Toward a methodology of the short-term effects of neurodevelopmental treatment

Single-case Design Studies in Children with Cerebral Palsy: A Scoping Review

Aim: To critically evaluate single-case design (SCD) studies performed within the population of children/adolescents with cerebral palsy (CP).Methods: A scoping review of SCD studies of children/adolescents with CP. Demographic, methodological, and statistical data were extracted. Articles were evaluated using the Risk of Bias in N-of-1 Trials (RoBiNT) Scale and the Consolidated Standards of Reporting Trials (CONSORT) extension for N-of-1 trials (CENT 2015). Comments regarding strengths and limitations were analyzed.Results: Studies investigated the effects of a wide range of interventions on various outcomes. Most SCD types were adopted in multiple studies. All studies used visual inspection rather than visual analysis, often complemented with basic statistical descriptives. Risk of bias was high, particularly concerning internal validity. Many CENT items were insufficiently reported. Several benefits and limitations of SCD were identified.Conclusions: The quality of evidence from results of SCD studies needs to be increased through risk of bias reduction.

Teaching Postural Reactions to Students with Severe Cerebral Palsy: An Evaluation of Theory and Technique

Neuromotor intervention approaches, based on central nervous system development among nonhandicapped infants and young children, are presently the most popular motor training approaches with cerebral palsied children. Empirical data in support of neuromotor or other approaches to motor training, however, are lacking. In response to the absence of a data base, the theoretical basis and effectiveness of a neuromotor intervention was investigated across seven cerebral palsied, severely handicapped children, ages 2 1/2 to 12 years. Results suggested a training effect in the data of three children. Theoretical relationships among abnormal tonic reflexes and normal motor patterns were not supported by the data. Because results were not consistent across all children, it was suggested that future research focus on subject characteristics that may relate to the effectiveness of intervention. Additionally, recommendations were made regarding measurement systems for evaluating change, and strategies for investigating multicomponent training procedures.

Facilitating the Acquisition of Sensorimotor Behavior with a Microcomputer-Mediated Teaching System: An Experimental Analysis

The effects of a combined neuromotor/behavioral approach on the acquisition of basic motor skills by young children with severe and multiple disabilities was examined. Two children, 17 and 24 months of age, were provided training via a microcomputer-mediated teaching system. Specific questions addressed were: (a) Do basic motor skills improve as a result of direct training using a neuromotor/behavioral approach? (b) Does generalization occur to other settings? (c) Do students demonstrate maintenance of the target skills once training has been terminated? (d) Can the microcomputer-mediated teaching system accurately reinforce and measure students' performance of the target motor behaviors? A multiple probe across behaviors design was used. Results indicated that the children increased the frequency and duration of the target behaviors in both the training and generalization settings. Maintenance of the effects was also demonstrated. These findings are discussed in light of the efficacy of using a neuromotor/behavioral training approach. Issues related to the implementation of a microcomputer-mediated teaching system in a classroom setting are also discussed.

Improving Prehension Skills of Children with Cerebral Palsy: A Clinical Study

The purpose of this study was to obtain preliminary data concerning the effectiveness of two treatment procedures—weight bearing on extended arms and passive trunk rotation—on the development of prehension skills. A multiple baseline across subjects, with reversal phases, research design was used. Measurement procedures were designed to be sensitive to small behavioral changes in the prehension skills of three children with spastic cerebral palsy. Eight movement components of reach, grasp, and release were measured. Prehension skills of all three subjects showed improvement as a result of weight bearing on extended arms. No measurable changes were observed as a result of passive trunk rotation. Results indicate that this type of measurement procedure is sensitive to the small behavioral changes seen frequently in the treatment of cerebral palsy.

Relationship of Upper Extremity Weight Bearing to Hand Skills of Boys with Cerebral Palsy

The purpose of this study was to obtain data concerning the relationship between a commonly used treatment technique—weight bearing on extended arms—and the reach, grasp, and release skills of 3 boys with spastic cerebral palsy. A multiple-baseline, across-subjects research design was used. With the possible exception of the results for one arm of 1 subject, the results indicated that the technique had a positive relationship with the prehension skills of the 3 boys. Direct and systematic replication is warranted to determine the generalizability of this technique. Although the results of studies of isolated techniques, such as weight bearing on upper extremities, cannot be generalized to total treatment procedures, they do provide tentative support for the use of commonly used techniques and direction for studies of total treatment approaches.

A Comparison of Service Provision Models in School-Based Occupational Therapy Services: A Pilot Study

Occupational therapists provide services to children within a number of service provision models. Although the literature discusses these service provision models, there have been very few investigations to identify the effects of these models. This pilot study compared the provision of direct serice (DS) and collaborative consultation (C) in 14 preschoolers and kindergarteners randomly assigned to interventions. Individualized Education Program goal attainment was used as the measure of educationally relevant child outcomes. Therapists and teachers completed an attitude survey before and after participating in the study. Pilot study results indicate that although children in both conditions achieved a similar percentage of IEP goals, teachers in the C condition reported much larger occupational therapy contributions to IEP goals and had more positive comments on the attitude scale. Results suggest that similar levels of goal attainment can be achieved in direct service and consultation, and that the relationships that develop between therapists and teachers may lead to a more positive overall view of the learning environment and the contribution of occupational therapy to that environment. Further study is needed to identify additional service provision factors that contribute to successful program outcomes.

Reliability and Validity of the Posture and Fine Motor Assessment of Infants

The Posture and Fine Motor Assessment of Infants (PFMAI) (Case-Smith, 1987) is a newly developed instrument for assessing the quality of motor function in infants. The test measures components of posture and fine motor control as they first develop. The purpose of this study was to support the test's reliability and validity. Interrater reliability, analyzed with intraclass correlation coefficients (ICCs), was high (.989 for total scores). Test-retest reliability, measured by ICCs, was .853 and .913 for the two test sections. The PFMAI demonstrated concurrent validity with the Peabody Developmental Motor Scales, Revised (Folio & Fewell, 1983) (correlations were .673 and .829 for the individual sections). Scores on the PFMAI were highly correlated with the infant's ages (.892 to .941); this finding provided one indication of construct validity.

Intraoperative monitoring during selective posterior rhizotomy: technique and patient outcome

We evaluated intraoperative electromyographic (EMG) results among 110 pediatric patients with spastic cerebral palsy who underwent selective posterior rhizotomy. We analyzed surgical outcomes for 60 of these patients who returned for follow-up assessment between 4 and 17 months postoperatively. Reduction in muscle tone (resistance to passive movement), increased range of motion and improvements in functional skills were seen at follow-up. To control for possible changes due to development, participation in therapy, or instability of measurements, 30 rhizotomy patients were evaluated twice during a baseline period of several months prior to surgery. No significant changes were found between these two measurement sessions during the baseline control period suggesting that the rhizotomy surgery itself caused the postoperative improvements. These intraoperative EMG monitoring techniques have been adopted at many other centers but variations in specific methods and EMG criteria have developed subsequently among major hospitals where selective posterior rhizotomy is performed. These variations in neurophysiologic methods and recent controversy about the usefulness of such intraoperative EMG monitoring created a need for us to publish our standard EMG selection technique. We describe here, in detail, methods for nerve rootlet testing and selection.

An experimental analysis of a neurobehavioral motor intervention

This study reports the effects of a neurobehavioral intervention approach on the motor skills of four children with cerebral palsy between 21 and 34 months of age. The intervention is based on the merging of neuromotor and behavioral approaches. The behavioral approach, using principles of 'how to teach', addressed motivational issues and allowed for precise definitions of expected outcomes which assisted in measuring acquisition and generalization of behaviors. The neuromotor approach provided 'what to teach' by focusing the intervention on underlying movement components (e.g., trunk rotation, weight bearing) rather than discrete milestone skills. The impact of the approach was assessed using a multiple-baseline design replicated three times. The children demonstrated the movement component by using it to perform both a treated exemplar skill (i.e. a motor skill requiring the movement component for execution) and an untreated exemplar skill.

Effects of upper-extremity weight-bearing on hand-opening and prehension patterns in children with cerebral palsy

The purpose of this study was to determine whether upper-extremity weight-bearing has an effect on hand-opening and prehension patterns of children with spastic cerebral palsy. Children at the Bobath Centre (London) were studied. Effectiveness of intervention was determined by blind scoring of video-tapes of prehension components. Computer calculations of hand surface-area were done. There was an over-all increase in surface area, indicating an increased ability to open the hand; in addition, there was an increase in the maturity of movement components of prehension. These results provide relevant information about the application of upper-extremity weight-bearing.

Single subject research designs in occupational therapy literature

This paper examines two years (1982-1983) of publications appearing in four occupational therapy journals in order to determine the type and proportion of articles which are descriptive, survey, correlational, case studies (including single subject design), quasi-experimental, or practical. In addition, a detailed analysis of articles using single subject methodology in occupational therapy is reported. The appropriateness of several single subject research designs in occupational therapy is discussed.