1,721,052 research outputs found
Defining functional therapy in research involving children with cerebral palsy: a systematic review
Full text linkAim: To review definitions and elements of interventions in studies, which used the word "functional" to describe their intervention for children with cerebral palsy (CP), and to determine whether definitions and elements are similar to criteria of functional therapy described in the Dutch Guidelines. Methods: Systematic review of intervention studies, which used the word "functional" to describe interventions for children with CP. We described criteria of functional therapy that were used to describe the intervention, and whether criteria were described similarly to the descriptions used in the Dutch Guidelines. Results: Of the 27 included studies, criteria "based on the activities/participation level of the ICF-CY", "goal-directed" and "context-specific" were referred to the most (40-59.3%). Descriptions of these criteria were less comparable to the suggested definition (43.8-69.2%). The remaining three criteria ("active involvement", "task-specific", and "focused on functionality instead of normality") were referred to less frequently (18.5-33.3%). The descriptions reported for these criteria were, however, the most comparable with the suggested definitions (80-100%). Conclusions: The included studies, in general have not used criteria of functional therapy. Future studies have to describe the elements of interventions in detail. Moreover, it is important to reach consensus on the definition and elements of functional therapy
Interlimb coordination and spatiotemporal variability during walking and running in children with developmental coordination disorder and typically developing children
No full textBackground: A different interlimb coordination and higher variability in movement patterns is evident in children with Developmental Coordination Disorder (DCD). The impact of DCD on interlimb coordination during walking and running is unknown. Aim: To assess interlimb coordination and spatiotemporal variability during overground walking and running in children with and without DCD. Methods: Children with DCD and typically developing children (TDC), from 8 to 12 years participated. Children were equipped with portable sensors. Participants walked and ran for 3 min in an oval-path at their comfortable pace. Interlimb coordination, expressed by the phase coordination index (PCI), and spatiotemporal variability (coefficient of variance (CoV)) were collected. Results: Twenty-one children with DCD and 23 TDC participated. During walking, PCI showed similar values in both groups, but a higher spatiotemporal variability was observed in children with DCD. During running, PCI was higher (reduced coordination) in children with DCD than TDC and a higher spatiotemporal variability was shown. Conclusions and implications: Only during running, interlimb coordination of children with DCD was lower than TDC. During both walking and running tasks, spatiotemporal variability was higher in DCD. Current results implicate that difficulties in children with DCD is more prominent when motor coordination is more challenged. What this paper adds: This paper adds to the literature on coordination and gait pattern in children with Developmental Coordination Disorder (DCD) through a cross-sectional analysis of interlimb coordination and variability of spatiotemporal measures of overground walking and running. Overground walking and running were performed in a large oval-path allowing the assessment of coordination and gait patterns in an ecological valid set-up. Our results indicate that during a more demanding task, namely running, children with DCD display a less coordinated running pattern, expressed by a significantly higher phase coordination index, than typically developing peers. During walking, the interlimb coordination was similar between both groups. The current result is in accordance with the hybrid model of DCD that states that motor coordination difficulties in DCD are dpendent on the interaction of the task, individual and environment. Thi
Physical therapy treatment in children with cerebral palsy after single-event multilevel surgery:a qualitative systematic review. A first step towards a clinical guideline for physical therapy after single-event multilevel surgery
No full textBackground: The aim of this study was to review available evidence for physical therapy treatment (PTT) after single-event multilevel surgery (SEMLS), and to realize a first step towards an accurate and clinical guideline for developing effective PTT for children with cerebral palsy (CP) after SEMLS. Methods: A qualitative systematic review (PubMed, Medline, Embase, CINAHL, and the Cochrane Library) investigating a program of PTT after SEMLS in children aged 4-18 years with CP classified by Gross Motor Function Classification System level I-III. Results: Six articles meeting the inclusion criteria were selected. The selected studies provide only incomplete descriptions of interventions, and show no consensus regarding PTT after SEMLS. Neither do they show any consensus on the outcome measures or measuring instruments. Conclusions: Based on the results of this literature review in combination with our best practice, we propose a preliminary protocol of PTT after SEMLS.</p
Auditory-motor synchronization and interlimb coordination when walking to metronomes with different tempi and structures: A comparison study of children with and without Developmental Coordination Disorder
No full textBackground: Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder affecting motor coordination, impacting daily-life activities like walking. Accurate sensorimotor interactions are crucial for optimal coordination. Auditory-motor synchronization paradigms allow to examine these interactions with tempo and temporal structure of auditory stimuli potentially influencing synchronization and coordination. Therefore, this study aims to investigate auditory-motor synchronization and interlimb coordination in children with DCD and typically developing children (TDC) during walking. Research question: What is the impact of metronome characteristics (tempo, temporal structure) on auditorymotor synchronization, interlimb coordination and spatiotemporal variability in children with and without DCD during walking to auditory metronomes? Methods: Twenty-one DCD and 22 TDC children walked for three minutes to auditory metronomes with different tempi and temporal structures. Synchronization, interlimb coordination and spatiotemporal variability were analyzed using mixed model analysis. Results: DCD presented lower synchronization consistency, inferior interlimb coordination and higher gait variability (speed, step length) across all tempi and temporal structures. At preferred tempo, both groups demonstrated best synchronization and interlimb coordination. The least synchronization and coordination were observed at lower tempo, with DCD additionally showing diminished tempo matching and increased cadence variability. Discrete structures optimized synchronization accuracy and continuous structures enhanced interlimb coordination accuracy. Conclusion: The study highlights difficulties in auditory-motor synchronization, interlimb coordination and spatiotemporal variability in DCD during walking, which were enlarged at lower tempo. Considering various tempi and temporal structures can enrich walking assessments and protentional interventions for DCD. What this paper adds: This paper contributes to the understanding of auditory-motor synchronization and interlimb coordination in children with Developmental Coordination Disorder (DCD) and typically developing children (TDC) during walking. This study expands previous research by exploring the impact of varied tempi and temporal structures on synchronization and interlimb coordination, which has been a relatively unexplored area in the context of DCD. The key findings suggest that children with DCD exhibit lower synchronization consistency and interlimb coordination compared to their typically developing peers across different tempi and temporal structures. We extend previous findings of tapping literature that optimal synchronization and coordination was present at 0 % tempo. Additionally, worsened performance was found at lower auditory tempi (-10 %) than their preferred walking tempo.M.G. received funding from the Flemish Fund for Scientific Research (FWO Vlaanderen, 11K8622N) and the Special Research Fund of Hasselt University (BOF21INCENT27) to conduct this study within the context of a PhD project. Co-author Dr. Lousin Moumdjian received funding from the Flemish Fund for Scientific Research (FWO Vlaanderen, 1295923N).
We acknowledge the assistance in recruitment and data collection by master students (A. Vos, J. Roufs, K. Hennen, S. Roox, B. Slechten, J. Bielen, M. Bertels, J. Bijloos). We also thank dr. Joeri Verbiest for the pre-processing of the interlimb coordination and spatiotemporal gait parameters
Functional strength measurement in cerebral palsy:feasibility, test-retest reliability, and construct validity
Full text linkPurpose: No instrument exists that measures functional strength in both lower and upper extremities in children with cerebral palsy (CP). Therefore, the functional strength measurement (FSM) was tested for feasibility, test-retest reliability and validity in CP. Methods: Thirty-seven children with CP (aged 4-10 years, Gross Motor Function Classification System I and II) participated. The most common compensations for CP were described; new item descriptions were standardized, and one item was removed. Test-retest reliability was examined. To measure convergent validity, correlations between the FSM-CP and isometric muscle strength measured with the handheld dynamometer (HHD) were determined. Results: Test-retest reliability was considered high for all items (intra-class correlation coefficient 0.79-0.95). Significant correlations between the HHD and FSM-CP ranged from r = 0.36 to 0.75. Conclusion: The FSM-CP is feasible, reliable, and valid to use in children with CP. The FSM-CP can be considered as a helpful tool in clinical practice of physical examination of children with CP.</p
Measuring Motor Fatigability in the Upper Limbs in Individuals With Neurologic Disorders: A Systematic Review
Full text linkOBJECTIVE: To summarize the literature on definitions, assessment protocols, and outcome measures for motor fatigability in patients with neurologic problems and investigates the known clinimetric properties according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. DATA SOURCES: Two databases were consulted for studies published between January 2003 and November 2018 using the terms "motor fatigability," "nervous system disease," and "upper limb." STUDY SELECTION: Studies were included if they were (1) not older than 15 years; (2) written in English, German, or Dutch; (3) involved upper limbs of patients with neurologic disease; and (4) adequately described protocols using maximum voluntary contractions. DATA EXTRACTION: Thirty-three studies were included, describing 14 definitions, 37 assessment protocols, and 9 outcome measures. The following data were obtained: (1) author and publication year; (2) aim; (3) fatigability definition; (4) sample characteristics; (5) fatigability protocol; (8) measurement system; and (9) outcome measure. DATA SYNTHESIS: Protocols relating to body function level of the International Classification of Functioning (ICF) were most often performed in patients with multiple sclerosis (MS) including maximal or submaximal, isometric or concentric, and eccentric contractions of variable duration. For ICF activities level, most protocols included wheelchair-related tasks. Clinimetric properties were known in 2 included protocols. Test-retest reliability in patients with MS were moderate to excellent for the static fatigue index and moderate for the dynamic fatigue index. CONCLUSIONS: Based on physiology, recommendations are made for protocols and outcome measures for motor fatigability at the ICF body function level. For the ICF activities level, too little is known to make sound statements on the use of protocols in populations with neurologic disease. Clinimetric properties should be further investigated for populations with neurologic problems.sponsorship: Supported by the Bijzonder Onderzoeksfonds by UHasselt (grant no. BOF17NI07). (Bijzonder Onderzoeksfonds by UHasselt|BOF17NI07)status: Publishe
How can instructions and feedback with external focus be shaped to enhance motor learning in children? A systematic review
No full textAim This systematic review investigates the effectiveness of instructions and feedback with external focus applied with reduced frequency, self-controlled timing and/or in visual or auditory form, on the performance of functional gross motor tasks in children aged 2 to 18 with typical or atypical development. Methods Four databases (PubMed, Web of Science, Scopus, Embase) were systematically searched (last updated May 31st 2021). Inclusion criteria were: 1. children aged 2 to 18 years old; 2. Instructions/feedback with external focus applied with reduced frequency, self-controlled timing, and/or visual or auditory form as intervention, to learn functional gross motor tasks; 3. Instructions/feedback with external focus applied with continuous frequency, instructor-controlled timing, and/or verbal form as control; 4. performance measure as outcome; 5. (randomized) controlled studies. Article selection and risk of bias assessment (with the Cochrane risk of bias tools) was conducted by two reviewers independently. Due to heterogeneity in study characteristics and incompleteness of the reported data, a best-evidence synthesis was performed. Results Thirteen studies of low methodological quality were included, investigating effectiveness of reduced frequencies (n = 8), self-controlled timing (n = 5) and visual form (n =1) on motor performance of inexperienced typically (n = 348) and atypically (n = 195) developing children, for acquisition, retention and/or transfer. For accuracy, conflicting or no evidence was found for most comparisons, at most time points. However, there was moderate evidence that self-controlled feedback was most effective for retention, and limited evidence that visual analogy was most effective for retention and transfer. To improve quality of movement, there was limited evidence that continuous frequency was most effective for retention and transfer. Conclusion More methodologically sound studies are needed to draw conclusions about the preferred frequency, timing or form. However, we cautiously advise considering self-controlled feedback, visual instructions, and continuous frequency
Parents’ Challenges and Needs after Inpatient Intensive Functional Rehabilitation Treatment of their Child with a Physical Disability
No full textRecent research showed that the disengagement of a child and family from an inpatient rehabilitation program to the home environment, can lead to a deterioration of the
achieved improvements over time. In order to fathom why this occurs this study focused on the challenges parents face once their child returns home from an inpatient Functional
Intensive Therapy program. A qualitative study was conducted (semi-structured indepth interviews) with parent couples (n=16) who’s child participated in an intensive
inpatient rehabilitation program. The data collected from the interviews were analyzed with directed content analysis.
The parents articulated challenges and needs once their child returned home:
1) Restricted knowledge about the child’s disability,
2) Coping with stress,
3) Empowering behavior regarding independent capabilities and
4) Parent roles and interactions between parents.
Out of these challenges and needs several possibilities emerged for this functional intensive inpatient program that could prevent relapses in the long term: provide psychoeducation on disability from physical, cognitive and social emotional perspective, and increase capacities of parents to deal with stress or unburden parents by outsourcing stressful tasks, guide parents with emotional challenges and feelings of loss regarding the possibilities of their disabled child, help parents identify their pedagogic values and finally adapt one unified approach for more clarity for the child.ARTICLE INFO ABSTRACT Recent research showed that the disengagement of a child and family from an in-patient rehabilitation program to the home environment, can lead to a deterioration of the achieved improvements over time. In order to fathom why this occurs this study focused on the challenges parents face once their child returns home from an inpatient Functional Intensive Therapy program. A qualitative study was conducted (semi-structured in-depth interviews) with parent couples (n=16) who's child participated in an intensive inpatient rehabilitation program. The data collected from the interviews were analyzed with directed content analysis. The parents articulated challenges and needs once their child returned home: 1) Restricted knowledge about the child's disability, 2) Coping with stress, 3) Empowering behavior regarding independent capabilities and 4) Parent roles and interactions between parents. Out of these challenges and needs several possibilities emerged for this functional intensive inpatient program that could prevent relapses in the long term: provide psycho-education on disability from physical, cognitive and social emotional perspective, and increase capacities of parents to deal with stress or unburden parents by outsourcing stressful tasks, guide parents with emotional challenges and feelings of loss regarding the possibilities of their disabled child, help parents identify their pedagogic values and finally adapt one unified approach for more clarity for the child
Barriers and Facilitators to the Acceptance of eHealth Interventions by Dutch Pediatric Physical Therapists in Times of the COVID-19 Pandemic:A Mixed-Methods Approach
Full text linkBackground:The COVID-19 pandemic created an urgent need for eHealth as the relevance of infection control and social distancing continues. Evidence describing the acceptability of implementing eHealth into pediatric physical therapy services is limited. Purpose:To investigate the determinants of eHealth acceptance by Dutch pediatric physical therapists during the COVID-19 pandemic. Methods:A mixed-methods approach was used. It included a quantitative exploratory questionnaire of 154 pediatric physical therapists and qualitative in-depth interviews of 16 pediatric physical therapists. Results:The eHealth interventions were beneficial for collaboration between health care professionals and in addition to face-to-face therapy. eHealth interventions were, however, found to be unsuitable especially in the diagnostic phase. Barriers to more extensive application include costs, technical difficulties, and a perceived negative attitude of children. Conclusion:Pediatric physical therapists used eHealth interventions extensively in times of the COVID-19 pandemic. However, the acceptance of eHealth interventions is dependent on the pediatric physical therapist's perception of usefulness in private practice, rehabilitation setting, or clinical hospital
How do paediatric physical therapists teach motor skills to children with Developmental Coordination Disorder? An interview study
No full textBackground
When teaching motor skills, paediatric physical therapists (PPTs) use various motor learning strategies (MLSs), adapting these to suit the individual child and the task being practised. Knowledge about the clinical decision-making process of PPTs in choosing and adapting MLSs when treating children with Developmental Coordination Disorder (DCD) is currently lacking. Therefore, this qualitative study aimed to explore PPTs’ use of MLSs when teaching motor skills to children with DCD.
Methods
Semi-structured individual and group interviews were conducted with PPTs with a wide range of experience in treating children with DCD. A conventional content analysis approach was used where all transcripts were open-coded by two reviewers independently. Categories and themes were discussed within the research group. Data were collected until saturation was reached.
Results
Twenty-six PPTs (median age: 49 years; range: 26–66) participated in 12 individual interviews and two focus-group interviews. Six themes were identified: (1) PPTs treated children in a tailor-made way; (2) PPTs’ teaching style was either more indirect or direct; (3) PPTs used various strategies to improve children’s motivation; (4) PPTs had reached the optimal level of practice when children were challenged; (5) PPTs gave special attention to automatization and transfer during treatment; and (6) PPTs considered task complexity when choosing MLSs, which appeared determined by task constraints, environmental demands, child and therapist characteristics.
Conclusion
PPTs’ clinical decision-making processes in choosing MLSs appeared strongly influenced by therapist characteristics like knowledge and experience, resulting in large variation in the use of MLSs and teaching styles to enhance motivation, automatization, and transfer. This study indicates the importance of the level of education on using MLSs to teach children motor skills, and clinical decision-making. Future research should focus on implementing this knowledge into daily practice.We are grateful to the PPTs who participated in this study. We also would like to thank the master’s students of the Master’s in Rehabilitation Sciences and Physiotherapy of Hasselt University (Belgium), and of the Master’s in Paediatric Physical Therapy of Avans+ (the Netherlands) for participating in conducting the interviews and analysing the data. Furthermore, we acknowledge Les Hearn ([email protected]) for proofreading and editing this article
- …
