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Liang KJ, Chen HL, Huang CW, Wang TN. Efficacy of Constraint-Induced Movement Therapy Versus Bimanual Intensive Training on Motor and Psychosocial Outcomes in Children With Unilateral Cerebral Palsy: A Randomized Trial. Am J Occup Ther 2023; 77:7704205030. [PMID: 37611319 DOI: 10.5014/ajot.2023.050104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
IMPORTANCE Emerging research has demonstrated that constraint-induced movement therapy (CIMT) and bimanual intensive training (BIT) show promising effectiveness for children with unilateral cerebral palsy (UCP). Considering that neurorehabilitative programs have always been designed with long training periods, psychosocial outcomes have received scarce attention and thus have not been investigated sufficiently. OBJECTIVE To compare the efficacy of CIMT and BIT with 36-hr interventional dosages for both motor and psychosocial outcomes. DESIGN Randomized trial. SETTING Community. PARTICIPANTS Forty-eight children with UCP, ages 6 to 12 yr. INTERVENTION Both CIMT and BIT delivered via individual intervention for 2.25 hr/day, twice a week, for 8 wk. OUTCOMES AND MEASURES The Melbourne Assessment 2, Pediatric Motor Activity Log-Revised, Bruininks-Oseretsky Test of Motor Proficiency, ABILHAND-Kids measure, and Parenting Stress Index-Short Form were administrated at pretreatment, midterm, posttreatment, and 6 mo after intervention. An engagement questionnaire for investigating the child's engagement in the intervention was used to collect the perspectives of the children and the parents weekly. RESULTS Children with UCP who received either CIMT or BIT achieved similar motor improvements. The only difference was that CIMT yielded larger improvements in frequency and quality of use of the more affected hand at the 6-mo follow-up. Similar child engagement and parental stress levels were found in the two groups. CONCLUSIONS AND RELEVANCE This study comprehensively compared the efficacy of motor and psychosocial outcomes for 36-hr dosages of CIMT and BIT. The promising findings support the clinical efficacy and feasibility of the proposed protocols. What This Article Adds: The core therapeutic principle of CIMT (i.e., remind the child to use the more affected hand) may be more easily duplicated by parents. Parents may have overestimated their child's engagement and given relatively higher scores; therefore, occupational therapists should also consider the opinions of the children themselves.
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Affiliation(s)
- Kai-Jie Liang
- Kai-Jie Liang, PhD, is Postdoctoral Researcher, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan City, Taiwan. At the time this article was submitted, Liang was PhD Student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Hao-Ling Chen
- Hao-Ling Chen, PhD, is Associate Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chen-Wei Huang
- Chen-Wei Huang, MS, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Chiali Branch, Tainan City, Taiwan
| | - Tien-Ni Wang
- Tien-Ni Wang, PhD, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan;
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Ragni LB, Dlugacz SK, Sadowsky C, Cammarata G, Sala DA, Bill V, Sukhov R, Chu A. Design and Use of a 3D-Printed Dynamic Upper Extremity Orthosis for Children With Cerebral Palsy and Severe Upper Extremity Involvement: A Pilot Study. Am J Occup Ther 2023; 77:7704205060. [PMID: 37611318 DOI: 10.5014/ajot.2023.050095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
IMPORTANCE Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses. OBJECTIVE To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V. DESIGN Pilot study. Assessments were performed pretreatment and immediately posttreatment. SETTING Hospital-based outpatient occupational therapy department. PARTICIPANTS Five patients, ages 13 to 17 yr, with CP and unilateral UE involvement MACS Levels III to V. INTERVENTION Custom forearm thumb opponens orthosis and the DUEO were designed and fabricated by a multidisciplinary team for use during eight 1-hr occupational therapy sessions targeting bimanual UE training. OUTCOMES AND MEASURES Pretreatment and posttreatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), and the Pediatric Quality of Life Inventory: CP Module (PedsQL:CP). RESULTS All participants had higher posttreatment scores on at least one measure. Four had minimal clinically important differences (MCID) on the AHA. Three met MCID criteria on MA-2 subtests (one negative change). Four demonstrated improvement on the PMAL-R (one participant achieved an MCID score), and three reported improvements in more than one PedsQL:CP domain. CONCLUSIONS AND RELEVANCE This novel 3D-printed device, in combination with occupational therapy, shows promising evidence that children who score in lower MACS levels can show gains in UE function. What This Article Adds: This study demonstrates that a customized, 3D-printed dynamic orthosis, in combination with occupational therapy intervention, can facilitate UE function in children with severe hand impairment.
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Affiliation(s)
- Lori B Ragni
- Lori B. Ragni, MS, OTR/L, BCP, is Supervisor, Pediatric Occupational Therapy, Rusk Rehabilitation, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Stacy Kirsch Dlugacz
- Stacy Kirsch Dlugacz, MS, OTR/L, C/NDT, is Clinical Specialist, Pediatric Occupational Therapy, Rusk Rehabilitation, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Cali Sadowsky
- Cali Sadowsky, MS, OTR/L, is Senior Occupational Therapist, Pediatric Occupational Therapy, Rusk Rehabilitation, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Gabriella Cammarata
- Gabriella Cammarata, MS, is Studio Research Coordinator, Tandon School of Engineering, New York University, Brooklyn, NY
| | - Debra A Sala
- Debra A. Sala, MS, PT, is Research Coordinator, Division of Pediatric Orthopedics, Hassenfeld Children's Hospital, NYU Langone Health, New York, NY
| | - Victoria Bill
- Victoria Bill, MS, is Director, MakerSpace, and Adjunct Professor, Tandon School of Engineering, New York University, Brooklyn, NY
| | - Renat Sukhov
- Renat Sukhov, MD, is Clinical Research Associate Professor of Rehabilitation Medicine, NYU Langone Health, New York, NY
| | - Alice Chu
- Alice Chu, MD, is Associate Professor of Orthopedic Surgery and Chief, Division of Pediatric Orthopedics, Rutgers New Jersey Medical School, Newark, NJ;
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Shih TY, Wang TN, Shieh JY, Lin SY, Ruan SJ, Tang HH, Chen HL. Comparative effects of kinect-based versus therapist-based constraint-induced movement therapy on motor control and daily motor function in children with unilateral cerebral palsy: a randomized control trial. J Neuroeng Rehabil 2023; 20:13. [PMID: 36703170 PMCID: PMC9880374 DOI: 10.1186/s12984-023-01135-6] [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: 04/30/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Constraint-induced movement therapy (CIMT) is a prominent neurorehabilitation approach for improving affected upper extremity motor function in children with unilateral cerebral palsy (UCP). However, the restraint of the less-affected upper extremity and intensive training protocol during CIMT may decrease children's motivation and increase the therapist's workload and family's burden. A kinect-based CIMT program, aiming to mitigate the concerns of CIMT, has been developed. The preliminary results demonstrated that this program was child-friendly and feasible for improving upper extremity motor function. However, whether the kinect-based CIMT can achieve better or at least comparable effects to that of traditional CIMT (i.e., therapist-based CIMT) should be further investigated. Therefore, this study aimed to compare the effects of kinect-based CIMT with that of therapist-based CIMT on upper extremity and trunk motor control and on daily motor function in children with UCP. METHODS Twenty-nine children with UCP were recruited and randomly allocated to kinect-based CIMT (n = 14) or therapist-based CIMT (n = 15). The intervention dosage was 2.25 h a day, 2 days a week for 8 weeks. Outcome measures, namely upper extremity and trunk motor control and daily motor function, were evaluated before and after 36-h interventions. Upper extremity and trunk motor control were assessed with unimanual reach-to-grasp kinematics, and daily motor function was evaluated with the Revised Pediatric Motor Activity Log. Between-group comparisons of effectiveness on all outcome measures were analyzed by analysis of covariance (α = 0.05). RESULTS The two groups demonstrated similar improvements in upper extremity motor control and daily motor function. In addition, the kinect-based CIMT group demonstrated greater improvements in trunk motor control than the therapist-based CIMT group did (F(1,28) > 4.862, p < 0.036). CONCLUSION Kinect-based CIMT has effects comparable to that of therapist-based CIMT on UE motor control and daily motor function. Moreover, kinect-based CIMT helps decrease trunk compensation during reaching in children with UCP. Therefore, kinect-based CIMT can be used as an alternative approach to therapist-based CIMT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02808195. Registered on 2016/06/21, https://clinicaltrials.gov/ct2/show/NCT02808195 .
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Affiliation(s)
- Tsai-Yu Shih
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tien-Ni Wang
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan ,grid.412094.a0000 0004 0572 7815Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jeng-Yi Shieh
- grid.412094.a0000 0004 0572 7815Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Yu Lin
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shanq-Jang Ruan
- grid.45907.3f0000 0000 9744 5137Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Hsien-Hui Tang
- grid.45907.3f0000 0000 9744 5137Department of Design, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Hao-Ling Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Delioğlu K, Seyhan Bıyık K, Uzumcugil A, Kerem Günel M. "How Well" and "How Often" questions for birth brachial plexus injury: a validity and reliability of the pediatric upper extremity motor activity log-revised. Disabil Rehabil 2022:1-7. [PMID: 35737641 DOI: 10.1080/09638288.2022.2085333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The pediatric upper extremity motor activity log-revised (PMAL-R) is a structured interview that measures use of the affected arm in daily life in children with unilateral pathologies like hemiparetic cerebral palsy (CP) or birth brachial plexus injury (BBPI). This study investigated validity and test-retest reliability of the PMAL-R in children with BBPI. MATERIALS AND METHODS The PMAL-R was administered to parents of 132 children with BBPI between 5 and 9 years for validity, also 98 parents were re-interviewed after 3 weeks to establish test-retest reliability. Its concurrent validity was examined by correlating scores on the PMAL-R How Well (HW) and How Often (HO) scales with Brachial Plexus Outcome Measure (BPOM) and Pediatric Outcomes Data Collection Instrument (PODCI) scores. RESULTS PMAL-R scores were strongly correlated with BPOM scores (HW, r = 0.943, p < 0.001; HO, r = 0.897, p < 0.001), also strongly correlated with PODCI (HW, r = 0.799, p < 0.001; HO, r = 0.797, p < 0.001). PMAL-R test-retest reliability (intraclass correlation; HO = 0.997, HW = 0.998) and internal consistency (Cronbach's a; HO = 0.99, HW = 0.99) were high. CONCLUSIONS The PMAL-R has good reliability and validity for measuring everyday use of the affected arm with "how often" and "how well" questions in children with BBPI. Implications for rehabilitationThe pediatric upper extremity motor activity log-revised (PMAL-R) is the first tool to assess both "how often" and "how well" the affected arm is used in unimanual activities in children with BBPI.PMAL-R is a real-world measure providing valuable information about "how often" and "how well" the affected arm is used to guide treatment.PMAL-R is valid in both concurrent and discriminative validity in children with BBPI.PMAL-R is reliable in children with BBPI.
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Affiliation(s)
- Kıvanç Delioğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Kübra Seyhan Bıyık
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Akin Uzumcugil
- Medicine Faculty, Department of Orthopedics and Traumaology, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem Günel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Kim SG, Kim DH. Reliability, minimum detectable change, and minimum clinically important difference of the balance subtest of the Bruininks-Oseretsky test of motor proficiency-second edition in children with cerebral palsy. J Pediatr Rehabil Med 2022; 15:175-180. [PMID: 35253658 DOI: 10.3233/prm-190639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study aimed to investigate the internal consistency, inter-rater, and test-retest reliability of the balance subtest of the Bruininks-Oseretsky test of motor proficiency-second edition (BOT-2) and to estimate the minimum detectable change (MDC) and minimum clinically important difference (MCID) of the balance subtest of the BOT-2 in children with cerebral palsy (CP). METHODS In total, 20 children with CP participated in the present study. Internal consistency, test-retest, and inter-rater reliability were computed to establish reliability of the balance subtest of the BOT-2. The MDC95 was estimated from the standard error of measurement (SEM) to determine a real change for an individual child with CP. The anchor- and distribution-based MCID were calculated to determine the smallest change that might be important to clinicians. For concurrent validity, the correlation between the balance subtest of the BOT-2 and the pediatric balance scale (PBS) were calculated using Spearman's correlation. RESULTS Internal consistency was good (Cronbach's alpha coefficient = 0.89). The BOT-2 had excellent test-retest (ICC = 0.99, p < 0.001) and inter-rater reliability (ICC = 0.99, p < 0.001). The balance subtest of the BOT-2 had an SEM of 0.70, MDC95 of 9.61, and MCIDs of 2.54 (anchor-based) and 1.38 (distribution-based). Additionally, there was a moderate positive correlation between the balance subtest of the BOT-2 and the PBS (Spearman's rho = 0.629, p = 0.003). CONCLUSIONS Our experimental results indicate that the balance subtest of the BOT-2 had good internal consistency, along with excellent test-retest and inter-rater reliability. The change in scores of an individual child with CP should attain 9.61 points on the balance subtest of the BOT-2 to indicate a clinically important change. The MDC95 and MCID values could be helpful in understanding therapeutic effects and evaluating balancing ability using the balance subtest of the BOT-2 in children with CP.
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Affiliation(s)
- Seong Gil Kim
- Department of Physical Therapy, Sunmoon University, Asan, Republic of Korea
| | - Do Hyun Kim
- Department of Physical Therapy, Ansan University, Ansan, Republic of Korea
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Liang KJ, Chen HL, Shieh JY, Wang TN. Measurement properties of the box and block test in children with unilateral cerebral palsy. Sci Rep 2021; 11:20955. [PMID: 34697312 PMCID: PMC8545961 DOI: 10.1038/s41598-021-00379-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/05/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to examine the reliabilities (test-retest reliability and measurement error), construct validity, and the interpretability (minimal clinically important difference) of the Box and Block Test (BBT) to interpret test scores precisely for children with UCP. A total of 100 children with UCP were recruited and 50 children from the whole sample assessed the BBT twice within 2-week interval. The BBT, the Melbourne Assessment 2, the Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition, and the Pediatric Motor Activity Log Revised were measured before and immediately after a 36-h intensive neurorehabilitation intervention. Measurement properties of the BBT were performed according to the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The test-retest reliability of the BBT was high (intraclass correlation coefficient = 0.98). The measurement error estimated by the MDC95 value was 5.95. Construct validity was considered good that 4 of 4 (100%) hypotheses were confirmed. The interpretability estimated by the MCID ranged from 5.29 to 6.46. The BBT is a reliable and valid tool for children with UCP. For research and clinical applications, an improvement of seven blocks on the BBT is recommended as an indicator of statistically significant and clinically important change.
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Affiliation(s)
- Kai-Jie Liang
- School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, Xu-Zhou Rd. 4th Floor, Taipei City, 100, Taiwan
| | - Hao-Ling Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, Xu-Zhou Rd. 4th Floor, Taipei City, 100, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Jeng-Yi Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Tien-Ni Wang
- School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, Xu-Zhou Rd. 4th Floor, Taipei City, 100, Taiwan. .,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, 100, Taiwan.
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Werner JM, Berggren J, Loiselle J, Lee GK. Constraint-induced movement therapy for children with neonatal brachial plexus palsy: a randomized crossover trial. Dev Med Child Neurol 2021; 63:545-551. [PMID: 33219706 DOI: 10.1111/dmcn.14741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022]
Abstract
AIM To determine if constraint-induced movement therapy (CIMT) is more effective than standard care in improving upper-limb activity outcomes in children with neonatal brachial plexus palsy (NBPP). METHOD Twenty-one children with NBPP (mean age 25mo, SD=10.3, range=17-48mo; 11 males, 10 females) were enrolled in a crossover trial and randomly allocated to first receive CIMT or standard care, each for 8 weeks. The intervention arm consisted of 3 weeks of casting the unaffected limb followed by 5 weeks of transference activities. The Assisting Hand Assessment (AHA) was used to measure bimanual activity performance at baseline, 8 weeks, and 16 weeks, scored by blinded raters. The Pediatric Motor Activity Log-Revised (PMAL-R) was used as a caregiver-reported secondary outcome measure. RESULTS After concealed random allocation (n=21), there were no significant differences on demographics or baseline measures. CIMT was superior compared to control in terms of bimanual activity performance with a mean difference in AHA change score of 4.8 (SD=10.5, p=0.04, Cohen's δ=0.46). There were no significant differences between treatment conditions on the PMAL-R. INTERPRETATION CIMT is favored over standard care for bimanual activity performance. Future research should investigate a longer follow-up period, additional comparator interventions, and analyse differences by participant characteristics. WHAT THIS PAPER ADDS Gains in bimanual activity performance were greater after constraint-induced movement therapy (CIMT) compared to no CIMT. Frequency and quality of movement were not significantly different between treatment groups.
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Affiliation(s)
- Julie M Werner
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jamie Berggren
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jennifer Loiselle
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Gina Kim Lee
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Günel MK, Seyhan K, Delioğlu K, Doğan TD, Altunalan T, Kala Y, Taub E, Uswatte G. Validity and reliability of the Turkish version of the pediatric motor activity log-revised (PMAL-R) for 2-17 year old children with hemiparetic cerebral palsy. Disabil Rehabil 2021; 44:4047-4054. [PMID: 33625932 DOI: 10.1080/09638288.2021.1887375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The Pediatric Upper-extremity Motor Activity Log-Revised (PMAL-R) is a structured interview that measures use of the more-affected arm in daily life in children with cerebral palsy (CP). This study investigated the concurrent validity and test-retest reliability of a Turkish version of the PMAL-R. MATERIALS AND METHODS The PMAL-R was translated and cross-culturally adapted to Turkish and administered to parents of eighty children with hemiplegic CP between 2-17 years. Its concurrent validity was examined by correlating scores on the PMAL-R How Well and How Often scales with ABILHAND-Kids scores. Fifty parents were re-interviewed after three weeks to establish test-retest reliability. RESULTS PMAL-R scores were strongly correlated with ABILHAND-Kids scores (How Well scale, r = 0.78, p < 0.001; How Often scale, r = 0.59, p < 0.001). PMAL-R test-retest reliability (Intraclass correlation; How Often = 0.98, How Well = 0.99) and internal consistency (Cronbach's α; How Often = 0.96, How Well = 0.97) were high. CONCLUSIONS This translation of the PMAL-R has good reliability and validity for measuring everyday use of the more-affected arm in Turkish children with hemiparesis due to CP between 2-17 years. Implications for rehabilitationAn instrument that evaluates real-world arm use in Turkish children with CP.Reliability and concurrent validity of the Turkish PMAL-R is established in 2-17-year old with upper-extremity hemiparesis.Systematic replication of the clinimetric properties of the English PMAL-R is demonstrated in a wider age range than previously, 2-17 years vs. 2-8 years.Reliability and concurrent validity of the PMAL-R is shown in both children with right and left hemiparesis.
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Affiliation(s)
- Mintaze Kerem Günel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Kübra Seyhan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Kıvanç Delioğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | | | | | - Yasemin Kala
- Spastic Children's Foundation of Turkey, Istanbul, Turkey
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Elnaggar RK, Alqahtani BA, Elbanna MF. Functional outcomes of botulinum neurotoxin-A injection followed by reciprocal electrical stimulation in children with cerebral palsy: A randomized controlled trial. Restor Neurol Neurosci 2021; 38:431-441. [PMID: 33252102 DOI: 10.3233/rnn-201088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The integration of therapeutic approaches is increasingly recommended for children with cerebral palsy, to enhance outcomes. Nevertheless, clinicians still opt for separate or combined therapies based on little credible knowledge. OBJECTIVE This study endeavored to evaluate the effect of botulinum neurotoxin-A (BoNT-A) injection and reciprocal neuromuscular electrical stimulation (rNMES) and their combination on the upper extremity function in children with spastic hemiplegia. METHODS Sixty-four children with spastic hemiplegia (aged 6- 10 years) were randomly assigned to four treatment-based groups [group I (BoNT-A), group II (rNMES), group III (combined BoNT-A and rNMES), and group IV (Control)]. All children received a physical rehabilitation program, thrice/week over three months. Unilateral upper-limb function, bimanual hand function, and real-time arm-hand function were assessed using Melbourne Assessment (MA), Assisting Hand Assessment (AHA), and Pediatric Motor Activity Log (PMAL) scales respectively pre-treatment, post-treatment, and at 6 months follow-up. RESULTS Post-treatment, group III achieved greater improvement in MA, AHA, and PMAL compared to other groups (all P < 0.05), and the difference remained in favor of group III at the follow-up (all P < 0.05). CONCLUSIONS This study suggests that BoNT-A and rNMES combined are more effective than either of them alone to enhance upper-extremity function in children with spastic hemiplegia.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Bader A Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohammed F Elbanna
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Steinhart S, Raz-Silbiger S, Beeri M, Gilboa Y. Occupation Based Telerehabilitation Intervention for Adolescents with Myelomeningocele: A Pilot Study. Phys Occup Ther Pediatr 2021; 41:176-191. [PMID: 32856511 DOI: 10.1080/01942638.2020.1807448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS This pilot study examined the impact of an occupation based intervention using a telerehabilitation format with adolescents with myelomeningocele (MMC). METHODS We conducted a nonrandomized pilot study including four adolescents ages 14-18 with MMC. The intervention program included 10-12 sessions of the Cognitive Orientation to daily Occupational Performance remotely delivered via videoconferencing. Outcome measures included the Canadian Occupational Performance Measure (COPM), Wee-Functional Independence Measure;(Wee-FIM), and the Pediatric Quality of Life Inventory (PedsQL). Assessments were administered at baseline, post intervention and at three-month follow-up. RESULTS Following intervention, participants rated their performance as having improved 2 points on the COPM for 8 out of 12 trained goals and on 2 out of 8 untrained goals. At 3-month follow-up improvement was reported on 9 out of 12 trained goals and 3 out of 8 untrained goals All participants made clinically significant improvements on the Wee-FIM total score following intervention and improvements were maintained at 3-month follow-up. The intervention effect on the PedsQL was inconclusive. Feedback interviews suggested that participants experience high satisfaction from the results and implementation of the intervention. CONCLUSIONS Our results demonstrate potential efficacy of occupation based teleintervention for adolescents with MMC.
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Affiliation(s)
- Shoshana Steinhart
- ALYN Hospital - Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - Shani Raz-Silbiger
- ALYN Hospital - Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - Maurit Beeri
- ALYN Hospital - Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Chen CL, Shen IH, Huang HH, Chen CY, Hsiao YT, Wu CY, Chen HC. Responsiveness and minimal clinically important difference of TNO-AZL Preschool Children Quality of Life in children with cerebral palsy. Qual Life Res 2019; 29:825-831. [PMID: 31782017 DOI: 10.1007/s11136-019-02370-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the responsiveness and minimal clinically important difference (MCID) of the TNO-AZL (Netherlands Organization for Applied Scientific Research Academic Medical Centre) Preschool Children Quality of Life (TAPQOL) in children with cerebral palsy (CP). METHODS Ninety-seven children with CP (60 males, 37 females; aged 1-6 years) and their caregivers were recruited from the rehabilitation programs of Chang Gung Memorial Hospital in Taiwan for this 6-month longitudinal follow-up study. The Functional Independence Measure for Children (WeeFIM) and TAPQOL outcomes were measured at baseline and at a 6-month follow-up. Responsiveness was examined using the standardized response mean (SRM). The distribution-based and anchor-based MCID were determined. The TAPQOL outcomes include physical functioning (PF), social functioning (SF), cognitive functioning (CF), and emotional functioning (EF) domains. RESULTS The responsiveness of the TAPQOL for all of TAPQOL domains was marked (SRM = 1.12-1.54). The anchor-based MCIDs of TAPQOL for PF, SF, CF, EF, and total domains were 1.25, 3.28, 2.93, 2.25, and 1.73, respectively, which were similar to the distribution-based MCID values of TAPQOL, except in the PF domain. The distribution-based MCIDs of TAPQOL in various domains were 2.85-3.73 when effect size (ES) was 0.2, 7.13-9.32 when ES was 0.5, and 11.40-14.91 when ES was 0.8. CONCLUSIONS TAPQOL is markedly responsive to detect change in children with CP. The caregivers perceived the minimally important change in HRQOL of their children at a relatively low treatment efficacy. Researchers and clinicians can utilize TAPQOL data to determine whether changes in TAPQOL scores indicate clinically meaningful effects post-treatment and at the follow-up.
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Affiliation(s)
- Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5 Fu-Hsing St. Kwei-Shan, Tao-Yuan, 333, Taiwan.
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, 333, Taiwan.
| | - I-Hsuan Shen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5 Fu-Hsing St. Kwei-Shan, Tao-Yuan, 333, Taiwan
- Department of Occupational Therapy, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, 333, Taiwan
| | - Hsiang-Han Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5 Fu-Hsing St. Kwei-Shan, Tao-Yuan, 333, Taiwan
- Department of Occupational Therapy, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, 333, Taiwan
| | - Chung-Yao Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, 222 Maijin Rd, Keelung, 204, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, 333, Taiwan
| | - Yi-Ting Hsiao
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, 333, Taiwan
| | - Ching-Yi Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5 Fu-Hsing St. Kwei-Shan, Tao-Yuan, 333, Taiwan
- Department of Occupational Therapy, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, 333, Taiwan
| | - Hsieh-Ching Chen
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan
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Liu H, Jiang H, Wang X, Zheng J, Zhao H, Cheng Y, Tao X, Wang M, Liu C, Huang T, Wu L, Jin C, Li X, Wang H, Yang J. Treatment response prediction of rehabilitation program in children with cerebral palsy using radiomics strategy: protocol for a multicenter prospective cohort study in west China. Quant Imaging Med Surg 2019; 9:1402-1412. [PMID: 31559169 DOI: 10.21037/qims.2019.04.04] [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: 12/26/2022]
Abstract
Background Cerebral palsy (CP) is a major cause of chronic childhood disability worldwide, causing activity limitation as well as impairments in sensation, cognition, and communication. Leveraging biomarkers to establish individualized predictions of future treatment responses will be of great value. We aim to develop and validate a model that can be used to predict the individualized treatment response in Children with CP. Methods A multicenter prospective cohort study will be conducted in 4 hospitals in west China. One hundred and thirty children with CP will be recruited and undergo clinical assessment using the Peabody Developmental Motor Scales, Manual Ability Classification System (MACS), Hand Assessment for Infants (HAI), Assisting Hand Assessment (AHA), and Gross Motor Function Classification System (GMFCS). The data collected will include MRI image, clinical status, and socioeconomic status. The clinical information and MRI features extracted using radiomics strategy will be combined for exploratory analysis. The accuracy, sensitivity, and specificity of the model will be assessed using multiple modeling methodologies. Internal and external validation will be used to evaluate the performance of the radiomics model. Discussion We hypothesized that the findings from this study could provide a critical step towards the prediction of treatment response in children with CP, which could also complement other biomarkers in the development of precision medicine approaches for this severe disorder. Trial registration The study was registered with clinicaltrials.gov (NCT02979743).
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Affiliation(s)
- Heng Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China.,Medical Imaging Center of Guizhou Province, Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Haoxiang Jiang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China
| | - Xiaoyu Wang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jie Zheng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Huifang Zhao
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yannan Cheng
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Xingxing Tao
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Miaomiao Wang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Congcong Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ting Huang
- Department of Radiology, the First Affiliated Hospital of Henan University of TCM, Zhengzhou 450046, China
| | - Liang Wu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China
| | - Chao Jin
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Xianjun Li
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Hui Wang
- Department of Brain Disease, Xi'an Brain Disease Hospital of Traditional Chinese Medicine, Xi'an 710032, China
| | - Jian Yang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China
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Hoare BJ, Wallen MA, Thorley MN, Jackman ML, Carey LM, Imms C. Constraint-induced movement therapy in children with unilateral cerebral palsy. Cochrane Database Syst Rev 2019; 4:CD004149. [PMID: 30932166 PMCID: PMC6442500 DOI: 10.1002/14651858.cd004149.pub3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Unilateral cerebral palsy (CP) is a condition that affects muscle control and function on one side of the body. Children with unilateral CP experience difficulties using their hands together secondary to disturbances that occur in the developing fetal or infant brain. Often, the more affected limb is disregarded. Constraint-induced movement therapy (CIMT) aims to increase use of the more affected upper limb and improve bimanual performance. CIMT is based on two principles: restraining the use of the less affected limb (for example, using a splint, mitt or sling) and intensive therapeutic practice of the more affected limb. OBJECTIVES To evaluate the effect of constraint-induced movement therapy (CIMT) in the treatment of the more affected upper limb in children with unilateral CP. SEARCH METHODS In March 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PEDro, OTseeker, five other databases and three trials registers. We also ran citation searches, checked reference lists, contacted experts, handsearched key journals and searched using Google Scholar. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs or clinically controlled trials implemented with children with unilateral CP, aged between 0 and 19 years, where CIMT was compared with a different form of CIMT, or a low dose, high-dose or dose-matched alternative form of upper-limb intervention such as bimanual intervention. Primarily, outcomes were bimanual performance, unimanual capacity and manual ability. Secondary outcomes included measures of self-care, body function, participation and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts to eliminate ineligible studies. Five review authors were paired to extract data and assess risk of bias in each included study. GRADE assessments were undertaken by two review authors. MAIN RESULTS We included 36 trials (1264 participants), published between 2004 and 2018. Sample sizes ranged from 11 to 105 (mean 35). Mean age was 5.96 years (standard deviation (SD) 1.82), range three months to 19.8 years; 53% male and 47% participants had left hemiplegia. Fifty-seven outcome measures were used across studies. Average length of CIMT programs was four weeks (range one to 10 weeks). Frequency of sessions ranged from twice weekly to seven days per week. Duration of intervention sessions ranged from 0.5 to eight hours per day. The mean total number of hours of CIMT provided was 137 hours (range 20 to 504 hours). The most common constraint devices were a mitt/glove or a sling (11 studies each).We judged the risk of bias as moderate to high across the studies. KEY RESULTS Primary outcomes at primary endpoint (immediately after intervention)CIMT versus low-dose comparison (e.g. occupational therapy)We found low-quality evidence that CIMT was more effective than a low-dose comparison for improving bimanual performance (mean difference (MD) 5.44 Assisting Hand Assessment (AHA) units, 95% confidence interval (CI) 2.37 to 8.51).CIMT was more effective than a low-dose comparison for improving unimanual capacity (Quality of upper extremity skills test (QUEST) - Dissociated movement MD 5.95, 95% CI 2.02 to 9.87; Grasps; MD 7.57, 95% CI 2.10 to 13.05; Weight bearing MD 5.92, 95% CI 2.21 to 9.6; Protective extension MD 12.54, 95% CI 8.60 to 16.47). Three studies reported adverse events, including frustration, constraint refusal and reversible skin irritations from casting.CIMT versus high-dose comparison (e.g. individualised occupational therapy, bimanual therapy)When compared with a high-dose comparison, CIMT was not more effective for improving bimanual performance (MD -0.39 AHA Units, 95% CI -3.14 to 2.36). There was no evidence that CIMT was more effective than a high-dose comparison for improving unimanual capacity in a single study using QUEST (Dissociated movement MD 0.49, 95% CI -10.71 to 11.69; Grasp MD -0.20, 95% CI -11.84 to 11.44). Two studies reported that some children experienced frustration participating in CIMT.CIMT versus dose-matched comparison (e.g. Hand Arm Bimanual Intensive Therapy, bimanual therapy, occupational therapy)There was no evidence of differences in bimanual performance between groups receiving CIMT or a dose-matched comparison (MD 0.80 AHA units, 95% CI -0.78 to 2.38).There was no evidence that CIMT was more effective than a dose-matched comparison for improving unimanual capacity (Box and Blocks Test MD 1.11, 95% CI -0.06 to 2.28; Melbourne Assessment MD 1.48, 95% CI -0.49 to 3.44; QUEST Dissociated movement MD 6.51, 95% CI -0.74 to 13.76; Grasp, MD 6.63, 95% CI -2.38 to 15.65; Weightbearing MD -2.31, 95% CI -8.02 to 3.40) except for the Protective extension domain (MD 6.86, 95% CI 0.14 to 13.58).There was no evidence of differences in manual ability between groups receiving CIMT or a dose-matched comparison (ABILHAND-Kids MD 0.74, 95% CI 0.31 to 1.18). From 15 studies, two children did not tolerate CIMT and three experienced difficulty. AUTHORS' CONCLUSIONS The quality of evidence for all conclusions was low to very low. For children with unilateral CP, there was some evidence that CIMT resulted in improved bimanual performance and unimanual capacity when compared to a low-dose comparison, but not when compared to a high-dose or dose-matched comparison. Based on the evidence available, CIMT appears to be safe for children with CP.
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Affiliation(s)
- Brian J Hoare
- Monash Children's HospitalVictorian Paediatric Rehabilitation Service246 Clayton RdClaytonVictoriaAustralia3168
| | - Margaret A Wallen
- Australian Catholic UniversitySchool of Allied Health, Faculty of Health SciencesNorth SydneyAustralia
| | - Megan N Thorley
- Royal Children's HospitalRehabilitationHerston RoadBrisbaneQueenslandAustralia4006
| | - Michelle L Jackman
- John Hunter Children's HospitalPaediatric Occupational TherapyLambton RoadNew LambtonNew South WalesAustralia2310
| | - Leeanne M Carey
- Florey Institute of Neuroscience and Mental Health, The University of MelbourneNeurorehabilitation and Recovery, Stroke DivisionMelbourneVictoriaAustralia3081
| | - Christine Imms
- Australian Catholic UniversityCentre for Disability & Development ResearchLevel 2, Daniel Mannix Building17 Young StreetMelbourneVictoriaAustralia3065
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Chen YL, Chen HL, Shieh JY, Wang TN. Preliminary Efficacy of a Friendly Constraint-Induced Therapy (Friendly-CIT) Program on Motor and Psychosocial Outcomes in Children with Cerebral Palsy. Phys Occup Ther Pediatr 2019; 39:139-150. [PMID: 29912601 DOI: 10.1080/01942638.2018.1484407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIMS Constraint-induced therapy (CIT) is effective, but concerns have been repeatedly raised regarding the generalizability, feasibility, and potentially intrusive nature of restraining a child's unimpaired upper limb. We examined the feasibility and efficacy of friendly-CIT, which uses home-based model, a caregiver-determined schedule, and gentle restraint, in children with cerebral palsy. METHODS In a one-group pre-post intervention trial, 15 children (median of age = 8 years, 4 months) participated in 8 weeks of friendly-CIT (36 hours). Motor and psychosocial outcomes were investigated. RESULTS Participants showed significant improvement on the manual dexterity subtest of the Bruininks-Oseretsky Test of Motor Proficiency (p = 0.004); the how often (p = 0.01) and how well (p = 0.02) scales of the Revised Pediatric Motor Activity Log; and the functional skills score on the Chinese version of the Pediatric Evaluation of Disability Inventory (p = 0.002). For psychosocial outcomes, children with CP consistently demonstrated high engagement and increased playfulness (p < 0.0001) during the 8-week intervention. Parents showed no change in stress status and high satisfaction with friendly-CIT. CONCLUSION Friendly-CIT is feasible and promising for improving a child's motor and psychosocial outcomes without increasing parental stress.
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Affiliation(s)
- Yu-Lun Chen
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Hao-Ling Chen
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
| | - Jeng-Yi Shieh
- b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
| | - Tien-Ni Wang
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
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15
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Wang TN, Liang KJ, Liu YC, Shieh JY, Chen HL. Psychometric and Clinimetric Properties of the Melbourne Assessment 2 in Children With Cerebral Palsy. Arch Phys Med Rehabil 2017; 98:1836-1841. [DOI: 10.1016/j.apmr.2017.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/01/2017] [Accepted: 01/23/2017] [Indexed: 11/28/2022]
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Cope S, Mohn-Johnsen S. The effects of dosage time and frequency on motor outcomes in children with cerebral palsy: A systematic review. Dev Neurorehabil 2017. [PMID: 28632463 DOI: 10.1080/17518423.2017.1282053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Provide an updated review regarding treatment dosage for children with cerebral palsy (CP) by examining the variables of type, time, frequency, and intensity. METHODS A systematic review was performed with 30 articles meeting the inclusion criteria. Two authors independently extracted data including information about risk of bias. Ten articles were included in the review. RESULTS Eight studies manipulated time, two studies manipulated frequency, and three studies manipulated both variables. No studies investigated intensity. Findings suggest that manipulating time and/or frequency may result in better motor function for higher total dosing; however, benefits were not consistent across studies and few showed clinically significant improvements. CONCLUSION This most current evidence regarding the effect of dosage on motor function for children with CP suggests that there is insufficient evidence to support implementing high-dosage therapy. Further research is needed to clarify the relationship between dosage variables on motor function for children with CP.
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Affiliation(s)
- Steven Cope
- a Department of Occupational Therapy , The College of St. Scholastica , Duluth , MN , USA
| | - Samantha Mohn-Johnsen
- b Department of Physical Therapy , The College of St. Scholastica , Duluth , MN , USA
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Pavão SL, Silva FPS, Dusing SC, Rocha NACF. Clinical tools designed to assess motor abilities in children with cerebral palsy. Dev Neurorehabil 2017; 20:149-159. [PMID: 27019351 DOI: 10.3109/17518423.2016.1150359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This systematic review aimed to list the tools used by rehabilitation professionals to test motor abilities in children with cerebral palsy (CP), to determine if these tools have psychometric properties specifically measured for CP, and to identify the main characteristics of these tools. METHOD Web of Science, PEDro, PubMed/MEDLINE, Science Direct, and SciELO databases were searched to identify the tools. PubMed/MEDLINE was then searched to identify the studies assessing those tools' psychometric properties. The agreement-based standards for the selection of health measurement tools and the Terwee criteria were used to assess the quality and the results of each included study, respectively. RESULTS Eighteen tools were identified. The psychometric properties of many of the tools used with children with CP have not been evaluated for this population. CONCLUSION The psychometric properties evaluated often have a poor methodological quality of measurement. Overall, we suggest the tools with most empirical support to evaluate children with CP.
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Affiliation(s)
- Silvia L Pavão
- a Department of Physiotherapy, Neuropediatrics Section , Federal University of São Carlos , São Carlos, São Paulo, Brazil
| | - Fernanda P S Silva
- a Department of Physiotherapy, Neuropediatrics Section , Federal University of São Carlos , São Carlos, São Paulo, Brazil
| | - Stacey C Dusing
- b Departments of Physical Therapy and Pediatrics , Virginia Commonwealth University , Richmond , VA , USA
| | - Nelci Adriana C F Rocha
- a Department of Physiotherapy, Neuropediatrics Section , Federal University of São Carlos , São Carlos, São Paulo, Brazil
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Effect of a Home-Based Virtual Reality Intervention for Children with Cerebral Palsy Using Super Pop VR Evaluation Metrics: A Feasibility Study. Rehabil Res Pract 2015; 2015:812348. [PMID: 26457202 PMCID: PMC4589626 DOI: 10.1155/2015/812348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/27/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022] Open
Abstract
Objective. The purpose of this pilot study was to determine whether Super Pop VR, a low-cost virtual reality (VR) system, was a feasible system for documenting improvement in children with cerebral palsy (CP) and whether a home-based VR intervention was effective. Methods. Three children with CP participated in this study and received an 8-week VR intervention (30 minutes × 5 sessions/week) using the commercial EyeToy Play VR system. Reaching kinematics measured by Super Pop VR and two fine motor tools (Bruininks-Oseretsky Test of Motor Proficiency second edition, BOT-2, and Pediatric Motor Activity Log, PMAL) were tested before, mid, and after intervention. Results. All children successfully completed the evaluations using the Super Pop VR system at home where 85% of the reaches collected were used to compute reaching kinematics, which is compatible with literature using expensive motion analysis systems. Only the child with hemiplegic CP and more impaired arm function improved the reaching kinematics and functional use of the affected hand after intervention. Conclusion. Super Pop VR proved to be a feasible evaluation tool in children with CP.
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Gerber CN, Labruyère R, van Hedel HJA. Reliability and Responsiveness of Upper Limb Motor Assessments for Children With Central Neuromotor Disorders. Neurorehabil Neural Repair 2015; 30:19-39. [PMID: 25921350 DOI: 10.1177/1545968315583723] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background. To investigate the effectiveness of upper limb rehabilitation, sound measures of upper limb function, capacity, and performance are paramount. Objectives. This systematic review investigates reliability and responsiveness of upper limb measurement tools used in pediatric neurorehabilitation. Methods. A 2-tiered search was conducted up to July 2014. The first search identified upper limb motor assessments for 1- to 18-year-old children with neuromotor disorders. The second search examined the psychometric properties of the tools. Methodological quality was rated according to COSMIN guidelines, and results for each tool were assembled in a “best evidence synthesis.” Furthermore, we delineated whether tools were unimanual or bimanual tests and if they measured recovery or did not distinguish between physiological and compensatory movements. Results. The first search delivered 2546 hits. Of these, 110 articles on 51 upper limb assessment tools were included. The second search resulted in 58 studies on reliability, 11 on measurement error, and 10 on responsiveness. Best evidence synthesis revealed only 2 assessments with moderate positive evidence for reliability, whereas no evidence on measurement error and responsiveness was found. The Melbourne Assessment showed moderate positive evidence for interrater and a fair positive level of evidence for intrarater reliability. The Pediatric Motor Activity Log Revised revealed moderate positive evidence for test–retest reliability. Conclusions. There is a lack of high-quality studies about psychometric properties of upper limb measurement tools in children with neuromotor disorders. To date, upper limb rehabilitation trials in children and adolescents risk being biased by insensitive measurement tools lacking reliability.
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Affiliation(s)
- Corinna N. Gerber
- Rehabilitation Center for Children and Adolescents, Affoltern am Albis, Switzerland
- University Children’s Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Rob Labruyère
- Rehabilitation Center for Children and Adolescents, Affoltern am Albis, Switzerland
- University Children’s Hospital Zurich, Zurich, Switzerland
| | - Hubertus J. A. van Hedel
- Rehabilitation Center for Children and Adolescents, Affoltern am Albis, Switzerland
- University Children’s Hospital Zurich, Zurich, Switzerland
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Wallen M, Stewart K. Upper limb function in everyday life of children with cerebral palsy: description and review of parent report measures. Disabil Rehabil 2014; 37:1353-61. [PMID: 25264734 DOI: 10.3109/09638288.2014.963704] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the role, in clinical practice and measurement of outcomes of upper limb interventions, of cerebral palsy-specific self- or parent-report measures of upper limb performance in everyday activities. METHOD Search of databases and handsearching for information on test development procedures, psychometric properties or relevant studies to inform study objectives. RESULTS Children's Hand-use Experience Questionnaire holds most promise for guiding treatment planning but requires more psychometric evidence. ABILHAND-Kids has the strongest evidence for reliability, validity and sensitivity to change; evaluates impact of intervention on bimanual performance and can be used for children with unilateral or bilateral cerebral palsy. The original and revised versions of the Pediatric Motor Activity Log (PMAL) evaluate unilateral rather than bimanual upper limb performance. Neither ABILHAND-Kids nor PMAL offer information to assist treatment planning. PMAL-R is the only measure for the 2-5-year age group. No measure was adequate for children younger than 2 years to ascertain parents' perception of upper limb function in everyday activities. CONCLUSIONS Understanding upper limb performance in everyday life, as perceived by children with cerebral palsy and their families, informs a comprehensive assessment and acknowledges the importance of the perspectives of child and family. Implications for Rehabilitation Cerebral palsy-specific self- or parent-report measures of upper limb performance in everyday life complement observational assessments in understanding upper limb performance CHEQ provides clinical information, ABILHAND-Kids is validated for children with unilateral and bilateral cerebral palsy and possesses the most robust psychometric properties, Revised PMAL measures unilateral upper limb use. No adequate measure for children under 2 years exists.
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Affiliation(s)
- Margaret Wallen
- Cerebral Palsy Alliance Research Institute , Frenchs Forest, Sydney , Australia
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Hassani S, Krzak JJ, Johnson B, Flanagan A, Gorton G, Bagley A, Õunpuu S, Romness M, Tylkowski C, Oeffinger D. One-Minute Walk and modified Timed Up and Go tests in children with cerebral palsy: performance and minimum clinically important differences. Dev Med Child Neurol 2014; 56:482-9. [PMID: 24843890 DOI: 10.1111/dmcn.12325] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This prospective multicenter study assessed performance and changes over time, with and without surgical intervention, in the modified Timed Up and Go (mTUG) and One-Minute Walk tests (1MWT) in children with bilateral cerebral palsy (CP). Minimum clinically important differences (MCIDs) were established for these tools. METHOD Two hundred and nineteen participants with bilateral spastic CP (Gross Motor Function Classification System [GMFCS] levels I–III) were evaluated at baseline and 12 months follow-up. The non-surgical group (n=168; 54 females, 114 males; mean age 12y 11mo, [SD 2y 7mo], range 8y 1mo–19y) had no surgical interventions during the study. The surgical group (n=51; 19 females, 32 males; mean age 12y 10mo [SD 2y 8mo] range 8y 2mo–17y 5mo) underwent soft-tissue and/or bony procedures within 12 months from baseline. The mTUG and 1MWT were collected and MCIDs were established from the change scores of the non-surgical group. RESULTS Dependent walkers (GMFCS level III) required more time to complete the mTUG (p≤0.01) than independent walkers (GMFCS levels I and II). For the 1MWT, distance walked decreased with increasing impairment (p≤0.01). 1MWT and mTUG change scores were not significantly different at any GMFCS level for either the surgical or non-surgical groups (p≤0.01). INTERPRETATION Children with varying levels of function (GMFCS level) perform differently on the 1MWT and mTUG. The data and MCID values can assist clinicians in interpreting changes over time and in assessing interventions.
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Affiliation(s)
- Sahar Hassani
- Shriners Hospitals for Children - Chicago; Chicago IL USA
| | - Joseph J Krzak
- Shriners Hospitals for Children - Chicago; Chicago IL USA
| | - Barbara Johnson
- Shriners Hospitals for Children - Salt Lake City; Salt Lake City UT USA
| | - Ann Flanagan
- Shriners Hospitals for Children - Chicago; Chicago IL USA
| | - George Gorton
- Shriners Hospitals for Children - Springfield; Springfield MA USA
| | - Anita Bagley
- Shriners Hospitals for Children - Northern California; Sacramento CA USA
| | - Sylvia Õunpuu
- Connecticut Children's Medical Center; Hartford CT USA
| | | | | | - Donna Oeffinger
- Shriners Hospitals for Children - Lexington; Lexington KY USA
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Chen CL, Lin KC, Kang LJ, Wu CY, Chen HC, Hsieh YW. Potential Predictors of Functional Outcomes After Home-Based Constraint-Induced Therapy for Children With Cerebral Palsy. Am J Occup Ther 2014; 68:159-66. [DOI: 10.5014/ajot.2014.009860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. Our objective was to identify predictors for treatment outcomes after home-based constraint-induced therapy (CIT) in children with cerebral palsy (CP).
METHOD. Forty-three children (aged 4–12 yr) with CP were treated with individualized CIT at home for 4 wk. Potential predictors were age, sex, affected hand, and upper-extremity motor capacity measured by the Peabody Developmental Motor Scale, 2nd edition (PDMS–2). Outcomes were the Pediatric Motor Activity Log (PMAL) Amount of Hand Use and Quality of Hand Use subscales and the Functional Independence Measure for Children (WeeFIM).
RESULTS. A higher PDMS–2 Visual–Motor Integration subscale score predicted a better WeeFIM score after home-based CIT (adjusted R2 = .35). Younger age predicted better performance on the PMAL Amount of Hand Use and Quality of Hand Use subscales (adjusted R2 = .06–.08) after home-based CIT.
CONCLUSION. The potential predictors may allow occupational therapy practitioners to target those children who will benefit most after home-based constraint-induced therapy.
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Affiliation(s)
- Chia-ling Chen
- Chia-ling Chen, MD, PhD, is Professor, Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan, and Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan
| | - Keh-chung Lin
- Keh-chung Lin, ScD, OTR, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei
| | - Lin-ju Kang
- Lin-ju Kang, PhD, is Assistant Professor, Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan
| | - Ching-yi Wu
- Ching-yi Wu, ScD, OTR, is Professor, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, and Healthy Aging Research Center at Chang Gung University, 259 Wen-Hwa First Road, Kwei-Shan, Tao-Yuan 333, Taiwan;
| | - Hsieh-ching Chen
- Hsieh-ching Chen, PhD, is Professor, Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan
| | - Yu-wei Hsieh
- Yu-wei Hsieh, PhD, is Assistant Professor, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan
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Johnson ML, Taub E, Harper LH, Wade JT, Bowman MH, Bishop-McKay S, Haddad MM, Mark VW, Uswatte G. An enhanced protocol for constraint-induced aphasia therapy II: a case series. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:60-72. [PMID: 24018698 DOI: 10.1044/1058-0360(2013/12-0168)] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The initial version of Constraint-Induced Aphasia Therapy (CIAT I) consisted of a single exercise. This study sought to evaluate the feasibility for future trials of an expanded and restructured protocol designed to increase the efficacy of CIAT I. METHOD The subjects were 4 native English speakers with chronic stroke who exhibited characteristics of moderate Broca's aphasia. Treatment was carried out for 3.5 hr/day for 15 consecutive weekdays. It consisted of 3 components: (a) intensive training by a behavioral method termed shaping using a number of expressive language exercises in addition to the single original language card game, (b) strong discouragement of attempts to use gesture or other nonverbal means of communication, and (c) a transfer package of behavioral techniques to promote transfer of treatment gains from the laboratory to real-life situations. RESULTS Participation in speech in the life situation improved significantly after treatment. The effect sizes (i.e., d') in this domain were ≥ 2.2; d' values ≥ 0.8 are considered large. Improvement in language ability on a laboratory test, the Western Aphasia Battery-Revised (Kertesz, 2006), did not achieve statistical significance, although the effect size was large--that is, 1.3 (13.1 points). CONCLUSION These pilot results suggest in preliminary fashion that CIAT II may produce significant improvements in everyday speech.
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Effect of virtual reality on upper extremity function in children with cerebral palsy: a meta-analysis. Pediatr Phys Ther 2014; 26:289-300. [PMID: 24819682 DOI: 10.1097/pep.0000000000000046] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To systematically examine the effect of virtual reality (VR) on upper extremity (UE) function in children with cerebral palsy (CP) and assess the association among VR effects and children's characteristics and an intervention protocol. METHOD A systematic literature search was conducted in PubMed, CINAHL, Cochrane, and PsycINFO up to June 2013. Research studies involving children with CP that used VR as the intervention method and UE outcome measures were included. RESULTS The search yielded 14 research articles, including 3 randomized controlled trials and 11 case series. Overall, VR provided a strong effect size (d = 1.00) when comparing pre- and postintervention. In subgroup analyses, younger children receiving home-based or laboratory-based VR and using an engineer-built VR system showed better improvement. CONCLUSIONS AND IMPLICATIONS Virtual reality is a viable tool to improve UE function in children with CP. However, a more vigorous research design is needed to make a conclusive recommendation.
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25
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Monteiro CB, Savelsbergh GJ, Smorenburg AR, Graciani Z, Torriani-Pasin C, de Abreu LC, Valenti VE, Kok F. Quantification of functional abilities in Rett syndrome: a comparison between stages III and IV. Neuropsychiatr Dis Treat 2014; 10:1213-22. [PMID: 25061307 PMCID: PMC4086772 DOI: 10.2147/ndt.s57333] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We aimed to evaluate the functional abilities of persons with Rett syndrome (RTT) in stages III and IV. The group consisted of 60 females who had been diagnosed with RTT: 38 in stage III, mean age (years) of 9.14, with a standard deviation of 5.84 (minimum 2.2/maximum 26.4); and 22 in stage IV, mean age of 12.45, with a standard deviation of 6.17 (minimum 5.3/maximum 26.9). The evaluation was made using the Pediatric Evaluation of Disability Inventory, which has 197 items in the areas of self-care, mobility, and social function. The results showed that in the area of self-care, stage III and stage IV RTT persons had a level of 24.12 and 18.36 (P=0.002), respectively. In the area of mobility, stage III had 37.22 and stage IV had 14.64 (P<0.001), while in the area of social function, stage III had 17.72 and stage IV had 12.14 (P=0.016). In conclusion, although persons with stage III RTT have better functional abilities when compared with stage IV, the areas of mobility, self-care, and social function are quite affected, which shows a great functional dependency and need for help in basic activities of daily life.
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Affiliation(s)
- Carlos Bm Monteiro
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
| | - Geert Jp Savelsbergh
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, the Netherlands
| | | | - Zodja Graciani
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | - Luiz Carlos de Abreu
- Laboratory of Scientific Writing, Department of Morphology and Physiology, School of Medicine of ABC, Santo Andre, Brazil
| | - Vitor E Valenti
- Department of Speech Language and Hearing Therapy, Faculty of Philosophy and Sciences, UNESP, Marilia, Brazil
| | - Fernando Kok
- Department of Neurology, University of São Paulo, São Paulo, Brazil
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Sakzewski L, Ziviani J, Boyd RN. Efficacy of upper limb therapies for unilateral cerebral palsy: a meta-analysis. Pediatrics 2014; 133:e175-204. [PMID: 24366991 DOI: 10.1542/peds.2013-0675] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children with unilateral cerebral palsy present with impaired upper limb (UL) function affecting independence, participation, and quality of life and require effective rehabilitation. This study aims to systematically review the efficacy of nonsurgical upper limb therapies for children with unilateral cerebral palsy. METHODS Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, the Cochrane Central Register of Controlled Trials, and PubMed were searched to December 2012. Randomized controlled or comparison trials were included. RESULTS Forty-two studies evaluating 113 UL therapy approaches (N = 1454 subjects) met the inclusion criteria. Moderate to strong effects favoring intramuscular injections of botulinum toxin A and occupational therapy (OT) to improve UL and individualized outcomes compared with OT alone were identified. Constraint-induced movement therapy achieved modest to strong treatment effects on improving movement quality and efficiency of the impaired UL compared with usual care. There were weak treatment effects for most outcomes when constraint therapy was compared with an equal dose (amount) of bimanual OT; both yielded similar improved outcomes. Newer interventions such as action observation training and mirror therapy should be viewed as experimental. CONCLUSIONS There is modest evidence that intensive activity-based, goal-directed interventions (eg, constraint-induced movement therapy, bimanual training) are more effective than standard care in improving UL and individualized outcomes. There is little evidence to support block therapy alone as the dose of intervention is unlikely to be sufficient to lead to sustained changes in UL outcomes. There is strong evidence that goal-directed OT home programs are effective and could supplement hands-on direct therapy to achieve increased dose of intervention.
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Affiliation(s)
- Leanne Sakzewski
- BOcc Thy, Queensland Cerebral Palsy and Rehabilitation Research Centre, Level 7, Block 6, Royal Brisbane Hospital, Herston Rd, Herston QLD 4029, Australia.
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Chen CL, Wu KPH, Liu WY, Cheng HYK, Shen IH, Lin KC. Validity and clinimetric properties of the Spinal Alignment and Range of Motion Measure in children with cerebral palsy. Dev Med Child Neurol 2013; 55:745-50. [PMID: 23590429 DOI: 10.1111/dmcn.12153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
AIM The aim of this study was to assess the validity, responsiveness, and clinimetric properties of the Spinal Alignment and Range of Motion Measure (SAROMM) in children with cerebral palsy (CP). METHOD Sixty-two children with CP (40 males, 22 females) with a median age of 3 years and 11 months (range 1-6y) and their caregivers participated in this study. Among the children, 56 had spastic CP while six had non-spastic CP; 53 had bilateral CP, while nine had unilateral limb involvement. Thirty-three children were classified as Gross Motor Function Classification System (GMFCS) levels I to III and 23 as levels IV or V. Fifty-six children (90%) received regular rehabilitation by means of regular physical or occupational therapy (50% once or twice per week and 40% more than two times per week) and six children (10%) received irregular rehabilitation (less than once a week). Construct validity was determined by assessing the strength of the correlation between the spinal alignment SAROMM (SAROMM-SA), the range of motion SAROMM (SAROMM-ROM), and the total SAROMM (SAROMM-total), and construct measures, including the 66-item Gross Motor Function Measure (GMFM-66) and Functional Independence Measures for Children (WeeFIM), at baseline and at 6-months follow-up. Responsiveness was examined using effect size. Minimal detectable change (MDC) at the 90% confidence level (MDC90) and minimal clinically important difference (MCID) were analysed. RESULTS The SAROMM with the GMFM-66 and WeeFIM had fair to good construct validity. The effect size values of all SAROMM scales were 0.24 to 0.48. The MDC90 values and MCID range were 1.43 and 0.47 to 1.67 for the SAROMM-SA, 3.12 and 3.68 to 4.07 for the SAROMM-ROM, and 3.22 and 4.53 to 4.62 for the SAROMM-total. INTERPRETATION The clinimetric properties of the SAROMM allow clinicians to determine whether a change in SAROMM score represents a clinically meaningful change.
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Affiliation(s)
- Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
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Wallen M, Ziviani J. Caution regarding the Pediatric Motor Activity Log to measure upper limb intervention outcomes for children with unilateral cerebral palsy. Dev Med Child Neurol 2013; 55:497-8. [PMID: 23336281 DOI: 10.1111/dmcn.12057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Margaret Wallen
- Occupational Therapy Department, The Children's Hospital at Westmead, Westmead, Australia.
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Chen CL, Chen CY, Shen IH, Liu IS, Kang LJ, Wu CY. Clinimetric properties of the Assessment of Preschool Children's Participation in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1528-1535. [PMID: 23475003 DOI: 10.1016/j.ridd.2013.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 06/01/2023]
Abstract
This study examines the criterion-related validity and clinimetric properties of the Assessment of Preschool Children's Participation (APCP) for children with cerebral palsy (CP). Eighty-two children with CP (age range, two to five years and 11 months) and their caregivers participated in this study. The APCP consists of diversity and intensity scores in the areas of play (PA), skill development (SD), active physical recreation (AP), social activities (SA), and total areas. Tests were administered at baseline and at six-month follow-up. Concurrent and predictive validities were identified by assessing the strength of correlations between APCP scores and criterion-related measures--the 66-item Gross Motor Function Measure (GMFM-66) and Functional Independence Measure for Children (WeeFIM). Responsiveness was measured by standardized response mean (SRM). Minimal detectable change (MDC) at the 95% confidence level (MDC95) and minimal clinically important difference (MCID) were analyzed. The APCP with GMFM-66 and WeeFIM had fair to excellent concurrent validity (r=0.39-0.85) and predictive validity (r=0.46-0.82). The SRM values of the APCP diversity and intensity scales in all areas were 0.8-1.3. The MDC95 and MCID ranges for all areas (i.e., PA, SD, AP, SA, and total areas) were 0.1-0.7 and 0.4-1.2 points for intensity scores, respectively, and 4-17% and 10-19% for diversity scores, respectively. Therefore, the APCP scale was markedly responsive to change. Clinicians and researchers can use these clinimetric APCP data to determine whether a change score represents a "true" or clinically meaningful effect at post-treatment and follow-up.
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Affiliation(s)
- Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5 Fu-Hsing Street, Kwei-Shan, Tao-Yuan 333, Taiwan.
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Wang TN, Wu CY, Chen CL, Shieh JY, Lu L, Lin KC. Logistic regression analyses for predicting clinically important differences in motor capacity, motor performance, and functional independence after constraint-induced therapy in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1044-1051. [PMID: 23291522 DOI: 10.1016/j.ridd.2012.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/15/2012] [Accepted: 11/15/2012] [Indexed: 06/01/2023]
Abstract
Given the growing evidence for the effects of constraint-induced therapy (CIT) in children with cerebral palsy (CP), there is a need for investigating the characteristics of potential participants who may benefit most from this intervention. This study aimed to establish predictive models for the effects of pediatric CIT on motor and functional outcomes. Therapists administered CIT to 49 children (aged 3-11 years) with CP. Sessions were 1-3.5h a day, twice a week, for 3-4 weeks. Parents were asked to document the number of restraint hours outside of the therapy sessions. Domains of treatment outcomes included motor capacity (measured by the Peabody Developmental Motor Scales II), motor performance (measured by the Pediatric Motor Activity Log), and functional independence (measured by the Pediatric Functional Independence Measure). Potential predictors included age, affected side, compliance (measured by time of restraint), and the initial level of motor impairment severity. Tests were administered before, immediately after, and 3 months after the intervention. Logistic regression analyses showed that total amount of restraint time was the only significant predictor for improved motor capacity immediately after CIT. Younger children who restrained the less affected arm for a longer time had a greater chance to achieve clinically significant improvements in motor performance. For outcomes of functional independence in daily life, younger age was associated with clinically meaningful improvement in the self-care domain. Baseline motor abilities were significantly predictive of better improvement in mobility and cognition. Significant predictors varied according to the aspects of motor outcomes after 3 months of follow-up. The potential predictors identified in this study allow clinicians to target those children who may benefit most from CIT.
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Affiliation(s)
- Tien-ni Wang
- College of Medicine, National Taiwan University, Taipei, Taiwan
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31
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Chen CL, Shen IH, Chen CY, Wu CY, Liu WY, Chung CY. Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:916-922. [PMID: 23291508 DOI: 10.1016/j.ridd.2012.11.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 11/07/2012] [Accepted: 11/07/2012] [Indexed: 05/28/2023]
Abstract
This study examined criterion-related validity and clinimetric properties of the pediatric balance scale (PBS) in children with cerebral palsy (CP). Forty-five children with CP (age range: 19-77 months) and their parents participated in this study. At baseline and at follow up, Pearson correlation coefficients were used to determine criterion-related validity by analyzing the correlation between the PBS, including PBS-static, PBS-dynamic, and PBS-total, and criterion measures, including the Gross Motor Function Measure-66 items (GMFM-66) and Functional Independence Measures for Children (WeeFIM). Responsiveness was examined by paired t test and by standardized response mean (SRM). The minimal detectable change (MDC) was analyzed at the 90% confidence level, and the minimal clinically important differences (MCID) was estimated by anchor-based and distribution-based approaches. The PBS with GMFM-66 and WeeFIM showed fair-to-excellent concurrent validity at pretreatment and follow up and predictive validity. The SRM values of all PBS scales were 0.75. For the PBS-static, PBS-dynamic, and PBS-total, the MDC(90) values were 0.79, 0.96, and 1.59, and the MCID ranges were 1.47-2.92, 2.23-2.92, and 3.66-5.83, respectively. Improvement of at least MDC values on the PBS can be considered a true change, not measurement error. A mean change must exceed the MCID range on PBS to be considered clinically important change. Therefore, all PBS scales were moderately responsive to change. Clinicians and researchers can use these clinimetric data for PBS to determine if a change score represents a true or clinically meaningful effect at posttreatment and follow up.
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Affiliation(s)
- Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial hospital, Linkou, Tao-Yuan, Taiwan
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32
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Uswatte G, Taub E, Griffin A, Vogtle L, Rowe J, Barman J. The pediatric motor activity log-revised: assessing real-world arm use in children with cerebral palsy. Rehabil Psychol 2012; 57:149-158. [PMID: 22686553 DOI: 10.1037/a0028516] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Widely accepted models of disability suggest that actual use of an impaired upper extremity in everyday life frequently deviates from its motor capacity, as measured by laboratory tests. Yet, direct measures of real-world use of an impaired upper extremity are rare in pediatric neurorehabilitation. This paper examines how well the Pediatric Motor Activity Log-Revised (PMAL-R) measures this parameter, when the PMAL-R is administered as a structured interview as originally designed. DESIGN Parents of 60 children between 2 and 8 years of age with upper-extremity hemiparesis due to cerebral palsy completed the PMAL-R twice. Additionally, the children were videotaped during play structured to elicit spontaneous arm use. More-affected arm use was scored by masked raters; it was thought to reflect everyday activity since no cues were given about which arm to employ. Testing sessions were separated by 3 weeks, during which 29 children received upper-extremity rehabilitation and 31 did not. RESULTS The PMAL-R had high internal consistency (Cronbach's alpha = .93) and test-retest reliability (r = .89). Convergent validity was supported by a strong correlation between changes in PMAL-R scores and more-affected arm use during play, r(53) = .5, p < .001. CONCLUSIONS The PMAL-R interview is a reliable and valid measure of upper-extremity pediatric neurorehabilitation outcome.
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Affiliation(s)
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham
| | - Angi Griffin
- Department of Physical Therapy and Occupational Therapy, Children's Hospital of Alabama, University of Alabama at Birmingham
| | - Laura Vogtle
- Department of Occupational Therapy, University of Alabama at Birmingham
| | - Jan Rowe
- Department of Occupational Therapy, University of Alabama at Birmingham
| | - Joydip Barman
- Department of Psychology, University of Alabama at Birmingham
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