Extremity Function In Children Research Articles

Forced-use therapy for children with cerebral palsy in the community setting: A single-blinded randomized controlled pilot trial

The aim of this study was to elucidate the feasibility, efficacy, and sustainability of a home-based, two-week, forced-use therapy (FUT) program for children with hemiplegic cerebral palsy (CP). A single-blinded, randomized controlled design was chosen. The Melbourne Assessment of Unilateral Upper Limb Function (MA) was carried out at baseline, pretest, post-test, and follow-up at two weeks, three months, and 12 months. Additionally, a questionnaire was used to evaluate the clinical relevance and integration of FUT in the home setting. 23 children, ages six to 16 years, took part in the study and were randomized into either an intervention group (n=12, mean age 9.8 ± 3.5 years) or a control group ($n=$ 11, mean age 11.7 ± 3.7 years). The intervention consisted of constraint of the unaffected hand for six hours per day and promotion of different activities of daily living according to an age-related manual for the use of the non-constraint hand. Unpaired t-tests for the change in MA scores relative to the pre-test values showed no difference between the groups at any time point: post-test (p=0.304), two weeks (p=0.193), or three months (p=0.957). Improvements in Activities of Daily Living (ADLs) assessed by questionnaires were observed by 64% of parents of the intervention group. Fifty-five percent of parents stated that the FUT program was exhausting and only 45% indicated that they achieved constraint for 6 hours per day. Our results evaluating a home-based FUT program of 14 days show no statistically significant improvement of upper extremity function in children with CP. The lack of compliance and absence of structured exercises proved to be considerable pitfalls of the home-based FUT program. Therefore, future home based FUT concepts should put special emphasis on the close monitoring and support of children and their families, as well as the integration of structured exercise sessions.

The effect of upper extremity weight bearing on upper extremity function in children with hemiplegic type of cerebral palsy

The main objective of this study was to quantify the effects ofweight bearing on upper limb function in children with hemiplegic cerebralpalsy. This study also sought to monitor the change in spasticity immediatelyfollowing weight bearing exercises. A quasi-experimental, one group pre-test,post-test design was used. Eleven children with hemiplegic type of cerebral palsyfrom a special school in KwaZulu Natal participated after fully informed consentof the caretaking guardian. The intervention consisted of a standardized programof weight bearing. The Melbourne A ssessment of Upper Extremity function wasused to quantify upper extremity function of reach, grasp and manipulation and the modified A shworth grading of spasticity was used to grade and monitor spasticity. The data was analysed using the Wilcoxon signed rank test. A significant decrease in spasticity during elbow extension (p= 0,004), wrist flexion (p=0,026) and extension (p=0,004)was noted. Statistically significant improvement in function, reach (p=0, 00), grasp (p=0, 02) manipulation (p=0, 05)and overall quality of function (p= 0,003) was also found. A n overall significant effect of weight bearing exercises onupper extremity function was noted providing evidence for practice.

A pilot study on the test re-test and the inter-rater reliability of the Melbourne Assessment of Unilateral Upper Limb Function

Objective: The Melbourne Assessment of Unilateral Upper Limb Function(commonly referred to as the Melbourne A ssessment) was identified as atool to quantify the quality of upper extremity function in children with cerebral palsy aged 5 to 15 years in South Africa. Since the tool was nottested in a South African population before, it became necessary to determine its inter-rater and test-retest reliability.Methods: Five South African Black children with hemiplegic cerebral palsy served as the test sample. The raters were 2 neurodevelopmental trained physiotherapists with more than 2 and 8 years of experience in pediatric physiotherapy but novice to the use of the Melbourne Assessment. Both therapists acquainted themselves with the tool kit and manual prior to the rating. The entire assessment of each child was video taped and reassessed a week later by one of the therapists for test-retestreliability. Results: Ratings of the 2 raters and test-retest scores were correlated using the weighted Kappa due to the small sample size. Kappa scores for individual scores for interrater reliability and test-retest was 0, 75 and that for the totalscores were 0, 72 and 0, 82 respectively. Conclusion: These findings suggest that good inter-tester and test-retest reliability can be achieved for the MelbourneA ssessment when used in a group of South African Black children.

Scapular Summit 2009, July 16, 2009, Lexington, Kentucky

This was the third research meeting focused on scapular function and dysfunction, following similar meetings in 2003 and 2006. The purpose of this meeting, hosted by the Shoulder Center of Kentucky, was to continue to examine the biomechanical and clinical factors thought to be associated with the role of the scapula in shoulder function and dysfunction. Since the last Summit, much more information has been created in this area, and it was thought that enough progress had been made that an organized overview of current knowledge could provide some consensus statements to guide further research and provide assessment and treatment guidelines. A call for abstracts was extended to researchers with proven interest and published research on the scapula. The meeting was organized around 3 primary categories of information: scapular kinematics and dysfunction, clinical evaluation of the scapula, and interventions. The last session of the meeting involved development of consensus statements for each category. This document represents the current state of knowledge concerning the aspects of scapular function and dysfunction discussed at the Summit. It is expected that, as more knowledge is developed, the gaps will be filled in and a clearer understanding of the roles of the scapula in shoulder function will emerge. This issue includes the consensus statements and abstracts from the Summit.

‘Both constraint‐induced movement therapy and bimanual training lead to improved performance of upper extremity function in children with hemiplegia’

‘Both constraint‐induced movement therapy and bimanual training lead to improved performance of upper extremity function in children with hemiplegia’

A Low-Cost Video Game Applied for Training of Upper Extremity Function in Children with Cerebral Palsy: A Pilot Study

The aim of the present study was to determine the user satisfaction of the EyeToy for the training of the upper limb in children with cerebral palsy (CP). User satisfaction was measured in 12 children with CP, using a postexperience questionnaire, primarily based on a presence questionnaire. In general, children with CP were satisfied with and motivated by the EyeToy training. In addition, a first evaluation study was performed to determine the effect of this training method on the upper limb function. Ten children with CP were randomly assigned to the intervention (mean age 11 years, 9 months; SD 2,3) and the control group (mean age 12 years, 3 months; SD 3,2). After a treatment period of 6 weeks, the intervention group completed a user satisfaction questionnaire. Functional outcome was measured using the Melbourne Assessment scores. Percentage scores of the Melbourne Assessment of 7 of the 10 children were the same or changed only 1% to 2% from baseline to followup. However, in the experimental group, two children improved more, 9% and 13% respectively. In conclusion, it can be said that the EyeToy is a motivational training tool for the training of children with CP and has the potential to improve upper extremity function.

Method of analysing the performance of self-paced and engine induced cycling in children with cerebral palsy

Purpose. To develop a method of quantifying the features of cycling in children with CP by comparing them to typically developed children, and to demonstrate the applications of this tool for evaluating treatment effects in children with CP.Methods. Twenty-seven typically developed children and 51 with CP, classified by their gross motor function levels, were studied. Angular velocities were measured during self-paced active cycling and during passive cycling imposed by an electrically powered stationary cycle. Angular velocities were compared with the gross motor function levels, Modified Ashworth Scale and the Adductor Tone Rating.Results. Significant differences between children with CP and those typically developed demonstrated in passive mode that the cycling task is sensitive to differences in resistance offered by the subjects. Active and passive cycling velocities differ significantly between groups classified by their functional levels (p < 0.01). Children with CP in the mild group showed no differences from typically developed children. The correlations between passive cycling and clinical tests were significant and higher at higher speeds (r = 0.62). Correlations with anthropometric measurements for the typically developed group associated the cycling task with growth and development, and for children with CP with motor control adjustments and impairments.Conclusions. Measuring of these two cycling modes could be applicable in assessing lower extremity function in children with CP and changes following interventions.

Validation of the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) for Children with Hemiplegic Cerebral Palsy

The Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) is a video-based tool for the assessment of upper extremity function in children with hemiplegic cerebral palsy. This tool includes spontaneous functional analysis and dynamic positional analysis and assesses the ability to perform grasp and release. The purpose of the present study was to assess the reliability, concurrent validity, and construct validity of this instrument. The Shriners Hospital for Children Upper Extremity Evaluation studies for eleven subjects with hemiplegic cerebral palsy were selected for the evaluation of intraobserver and interobserver reliability. Concurrent validity was determined through analysis of the Shriners Hospital for Children Upper Extremity Evaluation, Pediatric Evaluation of Disability Inventory, and Jebson-Taylor Test of Hand Function scores for twenty children. Construct validity was determined through analysis of Shriners Hospital for Children Upper Extremity Evaluation scores for eighteen children before and after flexor carpi ulnaris to extensor carpi radialis brevis tendon transfer. The absolute mean differences between the two scoring sessions for three raters were 1.2 and 1.0 for the spontaneous functional analysis and the dynamic positional analysis, respectively. Although the mean differences were significantly different from 0 (p < 0.001 and p = 0.003), the differences were small and not clinically important with regard to the total possible score. There was excellent intraobserver reliability between the two sessions with regard to both spontaneous functional analysis (r = 0.99) and dynamic positional analysis (r = 0.98). Assessment of interobserver reliability revealed absolute mean differences between four raters of 3.8 and 3.7 for the spontaneous functional analysis and the dynamic positional analysis, respectively. These differences were significantly different from 0 (p < 0.001); however, the magnitudes of these differences were not important with regard to total score or clinical interpretation. There was excellent interobserver reliability for both the spontaneous functional analysis (r = 0.90) and the dynamic positional analysis (r = 0.89). There was 100% agreement within and between examiners for the grasp-and-release section. The Shriners Hospital for Children Upper Extremity Evaluation showed fair correlation with the self-care scaled score from the Pediatric Evaluation of Disability Inventory (r = 0.47) and good inverse correlation with the non-dominant total time section of the Jebson-Taylor test (r = -0.76). The Shriners Hospital for Children Upper Extremity Evaluation wrist score improved for all eighteen subjects after the flexor tendon transfer, and the mean improvement was significant (p < 0.001). The present study establishes the clinical reliability, concurrent validity, and construct validity of the Shriners Hospital for Children Upper Extremity Evaluation for the assessment of upper extremity function in children with hemiplegic cerebral palsy.

Upper Extremity Function in Children with Congenital Hand Anomalies

The enhancement of function takes priority in the management of children with congenital hand anomalies. The authors conducted a systematic review of studies of pollicization and centralization surgery to examine functional outcome. The search strategy included MEDLINE, CINAHL, and reference lists from secondary resources. The selection criteria included all literature pertaining to the functional outcome of children having either pollicization or centralization surgery. The studies were analyzed according to the levels of evidence for primary research. Ten studies were reviewed; one study was evaluated at level 3 and the remaining were level 4. Rigorous research of functional outcome is needed to validate surgical interventions. Enhancing the quality of functional outcome studies in this population requires improvements in research methodology, sampling, and measurement of function.

Assessment of Children With Brachial Plexus Birth Palsy Using the Pediatric Outcomes Data Collection Instrument

The purpose of this study was to determine whether the Pediatric Outcomes Data Collection Instrument (PODCI) measures differences in function between children with brachial plexus birth palsy (BPBP) who are candidates for shoulder tendon surgery and age-matched controls. The PODCI was administered prospectively to 23 children with BPBP who were candidates for shoulder tendon surgery. Their results were compared with published PODCI data for control subjects, and factors associated with function within the BPBP cohort were determined. Children in the BPBP cohort had significantly lower PODCI scores in upper extremity function, sports, and global function than control subjects. Limited active shoulder external rotation was significantly associated with lower functional scores. The PODCI measures diminished upper extremity function in children with BPBP who are candidates for shoulder tendon surgery, thereby showing promise as a tool for measuring baseline function and postoperative functional gains for children with BPBP.

Botulinum toxin A in cerebral palsy: Functional outcomes

Botulinum toxin A in cerebral palsy: Functional outcomes

An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy

Objective: In a randomized, controlled, single-blind trial, to test the hypothesis that botulinum-A toxin (BTA) injections into the upper extremity of children with spastic hemiplegia improve upper extremity function. Study design: Thirty children with hemiplegia, aged 2.5 to 10 years, were randomly assigned to receive: (1) a BTA injection into 1 or more of 3 muscle groups (biceps, volar forearm muscles, adductor pollicis) plus occupational therapy or (2) occupational therapy alone. Blinded outcomes obtained at baseline and at 1, 3, and 6 months included the Quality of Upper Extremity Skills Test (QUEST), goniometry measurements, grip strength, and Ashworth scores. The caregiver completed the self-care domain of the Pediatric Evaluation of Disability Inventory. Results: Twenty-nine subjects completed the study. The QUEST demonstrated a significant improvement favoring the treatment group on a 2-way analysis of variance (F = 4.69, df = 1,83; P =.039). BTA treatment was also associated with an improvement in score on the self-care domain of the Pediatric Evaluation of Disability Inventory (F = 4.68, df = 1,82; P =.04). Conclusions: This study supports the effectiveness of BTA injections to improve upper extremity function of children with hemiplegia who have at least moderate spasticity. (J Pediatr 2000;137:331-7)

Restoration of Function in Children with Spinal Cord Injuries and Cerebral Palsy: Progress, Current State, and Future Vision of Functional Electrical Stimulation Research at the Shriners Hospitals for Children

In cases of spinal cord injury (SCI), functional electrical stimulation (FES) is based on the concept that a paralyzed muscle can be stimulated by small amounts of electric current in a coordinated fashion to produce functional movement. This article reviews the experience of the Philadelphia Shriners Hospital with the use of FES for restoring upper extremity function in children with cervical SCI at the C5/C6 level. In addition, restoration of the ability to stand and some limited upright mobility are available with an FES system for patients with complete or incomplete SCI. The ability of FES to restore bladder and bowel function is also described. The Philadelphia Shriners Hospital specifically has expertise in children described in this review article as well as experience in preclinical studies an applying FES technology in growing animals and in growing children.