Physical activity is important for young people's health. The emphasis over the last 2 decades has been on moderate to vigorous exercise when designing activity and exercise programs for children and ...adolescents with cerebral palsy (CP). Emerging evidence suggests that sedentary behavior is distinctly different from a lack of moderate to vigorous physical activity and has independent and different physiological mechanisms. The concept of concurrently increasing moderate to vigorous physical activity and replacing sedentary behavior with light physical activity may be beneficial for children and adolescents with CP. This article is a summary of the evidence for what works and what does not work for improving the physical activity of children and adolescents with CP. It also discusses what is known about sedentary behavior of children and adolescents with CP and what research directions are needed to build foundational knowledge in this area with this population.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objective To determine energy expenditure and muscle activity among children and adolescents with cerebral palsy (CP), across several conditions that approximate sedentary behavior, and standing. ...Study design Subjects with spastic CP (n = 19; 4-20 years of age; Gross Motor Function Classification System Expanded and Revised GMFCS-E&R levels I-V) participated in this cohort study. Energy-expenditure and muscle activity were measured during lying supine, sitting with support, sitting without support, and standing. Energy-expenditure was measured using indirect calorimetry and expressed in metabolic equivalents (METs). Muscle activation was recorded using surface electromyography. The recorded values were calculated for every child and then averaged per posture. Results Mean energy expenditure was >1.5 METs during standing for all GMFCS-E&R levels. There was a nonsignificant trend for greater muscle activation for all postures with less support. Only for children classified at GMFCS-E&R level III did standing result in significantly greater muscle activation ( P < .05) compared with rest. Conclusions Across all GMFCS-E&R levels, children and adolescents with CP had elevated energy expenditure during standing that exceeded the sedentary threshold of 1.5 METs. Our findings suggest that changing a child's position to standing may contribute to the accumulation of light activity and reduction of long intervals of sedentary behavior.
The objective of the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) evidence reports is to provide the biomedical research and clinical practice communities with the current ...state of evidence about various interventions for the management of developmental disabilities. AACPDM evidence reports aggregate all that has been published about outcomes of an intervention for a medical condition, gauge the credibility (i.e. strength of the internal validity) of that evidence, and identify gaps in our scientific knowledge. The original version of this report was published in the ‘AACPDM Database of Evidence Reports’ on the internet (www.aacpdm.org) where evidence reports are regularly updated to include new research.
Longitudinal research on gross motor percentile rank scores of children with typical development has documented intra-individual variability of scoring patterns. Clinically, interpreting these ...fluctuations presents a challenge for therapists.
The aim of this study was to determine the utility of cluster analysis as a technique to organize the gross motor scoring patterns of children with typical development into clinically relevant groups.
This was a descriptive, exploratory study using data from 2 longitudinal studies.
Sixty-six children with typical development participated in the study.
The children were assessed on the gross motor subscale of the Peabody Developmental Motor Scales at 9, 11, 13, 16, and 21 months of age and on the gross motor subscale of the Peabody Developmental Motor Scales, 2nd edition, at 4, 4.5, 5, and 5.5 years of age. Demographic and health data were collected. Parents were interviewed when the children were 8 years of age. Cluster analysis was conducted. Demographic and health data were compared across clusters.
Four distinct and clinically relevant clusters were identified. A significant difference was found among the clusters for total number of illnesses.
The children in these analyses were at low risk for gross motor problems. Further research with a more high-risk sample is needed to validate the clinical utility of the identified clusters.
Cluster analysis techniques may offer a mechanism to explore longitudinal data in physical therapy research. The techniques provided a mechanism to group data without losing the richness of information provided by the intra-individual variability of scoring patterns. Clinically, examination of distinct scoring patterns may lead to improved accuracy in screening for gross motor concerns compared with the traditional use of single-assessment cutoff points.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The use of measurement tools is an essential part of good evidence-based practice; however, physiotherapists (PTs) are not always confident when selecting, administering, and interpreting these ...tools. The purpose of this study was to evaluate the impact of a multifaceted knowledge translation intervention, using PTs as knowledge brokers (KBs) to facilitate the use in clinical practice of four evidence-based measurement tools designed to evaluate and understand motor function in children with cerebral palsy (CP). The KB model evaluated in this study was designed to overcome many of the barriers to research transfer identified in the literature.
A mixed methods before-after study design was used to evaluate the impact of a six-month KB intervention by 25 KBs on 122 practicing PTs' self-reported knowledge and use of the measurement tools in 28 children's rehabilitation organizations in two regions of Canada. The model was that of PT KBs situated in clinical sites supported by a network of KBs and the research team through a broker to the KBs. Modest financial remuneration to the organizations for the KB time (two hours/week for six months), ongoing resource materials, and personal and intranet support was provided to the KBs. Survey data were collected by questionnaire prior to, immediately following the intervention (six months), and at 12 and 18 months. A mixed effects multinomial logistic regression was used to examine the impact of the intervention over time and by region. The impact of organizational factors was also explored.
PTs' self-reported knowledge of all four measurement tools increased significantly over the six-month intervention, and reported use of three of the four measurement tools also increased. Changes were sustained 12 months later. Organizational culture for research and supervisor expectations were significantly associated with uptake of only one of the four measurement tools.
KBs positively influenced PTs' self-reported knowledge and self-reported use of the targeted measurement tools. Further research is warranted to investigate whether this is a feasible, cost-effective model that could be used more broadly in a rehabilitation setting to facilitate the uptake of other measurement tools or evidence-based intervention approaches.
Emerging Therapy Approaches Law, Mary; Darrah, Johanna
Journal of child neurology,
08/2014, Letnik:
29, Številka:
8
Journal Article
Recenzirano
Children and youth with cerebral palsy receive ongoing physical and occupational therapy services to improve their functional performance and participation in activities at home, school, and in the ...community. Over the past 2 decades, rehabilitation interventions have become more functional and goal oriented. In this article, we discuss factors that have influenced emerging intervention approaches. These factors include greater involvement of families in decision making, changing conceptual frameworks and theories underlying skill development and improved outcome measures. New research findings indicate that rehabilitation interventions embracing family-centered services and focusing on functional improvement can be more effective in promoting participation. This knowledge can serve as the platform for further examination of the most effective rehabilitation interventions for children and youth with cerebral palsy.
Aim
To systematically review the evidence on the effectiveness of motor interventions for infants from birth to 2 years with a diagnosis of cerebral palsy or at high risk of it.
Method
Relevant ...literature was identified by searching journal article databases (PubMed, Embase, CINAHL, Cochrane, Web of Knowledge, and PEDro). Selection criteria included infants between the ages of birth and 2 years diagnosed with, or at risk of, cerebral palsy who received early motor intervention.
Results
Thirty‐four studies met the inclusion criteria, including 10 randomized controlled trials. Studies varied in quality, interventions, and participant inclusion criteria. Neurodevelopmental therapy was the most common intervention investigated either as the experimental or control assignment. The two interventions that had a moderate to large effect on motor outcomes (Cohen's effect size>0.7) had the common themes of child‐initiated movement, environment modification/enrichment, and task‐specific training.
Interpretation
The published evidence for early motor intervention is limited by the lack of high‐quality trials. There is some promising evidence that early intervention incorporating child‐initiated movement (based on motor‐learning principles and task specificity), parental education, and environment modification have a positive effect on motor development. Further research is crucial.
What this paper adds
Updated review of early motor intervention studies of infants with cerebral palsy found evidence of efficacy was weak.
Promising approaches involve child‐initiated movement, task specificity, and environmental modification.
The Alberta Infant Motor Scale (AIMS) is a norm‐referenced measure of infant gross motor development. The objectives of this study were: (1) to establish the best cut‐off scores on the AIMS for ...predictive purposes, and (2) to compare the predictive abilities of the AIMS with those of the Movement Assessment of Infants (MAI) and the Peabody Developmental'Gross Motor Scale (PDGMS). One hundred and sixty‐four infants were assessed at 4 and 8 months adjusted ages on the three measures. A pediatrician assessed each infant's gross motor development at 18 months as normal, suspicious, or abnormal. For the AIMS, two different cut‐off points were identified: the 10th centile at 4 months and the 5th centile at 8 months. The MAI provided the best specificity rates at 4 months while the AIMS was superior in specificity at 8 months. Sensitivity rates were comparable between the two tests. The PDGMS in general demonstrated poor predictive abilities.
IMPORTANCE: Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but ...now can be made before 6 months’ corrected age. OBJECTIVES: To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy–specific early intervention that should follow early diagnosis to optimize neuroplasticity and function. EVIDENCE REVIEW: This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. FINDINGS: Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months’ corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months’ corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence. CONCLUSIONS AND RELEVANCE: Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
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