Gross Motor Function Measure Research Articles

Combination of standard physical therapy with partial body weight supported treadmill training in children with spastic diplegic cerebral palsy

Standard physical therapy (SPT) with ground gait training is well recognized to improve the motor skill in cerebral palsy (CP) disease. Confirmation is required on achieving better gross motor function with partial body weight supported treadmill training (PBWSTT). The objective of the study is to analyze combination of SPT with PBWSTT for gross motor function children with spastic diplegic CP who able to walk. A prospective design was conducted in CP patients 2-7 years of age with Gross Motor Function Classification System (GMFCS) I-III and received physical therapy 2 times per week, 20 minutes per session, a total of 20 sessions. The treatment group is continued by PBWSTT for 20 minutes per session. Gross Motor Function Measure (GMFM)-66 of walking, running, and jumping (dimension E) is measured in pre and post-physical therapy. Data were analyzed descriptively. There were 10 subjects and divided into 5 subjects in the control and the rest in the treatment group. The mean age was 48.4 months and 63.4 months respectively. The Average score of GMFM-66 dimension E pre and post-SPT were 63.54 and 65.24, the difference is 1.7 (2.67%) from the initial score.

Psychometric outcome measures in beta-propeller protein-associated neurodegeneration (BPAN).

Beta-propeller protein-associated neurodegeneration (BPAN) is a rare neurodegenerative disorder characterized by iron accumulation in the brain with spectrum of neurodevelopmental and movement phenotypes. In anticipation of future clinical trials and to inform clinical care, there is an unmet need to capture the phenotypic diversity of this rare disorder and better define disease subtypes. A total of 27 individuals with BPAN were included in our natural history study, from which traditional outcome measures were obtained in 18 subjects. Demographic and diagnostic information, along with acquisition of basic developmental skills and overall neurologic severity were extracted from the medical records. Functional outcome measures were administered at the time of the evaluation or applied retrospectively at the last clinical encounter for patients who were not able to travel for in person. Based on age and functional level, the following assessments were administered: Leiter-3, Gross Motor Function Measure (GMFM)-66 Item Sets, Vineland-3, and Peabody-2. Overall, cognitive function was more impaired compared to gross motor function. Onset of symptoms of BPAN within the first 6 months of life was associated with decreased gain of ambulation and gain of spoken language (ambulation: log-rank test p = 0.0015; gain of first word: p = 0.0015). There was no difference in age at seizure onset by age at initial symptom onset (p = 0.8823). Collection of prospective outcome measures was limited by attention and behavior in our patient population, reinforcing the complexity of phenotype assessment and inadequacy of available standardized tests. Overall, gross motor and adaptive behavior assessments were better able to capture the dynamic range of function across the BPAN population than the fine motor and non-verbal cognitive tests. Floor effects were noted across outcome measures in a subset of individuals for cognitive and adaptive behavior tests. Our data suggest the distinct phenotypes of BPAN: a severe, early onset form and an attenuated form with higher cognitive capabilities. Early age at onset was a key factor in predicting future neurologic impairment.

학교기능평가 기반의 과제 지향적 중재가 학령기 유전적 발달장애 아동에게 미치는 효과 : 사례군 연구

This study aimed to enhance the gross motor function, gait, balance, and quality of life of school-aged children using task-oriented approach based on the school function assessment (SFA). Total of three school-aged children who were diagnosed with genetic developmental disabilities (GDD) participated in the experiment. In a pre-test, the gross motor function measure (GMFM), pediatric evaluation of disability inventory (PEDI), pediatric balance scale (PBS), and GaitRite was evaluated. Then, 12 weeks of task-oriented approach based on SFA was performed. The treatment consisted of ‘traveling’, ‘maintaining and changing positions’, ‘manipulation with movement’, ‘using materials’, ‘recreational movement’, ‘hygiene’, ‘clothing management’, ‘up/down stairs’. After the treatment, a post-test followed. Gait analysis revealed increased symmetry in both time and distance of a single step. Furthermore, GMFM and PBS measures increased for every participant. Finally, daily life dependence in PEDI decreased for every participant. We demonstrated effect of task-oriented approach in three children with GDD. The proposed treatment effectively enhanced overall GMFM, ratio between swing and stance phases, and PBS. Especially, the ratio between swing and stance phases shifted close to 4:6, which is the presumed normal ratio. Also, daily life dependence in PEDI decreased for every participant, which indicates that it has a significant effect on physical function and participation. Increasing number of participants and applying the suggested protocol to patients with GDD could be future topics.

Effects of Transcranial Magnetic Stimulation Combined with Computer-Aided Cognitive Training on Cognitive Function of Children with Cerebral Palsy and Dysgnosia.

Objective This study is aimed at researching transcranial magnetic stimulation (TMS) effects combined with computer-aided cognitive training (CACT) on cognitive function of children suffering from cerebral palsy and dysgnosia. Methods From December 2019 to October 2021, 86 children with cerebral palsy and dysgnosia who were treated at our hospital were recruited and assigned into observation and control groups (n = 43, each) using the random number table technique. The observation group received TMS combined with CACT (TMS+CACT), whereas the control group received only TMS. Chinese Wechsler Young Children Scale of Intelligence (C-WYCSI) and Chinese-Wechsler Intelligence Scale for Children (C-WISC) were used to evaluate the intelligence level of the two groups; Gross Motor Function Measure-88 (GMFM-88) of Fudan Chinese version was employed for evaluating the gross motor function of the two groups; a comparison was drawn among the two groups for the cerebral hemodynamic parameters before and after the treatment. Results For young children, the verbal intelligence quotient (VIQ) scores at 6 and 12 weeks of treatment in the observation group were increased when compared to those in the control group (48.91 ± 3.70 vs. 47.32 ± 3.33, 54.25 ± 4.46 vs. 49.48 ± 3.36), and the observation group's performance intelligence quotient (PIQ) score at 12 weeks of treatment was higher as to that of the control group (65.38 ± 4.23 vs. 62.81 ± 4.74, all P < 0.05). For older age children, the observation group's VIQ and PIQ scores were greater than the control group's at 6 and 12 weeks of treatment, with statistical significance (63.80 ± 3.76 vs. 59.50 ± 5.32, 74.64 ± 12.04 vs. 65.08 ± 6.30; 63.91 ± 5.96 vs. 58.42 ± 3.70, 72.73 ± 5.06 vs. 66.42 ± 5.93; all P < 0.05). The GMFM-88 scale scores in both groups were increased after 6 and 12 weeks of treatment. After treatment for 12 weeks, the observation group's A-E scores were greater than those of the control group (all P < 0.05). The peak systolic velocity (Vs), end-diastolic velocity (Vd), and mean velocity (Vm) at the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) in the observation group were dramatically increased than those in the control group (all P < 0.05) after 12 weeks of treatment. Conclusion TMS+CACT can effectively improve the intelligence level, cognitive ability, gross motor function, and cerebral blood flow of children suffering from cerebral palsy and intellectual disability.

Concurrent validity, test-retest reliability, and sensitivity of a PostureRite system measurement on dynamic postural sway and risk of fall in cerebral palsy.

Accurately diagnosing dynamic postural sway (DPS) is essential for effective and sustainable intervention in children with cerebral palsy (CP). We developed an accurate, inexpensive, and wearable DPS measurement system to measure DPS accurately and consistently during walking and functional activities of daily living. We investigated the validity and reliability of this PostureRite system in children with CP, and the link between PostureRite and clinical measures including gross motor function measure (GMFM), pediatric balance scale (PBS), and fall efficacy scale (FES). Twenty-one participants were categorized as follows: 11 healthy adults (3 females, mean age, 25.00±1.00 years) and 10 children with CP (mean age, 11.10±6.28 years). We determined the concurrent validity of PostureRite by comparing DPS data to the gold standard accelerometer measurement results. We determined test-retest reliability by measuring DPS data on three occasions at 2-h intervals. We assessed PostureRite measurement sensitivity to ascertain differences between healthy children and children with CP DPS measurements. Random and mixed intraclass correlation coefficients (ICC2,k and ICC3,k) were obtained; an independent T-test was performed (P < 0.05). Concurrent validity analysis showed a good relationship between the gold standard accelerometer and PostureRite (ICC2,k = 0.973, P < 0.05). Test-retest reliability demonstrated a good relationship across the three repeated measures of the DPS data (ICC3,k = 0.816-0.924, P < 0.05). Independent T-test revealed a significant difference in DPS data between healthy adults and children with CP (P < 0.05). We developed a portable, wireless, and affordable PostureRite system to measure DPS during gross motor function associated with daily activity and participation, and established the concurrent validity, test-retest reliability as sensitivity, and clinical relevance by comparing the DPS obtained from the participants with and without CP.

Characteristics of sit-to-stand movement are associated with trunk and lower extremity selective control in children with cerebral palsy: a cross-sectional study.

Even though the effect of several factors on sit-to-stand (STS) performance of children with CP has been previously explored, the potential role of lower extremity selective control, trunk control and sitting function on the performance of STS has not been examined. This study aimed to investigate the association of trunk control and lower extremity selective motor control with STS performance in children with CP. We recruited 28 children with CP aged between 4 and 10 years whose Gross Motor Function Classification System levels were I and II and 32 age-matched typically developing (TP) children. Trunk control, sitting function, selective control of the lower extremities and STS were evaluated with Trunk Control Measurement Scale (TCMS), sitting section of Gross Motor Function Measure-88 (GMFM-88), Selective Control Assessment of the Lower Extremity (SCALE) and the STS outcomes of a force platform [weight transfer time, rising index, and center of gravity (COG) sway velocity], respectively. In all evaluations, children with CP demonstrated lower scores than TD children. A moderate correlation was found between total scores of TCMS, GMFM-88 sitting section scores and COG sway velocity during STS and a fair correlation between SCALE total scores and COG sway velocity in the CP group ( r = -0.51, r = -0.52, r = -0.39, respectively). A fair correlation was found between SCALE total scores and the weight transfer time during STS in children with CP ( r = -0.39). Based on these results, improving trunk and lower extremity selective control may enhance STS performance in children with CP.

Effects of Vestibular Stimulation on Balance in Children with Quadriplegic Cerebral Palsy

Objective: The objective of the study was to determine the effects of vestibular stimulation on balance in quadriplegic cerebral palsy. Methodology: This was quasi experimental study in which total 44 quadriplegic cerebral palsy children were included who have no associated neurogenic conditions which may be aggravated with vestibular stimulation such as epilepsy or other orthopedic or functional complication. The children were assessed by an independent assessor before and after 6 weeks of vestibular stimulation. The assessment was made on gross motor measure and pediatric evaluation disability index. The data was analyzed using SPSS 20.0. Paired sample t test was used for pre-post testing. Results: The descriptive statistics of paired samples regarding Gross Motor Function Measure showed mean and standard deviation to be 49.61±1.75 and 64.54±1.04 before and after treatment, respectively. Paired sample testing for pre-post treatment measurement of mean score of Gross Motor Function Measure (GMFM) showed that mean difference and standard deviation found to be 14.93±1.90 with a significant p value 0.00. The descriptive statistics of paired samples regarding Total PEDI score showed mean and standard deviation to be 42.88±0.86 and 51.47±1.24 before and after treatment, respectively. Paired sample testing for pre-post treatment measurement of mean score of total Pediatric Evaluation Disability Inventory (PEDI) showed that mean difference and standard deviation found to be 8.59±1.48 with a significant p value 0.00. Conclusion: The findings of study concluded that vestibular stimulation has significant effect of vestibular stimulation on balance in quadriplegic cerebral palsy. Moreover, there were seen significant improvement in other domains such as behavior, emotions, psychology and interactive learning approach. Keywords: Cerebral Palsy, Quadriplegia, Child, Vestibular Stimulation

Functional measures in response to electrical stimulation in children with unilateral cerebral palsy

Purpose: The purpose of this study was to determine the effect of neuromuscular electrical stimulation of abdominal and back muscles simultaneously on gross motor function measures (GMFM) in children with unilateral cerebral palsy. Materials and Procedures: Thirty children with unilateral spastic cerebral palsy participated in this study. They were classified randomly into two groups of equal numbers, control, and study groups. GMFM was used to evaluate function in the two groups before and after ten successive weeks of application of the treatment programs. The control group (A) received a selected physical therapy program based on the neuro-developmental approach used for rehabilitation of such patients and the control group received the same selected physical therapy program applied to the study group in addition to 30 minutes of neuromuscular electrical stimulation of abdominal and back muscles simultaneously. Results: Comparing the pre-and post-treatment results for the control and study groups revealed significant improvement in GMFM. Post-treatment significant improvement was recorded in favor of the study group. Conclusion: There was an effect of neuromuscular electrical stimulation of abdominal and back muscles simultaneously on function in children with unilateral cerebral palsy.

Effect of rehabilitation on the long-term efficacy of botulinum toxin-A for spastic cerebral palsy.

To investigate the long-term effects of botulinum toxin-A (BTX-A) nerve block on relaxation of spasticity in cerebral palsy. From June 2015 to December 2018, 52 children, aged 20-56 months, with spastic cerebral palsy were treated with BTX-A. The dose of BTX-A was selected based on the weight of the child and the modified Ashworth scale (MAS). The injection dose ranged from 45 IU to 150 IU (average 68.0±31.6 IIU). The muscle tone and motor functions of all children were evaluated before the block. The spasticity was measured using the MAS, and the motor function was measured using the Physician Rating Scale (PRS) and the gross motor function measure (GMFM). After two years, all children were re-evaluated. No significant difference was observed between the trial and control groups in terms of age, weight, MAS, PRS, and GMFM measurements before the block (p>0.05). The PRS and GMFM improved significantly in both groups after two years (p<0.05). The PRS and GMFM in the trial group increased more significantly than those in the control group (p<0.05). The BTX-A block showed a long-term positive effect. Rehabilitation training after the block could help children to improve their motor functions.

Feasibility of Overground Gait Training Using a Joint-Torque-Assisting Wearable Exoskeletal Robot in Children with Static Brain Injury.

Pediatric gait disorders are often chronic and accompanied by various complications, which challenge rehabilitation efforts. Here, we retrospectively analyzed the feasibility of overground robot-assisted gait training (RAGT) using a joint-torque-assisting wearable exoskeletal robot. In this study, 17 children with spastic cerebral palsy, cerebellar ataxia, and chronic traumatic brain injury received RAGT sessions. The Gross Motor Function Measure (GMFM), 6-min walk test (6 MWT), and 10-m walk test (10 MWT) were performed before and after intervention. The oxygen rate difference between resting and training was performed to evaluate the intensity of training in randomly selected sessions, while the Quebec User Evaluation of Satisfaction with assistive Technology 2.0 assessment was performed to evaluate its acceptability. A total of four of five items in the GMFM, gait speed on the 10 MWT, and total distance on the 6 MWT showed statistically significant improvement (p < 0.05). The oxygen rate was significantly higher during the training versus resting state. Altogether, six out of eight domains showed satisfaction scores more than four out of five points. In conclusion, overground training using a joint-torque-assisting wearable exoskeletal robot showed improvement in gross motor and gait functions after the intervention, induced intensive gait training, and achieved high satisfaction scores in children with static brain injury.

Neurologic and neurodevelopmental complications in cardiofaciocutaneous syndrome are associated with genotype: A multinational cohort study

PurposeDysregulation of RAS or its major effector pathway is the molecular mechanism of RASopathies, a group of multisystemic congenital disorders. Neurologic complications are especially challenging in the management of the rare RASopathy cardiofaciocutaneous (CFC) syndrome. This study evaluated clinical neurologic and neurodevelopmental features and their associations with CFC syndrome gene variants. MethodsA multinational cohort of 138 individuals with CFC syndrome (BRAF = 90, MAP2K1 = 36, MAP2K2 = 10, KRAS = 2) was recruited. Neurologic presentation was captured via clinician review of medical records and caregiver-completed electronic surveys. Validated measures of seizure severity, adaptive function, and gross motor function were obtained. ResultsThe overall frequency of intellectual disability and seizures was 82% and 55%, respectively. The frequency and severity of seizures was higher among individuals with BRAF or MAP2K1 variants than in those with MAP2K2 variants. A disproportionate incidence of severe, treatment-resistant seizures was observed in patients with variants in the catalytic protein kinase domain of BRAF and at the common p.Y130 site of MAP2K1. Neurodevelopmental outcomes were associated with genotype as well as seizure severity. ConclusionMolecular genetic testing can aid in prediction of epilepsy and neurodevelopmental phenotypes in CFC syndrome. Study results identified potential CFC syndrome-associated variants in the development of relevant animal models for neurologic, neurocognitive, and motor function impairment.

A Novel Intervention: Stand Up Paddle Boarding Aquatic Therapy (SUPAT) for Pediatric Patients With Cerebral Palsy: 2 Case Studies

Background and Purpose: Cerebral palsy (CP) is a nonprogressive neurological condition that typically causes motor dysfunction. Children with CP often have decreased endurance, balance, and strength. This leads to decreased physical activity and difficulty performing sports with their age-related peers. The purpose of these case studies was to determine whether stand up paddle boarding aquatic therapy (SUPAT) improves gross motor function and decreases the number of falls experienced by 2 children with spastic CP. Case Description: Participants included 2 adolescent girls diagnosed with spastic CP categorized as Gross Motor Function Classification System (GMFCS) level II. Intervention: Over 10 weeks, the patients attended seven 1-hour SUPAT sessions. The sessions included a 10-minute warm-up and a variety of paddle boarding skills. Both participants completed Gross Motor Function Measure-88 (GMFM-88) and reported the average number of falls before and after the SUPAT intervention. During each session, a trial run (the total duration a child could maintain balance on the paddle board) was also measured. Outcomes: Participant 1 increased GMFM-88 scores from 92.5% to 95.5% and trial run duration from 1 minute 24 seconds to 6 minutes 14 seconds. Participant 2 increased GMFM-88 scores from 91.6% to 92.9% and trial run duration from 1 minute 12 seconds to 3 minutes 7 seconds. Both participants reported a reduction in the number of falls. Discussion: These case studies indicated the SUPAT program was beneficial for pediatric patients with CP. Following the SUPAT intervention, both participants improved scores on the GMFM-88 and increased their ability to maintain balance on the board (trial run). These findings support the notion that the SUPAT program is beneficial for increasing gross motor function, improving balance, and decreasing the number of falls. SUPAT could be a viable alternative therapeutic intervention to traditional aquatic therapy and an opportunity to participate in an outdoor sport.

The effect of robotic rehabilitation on posture and trunk control in non-ambulatory cerebral palsy

ABSTRACT The purpose of this study was to investigate the effects of a combined robot-assisted gait training (RAGT) with standard physiotherapy (PT) on trunk control and posture in non-ambulatory children with cerebral palsy (CP). This nonrandomized, controlled study included 31 CP assigned into two groups. Study Group: RAGT (three times a week, 30 min/session, for 6 weeks) + PT. Control group: PT only. The patients were evaluated using gross motor function measure (GMFM)-88 (Section B, Sitting) and Trunk Impairment Scale (TIS), pre-treatment and 3rd month post-treatment. In the RAGT group, significant improvements were observed in the GMFM-B and TIS scores at the 3rd month post-treatment (p < 0.05). Comparison of the changes in GMFM-B and TIS scores from end to beginning of the study, the change in TIS static are significantly higher in the RAGT group than control group (p < 0.05). Addition of RAGT to standard physiotherapy seems to improve trunk control, sitting balance, and posture in non-ambulatory CP.

Urodynamic study findings and related influential factors in pediatric spastic cerebral palsy

To investigate the urodynamic study (UDS) result in pediatric patients suffering from spastic cerebral palsy (CP). Medical records of patients diagnosed CP having pre-operative UDS results underwent selective dorsal rhizotomy (SDR) from Jan. 2020 to May. 2021 were retrospectively reviewed. Fifty-seven cases diagnosed spastic CP were included in the study (mean age, 6.73 ± 2.84 years), among which, 46 were ambulatory and 11 non-ambulatory. Average gross motor function measure-66 (GMFM-66) score was 62.16 ± 11.39. Reduced bladder capacity was seen in 49.12% of these cases and cases with lower GMFM-66 score possessed a higher incidence rate of having low bladder capacity (p < 0.01). Detrusor overactivity (DO) was shown in 33.33% of the patients. Cases with younger age presented a higher prevalence of DO (p < 0.05). Meanwhile, more non-ambulant patients suffered from DO (p < 0.05). Increased post-voiding residual (PVR) was seen in 21.05% of the cases. Those with higher average threshold in sphincter-associated input spinal nerve roots (rootlets) witnessed a higher rate of having abnormal PVR (p < 0.05). Abnormal UDS results were prevalent in pediatric patients suffering from CP. Motor function, age and threshold of their sphincter-associated spinal nerve roots laid corresponding effect on the abnormal UDS results.

Early, Intensive, Lower Extremity Rehabilitation Shows Preliminary Efficacy After Perinatal Stroke: Results of a Pilot Randomized Controlled Trial

Background Perinatal stroke injures motor regions of the brain, compromising movement for life. Early, intensive, active interventions for the upper extremity are efficacious, but interventions for the lower extremity remain understudied. Objective To determine the feasibility and potential efficacy of ELEVATE—Engaging the Lower Extremity Via Active Therapy Early—on gross motor function. Methods We conducted a single-blind, two-arm, randomized controlled trial (RCT), with the Immediate Group receiving the intervention while the Delay Group served as a 3-month waitlist control. A separate cohort living beyond commuting distance was trained by their parents with guidance from physical therapists. Participants were 8 months to 3 years old, with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. The intervention was play-based, focused on weight-bearing, balance and walking for 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure-66 (GMFM-66). Secondary outcomes included steps and gait analyses. Final follow-up occurred at age 4. Results Thirty-four children participated (25 RCT, 9 Parent-trained). The improvement in GMFM-66 over 12 weeks was greater for the Immediate than the Delay Group in the RCT (average change 3.4 units higher) and greater in younger children. Average step counts reached 1370-3750 steps/session in the last week of training for all children. Parent-trained children also improved but with greater variability. Conclusions Early, activity-intensive lower extremity therapy for young children with perinatal stroke is feasible and improves gross motor function in the short term. Longer term improvement may require additional bouts of intervention. Clinical trial registration This study was registered at ClinicalTrials.gov (NCT01773369).

The Effect of a Horse-Riding Simulator with Virtual Reality on Gross Motor Function and Body Composition of Children with Cerebral Palsy: Preliminary Study.

This study aimed to evaluate the effect of a horse-riding simulator (HRS) with virtual reality (VR) on gross motor function, balance control, and body composition in children with spastic cerebral palsy (CP). Seventeen preschool and school-aged children with spastic CP were included; 10 children in the intervention group (HRS group) received 30 min of HRS with VR training twice a week for a total of 16 sessions in addition to conventional physiotherapy. Seven children in the control group were instructed to perform home-based aerobic exercises twice a week for 8 weeks in addition to conventional physiotherapy. Gross motor function measure (GMFM) and body composition were evaluated before the first session and after the last session. Before and after the 2-month intervention, Pediatric Balance Scale and Timed Up and Go test were evaluated for the HRS group. GMFM scores and body composition changed significantly in the HRS group (p < 0.05). However, no significant differences were observed in the control group. Changes in the GMFM total scores, GMFM dimension D scores, and skeletal muscle mass significantly differed between the HRS and control groups (p < 0.05). HRS with VR may be an effective adjunctive therapeutic approach for the rehabilitation of children with CP.

Commonly Used Outcome Measurement Tools in Pediatric Physical Therapy Telerehabilitation in the Philippines: A Quantitative Cross-Sectional Descriptive Study

Aim: The objective of the research is to identify the most common Outcome Measure Tools used in telerehabilitation by Filipino pediatric physical therapists. Methods: The research is a quantitative descriptive study with two phases. Phase I is the validation and pilot testing of an adapted questionnaire. A panel of three experts rated the questionnaire's items using a Likert scale; afterward, the content validity index was determined. In addition, pilot testing was done to determine the survey's average duration. Phase II is the questionnaire implementation using a Google Form. The study used frequencies and percentages to report participants' responses. Results: The final version of the adapted questionnaire had 23 items that were considered relevant. Of the 45 respondents, 51% used Outcome Measure Tools (OMT) during telerehabilitation. The most common OMT used in pediatric telerehabilitation is the Gross Motor Function Measure (GMFM) (100%), followed by the Pediatric Balance Scale (PBS) (30%), Goal Attainment Scale (GAS) (13%), and Test of Gross Motor Development - Second Edition (TGMD-2) (13%). The top enabler for OMT use in the telerehabilitation setting is the criterion of being easily understood by patients, clients, and caregivers (87%). Contrariwise, the main reason for the non-usage of OMTs is the difficulty for the stakeholders to complete OMTs independently (68%). Conclusion and Implications: The commonly used OMTs in telerehabilitation are the GMFM, PBS, GAS, and TGMD-2. The main reason for OMT use is the ease of understanding by the stakeholders.

The safety and efficacy of umbilical cord blood mononuclear cells in individuals with spastic cerebral palsy: a randomized double-blind sham-controlled clinical trial

IntroductionThe current multi-center, randomized, double-blind study was conducted among children with cerebral palsy (CP) to assess the safety and efficacy of umbilical cord blood mononuclear cell (UCB-MNC). We performed the diffusion tensor imaging to assess the changes in the white matter structure.MethodsMales and females aged 4 to 14 years old with spastic CP were included. Eligible participants were allocated in 4:1 ratio to be in the experimental or control groups; respectively. Individuals who were assigned in UCB-MNC group were tested for human leukocyte antigen (HLA) and fully-matched individuals were treated with UCB-MNCs. A single dose (5 × 106 /kg) UCB-MNCs were administered via intrathecal route in experimental group. The changes in gross motor function measure (GMFM)-66 from baseline to one year after treatment were the primary endpoints. The mean changes in modified Ashworth scale (MAS), pediatric evaluation of disability inventory (PEDI), and CP quality of life (CP-QoL) were also evaluated and compared between groups. The mean changes in fractional anisotropy (FA) and mean diffusivity (MD) of corticospinal tract (CST) and posterior thalamic radiation (PTR) were the secondary endpoints. Adverse events were safety endpoint.ResultsThere were 72 included individuals (36 cases in each group). The mean GMFM-66 scores increased in experimental group; compared to baseline (+ 9.62; 95%CI: 6.75, 12.49) and control arm (β: 7.10; 95%CI: 2.08, 12.76; Cohen’s d: 0.62) and mean MAS reduced in individuals treated with UCB-MNCs compared to the baseline (-0.87; 95%CI: -1.2, -0.54) and control group (β: -0.58; 95%CI: -1.18, -0.11; Cohen’s d: 0.36). The mean PEDI scores and mean CP-QoL scores in two domains were higher in the experimental group compared to the control. The imaging data indicated that mean FA increased and MD decreased in participants of UCB-MNC group indicating improvements in white matter structure. Lower back pain, headaches, and irritability were the most common adverse events within 24 h of treatment that were related to lumbar puncture. No side effects were observed during follow-up.ConclusionsThis trial showed that intrathecal injection of UCB-MNCs were safe and effective in children with CP.Trial RegistrationThe study was registered with ClinicalTrials.gov (NCT03795974).

Reliability and validity of the Swaymeter for measuring the trunk control in children with spastic cerebral palsy

ABSTRACT Aims To examine the reliability and validity of a simple device, the Swaymeter, for measuring trunk control in children with CP. Methods Twenty children with spastic CP participated in this study. Trunk sway was measured while quietly sitting for 30s. Children lean forward or backward as far as possible for measuring dynamic balance range. Test–retest reliability was conducted. The concurrent and construct validity of the Swaymeter was assessed by comparison to the motion capture system and gross motor function measure (GMFM). Results The reliability of the Swaymeter was moderate to excellent in measuring trunk sway and dynamic balance range (ICCs = 0.696–0.948). Concurrent validity showed good results (r = 0.818–0.997) and construct validity of dynamic balance in anterior direction showed moderate to high correlation with the GMFM (r = 0.599–0.849). Conclusion Assessment of trunk control in a sitting position using the Swaymeter in this study was valid and reliable in children with CP.

Telehealth Program for Infants at Risk of Cerebral Palsy during the Covid-19 Pandemic: A Pre-post Feasibility Experimental Study

Aim: To verify the effects of a telerehabilitation program for infants at high risk for Cerebral Palsy (CP) during the COVID-19 pandemic. Method: Longitudinal study. Infants were aged 3–18 months corrected age, at risk of developmental delay. The General Movement Assessment or a neurologic examination were performed to identify the risk of CP. Motor function was assessed using the Gross Motor Function Measure-88 (GMFM-88) and the Alberta Infant Motor Scale (AIMS). Caregivers of infants at high risk of CP applied a home-based program supervised by a Physical therapist, five times a week over 12 weeks. The program included guidance for optimal positioning, optimization of goal-directed activities, environmental enrichment, and educational strategies. Results: 100 infants at risk for delayed motor development were recruited. Eighteen infants were classified at high risk of CP, and 10 families completed telerehabilitation (83% final retention rate). No adverse events were reported. Adherence to the telecare program was high (90%). The costs were low. We found increased scores for all dimensions and the total score of the GMFM-88, and the AIMS percentile at the end of the intervention. Most infants presented a clinically significant change for the GMFM-88. Conclusions: The telecare program was feasible.