Effects of Lycra suits in children with cerebral palsy

Design and custom fabrication of specialized orthoses for the upper-limb stabilization in childhood dyskinesia

BACKGROUND

Childhood dyskinesia (CD) is a complex movement disorder with components of dystonic and hyperkinetic nature, characterized by involuntary, sometimes stereotypical postures and gestures that are often impossible to control and hinder the execution of willful motion. The standard orthoses for the treatment of neurological diseases, including CD, are generally poorly differentiated for functional characteristics. The application of similar devices for movement disorders is far less generalized because of the very different symptoms, including the incapacity to control rather than initiate movement.

OBJECTIVES

This article aims to describe an innovative method to fabricate personalized orthoses for the elbow-wrist joints in CD, taking into account anatomical and functional diversities. It also proposes functional elements to implement the required dynamic postural control.

METHODS

Wearable custom-made upper-limb orthoses have been fabricated and preliminarily tested on five patients with CD. Optoelectronic stereophotogrammetry was used as an innovative tool for all-in-one-frame acquisition of limb geometry. A new process for the functional personalization of the orthoses has been developed using shape memory alloys.

CONCLUSIONS

The innovative method presented, encompassing data acquisition, virtual design, fabrication, and assembling, overcomes the problems due to the involuntary movements of the patients, which cannot be avoided during the fitting operations, providing comfortable and useful orthoses with minimal nuisance for the patients. Initial tests show that the orthoses were well tolerated by all the subjects; the promising comments of caregivers, together with improvements, were observed by the clinicians using specific clinical scales.

Application of Space Technologies Aimed at Proprioceptive Correction in Terrestrial Medicine in Russia

Space technologies greatly contributed not only to space medicine but also to terrestrial medicine, which actively involves these technologies in everyday practice. Based on the existing countermeasures, and due to similarities of sensorimotor alterations provoked by the weightlessness with various neurological disorders, a lot of work has been dedicated to adaptation and introduction of these countermeasures for rehabilitation of patients. Axial loading suit and mechanical stimulation of the soles’ support zones are used in mitigation of stroke and traumatic brain injury consequences. They are also applied for rehabilitation of children with cerebral palsy. Complex application of these proprioceptive correction methods in neurorehabilitation programs makes it possible to effectively treat neurological patients with severe motor disturbances and significant brain damage.

Consensus Paper: Ataxic Gait

The aim of this consensus paper is to discuss the roles of the cerebellum in human gait, as well as its assessment and therapy. Cerebellar vermis is critical for postural control. The cerebellum ensures the mapping of sensory information into temporally relevant motor commands. Mental imagery of gait involves intrinsically connected fronto-parietal networks comprising the cerebellum. Muscular activities in cerebellar patients show impaired timing of discharges, affecting the patterning of the synergies subserving locomotion. Ataxia of stance/gait is amongst the first cerebellar deficits in cerebellar disorders such as degenerative ataxias and is a disabling symptom with a high risk of falls. Prolonged discharges and increased muscle coactivation may be related to compensatory mechanisms and enhanced body sway, respectively. Essential tremor is frequently associated with mild gait ataxia. There is growing evidence for an important role of the cerebellar cortex in the pathogenesis of essential tremor. In multiple sclerosis, balance and gait are affected due to cerebellar and spinal cord involvement, as a result of disseminated demyelination and neurodegeneration impairing proprioception. In orthostatic tremor, patients often show mild-to-moderate limb and gait ataxia. The tremor generator is likely located in the posterior fossa. Tandem gait is impaired in the early stages of cerebellar disorders and may be particularly useful in the evaluation of pre-ataxic stages of progressive ataxias. Impaired inter-joint coordination and enhanced variability of gait temporal and kinetic parameters can be grasped by wearable devices such as accelerometers. Kinect is a promising low cost technology to obtain reliable measurements and remote assessments of gait. Deep learning methods are being developed in order to help clinicians in the diagnosis and decision-making process. Locomotor adaptation is impaired in cerebellar patients. Coordinative training aims to improve the coordinative strategy and foot placements across strides, cerebellar patients benefiting from intense rehabilitation therapies. Robotic training is a promising approach to complement conventional rehabilitation and neuromodulation of the cerebellum. Wearable dynamic orthoses represent a potential aid to assist gait. The panel of experts agree that the understanding of the cerebellar contribution to gait control will lead to a better management of cerebellar ataxias in general and will likely contribute to use gait parameters as robust biomarkers of future clinical trials.

The impact of conservative soft orthotic intervention with strapping on thoracic kyphotic posture and spinal mobility in children with cerebral palsy: a randomized control trial

Background

This study mainly aimed to evaluate the influences of Thera Togs orthotic undergarment with its strapping system on dorsal kyphotic posture and spinal mobility in children with spastic diplegic cerebral palsy. The study also investigated the impact of the modulation of thoracic kyphosis on balance and risk of falls in these children.

Study design

This study was a randomized control trial.

Participants

Forty children with diplegic cerebral palsy, aged from 8 to 10 years were met the inclusion criteria and participated in this study. Only 38 children completed the study.

Methods

The children in the control group received 2 h of conventional exercise protocol aiming for modulating thoracic kyphotic posture. The treatment program was conducted 3 times/week, for 12 successive weeks. Children in the study group wore TheraTogs orthoses with the strapping system for 8 h every day in combination with the conventional exercise program.

Outcome measures

For both groups, the primary outcome measures (thoracic kyphotic angle, and thoracic flexion and extension range of motion), and the secondary outcomes (the overall stability index of fall risk test, and the pediatric balance scale score) were recorded at baseline and after completion of the treatment. T test was used to compare the changes within-and between-groups in all measured variables, at baseline and immediately after 12 weeks of treatment.

Results

Children in the study group showed significant improvements in the scores of all primary and secondary measures post-treatment compared to the control group (P < 0.05).

Conclusion

Conservative treatment composed of TheraTogs orthotic system with conventional exercise treatment is effective in modulating thoracic kyphosis and improving dorsal range of motion in children with spastic diplegic cerebral palsy. This improvement has a positive influence on postural balance performance and reduces the risk of fall in these children.

Trial registration

The ClinicalTrial.gov PRS (NCT05063175). 30 September 2021—retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05063175

Efficacy of TheraTogs orthotic undergarment on modulation of spinal geometry in children with diplegic cerebral palsy

Background

The use of TheraTogs orthotic undergarments has been suggested to improve the ability to stabilize the posture, to correct or prevent deformities, to improve functionality, and to enable the user a more appropriate functional pattern. The aim of this study was to investigate the efficacy of TheraTogs orthotic undergarment on modulation of spinal geometry in children with diplegic cerebral palsy. Forty children with diplegic cerebral palsy, with ages ranging from 6 to 9 years, were selected for this randomized controlled study. They were randomly assigned to (1) an experimental group that received TheraTogs orthotic undergarment (12 h/day, 3 days/week) plus traditional physical therapy for 3 successive months and (2) a control group that received only traditional physical therapy program for the same time period. Spinal geometry was measured at baseline and after 3 months of intervention using the Formetric system.

Results

Children in both groups showed significant improvements in the spinal geometry (P < 0.05), with significantly greater improvements in the experimental group than the control group. The post-treatment mean values of lateral deviation (mm), pelvic tilt (mm), trunk imbalance (mm), and surface rotation (mm) were 5.45, 6.35, 8.8, and 3.65 and 8, 8.9, 11.2, and 5.9 for the experimental and control group, respectively.

Conclusions

TheraTogs orthotic undergarment may be a useful tool for improving spinal geometry in children with diplegic cerebral palsy.

Trial registration

This study was registered in the ClinicalTrial.gov PRS (NCT04271618).

Efficacy of axial TheraTogs on gait pattern in children with dyskinetic cerebral palsy: a randomized controlled trial

Background

TheraTogs promotes proprioceptive sense of a child with cerebral palsy and improves abnormal muscle tone, posture alignment, balance, and gait. Therefore, the aim of this study was to investigate the efficacy of TheraTogs orthotic undergarment on gait pattern in children with dyskinetic cerebral palsy. Thirty children with dyskinetic cerebral palsy were selected for this randomized controlled study. They were randomly assigned to (1) an experimental group that received TheraTogs orthotic undergarment (12 h/day, 3 days/week) plus traditional physical therapy for 3 successive months and (2) a control group that received only traditional physical therapy program for the same time period. Gait parameters were measured at baseline and after 3 months of intervention using Pro-Reflex motion analysis.

Results

Children in both groups showed significant improvements in the gait parameters (P < 0.05), with significantly greater improvements in the experimental group than in the control group.

Conclusions

The use of TheraTogs may have a positive effect to improve gait pattern in children with dyskinetic cerebral palsy.

Trial registration

This trial was registered in the ClinicalTrial.gov PRS (NCT03037697).

A case study on interface pressure pattern of two garment orthoses on a child with cerebral palsy

Many studies have shown that medical compression products produce different levels of interface pressure during the usage of the products. However, limited studies have explored the pattern of interface pressure exerted by orthotic garments. This case study aimed to investigate the pattern of interface pressure exerted by two types of orthotic garments on a child with cerebral palsy. A 13-year-old child diagnosed with ataxic spastic diplegia cerebral palsy has difficulty to perform sit-to-stand motion even with a walking frame due to his truncal ataxia. A TheraTogsTM orthosis and a Dynamic Lycra® Fabric Orthosis (DLFO) were prepared for the child. The child’s sit-to-stand ability without and with the usage of orthoses was recorded using five sit-to-stand tests. The garments’ interface pressure was measured using F-scan (9811E) and F-scan 6.5.1 version software. The pressure was recorded when the child was in sitting position and performing sit-to-stand-to-sit motion. Overall, the child completed the five sit-to-stand test duration within 2.53 ± 0.04 s and 2.51 ± 0.09 s with the usage of TheraTogsTM orthosis and DLFO, respectively. Higher pressure was exerted by Dynamic Lycra Fabric Orthosis (axillary = 122 mmHg) in contrast to TheraTogsTM orthosis (77 mmHg) when the child was in a sitting position. Lower pressure was exerted by DLFO (7 mmHg), over xiphoid level and for TheraTogsTM orthosis is 1.2 mmHg over axillary level when the child was performing sit-to-stand motion. The largest range of pressure was exerted by TheraTogsTM orthosis with a minimum pressure of 5 mmHg and a maximum pressure of 155 mmHg during sit-to-stand motion. Overall, the DLFO exerted higher mean interface pressure on the child in comparison to TheraTogsTM orthosis when the child’s body was in a sitting position wearing both upper garment and pants. Both TheraTogsTM orthosis and DLFO presented a different range of interface pressure over different body segments and activities.

The clinical aspects and effectiveness of suit therapies for cerebral palsy: A systematic review

OBJECTIVES

The aim of this review to evaluate the clinical aspects and effectiveness of suit therapy for patients with cerebral palsy (CP).

MATERIALS AND METHODS

A literature search was performed in the PubMed, SCOPUS, Web of Science, and PEDro databases within the period from the establishment of the relevant database to July 2018. The articles were categorized according to their study design. We included studies published in peer-review journals focusing on the efficacy of suit therapies for CP and excluded review articles, duplications, non-related articles. A narrative synthesis approach was used, as it was not possible to classify extracted and analyzed data, and the overall effect size was unable to be calculated. Data regarding study subjects (number, age, CP type, Gross Motor Function Classification System [GMFCS] level), suit type, intervention including dose of suit therapy, outcome measurements, outcomes, adverse effects, and funding were extracted. The method introduced by Furlan, Pennick, Bombardier, and van Tulder was used to evaluate the risk of bias for the assessment of methodological quality of randomized-controlled trials (RCTs).

RESULTS

A total of 29 studies were included of which 10 were Class I, eight were Class II-III, and 11 were Class IV studies. Studies were heterogenous in design, sample size, study population, and outcomes measured. The methodological quality score of RCTs varied between 4 and 10. The results of the high-quality RCTs showed that wearing the suit along with conventional therapy improved proximal stability, gross motor function, and gait. The Class II-III and IV studies supported the findings of the Class I studies.

CONCLUSION

The major improvements from the RCTs were seen in proximal stability, gross motor function and gait, although grading was unable to be done due to the heterogeneity of included studies. In order to obtain gains in the function, it is important to carefully consider intended use, patient selection criteria, and suit type.