Virtual-based intervention to improve functional abilities in children with cerebral palsy

The use of virtual devices during motor functions interventions may facilitate the role of therapists, patients’ motivation and enhance treatment efficacy. However, despite the large variety of existing devices, there is no clear evidence for the efficacy of virtual-based interventions for improving motor functions of the upper/lower extremities and transfer of learnings in daily life activities or social participation in children with cerebral palsy. The most likely reason for this lack of efficacy is that none of the existing device has been designed to allow the application of therapeutic principles used in evidence-based motor skill learning based “intensive interventions”. This thesis will first focus on the development of a virtual device allowing the application of all the motor skill learning therapeutic principles. Second, we will test the efficacy of motor interventions implementing the newly developed device in children with cerebral palsy.L’utilisation d’outils virtuels en rééducation motrice peut permettre d’aider les thérapeutes dans leur prise en charge en améliorant la motivation des patients ainsi que l’efficacité du traitement. Cependant, il n'existe pas de preuve claire de l'efficacité des interventions basées sur l’utilisation d’outils virtuels pour améliorer les fonctions motrices ou l’indépendance dans les activités du quotidien pour les enfants atteints de paralysie cérébrale. La raison la plus probable de ce manque d'efficacité est qu'aucun des dispositifs existants n'a été conçu pour permettre l'application des principes thérapeutiques utilisés dans les thérapies « intensives » basées sur l’apprentissage moteur dont l’efficacité est largement démontrée. L’objectif de cette thèse est de travailler au développement d’un dispositif virtuel interactif permettant l'application de ces principes thérapeutiques mais également de tester son utilisation lors de prises en charges motrices.(MOTR - Sciences de la motricité) -- UCL, 202

Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials

Hand-Arm Bimanual Intensive Therapy (HABIT) promotes hand function using intensive practice of bimanual functional and play tasks. This intervention has shown to be efficacious to improve upper-extremity (UE) function in children with unilateral spastic cerebral palsy (USCP). In addition to UE function deficits, lower-extremity (LE) function and UE–LE coordination are also impaired in children with USCP. Recently, a new intervention has been introduced in which the LE is simultaneously engaged during HABIT (Hand-Arm Bimanual Intensive Therapy Including Lower Extremities; HABIT-ILE). Positive effects of this therapy have been demonstrated for both the UE and LE function in children with USCP. However, it is unknown whether the addition of this constant LE component during a bimanual intensive therapy attenuates UE improvements observed in children with USCP. This retrospective study, based on multiple randomized protocols, aims to compare the UE function improvements in children with USCP after HABIT or HABIT-ILE. This study included 86 children with USCP who received 90 h of either HABIT (n = 42) or HABIT-ILE (n = 44) as participants in previous studies. Children were assessed before, after, and 4–6 months after intervention. Primary outcomes were the ABILHAND-Kids and the Assisting Hand Assessment. Secondary measures included the Jebsen-Taylor Test of Hand Function, the Pediatric Evaluation of Disability Inventory [(PEDI); only the self-care functional ability domain] and the Canadian Occupational Performance Measure (COPM). Data analysis was performed using two-way repeated-measures analysis of variance with repeated measures on test sessions. Both groups showed similar, significant improvements for all tests (test session effect p < 0.001; group × test session interaction p > 0.05) except the PEDI and COPM. Larger improvements on these tests were found for the HABIT-ILE group (test session effect p < 0.001; group × test session interaction p < 0.05). These larger improvements may be explained by the constant simultaneous UE–LE engagement observed during the HABIT-ILE intervention since many daily living activities included in the PEDI and the COPM goals involve the LE and, more specifically, UE–LE coordination. We conclude that UE improvements in children with USCP are not attenuated by simultaneous UE–LE engagement during intensive intervention. In addition, systematic LE engagement during bimanual intensive intervention (HABIT-ILE) leads to larger functional improvements in activities of daily living involving the LE

The Seated Postural & Reaching Control Test in Cerebral Palsy: A Validation Study

Aim: Children with moderate-severe cerebral palsy (CP) show postural control deficits that affect their daily activities, like reaching. The Seated Postural and Reaching Control test (SP&R-co) was developed to address the need for clinical measures that objectively identify dimensions of postural imbalance and corresponding reaching limitations in children with CP. Methods: SP&R-co documentation was designed for test validity and rater training. Rater and internal consistency were examined using Cronbach’s α . Reference SP&R-co score sheets of children and rater’s scores were used for absolute item-by-item, average inter-rater, and intra-rater reliability. Motor classification systems and performance tests were used for construct and concurrent validity. Results: The SP&R-co scoring showed acceptable-good consistency ( α = 0.76 – 0.84). Interrelatedness of SP&R-co items was good-excellent ( α = 0.82 – 0.97). The raters demonstrated fair, good, and excellent item-by-item reliability (ICC = 0.41–0.92). Inter-rater and intra-rater reliability of SP&R-co dimensions were good-excellent (ICC = 0.68 – 0.86 and ICC = 0.64 – 0.95, respectively). Construct and concurrent validity showed moderate-excellent correlations ( r = 0.49 – 0.88). Conclusions: Results provide evidence that the SP&R-co is a reliable and valid test for therapists to objectively examine and quantify seated postural and reaching control in children with CP

Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery

Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Mirror movements after bimanual intensive therapy in children with unilateral cerebral palsy: A randomized controlled trial.

AIM: To investigate potential changes in mirror movements after Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) training in children with unilateral cerebral palsy (CP). METHOD: Thirty-one children with unilateral CP (mean age 9 years 4 months, SD 4 years 3 months; range 5 years 4 months-17 years 3 months; 14 females, 17 males) were randomized to either a control or treatment group. After allocation, children were assessed three times: before (T1, baseline) and after (T2) a 2-week interval and again at 3 months after T1 (T3) as follow-up. Between T1 and T2, the treatment group received 90 hours of HABIT-ILE training, while the control group continued their customary treatment. Mirror movements were assessed in all children using the Woods and Teuber Scale, as well as the Assisting Hand Assessment, Pediatric Evaluation of Disability Inventory, and Canadian Occupational Performance Measure. RESULTS: Repeated measures analysis of variance indicated a significant decrease in mirror movements in the more-affected (mean difference = 0.97; 95% confidence interval [CI] = 0.51-1.42; p < 0.001) and less-affected (mean difference = 0.71; 95% CI = 0.37-1.0; p < 0.001) hands of children after HABIT-ILE; these improvements were maintained at the 3-month follow-up. Moreover, the mirror movement changes observed at the second assessment (T2) were inversely correlated with changes in the assessment of activities of daily living, especially in the less-affected hand. INTERPRETATION: HABIT-ILE decreased the intensity of mirror movements in a group of children with CP. Furthermore, mirror movement changes were associated with bimanual performance and activities of daily living in these children. WHAT THIS PAPER ADDS: The intensity of mirror movements decreased in both hands after 2 weeks of Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) training. Mirror movement changes were maintained at the 3-month follow-up after HABIT-ILE. Mirror movement changes were associated with improvements in bimanual performance and activities of daily living

Feasibility and effectiveness of HABIT-ILE in children aged 1 to 4 years with cerebral palsy: A pilot study.

No abstract availabl

Changes in Tactile Function During Intensive Bimanual Training in Children With Unilateral Spastic Cerebral Palsy

Recently, an intensive bimanual intervention using sensory enriched materials resulted in improved tactile function in children with unilateral spastic cerebral palsy (USCP), raising the question of whether the observed tactile function improvement was due to the sensory enriched environment or the bimanual intervention per se. The present study investigates whether a bimanual intensive intervention improves tactile function. Nineteen children with USCP received 90 hours of bimanual training without enriched environment. Primary outcomes: Manual Form Perception Test/MFPT, Grating Orientation Task/GOT. Children were assessed before, after the training, and at the 4-month follow-up. Significant improvements were observed in MFPT for the more affected hand ( P = .015). Larger stereognosis/MFPT improvements correlated with poorer baseline motor function. Intensive bimanual training alone was sufficient to improve stereognosis, though no improvement in GOT was observed. Present and previously published findings suggest that environmental tactile enrichment incorporated into a bimanual motor training may be needed to improve spatial discrimination/GOT in children with USCP

Interrater Reliability of Activity Questionnaires After an Intensive Motor-Skill Learning Intervention for Children With Cerebral Palsy.

OBJECTIVE: To investigate the reliability of parents-reported activity questionnaires after a motor-skill learning intervention for children with cerebral palsy (CP). We hypothesize that the intervention process might influence parental judgment. DESIGN: Double-blind randomized trial. SETTING: Conventional therapy was delivered in the usual context while intensive intervention was provided at the Catholic University of Louvain. PARTICIPANTS: Children with CP (N=41; age range 5-18y, Gross Motor Function Classification System I-IV) were randomized to a control group (CG) (n=21, 2 dropouts) receiving conventional therapy or an intervention group (IG) (n=20) receiving hand-arm bimanual intensive therapy-including lower extremities (HABIT-ILE). INTERVENTIONS: Conventional therapy (mostly neurodevelopmental) was delivered as ongoing treatment (1-5 times/wk). HABIT-ILE, based on motor-skill learning, was delivered over 2 weeks. All children were assessed at T1 (baseline), T2 (3wk after baseline) and T3 (4mo after baseline). MAIN OUTCOMES MEASURES: ABILHAND-Kids and ACTIVLIM-CP questionnaires rated by parents (perception) and 2 examiners (videotapes). RESULTS: Agreement (level/range) between examiners was systematically almost perfect (P≤.001). At baseline, moderate to almost perfect agreement (level/range) was observed between parents and examiners (P≤.001). At T2 and T3, a similar agreement (level/range) was observed for the CG. For the IG, a similar level of agreement was observed, but the range of agreement varied from poor to almost perfect (P≤.001), with parents estimating higher performance measures compared to examiners after intervention. Higher performance was associated with higher satisfaction scores of the child's functional goals at T3. CONCLUSION: Parents and examiners have a similar perception of the child's performance at baseline and during conventional therapy. Their perceptions are less congruent after a motor-skill learning intervention, probably due to the goal-oriented process of the intervention. Therefore, our results favor the use of blind observations of home-videotaped items after intensive motor-skill learning interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02667613

Motor Skill Training May Restore Impaired Corticospinal Tract Fibers in Children With Cerebral Palsy.

. In children with unilateral cerebral palsy (UCP), the fibers of the corticospinal tract (CST) emerging from the lesioned hemisphere are damaged following the initial brain injury. The extent to which the integrity of these fibers is restorable with training is unknown. . To assess changes in CST integrity in children with UCP following Hand-and-Arm-Bimanual-Intensive-Therapy-Including-Lower-Extremity (HABIT-ILE) compared to a control group. . Forty-four children with UCP participated in this study. Integrity of the CSTs was measured using diffusion tensor imaging before and after 2 weeks of HABIT-ILE (treatment group, n = 23) or 2 weeks apart without intensive treatment (control group, n = 18). Fractional anisotropy (FA) and mean diffusivity (MD) were the endpoints for assessing the integrity of CST. . As highlighted in our whole tract analysis, the FA of the CST originating from the nonlesioned and lesioned hemispheres increased significantly after therapy in the treatment group compared to the control group (group * test session interaction: < .001 and = .049, respectively). A decrease in MD was also observed in the CST emerging from the nonlesioned and lesioned hemispheres (group * time interaction: both < .001). In addition, changes in manual ability correlated with changes in FA in both CSTs ( = 0.463, = .024; = 0.643, < .001) and changes in MD in CST emerging from nonlesioned hemisphere ( = -0.662, < .001). . HABIT-ILE improves FA/MD in the CST and hand function of children with UCP, suggesting that CST fibers retain a capacity for functional restoration. This finding supports the application of intensive motor skill training in clinical practice for the benefit of numerous patients