Dynamical structure of center-of-pressure trajectories with and without functional taping in children with cerebral palsy level I and II of GMFCS

Postural control during quiet standing was examined in typical children (TD) and children with cerebral palsy (CP) level I and II of GMFCS. The immediate effect on postural control of functional taping on the thighs was analyzed. We evaluated 43 TD, 17 CP children level I, and 10 CP children level II. Participants were evaluated in two conditions (with and without taping). The trajectories of the center of pressure (COP) were analyzed by means of conventional posturography (sway amplitude, sway-path-length) and dynamic posturography (degree of twisting-and-turning, sway regularity). Both CP groups showed larger sway amplitude than the TD while only the CP level II showed more regular COP trajectories with less twisting-and-turning. Functional taping didn’t affect sway amplitude or sway-path-length. TD children exhibited more twisting-and-turning with functional taping, whereas no effects on postural sway dynamics were observed in CP children. Functional taping doesn’t result in immediate changes in quiet stance in CP children, whereas in TD it resulted in faster sway corrections. Children level II invest more attention in postural control than level I, and TD. While quiet standing was more automatized in children level I than in level II, both CP groups showed a less stable balance than TD.     

Sensory processing disorders in children with cerebral palsy

ObjectiveTo evaluate sensory processing in children with CP using the Sensory Profile questionnaire and to compare results with the ones of children with typical development (TD).MethodsWe assessed sensory processing of 59 TD children and 43 CP children using the Sensory Profile, a standardized parent reporting measure that records children's responses to sensory events in daily life. Mann-Whitney test was used to compare the results of sensory processing evaluation among the groups. Bonferroni correction was applied.ResultsWe found differences in sensory processing between groups in 16 out of the 23 categories evaluated in the Sensory Profile.ConclusionOur results pointed out to the existence of disturbances in the processing of sensory information in CP. Based on the importance of the sensory integration process for motor function, the presence of such important disturbances draw the attention to the implementation of sensory therapies which improve function in these children.     

Approximate entropy used to assess sitting postural sway of infants with developmental delay

Infant sitting postural sway provides a window into motor development at an early age. The approximate entropy, a measure of randomness, in the postural sway was used to assess developmental delay, as occurs in cerebral palsy. Parameters used for the calculation of approximate entropy were investigated, and approximate entropy of postural sway in early sitting was found to be lower for infants with developmental delay in the anterior-posterior axis, but not in the medial-lateral axis. Spectral analysis showed higher frequency features in the postural sway of early sitting of infants with typical development, suggesting a faster control mechanism is active in infants with typical development as compared to infants with delayed development, perhaps activated by near-fall events.     

Effects of whole body vibration on spasticity and lower extremity function in children with cerebral palsy

AimThe aim of this study was to evaluate the effect of whole body vibration (WBV) on lower extremity spasticity and ambulatory function in children with cerebral palsy (CP) with a complete crossover design.MethodSixteen participants aged 9.8(2.3) years received a 20-min WBV and a control condition in a counterbalanced order on two separate days. Change scores of each outcome variable were used to show the improvement.ResultsRepeated-measures analyses revealed significant differences in condition scores among variables including active range-of-motion (active ROM, increased), relaxation index (RI, increased), Modified Ashworth Scale (MAS, decreased), timed up-and-go (TUG, decreased), and Six Minute Walk Test (6MWT, increased). Significant differences were also found in time change scores for MAS and 6MWT. Correlation results revealed that TUG was significantly correlated with RI (r = −.512, p = .042), and 6MWT (r = −.700, p = .003).InterpretationThis study suggested that WBV intervention can control the spasticity, enhance ambulatory performance and increase active ROM. Along with previous results, data from this study revealed the potential use of WBV in clinical rehabilitation in children with CP. Future investigations should focus on finding the combination of treatment frequency and duration to achieve an ideal result.     

Gradual increase of perturbation load induces a longer retention of locomotor adaptation in children with cerebral palsy

The goal of this study is to determine whether the size and the variability of error have an impact on the retention of locomotor adaptation in children with cerebral palsy (CP). Eleven children with CP, aged 7–16 years old, were recruited to participate in this study. Three types of force perturbations (i.e., abrupt, gradual and noisy loads) were applied to the right leg above the ankle starting from late stance to mid-swing in three test sessions while the subject walked on a treadmill. Spatial-temporal gait parameters were recorded using a custom designed 3D position sensor during treadmill walking. We observed that children with CP adapted to the resistance force perturbation and showed an aftereffect consisting of increased step length after load release. Further, we observed a longer retention of the aftereffect for the condition with a gradual load than that with an abrupt load. Results from this study suggested that the size of error might have an impact on the retention of motor adaptation in children with CP with a longer retention of motor adaptation for the condition with a small size of error than that with a large error. In addition, enhanced variability of error seems facilitate motor learning during treadmill training. Results from this study may be used for the development of force perturbation based training paradigms for improving walking function in children with CP.     

Dynamic touch is affected in children with cerebral palsy

Children with developmental disorders such as cerebral palsy have limited opportunities for effortful interactions with objects and tools. The goal of the study was to investigate whether children with cerebral palsy have deficits in their ability to perceive object length by dynamic touch when compared to typically developing children. Fourteen children with typical development and 12 children with cerebral palsy were asked to report the length of hand-held rods after wielding them out of sight. Multilevel regression models indicated that I₁ (maximum principal moment of inertia) was a significant predictor of perceived length – L_P (p < .0001). The effect of I₁ on L_P was significantly different among children (p = .001) and the presence of cerebral palsy (group factor) partially explained such variance (p = .002). In addition, accuracy and reliability of the length judgments made by children with cerebral palsy were significantly lower than the typically developing children (p < .05). Theoretical and clinical implications of these results were identified and discussed.     

Working memory and fine motor skills predict early numeracy performance of children with cerebral palsy

Early numeracy is an important precursor for arithmetic performance, academic proficiency, and work success. Besides their apparent motor difficulties, children with cerebral palsy (CP) often show additional cognitive disturbances. In this study, we examine whether working memory, non-verbal intelligence, linguistic skills, counting and fine motor skills are positively related to the early numeracy performance of 6-year-old children with CP. A total of 56 children (M = 6.0, SD = 0.61, 37 boys) from Dutch special education schools participated in this cross-sectional study. Of the total group, 81% of the children have the spastic type of CP (33% unilateral and 66% bilateral), 9% have been diagnosed as having diskinetic CP, 8% have been diagnosed as having spastic and diskinetic CP and 2% have been diagnosed as having a combination of diskinetic and atactic CP. The children completed standardized tests assessing early numeracy performance, working memory, non-verbal intelligence, sentence understanding and fine motor skills. In addition, an experimental task was administered to examine their basic counting performance. Structural equation modeling showed that working memory and fine motor skills were significantly related to the early numeracy performance of the children (β = .79 and p < .001, β = .41 and p < .001, respectively). Furthermore, counting was a mediating variable between working memory and early numeracy (β = .57, p < .001). Together, these findings highlight the importance of working memory for early numeracy performance in children with CP and they warrant further research into the efficacy of intervention programs aimed at working memory training.     

Bimanual circle drawing in children with spastic hemiparesis: effect of coupling modes on the performance of the impaired and unimpaired arms

The present study examined the effect of interlimb coupling on the performance of the impaired and unimpaired arm in children with spastic hemiparesis during bimanual circle drawing. The following questions were addressed: (1) does coupling positively influence the performance of the impaired arm compared to single-hand performance and (2) is such an effect dependent on mode of coordination (i.e., symmetric versus asymmetric). Twelve children with spastic hemiparesis produced circle drawings on a digitizer under different task conditions. Spatiotemporal characteristics and quality of movement of pen trajectories of the individual limbs as well as interlimb relative phase were analysed. Coupling in a symmetric coordination mode resulted in a decrease of temporal variability and an increase of smoothness of circle drawing movements in the impaired arm compared to single-handed performance. Coupling in an asymmetric coordination mode resulted in an increase of spatial and temporal variability in the unimpaired arm. It is concluded that coupling may enhance the performance of the impaired arm in children with spastic hemiparesis, but only during symmetric bimanual coordination. A possible underlying neural mechanism that might explain these findings is discussed.     

Effect of task goals on the reaching patterns of children with cerebral palsy

The authors examined whether the intended task goal of the subsequent action affects the reaching patterns before the intended goal in 17 children with cerebral palsy (CP). The authors hypothesized that when the children with CP used their less affected hand, they would not be affected by the task goals and that their reaching pattern would deviate from those of 17 age-matched children without CP and 20 young healthy adult participants. All participants were instructed to reach and grasp a tennis ball and then to either fit or throw it. Kinematic variables (movement time, straightness ratio, peak velocity, percentage of time to peak velocity, and number of movement units) were used as outcome measures. Children with CP used slower, less straight, less forceful, and jerkier reaching patterns to approach the object than did children without CP and adults. Unlike in children and adults without CP, the intended goal of the subsequent action did not affect the reaching pattern before the intended goal in children with CP. Children with CP may therefore have difficulty in anticipatory planning and thus must segment the integrative action plan into sequential submovements.     

Basic visual perceptual processes in children with typical development and cerebral palsy: The processing of surface,length, orientation,and position

The present study aims to assess how the processing of basic visual perceptual (VP) components (length, surface, orientation, and position) develops in typically developing (TD) children (n = 215, 4–14 years old) and adults (n = 20, 20–25 years old), and in children with cerebral palsy (CP) (n = 86, 5–14 years old) using the first four subtests of the Battery for the Evaluation of Visual Perceptual and Spatial processing in children. Experiment 1 showed that these four basic VP processes follow distinct developmental trajectories in typical development. Experiment 2 revealed that children with CP present global and persistent deficits for the processing of basic VP components when compared with TD children matched on chronological age and nonverbal reasoning abilities.     

The impact of Wii Fit intervention on dynamic balance control in children with probable Developmental Coordination Disorder and balance problems

The aim of this study was to examine differences in the performance of children with probable Developmental Coordination Disorder (p-DCD) and balance problems (BP) and typical developing children (TD) on a Wii Fit task and to measure the effect on balance skills after a Wii Fit intervention.Twenty-eight children with BP and 20 TD-children participated in the study. Motor performance was assessed with the Movement Assessment Battery for Children (MABC2), three subtests of the Bruininks Oseretsky Test (BOT2): Bilateral Coordination, Balance and Running Speed & Agility, and a Wii Fit ski slalom test. The TD children and half of the children in the BP group were tested before and after a 6 weeks non-intervention period. All children with BP received 6 weeks of Wii Fit intervention (with games other than the ski game) and were tested before and afterwards.Children with BP were less proficient than TD children in playing the Wii Fit ski slalom game. Training with the Wii Fit improved their motor performance. The improvement was significantly larger after intervention than after a period of non-intervention. Therefore the change cannot solely be attributed to spontaneous development or test–retest effect. Nearly all children enjoyed participation during the 6 weeks of intervention. Our study shows that Wii Fit intervention is effective and is potentially a method to support treatment of (dynamic) balance control problems in children.     

A psychometric evaluation of the social skills rating system in children with attention deficit hyperactivity disorder

The social skills rating system (SSRS) was developed to assess social skills of children, as observed by multiple raters (teacher, parent, child). Studies of the SSRS have been conducted with handicapped, mentally retarded and learning disabled children. No studies have reported the psychometric properties of the SSRS in a clinical ADHD sample. This is important, because deficient social functioning is associated with ADHD. The present study assesses the psychometric properties of the teacher, parent and child versions of the SSRS in children with ADHD (n = 123), and normal controls (n = 239). Also, the social skills of children with ADHD, as rated on the SSRS were examined. Results support the factor structure and internal consistency of the original SSRS-teacher version. Moreover, support was found for 3 out of 4 scales of the SSRS-parent version. The factor structure of the SSRS-child version could not be replicated. An explanatory factor analysis on the SSRS-child version yielded two factors. Evidence was found for discriminative ability of the SSRS between normal controls and children with ADHD. Finally, informant agreement between raters was found to be poor.     

Neural activation underlying cognitive control in the context of neutral and affectively charged pictures in children

The neural correlates of cognitive control for typically developing 9-year-old children were examined using dense-array ERPs and estimates of cortical activation (LORETA) during a go/no-go task with two conditions: a neutral picture condition and an affectively charged picture condition. Activation was estimated for the entire cortex after which data were exported for four regions of interests (ROIs): ventrolateral prefrontal cortex (VLPFC), dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (DLPFC), and orbitofrontal/ventromedial prefrontal cortex (OFC/VMPFC). Results revealed faster reaction times, greater N2 activation, and greater prefrontal activation for the affectively charged picture condition than the neutral picture condition. The findings are discussed in reference to the impact of affective stimuli on recruitment of specific brain regions involved in cognitive control.     

Brain mechanisms associated with background monitoring of the environment for potentially significant sensory events

Background monitoring is a necessary prerequisite to detect unexpected changes in the environment, while being involved in a primary task. Here, we used fMRI to investigate the neural mechanisms that underlie adaptive goal-directed behavior in a cued task switching paradigm during real response conflict or, more generally, when expectations on the repetitive features of the environment were violated. Unexpected changes in sensory stimulus attributes in the currently unattended stimulus dimension thereby led to activations in a bilateral network comprising inferior lateral frontal, intraparietal, and posterior medial frontal brain regions, independent of whether these attributes elicited a factual response conflict or not. This fronto-parietal network may thus play an important role in adaptive responding to potentially significant events outside the current focus of attention.     

Performance on the Test of Memory Malingering in children with neurological conditions

Despite increasing interest in the use of performance validity tests with youth, relatively little is known about how children and adolescents with neurological diagnoses perform on these measures. The purpose of this study was to examine performance on the Test of Memory Malingering (TOMM) in a general pediatric neurologic sample. Data were obtained from 266 consecutive patients (mean age = 13.0, SD = 3.7, range = 5–18) referred for a neuropsychological assessment in a tertiary care pediatric hospital. As part of a broader neuropsychological battery, patients were administered the TOMM. In this sample, 94% of children passed the TOMM. Pass rate was 87% for 5–7 year-olds but was ≥ 90% for all other ages. Children with a history of stroke had the lowest pass rate (86%), with other diagnostic groups scoring ≥ 90%, including epilepsy, traumatic brain injury, and hydrocephalus. Lower TOMM performance was related to slower processing speed and weaker memory performance. The results support using the TOMM with children and adolescents who have neurological diagnoses. Caution may still be warranted when interpreting scores in those who are younger and/or who have more significant cognitive difficulty.     

Effects of behavioral training on the functioning of a profoundly retarded microcephalic teenager with cerebral palsy and without language or verbal comprehension: A case study

In previous investigations (Jacobson, Berger, Bergman, Millham and Greeson, 1971; Jacobson and Greeson, 1972), it was reported that as a result of the use of a behavior modification program, preschool children from poverty backgrounds demonstrated rapid conceptual acquisition. In addition, the Ss increased from the dull-normal to the normal range of intellectual functioning within approximately 20 hr of program participation. Since the increases in IQ found were most pronounced for children of lowest IQ (IQs = 46–83), the investigators hypothesized that the program would prove to be useful with Ss of greater cognitive and behavioral deficits than the initial population investigated.The present study reports the use of a variant of the conceptual acquisition program with an institutionalized, profoundly retarded microcephalic teenager with chronic brain syndrome and cerebral palsy. Prior to the study the boy demonstrated neither language nor an ability to comprehend and follow verbal directions.     

Effects of stimulus presentation order during auditory–visual conditional discrimination training for children with autism spectrum disorder

Children with autism spectrum disorder are typically taught conditional discriminations using a match‐to‐sample arrangement. Consideration should be given to the temporal order in which antecedent stimuli (the sample and comparison stimuli) are presented during match‐to‐sample trials, as various arrangements have been used in the extant literature. The purpose of the current study was to compare the effects of four stimulus presentation orders on the acquisition of auditory–visual conditional discriminations. The study included participants from a clinically relevant population (three children with autism spectrum disorder), employed clinically relevant teaching procedures, and included two presentation formats not included in previous comparison evaluations (simultaneous and sample‐first with re‐presentation conditions). Results were found to be learner‐specific; that is, a different stimulus presentation format was most efficient for each participant. We provide suggestions to evaluate stimulus control topographies and enhance experimental control in match‐to‐sample arrangements.     

Effects of Developmental Task Constraints on Kinematic Synergies during Catching in Children with Developmental Delays

Abstract

The aim of this study was to examine effects of a task intervention on kinematic synergies in catching. Participants were young children (5.58?±?0.52?years) with the lowest scores on two-hand catching, according to assessments with the Test of Gross Motor Development-2 (TGMD-2) and were allocated into two groups. The constraints group took part in an 8-week intervention, whereas the control group experienced a typical physical education. Both groups were assessed with motor development and kinematic coordination measures with a catching task with a ball thrown from 2?m distance. Kinematic variables were recorded using a wireless motion capture system. A principal component analysis (PCA) was used to measure the kinematic synergies formed among active body parts. Two synergies that emerged in catching were mainly utilised for “reaching” and “catching” the ball. The control group tended to re-organise the majority of active body parts into two functional units in all phases, whereas the constraints group adapted their active parts into functional units according to the requirement of the novel movement in the transfer task. The findings of this study suggested that task constraints could facilitate object control by re-organisation of active body parts into functional synergies to achieve successful performance.     

Factor structure of the construct of adaptive behavior in children with and without intellectual disability

Although the presence of significant limitations in adaptive behavior constitutes one of the three necessary criteria for diagnosing intellectual disability, adaptive behavior structure has always been the subject of considerable controversy among researchers. The main goal of this study is to extend previous research results that provide further support to a multidimensional structure of conceptual, social, and practical skills compared to the unidimensional structure. One-factor and 3-correlated factors models as measured by 15 observable indicators were analyzed by means of confirmatory factor analysis (CFA), as well as their relationships with one second-order factor (i.e., adaptive behavior). To that end, 388 children with and without intellectual disabilities were assessed with the Diagnostic Adaptive Behavior Scale (DABS). Results of CFA indicated that the 3 first-order factors solution provides the best fit to the data. Reliability and validity of the multidimensional model were also analyzed through different methods such as the composite reliability and the average variance extracted. Finally, implications of these findings and possible directions for future research are discussed.     

A pilot study exploring the use of a telephone-assisted planning intervention to promote parental support for physical activity among children and youth with disabilities

Parent support is an important contributor to physical activity (PA) among children and youth with disabilities (CYD). Although many parents of CYD are motivated to provide parent PA support, CYD remain insufficiently active. The multi-process action control model has been applied to understand parent PA support and highlights behavioral regulation strategies such as action and coping planning as critical for translating intentions into behavior. Parents may struggle to create and carryout planning without support. There is no known research examining telephone support as a tool to promote planning and subsequent parent PA support behavior.MethodParents (43 mothers and 6 fathers) of CYD (child M_age = 12.53 years ± 5.53; 75% male; 38.6% developmental disability) completed a baseline questionnaire and were subsequently randomized to a telephone-assisted planning experimental group twice over four weeks (n = 23) or a control group who had access to planning tools but no telephone assistance (n = 26).ResultsNo significant main or interaction effects emerged for parent PA support behavior. However, a significant time × condition interaction was found for behavioral regulation strategies (i.e., action and coping planning and self-monitoring; F(1,44) = 5.05, p = 0.03) indicating a significant increase in the use of behavioral regulation strategies for parent PA support from baseline, for parents assigned to the telephone-assisted intervention.ConclusionThese findings suggest potential for planning support as a tool to enhance behavioral regulation strategies related to parent PA support among parents of CYD.