Effectiveness of Upper and Lower Limb Casting and Orthoses in Children with Cerebral Palsy

Autti-Rämö, Ilona; Suoranta, Jutta; Anttila, Heidi; Malmivaara, Antti; Mākelä, Marjukka

doi:10.1097/01.phm.0000179442.59847.27

Cited by 75 publications

(43 citation statements)

References 34 publications

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“…Treatments will aim to address the concerns and priorities identified by families at the initial screening visit, typically the reduction of impairments and symptom management to ease pain and discomfort. Therapy regimes will be based on international consensus recommendations [19,61,62] and will include practices such as: serial casting to lengthen muscles and reduce contractures, [45,63-66] strengthening of injected muscles and antagonists, [67] provision of stretching programs to be implemented into the child’s daily routines, [68] provision of splints/orthoses, [69] and/or targeted motor training. It is recognized that children with non-ambulant CP will have difficulties participating in movement based therapy.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial

et al. 2012

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BackgroundChildren with cerebral palsy (CP) whom are non-ambulant are at risk of reduced quality of life and poor health status. Severe spasticity leads to discomfort and pain. Carer burden for families is significant. This study aims to determine whether intramuscular injections of botulinum toxin A (BoNT-A) combined with a regime of standard therapy has a positive effect on care and comfort for children with CP whom are non-ambulant (GMFCS IV/V), compared with standard therapy alone (cycle I), and whether repeated injections with the same regime of adjunctive therapy results in greater benefits compared with a single injecting episode (cycle II). The regime of therapy will include serial casting, splinting and/or provision of orthoses, as indicated, combined with four sessions of goal directed occupational therapy or physiotherapy.Method/designThis study is a double blind randomized controlled trial. Forty participants will be recruited. In cycle I, participants will be randomized to either a treatment group who will receive BoNT-A injections into selected upper and/or lower limb muscles, or a control group who will undergo sham injections. Both groups will receive occupational therapy and /or physiotherapy following injections. Groups will be assessed at baseline then compared at 4 and 16 weeks following injections or sham control. Parents, treating clinicians and assessors will be masked to group allocation. In cycle II, all participants will undergo intramuscular BoNT-A injections to selected upper and/or lower limb muscles, followed by therapy.The primary outcome measure will be change in parent ratings in identified areas of concern for their child’s care and comfort, using the Canadian Occupational Performance Measure (COPM). Secondary measures will include the Care and Comfort Hypertonicity Scale (ease of care), the Cerebral Palsy Quality of Life Questionnaire (CP QoL–Child) (quality of life), the Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire (CPCHILD©) (health status) and the Paediatric Pain Profile (PPP) (pain). Adverse events will be carefully monitored by a clinician masked to group allocation.DiscussionThis paper outlines the theoretical basis, study hypotheses and outcome measures for a trial of BoNT-A injections and therapy for children with non-ambulant CP.Trial registrationAustralia New Zealand Clinical Trials Registry:N12609000360213

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Section: Methodsmentioning

confidence: 99%

Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial

et al. 2012

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“…However, it is important to determine what effect this improvement in quality of movement has on their ability to function in their everyday lives, as conflicting results have been reported in other studies 3,8,12,13 . The findings also emphasised that there is little evidence for the continued effect achieved by splinting, and that it has been found that once splinting is removed, the benefits ceased 7 .…”

mentioning

confidence: 87%

“…The findings also emphasised that there is little evidence for the continued effect achieved by splinting, and that it has been found that once splinting is removed, the benefits ceased 7 . Splinting material and regular monitoring of the correct fit and condition of the splint -if required for a long period of time -can be a costly intervention 12 . Therefore, the achievement of outcomes in the long term through the use of splinting must be weighed up against the cost of this intervention method used over an extended period 7 .…”

mentioning

confidence: 99%

The effect of neoprene thumb abduction splints on upper limb function in children with cerebral palsy

Hughes¹,

Franzsen²,

Freeme³

2017

S. Afr. j. occup. ther

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Key words: Cerebral palsy, thumb-in-palm deformity, neoprene thumb abductor splint, QUEST SCIENTIFIC ARTICLES INTRODUCTIONSkilled use of the hands and upper limbs in activities enables interaction with the environment, and is thus essential for participation in the occupational performance areas of self-care, work or education, and leisure 1 . At least 50% of children with cerebral palsy (CP) have limitations in arm and hand use, which is the main cause of their dysfunction in occupational performance areas 2 . The hand movements of a child with CP can be slow and weak, with incoordination, incomplete finger dissociation, spasticity, and impaired tactile sensation 3 . Other impairments described in the literature include increased deep tendon reflexes, tremors and muscular hypertonicity. In the upper limb, spasticity presents in a flexor pattern, which includes spasticity of the flexors and adductors of the fingers and thumb. The spasticity develops into hypertonicity over time, and muscles of the wrist and hand are often shortened Tutor, Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences University of Witwatersrand and stiff in a fisted position 4 . Deformities, due to the shortening and stiffness of muscles of the first web space, and hypermobility of the metacarpophalangeal and distal interphalangeal joints of the thumb are therefore common in children with CP 5 . The thumb-in-palm deformity is caused by a permanent position of thumb adduction and flexion, which affects both pinches and grasps required for normal hand function 6 . Intervention to correct this deformity and to support the hand and wrist in a functional position is essential to allow children with CP an opportunity to use their hands more functionally.Occupational therapists use splinting as one of the interventions to rehabilitate the above-mentioned impairments and to improve the use of the hands. Hand splints are specifically prescribed for children with CP to stabilise and protect the joints, stretch and lengthen muscles, prevent contractures or to maintain range of motion. They Introduction: Children with cerebral palsy (CP) have limitations in hand function due to weakness and spasticity, with long term effects causing shortening and stiffness of muscles in the hand and arm. The soft neoprene thumb abductor splint is prescribed by occupational therapists to correct these impairments. There is insufficient evidence for the effectiveness of this splint on upper limb function in children with CP with a thumb-in-palm deformity within the South African public health context. Methods: A non-blinded randomised intervention study was carried out in a CP clinic at a tertiary level public hospital. Twenty-eight CP children between the age of 18 and 68 months, presenting with thumb-in-palm deformity, functioning on a Level II to IV on the Gross Motor Function Classification Scale (GMFCS) participated in the study

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“…Ayr›ca pozisyonlama ve anormal kas tonusunun düzenlenmesinde son y›llarda bas›nç splintlerinin ve 1950'li y›llardan bu yana da anormal kas tonusunun düzenlenmesinde, postüral düzgünlü¤ün sa¤lanmas›nda, istemli kontrolün ö¤renme yolu ile sa¤lanmas›nda kullan›lan elektromyografik (EMG) biofeedback e¤itiminin etkinli¤i de vurgulanm›flt›r. Tüm bu yöntemlerin hemiplejik SP'li çocuklar›n rehabilitasyonunun yan› s›ra duyu, alg› ve iletiflim problemlerinin çözümünde de etkinli¤i oldukça önemlidir (8,(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: G Gi Ir Ri Ifl Flunclassified

Comparison of EMG Biofeedback and Johnstone Pressure Splints in Children with Hemiplegic Cerebral Palsy

Ki̇ti̇ş¹,

Kayıhan²

2010

tftr

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Ö Öz ze et tA Am ma aç ç: : Bu çal›flma, hemiplejik serebral paralizili (SP) çocuklarda Bobath'›n nörogeliflimsel tedavi yöntemine ek olarak Johnstone bas›nç splintleri ve elektromyografik (EMG) biofeedback e¤itiminin kas tonusu, günlük yaflam aktiviteleri, duyu-alg› ve motor bütünleflme fonksiyonlar› ile fonksiyonel el aktiviteleri üzerine olan etkilerini karfl›laflt›rmak amac›yla yap›lm›flt›r. G Ge er re eç ç v ve e Y Yö ön nt te em m: : Çal›flmaya motor geliflim düzeyleri ayn› olan 38 spastik hemiplejik SP'li olgu kat›lm›fl, olgular iki gruba ayr›lm›fllard›r. Çal›fl-mada Bobath'›n nörogeliflimsel tedavi yöntemine ek olarak, I. grupta üst ekstremiteye 3 ay süre ile EMG biofeedback e¤itimi, II. grupta ise yine üst ekstremiteye 3 ay süre ile Johnstone bas›nç splintleri uygulanm›flt›r. Her iki grupta da olgular haftada üç gün ve üç ay süre ile tedaviye al›n›rken, her bir tedavi seans› süresi Biofeedback grubunda 20 dakika, Johnstone grubunda ise splintli ve splintsiz toplam 50 dakika olacak flekilde düzenlenmifltir. Olgular›n tümü kas tonusu, duyu-alg› ve motor bütünleflme fonksiyonlar›, günlük yaflam aktiviteleri ile el fonksiyonlar› yönünden tedavi öncesi, 3 ayl›k tedavinin sonunda, tedavi sonras› 3. ve 6. aylarda de¤erlendirilmifllerdir. B Bu ul lg gu ul la ar r: : Tedavinin sonunda her iki grupta da tedavi sonras› 3. ve 6. aylarda kas tonusunda azalma, günlük yaflam aktiviteleri, duyu-alg› ve motor bütünleflme fonksiyonlar› ve üst ekstremite fonksiyonlar›nda ise anlaml› bir geliflme kaydedilmifl (p<0,05), 1. gruptan elde edilen sonuçlar istatistiksel olarak daha anlaml› bulunmufltur (p<0,001). S So on nu uç ç: : Bu sonuçlar, her iki tedavi yönteminin de SP rehabilitasyonunda Bobath yöntemine yard›mc› oldu¤unu, EMG biofeedback e¤itiminin çocuklar›n daha aktif kat›l›mlar›n› teflvik etmesi bak›m›ndan daha aktif ve etkili bir yöntem olabilece¤ini düflündürmektedir. Türk Fiz T›p Rehab Derg 2010;56:116-23. A An na ah ht ta ar r K Ke el li im me el le er r: : Serebral palsi, Johnstone bas›nç splintleri, EMG biofeedback S Su um mm ma ar ry y O Ob bj je ec ct ti iv ve e: : This study was carried out to compare Johnstone pressure splints and electromyographic (EMG) biofeedback in addition to neurodevelopmental therapy on activities of daily living, sensory perception and motor integration functions, functional hand activities, and muscle tone in children with hemiplegic cerebral palsy (CP). M Ma at te er ri ia al ls s a an nd d M Me et th ho od ds s: : Thirty-eight children with spastic hemiplegic cerebral palsy, whose motor development levels were similar, were included in this study and were divided into two groups. In addition to Bobath's neurodevelopmental therapy, Group I was treated with pressure splints for the upper extremity and Group II-with EMG biofeedback training, also applied to the upper extremity, three times a week for three months. In the biofeedback group the session length was 20 minutes and in the Johnstone group, it was 50 minutes in total, with and without splinting. Patients were evaluated for m...

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Effectiveness of Upper and Lower Limb Casting and Orthoses in Children with Cerebral Palsy

Cited by 75 publications

References 34 publications

Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial

Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial

The effect of neoprene thumb abduction splints on upper limb function in children with cerebral palsy

Comparison of EMG Biofeedback and Johnstone Pressure Splints in Children with Hemiplegic Cerebral Palsy

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