Effect of respiratory therapy on pulmonary functions in children with cerebral palsy: a systematic review

Abstract Background Children with cerebral palsy (CP) are at risk for respiratory dysfunction. Early initiation of pulmonary rehabilitation in addition to conventional physical therapy may result in improvement and maintenance of chest mobility and respiratory function. However, empirical support for respiratory therapy is limited. The aim of the review was to assess the evidence of the effectiveness of respiratory therapy on pulmonary functions in children with CP. Methods Four electronic databases (PubMed, Cochrane Library, Physiotherapy Evidence Database (PEDro), and Google Scholar) were searched till December 2019 using predefined terms by two independent reviewers. Randomized controlled trials published in English were included if they met the following criteria: population—children with different types of CP of both sex, aged up to 18 years; intervention—respiratory therapy; outcomes—pulmonary functions. Eight studies with 235 participants only met the inclusion criteria and were included in this review. Predefined data were tabulated using American Academy for Cerebral Palsy and Developmental Medicine by two reviewers and verified by a third reviewer. Methodological quality was assessed using rating system of quality assessment and PEDro scale; also, levels of evidence adopted from modified Sacket’s scale were used for each outcome. Results The quality of studies ranged from excellent (one study) to good (five studies) and fair (two studies). The results showed level 1 (six studies) and level 2 (two studies) on modified Sacket’s scale for level of evidence. Lack of allocation concealment and blinding was the major risk of bias in the included studies. Conclusions Meta-analysis revealed significant difference in the improvement of vital capacity, peak expiratory flow, and forced expiratory volume at 1 s in favor of the study groups. However, there is a need for high-quality studies to draw a clear conclusion.

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Effect of oromotor exercises on feeding in children with cerebral palsy: systematic review

Bulletin of Faculty of Physical Therapy ◽

10.1186/s43161-021-00054-8 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Rania El Nagar ◽

Alaa AL-Nemr ◽

Faten Abdelazeim

Keyword(s):

Systematic Review ◽

Cerebral Palsy ◽

Descriptive Analysis ◽

Sensory Stimulation ◽

Cochrane Library ◽

Feeding Problems ◽

Level Of Evidence ◽

Weak Evidence ◽

Children With Cerebral Palsy ◽

Meta Analyses

Abstract Background Feeding problems are prevalent in children with cerebral palsy (CP). Oromotor exercises (OME) should be started as soon as possible to enhance chewing and drooling. Oromotor exercises consist of active exercises, passive exercises, and sensory stimulation. The purpose of this review is to evaluate the effectiveness of oromotor exercises on feeding, chewing, and drooling in children with CP. Body The American Academy for Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology were used to conduct a systematic review. Four databases (PubMed, Cochrane Library, PEDro, and Google Scholar) were searched; this review includes seven articles, participants were 173 participants ranging in age from 18 months to 18 years. Articles were assessed according to their level of evidence and quality assessment was done by AACPDM, PEDro scale, and JBI scale. Due to the heterogeneity across included studies, descriptive analysis was performed on all of them. Primary outcomes were chewing and drooling. Results showed the effectiveness of OME in improving drooling, but with weak evidence while not effective in improving chewing. Conclusion High-quality studies are required to develop a firm judgment on the influence of oromotor exercises on feeding. The current level of evidence to support the effectiveness of oromotor exercises in children with CP is currently insufficient.

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Effects of backward gait training on balance, gross motor function, and gait in children with cerebral palsy: a systematic review

Clinical Rehabilitation ◽

10.1177/0269215518790053 ◽

2018 ◽

Vol 33 (1) ◽

pp. 3-12 ◽

Cited By ~ 6

Author(s):

Ahmed M Elnahhas ◽

Shorouk Elshennawy ◽

Maya G Aly

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Step Length ◽

Gait Training ◽

Cochrane Library ◽

Level Of Evidence ◽

Gross Motor ◽

Gross Motor Function ◽

Positive Effects ◽

Children With Cerebral Palsy

Objective: To investigate the effects of backward gait training on balance, gross motor function, and gait parameters in children with cerebral palsy. Data sources: PubMed, Cochrane Library, Web of Science, Science Direct, Physiotherapy Evidence Database (PEDro), and Google Scholar were searched up to May 2018. Review methods: Randomized controlled trials were included if they involved any form of backward gait training for children with cerebral palsy. Two authors independently screened articles, extracted data and assessed the methodological quality using PEDro scale, with any confliction resolved by the third author. Modified Sackett Scale was used to determine the level of evidence for each outcome. Results: Out of 1492 papers screened, 7 studies with 172 participants met the inclusion criteria. The duration of treatment ranged from 15 to 25 minutes, three times a week and for 6–12 weeks. The quality of studies ranged from good (two studies) to fair (four studies) and poor (one study), with a mean PEDro score of 4.7 out of 10. All included studies showed positive effects in the measured outcomes. The results showed level 1b evidence for balance when compared to no intervention, and for gross motor function, step length and walking speed when compared to same dose of forward gait training. The clinical heterogeneity of studies makes meta-analysis inappropriate. Conclusion: In children with cerebral palsy, there is moderate evidence that backward gait training improves balance, gross motor function, step length and walking velocity. More high-quality studies are needed.

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

Journal of Rehabilitation and Assistive Technologies Engineering ◽

10.1177/20556683211014023 ◽

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.

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Randomized controlled trial of occupational performance coaching for mothers of children with cerebral palsy

British Journal of Occupational Therapy ◽

10.1177/0308022618799944 ◽

2018 ◽

Vol 82 (4) ◽

pp. 213-219 ◽

Cited By ~ 4

Author(s):

Mina Ahmadi Kahjoogh ◽

Dorothy Kessler ◽

Seyed Ali Hosseini ◽

Mehdi Rassafiani ◽

Nazila Akbarfahimi ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cerebral Palsy ◽

Self Efficacy ◽

Controlled Trial ◽

Performance Measure ◽

Occupational Performance ◽

Randomized Controlled ◽

Performance Coaching ◽

Significant Difference ◽

Children With Cerebral Palsy

Introduction The purpose of this study was to assess the efficacy of occupational performance coaching in mothers of children with cerebral palsy. Method A randomized controlled trial was used. Thirty mothers of children with cerebral palsy were randomly assigned to an occupational performance coaching group or control group. The Canadian Occupational Performance Measure and Sherer General Self-efficacy Scale were measured before and after the study. Results Occupational performance coaching had significant effects on participants’ occupational performance and self-efficacy. In child-related goals, there was also a statistically significant difference between two groups ( p = 0.05). Conclusion The results indicated that occupational performance coaching could be an effective intervention to increase the self-efficacy of mothers and improve the occupational performance of children and mothers of children with cerebral palsy. This trial is registered at NCT02915926 at clinicaltrials.gov

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Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210044 ◽

2021 ◽

pp. 1-9

Author(s):

Robert M. Kay ◽

Kristan Pierz ◽

James McCarthy ◽

H. Kerr Graham ◽

Henry Chambers ◽

...

Keyword(s):

Cerebral Palsy ◽

Rectus Femoris ◽

Delphi Consensus ◽

Level Of Evidence ◽

Modified Delphi ◽

International Panel ◽

Children With Cerebral Palsy ◽

Stiff Knee ◽

Paediatric Orthopaedic ◽

Gmfcs Level

Purpose The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method. Methods The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. Results Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade. Conclusion This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP. Level of evidence V

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The Effectiveness and Safety of Thunder Fire Moxibustion for Treating Allergic Rhinitis: A PRISMA Compliant Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/6760436 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Ting Yuan ◽

Jun Xiong ◽

Jun Yang ◽

Xue Wang ◽

Yunfeng Jiang ◽

...

Keyword(s):

Allergic Rhinitis ◽

Adverse Events ◽

Assessment Tool ◽

Total Effective Rate ◽

Meta Analysis ◽

Effective Rate ◽

Cochrane Library ◽

Level Of Evidence ◽

Randomized Controlled ◽

Significant Difference

Background. Allergic rhinitis (AR) is a noninfectious inflammatory disease caused by allergic individuals exposed to allergens. Western medicine therapy for treating AR causes obvious adverse events, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Therefore, we conducted this meta-analysis to evaluate the effectiveness and safety of TFM for treating AR. Methods. PubMed, Web of Science, Embase, the Cochrane Library, CNKI, WanFang, VIP, and CBM from inception to April 5, 2020, were searched without any language restriction. Reviewers identified studies, extracted data, and assessed the quality, independently. The primary outcomes were the total effective rate and the TNSS. The secondary outcomes included TNNSS, RQLQ, VAS, serum IgE, IgA, or IgG level, and adverse events. Randomized controlled trials (RCTs) were collected; methodological quality was evaluated using the Cochrane risk of bias assessment tool (RoB), and the level of evidence was rated using the GRADE approach. Meta-analysis was performed using the RevMan5.3.0 software. Results. A total of 18 RCTs were included, including 1600 patients. The results of this meta-analysis showed a statistically significant effect in a total effective rate of T = TFM (RR = 1.07; 95% CI [1.03, 1.12]; P=0.45; I2 = 0%) and T = TFM + other treatments (RR = 1.18; 95% CI [1.11, 1.25]; P=0.03; I2 = 53%). In addition, TFM intervention also showed significant difference in total symptom score (T = TFM + other treatments) (MD = −1.42; 95% CI [−1.55, −1.29]; P=0.03; I2 = 60%) in patients with AR. Conclusion. Existing evidence shows that TFM is safe and effective for AR. Due to the universal low quality of the eligible trials and low evidence level, we should draw our conclusions with caution. Therefore, clinical researchers should carry out more large-sample, multicentre, high-quality randomized controlled clinical trials in the future to verify the clinical efficacy of TFM in treating AR.

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An evidence-based review of hyperbaric oxygen for children with cerebral palsy

South African Journal of Physiotherapy ◽

10.4102/sajp.v57i4.519 ◽

2001 ◽

Vol 57 (4) ◽

pp. 21-22

Author(s):

F. M. Bischof

Keyword(s):

Cerebral Palsy ◽

Pilot Study ◽

Motor Function ◽

Controlled Trial ◽

Evidence Based ◽

Level Of Evidence ◽

Double Blind ◽

Double Blind Placebo ◽

Children With Cerebral Palsy ◽

High Level

This paper reviews the evidence in the literature for the use of hypebaric oxygen (HBO) in the treatment of cerebral palsy (CP). To date there are only two published studies on the outcome of HBO administration in CP. A pilot study showed significant improvement in gross motor function but provided a low level of evidence. A recent multicentre, double blind, placebo controlled trial reported similar improvements in both HBO and placebo groups, but no difference between the groups. This study had a high level of evidence. The results suggest that participation in the trial produced clinically important gains in function. The outcome of the study implies that HBO may have a placebo effect in CP.

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Access to Intrathecal Baclofen Treatment for Children with Cerebral Palsy in European Countries: An SCPE Survey Reveals Important Differences

Neuropediatrics ◽

10.1055/s-0040-1701659 ◽

2020 ◽

Vol 51 (02) ◽

pp. 129-134

Author(s):

Kate Himmelmann ◽

Magnus Påhlman ◽

Guro L. Andersen ◽

Torstein Vik ◽

Daniel Virella ◽

...

Keyword(s):

Cerebral Palsy ◽

Gross Domestic Product ◽

Sex Difference ◽

Motor Function ◽

Classification System ◽

Intrathecal Baclofen ◽

Population Based ◽

Treatment Access ◽

Significant Difference ◽

Children With Cerebral Palsy

Abstract Aim The aim is to study access to intrathecal baclofen (ITB) for children with cerebral palsy (CP) in Europe, as an indicator of access to advanced care. Methods Surveys were sent to CP registers, clinical networks, and pump manufacturers. Enquiries were made about ITB treatment in children born in 1990 to 2005 by sex, CP type, level of gross motor function classification system (GMFCS) and age at the start of treatment. Access to ITB was related to the country's gross domestic product (GDP) and % GDP spent on health. Results In 2011 population-based data from Sweden, Norway, England, Portugal, Slovenia, and Denmark showed that 114 (3.4%) of 3,398 children with CP were treated with ITB, varying from 0.4 to 4.7% between centers. The majority of the children were at GMFCS levels IV-V and had bilateral spastic CP. In Sweden, dyskinetic CP was the most commonly treated subtype. Boys were more often treated with ITB than girls (p = 0.014). ITB was reported to be available for children with CP in 25 of 43 countries. Access to ITB was associated with a higher GDP and %GDP spent on health (p < 0.01). Updated information from 2019 showed remaining differences between countries in ITB treatment and sex difference in treated children was maintained. Conclusion There is a significant difference in access to ITB for children with CP across Europe. More boys than girls are treated. Access to ITB for children with CP is associated with GDP and percent of GDP spent on health in the country.

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The Appendicular Lean Mass Index Is a Suitable Surrogate for Muscle Mass in Children with Cerebral Palsy

Journal of Nutrition ◽

10.1093/jn/nxz127 ◽

2019 ◽

Vol 149 (10) ◽

pp. 1863-1868

Author(s):

Ibrahim Duran ◽

Kyriakos Martakis ◽

Mirko Rehberg ◽

Christina Stark ◽

Anne Koy ◽

...

Keyword(s):

Skeletal Muscle ◽

Cerebral Palsy ◽

Muscle Mass ◽

Lean Mass ◽

Skeletal Muscle Mass ◽

Rehabilitation Program ◽

Appendicular Lean Mass ◽

Significant Difference ◽

Children With Cerebral Palsy ◽

Level I

ABSTRACT Background Densitometrically measured lean body mass (LBM) is often used to quantify skeletal muscle mass in children with cerebral palsy (CP). Since LBM depends on the individual's height, the evaluation of $\frac{{{\rm{LBM}}}}{{heigh{t^2}}}\ $ (lean BMI) is often recommended. However, LBM includes not only skeletal muscle mass but also the mass of skin, internal organs, tendons, and other components. This limitation applies to a far lesser extent to the appendicular lean mass index (LMIapp). Objectives The aim of the study was to evaluate skeletal muscle mass in children with CP using total lean BMI (LMItot) and LMIapp. Methods The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation program. In total, 329 children with CP [148 females; Gross Motor Function Classification Scale (GMFCS) I, 32 children; GMFCS II, 73 children; GMFCS III, 133 children; GMFCS IV, 78 children; and GMFCS V, 13 children] were eligible for analysis. The mean age was 12.3 ± 2.75 y. Pediatric reference centiles for age-adjusted LMIapp were generated using data from NHANES 1999–2004. Low skeletal muscle mass was defined as a z score for DXA determined LMItot and LMIapp less than or equal to −2.0. Results The z scores for LMIapp were significantly lower than LMItot in children with CP, GMFCS levels II–V (P < 0.001), with the exception of GMFCS level I (P = 0.121), where no significant difference was found. The prevalence of low LMItot (16.1%; 95% CI: 16.1, 20.1%) was significantly lower (P < 0.001) than the prevalence of LMIapp (42.2%; 95% CI: 36.9, 47.9%) in the study population. Conclusions The prevalence of low skeletal muscle mass in children with CP might be underestimated by LMItot. LMIapp is more suitable for the evaluation of skeletal muscle mass in children with CP.

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Upper Extremity Strength Measurement for Children With Cerebral Palsy: A Systematic Review of Available Instruments

Physical Therapy ◽

10.2522/ptj.20130166 ◽

2014 ◽

Vol 94 (5) ◽

pp. 609-622 ◽

Cited By ~ 22

Author(s):

Koen J.F.M. Dekkers ◽

Eugene A.A. Rameckers ◽

Rob J.E.M. Smeets ◽

Yvonne J.M. Janssen-Potten

Keyword(s):

Cerebral Palsy ◽

Muscle Strength ◽

Upper Extremity ◽

Upper Limb ◽

Measurement Instruments ◽

Strength Measurement ◽

Level Of Evidence ◽

Best Evidence Synthesis ◽

Children With Cerebral Palsy

Background In order to make inferences about strength related to development or treatment interventions, it is important to use measurement instruments that have sound clinimetric properties. Purpose The objective of this review is to systematically evaluate the level of evidence of the clinimetric properties of instruments for measuring upper extremity muscle strength at the “body functions & structures” level of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) for children with cerebral palsy (CP). Data Sources A systematic search of the PubMed, EMBASE, OTseeker, CINAHL, PEDro, and MEDLINE databases up to November 2012 was performed. Study Selection Two independent raters identified and examined studies that reported the use of upper extremity strength measurement instruments and methods for children and adolescents with CP aged 0 to 18 years. Data Extraction The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist with 4-point rating scale was used by 2 independent raters to evaluate the methodological quality of the included studies. Best evidence synthesis was performed using COSMIN outcomes and the quality of the clinimetric properties. Data Synthesis Six different measurement instruments or methods were identified. Test-retest, interrater, and intrarater reliability were investigated. Two test-retest reliability studies were rated as “fair” for the level of evidence. All other studies were rated as “unknown” for the level of evidence. Limitations The paucity of literature describing clinimetric properties, especially other than reliability, of upper limb strength measurement instruments for children with CP was a limitation of the study. Conclusions For measuring grip strength, the Jamar dynamometer is recommended. For other muscle groups, handheld dynamometry is recommended. Manual muscle testing (MMT) can be used in case of limited (below MMT grade 4) wrist strength or for total upper limb muscle strength. Based on lacking information regarding other clinimetric properties, caution is advised regarding interpretation of the results.

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