Combined Effects of Mirror Therapy and Exercises on the Upper Extremities in Children with Unilateral Cerebral Palsy: A Randomized Controlled Trial.

Purpose: This study investigated the combined effects of mirror therapy involving power and strength exercises of the upper extremities in children with Unilateral Spastic Cerebral Palsy (USCP).Methods: Thirty children were included in either an experimental group or a control group. All participants were evaluated with the Quality of Upper Extremity Skill Test (QUEST), Canadian Occupational Performance Measure (COPM), and a handheld dynamometer to measure isometric muscle strength.Results: Compared to the control group, greater improvement was found in dissociated movements (p < .001, d = 1.82), grasp (p < .001, d = 1.38), weight bearing (p = .006, d = 0.91), and total scores (p = .001, d = 1.16) of QUEST; performance (p < .001, d = 2.9), satisfaction (p < .001, d = 1.91), and total scores (p < .001, d = 2.87) of COPM; and isometric muscle strength of the biceps brachii (p < .001, d = 1.27) and triceps brachii (p = .002, d = 2.22) of the affected upper limbs in the experimental group.Conclusions: Mirror therapy combined with power and strength exercises is a promising intervention approach to improve activity performance and upper-limb function in children with USCP.

Examination of touch-coordinate errors of adolescents with unilateral spastic cerebral palsy at an aiming-tapping task.

BACKGROUND/OBJECTIVE: This study aimed to investigate performance (touch-coordinate errors, inter-touch interval) of touch screen technology in adolescents with unilateral spastic cerebral palsy (USCP) and healthy peers. MATERIALS AND METHODS: This prospective case-control study included 31 adolescents. The participants consisted of 15 adolescents with CP in the USCP group and 16 age-matched healthy peers in the control group. All participants performed an aiming-tapping task with an Android tablet. Four sessions were randomly applied: visual feedback (VF) and no VF with the dominant hand's index finger (DHF), and VF and no VF with the non-dominant hand's index finger (NDHF). Inter-touch interval (ITI) and touch-coordinate errors (TCE) were calculated. RESULTS: There were significant differences between the groups for VF and no VF-NDHF TCE and ITI (respectively p= 0.001, p= 0.01, p= 0.001, p= 0.004) and VF and no VF-DHF TCE values (respectively p= 0.01, p= 0.008). When comparing the dominant and non-dominant hand in the USCP group, there was a significant difference on TCE with no VF (p= 0.01). CONCLUSION: This study provided insight into the touch screen performance of adolescents with USCP, who performed an aiming-tapping task with a tablet. Results showed that both affected and unaffected hand performance of touch screen tasks was impaired in adolescents with USCP.

The Effects of Functional Progressive Strength and Power Training in Children With Unilateral Cerebral Palsy.

PURPOSE: The purpose of this study was to investigate the effects of a novel functional strength and power-training program on gait and gross motor function in participants with unilateral cerebral palsy. METHODS: This 12-week trial of functional strength and power training included 30 participants with cerebral palsy, randomly assigned to the experimental or comparison group. The primary outcomes, 1-minute walk test, muscle power, and the Gross Motor Function Measure, were assessed at baseline and 12 weeks after the intervention. Secondary outcomes included dynamic balance as measured by Timed Up and Go, muscle strength, and 1-repetition maximum measures. RESULTS: Significantly greater improvements were seen in the experimental group for muscle power, Gross Motor Function Measure E score, and 1-minute walk test (P < .05), as well as for dynamic balance, 1-repetition maximum, and muscle strength. CONCLUSION: Functional strength training combined with plyometric exercises improved gait and gross motor function, dynamic balance, muscle strength, and power. VIDEO ABSTRACT: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A254.

The effect of two different aerobic training modalities in a child with spinal muscular atrophy type II: a case report.

This study examined the effect of two different aerobic training modalities in a boy with spinal muscular atrophy type II. Motor functions were measured with Hammersmith Functional Motor Scale (HFMS) and Gross Motor Function Measure (GMFM). Spirometry was utilized for assessing pulmonary functions and PedsQL 3.0 Neuromuscular module was utilized for quality of life of child. Ergometer training was applied 3 times per week for the duration of 12 weeks. After 6 weeks of wash-out period, aquatherapy was applied for twice a week for the duration of 12 weeks. HFMS and GMFM scores, and pulmonary functions of the child and quality of life scores of his parents were improved during both modalities. These improvements were largely maintained during 1-year follow-up. This study showed that both modalities had similar effects on our case's pulmonary, motor functions and quality life of himself and parents. It will be a guide for researchers working in the area of children with neuromuscular disorders regarding plan and diversification of therapy program.

Agreement between parents and clinicians on the communication function levels and relationship of classification systems of children with cerebral palsy.

BACKGROUND: Functional classification systems have generally been used by clinicians and recently by parents to classify various functions of children with cerebral palsy (CP). OBJECTIVE: This study evaluated the agreement between clinicians and parents when classifying the communication function of children with CP using the Communication Function Classification System (CFCS). In addition, the relationships between the Gross Motor Function Classification System - Expanded and Revised (GMFCS-E&R), the Manual Ability Classification System (MACS), and CFCS were investigated. METHODS: This study was a cross-sectional study and included 102 children aged 4-18 years with CP and their parents. The parents and clinician classified the communication of children by using the Turkish language version of CFCS. Furthermore GMFCS-E&R and MACS were used for classification only by the clinician. RESULTS: The weighted Kappa agreement between CFCS results of the parents and clinicians was 0.95 (95% CI 0.95-0.96, p < 0.001). GMFCS-E&R levels were highly correlated with CFCS levels (r = 0.78 (95%CI 0.68-0.84, p < 0.001)). MACS and CFCS results were also highly correlated (r = 0.73 (95%CI 0.63-0.81, p < 0.001). CONCLUSION: The child's communication was classified as indicating higher functioning by the parents compared with the clinicians. The excellent agreement between parents and clinicians with the Turkish language version of CFCS for children with CP indicated that parents and clinicians could use the same language while classifying the communication function of children.

What do the relationships between functional classification systems of children with cerebral palsy tell us?

[Purpose] To examine the distribution of and relationship between the Gross Motor Function, Manual Ability, and Communication Function Classification Systems in different limbs of children with spastic cerebral palsy. We also investigated whether the four predicting variables of gender, age, manual ability, and gross motor classifications could significantly predict effective and non-effective communicator groups in communication function. [Subjects and Methods] This retrospective cross-sectional study included 327 children with a mean age of 10.13 ± 4.09 years. Classifications were performed by an experienced pediatric physiotherapist. [Results] Gross motor function levels showed a strong correlation with manual ability levels (rs=0.78). Manual ability level was strongly correlated with communication function levels (rs=0.73), particularly in quadriplegic children (rs=0.78). Gross motor function levels were moderately correlated with communication function levels (rs=0.71). Effective communicators in communication function showed more functional levels of manual ability and were determined by Gross Motor Function classifications. The variables were better at predicting ineffective communicators (91% correct) compared with effective communicators (85% correct). [Conclusion] Further studies are needed to relate these functional performance systems to the activity and participation levels as well as the quality of life, desires, and participation of the subjects.