Twenty weeks of home-based interactive training of children with cerebral palsy improves functional abilities

BACKGROUND: Home-based training is becoming ever more important with increasing demands on the public health systems. We investigated whether individualized and supervised interactive home-based training delivered through the internet improves functional abilities in children with cerebral palsy (CP). METHODS: Thirty four children with CP (aged 9–16; mean age 10.9 ± 2.4 years) (GMFCS I-II; MACS I-II) were included in this non-randomized controlled clinical training study. 12 children (aged 7–16; mean age: 11.3+/−0.9 years) were allocated to a control group in which measurements were performed with 20 weeks interval without any intervening training. Daily activities, functional abilities of upper- and lower limbs, and balance were evaluated before, immediately after training and 12 weeks after training. The training consisted of 30 min daily home-based training for 20 weeks delivered through the internet. RESULTS: The training group on average completed 17 min daily training for the 20 week period (total of 40 h of training). The training group showed significant improvements of daily activities (AMPS), upper limb function (AHA) and functional tests of lower limbs (sit to stand, lateral step up, half knee to standing) after 20 weeks of training. No difference was found between the test after 20 weeks of training and the test 12 weeks after training. No significance was reached for balance after training. No difference was found for any parameter for the control group. CONCLUSIONS: Interactive home training of children with CP is an efficient way to deliver training, which can enable functional motor improvements and increased activity to perform daily activities. TRIAL REGISTRATION: ISRCTN13188513. Date of registration: 04/12/201

Altered sense of Agency in children with spastic cerebral palsy

<p>Abstract</p> <p>Background</p> <p>Children diagnosed with spastic Cerebral Palsy (CP) often show perceptual and cognitive problems, which may contribute to their functional deficit. Here we investigated if altered ability to determine whether an observed movement is performed by themselves (sense of agency) contributes to the motor deficit in children with CP.</p> <p>Methods</p> <p>Three groups; ₁₎CP children, ₂₎healthy peers, and ₃₎healthy adults produced straight drawing movements on a pen-tablet which was not visible for the subjects. The produced movement was presented as a virtual moving object on a computer screen. Subjects had to evaluate after each trial whether the movement of the object on the computer screen was generated by themselves or by a computer program which randomly manipulated the visual feedback by angling the trajectories 0, 5, 10, 15, 20 degrees away from target.</p> <p>Results</p> <p>Healthy adults executed the movements in 310 seconds, whereas healthy children and especially CP children were significantly slower (p < 0.002) (on average 456 seconds and 543 seconds respectively). There was also a statistical difference between the healthy and age matched CP children (p = 0.037). When the trajectory of the object generated by the computer corresponded to the subject's own movements all three groups reported that they were responsible for the movement of the object. When the trajectory of the object deviated by more than 10 degrees from target, healthy adults and children more frequently than CP children reported that the computer was responsible for the movement of the object. CP children consequently also attempted to compensate more frequently from the perturbation generated by the computer.</p> <p>Conclusions</p> <p>We conclude that CP children have a reduced ability to determine whether movement of a virtual moving object is caused by themselves or an external source. We suggest that this may be related to a poor integration of their intention of movement with visual and proprioceptive information about the performed movement and that altered sense of agency may be an important functional problem in children with CP.</p

Childhood development of common drive to a human leg muscle during ankle dorsiflexion and gait

Corticospinal drive has been shown to contribute significantly to the control of walking in adult human subjects. It is unknown to what extent functional change in this drive is important for maturation of gait in children. In adults, populations of motor units within a muscle show synchronized discharges during walking with pronounced coherence in the 15–50 Hz frequency band. This coherence has been shown to depend on cortical drive. Here, we investigated how this coherence changes with development. Forty-four healthy children aged 4–15 years participated in the study. Electromyographic activity (EMG) was recorded from pairs of electrodes placed over the right tibialis anterior (TA) muscle during static dorsiflexion and during walking on a treadmill (speed from 1.8 to 4.8 km h−1). A significant increase of coherence with increasing age was found in the 30–45 Hz frequency band (gamma) during walking and during static ankle dorsiflexion. A significant correlation with age was also found in the 15–25 Hz frequency band (beta) during static foot dorsiflexion. χ2 analysis of differences of coherence between different age groups of children (4–6, 7–9, 10–12 and 13–15 years of age) revealed a significantly lower coherence in the gamma band for recordings during walking in children aged 4–6 years as compared to older children. Recordings during static dorsiflexion revealed significant differences in both the beta and gamma bands for children in the 4–6 and 7–9 years age groups as compared to the older age groups. A significant age-related decrease in step-to-step variability of toe position during the swing phase of walking was observed. This reduction in the step-to-step variability of gait was correlated with increased gamma band coherence during walking. We argue that this may reflect an increased ability to precisely control the ankle joint position with age, which may be contingent on maturation of corticospinal control of the foot dorsiflexor muscles