Journal of Pediatric Rehabilitation Medicine - Volume 16, issue 1

Authors: Kim, Heakyung | Byrne, Rachel | Green, Michael

Article Type: Editorial

DOI: 10.3233/PRM-239002

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 1-2, 2023

Authors: McLaughlin, Matthew J. | Fisher, Mark T.

Article Type: Other

DOI: 10.3233/PRM-230003

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 3-9, 2023

Authors: Brandenburg, Joline E.

Article Type: Position Paper

Abstract: Baclofen is often considered a first-line treatment option for spasticity management in children. However, adverse effects, administration, and dosing can be barriers to effectiveness. In my practice, other medications for spasticity management are often used prior to initiating baclofen. In this article, baclofen use for spasticity management in children is briefly reviewed along with discussion of approaches using other medications as first-line treatment options. I will present a rationale for medication selection for spasticity management and discuss the approaches I take in medication selection that incorporate spasticity severity, patient goals, and medication side effect profiles.

Keywords: Pediatric, children, cerebral palsy, botulinum toxin

DOI: 10.3233/PRM-230001

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 11-17, 2023

Authors: Srinivasan, Rajashree

Article Type: Position Paper

Keywords: Spasticity, cerebral palsy, baclofen

DOI: 10.3233/PRM-230005

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 19-24, 2023

Authors: Smith, Julianna | DiVito, Michelle | Fergus, Andrea

Article Type: Research Article

Abstract: PURPOSE: The purpose of this study was to examine the reliability and discriminant validity of the Quantitative Timed up and Go (QTUG) in typically developing (TD) children and children with cerebral palsy (CP). METHODS: Twenty-eight TD children and 8 with CP (GMFCS I-II) completed 3 TUG trials while wearing QTUG sensors. Test-retest reliability and discriminative ability were examined for the 57 constituent parameters of the TUG. Relationships between age and these parameters were also examined. RESULTS: Forty-four of the parameters demonstrated moderate to excellent test-retest reliability, with measures of angular velocity being the most reliable. Twenty-six …parameters were different between TD children and those with CP, and twenty-eight gait parameters demonstrated correlations with age, further supporting its discriminative ability. CONCLUSION: The QTUG is a clinically feasible tool that is capable of both reliably measuring and discriminating many of the movement parameters with the TUG mobility task in TD children and those with CP GMFCS I-II. The results of the present study provide preliminary evidence that the QTUG can discriminate between children on several of the gait parameters within the TUG. Show more

Keywords: Cerebral palsy, children, children, gait, inertial sensors, QTUG, Quantitative Timed Up and Go, reliability

DOI: 10.3233/PRM-210034

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 25-35, 2023

Authors: Ashouri, Somayeh | Letafatkar, Amir | Thomas, Abbey C. | Yaali, Rasoul | Kalantari, Minoo

Article Type: Research Article

Abstract: PURPOSE: This study investigated the effects of the challenge point framework (CPF) to improve stepping reactions and enhance balance in children with hemiplegic cerebral palsy (HCP). The CPF relates practice variables to the skill level of the individual and task difficulty. METHODS: Nine children with HCP (age: 7.7±2.4 years) completed six weeks (12 sessions) of a CPF intervention which consisted of progressively fewer sets and repetitions of a stepping reaction task wherein participants sought to improve both step length and reaction rate. Stepping reaction (step length and reaction rate) to a balance perturbation in the anterior, posterior, and …lateral directions and static and dynamic balance (via the Pediatric Balance Scale) were measured at baseline, a second baseline 3 weeks later, and post-intervention. Repeated measures ANOVAs determined within-group changes. Cohen’s d effect sizes were calculated. RESULTS: Participants improved balance (d  = 0.948, p  = 0.010), step length (forward d  = 0.938, p  = 0.002; backward d  = 0.839, p  = 0.001; and lateral d  = 0.876, p  = 0.002), and reaction rate (forward d  = 0.249, p  = 0.042; backward d  = 0.21, p  = 0.047; and lateral d  = 0.198, p  = 0.049). CONCLUSION: These findings indicate that children with HCP may benefit from completing a CPF program with a motor learning approach. This approach of retraining stepping reactions helped to improve static and dynamic balance. The CPF may aid progression of functional task training in children with HCP aged 4–12, though more studies with a long-term follow-up analysis are needed to confirm this result. Show more

Keywords: Cerebral palsy, challenge point framework, balance

DOI: 10.3233/PRM-201522

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 37-48, 2023

Authors: Nawge, Surabhi | Karthikbabu, Suruliraj

Article Type: Research Article

Abstract: PURPOSE: Sixty percent of children with bilateral cerebral palsy have impaired hand function. The study’s purpose was to examine the benefits of bimanual task practice on the manual ability and hand function of children with bilateral spastic cerebral palsy. METHODS: In this pre-post study design, 18 children with bilateral spastic cerebral palsy with an average age of 11.5 (+/-1.9) years, Manual Ability Classification System levels I-III and Bimanual Fine Motor Function levels I-III participated in bimanual task practice of upper extremities. The task practice included clay activities, paper manipulation and activities of daily needs. The children underwent 45-minute …training sessions 3 times a week over 6 weeks. The outcome measures were ABILHAND-Kids, Quality of Upper Extremity Skills Test and grip strength. RESULTS: Post-training, a mean change of 6.44 logits in ABILHAND-Kids, 11 points on the Quality of Upper Extremity Skills Test, and 3.3 and 3.1 kilograms grip strength in the dominant and nondominant hands respectively were observed with a statistical significance (p  < 0.05). CONCLUSION: Bimanual task training might be beneficial in improving manual ability, hand function and grip strength in children with bilateral spastic cerebral palsy. Show more

Keywords: Bimanual training, bilateral spastic cerebral palsy, grip strength, task training, upper limb function

DOI: 10.3233/PRM-210109

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 49-57, 2023

Authors: Kolit, Zeynep | Ekici, Gamze

Article Type: Research Article

Abstract: PURPOSE: The study aimed to examine the effects of “Cognitive Orientation to daily Occupational Performance” (CO-OP) approach in terms of performance and satisfaction as well as functional status in children with cerebral palsy (CP) receiving neurodevelopmental treatment (NDT) and determine the parents’ satisfaction level. METHODS: Thirty-two children with CP were randomized to experimental (n  = 16) or control (n  = 16) groups, with n  = 2 dropouts. Therapy was applied twice a week for five weeks. The experimental group received a CO-OP plus NDT, while the control group received only NDT. RESULTS: No baseline differences existed, except for years …of schooling, which was higher in the experimental group. After treatment, there were statistically significant and clinically meaningful improvements in occupational performance and function, favouring children who received 5-weeks of CO-OP plus NDT over NDT alone (p  < 0.05). CONCLUSION: CO-OP is expected to be beneficial if incorporated into CP rehabilitation. Show more

Keywords: Cerebral palsy, occupations, cognitive orientation, functional status

DOI: 10.3233/PRM-210085

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 59-70, 2023

Authors: Bootsma, Jael N. | Campbell, Fiona | McCauley, Dayle | Hopmans, Sarah | Grahovac, Danijela | Cunningham, BJ | Phoenix, Michelle | de Camargo, Olaf Kraus | Geytenbeek, Johanna | Gorter, Jan Willem

Article Type: Research Article

Abstract: PURPOSE: This study aimed to 1) investigate the convergent and discriminant validity, internal consistency, and test-retest reliability of the Canadian English version of the Computer-Based instrument for Low motor Language Testing (C-BiLLT-CAN), and 2) explore feasibility of the C-BiLLT assessment for children with cerebral palsy (CP) and complex communication needs in the Canadian health care context. METHODS: Eighty typically developing children between 1.5 and 8.5 years of age completed the C-BiLLT-CAN, the Peabody Picture Vocabulary Test-IV (PPVT-4), the receptive language sub-test of the New Reynell Developmental Language Scales (NRDLS), and/or the Raven’s 2. Correlations between raw scores were …calculated for estimates of convergent and discriminant validity. Internal consistency was calculated for all items and separately for items pertaining to vocabulary and grammar. To calculate the standard error of measurement (SEM) and intraclass correlation coefficient (ICC), 33 participants were re-tested with the C-BiLLT within three weeks. Feasibility was explored with nine participants with CP. RESULTS: C-BiLLT-CAN’s convergent validity was good to excellent (Spearman’s rho > 0.78) and discriminant validity was higher than hypothesized (Spearman’s rho > 0.8). Internal consistency (Cronbach’s alpha = 0.96), test-retest reliability (ICC > 0.9), and measurement error (SEM < 5%) were excellent. The feasibility study could not be fully completed due to the COVID-19 pandemic. Preliminary data demonstrated some technical and practical barriers for using the C-BiLLT in children with CP in Canada. CONCLUSION: The C-BiLLT-CAN showed good to excellent psychometric properties in a sample of typically developing children, indicating that it is an adequate test for measuring language comprehension in English-speaking Canadian children. Further research is needed to investigate the feasibility of the C-BiLLT-CAN in children with CP. Show more

Keywords: Cerebral palsy, language comprehension, psychometrics, non-verbal communication, cognition

DOI: 10.3233/PRM-210101

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 71-81, 2023

Authors: Bonfert, Michaela | Heinen, Florian | 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: This pooled analysis of data from three Phase 3 studies investigated the effects of incobotulinumtoxinA on spasticity-related pain (SRP) in children/adolescents with uni-/bilateral cerebral palsy (CP). METHODS: Children/adolescents (ambulant and non-ambulant) were evaluated for SRP on increasingly difficult activities/tasks 4 weeks after each of four incobotulinumtoxinA injection cycles (ICs) using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to lower limb [LL] or upper limb [UL] spasticity and respondent type [child/adolescent, interviewer, or parent/caregiver]). IncobotulinumtoxinA doses were personalized, with all doses pooled for analysis. RESULTS: QPS key item responses were available from …331 and 155 children/adolescents with LL- and UL-spasticity, respectively, and 841/444 (LL/UL) of their parents/caregivers. IncobotulinumtoxinA efficacy was evident with the first IC. Efficacy was sustained and became more robust with further subsequent ICs. By Week 4 of the last (i.e. fourth) IC, 33.8–53.3% of children/adolescents reported complete SRP relief from their baseline pain for respective QPS items. Children/adolescents reported reductions in mean LL SRP intensity at levels that surpassed clinically meaningful thresholds. Similarly, parents/caregivers observed complete SRP relief and less frequent SRP with incobotulinumtoxinA. Similar results were found for UL SRP. CONCLUSION: These findings indicate that incobotulinumtoxinA could bring considerable benefit to children/adolescents with spasticity by reducing SRP, even during strenuous activities. Show more

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

DOI: 10.3233/PRM-220020

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 83-98, 2023