1
|
Metwaly MM, Salem EE, Abbass ME. Correlation between scapular alignment and upper extremity function in children with hemiparetic cerebral palsy. Physiother Theory Pract 2023; 39:2163-2170. [PMID: 35430957 DOI: 10.1080/09593985.2022.2066587] [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: 10/25/2021] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the relationship between scapular alignment and upper extremity function. METHODS Eighty-five children (63 boys and 22 girls) with spastic hemiplegic cerebral palsy aged 3 to 6 years were included in the study. Scapular upward rotation was assessed using Postural Zone software, and upper extremity function was assessed using the Pediatric Arm Function Test. RESULTS There was a significant difference (p = .0001) in the degree of upward scapular rotation between less affected and affected sides (-41.78 ± 4.87 and -26.42 ± 6.34, respectively). There was a significant difference (p = .0001) between the function of the upper extremity of the affected side and the less affected sides (48.15 ± 14.37, 62.1 ± 6.62, respectively). Pearson Correlation Coefficient (r) was calculated, and there was a strong negative significant correlation between the degree of scapular upward rotation of the affected side, a unilateral score of the affected side, and the total score of the Pediatric Arm Function Test (r = -0.976, p = .0001 and r = -0.973, p = .0001, respectively). The correlation between symmetry index and total score of the Pediatric Arm Function Test was a strong positive significant correlation (r = 0.946, p = .0001). CONCLUSION The degree of upward scapular rotation was less on the affected side. Scapular alignment and symmetry may contribute to upper extremity function in children with hemiplegic cerebral palsy. Clinically, correction of scapular deviations may be considered in the rehabilitation program for children with hemiplegic cerebral palsy. This study suggests further experimental studies to find the cause and effect.
Collapse
Affiliation(s)
- Mahmoud Mohammed Metwaly
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Eygpt
| | - Elham Elsayed Salem
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Eygpt
| | - Mai Elsayed Abbass
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Eygpt
| |
Collapse
|
2
|
Predictors of gross motor function and activities of daily living in children with cerebral palsy. Int J Rehabil Res 2021; 44:330-335. [PMID: 34545854 DOI: 10.1097/mrr.0000000000000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To determine the influence of selected impairment variables, spasticity, trunk control, upper limb function and selective motor control of the lower limb on gross motor function and activities of daily living in children with cerebral palsy (CP). Seventy children with CP, 40 boys and 30 girls, with age range between 11 and 156 months were recruited in this cross-sectional study. Data on spasticity, selective motor control of the lower limb, upper limb function and trunk control were assessed using modified Ashworth scale (MAS), selective motor control of the lower limb (SCALE), paediatric arm function test, trunk motor control assessment and GMFM88, respectively. Among all the variables assessed, only trunk control significantly predicted gross motor function (beta = 0.880; P < 0.001) and activities of daily living (beta = 0.550; P < 0.05). However, gross motor function and activities of daily living have significant (P < 0.05) negative correlations with spasticity, and positive correlations with selective motor control of the lower limb and trunk control. Trunk control is the most influencing factor on gross motor function and activities of daily living in children with CP. Therefore, achieving trunk control especially in those at GMFCS levels V and VI should be a priority during the rehabilitation of children with CP.
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Ravault L, Darbois N, Pinsault N. Methodological Considerations to Investigate Dosage Parameters of Intensive Upper Limb Rehabilitation in Children with Unilateral Spastic Cerebral Palsy: A Scoping Review of RCTs. Dev Neurorehabil 2020; 23:309-320. [PMID: 31710245 DOI: 10.1080/17518423.2019.1687599] [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: 10/25/2022]
Abstract
PURPOSES To identify and synthesize RCTs on the isolated effect of dosage parameters of upper limb Intensive Motor Rehabilitation Treatments (IMRT) of children with Unilateral Spastic Cerebral Palsy (USCP); to identify the most frequent methodological weaknesses. METHODS Searches were conducted until September 2018 in gray and published literature databases and supplemented by exploring the identified studies' references. Inclusion criteria applied: RCT; children aged 1.5 to 19 years with USCP; upper limb IMRT differing only from ≥1/4 dosage parameters between groups. Literature analyses conducted: qualitative and descriptive. RESULTS We identified 461 studies. Seventeen were included: three presented a rehabilitation dosage distinction between groups in Frequency-Time, four in Intensity-Progressivity, three in Intensity-Restraint, two in Intensity-Environment and five presented ≥3 distinctions above. CONCLUSIONS Inconsistencies were noted between USCP lifelong issues, and the short follow-ups and lack of participation assessments. Confounding factors and misstatements in Intent To Treat (ITT) analyses were identified. A meta-analysis was considered irrelevant. ABBREVIATIONS USCP, CP: Unilateral Spastic Cerebral Palsy, Cerebral Palsy; RCT: Randomized Controlled Trial; IMRT: Intensive Motor Rehabilitation Treatment.
Collapse
Affiliation(s)
- Lucas Ravault
- Grenoble Alps University Hospital , Grenoble, France
| | | | - Nicolas Pinsault
- Grenoble Alps University Hospital , Grenoble, France.,Grenoble Alps University , Grenoble, France.,ThEMAS team, TIMC-IMAG Laboratory, UMR CNRS-UGA 5525 , Grenoble, France
| |
Collapse
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
Braito I, Maselli M, Sgandurra G, Inguaggiato E, Beani E, Cecchi F, Cioni G, Boyd R. Assessment of upper limb use in children with typical development and neurodevelopmental disorders by inertial sensors: a systematic review. J Neuroeng Rehabil 2018; 15:94. [PMID: 30400992 PMCID: PMC6219116 DOI: 10.1186/s12984-018-0447-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
Understanding development of bimanual upper limb (UL) activities in both typical and atypical conditions in children is important for: i) tailoring rehabilitation programs, ii) monitoring progress, iii) determining outcomes and iv) evaluating effectiveness of treatment/rehabilitation. Recent technological advances, such as wearable sensors, offer possibilities to perform standard medical monitoring. Body-worn motion sensors, mainly accelerometers, have shown very promising results but, so far, these studies have mainly focused on adults. The main aim of this review was to report the evidence of UL activity of both typically developing (TD) children and children with neurodevelopmental disorders (NDDs) that are reliably reported and comparable, using a combination of multiple wearable inertial sensors, both in laboratory and natural settings. Articles were selected from three research databases (PubMed, Web of Science and EBSCO). Included studies reported data on children aged 0-20 years old simultaneously wearing at least two inertial sensors on upper extremities. The collected and reported data were relevant in order to describe the amount of physical activity performed by the two ULs separately. A total of 21 articles were selected: 11 including TD, and 10 regarding NDDs. For each article, a review of both clinical and technical data was performed. We considered inertial sensors used for following aims: (i) to establish activity intensity cut-points; (ii) to investigate validity and reliability of specified markers, placement and/or number of inertial sensors; (iii) to evaluate duration and intensity of natural UL movements, defined motor tasks and tremor; and (iv) to assess efficacy of certain rehabilitation protocols. Our conclusions were that inertial sensors are able to detect differences in use between both hands and that all reviewed studies support use of accelerometers as an objective outcome measure, appropriate in assessing UL activity in young children with NDDs and determining intervention effectiveness. Further research on responsiveness to interventions and consistency with use in real-world settings is needed. This information could be useful in planning UL rehabilitation strategies.
Collapse
Affiliation(s)
- Irene Braito
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
| | - Martina Maselli
- The BioRobotics Institute, Polo Sant'Anna Valdera, Viale Rinaldo Piaggio 34, 56026 Pontedera, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy. .,Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125, Pisa, Italy.
| | - Emanuela Inguaggiato
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
| | - Francesca Cecchi
- The BioRobotics Institute, Polo Sant'Anna Valdera, Viale Rinaldo Piaggio 34, 56026 Pontedera, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy. .,Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125, Pisa, Italy.
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Centre for Children's Health Research, South Brisbane, Australia
| |
Collapse
|
7
|
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.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Abd El-Kafy EM, Elshemy SA, Alghamdi MS. Effect of constraint-induced therapy on upper limb functions: a randomized control trial. Scand J Occup Ther 2013; 21:11-23. [PMID: 24325594 DOI: 10.3109/11038128.2013.837505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Children with congenital hemiparesis have unilateral upper extremity involvement, limiting their ability in unilateral or bilateral manual tasks, thus negatively influencing their participation in daily activities. Constraint-induced movement therapy (CIMT) has been shown to be promising for improving upper-limb functions in children with cerebral palsy. Clinical assessments may be needed to quantify and qualify changes in children's performance following its application. METHODS This study investigated the effectiveness of a child-friendly form of CIMT to improve upper extremity functional performance. Thirty congenitally hemiparetic children aged 4-8 years were randomly assigned to receive either a CIMT program (study group) or a conventional non-structured therapy program (control group). The programs were applied for both groups for six hours daily, five days weekly for four successive weeks. The Pediatric Arm Function Test, Quality of Upper Extremity Skills Test, and isokinetic muscular performances of shoulder flexors, extensors, and abductors expressed as peak torque were used to evaluate immediate and long-lasting efficacy of CIMT. RESULTS The results showed improvement in the involved upper extremity performances in different evaluated tasks immediately post-CIMT program application compared with the control group. These improvements continued three months later. CONCLUSION Pediatric CIMT with shaping produced considerable and sustained improvement in the involved upper extremity movements and functions in children with congenital hemiparesis.
Collapse
Affiliation(s)
- Ehab Mohamed Abd El-Kafy
- Department of Physical Therapy for Disturbances of Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University , Giza , Egypt
| | | | | |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
Affiliation(s)
- Chelsey Sterling
- Departments of aPsychology, University of Alabama at Birmingham, Birmingham, AL 35294-0018, USA.
| | | | | | | | | | | | | |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
- Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham, 1530 3rd Ave South, Room CH415, Birmingham, AL, 35294, USA
| | | | | | | | | | | |
Collapse
|
15
|
Uswatte G, Taub E, Griffin A, Vogtle L, Rowe J, Barman J. The pediatric motor activity log-revised: assessing real-world arm use in children with cerebral palsy. Rehabil Psychol 2012; 57:149-158. [PMID: 22686553 DOI: 10.1037/a0028516] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Widely accepted models of disability suggest that actual use of an impaired upper extremity in everyday life frequently deviates from its motor capacity, as measured by laboratory tests. Yet, direct measures of real-world use of an impaired upper extremity are rare in pediatric neurorehabilitation. This paper examines how well the Pediatric Motor Activity Log-Revised (PMAL-R) measures this parameter, when the PMAL-R is administered as a structured interview as originally designed. DESIGN Parents of 60 children between 2 and 8 years of age with upper-extremity hemiparesis due to cerebral palsy completed the PMAL-R twice. Additionally, the children were videotaped during play structured to elicit spontaneous arm use. More-affected arm use was scored by masked raters; it was thought to reflect everyday activity since no cues were given about which arm to employ. Testing sessions were separated by 3 weeks, during which 29 children received upper-extremity rehabilitation and 31 did not. RESULTS The PMAL-R had high internal consistency (Cronbach's alpha = .93) and test-retest reliability (r = .89). Convergent validity was supported by a strong correlation between changes in PMAL-R scores and more-affected arm use during play, r(53) = .5, p < .001. CONCLUSIONS The PMAL-R interview is a reliable and valid measure of upper-extremity pediatric neurorehabilitation outcome.
Collapse
Affiliation(s)
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham
| | - Angi Griffin
- Department of Physical Therapy and Occupational Therapy, Children's Hospital of Alabama, University of Alabama at Birmingham
| | - Laura Vogtle
- Department of Occupational Therapy, University of Alabama at Birmingham
| | - Jan Rowe
- Department of Occupational Therapy, University of Alabama at Birmingham
| | - Joydip Barman
- Department of Psychology, University of Alabama at Birmingham
| |
Collapse
|