Search Results (36)

Background/Objectives: Constraint-induced movement therapy (CIMT) and bimanual training (BIT) have been commonly used to improve upper limb (ULF) in paediatric populations. This study aimed to compare the efficacy of CIMT and BIT for the recovery of ULF in youth with unilateral cerebral palsy (CP) in the immediate, short, and long term. Methods: A systematic review with a meta-analysis of randomised controlled trials (RCTs) from the PubMed/Medline, Scopus, Web of Science, and PEDro databases was conducted. The primary outcomes were the immediate, short-, and long-term effects on ULF, and the secondary outcomes were related to occupational performance and disability. The risk of bias was assessed using the Cochrane RoB 2.0 tool by two researchers independently. Meta-analyses were performed using RevMan 5.3. Results: From the 174 records obtained, 10 RTCs comprising 418 participants were included. Favourable results were observed immediately after intervention for CIMT regarding unimanual ULF using the Quality of Upper Extremity Test (QUEST) (SMD = 1.08; 95% CI = (0.66;1.50)) and Jebsen–Taylor Hand Function Test (JTHFT) (SMD = −0.62; 95% CI = (−1.23;0.00)). These results were maintained in the short term for the QUEST for dissociated movements (SMD = 1.19; 95% CI = (0.40;1.99)) and in the long term for the JTHFT (SMD = −0.38; 95% CI = (−1;0.24)). Conversely, favourable results were obtained immediately after the intervention for BIT regarding bimanual ULF using the Assisting Hand Assessment (SMD = −0.42; 95% CI = (−0.78–0.05)). Conclusions: CIMT could be more effective for improving unimanual ULF and BIT in youth with unilateral CP. The differences between the interventions decreased in the long term. Nevertheless, these findings should be interpreted with caution due to the variability in the intervention programmes. Further research with standardised protocols is needed. Full article

Aim: This study explores the effects of core stabilization exercises on balance and upper extremity functions—both unilateral and bilateral—in children with cerebral palsy (CP). Method: Thirty-six children with CP (aged 5–12) were randomly assigned to a study group (n = 18) or control group (n = 18). Both groups received four weeks of physiotherapy and occupational therapy. The study group additionally performed ~45 min of daily core stabilization exercises. Outcome measures included the Box and Block Test (BBT), Assisting Hand Assessment (AHA), Pediatric Berg Balance Scale (PBBS), and Trunk Control Measurement Scale (TCMS). (ClinicalTrials.gov ID: NCT06973213). Results: No significant baseline differences were found between the groups (p > 0.05). Post-intervention, the study group showed significant improvements in PBBS (p = 0.011), TCMS static sitting (p = 0.003), dynamic reaching (p = 0.037), and total score (p = 0.044). Between-group differences remained non-significant for BBT, AHA, and TCMS selective movement control (p > 0.05). Within-group analysis revealed significant gains in BBT (median = 7), PBBS (median = 8), TCMS total (median = 12), static sitting (median = 3.5), and selective movement (median = 6) (all p < 0.001). AHA showed a near-significant trend (median = 6, p = 0.051). Conclusions: Core stabilization exercises significantly enhance balance and unilateral upper extremity function in children with CP. However, they show limited impact on bimanual function. Integration of these exercises into rehabilitation programs may optimize motor outcomes. Full article

Background/Objectives: The steady increase in the global older adult population highlights critical challenges, including the development of preventive strategies to extend healthy life expectancy and support independence in activities of daily living. Although there is an aging-related reduction in manual dexterity, the difference in bimanual coordination performance between young and older adults remains unclear. We aimed to elucidate the characteristics of bimanual coordination among young, young-old, and old-old adult participants. Methods: The participants performed in-phase (tapping the thumb and index finger together as fast as possible) and anti-phase (alternating movement between the left and right fingers) bimanual coordination tasks, and intergroup comparison of the task parameters was performed. The receiver operating characteristic curve was also conducted to calculate age cut-off points for bimanual coordination. Results: The number and frequency of taps significantly decreased sequentially in young, young-old, and old-old adults, whereas the average of tap interval significantly increased in this order (p < 0.05). There was no significant difference between the young-old and old-old groups in the average local maximum distance (p > 0.05). These findings indicate that bimanual coordination task performance varies depending on specific parameters. Furthermore, the age cut-off points for bimanual coordination were determined as 68.5 years for the right-hand number of taps (AUC = 0.73) in the anti-phase task, 73.5 years for the right-hand average of tapping interval (AUC = 0.72) in the anti-phase task, and 65.5 years for the left-hand frequency of taps (AUC = 0.72) of the anti-phase task. Conclusions: the number of taps, average of tapping interval, and frequency of taps are potential indicators of aging-related changes in bimanual coordination. Full article

Background/Objectives: There is high-level research evidence supporting task-focused upper limb therapy models for children with unilateral cerebral palsy (CP). However, a knowledge gap exists in understanding how to effectively implement distributed practice approaches in clinical practice and the effect on the development of bimanual performance. This study aims to evaluate clinical outcomes, examine key considerations for implementation outcomes, and propose a Model of Care for children with unilateral CP. Methods: A mixed-methods approach was applied, including a retrospective case series with an observational descriptive design. A convenience sample of nine children (<5 years of age) with unilateral CP who received multiple blocks of distributed, evidence-based upper limb therapy approaches between 2014 and 2020 were included. Outcomes were evaluated using the Assisting Hand Assessment family of assessments. A Model of Care framework was informed by the Updated Consolidated Framework for Implementation Research and the Conceptual Model for Implementation Research. Results: A total of 59 blocks of upper limb therapy (10 mCIMT and 49 bimanual therapy) were delivered, ranging from two to nine blocks (mean = 6.6) for each child. All children demonstrated improved outcomes in bimanual performance with an average change of 14 AHA units (range 1–22). Barriers to implementation included complexity and cost. Facilitators included the evidence base and adaptability of the approaches that allowed clinicians to respond to an individual child and family’s needs. Informed by evidence-based protocols and visual analysis of data, and in consideration of the barriers and/or facilitators to implementation from this study, a Model of Care for implementation of upper limb distributed practice approaches for children with unilateral CP in clinical practice is proposed. Conclusions: Implementing repeated, distributed blocks of evidence-based upper limb therapy in a clinical setting for children with unilateral CP led to incremental improvements in bimanual performance. There are a range of barriers and facilitators to the implementation of distributed practice approaches in clinical practice. The Model of Care outlines best practice care and service delivery for children with unilateral CP and their families and aims to support clinical practice and the future examination of implementation-effectiveness in practice. Full article

Early detection and rehabilitation interventions are essential to optimise motor function in infants and young children with unilateral cerebral palsy. In this paper we report a clinical framework aimed at enhancing upper limb therapy for infants and young children with unilateral cerebral palsy during a sensitive period of brain development. We describe two major therapeutic approaches based on motor learning principles and evidence: constraint-induced movement therapy and bimanual therapy. These two therapies have demonstrated efficacy in older children and emerging evidence is available for their application to infants younger than 2 years of age. To provide clinicians with guidance as to when to implement these therapies, we discuss the key consideration when undertaking upper limb therapy programs. In addition, we describe the factors to consider when choosing which approach may be suitable for an individual child and family. Detailed strategies for implementing these therapies in infants and young children of different ability levels are given. Full article

Background/Objectives: This quasi-experimental study examined the effectiveness of an intensive, group-based pediatric constraint-induced movement therapy (pCIMT) program for young children. Methods: Thirty-five children aged 21 months to 6 years, with unilateral hemiparesis (HP), or weakness on one side of the body from varying etiologies, participated in a 4-week intensive, interprofessional, theme- and group-based pCIMT clinic program in the Midwest, United States. The program ran for 4 weeks with 3 h of therapy per day, 5 days per week with 3 weeks of 24 h casting for the unaffected arm, followed by 1 week of bimanual focus. Outcome measures included the Quality Upper Extremity Skills Test (QUEST), Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure (COPM), and Pediatric Evaluation of Disability Inventory (PEDI). Results: The participants statistically significantly improved the unilateral function of the HP arm in four of five QUEST variables (p < 0.009), bimanual coordination as measured by the AHA (p < 0.001), and some areas of occupational performance as measured by the COPM (p < 0.001) and PEDI (p < 0.05). Conclusions: This study revealed the intensive, group-based pCIMT clinic model was effective and feasible to implement with the support from various stakeholders. Full article

(1) Background: Obstetric brachial plexus palsy (OBPP) is an unpredictable and unpreventable neurological injury, caused by shoulder dystocia during birth, that affects the brachial plexus and leads to motor and sensory deficits in the child’s upper extremity. The limited literature on early therapeutic assessment of newborns with OBPP highlights a gap in specialized care that, if filled, could enhance decision-making and support timely treatment. The objective of this paper is to analyze the therapeutic intervention techniques used at an early stage and their functional impact, from the occupational therapy discipline in the treatment of the upper extremity in babies and children with OBPP. (2) Method: Systematic review design and meta-analysis. A systematic review is a comprehensive analysis of existing research on a specific topic, using rigorous methods to identify, evaluate, and synthesize studies. Meta-analysis, often part of a systematic review, combines results from multiple studies to identify overall trends and enhance reliability, providing a clearer summary of evidence. Articles that included pediatric patients (from birth to 12 years of age) with a diagnosis of OBPP were reviewed. The results of the techniques used were analyzed according to each study, with the scale or method of assessment considered by the study for the presentation of data. The articles were assessed for methodological quality using the “PEDro Validity Scale”. (3) Results: A total of 2190 articles were found, with 108 analyzed and 22 fully meeting this study’s standards. Fourteen had a quantitative design, while the others included clinical guidelines. The most statistically reliable intervention techniques were CIMT (constraint-induced movement therapy) and splinting (dynamic and static), with second-tier techniques like joint manipulation, NMES, early infant management education, and serial casting used when needed. This study focused on children from birth to eight years old, with assessment tools primarily measuring upper limb range of motion, external rotation, supination, and impairment levels, though bimanual activity assessment was less common. (4) Conclusions: The early implementation of the techniques that provide us with the most data are CIMT, splinting, NMES, and joint manipulation linked to health education for families. In second place, we have the use of TB infiltrations and serial casts, when the treatment of the previous techniques fails in some cases. Full article

Arm and hand function play a critical role in the successful completion of everyday tasks. Lost function due to neurological impairment impacts millions of lives worldwide. Despite improvements in the ability to assess and rehabilitate arm deficits, knowledge about underlying sources of impairment and related sequela remains limited. The comprehensive assessment of function requires the measurement of both biomechanics and neuromuscular contributors to performance during the completion of tasks that often use multiple joints and span three-dimensional workspaces. To our knowledge, the complexity of movement and diversity of measures required are beyond the capabilities of existing assessment systems. To bridge current gaps in assessment capability, a new exoskeleton instrument is developed with comprehensive bilateral assessment in mind. The development of the BiLateral Upper-limb Exoskeleton for Simultaneous Assessment of Biomechanical and Neuromuscular Output (BLUE SABINO) expands on prior iterations toward full-arm assessment during reach-and-grasp tasks through the development of a dual-arm and dual-hand system, with 9 active degrees of freedom per arm and 12 degrees of freedom (six active, six passive) per hand. Joints are powered by electric motors driven by a real-time control system with input from force and force/torque sensors located at all attachment points between the user and exoskeleton. Biosignals from electromyography and electroencephalography can be simultaneously measured to provide insight into neurological performance during unimanual or bimanual tasks involving arm reach and grasp. Design trade-offs achieve near-human performance in exoskeleton speed and strength, with positional measurement at the wrist having an error of less than 2 mm and supporting a range of motion approximately equivalent to the 50th-percentile human. The system adjustability in seat height, shoulder width, arm length, and orthosis width accommodate subjects from approximately the 5th-percentile female to the 95th-percentile male. Integration between precision actuation, human–robot-interaction force-torque sensing, and biosignal acquisition systems successfully provide the simultaneous measurement of human movement and neurological function. The bilateral design enables use with left- or right-side impairments as well as intra-subject performance comparisons. With the resulting instrument, the authors plan to investigate underlying neural and physiological correlates of arm function, impairment, learning, and recovery. Full article

Individual grip strength provides a functional window into somatosensory processes and their effects on motor behaviour in healthy, impaired, and ageing individuals. Variations in grip strength during hand–tool interaction are therefore exploited in a variety of experimental tasks to study the effects of pathology or ageing-related changes on sensory, motor, and cognitive ability. However, many different factors may influence individual grip strength systematically in a given task context without being explicitly identified and controlled for. Grip strength may vary as a function of the location of the measurement device (sensor) on the fingers/hand, the shape, weight and size of object(s) being gripped, the type of grip investigated (static versus dynamic grip), and the hand (dominant versus non-dominant) used for gripping. This study tests for additional factors such as sight, sound, and interactions with/between any of the other factors in a complex task context. A wearable biosensor system, designed for measuring grip strength variations in operators gripping cylindrical objects bi-manually, was used. Grip force signals were recorded from all sensors of the wearable (glove) system, including three directly task-relevant sensors for bi-manually gripping cylindrical objects with the dominant and non-dominant hands. Five young male participants were tested for the effects of sound, movement, and sight on grip strength. The participants had to pick up two cylindrical objects of identical size and weight, then hold them still (static grip) or move them upwards and downwards (dynamic grip) for ten seconds while listening to soft or hard music, with their eyes open or blindfolded. Significant effects of sensor location, hand, movement, sight, and sound on bi-manual grip strength were found. Stronger grip force signals were produced by task-relevant sensors in the dominant hand when moving the cylindrical handles (dynamic grip) in comparison with the static grip condition, depending, as expected, on whether grip signals were measured from the dominant or the non-dominant hand. Significantly weaker grip strength was produced blindfolded (sight condition), and grips were significantly stronger with exposure to harder music (sound factor). It is concluded that grip strength is significantly influenced by sensory factors and interactions between the other factors tested for, pointing towards the need for identifying and systematically controlling such potential sources of variation in complex study task contexts. Full article

Children with unilateral cerebral palsy (UCP) require task-oriented practice several hours per week to produce meaningful gains in affected upper extremity (UE) motor function. Clinicians find it challenging to provide services at the required intensity and sustain child engagement. This pilot study assessed the acceptance and utility of a child-friendly program using dual-joystick-operated ride-on toys incorporated into an intensive UE rehabilitation camp. Eleven children with UCP between four and 10 years received ride-on-toy navigation training for 20–30 min/day, five days/week, for three weeks as part of camp programming. We report session adherence and percent time children spent in task-appropriate attention/engagement across sessions. The overall effects of camp programming on children’s motor function were assessed using the Shriner’s Hospital Upper Extremity Evaluation (SHUEE) from pretest to posttest and using training-specific measures of bimanual UE use and navigational accuracy. Children showed excellent adherence and sustained task-appropriate engagement across sessions. The combined program led to improved navigational accuracy (p-values $\le$ 0.007) as well as spontaneous affected UE use during bimanual activities outside the training context (p < 0.001). Our pilot study provides promising evidence for using modified, commercially available ride-on toys to incentivize rehabilitation and boost repetitive, task-oriented UE practice among children with UCP. Full article

The pilot study assessed the utility of a training program using modified, commercially available dual-joystick-operated ride-on toys to promote unimanual and bimanual upper extremity (UE) function in children with cerebral palsy (CP). The ride-on-toy training was integrated within a 3-week, intensive, task-oriented training camp for children with CP. Eleven children with hemiplegia between 4 and 10 years received the ride-on-toy training program 20–30 min/day, 5 days/week for 3 weeks. Unimanual motor function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the camp. During ride-on-toy training sessions, children wore activity monitors on both wrists to assess the duration and intensity of bimanual UE activity. Video data from early and late sessions were coded for bimanual UE use, independent navigation, and movement bouts. Children improved their total and subscale QUEST scores from pretest to post-test while increasing moderate activity in their affected UE from early to late sessions, demonstrating more equal use of both UEs across sessions. There were no significant changes in the rates of movement bouts from early to late sessions. We can conclude that joystick-operated ride-on toys function as child-friendly, intrinsically rewarding tools that can complement conventional therapy and promote bimanual motor functions in children with CP. Full article

In this contribution, we propose a hybrid interaction technique that integrates near-field and object-space interaction techniques for manipulating objects at a distance in virtual reality (VR). The objective of the hybrid interaction technique was to seamlessly leverage the strengths of both the near-field and object-space manipulation techniques. We employed bimanual near-field metaphor with scaled replica (BMSR) as our near-field interaction technique, which enabled us to perform multilevel degrees-of-freedom (DoF) separation transformations, such as 1~3DoF translation, 1~3DoF uniform and anchored scaling, 1DoF and 3DoF rotation, and 6DoF simultaneous translation and rotation, with enhanced depth perception and fine motor control provided by near-field manipulation techniques. The object-space interaction technique we utilized was the classic Scaled HOMER, which is known to be effective and appropriate for coarse transformations in distant object manipulation. In a repeated measures within-subjects evaluation, we empirically evaluated the three interaction techniques for their accuracy, efficiency, and economy of movement in pick-and-place, docking, and tunneling tasks in VR. Our findings revealed that the near-field BMSR technique outperformed the object space Scaled HOMER technique in terms of accuracy and economy of movement, but the participants performed more slowly overall with BMSR. Additionally, our results revealed that the participants preferred to use the hybrid interaction technique, as it allowed them to switch and transition seamlessly between the constituent BMSR and Scaled HOMER interaction techniques, depending on the level of accuracy, precision and efficiency required. Full article

Various accelerometry protocols have been used to quantify upper extremity (UE) activity, encompassing diverse epoch lengths and thresholding methods. However, there is no consensus on the most effective approach. The aim of this study was to delineate the optimal parameters for analyzing accelerometry data to quantify UE use in individuals with unilateral cerebral palsy (CP). Methods: A group of adults with CP (n = 15) participated in six activities of daily living, while a group of children with CP (n = 14) underwent the Assisting Hand Assessment. Both groups performed the activities while wearing ActiGraph GT9X-BT devices on each wrist, with concurrent video recording. Use ratio (UR) derived from accelerometry and video analysis and accelerometer data were compared for different epoch lengths (1, 1.5, and 2 s) and activity count (AC) thresholds (between 2 and 150). Results: In adults, results are comparable across epoch lengths, with the best AC thresholds being ≥ 100. In children, results are similar across epoch lengths of 1 and 1.5 (optimal AC threshold = 50), while the optimal threshold is higher with an epoch length of 2 (AC = 75). Conclusions: The combination of epoch length and AC thresholds should be chosen carefully as both influence the validity of the quantification of UE use. Full article

Robot-assisted bilateral arm training has demonstrated its effectiveness in improving motor function in individuals post-stroke, showing significant enhancements with increased repetitions. However, prolonged training sessions may lead to both mental and muscle fatigue. We conducted two types of robot-assisted bimanual wrist exercises on 16 healthy adults, separated by one week: long-duration, low-resistance workouts and short-duration, high-resistance exercises. Various measures, including surface electromyograms, near-infrared spectroscopy, heart rate, and the Borg Rating of Perceived Exertion scale, were employed to assess fatigue levels and the impacts of exercise intensity. High-resistance exercise resulted in a more pronounced decline in electromyogram median frequency and recruited a greater amount of hemoglobin, indicating increased muscle fatigue and a higher metabolic demand to cope with the intensified workload. Additionally, high-resistance exercise led to increased sympathetic activation and a greater sense of exertion. Conversely, engaging in low-resistance exercises proved beneficial for reducing post-exercise muscle stiffness and enhancing muscle elasticity. Choosing a low-resistance setting for robot-assisted wrist movements offers advantages by alleviating mental and physiological loads. The reduced training intensity can be further optimized by enabling extended exercise periods while maintaining an approximate dosage compared to high-resistance exercises. Full article

The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand–arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using standardized hand function tests. We found that accelerometer variables increased significantly during HABIT, indicating increased bimanual symmetry and intensity. Post-HABIT, children demonstrated significant improvements in all accelerometer metrics, reflecting real-world performance gains. Children also achieved significant and clinically relevant changes in hand capacity following HABIT. Therefore, our findings suggest that accelerometers can objectively quantify bimanual movement intensity during HABIT. Moreover, HABIT enhances hand function as well as activities and participation in real-world situations in children with UCP. Full article