Identifying fine motor difficulties in children with acute lymphoblastic leukemia: a scoping review.

PURPOSE: Survival rates for children diagnosed with acute lymphoblastic leukemia (ALL) have increased significantly over recent decades, and thus attention shifted toward understanding the adverse effects of cancer treatment. Chemotherapy has side effects that could affect muscle state and diminish motor performance. This scoping review was conducted to map the breadth of evidence for different tools used in fine motor skills assessment, the extent of upper extremity strength, and fine motor performance, highlighting the potential risk factors that may influence these skills. METHODS: In March 2023, full-text studies that examined fine motor performance and/or upper extremity strength were identified via searches in PubMed, Science Direct, Scopus, Web of Science, and PEDro databases. The titles and abstracts of selected studies were screened according to the inclusion and exclusion criteria. RESULTS: The search yielded initial 418 citations and 26 peer-reviewed articles were finally included in the review. Considerable heterogeneity was observed regarding the methods of evaluating fine motor skills. The results of this review indicate that children and adolescents with ALL experienced fine motor limitations and upper extremity weakness either during or after cessation of treatment. CONCLUSION: This scoping review presents a broad overview of the literature addressing fine motor difficulties in the pediatric population with ALL. Results accentuate the need to incorporate strengthening and occupational therapy training to preserve muscle strength and minimize future fine motor problems along the course of chemotherapeutic treatment. Little evidence was reported regarding the risk factors that may impair muscle strength and motor performance.

Impact of mother's care burden, fatigue and child's functional level on quality of life in spastic cerebral palsy.

BACKGROUND AND PURPOSE: Cerebral palsy (CP) may be considered one of the most common motor disabilities that require a lot of caregiving from mothers or caregivers; therefore, the mothers of children with CP face a lot of difficulties in their caregiving, which in turn may affect the child's quality of life (QOL). This work was conducted to evaluate the impact of the children's functional level in different types of spastic CP, mothers' care burden (CB), and fatigue on the child's QOL. METHODS: One hundred thirty-eight children with different types of spastic CP (unilateral and bilateral) with different levels of the gross motor function classification system (GMFCS), with an age range of 6-12 years, and their mothers with ages ranged from 25 to 45 years, participated in this study. Mother CB, fatigue, and child QOL were measured and compared between different groups by using the Zarit burden Interview (ZBI), Chalder Fatigue Questionnaire (CFQ), and Pediatric Quality of Life Inventory (PedsQL) CP Module, respectively. RESULTS: There were significant differences in all measured variables (ZBI, CFQ, GMFCS, and PedsQL) with p-value <0.001 among the different spastic groups (unilateral and bilateral CP). However, the results revealed a positive impact of the child's GMFCS, mother's CB, and fatigue level on the quality of the child's life, with a greater effect on those with quadriplegic type. CONCLUSION: The mother's CB and fatigue should be considered in the rehabilitation of spastic CP children based on their GMFCS, as they have a negative impact on child QOL; therefore, helping the mother with her needs should not be ignored, especially in families with severely spastic CP children and low financial income.

Investigating fine motor deficits during maintenance therapy in children with acute lymphoblastic leukemia.

OBJECTIVES: Children diagnosed with acute lymphoblastic leukemia (ALL) in their early childhood are more susceptible to neuromuscular and musculoskeletal impairments. This cross-sectional study was designed to address different types of fine motor impairments in Egyptian children diagnosed with ALL. METHODS: Fifty-four children treated for ALL in maintenance phase aged from four to seven years were compared with an age- and sex-matched control group. Fine motor performance was assessed using the total fine motor form of the Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-2). Sex- and age-specific norms of BOT-2 were used to calculate scale and standard scores in both groups. RESULTS: Children with ALL had significantly impaired fine motor skills in all subtests and composites of BOT-2 compared with the typically developing group (P < 0.00001). Cumulative doses of vincristine, methotrexate, and dexamethasone revealed no significant correlation with any BOT-2 measure. Males performed significantly better than females in all BOT-2 scores except for the fine motor integration subtest and the total fine motor control composite as no significant differences were observed. The protocol risk stratum, duration of maintenance treatment, and the age at assessment did not significantly affect the BOT-2 measures. CONCLUSION: About 67% of children with ALL on maintenance treatment experienced fine motor difficulties. Periodic evaluation along the course of chemotherapy could identify specific impaired fine motor domains providing the base for a successful rehabilitation program.

Immediate effect of induced fatigue of the unaffected limb on standing balance, proprioception and vestibular symptoms in children with hemiplegia.

OBJECTIVES: To study the effect of induced fatigue of the unaffected limb on the sensory components of standing balance; proprioception and vestibular symptoms in children with hemiplegic cerebral palsy. METHODS: Setting: Outpatient Clinic of Faculty of Physical Therapy, Cairo University. PATIENTS: Twenty-nine children with hemiplegic cerebral palsy [(ages 8.9 ± 2.3 years), motor ability I/II according to the GMFCS and spasticity of I/I+ according to the Modified Ashworth Scale]. OUTCOME MEASURES: Before and after the induced fatigue of the unaffected limb, the following measures were recorded: postural balance, using the Biodex Balance System and the Timed Up and Go test; vestibular sense, using the Paediatric Vestibular Symptom Questionnaire; and proprioception measures of both knees, using the Biodex isokinetic dynamometer. RESULTS: There was a significant increase in the post-fatigue values for the overall stability index (p< 0.05), the Timed Up and Go test (p< 0.05), reposition errors of proprioception of the unaffected limb (p< 0.05) and the vestibular questionnaire (p< 0.05); there was a non-significant decrease in the post-fatigue values for reposition errors of proprioception of the affected limb (p= 0.859). CONCLUSION: Fatigue of the unaffected limb negatively affects postural balance and related sensory systems (proprioception of the fatigued limb and vestibular function) but does not have an impact on proprioception of the unfatigued limb.

The effect of incentive spirometer training on oromotor and pulmonary functions in children with Down's syndrome.

OBJECTIVES: This study investigated the effect of incentive spirometry training on oromotor and pulmonary functions in children with Down's syndrome. METHODS: Thirty-four children with Down's syndrome were randomly divided into two groups; the children were of both sexes and aged between 6 and 12 years. Group A received only oromotor exercises, while Group B received oromotor exercises and incentive spirometry training. The pulmonary function test was performed using computerized spirometry model master screen that assessed pulmonary functions (peak expiratory flow, forced vital capacity, and forced expiratory volume in 1s), while the orofacial myofunctional evaluation with score (OMES) was used to evaluate oromotor function before and after treatment. RESULTS: The post treatment results showed significant difference in oromotor and pulmonary functions within both groups, but no significant differences were found between the two groups. CONCLUSIONS: Oromotor exercises are more effective than incentive spirometry training in improving both pulmonary and oromotor functions in children with Down's syndrome.

Relationship of cognitive functions and gross motor abilities in children with spastic diplegic cerebral palsy.

Spastic diplegic cerebral palsy can be accompanied by a myriad of symptoms affecting other body systems including cognitive dysfunction. The purpose of this study was to determine whether a relationship exists between cognitive functions in the form of selective attention and figural memory domains with standing and walking motor abilities in children with diplegic cerebral palsy. The research design was a correlational study. Tasks assessing cognitive function and gross motor abilities were carried out with a sample of 50 children. The data demonstrated the presence of correlation between selective attention and figural memory domains of cognitive function with standing, walking running, and jumping subscales of the Gross Motor Function Measure (GMFM) scale at different ages, and this correlation was significant between selective attention domain and gross motor abilities. The outcome measurements of the current study provide original evidence based on the necessity of including cognitive and physical impairments in the examination and evaluation of children with diplegic cerebral palsy in research and clinical settings.

Physical and cognitive consequences of fatigue: A review.

Fatigue is a common worrying complaint among people performing physical activities on the basis of training or rehabilitation. An enormous amount of research articles have been published on the topic of fatigue and its effect on physical and physiological functions. The goal of this review was to focus on the effect of fatigue on muscle activity, proprioception, and cognitive functions and to summarize the results to understand the influence of fatigue on these functions. Attaining this goal provides evidence and guidance when dealing with patients and/or healthy individuals in performing maximal or submaximal exercises.