Intensive Therapy of the Lower Limbs and the Trunk in Children with Bilateral Spastic Cerebral Palsy: Comparing a Qualitative Functional and a Functional Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Intervention
2.3.1. Setup and General Guidelines
2.3.2. Functional Approach
2.3.3. Qualitative Functional Approach
2.4. Assessment
2.4.1. Primary Outcomes
2.4.2. Secondary Outcomes
2.4.3. Additional Assessments
2.5. Statistics
3. Results
3.1. Participants
3.2. Treatment Efficacy
3.2.1. Primary Outcomes
3.2.2. Secondary Outcomes
3.2.3. Subgroup Analysis
3.2.4. Matched-Pair Analysis
4. Discussion
5. Study Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Prenatal risk factors |
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Perinatal risk factors |
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Postnatal risk factors |
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Motor Learning Principle | Description |
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Structure | The therapeutic program had a clear structure with a top-down system: five domains, prerequisites, and exercises. |
Repetition | Six individual sessions for each domain were incorporated into the program. Individual logbooks ensured the repetition of the exercises. |
Progression | The exercises were progressively graded toward increasing the participants’ capacities. Individual logbooks ensured shaping. |
Motivation | Motivation was an important factor during the assessments and therapy. Fun was a key feature and was achieved through rewards, group sessions, attractive leisure moments, and the overarching circus theme. |
Individual adjustments | Individual goals were based on baseline assessments. Each participant had their own logbook to ensure the continuity of the therapy. |
Therapists guide the execution | The child was considered an active actor seeking problem-solving strategies guided by the therapist. |
Focus on function | Functional activities took precedence during at least 70% of the therapeutic sessions. |
Qualitative Functional Approach (Pictures a–d) | Functional Approach (Pictures e–h) | ||
---|---|---|---|
Bobath-concept-oriented | Functional-therapy-oriented | ||
Activity- and impairment-focused | Activity-focused | ||
Active and passive preparation of the function
| No preparation of the function | ||
Hands-on, facilitation through handling skills, and hands-off Using key points of control to facilitate more efficient, qualitative strategies during the performance of a task | Hands-off adjustment of the environment | ||
Verbal cues enhance the quality of movement | No verbal cues on the quality of movement during the performance | ||
Goal setting on impairment and activity level of the International Classification of Functioning, Disability and Health (ICF) (e.g., enhance the extension of the hip in stance and during sit-to-stand or improve going up and down the stairs holding one handrail) | Goal setting on the activity level of the ICF (e.g., sit-to-stand without using the hands or improve transfers from sitting on the ground to standing position) | ||
a. | b. | e. | f. |
Qualitative functional approach | Functional approach | ||
c. | d. | g. | h. |
Qualitative functional approach | Functional approach |
Balance | |
Maintaining balance in different postures Balance in stance with one foot in front (length of one step) Dynamic balance | |
Transfers | |
Sit to stand From lying down to stand | Rolling from prone to supine and vice versa Roll-over |
Trunk stability | Trunk mobility |
Active upright position of the trunk Maintaining trunk position Trunk stability while moving, in sitting position Trunk stability while moving, in standing position | Trunk mobility in lying position Trunk mobility in sitting position |
Walking | |
Stance phase stability: flat foot, knee and hip extension, trunk alignment Stance on 1 leg Stance on 1 leg while moving the other leg Clearance of the foot during the swing phase Pre-position of the foot at the end of the swing phase | Step length Strength of the lower-limb muscles Walking (forward, sideways, and backwards) Transfers (sitting to standing and vice versa) Walking speed |
Going up and down the stairs | |
Balance in stance Balance on one leg Stance on a step on one leg, the other leg moves Stance with one foot on a step Pushing up on step | Going up and down the stairs: alternating versus not alternating Jumping from a step Active hip- and knee-extension of the stance leg |
8:30 | a.m. | – | 9:00 | a.m. | Briefing therapists |
9:00 | a.m. | – | 9:45 | a.m. | Group session 1 (warming up with, e.g., stretching and strengthening) |
9:45 | a.m. | – | 10:30 | a.m. | Individual session 1 |
10:30 | a.m. | – | 11:00 | a.m. | Break |
11:00 | a.m. | – | 11:45 | a.m. | Individual session 2 |
11:45 | a.m. | – | 12:45 | p.m. | Lunch break |
12:45 | p.m. | – | 1:45 | p.m. | Standing device group A |
1:45 | p.m. | – | 2:30 | p.m. | Individual session 3 |
2:30 | p.m. | – | 3:00 | p.m. | Break |
3:00 | p.m. | – | 3:45 | p.m. | Individual session 4 |
3:45 | p.m. | – | 4:00 | p.m. | Break |
4:00 | p.m. | – | 4:30 | p.m. | Group session 2 (showing newly achieved skills, preparing the circus show) |
4:30 | p.m. | – | 5:15 | p.m. | Briefing therapists |
6:30 | p.m. | – | 7:30 | p.m. | Standing device group B |
Alignment | Coordination | Dissociation | Stability | Weight Shift | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
GMFCS Level | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
2 | 2 | 1 | −3.75 | 0.007 | −7.45 | −0.06 | −1.64 | 0.118 | −4.44 | 1.16 | −4.74 | <0.001 | −8.08 | −1.39 | −2.83 | 0.007 | −5.60 | −0.07 | −1.7 | 0.082 | −4.38 | 0.92 |
3 | 1 | 9.29 | <0.001 | 4.21 | 14.38 | 10.91 | <0.001 | 7.01 | 14.81 | 7.15 | <0.001 | 2.54 | 11.76 | 8.98 | <0.001 | 5.14 | 12.82 | 11.65 | <0.001 | 7.98 | 15.33 | |
2 | 13.05 | <0.001 | 9.36 | 16.74 | 12.55 | <0.001 | 9.75 | 15.36 | 11.88 | <0.001 | 8.54 | 15.23 | 11.81 | <0.001 | 9.04 | 14.57 | 13.38 | <0.001 | 10.73 | 16.03 | ||
4 | 1 | 6.88 | 0.007 | 0.14 | 13.63 | 8.074 | <0.001 | 2.87 | 13.28 | 6.17 | 0.008 | 0.06 | 12.28 | 6.97 | <0.001 | 1.85 | 12.09 | 8.11 | <0.001 | 3.22 | 13.00 | |
2 | 10.64 | <0.001 | 4.76 | 16.51 | 9.71 | <0.001 | 5.21 | 14.22 | 10.91 | <0.001 | 5.59 | 16.23 | 9.80 | <0.001 | 5.37 | 14.23 | 9.84 | <0.001 | 5.60 | 14.08 | ||
3 | −2.41 | 0.172 | −7.13 | 2.31 | −2.84 | 0.036 | −6.43 | 0.76 | −1.0 | 0.540 | −5.25 | 3.30 | −2.0 | 0.130 | −5.55 | 1.54 | −3.54 | 0.006 | −6.94 | −0.15 | ||
3 | 2 | 1 | 1.83 | 0.439 | −4.50 | 8.16 | 0.05 | 0.978 | −4.77 | 4.87 | 2.3 | 0.273 | −3.39 | 8.08 | 0.0 | 0.986 | −4.72 | 4.79 | 0.0 | 0.977 | −4.50 | 4.60 |
3 | 1 | 16.16 | <0.001 | 8.39 | 23.94 | 7.97 | <0.001 | 2.01 | 13.93 | 7.52 | 0.005 | 0.48 | 14.56 | 6.27 | 0.005 | 0.40 | 12.13 | 10.71 | <0.001 | 5.10 | 16.32 | |
2 | 14.34 | <0.001 | 9.57 | 19.11 | 7.92 | <0.001 | 4.30 | 11.54 | 5.17 | 0.002 | 0.85 | 9.49 | 6.23 | <0.001 | 2.66 | 9.81 | 10.66 | <0.001 | 7.24 | 14.08 | ||
4 | 1 | 11.49 | 0.001 | 2.28 | 20.71 | 7.09 | 0.008 | −0.02 | 14.20 | 6.99 | 0.026 | −1.35 | 15.33 | 6.345 | 0.016 | −0.64 | 13.33 | 7.78 | 0.002 | 1.10 | 14.46 | |
2 | 9.67 | <0.001 | 2.64 | 16.69 | 7.04 | 0.001 | 1.66 | 12.42 | 4.6 | 0.052 | −1.72 | 11.01 | 6.32 | 0.002 | 1.02 | 11.62 | 7.73 | <0.001 | 2.66 | 12.80 | ||
3 | −4.67 | 0.021 | −10.05 | 0.71 | −0.88 | 0.564 | −4.97 | 3.21 | −0.5 | 0.770 | −5.40 | 4.34 | 0.1 | 0.957 | −3.95 | 4.12 | −2.94 | 0.043 | −6.80 | 0.93 |
Alignment | Coordination | Dissociation | Stability | Weight Shift | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
GMFCS Level | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
2 | 2 | 1 | 3.75 | 0.068 | −1.71 | 9.10 | 2.74 | 0.075 | −1.37 | 6.84 | 3.07 | 0.095 | −1.83 | 7.96 | 1.39 | 0.359 | −2.67 | 5.43 | 4.61 | 0.002 | 0.73 | 8.49 |
3 | 1 | 2.37 | 0.394 | −5.08 | 9.82 | 1.24 | 0.559 | −4.46 | 6.95 | 0.04 | 0.989 | −6.71 | 6.78 | −1.06 | 0.614 | −6.67 | 4.56 | 2.95 | 0.143 | −2.43 | 8.33 | |
2 | −1.33 | 0.510 | −6.73 | 4.08 | −1.49 | 0.329 | −5.60 | 2.61 | −3.03 | 0.099 | −7.93 | 1.87 | −2.44 | 0.108 | −6.49 | 1.61 | −1.66 | 0.251 | −5.54 | 2.22 | ||
4 | 1 | 3.0 | 0.397 | −6.49 | 12.50 | −4.29 | 0.119 | −11.62 | 3.05 | −3.60 | 0.263 | −12.19 | 5.00 | 1.07 | 0.69 | −6.13 | 8.28 | 3.27 | 0.205 | −3.62 | 10.15 | |
2 | −0.69 | 0.820 | −8.85 | 7.47 | −7.03 | 0.003 | −13.28 | −0.78 | −6.66 | 0.017 | −14.05 | 0.73 | −0.31 | 0.891 | −6.47 | 5.84 | −1.35 | 0.540 | −7.23 | 4.54 | ||
3 | 0.63 | 0.788 | −5.72 | 6.98 | −5.53 | 0.003 | −10.37 | −0.70 | −3.63 | 0.092 | −9.38 | 2.12 | 2.13 | 0.232 | −2.64 | 6.89 | 0.32 | 0.853 | −4.25 | 4.88 | ||
3 | 2 | 1 | 2.70 | 0.258 | −3.70 | 9.10 | 2.24 | 0.216 | −2.61 | 7.10 | 1.15 | 0.594 | −4.64 | 6.95 | 0.40 | 0.823 | −4.39 | 5.19 | 1.59 | 0.352 | −3.00 | 6.18 |
3 | 1 | −3.45 | 0.294 | −12.26 | 5.36 | 0.65 | 0.797 | −6.11 | 7.40 | −0.71 | 0.811 | −8.69 | 7.27 | −1.11 | 0.653 | −7.76 | 5.54 | 0.38 | 0.872 | −5.98 | 6.74 | |
2 | −6.15 | 0.011 | −12.55 | 0.25 | −1.60 | 0.377 | −6.45 | 3.26 | −1.86 | 0.389 | −7.66 | 3.93 | −1.51 | 0.397 | −6.30 | 3.28 | −1.21 | 0.479 | −5.80 | 3.38 | ||
4 | 1 | −11.17 | 0.023 | −24.17 | 1.83 | −0.31 | 0.933 | −10.33 | 9.71 | −1.41 | 0.747 | −13.18 | 10.35 | −2.24 | 0.542 | −12.09 | 7.61 | −4.04 | 0.251 | −13.46 | 5.38 | |
2 | −13.87 | 0.002 | −25.53 | −2.21 | −2.56 | 0.443 | −11.49 | 6.38 | −2.57 | 0.515 | −13.12 | 7.99 | −2.64 | 0.421 | −11.43 | 6.16 | −5.63 | 0.075 | −14.05 | 2.78 | ||
3 | −7.72 | 0.039 | −17.68 | 2.24 | −0.96 | 0.734 | −8.56 | 6.64 | −0.70 | 0.834 | −9.72 | 8.32 | −1.13 | 0.686 | −8.62 | 6.36 | −4.42 | 0.100 | −11.59 | 2.75 |
Dimension C | Dimension D | Dimension E | Total CDE | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
GMFCS Level | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
2 | 2 | 1 | 0.48 | 0.62 | −2.10 | 3.1 | 1.54 | 0.24 | −1.97 | 5.05 | 2.50 | 0.006 | 0.10 | 4.90 | 1.50 | 0.022 | −0.24 | 3.24 |
3 | 1 | 0.79 | 0.551 | −2.78 | 4.4 | 7.18 | <0.001 | 2.29 | 12.07 | 6.76 | <0.001 | 3.39 | 10.13 | 4.91 | <0.001 | 2.47 | 7.36 | |
2 | 0.32 | 0.741 | −2.26 | 2.9 | 5.64 | <0.001 | 2.13 | 9.15 | 4.26 | <0.001 | 1.86 | 6.66 | 3.40 | <0.001 | 1.67 | 5.15 | ||
4 | 1 | 0.86 | 0.628 | −3.89 | 5.6 | 3.85 | 0.116 | −2.69 | 10.39 | 6.24 | <0.001 | 1.72 | 10.77 | 3.61 | 0.004 | 0.32 | 6.90 | |
2 | 0.28 | 0.804 | −3.74 | 4.5 | 2.31 | 0.273 | −3.34 | 7.96 | 3.74 | 0.011 | −0.15 | 7.63 | 2.10 | 0.047 | −0.69 | 4.93 | ||
3 | 0.16 | 0.958 | −3.24 | 3.4 | −3.33 | 0.049 | −7.83 | 1.17 | −0.52 | 0.652 | −3.61 | 2.57 | −1.30 | 0.12 | −3.54 | 0.94 | ||
3 | 2 | 1 | 1.16 | 0.481 | −3.27 | 5.6 | 3.85 | 0.089 | −2.20 | 9.89 | 2.25 | 0.147 | −1.90 | 6.40 | 2.32 | 0.04 | −0.69 | 5.33 |
3 | 1 | 5.66 | 0.006 | 0.21 | 11.1 | 10.68 | <0.001 | 3.21 | 18.16 | 4.10 | 0.034 | −1.04 | 9.25 | 6.71 | <0.001 | 2.98 | 10.45 | |
2 | 4.50 | <0.001 | 1.17 | 7.8 | 6.83 | <0.001 | 2.31 | 11.37 | 1.85 | 0.111 | −1.25 | 4.96 | 4.40 | <0.001 | 2.15 | 6.64 | ||
4 | 1 | 1.39 | 0.565 | −5.09 | 7.9 | 7.94 | 0.018 | −0.98 | 16.87 | 2.91 | 0.207 | −3.26 | 9.08 | 4.06 | 0.017 | −0.43 | 8.55 | |
2 | 0.23 | 0.901 | −4.70 | 5.2 | 4.10 | 0.105 | −2.65 | 10.85 | 0.66 | 0.702 | −3.99 | 5.31 | 1.74 | 0.168 | −1.63 | 5.11 | ||
3 | −4.27 | 0.003 | −8.03 | −0.5 | −2.74 | 0.153 | −7.86 | 2.38 | −1.19 | 0.363 | −4.70 | 2.32 | −2.66 | 0.006 | −5.20 | −0.11 |
Dimension C | Dimension D | Dimension E | Total CDE | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
GMFCS Level | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
2 | 2 | 1 | 0.68 | 0.628 | −3.1 | 4.5 | 1.10 | 0.565 | −4.04 | 6.23 | 3.77 | 0.005 | 0.25 | 7.29 | 1.85 | 0.053 | −0.70 | 4.40 |
3 | 1 | −0.68 | 0.727 | −5.90 | 4.5 | 0.00 | 1.000 | −7.16 | 7.16 | 4.76 | 0.011 | −0.17 | 9.69 | 1.36 | 0.308 | −2.22 | 4.94 | |
2 | −1.36 | 0.334 | −5.14 | 2.4 | −1.10 | 0.565 | −6.23 | 4.04 | 0.99 | 0.449 | −2.53 | 4.51 | −0.49 | 0.606 | −3.04 | 2.06 | ||
4 | 1 | 0.74 | 0.767 | −5.95 | 7.4 | 2.49 | 0.469 | −6.72 | 11.70 | 3.05 | 0.201 | −3.33 | 9.42 | 2.11 | 0.223 | −2.53 | 6.75 | |
2 | 0.06 | 0.978 | −5.66 | 5.8 | 1.39 | 0.634 | −6.45 | 9.23 | −0.72 | 0.720 | −6.12 | 4.68 | 0.26 | 0.857 | −3.66 | 4.18 | ||
3 | 1.42 | 0.391 | −3.02 | 5.9 | 2.49 | 0.270 | −3.56 | 8.54 | −1.71 | 0.269 | −5.87 | 2.44 | 0.86 | 0.502 | −2.26 | 3.76 | ||
3 | 2 | 1 | 2.86 | 0.088 | −1.61 | 7.3 | −2.05 | 0.365 | −8.13 | 4.03 | 0.28 | 0.858 | −3.89 | 4.44 | 0.36 | 0.747 | −2.65 | 3.37 |
3 | 1 | 3.33 | 0.150 | −2.85 | 9.5 | −3.08 | 0.330 | −11.55 | 5.39 | 0.28 | 0.898 | −5.56 | 6.11 | 0.18 | 0.910 | −4.06 | 4.41 | |
2 | 0.48 | 0.774 | −3.99 | 4.9 | −1.03 | 0.650 | −7.10 | 5.05 | 0.00 | 1.000 | −4.16 | 4.16 | −0.18 | 0.870 | −3.20 | 2.83 | ||
4 | 1 | 4.35 | 0.204 | −4.80 | 13.5 | −2.99 | 0.524 | −15.57 | 9.59 | 0.38 | 0.908 | −8.32 | 9.07 | 0.59 | 0.801 | −5.73 | 6.92 | |
2 | 1.49 | 0.625 | −6.69 | 9.7 | −0.94 | 0.822 | −12.14 | 10.26 | 0.10 | 0.973 | −7.62 | 7.81 | 0.23 | 0.911 | −5.37 | 5.83 | ||
3 | 1.01 | 0.697 | −5.96 | 8.0 | 0.09 | 0.980 | −9.44 | 9.61 | 0.10 | 0.968 | −6.45 | 6.64 | 0.42 | 0.814 | −4.33 | 5.16 |
Static Sitting Balance | Selective Motor Control | Dynamic Reaching | Total TCMS | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
GMFCS Level | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
2 | 2 | 1 | −0.30 | 0.533 | −1.42 | 0.88 | 1.73 | 0.015 | −0.16 | 3.62 | 0.87 | 0.012 | −0.05 | 1.8 | 2.33 | 0.018 | −0.27 | 4.94 |
3 | 1 | 0.30 | 0.562 | −1.21 | 1.87 | 2.93 | 0.001 | 0.54 | 5.33 | 1.20 | 0.003 | 0.14 | 2.3 | 4.47 | 0.001 | 1.01 | 7.93 | |
2 | 0.60 | 0.163 | −0.55 | 1.75 | 1.20 | 0.090 | −0.69 | 3.09 | 0.33 | 0.329 | −0.58 | 1.3 | 2.13 | 0.030 | −0.47 | 4.74 | ||
4 | 1 | 1.10 | 0.140 | −0.89 | 3.11 | 2.99 | 0.009 | 0.01 | 6.99 | 1.01 | 0.034 | −0.26 | 2.3 | 5.02 | 0.003 | 0.56 | 9.49 | |
2 | 1.37 | 0.040 | −0.40 | 3.15 | 1.33 | 0.225 | −1.51 | 4.02 | 0.15 | 0.748 | −1.08 | 1.4 | 2.7 | 0.073 | −1.31 | 6.68 | ||
3 | 0.80 | 0.154 | −0.68 | 2.23 | 0.06 | 0.947 | −2.28 | 2.40 | −0.19 | 0.651 | −1.29 | 0.9 | 0.6 | 0.651 | −2.73 | 3.83 | ||
3 | 2 | 1 | 0.70 | 0.229 | −0.82 | 2.15 | 0.89 | 0.328 | −1.55 | 3.33 | 0.33 | 0.449 | −0.85 | 1.5 | 1.9 | 0.133 | −1.47 | 5.25 |
3 | 1 | 2.11 | 0.005 | 0.12 | 4.10 | 2.22 | 0.056 | −0.87 | 5.31 | 0.33 | 0.516 | −1.04 | 1.7 | 4.67 | 0.006 | 0.20 | 9.13 | |
2 | 1.44 | 0.010 | −0.04 | 2.93 | 1.33 | 0.144 | −1.10 | 3.77 | 0.00 | 1.00 | −1.18 | 1.2 | 2.78 | 0.028 | −0.58 | 6.14 | ||
4 | 1 | 3.24 | 0.001 | 0.72 | 5.76 | 2.68 | 0.059 | −1.09 | 6.46 | −0.18 | 0.769 | −1.77 | 1.4 | 5.83 | 0.006 | 0.20 | 11.45 | |
2 | 2.57 | 0.002 | 0.35 | 4.80 | 1.80 | 0.167 | −1.67 | 5.36 | −0.51 | 0.377 | −2.05 | 1.0 | 3.94 | 0.037 | −1.06 | 8.93 | ||
3 | 1.10 | 0.093 | −0.66 | 2.92 | 0.46 | 0.668 | −2.43 | 3.35 | −0.51 | 0.320 | −1.88 | 0.9 | 1.2 | 0.442 | −2.88 | 5.20 |
Static Sitting Balance | Selective Motor Control | Dynamic Reaching | Total TCMS | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
GMFCS Level | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
2 | 2 | 1 | −0.14 | 0.820 | −1.83 | 1.54 | −1.29 | 0.213 | −4.05 | 1.48 | 0.14 | 0.775 | −1.20 | 1.49 | −1.30 | 0.366 | −5.10 | 2.53 |
3 | 1 | −0.14 | 0.865 | −2.40 | 2.11 | −0.29 | 0.827 | −3.79 | 3.22 | 0.00 | 1.000 | −1.56 | 1.56 | −0.40 | 0.821 | −5.49 | 4.63 | |
2 | 0.00 | 1.000 | −1.68 | 1.68 | 1.00 | 0.332 | −1.76 | 3.6 | −0.14 | 0.775 | −1.49 | 1.20 | 0.90 | 0.546 | −2.96 | 4.67 | ||
4 | 1 | 0.328 | 0.798 | −2.68 | 3.25 | 0.54 | 0.748 | −3.92 | 4.99 | 0.81 | 0.255 | −1.08 | 2.69 | 1.70 | 0.489 | −4.91 | 8.33 | |
2 | 0.403 | 0.666 | −2.22 | 3.07 | 1.82 | 0.237 | −2.29 | 5.93 | 0.66 | 0.332 | −1.16 | 2.49 | 3.0 | 0.178 | −2.94 | 8.94 | ||
3 | 0.43 | 0.600 | −1.75 | 2.60 | 0.82 | 0.530 | −2.68 | 4.32 | 0.81 | 0.191 | −0.84 | 2.45 | 2.10 | 0.244 | −2.77 | 7.06 | ||
3 | 2 | 1 | 0.20 | 0.787 | −1.79 | 2.19 | −0.40 | 0.742 | −3.67 | 2.87 | 0.20 | 0.735 | −1.39 | 1.79 | 0.00 | 1.000 | −4.51 | 4.51 |
3 | 1 | 1.00 | 0.316 | −1.67 | 3.67 | 0.00 | 1.000 | −4.15 | 4.15 | 0.40 | 0.561 | −1.44 | 2.24 | 1.40 | 0.531 | −4.59 | 7.39 | |
2 | 0.80 | 0.282 | −1.19 | 2.79 | 0.40 | 0.742 | −2.87 | 3.67 | 0.20 | 0.735 | −1.39 | 1.79 | 1.40 | 0.405 | −3.11 | 5.91 | ||
4 | 1 | 2.10 | 0.106 | −1.36 | 5.57 | 2.04 | 0.296 | −3.17 | 7.24 | 0.37 | 0.651 | −1.83 | 2.58 | 4.80 | 0.099 | −2.94 | 12.54 | |
2 | 1.90 | 0.100 | −1.18 | 4.99 | 2.44 | 0.176 | −2.36 | 7.23 | 0.17 | 0.827 | −1.96 | 2.30 | 4.80 | 0.065 | −2.12 | 11.72 | ||
3 | 1.10 | 0.241 | −1.42 | 3.62 | 2.04 | 0.180 | −2.02 | 6.10 | −0.03 | 0.970 | −1.94 | 1.89 | 3.40 | 0.111 | −2.29 | 9.09 |
1MWT | mTUG | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
GMFCS Level | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
2 | 2 | 1 | −3.23 | 0.046 | −7.55 | 1.08 | 0.10 | 0.945 | −3.82 | 4.02 |
3 | 1 | 0.59 | 0.787 | −5.27 | 6.45 | −0.66 | 0.742 | −6.03 | 4.71 | |
2 | 3.83 | 0.019 | −0.49 | 8.14 | −0.76 | 0.604 | −4.68 | 3.17 | ||
4 | 1 | 1.93 | 0.501 | −5.75 | 9.62 | −0.85 | 0.749 | −7.93 | 6.24 | |
2 | 5.17 | 0.042 | −1.60 | 11.93 | −0.95 | 0.683 | −7.15 | 5.26 | ||
3 | 1.34 | 0.511 | −4.14 | 6.82 | −0.19 | 0.92 | −5.19 | 4.81 | ||
3 | 2 | 1 | 1.78 | 0.39 | −3.79 | 7.35 | 2.38 | 0.208 | −2.68 | 7.45 |
3 | 1 | 4.45 | 0.128 | −3.35 | 12.24 | −0.92 | 0.729 | −8.07 | 6.22 | |
2 | 2.67 | 0.225 | −3.22 | 8.55 | −3.31 | 0.099 | −8.66 | 2.05 | ||
4 | 1 | 6.18 | 0.094 | −3.64 | 15.99 | −4.85 | 0.153 | −13.91 | 4.21 | |
2 | 4.39 | 0.173 | −4.22 | 13.00 | −7.23 | 0.015 | −15.14 | 0.67 | ||
3 | 1.73 | 0.492 | −5.02 | 8.47 | −3.93 | 0.088 | −10.08 | 2.22 |
1MWT | mTUG | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
GMFCS Level | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
2 | 2 | 1 | 1.05 | 0.655 | −5.27 | 7.36 | −0.27 | 0.901 | −6.01 | 5.48 |
3 | 1 | 3.78 | 0.238 | −4.79 | 12.35 | −0.67 | 0.82 | −8.53 | 7.20 | |
2 | 2.73 | 0.247 | −3.58 | 9.05 | −0.40 | 0.852 | −6.14 | 5.34 | ||
4 | 1 | 5.52 | 0.173 | −5.28 | 16.32 | 0.26 | 0.944 | −9.71 | 10.23 | |
2 | 4.47 | 0.203 | −4.92 | 13.86 | 0.53 | 0.869 | −8.08 | 9.14 | ||
3 | 1.74 | 0.527 | −5.65 | 9.13 | 0.93 | 0.712 | −5.81 | 7.66 | ||
3 | 2 | 1 | 0.73 | 0.794 | −6.75 | 8.20 | −0.67 | 0.792 | −7.46 | 6.13 |
3 | 1 | 2.45 | 0.518 | −7.70 | 12.59 | −2.64 | 0.447 | −11.94 | 6.66 | |
2 | 1.72 | 0.536 | −5.75 | 9.20 | −1.98 | 0.436 | −8.77 | 4.82 | ||
4 | 1 | 8.52 | 0.126 | −6.32 | 23.35 | −1.81 | 0.722 | −15.48 | 11.85 | |
2 | 7.79 | 0.122 | −5.63 | 21.22 | −1.15 | 0.803 | −13.45 | 11.16 | ||
3 | 6.07 | 0.160 | −5.47 | 17.61 | 0.83 | 0.833 | −9.71 | 11.37 |
Time * Approach | Qualitative Functional Approach | Functional Approach | |
---|---|---|---|
Quality Function Measure (QFM) | |||
Alignment | <0.001 | <0.001 | 0.400 |
Coordination | <0.001 | <0.001 | 0.007 |
Dissociation | <0.001 | <0.001 | 0.130 |
Stability | <0.001 | <0.001 | 0.209 |
Weight shift | <0.001 | <0.001 | 0.150 |
Gross Motor Function Measurement (GMFM) | |||
Dimension C | 0.008 | 0.003 | 0.475 |
Dimension D | 0.007 | 0.003 | 0.635 |
Dimension E | 0.097 | <0.001 | 0.087 |
Total CDE | <0.001 | <0.001 | 0.303 |
Trunk Control Measurement Scale (TCMS) | |||
Static sitting balance | 0.773 | 0.189 | 0.469 |
Selective movement control | 0.230 | 0.124 | 0.212 |
Dynamic reaching | 0.234 | 0.111 | 0.689 |
Total TCMS | 0.109 | 0.029 | 0.109 |
Gait Capacity | |||
1MWT | 0.442 | 0.146 | 0.208 |
mTUG | 0.520 | 0.201 | 0.926 |
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Qualitative Functional Approach | Functional Approach | Total Group | |||
---|---|---|---|---|---|
Number | 24 * | 12 | 36 | ||
Age (y and m) | Mean (SD) | 8 y 6 m (1.84) | 8 y 10 m (2.23) | 8 y 7 m (1.96) | |
Sex | |||||
Female | n (%) | 14 (58) | 3 (25) | 17 (47) | |
Male | n (%) | 10 (42) | 9 (75) | 19 (53) | |
GMFCS level | |||||
II | n (%) | 15 (62) | 7 (58) | 22 (61) | |
III | n (%) | 9 (37) | 5 (42) | 14 (39) | |
Lost to follow-up | n (%) | 8 (33) II: 6 (6 BoNT-A) III: 2 (1 ML, 1 SDR) | 5 (42) II: 2 (1 BoNT-A, 1 ML) III: 3 (2 ML, 1 SDR) | 13 (36) |
Approach | Baseline | Pre-Intervention | Post-Intervention | Follow-Up | Time * Approach | Qualitative Functional (1) | Functional (2) | |
---|---|---|---|---|---|---|---|---|
QFM | ||||||||
Alignment | 1 | 54.68 (28.39) | 48.57 (25.08) | 62.10 (24.68) | 54.08 (36.99) | <0.001 | <0.001 | 0.410 |
2 | 49.68 (28.15) | 52.96 (29.48) | 49.63 (31.53) | 61.53 (31.07) | ||||
Coordination | 1 | 40.15 (21.18) | 35.16 (20.48) | 45.97 (23.40) | 41.88 (24.66) | <0.001 | <0.001 | 0.009 |
2 | 42.52 (26.18) | 45.05 (26.80) | 43.51 (26.88) | 44.37 (20.60) | ||||
Dissociation | 1 | 33.38 (19.51) | 27.46 (17.07) | 36.83 (21.37) | 34.19 (22.61) | <0.001 | <0.001 | 0.095 |
2 | 35.46 (22.59) | 37.72 (23.76) | 35.18 (23.36) | 37.71 (19.98) | ||||
Stability | 1 | 34.49 (19.49) | 29.09 (18.05) | 38.80 (21.73) | 35.01 (22.13) | <0.001 | <0.001 | 0.289 |
2 | 35.10 (23.63) | 36.08 (24.62) | 34.02 (24.02) | 40.00 (20.91) | ||||
Weight shift | 1 | 37.84 (19.77) | 32.97 (18.47) | 45.33 (20.49) | 39.00 (21.43) | <0.001 | <0.001 | 0.020 |
2 | 37.74 (22.68) | 41.09 (24.28) | 39.62 (24.18) | 44.73 (22.83) | ||||
GMFM | ||||||||
Dimension C | 1 | 89.76 (15.15) | 88.10 (16.16) | 89.98 (13.95) | 86.16 (16.97) | 0.108 | 0.033 | 0.419 |
2 | 89.29 (14.27) | 90.87 (13.35) | 90.28 (14.01) | 93.20 (12.93) | ||||
Dimension D | 1 | 64.36 (25.75) | 62.71 (26.78) | 68.80 (25.61) | 62.34 (29.51) | <0.001 | <0.001 | 0.702 |
2 | 65.60 (27.19) | 65.38 (28.71) | 64.32 (27.65) | 71.79 (24.28) | ||||
Dimension E | 1 | 55.14 (26.11) | 52.26 (27.01) | 55.61 (27.62) | 53.21 (30.48) | 0.185 | <0.001 | 0.116 |
2 | 55.21 (30.80) | 57.52 (21.48) | 58.10 (32.99) | 64.88 (28.53) | ||||
Total CDE | 1 | 69.75 (21.74) | 67.69 (22.41) | 71.47 (21.59) | 67.24 (25.03) | <0.001 | <0.001 | 0.324 |
2 | 70.03 (23.39) | 71.26 (24.04) | 70.90 (23.92) | 67.62 (21.14) | ||||
TCMS | ||||||||
Static sitting balance | 1 | 14.75 (4.66) | 14.83 (4.42) | 15.75 (3.78) | 16.80 (2.93) | 0.769 | 0.006 | 0.587 |
2 | 16.33 (2.77) | 16.33 (3.03) | 16.67 (2.50) | 17.29 (1.50) | ||||
Selective movement control | 1 | 9.00 (4.76) | 10.42 (4.78) | 11.67 (4.26) | 12.13 (4.42) | 0.077 | 0.003 | 0.290 |
2 | 13.83 (5.57) | 12.92 (5.95) | 13.67 (5.07) | 14.43 (5.50) | ||||
Dynamic reaching | 1 | 0.88 (0.80) | 1.54 (1.53) | 1.75 (1.73) | 1.40 (0.91) | 0.423 | 0.041 | 0.710 |
2 | 1.33 (1.23) | 1.50 (1.51) | 1.50 (1.24) | 1.86 (2.27) | ||||
Total TCMS | 1 | 24.63 (8.95) | 26.79 (9.43) | 29.17 (8.26) | 30.33 (7.44) | 0.780 | <0.001 | 0.162 |
2 | 31.50 (9.07) | 30.75 (9.39) | 31.83 (7.78) | 33.57 (8.70) | ||||
Gait Capacity | ||||||||
1MWT | 1 | 67.72 (20.10) | 66.37 (15.85) | 70.85 (16.48) | 72.46 (16.64) | 0.679 | 0.043 | 0.272 |
2 | 69.96 (17.01) | 70.88 (18.62) | 73.19 (19.50) | 81.02 (13.51) | ||||
mTUG | 1 | 15.77 (17.32) | 16.73 (22.76) | 14.40 (15.33) | 15.05 (15.21) | 0.680 | 0.286 | 0.885 |
2 | 13.07 (12.08) | 12.64 (12.75) | 11.58 (12.76) | 9.10 (4.70) |
Alignment | Coordination | Dissociation | Stability | Weight Shift | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Approach | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
Qualitative functional | 2 | 1 | −2.30 | 0.069 | −5.76 | 1.07 | −1.20 | 0.223 | −3.73 | 1.40 | −2.84 | 0.018 | −6.03 | 0.35 | −2.05 | 0.035 | −4.64 | 0.54 | −1.24 | 0.167 | −3.63 | 1.16 |
3 | 1 | 11.23 | <0.001 | 6.78 | 15.69 | 9.65 | <0.001 | 6.23 | 13.07 | 6.53 | <0.001 | 2.32 | 10.74 | 7.67 | <0.001 | 4.23 | 11.11 | 11.13 | <0.001 | 7.95 | 14.31 | |
2 | 13.53 | <0.001 | 10.45 | 16.62 | 10.81 | <0.001 | 8.47 | 13.16 | 9.37 | <0.001 | 6.45 | 12.29 | 9.72 | <0.001 | 7.35 | 12.09 | 12.36 | <0.001 | 10.18 | 14.55 | ||
4 | 1 | 7.87 | <0.001 | 2.21 | 13.53 | 7.68 | <0.001 | 3.30 | 12.05 | 5.77 | 0.004 | 0.44 | 11.11 | 6.59 | <0.001 | 2.20 | 10.98 | 7.86 | <0.001 | 3.81 | 11.92 | |
2 | 10.17 | <0.001 | 5.42 | 14.92 | 8.85 | <0.001 | 5.20 | 12.49 | 8.62 | <0.001 | 4.13 | 13.10 | 8.64 | <0.001 | 4.97 | 12.31 | 9.10 | <0.001 | 5.71 | 12.49 | ||
3 | −3.36 | 0.017 | −7.11 | 038 | −2.00 | 0.067 | −4.83 | 0.89 | −0.75 | 0.570 | −4.30 | 2.80 | −1.10 | 0.314 | −3.96 | 1.80 | −3.26 | 0.001 | −5.93 | −0.60 | ||
Functional | 2 | 1 | 3.28 | 0.045 | −1.08 | 7.65 | 2.53 | 0.043 | −0.79 | 5.85 | 2.27 | 0.142 | −1.87 | 6.40 | 1.00 | 0.435 | −2.38 | 4.33 | 3.35 | 0.004 | 0.26 | 6.45 |
3 | 1 | −0.06 | 0.980 | −6.06 | 5.95 | 1.00 | 0.563 | −3.62 | 5.61 | −0.28 | 0.896 | −5.95 | 5.40 | −1.10 | 0.533 | −5.72 | 3.56 | 1.88 | 0.240 | −2.41 | 6.17 | |
2 | −3.34 | 0.042 | −7.07 | 1.03 | −1.50 | 0.215 | −4.86 | 1.78 | −2.54 | 0.100 | −6.68 | 1.59 | −2.10 | 0.102 | −5.40 | 1.30 | −1.47 | 0.203 | −4.57 | 1.62 | ||
4 | 1 | −1.69 | 0.571 | −9.70 | 6.32 | −3.20 | 0.174 | −9.36 | 3.04 | −2.96 | 0.295 | −10.51 | 4.59 | 0.20 | 0.938 | −6.04 | 6.40 | 0.91 | 0.670 | −4.83 | 6.66 | |
2 | −4.97 | 0.059 | −11.97 | 2.02 | −5.69 | 0.005 | −11.06 | −0.32 | −5.22 | 0.036 | −11.83 | 1.38 | −0.80 | 0.693 | −6.20 | 4.61 | −2.44 | 0.192 | −7.43 | 2.56 | ||
3 | −1.64 | 0.437 | −7.29 | 4.02 | −4.15 | 0.011 | -8.47 | 0.16 | −2.68 | 0.180 | −8.03 | 2.67 | 1.30 | 0.438 | -3.09 | 5.61 | −0.97 | 0.518 | −4.99 | 3.05 |
Dimension C | Dimension D | Dimension E | Total CDE | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Approach | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
Qualitative functional | 2 | 1 | 0.63 | 0.481 | −1.76 | 3.02 | 2.12 | 0.066 | −0.95 | 5.20 | 2.46 | 0.003 | 0.31 | 4.61 | 1.71 | 0.003 | 0.18 | 3.25 |
3 | 1 | 2.51 | 0.035 | −0.66 | 5.68 | 8.21 | <0.001 | 4.10 | 12.31 | 5.82 | <0.001 | 2.93 | 8.71 | 5.49 | <0.001 | 3.43 | 7.55 | |
2 | 1.88 | 0.022 | 0.63 | 4.07 | 6.09 | <0.001 | 3.28 | 8.90 | 3.35 | <0.001 | 1.40 | 5.32 | 3.77 | <0.001 | 2.38 | 5.18 | ||
4 | 1 | 0.69 | 0.648 | −3.35 | 4.72 | 5.15 | 0.010 | −0.12 | 10.42 | 5.01 | <0.001 | 1.30 | 8.73 | 3.60 | <0.001 | 0.94 | 6.26 | |
2 | 0.06 | 0.963 | −3.32 | 3.44 | 3.03 | 0.066 | −1.36 | 7.41 | 2.55 | 0.028 | −0.53 | 5.63 | 1.89 | 0.023 | −0.31 | 4.09 | ||
3 | −1.83 | 0.067 | −4.49 | 0.83 | −3.06 | 0.018 | −6.49 | 0.36 | −0.80 | 0.369 | −3.20 | 1.60 | −1.89 | 0.004 | −3.60 | −0.18 | ||
Functional | 2 | 1 | 1.59 | 0.170 | −1.51 | 4.68 | −0.21 | 0.885 | −4.19 | 3.76 | 2.31 | 0.027 | −0.47 | 5.10 | 1.20 | 0.097 | −0.75 | 3.21 |
3 | 1 | 0.99 | 0.533 | −3.28 | 5.26 | −1.28 | 0.535 | −6.82 | 4.26 | 2.89 | 0.048 | −1.00 | 6.79 | 0.90 | 0.403 | −1.91 | 3.65 | |
2 | −0.60 | 0.605 | −3.69 | 2.50 | −1.07 | 0.471 | −5.05 | 2.91 | 0.58 | 0.576 | −2.20 | 3.46 | −0.40 | 0.624 | −2.34 | 1.62 | ||
4 | 1 | 2.22 | 0.298 | −3.49 | 7.93 | 0.54 | 0.846 | −6.92 | 8.00 | 1.75 | 0.374 | −3.52 | 7.02 | 1.50 | 0.277 | −2.24 | 5.30 | |
2 | 0.63 | 0.732 | −4.34 | 5.61 | 0.75 | 0.754 | −5.70 | 7.21 | −0.57 | 0.737 | −5.11 | 3.97 | 0.30 | 0.802 | −2.94 | 3.54 | ||
3 | 1.23 | 0.411 | −2.78 | 5.24 | 1.82 | 0.345 | −3.45 | 7.00 | −1.15 | 0.396 | −4.77 | 2.48 | 0.70 | 0.491 | −1.92 | 3.25 |
Static Sitting Balance | Selective Motor Control | Dynamic Reaching | Total TCMS | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Approach | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
Qualitative functional | 2 | 1 | 0.08 | 0.810 | −0.85 | 1.01 | 1.42 | 0.013 | −0.09 | 2.93 | 0.67 | 0.017 | −0.07 | 1.41 | 2.17 | 0.006 | 0.10 | 4.24 |
3 | 1 | 1.00 | 0.033 | −0.25 | 2.25 | 2.67 | <0.001 | 0.75 | 4.58 | 0.87 | 0.007 | 0.02 | 1.73 | 4.54 | <0.001 | 1.79 | 7.29 | |
2 | 0.92 | 0.009 | 0.01 | 1.85 | 1.25 | 0.028 | −0.26 | 2.76 | 0.21 | 0.448 | −0.53 | 0.95 | 2.37 | 0.003 | 0.30 | 4.45 | ||
4 | 1 | 1.92 | 0.002 | 0.32 | 3.52 | 2.89 | 0.001 | 0.52 | 5.26 | 0.56 | 0.141 | −0.45 | 1.58 | 5.34 | <0.001 | 1.83 | 8.86 | |
2 | 1.83 | 0.001 | 0.41 | 3.26 | 1.48 | 0.072 | −0.71 | 3.66 | −0.11 | 0.774 | −1.08 | 0.87 | 3.18 | 0.008 | 0.04 | 6.31 | ||
3 | 0.92 | 0.035 | −0.24 | 2.07 | 0.23 | 0.742 | −1.61 | 2.06 | −0.31 | 0.337 | −1.19 | 0.56 | 0.80 | 0.402 | −1.76 | 3.36 | ||
Functional | 2 | 1 | 0.00 | 1.000 | −1.32 | 1.32 | −0.92 | 0.249 | −3.05 | 1.22 | 0.17 | 0.667 | −0.88 | 1.00 | −0.80 | 0.492 | −3.68 | 2.18 |
3 | 1 | 0.33 | 0.612 | −1.43 | 2.10 | −0.17 | 0.869 | −2.87 | 2.54 | 0.17 | 0.713 | −1.05 | 1.38 | 0.33 | 0.818 | −3.56 | 4.22 | |
2 | 0.33 | 0.497 | −1.98 | 1.65 | 0.75 | 0.346 | −1.38 | 2.99 | 0.00 | 1.000 | −1.04 | 1.04 | 1.08 | 0.322 | −1.85 | 4.01 | ||
4 | 1 | 1.05 | 0.222 | −1.25 | 3.36 | 1.16 | 0.364 | −2.25 | 4.58 | 0.61 | 0.265 | −0.85 | 2.08 | 3.01 | 0.113 | −2.05 | 8.07 | |
2 | 1.05 | 0.171 | −1.00 | 3.11 | 2.08 | 0.080 | −1.08 | 5.23 | 0.45 | 0.400 | −1.97 | 1.86 | 3.76 | 0.028 | −0.78 | 8.29 | ||
3 | 0.72 | 0.253 | −0.97 | 2.41 | 1.33 | 0.185 | −1.35 | 4.01 | 0.45 | 0.348 | −0.83 | 1.72 | 2.68 | 0.057 | −1.07 | 6.42 |
1MWT | mTUG | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Approach | Time A | Time B | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound | Mean Difference (A–B) | Significance | Lower Bound | Upper Bound |
Qualitative functional | 2 | 1 | −1.35 | 0.299 | −4.85 | 2.14 | 0.96 | 0.418 | −2.21 | 4.12 |
3 | 1 | 2.05 | 0.252 | −2.74 | 6.84 | −0.71 | 0.666 | −5.08 | 3.67 | |
2 | 3.40 | 0.012 | −0.16 | 6.97 | −1.66 | 0.170 | −4.89 | 1.57 | ||
4 | 1 | 3.57 | 0.124 | −2.61 | 9.75 | −2.38 | 0.264 | −8.06 | 3.31 | |
2 | 4.92 | 0.017 | −0.52 | 10.36 | −3.33 | 0.074 | −8.31 | 1.64 | ||
3 | 1.52 | 0.305 | −2.84 | 5.88 | −1.67 | 0.258 | −5.63 | 2.29 | ||
Functional | 2 | 1 | 0.91 | 0.619 | −4.03 | 5.86 | −0.43 | 0.795 | −4.91 | 4.05 |
3 | 1 | 3.22 | 0.199 | −3.48 | 9.93 | −1.49 | 0.515 | −7.61 | 4.64 | |
2 | 2.31 | 0.211 | −2.63 | 7.25 | −1.06 | 0.527 | −5.54 | 3.43 | ||
4 | 1 | 6.32 | 0.058 | −2.53 | 15.18 | −0.54 | 0.858 | −8.68 | 7.59 | |
2 | 5.41 | 0.065 | −2.40 | 13.22 | −0.11 | 0.967 | −7.25 | 7.03 | ||
3 | 3.10 | 0.193 | −3.27 | 9.47 | 0.95 | 0.661 | −4.84 | 6.73 |
QFM | |||||
Alignment | Coordination | Dissociation | Stability | Weight shift | |
Approach 1 | 0.54 | 0.49 | 0.49 | 0.49 | 0.63 |
Approach 2 | −0.11 | −0.06 | −0.11 | −0.08 | −0.06 |
GMFM | |||||
Dimension C | Dimension D | Dimension E | Total CDE | ||
Approach 1 | 0.13 | 0.23 | 0.12 | 0.17 | |
Approach 2 | −0.04 | −0.04 | 0.02 | −0.02 | |
TCMS | |||||
Static sitting balance | Selective motor control | Dynamic reaching | Total TCMS | ||
Approach 1 | 0.22 | 0.28 | 0.14 | 0.26 | |
Approach 2 | 0.12 | 0.14 | 0.00 | 0.13 | |
1MWT | mTUG | ||||
Approach 1 | 0.28 | 0.12 | |||
Approach 2 | 0.12 | 0.06 |
Qualitative Functional Approach | Functional Approach | |||
---|---|---|---|---|
MCD | MCID | Mean Difference | Mean Difference | |
QFM (%) | ||||
Alignment | 13.5 | / | 13.5 | −3.3 |
Coordination | 8.7 | / | 10.8 | −1.5 |
Dissociation | 8.4 | / | 9.40 | −2.5 |
Stability | 9.9 | / | 9.70 | −2.0 |
Weight shift | 8.4 | / | 12.60 | −1.5 |
GMFM (%) | ||||
Dimension C | 7.90 | / | 1.88 | −0.59 |
Dimension D | 7.23 | 6.09 | −1.07 | |
II | 3.3 | 5.46 | −1.10 | |
III | 4.1 | 6.83 | −1.03 | |
Dimension E | 4.16 | 3.36 | 0.58 | |
II | 4.5 | 4.26 | 0.99 | |
III | 3.4 | 1.85 | 0.00 | |
TCMS | ||||
Total TCMS | 6 | / | 2.38 | 1.08 |
Gait capacity | ||||
1MWT (m) | / | |||
II | 5.1 | 3.8 | 2.7 | |
III | 3.8 | 2.7 | 1.7 | |
mTUG (s) | / | |||
II | 0.7 | 0.8 | 0.4 | |
III | 1.2 | 3.3 | 2.0 |
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van Tittelboom, V.; Heyrman, L.; De Cat, J.; Algoet, P.; Peeters, N.; Alemdaroğlu-Gürbüz, I.; Plasschaert, F.; Van Herpe, K.; Molenaers, G.; De Bruyn, N.; et al. Intensive Therapy of the Lower Limbs and the Trunk in Children with Bilateral Spastic Cerebral Palsy: Comparing a Qualitative Functional and a Functional Approach. J. Clin. Med. 2023, 12, 4078. https://doi.org/10.3390/jcm12124078
van Tittelboom V, Heyrman L, De Cat J, Algoet P, Peeters N, Alemdaroğlu-Gürbüz I, Plasschaert F, Van Herpe K, Molenaers G, De Bruyn N, et al. Intensive Therapy of the Lower Limbs and the Trunk in Children with Bilateral Spastic Cerebral Palsy: Comparing a Qualitative Functional and a Functional Approach. Journal of Clinical Medicine. 2023; 12(12):4078. https://doi.org/10.3390/jcm12124078
Chicago/Turabian Stylevan Tittelboom, Vanessa, Lieve Heyrman, Josse De Cat, Patrick Algoet, Nicky Peeters, Ipek Alemdaroğlu-Gürbüz, Frank Plasschaert, Katrin Van Herpe, Guy Molenaers, Nele De Bruyn, and et al. 2023. "Intensive Therapy of the Lower Limbs and the Trunk in Children with Bilateral Spastic Cerebral Palsy: Comparing a Qualitative Functional and a Functional Approach" Journal of Clinical Medicine 12, no. 12: 4078. https://doi.org/10.3390/jcm12124078