Health, Wellness, and the Pursuit of Happiness: Common Ground for Adults with Cerebral Palsy and Modern Physical Therapists

Health, wellness, and happiness are important long-term goals for adulthood, especially for children with cerebral palsy (CP). Physical therapists (PTs) can assist individuals with CP realize these goals; however it requires PTs to have a greater understanding of how to apply impairment, functional, or contextual interventions to meet these goals. A critical gap in knowledge exists about perceptions of happiness and health priorities of adults with CP. The purpose of this paper is to describe the beliefs, feelings, and perceptions of happiness and health of adults with CP as compared to adults without CP, specifically PTs

Protocol: Using single-case experimental design to evaluate whole-body dynamic seating on activity, participation, and quality of life in dystonic cerebral palsy

INTRODUCTION: People with hyperkinetic movement disorders, including dystonia, experience often painful, involuntary movements affecting functioning. Seating comfort is a key unmet need identified by families. This paper reports a protocol to assess the feasibility and preliminary evidence for the efficacy of dynamic seating to improve functional outcomes for young children with dystonic cerebral palsy (DCP). DESIGN: A series of single-case experimental design N-of-1 trials, with replications across participants, with a random baseline interval, and one treatment period (n = 6). METHODS: Inclusion criteria: DCP; 21.5 cm < popliteal fossa to posterior sacrum < 35 cm; Gross Motor Function Classification System level IV–V; mini-Manual Ability Classification System level IV–V; difficulties with seating. INTERVENTION: Trial of the seat (8 weeks), with multiple baseline before, during and after intervention and 2 month follow up. The baseline duration will be randomised per child (2–7 weeks). PRIMARY OUTCOMES: Performance Quality Rating Scale; Canadian Occupational Performance Measure; seating tolerance. The statistician will create the randomization, with allocation concealment by registration of participants prior to sending the allocation arm to the principal investigator. Primary outcomes will be assessed from video by an assessor blind to allocation. ANALYSIS: Participant outcome data will be plotted over time, with parametric and non-parametric analysis including estimated size effect for N-of-1 trials

Effect of patterned sensory enhancement on sit-to-stand movements in people with Parkinson's disease, The

2019 Summer.Includes bibliographical references.Parkinson's disease (PD) is considered an age-related neurologic disorder that causes motor and non-motor disabilities. Patients with PD present different motor characteristics including bradykinesia, reducing muscular strength, weaker motor and postural control, abnormal range of motion and joint torque, and greater variability during movement. These features cause difficulties in patients' activities of daily living and also bring higher fall risks when they do transferred movements, such as sit-to-stand (STS). The purpose of this study was to consider if Patterned Sensory Enhancement (PSE), a neurologic music therapy (NMT) technique might impact sit-to-stand movement with people with PD. Data were collected on fifteen participants who completed sit-to-stand exercises in baseline, PSE music, and no music conditions. Each sit-to-stand movement was divided into three phases: standing, balance, and sitting. Movements were analyzed for duration/time of movements, sum of movement acceleration (standard deviations) of x, y, and z, pitch of movements, and rotation rate (in z). Significant differences were found in sum of acceleration of x, y, and z in all three phases, with means that participants showed less postural control under PSE music condition. Another significant difference was found in fluctuations of the rotation rate (in z) in the sitting phase, with means indicating participants presented less postural control under PSE music condition compared to no music condition. No other significant differences were found. These results are contrary to prior findings and more research is needed to determine the influence of PSE on STS movements

Children’s Fitness and Quality of Movement

Introduction: Movement is essential to life and plays a key role in development throughout childhood. Movement can be assessed by its quantity and quality. Movement is important to measure as it can aid early intervention. Current research suggests that global levels of fitness are declining, with a lack of research surrounding children’s natural fitness levels as they get older. Quantity of movement is commonly studied, however quality is becoming increasingly popular. A clear understanding of the methods of technology used to measure quality of movement is important as understanding this area will aid in designing appropriate interventions.Methods: This thesis comprises of two experimental studies. Study one is a repeated measures design using previously collected Swanlinx data to investigate how components of children’s fitness change over a one-year period. Study two is a scoping review investigating the measurement of quality of movement with technology in the form of MEM’s devices, while aiming to gain clarity on the definition of quality.Results: Study one revealed that children’s fitness levels increase across a one-year period, in all components of fitness, except sit and reach. Boys performed significantly better in all fitness components, apart from sit and reach. Study two demonstrated the broad field that is included under the term of quality, showing clarity is needed in this area. A large number of devices, movements and populations are being observed, with multiple definitions of quality which is dependent on the metrics collected.Conclusion: Study one concludes that children’s fitness levels increase over one-year, with boys performing better than girls. This can be used to understand children’s natural fitness levels and aid future interventions in participation. Study two concludes that there are multiple ways to assess quality of movement however a clear definition of the quality should be stated, aiding comparison of quality

Technological advancements in the analysis of human motion and posture management through digital devices

Technological development of motion and posture analyses is rapidly progressing, especially in rehabilitation settings and sport biomechanics. Consequently, clear discrimination among different measurement systems is required to diversify their use as needed. This review aims to resume the currently used motion and posture analysis systems, clarify and suggest the appropriate approaches suitable for specific cases or contexts. The currently gold standard systems of motion analysis, widely used in clinical settings, present several limitations related to marker placement or long procedure time. Fully automated and markerless systems are overcoming these drawbacks for conducting biomechanical studies, especially outside laboratories. Similarly, new posture analysis techniques are emerging, often driven by the need for fast and non-invasive methods to obtain high-precision results. These new technologies have also become effective for children or adolescents with non-specific back pain and postural insufficiencies. The evolutions of these methods aim to standardize measurements and provide manageable tools in clinical practice for the early diagnosis of musculoskeletal pathologies and to monitor daily improvements of each patient. Herein, these devices and their uses are described, providing researchers, clinicians, orthopedics, physical therapists, and sports coaches an effective guide to use new technologies in their practice as instruments of diagnosis, therapy, and prevention

Assessments and Outcome Measures of Cerebral Palsy

In cerebral palsy (CP), numerous primary problems are observed including muscle tone problems, muscle weakness, insufficient selective motor control, postural control, and balance problems. In the persistence of these problems for a long period, secondary problems including torsional deformities, joint contractures, scoliosis, and hip dysplasia can occur in time, and strategies formed by children to cope with these problems make up the tertiary problems. Hence, the most accurate and brief assessment of all of these problems mentioned above is crucial to determine an effective and precise physiotherapy program. In the assessment of children with CP, it is very important to receive a detailed story consisting of the birth story, to question underlying medical situations and to carry out physical assessment. In clinics, gross motor function, muscle tone, muscle length, muscle strength, and joint range of motion assessments are the most preferred ones

Current Evidence and Future Directions for Physiotherapy Intervention in Cerebral Palsy: Physical Activity and Physical Fitness

The aim of this thesis was to examine the evidence for physiotherapy intervention for children with cerebral palsy. Cerebral palsy is the most common activity limiting disability in children and adolescents with the incidence being approximately 2-3 per 1,000 live births worldwide. The severity of cerebral palsy is highly variable, but inevitably results in some degree of activity limitation due to motor impairment. However, from the physiotherapist’s point of view the presence of motor impairments – and the subsequent effect that these impairments have on a child’s activity and participation – is the most relevant for intervention. Therefore, determining the most effective form of physiotherapy intervention to address motor impairment, to promote physical activity and enable community participation is an important issue. Four studies were undertaken in this thesis. The first study was a summary of systematic reviews of physiotherapy intervention for children with cerebral palsy and was conducted in order to identify the evidence located on electronic databases. This study found evidence for six physiotherapy interventions – casting, physiotherapy intervention in conjunction with botulinum toxin type-A, electrical stimulation, constraint-induced movement therapy, strength training and cardiorespiratory training. However, the evidence for the effect of intervention was equivocal due to the small numbers of randomised controlled trials, poor reporting of data in the trials and inconclusive results. Since there were a number of trials examining cardiorespiratory training in children with cerebral palsy, which is also an important focus in other areas of physiotherapy intervention, it was decided to investigate this further. In the second study, a systematic review was conducted to examine the evidence for improving cardiorespiratory fitness in children with cerebral palsy. This review showed that it was possible to increase cardiorespiratory fitness in these children. However, the improved fitness did not carry over into their everyday activity. This raised the question of whether there was a relationship between cardiorespiratory fitness and activity and led to the third study. The third study was a feasibility study which examined whether cardiorespiratory fitness or walking capacity influenced the amount of physical activity undertaken by children with cerebral palsy who had mild impairment and were able to walk. This study found that children with cerebral palsy had low cardiorespiratory fitness levels compared to reported values in typically-developing children. However, as there was a moderate correlation between peak heart rate and oxygen uptake during the progressive exercise test, these children demonstrated that they had a normal cardiorespiratory response to exercise of increasing intensity. To control for environmental influences, the children with cerebral palsy were compared to a matched group of siblings to examine the amount of their physical activity. The results revealed that the children with cerebral palsy were performing as much daily physical activity as their age-matched siblings, but that this activity was less than recommended guidelines for both groups. Overall, no relation was found between the cardiorespiratory fitness or walking capacity of the children with cerebral palsy, and the amount of their physical activity. Given that the amount of activity was not determined by the child’s physical characteristics (cardiorespiratory fitness or walking capacity), the fourth study was undertaken in order to identify whether there were barriers which were preventing the child performing activities. Parents were asked to indicate what they saw as being the barriers which were either preventing their child from performing an activity, or which were influencing how frequently their child performed the activity. This study found that these children were regularly engaged in physical activities which are fairly representative of typically-developing children. However, parents perceived cost as being the largest barrier to their child’s activities. Of concern, was that cost was preventing the child from being engaged in activities which could be performed frequently. Generally, children with cerebral palsy just want to engage in activities alongside their typically-developing peers. For children who are ambulant and capable of physical activity, it is important that they are given the opportunity to engage in regular activity which is performed at a moderate to vigorous level. Furthermore, identifying the barriers which are preventing physical activity means that there is a greater chance that children with cerebral palsy will have a more active lifestyle