Lin-Ju Kang

Use of Virtual Reality to Improve Upper-Extremity Control in Children With Cerebral Palsy: A Single-Subject Design

Background and Purpose: Virtual reality (VR) creates an exercise environment in which the intensity of practice and positive feedback can be systematically manipulated in various contexts. The purpose of this study was to investigate the training effects of a VR intervention on reaching behaviors in children with cerebral palsy (CP). Participants: Four children with spastic CP were recruited. Method: A single-subject design (A-B with follow-up) was used. All children were evaluated with 3 baseline, 4 intervention, and 2 follow-up measures. A 4-week individualized VR training program (2 hours per week) with 2 VR systems was applied to all children. The outcome measures included 4 kinematic parameters (movement time, path length, peak velocity, and number of movement units) for mail-delivery activities in 3 directions (neutral, outward, and inward) and the Fine Motor Domain of the Peabody Developmental Motor Scales–Second Edition (PDMS-2). Visual inspection and the 2-standard-deviation–band method were used to compare the outcome measures. Results: Three children who had normal cognition showed improvements in some aspects of reaching kinematics, and 2 children’s change scores on the PDMS-2 reached the minimal detectable change during the intervention. The improvements in kinematics were partially maintained during follow-up. Discussion and Conclusion: A 4-week individualized VR training program appeared to improve the quality of reaching in children with CP, especially in children with normal cognition and good cooperation. The training effects were retained in some children after the intervention.

Participation in Home, Extracurricular, and Community Activities among Children and Young People with Cerebral Palsy.

Aim  Participation in home, extracurricular, and community activities is a desired outcome of rehabilitation services for children and young people with cerebral palsy (CP). The purpose of this study was to investigate the effect of age and gross motor function on participation among children and young people with CP.

Social and Community Participation of Children and Youth With Cerebral Palsy Is Associated With Age and Gross Motor Function Classification

Background Through social and community participation, children and youth with cerebral palsy (CP) form friendships, gain knowledge, learn skills, express creativity, and determine meaning and purpose in life. Objective The purposes of this study were: (1) to determine whether social and community participation of children and youth with CP differ based on age, sex, and gross motor function, and (2) to identify the types of activities in which social and community participation are highest. Design and Methods A prospective cross-sectional analytic design was used. The participants were a sample of convenience of 291 children (6–12 years of age) and 209 youth (13–21 years of age) with CP (55.4% males, 44.6% females) receiving services from 7 childrens hospitals. Participants completed the Childrens Assessment of Participation and Enjoyment (CAPE) by structured interview. Gross Motor Function Classification System (GMFCS) level was determined by the researchers. Results Youth did a higher percentage of activities with friends and others and outside the home than children. Children and youth in level I did a higher percentage of activities with friends and others compared with children and youth in levels II and III and in levels IV and V. Children and youth in level I and in levels IV and V did a higher percentage of activities outside the home than children and youth in levels II and III. Differences were not found between females and males. The percentage of activities done with friends and others and outside the home was highest for physical and skill-based activities. Limitations Findings cannot be attributed only to GMFCS level. Conclusions The ability to walk without restrictions is desirable for social and community participation. For children and youth with CP who have limitations in mobility, physical therapists have roles as consultants for accessibility, activity accommodations, and assistive technology and as advocates for inclusive environments.

Efficacy of Constraint-Induced Therapy on Functional Performance and Health-Related Quality of Life for Children With Cerebral Palsy: A Randomized Controlled Trial

To better generalize training effects to the context of daily living, home-based constraint-induced therapy has been proposed. Therapeutic success of constraint-induced therapy is limited as to whether the improvements in functional performance can be transferred to quality of life. This randomized controlled trial aimed to investigate the efficacy of home-based constraint-induced therapy on functional performance and health-related quality of life. Twenty-two children with spastic unilateral cerebral palsy (6-8 years, 10 boys) were randomly assigned to receive constraint-induced therapy or traditional rehabilitation. Home-based constraint-induced therapy had immediate and maintaining effects on motor efficacy and functional performance and induced greater gains in health-related quality of life in the long run than in the short term. The home-based constraint-induced therapy protocol (relatively moderate intensity and shortened constraint time), which might balance the effectiveness and compliance of participants and caregivers, may be an effective alternative to conventional constraint-induced therapy.

A multidimensional model of optimal participation of children with physical disabilities

Abstract Purpose: To present a conceptual model of optimal participation in recreational and leisure activities for children with physical disabilities. Methods: The conceptualization of the model was based on review of contemporary theories and frameworks, empirical research and the authors’ practice knowledge. A case scenario is used to illustrate application to practice. Results: The model proposes that optimal participation in recreational and leisure activities involves the dynamic interaction of multiple dimensions and determinants of participation. The three dimensions of participation are physical, social and self-engagement. Determinants of participation encompass attributes of the child, family and environment. Experiences of optimal participation are hypothesized to result in long-term benefits including better quality of life, a healthier lifestyle and emotional and psychosocial well-being. Conclusion: Consideration of relevant child, family and environment determinants of dimensions of optimal participation should assist children, families and health care professionals to identify meaningful goals and outcomes and guide the selection and implementation of innovative therapy approaches and methods of service delivery. Implications for Rehabilitation Optimal participation is proposed to involve the dynamic interaction of physical, social and self-engagement and attributes of the child, family and environment. The model emphasizes the importance of self-perceptions and participation experiences of children with physical disabilities. Optimal participation may have a positive influence on quality of life, a healthy lifestyle and emotional and psychosocial well-being. Knowledge of child, family, and environment determinants of physical, social and self-engagement should assist children, families and professionals in identifying meaningful goals and guiding innovative therapy approaches.

Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study

Objective: To determine the effect of therapist-based constraint-induced therapy at home on motor performance, daily function and reaching control for children with cerebral palsy. Design: A single-blinded, randomized controlled trial. Subjects: Forty-seven children (23 boys; 24 girls) with unilateral cerebral palsy, aged 6–12 years, were randomized to constraint-induced therapy (n = 24) or traditional rehabilitation (n = 23). Interventions: Constraint-induced therapy involved intensive functional training of the more affected arm while the less affected arm was restrained. Traditional rehabilitation involved functional unilateral and bilateral arm training. Both groups received individualized therapist-based interventions at home for 3.5–4 hours/day, two days a week for four weeks. Main measures: Motor performance and daily function were measured by the Peabody Developmental Motor Scale, Second Edition and the Pediatric Motor Activity Log. Reaching control was assessed by the kinematics of reaction time, movement time, movement unit and peak velocity. Results: There were larger effects in favour of constraint-induced therapy on motor performance, daily function, and some aspects of reaching control compared with traditional rehabilitation. Children receiving constraint-induced therapy demonstrated higher scores for Peabody Developmental Motor Scale, Second Edition – Grasping (pretest mean ± SD, 39.9 ± 3.1; posttest, 44.1 ± 2.8; P < 0.001), Pediatric Motor Activity Log (pretest, 1.8 ± 0.3; posttest, 2.5 ± 0.3; P < 0.001) and shorter reaction time, normalized movement time (P < 0.001) and higher peak velocity (P = 0.004) of reaching movement. Conclusions: Constraint-induced therapy induced better grasping performance, daily function, and temporal and spatiotemporal control of reaching in children with unilateral cerebral palsy than traditional rehabilitation.

Improvement of Upper Extremity Motor Control and Function After Home-Based Constraint Induced Therapy in Children With Unilateral Cerebral Palsy: Immediate and Long-Term Effects

OBJECTIVE To investigate the long-term effects of home-based constraint induced therapy (CIT) on motor control underlying functional change in children with unilateral cerebral palsy (CP). DESIGN Randomized controlled trial. SETTING Home based. PARTICIPANTS Children with unilateral CP (N=45; aged 6-12 y) were randomly assigned to receive home-based CIT (n=23) or traditional rehabilitation (TR) (n=22). INTERVENTIONS Both groups received a 4-week therapist-based intervention at home. The home-based CIT involved intensive functional training of the more affected upper extremity during which the less affected one was restrained. The TR involved functional unimanual and bimanual training. MAIN OUTCOME MEASURES All children underwent kinematic and clinical assessments at baseline, 4 weeks (posttreatment), and 3 and 6 months (follow-up). The reach-to-grasp kinematics were reaction time (RT), normalized movement time, normalized movement unit, peak velocity (PV), maximum grip aperture (MGA), and percentage of movement where MGA occurs. The clinical measures were the Peabody Developmental Motor Scales, Second Edition (PDMS-2), Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), and Functional Independence Measure for children (WeeFIM). RESULTS The home-based CIT group showed a shorter RT (P<.05) and normalized movement time (P<.01), smaller MGA (P=.006), and fewer normalized movement units (P=.014) in the reach-to-grasp movements at posttreatment and follow-up than the TR group. The home-based CIT group improved more on the PDMS-2 (P<.001) and WeeFIM (P<.01) in all posttreatment tests and on the BOTMP (P<.01) at follow-up than the TR group. CONCLUSIONS The home-based CIT induced better spatial and temporal efficiency (smoother movement, more efficient grasping, better movement preplanning and execution) for functional improvement up to 6 months after treatment than TR.

Linkage of ICF-CY codes with environmental factors in studies of developmental outcomes of infants and toddlers with or at risk for motor delays

Abstract Purpose: Environmental variables have been explored in studies of the development of young children with motor delays. Linking environmental variables to the International Classification of Functioning, Disability and Health – Children and Youth (ICF-CY), environmental factors (EFs) categories can provide a common language for documenting their contribution to developmental outcomes. This review of studies aimed to (1) link EFs for developmental outcomes in infants with or at risk for motor delays to ICF-CY categories and (2) synthesize the influences of EFs (with ICF-CY linkage) on developmental outcomes. Method: A systematic literature search was performed of multiple databases. After applying selection criteria, environmental variables in 28 articles were linked to ICF-CY categories and underwent qualitative synthesis. Results: Results indicated that physical environmental variables could be linked successfully to ICF-CY EFs categories, but not social environmental variables. Multiple environmental variables were associated with motor and other developmental outcomes. Conclusion: Difficulties in linking social factors to ICF-CY categories indicate that additional EFs codes may need to be considered in the ICF-CY revision processes. The review provides empirical data on relationships between EFs and developmental outcomes in children with or at risk for motor delay. Implications for Rehabilitation Expansion of codes is needed in the ICF-CY for classifying environmental factors in programs for children. The temporary framework of categorizing the social environmental aspect by using ICF-CY as well as three broadly not-linked social categories can be used to promote communication among professionals serving children with special needs. Findings are consistent with theories that environmental facilitators (barriers) can lead to favorable (adverse) motor, cognitive or language outcomes for children of 2 years old or younger with or at risk for motor delay. Environmental factors can serve as significant indicators in early childhood intervention and habilitation programs.

Environmental Barriers to Participation of Preschool Children with and without Physical Disabilities

Environment plays a vital role in affecting participation of young children in home, school, and community. Knowledge of environmental barriers helps to develop solutions or strategies that enable participation. The study compared the environmental barriers perceived by parents of preschool children with physical disabilities (PD, n = 142) and with typical development (TD, n = 192) in Taiwan. Parents identified environmental barriers by structured interview using the Chinese version of the Child and Adolescent Scale of Environment (CASE-C). The CASE-C is an 18-item measure of the impact of problems with physical, social, and attitudinal environmental features. Differences between the PD and TD groups in the summary scores for the CASE-C and the percentages of parents who perceived a problem for each item were examined by the analysis of covariance (ANCOVA) and Chi-square test. Parents of children with PD more often identified barriers related to family resources and community programs or services, social attitudes, assistance and supports outside of home, physical design of home and community, transportation, and assistive devices or equipment. Greater impacts of barriers were also reported by parents of preschool children with PD. Our findings provide evidence of environmental barriers that inform practice and policies to modify the barriers and provide an accessible and inclusive environment for families with young children.

Younger Children with Cerebral Palsy Respond Better Than Older Ones to Therapist-Based Constraint-Induced Therapy at Home on Functional Outcomes and Motor Control.

ABSTRACT Aims: To examine the differences in efficacy of home-based constraint-induced therapy (CIT) on functional outcomes and motor control in two age groups of children with cerebral palsy (CP). Methods: Twenty-three children with spastic unilateral CP receiving 4-week home-based CIT by a therapist were divided into younger (6–8 years; n = 11) and older (9–12 years; n = 12) groups. The home-based CIT involved intensive functional training of the more affected upper-limb while restraining the less affected upper-limb. The outcome measures were Peabody Developmental Motor Scale-2nd edition (PDMS-2) that was being used in a modified way, Functional Independence Measure for Children (WeeFIM), and reach-to-grasp kinematic parameters, including reaction time (RT), normalized movement time (MT), normalized movement units (MUs), peak velocity (PV), and maximum grip aperture (MGA). The outcome measures were assessed at baseline, 4-weeks (post-treatment), 3- and 6-months (follow-up). Results: The younger group showed greater changes in visual motor integration skills and RT at all post-tests after intervention than the older group. Groups had comparable changes on any other measures. Conclusions: Younger children with CP responded better to home-based CIT on some areas of upper-limb functions and reach-to-grasp motor control strategies than older children.