Feasibility of High Repetition Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy.

AIMS: In pediatric upper extremity rehabilitation, feasible repetition rates are unknown. Our objectives were to examine repetition rates during rehabilitation and their impact on outcomes. METHODS: Children with unilateral cerebral palsy due to perinatal stroke (n = 55, median 10 y 7 mo, 30 males) received Constraint-Induced Movement Therapy (CIMT) followed by Bimanual Therapy, each for 5 days. Repetitions were documented during one-on-one therapy (1.5 h/day). Outcomes included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF), and Box and Block Test (BBT). Means and standard deviations for motor outcomes and frequencies for repetition rates were calculated. Factors associated with repetition rates and outcome change were explored using standard linear regression. RESULTS: Repetitions/hour averaged 365 ± 165 during CIMT and 285 ± 103 during Bimanual Therapy. Higher repetition rates were associated with higher baseline function by older age, a main effect of younger age, and improving motor skill (p < .05). Higher repetition rates corresponded with improvement of the AHA and BBT (p < .05, standardized ß = 0.392, 0.358). CONCLUSIONS: Results suggest high repetition therapy is feasible in school-aged children with perinatal stroke, albeit with high individual variability. Multiple associations between repetition rates and baseline function and change point to the clinical importance of this measurable and potentially modifiable factor.

Wearable wrist activity monitor as an indicator of functional hand use in children with cerebral palsy.

AIM: New tools that capture hand function in everyday activities and contexts are needed for assessing children with hemiplegic cerebral palsy. This study evaluates a wearable wrist monitor and tests the hypothesis that wrist extension frequency (FreqE) is an appropriate indicator of functional hand use. METHOD: Fifteen children (four females, 11 males; age range 6-12y; mean age 10y [SD 2y]) with hemiplegia (seven at level I and eight at level II on the Manual Ability Classification System) participated in the Assisting Hand Assessment (AHA) while wearing the wrist monitor. FreqEs were captured via the wrist monitor and validated using video analysis. Correlations between FreqE and AHA scores were calculated and a multivariate linear regression was conducted to explore other measures of wrist activity. RESULTS: Wrist extensions observed in video analyses were reliably detected by the wrist monitor (intraclass correlation coefficient, r=0.88; p<0.001) and were strongly correlated with the AHA scores (r=0.93; p<0.001). AHA scores were significantly correlated with FreqE (r=0.80; p=0.001) and the range of wrist extensions/flexions (r=0.70; p=0.008). The multivariate linear regression combining the FreqE and range of wrist extensions/flexions yielded a strong correlation with AHA scores (r=0.84; p=0.0043). INTERPRETATION: The wearable wrist monitor may offer a convenient, valid alternative to observer reports for functional assessments of the hemiplegic hand in everyday contexts.

Evaluation of an occupational therapy mentorship program: effects on therapists' skills and family-centered behavior.

There is growing interest in understanding the usefulness of mentorship programs for children's rehabilitation service providers. This evaluation study examined the effects of an occupational therapy mentorship program on the skills and behaviors of 8 new and 17 experienced occupational therapists practicing at a regional children's rehabilitation center. Self- and peer-report measures of family-centered behavior, critical thinking ability, listening/interactive communication skill, and clinical behavior were collected before and after an 11-month facilitated, collaborative group mentorship intervention. Significant pre-post changes associated with intervention were found on 9 of 12 outcome measures, including information provision, respectful treatment, self-confidence, and listening and clinical skill. Changes were not found on the more trait-like variables of open-mindedness, interpersonal sensitivity, and interpersonal skill. Experienced therapists had higher scores than new therapists on most variables, including family-centered behavior, listening skill, and clinical skill. Implications regarding the utility of mentorship programs in children's rehabilitation centers are discussed.

Force Resistance Training in Hand Grasp and Arm Therapy: Feasibility of a Low-Cost Videogame Controller.

OBJECTIVE: To design and evaluate a low-cost gaming station that supports force resistance training in pediatric arm/hand grasp therapies through mainstream videogame play. METHODS: The gaming station was developed through an iterative participatory design process and includes a force feedback game controller (Novint Falcon), custom grips, arm/wrist supports, and software to interface with mainstream games and manage difficulty settings in the controller. The station was tested for usability and feasibility with six therapists and six children with cerebral palsy, 7-16 years of age, attending weekly therapy sessions over 12 weeks. Pre- and post-assessments of perceived performance and satisfaction on self-identified goals were measured on the Canadian Occupational Performance Measure (COPM). RESULTS: The gaming station was considered highly usable by therapists with a score of 76.7 (standard deviation [SD] = 6.1) on the System Usability Scale. Overall, children enjoyed the games, achieved high repetition rates for wrist extensions and arm movements, and all made clinically significant progress on therapy goals. Increases of 3.13 (SD = 1.69) on the performance scale and 2.97 (SD = 0.98) on the satisfaction scale were reported on the COPM. Conclusiion: In-clinic force resistance training for development of upper limb functional capacities is feasible using low-cost video game components adapted to therapy through a participatory design process.

Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review.

BACKGROUND AND OBJECTIVE: Chronic pain in children with cerebral palsy (CP) is underrecognized, leading to detriments in their physical, social, and mental well-being. Our objective was to identify, describe, and critique pediatric chronic pain assessment tools and make recommendations for clinical use for children with CP. Secondly, develop an evidence-informed toolbox to support clinicians in the assessment of chronic pain in children with disabilities. METHODS: Ovid Medline, Cumulative Index to Nursing and Allied Health Literature, and Embase databases were systematically searched by using key terms "chronic pain" and "clinical assessment tool" between January 2012 and July 2014. Tools from multiple pediatric health conditions were explored contingent on inclusion criteria: (1) children 1 to 18 years; (2) assessment focus on chronic pain; (3) psychometric properties reported; (4) written in English between 1980 and 2014. Pediatric chronic pain assessment tools were extracted and corresponding validation articles were sought for review. Detailed tool descriptions were composed and each tool underwent a formal critique of psychometric properties and clinical utility. RESULTS: Of the retrieved 2652 articles, 250 articles met eligibility, from which 52 chronic pain assessment tools were retrieved. A consensus among interprofessional working group members determined 7 chronic pain interference tools to be of importance. Not all tools have been validated with children with CP nor is there 1 tool to meet the needs of all children experiencing chronic pain. CONCLUSIONS: This study has systematically reviewed and recommended, through expert consensus, valid and reliable chronic pain interference assessment tools for children with disabilities.