Therapeutic Positioning, Wheelchair Seating, and Pulmonary Function of Children with Cerebral Palsy: A Research Synthesis

Barks, Lee

doi:10.1002/j.2048-7940.2004.tb00337.x

Cited by 14 publications

(6 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Significant improvement in pulmonary functions (VC, FEV 1 , PEF) revealed in meta-analysis may be related to increased respiratory muscle strength from training [9]. Previous studies [30,31] reported that the increase in VC of the spastic CP children can be attributed to the better control of breathing through elimination of the abnormal breathing patterns and strengthening of the respiratory muscles. It is possible that the respiratory training is important to counterbalance the natural decline of pulmonary functions in these patients.…”

Section: Discussionmentioning

confidence: 87%

Effect of respiratory therapy on pulmonary functions in children with cerebral palsy: a systematic review

2020

View full text Add to dashboard Cite

Background Children with cerebral palsy (CP) are at risk for respiratory dysfunction. Early initiation of pulmonary rehabilitation in addition to conventional physical therapy may result in improvement and maintenance of chest mobility and respiratory function. However, empirical support for respiratory therapy is limited. The aim of the review was to assess the evidence of the effectiveness of respiratory therapy on pulmonary functions in children with CP. Methods Four electronic databases (PubMed, Cochrane Library, Physiotherapy Evidence Database (PEDro), and Google Scholar) were searched till December 2019 using predefined terms by two independent reviewers. Randomized controlled trials published in English were included if they met the following criteria: population—children with different types of CP of both sex, aged up to 18 years; intervention—respiratory therapy; outcomes—pulmonary functions. Eight studies with 235 participants only met the inclusion criteria and were included in this review. Predefined data were tabulated using American Academy for Cerebral Palsy and Developmental Medicine by two reviewers and verified by a third reviewer. Methodological quality was assessed using rating system of quality assessment and PEDro scale; also, levels of evidence adopted from modified Sacket’s scale were used for each outcome. Results The quality of studies ranged from excellent (one study) to good (five studies) and fair (two studies). The results showed level 1 (six studies) and level 2 (two studies) on modified Sacket’s scale for level of evidence. Lack of allocation concealment and blinding was the major risk of bias in the included studies. Conclusions Meta-analysis revealed significant difference in the improvement of vital capacity, peak expiratory flow, and forced expiratory volume at 1 s in favor of the study groups. However, there is a need for high-quality studies to draw a clear conclusion.

show abstract

Section: Discussionmentioning

confidence: 87%

Effect of respiratory therapy on pulmonary functions in children with cerebral palsy: a systematic review

2020

View full text Add to dashboard Cite

show abstract

“…Without trunk control, the paraspinal extensors and abdominal muscles cannot provide balanced co-contraction to hold the trunk upright. Gravity pulls downward, resulting in the collapse of the trunk into scoliosis or rotoscoliosis (Barks, 2004). The depth of the thoracic support of the IF decreased significantly compared with that of the AAF.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral palsy is the term for a range of non-progressive syndromes of posture and motor impairment that results from an insult to the developing central nervous system (Koman et al, 2004). People with cerebral palsy who have not developed trunk control have difficulty eating, speaking, moving about, and executing regular activities associated with daily living (Barks, 2004). Patients with cerebral palsy are often prescribed special seating systems for use in their wheelchairs for the purposes of improving posture and to help prevent the development of long-term deformity.…”

Section: ) Department Of Health Sciences Hokkaido University Schoolmentioning

confidence: 99%

Evaluating the Relationships between the Postural Adaptation of Patients with Profound Cerebral Palsy and the Configuration of the Seating Buggy's Seating Support Surface

Hatta

Nishimura²,

Inoue

et al. 2007

J Physiol Anthropol

View full text Add to dashboard Cite

We are currently investigating the physiological polymorphism of wheelchair users with profound cerebral palsy and the properties of the Seating Buggy (developed by S. Nishimura, 1998) to clarify important and general elements of wheelchairs for widespread use. Cerebral palsy is a diagnostic term used to describe a group of motor syndromes resulting from disorders in early brain development. Recently, it has been shown that the Seating Buggy produces functional head-neck alignments and active control of sitting balance for people with profound cerebral palsy. The Seating Buggy is a wheelchair for the profoundly disabled and features a wide adjustment range from heights of 120 cm to 175 cm. Its seating support surface is comprised of a sling-seat. To examine the relationships between the postural adaptation of patients with profound cerebral palsy and the configuration of the Seating Buggy's seating, we assessed the postural alignment of the Seating Buggy's user and then measured the configuration of its resulting seating support surface with a three dimensional scanning system. Twenty-one subjects were used for the purposes of this investigation in their everyday environment. Postural adaptation and wheelchair fitting in the Seating Buggy were assessed from the viewpoint of the Active Balanced Seating by a seating expert. The subjects fell into two categories, as follows: 11 for appropriate or nearly appropriate fitting, and 10 for ill-fitting. The depth of thoracic support and the forward distance of lumbar support for those who claimed that it was ill-fitting were significantly reduced compared with that of those who claimed that the Seating Buggy offered an appropriate or nearly appropriate fitting. It was suggested that the properly adjusted depth of thoracic support and distance of the lumbar support were related to the resulting satisfactory head-neck alignment and sitting balance of the patients with profound cerebral palsy

show abstract

“…Otherwise, chest wall development is impaired ( 77 ). Children who cannot sit unsupported cannot co-contract paraspinal and abdominal muscles, resulting in immediate mid-trunk collapse and slumped posture ( 78 ), and evolving into fixed kyphoscoliosis over time ( Figure 2 ). Malalignment of the spine from any cause contributes to reduced gas exchange (hypoxemia and hypercapnia), increased resistive load to breathing, and increased risk of upper airway obstruction (UAO), atelectasis, and pneumonia caused by unequal expansion of lungs ( 29 , 79 ).…”

Section: Risk Factors For Respiratory Illnessmentioning

confidence: 99%

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

et al. 2020

View full text Add to dashboard Cite

Cerebral palsy (CP) is the most common cause of disability in childhood. Respiratory illness is the most common cause of mortality, morbidity, and poor quality of life in the most severely affected children. Respiratory illness is caused by multiple and combined factors. This review describes these factors and discusses assessments and treatments. Oropharyngeal dysphagia causes pulmonary aspiration of food, drink, and saliva. Speech pathology assessments evaluate safety and adequacy of nutritional intake. Management is holistic and may include dental care, and interventions to improve nutritional intake, and ease, and efficiency of feeding. Behavioral, medical, and surgical approaches to drooling aim to reduce salivary aspiration. Gastrointestinal dysfunction, leading to aspiration from reflux, should be assessed objectively, and may be managed by lifestyle changes, medications, or surgical interventions. The motor disorder that defines cerebral palsy may impair fitness, breathing mechanics, effective coughing, and cause scoliosis in individuals with severe impairments; therefore, interventions should maximize physical, musculoskeletal functions. Airway clearance techniques help to clear secretions. Upper airway obstruction may be treated with medications and/or surgery. Malnutrition leads to poor general health and susceptibility to infection, and improved nutritional intake may improve not only respiratory health but also constipation, gastroesophageal reflux, and participation in activities. There is some evidence that children with CP carry pathogenic bacteria. Prophylactic antibiotics may be considered for children with recurrent exacerbations. Uncontrolled seizures place children with CP at risk of respiratory illness by increasing their risk of salivary aspiration; therefore optimal control of epilepsy may reduce respiratory illness. Respiratory illnesses in children with CP are sometimes diagnosed as asthma; a short trial of asthma medications may be considered, but should be discontinued if ineffective. Overall, management of respiratory illness in children with CP is complex and needs well-coordinated multidisciplinary teams who communicate clearly with families. Regular immunizations, including annual influenza vaccination, should be encouraged, as well as good oral hygiene. Treatments should aim to improve quality of life for children and families and reduce burden of care for carers.

show abstract

Therapeutic Positioning, Wheelchair Seating, and Pulmonary Function of Children with Cerebral Palsy: A Research Synthesis

Cited by 14 publications

References 24 publications

Effect of respiratory therapy on pulmonary functions in children with cerebral palsy: a systematic review

Effect of respiratory therapy on pulmonary functions in children with cerebral palsy: a systematic review

Evaluating the Relationships between the Postural Adaptation of Patients with Profound Cerebral Palsy and the Configuration of the Seating Buggy's Seating Support Surface

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

Contact Info

Product

Resources

About