Assessing the factors that influence the utilization and delivery of rehabilitation services among persons with Parkinson's disease: A scoping review.

RATIONALE: Rehabilitation has the potential to significantly improve the lives of people and, most importantly, for persons with Parkinson's disease (PD). Although numerous studies have reported the benefits of rehabilitation for persons with PD (PwPD), these services are still limited and underutilized even when patients exhibit problems that require rehabilitation. AIMS AND OBJECTIVES: This review aims to describe the (a) indication for referral for rehabilitation services, (b) patterns of referral for rehabilitation and (c) factors that facilitate or hinder the utilization and delivery of rehabilitation services among PwPD. METHODS: A comprehensive literature search was conducted across selected databases, African Journals Online, EBSCOhost (CINAHL, Africa-wide), PubMed, SCOPUS and Web of Science. Studies published in English from January 2002 until December 2022 were applied as limiters. Reference and grey data sources tracking were also conducted. Two reviewers conducted the study selection, screening of titles, abstracts and full text and data charting. A descriptive analysis was performed. Findings were narratively presented and illustrated with tables, diagrams and descriptive formats as appropriate. RESULTS: Twelve studies were included in the review; however, none were from Africa. Impairments and activity limitations were the key functioning problems indicated for rehabilitation. Age, gender, income, race, disease stage, specific functioning problems, quality of life and care by a neurologist were the main predictors for referral to rehabilitation. Physiotherapy, occupational therapy and speech and language therapy were the most utilized rehabilitation services and were sometimes utilized together. The rate of rehabilitation service utilization among PwPD ranged from 0.9% to 62.5%. Lack of referrals and limited rehabilitation units/professionals were the common barriers to rehabilitation service utilization. CONCLUSION: Per the studies reviewed, utilization of rehabilitation services is generally low among PwPD. Lack of referral and nonavailability of professionals are cited as barriers to access. Adequate measures are needed to improve rehabilitation services for all PwPD.

Do children with disabilities have the same opportunities to play as children without disabilities? Evidence from the multiple indicator cluster surveys in 38 low and middle-income countries.

Background: Play is essential for the cognitive, social, and emotional development of all children. Disparities potentially exist in access to play for children with disabilities, and the extent of this inequity is unknown. Methods: Data from 212,194 children aged 2-4 years in 38 Low and Middle-Income Countries were collected in the UNICEF supported Multiple Indicator Cluster Survey (2017-2020). Disability was assessed by the Washington Group-Child Functioning Module. Logistic regression models were applied to investigate the relationship between disability and play opportunities, controlling for age, sex, and wealth status. Meta-analysis was used to pool the estimates (overall, and disaggregated by sex), with heterogeneity assessed by Cochran's Q test. Findings: Children with disabilities have approximately 9% fewer play opportunities than those without disabilities (adjusted RR [aRR] = 0.88, 95% CI = 0.82-0.93), and this varied across countries. Mongolia and Democratic Republic of São Tomé and Príncipe had the lowest likelihood of play opportunities for children with disabilities ((aRR = 0.26, 95% CI = 0.09-0.75; aRR = 0.46, 95% CI = 0.23-0.93, respectively). Moreover, children with disabilities are 17% less likely to be provided with opportunities to play with their mothers (aRR = 0.83, 95% CI: 0.73-0.93), which is further reduced for girls with disabilities (aRR = 0.74, 95% CI: 0.60-0.90) compared to their peers without disabilities. The associations varied by impairment type, and children with communication and learning impairments are less likely to have opportunities for play with aRR of 0.69 (95% CI: 0.60-0.79) and 0.78 (95% CI: 0.71-0.86), compared to those without disabilities, respectively. Interpretation: Children with disabilities are being left behind in their access to play and this is likely to have negative impacts on their overall development and well-being. Funding: HK and TS are funded by HK's NIHR Global Research Professorship (NIHR301621). SR is funded by a Rhodes Scholarship. This study was funded by the Programme for Evidence to Inform Disability Action (PENDA) grant from the UK Foreign, Commonwealth and Development Office.

Persistent Maternal Mental Health Disorders and Toddler Neurodevelopment at 18 Months: Longitudinal Follow-up of a Low-Income South African Cohort.

One of the biggest threats to early childhood development in Africa is poor maternal mental health. The present study reports on the relationships between clinical diagnoses of persistent maternal mental health disorders (at 3- and/or 6- and 18-month post-term age) and toddler neurodevelopment at 18 months of age. Eighty-three mother-toddler dyads from low socio-economic status settings in Cape Town, South Africa, were included. At the 3-, 6- and 18-month postnatal visits, clinician-administered structured diagnostic assessments were carried out according to the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) criteria. Toddler neurodevelopment at 18 months corrected age was assessed with the Bayley Scales of Infant and Toddler Development (BSID-III). No significant differences (p > 0.05) were found between toddlers with exposure to persistent mood or psychotic disorders in the different BSID-III domains compared to toddlers with no exposure. Toddlers exposed to persistent comorbid anxiety and mood disorders scored significantly higher on the cognitive (p = 0.049), motor (p = 0.013) and language (p = 0.041) domains and attained significantly higher fine motor (p = 0.043) and gross motor (p = 0.041) scaled scores compared to toddlers with no maternal mental health disorder exposure. Future investigations should focus on the role of protective factors to explain the pathways through which maternal mental health status is associated with positive toddler neurodevelopmental outcomes.

Maternal mental health and infant neurodevelopment at 6 months in a low-income South African cohort.

Maternal mental health disorders and the adverse consequences for infant neurodevelopment have received substantial research attention in high-income countries over the past five decades. In Africa, where relatively little work has been done on this topic, researchers have largely focused on infant physical health outcomes. This longitudinal study investigated the neurodevelopment of infants at 6 months post-term with exposure to mothers with a clinical diagnosis of persistent mental health disorders residing in low-income communities in Cape Town, South Africa. Adjusted models revealed no significant differences on the Bayley Scales of Infant and Toddler Development (BSID-III) domains (cognitive, motor, language, socio-emotional, and adaptive behavior) between infants exposed to maternal mental health disorders (n = 62) and the comparison group (n = 35) at 3 and 6 months. Subgroup analyses found no significant differences on the BSID-III domains between infants with exposure to mood disorders (n = 31), as well as infants with exposure to comorbid (i.e., a combination of two or three) mental health disorders (n = 14) and the comparison group. However, infants with exposure to psychotic disorders (n = 14) scored significantly lower on the cognitive and the motor domains and the fine motor subscale. These novel data provide an important contribution to the scientific literature especially in the field of maternal psychotic disorders in Africa.

Los trastornos de la salud mental materna y las consecuencias adversas para el neurodesarrollo del infante han recibido una considerable atención investigativa en países de altos niveles económicos a lo largo de las últimas cinco décadas. En África, donde se ha llevado a cabo relativamente poco trabajo sobre este tema, los investigadores se han enfocado por la mayor parte en los resultados de la salud física del infante. Este estudio longitudinal investigó el neurodesarrollo de infantes a los 6 meses después del término de gestación que habían sido expuestos a madres con un diagnóstico clínico de trastornos de salud mental persistentes quienes residían en comunidades de bajos recursos en Ciudad del Cabo, Sudáfrica. Los ajustados modelos no revelaron significativas diferencias en los dominios de las Escalas Bayley del Desarrollo del Infante y Niños Pequeñitos (BSID-III) (cognitivo, motor, lenguaje, comportamiento socioemocional y de adaptación) entre los infantes que habían estado expuestos a los trastornos de salud mental materna (n = 62) y el grupo de comparación (n = 35) a los 3 y 6 meses. Los análisis de subgrupo no encontraron diferencias significativas en los dominios de BSID-III entre los infantes que habían estado expuestos a los trastornos de estado de ánimo (n = 31), así como los infantes que habían estado expuestos a trastornos de salud mental comórbidos (v.g. una combinación de dos o tres) (n = 14) y el grupo de comparación. Sin embargo, los infantes que habían estado expuestos a trastornos sicóticos (n = 14) tuvieron puntajes significativamente más bajos en los dominios cognitivo y motor, así como en la subescala de las habilidades motoras finas. Estos novedosos datos ofrecen una contribución importante a la literatura científica especialmente en el campo de los trastornos sicóticos maternos en África.

Les troubles de la santé mentale maternelle et les conséquences négatives pour le neurodéveloppement du nourrisson ont reçu l'attention de beaucoup de recherches dans les pays à revenu élevé ces cinquante dernières années. En Afrique où relativement peu de travail a été fait sur ce sujet, les chercheurs se sont en grande partie penchés sur les résultats de la santé physique des nourrissons. Cette étude longitudinale s'est penchée sur le neurodéveloppement de nourrissons à 6 mois après terme avec une exposition aux mères avec un diagnostic clinique de troubles de la santé mentale persistants, résidant dans des communautés défavorisées à Cape Town, en Afrique du Sud. Les modèles ajustés n'ont révélé aucunes différences importantes dans les domaines (cognitif, moteur, langage, comportement socio-émotionnel et comportement adaptif) des Echelles Bayley du Développement du Nourrisson et du Jeune Enfant (BSID-III) entre les nourrissons exposés à des troubles de la santé mentale maternelle (n = 62) et le groupe de comparaison (n-35) à 3 et 6 mois. Les analyses de sous-groupes n'ont trouvé aucunes différences concernant les domaines BSID-III entre les nourrissons avec une exposition à des troubles de l'humeur (n-31), ainsi que des nourrissons avec une exposition à des troubles de santé mentale comorbides (c'est-à-dire une combinaison de deux ou trois) (n-14) et le groupe de comparaison. Cependant, les nourrissons ayant été exposés à des troubles psychotiques (n = 14) ont reçu des scores bien plus bas dans le domaine cognitif, dans le domaine moteur, et à la sous-échelle motrice fine. Ces nouvelles données offrent une contribution importante aux recherches scientifiques, surtout dans le domaine des troubles psychotiques maternels en Afrique.

Early motor behavior of infants exposed to maternal mental health disorders - A South African perspective.

INTRODUCTION: Over the past five decades the bulk of research on exposure to maternal mental health disorders and infant neurodevelopment has been generated in high-income countries. The current study included infants, residing in low-income communities in South Africa, born to mothers with a history of psychiatric disorders. AIM: To assess the motor behavior of 10- to 20-week-old infants exposed to maternal mental health disorders, and a subgroup of infants with prenatal psychotropic medication exposure. METHODS: The present study is a cross-sectional descriptive study, with a longitudinal subgroup analysis. General Movement Assessment (GMA), including the Motor Optimality Score-Revised (MOS-R), was used at 10-20 weeks corrected age to assess infant motor behavior. RESULTS: The study included 112 infants. No significant difference (p = 0.523) was found on the MOS-R between infants exposed to maternal mental health disorders (n = 70) and the comparison group (n = 42). Both the exposed and comparison groups scored within the mildly reduced range on the MOS-R. No significant differences were found in a subgroup of infants with prenatal exposure to multi-class psychotropic medication (n = 17), mono-class psychotropic medication (n = 35) or valproate exposure (n = 10) (p > 0.1). CONCLUSION: No association was found between exposure to maternal mental health disorders or exposure to psychotropic medication and infant motor behavior at 10-20 weeks post-term age on the MOS-R. Future research should focus on the contribution of exposure to specific classes and types of psychotropic medication on neurodevelopmental outcome of infants in larger cohorts.

Prioritising maternal mental health and infant neurodevelopment research in Africa ­ A call for action amidst the backdrop of the COVID­19 pandemic

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Motor skill intervention for pre-school children: A scoping review.

BACKGROUND: There is a high prevalence of motor skill difficulties amongst pre-school children living in low socio-economic areas. Motor skill impairment can affect these children's school readiness and academic progress, social skills, play and general independence. OBJECTIVES: This scoping review investigates the key elements of existing motor skill interventions for pre-school children. METHOD: We gathered information through structured database searches from Cinahl, Eric, PubMed, Cochrane, ProQuest, Psych Net, PEDro and Scopus, using a keyword string. The PRISMA-SCR design was used to identify 45 eligible studies. All included studies investigated a motor skill intervention with well-defined outcome measures for children aged 4-7 years with motor skill difficulties. Studies that exclusively focused on children with neurological conditions such as cerebral palsy, physical disabilities or medical/physical deteriorating conditions were excluded. Information was charted on MS Excel spreadsheets. Fundamental concepts were categorised into common key themes and were converted into a proposed framework. RESULTS: Fifteen intervention approaches were identified. Treatment is mostly managed by occupational therapists and physiotherapists. Evidence supports individual and group treatment with a child-centred, playful approach in a school or therapeutic setting. Whilst session information varied, there is moderate evidence to suggest that a 15-week programme, with two weekly sessions, may be feasible. CONCLUSION: Children with motor skill difficulties need therapeutic intervention. This study identified the key elements of existing therapy intervention methods and converted it into a proposed framework for intervention planning. It is a first step towards addressing motor skill difficulties amongst pre-school children in low socio-economic areas.

Maternal perinatal mental health and infant and toddler neurodevelopment - Evidence from low and middle-income countries. A systematic review.

BACKGROUND: There is extensive lack of awareness of maternal mental health and its impact on child development in low- and middle-income countries (LAMICs). The aim of this systematic review was to analyze evidence for various maternal perinatal mental health disorders and their association with different domains of infant and toddler neurodevelopment during the first two postnatal years in LAMICs. METHODS: A comprehensive literature search was conducted within six databases from Jan 1990-April 2019. All included studies were narratively synthesized. RESULTS: Twenty-four studies, nine cross sectional and 15 longitudinal cohort studies, were included. Three studies were conducted in low-income, 11 in lower-middle-income and ten in upper-middle-income countries. The majority of studies assessed maternal mental health postnatally and 14 of these 22 studies found a significant association with infant and toddler neurodevelopment. Five of the ten studies reporting on exposure to prenatal mental health found a significant association. The most common maternal mental health disorder studied was depression, while the main neurodevelopmental outcomes assessed were motor, cognitive and language development. LIMITATIONS: Meta-analysis could not be conducted due to the variability in the reported maternal mental health disorders and the different times of assessment of exposures and outcomes. CONCLUSIONS: Maternal perinatal mental health disorders and their association with different domains of neurodevelopment in LAMICs is still inconclusive due to a limited number of papers. Mother-infant dyads in LAMICs are exposed to multiple and cumulative risk factors and causal pathways between maternal mental health and infant neurodevelopment are still poorly understood.

The efficacy of kinesiology taping for improving gross motor function in children with cerebral palsy: A systematic review.

BACKGROUND: Kinesiology taping is an increasingly popular technique used as an adjunct to physiotherapy intervention for children with cerebral palsy (CP), but as yet we do not have a review of the available evidence as to its efficacy. OBJECTIVES: To critically appraise and establish best available evidence for the efficacy of truncal application of kinesiology taping combined with physiotherapy, versus physiotherapy alone, on gross motor function (GMF) in children with CP. METHOD: Seven databases were searched using the terms CP, kinesio taping and/or kinesiology tape and/or taping, physiotherapy and/or physical therapy and GMF. Only randomised controlled trials (RCTs) were included and appraised using the PEDro scale. Revman© Review Manager was used to combine effects for GMF in sitting, standing and activities of daily living. RESULTS: Five level IIB RCTs that scored 3-6/8 on the PEDro scale were included. Meta-analysis showed that taping was effective for improving GMF in sitting and standing as measured by the Gross Motor Function Measure (B) (p < 0.001) and (D) (p < 0.001), respectively. CONCLUSION: There is moderate evidence to support kinesiology taping applied to the trunk as an effective intervention when used as an adjunct to physiotherapy to improve GMF in children with CP, especially those with GMF Classification Scale levels I and II, and particularly for improving sitting control. CLINICAL IMPLICATIONS: Kinesiology taping is a useful adjunct to physiotherapy intervention in higher functioning children with CP. Current evidence however is weak and further research into methods of truncal application is recommended.

An ultrasonographic analysis of the activation patterns of abdominal muscles in children with spastic type cerebral palsy and in typically developing individuals: a comparative study.

BACKGROUND: Abdominal muscles have stiffer appearance in individuals with spastic type cerebral palsy (STCP) than in their typically developing (TD) peers. This apparent stiffness has been implicated in pelvic instability, mal-rotation, poor gait and locomotion. This study was aimed at investigating whether abdominal muscles activation patterns from rest to activity differ in the two groups. METHOD: From ultrasound images, abdominal muscles thickness during the resting and active stages was measured in 63 STCP and 82 TD children. The thickness at each stage and the change in thickness from rest to activity were compared between the two groups. RESULTS: Rectus abdominis (RA) muscle was the thickest muscle at rest as well as in active stage in both groups. At rest, all muscles were significantly thicker in the STCP children (p <  0.001). From rest to active stages muscle thickness significantly increased (p <  0.001) in the TD group and significantly decreased (p <  0.001) in the STCP children, except for RA, which became thicker during activity in both groups. In active stages, no significant differences in the thickness in the four abdominal muscles were found between the STCP and the TD children. CONCLUSION: Apart from the RA muscle, the activation pattern of abdominal muscles in individuals with STCP differs from that of TD individuals. Further studies required for understanding the activation patterns of abdominal muscles prior to any physical fitness programmes aimed at improving the quality of life in individuals with STCP. TRIAL REGISTRATION: HREC REF: 490/2011. Human Research Ethics Committee, Faculty of Health Sciences, University of Cape Town, South Africa. November 17, 2011.

An investigation into the use of ultrasound as a surrogate measure of diaphragm function.

PURPOSE: Sonographic assessment of the diaphragm may be a surrogate for interpretation of diaphragm function in mechanically ventilated patients. This study aimed to determine the correlation between respiratory muscle function and diaphragm thickness in a healthy population. METHODS: A descriptive study was conducted. Diaphragm thickness was determined by sonographic measurement. Respiratory muscle strength, fatigue and endurance was determined using a mouth pressure manometer. RESULTS: 55 subjects with a mean (SD) age 21.16 ± 1.55 years were studied. Diaphragm thickness was moderately correlated with strength (r = 0.52; r2=0.27; p < 0.001). Respiratory muscle fatigue was not correlated with thickness (r=-0.15; r2=0.02; p = 0.29) or strength (r=-0.19; r2=0.04; p = 0.16). CONCLUSION: Diaphragm thickness was moderately correlated to strength but not to fatigue or endurance in healthy individuals. Sonography may be a surrogate measure of volitional respiratory muscle strength and requires confirmation in critically ill patients.

WHOLE-BODY VIBRATION EXERCISE IS WELL TOLERATED IN PATIENTS WITH DUCHENNE MUSCULAR DYSTROPHY: A SYSTEMATIC REVIEW.

BACKGROUND: Duchenne muscular dystrophy (DMD) is caused by a defective gene located on the X-chromosome, responsible for the production of the dystrophin protein. Complications in the musculoskeletal system have been previously described in DMD patients. Whole body vibration exercise (WBVE) is a treatment that improves musculoskeletal function in movement disorders. The aim of this study was to review the effects of WBVE on functional mobility, bone and muscle in DMD patients. MATERIALS AND METHODS: Four databases were searched. Three eligible studies were found; all three conclude the management of DMD patients with WBV was clinically well tolerated. The studies used a side-alternating WBV system, frequencies 7 - 24 Hz; and amplitudes 2 - 4 mm. RESULTS: A work indicates that a temporary increase in creatine kinase in DMD during the first days of WBV was observed, but other authors did not find changes. No significant changes in bone mass, muscle strength or bone markers. Some patients reported subjective functional improvement during training. Interpretation. CONCLUSION: It is concluded that WBV seems to be a feasible and well tolerated exercise modality in DMD patients.

WHOLE-BODY VIBRATION EXERCISE IMPROVES FUNCTIONAL PARAMETERS IN PATIENTS WITH OSTEOGENESIS IMPERFECTA: A SYSTEMATIC REVIEW WITH A SUITABLE APPROACH.

BACKGROUND: Patients with osteogenesis imperfecta (OI) have abnormal bone modelling and resorption. The bone tissue adaptation and responsivity to dynamic and mechanical loading may be of therapeutic use under controlled circumstances. Improvements due to the wholebody vibration (WBV) exercises have been reported in strength, motion, gait, balance, posture and bone density in several osteopenic individuals, as in post-menopausal women or children with disabling conditions, as patients with OI. The aim of this investigation was to systematically analyse the current available literature to determine the effect of WBV exercises on functional parameters of OI patients. MATERIALS AND METHODS: Three reviewers independently accessed bibliographical databases. Searches were performed in the PubMed, Scopus, Science Direct and PEDro databases using keywords related to possible interventions (including WBV) used in the management of patients with osteogenesis imperfecta. RESULTS: Three eligible studies were identified by searches in the analysed databases. CONCLUSION: It was concluded that WBV exercises could be an important option in the management of OI patients improving the mobility and functional parameters. However, further studies are necessary for establishing suitable protocols for these patients.

An electromyographic study of abdominal muscle activity in children with spastic cerebral palsy.

BACKGROUND: Inadequate knowledge in the recruitment patterns of abdominal muscles in individuals with spastic-type cerebral palsy (STCP). OBJECTIVES: To determine whether there is any difference between the neuromuscular activity (activation pattern) of the abdominal muscles in children with STCP and those of their typically developing (TD) peers. METHOD: The NORAXAN® electromyography (EMG) was used to monitor the neuromuscular activity in abdominal muscles of individuals with STCP (n = 63), and the results were compared with the findings from age-matched TD individuals (n = 82). RESULTS: EMG frequencies were recorded during rest and during active states and compared using repeated measures ANOVA. Spearman's rank order correlation was used to explore relationships between age, body mass index and abdominal muscle activity. With the exception of the rectus abdominis (RA) muscle, the pattern of neuromuscular activity in children with STCP differs significantly from that of their TD peers. Three of the muscles - external oblique abdominis (EO), internal oblique abdominis (IO) and RA - in both groups showed significant changes (p < 0.001) in the frequency of EMG activity between the resting and active states. An elevated EMG activity at rest in the EO and IO was recorded in the STCP group, whereas the RA during resting and active stages showed similar results to TD individuals. CONCLUSION: The findings from this study suggest that the RA could be targeted during rehabilitation regimens; however, the force generated by this muscle may not be sufficient for the maintenance of trunk stability without optimal support from the EO and IO muscles.

Systematic review of whole body vibration exercises in the treatment of cerebral palsy: Brief report.

OBJECTIVE: Whole body vibration (WBV) is increasingly being used to improve balance and motor function and reduce the secondary complications associated with cerebral palsy (CP). The purpose of this study was to systematically appraise published research regarding the effects of static and/or dynamic exercise performed on a vibrating platform on gait, strength, spasticity and bone mineral density (BMD) within this population. METHODS: Systematic searches of six electronic databases identified five studies that met our inclusion criteria (2 at Level II and 3 at Level III-2). Studies were analysed to determine: (a) participant characteristics; (b) optimal exercise and WBV treatment protocol; (c) effect on gait, strength, spasticity and BMD; and (d) the outcome measures used to evaluate effect. As data was not homogenous a meta-analysis was not possible. RESULTS: Several design limitations were identified and intervention protocols are poorly described. The effects on strength, gait, spasticity and BMD in persons with CP remain inconclusive with weak evidence that WBV may improve selected muscle strength and gait parameters and that prolonged exposure may improve BMD; there is currently no evidence that WBV can reduce spasticity. CONCLUSIONS: The evidence for exercise performed on a vibrating platform on mobility, strength, spasticity and BMD in CP remains scant and further larger scale investigations with controlled parameters to better understand the effects of WBV exercises in this population is recommended.

Effects of Short-Period Whole-Body Vibration of 20 Hz on Selected Blood Biomarkers in Wistar Rats.

There is a growing interest in the use of vibration generated by oscillating/vibratory platforms - also known as whole-body vibration (WBV) - for achieving therapeutic, preventative and/or physical performance goals. This study investigated the effects of vibration generated by an oscillating platform on the concentration of blood biomarkers in rats. Wistar rats (n = 8) were divided in 2 groups, sedated and individually positioned on an oscillating platform. The experimental group (EG) was subjected to vibrations of 20 Hz for one min per day for one week while the control group (CG) experienced no vibration. Samples of heparinized whole blood were drawn by cardiac puncture for biochemical analysis. Concentrations of total cholesterol, triglycerides, HDL, LDL, VLDL, glucose, CK, albumin, alkaline phosphates, TGP, TGO, γGT, lipase, amylase, urea and creatinine were determined. White blood cell count and a platelet hemogram were also performed. Following seven sessions of exposure to the vibration, a significant (P < 0.05) reduction in γGT, VLDL and leukocytes was found. A weekly 1-min/day exposure of 20 Hz vibration can was shown to alter the concentrations of selected blood biomarkers in rats. The action mechanism associated with these effects seems highly complex, but the findings might contribute to the understanding of these mechanisms related to the exposure to 20 Hz vibration.

Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy: a randomized control trial.

AIM: This study aimed to determine whether strengthening trunk muscles using vibration can improve posture and gait in children with spastic-type cerebral palsy (STCP). METHODS: A total of 27 children (6-13 years) participated in a single-blinded pre-post crossover experimental trial. The 1-Minute Walk Test, 2D-posturography, ultrasound imaging and sit-ups in one minute were used to assess effect on gait, posture, resting abdominal muscle thickness and functional strength. RESULTS: Significant increase in distance walked (p < 0.001), more upright posture, an increase in sit-ups executed (p < 0.001) and an increase in resting thicknesses of all the four abdominal muscles--transversus abdominis (p = 0.047), obliquus internus (p = 0.003), obliquus externus (p = 0.023) and the rectus abdominis (p = 0.001) was recorded. Strength and posture were maintained at 4-weeks post-intervention. CONCLUSION: A trunk-targeted intervention using vibration can improve posture and gait in children with STCP without any known side effects. It is recommended that vibration and specific trunk strengthening is included in training or rehabilitation programmes. Effects of vibration on force generation and spasticity need further investigation.

Functional electrical stimulation to lower limb muscles after botox in children with cerebral palsy.

PURPOSE: This study examined the effect of lower limb functional electrical stimulation (FES) after botulinum toxin injection in children with cerebral palsy on self-selected walking speed, plantar flexor and dorsiflexor muscle strength, and an optimal time frame for initiating FES after the injection. METHODS: Five subjects participated in a single-subject design. All subjects received a single botulinum toxin injection into the calf muscle, followed by a 4-week FES home program. Three subjects followed the protocol as prescribed; 2 subjects received no FES. RESULTS: FES after botulinum toxin increased isometric plantar flexor muscle strength, but did not produce changes in self-selected walking speeds or isometric dorsiflexor strength. A 32-day interval between botulinum toxin and the start of FES was most effective. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE: FES after botulinum toxin seems to be effective in improving some gait variables, although further research is needed for substantiation.

The effect of lower limb functional electrical stimulation on gait of children with cerebral palsy.

PURPOSE: To examine the effect of lower limb functional electrical stimulation (FES) in children with cerebral palsy. METHODS: A comprehensive search yielded 37 citations. English articles included in the review applied either surface or percutaneous FES to the lower limb, if subjects were younger than 18 years old, and if the stimulator was removed or off at the time of testing. RESULTS: Five articles were included in this review, including 3 case reports, 1 single subject, and 1 crossover design. Among the wide range of stimulation protocols, stimulation of the gastrocnemius with or without the tibialis anterior muscle may effect greater gait improvements than stimulating the tibialis anterior muscle alone. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE: Future research differentiating between optimal FES and neuromuscular electrical stimulation protocols as well as more rigorous research designs are needed to provide clinically relevant results.