Novak et al. reply

Novak, Iona; McIntyre, Sarah; Morgan, Catherine; Campbell, Lanie; Dark, Leigha; Morton, Natalie A de; Stumbles, Elise; Wilson, Salli-Ann; Goldsmith, Shona

doi:10.1111/dmcn.12426

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…As a consequence of the rapid growth in CP research in the last decade, safer and more effective interventions for children with cerebral palsy have been introduced. At least 64 different interventions for cerebral palsy aimed at different dysfunctions have been presented and analyzed in the systematic review [4].…”

Section: оригінальні дослідження /Original Researches/mentioning

confidence: 99%

Зміни рухових функцій у дітей iз церебральним паралічем після курсу інтенсивної нейрофізіологічної реабілітації: сліпе дослідження

Kachmar¹,

Mysula²,

Kushnir³

et al. 2021

INJ

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Background. Modern intensive interventions addressing multiple challenges in children with cerebral palsy are attracting clinicians' and researchers' attention. One of such methods is the intensive neurophysiological rehabilitation system (INRS)-a combination of interventions focusing on different functional goals, merged into one intensive course. The purpose of the study was to assess changes in gross motor functions, muscle spasticity and passive range of motion (PROM) in children with spastic forms of cerebral palsy (CP) after the two-week of treatment course with INRS. Materials and methods. A single-arm, single-blind pre-post study was conducted among 57 children aged 4 to 12 years with spastic CP, admitted for treatment to the tertiary care center. Patients were examined before and after the two-week course using INRS, which included multiple interventions totalling 4-5 hours of treatment daily. The Gross Motor Function Measure-66 (GMFM-66) tasks were video-recorded and evaluated independently by two investigators. The time of recordings (baseline or post-intervention) was masked. PROM in the lower extremity joints was assessed with a manual goniometer, muscle spasticity-with the Modified Ashworth scale. Results. GMFM-66 scores after INRS use increased statistically significantly from 58.8 to 60.2 points, with a mean difference of 1.4 ± 2.9 points. Substantial improvement in PROM was noted for 5 of 7 movements; the most substantial improvement was observed in hip abduction-an average of 8.0 ± 5.8° and foot dorsiflexion-8.0 ± 6.1°. Reduction of the muscle tone was observed in all measured muscle groups. Statistically significant decrease of spasticity was noted in hip flexors, with an average reduction of 0.25 scale steps (95% confidence interval (CI) = 0.06-0.44), and hip adductors-0.30 steps (95% CI = 0.08-0.51). Conclusions. Improvements of gross motor functions, an increase of PROM in the lower extremities and reduction of muscle spasticity have been detected after the two-week course with INRS. Intensive treatment using INRS requires further studies, including randomized controlled ones.

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Section: оригінальні дослідження /Original Researches/mentioning

confidence: 99%

Зміни рухових функцій у дітей iз церебральним паралічем після курсу інтенсивної нейрофізіологічної реабілітації: сліпе дослідження

Kachmar¹,

Mysula²,

Kushnir³

et al. 2021

INJ

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“…In their response to the letters to the editor, Novak and colleagues 22 acknowledged the limitations of RCTs and supported the use of alternative research designs. Furthermore, they strongly agreed with others 17 that "the essential next step for the field is to prioritize the development of in-depth, subgroupspecific, valid and patient-oriented, internationally endorsed clinical guidelines, using rigorous, accepted methodologies and involving appropriate consultation."…”

Section: Difficulties In Applying Knowledge From Intervention Studiesmentioning

confidence: 99%

A Collaborative Approach to Decision Making Through Developmental Monitoring to Provide Individualized Services for Children With Cerebral Palsy

et al. 2018

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In this perspective paper, we explore the challenge that physical and occupational therapists face when attempting to use evidence of effectiveness of interventions to support people with heterogeneous health conditions, such as cerebral palsy (CP). We define CP and describe how variable children with this diagnosis are. We then selectively review published literature that highlights difficulties in using information from randomized controlled trials (RCTs) and systematic reviews to inform service planning for children with CP. We propose an evidence-based alternative using prospective cohort studies that produce knowledge of determinants of outcomes important to children and families and methods for developmental monitoring using longitudinal and reference percentile curves to inform individualized care. We provide guidelines to explore how this evidence can be used to plan family-centred, collaborative, strengths-based services to support development and function. Cerebral Palsy and Heterogeneity Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture ….. often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems. 1, pg9 Traditionally, children with CP have been described by type of motor disorder or distribution of involvement. Recently, functional classification systems have been identified to be more useful and reliable than systems based on impairments. 2 The Gross Motor Function Classification System (GMFCS), 3,4 the Manual Ability Classification System (MACS), 5 and the Communication Function Classification System (CFCS) 6 are 5-level ordinal classification systems to categorize usual performance in gross motor, hand, and communication function in everyday life with evidence supporting their reliability and validity. In all systems, level I represents the highest function and level V the lowest. Together, these systems contribute significantly in understanding the variable manifestation of CP. They also provide enhanced

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“…How such models relate to available rehabilitation therapies is increasingly understood. Constraint-induced movement therapy (CIMT) and bimanual therapies can be effective for some but require high doses and effect sizes are modest (Novak et al, 2013). Models have also defined targets for non-invasive neuromodulation, namely the non-lesioned primary motor cortex, where controlled clinical trials suggest additional efficacy (Kirton et al, 2015;Hilderley et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

BCI-activated electrical stimulation in children with perinatal stroke and hemiparesis: A pilot study

Jadavji

Kirton

Metzler

et al. 2023

Front. Hum. Neurosci.

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BackgroundPerinatal stroke (PS) causes most hemiparetic cerebral palsy (CP) and results in lifelong disability. Children with severe hemiparesis have limited rehabilitation options. Brain computer interface- activated functional electrical stimulation (BCI-FES) of target muscles may enhance upper extremity function in hemiparetic adults. We conducted a pilot clinical trial to assess the safety and feasibility of BCI-FES in children with hemiparetic CP.MethodsThirteen participants (mean age = 12.2 years, 31% female) were recruited from a population-based cohort. Inclusion criteria were: (1) MRI-confirmed PS, (2) disabling hemiparetic CP, (3) age 6–18 years, (4) informed consent/assent. Those with neurological comorbidities or unstable epilepsy were excluded. Participants attended two BCI sessions: training and rehabilitation. They wore an EEG-BCI headset and two forearm extensor stimulation electrodes. Participants’ imagination of wrist extension was classified on EEG, after which muscle stimulation and visual feedback were provided when the correct visualization was detected.ResultsNo serious adverse events or dropouts occurred. The most common complaints were mild headache, headset discomfort and muscle fatigue. Children ranked the experience as comparable to a long car ride and none reported as unpleasant. Sessions lasted a mean of 87 min with 33 min of stimulation delivered. Mean classification accuracies were (M = 78.78%, SD = 9.97) for training and (M = 73.48, SD = 12.41) for rehabilitation. Mean Cohen’s Kappa across rehabilitation trials was M = 0.43, SD = 0.29, range = 0.019–1.00, suggesting BCI competency.ConclusionBrain computer interface-FES was well -tolerated and feasible in children with hemiparesis. This paves the way for clinical trials to optimize approaches and test efficacy.

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Novak et al. reply

Cited by 6 publications

References 16 publications

Зміни рухових функцій у дітей iз церебральним паралічем після курсу інтенсивної нейрофізіологічної реабілітації: сліпе дослідження

Зміни рухових функцій у дітей iз церебральним паралічем після курсу інтенсивної нейрофізіологічної реабілітації: сліпе дослідження

A Collaborative Approach to Decision Making Through Developmental Monitoring to Provide Individualized Services for Children With Cerebral Palsy

BCI-activated electrical stimulation in children with perinatal stroke and hemiparesis: A pilot study

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