AIM: The goal of this study was to contribute evidence towards the effectiveness of task-oriented training with and without restriction of trunk movement (trunk restraint) on the quality of upper limb movement in children with cerebral palsy (CP). METHOD: We used a prospective, single-subject research design in 12 children (three males, nine females; aged 6-11 y; median 9 y) with di-, hemi-, or quadriplegia. Movements of the most affected arm were assessed five times: three times before training, immediately after training, and 3 months after training. The main outcome measures were the Melbourne Assessment of Unilateral Upper Limb Function (Melbourne) and upper limb movement kinematics during a functional reaching task. Children were randomly allocated to one of two groups: task-oriented training with or without trunk restraint. Treatment consisted of three 1-hour sessions per week for 5 weeks (total training duration 15 h). Treatment effects were determined using single-subject research design analysis--regression through baseline data and standard mean differences. RESULTS: Although the Melbourne scores were largely unchanged after training, some children in each group improved arm trajectory smoothness (effect size 0.55-1.87), and most children improved elbow extension range (effect size 0.55-4.79). However, more children in the trunk restraint group than in the no restraint group demonstrated reduced trunk displacement (effect size 0.94-2.25) and longer-term improvements in elbow extension and trunk use. Among the group who underwent training without trunk restraint, trunk displacement was unchanged or increased, and fewer carry-over effects were apparent at follow-up. INTERPRETATION: This proof-of-principle study showed that greater improvement in the quality of upper limb movement in children with CP, including less compensatory trunk use and better carry-over effects, was achieved by training with trunk restraint.
RCT Entities:
AIM: The goal of this study was to contribute evidence towards the effectiveness of task-oriented training with and without restriction of trunk movement (trunk restraint) on the quality of upper limb movement in children with cerebral palsy (CP). METHOD: We used a prospective, single-subject research design in 12 children (three males, nine females; aged 6-11 y; median 9 y) with di-, hemi-, or quadriplegia. Movements of the most affected arm were assessed five times: three times before training, immediately after training, and 3 months after training. The main outcome measures were the Melbourne Assessment of Unilateral Upper Limb Function (Melbourne) and upper limb movement kinematics during a functional reaching task. Children were randomly allocated to one of two groups: task-oriented training with or without trunk restraint. Treatment consisted of three 1-hour sessions per week for 5 weeks (total training duration 15 h). Treatment effects were determined using single-subject research design analysis--regression through baseline data and standard mean differences. RESULTS: Although the Melbourne scores were largely unchanged after training, some children in each group improved arm trajectory smoothness (effect size 0.55-1.87), and most children improved elbow extension range (effect size 0.55-4.79). However, more children in the trunk restraint group than in the no restraint group demonstrated reduced trunk displacement (effect size 0.94-2.25) and longer-term improvements in elbow extension and trunk use. Among the group who underwent training without trunk restraint, trunk displacement was unchanged or increased, and fewer carry-over effects were apparent at follow-up. INTERPRETATION: This proof-of-principle study showed that greater improvement in the quality of upper limb movement in children with CP, including less compensatory trunk use and better carry-over effects, was achieved by training with trunk restraint.
Authors: Véronique F P Plasschaert; Johanna E Vriezekolk; Pauline B M Aarts; Alexander C H Geurts; Cornelia H M Van den Ende Journal: Dev Med Child Neurol Date: 2019-01-10 Impact factor: 5.449
Authors: Victor Santamaria; Moiz Khan; Tatiana Luna; Jiyeon Kang; Joseph Dutkowsky; Andrew M Gordon; Sunil K Agrawal Journal: IEEE Trans Neural Syst Rehabil Eng Date: 2021-01-28 Impact factor: 4.528
Authors: L Sheehy; A Taillon-Hobson; H Sveistrup; M Bilodeau; D Fergusson; D Levac; H Finestone Journal: BMC Neurol Date: 2016-03-31 Impact factor: 2.474