Corinne Ammann-Reiffer

Feasibility of robotic-assisted locomotor training in children with central gait impairment.

Intensive, task‐specific training enabled by a driven gait orthosis (DGO) may be a cost‐effective means of improving walking performance in children. A paediatric DGO has recently been developed. This study was the first paediatric trial aimed to determine the feasibility of robotic‐assisted treadmill training in children with central gait impairment (n=26; 11 females, 15 males; mean age 10y 1mo [SD 4y]; range 5y 2mo‐19y 5mo). Diagnoses of the study group included cerebral palsy (n=19; Gross Motor Function Classification System Levels I–IV), traumatic brain injury (n=1), Guillain‐Barré syndrome (n=2), incomplete paraplegia (n=2), and haemorrhagic shock (n=1), and encephalopathy (n=1). Sixteen children were in‐patients and 10 were outpatients. Twenty‐four of the 26 patients completed the training which consisted of a mean of 19 sessions (SD 2.2; range 13–21) in the in‐patient group and 12 sessions (SD 1.0; range 10–13) in the outpatient group. Gait speed and 6‐Minute Walking Test increased significantly (p<0.01). Functional Ambulation Categories and Standing dimension (in‐patient group p<0.01; outpatient group p<0.05) of the Gross Motor Function Measure improved significantly. DGO training was successfully integrated into the rehabilitation programme and findings suggest an improvement of locomotor performance.

Improvement of walking abilities after robotic-assisted locomotion training in children with cerebral palsy

Objective: To measure functional gait improvements of robotic-assisted locomotion training in children with cerebral palsy (CP). Design: Single-case experimental A-B design. Settings: Rehabilitation Centre Affoltern am Albis, Children’s University Hospital Zurich, Switzerland (inpatient group) and Neurology Department of the Dr von Haunersches Children’s Hospital Munich, Germany (outpatient group). Participants: 22 children (mean age 8.6 years, range 4.6–11.7) with CP and a Gross Motor Function Classification System level II to IV. Interventions: 3 to 5 sessions of 45–60 minutes/week during a 3–5-week period of driven gait orthosis training. Main outcome measures: 10-metre walk test (10MWT), 6-minute walk test (6MinWT), Gross Motor Function Measure (GMFM-66) dimension D (standing) and dimension E (walking), and Functional Ambulation Categories (FAC). Results: The mean (SD) maximum gait speed (0.78 (0.57) to 0.91 (0.61) m/s; p<0.01) as well as the mean (SD) dimension D of the GMFM-66 (40.3% (31.3%) to 46.6% (28.7%); p<0.05) improved significantly after the intervention period. The mean (SD) 6MinWT (176.3 (141.8) to 199.5 (157.7) m), the mean FAC (2.6 (1.7) to 3.0 (1.6)) and the mean (SD) dimension E of the GMFM-66 (29.5% (30.3%) to 31.6% (29.2%)) also showed an increase, but did not reach a statistically significant level. Conclusion: These results suggest that children with CP benefit from robotic-assisted gait training in improving functional gait parameters.

Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy

OBJECTIVE Task-specific body-weight-supported treadmill therapy improves walking performance in children with central gait impairment. The aim of the study was to investigate the effect of robotic-assisted treadmill therapy on standing and walking performance in children and adolescents with cerebral palsy and to determine parameters influencing outcome. METHODS 20 Patients (mean age 11.0 ± 5.1, 10 males and 10 females) with cerebral palsy underwent 12 sessions of robotic-assisted treadmill therapy using the driven gait orthosis Lokomat. Outcome measures were the dimensions D (standing) and E (walking) of the Gross Motor Function Measure (GMFM). RESULTS Significant improvements in dimension D by 5.9% (± 5.2, p=0.001) and dimension E by 5.3% (± 5.6, p<0.001) of the GMFM were achieved. Improvements in the GMFM D and E were significantly greater in the mildly affected cohort (GMFCS I and II) compared to the more severely affected cohort (GMFCS III and IV). Improvement of the dimension E but not of D correlated positively with the total distance and time walked during the trial (r(s)=0.748, p<0.001). CONCLUSIONS Children and adolescents with bilateral spastic cerebral palsy showed improvements in the functional tasks of standing and walking after a 3-week trial of robotic-assisted treadmill therapy. The severity of motor impairment affects the amount of the achieved improvement.

Constraint-induced movement therapy for children with obstetric brachial plexus palsy: two single-case series.

The objective of this pilot study was to investigate the feasibility of constraint-induced movement therapy (CIMT) in children with obstetric brachial plexus palsy and receive preliminary information about functional improvements. Two patients (age 12 years) with obstetric brachial plexus palsy were included for a 126-h home-based CIMT intervention (3 and 4.5 weeks) and weekly monitored with the Melbourne Assessment of Unilateral Upper Limb function and the Nine-hole Peg Test. The Assisted Hand Assessment was performed 3 weeks before the beginning of intervention, preintervention, postintervention, and at 3 weeks follow-up (ABA single-case design). Tests were analyzed descriptively, visually, and where possible, using a time series analysis with C statistic. Results revealed changes of arm function in both patients between preintervention and follow-up test as follows: Assisted Hand Assessment from 85 to 92% in patient A and 80 to 89% in patient B, in the Melbourne Assessment of Unilateral Upper Limb function from 87 to 90% (C=0.578, z=1.876, P<0.05) in patient A and 72 to 80% (C=0.827, z=2.68, P<0.005) in patient B. There was no improvement in the Nine-hole Peg Test in both patients. Improvements as a result of CIMT found in this pilot study may not be considered substantial. However, they justify further research as some findings indicate relationship to the CIMT intervention in the ‘B’ phase. To enhance motivation and to plan a controlled, randomized clinical trial, child-friendly applications of the CIMT concept and adequate measures to monitor compliance are being discussed.

Measurement Properties of Gait-Related Outcomes in Youth With Neuromuscular Diagnoses: A Systematic Review

Background Sound measurement properties of outcome tools are essential when evaluating outcomes of an intervention, in clinical practice and in research. Purpose The purpose of this study was to review the evidence on reliability, measurement error, and responsiveness of measures of gait function in children with neuromuscular diagnoses. Data Sources The MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched up to June 15, 2012. Study Selection Studies evaluating reliability, measurement error, or responsiveness of measures of gait function in 1- to 18-year-old children and youth with neuromuscular diagnoses were included. Data Extraction Quality of the studies was independently rated by 2 raters using a modified COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. Studies with a fair quality rating or better were considered for best evidence synthesis. Data Synthesis Regarding the methodological quality, 32 out of 35 reliability studies, all of the 13 measurement error studies, and 5 out of 10 responsiveness studies were of fair or good quality. Best evidence synthesis revealed moderate to strong evidence for reliability for several measures in children and youth with cerebral palsy (CP) but was limited or unknown in other diagnoses. The Functional Mobility Scale (FMS) and the Gross Motor Function Measure (GMFM) dimension E showed limited positive evidence for responsiveness in children with CP, but it was unknown or controversial in other diagnoses. No information was reported on the minimal important change; thus, evidence on measurement error remained undetermined. Limitations As studies on validity were not included in the review, a comprehensive appraisal of the best available gait-related outcome measure per diagnosis is not possible. Conclusions There is moderate to strong evidence on reliability for several measures of gait function in children and youth with CP, whereas evidence on responsiveness exists only for the FMS and the GMFM dimension E.

Interrater reliability of two gait performance measures in children with neuromotor disorders across two different settings

To examine the interrater agreement of the two gait performance measures – the Functional Mobility Scale (FMS) and Gillette Functional Assessment Questionnaire – walking scale (FAQ) – within health professionals and parents in children with neuromotor disorders, measured in an inpatient setting and at home.

Concurrent Validity of Two Gait Performance Measures in Children with Neuromotor Disorders

ABSTRACT Aims: To investigate the concurrent validity of two mobility performance measures, the Functional Mobility Scale (FMS) and the Gillette Functional Assessment Questionnaire – walking scale (FAQ) in an inpatient pediatric neurorehabilitation setting. Methods: Cross-sectional data were collected on 71 children (mean age 12.7 years) with neuromotor gait impairments who participated in an inpatient rehabilitation program to evaluate aspects of concurrent validity of the FMS and FAQ. Physiotherapists independently performed ratings. Comparator instruments included the walking item of the Functional Independence Measure for children, 10-m and 6-minute walking tests, and Gross Motor Function Measure-88 dimension E. All tests were completed within 7 days. Spearman correlation coefficients were calculated to test a priori formulated hypotheses regarding the strength and direction of the measures relationships. Results: The children had a broad spectrum of mobility levels, including all levels of FMS and levels 2–10 of FAQ. Spearman correlation coefficients with comparator measures varied between 0.58–0.79 for the FMS and 0.69–0.73 for the FAQ. Hypotheses concerning correlation strengths and directions were met for FMS and FAQ. Conclusions: The findings demonstrate that the FMS and FAQ are valid to evaluate functional mobility in pediatric inpatient neurorehabilitation.

Measuring change in gait performance of children with motor disorders: assessing the Functional Mobility Scale and the Gillette Functional Assessment Questionnaire walking scale

To examine the responsiveness and minimal important change (MIC) of two gait performance measures, the Functional Mobility Scale (FMS) and the Gillette Functional Assessment Questionnaire walking scale (FAQ), in a paediatric inpatient setting.