Commentary on "Effects of Suit-Orthosis on Postural Adjustments During Seated Reaching Task in Children With Cerebral Palsy".

Abstract

“How should I apply this information?” Garments, such as the suit in this study, are used in therapy sessions and at home, with the goal of increasing postural support and alignment. They are often combined with intensive training programs that are costly to families both in time and money. Studies such as this one that dissect interventions that include suit wear compared with a control condition are important to evaluate their benefits. Although postural control during reaching is a functional activity, the data collected in this study does not simulate real-world reaching, which is typically more dynamic and involves reaching in a variety of planes during functional tasks. Overall, results from this study suggest that wearing the suit may be helpful for children classified as Manual Ability Classification System (MACS) II or III rather than MACS I. This intervention should be used with caution and the clinician should assess client goals and level of function when applying this intervention. “What should I be mindful about when applying this information?” The authors do not provide a rationale for using knee pads and shoes during seated activities. The suit in this study takes time to don, and it would be important to compare it to other garments that are less cumbersome and easier to don. This study would be strengthened if investigators examined the effect of the Gross Motor Function Classification System combined with the MACS level on the outcome. Furthermore, including a functional outcome measure such as the Trunk Control Measurement Scale1,2 would offer a more detailed picture of the children's trunk performance and may have provided information about those children for whom the suit was helpful. The design of this study does not allow us to know whether the gains in postural control when wearing the orthosis translate to improved function when the suit is removed. More studies like this are needed that investigate a multidimensional intervention and evaluate the effects on a functional task. Amy F. Bailes PT, PhD, PCS Cincinnati Children's Hospital, Department of Rehabilitation Sciences, University of Cincinnati Cincinnati, Ohio Jenny Dorich, MBA, OTR/L, CHT Cincinnati Children's Hospital Cincinnati, Ohio