First name
Laura
Middle name
A
Last name
Prosser

Title

The Relationship between Family Empowerment and Fine Motor, Gross Motor, and Cognitive Skills in Young Children with Cerebral Palsy.

Year of Publication

2022

Date Published

12/2022

ISSN Number

1365-2214

Abstract

BACKGROUND: Family empowerment in families of young children with cerebral palsy (CP) is an important consideration because the first few years of life can be overwhelming for parents. The purpose of this research was to investigate the relationship between family empowerment, fine motor (FM), gross motor (GM), and cognitive development in children with CP who were under three years of age.

METHODS: Forty-one children with a mean age of 23.8 months participated in this study. The FES was completed by the participants' parents while the FM, GM, and cognitive subscales of the Bayley Scales of Infant and Toddler Development Third edition (B-III) were administered by physical therapists.

RESULTS: Statistically significant positive correlations were found between the FES total and B-III raw scores for FM, GM, and cognitive subscales with coefficients ranging from 0.35-0.41. Significant relationships were also found between the FES Community subscale and the B-III FM, GM, and cognitive subscales.

CONCLUSIONS: This study provides evidence of a relationship between family empowerment and FM, GM, and cognitive abilities in young children with CP, with a greater severity of impairments related to lower levels of caregiver empowerment.

DOI

10.1111/cch.13091

Alternate Title

Child Care Health Dev

PMID

36519729

Title

Walking speed influences spatiotemporal but not symmetry measures of gait in children and adolescents with hemiplegia.

Year of Publication

2022

Number of Pages

233-236

Date Published

10/2022

ISSN Number

1879-2219

Abstract

BACKGROUND: The measurement of gait is likely influenced by walking speed in children with hemiplegia, but this relationship is not well characterized.

RESEARCH QUESTION: What is the influence of walking speed on spatiotemporal and symmetry measures of gait in children with hemiplegia, with consideration of side and footwear condition?

METHODS: Children with hemiparetic gait due to stroke were recruited for a small pilot intervention study. Participants walked at self-selected and fast speeds while barefoot and while wearing shoes. Data from baseline sessions were included in this analysis. The influence of walking speed on five spatiotemporal gait measures was determined using a generalized estimating equation to calculate the proportion of variability in the gait measures that was explained by walking speed. Differences between sides and footwear conditions, and the relationships between walking speed and two symmetry measures, are also reported.

RESULTS: A total of 820 steps were analyzed from ten children (11.2 ± 4.1 years). Walking velocity significantly influenced all spatiotemporal measures of gait. As speed increased, step length increased and all temporal measures decreased, on both paretic and nonparetic sides. Wearing shoes increased step length and stance time for both paretic and nonparetic sides, and slowed step time on the nonparetic side. Regardless of footwear, the paretic side demonstrated slower step and swing times, and faster stance and single support times. We did not observe significant relationships between walking speed and gait symmetry.

SIGNIFICANCE: Our observations suggest that walking speed alone influences the spatiotemporal measurement of gait in children with hemiplegia and should be considered in the interpretation of walking function. Yet, controlling for walking speed is often not feasible or not preferred in this population. We offer suggestions for clinicians and researchers who seek to measure gait during overground walking at freely-selected speeds.

DOI

10.1016/j.gaitpost.2022.09.088

Alternate Title

Gait Posture

PMID

36191582

Title

Normalizing step-to-step variability to age in children and adolescents with hemiplegia.

Year of Publication

2022

Number of Pages

6-8

Date Published

08/2022

ISSN Number

1879-2219

Abstract

BACKGROUND: Children with hemiplegia often demonstrate gait deviations including increased variability and asymmetry. Step-to-step gait variability decreases over childhood and increases in the presence of neurologic dysfunction. Gait variability in children with hemiplegia should therefore be interpreted in reference to age-related norms RESEARCH QUESTION: Does conversion of the enhanced gait variability index (eGVI) to age-normalized z-scores improve interpretation of gait variability in children with hemiplegia?

METHODS: Ten children (11.2 +/- 4.1 years) with hemiparetic gait due to stroke were recruited for a small prospective pilot intervention study. Participants walked at self-selected speed over an instrumented walkway while barefeet and while wearing shoes. eGVI values from baseline sessions were calculated and converted to age-normalized z-scores (eGVI) based on published norms. Differences in gait variability between sides and footwear conditions, and its relationship to walking speed, were examined.

RESULTS: There were no differences in raw eGVI or eGVI between paretic and nonparetic sides (eGVI p = 0.31; eGVI p = 0.31) or between footwear conditions (eGVI p = 0.62; eGVI p = 0.33). Average raw eGVI values were just over two standards deviations above the reference mean of 100 (121.2, 122.1, 120.3 for mean (average of both limbs), nonparetic side and paretic side, respectively), indicating significantly greater step-to-step gait variability than in typical gait. However, when converted to age-normalized z-scores (eGVI), variability deviated less from the normative sample, averaging just over one standard deviation above the reference mean (1.2, 1.3, 1.1 for mean, nonparetic side and paretic side, respectively). We also observed a relationship between eGVI and walking speed in our sample.

SIGNIFICANCE: We suggest that eGVI values in children be converted to z-scores or otherwise age-normalized so as not to inflate the degree of variability reported in clinical pediatric populations. Future work with larger samples will offer greater insight into gait variability in various clinical pediatric populations.

DOI

10.1016/j.gaitpost.2022.08.009

Alternate Title

Gait Posture

PMID

35994953

Title

The Use of Dynamic Weight Support with Principles of Infant Learning in a Child with Cerebral Palsy: A Case Report.

Year of Publication

2021

Number of Pages

166-175

Date Published

2021

ISSN Number

1541-3144

Abstract

<p><strong>AIMS: </strong>Typical infant movement is characterized by a high degree of motor exploration, error, and variability. However, children with cerebral palsy (CP) often cannot create these experiences due to their neuromotor impairments. The purpose of this case study is to describe a 6-month course of physical therapy (PT) incorporating principles of infant motor learning using dynamic weight support (DWS) in a child with CP.</p>

<p><strong>METHODS: </strong>The child was a 27-month-old girl with diplegic CP who functioned at Gross Motor Function Classification System Level IV. The child received 68 PT sessions over a six-month period. DWS was used during therapy to encourage motor practice. The therapy area was arranged to encourage active exploration, motor variability, and error experience. Gross motor function, postural control, parent perception of performance, and parent satisfaction were measured before, during, and after the course of therapy.</p>

<p><strong>RESULTS: </strong>Gross motor function increased during the treatment beyond the level predicted from natural progression. Postural control fluctuated and demonstrated no appreciable improvement. Parent-perceived performance and satisfaction improved on three of four goals.</p>

<p><strong>CONCLUSIONS: </strong>Using DWS to incorporate principles of infant learning may have facilitated the development of gross motor skills in a child with diplegic CP.</p>

DOI

10.1080/01942638.2020.1766638

Alternate Title

Phys Occup Ther Pediatr

PMID

32423264

Title

Infants at risk for physical disability may be identified by measures of postural control in supine.

Year of Publication

2021

Date Published

2021 Jun 26

ISSN Number

1530-0447

Abstract

<p><strong>BACKGROUND: </strong>Early detection of delay or impairment in motor function is important to guide clinical management and inform prognosis during a critical window for the development of motor control in children. The purpose of this study was to investigate the ability of biomechanical measures of early postural control to distinguish infants with future impairment in motor control from their typically developing peers.</p>

<p><strong>METHODS: </strong>We recorded postural control from infants lying in supine in several conditions. We compared various center of pressure metrics between infants grouped by birth status (preterm and full term) and by future motor outcome (impaired motor control and typical motor control).</p>

<p><strong>RESULTS: </strong>One of the seven postural control metrics-path length-was consistently different between groups for both group classifications and for the majority of conditions.</p>

<p><strong>CONCLUSIONS: </strong>Quantitative measures of early spontaneous infant movement may have promise to distinguish early in life between infants who are at risk for motor impairment or physical disability and those who will demonstrate typical motor control. Our observation that center of pressure path length may be a potential early marker of postural instability and motor control impairment needs further confirmation and further investigation to elucidate the responsible neuromotor mechanisms.</p>

<p><strong>IMPACT: </strong>The key message of this article is that quantitative measures of infant postural control in supine may have promise to distinguish between infants who will demonstrate future motor impairment and those who will demonstrate typical motor control. One of seven postural control metrics-path length-was consistently different between groups. This metric may be an early marker of postural instability in infants at risk for physical disability.</p>

DOI

10.1038/s41390-021-01617-0

Alternate Title

Pediatr Res

PMID

34175891

Title

Factors that Predict Overall Health and Quality of Life in Non-Ambulatory Individuals with Cerebral Palsy.

Year of Publication

2018

Number of Pages

147-152

Date Published

2018

ISSN Number

1555-1377

Abstract

<p><strong>Background: </strong>It is unknown what role specific tasks associated with personal care, positioning, communication and social interaction, and comfort and emotions play in predicting the overall health and quality of life of individuals with non-ambulatory cerebral palsy (CP). In this study, we prospectively evaluated which of these factors were significant predictors of overall health and quality of life.</p>

<p><strong>Methods: </strong>Parents and guardians of non-ambulatory children, adolescents and young adults with CP were prospectively recruited from the Cerebral Palsy Clinic of a large pediatric academic hospital. Caregivers completed the CP Child Questionnaire®. Univariate analyses were used to identify relationships between overall health, overall quality of life (QOL), and responses in the following categories: personal care and activities of daily living, positioning and transfer mobility, comfort and emotions, and communication and social interaction. Significant predictors of overall health and QOL were then determined via logistic regression.</p>

<p><strong>Results: </strong>64 patients ages 0-20 years and Gross Motor Function Classification System levels IV and V were included in our study (mean age 9.16 ±4.96 years). Overall QOL (OR 194.2, 95% CI, 9.5-3964.9) and comfort while sitting (OR 15.9, 95% CI, 1.2-205.3) were significant predictors of overall health. Feelings of unhappiness or sadness (OR 59.9, 95% CI, 1.6-2209.8), difficulty understanding the parent or guardian (OR 29.8, 95% CI, 1.6-543.7), and not attending school (OR 57.2, 95% CI, 2.6-1274.4) were significant predictors of lower overall quality of life.</p>

<p><strong>Conclusions: </strong>Overall QOL appears to predict overall health. Factors associated with comfort and emotions and communication and social interaction appear to predict overall QOL to a greater extent than personal care and transfer mobility. Level of Evidence: Prognostic II.</p>

Alternate Title

Iowa Orthop J

PMID

30104938

Title

Which Children Are Not Getting Their Needs for Therapy or Mobility Aids Met? Data From the 2009-2010 National Survey of Children With Special Health Care Needs.

Year of Publication

2016

Number of Pages

222-31

Date Published

2016 Feb

ISSN Number

1538-6724

Abstract

<p><strong>BACKGROUND: </strong>Pediatric rehabilitation therapy services and mobility aids have an important role in the health of children with special health care needs, and the Affordable Care Act (ACA) may increase coverage for these needs. Identifying the prevalence of and factors associated with therapy and mobility aid needs and unmet needs prior to the full implementation of the ACA will be useful for future evaluation of its impact.</p>

<p><strong>OBJECTIVE: </strong>The purpose of this study was to identify the prevalence of and factors associated with caregiver perceived needs and unmet needs for therapy or mobility aids among children with special health care needs living in the United States.</p>

<p><strong>DESIGN: </strong>A cross-sectional, descriptive, multivariate analysis was conducted.</p>

<p><strong>METHODS: </strong>The 2009-2010 National Survey of Children With Special Health Care Needs was used to identify a nationally representative sample of children with special health care needs with needs for therapy (weighted n=2,603,605) or mobility aids (weighted n=437,971). Odds of having unmet needs associated with child and family characteristics were estimated.</p>

<p><strong>RESULTS: </strong>Nearly 1 in 5 children with therapy needs had unmet needs, and nearly 1 in 10 children with mobility aid needs had unmet needs. Unmet needs were most strongly associated with how frequently the condition affected function and being uninsured in the previous year.</p>

<p><strong>LIMITATIONS: </strong>Data were caregiver reported and not verified by clinical assessment. Survey data grouped physical therapy, occupational therapy, and speech therapy; analysis was not discipline specific.</p>

<p><strong>CONCLUSIONS: </strong>This evidence serves as a baseline about the future impact of the ACA. Pediatric rehabilitation professionals should be aware that children with special health care needs whose condition more frequently affects function and who have insurance discontinuity may need more support to meet therapy or mobility aid needs.</p>

DOI

10.2522/ptj.20150055

Alternate Title

Phys Ther

PMID

26586857

Title

The relationship between spasticity and muscle volume of the knee extensors in children with cerebral palsy.

Year of Publication

2012

Number of Pages

177-81; discussion 182

Date Published

2012 Summer

ISSN Number

1538-005X

Abstract

<p><strong>PURPOSE: </strong>The purpose of this study was to examine the relationship between spasticity and muscle volume in children with cerebral palsy (CP), using isokinetic dynamometry and magnetic resonance imaging.</p>

<p><strong>METHODS: </strong>A retrospective sample of 8 children with diplegic CP was analyzed. One set of 10 passive knee flexion movements was completed at a velocity of 180° per second with concurrent surface electromyography of the medial hamstrings (MH) and vastus lateralis (VL) to assess knee extensor spasticity. Magnetic resonance imaging was used to measure maximum cross-sectional area and muscle volume of the quadriceps femoris.</p>

<p><strong>RESULTS: </strong>The quadriceps femoris muscle volume was positively correlated with MH reflex activity, VL reflex activity, MH/VL co-contraction, and peak knee extensor passive torque (P &lt; .05).</p>

<p><strong>CONCLUSION: </strong>The present findings suggest that higher levels of knee extensor muscle spasticity are associated with greater quadriceps muscle volume in children with spastic diplegic CP.</p>

DOI

10.1097/PEP.0b013e31824cc0a9

Alternate Title

Pediatr Phys Ther

PMID

22466388

Title

Trunk and hip muscle activation patterns are different during walking in young children with and without cerebral palsy.

Year of Publication

2010

Number of Pages

986-97

Date Published

2010 Jul

ISSN Number

1538-6724

Abstract

<p><strong>BACKGROUND: </strong>Poor control of postural muscles is a primary impairment in people with cerebral palsy (CP).</p>

<p><strong>OBJECTIVE: </strong>The purpose of this study was to investigate differences in the timing characteristics of trunk and hip muscle activity during walking in young children with CP compared with children with typical development (TD).</p>

<p><strong>METHODS: </strong>Thirty-one children (16 with TD, 15 with CP) with an average of 28.5 months of walking experience participated in this observational study. Electromyographic data were collected from 16 trunk and hip muscles as participants walked at a self-selected pace. A custom-written computer program determined onset and offset of activity. Activation and coactivation data were analyzed for group differences.</p>

<p><strong>RESULTS: </strong>The children with CP had greater total activation and coactivation for all muscles except the external oblique muscle and differences in the timing of activation for all muscles compared with the TD group. The implications of the observed muscle activation patterns are discussed in reference to existing postural control literature.</p>

<p><strong>LIMITATIONS: </strong>The potential influence of recording activity from adjacent deep trunk muscles is discussed, as well as the influence of the use of an assistive device by some children with CP.</p>

<p><strong>CONCLUSIONS: </strong>Young children with CP demonstrate excessive, nonreciprocal trunk and hip muscle activation during walking compared with children with TD. Future studies should investigate the efficacy of treatments to reduce excessive muscle activity and improve coordination of postural muscles in CP.</p>

DOI

10.2522/ptj.20090161

Alternate Title

Phys Ther

PMID

20430948

Title

Acceptability and potential effectiveness of a foot drop stimulator in children and adolescents with cerebral palsy.

Year of Publication

2012

Number of Pages

1044-9

Date Published

2012 Nov

ISSN Number

1469-8749

Abstract

<p><strong>AIM: </strong>Ankle-foot orthoses are the standard of care for foot drop in cerebral palsy (CP), but may overly constrain ankle movement and limit function in those with mild CP. Functional electrical stimulation (FES) may be a less restrictive and more effective alternative, but has rarely been used in CP. The primary objective of this study was to conduct the first trial in CP examining the acceptability and clinical effectiveness of a novel, commercially available device that delivers FES to stimulate ankle dorsiflexion.</p>

<p><strong>METHOD: </strong>Twenty-one individuals were enrolled (Gross Motor Function Classification System [GMFCS] levels I and II, mean age 13y 2mo). Gait analyses in FES and non-FES conditions were performed at two walking speeds over a 4 month period of device use. Measures included ankle kinematics and spatiotemporal variables. Differences between conditions were revealed using repeated measures multivariate analyses of variance.</p>

<p><strong>RESULTS: </strong>Nineteen individuals (nine females, 10 males; mean age 12y 11mo, range 7y 5mo to 19y 11mo; 11 at GMFCS level I, eight at level II) completed the FES intervention, with all but one choosing to continue using FES beyond that phase. Average daily use was 5.6 hours (SD 2.3). Improved dorsiflexion was observed during swing (mean and peak) and at foot-floor contact, with partial preservation of ankle plantarflexion at toe-off when using the FES at self-selected and fast walking speeds. Gait speed was unchanged.</p>

<p><strong>INTERPRETATION: </strong>This FES device was well accepted and effective for foot drop in those with mild gait impairments from CP.</p>

DOI

10.1111/j.1469-8749.2012.04401.x

Alternate Title

Dev Med Child Neurol

PMID

22924431

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