Capacidades físicas y motoras de miembro superior y su relación con la independencia funcional en parálisis cerebral infantil / Physical and motor skills of upper limb and its relation with functional independence in childhood cerebral palsy

Objetivo: Analizar las capacidades físicas de miembro superior y su relación con el nivel funcional en parálisis cerebral infantil (PCI). Material y métodos: Estudio descriptivo. Los participantes fueron niños diagnosticados de PCI escolarizados en colegios de educación especial. Las capacidades física y motora fueron evaluadas mediante la destreza manual, fuerza y rango de movimiento activo. Resultados: La muestra final estuvo compuesta por 31 niños con PCI escolarizados. Se dividieron en 2 grupos según el nivel funcional de los miembros superiores mediante la escala MACS. El grupo de menor afectación (n=18) englobaba los valores I y II de la MACS, mientras que el grupo de mayor afectación recogió los valores III, IV y V (n=13). Se encontraron diferencias significativas entre grupos en las variables GMFCS (p = 0,009), capacidad de movilidad evaluada con el PEDI (p = 0,016), en la destreza manual de la mano dominante evaluada con Nine Hole Peg Test (p=0,004), fuerza de la pinza de la mano no dominante (p=0,042), rango de movimiento activo de la articulación de la muñeca de ambas manos, postura al escribir y total de números escritos. Conclusiones: Los niños con PCI presentan una afectación de las capacidades motoras y funcionales. La afectación de la fuerza de la pinza digital, la destreza y la movilidad activa de la muñeca mostraron gran repercusión en la ejecución de las actividades de la vida diaria. Estrategias terapéuticas centradas en estas habilidades pueden resultar en mejores tasas de independencia funcional

Objective: to analyse upper limb physical and motor skills of and their relation with functional independence in childhood cerebral palsy. Material and methods: Descriptive survey. Participants were children diagnosed with childhood cerebral palsy (CCP) enrolled in special education schools. Physical and motor skills were evaluated through manual dexterity, strength and active range of motion. Results: The final sample consisted of 31 children with CCP. They were divided in two groups according to the functional level of the upper limbs using MACS scale. The less affected group (n=18) encompassed the MACS's values I and II, while the group most affected collected values III, IV and V (n=13). Significant differences were found between groups in the variables GMFCS (P=.009), assessed mobility capacity using PEDI (P =.016) in the manual dexterity of the dominant hand assessed Nine Hole Peg Test (P=.004), clamp force of the non-dominant hand (P=.042), active range of motion of the wrist joint in both hands, typing position and total numbers written. Conclusions: Children with CCP show a motor and functional skills’ affectation. The strength of the digital clamp's affectation, the dexterity and the wrist's active mobility showed great impact on the implementation of the Activities of Daily Living. Therapeutic strategies focusing on these skills can result in best rates of functional independence

Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study.

PURPOSE: Despite growing evidence regarding nonsynostotic plagiocephaly and their repercussions on motor development, there is little evidence to support the use of manual therapy as an adjuvant option. The aim of this study was to evaluate the effects of a therapeutic approach based on manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly. METHODS: This is a randomised controlled pilot study. The study was conducted at a university hospital. Forty-six infants with severe nonsynostotic plagiocephaly (types 4-5 of the Argenta scale) referred to the Early Care and Monitoring Unit were randomly allocated to a control group receiving standard treatment (repositioning and an orthotic helmet) or to an experimental group treated with manual therapy added to standard treatment. Infants were discharged when the correction of the asymmetry was optimal taken into account the previous clinical characteristics. The outcome measures were treatment duration and motor development assessed with the Alberta Infant Motor Scale (AIMS) at baseline and at discharge. RESULTS: Asymmetry after the treatment was minimal (type 0 or 1 according to the Argenta scale) in both groups. A comparative analysis showed that treatment duration was significantly shorter (p < 0.001) in the experimental group (109.84 ± 14.45 days) compared to the control group (148.65 ± 11.53 days). The motor behaviour was normal (scores above the 16th percentile of the AIMS) in all the infants after the treatment. CONCLUSIONS: Manual therapy added to standard treatment reduces the treatment duration in infants with severe nonsynostotic plagiocephaly.

Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program.

PURPOSE: The aim of this study was to evaluate the results of a conservative intervention in infants with plagiocephaly according to their specific clinical profile. METHODS: Prospective clinical trial in which 104 infants with plagiocephaly accompanied or not by congenital or positional torticollis were referred to Early Care and Monitoring Unit (USAT) of San Cecilio Hospital in Granada, between 2009 and 2012. All the infants, grouped into three categories of severity, were included in the physiotherapy protocol until adequate craniofacial morphology and motor development were achieved. The study included an assessment of parents and infants. Parents were assessed with a questionnaire about the mother's medical history and birth-related issues. The assessment of infants included anthropometric measures, a positional assessment, the observation of the head, the assessment of severity, and motor development. RESULTS: Birth characteristics were similar in the total sample but showed different clinical profiles according to treatment aspects. More specifically, infants with severe plagiocephaly were referred to treatment later and spent more time in treatment; use of an orthotic helmet was also more prevalent in this category. There were also significant differences (P < 0.05) in the acquisition of specific gross motor skills depending on the severity of plagiocephaly. CONCLUSION: The findings suggest that the physiotherapy protocol presented is effective to correct plagiocephaly. Severity of plagiocephaly is a marker that should be taken into account when designing actions aimed at improving gross motor skill development.