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The effect of different physiotherapy interventions in post-BTX-A treatment of children with cerebral palsy
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Abstracts / Gait & Posture 30S (2009) S1–S153
Fig. 1. Mean (±S.D.): (A) walking endurance and (B) stride length pre- and post-training and follow-up (* p < 0.05).
of robotic-assisted walking involving three 30-min sessions per week. During each session subjects were encouraged to walk continuously and as actively as possible. As training progressed, the assistance provided by the DGO, the amount of bodyweight support and treadmill speed was adjusted for each subject. Pre- and post-training and 3-month follow-up evaluations were performed including clinical tests of standing and walking function, walking speed, and walking endurance. Clinical gait analysis was also performed using a motion capture system (Vicon 512). Mean data of the 20 subjects were pooled and pre- and post-training comparisons were made using repeated measures ANOVA. Results Post-training evaluations revealed improvements in standing (27% increase, p = 0.006) and walking function (18% increase, p = 0.002). Increases in walking speed and walking endurance (Fig. 1A) were also observed outcomes of training. Enhanced locomotor function was associated with better gait mechanics including a 11% increase in stride length (p < 0.001, Fig. 1B) and a 25% decrease in double support time (p < 0.01). The group demonstrated greater range of motion of sagittal plane hip, knee and ankle kinematics following training. Post-training improvements showed retention at 3-month follow-up (Fig. 1A and B). Discussion The results of this study support recent findings for the same robotic training modality [3]. Overall the changes in sagittal plane joint kinematics indicate the children were able to walk with a less crouched gait pattern following training leading to more efficient and faster walking. One of the benefits accrued from the training may be a greater motivation to walk, facilitating the retention of the observed outcomes. References [1] Cherng RJ, et al. Am J Phys Med Rehabil 2007;86(7):548–55. [2] Dodd KJ, Foley S. Deve Med Child Neurol 2007;49(2):101–5. [3] Meyer-Heim A, et al. Deve Med Child Neurol 2007;49(12):900–6.
doi:10.1016/j.gaitpost.2009.08.017
O14 The effect of different physiotherapy interventions in post-BTXA treatment of children with cerebral palsy Inge Franki 1,∗ , Chris Van den Broeck 1 , Jos De Cat 2 , Guy Molenaers 3 , Eveline Himpens 1 , Hilde Van Waelvelde 1 , Katrien Fagard 2 , Kaat Desloovere 2,4 1 Rehabilitation Sciences and Physiotherapy, Artevelde University College, University Ghent, Ghent, Belgium 2 Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Leuven, Belgium 3 Department of Musculoskeletal Sciences, KULeuven, Leuven, Belgium 4 Department of Rehabilitation Sciences, KULeuven, Leuven, Belgium
Summary The results of a single-blind controlled study aiming to distinguish the effects of different physiotherapeutic programs in a post-BTX-A regime of 76 children with Cerebral Palsy (CP) are presented. Treatment effects defined by Goal Attainment Scaling (GAS) were significantly higher in the group of children following Neurodevelopment Treatment (NDT) compared to the group of children following more conventional physiotherapy. Conclusions This study shows an obvious trend demonstrating that a NDT approach is more effective than conventional physiotherapy techniques in the post-BTX-A treatment of CP children. Introduction In children with CP, increased muscle tone often complicates the optimal setup of a physiotherapy program and may be one of the causes of a lack of response. The post-BTX-A situation can be seen as an optimal condition to evaluate differences between different physiotherapy approaches, as the reduced tone facilitates exercises for motor learning. Studies investigating the combined effect of a BTX-A treatment program with an intensive physiotherapy program show no consensus on which specific exercises and techniques indicated to optimize the effect of tone-reduction [1]. Patients, materials and methods A group of 38 children (X¯ = 7y7m, GMFCS I-III, 27 diplegia, 11 hemiplegia) receiving an individually defined Neurodevelopment Treatment (NDT) program, was compared with a group of 38 children with the same age, GMFCS and diagnosis, receiving more conventional physiotherapy. All patients received selective tone-reduction by means of multilevel BTX-A injections and adequate follow-up treatment, including physiotherapy [2]. Threedimensional gait analyses and clinical examination was performed pre- and 2 months post-injection. Treatment success was defined using the Goal Attainment Scale (GAS) [3]. To give general descriptive information on both therapy approaches, an explorative questionnaire regarding physiotherapy contents and methods was used.
Abstracts / Gait & Posture 30S (2009) S1–S153
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translation of laboratory findings into activities of every day activity. Conclusion Laboratory measures tend to be reflected in the overall activity patterns of people with CFS suggesting that objectively monitoring physical activity patterns is a useful adjunct to laboratory testing.
Fig. 1. Mean goal attainment score for children undergoing NDT and conventional physiotherapy.
Results The average converted GAS score was higher in the group of children receiving NDT than in the group receiving conventional physiotherapy (p < 0.05) (Fig. 1). In the NDT group, treatment success was achieved in 76% of the goals, compared to 68% of the goals defined for the conventional physiotherapy group. Specifically for the goals based on gait analyses (p < 0.05) and in the group of diplegic children (p < 0.05), treatment success was higher in the NDT group. Where NDT therapists reported an average time per therapy session of 42% spent on functional training, the conventional physiotherapists reported only 28%. Discussion The results support the importance of an intensive physiotherapy program during the period of tone-reduction. An indication that an NDT approach more frequently implements functional training than conventional physiotherapy and thereby attempts to benefit more optimally from the use of BTX-A was given. References [1] Lannin N, Scheinberg A, Clark K. AACPDM systematic evidence report of therapy for children with cerebral palsy after Botulinum Toxin A injections. Dev Med Child Neurol 2006;47:533–9. [2] Heinen F, Molenaers G, Fairhust C, et al. European Consensus Table 2006 on Botulinum Toxin for children with cerebral palsy. Eur J Paediatr Neurol 2006;10:215–25. [3] Kirusek TJ, Smith A, Cardillo JE. Goals attainment scaling: applications, theory and measurement. Hillsdale, New Jersey: Laurence Erlbaum Associates; 1994.
doi:10.1016/j.gaitpost.2009.08.018 Day 1 – 17 September 2009, Session 3: Validity of Measurements, 16:10–17:10, Lecture Theatre O15 Are laboratory measures reflected in the every day living activities of people with Chronic Fatigue Syndrome (CFS)? Daniel Rafferty 1,∗ , Lorna Paul 2 , Rebecca Marshall 2 , Philippa Dall 1 1 2
Glasow Caledonian University, Glasgow, United Kingdom University of Glasgow, Glasgow, United Kingdom
Summary Research in the laboratory setting indicates that people with CFS tend to walk slower and with greater energy cost than matched controls [1,2]. This study aimed to investigate if these characteristics were reflected in activities of every day life when monitored using an activity monitor. Over a 24-h period all outcome measures indicate a reduction in activity for those with CFS supporting the
Introduction CFS is characterised by fatigue, substantial physical disability and post-exertional malaise and is estimated to affect approximately 240,000 people in the UK. CFS sufferers report that they are profoundly less physically active and unable to participate in every day activities in comparison to their healthy counterparts. Patients/materials and methods Fourteen CFS subjects (11 females and 3 males) and a convenience sample of fourteen age and gender matched healthy controls took part in the study. The level of physical activity of each of the subjects, both CFS and controls, was assessed using an activPAL activity monitor. Subjects were advised to wear the monitor for a period of 3 days. The outcome measures to quantify daily activity were: time upright, time standing, time walking, number of steps taken and cadence. To further categorise the gross daily activity recorded into more directly comparable epochs of activity these data were divided into two time periods: day (9 am till 4 pm); and evening (6 pm till 10 pm) [3]. Results Over a 24-h period people with CFS spent less time upright (4.31 h (1.62) vs. 5.97 h (0.98), p = 0.012), and took fewer steps (6146 (2190) vs. 9644 (2102), p = 0.001) at a slower cadence (51.4 steps/min (4.71) vs. 62.2 steps/min (10.6), p = 0.006) than healthy controls. Daytime activity showed similar periods spent upright (2.1 h (1.05) vs. 2.7 h (0.76), p = 0.14) but CFS subject took fewer steps (2972 (1475) vs. 4580 (1472), p = 0.017) and had a slower cadence (53.4 (6.21) vs. 67.6 (13.14), p = 0.002) than matched controls. In the evening people with CFS spent less time upright (0.87 h (0.42) vs. 1.19 h (0.38), p = 0.044) and took fewer steps (1160 (493) vs. 1629 (802), p = 0.09) but had similar cadence (49.4 (7.1) vs. 54.6 (10.2), p = 0.22) than matched controls. Discussion Laboratory measures provide meaningful snapshots of how a patient’s condition affects their performance in a laboratory situation. How a patient functions in every day activity and clinical regimes to restore that function is the goal of most of health care practitioners. These results suggest that employing objective activity monitoring provides useful information on how laboratory measures are translated into every day activity. References [1] Paul L, et al. Journal of NeuroEngineering and Rehabilitation 2008;5(16). [2] Paul L, et al. Disability & Rehabilitation; in press. [3] Spenkelenk, et al. Clinical Rehabilitation 2002;16:16–26.
doi:10.1016/j.gaitpost.2009.08.019
Abstracts / Gait & Posture 30S (2009) S1–S153
Fig. 1. Mean (±S.D.): (A) walking endurance and (B) stride length pre- and post-training and follow-up (* p < 0.05).
of robotic-assisted walking involving three 30-min sessions per week. During each session subjects were encouraged to walk continuously and as actively as possible. As training progressed, the assistance provided by the DGO, the amount of bodyweight support and treadmill speed was adjusted for each subject. Pre- and post-training and 3-month follow-up evaluations were performed including clinical tests of standing and walking function, walking speed, and walking endurance. Clinical gait analysis was also performed using a motion capture system (Vicon 512). Mean data of the 20 subjects were pooled and pre- and post-training comparisons were made using repeated measures ANOVA. Results Post-training evaluations revealed improvements in standing (27% increase, p = 0.006) and walking function (18% increase, p = 0.002). Increases in walking speed and walking endurance (Fig. 1A) were also observed outcomes of training. Enhanced locomotor function was associated with better gait mechanics including a 11% increase in stride length (p < 0.001, Fig. 1B) and a 25% decrease in double support time (p < 0.01). The group demonstrated greater range of motion of sagittal plane hip, knee and ankle kinematics following training. Post-training improvements showed retention at 3-month follow-up (Fig. 1A and B). Discussion The results of this study support recent findings for the same robotic training modality [3]. Overall the changes in sagittal plane joint kinematics indicate the children were able to walk with a less crouched gait pattern following training leading to more efficient and faster walking. One of the benefits accrued from the training may be a greater motivation to walk, facilitating the retention of the observed outcomes. References [1] Cherng RJ, et al. Am J Phys Med Rehabil 2007;86(7):548–55. [2] Dodd KJ, Foley S. Deve Med Child Neurol 2007;49(2):101–5. [3] Meyer-Heim A, et al. Deve Med Child Neurol 2007;49(12):900–6.
doi:10.1016/j.gaitpost.2009.08.017
O14 The effect of different physiotherapy interventions in post-BTXA treatment of children with cerebral palsy Inge Franki 1,∗ , Chris Van den Broeck 1 , Jos De Cat 2 , Guy Molenaers 3 , Eveline Himpens 1 , Hilde Van Waelvelde 1 , Katrien Fagard 2 , Kaat Desloovere 2,4 1 Rehabilitation Sciences and Physiotherapy, Artevelde University College, University Ghent, Ghent, Belgium 2 Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Leuven, Belgium 3 Department of Musculoskeletal Sciences, KULeuven, Leuven, Belgium 4 Department of Rehabilitation Sciences, KULeuven, Leuven, Belgium
Summary The results of a single-blind controlled study aiming to distinguish the effects of different physiotherapeutic programs in a post-BTX-A regime of 76 children with Cerebral Palsy (CP) are presented. Treatment effects defined by Goal Attainment Scaling (GAS) were significantly higher in the group of children following Neurodevelopment Treatment (NDT) compared to the group of children following more conventional physiotherapy. Conclusions This study shows an obvious trend demonstrating that a NDT approach is more effective than conventional physiotherapy techniques in the post-BTX-A treatment of CP children. Introduction In children with CP, increased muscle tone often complicates the optimal setup of a physiotherapy program and may be one of the causes of a lack of response. The post-BTX-A situation can be seen as an optimal condition to evaluate differences between different physiotherapy approaches, as the reduced tone facilitates exercises for motor learning. Studies investigating the combined effect of a BTX-A treatment program with an intensive physiotherapy program show no consensus on which specific exercises and techniques indicated to optimize the effect of tone-reduction [1]. Patients, materials and methods A group of 38 children (X¯ = 7y7m, GMFCS I-III, 27 diplegia, 11 hemiplegia) receiving an individually defined Neurodevelopment Treatment (NDT) program, was compared with a group of 38 children with the same age, GMFCS and diagnosis, receiving more conventional physiotherapy. All patients received selective tone-reduction by means of multilevel BTX-A injections and adequate follow-up treatment, including physiotherapy [2]. Threedimensional gait analyses and clinical examination was performed pre- and 2 months post-injection. Treatment success was defined using the Goal Attainment Scale (GAS) [3]. To give general descriptive information on both therapy approaches, an explorative questionnaire regarding physiotherapy contents and methods was used.
Abstracts / Gait & Posture 30S (2009) S1–S153
S11
translation of laboratory findings into activities of every day activity. Conclusion Laboratory measures tend to be reflected in the overall activity patterns of people with CFS suggesting that objectively monitoring physical activity patterns is a useful adjunct to laboratory testing.
Fig. 1. Mean goal attainment score for children undergoing NDT and conventional physiotherapy.
Results The average converted GAS score was higher in the group of children receiving NDT than in the group receiving conventional physiotherapy (p < 0.05) (Fig. 1). In the NDT group, treatment success was achieved in 76% of the goals, compared to 68% of the goals defined for the conventional physiotherapy group. Specifically for the goals based on gait analyses (p < 0.05) and in the group of diplegic children (p < 0.05), treatment success was higher in the NDT group. Where NDT therapists reported an average time per therapy session of 42% spent on functional training, the conventional physiotherapists reported only 28%. Discussion The results support the importance of an intensive physiotherapy program during the period of tone-reduction. An indication that an NDT approach more frequently implements functional training than conventional physiotherapy and thereby attempts to benefit more optimally from the use of BTX-A was given. References [1] Lannin N, Scheinberg A, Clark K. AACPDM systematic evidence report of therapy for children with cerebral palsy after Botulinum Toxin A injections. Dev Med Child Neurol 2006;47:533–9. [2] Heinen F, Molenaers G, Fairhust C, et al. European Consensus Table 2006 on Botulinum Toxin for children with cerebral palsy. Eur J Paediatr Neurol 2006;10:215–25. [3] Kirusek TJ, Smith A, Cardillo JE. Goals attainment scaling: applications, theory and measurement. Hillsdale, New Jersey: Laurence Erlbaum Associates; 1994.
doi:10.1016/j.gaitpost.2009.08.018 Day 1 – 17 September 2009, Session 3: Validity of Measurements, 16:10–17:10, Lecture Theatre O15 Are laboratory measures reflected in the every day living activities of people with Chronic Fatigue Syndrome (CFS)? Daniel Rafferty 1,∗ , Lorna Paul 2 , Rebecca Marshall 2 , Philippa Dall 1 1 2
Glasow Caledonian University, Glasgow, United Kingdom University of Glasgow, Glasgow, United Kingdom
Summary Research in the laboratory setting indicates that people with CFS tend to walk slower and with greater energy cost than matched controls [1,2]. This study aimed to investigate if these characteristics were reflected in activities of every day life when monitored using an activity monitor. Over a 24-h period all outcome measures indicate a reduction in activity for those with CFS supporting the
Introduction CFS is characterised by fatigue, substantial physical disability and post-exertional malaise and is estimated to affect approximately 240,000 people in the UK. CFS sufferers report that they are profoundly less physically active and unable to participate in every day activities in comparison to their healthy counterparts. Patients/materials and methods Fourteen CFS subjects (11 females and 3 males) and a convenience sample of fourteen age and gender matched healthy controls took part in the study. The level of physical activity of each of the subjects, both CFS and controls, was assessed using an activPAL activity monitor. Subjects were advised to wear the monitor for a period of 3 days. The outcome measures to quantify daily activity were: time upright, time standing, time walking, number of steps taken and cadence. To further categorise the gross daily activity recorded into more directly comparable epochs of activity these data were divided into two time periods: day (9 am till 4 pm); and evening (6 pm till 10 pm) [3]. Results Over a 24-h period people with CFS spent less time upright (4.31 h (1.62) vs. 5.97 h (0.98), p = 0.012), and took fewer steps (6146 (2190) vs. 9644 (2102), p = 0.001) at a slower cadence (51.4 steps/min (4.71) vs. 62.2 steps/min (10.6), p = 0.006) than healthy controls. Daytime activity showed similar periods spent upright (2.1 h (1.05) vs. 2.7 h (0.76), p = 0.14) but CFS subject took fewer steps (2972 (1475) vs. 4580 (1472), p = 0.017) and had a slower cadence (53.4 (6.21) vs. 67.6 (13.14), p = 0.002) than matched controls. In the evening people with CFS spent less time upright (0.87 h (0.42) vs. 1.19 h (0.38), p = 0.044) and took fewer steps (1160 (493) vs. 1629 (802), p = 0.09) but had similar cadence (49.4 (7.1) vs. 54.6 (10.2), p = 0.22) than matched controls. Discussion Laboratory measures provide meaningful snapshots of how a patient’s condition affects their performance in a laboratory situation. How a patient functions in every day activity and clinical regimes to restore that function is the goal of most of health care practitioners. These results suggest that employing objective activity monitoring provides useful information on how laboratory measures are translated into every day activity. References [1] Paul L, et al. Journal of NeuroEngineering and Rehabilitation 2008;5(16). [2] Paul L, et al. Disability & Rehabilitation; in press. [3] Spenkelenk, et al. Clinical Rehabilitation 2002;16:16–26.
doi:10.1016/j.gaitpost.2009.08.019