Journal of Pediatric Rehabilitation Medicine - Volume 15, issue 1

Authors: Green, Michael M. | Kim, Heakyung | Gauden, Ruth | Scheinberg, Adam | Schroeder, A. Sebastian | Heinen, Florian | Berweck, Steffen | Hong, Bo Young | Gormley, Mark

Article Type: Other

Keywords: Cerebral palsy, spasticity, botulinum toxin, GMFCS Level II, neurodevelopment, ambulation

DOI: 10.3233/PRM-220006

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 91-106, 2022

Authors: Dursun, Nigar | Akyuz, Merve | Gokbel, Tugba | Akarsu, Melike | Yilmaz, Esin | Karacan, Cagla | Dursun, Erbil

Article Type: Research Article

Abstract: PURPOSE: The Gross Motor Functional Classification System (GMFCS) provides a standardized classification of motor disability in children with cerebral palsy (CP) that is typically considered longitudinally stable. Here, changes in GMFCS levels of children with CP who received repeated botulinum toxin A (BoNT-A) injections within an intensive rehabilitation approach were evaluated. METHODS: This retrospective, observational study included 503 children with CP (GMFCS I-V) treated in a single university rehabilitation clinic. Individualized treatment plans and a variety of rehabilitation techniques were incorporated within an integrated model of care. Each child received≥2 repeated BoNT-A injections as well as an intensive …rehabilitation program. RESULTS: GMFCS level following repeat treatment improved in 42.1% of the patients and worsened in 3 patients; 14.9% of children showed improvement after 1 treatment cycle, 12.3% after 2 cycles, 7.6% after 3 cycles, 3.6% after 4 cycles, and 3.8% after≥5 cycles. Type of involvement (p  < 0.001), baseline GMFCS (p  = 0.001), number of treatment cycles (p  < 0.001) and presence of severe dystonia (p  = 0.032) were significant predictors of GMFCS improvement, but age and gender were not. CONCLUSION: Children with CP may change GMFCS level when intensive rehabilitation programs are combined with repeated BoNT-A injections. Show more

Keywords: Cerebral palsy, GMFCS, botulinum toxin

DOI: 10.3233/PRM-210013

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 107-112, 2022

Authors: Kaňovský, Petr | Heinen, Florian | Schroeder, A. Sebastian | Chambers, Henry G. | Dabrowski, Edward | Geister, Thorin L. | Hanschmann, Angelika | Martinez-Torres, Francisco J. | Pulte, Irena | Banach, Marta | Gaebler-Spira, Deborah

Article Type: Research Article

Abstract: PURPOSE: The open-label phase 3 “Treatment with IncobotulinumtoxinA in Movement Open-Label” (TIMO) study investigated longer-term safety and efficacy of incobotulinumtoxin A in children/adolescents with cerebral palsy (CP). METHODS: Patients on standard treatment, with unilateral or bilateral lower limb (LL) or combined upper limb (UL)/LL spasticity received four incobotulinumtoxinA injection cycles (16 or 20 Units/kg bodyweight total [maximum 400 or 500 Units] per cycle depending on ambulatory status/clinical pattern treated), each followed by 12–16 weeks’ observation. Treatment for pes equinus was mandatory; flexed knee or adducted thigh were options for unilateral treatment and/or ULs for unilateral/bilateral treatment. The primary …endpoint was safety; changes in Ashworth Scale and Gross Motor Function Measure-66 scores, and Global Impression of Change Scale scores at week 4 of each injection cycle were also evaluated. RESULTS: IncobotulinumtoxinA (≤500 Units for ≤98 weeks) was safe, well-tolerated, and effective across all endpoints for multipattern treatment of LL and combined LL/UL spasticity in ambulant/nonambulant children/adolescents with CP. Treatment effects increased with each injection cycle. No new/unexpected safety concerns were identified. CONCLUSION: IncobotulinumtoxinA showed a good safety and tolerability profile, with efficacy over multiple clinical presentations. As an adjunct treatment, it offers an effective, individualized treatment option for pediatric CP-related spasticity. Show more

Keywords: Botulinum toxins, Type A, muscle spasticity, movement disorders, paediatric, cerebral palsy

DOI: 10.3233/PRM-210041

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 113-127, 2022

Authors: Heinen, Florian | Bonfert, Michaela | Kaňovský, Petr | Schroeder, A. Sebastian | Chambers, Henry G. | Dabrowski, Edward | Geister, Thorin L. | Hanschmann, Angelika | Althaus, Michael | Banach, Marta | Gaebler-Spira, Deborah

Article Type: Research Article

Abstract: PURPOSE: A large prospective database from three Phase 3 studies allowed the study of spasticity-related pain (SRP) in pediatric cerebral palsy (CP). METHODS: Baseline (pretreatment) SRP data occurring during different activities in children/adolescents (aged 2–17 years, ambulant/nonambulant) with uni-/bilateral spastic CP was obtained using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to spasticity level [lower limb (LL) or upper limb (UL)] and type of respondent [child/adolescent, interviewer, or parent/caregiver]). RESULTS: At baseline, 331 children/adolescents with LL- and 155 with UL-spasticity completed at least one key item of their modules; LL/UL QPS modules …of parent/caregivers were at least partially completed (key items) by 841/444 parents/caregivers. SRP with at least one activity at baseline was self-reported in 81.9% /69.7% (LLs/ULs) of children/adolescents with spasticity. Parents/caregivers observed LL/UL SRP behaviors in 85.9% /77.7% of their children, with multiple body regions affected. SRP negatively affected the great majority of the children in various ways. Child/adolescent-reported mean SRP intensity and parent/caregiver-observed mean SRP behavior frequencies were higher for LLs than ULs, and the level of SRP increased with more physically demanding activities. CONCLUSION: These data suggest SRP is more common and intense in pediatric CP than generally thought, emphasizing the need for effective, long-term pain management. Show more

Keywords: Botulinum toxin, muscle spasticity, all movement disorders, all pediatric, cerebral palsy, pain

DOI: 10.3233/PRM-220011

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 129-143, 2022

Authors: Wu, Jennifer | Ceverha, Barry | Yeh, Bi-Ying | BeDell, Kimberly K.

Article Type: Research Article

Abstract: PURPOSE: The aim of the study was to evaluate the use of a novel technique for baclofen delivery using an intrathecal catheter inserted through a lumbar laminotomy with the tip placed at the cisterna magna (supraspinal baclofen (SSB)) for the treatment of severe generalized secondary dystonia. METHODS: A cohort study of six individuals (4M/2F, mean±SD = 15±4.86 years) with generalized dystonia unresponsive to oral medications were treated with SSB and followed clinically for 9 years. Intrathecal catheter tips were positioned under fluoroscopic guidance just above the level of the foramen magnum, at the cisterna magna. RESULTS: Five of …the 6 patients experienced sustained benefit with SSB; the group mean modified Fahn-Marsden scale scores decreased from 95 to 55 (t  = 3.29, p  = 0.02). One patient suffered complex pump pocket infection, and therefore underwent pump explantation. CONCLUSION: Supraspinal baclofen may be an effective method for infusing baclofen into the ventricular system of the brain for treatment of secondary dystonia which is unresponsive to oral therapy. Show more

Keywords: Dystonia, spasticity, baclofen, neurosurgery

DOI: 10.3233/PRM-210044

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 145-150, 2022

Authors: Ansari, Noureddin Nakhostin | Rahimi, Maryam | Naghdi, Soofia | Barzegar-Ganji, Zahra | Hasson, Scott | Moghimi, Ehsan

Article Type: Research Article

Abstract: PURPOSE: The aim of the study was to investigate the inter- and intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the assessment of lower extremity spasticity in children with spastic cerebral palsy (CP). METHODS: Fifteen children (10 boys) with a mean age of 8.7±3.4 years participated. Two physiotherapists rated the spasticity of the hip adductors, knee extensors, and ankle plantar flexors for inter-rater reliability. Each child was examined again by one of the physiotherapists (same physiotherapist for all of the children) for intra-rater reliability (mean interval = 7 days). A random sequence of raters and muscles tested was …applied. RESULTS: The reliability of the intraclass correlation coefficients (ICC) for individual muscle groups ranged between good to excellent (ICCagreement of 0.60–0.83). The ICC values for overall inter-rater (ICCagreement  = 0.82) and intra-rater reliability (ICCagreement  = 0.85) were excellent. CONCLUSION: The MMAS showed excellent reliability for the assessment of lower extremity muscle spasticity in children with cerebral palsy. However, an interpretation should be made with caution due to the small sample size and wide range of confidence interval values. Show more

Keywords: Cerebral palsy, muscle spasticity, lower extremity, modified modified ashworth scale, inter-rater reliability, intra-rater reliability

DOI: 10.3233/PRM-190648

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 151-158, 2022

Authors: Wardhani, Rizky Kusuma | Wahyuni, Luh Karunia | Laksmitasari, Budiati | Lakmudin, Alvin

Article Type: Research Article

Abstract: PURPOSE: To evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) according to total number of pulses on hamstring muscle spasticity in children with spastic type cerebral palsy (CP). METHODS: This study is a randomized controlled trial consisting of thirteen patients with spastic CP, 9 males and 4 females, aged 5 to 14 years (mean age 9.2). Twenty-five spastic hamstring muscles were divided in four groups. Group I: 500 pulses, Group II: 1,000 pulses, Group III: 1,500 pulses, and Group IV: 2,000 pulses. Australian Spasticity Assessment Scale (ASAS) was measured at four different time points …(pre-ESWT, post-ESWT, 2 weeks post-ESWT, and 4 weeks post-ESWT). RESULTS: All four groups showed improvement in ASAS relative to pre-treatment, although only significant in Group III (1,500 pulses). There were no statistically significant differences in ASAS between all four groups in pre-ESWT [|2 (2) = 3.907, p  = 0.272], immediately post-ESWT [|2 (2) = 1.250, p  = 0.741], 2 weeks post-ESWT vs pre-ESWT [|2 (2) = 3.367, p  = 0.338], and 4 weeks post-ESWT vs pre-ESWT [|2 (2) = 1.566, p  = 0.667]. CONCLUSION: The effect of rESWT on spastic hamstring in children with spastic CP is not dependent on the number of pulses. Show more

Keywords: Cerebral palsy, children, ESWT, hamstring, pulses, spasticity

DOI: 10.3233/PRM-200796

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 159-164, 2022

Authors: Maitre, Nathalie L | Byrne, Rachel | Duncan, Andrea | Dusing, Stacey | Gaebler-Spira, Deborah | Rosenbaum, Peter | Winter, Sarah

Article Type: Other

DOI: 10.3233/PRM-220030

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 165-174, 2022

Authors: Kim, Seong Gil | Kim, Do Hyun

Article Type: Research Article

Abstract: PURPOSE: This study aimed to investigate the internal consistency, inter-rater, and test-retest reliability of the balance subtest of the Bruininks-Oseretsky test of motor proficiency-second edition (BOT-2) and to estimate the minimum detectable change (MDC) and minimum clinically important difference (MCID) of the balance subtest of the BOT-2 in children with cerebral palsy (CP). METHODS: In total, 20 children with CP participated in the present study. Internal consistency, test-retest, and inter-rater reliability were computed to establish reliability of the balance subtest of the BOT-2. The MDC95 was estimated from the standard error of measurement (SEM) to determine a …real change for an individual child with CP. The anchor- and distribution-based MCID were calculated to determine the smallest change that might be important to clinicians. For concurrent validity, the correlation between the balance subtest of the BOT-2 and the pediatric balance scale (PBS) were calculated using Spearman’s correlation. RESULTS: Internal consistency was good (Cronbach’s alpha coefficient = 0.89). The BOT-2 had excellent test-retest (ICC = 0.99, p  < 0.001) and inter-rater reliability (ICC = 0.99, p  < 0.001). The balance subtest of the BOT-2 had an SEM of 0.70, MDC95 of 9.61, and MCIDs of 2.54 (anchor-based) and 1.38 (distribution-based). Additionally, there was a moderate positive correlation between the balance subtest of the BOT-2 and the PBS (Spearman’s rho = 0.629, p  = 0.003). CONCLUSIONS: Our experimental results indicate that the balance subtest of the BOT-2 had good internal consistency, along with excellent test-retest and inter-rater reliability. The change in scores of an individual child with CP should attain 9.61 points on the balance subtest of the BOT-2 to indicate a clinically important change. The MDC95 and MCID values could be helpful in understanding therapeutic effects and evaluating balancing ability using the balance subtest of the BOT-2 in children with CP. Show more

Keywords: Balance, cerebral palsy, minimum detectable change, minimum clinically important difference, rehabilitation

DOI: 10.3233/PRM-190639

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 175-180, 2022

Authors: Cristella, Giovanna | Allighieri, Martina | Pasquini, Guido | Simoni, Laura | Antonetti, Antonella | Beni, Chiara | Macchi, Claudio | Ferrari, Adriano

Article Type: Research Article

Abstract: PURPOSE: This study explores non-motor impairment of the upper dominant limb in children with diplegic cerebral palsy (CP). Specifically, it firstly investigates sense of position without visual control, ability to compare visual and proprioceptive information, and capacity to recognize effects of self-movement. Secondly, it explores the possible association between these items with cognitive function, perceptual disorder (PD), and manual ability (Manual Ability Classification System -MACS). METHODS: Ten subjects (7 female; 3 male) were tested with three protocols: the first one (A) explored sense of position, the second one (B) collimation between visual and proprioceptive information, and the last …one (C) sense of agency with the use of videogames. RESULTS: All subjects executed Protocol A without making any mistakes, while in Protocol B the median percentage of mistakes was 4.8%. Mistakes were recorded more frequently in positions characterized by wrist extension. Data reported a significant correlation with Processing Speed Index (PSI). Sense of agency was positively associated with cognitive functioning, with a significant correlation with PSI. PD, MACS, and Video-Gaming Experience (VGE) showed no correlation with Protocol C. CONCLUSION: In the observed sample with diplegic CP, preliminary data support the hypothesis that there is an alteration of both sense of position and sense of agency. They were both associated to PSI, with a positive trend of correlation with cognitive functioning. PD seemed to have no influence. Further studies, with a larger sample size, a control group, and involving children without CP, are required to corroborate the results obtained. Show more

Keywords: Sense of position, sense of agency, upper limb rehabilitation, cerebral palsy

DOI: 10.3233/PRM-200703

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 181-191, 2022

Authors: Ruhde, Logan | Hulla, Ryan

Article Type: Review Article

Abstract: The purpose of this review is to examine how whole-body vibration can be used as a tool in therapy to help improve common physical weaknesses in balance, bone density, gait, spasticity, and strength experienced by individuals with cerebral palsy. Cerebral palsy is the most common movement disorder in children, and whole-body vibration is quickly becoming a potential therapeutic tool with some advantages compared to traditional therapies for individuals with movement disorders. The advantages of whole-body vibration include less strain and risk of injury, more passive training activity, and reduced time to complete an effective therapeutic session, all of which are …appealing for populations with physiological impairments that cause physical weakness, including individuals with cerebral palsy. This review involves a brief overview of cerebral palsy, whole-body vibration’s influence on physical performance measures, its influence on physical performance in individuals with cerebral palsy, and then discusses the future directions of whole-body vibration therapy in the cerebral palsy population. Show more

Keywords: Cerebral palsy, whole-body vibration, gait, spasticity, strength

DOI: 10.3233/PRM-201508

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 193-210, 2022

Authors: McCall, James V. | Ludovice, Miranda C. | Elliott, Catherine | Kamper, Derek G.

Article Type: Review Article

Abstract: PURPOSE: Hemiplegic cerebral palsy (hCP) typically impacts sensorimotor control of the hand, but comprehensive assessments of the hands of children with hCP are relatively rare. This scoping review summarizes the development of hand function for children with hCP. METHODS: This scoping review focused on the development of hand function in children with hCP. Electronic databases (PubMed, PEDro, Web of Science, CINAHL, and SpringerLink) were searched to identify studies assessing hand function in children with hCP. The search was performed using keywords (e.g., “hemiplegia”). An iterative approach verified by two authors was used to select the studies. …Articles which reported quantitative data for children with hCP on any items of a specified set of hand evaluations were included. Measures were sorted into three categories: quantitative neuromechanics, clinical assessments, and clinical functional evaluations. RESULTS: Initial searches returned 1536 articles, 131 of which were included in the final review. Trends between assessment scores and age were examined for both hands. CONCLUSION: While several studies have evaluated hand function in children with hCP, the majority relied on clinical scales, assessments, or qualitative descriptions. Further assessments of kinematics, kinetics, and muscle activation patterns are needed to identify the underlying impairment mechanisms that should be targeted for treatment. Show more

Keywords: Hand function, assessment methods, hemiplegia, cerebral palsy, upper limb

DOI: 10.3233/PRM-200714

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 211-228, 2022

Authors: Frisina, Cynthia | Thornton, Lisa

Article Type: Other

Abstract: Cerebral palsy (CP) is the most common motor disability of childhood, but US federal government investment into CP research has historically been under-prioritized and under-funded. This issue was brought to the forefront by the parent advocacy group Reaching for the Stars who partnered with the American Academy for Cerebral Palsy and Developmental Medicine to create a strong parent/professional partnership. This collaboration has resulted in increased awareness and federal commitment to cerebral palsy. This article highlights the important steps and lessons learned in the continuing journey of federal advocacy for CP research.

Keywords: Cerebral palsy, advocacy

DOI: 10.3233/PRM-220023

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 229-235, 2022

Authors: Houtrow, Amy J. | Akamagwuna, Unoma O. | Holman, Lainie | Bosques, Glendaliz

Article Type: Other

Abstract: Academic promotion is desired by many faculty practicing at academic medical institutions, but the criteria for promotion often appear opaque to many physician faculty. In nearly all cases, evidence of scholarship is required regardless of academic track. Academic advancement can be stymied by unclear expectations, lack of protected time to engage in scholarly projects, insufficient evidence of dissemination, and limited guidance, mentorship and sponsorship. In addition to being important for promotion, scholarship is an essential aspect of academic medicine because it helps inform and advance the science. Pursuing academic excellence is an important goal for pediatric rehabilitation medicine faculty members …because it helps advance the care of children with disabilities and the field itself. Pediatric rehabilitation medicine faculty in the clinician educator or clinician leader tracks are encouraged to understand the criteria for advancement, seek out mentorship, scholarize their career ikigai and identify opportunities to demonstrate academic excellence. Show more

Keywords: Clinician educator, advancement, pediatric rehabilitation medicine, career ikigai

DOI: 10.3233/PRM-220033

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 237-247, 2022

Authors: Murphy, Kevin P.

Article Type: Other

DOI: 10.3233/PRM-220009

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 249-251, 2022

Authors: MacCarthy, Matthew

Article Type: Other

DOI: 10.3233/PRM-220029

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 253-254, 2022

Authors: Ridosh, Monique M. | Stiles-Shields, Colleen | Stern, Alexa | Winning, Adrien M. | Anderson, Lara | Sawin, Kathleen J. | Holmbeck, Grayson N.

Article Type: Correction

DOI: 10.3233/PRM-229001

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 1, pp. 255-255, 2022