Therapy For Cerebral Palsy Research Articles

Stem cell treatment and cerebral palsy: Systemic review and meta-analysis.

BACKGROUNDPerinatal complications may result in life-long morbidities, among which cerebral palsy (CP) is the most severe motor disability. Once developed, CP is a non-progressive disease with a prevalence of 1-2 per 1000 live births in developed countries. It demands an extensive and multidisciplinary care. Therefore, it is a challenge for our health system and a burden for patients and their families. Recently, stem cell therapy emerged as a promising treatment option and raised hope in patients and their families.AIMThe aim is to evaluate the efficacy and safety of stem cell treatment in children with CP using a systematic review and meta-analysisMETHODSWe performed a systematic literature search on PubMed and EMBASE to find randomized controlled clinical trials (RCT) investigating the effect of stem cell transplantation in children with CP. After the review, we performed a random-effects meta-analysis focusing on the change in gross motor function, which was quantified using the gross motor function measure. We calculated the pooled standardized mean differences of the 6- and/or 12-mo-outcome by the method of Cohen. We quantified the heterogeneity using the I-squared measure.RESULTSWe identified a total of 8 RCT for a qualitative review. From the initially selected trials, 5 met the criteria and were included in the meta-analysis. Patients’ population ranged from 0.5 up to 35 years (n = 282). We detected a significant improvement in the gross motor function with a pooled standard mean difference of 0.95 (95% confidence interval: 0.13-1.76) favoring the stem cell group and a high heterogeneity (I2 = 90.1%). Serious adverse events were rare and equally distributed among both intervention and control groups.CONCLUSIONStem cell therapy for CP compared with symptomatic standard care only, shows a significant positive effect on the gross motor function, although the magnitude of the improvement is limited. Short-term safety is present and further high-quality RCTs are needed.

Using TheraBracelet as an Adjunct to Pediatric Constraint-Induced Movement Therapy in Cerebral Palsy

Abstract Date Presented 04/05/19 Primary Author and Speaker: Turki Aljuhani Additional Authors and Speakers: Amanda Vatinno Contributing Authors: Alison Fluharty, Catilyn Taylor, Eli Schuster, V. Ramakrishnan, Patty Coker-Bolt, Na Jin Seo

The effectiveness and safety of electromyography biofeedback therapy for motor dysfunction of children with cerebral palsy: A protocol for systematic review and meta-analysis.

To investigate the effectiveness and safety of electromyography (EMG) biofeedback therapy in improving motor dysfunction among children with cerebral palsy (CP). The following databases will be searched: PubMed, EMBASE, ScienceDirect, the Cochrane Library, China National Knowledge infrastructure (CNKI), Technology Periodical Database (VIP), WanFang Data and China Biology Medicine (CBM) from inception to June 2019. All relevant randomized controlled trials (RCTs) utilizing EMG biofeedback therapy for CP will be included. The main outcome is the Gross Motor Function Measure (GMFM). Additional outcomes such as the Modified Ashworth Scale (MAS), Integral Electromyogram (iEMG), Composite Spasticity Scale (CSS), passive range of motion (PROM) or other related outcomes will be included, adverse effects of EMG biofeedback therapy and comparators will also be included. Two reviewers will screen studies, extract data and assess quality independently. Review Manager 5.3 will be used to assess the risk of bias, data synthesis, and subgroup analysis. This systematic review does not require formal ethical approval because all data will be analyzed anonymously. Results will provide a general overview and evidence concerning the effectiveness and safety of EMG biofeedback therapy for children with CP. The findings of this systematic review will be disseminated through peer-reviewed publications or conference presentations.

The clinical aspects and effectiveness of suit therapies for cerebral palsy: A systematic review.

The aim of this review to evaluate the clinical aspects and effectiveness of suit therapy for patients with cerebral palsy (CP). A literature search was performed in the PubMed, SCOPUS, Web of Science, and PEDro databases within the period from the establishment of the relevant database to July 2018. The articles were categorized according to their study design. We included studies published in peer-review journals focusing on the efficacy of suit therapies for CP and excluded review articles, duplications, non-related articles. A narrative synthesis approach was used, as it was not possible to classify extracted and analyzed data, and the overall effect size was unable to be calculated. Data regarding study subjects (number, age, CP type, Gross Motor Function Classification System [GMFCS] level), suit type, intervention including dose of suit therapy, outcome measurements, outcomes, adverse effects, and funding were extracted. The method introduced by Furlan, Pennick, Bombardier, and van Tulder was used to evaluate the risk of bias for the assessment of methodological quality of randomized-controlled trials (RCTs). A total of 29 studies were included of which 10 were Class I, eight were Class II-III, and 11 were Class IV studies. Studies were heterogenous in design, sample size, study population, and outcomes measured. The methodological quality score of RCTs varied between 4 and 10. The results of the high-quality RCTs showed that wearing the suit along with conventional therapy improved proximal stability, gross motor function, and gait. The Class II-III and IV studies supported the findings of the Class I studies. The major improvements from the RCTs were seen in proximal stability, gross motor function and gait, although grading was unable to be done due to the heterogeneity of included studies. In order to obtain gains in the function, it is important to carefully consider intended use, patient selection criteria, and suit type.

Evidence-based Approach to Physical Therapy in Cerebral Palsy.

Physiotherapy plays a key role in the management of cerebral palsy (CP) and comprises of various therapeutic interventions in enhancing the various physiological and functional outcomes. Though physiotherapy is used widely and recommended by all members of the health-care team, the effectiveness of physiotherapy is inconsistent. The objective of this review was to summarize and evaluate the effectiveness of physiotherapy interventions in children with CP. PubMed and Cochrane database were searched from January 2006 to April 2017 using the Medical Subject Heading and general keywords. Only systematic reviews and meta-analysis on PT interventions in children diagnosed with CP were included. Two reviewers independently assessed the methodological quality and retrieved the results. Thirty-four systematic reviews were identified that distinguished 15 different interventions. Moderate evidence of effectiveness was found for constraint-induced movement therapy for upper limb recovery, goal-directed/functional training, and gait training to improve gait speed. Conflicting evidence was found for the role of exercises on strength training and cardiorespiratory training. Intervention such as neurodevelopmental therapy (NDT) was found ineffective. This review suffer from limitations such as including reviews that had small sample size and that had considered heterogeneity of treatment interventions. Hence, the effectiveness of most PT interventions is found to be limited. On the basis of the present evidence, functional goal-oriented approaches are found to be effective and future research is required to determine the best ways to improve functional outcomes in children with CP.

Dance as art and therapy in cerebral palsy.

This commentary is on the systematic review by López‐Ortiz et al. on pages 393–398 of this issue.

The effects of Constraint Induced Movement Therapy on functions of cerebral palsy children: a systematic review of studies in Iran.

Objective Constraint Induced Movement Therapy (CIMT) is an intervention method that can enhance cerebral palsy children’s hand function. Cerebral palsy (CP) is a pervasive and common disorder which affects many aspects of a child life. Hemiplegic cerebral palsy affects one side of a child’s hand and has great effect on child’s independence. The aim of this study is to investigate the CIMT’s studies which have conducted in Iran . And indicate that Does CIMT’s effectiveness related to its duration and child’s age? Does CIMT have any effect of muscle tone and protective extension? Material & Methods This study is a systematic review study. For doing this study the Electronic databases such as Medlin PubMed, CINAHL… Iranian and foreigner famous journals in the fields of pediatrics such as Iranian Journal of Pediatrics (IJP), Iranian Rehabilitation Journal (IRJ)… and Google scholar and some specific key words such as CP, CIMT, and occupational therapy had been used. Results Based on the research and key words the 43 articles were found that, from those 43 articles because of lack of relevancy and other issues the 28 articles had been removed. And from obtained 25 articles, 10 of them omitted based on duplication and study’s exclusion criteria, so finally 15 articles included to this study. In Conclusion This study showed that CIMT is effective compared to no intervention but there are some inconsistencies regarding some parts of CIMT effectiveness such as CIMT effectiveness on muscle tone and protective extension.

A comparative study on the effectiveness of mirror therapy and constrained induced movement therapy in cerebral palsy

Mirror therapy (MT) (affected limb is masked inside the mirror box) and modified constraint induced movement therapy (mCIMT) (unaffected limb is constrained during therapy hours) are well established and effective therapies in the upper extremity functioning of children with Cerebral Palsy (CP). But comparing the effectiveness of MT and mCIMT is an understudied area, especially in CP. The aim of this study was to compare the effectiveness MT with mCIMT in the rehabilitation of persons with hemiplegic CP post orthopaedic selective spasticity surgery (OSSCS). A prospective clinical trial was conducted among 80 persons with CP, who were selected and randomly assigned into two groups. All the persons underwent OSSCS of forearm flexors and pronators of affected upper limb and were undergoing rehabilitation with a sequenced protocol based physical and occupational therapy. Group A (n = 40) received MT (6 weeks-1 hour/day), Group B (n = 40) received mCIMT (6 weeks-1 hour/day) and both the groups received regular intensive physical and occupational therapy apart from the above interventions. The primary outcome measures included were the Besta scale and Melbourne assessment of upper extremity function (MAUULF). Outcomes were measured at baseline, 6 weeks after the treatment and follow-ups at 1 month and 3 months later. After six weeks of treatment, the mCIMT group showed significant improvements compared to the MT group in both Besta (P < 0.01) and MAUULF (P < 0.01) scores for hemiplegic upper extremity who underwent OSSCS. The obtained outcomes were maintained at 1 month and 3 months follow up also. Modified CIMT showed greater improvement than MT in the upper extremity function of persons with hemiplegic CP. However, both the groups improved in their outcomes compared to baseline.

56. Pañcakarma therapy in cerebral palsy (CP) in a tertiary care hospital – A case report

56. Pañcakarma therapy in cerebral palsy (CP) in a tertiary care hospital – A case report

Transcranial direct current stimulation and constraint-induced therapy in cerebral palsy: A randomized, blinded, sham-controlled clinical trial.

Clinicaltrials.govNCT 02250092.

A Review on Stem Cell Therapy in Cerebral Palsy with a Focus on Motor Function Improvement

: The current knowledge on how to use stem cells therapeutically for improving motor function in patients with cerebral palsy is growing. The present review aimed at assessing clinical trials related to beneficial effects of stem cells in patients with cerebral palsy. Electronic searches including “stem cell” and “cerebral palsy” as keywords were conducted using PubMed, Ovid, Web of Science, Scopus, Cochrane library, and CINAHL till February 2016. Two assessors reviewed the methodological quality and eligibility of the retrieved articles, independently. Among 77 studies initially reviewed based on the keywords, only 6 clinical trials were identified that met the inclusion criteria. Pooled response rate of stem cell therapy to treat cerebral palsy was estimated by assessing the percentage of improvement with a gross motor function classification system score. The resulting pooled estimate indicated a 30.7% (95% CI: 25.80% to 35.69%) increase in the score, 1 to 6 months after cell transplantation. In this regard, the test for heterogeneity was statistically significant (I2 = 87.9%, χ2 = 41.22, P < 0.0001). Stem cell therapy has the potential to improve motor function in patients with cerebral palsy. However, promising results from limited studies warrant further research.

Umbilical cord mesenchymal stem cell and neural stem cell therapy for cerebral palsy: study protocol for a randomized, parallel-controlled trial

Background and objectives: Cerebral palsy is the most common cause of dyskinesia in children and is not curable by generalized rehabilitation, pharmacotherapy, Chinese medicine, exercise therapy, or surgery. To date, several case reports have demonstrated that umbilical cord mesenchymal stem cells (UCMSCs)/neural stem cells (NSCs) have a therapeutic role in children with cerebral palsy; however, there has been no large-sample clinical trial to verify this. Therefore, there is a need to evaluate the safety and effectiveness of UCMSCs/NSCs for the treatment of cerebral palsy in children. Design: A prospective randomized parallel-controlled trial. Methods: One hundred and ten children with cerebral palsy who will receive treatment in the First Affiliated Hospital of Dalian Medical University, China, will be randomly divided into five groups (n = 22 per group): control, nasal transplantation of UCMSCs, lumbar puncture transplantation of UCMSCs, nasal transplantation of NSCs, and lumbar puncture transplantation of NSCs. Cell transplantation will be correspondingly conducted in the latter four groups, with at least 1 × 107 cells per session, for two sessions within 4 weeks as one course, for a total of two courses. Outcome measures: Evaluations will be performed before cell treatment and at 1, 3, 6, 9, and 12 months after the completion of two treatment courses, including Gross Motor Function Measure (GMFM)-88, GMFM-66, Fine Motor Function Measure (FMFM), Modified Ashworth Scale, the Gesell Developmental Schedules, electroencephalogram examination and brain imaging examination. The primary outcome of this study is the overall objective response rate calculated on the basis of the changes in GMFM-88 total score and GMFM-66 reference percentile. The secondary outcomes of this study include the duration of response and progression-free survival based on the GMFM-88 total score change and GMFM-66 percentile change as well as overall survival, FMFM score, Modified Ashworth Scale score, the Gesell Developmental Schedules score, electroencephalogram examination and brain imaging examination. Discussion: This study aims to verify the efficacy and safety of UCMSCs/NSCs transplantation for the treatment of cerebral palsy in children, providing experimental data to support UCMSCs/NSCs therapy for cerebral palsy in clinical practice. Ethics and dissemination: Written informed consent will be given by legal guardians or authorized surrogates of children with cerebral palsy as well as donors or their legal guardians. Design of the trial was completed in November 2016, and registered with ClinicalTrials.gov in December 2016. Participant recruitment was initialized in March 2017, and is expected to last 2 years. Data collection and follow-up visit will end in June 2020, and data analysis will be completed in December 2020. The results of this study will be disseminated by publications in peer-reviewed journals. Trial registration: This trial was registered in the ClinicalTrials.gov with registration No. NCT03005249 on December 26, 2016.

The Concept of «Key Muscles» and the Early Onset of Botulinum Therapy in Spastic Forms of Cerebral Palsy

The botulinum therapy remains the most effective and safe method for reducing local spasticity in patients with cerebral palsy (CP). However, the list of indications for injections of botulinum toxin type A (BTA) in cerebral palsy is limited both in terms of target muscles and the treatment initiation age. In this regard, doctors are guided by the data of clinical studies, reviews and consensuses of experts, which are advisory in nature. One of the most urgent issues in the modern CP botulinum therapy is the evaluation of risks and benefits of initiating injections at an early age (up to 2 years) in order to prevent orthopedic complications and stimulate the optimal motor development of a child. The review analyzes the history of the development of modern approaches to the use of botulinum therapy in cerebral palsy and the tactics of selecting target muscles and doses for multilevel injections. The authors focus on the latest international data on the feasibility and safety of reducing the admissible initiation age for botulinum therapy in cerebral palsy. The results from the studies of the effect of the early initiation of BTA injections on motor development, formation of secondary orthopedic complications in children under 2 years of age, and morphological changes in the neuromotor apparatus in animal experiments are presented. The concept of «key muscles» is considered in detail as one of the possible reference points in the planning of safe and effective early injections.

Peptidergic nootropic therapy in cerebral palsy associated with epilepsy

To assess the efficacy and safety of сortexin in the treatment of children with cerebral palsy (CP) combined with epilepsy. Eighty-four patients (55 boys and 29 girls), aged from 1 to 11 years, with CP combined with epilepsy received cortexin together with antiepileptic drugs (AEDs). Cortexin was administered in doses of 5-10 mg depending on the patient's age and body weight intramuscularly during hospitalization. Cortexin as add-on to AEDs reduced for more than two times the number of seizures, along with improvement of motor function, in 31 (36.9%) patients. The improvement of motor function, but without a significant decrease in epileptic seizures, was achieved in 15 (17.8%) of the patients. Reduction of epileptic seizures frequency (>2 times), but without a significant effect on motor function, was observed in 14 cases (16.7%). Twenty-three patients (27.4%) did not respond the therapy. The aggravation of epileptic seizures during cortexin therapy was observed in only 1 girl with West syndrome (1.2%), and this was significantly lower than the probability of seizures aggravation on AED. Polypeptide nootropic medication cortexin demonstrated efficacy and safety as adjunctive therapy in children with CP combined with epilepsy.

Action observation therapy: handle with caution?

This commentary is on the original article by Kirkpatrick et al. on pages 1049–1056 of this issue. Observing the movements of another person activates the mirror neuron system. This network of specialized neurons, that discharge either when performing or observing an action, is mainly distributed in the human premotor and parietal cortex. The mirror neuron network is believed to play an essential role in understanding the actions of others, as well as in our capacity to learn by imitation. Action observation therapy is basically a backdoor approach to improve motor (re)learning, allegedly by tapping directly into the mirror neuron system and activating cortical areas which strongly overlap those involved in movement execution.1 In order to facilitate motor learning, action observation therapy typically relies on repeated phases of observation of goal-directed actions followed by their execution. There is increasing evidence for the efficacy of this method in adults with hemiplegia during the subacute and chronic phases of stroke.2 In their trial, which addresses the efficacy of action observation therapy in children with unilateral cerebral palsy (CP), Kirkpatrick et al.3 demonstrate that there is no added-value of action observation over repetitive motor training, in a home-based, parent-delivered variant of the approach. This contrasts with a previous randomized trial in children with unilateral CP by Sgandurra et al.,4 which had shown significant improvements in bimanual function following more intensive, therapist-delivered, action observation therapy. Are these divergent findings due to differing settings and interventions in both studies, or could there be a more fundamental issue about applying action observation to children with early brain lesions? Kirkpatrick et al.3 adopted a pragmatic approach to intervention delivery. In the action observation group, children were repeatedly provided with the opportunity to imitate the motor tasks shown by their parents; whereas those in the control group repeated identical goal-directed tasks for the same time, without the opportunity to imitate their parents. Both groups improved similarly. In Sgandurra et al.'s4 earlier study children in the action observation group watched videos of the actions they were then expected to perform, while those in the control group watched video-games. The action observation group fared better. If this does indicate an intrinsic value of action observation above observing unrelated actions in improving motor performance, the study by Kirkpatrick et al. seems to show that improvements are similar if the time spent observing a movement is actually used to execute the movement. Can all children with unilateral CP be considered responsive to action observation? Indeed if brain lesions have affected the core circuitry of the mirror neuron network, i.e. the premotor and/or parietal cortex and/or their connections, action observation therapy could prove pointless. A functional magnetic resonance imaging study including 18 children with unilateral CP and either cortical or sub-cortical lesions showed that observation of hand movements engaged the motor observation and execution network, regardless of the degree of motor impairment or lesion localization.1 Consequently, a majority of children with unilateral CP might be expected to respond to action observation. To what degree does the activation of the mirror neuron system, based on movement observation, contribute to consolidate motor programmes? A notable study on professional ballet dancers, who based on their sex were familiar or unfamiliar with performing specific moves, demonstrated that mirror circuits have a pure motor response over and above visual representations of movements.5 Mirror system activity seems to depend on possessing the motor representation for an observed action, or in other words on being familiar with performing the movement. The efficacy of action observation therapy in adults after stroke may rely on the remains of their motor observation and execution networks, constituted through a lifetime of repeated normal motor experiences. Children who have never experienced the competent and normal movement patterns that they observe may not have quite the same ability to mimic activities in their mirror neuron systems. In all studies of action observation therapy for unilateral CP, children watched motor tasks performed by expert models. It may be that a shift towards observing less expert learning models (such as other children or even peers with a similar movement disorder) could provide a larger keyhole into their mirror systems. If for the time being action observation should be used cautiously in children, further research may provide refinements that may considerably increase its ability to tap into the developing mirror neuron system.

Efficacy and safety of stem cell therapy in cerebral palsy

Efficacy and safety of stem cell therapy in cerebral palsy

Robotic Therapies for Children with Cerebral Palsy: A Systematic Review

Title: This paper presents a systematic review of robotic devices and therapies for cerebral palsy (CP), trying to shed some light on the present literature on robot-based CP rehabilitation. Background: Recent publications have demonstrated that robot-assisted therapies may constitute an effective tool for the compensation and rehabilitation of the functional skills of people with CP. The most important robotic devices for lower and upper limb rehabilitation were selected, specifying the assisted therapies, experiments done with them, and their results in children with CP. Methods: Scientific articles were obtained by means of an extensive search in electronic databases, primarily PubMed and Scopus. Papers published from the year 2000 to 2015 were considered for inclusion. The search was performed by using the following keywords in combination: robot, Cerebral Palsy, children, and therapies. Moreover, some web pages about CP organizations were used to complete the review. Conclusions: There is still a lack of randomized clinical trials with a representative number of subjects, which makes it difficult to evaluate the impact of robot-based therapy, especially the long-term effects. The inclusion of cognitive aspects into the therapies and the design of virtual scenarios in combination with robotic devices provide promising results.

Forty cases of cerebral palsy treated with human neural stem cell transplantation

Objective To assess the clinical efficacy of human neural stem cell (hNSC) transplantation in the treatment of severe cerebral palsy (CP) in children. Methods hNSCs were obtained from the forebrain of 10 to 12-week-fetus. Forty children with CP were voluntarily received hNSC transplantation that were injected into cerebral ventricle. The development of motor and fine motor functions were evaluated by GMFM and PDMS-FM 1 month before hNSC transplantation, as well as 3 and 6 months after hNSC transplantation. Results Twenty six (65%) cases displayed improvement from day 5 to month 6 after hNSC transplantation. GMFM assessment showed that the percentage was (4.52±2.50)% 1 month before hNSC transplantation, (7.74±2.94)% 3 months after hNSC transplantation and (13.01±6.71)% 6 months after hNSC transplantation, indicating a significant improvement by the treatment of hNSC transplantation(P<0.05). The percentage in PDMS-FM evaluation was (15.01±12.00)%, (20.34±11.91)% and (30.02±12.50)% one month before hNSC transplantation, 3 and 6 months after hNSC transplantation, respectively, also suggesting a significant improvement induced by hNSC transplantation treatment(P<0.05). Moreover, the developmental improvement was the most prominent among 1-3 months post hNSC transplantation. Then the development slowed down. Significantly, patients received no hNSC transplantation experienced serious adverse events or complications. Conclusions hNSC transplantation is an effective and safer therapy for severe CP. Future observations are needed to evaluate long-term clinical efficacy of the therapy. Key words: Neural stem cell; Transplantation; Severe; Cerebral palsy

Clinical observation on Nie-pinching spine manipulation combined with point therapy for cerebral palsy in children with spleen deficiency

Objective To observe the clinical effect of Nie-pinching spine coupled with point application and injection for cerebral palsy (CP) in children with spleen deficiency.

Reeducação postural global em um adulto com paralisia cerebral: um estudo de caso

The effects of an intervention program with global postural reeducation (GPR) and a period of no treatment (8 weeks) were evaluated by kinematic analysis and evaluation of static and dynamic balance of an adult with Cerebral Palsy (CP). Evaluations of balance were made using the Berg Balance Scale, as well as gait kinematics evaluations, in which spatiotemporal and angular variables were analyzed. These assessments were made at the beginning and at the end of each intervention period. To characterize the parameters examined, descriptive statistics (mean and standard deviation) was used. The studied subject showed improvement of balance after the intervention period and, regarding angular variables, decreased hip extension and less trunk tilt were found. With the improvement of balance, hip extension and alignment of the trunk of the treated patient, it is suggested that the GPR intervention method can be effective as a practice of physical therapy for CP; however, more effective results may be associated with continuous treatment with this method, since during the intervals of the intervention, there was a reduction in balance.