Effects of the Combination of Music Therapy and Physiotherapy in the Improvement of Motor Function in Cerebral Palsy: A Challenge for Research

Background: There are different therapeutic strategies such as physiotherapy and music therapy for the treatment of cerebral palsy. Intervention protocols using both therapies to unify the measurement of motor function have not been investigated. Aims and scope: To summarize the effects of the treatment of cerebral palsy through the use of both for the improvement of motor function, analyse the challenges encountered, and submit proposals for improving them. Methods: The systematic review was conducted following PRISMA guidelines and registered in the PROSPERO database (CRD42020162493). Clinical trials that described the results obtained in terms of motor function through physiotherapy and music therapy were included. Results: Eight clinical trials with 234 participants were considered with a significant improvement in motor function. Results of meta-analysis suggested improvements in gait velocity in favour of the control group for cerebral palsy (mean differences = 0.03; 95% confidence interval = 0.01, 0.04, p = 0.001; I2 = 97%). However, high heterogeneity was identified in the meta-analysis due to the small number of studies included. Conclusions: The combination can be effective in subjects with cerebral palsy to improve motor function, although due to the diversity of studies analysed, it is complex to extrapolate results.

Download Full-text

Hyperbaric Oxygen Therapy Is Beneficial for the Improvement of Clinical Symptoms of Cerebral Palsy: A Systematic Review and Meta-Analysis

Complementary Medicine Research ◽

10.1159/000518785 ◽

2021 ◽

pp. 1-14

Author(s):

Yingqian Zhang ◽

Jing Wu ◽

Nong Xiao ◽

Bo Li

Keyword(s):

Systematic Review ◽

Cerebral Palsy ◽

Motor Function ◽

Hyperbaric Oxygen ◽

Clinical Symptoms ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Gross Motor ◽

Gross Motor Function

Introduction: Hyperbaric oxygen (HBO) has been used for the treatment of cerebral palsy for more than 20 years, but its efficacy and safety are still controversial. In this systematic review and meta-analysis, we evaluated the currently promulgated data related to the efficacy of HBO for patients with cerebral palsy. Methods: We searched the PubMed/Medline, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases (from their inception to April 2020) for randomized controlled trials published in English or Chinese. Two researchers used the Cochrane Collaboration tool for data extraction and an independent quality assessment. The extracted data were analyzed by Review Manager 5.3 software. Results: A total of 25 studies consistent with the inclusion criteria were included, with a total of 2,146 people, which included 1,185 participants in the HBO group and 961 in the control group. This meta-analysis showed that when compared with the controls, HBO therapy can improve the gross motor functions evaluated by the Gross Motor Function Measure (n = 696, SMD 0.29, 95% CI [0.07–0.51], Z = 2.62, p = 0.009) and Gross Motor Function Classification System (n = 248, MD –0.40, 95% CI [–0.52 to –0.27], Z = 6.28, p < 0.00001), global developmental level evaluated by Gesell (n = 560, RR 1.30, 95% CI [1.19–1.42], Z = 6.03, p < 0.00001) and developmental quotient (n = 374, MD 8.25, 95% CI [6.48–10.01], Z = 9.15, p < 0.00001) and language expression (n = 270, MD 4.34, 95% CI [2.30–6.38], Z = 4.17, p < 0.00001) and comprehension (n = 270, MD 4.87, 95% CI [2.87–6.88], Z = 4.76, p < 0.00001). HBO therapy only caused mild ear pain. However, the quality of the data for all outcomes evaluated by the Grading of Recommendations Assessment, Development, and Evaluation analysis was very low. Conclusions: HBO therapy may produce a much more efficient clinical experiment result than the control group with cerebral palsy patients, and HBO therapy is well tolerated and relatively safe for the included participants.

Download Full-text

Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/02692155211040199 ◽

2021 ◽

pp. 026921552110401

Author(s):

Javier Merino-Andrés ◽

Agustín García de Mateos-López ◽

Diane L Damiano ◽

Alberto Sánchez-Sierra

Keyword(s):

Cerebral Palsy ◽

Muscle Strength ◽

Strength Training ◽

Children And Adolescents ◽

Training Program ◽

Meta Analysis ◽

Spastic Cerebral Palsy ◽

Control Group ◽

Therapy Technique ◽

Mean Differences

Objective: This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function, activity, and participation. Data sources: Five electronic databases (MEDLINE-Pubmed, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were systematically searched for full-text articles published from inception to 30 June 2021. Review methods: Randomized controlled trials were included, who compared: (i) child population with spastic cerebral palsy population between 0 and 22 years; (ii) studies in which a muscle strength training program was performed and included dosing information; (iii) studies comparing strength training with other physical therapy technique(s) or untreated control group. Studies with similar outcomes were pooled by calculating standardized mean differences. Risk of bias was assessed with Cochrane Collaboration’s tool for assessing the risk of bias and PROSPERO’s registration number ID: CRD42020193535. Results: Twenty-seven studies, comprising 847 participants with spastic cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of strength training program compared to other physical therapy technique(s) or untreated control group(s) for muscle strength at the knee flexors, at the knee extensor, at the plantarflexors, maximum resistance, balance, gait speed, GMFM (global, D and E dimension) and spasticity. Conclusion: A strength training program has positive functional and activity effects on muscle strength, balance, gait speed, or gross motor function without increasing spasticity for children and adolescents with cerebral palsy in Gross Motor Function Classification System levels I, II, and III when adequate dosage and specific principles are utilized.

Download Full-text

Impact of Resistance Therapy on Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224513 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4513 ◽

Cited By ~ 2

Author(s):

Luisa Collado-Garrido ◽

Paula Parás-Bravo ◽

Pilar Calvo-Martín ◽

Miguel Santibáñez-Margüello

Keyword(s):

Clinical Trials ◽

Cerebral Palsy ◽

Motor Function ◽

Random Effects ◽

Meta Analysis ◽

Scientific Information ◽

Mean Difference ◽

Random Effects Model ◽

Controlled Clinical Trials ◽

The Impact

Cerebral palsy is one of the main causes of disability in childhood. Resistance therapy shows benefits in increasing strength and gait in these patients, but its impact on motor function is not yet clear. The objective was to analyze the impact of resistance therapy on the improvement in the motor function using a review and meta-analysis. A comprehensive literature research was conducted in Medline (PubMed), Institute for Scientific Information (ISI) Web of Knowledge, and Physiotherapy Evidence Database (PEDro) in relation to clinical trials in which resistance therapy was used and motor function was assessed. Twelve controlled clinical trials and three non-controlled clinical trials (only one intervention arm) studies were identified. In terms of pre–post difference, the overall intra-group effect was in favor of resistance therapy intervention: standardized mean difference (SMD) = 0.37, 95% confidence interval (CI) = 0.21 to 0.52, p < 0.001 (random-effects model), with moderate heterogeneity (I2 = 59.82%). SMDs were also positive by restricting to each of the analyzed scales: SMD = 0.37, 1.33, 0.10, and 0.36 for Gross Motor Function Measure (GMFM), Lateral Step Up (LSU), Time Up and Go (TUG), and Mobility Questionnaire (MobQue) scales, respectively. Regarding the difference between groups, the results showed a high heterogeneity (I2 < 99%), with the mean difference (MD) also favorable for the GMFM scale: MD = 1.73, 95% CI = 0.81 to 2.64, p < 0.001 (random-effects model). Our results support a positive impact of resistance therapy on motor function. Further studies should delve into the clinical relevance of these results.

Download Full-text

Effects of electromyographic biofeedback interventions for shoulder pain and function: Systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215521990950 ◽

2021 ◽

pp. 026921552199095

Author(s):

Danilo Harudy Kamonseki ◽

Letícia Bojikian Calixtre ◽

Rodrigo Py Gonçalves Barreto ◽

Paula Rezende Camargo

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Confidence Interval ◽

Shoulder Pain ◽

Meta Analysis ◽

Quality Of Evidence ◽

Electromyographic Biofeedback ◽

Mean Differences ◽

And Function

Objective: To systematically review the effectiveness of electromyographic biofeedback interventions to improve pain and function of patients with shoulder pain. Design: Systematic review of controlled clinical trials. Literature search: Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched in December 2020. Study selection criteria: Randomized clinical trials that investigated the effects of electromyographic biofeedback for individuals with shoulder pain. Patient-reported pain and functional outcomes were collected and synthesized. Data synthesis: The level of evidence was synthesized using GRADE and Standardized Mean Differences and 95% confidence interval were calculated using a random-effects inverse variance model for meta-analysis. Results: Five studies were included with a total sample of 272 individuals with shoulder pain. Very-low quality of evidence indicated that electromyographic biofeedback was not superior to control for reducing shoulder pain (standardized mean differences = −0.21, 95% confidence interval: −0.67 to 0.24, P = 0.36). Very-low quality of evidence indicated that electromyographic biofeedback interventions were not superior to control for improving shoulder function (standardized mean differences = −0.11, 95% confidence interval: −0.41 to 0.19, P = 0.48). Conclusion: Electromyographic biofeedback may be not effective for improving shoulder pain and function. However, the limited number of included studies and very low quality of evidence does not support a definitive recommendation about the effectiveness of electromyographic biofeedback to treat individuals with shoulder pain.

Download Full-text

Association between serum visfatin levels and psoriasis and their correlation with disease severity: a meta-analysis

Journal of International Medical Research ◽

10.1177/03000605211002381 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052110023

Author(s):

Qian Zou ◽

Jiawei Si ◽

Yatao Guo ◽

Jiayu Yu ◽

Huijuan Shi

Keyword(s):

Body Mass Index ◽

Meta Analysis ◽

Severity Index ◽

Cochrane Library ◽

Control Group ◽

Inclusion Criteria ◽

Subgroup Analyses ◽

Mean Differences ◽

The Cochrane Library ◽

Psoriasis Severity

Objective To determine the association between serum visfatin levels and psoriasis and to evaluate the correlation between serum visfatin levels and the severity of psoriasis. Methods The electronic databases PubMed®, Embase® and the Cochrane Library were searched for articles published from inception to 1 May 2020. Data were extracted and then standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for pooled estimates. Results A total of 11 studies met the inclusion criteria and were included (448 patients diagnosed with psoriasis and 377 controls). This meta-analysis demonstrated that patients with psoriasis had significantly higher levels of visfatin than the controls (SMD = 0.90, 95% CI 0.52, 1.28). Subgroup analyses showed that differences in serum visfatin levels between the patient group and the control group were associated with ethnicity, Psoriasis Area and Severity Index (PASI) and body mass index. Additionally, a meta-analysis of correlations showed that visfatin levels in patients with psoriasis were positively correlated with PASI ( r = 0.51, 95% CI 0.14, 0.75). Conclusions This meta-analysis showed that serum visfatin levels in patients with psoriasis were significantly higher than those in the controls and a positive correlation between serum visfatin levels and psoriasis severity was observed.

Download Full-text

Motor learning-based activities may improve functional ability in adults with severe cerebral palsy: A controlled pilot study

Neurorehabilitation ◽

10.3233/nre-201581 ◽

2021 ◽

pp. 1-11

Author(s):

Helle Hüche Larsen ◽

Rasmus Feld Frisk ◽

Maria Willerslev-Olsen ◽

Jens Bo Nielsen

Keyword(s):

Cerebral Palsy ◽

Motor Learning ◽

Motor Function ◽

Functional Ability ◽

Active Group ◽

Control Group ◽

Gross Motor ◽

Gross Motor Function ◽

Learning Principles

BACKGROUND: Cerebral palsy (CP) is a neurodevelopmental disturbance characterized by impaired control of movement. Function often decreases and 15% of adults are classified as severely affected (Gross Motor Function Classification Scale III-V). Little is known about interventions that aim to improve functional abilities in this population. OBJECTIVE: To evaluate a 12-week intervention based on motor learning principles on functional ability in adults with severe CP. METHODS: 16 adults (36±10 years, GMFCS III-V) were enrolled and divided into an intervention group (Active group) and a standard care group (Control group). Primary outcome measure was Gross Motor Function Measure (GMFM-88). Secondary measures were neurological status. The Active group were measured at baseline, after the intervention and at one-month follow-up. The Control group were measured at baseline and after one month. RESULTS: Analysis showed statistically significant improvement in GMFM-88 for the Active group from baseline to post assessment compared with the Control group (group difference: 5 points, SE 14.5, p = 0.008, CI: 1.2 to 8.7). Improvements were maintained at follow-up. Results from the neurological screening showed no clear tendencies. CONCLUSIONS: The study provides support that activities based on motor learning principles may improve gross motor function in adults with severe CP.

Download Full-text

Evaluating the effectiveness of interventions to reducing screen time in children: meta-analysis of randomized controlled trials

Journal of Public Mental Health ◽

10.1108/jpmh-03-2021-0039 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Duygu Akçay ◽

Nuray Barış

Keyword(s):

Effect Size ◽

Subgroup Analysis ◽

Screen Time ◽

Meta Analysis ◽

Intervention Group ◽

Evidence Base ◽

Control Group ◽

Content Type ◽

Mean Differences ◽

The Impact

Purpose The purpose of this paper is to evaluate the impact of interventions focused on reducing screen time in children. Design/methodology/approach Studies that aim to investigate the effects of interventions aimed at reducing the time spent in front of the screen (i.e. screen time). A Random-effects model was used to calculate the pooled standard mean differences. The outcome was to evaluate the screen time in children in the 0–18 age range. A subgroup analysis was performed to reveal the extent to which the overall effect size varied by subgroups (participant age, duration of intervention and follow). Findings For the outcome, the meta-analysis included 21 studies, and the standard difference in mean change in screen time in the intervention group compared with the control group was −0.16 (95% confidence interval [CI], −0.21 to −0.12) (p < 0.001). The effect size was found to be higher in long-term (=7 months) interventions and follow-ups (p < 0.05). Originality/value Subgroup analysis showed that a significant effect of screen time reduction was observed in studies in which the duration of intervention and follow-up was =7 months. As the evidence base grows, future researchers can contribute to these findings by conducting a more comprehensive analysis of effect modifiers and optimizing interventions to reduce screen time.

Download Full-text

Comparison of functional outcomes from orthopedic and neurosurgical interventions in spastic diplegia

Neurosurgical FOCUS ◽

10.3171/foc.1998.4.1.6 ◽

1998 ◽

Vol 4 (1) ◽

pp. E5 ◽

Cited By ~ 5

Author(s):

Mark F. Abel ◽

Diane L. Damiano ◽

John F. McLaughlin ◽

Kit M. Song ◽

Catherine S. Graubert ◽

...

Keyword(s):

Clinical Trials ◽

Motor Function ◽

Three Dimensional ◽

Gait Velocity ◽

Spastic Diplegia ◽

Five Dimensions ◽

Dorsal Rhizotomy ◽

Multicenter Clinical Trials ◽

Functional Outcome Measures ◽

Post Hoc

Selective dorsal rhizotomy (SDR) and orthopedic surgery, in the form of muscle-tendon (MT) lengthening surgery are commonly performed in ambulatory children with spastic diplegia to improve their level of motor function. This investigation is a post hoc comparison of the functional effects from each of these surgical options in 30 patients with spastic diplegia who underwent one of these interventions as their initial surgical procedure. Sixteen children underwent SDR and 14 underwent MT surgery in two separate prospective clinical trials. The same functional outcome measures preoperatively and approximately 1 year postoperatively were used in both studies including temporospatial parameters from three-dimensional gait analysis, the total score, and score on each of the five dimensions of the Gross Motor Function Measure (GMFM). Comparisons indicate that patients who underwent SDR had significant improvements in GMFM Dimensions 2, 4, and 5 as well as in total score, although 63% of those studied had a 10% or more reduction in gait velocity. Gait was more predictably improved in the MT group, with only 21% demonstrating reductions in velocity. Conversely, the change in GMFM scores in the MT group was not as pervasive and skewed toward higher skills with only GMFM Dimension 5 and total score improved significantly. Several important hypotheses are derived from these comparisons. Multicenter clinical trials are needed to define more clearly the indications for and to assess more comprehensively the outcomes from each intervention.

Download Full-text

Nervous and Muscular Adverse Events after COVID-19 Vaccination: A Systematic Review and Meta-Analysis of Clinical Trials

Vaccines ◽

10.3390/vaccines9080939 ◽

2021 ◽

Vol 9 (8) ◽

pp. 939

Author(s):

Jiaxin Chen ◽

Yuangui Cai ◽

Yicong Chen ◽

Anthony P. Williams ◽

Yifang Gao ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Adverse Events ◽

Fixed Effects ◽

Meta Analysis ◽

Phase 1 ◽

Cochrane Library ◽

Categorical Variables ◽

Control Group ◽

Open Label

Background: Nervous and muscular adverse events (NMAEs) have garnered considerable attention after the vaccination against coronavirus disease (COVID-19). However, the incidences of NMAEs remain unclear. We aimed to calculate the pooled event rate of NMAEs after COVID-19 vaccination. Methods: A systematic review and meta-analysis of clinical trials on the incidences of NMAEs after COVID-19 vaccination was conducted. The PubMed, Medline, Embase, Cochrane Library, and Chinese National Knowledge Infrastructure databases were searched from inception to 2 June 2021. Two independent reviewers selected the study and extracted the data. Categorical variables were analyzed using Pearson’s chi-square test. The pooled odds ratio (OR) with the corresponding 95% confidence intervals (CIs) were estimated and generated with random or fixed effects models. The protocol of the present study was registered on PROSPERO (CRD42021240450). Results: In 15 phase 1/2 trials, NMAEs occurred in 29.2% vs. 21.6% (p < 0.001) vaccinated participants and controls. Headache and myalgia accounted for 98.2% and 97.7%, and their incidences were 16.4% vs. 13.9% (OR = 1.97, 95% CI = 1.28–3.06, p = 0.002) and 16.0% vs. 7.9% (OR = 3.31, 95% CI = 2.05–5.35, p < 0.001) in the vaccine and control groups, respectively. Headache and myalgia were more frequent in the newly licensed vaccines (OR = 1.97, 95% CI = 1.28–3.06, p = 0.02 and OR = 3.31, 95% CI = 2.05–5.35, p < 0.001) and younger adults (OR = 1.40, 95% CI = 1.12–1.75, p = 0.003 and OR = 1.54, 95% CI = 1.20–1.96, p < 0.001). In four open-label trials, the incidences of headache, myalgia, and unsolicited NMAEs were 38.7%, 27.4%, and 1.5%. Following vaccination in phase 3 trials, headache and myalgia were still common with a rate of 29.5% and 19.2%, although the unsolicited NMAEs with incidence rates of ≤ 0.7% were not different from the control group in each study. Conclusions: Following the vaccination, NMAEs are common of which headache and myalgia comprised a considerable measure, although life-threatening unsolicited events are rare. NMAEs should be continuously monitored during the ongoing global COVID-19 vaccination program.

Download Full-text

A DYNAMIC SEATING SYSTEM FOR CHILDREN WITH CEREBRAL PALSY

Journal of Musculoskeletal Research ◽

10.1142/s0218957709002158 ◽

2009 ◽

Vol 12 (01) ◽

pp. 21-30 ◽

Cited By ~ 3

Author(s):

Michael E. Hahn ◽

Sheri L. Simkins ◽

Jacob K. Gardner ◽

Gaurav Kaushik

Keyword(s):

Cerebral Palsy ◽

Range Of Motion ◽

Motor Function ◽

Control Group ◽

Significant Group ◽

Gross Motor ◽

Gross Motor Function ◽

Muscle Spasticity ◽

Children With Cerebral Palsy ◽

Dynamic Seating

The study's aim was to determine the initial effects of a dynamic seating system as a therapeutic intervention in children with cerebral palsy. A two-factor, repeated-measures design was used. Twelve children with neuromuscular dysfunction (mean age 6.0, SD 2.7 years) were included in the study, randomly assigned to an experimental or a control group. At study initiation the experimental group received a wheelchair with dynamic seating components that allows limited range of motion in the hip and knee, and the control group received a static setting wheelchair. Participants were evaluated for range of motion, muscle spasticity (Modified Ashworth Scale), motor function (Gross Motor Function Measure), and level of disability (Pediatric Evaluation of Disability Inventory) at study initiation, 3-months, and 6-months post intervention. Both groups improved in motor function over time, particularly in the categories of Sitting and Crawl/Kneel. Measures of disability improved in both groups for the categories of self-care, mobility, and social function. A larger, more homogeneous sample would likely show significant group differences in measures of muscle spasticity, gross motor function and disability.

Download Full-text