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Background: Parental participation in their young children's rehabilitation has been promoted to increase intervention intensity, but parents' perspectives on increased involvement remain unclear. The objective of this study was to explore parents' experiences partnering with physical therapists (PTs) to administer early, intensive rehabilitation to their young children with cerebral palsy (CP). Methods: Twelve mothers and one father of children between 8 months and 3 years old with CP were interviewed. Semistructured interviews were conducted before and after parents partnered with a PT to deliver a 12 week activity‐based intervention targeting their child's lower extremities. The intervention occurred in the child's home and in PT clinical sites. Interviews were audio recorded and transcribed verbatim. Interpretive description was used as the methodological framework. Results: The three themes were (1) focus on maximizing the child's potential, (2) participation in intensive rehabilitation is challenging, and (3) the importance of a positive experience with therapy. Families discussed a number of barriers and facilitators to participating in intensive rehabilitation. Conclusions: These results provide considerations for clinicians and researchers to facilitate meaningful engagement of parents in their young children's rehabilitation. This is especially important with increasing evidence for early, activity‐based interventions for young children with CP. [ABSTRACT FROM AUTHOR]

Background For children with hemiplegic cerebral palsy (HCP), rehabilitation aims to increase movement of the affected arm. However, no validated measure objectively examines this construct in pediatric practice or daily life. Objective The objective of this study was to evaluate the criterion and known-groups validity of accelerometry as a measure of arm movement in children and adolescents with HCP. Design This was a prospective cross-sectional study. Methods Twenty-seven children and adolescents with typical development (3.4–13.9 years old) and 11 children and adolescents with HCP (4.7–14.7 years old; Manual Ability Classification System rating I or II) wore accelerometers on their wrists while engaged in 20 minutes of play, which included intermittent intervals of stillness and vigorous movement of the arms. Vector magnitude (VM) values identified the presence (VM > 2.0 counts per epoch) and absence (VM ≤ 2.0 counts per epoch) of arm movement for every 2-second epoch. Video was simultaneously recorded; each 2-second interval of footage was scored as "movement" or "no movement" for each arm. Results Agreement between accelerometry and video observation was greater than or equal to 81%, and the prevalence-adjusted and bias-adjusted κ value was greater than or equal to 0.69 for both groups of participants; these results supported the criterion validity of accelerometry. The ratio of nondominant arm movement to dominant arm movement measured by accelerometry was significantly greater in participants with typical development (mean [SD] = 0.87 [0.09]) than in participants with HCP (mean = 0.78 [0.07]) on the basis of 10 age- and sex-matched pairs; these results supported known-groups validity. Limitations The small sample size of the group with HCP prevented the stratification of data by age. Participants with HCP had high or moderately high function of the affected arm; hence, the findings do not apply to children and adolescents with more significant hemiparesis. Conclusions Accelerometry is a valid measure of arm movement in children with HCP and children without HCP. These findings contribute to the development of innovative upper limb assessments for children with hemiparesis. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effectiveness and feasibility (i.e. tolerability, adherence) of functional electrical stimulation (FES) for the upper extremity (UE) in a two-year-old child with perinatal stroke.Methods: Forty hours of FES over eight weeks was prescribed. FES to the hemiplegic triceps, extensor carpi radialis longus and brevis, extensor carpi ulnaris and extensor digitorum was timed with reaching during play. Assessments were performed before, during, and two months post-intervention. UE function (Melbourne Assessment 2 (MA2), Assisting Hand Assessment (AHA)) and spasticity (Modified Tardieu with electrogoniometry and electromyography) were measured. The mother completed a semi-structured interview post-intervention. Descriptive statistics were used for adherence and UE measures. A repeated-measures ANOVA compared Modified Tardieu parameters (e.g. catch angle) over time. Conventional content analysis was used for the interview data.Results: The child completed 39.2/40 hours. Immediately post-intervention, improvements were observed on MA2's Range of Motion subscale and catch angle (Modified Tardieu,p< 0.001). Two months post-intervention, improvements were observed on MA2's Accuracy and Fluency subscales. No change in AHA score occurred. Three themes emerged from the interview: (1) Ingredients for program success; (2) Information about the FES device; and (3) The child's response.Conclusions: UE FES was feasible in a two-year-old child with hemiplegia. [ABSTRACT FROM AUTHOR]

Background. Development of motor pathways is modulated by activity in these pathways, when they are maturing (ie, critical period). Perinatal stroke injures motor pathways, including the corticospinal tracts, reducing their activity and impairing motor function. Current intervention for the lower limb emphasizes passive approaches (stretching, braces, botulinum toxin injections). The study hypothesis was that intensive, early, child-initiated activity during the critical period will enhance connectivity of motor pathways to the legs and improve motor function. Objective. The study objective was to determine whether early intervention with intensive activity is better than standard care, intervention delivered during the proposed critical period is better than after, and the outcomes are different when the intervention is delivered by a physical therapist in an institution vs. a parent at home. Design. A prospective, delay-group, single-blind, randomized controlled trial (RCT) and a parallel, cohort study of children living beyond commuting distance and receiving an intervention delivered by their parent. Setting. The RCT intervention was provided in university laboratories, and parent training was provided in the childs home. Participants. Children 8 months to 3 years old with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. Intervention. Intensive, play-based leg activity with weights for the affected leg and foot, 1 hour/day, 4 days/week for 12 weeks. Measurements. The primary outcome was the Gross Motor Function Measure-66 score. Secondary outcomes were motion analysis of walking, full-day step counts, motor evoked potentials from transcranial magnetic stimulation, and patellar tendon reflexes. Limitations. Inter-individual heterogeneity in the severity of the stroke and behavioral differences are substantial but measurable. Differences in intervention delivery and assessment scoring are minimized by standardization and training. Conclusions. The intervention, contrary to current practice, could change physical therapy interventions for children with perinatal stroke. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the responsiveness of the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP) after spinal cord injury (SCI). The study compared the responsiveness of the SCI-FAP with that of the 10-Meter Walk Test (10MWT) and the Six-Minute Walk Test (6MWT). It also calculated the minimal detectable change. Results showed improvement in SCI-FAP scores with both interventions.

Background. It is unclear which individuals with incomplete spinal cord injury best respond to body-weight-supported treadmill training. Objective. The purpose of this study was to determine the factors that predict whether a person with motor incomplete spinal cord injury will respond to bodyweight- supported treadmill training. Design. This was a prognostic study with a one-group pretest-posttest design. Methods. Demographic, clinical, and electrophysiological measurements taken prior to training were examined to determine which measures best predicted improvements in walking speed in 19 individuals with chronic (>7 months postinjury), motor-incomplete spinal cord injuries (ASIA Impairment Scale categories C and D, levels C1-L1). Results. Two initial measures correlated significantly with improvements in walking speed: (1) the ability to volitionally contract a muscle, as measured by the lower-extremity manual muscle test (LE MMT) (r=.72), and (2) the peak locomotor electromyographic (EMG) amplitude in the legs (r=.56). None of the demographics (time since injury, age, body mass index) were significantly related to improvements in walking speed, nor was the clinical measure of balance (Berg Balance Scale). Further analysis of LE MMT scores showed 4 key muscle groups were significantly related to improvements in walking speed: knee extensors, knee flexors, ankle plantar flexors, and hip abductors (r=.82). Prediction using the summed MMT scores from those muscles and peak EMG amplitude in a multivariable regression indicated that peak locomotor EMG amplitude did not add significantly to the prediction provided by the LE MMT alone. Change in total LE MMT scores from the beginning to the end of training was not correlated with a change in walking speed over the same period. Limitations. The sample size was limited, so the results should be considered exploratory. Conclusions. The results suggest that preserved muscle strength in the legs after incomplete spinal cord injury, as measured by MMT, allows for improvements in walking speed induced by locomotor training. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]