Walking activities beyond gait training: Priorities in everyday life for parents and adolescents in pediatric neurorehabilitation

Purpose: This study aimed to gain knowledge about which walking-related everyday life activities and situations are relevant for parents of children with a neuromotor disorder and adolescents undergoing inpatient neurorehabilitation. Methods: Two focus group interviews with purposive samples were performed, one with seven parents of children with acquired or congenital neuromotor disorders, and one with four adolescents undergoing inpatient neurorehabilitation. Data were analyzed with a qualitative descriptive research approach. Results: Parents identified 120 activities that they considered as relevant in their everyday life and the adolescents identified 113 activities. Based on these activities, ten different categories that have a direct relation to walking in everyday life were identified. "Dealing with obstacles," "moving in public areas," "moving in a group," and "walking in general" were perceived as the highest priority categories by the focus group participants. Conclusion: Activities incorporating walking tasks related to moving in a group or public areas and dealing with obstacles are perceived as meaningful by adolescents and parents in their everyday life. Addressing these categories in the goal setting process with families could facilitate the definition of walking-related goals aimed at increasing children's and adolescents' independence in daily life. Keywords: Adolescent; focus groups; parent; patient involvement; rehabilitation; walkin

The role of the practice order: A systematic review about contextual interference in children

Aim: We aimed to identify and evaluate the quality and evidence of the motor learning literature about intervention studies regarding the contextual interference (CI) effect (blocked vs. random practice order) in children with brain lesions and typically developing (TD) children. Method: Eight databases (Cinahl, Cochrane, Embase, PubMed, Pedro, PsycINFO, Scopus and Web of Knowledge) were searched systematically with predefined search terms. Controlled studies examining the CI effect in children (with brain lesions or TD) were included. Evidence level, conduct quality, and risk of bias were evaluated by two authors independently. A best evidence synthesis was performed. Results: Twenty-five papers evaluating TD children were included. One of these studies also assessed children with cerebral palsy. Evidence levels were I, II, or III. Conduct quality was low and the risk of bias high, due to methodological issues in the study designs or poor description thereof. Best evidence synthesis showed mainly no or conflicting evidence. Single tasks showed limited to moderate evidence supporting the CI effect in TD children. Conclusion: There is a severe limitation of good-quality evidence about the CI effect in children who practice different tasks in one session, especially in children with brain lesions

Contextual interference in children with brain lesions: protocol of a pilot study investigating blocked vs. random practice order of an upper limb robotic exergame

Background If adults practice several motor tasks together, random practice leads to better transfer and retention compared to blocked practice. Knowledge about this contextual interference (CI) effect could be valuable to improve neurorehabilitation of children. We present the protocol of a randomised controlled pilot study investigating the feasibility of blocked practice vs. random practice of robot-assisted upper limb reaching in children with brain lesions undergoing neurorehabilitation. Methods Children with affected upper limb function due to congenital or acquired brain lesions undergoing neurorehabilitation will be recruited for a randomised controlled pilot study with a 3-week procedure. In the control week (1), two assessment blocks (robot-assisted reaching tasks, Melbourne assessment 2, subscale fluency), 2 days apart, take place. In the practice week (2), participants are randomly allocated to blocked practice or random practice and perform 480 reaching and backward movements in the horizontal and vertical plane using exergaming with an exoskeleton robot per day during three consecutive days. Assessments are performed before, directly after and 1 day after the practice sessions. In the follow-up week (3), participants perform the assessments 1 week after the final practice session. The primary outcome is the immediate transfer of the Melbourne Assessment 2, subscale fluency. Secondary outcomes are the immediate retention, 1-day and 1-week delayed transfer and retention and acquisition during the practice sessions. We will evaluate the feasibility of the inclusion criteria, the recruitment rate, the scheduling procedure, the randomisation procedure, the procedure for the participants, the handling of the robot, the handling of the amount of data, the choice of the outcome measures and the influence of other therapies. Furthermore, we will perform a power calculation using the data to estimate the sample size for the main trial. Discussion The protocol of the pilot study is a first step towards a future main randomised controlled trial. This low risk pilot study might induce some benefits for the participants. However, we need to place its results into perspective, especially concerning the generalisability, as it remains questionable whether improving reaching constrained within a robotic device will ameliorate daily life reaching tasks. Trial registration ClinicalTrials.gov Identifier: NCT02443857

Reliability of timed walking tests and temporo-spatial gait parameters in youths with neurological gait disorders

BACKGROUND: The 10-Meter Walk Tests (10MWT) and the 6-Minute Walk Test (6MinWT) are applied to assess gait capacity in paediatric patients. To better objectify changes in qualitative aspects of gait, temporo-spatial parameters like stride length or step symmetry could be simultaneously assessed with a GAITRite system. Reliability has not yet been evaluated in a heterogeneous sample of children with various neurological gait disorders such as is representative for paediatric neuro-rehabilitation. The aim of this study was to assess test-retest reliability of the 10MWT, the 6MinWT and simultaneously recorded gait parameters captured with the GAITRite system in children with neurological gait disorders. METHODS: This is a cross-sectional study with two measurement time-points. Thirty participants (9 females; mean (standard deviation) age 13.0 (3.6) years, 10 with cerebral palsy, 6 after stroke, among other diagnoses) performed the 10MWT at preferred (10MWTpref) and maximum speed (10MWTmax) and the 6MinWT on two occasions (mean time interval: 7.0 (1.9) days). Relative reliability was quantified with an intra-class correlation coefficient (ICC); the measurement error reflecting absolute reliability was quantified with the standard error of measurement and the smallest real difference. RESULTS: ICCs of timed walking tests (time measured with a stopwatch, step count for the 10MWT and walking distance for the 6MinWT) ranged from 0.89-0.97. ICCs of temporo-spatial gait parameters ranged from 0.81-0.95 (10MWTpref), from 0.61-0.90 (10MWTmax) and from 0.88-0.97 (6MinWT). In general, absolute reliability was greatest in the 6MinWT. CONCLUSION: Timed walking tests and temporo-spatial gait parameters obtained from the GAITRite system appear reliable in children with neurological gait disorders. However, especially in children with poorer walking ability, the reliability of temporo-spatial parameters might have been positively influenced, as unclear steps had to be removed using the GAITRite software. As absolute reliability is rather low, the responsiveness of these measures needs to be further evaluated

Effectiveness of Facilitation, Arrangement of Task and Situation, (Non-)verbal Communication, and Counseling of Caregivers in Children with Neuromotor Disorders: a Systematic Review

Objectives The techniques facilitation of activities, arrangement of task or situation, verbal and non-verbal communication, and counseling and empowerment of parents and caregivers are applied in different therapy approaches to improve motor function in children with neuromotor disorders. This review quantitatively examines the effectiveness of these four techniques allocated to pre-defined age groups and levels of disability. Methods We followed the systematic review methodology proposed by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM). The search was conducted on PubMed, Scopus, EMBASE, PEDro, OT Seeker, ERIC, and CINAHL. The main outcomes of the included articles were allocated to the framework of the International Classification of Functioning, Disability, and Health (body functions, activities, and participation). Results The search yielded eleven studies for facilitation, 22 for arrangement of task or situation, three for verbal and non-verbal communication, and three studies for counseling and empowerment. The effect sizes indicated strong evidence for body function and activity outcomes for the use of facilitation in newborns until the age of 2 years and the arrangement of tasks in children between 2 and 5 years with cerebral palsy. Conclusions Thus, while some evidence exist for facilitation and arrangement of task or situation, further research is needed on the effectiveness of verbal and non-verbal communication and counseling and empowerment of parents and caregivers to improve motor function, activities, and participation. Systematic review registration. PROSPERO CRD42017048583

Effectiveness of facilitation, arrangement of task and situation, (non-)verbal communication, and counseling of caregivers in children with neuromotor disorders: A systematic review

From Springer Nature via Jisc Publications RouterObjectives: The techniques facilitation of activities, arrangement of task or situation, verbal and non-verbal communication, and counseling and empowerment of parents and caregivers are applied in different therapy approaches to improve motor function in children with neuromotor disorders. This review quantitatively examines the effectiveness of these four techniques allocated to pre-defined age groups and levels of disability. Methods: We followed the systematic review methodology proposed by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM). The search was conducted on PubMed, Scopus, EMBASE, PEDro, OT Seeker, ERIC, and CINAHL. The main outcomes of the included articles were allocated to the framework of the International Classification of Functioning, Disability, and Health (body functions, activities, and participation). Results: The search yielded eleven studies for facilitation, 22 for arrangement of task or situation, three for verbal and non-verbal communication, and three studies for counseling and empowerment. The effect sizes indicated strong evidence for body function and activity outcomes for the use of facilitation in newborns until the age of 2 years and the arrangement of tasks in children between 2 and 5 years with cerebral palsy. Conclusions: Thus, while some evidence exist for facilitation and arrangement of task or situation, further research is needed on the effectiveness of verbal and non-verbal communication and counseling and empowerment of parents and caregivers to improve motor function, activities, and participation. Systematic review registration.: PROSPERO CRD42017048583.This work was supported by the Mäxi foundation, Switzerland.5pubpu

The role of the practice order: A systematic review about contextual interference in children

AimWe aimed to identify and evaluate the quality and evidence of the motor learning literature about intervention studies regarding the contextual interference (CI) effect (blocked vs. random practice order) in children with brain lesions and typically developing (TD) children.MethodEight databases (Cinahl, Cochrane, Embase, PubMed, Pedro, PsycINFO, Scopus and Web of Knowledge) were searched systematically with predefined search terms. Controlled studies examining the CI effect in children (with brain lesions or TD) were included. Evidence level, conduct quality, and risk of bias were evaluated by two authors independently. A best evidence synthesis was performed.ResultsTwenty-five papers evaluating TD children were included. One of these studies also assessed children with cerebral palsy. Evidence levels were I, II, or III. Conduct quality was low and the risk of bias high, due to methodological issues in the study designs or poor description thereof. Best evidence synthesis showed mainly no or conflicting evidence. Single tasks showed limited to moderate evidence supporting the CI effect in TD children.ConclusionThere is a severe limitation of good-quality evidence about the CI effect in children who practice different tasks in one session, especially in children with brain lesions

Test-retest reliability of upper limb robotic exoskeleton assessments in children and youths with brain lesions

In children with congenital or acquired brain lesions, impaired upper limb function can affect independence. Assessing upper limb function is important for planning and evaluating neurorehabilitative interventions. Robotic devices increase measurement-objectivity and enable measuring parameters reflecting more complex motor functions. We investigated the relative and absolute test-retest reliability of assessments to measure upper limb functions in children and adolescents with brain lesions with the exoskeleton ChARMin. Thirty children (9 females, mean age ± SD = 12.5 ± 3.3 years) with congenital brain injuries (n = 15), acquired (n = 14), both (n = 1) and impaired upper limb function participated. They performed the following ChARMin assessments and repeated them within three to seven days: active and passive Range of Motion (ROM), Strength, Resistance to Passive Movement, Quality of Movement, Circle, and Workspace. We calculated the systematic difference, Intraclass Correlation Coefficient (ICC) and Smallest Real Difference (SRD) for each parameter. Six parameters of three assessments showed systematic errors. ICCs ranged from little to very high and SRD values varied considerably. Test-retest reliability and measurement errors ranged widely between the assessments. Systematic differences indicated that random day-to-day variability in performance would be responsible for reduced reliability of those parameters. While it remains debatable whether robot-derived outcomes should replace certain routine assessments (e.g., ROM, strength), we recommend applying certain technology-based assessments also in clinical practice.Trial registration: This study was registered prospectively at ClinicalTrials.gov (identifier: NCT02443857) on May 14, 2015

Contextual interference in children with brain lesions:protocol of a pilot study investigating blocked vs. random practice order of an upper limb robotic exergame

Background: If adults practice several motor tasks together, random practice leads to better transfer and retention compared to blocked practice. Knowledge about this contextual interference (CI) effect could be valuable to improve neurorehabilitation of children. We present the protocol of a randomised controlled pilot study investigating the feasibility of blocked practice vs. random practice of robot-assisted upper limb reaching in children with brain lesions undergoing neurorehabilitation. Methods: Children with affected upper limb function due to congenital or acquired brain lesions undergoing neurorehabilitation will be recruited for a randomised controlled pilot study with a 3-week procedure. In the control week (1), two assessment blocks (robot-assisted reaching tasks, Melbourne assessment 2, subscale fluency), 2 days apart, take place. In the practice week (2), participants are randomly allocated to blocked practice or random practice and perform 480 reaching and backward movements in the horizontal and vertical plane using exergaming with an exoskeleton robot per day during three consecutive days. Assessments are performed before, directly after and 1 day after the practice sessions. In the follow-up week (3), participants perform the assessments 1 week after the final practice session. The primary outcome is the immediate transfer of the Melbourne Assessment 2, subscale fluency. Secondary outcomes are the immediate retention, 1-day and 1-week delayed transfer and retention and acquisition during the practice sessions. We will evaluate the feasibility of the inclusion criteria, the recruitment rate, the scheduling procedure, the randomisation procedure, the procedure for the participants, the handling of the robot, the handling of the amount of data, the choice of the outcome measures and the influence of other therapies. Furthermore, we will perform a power calculation using the data to estimate the sample size for the main trial. Discussion: The protocol of the pilot study is a first step towards a future main randomised controlled trial. This low risk pilot study might induce some benefits for the participants. However, we need to place its results into perspective, especially concerning the generalisability, as it remains questionable whether improving reaching constrained within a robotic device will ameliorate daily life reaching tasks. Trial registration: ClinicalTrials.gov Identifier: NCT02443857

Contextual interference in children with brain lesions: a pilot study investigating blocked vs. random practice order of an upper limb robotic exergame

Introduction Evidence about contextual interference in children with brain lesions when practising motor tasks is lacking. Our main objective was to evaluate the feasibility of a randomised controlled trial (RCT) comparing blocked with random practice order of an upper limb robotic exergame to improve reaching in children with neuromotor disorders with a pilot trial. Methods We recruited children with brain lesions and impaired upper limb functions who underwent a 3-week schedule that consisted of baseline assessments, intervention period (participants were randomised to a blocked or random order group), and follow-up assessment. We evaluated ten feasibility criteria, including the practicability of the inclusion/exclusion criteria, recruitment rate, feasibility of randomisation, scheduling procedure, and the participants’ programme adherence. Results The inclusion/exclusion criteria were not completely feasible as patients who were not able to perform the exergames were included. Twelve participants were recruited, and six datasets were used for analysis. The scheduling and randomisation procedures were generally feasible, but the procedure was only partially feasible for the participants, as some sessions were aborted due to lack of motivation and fatigue. Conclusion An RCT following this study protocol is not feasible. We formulated suggestions for future studies that aim to investigate contextual interference as in this pilot study. Trial registration ClinicalTrials.gov Identifier: NCT02443857, registered on May 14, 201