16 research outputs found

    Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy

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    Aim: To evaluate the sensitivity, specificity, and predictive value of the Hand Assessment for Infants (HAI) in identifying infants at risk of being diagnosed with unilateral cerebral palsy(CP), and to determine cut-off values for this purpose. Method: A convenience sample of 203 infants (106 females, 97 males) was assessed by the HAI at 3, 6, 9, and 12 months. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using receiver operating characteristic curve analysis. Cut-off values were derived for different ages. The clinical outcome (unilateral CP yes/no) at 24 months or more served as an external criterion to investigate the predictive validity of HAI. Results: Half of the infants developed unilateral CP. The area under the curve ranged from0.77 (95% CI [confidence interval] 0.63–0.91) to 0.95 (95% CI 0.90–1.00) across HAI scales and age intervals. Likewise, sensitivity ranged from 63% to 93%, specificity from 62% to 91%, and accuracy from 73% to 94%. Interpretation: HAI scores demonstrated overall accuracy that ranged from very good to excellent in predicting unilateral CP in infants at risk aged between 3.5 and 12 months. This accuracy increased with age at assessment and the earliest possible prediction was at3.5 months of age, when appropriate HAI cut-off values for different ages were applied

    Action observation training for rehabilitation in brain injuries: A systematic review and meta-analysis

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    Background : To systematically review and analyse the effects of Action Observation Training on adults and children with brain damage. Methods : Seven electronic databases (Cochrane, EBSCO, Embase, Eric, PubMed, Scopus and Web of Science) were searched up to 16 September 2018 to select Randomized Controlled Trials focused on adults and children with brain damage that included AOT training on upper and/or lower limb carried out for at least 1 week. Identification of studies and data extraction was conducted with two reviewers working independently. Oxford Centre for Evidence-based Medicine (March2009) – Levels of Evidence and Physiotherapy Evidence Database scale were used to grade studies. The data collected from the articles were analysed using software R, version 3.4.3. Hedge’s g values were calculated and effect size estimates were pooled across studies. Separate meta-analyses were carried out for each ICF domain (i.e. body function and activity) for upper and lower limb. Results : Out of the 210 records identified after removing duplicates, 22 were selected for systematic review and 19 were included in the meta-analysis. Thirteen studies included in the meta-analysis focused on upper limb rehabilitation (4 in children and 9 in adults) and 6 on lower limb rehabilitation (only studies in adults). A total of 626 patients were included in the meta-analysis. An overall statistically significant effect size was found for upper limb body function (0.44, 95% CI: [0.24, 0.64], p<0.001) and upper limb activity domain (0.47, 95% CI: [0.30, 0.64], p<0.001). For lower limb, only the activity domain was analysed, revealing a statistically significant overall effect size (0.56, 95% CI: [0.28, 0.84], p<0.001). Conclusions : Action Observation Training (AOT) is an innovative rehabilitation tool for individuals with brain damage, which shows promising results in improving the activity domain for upper and lower limbs, and also the body function domain for the upper limb. However, the examined studies lack uniformity and further well-designed, larger controlled trials are necessary to determine the most suitable type of AOT particularly in childre

    Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy

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    Aim: To evaluate the sensitivity, specificity, and predictive value of the Hand Assessment for Infants (HAI) in identifying infants at risk of being diagnosed with unilateral cerebral palsy (CP), and to determine cut-off values for this purpose. Method: A convenience sample of 203 infants (106 females, 97 males) was assessed by the HAI at 3, 6, 9, and 12&nbsp;months. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using receiver operating characteristic curve analysis. Cut-off values were derived for different ages. The clinical outcome (unilateral CP yes/no) at 24&nbsp;months or more served as an external criterion to investigate the predictive validity of HAI. Results: Half of the infants developed unilateral CP. The area under the curve ranged from 0.77 (95% CI [confidence interval] 0.63–0.91) to 0.95 (95% CI 0.90–1.00) across HAI scales and age intervals. Likewise, sensitivity ranged from 63% to 93%, specificity from 62% to 91%, and accuracy from 73% to 94%. Interpretation: HAI scores demonstrated overall accuracy that ranged from very good to excellent in predicting unilateral CP in infants at risk aged between 3.5 and 12&nbsp;months. This accuracy increased with age at assessment and the earliest possible prediction was at 3.5&nbsp;months of age, when appropriate HAI cut-off values for different ages were applied

    Upper limb children action-observation training (UP-CAT) study: design of a randomised clinical trial for children with hemiplegia

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    Objective: The purpose of the present study was to design and test a Randomised Clinical Trial (RCT) for evaluating the efficacy of action-observation therapy in improving the upper limb (UL) activity in children with hemiplegia. Background: Rehabilitation for children with hemiplegia to improve function in the impaired UL uses a wide range of intervention programs; researches using adequately powered RCTs, rigorous methodology and valid outcome measures are essential, to provide the highest level support of therapy effectiveness. Design/Methods: The trial was designed according to Consolidated Standards of Reporting Trials (CONSORT) Statement. It was a randomised, evaluator-blinded, matchpair group trial. Children were randomised within pairs to either experimental or control group. The experimental group performed an Action–Observation Therapy based on watching video sequences of goal actions, chosen according to their UL functional level, combined with motor training with their hemiplegic UL. The control group performed the same tailored actions after watching computer games. A carefully revision of psychometric properties (e.g. small detectable differences) of UL outcome measures for hemiplegic children was performed. Assisting Hand Assessment was chosen as primary measure and based on its power calculation a sample size of 12 matched pairs was established. Moreover, Melbourne and ABILHAND-Kids were included as secondary measures. The time line of assessments was T0 (on the week preceding the onset of the treatment), T1 and T2 (on the week and 8 weeks after the end of the treatment, respectively). Results: We were able to perform children recruitment and testing in the 24 consecutive children according to above experimental planning. The two experimental and control groups differ only for the type of observation but the performed actions were similar so that the changes induced by observation should be measured. Conclusions: To provide reliable results of program rehabilitation effectiveness it is essential to design RCT studies according to CONSORT guidelines
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