Evaluating the adult with cerebral palsy for specialized adaptive seating

Physical therapists may not expect to have a pronounced effect on the neuro-developmental function of the cerebral palsied adult because the neuroplasticity of the child is no longer present in the adult. Adapting the environment to such an adult, therefore, becomes of utmost importance. The wheelchair may be the most important structure of the environment for cerebral palsied adults. I present methods for assessing the severely involved adult client and evaluating adaptations of the wheelchair for therapeutic seating. The anterior and posterior tilt of the pelvis and the vertical angle of the backrest are emphasized in achieving therapeutic seating for the severely multiply handicapped adult.     

Participation and activity performance of students with cerebral palsy within the school environment

Purpose.?The aims of this study were to investigate the levels of participation and activity performance of students with cerebral palsy within the inclusive school context, to explore the relationships between these two aspects of function and to identify predictors of participation among the various school activities.

Method.?Two hundred and forty-eight elementary school students were divided into three groups: 100 fully included (FI) students with CP, 100 matched by class and gender typical students (TS) and 48 students with CP in self-contained classes (SC). The School Function Assessment (SFA) was used as the main measurement for assessing the levels of participation and functional performance profiles.

Results.?Significant differences (P?<?0.0001) in levels of participation were evident across the three study groups using MANOVA and ANOVAs analyses, where the TS level was the highest and the SC was the lowest. Comparison of the mean score of the physical and the cognitive/behavioural tasks performance revealed similar results among the three groups. Positive Pearson correlations were obtained between participation and both motor and cognitive/behavioural activity performance in the FI and the SC groups. Regression models for the FI and the SC groups were found significant (P?<?0.0001) and explained above 69% of the participation variance with physical activity performance as the most predictive variable.

Conclusions.?Significant differences exist between participation and activity performance of typical students and students with CP included in regular schools. Moreover, activity performance limitations were found to impact on school participation. These findings stress the continuing need to provide rehabilitative intervention towards removing existing barriers within the inclusive environment.     

Review of the efficacy and effectiveness of adaptive seating for children with cerebral palsy

The purpose of this article is to review the published research evidence for the efficacy and effectiveness of adaptive seating in the management of children with cerebral palsy. This review is undertaken to determine whether adaptive seating outcomes proposed in the clinical literature have been substantiated. The literature search was confined to English-language publications between 1982 and 1994. Thirty-seven research studies were identified through: 1) on-line search of Index Medicus, Cumulative Index to Nursing and Allied Health Literature, and Psychological Abstracts; 2) scanning conference proceedings and article reference lists; and, 3) tracking of author citations through the Science Citations Index. Eight studies met the selection criteria of using subjects who were children with cerebral palsy, including adaptive seating as an independent variable, and including an unsupported sitting comparison condition. Study quality was evaluated using an adaptation of Sackett's validity criteria. Sackett's classification system was utilized to identify levels of evidence and to grade recommendations. Grade A, B, and C recommendations were generated from Level I to Level V evidence for some of the clinically proposed seating outcomes. Additional seating research is required to strengthen the recommendations and investigate unexplored outcomes. Limitations of the review are potential reviewer and publication bias.     

Evaluation of computer-access solutions for students with quadriplegic athetoid cerebral palsy.

People with multiple physical impairments are not capable of using proper pointer devices, thus diminishing their opportunities to communicate and learn through computers. This research design used a replicated single-case experimental approach to compare the individual performance of two students with speech impairments and quadriplegic athetoid cerebral palsy in using four different computer-access solutions (the CameraMouse, the ASL Head Array mouse emulator, the CrossScanner, and the Quick Glance Eye Tracking System). The results demonstrate statistical significance in the correlation of movement time and accuracy to the level of comfort and satisfaction, which was used to guide the selection of computer-access solutions for clinical interventions. The WinFitts and Assessment of Comfort tests used in this study can be replicated for further clinical research into computer-access systems.     

Evaluating the applicability of optic microswitches for eyelid responses in students with profound multiple disabilities

Purpose. The two studies reported here served as replication and extension of preliminary research on the use of optic microswitches for eyelid responses with students with profound multiple disabilities.

Method. In Study I, a young boy was taught to use the same combination of upward eyelid movement and optic microswitch utilized before. In Study II, an adolescent was taught to use a new combination of single blink response and optic microswitch. Study I included an ABAB sequence (in which A represented baseline and B intervention phases) and post-intervention checks. Study II included four phases assessing the effects of baseline, intervention, and non-contingent stimulation conditions.

Results. The results of Study I showed that the boy displayed high frequencies of the upward eyelid response during the intervention phases and post-intervention checks (suggesting learning effects). The results of Study II showed that the adolescent performed the single blink response at a significantly higher frequency during intervention as opposed to the other conditions (again suggesting learning effects).

Conclusions. The results of Study I and Study II provide encouraging new evidence, with potentially important practical implications, about the applicability of eyelid responses and optic microswitches for students with profound multiple disabilities and minimal motor behaviour.     

Aging with cerebral palsy

Before the mid-twentieth century, few people with CP survived to adulthood. Now, 65% to 90% of children with CP survive. Because of improvements in intensive care techniques leading to the increased survival of very low-birth-weight infants and the increased longevity of the general population, there are a large number of disabled adults requiring medical care. Adults with CP have medical and social issues that are unique to them. Although there is an increasing awareness of the rights of people with disabilities, there is more work to be done particularly as relates to the cost and availability of adaptive equipment and exercise. In recent years, more attention has been given to studying the needs of this growing part of the population. However, much remains to be investigated to improve the quality of life for these patients.     

A comparison of leg stiffness in running between typically developing children and children with cerebral palsy

BackgroundLeg stiffness is important during running to increase velocity and maximise efficiency by facilitating use of the stretch-shortening cycle. Children with cerebral palsy who have neuromuscular impairments may have altered leg stiffness. The aim of this study was to describe leg stiffness during running in typically developing children and those with cerebral palsy in Gross Motor Function Classification Scale levels I and II at a range of speeds.MethodsThis cross-sectional study examined kinematic data collected from typically developing children (n = 21) and children with cerebral palsy (Gross Motor Function Classification Scale level I n = 25, Gross Motor Function Classification Scale level II n = 13) during jogging, running and sprinting. Derived variables were resultant ground reaction force, change in leg length and three-dimensional leg stiffness. Linear mixed models were developed for statistical analysis.FindingsChildren with cerebral palsy had reduced stiffness when jogging (Gross Motor Function Classification Scale level I affected t = 3.81 p < 0.01; non-affected t = 2.19 p = 0.03; Gross Motor Function Classification Scale level II affected t = 2.04 p = 0.04) and running (Gross Motor Function Classification Scale level I affected t = 3.23 p < 0.01) compared to typically developing children. Affected legs were less stiff than non-affected legs only in Gross Motor Function Classification Scale level I during running (t = 2.26 p = 0.03) and sprinting (t = 2.95 p < 0.01).InterpretationChildren with cerebral palsy have atypical leg stiffness profiles which differ according to functional classification.     

Evaluation of a parent-report diary of the home use of assistive devices by young children with cerebral palsy

Purpose.?To develop and evaluate the preliminary measurement properties of a parent-report diary of the home use of seating and mobility devices by young children with cerebral palsy (CP).

Method.?Four AT experts reviewed the home use of technology for children (HUTCH) diary to confirm its coverage of AT devices, and six parents of young children with CP examined its content, wording and organization. A random sample of 12 other parents independently completed a HUTCH diary daily for 1 week to record their child's use of seating, mobility and orthotic devices at home. Two to three weeks later, parents completed a second diary of AT device use over another seven consecutive days.

Results.?The face validity, content validity and test–retest reliability (ICC = 0.91; 95% CI = 0.69–0.97) of the HUTCH were very good. Parents reported that they completed the diary quickly and easily.

Conclusions.?The HUTCH diary shows promise as a reliable and practical way to record the frequency and number of hours that children use different types of seating and mobility-related devices at home. Testing the concurrent validity of the HUTCH diary against an acceptable criterion measure will improve its acceptance as measure of AT device use.     

Performance of physical activities by adolescents with cerebral palsy

BACKGROUND AND PURPOSE: Mobility and self-care are important considerations for successful transition of adolescents with cerebral palsy to adulthood. The purpose of this study was to characterize performance of physical activities from the perspective of adolescents themselves. SUBJECTS: The subjects were 156 adolescents with cerebral palsy, 11.6 to 17.7 years of age. METHODS: A therapist completed the Gross Motor Function Classification System (GMFCS). Adolescents completed the Activities Scale for Kids-Performance Version (ASKp) twice over a 1-year period. RESULTS: A repeated-measures analysis of variance indicated a main effect for GMFCS level. The main effect for time and the GMFCS level x time interaction were not significant. Post hoc comparisons indicated that ASKp scores differed among all GMFCS levels. DISCUSSION AND CONCLUSION: Performance of physical activities by adolescents with cerebral palsy differed based on GMFCS level and did not change over 1 year. The ASKp scores of adolescents in levels II through V suggest the need for physical assistance at times throughout the day. The results have implications for the role of the physical therapist in transition planning.     

Assistive technology for promoting adaptive skills of children with cerebral palsy: ten cases evaluation

Abstract

Objectives: To extend the use of assistive technology for promoting adaptive skills of children with cerebral palsy. To assess its effects on positive participation of ten participants involved. To carry out a social validation recruiting parents, physiotherapists and support teachers as external raters.

Method: A multiple probe design was implemented for Studies I and II. Study I involved five participants exposed to a combined program aimed at enhancing choice process of preferred items and locomotion fluency. Study II involved five further children for a combined intervention finalized at ensuring them with literacy access and ambulation responses. Study III recruited 60 external raters for a social validation assessment.

Results: All participants improved their performance, although differences among children occurred. Indices of positive participation increased as well. Social raters favorably scored the use of both technology and programs.

Conclusion: Assistive technology-based programs were effective for promoting independence of children with cerebral palsy.

• Implications for Rehabilitation

• A basic form of assistive technology such as a microswitch-based program may be useful and helpful for supporting adaptive skills of children with cerebral palsy and different levels of functioning.

• The same program may improve the participants' indices of positive participation and constructive engagement with beneficial effects on their quality of life.

• The positive social rating provided by external experts sensitive to the matter may recommend a favorable acceptance and implementation of the program in daily settings.

     

A critical evaluation of the rehabilitation of children with cerebral palsy

Background. The aim of this study is to present the authors clinical experience in the rehabilitation of cerebral palsied children in the Podkarpacie district of Poland. Material and method. During the period 1989-2001 the authors treated 1980 children in the Outpatient Rehabilitation Clinic for Children at District Hospital No. 2 in Rzeszow, Poland. 712 of these children suffered from cerebral palsy. At present there are 1300 children living in Rzeszow and the vicinity under the permanent care of our outpatient clinic. The rehabilitation procedure consists of physioteraphy, long-term follow-up by rehabilitation specialists, otolaryngologists, and psychologists, and parent education. The children are also provided with orthopedic equipment and orthopedic treatment in all cases requiring surgery (4,7% of all the CP children). Conclusions. All problems involving the comprehensive rehabilitation of the children treated in our Outpatient Rehabilitation Clinic for Children are discussed. We also present conclusions on how to make access to rehabilitation easier for patients and improve the cooperation of the rehabilitation team.     

Children with cerebral palsy participate: A review of the literature

Purpose.?To review research that examined the participation in activities of children who have cerebral palsy, in order to understand their extent of participation and the factors that influenced participation.

Methods.?A comprehensive search of seven databases retrieved 2,111 papers, 40 of which met criteria and were relevant for critique. As this paper intended to examine participation broadly, an ecological framework was used to organise the relevant papers into those studies that considered personal, environmental and occupational factors related to participation.

Results.?Children with cerebral palsy participated in a diverse array of activities across a range of occupational contexts. Their participation was not always a positive experience. Factors most commonly identified as barriers to participation were social attitudes and the physical environment. This review identified only emergent understandings of the naturally occurring changes in the participation of children with cerebral palsy that come with increasing age and, concurrently, with increasing social and environmental demands.

Conclusions.?Future research designs must accommodate the complexity of participation to further our knowledge and improve our ability to target therapeutic interventions at community, family and child levels.     

The psychosocial well-being of parents of children with cerebral palsy: a comparison study

Purpose.?Parents of children with cerebral palsy (CP) may be at risk from poor psychosocial well-being, compared with parents of children without a long-term health condition (LTHC). However, research has produced some conflicting findings on the topic and no comparison studies have been conducted in the UK. Furthermore, studies have only used measures of negative psychosocial well-being. The aim of this study was to conduct a comparative study of parents of children with CP and parents of children without a LTHC in the UK.

Method.?Seventy parents of children with CP and 70 parents of children without a LTHC completed self-administered questionnaires, comprising measures of psychosocial distress and positive psychosocial well-being.

Results.?This study demonstrated that parents of children with CP have significantly poorer psychosocial well-being compared with parents of children without a LTHC: parents of children with CP had lower satisfaction with life and higher levels of anxious and depressed mood.

Conclusions.?These results suggest caring for a child with CP may put parents at risk from poor psychosocial well-being. Interventions to improve parental well-being are urgently needed.