Effects of a full-body electrostimulation garment application in a cohort of subjects with cerebral palsy, multiple sclerosis, and stroke on upper motor neuron syndrome symptoms.

OBJECTIVES: Dysfunction of the central nervous system may inflict spastic movement disorder (SMD). Electrical stimuli were identified as promising therapeutic option. Electrical stimulation provided by a 58-electrode full body garment was investigated based on data from regular trial fittings. METHODS: Data from 72 testees were investigated. Age averages 36.6 (19.8) ys with 44 females. The cohort spans infantile cerebral paresis (CP) (n=29), multiple sclerosis (MS) (n=23) and stroke (n=20). Data were stratified by etiology and an entry BBS Score<45. RESULTS: Effect sizes (Cohen`s d) related BBS, TUG, FGA, 10mWT, WMFT, EQ5D5L and Pain. Significance levels are indicated by *: p<0.05, **: p<0.01, ***: p<0.001, (t): p<0.1: CP: 1.64***, 0.29*, 1.59***, 0.76(t), 1.00***, 0.5*, 1.28***; MS: 1.83***, 0.83***, 1.28**, 1.07***, 0.93*, 1,11**, 0.78*; Stroke: 1.28**, 0.78**, 0.89, 0.92**, 0.71, 1.26*, 0.78*. CONCLUSIONS: Multi-site transcutaneous electrical stimulation may increase ambulation related skills in subjects with SMD stemming from CP, MS and stroke. The results indicate effects on static and dynamic balance, fall risk, mobility, upper extremity improvement and an overall increase in health utility and a reduction in spasticity related pain. Effects are immediate as well as sustained. These results may inspire individual trial fittings and inform further controlled trials.

Stories of restitution: Family experiences of diagnosis and help-seeking for a child with cerebral palsy.

BACKGROUND: The experience of living with children with CP is dominated by the voice of the mother while others are rarely reported. Incorporation of the voices of other family members is important for a holistic understanding. METHODS: Drawing on the philosophical perspectives of pragmatism, generic qualitative methodology, and Frank's narratives, this article highlights how restitution was constructed by 30 family members. FINDINGS: They constructed restitution by hoping for a cure through either biomedical and/or alternative models of treatment, followed by intransitive and transcendent restitution. DISCUSSION: This appears to be the first time that restitution has been extended to families living with children with chronic illnesses. APPLICATION TO PRACTICE: This would mean that paediatric nursing professionals and other health professionals dealing with family members living with children with CP could attend to their stories in an open and focused manner to honour and validate their stories as well as their experiences.

Can hippotherapy make a difference in the quality of life of children with cerebral palsy? A pragmatic study.

Objective: To determine if the addition of 12 weekly therapy sessions, incorporating hippotherapy as the primary intervention to each child's usual therapy program, will improve balance, participation, and quality of life.Methods: Pragmatic, multi-center, randomized, controlled trial of 13 children with cerebral palsy (CP), ages 3 to 6 years. A treatment group received 12 weeks of weekly hippotherapy intervention in addition to their usual therapy. A control group continued with their usual therapy only. Assessments were completed for the treatment group pre-intervention (P0), post intervention (P1), and 12 weeks post no intervention (P2). Control group assessments occurred in the same timeframe: baseline, 12 weeks and 24 weeks.Results: The only significant difference between the groups, post intervention, was on the Pediatric Balance Scale (PBS). Within group analysis showed no significant changes for the control group between any pretest/posttest measures. The treatment group demonstrated significant improvement on the PBS (P0-P1, p = .02; P0-P2, p = .02) and Activities Scale for Kids (P0-P1, p = .02; P0-P2, p = .02) with delayed improvement on the 1 Minute Walk Test (P1-P2, p = .02) and Pediatric Quality of Life - CP Module (P0-P2, p = .03).Conclusions: Improvements in balance in children with CP may promote increased participation and quality of life when hippotherapy is added to their treatment plan.

Essence of the Bobath concept in the treatment of children with cerebral palsy. A qualitative study of the experience of Spanish therapists.

Objective: The aim was to explore the experiences of a group of Spanish physical therapists who apply the Bobath concept in the treatment of children with cerebral palsy, specifically to identify the components they experience as core and essential to the Bobath concept.Design: A qualitative phenomenological study.Methods: This study used purposive sampling. Non-structured interviews were carried out with 10 Spanish Bobath-trained physical therapists who treat children with cerebral palsy. Thematic analysis was applied.Results: Five themes regarding the essence of the Bobath concept emerged: 1) "normal movement" as a guide; 2) a "global" concept; 3) observation; 4) the centrality of tone; and 5) working with families. Within these themes, additional principles were reflected cross-sectionally, such as therapy being a continuous process of assessment and treatment, the application of principles of motor learning, and the importance of carryover of treatment into function.Conclusions: The results demonstrated themes traditionally identified as core to the Bobath concept, including working with families, which is also considered integral to the approach. The study participants used outdated terminology at times when discussing tone and movement. However, they reported that they no longer adhere to the theoretical perspective of pathological reflexes and reflex/tone inhibition. This study provides insight into how treatment of children with cerebral palsy based on the Bobath concept is experienced by a group of Spanish physiotherapists, who identified five main themes that they perceive as essential. The results provide grounds for further research into the application of the Bobath concept in children.

Acupuncture for drooling in children with cerebral palsy: A protocol for systematic review.

BACKGROUND: The aim of this study is to provide the methods used to evaluate the effectiveness and safety of acupuncture therapy for treating drooling in children with cerebral palsy. METHODS AND ANALYSIS: A comprehensive search of Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, 4 Chinese databases (China National Knowledge Infrastructure, Chinese Biomedical Literatures database, Wan-Fang Database and Chinese Science and Technology Periodicals will be conducted to identify randomized controlled trials of acupuncture for treating children with cerebral palsy salivation with no restriction on time or language. The primary outcome of this systematic review will be the effective rate. The risk of bias will be implemented according to Cochrane Handbook for Systematic Reviews of Interventions. We will conduct the meta-analysis to synthesize the evidence for each outcome, if possible. The heterogeneity will be evaluated statistically using the χ2 test and the I2 statistic. The random-effect model will be used to provide more conservative results, if significant heterogeneity is identified (I2 > 50% or P < .10). ETHICS/DISSEMINATION: Our findings will be disseminated in a peer-reviewed journal and at conference meetings. It is not necessary for formal ethical approval as no primary data are collected. TRIAL REGISTRATION NUMBER: INPLASY2020110024.

How are children with cerebral palsy managed in public hospitals of KwaZulu-Natal, South Africa?

Background: Medical advances have resulted in the survival of infants who are born prematurely. This makes them at risk of developing neurological manifestations and increases the incidence of children diagnosed with cerebral palsy (CP). Physiotherapy plays an important role in the management of children with CP. However, in KwaZulu-Natal (KZN) there are challenges for rehabilitation of children presenting with CP due to limited equipment, assistive devices and shortage of health care professionals. The aim of this study was to determine the current physiotherapy management for children presenting with CP in public hospitals of KZNMethods: One hundred and fifty-two physiotherapists were recruited using convenience sampling from different levels of public hospitals in KZN. The design was a cross-sectional study using a survey with a self-designed questionnaire to review current physiotherapy management of CP. The data was analyzed and presented by means of descriptive statisticsResults: Seventy-two participants completed the study indicating a 47.4% response rate with an age range of 31 to 40 years. Thirty-five (48.6%) of participants treated one to ten children with CP each month. Twenty-five (34.7%) used outcome measures to evaluate their CP management. This study showed the most common treatment techniques used by physiotherapists were: postural stabilizing activities - 68 (94.4%); respiratory care - 67 (92.9%); and positioning - 67 (92.9%)Conclusion: Despite challenges by physiotherapists in KZN, the overall management of children with CP was holistic and favorable. The most common treatment approach was postural stabilizing activities with children with CP receiving treatment once a month for 30 minutes.

Functional outcomes of botulinum neurotoxin-A injection followed by reciprocal electrical stimulation in children with cerebral palsy: A randomized controlled trial.

BACKGROUND: The integration of therapeutic approaches is increasingly recommended for children with cerebral palsy, to enhance outcomes. Nevertheless, clinicians still opt for separate or combined therapies based on little credible knowledge. OBJECTIVE: This study endeavored to evaluate the effect of botulinum neurotoxin-A (BoNT-A) injection and reciprocal neuromuscular electrical stimulation (rNMES) and their combination on the upper extremity function in children with spastic hemiplegia. METHODS: Sixty-four children with spastic hemiplegia (aged 6- 10 years) were randomly assigned to four treatment-based groups [group I (BoNT-A), group II (rNMES), group III (combined BoNT-A and rNMES), and group IV (Control)]. All children received a physical rehabilitation program, thrice/week over three months. Unilateral upper-limb function, bimanual hand function, and real-time arm-hand function were assessed using Melbourne Assessment (MA), Assisting Hand Assessment (AHA), and Pediatric Motor Activity Log (PMAL) scales respectively pre-treatment, post-treatment, and at 6 months follow-up. RESULTS: Post-treatment, group III achieved greater improvement in MA, AHA, and PMAL compared to other groups (all P < 0.05), and the difference remained in favor of group III at the follow-up (all P < 0.05). CONCLUSIONS: This study suggests that BoNT-A and rNMES combined are more effective than either of them alone to enhance upper-extremity function in children with spastic hemiplegia.

Integrative medicine rehabilitation for children with cerebral palsy: a study protocol for a multicenter pragmatic randomized controlled trial.

BACKGROUND: Traditional Korean medicine (TKM) has been employed for the treatment of children with cerebral palsy in Korea; however, the addition of TKM to usual rehabilitation (UR) treatment is hindered by insufficient evidence of clinical improvement with TKM in patients with cerebral palsy. In this study, we will evaluate the effectiveness and safety of integrative medicine rehabilitation (IMR) for cerebral palsy through a randomized controlled clinical study. METHODS: Eighty children (2-6 years old) diagnosed with cerebral palsy will be recruited and randomly divided into groups A and B. Patients in group A will receive IMR with UR, while those in group B will receive only UR during weeks 1-12 of the study. IMR includes acupuncture treatment (head and limb acupuncture) three times a week and the administration of herbal medicine (Yukgunza-tang and Yukmijihwang-tang extracts) twice a day in parallel with UR. Evaluations will be conducted at the beginning of the study and at 12 and 24 weeks (follow-up). The primary outcome is the Gross Motor Function Measure-88 score, and the secondary outcomes are the scores for the Goal Attainment Scale, Korean Bayley Scales of Infant Development III, and the Pediatric Quality of Life Inventory, and adverse events. DISCUSSION: This will be the first pragmatic randomized controlled trial to evaluate the efficacy and safety of IMR in children with cerebral palsy in Korea. The results will help to demonstrate if IMR is an effective therapeutic approach for cerebral palsy. TRIAL REGISTRATION: Ministry of Food and Drug Safety 31361 ( http://www.mfds.go.kr ). Registered on 29 June 2017. Clinical Research Information Service KCT0002620 ( https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=9819 ). Registered on 29 December 2017.

Efficacy of Supporting Play Exploration and Early Development Intervention in the First Months of Life for Infants Born Very Preterm: 3-Arm Randomized Clinical Trial Protocol.

OBJECTIVE: The aim of this project is to study the effect of a physical therapist intervention provided in the first months of life on developmental outcomes of infants born very preterm. Secondary aims are to investigate the impact of intervention timing on the efficacy and impact of the intervention on infants with and without cerebral palsy. METHODS: This study is a multisite longitudinal controlled trial comparing developmental outcomes from infants in the Supporting Play, Exploration, and Early Development Intervention (SPEEDI)_Late or SPEEDI_Early group to a usual care group. SETTINGS ARE URBAN: Urban and rural areas surrounding 2 academic medical centers. There will be 90 preterm infants enrolled in this study born at <29 weeks of gestation. SPEEDI is a developmental intervention provided by collaboration between a physical therapist and parent to support a child's motor and cognitive development. The primary outcome measure is the Bayley Scale of Infant and Toddler Development Cognitive and Gross Motor Scaled Scores. Secondary measures include behavioral coding of early problem solving skills, the Gross Motor Function Measure, and Test of Infant Motor Performance. IMPACT: More than 270,000 infants are born very preterm in the United States each year, 50% of whom will have neurological dysfunction that limits their ability to keep pace with peers who are typically developing. This study is a step toward understanding the impact that intensive developmental intervention could have in this population in the first months of life.

Acupuncture treatment on the motor area of the scalp for motor dysfunction in children with cerebral palsy: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Scalp acupuncture has been widely used as treatment for motor dysfunction in children with cerebral palsy in China. Previous studies have failed to provide high-quality evidence to demonstrate the effectiveness of this treatment in children with cerebral palsy. No high-quality randomized controlled trials on scalp acupuncture have been published. The aim of this study is to evaluate the effectiveness of Jiao's scalp acupuncture when combined with routine rehabilitation treatment versus routine rehabilitation treatment alone for motor dysfunction in children with cerebral palsy. METHODS/DESIGN: This is a four-centre randomized controlled trial. One hundred cerebral palsy patients with motor dysfunction were enrolled. Patients will be allocated in a 1:1 ratio into either an acupuncture treatment group or a control group. Cerebral palsy patients in the control group will receive conventional rehabilitation treatment, whereas patients in the acupuncture group will receive a combination of scalp acupuncture and conventional rehabilitation treatment. Thirty-six treatment sessions will be performed over a 12-week period. The Gross Motor Function Measure and the Fine Motor Function Measure Scale will be assessed as the primary outcome measures. The Paediatric Evaluation of Disability Inventory and the Cerebral Palsy Quality of Life Questionnaire for Children will be selected as secondary outcome measures. All assessments will be conducted at baseline, week 4 (treatment 12), week 8 (treatment 24), week 12 (treatment 36) and week 24 (follow-up). DISCUSSION: This is the first trial evaluating the efficacy and safety of scalp acupuncture as a treatment for motor dysfunction in children with cerebral palsy. The results of this trial are expected to provide relevant evidence demonstrating that scalp acupuncture can be used as an effective rehabilitation treatment method for improving motor dysfunction in children with cerebral palsy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03921281. Registered on 19 April 2019.

Factors Influencing Motor Outcome of Hippotherapy in Children with Cerebral Palsy.

OBJECTIVE: This study was aimed to identify individual factors influencing the gross motor outcome of hippotherapy in children with cerebral palsy (CP). METHODS: One hundred and forty-six children with CP (mean age: 5.78 ± 1.72 years, male: 56.2%) presenting variable function (gross motor function classification system [GMFCS], levels I-IV) participated in this study. Participants received 30 minutes of hippotherapy twice a week for 8 weeks. Clinical information including GMFCS level, age, sex, CP distribution, CP type, gross motor function measure-88 (GMFM-88), GMFM-66, and pediatric balance scale (PBS) score were collected retrospectively. We regarded the children with GMFM-66 score increased by 2.0 points as good responders to hippotherapy. Further we analyzed factors affecting good responders. RESULTS: GMFCS level I and II compared with IV (odds ratio [OR] = 6.83) and III compared with IV (OR = 4.45) were significantly associated with a good response to hippotherapy. Higher baseline GMFM E (OR = 1.05) and lower baseline GMFM B (OR = 0.93) were also significantly associated with a good response to hippotherapy. Sex, age, CP type, and distribution were not factors influencing gross motor outcome of hippotherapy. CONCLUSIONS: The children with CP, GMFCS level I-III, with relatively poor postural control in sitting might have a greater chance to improve their GMFM-66 scores through hippotherapy. This supports the hypothesis that hippotherapy is a context-focused therapy to improve postural control in sitting.

Efetividade da equoterapia na marcha de crianças com paralisia cerebral: revisão sistemática de ensaios clínicos / Effectiveness of equine assisted therapy in gait of children with cerebral palsy: systemactic review of clinical trials

A marcha das crianças com paralisia cerebral (PC) tem sido alvo de intervenções conservadoras como a Equoterapia. Entretanto, seus efeitos têm sido pouco sistematizados na literatura. Objetivo: Analisar a evidência da efetividade da Equoterapia na marcha de crianças com PC comparada às terapias conservadoras não invasivas de ensaios clínicos. Método: Trata-se de uma revisão sistemática com busca nas bases de dados Cinahl, Cochrane, Embase, Google Scholar, Lilacs, Lisa (ProQuest), PEDro, PsycINFO (APA), Pubmed e Scopus, sem fltros. Foram incluídos ensaios clínicos que compararam Equoterapia e terapias convencionais (terapias conservadoras não invasivas) versus terapias convencionais, que avaliaram parâmetros da marcha em crianças com diagnóstico de PC com idade ≤ 12 anos. Os estudos foram avaliados quanto à qualidade metodológica pela escala Physiotherapy Evidence Database Scale. Resultados: Dentre os 668 estudos identificados, seis ensaios clínicos foram selecionados. Destes, a amostra total foi de 283 crianças, sendo 151 crianças alocadas no grupo experimental (GE) (hipoterapia + terapia convencional) e 132 crianças, no grupo controle (GC) (terapia convencional). Quatro estudos apresentaram elevada qualidade metodológica e dois estudos, baixa qualidade. Em relação à melhora dos parâmetros da marcha, GE e GC melhoraram, no entanto o GE apresentou significante melhora na análise da dimensão e (andar-pular-correr) da medida da função motora grossa, redução da assimetria muscular durante a deambulação e aumento da velocidade da marcha. Conclusão: A revisão sistemática sugere que o tratamento com associação de hipoterapia e terapia convencional promove melhora da marcha de crianças com PC.

Gait in cerebral palsy (CP) has been the target of conservative interventions as hippotherapy. However, the effects of this therapy on the promotion and functional adaptation of gait have been little systematized in the literature. Objective: To analyze the evidence of the effectiveness of hippotherapy in the gait of children with CP comparing to noninvasive conservative therapies of clinical trials. Methods: A systematic review of clinical trials was performed with search indatabases Cinahl, Cochrane, Embase, Google Scholar, Lilacs, Lisa (ProQuest), PEDro, PsycINFO (APA), Pubmed and Scopus), with no flters. It was included clinical trials comparing hippotherapy plus conventional therapy (non-invasive conservative therapies) versus conventional therapy that assessed gait parameters in children with CP diagnosis and age ≤ 12 years old. The studies were examined as methodological quality by the Physiotherapy Evidence Database Scale. Results: Of the 668 studies identifed, six trials were selected. Of these, the total sample consisted of 283 children (151 children were allocated to the experimental group (hippotherapy) and 132 children, in the control group (conventional therapies). Four studies presented high methodological quality and two studies, low quality. Regarding the improvement of gait parameters, experimental group and control group improved, however, the experimental group presented signifcant improvement in the analysis of the E dimension (walk-jump-run) of the gross motor function measure instrument, reduction of muscular asymmetry during walking and increase in walking speed. Conclusion: The systematic review, suggests that the treatment with association of hippotherapy and conventional therapy promotes improvement of gait of children with CP.

Prolonged length of stay for acute hospital admissions as the increasing of age: A nationwide population study for Taiwan's patients with cerebral palsy.

BACKGROUND: Studies investigating reasons for the admission and the associated lengths of stay (LOSs) among cerebral palsy (CP) patients are limited. This study determined common reasons for acute hospitalizations and the LOSs among children, adolescents, and young adults with CP. METHODS: We performed a secondary analysis of data. CP patients aged 4-32.9 years were identified by CP registry in the catastrophic illness patient registry of the 2010 Taiwan National Health Insurance Research Database. Data of admission claims from 2010 to 2011 were analyzed. Reasons for admissions were identified according to International Classification of Diseases codes. Common reasons, frequencies of admissions for each reason, and LOSs were reported. RESULTS: Pneumonia, other respiratory problems, and epilepsy were the top three reasons for admissions in all groups. Other common reasons in all groups were sepsis, other respiratory infections, and gastrointestinal problems. The reasons specific to children included orthopedic issues; ear, nose, and throat problems; and urinary tract infections (UTIs). In youths, scoliosis, and contractures, were unique reasons. In young adults, UTIs, blood problems, and mental illness, were special reasons. Most admission reasons appeared to prolong LOS, and the LOS exhibited an increasing trend as age increased. CONCLUSION: The results implied that patients with CP are more susceptible to most disease invasions. Our results also suggest that the current care system in Taiwan is unsuitable for patients with CP. These results can be used as guidance for planning effective multidisciplinary assessments in the future.

Age at referral for diagnosis and rehabilitation services for cerebral palsy: a scoping review.

AIM: This study sought to: (1) determine what is known about age at referral for diagnosis and rehabilitation services for children suspected of having cerebral palsy (CP); and (2) identify factors associated with earlier referral. METHOD: A scoping review was conducted to summarize existing literature. We systematically searched Allied and Complementary Medicine, CINAHL, Cochrane Library, Embase, and PsycINFO for evidence published between 1979 and 2017 on age at referral for diagnosis or age at referral to rehabilitation services for children suspected of having CP. Quantitative and thematic analyses of the literature were performed. RESULTS: Our search yielded 777 articles, of which 15 met the inclusion criteria. Only one study focused on age at referral for diagnosis of CP (mean 16.6mo±19.2mo), with two on age at referral to rehabilitation services (means 13.9mo±15.8mo and 12.4mo). Potential predictors of earlier referral identified include referral source, type of CP, and a complicated birth history. INTERPRETATION: Evidence is sparse; however, available studies suggest high variation in the age at which children are being referred for diagnosis, typically ranging from 10 months to 21 months. Evidence indicates that subgroups of children with CP might be experiencing prolonged delays. Findings highlight the need to better understand what contributes to delays in referral for diagnosis and rehabilitation. WHAT THIS PAPER ADDS: Evidence on age at referral for diagnosis of cerebral palsy is sparse. Potential predictors of delayed referral represent targets to minimize delays in diagnosis. A subset of children may be experiencing unnecessary delays in referral.

EDAD DE DERIVACIÓN A LOS SERVICIOS DE DIAGNÓSTICO Y REHABILITACIÓN EN LA PARÁLISIS CEREBRAL: REVISIÓN DEL ALCANCE: OBJETIVO: Este estudio buscó (1) determinar qué se conoce sobre la edad de derivación a los servicios de diagnóstico y rehabilitación de niños con sospecha de tener parálisis cerebral (PC) e (2) identificar factores asociados con una derivación más temprana. MÉTODO: Se llevó a cabo una revisión panorámica para resumir la literatura existente. Buscamos sistemáticamente en Allied and Complementary Medicine, CINAHL, Cochrane Library, Embase, and PsycINFO la evidencia publicada entre 1979 y 2017 sobre la edad de derivación para el diagnóstico o la edad de derivación a los servicios de rehabilitación de niños con sospecha de PC. Se realizaron análisis cuantitativos y temáticos de la literatura. RESULTADOS: Nuestra búsqueda arrojó 777 artículos, de los cuales 15 cumplieron los criterios de inclusión. Solo un estudio estaba enfocado en la edad de la derivación para el diagnóstico de PC (media 16.6m±19.2m), y dos sobre la edad de derivación a los servicios de rehabilitación (media 13.9m±15.8m and 12.4m). Los posibles predictores de la derivación más temprana incluyen la procedencia de la derivación, el tipo de PC, y una historia de nacimiento con complicaciones. INTERPRETACIÓN: La evidencia es escasa; sin embargo, los estudios disponibles sugieren que existe una alta variación de la edad en la que los niños son derivados para ser diagnosticados, típicamente oscilando entre los 10 meses y los 21 meses. La evidencia indica que subgrupos de niños con PC pueden estar experimentando retrasos prolongados. Los hallazgos resaltan la necesidad de comprender mejor lo que contribuye al retraso en la derivación para el diagnóstico y para la rehabilitación.

IDADE DE ENCAMINHAMENTO PARA DIAGNÓSTICO E SERVIÇOS DE REABILITAÇÃO PARA PARALISIA CEREBRAL: UMA REVISÃO ABRANGENTE: OBJETIVO: Este estudo buscou (1) determinar o que se sabe sobre a idade de encaminhamento para diagnóstico e serviços de reabilitação para crianças com suspeita de paralisia cerebral (PC) e 2) identificar fatores associados com o encaminhamento precoce. MÉTODO: Uma revisão de escopo foi realizada para sintetizar a literatura existente. Nós sistematicamente buscamos a Allied and Complementary Medicine, CINAHL, Biblioteca Cochrane, Embase e PsycINFO por evidências publicadas entre 1979 e 2017 sobre idade no momento do encaminhmento para diagnóstico ou idade no momento do encaminhamento para serviços de reabilitação para crianças com suspeita de PC. Análise quantitativa e temática da literatura foram realizadas. RESULTADOS: Nossa busca resultou em 777 artigos, dos quais 15 atenderam aos critérios de inclusão. Apenas um estudo enfocou a idade de encaminhamento para diagnóstico de PC (média 16,6 m ± 19,2 m), com dois sobre a idade de encaminhamento para serviços de reabilitação (média 13,9 m ± 15,8 m e 12,4 m). Potenciais preditores do encaminhamento precoce incluíram a fonte do encaminhamento, o tipo de PC, e uma história de nascimento complicado. INTERPRETAÇÃO: A evidência é escassa; no entanto, os estudos disponíveis sugerem alta variação na idade em que crianças são encaminhadas para diagnóstico, tipicamente variando de 10 a 21 meses. A evidência indica que subgrupos de crianças com PC podem vivencar atrasos prolongados. Os achados enfatizam a necessidade de compreender melhor o que contribui para os atrasos no encaminhamento para diagnóstico e reabilitação.

Pediatric Orthopaedic Consults From Chiropractic Care.

Alternative medicine in pediatrics is expanding, with chiropractic now a common choice for families seeking alternative medical care. Currently, there is sparse information in the literature exploring the role of chiropractic in orthopaedic pathology. The objective of this case series is to present pediatric patients who received treatment from chiropractors and orthopaedic physicians as well as to review the respective existing research. Data collected included chiropractic diagnosis, orthopaedic diagnosis, imaging studies, treatments, and complications. Twenty-three patients were studied. Scoliosis, Legg-Calvé-Perthes disease, developmental dysplasia of the hip, cerebral palsy, skeletal dysplasia, and slipped capital femoral epiphysis were diagnoses included. Children had multiple sessions of chiropractic for management of these conditions. The parents' perception for chiropractic was positive in every case. Delayed referral, misdiagnosis, adverse events from manipulative therapy, and ineffective treatments were observed in the present study. More research is indicated to validate chiropractic in children with orthopaedic pathology. (Journal of Surgical Orthopaedic Advances 27(1):58-63, 2018).

The effectiveness of Baby-CIMT in infants younger than 12 months with clinical signs of unilateral-cerebral palsy; an explorative study with randomized design.

AIM: To explore the effectiveness of baby-CIMT (constraint-induced movement therapy) and baby-massage for improving the manual ability of infants younger than 12 months with unilateral cerebral palsy (CP). METHOD: Infants eligible for inclusion were 3-8 months old with asymmetric hand function and at high risk of developing unilateral CP. Thirty-seven infants were assigned randomly to receive baby-CIMT or baby-massage. At one year of age 31 children were diagnosed with unilateral CP, 18 (8 boys, 6.1±1.7months) of these had received baby-CIMT and 13 (8 boys, 5.0±1.6months) baby-massage. There were two 6-week training periods separated by a 6-week pause. The Hand Assessment for Infants (HAI), Assisting Hand Assessment (AHA), the Parenting Sense of Competence Scale (PSCS) and a questionnaire concerning feasibility were applied. RESULTS: There was improvement in the "Affected hand score" of HAI from median 10 (6;13 IQR) to 13 (7;17 IQR) raw score in the baby-CIMT group and from 5 (4;11 IQR) to 6 (3;12 IQR) for baby-massage with a significant between group difference (p=0.041). At 18-month of age, the median AHA score were 51 (38;72 IQR) after baby-CIMT (n=18) compared to 24 (19;43 IQR) baby-massage (n=9). The PSCS revealed an enhanced sense of competence of being a parent among fathers in the baby-CIMT group compared to fathers in the baby-massage (p=0.002). Parents considered both interventions to be feasible. CONCLUSION: Baby-CIMT appears to improve the unimanual ability of young children with unilateral CP more than massage.

From "apparent death" to "birth asphyxia": a history of blame.

Since the sixteenth century, competition between midwives and surgeons has created a culture of blame around the difficult delivery. In the late seventeenth century, 100 years before oxygen was discovered, researchers associated "apparent death of the newborn" with impaired respiratory function of the placenta. The diagnosis "birth asphyxia" replaced the term "apparent death of the newborn" during the mass phobia of being buried alive in the eighteenth century. This shifted the interpretation from unavoidable fate to a preventable condition. Although the semantic inaccuracy ("pulselessness") was debated, "asphyxia" was not scientifically defined until 1992. From 1792 the diagnosis was based on a lack of oxygen. "Blue" and "white" asphyxia were perceived as different disorders in the eighteenth, and as different grades of the same disorder in the nineteenth century. In 1862, William Little linked birth asphyxia with cerebral palsy, and although never confirmed, his hypothesis was accepted by scientists and the public. Fetal well-being was assessed by auscultating heart beats since 1822, and continuous electronic fetal monitoring was introduced in the 1960s without scientific assessment. It neither diminished the incidence of birth asphyxia nor of cerebral palsy, but rather raised the rate of cesarean sections and litigation against obstetricians and midwives.

Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial.

BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patient's everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mollii®, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants' homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each, followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patient's own rehabilitation goals is recommended and may increase the value of the evaluated concept.

Artificial Walking Technologies to Improve Gait in Cerebral Palsy: Multichannel Neuromuscular Stimulation.

Cerebral palsy (CP) is the most common childhood motor disability and often results in debilitating walking abnormalities, such as flexed-knee and stiff-knee gait. Current medical and surgical treatments are only partially effective in improving gait abnormalities and may cause significant muscle weakness. However, emerging artificial walking technologies, such as step-initiated, multichannel neuromuscular electrical stimulation (NMES), can substantially improve gait patterns and promote muscle strength in children with spastic CP. NMES may also be applied to specific lumbar-sacral sensory roots to reduce spasticity. Development of tablet computer-based multichannel NMES can leverage lightweight, wearable wireless stimulators, advanced control design, and surface electrodes to activate lower-limb muscles. Musculoskeletal models have been used to characterize muscle contributions to unimpaired gait and identify high muscle demands, which can help guide multichannel NMES-assisted gait protocols. In addition, patient-specific NMES-assisted gait protocols based on 3D gait analysis can facilitate the appropriate activation of lower-limb muscles to achieve a more functional gait: stance-phase hip and knee extension and swing-phase sequence of hip and knee flexion followed by rapid knee extension. NMES-assisted gait treatment can be conducted as either clinic-based or home-based programs. Rigorous testing of multichannel NMES-assisted gait training protocols will determine optimal treatment dosage for future clinical trials. Evidence-based outcome evaluation using 3D kinematics or temporal-spatial gait parameters will help determine immediate neuroprosthetic effects and longer term neurotherapeutic effects of step-initiated, multichannel NMES-assisted gait in children with spastic CP. Multichannel NMES is a promising assistive technology to help children with spastic CP achieve a more upright, functional gait.