THE RELATIONSHIP BETWEEN THE FUNCTIONALITY OF CHILDREN WITH DISABILITIES AND ITS EFFECTS ON PARENTS DURING THE COVID-19 PANDEMIC PROCESS.

Purpose: The aim of this study was to investigate the relationship between the functionality of disabled children and its effects on parents during the Covid-19 pandemic. Method(s): A total of 168 people, including 84 disabled children and 84 mothers, were included in the study. The Pediatric Disability Assessment Inventory (PEDI) and Gross Motor Function Classification System (GMFCS) were used for children with disabilities. The Zarit Burden Scale (ZBS), Fatigue Severity Scale (FSS) and The Nordic Musculoskeletal Questionnaire (NMQ) were applied to the mothers to question musculoskeletal disorders. Result(s): There was no correlation between care burden score and PEDI, total score, self-care and mobility scores (p>0.05). A moderately negative (r=-0.306;p<0.01) significant linear relationship was found between care burden score and social function score. There was no significant linear relationship between the fatigue severity score and PEDI total score, self-care, mobility and social function scores (p>0.05). No correlation was found between care burden score and fatigue severity score (p>0.05). For the last 12 months, only the pain in the lumbar region of the parents prevented them from doing their usual work. It was determined that the most aching body parts of the parents who complained of musculoskeletal pain during the last 12 months were in the waist, neck, shoulder, back, and knee regions. Conclusion(s): As a result, no relationship was found between the functionality of disabled children and their parents' influences during the Covid-19 pandemic.Copyright © 2022 Turkish Physiotherapy Association. All rights reserved.

Swimming × Online Coaching: Online Conditioning of Competitive Swimmers - Focusing on the Thorax - via Smartphones and Wearable Sensors

In response to the decline in motor function (centered on the thorax) caused by chronic muscle tension associated with strengthening exercises for competitive swimmers, we devised a training program that promotes awareness of the functional coordination of the thorax;spine, ribs, and core muscles, and restores natural and efficient body movement. This article presents the results of supporting athlete training during the novel coronavirus pandemic by providing regular coaching remotely using a web-conference system with smartphones, video recording, and a multi-sensor belt equipped with hitoe™ for measuring myoelectricity, respiration, and motion. © 2022 Nippon Telegraph and Telephone Corp.. All rights reserved.

Therapeutic Effects of Metaverse Rehabilitation for Cerebral Palsy: A Randomized Controlled Trial.

Metaverse physical therapy (MPT), an adjuvant technology for the rehabilitation of children with cerebral palsy (CP), has gained notoriety in the clinical field owing to its accessibility and because it provides motivation for rehabilitation. The aim is to compare the gross motor function and cardiopulmonary function, the activities of daily living, quality of life (QOL), and the perceived risk of coronavirus disease (COVID)-19 transmission between MPT and conventional physical therapy (CPT). A convenience sample of 26 children with CP (mean age, 11.23 ± 3.24 years, 14 females) were randomized into either the MPT or CPT group and received therapy three days/week for four weeks. Clinical outcomes included gross-motor-function measure 66 (GMFM-66), heart rate (HR), Borg-rating perceived exertion (BRPE), functional independence measure (FIM), pediatric QOL, and the risk of COVID-19 transmission. An analysis of variance showed that compared with CPT, MPT exerted positive effects on GMFM, HR, and BRPE. An independent t-test showed that compared with CPT, MPT exerted positive effects on the perceived transmission risk of COVID-19 but not on FIM and QOL. Our results provide promising therapeutic evidence that MPT improves gross motor function, cardiopulmonary function, and the risk of COVID-19 in children with CP.

Long-term efficacy of nusinersen and its evaluation in adolescent and adult patients with spinal muscular atrophy types 1 and 2.

BACKGROUNDS: The efficacy of nusinersen and its evaluation in patients with spinal muscular atrophy (SMA) has been established in clinical trials only for pediatric patients, not for adolescent and adult patients who developed SMA in infancy or early childhood. We report a long-term follow-up in adolescent and adult patients with SMA types 1 and 2. METHODS: Nusinersen-treated patients with SMA types 1 and 2 between 2017 and 2022 were retrospectively reviewed. We compared baseline motor function tests with those after the final treatment. Physical and occupational therapists performed Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND), Hammersmith Functional Motor Scale-Expanded (HFMSE), and Revised Upper Limb Module (RULM). The Landau and Galant reflexes were not performed in CHOP-INTEND. Meaningful improvement was defined as CHOP-INTEND, 4; HFSME, 3; and RULM, 2. RESULTS: Seven patients with SMA (type 1, 1; type 2, 6) with a median age of 23 (range, 12-40)years were treated with nusinersen for 3.55 (1.78-4.53)years. Improvement was detected in CHOP-INTEND (pre, 5 [0-31]; post, 21 [0-39]; difference, 5 [0-26]; p = 0.100) without significance, although not in HFMSE (pre, 0 [0-3]; post, 0 [0-5]; difference, 0 [0-2]; p = 0.346) and RULM (pre, 1 [0-20]; post, 3 [0-21]; difference, 1 [0-2]; p = 0.089). Owing to prolonged treatment intervals with the COVID-19 pandemic, RULM worsened in two patients. CONCLUSION: Nusinersen was effective in long-term follow-up. Only CHOP-INTEND showed meaningful improvement. The interval between doses of nusinersen should not be prolonged even with the COVID-19 pandemic.

Effects of COVID-19 related physical inactivity on motor skills in children with intellectual disability.

BACKGROUND: Children with intellectual disabilities (ID) may show declines in motor skills during the Covid-19 restrictions. This study compared the effects of physical inactivity due to COVID-19 on the motor skills of active and inactive children with ID. METHOD: In this prospective cohort study, 30 boys with ID were divided into two groups based on study inclusion criteria (mean age 10.86 ± 1.81 active, 10.20 ± 1.42 inactive). The BESS test, the Y test, the Timed Up and Go (TUG) test, and the Bruininks-Oseretsky test-short form were used. RESULTS: Results showed a significant difference between active and inactive groups in the total score of gross motor skills (P = 0.001), fine motor skills (P = 0.002), motor skills (P = 0.001), postural control (P = 0.01), and dynamic balance (P = 0.01). CONCLUSIONS: The results showed a significant difference between active and inactive children with ID in terms of gross and fine motor skills after a one-year movement restriction. Therefore, considering the tendency to be sedentary among these people and the subsequent complications caused by this inactivity, including obesity and chronic diseases, it is suggested that parents and educators design practical and numerous exercises and encourage them to be more active and participate in physical activity programs.

Implementation of a telerehabilitation program for children with neurodevelopmental disorders during the lockdown caused by COVID-19

Introduction: Telerehabilitation is a tool for patients who, for different reasons, cannot participate in person with their physical presence. We aimed to identify the factors associated with satisfaction with telerehabilitation in families with children with neurodevelopmental disorders through a program that included physiotherapy, occupational therapy, and speech therapy. Methods: The program was developed during the COVID-19 lockdown period. Outcome measures: Child's age, the school stage to which they belonged, the person of reference in their daily care at home. The resources provided to the families, as well as the frequency of activities and difficulties detected, were evaluated through a survey. Findings: One hundred thirteen families responded to the survey. The general assessment resources were classified as very good. The average frequency of carrying out the activities was two times a week, with an average of 30 minutes per session. The ability to understand the information in the manual was not affected by the academic status of the caregivers (p = 0.286). Conclusions: This is the first study to quantify the multidisciplinary approach to children with neurodevelopmental disorders using telerehabilitation. The results show high levels of participation and satisfaction. The resources could be shared for their applicability in other countries whose families have similar needs conditioned by COVID-19.

Systematic Review Examining the Effect of Vitamin D Supplementation on Outcomes Post Stroke

Objective(s): The objective of this systematic review was to explore the effect of vitamin D supplementation on functional outcomes among individuals post stroke(PROSPERO CRD42022296462). Data Sources: MEDLINE, PsycInfo, EMBASE, and CINAHL were searched for articles published in any language from database inception to January 5, 2022. Study Selection: Only interventional studies assessing vitamin D supplementation compared to placebo or usual care in adult stroke patients were selected. After duplicate removal, 2,825 studies were screened by two independent reviewers. A total of 41 studies underwent full text review;8 studies met inclusion criteria (6 randomized controlled trials [RCTs] and 2 observational studies). Data Extraction: Data were extracted by two independent reviewers using Covidence software. Motor function (Brunnstrom Recovery Stage, Berg Balance Score), mobility (Functional Ambulation Category), activities of daily living (Barthel Index, Functional Independence Measure) and stroke impairment (Modified Rankin Scale, National Institutes for Health Stroke Severity, Scandinavian Stroke Severity) were the outcome measures of interest included in the studies. Data Synthesis: In total, 562 patients were studied for which 9 of 13 outcome measures showed improvement with vitamin D supplementation. Conclusion(s): The majority of studies showed an improvement in motor function, mobility, and stroke impairment with vitamin D supplementation;however, the evidence did not support an improvement in activities of daily living with treatment. Strong, methodologically sound RCTs are required to verify these findings. Author(s) Disclosures: None. Copyright © 2022

Enhancing Physical Activity Self-efficacy in Adolescents with Physical Disability Through Virtual Peer Health Coaching: Feasibility Results

Background and/or Objectives: We evaluated the feasibility of implementing a virtual peer health coaching intervention which aimed to increase physical activity behaviors in adolescents with cerebral palsy and spina bifida. Design(s): Pilot randomized-control trial of the peer health coaching intervention versus usual care, with follow-up throughout the 3-month intervention period and at 3 months post-intervention. Setting(s): Recruitment was performed in pediatric cerebral palsy and spina bifida clinics. The intervention took place virtually during the COVID-19 pandemic. Participant(s): Participants were adolescents 12-17 years old with cerebral palsy (gross motor function classification system levels II or III) or spina bifida with motor impairment with intentions of physical activity engagement. Intervention(s): Weekly 30-minute virtual sessions consisting of physical activity-focused coaching over 3 months. Main Outcome Measure(s): Feasibility outcome measures evaluated recruitment (goal >10% recruitment rate), stratification (goal for well-balanced intervention/ control groups with regard to age, gender, diagnosis), attrition (goal 80% completion of study), and engagement/ intervention adherence (goal completion of at least 8 peer health coach sessions). Result(s): A total of 68% (25/37) of eligible individuals were enrolled and randomized, including 19 individuals with cerebral palsy (9 control (5 female, 4 male), 10 intervention (5 female, 5 male)) and 6 individuals with spina bifida (2 control (1 female, 1 male), 4 intervention (2 female, 2 male)). The mean age of participants was 14 for both control (range 12-16) and intervention (range 12-17) groups. A total of 86% of participants (12/14) completed the intervention with 79% (11/14) completing at least 8 peer health coaching sessions, including 10/11 (91%) of individuals with cerebral palsy and 2/4 (50%) of individuals with spina bifida. Conclusion(s): Amidst societal integration of virtual modes of interaction due to the COVID-19 pandemic, this pilot study demonstrated excellent feasibility of implementing a virtual peer health coaching intervention to influence physical activity behaviors in adolescents with physical disabilities, particularly in those with cerebral palsy.

Quick Clinical Outcome Assessments

The Covid-19 pandemic has highlighted the diffi- culty in the management of neuromuscular patients and the need for continued implementation of the standard of care. With the new pandemia psychometrically robust but quick outcome measures are needed to monitor patients' clinical status. The slow progressive nature of several muscle disorders and the wide pattern of involvement in muscular dystrophies and myopathies make it difficult to establish the prognosis, predict clinical evolution and perform trials and define the impact of natural history, and use new therapies that are becoming available. We constructed a motor function test that is easy and quick to use. This quick Motor Function test: Gait, Stair, Gower's, Chair (GSGC) was constructed based on the clinical expertise of several physicians involved in the care of DMD;LGMD, and Pompe patients. The GSGC score can be integrated by the use of the motor function of the upper motor limbs with the arm function test (GSGCA). It consists of a simple standardized functional test which grades the ability of the patient to raise their upper arms over the head. Grade 0 corresponds to a full circle of arm abduction, while with grade 6 the patients cannot raise their arms to their mouth and effectively use their hands. The Gardner-Medwin Walton (GMW) scale even modifi ed appears in comparison rather insensitive. The GSGC test includes 4 items. The test provides a detailed picture of motor function by including a quantitative measure of four performances i.e. time to perform four activities: Gait =walking for 10 meters, S=climbing 4 steps on a Stair, G= Gower's maneuver, C= rising from a Chair (Figure) The GSGC final score is obtained by adding the grades of the four functional tests and ranges from a minimum of 4 (normal performance) to a maximum of 27 (worst performance).GSGCA test includes 5 tests (total score from 5 to 32). Validity and test reliability were determined in a cohort of 9 adult Pompe patients (15 to 54 years of age) and then validated in 40 LOPD cases by a collaborative group. The responsiveness of the GSGCA scale to changes in clinical course over time was examined in a subgroup of 13 LGMD 2B/R2 untreated patients. Interrater and intrarater reliabilities were most usually confirmatory. The motor outcomes are different in various myopathies and depend on a correct diagnosis, while exercise in myopathy patients should be moderate, but not necessarily discouraged. The muscle MRI imaging might be helpful for follow-up of the proximal or distal muscle involvement, to detect fat, and connective tissue replacement, which might be usually absent in metabolic myopathies, except for LOPD. Diet and exercise in LOPD might be an additional therapeutic option synergistic to ERT. In this presentation, we examine the use of the GSGC scale in LOPD, DMD, and GSGCA scales in the natural history of LGMD R2. The development of smart care using telemedicine and eHealth technologies to share images, clinical data, reports, and video meetings of collaborative groups should be implemented. Keywords: GSGC scale, Covid-19, DMD, LGMD, Pompe.

Telerehabilitation of Post-Stroke Patients with Motor Function Disorders: A Review

Strokeis the main reason for disabilities of increasing geriatric population. It affects brain and motor function domains significantly reducing the life quality. Recent coronavirus pandemic raised a question on changing approaches to deliver post-stroke rehabilitation services to geriatric patients due to their high risk of serious illness. This paper presents an overview of current telerehabilitation approaches for motor function recovery and balance training of post-stroke patients. We used papers from peer-reviewed medical journals on stroke telerehabilitation. The review showed exergames, virtual reality (VR), web-platforms, and applications are extensively used in rehabilitation programs to gain clinical outcomes among geriatric stroke patients. Findings indicate telerehabilitation improves older patients' functional ability via systematic training, positively affecting their life quality. The treatment therapy of older adults using telerehabilitation can be organized synchronously and asynchronously in home-based environment or in-clinic conditions. Telerehabilitation can be used as complementary therapy or as an alternative to conventional treatment. However, further research is required to test a variety of telerehabilitation systems using larger samples of post-stroke geriatric patients.

EFFECT OF TELEREHABILITATION IN FACILITATING UPPER EXTREMITY HOME PROGRAMS AND ASSOCIATED FUNCTIONAL REGAIN AMONG CHRONIC STROKE SURVIVORS: A PILOT STUDY

Background: Stroke is a leading cause of disability in adults, requiring regular patient-therapist contacts to achieve greater functional regain of the affected extremities. Factors such as the recent Covid-19 pandemic have limited access to Rehabilitation services across several communities globally. A proliferation of telerehabilitation to ameliorate these healthcare challenges has been palpable in the recent years across the globe. Purpose: To assess the effect of telerehabilitation in facilitating upper extremity home program and associated functional regain among chronic stroke survivors. Methods: Two groups pretest-posttest study design was employed. Participants were instructed to perform upper extremity home programs three times a week for four weeks. A task-oriented, individually tailored, and intensive home-based telerehabilitation program was administered to the participants using audio calls. Upper extremity functional status was assessed using Fugl-Meyer Motor Assessment, and Wolf Motor Function Test. The Barthel Index was used to assess the extent of activities of daily living. Results: A total number of 14 people were recruited (experimental n=7 age, 58 ± 5.83;control n=7, age 50.71 ± 8.62). Participants showed significant improvement for Fugl-Meyer Motor Assessment changed from 17.57 to 25.86 (p=0.02), whereas Wolf Motor Function Test changed from 28.14 to 43.71 (p=0.03). Conclusions: Amidst situations restricting regular hospital visit among stroke survivors;telerehabilitation could serve as an adjunct therapeutic option for upper extremity rehabilitation. Future studies should employ a randomized controlled trial design with a larger sample size to confirm the utility of telerehabilitation.

How did the COVID-19 pandemic countermeasures affect children with cerebral palsy receiving Botulinum toxin therapy: A single-center study

Introduction: The COVID-19 pandemic caused disruption of follow-up evaluations, physiotherapy and Botulinum toxin treatment (BoNT A) in children with cerebral palsy (CP). The aim of this study was to determine the changes in pain, spasticity level and range of motion in children with spastic CP after the COVID-19 stay-at- home period. Patients and methods: Fifteen children (GMFCS level I-IV, aged 4-12 years) with spastic CP were enrolled in this study. All received BoNT A treatment in October/November 2019, which was followed by physiotherapy. Their next appointments were scheduled for March and April 2020. Due to the COVID-19 outbreak, all of the treatments were canceled, and the children were sent home and advised to perform home-based exercise programs. The children were able to have their next regular check-up in October 2020. Assessments of range of motion (ROM), spasticity and pain levels were done, and the data was compared with data from 2019. Results: The pain and spasticity severity of the participants were significantly increased during the 10-12 months stay-at- home period. Range of motion was significantly decreased, especially dorsiflexion of the foot. Joint contractures and hip dislocation were noted in three cases. Conclusion: The study participants did not comply with the home exercise program in a satisfactory manner. The COVID-19 pandemic has made a detrimental effect on ROM, spasticity and pain in children with CP. Telerehabilitation and online communication with health professionals should be at a higher level in Serbia.

Supporting ultra-poor children with cerebral palsy and their families with integrated microfinance/livelihood and community-based rehabilitation program -a cluster randomized controlled trial

Introduction: This trial aimed to test the efficacy of an integrated microfinance/livelihood and community-based rehabilitation (CBR) (IMCBR) program in improving health-related quality of life (HRQoL) and motor function of children with cerebral palsy (CP) from ultra-poor families and social capital gain to those families from such intervention in rural Bangladesh. Patients and Methods: This was an open-label cluster randomized controlled trial among children with CP aged ≤5 years randomly allocated in three arms;Arm-A: livelihood support and CBR (IMCBR), Arm-B: CBR only and Arm-C: care-as- usual. The CBR was stopped 2.5 months post-enrollment due to the COVID-19 pandemic and was replaced with phone follow-up followed by home-based CBR. The primary outcome was HRQoL of children while Gross Motor Function Classification System (GMFCS) level of children and social capital of their families were the secondary outcomes. Intention-to- treat analysis was performed. Results: Twenty-four clusters including 251 children-primary caregivers' dyads were assigned to three arms;Arm-A = 80, Arm-B = 82 and Arm-C = 89. Between baseline and endline, the percentage change in mean HRQoL was highest in Arm-A (30.0%) with significant mean differences between Arm-A and Arm-B (p = 0.015). The GMFCS level significantly changed both in Arm-A (p = 0.007) and Arm-C (p = 0.011). Also, the improvement in mean total social capital score was significantly higher in Arm-A compared to Arm-B (p <0.001) and Arm-C (p <0.001). Conclusion: The findings suggest that IMCBR could improve HRQoL and motor functions of children with CP and social capital of their ultra-poor families. Long-term follow- up of the trial participants and/or future exploration of such interventions are essential.

Effects of the COVID-19 pandemic on walking activity in youth with cerebral palsy

Objective: The COVID-19 pandemic has necessitated public health measures including school closures and stay-at-home orders. These measures have resulted in decreased physical activity and walking activity (WA). Children with cerebral palsy (CP) have decreased WA compared to typically developing youth. Our objective was to determine how isolation orders have affected WA in children with CP. We hypothesized that children with CP would exhibit decreased WA during the pandemic compared to pre-pandemic. Design: This was an IRB-approved retrospective cohort study. Method: Inclusion criteria were a diagnosis of CP, Gross Motor Function Classification System (GMFCS) levels I-III, and WA monitoring using a StepWatch™ device during the pandemic (3/13/2020 to 10/5/2020) and within two years before the pandemic. Forty-three youth (age 12.0 [4], GMFCS I [7], II [17], III [19]) met the inclusion criteria. WA was compared using paired t-tests before versus during the pandemic across all participants and each GMFCS level. Two case studies were included to demonstrate the effects of remote and hybrid school on WA. The first case is a 15-year-old girl (GMFCS III) who had orthopaedic surgery in December 2018 and underwent WA monitoring in June 2019 and June 2020. The second case is a 14-year-old girl who had no surgical history and underwent WA monitoring in January 2021. Results: Average time between pre-pandemic and pandemic WA monitoring was 9.2 (5.3) months. The overall study group (p < 0.01) and the GMFCS III group (p < 0.05) had a significant reduction in walking activity during the pandemic. The GMFCS I and II groups demonstrated a trend to decreasing WA (p < 0.2), with a majority of children in each group having decreased WA. For the first case, during remote school, a child classified GMFCS III walked less than the non-pandemic GMFCS III average and her most active days changed from weekdays to weekends. For the second case, during hybrid school, the child's WA was drastically higher on days with in-person instruction compared to remote. Conclusion: Children with CP were less active, as evaluated by step count, during the pandemic. Additionally, our case studies demonstrate that in-person school days drive WA. It is important to understand the effects of school closures on activity behaviours and prioritize future work to mitigate negative health effects as we emerge from this crisis.

Supporting ultra-poor children with cerebral palsy and their families with integrated microfinance/livelihood and community-based rehabilitation: A cluster randomized controlled trial

Objective: This study aimed to test the effectiveness of an 'integrated microfinance/livelihood and community-based rehabilitation (CBR)' (IMCBR) program in improving quality of life and physical ability of children with cerebral palsy (CP), mental health of primary caregivers and social/economic capital of ultra-poor families of children with CP in rural Bangladesh. Design: Open-label pragmatic randomized controlled trial (registration: ACTRN12619001750178). Method: Children with CP aged ≤5 years were recruited in three arms: Arm-A: IMCBR, Arm-B: CBR, and Arm-C: control (i.e. care as usual). Each arm had eight clusters of 10-14 child-caregiver dyads. Caregivers recruited in the Arm-A received livelihood support (e.g., goat/lamb/poultry) and their children with CP received CBR once a week. The child-caregiver dyads in Arm-B received CBR only. The control Arm did not receive any intervention. However, CBR was stopped at 2.5 months of intervention due to COVID-19 pandemic and weekly phone follow-up was completed for home-based CBR. TNO-AZL Preschool children Quality of Life (TAPQoL), Gross Motor Function Classification System (GMFCS) and Communication Function Classification System (CFCS) were used to assess quality of life, motor function and communication of children, respectively. Depression, Anxiety, Stress Scale-Short Form-21 (DASS-21) was used to assess depression, anxiety and stress of primary caregivers. Results: Out of 251 children with CP and their caregivers recruited at baseline, 233 children and primary caregivers (Arm-A: n = 74, Arm-B: n = 77, and Arm-C: n = 82 dyads) completed the 12 month trial. The mean values of livelihood items given per family in Arm A increased from ∼USD66 to ∼USD79 between 0month(m) and 12m (p = 0.066), respectively. The mean TAPQoL score for physical functioning significantly increased between 0m and 12m in all three Arms (p < 0.001, p = 0.017 and p < 0.001 in Arm A, Arm B and Arm C, respectively), however, the improvement in the score was highest in Arm A. Similarly, significant improvement in the GMFCS level was observed between 0m and 12m in all three Arms with the highest improvement in Arm A (p < 0.001). Children's CFCS levels deteriorated slightly at 12m follow up in all three Arms. The depression, anxiety and stress levels among primary caregivers of children reduced significantly between the 0m and 12m in all three Arms (p ≤ 0.001 for all). Conclusion: Our findings suggest that the IMCBR is effective in enhancing quality of life and motor functions of children with CP, mental health of primary caregivers and economic status of ultra-poor families.

PartiCipa Brazil: Preliminary results of differences in physical activity levels in children and adolescents with cerebral palsy

Objectives: Children and adolescents with cerebral palsy (CP) presents lower physical activity levels in comparison with typically development peers, leading to sedentary behaviours and poor endurance. Up to now, there is no information of the physical activity levels among Brazilian children and adolescents with CP and its comparison among different Gross Motor Function Classification System (GMFCS) levels. The aims of this study were to characterise levels of physical activity in Brazilian individuals with CP and analyse differences between GMFCS levels. Design: Cross-sectional study. Preliminary data from a multicentric prospective study 'Functioning curves and trajectories for children and adolescents with cerebral palsy in Brazil: PartiCipa Brazil'. Method: Parents and caregivers of 52 children and adolescents with CP (mean age 7.5±3.5) participated in an online interview. Participants filled out an online form that included the GMFCS Family Report and the 4-item Early Activity Scale for Endurance (EASE) for children and adolescents. The interview was conducted by a trained physical therapist. One-way analysis of variance (ANOVA) was used to identify differences among physical activity levels according to the EASE in the five different GMFCS levels, considering an alpha = 0.05 as statistically significant. This study was approved by the ethics committee (CAAE: 28540620.6.1001.5133). Results: Of the 52 participants, 17.3% were classified as GMFCS level I, 30.8% level II, 11.5% level III, 15.4% level IV, and 25.0% level V. Overall Brazilian participants' EASE mean scores were 2.92 ±1.96. EASE mean scores by each GMFCS levels were 4.13±0.70 for GMFCS level I, 2.98±0.91 level II, 3.16±0.70 level III, 2.68±1.0 level IV, and 2.92±1.06 level V. There were statistically significant differences on physical activity levels among the GMFCS groups (p > 0.01). Post-hoc analysis via Tukey test, indicated that these differences were between individuals GMFCS level I and levels IV (p > 0.01). No other statistically significant differences among the remaining GMFCS levels were found. Conclusion: Overall, Brazilian children and adolescents with CP present low levels of physical activity, with differences seen amongst the GMFCS levels. The main differences were presented between those children and adolescents with higher mobility levels and those with more restricted mobility. The presented results might be influenced by COVID-19 related social isolation. Further data will confirm this results and present physical activity curves of Brazilian children and adolescents with CP.

Recent trends in telerehabilitation of stroke patients: A narrative review.

BACKGROUND: Stroke is the main reason for disabilities worldwide leading to motor dysfunction, spatial neglect and cognitive problems, aphasia, and other speech-language pathologies, reducing the life quality. To overcome disabilities, telerehabilitation (TR) has been recently introduced. OBJECTIVE: The aim of this review was to analyze current TR approaches for stroke patients' recovery. METHODS: We searched 6 online databases from January 2018 to October 2021, and included 70 research and review papers in the review. We analyzed TR of 995 individuals, which was delivered synchronously and asynchronously. RESULTS: Findings show TR is feasible improving motor function, cognition, speech, and language communication among stroke patients. However, the dose of TR sessions varied significantly. We identified the following limitations: lack of equipment, software, and space for home-based exercises, insufficient internet capacity and speed, unavailability to provide hands on guidance, low digital proficiency and education, high cognitive demand, small samples, data heterogeneity, and no economic evaluation. CONCLUSIONS: The review shows TR is superior or similar to conventional rehabilitation in clinical outcomes and is used as complementary therapy or as alternative treatments. More importantly, TR provides access to rehabilitation services of a large number of patients with immobility, living in remote areas, and during COVID-19 pandemic or similar events.

Management of Spinal Muscular Atrophy in the Adult Population.

Spinal muscular atrophy (SMA) is a group of neurodegenerative disorders resulting from the loss of spinal motor neurons. 95% of patients share a pathogenic mechanism of loss of survival motor neuron (SMN) 1 protein expression due to homozygous deletions or other mutations of the SMN1 gene, with the different phenotypes influenced by variable copy numbers of the SMN2 gene. Advances in supportive care, disease modifying treatment and novel gene therapies have led to an increase in the prevalence of SMA, with a third of SMA patients now represented by adults. Despite the growing number of adult patients, consensus on the management of SMA has focused primarily on the pediatric population. As the disease burden is vastly different in adult SMA, an approach to treatment must be tailored to their unique needs. This review will focus on the management of the adult SMA patient as they age and will discuss proper transition of care from a pediatric to adult center, including the need for continued monitoring for osteoporosis, scoliosis, malnutrition, and declining mobility and functioning. As in the pediatric population, multidisciplinary care remains the best approach to the management of adult SMA. Novel and emerging therapies such as nusinersen and risdiplam provide hope for these patients, though these medications are of uncertain efficacy in this population and require additional study.

[The specificities of the interventions of physiotherapists in intensive care]. / Les spécificités des interventions des masseurs-kinésithérapeutes en réanimation.

The intervention of physiotherapists in the intensive care unit allows the optimisation of the care project through the assessment and management of the motor, respiratory and swallowing functions of patients. If COVID-19 has only slightly modified the practice of these professionals, the impact of the pandemic on intensive care units has reinforced the added value of their care.

[Is the implementation of Vojta therapy associated with faster gross motor development in children with cerebral palsy?] / Segíti-e a cerebralis paresisben szenvedo gyermekek bruttó motoros funkcióinak fejlodését a Vojta-módszer?

BACKGROUND AND PURPOSE: Vojta therapy has been reported as clinically beneficial for strength, movement and gross motor activities in individual cases and is being included within the second of three levels of evidence in interventions for cerebral palsy. The goal of this study is to understand the effect of Vojta therapy on the gross motor function. METHODS: Our clinical trial followed a one group, pre-post design to quantify rates of changes in GMFM-88 after a two-months period undergoing Vojta therapy. RESULTS: A total of 16 patients were recruited. Post-intervention acceleration rates of GMFM-88-items acquisition (0.005; p<0.001) and Locomotor Stages (1.063; p<0.0001) increased significatively following Vojta the-rapy intervention. CONCLUSION: In this study, Vojta therapy has shown to accelerate the acquisition of GMFM-88-items and Loco-motor Stages in children with cerebral palsy younger than 18 months. Because functional training was not utilised, and other non-Vojta therapy intervention did not influence the outcome, Vojta therapy seems to activate the postural control required to achieve uncompleted GMFM-88-items.