scholarly journals Protocol: Using Single-Case Experimental Design to Evaluate Whole-Body Dynamic Seating on Activity, Participation, and Quality of Life in Dystonic Cerebral Palsy

Healthcare ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 11
Author(s):  
Gimeno ◽  
Adlam
Keyword(s):  
Cerebral Palsy ◽  
Experimental Design ◽  
Classification System ◽  
Rating Scale ◽  
Single Case ◽  
Unmet Need ◽  
Performance Measure ◽  
System Level ◽  
Whole Body ◽  
Dynamic Seating

Introduction: People with hyperkinetic movement disorders, including dystonia, experience often painful, involuntary movements affecting functioning. Seating comfort is a key unmet need identified by families. This paper reports a protocol to assess the feasibility and preliminary evidence for the efficacy of dynamic seating to improve functional outcomes for young children with dystonic cerebral palsy (DCP). Design: A series of single-case experimental design N-of-1 trials, with replications across participants, with a random baseline interval, and one treatment period (n = 6). Methods: Inclusion criteria: DCP; 21.5 cm < popliteal fossa to posterior sacrum < 35 cm; Gross Motor Function Classification System level IV–V; mini-Manual Ability Classification System level IV–V; difficulties with seating. Intervention: Trial of the seat (8 weeks), with multiple baseline before, during and after intervention and 2 month follow up. The baseline duration will be randomised per child (2–7 weeks). Primary outcomes: Performance Quality Rating Scale; Canadian Occupational Performance Measure; seating tolerance. The statistician will create the randomization, with allocation concealment by registration of participants prior to sending the allocation arm to the principal investigator. Primary outcomes will be assessed from video by an assessor blind to allocation. Analysis: Participant outcome data will be plotted over time, with parametric and non-parametric analysis including estimated size effect for N-of-1 trials.

scholarly journals Gastrocnemius operating length with ankle foot orthoses in cerebral palsy

2016 ◽  
Vol 41 (3) ◽  
pp. 274-285 ◽  
Author(s):  
Hwan Choi ◽  
Tishya Anne Leong Wren ◽  
Katherine Muterspaugh Steele
Keyword(s):  
Cerebral Palsy ◽  
Classification System ◽  
Daily Life ◽  
System Level ◽  
Foot Orthoses ◽  
Functional Classification ◽  
Ankle Foot Orthosis ◽  
Ankle Foot Orthoses ◽  
Children With Cerebral Palsy ◽  
Foot Orthosis

Background:Many individuals with cerebral palsy wear ankle foot orthoses during daily life. Orthoses influence joint motion, but how they impact muscle remains unclear. In particular, the gastrocnemius is commonly stiff in cerebral palsy. Understanding whether orthoses stretch or shorten this muscle during daily life may inform orthosis design and rehabilitation.Objectives:This study investigated the impact of different ankle foot orthoses on gastrocnemius operating length during walking in children with cerebral palsy.Study design:Case series, within subject comparison of gastrocnemius operating length while walking barefoot and with two types of ankle foot orthoses.Methods:We performed gait analyses for 11 children with cerebral palsy. Each child was fit with two types of orthoses: a dynamic ankle foot orthosis (Cascade dynamic ankle foot orthosis) and an adjustable dynamic response ankle foot orthosis (Ultraflex ankle foot orthosis). Musculoskeletal modeling was used to quantify gastrocnemius musculotendon operating length and velocity with each orthosis.Results:Walking with ankle foot orthoses could stretch the gastrocnemius more than barefoot walking for some individuals; however, there was significant variability between participants and orthoses. At least one type of orthosis stretched the gastrocnemius during walking for 4/6 and 3/5 of the Gross Motor Functional Classification System Level I and III participants, respectively. AFOs also reduced peak gastrocnemius lengthening velocity compared to barefoot walking for some participants, with greater reductions among the Gross Motor Functional Classification System Level III participants. Changes in gastrocnemius operating length and lengthening velocity were related to changes in ankle and knee kinematics during gait.Conclusion:Ankle foot orthoses impact gastrocnemius operating length during walking and, with proper design, may assist with stretching tight muscles in daily life.Clinical relevanceDetermining whether ankle foot orthoses stretch tight muscles can inform future orthotic design and potentially provide a platform for integrating therapy into daily life. However, stretching tight muscles must be balanced with other goals of orthoses such as improving gait and preventing bone deformities.

Evaluating the Effects of Performance-Focused Swimming Training on People with Cerebral Palsy Who Have High Support Needs – A Study Protocol Using Single-Case Experimental Design

2019 ◽  
Vol 21 (2) ◽  
pp. 217-234
Author(s):  
I. M. Dutia ◽  
M. J. Connick ◽  
E. M. Beckman ◽  
L. M. Johnston ◽  
P. J. Wilson ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Experimental Design ◽  
Single Case ◽  
Phase 1 ◽  
Maintenance Phase ◽  
Support Needs ◽  
Training Phase ◽  
Phase 2 ◽  
Swimming Training ◽  
High Support

AbstractBackground:People with cerebral palsy (CP) are less physically active than the general population and, consequently, are at increased risk of preventable disease. Evidence indicates that low-moderate doses of physical activity can reduce disease risk and improve fitness and function in people with CP. Para athletes with CP typically engage in ‘performance-focused’ sports training, which is undertaken for the sole purpose of enhancing sports performance. Anecdotally, many Para athletes report that participation in performance-focused sports training confers meaningful clinical benefits which exceed those reported in the literature; however, supporting scientific evidence is lacking. The aim of this paper is to describe the protocol for an 18-month study evaluating the clinical effects of a performance-focused swimming training programme for people with CP who have high support needs.Methods:This study will use a concurrent multiple-baseline, single-case experimental design across three participants with CP who have high support needs. Each participant will complete a five-phase trial comprising: baseline (A1); training phase 1 (B1); maintenance phase 1 (A2); training phase 2 (B2); and maintenance phase 2 (A3). For each participant, measurement of swim velocity, health-related quality of life and gross motor functioning will be carried out a minimum of five times in each of the five phases.Discussion:The study described will produce Level II evidence regarding the effects of performance-focused swimming training on clinical outcomes in people with CP who have high support needs. Findings are expected to provide an indication of the potential for sport to augment outcomes in neurological rehabilitation.

scholarly journals Chronic pain among children with cerebral palsy attending a Ugandan hospital: a cross-sectional study

2021 ◽  
Author(s):  
Emma Nsalazi Bambi ◽  
Angelina Kakooza Mwesige ◽  
Hervé Monka Lekuya ◽  
Philip Kasirye ◽  
Richard Idro
Keyword(s):  
Chronic Pain ◽  
Cerebral Palsy ◽  
Pain Management ◽  
Classification System ◽  
Behavioral Problem ◽  
Cross Sectional Study ◽  
System Level ◽  
Sectional Study ◽  
Cross Sectional ◽  
Children With Cerebral Palsy

Abstract Background: Children with cerebral palsy (CP) frequently experience chronic pain. The burden and severity of such pain is often underestimated in relation to their other impairments.Recognition and awareness of this chronic pain among children with CP constitute the cornerstone for caretakers and clinicians to improve the quality of life of those children. This study aimed to determine the prevalence of chronic pain among children with CP, and the factors associated.Methods: A cross-sectional study of children with CP, aged 2 – 12 years, attending the CP rehabilitation clinic and Pediatric Neurology Clinic at Mulago Hospital, Uganda from November 2017 to May 2018. A detailed history and clinical examination were performed and the co-morbidities were determined. CP was classified using the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, Communication Function Classification System (CFCS), and the Eating and Drinking Ability Classification System (EDACS) and documented with the level of impairment in the different domains. Pain was assessed by using the revised Face, Legs, Activity, Consolability, Cry pain scale.Results: A total of 224 children with CP were enrolled. The prevalence of chronic pain was 64.3%. The majority had spastic bilateral CP (77.8%), moderate pain lasting over 6 months, and none of them was on long-term pain management. Epilepsy (60.9%), behavioral problem (63.2%), hearing impairment (66,7%), learning problem (67,6%), dental caries (75%), gastro-esophageal reflux (75%), sleep disorders (79.5%), vision impairment (80%), and malnutrition (90%) were comorbid conditions of chronic pain in children with CP in this study. The factors independently associated with chronic pain among children with CP were the GMFC system level 4 & 5, CFCS level 4 & 5, EDACS level 4 & 5, female children, and caretaker aged more than 30 years.Conclusion: Two-thirds of children with CP attending rehabilitation in this hospital had chronic pain. None was receiving pain management. Chronic pain was associated with the presence of multiple co-morbidities and more severe disability. Rehabilitation and care programs for children with CP should include assessment of pain in routine care and provide interventions for pain relief in children with CP even at an early age.

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