Escolar Documentos
Profissional Documentos
Cultura Documentos
Abstract
This preliminary study is on the effect of Keywords : Cerebral palsy, Adaptive seating,
forward-tilting of the seat-surface on arm-hand Forward-tilting seat, Arm-hand mobility
function of young children with cerebral palsy (CP).
Five children were recruited (two females, three Clinical Messages:
males; median age 2 years 7 months). Inclusion The preliminary study suggests that 10 to
criteria: preschool age, bilateral spastic CP 20 degrees forward tilting of the seat surface with
with truncal hypotonia, Gross Motor Function additional foot support may enhance arm-hand
function in preschool children with bilateral spastic
served as their own controls. Adaptive seating with cerebral palsy
three wedge-inserts inducing 10, 20 or 30 degrees
forward-tilt of the seat-surface was used. The tilt Introduction
which induced best postural stability and alignment
was applied. Arm mobility was assessed three impaired development of motor control causing
times with one week intervals. Arm-hand function activity limitation (Beckung & Hagberg, 2002;
was assessed using the upper limb physicians rating Hadders-Algra & Carlberg, 2008). Postural
dysfunctions play a pivotal role in motor
and forward tilt condition (FW), 10 minutes per impairments (Hadders-Algra & Carlberg, 2008;
condition in random order. Two children were
tested with 10-degree FW tilted seating, three devices are used to assist postural control and to
enhance functional activities of children with CP.
higher in FW [dominant arm: 19.73 (1.94), non-
dominant arm: 16.53 (2.21)] than in H condition
[dominant arm: 17.93 (1.92), non-dominant arm: studies reported that forward tilting of the
13.73 (2.52)]. ANOVA demonstrated an effect of seat-surface improved reaching and grasping
condition (dominant arm: p=0.001, non-domi-
nant arm: p=0.009), but not of the testing session Myhr & von Wendt, 1991; Myhr, Wendt, von
(dominant arm: p=0.970, non-dominant arm:
p=0.724). Therefore, forward-tilting of the seat- Bablich, Milner, & Lotto, 1991). Yet, only
surface may enhance arm-hand function in McClenaghan and colleagues (1992) indicated that
preschool children with Bi-CP. especially 5-degree backward tilting was associated
International Journal of Child
Development and Mental Health CDMH 11
Vol. 5 No. 2 February July 2017 (11-21)
contrasts with our daily physical therapy practice, with a primary diagnosis of CP from May to August
where we have the impression that young children
children with CP aged 1 to 4 years (two females,
seat-surface in daily-life situations. three males; median age 2 year 7 month) was
-
visual impairment and severe communication were recorded by two cameras with a frontal
problems. All parents signed a form of consent. and lateral view (side of the tested arm). The
hand which the child preferred to use to draw or
Procedure
angle was developed. With a wedge insert, the developed for the evaluation of change in arm
seat angle could be set at three different angles, movement patterns in children with CP during
i.e., at 10-, 20- or 30-degree forward tilt. First, spontaneous behaviour (Graham, Aoki, Autti-Ramo,
Boyd, Delgado & Deborah, et al., 2000). In the
determined the childs best degree of forward
tilting on the basis of the following criteria: The set of three playing conditions. The conditions
presence of the wedge should result in (a)
stable sitting with the head and trunk as upright
Table 3). The conditions consisted of (a) a childrens
in front of the line through the ischial tuberosities; book; (b) cubes and a cup; and (c) a ball. The
(c) weight bearing on the pelvis and feet. The child
was placed in front of a grid line mirror for posture assessor who was a Bachelor undergraduate
checking. Arm mobility was assessed three
situation resulted in spontaneously generated
scheduled in the morning with each individuals
session taking place at the same time of the day.
started to open the book. This allowed for
three-week period, participants attended daily
rehabilitation sessions from Monday to Friday.
During each session, arm-hand performance cubes and cup, the child often started to put the
was tested with the Upper Limb Physicians Rating cubes into the cup, allowing for assessment of
Delgado & Deborah, et al., 2000). in two seating introduced by putting the ball in three different
conditions, 10 minutes per condition: (1) positions, thus eliciting reaches to the midline and
condition H, in which seat-surface was oriented to both sides.
On the basis of the video recording, the
which the childs best degree of forward tilting
run for each arm separately, with the right and left sessions) were assessed in random order by a
selected to be a masked assessor. The other in the FW [dominant arm: 20 (16-22), non-
dominant arm: 16 (11-21)] than in the H condition
video-recording. [dominant arm: 17 (13-21), non-dominant arm: 13
Variables S1 S2 S3 S4 S5
(F, M) F M M F M
Handedness L R L R L
Weight (kg) 15 11 15 11 14
Height (cm) 84 83 87 85 103
degrees of forward tilting of seat-surface, UE= upper extremity, R= The Right handedness, L= The Left
handedness, GA= gestational age at birth (median = 28 wk GA), median weight = 14 kg, median height
Table 3: et al.,
2000) (In brackets: playing conditions eliciting spontaneous behaviour of ULPRS parameters, designed
activities used in this preliminary study)
ADL = Activity daily living
Parameter Scores
1. Active elbow extension (normal 180) >10 reduction 0
(reach out in midline) 010 reduction 1
No reduction 2
None 0
None 0
supinates) (open a book) Under mid-position 1
To mid-position, 2
Past mid-position 3
None 0
Under mid-position 1
To mid-position, 2
Mid-position: palm level with forearm Past mid-position 3
(grasp & release a cube/a ball/ put a cube in a cup)
Parameter Scores
5 movement) With ulnar deviation 0
(throw a ball) With radial deviation 0
Neutral 1
6. Finger opening 0
(grasp & release a cube/a ball) With wrist in neutral position 1
2
Total scores = 24
Discussions Limitation
This exploratory preliminary study indicated
that the FW condition was associated with a
with no effect of testing sessions. A latter result a parametric test and thus not optimal for the
indicated that a repeated measure on these seating present set of data, but it was the only way to
conditions did not affect participants learning of get some idea of the effect of multiple testing.
a task. Our results are in agreement with several
studies (Miedaner, 1990; Myhr & von Wendt,
1991; Myhr, Wendt, von Norrlin & Radell, 2008; needed to evaluate the exact nature of the effect
of FW tilting of the seat surface in children with CP,
Also, McClenaghan, Thombs & Milner. (1992) found on arm-hand function and postural performance.
These studies should address the effect of
one, which could be related to the minor degree additional foot support and include children with
of FW tilting, i.e., 5 degrees. However, Reid and bilateral and unilateral spastic CP.
In conclusion, our preliminary study
15-degree FW tilting, presumably due to the suggests that FW tilting of the seat-surface may
limited power of the studies (Reid, 2008; Reid, enhance arm-hand function in preschool children
References
Angsupaisal, M., Maathuis, C.G.B., & Hadders-Algra, palsy. Dev Med Child Neurol, 48:95053.
M. (2015). Adaptive seating systems in Myhr, U., & von Wendt, L. (1991). Improvement of
children with severe cerebral palsy across functional sitting positions for children with
cerebral palsy. Dev Med Child Neurol, 33, 246-56.
Disability and Health for Children and Youth
version domains: a systematic review. Dev (1995). Five-year follow-up of functional
Med Child Neurol, 57:919-31. position in children with cerebral palsy. Dev
Beckung, E., & Hagberg, G. (2002). Neuroimpair- Med Child Neurol, 37, 587-96.
ments, activity limitations, and participation
restrictions in children with cerebral palsy. upper extremity function in children with
44(5), 309-16. cerebral palsy. Physical Therapy, 67, 1209-12.
Nwaobi, O. M., Brubaker, C. E., Cusick, B., &
N., Delgado, M. R., Deborah, J., et al. (2000).
Recommendations for the use of botulinum investigation of extensor activity in cerebral-
toxin type A in the management of cerebral palsied children in different seating positions.
palsy. Gait Posture, 11, 67-79. Dev Med Child Neurol, 25, 175-83.
Hadders-Algra, M., & Carlberg, E. B. (2008). Postural
control: a key issue in developmental Wood, E., & Galuppi, B. (1997). Development
disorders. In M. Hadders-Algra & E. Brogren and reliability of a system to classify gross
Carlberg (Eds.), Clinics in Developmental motor function in children with Cerebral Palsy.
Medicine No. 179. Dev Med Child Neurol, 39, 214-23.
Hadders-Algra, M., van der Heide, J. C., Fock, J. M.,
Postural Control During Reaching in Preterm with Cerebral Palsy. Yonsei Med J, 56(1), 271
Children With Cerebral Palsy. Physical Therapy,
87(7), 861-71. Reid, D. T. (1996). The effects of the saddle seat on
McClenaghan, B. A., Thombs, L., & Milner, M. (1992). seated postural control and upper-extremity
Effect of seat-surface inclination on postural movement in children with cerebral palsy. Dev
stability and function of the upper extremities Med Child Neurol, 38, 805-15.
of children with cerebral palsy. Dev Med Child
Neurol, 34, 40-48. Instrumentation and a Protocol for
Miedaner, J. (1990). The effects of sitting positions
on trunk extension for children with motor Children With and Without Cerebral Palsy in
impairment. Pediatric Physical Therapy, 2, 11-4. Neurorehabilitation and
Neural Repair, 6(1), 25-34.
PL. (2006). Reliability of the manual ability