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Hoskens J, Schiava M, Goemans N, Feys H, McDermott MP, Martens WB, Mayhew A, Griggs RC, Klingels K, Guglieri M. Reference curves of motor function outcomes in young steroid-naïve males with Duchenne muscular dystrophy. Dev Med Child Neurol 2024; 66:644-653. [PMID: 37885269 DOI: 10.1111/dmcn.15788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023]
Abstract
AIM To investigate functional motor performance in a large cohort of young steroid-naïve males with Duchenne muscular dystrophy (DMD) and typically developing males, and to develop specific reference curves for both groups. Also, to describe associations between anthropometric values and functional motor outcomes. METHOD Cross-sectional data of 196 steroid-naïve males with DMD aged 4 to 8 years and 497 typically developing males aged 2 years 6 months to 8 years were included. Both groups were evaluated with the time to rise from the floor test, 10-metre walk/run test, 6-minute walk test, and North Star Ambulatory Assessment. Reference curves with centiles 5%, 10%, 25%, 50%, 75%, 90%, and 95% were estimated using quantile regression. RESULTS Males with DMD scored significantly worse on all functional motor outcomes than age-matched typically developing males (p < 0.001): 89% to 95% of the males with DMD scored below the 5th centile of the typically developing males. No or weak correlations exist between anthropometric values and functional motor outcomes. INTERPRETATION The estimated reference curves can support consultation with families of young males with DMD and can support the evaluation of treatment for reaching motor skills and functional motor outcomes compared with typically developing males.
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Affiliation(s)
- Jasmine Hoskens
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), UHasselt, Leuven, Belgium
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Leuven, Belgium
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle upon Tyne, UK
| | - Nathalie Goemans
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Leuven, Belgium
| | - Michael P McDermott
- Department of Neurology, University of Rochester Medical Centre, Rochester, NY, USA
- Department of Biostatistics and Computational Biology, University of Rochester Medical Centre, Rochester, NY, USA
| | - William B Martens
- Department of Neurology, University of Rochester Medical Centre, Rochester, NY, USA
| | - Anna Mayhew
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle upon Tyne, UK
| | - Robert C Griggs
- Department of Neurology, University of Rochester Medical Centre, Rochester, NY, USA
| | - Katrijn Klingels
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), UHasselt, Leuven, Belgium
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Leuven, Belgium
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle upon Tyne, UK
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Velghe S, Rameckers E, Meyns P, Johnson C, Hallemans A, Verbecque E, Klingels K. Effects of a highly intensive balance therapy camp in children with developmental coordination disorder - An intervention protocol. Res Dev Disabil 2024; 147:104694. [PMID: 38382234 DOI: 10.1016/j.ridd.2024.104694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Children with Developmental Coordination Disorder (DCD) often (<87 %) experience postural control problems, impacting all levels of the International Classification of Functioning, Disability and Health (ICF) including their daily participation, self-esteem and mental health. Due to the multisystemic nature of postural control, comprehensive therapy should target all systems which is currently not the case. Highly intensive therapy is effective and commonly used in pediatric populations, but has not been explored yet to train postural control in children with DCD. AIMS To investigate the effects of a highly intensive functional balance therapy camp at all ICF levels in children with DCD. METHODS AND PROCEDURES The effects on postural control, muscle activity, brain alterations, self-perceived competence, self-identified goals, gross motor activities and participation are evaluated. Participants are assessed pre- and post-intervention, including a 3 months follow-up. Forty-eight children with DCD, aged 6-12 years old, receive 40 h of comprehensive balance training. This intervention is fun, individually tailored, targets all postural control systems, implements different motor learning strategies and includes both individual and group activities. CONCLUSION Novel insights into the effects of a highly intensive comprehensive balance therapy camp designed for children with DCD will be gained at all levels of the ICF.
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Affiliation(s)
- Silke Velghe
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
| | - Eugene Rameckers
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation research line, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, the Netherlands
| | - Pieter Meyns
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Charlotte Johnson
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Research group MOVANT, University of Antwerp, Antwerp, Belgium
| | - Ann Hallemans
- Research group MOVANT, University of Antwerp, Antwerp, Belgium
| | - Evi Verbecque
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Katrijn Klingels
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Kleeren L, Mailleux L, McLean B, Elliott C, Dequeker G, Van Campenhout A, de Xivry JJO, Verheyden G, Ortibus E, Klingels K, Feys H. Does somatosensory discrimination therapy alter sensorimotor upper limb function differently compared to motor therapy in children and adolescents with unilateral cerebral palsy: study protocol for a randomized controlled trial. Trials 2024; 25:147. [PMID: 38409060 PMCID: PMC10895830 DOI: 10.1186/s13063-024-07967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Besides motor impairments, up to 90% of the children and adolescents with unilateral cerebral palsy (uCP) present with somatosensory impairments in the upper limb. As somatosensory information is of utmost importance for coordinated movements and motor learning, somatosensory impairments can further compromise the effective use of the impaired upper limb in daily life activities. Yet, intervention approaches specifically designated to target these somatosensory impairments are insufficiently investigated in children and adolescents with uCP. Therefore, the aim of this randomized controlled trial (RCT) is to compare the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP, who experience somatosensory impairments in the upper limb. We will further explore potential behavioral and neurological predictors of therapy response. METHODS A parallel group, evaluator-blinded, phase-II, single-center RCT will be conducted for which 50 children and adolescents with uCP, aged 7 to 15 years, will be recruited. Participants will be randomized to receive 3 weekly sessions of 45 minutes of either somatosensory discrimination therapy or upper limb motor therapy for a period of 8 weeks. Stratification will be performed based on age, manual ability, and severity of tactile impairment at baseline. Sensorimotor upper limb function will be evaluated at baseline, immediately after the intervention and after 6 months follow-up. The primary outcome measure will be bimanual performance as measured with the Assisting Hand Assessment. Secondary outcomes include a comprehensive test battery to objectify somatosensory function and measures of bimanual coordination, unimanual motor function, and goal attainment. Brain imaging will be performed at baseline to investigate structural brain lesion characteristics and structural connectivity of the white matter tracts. DISCUSSION This protocol describes the design of an RCT comparing the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP. The results of this study may aid in the selection of the most effective upper limb therapy, specifically for children and adolescents with tactile impairments. TRIAL REGISTRATION ClinicalTrials.gov (NCT06006065). Registered on August 8, 2023.
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Affiliation(s)
- Lize Kleeren
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium.
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium.
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, B-3590, Belgium.
| | - Lisa Mailleux
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
| | - Belinda McLean
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Kids Rehab WA, Telethon Kids Institute, Perth, Australia
| | - Catherine Elliott
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Kids Rehab WA, Telethon Kids Institute, Perth, Australia
| | - Griet Dequeker
- University Hospitals Leuven, Cerebral Palsy Reference Centre, Leuven, B-3000, Belgium
| | - Anja Van Campenhout
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
- University Hospitals Leuven, Cerebral Palsy Reference Centre, Leuven, B-3000, Belgium
- KU Leuven, Department of Development and Regeneration, Leuven, B-3000, Belgium
| | - Jean-Jacques Orban de Xivry
- KU Leuven, Leuven Brain Institute, Leuven, B-3000, Belgium
- KU Leuven, Department of Movement Sciences, Research Group of Motor Control and Neuroplasticity, Leuven, B-3000, Belgium
| | - Geert Verheyden
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
| | - Els Ortibus
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
- University Hospitals Leuven, Cerebral Palsy Reference Centre, Leuven, B-3000, Belgium
- KU Leuven, Department of Development and Regeneration, Leuven, B-3000, Belgium
| | - Katrijn Klingels
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, B-3590, Belgium
| | - Hilde Feys
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
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van der Veer IPA, Rameckers EAA, Steenbergen B, Bastiaenen CHG, Klingels K. How do paediatric physical therapists teach motor skills to children with Developmental Coordination Disorder? An interview study. PLoS One 2024; 19:e0297119. [PMID: 38300942 PMCID: PMC10833570 DOI: 10.1371/journal.pone.0297119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND When teaching motor skills, paediatric physical therapists (PPTs) use various motor learning strategies (MLSs), adapting these to suit the individual child and the task being practised. Knowledge about the clinical decision-making process of PPTs in choosing and adapting MLSs when treating children with Developmental Coordination Disorder (DCD) is currently lacking. Therefore, this qualitative study aimed to explore PPTs' use of MLSs when teaching motor skills to children with DCD. METHODS Semi-structured individual and group interviews were conducted with PPTs with a wide range of experience in treating children with DCD. A conventional content analysis approach was used where all transcripts were open-coded by two reviewers independently. Categories and themes were discussed within the research group. Data were collected until saturation was reached. RESULTS Twenty-six PPTs (median age: 49 years; range: 26-66) participated in 12 individual interviews and two focus-group interviews. Six themes were identified: (1) PPTs treated children in a tailor-made way; (2) PPTs' teaching style was either more indirect or direct; (3) PPTs used various strategies to improve children's motivation; (4) PPTs had reached the optimal level of practice when children were challenged; (5) PPTs gave special attention to automatization and transfer during treatment; and (6) PPTs considered task complexity when choosing MLSs, which appeared determined by task constraints, environmental demands, child and therapist characteristics. CONCLUSION PPTs' clinical decision-making processes in choosing MLSs appeared strongly influenced by therapist characteristics like knowledge and experience, resulting in large variation in the use of MLSs and teaching styles to enhance motivation, automatization, and transfer. This study indicates the importance of the level of education on using MLSs to teach children motor skills, and clinical decision-making. Future research should focus on implementing this knowledge into daily practice.
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Affiliation(s)
- Ingrid P. A. van der Veer
- Rehabilitation Research Centre—REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Eugene A. A. Rameckers
- Rehabilitation Research Centre—REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation Research Line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Caroline H. G. Bastiaenen
- Department of Epidemiology, Functioning, Participation & Rehabilitation Research Line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Katrijn Klingels
- Rehabilitation Research Centre—REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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van der Veer IPA, Bastiaenen CHG, Rameckers EAA, Klingels K. Experts' perspectives on how to promote implicit and explicit motor learning in children: A mixed-methods study. Child Care Health Dev 2024; 50:e13147. [PMID: 37365914 DOI: 10.1111/cch.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Little is known about how motor learning strategies (MLSs) can promote implicit and explicit motor learning processes. This study aimed to explore experts' perspectives on therapists' use of MLSs to promote specific learning processes in children with and without developmental coordination disorder (DCD). METHODS In this mixed-methods study, two consecutive digital questionnaires were used to ascertain the opinions of international experts. Questionnaire 2 explored the findings of Questionnaire 1 in greater depth. In order to reach a certain level of agreement about the classification of MLSs as promoting either (more) implicit or (more) explicit motor learning, 5-point Likert scales were used in addition to open-ended questions. The open-ended questions were analysed with a conventional analysis approach. Open coding was performed by two reviewers independently. Categories and themes were discussed within the research team, taking both questionnaires as one dataset. RESULTS Twenty-nine experts from nine different countries with different backgrounds in research, education and/or clinical care completed the questionnaires. The results of the Likert scales showed large variation. Two themes emerged from the qualitative analyses: (1) Experts found it difficult to classify MLSs as promoting either implicit or explicit motor learning, and (2) experts stressed the need for clinical decisionmaking when choosing MLSs. CONCLUSIONS Insufficient insight was gained into how MLSs could promote (more) implicit or (more) explicit motor learning in children in general and in children with DCD specifically. But this study demonstrated the importance of clinical decisionmaking to model and adapt MLSs to child, task and environment, with therapists' knowledge of MLSs being an important prerequisite. Research is needed to better understand the various learning mechanisms of children and how MLSs can be used to manipulate these mechanisms.
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Affiliation(s)
- Ingrid P A van der Veer
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Functioning, Participation & Rehabilitation Research Line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Eugene A A Rameckers
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation Research Line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - Katrijn Klingels
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Decraene L, Orban de Xivry JJ, Kleeren L, Crotti M, Verheyden G, Ortibus E, Feys H, Mailleux L, Klingels K. In-depth quantification of bimanual coordination using the Kinarm exoskeleton robot in children with unilateral cerebral palsy. J Neuroeng Rehabil 2023; 20:154. [PMID: 37951867 PMCID: PMC10640737 DOI: 10.1186/s12984-023-01278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Robots have been proposed as tools to measure bimanual coordination in children with unilateral cerebral palsy (uCP). However, previous research only examined one task and clinical interpretation remains challenging due to the large amount of generated data. This cross-sectional study aims to examine bimanual coordination by using multiple bimanual robotics tasks in children with uCP, and their relation to task execution and unimanual performance. METHODS The Kinarm exoskeleton robot was used in 50 children with uCP (mean age: 11 years 11 months ± 2 years 10 months, Manual Ability Classification system (MACS-levels: l = 27, ll = 16, lll = 7)) and 50 individually matched typically developing children (TDC). All participants performed three tasks: object-hit (hit falling balls), ball-on-bar (balance a ball on a bar while moving to a target) and circuit task (move a cursor along a circuit by making horizontal and vertical motions with their right and left hand, respectively). Bimanual parameters provided information about bimanual coupling and interlimb differences. Differences between groups and MACS-levels were investigated using ANCOVA with age as covariate (α < 0.05, [Formula: see text]). Correlation analysis (r) linked bimanual coordination to task execution and unimanual parameters. RESULTS Children with uCP exhibited worse bimanual coordination compared to TDC in all tasks (p ≤ 0.05, [Formula: see text] = 0.05-0.34). The ball-on-bar task displayed high effect size differences between groups in both bimanual coupling and interlimb differences (p < 0.001, [Formula: see text] = 0.18-0.36), while the object-hit task exhibited variations in interlimb differences (p < 0.001, [Formula: see text] = 0.22-0.34) and the circuit task in bimanual coupling (p < 0.001, [Formula: see text] = 0.31). Mainly the performance of the ball-on-bar task (p < 0.05, [Formula: see text] = 0.18-0.51) was modulated by MACS-levels, showing that children with MACS-level lll had worse bimanual coordination compared to children with MACS-level l and/or II. Ball-on-bar outcomes were highly related to task execution (r = - 0.75-0.70), whereas more interlimb differences of the object-hit task were moderately associated with a worse performance of the non-dominant hand (r = - 0.69-(- 0.53)). CONCLUSION This study gained first insight in important robotic tasks and outcome measures to quantify bimanual coordination deficits in children with uCP. The ball-on-bar task showed the most discriminative ability for both bimanual coupling and interlimb differences, while the object-hit and circuit tasks are unique to interlimb differences and bimanual coupling, respectively.
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Affiliation(s)
- Lisa Decraene
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium.
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, 3590, Diepenbeek, Belgium.
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium.
| | - Jean-Jacques Orban de Xivry
- Department of Movement Sciences, Research Group of Motor Control and Neuroplasticity, KU Leuven, 3000, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, 3000, Leuven, Belgium
| | - Lize Kleeren
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
| | - Monica Crotti
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
| | - Els Ortibus
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium
- Department of Pediatric Neurology, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, 3590, Diepenbeek, Belgium
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Beani E, Menici V, Sicola E, Ferrari A, Feys H, Klingels K, Mailleux L, Boyd R, Cioni G, Sgandurra G. Effectiveness of the home-based training program Tele-UPCAT (Tele-monitored UPper Limb Children Action Observation Training) in unilateral cerebral palsy: a randomized controlled trial. Eur J Phys Rehabil Med 2023; 59:554-563. [PMID: 37462399 PMCID: PMC10664769 DOI: 10.23736/s1973-9087.23.07945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/10/2023] [Accepted: 06/09/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The effects of unilateral cerebral palsy (UCP) are largely observed in the upper limb (UL), which represents the main focus of rehabilitation for this disorder. Thanks to an increment in home training and progress in technology innovative systems have been created. The Tele-UPCAT (Tele-monitored UPper Limb Children Action Observation Training) platform is dedicated to the delivery at home of a program for UL rehabilitation, based on action observation therapy (AOT). AIM This study aimed to investigate the immediate effectiveness of Tele-UPCAT for promoting UL skills in children with UCP and to determine if immediate effects were retained in the medium and long term. DESIGN Tele-UPCAT was conducted on an intention-to-treat basis and was proposed as a randomized, allocation concealed (waitlist controlled) and evaluator-blinded clinical trial with two investigative arms: intensive in-home AOT program and standard care (SC). SETTING This is a home-based AOT program delivered with a customized ICT platform. POPULATION Thirty children (mean age 11.61±3.55 years) with confirmed diagnosis of spastic UCP with predominant UL involvement and cognitive level within or at normal limits were enrolled in this study. Orthopedic surgery or an intramuscular botulinum toxin A injection in the UL within 6 months prior to enrolment represented an exclusion criteria. METHODS Participants were randomized using concealed random allocation. They were assessed according to the study design with the Assisting Hand Assessment (AHA), the Box and Block Test (BBT) and the Melbourne Assessment 2 (MA2). Linear mixed models were used for statistical analysis. RESULTS A significant difference between the AOT and SC groups was identified immediately after the training on the AHA (6.406 [2.73] P=0.021) with an effect size (ES) of 1.99, and for the BBT of the less affected hand (9.826 [4.535] P=0.032) with an ES of 1.44. These effects were sustained at medium and long term. CONCLUSIONS This study supports the effectiveness of AOT home training in promoting UL skills in children with UCP, with immediate effects lasting for 6 months. CLINICAL REHABILITATION IMPACT This should encourage the use of technology for rehabilitative purposes and further applications of the AOT paradigm.
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Affiliation(s)
- Elena Beani
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valentina Menici
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Elisa Sicola
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Adriano Ferrari
- Unit of Children Rehabilitation, IRCCS S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Hasselt, Belgium
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy -
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Bieber E, Smits-Engelsman BCM, Sgandurra G, Martini G, Guzzetta A, Cioni G, Feys H, Klingels K. Insights on action observation and imitation abilities in children with Developmental Coordination Disorder and typically developing children. Res Dev Disabil 2023; 139:104556. [PMID: 37327576 DOI: 10.1016/j.ridd.2023.104556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Children with Developmental Coordination Disorder (DCD) face difficulties in motor learning. Action observation and imitation are strategies frequently used to teach motor skills. AIMS (1) To study action observation and imitation abilities in children with DCD compared with typically developing peers with a new protocol. (2) To gain insights in the relation between action observation, imitation, motor performance and activities of daily living (ADL). METHOD Twenty-one children with DCD (mean age 7 years 9 months, range 6-10 years) and 20 age-matched controls (mean age 7 years 8 months, range 6-10 years) were included. A newly developed protocol was used for testing action observation and imitation proficiency. Motor performance were evaluated with the Movement Assessment Battery for Children-2. ADL were investigated with DCD Questionnaire'07. RESULTS Children with DCD presented significantly lower action observation (p = .037) and imitation abilities (p < .001) than peers. Worse action observation and imitation abilities were related to lower motor performance and ADL skills and a younger age. Non-meaningful gestures imitation proficiency had predictive value for global motor performance (p = .009), manual dexterity (p = .02) and ADL (p = .004). CONCLUSIONS The new protocol for action observation and imitation abilities can be helpful for detecting motor learning difficulties and for delineating new opportunities for motor teaching approaches in children with DCD.
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Affiliation(s)
- Eleonora Bieber
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris,Pisa, Italy.
| | | | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris,Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Giada Martini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris,Pisa, Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris,Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris,Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Hilde Feys
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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9
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van der Veer IPA, Bastiaenen CHG, Goetschalckx M, van der Wielen-Heezius NNF, Rameckers EAA, Klingels K. Therapists' Use of Instructions and Feedback in Motor Learning Interventions in Children with Developmental Coordination Disorder: A Video Observation Study. Phys Occup Ther Pediatr 2023; 43:678-696. [PMID: 37012672 DOI: 10.1080/01942638.2023.2194408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
AIM This qualitative study explored therapists' use of instructions and feedback when teaching motor tasks to children with developmental coordination disorder (DCD) as a first step in developing practical recommendations. METHODS A conventional content analysis approach was used to analyze videotaped treatment sessions of physical therapists using a newly developed analysis plan. Inductive coding was used to code purposively selected video segments. The codes were sorted into categories to identify key themes. Analyses were performed independently by two researchers until data saturation was reached. RESULTS Ten video-taped sessions were analyzed and 61 segments were coded. Three key themes were identified: (1) therapists' intention with the instructions and feedback was to motivate or to provide information; (2) the preferred therapists' teaching style was either direct or indirect; and (3) parameters to shape specific instructions and feedback were the focus of attention, modality, information content, timing and frequency. CONCLUSION Therapists used numerous instructions and feedback with different information content, often shaped by multiple focuses and/or modalities to motivate children or to provide specific information about task performance. Although therapists adapted instructions and feedback to child and task, future research should explore how characteristics of child and task can guide therapists' clinical decision-making.
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Affiliation(s)
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Functioning, Participation & Rehabilitation research line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Mieke Goetschalckx
- Rehabilitation Research Centre - REVAL, Hasselt University, Hasselt, Belgium
| | | | - Eugene A A Rameckers
- Rehabilitation Research Centre - REVAL, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation research line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - Katrijn Klingels
- Rehabilitation Research Centre - REVAL, Hasselt University, Hasselt, Belgium
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10
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Radwan A, Decraene L, Dupont P, Leenaerts N, Simon-Martinez C, Klingels K, Ortibus E, Feys H, Sunaert S, Blommaert J, Mailleux L. Exploring structural connectomes in children with unilateral cerebral palsy using graph theory. Hum Brain Mapp 2023; 44:2741-2753. [PMID: 36840930 PMCID: PMC10089093 DOI: 10.1002/hbm.26241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/26/2023] Open
Abstract
We explored structural brain connectomes in children with spastic unilateral cerebral palsy (uCP) and its relation to sensory-motor function using graph theory. In 46 children with uCP (mean age = 10 years 7 months ± 2 years 9 months; Manual Ability Classification System I = 15, II = 16, III = 15) we assessed upper limb somatosensory and motor function. We collected multi-shell diffusion-weighted, T1-weighted and T2-FLAIR MRI and identified the corticospinal tract (CST) wiring pattern using transcranial magnetic stimulation. Structural connectomes were constructed using Virtual Brain Grafting-modified FreeSurfer parcellations and multi-shell multi-tissue constrained spherical deconvolution-based anatomically-constrained tractography. Graph metrics (characteristic path length, global/local efficiency and clustering coefficient) of the whole brain, the ipsilesional/contralesional hemisphere, and the full/ipsilesional/contralesional sensory-motor network were compared between lesion types (periventricular white matter (PWM) = 28, cortical and deep gray matter (CDGM) = 18) and CST-wiring patterns (ipsilateral = 14, bilateral = 14, contralateral = 12, unknown = 6) using ANCOVA with age as covariate. Using elastic-net regularized regression we investigated how graph metrics, lesion volume, lesion type, CST-wiring pattern and age predicted sensory-motor function. In both the whole brain and subnetworks, we observed a hyperconnectivity pattern in children with CDGM-lesions compared with PWM-lesions, with higher clustering coefficient (p = [<.001-.047], η p 2 $$ {\eta}_p^2 $$ =[0.09-0.27]), characteristic path length (p = .003, η p 2 $$ {\eta}_p^2 $$ =0.19) and local efficiency (p = [.001-.02], η p 2 $$ {\eta}_p^2 $$ =[0.11-0.21]), and a lower global efficiency with age (p = [.01-.04], η p 2 $$ {\eta}_p^2 $$ =[0.09-0.15]). No differences were found between CST-wiring groups. Overall, good predictions of sensory-motor function were obtained with elastic-net regression (R2 = .40-.87). CST-wiring pattern was the strongest predictor for motor function. For somatosensory function, all independent variables contributed equally to the model. In conclusion, we demonstrated the potential of structural connectomics in understanding disease severity and brain development in children with uCP.
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Affiliation(s)
- Ahmed Radwan
- Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Lisa Decraene
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,KU Leuven Child & Youth Institute, Leuven, Belgium
| | - Patrick Dupont
- Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Department of Neurosciences, Lab for Cognitive Neurology, KU Leuven, Leuven, Belgium
| | - Nicolas Leenaerts
- Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Department of Neurosciences, Mind-Body Research, KU Leuven, Leuven, Belgium
| | - Cristina Simon-Martinez
- Institute of Information Systems, University of Applied Sciences Western Switzerland (HES-SO) Valais-Wallis, Sierre, Switzerland
| | - Katrijn Klingels
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Els Ortibus
- KU Leuven Child & Youth Institute, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,KU Leuven Child & Youth Institute, Leuven, Belgium
| | - Stefan Sunaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Jeroen Blommaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium.,KU Leuven Child & Youth Institute, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,KU Leuven Child & Youth Institute, Leuven, Belgium
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11
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Brauers L, Smeets R, Feys P, Gordon AM, Janssen-Potten Y, Ortibus E, Feys H, Rameckers E, Klingels K. Children With Cerebral Palsy Show Higher Static-But Not Higher Dynamic-Motor Fatigability in Grip and Pinch Tasks Than Children With Typical Development Do. Phys Ther 2023; 103:pzac155. [PMID: 37104625 PMCID: PMC10071583 DOI: 10.1093/ptj/pzac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/16/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate differences in static and dynamic motor fatigability during grip and pinch tasks between children with unilateral spastic cerebral palsy (USCP) and children with typical development (TD) and between preferred and nonpreferred hands. METHODS Fifty-three children with USCP and 53 age-matched children with TD (mean = 11 years 1 month; SD = 3 years 8 months) participated in 30-second maximum exertion sustained and repeated grip and pinch tasks. For sustained tasks, the Static Fatigue Index and the ratio of mean force between the first and last thirds of the curve were calculated. For repeated tasks, the ratio of mean force and the ratio of numbers of peaks between the first and last thirds of the curve were calculated. RESULTS Higher Static Fatigue Index scores for grip and pinch were found with USCP in both hands and between hands in both groups. Dynamic motor fatigability showed inconsistent results, with higher levels of fatigability in children with TD than in children with USCP for grip in the ratio of mean force between the first and last thirds of the curve in nonpreferred hands and in the ratio of number of peaks between the first and last thirds of the curve in preferred hands. CONCLUSION Higher motor fatigability in children with USCP than in children with TD was found for static but not dynamic grip and pinch. Underlying mechanisms may play different roles in static and dynamic motor fatigability. IMPACT These results highlight that static motor fatigability in grip and pinch tasks should be part of a comprehensive upper limb assessment and that this could be the target of individualized interventions.
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Affiliation(s)
- Lieke Brauers
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Peter Feys
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Yvonne Janssen-Potten
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
- Center of Expertise, Adelante Rehabilitation Center, Valkenburg, the Netherlands
| | - Els Ortibus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hilde Feys
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Eugene Rameckers
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
- Center of Expertise, Adelante Rehabilitation Center, Valkenburg, the Netherlands
| | - Katrijn Klingels
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium
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12
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Kleeren L, Hallemans A, Hoskens J, Klingels K, Smits-Engelsman B, Verbecque E. A Critical View on Motor-based Interventions to Improve Motor Skill Performance in Children With ADHD: A Systematic Review and Meta-analysis. J Atten Disord 2023; 27:354-367. [PMID: 36635879 DOI: 10.1177/10870547221146244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To map the effect of motor-based interventions on motor skills in children with ADHD. METHOD A systematic literature search was performed in Pubmed, Web of Science, and the SCOPUS database (last search: October 30th 2022). Methodological quality was assessed using the PEDro-scale and the quality of evidence was determined with the GRADE-method. Meta-analysis was performed when at least five studies were available. RESULTS Thirteen studies (7 RCTs) satisfied the inclusion criteria, five of which were eligible for meta-analysis. Only one of the included studies reached the low risk of bias threshold. Comparing different motor-based interventions to any non-motor control intervention showed large motor skill improvements (SMD = 1.46; 95% CI = [1.00;1.93]; I² = 47.07%). The most effective type of motor-based intervention and the optimal treatment parameters could not be determined yet. CONCLUSION Motor-based interventions in general seem to improve motor skills in children with ADHD. Additional RCTs are needed to increase current low GRADE confidence.
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13
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Brauers L, Smeets R, Feys P, Gordon AM, van der Leij-Roelofsen B, Bastiaenen C, Rameckers E, Klingels K. Test-Retest Reliability of a Static and Dynamic Motor Fatigability Protocol Using Grip and Pinch Strength in Children With Cerebral Palsy. Phys Ther 2022; 102:6632290. [PMID: 35793460 DOI: 10.1093/ptj/pzac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/03/2021] [Accepted: 01/02/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the test-retest reliability, measurement error, and interpretability of new motor fatigability outcomes of grip and pinch strength for children with unilateral cerebral palsy (UCP). METHODS Motor fatigability during grip and pinch strength was measured twice (within 48 hours) in both hands of 50 children (mean age = 11 years 2 months; 14, 31, and 5 children with Manual Ability Classification System levels I, II, and III, respectively) using a 30-second static and dynamic maximum exertion protocol. For static motor fatigability, the Static Fatigue Index (SFI) and mean force (Fmean) in the first (Fmean1) and last (Fmean3) 10 seconds were calculated. For dynamic motor fatigability, Fmean1, Fmean3, and the number of peaks in the first and last 10 seconds were calculated. RESULTS For static motor fatigability, the intraclass correlation coefficients (ICCs) were moderate to high for Fmean1 and Fmean3 (0.56-0.88), and the SFI showed low to moderate reliability (ICC = 0.32-0.72). For dynamic motor fatigability, the ICCs were moderate to high for all outcomes (0.54-0.91). The standard error of measurement agreement and the smallest detectable difference agreement were large in all outcomes, except for the SFI in static motor fatigability. Details per age group are provided. In general, younger children (6-11 years old) showed lower reliability than older children (12-18 years old). CONCLUSION Most outcome measures for static and dynamic motor fatigability of grip and pinch strength show moderate to high reliability in children with UCP, indicating that these tests can be used reliably to investigate the presence of motor fatigability in UCP, especially in older children. Standard error of measurement agreement and smallest detectable difference agreement indicated that these outcome measures should be interpreted with caution when evaluating change. IMPACT Most of the proposed outcome measures for static and dynamic motor fatigability of grip and pinch are reliable in children with UCP and can be used for discriminative purposes.
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Affiliation(s)
- Lieke Brauers
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Peter Feys
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York
| | | | - Caroline Bastiaenen
- Department of Epidemiology, Research Line: Function, Participation and Rehabilitation, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Eugene Rameckers
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - Katrijn Klingels
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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14
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van der Veer IPA, Verbecque E, Rameckers EAA, Bastiaenen CHG, Klingels K. How can instructions and feedback with external focus be shaped to enhance motor learning in children? A systematic review. PLoS One 2022; 17:e0264873. [PMID: 36007080 PMCID: PMC9409566 DOI: 10.1371/journal.pone.0264873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Aim
This systematic review investigates the effectiveness of instructions and feedback with external focus applied with reduced frequency, self-controlled timing and/or in visual or auditory form, on the performance of functional gross motor tasks in children aged 2 to 18 with typical or atypical development.
Methods
Four databases (PubMed, Web of Science, Scopus, Embase) were systematically searched (last updated May 31st 2021). Inclusion criteria were: 1. children aged 2 to 18 years old; 2. Instructions/feedback with external focus applied with reduced frequency, self-controlled timing, and/or visual or auditory form as intervention, to learn functional gross motor tasks; 3. Instructions/feedback with external focus applied with continuous frequency, instructor-controlled timing, and/or verbal form as control; 4. performance measure as outcome; 5. (randomized) controlled studies. Article selection and risk of bias assessment (with the Cochrane risk of bias tools) was conducted by two reviewers independently. Due to heterogeneity in study characteristics and incompleteness of the reported data, a best-evidence synthesis was performed.
Results
Thirteen studies of low methodological quality were included, investigating effectiveness of reduced frequencies (n = 8), self-controlled timing (n = 5) and visual form (n = 1) on motor performance of inexperienced typically (n = 348) and atypically (n = 195) developing children, for acquisition, retention and/or transfer. For accuracy, conflicting or no evidence was found for most comparisons, at most time points. However, there was moderate evidence that self-controlled feedback was most effective for retention, and limited evidence that visual analogy was most effective for retention and transfer. To improve quality of movement, there was limited evidence that continuous frequency was most effective for retention and transfer.
Conclusion
More methodologically sound studies are needed to draw conclusions about the preferred frequency, timing or form. However, we cautiously advise considering self-controlled feedback, visual instructions, and continuous frequency.
Trial registration
Registration: Prospero CRD42021225723. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021225723.
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Affiliation(s)
- Ingrid P. A. van der Veer
- Faculty of Rehabilitation Sciences and Physiotherapy, Rehabilitation Research Centre—REVAL, Hasselt University, Hasselt, Belgium
- * E-mail:
| | - Evi Verbecque
- Faculty of Rehabilitation Sciences and Physiotherapy, Rehabilitation Research Centre—REVAL, Hasselt University, Hasselt, Belgium
| | - Eugene A. A. Rameckers
- Faculty of Rehabilitation Sciences and Physiotherapy, Rehabilitation Research Centre—REVAL, Hasselt University, Hasselt, Belgium
- Department of Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - Caroline H. G. Bastiaenen
- Department of Epidemiology, Functioning, Participation & Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Katrijn Klingels
- Faculty of Rehabilitation Sciences and Physiotherapy, Rehabilitation Research Centre—REVAL, Hasselt University, Hasselt, Belgium
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15
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Zbytniewska-Mégret M, Decraene L, Mailleux L, Kleeren L, Kanzler CM, Gassert R, Ortibus E, Feys H, Lambercy O, Klingels K. Reliable and Valid Robotic Assessments of Hand Active and Passive Position Sense in Children With Unilateral Cerebral Palsy. Front Hum Neurosci 2022; 16:895080. [PMID: 35978982 PMCID: PMC9376476 DOI: 10.3389/fnhum.2022.895080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Impaired hand proprioception can lead to difficulties in performing fine motor tasks, thereby affecting activities of daily living. The majority of children with unilateral cerebral palsy (uCP) experience proprioceptive deficits, but accurately quantifying these deficits is challenging due to the lack of sensitive measurement methods. Robot-assisted assessments provide a promising alternative, however, there is a need for solutions that specifically target children and their needs. We propose two novel robotics-based assessments to sensitively evaluate active and passive position sense of the index finger metacarpophalangeal joint in children. We then investigate test-retest reliability and discriminant validity of these assessments in uCP and typically developing children (TDC), and further use the robotic platform to gain first insights into fundamentals of hand proprioception. Both robotic assessments were performed in two sessions with 1-h break in between. In the passive position sense assessment, participant's finger is passively moved by the robot to a randomly selected position, and she/he needs to indicate the perceived finger position on a tablet screen located directly above the hand, so that the vision of the hand is blocked. Active position sense is assessed by asking participants to accurately move their finger to a target position shown on the tablet screen, without visual feedback of the finger position. Ten children with uCP and 10 age-matched TDC were recruited in this study. Test-retest reliability in both populations was good (intraclass correlation coefficients (ICC) >0.79). Proprioceptive error was larger for children with uCP than TDC (passive: 11.49° ± 5.57° vs. 7.46° ± 4.43°, p = 0.046; active: 10.17° ± 5.62° vs. 5.34° ± 2.03°, p < 0.001), indicating discriminant validity. The active position sense was more accurate than passive, and the scores were not correlated, underlining the need for targeted assessments to comprehensively evaluate proprioception. There was a significant effect of age on passive position sense in TDC but not uCP, possibly linked to disturbed development of proprioceptive acuity in uCP. Overall, the proposed robot-assisted assessments are reliable, valid and a promising alternative to commonly used clinical methods, which could help gain a better understanding of proprioceptive impairments in uCP, facilitating the design of novel therapies.
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Affiliation(s)
- Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- *Correspondence: Monika Zbytniewska-Mégret
| | - Lisa Decraene
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), University of Hasselt, Diepenbeek, Belgium
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lize Kleeren
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), University of Hasselt, Diepenbeek, Belgium
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16
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Johnson C, Klingels K, Verbecque E, Meyns P, Hallemans A. Feasibility of fNIRS in Children with Developmental Coordination Disorder. Eur Psychiatry 2022. [PMCID: PMC9567494 DOI: 10.1192/j.eurpsy.2022.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Balance deficits are heterogeneous among children with Developmental Coordination Disorder (DCD). Balance performance depends on different balance domains, each associated with specific underlying neurological systems. In DCD, any of these domains can be affected, but the control mechanisms are poorly understood. The mirror neuron system (MNS) seems to play a key-role in DCD-related deficits. To understand the role of MNS as a control mechanism underlying the balance deficits, simultaneous registration of cortical MNS activity while performing balance tasks is imperative. Therefore, a protocol for combining real-time registration of cortical MNS activity during functional balance tasks in children with DCD, CP and TD is introduced. Methods: Children with DCD, CP and TD (n=108) aged 5-10yr perform preselected tasks of the Kids-BESTest, representing specific balance domains (mixed design): leaning with eyes closed (stability limits/verticality), single-leg-stance, alternate stair touching (anticipatory balance), in-place response, compensatory stepping backward (reactive balance) and walking over obstacles (gait stability). Simultaneously, functional Near-Infrared Spectroscopy (fNIRS) monitors cortical activity involving the MNS: premotor, inferior and superior parietal cortex and supplementary motor area. An 8-8-optode bundle, making 22 channels, targets this region of interest. Outcome measures are: (de)oxygenated hemoglobin concentration changes per task per channel. Results: In this ongoing research, the protocol was already feasible in 19 children (7.52±1.19). Conclusion: Simultaneous registration of cortical MNS activity (fNIRS) and Kids-BESTest scores will help increase the understanding of the control mechanisms underlying the heterogeneous balance problems in DCD. Consequently, first steps are made to confirm whether DCD shows deviant or delayed development. Disclosure No significant relationships.
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17
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Verbecque E, Klingels K, Rameckers E, Ferguson G, Smits-Engelsman B. The construct of balance control in primary school-aged children: Unidimensional and task-specific. Hum Mov Sci 2021; 79:102847. [PMID: 34274608 DOI: 10.1016/j.humov.2021.102847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 06/13/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study was to determine the dimensionality and task-specificity of balance control by investigating the relationships between different tasks and the degree to which these tasks belong to the same construct in primary school-aged children. Seventy-four South African children were randomly selected from a sample of convenience. They performed 18 different balance tasks that were grouped into four balance scales: the Performance and Fitness (PERF-FIT) static balance score, the PERF-FIT dynamic balance score, the PERF-FIT moving cans balance score and the Balance Sensory score. Spearman rank correlations were calculated between the scores. Principal component analysis (PCA) was used to investigate the number of factors within the construct. Moderate to good correlations were found between: i) PERF-FIT Moving cans balance score and the Balance Sensory score (r = 0.605, p < 0.001); ii) PERF-FIT static balance score and the PERF-FIT Moving cans (r = 0.586, p < 0.001); iii) PERF-FIT static balance score and the Balance Sensory score (r = 0.541, p < 0.001). All other correlations were low to fair. The PCA revealed one component. The three PERF-FIT items (moving cans-, static- and dynamic balance score) and the Balance Sensory score explained 59.4% of the variance of total balance performance.
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Affiliation(s)
- Evi Verbecque
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Belgium, Agoralaan Building A, 3590 Diepenbeek, Belgium.
| | - Katrijn Klingels
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Belgium, Agoralaan Building A, 3590 Diepenbeek, Belgium
| | - Eugène Rameckers
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Belgium, Agoralaan Building A, 3590 Diepenbeek, Belgium; Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Center of expertise Adelante rehabilitation, Valkenburg, the Netherlands
| | - Gillian Ferguson
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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18
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Decraene L, Feys H, Klingels K, Basu A, Ortibus E, Simon-Martinez C, Mailleux L. Tyneside Pegboard Test for unimanual and bimanual dexterity in unilateral cerebral palsy: association with sensorimotor impairment. Dev Med Child Neurol 2021; 63:874-882. [PMID: 33720409 DOI: 10.1111/dmcn.14858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/27/2022]
Abstract
AIM We explored the psychometric properties of the recently developed Tyneside Pegboard Test (TPT) for unimanual and bimanual dexterity in children with unilateral cerebral palsy (CP) and investigated the impact of sensorimotor impairments on manual dexterity. METHOD In this cross-sectional study, the TPT was assessed in 49 children with unilateral CP (mean age 9y 8mo, SD 1y 11mo, range 6-15y; 30 males, 19 females; 23 with right unilateral CP). All participants additionally underwent a standardized upper limb evaluation at body function and activity level. We investigated: (1) known-group, concurrent, and construct validity and (2) impact of sensorimotor impairments including spasticity, grip force, stereognosis, and mirror movements using analysis of covariance, Spearman's rank correlation (r), and multiple linear regression (R2 ) respectively. RESULTS TPT outcomes significantly differed according to the Manual Ability Classification System (p<0.001, known-group validity). Relationships were found between the unimanual TPT tasks and the Jebsen-Taylor Hand Function Test (r=0.86-0.88, concurrent validity). Bimanual TPT tasks were negatively correlated with the Assisting Hand Assessment, ABILHAND-Kids, and Children's Hand-use Experience Questionnaire (r=-0.38 to -0.78, construct validity). Stereognosis was the main determinant influencing all tasks (p<0.001, R2 =37-50%). Unimanual dexterity was additionally determined by grip strength (p<0.05, R2 =8-9%) and mirror movements in the more impaired hand (p<0.05, R2 =4-8%). Bimanual dexterity was also explained by mirror movements in the more impaired hand (p<0.01, R2 =10-16%) and spasticity (p=0.04, R2 =5%). INTERPRETATION The TPT is a valid test to measure unimanual and bimanual dexterity in unilateral CP. The results further emphasize the importance of somatosensory impairments in children with unilateral CP. What this paper adds The Tyneside Pegboard Test is valid for measuring unimanual and bimanual dexterity in unilateral cerebral palsy. Children with poorer manual ability show worse unimanual and bimanual dexterity. Stereognosis is the main predictor of both unimanual and bimanual dexterity. Stronger mirror movements in the more impaired hand result in worse bimanual dexterity.
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Affiliation(s)
- Lisa Decraene
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium
| | - Anna Basu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Paediatric Neurology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Cristina Simon-Martinez
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Information Systems Institute, University of Applied Sciences Western Switzerland (HES-SO Valais), Sierre, Switzerland.,Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
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19
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Magne VA, Adde L, Hoare B, Klingels K, Simon-Martinez C, Mailleux L, Lydersen S, Elvrum AKG. Assessment of mirror movements in children and adolescents with unilateral cerebral palsy: reliability of the Woods and Teuber scale. Dev Med Child Neurol 2021; 63:736-742. [PMID: 33469938 DOI: 10.1111/dmcn.14806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
AIM To investigate the inter- and intrarater reliability of the Woods and Teuber scale to detect mirror movements in children and adolescents with unilateral cerebral palsy (CP). METHOD A convenience sample of children and adolescents with unilateral CP (n=68; 31 males, 37 females; mean age 12y 2mo, SD 3y 6mo) in Manual Ability Classification levels I to III was recruited from Norway, Australia, and Belgium. Three therapists scored mirror movements according to the Woods and Teuber scale from three video-recorded tasks at two separate time points. A two-way, mixed model regression was used to calculate intraclass correlation coefficients (ICCs) reflecting overall inter- and intrarater reliability. In addition, ICCs for each hand and task were calculated separately. RESULTS The overall interrater reliability ICC was 0.90 and the corresponding intrarater reliability ICC was 0.92. The ICCs for each hand ranged from 0.86 to 0.92 and for each task from 0.63 to 0.89. INTERPRETATION The Woods and Teuber scale shows excellent reliability for scoring mirror movements in children and adolescents with unilateral CP. The assessment is easy to administer with no need for specific equipment and scoring can be determined from short video recordings, making it a feasible instrument in research and clinical practice.
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Affiliation(s)
- Victoria A Magne
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Adde
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Brian Hoare
- School of Occupational Therapy, La Trobe University, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Cristina Simon-Martinez
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Institute of Information Systems, University of Applied Sciences Western Switzerland Valais, Sierre, Switzerland
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ann-Kristin G Elvrum
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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20
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Verbecque E, Johnson C, Rameckers E, Thijs A, van der Veer I, Meyns P, Smits-Engelsman B, Klingels K. Balance control in individuals with developmental coordination disorder: A systematic review and meta-analysis. Gait Posture 2021; 83:268-279. [PMID: 33227605 DOI: 10.1016/j.gaitpost.2020.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/28/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although it is recognized that the majority of children with developmental coordination disorder (DCD) have balance deficits, comprehensive insights into which balance domains are affected, are still lacking in literature. RESEARCH QUESTION To what extent is balance control deficient in individuals with DCD compared to controls? METHODS Pubmed, Scopus and Web of Science were systematically searched. Risk of bias was assessed with the Scottish Intercollegiate Guidelines Network checklist for case-control studies. Mean and standard deviations characterizing balance control were extracted to calculate standardized mean differences (SMD) and pooled, if possible, using Review Manager. RESULTS The results of 31 studies (1152 individuals with DCD, 1103 typically developing (TD) peers, mean age 10.4 years old) were extracted of which 17 were used for meta-analysis. The mean SMD for the balance subscale of the Movement Assessment Battery for Children was 1.63 (pooled 95 %CI =[1.30;1.97]), indicating children with DCD to perform significantly poorer than their TD peers. Force plate studies also revealed that children with DCD present with a larger sway path during bipedal stance with eyes closed (pooled mean SMD = 0.55; 95 %CI=[0.32;0.78]). Children with DCD tend to have direction-specific limited stability limits and task-independent delayed onset of anticipatory postural adjustments. INTERPRETATION Children with DCD perform poorer on different domains of balance compared to TD peers. Future research should focus on comprehensive balance assessment in these children, preferably using a longitudinal design.
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Affiliation(s)
- Evi Verbecque
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium; Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
| | - Charlotte Johnson
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Eugène Rameckers
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium; Department of Rehabilitation Medicine Maastricht University, Maastricht, the Netherlands; Center of Expertise Adelante Rehabilitation, Valkenburg, the Netherlands; AVANSplus, University for Professionals, Breda, the Netherlands
| | - Angelina Thijs
- Center of Development Advancement and Pediatric Neurorehabilitation of the Wildermeth Foundation, Biel/Bienne, Switzerland
| | - Ingrid van der Veer
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium; AVANSplus, University for Professionals, Breda, the Netherlands
| | - Pieter Meyns
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, Division of Physiotherapy, University, Cape Town, South Africa
| | - Katrijn Klingels
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
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21
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Bieber E, Smits-Engelsman BCM, Sgandurra G, Di Gregorio F, Guzzetta A, Cioni G, Feys H, Klingels K. A new protocol for assessing action observation and imitation abilities in children with Developmental Coordination Disorder: A feasibility and reliability study. Hum Mov Sci 2020; 75:102717. [PMID: 33360601 DOI: 10.1016/j.humov.2020.102717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 10/24/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
AIMS To develop a new protocol for the assessment of action observation (AO) abilities and imitation of meaningful and non-meaningful gestures, to examine its psychometric properties in children with DCD and typically developing (TD) children. BACKGROUND For learning manual skills, AO and imitation are considered fundamental abilities. Knowledge about these modalities in children with DCD is scarce and an assessment protocol is lacking. METHOD The protocol consists of 2 tests. The AO test consists of two assembly tasks. The imitation test includes 12 meaningful and 20 non-meaningful gestures. Items of both tests are rated on a 4-point scale. Twelve children with DCD (mean age 8y3m, SD, 1.30) and 11 TD children (mean age 8y2m, SD 1.52) were enrolled. For inter-rater reliability, intraclass correlation coefficients (ICC) were calculated for the total score, weighted kappa and percentage agreement for single items. Known group validity was assessed by comparison of DCD and TD group (Wilcoxon rank sum test). For construct validity, the mABC-2 test was used. The protocol was adapted and confirmed by an intra and inter-rater reliability study (new sample of 11 DCD children, mean age 7y5m, SD 1.37). RESULTS Excellent ICCs were reported for intra and inter-rater reliability for the final protocol. A significant difference between DCD and TD group was found for AO abilities (p < .01), for nonmeaningful gestures (p < .001). A significant correlation was reported between the AO test and the mABC-2 test (r = 56;p ≤0.0001). No significant correlations were revealed for the imitation tests. DISCUSSION AND CONCLUSION The results support the psychometric properties of this protocol. When fully validated, it may contribute to map the deficits in AO abilities and imitation, to evaluate treatment effects of imitation and AO interventions.
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Affiliation(s)
- E Bieber
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.
| | - B C M Smits-Engelsman
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - G Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Di Gregorio
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - A Guzzetta
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - H Feys
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - K Klingels
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Belgium
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22
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Simon-Martinez C, Mailleux L, Jaspers E, Ortibus E, Desloovere K, Klingels K, Feys H. Effects of combining constraint-induced movement therapy and action-observation training on upper limb kinematics in children with unilateral cerebral palsy: a randomized controlled trial. Sci Rep 2020; 10:10421. [PMID: 32591590 PMCID: PMC7320002 DOI: 10.1038/s41598-020-67427-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/26/2020] [Indexed: 11/15/2022] Open
Abstract
Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children also show motor planning deficits, action-observation training (AOT) might be of additional value. Here, we investigated the combined value of AOT to mCIMT on UL kinematics in children with uCP in a randomized controlled trial. Thirty-six children with uCP completed an UL kinematic and clinical evaluation after participating in a 9-day mCIMT camp wearing a splint for 6 h/day. The experimental group (mCIMT + AOT, n = 20) received 15 h of AOT, i.e. video-observation and execution of unimanual tasks. The control group (mCIMT + placebo, n = 16) watched biological-motion free videos and executed the same tasks. We examined changes in motor control (movement duration, peak velocity, time-to-peak velocity, and trajectory straightness) and kinematic movement patterns (using Statistical Parametric Mapping) during the execution of three unimanual, relevant tasks before the intervention, after and at 6 months follow-up. Adding AOT to mCIMT mainly affected movement duration during reaching, whereas little benefit is seen on UL movement patterns. mCIMT, with or without AOT, improved peak velocity and trajectory straightness, and proximal movement patterns. Clinical and kinematic improvements are poorly related. Although there seem to be limited benefits of AOT to CIMT on UL kinematics, our results support the inclusion of kinematics to capture changes in motor control and movement patterns of the proximal joints.
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Affiliation(s)
- Cristina Simon-Martinez
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium. .,Information Systems Institute, University of Applied Sciences Western Switzerland (HES-SO Valais), Sierre, Switzerland.
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Ellen Jaspers
- Neural Control of Movement Lab, ETH Zurich, Zurich, Switzerland
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium.,Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
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23
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Brauers L, Rameckers E, Severijns D, Feys P, Smeets R, Klingels K. Measuring Motor Fatigability in the Upper Limbs in Individuals With Neurologic Disorders: A Systematic Review. Arch Phys Med Rehabil 2020; 101:907-916. [DOI: 10.1016/j.apmr.2019.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 01/21/2023]
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24
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Mayhew AG, Coratti G, Mazzone ES, Klingels K, James M, Pane M, Straub V, Goemans N, Mercuri E, Muntoni F, Ridout D, Selby V. Performance of Upper Limb module for Duchenne muscular dystrophy. Dev Med Child Neurol 2020; 62:633-639. [PMID: 31538331 DOI: 10.1111/dmcn.14361] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2019] [Indexed: 11/28/2022]
Abstract
AIM To report the differences between Performance of Upper Limb (PUL) versions 1.2 and 2.0, compare the measurement ability of the two versions, and compare their longitudinal performance in Duchenne muscular dystrophy. METHOD Rasch analysis was performed on the dual data from three centres to confirm whether the two scales measure the same construct. Change scores in natural history for the different domains were compared for the two versions. RESULTS Rasch analysis demonstrated that both versions measure the same construct and that the PUL 2.0 was a better fit to the construct of motor performance and better able to detect change at 12 months in all levels of ability than the PUL 1.2. This was also true when change scores were reviewed over 2 years. INTERPRETATION Our results confirm that the PUL 1.2 and 2.0 versions detect change in all domains over 2 years. They also demonstrate that simplifying the original scoring of the PUL 1.2 for the revised PUL 2.0 maintains the validity of the construct and enhances the scale measurement qualities. WHAT THIS PAPER ADDS The original and revised Performance of Upper Limb (PUL) scales measure the same construct. Both scales detected change in all domains over 2 years. The PUL 2.0 enhances the measurement qualities of the scale.
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Affiliation(s)
- Anna G Mayhew
- The John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Giorgia Coratti
- Child Neurology Unit e Centro Nemo, IRCCS Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Stacy Mazzone
- Child Neurology Unit e Centro Nemo, IRCCS Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Heverlee, Belgium.,Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Hasselt, Belgium
| | - Meredith James
- The John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marika Pane
- Child Neurology Unit e Centro Nemo, IRCCS Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Natalie Goemans
- Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Eugenio Mercuri
- Child Neurology Unit e Centro Nemo, IRCCS Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
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25
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Mailleux L, Simon-Martinez C, Radwan A, Blommaert J, Gooijers J, Wenderoth N, Klingels K, Ortibus E, Sunaert S, Feys H. White matter characteristics of motor, sensory and interhemispheric tracts underlying impaired upper limb function in children with unilateral cerebral palsy. Brain Struct Funct 2020; 225:1495-1509. [PMID: 32318818 DOI: 10.1007/s00429-020-02070-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/11/2020] [Indexed: 12/19/2022]
Abstract
This study explored the role of lesion timing (periventricular white matter versus cortical and deep grey matter lesions) and type of corticospinal tract (CST) wiring pattern (contralateral, bilateral, ipsilateral) on white matter characteristics of the CST, medial lemniscus, superior thalamic radiations and sensorimotor transcallosal fibers in children with unilateral cerebral palsy (CP), and examined the association with upper limb function. Thirty-four children (mean age 10 years 7 months ± 2 years 3 months) with unilateral CP underwent a comprehensive upper limb evaluation and diffusion weighted imaging (75 directions, b value 2800). Streamline count, fractional anisotropy and mean diffusivity were extracted from the targeted tracts and asymmetry indices were additionally calculated. Transcranial magnetic stimulation was applied to assess the CST wiring pattern. Results showed a more damaged CST in children with cortical and deep grey matter lesions (N = 10) and ipsilateral CST projections (N = 11) compared to children with periventricular white matter lesions (N = 24; p < 0.02) and contralateral CST projections (N = 9; p < 0.025), respectively. Moderate to high correlations were found between diffusion metrics of the targeted tracts and upper limb function (r = 0.45-0.72; p < 0.01). Asymmetry indices of the CST and sensory tracts could best explain bimanual performance (74%, p < 0.0001) and unimanual capacity (50%, p = 0.004). Adding lesion timing and CST wiring pattern did not further improve the model of bimanual performance, while for unimanual capacity lesion timing was additionally retained (58%, p = 0.0002). These results contribute to a better understanding of the underlying neuropathology of upper limb function in children with unilateral CP and point towards a clinical potential of tractography.
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Affiliation(s)
- Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | | | - Ahmed Radwan
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | | | - Nicole Wenderoth
- Department of Movement Sciences, KU Leuven, Leuven, Belgium.,Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,BIOMED, Rehabilitation Research Center (REVAL), UHasselt, Diepenbeek, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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26
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Simon-Martinez C, Mailleux L, Hoskens J, Ortibus E, Jaspers E, Wenderoth N, Sgandurra G, Cioni G, Molenaers G, Klingels K, Feys H. Randomized controlled trial combining constraint-induced movement therapy and action-observation training in unilateral cerebral palsy: clinical effects and influencing factors of treatment response. Ther Adv Neurol Disord 2020; 13:1756286419898065. [PMID: 32031542 PMCID: PMC6977217 DOI: 10.1177/1756286419898065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/09/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction: Constraint-induced movement therapy (CIMT) improves upper limb (UL) motor
execution in unilateral cerebral palsy (uCP). As these children also show
motor planning deficits, action-observation training (AOT) might be of
additional value. Here, we investigated the combined effect of AOT to CIMT
and identified factors influencing treatment response. Methods: A total of 44 children with uCP (mean 9 years 6 months, SD 1 year 10 months)
participated in a 9-day camp wearing a splint for 6 h/day and were allocated
to the CIMT + AOT (n = 22) and the CIMT + placebo group
(n = 22). The CIMT + AOT group received 15 h of AOT
(i.e. video-observation) and executed the observed tasks, whilst the
CIMT + AOT group watched videos free of biological motion and executed the
same tasks. The primary outcome measure was bimanual performance. Secondary
outcomes included measures of body function and activity level assessed
before (T1), after the intervention (T2), and at 6 months follow-up (T3).
Influencing factors included behavioural and neurological
characteristics. Results: Although no between-groups differences were found
(p > 0.05; η2 = 0–16), the addition of AOT
led to higher gains in children with initially poorer bimanual performance
(p = 0.02; η2 = 0.14). Both groups improved
in all outcome measures after the intervention and retained the gains at
follow up (p < 0.01; η2 = 0.02–0.71). Poor
sensory function resulted in larger improvements in the total group
(p = 0.03; η2 = 0.25) and high amounts of
mirror movements tended to result in a better response to the additional AOT
training (p = 0.06; η2 = 0.18). Improvements
were similar irrespective of the type of brain lesion or corticospinal tract
wiring pattern. Conclusions: Adding AOT to CIMT, resulted in a better outcome for children with poor motor
function and high amounts of mirror movements. CIMT with or without AOT
seems to be more beneficial for children with poor sensory function. Trial registration: Registered at ClinicalTrials.gov on 22nd August 2017 (ClinicalTrials.gov
identifier: NCT03256357).
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Affiliation(s)
- Cristina Simon-Martinez
- KU Leuven, Department of Rehabilitation Sciences, Herestraat 49, bus 1510, Leuven, 3000, Belgium
| | - Lisa Mailleux
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Jasmine Hoskens
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Els Ortibus
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Ellen Jaspers
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Nicole Wenderoth
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, Italy
| | - Guy Molenaers
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Katrijn Klingels
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Hilde Feys
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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Buchignani B, Beani E, Pomeroy V, Iacono O, Sicola E, Perazza S, Bieber E, Feys H, Klingels K, Cioni G, Sgandurra G. Action observation training for rehabilitation in brain injuries: a systematic review and meta-analysis. BMC Neurol 2019; 19:344. [PMID: 31881854 PMCID: PMC6935205 DOI: 10.1186/s12883-019-1533-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022] Open
Abstract
Background To systematically review and analyse the effects of Action Observation Training on adults and children with brain damage. Methods Seven electronic databases (Cochrane, EBSCO, Embase, Eric, PubMed, Scopus and Web of Science) were searched up to 16 September 2018 to select Randomized Controlled Trials focused on adults and children with brain damage that included AOT training on upper and/or lower limb carried out for at least 1 week. Identification of studies and data extraction was conducted with two reviewers working independently. Oxford Centre for Evidence-based Medicine (March2009) – Levels of Evidence and Physiotherapy Evidence Database scale were used to grade studies. The data collected from the articles were analysed using software R, version 3.4.3. Hedge’s g values were calculated and effect size estimates were pooled across studies. Separate meta-analyses were carried out for each ICF domain (i.e. body function and activity) for upper and lower limb. Results Out of the 210 records identified after removing duplicates, 22 were selected for systematic review and 19 were included in the meta-analysis. Thirteen studies included in the meta-analysis focused on upper limb rehabilitation (4 in children and 9 in adults) and 6 on lower limb rehabilitation (only studies in adults). A total of 626 patients were included in the meta-analysis. An overall statistically significant effect size was found for upper limb body function (0.44, 95% CI: [0.24, 0.64], p < 0.001) and upper limb activity domain (0.47, 95% CI: [0.30, 0.64], p < 0.001). For lower limb, only the activity domain was analysed, revealing a statistically significant overall effect size (0.56, 95% CI: [0.28, 0.84], p < 0.001). Conclusions Action Observation Training (AOT) is an innovative rehabilitation tool for individuals with brain damage, which shows promising results in improving the activity domain for upper and lower limbs, and also the body function domain for the upper limb. However, the examined studies lack uniformity and further well-designed, larger controlled trials are necessary to determine the most suitable type of AOT particularly in children. Systematic review registration CRD42019119600.
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Affiliation(s)
- Bianca Buchignani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
| | - Valerie Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, School of health Sciences, University of East Anglia, Research Park, Norwich, NR31 9HL, UK
| | - Oriana Iacono
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
| | - Elisa Sicola
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
| | - Silvia Perazza
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
| | - Eleonora Bieber
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy. .,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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Hoskens J, Goemans N, Feys H, De Waele L, Van den Hauwe M, Klingels K. Normative data and percentile curves for the three-minute walk test and timed function tests in healthy Caucasian boys from 2.5 up to 6 years old. Neuromuscul Disord 2019; 29:585-600. [DOI: 10.1016/j.nmd.2019.06.597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/06/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
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29
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Simon-Martinez C, Jaspers E, Alaerts K, Ortibus E, Balsters J, Mailleux L, Blommaert J, Sleurs C, Klingels K, Amant F, Uyttebroeck A, Wenderoth N, Feys H. Influence of the corticospinal tract wiring pattern on sensorimotor functional connectivity and clinical correlates of upper limb function in unilateral cerebral palsy. Sci Rep 2019; 9:8230. [PMID: 31160679 PMCID: PMC6547689 DOI: 10.1038/s41598-019-44728-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/21/2019] [Indexed: 12/02/2022] Open
Abstract
In children with unilateral cerebral palsy (uCP), the corticospinal tract (CST)-wiring patterns may differ (contralateral, ipsilateral or bilateral), partially determining motor deficits. However, the impact of such CST-wiring on functional connectivity remains unknown. Here, we explored resting-state sensorimotor functional connectivity in 26 uCP with periventricular white matter lesions (mean age (standard deviation): 12.87 m (±4.5), CST wiring: 9 contralateral, 9 ipsilateral, 6 bilateral) compared to 60 healthy controls (mean age (standard deviation): 14.54 (±4.8)), and between CST-wiring patterns. Functional connectivity from each M1 to three bilateral sensorimotor regions of interest (primary sensory cortex, dorsal and ventral premotor cortex) and the supplementary motor area was compared between groups (controls vs. uCP; and controls vs. each CST-wiring group). Seed-to-voxel analyses from bilateral M1 were compared between groups. Additionally, relations with upper limb motor deficits were explored. Aberrant sensorimotor functional connectivity seemed to be CST-dependent rather than specific from all the uCP population: in the dominant hemisphere, the contralateral CST group showed increased connectivity between M1 and premotor cortices, whereas the bilateral CST group showed higher connectivity between M1 and somatosensory association areas. These results suggest that functional connectivity of the sensorimotor network is CST-wiring-dependent, although the impact on upper limb function remains unclear.
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Affiliation(s)
| | - Ellen Jaspers
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH, Zurich, Switzerland
| | - Kaat Alaerts
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
| | - Els Ortibus
- KU Leuven Department of Development and Regeneration, Leuven, Belgium
| | - Joshua Balsters
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH, Zurich, Switzerland.,Department of Psychology, Royal Holloway University of London, Egham, United Kingdom
| | - Lisa Mailleux
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
| | | | | | - Katrijn Klingels
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frédéric Amant
- KU Leuven Department of Oncology, Leuven, Belgium.,Centre for Gynaecologic Oncology, Antoni van Leeuwenhoek, Amsterdam, Netherlands.,Centre for Gynaecologic Oncology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Nicole Wenderoth
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH, Zurich, Switzerland
| | - Hilde Feys
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
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30
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Hoskens J, Klingels K, Smits-Engelsman B. Validity and cross-cultural differences of the Bayley Scales of Infant and Toddler Development, Third Edition in typically developing infants. Early Hum Dev 2018; 125:17-25. [PMID: 30172781 DOI: 10.1016/j.earlhumdev.2018.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Dutch translation of Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III-NL) is a comprehensive tool assessing cognitive, language and motor development in children up to 42 months. AIMS The first aim of this study was to evaluate concurrent validity of the Bayley-III-NL Gross Motor Scale (GMS) in relation to the Alberta Infant Motor Scale (AIMS). Secondly, divergent validity between the other subscales mutually and the AIMS was investigated. Finally, the importance of population-specific reference values was examined. METHODS AND PROCEDURES A sample of 122 healthy, typically developing Flemish children (mean age: 9 months 7 days), born full term was assessed with the Bayley-III-NL and the AIMS. OUTCOMES AND RESULTS Concurrent validity of the Bayley-III-NL GMS and the AIMS was moderate to high (0.59-0.98; p < 0.001). In addition, weak correlations (-0.10-0.27) between the non-motor-Bayley-III-NL subscales and the AIMS were found. Finally, significant differences were found between Bayley-III scores based on Flemish and American norms (p < 0.001), except for fine motor skills (p = 0.11). CONCLUSIONS AND IMPLICATIONS This study provides support for the concurrent validity of the Bayley-III-NL GMS and divergent validity of the different Bayley-III-NL subscales. Secondly, population-specific reference values should be used to avoid over- and under estimation of infant's development.
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Affiliation(s)
- Jasmine Hoskens
- KU Leuven - University of Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Herestraat 49, Box 1510, B-3000 Leuven, Belgium; Hasselt University, REVAL Rehabilitation Research Center, BIOMED, Agoralaan gebouw D, B-3590 Diepenbeek, Belgium.
| | - Katrijn Klingels
- KU Leuven - University of Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Herestraat 49, Box 1510, B-3000 Leuven, Belgium; Hasselt University, REVAL Rehabilitation Research Center, BIOMED, Agoralaan gebouw D, B-3590 Diepenbeek, Belgium.
| | - Bouwien Smits-Engelsman
- Department of Health and Rehabilitation, University of Cape Town, Old Main Building, Groote Schuur Hospital, Cape Town, South Africa
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31
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Zielinski IM, Steenbergen B, Schmidt A, Klingels K, Simon Martinez C, de Water P, Hoare B. Windmill-task as a New Quantitative and Objective Assessment for Mirror Movements in Unilateral Cerebral Palsy: A Pilot Study. Arch Phys Med Rehabil 2018; 99:1547-1552. [DOI: 10.1016/j.apmr.2018.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/23/2018] [Indexed: 11/30/2022]
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Simon-Martinez C, Mailleux L, Ortibus E, Fehrenbach A, Sgandurra G, Cioni G, Desloovere K, Wenderoth N, Demaerel P, Sunaert S, Molenaers G, Feys H, Klingels K. Combining constraint-induced movement therapy and action-observation training in children with unilateral cerebral palsy: a randomized controlled trial. BMC Pediatr 2018; 18:250. [PMID: 30064396 PMCID: PMC6069849 DOI: 10.1186/s12887-018-1228-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 07/19/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Upper limb (UL) deficits in children with unilateral cerebral palsy (uCP) have traditionally been targeted with motor execution treatment models, such as modified Constraint-Induced Movement Therapy (mCIMT). However, new approaches based on a neurophysiological model such as Action-Observation Training (AOT) may provide new opportunities for enhanced motor learning. The aim of this study is to describe a randomised controlled trial (RCT) protocol investigating the effects of an intensive treatment model, combining mCIMT and AOT compared to mCIMT alone on UL function in children with uCP. Additionally, the role of neurological factors as potential biomarkers of treatment response will be analysed. METHODS An evaluator-blinded RCT will be conducted in 42 children aged between 6 and 12 years. Before randomization, children will be stratified according to their House Functional Classification Scale, age and type of corticospinal tract wiring. A 2-week day-camp will be set up in which children receive intensive mCIMT therapy for 6 hours a day on 9 out of 11 consecutive days (54 h) including AOT or control condition (15 h). During AOT, these children watch video sequences showing goal-directed actions and subsequently execute the observed actions with the more impaired UL. The control group performs the same actions after watching computer games without human motion. The primary outcome measure will be the Assisting Hand Assessment. Secondary outcomes comprise clinical assessments across body function, activity and participation level of the International Classification of Function, Disability and Health. Furthermore, to quantitatively evaluate UL movement patterns, a three-dimensional motion analysis will be conducted. UL function will be assessed at baseline, immediately before and after intervention and at 6 months follow up. Brain imaging comprising structural and functional connectivity measures as well as Transcranial Magnetic Stimulation (TMS) to evaluate corticospinal tract wiring will be acquired before the intervention. DISCUSSION This paper describes the methodology of an RCT with two main objectives: (1) to evaluate the added value of AOT to mCIMT on UL outcome in children with uCP and (2) to investigate the role of neurological factors as potential biomarkers of treatment response. TRIAL REGISTRATION NCT03256357 registered on 21st August 2017 (retrospectively registered).
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Affiliation(s)
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anna Fehrenbach
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Nicole Wenderoth
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH, Zurich, Switzerland
| | - Philippe Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Rehabilitation Research Centre, BIOMED, Hasselt University, Diepenbeek, Belgium
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Simon-Martinez C, dos Santos GL, Jaspers E, Vanderschueren R, Mailleux L, Klingels K, Ortibus E, Desloovere K, Feys H. Age-related changes in upper limb motion during typical development. PLoS One 2018; 13:e0198524. [PMID: 29874278 PMCID: PMC5991355 DOI: 10.1371/journal.pone.0198524] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/21/2018] [Indexed: 12/04/2022] Open
Abstract
Background and aim Understanding the maturation of upper limb (UL) movement characteristics in typically developing (TD) children is key to explore UL deficits in those with neurodevelopmental disorders. Three-dimensional motion analysis (3DMA) offers a reliable tool to comprehensively evaluate UL motion. However, studies thus far mainly focused on specific pre-defined parameters extracted from kinematic waveforms. Here, we investigated age-related differences in UL movement characteristics over the entire movement cycle in TD children. Participants and methods We assessed the non-dominant UL of 60 TD children (mean age 10y3m±3y1m) using 3DMA during eight tasks: reaching (forwards (RF), upwards (RU), sideways (RS)), reach-to-grasp (sphere (RGS), vertical cylinder (RGV)) and activities-of-daily-living mimicking tasks (hand-to-head (HTH), hand-to-mouth (HTM), hand-to-shoulder (HTS)). We investigated differences between four age-groups (5-7y, 8-10y, 11-12y, 13-15y) in: (1) spatiotemporal parameters (movement duration, peak velocity, time-to-peak velocity and trajectory straightness), and (2) 12 UL joint angles, using Statistical Parametric Mapping (SPM). Results We found that the 5-7y children moved with lower peak velocity and less straight trajectories compared to the 11-12y group (peak velocity: RS, HTS, p<0.01; trajectory: RU, RS, RGV, HTS, p<0.01) and the 13-15y group (peak velocity: RF, RS, RGS, RGV, HTH, HTS, p<0.01; trajectory, all tasks, p<0.01). The 5-7y children showed increased scapular protraction compared to older children (8-10y and 11-12y, HTS), as well as increased scapular medial rotation compared to the 13-15y group (RGS). During RU, the 5-7y children moved more towards the frontal plane (shoulder), unlike the 13-15y group. Lastly, the 5-7y group used less elbow flexion than older children (11-12y and 13-15y) during HTH and HTS. Discussion and conclusion In conclusion, our results point toward a maturation in UL movement characteristics up to age 11-12y, when UL motion seemed to reach a plateau. The reference values provided in this study will help to further optimize the interpretation of UL deficits in children with neurodevelopmental disorders.
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Affiliation(s)
- Cristina Simon-Martinez
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- * E-mail:
| | - Gabriela Lopes dos Santos
- Laboratory of Neurological Physiotherapy Research, Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Ellen Jaspers
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Ruth Vanderschueren
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Lisa Mailleux
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Katrijn Klingels
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Rehabilitation Research Centre, BIOMED, Hasselt University, Diepenbeek, Belgium
| | - Els Ortibus
- KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Kaat Desloovere
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Pellenberg, Belgium
| | - Hilde Feys
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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34
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Sgandurra G, Cecchi F, Beani E, Mannari I, Maselli M, Falotico FP, Inguaggiato E, Perazza S, Sicola E, Feys H, Klingels K, Ferrari A, Dario P, Boyd RN, Cioni G. Tele-UPCAT: study protocol of a randomised controlled trial of a home-based Tele-monitored UPper limb Children Action observation Training for participants with unilateral cerebral palsy. BMJ Open 2018; 8:e017819. [PMID: 29764869 PMCID: PMC5961615 DOI: 10.1136/bmjopen-2017-017819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A new rehabilitative approach, called UPper Limb Children Action Observation Training (UPCAT), based on the principles of action observation training (AOT), has provided promising results for upper limb rehabilitation in children with unilateral cerebral palsy (UCP). This study will investigate if a new information and communication technology platform, named Tele-UPCAT, is able to deliver AOT in a home setting and will test its efficacy on children and young people with UCP. METHODS AND ANALYSIS A randomised, allocation concealed (waitlist control) and evaluator-blinded clinical trial with two investigative arms will be carried out. The experimental group will perform AOT at home for 3 weeks using a customised Tele-UPCAT system where they will watch video sequences of goal-directed actions and then complete the motor training of the same actions. The control group will receive usual care for 3 weeks, which may include upper limb training. They will be offered AOT at home after 3 weeks. Twenty-four children with UCP will be recruited for 12 participants per group. The primary outcome will be measured using Assisting Hand Assessment. The Melbourne Assessment 2, ABILHAND, Participation and Environment Measure-Children and Youth and Cerebral Palsy Quality of Life Questionnaire will be included as secondary measures. Quantitative measures from sensorised objects and participants worn Actigraphs GXT3+ will be analysed. The assessment points will be the week before (T0) and after (T1) the period of AOT/standard care. Further assessments will be at T1 plus, the week after the AOT period for the waitlist group and at 8 weeks (T2) and 24 weeks (T3) after AOT training. ETHICS AND DISSEMINATION The trial has been approved by the Tuscany Paediatric Ethics Committee (169/2016). Publication of all outcomes will be in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NCT03094455.
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Affiliation(s)
- Giuseppina Sgandurra
- Department of
Developmental Neuroscience, IRCCS Fondazione Stella
Maris, Pisa,
Italy
- Department of Clinical
and Experimental Medicine, University of Pisa,
Pisa, Italy
| | | | - Elena Beani
- Department of
Developmental Neuroscience, IRCCS Fondazione Stella
Maris, Pisa,
Italy
| | - Irene Mannari
- The BioRobotics Institute, Polo Sant’Anna
Valdera, Pisa,
Italy
| | - Martina Maselli
- The BioRobotics Institute, Polo Sant’Anna
Valdera, Pisa,
Italy
| | | | - Emanuela Inguaggiato
- Department of
Developmental Neuroscience, IRCCS Fondazione Stella
Maris, Pisa,
Italy
| | - Silvia Perazza
- Department of
Developmental Neuroscience, IRCCS Fondazione Stella
Maris, Pisa,
Italy
| | - Elisa Sicola
- Department of
Developmental Neuroscience, IRCCS Fondazione Stella
Maris, Pisa,
Italy
| | - Hilde Feys
- Department of
Rehabilitation Sciences, KU Leuven – University of
Leuven, Leuven,
Belgium
| | - Katrijn Klingels
- Department of
Rehabilitation Sciences, KU Leuven – University of
Leuven, Leuven,
Belgium
- REVAL Rehabilitation
Research Center, Biomedical Research Institute, Hasselt
University, Diepenbeek,
Belgium
| | - Adriano Ferrari
- Children Rehabilitation
Unit, IRCCS S. Maria Nuova Hospital, Reggio Emilia, Italy
- Department of
Neuroscience, University of Modena and Reggio
Emilia, Modena,
Italy
| | - Paolo Dario
- The BioRobotics Institute, Polo Sant’Anna
Valdera, Pisa,
Italy
| | - Roslyn N Boyd
- Queensland Cerebral
Palsy and Rehabilitation Research Centre, Centre for Children’s Health Research,
Faculty of Medicine, The University of
Queensland, Brisbane, Queensland, Australia
| | - Giovanni Cioni
- Department of
Developmental Neuroscience, IRCCS Fondazione Stella
Maris, Pisa,
Italy
- Department of Clinical
and Experimental Medicine, University of Pisa,
Pisa, Italy
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Jaspers E, Klingels K, Simon-Martinez C, Feys H, Woolley DG, Wenderoth N. GriFT: A Device for Quantifying Physiological and Pathological Mirror Movements in Children. IEEE Trans Biomed Eng 2018; 65:857-865. [DOI: 10.1109/tbme.2017.2723801] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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36
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Mailleux L, Simon-Martinez C, Klingels K, Jaspers E, Desloovere K, Demaerel P, Fiori S, Guzzetta A, Ortibus E, Feys H. Structural Brain Damage and Upper Limb Kinematics in Children with Unilateral Cerebral Palsy. Front Hum Neurosci 2017; 11:607. [PMID: 29311871 PMCID: PMC5733007 DOI: 10.3389/fnhum.2017.00607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background: In children with unilateral cerebral palsy (uCP) virtually nothing is known on the relation between structural brain damage and upper limb (UL) kinematics quantified with three-dimensional movement analysis (3DMA). This explorative study aimed to (1) investigate differences in UL kinematics between children with different lesion timings, i.e., periventricular white matter (PWM) vs. cortical and deep gray matter (CDGM) lesions and (2) to explore the relation between UL kinematics and lesion location and extent within each lesion timing group. Methods: Forty-eight children (age 10.4 ± 2.7 year; 29 boys; 21 right-sided; 33 PWM; 15 CDGM) underwent an UL 3DMA during a reach-to-grasp task. Spatiotemporal parameters [movement duration, (timing of) maximum velocity, trajectory straightness], the Arm Profile Score (APS) and Arm Variable Scores (AVS) were extracted. The APS and AVS refer to the total amount of movement pathology and movement deviations of the wrist, elbow, shoulder, scapula and trunk respectively. Brain lesion location and extent were scored based on FLAIR-images using a semi-quantitative MRI-scale. Results: Children with CDGM lesions showed more aberrant spatiotemporal parameters (p < 0.03) and more movement pathology (APS, p = 0.003) compared to the PWM group, mostly characterized by increased wrist flexion (p = 0.01). In the CDGM group, moderate to high correlations were found between lesion location and extent and duration, timing of maximum velocity and trajectory straightness (r = 0.53-0.90). Lesion location and extent were further moderately correlated with distal UL movement pathology (wrist flexion/extension, elbow pronation/supination, elbow flexion/extension; r = 0.50-0.65) and with the APS (r = 0.51-0.63). In the PWM group, only a few and low correlations were observed, mostly between damage to the PLIC and higher AVS of elbow flexion/extension, shoulder elevation and trunk rotation (r = 0.35-0.42). Regression analysis revealed damage to the temporal lobe with lesion timing as interactor (27%, p = 0.002) and the posterior limb of the internal capsule (PLIC) (7%, p = 0.04) as the strongest predictors, explaining 34% of the variance in APS. Conclusion: UL kinematic deviations are more influenced by lesion location and extent in children with later (CDGM) versus earlier lesions (PWM), except for proximal movement pathology. Damage to the PLIC is a significant predictor for UL movement pathology irrespective of lesion timing.
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Affiliation(s)
- Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,BIOMED, Rehabilitation Research Center (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Ellen Jaspers
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Andrea Guzzetta
- IRCCS Stella Maris Foundation, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Simon-Martinez C, Jaspers E, Mailleux L, Desloovere K, Vanrenterghem J, Ortibus E, Molenaers G, Feys H, Klingels K. Negative Influence of Motor Impairments on Upper Limb Movement Patterns in Children with Unilateral Cerebral Palsy. A Statistical Parametric Mapping Study. Front Hum Neurosci 2017; 11:482. [PMID: 29051729 PMCID: PMC5633911 DOI: 10.3389/fnhum.2017.00482] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/19/2017] [Indexed: 11/13/2022] Open
Abstract
Upper limb three-dimensional movement analysis (UL-3DMA) offers a reliable and valid tool to evaluate movement patterns in children with unilateral cerebral palsy (uCP). However, it remains unknown to what extent the underlying motor impairments explain deviant movement patterns. Such understanding is key to develop efficient rehabilitation programs. Although UL-3DMA has been shown to be a useful tool to assess movement patterns, it results in a multitude of data, challenging the clinical interpretation and consequently its implementation. UL-3DMA reports are often reduced to summary metrics, such as average or peak values per joint. However, these metrics do not take into account the continuous nature of the data or the interdependency between UL joints, and do not provide phase-specific information of the movement pattern. Moreover, summary metrics may not be sensitive enough to estimate the impact of motor impairments. Recently, Statistical Parametric Mapping (SPM) was proposed to overcome these problems. We collected UL-3DMA of 60 children with uCP and 60 typically developing children during eight functional tasks and evaluated the impact of spasticity and muscle weakness on UL movement patterns. SPM vector field analysis was used to analyze movement patterns at the level of five joints (wrist, elbow, shoulder, scapula, and trunk). Children with uCP showed deviant movement patterns in all joints during a large percentage of the movement cycle. Spasticity and muscle weakness negatively impacted on UL movement patterns during all tasks, which resulted in increased wrist flexion, elbow pronation and flexion, increased shoulder external rotation, decreased shoulder elevation with a preference for movement in the frontal plane and increased trunk internal rotation. Scapular position was altered during movement initiation, although scapular movements were not affected by muscle weakness or spasticity. In conclusion, we identified pathological movement patterns in children with uCP and additionally mapped the negative impact of spasticity and muscle weakness on these movement patterns, providing useful insights that will contribute to treatment planning. Last, we also identified a subset of the most relevant tasks for studying UL movements in children with uCP, which will facilitate the interpretation of UL-3DMA data and undoubtedly contribute to its clinical implementation.
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Affiliation(s)
| | - Ellen Jaspers
- Neural Control of Movement Lab, ETH Zurich, Zurich, Switzerland
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | | | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Orthopedic Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Rehabilitation Research Center (REVAL), BIOMED, University of Hasselt, Diepenbeek, Belgium
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Klingels K. The iterative process in the development of a parent-reported questionnaire for children with unilateral paresis. Dev Med Child Neurol 2017; 59:885. [PMID: 28586084 DOI: 10.1111/dmcn.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Katrijn Klingels
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Heverlee, Belgium.,Hasselt University, BIOMED, REVAL, Diepenbeek, Belgium
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Mailleux L, Jaspers E, Ortibus E, Simon-Martinez C, Desloovere K, Molenaers G, Klingels K, Feys H. Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy. PLoS One 2017; 12:e0180196. [PMID: 28671953 PMCID: PMC5495347 DOI: 10.1371/journal.pone.0180196] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/12/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The clinical application of upper limb (UL) three-dimensional movement analysis (3DMA) in children with unilateral cerebral palsy (uCP) remains challenging, despite its benefits compared to conventional clinical scales. Moreover, knowledge on UL movement pathology and how this relates to clinical parameters remains scarce. Therefore, we investigated UL kinematics across different manual ability classification system (MACS) levels and explored the relation between clinical and kinematic parameters in children with uCP. PATIENTS AND METHODS Fifty children (MACS: I = 15, II = 26, III = 9) underwent an UL evaluation of sensorimotor impairments (grip force, muscle strength, muscle tone, two-point discrimination, stereognosis), bimanual performance (Assisting Hand Assessment, AHA), unimanual capacity (Melbourne Assessment 2, MA2) and UL-3DMA during hand-to-head, hand-to-mouth and reach-to-grasp tasks. Global parameters (Arm Profile Score (APS), duration, (timing of) maximum velocity, trajectory straightness) and joint specific parameters (angles at task endpoint, ROM and Arm Variable Scores (AVS)) were extracted. The APS and AVS refer respectively to the total amount of movement pathology and movement deviations of wrist, elbow, shoulder, scapula and trunk. RESULTS Longer movement durations and increased APS were found with higher MACS-levels (p<0.001). Increased APS was also associated with more severe sensorimotor impairments (r = -0.30-(-0.73)) and with lower AHA and MA2-scores (r = -0.50-(-0.86)). For the joint specific parameters, stronger movement deviations distally were significantly associated with increased muscle weakness (r = -0.32-(-0.74)) and muscle tone (r = 0.33-(-0.61)); proximal movement deviations correlated only with muscle weakness (r = -0.35-0.59). Regression analysis exposed grip force as the most important predictor for the variability in APS (p<0.002). CONCLUSION We found increased movement pathology with increasing MACS-levels and demonstrated the adverse impact of especially muscle weakness. The lower correlations suggest that 3DMA provides additional information regarding UL motor function, particularly for the proximal joints. Integrating both methods seems clinically meaningful to obtain a comprehensive representation of all aspects of a child's UL functioning.
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Affiliation(s)
- Lisa Mailleux
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- * E-mail:
| | - Ellen Jaspers
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Els Ortibus
- KU Leuven–University of Leuven, Department of Development and Regeneration, Leuven, Belgium
| | | | - Kaat Desloovere
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University Hospitals Leuven, Clinical Motion Analysis Laboratory, Leuven, Belgium
| | - Guy Molenaers
- KU Leuven–University of Leuven, Department of Development and Regeneration, Leuven, Belgium
- University Hospitals Leuven, Department of Orthopaedic Medicine, Leuven, Belgium
| | - Katrijn Klingels
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- UHasselt–Hasselt University, BIOMED, Rehabilitation Research Center (REVAL), Diepenbeek, Belgium
| | - Hilde Feys
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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Klingels K, Mayhew AG, Mazzone ES, Duong T, Decostre V, Werlauff U, Vroom E, Mercuri E, Goemans NM. Development of a patient-reported outcome measure for upper limb function in Duchenne muscular dystrophy: DMD Upper Limb PROM. Dev Med Child Neurol 2017; 59:224-231. [PMID: 27671699 DOI: 10.1111/dmcn.13277] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 11/30/2022]
Abstract
AIM To develop a patient-reported outcome measure (PROM) assessing upper limb function related to activities of daily living (ADL) that cannot be observed in a clinical setting, specifically for patients with Duchenne muscular dystrophy (DMD) across a wide age range, applicable in the different stages of the disease. METHOD The developmental process was based on US Food and Drug Administration guidelines. This included item generation from a systematic review of existing tools and expert opinion on task difficulty and relevance, involving individuals with DMD. Cultural aspects affecting ADL were taken into consideration to make this tool applicable to the broad DMD community. Items were selected in relation to a conceptual framework reflecting disease progression covering the full range of upper limb function across different ADL domains. RESULTS After pilot testing and iterative Rasch analyses, redundant or clinically irrelevant items were removed. The final questionnaire consists of 32 items covering four domains of ADL (food, self-care, household and environment, leisure and communication). Test-retest reliability was excellent. INTERPRETATION A DMD-specific upper limb PROM was developed on the basis of clinical relevance and psychometric robustness. Its main purpose is to document the patient self-reported natural history of DMD and assess the efficacy of interventions.
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Affiliation(s)
- K Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Rehabilitation Research Center (REVAL), Biomed, Hasselt University, Diepenbeek, Belgium
| | - A G Mayhew
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle upon Tyne, UK
| | - E S Mazzone
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - T Duong
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - V Decostre
- Institut de Myologie, GH Pitié Salpêtrière, Paris, France
| | - U Werlauff
- Danish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - E Vroom
- Duchenne Parent Project, Veenendaal, the Netherlands
| | - E Mercuri
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - N M Goemans
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
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Klingels K, van den Hauwe M, Hoskens J, Eertmans B, Desaever H, Goemans N. Normative data and reference equation for the six-minute walk test in healthy Caucasian boys aged 13–18 years. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bieber E, Smits-Engelsman BCM, Sgandurra G, Cioni G, Feys H, Guzzetta A, Klingels K. Manual function outcome measures in children with developmental coordination disorder (DCD): Systematic review. Res Dev Disabil 2016; 55:114-131. [PMID: 27062096 DOI: 10.1016/j.ridd.2016.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
This study systematically reviewed the clinical and psychometric properties of manual function outcome measures for children with developmental coordination disorder (DCD) aged 3-18 years. Three electronic databases were searched to identify manual function tools at the ICF-CY body function, activity and participation level used in children with DCD. Study selection and data extraction was conducted by two blind assessors according to the CanChild Outcome Measures Rating Form. Nineteen clinical tests (seven fine hand use tools and 12 handwriting measures), three naturalistic observations and six questionnaires were identified. The fine-motor subdomain of the Movement Assessment Battery for Children, the Bruininks-Oseretsky Test of Motor Proficiency-2 and the Functional Strength Measurement, with adequate reliability and validity properties, might be useful for manual function capacity assessment. The Systematic Detection of Writing Problems (SOS) and the Detailed Assessment of Speed of Handwriting (DASH) could be adopted for handwriting assessment, respectively from 6 and 9 years old. Naturalistic observations and questionnaires, whose psychometric properties have been investigated into limited extent, offer an assessment of the daily performances. This review shows that a combination of different tools is needed for a comprehensive assessment of manual function in children with DCD including the three levels of the ICF-CY. Further investigation of psychometric properties of those tools in children with DCD is warranted. Tests validated in other populations should be explored for their applicability for assessing manual function in children with DCD.
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Affiliation(s)
- Eleonora Bieber
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy; Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Bouwien C M Smits-Engelsman
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Old Main Building, Groote Schuur Hospital, Cape Town, South Africa.
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy.
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy.
| | - Hilde Feys
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy.
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium; REVAL Rehabilitation Research Center, BIOMED, Faculty of Medicine and Life Sciences Hasselt University, Diepenbeek, Belgium.
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Klingels K, Jaspers E, Staudt M, Guzzetta A, Mailleux L, Ortibus E, Feys H. Do mirror movements relate to hand function and timing of the brain lesion in children with unilateral cerebral palsy? Dev Med Child Neurol 2016; 58:735-42. [PMID: 26645574 DOI: 10.1111/dmcn.12977] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to systematically map the severity of mirror movements in both hands in a prospective cohort of children with unilateral cerebral palsy, and to explore the relationship with hand function and brain lesion type. METHOD Seventy-eight children were included (41 males, 37 females; age 9y 4mo, SD 3y 1mo, range 5-15y). Mirror movements were scored during three repetitive tasks following Woods and Teuber criteria. Strength, tone, Melbourne Assessment, Jebsen-Taylor test, and Assisting Hand Assessment were evaluated. Lesions were classified into malformations (n=5), periventricular (n=43), cortico-subcortical (n=22), and postnatally acquired lesions (n=8). RESULTS Significantly more mirror movements were observed in the non-paretic versus the paretic hand (p≤0.003). Higher mirror movement scores in the non-paretic hand significantly correlated with lower distal strength and lower scores on unimanual and bimanual assessments (r=0.29-0.41). In the paretic hand, significant differences were found between lesion types (p=0.03). INTERPRETATION The occurrence of mirror movements in the non-paretic hand seems related to hand function while mirror movements in the paretic hand seem more related to the lesion timing, whereby children with earlier lesions present with more mirror movements.
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Affiliation(s)
- Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Rehabilitation Research Center (REVAL), Biomed, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ellen Jaspers
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Epilepsy Center for Children and Adolescents, Clinic for Neuropediatrics and Neurorehabilitation, Schoen Klinik Vogtareuth, Vogtareuth, Germany
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
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Monbaliu E, de Cock P, Ortibus E, Heyrman L, Klingels K, Feys H. Clinical patterns of dystonia and choreoathetosis in participants with dyskinetic cerebral palsy. Dev Med Child Neurol 2016; 58:138-44. [PMID: 26173923 DOI: 10.1111/dmcn.12846] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2015] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to map clinical patterns of dystonia and choreoathetosis and to assess the relation between functional classifications and basal ganglia and thalamus lesions in participants with dyskinetic cerebral palsy (CP). METHODS In this cross-sectional study, 55 participants with dyskinetic CP (mean age 14y 6mo, SD 4y 1mo; range 6-22y) were assessed with the Dyskinesia Impairment Scale and classified with the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). RESULTS Dystonia and choreoathetosis are simultaneously present. Median levels of dystonia (70.2%) were significantly higher than levels of choreoathetosis (26.7%) and both were significantly higher during activity than at rest (both p<0.01). High correlations were found between dystonia levels and GMFCS level (Spearman's rank correlation coefficient, rS =0.70; 95% confidence interval [CI] 0.53-0.81; p<0.01) and MACS (rS =0.65; 95% CI 0.47-0.81; p<0.01), and fair correlation with CFCS (rs =0.36; 95% CI=0.11-0.57; p<0.05). No significant correlation was found between choreoathetosis levels and motor classifications. Finally, higher choreoathetosis levels were found in participants with pure thalamus and basal ganglia lesions (p=0.03) than mixed lesions, but not for dystonia (p=0.41). INTERPRETATION Dystonia and choreoathetosis increase during activity. However, dystonia predominates and seems to have a larger impact on functional abilities. Our findings further suggest that choreoathetosis seems to be more linked to pure thalamus and basal ganglia lesions than dystonia.
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Affiliation(s)
- Elegast Monbaliu
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Paul de Cock
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lieve Heyrman
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Klingels K, van den Hauwe M, Smeets F, Schraeyen M, Buyse G, Goemans N. Assessment of early motor development in young boys with Duchenne muscular dystrophy. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Klingels K, Mayhew A, Mazzone E, Main M, Decostre V, van den Hauwe M, Eagle M, Duong T, de Groot I, Ricotti V, Werlauff U, Campion G, Vroom E, Mercuri E, Goemans N. Development of a patient-reported outcome measure for arm and hand function in Duchenne muscular dystrophy (UL-PROM DMD). Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Klingels K, Van Verdegem L, van den Hauwe M, Buyse G, Goemans N. Reference values for the three-minute walk test, North Star ambulatory assessment and timed tests in typically developing boys aged 2.5–5 years. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fiori S, Guzzetta A, Pannek K, Ware RS, Rossi G, Klingels K, Feys H, Coulthard A, Cioni G, Rose S, Boyd RN. Validity of semi-quantitative scale for brain MRI in unilateral cerebral palsy due to periventricular white matter lesions: Relationship with hand sensorimotor function and structural connectivity. Neuroimage Clin 2015; 8:104-9. [PMID: 26106533 PMCID: PMC4473818 DOI: 10.1016/j.nicl.2015.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/20/2022]
Abstract
AIM To provide first evidence of construct validity of a semi-quantitative scale for brain structural MRI (sqMRI scale) in children with unilateral cerebral palsy (UCP) secondary to periventricular white matter (PWM) lesions, by examining the relationship with hand sensorimotor function and whole brain structural connectivity. METHODS Cross-sectional study of 50 children with UCP due to PWM lesions using 3 T (MRI), diffusion MRI and assessment of hand sensorimotor function. We explored the relationship of lobar, hemispheric and global scores on the sqMRI scale, with fractional anisotropy (FA), as a measure of brain white matter microstructure, and with hand sensorimotor measures (Assisting Hand Assessment, AHA; Jebsen-Taylor Test for Hand Function, JTTHF; Melbourne Assessment of Unilateral Upper Limb Function, MUUL; stereognosis; 2-point discrimination). RESULTS Lobar and hemispheric scores on the sqMRI scale contralateral to the clinical side of hemiplegia correlated with sensorimotor paretic hand function measures and FA of a number of brain structural connections, including connections of brain areas involved in motor control (postcentral, precentral and paracentral gyri in the parietal lobe). More severe lesions correlated with lower sensorimotor performance, with the posterior limb of internal capsule score being the strongest contributor to impaired hand function. CONCLUSION The sqMRI scale demonstrates first evidence of construct validity against impaired motor and sensory function measures and brain structural connectivity in a cohort of children with UCP due to PWM lesions. More severe lesions correlated with poorer paretic hand sensorimotor function and impaired structural connectivity in the hemisphere contralateral to the clinical side of hemiplegia. The quantitative structural MRI scoring may be a useful clinical tool for studying brain structure-function relationships but requires further validation in other populations of CP.
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Key Words
- AHA, Assisting Hand Assessment
- Brain structure
- CP, cerebral palsy
- Diffusion
- FA, fractional anisotropy
- GMFCS, Gross Motor Function Classification System
- HARDI
- JTTHF, Jebsen–Taylor test of hand function
- MACS, Manual Ability Classification System
- MRI, magnetic resonance imaging
- MUUL, Melbourne Assessment of Unilateral Upper Limb function
- Magnetic resonance imaging
- PWM, periventricular white matter
- Sensorimotor function
- Unilateral cerebral palsy
- sqMRI, semi-quantitative MRI
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Affiliation(s)
- Simona Fiori
- IRCCS Fondazione Stella Maris, Pisa, Italy
- Corresponding author. Tel.: +39 050886313; fax: +39 050886324.
| | - Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Kerstin Pannek
- Australia E-Health Research Centre, Brisbane, Australia
- University of Queensland, School of Medicine, Brisbane, QLD, Australia
- Department of Computing, Imperial College London, Biomedical Image Analysis Group, London, UK
| | - Robert S. Ware
- School of Population Health, The University of Queensland, Brisbane, QLD, Australia
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Giuseppe Rossi
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Alan Coulthard
- Academic Discipline of Medical Imaging, Royal Brisbane and Women's Hospital, QLD, Australia
| | - Giovanni Cioni
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Stephen Rose
- Australia E-Health Research Centre, Brisbane, Australia
| | - Roslyn N. Boyd
- Queesland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Australia
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Goemans N, Klingels K, Hauwe MV, Feys H, Buyse G. T.P.6. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Eliasson AC, Krumlinde-Sundholm L, Gordon AM, Feys H, Klingels K, Aarts PBM, Rameckers E, Autti-Rämö I, Hoare B. Guidelines for future research in constraint-induced movement therapy for children with unilateral cerebral palsy: an expert consensus. Dev Med Child Neurol 2014; 56:125-37. [PMID: 24266735 DOI: 10.1111/dmcn.12273] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 01/22/2023]
Abstract
AIM The aim of this study was to provide an overview of what is known about constraintinduced movement therapy (CIMT) in children with unilateral cerebral palsy (CP), to identify current knowledge gaps, and to provide suggestions for future research. METHOD Nine experts participated in a consensus meeting. A comprehensive literature search was conducted and data were summarized before the meeting. The core model produced by the European network for Health Technology Assessment was used as a framework for discussion and to identify critical issues for future research. RESULTS All models of CIMT have demonstrated improvements in the upper limb abilities of children with unilateral CP. A consensus was reached on 11 important questions to be further explored in future studies. The areas of highest priority included the effect of dosage, the effect of repeated CIMT, and the impact of predictive factors, such as age, on the response to CIMT. Consensus suggestions for future study designs and the use of validated outcome measures were also provided. INTERPRETATION The CIMT construct is complex, and much remains unknown. It is unclear whether a specific model of CIMT demonstrates superiority over others and whether dosage of training matters. Future research should build upon existing knowledge and aim to provide information that will help implement CIMT in various countries with different healthcare resources and organizational structures.
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Affiliation(s)
- Ann Christin Eliasson
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Lena Krumlinde-Sundholm
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Andrew M Gordon
- Department of Biobehavioral Sciences; Teachers College; Columbia University; New York NY USA
| | - Hilde Feys
- Department of Rehabilitation Sciences; Katholieke Universiteit; Leuven Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences; Katholieke Universiteit; Leuven Belgium
| | - Pauline B M Aarts
- Department of Paediatric Rehabilitation; Sint Maartenskliniek; Nijmegen The Netherlands
| | - Eugene Rameckers
- Adelante Rehabilitation Center; Valkenburg The Netherlands
- Rehabilitation Medicine CAPHRI; University Maastricht; Maastricht The Netherlands
- Master of Specialised Physical Therapy; AVANSplus; Breda the Netherlands
| | - Ilona Autti-Rämö
- Research Department; Social Insurance Institution; Helsinki Finland
- Department of Child Neurology; Helsinki University Hospital; Helsinki Finland
| | - Brian Hoare
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Monash Children's Hospital; Clayton Vic. Australia
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