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Zarei H, Norasteh AA, Lieberman LJ, Ertel MW, Brian A. Effects of proprioception and core stability training on gait parameters of deaf adolescents: a randomized controlled trial. Sci Rep 2023; 13:21867. [PMID: 38072849 PMCID: PMC10710996 DOI: 10.1038/s41598-023-49335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
The current study aimed to explore the effects of proprioception versus core stability training over 8 weeks on the gait parameters of deaf adolescents. A total of 20 deaf adolescents were randomized into two groups: one group receiving proprioception training (PT, n = 10), another group receiving core stability training (CST, n = 10), and eleven typically developing adolescents assigned into the control group (CON; n = 11). Gait was recorded by two digital cameras; then, using the Kinovea software, the parameters of gait included: gait velocity, cadence, stride length, stride time, stance time, and swing time were calculated in terms of percentages of the walking cycle. After 8 weeks of PT, no significant differences were observed for all gait parameters between PT and control groups (p > 0.05). Also, after 8 weeks of CST, no significant differences were observed in gait velocity and cadence between the CST and control groups (p > 0.05). However, after 8 weeks of CST, stride length (p = 0.02) was higher in the control group; Stride time (p = 0.03), stance time (p = 0.04) and swing time (p = 0.04) were higher in the CST group. Moreover, after 8 weeks of PT, values showed significant improvements in all gait parameters (p = 0.001). Also, after 8 weeks of CST, values showed significant improvements in gait velocity and cadence (p = 0.001), but no significant differences were observed in other gait parameters (p > 0.05). The findings of this study indicated that PT improved all gait parameters, whereas CST improved gait velocity and cadence. The results of the present study also demonstrated that PT had a greater effect on gait parameters of deaf adolescents compared with CST. It seems that PT induces more training effects than CTS for enhancing gait parameters of deaf adolescents.Trial registration: Clinical trial registry number: IRCT20170312033029N2. URL: https://en.irct.ir/trial/25584 .
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Affiliation(s)
- Hamed Zarei
- Corrective Exercises and Sports Injury Department, College of Physical Education & Sport Sciences, Faculty of Physical Education & Sport Sciences, University of Guilan, kilometers 10 Rasht-Ghazvin Road, Rasht, 4199613776, Iran.
| | - Ali Asghar Norasteh
- Physiotherapy Department, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, 4199613776, Iran
| | - Lauren J Lieberman
- Department of Kinesiology, Sport Studies and Physical Education, State University of New York (SUNY), Brockport, NY, 14420, USA
| | - Michael W Ertel
- Department of Physical Education, University of South Carolina, Columbia, SC, USA
| | - Ali Brian
- Department of Physical Education, University of South Carolina, Columbia, SC, USA
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Liu W, Hu Y, Li J, Chang J. Effect of Virtual Reality on Balance Function in Children With Cerebral Palsy: A Systematic Review and Meta-analysis. Front Public Health 2022; 10:865474. [PMID: 35548088 PMCID: PMC9081327 DOI: 10.3389/fpubh.2022.865474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
Virtual Reality (VR) therapy is popular in treating children with Cerebral Palsy (CP) as a new technology for rehabilitation. Nevertheless, no substantial evidence supporting VR therapy promotion has been developed to date. This study aimed to investigate the effects of VR therapy on balance in children with CP. We conducted a systematic search in PubMed and Web of Science (updated to December 30, 2021). The systematic review and meta-analysis included all randomized controlled trials that included children with CP. A total of 18 RCT studies were eligible for inclusion in the systematic review, and meta-analysis was performed on 16 of them. Results showed that the VR intervention was beneficial for balance (SMD 0.47 [95% CI, SD 0.28, 0.66]). We concluded that VR therapy interventions for children with CP have positive effects. However, cautious implementation is needed in clinical applications.
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Affiliation(s)
- Wei Liu
- School of Physical Education, Xuzhou Kindergarten Teachers College, Xuzhou, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Yuanyan Hu
- School of Mathematics and Statistics, Yunlin Normal University, Yunlin, China
| | - Junfeng Li
- Ministry of Sports, Shandong Technology and Business University, Yantai, China
- *Correspondence: Junfeng Li
| | - Jindong Chang
- Institute of Motor Quotient, Southwest University, Chongqing, China
- Jindong Chang
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Elnaggar RK, Diab RH, Alghadier M, Azab AR. Block-sequence of plyometric and balance training is superior to the alternating-sequence for enhancing motor function in children with hemiplegic cerebral palsy: A comparative randomized clinical trial. ISOKINET EXERC SCI 2022. [DOI: 10.3233/ies-220005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND: Postural control deficits are prevalent in children with hemiplegic cerebral palsy (CwHCP). Therefore, the best rehabilitative strategies for remediating these deficits are warranted, which could then enhance function. OBJECTIVE: To examine effects of a block versus an alternating sequence of balance training (BT) and plyometric training (PT) on postural control in CwHCP. METHODS: Forty-eight CwHCP (812 years) were randomized to a block or an alternating BT/PT training. The block BT/PT group (n= 24) received a sixweek BT followed by a sixweek PT, twice/week over 12 consecutive weeks. The alternating BT/PT group (n= 24) received an interchanging sequence of BT and PT changed every two weeks for 12 weeks. Postural control [center-of-pressure reaction time (RT), movement velocity (MV), maximum excursion (ME), end-point excursion (EE), and directional control (DC)], functional balance (indicated by pediatric balance scale; PBS), and balance/risk-of-falls during walking (denoted by dynamic gait index; DGI) were assessed before and after training. RESULTS: The block BT/PT group showed greater enhancements in postural control variables [RT (P= 0.004), MV (P= 0.028), ME (P= 0.002), EE (P= 0.003), and DC (P= 0.012)] and functional balance (P= 0.006), and lesser risk-of-falls during walking (P= 0.018) when compared to the alternating BT/PT group. CONCLUSION: The block BT/PT sequence is more effective to enhance postural control than the alternating sequence in CwHCP.
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Affiliation(s)
- Ragab K. Elnaggar
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Reham H. Diab
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University, Madina, Saudi Arabia
| | - Mshari Alghadier
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Alshimaa R. Azab
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Ruhde L, Hulla R. An overview of the effects of whole-body vibration on individuals with cerebral palsy. J Pediatr Rehabil Med 2022; 15:193-210. [PMID: 35275570 DOI: 10.3233/prm-201508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this review is to examine how whole-body vibration can be used as a tool in therapy to help improve common physical weaknesses in balance, bone density, gait, spasticity, and strength experienced by individuals with cerebral palsy. Cerebral palsy is the most common movement disorder in children, and whole-body vibration is quickly becoming a potential therapeutic tool with some advantages compared to traditional therapies for individuals with movement disorders. The advantages of whole-body vibration include less strain and risk of injury, more passive training activity, and reduced time to complete an effective therapeutic session, all of which are appealing for populations with physiological impairments that cause physical weakness, including individuals with cerebral palsy. This review involves a brief overview of cerebral palsy, whole-body vibration's influence on physical performance measures, its influence on physical performance in individuals with cerebral palsy, and then discusses the future directions of whole-body vibration therapy in the cerebral palsy population.
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Affiliation(s)
- Logan Ruhde
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Ryan Hulla
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
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Kepenek-Varol B, Gürses HN, İçağasıoğlu DF. Effects of Inspiratory Muscle and Balance Training in Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial. Dev Neurorehabil 2022; 25:1-9. [PMID: 33792496 DOI: 10.1080/17518423.2021.1905727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of the study was to investigate the effects of inspiratory muscle and balance training on pulmonary function, respiratory muscle strength (RMS), functional capacity, and balance in children with hemiplegic cerebral palsy (CP). Thirty children with hemiplegic CP (Gross Motor Function Classification System I-II) included in this study. The control group (n = 15) underwent conventional physiotherapy rehabilitation program (CPRP) that included balance exercises, and the training group's (n = 15) program included inspiratory muscle training (IMT) in addition to CPRP for 8 weeks. The outcome measures were pulmonary function test, RMS measurement, the six-minute walk test (6MWT), and balance tests. There were no significant differences in the score changes of pulmonary function, balance, and 6MWT distance between groups (p > .05), whereas maximum inspiratory and expiratory pressure further increased in the training group (p > .05). RMS assessment and the identification of children who need it, and adding IMT to CPRP will contribute greatly to the rehabilitative approach of children with CP.
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Affiliation(s)
- Büşra Kepenek-Varol
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Nuh Naci Yazgan University, Kayseri, Turkey.,Department of Cardiopulmonary Physiotherapy Rehabilitation, Health Sciences Institute, Bezmialem Vakif University, Istanbul, Turkey
| | - Hülya Nilgün Gürses
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
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Elnaggar RK. Acute responses to locomotor tasks differ according to gait-asymmetry patterns in children with hemiplegic cerebral palsy: An exploratory analysis. Hum Mov Sci 2021; 79:102860. [PMID: 34385053 DOI: 10.1016/j.humov.2021.102860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
This study aimed at determining if differential responses to locomotor tasks in children with spastic hemiplegia occur on account of step-length asymmetry patterns [symmetrical step-length (S-SL); affected side short (AFFshort), and non-affected short (Non-AFFshort)] observed during on-ground walking. Thirty-two children (5-8 years) were assessed for spatial/temporal measures of gait while walking on the ground with self-selected speed. Data from on-ground walking were compared against three locomotor tasks that were examined on a treadmill: self-imposed walking velocity with bodyweight support of 0% (BWS-0%), self-imposed walking velocity with a BWS of 20% (BWS-20%), and fastest walking velocity with a BWS of 20% and a manually-guided response of the non-affected leg (MGRnon-affected). The primary outcome measures were the spatial (step length) and temporal (single-limb support time) symmetry indices. The step-length asymmetry subgroups responded differently to the locomotor tasks. The MGRnon-affected produced spatial symmetry in the S-SL and Non-AFFshort groups and temporal symmetry in the AFFshort group. The BWS-0% and BWS-20% treadmill walking conditions were insufficient to remediate either spatial or temporal walking asymmetry. In conclusion, acute responses to locomotor tasks are not consistent among asymmetry subgroups, suggesting that they might need individual treatment plans. In spite of the differences in walking characteristics between asymmetry subgroups, the improvement in gait-symmetry arose out of changes in affected and non-affected sides together.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
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Postural Control Performance on the Functional Reach Test: Validity of the Kids-Balance Evaluation Systems Test (Kids-BESTest) Criteria. Arch Phys Med Rehabil 2021; 102:1170-1179. [PMID: 33508337 DOI: 10.1016/j.apmr.2020.12.018] [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: 06/01/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Evaluate the validity of the Kids-Balance Evaluation Systems Test (Kids-BESTest) clinical criteria for the Functional Reach Test (FRT) forward and lateral with laboratory measures of postural control in children with cerebral palsy (CP). DESIGN Psychometric study of face, concurrent, and content validity. SETTING Clinical laboratory. PARTICIPANTS Children (N=58) aged 7-18 years (ambulant CP n=17, typically developing [TD] n=41). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Stability limits in standing were assessed using the Kids-BESTest items for FRT forwards (FRTFORWARD), FRT lateral preferred (FRTLATERAL(P)), and FRT lateral nonpreferred (FRTLATERAL(NP)). Force platforms and kinematic markers were used to collect information on center of pressure (CoP) and joint movement during reach. Analyses included face validity (Kids-BESTest scores compared between CP and TD groups), concurrent validity (agreement between Kids-BESTest scores and digitally derived scores), and content validity (relations between Kids-BESTest scores with kinematic and CoP data). RESULTS Face validity of Kids-BESTest criteria was demonstrated with lower scores for CP compared to TD groups for FRTFORWARD (P<.001) and FRTLATERAL(NP) (P=.03) and equal scores for FRTLATERAL(P) (P=.12). For concurrent validity, agreement between Kids-BESTest scores and digitally derived scores was good to excellent for FRTLATERAL(both P/NP) (88%-100%) and good for FRTFORWARD (86%-88%) for both groups. For content validity, the CP group Kids-BESTest scores were correlated with CoP-RangeFORWARD during FRTFORWARD (ρ=0.68) and CoP-RangeLATERAL during FRTLATERAL(NP) (ρ=0.57). For kinematic data, correlations were moderate-high between Kids-BESTest scores and range of hip flexion (ρ=0.51) and ankle plantar flexion (ρ=0.75) during FRTFORWARD, and trunk lateral flexion (ρ=0.66) during FRTLATERAL(NP). CONCLUSION The FRTFORWARD demonstrated face, concurrent, and content validity. The FRTLATERAL(P/NP) demonstrated concurrent validity, but partial face and content validity. To improve validity of Kids-BESTest FRT criteria, additional descriptors have been added under the scoring criteria to enable clinicians to quantify observed reach strategies.
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Warnier N, Lambregts S, Port IVD. Effect of Virtual Reality Therapy on Balance and Walking in Children with Cerebral Palsy: A Systematic Review. Dev Neurorehabil 2020; 23:502-518. [PMID: 31674852 DOI: 10.1080/17518423.2019.1683907] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: To investigate the effect of Virtual Reality Therapy (VRT) on balance and walking in children with cerebral palsy (CP). Method: A systematic search in Pubmed and Embase was performed until the 9th of July 2019. Articles were included if the population consisted of children with CP and data on balance and/or walking were reported. Results were pooled in two meta-analyses. Results: 26 articles were included. For 'balance' 5 and for 'walking' 4 were used for the meta-analyses. The meta-analyses showed a significant result in favor of VRT for balance, SMD 0.89 [95% CI, SD 0.14, 1.63] and for walking, SMD 3.10 [95% Cl, SD 0.78, 5.35]. Interpretation: VRT seems a promising intervention for rehabilitation in children with CP. The meta-analysis confirmed this positive effect. These results must be interpreted with caution due to differences in the interventions used, the lack of randomized-controlled trials, and the relatively small groups.
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Affiliation(s)
- Nadieh Warnier
- Rijndam Revalidatie centrum , Rotterdam, LJ, Netherlands
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Chesser BT, Blythe SA, Ridge LD, Tomaszewski RER, Kinne BL. Effectiveness of the Wii for pediatric rehabilitation in individuals with cerebral palsy: a systematic review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1740402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Brianna T. Chesser
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Stefanie A. Blythe
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Logan D. Ridge
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | | | - Bonni L. Kinne
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
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Kupper C, Roemer K, Jusko E, Zentgraf K. Distality of Attentional Focus and Its Role in Postural Balance Control. Front Psychol 2020; 11:125. [PMID: 32153451 PMCID: PMC7050164 DOI: 10.3389/fpsyg.2020.00125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/16/2020] [Indexed: 11/29/2022] Open
Abstract
The role of attentional focusing in motor tasks has been highlighted frequently. The "internal-external" dimension has emerged, but also the spatial distance between body and attended location. In two experiments, an extended attentional focus paradigm was introduced to investigate distality effects of attentional foci on balance performance. First, the distality of the coordinates of the point of focus was varied between a proximal and distal position on an artificial tool attached to the body. Second, the distance of the displayed effect on the wall was varied between a 2.5 and 5 m condition. Subjects were instructed to focus on controlling either a proximal or distal spot on a tool attached to their head, represented by two laser pointers. Subsequently, they needed to visually track their own body-movement effect of one of the laser pointers at a wall while completing various single leg stance tasks. Center of pressure (COP) sway was analyzed using a linear method (classic sway variables) as well as a non-linear method (multiscale entropy). In addition, laser trajectories were videotaped and served as additional performance outcome measure. Experiment 1 revealed differences in balance performance under proximal compared to distal attentional focus conditions. Moreover, experiment 2 yielded differences in balance-related sway measures and laser data between the 2.5 and 5 m condition of the visually observable movement effect. In conclusion, varying the distality of the point of focus between proximal and distal impacted balance performance. However, this effect was not consistent across all balance tasks. Relevantly, the distality of the movement effect shows a significant effect on balance plus laser performance with advantages in more distal conditions. This research emphasizes the importance of the spatial distality of movement effects for human behavior.
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Affiliation(s)
- Christian Kupper
- Institute of Sport Sciences, Department of Movement Science and Training in Sports, Faculty of Psychology and Sports Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Karen Roemer
- Department of Health Sciences, College of Education and Professional Studies, Central Washington University, Ellensburg, WA, United States
| | - Elizabeth Jusko
- Department of Health Sciences, College of Education and Professional Studies, Central Washington University, Ellensburg, WA, United States
| | - Karen Zentgraf
- Institute of Sport Sciences, Department of Movement Science and Training in Sports, Faculty of Psychology and Sports Sciences, Goethe University Frankfurt, Frankfurt, Germany
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Yardımcı-Lokmanoğlu BN, Bingöl H, Mutlu A. The forgotten sixth sense in cerebral palsy: do we have enough evidence for proprioceptive treatment? Disabil Rehabil 2019; 42:3581-3590. [DOI: 10.1080/09638288.2019.1608321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Hasan Bingöl
- Vocational School of Health, Department of Health Care, Muş Alparslan University, Turkey
| | - Akmer Mutlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Abstract
PURPOSE To investigate postural effects of the family-centered program, COPing with and CAring for infants with special needs (COPCA), applied at 3 to 6 months' corrected age in infants at high risk of cerebral palsy. Previously, we reported postural differences between the infants at risk of CP in the control group of the current study and a group of infants developing typically. Now we focus on differences between 2 intervention groups. METHODS We explored postural adjustments during reaching in seated infants at 4, 6, and 18 months using surface electromyography of arm, neck, and trunk muscles. Infants randomly received the family-centered program or another infant physical therapy. Using videotaped intervention sessions, we investigated correlations between time spent on specific physical therapeutic actions and direction specificity, recruitment order, and anticipatory activation at 18 months. RESULTS Postural adjustments in both groups were similar, but development of direction specificity and anticipatory activation in COPCA infants better mimicked typical development. These 2 parameters were associated with COPCA-type physical therapeutic actions. CONCLUSIONS Postural control was similar after both interventions. Positive outcomes were associated with fewer intervening actions of the therapist and greater allowance of spontaneous movements.
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El Shemy SA. Effect of Treadmill Training With Eyes Open and Closed on Knee Proprioception, Functional Balance and Mobility in Children With Spastic Diplegia. Ann Rehabil Med 2018; 42:854-862. [PMID: 30613079 PMCID: PMC6325311 DOI: 10.5535/arm.2018.42.6.854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/15/2018] [Indexed: 01/14/2023] Open
Abstract
Objective To investigate the effect of treadmill training with eyes open (TEO) and closed (TEC) on the knee joint position sense (JPS), functional balance and mobility in children with spastic diplegia. Methods Forty-five children with spastic diplegia aged 11–13 years participated in this study. They were randomly assigned to three groups of equal number. The control group (CON) underwent designed physical therapy program whereas, the study groups (TEO and TEC) underwent the same program, in addition to treadmill gait training with eyes open and closed, respectively. Outcome measures were the degree of knee joint position error, functional balance and mobility. Measurements were taken before and after 12 weeks of intervention. Results After training, the three groups showed statistically significant improvement in all measured outcomes, compared to the baseline with non-significant change in the knee JPS in the CON group. When comparing posttreatment results, the TEC group showed greater significant improvement in all measured outcomes, than the TEO and CON groups. Conclusion Treadmill training with eyes open and closed is effective in rehabilitation of children with diplegia, but blocked vision treadmill training has more beneficial effect.
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Affiliation(s)
- Samah Attia El Shemy
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Abstract
PURPOSE A platform requiring multidimensional trunk movement facilitated postural balance in children with cerebral palsy. METHODS The intervention group (n = 20) received 12 weeks of playing personal computer (PC) games using the platform, and the control group (n = 20) played the same games using a computer mouse. Outcomes were center-of-pressure sway, the Berg Balance Scale (BBS), Fullerton Advanced Balance Scale (FAB), and Timed Up and Go (TUG) test scores. RESULTS There were significant interactions between groups and time. There was a significant between-group difference in center-of-pressure sway excursion, BBS test, and TUG test over time. Participants in the intervention group had better balance performance compared with the control group. CONCLUSION Balance training using a PC gaming platform may improve exercise compliance and enhance recovery of balance in children with cerebral palsy.
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Affiliation(s)
- Hsieh-Chun Hsieh
- Department of Special Education, National Tsing Hua University, Hsinchu City, Taiwan
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Kręcisz K, Kuczyński M. Attentional demands associated with augmented visual feedback during quiet standing. PeerJ 2018; 6:e5101. [PMID: 30042878 PMCID: PMC6056264 DOI: 10.7717/peerj.5101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/05/2018] [Indexed: 01/04/2023] Open
Abstract
To investigate how additional visual feedback (VFB) affects postural stability we compared 20-sec center-of-pressure (COP) recordings in two conditions: without and with the VFB. Seven healthy adult subjects performed 10 trials lasting 20 seconds in each condition. Simultaneously, during all trials the simple auditory reaction time (RT) was measured. Based on the COP data, the following sway parameters were computed: standard deviation (SD), mean speed (MV), sample entropy (SE), and mean power frequency (MPF). The RT was higher in the VFB condition (p < 0.001) indicating that this condition was attention demanding. The VFB resulted in decreased SD and increased SE in both the medial-lateral (ML) and anterior-posterior (AP) planes (p < .001). These results account for the efficacy of the VFB in stabilizing posture and in producing more irregular COP signals which may be interpreted as higher automaticity and/or larger level of noise in postural control. The MPF was higher during VFB in both planes as was the MV in the AP plane only (p < 0.001). The latter data demonstrate higher activity of postural control system that was caused by the availability of the set-point on the screen and the resulting control error which facilitated and sped up postural control.
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Affiliation(s)
- Krzysztof Kręcisz
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Michał Kuczyński
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Wroclaw, Poland
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MacIntosh A, Lam E, Vigneron V, Vignais N, Biddiss E. Biofeedback interventions for individuals with cerebral palsy: a systematic review. Disabil Rehabil 2018; 41:2369-2391. [PMID: 29756481 DOI: 10.1080/09638288.2018.1468933] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose: The purpose of this study is to evaluate the quality of evidence of biofeedback interventions aimed at improving motor activities in people with Cerebral Palsy (CP). Second, to describe the relationship between intervention outcomes and biofeedback characteristics. Methods: Eight databases were searched for rehabilitation interventions that provided external feedback and addressed motor activities. Two reviewers independently assessed and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to evaluate quality of evidence for outcome measures related to two International Classification of Functioning, Disability and Health (ICF) chapters. Results: Fifty-seven studies were included. There were 53 measures related Activities and Participation and 39 measures related to Body Functions. Strength of evidence was "Positive, Very-Low" due to the high proportion of non-controlled studies and heterogeneity of measures. Overall, 79% of studies and 63% of measures showed improvement post-intervention. Counter to motor learning theory recommendations, most studies provided feedback consistently and concurrently throughout the intervention regardless of the individual's desire or progress. Conclusion: Heterogeneous interventions and poor study design limit the strength of biofeedback evidence. A thoughtful biofeedback paradigm and standardized outcome toolbox can strengthen the confidence in the effect of biofeedback interventions for improving motor rehabilitation for people with CP. Implications for Rehabilitation Biofeedback can improve motor outcomes for people with Cerebral Palsy. If given too frequently, biofeedback may prevent the client from learning autonomously. Use consistent and concurrent feedback to improve simple/specific motor activities. Use terminal feedback and client-directed feedback to improve more complex/general motor activities.
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Affiliation(s)
- Alexander MacIntosh
- a Institute of Biomaterials and Biomedical Engineering , University of Toronto , Toronto , Canada.,b Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Canada
| | - Emily Lam
- b Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Canada
| | - Vincent Vigneron
- c Informatique, Biologie Intégrative et Systèmes Complexes (IBISC) laboratoire, Université d'Evry-Val-d'Essonne , Evry , France
| | - Nicolas Vignais
- d Complexity, Innovation, Sports & Motor Activities (CIAMS) laboratoire, Université Paris-Sud , Orsay , France
| | - Elaine Biddiss
- a Institute of Biomaterials and Biomedical Engineering , University of Toronto , Toronto , Canada.,b Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Canada
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17
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Multimodale Komplexbehandlungen und Funktionstherapien für Kinder und Jugendliche mit Zerebralparese. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-018-0382-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Velasco MA, Raya R, Muzzioli L, Morelli D, Otero A, Iosa M, Cincotti F, Rocon E. Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games. Biomed Eng Online 2017; 16:74. [PMID: 28830552 PMCID: PMC5568605 DOI: 10.1186/s12938-017-0364-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise. MATERIALS The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head. METHODS Ten users with CP participated in the study. Whereas the control group (n = 5) followed traditional therapies, the experimental group (n = 5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment. RESULTS The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p < 0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention. CONCLUSIONS Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n = 10) additional studies are needed to corroborate this hypothesis.
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Affiliation(s)
- Miguel A Velasco
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics (CAR) CSIC-UPM, Ctra. Campo Real Km 0.2, 28500, Arganda del Rey, Spain.
| | - Rafael Raya
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics (CAR) CSIC-UPM, Ctra. Campo Real Km 0.2, 28500, Arganda del Rey, Spain.,Department of Information Technologies, Universidad CEU San Pablo, Urbanización Montepríncipe, 28668, Boadilla del Monte, Spain
| | - Luca Muzzioli
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Daniela Morelli
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Abraham Otero
- Department of Information Technologies, Universidad CEU San Pablo, Urbanización Montepríncipe, 28668, Boadilla del Monte, Spain
| | - Marco Iosa
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Febo Cincotti
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Eduardo Rocon
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics (CAR) CSIC-UPM, Ctra. Campo Real Km 0.2, 28500, Arganda del Rey, Spain
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19
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Dynamical structure of center-of-pressure trajectories with and without functional taping in children with cerebral palsy level I and II of GMFCS. Hum Mov Sci 2017; 54:137-143. [DOI: 10.1016/j.humov.2017.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 04/26/2017] [Accepted: 04/30/2017] [Indexed: 11/18/2022]
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20
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Saxena S, Rao BK, Senthil KD. Short-term balance training with computer-based feedback in children with cerebral palsy: A feasibility and pilot randomized trial. Dev Neurorehabil 2017; 20:115-120. [PMID: 26889691 DOI: 10.3109/17518423.2015.1116635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the feasibility of using short-term balance training with computer-based visual feedback (BTVF) and its effect on standing balance in children with bilateral spastic cerebral palsy (BSCP). METHODS Out of the fourteen children with BSCP (mean age = 10.31 years), seven children received four sessions of BTVF (two such sessions/day, each session = 15 min) in comparison to the control group that received standard care. Feasibility was measured as percentages of recruitment, retention and safety and balance was measured using a posturography machine as sway velocity (m/s) and velocity moment (m/s2) during quiet standing. RESULTS No serious adverse events occurred in either group. There were no differences in the retention percentages and in any clinical outcome measure between both groups. CONCLUSION Use of BTVF is feasible in children with BSCP but further investigation is required to estimate a dose-effect relationship.
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Affiliation(s)
- Shikha Saxena
- a School of Physical and Occupational Therapy , McGill University , Canada
| | - Bhamini K Rao
- b Manipal College of Allied Health Sciences , Manipal University , India
| | - Kumaran D Senthil
- b Manipal College of Allied Health Sciences , Manipal University , India
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21
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Rougier PR, Boudrahem S. Interaction between postural asymmetry and visual feedback effects in undisturbed upright stance control in healthy adults. Neurophysiol Clin 2017; 47:305-314. [PMID: 28314520 DOI: 10.1016/j.neucli.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/18/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The technique of additional visual feedback has been shown to significantly decrease the center of pressure (CP) displacements of a standing subject. Body-weight asymmetry is known to increase postural instability due to difficulties in coordinating the reaction forces exerted under each foot and is often a cardinal feature of various neurological and traumatic diseases. To examine the possible interactions between additional visual feedback and body-weight asymmetry effects, healthy adults were recruited in a protocol with and without additional visual feedback, with different levels of body-weight asymmetry. METHODS CP displacements under each foot were recorded and used to compute the resultant CP displacements (CPRes) and to estimate vertically projected center of gravity (CGv) and CPRes-CGv displacements. Overall, six conditions were randomly proposed combining two factors: asymmetry with three BW percentage distributions (50/50, 35/65 and 20/80; left/right leg) and feedback (with or without additional VFB). RESULTS The additional visual feedback technique principally reduces CGv displacements, whereas asymmetry increases CPRes-CGv displacements along the mediolateral axis. Some effects on plantar CP displacements were also observed, but only under the unloaded foot. Interestingly, no interaction between additional visual feedback and body-weight asymmetry was reported. DISCUSSION These results suggest that the various postural effects that ensue from manipulating additional visual feedback parameters, shown previously in healthy subjects in various studies, could also apply independently of the level of asymmetry. CONCLUSION Visual feedback effects could be observed in patients presenting weight-bearing asymmetries.
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Affiliation(s)
- Patrice R Rougier
- Laboratoire interdisciplinaire de biologie de la motricité, université de Savoie- Mont Blanc, domaine scientifique de Savoie-Technolac, 73376 le Bourget du Lac cedex, France.
| | - Samir Boudrahem
- Laboratoire interdisciplinaire de biologie de la motricité, université de Savoie- Mont Blanc, domaine scientifique de Savoie-Technolac, 73376 le Bourget du Lac cedex, France
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22
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Lucas BR, Elliott EJ, Coggan S, Pinto RZ, Jirikowic T, McCoy SW, Latimer J. Interventions to improve gross motor performance in children with neurodevelopmental disorders: a meta-analysis. BMC Pediatr 2016; 16:193. [PMID: 27899082 PMCID: PMC5129231 DOI: 10.1186/s12887-016-0731-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gross motor skills are fundamental to childhood development. The effectiveness of current physical therapy options for children with mild to moderate gross motor disorders is unknown. The aim of this study was to systematically review the literature to investigate the effectiveness of conservative interventions to improve gross motor performance in children with a range of neurodevelopmental disorders. METHODS A systematic review with meta-analysis was conducted. MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, PEDro, Cochrane Collaboration, Google Scholar databases and clinical trial registries were searched. Published randomised controlled trials including children 3 to ≤18 years with (i) Developmental Coordination Disorder (DCD) or Cerebral Palsy (CP) (Gross Motor Function Classification System Level 1) or Developmental Delay or Minimal Acquired Brain Injury or Prematurity (<30 weeks gestational age) or Fetal Alcohol Spectrum Disorders; and (ii) receiving non-pharmacological or non-surgical interventions from a health professional and (iii) gross motor outcomes obtained using a standardised assessment tool. Meta-analysis was performed to determine the pooled effect of intervention on gross motor function. Methodological quality and strength of meta-analysis recommendations were evaluated using PEDro and the GRADE approach respectively. RESULTS Of 2513 papers, 9 met inclusion criteria including children with CP (n = 2) or DCD (n = 7) receiving 11 different interventions. Only two of 9 trials showed an effect for treatment. Using the least conservative trial outcomes a large beneficial effect of intervention was shown (SMD:-0.8; 95% CI:-1.1 to -0.5) with "very low quality" GRADE ratings. Using the most conservative trial outcomes there is no treatment effect (SMD:-0.1; 95% CI:-0.3 to 0.2) with "low quality" GRADE ratings. Study limitations included the small number and poor quality of the available trials. CONCLUSION Although we found that some interventions with a task-orientated framework can improve gross motor outcomes in children with DCD or CP, these findings are limited by the very low quality of the available evidence. High quality intervention trials are urgently needed.
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Affiliation(s)
- Barbara R Lucas
- Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Clinical School, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
- The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, , Missenden Rd, Sydney, NSW, 2050, Australia.
- Poche Centre for Indigenous Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
- Physiotherapy Department, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Clinical School, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia
- The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, , Missenden Rd, Sydney, NSW, 2050, Australia
- The Sydney Children's Hospital Networks (Westmead), Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia
| | - Sarah Coggan
- The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, , Missenden Rd, Sydney, NSW, 2050, Australia
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Rafael Z Pinto
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, UNESP-Univ Estadual Paulista, Presidente Prudente, SP, 19060-900, Brazil
| | - Tracy Jirikowic
- Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Sarah Westcott McCoy
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, , Missenden Rd, Sydney, NSW, 2050, Australia
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Vieira TM, Baudry S, Botter A. Young, Healthy Subjects Can Reduce the Activity of Calf Muscles When Provided with EMG Biofeedback in Upright Stance. Front Physiol 2016; 7:158. [PMID: 27199773 PMCID: PMC4850153 DOI: 10.3389/fphys.2016.00158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/14/2016] [Indexed: 11/13/2022] Open
Abstract
Recent evidence suggests the minimization of muscular effort rather than of the size of bodily sway may be the primary, nervous system goal when regulating the human, standing posture. Different programs have been proposed for balance training; none however has been focused on the activation of postural muscles during standing. In this study we investigated the possibility of minimizing the activation of the calf muscles during standing through biofeedback. By providing subjects with an audio signal that varied in amplitude and frequency with the amplitude of surface electromyograms (EMG) recorded from different regions of the gastrocnemius and soleus muscles, we expected them to be able to minimize the level of muscle activation during standing without increasing the excursion of the center of pressure (CoP). CoP data and surface EMG from gastrocnemii, soleus and tibialis anterior muscles were obtained from 10 healthy participants while standing at ease and while standing with EMG biofeedback. Four sensitivities were used to test subjects' responsiveness to the EMG biofeedback. Compared with standing at ease, the two most sensitive feedback conditions induced a decrease in plantar flexor activity (~15%; P < 0.05) and an increase in tibialis anterior EMG (~10%; P < 0.05). Furthermore, CoP mean position significantly shifted backward (~30 mm). In contrast, the use of less sensitive EMG biofeedback resulted in a significant decrease in EMG activity of ankle plantar flexors with a marginal increase in TA activity compared with standing at ease. These changes were not accompanied by greater CoP displacements or significant changes in mean CoP position. Key results revealed subjects were able to keep standing stability while reducing the activity of gastrocnemius and soleus without loading their tibialis anterior muscle when standing with EMG biofeedback. These results may therefore posit the basis for the development of training protocols aimed at assisting subjects in more efficiently controlling leg muscle activity during standing.
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Affiliation(s)
- Taian M Vieira
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di TorinoTorino, Italia; Escola de Educação Física e Desportos, Departamento de Arte Corporal, Universidade Federal do Rio de JaneiroRio de Janeiro, Brasil
| | - Stéphane Baudry
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université libre de Bruxelles Brussels, Belgium
| | - Alberto Botter
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino Torino, Italia
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24
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Cabrera-Martos I, Valenza MC, Valenza-Demet G, Benítez-Feliponi Á, Robles-Vizcaíno C, Ruiz-Extremera Á. Repercussions of plagiocephaly on posture, muscle flexibility and balance in children aged 3-5 years old. J Paediatr Child Health 2016; 52:541-6. [PMID: 27329908 DOI: 10.1111/jpc.13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/04/2015] [Accepted: 12/16/2015] [Indexed: 11/26/2022]
Abstract
AIM The objective of the study was to assess posture, muscle flexibility and balance in children aged 3-5 years old with a history of nonsynostotic plagiocephaly. METHODS Fifty-two children with previous history of plagiocephaly were evaluated, along with 52 control subjects matched for age, sex, height, weight and physical activity. The outcome measures included static posture, assessed through the measurement of angles and distances between anatomical landmarks; muscle flexibility, evaluated with the Stibor, Shober and finger-to-floor distance tests and balance, assessed by the Pediatric Balance Scale. RESULTS One-way analysis of variance afforded statistically significant differences (P < 0.05) in head position, muscle flexibility (thoracic mobility and trunk and lower limbs muscle shortening) and balance. CONCLUSION Children with previous history of non-synostotic plagiocephaly present changes in head position, muscle shortening and a poor balance when compared to control children at 3-5 years old.
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Affiliation(s)
- Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Gerald Valenza-Demet
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | | | - Ángeles Ruiz-Extremera
- Early Care and Monitoring Unit, Pediatrics Service, San Cecilio University Hospital, Granada, Spain, Granada, Spain
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25
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Dewar R, Love S, Johnston LM. Exercise interventions improve postural control in children with cerebral palsy: a systematic review. Dev Med Child Neurol 2015; 57:504-20. [PMID: 25523410 DOI: 10.1111/dmcn.12660] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 01/20/2023]
Abstract
AIM The aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP). METHOD A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Six databases were searched using the following keywords: ('cerebral palsy' OR 'brain injury'); AND ('postur*' OR 'balance' OR 'postural balance' [MeSH]); AND ('intervention' OR 'therapy' OR 'exercise' OR 'treatment'). Articles were evaluated based on their level of evidence and conduct. RESULTS Searches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with CP. Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no-BWS), trunk-targeted training, and reactive balance training. Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high-level evidence. INTERPRETATION The use of exercise-based treatments to improve postural control in children with CP has increased significantly in the last decade. Improved study design provides more clarity regarding broad treatment efficacy. Research is required to establish links between postural control impairments, treatment options, and outcome measures. Low-burden, low-cost, child-engaging, and mainstream interventions also need to be explored.
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Affiliation(s)
- Rosalee Dewar
- The University of Queensland, Brisbane, Qld, Australia
| | - Sarah Love
- Princess Margaret Hospital, Perth, WA, Australia
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26
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Ledebt A, Savelsbergh GJP. Postural adaptation during arm raising in children with and without unilateral cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1782-1788. [PMID: 24670884 DOI: 10.1016/j.ridd.2014.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 02/10/2014] [Accepted: 02/14/2014] [Indexed: 06/03/2023]
Abstract
Postural sway during arm movements were related to the size of the base of support (BOS) and the limits of stability (LOS) of children with unilateral cerebral palsy (USCP) and typically developing (TD) children. For half of the trials the mechanical disturbance due to the rapid arm movement was increased by attaching small weights at the wrists. The participants stood with both feet on a large force plate, which recorded the displacements of the center of pressure (CoP). The results showed that in the children with USCP the LOS forward and toward the non-dominant (more-affected) side were smaller than in the TD children whereas the LOS backward and toward the dominant (less-affected) side did not differ between the two groups. When rapidly moving the arms the children with USCP swayed over a larger portion of their base of support in the forward direction and toward their more-affected side. In addition, the maximal sway toward the more-affected side during arm movement exceeded the LOS while balance was maintained. These effects increased when the movements were performed with the weights at the wrists. These results show that an area of permissible sway, which was not spontaneously explored during the leaning task, was required to maintain balance during the supra-postural task. Training to enlarge the LOS that includes weight shifts toward the more-affected side might reduce the area of the BOS that is self-perceived as less secure.
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Affiliation(s)
- Annick Ledebt
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van Der Boechorststraat 9, Amsterdam 1081 BT, The Netherlands.
| | - Geert J P Savelsbergh
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van Der Boechorststraat 9, Amsterdam 1081 BT, The Netherlands
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27
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Radtka S, Hone R, Brown C, Mastick J, Melnick ME, Dowling GA. Feasibility of Computer-Based Videogame Therapy for Children with Cerebral Palsy. Games Health J 2014; 2:222-228. [PMID: 24761324 DOI: 10.1089/g4h.2012.0071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Standing and gait balance problems are common in children with cerebral palsy (CP), resulting in falls and injuries. Task-oriented exercises to strengthen and stretch muscles that shift the center of mass and change the base of support are effective in improving balance. Gaming environments can be challenging and fun, encouraging children to engage in exercises at home. The aims of this project were to demonstrate the technical feasibility, ease of use, appeal, and safety of a computer-based videogame program designed to improve balance in children with CP. MATERIALS AND METHODS This study represents a close collaboration between computer design and clinical team members. The first two phases were performed in the laboratory, and the final phase was done in subjects' homes. The prototype balance game was developed using computer-based real-time three-dimensional programming that enabled the team to capture engineering data necessary to tune the system. Videogame modifications, including identifying compensatory movements, were made in an iterative fashion based on feedback from subjects and observations of clinical and software team members. RESULTS Subjects (n=14) scored the game 21.5 out of 30 for ease of use and appeal, 4.0 out of 5 for enjoyment, and 3.5 on comprehension. There were no safety issues, and the games performed without technical flaws in final testing. CONCLUSIONS A computer-based videogame incorporating therapeutic movements to improve gait and balance in children with CP was appealing and feasible for home use. A follow-up study examining its effectiveness in improving balance in children with CP is recommended.
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Affiliation(s)
- Sandra Radtka
- University of California , San Francisco and San Francisco State University Joint Graduate Program in Physical Therapy, San Francisco, California
| | | | | | - Judy Mastick
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California
| | - Marsha E Melnick
- University of California , San Francisco and San Francisco State University Joint Graduate Program in Physical Therapy, San Francisco, California
| | - Glenna A Dowling
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California
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Keller M, Röttger K, Taube W. Ice skating promotes postural control in children. Scand J Med Sci Sports 2014; 24:e456-461. [PMID: 24739083 DOI: 10.1111/sms.12230] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 01/18/2023]
Abstract
High fall rates causing injury and enormous financial costs are reported for children. However, only few studies investigated the effects of balance training in children and these studies did not find enhanced balance performance in postural (transfer) tests. Consequently, it was previously speculated that classical balance training might not be stimulating enough for children to adequately perform these exercises. Therefore, the aim of this study is to evaluate the influence of ice skating as an alternative form of balance training. Volunteers of an intervention (n = 17; INT: 13.1 ± 0.4 years) and a control group (n = 13; CON: 13.2 ± 0.3 years) were tested before and after training in static and dynamic postural transfer tests. INT participated in eight sessions of ice skating during education lessons, whereas CON participated in normal physical education. Enhanced balance performance was observed in INT but not in CON when tested on an unstable free-swinging platform (P < 0.05) or when performing a functional reach test (P < 0.001). This is the first study showing significantly enhanced balance performance after ice skating in children. More importantly, participating children improved static and dynamic balance control in postural tasks that were not part of the training.
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Affiliation(s)
- M Keller
- Movement and Sport Science, Department of Medicine, University of Fribourg, Fribourg, Switzerland
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29
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Jaume-i-Capo A, Martinez-Bueso P, Moya-Alcover B, Varona J. Interactive Rehabilitation System for Improvement of Balance Therapies in People With Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng 2014; 22:419-27. [DOI: 10.1109/tnsre.2013.2279155] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Analysis of postural stability in children with cerebral palsy and children with typical development: an observational study. Pediatr Phys Ther 2014; 26:325-30. [PMID: 24979087 DOI: 10.1097/pep.0000000000000060] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze and compare postural stability during static upright standing between children with cerebral palsy (CP) and age-matched peers with typical development (TD). METHODS Forty-five children with spastic CP (34 with diplegia and 11 with hemiplegia) and 45 children with TD aged 5 to 12 years were assessed using a posturography device. Postural stability was evaluated under 4 sensory conditions: eyes open and eyes closed on a firm surface; eyes open and eyes closed on a foam surface. RESULTS Statistically significant differences were obtained between children with spastic diplegic CP and children with TD under all conditions involving visual and somatosensory conflicts (P < .05), but no significant differences were found between children with hemiplegic CP and children with TD. CONCLUSION Children with spastic diplegic CP have increased postural instability under sensory conditions that involve both visual and somatosensory conflicts.
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31
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Saether R, Helbostad JL, Riphagen II, Vik T. Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review. Dev Med Child Neurol 2013; 55:988-99. [PMID: 23679987 DOI: 10.1111/dmcn.12162] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2013] [Indexed: 01/26/2023]
Abstract
We aimed to review tools used to assess balance in clinical practice in children and adults with cerebral palsy (CP), to describe their content and measurement properties and to evaluate the quality of the studies that have examined these properties. CINAHL, Embase, and PubMed/MEDLINE were searched. The COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) was used to assess the 'quality of studies' and the Terwee criteria were used to assess the 'result of studies'. Twenty-two clinical balance tools were identified from 35 papers. The content and focus of the tools varied significantly. There was moderate or limited levels of evidence for most of the measurement properties of the tools; the strongest level of evidence was found for the Trunk Control Measurement Scale and the Level of Sitting Scale, in the category 'maintain balance', the Timed Up and Go and the Segmental Assessment of Trunk Control in the categories 'achieve balance' and 'restore balance' respectively. Information on responsiveness was scarce. Further studies providing better evidence for reliability and responsiveness for clinical balance tools are needed. In the meantime, results of studies evaluating effects of treatment of balance in individuals with CP should be interpreted with caution.
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Affiliation(s)
- Rannei Saether
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Paediatrics, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Rojas VG, Rebolledo GM, Muñoz EG, Cortés NI, Gaete CB, Delgado CM. Differences in standing balance between patients with diplegic and hemiplegic cerebral palsy. Neural Regen Res 2013; 8:2478-83. [PMID: 25206558 PMCID: PMC4146108 DOI: 10.3969/j.issn.1673-5374.2013.26.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 07/20/2013] [Indexed: 11/24/2022] Open
Abstract
Maintaining standing postural balance is important for walking and handling abilities in patients with cerebral palsy. This study included 23 patients with cerebral palsy (seven with spastic diplegia and 16 with spastic hemiplegia), aged from 7 to 16 years of age. Standing posture balance measurements were performed using an AMTI model OR6-7 force platform with the eyes open and closed. Patients with diplegic cerebral palsy exhibited greater center of pressure displacement areas with the eyes open and greater center of pressure sway in the medial-lateral direction with the eyes open and closed compared with hemiplegic patients. Thus, diplegic patients exhibited weaker postural balance control ability and less standing stability compared with hemiplegic cerebral palsy patients.
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Affiliation(s)
- Valeska Gatica Rojas
- Laboratory of Human Motor Control, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Guillermo Méndez Rebolledo
- Laboratory of Human Motor Control, School of Kinesiology, Faculty of Health Sciences, University of Talca, Talca, Chile
| | | | - Natalia Ibarra Cortés
- Student School of Kinesiology, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Caterine Berrios Gaete
- Student School of Kinesiology, Faculty of Health Sciences, University of Talca, Talca, Chile
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El-Shamy SM, Abd El Kafy EM. Effect of balance training on postural balance control and risk of fall in children with diplegic cerebral palsy. Disabil Rehabil 2013; 36:1176-83. [PMID: 24032716 DOI: 10.3109/09638288.2013.833312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of balance training on postural control and fall risk in children with diplegic cerebral palsy. METHODS Thirty spastic diplegic cerebral palsied children (10-12 years) were included in this study. Children were randomly assigned into two equal-sized groups: control and study groups. Participants in both groups received a traditional physical therapy exercise program. The study group additionally received balance training on the Biodex balance system. Treatment was provided 30 min/d, 3 d/week for 3 successive months. To evaluate the limit of stability and fall risk, participated children received baseline and post-treatment assessments using the Biodex balance system. Overall directional control, total time to complete the test, overall stability index of the fall risk test and total score of the pediatric balance scale were measured. RESULTS Children in both groups showed significant improvements in the mean values of all measured variables post-treatment (p < 0.05). The results also showed significantly better improvement in the measured parameters for the study group, as compared to the control group (p < 0.05). CONCLUSION Balance training on Biodex system is a useful tool that can be used in improving postural balance control in children with diplegic cerebral palsy.
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Affiliation(s)
- Shamekh Mohamed El-Shamy
- Physical Therapy for Disturbance of Growth and Development in Children and its Surgery, Faculty of Physical Therapy, Cairo University , Egypt and
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Slaboda JC, Lauer RT, Keshner EA. Postural responses of adults with cerebral palsy to combined base of support and visual field rotation. IEEE Trans Neural Syst Rehabil Eng 2013; 21:218-24. [PMID: 23476004 DOI: 10.1109/tnsre.2013.2246583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We employed a virtual environment to examine the postural behaviors of adults with cerebral palsy (CP). Four adults with CP (22-32 years) and nine healthy adults (21-27 years) were tested with a Rod and Frame protocol. They then stood quietly on a platform within a three-wall virtual environment. The platform was either kept stationary or tilted 3(°) into dorsiflexion in the dark or with pitch up and down visual field rotations at 30(°)/s and 45(°)/s. While the visual field rotated, the platform was held tilted for 30 s and then slowly returned to a neutral position over 30 s. Center of pressure (CoP) was recorded and center of mass (CoM) as well as trunk and ankle angles were calculated. Electromyography (EMG) responses of the ankle and the hip muscles were recorded and analyzed using wavelets. Larger angular deviations from vertical and horizontal in the Rod and Frame test indicated that adults with CP were more visually dependent than healthy adults. Adults with CP had difficulty maintaining balance when standing on a stationary platform during pitch upward rotation of the visual scene. When the platform was tilted during visual field rotations, adults with CP took longer to stabilize their posture and had larger CoM oscillations than when in the dark. The inability to compensate for busy visual environments could impede maintenance of functional locomotion in adults with CP. Employing a visual field stimulus for assessment and training of postural behaviors would be more meaningful than testing in the dark.
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Affiliation(s)
- Jill C Slaboda
- Department of Physical Therapy, Temple University, Philadelphia, PA 19140, USA.
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Pyzio-Kowalik M, Wójtowicz D, Skrzek A. Assessing postural asymmetry with a podoscope in infants with Central Coordination Disturbance. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1832-1842. [PMID: 23523987 DOI: 10.1016/j.ridd.2013.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to digitally evaluate the incidence and severity of postural asymmetry in infants with Central Coordination Disturbance (CCD) by using a computer-aided podoscope (PodoBaby) from CQ Elektronik System. A sample of 120 infants aged from 3 months (± 1 week) to 6 months (± 1 week) took part in the study, of which 60 were diagnosed with CCD by a neurologist using Vojta's method and the remaining half healthy, non-afflicted infants. The relationships between Vojta's method, as a subjective clinical diagnostic tool for assessing the functional performance of infants with CCD, and the postural asymmetry results recorded with the podoscope, were also defined. Each infant was placed on the podoscope and photographed underneath in two positions: first lying on their back and then on their stomach. A symmetry index was used to calculate body asymmetry, i.e., the percent difference of abnormal body posture by favoring one side of the body to the other. The results confirmed that postural asymmetry assessed by the PodoBaby was in line with the earlier clinical diagnosis using Vojta's method. Statistically significant differences in postural asymmetry were also found between the healthy infants and infants with CCD. In addition, significant relationships were demonstrated in the magnitude and direction of asymmetry in the stomach and back positions.
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Visicato LP, Costa CSND, Taube OLS, Campos ACD. Proposta de atuação fisioterapêutica em uma criança com síndrome de Angelman, enfatizando o equilíbrio postural: estudo de caso. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A síndrome de Angelman (SA) é caracterizada por alterações neuromotoras como marcha atáxica e atraso na aquisição de habilidades motoras, porém são escassos os estudos investigando o efeito de intervenções aplicadas a essa população. O objetivo do estudo foi verificar o efeito de um treino de equilíbrio em uma criança com SA. Participou do estudo uma criança de nove anos de idade com diagnóstico de SA, sexo feminino. Foi aplicado um protocolo para treino de equilíbrio por oito semanas, com frequência de duas vezes por semana. O treino consistiu em atividades envolvendo equilíbrio estático sob diversas condições de dificuldade. Após o treino, a análise de biofotogrametria computadorizada do equilíbrio estático revelou redução do grau de oscilação, que passou de 38° para 13,78°. A pontuação na escala de Berg passou de 27 pontos, na avaliação, para 37 pontos na reavaliação. No teste Timed Up & Go, a criança realizou a tarefa em 15 segundos, na avaliação, e, na reavaliação, em 12 segundos. Em conjunto, os resultados sugerem que o treino favoreceu melhora no equilíbrio estático e dinâmico, bem como na mobilidade funcional.
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Lopes GHR, David ACD. Posturografia na análise do equilíbrio em crianças com paralisia cerebral: revisão de literatura. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000100016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Crianças com paralisia cerebral (PC) apresentam menor equilíbrio postural pelo comprometimento de funções motoras, sensoriais e centrais. Existem diversos protocolos funcionais para análise do equilíbrio, mas poucos estudos têm utilizado a plataforma de força como instrumento de precisão nessa avaliação. O objetivo desta revisão foi identificar artigos publicados que utilizaram essa avaliação em crianças com PC e analisar os protocolos e parâmetros utilizados. Para tanto, foi realizada uma busca nas seguintes bases de dados: LILACS, IBECS, MEDLINE, Biblioteca Cochrane e SciELO, por meio da Biblioteca Virtual em Saúde. Foram encontrados 165 artigos; a partir dos critérios de inclusão e exclusão, foram selecionados 16 artigos. Os estudos mostraram que os parâmetros lineares de deslocamento médio-lateral e anteroposterior do centro de pressão e a razão desses deslocamentos têm sido utilizados com maior frequência, e que o tempo de avaliação na plataforma de força, na maioria dos estudos, não excede os 20 segundos. Foi demonstrado ainda que crianças com desenvolvimento típico apresentam melhor controle postural, e que crianças com PC podem incrementar seu equilíbrio a partir de intervenções específicas, inclusive em plataforma de força.
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Baram Y, Lenger R. Gait improvement in patients with cerebral palsy by visual and auditory feedback. Neuromodulation 2011; 15:48-52; discussion 52. [PMID: 22151772 DOI: 10.1111/j.1525-1403.2011.00412.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To study the effects of gait training with visual and auditory feedback cues on the walking abilities of patients with gait disorders due to cerebral palsy. MATERIALS AND METHODS Visual and auditory feedback cues were generated by a wearable device, driven by inertial sensors. Ten randomly selected patients with gait disorders due to cerebral palsy and seven age-matched healthy individuals trained with visual feedback cues, while ten patients and eight age-matched healthy individuals trained with auditory feedback cues. Baseline performance (walking speed and stride length along a 10-m straight track) was measured before device use. Following 20-min training with the device and a 20-min break, performance without the device was measured again and compared with the baseline performance. RESULTS For the patients who trained with visual feedback, the average improvement was 21.70% ± 36.06% in the walking speed and 8.72% ± 9.47% in the stride length. For the patients who trained with auditory feedback, the average improvement was 25.43% ± 28.65% in the walking speed and 13.58% ± 13.10% in the stride length. For the healthy individuals who trained with visual feedback, the average improvement was -2.41% ± 9.54% in the walking speed and -2.84% ± 10.11% in the stride length. For the healthy individuals who trained with auditory feedback, the average improvement was 0.01% ± 7.73% in the walking speed and -2.03% ± 6.15% in the stride length. CONCLUSIONS Training with visual and auditory feedback cues can improve gait parameters in patients with gait disorders due to cerebral palsy. This was contrasted by no improvement in age-matched healthy individuals.
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Affiliation(s)
- Yoram Baram
- Computer Science Department, Technion-Israel Institute of Technology, Haifa, Israel; and ILAN-Israel Foundation for Handicapped Children, Haifa, Israel
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Barela JA, Focks GMJ, Hilgeholt T, Barela AMF, Carvalho RDP, Savelsbergh GJP. Perception-action and adaptation in postural control of children and adolescents with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:2075-2083. [PMID: 21985991 DOI: 10.1016/j.ridd.2011.08.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 08/22/2011] [Indexed: 05/31/2023]
Abstract
The aim of this study was to examine the coupling between visual information and body sway and the adaptation in this coupling of individuals with cerebral palsy (CP). Fifteen children with and 15 without CP, 6-15 years old, were required to stand upright inside of a moving room. All children first performed two trials with no movement of the room and eyes open or closed, then four trials in which the room oscillated at 0.2 or 0.5 Hz (peak velocity of 0.6 cm/s), one trial in which the room oscillated at 0.2 Hz (peak velocity of 3.5 cm/s), and finally two other trials in which the room oscillated again at 0.2 Hz (peak velocity of 0.6 cm/s). Participants with CP coupled body sway to visual information provided by the moving room, comparable to the coupling of participants without CP. However, participants with CP exhibited larger body sway in maintaining upright position and more variable sway when body sway was induced by visual manipulation. They showed adaptive sensory motor coupling, e.g. down-weighting visual influence when a larger stimulus was provided, but not with the same magnitude as typically developing participants. This indicates that participants with CP have less capability of adaptation.
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Affiliation(s)
- José A Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University - São Paulo, SP, Brazil.
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Granacher U, Muehlbauer T, Maestrini L, Zahner L, Gollhofer A. Can Balance Training Promote Balance and Strength in Prepubertal Children? J Strength Cond Res 2011; 25:1759-66. [DOI: 10.1519/jsc.0b013e3181da7886] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Granacher U, Gollhofer A, Kriemler S. Effects of balance training on postural sway, leg extensor strength, and jumping height in adolescents. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2010; 81:245-251. [PMID: 20949844 DOI: 10.1080/02701367.2010.10599672] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Deficits in strength of the lower extremities and postural control have been associated with a high risk of sustaining sport-related injuries. Such injuries often occur during physical education (PE) classes and mostly affect the lower extremities. Thus, the objectives of this study were to investigate the effects of balance training on postural sway, leg extensor strength, and jumping height in adolescents. Twenty high school students participated in this study and were assigned to either an intervention (n = 10) or control group (n = 10). The intervention group participated in a 4-week balance-training program integrated in their physical education lessons. Pre- and posttests included the measurements of postural sway on a balance platform, jumping height on a force platform, and maximal isometric leg extension force on a leg-press. Balance training resulted in significantly improved postural control, increased jumping height, and enhanced rate of force development of the leg extensors. Physiological adaptations rather than learning effects seem to be responsible for the observed findings. These results could have an impact on improving the performance level in various sports and on reducing the injury prevalence of the lower extremities.
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Affiliation(s)
- Urs Granacher
- Institute of Exercise and Health Sciences at the University of Basel, Switzerland.
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Granacher U, Muehlbauer T, Gollhofer A, Kressig RW, Zahner L. An intergenerational approach in the promotion of balance and strength for fall prevention - a mini-review. Gerontology 2010; 57:304-15. [PMID: 20720401 DOI: 10.1159/000320250] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 06/21/2010] [Indexed: 12/31/2022] Open
Abstract
The risk of sustaining a fall is particularly high in children and seniors. Deficits in postural control and muscle strength either due to maturation, secular declines or biologic aging are two important intrinsic risk factors for falls. During life span, performance in variables of static postural control follows a U-shaped curve with children and seniors showing larger postural sway than healthy adults. Measures of dynamic postural control (i.e. gait speed) as well as isometric (i.e. maximal strength) and dynamic muscle strength (i.e. muscular power) follow an inverted U-shaped curve during life span, again with children and seniors showing deficits compared to adults. There is evidence that particularly balance and resistance training are effective in counteracting these neuromuscular constraints in both children and seniors. Further, these training regimens are able to reduce the rate of sustaining injuries and falls in these age groups. An intergenerational intervention approach is suggested to enhance the effectiveness of these training programs by improving compliance and increasing motivation of children and seniors exercising together. Thus, the objectives of this mini-review are: (1) to describe the epidemiology and etiology of falls in children and seniors; (2) to discuss training programs that counteract intrinsic fall risk factors by reducing the rate of falling, and (3) to present an intergenerational approach that has the potential to make training programs even more effective by including children and seniors together in one exercise group.
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Affiliation(s)
- Urs Granacher
- Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland.
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Anttila H, Autti-Rämö I, Suoranta J, Mäkelä M, Malmivaara A. Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review. BMC Pediatr 2008; 8:14. [PMID: 18435840 PMCID: PMC2390545 DOI: 10.1186/1471-2431-8-14] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 04/24/2008] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP). METHODS A search was made in Medline, Cinahl, PEDro and the Cochrane library for the period 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health (ICF). RESULTS Twenty-two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited due to low methodological quality and the statistically insignificant results of the studies. CONCLUSION Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well-designed trials are needed especially for focused PT interventions.
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Affiliation(s)
- Heidi Anttila
- Finnish Office for Health Technology Assessment (FinOHTA), at the National Research and Development Centre for Welfare and Health (STAKES), PO Box 220, FIN-00531 Helsinki, Finland.
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Sidaway B, Ahn S, Boldeau P, Griffin S, Noyes B, Pelletier K. A Comparison of Manual Guidance and Knowledge of Results in the Learning of a Weight-bearing Skill. J Neurol Phys Ther 2008; 32:32-8. [PMID: 18463553 DOI: 10.1097/npt.0b013e318165948d] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Donker SF, Ledebt A, Roerdink M, Savelsbergh GJP, Beek PJ. Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children. Exp Brain Res 2007; 184:363-70. [PMID: 17909773 PMCID: PMC2137946 DOI: 10.1007/s00221-007-1105-y] [Citation(s) in RCA: 178] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 08/13/2007] [Indexed: 11/28/2022]
Abstract
Following recent advances in the analysis of centre-of-pressure (COP) recordings, we examined the structure of COP trajectories in ten children (nine in the analyses) with cerebral palsy (CP) and nine typically developing (TD) children while standing quietly with eyes open (EO) and eyes closed (EC) and with concurrent visual COP feedback (FB). In particular, we quantified COP trajectories in terms of both the amount and regularity of sway. We hypothesised that: (1) compared to TD children, CP children exhibit a greater amount of sway and more regular sway and (2) concurrent visual feedback (creating an external functional context for postural control, inducing a more external focus of attention) decreases both the amount of sway and sway regularity in TD and CP children alike, while closing the eyes has opposite effects. The data were largely in agreement with both hypotheses. Compared to TD children, the amount of sway tended to be larger in CP children, while sway was more regular. Furthermore, the presence of concurrent visual feedback resulted in less regular sway compared to the EO and EC conditions. This effect was less pronounced in the CP group where posturograms were most regular in the EO condition rather than in the EC condition, as in the control group. Nonetheless, we concluded that CP children might benefit from therapies involving postural tasks with an external functional context for postural control.
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Affiliation(s)
- Stella F. Donker
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
- Department of Otorhinolaryngology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Annick Ledebt
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - Melvyn Roerdink
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - Geert J. P. Savelsbergh
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
- Research Institute for Biophysical and Clinical Research into Human Movement, Manchester Metropolitan University, Manchester, UK
| | - Peter J. Beek
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
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Abstract
Cerebral palsy (CP) is one of the most common conditions we follow in our pediatric neurology offices. This review will hopefully convince you that the care of children with CP extends far beyond the diagnosis. The review addresses issues surrounding diagnosis, coimpairments, prognosis, and family-centeredness of care. It will also deal with routine office follow-up to prevent or identify complications, management of spasticity and other morbidities, alternative and complementary therapies, and finally transition.
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Affiliation(s)
- Ellen Wood
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
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