scholarly journals Designing a Gait Enhancer and Determining its Effect on Standing Ability and Gait Speed of Children With Cerebral Palsy Spastic Diplegia

2021 ◽  
Vol 21 (4) ◽  
pp. 436-453
Author(s):  
Seyed Mehdi Hosseini ◽  
◽  
Saeid Fatorehchy ◽  
Seyed Ali Hosseini ◽  
Hojjat Allah Haghgoo ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Occupational Therapy ◽  
Effect Size ◽  
Gait Speed ◽  
Walking Speed ◽  
Spastic Diplegia ◽  
Cohen’S D ◽  
Children With Cerebral Palsy ◽  
Cohen's D ◽  
Therapy Sessions

Objective: This study aimed to design a “gait enhancer” and investigate its effect on standing ability and gait speed of children with cerebral palsy spastic diplegia. Materials & Methods: A new gate trainer was designed based on Theo Johnson mechanism. Johnson's two separate movement chains were placed on either side of the gate trainer body and attached to the lower limbs by a foot plate. To investigate the effect of the designed device, a single-item experimental study with baseline design, treatment and maintenance (ABA) was performed on four children with available spastic diplegia cerebral palsy. These children received routine occupational therapy sessions. Results: The designed “gait enhancer” increased standing ability and gait speed scores in all subjects. Non-overlapping measures also indicated the improvement in both variables. Measured by Cohen’s d, the effect size for standing ability were 1.95, 2.29, 1.83, and 2.3 for the child No. 1, 2, 3, and 4, respectively. Regarding walking speed, the effect size for these children, No. 1 to 4, were 1.13, 3.37, 2.15, and 2.21, respectively. Cohen’s d values were greater than 0.8, indicating the considerable effect of the intervention. Hedges’ g was also calculated due to the small sample size, which was greater than 0.8 for all subjects in standing ability and gait speed. Conclusion: Following the use of Gait Enhancer along with conventional occupational therapy, we observed an increase in the ability to stand and walk at children with cerebral palsy. Findings showed that the change in standing ability and walking speed occurred more during the period of using the designed device than other stages, which could be a consequence of using Gait Enhancer along with routine occupational therapy sessions at this stage of the study. However, it should be noted that this study was only a single case study and to prove the effectiveness of this tool in children with cerebral palsy, it is necessary to conduct clinical trial studies.

scholarly journals Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis

2016 ◽  
Vol 96 (12) ◽  
pp. 1938-1954 ◽  
Author(s):  
Noelle G. Moreau ◽  
Amy Winter Bodkin ◽  
Kristie Bjornson ◽  
Amy Hobbs ◽  
Mallary Soileau ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Resistance Training ◽  
Confidence Interval ◽  
Effect Size ◽  
Gait Speed ◽  
Outcome Measure ◽  
Meta Analysis ◽  
Gait Training ◽  
Biofeedback Training ◽  
Children With Cerebral Palsy

AbstractBackgroundChildren with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear.PurposeThe purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP.Data SourcesMEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014.Study SelectionThe selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure.Data ExtractionMethodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded.Data SynthesisTwenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=−0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category.LimitationsGait speed was the only outcome measure analyzed.ConclusionsGait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.

Comparison of Three Heel Cord Surgeries in Children with Cerebral Palsy

2005 ◽  
Vol 21 (4) ◽  
pp. 322-333 ◽  
Author(s):  
Jack R. Engsberg ◽  
Donna J. Oeffinger ◽  
Sandy A. Ross ◽  
Hank D. White ◽  
Chester M. Tylkowski ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Gait Speed ◽  
Descriptive Study ◽  
Objective Measures ◽  
Spastic Diplegia ◽  
Active Range Of Motion ◽  
Gross Motor Function Measure ◽  
Children With Cerebral Palsy ◽  
Function Measure

This nonrandomized prospective descriptive study compared outcomes of three isolated heel cord surgeries in children with spastic diplegia cerebral palsy (CP): (1) heel cord advancement (HCA), (2) heel cord lengthening according to Vulpius (HCL-V), and (3) heel cord lengthening according to White (HCL-W). Thirty-two children were tested prior to and approximately 1 year after undergoing one of the three surgeries. Objective measures were collected for ankle passive and active range of motion, gross motor function measure (GMFM), and gait. All surgeries indicated significant improvements in end range passive and active ankle dorsifiexion, GMFM, and dorsifiexion during gait. Gait speed was significantly improved for the HCA group, but appeared to be the result of maturity. Gait speed for the HCL-V and HCL-W groups was unchanged. The study was the first to directly compare three heel-cord-lengthening surgeries.

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

PEDIATRICS ◽  
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.

Immediate Effects of the Dorsiflexion Angle of Hinged Ankle-foot Orthosis on the Spatiotemporal Gait Parameters of Children With Spastic Cerebral Palsy

2021 ◽  
Author(s):  
IlHyun Son ◽  
GyuChang Lee
Keyword(s):  
Cerebral Palsy ◽  
Stride Length ◽  
Step Length ◽  
Gait Velocity ◽  
Spastic Cerebral Palsy ◽  
Spastic Diplegia ◽  
Ankle Foot Orthosis ◽  
Gait Parameters ◽  
Children With Cerebral Palsy ◽  
Foot Orthosis

Abstract Background: It has been reported the effects of a hinged ankle-foot orthosis on the gait ability of children with cerebral palsy. However, no studies investigated the effects of the dorsiflexion angle of the hinged ankle-foot orthosis on the spatiotemporal gait parameters of children with cerebral palsy. This study aimed to investigate the immediate effects of a 10° dorsiflexion inducing ankle-foot orthosis the spatiotemporal gait parameters of children with spastic diplegia compared to barefoot and a hinged ankle-foot orthosis.Methods: This study was cross-over design. 10 children with spastic diplegia were walked with barefoot, a hinged ankle-foot orthosis, and a 10° dorsiflexion inducing ankle-foot orthosis. GAITRite was used to collect the spatiotemporal gait parameters including gait velocity, cadence, step length, stride length, single leg support, and double leg support. Results: It showed that a 10° dorsiflexion inducing ankle-foot orthosis significantly improved the gait velocity, cadence, step length, stride length, single leg support, and double leg support than barefoot and a hinged ankle-foot orthosis (p<.05). Conclusion: The results of this study implied that a 10° dorsiflexion inducing ankle-foot orthosis could improve the gait ability of children with spastic diplegia more than barefoot or a hinged ankle-foot orthosis. High quality future studies will need to examine the effects of hinged ankle-foot orthosis on gait ability according to dorsiflexion angles.

A non-parametric effect size measure capturing changes in central tendency and shape of data distributions more flexibly than Cohen’s d

2020 ◽  
Author(s):  
Jörn Lötsch ◽  
Alfred Ultsch
Keyword(s):  
Effect Size ◽  
Data Science ◽  
Heterogeneous Data ◽  
Machine Learning Algorithms ◽  
Central Tendency ◽  
Effect Size Measure ◽  
Specific Data ◽  
Cohen’S D ◽  
Size Measure ◽  
Cohen's D

Abstract Calculating the magnitude of treatment effects or of differences between two groups is a common task in quantitative science. Standard effect size measures based on differences, such as the commonly used Cohen's, fail to capture the treatment-related effects on the data if the effects were not reflected by the central tendency. "Impact” is a novel nonparametric measure of effect size obtained as the sum of two separate components and includes (i) the change in the central tendency of the group-specific data, normalized to the overall variability, and (ii) the difference in the probability density of the group-specific data. Results obtained on artificial data and empirical biomedical data showed that impact outperforms Cohen's d by this additional component. It is shown that in a multivariate setting, while standard statistical analyses and Cohen’s d are not able to identify effects that lead to changes in the form of data distribution, “Impact” correctly captures them. The proposed effect size measure shares the ability to observe such an effect with machine learning algorithms. It is numerically stable even for degenerate distributions consisting of singular values. Therefore, the proposed effect size measure is particularly well suited for data science and artificial intelligence-based knowledge discovery from (big) and heterogeneous data.

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