Bimanual Movement Characteristics and Real-World Performance Following Hand-Arm Bimanual Intensive Therapy in Children with Unilateral Cerebral Palsy

The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand-arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using standardized hand function tests. We found that accelerometer variables increased significantly during HABIT, indicating increased bimanual symmetry and intensity. Post-HABIT, children demonstrated significant improvements in all accelerometer metrics, reflecting real-world performance gains. Children also achieved significant and clinically relevant changes in hand capacity following HABIT. Therefore, our findings suggest that accelerometers can objectively quantify bimanual movement intensity during HABIT. Moreover, HABIT enhances hand function as well as activities and participation in real-world situations in children with UCP

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Bimanual Movement Characteristics and Real-World Performance Following Hand–Arm Bimanual Intensive Therapy in Children with Unilateral Cerebral Palsy

The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand–arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using standardized hand function tests. We found that accelerometer variables increased significantly during HABIT, indicating increased bimanual symmetry and intensity. Post-HABIT, children demonstrated significant improvements in all accelerometer metrics, reflecting real-world performance gains. Children also achieved significant and clinically relevant changes in hand capacity following HABIT. Therefore, our findings suggest that accelerometers can objectively quantify bimanual movement intensity during HABIT. Moreover, HABIT enhances hand function as well as activities and participation in real-world situations in children with UCP

THE EFFECTS OF MATERNAL PERINATAL EXERCISE ON INFANT NEUROMOTOR OUTCOMES

BACKGROUND: Aerobic exercise during pregnancy has been well established as safe and effective for both mother and infant. Few studies have examined the effects of different exercise modes during pregnancy on infant outcomes. The purpose of this study is to examine the effects of exercise mode during pregnancy on 1-month infant neuromotor outcomes. METHODS: Pregnant women were recruited and randomized to either aerobic (AE), resistance (RE), combination (CE), or control (CON) groups. Participants completed 150 min each week of supervised activity. After delivery, 1-month infant neuromotor skills were assessed using the Alberta Infant Motor Scales (AIMs) and Peabody Developmental Motor Scales, 2nd Edition. ANOVAs were used to compare differences between exercise groups; data was stratified by pre-pregnancy BMI (healthy weight, HW vs. overweight-obese, OO) and infant sex (M, F). Regressions assessed predictors of 1-month neuromotor outcomes. RESULTS: Groups were similar in maternal, neonate, and 1-month descriptors. Trends for improved subscores included: AE and RE in Prone (p=.20); CE in Sitting (p=.11); RE in Standing (p=.20) relative to controls. In females (F) from Healthy Weight (HW) women, all exercise types had increased gestational age (p=.03), AE and CE had greater Stationary (p=.17) subscores; in males (M) of HW women, all exercise types had greater Sitting (p=.02) subscores. In F from OO women, AE had greater total AIMs score (p=.20), while AE and RE had greater Stationary (p=.02) Locomotion (p=.06) subscores, as well as GMQ (p=.05) scores; in M of OO women, all exercise with increased height (p=.03) and weight (p=.02), RE with greater Prone (p=.03) and Standing (p=.04) subscores, with greater total AIMS (p=.04) scores. Controlling for other factors, we found significant predictors of 1-month neuromotor scores. Reflex scores were predicted by maternal exercise attendance, pre-pregnancy activity, fitness level, ethnicity, infant sex and body fat. Stationary scores were predicted by exercise mode, pre-pregnancy activity, baby BMI. GMQ was predicted by maternal exercise mode, race, delivery type, pre-pregnancy activity, BMI, and 1-month body fat. CONCLUSION: Maternal exercise mode or attendance, and infant body fat influences 1-month neuromotor skills. There are differences in 1-month neuromotor outcomes based on infant sex as well as maternal pre-pregnancy BMI. Further research is needed to understand this

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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