Physical Therapy Clinical Management Recommendations for Children with Cerebral Palsy - Spastic Diplegia: Achieving Functional Mobility Outcomes

Background: Few studies have focused on magnetic resonance imaging (MRI) brain findings associated with functional mobility in cerebral palsy. Objective: To determine association between MRI findings and Gross Motor Functional Classification System (GMFCS) levels in cerebral palsy. Methods: Prospective-observational study conducted in Pediatric Neurology Clinic at a public teaching hospital, Northern India. First 3 new cases of cerebral palsy were enrolled on particular neuro-clinic day per week for 1 year. Functional mobility was classified according to GMFCS. Association between MRI findings, cerebral palsy type, and GMFCS levels were evaluated using χ2 test. Results: A total of 138 cases (mean age 2.71 [SD = 1.91] years; male [64.5%]) were enrolled. Reported types of cerebral palsy were as follows: spastic quadriplegia (47.8%), spastic diplegia (28.35%), spastic hemiplegia (11.6%), extrapyramidal (6.5%), and ataxic/hypotonic (5.8%). GMFCS were classified into level 1 (13%), level 2 (7.2%), level 3 (4.3%), level 4 (10.9%), and level 5 (64.5%). Spastic quadriplegia and extrapyramidal cerebral palsy were significantly associated with higher (severe) levels (IV and V), whereas spastic diplegia and hemiplegia were significantly associated with lower (mild) levels (I-III) of GMFCS. MRI features of periventricular white matter injury, deep gray matter injury, basal ganglia and thalamic changes, and superficial gray matter injury were significantly associated with severe levels of GMFCS (V and IV). MRI was normal in 8 children (5 = mild category, 3 = severe category). Conclusion: Severe cerebral palsy is most often associated with spastic quadriplegia, extrapyramidal cerebral palsy, superficial gray matter lesions, deep gray matter lesions, and periventricular white matter injury. This information is useful for anticipating and addressing the needs of children with cerebral palsy and for prognostication.

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Efficiency of image visualization simulator technology for physical rehabilitation of children with cerebral palsy through play

Bulletin of Russian State Medical University ◽

10.24075/brsmu.2019.051 ◽

2019 ◽

pp. 39-46 ◽

Cited By ~ 1

Author(s):

V.V. Gorelik ◽

S.N. Filippova ◽

V.S. Belyaev ◽

E.V. Karlova

Keyword(s):

Virtual Reality ◽

Cerebral Palsy ◽

Physical Therapy ◽

Physical Rehabilitation ◽

Spastic Cerebral Palsy ◽

Control Group ◽

Spastic Diplegia ◽

Training Simulator ◽

Image Visualization ◽

Children With Cerebral Palsy

The number of children born with cerebral palsy (CP) remains stably high. Novel approaches for rehabilitation of such patients are being sought. This study aimed to define the efficiency of the image visualization technologies in play activity for the physical rehabilitation of children with cerebral palsy. Sixteen boys with spastic diplegia aged 7–9 participated in the study. They were divided into treatment group (TG) and control group (CG), 8 children each. The TG patients were trained using the virtual reality based Krisaf training simulator twice a week for 40 minutes during 8 months. The child was suspended in the horizontal position and looked at the monitor through the specialised eyeglasses. Under the conditions of the marine environment immersion simulation with reduced gravity children performed motor tasks through play: searched for treasures, competed with dolphins etc. The CG patients attended the physical therapy lessons. Rehabilitation lessons using the virtual reality based Krisaf training simulator for children affected with spastic cerebral palsy led to a significant improvement of motor skills. Various motion tests showed an improvement over baseline, the average indicators increased 1.30–1.48 times. The difference between TG and CG results was statistically significant. In the CG referred to physical therapy the indicators increase was less than 10%, in the TG the increase reached 30–40%. It was concluded that the use of virtual reality based technologies promotes the optimization of neurophysiological processes in the motor analyzer cortical areas and better adaptation to motor loads.

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Physical therapy treatments incorporating equine movement: a pilot study exploring interactions between children with cerebral palsy and the horse

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00929-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Priscilla Lightsey ◽

Yonghee Lee ◽

Nancy Krenek ◽

Pilwon Hur

Keyword(s):

Cerebral Palsy ◽

Pilot Study ◽

Physical Therapy ◽

Functional Mobility ◽

Human Gait ◽

Measurement Unit ◽

Link Type ◽

Children With Cerebral Palsy ◽

Vertical Accelerations ◽

Therapy Sessions

Abstract Background Physical therapy treatments incorporating equine movement are recognized as an effective tool to treat functional mobility and balance in children with cerebral palsy (CP). To date, only a few studies examined kinematic outputs of the horses and children when mounted. In this pilot study, to better understand the effectiveness of this type of treatment, we examined the interaction between the horses and children with CP during physical therapy sessions where equine movement was utilized. Methods Four children with CP participated in eight physical therapy sessions incorporating hippotherapy as a treatment intervention. Functional mobility was assessed using the Timed Up Go or the 10 m Walk Test. Inertial measurement unit sensors, attached to children and horses, recorded movements and tracked acceleration, angular velocity, and body orientation. Correlation between vertical accelerations of children and horses were analyzed. In addition, peak frequencies of vertical accelerations of children and horses were compared. Results Functional tests modestly improved over time. The children’s movements, (quantified in frequency and temporal domains) increasingly synchronized to the vertical movement of the horse’s walk, demonstrated by reduced frequency errors and increased correlation. Conclusions The findings suggest that as the sessions progressed, the participants appeared to become more familiar with the horse’s movement. Since the horse’s gait at a walk mimics the human gait this type of treatment may provide individuals with CP, who have abnormal gait patterns, an opportunity for their neuromuscular system to experience a typical gait pattern. The horse’s movement at the walk are consistent, cyclical, rhythmical, reciprocal and multi-dimensional, all of which can facilitate motor learning. The increased synchronization between horse and the mounted participant suggests that physical therapy utilizing equine movement is a viable treatment tool to enhance functional mobility. This study may provide a useful baseline for future work. Trial registrationTexas A&M University Institutional Review Board. IRB2018-0064. Registered 8 March 2018. Link: https://rcb.tamu.edu/humans/irb and https://github.com/pilwonhur/HPOT

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Physical Therapy Treatments Incorporating Equine Movement: A Pilot Study Exploring Kinetic Interactions between Children with Cerebral Palsy and the Horse

10.21203/rs.3.rs-382424/v1 ◽

2021 ◽

Author(s):

Priscilla Lightsey ◽

Yonghee Lee ◽

Nancy Krenek ◽

Pilwon Hur

Keyword(s):

Cerebral Palsy ◽

Pilot Study ◽

Physical Therapy ◽

Functional Mobility ◽

Human Gait ◽

Measurement Unit ◽

Abnormal Gait ◽

Children With Cerebral Palsy ◽

Vertical Accelerations ◽

Therapy Sessions

Abstract BackgroundPhysical therapy treatments incorporating equine movement is recognized as an effective tool to treat functional mobility and balance in children with cerebral palsy (CP). To date, only a few studies examined kinematic outputs of the horses and children when mounted. In this pilot study, we examined the interaction between the horses and children with CP during physical therapy sessions where equine movement was utilized to better understand the effectiveness of this type of treatment.MethodsFour children with CP participated in eight physical therapy sessions incorporating hippotherapy as a treatment intervention. Functional mobility was assessed using the Timed Up Go or 10m Walk Test. Inertial measurement unit sensors, attached to children and horses, recorded movements and tracked acceleration, angular velocity, and body orientation. Correlation between vertical accelerations of children and horses were analyzed. In addition, peak frequencies of vertical accelerations of children and horses were compared.ResultsFunctional tests modestly improved over time. The children’s movements, (quantified in frequency and temporal domains) increasingly synchronized to the vertical movement of the horse’s walk, demonstrated by reduced frequency errors and increased correlation.ConclusionsThe findings suggest that as the sessions progressed, the participants appeared to become more familiar with the horse’s movement. Since the horse’s gait at a walk mimics the human gait this type of treatment may provide individuals with CP, who have abnormal gait patterns, an opportunity for the neuromuscular system to experience a typical gait pattern. The horse’s movement at the walk are consistent, cyclical, rhythmical, reciprocal and multi-dimensional which can facilitate motor learning. Thus, the increased synchronization between horse and the mounted participant suggests that physical therapy utilizing equine movement is a viable treatment tool to enhance functional mobility. This study may provide a useful baseline for future work.Trial registrationTexas A&M University Institutional Review Board. IRB2018-0064. Registered 8 March 2018. Link: https://rcb.tamu.edu/humans/irb and https://github.com/pilwonhur/HPOT

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Standardized Outcomes Measures in Physical Therapy Practice for Treatment and Rehabilitation of Cerebral PALSY: A Systematic Review

Journal of Personalized Medicine ◽

10.3390/jpm11070604 ◽

2021 ◽

Vol 11 (7) ◽

pp. 604

Author(s):

Maria Dolores Apolo-Arenas ◽

Aline Ferreira de Araújo Jerônimo ◽

Alejandro Caña-Pino ◽

Orlando Fernandes ◽

Joana Alegrete ◽

...

Keyword(s):

Cerebral Palsy ◽

Physical Therapy ◽

Gait Training ◽

Physical Therapy Modalities ◽

Spastic Diplegia ◽

Evaluation Procedures ◽

Outcomes Measures ◽

Prisma Statement ◽

Spastic Hemiplegia

Cerebral palsy (CP) treatment includes physical therapy and various complementary therapies to the standard clinical treatment. However, there are not many reviews that focus on the methods used and evaluation procedures. This study aims to analyze which tools are most suitable for the evaluation and methodology of patients with CP treated with physical therapy. Following the PRISMA statement, through a PICOS strategy, PubMed/MEDLINE, Web of Science (WOS), Scopus, Science Direct, and Scielo were searched with the following terms: cerebral palsy AND (physical therapy modalities OR therapeutics) AND outcome assessment. The methodological quality of the RCTs was assessed with the Evidence Project risk of bias tool. Thirty-seven RCTs and six RCT protocols, comprising 1359 participants with different types of CP: spastic hemiplegia/paresis, spastic diplegia/paresis, and spastic CP, met the inclusion criteria, uncovering 21 variables measured through 77 different instruments and several interventions. The therapies most widely used in CP are gaming or technology-assisted therapies, aerobic training, hippotherapy, music therapy, gait training, and aquatic exercises. This study provides an overview of what the authors used in the neurorehabilitation field through procedure evaluation and checking the technological advance that began to be used.

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Effect of physical therapy interventions on spatiotemporal gait parameters in children with cerebral palsy: a systematic review

Disability and Rehabilitation ◽

10.1080/09638288.2019.1671500 ◽

2019 ◽

pp. 1-10

Author(s):

Carolina Corsi ◽

Mariana M. Santos ◽

Roberta F. C. Moreira ◽

Adriana N. dos Santos ◽

Ana C. de Campos ◽

...

Keyword(s):

Systematic Review ◽

Cerebral Palsy ◽

Physical Therapy ◽

Gait Parameters ◽

Children With Cerebral Palsy ◽

Therapy Interventions

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Effects of Dynamic Elastomeric Fabric Orthoses on Children with Cerebral Palsy

Prosthetics and Orthotics International ◽

10.3109/03093640903150287 ◽

2009 ◽

Vol 33 (4) ◽

pp. 339-347 ◽

Cited By ~ 17

Author(s):

Martin John Matthews ◽

Martin Watson ◽

Barbara Richardson

Keyword(s):

Cerebral Palsy ◽

Single Case ◽

Phase 1 ◽

Functional Mobility ◽

Gait Velocity ◽

Controlled Study ◽

Patient Specific ◽

Spastic Diplegia ◽

Cost Index ◽

Beneficial Effects

This phase 1 exploratory study aimed to establish proof of concept of the effects of dynamic elastomeric fabric orthoses (DEFOs) on the gait of children with spastic diplegic cerebral palsy. Replicated single case experiments employing an ABA methodology were carried out on eight subjects (median age 5.5 years, range 3–13 years; 4 girls/boys) utilizing quantitative/qualitative data collection. Outcome measures were: Ten metre walking test (10MWT); physiological cost index (PCI); visual analogue scale (VAS) scoring of perceived gait changes; functional mobility changes using Patient Specific Functional Scale (PSFS); subject/carer perceptions recorded in daily diaries. Results identified following analysis of quantitative data indicated a treatment effect from the orthoses which could be corroborated by participant subjective impressions and comments. Statistically significant ( p < 0.05) intervention-related improvements in gait velocity and gait consistency were identified respectively in 5/8 and 4/8 subjects. Power calculations support the feasibility of a larger controlled study to further investigate this orthotic intervention. This study indicates that DEFO leggings can confer beneficial effects on the gait of some children with spastic diplegia resulting from CP. These findings have implications for orthotic intervention with this subject group.

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INTENSIVE PHYSICAL THERAPY FOR TWO CHILDREN WITH CEREBRAL PALSY

Pediatric Physical Therapy ◽

10.1097/00001577-200601810-00029 ◽

2006 ◽

Vol 18 (1) ◽

pp. 84-85 ◽

Cited By ~ 1

Author(s):

Jennifer Braswell ◽

Anna Benedict ◽

Corinne Chapman ◽

Lisa Steed ◽

Sheree C. York

Keyword(s):

Cerebral Palsy ◽

Physical Therapy ◽

Children With Cerebral Palsy

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Discontinuation of Antiepileptic Drug Treatment After Two Seizure-free Years in Children With Cerebral Palsy

PEDIATRICS ◽

10.1542/peds.97.2.192 ◽

1996 ◽

Vol 97 (2) ◽

pp. 192-197

Author(s):

Mauricio R. Delgado ◽

Anthony R. Riela ◽

Janith Mills ◽

Alan Pitt ◽

Richard Browne

Keyword(s):

Cerebral Palsy ◽

Mental Retardation ◽

Antiepileptic Drug ◽

Spastic Diplegia ◽

Multiple Factors ◽

Spastic Hemiparesis ◽

Children With Cerebral Palsy ◽

Epileptic Children ◽

Seizure Relapse ◽

Antiepileptic Drug Treatment

Objective. The risk of seizure relapse after antiepileptic drug (AED) discontinuation in children has been reported to vary between 6% and 40%. It has been suggested that neurologic deficit and mental retardation are poor prognostic factors for seizure relapse after AED discontinuation. Because epileptic children with cerebral palsy (CP) have neurologic deficits, and many have mental retardation, it is important to know their risk for seizure relapse. Methods. AED treatment was discontinued in 65 children with CP and histories of epilepsy after 2 seizure-free years. All of the patients were followed until they had seizure relapses or for at least 2 years without seizures after AEDs were stopped. Multiple factors were analyzed for possible association with seizure relapse. Results. Twenty-seven patients (41.5%) had seizure relapses. Patients with spastic hemiparesis had the highest relapse rate (61.5%), and those with spastic diplegia had the lowest rate (14.3%). No other factor correlated significantly with the risk of seizure relapse. Conclusions. Discontinuation of AEDs in children with CP can, and should, be practiced when possible after patients have been seizure-free for at least 2 years. AED discontinuation in patients with spastic hemiparesis is significantly more likely to lead to seizure relapse than in patients with other CP types, but no other factor is yet known to increase the chance of relapse.

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