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Hwang Y, Kwon JY. Identifying the most representative actigraphy variables reflecting standardized hand function assessments for remote monitoring in children with unilateral cerebral palsy. BMC Pediatr 2024; 24:273. [PMID: 38664706 PMCID: PMC11044557 DOI: 10.1186/s12887-024-04724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/27/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Accurate assessment of physical activity and motor function in children with cerebral palsy is crucial for determining the effectiveness of interventions. This study aimed to investigate the correlation between real-world activity monitoring outcomes and in-laboratory standardized hand function assessments in children with unilateral cerebral palsy. METHODS Actigraphy data were collected over 3 days from children aged 4-12 years with unilateral cerebral palsy before in-laboratory assessments. To tackle the high dimensionality and collinearity of actigraphy variables, we first applied hierarchical clustering using the Pearson correlation coefficient as the distance metric and then performed a principal component analysis (PCA) to reduce the dimensionality of our data. RESULTS Both hierarchical clustering and PCAs revealed a consistent pattern in which magnitude ratio variables (ln[affected side magnitude/less-affected side magnitude]) were more strongly associated with standardized assessments of hand function than with activity time and distance domain variables. Hierarchical clustering analysis identified two distinct clusters of actigraphy variables, with the second cluster primarily consisting of magnitude ratio variables that exhibited the strongest correlation with Melbourne Assessment 2, Pediatric Motor Activity Log, Assisting Hand Assessment, and Manual Ability Classification System level. Principal component 2, primarily representing the magnitude ratio domain, was positively associated with a meaningful portion of subcategories of standardized measures, whereas principal component 1, representing the activity time and distance component, showed limited associations. CONCLUSIONS The magnitude ratio of actigraphy can provide additional objective information that complements in-laboratory hand function assessment outcomes in future studies of children with unilateral cerebral palsy. TRIAL REGISTRATION IN CLINICALTRIALS.GOV: NCT04904796 (registered prospectively; date of registration: 23/05/2021).
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Affiliation(s)
- Youngsub Hwang
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jeong-Yi Kwon
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Hwang Y, Kwon JY, Na Y. An Exploration of Tri-Axial Accelerometers in Assessing the Therapeutic Efficacy of Constraint-Induced Movement Therapy in Children with Unilateral Cerebral Palsy. SENSORS (BASEL, SWITZERLAND) 2023; 23:9393. [PMID: 38067766 PMCID: PMC10708848 DOI: 10.3390/s23239393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
This study aimed to elucidate the role of tri-axial accelerometers in assessing therapeutic interventions, specifically constraint-induced movement therapy (CIMT), in children with unilateral cerebral palsy (UCP). The primary focus was understanding the correlation between the actigraphy metrics recorded during CIMT sessions and the resultant therapeutic outcomes. Children with UCP, aged between 4 and 12 years, participated in this study from July 2021 to December 2022. In conjunction with in-clinic sessions, during which participants wore tri-axial accelerometers on both limbs, we analyzed actigraphy data over three days of routine activities pre- and post-CIMT. While not all metrics derived from the accelerometers indicated significant improvements post-intervention, there was a clear trend towards a more balanced usage of both limbs, particularly evident in Axis 3, associated with vertical movement (p = 0.017). Additionally, a discernible correlation was observed between changes in the magnitude ratio derived from actigraphy data during CIMT (Δweek3-week1) and variations in traditional assessments pre- and post-intervention (ΔT0-T1), specifically the Assisting Hand Assessment grasp and release. Using tri-axial accelerometers has helped clarify the potential impacts of CIMT on children with UCP. The preliminary results suggest a possible link between actigraphy metrics taken during CIMT and the subsequent therapeutic outcomes determined by standardized tests.
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Affiliation(s)
- Youngsub Hwang
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea;
| | - Jeong-Yi Kwon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Yoonju Na
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
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Bingol H, Kerem Gunel M. Exploration of the relationship between functional motor and communication performance levels and amount of use of the more affected upper extremity based on the caregivers' perceptions in children with hemiplegic cerebral palsy: A cross-sectional study. Rehabilitacion (Madr) 2023; 57:100784. [PMID: 36739683 DOI: 10.1016/j.rh.2023.100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Accepted: 12/08/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate relationships between amount of use of the more affected upper extremity and functional motor and communication performance classification systems. MATERIAL AND METHODS The study comprised 95 children with congenital hemiplegic cerebral palsy (CP) aged 6-15 years (52 males, 43 females; mean age 9.53, SD 3.1) and their parents/caregivers. The amount of use of the more affected upper extremity was assessed using Pediatric Motor Activity Log-Revised-How Often subscale (PMAL-R HO). Functional levels of the enrolled children were defined by the parents/caregivers using Manual Ability Classification System (MACS), Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R), and Communication Function Classification System (CFCS). RESULTS A strong and negative correlation was found between PMAL-R HO subscale score and MACS (r=-0.819), suggesting that children with lower MACS levels are more likely to use their more affected upper extremity spontaneously. Additionally, negative and moderate associations between PMAL-R HO subscale score and GMFCS and CFCS were revealed (r1=-0.549 and r2=-0.567). CONCLUSION The amount of use of the more affected upper extremity is more sensitive to MACS than GMFCS-E&R and CFCS. Children with a given MACS level had a wide range of PMAL-R HO subscale score. In addition to MACS, a score on the PMAL-R HO subscale related to the more affected upper extremity should be included as an inclusion criterion in clinical trials to avoid misleading effects of intervention approaches aimed at improving the amount of use of the more affected upper extremity in children with congenital hemiplegic CP.
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Affiliation(s)
- H Bingol
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Mus Alparslan University, Mus, Turkey.
| | - M Kerem Gunel
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Sıhhiye, Ankara, Turkey
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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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Coxon ML, Hoyt CR, Smith AE, Hadders-Algra M. Going Beyond Conventional Assessment of Developmental Motor Disorders: Exploring Video Methods for Early Identification Among Children 0 to 3 Years. ADVANCES IN REHABILITATION SCIENCE AND PRACTICE 2023; 12:27536351231207740. [PMID: 37928362 PMCID: PMC10621290 DOI: 10.1177/27536351231207740] [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: 07/17/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
Motor skills and movement-related functioning significantly shape how children experience and interact with the world around them. Among infants and young children, developmental motor disorders contribute to delays with motor, cognitive, and psychosocial development. Early and accurate identification of these disorders is necessary to facilitate timely access to therapeutic interventions that minimize the long-term effects of disability on everyday activities and participation. In the United States, motor assessments commonly used among children 0 to 3 years focus on completion of specific motor skills at a single point in time, which provides only a part of the greater picture that is a child's motor and movement-related functioning. Video-capture methods, like the General Movements Assessment (GMA) and the Infant Motor Profile (IMP), offer greater accuracy and predictive power to (1) identify motor deficits in young children and (2) facilitate early access to supportive, therapeutic intervention.
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Affiliation(s)
- Maria Lopez Coxon
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine R Hoyt
- Departments of Neurology and Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Alyssa E Smith
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Centre Groningen, Department of Pediatrics, Division of Developmental Neurology, Groningen, the Netherlands
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Thomé Teixeira da Silva LV, Vegas M, Aquaroni Ricci N, Cardoso de Sá CS, Alouche SR. Selecting assessment tools to characterize upper limb function of children with cerebral palsy: A mega-review of systematic reviews. Dev Neurorehabil 2022; 25:378-391. [PMID: 35282778 DOI: 10.1080/17518423.2022.2046656] [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: 11/03/2022]
Abstract
AIM A mega-review of published systematic reviews without restriction on year of publication was implemented to summarize available assessment tools of upper limb (UL) function in children with Cerebral Palsy (CP). METHOD A multi-prong search strategy was used to identify 12 systematic literature reviews for inclusion in the mega-review. Included reviews were coded by descriptive analyses, which included methodological and reported measurement property description. Methodological quality of the selected systematic reviews was evaluated with the AMSTAR-2. We synthetized the measurement properties of the revised assessment tools and their coverage within the International Classification of Functioning, Disability and Health (ICF) domains. RESULTS The 12 systematic reviews addressed 84 assessment tools. Systematic reviews' methodological quality varied between critically low to moderate. Suggested assessment tools covered ICF domains of body structure and function, and activities and participation. Measurement property data analysis was based mostly on reliability and validity. INTERPRETATION Based on the findings of the mega-review, the ABILHAND-Kids, Assisting Hand Assessment (AHA) and Melbourne Assessment of Unilateral Upper Limb Function (MUUL) are the most suitable tools to evaluate children between 6 and 12 years of age with unilateral CP.
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Affiliation(s)
| | - Milena Vegas
- School of Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Natalia Aquaroni Ricci
- Master's and Doctoral Program in Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - Sandra Regina Alouche
- Master's and Doctoral Program in Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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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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Hollis A, Cole L, Zewdie E, Metzler MJ, Kirton A. Bilateral actigraphic quantification of upper extremity movement in hemiparetic children with perinatal stroke: a case control study. J Neuroeng Rehabil 2021; 18:172. [PMID: 34915898 PMCID: PMC8680110 DOI: 10.1186/s12984-021-00962-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemiparetic cerebral palsy impacts millions of people worldwide. Assessment of bilateral motor function in real life remains a major challenge. We evaluated quantification of upper extremity movement in hemiparetic children using bilateral actigraphy. We hypothesized that movement asymmetry correlates with standard motor outcome measures. METHODS Hemiparetic and control participants wore bilateral wrist Actiwatch2 (Philips) for 48 h with movement counts recorded in 15-s intervals. The primary outcome was a novel statistic of movement asymmetry, the Actigraphic Movement Asymmetry Index (AMAI). Relationships between AMAI and standard motor outcomes (Assisting Hand Assessment, Melbourne Assessment, and Box and Block Test [BB]) were explored with Pearson or Spearman correlation. RESULTS 30 stroke (mean 11 years 2 months (3 years 10 months); 13 female, 17 male) and 23 control (mean 11 years 1 month (4 years 5 months); 8 female, 15 male) were enrolled. Stroke participants demonstrated higher asymmetry. Correlations between AMAI and standard tests were moderate and strongest during sleep (BB: r = 0.68, p < 0.01). CONCLUSIONS Standard tests may not reflect the extent of movement asymmetry during daily life in hemiparetic children. Bilateral actigraphy may be a valuable complementary tool for measuring arm movement, potentially enabling improved evaluation of therapies with a focus on child participation.
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Affiliation(s)
- Asha Hollis
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lauran Cole
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ephrem Zewdie
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Megan J Metzler
- Clinical Neurosciences, Alberta Children's Hospital, Calgary, Canada
| | - Adam Kirton
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Pediatric Neurology, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B6A8, Canada.
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11
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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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12
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Fehlings D, Krishnan P, Ragguett R, deVeber G, Gorter JW, Hunt C, Kim M, Mesterman R, McCormick A. Neurodevelopmental profiles of children with unilateral cerebral palsy associated with middle cerebral artery and periventricular venous infarctions. Dev Med Child Neurol 2021; 63:729-735. [PMID: 33521966 PMCID: PMC8247945 DOI: 10.1111/dmcn.14818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
AIM To compare the neurodevelopment of children with unilateral cerebral palsy (CP) with middle cerebral artery (MCA) and periventricular venous infarctions (PVIs). METHOD In this cross-sectional study, children with unilateral CP completed a neurological exam, unimanual Quality of Upper Extremity Skills Test, hand usage questionnaires, and IQ test. Neuroimaging was obtained from health records. RESULTS Two hundred and forty-five participants with unilateral CP had neuroimaging (151 [61.9%] male, ages 2-18y, median=7y 6mo, interquartile range [IQR]=6y 7mo, with 93.6% in Gross Motor Function Classification System level I/II and 78.8% in Manual Ability Classification System level I/II). Ninety-seven (39.6%) had MCA injuries and 106 (43.3%) had periventricular white matter injuries, of which 48 (45.3%) were PVIs. Median Quality of Upper Extremity Skills Test for the MCA group was 49.2 (IQR=55.8), PVI 79.9 (IQR=23.6) (Mann-Whitney U=988.50, p<0.001). Bimanual hand usage (Children's Hand-use Experience Questionnaire) (Mann-Whitney U=425, p<0.001) and light touch (odds ratio=9.12, 95% confidence interval 1.28-400.76, Fisher's exact test p=0.017) were lower in the MCA compared to the PVI group. Full-scale IQ median centile score for the MCA group was 18.0 (IQR=35.5) and 50.0 (IQR=30.0) for the PVI group (Mann-Whitney U=382, p<0.001). INTERPRETATION Children with unilateral CP and MCA injuries demonstrated lower hand function and usage, decreased light touch, and lower IQs compared to the PVI group. This study aids in defining rehabilitation needs informed by brain injury patterns.
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Affiliation(s)
- Darcy Fehlings
- Department of PaediatricsBloorview Research InstituteHolland Bloorview Kids Rehabilitation HospitalUniversity of TorontoTorontoONCanada
| | - Pradeep Krishnan
- Department of Diagnostic ImagingThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Renee‐Marie Ragguett
- Department of PaediatricsBloorview Research InstituteHolland Bloorview Kids Rehabilitation HospitalUniversity of TorontoTorontoONCanada
| | - Gabrielle deVeber
- Department of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Jan Willem Gorter
- Department of PediatricsCanChildMcMaster Children's HospitalMcMaster UniversityHamiltonONCanada
| | - Carolyn Hunt
- Department of PaediatricsGrandview Children's CentreUniversity of TorontoTorontoONCanada
| | - Marie Kim
- Erinoak Kids Center for Treatment and DevelopmentMississaugaONCanada
| | - Ronit Mesterman
- Department of PediatricsCanChildMcMaster Children's HospitalMcMaster UniversityHamiltonONCanada
| | - Anna McCormick
- Department of Pediatricsthe Children's Hospital of Eastern Ontario (CHEO)OttawaONCanada
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13
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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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14
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Mirich R, Kyvelidou A, Greiner BS. The Effects of Virtual Reality Based Rehabilitation on Upper Extremity Function in a Child with Cerebral Palsy: A Case Report. Phys Occup Ther Pediatr 2021; 41:620-636. [PMID: 33926350 DOI: 10.1080/01942638.2021.1909688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 02/12/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
AIM This case report was designed to assess the efficacy of virtual reality (VR) rehabilitation on improving upper extremity function for a child with spastic hemiplegic cerebral palsy. METHODS In addition to conventional therapies completed three times per week, the participant engaged in virtual reality rehabilitation with the Neofect Smart Kids five to seven days per week for six weeks totaling just over twelve hours of intervention time. Outcome measures were administered pre-intervention, post-intervention, and 6-weeks post-intervention. RESULTS Varying levels of improvement in motor function, quality of movement, and functional use were observed during intervention evidenced by improved scores on the following standardized assessments: Peabody Developmental Motor Scales, Second Edition; the Quality of Upper Extremity Skills Test; and the Pediatric Evaluation and Disability Inventory-Computer Adaptive Test. The participant maintained improvements in motor skills at 6-weeks post intervention, however, the quality of his movements and overall frequency of use with his affected upper extremity decreased in the 6-weeks following termination of intervention. CONCLUSIONS Even though the results are not generalizable, the VR intervention for this child allowed for greater movement repetition and improved functional upper extremity use.
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Affiliation(s)
- Rachael Mirich
- Occupational Therapy, Creighton University, Omaha, Nebraska, USA
| | | | - Bobbi S Greiner
- Occupational Therapy, Creighton University, Omaha, Nebraska, USA
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15
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Wang TN, Howe TH, Liang KJ, Chang TW, Shieh JY, Chen HL. Bimanual motor performance in everyday life activities of children with hemiplegic cerebral palsy. Eur J Phys Rehabil Med 2021; 57:568-576. [PMID: 33733719 DOI: 10.23736/s1973-9087.21.06504-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Motor impairments in children with cerebral palsy significantly reduce their ability to learn and adapt bimanual actions into their life roles. The current evidence on bimanual coordination performance in children with hemiplegic cerebral palsy were mostly drawn from kinematic studies. Whether these kinematic findings on bimanual motor performance can be observed when performing daily life activities in a natural environment is not clear. Further, there is no evidence what and how the verbal prompting influences bilateral motor performance. We intend to explore its role on bimanual motor performance as well. AIM This study aimed to investigate the bimanual motor performance in everyday life activities of children with hemiplegic cerebral palsy and the role of verbal prompts in facilitating affected hand use. DESIGN Observational study. SETTING Local medical center and community. POPULATION Twenty-five children with hemiplegic cerebral palsy and 25 age-matched typically developing children. METHODS The Observation-based Test of Capacity, Performance, and Developmental Disregard and Melbourne Assessment 2 were used to assess the quantitative and qualitative use of hands in everyday activities. RESULTS Children with hemiplegic cerebral palsy, demonstrated different motor coordination patterns in daily bimanual activities compared with their counterparts. With verbal prompts, children with hemiplegic cerebral palsy significantly increased the use of their affected hands in bimanual activities. However, the increases were observed only in basic motor components, such as reaching and grasping, and not in complex motor components such as manipulation. CONCLUSIONS These findings will assist researchers and clinicians to develop and refine intervention programs that maximize rehabilitation benefits in improving bimanual hand coordination performance for children with hemiplegic cerebral palsy. CLINICAL REHABILITATION IMPACT This study increased our understanding of bimanual motor performance of children with hemiplegic cerebral palsy in everyday life activities. The results demonstrated children with cerebral palsy rely more on their less-affected hand to perform bimanual activities with or without verbal prompts. Incorporating bimanual activities and verbal prompts during intervention may only be effective on facilitating basic hand movements but not on improving complex movements of affected hands. Further research is needed to explore other intervention strategies to facilitate complex bilateral hand movements.
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Affiliation(s)
- Tien-Ni Wang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsu-Hsin Howe
- Department of Occupational Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New Yourk, NY, USA
| | - Kai-Jie Liang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ting-Wei Chang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jeng-Yi Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Hao-Ling Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan - .,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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16
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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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Ribeiro MTC, Pfeifer LI. Intervention bimanual stimulates the abilities in infants with asymmetry. FISIOTERAPIA EM MOVIMENTO 2021. [DOI: 10.1590/fm.2021.34301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: The cerebral palsy and brachial plexus injury may cause asymmetry in the use of the upper limbs (UL). This condition requires early treatment to reduce the impact of the child's life; therefore, several proposed interventions aim to increase their functional independence. The Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Therapy (HABIT) have been widely considered effective interventions to improve hand function. Objective: Investigate the effects of an intervention protocol based on the CIMT and HABIT theoretical foundations in the stimulation of manual function in infants with the UL asymmetry. Methods: Five infants (6-24 months) participated in the study. To evaluate the motor function of infants we used Pediatric Motor Activity Log (PMAL-R) and Manual Function Evaluation (AMIGO), and to assess the caregiver's perception of the participation of the infant in daily tasks, we used the Pediatric Disability Assessment Inventory (PEDI). All evaluations occurred before, immediately after the intervention, and after four months for follow-up recording, and were analyzed descriptively by Jacobson- Truax method. Results: The results between evaluation and reevaluation demonstrated evolution in all aspects studied. In the PEDI self-care session, an average of 38.6 (±8.4) - 44.2 (±7.4); PEDI Mobility: 28.8 (±20.3) - 36.28 (±21.7); PEDI Social Function: 40.1 (±10.2) - 42.3 (±8.9). The PMAL-R quantity and quality results evidence a highly positive clinical significance in all infants. Conclusion: The application of the modified restriction intervention protocol resulted in reliable and clinically significant changes in all cases.
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Carey H, Hay K, Nelin MA, Sowers B, Lewandowski DJ, Moore-Clingenpeel M, Maitre NL. Caregiver perception of hand function in infants with cerebral palsy: psychometric properties of the Infant Motor Activity Log. Dev Med Child Neurol 2020; 62:1266-1273. [PMID: 32779197 DOI: 10.1111/dmcn.14644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 02/01/2023]
Abstract
AIM To evaluate the properties of the Infant Motor Activity Log (IMAL), a caregiver-report for frequency and quality of use of more affected upper extremity in infants with neurological and functional impairments. METHOD This was a prospective cohort study of 66 children (34 females, 32 males) aged 6 to 24 months (mean age [SD] 13.7mo [5.3]) with neurological and functional impairments and a confirmed cerebral palsy diagnoses after 2 years, and 51 age-matched typically developing children. The IMAL was administered at baseline and 4 weeks later. Typically developing infants were tested with randomly assigned 'more affected' upper extremity. Psychometric properties were evaluated using Spearman's correlation coefficient, Cronbach's alpha, and Jonckheere-Terpstra tests. RESULTS In the children with impairments, the IMAL showed internal consistency (alpha≥0.88) for the How Well Scale (HWS) and How Often Scale (HOS). Test-retest reliability was 0.64 (HOS) and 0.70 (HWS), demonstrating stability over time. Correlation with Bayley Scales of Infant and Toddler Development, Third Edition more affected arm raw scores were 0.70 (HOS) and 0.72 (HWS) (p<0.001) demonstrating construct validity. Both scale scores decreased with increasing Gross Motor Function Classification System and Mini-Manual Ability Classification System (p<0.001) levels, supporting discriminative validity. Discrimination between typically developing infants and infants with impairments was high (HWS: area under the receiver operating characteristic curve [AUC] 0.96, 95% confidence interval [CI] 0.94-0.99 and HOS AUC=0.95, CI 0.92-0.99). INTERPRETATION The IMAL is a valid and reliable discriminative caregiver measure of upper limb performance and may complement measures of capacity in infants with neurological and functional impairments. WHAT THIS PAPER ADDS The Infant Motor Activity Log (IMAL) is a valid and reliable measure of caregiver perception of upper limb function. The IMAL fills a measurement gap for infant motor performance in children with impairments. The IMAL discriminates among motor function levels.
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Affiliation(s)
- Helen Carey
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Krystal Hay
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mary Ann Nelin
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brianna Sowers
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dennis J Lewandowski
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nathalie L Maitre
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
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19
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Spencer K, Yuen HK, Jenkins GR, Kirklin K, Griffin AR, Vogtle LK, Davis D. Evaluation of a Magic Camp for Children with Hemiparesis: A Pilot Study. Occup Ther Health Care 2020; 34:155-170. [PMID: 32202452 DOI: 10.1080/07380577.2020.1741055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 06/10/2023]
Abstract
This single-group open trial was designed to evaluate the effectiveness of a two-week magic camp as a means of hand-arm motor skills training to improve upper limb motor function (unilateral and bilateral) in children with hemiparesis. Seven children with hemiparesis participated in a magic camp program which met 3 days a week, 4 hours each day, for two consecutive weeks for a total of 24 hours. Participants completed three assessments at the beginning of the camp, post-camp, and at a three-month follow-up: the Jebsen Hand Function Test (JHFT), Children's Hand Experience Questionnaire (CHEQ), and a box opening task that required coordination of both upper limbs. A Wilcoxon signed-rank test revealed significant improvement in JHFT composite scores of the affected limb at post-camp (p = .04) and three-month follow-up (p = .04). In addition, a significant improvement in the number of activities performed using two hands from baseline to three-month follow-up was observed (p = .03). This pattern of improvement was also observed in the speed of completion for the box opening task. The improvement in motor function seems related to the participants' continuing performing daily activities with the affected hand and two hands after the magic camp.
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Affiliation(s)
- Kevin Spencer
- Hocus Focus, Inc., Lynchburg, VA, USA
- Department of Education, Carlow University, Pittsburgh, PA, USA
| | - Hon K Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gavin R Jenkins
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimberly Kirklin
- UAB's Institute for Arts in Medicine, Alys Stephens Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Angla R Griffin
- Pediatric CI Therapy Program, Children's of Alabama, Birmingham, AL, USA
| | - Laura K Vogtle
- Department of Occupational Therapy, School of Health Professions Building, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Drew Davis
- Pediatric Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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20
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Dawe J, Yang JF, Fehlings D, Likitlersuang J, Rumney P, Zariffa J, Musselman KE. Validating Accelerometry as a Measure of Arm Movement for Children With Hemiplegic Cerebral Palsy. Phys Ther 2019; 99:721-729. [PMID: 30801644 DOI: 10.1093/ptj/pzz022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 01/01/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND For children with hemiplegic cerebral palsy (HCP), rehabilitation aims to increase movement of the affected arm. However, no validated measure objectively examines this construct in pediatric practice or daily life. OBJECTIVE The objective of this study was to evaluate the criterion and known-groups validity of accelerometry as a measure of arm movement in children and adolescents with HCP. DESIGN This was a prospective cross-sectional study. METHODS Twenty-seven children and adolescents with typical development (3.4-13.9 years old) and 11 children and adolescents with HCP (4.7-14.7 years old; Manual Ability Classification System rating I or II) wore accelerometers on their wrists while engaged in 20 minutes of play, which included intermittent intervals of stillness and vigorous movement of the arms. Vector magnitude (VM) values identified the presence (VM > 2.0 counts per epoch) and absence (VM ≤ 2.0 counts per epoch) of arm movement for every 2-second epoch. Video was simultaneously recorded; each 2-second interval of footage was scored as "movement" or "no movement" for each arm. RESULTS Agreement between accelerometry and video observation was greater than or equal to 81%, and the prevalence-adjusted and bias-adjusted κ value was greater than or equal to 0.69 for both groups of participants; these results supported the criterion validity of accelerometry. The ratio of nondominant arm movement to dominant arm movement measured by accelerometry was significantly greater in participants with typical development (mean [SD] = 0.87 [0.09]) than in participants with HCP (mean = 0.78 [0.07]) on the basis of 10 age- and sex-matched pairs; these results supported known-groups validity. LIMITATIONS The small sample size of the group with HCP prevented the stratification of data by age. Participants with HCP had high or moderately high function of the affected arm; hence, the findings do not apply to children and adolescents with more significant hemiparesis. CONCLUSIONS Accelerometry is a valid measure of arm movement in children with HCP and children without HCP. These findings contribute to the development of innovative upper limb assessments for children with hemiparesis.
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Affiliation(s)
- Jaclyn Dawe
- Rehabilitation Sciences Institute, University of Toronto; and Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Jaynie F Yang
- Department of Physical Therapy, Faculty of Rehabilitation Medicine; and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Darcy Fehlings
- Rehabilitation Sciences Institute, University of Toronto; Bloorview Research Institute, Toronto; and Department of Pediatrics, Faculty of Medicine, University of Toronto
| | - Jirapat Likitlersuang
- Toronto Rehabilitation Institute, University Health Network; and Institute of Biomaterials and Biomedical Engineering, University of Toronto
| | - Peter Rumney
- Bloorview Research Institute; and Department of Pediatrics, Faculty of Medicine, University of Toronto
| | - José Zariffa
- Rehabilitation Sciences Institute, University of Toronto; Toronto Rehabilitation Institute, University Health Network; and Institute of Biomaterials and Biomedical Engineering, University of Toronto
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto; SCI Mobility Lab, Lyndhurst Centre, Toronto Rehabilitation Institute-UHN, 520 Sutherland Dr, Toronto, ON, M4G 3V9, Canada; Toronto Rehabilitation Institute, University Health Network; and Department of Physical Therapy, Faculty of Medicine, University of Toronto
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21
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Hoyt CR, Van AN, Ortega M, Koller JM, Everett EA, Nguyen AL, Lang CE, Schlaggar BL, Dosenbach NUF. Detection of Pediatric Upper Extremity Motor Activity and Deficits With Accelerometry. JAMA Netw Open 2019; 2:e192970. [PMID: 31026032 PMCID: PMC6487720 DOI: 10.1001/jamanetworkopen.2019.2970] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Affordable, quantitative methods to screen children for developmental delays are needed. Motor milestones can be an indicator of developmental delay and may be used to track developmental progress. Accelerometry offers a way to gather real-world information about pediatric motor behavior. OBJECTIVE To develop a referent cohort of pediatric accelerometry from bilateral upper extremities (UEs) and determine whether movement can accurately distinguish those with and without motor deficits. DESIGN, SETTING, AND PARTICIPANTS Children aged 0 to 17 years participated in a prospective cohort from December 8, 2014, to December 29, 2017. Children were recruited from Ranken Jordan Pediatric Bridge Hospital, Maryland Heights, Missouri, and Washington University School of Medicine in St Louis, St Louis, Missouri. Typically developing children were included as a referent cohort if they had no history of motor or neurological deficit; consecutive sampling and matching ensured equal representation of sex and age. Children with diagnosed asymmetric motor deficits were included in the motor impaired cohort. EXPOSURES Bilateral UE motor activity was measured using wrist-worn accelerometers for a total of 100 hours in 25-hour increments. MAIN OUTCOMES AND MEASURES To characterize bilateral UE motor activity in a referent cohort for the purpose of detecting irregularities in the future, total activity and the use ratio between UEs were used to describe typically developing children. Asymmetric impairment was classified using the mono-arm use index (MAUI) and bilateral-arm use index (BAUI) to quantify the acceleration of unilateral movements. RESULTS A total of 216 children enrolled, and 185 children were included in analysis. Of these, 156 were typically developing, with mean (SD) age 9.1 (5.1) years and 81 boys (52.0%). There were 29 children in the motor impaired cohort, with mean (SD) age 7.4 (4.4) years and 16 boys (55.2%). The combined MAUI and BAUI (mean [SD], 0.86 [0.005] and use ratio (mean [SD], 0.90 [0.008]) had similar F1 values. The area under the curve was also similar between the combined MAUI and BAUI (mean [SD], 0.98 [0.004]) and the use ratio (mean [SD], 0.98 [0.004]). CONCLUSIONS AND RELEVANCE Bilateral UE movement as measured with accelerometry may provide a meaningful metric of real-world motor behavior across childhood. Screening in early childhood remains a challenge; MAUI may provide an effective method for clinicians to measure and visualize real-world motor behavior in children at risk for asymmetrical deficits.
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Affiliation(s)
- Catherine R. Hoyt
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Andrew N. Van
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Elyse A. Everett
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Annie L. Nguyen
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Catherine E. Lang
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Bradley L. Schlaggar
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Anatomy and Neurobiology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Kennedy Krieger Institute, Baltimore, Maryland
- Department of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nico U. F. Dosenbach
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Biomedical Engineering, Washington University School of Medicine in St Louis, St Louis, Missouri
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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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Sensor Measures of Symmetry Quantify Upper Limb Movement in the Natural Environment Across the Lifespan. Arch Phys Med Rehabil 2019; 100:1176-1183. [PMID: 30703350 DOI: 10.1016/j.apmr.2019.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/06/2019] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
Abstract
Knowledge of upper limb activity in the natural environment is critical for evaluating the effectiveness of rehabilitation services. Wearable sensors allow efficient collection of these data and have the potential to be less burdensome than self-report measures of activity. Sensors can capture many different variables of activity and daily performance, many of which could be useful in identifying deviation from typical movement behavior or measuring outcomes from rehabilitation interventions. Although it has potential, sensor measurement is just emerging, and there is a lack of consensus regarding which variables of daily performance are valid, sensitive, specific, and useful. We propose that symmetry of full-day upper limb movement is a key variable. We describe here that symmetry is valid, robustly observed within a narrow range across the lifespan in typical development, and shows evidence of being different in populations with neuromotor impairment. Key next steps include the determination of sensitivity, specificity, minimal detectable change, and minimal clinically important change/difference. This information is needed to determine whether an individual belongs to the typical or atypical group, whether change has occurred, and whether that change is beneficial.
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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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Trac J, Dawe J, Likitlersuang J, Musselman K, Zariffa J. Influence of upper limb movement patterns on accelerometer measurements: a pediatric case series. Physiol Meas 2018; 39:04NT02. [PMID: 29578452 DOI: 10.1088/1361-6579/aab994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous studies showed success using wrist-worn accelerometers to monitor upper-limb activity in adults and children with hemiparesis. However, a knowledge gap exists regarding which specific joint movements are reflected in accelerometry readings. We conducted a case series intended to enrich data interpretation by characterizing the influence of different pediatric upper-limb movements on accelerometry data. APPROACH The study recruited six typically developing children and five children with hemiparetic cerebral palsy. The participants performed unilateral and bilateral activities, and their upper limb movements were measured with wrist-worn accelerometers and the Microsoft Kinect, a markerless motion-capture system that tracks skeletal data. The Kinect data were used to quantify specific upper limb movements through joint angle calculations (trunk, shoulder, elbow and wrist). Correlation coefficients (r) were calculated to quantify the influence of individual joint movements on accelerometry data. Regression analyses were performed to examine multi-joint patterns and explain variability across different activities and participants. MAIN RESULTS Single-joint correlation results suggest that pediatric wrist-worn accelerometry data are not biased to particular individual joint movements. Rather, the accelerometry data could best be explained by the movements of the joints with the most functional relevance to the performed activity. SIGNIFICANCE This case series provides deeper insight into the interpretation of wrist-worn accelerometry data, and supports the use of this tool in quantifying functional upper-limb movements in pediatric populations.
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Affiliation(s)
- Jessica Trac
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada. Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Musselman KE, Manns P, Dawe J, Delgado R, Yang JF. The Feasibility of Functional Electrical Stimulation to Improve Upper Extremity Function in a Two-year-old Child with Perinatal Stroke: A Case Report. Phys Occup Ther Pediatr 2018; 38:97-112. [PMID: 28071962 DOI: 10.1080/01942638.2016.1255291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To evaluate the effectiveness and feasibility (i.e. tolerability, adherence) of functional electrical stimulation (FES) for the upper extremity (UE) in a two-year-old child with perinatal stroke. METHODS Forty hours of FES over eight weeks was prescribed. FES to the hemiplegic triceps, extensor carpi radialis longus and brevis, extensor carpi ulnaris and extensor digitorum was timed with reaching during play. Assessments were performed before, during, and two months post-intervention. UE function (Melbourne Assessment 2 (MA2), Assisting Hand Assessment (AHA)) and spasticity (Modified Tardieu with electrogoniometry and electromyography) were measured. The mother completed a semi-structured interview post-intervention. Descriptive statistics were used for adherence and UE measures. A repeated-measures ANOVA compared Modified Tardieu parameters (e.g. catch angle) over time. Conventional content analysis was used for the interview data. RESULTS The child completed 39.2/40 hours. Immediately post-intervention, improvements were observed on MA2's Range of Motion subscale and catch angle (Modified Tardieu, p < 0.001). Two months post-intervention, improvements were observed on MA2's Accuracy and Fluency subscales. No change in AHA score occurred. Three themes emerged from the interview: (1) Ingredients for program success; (2) Information about the FES device; and (3) The child's response. CONCLUSIONS UE FES was feasible in a two-year-old child with hemiplegia.
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Affiliation(s)
- Kristin E Musselman
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Department of Physical Therapy , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.,c School of Physical Therapy, College of Medicine, University of Saskatchewan , Saskatoon , SK , Canada.,d Rehabilitation Sciences Institute, University of Toronto , Toronto , ON , Canada
| | - Patricia Manns
- e Department of Physical Therapy , Faculty of Rehabilitation Medicine, University of Alberta , Edmonton , AB , Canada
| | - Jaclyn Dawe
- d Rehabilitation Sciences Institute, University of Toronto , Toronto , ON , Canada
| | - Rhina Delgado
- f University of Alberta Hospital , Edmonton , AB , Canada
| | - Jaynie F Yang
- e Department of Physical Therapy , Faculty of Rehabilitation Medicine, University of Alberta , Edmonton , AB , Canada.,g Neuroscience & Mental Health Institute, University of Alberta , Edmonton , AB , Canada
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Geerdink Y, Aarts P, van der Holst M, Lindeboom R, Van Der Burg J, Steenbergen B, Geurts AC. Development and psychometric properties of the Hand-Use-at-Home questionnaire to assess amount of affected hand-use in children with unilateral paresis. Dev Med Child Neurol 2017; 59:919-925. [PMID: 28555780 DOI: 10.1111/dmcn.13449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/27/2022]
Abstract
AIM To describe the development of the parent-rated Hand-Use-at-Home questionnaire (HUH) assessing the amount of spontaneous use of the affected hand in children with unilateral paresis, and to test its internal structure, unidimensionality, and validity. METHOD Parents of children with unilateral cerebral palsy (CP) and professionals participated in the development of the HUH. To examine internal validity, data of 322 children (158 males, 164 females; mean age 6y 7mo, standard deviation [SD] 2y 1mo) with unilateral CP (n=131) or neonatal brachial plexus palsy (NBPP) (n=191) were collected. Rasch analysis was used to examine discriminative capacity of the 5-category rating scale as well as unidimensionality and hierarchy of the item set. Additionally, data of 55 children with typical development (24 males, 31 females; 6y 9mo, SD 2y 5mo) were used to examine construct validity. RESULTS The 5-category rating scale was disordered in all items and was collapsed to obtain the best discriminating sum score. Ten misfitting or redundant items were removed. Eighteen hierarchically ordered bimanual items fitted the unidimensional model within acceptable range. The HUH significantly discriminated between the three groups (children with typical development, NBPP, unilateral CP; H(2) =118.985, p<0.001), supporting its construct validity. INTERPRETATION The HUH is a valid instrument to assess the amount of spontaneous use of the affected hand in children with unilateral upper-limb paresis.
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Affiliation(s)
- Yvonne Geerdink
- Department of Pediatric Rehabilitation, Sint Maartenskliniek Nijmegen, Nijmegan, The Netherlands
| | - Pauline Aarts
- Department of Pediatric Rehabilitation, Sint Maartenskliniek Nijmegen, Nijmegan, The Netherlands
| | - Menno van der Holst
- Department of Orthopedics, Pediatric Rehabilitation & Physical Therapy Leiden University Medical Center, Rijnlands Revalidatie Centrum, Leiden, The Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Van Der Burg
- Department of Pediatric Rehabilitation, Sint Maartenskliniek Nijmegen, Nijmegan, The Netherlands
| | - Bert Steenbergen
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands.,School of Psychology, Australian Catholic University, Melbourne, Qld, Australia
| | - Alexander C Geurts
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen.,Donders Centre for Neuroscience (DCN), Nijmegen, the Netherlands
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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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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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Abstract
PURPOSE The purpose of this pilot study was to investigate the feasibility of a 3-week constraint-induced movement therapy program in children with brain tumors and upper extremity hemiplegia and to describe resultant change in extremity use. METHODS Affected arm use, health-related quality of life, and parent-reported feasibility of program participation were measured before and after the intervention and at a 3-month follow-up visit. RESULTS All 9 participants completed the entire study. The quality and amount of affected arm use improved significantly; gains were maintained at the 3-month follow-up evaluation. Some parents (44%) reported that program participation was difficult; however, all reported satisfaction with the program. Participants did not experience negative changes in health-related quality of life during the intervention, indicating that they tolerated the program well. CONCLUSIONS Findings suggest that a child with hemiplegia as a result of a brain tumor can adhere to and benefit from a constraint-induced movement therapy program.
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Matuti GDS, Santos JFD, Silva ACRD, Eras-Garcia R, Uswatte G, Taub E. Translation and cross cultural adaptation of the Pediatric Motor Activity Log-Revised scale. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:555-60. [DOI: 10.1590/0004-282x20160084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 05/16/2016] [Indexed: 11/21/2022]
Abstract
ABSTRACT The standardized instrument developed to assess the use of the affected upper limb in children with cerebral palsy (CP) is the Pediatric Motor Activity Log Revised (PMAL-R). Objectives To translate PMAL-R and adapt for the Brazilian culture; analyze the reliability and the internal consistency of the Brazilian version. Method Translation of PMAL-R to the Portuguese-Brazil and back translation. The back-translated version was revised by the authors of the scale. The final version was administered to a sample of 24 patients with spastic hemiparesis CP between 2–8 years. Results The reliability intra and inter-rater were suitable (how often = 0.97 and 0.98, how well = 0.98 and 0.99 respectively) and so the internal consistency (0.98). Conclusion The Brazilian version of PMAL-R has adequate internal consistency, reliability intra and inter raters and can be used to assess the spontaneous use of the upper limb of children with CP type spastic hemiparesis, aged 2–8 years.
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Affiliation(s)
| | | | | | | | - Gitendra Uswatte
- University of Alabama at Birmingham, USA; University of Alabama at Birmingham, USA
| | - Edward Taub
- University of Alabama at Birmingham, USA; University of Alabama at Birmingham, USA
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DeLuca SC, Ramey SL, Trucks MR, Wallace DA. Multiple Treatments of Pediatric Constraint-Induced Movement Therapy (pCIMT): A Clinical Cohort Study. Am J Occup Ther 2016; 69:6906180010p1-9. [PMID: 26565094 DOI: 10.5014/ajot.2015.019323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pediatric constraint-induced movement therapy (pCIMT) is one of the most efficacious treatments for children with cerebral palsy (CP). Distinctive components of pCIMT include constraint of the less impaired upper extremity (UE), high-intensity therapy for the more impaired UE (≥ 3 hr/day, many days per week, for multiple weeks), use of shaping techniques combined with repetitive task practice, and bimanual transfer. A critical issue is whether multiple treatments of pCIMT produce additional benefit. In a clinical cohort (mean age = 31 mo) of 28 children with asymmetrical CP whose parents sought multiple pCIMT treatments, the children gained a mean of 13.2 (standard deviation [SD] = 4.2) new functional skills after Treatment 1; Treatment 2 produced a mean of 7.3 (SD = 4.7) new skills; and Treatment 3, 6.5 (SD = 4.2). These findings support the conclusion that multiple pCIMT treatments can produce clinically important functional gains for children with hemiparetic CP.
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Affiliation(s)
- Stephanie C DeLuca
- Stephanie C. DeLuca, PhD, is Director, Neuromotor Research Clinic, Virginia Tech Carilion Research Institute, and Assistant Professor, Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke; Assistant Professor, Department of Psychology, Virginia Tech, Blacksburg; and Assistant Professor, Department of Rehabilitation and Wellness, Jefferson College of Health Sciences, Roanoke, VA;
| | - Sharon Landesman Ramey
- Sharon Landesman Ramey, PhD, is Distinguished Scholar and Professor, Virginia Tech Carilion Research Institute, and Professor, Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke; Professor, Department of Psychology, Virginia Tech, Blacksburg; and Professor, Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke
| | - Mary Rebekah Trucks
- Mary Rebekah Trucks, OTR/L, is Research Faculty and Senior Occupational Therapist, Virginia Tech Carilion Research Institute, Roanoke
| | - Dorian Ainsworth Wallace
- Dorian Ainsworth Wallace, OTR/L, is Research Faculty and Senior Occupational Therapist, Virginia Tech Carilion Research Institute, Roanoke
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Liu KC, Chen HL, Wang TN, Shieh JY. Developing the Observatory Test of Capacity, Performance, and Developmental Disregard (OTCPDD) for Children with Cerebral Palsy. PLoS One 2016; 11:e0151798. [PMID: 27010941 PMCID: PMC4806991 DOI: 10.1371/journal.pone.0151798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/17/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was to develop a reliable and valid instrument, named the Observatory Test of Capacity, Performance, and Developmental Disregard (OTCPDD), for measuring the amount and quality of use of affected upper limb functions in the daily routines of children with CP. METHODS Forty-eight participants (24 children with CP and 24 matched typically developing children) were recruited. The OTCPDD was administered twice (the spontaneous use condition first, followed by the forced use condition) on children with CP. Their parents were asked to complete the Pediatric Motor Activity Log-Revised (PMAL-R). The internal consistency, the intrarater and interrater reliabilities, and the convergent and discriminate validities were measured. RESULTS The internal consistency (Cronbach's alpha) and the intrarater and interrater reliabilities were higher than 0.9 for all of the OTCPDD scores. The convergent validity was confirmed by significant correlations between the OTCPDD and the PMAL-R. For the discriminant validity, significant differences (p<0.05) were found between children with CP and typically developing children. CONCLUSIONS The results support that the OTCPDD is a reliable and valid observation-based assessment. The OTCPDD, which uses bimanual daily living activities, is able to represent the children's general affected hand functions (including capacity, performance, and developmental disregard) in their daily routines.
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Affiliation(s)
- Kuan-Chun Liu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hao-Ling Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Tien-Ni Wang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
| | - Jeng-Yi Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Rocha ACP, Tudella E, Pedro LM, Appel VCR, da Silva LGP, Caurin GADP. A Novel Device for Grasping Assessment during Functional Tasks: Preliminary Results. Front Bioeng Biotechnol 2016; 4:16. [PMID: 26942178 PMCID: PMC4761859 DOI: 10.3389/fbioe.2016.00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/04/2016] [Indexed: 11/16/2022] Open
Abstract
This paper presents a methodology and first results obtained in a study with a novel device that allows the analysis of grasping quality. Such a device is able to acquire motion information of upper limbs allowing kinetic of manipulation analysis as well. A pilot experiment was carried out with six groups of typically developing children aged between 5 and 10 years, with seven to eight children in each one. The device, designed to emulate a glass, has an optical system composed by one digital camera and a special convex mirror that together allow image acquisition of grasping hand posture when it is grasped and manipulated. It also carries an Inertial Measurement Unit that captures motion data as acceleration, orientation, and angular velocities. The novel instrumented object is used in our approach to evaluate functional tasks performance in quantitative terms. During tests, each child was invited to grasp the cylindrical part of the device that was placed on the top of a table, simulating the task of drinking a glass of water. In the sequence, the child was oriented to transport the device back to the starting position and release it. The task was repeated three times for each child. A grasping hand posture evaluation is presented as an example to evaluate grasping quality. Additionally, motion patterns obtained with the trials performed with the different groups are presented and discussed. This device is attractive due to its portable characteristics, the small size, and its ability to evaluate grasping form. The results may be also useful to analyze the evolution of the rehabilitation process through reach-to-grasping movement and the grasping images analysis.
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Affiliation(s)
- Ana Carolinne Portela Rocha
- Research in Motion Analysis Laboratory, Department of Physical Therapy, Federal University of São Carlos , São Carlos , Brazil
| | - Eloisa Tudella
- Research in Motion Analysis Laboratory, Department of Physical Therapy, Federal University of São Carlos , São Carlos , Brazil
| | - Leonardo M Pedro
- Mechatronics Group, Department of Mechanical Engineering, Federal University of São Carlos , São Carlos , Brazil
| | - Viviane Cristina Roma Appel
- Mechatronics Group, Department of Mechanical Engineering, São Carlos School of Engineering, University of São Paulo , São Carlos , Brazil
| | | | - Glauco Augusto de Paula Caurin
- Mechatronics Group, Department of Mechanical Engineering, São Carlos School of Engineering, University of São Paulo , São Carlos , Brazil
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Wallen M, Stewart K. Grading and Quantification of Upper Extremity Function in Children with Spasticity. Semin Plast Surg 2016; 30:5-13. [PMID: 26869858 DOI: 10.1055/s-0035-1571257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides an ideal framework within which to conceptualize grading and quantification of upper extremity function for children with spasticity. In this article the authors provide an overview of assessments and classification tools used to (1) understand upper extremity function associated with spasticity and the factors that contribute to dysfunction, (2) guide the selection of appropriate interventions, (3) identify specific muscles to target using surgical interventions and botulinum toxin-A injections, and (4) measure the outcomes of upper extremity interventions. Assessments of upper extremity function are briefly described and categorized as to whether they (1) measure children's best ability or actual performance in daily life, (2) are clinician administered or are a child/proxy report, (3) assist in planning intervention and/or measuring outcomes, and (4) evaluate unimanual or bimanual ability. In addition, measures of spasticity and hypertonicity, and classifications of static and dynamic upper extremity postures are summarized.
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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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Maitre NL, Henderson G, Gogliotti S, Pearson J, Simmons A, Wang L, Slaughter JC, Key AP. Feasibility of event-related potential methodology to evaluate changes in cortical processing after rehabilitation in children with cerebral palsy: a pilot study. J Clin Exp Neuropsychol 2014; 36:669-79. [PMID: 24953907 DOI: 10.1080/13803395.2014.925094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined the feasibility of using event-related potentials (ERPs) to measure changes in cortical processing following an established rehabilitative intervention (constraint-induced movement therapy, CIMT) for children with cerebral palsy (CP). Sixteen participants with a diagnosis of hemiparetic CP, with a median age of 6 years, were assessed pre and immediately post CIMT and at 6-month follow-up, using a picture-word match/mismatch discrimination task and standard neurobehavioral measures. Intervention effects were evident in improved performance on behavioral tests of sensory and motor function and the increased mean ERP amplitude of the N400 match/mismatch response on the side ipsilateral to the lesion. These effects were maintained 6 months after the intervention. No such changes were observed on the side contralateral to the lesion. This research suggests that ERPs can measure rehabilitation-induced changes in neural function in children with CP.
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Affiliation(s)
- Nathalie L Maitre
- a Department of Pediatrics , Vanderbilt University , Nashville , TN , USA
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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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Lowes LP, Lo WD, Alfano LN, Case-Smith J. Authors' response to evidence to practice commentary. Phys Occup Ther Pediatr 2014; 34:25-9. [PMID: 24460081 DOI: 10.3109/01942638.2014.880260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Linda P Lowes
- 1Nationwide Children's Hospital, Columbus, Ohio, USA
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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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Rickards T, Sterling C, Taub E, Perkins-Hu C, Gauthier L, Graham M, Griffin A, Davis D, Mark VW, Uswatte G. Diffusion tensor imaging study of the response to constraint-induced movement therapy of children with hemiparetic cerebral palsy and adults with chronic stroke. Arch Phys Med Rehabil 2013; 95:506-514.e1. [PMID: 24055785 DOI: 10.1016/j.apmr.2013.08.245] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/19/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the relationship of white matter integrity and path of the corticospinal tract (CST) on arm function before and after constraint-induced (CI) movement therapy in children with hemiparetic cerebral palsy (CP) and adults with chronic stroke. DESIGN Study 1 used a multiple-baseline pre-post design. Study 2 was a randomized controlled trial. SETTING Outpatient rehabilitation laboratory. PARTICIPANTS Study 1 included children with hemiparetic CP (n=10; mean age ± SD, 3.2±1.7y). Study 2 included adults with chronic stroke (n=26; mean age ± SD, 65.4±13.6y) who received either CI therapy or a comparison therapy. INTERVENTIONS Children in study 1 received CI therapy for 3.5h/d for 15 consecutive weekdays. Adults in study 2 received either CI therapy or a comparison therapy for 3.5h/d for 10 consecutive weekdays. MAIN OUTCOME MEASURES Diffusion tensor imaging was performed to quantify white matter integrity. Motor ability was assessed in children using the Pediatric Motor Activity Log-Revised and Pediatric Arm Function Test, and in adults with the Motor Activity Log and Wolf Motor Function Test. RESULTS Participants in both studies improved in real-world arm function and motor capacity. Children and adults with disrupted/displaced CSTs and children with reduced fractional anisotropy values were worse on pretreatment tests of motor function than participants with unaltered CSTs. However, neither integrity (fractional anisotropy) nor distorted or disrupted path of the CST affected motor improvement after treatment. CONCLUSIONS Participants who had reduced integrity, displacement, or interruption of their CST performed worse on pretreatment motor testing. However, this had no effect on their ability to benefit from CI therapy. The results for children and adults are consistent with one another.
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Affiliation(s)
- Tyler Rickards
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Chelsey Sterling
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL.
| | | | - Lynne Gauthier
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH
| | - Michael Graham
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Angi Griffin
- Physical Therapy and Occupational Therapy Department, Children's of Alabama, Birmingham, AL
| | - Drew Davis
- Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Victor W Mark
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL; Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL; Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
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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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Sterling C, Taub E, Davis D, Rickards T, Gauthier LV, Griffin A, Uswatte G. Structural neuroplastic change after constraint-induced movement therapy in children with cerebral palsy. Pediatrics 2013; 131:e1664-9. [PMID: 23610209 DOI: 10.1542/peds.2012-2051] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Research from the present laboratory with adult stroke patients showed that structural neuroplastic changes are correlated with clinical improvements due to constraint-induced movement (CI) therapy. This pilot study evaluated whether comparable changes occur in children receiving CI therapy. Ten children (6 boys) with congenital hemiparesis (mean age: 3 years, 3 months) underwent MRI scans 3 weeks before, immediately before, and immediately after receiving 3 weeks of CI therapy. Longitudinal voxel-based morphometry was performed on MRI scans to determine gray matter change. In addition, the Pediatric Motor Activity Log-Revised was administered at these time points to assess arm use in daily life before and after treatment. Children exhibited large improvements after CI therapy in spontaneous use of the more-affected arm (P < .001, d' = 3.24). A significant increase in gray matter volume occurred in the sensorimotor cortex contralateral to the more-affected arm (P = .04); there was a trend for these changes to be correlated with motor improvement (r = 0.63, P = .063). Trends were also observed for increases in gray matter volume in the ipsilateral motor cortex (P = .055) and contralateral hippocampus (P = .1). No significant gray matter change was seen during the 3 weeks before treatment. These findings suggest that CI therapy produces gray matter increases in the developing nervous system and provide additional evidence that CI therapy is associated with structural remodeling of the human brain while producing motor improvement in patients with disabling central nervous system diseases.
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Affiliation(s)
- Chelsey Sterling
- Departments of aPsychology, University of Alabama at Birmingham, Birmingham, AL 35294-0018, USA.
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Uswatte G, Taub E, Griffin A, Rowe J, Vogtle L, Barman J. Pediatric Arm Function Test: reliability and validity for assessing more-affected arm motor capacity in children with cerebral palsy. Am J Phys Med Rehabil 2012; 91:1060-9. [PMID: 23103486 PMCID: PMC3501559 DOI: 10.1097/phm.0b013e318269ec76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although there are several validated upper-extremity measures in young children with cerebral palsy, none of these primarily assess the capacity to carry out actions and tasks with the more-affected arm. To address this need, we developed the Pediatric Arm Function Test (PAFT), which involves the behavioral observation of how children use their more-affected arm during structured play in a laboratory or clinic. This article evaluates the reliability and validity of the PAFT Functional Ability scale. DESIGN In study 1, a total of 20 children between 2 and 8 yrs old with a wide range of upper-extremity hemiparesis caused by cerebral palsy completed the PAFT on two occasions separated by 3 wks. In study 2, a total of 41 children between 2 and 6 yrs old with similar characteristics completed the PAFT and received a grade reflecting the severity of more-affected arm motor impairment. RESULTS In study 1, the PAFT test-retest reliability correlation coefficient was 0.74. In study 2, convergent validity was supported by a strong inverse correlation (r = -0.6, P < 0.001) between the PAFT scores and the grade of impairment. CONCLUSIONS The PAFT Functional Ability scale is a reliable and valid measure of more-affected arm motor capacity in children between 2 and 6 yrs old with cerebral palsy. It can be used to measure upper-extremity neurorehabilitation outcome.
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Affiliation(s)
- Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham, 1530 3rd Ave South, Room CH415, Birmingham, AL, 35294, USA
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