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Children with Cerebral Palsy

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Various Treatments for Children with Cerebral Palsy
Grand Canyon University: NRS-433V Introduction to Nursing Research
Dr. Diana Naser

Various Treatments for Children with Cerebral Palsy
First Quantitative Study
Honkavaara, M., Rintala, P., (2010), The influence of short term, intensive hippotherapy on gait in children with cerebral palsy. European Journal of Adapted Physical Activity, 3(2), 29- 36. Retrieved from: http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?sid=a73e5036- 0d8e-4cc4-97c5-ec0c3cbd1e4a%40sessionmgr115&vid=32&hid=104

Abstract The purpose of this study was to investigate the effects of short term hippotherapy on functional gait changes in children with cerebral palsy (CP). Participants were two boys (ages 12 and 13) with spastic diplegia and a girl (14 yrs) with athetoid CP. Single-subject (ABA) design was used to determine quantitative changes in functional gait parameters (velocity, stride length, and cadence) following three weeks of hippotherapy. The two boys demonstrated improvement in stride length and gait velocity without sustained improvement in cadence. There was increase in stride length and cadence, but most noticeable improvements in velocity for the girl. The results indicated that it is possible that short-term hippotherapy may improve functional gait in children with cerebral palsy

Second Quantitative Study
Galli, M., Cimolin, V., Valente, E., Crivellini, M., Ialongo, T., Albertini, G. (2006). Computerized gait analysis of Botulinum Toxin treatment in children. Disability and Rehabilitation, 29(8): 659 – 664. Retrieved from: http://eds.b.ebscohost.com.library.gcu.edu:2048/eds/pdfviewer/pdfviewer?sid=4a481f32-7772-4bef-acbe-db1d4105ac1a%40sessionmgr113&vid=2&hid=115

Abstract
Purpose. Intramuscular botulinum toxin A (BTA) injection is a local reversible treatment with a wide range of therapeutic applications, including temporary reduction of spasticity. The aim of this work was a quantitative, computerized objective evaluation of BTA-induced improvement of the walking functional ability in a group of children with cerebral palsy (CP).
Methods. Fifteen children with CP and 20 healthy children were evaluated. All patients were equinus walkers without fixed contractures of triceps surae muscles and they were evaluated before and after about 1.5 months from BTA injections into the calf muscles. The effectiveness of treatment was evaluated by 3D computerized gait analysis.
Results. Data analysis revealed a significant improvement of equinus foot and ankle range of motion during gait after BTA injection. Positive effects were evident also at the knee joint as documented by the improvement of kinetics characteristics (moment and power).
Conclusions. Computerized gait analysis is a valid method for quantification of BTA effect on walking in children with CP, allowing a detailed evaluation of improvement at each joint and a quantitative evaluation of treatment outcome.
Keywords: Botulinum Toxin A, cerebral palsy, equinus foot, gait analysis, gastrocnemius

Third quantative study
Chaturvedi, S.K., Rai, Y., Chourasia, A., Goel, P., Paliwal, V., Garg, R.k., … Gupta, R.K. (2012). Comparative assessment of therapeutic response to physiotherapy with or without botulinum toxin injection using diffusion tensor tractography and clinical scores in term diplegic cerebral palsy children. Brain and Development, 35(7), 647-653. Retrieved from: http://www.sciencedirect.com.library.gcu.edu:2048/science/article/pii/S03877604120027 07 Abstract The present study was to compare the effects of combined therapy [botulinum (BTX) plus physiotherapy] with physiotherapy alone using diffusion tensor imaging (DTI) derived fractional anisotropy (FA) values of motor and sensory fiber bundles and clinical grade of the disability to see the value of BTX in term children with spastic diplegic cerebral palsy (CP). Clinically diagnosed 36 children participated in the study. All these children were born at term, and had no history of seizures. The study was randomly categorized into two groups: group I (n = 18) – physiotherapy alone and group II (n = 18) – physiotherapy plus BTX injection. Quantitative diffusion tensor tractography on all these children was performed on motor and sensory fiber bundles on baseline as well as after 6 months of therapy. Motor function and clinical grades were also measured by gross motor function measures (GMFM) scale on both occasions. We observed significant change in FA value in motor and sensory fiber bundle as well as in GMFM scores at 6 months compared to baseline study in both the groups. However, delta change and relative delta change in FA values of sensory and motor fiber bundle as well as GMFM score between group I and group II was statistically insignificant. We conclude that addition of BTX to physiotherapy regimen does not influence the outcome at 6 months with similar insult in children with term diplegic spastic CP. This information may influence management of diplegic CP especially in developing countries, where BTX is beyond the reach of these children.

First Qualitative
Ahonen-Eerikäinen, H., Lamont, A., Knox, R., ( 2008). Rehabilitation for children with cerebral palsy: seeing through the looking glass. International Journal of Psychosocial Rehabilitation. 12(2),4. Retrieved from: http://eds.b.ebscohost.com.library.gcu.edu:2048/ehost/detail?vid=3&sid=8082fd77-a213- 4b4b-91ea6507f1177f66%40sessionmgr115&hid=115&bdata= JnNpdGU9ZWhvc3QtbGl2ZSZzY2 9wZT1zaXRl#db=a9h&AN=3312249 Abstract This paper presents the results of a qualitative pilot study conducted on an innovative psychosocial rehabilitation technology developed and applied at Bloorview Kids Rehab, Toronto, Ontario, Canada. The Virtual Music Instrument (VMI) developed by Dr. Tom Chau is a video-capture software program that increases music-making opportunities for children and youth and allows children with disabilities to play musical sounds and melodies using gestures. The qualitative study was conducted to identify suitable music therapy interventions and techniques using the VMI with children with cerebral palsy (CP), to categorize areas of benefit that are made possible by the VMI, and to build theory on the role and significance of the VMI in music therapy. The research questions included: (1) What interventions and techniques are best used by the music therapist to promote the therapeutic relationship in application of the VMI?[n4] (2) In which domains is there benefit, both during sessions and over the time period of the study, from the use of this instrument within music therapy?[n5] Six participants aged 5.5 to 10 were recruited on a cross-disability basis. Each participant received ½-hour individual music therapy sessions, twice per week over 10 weeks, using the VMI. The Music Therapist employed a variety of techniques, including both clinical improvisation and task-oriented activities. The sessions were videotaped, transcribed and reviewed by a multi-disciplinary team. The clinician notes were also transcribed. Using a multiple case study qualitative methodology and grounded theory techniques, the transcribed material was coded and analyzed according to emerged themes using the QSR N6 software program. The results bring better understanding of using the VMI for optimum benefit, and also lead to theoretical and practical advances in the use of gesture recognition technology on music therapy and psychosocial rehabilitation among children with cerebral palsy.[n6]

Second Qualitative
Larsson, I., Miller,M., Liljedahl, K., Gard, G., (2012). Physiotherapists’ experiences of physiotherapy interventions in scientific physiotherapy publications focusing on interventions for children with cerebral palsy: a qualitative phenomenographic approach. BMC Pediatrics12. 90-103 retrieved from: http://search.proquest.com.library.gcu.edu:2048/docview/1034508742/fulltextPDF/482E 5A5B7B7347BCPQ/137?accountid=7374

Abstract
Background
Physiotherapy research concerning interventions for children with CP is often focused on collecting evidence of the superiority of particular therapeutic methods or treatment modalities. Articulating and documenting the use of theory, instrumentation and research design and the assumptions underlying physiotherapy research interventions are important. Physiotherapy interventions focusing on children with Cerebral Palsy should, according to the literature, be based on a functional and environmental perspective with task-specific functional activity, motor learning processes and Family-Centred Service i.e. to enhance motor ability and improve capacity so that the child can perform the tasks necessary to participate actively in everyday life. Thus, it is important to coordinate the norms and values of the physiotherapist with those of the family and child. The aim of this study was to describe how physiotherapists’ experiences physiotherapy interventions for children with CP in scientific physiotherapy publications written by physiotherapists.
Methods
A qualitative phenomenographic approach was used. Twenty- one scientific articles, found in PubMed, strategically chosen according to year of publication (2001–2009), modality, journals and country, were investigated.
Results
Three qualitatively different descriptive categories were identified: A: Making it possible a functional-based intervention based on the biopsychosocial health paradigm, and the role of the physiotherapist as collaborative, interacting with the child and family in goal setting, intervention planning and evaluation, B: Making it work an impairment-based intervention built on a mixed health paradigm (biomedical and biopsychosocial), and the role of the physiotherapist as a coach, leading the goal setting, intervention planning and evaluation and instructing family members to carry out physiotherapist directed orders, and; C: Making it normal an impairment-based intervention built on a biomedical health paradigm, and the role of the physiotherapist as an authoritative expert who determine goals, intervention planning and evaluation.
Conclusions
Different paradigms of health and disability lead to different approaches to physiotherapy which influence the whole intervention process regarding strategies for the assessment and treatment, all of which influence Family-Centred Service and the child’s motor learning strategies. The results may deepen physiotherapists’ understanding of how different paradigms of health influence the way in which various physiotherapy approaches in research seek to solve the challenge of CP.

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