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Introducción. La parálisis cerebral (PC) es una de las principales causas de discapacidad en la población infantil, afectando diversas áreas del desarrollo como la función motora gruesa; equilibrio y marcha. Hay evidencia de los beneficios de la terapia acuática y de cómo puede complementar la rehabilitación. Objetivo. Describir la efectividad de las intervenciones acuáticas en personas con PC, determinar mejoras en la función motora gruesa uso de métodos, protocolos y dosificación. Métodos. Se analizaron 9 estudios aleatorizados controlados desde el 2012 a la fecha, seleccionados por un experto y cuyos sujetos tenían PC espástica, Gross Motor Function Classification System (GMFCS) I a IV, entre los 2 y 20 años. Post intervención acuática se reportan mejoras significativas en el promedio de los ítems medidos por Gross motor function measure (GMFM). De los métodos que contribuyeron a mejoras se encuentra Halliwick y ejercicios acuáticos sin un programa específico. Resultados. Se obtuvieron mejoras de 35 a 100 minutos, y de 12 a 30 sesiones en total. No se logra concluir el tipo de terapia más efectiva, ya que las medidas de resultado y las características de los sujetos eran diversas. Conclusión. Una dosificación mínima de 2 veces por semana, 35 minutos de intervención en un total de 16 sesiones (9,3 horas en total) pareciera mejorar la función motora gruesa, cuyos resultados son transferibles a las actividades en tierra inmediatamente, sin embargo, no se obtiene información si se mantienen a mediano o largo plazo.
Background. Cerebral palsy (CP) is one of the main causes of disability in the child population, affecting various areas of development such as gross motor function; balance and gait. There is evidence of the benefits of aquatic therapy and how it can complement rehabilitation. Objective. to describe the effectiveness of aquatic interventions in people with CP, to determine improvements in gross motor function using methods, protocols, and dosage. Methods. Nine randomized controlled studies were analyzed from 2012 to date, selected by an expert and whose subjects had spastic CP, Gross Motor Function Classification System (GMFCS) I to IV, between 2 and 20 years of age. Results. After the aquatic intervention, significant improvements were reported in the average of the Gross motor function measure (GMFM) items measured. Of the methods that contributed to improvements, there is Halliwick and aquatic exercises without a specific program. Results. Improvements were obtained from 35 to 100 minutes, and from 12 to 30 sessions in total. It is not possible to conclude the most effective type of therapy, since the outcome measures and the characteristics of the subjects were diverse. Conclusion. A minimum dosage of 2 times per week, 35 minutes of intervention in a total of 16 sessions (9.3 hours in total) seems to improve gross motor function, the results of which are immediately transferable to activities on land, however, it is not obtains information if they are maintained in the medium or long term.
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ObjectiveTo investigate the developmental characteristics of gross motor skills and executive functions, and the correlation between them in school-age children with attention deficit hyperactivity disorder (ADHD). MethodsFrom November, 2020 to May, 2021, 90 children with ADHD were recruited from Peking University Sixth Hospital and Beijing Haidian Wanquan Primary School, and other 90 children with normal development from this primary school were recruited matched their age and gender. Gross motor skills were assessed with the Test of Gross Motor Development in Children, Third Edition (TGMD-3), and inhibitory control, working memory, and cognitive flexibility were assessed with Stroop Color Words Test (SCWT), Rey-Osterrich Complex Figure Test (ROCFT) and Trail Making Test (TMT), respectively. ResultsThe TGMD-3 score was significantly lower in children with ADHD than in normal children (t = -6.275, P < 0.001), while the test results of SCWT, ROCFT and TMT were worse (|t| ≥ 1.986, P ≤ 0.05). The TGMD-3 score of children with ADHD was negatively correlated with the word sense reaction time (r = -0.261), the number of word sense errors (r = -0.404) and the number of color errors (r = -0.326) (P < 0.05), positively correlated with the delayed structural memory scores (r = 0.228) (P < 0.05), and negatively correlated with the TMT-A reaction time (r = -0.255), the number of TMT-A errors (r = -0.329), TMT-B reaction time (r = -0.214) and the number of TMT-B errors (r = -0.474) (P < 0.05). Stratified linear regression analyses showed that the TGMD-3 score of children with ADHD was significant only in predicting test results for inhibitory control and cognitive flexibility (P < 0.05), with explanations of 8.7% and 22.5%, respectively. ConclusionDevelopments of both gross motor skills and executive function delay in children with ADHD, and there is a relation between them, especially the level of gross motor skills relating to the developments of inhibitory control and cognitive flexibility.
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Background: Cerebral palsy (CP) is the most common motor disability in childhood. Quality of life (QOL) has emerged as an important concept in childhood, especially for children with disabilities. CP has an impact on a child’s capacity to do activities of daily living thus affecting QOL of patients and their families. Aims and Objectives: The objective of present study was to assess the QOL in children with CP. Materials and Methods: In this study, 29 children with CP in the age group of 4–12 years were evaluated for QOL was assessed using CPQOL-Child Primary Caregiver Questionnaire (4–12 years). The questionnaire was completed by one of the parents or their caregiver. Scores for each domain of QOL were converted to a scale ranging from 0 to 100 and analyzed. Results: The scores as reported by the parents were low for each of the domains with maximum effect seen in functioning domain and least in pain domain. Girls had better QOL than boys. The QOL scores were negatively related to the severity of CP which was assessed by gross motor function classification system suggesting that severity of disability had negative impact on QOL. Conclusion: QOL of children with CP was found to be poor and was influenced by age, sex and motor functioning
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Objective:To investigate the characteristics of resting energy expenditure (REE) in children with cerebral palsy (CP) graded with different levels of Gross Motor Function Classification System (GMFCS), and to evaluate the accuracy and association of commonly used REE prediction formulas in children with CP.Methods:It was a retrospective study involving 36 children with CP aged 24-144 months who visited the Third Affiliated Hospital of Zhengzhou University between September 2021 and August 2022.REE was measured by the indirect calorimetry.Based on the GMFCS, children with CP were divided into grade Ⅰ-Ⅱ group (20 cases), grade Ⅲ group (6 cases) and grade Ⅳ-Ⅴ group(10 cases). During the same period, 11 age-matched healthy children were included in control group.The measured REE (MREE) between children with CP and healthy controls was compared.Predicted REE (PREE) calculated by the Harris-Benedict, WHO, Schofield-W, Schofield-WH and Oxford prediction formulas were compared with MREE in children for their consistency and correlation.Independent samples were analyzed using t-test or Mann- Whitney U test, and categorical data were analyzed using Chi- square test.Using paired t-test and Pearson linear correlation analysis to analyze the correlation between MREE and PREE.The accuracy of PREE values calculated by different formulas was assessed using the root mean square error. Results:The MREE in control group and children with CP were (952.18±270.56) kcal/d and (801.81±201.89) kcal/d, respectively.There was no significant difference in the MREE between grade Ⅰ-Ⅱ group versus control group[(868.30±194.81) kcal/d vs.(952.18±270.56) kcal/d, P>0.05], and grade Ⅲ group versus control group [(813.17±192.48) kcal/d vs.(952.18±270.56) kcal/d, P>0.05]. The MREE was significantly lower in grade Ⅳ-Ⅴ group than that of control group [666.00(513.50, 775.50) kcal/d vs.(952.18±270.56) kcal/d, P=0.011]. There were no significant difference between MREE and PREEs calculated by Harris-Benedict, WHO, Schofield-W, Schofield-WH, and Oxford (all P>0.05). The correct classification fraction calculated by the 5 formulas were 33.3%, 47.2%, 41.7%, 47.2%, and 41.7%, respectively.The r values of the consistency of PREE calculated by the 5 formulas were 0.585, 0.700, 0.703, 0.712, and 0.701, respectively.The Blande-Altman Limits of Agreement were (-297.77, 359.22), (-245.60, 326.94), (-250.62, 316.05), (-242.22, 177.36) and (-241.28, 325.81), respectively.The clinically acceptable range was -80.18 to 80.18 kcal/d.The root mean square error were 168.09 kcal/d, 149.64 kcal/d, 146.24 kcal/d, 144.23 kcal/d and 148.77 kcal/d, respectively. Conclusions:The MREE values decreased significantly in children with CP classified as CMFCS grade Ⅳ and Ⅴ.When REE cannot be regularly monitored by indirect calorimetry to develop nutritional support programs, children with CP may be prioritized to estimate REE using the prediction formula of Schofield-WH.
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Objective:To explore the scheme of assigning rational scores to the Modified Pediatric Nutritional Risk Screening Tool for children with cerebral palsy(CP) at different Gross Motor Function Classification System(GMFCS) levels.Methods:The clinical data of 360 children with CP hospitalized in the Department of Children′s Rehabilitation, the Third Affiliated Hospital of Zhengzhou University from January to October 2019 were analyzed retrospectively.All the CP children at different GMFCS levels who met the inclusion criteria were subject to nutrition screening and assessment by using the Modified Pediatric Nutritional Risk Screening Tool and the Subjective Global Nutritional Assessment(SGNA) scale.The distribution of malnutrition rates assessed by the SGNA scale among the children at different GMFCS levels was examined.Data between groups were compared by the χ2 test.Children at different GMFCS levels were divided into different subgroups according to the statistical difference.Then, 0 or 1 score was assigned to the Modified Pediatric Nutritional Risk Screening Tool in different subgroups, and different combinations were formed.The nutritional risk screening results of different combinations were evaluated by using the SGNA scale assessment results as a reference. Results:In children with CP, the risk detection rate and incidence rate of malnutrition were 58.1%(209/360) and 36.9%(133/360), respectively.There was no significant difference in the incidence rate of malnutrition between GMFCS Ⅱ and GMFCS Ⅲ, as well as between GMFCS Ⅳ and GMFCS Ⅴ(all P>0.05). Therefore, children with CP were divided into 3 subgroups, namely, group Ⅰ, group Ⅱ to Ⅲ, and group Ⅳ to Ⅴ.Different CP disease scores were given to the Modified Pediatric Nutritional Risk Screening Tool in 3 subgroups, forming 3 different protocols[protocol 1 (0, 0, 1 point); protocol 2(0, 1, 1 point); current protocol (1, 1, 1 point)]. Taking the SGNA scale assessment results as a reference, the sensitivity of protocol 1, protocol 2 and current protocol were 85.7%, 92.5%, and 93.2% respectively.The specificity protocol 1, protocol 2 and current protocol were 81.1%, 78.0%, and 62.6%, respectively.And the Youden indexes of above three protocols were 0.668, 0.705, and 0.558, respectively.The Youden index of protocol 2 was relatively high. Conclusions:The Modified Pediatric Nutritional Risk Screening Tool can effectively identify the risk of malnutrition in children with CP.The scheme of assigning 0 points to children with GMFCS grade Ⅰ and 1 point to children with GMFCS grade Ⅱ to Ⅴ is more reasonable.
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OBJECTIVE@#To investigate the relationship among the gross motor function classification system (GMFCS)and the development of hip joint and lumbar spine in children with spastic cerebral palsy.@*METHODS@#The clinical data of 125 children with spastic cerebral palsy admitted from January 2018 to July 2021 were retrospectively analyzed. There were 85 males and 40 females, aged from 4 to 12 years old with an average of (8.4±2.9) years. According to GMFCS, the patients were divided into gradeⅠ, Ⅱ, Ⅲ and Ⅳ groups. There were 27 cases in gradeⅠgroup, 40 cases in gradeⅡgroup, 35 cases in grade Ⅲ group and 23 cases in grade Ⅳ group. The migration percentage(MP), central edge angle(CE), neck-shaft angle(NSA), acetabular index(AI) were measured by the radiograph of pelvis, abnormal parameters were selected to evaluate the relationship between different GMFCS grades and hip joint development. Lumbar sagittal Cobb angle, lumbar sacral angle, lumbar lordosis index and apical distance were measured by lateral lumbar radiographs to evaluate the relationship between different GMFCS grades and lumbar spine development.@*RESULTS@#①Among the 125 spastic cerebral palsy children, there were 119 cases of pelvic radiographs that met the measurement standards. In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, MP was (22.72±3.88), (26.53±4.36), (33.84±4.99), and (49.54±7.87)%, CE was(30.10±6.99) °, ( 22.92±4.19) °, ( 17.91±5.50) °, and (-0.70±17.33)°, AI was (16.41±2.77) °, (20.46±4.63) °, (23.76±5.10) °, and ( 29.15±7.35)°, respectively, there were significant differences between the two comparisons (P<0.05). And the higher GMFCS grade, the greater MP and AI, and the smaller CE.The NSA was(142.74±10.03) °, (148.66±9.09) °, (151.66±10.52) °, and (153.70±8.05)° in four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively. The differences between the two comparisons of the GMFCS gradeⅠgroup and the other three groups were statistically significant (P<0.05). NSA of GMFCSⅠgroup was significantly lower than that of the others, there was no significant difference among other groups(P>0.05). ② Among the 125 spastic cerebral palsy children, there were 88 cases of lumbar spine radiographs that met the measurement standards. ③The lumbar sagittal Cobb angle was(32.62±11.10) °, (29.86±9.90) °, (31.70±11.84) °, and (39.69±6.80)° in the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively;GMFSS of grade Ⅳ group was significantly higher than that of other three groups, there was significant difference between the two comparisons (P<0.05);there were no significant differences between other groups (P>0.05). In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, the lumbosacral angle was (31.02±9.91) °, ( 26.57±9.41) °, (28.08±8.56) °, and ( 27.31±11.50)°, the lumbar lordosis index was (4.14±12.89), (8.83±13.53), (13.00±11.78), and (10.76±9.97) mm, the arch apex distance was (9.50±6.80), (6.68±3.20), (7.16±4.94), and (6.62±4.13) mm, respectively, there were no significant differences between the two comparisons(P>0.05).@*CONCLUSION@#①In children with GMFCS gradeⅠ-Ⅳ, the higher the GMFCS grade, the worse the hip develops. ② Children with GMFCS grade Ⅲ-Ⅳ may be at greater risk for lumbar kyphosis.
Subject(s)
Male , Female , Humans , Child , Child, Preschool , Lordosis , Retrospective Studies , Cerebral Palsy , Hip Dislocation , Lumbar Vertebrae/diagnostic imaging , Muscle SpasticityABSTRACT
Abstract The purpose of this work was to systematically evaluate the intervention effects of video games training (VGT) on the gross motor skills (GMS) development of children with cerebral palsy (CP). Seven Chinese and English databases (PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, EBSCO) were searched. Data were retrieved from randomized controlled trials on the GMS among individuals with CP. The retrieval was from the inception of each database to March 16, 2021. The included studies were evaluated quantitatively using the PEDro Scale. Then, relevant data were inputted and analyzed in Review Manager 5.4. Thirteen papers were included: seven written in English and six in Chinese. In the three subordinate concept of GMS, VGT could significantly improve locomotor skills (LS) (standardized mean difference = 0.80, 95% confidence interval 0.55-105, P<0.00001), and non-locomotor skills (NLS) (standardized mean difference = 0.83, 95% confidence interval 0.38-1.28, P=0.0003) in CP. However, there was no significant difference in object control skills (OCS), when compared with the control group (standardized mean difference = 0.55, 95% confidence interval -0.01-0.72, P=0.05). VGT can improve LS and NLS in CP, but the effect on OCS is uncertain; therefore, it is recommended that additional high-quality literature be included in the future. In general, VGT has been proven an effective intervention tool on the GMS development in CP.
Resumen Este artículo intentó evaluar sistemáticamente el efecto de la intervención del entrenamiento con videojuegos (VGT) en el desarrollo de las habilidades motoras gruesas (GMS) de niños con parálisis cerebral (CP), basándose en un cuerpo de datos logrado de las conclusiones de pruebas controladas aleatorias sobre las habilidades motoras gruesas de niños con CP, obtenidos de la búsqueda sistemática en siete bases de datos chinos y extranjeros, tales como PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang y EBSCO. El lapso de búsqueda fue desde la fecha de establecimiento de cada base de datos hasta el 16 de marzo del 2021. Se aplicó la escala PEDro para realizar un estudio cuantitativo y después, se analizaron los datos relevantes con Review Manager 5.4. Se incluyeron 13 publicaciones, 7 artículos escritos en inglés y 6 en chino. En el marco del concepto de los tres subordinados de GMS, la VGT podría mejorar significativamente la habilidad locomotora (LS) (diferencia de medias estandarizada = 0.80, intervalo de confianza del 95%: 0.55-105, P<0.00001), y las habilidades no locomotoras (NLS) (diferencia de medias estandarizada = 0.83, intervalo de confianza del 95%: 0.38-1.28, P= 0,0003) en PC; pero no hubo una diferencia significativa en las habilidades de control de objetos (OCS), cuando se compararon con el grupo control (diferencia de medias estandarizada= 0,55, intervalo de confianza del 95% -0,01-0,72, P= 0,05). En conclusión, el VGT puede mejorar las LS y NLS en CP, pero el efecto sobre OCS es incierto; por lo que se recomienda la inclusión de literatura adicional de alta calidad en el futuro. De este modo se pudo demostrar que el VGT es una herramienta de intervención eficaz en el desarrollo de las GMS en niños con CP.
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Objective:To evaluate the clinical value of the General Movements (GMs) in predicting the neurological outcome of high-risk infants with cerebral palsy in the early stage, and to analyze the application of the Peabody Developmental Motor Scale-Gross Motor (PDMS-GM) and Gross Motor Function Measure Scale (GMFM) in the rehabilitation assessment and intervention of high-risk infants with cerebral palsy.Methods:The gross motor function of 64 high-risk infants with cerebral palsy before treatment and after 2 months of treatment in Department of Child Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2017 to December 2019 was evaluated using PDMS-GM and GMFM.The total percentage of PDMS-GM and GMFM before and after treatment, and the monthly relative percentage of PDMS-GM and GMFM were compared.The correlation between PDMS-GM and GMFM original scores in the writhing and fidgety movements period before treatment, and that between PDMS-GM and GMFM original scores before and after treatment were compared.High-risk infants with cerebral palsy were followed up to 1 year old, and their neurological outcome was determined according to the clinical diagnosis and evaluation results.The predictive value of GMs on the outcome of cerebral palsy was evaluated.Results:Compared with that before treatment, the total percentage of PDMS-GM and GMFM in high-risk infants with cerebral palsy increased significantly after treatment [PDMS-GM: (37.250±13.690)% vs.(20.992±10.273)%, t=-15.793, P<0.01; GMFM: (22.672±8.438)% vs.(10.601±7.890)%, t=-16.442, P<0.01]. PDMS-GM original scores in the writhing movements period and fidgety movements period before treatment were highly correlated with those of GMFM (writhing movements period: r=0.922, P<0.01; fidgety movements period: r=0.905, P<0.01). PDMS-GM original score before and after treatment were highly correlated with those of GMFM (before treatment: r=0.901, P<0.01; after treatment: r=0.801, P<0.01). There was no significant difference in the monthly relative percentage of PDMS-GM and GMFM [(97.286±88.330)% vs.(76.885±43.815)%, t=-1.656, P=0.103]. The sensitivity, specificity, positive predictive value and negative predictive value of the writhing movements period to the prediction of cerebral palsy outcome were 90.7%, 82.3%, 23.4%, and 95.8%, respectively, which were 98.3%, 88.1%, 27.6% and 96.8% in the fidgety movements period, respectively.At 1-year-old follow-up, 3 cases of spastic cerebral palsy were found in a high risk with cerebral palsy, and 1 case was cramped synchronized and 2 cases were absence of fidgety movements. Conclusions:Gross motor function of high-risk infants with cerebral palsy was significantly improved after treatment compared with that before treatment, and PDMS-GM and GMFM were consistent in the assessment of gross motor function of high-risk infants with cerebral palsy in the writhing and fidgety movements period before and after treatment.In the early screening of infants at high risk of cerebral palsy, absence of fidgety movements and cramped synchronized maybe predict spastic cerebral palsy more sensitively, and fidgety movements assessment was more sensitive to predict spastic cerebral palsy outcome than writhing movements assessment.
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OBJECTIVE@#To compare the effect of acupoint injection and intramuscular injection with mouse nerve growth factor (mNGF) on gross motor function development of children with cerebral palsy (CP), and explore the treatment mechanism.@*METHODS@#A total of 63 children with CP were randomly divided into an observation group (32 cases, 4 cases dropped off ) and a control group (31 cases, 3 cases dropped off). Based on the routine rehabilitation therapy, the control group received intramuscular injection of mNGF(18 µg/2 mL), and the observation group received acupoint injection of mNGF at Xinshu (BL 15), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Sanjiaoshu (BL 22), Shenting (GV 24), Baihui (GV 20), Fengfu (GV 16), Dazhui (GV 14), etc. Of them, 5-6 acupoints alternately were selected each time, and each acupoint was given 0.3-0.5 mL, totally 18 µg/2 mL. Both treatment were carried out once every other day for six months. Before and after treatment, the children's development of brain function was assessed using gross motor function classification system (GMFCS). Before treatment (T), after 2 (T), 4 (T) and 6 (T) months of treatment, the motor function was evaluated by gross motor function measure (GMFM-88). The systolic peak velocity (Vs), mean velocity (Vm) and vascular resistance index (RI) of anterior cerebral artery (ACA) and middle cerebral artery (MCA) were measured, and the level of N-acetyl aspartate acid (NAA), choline (Cho), lactate (Lac) and creatine (Cr) from the basal ganglia, thalamus and periventricular white mater were detected by magnetic resonance spectroscopy (MRS) technology with MAGNETOM Skyra3.0T magnetic resonance imaging system before and after treatment.@*RESULTS@#Compared with before treatment, the GMFCS classification of the observation group after treatment was significantly improved (0.05), however, the observation group had a 3.142 times of feasibility for good gross motor function development by more than level 1 compared to the control group (<0.05). After 2, 4, and 6 months of treatment, the GMFM-88 scores of the two groups showed an upward trend (<0.01), and the increase of the observation group was greater than that of the control group (<0.05). Compared with before treatment, in the ACA and MCA, the Vs and Vm increased, RI decreased in both groups after treatment (<0.01), and in the brain, NAA/Cr increased, Cho/Cr and Lac/Cr decreased (<0.01), and after treatment, the Vs, Vm of ACA and MCA and NAA/Cr of brain in the observation group were higher than those in the control group (<0.05), and the RI of ACA and MCA and Cho/Cr and Lac/Cr of brain in the observation group were lower than those in the control group (<0.05).@*CONCLUSION@#The mNGF acupoint injection has a better effect on the gross motor function in the children with cerebral palsy compared with the intramuscular injection, and the mechanism may be associated with exhibiting the double effects of acupoint effect and the targeting therapy of drug, which can effectively improve the cerebral hemodynamics and the metabolism of cerebral nervous substances.
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Objectives: The objectives were to find out the sociodemographic characteristics, comorbidities, types of CP, level of GMFCS and to determine the association between GMFCS with age, gender, types of CP and topographic distribution among children with cerebral palsy. Methods and Materials: A retrospectives study was done in children with cerebral palsy. Total 384 participants were included in this study. The study setting was Paediatric Department, Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka, Bangladesh. The samples were collected through convenient sampling. The Chi-Square was used to find out the association between GMFCS with age, gender, types of CP and others. Results: Males were affected than female among all participants. The majority participants came from rural area. The children were more in 2 to 4-year age band in GMFCS. The majority participants (81%) had visual problem, 11% hearing and 31% had convulsion. The common levels were II and III. The age bands, topographic classification was associated with GMFCS (p<0.05) but gender and types of CP were not statistically associated (p>0.05). Conclusion: The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP).
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Objective: The aim of the study was to find how affected is the unaffected side of stroke population. Methods: 20 participants were recruited who met the inclusion criteria of more than 3-month first time unilateral both male and female stroke patients of age group 40-60 years were assessed and evaluated for the 3 parameters using grip dynamometer, peg board and reaction time machine respectively and compared it to the normal healthy age, gender and dominance matched individuals. Results: The unaffected side of stroke patients was significantly affected in gross motor strength, fine motor dexterity, reaction time audio and visual when compared to normal population. Conclusion: There are significant motor deficits seen in the unaffected side of stroke patients.
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Resumen Introducción. Recientemente, en el Ecuador se está sensibilizado sobre la inclusión escolar de niños/as con diversidad funcional. Sin embargo, la ausencia de espacios adecuados y profesionales preparados hace que estos sean remitidos a hospitales o centros de rehabilitación. Además, los beneficios de la terapia física no se limitan al ámbito de la motricidad, ofreciendo igualmente avances en la función cognitiva y el aprendizaje. Así pues, este trabajo muestra una investigación realizada en el área de Medicina Física y Rehabilitación del Hospital Teófilo Dávila (Ecuador). Objetivo. El propósito del estudio es determinar el impacto de un programa de actividad física integral, respecto de la motricidad gruesa de niños/as con diversidad funcional. Materiales y métodos. La investigación acomete un diseño cuasi-experimental con un grupo experimental, tomando medidas pretest y postest. La metodología utilizada es cuantitativa descriptiva, implementando el test Gross Motor Function Measure (GMFM 88) y dos encuestas de valoración personal. Resultados. El análisis de datos revela mejoras estadísticamente significativas (p<0,001) en la motricidad gruesa de los niños/as, tanto a nivel global como en cada una de las categorías del test. Igualmente, las encuestas proporcionaron información relevante respecto de la opinión de maestros y padres/tutores. Conclusiones. Los resultados de las pruebas estadísticas no dejan lugar a dudas respecto a la mejora en la motricidad gruesa de los niños/as. Asimismo, las encuestas reflejan un grado de satisfacción muy elevado, además de resaltar beneficios en la función cognitiva y el aprendizaje.
Abstract Introduction. Recently, in Ecuador, we are aware of school inclusion of children with functional diversity. However, the absence of adequate spaces and trained professionals make them to be referred to hospitals or rehabilitation centers. In addition, the benefits of physical therapy are not limited to the field of motor skills, offering advances in cognitive function and learning as well. Thus, this work shows an investigation carried out in the area of Physical Medicine and Rehabilitation at Teófilo Dávila Hospital (Ecuador). Objective. The purpose of the study is to determine the impact of a Physical Therapy program on the gross motor skills of children with functional diversity. Materials and methods. The research is approached through a quasi-experimental design with an Experimental Group, taking Pretest and Posttest measurements. The methodology used is descriptive quantitative, implementing the Gross Motor Function Measure Test (GMFM 88) and two opinion surveys. Results. The data analysis reveals statistically significant improvements (p<0.001) in the gross motor skills of the children, both globally and in each of the test categories. Likewise, the surveys provided relevant information regarding the opinion of the children's teachers and parents/ guardians. Conclusions. The results of the statistical tests leave no doubt about the improvement in the children's gross motor skills. Likewise, the surveys revealed a very high level of satisfaction, highlighting benefits in cognitive function and learning as well.
Resumo Introdução. Recentemente, no Equador está sendo promovida a inclusão escolar de crianças com diversidade funcional. No entanto, a ausência de espaços adequados e professionais capacitados faz com que estes sejam encaminhados à hospitais ou centros de reabilitação. Além disso, os benefícios da fisioterapia física não se limitam ao âmbito da motricidade, oferecendo de igual maneira avanços na função cognitiva e na aprendizagem. Assim, este trabalho amostra uma pesquisa realizada na área de Medicina Física e Reabilitação do Hospital Teofilo Davila (Equador). Objetivo. O propósito do estudo é determinar o impacto de um programa de atividade física integral, respeito da motricidade de grande porte de crianças com diversidade funcional. Materiais e métodos. A pesquisa é abordada por meio de um delineamento quase-experimental com uma turma experimental, utilizando medidas pré-teste e pós-teste. A metodologia utilizada é quantitativa descritiva, implementando o Teste Gross Motor Function Measure (GMFM 88) e duas entrevista de avaliação pessoal. Resultados. A análise de dados revela melhorias estatisticamente significativas (p<0,001) na motricidade de grande porte nas crianças, tanto globalmente quanto em cada uma das categorias do teste. Igualmente, as entrevistas forneceram informação relevante respeito da opinião dos docentes e pais/representantes. Conclusões. Os resultados dos testes estatísticos não deixam margem para dúvidas respeito a melhoria da motricidade de grande porte nas crianças. Da mesma forma, as entrevistas refletem um grau elevado de satisfação, além de destacar os benefícios na função cognitiva e na aprendizagem.
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Objective@#To observe the effect of combining whole body vibration with botulinum neurotoxin A injections on tiptoe and the gross motor function of children with spastic diplegic cerebral palsy.@*Methods@#Sixty spastic diplegic children with tipped foot aged between 2 to 5 were equally divided into a control group and an experimental group randomly. The control group received 3 IU/kg botulinum neurotoxin A injections to the medial and lateral heads of the gastrocnemius muscle. Then 5 daily courses of conventional training were administered 5 days a week for 3 weeks beginning 24 hours after the injections. The experimental group additionally received 2min of whole body vibration 3 or 4 times per day with one-minute rests, 5 days per week for 5 weeks. All of the children were assessed before the experiment and 1, 3 and 6 months later using the modified Tardieu scale (MTS) and the R1 and R2 ankle and dimensions D and E of the gross motor function measurement scale (GMFM-88).@*Results@#There were no significant differences between the two groups before the treatment. Afterward, the average MTS, R1, R2 and GMFM-88 scores of both groups were significantly improved. The average MTS, R1 and R2 scores of the experimental group after treatment were significantly better than the control group′s averages. The average GMFM-88 score of the experimental group was not significantly different from that of the control group after 1 month, but after 3 and 6 months significant differences emerged.@*Conclusion@#Whole body vibration improves the effectiveness of botulinum neurotoxin A injections in relieving tiptoe and improving the gross motor function of children with spastic diplegic cerebral palsy.
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Objective@#To explore the effect of sleep nursing intervention on infants' sleep status and gross motor development.@*Methods@#Eighty-nine normal infants aged 8-9 months were randomly divided into two groups: experimental group (n=45) and control group (n=44). The control group received general family nursing intervention, while the experimental group received sleep nursing intervention.The whole intervention lasted for 56 consecutive natural days.Before and after the intervention, polysomnography (PSG) was used to monitor the electrophysiology during sleep, and Gesell development assessment scale was used to assess the gross motor development of the subjects.@*Results@#There were no significant difference in sleep duration ((79.6±15.0)min, (78.3±20.4)min), REM sleep ((28.3±5.9)%, (28.2±9.0)%), NREM sleep((71.2±3.6)%, (72.6±5.1)%), deep sleep ((13.0±2.7)%, (13.6±3.7)%), sleep latency ((9.1±3.6)min, (8.7±2.9)min)and sleep efficiency ((78.6±1.9)%, (84.4±5.5)%)before and after the intervention in the control group (all P>0.05). The sleep duration ((82.7±13.4) min, (95.6±12.1) min), the proportion of deep sleep((10.4±4.7)%, (16.6±3.0)%), the proportion of NREM period((74.9±1.6)%, (76.9±1.0)%), the sleep efficiency((82.3±2.6)%, (89.4±3.7)%) in the experimental group were significantly different before and after the intervention(P<0.05). The differences value of the total sleep duration, NREM sleep proportion, deep sleep proportion and sleep efficiency before and after the intervention in the experimental group were significantly higher than those in the control group (P<0.05). The difference value of gross motor development between the two groups before and after intervention was statistically significant (test group (6.0±3.0), control group (2.0±1.5), t=4.687, P<0.05).@*Conclusion@#Sleep nursing intervention can improve the proportion of deep sleep in infants and improve the development level of gross exercise.The community health service can make sleep nursing intervention plan according to different families and infants' psychological development to optimize infants' deep sleep and promote the level of gross motor development.
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Objective To explore the effect of sleep nursing intervention on infants' sleep status and gross motor development. Methods Eighty-nine normal infants aged 8-9 months were randomly divided into two groups:experimental group (n=45) and control group (n=44). The control group received general fami-ly nursing intervention,while the experimental group received sleep nursing intervention. The whole interven-tion lasted for 56 consecutive natural days. Before and after the intervention,polysomnography ( PSG) was used to monitor the electrophysiology during sleep,and Gesell development assessment scale was used to as-sess the gross motor development of the subjects. Results There were no significant difference in sleep du-ration ((79. 6±15. 0) min,(78. 3± 20. 4) min),REM sleep (( 28. 3 ± 5. 9)%,( 28. 2 ± 9. 0)%),NREM sleep((71. 2 ± 3. 6)%,( 72. 6 ± 5. 1)%),deep sleep (( 13. 0 ± 2. 7)%,( 13. 6 ± 3. 7)%),sleep latency ((9. 1±3. 6)min,(8. 7±2. 9)min)and sleep efficiency ((78. 6±1. 9)%,(84. 4±5. 5)%) before and after the intervention in the control group (all P>0. 05). The sleep duration ((82. 7±13. 4) min,(95. 6±12. 1) min),the proportion of deep sleep (( 10. 4 ± 4. 7)%, ( 16. 6 ± 3. 0)%),the proportion of NREM period ((74. 9±1. 6)%,(76. 9±1. 0)%),the sleep efficiency(( 82. 3± 2. 6)%,(89. 4± 3. 7)%) in the experi-mental group were significantly different before and after the intervention(P<0. 05). The differences value of the total sleep duration,NREM sleep proportion,deep sleep proportion and sleep efficiency before and after the intervention in the experimental group were significantly higher than those in the control group (P< 0. 05). The difference value of gross motor development between the two groups before and after intervention was statistically significant (test group (6. 0±3. 0),control group (2. 0±1. 5),t=4. 687,P<0. 05). Conclu-sion Sleep nursing intervention can improve the proportion of deep sleep in infants and improve the devel-opment level of gross exercise. The community health service can make sleep nursing intervention plan ac-cording to different families and infants' psychological development to optimize infants' deep sleep and pro-mote the level of gross motor development.
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@#Children with dyslexia are commonly associated with gross motor difficulties. However, this non-literacy symptom is often overlooked as an important feature of dyslexia. Therefore, the aims of this study were to determine gross motor skills status among children with dyslexia and to compare the gross motor skills between younger and older children. A cross-sectional study was conducted on children with dyslexia from government schools and Dyslexia Association Malaysia. The participants were divided into two groups, namely younger (4 to 10 years) and older children (11 to 17 years old), and were recruited randomly. The gross motor skills were measured using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) (subtests: Body Coordination, and, Strength and Agility) and the Movement Assessment Battery for Children, Second Edition (MABC-2) (subtest: Aiming and Catching). Standard scores and percentile rankings were used for statistical analysis. A total of 82 children with dyslexia were recruited for this study, consisted of younger (n = 57) and older groups of children (n = 25). The younger children were found to have a significantly lower performance in gross motor skills in Body Coordination (Mdn = 48, IQR = 26-63), compared to the older children, (Mdn = 54, IQR = 30-77), with a small effect size (r = -.25). There were no significant different for other findings. The older children were found to demonstrate the highest level of gross motor skills. This study may suggest the need for an early intervention program for young age children with dyslexia. Future studies that assess gross motor skills using longitudinal design are recommended to investigate the changes in gross motor performance over time.
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OBJECTIVE@#To explore the effect of selective lumbosacral posterior rhizotomy(SPR) on lower limb spasticity and gross motor function in patients with cerebral palsy.@*METHODS@#From January 2018 to October 2018, 47 patients with cerebral palsy were treated with rehabilitation alone and SPR combined with rehabilitation. According to whether SPR was performed, the patients were divided into group A and group B. Group A was treated with rehabilitation combined with SPR at lumbosacral level, and group B was treated with rehabilitation alone. There were 23 cases in group A, including 15 males and 8 females, with an average age of (7.30±3.25) years old; 24 cases in group B, 13 males and 11 females, with an average age of (7.00±3.09) years old. Forty-seven patients were assessed with modified Ashworth(MAS) and Gross Motor Function Scale(GMFM-88 items) before and after treatment. The changes of MAS and GMFM-88 scores before and after treatment were compared to evaluate the degree of spasm and the improvement of gross motor function in the two groups.@*RESULTS@#All 47 patients were followed up. At 6 months after treatment, the MAS classification of the two groups was significantly improved(<0.05), and the improvement of group A was more obvious than that of group B(<0.05). Six months after treatment, the D, E and total scores of GMFM-88 between two groups were significantly improved compared with those before operation(<0.05). The improvement of D and total scores in group A was more obvious than that in group B. There was no significant difference in the improvement of area E between two groups.@*CONCLUSIONS@#Selective posterior rhizotomy combined with rehabilitation can significantly improve the spastic state and gross motor function of lower limbs in children with cerebral palsy, and can effectively promote the reconstruction and recovery of motor function of lower limbs in children with cerebral palsy.
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Child , Child, Preschool , Female , Humans , Male , Cerebral Palsy , General Surgery , Lower Extremity , Movement , Muscle Spasticity , RhizotomyABSTRACT
OBJECTIVE@#To explore the therapeutic effect of acupuncture for spastic cerebral palsy in infancy stage.@*METHODS@#A total of 62 children with spastic cerebral palsy were randomized into an observation group and a control group, 31 cases in each one. Both groups were given comprehensive rehabilitation therapy (sport therapy, electronic biofeedback therapy, speech cognitive training, massage therapy). On the basis of comprehensive rehabilitation therapy, the acupuncture group was treated with acupuncture at Baihui (GV 20), Sishencong (EX-HN1), motor area, Jiaji (EX-B 2), Weizhong (BL 40), Xuanzhong (GB 39), Zusanli (ST 36) and Hegu (LI 4), etc, the needles were retained for 15-20 min each time, once a day, 5 days a week, 45 days as a course with 10 days interval, a total of 3 courses were required. The Gesell development scale adaptive DQ scores, gross motor function measure (GMFM88) and muscular tension of adductor and gastrocnemius muscle were compared before and after treatment in the two groups.@*RESULTS@#The Gesell development scale adaptive DQ score after treatment in the observation group was increased (0.05), the change of the observation group was larger than the control group (0.05).@*CONCLUSION@#Acupuncture combined with comprehensive rehabilitation therapy can improve cognitive function, spasticity and motor function of children with spastic cerebral palsy.
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Child , Humans , Infant , Acupuncture Points , Acupuncture Therapy , Cerebral Palsy , Therapeutics , Muscle Spasticity , NeedlesABSTRACT
Objective To explore the development and clinical effect of weight_adjustable suit for children with dyskinetic cerebral palsy. Methods Twenty_six cerebral_palsy children with involuntary movement admitted to the Third Hospital Affiliated to Jiamusi University from March to October 2016 were randomly divided into the observa_tion group and the control group,13 cases in each group. The control group was treated with routine rehabilitation trai_ning. The observation group was put on adjustable heavy clothes besides conventional rehabilitation. Before and after treatment,childrenˊs functional independence and gross motor function were assessed and compared by using Wee Punc_tional Independence Measure(Wee_PIM)and Gross Motor Punction Rating Scale(GMPM_88). Results After treat_ment the Wee_PIM score of the control group was(43. 24 ± 5. 58),the GMPM score was(61. 81 ± 9. 46),the Wee_PIM score of the observation group was(50. 21 ± 6. 03),and the GMPM score was(65. 73 ± 10. 17). There were sig_nificant differences between the two groups(P〈0. 05),while the scores of the observation group were significantly higher than those of the control group,and the difference was significant(t﹦2. 582,2. 346,all P〈0. 05). Conclusions The adjustable heavy suit can effectively improve the functional independence and gross motor function of cerebral palsy children with involuntary movement and their comprehensive ability,and it is worth trying clinically.
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Objective To observe the effect of combining whole body vibration with botulinum neurotoxin A injections on tiptoe and the gross motor function of children with spastic diplegic cerebral palsy. Methods Sixty spastic diplegic children with tipped foot aged between 2 to 5 were equally divided into a control group and an ex-perimental group randomly. The control group received 3 IU/kg botulinum neurotoxin A injections to the medial and lateral heads of the gastrocnemius muscle. Then 5 daily courses of conventional training were administered 5 days a week for 3 weeks beginning 24 hours after the injections. The experimental group additionally received 2min of whole body vibration 3 or 4 times per day with one-minute rests, 5 days per week for 5 weeks. All of the children were assessed before the experiment and 1, 3 and 6 months later using the modified Tardieu scale ( MTS) and the R1 and R2 ankle and dimensions D and E of the gross motor function measurement scale ( GMFM-88) . Results There were no significant differences between the two groups before the treatment. Afterward, the average MTS, R1, R2 and GMFM-88 scores of both groups were significantly improved. The average MTS, R1 and R2 scores of the experimental group after treatment were significantly better than the control group' s averages. The average GMFM-88 score of the experimental group was not significantly different from that of the control group after 1 month, but after 3 and 6 months significant differences emerged. Conclusion Whole body vibration improves the effectiveness of botulinum neurotoxin A injections in relieving tiptoe and improving the gross motor function of chil-dren with spastic diplegic cerebral palsy.