1,720,965 research outputs found
A Critical View on Motor-based Interventions to Improve Motor Skill Performance in Children With ADHD: A Systematic Review and Meta-analysis
No full textOBJECTIVE: To map the effect of motor-based interventions on motor skills in children with ADHD. METHOD: A systematic literature search was performed in Pubmed, Web of Science, and the SCOPUS database (last search: October 30th 2022). Methodological quality was assessed using the PEDro-scale and the quality of evidence was determined with the GRADE-method. Meta-analysis was performed when at least five studies were available. RESULTS: Thirteen studies (7 RCTs) satisfied the inclusion criteria, five of which were eligible for meta-analysis. Only one of the included studies reached the low risk of bias threshold. Comparing different motor-based interventions to any non-motor control intervention showed large motor skill improvements (SMD = 1.46; 95% CI = [1.00;1.93]; I² = 47.07%). The most effective type of motor-based intervention and the optimal treatment parameters could not be determined yet. CONCLUSION: Motor-based interventions in general seem to improve motor skills in children with ADHD. Additional RCTs are needed to increase current low GRADE confidence.status: Published onlin
The assessment of grip strength in preschool-aged children with and without unilateral cerebral palsy
No full textPurpose To investigate reliability and validity of two grip strength devices in children with and without unilateral cerebral palsy (uCP) aged 2-6 years. Method We assessed grip strength in 20 pre-school-aged children with predominantly spastic uCP (mean age 4y0 +/- 1y2m) and 20 age-matched children without uCP (mean age 3y11m +/- 1y3m) using the Martin Vigorimeter and MyoGrip to investigate test-retest reliability (intraclass correlation coefficients; ICC), known-group validity (comparative statistics) and convergent validity (correlation analyses) in a cross-sectional design. Results In both groups, test-retest reliability was excellent for both devices and both hands (ICC 0.91-0.97). Grip strength of the non-preferred hand was lower in children with uCP for both devices (p < 0.001). Grip strength was decreased in the non-preferred compared to the preferred hand in children with uCP for both devices (p < 0.001). In children without uCP, grip strength was lower in the non-preferred compared to the preferred hand only for the MyoGrip (p = 0.02). The relation between both devices for both hands was good to very high (r = 0.62-0.92, p < 0.007). Conclusion Both devices can be implemented in clinical practice to assess grip strength in preschool-aged children with uCP. Only the MyoGrip detected differences between both hands in children without uCP and might be more sensitive.The author(s) reported there is no funding associated with the work featured in this article
Visual, perceptual functions, and functional vision in children with unilateral cerebral palsy compared to children with neurotypical development
No full textAim To investigate visual (perceptual) function and functional vision in children with unilateral cerebral palsy (CP) and children with neurotypical development (NTD). Method Fifty children with unilateral CP (mean age 11 years 11 months, SD 2 years 10 months, range 7-15 years; 27 males; 26 left-sided unilateral CP; Manual Ability Classification System [MACS] levels: I, 27; II, 16; III, 7) and 50 age- and sex-matched children with NTD participated in a cross-sectional study. Visual acuity, stereoacuity, and visual-perceptual functions were measured with standardized clinical tests. Functional vision was assessed in children with unilateral CP with the Flemish cerebral visual impairment questionnaire (FCVIQ). Group differences were investigated with Mann-Whitney U tests, Kruskal-Wallis tests, and the relative effect sizes r, eta(2) respectively. Correlations between visual assessments and the FCVIQ were investigated with Spearman's rank correlations. Results The total group of children with unilateral CP showed reduced visual acuity compared with children with NTD (p = 0.02, r = 0.23). Only children with left-sided unilateral CP scored lower than those with NTD on stereoacuity (p < 0.01, r = 0.36). Children with right/left-sided unilateral CP scored significantly lower than those with NTD on visual-perceptual functions (p = 0.001-0.02), with large effect sizes on visuomotor integration and visual closure (both r = 0.57). Children with unilateral CP classified in MACS level III showed significantly lower scores on visual-perceptual assessments than children classified in MACS level I. Stereoacuity and visual-perceptual functions negatively correlated with the FCVIQ, with the highest association with visual (dis)interest and anxiety-related behaviours. Interpretation Multi-level visual profiling is warranted in the clinical intake of children with unilateral CP to detect visual impairments that further compromise their level of functioning.FUNDING INFORMATION
The Flemish Research Foundation (FWO project, G0C4919N). The project ‘PARENT’ funded by the European Union's Horizon 2020 Project MSCA-ITN-2020 – Innovative Training Networks Grant No. 956394
ACKNOWLEDGEMENTS
We thank all the participating families and children. We also thank the master's students who assisted with data collection
Neural micro and macrostructural correlates of visual outcomes in children with unilateral cerebral palsy: A fixel-based study
No full textChildren with unilateral cerebral palsy (uCP) present with brain damage, predominantly lateralized to one hemisphere, and white matter (WM) lesions, which are known to affect visual functions. However, the relation between WM tract damage and visual outcomes remains unclear. Additionally, no prior study comprehensively investigated hemispheric-specific differences in WM visual pathways between children with left-and right-sided uCP. Therefore, this exploratory study aims to investigate differences in micro-and macrostructural properties of the visual pathways between children with left-and right-sided uCP and their relation to visual outcomes, using fixel-based analysis of diffusion MRI (dMRI). dMRI data and visual assessments, including visual acuity and stereoacuity (i.e., geniculostriate functions), motor-free visual perception, visuomotor integration, and functional vision, were analysed in 36 children with uCP (aged 7-15, 9 males, 17 left-sided, 15 preterm). Apparent fiber density (AFD), fiber-bundle cross-section (FC), and combined fiber density and cross-section (FDC) were calculated for 17 WM tracts related to visual functions. Differences between children with left-and right-sided uCP were investigated using the Mann-Whitney U-test (r) on the AFD and one-way analysis of covariance (ANCOVA) (η p 2) on the FC and FDC, with age and intracranial volume as covariates. Correlations between visual outcomes and WM properties of the visual tracts were studied using (semi-partial) Spearman Rank correlations (r s). Children with left-sided uCP showed significantly lower fixel metrics in the right superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and optic radiation. Children with right-sided uCP had lower AFD, FC, and FDC in the left superior longitudinal fasciculus only. Reduced geniculostriate visual functions and more impairments in functional vision were associated with lower fiber density (AFD), reduction in bundle size (FC), and their combination (FDC) of several WM tracts. Lower performance on motor-free visual perception and visuomotor integration showed more associations with lower fiber density (AFD). While the primary analyses were exploratory and uncorrected for multiple comparison, false discovery rate (FDR) correction was additionally performed for transparency: several differences in FC and FDC between children with left-and right-sided uCP, and correlations between AFD and visual function, remained significant and are reported in the Supplementary Materials. In conclusion, our exploratory study highlights that fixel-based analysis can provide further insights into hemispheric differences in the visual system and the complex relations between visual functions and brain damage in children with uCP. Based on our results, future studies could refine regression models to target key WM tracts linked to visual outcomes, identifying potential biomarkers to predict visual impairments and enable early tailored support in children with uCP.Funding
The Flemish Research Foundation (FWO project, G0C4919N) provided financial support for this study. This work was additionally supported by the project: “PARENT” funded by the European Union’s Horizon 2020 Project MSCA-ITN-2020—Innovative Training Networks Grant No. 956394.
Acknowledgments
The authors would like to express their gratitude to all the participating families and children. We also extend our appreciation to the master students who assisted with data collection. We are especially grateful to Professor Stefan Sunaert and Daan Christiaens for their significant contributions to developing the script for the fixel-based analysis. Furthermore, we would like to acknowledge Steffen Fieuws, from the Leuven Biostatistics and Statistical Bioinformatics Centre, for the statistical support. Lastly, we thank the developers of the Schol-AR framework for their technical support in developing the 3D augmentations
The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy
No full textBackground: Accurate visual information is needed to guide and perform efficient movements in daily life. Aims: To investigate the relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy (uCP). Methods and procedures: In 49 children with uCP (7-15 y), we investigated the relation between stereoacuity (Titmus Stereo Fly test), visual perception (Test of Visual Perceptual Skills), visuomotor integration (Beery Buktenica Test of Visual-Motor Integration) and functional vision (Flemish cerebral visual impairment questionnaire) with bimanual dexterity (Tyneside Pegboard Test), bimanual coordination (Kinarm exoskeleton robot, Box opening task), and functional hand use (Children 's Hand-use Experience Questionnaire; Assisting Hand Assessment) using correlations ( r s ) and elastic-net regularized regressions ( d ). Outcomes and results: Visual perception correlated with bimanual coordination ( r s =0.407-0.436) and functional hand use ( r s =0.380-0.533). Stereoacuity ( r s =- 0.404), visual perception ( r s =- 0.391 to-0.620), and visuomotor integration ( r s =- 0.377) correlated with bimanual dexterity. Functional vision correlated with functional hand use ( r s =- 0.441 to-0.458). Visual perception predicted bimanual dexterity ( d =0.001-0.315), bimanual coordination ( d =0.004- 0.176), and functional hand use ( d =0.001-0.345), whereas functional vision mainly predicted functional hand use ( d =0.001-0.201). Conclusions and implications: Visual functions and functional vision are related to bimanual function in children with uCP highlighting the importance of performing extensive visual assessment to better understand children 's difficulties in performing bimanual tasks. What this paper adds: Previous findings showed that up to 62 % of children with unilateral cerebral palsy (uCP) present with visual impairment, which can further compromise their motor performance. However, the relation between visual and motor function has hardly been investigated in this population. This study makes a significant contribution to the literature by comprehensively investigating the multi-level relation between the heterogenous spectrum of visual abilities and bimanual function in children with uCP. We found that mainly decreased visual perception was related to decreased bimanual dexterity, bimanual coordination, and functional hand use while impairments in functional vision were only related to decreased functional hand use. Additionally, elastic-net regression models showed that visual assessments can predict bimanual function in children with uCP, however, effect sizes were only tiny to small. With our study, we demonstrated a relation between visual functions and bimanual function in children with uCP. These findings suggest the relevance of thoroughly examining visual functions in children with uCP to identify the presence of visual impairments that may further compromise their bimanual function.Funding
The project was funded by the Ready, Willing and Able Fund from Inclusion Canada. T.C.K. was supported by the SickKids Garry Hurvitz Clinician Scientist Fellowship.
Acknowledgments
We are grateful for our project team member Hogan Lam, and the following helpers: Hong Suen, Kara Chan, Kae Chan, Phoebe M. Crotti et al. Research in Developmental Disabilities 152 (2024) 104792 10 Chow, Shannon Liang, Crystal Leung, and Nicole Kong. Heartfelt appreciation for all the participating individuals, family members, and employers
Does somatosensory discrimination therapy alter sensorimotor upper limb function differently compared to motor therapy in children and adolescents with unilateral cerebral palsy: study protocol for a randomized controlled trial
No full textBackgroundBesides motor impairments, up to 90% of the children and adolescents with unilateral cerebral palsy (uCP) present with somatosensory impairments in the upper limb. As somatosensory information is of utmost importance for coordinated movements and motor learning, somatosensory impairments can further compromise the effective use of the impaired upper limb in daily life activities. Yet, intervention approaches specifically designated to target these somatosensory impairments are insufficiently investigated in children and adolescents with uCP. Therefore, the aim of this randomized controlled trial (RCT) is to compare the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP, who experience somatosensory impairments in the upper limb. We will further explore potential behavioral and neurological predictors of therapy response.MethodsA parallel group, evaluator-blinded, phase-II, single-center RCT will be conducted for which 50 children and adolescents with uCP, aged 7 to 15 years, will be recruited. Participants will be randomized to receive 3 weekly sessions of 45 minutes of either somatosensory discrimination therapy or upper limb motor therapy for a period of 8 weeks. Stratification will be performed based on age, manual ability, and severity of tactile impairment at baseline. Sensorimotor upper limb function will be evaluated at baseline, immediately after the intervention and after 6 months follow-up. The primary outcome measure will be bimanual performance as measured with the Assisting Hand Assessment. Secondary outcomes include a comprehensive test battery to objectify somatosensory function and measures of bimanual coordination, unimanual motor function, and goal attainment. Brain imaging will be performed at baseline to investigate structural brain lesion characteristics and structural connectivity of the white matter tracts.DiscussionThis protocol describes the design of an RCT comparing the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP. The results of this study may aid in the selection of the most effective upper limb therapy, specifically for children and adolescents with tactile impairments.Trial registrationClinicalTrials.gov (NCT06006065). Registered on August 8, 2023.Funding
Financial support for this study will be provided by the Flemish Research Foundation (FWO project, G0C4919N; FWO-fellowship Lize Kleeren, 11PP224N). The funding body was not involved in the conception or writing of this study protocol. The funding body will not be involved in the collection, management, analysis, or interpretation of data.
Acknowledgements
The authors would like to express their appreciation to all stakeholders, including families and physiotherapists, who provided valuable insights for the conception of this study protocol. We further want to thank the collaborators from L-BioStat for their statistical advice on the design and sample size calculation. Lastly, we would like to thank all children and adolescents and their parents that will participate in this stud
Automatic brain quantification in children with unilateral cerebral palsy
No full textAssessing brain damage in children with spastic unilateral cerebral palsy (uCP) is challenging, particularly in clinical settings. In this study, we developed and validated a deep learning-based pipeline to automatically quantify lesion-free brain volumes. Using T1-weighted and FLAIR MRI data from 35 patients (aged 5-15 years), we trained models to segment brain structures and lesions, utilizing an automatic label generation workflow. Validation was performed on 54 children with CP (aged 7-16 years) using quantitative and qualitative metrics, as well as an independent dataset of 36 children with congenital or acquired brain anatomy distortions (aged 1-17 years). Clinical evaluation examined the correlation of lesion-free volumes with visual-based assessments of lesion extent and motor and visual outcomes. The models achieved robust segmentation performance in brains with severe anatomical alterations and heterogeneous lesion appearances, identifying reduced volumes in the affected hemisphere, which correlated with lesion extent (p < 0.05). Further, regional lesion-free volumes, especially in subcortical structures such as the thalamus, were linked to motor and visual outcomes (p < 0.05). These results support the utility of automated lesion-free volume quantification for exploring brain structure-function relationships in uCP.Funding
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The PARENT project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Maria Skłodowska Curie – Innovative Training Network 2020, Grant Agreement No 956394. Data acquisition was possible through the support of the Flemish Research Foundation (FWO project, grants
G0C4919N and G087213N).
Acknowledgments
We thank all the participating families and children. We thank Dr. Lisa Decraene for her contribution to the recruitment process and data collection and Prof. Dr. Stefan Sunaert, Prof. Dr. Simón Lubián-López and Prof. Dr. Isabel Benavente-Fernández for their valuable scientific contributions to this manuscript. We also extend our gratitude to Dr. Rafay Khan for his assistance in proofreading the manuscript
Erratum to “The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy” [Research in Developmental Disabilities 152 (2024) 104792]
No full textThe publisher regrets that the Funding section and Acknowledgements section in this article got incorrectly published. Below is the correctedFunding
The Flemish Research Foundation (FWO project, G0C4919N) provided financial support for this study. This work was additionally supported by the project: “PARENT” funded by the European Union’s Horizon 2020 Project MSCAITN-2020 – Innovative Training Networks Grant No. 956394.
Acknowledgments
The authors would like to express their gratitude to all the participating families and children. Moreover, we thank the master students who assisted with data collection. Lastly, the authors would like to thank Annouschka Laenen, from the Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), for the statistical support. The publisher would like to apologise for any inconvenience caused
In-depth quantification of bimanual coordination using the Kinarm exoskeleton robot in children with unilateral cerebral palsy
No full textBackground Robots have been proposed as tools to measure bimanual coordination in children with unilateral cerebral palsy (uCP). However, previous research only examined one task and clinical interpretation remains challenging due to the large amount of generated data. This cross-sectional study aims to examine bimanual coordination by using multiple bimanual robotics tasks in children with uCP, and their relation to task execution and unimanual performance. Methods The Kinarm exoskeleton robot was used in 50 children with uCP (mean age: 11 years 11 months +/- 2 years 10 months, Manual Ability Classification system (MACS-levels: l = 27, ll = 16, lll = 7)) and 50 individually matched typically developing children (TDC). All participants performed three tasks: object-hit (hit falling balls), ball-on-bar (balance a ball on a bar while moving to a target) and circuit task (move a cursor along a circuit by making horizontal and vertical motions with their right and left hand, respectively). Bimanual parameters provided information about bimanual coupling and interlimb differences. Differences between groups and MACS-levels were investigated using ANCOVA with age as covariate (alpha < 0.05, eta(2)(p)). Correlation analysis (r) linked bimanual coordination to task execution and unimanual parameters. Results Children with uCP exhibited worse bimanual coordination compared to TDC in all tasks (p <= 0.05, eta(2)(p)= 0.05-0.34). The ball-on-bar task displayed high effect size differences between groups in both bimanual coupling and inter limb differences (p < 0.001, eta(2)(p)= 0.18-0.36), while the object-hit task exhibited variations in interlimb differences (p < 0.001, eta(2)(p)= 0.22-0.34) and the circuit task in bimanual coupling (p < 0.001, eta(2)(p)= 0.31). Mainly the performance of the ball-on-bar task (p < 0.05, eta(2)(p)= 0.18-0.51) was modulated by MACS-levels, showing that children with MACS level lll had worse bimanual coordination compared to children with MACS-level l and/or II. Ball-on-bar outcomes were highly related to task execution (r = - 0.75-0.70), whereas more interlimb differences of the object-hit task were moderately associated with a worse performance of the non-dominant hand (r = -0.69-(- 0.53)). Conclusion This study gained first insight in important robotic tasks and outcome measures to quantify bimanual coordination deficits in children with uCP. The ball-on-bar task showed the most discriminative ability for both bimanual coupling and interlimb differences, while the object-hit and circuit tasks are unique to interlimb differences and bimanual coupling, respectively
Daily-life executive functions and bimanual performance in children with unilateral cerebral palsy
No full textAim: To explore daily-life reported executive functions and their relation with bimanual performance in children with unilateral cerebral palsy (CP). Method: In this cross-sectional study of 46 children with unilateral CP (mean age 11 years 10 months, standard deviation 2 years 10 months), executive functions were evaluated using the Behavior Rating Inventory of Executive Function (BRIEF) and bimanual performance with the Assisting Hand Assessment (AHA) and Children's Hand-use Experience Questionnaire (CHEQ). One-sample z-tests were used to compare participants' executive functions with population norms, while taking autism spectrum disorder (ASD, n = 16) as a comorbidity into account. Moreover, we used regression analysis to estimate the effect of manual ability (Manual Ability Classification System levels: I = 25, II = 15, III = 6) and having a comorbid diagnosis of ASD on executive functions (p < 0.05, R2). Lastly, non-parametric correlations (rs, p < 0.05) were calculated between the BRIEF, CHEQ, and AHA. Results: In general, executive functions in children with unilateral CP were poorer compared with the normative mean (p <= 0.024). However, when excluding participants with ASD, no difference compared with the normative mean was found. A significant effect of manual ability was found for Inhibition (p = 0.042), while ASD effects were found for most of the BRIEF subscales (p <= 0.001). Multiple significant correlations were found between the BRIEF and CHEQ (rs = -0.50 to -0.29), while only the BRIEF subscale Inhibition was significantly correlated with the AHA (rs = -0.35). Interpretation: A higher number of children with unilateral CP exhibit difficulties in daily-life executive functions, which appear to be mainly co-occurring with ASD. Manual ability was a significant factor of inhibition-related behavioural challenges. Furthermore, there seems to be a relation between impaired executive functions and decreased bimanual performance. The findings emphasize the importance of further research, including performance-based assessments of executive functions in children with unilateral CP.Founding:
The Flemish Research Foundation (FWO project, grant G0C4919N; FWO fellowship, grant 11PP224N).
Acknowledgements
The present study was funded by the Flemish Researc Foundation (FWO project, grant G0C4919N). Alexandra Kalkantzi, as shared first author, was supported by funding from the European Commission, Horizon Europe
Research and Innovation Action under grant agreement number 101057309, in the context of the AINCP project. Lize Kleeren, as shared first author, was funded by an FWO fellowship (grant 11PP224N). We thank all participants and their families for their willingness to take part in this study. We also thank Geert Molenberghs for his statistical advice and Nofar Ben Itzhak for her insights in the analyses
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