Effects of Forward Tilting of Seat Surface on Arm-hand Mobility of Young Children with Bilateral Spastic Cerebral Palsy: a Preliminary Study

This preliminary study is on the effect of forward-tilting of the seat-surface on arm-hand function of young children with cerebral palsy (CP). Five children were recruited (two females, three males; median age 2 years 7 months). Inclusion criteria: preschool age, bilateral spastic CP with truncal hypotonia, Gross Motor Function Classification System levels II-IV. Participants served as their own controls. Adaptive seating with three wedge-inserts inducing 10, 20 or 30 degrees forward-tilt of the seat-surface was used. The tilt which induced best postural stability and alignment was applied. Arm mobility was assessed three times with one week intervals. Arm-hand function was assessed using the upper limb physicians rating scale (ULPRS) in the horizontal condition (H), and forward tilt condition (FW), 10 minutes per condition in random order. Two children were tested with 10-degree FW tilted seating, three children with 20 degrees. Mean ULPRS scores were higher in FW [dominant arm: 19.73 (1.94), non-dominant arm: 16.53 (2.21)] than in H condition [dominant arm: 17.93 (1.92), non-dominant arm: 13.73 (2.52)]. ANOVA demonstrated an effect of condition (dominant arm: p=0.001, non-dominant arm: p=0.009), but not of the testing session (dominant arm: p=0.970, non-dominant arm: p=0.724). Therefore, forward-tilting of the seat-surface may enhance arm-hand function in preschool children with Bi-CP

Developmental performance of young children aged 1 - 42 months in Mueang Pitsanulok, Thailand: The Bayley-III Screening Survey.

The Bayley-III Screening test is one of the most worldwide used standardized assessments for young children aged between 1-42 months, however, it is less well-known in Thailand. This preliminary study aimed to conduct developmental screening using the Bayley-IIIscreening test and to report the cross-sectional developmental performance of infants and toddlers in Mueang Phitsanulok, Thailand during August 2007. The secondary objective was to explore the feasibility of using Bayley-III Screening in Thailand. We assessed 67 Thai children (31 boys and 36 girls; age range 1-42 months old [mean=16 months; SD=9.74, this included bothchronological age and corrected age for prematurity]). The Bayley-III test was administered to assess five subtests of development: cognitive, expressive- and receptive-communication, fine and gross-motor functioning. Summary scores for each subtest were determined using the Bayley-III subtest cut-score information regarding the child’s age, and classified into ‘competent’, ‘emerging’, and ‘at risk’ categories. All 67 children were assessed but three infants were dropped-off during the assessments as they were in an inattentive state. In all five subtests, the majority of those 64 included children were classified as ‘competent’, i.e. as typically developing, while only about 3-20% of the children were categorized as ‘emerging’ risk and 3-7% of the children were found ‘at risk’ to developmental delays. For the latter, 4 children exhibited ‘at risk’ in both cognitive and communication subtests. Based on the Bayley-III identification, the developmental performance of young children in Mueang Phitsanulok during August 2007 was generally at the lowest risk for developmental delays

Adaptive seating and adaptive riding in children with cerebral palsy: In children with cerebral palsy

Physiotherapeutic interventions in children with cerebral palsy (CP) are generally focusing on the child’s functioning and his/her ability to perform activities in daily life. Children with CP perform many daily activities in the sitting position, such as reaching while eating, playing, or during school tasks. This functional activity largely depends on the ability to control posture, balance, and arm and hand motor skills. Thus, many interventions aim to enhance the child’s postural control and upper extremity function. The need of children with CP to improve mobility has led to the development of seating interventions and the adaptive riding intervention. This thesis suggests that in children with spastic CP functioning at GMFCS levels I-III two forms of postural interventions, i.e., specific forms of adaptive seating and adaptive riding, may improve children’s functioning, and enhance their postural control during sitting while performing arm reaching. - In children with US-CP, GMFCS levels I-III, FW-tilting with foot-support is associated with better reaching performance; in children with BS-CP, GMFCS levels I-III, a horizontal seat surface with foot-support is associated with better reaching. - The feasibility study on TDAR intervention in children with BS-CP, GMFCS level III, suggested not only that TDAR intervention and the complex evaluation protocol were feasible, but also that 6 weeks of TDAR may be associated with improved gross motor function and postural adjustments Our systematic review on the effect of AdSS in children with severe CP (GMFCS levels IV-V) revealed that the nine best studies available had a low level of evidence. Most promising seems to be AdSSs consisting of a combination of trunk and hip support which may be associated with better postural control and – in turn – better upper extremity activity. This type of AdSS may also be provided as a special purpose AdSS, that may have the potential to improve children’s activities and participation. It should be realized that the low level of evidence of the available studies precluded firm conclusions. This implies that additional research in this area is urgently needed

Therapist-Designed Adaptive Riding in Children With Cerebral Palsy:Results of a Feasibility Study

Background. It is debatable whether adaptive riding (AR) in children with cerebral palsy (CP) improves postural control and gross motor development. Objective. The study aim was to explore the feasibility of an extensive assessment protocol for a randomized controlled trial of therapist-designed adaptive riding (TDAR) in children with CP, with the goals of assessing the effect on child outcomes and evaluating working mechanisms of sitting postural control. Design. A pretest-posttest group design with 2 baseline measurements was used. Methods. Six children (1 girl, 5 boys; age range = 6 -12 years, median age = 8 years 9 months) with bilateral spastic CP (Gross Motor Function Classification System level III) participated. Outcomes were evaluated 3 times (TO, T1, and T2) at 6-week intervals. TO and T1 were baseline measurements; between T1 and T2, a TDAR intervention including an integrated program of postural challenge exercises (2 times per week for 1 hour) was applied. The complex protocol included the 88-item Gross Motor Function Measure (GMFM-88) and electromyographic (EMG) recording of postural muscle activity during reaching while sitting (EMG recording at T1 and T2 only). Results. The protocol was feasible. Median GMFM-88 scores changed from 64.4 at TO to 66.7 at T1 and from 66.7 at T1 to 73.2 at T2. The change scores for all children exceeded the minimal clinically important difference of the GMFM-88. Five of 6 children showed a decrease in stereotyped top-down recruitment between Ti and T2. Limitations. Study limitations included the lack of a control group, small sample size, and potential assessor bias for all but the EMG parameters. Conclusions. The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial

Best seating condition in children with spastic cerebral palsy:One type does not fit all

Background: The effect of forward-tilting of the seat surface and foot-support in children with spastic cerebral palsy (CP) is debated. Aim: To assess the effect of forward-tilting of the seat surface and foot-support in children with CP on kinematic head stability and reaching. Methods: Nineteen children functioning at Gross Motor Function Classification System levels I-III participated [range 6-12y; ten unilateral spastic CP (US-CP) and nine bilateral spastic CP (BS-CP)]. Kinematic data were recorded of head sway and reaching with the dominant arm in four sitting conditions: a horizontal and a 15 forward (FW) tilted seat surface, each with and without foot-support. Results: Seating condition did not affect head stability during reaching, but did affect kinematic reaching quality. The major reaching parameters, i.e., the proportion of reaches with one movement unit (MU) and the size of the transport MU, were not affected by foot-support. Forward-tilting had a positive effect on these parameters in children with US-CP, whereas the horizontal condition had this effect in children with BS-CP. Implications: A 15 degrees forward-tilted seating and foot-support do not affect head stability. Reaching in children with US-CP profits from forward-tilting; in children with BS-CP forward-tilting worsens reaching - effects that are independent of foot-support

Effects of forward tilted seating and foot-support on postural adjustments in children with spastic cerebral palsy:An EMG-study

OBJECTIVE: To evaluate the effect of 15° forward (FW) seat inclination and foot-support in children with cerebral palsy (CP) on postural adjustments during reaching. DESIGN: Observational study repeated-measures design; step two of two-step-project. SETTING: Laboratory unit within University Hospital and two special education schools. PARTICIPANTS: 19 children (ten unilateral spastic CP (US-CP); nine bilateral spastic CP (BS-CP); Gross Motor Function Classification System levels I-III; 6-12 years old). Participants were able to take part for one one-hour session. INTERVENTION: Reaching while sitting in four seating conditions (FW or horizontal seat; with or without foot-support) applied in randomized order. OUTCOME MEASURES: Simultaneously, surface electromyography (EMG) of neck, trunk and arm muscles and kinematics of head and reaching arm (step one of two-step-project) were recorded. Primary outcome parameters were the ability to modulate EMG-amplitudes at baseline and during reaching (phasic muscle activity). Other EMG-parameters were direction-specificity (1st control level), and 2nd level of control parameters: recruitment order, and anticipatory postural activity. Motor behaviour measures: ability to modulate EMG-amplitudes to kinematic characteristics of reaching and head stability. RESULTS: Only foot-support was associated with increased tonic background EMG-amplitudes and decreased phasic EMG-amplitudes of the trunk extensors in children with US-CP and BS-CP (mixed-models analyses; p-values <0.01). The foot-support effect was also associated with better kinematics of reaching (Spearman's Rho; p-values <0.01). CONCLUSION: In terms of postural adjustments during forward reaching, foot-support enhanced the children's capacity to modulate trunk extensor activity, which was associated with improved reaching quality. FW-tilting did not affect postural muscle activity