This study compared the efficacy of Adeli suit treatment (AST) with neurodevelopmental treatment (NDT) in children with cerebral palsy (CP). Twenty-four children with CP, Levels II to IV according to the Gross Motor Function Classification System (GMFCS), were matched by age and functional status and randomly assigned to the AST or NDT treatment groups. In the AST group (n=12; eight males, four females; mean age 8.3y [SD 2.0]), six children had spastic/ataxic diplegia, one triplegia and five spastic/mixed quadriplegia. In the NDT group (n=12; nine males, three females; mean age 8.1y [SD 2.2]), five children had spastic diplegia and seven had spastic/mixed quadriplegia. Both groups were treated for 4 weeks (2 hours daily, 5 days per week, 20 sessions). To compare treatments, the Gross Motor Function Measure (GMFM-66) and the mechanical efficiency index (EI HB ) during stair-climbing were measured at baseline, immediately after 1 month of treatment, and 10 months after baseline. The small but significant time effects for GMFM-66 and EI HB that were noted after 1 month of both intensive physiotherapy courses were greater than expected from natural maturation of children with CP at this age. Improvements in motor skills and their retention 9 months after treatment were not significantly different between the two treatment modes. Post hoc analysis indicated a greater increase in EI HB after 1 month (p=0.16) and 10 months (p=0.004) in AST than that in NDT, predominantly in the children with higher motor function (GMFCS Levels II and III). The results suggest that AST might improve mechanical efficiency without a corresponding gain in gross motor skills, especially in children with higher levels of motor function.
Both programs were effective in improving motor function in adolescents with cerebral palsy. The GT program had generally greater benefits based on the functional measures.
In higher functioning children with cerebral palsy, the motor learning coaching treatment resulted in significantly greater retention of gross motor function and transfer of mobility performance to unstructured environments than neurodevelopmental treatment.
AIM Adolescents and young adults with cerebral palsy (CP) show reduced motor function and gait efficiency, and lower levels of habitual physical activity (HPA), than adolescents with typical development and children with CP. This study examined activity duration and patterns in this population in the Middle East through long-term monitoring of a large sample using accelerometers. METHOD Adolescents and young adults with bilateral CP at Gross Motor FunctionClassification System (GMFCS) levels II, III, and IV, were monitored in their habitual environment for four consecutive days with ActivPAL3 monitors. Time spent in sedentary, standing, and walking activities, and frequency of walking steps and transitions, were analysed for each GMFCS level.RESULTS Measurements were made on 222 participants (132 males, 90 females; mean age 16y 9mo SD 2y, range 13y 4mo-22y). The Mann-Whitney U test demonstrated significant differences (p<0.05) between GMFCS levels, showing reduced walking and standing activity and increased sedentary duration at higher GMFCS levels (p<0.001), except for increased standing time between GMFCS levels II and III (p=0.07). Participants in educational facilities exhibited less sedentary behaviour than those who were homebound (p<0.05).INTERPRETATION These descriptions of duration and frequency of active and sedentary behaviours may serve as a basis for recommendations to minimize inactivity in this population. Adolescents and young adults with CP in the Middle East demonstrate similar patterns of HPA to their peers in other regions.Habitual physical activity (HPA) may be defined as the magnitude and pattern of body movements during the usual activities of daily living, including sleep and rest, work, and leisure. Sedentary behaviour refers to activities that increase energy expenditure above the resting level by less than 50% and includes activities such as sleeping, sitting, lying down, and watching screen-based entertainment.1,2 Regular and intensive physical activity, even in individuals with disabilities, is directly associated with physical fitness, improved quality of life, and psychological functions; 3 low levels of activity contribute to the risk of chronic cardiovascular disease 4 and other health issues. 5Adolescents and young adults with cerebral palsy (CP) face many difficulties with functional mobility in their transitional growth stages because, during adolescence, gross motor function capacity and gait efficiency decline. 6 Additionally, adolescents with CP face a discontinuity of care; as paediatric rehabilitation ends and they do not qualify for paediatric services there are few adult rehabilitation services available to meet their health needs.7 Compared with younger children with CP, adolescents and young adults with CP exhibit lower levels of physical activity, less walking activity, and more sedentary behaviour, 8 and their activity decreases as gross motor function deteriorates. 8,9 Adolescents and young adults are less physically active than their peers with typical development...
This pilot trial reveals the feasibility and applicability of this unique measurement and perturbation system for evaluating functional disabilities and changes with interventions to improve walking. Implication for Rehabilitation Walking, of individuals with cerebral palsy and hemiparesis following stroke, can be viewed in terms of a rigid motor behavior that prevents adaptation to changing environmental conditions. Re-Step system (a) measures and records linear and non-linear gait parameters during free walking to provide a detailed evaluation of walking disabilities, (b) is an intervention training modality that applies unexpected perturbations during walking. This perturbation intervention may improve gait and motor functions of individuals with hemiparesis and cerebral plasy.
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