Feasibility and effectiveness of home-based therapy programmes for children with cerebral palsy: a systematic review.

OBJECTIVE: To assess the feasibility and effectiveness of home-based occupational therapy and physiotherapy programmes in children with cerebral palsy (CP), focusing on the upper extremity and reporting on child-related and/or parent-related outcomes. DESIGN: Systematic review. DATA SOURCES: Electronic searches were performed in MEDLINE, EMBASE, CINAHL, PsycINFO, OTseeker and PEDro, and in ICTRP and CENTRAL trial registers, from inception to 6 June 2019. ELIGIBLE CRITERIA: The review included all types of original studies concerning feasibility or effectiveness of home-based therapy in children aged <18 years with any type of CP. No language, publication status or publication date restrictions were applied. DATA EXTRACTION AND SYNTHESIS: Study and intervention characteristics and the demographics of participating children and their parents were extracted. Feasibility was assessed by outcomes related to acceptability, demand, implementation, practicality, adaptation, expansion or integration. Regarding effectiveness, child-related outcome measures related to any level of the International Classification of Functioning, Disability and Health, or parent-related outcomes were investigated. Two authors independently extracted the data. Risk of bias was assessed using the Downs and Black checklist and the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS: The search resulted in a total of 92 records: 61 studies and 31 conference abstracts. Feasibility studies reported mainly on acceptability and implementation. Overall compliance to home-based training programmes (implementation) was moderate to high, ranging from 56% to 99%. In the effectiveness studies, >40 different child-related outcome measures were found. Overall, an improvement in arm-hand performance within group across time was shown. Only two studies reported on a parent-related outcome measure. No increase in parental stress was found during the intervention. CONCLUSIONS: Based on the results of the included studies, home-based training programmes seem to be feasible. However, conclusions about the effectiveness of home programmes cannot be made due to the large variability in the study, patient and intervention characteristics, comparators, and outcome measures used in the included studies. PROSPERO REGISTRATION NUMBER: CRD42016043743.

Evidence-based rehabilitation therapy following surgery for (peri-)articular fractures: A systematic review.

OBJECTIVE: To assess the availability of explicitly reported protocols describing post-surgery rehabilitation of (peri-)articular fractures of the proximal humerus, acetabulum and/or tibial plateau, and to critically review any scientific evidence on the effectiveness of these protocols. DATA SOURCES: MEDLINE (PubMed), Cochrane databases, CINAHL, PEDro and Embase (Ovid) were searched to November 2018. Furthermore, stakeholder internet sites, clinical guidelines and standard textbooks were searched. STUDY SELECTION: Screening was performed independently by 2 researchers based on a priori defined eligibility criteria. DATA SYNTHESIS: Five papers addressed post-surgical rehabilitation of proximal humerus fractures, 1 paper that of acetabulum fractures. No eligible information was found on stakeholder sites or in standard textbooks. Overall, the main focus of the protocols identified was on the International Classification of Functioning, Disability and Health (ICF) Body Functions and Structures level. In general, little information about therapy dosage was reported. None of the protocols provided scientific evidence on which the content of described rehabilitation programmes was based. CONCLUSION: This review reveals a paucity of explicitly formulated protocols focussing on post-surgical rehabilitation of common (peri-)articular fractures targeting patient-centred care at all ICF levels. There is a need for more scientific evidence on which to base protocols regarding common (peri-)articular fracture rehabilitation.

Reproducibility of Task-Oriented Bimanual and Unimanual Strength Measurement in Children with Unilateral Cerebral Palsy.

Aim: To examine reproducibility of the arm-hand strength measured while performing the bimanual crate task and the unimanual pitcher task. Methods: 105 children diagnosed with unilateral Cerebral Palsy, aged between 6 and 18 years, participated in this study. The test-retest reliability of the force generated during bimanual crate task and unimanual pitcher task of the Task-oriented Arm-hAnd Capacity instrument was investigated using intraclass correlation two-way random model with absolute agreement. The intraclass correlations were calculated for two age groups (6-12 and 13-18 years old). Results: The results showed good test-retest reliability for the crate and pitcher task with the non-affected hand for both age groups. The results of the pitcher task for the affected hand showed moderate test-retest reliability for both age groups. Conclusion: The Task-oriented Arm-hAnd Capacity instrument has moderate to good test-retest reliability. It is a simple and objective instrument to assess task-oriented strength in children with unilateral cerebral palsy.

Home-based bimanual training based on motor learning principles in children with unilateral cerebral palsy and their parents (the COAD-study): rationale and protocols.

BACKGROUND: Home-based training is considered an important intervention in rehabilitation of children with unilateral cerebral palsy. Despite consensus on the value of home-based upper limb training, no evidence-based best practice exists. Promoting compliance of children to adhere to an intensive program while keeping parental stress levels low is an important challenge when designing home-based training programs. Incorporating implicit motor learning principles emerges to be a promising method to resolve this challenge. METHODS: Here we describe two protocols for home-based bimanual training programs, one based on implicit motor learning principles and one based on explicit motor learning principles, for children with unilateral spastic cerebral palsy aged 2 through 7 years. Children receive goal-oriented, task-specific bimanual training in their home environment from their parents for 3.5 h/week for 12 weeks according to an individualized program. Parents will be intensively coached by a multidisciplinary team, consisting of a pediatric therapist and remedial educationalist. Both programs consist of a preparation phase (goal setting, introductory meetings with coaching professionals, design of individualized program, instruction of parents, home visit) and home-based training phase (training, video-recordings, registrations, and telecoaching and home visits by the coaching team). The programs contrast with respect to the teaching strategy, i.e. how the parents support their child during training. In both programs parents provide their child with instructions and feedback that focus on the activity (i.e. task-oriented) or the result of the activity (i.e. result-oriented). However, in the explicit program parents are in addition instructed to give exact instructions and feedback on the motor performance of the bimanual activities, whereas in the implicit program the use of both hands and the appropriate motor performance of the activity are elicited via manipulation of the organization of the activities. DISCUSSION: With the protocols described here, we aim to take a next step in the development of much needed evidence-based home-based training programs for children with unilateral cerebral palsy.

To What Extent Can Arm-Hand Skill Performance--of Both Healthy Adults and Children-Be Recorded Reliably Using Multiple Bodily Worn Sensor Devices?

Neurological patients often encounter arm-hand problems in daily life. Bodily worn sensors may be used to assess actual performance by quantifying specific movement patterns associated with specific activities. However, signal reliability during activities of daily living should be determined first. The aim is to determine to what extent standardized arm-hand skill performance of both healthy adults and healthy children can be recorded reliably using a combination of multiple sensor devices. Thirty adults (aged > 50 years) and thirty-two children (aged between 6-18 years) performed the activities drinking, eating and combing five times in a standardized setting. Sensor devices, each containing a triaxial accelerometer, gyroscope and magnetometer were attached to the arms, hands and trunk of the participants. Within-subject and between-subject reliability of the signal patterns amongst skill repetitions was determined by calculating Intraclass Correlation Coefficients (ICCs). Median reliability was good to very good for all activities performed (both within and between subjects). Regarding within-subject reliability (instruction-condition), median ICCs ranged between 0.76-0.90 and 0.68-0.92 for the adults and children, respectively. For between-subject reliability (instruction-condition), median ICCs ranged 0.75-0.86 and 0.61-0.90 for the adults and children, respectively. It can be concluded that the above-mentioned sensor system can reliably record activities of daily living in a standardized setting.