Improvement In Gross Motor Function Research Articles

Effects of Treadmill Walking and Overground Walking in Young Children With Non-progressive Neurodevelopmental Disorders.

Introduction Neurodevelopmental disorders (NDDs) are responsible for childhood brain dysfunction and developmental disability. Physical therapists are important team members in providing a beneficial impact on the gross motor function of children with NDDs. Early intervention provides a beneficial effect on the improvement of gross motor function; however, most of the studies on treadmill training were in late age and the effect of early treadmill walking along with conventional physiotherapy was not studied. Hence, the objective of the present study was to compare the effect of overground walking with treadmill walking in young children aged 12-36 months with non-progressive NDDs. Methodology An experimental study was performed for one year on diagnosed cases of non-progressive NDD. A total of 36 children with non-progressive NDD were recruited for the study between the ages of 12 and 36 months of either gender and were allocated into treadmill walking and overground walking groups. The intervention was given for eight consecutive weeks, four days per week, and for 20-25 minutes per day. The children were assessed using Gross Motor Function Measure-66 (GMFM-66) and Peabody Developmental Motor Scale-2 (PDMS-2) for both stationary and locomotion components. Results The comparison of both the groups with PDMS-2 (stationary) at baseline, follow-up, and post intervention reported mean values of 25.56 ± 12.16, 27.22 ± 11.74, and 28.44 ± 11.72, respectively, in the overground walking group and 28.72 ± 8.96, 29.72 ± 9.46, and 31.33 ± 8.85 in the treadmill walking group, respectively, with statistically significant results (p = 0.0022). Additionally, the comparison of both the groups with PDMS-2 (locomotion) reported mean values of 35.78 ± 24.02, 39.11 ± 23.21, and 43.00 ± 23.58, respectively, in the overground walking group and 39.67 ± 22.28, 43.17 ± 22.94, and 46.61 ± 24.16 in the treadmill walking group, respectively, with statistically significant results (p = 0.020). Moreover, the comparison of both the groups with total GMFM-66 reported mean values of 16.97 ± 14.52, 18.35 ± 14.88, and 20.49 ± 16.86, respectively, in the overground walking group and 18.52 ± 14.28, 21.66 ± 15.76, and 25.92 ± 16.95 in the treadmill walking group with statistically significant results (p = 0.0118). Conclusion The present study concluded that between both the groups, a statistically significant difference was observed for PDMS-2 (stationary and locomotion)and GMFM-66 after a scheduled intervention of eight weeks. Hence, walking should be carried out as a part of therapy in early intervention and further studies can be performed to determine the long-term effect of these interventions and their role in the prevention of secondary complications.

White matter characteristics in children with cerebral palsy prior to selective dorsal rhizotomy: a multicenter diffusion tensor imaging study.

The aims of this study were to 1) assess and quantify white matter (WM) microstructural characteristics derived from diffusion tensor imaging (DTI) in children with cerebral palsy (CP) prior to selective dorsal rhizotomy (SDR), and 2) investigate potential associations between WM diffusion properties and gross motor function and spasticity in children with spastic CP who underwent SDR. This study is a multisite study based on DT images acquired prior to SDR as well as postoperative outcome data. DTI data collected from two sites were harmonized using the ComBat approach to minimize intersite scanner difference. The DTI abnormalities between children with spastic CP and controls were analyzed and correlated with the severity of impaired mobility based on the Gross Motor Function Classification System (GMFCS). The improvement in gross motor function and spasticity after SDR surgery was assessed utilizing the Gross Motor Function Measure-66 (GMFM-66), the Modified Tardieu Scale (MTS), and the modified Ashworth scale (MAS). Alterations in these outcome measures were quantified in association with DTI abnormalities. Significant DTI alterations, including lower fractional anisotropy (FA) in the genu of the corpus callosum (gCC) and higher mean diffusivity (MD) in the gCC and posterior limb of the internal capsule (PLIC), were found in children in the SDR group when compared with the age-matched control group (all p < 0.05). Greater DTI alterations (FA in gCC and MD in gCC and PLIC) were associated with lower mobility levels as determined based on GMFCS level (p < 0.05). The pre- to post-SDR improvement in motor function based on GMFM-66 was statistically significant (p = 0.006 and 0.002 at 6-month and 12-month follow-ups, respectively). The SDR efficacy was also identified as improving spasticity in lower-extremity muscle groups assessed with the MTS and MAS. Partial correlation analysis presented a significant association between pre- to post-SDR MTS alteration and DTI abnormalities. The findings in the present study provided initial quantitative evidence to establish the WM microstructural characteristics in children with spastic CP prior to SDR surgery. The study generated data for the association between baseline DTI characteristics and mobility in children with CP prior to SDR surgery. The study also demonstrated SDR efficacy in improving motor function and spasticity based on the GMFM-66, MTS, and MAS, respectively, in association with DTI data.

Effects of Therapeutic Dosing through Enriched Environment on Gross Motor Function in Spastic Quadriplegic Cerebral Palsy

Background: Cerebral palsy differs in every child in terms of impairments, activity limitations and participation restrictions, so intervention should be designed in a way which is specific to every child and is constantly adjusted according to the needs of the child. Level appropriate selection of dosage (frequency, type, time, intensity) of treatment plays a vital role in treatment efficacy. Objective: To investigate the effects of therapeutic dosing through age-appropriate enriched environment on gross motor function in spastic quadriplegic cerebral palsy. Methods: In this RCT, 82 spastic cerebral palsy children were randomly allocated to two groups. Group A received level appropriate enriched environmental inputs consisting of motor and sensory enriched play environment with therapeutic dosing (20-25 minutes intermittently, 5 hours per day, 5 days a week for 24 weeks) along with Neurodevelopmental Technique. The goal was to promote participant’s self-generated movements, exploration of the environment and successful task completion. Group B received clinical based regular physical therapy consisting of NDT. Guidance was given to parents on how to carry out a home program. Data was collected at the end of 5 months on GMFM scale to check improvement in gross motor function. Results: The data was analyzed using Mann Whitney U test. There was statistically significant difference between the two groups. Group A showed improvement in gross motor function (p value&lt;0.05) whereas improvement in group B was not as significant (p-value&gt;0.05). Conclusion: This study concluded that optimal dosage of an intervention along with parent/caregiver education started at an early age resulted in significant functional improvements in spastic quadriplegic cerebral palsy children. These improvements were observed not only in body functions but also in active involvement and participation of the child.

Effectiveness of Tizanidine and intensive rehabilitation in Spastic Cerebral Palsy

Background: The treatment of cerebral palsy is multifactorial. The aim of the study is to find out the efficacy of tizanidine and intensive rehabilitation in the treatment of spastic cerebral palsy. Methods: This observational study was conducted over 35 patients in Sir Salimullah Medical Mitford Hospital from January 2022 to December 2022.The patients satisfying the inclusion and exclusion criteria were enrolled: total 35 patients received tizanidine (2mg) orally at a dose of 1 mg given at bed time under 10 years and 2 mg given at bed time more than 10 years of age, then after 1 week maintenance dose was given at 0.3 mg/kg/day, three times daily in combination with intensive rehabilitation 1 hour daily five times a week. Total 24 weeks of intensive rehabilitation was given. All patients were followed up at 4 weeks interval and were evaluated for a total of 24 weeks. Results: The study shows high efficacy in reducing tone in spastic cerebral palsy measured by using Modified Ashworth scale (p&lt;0.001).Also there is improvement in physician rating scale crouch (p&lt;0.0001) and foot contact, (p&lt;0.0001) and also improvement in gross motor function (p&lt;0.01). Conclusion: Combination of tizanidine and intensive rehabilitation is effective for reduction of generalized spasticity regarding muscle tone, range of motion of the joint and improvement of gait in cerebral palsy patients. Bangladesh J Medicine 2023; 34(3): 223-228

Electrical Stimulation for Children with Cerebral Palsy: A Meta-analysis for Randomized Controlled Trials.

Different types of electrical stimulation (ES) showed diverse effects on children with cerebral palsy (CP). Previous studies reported inconsistent results for effects of ES on children with CP. The present study aimed to conduct a meta-analysis to summarize these diverse results. We searched for studies exploring effects of ES on children with CP in databases (PubMed and Web of Science) from their inception until December 2022. Standard mean differences (SMDs) and 95% confidence intervals (CIs) were computed using STATA 12.0 software. The meta-analysis included 19 randomized controlled trials (including 265 CP patients in test group and 263 CP patients in corresponding control group). The study showed an increased improvement in gross motor function, walking speed, step length, and daily living activities in ES group compared with corresponding control group with random effects models (gross motor function: SMD = 2.04, 95% CI = 1.43-2.65; walking speed: SMD = 3.71, 95% CI = 1.49-5.92; step length: SMD = 1.89, 95% CI = 0.65-3.13; daily living activities: SMD = 5.18, 95% CI = 3.04-7.31), whereas the study showed no significant difference in change of muscle strength between ES group and the corresponding control group with a random effects model (SMD = 0.42, 95% CI = -0.12 to 0.97). The study demonstrated that ES might be used as therapy to improve gross motor function, gait, and daily living activities in children with CP.

Effects of Ballet &amp; Dance Programs on Gross Motor Skills in Children With Intellectual &amp; Developmental Disabilities: A Scoping Review

Abstract Date Presented 04/21/2023 The purpose of this study was to systematically review the best available evidence regarding ballet and dance therapy for children with intellectual disabilities. Of the 21 articles, 20 found statistically significant improvements in gross motor function and social development. Dance therapy is a unique form of therapy within the OT scope of practice because it uses the activity or occupation of dance to promote play, enhance mobility, and improve performance skills. Primary Author and Speaker: Phil Esposito Additional Authors and Speakers: Corinne Marascio

Intensive Rehabilitation is better when it is combined with Tizanidine in Spastic Cerebral Palsy- A Randomized Clinical Trial

Background: To find out the combined efficacy of Tizanidine and intensive rehabilitation in the treatment of spastic cerebral palsy. Methods: This randomized clinical trial was conducted over 70 patients in Sir Salimullah Medical College Hospital from January 2022 to December 2022.The patient satisfying the inclusion and exclusion criteria was randomly enrolled into two groups; Group- A (Case) included 35 patients received only intensive rehabilitation and Group- B (Control). included 35 patients who received Tizanidine (2mg) orally at a dose of 1 mg given at bed time under 10 years and 2 mg 10 years or more, then after 1 week maintenance dose was 0.3 mg/kg/day three times daily in combination with intensive rehabilitation 1 hour daily five times a week for 24 weeks. All patients were followed up at 4 weeks interval and were evaluated for a total of 24 weeks. Combination of Tizanidine and intensive rehabilitation has superior efficacy in reducing tone in spastic cerebral palsy over only rehabilitation measured by using Modified ashworth scale (p&lt;0.001). Results: Combination of Tizanidine and intensive rehabilitation is improved in physician rating scale crouch (p&lt;0.0001) and foot contact, (p&lt;0.0001) and also improvement in gross motor function (p&lt;0.01). Conclusion: Combination of Tizanidine and intensive rehabilitation group has superior efficacy than only rehabilitation group for reduction of generalized spasticity regarding muscle tone, range of motion of the joint and improvement of gait in cerebral palsy patients. Bangladesh J Medicine 2023; 34(2): 98-104

Effectiveness of a Telecare Physical Therapy Program in Improving Functionality in Children and Adolescents with Cerebral Palsy: A Cases Study.

Cerebral palsy (CP) is the most common physical disability in childhood and results in motor impairment that is often associated with other disorders. The aim of this study was to assess whether a telecare intervention consisting of Action Observation Therapy with a family-center approach produces improvements in functionality in children and adolescents with CP. Seven girls with CP ages between 6 and 17 participated in this case series study that lasted 12 weeks: 6 weeks of telecare program with a total of six sessions; and a follow-up period of 6 weeks. The outcome variables were Gross Motor Function (Spanish version of the Gross Motor Function Measure), balance (Spanish version of the Pediatric Balance Scale), walking endurance (6-min walk test) and walking speed (10-m walk test). The variables were measured before starting the study, after 6 weeks of intervention and after the 6-week follow-up period. Results showed statistically significant improvements in gross motor function (p = 0.02) after the intervention. After the follow-up period, gross motor function remained statistically significant (p = 0.02), as well as balance (p = 0.04) and walking endurance (p = 0.02). These results show that a telecare program has been beneficial in improving functionality with enhancements in gross motor function, balance and endurance in children and adolescents with CP that will facilitate participation.

Virtual Reality Training Improves Upper Limb Functions in Stroke Survivors

Stroke survivors with upper extremity functional limitation are particularly susceptible to problems in performing independent ADLs. Virtual Reality training has a significant contribution to enhancing the independence of stroke survivors. Objective: To determine the effect of additional VR training on upper limb gross motor function, gross manual dexterity, and functional activities in hemiplegic stroke survivors. Methods: It was a single-group experimental study in which 20 participants were recruited through non-probability convenient sampling. Participants were included in the study if they had any sort of stroke (hemorrhagic or infarct), were between the ages of 30 and 70, had at least one score on the box and block test, and did not have any cognitive deficits or uncontrolled high blood pressure. The intervention was provided three days a week for a total of six weeks. Gross motor function, gross manual dexterity, and functional capacities of the upper limb were measured at baseline, 2nd, 4th and at 6th week of intervention through Fugl-Meyer Assessment, Box and Block Test, and Wolf Motor Assessment Scale respectively. Data were analyzed through within-group inferential analysis using SPSS-21 software. Results: The mean age of patients was 49.45 ± 11.02 years. The scores of the Fugl-Mayer Assessment Scale, Box and Block Test and Wolf Motor Assessment Scale were significantly improved from baseline to six weeks (p&lt;0.05). Conclusion: This study concluded that the hemiplegic stroke survivors who received additional Virtual Reality training using Xbox Kinect showed significant improvement in Gross motor Function, Gross Manual Dexterity and Functional Abilities of the Upper Limb.

Improvement of the gait pattern after selective dorsal rhizotomy derives from changes of kinematic parameters in the sagittal plane.

Selective dorsal rhizotomy (SDR) can decrease spasticity in children suffering from spastic cerebral palsy (SCP) and thus improve their moving ability when supplemented with the post-operational rehabilitation program. In this case, the study aims to investigate the gait changes in children with mild SCP after SDR in short-term follow-up. The information of ambulatory SCP cases who underwent SDR in our center was retrospectively reviewed, and comparisons of changes in spasticity, motor function and data of gait analysis before and after SDR were analyzed. In total, 32 cases were included in this study, with a mean age of 5.9 ± 2.1 years old. Noticeable decrease was found in the median value of the pre-operational MAS score after SDR at last follow-up in both sides of adductors, gastrocnemius, soleus, and left hamstrings. The Gross Motor Function Measure-66 score increased from 70.6 ± 9.2 to 73.4 ± 8.2, and the gait deviation index increased after SDR compared with the pre-operational data (right side: 65.8 ± 8.8 vs. 60.1 ± 10.7; left side: 63.5 ± 10.1 vs. 57.0 ± 9.9). Noticeable changes were found that the maximum angle of affected ankles in the sagittal plane (the dorsal-flexion angle) increased from 2.5° to 8.2°, the angles at initial contact (1% gait cycle) of affected knees in the sagittal plane decreased from 34.0° to 27.8°, and the angles at the end of swing phase (100% gait cycle) of affected knees in the sagittal plane decreased from 35.8° to 28.3°. In short-term follow-up, SDR can lower spasticity in children with SCP. Post-operational gait analysis showed improvements in gross motor function and gait, which derived from the changes in the sagittal plane (ankle and knee). A longer follow-up duration is thus needed to clarify the long-term outcome.

Effect of task-oriented training on gross motor function, balance and activities of daily living in children with cerebral palsy: A systematic review and meta-analysis.

To systematically evaluate task-oriented training (TOT) on the improvement of gross motor function, balance and activities of daily living in children with cerebral palsy (CP). A number of randomized controlled trials (RCTs) of TOT in children with CP were searched from Pubmed, Cochrane Library, Web of Science, EmBase, China National Knowledge Infrastructure, Chinese Biology Medicine, Chinese Scientific Journals Database and Wanfang data from the establishment of database to March 2022. The methodological quality of the included studies was evaluated, and meta-analysis was performed by RevMan5.4 software. A total of 16 studies were included in the systematic review (n = 893). Meta-analysis showed that the gross motor function measure (GMFM) (MD = 11.05, 95%CI [8.26, 13.83], P < .00001), dimension D (MD = 3.05, 95%CI [1.58, 4.53], P < .0001) of the GMFM, dimension E (MD = 7.36, 95%CI [5.88, 8.84], P < .00001) of the GMFM, the Berg Balance Scale (BBS) (MD = 6.23, 95%CI [3.31, 9.15], P < .0001), the pediatric evaluation of disability inventory (PEDI) mobile function (MD = 6.44, 95%CI [3.85, 9.02], P < .00001) score improved significantly in the TOT group compared with the control group. Current evidence shows that TOT could effectively improve gross motor function, balance and activities of daily living in children with CP. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.

Effect of Enriched Environment on Gross Motor Control in Cerebral Palsy

Objective of study: To evaluate the usefulness of Enriched environment (EE) and Neuro Developmental Technique (NDT) in the perspective of gross motor function in cerebral palsy (CP) . Methodology: This Randomized control trial (RCT) was conducted from March 2016 to November 2016 in Armed Forces Institute of Rehabilitation Medicine Rawalpindi, Pakistan. Sample size was 40 CP children. The data was gathered from 1 to 6 years of spastic CP children through a standard Gross motor function measure (GMFM)tool. This statistical analysis was done on SPSS 21. To evaluate the inferential statistics, independent sample and paired t-test was applied. Results: Participants' average ages in groups A and B were respectively 4.01.7 and 3.81.8. According to our findings, both the treatment group and the control group had significant change (p=0.00). This shows that EE therapy had a significant impact on the children with CP who are spastic; p 0.05. Practical implication: This research will help to incorporate appropriate treatment in the rehabilitation settings to gain effective results. Conclusion: EE plays an effective role in improvement of gross motor function of spastic CP children. But NDT treatment approach was also effective, although less than EE. Key words: Cerebral palsy, Enriched Environment, Neuro-developmental treatment, GMFM

Effects of Neurodevelopmental Therapy on Gross Motor Function and Postural Control in Children with Spastic Cerebral Palsy: A Randomized Controlled Trial

Cerebral palsy (CP) is one of the most prevalent childhood-onset causes of permanent disability affecting gross motor functioning and postural control ability. Objective: To determine the effects of neurodevelopmental treatment on the gross motor function postural control among children with spastic CP. Methods: A single-blinded randomized controlled trial was carried out at Sher e Rabbani Hospital, Department of Pediatric Rehabilitation, Sheikhupura. 66 children fulfilling the inclusion criteria were recruited using the non-probability sampling technique. Participants were divided into two groups, Group A which received beuro developmental techniques along with routine physical therapy while Group B received only routine physical therapy treatment. To collect data, Gross motor function measure scale (GMFM-88) and posture and postural ability scale (PPAS) were employed as outcome measures. Results: Repeated measure ANOVA and an independent t-test were executed for parametric data after assuming normality. Pairwise comparison of both groups demonstrated that gross motor function was significantly improved from baseline to 4th, 8th, and 12th week after applying NDT treatment (p-value≤ 0.05). Pairwise comparison of both groups revealed that postural ability post NDT treatment and significant improvement was observed after 12 weeks in comparison to baseline. While within-group comparison at different follows up for gross motor function measure and postural control also expressed p≤ 0.05 as significant. Conclusions: Children with spastic CP who received Neurodevelopmental Therapy along with conventional physical therapy treatment showed significant improvements in gross motor function and postural control as compared to the control group.

Evaluating functional change using the Physical Abilities and Mobility Scale in acute paediatric neurorehabilitation

Background/Aims Childhood acquired brain injury is the leading cause of death and long-term disability among children and young people in the UK. Following a childhood brain injury, function is shown to improve within a specialist neurorehabilitation setting. Little evidence currently exists to demonstrate gross motor functional change within an acute hospital setting. The Physical Abilities and Mobility Scale is a valid and reliable outcome measure for use within inpatient paediatric neurorehabilitation following brain injury. The primary aim of this study was to evaluate how the gross motor function of paediatric patients with a new acquired brain injury changes during an acute hospital admission. Methods Data were collected for all patients admitted as an inpatient to one acute hospital over a 12-month period. The Physical Abilities and Mobility Scale was completed at baseline, at least weekly and again at discharge. Views relating to the utility of the Physical Abilities and Mobility Scale were sought among physiotherapists using the measure in order to inform acceptability. Results A total of 28 patients were included in this study. A Wilcoxon signed rank test was performed, which showed a highly significant improvement in function as scored on the Physical Abilities and Mobility Scale between baseline assessment (median 29.00, interquartile range 25.00–35.50) and discharge (median 85.00, interquartile range 75.00–95.00, Z=-4.624, P&lt;0.001). A total of five patients (17.86%) were referred on for specialist residential neurorehabilitation. A post hoc analysis found that the rate of change of the Physical Abilities and Mobility Scale appeared to have an impact on final discharge destination, with slow improvers 18.60 times more likely to require specialist rehabilitation than others. The Physical Abilities and Mobility Scale was found to be acceptable among physiotherapists using it. Conclusions Children with a new acquired brain injury make significant improvements in gross motor function during a period of acute inpatient neurorehabilitation. Further work should look to refine the measure and gain a full understanding of its clinical utilities.

Gross Motor Function in Children with Congenital Zika Syndrome.

Little information on gross motor function of congenital Zika syndrome (CZS) children is available. To evaluate gross motor function in CZS children aged up to 3 years, and its associated factors and changes in a minimum interval of 6 months. One hundred children with CZS and cerebral palsy (36 with confirmed and 64 with presumed CZS) were evaluated with the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM-88/GMFM-66). Forty-six were reevaluated. Wilcoxon tests, Wilcoxon tests for paired samples, percentile scores, and score changes were performed. Clinical and socioeconomic characteristics (except maternal age), GMFM scores and GMFCS classification of confirmed and probable cases, which were analyzed together, were similar. The mean age was 25.6 months (±5.5); the median GMFM-88 score was 8.0 (5.4-10.8); and the median GMFM-66 score was 20.5 (14.8-23.1); 89% were classified as GMFCS level V. Low economic class, microcephaly at birth, epilepsy, and brain parenchymal volume loss were associated with low GMFM-66 scores. The median GMFM-66 percentile score was 40 (20-55). On the second assessment, the GMFM-66 scores in two GMFCS level I children and one GMFCS level IV child improved significantly. In one GMFCS level III child, one GMFCS level IV child, and the group of GMFCS level V children, no significant changes were observed. Almost all CZS children had severe cerebral palsy; in the third year of life, most presented no improvement in gross motor function and were likely approaching their maximal gross motor function potential.

A study to compare the effect of task oriented training versus functional progressive resistance exercise strength training on gross motor functions in spastic diplegics

Cerebral palsy is a disorder of the development of movement and posture, causing activity limitations. Spastic Diplegic CP is the commonest and it occurs due to the brain damage inhibits the proper development of UMN function impacting the motor cortex, the basal ganglia and the corticospinal tract. The impairments of spastic diplegic children are spasticity in lower limbs, ROM deficits and selective motor control problems. These impairments may limit the performance of gross motor, fine motor with limitations of participation in daily life. Improvement in mobility has been primary goal in treatment of cerebral palsy. This interventional study was conducted to compare the effect on gross motor function in spastic diplegics treated with task oriented training and spastic diplegics treated with functional progressive resistance exercise strength training. Sixty subjects with spastic diplegics were assessed for the inclusion and exclusion criteria and equally divided into two groups group - A received task oriented training and Group - B received functional progressive resistance exercise strength training five times a week for 5 weeks. The outcome measures were taken on GMFM88 (Dimension D and E) and Mobility Questionnaire on day 1 and at the end of 5th week. The result showed statistically significant improvement in Gross motor function in both the groups after 5 weeks of treatment, But Group A treated with task oriented training shows better improvement in outcome measures as compared to group B treated with functional progressive strength training.

Pilot Evaluation of a School-Based Programme Focused on Activity, Fitness, and Function among Children with Cerebral Palsy at GMFCS Level IV: Single-Subject Research Design.

Purpose: Children with cerebral palsy (CP) who function at Gross Motor Function Classification System (GMFCS) Level IV have difficulty achieving sufficient levels of physical activity to promote fitness. The purpose of this pilot evaluation was to investigate the practicability and impact of a school-based supported physical activity programme, using adaptive bicycles, on cardiorespiratory fitness and gross motor function among children with CP at GMFCS Level IV. Method: We used a single-subject, A-B-A-B research design replicated across three participants aged 8-14 years with CP at GMFCS Level IV who attended three different schools. Cardiorespiratory fitness was assessed weekly during all study phases using the energy expenditure index (EEI). Gross motor function was assessed using the Gross Motor Function Measure-66 (GMFM-66) and goal attainment scaling (GAS). During the intervention phases, an adaptive bicycle-riding programme was carried out daily at school for up to 30 minutes. Results: One participant demonstrated significant improvement on the EEI. All participants demonstrated improvement in gross motor function as determined by the GMFM-66 and GAS. Insights were garnered pertaining to the design for large-scale future studies. Conclusions: This pilot evaluation supports further investigation of school-based adaptive bicycle-riding programmes for children who have CP at GMFCS Level IV.

Clinical observation of selective posterior rhizotomy for improving spasticity and gross movement in patients with cerebral palsy

To explore the effect of selective lumbosacral posterior rhizotomy(SPR) on lower limb spasticity and gross motor function in patients with cerebral palsy. From January 2018 to October 2018, 47 patients with cerebral palsy were treated with rehabilitation alone and SPR combined with rehabilitation. According to whether SPR was performed, the patients were divided into group A and group B. Group A was treated with rehabilitation combined with SPR at lumbosacral level, and group B was treated with rehabilitation alone. There were 23 cases in group A, including 15 males and 8 females, with an average age of (7.30±3.25) years old; 24 cases in group B, 13 males and 11 females, with an average age of (7.00±3.09) years old. Forty-seven patients were assessed with modified Ashworth(MAS) and Gross Motor Function Scale(GMFM-88 items) before and after treatment. The changes of MAS and GMFM-88 scores before and after treatment were compared to evaluate the degree of spasm and the improvement of gross motor function in the two groups. All 47 patients were followed up. At 6 months after treatment, the MAS classification of the two groups was significantly improved(P<0.05), and the improvement of group A was more obvious than that of group B(P<0.05). Six months after treatment, the D, E and total scores of GMFM-88 between two groups were significantly improved compared with those before operation(P<0.05). The improvement of D and total scores in group A was more obvious than that in group B. There was no significant difference in the improvement of area E between two groups. Selective posterior rhizotomy combined with rehabilitation can significantly improve the spastic state and gross motor function of lower limbs in children with cerebral palsy, and can effectively promote the reconstruction and recovery of motor function of lower limbs in children with cerebral palsy.

Clinical response of Abhaya Ghrita and procedure based therapy on Gross Motor Functions in children with Cerebral Palsy : An Open Label, Randomized Clinical Trial

Introduction - Cerebral Palsy (CP) being the leading cause of disability in children is a symptom complex, whichv has worldwide incidence of 2.1/1000 live births, and for India it is 3/1000 live births. In Ayurveda, the cerebral palsy can be correlated with various conditions due to Vata predominance. There is no satisfactory criterion in managing this condition is developed till date. The present study is planned with Abhaya Ghrita and procedure based therapy to provide possible improvement in gross motor function of children with cerebral palsy and thereby improving their quality of life. Material and Methods - A Trial was conducted at a tertiary health care setting to evaluate the clinical efficacy of Ayurvedic Intervention (Abhaya Ghrita and procedure based therapy Udvartana, Sarvanga Abhyanga, Nadi Sweda and Matra Basti). Diagnosed children of cerebral palsy, aged 1-12 years of either gender were selected. The scale gross motor function manual (GMFM) and Cerebral Palsy quality of life (CP-QOL) were used for assessment. Results - Total 20 patients were registered in the present study. 70% patients were below 8 years of age with clear male predominance comprised of 85% of the total sample size. As per the birth history of the patients 15% were preterm, home delivery was present in 20%. 45% and 10% were Low birth weight (LBW) and Very Low birth weight (VLBW) after birth respectively. History of delayed cry was present in 80% cases. 45% required Hospitalization and 65% were subjected to Resuscitation and need of incubator just after birth was present in 25% patients. Discussion - Gross Motor Function scale has shown significant improvement in motor activities like lying and rolling, sitting and total score with pandlt;0.001, on crawling and kneeling and standing with pandlt;0.01 and on walking and running with pandlt;0.02. The CP-QOL has also shown significant results on health and family and friends component. Conclusion - Thus, it may be concluded that the Ayurveda approach is effective in improving the gross motor function and quality of life of children with cerebral palsy.

Improvement in gross motor function and muscle tone in children with cerebral palsy related to neonatal icterus: an open-label, uncontrolled clinical trial

BackgroundAlthough stem cell transplantation has been successfully performed for cerebral palsy (CP) related to oxygen deprivation, clinical trials involving the use of stem cell transplantation for CP related to neonatal icterus have not been reported. The aim of this study was to evaluate the effectiveness of transplantation of autologous bone marrow mononuclear cell (BMMC) for improving gross motor function and muscle tone in children with CP related to neonatal icterus.MethodsThis open-label, uncontrolled clinical trial, which included 25 patients with CP related to neonatal icterus who had a Gross Motor Function Classification System (GMFCS) score between level II and level V, was conducted between July 2014 and July 2017 at Vinmec International Hospital (Vietnam). BMMC were harvested from the patients’ iliac crests. Two procedures involving BMMC transplantation via the intrathecal route were performed: the first transplantation was performed at baseline, and the second transplantation was performed 6 months after the first transplantation. Gross motor function and muscle tone were measured at three time points (baseline, 6 months, and 12 months) using the Gross Motor Function Measure (GMFM) and the Modified Ashworth Scale.ResultsIn this trial, we observed significant improvement in gross motor function and a significant decrease in muscle tone values. Total score on the 88-item GMFM (GMFM-88), scores on each GMFM-88 domain, and the 66-item GMFM (GMFM-66) percentile were significantly enhanced at 6 months and 12 months after the first transplantation compared with the corresponding baseline measurements (p-values < 0.05). In addition, a significant reduction was observed in muscle tone score after the transplantations (p-value < 0.05).ConclusionAutologous BMMC transplantation can improve gross motor function and muscle tone in children with CP related to neonatal icterus.Trial registrationClinicalTrials.gov identifier: NCT03123562. Retrospectively registered on December 26, 2017.