Training of head control in the sitting and semi-prone positions

HeadUp: A Low-Cost Solution for Tracking Head Movement of Children with Cerebral Palsy Using IMU

Cerebral palsy (CP) is a common reason for human motor ability limitations caused before birth, through infancy or early childhood. Poor head control is one of the most important problems in children with level IV CP and level V CP, which can affect many aspects of children’s lives. The current visual assessment method for measuring head control ability and cervical range of motion (CROM) lacks accuracy and reliability. In this paper, a HeadUp system that is based on a low-cost, 9-axis, inertial measurement unit (IMU) is proposed to capture and evaluate the head control ability for children with CP. The proposed system wirelessly measures CROM in frontal, sagittal, and transverse planes during ordinary life activities. The system is designed to provide real-time, bidirectional communication with an Euler-based, sensor fusion algorithm (SFA) to estimate the head orientation and its control ability tracking. The experimental results for the proposed SFA show high accuracy in noise reduction with faster system response. The system is clinically tested on five typically developing children and five children with CP (age range: 2–5 years). The proposed HeadUp system can be implemented as a head control trainer in an entertaining way to motivate the child with CP to keep their head up.

Biofeedback interventions for individuals with cerebral palsy: a systematic review

Purpose: The purpose of this study is to evaluate the quality of evidence of biofeedback interventions aimed at improving motor activities in people with Cerebral Palsy (CP). Second, to describe the relationship between intervention outcomes and biofeedback characteristics. Methods: Eight databases were searched for rehabilitation interventions that provided external feedback and addressed motor activities. Two reviewers independently assessed and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to evaluate quality of evidence for outcome measures related to two International Classification of Functioning, Disability and Health (ICF) chapters. Results: Fifty-seven studies were included. There were 53 measures related Activities and Participation and 39 measures related to Body Functions. Strength of evidence was "Positive, Very-Low" due to the high proportion of non-controlled studies and heterogeneity of measures. Overall, 79% of studies and 63% of measures showed improvement post-intervention. Counter to motor learning theory recommendations, most studies provided feedback consistently and concurrently throughout the intervention regardless of the individual's desire or progress. Conclusion: Heterogeneous interventions and poor study design limit the strength of biofeedback evidence. A thoughtful biofeedback paradigm and standardized outcome toolbox can strengthen the confidence in the effect of biofeedback interventions for improving motor rehabilitation for people with CP. Implications for Rehabilitation Biofeedback can improve motor outcomes for people with Cerebral Palsy. If given too frequently, biofeedback may prevent the client from learning autonomously. Use consistent and concurrent feedback to improve simple/specific motor activities. Use terminal feedback and client-directed feedback to improve more complex/general motor activities.

Position of pelvis in the 3rd month of life predicts further motor development

The aim of the study is to select elements of motor skills assessed at 3 months that provide the best predictive properties for motor development at 9 months. In all children a physiotherapeutic assessment of the quantitative and qualitative development at the age of 3 months was performed in the prone and supine positions, which was presented in previous papers as the quantitative and qualitative assessment sheet of motor development. The neurological examination at the age of 9 months was based on the Denver Development Screening Test II and the evaluation of reflexes, muscle tone (hypotony and hypertony), and symmetry. The particular elements of motor performance assessment were shown to have distinct predictive value for further motor development (as assessed at 9 months), and the pelvis position was the strongest predictive element. Irrespective of the symptomatic and anamnestic factors the inappropriate motor performance may already be detected in the 3rd month of life and is predictive for further motor development. The assessment of the motor performance should be performed in both supine and prone positions. The proper position of pelvis summarizes the proper positioning of the whole spine and ensures proper further motor development. To our knowledge, the presented motor development assessment sheet allows the earliest prediction of motor disturbances.

Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games

BACKGROUND

This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise.

MATERIALS

The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head.

METHODS

Ten users with CP participated in the study. Whereas the control group (n = 5) followed traditional therapies, the experimental group (n = 5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment.

RESULTS

The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p < 0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention.

CONCLUSIONS

Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n = 10) additional studies are needed to corroborate this hypothesis.

Further Evaluation of Microswitch Clusters to Enhance Hand Response and Head Control in Persons with Multiple Disabilities

This study was a further evaluation of microswitch clusters (combinations of two microswitches) to improve adaptive responding together with correct head position in two persons with multiple disabilities. The two participants were 19.7 and 6.6 yr. old and had profound intellectual disabilities, spastic tetraparesis, and visual impairment. They were initially taught an adaptive hand response that activated a pressure microswitch and produced favorite stimulation. Thereafter, their performance of the hand response produced favorite stimulation only when it was combined with a correct head position (detected through a mercury microswitch). Analysis showed that both participants increased the frequency of the hand response and, subsequently, the percentage of times they emitted this response in combination with correct (upright) head position. In essence, they were able to coordinate constructive occupation with exercise of appropriate posture. Performance was maintained at a 2-mo. postintervention check.

Clinical tools that measure sitting posture, seated postural control or functional abilities in children with motor impairments: a systematic review

OBJECTIVE

To identify and critically appraise clinical measurement tools used to assess sitting posture, seated postural control or functional abilities for children with motor impairment who are candidates for seating interventions.

DATA SOURCES

Searches were run in 15 electronic databases along with hand searching. The search included articles published in English to December 2011.

REVIEW METHODS

Key terms included: posture, sitting, sitting posture, seated posture, seated postural control, sitting position, seating, wheelchair(s), outcome and assess(ment). The PRISMA statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, reviewed abstracts and identified full-text articles that met criteria. Data extraction included tool description and clinical utility. Two quality-rating scales were used to evaluate conduct of the studies and psychometric properties of the tools.

RESULTS

Of the 497 titles found in the search, 29 full-text articles met the inclusion criteria and 19 tools were identified. Tools represented all components of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), with emphasis on body structure and function and activity components. Evidence supporting reliability and validity varied, with small sample sizes influencing quality ratings. Evidence of the tools' reliability was more prevalent than evidence of the tools' validity. Only four tools reported on responsiveness, an important consideration for evaluating change. Little information on clinical utility was provided.

CONCLUSION

Although a number of tools are available, evidence supporting their use for seating interventions is limited, as is the evidence supporting the strength of their measurement properties. Few tools address participation, environmental factors or the child's and family's perspective.

Early intensive postural and movement training advances head control in very young infants

BACKGROUND

Daily experiences are thought to play an important role in motor development during infancy. There are limited studies on the effect of postural and movement experiences on head control.

OBJECTIVE

The purpose of this study was to quantify the effects of postural and movement experiences on head control through a comprehensive set of measurements beginning when infants were 1 month old.

DESIGN

This was a prospective, longitudinal, 2-cohort study.

METHODS

Twenty-two full-term infants who were healthy were randomly assigned to either a training group or a control group. Infants were observed every other week from 1 to 4 months of age. Head control was assessed using a standardized developmental assessment tool, the Test of Infant Motor Performance (TIMP), as well as behavioral coding and kinematics of infants' head postures and movements in a supported sitting position. Caregivers performed at least 20 minutes of daily postural and movement activities (training group), or social interaction (control group) for 4 weeks.

RESULTS

The training group had higher TIMP scores on head control-related items during the training period and after training stopped compared with the control group. Starting from the during training phase, the training group infants had their heads in a vertical and midline position longer compared with the control group infants. After training stopped, the training group infants actively moved their heads forward more often and for larger distances.

LIMITATIONS

The experiences outside daily training were not monitored, and the results may be specific to the experimental setup for infants with typical development.

CONCLUSIONS

Young infants are able to take advantage of postural and movement experiences to rapidly advance their head control as early as 4 to 6 weeks of postnatal life. Infant positioning, caregiver handling, and caregiver-infant interactions were likely contributing factors. This database of comprehensive measures may be useful in future trials focused on head control in infants with special needs.

Microswitch clusters to enhance adaptive responses and head control: A programme extension for three children with multiple disabilities

PURPOSE

We assessed the possibility of extending adaptive responding and head control in three children with multiple disabilities through the use of microswitch clusters.

METHOD

The children had previously learned to perform an adaptive hand response and to control head position during that response. They were now taught one or two new adaptive responses (foot lifting, leg touching, or vocalization) and to combine such responses with appropriate head position. Microswitch clusters served to ensure that an adaptive response was followed by positive stimulation only if it was combined with appropriate head position.

RESULTS

The results were positive with the children learning the new adaptive responses and combining them with appropriate head position. This performance was maintained during two- or three-month post-intervention checks. During these checks, the children were also successful in using the old adaptive hand response with appropriate head position.

CONCLUSIONS

The use of microswitch clusters was effective to extend the level of adaptive responding and enhance appropriate head position during this responding. This outcome, which indicates a successful technical replication and procedural extension of previous work in the area, has positive practical implications for educational and occupational programmes for children with multiple disabilities.

A microswitch-cluster program to foster adaptive responses and head control in students with multiple disabilities: replication and validation assessment

A program relying on microswitch clusters (i.e., combinations of microswitches) and preferred stimuli was recently developed to foster adaptive responses and head control in persons with multiple disabilities. In the last version of this program, preferred stimuli (a) are scheduled for adaptive responses occurring in combination with head control (i.e., head upright) and (b) last through the scheduled time only if head control is maintained for that time. The first of the present two studies was aimed at replicating this program with three new participants with multiple disabilities adding to the three reported by Lancioni et al. [Lancioni, G. E., Singh, N. N., O'Reilly, M. F., Sigafoos, J., Didden, R., Oliva, D., et al. (2007). Fostering adaptive responses and head control in students with multiple disabilities through a microswitch-based program: Follow-up assessment and program revision. Research in Developmental Disabilities, 28, 187-196]. The second of the two studies served to carry out an expert validation of the program's effects on head control and general physical condition with the three participants of Study I as well as the three participants involved in the Lancioni et al. study mentioned above. The expert raters were 72 new physiotherapists and 72 experienced physiotherapists. The results of Study I supported previous data and indicated that the program was effective in helping the participants increase the frequency of adaptive responses in combination with head control and the length of such control. The results of Study II showed that the raters found the effects of the new program more positive than those of other intervention conditions and also considered such program a useful complement to formal motor rehabilitation programs.

A preliminary report on the effectiveness of trunk targeting in achieving independent sitting balance in children with cerebral palsy

OBJECTIVE

To assess the potential of Targeted Training in initiating or accelerating improved movement control of the trunk and hip joints in children with cerebral palsy so that independent sitting balance without specialized seating could be achieved.

DESIGN

Six single case studies.

SETTING

Assessment and review were undertaken in a specialized centre with intervention in the subjects' home or school.

SUBJECTS

Children between the ages of two years five months and seven years five months (mean four years seven months) with an established diagnosis of cerebral palsy. None had independent sitting balance at the start of the study.

INTERVENTION

Targeted Training using specialized equipment was directed at the appropriate few joints of the trunk as determined by initial testing and progressed when control at those joints had become automatic. The equipment provided support and challenged control learning. Periods of no intervention and placebo intervention, when the equipment was inappropriately set up, were also used. Two of the children ceased their traditional physiotherapy input while Targeted Training or placebo training took place.

MAIN OUTCOME MEASURE

A new test was devised and validated to determine the most caudal extent of control of the vertical posture. In addition, a functional test of independent sitting balance was defined.

RESULTS

All six children showed an increase in movement control and all gained independent sitting balance within 12-25 weeks (mean 16 weeks). This was irrespective of the continuation or cessation of traditional physiotherapy.

CONCLUSION

These preliminary findings suggest that Targeted Training may be an effective means of promoting movement control and functional ability. Confirmation of these findings by other investigators would be of value.