Objective:
To compare efficacy of a web-based multimodal training programme, ‘Move it to improve it’ (MitiiTM), to usual care on gross motor capacity and performance for children with an acquired ...brain injury.
Design:
Randomized waitlist controlled trial.
Setting:
Home environment.
Participants:
A total of 60 independently ambulant children (30 in each group), minimum 12 months post-acquired brain injury were recruited and randomly allocated to receive either 20 weeks of MitiiTM training (30 minutes/day, six days/week, total 60 hours) immediately, or waitlisted (usual care control group) for 20 weeks. A total of 58 children completed baseline assessments (32 males; age 11 years 11 months ± 2 years 6 months; Gross Motor Function Classification System equivalent I = 29, II = 29).
Intervention:
The MitiiTM program comprised of gross motor, upper limb and visual perception/cognitive activities.
Main measures:
The primary outcome was 30-second, repetition maximum functional strength tests for the lower limb (sit-to-stand, step-ups, half-kneel to stand). Secondary outcomes were the 6-minute walk test, High-level Mobility Assessment Tool, Timed Up and Go Test and habitual physical activity as captured by four-day accelerometry.
Results:
Groups were equivalent at baseline on demographic and clinical measures. The MitiiTM group demonstrated significantly greater improvements on combined score of functional strength tests (mean difference 10.19 repetitions; 95% confidence interval, 3.26–17.11; p = 0.006) compared with the control group. There were no other between-group differences on secondary outcomes.
Conclusion:
Although the MitiiTM programme demonstrated statistically significant improvements in the functional strength tests of the lower limb, results did not exceed the minimum detectable change and cannot be considered clinically relevant for children with an acquired brain injury.
Clinical Trial Registration:
Australian New Zealand Clinical Trials Registration Number, ANZCTR12613000403730.
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•We compared two doses of mCIMT and bimanual therapy from two separate randomized controlled trials.•30h of mCIMT or bimanual therapy was not enough to achieve improvements in upper limb motor ...outcomes.•30h of mCIMT or bimanual therapy was enough to yield meaningful gains in occupational performance.•At least 60h of mCIMT or bimanual therapy is required to improve upper limb motor outcomes.
This study aimed to compare efficacy of two dosages of modified constraint induced movement therapy (mCIMT) and bimanual therapy on upper limb and individualized outcomes for children with unilateral cerebral palsy. This secondary analysis included two separate randomized trials that compared equal doses (high or low) of mCIMT to bimanual therapy; Study 1 (full dose – 60h) n=64 and; Study 2 (half dose – 30h) n=18 for children aged five to 16 years with unilateral cerebral palsy. Outcomes for both studies included the Melbourne Assessment of Unilateral Upper Limb Function, Assisting Hand Assessment, Jebsen Taylor Test of Hand Function and Canadian Occupational Performance Measure which were administered at baseline, three and 26 weeks. Mixed linear modelling was used to compare between dose (e.g. “full dose” to “half dose” of either mCIMT or bimanual therapy) on outcomes at three and 26 weeks post-intervention. There were no significant differences between groups at baseline, however, on average the half dose mCIMT group was younger with better hand function compared to the other groups. The full compared to half dose mCIMT group achieved greater gains in bimanual performance at three weeks and dexterity and quality of movement at 26 weeks. There were no between group differences for bimanual therapy doses. Half dose groups receiving either mCIMT or bimanual therapy did not make significant within group gains on any upper limb motor outcome, however gains in occupational performance were clinically meaningful.
These results suggest that a half dose (30h) of either mCIMT or bimanual therapy may not be sufficient to impact upper limb outcomes, but made clinically meaningful gains in occupational performance for school aged children with UCP.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Aim
To identify developmental trajectories of hand function in infants aged 3 months to 12 months with unilateral cerebral palsy (CP).
Method
Infants at high risk of unilateral CP were recruited from ...3 months of age from follow‐up programmes and clinics in Sweden, the Netherlands, Italy, and Australia. Measurements on the Hand Assessment for Infants (HAI) were completed until 12 months of age. Group‐based trajectory modelling was used to identify subgroups of infants with similar trajectories of development. Multinomial logistic regression determined associations between demographic variables and trajectory membership.
Results
Ninety‐seven infants (52 males, 45 females; median gestational age 38wks interquartile range 30–40wks) were included. Infants were assessed between two and seven times (mean 4, SD 1.2) with a total of 387 observations. A three‐group trajectory model identified a ‘low‐functioning group’ (n=45: 46%), ‘moderate‐functioning group’ (n=30: 31%), and ‘high‐functioning group’ (n=22: 23%). Mean posterior probabilities (0.91–0.96) and odds of correct classification (26.3–33.2) indicated good model fit. Type of brain lesion, sex, side of hemiplegia, country, gestational age, and access to intensive intervention were not associated with group membership.
Interpretation
Three trajectories of hand function development for infants with unilateral CP were identified and indicate some greater distinctions between groups with increasing age. The HAI is a valuable measure, capturing development of hand function of infants with unilateral CP over time.
What this paper adds
Three distinct developmental trajectories of hand function in infants with unilateral cerebral palsy were identified.
A low‐functioning group made little progress in development of hand function in the first year of life.
The degree of impairment on the impaired hand at 6 months of age is highly associated with trajectory membership.
Infants with all types of brain lesion were represented across each trajectory group.
Resumen
Desarrollo de la función manual durante el primer año de vida en niños con parálisis cerebral unilateral
Objetivo
Identificar la trayectoria del desarrollo de la función manual en niños de 3 a 12 meses con parálisis cerebral unilateral (PC).
Metodo
Fueron evaluados niños con alto riesgo de PC unilateral desde los 3 meses de edad en programas de seguimiento en clínicas en Suecia, Países Bajos, Italia y Australia. Las mediciones con la Hand Assessment for Infants (HAI) fueron completadas hasta los 12 meses de edad. Se utilizó la trayectoria modelada de un grupo basal para identificar subgrupos de niños con similar trayectoria de desarrollo. La regresión logística multinomial determinó las asociaciones entre las variables demográficas y la pertenencia a la trayectoria.
Resultados
Noventa y siete niños (52 masculinos, 45 femeninos; edad gestacional media 38 semanas rango 30–40 semanas) fueron incluidos. Los niños fueron evaluados entre dos y siete veces (media 4, SD 1,2) con un total de 387 observaciones. Un modelo de trayectoria de tres grupos identificó un¨ grupo de bajo funcionamiento¨(n=45: 46%), un ¨grupo de moderado funcionamiento¨ (n=30: 31%), y un ¨grupo de alto funcionamiento¨ (n=22: 23%). La probabilidad media posterior (0,91–0,96) y las probabilidades de clasificación correcta (26,3–33,2) indicaron un buen ajuste del modelo. El tipo de lesión cerebral, sexo, localización de la hemiplejía, país, edad gestacional y el acceso a la intervención no fue asociado a la membresía del grupo.
Interpretacion
En niños con PC unilateral fueron identificados tres trayectorias del desarrollo de la función manual, los cuales indicaron mayor distinción entre los grupos a mayor edad. El HAI es una medida valiosa, capturando el desarrollo de la función manual de los niños con PC bilateral en el tiempo.
Resumo
Desenvolvimento da função manual durante o primeiro ano de vida em crianças com paralisia cerebral unilateral
Objetivo
Identificar trajetórias de desenvolvimento da função manual em lactentes com idade entre 3 e 12 meses com paralisia cerebral unilateral.
Métodos
Lactentes com alto risco para paralisia cerebral unilateral foram recrutadas aos 3 meses de idade em programas de follow‐up e clínicas na Suécia, Países Baixos, Itália e Austrália. Medidas da Avaliação manual para lactentes (AML) foram realizadas até os 12 meses de idade. A modelagem de trajetória baseada em grupos foi usada para identificar subgrupos de lactentes com trajetórias similares de desenvolvimento. Uma regressão logística multinomial determinou associações entre variáveis demográficas e a trajetória utilizada.
Resultados
Noventa e sete lactentes (52 do sexo masculino e 45 do sexo feminino; mediana da idade gestacional de 38 semanas intervalo interquartil 30‐40 semanas) foram incluídos. Os lactentes foram avaliados entre duas e sete vezes (média 4, DP 1,2) com um total de 387 observações. Um modelo de trajetória de três grupos identificou um ‘grupo de baixa função’ (n= 45: 46%), ‘grupo de moderada função’ (n=30: 31%) e ‘grupo de alta função’ (n=22: 23%). Probabilidades posteriores médias (0,91‐0,96) e chances de classificação correta (26,3‐33,2) indicaram bom ajuste do modelo. O tipo de lesão cerebral, sexo, lado da hemiplegia, país, idade gestacional e acesso a intervenção não foram associados a participação no grupo.
Interpretação
Três trajetórias de desenvolvimento de função manual para lactentes com paralisia cerebral unilateral foram identificados e demonstram maiores diferenças entre os grupos com o aumento da idade. A AML é uma medida valiosa, capturando o desenvolvimento da função manual em lactentes com paralisia cerebral unilateral ao longo do tempo.
What this paper adds
Three distinct developmental trajectories of hand function in infants with unilateral cerebral palsy were identified.
A low‐functioning group made little progress in development of hand function in the first year of life.
The degree of impairment on the impaired hand at 6 months of age is highly associated with trajectory membership.
Infants with all types of brain lesion were represented across each trajectory group.
This article is commented on by Holmefur on page 507 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
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Aim
To determine the predictors of magnitude of change in response to a participation‐focused leisure‐time physical activity intervention in children with cerebral palsy (CP) using the ParticiPAte CP ...protocol.
Method
We included 33 children (16 males, 17 females) aged 8 to 12 years (mean age=10y, SD=1y 6mo) with CP with pre/postintervention data from a wait‐list randomized trial. The hypothesized linear predictors of change in primary outcomes (Canadian Occupational Performance Measure COPM‐performance and COPM‐satisfaction, Belief in Goal Self‐Competence Scale (BiGSS), and minutes per day moderate‐to‐vigorous physical activity MVPA) were: age; Gross Motor Function Classification System level; comorbid autism spectrum disorder (ASD); Goal Attainment Scaling T score; Problems in Schools Questionnaire; Physical Activity Climate Questionnaire; Motives for Physical Activities Measure‐Revised; and stage of behaviour change. Multivariable models were selected using the Bayesian information criterion.
Results
Overcoming barriers to participation, age, and comorbid ASD explained 49% of the variance in change in COPM‐performance. Being motivated by interest and/or enjoyment and age explained 32% of the variance in change in COPM‐satisfaction. Being motivated by physical activity competence or appearance (extrinsic motivation) explained 24% of the variance in change in BiGSS. Parental autonomy supportiveness, overcoming barriers to participation, appearance motivation, and baseline MVPA explained 59% of the variance in change in MVPA.
Interpretation
These findings support a behaviour paradigm for conceptualizing physical activity in children with CP.
What this paper adds
Children who met their treatment goals showed a greater increase in physical activity participation.
Children who were more intrinsically motivated by physical activity at baseline improved more.
Being older and having a comorbid diagnosis of autism spectrum disorder were associated with an attenuated effect of the therapy.
What this paper adds
Children who met their treatment goals showed a greater increase in physical activity participation.
Children who were more intrinsically motivated by physical activity at baseline improved more.
Being older and having a comorbid diagnosis of autism spectrum disorder were associated with an attenuated effect of the therapy.
Editor's Choice
More and more, participation in any life situation is rightly highlighted as a goal for intervention, and a most relevant outcome measure.1 This contrasts with previews views that focused on the ability to perform tasks as expected. My Editor’s Choice for the May issue is this study of change observed in children with cerebral palsy following an individualized family‐centred, ecological leisure‐time physical activity intervention focused on motivation and participation. It illustrates that participation can be supported meaningfully by organizing therapy in settings that are natural to the child and family.
REFERENCE
1. Imms C, Green D, editors. Participation: Optimising Outcomes in Childhood‐Onset Neurodisability. London: Mac Keith Press, 2020.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The objective of this review is to evaluate the efficacy of group social skills interventions in improving social knowledge, social competency, and social participation in adolescents with acquired ...and developmental disabilities.
Difficulties with social functioning and participation are commonly experienced by adolescents with a range of acquired and developmental disabilities. There is evidence for the use of group social skills interventions in youth with autism spectrum disorder, although less is known about their efficacy with youth with other disabilities.
This review will include studies that evaluate group social skills interventions in adolescents with an acquired or developmental disability, excluding a primary mental health disorder. Randomized controlled trials will be the only experimental design included and group social skills interventions must have an available intervention manual to allow use in clinical practice. Primary outcomes will include measures of social knowledge, social competence, and social participation.
PubMed, CINAHL, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Web of Science will be searched for eligible studies published in English. Clinical Trials Registry, Google Scholar, and ProQuest Dissertations and Theses will also be searched. Screening, study selection, critical appraisal, and data extraction will be conducted by two independent reviewers using standardized tools. Studies will be pooled, where possible, with statistical meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented.
PROSPERO CRD42020158189.
To examine sleep problems in a population-based sample of school-aged children (8–12yo) with Cerebral Palsy (CP)
Eighty-six children (mean 9 years, 5 months, SD = 1 year, 6 months; male = 60) with CP ...(Gross Motor Function Classification System; GMFCS I=46; II=21; III=9; IV=6; V=6) participated. Classifications/assessments included: Sleep Disturbance Scale for Children (SDSC), Gross Motor Function Measure (GMFM-66), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), Strengths and Difficulties Questionnaire (SDQ) and the Cerebral Palsy- Quality of Life (CP-QOL) Pain Impact subscale. Analysis included linear and logistic regression.
38 (44 %) children were within the clinical range for sleep problems. Sleep problems were significantly associated with epilepsy, (95 % CI) = 14.48 (7.95 to 21.01), gross motor function, –0.13 (–0.26 to –0.01), manual ability, 7.26 (0.82 to 13.69), communication, 10.01 (2.21 to 17.80), child behaviour, 1.134 (0.74 to 1.53), and pain related QOL, 0.33 (0.12 to 0.53). For the multivariable model, sleep problems remained significantly associated with epilepsy, b (95 % CI) = 11.72 (4.88 to 18.57), child behaviour, 1.03 (0.65 to 1.41) and pain-related QOL, 0.21 (0.29 to 0.38).
Sleep problems are common and associated with epilepsy, child behaviour and pain related QOL.
This paper explored sleep problems in a representative population-based cohort study of school-age Australian children, finding that 44 % of primary-school aged children with CP were in the clinical range for sleep problems and that the most common problems were in initiating and maintaining sleep and sleep-wake transitions. This demonstrates the importance of screening for sleep problems in the CP population.
Sleep problems were found to be associated with motor functioning, manual ability, communication, epilepsy, child behaviour and pain related quality of life, however, only the associated with epilepsy, child behaviour and pain related quality of life remained in the multivariable models. This is the first paper to examine the relationships between pain related quality of life and sleep.
•44 % of primary-school aged children with CP are in the clinical range for sleep problems.•The most common problems are in initiating and maintaining sleep and sleep-wake transitions.•Sleep problems are related to epilepsy, child behaviour and pain related quality of life.
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Abstract Aim To systematically review the evidence for intensive mobility training in cerebral palsy (CP) and to determine the minimum effective dose to improve mobility. Method Randomized controlled ...trials (RCTs) or quasi‐RCTs that included participants with CP, and which used intensive task‐oriented training (TOT) mobility interventions and reported mobility outcomes, were included. Five databases were searched; two independent reviewers selected studies and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation system and the Cochrane Risk of Bias 2 tool were used to rate the certainty of evidence at the outcomes level and to determine the risk of bias respectively. Meta‐analyses were conducted with clinically homogeneous studies. Threshold dose was analysed through meta‐regression. Results Forty‐six RCTs with 1449 participants (mean age range 1 year 2 months to 16 years 4 months) were included. TOT had statistically and clinically significant effects on walking speed ( p = 0.001), cadence ( p = 0.02), gross motor function ( p = 0.03), and functional mobility ( p = 0.009) compared with control interventions. The threshold dose was undeterminable owing to the high heterogeneity of studies. Interpretation TOT may improve walking speed, walking endurance, and balance. Studies with homogeneous samples and outcomes are needed to support clinical recommendations for intensive mobility interventions.
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48.
Sakzewski et al. reply Sakzewski, Leanne; Boyd, Roslyn
Developmental medicine and child neurology,
April 2012, Volume:
54, Issue:
4
Journal Article
Peer reviewed
Open access
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To investigate the reliability of a measure of fidelity of therapist delivery, quantify fidelity of delivery, and determine factors impacting fidelity in the Rehabilitation EArly for Congenital ...Hemiplegia (REACH) clinical trial.
Ninety-five infants (aged 3-9 months) with unilateral cerebral palsy participated in the REACH clinical trial. The Therapist Fidelity Checklist (TFC) evaluated key intervention components. Video-recorded intervention sessions were scored using the TFC.
Inter- and intrarater reliability was percentage agreement 77% to 100%. Fidelity of delivery was high for 88.9% of sessions and moderate for 11.1% of sessions. Sessions with moderate scores included infants receiving infant-friendly bimanual therapy and occurred at the intervention midpoint or later. No significant relationships were found for TFC scores and infant age, manual ability, or parent engagement.
Fidelity of delivery was high for the REACH trial in most intervention sessions. Standardized therapist training with intervention manuals and monthly peer-to-peer support likely contributed to these results.
Aim
To test the efficacy of a group social skills intervention on social functioning in adolescents with a brain injury.
Method
Thirty‐six adolescents (mean age 14y, SD 1y 8mo, age range 12y 1mo–16y ...3mo; 17 females) with acquired brain injury (ABI; ≥12mo postintervention; n=19) or cerebral palsy (n=17) were randomly allocated to the Program for the Education in Enrichment of Relational Skills (PEERS) or usual care. The primary outcome was the Social Skills Improvement System‐Rating Scales (SSIS‐RS). Secondary outcomes were scores derived from the Test of Adolescent Social Skills Knowledge‐Revised (TASSK‐R), Social Responsiveness Scale, Second Edition, and Quality of Socialization Questionnaire. Between‐group differences postintervention and at the 26‐week retention time point were compared using linear mixed modelling for continuous outcomes and Poisson regression for count data.
Results
There were no between‐group differences on the primary outcome (SSIS‐RS). Regarding the secondary outcomes, the PEERS‐exposed group achieved significantly greater improvements on the TASSK‐R (mean difference MD=6.8, 95% confidence interval CI=4.8–8.8, p<0.001), which were maintained at the 26‐week retention time point (MD=8.1, 95% CI=6.0–10.2, p<0.001). PEERS was also associated with a significant increase in parent‐reported invited get‐togethers at 26 weeks (incidence rate ratio=4.0, 95% CI=1.0–16.0, p=0.05).
Interpretation
Adolescents with brain injury who completed the PEERS learned and retained social knowledge and increased social participation.
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