Intensive Therapy of the Lower Limbs and the Trunk in Children with Bilateral Spastic Cerebral Palsy: Comparing a Qualitative Functional and a Functional Approach.

Few studies have examined the effect of intensive therapy on gross motor function and trunk control in children with cerebral palsy (CP). This study evaluated the effects of an intensive burst of therapy on the lower limbs and trunk by comparing qualitative functional and functional approaches. This study was designed as a quasi-randomized, controlled, and evaluator-blinded trial.

Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy.

The aim of this paper is to provide a clinically applicable overview of different tone reducing modalities and how these can interact with or augment concurrent physical therapy (PT). Botulinum toxin (BoNT), oral tone-regulating medication, intrathecal baclofen (ITB), and selective dorsal rhizotomy are discussed within a physiotherapeutic context and in view of current scientific evidence. We propose clinical reasoning strategies to identify treatment goals as well as the appropriate and corresponding treatment interventions.

Influence of the spatial heterogeneity in tick abundance in the modeling of the seasonal activity of Ixodes ricinus nymphs in Western Europe.

The seasonal weather-driven activity of the tick Ixodes ricinus is frequently explored using multisite surveys. This study aimed to investigate the statistical modeling of seasonal trends in the activity of I. ricinus nymphs when both the influence of abiotic factors and spatial heterogeneity were taken into account.

Identification of joint patterns during gait in children with cerebral palsy: a Delphi consensus study.

Aim: This study aims to achieve an international expert consensus on joint patterns during gait for children with cerebral palsy (CP) by means of Delphi surveys.

Method: In Stage 1, seven local experts drafted a preliminary proposal of kinematic patterns for each lower limb joint in the sagittal, coronal, and transverse plane. In Stage 2, 13 experts from eight gait laboratories (four in the USA and four in Europe), participated in a Delphi consensus study.

An evaluator-blinded randomized controlled trial evaluating therapy effects and prognostic factors for a general and an individually defined physical therapy program in ambulant children with bilateral spastic cerebral palsy.

Background: Cerebral palsy (CP) is characterized by a heterogeneous nature with a variety of problems. Therefore, individualized physical therapy might be more appropriate to address the needs for these children.

Aim: The first aim was to compare the effectiveness of an individually-defined therapy program (IT) and a general therapy program (GT) on gait and gross motor function in children with CP.

Maxwell's color statistics: from reduction of visible errors to reduction to invisible molecules.

This paper presents a cross-disciplinary and multi-disciplinary account of Maxwell's introduction of statistical models of molecules for the composition of gases. The account focuses on Maxwell's deployment of statistical models of data in his contemporaneous color researches as established in Cambridge mathematical physics, especially by Maxwell's seniors and mentors. The paper also argues that the cross-disciplinary, or cross-domain, transfer of resources from the natural and social sciences took place in both directions and relied on the complex intra-disciplinary, or intra-domain, dynamics of Maxwell's researches in natural sciences, in color theory, physical astronomy, electromagnetism and dynamical theory of gases, as well as involving a variety of types of communicating and mediating media, from material objects to concepts, techniques and institutions.

A study of whether video scoring is a reliable option for blinded scoring of the Gross Motor Function Measure-88.

Objective: To investigate the agreement between live and video scores of the Gross Motor Function Measure-88.

Design: Reliability study.

Subjects: Forty children with bilateral spastic cerebral palsy.

A randomized, single-blind cross-over design evaluating the effectiveness of an individually defined, targeted physical therapy approach in treatment of children with cerebral palsy.

Objective: A pilot study to compare the effectiveness of an individual therapy program with the effects of a general physical therapy program.

Design: A randomized, single-blind cross-over design.

Participants: Ten ambulant children with bilateral spastic cerebral palsy, age four to nine years.

A clinical decision framework for the identification of main problems and treatment goals for ambulant children with bilateral spastic cerebral palsy.

The primary aim of the study was to investigate how a clinical decision process based on the International Classification of Function, Disability and Health (ICF) and the Hypothesis-Oriented Algorithm for Clinicians (HOAC-II) can contribute to a reliable identification of main problems in ambulant children with cerebral palsy (CP). As a secondary aim, to evaluate how the additional information from three-dimensional gait analysis (3DGA) can influence the reliability. Twenty-two physical therapists individually defined the main problems and specific goals of eight children with bilateral spastic CP.

Can the Dyskinesia Impairment Scale be used by inexperienced raters? A reliability study.

Background: The Dyskinesia Impairment Scale (DIS) is a new scale for measuring dystonia and choreoathetosis in dyskinetic Cerebral Palsy (CP). Previously, reliability of this scale has only been assessed for raters highly experienced in discriminating between dystonia and choreoathetosis.

Aims: The aims of this study are to examine the reliability of the DIS used by inexperienced raters, new to discriminating between dystonia and choreoathetosis and to determine the effect of clinical expertise on reliability.

The evidence-base for conceptual approaches and additional therapies targeting lower limb function in children with cerebral palsy: a systematic review using the ICF as a framework.

Objective: This systematic review provides an overview of the effectiveness of conceptual approaches and additional therapies used in lower limb physical therapy of children with cerebral palsy and supports the development of clinical guidelines.

Data Sources And Study Selection: A literature search in 5 electronic databases was performed, extracting literature published between 1995 and 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health (ICF).

The evidence-base for basic physical therapy techniques targeting lower limb function in children with cerebral palsy: a systematic review using the International Classification of Functioning, Disability and Health as a conceptual framework.

Objective: This systematic review provides an overview of the effectiveness of basic techniques used in lower limb physical therapy of children with cerebral palsy. It aims to support the development of clinical guidelines for evidence-based physical therapy planning for these children.

Data Sources And Study Selection: A literature search in 5 electronic databases extracted literature published between January 1995 and December 2009.

The effect of different physiotherapy interventions in post-BTX-A treatment of children with cerebral palsy.

Aim: To distinguish the effects of different physiotherapeutic programs in a post BTX-A regime for children with Cerebral Palsy (CP).

Design: Retrospective, controlled intervention study.

Participants And Interventions: A group of 38 children (X¯ = 7y7m, GMFCS I-III, 27 bilateral, 11 unilateral CP) receiving an individually defined Neurodevelopment Treatment (NDT) program, was matched and compared to a group of children with the same age, GMFCS and diagnosis, receiving more conventional physiotherapy treatment.

Botulinum toxin type A treatment in children with cerebral palsy: evaluation of treatment success or failure by means of goal attainment scaling.

Background: There is considerable variability in the amount of response to BTX-A treatment between and within patients with cerebral palsy (CP).

Aims: The purpose of this retrospective cohort study was to evaluate the clinical responsiveness of Botulinum toxin type A (BTX-A) treatment in children with CP and specifically delineate features of treatment success and failure.

Methods: Four hundred and thirty-eight children (251 boys, 187 girls; mean age 8 years 2 months, SD 4 years) were included into the study.

A clinical tool to measure trunk control in children with cerebral palsy: the Trunk Control Measurement Scale.

In this study the psychometric properties of the Trunk Control Measurement Scale (TCMS) in children with cerebral palsy (CP) were examined. Twenty-six children with spastic CP (mean age 11 years 3 months, range 8-15 years; Gross Motor Function Classification System level I n = 11, level II n = 5, level III n = 10) were included in this study. To determine the discriminant ability of the TCMS, 30 typically developing (TD) children (mean age 10 years 6 months, range 8-15 years) were also included.

The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb.

Purpose: The purpose of this review is to clarify the role of botulinum toxin serotype A (BTX-A) in the treatment of children with cerebral palsy (CP), with a special focus on the lower limb.

Background: The treatment of spasticity is central in the clinical management of children with CP. BTX-A blocks the release of acetylcholine at the motor end plate, causing a temporary muscular denervation and, in an indirect way, a reduced spasticity.

The effect of individually defined physiotherapy in children with cerebral palsy (CP).

Aim: This prospective double blind intervention study aims to evaluate the effectiveness of an individually defined physiotherapy program on the function and gait pattern of 16 children with diplegia (age 3-12 year, GMFCS I-II).

Method: A 6 weeks general training program was followed by a specific training program based on individual goals determined by the results of 3D gait analyses, GMFM-88 and a clinical evaluation. Goal attainment scores were used for the evaluation of the achievement of individual goals.

Long-term use of botulinum toxin type A in children with cerebral palsy: treatment consistency.

At the University Hospital of Pellenberg (Belgium), more than 1000 patients have been treated with Botulinum toxin type A (BTX-A) over the last decade. Ten percent of these patients (n=106) received multiple (at least four times), multi-level, high-dosage treatments. The aim of this study was to evaluate the stability of dosage and treatment intervals in long-term, multi-level, high-dosage treated children with cerebral palsy and to evaluate the evidence for a safe and stable response to this treatment.

Motor function following multilevel botulinum toxin type A treatment in children with cerebral palsy.

This study evaluated the effects of multilevel botulinum toxin type A (BTX-A) treatments on the gait pattern of children with spastic cerebral palsy (Gross Motor Function Classification System Levels I-III). In this nested case-control design, 30 children (mean age 6y 11mo [SD 1y 5mo]; 21 males, nine females; 19 with hemiplegia, 11 with diplegia) were treated according to best practice guidelines in paediatric orthopaedics, including BTX-A injections. A matched control group of 30 children (mean age 7y 8mo [SD 1y 10mo]; 13 males, 17 females; 19 with hemiplegia, 11 with diplegia) were treated identically, but without BTX-A.

[Botulinum toxin A in the treatment of infantile cerebral palsy. Taking into account multilevel, integrated treatment].

Botulinum toxin A represents a significant development in the management of children and adolescents with spastic cerebral palsy. Prerequisites for an adequate result are a correct indication, an exact injection technique and an intensive post-treatment programme. Spastic muscle overactivity and the constant tendency of the involved muscles to shorten with growth cannot be treated by only one method.

Single event multilevel botulinum toxin type A treatment and surgery: similarities and differences.

The present study attempts to provide objective evidence of two treatment options for children with cerebral palsy (CP): multilevel botulinum toxin type A (BTX-A) injections and multilevel surgery. The purpose of the study was to clarify the differences and the similarities, and common treatment principles of both treatment strategies. Objective three dimensional gait analysis data were studied retrospectively in two patient groups pre- and post-treatment (randomly selected from a group of children that were treated between 1998 and 1999).

A randomized study of combined botulinum toxin type A and casting in the ambulant child with cerebral palsy using objective outcome measures.

It is recognized that objective gait analysis is of great value in planning a multilevel botulinum toxin type A (BTX-A) treatment. After BTX-A treatment, objective outcome measures can provide new and interesting information for each individual child with cerebral palsy (CP). Moreover, by studying group results, we may evaluate our treatment hypotheses.