Mattana Angsupaisal1, Baudina Visser2, Anne Alkema3, Marja Meinsma-van der Tuin4, Carel G B Maathuis5, Heleen Reinders-Messelink6, Mijna Hadders-Algra7. 1. M. Angsupaisal, PT, MSc, Division of Developmental Neurology, Department of Paediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 2. B. Visser, PT, MPPT, Division of Developmental Neurology, Department of Paediatrics, University of Groningen, University Medical Center Groningen. 3. A. Alkema, BSc, Division of Developmental Neurology, Department of Paediatrics, University of Groningen, University Medical Center Groningen. 4. M. Meinsma-van der Tuin, MD, Rehabilitation Center Revalidatie Friesland, Beetsterzwaag, the Netherlands. 5. C.G.B. Maathuis, MD, PhD, Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen. 6. H. Reinders-Messelink, PhD, Rehabilitation Center Revalidatie Friesland. 7. M. Hadders-Algra, MD, PhD, Division of Developmental Neurology, Department of Paediatrics, University of Groningen, University Medical Center Groningen, Y3208, Hanzeplein 1, 9713 GZ Groningen, the Netherlands. m.hadders-algra@umcg.nl.
Abstract
BACKGROUND: It is debatable whether adaptive riding (AR) in children with cerebral palsy (CP) improves postural control and gross motor development. OBJECTIVE: The study aim was to explore the feasibility of an extensive assessment protocol for a randomized controlled trial of therapist-designed adaptive riding (TDAR) in children with CP, with the goals of assessing the effect on child outcomes and evaluating working mechanisms of sitting postural control. DESIGN: A pretest-posttest group design with 2 baseline measurements was used. METHODS:Six children (1 girl, 5 boys; age range=6-12 years, median age=8 years 9 months) with bilateral spastic CP (Gross Motor Function Classification System level III) participated. Outcomes were evaluated 3 times (T0, T1, and T2) at 6-week intervals. T0 and T1 were baseline measurements; between T1 and T2, a TDAR intervention including an integrated program of postural challenge exercises (2 times per week for 1 hour) was applied. The complex protocol included the 88-item Gross Motor Function Measure (GMFM-88) and electromyographic (EMG) recording of postural muscle activity during reaching while sitting (EMG recording at T1 and T2 only). RESULTS: The protocol was feasible. Median GMFM-88 scores changed from 64.4 at T0 to 66.7 at T1 and from 66.7 at T1 to 73.2 at T2. The change scores for all children exceeded the minimal clinically important difference of the GMFM-88. Five of 6 children showed a decrease in stereotyped top-down recruitment between T1 and T2. LIMITATIONS: Study limitations included the lack of a control group, small sample size, and potential assessor bias for all but the EMG parameters. CONCLUSIONS: The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial.
RCT Entities:
BACKGROUND: It is debatable whether adaptive riding (AR) in children with cerebral palsy (CP) improves postural control and gross motor development. OBJECTIVE: The study aim was to explore the feasibility of an extensive assessment protocol for a randomized controlled trial of therapist-designed adaptive riding (TDAR) in children with CP, with the goals of assessing the effect on child outcomes and evaluating working mechanisms of sitting postural control. DESIGN: A pretest-posttest group design with 2 baseline measurements was used. METHODS: Six children (1 girl, 5 boys; age range=6-12 years, median age=8 years 9 months) with bilateral spastic CP (Gross Motor Function Classification System level III) participated. Outcomes were evaluated 3 times (T0, T1, and T2) at 6-week intervals. T0 and T1 were baseline measurements; between T1 and T2, a TDAR intervention including an integrated program of postural challenge exercises (2 times per week for 1 hour) was applied. The complex protocol included the 88-item Gross Motor Function Measure (GMFM-88) and electromyographic (EMG) recording of postural muscle activity during reaching while sitting (EMG recording at T1 and T2 only). RESULTS: The protocol was feasible. Median GMFM-88 scores changed from 64.4 at T0 to 66.7 at T1 and from 66.7 at T1 to 73.2 at T2. The change scores for all children exceeded the minimal clinically important difference of the GMFM-88. Five of 6 children showed a decrease in stereotyped top-down recruitment between T1 and T2. LIMITATIONS: Study limitations included the lack of a control group, small sample size, and potential assessor bias for all but the EMG parameters. CONCLUSIONS: The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial.