scholarly journals Protocol and Feasibility-Randomized Trial of Telehealth Delivery for a Multicomponent Upper Extremity Intervention in Infants With Asymmetric Cerebral Palsy

2020 ◽  
Vol 7 ◽  
pp. 2329048X2094621
Author(s):  
Lindsay Pietruszewski ◽  
Stephanie Burkhardt ◽  
Paul J. Yoder ◽  
Jill Heathcock ◽  
Dennis J. Lewandowski ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Upper Extremity ◽  
Training Session ◽  
Treatment Fidelity ◽  
Group Differences ◽  
Fine Motor ◽  
Motor Functioning ◽  
Intervention Delivery ◽  
Multicomponent Intervention ◽  
Telehealth Intervention

Background: Past work showed that an in-person, therapist-guided, parent-implemented multicomponent intervention increased the motor functioning of the more affected upper extremity (UE) in infants with asymmetric cerebral palsy. The authors document treatment fidelity and provide initial testing of telehealth intervention delivery in a new subject sample. Methods: The authors adapted the intervention manual used in the previous trial for telehealth. Infants (6-24 months) were randomly assigned to intervention (n = 7) or waitlist (n = 6). The intervention prescribed soft-constraint wear on the less affected UE for 6 hours, 5 d/wk, and exercises. After an initial in-person training session, three 15- to 45-minute telehealth sessions were performed. Results: Median weekly constraint wear was 21 hours (interquartile range = 10.3-29.7); average parent-treatment fidelity was 95.7% (SD 11.2). A significant large (Cohen d = 0.92) between-group differences occurred on fine motor functioning of more affected UEs. Conclusion: The telehealth intervention was feasible and potentially effective, but a larger trial is needed to evaluate efficacy.

scholarly journals Between Limb Muscle Co-activation Patterns in the Paretic Arm During Non-paretic Arm Tasks in Hemiparetic Cerebral Palsy

2021 ◽  
Vol 15 ◽  
Author(s):  
Nayo M. Hill ◽  
Theresa Sukal-Moulton ◽  
Julius P. A. Dewald
Keyword(s):  
Cerebral Palsy ◽  
Upper Extremity ◽  
Muscle Activation ◽  
Fine Motor ◽  
Shoulder Abduction ◽  
Descending Pathways ◽  
Activation Patterns ◽  
Effort Level ◽  
Co Activation ◽  
Muscle Activations

Tasks of daily life require the independent use of the arms and hands. Individuals with hemiparetic cerebral palsy (HCP) often experience difficulty with fine motor tasks demonstrating mirrored movements between the arms. In this study, bilateral muscle activations were quantified during single arm isometric maximum efforts and submaximal reaching tasks. The magnitude and direction of mirrored activation was examined in 14 individuals with HCP and 9 age-matched controls. Participants generated maximum voluntary torques (MVTs) in five different directions and completed ballistic reaches while producing up to 80% of shoulder abduction MVT. Electromyography (EMG) signals were recorded from six upper extremity muscles bilaterally. Participants with HCP demonstrated more mirrored activation when volitionally contracting the non-paretic (NP) arm than the paretic arm (F = 83.543, p < 0.001) in isometric efforts. Increased EMG activation during reach acceleration resulted in a larger increase in rest arm co-activation when reaching with the NP arm compared to the paretic arm in the HCP group (t = 8.425, p < 0.001). Mirrored activation is more pronounced when driving the NP arm and scales with effort level. This directionality of mirroring is indicative of the use of ipsilaterally terminating projections of the corticospinal tract (CST) originating in the non-lesioned hemisphere. Peripheral measures of muscle activation provide insight into the descending pathways available for control of the upper extremity after early unilateral brain injury.

Lumbopelvic Control and the Development of Upper Extremity Injury in Professional Baseball Pitchers

2021 ◽  
pp. 036354652098812
Author(s):  
Kevin Laudner ◽  
Regan Wong ◽  
Daniel Evans ◽  
Keith Meister
Keyword(s):  
Upper Extremity ◽  
Lower Limbs ◽  
Group Differences ◽  
Professional Baseball ◽  
Extremity Injury ◽  
Level Of Evidence ◽  
Balance Task ◽  
Upper Extremity Injury ◽  
Baseball Pitchers ◽  
Extremity Injuries

Background: The baseball-throwing motion requires a sequential order of motions and forces initiating in the lower limbs and transferring through the trunk and ultimately to the upper extremity. Any disruption in this sequence can increase the forces placed on subsequent segments. No research has examined if baseball pitchers with less lumbopelvic control are more likely to develop upper extremity injury than pitchers with more control. Purpose: To determine if baseball pitchers who sustain a chronic upper extremity injury have less lumbopelvic control before their injury compared with a group of pitchers who do not sustain an injury. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 49 asymptomatic, professional baseball pitchers from a single Major League Baseball organization participated. Lumbopelvic control was measured using an iPod-based digital level secured to a Velcro belt around each player’s waist to measure anteroposterior (AP) and mediolateral (ML) deviations (degrees) during single-leg balance with movement and static bridge maneuvers. During a competitive season, 22 of these pitchers developed upper extremity injuries, while the remaining 27 sustained no injuries. Separate 2-tailed t-tests were run to determine if there were significant differences in lumbopelvic control between groups ( P < .05). Results: There were no significant between-group differences for the stride leg (nondominant) during the bridge test in either the AP ( P = .79) or the ML ( P = .42) directions, or either direction during the drive leg bridge test ( P > .68). However, the injured group had significantly less lumbopelvic control than the noninjured group during stride leg balance in both the AP ( P = .03) and the ML ( P = .001) directions and for drive leg balance in both the AP ( P = .01) and the ML ( P = .04) directions. Conclusion: These results demonstrate that baseball pitchers with diminished lumbopelvic control, particularly during stride leg and drive leg single-leg balance with movement, had more upper extremity injuries than those with more control. Clinicians should consider evaluating lumbopelvic control in injury prevention protocols and provide appropriate exercises for restoring lumbopelvic control before returning athletes to competition after injury. Specific attention should be given to testing and exercises that mimic a single-limb balance task.

scholarly journals Reliability and validity of a computer game-based tool of upper extremity assessment for object manipulation tasks in children with cerebral palsy

2021 ◽  
Vol 8 ◽  
pp. 205566832110140
Author(s):  
Anuprita Kanitkar ◽  
Sanjay T Parmar ◽  
Tony J Szturm ◽  
Gayle Restall ◽  
Gina Rempel ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Upper Extremity ◽  
Performance Measures ◽  
Assessment Tool ◽  
Computer Game ◽  
Object Manipulation ◽  
Manual Dexterity ◽  
Assessment Tools ◽  
Significant Difference ◽  
Children With Cerebral Palsy

Introduction A computer game-based upper extremity (CUE) assessment tool is developed to quantify manual dexterity of children with Cerebral Palsy (CP). The purpose of this study was to determine test-retest reliability of the CUE performance measures (success rate, movement onset time, movement error, and movement variation) and convergent validity with the Peabody Developmental Motor Scale version 2 (PDMS-2) and the Quality of Upper Extremity Skills Test (QUEST). Methods Thirty-five children with CP aged four to ten years were tested on two occasions two weeks apart. Results CUE performance measures of five chosen object manipulation tasks exhibited high to moderate intra-class correlation coefficient (ICC) values. There was no significant difference in the CUE performance measures between test periods. With few exceptions, there was no significant correlation between the CUE performance measures and the PDMS-2 or the QUEST test scores. Conclusions The high to moderate ICC values and lack of systematic errors indicate that the CUE assessment tool has the ability to repeatedly record reliable performance measures of different object manipulation tasks. The lack of a correlation between the CUE and the PDMS-2 or QUEST scores indicates that performance measures of these assessment tools represent distinct attributes of manual dexterity.

Learning, Forgetting, and Relearning: Skill Learning in Children With Language Impairment

2014 ◽  
Vol 23 (4) ◽  
pp. 696-707 ◽  
Author(s):  
Esther Adi-Japha ◽  
Haia Abu-Asba
Keyword(s):  
Motor Skills ◽  
Skill Acquisition ◽  
Language Impairment ◽  
Specific Language Impairment ◽  
Skill Learning ◽  
Group Differences ◽  
Fine Motor ◽  
Specific Language ◽  
Retention Testing ◽  
Over Time

Purpose The current study tested whether the difficulties of children with specific language impairment (SLI) in skill acquisition are related to learning processes that occur while practicing a new skill or to the passage of time between practice and later performance. Method The acquisition and retention of a new complex grapho-motor symbol were studied in 5-year-old children with SLI and peers matched for age and nonverbal IQ. The children practiced the production of the symbol for 4 consecutive days. Retention testing took place 10 days later. Results Children with SLI began each practice day slower than their peers but attained similar levels of performance by its end. Although they increased their performance speed within sessions more than their peers, they did not retain their learning as well between sessions. The loss in speed was largest in the 10-day retention interval. They were also less accurate, but accuracy differences decreased over time. Between-session group differences in speed could not fully be accounted for based on fine motor skills. Conclusions In spite of effective within-session learning, children with SLI did not retain the new skill well. The deficit may be attributed to task forgetting in the presence of delayed consolidation processes.

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