Review. The effectiveness of passive stretching in children with cerebral palsy

Size: px
Start display at page:

Download "Review. The effectiveness of passive stretching in children with cerebral palsy"

Transcription

1 The effectiveness of passive stretching in children with cerebral palsy Review Tamis Pin* MSc, Probationary PhD Candidate, University of Melbourne, Victoria; Paula Dyke MSc, Manager, School-aged Programme; Michael Chan MSc, Senior Physiotherapist, Cerebral Palsy Association of WA, Western Australia, Australia. *Correspondence to first author at PO Box 143, North Melbourne, VIC 3051 Australia. Passive stretching is widely used for individuals with spasticity in a belief that tightness or contracture of soft tissues can be corrected and lengthened. Evidence for the efficacy of passive stretching on individuals with spasticity is limited. The aim of this review was to evaluate the evidence on the effectiveness of passive stretching in children with spastic cerebral palsy. Seven studies were selected according to the selection criteria and scored against the Physiotherapy Evidence Database scale. Effect size and 95% confidence intervals were calculated for comparison. There was limited evidence that manual stretching can increase range of movements, reduce spasticity, or improve walking efficiency in children with spasticity. It appeared that sustained stretching of longer duration was preferable to improve range of movements and to reduce spasticity of muscles around the targeted joints. Methods of passive stretching were varied. Further research is required given the present lack of knowledge about treatment outcomes and the wide use of this treatment modality. Cerebral palsy (CP) is an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of its development. 1 This neurological disorder can cause secondary changes in the musculoskeletal system such as decreased muscle strength, tightness or contractures around joints, and abnormalities in both bony structures and gait. 2 Passive stretching is a common treatment to combat this soft tissue tightness. 3,4 The stretching can be done manually by the therapist or the patient or by other external devices such as splints, casts, or tilt-table. 5 Despite the widespread use of passive stretching, there is a lack of research evidence demonstrating its effectiveness and the rationale behind the stretch-based techniques in spastic human muscles. 5,6 Clinicians seek the best evidence available from existing research studies to support their intervention procedures. 7 This review aims to investigate the current research evidence on the effectiveness of passive stretching in children with spastic CP by using the World Health Organization s International Classification of Impairment, Disability and Handicap (ICIDH-2) to classify the outcomes described by different studies as recommended by the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM). 7 Method SEARCH STRATEGY The clinical question of this review was: Does passive stretching improve passive joint range of movements and reduce spasticity more effectively in children with CP than no passive stretching? The inclusion criteria of this review were: (1) studies on children under 18 years of age with spasticity due to CP; (2) studies demonstrating the effects of passive stretching programmes with reported findings for analysis of its effectiveness; (3) studies with all research designs except expert opinions; and (4) fully published studies in peerreviewed journals. Studies that compared passive stretching programmes with the effects of medications, surgery, or serial Developmental Medicine & Child Neurology 2006, 48:

2 Table I: Methodology assessment of studies according to the Physiotherapy Evidence Database (PEDro) scale Study Specified Random Concealed Similar Blinded Blinded Blinded More than eligibility allocation of allocation prognosis participant therapists assessors 85% FU for criteria a participants at baseline at least one key outcome Fragala et al. (2003) 20 Yes No No Yes No No No Yes Lespargot et al. (1994) 19 Yes No No Yes No No No Yes McPherson et al. (1984) 21 Yes No No Yes No No No Yes Miedaner and Renander (1987) 16 Yes Yes No Yes No No Yes Yes O Dwyer et al. (1994) 14 Yes Yes No Yes Yes No Yes to Yes half of participants Richards et al. (1991) 17 Yes Yes No Yes No No No Yes Tremblay et al. (1990) 18 Yes Yes No Yes No No No Yes a This criteria is not counted for the total PEDro score; FU, follow-up. casting were excluded as the area of interest was mainly on passive stretching without assistance from surgery and antispasticity medications. Electronic databases (Medline, CINAHL, PsycINFO, Embase, full Cochrane Library, and Physiotherapy Evidence Database [PEDro]) were searched from the earliest date until April The keywords used for the search were cerebral palsy, muscle spasticity, stretching, physical therapy, and range of movement. Subject headings, truncations, and thesaurus were used wherever possible. Reference lists in relevant studies and review articles were examined. The titles and abstracts of articles identified in the initial search were initially screened by the first author (TP) against the inclusion and exclusion criteria. When the title and abstract did not indicate clearly if an article should be included, the complete article would be read to determine its suitability. QUALITY ASSESSMENT OF METHODOLOGY All the included studies were scored on their methodological rigour with the PEDro scale. 8 The PEDro scale examines 11 aspects of the quality of methodology: (1) specification of eligibility of participants; (2) randomization of participants; (3) allocation concealment of participants; (4) comparability of subject groups at baseline; (5) blinding of participants; (6) Table II: Summary of study characteristics Study Research design Level of Participant characteristics Nr of participants Age range evidence Treatment Control group group Fragala et al. Multiple single-subject II Children with spasticity in 7 7 a 4 18 (2003) 20 ABAB design lower limbs with classification of Levels IV and V by GMFCS Lespargot et al. Before-and-after V Children with spastic CP (1994) 19 design with spasticity in hip adductors (median 10y 3mo) McPherson et al. Multiple single-subject III Children with severe spastic 4 4 a (1984) 21 design quadriplegic CP with knee contracture Miedaner and Renander Multiple single-subject I Children with severe physical a 6 20 (1987) 16 with randomized and cognitive impairment (mean 10y 6mo) cross-over design and decrease in joint ranges of lower limbs O Dwyer et al. Randomized I Children with spastic CP (1994) 14 controlled trial with spastic triceps surae Richards et al. Randomized I Children with spastic diplegia (1991) 17 controlled trial or hemiplegia (mean 7y [SD 3]) Tremblay et al. Randomized I Children with spastic CP (1990) 18 controlled trial (diplegia, hemiplegia, and Experimental group quadriplegia) (mean 7y [SD 2y 7mo]) Control group (mean 5y 11mo [SD 2y 5mo]) a Participants acting as their own contols. GMFCS, Gross Motor Function Classification System; CP, cerebral palsy. 856 Developmental Medicine & Child Neurology 2006, 48:

3 Table I: continued Intention Between group Point estimates PEDro score to treat statistical analysis of variability analysis for at least one for at least one key outcome key outcome Yes Yes No 4/10 Yes No No 3/10 Yes Yes No 4/10 Yes Yes Yes 7/10 Yes Yes Yes 8/10 Yes Yes Yes 6/10 Yes Yes Yes 6/10 blinding of therapists; (7) blinding of assessors; (8) more than 85% follow-up of participants in at least one of key outcomes; (9) intention to treat analysis; (10) between group statistical analysis of at least one of the key outcomes; and (11) point estimate of at least one of the key outcomes. According to the PEDro guidelines, a positive answer to each of the criteria 2 to 11 will yield one point, obtaining a PEDro score between 0 to The details of the scoring criteria can be found in their weblink (http://www.pedro.fhs.usyd. edu.au/criteria.html). The PEDro scale has been shown to have moderate interrater reliability (intraclass coefficient for the total score is 0.56, 95% confidence interval [CI] ). 9 The AACPDM evidence table of internal validity was used to grade the levels of evidence of each selected study. 7 This classification of levels of evidence is a modification of Sackett s hierarchy of levels of evidence, 10 but it includes and grades single subject research design, which is increasingly common in research in the developmental disability domain. 7 This grading procedure was done independently by the first (TP) and second (PD) authors. Any disagreements were resolved with discussion. DATA EXTRACTION Data from all the included studies were summarized in the format as suggested by the AACPDM. 7 The format includes: participants characteristics (number in each group, target population, diagnosis, numbers in each diagnostic subgroup, and ages), intervention used, control used, research design and level of evidence for the study, and outcomes of interest. DATA ANALYSIS Effect sizes with 95% CIs were calculated if raw data were available in the studies. 11 The effect sizes give easy understanding of how big the treatment effect is and the clinical significance of these statistically significant treatment effects can also be justified. The effect size was the difference between the means of outcome measures of the participant and control groups. If there was no control group, the difference of the pre- and posttreatment means would be used as the participants were acting as their own controls. The 95% CI was approximated by the following formula: 3 x SD/ N (SD, standard deviation; N, number of participants in the study). The averages of the standard deviations of the group means and the numbers of participants would be used if there were participant and control groups. 11 This formula for calculating the effect size with 95% CI was chosen as it has been deliberately simplified for clinicians who are not experienced in complicated statistical calculations. 11 Results An electronic search on various databases and reference lists identified 615 articles, among which 10 studies met the inclusion criteria. The full articles of these 10 studies were reviewed and three studies were further excluded because of the following reasons. One study was a systematic review 12 that evaluated studies on passive stretching of participants in vegetative and minimally conscious states. As the participants had heterogeneous diagnoses and included both adults and children, it was excluded from this report. Two papers 13,14 reported the data of the same study, 14 and hence they were treated as a single entity. 14 One study 15 did not have any intervention but investigated the time that the soleus muscle was stretched during daily activities in a 24-hour period in children with CP so as to deduce how long the muscle needed to be stretched to prevent contracture. 15 Therefore, this report analyzed the results from seven research studies on the effects of passive stretching in children with CP. The scoring of each study with the PEDro scale is listed in Table I. The median score of the seven studies was 6 (interquartile range is 4 6.5). According to the AACPDM evidence table of internal validity, four studies are level I randomized controlled trials (Table II). 14, There was no available information from these four studies to determine if the allocation was concealed (criterion 3). The participants, therapists, and assessors in most of the studies were not blinded (criteria 5 7). Most of the studies were able to follow up all the participants and all except one study 19 used statistical comparison of at least one key outcome measure between the study and control groups (criteria 8 11). Hence, although more than half of the studies are of level I or II evidence, their methodological quality is average. Table II summarizes the characteristics of the research participants in these seven studies. The participants were aged from 3 to 20 years of age. As there was no raw data available in two studies including participants more than 18 years of age, 14,16 it was impossible to exclude the data relating to those participants more than 18 years of age. These two studies were still included in this review of the effects of passive stretching in children with CP. Table III summarizes the outcomes of interest of these seven studies and codes the outcomes of interest according to the different dimensions of disablement. All the outcomes of interest in these studies were at the level of impairment. 7 CHANGE IN RANGE OF MOVEMENTS There are five studies investigating the effect of passive stretching in improving the range of movement of identified joints. 14, 16, Two studies showed an increase in range of movement poststretching (of level III 21 and level I 16 evidence). The study by McPherson et al. 21 of level III evidence showed that there was a significant reduction in knee flexion contracture in three out of four treatment periods and a significant increase in knee flexion contracture in three out of four non-treatment periods. The difference in means between treatment and Review 857

4 Table III: Summary of study results Study Intervention Outcome of interest Measures Dimension of disablement Fragala et al. Manual stretch with hold for 40 60s, Passive range of hip flexion, hip Goniometer I (2003) 20 3 times for each movement, 1 or 2 times per week extension, hip abduction, popliteal and routine positioning regime in classrooms angle, knee flexion, and knee extension Lespargot Manual stretch for 15 20min in Passive hip abduction angle Specially I et al. (1994) 19 physiotherapy session and wedge-sitting designed 5 7h daily apparatus a McPherson First year: manual stretch with hold for Range of knee flexor contractures Goniometer I et al. (1984) 21 60s, 5 repetitions for each joint, 3 times a day and 5 days a week Second year: 30min on prone-stander Hypertonicity Specially I per day, 30min on supine positioning designed device per day, 5 days a week apparatus b Miedaner and Manual stretch with 5 repetitions for each joint, Passive range of movement of hips, Goniometer I Renander hold for 20 60s. One group having knees, ankles, and forefeet (1987) 16 5 days a week and one group having 2 days a week. After 5 weeks, the groups were switched for another 5 weeks O Dwyer et al. Sinusoidal stretch by specifically designed Spasticity of triceps surae Tonic stretch I (1994) 14 apparatus using stretch reflex as biofeedback, reflex 30min per session, 3 times per week for Contracture of triceps surae Ankle joint I average 42 days passive torque Richards et al. Standing in tilt-table with various ankle Muscle activation of tibialis anterior EMG I (1991) 17 positions for 30min each time and triceps surae Gait analysis Video I recording EMG during walking Spastic I Locomotion Disorder Index Tremblay et al. Standing in tilt-table with ankles in dorsiflexion Quality of passive movement of ankles Kin-Com I (1990) 18 for 30min dynamometer and surface electrodes (in terms of torque, ankle angle, and EMG) Quality of voluntary contraction Kin-Com I of triceps surae dynamometer and surface electrodes (in terms of torque and EMG) a The reliability and validity of the apparatus not mentioned in the text; b Inter- and intrareliability of this apparatus were reported in the text on measuring tone over wrists; c favours stretches. ND, no difference before and after stretches; I, impairment; PROM, passive range of movements; CI, confidence interval; NS, non-significant results; NA, not applicable; EMG, surface electromyography; PF, plantarflexion; DF, dorsiflexion; TS, triceps surae; TA, tibialis anterior. 858 Developmental Medicine & Child Neurology 2006, 48:

5 Table III: continued Results Statistics Effect size (95% CI) Statistically decrease in PROM Wilcoxon signed-rank test. No raw data provided for calculation. Authors after the first non-stretch phase c Z-statistic= 1.999, p=0.046 defined changes >8 as real differences No comparison of outcome of interest Not specified in text. Raw data provided Hip abduction with knee flexion, 6.13 before and after stretches c for 4 participants. Calculation of effect size ( 6.31 to 18.57) and 1.38 ( 5.02 to 2.26). shown no significant difference found Hip abduction with knee extension, 0.63 before and after stretching ( 8.76 to 10.02) and 2 ( to 7.06) 3 out of 4 treatment periods c Wilcoxon Match-paired, signed-rank Unable to calculate (see text under section 3 out of 4 non-treatment periods c test p<0.05 and p<0.02 respectively Change in range of movements for explanation) 1 out of 4 treatment periods c Wilcoxon Match-paired, signed-rank test 1.56 ( 3.1 to 0.02) p<0.05 In right hip flexion and right Hip flexion: F=10.21, p< 0.01 Right hip flexion 12 (1.52 to 22.48) straight-leg raising i.e. 2 out of 7 joints after Straight leg raising: F=5.71, p< 0.01 Right straight leg raising 8.2 (0.19 to 16.21) 5 days per week stretch. c No significant difference between the 2 regimes of manual stretching except in right straight-leg raising i.e. 1 out of 7 joints Significant decrease in spasticity of triceps F(1, 12) >6.83, p<0.025 and No raw data provided for calculation surae c F(1, 12) >5.61, p< 0.05 ND NS NA Significant reduction in pre/post-ratio of p<0.01 No raw data provided for calculation tibialis anterior in initial gait cycle c ND NS NA ND NS NA Decreased resistance to passive p<0.05 At 30 = 0.28 ( 0.56 to 0) movements of ankles immediately and At 60 = 0.56 ( 0.89 to 0.23) up to 35min after stretch c At 60 after 25min= 0.67 ( 1.26 to 0.19) decreased EMG response during passive At 60 after 35min= 0.65 ( 1.24 to 0.06) movements of ankle immediately and TS EMG up to 35min after stretch c 30 DF= 0.23 ( 0.39 to 0.07) 30 PF= 0.2 ( 0.37 to 0.03) 60 PF= 0.41 ( 0.71 to 0.11) 120 PF= 0.26 ( 0.47 to 0.05) 60 PF after 25min= 0.42 ( 0.73 to 0.11) 60 PF after 35min= 0.33 ( 0.65 to 0.01) TA EMG 30 DF= 0.33 ( 0.59 to 0.07) 60 DF= 0.48 ( 0.85 to 0.11) 120 DF= 0.35 ( 0.61 to 0.07) 30 PF= 0.44 ( 0.73 to 0.15) 60 PF= 0.46 ( 0.86 to 0.06) Increased torque during PF c p< (0.28 to 1.14) Review 859

6 non-treatment phases were <10 in general. The effect size and 95% CI in this study were unable to be calculated due to the small sample size (four participants) and the violation of assumption of normal distribution of data. The study by Miedaner and Renander of level I evidence 16 showed a statistically significant increase in two out of 14 joint measurements after stretching five times a week for 5 weeks. The effect sizes of these two measurements were 8.2 and 12 respectively. One study of level II evidence showed loss in range of movements in 28 motions after the cessation of passive stretching in one out of four phases of study periods. 20 No raw data was provided for the calculation of the effect sizes but the authors defined that changes greater than 8 were considered not due to measurement errors. Thus, it is believed that the difference in these 28 motions should be greater than 8. One level I evidence study, however, showed no difference in the range of movement of triceps surae poststretching. 14 Although the level V study by Lespargot 19 did not use statistical comparison in range of movements before and after stretching, raw data of the four participants were available for the calculation of the effect size and the 95% CI. No statistical difference in the range of hip abduction was demonstrated after passive stretching (Table III). CHANGE IN SPASTICITY In terms of changes in spasticity poststretching, there are four studies (level III, 21 level I, 14 level I, 17 and level I 18 evidence) all showing a reduction in spasticity posttreatment. McPherson et al. 21 reported that there was a statistically significant reduction in hypertonus over the knee joints in one out of four treatment periods (effect size was 1.56 units in the torque of passive knee flexion; Table III). O Dwyer et al. 14 found a decrease in spasticity in the triceps surae after the stretching but no raw data provided for calculation of the effect sizes. Richards et al. 17 demonstrated a significant reduction in the electromyography (EMG) pre/post-ratio for the tibialis anterior muscles only at the initial gait cycle after 30 minutes of stretching on a tilt-table. The difference between the treatment and control groups was 0.25 (no 95% CI calculated). The authors considered this reduction to be clinically non-significant 17 as the reduction was not demonstrated in the other outcome measure used in the study (Spastic Locomotion Disorder Index). Tremblay et al. 18 reported a significant reduction in resistance during passive plantar flexion of the ankles after stretching and the effect lasted up to 35 minutes poststretching on a tilt-table (effect sizes ranging from 0.28 to 0.67). In addition, there was a significant reduction in the surface EMG post/pre-ratio during passive shortening in the ankle muscles (effect sizes ranging from 0.20 to 0.42 for triceps surae and 0.33 to 0.48 for tibialis anterior muscles; Table III). 18 CHANGE IN GAIT Richards et al. 17 (level I evidence) also examined the effects of passive stretching on children s gait pattern. They did not find any significant changes in gait patterns as measured by video recording after 30 minutes of stretching on a tilt-table. COMPARISON OF MANUAL AND SUSTAINED STRETCHING The nature of the stretching intervention used in the studies varied in method and dosage. The stretching regimes can be roughly divided into two categories. 5 The first category involves sustained stretches by holding the targeted joint to the available end range of movement by mechanical means such as standing table or position equipment. 14,17,18 The other category is manual stretching, i.e. by holding the joint to the available end range of movement manually for a set amount of time and then releasing it. 16, The latter, therefore describes a short time limit for stretching (expressed as seconds), when compared with the first category (expressed as minutes, or up to 5 7h in some studies). Three studies combined sustained and manual stretching as their intervention procedures It is of interest to compare the effects of manual and sustained stretching. The study using manual stretching of shorter duration by Miedaner and Renander 16 (level I evidence) showed some significant increases in range of movements but only in a small portion of total measurements taken. The effect sizes were small (Table III). In studies using sustained stretching, the studies by O Dwyer et al. 14 (level I evidence) and Tremblay et al. 18 (level I evidence) demonstrated a statistically significant decease in spasticity after stretching. The study by Richards et al. 17 (level I evidence) concluded there was no clinical significance in their statistically significant findings in the reduction of spasticity following sustained stretching. Discussion CHANGE IN RANGE OF MOVEMENTS There is conflicting evidence on whether passive stretching can increase the range of movement in a joint. One study 14 of high level of evidence and good methodological quality showed no difference poststretching but three studies 16,20,21 of moderately poor to good methodological quality showed improvements in the range of movement. For those studies showing improvements in the range of movements, the effect sizes were fairly small (in general less than 10 ). One may argue that some increase in range of movements can assist in positioning of these children. An increase in range of hand and hip movements is also important in hand and perineal hygiene respectively. However, these arguments can only be verified with more rigorous studies. As most of the authors in these studies did not declare their acceptable cut-off points for clinical significance, it is difficult to judge if those improvements in range of movements were clinically relevant. 11 Hence, there appears to be no conclusive evidence to definitely state that passive stretching can increase the range of movement in a joint, although there is some evidence favouring passive stretching in an increasing range of movements in children with CP. CHANGE IN SPASTICITY There is some evidence to suggest that passive stretching can reduce spasticity in children with CP as those studies showing favourable outcomes after passive stretching were mainly of higher levels of evidence and had more rigorous methodology. Similar to the range of movements, the effect sizes were fairly small and it was difficult to judge if the decrease was clinically significant. In addition, the reduction in spasticity was unable to be carried over to more functional activity such as walking. COMPARISON OF MANUAL AND SUSTAINED STRETCHING From the reported studies, there appears to be some evidence to indicate sustained stretching is preferable to improve range of movements and to reduce spasticity of targeted joints in children with spasticity. More studies of higher levels of evidence 860 Developmental Medicine & Child Neurology 2006, 48:

7 and better methodological quality showed improvements in the range of movements and spasticity by means of sustained stretching, although the effect sizes were small. Among those studies using sustained stretching, there was no justification given by the authors 14,17,18,21 regarding the duration of stretching chosen. A duration of 30 minutes stretching was the most commonly chosen in the studies 14,17,18,21 which may be based on previous animal studies. 5 LIMITATIONS The significant limiting factor of this review is that the selection of studies was done by one person. Two or more reviewers should reduce the risk of selection bias in future. Another limitation of this body of evidence is the small number of participants in each study and their heterogeneity, which has already been identified as a major barrier in research, particularly in children with CP. 22 The children s ages varied at the point of investigation, implying variability in their growth rate and their stage of neuronal plasticity, which, in turn, affects the influence of different interventions. 22 None of the studies reported if the power of the sample size was calculated a priori. As the power of these studies was unknown, it is suggested that readers interpret the statistically non-significant results as inconclusive, rather than indicative of there being no effect from passive stretching. 7 Most of the studies were in the middle range in the total PEDro score. It appears that there is a need to carry out well-designed trials for evaluation of the effects of passive stretching in children with CP. Due to the limitations in the methodology of these studies, it was difficult to make definite recommendations regarding the current clinical practice for children with CP. Conclusion The current level of evidence to support the effectiveness of passive stretching in children with spastic CP remains weak. The main limitations are the inadequate rigorousness of the research designs and the small number of the participants involved. There are a few conclusions that can be drawn from the existing evidence: (1) there appears to be some evidence favouring passive stretching in increasing range of movements in children with CP, although the effect size remained small; (2) there is some favourable evidence indicating that passive stretching may reduce spasticity in children with CP although the effect size and clinical merit remain limited; and (3) there is some evidence to indicate that sustained stretching is preferable to manual stretching in improving range of movement and reducing spasticity in targeted joints and muscles in studies of children with spasticity. CLINICAL IMPLICATIONS The findings of this review prompt clinicians to rethink the use of passive stretching in their clinical settings. Clinically there are many children with CP, particularly those profoundly impaired, who like passive stretching as they feel it prevents muscle cramps and gives them a chance to change their position. Parents of these children also like passive stretching as they feel that they are doing something for their children. If there is no definite evidence to indicate that passive stretching has an effect on improving range of motion and reducing spasticity, perhaps passive stretching should only be used as an adjunct to other treatment techniques, rather than solely on its own. In addition, clinicians should investigate ways of prolonging the effects of passive stretching by including it in the daily routine of patients. As there appears to be some evidence to show that sustained stretching is more effective than manual stretching of short duration in improving range of motion and reducing spasticity, perhaps emphasis should be placed on the optimum positioning of patients (both daytime and night-time positioning) so as to maximize the effects of passive stretching. Equipment such as orthoses, splinting, and serial casting can be used as alternatives to sustained stretching. However, this needs to be verified by studies of more rigorous methodological quality and of larger sample size. There are substantial gaps in this existing evidence related to passive stretching that need to be addressed by future research. More rigorous, well-controlled trials are required to investigate the impact of passive stretching in children with CP, particularly with regard to functional limitation/activity and participation. Studies that aim to investigate the optimal duration and frequency of passive stretching to obtain the desirable clinical changes in patients are necessary. DOI: /S Accepted for publication 14th July Acknowledgement This review was an outcome of the Evidence-based Practice project funded by the Community Development Services in the Cerebral Palsy Association of Western Australia in Perth, Australia between 2000 and References 1. Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV. (1992) Cerebral palsy epidemiology: where are we now and where are we going? Dev Med Child Neurol 34: Rang M, Silver R, De la Gracia J. (1990) Cerebral Palsy. In: Lovell WW, Winter RB, editors. Pediatric Orthopaedics. 3rd edn. Philadelphia: JB Lippincott & Co. p Farmer SE, James M. (2001) Contractures in orthopaedics and neurological conditions: a review of causes and treatment. Disabil Rehabil 23: Massagli TL. (1991) Spasticity and its management in children. Phys Med Rehabil Clin N Am 2: Gracies J-M. (2001) Pathophysiology of impairment in patients with spasticity and use of stretch as a treatment of spastic hypertonia. Phys Med Rehabil Clin N Am 12: De Deyne PG. (2001) Application of passive stretch and its implications for muscle fibers. Phys Ther 81: Butler C. (1999) AACPDM methodology for developing evidence tables and reviewing treatment outcome research. (Accessed 19 June 2006) 8. PEDro. (2000) The Physiotherapy Evidence Database (PEDro) frequently asked questions: how are trials rated? (Accessed 19 June 2006) 9. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83: Sackett DL, Richardson WS, Rosenberg W, Haynes RB. (1997) Evidence-Based Medicine: How to Practice and Teach EBM. New York: Churchill Livingstone. 11. Herbert R. (2000) How to estimate treatment effects from reports of clinical trials. I: continuous outcomes. Aust J Physiother 46: Leong B. (2002) Critical review of passive muscle stretch: implications for the treatment of children in vegetative and minimally conscious states. Brain Inj 16: Nash J, Neilson PD, O Dwyer NJ. (1989) Reducing spasticity to control muscle contracture of children with cerebral palsy. Dev Med Child Neurol 31: O Dwyer N, Neilson P, Nash J. (1994) Reduction of spasticity in cerebral palsy using feedback of the tonic stretch reflex: a Review 861

8 controlled study. Dev Med Child Neurol 36: Tardieu C, Lespargot A, Tabary C, Bret MD. (1988) For how long must the soleus muscle be stretched each day to prevent contracture? Dev Med Child Neurol 30: Miedaner JA, Renander J. (1987) The effectiveness of classroom passive stretching programs for increasing or maintaining passive range of motion in non-ambulatory children: an evaluation of frequency. Phys Occup Ther Pediatr 7: Richards CL, Malouin F, Dumas F. (1991) Effects of a single session of prolonged plantarflexor stretch on muscle activations during gait in spastic cerebral palsy. Scand J Rehabil Med 23: Tremblay F, Malouin F, Richards CL, Dumas F. (1990) Effects of prolonged muscle stretch on reflex and voluntary muscle activations in children with spastic cerebral palsy. Scand J Book Review Autism: A Neurological Disorder of Early Brain Development International Review of Child Neurology Series Edited by Roberto Tuchman and Isabelle Rapin London: Mac Keith Press (for the International Child Neurology Association), 2006, pp 354, 65.00, $US ISBN (Hardback) The title of this book highlights the essence of the revolution in ideas concerning the nature of autistic conditions. In the 1940s and 50s, the prevailing view was that autism was due to the cold, distant, child-rearing practices of parents, especially mothers. From the 1960s onwards the hypothesis that autistic conditions are developmental disorders with a neurological basis has evolved and is now generally accepted. The editors and contributors agree with the concept of a spectrum of autistic conditions that is much wider than Kanner s original description of early infantile autism. The term autism is used in the book and in this review to refer to the whole spectrum. There are chapters discussing each of the major clinical features the social deficit, language and communication problems, stereotypies and repetitive behaviour, unusual sensory responses, motor problems, and sleep disorders. Other chapters deal in detail with research in the neurobiology of autistic spectrum disorders, including genetics and the relationship of epilepsy with the basic neuropathology. The concepts underlying neuropsychological assessment, methods used, and the value of such assessments in clinical work have a chapter to themselves, as does the epidemiology of autism. The editors focus the first chapter on Where are we now and the final one on What we have learned and where we need to go, both of which are informative summaries. The book provides a comprehensive overview of current research and theoretical ideas on the neurological basis of autistic spectrum disorders. It is refreshing to find that the contributors are able to criticise and look beyond conventional views when they deem this to be necessary. For example, the editors, in their first chapter, discuss the disadvantages of the categorical nature of the diagnostic criteria laid down in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (1994) and the ICD-10 Rehabil Med 22: Lespargot A, Renaudin E, Khouri N, Robert M. (1994) Extensibility of hip adductors in children with cerebral palsy. Dev Med Child Neurol 36: Fragala MA, Goodgold S, Dumas HM. (2003) Effects of lower extremity passive stretching: pilot study of children and youth with severe limitations in self-mobility. Pediatr Phys Ther 15: McPherson JJ, Arends TG, Michaels MJ, Trettin K. (1984) The range of motion of long term knee contractures of four spastic cerebral palsied children: A pilot study. Phys Occup Ther Pediatr 4: Stanley F, Blair E, Alberman E. (2000) Cerebral palsies: Epidemiology & Causal Pathways. Clinics in Developmental Medicine No London: Mac Keith Press. Classification of Mental and Behavioural disorders. Diagnostic Criteria for Research 10th revision (1993). They point out that a dimensional approach is far more appropriate and emphasize that behaviour is inherently dimensional, creating problems in defining subgroups within the spectrum. Reliable and valid definitions of subgroups will be possible only when the underlying neuropathologies of different types of autism are understood. The editors also emphasize the overlap of autistic disorders with other developmental and psychiatric conditions, especially as manifested in more able individuals. The authors of the chapter on stereotypies do not agree with the currently popular hypothesis that they are a form of self-stimulation. They consider that the movements are involuntary, due to an immature and aberrant central nervous system. Yet another example of a willingness to take an unconventional view can be found in Martha Bridge Denckla s preface. She points out that the overly conventional approaches within neuropsychology, while emphasizing the neuropathological basis of autism, have had the disadvantage of focusing on cortical functions. This is not appropriate for a disorder starting early in life, probably in most cases before birth, with diverse developmental consequences which include, but are by no means limited to, functions affiliated with the cerebral cortex. Dr Denckla notes that many of the chapters in the book indicate the need to investigate subcortical systems that are basic to the development of the social emotional brain. In a book that is so comprehensive and detailed it is surprising that there is no mention of the catatonia-like problems causing deterioration of movement and behaviour that affect around 10% or more of adolescents and adults with autistic disorders. 1 However, apart from this small criticism, this book is to be recommended to researchers and professional workers engaged in clinical work in the field. It would also be of interest to parents and carers who want to broaden their understanding of the fascinating and mysterious conditions making up the autistic spectrum. Lorna Wing DOI: /S Reference 1. Wing L, Shah A. (2000) Catatonia in autistic spectrum disorders. Br J Psychiatry 176: Developmental Medicine & Child Neurology 2006, 48:

Edited by P Larking ACC Date report completed 18 January 2010

Edited by P Larking ACC Date report completed 18 January 2010 Brief report Hart Walker Reviewer Adrian Purins AHTA Edited by P Larking ACC Date report completed 18 January 2010 1. Background Cerebral Palsy (CP) is a group of disorders that arise from brain damage

More information

Splinting in Neurology. Jo Tuckey MSc MCSP

Splinting in Neurology. Jo Tuckey MSc MCSP Splinting in Neurology Jo Tuckey MSc MCSP Splinting in Neurology When should splinting be considered? How to choose the most appropriate splint or position for splinting. Practicalities of providing a

More information

Tone Management in Cerebral Palsy. Jenny Wilson, MD wilsjen@ohsu.edu OHSU and Shriners Hospital for Children October, 2015

Tone Management in Cerebral Palsy. Jenny Wilson, MD wilsjen@ohsu.edu OHSU and Shriners Hospital for Children October, 2015 Tone Management in Cerebral Palsy Jenny Wilson, MD wilsjen@ohsu.edu OHSU and Shriners Hospital for Children October, 2015 Disclosures I am involved in a Dysport sponsored research study Goals Describe

More information

Cerebral Palsy: Intervention Methods for Young Children. Emma Zercher. San Francisco State University

Cerebral Palsy: Intervention Methods for Young Children. Emma Zercher. San Francisco State University RUNNING HEAD: Cerebral Palsy & Intervention Methods Cerebral Palsy & Intervention Methods, 1 Cerebral Palsy: Intervention Methods for Young Children Emma Zercher San Francisco State University May 21,

More information

Cerebral Palsy. www.teachinngei.org p. 1

Cerebral Palsy. www.teachinngei.org p. 1 Cerebral Palsy What is cerebral palsy? Cerebral palsy (CP) is a motor disability caused by a static, non-progressive lesion (encephalopathy) in the brain that occurs in early childhood, usually before

More information

Cerebral palsy in Victoria: Motor types, topography and gross motor function

Cerebral palsy in Victoria: Motor types, topography and gross motor function J. Paediatr. Child Health (2005) 41, 479 483 Cerebral palsy in Victoria: Motor types, topography and gross motor function Jason Howard, 1 Brendan Soo, 1,4 H Kerr Graham, 1,4,5 Roslyn N Boyd, 1,2,4 Sue

More information

Prepared by:jane Healey (Email: janie_healey@yahoo.com) 4 th year undergraduate occupational therapy student, University of Western Sydney

Prepared by:jane Healey (Email: janie_healey@yahoo.com) 4 th year undergraduate occupational therapy student, University of Western Sydney 1 There is fair (2b) level evidence that living skills training is effective at improving independence in food preparation, money management, personal possessions, and efficacy, in adults with persistent

More information

Cerebral palsy, neonatal death and stillbirth rates Victoria, 1973-1999

Cerebral palsy, neonatal death and stillbirth rates Victoria, 1973-1999 Cerebral Palsy: Aetiology, Associated Problems and Management Lecture for FRACP candidates July 2010 Definitions and prevalence Risk factors and aetiology Associated problems Management options Cerebral

More information

Cerebral palsy can be classified according to the type of abnormal muscle tone or movement, and the distribution of these motor impairments.

Cerebral palsy can be classified according to the type of abnormal muscle tone or movement, and the distribution of these motor impairments. The Face of Cerebral Palsy Segment I Discovering Patterns What is Cerebral Palsy? Cerebral palsy (CP) is an umbrella term for a group of non-progressive but often changing motor impairment syndromes, which

More information

Review of Selected Physical Therapy Interventions for School Age Children with Disabilities

Review of Selected Physical Therapy Interventions for School Age Children with Disabilities Review of Selected Physical Therapy Interventions for School Age Children with Disabilities Prepared for the Center on Personnel Studies in Special Education EXECUTIVE SUMMARY by Susan K. Effgen University.

More information

WorkCover s physiotherapy forms: Purpose beyond paperwork?

WorkCover s physiotherapy forms: Purpose beyond paperwork? WorkCover s physiotherapy forms: Purpose beyond paperwork? Eva Schonstein, Dianna T Kenny and Christopher G Maher The University of Sydney We retrospectively analysed 219 consecutive treatment plans submitted

More information

The R- Wrap AFO: An Old Concept, A New Application

The R- Wrap AFO: An Old Concept, A New Application The R- Wrap AFO: An Old Concept, A New Application By Beverly Cusick, MS, PT, BOC Orthotist, John Russell, CPO, BOCOP, CPO, BOCOP Anne Russell, MA, PT. John G. Russell Jr. Academic Degrees AA. Primary

More information

Developmental Pediatrics Rehabilitation Learner Orientation Package

Developmental Pediatrics Rehabilitation Learner Orientation Package Spasticity Clinic Follow Up Assessment Template This letter should be directed to the family, and copied to the involved family physician, any specialists that are involved of the care and also the relevant

More information

Orthopaedic Issues in Adults with CP: If I Knew Then, What I Know Now

Orthopaedic Issues in Adults with CP: If I Knew Then, What I Know Now Orthopaedic Issues in Adults with CP: If I Knew Then, What I Know Now Laura L. Tosi, MD Director, Bone Health Program Children s National Medical Center Washington, DC Epidemiology 87-93% of children born

More information

The Use of the Lokomat System in Clinical Research

The Use of the Lokomat System in Clinical Research International Neurorehabilitation Symposium February 12, 2009 The Use of the Lokomat System in Clinical Research Keith Tansey, MD, PhD Director, Spinal Cord Injury Research Crawford Research Institute,

More information

1. What is Cerebral Palsy?

1. What is Cerebral Palsy? 1. What is Cerebral Palsy? Introduction Cerebral palsy refers to a group of disorders that affect movement. It is a permanent, but not unchanging, physical disability caused by an injury to the developing

More information

Regence. Section: Mental Health Last Reviewed Date: January 2013. Policy No: 18 Effective Date: March 1, 2013

Regence. Section: Mental Health Last Reviewed Date: January 2013. Policy No: 18 Effective Date: March 1, 2013 Regence Medical Policy Manual Topic: Applied Behavior Analysis for the Treatment of Autism Spectrum Disorders Date of Origin: January 2012 Section: Mental Health Last Reviewed Date: January 2013 Policy

More information

Executive Summary Relationship of Student Outcomes to School-Based Physical Therapy Service PT COUNTS

Executive Summary Relationship of Student Outcomes to School-Based Physical Therapy Service PT COUNTS Executive Summary Relationship of Student Outcomes to School-Based Physical Therapy Service PT COUNTS Physical Therapy related Child Outcomes in the Schools (PT COUNTS) was a national study supported by

More information

9th International Congress on Cerebral Palsy

9th International Congress on Cerebral Palsy Medimond - Monduzzi Editore International Proceedings Division 9th International Congress on Cerebral Palsy Mental and Physical Activity are Imperative Bled, Slovenia, 15-18 May 2013 Editor Milivoj Velickovic

More information

Clinical Medical Policy Outpatient Rehab Therapies (PT & OT) for Members With Special Needs

Clinical Medical Policy Outpatient Rehab Therapies (PT & OT) for Members With Special Needs Benefit Coverage Rehabilitative services, (PT, OT,) are covered for members with neurodevelopmental disorders when recommended by a medical provider to address a specific condition, deficit, or dysfunction,

More information

Critical Review: Sarah Rentz M.Cl.Sc (SLP) Candidate University of Western Ontario: School of Communication Sciences and Disorders

Critical Review: Sarah Rentz M.Cl.Sc (SLP) Candidate University of Western Ontario: School of Communication Sciences and Disorders Critical Review: In children with cerebral palsy and a diagnosis of dysarthria, what is the effectiveness of speech interventions on improving speech intelligibility? Sarah Rentz M.Cl.Sc (SLP) Candidate

More information

The Surgical Correction Of Forearm Pronation Contracture By Pronator Teres Re Routing. Dr.(Lt Col) S Suresh Kumar, VSM MS (Orth), DNB (Orth)

The Surgical Correction Of Forearm Pronation Contracture By Pronator Teres Re Routing. Dr.(Lt Col) S Suresh Kumar, VSM MS (Orth), DNB (Orth) The Surgical Correction Of Forearm Pronation Contracture By Pronator Teres Re Routing. Dr.(Lt Col) S Suresh Kumar, VSM MS (Orth), DNB (Orth) Key Words: Cerebral Palsy, Pronation contracture Abstract 6

More information

Documentation Requirements ADHD

Documentation Requirements ADHD Documentation Requirements ADHD Attention Deficit Hyperactivity Disorder (ADHD) is considered a neurobiological disability that interferes with a person s ability to sustain attention, focus on a task

More information

?Clinical question: What are the effects, if any, of lowerextremity

?Clinical question: What are the effects, if any, of lowerextremity ?Clinical question: What are the effects, if any, of lowerextremity strength training on gait in children with cerebral palsy? The purpose of Evidence in Practice is to illustrate the literature search

More information

The goals of surgery in ambulatory children with cerebral

The goals of surgery in ambulatory children with cerebral ORIGINAL ARTICLE Changes in Pelvic Rotation After Soft Tissue and Bony Surgery in Ambulatory Children With Cerebral Palsy Robert M. Kay, MD,* Susan Rethlefsen, PT,* Marty Reed, MD, K. Patrick Do, BS,*

More information

CLINICAL OUTCOME SCORES FOR THE FAMILY HOPE CENTER FOR 13.0 YEARS, COMPARED TO NATIONAL SAMPLE OF OUTPATIENT REHABILITATION FOR SIMILAR DIAGNOSES

CLINICAL OUTCOME SCORES FOR THE FAMILY HOPE CENTER FOR 13.0 YEARS, COMPARED TO NATIONAL SAMPLE OF OUTPATIENT REHABILITATION FOR SIMILAR DIAGNOSES CLINICAL OUTCOME SCORES FOR THE FAMILY HOPE CENTER FOR 13.0 YEARS, COMPARED TO NATIONAL SAMPLE OF OUTPATIENT REHABILITATION FOR SIMILAR DIAGNOSES This document references data from a Report compiled and

More information

Form B-1. Inclusion form for the effectiveness of different methods of toilet training for bowel and bladder control

Form B-1. Inclusion form for the effectiveness of different methods of toilet training for bowel and bladder control Form B-1. Inclusion form for the effectiveness of different methods of toilet training for bowel and bladder control Form B-2. Assessment of methodology for non-randomized controlled trials for the effectiveness

More information

September 2009. 2. Describe briefly the various approaches used in occupational therapy for children with cerebral palsy.

September 2009. 2. Describe briefly the various approaches used in occupational therapy for children with cerebral palsy. September 2009 [KV 804 F] Sub. Code: 9108 M.O.T. DEGREE EXAMINATION (Revised Regulations) Part II Branch III Time : Three hours Paper II CLINICAL SPECIALITY -II Answer All questions Draw suitable diagrams

More information

Evidence-Based Practice in Speech Pathology

Evidence-Based Practice in Speech Pathology Level 2 / 11-19 Bank Place T 61 3 9642 4899 office@speechpathologyaustralia.org.au Melbourne Victoria 3000 F 61 3 9642 4922 www.speechpathologyaustralia.org.au Position Statement Copyright 2010 Speech

More information

People First Language. Style Guide. A reference for media professionals and the public

People First Language. Style Guide. A reference for media professionals and the public People First Language Style Guide A reference for media professionals and the public What is People First Language? People First Language (also referred to as Person First ) is an accurate way of referring

More information

Gait Analysis Laboratory Centro de Rehabilitación Infantil Teletón Estado de México

Gait Analysis Laboratory Centro de Rehabilitación Infantil Teletón Estado de México Gait Analysis Laboratory Centro de Rehabilitación Infantil Teletón Estado de México Dr. Demetrio Villanueva Ayala Doctorado en Biomecánica, CINVESTAV Dr. Juan Carlos Pérez Moreno Especialista en Medicina

More information

Passive Range of Motion Exercises

Passive Range of Motion Exercises Exercise and ALS The physical or occupational therapist will make recommendations for exercise based upon each patient s specific needs and abilities. Strengthening exercises are not generally recommended

More information

2014 Neurologic Physical Therapy Professional Education Consortium Webinar Course Descriptions and Objectives

2014 Neurologic Physical Therapy Professional Education Consortium Webinar Course Descriptions and Objectives Descriptions and Neuroplasticity Health care providers are facing greater time restrictions to render services to the individual with neurological dysfunction. However, the scientific community has recognized

More information

THE EFFECTS OF WHOLE BODY VIBRATION THERAPY IN CHILDREN WITH CEREBRAL PALSY: A META- ANALYSIS

THE EFFECTS OF WHOLE BODY VIBRATION THERAPY IN CHILDREN WITH CEREBRAL PALSY: A META- ANALYSIS THE EFFECTS OF WHOLE BODY VIBRATION THERAPY IN CHILDREN WITH CEREBRAL PALSY: A META- ANALYSIS Lauren Cochran, DPTc UCSF/SFSU Graduate Program in Physical Therapy CEREBRAL PALSY (CP) Motor impairment resulting

More information

Evidence-Based Practice in Occupational Therapy: An Introduction

Evidence-Based Practice in Occupational Therapy: An Introduction Evidence-Based Practice in Occupational Therapy: An Introduction Sally Bennett Division of Occupational Therapy School of Health and Rehabilitation Sciences The University of Queensland Australia Evidence

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. Rehabilitation for movement difficulties after stroke bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online.

More information

National Academy of Sciences Committee on Educational Interventions for Children with Autism

National Academy of Sciences Committee on Educational Interventions for Children with Autism National Academy of Sciences Committee on Educational Interventions for Children with Autism Conclusion and (The following is an adapted excerpt from Chapter 16, and, ( pp. 211-229), National Research

More information

Dr. Enas Elsayed. Brunnstrom Approach

Dr. Enas Elsayed. Brunnstrom Approach Brunnstrom Approach Learning Objectives: By the end of this lab, the student will be able to: 1. Demonstrate different reflexes including stimulus and muscle tone response. 2. Demonstrate how to evoke

More information

EFFECT OF VIBRATORY PLATFORM THERAPY ON POSTURE IN CHILDREN WITH CEREBRAL PALSY: A PILOT STUDY

EFFECT OF VIBRATORY PLATFORM THERAPY ON POSTURE IN CHILDREN WITH CEREBRAL PALSY: A PILOT STUDY EFFECT OF VIBRATORY PLATFORM THERAPY ON URE IN CHILDREN WITH CEREBRAL PALSY: A PILOT STUDY Pierina MAGNA a, Natalia JERIA a, Carlos ALVAREZ a,b, Chiara RIGOLDI c & Manuela GALLI c a Departamento de Kinesiología

More information

SAMPLE. Autism Spectrum Rating Scales (6-18 Years) Teacher Ratings. Interpretive Report. By Sam Goldstein, Ph.D. & Jack A. Naglieri, Ph.D.

SAMPLE. Autism Spectrum Rating Scales (6-18 Years) Teacher Ratings. Interpretive Report. By Sam Goldstein, Ph.D. & Jack A. Naglieri, Ph.D. Autism Spectrum Rating Scales (6-18 Years) Teacher Ratings By Sam Goldstein, Ph.D. & Jack A. Naglieri, Ph.D. Interpretive Report This Interpretive Report is intended for use by qualified assessors only.

More information

In This Issue... From the Coordinator by Amy Goldman... 2. Early AAC Intervention: Some International Perspectives by Mary Jo Cooley Hidecker...

In This Issue... From the Coordinator by Amy Goldman... 2. Early AAC Intervention: Some International Perspectives by Mary Jo Cooley Hidecker... Unless otherwise noted, the publisher, which is the American Speech-Language-Hearing Association (ASHA), holds the copyright on all materials published in Perspectives on Augmentative and Alternative Communication,

More information

Developmental delay and Cerebral palsy. Present the differential diagnosis of developmental delay.

Developmental delay and Cerebral palsy. Present the differential diagnosis of developmental delay. Developmental delay and Cerebral palsy objectives 1. developmental delay Define developmental delay Etiologies of developmental delay Present the differential diagnosis of developmental delay. 2. cerebral

More information

STROKE CARE NOW NETWORK CONFERENCE MAY 22, 2014

STROKE CARE NOW NETWORK CONFERENCE MAY 22, 2014 STROKE CARE NOW NETWORK CONFERENCE MAY 22, 2014 Rehabilitation Innovations in Post- Stroke Recovery Madhav Bhat, MD Fort Wayne Neurological Center DISCLOSURE Paid speaker for TEVA Neuroscience Program.

More information

Developmental Disabilities

Developmental Disabilities RIGHTS UNDER THE LAN TERMAN ACT Developmental Disabilities Chapter 2 This chapter explains: - What developmental disabilities are, - Who is eligible for regional center services, and - How to show the

More information

SUMMARY This PhD thesis addresses the long term recovery of hemiplegic gait in severely affected stroke patients. It first reviews current rehabilitation research developments in functional recovery after

More information

Occupational Therapy Entry-Level Degree Program M.S. Curriculum Guide

Occupational Therapy Entry-Level Degree Program M.S. Curriculum Guide Occupational Therapy Entry-Level Degree Program M.S. Curriculum Guide OCCUPATIONAL THERAPY ENTRY- LEVEL PROGRAM CURRICULUM (Residential) Enrollment in any course will not be permitted until prerequisites

More information

DETECTION AND NONOPERATIVE MANAGEMENT OF PEDIATRIC DEVELOPMENTAL DYSPLASIA OF THE HIP IN INFANTS UP TO SIX MONTHS OF AGE SUMMARY

DETECTION AND NONOPERATIVE MANAGEMENT OF PEDIATRIC DEVELOPMENTAL DYSPLASIA OF THE HIP IN INFANTS UP TO SIX MONTHS OF AGE SUMMARY DETECTION AND NONOPERATIVE MANAGEMENT OF PEDIATRIC DEVELOPMENTAL DYSPLASIA OF THE HIP IN INFANTS UP TO SIX MONTHS OF AGE SUMMARY Disclaimer This Clinical Practice Guideline was developed by an AAOS clinician

More information

Physical Therapy and Occupational Therapy Services of Young Children with Cerebral Palsy

Physical Therapy and Occupational Therapy Services of Young Children with Cerebral Palsy Physical Therapy and Occupational Therapy Services of Young Children with Cerebral Palsy Denise Begnoche, PT, DPT, Lisa Chiarello, PT, PhD, PCS, Doreen Bartlett, PT, PhD, Robert Palisano, PT, ScD Hui-Ju

More information

Webinar title: Know Your Options for Treating Severe Spasticity

Webinar title: Know Your Options for Treating Severe Spasticity Webinar title: Know Your Options for Treating Severe Spasticity Presented by: Dr. Gerald Bilsky, Physiatrist Medical Director of Outpatient Services and Associate Medical Director of Acquired Brain Injury

More information

Transmittal 55 Date: MAY 5, 2006. SUBJECT: Changes Conforming to CR3648 for Therapy Services

Transmittal 55 Date: MAY 5, 2006. SUBJECT: Changes Conforming to CR3648 for Therapy Services CMS Manual System Pub 100-03 Medicare National Coverage Determinations Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 55 Date: MAY 5, 2006 Change

More information

Ambulatory Outcome in Children with Developmental Delay. Rehab Al-Marzooq, MRCP, Arab Board, DCH*

Ambulatory Outcome in Children with Developmental Delay. Rehab Al-Marzooq, MRCP, Arab Board, DCH* Bahrain Medical Bulletin, Vol 29, No. 2, June 2007 Ambulatory Outcome in Children with Developmental Delay Rehab Al-Marzooq, MRCP, Arab Board, DCH* Objective: To identify early predictors of walking in

More information

Robot-Assisted Stroke Rehabilitation

Robot-Assisted Stroke Rehabilitation American Heart Association International Stroke Conference, 2012, New Orleans Robot-Assisted Stroke Rehabilitation Albert Lo, M.D., PhD Departments of Neurology and Epidemiology Associate Director, Center

More information

33 % of whiplash patients develop. headaches originating from the upper. cervical spine

33 % of whiplash patients develop. headaches originating from the upper. cervical spine 33 % of whiplash patients develop headaches originating from the upper cervical spine - Dr Nikolai Bogduk Spine, 1995 1 Physical Treatments for Headache: A Structured Review Headache: The Journal of Head

More information

Is There a Difference Between Asperger's Syndrome and High Functioning Autism? Dr Tony Attwood

Is There a Difference Between Asperger's Syndrome and High Functioning Autism? Dr Tony Attwood Is There a Difference Between Asperger's Syndrome and High Functioning Autism? Dr Tony Attwood We have been exploring the nature of autism, as described by Leo Kanner, for nearly 60 years. He described

More information

Review Article. J Rehabil Med 2012; 44: 385 395

Review Article. J Rehabil Med 2012; 44: 385 395 J Rehabil Med 2012; 44: 385 395 Review Article The evidence-base for basic physical therapy techniques targeting lower limb function in children with cerebral palsy: a systematic review using the International

More information

Mædica - a Journal of Clinical Medicine

Mædica - a Journal of Clinical Medicine Mædica - a Journal of Clinical Medicine ORIGINAL PAPERS Clinical Correlations in Cerebral Palsy Ioana MINCIU, MD Paediatric Neurology Clinic, Al Obregia Hospital, Carol Davila University of Medicine and

More information

THE CEREBRAL palsies (CPs) have been

THE CEREBRAL palsies (CPs) have been The World Health Organization International Classification of Functioning, Disability, and Health: A Model to Guide Clinical Thinking, Practice and Research in the Field of Cerebral Palsy Peter Rosenbaum

More information

The Influence of Functional Electrical Stimulation (FES) Cycling on Spasticity in Adolescents with Spinal Cord Injury

The Influence of Functional Electrical Stimulation (FES) Cycling on Spasticity in Adolescents with Spinal Cord Injury 1 The Influence of Functional Electrical Stimulation (FES) Cycling on Spasticity in Adolescents with Spinal Cord Injury Prepared by:rebecca Martin, OTR/L, OTD 1, Meredith Bourque, PT, DPT 1, Glendaliz

More information

Postural asymmetries in young adults with cerebral palsy

Postural asymmetries in young adults with cerebral palsy DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY ORIGINAL ARTICLE Postural asymmetries in young adults with cerebral palsy ELISABET RODBY-BOUSQUET 1,2 TOMASZ CZUBA 3 GUNNAR H AGGLUND 2 LENA WESTBOM 4 1 Centre

More information

Correlation between ICIDH handicap code and Gross Motor Function Classification System in children with cerebral palsy

Correlation between ICIDH handicap code and Gross Motor Function Classification System in children with cerebral palsy Correlation between ICIDH handicap code and Gross Motor Function Classification System in children with cerebral palsy Eva Beckung* PT PhD; Gudrun Hagberg BA BM PhD, Department of Pediatrics, Göteborg

More information

Goals of Presentation. Introduction to Developmental Diagnosis. Outline of Presentation. Outline of Presentation. Goals of Developmental Monitoring

Goals of Presentation. Introduction to Developmental Diagnosis. Outline of Presentation. Outline of Presentation. Goals of Developmental Monitoring Introduction to Developmental Diagnosis Brian Rogers MD Professor of Pediatrics Director of the Child Development and Rehabilitation Center Goals of Presentation Develop an understanding of the goals for

More information

The Science Behind MAT

The Science Behind MAT The Science Behind MAT Muscle Activation Techniques (MAT) is a system designed to evaluate and treat muscular imbalances, I will expand on the process of evaluation in response and the use of isometrics

More information

Guidelines for Medical Necessity Determination for Occupational Therapy

Guidelines for Medical Necessity Determination for Occupational Therapy Guidelines for Medical Necessity Determination for Occupational Therapy These Guidelines for Medical Necessity Determination (Guidelines) identify the clinical information MassHealth needs to determine

More information

Submission by Cerebral Palsy Alliance to the Productivity Commission on Disability Care and Support: Draft Inquiry Report

Submission by Cerebral Palsy Alliance to the Productivity Commission on Disability Care and Support: Draft Inquiry Report Submission by Cerebral Palsy Alliance to the Productivity Commission on Disability Care and Support: Draft Inquiry Report Cerebral Palsy Alliance welcomes the recommendations of the draft report and offers

More information

THE PLACE OF THE HYPERBARIC OXYGENATION (HBO) IN THE TREATMENT STRATEGY OF CHILDREN WITH CEREBRAL PALSY AND RELATED DISORDERS

THE PLACE OF THE HYPERBARIC OXYGENATION (HBO) IN THE TREATMENT STRATEGY OF CHILDREN WITH CEREBRAL PALSY AND RELATED DISORDERS THE PLACE OF THE HYPERBARIC OXYGENATION (HBO) IN THE TREATMENT STRATEGY OF CHILDREN WITH CEREBRAL PALSY AND RELATED DISORDERS IVAN CHAVDAROV, MD, PhD The high incidence of cerebral palsy (CP) and the difficulties

More information

ALL ABOUT SPASTICITY. www.almirall.com. Solutions with you in mind

ALL ABOUT SPASTICITY. www.almirall.com. Solutions with you in mind ALL ABOUT SPASTICITY www.almirall.com Solutions with you in mind WHAT IS SPASTICITY? The muscles of the body maintain what is called normal muscle tone, a level of muscle tension that allows us to hold

More information

Web-based home rehabilitation gaming system for balance training

Web-based home rehabilitation gaming system for balance training Web-based home rehabilitation gaming system for balance training V I Kozyavkin, O O Kachmar, V E Markelov, V V Melnychuk, B O Kachmar International Clinic of Rehabilitation, 37 Pomiretska str, Truskavets,

More information

What are confidence intervals and p-values?

What are confidence intervals and p-values? What is...? series Second edition Statistics Supported by sanofi-aventis What are confidence intervals and p-values? Huw TO Davies PhD Professor of Health Care Policy and Management, University of St Andrews

More information

Treatment of Spastic Foot Deformities

Treatment of Spastic Foot Deformities Penn Comprehensive Neuroscience Center Treatment of Spastic Foot Deformities Penn Neuro-Orthopaedics Service 1 Table of Contents Overview Overview 1 Treatment 2 Procedures 4 Achilles Tendon Lengthening

More information

Advanced Certificate in Neurological Physiotherapy 2013

Advanced Certificate in Neurological Physiotherapy 2013 Advanced Certificate in Neurological Physiotherapy 2013 Fast Facts The Advanced Certificate in Neurological Physiotherapy (ACNP) is conducted jointly by SGH Department of Physiotherapy and SGH Postgraduate

More information

Cerebral Palsy. 1 - Introduction. An informative Booklet for families in the Children and Teens program

Cerebral Palsy. 1 - Introduction. An informative Booklet for families in the Children and Teens program Cerebral Palsy 1 - Introduction An informative Booklet for families in the Children and Teens program Centre de réadaptation Estrie, 2008 Preface Dear parents, It is with great pleasure that we present

More information

Toe-Walking in Children with Cerebral Palsy: Contributions of Contracture and Excessive Contraction of Triceps Surae Muscle

Toe-Walking in Children with Cerebral Palsy: Contributions of Contracture and Excessive Contraction of Triceps Surae Muscle Toe-Walking in Children with Cerebral Palsy: Contributions of Contracture and Excessive Contraction of Triceps Surae Muscle The study was designed to provide a quantitative analysis of toe-walking in children

More information

Non-Surgical Treatments for Spasticity in Cerebral Palsy and Similar Conditions by Susan Agrawal

Non-Surgical Treatments for Spasticity in Cerebral Palsy and Similar Conditions by Susan Agrawal www.complexchild.com Non-Surgical Treatments for Spasticity in Cerebral Palsy and Similar Conditions by Susan Agrawal Children with cerebral palsy and other conditions that affect muscle tone often present

More information

A Study on Patients with Cerebral Palsy

A Study on Patients with Cerebral Palsy A Study on Patients with Cerebral Palsy MSZ Khan', M Moyeenuzzaman2, MQ Islam' Bangladesh Med. Res. Counc. Bull. 2006; 32(2): 38-42 Summary A prospective study was carried-out in the department of Physical

More information

EQUINUS DEFORMITY IN CEREBRAL PALSY. A Comparison between Elongation of the Tendo Calcaneus and Gastrocnemius Recession

EQUINUS DEFORMITY IN CEREBRAL PALSY. A Comparison between Elongation of the Tendo Calcaneus and Gastrocnemius Recession EQUINUS DEFORMITY IN CEREBRAL PALSY A Comparison between Elongation of the Tendo Calcaneus and Gastrocnemius Recession W. J. W. SHARRARD and S. BERNSTEIN,* SHEFFIELD, ENGLAND From the Children s Hospital,

More information

ABILITIES Index: A Functional Assessment Approach. 9 October, 2003 Monterrey, Mexico

ABILITIES Index: A Functional Assessment Approach. 9 October, 2003 Monterrey, Mexico ABILITIES Index: A Functional Assessment Approach 9 October, 2003 Monterrey, Mexico Rune J. Simeonsson,, Ph.D., M.S.P.H. FPG Child Development University of North Carolina at Chapel Hill Grant support

More information

Children with cerebral palsy in Europe: figures and disability

Children with cerebral palsy in Europe: figures and disability Children with cerebral palsy in Europe: figures and disability on behalf of SCPE Collaborative Group Coordinator: Christine Cans, Grenoble Javier de la Cruz, Hosp Univ 12 de Octubre, Madrid Surveillance

More information

Clinical Guidelines for Stroke Management

Clinical Guidelines for Stroke Management Stop stroke. Save lives. End suffering. Clinical Guidelines for Stroke Management quick guide for physiotherapy This summary is an implementation tool designed to raise the awareness of the recommendations

More information

If several different trials are mentioned in one publication, the data of each should be extracted in a separate data extraction form.

If several different trials are mentioned in one publication, the data of each should be extracted in a separate data extraction form. General Remarks This template of a data extraction form is intended to help you to start developing your own data extraction form, it certainly has to be adapted to your specific question. Delete unnecessary

More information

Joseph K. Torgesen, Department of Psychology, Florida State University

Joseph K. Torgesen, Department of Psychology, Florida State University EMPIRICAL AND THEORETICAL SUPPORT FOR DIRECT DIAGNOSIS OF LEARNING DISABILITIES BY ASSESSMENT OF INTRINSIC PROCESSING WEAKNESSES Author Joseph K. Torgesen, Department of Psychology, Florida State University

More information

Cerebral Palsy. 1995-2014, The Patient Education Institute, Inc. www.x-plain.com nr200105 Last reviewed: 06/17/2014 1

Cerebral Palsy. 1995-2014, The Patient Education Institute, Inc. www.x-plain.com nr200105 Last reviewed: 06/17/2014 1 Cerebral Palsy Introduction Cerebral palsy, or CP, can cause serious neurological symptoms in children. Thousands of children are diagnosed with cerebral palsy every year. This reference summary explains

More information

CRITICALLY APPRAISED PAPER (CAP)

CRITICALLY APPRAISED PAPER (CAP) CRITICALLY APPRAISED PAPER (CAP) FOCUSED QUESTION Does a neurocognitive habilitation therapy service improve executive functioning and emotional and social problem-solving skills in children with fetal

More information

Therapeutic Recreation: Effects of a Riding Protocol on a Child with Cerebral Palsy

Therapeutic Recreation: Effects of a Riding Protocol on a Child with Cerebral Palsy May 2009 Rose Flammang, SPT Katrina Francis, SPT Therapeutic Recreation: Effects of a Riding Protocol on a Child with Cerebral Palsy The purpose of our research project was to Evaluate the effect of a

More information

LEVEL ONE MODULE EXAM PART ONE [Clinical Questions Literature Searching Types of Research Levels of Evidence Appraisal Scales Statistic Terminology]

LEVEL ONE MODULE EXAM PART ONE [Clinical Questions Literature Searching Types of Research Levels of Evidence Appraisal Scales Statistic Terminology] 1. What does the letter I correspond to in the PICO format? A. Interdisciplinary B. Interference C. Intersession D. Intervention 2. Which step of the evidence-based practice process incorporates clinical

More information

Switch Assessment and Planning Framework for Individuals with Physical Disabilities

Switch Assessment and Planning Framework for Individuals with Physical Disabilities Guidance Notes Pre- assessment: It is important to gather together appropriate information before the assessment to inform on possible starting points for the assessment. The Pre-Assessment Form should

More information

Citation: Robertson, I.H., Gray, J.M., Pentland, B., & Waite, L.J. (1990). Microcomputerbased

Citation: Robertson, I.H., Gray, J.M., Pentland, B., & Waite, L.J. (1990). Microcomputerbased A computer-based cognitive rehabilitation program, involving scanning training twice a week for 7 weeks, did not improve cognitive function in patients with unilateral left visual neglect. Prepared by:

More information

A Rapidly Growing Population with. - Murray Goldstein, DO, MPH Chairman, Cerebral Palsy International Research CPIRF

A Rapidly Growing Population with. - Murray Goldstein, DO, MPH Chairman, Cerebral Palsy International Research CPIRF Adults with Cerebral Palsy A Rapidly Growing Population with Complex Health Issues - Murray Goldstein, DO, MPH Chairman, Cerebral Palsy International Research Foundation Scientific Advisory Council CPIRF

More information

Gait. Maturation of Gait Beginning ambulation ( Infant s gait ) Upper Limb. Lower Limb

Gait. Maturation of Gait Beginning ambulation ( Infant s gait ) Upper Limb. Lower Limb Gait Terminology Gait Cycle : from foot strike to foot strike Gait Phase : stance (60%) : swing (40%) Velocity : horizontal speed along progression Cadence : no. of steps per unit time Step length : distance

More information

Cerebral Palsy. In order to function, the brain needs a continuous supply of oxygen.

Cerebral Palsy. In order to function, the brain needs a continuous supply of oxygen. Cerebral Palsy Introduction Cerebral palsy, or CP, can cause serious neurological symptoms in children. Up to 5000 children in the United States are diagnosed with cerebral palsy every year. This reference

More information

Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Special Education

Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Special Education Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Special Education 0731111 Psychology and life {3} [3-3] Defining humans behavior; Essential life skills: problem

More information

Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache

Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache Douglas C. McCrory, MD, MHSc Donald B. Penzien, PhD Vic Hasselblad, PhD Rebecca N. Gray, DPhil Duke University

More information

Surgery of the Upper Extremity in Children with Hemiplegic Cerebral Palsy

Surgery of the Upper Extremity in Children with Hemiplegic Cerebral Palsy Article submitted, at the request of CHASA, by Robert Bunata, M.D., Board Certified Orthopedic Surgeon. Dr. Bunata has a special interest in upper extremity surgery in children who have hemiplegia. He

More information

Association of Handwriting Impairment in Elementary School-aged Children with Autism Spectrum Disorders

Association of Handwriting Impairment in Elementary School-aged Children with Autism Spectrum Disorders 2 Association of Handwriting Impairment in Elementary School-aged Children with Autism Spectrum Disorders Prepared by: Ivonne Montgomery (imontgomery@cw.bc.ca) Date: November 2013 Review date: November

More information

INDIVIDUAL FAMILY SERVICE PLAN (IFSP)

INDIVIDUAL FAMILY SERVICE PLAN (IFSP) INDIVIDUAL FAMILY SERVICE PLAN (IFSP) Check here if this is an Interim IFSP Resident District: IFSP Meeting Date: IDENTIFYING INFORMATION MARSS ID #: Gender: M F Date of Birth: / / School: Providing District

More information

Comprehensive Special Education Plan. Programs and Services for Students with Disabilities

Comprehensive Special Education Plan. Programs and Services for Students with Disabilities Comprehensive Special Education Plan Programs and Services for Students with Disabilities The Pupil Personnel Services of the Corning-Painted Post Area School District is dedicated to work collaboratively

More information

Prevalence and disabilities in 4 to 8 year olds with

Prevalence and disabilities in 4 to 8 year olds with Archives of Disease in Childhood, 85,, -5 Prevalence and disabilities in to 8 year olds with cerebral palsy P EVANS, M ELLIOT,* E ALBERMAN, AND S EVANS Department of ical Epidemiology, London Hospital

More information

Specialist Children s Service

Specialist Children s Service Specialist Children s Service Information and Guidelines for Referrers March 2009, Version 3.0 Contents CONTENTS... 2 INTRODUCTION... 3 TEAMS BASED AT THE WOOD STREET HEALTH CENTRE:... 3 TEAMS BASED ELSEWHERE

More information

Systematic reviews and meta-analysis

Systematic reviews and meta-analysis Evidence-Based Medicine And Healthcare Singapore Med J 2005 Vol 46(6) : 270 CME Article Systematic reviews and meta-analysis S Green ABSTRACT Systematic reviews form a potential method for overcoming the

More information

AUTISM SPECTRUM DISORDERS

AUTISM SPECTRUM DISORDERS AUTISM SPECTRUM DISORDERS JAGWINDER SANDHU, MD CHILD, ADOLESCENT AND ADULT PSYCHIATRIST 194 N HARRISON STREET PRINCETON, NJ 08540 PH: 609 751 6607 Staff Psychiatrist Carrier clinic Belle Mead NJ What is

More information

Professional Development: Applied Behavior Analysis Video Series

Professional Development: Applied Behavior Analysis Video Series Autism Overview: Course 1 Autistic Spectrum Disorders, including Asperger s Disorder and Pervasive Developmental Disorder, are neurological disorders that can have a significant impact on all areas of

More information