A Goal Oriented Physical Therapy in Rett Syndrome: A Single Case Study
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Abstract:
Introduction: Rett Syndrome is a serious and global developmental disorder that affects the central nervous system. The course of this syndrome is in 4 stages. Till date, there is no cure for Rett Syndrome, so rather than addressing the syndrome as a whole, most treatments try to alleviate specific symptoms.
Materials and Methods: For the evaluation of tightness, popliteal angle and adductor angle was measured. For gross motor developmental milestones, Gross Motor Function Measure (GMFM)-88 was used. After the evaluation, goal oriented Physical Therapy was given for 45 minutes per day for 5 days per week for 6 weeks. After 6 weeks, post-intervention assessment was done using same measures.
Results: After intervention, both popliteal angle on right & left side and adductor angle was increased. The improvement was seen in scores of Gross Motor Function Measure (GMFM)-88 Dimension B, C, D and E those are Sitting, Crawling, Kneeling, Standing, Walking, Running and Jumping Component. Also the total score of Gross Motor Function Measure (GMFM)-88 was improved.
Conclusion: Physical Therapy helps the children withKeywords:
Rett Syndrome
Gross motor skill
Sitting
Squatting position
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Aim The aim of this study is to evaluate the long‐term effects of selective dorsal rhizotomy ( SDR ), 15 to 20 years after surgery in patients with cerebral palsy. Method Eighteen children (four females, 14 males; mean age at SDR 4y 7mo, SD 1y 7mo) with bilateral spastic cerebral palsy ( CP ), were prospectively assessed after SDR . This study focuses on the outcome 15 to 20 years after the procedure. The assessments include the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure ( GMFM ‐88), the Wilson Mobility Scale, The Health‐Related Quality of Life Health Survey, SF ‐36v2, and the Brief Pain Inventory. Results The effect of normalized muscle tone in lower extremities after SDR was sustained after a median of 17 years. The best gross motor function capacity, according to the GMFM score, was seen at the 3‐year follow‐up, thereafter a gradual decline followed. Half of the individuals reported low intensity pain and interference. Compared to a norm sample the physical health component of SF ‐36v2 was slightly lower and the mental health component slightly higher. Interpretation The spasticity‐reducing effect of SDR does not improve long‐term functioning, nor prevent contractures, but it can possibly reduce the pain often experienced by individuals with CP .
Rhizotomy
Muscle tone
Modified Ashworth scale
Spastic cerebral palsy
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The effects of recreational horseback riding therapy (HBRT) on gross motor function in children with cerebral palsy (CP: spastic diplegia, spastic quadriplegia, and spastic hemiplegia) were determined in a blinded study using the Gross Motor Function Measure (GMFM). Seventeen participants (nine females, eight males; mean age 9 years 10 months, SE 10 months) served as their own control. Their mean Gross Motor Function Classification System score was 2.7 (SD 0.4; range 1 to 5). HBRT was 1 hour per week for three riding sessions of 6 weeks per session (18 weeks). GMFM was determined every 6 weeks: pre-riding control period, onset of HBRT, every 6 weeks during HBRT for 18 weeks, and 6 weeks following HBRT. GMFM did not change during pre-riding control period. GMFM Total Score (Dimensions A-E) increased 7.6% (p<0.04) after 18 weeks, returning to control level 6 weeks following HBRT. GMFM Dimension E (Walking, Running, and Jumping) increased 8.7% after 12 weeks (p<0.02), 8.5% after 18 weeks (p<0.03), and remained elevated at 1.8% 6 weeks following HBRT (p<0.03). This suggests that HBRT may improve gross motor function in children with CP, which may reduce the degree of motor disability. Larger studies are needed to investigate this further, especially in children. with more severe disabilities. Horseback riding should be considered for sports therapy in children with CP.
Horseback riding
Gross motor skill
Spastic diplegia
Spastic quadriplegia
Spastic cerebral palsy
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Objective To explore the effect of core strength training on rehabilitation of cerebral palsy.Methods Forty cases of cerebral palsy patients were randomly divided into two groups,each of 20 patients,the control group was given routine rehabilitation therapy,the experiment group was given core strength training therapy.Evaluated the effect of two groups before and after treatment according to the gross motor function measure(GMFM-88).Results After three months training therapy,the scores of GMFM of two groups were higher than scores before treatment,the effect of experiment group was better than control group,difference had statistics meaning(P0.05).The total effective rate of experiment group after treatment was higher than control group,difference had statistics meaning(P0.05).Conclusion The core strength training can improve trunk and pelvic control ability of children and gross motor function,it promote the development of movement and balance ability and rehabilitation of patients,achieve good clinical effect.
Core stability
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Objective To investigate the effect of muscle spasticity therapeutic apparatus on spastic cerebral palsy(CP) in children.Methods Twenty-two spastic CP children aged from 2 to 4 years old were randomly divided into treatment group and control group with 11 cases in each group.All children were treated with physical therapy,massage and cerebral circulation therapy,while those of treatment group were added with muscle spasticity therapeutic apparatus.It lasted for 30 days with one time daily,15 minutes each time.All children were evaluated in terms of tests of the muscle tone of the lower limb by Modified Ashworth Scale(MAS),passive range of motion(PROM) of the popliteal angle,D and E dimensions of gross motor function measure score-88(GMFM-88),and the composite spasticity scale(CSS) at the start and after 30 days.Results No statistically significant differences were found in clinical assessments(the popliteal angle,CSS,GMFM-88)before treatment between 2 groups(Pa0.05).MAS and CSS of the lower extremity muscle tone of all children in 2 groups were decreased 30 days after treatment(Pa0.05).There were significant improvements of the popliteal angle,section D,E of the GMFM-88 for variation in treating period(Pa0.05).Conclusions Muscle spasticity therapeutic apparatus decreases the muscle tone of the children and improves gross motor function and range of motion in spastic CP,so it can be an effective therapeutic technique in children with spastic CP.
Muscle tone
Modified Ashworth scale
Spastic cerebral palsy
Therapeutic effect
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Gross motor skill
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Object The primary aim of this prospective cohort study was to evaluate the short-term (1 year) and long-term (mean 6 years) effects of selective dorsal rhizotomy (SDR) on gross motor function and spasticity in ambulatory children with spastic diplegia. Secondary aims were to investigate side effects, additional treatment during follow-up (botulinum toxin type A injections or orthopedic surgery), and parental satisfaction. Methods Thirty-three children who had undergone SDR at a mean age of 6 years and 7 months (± 2 years) were included. There were 7 children at Gross Motor Function Classification System (GMFCS) Level I, 7 at Level II, and 19 at Level III. Gross motor function was assessed with the Gross Motor Function Measure–66 (GMFM-66). Spasticity was measured according to a modified Tardieu scale. Side effects, additional treatment, and parental satisfaction were recorded using a parental questionnaire and medical records. Results At 1-year follow-up, mean GMFM-66 scores improved significantly by 4.3 ± 4.1 points. Children at GMFCS Levels I and II showed significantly more improvement (7.2 points) on the GMFM-66 compared with children at GMFCS Level III (2.9 points). On long-term follow-up (mean 6 years ± 22 months), mean GMFM-66 scores improved significantly by 6.5 ± 5.9 points, without a difference between children at GMFCS Levels I and II and Level III. No relapse of spasticity was noted. Ten children (30%) needed orthopedic surgery and 13 children (39%) received botulinum toxin type A treatment after SDR. Twenty (91%) of the 22 parents who answered the questionnaire at long-term follow-up believed that their child's functioning had improved after SDR. Conclusions Selective dorsal rhizotomy resulted in short- and long-term improvements in gross motor function, without relapse of spasticity. However, the majority of the children still needed additional surgery or botulinum toxin A treatment.
Rhizotomy
Spastic diplegia
Gross motor skill
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Objective: To verify whether hippotherapy once or twice a week has a different effect on gross motor function and functional performance in children with cerebral palsy. Methods: This trial had 20 children (age 2 to 5 years and 11 months) with cerebral palsy who were assigned to the groups once a week (n = 9) or twice a week (n = 11) and underwent 30-minute hippotherapy sessions for 16 weeks. The instruments used were the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI), assessed at baseline and after 16 weeks. Results: A significant time effect was observed for both groups without significant interactions between groups. Conclusions: Hippotherapy improved the gross motor function and functional performance of children with cerebral palsy, regardless of the weekly frequency of the sessions. This result has relevant clinical implications, since hippotherapy has a high cost and the prescription of weekly sessions could make this treatment more available for this population.
Key-words: Equine-assisted therapy, Cerebral Palsy, Heavy Motor Function, Functional Performance
Gross motor skill
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Introduction : The Bobath`s Concept main principles are specific preparation for goals, use of concepts of motor control and motor learning with active participation of the patients , functional goals and practice, emphasis on quality of movements and individually planned treatment. Key points of control are used to influence postures and movements. Purpose: To evaluate the motor improvement in the group of patients who were treated in a Bobath Course and to see if this improvement is more significant than another group of patients who were treated by therapists who were not Bobath trained. Subjects: 16 subjects age 1 year and 4 months to 7 years and 8 months, mean age 4 years. The control group (N=8) and experimental group (N=8) were matched for age, quality of tonus (spasticity or atetose), level of GMFCS (Gross Motor Functional Classification System), initial score of GMFM (Gross Motor Function Measure). Methods: Controlled trial. The experimental group was treated in a Basic Bobath course and control group continued to receive the same classical treatment they were receiving before the assessment. For both groups only physiotherapy treatment hours (10 hours + or ? 1) were computed because the main point of this study was the gross motor function. The method of assessment was GMFM-66 that was applied just before the beginning of the treatment at Bobath course for the experimental group and after 10 hours (+or-1) of physiotherapy treatment. In the control group the GMFM was applied and the next session started to count the 10 hours (+or-1) of classical Physiotherapy treatment and the patients were regularly being treated, as established. Analysis: t of Student Test was used. Results: GMFM detected gross motor functional changes showing t=2,36 and p = 0,03 for the experimental group. Conclusions: The experimental group had a more statistical significant improvement in motor gross function than the control group. For other studies we planned a larger sample as well as the study of the difference of evolution between spastic and athetosic patients using GMFM assessment. They seem to be different.
Gross motor skill
Motor Control
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to investigate feasibility, safety and efficacy of home-based side-alternating whole body vibration (sWBV) to improve motor function in toddlers with cerebral palsy (CP).Randomized controlled trial including 24 toddlers with CP (mean age 19 months (SD±3.1); 13 boys).14 weeks sWBV with ten 9-minute sessions weekly (non-individualized). Group A started with sWBV, followed by 14 weeks without; in group B this order was reversed. Feasibility (≥70% adherence) and adverse events were recorded; efficacy evaluated with the Gross Motor Function Measure (GMFM-66), Pediatric Evaluation of Disability Inventory (PEDI), at baseline (T0), 14 (T1) and 28 weeks (T2).Developmental change between T0 and T1 was similar in both groups; change scores in group A and B: GMFM-66 2.4 (SD±2.1) and 3.3 (SD±2.9) (p=0.412); PEDI mobility 8.4 (SD±6.6) and 3.5 (SD±9.2) (p=0.148), respectively. In two children muscle tone increased post-sWBV. 24 children received between 67 and 140 sWBV sessions, rate of completed sessions ranged from 48 to 100% and no dropouts were observed.A 14-week home-based sWBV intervention was feasible and safe in toddlers with CP, but was not associated with improvement in gross motor function.
Muscle tone
Whole body vibration
Gross motor skill
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Objective To investigate the effect of acupuncture plus exercise therapy for treating gross motor function in children with cerebral palsy( CP). Methods Sixty children with CP were approximately divided into control group and observation group according to age,clinical manifestation and diagnosis classification,thirty cases in each group. The patients in observation group was treated by acupuncture plus exercise therapy,while the patients in control group only treated by exercise therapy. Curative effect which was estimated by gross motor function measure( GMFM-88) was compared four months after treatment. Results After treatment,the overall percentage of GMFM-88 in the two groups was significantly higher than that before treatment( P 0. 01). After treatment,the improvement of GMFM-88 and the scores of dimension sore( B,D) which were tightly tied to sitting and standing of observation group were better than those of control group( P 0. 01). Conclusion Acupuncture plus exercise therapy can significantly improve the gross motor function of children with CP,and the curative effect is better than the pure exercise therapy,especially in improving the sitting and standing ability more effectively.
Sitting
Gross motor skill
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