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Zhang Y, Hui Z, Qi W, Zhang J, Wang M, Zhu D. Clinical study on the safety and feasibility of AiWalker-K for lower limbs exercise rehabilitation in children with cerebral palsy. PLoS One 2024; 19:e0303517. [PMID: 38776339 PMCID: PMC11111022 DOI: 10.1371/journal.pone.0303517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/24/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Robotic-assisted gait training (RAGT) devices are effective for children with cerebral palsy (CP). Many RAGT devices have been created and put into clinical rehabilitation treatment. Therefore, we aimed to investigate the safety and feasibility of a new RAGT for children with CP. METHODS This study is a cross-over design with 23 subjects randomly divided into two groups. The occurrence of adverse events and changes in heart rate and blood pressure were recorded during each AiWalker-K training. Additionally, Gross Motor Function Measure-88 (GMFM-88), Pediatric Balance Scale (PBS), 6 Minutes Walking Test (6MWT), Physiological Cost Index, and Edinburgh Visual Gait Score (EVGS) were used to assess treatment, period, carry-over, and follow-up effects in this study. RESULTS Adverse events included joint pain, skin pain, and injury. Heart rate and blood pressure were higher with the AiWalker-K compared to the rest (P < 0.05), but remained within safe ranges. After combined treatment with AiWalker-K and routine rehabilitation treatment, significant improvements in 6MWT, GMFM-88 D and E, PBS, and EVGS were observed compared to routine rehabilitation treatment alone (P < 0.05). CONCLUSIONS Under the guidance of experienced medical personnel, AiWalker-K can be used for rehabilitation in children with CP.
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Affiliation(s)
- Yi Zhang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhichong Hui
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weihang Qi
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiamei Zhang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingmei Wang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dengna Zhu
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Niedzwecki C, Barbuto A, Mitchell K, Wirt S, Seymour M, Thomas S, Schwabe A. Comparison of outcomes following surgical intervention and inpatient rehabilitation stays in children with cerebral palsy. PM R 2024; 16:449-461. [PMID: 37801614 DOI: 10.1002/pmrj.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/28/2023] [Accepted: 09/01/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Literature is limited on functional outcomes in children with cerebral palsy (CP) following surgical procedures and a subsequent inpatient rehabilitation unit (IRU) stay. OBJECTIVE To compare functional outcomes and length of stay (LOS) in children with CP following a surgical procedure and IRU stay based on the surgical procedure performed, pattern of involvement, etiology, and Gross Motor Function Classification System (GMFCS) level. DESIGN Retrospective cohort study. SETTING Tertiary care pediatrics. PARTICIPANTS Pediatric patients with CP who underwent one of three surgical procedures followed by an IRU stay. INTERVENTIONS Selective dorsal rhizotomy (SDR), single-event multilevel orthopedic surgery (SEMLS), or intrathecal baclofen (ITB) pump implantation and subsequent IRU stay. MAIN OUTCOME MEASURES IRU LOS, Functional Independence Measure for Children (WeeFIM) total score, sub-scores, and efficiency. RESULTS Children undergoing SDR had a longer LOS (p ≤ .015). Children with spastic diplegia, GMFCS level II, and prematurity-based CP had higher WeeFIM efficiency scores (p ≤ .046, ≤.021, and .034 respectively). Greater changes in WeeFIM™ scores were associated with spastic diplegia, SDR, GMFCS level II, longer LOS, and higher admission scores (p ≤ .045). CONCLUSIONS Although statistically and functionally significant improvements in children with CP following surgical interventions and an IRU stay were seen, those with higher WeeFIM change scores tended to have spastic diplegia, to have undergone SDR, GMFCS level II, longer LOS, and higher admission scores.
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Affiliation(s)
- Christian Niedzwecki
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Barbuto
- Department of Physical and Occupational Therapy, Texas Children's Hospital-The Woodlands, The Woodlands, Texas, USA
| | - Katy Mitchell
- Department of Physical Therapy, Texas Woman's University-Houston, Houston, Texas, USA
| | - Steven Wirt
- Department of Physical and Occupational Therapy, Texas Children's Hospital-Main Campus, Houston, Texas, USA
| | - Michelle Seymour
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Sruthi Thomas
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Aloysia Schwabe
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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Hui Z, Qi W, Zhang Y, Wang M, Zhang J, Li D, Zhu D. Efficacy of a Soft Robotic Exoskeleton to Improve Lower Limb Motor Function in Children with Spastic Cerebral Palsy: A Single-Blinded Randomized Controlled Trial. Brain Sci 2024; 14:425. [PMID: 38790405 PMCID: PMC11118818 DOI: 10.3390/brainsci14050425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/31/2024] [Accepted: 04/13/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE Soft robotic exoskeletons (SREs) are portable, lightweight assistive technology with therapeutic potential for improving lower limb motor function in children with cerebral palsy. To understand the effects of long-term SRE-assisted walking training on children with spastic cerebral palsy (SCP), we designed a study aiming to elucidate the effects of SRE-assisted walking training on lower limb motor function in this population. METHODS In this randomized, single-blinded (outcome assessor) controlled trial, forty children diagnosed with SCP were randomized into the routine rehabilitation (RR) group (N = 20) and the SRE group (N = 20) for comparison. The RR group received routine rehabilitation training, and the SRE group received routine rehabilitation training combined with SRE-assisted overground walking training. Assessments (without SRE) were conducted pre- and post-intervention (8 weeks after the intervention). The primary outcome measures included the 10 m walk test (10MWT) and the 6 min walk test (6MWT). Secondary outcome measures comprised the gross motor function measure-88, pediatric balance scale modified Ashworth scale, and physiological cost index. RESULTS Both groups showed significant improvements (p < 0.01) across all outcome measures after the 8-week intervention. Between-group comparisons using ANCOVA revealed that the SRE group demonstrated greater improvement in walking speed from the 10MWT (+6.78 m/min, 95% CI [5.74-7.83]; p < 0.001) and walking distance during the 6MWT (+34.42 m, 95% CI [28.84-39.99]; p < 0.001). The SRE group showed greater improvement in all secondary outcome measures (p < 0.001). CONCLUSIONS The study findings suggested that the integration of SRE-assisted overground walking training with routine rehabilitation more effectively enhances lower limb motor function in children with SCP compared to routine rehabilitation alone.
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Affiliation(s)
- Zhichong Hui
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Weihang Qi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Mingmei Wang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Jiamei Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Dong Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Dengna Zhu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
- Zhengzhou Key Laboratory of the Prevention and Cure of Cerebral Palsy Children, Zhengzhou 450052, China
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Stergiou AN, Varvarousis DN, Mattila-Rautiainen S, Tzoufi M, Doulgeri S, Ploumis A. Clinical effects of equine-assisted therapeutic exercises in static and dynamic balance of children with cerebral palsy. Rehabilitacion (Madr) 2024; 58:100841. [PMID: 38457869 DOI: 10.1016/j.rh.2024.100841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To evaluate the efficacy of equine-assisted therapy for the static and dynamic balance in the rehabilitation of children and adolescents with cerebral palsy maintaining obtained improvement 8-weeks after the end of the intervention. METHOD The study lasted 28 weeks, of which the intervention lasted 12 weeks. Measurements were taken before, in the middle, after the end of the intervention and follow-up after 12 weeks. Paediatric Balance Scale and dynamic plate were used to evaluate the balance. Wechsler Intelligence Scale for Children (3rd edition) was used to assess mental capacity, and the Gross Motor Function Classification System for the assessment of functional capacity for the participants. Exercises on the horseback were individualised for every participant. RESULTS The study comprised 27 participants with cerebral palsy. Statistically significant improvements were found for the Paediatric Balance Scale (p<0.001) and the mean dynamic plate pressure for both feet (p<0.05). The Paediatric Balance Scale results remained in the follow-up and were found clinically significant. CONCLUSIONS The results suggest that this type of approach in rehabilitation can be beneficial with clinical significance for improving the motor dysfunctions and quality of life in cerebral palsy.
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Affiliation(s)
- A N Stergiou
- Department of Physical Medicine and Rehabilitation, Division of Surgery, University of Ioannina Medical School, Ioannina, Greece; Ioannina Therapeutic Riding Center, Ioannina, Greece.
| | - D N Varvarousis
- Department of Physical Medicine and Rehabilitation, Division of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | | | - M Tzoufi
- Department of Paediatrics, Division of Child's Health, University of Ioannina Medical School, Ioannina, Greece
| | - S Doulgeri
- Department of Physical Medicine and Rehabilitation, Division of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - A Ploumis
- Department of Physical Medicine and Rehabilitation, Division of Surgery, University of Ioannina Medical School, Ioannina, Greece
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Alotaibi M, Almutairi AB, Alhirsan S, Alkazemi A, Alharbi M, Alrashdi N, Taqi A, Alamiri B, Vogtle L, Alqahtani MM. Psychostimulant Medications for Physical Function and Spasticity in Children With Cerebral Palsy: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53728. [PMID: 38441919 PMCID: PMC10951828 DOI: 10.2196/53728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Cerebral palsy (CP) is a prevalent nonprogressive disorder that leads to impaired movement (ie, spasticity), posture, and balance, which affects functions such as walking and upper extremity tasks. Current medical treatments show efficacy in improving motor performance but have considerable side effects. Emerging off-label use of central nervous system (CNS) medications for improving motor performance has shown promising results in children with CP and other populations. OBJECTIVE The aim of this study is to describe a protocol for a pilot randomized controlled trial (RCT) to examine the safety, tolerability, and efficacy of methylphenidate (MPH) and modafinil on spasticity and motor performance in children with CP. METHODS This will be a protocol study for a pilot, triple-masked, placebo-controlled RCT (a class I trial following the American Academy of Neurology criteria) with blinded patients, outcome assessors, and intervention delivery team. Eligible children should be diagnosed with CP levels I or II based on the Gross Motor Function Classification System and be aged between 7 and 12 years. Thirty-six children with CP will be randomized into 3 groups to receive (1) MPH (2.5 mg of MPH + 100 mg placebo), (2) modafinil (100 mg modafinil + 2.5 mg placebo), or (3) a placebo (2.5 mg placebo + 100 mg placebo), in addition to physical therapy for 12 weeks. Primary outcomes include the Gross Motor Function Measure-66 and the Modified Ashworth Scale. Secondary outcomes include the Timed Up and Go test, 5 Time Sit to Stand test, Modified Clinical Test for Sensory Interaction of Balance, and 10-Meter Walk Test. RESULTS The protocol has been accepted by Kuwait University (VDR/EC-225) and the Ministry of Health of Kuwait (2022/2157). The inclusion of participants will start in June 2024. CONCLUSIONS The combination of CNS stimulant medications and controlling for rehabilitation has not been studied yet. The findings of this study may determine if using CNS stimulant medications is beneficial for the reduction of spasticity and improvement of physical function in children with spastic CP. TRIAL REGISTRATION ClinicalTrials.gov NCT05675098; https://clinicaltrials.gov/study/NCT05675098. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53728.
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Affiliation(s)
- Mansour Alotaibi
- Department of Rehabilitation, Faculty of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia
- Center for Health Research, Northern Border University, Arar, Saudi Arabia
| | - Anwar B Almutairi
- Department of Physical Therapy, Faculty of Allied Health, Kuwait University, Kuwait City, Kuwait
| | - Saleh Alhirsan
- Department of Physical Therapy, College of Applied Medical Sciences, Jouf University, Aljouf, Saudi Arabia
| | - Afrah Alkazemi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Maha Alharbi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Naif Alrashdi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
- The Health and Scientific Research Center, Majmaah University, Majmaah, Saudi Arabia
| | - Ahmad Taqi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Bibi Alamiri
- Kuwait Center for Mental Health, Public Authority for Disability Affairs, Almanara, Kuwait
| | - Laura Vogtle
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohammed M Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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6
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Papageorgiou E, Peeters N, Staut L, Molenaers G, Ortibus E, Van Campenhout A, Desloovere K. Botulinum neurotoxin type A responders among children with spastic cerebral palsy: Pattern-specific effects. Eur J Paediatr Neurol 2024; 49:131-140. [PMID: 38518417 DOI: 10.1016/j.ejpn.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 10/31/2023] [Accepted: 02/29/2024] [Indexed: 03/24/2024]
Abstract
AIM To identify short-term effects of botulinum neurotoxin type A (BoNT) injections on gait and clinical impairments, in children with spastic cerebral palsy (CP), based on baseline gait pattern-specific subgroups. METHOD Short-term effects of BoNT injections in the medial hamstrings and gastrocnemius were defined in a retrospective convenience sample of 117 children with CP (median age: 6 years 4 months; GMFCS I/II/III: 70/31/16; unilateral/bilateral: 56/61) who had received gait analyses before and 2 months post-BoNT. First, baseline gait patterns were classified. Statistical and meaningful changes were calculated between pre- and post-BoNT lower limb sagittal plane kinematic waveforms, the gait profile score, and non-dimensional spatiotemporal parameters for the entire sample and for pattern-specific subgroups. These gait waveforms per CP subgroup at pre- and post-BoNT were also compared to typically developing gait and composite scores for spasticity, weakness, and selectivity were compared between the two conditions. RESULTS Kinematic improvements post-BoNT were identified at the ankle and knee for the entire sample, and for subgroups with apparent equinus and jump gait. Limbs with baseline patterns of dropfoot and to a lesser extent true equinus showed clear improvements only at the ankle. In apparent equinus, jump gait, and dropfoot, spasticity improved post-BoNT, without leading to increased weakness or diminished selectivity. Compared to typical gait, knee and hip motion improved in the crouch gait subgroup post-BoNT. CONCLUSION This comprehensive analysis highlighted the importance of investigating BoNT effects on gait and clinical impairments according to baseline gait patterns. These findings may help identify good treatment responders.
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Affiliation(s)
- E Papageorgiou
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
| | - N Peeters
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - L Staut
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - G Molenaers
- KU Leuven, Locomotor and Neurological Disorders, Department of Development and Regeneration, Leuven, Belgium; Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - E Ortibus
- KU Leuven, Locomotor and Neurological Disorders, Department of Development and Regeneration, Leuven, Belgium; Center for Developmental Disabilities, Leuven, Belgium
| | - A Van Campenhout
- KU Leuven, Locomotor and Neurological Disorders, Department of Development and Regeneration, Leuven, Belgium; Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - K Desloovere
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
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Podurgiel J, Piscitelli D, Denegar C. Challenges in applying minimal clinically important difference: a critical review. Int J Rehabil Res 2024; 47:10-19. [PMID: 38250825 DOI: 10.1097/mrr.0000000000000613] [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: 01/23/2024]
Abstract
Healthcare clinicians strive to make meaningful changes in patient function and participation. A minimal clinically important difference (MCID) is an estimate of the magnitude of change needed to be meaningful to a patient. Clinicians and investigators may assume that a cited MCID is a valid and generalizable estimate of effect. There are, however, at least two concerns about this assumption. First, multiple methods exist for calculating an MCID that can yield divergent values and raise doubt as to which one to apply. Second, MCID values may be erroneously generalized to patients with dissimilar health conditions. With this in mind, we reviewed the methods used to calculate MCID and citations of reported MCID values for outcome measures commonly used in neurologic, orthopedic, and geriatric populations. Our goal was to assess whether the calculation methods were acknowledged in the cited work and whether the enrolled patients were similar to the sample from which the MCID estimate was derived. We found a concerning variation in the methods employed to estimate MCID. We also found a lack of transparency in identifying calculation methods and applicable health conditions in the cited work. Thus, clinicians and researchers must pay close attention and exercise caution in assuming changes in patient status that exceed a specific MCID reflect meaningful improvements in health status. A common standard for the calculation and reporting of an MCID is needed to address threats to the validity of conclusions drawn from the interpretation of an MCID.
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Affiliation(s)
- Joseph Podurgiel
- Doctor of Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
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Russo RS, Gasperini S, Bubb G, Neuman L, Sloan LS, Diaz GA, Enns GM. Efficacy and safety of pegzilarginase in arginase 1 deficiency (PEACE): a phase 3, randomized, double-blind, placebo-controlled, multi-centre trial. EClinicalMedicine 2024; 68:102405. [PMID: 38292042 PMCID: PMC10825663 DOI: 10.1016/j.eclinm.2023.102405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/01/2024] Open
Abstract
Background Arginase 1 Deficiency (ARG1-D) is a rare debilitating, progressive, inherited, metabolic disease characterized by marked increases in plasma arginine (pArg) and its metabolites, with increased morbidity, substantial reductions in quality of life, and premature mortality. Effective treatments that can lower arginine and improve clinical outcomes is currently lacking. Pegzilarginase is a novel human arginase 1 enzyme therapy. The present trial aimed to demonstrate efficacy of pegzilarginase on pArg and key mobility outcomes. Methods This Phase 3 randomized, double-blind, placebo-controlled, parallel-group clinical trial (clinicaltrials.govNCT03921541, EudraCT 2018-004837-34), randomized patients with ARG1-D 2:1 to intravenously/subcutaneously once-weekly pegzilarginase or placebo in conjunction with their individualized disease management. It was conducted in 7 countries; United States, United Kingdom, Canada, Austria, France, Germany, Italy. Primary endpoint was change from baseline in pArg after 24 weeks; key secondary endpoints were change from baseline at Week 24 in Gross Motor Function Measure part E (GMFM-E) and 2-min walk test (2MWT). Full Analysis Set was used for the analyses. Findings From 01 May 2019 to 29 March 2021, 32 patients were enrolled and randomized (pegzilarginase, n = 21; placebo, n = 11). Pegzilarginase lowered geometric mean pArg from 354.0 μmol/L to 86.4 μmol/L at Week 24 vs 464.7 to 426.6 μmol/L for placebo (95% CI: -67.1%, -83.5%; p < 0.0001) and normalized levels in 90.5% of patients (vs 0% with placebo). In addition, clinically relevant functional mobility improvements were demonstrated with pegzilarginase treatment. These effects were sustained long-term through additional 24 weeks of subsequent exposure. Pegzilarginase was well-tolerated, with adverse events being mostly transient and mild/moderate in severity. Interpretation These results support pegzilarginase as the first potential treatment to normalize pArg in ARG1-D and achieve clinically meaningful improvements in functional mobility. Funding Aeglea BioTherapeutics.
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Affiliation(s)
- Rossana Sanchez Russo
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Serena Gasperini
- Paediatric Department, Fondazione IRCSS San Gerardo dei Tintori, Monza, Italy
| | - Gillian Bubb
- Aeglea BioTherapeutics, Inc., Austin, TX, United States
| | - Linda Neuman
- Aeglea BioTherapeutics, Inc., Austin, TX, United States
| | | | - George A. Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Gregory M. Enns
- Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine and Lucille Packard Children's Hospital, Stanford, CA, United States
| | - PEACE Investigators
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
- Paediatric Department, Fondazione IRCSS San Gerardo dei Tintori, Monza, Italy
- Aeglea BioTherapeutics, Inc., Austin, TX, United States
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
- Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine and Lucille Packard Children's Hospital, Stanford, CA, United States
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Matsumoto Y, Yoshii Y, Ikutomo A, Yagi M, Nishimura M, Kawasaki Y, Sarafian A, Kim H, Roye DP, Matsumoto H. Improvement in a post-stroke pediatric patient with hemiplegia: Use of a hand-arm bimanual intensive therapy with hybrid assistive limb. Brain Dev 2024; 46:68-72. [PMID: 37652813 DOI: 10.1016/j.braindev.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/04/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Pediatric stroke is a rare medical condition that often leads to long-lasting motor and cognitive impairments. Although therapies for adults after a stroke are well described, treatments for motor deficits following a pediatric stroke are yet to be investigated. We report a case of pediatric stroke in the chronic phase, in which a combination of novel treatments resulted in a significant improvement in physical function. CASE REPORT A seven-year-old girl with a left hemispheric cerebral infarction lost almost all right upper extremity motor function. Following onabotulinumtoxinA treatment, she underwent hand-arm bimanual intensive therapy augmented with a hybrid assistive limb for 90 h over 15 days. Evaluation after the training revealed significant improvements in physical function, daily activities, and occupational performance. CONCLUSIONS This report highlights the importance of innovative combinations of techniques in the treatment of pediatric stroke.
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Affiliation(s)
- Yoko Matsumoto
- NikoNiko House Medical and Welfare Center, Kobe, Japan; Department of Public Health and Health Science, Kobe University Graduate School of Health Sciences, Kobe, Japan; Tokyo Metropolitan Fuchu Rehabilitation Center, Tokyo, Japan.
| | - Yuji Yoshii
- PorePore-no-Ki, Children Development Support Center, Himeji, Japan
| | - Akiyo Ikutomo
- NikoNiko House Medical and Welfare Center, Kobe, Japan
| | - Mariko Yagi
- NikoNiko House Medical and Welfare Center, Kobe, Japan; Department of Childhood Development and Education, Faculty of Human Science, Konan Women's University, Kobe, Japan
| | - Mio Nishimura
- NikoNiko House Medical and Welfare Center, Kobe, Japan
| | - Yoko Kawasaki
- NikoNiko House Medical and Welfare Center, Kobe, Japan
| | | | - Heakyung Kim
- Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, TX, USA
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, MA, USA
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, MA, USA; Department of Orthopaedic Surgery, Harvard Medical School, MA, USA
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Vezér M, Gresits O, Engh MA, Szabó L, Molnar Z, Hegyi P, Terebessy T. Evidence for gait improvement with robotic-assisted gait training of children with cerebral palsy remains uncertain. Gait Posture 2024; 107:8-16. [PMID: 37703782 DOI: 10.1016/j.gaitpost.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Cerebral palsy (CP) is a group of neuromotor diseases that develops as a result of damage to the developing central nervous system during the perinatal period. The condition is usually accompanied by musculoskeletal problems resulting in movement disorders. Gait improvement therefore, is an important part of its treatment. Roboticassisted gait training (RAGT) is a new potential rehabilitation tool for CP patients, however there is no clear evidence for the effectiveness of this method. RESEARCH QUESTION Can robotic-assisted gait training improve walking function in children with CP? METHODS A systematic search was performed in five databases: MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Scopus, and Web of Science. Eligible studies were randomized controlled trials (RCT) with CP patients under the age of 18. Gross motor function and kinematic gait parameters of patients were the main outcomes. Two authors determined the risk of bias of the RCTs independently using the revised Risk of Bias 2 (ROB 2) tool. Mean Differences (MDs) along with their 95% Confidence Interval (CI) were calculated when at least three studies were present for an outcome, subgroup analysis was performed based on the treatment of the control group. RESULTS Of the 7363 screened articles, 13 papers met our inclusion criteria and among them, 7 studies could be used in our meta-analyses. The results related to RAGT suggest nonsignificant improvement in standing and walking function (Gross Motor Function Measure D, E), moreover changes in gait speed, step length, and in cadence were also only comparable to controls. SIGNIFICANCE The results indicate that there is a trend in some gait parameters where the improvement was higher in the intervention group than in control group. The therapeutic effect of RAGT was probably not superior to physiotherapy combined with treadmill training.
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Affiliation(s)
- Mátyás Vezér
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Orsolya Gresits
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Marie Anne Engh
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Laszlo Szabó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Zsolt Molnar
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary; Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Peter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross út 22-24, 1085 Budapest, Hungary
| | - Tamás Terebessy
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary.
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Valadão P, Cenni F, Piitulainen H, Avela J, Finni T. Effects of the EXECP Intervention on Motor Function, Muscle Strength, and Joint Flexibility in Individuals with Cerebral Palsy. Med Sci Sports Exerc 2024; 56:1-12. [PMID: 37565430 DOI: 10.1249/mss.0000000000003273] [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: 08/12/2023]
Abstract
PURPOSE Numerous exercise interventions to enhance motor function in cerebral palsy (CP) have been proposed, with varying degrees of effectiveness. Because motor function requires a combination of muscle strength, joint flexibility, and motor coordination, we designed a supervised multicomponent exercise intervention (EXErcise for Cerebral Palsy, or EXECP) for individuals with CP. Our aim was to evaluate the effects of the EXECP intervention and its retention after it ceased. METHODS The EXECP intervention combined strength training for the lower limbs and trunk muscles, passive stretching for the lower limb muscles, and inclined treadmill gait training. Eighteen participants with CP (mean age, 14 yr; 13 were male) were tested twice before the 3-month intervention and twice after the intervention, each test separated by 3 months. Seventeen typically developing age- and sex-matched controls were tested twice. Motor function was assessed with the 6-min walking test (6MWT) and the gross motor function measure dimensions D and E. Passive joint flexibility was measured with goniometry. Isometric and concentric muscle strength were assessed at the knee, ankle, and trunk joints. RESULTS The EXECP intervention successfully increased 6MWT ( P < 0.001), gross motor function measure ( P = 0.004), and muscle strength for knee and trunk muscles ( P < 0.05), although no changes were observed for ankle joint muscles. Hip and knee joint flexibility also increased ( P < 0.05). After the retention period, all tested variables except the 6MWT and knee joint flexibility regressed and were not different from the pretests. CONCLUSIONS The improvements in strength, flexibility, and possibly motor coordination brought by the EXECP intervention were transferred to significant functional gains. The regression toward baseline after the intervention highlights that training must be a lifelong decision for individuals with CP.
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Affiliation(s)
- Pedro Valadão
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - Francesco Cenni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | | | - Janne Avela
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - Taija Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
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Suh MR, Min K, Cho KH, Kim J, Lim I, Park M, Noh EM, Kim MY. Maintenance of the synergistic effects of cord blood cells and erythropoietin combination therapy after additional cord blood infusion in children with cerebral palsy: 1-year open-label extension study of randomized placebo-controlled trial. Stem Cell Res Ther 2023; 14:362. [PMID: 38087394 PMCID: PMC10717973 DOI: 10.1186/s13287-023-03600-4] [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] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND This 1-year open-label extension study aimed to identify the persistent synergistic effects of allogeneic umbilical cord blood (UCB) cells and erythropoietin (EPO) in children with cerebral palsy (CP) for up to 2 years. METHODS This open-label extension study followed children with CP who were enrolled in the previous randomized, double blind, placebo-controlled trial. The following groups from the first trial were maintained: (A) UCB + EPO, (B) UCB, (C) EPO, and (D) only placebo, and all the participants had continued active rehabilitation. This extended study started 3 months after termination of the first trial, which had a 1-year follow-up duration. All subjects received single additional UCB intravenous infusion at the extension baseline regardless of their initial allocation. Outcome measures were the gross motor performance measure (GMPM), gross motor function measure-66 (GMFM-66), and Bayley scales of infant development-II (BSID-II), which were followed at 3, 6, and 12 months after the extension baseline. Changes in the outcome scores from the baseline values of the previous trial and this study were analysed. RESULTS Sixty-nine children (4.29 ± 1.28 years, M:F = 34:35) were included in this study. Each group showed improvements in the outcome measures at 12 months after additional UCB infusion compared to the baseline scores, except for GMFM and GMPM in Group C which were elevated at 3 and 6 months post-therapy. Total subject analyses did not show significant differences in the outcome measures between the four different groups at 3, 6 and 12 months after additional UCB therapy. However, patients with severe dysfunction, whose GMFCS levels were IV and V, revealed a larger improvement of the GMPM score in Group A than in Group D (Ps < 0.05) from the baseline value of the previous trial. The changes in BSID-II mental scale scores were positively correlated with the number of administered total nucleated cells per unit body weight during this one-year extension study period (r = 0.536, P = 0.001). CONCLUSIONS These results suggest that when administering UCB to treat patients with CP, combination therapy with EPO is more effective, and the effect might last as long as 2 years, especially in patients with severe impairments. TRIAL REGISTRATION CHA Bundang Medical Center IRB, No. 2015-06-093, approved on July 29, 2015, ( https://www.e-irb.com:3443/devlpg/nlpgS200.jsp ), ClinicalTrials.gov, NCT03130816, retrospectively registered on April 27, 2017 ( https://clinicaltrials.gov/ct2/show/NCT03130816?term=NCT03130816&draw=2&rank=1 ).
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Affiliation(s)
- Mi Ri Suh
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, Republic of Korea
- Rehabilitation and Regeneration Research Center, CHA University, Pocheon, Republic of Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, Republic of Korea
- Rehabilitation and Regeneration Research Center, CHA University, Pocheon, Republic of Korea
| | - Kye Hee Cho
- Rehabilitation and Regeneration Research Center, CHA University, Pocheon, Republic of Korea
- Department of Rehabilitation Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Republic of Korea
| | - Jongwook Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, Republic of Korea
- Rehabilitation and Regeneration Research Center, CHA University, Pocheon, Republic of Korea
| | - Ikhyun Lim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, Republic of Korea
- Rehabilitation and Regeneration Research Center, CHA University, Pocheon, Republic of Korea
| | - Mijin Park
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Eun-Min Noh
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Min Young Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, Republic of Korea.
- Rehabilitation and Regeneration Research Center, CHA University, Pocheon, Republic of Korea.
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13
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Gill I, Davidson SA, Stevenson PG, Robinson R, Pool D, Valentine J. Outcomes following intensive day rehabilitation for young people in Western Australia. J Pediatr Rehabil Med 2023:PRM220102. [PMID: 38108363 DOI: 10.3233/prm-220102] [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: 12/19/2023] Open
Abstract
PURPOSE Intensive rehabilitation aims to improve and maintain functioning in young people who experience disability due to illness or injury. Day rehabilitation may have advantages for families and healthcare systems over inpatient models of rehabilitation. METHODS This study evaluated the goals and outcomes of a cohort of young people in Western Australia who attended a specialist intensive day rehabilitation programme ("iRehab") at Perth Children's Hospital. Analysis of the iRehab service database was performed. Rehabilitation goals and outcomes were recorded as per the Canadian Occupational Performance Measure (COPM), Children's Functional Independence Measure (WeeFIM), and Goal Attainment Scale (GAS). RESULTS There were 586 iRehab admissions between August 11, 2011, and December 31, 2018. Admissions were divided by diagnosis: Cerebral Palsy (228, 38.5%), Acquired Brain Injury (125, 21.3%), Spinal Cord Disorders (91, 15.5%), and Other (141, 24.2%). Mean COPM Performance increased by 2.78 points from admission to discharge (95% CI 2.58 to 2.98, p < 0.001). Mean COPM Satisfaction was 3.29 points higher at discharge than admission (95% CI 3.07 to 3.51, p < 0.001). Mean total WeeFIM score improved by 6.51 points between admission and discharge (95% CI 5.56 to 7.45, p < 0.001), and by 3.33 additional points by six months post discharge (95% CI 2.14 to 4.53, p < 0.001). Mean GAS T-scores increased by 27.85 (95% CI 26.73 to 28.97, p < 0.001) from admission to discharge, and by 29.64 (95% CI 28.26 to 31.02, p < 0.001) from admission to six months post discharge, representing improvement consistent with team expectations. CONCLUSION This study describes a model by which intensive rehabilitation can be delivered in a day rehabilitation setting. A diverse population of young people who experienced disability achieved significant improvements in occupational performance, independence, and goal attainment after accessing intensive day rehabilitation. Improvements were measured in all diagnostic subgroups and were maintained six months after discharge.
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Affiliation(s)
- Irwin Gill
- Kids Rehab WA, Perth Children's Hospital, Perth, Australia
| | | | - Paul G Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Rae Robinson
- Kids Rehab WA, Perth Children's Hospital, Perth, Australia
| | - Dayna Pool
- Kids Rehab WA, Perth Children's Hospital, Perth, Australia
| | - Jane Valentine
- Kids Rehab WA, Perth Children's Hospital, Perth, Australia
- Curtin University, Perth, Australia
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Nielsen C, Merrell D, Reichenbach R, Mayolo P, Qubain L, Hustedt JW. An Evaluation of Patient-reported Outcome Measures and Minimal Clinically Important Difference Usage in Hand Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5490. [PMID: 38111720 PMCID: PMC10727676 DOI: 10.1097/gox.0000000000005490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/31/2023] [Indexed: 12/20/2023]
Abstract
Background This study was designed to examine the current use of patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) calculations in the hand surgery literature in an effort to standardize their use for research purposes. Methods A systematic review of the hand surgery literature was conducted. All nonshoulder upper extremity articles utilizing PROMs were compared between different journals, different surgical indications, and differing usage. MCID values were reported, and calculation methods assessed. Results In total, 4677 articles were reviewed, and 410 met the inclusion criteria of containing at least one PROM. Of the 410 articles reporting PROMs, 148 also mentioned an associated MCID. Of the articles that mentioned MCIDs, 14 calculated MCID values based on their specific clinical populations, whereas the remainder referenced prior studies. An estimated 35 different PROMs were reported in the study period; 95 different MCID values were referenced from 65 unique articles. Conclusions There are many different PROMs currently being used in hand surgery clinical reports. The reported MCIDs from their related PROMs are from multiple different sources and calculated by different methods. The lack of standardization in the hand surgery literature makes interpretation of studies utilizing PROMs difficult. There is a need for a standardized method of calculating MCID values and applying these values to established PROMs for nonshoulder upper extremity conditions.
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Affiliation(s)
- Colby Nielsen
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Dallin Merrell
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Rachel Reichenbach
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Patrick Mayolo
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Leeann Qubain
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Joshua W Hustedt
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
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Takahashi K, Mizukami M, Watanabe H, Kuroda MM, Shimizu Y, Nakajima T, Mutsuzaki H, Kamada H, Tokeji K, Hada Y, Koseki K, Yoshikawa K, Nakayama T, Iwasaki N, Kawamoto H, Sankai Y, Yamazaki M, Matsumura A, Marushima A. Feasibility and safety study of wearable cyborg Hybrid Assistive Limb for pediatric patients with cerebral palsy and spinal cord disorders. Front Neurol 2023; 14:1255620. [PMID: 38020664 PMCID: PMC10656736 DOI: 10.3389/fneur.2023.1255620] [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: 07/09/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The wearable cyborg Hybrid Assistive Limb (HAL) is the world's first cyborg-type wearable robotic device, and it assists the user's voluntary movements and facilitates muscle activities. However, since the minimum height required for using the HAL is 150 cm, a smaller HAL (2S size) has been newly developed for pediatric use. This study aimed to (1) examine the feasibility and safety of a protocol for treatments with HAL (2S size) in pediatric patients and (2) explore the optimal method for assessing the efficacy of HAL. Methods This clinical study included seven pediatric patients with postural and motor function disorders, who received 8-12 sessions of smaller HAL (2S size) treatment. The primary outcome was the Gross Motor Function Measure-88 (GMFM-88). The secondary outcomes were GMFM-66, 10-m walk test, 2- and 6-min walking distances, Canadian Occupational Performance Measure (COPM), a post-treatment questionnaire, adverse events, and device failures. Statistical analyses were performed using the paired samples t-test or Wilcoxon signed-rank test. Results All participants completed the study protocol with no serious adverse events. GMFM-88 improved from 65.51 ± 21.97 to 66.72 ± 22.28 (p = 0.07). The improvements in the secondary outcomes were as follows: GMFM-66, 53.63 ± 11.94 to 54.96 ± 12.31, p = 0.04; step length, 0.32 ± 0.16 to 0.34 ± 0.16, p = 0.25; 2-MWD, 59.1 ± 57.0 to 62.8 ± 63.3, p = 0.54; COPM performance score, 3.7 ± 2.0 to 5.3 ± 1.9, p = 0.06; COPM satisfaction score, 3.3 ± 2.1 to 5.1 ± 2.1, p = 0.04. Discussion In this exploratory study, we applied a new size of wearable cyborg HAL (2S size), to children with central nervous system disorders. We evaluated its safety, feasibility, and identified an optimal assessment method for multiple treatments. All participants completed the protocol with no serious adverse events. This study suggested that the GMFM would be an optimal assessment tool for validation trials of HAL (2S size) treatment in pediatric patients with posture and motor function disorders.
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Affiliation(s)
- Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroki Watanabe
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Takashi Nakajima
- Department of Neurology, National Hospital Organization Niigata National Hospital, Kashiwazaki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kayo Tokeji
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Tomohiro Nakayama
- Department of Pediatric, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Nobuaki Iwasaki
- Department of Pediatric Neurology, Tsuchiura Rehabilitation Hospital, Tsuchiura, Japan
| | - Hiroaki Kawamoto
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Matsumura
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
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Liu J, Poehlein E, Chow SC. Statistical Evaluation of Responder Analysis in Stem Cell Clinical Trials. Ther Innov Regul Sci 2023; 57:1238-1247. [PMID: 37555886 DOI: 10.1007/s43441-023-00556-8] [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: 05/10/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND In evaluating treatment efficacy, there is an ongoing discussion about which endpoint is more efficient to represent the treatment effect. Absolute change (AC) is the difference between before and after treatment, while relative change (RC) is the AC relative to the baseline value. Principal investigators sometimes support the credibility of relative change, but the FDA is more likely to support absolute change. Therefore, whether these two endpoints can be translated or combined is worth investigating in order to satisfy both parties. METHODS In this article, a motivating example is presented to show that the choice of endpoint will result in different conclusions. The compared relationship of AC and RC is discussed in terms of required sample size, power, and precision. A new type of responder endpoint that combines the concepts of AC and RC is proposed. The comparative relationship regarding sample size, power, and precision of the proposed responder endpoint and the original two endpoints are also investigated. RESULTS As a result, the performance of AC and RC is highly dependent on the choice of threshold that is often informed based on minimum clinically important difference or other clinical experience. Therefore, an absolute translation between them is hard to achieve. Inspired by the concept of responder analysis, three types of responder endpoints are proposed and discussed. The pattern of the third type of responder endpoint is having higher power, higher precision, and less required sample size in estimating the treatment effect compared to AC and RC within a range of thresholds. This advantage becomes more obvious when applying higher AC and RC thresholds and lower [Formula: see text] threshold. CONCLUSION The proposed endpoint incorporates the information from the AC and RC endpoints and could be another wise choice when designing clinical trials especially when there is no absolute preference between AC and RC.
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Affiliation(s)
- Jiajun Liu
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC, USA
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC, USA
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Hurd CL, Livingstone D, Smith A, Yang JF. Engaging the Lower Extremity via Active Therapy Early (ELEVATE) Is Feasible and May Improve Gross Motor Function in Children with Spastic Bilateral Cerebral Palsy: A Case Series. Physiother Can 2023; 75:311-321. [PMID: 38037582 PMCID: PMC10686296 DOI: 10.3138/ptc-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/15/2023] [Indexed: 12/02/2023]
Abstract
Purpose The feasibility of ELEVATE with respect to adherence and preliminary efficacy was determined for children with spastic bilateral cerebral palsy (CP) from encephalopathy of prematurity. Methods A case series was used. Participants were randomized to receive ELEVATE immediately or delay the intervention by 3 months before receiving the intervention. The outcomes included feasibility measures of (1) number of children recruited, (2) percentage of sessions attended, (3) stride counts during the intervention, and preliminary efficacy measures of change over the intervention period in (4) Gross Motor Function Measure-66 (GMFM-66), and (5) kinematics and weight-bearing during treadmill walking. Results Four boys under 3 years of age participated. All participants tolerated 60-minute intervention sessions four times/week for 12 weeks, and attended 75%-94% (min-max) of the targeted sessions. The median step count per session ranged from 833 to 2484 steps (min-max) during the final week of training. Participants showed an increase in GMFM-66 score of 2.4-7.5 points (min-max) over the 3-month intervention phase, as compared to a decrease of 1.7 for one participant and an increase of 1.3 for another over the delay period. Three participants demonstrated small improvements in their gait with the intervention. Conclusions Engaging young children with bilateral CP in intensive rehabilitation targeting gross motor function was feasible and demonstrated preliminary efficacy. The results have guided the design of a larger clinical trial to assess efficacy of early, active interventions for children with spastic bilateral CP.
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Affiliation(s)
- Caitlin L. Hurd
- From the:
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Donna Livingstone
- From the:
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Smith
- From the:
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Jaynie F. Yang
- From the:
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
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Janssen-Potten YJM, Roks L, Roijen R, Vermeulen RJ, Rameckers EEA. Effectiveness of functional intensive therapy on mobility and self-care activities in children and adolescents with cerebral palsy - a prospective clinical study. Disabil Rehabil 2023; 45:3529-3538. [PMID: 36226733 DOI: 10.1080/09638288.2022.2130445] [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: 03/15/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Cerebral palsy (CP) is a major cause of childhood disability. Children with CP often lack motor skills to effectively perform activities of daily living. The aim is to assess the effectiveness of a functional intensive therapy program focused on improving individual goals in the domain of mobility and self-care in children and adolescents with CP. MATERIAL AND METHODS Thirty-five CP patients, aged 11-19 years, GMFCS I-IV, received daily 6-7 h of functional therapy for 15 days. Outcomes were assessed at baseline, immediately after the program and at three months follow-up. RESULTS Significant post-intervention improvement was seen on all primary and secondary outcome measures; personal goals (GAS score; COPM performance and COPM satisfaction), daily activities (ACTIVLIM), hand function (ABILHAND-Kids), mobility (ABILOCO-Kids; GMFM-66-IS score). There was no loss to follow up during the program and after three months. At follow-up, improvements were retained except for ABILOCO and GMFM-66-IS. CONCLUSIONS Functional intensive therapy appears feasible and seems to be effective in improving treatment goals focused on mobility and self-care, even in older and more severely affected children and adolescents with CP. After three months, these possible effects were still present.Implications for rehabilitationShort intensive functional training is feasible and showing no loss to follow up in the older and more severely affected children and adolescents with cerebral palsy (CP).Short intensive functional training appears effective in improving individual goals in children and adolescents with CP and improvements endorse three months.Short intensive functional training seems to be effective on both mobility and self-care domains of the ICF-CY.
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Affiliation(s)
- Yvonne J M Janssen-Potten
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Lars Roks
- Department of Quality & Safety, Zuyderland Medical Centre, Sittard, The Netherlands
| | - Ruud Roijen
- Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Research School MHeNS, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eugène E A Rameckers
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Pediatric Rehabilitation, BIOMED, Hasselt University, Hasselt, Belgium
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19
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Pereira F, Cameirão MS, Bermúdez I Badia S. The impact of exergames on the functional balance of a teenager with cerebral palsy - a case report. Disabil Rehabil Assist Technol 2023; 18:1074-1083. [PMID: 34591721 DOI: 10.1080/17483107.2021.1980623] [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: 01/19/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To understand the impact of an intensive rehabilitation program based on exergames in balance and lower limb function in a teenager with cerebral palsy. METHODS The rehabilitation program comprised different customised exergames and was delivered in 5 weekly sessions of 30 min for 4 weeks. Pre-, post-, and 1-month Follow-up assessments included the following metrics: Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Gross Motor Function Measure (GMFM), Posturography, and Gait analysis. RESULTS We observed increased scores after the intervention of 9/72 points in GMF - Module E (Walk, Run and Jump) and of 9/56 points in BBS, sustained at Follow-up. Changes in function, specifically in the quality and independence of the performance of specific movements such as turning 360°, increased distance reaching forward, walk behind, step over obstacles, and step stairs up and down were also observed. Gait kinematics and Spatio-temporal parameters tended to get closer to the 50th percentile. CONCLUSIONS We observed positive changes in motor function of a teenager with cerebral palsy, with sustained increased scores at a 1-month Follow-up. Findings are suggestive that intensive rehabilitation programs using exergames with high customisation features are a potentially valuable rehabilitation tool for training balance in teenagers with Cerebral Palsy.Implications for rehabilitationExergames may be a useful for providing balance training for teenagers who have a mixed form of cerebral palsy.Exergames that require body displacement may be suitable for modulating gait kinematics and spatio-temporal parameters.The customisation of virtual rehabilitation tools seems to impact the motivation and effort of the user positively.
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Affiliation(s)
- Fábio Pereira
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Caparica, Portugal
| | - Mónica S Cameirão
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Caparica, Portugal
| | - Sergi Bermúdez I Badia
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Caparica, Portugal
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20
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Stevens PM, Grothaus OF, MacWilliams BA. Drop landing analysis of rotational osteotomies. J Pediatr Orthop B 2023:01202412-990000000-00152. [PMID: 37751370 DOI: 10.1097/bpb.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Pathomechanics resulting from rotational deformities of the long bones in an idiopathic population have not been extensively studied, and are chiefly limited to level over ground walking. Thirty-five adolescents with excessive idiopathic outward tibial torsion (TT), femoral rotation, or both (pan genu) were studied both before and after corrective surgery. Data collected included computational motion analysis of a drop jump and patient-reported outcomes consisting of PODCI and Goal Attainment Scores. Results were compared to an age-matched typically developing cohort (n = 25). Subjects with femoral anteversion (FA) exhibited compensatory hip rotations to normalize knee progression angles at landing. Subjects with only TT did not compensate at the hip, landing with typical knee progression but excessive outward foot progression. These strategies resulted in elevated frontal plane knee moments for FA (P = 0.008), and elevated lateral knee forces in all groups compared to typical, with the TT group reaching significance (P < 0.001). Rotational osteotomies successfully restored elevated kinematics and kinetics to within or below typically developing ranges. Patient-reported outcomes generally improved after surgery across all domains studied. Drop jump testing elucidated compensation strategies employed by these cohorts. Compensation did not fully alleviate elevated forces at the knees. Surgical intervention normalized pathokinematics and pathokinetics, reduced pain, and improved patients' perception of their functional abilities. Greater improvements were found in individuals in the two groups with FA compared to the group with TT only.
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Affiliation(s)
- Peter M Stevens
- Department of Orthopedic Surgery, University of Utah
- Primary Children's
| | | | - Bruce A MacWilliams
- Department of Orthopedic Surgery, University of Utah
- Motion Analysis Center, Shriners Children's, Salt Lake City, Utah, USA
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21
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Stergiou AN, Mattila-Rautiainen S, Varvarousis DN, Tzoufi M, Plyta P, Beris A, Ploumis A. The efficacy of Equine Assisted Therapy intervention in gross motor function, performance, and spasticity in children with Cerebral Palsy. Front Vet Sci 2023; 10:1203481. [PMID: 37649564 PMCID: PMC10464617 DOI: 10.3389/fvets.2023.1203481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/01/2023] [Indexed: 09/01/2023] Open
Abstract
Purpose To evaluate the efficacy of Equine Assisted Therapy in children with Cerebral Palsy, in terms of gross motor function, performance, and spasticity as well as whether this improvement can be maintained for 2 months after the end of the intervention. Methods Children with Cerebral Palsy participated in this prospective cohort study. The study lasted for 28 weeks, of which the equine assisted therapy lasted 12 weeks taking place once a week for 30 min. Repeated measures within the subject design were used for the evaluation of each child's physical performance and mental capacity consisting of six measurements: Gross Motor Function Measure-88 (GMFM-88), Gross Motor Performance Measure (GMPM), Gross Motor Function Classification System (GMFCS), Modified Ashworth Scale (MAS) and Wechsler Intelligence Scale for Children (WISC III). Results Statistically significant improvements were achieved for 31 children in Gross Motor Function Measure and all its subcategories (p < 0.005), also in total Gross Motor Performance Measure and all subcategories (p < 0.005). These Gross Motor Function Measure results remained consistent for 2 months after the last session of the intervention. Regarding spasticity, although an improving trend was seen, this was not found to be statistically significant. Conclusion and implications Equine Assisted Therapy improves motor ability (qualitatively and quantitatively) in children with Cerebral Palsy, with clinical significance in gross motor function.
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Affiliation(s)
- Alexandra N. Stergiou
- Division of Surgery, Department of Physical Medicine and Rehabilitation, University of Ioannina Medical School, Ioannina, Greece
- Ioannina Therapeutic Riding Center, Ioannina, Greece
| | | | | | - Meropi Tzoufi
- Division of Child’s Health, Department of Paediatrics, University of Ioannina Medical School, Ioannina, Greece
| | - Panagiota Plyta
- Division of Surgery, Department of Physical Medicine and Rehabilitation, University of Ioannina Medical School, Ioannina, Greece
- Ioannina Therapeutic Riding Center, Ioannina, Greece
| | - Alexandros Beris
- Division of Surgery, Department of Orthopaedics, University of Ioannina Medical School, Ioannina, Greece
| | - Avraam Ploumis
- Division of Surgery, Department of Physical Medicine and Rehabilitation, University of Ioannina Medical School, Ioannina, Greece
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22
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Kimoto M, Okada K, Mitobe K, Saito M, Sakamoto H. Gait velocity control using projection mapping for children with spastic diplegia cerebral palsy. Clin Biomech (Bristol, Avon) 2023; 108:106043. [PMID: 37473607 DOI: 10.1016/j.clinbiomech.2023.106043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Gait characteristics in children with cerebral palsy vary according to their individual walking speed. As such, establishing methods to maintain a consistent gait velocity are necessary to evaluate specific intervention effects in this clinical population. Our study aim was to validate the accuracy of projection mapping for guiding gait velocity to a control gait velocity. METHODS This was a cross-sectional study of 13 children with cerebral palsy (mean age [standard deviation] of 12.42 [2.31] years). The target velocity was calculated from the average speed obtained across three trials of self-selected walking speed. A virtual reality system with four projectors was used to project an image onto the floor to guide children to match two gait conditions: 100% and 125% velocity of the average speed. Participants completed three gait trials at each velocity under image guidance. Gait velocity was quantified using a 3-dimensional motion capture system. Bland-Altman plots were used to analyze systematic errors and the limits of agreement calculated. FINDINGS The results indicated the limits of agreement were acceptable for 0.10 m/s for 100% velocity and 0.12 m/s for 125% velocity. Therefore, projection mapping was effective in guiding children to adjust their gait to the intended velocity. INTERPRETATION Projection mapping is a novel method for guiding children with cerebral palsy to walk at a controlled target velocity that may improve the reliability of gait analysis.
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Affiliation(s)
- Minoru Kimoto
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan; Department of Medicine, Akita Prefectural Center on Development and Disability, Akita, Japan.
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Kazutaka Mitobe
- Akita University Graduate School of Engineering Science, Akita, Japan
| | - Masachika Saito
- Akita University Graduate School of Engineering Science, Akita, Japan
| | - Hitoshi Sakamoto
- Department of Medicine, Akita Prefectural Center on Development and Disability, Akita, Japan
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23
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Grosse L, Späh MA, Börner C, Schnabel JF, Meuche AC, Parzefall B, Breuer U, Warken B, Sitzberger A, Hösl M, Heinen F, Berweck S, Schröder SA, Bonfert MV. Addressing gross motor function by functional repetitive neuromuscular magnetic stimulation targeting to the gluteal muscles in children with bilateral spastic cerebral palsy: benefits of functional repetitive neuromuscular magnetic stimulation targeting the gluteal muscles. Front Neurol 2023; 14:1161532. [PMID: 37564737 PMCID: PMC10410564 DOI: 10.3389/fneur.2023.1161532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023] Open
Abstract
Background Impaired selective motor control, weakness and spasticity represent the key characteristics of motor disability in the context of bilateral spastic cerebral palsy. Independent walking ability is an important goal and training of the gluteal muscles can improve endurance and gait stability. Combining conventional physical excercises with a neuromodulatory, non-invasive technique like repetitive neuromuscular magnetic stimulation probably enhances effects of the treatment. This prospective study aimed to assess the clinical effects of repetitive neuromuscular magnetic stimulation in combination with a personalized functional physical training offered to children and adolescents with bilateral spastic cerebral palsy. Methods Eight participants Gross Motor Function Classification System level II and III (10.4 ± 2y5m; 50% Gross Motor Function Classification System level II) received a personalized intervention applying functional repetitive neuromuscular magnetic stimulation (12 sessions within 3 weeks; 12,600 total stimuli during each session). At baseline and follow up the following assessments were performed: 10-m-walking-test, 6-min-walking-test, GMFM-66. Six weeks after the end of treatment the patient-reported outcome measure Gait Outcome Assessment List was completed. Results GMFM-66 total score improved by 1.4% (p = 0.002), as did scoring in domain D for standing (1.9%, p = 0.109) and domain E for walking, jumping and running (2.6%, p = 0.021). Gait speed or distance walked during 6 min did not improve from baseline to follow up. Patient-reported outcome showed improvement in 4 patients in altogether 14 ratings. Caregiver-reported outcome reported benefits in 3 participants in altogether 10 ratings. Conclusion Repetitive neuromuscular magnetic stimulation promises to be a meaningful, non-invasive treatment approach for children and adolescents with bilateral spastic cerebral palsy that could be offered in a resource-efficient manner to a broad number of patients. To further investigate the promising effects of repetitive neuromuscular magnetic stimulation and its mechanisms of action, larger-scaled, controlled trials are needed as well as comprehensive neurophysiological investigations.
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Affiliation(s)
- Leonie Grosse
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Malina A. Späh
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Corinna Börner
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julian F. Schnabel
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne C. Meuche
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Barbara Parzefall
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ute Breuer
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Birgit Warken
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexandra Sitzberger
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Florian Heinen
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Steffen Berweck
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Sebastian A. Schröder
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michaela V. Bonfert
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
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24
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Santos KP, SiIva VMMD, Reis IFD, Aquino MRCD, Lana MRV, Teixeira CMMDF. Physical conditioning in children and adolescents with cerebral palsy: Systematic review and meta-analysis. J Bodyw Mov Ther 2023; 35:158-163. [PMID: 37330763 DOI: 10.1016/j.jbmt.2023.04.036] [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: 11/08/2021] [Revised: 02/01/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Cerebral palsy (CP) can be described as a group of permanent non-progressive disorders that occur in the developing fetal or infant brain. Studies have shown that children and adolescents with CP have low cardiorespiratory fitness and higher energy expenditure during daily activities when compared to typical children. Therefore, interventions focused on the physical conditioning of this population could be critical. OBJECTIVE To evaluate the effect of physical conditioning training on distance walked and maximum oxygen consumption (VO₂ max) in individuals with CP, through a systematic review. METHOD Two independent researchers performed systematic searches in the PUBMED, SciELO, PEDro, ERIC, and Cochrane databases using the search terms "physical fitness", "aerobic training" or "endurance" combined with "cerebral palsy". INCLUSION CRITERIA (1) population (children and adolescents with CP between 5 and 18 years old); (2) type of study (experimental studies); (3) type of intervention (physical conditioning protocols); (4) outcome (distance walked in the 6 min walking test - 6MWT, and VO₂ max). RESULTS 386 studies were identified and 5 articles were considered eligible. After physical conditioning training, there was an increase of 46.34 m (p = 0.07) and 5.93. ml. kg-1. min -1 (p < 0.001) in the 6MWT and VO₂ max, respectively. CONCLUSION Physical conditioning training appears to be clinically beneficial to the cardiorespiratory fitness of children and adolescents with CP.
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Affiliation(s)
- Kamilla Passini Santos
- Physiotherapist Graduated from the Newton Paiva University Center, Belo Horizonte, MG, Brazil.
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25
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Campagnini S, Pasquini G, Schlechtriem F, Fransvea G, Simoni L, Gerli F, Magaldi F, Cristella G, Riener R, Carrozza MC, Mannini A. Estimation of Spatiotemporal Gait Parameters in Walking on a Photoelectric System: Validation on Healthy Children by Standard Gait Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:6059. [PMID: 37447908 DOI: 10.3390/s23136059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
The use of stereophotogrammetry systems is challenging when targeting children's gait analysis due to the time required and the need to keep physical markers in place. For this reason, marker-less photoelectric systems appear to be a solution for accurate and fast gait analysis in youth. The aim of this study is to validate a photoelectric system and its configurations (LED filter setting) on healthy children, comparing the kinematic gait parameters with those obtained from a three-dimensional stereophotogrammetry system. Twenty-seven healthy children were enrolled. Three LED filter settings for the OptoGait were compared to the BTS P6000. The analysis included the non-parametric 80% limits of agreement and the intraclass correlation coefficient (ICC). Additionally, normalised limits of agreement and bias (NLoAs and Nbias) were compared to the clinical experience of physical therapists (i.e., assuming an error lower than 5% is acceptable). ICCs showed excellent consistency for most of the parameters and filter settings; NLoAs varied between 1.39% and 12.62%. An inverse association between the number of LEDs for filter setting and the bias values was also observed. Observations confirm the validity of the OptoGait system for the evaluation of spatiotemporal gait parameters in children.
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Affiliation(s)
| | - Guido Pasquini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
| | - Florian Schlechtriem
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Giulia Fransvea
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
| | - Laura Simoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
| | - Filippo Gerli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
| | | | | | - Robert Riener
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
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26
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Gill PK, Steele KM, Donelan JM, Schwartz MH. Causal modelling demonstrates metabolic power is largely affected by gait kinematics and motor control in children with cerebral palsy. PLoS One 2023; 18:e0285667. [PMID: 37224117 DOI: 10.1371/journal.pone.0285667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/27/2023] [Indexed: 05/26/2023] Open
Abstract
Metabolic power (net energy consumed while walking per unit time) is, on average, two-to-three times greater in children with cerebral palsy (CP) than their typically developing peers, contributing to greater physical fatigue, lower levels of physical activity and greater risk of cardiovascular disease. The goal of this study was to identify the causal effects of clinical factors that may contribute to high metabolic power demand in children with CP. We included children who 1) visited Gillette Children's Specialty Healthcare for a quantitative gait assessment after the year 2000, 2) were formally diagnosed with CP, 3) were classified as level I-III under the Gross Motor Function Classification System and 4) were 18 years old or younger. We created a structural causal model that specified the assumed relationships of a child's gait pattern (i.e., gait deviation index, GDI) and common impairments (i.e., dynamic and selective motor control, strength, and spasticity) with metabolic power. We estimated causal effects using Bayesian additive regression trees, adjusting for factors identified by the causal model. There were 2157 children who met our criteria. We found that a child's gait pattern, as summarized by the GDI, affected metabolic power approximately twice as much as the next largest contributor. Selective motor control, dynamic motor control, and spasticity had the next largest effects. Among the factors we considered, strength had the smallest effect on metabolic power. Our results suggest that children with CP may benefit more from treatments that improve their gait pattern and motor control than treatments that improve spasticity or strength.
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Affiliation(s)
- Pavreet K Gill
- Department of Biomedical Physiology & Kinesiology, Locomotion Lab, Simon Fraser University, Burnaby, BC, Canada
| | - Katherine M Steele
- Department of Mechanical Engineering, Ability and Innovation Lab, University of Washington, Seattle, WA, United States of America
| | - J Maxwell Donelan
- Department of Biomedical Physiology & Kinesiology, Locomotion Lab, Simon Fraser University, Burnaby, BC, Canada
| | - Michael H Schwartz
- Gillette Children's Specialty Healthcare, St. Paul, MN, United States of America
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States of America
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27
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Haddon M, West L, Elliott C, Walmsley C, Valentine J, Bear N, Pool D. Kindy Moves: the feasibility of an intensive interdisciplinary programme on goal and motor outcomes for preschool-aged children with neurodisabilities requiring daily equipment and physical assistance. BMJ Open 2023; 13:e068816. [PMID: 37169503 DOI: 10.1136/bmjopen-2022-068816] [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: 05/13/2023] Open
Abstract
OBJECTIVES To determine the feasibility of an intensive interdisciplinary programme in improving goal and motor outcomes for preschool-aged children with non-progressive neurodisabilities. The primary hypothesis was that the intervention would be feasible. DESIGN A single group feasibility study. SETTING An Australian paediatric community therapy provider. PARTICIPANTS Forty children were recruited. Inclusion criteria were age 2-5 years with a non-progressive neurodisability, Gross Motor Function Classification System (GMFCS) levels III-V or equivalent, and goals relating to mobility, communication and upper limb function. Exclusion criteria included orthopaedic surgery in the past 6 months, unstable hip subluxation, uncontrolled seizure disorder or treadmill training in the past month. INTERVENTION A goal-directed programme of three 2-hour sessions per week for 4 weeks (24 hours total). This consisted of treadmill and overground walking, communication practice, and upper limb tasks tailored by an interdisciplinary team. PRIMARY AND SECONDARY OUTCOME MEASURES Limited-efficacy measures from preintervention (T1) to postintervention (T2) and 4-week follow-up (T3) included the Goal Attainment Scaling (GAS), Canadian Occupational Performance Measure (COPM), Gross Motor Function Measure (GMFM-66) and 10-Metre Walk Test (10MWT). Acceptability, demand, implementation and practicality were also explored. RESULTS There were improvements at T2 compared with T1 for all limited-efficacy measures. The GAS improved at T2 (mean difference (MD) 27.7, 95% CI 25.8 to 29.5) as well as COPM performance (MD 3.2, 95% CI 2.8 to 3.6) and satisfaction (MD 3.3, 95% CI 2.8 to 3.8). The GMFM-66 (MD 2.3, 95% CI 1.0 to 3.5) and 10MWT (median difference -2.3, 95% CI -28.8 to 0.0) improved at T2. Almost all improvements were maintained at T3. Other feasibility components were also demonstrated. There were no adverse events. CONCLUSIONS An intensive interdisciplinary programme is feasible in improving goal and motor outcomes for preschool children with neurodisabilities (GMFCS III-V or equivalent). A randomised controlled trial is warranted to establish efficacy. TRIAL REGISTRATION NUMBER ACTRN12619000064101.
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Affiliation(s)
- Matthew Haddon
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Loren West
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Catherine Elliott
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Corrin Walmsley
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Jane Valentine
- Telethon Kids Institute, Perth, Western Australia, Australia
- Paediatric Rehabilitation, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Dayna Pool
- The Healthy Strides Foundation, Perth, Western Australia, Australia
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28
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Schreiber J, Wenskovitch J, Belt J, O'Donnell A, Wolf D. Clinical Outcomes of an Intensity Program for Children With Movement Challenges. Pediatr Phys Ther 2023:00001577-990000000-00053. [PMID: 37071878 DOI: 10.1097/pep.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE Physical therapists at an outpatient pediatric facility developed and implemented an Intensity Program for children with movement challenges. The program was initiated on the basis of best evidence, parent advocacy, and clinician expertise. The purpose of this investigation is to analyze outcome data gathered from the program since 2012 to determine the effect of the program along with any specific child characteristics that were more likely to lead to positive outcomes. METHODS A variety of outcome data were analyzed to compare preprogram performance with postprogram performance. RESULTS Program participants made statistically significant and clinically important improvement in most outcome measures. Parents were highly satisfied with the program, including 98% of respondents who indicated that they would like to repeat their participation in the program. CONCLUSIONS The results of this investigation suggest that many children with movement challenges are likely to benefit from participation in an Intensity Program.
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Affiliation(s)
- Joseph Schreiber
- Doctor of Physical Therapy Program (Dr Schreiber) and Health Informatics Program (Dr Wolf), Chatham University, Pittsburgh, Pennsylvania; Computer Science Program (Dr Wenskovitch), Virginia Tech, Blacksburg, Virginia; Independent Contractor Working in Early Intervention (Ms Belt); The Children's Institute of Pittsburgh (Dr O'Donnell), Pittsburgh, Pennsylvania
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Rodríguez-Costa I, Abuín-Porras V, Terán-García P, Férez-Sopeña A, Calvo-Fuente V, Soto-Vidal C, Pacheco-da-Costa S. Effectiveness of a Telecare Physical Therapy Program in Improving Functionality in Children and Adolescents with Cerebral Palsy: A Cases Study. CHILDREN 2023; 10:children10040663. [PMID: 37189912 DOI: 10.3390/children10040663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
Cerebral palsy (CP) is the most common physical disability in childhood and results in motor impairment that is often associated with other disorders. The aim of this study was to assess whether a telecare intervention consisting of Action Observation Therapy with a family-center approach produces improvements in functionality in children and adolescents with CP. Seven girls with CP ages between 6 and 17 participated in this case series study that lasted 12 weeks: 6 weeks of telecare program with a total of six sessions; and a follow-up period of 6 weeks. The outcome variables were Gross Motor Function (Spanish version of the Gross Motor Function Measure), balance (Spanish version of the Pediatric Balance Scale), walking endurance (6-min walk test) and walking speed (10-m walk test). The variables were measured before starting the study, after 6 weeks of intervention and after the 6-week follow-up period. Results showed statistically significant improvements in gross motor function (p = 0.02) after the intervention. After the follow-up period, gross motor function remained statistically significant (p = 0.02), as well as balance (p = 0.04) and walking endurance (p = 0.02). These results show that a telecare program has been beneficial in improving functionality with enhancements in gross motor function, balance and endurance in children and adolescents with CP that will facilitate participation.
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Kuroda MM, Iwasaki N, Mutsuzaki H, Yoshikawa K, Takahashi K, Nakayama T, Nakayama J, Takeuchi R, Mataki Y, Ohguro H, Tomita K. Benefits of a Wearable Cyborg HAL (Hybrid Assistive Limb) in Patients with Childhood-Onset Motor Disabilities: A 1-Year Follow-Up Study. Pediatr Rep 2023; 15:215-226. [PMID: 36976724 PMCID: PMC10057157 DOI: 10.3390/pediatric15010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Rehabilitation robots have shown promise in improving the gait of children with childhood-onset motor disabilities. This study aimed to investigate the long-term benefits of training using a wearable Hybrid Assistive Limb (HAL) in these patients. Training using a HAL was performed for 20 min a day, two to four times a week, over four weeks (12 sessions in total). The Gross Motor Function Measure (GMFM) was the primary outcome measure, and the secondary outcome measures were gait speed, step length, cadence, 6-min walking distance (6MD), Pediatric Evaluation of Disability Inventory, and Canadian Occupational Performance Measure (COPM). Patients underwent assessments before the intervention, immediately after the intervention, and at 1-, 2-, 3-month and 1-year follow-ups. Nine participants (five males, four females; mean age: 18.9 years) with cerebral palsy (n = 7), critical illness polyneuropathy (n = 1), and encephalitis (n = 1) were enrolled. After training using HAL, GMFM, gait speed, cadence, 6MD, and COPM significantly improved (all p < 0.05). Improvements in GMFM were maintained one year after the intervention (p < 0.001) and in self-selected gait speed and 6MD three months after the intervention (p < 0.05). Training using HAL may be safe and feasible for childhood-onset motor disabilities and may maintain long-term improvements in motor function and walking ability.
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Affiliation(s)
- Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Nobuaki Iwasaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Tomohiro Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Junko Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Yuki Mataki
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan
| | - Haruka Ohguro
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
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Hsieh WH, Chen YK, Lee WC, Hsieh RL. Feasibility of Family-Centered Workshops for Children Aged 18-36 Months with Language Developmental Delay. Pediatr Neurol 2023; 143:26-33. [PMID: 36989540 DOI: 10.1016/j.pediatrneurol.2023.02.018] [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] [Received: 04/16/2022] [Revised: 07/21/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Family-centered workshops' effects on children with language developmental delay remain unknown. This study assessed the feasibility of workshops for children with language developmental delay. METHODS A total of 122 children aged 18-36 months with language developmental delays and their parents participated in six sessions of 2-h family-centered multidisciplinary workshops for 6 weeks. The Mandarin-Chinese Communicative Development Inventory, Peabody Developmental Motor Scale, Emotional Competency Rating Scales, Pediatric Outcomes Data Collection Instrument, Child Health Questionnaire, Pediatric Quality of Life Inventory, Caregiver Strain Index, Impact on Family Scale, PedsQL Family Impact Module, and World Health Organization Quality of Life (QOL) were administered to the children and their parents before and after the workshop. RESULTS We found improvement of emotion (P = 0.037), upper extremity and physical function (P = 0.038), and transfer and basic mobility (P = 0.019) in children and parental QOL related to children's conditions (P = 0.049), with no effect on communication ability and QOL in children and family strain and function. We also noted more significant improvement in children with pure developmental language delay than in children with nonpure developmental language delay concerning the success rates (from delayed to normal development) for expressive vocabulary (P < 0.001) and word combination (P = 0.002). Satisfaction levels toward the workshop were high. CONCLUSIONS Family-centered workshops improved children's emotions, functional performance, and parental QOL. Although the samples were too small to test different conditions of the developmental delay, the workshops for children with language developmental delays are acceptable and feasible.
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Affiliation(s)
- Wen-Huei Hsieh
- Department of Child Care and Education, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yi-Kuang Chen
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ru-Lan Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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de Miguel-Fernández J, Lobo-Prat J, Prinsen E, Font-Llagunes JM, Marchal-Crespo L. Control strategies used in lower limb exoskeletons for gait rehabilitation after brain injury: a systematic review and analysis of clinical effectiveness. J Neuroeng Rehabil 2023; 20:23. [PMID: 36805777 PMCID: PMC9938998 DOI: 10.1186/s12984-023-01144-5] [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] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/07/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND In the past decade, there has been substantial progress in the development of robotic controllers that specify how lower-limb exoskeletons should interact with brain-injured patients. However, it is still an open question which exoskeleton control strategies can more effectively stimulate motor function recovery. In this review, we aim to complement previous literature surveys on the topic of exoskeleton control for gait rehabilitation by: (1) providing an updated structured framework of current control strategies, (2) analyzing the methodology of clinical validations used in the robotic interventions, and (3) reporting the potential relation between control strategies and clinical outcomes. METHODS Four databases were searched using database-specific search terms from January 2000 to September 2020. We identified 1648 articles, of which 159 were included and evaluated in full-text. We included studies that clinically evaluated the effectiveness of the exoskeleton on impaired participants, and which clearly explained or referenced the implemented control strategy. RESULTS (1) We found that assistive control (100% of exoskeletons) that followed rule-based algorithms (72%) based on ground reaction force thresholds (63%) in conjunction with trajectory-tracking control (97%) were the most implemented control strategies. Only 14% of the exoskeletons implemented adaptive control strategies. (2) Regarding the clinical validations used in the robotic interventions, we found high variability on the experimental protocols and outcome metrics selected. (3) With high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented a combination of trajectory-tracking and compliant control showed the highest clinical effectiveness for acute stroke. However, they also required the longest training time. With high grade of evidence and low number of participants (N = 8), assistive control strategies that followed a threshold-based algorithm with EMG as gait detection metric and control signal provided the highest improvements with the lowest training intensities for subacute stroke. Finally, with high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented adaptive oscillator algorithms together with trajectory-tracking control resulted in the highest improvements with reduced training intensities for individuals with chronic stroke. CONCLUSIONS Despite the efforts to develop novel and more effective controllers for exoskeleton-based gait neurorehabilitation, the current level of evidence on the effectiveness of the different control strategies on clinical outcomes is still low. There is a clear lack of standardization in the experimental protocols leading to high levels of heterogeneity. Standardized comparisons among control strategies analyzing the relation between control parameters and biomechanical metrics will fill this gap to better guide future technical developments. It is still an open question whether controllers that provide an on-line adaptation of the control parameters based on key biomechanical descriptors associated to the patients' specific pathology outperform current control strategies.
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Affiliation(s)
- Jesús de Miguel-Fernández
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | | | - Erik Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522AH Enschede, Netherlands
| | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Laura Marchal-Crespo
- Cognitive Robotics Department, Delft University of Technology, Mekelweg 2, 2628 Delft, Netherlands
- Motor Learning and Neurorehabilitation Lab, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Everaert L, Papageorgiou E, Van Campenhout A, Labey L, Desloovere K. The influence of ankle-foot orthoses on gait pathology in children with cerebral palsy: A retrospective study. Gait Posture 2023; 100:149-156. [PMID: 36528000 DOI: 10.1016/j.gaitpost.2022.11.063] [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] [Received: 06/23/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are frequently prescribed in children with cerebral palsy (CP) to improve their gait. Due to the heterogeneous nature of CP and contradictions among previous studies, it is important to evaluate the AFO-specific effects, as well as explore their effects on different gait patterns. RESEARCH QUESTIONS a) What are the prevalence and specific features of AFOs in children with CP? b) How do AFOs affect gait pathology in children with CP? c) What are the pattern-specific effects of AFOs in children with CP? METHODS A group of 170 patients with CP underwent a three-dimensional gait analysis with and without AFOs (either carbon fiber, rigid, flexible or hinged). The gait profile score, the gait variable scores of the hip, knee and ankle joints, non-dimensional step length and walking speed were used as outcome measures. The AFO-specific effects on the kinematic and kinetic waveforms were investigated using statistical non-parametric mapping (SnPM). Effects were considered relevant when the minimal clinically important difference (MCID) or the standard errors of measurement, for the parameters or the waveforms respectively, were exceeded. RESULTS Rigid AFOs were prescribed for more than 80 % of the children. Significant beneficial effects were observed for non-dimensional step length and walking speed. Most changes in gait indices were not considered relevant. The SnPM-analyses on the total group and specific gait patterns revealed that walking with AFOs improved the kinematic and kinetic waveforms. These effects were relevant, and were most obvious for crouch, apparent equinus and the total group. SIGNIFICANCE The use of AFOs improves gait, whether we inspect a total -and thus heterogeneous- group or focus on specific gait patterns. However, focussing on specific parameters (i.e. general gait indices) does not provide a full picture of the AFO-effects.
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Affiliation(s)
- Laure Everaert
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium.
| | - Eirini Papageorgiou
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium
| | - Anja Van Campenhout
- KU Leuven, Department of Development and Regeneration, Organ Systems, Leuven, Belgium; University Hospitals Leuven, Department of Orthopedics, Leuven, Belgium
| | - Luc Labey
- KU Leuven, Department of Mechanical Engineering, Geel, Belgium
| | - Kaat Desloovere
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium
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White H, Barney B, Augsburger S, Miller E, Iwinski H. AFOs Improve Stride Length and Gait Velocity but Not Motor Function for Most with Mild Cerebral Palsy. SENSORS (BASEL, SWITZERLAND) 2023; 23:569. [PMID: 36679366 PMCID: PMC9860799 DOI: 10.3390/s23020569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Ankle-foot orthoses (AFOs) are prescribed to children with cerebral palsy (CP) in hopes of improving their gait and gross motor activities. The purpose of this retrospective study was to examine if clinically significant changes in gross motor function occur with the use of AFOs in children and adolescents diagnosed with CP (Gross Motor Function Classification System levels I and II). Data from 124 clinical assessments were analyzed. Based on minimum clinically important difference (MCID), 77% of subjects demonstrated an increase in stride length, 45% of subjects demonstrated an increase in walking velocity, and 30% demonstrated a decrease in cadence. Additionally, 27% of the subjects demonstrated increase in gait deviation index (GDI). Deterioration in gait was evident by decreases in walking speed (5% of subjects), increases in cadence (11% of subjects), and 15% of subjects demonstrated decreases in gait deviation index. Twenty-two percent of subjects demonstrated no change in stride lengths and one participant demonstrated a decrease in stride length. However, AFOs improved Gross Motor Function Measure (GMFM) scores for a minority (10%) of children with mild CP (GMFCS level I and II), with 82-85% of subjects demonstrating no change in GMFM scores and 5-7% demonstrating decrease in GMFM scores.
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Affiliation(s)
- Hank White
- Shriners Children’s Lexington, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Brian Barney
- Division of Physical Therapy, College of Health Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536, USA
| | - Sam Augsburger
- Shriners Children’s Lexington, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Eric Miller
- Pediatric Orthotic & Prosthetic Services—Midwest, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Henry Iwinski
- Shriners Children’s Lexington, 110 Conn Terrace, Lexington, KY 40508, USA
- Department of Orthopaedic Surgery, University of Kentucky, 740 S Limestone St., Room K423, Lexington, KY 40536, USA
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Is Standing Function Improved After Orthopaedic Surgery in Children With Cerebral Palsy at GMFCS Levels III/IV? J Pediatr Orthop 2023; 43:e48-e53. [PMID: 36240672 DOI: 10.1097/bpo.0000000000002276] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) levels III/IV are at risk for losses in standing function during adolescence and transition to adulthood. Multilevel surgery (MLS) is an effective treatment to improve gait, but its effects on standing function are not well documented. The objectives of our study were to describe standing function in children with CP classified as GMFCS levels III/IV and evaluate change after MLS. METHODS This retrospective study included children with CP (GMFCS III/IV) ages 6 to 20 years who underwent instrumented gait analysis. A subset who underwent MLS were evaluated for change. Primary outcome measures were Gross Motor Function Measure dimension D, gait velocity, functional mobility scale, and the Pediatric Outcomes Data Collection Instrument (PODCI). Additional impairment level measures included foot pressure, knee extension during stance phase of gait, and knee extension passive range of motion. RESULTS Four hundred thirty-seven instrumented gait analysis sessions from 321 children with CP (ages 13.7±4.8 y; GMFCS III-81%/IV-19%) were included. The GMFCS III group had higher Gross Motor Function Measure dimension D, gait velocity, PODCI scores, and better knee extension compared with the GMFCS IV group ( P <0.05); 94 MLS were evaluated for postoperative change 15.3±4.2 months after MLS. Children at GMFCS level III had improved PODCI scores ( P <0.05), better knee extension passive range of motion ( P <0.01), and improved coronal plane foot pressure ( P <0.05) post MLS. Maximum knee extension during stance and heel impulse improved significantly in both groups ( P <0.01). CONCLUSIONS Standing function of children with CP at GMFCS IV was significantly more limited than at GMFCS III. After MLS, both groups (III/IV) showed improvement in impairment level outcomes (knee extension and foot position), whereas only those functioning at GMFCS III had improvement in activity/participation outcomes according to the PODCI. For children with CP at GMFCS levels IV, MLS may improve standing function, but appropriate goals related to assisted standing and measurement protocols sensitive to limited functional mobility should be adopted. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Chu SY, Lin YC, Weng CY, Liang CC. The effects of rehabilitation on functional independence of Eastern Taiwanese children with rare or genetic diseases. Tzu Chi Med J 2023. [PMID: 37545798 PMCID: PMC10399839 DOI: 10.4103/tcmj.tcmj_170_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Objectives This study investigated the effects of outpatient rehabilitation therapy (RT) on the functional performance of children from Eastern Taiwan with rare or genetic diseases. Materials and Methods This retrospective observational cohort study included 73 children from Eastern Taiwan who were affected with rare or genetic diseases, with an average age of 8.57 ± 5.33 years (47 boys and 26 girls). Each child received the goal-directed therapy known as outpatient RT, which was delivered by a multidisciplinary team of specialists. To assess the effectiveness of RT, the WeeFIM-C questionnaire data were collected and analyzed. Results After receiving outpatient RT, most of the children only required low-to-moderate assistance with self-care tasks (4.36 ± 2.38), and they could perform mobility-related activities under supervision or independently (5.70 ± 2.29). Moreover, most only required minimal assistance with tasks related to cognitive functioning and tended to complete such tasks under supervision (4.97 ± 2.05). The functional performance was significantly different among three studied groups, in terms of self-care (F[2, 68] = 5.42, P < 0.007), mobility (F[2, 68] = 8.17, P < 0.001), cognitive functioning (F[2, 68] = 3.31, P < 0.042), and overall (F[2, 68] = 6.44, P < 0.003) functional performance. Conclusion The results of this study demonstrated that the functional status was different among three studied groups in terms of self-care, mobility, and cognitive functioning after receiving outpatient RT.
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Sun JM, Case LE, McLaughlin C, Burgess A, Skergan N, Crane S, Jasien JM, Mikati MA, Troy J, Kurtzberg J. Motor function and safety after allogeneic cord blood and cord tissue-derived mesenchymal stromal cells in cerebral palsy: An open-label, randomized trial. Dev Med Child Neurol 2022; 64:1477-1486. [PMID: 35811372 PMCID: PMC9796267 DOI: 10.1111/dmcn.15325] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 01/31/2023]
Abstract
AIM To evaluate safety and motor function after treatment with allogeneic umbilical cord blood (AlloCB) or umbilical cord tissue-derived mesenchymal stromal cells (hCT-MSC) in children with cerebral palsy (CP). METHOD Ninety-one children (52 males, 39 females; median age 3 years 7 months [range 2-5 years]) with CP due to hypoxic-ischemic encephalopathy, stroke, or periventricular leukomalacia were randomized to three arms: (1) the AlloCB group received 10 × 107 AlloCB total nucleated cells (TNC) per kilogram at baseline (n = 31); (2) the hCT-MSC group received 2 × 106 hCT-MSC at baseline, 3 months, and 6 months (n = 28); (3) the natural history control group received 10 × 107 AlloCB TNC per kilogram at 12 months (n = 31). Motor function was assessed with the Gross Motor Function Measure-66 (GMFM-66) and Peabody Developmental Motor Scale, Second Edition. RESULTS Infusions (n = 143) were well tolerated, with eight infusion reactions (three in the AlloCB group, five in hCT-MSC) and no other safety concerns. At 12 months, the mean differences (95% confidence intervals [CI]) between actual and expected changes in GMFM-66 score were AlloCB 5.8 points (3.4-8.2), hCT-MSC 4.3 (2.2-6.4), and natural history 3.1 (1.4-5.0). In exploratory, post hoc analysis, the mean GMFM-66 score (95% CI) of the hCT-MSC group was 1.4 points higher than natural history (-1.1 to 4.0; p = 0.27), and the AlloCB group was 3.3 points higher than natural history (0.59-5.93; p = 0.02) after adjustment for baseline Gross Motor Function Classification System level, GMFM-66 score, and etiology. INTERPRETATION High-dose AlloCB is a potential cell therapy for CP and should be further tested in a randomized, blinded, placebo-controlled trial. WHAT THIS PAPER ADDS Unrelated donor allogeneic umbilical cord blood (AlloCB) and human umbilical cord tissue-derived mesenchymal stromal cell infusion is safe in young children with cerebral palsy. Significant changes in motor function were not observed 6 months after treatment. One year later, treatment with AlloCB was associated with greater increases in Gross Motor Function Measure-66 scores.
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Affiliation(s)
- Jessica M. Sun
- Marcus Center for Cellular CuresDuke University School of MedicineDurhamNCUSA
| | - Laura E. Case
- Department of Physical and Occupational TherapyDuke University School of MedicineDurhamNCUSA
| | - Colleen McLaughlin
- Marcus Center for Cellular CuresDuke University School of MedicineDurhamNCUSA
| | - Alicia Burgess
- Marcus Center for Cellular CuresDuke University School of MedicineDurhamNCUSA
| | - Natalie Skergan
- Marcus Center for Cellular CuresDuke University School of MedicineDurhamNCUSA
| | - Sydney Crane
- Marcus Center for Cellular CuresDuke University School of MedicineDurhamNCUSA
| | - Joan M. Jasien
- Division of Pediatric NeurologyDuke University School of MedicineDurhamNCUSA
| | - Mohamad A. Mikati
- Division of Pediatric NeurologyDuke University School of MedicineDurhamNCUSA
| | - Jesse Troy
- Marcus Center for Cellular CuresDuke University School of MedicineDurhamNCUSA,Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNCUSA
| | - Joanne Kurtzberg
- Marcus Center for Cellular CuresDuke University School of MedicineDurhamNCUSA
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Feasibility of Functional Repetitive Neuromuscular Magnetic Stimulation (frNMS) Targeting the Gluteal Muscle in a Child with Cerebral Palsy: A Case Report. Phys Occup Ther Pediatr 2022; 43:338-350. [PMID: 37016574 DOI: 10.1080/01942638.2022.2138732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Motor impairment due to spasticity, weakness, and insufficient selective motor control is a key feature of cerebral palsy (CP). For standing and walking, the gluteal muscles play an important role. Physical therapy represents an evidence-based treatment to promote strength and endurance but may be limited to address selective motor control. Treatment incorporating neurostimulating techniques may increase the therapeutic benefits in these situations. PURPOSE The aim of this case report was to evaluate the feasibility, safety and clinical effects of a customized protocol of functional repetitive neuromuscular magnetic stimulation (frNMS). METHODS This case report describes a frNMS protocol applied to the gluteal muscles in an 8-year old boy with bilateral spastic CP. The protocol combines 12 sessions of customized physiotherapeutic exercises with simultaneous electromagnetic stimulation. RESULTS frNMS protocol was adhered to as planned, no relevant adverse events were observed. At day fourafter the intervention the patient reported clinical benefits and improvements of standing and walking assessed by Gross Motor Function Measure dimensions D (+5.1%) and E (+4.2%) were documented. Body sway as measured by center of pressure displacement during posturography decreased. CONCLUSION Clinical studies are warranted to assess effects of frNMS and its mechanisms of action in a controlled setting.
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Kikuchi H, Saitoh S, Tsuno T, Hosoda R, Baba N, Wang F, Mitsuda N, Tsuda M, Maeda N, Sagara Y, Fujieda M. Safety and feasibility of autologous cord blood infusion for improving motor function in young children with cerebral palsy in Japan: A single-center study. Brain Dev 2022; 44:681-689. [PMID: 36050140 DOI: 10.1016/j.braindev.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is the most prevalent motor disorder of childhood. It typically results from in utero or perinatal brain injury. Recently, it has been reported that autologous cord blood (ACB) infusion for children with CP improved gross motor function and brain connectivity, but unfortunately, it has never been tried in Japan. We conducted a pilot study of the infusing of ACB, which was delivered from private bank, in the children with CP to assess the safety and feasibility to the procedure as well as any effect in improving neurological function. METHODS After demonstrating the induction of tissue regeneration in animal model studies conducted a single-arm pilot study of intravenous ACB infusion in 6 young Japanese children with CP (ages 1-6 years). Primary outcomes were safety assessed by vital signs, clinical symptoms, and blood and urinary examinations at baseline and 1 weeks, 1, 2 and 3 years after treatment. In addition, motor function evaluations, neurodevelopmental examinations, magnetic resonance imaging, and electroencephalography (EEG) were performed at the same time. RESULTS Infusion was generally well-tolerated, although one patient experienced microhematuria 1 year after treatment and another one patient experienced febrile convulsion once 9 months after treatment. These events were transient, no relapse was seen during observation study. All patients improved a median of 6.8 points on the 1-year Gross Motor Functional Measure-66 (GMFM-66) scores, greater than predicted by age and severity. Furthermore, the 2-year and 3-year GMFM-66 scores were also greater than expected (median 6.2 points and 5.5 points, respectively). Overall scales and language-social scales of the developmental quotient (DQ) improved in 3 of 6 patients, who had greater changes in their GMFM-66 scores than the other cases after treatment. There were no significant correlations among the GMFM-66 scores, DQ, and infusion cell counts. CONCLUSION ACB infusion was safe and feasible for clinical use in patients with CP. However, much more clinical study with larger numbers of patients and in-depth studies of treatment mechanism of CP are needed.
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Affiliation(s)
- Hiroaki Kikuchi
- Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan; Regenerative Medicine Research Center for Cerebral Palsy, Kochi Medical School Hospital, Kochi, Japan
| | - Shiho Saitoh
- Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan; Regenerative Medicine Research Center for Cerebral Palsy, Kochi Medical School Hospital, Kochi, Japan
| | - Terumasa Tsuno
- Department of Transfusion Medicine and Cell Therapy, Kochi Medical School Hospital, Kochi, Japan
| | - Rina Hosoda
- Rehabilitation Department, Kochi Medical School Hospital, Kochi, Japan
| | - Nobuyasu Baba
- Center for Innovative and Translational Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Feifei Wang
- Center for Innovative and Translational Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naomi Mitsuda
- Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Masayuki Tsuda
- Center for Innovative and Translational Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Nagamasa Maeda
- Regenerative Medicine Research Center for Cerebral Palsy, Kochi Medical School Hospital, Kochi, Japan; Center for Innovative and Translational Medicine, Kochi Medical School, Kochi University, Kochi, Japan; Department of Obstetrics and Gynecology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yusuke Sagara
- Center for Innovative and Translational Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan; Regenerative Medicine Research Center for Cerebral Palsy, Kochi Medical School Hospital, Kochi, Japan.
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Rast FM, Aschwanden S, Werner C, Demkó L, Labruyère R. Accuracy and comparison of sensor-based gait speed estimations under standardized and daily life conditions in children undergoing rehabilitation. J Neuroeng Rehabil 2022; 19:105. [PMID: 36195950 PMCID: PMC9531434 DOI: 10.1186/s12984-022-01079-3] [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: 11/18/2021] [Accepted: 09/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background Gait speed is a widely used outcome measure to assess the walking abilities of children undergoing rehabilitation. It is routinely determined during a walking test under standardized conditions, but it remains unclear whether these outcomes reflect the children's performance in daily life. An ankle-worn inertial sensor provides a usable opportunity to measure gait speed in the children's habitual environment. However, sensor-based gait speed estimations need to be accurate to allow for comparison of the children's gait speed between a test situation and daily life. Hence, the first aim of this study was to determine the measurement error of a novel algorithm that estimates gait speed based on data of a single ankle-worn inertial sensor in children undergoing rehabilitation. The second aim of this study was to compare the children’s gait speed between standardized and daily life conditions. Methods Twenty-four children with walking impairments completed four walking tests at different speeds (standardized condition) and were monitored for one hour during leisure or school time (daily life condition). We determined accuracy by comparing sensor-based gait speed estimations with a reference method in both conditions. Eventually, we compared individual gait speeds between the two conditions. Results The measurement error was 0.01 ± 0.07 m/s under the standardized and 0.04 ± 0.06 m/s under the daily life condition. Besides, the majority of children did not use the same speed during the test situation as in daily life. Conclusion This study demonstrates an accurate method to measure children's gait speed during standardized walking tests and in the children's habitual environment after rehabilitation. It only requires a single ankle sensor, which potentially increases wearing time and data quality of measurements in daily life. We recommend placing the sensor on the less affected side, unless the child wears one orthosis. In this latter case, the sensor should be placed on the side with the orthosis. Moreover, this study showed that most children did not use the same speed in the two conditions, which encourages the use of wearable inertial sensors to assess the children's walking performance in their habitual environment following rehabilitation. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01079-3.
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Affiliation(s)
- Fabian Marcel Rast
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland. .,Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Seraina Aschwanden
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Charlotte Werner
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - László Demkó
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Rob Labruyère
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Duong T, Kishnani PS, An Haack K, Foster MC, Gibson JB, Wilson C, Hahn SH, Hillman R, Kronn D, Leslie ND, Peña LD, Sparks SE, Stockton DW, Tanpaiboon P, Day JW. Motor Responses in Pediatric Pompe Disease in the ADVANCE Participant Cohort. J Neuromuscul Dis 2022; 9:713-730. [DOI: 10.3233/jnd-210784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: ADVANCE (NCT01526785) presented an opportunity to obtain a more nuanced understanding of motor function changes in treatment-experienced children with Pompe disease receiving 4000L-production-scale alglucosidase alfa for 52 weeks. Objective: To estimate minimal detectable change (MDC) and effect size on Gross Motor Function Measure-88 (GMFM-88) after 52 weeks of 4000L alglucosidase alfa (complete data N = 90). Methods: The GMFM-88 mean total % score changes, MDC, and effect size were analyzed post hoc by Pompe Motor Function Level at enrollment, age groups at enrollment, and fraction of life on pre-study 160L-production-scale alglucosidase alfa. Results: Overall, participants aged < 2 years surpassed MDC at Week 52 (change [mean±standard deviation] 21.1±14.1, MDC range 5.7–13.3, effect size 1.1), whereas participants aged≥2 years did not attain this (change –0.9±15.3, MDC range 10.8–25.2, effect size –0.03). In participants aged < 2 years, improvements surpassed the MDC for walkers (change 17.1±13.3, MDC range 3.0–6.9, effect size 1.7), supported standers (change 35.2±18.0, MDC range 5.9–13.7, effect size 1.8) and sitters (change 24.1±12.1, MDC range 2.6–6.2, effect size 2.7). Age-independent MDC ranges were only attained by walkers (change 7.7±12.3, MDC range 6.4–15.0, effect size 0.4) and sitters (change 9.9±17.2, MDC range 3.3–7.7, effect size 0.9). Conclusions: These first GMFM-88 minimal-detectable-change estimates for alglucosidase alfa-treated Pompe disease offer utility for monitoring motor skills. Trial registration: ClinicalTrials.gov; NCT01526785; Registered 6 February 2012; https://clinicaltrials.gov/ct2/show/NCT01526785
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Affiliation(s)
- Tina Duong
- Department of Neurology, Division of Neuromuscular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Priya S. Kishnani
- Department of Pediatrics, Duke University Medical Center, GSRB1, Durham, NC, USA
| | | | | | - James B. Gibson
- Clinical and Metabolic Genetics, DellChildren’s Medical Group, Barbara Jordan Boulevard, Suite, Austin, TX, USA
| | | | - Si Houn Hahn
- Departments of Pediatrics and Medicineand Biochemical Genetics Program, Seattle Children’s Hospital/University of Washington, Sand Point Way, MB, Seattle, WA, USA
| | - Richard Hillman
- University of Missouri Child Health, Hospital Drive, Columbia, MO, USA
| | - David Kronn
- Departments of Pathology and Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Nancy D. Leslie
- Division of Human Genetics, Cincinnati Children’sHospital Medical Center, MC, Cincinnati, OH, USA
| | - Loren D.M. Peña
- Department of Pediatrics, Duke University Medical Center, GSRB1, Durham, NC, USA
- Current address: Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, MC, Cincinnati, OH, USA
- Current address: University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - David W. Stockton
- Division of Genetic, Genomic, and Metabolic Disorders, Central Michigan University and Children’s Hospital ofMichigan, Detroit, MI, USA
| | - Pranoot Tanpaiboon
- Rare Disease Institute, Children’s National Hospital, Michigan Avenue NW, Washington, DC, USA
- Current address: Division of Medical Genetics, Child Health Research Center, Torrance, CA, USA
| | - John W. Day
- Department of Neurology, Division of Neuromuscular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Maintenance of Functional Gains Following a Goal-Directed and FES-Assisted Cycling Program for Children With Cerebral Palsy. Pediatr Phys Ther 2022; 34:480-487. [PMID: 36067381 DOI: 10.1097/pep.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated whether the functional improvements associated with functional electrical stimulation-assisted cycling, goal-directed training, and adapted cycling in children with cerebral palsy were maintained 8 weeks after the intervention ceased. METHODS The intervention (2 × 1-hour supervised sessions and 1-hour home program/week) ran for 8 weeks. Primary outcomes were the Gross Motor Function Measure (GMFM-88) and the Canadian Occupational Performance Measure (COPM). Secondary outcomes included the GMFM-66 and goal scores, 5 times sit-to-stand test (FTSTS), Participation and Environment Measure-Children and Youth (PEM-CY), Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT), and cycling power output (PO). Outcomes were assessed at baseline, 8 and 16 weeks. RESULTS Twenty children participated (mean age = 10 years 3 months; SD = 2 years 11 months; Gross Motor Function Classification System II = 5, III = 6, and IV = 9). Improvements were retained above baseline at 16 weeks on the GMFM and COPM. Improvements in cycling PO, PEDI-CAT scores, PEM-CY environmental barriers and FTSTS were also retained. CONCLUSION Functional improvements in children with cerebral palsy were retained 8 weeks post-intervention.
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Guinet AL, Bouyer G, Otmane S, Desailly E. Visual Feedback in Augmented Reality to Walk at Predefined Speed Cross-Sectional Study Including Children With Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng 2022; 30:2322-2331. [PMID: 35951576 DOI: 10.1109/tnsre.2022.3198243] [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: 11/09/2022]
Abstract
In an augmented reality environment, the range of possible real-time visual feedback is extensive. This study aimed to compare the impact of six scenarios in augmented reality combining four visual feedback characteristics on achieving a target walking speed. The six scenarios have been developed for Microsoft Hololens augmented reality headset. The four feedback characteristics that we have varied were: Color; Spatial anchoring; Speed of the feedback, and Persistence. Each characteristic could have different values (for example, the color could be unicolor, bicolor, or gradient). Participants had to walk for two consecutive walking trials for each scenario: at their maximal speed and an intermediate speed. Mean speed, percentage of time spent above or around target speed, and time to reach target speed were compared between scenarios using mixed linear models. A total of 25 children with disabilities have been included. The feasibility and user experience were excellent. Mean speed during scenario 6, which displayed feedback with gradient color, attached to the world, with a speed relative to the player equal to his speed, and that disappeared over time, was significantly higher than other scenarios and control (p =0.003). Participants spent 80.98% of time above target speed during scenario 6. This scenario mixed the best combination of feedback characteristics to exceed the target walking speed (p=0.0058). Scenarios 5 and 6, which shared the same feedback characteristics for spatial anchoring (world-locked) and feedback speed (equal to the player speed), decreased the time to reach the target speed (p=0.019). Delivering multi-modal feedback has been recognized as more effective for improving motor performance. Therefore, our results showed that not all visual feedback had the same impact on performance. Further studies are required to test the weight of each feedback characteristic and their possible interactions inside each scenario. This study was registered in the ClinicalTrials.gov database (NCT04460833).
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Wessel LE, Goldfarb CA, Vuillermin C, Hutchinson DT, Bohn D, Steinman S, Wall LB. The Impact of Isolated Versus Multiple Osteochondromas: Analysis of the CoULD Registry. J Pediatr Orthop 2022; 42:387-392. [PMID: 35749762 DOI: 10.1097/bpo.0000000000002167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The burden of upper extremity (UE) osteochondromas on function and self-perception among pediatric patients is unclear. The purpose of our study was to study the impact of osteochondromas in comparison to population norms and to evaluate solitary versus multiple osteochondromas on subjective UE function as measured by patient rated outcomes. METHODS We utilized the CoULD (Congenital Upper Limb Differences) Registry to review all pediatric patients presenting with osteochondromas between January 2014 and February 2021. Demographic information was collected and patients were classified as having either single or multiple osteochondromas. Patient-Reported Outcome Measurement Information System (PROMIS) and Pediatric Outcomes Data Collection Instrument (PODCI) tools were utilized for assessment. Scores for PODCI subscales of UE function, Pain/comfort, and Happiness and PROMIS domains of UE Function, Pain, Depression, Anxiety, and Peer Relations were reviewed. Differences between groups were analyzed using the Student t test. RESULTS Ninety-nine patients met inclusion criteria for the study with an average age of presentation of 9.3 years and 61 patients (62%) were male. Overall, patients demonstrated worse UE Function as well as greater Anxiety and Depression in comparison to the population normals on PROMIS assessment. Patients also demonstrated worse patient and parent reported PODCI UE, Sports and Physical Functioning, Pain/Comfort and Global Functioning scores compared with population norms but demonstrated better than average happiness scores. Patients with multiple osteochondromas demonstrated greater PROMIS pain interference and more disability in PODCI Sports and Physical Functioning, Pain/Comfort and Global Functioning compared with those with solitary osteochondromas. CONCLUSION Patients with UE osteochondromas have worse overall function in comparison to population norms, exceeding established minimally clinically important difference values. In addition, patients with multiple osteochondromas reported more pain and poorer physical function than those with solitary osteochondromas. Physicians should be alert to the physical and psychosocial burden of this disease. LEVEL OF EVIDENCE Level II-prognostic.
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Affiliation(s)
- Lauren E Wessel
- Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, CA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Carley Vuillermin
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
| | | | - Deborah Bohn
- Department of Orthopedics, Gillette Children's Specialty Healthcare, Saint Paul, MN
| | - Suzanne Steinman
- Department of Orthopedic Surgery, Seattle Children's Hospital, Seattle, WA
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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Jensen-Willett S, Cunha A, Lobo MA, Harbourne R, Dusing SC, McCoy SW, Koziol NA, Hsu LY, Marcinowski EC, Babik I, An M, Bovaird JA. The Effect of Early-Life Seizures on Cognitive and Motor Development: A Case Series. Pediatr Phys Ther 2022; 34:425-431. [PMID: 35703307 DOI: 10.1097/pep.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This case series documents developmental changes over time and in response to a novel intervention, Sitting Together and Reaching to Play (START-Play), in children with early-life seizures. METHODS Thirteen children with early-life seizures were included from a subset of participants in the START-Play multisite, randomized controlled trial. Seven received 3 months of twice weekly START-Play intervention; 6 continued with usual care early intervention. Bayley Scales of Infant Development-III (Cognitive Composite), Gross Motor Function Measure-66 Item Set, Assessment of Problem-Solving in Play, and reaching assessments were administered at baseline, 3, 6, and 12 months postbaseline. Change scores are reported at 3 and 12 months postbaseline. RESULTS Over time, plateau or decline was noted in standardized cognition measures; motor development improved or was stable. Children receiving START-Play showed positive trends in problem-solving (71.4%) and reaching behaviors (57.2%). CONCLUSIONS Interventions such as START-Play that combine motor and cognitive constructs may benefit children with early-life seizures.
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Affiliation(s)
- Sandra Jensen-Willett
- Department of Physical Therapy (Dr Willett), Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska; Department of Physical Therapy (Drs Cunha and Lobo), Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware; Department of Physical Therapy (Dr Harbourne), Duquesne University, Pittsburgh, Pennsylvania; Division of Biokinesiology and Physical Therapy (Dr Dusing), University of Southern California, Los Angeles CA; Department of Rehabilitation Medicine (Drs Westcott-McCoy and Hsu), University of Washington, Seattle, Washington; Nebraska Center for Research on Children, Youth, Families and Schools (Drs Koziol and Bovaird), University of Nebraska-Lincoln, Lincoln, Nebraska; College of Human Science and Education (Dr Marcinowski), Louisiana State University, Baton Rouge, Louisiana; Department of Psychological Science (Dr Babik), Boise State University, Boise, Idaho; Department of Physical Therapy (Dr An), Kaya University, Gimhae-si, Gyeongsangnam-do, Republic of Korea
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Smati S, Pouliot-Laforte A, Chevalier M, Lemay M, Ballaz L. Effect of power training on locomotion capacities in children with cerebral palsy with GMFCS level III-IV. Disabil Rehabil 2022:1-7. [PMID: 35737476 DOI: 10.1080/09638288.2022.2090623] [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 Power training (PT) is a promising training modality to improve functional abilities in children with cerebral palsy (CP). This study aimed to implement PT in an adapted school and to assess its effect on locomotion capacities in children with Gross Motor Function Classification System (GMFCS) level III-IV. MATERIALS AND METHODS Nine children with CP (GMFCS level III-IV) were trained three times/week for 12 weeks. The training sessions took place during the 50-minute physical activity classes and included high intensity exercise. The outcome measures were the performance on the 10-meter comfortable and fast walking tests, the 50-meter sprint test (50M-ST), and the energy expenditure index (EEI). RESULTS Participants spent 12 ± 7 and 7 ± 9 min per session at an intensity superior to 40% and 60% of the heart rate reserve, respectively. Performance in the 10-meter walking test (13.5 ± 7.8 to 9.9 ± 4.6 s, p < 0.05), the 10-meter fast walking test (8.8 ± 3.1 to 7.0 ± 3.2 s, p < 0.05), the 6-minute walking exercise (199.0 ± 48.6 to 316.6 ± 107.2 m, p < 0.05), and in 50M-ST (53.8 ± 29.5 to 42.3 ± 16.2 s, p < 0.05) increased after training. The EEI was reduced after training (p = 0.01), resulting in a more efficient gait. CONCLUSIONS PT was successfully implemented in children with CP with GMFCS level III-IV. Results suggest that PT increases walking capacities.Implications for rehabilitationPower training (PT) is feasible with children with bilateral cerebral palsy with GMFCS level III and IV.Physical education course in specialist school is a valuable environment to implement PT in children with poor gross motor function.Power training results in locomotion capacities improvement.
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Affiliation(s)
- Sofia Smati
- Department of Physical Activity Sciences, UQAM, Montreal, Canada.,Sainte-Justine UHC Research Center, Montreal, Canada
| | - Annie Pouliot-Laforte
- Department of Physical Activity Sciences, UQAM, Montreal, Canada.,Sainte-Justine UHC Research Center, Montreal, Canada
| | | | - Martin Lemay
- Department of Physical Activity Sciences, UQAM, Montreal, Canada.,Sainte-Justine UHC Research Center, Montreal, Canada.,Groupe de Recherche en Activité Physique Adaptée (GRAPA), Montreal, Canada
| | - Laurent Ballaz
- Department of Physical Activity Sciences, UQAM, Montreal, Canada.,Sainte-Justine UHC Research Center, Montreal, Canada.,Groupe de Recherche en Activité Physique Adaptée (GRAPA), Montreal, Canada
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Cox CS, Juranek J, Kosmach S, Pedroza C, Thakur N, Dempsey A, Rennie K, Scott MC, Jackson M, Kumar A, Aertker B, Caplan H, Triolo F, Savitz SI. Autologous cellular therapy for cerebral palsy: a randomized, crossover trial. Brain Commun 2022; 4:fcac131. [PMID: 35702731 PMCID: PMC9188321 DOI: 10.1093/braincomms/fcac131] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022] Open
Abstract
We examined an autologous mononuclear-cell-therapy-based approach to treat cerebral palsy using autologous umbilical cord blood or bone-marrow-derived mononuclear cells. The primary objective was to determine if autologous cells are safe to administer in children with cerebral palsy. The secondary objectives were to determine if there was improvement in motor function of patients 12 months after infusion using the Gross Motor Function Measure and to evaluate impact of treatment on corticospinal tract microstructure as determined by radial diffusivity measurement. This Phase 1/2a trial was a randomized, blinded, placebo-controlled, crossover study in children aged 2-10 years of age with cerebral palsy enrolled between November 2013 and November 2016. Participants were randomized to 2:1 treatment:placebo. Treatment was either autologous bone-marrow-derived mononuclear cells or autologous umbilical cord blood. All participants who enrolled and completed their baseline visit planned to return for follow-up visits at 6 months, 12 months and 24 months after the baseline visit. At the 12-month post-treatment visit, participants who originally received the placebo received either bone-marrow-derived mononuclear cell or umbilical cord blood treatment. Twenty participants were included; 7 initially randomized to placebo, and 13 randomized to treatment. Five participants randomized to placebo received bone-marrow-derived mononuclear cells, and 2 received umbilical cord blood at the 12-month visit. None of the participants experienced adverse events related to the stem cell infusion. Cell infusion at the doses used in our study did not dramatically alter motor function. We observed concordant bilateral changes in radial diffusivity in 10 of 15 cases where each corticospinal tract could be reconstructed in each hemisphere. In 60% of these cases (6/10), concordant decreases in bilateral corticospinal tract radial diffusivity occurred post-treatment. In addition, 100% of unilateral corticospinal tract cases (3/3) exhibited decreased corticospinal tract radial diffusivity post-treatment. In our discordant cases (n = 5), directionality of changes in corticospinal tract radial diffusivity appeared to coincide with handedness. There was a significant improvement in corticospinal tract radial diffusivity that appears related to handedness. Connectivity strength increased in either or both pathways (corticio-striatal and thalamo-cortical) in each participant at 12 months post-treatment. These data suggest that both stem cell infusions are safe. There may be an improvement in myelination in some groups of patients that correlate with small improvements in the Gross Motor Function Measure scales. A larger autologous cord blood trial is impractical at current rates of blood banking. Either increased private banking or matched units would be required to perform a larger-scale trial.
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Affiliation(s)
- Charles S. Cox
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Program in Pediatric Regenerative Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jenifer Juranek
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Program in Pediatric Regenerative Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Steven Kosmach
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Nivedita Thakur
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Allison Dempsey
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Kimberly Rennie
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Department of Neuropsychology, NeuroBehavioral Health, Milwaukee, WI, USA
| | - Michael C. Scott
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Margaret Jackson
- Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Akshita Kumar
- Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Benjamin Aertker
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Henry Caplan
- Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Fabio Triolo
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Program in Pediatric Regenerative Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Sean I. Savitz
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Hurd C, Livingstone D, Brunton K, Smith A, Gorassini M, Watt MJ, Andersen J, Kirton A, Yang JF. Early, Intensive, Lower Extremity Rehabilitation Shows Preliminary Efficacy After Perinatal Stroke: Results of a Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:360-370. [PMID: 35427191 PMCID: PMC9127938 DOI: 10.1177/15459683221090931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Perinatal stroke injures motor regions of the brain, compromising movement for life. Early, intensive, active interventions for the upper extremity are efficacious, but interventions for the lower extremity remain understudied. Objective To determine the feasibility and potential efficacy of ELEVATE—Engaging the Lower Extremity Via Active Therapy Early—on gross motor function. Methods We conducted a single-blind, two-arm, randomized controlled trial (RCT), with the Immediate Group receiving the intervention while the Delay Group served as a 3-month waitlist control. A separate cohort living beyond commuting distance was trained by their parents with guidance from physical therapists. Participants were 8 months to 3 years old, with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. The intervention was play-based, focused on weight-bearing, balance and walking for 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure-66 (GMFM-66). Secondary outcomes included steps and gait analyses. Final follow-up occurred at age 4. Results Thirty-four children participated (25 RCT, 9 Parent-trained). The improvement in GMFM-66 over 12 weeks was greater for the Immediate than the Delay Group in the RCT (average change 3.4 units higher) and greater in younger children. Average step counts reached 1370-3750 steps/session in the last week of training for all children. Parent-trained children also improved but with greater variability. Conclusions Early, activity-intensive lower extremity therapy for young children with perinatal stroke is feasible and improves gross motor function in the short term. Longer term improvement may require additional bouts of intervention. Clinical trial registration This study was registered at ClinicalTrials.gov (NCT01773369).
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Affiliation(s)
- Caitlin Hurd
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Donna Livingstone
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Kelly Brunton
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Allison Smith
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Monica Gorassini
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Man-Joe Watt
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - John Andersen
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Adam Kirton
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Jaynie F. Yang
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Saisongcroh T, Shrader MW, Lennon N, Church C, Sees JP, Miller F. Residual Deformity and Outcome of Ambulatory Adults With Cerebral Palsy: A Long-term Longitudinal Assessment. J Pediatr Orthop 2022; 42:215-221. [PMID: 35067603 DOI: 10.1097/bpo.0000000000002057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Advances in pediatric orthopaedic care have improved mobility and function for children with cerebral palsy (CP) as mobility declines from adolescence into adulthood. The long-term effectiveness of modern orthopaedic care is not widely reported. This study aimed to report the pediatric orthopaedic surgical burden, residual deformities, and outcomes using objective evidence of mobility in ambulatory adults with CP. METHODS An institutional review board-approved prospective cohort study was performed in ambulatory adults with CP between 25 and 45 years, who had an adolescent gait analysis. Orthopaedic interventions were reviewed, and adolescent and adult gait analyses were compared using paired 2-tailed t tests. Adults were categorized by the presence of no, mild, or severe residual deformities in rotation, crouch, stiff knee, equinus, and foot deformity. RESULTS Of 106 adults with CP, Gross Motor Function Classification System (GMFCS) distribution was grade I (22%), II (50%), III (23%), and IV (5%). Sixty-one males and 45 females were tested. The average age was 30±4 years with follow-up of 13±4 years since previous analysis; 279 surgical events (1165 procedures) were performed with a mean per patient of 2.6 events and 11 procedures. Comm on procedures were gastrocsoleus complex (88%) and hamstring lengthening (79%). The mean gait deviation index at adolescent and adult visit were 72.7±13 and 72.3±13 (P=0.78). Mean gait velocity at the adolescent visit was 85±27 and 79±31 cm/s at adult visit (P=0.02). Both gait deviation index and gait velocity change were clinically insignificant. Fifty-seven adults (81 limbs, 54%) had mild residual deformities. Residual hip internal rotation, pes planovalgus, and crouch gait were common. Severe deformities impacting function or causing pain were present in 11 participants (14 limbs, 10%). Seven of the 11 adults with severe deformities were worse compared with their adolescent evaluation; 4 were unchanged. CONCLUSIONS Correcting deformities before adulthood has lasting stability with little functional loss in most ambulatory young adults with CP. Increasing deformity after adolescence can occur in young adults but is uncommon. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | - Chris Church
- Gait Analysis Lab, Nemours Children's Hospital, Delaware, Wilmington, DE
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50
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Boyer ER, Novaczyk ZB, Novacheck TF, Symons FJ, Burkitt CC. Presence and predictors of pain after orthopedic surgery and associated orthopedic outcomes in children with cerebral palsy. PAEDIATRIC AND NEONATAL PAIN 2022; 4:44-52. [PMID: 35546914 PMCID: PMC8975226 DOI: 10.1002/pne2.12067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/28/2021] [Accepted: 12/05/2021] [Indexed: 12/29/2022]
Abstract
While children with cerebral palsy (CP) may undergo 8‐22 orthopedic surgeries in their lifetime, little is known about the associated pain. We aimed to assess the pain presence before and one year after lower extremity orthopedic surgery, predictors of pain presence at follow‐up, and the association between pain and orthopedic outcomes related to surgery. This retrospective study included 86 children with CP (M age = 10.0 years, SD = 3.2; range = 4.1‐17.3 years, Gross Motor Functional Classification System (GMFCS) level I‐III) who underwent orthopedic surgery and had completed questionnaires at gait analyses before (M = 2.7 months; range = 0.0‐5.7) and after surgery (M = 11.8 months; range = 9.0‐14.9). Pain presence, location, and Pediatric Outcomes Data Collection Instrument (PODCI) scores were documented before and after surgery at gait analyses. Pain prevalence was 60% at baseline and 56% at follow‐up. Significant predictors of pain presence at follow‐up included (1) pain presence at baseline (range of odds ratios [OR] across any/all locations = 3.22 to 15.54), (2) older age (range of OR for any pain, back, knee, and foot pain = 1.24‐1.26), (3) female sex (decreased OR for males for ankle pain = 0.12), (4) having hip surgery (decreased OR for foot pain = 0.20), and (5) lower GMFCS level (OR for foot pain = 0.41). Changes in PODCI Sports and Physical Function scores were associated with changes in hip and knee pain (P < .03); PODCI scores worsened for patients who had pain at both time points and improved for patients who had pain at baseline but not follow‐up. Pain was present for over half of the participants before and after orthopedic surgery. Pain presence at follow‐up was predicted by pain presence at baseline. Pain and functional outcomes were correlated at follow‐up. Prospective studies examining perioperative pain experience and factors predicting pain outcomes are warranted.
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Affiliation(s)
- Elizabeth R. Boyer
- Gillette Children’s Specialty Healthcare St. Paul MN USA
- Department of Orthopedic Surgery University of Minnesota Minneapolis MN USA
| | | | - Tom F. Novacheck
- Gillette Children’s Specialty Healthcare St. Paul MN USA
- Department of Orthopedic Surgery University of Minnesota Minneapolis MN USA
| | - Frank J. Symons
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
| | - Chantel C. Burkitt
- Gillette Children’s Specialty Healthcare St. Paul MN USA
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
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