Spastic Hemiparetic Cerebral Palsy Research Articles

O efeito da terapia por contensão induzida avaliada por meio de acelerômetros: o impacto na atividade diurna e no sono em crianças com paralisia cerebral

Abstract Introduction Spastic hemiparetic cerebral palsy (CP) is the most prevalent type of CP. Children with spastic hemiparesis experience difficulties when using their affected upper extremities, and one effective treatment is the Constraint-Induced Movement Therapy (CIMT). The study of rest-activity patterns provides information on children’s daily activities with spastic hemiparetic CP during the day and sleep. Objective To investigate the effect of CIMT on the rest-activity patterns in children with spastic hemiparetic CP vs in a healthy group. Methods Nonrandomized controlled trial was conducted at the Neuropediatric Center of the Hospital de Clínicas Complex, in Curitiba, Brazil. Children with spastic hemi-paretic CP between 5 and 16 years old participated in the study group and receive the CIMT. The healthy group was composed of children between 5 and 15 years old. Both groups used accelerometer to record rest-activity patterns, that may be studied through nonparametric variables of accelerometer: M10 (an individual’s most active 10h); L5 (an individual’s least active 5h); and RA (relative amplitude of the circadian rest-activity patterns). Results Forty-five children were recruited, and 38 were included in the analyses (19 allocated to each group). In the study group, there was a significant increase in M10 and L5 (p < 0.001) after CIMT. The values of M10 and L5 were significantly higher (p < 0.001) in the healthy group compared to the study group after CIMT. Conclusion Our results showed that children with spastic hemiparetic CP became more active and participant in their daily life during the day as well as more efficient sleeping.

Effect of upper extremity kinesio tape application on hand function, wrist joint position and grip strength in children with hemiparetic cerebral palsy

Abstract Although kinesio taping (KT) is frequently used in musculoskeletal disorders, there is not enough data on the effectiveness of holistic KT application on the upper extremity in spastic hemiparetic children. Our study aims to evaluate the effect of KT application on spasticity, range of motion, dexterity and hand grip strength in these patients. Twenty patients diagnosed with spastic hemiparetic cerebral palsy, aged 5-17 years, who were trained and treated in a private educational institution, were included in the study. Between November 2021 and January 2022, in addition to neurodevelopmental therapy for 12 weeks, KT was applied from the lateral epicondyle region to the end of the metacarpals, with 15-25% tension, to the dorsal face of the hand, with the taping direction facilitation technique (starting direction is the origin of the muscle). Spasticity, range of motion, dexterity and hand grip strength were evaluated as pre-test and post-test. It was determined that the mean score difference between the pre-test and post-test range of motion (ROM) shoulder abduction, ROM supination, ROM wrist flexion, ROM wrist extension and hand grip strength of the individuals was statistically significant (). It was determined that the individuals’ pre-test-post-test Jebsen hand function test (JHFT) Writing, JHFT card flipping, JHFT small objects, JHFT nutrition simulation, JHFT backgammon checkers stamps, JHFT large light objects, JHFT total score average difference was statistically significant (). These results indicate that KT application positively affects upper extremity functions in the rehabilitation of hemiparetic cerebral palsy. Longitudinal studies are recommended in patients with hemiparetic cerebral palsy.

A New Training Protocol Based on Bimanual Playing a Computer Game for Motion-Cognitive Rehabilitation in Children with Spastic Hemiparetic Cerebral Palsy

Background: Spastic hemiparetic cerebral palsy (CP) occurs due to damage to the hemisphere of the brain responsible for controlling movement. Objectives: This study aims to propose a novel bimanual training approach utilizing a specific computer game to improve hand movement function and enhance working memory in children with hemiparetic CP. Methods: Five children with hemiparetic CP participated in a 15-session intervention three times a week, each lasting 30 minutes, incorporating bimanual training through a computer game. The Fugl-Meyer assessment (FMA-UE) and the Corsi block-tapping test evaluated sensorimotor and cognitive abilities. Statistical analyses were conducted using SPSS software. Results: The mean FMA-UE score before and after the intervention was 51 ± 3.31 and 59.5 ± 1.14, respectively, indicating a statistically significant difference (P = 0.008) and an increase in total upper extremity motor function score. Additionally, the mean Corsi block-tapping test score for memory span before and after the intervention was 2.3 ± 0.84 and 3.1 ± 1.14, respectively, demonstrating improved cognitive ability. Conclusions: The combination of bimanual hand training and video games has been shown to be effective in enhancing motor-cognitive abilities in children with hemiparetic CP.

A Scoping Review on the Leading Interventions of Upper Limb Rehabilitation in Cerebral Palsy

Motor impairment in children with spastic hemiparetic cerebral palsy (CP) is generally more prominentin the affected upper limb, leading to limitations in hand function as muscle weakness, slower execution ofmovements and deficient integration of sensory-motor information. The aim of the proposed study is to performa comparative analysis of functional training effects for the paretic upper limb with and without transcranialdirect current stimulation (tDCS) over the primary motor cortex in children with spastic hemiparetic cerebralpalsy. The purpose of the project is to outline the specific methods and procedures and to determine whethera single or combined effects with other interventions of tDCS is effective. Subjects of age group (5-28) yearswho were spastic hemiparetic were included in the study. The design of the study is review. Google scholar,PubMed, Science Direct and Cochrane Library were systemically searched between January 2013 to January2023 in which children were affected with cerebral palsy and that in which we included only spastic hemiparetic,unilaterally affected patients. Total of 10 articles were included based on the inclusion criteria in there were total245 children. Children in both the groups were studied intensively. The result turns out to be the group whoreceived Transcutaneous electrical nerve stimulation (TENS), Transcranial magnetic stimulation (TMS) andElectrical Stimulation were at much benefit. Furthermore, the effect of anodal tDCS showed greater improvementthan cathodal tDCS. In conclusion, greater improvement was seen in the patients who received anodal tDCSbut for a very small duration. Though the combination of tDCS with other interventions is shown to be morebeneficial but more research on the effect of the tDCS alone we are looking forward to. This study can be helpfulin determining the effect of the leading intervention among other electrical interventions in decreasing muscleduration and re-education time and is considered helpful in the vocational aspect and their activities of dailyliving (ADL) in CP patients.

Effect of Whole-Body Vibration Exercise on Hamstrings-to-Quadriceps Ratio, Walking Performance, and Postural Control in Children With Hemiparetic Cerebral Palsy: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to investigate the effect of whole-body vibration (WBV) exercises combined with traditional physiotherapy on the hamstrings-to-quadriceps (H:Q) ratio, walking ability, and control of posture in children with hemiparetic cerebral palsy (CP). MethodsA total of 34 children with spastic hemiparetic CP (boys and girls) participated in this 2-arm, parallel, randomized controlled trial. The inclusion criteria were spasticity ranging from 1 to 1+, gross level skills (I and II), at least 1 meter tall, standing alone, and walking forward and backward. They were randomly allocated to the control group (traditional physiotherapy) and study group and were treated by the same physiotherapy program combined with WBV training (3 times per week for 2 successive months). Quadriceps and hamstring muscle strength, walking performance, and postural control were evaluated before and after intervention by a blinded assessor. ResultsThe post-intervention values of the hamstring and quadriceps muscle force, gross motor function, and stability indices of the 2 groups were higher than the pre-values (P < .05). In addition, the post-values of the study group were higher than those of the control group (P < .05). Regarding the H:Q ratio, there was no significant difference between pre-values or the post-values of both groups (P = .948 and P = .397, respectively). There were no significant differences between the pre- and post-values of each group (P = .500 and P = .195, respectively). ConclusionEight weeks of WBV training combined with traditional physiotherapy was more effective than traditional physiotherapy alone in improving walking ability and postural control. Furthermore, the combined intervention strengthened the quadriceps and hamstring muscles, with no change in the H:Q ratio in children with hemiparetic CP.

Can Functional Electrical Stimulation affect Equilibrium and motor functions in Spastic hemiparetic Cerebral Palsy A Randomized Controlled Study

Background and aim: Using of F.E.S in rehabilitation program results is auspicious, although there’re doubts about FES efficiency in balance and main motor functions amelioration in hemiplegic infants. The research studied the impact of FES in balance and main motor skills improvement in infants diagnosed with hemiparetic cerebral palsy if we placed it on ventral muscle group of leg. Design and Place: Randomized controlled study in National Institute for Neuro-Motor System in Egypt. Methodology: 30 infants who are diagnosed with hemiplegic CP aging from 6 to 8 years is chosen from both genders. In two egalitarian sets randomly (control and study). Prior and after 3 months of treatment Assessment was carried out, utilizing Biodex balance system to gauge static balance plus Peabody progressive motor scale to evaluate gross motor functions. Control set is put in an elected Physiotherapy program. The other set (study one) received FES as well as the elected Physiotherapy program. Results: Study group patients showed a considerable amelioration in main motor skills test. Furthermore, in same group it’s showed that balance control was better according to the other set (control group) after training. Conclusion: Electrical stimulation addition to traditional Physiotherapy program over leg ventral group muscles can ameliorate balance and the gross motor functions in hemiparetic cerebral palsy infants.

Effect of Kinesio Taping on Grasp and Release in Children with Spastic Hemiparetic Cerebral Palsy: A Pilot Study

AbstractBackground: Cerebral Palsy (CP) children have motor dysfunction due to non-progressive brain damage. Hemiplegic cerebral palsy children usually have marked hand involvement with limited active wrist extension and excessive thumb adduction and flexion which appears from infancy. Various techniques are generally used in the course of CP management. A recent method such as taping is frequently used in pediatrics rehabilitation clinics. It is easy to apply and inexpensive and can be easily removed or changed according to therapy objects. In CP it corrects postural misalignment enhance joint stability, activate weak muscle and manage spasticity.Aim of Study: To determine the short term effect of kinesio taping on hand functions especially grasp and release in the children with spastic hemiparetic cerebral palsy.Participants and Methods: Eleven spastic hemiparetic cerebral palsied children (2-7 years old) of both sexes with mild hand and/or wrist spasticity (grade 1 to 1+) according to the Modified Ashowrth Scale, and had impaired hand functions level II, III and IV according to Manual Ability Classification System (MACS) participated in this study. Participants received kinesio tape for wrist and thumb in addition to the standard conventional physical therapy program (2-3 hours per week). Participants were evaluated before and after four weeks using the Grasping subtests of the Quality of Upper Extremity Skills Test (QUEST) and Peabody Devel-opmental Motor Scale (PDMS).Results: After Four weeks of intervention results showed that no significant changes post treatment application when compared with corresponding pretreatment for the PDMS (p-value=0.096) and QUEST (p-value=0.052) scores.Conclusion: These results suggested that four weeks Kinesio taping was not effective in improving the hand functions of spastic hemiparetic cerebral palsy children.

Análise da marcha de crianças com paralisia cerebral com e sem uso de órteses de tornozelo e pé

AIMS: To analyze the linear parameters of the gait of children with spastic hemiparetic cerebral palsy, users of articulated ankle and foot orthoses.METHODS: A three-dimensional analysis of the gait of eight children with spastic hemiparetic cerebral palsy, aged 5 to 10 years, classified in levels I and II of the Gross Motor Function Classification System, was made with and without the use of ankle and foot orthoses. A kinematic system with seven integrated cameras captured the three-dimensional trajectory of markers in the participants' body during gait, with data being collected at a sampling rate of 100 Hz. For the comparisons, the paired t-test and the t-test for a sample were used.RESULTS: Considering the gait’s spatiotemporal variables of these children with cerebral palsy compared to normal values, only velocity (with the orthosis and without the orthoses) presented a statistically significant difference. The mean normal gait velocity is 1.25 m/s, while in the non-orthoses participants the mean velocity was 0.98±0.10 m/s (p=0.0001) and with the use of orthoses the mean velocity was 0.96±0.21 m/s (p=0.0001). In the comparison between children using or not the ankle and foot orthoses, velocity, cadence and pitch length were respectively 0.98±0.10 m/s, 131±16.15 steps/min and 0.44±0.08 m in the children without the orthoses; and 0.96±0.21 m/s, 128.37±22.9 steps/min and 0.48±0.05 m in the children with the orthoses. The differences were not statistically significant.CONCLUSIONS: Comparison between the same group with and without the use of ankle and foot orthoses suggests that their use in children with cerebral palsy may promote an increase in step length and a decrease in velocity and cadence in relation to condition without orthosis, favouring a better distribution of weight in the paretic member and providing a better symmetry in gait. However, the differences were not statistically significant. Thus, it is expected that the results obtained in this study can serve as a pilot for future research, with larger samples.

Effects of a single session of transcranial direct current stimulation on upper limb movements in children with cerebral palsy: A randomized, sham-controlled study

ABSTRACTIntroduction: Motor impairment in children with spastic hemiparetic cerebral palsy (CP) is generally more prominent in the affected upper limb, leading to limitations in hand function stemming from deficiencies in motor coordination and selective motor control as well as muscle weakness, slower execution of movements and deficient integration of sensory-motor information. Objective: Determine the effect of a single session of anodal transcranial direct current stimulation (tDCS) combined with functional training on the spatiotemporal variables of upper arm movements in children with spastic hemiparesis. Method: A randomized, sham-controlled trial with a blinded evaluator was conducted involving 20 children with CP between 6 and 12 years of age. The spatiotemporal variables of the upper limbs were analyzed by comparing the results of Evaluation 1 (before stimulation) and Evaluation 2 (immediately after stimulation). The protocol consisted of a 20-minute session of functional training of the paretic upper limb combined with tDCS administered over the primary motor cortex of the hemisphere contralateral to the motor impairment at an intensity of 1 mA. The participants were randomly allocated to two groups: experimental group (anodal tDCS) and control group (sham tDCS). Results: Statistically significant (p < 0.05) reductions in total movement duration and returning movement duration were found in both the paretic and non-paretic limbs in the group submitted to active tDCS. No significant differences were found in the control group for any of the variables analyzed. Conclusion: A single session of anodal tDCS over the primary motor cortex of the hemisphere ipsilateral to the brain lesion led to momentary motor improvements in both upper limbs of the children with spastic hemiparetic CP analyzed in the present study.

Transcranial direct current stimulation combined with upper limb functional training in children with spastic, hemiparetic cerebral palsy: study protocol for a randomized controlled trial.

BackgroundThe aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy.MethodsThe sample will comprise 34 individuals with spastic hemiparetic cerebral palsy, 6 to 16 years old, classified at level I, II, or III of the Manual Ability Classification System. Participants will be randomly allocated to two groups: (1) functional training of the paretic upper limb combined with anodic transcranial stimulation; (2) functional training of the paretic upper limb combined with sham transcranial stimulation. Evaluation will involve three-dimensional movement analysis and electromyography using the SMART-D 140® system (BTS Engineering) and the FREEEMG® system (BTS Engineering), the Quality of Upper Extremity Skills Test, to assess functional mobility, the Portable Device and Ashworth Scale, to measure movement resistance and spasticity, and the Pediatric Evaluation of Disability Inventory, to evaluate performance. Functional reach training of the paretic upper limb will include a range of manual activities using educational toys associated with an induced constraint of the non-paretic limb during the training. Training will be performed in five weekly 20-minute sessions for two weeks. Transcranial stimulation over the primary motor cortex will be performed during the training sessions at an intensity of 1 mA. Findings will be analyzed statistically considering a 5 % significance level (P ≤ 0.05).DiscussionThis paper presents a detailed description of a prospective, randomized, controlled, double-blind, clinical trial designed to demonstrate the effects of combining transcranial direct current stimulation over the primary motor cortex and functional training of the paretic limb in children with cerebral palsy classified at level I, II, or III of the Manual Ability Classification System. The results will be published and evidence found may contribute to the use of transcranial stimulation for this population.Trial registrationReBEC RBR-6V4Y3K. Registered on 11 February 2015.

Effect of backward walking training on postural balance in children with hemiparetic cerebral palsy: a randomized controlled study

Objective: To study the effect of additional backward walking training on postural control in children with hemiparetic cerebral palsy. Design: Randomized controlled study. Setting: Physical therapy clinics. Subjects: Thirty spastic hemiparetic cerebral palsied children of both sexes (10-14 years, 14 girls and 16 boys). Intervention: Children were randomly assigned into two equal groups: experimental and control groups. Both groups received a traditional physical therapy program for 12 weeks. Experimental group additionally received backward walking training which was provided 25 min/day, 3 days/week for 3 successive months. Outcome measures: Baseline and post-treatment assessment for overall, anteroposterior, and mediolateral stability indices were evaluated by using Biodex balance system. Results: After treatment; two way ANOVA revealed significant improvement in overall, anteroposterior and mediolateral stability indices of experimental group at the most stable level (level 12) and moderately unstable level (level 7) (1.40 ± 0.44 and 1.73 ± 0.51; 1.11 ± 0.34 and 2.13 ± 0.52; 1.93 ± 0.51 and 2.68 ± 0.52) respectively, than control group (1.77 ± 0.44 and 2.17 ± 0.56; 1.44 ± 0.44 and 2.54 ± 0.49; 2.39 ± 0.65 and 3.11 ± 0.49) respectively, (P < 0.05). There were significant improvement in all measured variables for both groups at both levels (P < 0.05). Conclusion: Additional backward walking training to traditional physical therapy program yields improvement in postural stability indices in children with spastic hemiparetic cerebral palsy than traditional physical therapy alone.

Noninvasive and Painless Magnetic Stimulation of Nerves Improved Brain Motor Function and Mobility in a Cerebral Palsy Case

Motor deficits in cerebral palsy disturb functional independence. This study tested whether noninvasive and painless repetitive peripheral magnetic stimulation could improve motor function in a 7-year-old boy with spastic hemiparetic cerebral palsy. Stimulation was applied over different nerves of the lower limbs for 5 sessions. We measured the concurrent aftereffects of this intervention on ankle motor control, gait (walking velocity, stride length, cadence, cycle duration), and function of brain motor pathways. We observed a decrease of ankle plantar flexors resistance to stretch, an increase of active dorsiflexion range of movement, and improvements of corticospinal control of ankle dorsiflexors. Joint mobility changes were still present 15 days after the end of stimulation, when all gait parameters were also improved. Resistance to stretch was still lower than prestimulation values 45 days after the end of stimulation. This case illustrates the sustained effects of repetitive peripheral magnetic stimulation on brain plasticity, motor function, and gait. It suggests a potential impact for physical rehabilitation in cerebral palsy.

Effects of adding load to the gait of children with cerebral palsy: a three-case report

Our purpose in this study was to analyze the immediate effects of locomotor gait training with different loads on a treadmill on the kinematic parameters of gait in children with Spastic Hemiparetic Cerebral Palsy (SHCP), as well as investigating which load prompted the most adequate motor responses to promote the propulsion of the Paretic Lower Limb (PLL). This case report included 3 children of both sexes, aged 8-12 years. The children walked on the treadmill with loads on their ankles that corresponded to 40, 50 and 60% of the weight of the Lower Limb (LL), on 3 different non-consecutive days. The kinematic parameters were assessed during the pre-training phase (PTPH) and immediately after training (PHI). The spatiotemporal variables did not change immediately after gait training with the aforementioned loads. On the other hand, we observed wider joint angles in the hip and knee during the swing phase immediately after training, especially with a load of 60% of the weight of the lower limb. These findings indicate that the 60% load is the most appropriate to prompt immediate changes in the joint kinematics of the PLL. These alterations can be important in improving propulsion during the swing phase of gait in children with SHCP.

Impact of Computer Feedback on Hand Performance in Cerebral Palsied Children

The purpose was to investigate the effect of using advanced technology in a form of computer biofeedback program(CBFP) for improving fine motor abilities and hand grip force through stimulation of visual-motor integration skills, the second part was to compare this new treatment with the traditional one used for improving fine-motor abilities and hand grip force for spastic hemiparetic cerebral palsied children(SHCPC). Hand grip dynamometer was used to assess hand grip force. Thirty children with (SHCPC) participated in this study ranging in age from five to seven years. The patients were randomly divided into two groups. The first group treated by the traditional treatment used for improving fine-motor abilities, the second group treated by using a (CBFP) the results revealed that the (CBP) in form of attractive games drew the child's attention and concentration for longer periods of time. It was recommended to use a source of augmented feedback in conjunction with the traditional treatment in the rehabilitation of upper extremities of children with spastic hemiparetic cerebral palsy.

Effects of Gait Training with Added Load on Children with Hemiparetic Cerebral Palsy

The study aimed to evaluate the immediate effects of treadmill training with leg load on kinematic parameters of gait in children with spastic hemiparetic cerebral palsy (SHCP). Quasi-experimental study. Laboratory of Intervention and Movement Analysis on Federal University of Rio Grande do Norte (UFRN). 20 children with SHCP clinical diagnosis (mean age was 8.8 years ± 2.39), and independent walk (GMFCS I-II). Children walked with added load on ankles in a single treadmill training session during 5 minutes. Kinematic parameters were evaluated using the Qualisys Motion Capture System in three phases: before training (FBT); immediately after training (FPT); and 5 minutes after the end of training (FET). Significant increase in range of motion on knee (F=8.654; P =.001) and hip joint (F=6.053; P=.005), maximum flexion in swing phase of knee (F=16.252; P<.001) and hip joint (F=7.876; P=.001) and the maximum height of the paretic leg during the swing phase (F=12.309; P<.001) were observed when comparing FBT versusFPT versus FET. The Bonferroni test identified that difference occurred when comparing phases FBTversus FPT and FPTversus FET. Gait training with leg load seems modifies the locomotor strategy for children with SHCP, suggesting that this therapy may benefit the gait of these children.

Practicing a matching movement with a mirror in individuals with spastic hemiplegia

This experimental study aimed to determine the effect of practicing a position matching task with (mirror) visual feedback of the less-impaired arm on the matching accuracy of the impaired arm in children and adolescents with spastic hemiparetic cerebral palsy. Practice consisted of 40 trials of bimanual target matching, where one group received regular visual feedback and a second group received mirror visual feedback of the less-impaired arm. On three occasions (pre, post, and after a 1-week-retention) position sense (matching accuracy measured as the endpoint error in cm) of the impaired arm was tested with a unimanual and bimanual matching task, performed without any visual information of either hand. Matching accuracy of the impaired arm was better in the post-test than in the pre-test, but this improvement was similar for both practice groups. In the retention-test, accuracy had returned to pre-test-level, which might be ascribed to the short duration of the practice period. These outcomes suggest that practicing a matching task with visual feedback of the less-impaired arm might help to improve the matching accuracy of the impaired arm in individuals with spastic hemiparetic cerebral palsy.

Supervised V/s Unsupervised Constraint Induced Movement Therapy in Improving Upper Extremity Function in Spastic Hemiparetic Cerebral Palsy Children

Objective: Constraint Induced Movement Therapy has been found to be a promising treatment for substantially improving the use of extremities affected by neurologic injuries such as stroke and traumatic brain injury in adults. The purpose of this study was to determine the applicability of a child friendly form of CI Therapy on young children with cerebral palsy. Method: Thirty Children with hemiplegic Cerebral Palsy age 4-8 years received CI Therapy and completed evaluations. They were randomized to either Group A or Group B. In both the groups children wore mitt as restraint on their non-involved upper extremity and the involved upper extremity was engaged into play & functional activities for six hours per day for ten week days. In Group A all the activities done by children were under the supervision of therapist where as Group B was more of home based program although activities were therapist guided. Changes in upper extremity function were evaluated with Quality of Upper Extremity Skills Test. The evaluations took place at the onset of intervention and after completing two weeks of intervention. Results: Children in both the groups demonstrated significant improved functional efficiency of their involved upper extremity (p Conclusion: Results suggest that the CI Therapy can improve motoric function among children with hemiparesis and that this efficacy is more in a therapist supervised CIMT program.

Effects of modified constraint-induced movement therapy in virtual environment on upper-limb function in children with spastic hemiparetic cerebral palsy: A randomised controlled trial

To determine effects of implementing a practice period of modified constraint-induced movement therapy in a virtual environment on upper limb function in children with spastic hemiparetic cerebral palsy. In a single-blinded, randomised, controlled trial, 32 participants (18 female, 14 male) received 18 hours training in 3 different groups (virtual reality, modified constraint-induced movement therapy, and a combination group). The fourth group was a control group. Training sessions occurred every other day, 3 times per week for 4-week. Each session lasted for 1.5 hours. Assessment sessions were conducted before, after, and 3-month after treatment period using pediatric motor activity log and the speed and dexterity subtest of the bruininks-oseretsky test of motor proficiency. Data analysis was conducted by ANOVA with repeated measures using SPSS 16.0 with alpha levels set at P< 0.05. Significantly higher gains were observed in the combination therapy group for the amount of limb use (mean change, 2.72), quality of movement (mean change, 2.79), and speed and dexterity (mean change, 1.74) at post-test. These gains were maintained at the 3-month follow-up assessment. Modified constraint-induced movement therapy in a virtual environment could be a promising rehabilitation procedure to enhance the benefits of both virtual reality and constraint-induced therapy techniques.

Matching accuracy in hemiparetic cerebral palsy during unimanual and bimanual movements with (mirror) visual feedback

In the present study participants with Spastic Hemiparetic Cerebral Palsy (SHCP) were asked to match the position of a target either with the impaired arm only (unimanual condition) or with both arms at the same time (bimanual condition). The target was placed at 4 different locations scaled to the individual maximum reaching distance. To test the effect of mirror visual feedback of the less-impaired arm on the matching accuracy, an opaque screen or a mirror was placed in between the arms which masked vision of the impaired arm. Absolute endpoint error was smaller in the bimanual condition compared to the unimanual condition, but there was no effect of mirror visual feedback. Inspection of the individual data, however, showed that 13 out of 23 participants did experience a positive effect of mirror visual feedback. A positive correlation between the baseline error (screen) and the improvement in accuracy with mirror visual feedback seems to suggest that individuals with lower proprioceptive accuracy in the baseline condition may benefit more from mirror visual feedback. Together these findings indicate that bimanual therapy and therapy with mirror visual feedback might be valuable approaches for rehabilitation for a subset of the individuals with SHCP.

Deficits in upper limb position sense of children with Spastic Hemiparetic Cerebral Palsy are distance-dependent

This study examined the arm position sense in children with Spastic Hemiparetic Cerebral Palsy (SHCP) and typically developing children (TD) by means of a contralateral matching task. This task required participants to match the position of one arm with the position of the other arm for different target distances and from different starting positions. Results showed that children with SHCP exhibited with both arms larger matching errors than the TD group, but only when the distance between the arms at the start of the movement was large. In addition, the difference in errors between the less-impaired and the impaired limb changed as a function of the distance in the SHCP group whereas no interlimb differences were found in the TD group. Finally, spasticity and restricted range of motion in children with SHCP were not related to the proportion of undershoot and size of absolute error. This suggests that SHCP could be associated with sensory problems in conjunction with their motor problems. In conclusion, the current study showed that accurate matching of the arms is greatly impaired in SHCP when compared to TD children, irrespective of which arm is used. Moreover, this deficit is particularly present for large movement amplitudes.