Minimising impairment: Protocol for a multicentre randomised controlled trial of upper limb orthoses for children with cerebral palsy.

BACKGROUND: Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone. METHODS/DESIGN: This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score =1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed. DISCUSSION: This study will provide evidence to inform clinicians, services, funding agencies and parents/carers of children with CP whether the provision of a rigid WHO to reduce upper limb impairment, in combination with usual multidisciplinary care, is worth the effort and costs. TRIAL REGISTRATION: ANZ Clinical Trials Registry: U1111-1164-0572

INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia

Background: Congenital hemiplegia is the most common form of cerebral palsy (CP) accounting for 1 in 1300 live births. These children have limitations in capacity to use the impaired upper limb and bimanual coordination deficits which impact on daily activities and participation in home, school and community life. There are currently two diverse intensive therapy approaches. Traditional therapy has adopted a bimanual approach (BIM training) and recently, constraint induced movement therapy (CIMT) has emerged as a promising unimanual approach. Uncertainty remains about the efficacy of these interventions and characteristics of best responders. This study aims to compare the efficacy of CIMT to BIM training to improve outcomes across the ICF for school children with congenital hemiplegia

The construct of balance control in primary school-aged children: Unidimensional and task-specific

The aim of this study was to determine the dimensionality and task-specificity of balance control by investigating the relationships between different tasks and the degree to which these tasks belong to the same construct in primary school-aged children. Seventy-four South African children were randomly selected from a sample of convenience. They performed 18 different balance tasks that were grouped into four balance scales: the Performance and Fitness (PERF-FIT) static balance score, the PERF-FIT dynamic balance score, the PERF-FIT moving cans balance score and the Balance Sensory score. Spearman rank correlations were calculated between the scores. Principal component analysis (PCA) was used to investigate the number of factors within the construct. Moderate to good correlations were found between: i) PERF-FIT Moving cans balance score and the Balance Sensory score (r = 0.605, p < 0.001); ii) PERF-FIT static balance score and the PERF-FIT Moving cans (r = 0.586, p < 0.001); iii) PERF-FIT static balance score and the Balance Sensory score (r = 0.541, p < 0.001). All other correlations were low to fair. The PCA revealed one component. The three PERF-FIT items (moving cans-, static- and dynamic balance score) and the Balance Sensory score explained 59.4% of the variance of total balance performance

Windmill-task as a new quantitative and objective assessment for mirror movements in unilateral cerebral palsy: A pilot study

Contains fulltext : 194032.pdf (Publisher’s version ) (Open Access)Objective: To introduce the Windmill-task, a new objective assessment to quantify the presence of mirror movements (MMs) in children with unilateral cerebral palsy (uCP). In children with uCP MMs are frequently observed. They are typically assessed with the observation-based Woods and Teuber scale (W&T). However, due to its subjective nature and variable administration, interpretation of data across studies is problematic. Design: Prospective, observational, cohort pilot study. Setting: Children with uCP were recruited from Monash Children’s Hospital, Melbourne, Australia as a convenience sample from a cohort of children previously recruited for a larger study. Participants: Prospective cohort of 23 children with uCP (age range:6-15y, mean age=10y5m, SD=2y7m). Inclusion criteria were diagnosis of uCP with a Manual Ability Classification System (MACS)20 level I-III. Interventions: Not applicable. Main Outcome Measure(s): The concurrent validity of the Windmill-task is assessed and sensitivity and specificity for MM detection is compared between both assessments. To assess the concurrent validity, Windmill-data are compared to W&T-data using Spearman-rank (rho) correlations for two conditions (affected-hand-moving vs. less-affected-hand-moving). Sensitivity and specificity are compared by presenting the mean percentage of children being assessed inconsistently across both assessments. Results: Outcomes of both assessments correlated significantly (affected-hand-moving: rho=.520;p=.005; less-affected-hand-moving: rho=.488;p=.009). However, many children displayed MMs on the Windmill-task, but not on the W&T (sensitivity: affected-hand-moving:27.5%; less-affected-hand-moving:40.6%). Only two children displayed MMs on the W&T, but not on the Windmill-task (specificity: affected-hand-moving:2.9%; less-affected-hand-moving:1.4%)). Conclusions: The Windmill-task seems to be a valid tool to assess MMs in children with uCP and has additional advantage of sensitivity to detect MMs.6 p

Therapists' Use of Instructions and Feedback in Motor Learning Interventions in Children with Developmental Coordination Disorder: A Video Observation Study

AimThis qualitative study explored therapists' use of instructions and feedback when teaching motor tasks to children with developmental coordination disorder (DCD) as a first step in developing practical recommendations.MethodsA conventional content analysis approach was used to analyze videotaped treatment sessions of physical therapists using a newly developed analysis plan. Inductive coding was used to code purposively selected video segments. The codes were sorted into categories to identify key themes. Analyses were performed independently by two researchers until data saturation was reached.ResultsTen video-taped sessions were analyzed and 61 segments were coded. Three key themes were identified: (1) therapists' intention with the instructions and feedback was to motivate or to provide information; (2) the preferred therapists' teaching style was either direct or indirect; and (3) parameters to shape specific instructions and feedback were the focus of attention, modality, information content, timing and frequency.ConclusionTherapists used numerous instructions and feedback with different information content, often shaped by multiple focuses and/or modalities to motivate children or to provide specific information about task performance. Although therapists adapted instructions and feedback to child and task, future research should explore how characteristics of child and task can guide therapists' clinical decision-making