Determination of interventions for upper extremity tactile impairment in children with cerebral palsy: a systematic review

Abstract

Aim This study reviewed interventions suitable for treating tactile dysfunction in children with cerebral palsy (CP). Method A systematic review was conducted of six databases, searched for population: (‘brain injury’ OR ‘cerebral palsy’ OR ‘stroke’ OR ‘cerebrovascular accident’) and intervention: (‘tactile’ OR ‘sensation’). Inclusion criteria were: (1) published after 1950 in English; (2) participants older than 4 years with brain injury; (3) upper limb intervention; and (4) examined tactile registration or perception. Results Of 2938 studies identified, 30 met the inclusion criteria. Results from included studies indicated that tactile function improved in adults with stroke after transfer enhanced training (t[47]=2.75, p=0.004), stimulus specific training (p<0.001), ice therapy (F=5.71, p=0.028), mirror therapy (F=7.7, p=0.009), and functional deafferentation using an anaesthetic cream (t=3.76; p<0.01). No intervention reported improvement in tactile dysfunction for children with CP. Interpretation Research is required to develop tactile interventions for children with CP that integrate methodology from effective approaches for adults after stroke. Stimulus specific training, transfer enhanced training, and mirror therapy are promising. Other approaches are less suitable for children because of invasiveness (electrical stimulation), safety (ice therapy), or limitation of bimanual function (eutectic mixture of local anaesthetics, pneumatic cuff).

What is the current practice of therapists in the measurement of somatosensation in children with cerebral palsy and other neurological disorders?

“…Of the clinical measures available, most only have established psychometric properties for use with adults post‐stroke or peripheral nerve injury (Connell & Tyson, ; Krumlinde‐Sundholm & Eliasson, ). Over recent years, the clinimetric properties of some of these assessments have been explored for use in children with CP (Auld, Russo, Moseley & Johnston, ). Auld and colleagues (2012a) compared the reliability of the following assessments in measuring somatosensation of the impaired hand of 16 children with CP using intraclass correlation coefficient (ICC) and agreement scores (percentage of exact agreement (%EA)).…”

The effects of intensive bimanual training with and without tactile training on tactile function in children with unilateral spastic cerebral palsy: A pilot study

“…Tactile registration, tactile perception, and sensorimotor integration are essential for grasping and releasing objects (Gordon & Duff, 1999a, 1999b), dexterous manipulation (Bleyenheuft & Gordon, 2013), and activities of daily living (Auld, Boyd, Moseley, Ware, & Johnston, 2012). There have been studies investigating sensory contribution to motor control in children with USCP (Auld et al, 2012; Auld, Russo, Moseley, & Johnston, 2014; Gordon & Duff, 1999a). However, whether intensive bimanual training or tactile training is effective in modifying tactile impairments in children with USCP has never been investigated.…”

“…While it has been acknowledged that the sensory impairment is a major contribution to motor impairments in children with USCP (Bleyenheuft & Gordon, 2013), effective therapy in improving tactile impairment is lacking (Auld et al, 2014). The study by Charles, Lavinder, and Gordon (2001) is the only study using intensive hand therapy which reported an improvement in tactile discrimination in 3 children after constraint-induced movement therapy (CIMT).…”

Stability of stereognosis after pediatric repetitive transcranial magnetic stimulation and constraint-induced movement therapy clinical trial

“…14 Stereognosis is a component of sensibility, wherein it allows an individual to identify an object in one’s hand with only tactile input and is an important factor in motor learning development. 15 Awareness of objects in the hand can impact daily living skills such as reaching into a coat pocket and identifying car keys vs. coins.…”