scholarly journals A Terapia por contensão induzida no desempenho ocupacional de crianças com paralisia cerebral / Intervention by contraint- induced movement therapy on the occupational performance of children with cerebral palsy

2018 ◽  
Vol 2 (2) ◽  
pp. 292-304
Author(s):  
Cassandra Da Silva Fonseca ◽  
Nicole Ruas Guarany
Keyword(s):  
Cerebral Palsy ◽  
Motor Activity ◽  
Functional Performance ◽  
Randomized Study ◽  
Movement Therapy ◽  
Intensive Training ◽  
Function Test ◽  
Before And After ◽  
Motor Activities ◽  
Arm Function

A paralisia cerebral (PC) constitui um quadro clínico importante que pode acometer crianças, causando déficits de movimento, controle postural, prejuízos sensoriais e cognitivos, com isso, faz-se necessário estimular as habilidades da criança para que alcance um desempenho efetivo em todas as áreas de ocupação. O objetivo deste trabalho foi realizar terapia por contensão induzida que consiste na imobilização do membro superior não afetado com um treino intensivo da extremidade afetada, em crianças com PC hemiplégica. Trata-se de um estudo quase experimental, do tipo antes e depois, não cego e não randomizado. Utilizou-se a Teenager Motor Activity Log- TMAL, a Pediatric Arm Function Test- PAFT e a Inventory of New Motor Activities Program- INMAP para analisar o desempenho funcional dos participantes antes e após o tratamento. A amostra do estudo foi composta por 2 crianças com PC Hemiplégica. A avaliação TMAL identificou melhora na freqüência e qualidade dos movimentos realizados com o membro afetado nas duas intervenções. Da mesma forma a avaliação PAFT demonstrou um aumento na realização de tarefas unilaterais e bilaterais com o membro afetado, sem necessitar de comandos. A INMAP apresentou melhora principalmente nos padrões de alcance, pinça eficiente e preensão. Os resultados demonstram que após a intervenção, houve um aumento significativo no desempenho funcional de atividades motoras das crianças. Neste sentido, acredita-se que intervenções como esta permitem uma reabilitação para aquisição de maior autonomia e independência em atividades cotidianas. AbstractCerebral palsy (CP) forms an important clinical picture that may affect children by causing them movement and postural control deficits, sensory and cognitive damages. Therefore, it is necessary to stimulate children's skills so that they can achieve an effective performance in all occupational areas. The aim of this work is to carry out a constraint-induced movement therapy which is the immobilization of  theirnot affected upper limb and an intensive training of their affected end in children with hemiplegic CP. It is a quasi-experimental, before and after, non-blinded and non-randomized study. A Teenager Motor Activity Log (TMAL), a Pediatric Arm Function Test (PAFT) and an Inventory of New Motor Activities Program (INMAP) were used to analyze the functional performance of the participants before and after the treatment. The study sample included two children with hemiplegic CP. The TMAL evaluation showed a better frequency and quality of the movements performed with the affected limb in both interventions. In the same way, the PAFT evaluation showed an increase in unilateral and bilateral tasks when they used their affected limb with no need for commands. The INMAP showed some improvement of reaching, effective pinching and gripping standards mainly. The results showed that after the intervention, there was a significant increase in the functional performance of the children's motor activities. Therefore, it is believed that this type of intervention provides a rehabilitation to obtain a greater autonomy and independence in daily activities.Keywords: Functional Performance; Cerebral Palsy; Rehabilitation; Occupational therapy.

scholarly journals Designing a tangible solution to encourage playful hand usage for children with cerebral palsy

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Christina Mittag ◽  
Regina Leiss ◽  
Katharina Lorenz ◽  
Dagmar Siebold
Keyword(s):  
Cerebral Palsy ◽  
Support System ◽  
Functional Test ◽  
Intensive Training ◽  
Affected Side ◽  
Motivational Support ◽  
Children With Cerebral Palsy ◽  
Unilateral Cerebral Palsy ◽  
Arm Function ◽  
Inertial Measurements

AbstractChildren with unilateral cerebral palsy (CCP) benefit from intensive training with the affected side. The SHArKi project strives for a motivational support system, using wristbands with inertial measurements units (IMU) to measure arm function, providing biofeedback as well as motivating stimuli. To consider finger and wrist movements as well, this paper covers concepts for a tangible solution and its first implementation including the gamification development. Finalizations of the demonstrator, an overall functional test as well as concluding feedback from CCP are pending.

scholarly journals Children with Cerebral Palsy Return to Baseline Community Arm Movement after Constraint Induced Movement Therapy

2019 ◽  
Author(s):  
Brianna M. Goodwin ◽  
Emily K. Sabelhaus ◽  
Ying-Chun Pan ◽  
Kristie F. Bjornson ◽  
Kelly L. D. Pham ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Community Setting ◽  
Arm Movement ◽  
Movement Therapy ◽  
Tertiary Hospital ◽  
Typically Developing ◽  
Constraint Induced Movement Therapy ◽  
Transfer Of Skills ◽  
Before And After ◽  
Clinical Measures

AbstractImportanceConstraint Induced Movement Therapy (CIMT) is a common treatment for children with unilateral cerebral palsy (CP). While clinic-based assessments have demonstrated improvements in arm function after CIMT, quantifying if these changes are translated and sustained outside of a clinic setting remains unclear.ObjectiveAccelerometers were used to quantify arm movement for children with CP one week before, during, and 4+ weeks after CIMT and compared to typically-developing (TD) peers.DesignObservational during CIMTSettingClinical assessments and treatment occurred in a tertiary hospital and accelerometry data were collected in the communityParticipants7 children with CP (5m/2f, 7.4 ± 1.2 yrs) and 7 TD peers (2m/5f, 7.0 ± 2.3 yrs)Intervention30-hour CIMT protocolOutcomes and MeasuresThe use ratio, magnitude ratio, and bilateral magnitude were calculated from the accelerometry data. Clinical measures were evaluated before and after CIMT and surveys were used to assess the feasibility of using accelerometers.ResultsBefore CIMT, children with CP used their paretic arm less than their TD peers. During therapy, their frequency and magnitude of paretic arm use increased in the clinic and in daily life. After therapy, although clinical scores improved, children reverted to baseline accelerometry values. Additionally, children and parents in both cohorts had positive perceptions of wearing accelerometers.Conclusions and RelevanceThe lack of sustained improved accelerometry metrics following CIMT suggest therapy gains did not translate to increased movement outside the clinic. Additional therapy may be needed to help the transfer of skills to the community setting.What this Article AddsThis study compares the movement of children with CP undergoing CIMT in the community setting with their typically developing peers. Additional interventions may be needed in combination with or following CIMT to sustain the benefits of the therapy outside of the clinic.

scholarly journals Application of Constraint-Induced Movement Therapy for an Individual With Severe Chronic Upper-Extremity Hemiplegia

2003 ◽  
Vol 83 (4) ◽  
pp. 384-398 ◽  
Author(s):  
Nancy (McNamara) Bonifer ◽  
Kristin M Anderson
Keyword(s):  
Case Report ◽  
Motor Activity ◽  
Upper Extremity ◽  
Motor Function ◽  
Movement Therapy ◽  
Motor Deficits ◽  
Intensive Training ◽  
Constraint Induced Movement Therapy ◽  
Task Practice

Abstract Background and Purpose. Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. Case Description. The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. Methods. The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. Outcomes. Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. Discussion. This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.

Efficacy of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy: a systematic review

2017 ◽  
Vol 31 (11) ◽  
pp. 1445-1456 ◽  
Author(s):  
MH Tervahauta ◽  
GL Girolami ◽  
GK Øberg
Keyword(s):  
Systematic Review ◽  
Cerebral Palsy ◽  
Meta Analysis ◽  
Movement Therapy ◽  
Effect Sizes ◽  
System Level ◽  
Cochrane Library ◽  
Intensive Training ◽  
Constraint Induced Movement Therapy ◽  
Unilateral Cerebral Palsy

Objective: To systematically review the evidence on the effect of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy. Data sources: Seven electronic databases (Cinahl, Cochrane Library, EMBASE, Ovid MEDLINE, PEDro, PsycINFO, PubMed) were searched from database inception through December 2016. Methods: A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Standardised mean differences (effect sizes) were calculated for each study and outcome. Results: Nine studies met the eligibility criteria. All studies provided level II evidence. Methodological quality was high in two studies, moderate in four studies and low in three studies. The methodology, participant and intervention characteristics were heterogeneous. The participants’ ages ranged from 1.5 to 16 years. Their initial hand function ranged from Manual Ability Classification System Level I to Level III. The total intervention dose ranged from 24 to 210 hours and duration from one week to ten weeks. The studies measured outcomes assessing unimanual and bimanual hand and arm function, participation and attainment of individualised goals. Overall, the effect sizes did not favour one of the interventions at short- or long-term follow-up. The 95% confidence intervals were broad, indicating inaccurate precision of the effect sizes. Pooling of the data for a meta-analysis was judged to be of little clinical value owing to heterogeneity. Conclusion: It is not possible to conclude whether constraint-induced movement therapy or bimanual intensive training is more effective than the other in children with unilateral cerebral palsy.

scholarly journals ANÁLISE DA FUNÇÃO MANUAL DE UMA CRIANÇA COM HEMIPARESIA ESPÁSTICA PRÉ E PÓS-TRATAMENTO FISIOTERAPÊUTICO: ESTUDO DE CASO

2019 ◽  
Vol 3 ◽  
pp. 130
Author(s):  
Simone De Paula ◽  
Daniela Klunck
Keyword(s):  
Cerebral Palsy ◽  
Physical Therapy ◽  
Motor Activity ◽  
Upper Extremity ◽  
Motor Skills ◽  
Upper Limb ◽  
Spastic Hemiparesis ◽  
Intervention Protocol ◽  
Before And After

RESUMOA alteração da função manual é um dos sintomas mais incapacitantes da hemiparesia espástica resultante da Paralisia Cerebral. O indivíduo pode apresentar alterações neuromusculoesqueléticas na extremidade superior acometida, como aumento do tônus muscular, diminuição da força e prejuízos na motricidade fina. Com base nisso, o objetivo deste estudo foi avaliar os efeitos da Fisioterapia na função manual de uma criança com hemiparesia espástica. Pesquisa quase-experimental, do tipo estudo de caso, com análise comparativa antes e depois do tratamento. A amostra foi composta pelo paciente G.N., de 6 anos de idade e portador de hemiparesia espástica à direita. O protocolo de intervenção foi constituído de 12 sessões de Fisioterapia, com frequência semanal e duração de 50 minutos. A Fisioterapia baseou-se na Terapia de Contensão Induzida, no Conceito Neuroevolutivo Bobath e na Gameterapia. Para a análise antes e depois da intervenção, a escala Pediatric Motor Activity Log (PMAL) foi aplicada no primeiro e último dia de atendimento a fim de avaliar a frequência e a qualidade de movimento do membro superior acometido. Os resultados da PMAL mostraram um aumento da média da pontuação de frequência de movimento e na média da pontuação de qualidade de movimento. O presente estudo de caso evidenciou que a Fisioterapia resultou em uma maior funcionalidade do membro superior direito da criança e favoreceu aquisições de novas habilidades motoras. Além da diversidade de estímulos para o aprendizado motor, a contribuição familiar foi determinante para o sucesso do tratamento.Palavras-chave: Paralisia cerebral. Fisioterapia. Reabilitação. Extremidade superior.ABSTRACTHand function impairment is one of the most disabling symptoms of spastic hemiparesis resulting from Cerebral Palsy. Patients may present neuromusculoskeletal disorders on the affected upper extremity, such as increase of the muscle tone, decrease of strength and losses on fine motor skills. Based on that, the goal of this study is to evaluate the effects of Physical Therapy on the hand function of a child with spastic hemiparesis. Quasi-experimental design, case-study research, with comparative analysis before and after the treatment. The sample was composed of a six-year-old patient with spastic hemiparesis on the right side. The intervention protocol was constituted of twelve Physical Therapy sessions, performed weekly and with 50 minutes duration. The Physical Therapy was based on the Constraint-induced Movement Therapy, Bobath Concept and Game Therapy. In order to measure outcomes before and after the intervention, the Pediatric Motor Activity Log (PMAL) scale was applied on the first and last session for assessment of the frequency and quality of movement on the affected upper limb. The PMAL‘s results showed an increase in the average movement frequency score and in the average movement quality score. This case study showed that Physical Therapy resulted in greater upper limb functionality to the child and favored the acquisition of new motor skills. Besides the diversity of stimuli for motor learning, the family contribution was determinant for the success of the treatment.Keywords: Cerebral palsy. Physical therapy specialty. Rehabilitation. Upper extremity.

scholarly journals Gait biometrics in children with cerebral palsy before and after robotic mechanotherapy

2020 ◽  
Vol 8 (2) ◽  
pp. 159-168
Author(s):  
Igor E. Nikityuk ◽  
Galina A. Ikoeva ◽  
Elizaveta L. Kononova ◽  
Irina Yu. Solokhina
Keyword(s):  
Cerebral Palsy ◽  
Motor Activity ◽  
Lower Extremities ◽  
Diagnostic Methods ◽  
Locomotor Training ◽  
Healthy Children ◽  
Step Cycle ◽  
Software Complex ◽  
Children With Cerebral Palsy ◽  
Before And After

Background. The improvement in existing methods and the development of new principles for treating children with cerebral palsy necessitates a quantitative assessment of the parameters of motor activity. However, because of the explicit and complex abnormalities in motor skills in patients with severe forms of cerebral palsy, an evaluation of their locomotor function dynamics using instrumental diagnostic methods remains a serious problem. Aim. This work aimed to study the walking function in patients with cerebral palsy before and after motor rehabilitation using a biomechanical method with biometric sensors. Materials and methods. We examined 14 patients with cerebral palsy aged 8 to 13 years with III level of restriction of motor activity according to the gross motor function classification system (GMFCS). All patients underwent rehabilitation in the Lokomat robotic simulator for three weeks. The course consisted of 15 sessions of 45 min each. The temporal and dynamic parameters of walking were studied in 14 patients with cerebral palsy before and after a course of locomotor training. The biometry of the step cycle was studied using the STEDIS hardware-software complex, including the Neurosens set of wireless biometric sensors. The temporal characteristics of the step cycle and the force interaction of the lower extremities with the supporting surface during walking were recorded. For comparison, we conducted a biomechanical examination of 18 healthy children of the same age who did not have signs of orthopedic disorders. Results. Although after a course of mechanotherapy, the indices of the support phases in biometry in children with cerebral palsy did not reach the level of healthy individuals, a physiological tendency to roll foot was observed in the phase of pushing and accelerating the foot. Active braking of the lower limb increased. The studied time parameters showed a relative improvement in the step structure because of the emerging tendency to normalize the ratio of the periods of the double support of the contralateral lower extremities. Conclusion. Robotic mechanotherapy helps to change the biomechanical pattern of walking of a child with a severe degree of cerebral palsy. An instrumental analysis of walking using wireless biometric sensors allows you to evaluate the results and effectiveness of rehabilitation measures in patients with severe motor impairment objectively.

Efeitos da terapia por contensão induzida nas lesões encefálicas adquiridas

2016 ◽  
Vol 17 (1) ◽  
pp. 30
Author(s):  
Gabriela Da Silva Matuti ◽  
Rafaela Do Nascimento Borges Marques ◽  
Amanda Conte Magesto ◽  
Rafael Eras Garcia ◽  
Clarissa Barros De Oliveira
Keyword(s):  
Motor Activity ◽  
Motor Function ◽  
Function Test ◽  
Wolf Motor Function Test

Introdução: A Terapia por Contensão Induzida (TCI) é uma técnica de reabilitação que tem como objetivo melhora da função do membro superior.acometido. Objetivos: Determinar se o protocolo da TCI é adequado para a reabilitação do membro superior em adultos com Lesões Encefálicas Adquiridas (LEA), analisar a manutenção dos resultados e identificar possíveis preditores de eficácia da técnica. Método: Estudo retrospectivo, 40 pacientes. As escalas utilizadas foram Motor Activity Log (MAL), Quantidade (QT) e Qualidade (QL) de movimento do membro superior acometido e Wolf Motor Function Test (WMFT). Resultados e discussão: As médias de QT e QL do membro superior acometido no pré e pós-tratamento tiveram um aumento significativo (p < 0,001), enquanto as do WMFT apresentaram uma redução significativa do tempo (p < 0,001), o que representa uma melhora na habilidade motora e maior uso fora do ambiente terapêutico. Os ganhos foram mantidos após 12 meses do término do protocolo, e não foi evidenciado nenhum preditor de evolução. Conclusão: A TCI demonstrou eficácia na melhora da habilidade motora e reversão do não uso aprendido do membro superior acometido, estes resultados foram mantidos após um ano da intervenção. Não foi evidenciado no estudo nenhum fator preditor de eficácia da técnica.Palavras-chave: lesões encefálicas adquiridas, hemiplegia, terapia por contensão induzida, reabilitação.

DETERMINATION OF BLOOD CORTICOIDS USING THE IN VITRO RESIN UPTAKE OF 3H-PREDNISOLONE

1968 ◽  
Vol 57 (1) ◽  
pp. 23-32 ◽  
Author(s):  
Hironori Nakajima ◽  
Mitsunori Murala ◽  
Masumitsu Nakata ◽  
Takeshi Naruse ◽  
Seiji Kubo
Keyword(s):  
Thyroid Function Test ◽  
Normal Subjects ◽  
Adrenal Function ◽  
Function Test ◽  
Before And After ◽  
Adrenal Response ◽  
Suppression Test

ABSTRACT The in vitro resin uptake of 3H-prednisolone was used for the determination of blood cortisol after addition of radioactive prednisolone followed by Amberlite CG 400 Type 1 to the test serum, and incubation of the mixture. The radioactivity of the supernatant was compared before and after the addition of the resin. The principle of this method is similar to that of the 131I-triiodothyronine resin uptake for the thyroid function test. The tests for the specificity, reproducibility and sensitivity gave satisfactory results. The mean basal value ± SD of the 3H-prednisolone resin uptake was 35.3 ± 9.2% in normal subjects, and 27.1 ± 4.8% in pregnant women. This method was valid in various adrenal function tests, i. e. the adrenal circadian rhythm, corticotrophin (ACTH) test, dexamethasone suppression test and the adrenal response to lysine-8-vasopressin. It proved to be a sensitive indicator of the adrenal function. These results suggest that this method should be useful for a routine adrenal function test.

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