Feasibility and effectiveness of home-based therapy programmes for children with cerebral palsy: a systematic review

Beckers, Laura; Geijen, Mellanie; Kleijnen, Jos; Rameckers, Eugène; Schnackers, Marlous; Smeets, Rob; Janssen-Potten, Yvonne

doi:10.1136/bmjopen-2019-035454

Cited by 45 publications

(65 citation statements)

References 90 publications

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“…Home-based therapies for patients with CP seem to be feasible; however, the available studies have used diverse methods and strategies, and, therefore, it is hard to determine the impact of these kinds of therapies. 49 An efficient way to deliver these home-based therapies is using TR, which appears to be an option to improve physical function in patients with disabilities. However, most research has included low-quality evidence studies that make it impossible to determine the effectiveness of TR.…”

Section: Discussionmentioning

confidence: 99%

Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: Protocol for a clinical trial

Gatica-Rojas

Cartes‐Velásquez

Soto

et al. 2022

Preprint

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ObjectiveTo establish the feasibility and effectiveness of a rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral type palsy spastic hemiplegia. It also seeks to compare low-cost virtual reality under two delivery modalities, telerehabilitation (TR) and face-to-face (FtF).MethodsRandomized controlled clinical trial from the ACTRN platform ACTRN12621000117819. Eighteen sessions of low-cost virtual reality therapy will be provided through both, FtF and TR modalities using a Nintendo Wii balance board. Each programme will last for 6 weeks and will consist of 3 sessions per week of 25 minutes each. The participants will include 40 patients diagnosed with cerebral palsy type spastic hemiplegia. Twenty participants for each group. Participants will be assessed at baseline, by the end of weeks 2, 4, and 6, and at weeks 8 and 10 (post-intervention follow-ups). Clinical measures include the Modified-Modified Ashworth Scale for lower limbs, Modified Ashworth Scale for upper limbs, timed up-and-go tests, the timed one-leg standing and 6-minute walk test. Posturographic measures, including sway area and velocity, under six conditions will be used: 2 statics and 4 dynamic conditions, which include voluntary sway in the mediolateral direction following a metronome set at 30Hz and 60Hz, and sway while playing 2 different videogames.ResultsThis study provides an assessment of the feasibility and effectiveness of an affordable rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral palsy.ConclusionRehabilitation programme using low-cost virtual reality will improve postural control in children with cerebral palsy type spastic hemiplegia and this programme delivered using TR will be as effective as a FtF modality. The TR programme has be designed to expand the coverage of physiotherapy services for children with cerebral palsy in low-resource settings and in remote areas.

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Section: Discussionmentioning

confidence: 99%

Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: Protocol for a clinical trial

Gatica-Rojas

Cartes‐Velásquez

Soto

et al. 2022

Preprint

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“…In recent times, there has been an increasing shift towards greater participation of primary caregivers in therapy for their children [46,47]. Studies have reported improved child and caregiver outcomes through this approach.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Community-Based Early Intervention and Rehabilitation for Children with Cerebral Palsy in Rural Bangladesh: A Quasi-Experimental Study

et al. 2021

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We evaluated the outcome of a community-based early intervention and habilitation for children with cerebral palsy (CP) in Bangladesh. Children registered on the Bangladesh CP Register (BCPR) were recruited in two groups for this study: Group A received a comprehensive six-month long community-based caregiver-led intervention program at the “Shishu Shorgo” (Bengali title, which translates to ‘Children’s Heaven’) Early Intervention and Rehabilitation Centres developed to support participants from the BCPR. Group B received standard care. A quasi-experimental study was conducted. Data were obtained at baseline, at the end of the program (i.e., 6 months), and at a 12-month follow-up. Outcome measures for children included gross motor functional measure (GMFM-66), Communication Function Classification System (CFCS), and Viking Speech Scale (VSS) and, for adult caregivers, the depression, anxiety, and stress scale (DASS 21). Between October 2016 and March 2017, 156 children with CP were recruited (77 in Group A and 79 in Group B). The total score of GMFM-66, CFCS level, and VSS level significantly improved statistically in Group A (p < 0.05 for all) and deteriorated in Group B (p < 0.001, p = 0.095, p = 0.232). The intervention showed promising outcomes particularly for children with CP under five years of age. There is a need for caregiver-led community-based programs for children with CP in LMICs.

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“… 67 They consider the home to be a safe environment for the child to unwind, wanting to be there for their child and to provide stimulation, but without forcing the child to practice activities. 68 The intention of parents to avoid emphasising the disability at home, in order to normalise the child’s condition, could be mentioned as a reason to decline home-based training. Parents may need guidance in stimulating and guiding their child in a playful way at home.…”

Section: Discussionmentioning

confidence: 99%

“…Parents may need guidance in stimulating and guiding their child in a playful way at home. 68 , 69 In addition, the interventions should include motivation sessions for children and parents. Alternating therapy periods at the centre and at home might be performed in parents’ situations in which their involvement is not possible.…”

Section: Discussionmentioning

confidence: 99%

Combined intensive therapies at home in spastic unilateral cerebral palsy with high bimanual functional performance. What do they offer? A comparative randomised clinical trial

Palomo-Carrión

Lirio-Romero

Ferri-Morales

et al. 2021

Therapeutic Advances in Chronic Disease

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Background: Children with unilateral spastic cerebral palsy (USCP) receive different treatments, including the application of modified constraint induced movement therapy (mCIMT) or bimanual intensive therapy (BIT) to increase affected upper limb functionality. The aim of this study was to compare the effectiveness of two protocols with different proportions and orders of mCIMT/BIT within combined intensive home-therapy in children with USCP (6–8 years old) with high bimanual functional performance, applied by the family. Methods: The protocols were performed on 20 children with an average age of 7.12 years [standard deviation (SD): 0.70], allocated to two different combined therapies. The protocols were designed by 100 h of dose for 10 weeks: 80 h of mCIMT followed by 20 h of BIT (mCIMT-B group) and 80 h of BIT followed by 20 h of mCIMT (BIT-mCI group). Bimanual functional performance was measured with Assisting Hand Assessment Scale (AHA) and the affected upper limb-use experience with Children’s Hand-use Experience Questionnaire (CHEQ). Parent satisfaction and expectations with therapy were measured using a specific questionnaire. There were five assessment timepoints (week 0, week 4, week 8, week 10 and week 34). Results: There were no statistically significant ( p > 0.05) inter- and intra-group changes in the bimanual functional performance of both groups. The affected upper limb-use experience obtained significant changes in BIT-mCI group, with statistically significant differences in the pairwise comparisons between week 0–10 and week 4–10 ( p = 0.028) for use of the affected hand and the use of the affected hand to grasp between week 4 and week 8 ( p = 0.028). Grasp efficacy and discomfort acquired statistically significant differences only in the BIT-mCI group for pairwise comparisons week 0–week 10/week 4–week 10 ( p = 0.035). Although task execution time compared with a typically developing child of the same age obtained statistically significant differences only in the group mCIMT-B for pairwise comparisons week 0–week 8 ( p = 0.03), week 0–week 10 ( p = 0.03), week 4–week 8 ( p = 0.04) and week 4–week 10 ( p = 0.03). Family satisfaction and expectations acquired an increase between week 0 and week 10 ( p ⩽ 0.02). Conclusion: Applying 80 h of BIT for 8 weeks in children with high bimanual functional performance USCP (6–8 years old), executed at home with family involvement would be sufficient to obtain improvements in affected upper limb-use experience, without the need to use combined protocols of 100 h. However, no statistically significant increase in bimanual functional performance would be obtained, with the basal situation of the child being a factor to consider for the execution of mCIMT and BIT. Registration number and name of trial registry: [ClinicalTrials.gov identifier: NCT03465046]

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Feasibility and effectiveness of home-based therapy programmes for children with cerebral palsy: a systematic review

Cited by 45 publications

References 90 publications

Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: Protocol for a clinical trial

Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: Protocol for a clinical trial

Outcome of Community-Based Early Intervention and Rehabilitation for Children with Cerebral Palsy in Rural Bangladesh: A Quasi-Experimental Study

Combined intensive therapies at home in spastic unilateral cerebral palsy with high bimanual functional performance. What do they offer? A comparative randomised clinical trial

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