Neural and visceral manipulation in infants with congenital muscular torticollis: a feasibility study.

[Purpose] As an alternative to manual stretching, the aim of this study was to investigate the feasibility of using neural/visceral manipulation as a safe and effective intervention to increase neck range of motion of infants with congenital muscular torticollis. [Participants and Methods] Ten 4-month old infants with congenital muscular torticollis received eight sessions of neural/visceral manipulation administered for 30-50 minutes without observed pain. Specific palpation techniques addressed restricted tissue areas of neck, head, trunk and extremities. Neck rotation and lateral flexion were assessed by still photography and a computer program calculating ROM angles before, immediately following, and 4 months post intervention. Motor development and social competence were monitored over time using the Alberta Infant Motor Scale and Bayley-III Social Emotional Scale. [Results] Results of analysis of variances revealed significant improvements in passive and active neck rotation and lateral flexion. Significant increases were also found on the Alberta Infant Motor Scale and Bayley-III Social-Emotional scale. [Conclusion] Neural/visceral manipulation can be used safely in infants with congenital muscular torticollis to improve neck range of motion.

Motor learning in children with hemiplegic cerebral palsy: feedback effects on skill acquisition.

AIM: Motor learning is enhanced with practice and feedback. This cohort control study investigated the effect of different relative feedback frequencies during skill acquisition in children with cerebral palsy (CP) and children with typical development. METHOD: Nineteen children with spastic hemiplegic CP (nine males, 10 females; mean age 11 y 7 mo; range 8-16 y) and 20 children with typical development (12 males, eight females; mean age 10 y 8 mo; range 8-14 y) were assigned to 100% or reduced (62%) feedback subgroups as they practised 200 trials of a discrete arm movement with specific spatiotemporal parameters. Children with CP used their less involved hand. Learning was inferred by delayed (24 h) retention and reacquisition tests. RESULTS: All children improved in accuracy and consistency. Children with typical development demonstrated significantly greater accuracy than children with CP during acquisition (p=0.001), retention (p=0.031), and reacquisition (p=0.001), and greater consistency during retention (p=0.038). The typically developing group who received 100% feedback performed with significantly less error than the 62% feedback group during acquisition (p=0.001), and with greater retention (p=0.017). No statistically significant difference was found between feedback subgroups of children with CP, although the 100% feedback group consistently demonstrated less error. INTERPRETATION: Children with CP use feedback in a manner similar to children with typical development when learning new skills with their less involved hand, but demonstrate less accuracy and consistency.

The evolving practice of developmental care in the neonatal unit: a systematic review.

Many neonatal intensive care units (NICUs) are experiencing changes in their approaches to preterm infant care as they consider and incorporate the philosophy of individualized developmental care. The aim of this systematic review is to research current literature documenting the short-term effects of developmental care and the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). The following databases were reviewed: PubMED, CINAHL, and PsychINFO by using the keywords developmental care, individualized care, preterm infant, early intervention, and NIDCAP. Fifty-four articles were found with a total of 15 matching the selection criteria. All 15 articles were assessed using a research design developed by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM). Twelve of the 15 articles contained strong Levels of Evidence (I or II). Our findings suggest evidence supporting developmental care and NIDCAP, however, further research documenting outcomes for preterm infants receiving developmental care and/or NIDCAP is needed.

A pilot study of quality of life in children with cerebral palsy after intensive body weight-supported treadmill training.

PURPOSE: This pilot study was designed to examine the effects of a 2-week program of intensive body weight-supported treadmill training (BWSTT) on clinical measures of perceived health-related quality of life and fatigue in children with cerebral palsy. METHODS: Six children with spastic cerebral palsy (aged 6-14 years; all classified as Gross Motor Function Classification System Level I) received two 30-minute sessions of BWSTT daily for 2 weeks, and completed questionnaires preintervention and postintervention. RESULTS: Ratings by children and their parents who completed the Pediatric Quality of Life Inventory and Multidisciplinary Fatigue module resulted in nonsignificant higher mean postscores. However, of the children with complete data, 4 showed minimal clinically important differences by child and parent-proxy report. CONCLUSIONS: Results suggest that positive health-related quality of life changes can be identified after an intensive intervention of BWSTT, and should include ratings from both children and parents.

Case report: ICF-level changes in a preschooler after constraint-induced movement therapy.

The authors examined changes associated with constraint-induced movement therapy (CIMT) provided to a preschool-aged child with right spastic hemiplegia. This case study design used a 2-week pretest measure baseline period, 2 weeks of CIMT, and postmeasures at 1 week and 3 months. Measures were chosen to document changes at the different levels of International Classification of Functioning, Disability and Health (ICF), including the Canadian Occupational Performance Measure (COPM), Pediatric Evaluation of Disability Inventory (PEDI) Self-Care Section, Melbourne Assessment of Unilateral Upper Limb Function, and grip and pinch strength. Results showed increases on COPM-identified goals of increased independence with bilateral hand play and participation in gross motor play with friends. Changes were also documented in self-care, arm function, and grip strength. Another unexpected association reported by parents and professionals was increased speech intelligibility. Potential implications of implementing CIMT with young children are presented.

Motor measures: a moving target?

Outcome measures may be used for a variety of reasons by clinicians and researchers. This paper provides an overview on motor measures that can be used in research or practice and are classified within the International Classification of Functioning, Disability and Health or ICF. Specifically, body function measures of neuromusculoskeletal and movement-related functions are presented, as are mobility measures within the activity and participation domain of the ICF. Descriptions of measures within these categories and their psychometric properties are provided. Current challenges and future directions for motor measurement are delineated.

A model of mentorship in occupational therapy: the leadership of a. Jean ayres.

Over a period of 30 years, Dr. A. Jean Ayres conducted and disseminated research related to the theory and practice of sensory integration. The Center for the Study of Sensory Integrative Dysfunction was established to promote Ayres' research with 66 faculty members recruited by 1982. To describe how Dr. Ayres may have influenced the occupational therapy profession, a survey was conducted to document the scholarly/leadership productivity of Sensory Integration faculty. Of the 66 faculty members, 48 were located and sent survey packets. The return rate was 79% (n = 38). Respondents documented their productivity in eight categories and answered 18 questions about their leadership qualities. Ninety-seven percent of respondents indicated that Ayres had professionally influenced them. Fifty-one percent of respondents had doctorate degrees with 78% reported having academic teaching experience. This group of 38 professionals had produced 438 peer-reviewed articles, 707 nonpeer-reviewed publications, and 265 grants. Ayres' legacy is continued with the scholarly work of the Sensory Integration faculty who received professional mentorship.

The Framework of Occupational Gradation (FOG) to Treat Upper Extremity Impairments in Persons With Central Nervous System Impairments.

Occupational therapists providing treatment of persons with central nervous system (CNS) impairments now embrace a motor control approach based on principles of strength training and practice of meaningful occupations. This paper describes the Framework of Occupational Gradation (FOG), which was developed to assist occupational therapists to systematically challenge upper extremity function by manipulating the degrees of freedom of active motion in a person's extremity. Clients may be able to perform occupations under several or all levels within the framework. However, the person, task, or object properties and the environment can also be manipulated by the occupational therapist to optimize or challenge a person's performance at each level. Application of the FOG is presented through case studies.

Motor learning in children: feedback effects on skill acquisition.

BACKGROUND AND PURPOSE: Reduced feedback during motor skill practice benefits motor learning. However, it is unknown whether these findings can be applied to motor learning in children, given that children have different information-processing capabilities than adults. The purpose of this study was to determine the effect of different relative frequencies of feedback on skill acquisition in children compared with young adults. SUBJECTS: The participants were 20 young adults and 20 children. METHODS: All participants practiced 200 trials of a discrete arm movement with specific spatiotemporal parameters. Participants from each group (adults and children) were randomly assigned to either a 100% feedback group or a reduced (62% faded) feedback group. Learning was inferred from the performance on the delayed (24-hour) retention and reacquisition tests. RESULTS: All participants improved accuracy and consistency across practice trials. During practice, the adults performed with significantly less error than the children. Adults who practiced with reduced feedback performed with increased consistency during the retention test compared with those who practiced with 100% feedback. In contrast, children who received reduced feedback during practice performed with less accuracy and consistency during the retention test than those who received 100% feedback. However, when feedback was reintroduced during the reacquisition test, the children in the reduced feedback group were able to improve their performance comparable to those in the 100% feedback group. DISCUSSION AND CONCLUSION: During motor learning, children use feedback in a manner different from that of adults. To optimize motor learning, children may require longer periods of practice, with feedback reduced more gradually, compared with young adults.

Effect of wrist hand splints on grip, pinch, manual dexterity, and muscle activation in children with spastic hemiplegia: a preliminary study.

The effect of wrist/hand orthoses on force production, dexterity, and upper extremity muscle recruitment was investigated in children with and without cerebral palsy (CP) to determine if splint design affects 1) hand function and 2) muscle activation. Ten children with hemiplegic CP used hands with spasticity (n=10) and five age-matched control children used dominant and nondominant hands (n=10) in three splint conditions (no, dynamic, static) during grip, pinch, and peg-board tests while electromyography (EMG) recorded muscle activation. Children with spasticity increased their grip (p=0.008) and dexterity (p=0.02) when wearing dynamic splints and pinch (p=0.04) with no splints. All children had significantly less wrist EMG activity during grip with static splints; only children with CP had greater compensatory shoulder activation. Preliminary findings suggest that dynamic splints increased function of children with CP while static splints decreased muscle activation at wrist and increased compensatory shoulder muscle recruitment.

Ankle dorsiflexion fMRI in children with cerebral palsy undergoing intensive body-weight-supported treadmill training: a pilot study.

This pilot study investigated the feasibility of using functional magnetic resonance imaging (fMRI) as a physiological marker of brain plasticity before and after an intensive body-weight-supported treadmill training (BWSTT) program in children with cerebral palsy (CP). Six ambulatory children (four males, two females; mean age 10y 6mo, age range 6-14y) with spastic CP (four hemiplegia, two asymmetric diplegia, all Gross Motor Function Classification System Level I) received BWSTT twice daily for 2 weeks. All children tolerated therapy; only one therapy session was aborted due to fatigue. With training, over ground mean walking speed increased from 1.47 to 1.66m/s (p=0.035). There was no change in distance walked for 6 minutes (pre-: 451m; post-: 458m;p 0.851). In three children, reliable fMRIs were taken of cortical activation pre- and post-intervention. Post-intervention increases in cortical activation during ankle dorsiflexion were observed in all three children. This study demonstrates that children with CP between 6 and 14 years of age can tolerate intensive locomotor training and, with appropriate modifications, can complete an fMRI series. This study supports further studies designed to investigate training-dependent plasticity in children with CP.

Endurance and gait in children with cerebral palsy after intensive body weight-supported treadmill training.

PURPOSE: This study was designed to investigate changes in endurance, functional gait, and balance after intensive body weight-supported treadmill training in children with CP who were ambulatory. METHODS: Six school-aged children with CP (four boys, two girls; age range: six to 14 years) participated in an intensive program of body weight-supported treadmill training 30 minutes twice daily for two weeks. RESULTS: Statistically significant improvement in walking velocity and energy expenditure were observed. Variability of individual outcomes was observed with some children showing positive changes, and others no change or a decline in performance. Four children showed minimal detectable changes in a positive direction on both an endurance measure and a functional gait measure. Each endurance and functional gait measure included at least one child with a positive minimal detectable change. CONCLUSION: Intensive body weight-supported treadmill training may be an effective intervention for some children with CP who are ambulatory.

Measuring dexterity in children using the Nine-hole Peg Test.

The purpose of this study was to measure dexterity in children aged 4-19 years using the Nine-hole Peg Test. Four hundred and six children were tested with their dominant hand and then their nondominant hand. A commercial version of the Nine-hole Peg Test was used. An analysis of variance showed a main effect for age, gender, and hand dominance. Speed of dexterity improved with age. In all age groups, females performed faster than males. Participants performed faster with the dominant hand than the nondominant hand. The normative data collected provide information for comparing scores to children with different diagnostic categories to screen for fine motor difficulties.

Postural control in children: implications for pediatric practice.

Based on a systems theory of motor control, reactive postural control (RPA) and anticipatory postural control (APA) in children are reviewed from several perspectives in order to develop an evidence-based intervention strategy for improving postural control in children with limitations in motor function. Research on development of postural control, postural control in children with specific motor disabilities, and interventions to improve postural control is analyzed. A strategy for intervention to improve postural control systems at the impairment and functional activity levels based on a systems theoretical perspective is presented. Suggestions for research to improve evidence for best practice are provided.

Survey of occupational therapy practitioners in southwestern schools: assessments used and preparation of students for school-based practice.

PURPOSE: The purpose of this study was to identify current practice in assessment use of school-based occupational therapy practitioners and to identify their expectations of student performance in assessment upon completion of the pediatric Fieldwork II experience. A survey of school-based occupational therapists in the southwestern states was conducted to answer three research questions: (1) what standardized assessments are currently used frequently and occasionally by occupational therapy practitioners in the school setting, (2) what level of competency in assessment administration by Fieldwork II students is expected by supervising occupational therapists, and (3) what educational preparation did the practitioners receive prior to their employment in schools and what professional support is currently available to them? METHOD: A five page questionnaire was mailed to 406 practicing therapists in four southwestern states with a response rate of 74.1 percent using Dillman's Total Design Method. RESULTS: Respondents reported use of motor and visual perception tests most frequently in their practice. When trends of this survey were compared to previous surveys, practitioners reported similar use of motor and visual perception tests, a decreased use of sensory integration measures, and an increase in the use of function-based assessments.

Keyboarding and visual-motor skills in elementary students: a pilot study.

UNLABELLED: With the increased integration of technology in public school settings, occupational therapists have utilized computers in their role as related special education service providers. Although computers are used as an intervention tool, no studies have documented the efficacy of computer training on functional skills in students. PURPOSE: The purpose of this pilot study was to investigate the effect of a structured keyboarding (typing) program on visual-motor (eye-hand coordination) and written communication skills in children enrolled in second grade public school classrooms. METHOD: Sixty-six children participated in the study. Thirty-two children received typing instruction on a daily basis for eight months and thirty-four students served as control children receiving no formal instruction. RESULTS: RESULTS of a mixed ANOVA with repeated factor showed a significant difference in visual-motor abilities in students who received keyboarding instruction as compared to control children. In addition, average typing speeds approached handwriting speeds at this grade level. These preliminary results support the use of keyboarding as a compensatory handwriting approach in the classroom. Further investigation of the use of keyboarding for students with milder disorders such as learning disabilities is recommended.

Test-retest reliability of the Motor-Free Visual Perception Test Revised (MVPT-R) in children with and without learning disabilities.

The Motor-Free Visual Perceptual Test Revised (MVPT-R) is an updated edition of the original test with the addition of four items and normative data for 9-11-year-old children. Test-retest reliability studies on the MVPT-R are not reported. The purpose of this paper is to report the test-retest reliability of the MVPT-R in children with and without learning disabilities. The MVPT-R was administered to 38 children with identified learning disabilities and 37 control children (aged 7-10 years) on two separate occasions within a 2.5 week window of time. Inter-rater reliability agreement between examiners was 99%. Intra-class correlations for perceptual quotient scores ranged from .63-.79 and perceptual age scores ranged from .69-.86. Pearson product moment correlations for perceptual quotient scores ranged from .70-.80 and perceptual age scores ranged from .77-.87. Results suggest moderate test-retest reliability for the MVPT-R with more stability in visual perceptual scores for children with learning disabilities. This information will be helpful for therapists using the MVPT-R as a descriptive measure for children.

A comparison of static and dynamic wrist splints using electromyography in individuals with rheumatoid arthritis.

This study compared strength, dexterity, and the muscle activation of individuals with rheumatoid arthritis (RA) when different splints were worn. Five persons with RA were observed in four splint conditions (none, static, hinged, spiral) during grip, pinch, and dexterity tests by recording muscle activity of eight muscles in the upper extremity using electromyography (EMG). Statistically significant differences were found in clinical tests when hinged (p<0.001) and spiral splints (p=0.02) were worn. Grip strength decreased when hinged splints were worn, whereas two-point pinch increased and dexterity improved on the Nine-Hole Peg Test with the spiral splint. Although no significant EMG differences were found during different splint conditions, wrist muscles were recruited more for grip, and shoulder muscles were used most during pinch and dexterity tests. Individuals with RA who wore splints had decreased grip when wearing hinged splints, but improved pinch and dexterity were found when the spiral splint was worn. Increased use of proximal shoulder muscles was observed during pinch and dexterity tests with and without splints.