Task-Oriented Training for Children with Hemiplegia

Task-Oriented Training for Children with Hemiplegia

The Journal of Physical Therapy published research on task-oriented training for children with hemiplegia.  The researchers investigated the effects of task-oriented training (TOT) on hand dexterity and strength in 12 children with spastic hemiplegic cerebral palsy.  Six children were assigned to the experimental group who received the task-oriented training for 20 minutes of a 60-minute conventional occupational therapy session.  The other six children served as the control group and received 60 minutes of conventional occupational therapy.

The task-oriented training sessions consisted of activities such as repeated reaching, ring activity, and stacking cup to catch the target using the involved hand with therapist feedback provided.  Following 4 weeks of 2 sessions per week, the following results were seen from dynamometer testing and the Box and Block Test (number of blocks moved from one box to another in one minute):

• the task-oriented group showed a significant improvement in hand dexterity but not in strength
• the control group did not show a significant improvement in hand dexterity or strength

The researchers recommend further research with a larger sample size and to determine any long-term effects.

Reference:  Moon, J. H., Jung, J. H., Hahm, S. C., & Cho, H. Y. (2017). The effects of task-oriented training on hand dexterity and strength in children with spastic hemiplegic cerebral palsy: a preliminary study. Journal of physical therapy science, 29(10), 1800-1802.

Therapeutic Play Activities for Children– Do you work with young children with cerebral palsy, autism spectrum disorders, developmental disabilities or delays? Are you in search of new, creative ideas for your therapy sessions? Do you need home exercise program sheets to encourage carryover of therapeutic activities? Do you need simple ideas that use materials that you have around your house, therapy room or classroom already? Do you work with children who receive constraint or bimanual therapy? Therapeutic Play Activities for Children includes 100 play activity sheets with a photo of the activity, purpose of each activity and materials list. The 12 tip sheets include topics such as modifications, peer interaction, guided play, prompts and several specifically for children with cerebral palsy. FIND OUT MORE INFORMATION.

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Young People’s Attitudes About Standing Frames

Young People’s Attitudes About Standing Frames

As therapists, we frequently recommend standing frames for children with cerebral palsy or other developmental disorders.  A question to ask yourself is do you frequently check for ease and comfort of use with the client? This is a question that needs to be asked over and over again. Children grow and change so rapidly. Comfort and ease of use for any device (be it a computer, stander, wheelchair, adapted toilet, etc) needs to be constantly assessed.

Child: Care, Health and Development published research on a semistructured interview with 12 young people with cerebral palsy regarding the positive and negative experiences regarding standing frame use.  The interviews revealed that some young people:

• reported that although standing frames can be painful, it should be endured to improve their body structure and function.
• feel excluded from their peers, and others feeling as though standing frames helped them “fit in.”
• are not offered a choice about how and when they use their standing frame.
• that there are challenges to standing frame use such as manual handling, interference from siblings, and the lack of aesthetically pleasing standing frame designs.

The researchers recommend an exploration of each young person’s personal goals and experiences as well as therapeutic outcomes is necessary when prescribing standing frames.

Remember not to just ask the parent, teacher or caregiver but check with the clients themselves.

Reference:  Goodwin, J., Lecouturier, J., Crombie, S., Smith, J., Basu, A., Colver, A., … & Roberts, A. (2017). Understanding frames: A qualitative study of young people’s experiences of using standing frames as part of postural management for cerebral palsy. Child: Care, Health and Development.

Read more on standing frames:

Dosing for Standing Programs

Standing Program and Cerebral Palsy

Effects of Standing Programs on Walking in Children with Cerebral Palsy

More resources for children with cerebral palsy:

Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders: The ELECTRONIC version of Teaching Motor Skills is a must-have reference for all therapists who work with children with cerebral palsy.   Whether you are a beginner or experienced therapist you will find the information concise, informative and very helpful to carry out everyday functional tasks including stretching with children with cerebral palsy. The book provides activity suggestions throughout the developmental sequence such as head control, tummy time, sitting, transitions, walking and beyond.  There is also great information that reviews additional interventions for children with cerebral palsy such as bracing, surgical and medical management.  The author, Sieglinde Martin, is an experienced PT and a mother of a child with cerebral palsy. FIND OUT MORE.

Therapeutic Play Activities for Children digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy.  FIND OUT MORE INFORMATION.

 

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Less Affected Hand in Unilateral Cerebral Palsy

Less Affected Hand in Unilateral Cerebral Palsy

When working with children who have hemiplegia, do you address the less affected hand in unilateral cerebral palsy?  Or do you assume that the less affected hand is within normal limits for typical child development?  Sometimes, the difference between the hands, gives the impression that the less affected hand is functional and age appropriate but in reality, there may be decreased function in both hands.

Neurorehabilitation and Neural Repair published research to compare hand function in 47 children, by timed motor performance on the Jebsen-Taylor Test of Hand Function (JTTHF) and grip strength of children with unilateral cerebral palsy to children with typical development.  Each participant was evaluated for baseline hand skills and single-pulse transcranial magnetic stimulation testing to assess corticospinal tract and motor threshold.

The results indicated the following:

• the mean difference of the less-affected hand of children with unilateral cerebral palsy to the dominant hand of children of typical development the JTTHF was 21.4 seconds.
• the mean difference in grip strength was −30.8 N
• resting motor thresholds between groups were not significant.
• age was significantly associated with resting motor threshold.

Regarding the single-pulse transcranial magnetic stimulation testing:

• children with unilateral cerebral palsy ipsilateral pattern of motor representation demonstrated greater mean differences between hands than children with contralateral pattern of motor representation.

The typical pattern is a contralateral motor pattern where the motor-evoked potential response is in the more-affected hand following stimulation of the contralateral, lesioned hemisphere.  An ipsilateral motor pattern describes an absent motor evoked potential response in the more-affected hand following stimulation of the lesioned hemisphere and a present motor-evoked response in the more-affected hand following stimulation of the nonlesioned hemisphere.

Overall, deficits in speed and strength of the less-affected hand in children with unilateral cerebral palsy were observed when compared to the dominant hand of typically developing peers.

The researchers concluded that the less-affected hand in children with unilateral cerebral palsy underperformed the dominant hand of children with typical development. The less affected hand should be assessed and intervene if necessary during rehabilitation.  Future research should focus on bilateral hand function.

Reference: Rich, T. L., Menk, J. S., Rudser, K. D., Feyma, T., & Gillick, B. T. (2017). Less-Affected Hand Function in Children With Hemiparetic Unilateral Cerebral Palsy: A Comparison Study With Typically Developing Peers. Neurorehabilitation and Neural Repair, 1545968317739997.

Therapeutic Play Activities for Children– Do you work with young children with cerebral palsy, autism spectrum disorders, developmental disabilities or delays? Are you in search of new, creative ideas for your therapy sessions? Do you need home exercise program sheets to encourage carryover of therapeutic activities? Do you need simple ideas that use materials that you have around your house, therapy room or classroom already? Do you work with children who receive constraint or bimanual therapy? Therapeutic Play Activities for Children includes 100 play activity sheets with a photo of the activity, purpose of each activity and materials list. The 12 tip sheets include topics such as modifications, peer interaction, guided play, prompts and several specifically for children with cerebral palsy. FIND OUT MORE INFORMATION.

 

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Motor Planning and Cerebral Palsy

Motor Planning and Cerebral Palsy

The Journal of Clinical and Experimental Neuropsychology recently published longitudinal research on motor planning and cerebral palsy.  Motor planning is the ability to plan out all the steps required for a motor action and carry out each step in the correct order.  It is important to have efficient motor planning to produce coordinated movements.  The researchers defined motor planning as “selecting a single pattern of behavior from many alternatives that allows the performer to achieve a task goal”.  This study included 22 children with cerebral palsy and 22 age-matched controls.   Each participant performed a bar transport task in which some conditions (“critical angles”) required participants to sacrifice initial posture comfort in order to achieve end-state comfort.  The longitudinal study was carried out with three measurements each separated by one year.  The following results were reported:

• children with CP showed poor end-state planning for critical angles.
• unlike in controls, motor planning ability did not improve across the three measurement occasions in children with CP.

The researchers concluded that children with cerebral palsy may have motor planning deficits that do not resolve with development over childhood.

Suggested Strategies for Intervention

Some research suggests that children with cerebral palsy may improve motor planning skills through training due to plasticity in the brain.  Current training for motor planning includes physical training and environmental stimulation.  New research with adults following brain injury and children with congenital motor disorders indicated two beneficial types of motor planning training:

1. Motor Imagery – internal rehearsal of a future motor action without overt motor output.  Motor imagery requires the conscious activation of brain regions that are also involved in the actual movement preparation and execution.
2. Action Observation – observation of the action performed by someone.

Deficits in motor planning in children with cerebral palsy do not appear to resolve throughout development.  Researchers suggest physical training, environmental stimulation, motor imagery and action observation to help with motor planning and cerebral palsy.

Reference: Lust, J. M., Spruijt, S., Wilson, P. H., & Steenbergen, B. (2017). Motor planning in children with cerebral palsy: A longitudinal perspective. Journal of Clinical and Experimental Neuropsychology, 1-8.

Go here for more blog posts on motor planning.

Therapeutic Play Activities for Children

Therapeutic Play Activities for Children digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy.  FIND OUT MORE INFORMATION.

 

Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders: The ELECTRONIC version of Teaching Motor Skills is a must-have reference for all therapists who work with children with cerebral palsy.   Whether you are a beginner or experienced therapist you will find the information concise, informative and very helpful to carry out everyday functional tasks including stretching with children with cerebral palsy. The book provides activity suggestions throughout the developmental sequence such as head control, tummy time, sitting, transitions, walking and beyond.  There is also great information that reviews additional interventions for children with cerebral palsy such as bracing, surgical and medical management.  The author, Sieglinde Martin, is an experienced PT and a mother of a child with cerebral palsy. FIND OUT MORE.

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Research Review on CIMT and Bimanual Therapy for Children with Cerebral Palsy

Research Review on CIMT and Bimanual Therapy for Children with Cerebral Palsy

Pediatric Physical Therapy published a systematic review comparing modified constraint-induced movement therapy (CIMT) and intensive bimanual therapy in upper limb function in children with unilateral cerebral palsy.  After searching 4 electronic databases from 2009-2015, eight articles met the inclusion criteria with a total of 221 participants who received either intensive bimanual therapy or modified CIMT.

The results indicated the following:

• both intensive bimanual therapy and modified CIMT improved quality of unimanual movement, bimanual capacity, and movement efficiency.
• a weak, specific recommendation for intensive bimanual therapy in improving movement quality
• a specific but weak recommendation favoring intensive bimanual therapy to improve the child’s performance on parent-reported outcomes.

Reference:  Klepper, S. E., Krasinski, D. C., Gilb, M. C., & Khalil, N. (2017). Comparing Unimanual and Bimanual Training in Upper Extremity Function in Children With Unilateral Cerebral Palsy. Pediatric Physical Therapy, 29(4), 288-306.

Read more about unilateral cerebral palsy:

Motor Learning in Children with Unilateral Cerebral Palsy

Goal-Directed OT Programs for Unilateral Cerebral Palsy

Tactile Function of Children with Cerebral Palsy

CIMT, Bimanual Therapy, and OT Home Programs

Therapeutic Play Activities for Children digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy.  FIND OUT MORE INFORMATION.

 

 

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Functional Power Training Program for Children with Cerebral Palsy

Functional Power Training Program for Children with Cerebral Palsy

Did you know that 60-70% of ambulatory children with spastic cerebral palsy are integrated into their community, schools and recreational activities?  These children strive to participate in the same activities as their typical developing friends and peers. It can be very difficult though due to decreased walking speed and muscle strength especially in the distal musculature which is crucial for the push off phase of walking. Previous research indicates that progressive resistance exercises in children with cerebral palsy do increase muscle strength in the lower extremities but this increase in strength does not improve their walking capacity.

Neurorehabilitation and Neural Repair recently published research on a functional power-training program that consists of loaded functional exercises, such as walking, running, and climbing stairs, performed at high movement velocities with a focus on strengthening the plantar muscles in order to improve walking capacity in children with CP. The participants included 22 children with spastic cerebral palsy, GMFCS Level I and II who completed a 14-week functional power training program in groups 3x/week. To determine effectiveness, the muscle power sprint test, 1-minute walk test, 10-m shuttle run test, gross motor function (GMFM-66), isometric strength of lower-limb muscles and dynamic ankle plantar flexor strength were completed.

The results indicated the following:

• changes during the training period were significantly larger than changes in the usual care period for all outcome measures.
• large improvements were found during the training period for walking capacity and muscle strength.

The researchers concluded that functional power-training is an effective training for improving walking capacity in young children with cerebral palsy.

Reference:  van Vulpen, L. F., de Groot, S., Rameckers, E., Becher, J. G., & Dallmeijer, A. J. (2017). Improved Walking Capacity and Muscle Strength After Functional Power-Training in Young Children With Cerebral Palsy. Neurorehabilitation and Neural Repair, 1545968317723750.

Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders: The ELECTRONIC version of Teaching Motor Skills is a must-have reference for all therapists who work with children with cerebral palsy.   Whether you are a beginner or experienced therapist you will find the information concise, informative and very helpful to carry out everyday functional tasks including stretching with children with cerebral palsy. The book provides activity suggestions throughout the developmental sequence such as head control, tummy time, sitting, transitions, walking and beyond.  There is also great information that reviews additional interventions for children with cerebral palsy such as bracing, surgical and medical management.  The author, Sieglinde Martin, is an experienced PT and a mother of a child with cerebral palsy. FIND OUT MORE.

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Motor Learning in Children with Unilateral Cerebral Palsy

Motor Learning in Children with Unilateral Cerebral Palsy

Disability and Rehabilitation published research to examine explicit and implicit learning in children with unilateral cerebral palsy.  The study compared the motor learning of children with left and right unilateral cerebral palsy and typically developing children while they shuffled disks toward a target using a prism-adaptation design.  Each trial consisted of pre-exposure, prism exposure, and post-exposure phases with half of the participants being instructed about the function of the prism glasses while the other half were not.

To measure motor learning, the distance between the target and the shuffled disk was measured.  Explicit and implicit motor learning was determined using the prism adaptation design.  Prism adaptation is when the motor system adapts to new visuospatial coordinates imposed by prisms that displace the visual field. Once the prisms are withdrawn, the degree and strength of the adaptation can be measured by the spatial deviation of the motor actions in the direction opposite to the visual displacement imposed by the prisms, a phenomenon known as after effect.

The results indicated the following:

• no significant effects were revealed between typically developing participants and participants with unilateral cerebral palsy.
• participants with right unilateral cerebral palsy had a significantly lower rate of adaptation than participants with left unilateral cerebral palsy, but only when no instructions were provided.
• the magnitude of the negative after-effects did not differ significantly between participants with right and left unilateral cerebral palsy.

The researchers concluded that the capacity for explicit motor learning is reduced among individuals with right unilateral cerebral palsy when the accumulation of declarative knowledge is unguided (i.e., discovery learning).  It was recommended to use implicit motor learning interventions for individuals with cerebral palsy, especially for children with right unilateral cerebral palsy.  When using explicit motor learning interventions use singular verbal instruction.

References:

Fernández-Ruiz, J., & Díaz, R. (1999). Prism adaptation and aftereffect: specifying the properties of a procedural memory system. Learning & Memory, 6(1), 47-53.

van der Kamp, J., Steenbergen, B., & Masters, R. S. (2017). Explicit and implicit motor learning in children with unilateral cerebral palsy. Disability and Rehabilitation, 1-8.

Therapeutic Play Activities for Children digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy.  FIND OUT MORE INFORMATION.

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AFOs, Walking and Cerebral Palsy

The Annals of Physical Medicine and Rehabilitation published a systemic review on ankle foot orthotics AFOs, walking and cerebral palsy. The purpose of the study was to complete a systematic review of the literature to determine if AFOs produce a more normal gait pattern by positioning joints in the proper position to reduce pathological reflex or spasticity in children with cerebral palsy.

An article search was performed from 2007 to 2015 of studies of children with CP wearing the following AFOs: hinged (HAFO), solid (SAFO), floor reaction (FRO), posterior leaf spring (PLS) and dynamic (DAFO) to determine if there was a change in gait pattern and walking ability.

Seventeen studies were included with a total of 1139 children with CP. The PEDro score was poor for most studies (3/10) with only 4 randomized controlled studies with an appropriate level of evidence.

The results indicated the following:

• overall the use of AFOs improved speed and stride length.
• the HAFO was effective for improving stride length, speed of walking, single limb support and gait symmetry and decreasing energy expenditure with hemiplegic CP as compared with the barefoot condition.
• the plastic SAFO and FRO were effective in reducing energy expenditure with diplegic CP.
• for children with diplegic CP, the HAFO and SAFO improved gross motor function.

The researchers concluded that for children with hemiplegic CP, certain AFOs improved gait parameters, including ankle and knee range of motion, walking speed and stride length. AFOs reduced energy expenditure in children with spastic and hemiplegic CP. The researchers recommend further studies with improved PEDro scores for more conclusive evidence regarding the effectiveness of AFOs in children with CP.

Reference:  Aboutorabi, A., Arazpour, M., Bani, M. A., Saeedi, H., & Head, J. S. (2017). Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review. Annals of Physical and Rehabilitation Medicine.

Therapeutic Play Activities for Children digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy.  FIND OUT MORE INFORMATION.

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Feeding Difficulties and Children with Cerebral Palsy

Children with cerebral palsy may present with feeding difficulties which have an effect on growth, nutrition, general health and social interaction.  These feeding difficulties in children with cerebral palsy include issues such as choking, feeding time greater than 3 hours per day, frequent vomiting and and difficulties with chewing.  One protocol that has been created to help with difficulties chewing is the Functional Chewing Training.   The Functional Chewing Training was created to improve chewing function by providing postural alignment, sensory and motor training, and food and environmental modifications.

The Functional Chewing Training includes 5 steps to address feeding difficulties in children with cerebral palsy:

Step 1:  Positioning the child. A proper head and trunk control is crucial to facilitate smooth chin and lip closure and encourage
tongue movement.   For Functional Chewing Training the child is placed in a sitting position with the body tilted 60–90° tilted and head in neutral position, with the arms and legs supported.  Read more on postural control and mealtime here.
Step 2: Positioning the food.  The food is placed through corners of lips to the molar area during every feeding to help prevent abnormal reflexes.
Step 3:  Sensory stimulation of the upper and lower gums from the front teeth to molar area using massage helps to encourage lip closure, tongue lateralization and rotary chewing.  This helps to prevent tongue thrust, decrease tactile hypersensitivity and facilitate chewing function.
Step 4:  The chewing exercises are performed using a chewing tube placed in the molar area of the child.  The caregiver moves the tube from one side of the mouth to other side which the child completes the chewing exercises.
Step 5:  Adjustment of food consistency included increasing the food consistency gradually.

When a 12 week Functional Chewing Training program was completed in a double blind randomized group of 80 children with cerebral palsy who experienced feeding difficulties, the training program was shown to improve the chewing performance and mealtime functioning of children with cerebral palsy.

Additional research indicated that the Functional Chewing Training program is an effective approach on the severity of tongue thrust and drooling in children with cerebral palsy.

You can read the full article on Functional Chewing Training here.

References:

Inal, Ö., Serel Arslan, S., Demir, N., Yilmaz, Ö. T., & Karaduman, A. A. (2017). Effect of Functional Chewing Training on tongue thrust and drooling in children with cerebral palsy: A randomised controlled trial. Journal of Oral Rehabilitation.

Serel Arslan, S., Demir, N., & Karaduman, A. A. (2017). Effect of a new treatment protocol called Functional Chewing Training on chewing function in children with cerebral palsy: a double‐blind randomised controlled trial. Journal of oral rehabilitation, 44(1), 43-50.

Meal Time Rubrics include assessments for: finger feeding, using a spoon, using a fork, using a knife to cut, using a knife to spread, drinking from a cup, drinking with a straw, drinking from a water fountain, pouring liquids, cafeteria, meal preparation, cleaning up from meal, manners and independent feeding. The rubrics will be delivered electronically in PDF format and in a word processing format so that you can edit the document if necessary. This allows you to customize the rubric to your individual caseload if necessary.

Some suggested uses of Meal Time Rubrics are:

• assessment at initial evaluation and annual reviews
• progress reports
• establish entrance or exit criteria for therapy
• creating measurable goals

FIND OUT MORE ABOUT MEAL TIME RUBRICS AND DOWNLOAD A FREE SAMPLE RUBRIC.

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Trunk Control Measurement Scale for Children

The Trunk Control Measurement Scale is a clinical tool to measure trunk control in children with cerebral palsy.  Developmental Medicine and Child Neurology recently published research examining the reliability of the Trunk Control Measurement Scale (TCMS) with its subscores, in children with neuromotor disorders.  In addition, the discriminative validity of the TCMS was assessed by comparing the TCMS scores with the Functional Independence Measure for children.

The participants in the reliability study included 90 children, ranging in age from 5 years to almost 19 years old and 50 participated for the discriminative validity study. The results indicated the following:

• reliability was excellent.
• change in the TCMS total score of six points (10%) can be considered a true change.
• TCMS subscores appeared to be clinically relevant because children with less than around 80% of the static balance score, less than 55% of the dynamic reaching score, or less than around 35% of the selective movement control score needed support for daily life activities.

The researchers concluded that the TCMS is a reliable and clinically relevant assessment for children aged 5 years and older with different neurological impairments.

Click here to view the full Trunk Control Measurement Scale.

Reference:  Marsico, P., Mitteregger, E., Balzer, J., & Hedel, H. J. (2017). The Trunk Control Measurement Scale: reliability and discriminative validity in children and young people with neuromotor disorders. Developmental Medicine & Child Neurology, 59(7), 706-712.

If you need core strengthening activities for children check out:

The Core Strengthening Handbook:  This download includes 50+ activities including:

• Quick and Easy Core Strengthening Activities for Kids
• Core Strengthening Exercises With Equipment
• Core Strengthening Play Ideas

FIND OUT MORE.

The Core Strengthening Exercise Program: This digital download includes exercises to help make core strengthening fun and entertaining for kids while promoting carryover in the classroom and at home!  FIND OUT MORE.

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CIMT, Bimanual Therapy and OT Home Programs

CIMT, Bimanual Therapy and OT Home Programs: The British Journal of Occupational Therapy published a research review to determine how bimanual therapy and modified constraint induced movement therapy or constraint induced movement therapy (CIMT) methods are used for occupational therapy home programs.

A literature search was completed and 5 studies met the inclusion criteria.  The research review revealed the following:

• family collaboration, strategic use of outcome measures, construction of the program within the home environment and occupation-focused goals and activities were commonly used methods.
• enhanced descriptions of intervention context, getting the child’s input for goal development and challenges in occupational balance were considered gaps in the programs.

The researchers concluded that using bimanual therapy and CIMT in an OT home program requires the combination of motor and non-motor approaches, core OT skills and respect of family preferences.  They recommended that the child help in goal setting to improve participation.

Here are 4 suggestions when providing CIMT, bimanual therapy and OT home programs:

1. Encourage the child to participate in goal setting.
2. Suggest activities that match the child and family’s goals.
3. Demonstrate ways to grade the activity so that it is the just right challenge.
4. Create the home program in the child’s natural environment in the home i.e. use the child’s own toys or materials from around the house.
5. Use a variety of outcome measures to determine progress.

Reference:  Milton, Y., & Roe, S. (2016). Occupational therapy home programmes for children with unilateral cerebral palsy using bimanual and modified constraint induced movement therapies: A critical review. British Journal of Occupational Therapy, 0308022616664738.

Do you work with young children with cerebral palsy, autism spectrum disorders, developmental disabilities or delays?  Are you in search of new, creative ideas for your therapy sessions?  Do you need home exercise program sheets to encourage carry over of therapeutic activities? Do you need simple ideas that use materials that you have around your house, therapy room or classroom already?  Do you work with children who receive constraint or bimanual therapy?   Therapeutic Play Activities for Children includes 100 play activity sheets with a photo of the activity, purpose of each activity and materials list.  The 12 tip sheets include topics such as modifications, peer interaction, guided play, prompts and several specifically for children with cerebral palsy.   The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy. Find out more information.

The post CIMT, Bimanual Therapy and OT Home Programs appeared first on Your Therapy Source.

Effects of Stabilization Exercises on Balance in Children with Cerebral Palsy

The Journal of Physical Therapy Science published research examining  the effects of stabilization exercises on balance in children with cerebral palsy.  The participants included 11 school aged children diagnosed with cerebral palsy (GMFCS Levels I-III).

Each child engaged in stabilization exercises of neck and trunk twice per week for eight weeks with each treatment lasting for 45 minutes.  The treatment sessions included a warm-up exercises, neck and trunk stabilization exercises, postural control exercises and cool down exercises. The neck and trunk exercises involved:

1) lifting the head in a modified bridge exercise to activate the neck flexor muscles and the lower abdominal muscles simultaneously

2) pushing the neck backward in supine position to activate the erector muscles of the neck and the upper thoracic vertebrae through the extension of the muscles of the back of the neck

3) activation of the deep abdominal muscles in bridge exercise positions with a posterior inclined movement of the pelvis.

The Trunk Control Measurement Scale (TCMS) was used to evaluate the children’s trunk control ability.

After treatment, the Trunk Control Measurement Scale evaluation indicated that the exercise treatments had a significant effect on:

• static sitting balance
• selective movement control
• dynamic reaching
• total Trunk Control Measurement Scale scores

The researchers concluded that neck and trunk stabilization exercises that require children’s active participation are helpful for improving static and dynamic balance ability in children with cerebral palsy.

Reference: Shin, J. W., Song, G. B., & Ko, J. (2017). The effects of neck and trunk stabilization exercises on cerebral palsy children’s static and dynamic trunk balance: case series. Journal of Physical Therapy Science, 29(4), 771-774.

 

The Core Strengthening Handbook:  This download includes 50+ activities including:

• Quick and Easy Core Strengthening Activities for Kids
• Core Strengthening Exercises With Equipment
• Core Strengthening Play Ideas

Also includes information on why core strengthening is important and details about the core muscles.  FIND OUT MORE.

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CIMT and Bimanual Therapy are Complementary

The Journal of Pediatric Rehabilitation Medicine published research indicating that constraint-induced movement therapy (CIMT) and bimanual therapy for children with unilateral cerebral palsy are complementary.  Using literature and clinical insight, the authors discuss the evidence-based interventions that CIMT and bimanual therapy highlighting the time-limited, goal-directed, skills-based, intensive blocks of practice based on motor learning theory.   The authors determined the following:

• focusing on total dosage of practice for achieving positive outcomes fails to acknowledge the influence of other critical concepts within motor learning.
• limitations exist in the application of motor learning principles using CIMT due to its unimanual nature.
• CIMT is effective for development of unimanual actions generated by implicit learning, but it is hard to encourage explicit learning that is required for learning how to use two hands together.
• using bimanual therapy, object properties can be changed to trigger goal-related perceptual and cognitive processes required for children to learn to determine when two hands are required for task completion.

The authors concluded that CIMT and bimanual therapy are complementary using CIMT to focus on unimanual actions and progressing to bimanual therapy for children to learn how to use these actions for bimanual skill development.

Reference:  Hoare, B., & Greaves, S. (2017). Unimanual versus bimanual therapy in children with unilateral cerebral palsy: Same, same, but different. Journal of Pediatric Rehabilitation Medicine, 10(1), 47-59.

Do you work with young children with cerebral palsy, autism spectrum disorders, developmental disabilities or delays?  Are you in search of new, creative ideas for your therapy sessions?  Do you need home exercise program sheets to encourage carry over of therapeutic activities? Do you need simple ideas that use materials that you have around your house, therapy room or classroom already?  Do you work with children who receive constraint or bimanual therapy?   Therapeutic Play Activities for Children includes 100 play activity sheets with a photo of the activity, purpose of each activity and materials list.  The 12 tip sheets include topics such as modifications, peer interaction, guided play, prompts and several specifically for children with cerebral palsy.   The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy. Find out more information.

 

Read more blog posts about constraint-induced movement therapy for children with unilateral cerebral palsy.

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Speech Production and Constraint-Induced Movement Therapy

Recent research examined changes in speech skills of children who have hemiparesis and speech impairment after participation in a constraint-induced movement therapy (CIMT) program.  The participants in the study included 18 children with hemiparesis and co-occurring speech impairment who participated in a 21-day clinical CIMT program. The Goldman-Fristoe Test of Articulation-2 (GFTA-2) was used to evaluate children’s articulation of speech sounds before and after the intervention using changes in percent of consonants correct to measure speech production.  The results indicated the following:

• children with hemiparesis and speech impairment made significant gains in the percent of consonants correct following CIMT.
• gains were similar in children with left and right-sided hemiparesis, and across age groups.

The researchers concluded that due to the significant collateral gains in speech production following CIMT, the benefits of CIMT may also spread to speech motor domains.

Reference:  Allison, K. M., Reidy, T. G., Boyle, M., Naber, E., Carney, J., & Pidcock, F. S. (2017). Speech production gains following constraint-induced movement therapy in children with hemiparesis. Journal of Pediatric Rehabilitation Medicine, 10(1), 3-9.

Therapeutic Play Activities for Children: digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy. Find out more information.

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Research: Constraint Induced Movement Therapy Improves Upper Limb Activity

The Journal of Physiotherapy completed a research review examining whether constraint-induced movement therapy improves upper limb activity and participation in children with hemiplegic cerebral palsy.  Only randomized trials (31 papers out of 597 screened abstracts) were included in the review.   The randomized trials included children with hemiplegic cerebral palsy with any level of motor disability placed in either an experimental group who received constraint-induced movement therapy (defined as restraint of the less affected upper limb during supervised activity practice of the more affected upper limb) or  a control group who received no intervention, sham intervention, or the same dose of upper limb therapy.

The results indicated that:

• constraint-induced movement therapy was more effective than no/sham intervention in terms of upper limb activity and participation.
• although constraint-induced movement therapy was no better than the same dose of upper limb therapy without restraint either in terms of upper limb activity or participation.
• the effect of constraint-induced movement therapy was not related to the duration of intervention or the age of the children.

The researchers concluded that constraint-induced movement therapy is more effective than no intervention, but no more effective than the same intervention of upper limb practice without restraint.

Reference:  Chiu H-C, Ada L (2016) Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review. Journal of Physiotherapy 62: 130–137.
Therapeutic Play Activities for Children digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy.  Find out more.

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Side Stepping Ball Drop Activity

Side stepping ball drop is a fun activity to set up that encourages standing, side stepping, reaching, crossing midline, trunk rotation and wrist extension.  You will need recycled cardboard tubes, tape, balls (that fit inside the tubes) and a bench.  This idea is from Therapeutic Play Activities for Children.

For set up, tape the recycled cardboard tubes along the wall near the back of the bench. Place each tube far enough apart so the child has to side step to get to the next tube. Make sure the bottom of the tubes are on top of the bench. This will prevent the balls from rolling away and encourage your child to keep his/her focus on the activity. Place the bowl of balls or one ball near the first tube. The child can pick up a ball and place it inside a tube. Encourage your child to take turns with the left and right hands when picking up a ball. When the child side steps to the next tube, refill the bowl with new balls and place the bowl on the other side of the child. For example, in the picture the bowl is to the right of the child. When the child moves to the next tube, place the bowl to the left of the child.  If needed, place your hands at the child’s hips to provide a key point of control to assist with standing or squatting.

If you do not have a bench, try using a large cardboard box. If you want to work on strengthening the hip muscles, try the activity in tall kneeling.

This activity is from Therapeutic Play Activities for Children.  This digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy. FIND OUT MORE INFORMATION

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Positioning for Play

During physical play time, children tend to move through various positions and during sedentary play time children tend to maintain the same position for a longer period of time. For example, when playing hide and go seek children move in all different ways such as sitting, crawling, squatting, walking or running. In contrast, when completing a puzzle, using blocks or playing a tabletop game, children may stay in one position for a longer period of time. It is beneficial to be aware of ideal positioning during play. In general, it is helpful to change positions every 20-30 minutes to prevent asymmetries in muscles and bad habits. Most of the time during play, children will move in and out of positions frequently which is wonderful. When children are in one position for a longer period of time, there are some general guidelines based on the position of the child.

Head to the original blog post to enter your email to download the printable, one page hand out with all the information on positioning for play and sign up to receive information on research, freebies and new products.  The hand out provides suggestions for positioning during play in supine (back), prone (belly), sitting and standing.

Shaving Cream Tracks – Fine Motor and Sensory Activity

Shaving Cream Tracks is a fun activity to set up that encourages fine motor skills, tactile input and crossing midline.  You will need plates, toy cars and shaving cream for this activity.  This idea is from Therapeutic Play Activities for Children.

Place the plates in front of the child or one large tray. Squirt shaving cream on each tray. Put a toy car in the shaving cream. Demonstrate driving one toy car in the shaving cream leaving tracks.

Encourage the child to play with each toy car as they are positioned in the picture using the more involved hand. This set up requires the child to reach in all different directions such as midline and reaching across the body to the other side (crossing midline).

If you are concerned about the child mouthing the shaving cream try whipped cream or flour instead.

This activity is from Therapeutic Play Activities for Children.  This digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy. FIND OUT MORE INFORMATION

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10 Tips for Helping Children with Cerebral Palsy During Playtime

This hand out includes 10 tips for helping children with cerebral palsy during playtime (download below).  This printable tip sheet is from Therapeutic Play Activities for Children.

All children learn through play and exploration. Playtime helps children to develop fine motor, gross motor, cognitive, emotional and communication skills. Children with cerebral palsy also enjoy and learn through play but it may be more difficult for them to explore and interact with their environment due to motor skill delays. Here are some suggestions to help children with cerebral palsy during play time.

1. Provide an open, safe space for floor time for the child to explore.
2. If the child needs help to be positioned, vary the positions that you place the child in for different play time experiences. Positions could include the stomach, back, sidelying, supported sitting, all fours and supported standing.
3. Provide open-ended equipment that has many uses. Play equipment that is too challenging, not challenging enough, or not related to children’s play interests will not help them develop a sense of mastery in their motor play (Martin, 2000).
4. Research shows that infants show a preference for certain kinds of toys and will display higher levels of play when using preferred toys. If necessary, change the selection of toys in the home or classroom to increase the interest of the baby or child (Schneider, 2009).
5. Children who are not yet crawling should spend play time on their stomachs on the floor with preferred toys and people/peers near them but maybe slightly out of reach to encourage movement. Musical play can encourage children to move.
6. When playing with small objects that require fine motor skills, the child should be positioned with a stable trunk and secure base of support to allow for wrist and hand movements.
7. Be respectful and observant of a child’s sensory preferences. Environments that are too loud or busy may be overwhelming for some children. Some children may dislike touching certain play objects.
8. Use simple, clear and concise directions when explaining how to play with an object or game.
9. If necessary, provide adaptive equipment for children with physical disabilities to engage in active play and facilitate free movement.
10. Most of all, keep it fun. Children who enjoy playtime will be motivated to play and learn even more!

DOWNLOAD the tip sheet and other sample pages from Therapeutic Play Activities for Children

Therapeutic Play Activities for Children digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy.  FIND OUT MORE INFORMATION.

References:

Martin, E. (2000). Developmentally appropriate equipment: What does that mean? Teaching Elementary Physical Education, 11(6), 5-8.; (2)

Schneider, E. (2009). Longitudinal observations of infants’ object play behavior in the home context. OTJR: Occupation, Participation and Health, 29, 79-87.

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Management of Scoliosis in Children with Cerebral Palsy

The Journal of Spine Surgery published an open access review on the management of scoliosis in children with cerebral palsy (CP). Research indicates that 21-64% of children with CP develop scoliosis most likely to occurring before 10 years of age.  In children with CP, scoliosis can progress beyond skeletal maturity which is different from idiopathic scoliosis.

The development of scoliosis is related to the the child’s level of disability.  Research indicates the following:

• statistically significant relationship between Gross Motor Function Classification System (GMFCS) level and development of scoliosis with 50% of children GMFCS IV–V developing a severe scoliosis.
• Cobb angle of greater than 40 degrees at an early age has been found to predict significant progression of a CP scoliosis.
• inverse relationship between development of scoliosis and ambulation with the least mobile children at greatest risk.

The rate of progression of scoliosis varies:

• in the adult, largely non ambulatory population, progression can range between 3.0 – 4.4 degrees per year.
• according to size of curve; larger curves (>50 degrees) have been shown to progress almost twice as fast than smaller curves.
• curves were most likely to progress GMFCS IV and V.

There are two patterns of scoliotic curves in individuals with CP:

• Group-I curves can be considered double curves with a thoracic and lumbar component and occurred most often in ambulatory patients, with minimal pelvic obliquity.
• Group-II curves are single curves in either the thoracic or lumbar spines and were of greater magnitude. They occur more frequently in quadriplegic patients and almost all display significant pelvic obliquity.

There are several approaches to the non-surgical management of scoliosis in children with CP:

• Bracing – there is mixed evidence to support this approach.  There is evidence to support bracing to assist with sitting balance and trunk support, providing better control of the head, neck and arms.   Some research suggests bracing may slow curve progression, particularly in younger patients with curves less than 40 degrees.  Although other research has reported limited success and recommend bracing as an interim measure before surgical correction.
• Seating and positioning has been shown to provide increased support and improve functional outcomes although there are limited studies on the specific effects of seating systems on correction of spinal deformity.  One study indicated that the placement of a 3-point system of lateral support pads was shown to offer a more symmetrical trunk posture and correct curve angles by 35% in non-ambulatory CP patients with scoliosis.
• Botulinum toxin injection – one small study indicated that it did not worsen scoliosis and provided some reduction in magnitude of the curve in all patients.
• Intrathecal baclofen (ITB) – there is conflicting evidence regarding ITB pumps.  Some research indicated a significant increase in Cobb angle was observed following ITB pump insertion although other studies have shown there to be no difference in progression of scoliotic curves.

Currently, research indicates that surgery is the only option for the definitive management of scoliosis in CP.   The goal of surigcal correction is a balanced spine, prevention of curve progression and improvement in quality of life.   Surgery should be considered in individuals with CP who have:

1. large curves (>50 degrees).
2. scoliosis progressing beyond skeletal maturity.
3. significant curves resulting in functional or physiological disturbance.

Following surgical correction, outcomes are varied.  Survey following surgery indicate a high level of satisfaction with up to 99% of parents being satisfied with the outcome of the procedure with 85–94% willing to consider surgical intervention for their children again.  Although other research suggests that surgery provides no improvement in function, school attendance or co-morbidities but improvement in postoperative quality of life has been reported.  There is high risk of postoperative complications following surgical correction.

The decision making for the management of scoliosis in children with CP should be on an individual basis, with involvement of the physician, child, family and wider members of the multi-disciplinary team.

Reference:  Cloake, T., & Gardner, A. (2016). The management of scoliosis in children with cerebral palsy: a review. Journal of Spine Surgery, 2(4), 299-309.  Read the full text here http://ift.tt/2j4Qi1I

Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders – A Guide for Parents and Professionals is a must have reference for all therapists who work with children with cerebral palsy. Whether you are a beginner or experienced therapist you will find the information concise, informative and very helpful to carry out everyday functional tasks including stretching with children with cerebral palsy. The book provides activity suggestions throughout the developmental sequence such as head control, tummy time, sitting, transitions, walking and beyond. There is also great information that reviews additional interventions for children with cerebral palsy such as bracing, surgical and medical management. The author, Sieglinde Martin, is an experienced PT and a mother of a child with cerebral palsy.  Find out more information.

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