A Home-Based Program Using Patterned Sensory Enhancement Improves Resistance Exercise Effects for Children With Cerebral Palsy

Previous research has suggested there is a high level of comparability between the Gross Motor Function Measure-66 (GMFM-66) and the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Mobility domain. However, there are only a few studies that have examined the correlations between these instruments. The purpose of this study was to determine the correlation between the GMFM-66 and the PEDI Functional Skills Mobility domain scaled scores in a group of Chinese children with spastic cerebral palsy, at the ages of 12-70 months, in order to explore the feasibility of using them interchangeably. Secondary data analysis was conducted of data collected during a prospective international collaborative study that used the GMFM-66 and the PEDI to examine the impact of treatment. This study examined the Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain at six time points over the course of 28 consecutive weeks for 115 Chinese children who participated at baseline. Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain ranged from 0.83 to 0.90 for the six time points of data collection, with statistically significant P-values <0.0001 for each correlation. These results support previous research that the GMFM-66 and the PEDI Functional Skills Mobility domain are complementary assessments that may be used interchangeably when it is not possible to administer both.

This study aimed to evaluate functional effects of Bobath therapy in children with cerebral palsy (CP). Fifteen children with a diagnosis of CP were recruited (9 males, 6 females; mean age 7 years 4 months, SD 2 years 8 months; age range 2 to 12 years). Types of motor disorder were as follows: spastic quadriplegia (n=9); spastic diplegia (n=4); athetoid quadriplegia (n=1), and ataxia (n=1). Participants were distributed across the following Gross Motor Function Classification levels: level I, n=1; level II, n=4; level III, n=5; level IV, n=4; and level V, n=1. Children awaiting orthopaedic intervention were excluded. A repeated measures design was used with participants tested with the Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) at 6-weekly intervals (baseline, before and after Bobath therapy, and follow-up). As the data were of ordinal type, non-parametric statistics were used, i.e. Wilcoxon's test. Participants showed a significant improvement in scores in the following areas following Bobath therapy compared with the periods before and after Bobath therapy: GMFM total score (p=0.009); GMFM goal total (p=0.001); PEDI self care skills (p=0.036); and PEDI caregiver assistance total score (p=0.012). This demonstrates that in this population, gains were made in motor function and self care following a course of Bobath therapy.

We conducted a randomized, double-blind, controlled clinical trial to determine whether hyperbaric oxygen (HBO) improves gross motor function in children with cerebral palsy. Forty-nine children aged 3 to 8 years with spastic cerebral palsy were randomized to 40 treatments of HBO (100% oxygen at 1.5atm) or hyperbaric air (HBA, 14% oxygen at 1.5atm) over an 8-week period. The primary outcome was the Gross Motor Function Measure (GMFM) global score. Other outcomes included the Pediatric Evaluation of Disability Inventory (PEDI). Assessments were made before and immediately, 3 months, and 6 months after the treatment period. Within-group changes were analyzed with paired t tests or repeated measures analysis of variance. Analysis of covariance was used for between-group comparisons. Forty-six children (24 HBO, 22 HBA) were analyzed at the second interim analysis, which was scheduled to take place when at least half of the required number of patients in each group had completed pre- and post-treatment testing. No changes occurred in the GMFM from pre- to post-treatment in either group or between groups. Statistically significant increases occurred in both groups on the PEDI, with no difference between groups. The study was stopped because the calculated conditional probability of obtaining a difference between groups if the study continued to the end was only between 0.5% and 1.6%. HBO was not effective in improving GMFM scores, and was no more effective than HBA in improving PEDI scores. These results do not support use of HBO as a therapy for cerebral palsy in young children who did not have neonatal hypoxic-ischemic encephalopathy.

ABSTRACTAim: To study the effects of single versus serial casting post-Botulinum toxin A (BoNT-A) injections on hypoextensibility of triceps surae in children, 2–7 years old, with cerebral palsy and equinus gait. Methods: A randomized, stratified, parallel, two-group trial was conducted at a pediatric health center with assessments at baseline, precast, postcast and, 1-, 2-, and 6-month follow-ups. One week following BoNT-A injections into triceps surae muscle, a single below-knee cast (n = 10) or 3 serial casts (n = 10) were applied for 3 weeks. Primary outcome measure was the Modified Tardieu Scale (MTS), secondary outcome measures were Modified Ashworth Scale (MAS), GAITRite™, Gross Motor Function Measure-66 (GMFM-66), and Pediatric Evaluation of Disability Inventory (PEDI). Results: Significant effects of time, but not group-by-time, were found for MTS R1 (P < 0.001), MTS R2 (P < 0.001), MAS (P = 0.001), GMFM-66 (P = 0.002), and PEDI (P < 0.001–0.009). One participant who received a single cast did not complete the 6-month assessment. Conclusions: Magnitudes of improvements were similar using single or serial casting. If these findings are corroborated in a larger scale study, the recommendation of a single cast may be appropriate due to its greater convenience for families and clinicians.

In this study we assessed the distribution of spasticity, range of motion (ROM) deficits, and selective motor control problems in children with cerebral palsy (CP), and examined how these impairments relate to each other and to gross motor function and everyday activities. Ninety‐five children (55 males, 40 females; mean age 58 months, SD18 months, range 25 to 87 months) were evaluated with the modified Ashworth scale (MAS), passive ROM, the Selective Motor Control scale (SMC), the Gross Motor Function Measure (GMFM), and the Pediatric Evaluation of Disability Inventory (PEDI). Types of CP were hemiplegia (n=19), spastic diplegia (n=40), ataxic diplegia (n=4), spastic quadriplegia (n=16), dyskinetic (n=9), and mixed type (n=7). Severity spanned all five levels of the Gross Motor Function Classification System (GMFCS). The findings highlight the importance of measuring spasticity and ROM in several muscles and across joints. Wide variability of correlations of MAS, ROM, and SMC indicates a complex relationship between spasticity, ROM, and selective motor control. Loss of selective control seemed to interfere with gross motor function more than the other impairments. Further analyses showed that motor impairments were only one component among many factors that could predict gross motor function and everyday activities. Accomplishment of these activities was best predicted by the child's ability to perform gross motor tasks.

To examine the effects of suit wear during an intensive therapy program on motor function among children with cerebral palsy. Twenty children were randomized to an experimental (TheraSuit) or a control (control suit) group and participated in an intensive therapy program. The Pediatric Evaluation of Disability Inventory (PEDI) and Gross Motor Function Measure (GMFM)-66 were administered before and after (4 and 9 weeks). Parent satisfaction was also assessed. No significant differences were found between groups. Significant within-group differences were found for the control group on the GMFM-66 and for the experimental group on the GMFM-66, PEDI Functional Skills Self-care, PEDI Caregiver Assistance Self-care, and PEDI Functional Skills Mobility. No adverse events were reported. Children wearing the TheraSuit during an intensive therapy program did not demonstrate improved motor function compared with those wearing a control suit during the same program.

SIR–We would like to thank Professor Vles for his in-depth comments on our systematic review on the use of intrathecal baclofen in ambulant children and adolescents with spasticity of cerebral origin.1 In our literature search, we found two studies published by Hoving et al2, 3 on the same group of participants. The first paper was a randomized controlled trial (RCT) investigating the efficacy of intrathecal baclofen on children with spastic cerebral palsy (CP) compared with traditional intervention.2 The second paper was a longitudinal follow-up study on the same group of children, who eventually all had an implanted intrathecal baclofen pump. This second paper examined the 2-year safety and 1-year efficacy of intrathecal baclofen using the same outcome measures, namely visual analogue scales assessing individually formulated problems (e.g. ease of care and pain), Gross Motor Function Measure 66 (GMFM-66) for gross motor function, Pediatric Evaluation of Disability Inventory for activities and participation, and Child Health Questionnaire-Parent Form 50 for quality of life.3 We decided to include the latter in our systematic review as it provided more data on the gross motor function of the participants and had a larger sample size than the previous paper. However, the latter study was a case series as it pooled both the intervention and control groups from the previous RCT into one group for data analyses, thus the level of evidence for this study is level IV.4, 5 In the process of preparing this reply, we found an error in Table II of our paper regarding the study by Hoving et al.3 under the heading of ‘Gross motor activities’: the number inside the second bracket should be ‘12/12 with 11 non-ambulant’, not 17/17 as there was only one ambulant participant in the group of 12 participants who were assessed and showed statistically significant improvement in this area with the GMFM-66. Thus the sentence in the last paragraph on page 7 starting ‘Gross motor skills as measured using the GMFM were significantly improved in three studies … (n=51/51 in total)’ should read ‘(n=46/46 in total including 11 non-ambulant participants)’.3 Although the number of participants has changed, the conclusions have not. We are pleased to have been able to correct this error. We acknowledge there was only one participant in this study3 at Gross Motor Function Classification System (GMFCS) level III, which was explicitly stated in the supplementary online table (Table SIII) in our paper. Only this child was included in our review, a similar strategy was used for other studies in the review (Table SIII and Table II). Our clinical question was to review the evidence for the use of intrathecal baclofen on transfers between positions, gross motor activities, and walking in ambulant children with CP. No data were provided on this child’s ambulatory status and quality of gait in the paper so this child was not included in our discussion regarding these outcomes. This child was included in our discussion on gross motor activities as group data on the score of the sitting dimension of the GMFM-66 was provided.3 We do not believe that our conclusion contradicts the consensus statement by Dan et al.6 regarding the work of Hoving et al.3 The conclusion on the efficacy of intrathecal baclofen (when compared with traditional intervention) drawn by Dan et al.6 was specifically on children with severe CP (as participants in the RCT quoted by Dan et al. were at GMFCS levels IV and V6). Our conclusion of the review was specifically on individuals at GMFCS levels I to III. At present, there is no RCT examining the efficacy of intrathecal baclofen on this ambulant group. In addition, as discussed above, the fact that this follow-up study was not an RCT further strengthens our recommendation for high quality rigorous studies on this intervention in the future. It was never our intention to discourage the use of intrathecal baclofen for children with intractable spastic CP; in fact we strongly support the use of intrathecal baclofen for spasticity and/or dystonia in GMFCS levels IV and V.7, 8 As stated in the consensus statement by Dan et al.,6‘the efficacy of ITB has been less well studied in patients in GMFCS levels I–III than in patients at levels IV–V’. We consider our review a step towards identifying existing research gaps for this intervention in this specific population group. We would encourage more rigorous longitudinal studies in the future that provide evidence for ‘identification of the ideal patient for this treatment’.8 We also hope this review will provide research evidence to families (and clinicians) to make an informed decision about interventions for their children.

To provide an overview of functional assessment measures for children with cerebral palsy, supporting the selection of measures and the interpretation of results from measures. Instruments were selected on the basis of a literature search of the Medline, Sportdisk and PsychLIT databases. ISSUES REVIEWED: Instruments were reviewed with respect to target group, purpose, nature, type and psychometric properties. In the literature 17 instruments that are used in paediatric rehabilitation and paediatric physical therapy to assess the functional motor abilities of children with cerebral palsy were found. While there is an urgent need for measures that can evaluate change in functional abilities, it was found that most measures are developed and validated for discriminative purposes. Although instruments developed within the last decade meet psychometric criteria more adequately than those developed previously, it is concluded that only two evaluative assessment measures, the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI), fulfil the criteria of reliability and validity with respect to responsiveness to change.

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

To assess a possible therapeutic effect in children and adolescents with cerebral palsy of a habilitation programme in a warm sunny climate. Fifty-seven children and adolescents with cerebral palsy, all integrated with normal functioning children through mainstream schooling, received an individualized four-week habilitation programme at a habilitation centre in Lanzarote in the Canary Islands. They were clinically assessed before and after treatment, and again after three and six months. The clinical tests included gross motor function measure (GMFM) and the paediatric evaluation of disability inventory (PEDI). Mental health and self-esteem were assessed by using the youth self report (YSR), the child behaviour checklist (CBCL) and the Harter's self-perception profile. We also used focus-group interviews on all 57 parents by the end of the treatment period. The study revealed some improvements in the level of physical performance. The most striking finding, however, was the lasting effect on behavioural and emotional parameters and the children's self-esteem. Training in a warm climate may explain some of this positive effect. However, based on the focus-group interviews and its quantitative findings a more plausible explanation may be the interaction in a social setting with others in a similar situation.

Purpose: This study evaluated the usefulness of International Classification of Functioning, disability and health core set for children and youths with cerebral palsy (ICF-core set for CP) by comparing the Gross Motor Function Measure-88 (GMFM-88), which is the most widely used outcome measure in children with cerebral palsy (ICF-core set for CP). Method: One subject (Female, 14) was evaluated by GMFM-88 and ICF-core set for CP. In addition, the concept of GMFM-88 was com pared with the concept of the ICF-core set for CP in compliance with ICF linking rules. The numerical values both of the GMFM-88 cate gories and the ICF-core set for CP’s items were compared. Results: The ICF b760 was linked to the GMFM-88 59~61. d415 was linked to 57~58 of GMFM-88. d450 was linked to GMFM-88’s 65~72. d455 was linked to GMFM-88 at 77and 80~83. Conclusion: The association of the ICF-core set for CP and GMFM-88 was confirmed. In addition, the number of categories of ICF-core set for CP was smaller than the number of items of GMFM-88. In conclusion, the ICF-core set for CP is an evaluation tool that can iden tify the various features of children. In addition, GMFM-88 was linked to the ICF core set for CP according to the ICF linking rules.

Parents’ expectations are known to be a central component in children’s development through multiple pathways; however, limited information exists regarding expectations of parents of children with developmental disabilities. The purpose of the current study was to examine future expectations of parents of children with cerebral palsy (CP), as well as the differences in expectations between mothers and fathers. Forty-nine mothers and fathers of children with CP (6–12 years) participated in this study. Parents completed a Parental Future Expectations Questionnaire for Children with Disabilities, and a Perception of Child’s Ability questionnaire, as well as the Pediatric Evaluation Disability Inventory (PEDI). The Gross Motor Function Measure-66 (GMFM-66) was completed by physical therapists. Parental differences in future expectations were analyzed and multiple-stepwise regressions established parental expectations’ predictors. Parents’ expectations correlated with their child’s characteristics. Parents of children with lower levels of functioning reported lower expectations. No differences were found between mothers’ and fathers’ future expectations; however, differences were found between expectations’ predictors. Predictors of mothers’ expectations were their perceptions of their child’s abilities as well as child’s performance. Fathers’ predictors were child’s level of functional impairment and their perceptions of their child’s abilities. The results indicate that parental expectations relate to their child’s functional ability and differ between parents in relation to the child’s level of impairment (fathers) or child’s actual performance (mothers). These differences should be acknowledged by clinicians when they provide specific support for children with chronic physical disabilities and their families.

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

The purpose of this study was to compare the Gross Motor Function Measure (GMFM) and the Peabody Developmental Gross Motor Scale (PDMS-GM) as measures of change in infants with cerebr-al palsy (CP) and infants with motor delays. We hypothesized that mean change scores would be greater for the GMFM than for the PDMS-GM. Subjects were 42 infants with a mean adjusted age of 13.9 months (SD=6.1, range=4.2-24.2). Twenty-four infants had CP, and 18 infants had motor delays. The GMFM and the PDMS-GM were administered to the infants 3 times over a 6-month period. Raw scores were standardized for data analysis. Data were analyzed using a 3-factor repeated-measures analysis of variance. For the 6-month period, mean PDMS-GM age-equivalent scores increased 3.8 months and mean scaled scores increased 35 points for infants with motor delays compared with increased scores of 1.8 months and 13 points for infants with CP. Mean GMFM scores increased by 12.2% for infants with rmotor delays and by 4.2% for infants with CP. The diagnosis X time interaction was significant. Infants with motor delays had a greater change in motor development compared with the infants with CP. The hypothesis that the GMFM is more responsive to change than the PDMS-GM was not supported. The findings suggest that the GMFM and the PDMS-GM are comparable in measuring change in infants with CP or motor delays. Implications for selection and use of either measure are discussed.

Research Article| November 01 2013 Long-term Benefits of Selective Dorsal Rhizotomy AAP Grand Rounds (2013) 30 (5): 51. https://doi.org/10.1542/gr.30-5-51 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Long-term Benefits of Selective Dorsal Rhizotomy. AAP Grand Rounds November 2013; 30 (5): 51. https://doi.org/10.1542/gr.30-5-51 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: rhizotomy, muscle spasticity, spastic cerebral palsy Source: Dudley RWR, Parolin M, Gagnon B, et al. Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg Pediatrics. 2013; 12(2): 142– 150; doi: https://doi.org/10.3171/2013.4.PEDS12539Google Scholar Investigators from multiple centers assessed the longterm functional benefit of selective dorsal rhizotomy (SDR) surgery in children with spastic cerebral palsy (CP). They included children who underwent preoperative evaluation for SDR at McGill University between 1991 and 2001 and who were evaluated at 1, 5, 10, and 15 years after SDR with quantitative, standardized assessments of lower-limb spasticity (Ashworth Scale scores of hip adduction, ankle dorsiflexion, hamstrings), Gross Motor Function Measure (GMFM), and performance of activities of daily living (ADLs). Patients with severely limited self-mobility were not typically offered SDR according to the protocol at McGill. The primary outcome was participant course over time for spasticity scores, GMFM scores, and performance of ADLs. Postoperative scores for each of these outcomes were compared to preoperative scores at each follow-up time point. Modeling was used to determine whether there was any heterogeneity of response to SDR among subgroups of children. A secondary outcome, assessed by chart review, was the participant’s need for additional orthopedic or medical interventions. Of the 102 patients who underwent preoperative evaluation, 97, 62, 57, and 14 completed postoperative assessments at 1, 5, 10, and 15 years, respectively. The study population was comprised of 65 boys and 40 girls with a mean age of 5 years at the time of surgery. Most children (n=65) had spastic diplegia, 5 had spastic triplegia, and 11 had spastic quadriplegia. Spasticity scores were significantly improved throughout the study period compared with preoperative scores (P < .001). Similarly, GMFM total scores and performance of ADLs significantly improved throughout follow-up relative to preoperative scores. The participants most likely to display long-term benefits (eg, 10 years with maintenance of function) in spasticity, GMFM, and ADLs were those who were categorized preoperatively into lower (less impaired) GMFCS groups, who had spastic diplegia, who had less hip adductor spasticity, and who had higher (better) GMFM scores. After SDR, a total of 36 patients had additional procedures performed over the course of follow-up; 11 had Botox injections and 25 had lower extremity orthopedic surgeries. The investigators conclude that the benefits of SDR persist well into adolescence and early adulthood. Drs Conley and Ritter have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Selective dorsal rhizotomy has been generally well tolerated by patients, and both surgeons and primary care physicians have seen an improvement in function during the postoperative period. The current study provides valuable assessment of long-term follow-up of a significant number of patients. The authors provide objective data to support the use of SDR in patients with spastic CP. They show not only improvement in function already lost at the time of surgery, but, perhaps more importantly, they demonstrate that... You do not currently have access to this content.