Is functional mobility associated with quality of sitting in cerebral palsy? A cross-sectional study.

Objectives: A group of neuromuscular system anomalies associated with non-progressive issues in the developing fetal or newborn brain are known as cerebral palsy (CP). These abnormalities are typified by poor posture and motor development, which limits the execution of functional activities. Consequently, to achieve the same goals as peers who are typically developing, children with CP employ a variety of compensatory postures and techniques. Given that both sitting and mobility are essential for functioning, assessing each skill alone and in relation to the other is necessary. This study aims to determine if a child's functional mobility affects their sitting ability. Materials and Methods: Twenty CP (Gross Motor Function Classification System [GMFCS] levels I and II) children, aged 6-12, were enrolled in the research. The level of sitting scale (LSS) and the modified timed up and go (mTUG) test were utilized to evaluate sitting and functional mobility, respectively. Results: The quality of sitting was shown to have a substantial effect on functional mobility, as a significant difference in mTUG durations was established between LSS levels (P < 0.001) and persisted when analyzed within the same GMFCS level (P = 0.007). Conclusion: The importance of trunk control in functional mobility can be inferred from the link between sitting quality and mobility. To improve children with CP's functional mobility, this evidence may be utilized to design a well-informed and specific intervention program incorporating trunk control.

Immediate effects of a novel hand rehabilitation board on fine motor skills in children with cerebral palsy: A pilot study.

BACKGROUND: In children with cerebral palsy (CP), fine motor skills limit forearm supination and active extension of the elbow, wrist, or fingers. Therapeutic interventions focusing on improving the ranges at these joints while facilitating active movements are the key to augmenting fine motor skills. OBJECTIVE: This pilot study examines if children with CP (with UE involvement) exposed to the Novel Hand Rehabilitation (NHR) Board will demonstrate 1) changes in spasticity and passive ROM of forearm and wrist/finger muscles, and 2) improvement in fine motor abilities. METHODS: The forearm and wrist/fingers of children with spastic CP (N = 15; M = 7, F = 8) aged 49-72 months (65.33±6.355 months) were positioned on the NHR board till their tolerance limit or a minimum duration of 30 minutes. The outcome measures, i.e., spasticity (Modified Ashworth Scale), passive range of motion (PROM) of wrist and fingers, and fine motor skills (PDMS-2 - Fine motor scale), were recorded. RESULTS: The spasticity of forearm pronators (0.001) and wrist flexors (0.008) reduced significantly, but not in wrist extensors. Post-intervention improvements in wrist extension (p = 0.005) and ulnar deviation ROM (p = 0.007) were significant. In thumb, changes were non-significant for the CMC flexion, but extension (0.003) and abduction (0.001) as well as MCP extension (0.004) were significant. The post-intervention MCP extension ROM for the 2nd (0.001), 3rd (0.007), and 4th fingers (0.014) were also substantial, but not for PIP and DIP joints. The post-intervention percentage change in the Grasping and Visual-motor integration subtests of PDMS-2 was 11.03% (p = 0.002) and 5.09% (p = 0.001) respectively. CONCLUSION: The immediate effects on fine motor skills in children with CP after the NHR board application were positive and encouraging. Hence, the NHR board can be recommended as an intervention to improve the fine motor abilities of children with CP.

Cervical Vestibular-Evoked Myogenic Potentials in Individuals with Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Vestibular evoked myogenic potentials (VEMPs) in individuals with diabetes mellitus (DM) provide evidence as how diabetes can bring about changes in the peripheral nervous system. Cervical VEMP (cVEMP) evaluates the function and integrity of the sacullo- collic pathway and ocular VEMP (oVEMP) evaluates the utriculo-collic pathway. cVEMP is an ipsilateral inhibitory response of the sternocleidomastoid muscle. cVEMP is recorded at higher intensity above 80-85 dBnHL with biphasic waveforms having initial peak positivity P13 followed by a negativity N23. We performed a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to evaluate cVEMP in diabetes mellitus. The search was conducted in the databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Cochrane library using the keywords "diabetes mellitus" and "vestibular evoked myogenic potential" or "cVEMP." A two-phase selection process was used for the final inclusion of studies, and the methodological quality of these studies was assessed using the Newcastle Ottawa scale (NCOS). Meta-analysis was performed using a random-effects model. For comparisons between DM and healthy controls, a significant difference was observed for cVEMP amplitude (P = 0.01). Our meta-analysis's results suggest peripheral vestibular dysfunction can be observed in DM. It appears that cVEMPs may be useful in the early detection of neuropathy in DM.

Effect of hip abductors and lateral rotators' muscle strengthening on pain and functional outcome in adult patients with patellofemoral pain: A systematic review and meta-analysis.

BACKGROUND: Even though literature indicates presence of weak hip abductors and lateral rotators' in Patellofemoral Pain (PFP), studies evaluating the effect of hip abductors and lateral rotators strengthening to improve knee function and quality of life in PFP are limited. OBJECTIVE: This study systematically reviews and meta-analyzes the best evidence on the therapeutic value of strengthening hip abductors and lateral rotators muscles for treating PFP with a presumptive hypothesis that strengthening hip muscles stabilizes the patellofemoral joint, relieves pain, and enhances knee functions. METHOD: Medline, EMBASE, CINAHL, PEDro and PubMed Central databases were searched between January 1994 and September 2019 using the PICOS tool. The methodological quality of the selected studies were appraised individually using the 20-item McMaster Critical Review Form for Quantitative Studies. Supplemental quality appraisal of randomized controlled clinical trials performed using the Cochrane Collaboration's 'Risk of bias' quality criteria. Data on patient population demographics, interventions, duration of intervention, and outcome measures were extracted and summarized in evidence tables and descriptive analysis. Meta-analyses under both fixed and random-effects models determined pooled effects size from appropriate RCTs. RESULTS: All fourteen studies demonstrated that hip muscle strengthening improved pain and knee function. All RCTs, except one, demonstrated that hip muscle strengthening is superior to quadriceps strengthening. Of the five RCTs assessing the additional effect of hip-quad versus quadriceps strengthening, four suggested that hip-quad strengthening is superior to standard quadriceps strengthening alone to improve PFP and knee function. CONCLUSION: In adult patients with PFP, strengthening hip abductors and lateral rotators' have beneficial therapeutic effects than the conventional quadriceps exercises in improving knee pain and function both in the short- and long term. However, the present review data can be used to develop a standardized hip-quad protocol in the future.

Perceptions of family-centred care among caregivers of children with cerebral palsy in South India: An exploratory study.

BACKGROUND: Parental views and expectations about family-centred care (FCC) need to be understood for its successful implementation. Knowledge of caregiver's perceptions and needs, within their social and cultural context, forms the basis for effective health care partnerships with families. The purpose of this study was to explore perceptions about FCC among caregivers of children with cerebral palsy (CP) in South India. METHOD: Fourteen caregivers of children with CP (aged 4-12 years) living in rural areas of the coastal region of Karnataka, India, participated in this qualitative study. Face-to-face semi-structured interviews were recorded and transcribed for analysis using the framework and hybrid approaches. Thematic mapping of the categories and themes was done to explore relationships about perceptions of FCC. RESULTS: Caregiver's life emerged inductively as a new theme highlighting caregiver's own physical and mental health, family roles and well-being, integrating the onus of care with household responsibilities, limited participation in personal activities and social isolation. The qualitative findings revealed the ubiquity of respectful and trusting relationships with health professionals while expressing paucity of coordinated comprehensive care, sporadic partnerships and opportunities for shared decision-making; desire for receiving specific information related to child's progress and prognosis; and general information on community resources and the need of empowerment and support groups. CONCLUSION: Our study has practical implications for the implementation of FCC within the South Indian context, by recognizing unique caregiver needs and expectations in sync with cultural perspectives towards childhood disability such as societal stigma, values and traditional beliefs; attitudes towards medical professionals; and life stressors and gender responsibilities.

Functional independence measure (WeeFIM) reference values in Indian children aged 3-7 years: A cross-sectional study.

Background: . We sought to establish reference values of the functional independence measure (WeeFIM; Unified Data System for Medical Rehabilitation, Buffalo, NY, USA) for children aged 3-7 years in India using this cross-sectional study. Methods: . We obtained permission from the Unified Data System for Medical Rehabilitation, a non-profit organization to use the WeeFIM instrument. Participants were recruited randomly from schools. After obtaining written informed consent, direct interviews for WeeFIM II Clinical Guide (version 6.0) were conducted for parent/guardian/teacher of 182 typically developing children. Results: . There was a progressive increase of functional independence with increasing chronological age across all WeeFIM domains. Total score of the WeeFIM instrument showed a similar performance between boys and girls. At the beginning of 3 years, children were at WeeFIM level 3 that is moderate assistance stage in their functional independence, but by the age of 7 years, they became completely independent on all the three domains of WeeFIM functional scale. Conclusions: . We have provided reference values for WeeFIM in children of India aged 3-7 years (35-84 months). There were no differences between boys and girls regarding WeeFIM performance. Children in private schools showed better performance versus children in government schools in the early age ranges. We could not find any effect of socioeconomic status on WeeFIM raw rating or functional independence level.

Respiratory Muscle Strength in Healthy Indian Children of Age 7-17 Years: A Cross-Sectional Study.

PURPOSE: As the values of respiratory muscle strength vary according to race, ethnicity, and geographical area, there is a wide-ranging difference among different populations. Thus, the available reference values may not have an application for use in the Indian paediatric population, creating a need for generating values which will be appropriate for the Indian paediatric context. MATERIALS AND METHODS: Assessment of respiratory muscle strength was carried out by assessing maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and synthesising predictive formulas using anthropometric variables like height, gender and age, which will be suitable for Indian children. RESULTS: We calculated MIP and MEP of 320 (boys=160 and girls= 160) children in the age range of 7 years to 17 years of Mangaluru city, India. Results stated that mean MIP and MEP for boys were 72.5±32.8 cm H2O and 73±33.2 cm H2O, while for the girls it was 67±30.2 cm H2O and 68±30.1 cm H2O, respectively. CONCLUSION: This study concluded that there is a difference in respiratory pressure values of Indian children with respect to those of other countries. Age, gender, height and BMI have a significant role in determining respiratory muscle strength. Boys demonstrated higher MIP and MEP. As age, height, weight and BMI increases, so does MIP and MEP.

Treatment and re/habilitation of children with cerebral palsy in India: a scoping review.

AIM: To describe the nature and extent of the literature addressing the medical and its re/habilitative management of cerebral palsy (CP) in India. METHOD: Online worldwide scholarly databases, research hosting directories, Indian publishing houses, and grey literature were used to identify papers published between 2005 and 2016. We retrieved 144 English language papers that described the medical and rehabilitative management of Indian children with CP. RESULTS: Quantitative, qualitative, and mixed research designs are published by a variety of health care professionals in India. Intervention (45%) and observational studies (30%) predominate. Outcomes were categorized using the World Health Organization's International Classification of Functioning, Disability and Health framework, with body structure and function most reported and activity/participation least reported; 57% described its re/habilitation interventions and 43% were medical interventions. INTERPRETATION: There is a substantial body of CP research in India that focuses on interventions to reduce impairments, with minimal attention given to activities and participation, environmental, and personal factors. Twenty-six per cent of studies are published in what appear to be 'predatory journals'. This paper serves as an alert about the presence of 'predatory journals' in medicine that may introduce publication bias, which can distort results reported in those studies individually, or from conclusions drawn in reviews that contain those studies. WHAT THIS PAPER ADDS: Cerebral palsy research in India focuses on interventions to reduce impairment. Activities, participation, and environmental factors are minimally addressed. Quantitative studies are more common than qualitative studies. Many Indian studies are published in journals that are not indexed in worldwide databases of scholarly journals.

TRATAMIENTO Y REHABILITACIÓN DE NIÑOS CON PARÁLISIS CEREBRAL EN LA INDIA: REVISIÓN PANORÁMICA: OBJETIVO: Describir la naturaleza y extensión de la literatura que trata sobre el manejo médico y de rehabilitación de la parálisis cerebral (PC) en la India. METODO: Con el fin de identificar artículos publicados entre 2005 y 2016, se utilizaron bases de datos académicos en línea de todo el mundo, directorios de investigación, imprentas de publicación de la India, y literatura no convencional. Obtuvimos 144 publicaciones en el idioma inglés que describían el manejo médico y de rehabilitación de niños con PC en la India. RESULTADO: Diseños de investigación de tipo cuantitativos, cualitativos y mixtos fueron publicados por una variedad de profesionales de la salud en India. Predominan los estudios de intervención (45%) y de observación (30%). Los resultados fueron categorizados utilizando el marco de la Clasificación Internacional de Funcionamiento, Discapacidad y Salud de la Organización Mundial de la Salud (OMS) con más reportes sobre estructuras y funciones corporales y menos reportes sobre actividad y participación; 57% describieron intervenciones de rehabilitación y 43% fueron intervenciones médicas. INTERPRETACIÓN: En la India hay un inventario sustancial de investigaciones sobre PC que se focalizan en intervenciones destinadas a reducir limitaciones, dando mínima atención a actividades y participación, factores ambientales y factores personales. Se publican 26% de estudios en los que parecerían ser revistas de dudosa calidad científica llamadas "revistas depredadoras". Este trabajo sirve como una alerta sobre la presencia en medicina de "revistas depredadoras" que pueden introducir publicaciones sesgadas, las que pueden distorsionar resultados publicados en esos estudios de manera individual, o sacar conclusiones erróneas en revisiones que contienen dichos estudios.

TRATAMENTO E REABILITAÇÃO DE CRIANÇAS COM PARALISIA CEREBRAL NA ÍNDIA: UMA REVISÃO DE ESCOPO: OBJETIVO: Descrever a natureza e extensão da literatura abordando o manejo médico e de reabilitação da paralisia cerebral (PC) na Índia. MÉTODO: Bases de dados científicas online de todo o mundo, diretórios de pesquisa, casas de publicação indianas, e literatura cinzenta foram usadas para identificar artigos publicados entre 2005 e 2016. Obtivemos 144 artigos em língua inglesa que descreveram o manejo médico e de reabilitação de crianças indianas com PC. RESULTADOS: Desenhos de pesquisas quantitativos, qualitativos, e mistos foram publicados por uma variedade de profissionais da saúde na Índia. Estudos de intervenção (45%) e observacionais (30%) predominaram. Os resultados foram categorizados usando a estrutura da Classificação Internacional de Funcionalidade, Incapacidade e Saúde da Organização Mundial de Saúde, sendo que a estrutura e função do corpo foi o domínio mais reportado e atividades/participação o menos reportado; 57% descreveram intervenções de reabilitação e 43% eram intervenções médicas. INTERPRETAÇÃO: Há uma quantidade substancial de pesquisas em PC na Índia que focam em intervenções para reduzir deficiências, com atenção mínima dada a atividades e participação, e fatores pessoais e ambientais. Vinte e seis por cento dos estudos foram publicados em jornais médicos aparentemente predatórios, o que pode introduzir vieses de publicação, e distorcer os resultados relatados nestes estudos individualmente, ou em conclusões obtidas em revisões que contém este estudo.

Perspectives on rehabilitation of children with cerebral palsy: exploring a cross-cultural view of parents from India and Canada using the international classification of functioning, disability and health.

PURPOSE: To explore parents' perspectives on rehabilitation of their child with cerebral palsy and their information needs. METHODS: Semistructured interviews were conducted with parents of children with CP from India (n = 11) and Canada (n = 7). Data were analyzed through an interpretive description approach using the International Classification of Functioning, Disability and Health framework. RESULTS: Body Structure and Function: Indian parents were more focused on fixing body structure and function challenges, and independent walking, than Canadian parents. Activity and Participation: All Canadian children were actively involved in school and fun activities in the community. Due to lack of accessible services, Indian children had less school and community participation. Environmental factors: accessible communities, occupational therapy services and greater use of assistive devices enabled Canadian children. Social and cultural beliefs, lack of access to services and inaccessible communities were the barriers experienced by Indian parents. Information needs: both groups needed information to make their child more functional. CONCLUSION: Canadian parents experience a more enabling environment and express a more social view of their child's health, suggesting both education on the International Classification of Functioning, Disability and Health principles and services are needed to better enable and empower Indian parents. There remains a need for healthcare professionals and services in both countries to be more family-centered. Implications for rehabilitation To help parents in rehabilitating their children with cerebral palsy (CP), in India, there is a need to (1) incorporate ICF education into medical curricula and clinical practice; (2) increase the availability of skilled healthcare professionals and centers; (3) make infrastructural and policy reforms to make the society more accessible for the disabled children. Education, counseling and awareness about CP might help both groups of parents, society, and HCPs to change their beliefs and attitudes regarding CP and its rehabilitation. Both countries would benefit from user-friendly and transparent policies. This will help parents to become more aware of them and use them in the rehabilitation process.

Relationship Between Trunk Control and Balance in Children with Spastic Cerebral Palsy: A Cross-Sectional Study.

INTRODUCTION: Trunk control is impaired in children with Cerebral Palsy (CP) thus influencing their functional balance. However, there is a paucity of literature determining the relationship between trunk control and balance in children with CP. AIM: To find the relationship between trunk control and balance by means of Trunk Control Measurement Scale (TCMS) and Paediatric Balance Scale (PBS). MATERIALS AND METHODS: Twenty four children {age range 8-14 years, Gross Motor Function Classification System (GMFCS) Level I-III} with spastic CP were recruited and evaluated using TCMS and PBS. The results were expressed as summary measures median (M) and Inter-Quartile Range (IQR). The correlation of TCMS and PBS were done using Spearman's correlation coefficient. A p-value <0.05 was considered statistically significant. RESULTS: The children obtained a median score of 52 out of 58 on the TCMS and 50 out of 56 on PBS. There was a significantly strong correlation with rs=0.77 and p<0.01. A strong correlation (p<0.01) was seen between static, dynamic and total components of TCMS and PBS. The median scores of TCMS and PBS had a strong correlation for boys with rs=0.74 and very strong correlation for girls with rs=0.84. Based on the type of spastic CP, diplegics had a very strong correlation with rs=0.85. While based on GMFCS levels, Level II and Level III had a very strong correlation (For level II rs=0.81 and level III rs=0.86) and weak correlation for level I (rs=0.27). CONCLUSION: Based on gender, topography and severity of the motor impairment both trunk control and balance are impaired to a different degree in children with CP. The findings of this study showed a high positive correlation between trunk control and balance in children with spastic CP.

The Effectiveness of a Computer Game-Based Rehabilitation Platform for Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial.

BACKGROUND: It is difficult to engage young children with cerebral palsy (CP) in repetitive, tedious therapy. As such, there is a need for innovative approaches and tools to motivate these children. We developed the low-cost, computer game-based rehabilitation platform CGR that combines fine manipulation and gross movement exercises with attention and planning game activities appropriate for young children with CP. OBJECTIVE: The objective of this study is to provide evidence of the therapeutic value of CGR to improve upper extremity (UE) motor function for children with CP. METHODS: This randomized controlled, single-blind, clinical trial with an active control arm will be conducted at 4 sites. Children diagnosed with CP between the ages of 4 and 10 years old with moderate UE impairments and fine motor control abnormalities will be recruited. RESULTS: We will test the difference between experimental and control groups using the Quality of Upper Extremity Skills Test (QUEST) and Peabody Developmental Motor Scales, Second Edition (PDMS-2) outcome measures. The parents of the children and the therapist experiences with the interventions and tools will be explored using semi-structured interviews using the qualitative description approach. CONCLUSIONS: This research protocol, if effective, will provide evidence for the therapeutic value and feasibility of CGR in the pediatric rehabilitation of UE function. TRIAL REGISTRATION: Clinicaltrials.gov NCT02728375; http:https://clinicaltrials.gov/ct2/show/NCT02728375 (Archived by WebCite at http://www.webcitation.org/6qDjvszvh).

Muscle strength differences in healthy young adults with and without generalized joint hypermobility: a cross-sectional study.

BACKGROUND: Generalized joint hypermobility (GJH), in the absence of symptoms, is a common clinical finding. The joint instability present due to excessive musculoskeletal flexibility in hypermobile joints impairs the external force production during muscle contraction. However, whether GJH is associated with muscle weakness is unclear. This study evaluated differences in upper and lower limb muscle strengths among asymptomatic young adults with and without GJH. METHODS: One hundred six young adults (53 hypermobile, i.e. 25 male (mean age 22 ± 1.8); 28 female (mean age 21 ± 1.8), and 53 non-hypermobile, i.e. 25 male (mean age 19 ± 1.06); 28 female (mean age 20 ± 1.4) were selected using a cut-off ≥ 4 on Beighton and Horan Joint Mobility Index. Isometric strength of elbow and knee extensors was measured using an isokinetic dynamometer. Independent sample t- tests were done to compare the muscle strengths of hypermobile and non-hypermobile participants. One-way ANCOVA was applied to control the effect of height and body mass on muscle strength. RESULTS: Male hypermobile participants had significantly less strength than non-hypermobile males in the right (71.7 Nm, SD = 23.1, vs 97.6 Nm, SD = 47.4, p = 0.006*) and left (74.8 Nm, SD = 24.3, vs 97.7 Nm, SD = 45.5, p = 0.007*) elbow extensors and right knee extensors (188.7 Nm, SD = 83.3, vs 228.3 Nm, SD = 106.7, p = 0.03*). In females, both elbow extensors (right: 51.9 Nm, SD = 16.2 vs 48.8 Nm, SD = 17.8, p = 0.4; left: 48.9 Nm, SD = 17.2, vs 44.7 Nm, SD = 15.1, p = 0.2) and knee extensors (right: 161.3 Nm, SD = 74.9 vs 145.5 Nm, SD = 75.8, p = 0.3; left: 155.2 Nm, SD = 73 vs 124.3 Nm, SD = 69.6, p = 0.07) strength were not statistically different between hypermobile and non-hypermobile participants. CONCLUSION: The findings indicate that male participants with GJH have less isometric muscle strength in both elbow extensors and right knee extensors compared to non-hypermobile male participants. Female hypermobile participants did not show any significant differences in muscle strength compared to non-hypermobile female participants.

Provocative poliomyelitis causing postpolio residual paralysis among select communities of two remote villages of North Karnataka in India: a community survey.

Intramuscular injections can provoke muscular paralysis especially, if the child has had exposure to polio virus. The purpose of the study was to determine the association with known risk factors for motor disabilities in two remote villages of North Karnataka (India), where an increased number of disabled people among select communities had been reported. A community based survey was conducted. The selection of study subjects was done through screening, history related with occurrence of musculoskeletal disability, screening and general examination of the affected joints and muscles. Data analysis was done by estimation of percentages. Among the physical disabilities identified, the most common was post-polio residual paralysis. 35.65% (n = 41) subjects had developed paralysis following the administration of an intramuscular injection when they had acute viremia in childhood, indicating that (probably) muscle paralysis would have been provoked by intramuscular injections, resulting in provocative poliomyelitis. Unnecessary injection must be avoided in children during acute viremia state and use of oral polio vaccine should be encouraged.