Laurie Snider

Virtual reality as a therapeutic modality for children with cerebral palsy

Objective: The evidence for using virtual reality (VR) with children with cerebral palsy (CP) was examined. Methods: A search of 13 electronic databases identified all types of studies examining VR as an intervention for children with CP. The most recent article included was published in October 2008. For each study, the quality of the methods was assessed using the appropriate scale. A total of 19 articles were retrieved. Thirteen studies from 11 articles were included in the final analysis. Results: Outcomes documented brain reorganization/plasticity, motor capacity, visual-perceptual skills, social participation and personal factors. Two studies were randomized controlled trials. These reported conflicting results regarding motor outcomes. Twelve of the 13 studies presented positive outcomes in at least one domain. Conclusions: VR has potential benefits for children with CP. However, the current level of evidence is poor and empirical data is lacking. Future methodologically rigorous studies are required.

Horseback riding as therapy for children with cerebral palsy: is there evidence of its effectiveness?

A systematic review of the literature on horseback riding therapy as an intervention for children with cerebral palsy (CP) was carried out. The terms horse, riding, hippotherapy, horseback riding therapy, equine movement therapy, and cerebral palsy were searched in electronic databases and hand searched. Retrieved articles were rated for methodological quality using PEDro scoring to assess the internal validity of randomized trials and the Newcastle Ottawa Quality Assessment Scale to assess cohort studies. PICO questioning (Population, Intervention, Comparison, and Outcomes) was used to identify questions of interest to clinicians for outcomes within the context of the International Classification of Functioning, Disability and Health. Levels of evidence were then accorded each PICO question. There is Level 2a evidence that hippotherapy is effective for treating muscle symmetry in the trunk and hip and that therapeutic horseback riding is effective for improved gross motor function when compared with regular therapy or time on a waiting list. No studies addressed participation outcomes.

Handwriting performance in children with attention deficit hyperactivity disorder (ADHD).

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral condition of childhood. Consequences are multifaceted and include activity limitations in daily-living skills, academic challenges, diminished socialization skills, and motor difficulties. Poor handwriting performance is an example of an affected life skill that has been anecdotally observed by educators and clinicians for this population and can negatively impact academic performance and self-esteem. To guide health and educational service delivery needs, the authors reviewed the evidence in the literature on handwriting difficulties in children with ADHD. Existing evidence would suggest that children with ADHD have impaired handwriting performance, characterized by illegible written material and/or inappropriate speed of execution compared to children without ADHD. Studies with larger sample sizes using standardized measures of handwriting performance are needed to evaluate the prevalence of the problem and to better understand the nature of handwriting difficulties and their impact in this population.

Predictive validity of Prechtl's Method on the Qualitative Assessment of General Movements: a systematic review of the evidence.

Aim  The aim of this systematic review was to examine the evidence for the predictive validity of Prechtl’s Method on the Qualitative Assessment of General Movements (GMsA) with respect to neurodevelopmental outcomes.

Actual vs. best practices for young children with cerebral palsy: A survey of paediatric occupational therapists and physical therapists in Quebec, Canada

Rationale: Cerebral palsy (CP) constitutes a substantial portion of paediatric rehabilitation, yet little is known regarding actual occupational therapy (OT) and physical therapy (PT) practices. This study describes OT and PT practices for young children with CP in Quebec, Canada. Methods: This was a cross-sectional survey. All eligible, consenting paediatric occupational therapists (OTs) and physical therapists (PTs) were interviewed using a structured telephone interview based on vignettes of two typical children with CP at two age points—18 months and 4 years. Reported practices were grouped according to the International Classification of Functioning, Disability and Health (ICF). Results: 91.9% of PTs (n = 62; 83.8% participation rate) and 67.1% of OTs (n = 85; 91.4% participation rate) reported using at least one standardized paediatric assessment. OT and PT interventions focused primarily on impairments and primary function (such as gait function and activities of daily living). Both professions gave little attention to interventions related to play and recreation/leisure. Clinicians reported the need for more training and education specific to CP and to the use of research findings in clinical practice. Conclusion: Wide variations and gaps were identified in clinicians’ responses suggesting the need for a basic standard of OT and PT management as well as strategies to encourage knowledge dissemination regarding current best practice. Fundamento: La parálisis cerebral (PC) constituye una parte sustancial de la rehabilitación pediátrica, sin embargo se sabe poco acerca del ejercicio actual de la terapia física (TF) y de la terapia ocupacional (TO). Este estudio describe la aplicación de la TF y de la TO a niños pequeños con PC en Quebec, Canadá. Métodos: Este fue un estudio prospectivo, de corte transversal. Todos los terapistas físicos (TF) y los terapistas ocupacionales (TO) pediátricos elegibles, previo consentimiento, fueron entrevistados utilizando un cuestionario telefónico estructurado basado en viñetas de dos niños típicos con PC a dos edades - 18 meses y 4 años de edad. Las prácticas reportadas fueron agrupadas en base a la Clasificación Internacional de Funcionalidad, discapacidad y salud (CIF). Resultados: 91.9% de los TFs (n = 62; 83.8% rango de participación) y 67.1% de los TOs (n = 85; 91.4% rango de participación) reportaron usar por lo menos una forma de evaluación pediátrica estandarizada. Las intervenciones de TF y TO se enfocaron principalmente en las discapacidades y en las funciones primarias (tales como la marcha y las actividades de la vida diaria). Ambas profesiones prestaron poca atención a las intervenciones relacionadas al juego y a las actividades recreativas y de entretenimiento. Los médicos manifestaron la necesidad de un mayor entrenamiento y educación específicos a la PC y la aplicación de los hallazgos de las investigaciones en la práctica clínica. Conclusión: Se identificaron amplias variaciones y un desconocimiento en las respuestas de los médicos, sugiriendo esto la necesidad de un manejo estándar básico de TF y TO, así como estrategias que impulsen la diseminación del conocimiento en relación a una mejor práctica. Palabras clave: Terapia ocupacional, terapia física, parálisis infantil, Clasificación Internacional de Funcionalidad, tratamiento basado en la evidencia, rehabilitación pediátrica

The Internet is valid and reliable for child-report: an example using the Activities Scale for Kids (ASK) and the Pediatric Quality of Life Inventory (PedsQL).

OBJECTIVE This study tested the impact of web administration on well-established measures of childrens physical function and quality of life. STUDY DESIGN AND SETTING Participants were recruited from clinics at six hospitals. They completed the Activities Scale for Kids (ASK) and the Pediatric Quality of Life Inventory (PedsQL) questionnaires twice, in a crossover design that used paper and web-based modes of administration. Intraclass correlation coefficients were used to assess the validity of the new web formats relative to the original paper formats and their test-retest reliability. RESULTS Sixty-nine children ranging in age from 8.0 to 13.4 years (mean=11.0 years) completed the study. The sample included children with cerebral palsy (19), spina bifida (23), and cystic fibrosis (27). The mean ASK score was 77.5 and the mean PedsQL score was 69.1. The intermethod intraclass correlation coefficients were 0.98 (lower limit 0.94) for the ASK and 0.64 (lower limit 0.35) for the PedsQL. These compare to intraclass correlation coefficients of 0.99 and 0.94, respectively, for traditional paper formats. CONCLUSION The web ASK was valid in comparison to the original paper format. Consistency in mode of administration may be more important when using the PedsQL. Both measures were highly reliable on paper and on the web.

Motor Skills of Children Newly Diagnosed with Attention Deficit Hyperactivity Disorder Prior to and Following Treatment with Stimulant Medication.

Motor difficulties are common in children with Attention Deficit Hyperactivity Disorder (ADHD). Although preliminary evidence has suggested that methylphenidate can improve the motor skills in children with ADHD and Developmental Coordination Disorder (DCD), the effect of stimulant medication on motor performance in children newly diagnosed with ADHD with or without motor impairment remains unclear. A cohort study of 49 medication-naïve children (39 male; mean age 8.4±1.3 years) with ADHD was conducted. Children were evaluated using the Movement Assessment Battery for Children and the developmental test of visual motor integration at diagnosis and again three months following daily treatment with a stimulant medication. Motor difficulties were highly present at baseline (73.5%) but resolved in a subset after treatment with stimulant medication, suggesting that their motor difficulties may be attributed in part to their attentional problems. Nevertheless, motor impairment persisted in 55.1% of the sample. The severity of the behavioural symptoms was significantly associated with balance skills in children without motor impairments (r(2)=0.30, p<0.01) and with visual motor integration skills in children with persisting motor difficulties (r(2)=0.27, p<0.01). Attentional difficulties negatively affect the motor skills of children with ADHD. Following the use of stimulant medication, an important subset continued to demonstrate motor difficulties. The improvement in behaviour was insufficient to resolve motor problems and these children should therefore be targeted for rehabilitation services.

Handwriting capacity in children newly diagnosed with Attention Deficit Hyperactivity Disorder

UNLABELLED Preliminary evidence suggests that children with Attention Deficit Hyperactivity Disorder (ADHD) may exhibit handwriting difficulties. However, the exact nature of these difficulties and the extent to which they may relate to motor or behavioural difficulties remains unclear. The aim of this study was to describe handwriting capacity in children newly diagnosed with ADHD and identify predictors of performance. Forty medication-naïve children with ADHD (mean age 8.1 years) were evaluated with the Evaluation Tool of Childrens Handwriting-Manuscript, the Movement Assessment Battery for Children (M-ABC), the Developmental Test of Visual Motor Integration (VMI) and the Conner Global Index. An important subset (85.0%) exhibited manual dexterity difficulties. Handwriting performance was extremely variable in terms of speed and legibility. VMI was the most important predictor of legibility. Upper extremity coordination, as measured by the M-ABC ball skills subtest, was also a good predictor of word legibility. CONCLUSION Poor handwriting legibility and slow writing speed were common in children newly diagnosed with ADHD and were associated with motor abilities. Future studies are needed to determine whether interventions, including stimulant medications, can improve handwriting performance and related motor functioning.

Prediction of Motor and Functional Outcomes in Infants Born Preterm Assessed at Term

Purpose: To compare 3 different assessment approaches at term to infants born preterm to predict motor and functional outcomes at 12 months adjusted age. Methods: Infants (n = 100) born at less than 32 weeks postconceptional age were assessed at term using the General Movements Assessment, Einstein Neonatal Neurobehavioral Assessment Scales, Test of Infant Motor Performance, and at 12 months adjusted age using the Alberta Infant Motor Scales, Peabody Developmental Motor Scales-2, Vineland Adaptive Behavior Scales-Daily Living Skills, and Battelle Developmental Inventory. Results: The General Movements Assessment (r2 = 0.04; p = 0.05) and the Test of Infant Motor Performance (r2 = 0.05; p = 0.04) predicted outcomes on the Peabody Developmental Motor Scales-2. The Test of Infant Motor Performance predicted outcomes on the Alberta Infant Motor Scales (r2 = 0.05; p = 0.04) and Vineland Adaptive Behavior Scales-Daily Living Skills (odds ratio: 0.93). Delays in functional performance were found. Conclusions: Neonatal tests at term explained a small but significant proportion of the variance in gross motor and daily living skills at 12 months adjusted age.

Intervention Minimizing Preterm Infants’ Exposure to NICU Light and Noise:

Neonatal intensive care unit (NICU) light and noise may be stressful to preterm infants. This research evaluated the physiological stability of 54 infants born at 28- to 32-weeks’ gestational age while wearing eye goggles and earmuffs for a 4-hour period in the NICU. Infants were recruited from four NICUs of university-affiliated hospitals and randomized to the intervention–control or control–intervention sequences. Heart rate (HR), heart rate variability (HRV), and oxygen saturation (O2 sat) were collected using the SomtéTM device. Confounding variables such as position and handling were assessed by videotaping infants during the study periods. Results indicated that infants had more stress responses while wearing eye goggles and earmuffs since maximum HR was found to be significantly higher and high-frequency power of HRV significantly lower during the intervention as compared with the control period. Therefore, this intervention is not recommended for the clinical practice.