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The emergence of large language models (LLMs) and assisted artificial intelligence (AI) technologies have revolutionized the way in which we interact with technology. A recent symposium at the Walter and Eliza Hall Institute explored the current practical applications of LLMs in medical research and canvassed the emerging ethical, legal and social implications for the use of AI-assisted technologies in the sciences. This paper provides an overview of the symposium's key themes and discussions delivered by diverse speakers, including early career researchers, group leaders, educators and policy-makers highlighting the opportunities and challenges that lie ahead for scientific researchers and educators as we continue to explore the potential of this cutting-edge and emerging technology.
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Inteligência Artificial , Pesquisa Biomédica , TecnologiaRESUMO
AIM: To investigate temporal trends in birth prevalence, disability severity, and motor type for singletons with prenatal or perinatally acquired cerebral palsy (CP). METHOD: Numerator data, number of children with CP born a singleton between 1995 and 2014, confirmed at 5 years of age, were drawn from three state registers with population-level ascertainment. Birth prevalence estimates and 95% confidence intervals (CI) were calculated per 1000 singleton live births for the three states combined, overall, by gestational age group, by dichotomized disability severity, and spastic laterality. Poisson regression models were used to analyse trends. Using data from all eight registers, trends in the proportional distribution of CP subtypes overall and stratified by gestational age were examined. RESULTS: Birth prevalence of CP declined from 1.8 (95% CI 1.6-2.0) in 1995 to 1996 to 1.2 (95% CI 1.1-1.4) in 2013 to 2014 (average 5% per 2-year epoch, p < 0.001). Declines in birth prevalence were observed across all gestational age groups with the largest decline in children born at <28 weeks (average 8% per epoch, p < 0.001). Prevalence of moderate-severe disability declined for children born at <28 and ≥37 weeks (average 11% and 7% per epoch respectively, p < 0.001). The proportions of bilateral spastic CP declined (p < 0.001) at <28 weeks (p = 0.014) and ≥37 weeks (p < 0.001). The proportion of children with dyskinesia increased (28-31 weeks: p = 0.021, 32-36 weeks: p = 0.001, and ≥37 weeks: p < 0.001). INTERPRETATION: Birth prevalence of CP and moderate-severe disability (<28 and ≥37 weeks) declined in Australian singletons between 1995 and 2014, reflecting changes in prenatal and perinatal care over time. WHAT THIS PAPER ADDS: Declines in birth prevalence of prenatal or perinatally acquired cerebral palsy were observed for singletons born in Australia between 1995 and 2014. These declines were evident across all gestational age groups. Declines in birth prevalence of moderate-severe disability were observed for children born at <28 weeks and ≥37 weeks.
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Paralisia Cerebral , Austrália/epidemiologia , Paralisia Cerebral/epidemiologia , Criança , Feminino , Idade Gestacional , Humanos , Lactente , Espasticidade Muscular , Gravidez , PrevalênciaRESUMO
AIM: To examine the psychometric evidence for high-level motor skills assessment tools for ambulant, school-aged children with cerebral palsy (CP). METHOD: We searched five databases for population (children with CP aged 5-18y in Gross Motor Function Classification System levels I and II), assessment focus (high-level motor skills), and psychometric evidence. We evaluated evidence strength using the number of studies, quality, and conduct according to COnsensus-based Standards for the selection of health status Measurement INstruments checklists. RESULTS: Eleven assessments (39 studies) met the criteria. Seven high-level motor skills assessment items (Muscle Power Sprint Test, 10m Shuttle Run Test, 10×5m Sprint Test, vertical jump, standing broad jump, seated throw, and Timed Up and Down Stairs) had strong validity and responsiveness evidence. Jumping items and seated throw lacked reliability data. Four high-level motor skills assessment batteries (Functional Strength Measure in CP, Gross Motor Function Measure-Challenge, Peabody Developmental Motor Scale, and Test of Gross Motor Development, Second Edition) had moderate-to-strong validity and/or reliability evidence. Responsiveness data were only available for the Gross Motor Function Measure-Challenge battery. The decision tree was developed with five levels: clinical feasibility, relevance, tool design, clinical utility, and psychometric properties. INTERPRETATION: High-level motor skills assessment tools have strong psychometric evidence for ambulant, school-aged children with CP. The decision tree can assist clinicians and researchers in identifying appropriate tools to measure high-level motor skills. WHAT THIS PAPER ADDS: An evidence-based decision tree guides the selection of appropriate high-level motor skills assessment tools. Seven high-level motor skills assessment items have strong psychometric evidence and clinical utility for ambulant children with cerebral palsy. Four high-level motor skills assessment batteries with recreation and mobility items have emerging psychometric evidence in this population.
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Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/psicologia , Árvores de Decisões , Destreza Motora/fisiologia , Caminhada , Criança , Humanos , PsicometriaRESUMO
BACKGROUND: Modified sport interventions run by physiotherapists have shown potential as cost-effective, engaging, and effective interventions to improve gross motor skills and support transition to real-world sports participation for children with cerebral palsy. At present, this population demonstrates decreased participation in physical activities and sport compared to peers due to barriers ranging from body function to accessibility challenges. Sport provides culturally relevant opportunities for social integration, community participation and physical activity and has been shown to improve the fitness, self-esteem, confidence and quality of life of children with disabilities. The Sports Stars physiotherapy group has been designed to support the development of a range of fundamental movement and sports skills through activity skill practice and participation in modified popular Australian sports. METHODS: This randomised, waitlist controlled, assessor blinded, superiority trial with two parallel groups will aim to compare the effectiveness of Sports Stars to standard care across all ICF domains. Children in the Sports Stars group are expected to demonstrate greater improvement in their individually-selected, sports related goals measured by the Canadian Occupational Performance Measure. This study will aim to assess sixty ambulant children aged six to 12 years with a diagnosis of cerebral palsy. Children will be excluded if they have had recent Botox or neurological/orthopaedic surgery. The Sports Stars intervention includes eight, one-hour, weekly physiotherapy group sessions with four to six participants and one lead physiotherapist. Outcome measures will be collected pre, post and 12 weeks post the immediate Sports Stars group to assess change immediately after, and at follow up time points. DISCUSSION: This will be the first study of its kind to investigate a culturally relevant sports-focussed fundamental movement skills physiotherapy group for ambulant children with cerebral palsy. The findings will add to a growing pool of evidence supporting group physiotherapy for children with cerebral palsy and the Sports Stars group will provide an avenue for children to transition from individual physiotherapy to mainstream and modified recreational and competitive sports. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12617000313336 Registered 28, February 2017. WHO Universal Trial Number: U1111-1189-3355 Registered 1, November 2016.
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Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia , Esportes , Paralisia Cerebral/fisiopatologia , Criança , Exercício Físico , Humanos , Avaliação de Resultados em Cuidados de Saúde , Fisioterapeutas , Qualidade de Vida , Projetos de Pesquisa , Método Simples-Cego , Listas de EsperaRESUMO
Cerebral palsy (CP) is predominantly a disorder of movement, with evidence of sensory-motor dysfunction. CIMT1 is a widely used treatment for hemiplegic CP. However, effects of CIMT on somatosensory processing remain unclear. To examine potential CIMT-induced changes in cortical tactile processing, we designed a prospective study, during which 10 children with hemiplegic CP (5 to 8 years old) underwent an intensive one-week-long nonremovable hard-constraint CIMT. Before and directly after the treatment, we recorded their cortical event-related potential (ERP) responses to calibrated light touch (versus a control stimulus) at the more and less affected hand. To provide insights into the core neurophysiological deficits in light touch processing in CP as well as into the plasticity of this function following CIMT, we analyzed the ERPs within an electrical neuroimaging framework. After CIMT, brain areas governing the more affected hand responded to touch in configurations similar to those activated by the hemisphere controlling the less affected hand before CIMT. This was in contrast to the affected hand where configurations resembled those of the more affected hand before CIMT. Furthermore, dysfunctional patterns of brain activity, identified using hierarchical ERP cluster analyses, appeared reduced after CIMT in proportion with changes in sensory-motor measures (grip or pinch movements). These novel results suggest recovery of functional sensory activation as one possible mechanism underlying the effectiveness of intensive constraint-based therapy on motor functions in the more affected upper extremity in CP. However, maladaptive effects on the less affected constrained extremity may also have occurred. Our findings also highlight the use of electrical neuroimaging as feasible methodology to measure changes in tactile function after treatment even in young children, as it does not require active participation.
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Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/terapia , Terapia Passiva Contínua de Movimento/métodos , Plasticidade Neuronal/fisiologia , Córtex Somatossensorial/fisiologia , Paralisia Cerebral/diagnóstico , Criança , Pré-Escolar , Eletroencefalografia/métodos , Potenciais Somatossensoriais Evocados/fisiologia , Feminino , Humanos , Masculino , Modalidades de Fisioterapia , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologiaRESUMO
AIM: This study reviewed interventions suitable for treating tactile dysfunction in children with cerebral palsy (CP). METHOD: A systematic review was conducted of six databases, searched for population: ('brain injury' OR 'cerebral palsy' OR 'stroke' OR 'cerebrovascular accident') and intervention: ('tactile' OR 'sensation'). Inclusion criteria were: (1) published after 1950 in English; (2) participants older than 4 years with brain injury; (3) upper limb intervention; and (4) examined tactile registration or perception. RESULTS: Of 2938 studies identified, 30 met the inclusion criteria. Results from included studies indicated that tactile function improved in adults with stroke after transfer enhanced training (t[47]=2.75, p=0.004), stimulus specific training (p<0.001), ice therapy (F=5.71, p=0.028), mirror therapy (F=7.7, p=0.009), and functional deafferentation using an anaesthetic cream (t=3.76; p<0.01). No intervention reported improvement in tactile dysfunction for children with CP. INTERPRETATION: Research is required to develop tactile interventions for children with CP that integrate methodology from effective approaches for adults after stroke. Stimulus specific training, transfer enhanced training, and mirror therapy are promising. Other approaches are less suitable for children because of invasiveness (electrical stimulation), safety (ice therapy), or limitation of bimanual function (eutectic mixture of local anaesthetics, pneumatic cuff).
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Paralisia Cerebral/complicações , Transtornos de Sensação/etiologia , Transtornos de Sensação/terapia , Tato , Extremidade Superior , Criança , HumanosRESUMO
BACKGROUND: Knowledge translation (KT) is an essential skill to assist health academics to better develop, disseminate, and implement research findings to improve health care quality and impact, but many academics lack knowledge and skills in this area. OBJECTIVES: This study aimed to describe the KT-informed approach used to develop the Knowledge Translation and Impact Planner (KTIPs) to improve the quality of KT planning, and to examine the acceptability of the KTIPs. METHODS: The process of developing the tool is described, including use of published literature, application of integrated KT, and consultation with end-users (n=18), including university academics, higher degree research (HDR) candidates, and experts in the KT field. The Expert Recommendations for Implementing Change (ERIC) framework was used to categorize strategies used during pilot implementation. The tool includes a comprehensive instructional guide and accompanying template that systematically takes researchers through each step of the KT process: synthesis, exchange, dissemination, and implementation, as well as guidance on planning for impact following effective KT. RESULTS: Academic staff and HDR candidate stakeholders, and comprehensive advice from experts shaped development of the tool. The tool went through three rounds of concurrent feedback with different end-users. End-users confirmed its acceptability, indicating the KTIPs was adaptable, comprehensive, instructional, and facilitated development of KT and impact plans addressing varied KT goals. CONCLUSION: The KTIPs was acceptable among academic staff and HDR candidates and facilitated the KT and impact planning process. The KTIPs is freely available and is designed to be navigated, completed, and saved electronically to facilitate implementation of developed plans. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A253.
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PURPOSE: To identify specific factors influencing the participation experiences of young people with cerebral palsy (CP) aged 15 to 26 years. MATERIALS AND METHODS: A three-round Delphi survey study design was used. Consumers (young people with CP and caregivers) and health professionals were asked to generate and then rate items influencing positive and negative participation experiences. Qualitative content analysis and descriptive statistics were used to classify items across the family of Participation-Related Constructs (fPRC) framework. RESULTS: Sixty-eight participants completed Round I (25 consumers, 43 health professionals). Round II resulted in a consensus for all but two items, with Round III not required. The fPRC construct with the most items rated as extremely important for positive participation experiences was Environment-Availability, and for negative participation, experiences were Environment-Acceptability for both adolescents and young adults. CONCLUSIONS: A consensus was reached on the most important items influencing the positive and negative participation experiences of young people with CP. These items should be prioritised when developing support services and allocating funding to improve the participation experiences of young people with CP.
This study is reporting consumer and professional consensus on the factors promoting positive and negative participation for young people with cerebral palsy.Ensuring availability of appropriate activities and services is extremely important for enabling positive participation experiences.Promoting acceptable attitudes of others is extremely important for alleviating negative participation experiences.
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Paralisia Cerebral , Adolescente , Adulto Jovem , Humanos , Técnica Delphi , Pessoal de Saúde , Cuidadores , ConsensoRESUMO
This study explored the home-based participation of young people with cerebral palsy (CP) and described factors that make participation easier or harder. Fifteen young people with CP aged 15 to 26 years provided written reflections, photographs, or videos about their home-based participation experiences. Data were analyzed using reflexive thematic analysis. Self-reported reflections were grouped inductively into 129 codes, then 20 subthemes and 5 themes which emphasized CP characteristics, thoughts, emotions, equipment, environment, supports, and inclusion as important factors influencing home-based participation. Young people with CP largely described the home environment as an inclusive place to participate.
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Paralisia Cerebral , Autorrelato , Humanos , Paralisia Cerebral/psicologia , Paralisia Cerebral/reabilitação , Adolescente , Masculino , Feminino , Adulto Jovem , Adulto , Participação SocialRESUMO
PURPOSE: To identify participation-focused measures used for young people with cerebral palsy (CP), evaluate their psychometric evidence, and map item content to the International Classification of Functioning, Disability, and Health (ICF), and family of Participation-Related Constructs (fPRC) frameworks. METHODS: Four databases (PubMed, Embase, Web of Science, CINAHL) were searched for papers that involved young people with CP aged 15 to 25 years and reported original data from a participation measure. Each measure was examined for validity, reliability, responsiveness (using the COSMIN checklist), clinical utility, the inclusion of accessible design features, self- and/or proxy-report from people with communication support needs, and item content according to ICF and fPRC. RESULTS: Of 895 papers, 80 were included for review. From these, 26 measures were identified. Seven measures (27 papers/resources) were participation-focused, capable of producing a score for participation Attendance and/or Involvement. Of these, all measured Attendance (n = 7) but fewer than half measured Involvement (n = 3). Few included studies (37%) reported including some self-report of people with communication support needs. CONCLUSIONS: Participation measures for young people with CP are evolving but require more: (i) emphasis on measurement of involvement; (ii) investigation of psychometric properties; and (iii) adaptation to enable self-report by young people with communication support needs.IMPLICATIONS FOR REHABILITATIONIdentifies seven participation-focused measures which are available for young people with cerebral palsy, all seven measure Attendance and three measure Involvement.Provides a decision-making tool to assist clinicians and researchers with the selection of participation-focused measures for young people with cerebral palsy.Recommends that more accessible self-report measures are needed which capture age-appropriate participation of young people with cerebral palsy.
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OBJECTIVE: To determine the relationship between tactile function and upper-limb function in children with unilateral cerebral palsy (CP). DESIGN: Cross-sectional study. SETTING: Assessments were performed in community or hospital venues or in participants' homes. PARTICIPANTS: Recruitment information was sent to 253 possible participants with unilateral CP (aged 8-18 y), and N=52 participated (median age [interquartile range], 12 y [9-14 y]; Gross Motor Functional Classification System level I=34; II=18; Manual Abilities Classification Scale level I=36; II=16). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Tactile assessment included 1 test of registration, 5 tests for spatial perception, and 1 test for texture perception. Upper-limb motor function was assessed using 2 unimanual tests, the Melbourne Unilateral Upper Limb Assessment (MUUL) and Jebsen-Taylor Test of Hand Function (JTTHF), and 1 bimanual test, the Assisting Hand Assessment (AHA). RESULTS: Tactile registration and all tests of spatial perception were moderately related to the MUUL, JTTHF, and AHA (P<.001). Texture perception was not related to upper-limb motor function. Regression analysis showed that single point localization, a unilateral tactile spatial perception test, contributed most strongly to unimanual capacity (29% explained variance in MUUL and 26% explained variance in JTTHF), whereas double simultaneous, a bilateral tactile spatial perception test, contributed most strongly to bimanual performance (33% for the AHA). CONCLUSIONS: Spatial tactile deficits account for approximately 30% of the variance in upper-limb motor function in children with unilateral CP. This emphasizes the need for routine tactile assessment and targeted treatment of tactile spatial deficits in this population.
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Paralisia Cerebral/fisiopatologia , Avaliação da Deficiência , Hemiplegia/fisiopatologia , Percepção Espacial/fisiologia , Percepção do Tato/fisiologia , Extremidade Superior/fisiopatologia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Queensland/epidemiologia , Análise de RegressãoRESUMO
A systematic review identified tactile assessments used in children with cerebral palsy (CP), but their reproducibility is unknown. Sixteen children with unilateral CP and 31 typically developing children (TDC) were assessed 2-4 weeks apart. Test-retest percent agreements within one point for children with unilateral CP (and TDC) were Semmes-Weinstein monofilaments: 75% (90%); single-point localization: 69% (97%); static two-point discrimination: 93% (97%); and moving two-point discrimination: 87% (97%). Test-retest reliability for registration and unilateral spatial tactile perception tests was high in children with CP (intraclass correlation coefficient [ICC] = 0.79-0.96). Two tests demonstrated a learning effect for children with CP, double simultaneous and tactile texture perception. Stereognosis had a ceiling effect for TDC (ICC = 0) and variability for children with CP (% exact agreement = 47%-50%). The Semmes-Weinstein monofilaments, single-point localization, and both static and moving two-point discrimination are recommended for use in practice and research. Although recommended to provide a comprehensive assessment, the measures of double simultaneous, stereognosis, and tactile texture perception may not be responsive to change over time in children with unilateral CP.
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Paralisia Cerebral/fisiopatologia , Transtornos de Sensação/diagnóstico , Percepção do Tato , Adolescente , Análise de Variância , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Técnicas de Diagnóstico Neurológico , Feminino , Lateralidade Funcional , Mãos , Humanos , Masculino , Reprodutibilidade dos Testes , Transtornos de Sensação/etiologiaRESUMO
PURPOSE: To investigate the effectiveness of a practitioner-led, peer-group sports intervention for children with CP at GMFCS Level I-II. METHOD: Children with CP (GMFCS I-II; 6-12 years) were randomised to Sports Stars or waitlist-control groups. Sports Stars included eight-weeks (eight hours) of physiotherapist-led, sports-specific gross motor activity training, sports education, teamwork development and confidence building. Sports participation was measured using self-identified participation goals (modified Canadian Occupational Performance Measure (mCOPM)). Physical competence was measured with mCOPM activity goals and high-level gross motor batteries (Test of Gross Motor Development (TGMD-2); GMFM-Challenge) and walking (Timed-Up-and-Go), running (Muscle Power Sprint Test; 10x5m Sprint Test), jumping (Standing Broad Jump; Vertical Jump) and throwing (Seated Throw) items. General participation and quality of life were also measured. Outcomes were measured pre, post and 12-weeks post-intervention. Data were analysed using linear mixed models. RESULTS: Fifty-four children were randomised into Sports Stars (n = 29; GMFCS I = 7, II = 22; male = 19; 8.9 ± 2 years) or waitlist-control groups (n = 25; GMFCS I = 10, II = 15; male = 14; 8.6 ± 2 years). The Sports Stars group improved sports participation and activity goals (mCOPM F = 5.49-10.29, p < 0.001) and sports-specific physical competence (TGMD-2, F = 3.45-5.19, p = 0.001-0.009) compared to the waitlist-control. CONCLUSION: Sports Stars is effective for improving sports-specific participation and physical competence for children with CP.Implications for rehabilitationSports Stars improves performance and satisfaction in sports-specific participation and activity goals for ambulant children with CP.Sports Stars improves sports-specific physical activity competence in locomotor and object control skills.Sport-specific interventions should incorporate sport-specific gross motor activity training as well as sports education, confidence building and teamwork.
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Paralisia Cerebral , Corrida , Canadá , Criança , Humanos , Masculino , Destreza Motora , Modalidades de Fisioterapia , Qualidade de VidaRESUMO
BACKGROUND: Sports participation is an important goal for children with cerebral palsy classified at GMFCS Level I or II, however there are no studies of parent or physiotherapist perspectives on effectiveness or overall acceptability of transition-to-sports interventions. METHODS: Parent and physiotherapist perspectives of Sports Stars: a novel, practitioner-led, peer-group sports intervention (Trial registration: ACTRN12617000313336) were collected from Sports Stars Session Reports (39 children, 6-12 years, GMFCS I = 11, II = 28, Female = 12), Fidelity Evaluations (28 children), and Perspectives Surveys (Parents = 29, female = 26; Physiotherapists = 8, female = 5). Outcomes were perceived impact on: (1) sports Participation (Attendance, Involvement), (2) sports Activity Competence across Physical, Social, Cognitive and Psychological Physical Literacy domains and (3) overall acceptability. RESULTS: Over 84% of children Attended most sessions. Physiotherapists rated session Involvement as high (median = 3/4). In Session Reports, physiotherapists recorded quantitative improvements in Physical and Cognitive performance and described improvements across all domains. Parents reported improvements across all domains, with comments focusing on Social and Psychological performance. All physiotherapists (8/8) and most parents (26/29) reported a community-based peer-group was the intervention design of choice for sports-focused goals. CONCLUSIONS: Parents and physiotherapists perceived Sports Stars, a practitioner-led, peer-group sports intervention, as effective and acceptable for children with cerebral palsy with sports-focussed goals.IMPLICATIONS FOR REHABILITATIONParents and physiotherapists agree that Sports Stars improved sports Participation and Physical, Social, Psychological and Cognitive Activity Competence for children with cerebral palsy.Children with sports-focused goals should be offered practitioner-led, peer-group sports interventions in community environments.Therapists should design sports interventions with Physical, Cognitive, Social and Psychological content and outcomes.
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Paralisia Cerebral , Fisioterapeutas , Esportes , Paralisia Cerebral/psicologia , Criança , Feminino , Humanos , Pais/psicologia , Inquéritos e QuestionáriosRESUMO
This review evaluates the clinimetric properties of tactile assessments for children with cerebral palsy. Assessment of registration was reported using Semmes Weinstein Monofilaments (SWMs) or exteroception. Assessment of two-point discrimination was reported using the Disk-Criminator® or paperclip methods; Single point localization and double simultaneous were reported from the Neurosensory Motor Developmental Assessment (NSMDA); graphaesthesia was reported from the Sensory Integration and Praxis Test (SIPT); and stereognosis was assessed using Manual Form Perception from the SIPT and the Klingels method (Klingels, K. et al. (2010). Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy. Can they be measured reliably? Disability and Rehabilitation, 32(5), 409-416) and the Cooper method (Cooper, J., Majnemer, A., Rosenblatt, B., & Birnbaum, R. (1995). The determination of sensory deficits in children with hemiplegic cerebral palsy. Journal of Child Neurology, 10, 300-309). The SIPT and NSMDA demonstrated stronger content validity. Inter-rater reliability was excellent for SIPT (ICC = 0.99) and exteroception (k = 0.88). Test-retest reliability was excellent for exteroception (k = 0.89) and stereognosis (ICC = 0.86; 100%), moderate for SIPT (r = 0.69-0.74) and poor for SWM (k = 0.22). Together these assessments measure tactile registration and spatial perception. Temporal and textural tests are to be developed for comprehensive tactile examination.
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Paralisia Cerebral/fisiopatologia , Transtornos de Sensação/diagnóstico , Transtornos de Sensação/fisiopatologia , Percepção do Tato , Tato , Criança , HumanosRESUMO
PURPOSE: To investigate performance of children with cerebral palsy (CP) at GMFCS Levels I-II on sports-focussed gross motor assessments; and concurrent validity of mainstream and CP-specific high-level assessment batteries and field tests. METHODS: Fifty-four children (6-12 years) with CP at GMFCS I-II completed the Test of Gross Motor Development-second edition, Gross Motor Function Measure-Challenge Module, Muscle Power Sprint Test (MPST), 10 × 5 m Sprint Test (10 × 5 mST), Vertical Jump, Broad Jump, and Seated Throw. Correlations between measures, age and mobility level, and group differences between age and mobility level were examined and content analysis performed. RESULTS: Children at GMFCS I demonstrated significantly higher gross motor assessment battery scores than children at GMFCS II (U = 73.5-109.0, p < 0.001). Performance improved with age for children at Level I but not II. Children with higher overall motor scores scored higher on running (MPST, 10 × 5 mST, r = -0.516 to -0.816, p < 0.001), jumping (Vertical Jump, Broad Jump, r = 0.499-0.774, p < 0.001) and throwing (Seated Throw, r = 0.341-0.500, p = 0.012 < 0.001) field tests. CONCLUSIONS: High-level gross motor assessments were achievable and appropriately challenging for children with CP at GMFCS I-II. Scores discriminated between performance and were associated with mobility level. Concurrent validity was established between gross motor assessment batteries, and locomotor field tests.IMPLICATIONS FOR REHABILITATIONFor children with cerebral palsy at GMFCS I-II, sports-focussed assessments should be used to assess high-level gross motor function.The Gross Motor Function Measure-Challenge and Test of Gross Motor Development demonstrate no ceiling for children with cerebral palsy at GMFCS I-II.Single-item running and jumping field tests provide targeted skill assessment and estimate sports skills for children with cerebral palsy.
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Paralisia Cerebral , Corrida , Criança , Humanos , Destreza Motora , Instituições AcadêmicasRESUMO
PURPOSE: Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP). METHOD: A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters. RESULTS: Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II-IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n = 3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n = 2, all Evidence Level II) and Physical Fitness Training (n = 4, Evidence Level II-V). Weak positive evidence was available for Modified Sport (n = 3, Evidence Level IV-V) and Non-Immersive Virtual Reality (n = 12, Evidence Level II-V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n = 4, all Evidence Level II). INTERPRETATION: Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP. Implications for rehabilitation Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy. Gross Motor Activity Training is the most common and effective intervention. Practice variability is essential to improve gross motor function. Participation was rarely measured and requires further research, particularly in interventions that embed real-world participation opportunities like Modified Sport.
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Paralisia Cerebral , Crianças com Deficiência/reabilitação , Terapia por Exercício/métodos , Destreza Motora , Desempenho Físico Funcional , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/reabilitação , Criança , Humanos , Modalidades de Fisioterapia , População , Resultado do TratamentoRESUMO
Background: Tactile impairments are common in children with cerebral palsy (CP), however assessment is not routinely carried out by therapists. We investigated a multi-faceted Knowledge Translation intervention to improve Knowledge, remove Barriers and enhance Practice of tactile assessments by paediatric therapists. Method: Twelve therapists from a state-wide service for children with CP (seven physiotherapists, five occupational therapists; 12 female) received: written information, demonstration videos, a face-to-face workshop, equipment provision, and on-call mentoring. Therapists completed pre-post-intervention questionnaires reporting their perceived tactile assessment Knowledge, current Practices and implementation Barriers. Results: Following intervention, therapists improved Knowledge of correct (1) tactile impairment prevalence in children with CP (pre 3/12; post 9/12), (2) tactile assessment items (e.g. Registration - pre 1/12; post 9/12; Localisation - pre 2/12; post 10/12), and (3) equipment choice (e.g. Monofilaments - pre 1/12; post 10/12). Tactile assessment Practice improved slightly. All major clinician-level implementation Barriers were resolved and less obvious organisational-level Barriers were identified for follow-up. Conclusion: A 12-month multi-faceted Knowledge Translation intervention can improve tactile assessment Knowledge, resolve major clinician-level implementation Barriers, and identify less obvious organisational-level Barriers to be addressed to achieve maximum Practice improvement. Ongoing multi-faceted knowledge translation processes are essential for high-performing organisations. Implications for rehabilitation A multi-faceted knowledge translation intervention significantly improved paediatric therapists' knowledge of the items and equipment necessary for tactile assessment. A 12-month intervention can address clinician-level barriers of knowledge, confidence, and access to equipment and assist in the identification of less obvious organisational-level barriers. Consideration of motivational readiness for change, intervention timelines, monitoring of emergent barriers, and fitting tactile assessment into a broader assessment framework are critical for improving uptake of tactile assessment in practice.
Assuntos
Paralisia Cerebral/reabilitação , Avaliação da Deficiência , Percepção do Tato , Tato , Atitude do Pessoal de Saúde , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Terapeutas Ocupacionais , Avaliação de Resultados em Cuidados de Saúde , Pediatria/métodos , Fisioterapeutas , Inquéritos e Questionários , Pesquisa Translacional BiomédicaRESUMO
PURPOSE: Many children with cerebral palsy (CP) are known to experience tactile impairments. Research evaluating specific interventions to manage this is, however, minimal. This paper seeks to consolidate current literature and provide a framework to help clinicians and researchers think strategically about tactile treatment selection and future research planning. METHOD: The framework is described via a novel analogy - "The Apartment Block Theory". The theory describes the relative effectiveness of three intervention strategies aimed at overcoming a poorly responsive tactile system: (1) Pressing the buzzer - providing repeated passive tactile stimulation at the periphery; (2) Sneaking in the door - providing active tactile-enhanced motor training that capitalises on the opportunity to provide high-dose tactile input during motor interventions; and (3) Connecting another way - providing visually enhanced touch strategies with the aim of enhancing tactile function, which can be compared to phoning the apartment as an alternative to using the buzzer. RESULTS: Using this theory, the paper describes which sub-groups of children with CP may benefit from each intervention strategy when considering their capabilities in visual, motor, and attention domains. CONCLUSIONS: This theory can assist clinicians to provide effective interventions and researchers to make informed future research decisions to optimise tactile function for children with CP. Implications for Rehabilitation Although tactile impairments are reported to be common in children with cerebral palsy, very few successful interventions are reported in the literature. Visually enhanced touch is a successful strategy for treating tactile impairments in children with cerebral palsy who have sufficient vision and attention. Combining intentional tactile input with upper limb movement training may improve tactile function in children with cerebral palsy who have sufficient movement and attention. In children who have complex co-morbidities, including both visual and movement impairments, it may be necessary to consider providing passive tactile stimulation in tactile intervention.