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Shekari Z, Sadeghian Afarani R, Fatorehchy S, Bakhshi E, Shahshahani S, Mousavi E. Relationship Between Postural Asymmetry, Balance, and Pain in Children With Spastic Cerebral Palsy. Pediatr Neurol 2024; 155:84-90. [PMID: 38608553 DOI: 10.1016/j.pediatrneurol.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Primary symptoms of cerebral palsy (CP), such as spasm and weakness, can lead to secondary musculoskeletal problems. Exploring the interplay and impact of secondary symptoms is essential in CP management. METHODS A total of 56 children (32 males and 24 females) aged eight to 12 years in level I to III of Gross Motor Function Classification System (GMFCS) completed The Pediatric Balance Scale and Wong-Baker Faces Scale and the Posture and Postural Ability Scale. Relationships between the three groups were examined using the Kruskal-Wallis test, Tukey test, gamma coefficient, De Somers D, phi coefficient, Cramér V, and one-way analysis of variance. RESULTS There was a significant correlation between balance and postural asymmetry (P < 0.001), and no significant difference in balance was there between the severe and moderate asymmetry groups (P = 0.759) and between the mild asymmetry and no asymmetry groups (P = 0.374). Furthermore, there was a significant relationship between postural asymmetry and each of the variables of pain (P < 0.001) and gross motor function (P = 0.002). Although a meaningful correlation was identified between balance and gross motor function (P < 0.001), the relationship between postural asymmetry and balance in GMFCS levels was not found (P = 0.052, P = 0.052, P = 0.233). Conversely, no significant relationship was detected between pain and gross motor function (P = 0.072). SIGNIFICANCE Postural asymmetry negatively impacts balance and correlates with pain intensity. Addressing postural problems can contribute to pain management and improved balance.
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Affiliation(s)
- Zahra Shekari
- Masters Degree, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Razieh Sadeghian Afarani
- Masters' Student, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Saeid Fatorehchy
- Assistant Professor, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Enayatollah Bakhshi
- Professor, Department of Biostatistics and Epidemiology, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Soheila Shahshahani
- Associate Professor, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Elahe Mousavi
- Masters Degree, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Willaert J, Martino G, Desloovere K, Van Campenhout A, Ting LH, De Groote F. Increased muscle responses to balance perturbations in children with cerebral palsy can be explained by increased sensitivity to center of mass movement. Gait Posture 2024; 107:121-129. [PMID: 36990910 PMCID: PMC10517062 DOI: 10.1016/j.gaitpost.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Balance impairments are common in children with cerebral palsy (CP). Muscle activity during perturbed standing is higher in children with CP than in typically developing (TD) children, but we know surprisingly little about how sensorimotor processes for balance control are altered in CP. Sensorimotor processing refers to how the nervous system translates incoming sensory information about body motion into motor commands to activate muscles. In healthy adults, muscle activity in response to backward support-surface translations during standing can be reconstructed by center of mass (CoM) feedback, i.e., by a linear combination of delayed (due to neural transmission times) CoM displacement, velocity, and acceleration. The level of muscle activity in relation to changes in CoM kinematics, i.e., the feedback gains, provides a metric of the sensitivity of the muscle response to CoM perturbations. RESEARCH QUESTION Can CoM feedback explain reactive muscle activity in children with CP, yet with higher feedback gains than in TD children? METHODS We perturbed standing balance by backward support-surface translations of different magnitudes in 20 children with CP and 20 age-matched TD children and investigated CoM feedback pathways underlying reactive muscle activity in the triceps surae and tibialis anterior. RESULTS Reactive muscle activity could be reconstructed by delayed feedback of CoM kinematics and hence similar sensorimotor pathways might underlie balance control in children with CP and TD children. However, sensitivities of both agonistic and antagonistic muscle activity to CoM displacement and velocity were higher in children with CP than in TD children. The increased sensitivity of balance correcting responses to CoM movement might explain the stiffer kinematic response, i.e., smaller CoM movement, observed in children with CP. SIGNIFICANCE The sensorimotor model used here provided unique insights into how CP affects neural processing underlying balance control. Sensorimotor sensitivities might be a useful metric to diagnose balance impairments.
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Affiliation(s)
- J Willaert
- Department of Movement Sciences, KU Leuven, Belgium.
| | - G Martino
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States
| | - K Desloovere
- Department of Rehabilitation Sciences, KU Leuven - UZ Leuven, Belgium
| | - A Van Campenhout
- Department of Development and Regeneration, KU Leuven - UZ Leuven, Belgium
| | - L H Ting
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - F De Groote
- Department of Movement Sciences, KU Leuven, Belgium
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Long-Term Effect of Hyperbaric Oxygen Therapy on Gait and Functional Balance Skills in Cerebral Palsy Children-A Randomized Clinical Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020394. [PMID: 36832523 PMCID: PMC9955998 DOI: 10.3390/children10020394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
This study aimed to explore the long-term effects of hyperbaric oxygen therapy on spatiotemporal gait parameters and functional balance in children with cerebral palsy. Thirty-nine children with hemiplegic cerebral palsy were randomly allocated to one of two groups: control or study. The children in both groups received traditional physical therapy three times per week for six months. In addition, the children in the study group received hyperbaric oxygen therapy five times/week for eight weeks. The GAITRite system and pediatric balance scale were used to assess spatiotemporal gait parameters and functional balance at baseline, post-intervention, and six months after the cessation of hyperbaric oxygen therapy. Post-intervention means of all measured parameters were significantly higher than pre-intervention means, but only for the study group (p < 0.05). However, both groups' means at the six-month follow up were significantly greater than those at pre-intervention (p < 0.05). At the post-intervention and follow-up evaluations, comparisons between groups revealed a statistically significant difference in all measured parameters for the study group against the control group (p < 0.05). It can be concluded that adding hyperbaric oxygen therapy to physical therapy rehabilitation could be effective in improving spatiotemporal gait parameters and functional balance in children with cerebral palsy.
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An increase in relative contribution of compensatory postural adjustments during voluntary movement while standing in adolescents and young adults with bilateral spastic cerebral palsy. Exp Brain Res 2022; 240:3315-3325. [PMID: 36318317 DOI: 10.1007/s00221-022-06499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022]
Abstract
Previous studies have revealed several deficits in anticipatory postural adjustments (APAs) during voluntary movements while standing in individuals with bilateral spastic cerebral palsy (BSCP). However, it remains unclear whether compensatory postural adjustments (CPAs) during movement increase to compensate for APA deficits. We investigated the anticipatory and compensatory activities of postural muscles during voluntary movement while standing in adolescents and young adults with BSCP. The study included seven participants with BSCP with level II on the Gross Motor Function Classification System (GMFCS), seven with BSCP with level III on the GMFCS, and fourteen healthy controls. The participants stood on a force platform and lifted a load under two weight conditions (light and heavy). The electromyographic activities of postural muscles were analyzed at time intervals typical for APAs and CPAs. The percentage of muscle activity in the CPA time epoch against the total muscle activity during the APA and CPA time epochs was higher in the two BSCP groups than in the control group. In the control group, a load-related modulation was observed only in the APA time epoch, whereas in the BSCP-II group, the load-related increase was observed in both the APA and CPA time epochs. No load-related modulations were observed in the BSCP-III group. These findings suggest that adolescents and young adults with BSCP exhibit an increase in the relative contribution of CPAs during voluntary movement and that there exist severity-related differences in the modulation of APAs and CPAs.
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Franjoine MR, Darr N, Young B, McCoy SW, LaForme Fiss A. Examination of the effects of age, sex, and motor ability level on balance capabilities in children with cerebral palsy GMFCS levels I, II, III and typical development using the Pediatric Balance Scale. Dev Neurorehabil 2022; 25:115-124. [PMID: 34282712 DOI: 10.1080/17518423.2021.1943033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Explore effects of age, sex, and motor ability level on balance capabilities in preschoolers with and without Cerebral Palsy (CP). METHOD PBS was administered to 477 children 24 through 59 months: 258 with typical development (TD) and 219 with CP GMFCS levels I, II and III. RESULTS 3-way ANOVA indicated PBS scores were significantly affected by age (F4,437=26.95, p<0.0001, η2p=0.198), motor ability level (F3,437=482.15, p<0.0001, η2p=0.768) and sex (F1,437=4.64, p<0.03, η2p=0.01) with significant interaction between motor ability level and age (F 12,437=5.25, p<0.001, η2p=0.126). Children's performance on individual items was analyzed by age, sex and motor ability level. CONCLUSION Children with TD outperformed children with CP GMFCS level I 36-59 months and children with CP GMFCS levels II and III 24-59 months. Expected performance values for children with TD and children with CP, ages 24-59 months, at GMFCS levels I, II and III are provided.
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Affiliation(s)
| | - Nancy Darr
- School of Physical Therapy, Belmont University, Nashville, Tennessee, USA
| | - Brenda Young
- Department Natural Sciences, Daemen College, Amherst, New York, USA
| | - Sally Westcott McCoy
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Efficacy of foot-ankle orthosis on balance for children with hemiplegic cerebral palsy: An observational study. Turk J Phys Med Rehabil 2021; 67:336-343. [PMID: 34870121 PMCID: PMC8607003 DOI: 10.5606/tftrd.2021.5175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 07/10/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives
The aim of this study was to investigate the impact of ankle-foot orthoses (AFOs) on the balance and gait and to compare the effects of hinged AFOs with solid AFOs on balance in patients with cerebral palsy (CP).
Patients and methods
Between January 2015 and January 2016, 19 hemiplegic children with CP (11 males, 8 females; mean age: 9.5±2.2 years; range, 6 to 15 years) and 23 sex- and age-matched controls (8 males, 15 females; mean age: 10±1.6 years; range, 6 to 13 years) were included in this study. All patients were using either solid or hinged AFO. Hemiplegic patients were attended to specific tests with orthoses and barefoot. Pediatric Balance Scale (PBS) and Five Times Sit to Stand Test (FTSST) were used for functional evaluation. The quantitative balance was evaluated using the device-assisted balance tests, Limits of Stability (LOS), Walk Across (WA), and Sit to Stand (STS) tests.
Results
The control group had a better functional balance than the CP group (p<0.001 for PBS and p<0.001 for FTSST) and the CP group with AFO had a better balance than the barefoot (p=0.001 for PBS and p=0.009 for FTSST). Children with CP also showed a higher sway velocity in STS (p<0.001) than the control group. In patients with AFO, a decrease in the sway velocity in STS (p=0.037) and an increase in directional control in LOS (p=0.044) were observed, compared to barefoot.
Conclusion
The AFO use offers a significant contribution to the functional balance in CP. Prescribing AFOs are usually required in ambulatory CP patients in combined with a well-designed standard physiotherapy.
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The Effects of Over-Ground Robot-Assisted Gait Training for Children with Ataxic Cerebral Palsy: A Case Report. SENSORS 2021; 21:s21237875. [PMID: 34883877 PMCID: PMC8659941 DOI: 10.3390/s21237875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022]
Abstract
Poor balance and ataxic gait are major impediments to independent living in ataxic cerebral palsy (CP). Robot assisted-gait training (RAGT) has been shown to improve the postural balance and gait function in children with CP. However, there is no report on the application of RAGT for children with ataxic CP. Here, we report two cases of children with ataxic CP who underwent over-ground RAGT along with conventional therapy for 4 weeks. Outcome measures including the gross motor function measure (GMFM), pediatric balance scale, pediatric reach scale, one-minute walk test, and Timed Up and Go test were assessed before and after the 4-week intervention. Both cases were well adapted to the RAGT system without any significant adverse event. Improvements in the GMFM after RAGT, compared with that in the GMFM, after intensive conventional therapy have been reported previously. It is noteworthy that over-ground RAGT improved areas of the GMFM that did not improve with conventional therapy. In addition, over-ground RAGT with conventional therapy led to improvements in functional balance and walking capacity. These findings suggest that over-ground RAGT is feasible and may be a potential option for enhancing balance and functional walking capacity in children with ataxic CP.
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Vila-Nova F, Dos Santos Cardoso de Sá C, Oliveira R, Cordovil R. Differences in Leisure Physical Activity Participation in Children with Typical Development and Cerebral Palsy. Dev Neurorehabil 2021; 24:180-186. [PMID: 32981411 DOI: 10.1080/17518423.2020.1819461] [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: 10/23/2022]
Abstract
AIM To compare participation in leisure physical activities in children with typical development (TD) and cerebral palsy (CP). METHODS A total of 170 children with TD (n = 101) and CP (n = 69) aged 8 to 18 years reported participation in 16 extracurricular physical activities. Non-parametric statistics examined differences between groups. RESULTS Children with TD participated more frequently in individual physical activities (p = .018), team sports (p = .026), and bicycling (p = .001), and less in horseback riding (p = .031) than children with CP in GMFCS II-V. The differences between children with TD and CP in GMFCS I and within the CP group were not statistically significant. We did not find differences between groups in enjoyment. CONCLUSION Children with CP in GMFCS II-V tend to participate less in leisure physical activities that require higher motor and perceptual skills. Support in the adaptation of physical recreation and sports may help improve participation.
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Affiliation(s)
- Fabio Vila-Nova
- Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | | | - Raul Oliveira
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Rita Cordovil
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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Sousa Junior RR, Gontijo APB, Santos TRT, Wright FV, Mancini MC. Measurement Properties and Translation to Brazilian-Portuguese of the Challenge for Children and Adolescents with Cerebral Palsy. Phys Occup Ther Pediatr 2021; 41:372-389. [PMID: 33342345 DOI: 10.1080/01942638.2020.1859663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aims: Translate the Challenge assessment into Brazilian-Portuguese, determine its face validity, evaluate the reliability of the total score and score per item, investigate whether the child's gross motor level (classified by the Gross Motor Function Classification System-GMFCS) influences the reliability levels, and estimate responsiveness to change.Methods: The translation followed four stages: translation, synthesis, back-translation, and review. For face validity, ten physical therapists evaluated item relevance. Children and adolescents with cerebral palsy (n = 50, 5-18 years of age) GMFCS I and II were evaluated by two therapists for inter and intra-rater reliability. Thirty of these participants were recruited for the instrument's responsiveness evaluation and reassessed (n = 28) after three months of treatment. Minimal Detectable Change (MDC), and Minimal Clinically Important Difference (MCID) were estimated.Results: The back-translated version was similar to the English version. All test items were considered relevant by the physical therapists. Total score intra and inter-rater reliability were excellent for both GMFCS levels (ICC = 0.94-0.99). Items' intra- and inter- rater reliability varied from low to almost perfect (kw=-0.14-0.94). MDC90 and MDC95 values were 3.90-6.35 and 4.63-7.54, respectively. MCID values were 3.57-4.56.Conclusion: The translated version of the Challenge showed excellent face validity and reliability and was able to document longitudinal change.
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Affiliation(s)
| | | | | | | | - Marisa C Mancini
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Towns M, Lindsay S, Arbour-Nicitopoulos K, Mansfield A, Wright FV. Balance confidence and physical activity participation of independently ambulatory youth with cerebral palsy: an exploration of youths' and parents' perspectives. Disabil Rehabil 2020; 44:2305-2316. [PMID: 33186057 DOI: 10.1080/09638288.2020.1830191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Youth with cerebral palsy generally participate in less physical activity than typically developing peers. In adults with physical disabilities, balance confidence is a strong predictor of participation and community re-integration. However, balance confidence has not been studied in youth with cerebral palsy. METHOD Qualitative descriptive methodology with interviews of eight youth with cerebral palsy (9-17 years old, three girls) in Gross Motor Function Classification System Levels I-III, and eight parents (five mothers) of youth with cerebral palsy (9-17 years old, two girls) in Levels I-III. RESULTS Three themes arose: (1) youth in Gross Motor Function Classification System Levels I-II are more concerned about losing their balance during physical activities than those in Level III; (2) when balance is lost, embarrassment and frustration are more common than fear, especially for those in Levels I-II; and (3) social factors can create a favorable participation environment when balance confidence is low, especially for youth in Levels I-II. CONCLUSION Balance confidence may have greater influence on physical activity participation for youth in Gross Motor Function Classification System Levels I-II than those in Level III. Youth in Levels I-II may draw greater benefit from interventions targeting balance confidence when addressing physical activity goals.IMPLICATIONS FOR REHABILITATIONBalance confidence may have a greater influence on activity avoidance for youth with cerebral palsy in Gross Motor Function Classification System Levels I and II (who are independently ambulatory without walkers or cane(s)) than for those in Level II (who use walkers or cane(s) to ambulate).Youth who are independently ambulatory without walkers or cane(s) may benefit more from interventions directed at balance confidence (e.g., enactive mastery and verbal persuasion) to address their physical activity participation goals.For youth who are independently ambulatory without walkers or cane(s), addressing factors that could reduce the influence of balance confidence on physical activity participation, such as providing a positive and supportive social environment in which to participate, may be beneficial.
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Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Sally Lindsay
- Bloorview Research Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kelly Arbour-Nicitopoulos
- Bloorview Research Institute, Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Araújo PAD, Starling JMP, Oliveira VC, Gontijo APB, Mancini MC. Combining balance-training interventions with other active interventions may enhance effects on postural control in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Braz J Phys Ther 2020; 24:295-305. [PMID: 31076254 PMCID: PMC7351984 DOI: 10.1016/j.bjpt.2019.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Improvement of postural control in children and adolescents with cerebral palsy is a primary goal in child rehabilitation. OBJECTIVE A systematic review investigated whether combining balance-training interventions with other active interventions enhances the effects of the active intervention alone on postural control of children and adolescents with cerebral palsy. METHODS Searches were performed in MEDLINE, PEDro, CINAHL, Cochrane and EMBASE databases without date or language restrictions. Randomized controlled trials investigating the combination of balance-training interventions with other active interventions on the postural control of children and adolescents with cerebral palsy were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. Meta-analysis was conducted, and quality of the evidence followed the GRADE methodology. Pooled data were presented using standardized mean difference and 95% confidence interval. RESULTS Seven studies involving 194 participants were included in this review. A large additional effect on postural control was found when balance-training interventions were combined with Neurodevelopmental Treatment at short-term (standardized mean difference of 1.3; 95% confidence interval 0.5, 2.0, p=0.001). The quality of the evidence was very low due to publication bias, imprecision and inconsistency. CONCLUSION Combining balance-training interventions with other active interventions may enhance effects on postural control of this population at short-term. As the estimated effect had only very low quality of evidence to support it, larger studies with low risk of bias are needed.
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Affiliation(s)
| | - Juliana Maria Pimenta Starling
- Hospital Foundation of Minas Gerais State (FHEMIG), Hippotherapy Center of the Alferes Tiradentes Cavalry Regiment (CERCAT), Belo Horizonte, MG, Brazil
| | - Vinícius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, MG, Brazil.
| | - Ana Paula Bensemann Gontijo
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Marisa Cotta Mancini
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Pavão SL, Maeda DA, Corsi C, Santos MMD, Costa CSND, de Campos AC, Rocha NACF. Discriminant ability and criterion validity of the Trunk Impairment Scale for cerebral palsy. Disabil Rehabil 2018; 41:2199-2205. [PMID: 29663838 DOI: 10.1080/09638288.2018.1462410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aims: To compare the performance of children with mild and moderate-to-severe cerebral palsy (CP) on the Trunk Impairment Scale (TIS), Gross Motor Function Measure (GMFM), and on center-of-pressure variables; to establish the discriminant ability of these tools to predict severity of motor impairment in CP; and to investigate the criterion validity of the TIS. Methods: Children with mild (n = 18, 11 males, 7 females, mean age = 9.5 ± 2.9 years, Gross Motor Function Classification System I-II) and moderate-to-severe (n = 18, 11 males, 7 females, mean age = 9.2 ± 229, Gross Motor Function Classification System III-IV) CP were tested using the TIS and the GMFM, and during static sitting on force-plate. Results: Children with mild CP showed better trunk (median; 95% confidence interval = 22.5; 21.29-22.59 vs. 13; 11.97-14.8; p < 0.001) and gross motor (60; 57.73-59.3 vs. 40; 38.96-46.25; p < 0.001) scores, and better postural control (lower center of pressure (CoP) displacement [anterior-posterior: (0.42; 0.32-1.11 vs. 0.89; 0.70-1.65; p = 0.022); medial-lateral: (0.42; 0.31-1.08 vs. 0.91; 0.65-1.17; p = 0.044)], and lower area of sway, (0.05; -0.15-0.97 vs. 0.44; 0.23-0.90; p = 0.008) than the moderate-to-severe group. Trunk control and gross motor function explained 81.5% of the variance in the severity of motor condition. Correlations between the TIS and the GMFM were excellent (ρ = 0.944, p < 0.001); correlations between the TIS and CoP variables were low (anterior-posterior displacement: ρ = -0.411, p < 0.05; medial-lateral displacement: ρ = -0.327, p < 0.05); area of sway: ρ = -0.430, p < 0.05; velocity of sway: ρ = -0.308, p < 0.05). Conclusions: The TIS is able to differentiate levels of trunk control across various levels of motor impairments in CP. It is a valid tool to assess trunk control, showing very high concurrent validity with the GMFM sitting dimension. Implications for Rehabilitation Trunk Impairment Scale (TIS) can be used by rehabilitation professionals to differentiate levels of trunk control across levels of motor impairment. TIS showed concurrent validity with Gross Motor Function Measure and should be used to assess trunk control in children with cerebral palsy (CP) in clinical settings. The use of TIS allows a reliable assessment of postural control in children with CP in clinical settings.
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Affiliation(s)
- Sílvia Leticia Pavão
- a Department of Physiotherapy, Neuropediatrics Section , Federal University of São Carlos , São Carlos , Brazil
| | - Davi Adiwardana Maeda
- a Department of Physiotherapy, Neuropediatrics Section , Federal University of São Carlos , São Carlos , Brazil
| | - Carolina Corsi
- a Department of Physiotherapy, Neuropediatrics Section , Federal University of São Carlos , São Carlos , Brazil
| | - Mariana Martins Dos Santos
- a Department of Physiotherapy, Neuropediatrics Section , Federal University of São Carlos , São Carlos , Brazil
| | - Carolina Souza N da Costa
- a Department of Physiotherapy, Neuropediatrics Section , Federal University of São Carlos , São Carlos , Brazil
| | - Ana Carolina de Campos
- a Department of Physiotherapy, Neuropediatrics Section , Federal University of São Carlos , São Carlos , Brazil
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Panibatla S, Kumar V, Narayan A. Relationship Between Trunk Control and Balance in Children with Spastic Cerebral Palsy: A Cross-Sectional Study. J Clin Diagn Res 2017; 11:YC05-YC08. [PMID: 29207820 DOI: 10.7860/jcdr/2017/28388.10649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/06/2017] [Indexed: 11/24/2022]
Abstract
Introduction Trunk control is impaired in children with Cerebral Palsy (CP) thus influencing their functional balance. However, there is a paucity of literature determining the relationship between trunk control and balance in children with CP. Aim To find the relationship between trunk control and balance by means of Trunk Control Measurement Scale (TCMS) and Paediatric Balance Scale (PBS). Materials and Methods Twenty four children {age range 8-14 years, Gross Motor Function Classification System (GMFCS) Level I-III} with spastic CP were recruited and evaluated using TCMS and PBS. The results were expressed as summary measures median (M) and Inter-Quartile Range (IQR). The correlation of TCMS and PBS were done using Spearman's correlation coefficient. A p-value <0.05 was considered statistically significant. Results The children obtained a median score of 52 out of 58 on the TCMS and 50 out of 56 on PBS. There was a significantly strong correlation with rs=0.77 and p<0.01. A strong correlation (p<0.01) was seen between static, dynamic and total components of TCMS and PBS. The median scores of TCMS and PBS had a strong correlation for boys with rs=0.74 and very strong correlation for girls with rs=0.84. Based on the type of spastic CP, diplegics had a very strong correlation with rs=0.85. While based on GMFCS levels, Level II and Level III had a very strong correlation (For level II rs=0.81 and level III rs=0.86) and weak correlation for level I (rs=0.27). Conclusion Based on gender, topography and severity of the motor impairment both trunk control and balance are impaired to a different degree in children with CP. The findings of this study showed a high positive correlation between trunk control and balance in children with spastic CP.
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Affiliation(s)
- Sivatejaa Panibatla
- Senior Resident, Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Vijaya Kumar
- Associate Professor, Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Amitesh Narayan
- Professor and Head, Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
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Abstract
BACKGROUND Primary family caregivers (PFCs) of children with cerebral palsy have many worries and concerns when their children face orthopedic surgery. Levels of PFC stress about the upcoming surgery is related to the child's level of gross motor function as well as the support they receive from medical professionals. PURPOSE The purposes of the present study were to (1) explore the levels of concern about orthopedic surgery; and (2) explore the predictive factors associated with concerns about orthopedic surgery among PFCs of children with cerebral palsy during the preoperative period. METHODS A cross-sectional, correlational study was conducted. Primary family caregivers were assessed preoperatively using the Single-event Multilevel Surgery Scale, Social Support Scale, Gross Motor Function Classification System-Expanded and Revised, and background information form. Primary family caregivers were recruited from the outpatient department of orthopedic surgery and pediatric rehabilitation of a medical center in northern Taiwan. Data were analyzed by descriptive analysis, Pearson product-moment correlation, and multiple regression analysis. RESULTS A total of 63 eligible subjects were enrolled in this study. Primary family caregivers had moderate levels of concern and mild-to-moderate levels of social support. The higher severity of motor function impairment in children with cerebral palsy, prior caregiving by PFCs for another family member, and PFCs' lower level of social support from healthcare providers were associated with higher levels of PFC concern. CONCLUSIONS Concerns about orthopedic surgery is an overlooked issue that needs more attention from healthcare providers. This study determined that PFCs who perceived a lack of social support from their healthcare providers and those with children who had limited gross motor function were more concerned and anxious about their children's upcoming orthopedic surgery. Health professionals should provide adequate health education and counseling to help PFCs of children with cerebral palsy in the decision-making process prior to orthopedic surgery.
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Tomita H, Fukaya Y, Takagi Y, Yokozawa A. Effects of severity of gross motor disability on anticipatory postural adjustments while standing in individuals with bilateral spastic cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 57:92-101. [PMID: 27399205 DOI: 10.1016/j.ridd.2016.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 04/23/2016] [Accepted: 06/26/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Although individuals with bilateral spastic cerebral palsy (BSCP) exhibit several deficits in anticipatory postural adjustments (APAs) while standing, effects of severity of motor disability on their APAs are unclear. AIMS To determine whether individuals with BSCP exhibit severity-dependent deficits in APAs. METHODS AND PROCEDURES Seven individuals with level II BSCP (BSCP-II group) and seven with level III BSCP (BSCP-III group) according to the Gross Motor Function Classification System and seven healthy controls lifted a load under two different load conditions. OUTCOMES AND RESULTS Anticipatory activities of the erector spinae (ES), medial hamstring (MH), and gastrocnemius (GCM) were smaller in the two BSCP groups than in the control group. Although the anticipatory GCM activity was similar between the BSCP groups, the ES and MH activities were larger in the BSCP-II group than in the BSCP-III group. In the BSCP-II group, an increase in anticipatory activity with an increase in load was observed in the MH, but not in the GCM. In the BSCP-III group, load-related modulation was not found in the MH or GCM. CONCLUSIONS AND IMPLICATIONS The present findings suggest that in individuals with BSCP with severe motor disability, APA deficits extend to more proximal parts of the body.
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Affiliation(s)
- Hidehito Tomita
- Aichi Prefectural Hospital and Rehabilitation Center for Disabled Children, Dai-ni Aoitorigakuen, 5-1 Aza-yanagisawa, Motojyuku-cho, Okazaki 444-3505, Japan; Graduate School of Health Sciences, Toyohashi SOZO University, 20-1 Matsushita, Ushikawa-cho, Toyohashi 440-8511, Japan.
| | - Yoshiki Fukaya
- Aichi Prefectural Hospital and Rehabilitation Center for Disabled Children, Dai-ni Aoitorigakuen, 5-1 Aza-yanagisawa, Motojyuku-cho, Okazaki 444-3505, Japan
| | - Yukina Takagi
- Yachiyo Hospital, 2-2-7 Sumiyoshi-cho, Anjo 446-8510, Japan
| | - Asami Yokozawa
- Suzukake Health Care Hospital, 2042-4 Ohara, Iwata 438-0043, Japan
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16
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Lim H. Correlation between the selective control assessment of lower extremity and pediatric balance scale scores in children with spastic cerebral palsy. J Phys Ther Sci 2015; 27:3645-9. [PMID: 26834323 PMCID: PMC4713762 DOI: 10.1589/jpts.27.3645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/01/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the correlation between the
Selective Control Assessment of Lower Extremity (SCALE) and Pediatric Balance Scales (PBS)
in children with spastic cerebral palsy and further to test whether the SCALE is a valid
tool to predict the PBS. [Subjects and Methods] A cross-sectional study was conducted to
evaluate the SCALE and PBS in 23 children (9 females, 14 males, GMFCS level I–III) with
spastic cerebral palsy. [Results] Both the SCALE and PBS scores for children with spastic
hemiplegia were significantly higher than those for children with spastic diplegia. The
scores for SCALE items were low for distal parts. The PBS items that were difficult for
the participants to perform were items 8, 9, 10, and 14 with the highest difficulty
experienced for item 8 followed by items 9, 10, and 14. The correlation coefficient
(0.797) between the SCALE and PBS scores was statistically significant. The correlations
between each SCALE item and the PBS scores were also statistically significant. SCALE
items were significantly correlated with two PBS dimensions (standing and postural
change). [Conclusion] In SCALE assessment, more severe deficits were observed in the
distal parts. Standing and postural changes in the PBS method were difficult for the
participants to perform. The two tests, that is, the SCALE and PBS, were highly
correlated. Therefore, the SCALE is useful to prediction of PBS outcomes and is also
applicable as a prognostic indicator for treatment planning.
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Affiliation(s)
- Hyoungwon Lim
- Department of Physical Therapy, College of Health Sciences, Dankook University, Republic of Korea
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17
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Grazziotin Dos Santos C, Pagnussat AS, Simon AS, Py R, Pinho ASD, Wagner MB. Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:134-141. [PMID: 25462474 DOI: 10.1016/j.ridd.2014.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/13/2014] [Accepted: 09/22/2014] [Indexed: 06/04/2023]
Abstract
This study aimed to investigate the electromyographic activity of cervical and trunk extensors muscles in children with cerebral palsy during two handlings according to the Bobath concept. A crossover trial involving 40 spastic diplegic children was conducted. Electromyography (EMG) was used to measure muscular activity at sitting position (SP), during shoulder internal rotation (IR) and shoulder external rotation (ER) handlings, which were performed using the elbow joint as key point of control. Muscle recordings were performed at the fourth cervical (C4) and at the tenth thoracic (T10) vertebral levels. The Gross Motor Function Classification System (GMFCS) was used to assess whether muscle activity would vary according to different levels of severity. Humeral ER handling induced an increase on EMG signal of trunk extensor muscles at the C4 (P=0.007) and T10 (P<0.001) vertebral levels. No significant effects were observed between SP and humeral IR handling at C4 level; However at T10 region, humeral IR handling induced an increase of EMG signal (P=0.019). Humeral ER resulted in an increase of EMG signal at both levels, suggesting increase of extensor muscle activation. Furthermore, the humeral ER handling caused different responses on EMG signal at T10 vertebra level, according to the GMFCS classification (P=0.017). In summary, an increase of EMG signal was observed during ER handling in both evaluated levels, suggesting an increase of muscle activation. These results indicate that humeral ER handling can be used for diplegic CP children rehabilitation to facilitate cervical and trunk extensor muscles activity in a GMFCS level-dependent manner.
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Affiliation(s)
- C Grazziotin Dos Santos
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Associação de Assistência à Criança Deficiente (AACD), Porto Alegre RS, Brazil
| | - Aline S Pagnussat
- Departamento de Fisioterapia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
| | - A S Simon
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Rodrigo Py
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Alexandre Severo do Pinho
- Bolsista de desenvolvimento técnico e industrial da Fundação de Amparo à Pesquisa do Rio Grande do Sul (FAPERGS), Brazil
| | - Mário B Wagner
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
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