Commonly Used Outcome Measurement Tools in Pediatric Physical Therapy Telerehabilitation in the Philippines: A Quantitative Cross-Sectional Descriptive Study

With the COVID-19 pandemic, the adoption of telerehabilitation has rapidly increased to improve access and minimize cross-infection risk to patients. Nevertheless, Filipino pediatric physical therapists (PTs) must ensure that they conduct evidence-based procedures for specific tests and measures to determine patient outcomes. This investigation reported the most common pediatric outcome measurement tools (OMTs) used in telerehabilitation by Filipino pediatric PTs treating 0 to 21-year-olds in the Philippines. Validation and pilot testing of an adapted questionnaire on OMT usage was undertaken before dissemination via email and social media. Pediatric PTs reported that the commonly used OMTs in telerehabilitation are Gross Motor Function Measure (GMFM) (100%)—including both versions of GMFM-88 and GMFM-66 followed by Pediatric Balance Scale (PBS) (30%). These findings support the use of feasible OMTs in pediatric telerehabilitation due to their applicability in the online setting.

Gambaran Peningkatan Fungsi Motorik Kasar Pada Anak Cerebral Palsy Spastik Setelah Pemberian Hippotherapy: Literature Review

Spastic Cerebral Palsy is a type of Cerebral Palsy that experiences stiffness or tightness of the muscles. These muscles become stiff because messages to the muscles are conveyed incorrectly by the damaged part of the brain. The presence of spasticity will affect gross motor function disorders in children with cerebral palsy. One of the physiotherapy approaches to improve gross motor function is hippotherapy. This literature review study aims to describe gross motor function in Spastic Cerebral Palsy children after giving hippotherapy from several articles. The selection of articles in this study was a literature review analysis using the PICO method, five articles were obtained for review from several data bases such as PubMed (n=2) and Google Scholar (n=3). The measuring instrument uses GMFM (Gross Motor Function Measure) to measure gross motor function in Spastic Cerebral Palsy children. The results of the literature review analysis in these five articles indicate that hippotherapy can improve gross motor function in Spastic Cerebral Palsy children with an average value before the action of 63.65 and after the action of 66.68. From the results of the literature review of these five articles, it shows that hippotherapy is proven to improve gross motor function in Spastic Cerebral Palsy children before and after giving intervention with hippotherapy modality with an average difference of 3.03. Hippotherapy can be used as a reference material for interventions or research materials or physiotherapy research, especially in pediatric cases.Keywords: GMFM; spastic cerebral palsy; hippotherapy AbstrakCerebral Palsy Spastik merupakan salah satu jenis Cerebral Palsy yang mengalami kekakuan atau keketatan otot-otot. Otot ini menjadi kaku karena pesan pada otot disampaikan secara tidak benar oleh bagian otak yang rusak. Adanya spastisitas akan berpengaruh terhadap gangguan fungsi motorik kasar pada anak Cerebral Palsy. Salah satu pendekatan fisioterapi untuk meningkatkan fungsi motorik kasar adalah hippotherapy. Penelitian literature review ini bertujuan untuk mengetahui gambaran fungsi motorik kasar pada anak Cerebral Palsy Spastik setelah pemberian hippotherapy dari beberapa artikel. Pemilihan artikel pada penelitian ini yaitu analisis literature review dengan metode PICO, didapatkan lima artikel untuk direview dari beberapa data base sepertiPubMed (n=2) dan Google Scholar (n=3). Alat ukur menggunakan GMFM (Gross Motor Function Measure) untuk mengukur fungsi motorik kasar pada anak Cerebral Palsy Spastik. Hasil analisis literature review pada kelima artikel ini menunjukkan bahwa hippotherapy dapat meningkatkan fungsi motorik kasar pada anak Cerebral Palsy Spastik dengan nilai rata-rata sebelum tindakan 63,65 dan sesudah tindakan 66,68. Dari hasil literature review kelima artikel ini menunjukkan bahwa hippotherapy terbukti dapat meningkatkan fungsi motorik kasar pada anak Cerebral Palsy Spastik sebelum dan sesudah pemberian intervensi dengan modalitas hippotherapy dengan hasil selisih rata-rata sebesar 3,03. Hippotherapy dapat digunakan sebagai bahan acuan untuk intervensi maupun bahan riset atau penelitian fisioterapi khususnya pada kasus pediatric.Kata kunci : GMFM;cerebral palsy spastik;hippotherapy

Urodynamic Findings in Pediatric Spastic Cerebral Palsy: Retrospective Study From a Single Center

Objective To investigate the urodynamic study (UDS) result in pediatric patients with spastic cerebral palsy (CP). Material and methods Medical records of CP with pre-operative UDS results underwent selective dorsal rhizotomy (SDR) from Jan. 2020 to May. 2021 were retrospectively reviewed. Results Fifty-seven cases with spastic CP were included in the study. Among these cases, 46 were ambulatory and 11 were non-ambulatory. Average gross motor function measure - 66 (GMFM - 66) score was 62.16 ± 11.39. Reduced bladder capacity was seen in 49.12% of these cases and cases with lower GMFM - 66 score had a higher incidence rate of having low bladder capacity (p < 0.01). Detrusor overactivity (DO) was shown in 33.33% of patients. Cases with younger age had higher prevalence of DO (p < 0.05). Meanwhile, more non-ambulant patients had DO (p < 0.05). Increased post-voiding residual (PVR) was seen in 21.05% of cases. Those with higher average threshold in sphincter-associated input spinal nerve roots (rootlets) had higher rate of having abnormal PVR (p < 0.05). Conclusion Abnormal UDS results were prevalent in pediatric spastic CP. Motor function, age and threshold of their sphincter-associated spinal nerve rootlets were related to the abnormal UDS results.

Effects of Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: A Network Meta-Analysis

Gait disturbances are common in children and adolescents with cerebral palsy (CP). Robotic-assisted gait training (RAGT) is becoming increasingly widespread, and hence it is important to examine its effectiveness. A network meta-analysis (NMA) of clinical trials comparing treatments with RAGT vs. other physical therapy treatments was carried out. This study was conducted according to the NMA version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-NMA) guidelines and following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. The outcome variables used were the D and E dimensions of the Gross Motor Function Measure (GMFM), gait speed, resistance, and stride length. Among 120 records, 8 trials were included. This NMA did not find statistically significant results for any of the comparisons examined in any of the outcomes studied and the magnitude of the effect size estimates was low or very low. Our NMA results should be interpreted with caution due to the high clinical heterogeneity of the studies included.

Effectiveness of Functional Electrical Stimulation - Cycling Treatment in Children with Cerebral Palsy

AimThe purpose of this study was to evaluate the effects of functional electrical stimulation (FES) bicycle therapy system on motor function, gait pattern, spasticity, daily living activities, and aerobic capacity in children with cerebral palsy (CP) and to compare the results with sham stimulation and standard treatment.MethodsPatients with cerebral palsy who received botulinum toxin type-A injections to lower extremities and those with Gross Motor Function Measure Classification System (GMFCS) levels I – III, were included in the study. Twenty-five patients were randomly assigned into three treatment groups for 4-weeks: Group 1, FES-cycling and standard treatment; Group 2, Sham stimulus FES-cycling and standard treatment; Group 3, Standard treatment. Clinical assessment tools included the Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Pediatric Functional Independence Measure (WeeFIM), GMFCS, Gross Motor Function Measure-88 (GMFM-88), selective motor control tests, 6-minute walk test, and Visual Gait Analysis (VGA).ResultsIn all groups, there were significant improvements in MAS, MTS, WeeFIM, GMFM-88, 6-minute walk test, and VGA scores. No changes in GMFCS levels were observed in any group. At the end of the study, there was no significant difference among the groups in terms of any clinical assessment parameter.ConclusionsAll groups showed statistically significant improvements in motor function, walking pattern, spasticity, daily living activities, and aerobic capacity in patients with CP following the rehabilitation period. Although FES-cycling demonstrated no superiority over the other approaches and provided no additional benefit to the results, FES appears to be safe and well-tolerated in children with CP, at least as much as standard exercise treatment.

Psychometric properties of trunk impairment scale in children with spastic diplegia

The Trunk Impairment Scale (TIS) is a valid and reliable tool to assess trunk impairment in children with heterogeneous cerebral palsy. The purpose of this study was to determine the reliability and validity of the TIS in assessing children with spastic diplegic cerebral palsy. The sample was a total of 30 subjects (15 = boys, 15 = girls). All subjects underwent an assessment of the sitting component of the Gross Motor Function Measure-88 and TIS by rater 1. Rater one observed video recordings within 24 h and scored TIS for intra-rater reliability, while rater two did likewise after 48 h for inter-rater reliability. The mean and standard deviation of the TIS and sitting components of the Gross Motor Function Measure-88 were 15.66 ± 4.20 and 52.36 ± 6.26, respectively. We established intra-rater and inter-rater reliability of the TIS with Intra Class Correlation Coefficient 0.991 and 0.972, respectively. The concurrent validity of the TIS with the sitting component of the Gross Motor Function Measure-88 was good, with an r-value of 0.844 (p < 0.001). This study showed the excellent intra-rater and inter-rater reliability and high concurrent validity of the TIS in assessing children with spastic diplegic cerebral palsy.