Physical Therapy Interventions For Children Research Articles

The effects of obesity in childhood and adolescence: The role of physiotherapy: Review of reviews

Introduction: Obesity remains a growing global issue with its prevalence in the developed world increasing fourfold in recent decades. Childhood may represent a critical window of opportunity for intervention and prevention of long-term consequences. While physiotherapy has the practical potential to contribute to the treatment of childhood obesity, its role remains unclear due to a lack of specific guidelines. Aim: The aim of this review is to explore the existing literature to delineate, identify and evaluate the role of physiotherapy in the management of childhood obesity Method: A review was conducted of existing literature in 4 databases, Pubmed. Embase, Cinahl, Medline. Results: Of the original 273 articles collected based on title and abstracts, 36 were included which were reviews. Of these, 23 were systematic reviews and 13 were literature reviews. The interventions involved quality-oriented physical activity and quantity-oriented physical activity as well as combined interventions involving different disciplines. The physical therapy interventions for children with obesity that appear to be significantly effective are: First, multi-component interventions involving environmental modification and family involvement and second, quantity-based physical activity interventions Conclusion: Physical therapy in the treatment of children with obesity can play an important role as part of a multidisciplinary team (doctors, psychologists, teachers, trainers and others), evaluating and developing exercise programs with the ultimate goal of increasing quantitative physical activity, a practice that seems to yield the best results. Future studies should examine the impact of different rehabilitation programs depending on the individual characteristics of the children (profile, size of the problem, presence of comorbidities).

Acute Care Physical Therapy and Sickle Cell Disease

Background and Purpose: Vaso-occlusive crises (VOC) are the most common cause for hospitalization in children and adolescents with sickle cell disease (SCD) in the United States. Physical therapy interventions provide nonpharmacological pain management and help hospitalized patients maintain mobility and function, but little is known about their application to the unique pathophysiology of those with SCD. The purpose of this review is to summarize evidence relevant to the physical therapy management of children and adolescents hospitalized with VOC. Methods: A literature search of PubMed, Cochrane, CINAHL, and EMBASE databases was performed using key words relevant to physical therapy interventions for children and adolescents with SCD and acute pain. Results: Sixteen articles were included in this review. Interventions identified included heat, mobilization, transcutaneous electrical nerve stimulation, massage, yoga, mindfulness, breathing exercises, virtual reality, incentive spirometry, and patient/family education. Conclusions: Physical therapists may be able to aid in the acute pain management of patients with SCD. Current literature relies on small observational studies making generalization difficult. Future studies are critical to improve evidence-based physical therapy practice in this population.

Specifying current physical therapy practice for paediatric trials: A survey of UK physical therapists.

Advancing physical therapy interventions for children and young people is a high research priority. This includes research to describe and specify the control condition, typically 'current care', for effectiveness trials. This paper aims to identify physical therapy outcomes commonly targeted, and intervention techniques and approaches commonly used, by physiotherapists working with children (aged 2-19 years) with mobility limitations in the United Kingdom. A cross-sectional survey. Participants were recruited through the interactive Chartered Society of Physiotherapy members-only online discussion forum, the Association of Paediatric Chartered Physiotherapists, direct emails and snowball sampling within the authors' professional networks and Twitter. Data were collected using a structured online questionnaire and analysed using descriptive statistics. We received 146 responses, 95/146 (65.1%) of which were fully complete. Therapists reported targeting 367 unique outcome constructs, of which 193 (52.6%) mapped onto activities and participation (e.g. moving around using equipment, maintaining body position and walking), 158 (43.1%) on body functions (e.g. muscle strength, joint mobility and gait functions), 11 (3.0%) on body structure (e.g. muscle length) and 3 (0.8%) on environmental factors (e.g. access home environment, access school environment and family confidence). The most commonly used interventions related to postural management (115/133 of respondents, 86.4%) and exercise therapy (116/137, 84.67%) and included techniques such as 'use equipment' (118/137, 86.1%), 'instruct how to do something' (117/137, 85.4%), 'practice' (105/137, 76.6%) and 'stretch' (99/137, 72.3%). In designing trials, current care can be described as a combination of biomechanical and physiological techniques and approaches targeted at body functions and through that to activity and participation. Although some environmental behaviour change techniques and strategies were reported, the explicit use of these in current care appears limited.

Role of Early Rehabilitation in An Infant with Arthrogryposis Multiplex Congenita: A Case Report with 11 Months of Follow up

Background: Arthrogryposis multiplex congenital (AMC) is etiopathogenetically a heterogeneous disorderwhich is considered to be a neuromuscular syndrome present at birth. It is characterized by presence ofcontractures in more than two body areas at the prevalence rate of 1 in every 3000 to 5000 live births.Purpose: There are no reports in the literature which provides clear guidelines regarding physical therapyinterventions for children with AMC. The purpose of this case report is to document the infant’s recoverybased on the frequency and duration of physical therapy interventions during first 11 months of life.Key points of case: An infant with arthrogryposis multiplex congenital was followed from day 15 to 11months of early developmental period. Following continuous and integrated physical therapy, infant achievednormal developmental sequence with visible improvement in joint contractures. Without interveningsurgically, there is improvement in club foot of the baby. This article enlightens physiotherapeutic treatmentstrategies for child with AMC.Conclusion: Physical therapy of a child with AMC should be multi-centred, holistic and continuous.Early approach to physical therapist minimise the complications following AMC. Early physical therapyinterventions can help in prolonging the early need of surgical interventions during developmental age.

Effectiveness of physical therapy interventions for children with cerebral palsy

Cerebral palsy (CP) describes a group of permanent disorders of motor development and posture that cause limiting activity that are attributed to non-progressive dysfunctions occurring in the development of fetal brain or of the child.The main purpose of the paper is to study the clinical and functional aspects with implications in the design and evaluation of the complex recovery therapy of the child with psycho-neuro-motor disabilities diagnosed with infantile cerebral palsy (ICP).The study took place during the period June 2016 - March 2018, is of the type prospectively and comprised 5 children diagnosed with ICP, aged 4 to 12 years. Criteria for inclusion in the recovery group: children diagnosed with infantile cerebral palsy form spastic tetra- spastic, without orthopedic surgery, during the study period. Children have been given a comprehensive assessment of body attitude, upper and lower limb hypertonia, upper limbs functionality, and global motor function.The major objective of recovering the child with infantile cerebral palsy was to improve the quality of life by creating conditions for minimum patient autonomy. The functional recovery program was carried out three times a week using exercises and methods of neuro-motor rehabilitation. Duration of the session was 50-60 min.Due to the results obtained at the initial and final evaluation, a tonus improvement was observed in all the tested muscles, with a decrease in the mobilization resistance of all the muscle groups. In global functional evaluation the total score on the 5 sections of the 5 children with CP had an initial mean value of 34.92 (± 16.60) and a final of 47.72 (± 26.53)Stretching, neuro-motor reeducation methods and active physical exercises help to increase the degree of the functional independence.

A Physical Therapy Intervention to Advance Cognitive and Motor Skills: A Single Subject Study of a Young Child With Cerebral Palsy.

Physical therapy interventions for children with severe motor impairments do not address the relationship between motor and cognitive development. Evaluate the potential of a physical therapy intervention focusing on enhancing cognitive and motor outcomes in a child with severe motor impairments. AB phase design without reversal. One child participated in 8 assessments from 4 to 29 months of age. The START-Play intervention was provided for 3 months following 4 baseline assessments over 12 months. Total Gross Motor Function Measure (GMFM), Sitting, Reaching, and Problem Solving assessments were completed. Visual inspection, 2 standard deviation (SD) Band Method, and percent of nonoverlapping data methods evaluated change. This child had improved GMFM total and sitting scores, increased frequency of toys contacts, and increased rate of problem-solving behaviors following intervention. START-Play shows promise for children with severe motor impairments. Additional research is needed to evaluate efficacy.

A Scoping Review of Physical Therapy Interventions for Childhood Cancers.

Purpose: Children and adolescents undergoing cancer treatment are at high risk of developing serious adverse effects, many of which respond to physical therapy (PT). This scoping review aims to (1) outline the state of the research involving PT for children with cancer and (2) identify gaps in the literature for future research. Method: From January 2002 to October 2017, we conducted electronic searches of three major databases and conference proceedings and checked references of screened articles. Results: A total of 12 articles were included in the review: one randomized controlled trial, one pilot randomized trial, five pilot or feasibility studies, two prospective studies, one case series, one case report, and one retrospective study. The research to date supports the feasibility of PT interventions for children with cancer, but the current evidence is not yet at a level to inform clinical practice. To better elucidate treatment protocols and assess their benefits for tumour-specific impairments, research needs to examine the effects of PT on specific impairments or for specific cancer tumour types. Conclusions: Collaborative efforts to conduct multi-centre trials are needed to further the field of paediatric oncology PT.

Occupational and physical therapy interventions for children with central hypotonia

Occupational and physical therapy interventions for children with central hypotonia

Early Intensive Leg Training to Enhance Walking in Children With Perinatal Stroke: Protocol for a Randomized Controlled Trial.

Development of motor pathways is modulated by activity in these pathways, when they are maturing (ie, critical period). Perinatal stroke injures motor pathways, including the corticospinal tracts, reducing their activity and impairing motor function. Current intervention for the lower limb emphasizes passive approaches (stretching, braces, botulinum toxin injections). The study hypothesis was that intensive, early, child-initiated activity during the critical period will enhance connectivity of motor pathways to the legs and improve motor function. The study objective was to determine whether early intervention with intensive activity is better than standard care, intervention delivered during the proposed critical period is better than after, and the outcomes are different when the intervention is delivered by a physical therapist in an institution vs. a parent at home. A prospective, delay-group, single-blind, randomized controlled trial (RCT) and a parallel, cohort study of children living beyond commuting distance and receiving an intervention delivered by their parent. The RCT intervention was provided in university laboratories, and parent training was provided in the childs home. Children 8 months to 3 years old with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. Intensive, play-based leg activity with weights for the affected leg and foot, 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure-66 score. Secondary outcomes were motion analysis of walking, full-day step counts, motor evoked potentials from transcranial magnetic stimulation, and patellar tendon reflexes. Inter-individual heterogeneity in the severity of the stroke and behavioral differences are substantial but measurable. Differences in intervention delivery and assessment scoring are minimized by standardization and training. The intervention, contrary to current practice, could change physical therapy interventions for children with perinatal stroke.

Effectiveness of Interventions for Children With Developmental Coordination Disorder in Physical Therapy Contexts: A Systematic Literature Review and Meta-Analysis

Purpose:The purpose of this systematic literature review and meta-analysis is to identify the types of interventions in physical therapy contexts that have been explored in children with developmental coordination disorder, the most common variables being addressed, and whether these interventions are effective. Method:This systematic search of MEDLINE, PEDro, CINAHL, SPORTDiscus, PsycINFO, and Cochrane Library identified interventions in physical therapy contexts for children and adolescents with DCD, and studies were screened using these criteria and assessed using the PEDro and NIH quality assessment scales. AMSTAR was used to evaluate systematic reviews and a meta-analysis was conducted. Results:From the articles reviewed, 29 articles of moderate to good quality were included in the qualitative analysis. Task-oriented approaches as well as motor skill training–based interventions have shown beneficial effects in improving motor function in children with DCD. Data from 14 articles was extracted for inclusion in the meta-analysis, providing support for the effectiveness of physical therapy interventions against inaction. Conclusion:Researchers recommend the use of task-oriented and traditional physical therapy interventions for children with DCD. In addition, interventions in physical therapy contexts need clear goals and outcome measures for individual children.

Development and Reliability Evaluation of the Movement Rating Instrument for Virtual Reality Video Game Play.

BackgroundVirtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation.ObjectiveThe objectives of this study were to develop and evaluate the feasibility and reliability of the Movement Rating Instrument for Virtual Reality Game Play (MRI-VRGP).MethodsItem generation occurred through an iterative process of literature review and sample videotape viewing. The MRI-VRGP includes 25 items quantifying upper extremity, lower extremity, and total body movements. A total of 176 videotaped 90-second game play sessions involving 7 typically developing children and 4 children with cerebral palsy were rated by 3 raters trained in MRI-VRGP use. Children played 8 games on 2 virtual reality and active video game systems. Intraclass correlation coefficients (ICCs) determined intra-rater and interrater reliability.ResultsExcellent intrarater reliability was evidenced by ICCs of >0.75 for 17 of the 25 items across the 3 raters. Interrater reliability estimates were less precise. Excellent interrater reliability was achieved for far reach upper extremity movements (ICC=0.92 [for right and ICC=0.90 for left) and for squat (ICC=0.80) and jump items (ICC=0.99), with 9 items achieving ICCs of >0.70, 12 items achieving ICCs of between 0.40 and 0.70, and 4 items achieving poor reliability (close-reach upper extremity-ICC=0.14 for right and ICC=0.07 for left) and single-leg stance (ICC=0.55 for right and ICC=0.27 for left).ConclusionsPoor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements.

Lidocaine iontophoresis combined with physical therapy interventions for children with spastic hemiplegic cerebral palsy

using subjects with stroke, we also wanted to shed light on a long standing question regarding the underling neural mechanism of a more pronounced decrease in concentric strength following stroke. Methods: Functional magnetic resonance imaging was used to examine differences in VLPFC and motor regions during the concentric and the eccentric phase of imagined maximum contractions in a selected sample of subjects with stroke (n= 4). The subjects were included as they exhibited disturbed modulation of force. Results: The previously demonstrated pattern within VLPFC was evident only on the contralesional hemisphere. On the ipsilesional hemisphere, the recruitment in VLPFC was similar for both modes of contractions. Conclusion(s): The findings support a hypothesis of an involvement of VLPFC in contraction mode-specific modulation of maximum force production. A lack of the expected motor inhibition during eccentric contractions is a suggested mechanism behind a better-preserved eccentric strength among subjects with stroke. The data in this study opens up for another explanation behind a better preservation of eccentric strength among subjects with stroke that fits into the clinical picture of a general strength reduction. Implications: A lack of contraction mode specific modulation of motor activation among stroke subjects, often expressed as an increased ratio between eccentric and concentric strength may be explained by disturbed pre-frontally mediated motor inhibition.

The Underwater Treadmill as a Physical Therapy Intervention for Children with Cerebral Palsy

Cerebral Palsy is a congenital and physical disability that leads into abnormal muscle tone, dyskinesia, and muscle spasticity, which can negatively impact functional gait patterns. Using the principles of activity based programs and repetitive task specific exercises involving a treadmill in physical therapy can replicate normal gait patterns, which can improve the quality of life. There is a scarcity of research that explores the effectiveness of underwater treadmill training as a form of physical therapy intervention. As such, the purpose of the study is to examine available research that studied the benefits of aquatic therapy, land based treadmill training, and underwater treadmill training on the gait patterns in children with cerebral palsy. The researchers conducted a review of literature that focuses on beneficial effects of physical therapy interventions such as aquatic exercise, resistance training, land‐based treadmill training, as well as underwater treadmill training; then ranked them using the Oxford Level of Evidence‐based Medicine. Based on the evidence gathered, we can conclude that the physiological benefits associated with aquatic therapy in combination with the repetitive task specific exercise used with treadmill training can improve mobility and functional gait patterns of children with cerebral palsy.

Structural equation modeling of motor impairment, gross motor function, and the functional outcome in children with cerebral palsy

Physical therapy intervention for children with cerebral palsy (CP) is focused on reducing neurological impairments, improving strength, and preventing the development of secondary impairments in order to improve functional outcomes. However, relationship between motor impairments and functional outcome has not been proved definitely. This study confirmed the construct of motor impairment and performed structural equation modeling (SEM) between motor impairment, gross motor function, and functional outcomes of regarding activities of daily living in children with CP. 98 children (59 boys, 39 girls) with CP participated in this cross-sectional study. Mean age was 11 y 5 mo (SD 1 y 9 mo). The Manual Muscle Test (MMT), the Modified Ashworth Scale (MAS), range of motion (ROM) measurement, and the selective motor control (SMC) scale were used to assess motor impairments. Gross motor function and functional outcomes were measured using the Gross Motor Function Measure (GMFM) and the Functional Skills domain of the Pediatric Evaluation of Disability Inventory (PEDI) respectively. Measurement of motor impairment was consisted of strength, spasticity, ROM, and SMC. The construct of motor impairment was confirmed though an examination of a measurement model. The proposed SEM model showed good fit indices. Motor impairment effected gross motor function (β=-.0869). Gross motor function and motor impairment affected functional outcomes directly (β=0.890) and indirectly (β=-0.773) respectively. We confirmed that the construct of motor impairment consist of strength, spasticity, ROM, and SMC and it was identified through measurement model analysis. Functional outcomes are best predicted by gross motor function and motor impairments have indirect effects on functional outcomes.

Perceived Effectiveness and Barriers to Physical Therapy Services for Families and Children With Friedreich Ataxia

To describe the frequency, type, and perceived effectiveness of physical therapy interventions for children with Friedreich ataxia (FA); identify barriers to therapy; and solicit advice from parents. Parents of 30 children with FA participated in semistructured interviews. Qualitative and quantitative methods were used to analyze the data. Sixty-seven percent of children received direct physical therapy service. Stretching and strengthening exercises were used most frequently, and their perceived usefulness increased as the children aged. Seventy-three percent received home exercise programs; 9% implemented these consistently. External barriers included a lack of expert providers and limited reimbursement. Internal barriers included limited time and energy, lack of awareness of services, and children's preferences not to be treated differently. Parents advised therapists to become experts, advocates, and use approaches based on family and child preferences. Outcomes provide a starting point for developing further research, education, and effective interventions for children with FA.

Documenting the Content of Physical Therapy for Children With Acquired Brain Injury: Development and Validation of the Motor Learning Strategy Rating Instrument

A goal of physical therapy interventions for children and youth with acquired brain injury (ABI) is the learning and relearning of motor skills. Therapists can apply theoretically derived and evidence-based motor learning strategies (MLSs) to structure the presentation of a task and organize the environment in ways that may promote effective, transfer-oriented practice. However, little is known about how MLSs are used in physical therapy interventions for children with ABI. The purpose of this study was to develop and validate an observer-rated Motor Learning Strategy Rating Instrument (MLSRI) quantifying the application of MLSs in physical therapy interventions for children with ABI. A multi-stage, iterative, item generation and reduction approach was used. An initial list of MLS items was generated through literature review. Seven experts participated in face validation to confirm item comprehensiveness. In a content validation process, 12 physical therapists with pediatric ABI experience responded to a questionnaire evaluating feasibility and importance of items. Six physical therapy sessions with clients with ABI were videotaped at a children's rehabilitation center. The 12 physical therapists participated in a session where they: (1) rated session videos to test the MLSRI and (2) provided verbal feedback. Revisions were made sequentially to the MLSRI based on these processes. The MLSRI was scored during videotape observation rather than being given a live rating, which may be onerous in certain settings and may influence therapist or child behavior. Further reliability investigations will determine whether the 33-item MLSRI is of help in documenting strategy use during intervention, as an evaluation tool in research, and as a knowledge transfer resource in clinical practice.

Using Transformative Learning Theory to Enhance Professional Development

Purpose: Pediatric occupational therapy and physical therapy interventions for children with disabilities are designed to increase function and often focus on developmental skills instead of on the environmental context and promoting self-determination skills. A professional development course was developed to help therapists develop intervention strategies to meet developmental outcomes, while also promoting children's self-determination and creating opportunities for children to authentically participating in daily routines, including leisure and community play. Transformative learning theory was used as a basis to develop this course. The purpose of this article is to report on course activities and the assessment of participants' "transformation" at the completion of the course. Method: A pre-test/post-test design was used to determine whether participants in this course (n=3) had made transformations in their habits of mind when designing client goals, intervention plans and recommendations for a fictional case study of a child with a disability. Results: Participants wrote pre-test goals that focused on building skill in typical developmental sequences; whereas post-test goals focused on using strengths the child had and changing the environment to encourage authentic participation of the child. In addition post-test goals and interventions focused on determining the child's preference and choice about activities to participate in. Pre-test referrals were for equipment and other programs to address skill development; while post-test referrals focused on play and recreation opportunities. Conclusion: Following completion of a course using transformative learning strategies, participants demonstrated changes in habits of mind upon completion of a post-test case study in which goals, interventions, and referrals were more consistent with themes of the course including self-determination and authentic participation.

Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review

. Anttila H., Autti‐Rämö I., Suoranta J., Mäkelä M. & Malmivaara A. ( 2008 ) , 8 , 14 . DOI: 10.1186/1471‐2431‐8‐14 . Aim To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP).Methods A search was made in Medline, Cinahl, PEDro and the Cochrane Library for the period from 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health.Results Twenty‐two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint‐induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited because of low methodological quality and the statistically insignificant results of the studies.Conclusion Because of limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well‐designed trials are needed especially for focused PT interventions.

Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review

BackgroundTo assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP).MethodsA search was made in Medline, Cinahl, PEDro and the Cochrane library for the period 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health (ICF).ResultsTwenty-two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited due to low methodological quality and the statistically insignificant results of the studies.ConclusionDue to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well-designed trials are needed especially for focused PT interventions.

Physical Therapy Intervention for Children with Cerebral Palsy Who Receive Botulinum Toxin A Injections

This study describes changes in physical therapy (PT) service delivery, intervention strategies, and anticipated goals after botulinum toxin A (BtA) injections for children with cerebral palsy and lower extremity spasticity. Subjects were six physical therapists who were the primary therapists for children who received BtA injections. A questionnaire was developed for this study. Data were collected by structured telephone interview during a six-month period that included a two-month preinjection and four-month postinjection phase for each child. A descriptive analysis was done to determine changes in PT over time. Three therapists reported increased levels of PT in the postinjection phase. Trends in interventions indicated use of strategies that were impairment and function based to achieve goals. Most goals emphasized functional change. This study identifies PT interventions and trends in goal achievement for children with cerebral palsy after BtA injections.