Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) in Children With Unilateral Spastic Cerebral Palsy

2014 ◽  
Vol 29 (7) ◽  
pp. 645-657 ◽  
Author(s):  
Yannick Bleyenheuft ◽  
Carlyne Arnould ◽  
Marina B. Brandao ◽  
Corrine Bleyenheuft ◽  
Andrew M. Gordon
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Intensive Therapy ◽  
Spastic Cerebral Palsy

Effectiveness of Lower-Extremity Functional Training (LIFT) in Young Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial

2019 ◽  
Vol 33 (10) ◽  
pp. 862-872 ◽  
Author(s):  
Bhavini K. Surana ◽  
Claudio L. Ferre ◽  
Ashley P. Dew ◽  
Marina Brandao ◽  
Andrew M. Gordon ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Intensive Therapy ◽  
Mode Of Delivery ◽  
Spastic Cerebral Palsy ◽  
Control Group ◽  
Walking Ability ◽  
Home Setting ◽  
Functional Training ◽  
Secondary Outcomes

Background. Children with unilateral spastic cerebral palsy (USCP) have strength, coordination, and balance deficits affecting gross motor skills, such as walking, running, and jumping. However, there is a paucity of evidence for effective treatments for lower-extremity (LE) function in children with USCP. Objective. To determine the effectiveness of LE intensive functional training (LIFT) compared with an attention control group receiving upper-extremity bimanual training (Hand-Arm Bimanual Intensive Therapy [H-HABIT]). Methods. A total of 24 children with USCP were randomized to receive 90 hours of LIFT (5.8 [2.3] years) or an equivalent dosage of H-HABIT (5.1 [2.6] years) delivered 2 h/d, 5 d/wk for 9 weeks. Caregivers were trained to administer the intervention in the home setting. Progress and skill progression were monitored, and supervision was provided via weekly telerehabilitation. The primary outcome was the 1-minute walk test (1MWT). Secondary outcomes included self-selected and fast walking speeds, ABILOCO-kids, 30-s chair rise test, and single-leg stance. Results. LIFT showed greater improvement for the 1MWT ( P = .017) and ABILOCO-kids ( P = .008) compared with controls. The other secondary outcomes were not different between groups. Conclusions. The administration of LE intensive interventions in the home setting by caregivers was shown to be an effective and novel mode of delivery for improving gait capacity and performance. LIFT delivered in the home setting using telerehabilitation for monitoring resulted in improvements in ambulation distance and overall walking ability as compared to an intervention of equal intensity and duration that also controlled for the increased social interaction and attention between caregiver and child.

scholarly journals Effect of Passive Range of Motion Exercises on Lower-Extremity Goniometric Measurements of Adults With Cerebral Palsy: A Single-Subject Design

2002 ◽  
Vol 82 (7) ◽  
pp. 658-669 ◽  
Author(s):  
Sherri L Cadenhead ◽  
Irene R McEwen ◽  
David M Thompson
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Range Of Motion ◽  
Visual Analysis ◽  
Spastic Cerebral Palsy ◽  
Single Subject ◽  
Single Subject Design ◽  
Subject Design ◽  
Spastic Quadriplegia ◽  
Goniometric Measurements

Abstract Background and Purpose. People with spastic cerebral palsy often receive passive stretching that is intended to maintain or increase joint passive range of motion (PROM) even though the effectiveness of these exercises has not been definitively demonstrated. The purpose of this study was to determine the effect of PROM exercises on 6 adults with spastic quadriplegia and contractures. Participants. Four men and 2 women (X̄=31 years of age, range=20–44 years) who lived in an institution for people with mental retardation participated in the study. Methods. The authors used 2 multiple baseline designs. Three participants (group 1) received lower-extremity PROM exercises during phase A; PROM exercises were discontinued during phase B. Three participants (group 2) did not receive PROM exercises during phase A; PROM exercises were initiated during phase B. Data were analyzed using visual analysis and the C statistic. Results. Results varied with the method of analysis; however, phase A and phase B measurements, overall, did not differ for either group. Discussion and Conclusion. This study demonstrated use of a single-subject design to measure the effect of PROM exercises on adults with cerebral palsy. The authors concluded that the PROM exercise protocol did not have an effect on the lower-extremity goniometric measurements of the participants.

scholarly journals Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy

1998 ◽  
Vol 4 (1) ◽  
pp. E7 ◽  
Author(s):  
Peter C. Gerszten ◽  
A. Leland Albright ◽  
Graham F. Johnstone
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Orthopedic Surgery ◽  
Intrathecal Baclofen ◽  
Orthopedic Procedures ◽  
Spastic Cerebral Palsy ◽  
Spastic Diplegia ◽  
Spastic Quadriplegia ◽  
Orthopedic Operation ◽  
The Mean

Intrathecal baclofen infusion (IBI) is an effective treatment for spasticity secondary to cerebral palsy (CP). The authors retrospectively reviewed the need for orthopedic surgery of the lower extremities in 48 patients with spastic CP who were treated with IBI. Forty pumps were placed in patients suffering from spastic quadriplegia (84%) and eight (16%) in patients with spastic diplegia. The patients' ages ranged from 5 to 43 years (mean 15 years). The mean follow-up period was 53 months (range 22-94 months). The mean baclofen dosage was 306 μg/day (range 25-1350 μg/day). At the time of pump placement, subsequent orthopedic surgery was planned in 28 patients (58%); however, only 10 (21%) underwent orthopedic surgery after IBI therapy. In all 10 cases, the surgical procedure was planned at the time of initial evaluation for IBI therapy. In the remaining 18 patients, who did not subsequently undergo their planned orthopedic operation, it was believed that their lower-extremity spasticity had improved to the degree that orthopedic intervention was no longer indicated. In addition, although six patients had undergone multiple orthopedic operations before their spasticity was treated, no patient required more than one orthopedic operation after IBI treatment for their spasticity. The authors conclude that IBI for treatment of spastic CP reduces the need for subsequent orthopedic surgery for the effects of lower-extremity spasticity. In patients with spastic CP and lower-extremity contractures, spasticity should be treated before orthopedic procedures are performed.

Effectiveness of Hand-Arm Bimanual Intensive Therapy on Hand Function among Children with Unilateral Spastic Cerebral Palsy: A Meta-Analysis

2020 ◽  
Vol 83 (2) ◽  
pp. 131-137
Author(s):  
Khalid Alahmari ◽  
Jaya Shanker Tedla ◽  
Devika Rani Sangadala ◽  
Debjani Mukherjee ◽  
Ravi Shankar Reddy ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Effect Size ◽  
Meta Analysis ◽  
Hand Function ◽  
Intensive Therapy ◽  
Spastic Cerebral Palsy ◽  
Randomized Controlled ◽  
Constraint Induced Movement Therapy ◽  
Evidence Database ◽  
The Individual

Background: Hand-arm bimanual intensive therapy (HABIT) has been shown to be an effective method for improving upper-extremity function. However, owing to ambiguity within the evidence of HABIT’s effects on hand function among children with unilateral spastic cerebral palsy (CP), this meta-analysis sought to elucidate whether the same was true in this patient population. Summary: A computerized database search yielded 468 studies. After meticulous scrutiny and screening of these studies according to the selection criteria, 4 full-text articles were included in the meta-analysis. All 4 studies underwent a methodological quality assessment according to the Physiotherapy Evidence Database Scale (PEDro), with a score of greater than 8. Five comparisons were then made involving the 4 selected randomized controlled trials (RCTs). The effect size was measured using the correlation coefficient (r value). The effect sizes of the individual studies were 0.006, 0.03, 0.04, 0.22, and 0.15. The total effect size was 0.06. Key Message: This meta-analysis determined that there is a trivial benefit using HABIT when compared to constraint-induced movement therapy or structured and unstructured bimanual therapy in pediatric patients with unilateral spastic CP. More RCTs are needed to substantiate our evidence.

Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy

2013 ◽  
Vol 12 (6) ◽  
pp. 588-594 ◽  
Author(s):  
Paul Gigante ◽  
Michael M. McDowell ◽  
Samuel S. Bruce ◽  
Genevieve Chirelstein ◽  
Claudia A. Chiriboga ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Upper Extremities ◽  
Spastic Cerebral Palsy ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Modified Ashworth Scale ◽  
Muscle Groups ◽  
Ashworth Scale

Object Randomized clinical trials have established that lumbar selective dorsal rhizotomy (SDR) reduces lower-extremity tone and improves functional outcome in children with spastic cerebral palsy. Significant data exist to support a secondary effect on upper-extremity function in patients with upper-extremity spasticity. The effects of SDR on upper-extremity tone, however, are not well characterized. In this report, the authors sought to assess changes in upper-extremity tone in individual muscle groups after SDR and tried to determine if these changes could be predicted preoperatively. Methods The authors retrospectively reviewed 42 children who underwent SDR at Columbia University Medical Center/Morgan Stanley Children's Hospital of NewYork-Presbyterian between 2005 and 2011. Twenty-five had upper-extremity spasticity. All underwent pre- and postoperative examination for measuring tone (Modified Ashworth Scale) and assessing functional outcome. Follow-up examinations with therapists were performed at least once at a minimum of 2 months postoperatively (mean 15 months). Results In the upper extremities, 23 (92%) of 25 patients had improvements of at least 1 Ashworth point in 2 or more independent motor groups on the Modified Ashworth Scale, and 12 (71%) of 17 families surveyed reported increases in motor control or spontaneous movement. The mean Modified Ashworth Scale scores for all upper-extremity muscle groups demonstrated an improvement from 1.34 to 1.22 (p < 0.001). Patients with a mean preoperative upper-extremity tone of 1.25–1.75 were most likely to benefit from reduction in tone (p = 0.0019). Proximal and pronator muscle groups were most likely to demonstrate reduced tone. Conclusions In addition to improvements in lower-extremity tone and function, SDR has demonstrable effects on upper extremities. Greater than 90% of our patients with elevated upper-extremity tone demonstrated reduction in tone in at least 2 muscle groups postoperatively. Patients with a mean Modified Ashworth Scale upper-extremity score of 1.25–1.75 may encounter the greatest reduction in upper-extremity tone.

Sign in / Sign up

Export Citation Format

Share Document