Outcomes and Hand Use of Reaching Attempts: Comparison of Infants at Risk for Developmental Disability and Infants With Typical Development.

Background: Infants at risk for developmental disabilities often show signs of motor delay. Reaching is a skill that can help us identify atypical motor trajectories in early infancy. Researchers have studied performance after onset of reaching, but none have followed infants at risk from pre-reaching to skilled reaching. Aims: We assessed differences in reaching outcomes and hand use as reaching skill emerged in infants at risk for developmental disabilities and with typical development. Methods and Procedures: We followed infants at risk for developmental disabilities (n = 11) and infants with typical development (n = 21) longitudinally as they developed reaching skill. Infants reached for a toy at midline while sitting in the caregiver's lap. Video data were coded for reach outcome (miss, touch, partial grasp, and whole-hand grasp) and hand use (right, left, and bilateral). Outcomes and Results: Infants at risk had a larger proportion of missed reaches across visits compared to infants with typical development. Infants at risk also showed less variability in hand use when grasping over the study period. Conclusion and Implications: Our results provide information to support early differences in reaching performance to inform identification of typical and atypical developmental trajectories. Future studies should assess how the missed reaches are different and consider other quantitative measures of movement variability in infants at risk.

Is robotic gait training effective for individuals with cerebral palsy? A systematic review and meta-analysis of randomized controlled trials.

AIM: To determine if robotic gait training for individuals with cerebral palsy is more effective than the standard of care for improving function. METHOD: PubMed, Embase, Scopus, and Cochrane databases were searched from 1980-January, 2022 for articles that investigated robotic gait training versus standard of care (i.e. physical therapy or standard gait training) for individuals with cerebral palsy. Articles were included if a randomized controlled trial design was used, and excluded if robotic gait training was combined with another neuromuscular intervention, such as functional electrical stimulation. A meta-analysis of outcomes measured in at least four studies was conducted. RESULTS: Eight citations met all criteria for full-text review and inclusion in the meta-analysis. A total of 188 individuals with cerebral palsy, ages four to 35, and Gross Motor Function Classification System levels I-IV were studied. Level of evidence ranged from 2b-1b. All studies utilized a tethered, assistive device for robotic gait training. The overall effect was not significantly different between the robotic gait training and control interventions for six minute walk test performance (95% CI: -0.17, 0.73; P = 0.22), free walking speed (95% CI: -0.18, 0.57; P = 0.30), or Gross Motor Function Measures D (Standing) (95% CI: -0.29, 0.39; P = 0.77) and E (Walking, Running and Jumping) (95% CI: -0.11, 0.57; P = 0.19). CONCLUSION: Tethered robotic devices that provide assistive gait training for individuals with cerebral palsy do not provide a greater benefit for improving mobility than the standard of care.

Relationship between ankle function and walking ability for children and young adults with cerebral palsy: A systematic review of deficits and targeted interventions.

BACKGROUND: A primary goal of treatment for children with cerebral palsy is improved walking ability to allow for a more active and independent lifestyle. With the importance of ankle function to walking ability, and the deficits in ankle function associated with cerebral palsy, there is good rationale for targeting this joint in an effort to improve walking ability for this population. RESEARCH QUESTION: How do deficits and targeted interventions of the ankle joint influence walking ability in children with cerebral palsy? METHODS: A specific search criteria was used to identify articles that either (1) provided information on the relationship between ankle function and walking ability or (2) investigated the effect of a targeted ankle intervention on walking ability in cerebral palsy. PubMed, Embase, CINAHL, and Web of Science databases were searched from 1980-April, 2020. Resulting citations were compared against a prospective set of inclusion and exclusion criteria. Data relevant to the original research question was extracted, and the level of evidence for each intervention study was scored. Interpretation was focused on specific, pre-determined mobility measures. RESULTS: Sixty-one citations met all criteria for data extraction, six of which were observational, and fifty-five of which were interventional. Level of evidence ranged from 2 to 4. Self-selected walking speed was the most common measure of walking ability, while physical activity level was the least common. SIGNIFICANCE: Ankle function is an important contributor to the walking ability of children with cerebral palsy, and most interventions targeting the ankle seem to demonstrate a benefit on walking ability, but future higher-powered and/or controlled studies are necessary to confirm these findings.

Wearable Adaptive Resistance Training Improves Ankle Strength, Walking Efficiency and Mobility in Cerebral Palsy: A Pilot Clinical Trial.

GOAL: To determine the efficacy of wearable adaptive resistance training for rapidly improving walking ability in children with cerebral palsy (CP). METHODS: Six children with spastic CP (five males, one female; mean age 14y 11mo; three hemiplegic, three diplegic; Gross Motor Function Classification System [GMFCS] levels I and II) underwent ten, 20-minute training sessions over four weeks with a wearable adaptive resistance device. Strength, speed, walking efficiency, timed up and go (TUG), and six-minute walk test (6MWT) were used to measure training outcomes. RESULTS: Participants showed increased average plantar flexor strength (17 ± 8%, p = 0.02), increased preferred walking speed on the treadmill (39 ± 25%, p = 0.04), improved metabolic cost of transport (33 ± 9%, p = 0.03), and enhanced performance on the timed up and go (11 ± 9%, p = 0.04) and six-minute walk test (13 ± 9%, p = 0.04). CONCLUSIONS: The observed increase in preferred walking speed, reduction in metabolic cost of transport, and improved performance on clinical tests of mobility highlights the potentially transformative nature of this novel therapy; the rate at which this intervention elicited improved function was 3 - 6 times greater than what has been reported previously.

A description of professional pediatric physical therapy education.

PURPOSE: The purpose of this work was to reexamine the status of professional pediatric physical therapy education in the United States. METHODS: A task force designed a 16-item survey and contacted representatives from all professional physical therapy programs. RESULTS: Surveys were gathered from 151 programs for a return rate of 75%. Much variability exists across programs in total number of hours devoted to pediatrics (range, 35-210 hours). In addition, almost 60% of respondents indicated that the individual responsible for delivering the pediatric content will be retiring within the next 15 years. CONCLUSION: These results describe current pediatric professional education and provide numerous opportunities and challenges for the development of optimal professional pediatric education.