sweating, constipation, vomiting, a flu-like syndrome and emerging hypertonus in adjacent muscles. Their incidence was associated with GMFCS level and with the presence of epilepsy (Odds ratio (OR) = 2.74 - p = 0.016 and OR = 2.35 - p = 0.046, respectively) but not with BoNT-A dose (either total or per kilogram). In conclusion, treatment with BoNT-A was safe; adverse reactions were mostly mild even for severely affected patients. Their appearance did not necessitate major changes in our practice.
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Affiliation(s)
- Antigone S. Papavasiliou
- Department of Neurology, Pendeli Children’s Hospital, 8 Hippokrates street, Palaia Penteli 15236, Athens, Greece; E-Mails: (I.N.); (K.F.); (P.B.); (G.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +30-2132052597; Fax: +30-2108033012
| | - Irene Nikaina
- Department of Neurology, Pendeli Children’s Hospital, 8 Hippokrates street, Palaia Penteli 15236, Athens, Greece; E-Mails: (I.N.); (K.F.); (P.B.); (G.M.)
| | - Katerina Foska
- Department of Neurology, Pendeli Children’s Hospital, 8 Hippokrates street, Palaia Penteli 15236, Athens, Greece; E-Mails: (I.N.); (K.F.); (P.B.); (G.M.)
| | - Panagiotis Bouros
- Department of Neurology, Pendeli Children’s Hospital, 8 Hippokrates street, Palaia Penteli 15236, Athens, Greece; E-Mails: (I.N.); (K.F.); (P.B.); (G.M.)
| | - George Mitsou
- Department of Neurology, Pendeli Children’s Hospital, 8 Hippokrates street, Palaia Penteli 15236, Athens, Greece; E-Mails: (I.N.); (K.F.); (P.B.); (G.M.)
| | - Constantine Filiopoulos
- Department of Orthopedics, Pendeli Children’s Hospital, 8 Hippokrates street, Palaia Penteli 15236, Athens, Greece; E-Mail:
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Gimeno H, Tustin K, Selway R, Lin JP. Beyond the Burke-Fahn-Marsden Dystonia Rating Scale: deep brain stimulation in childhood secondary dystonia. Eur J Paediatr Neurol 2012; 16:501-8. [PMID: 22258088 DOI: 10.1016/j.ejpn.2011.12.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 12/22/2011] [Accepted: 12/27/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Deep brain stimulation is now widely accepted as an effective treatment for children with primary generalized dystonia. More variable results are reported in secondary dystonias and its efficacy in this heterogeneous group has not been fully elucidated. Deep brain stimulation outcomes are typically reported using impairment-focused measures, such as the Burke-Fahn-Marsden Dystonia Rating Scale, which provide little information about function and participation outcomes or changes in non-motor areas. The aim is to demonstrate that in some cases of secondary dystonia, the sole use of impairment level measures, such as the Burke-Fahn-Marsden Dystonia Rating Scale, may be insufficient to fully evaluate outcome following deep brain stimulation. METHODS Six paediatric cases who underwent deep brain stimulation surgery with a minimum of one year follow up were selected on the basis of apparent non-response to deep brain stimulation, defined as a clinically insignificant change in the Burke-Fahn-Marsden Dystonia Movement Scale (<20%), but where other evaluation measures demonstrated clinical efficacy across several domains. RESULTS Despite no significant change in Burke-Fahn-Marsden Dystonia Rating Scale scores following deep brain stimulation, parallel outcome measures demonstrated significant benefit in a range of child and family-centred goal areas including: pain and comfort, school attendance, seating tolerance, access to assistive technology and in some cases carer burden. CONCLUSIONS Sole use of impairment-focused measures, are limited in scope to evaluate outcome following deep brain stimulation, particularly in secondary dystonias. Systematic study of effects across multiple dimensions of disability is needed to determine what deep brain stimulation offers patients in terms of function, participation, care, comfort and quality of life. Deep brain stimulation may offer meaningful change across multiple domains of functioning, disability and health even in the absence of significant change in dystonia rating scales.
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Affiliation(s)
- Hortensia Gimeno
- Complex Motor Disorders Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK.
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