The effect of orthotic devices on knee adduction moment,pain and function in medial compartment knee osteoarthritis: a literature review

Background Knee braces and foot orthoses are commonly used to improve knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). However, no literature review has been performed to compare the effects of foot orthoses and knee braces in this group of patients. Purpose The aim of this review was to evaluate the effects of foot orthoses and knee braces on knee adduction moment, pain and function in individuals with knee OA. Study design Literature review. Method The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar and ISI web of knowledge databases using the PRISMA method and based on selected keywords. Thirty-one related articles were selected for final evaluation. Results The results of the analysis of these studies demonstrated that orthotic devices reduce knee adduction moment and also improve pain and function in individuals with knee OA. Conclusion Foot orthoses may be more effective in improving pain and function in subjects with knee OA. Both knee braces and foot orthoses reduce the knee adduction moment in knee OA and consequently patients typically do not need to use knee braces for a long period of time. Also, foot orthoses and knee braces may be more effective for medial compartment knee OA patients due to the fact that this treatment helps improve pain and function.

• Implications for Rehabilitation

• Knee braces and foot orthoses are commonly used for improving knee adduction moment, pain and function in subjects with knee osteoarthritis (OA).

• Orthotic devices can reduce knee adduction moment, pain and improve function in knee OA.

• The combined use of a knee braces and foot orthoses can provide more improvement in knee adduction moment, reduced pain and increased function.

     

The efficacy of GMFM-88 and GMFM-66 to detect changes in gross motor function in children with cerebral palsy (CP): a literature review

Abstract

Aim: The purpose of this study was to review published research on the use of the Gross Motor Function Measure (GMFM-88) and (GMFM-66) as outcome measures to determine if these tools detect changes in gross motor function in children with cerebral palsy (CP) undergoing interventions. Methods: A comprehensive literature search was conducted using Medline and PubMed to identify studies published from January 2000 through January 2011 that reported the accuracy of GMFM-88 and GMFM-66 to measure changes over time in children with CP undergoing interventions. The keywords used for the search were “GMFM” and “CP”. Two of the authors (M.A. and S.B.) reviewed the titles and abstracts found in the databases. The methodological quality of the studies was assessed by using the Critical Review Form-Quantitative Studies. Results: Of 62 papers initially identified, 21 studies fulfilled the inclusion criteria. These articles consist of three longitudinal studies, six randomized controlled trials, four repeated measure design, six pre–post test design, a case series and one non-randomized prospective study. The included studies were generally of moderate to high methodological quality. The studies included children from a wide age range of 10?months to 16?years. According to the National Health and Medical Research Council, the study designs were level II, III-2, III-3 and IV. Conclusion: The review suggests that the GMFM-88 and GMFM-66 are useful as outcome measures to detect changes in gross motor function in children with CP undergoing interventions.

• Implications for Rehabilitation

• Accurate measurement of change in gross motor skill acquisition is important to determine effectiveness of intervention programs in children with cerebral palsy (CP).

• The Gross Motor Function Measure (GMFM-88 and GMFM-66) are common tools used by rehabilitation specialists to measure gross motor function in children with CP.

• The GMFM appears to be an effective outcome tool for measuring change in gross motor function according to a small number of randomized control studies utilizing participant populations of convenience.

     

Oropharyngeal dysphagia in children with cerebral palsy: comparisons between a high- and low-resource country

Purpose: There is paucity of research investigating oropharyngeal dysphagia (OPD) in young children with cerebral palsy (CP), and most studies explore OPD in high-resource countries. This study aimed at determining the proportion and severity of OPD in preschool children with CP in Bangladesh, compared to Australia.

Method: Cross-sectional, comparison of two cohorts. Two hundred and eleven children with CP aged 18–36 months, 81 in Bangladesh (mean?=?27.6 months, 61.7% males), and 130 in Australia (mean?=?27.4 months, 62.3% males). The Dysphagia Disorders Survey (DDS) – Part 2 was the primary OPD outcome for proportion and severity of OPD. Gross motor skills were classified using the Gross Motor Function Classification System (GMFCS), motor type/distribution.

Results: (i) Bangladesh sample: proportion OPD?=?68.1%; severity?=?10.4 SD?=?7.9. Australia sample: proportion OPD?=?55.7%; severity?=?7.0 SD?=?7.5. (ii) There were no differences in the proportion or severity of OPD between samples when stratified for GMFCS (OR?=?2.4, p?=?0.051 and β?=?1.2, p?=?0.08, respectively).

Conclusions: Despite overall differences in patterns of OPD between Bangladesh and Australia, proportion and severity of OPD (when adjusted for the functional gross motor severity of the samples) were equivalent. This provides support for the robust association between functional motor severity and OPD proportion/severity in children with CP, regardless of the resource context.

• Implications for Rehabilitation

• The proportion and severity of OPD according to gross motor function level were equivalent between high- and low-resource countries (LCs).

• Literature from high-resource countries may be usefully interpreted by rehabilitation professionals for low-resource contexts using the GMFCS as a framework.

• The GMFCS is a useful classification in LCs to improve earlier detection of children at risk of OPD and streamline management pathways for optimal nutritional outcomes.

• Rehabilitation professionals working in LCs are likely to have a caseload weighted towards GMFCS III–V, with less compensatory OPD management options available (such as non-oral nutrition through tubes).

     

An overview of systematic reviews of adaptive seating interventions for children with cerebral palsy: where do we go from here?

Purpose: This article provides an overview and assessment of systematic reviews of adaptive seating outcomes in children with cerebral palsy (CP) and proposes strategies to advance and improve the clinical utility of future research evidence. Methods: A comprehensive search for systematic reviews was performed to locate and evaluate the functional effects of adaptive seating in children with CP. Relevant electronic databases were searched to identify reviews published between January 1990 and December 2010. Results: The search yielded five reviews of adaptive seating interventions that found generally positive, but inconclusive evidence of effectiveness for postural control and management, seated posture, upper extremity function, and overall clinical outcomes. Review authors consistently reported that they were unable to combine data from original research studies to make sound clinical recommendations due to the low quality of studies, the lack of appropriate outcome indicators, and the heterogeneity and lack of clarity in population characteristics and adaptive seating interventions. Conclusions: Strategies to improve the quality and clinical relevance of new research evidence for adaptive seating interventions include the adoption of an expanded view of child functioning, a child motor function classification and development approach, and contemporary frameworks for the measurement and evaluation of assistive technology outcomes.

Implications for Rehabilitation

• Assistive technology practitioners recommend adaptive seating devices to improve child functioning.

• Past systematic reviews of adaptive seating outcomes in children with cerebral palsy provide limited empirical support.

• Current thinking about child health and assistive technology outcomes provides direction to inform research and clinical practice.

     

Non-invasive brain stimulation for the lower limb after stroke: what do we know so far and what should we be doing next?

Background: Non-invasive brain stimulation (NIBS) is promising as an adjuvant to rehabilitation of motor function after stroke. Despite numerous studies and reviews for the upper limb, NIBS targeting the lower limb and gait recovery after stroke is a newly emerging field of research. Purpose: To summarize findings from studies using NIBS to target the lower limb in stroke survivors. Methods: This narrative review describes studies of repetitive transcranial magnetic stimulation, paired associative stimulation and transcranial direct current stimulation with survivors of stroke. Results: NIBS appears capable of inducing changes in cortical excitability and lower limb function, but stimulation parameters and study designs vary considerably making it difficult to determine effectiveness. Conclusions: Future research should systematically assess differences in response with different stimulation parameters, test measures for determining who would be most likely to benefit and assess effectiveness with large samples before NIBS can be considered for use in clinical practice.

• Implications for Rehabilitation

• Stroke is a leading cause of disability, often resulting in dependency in activities of daily living and reduced quality of life.

• Non-invasive brain stimulation has received considerable interest as a potential adjuvant to rehabilitation after stroke and this review summarizes studies targeting the lower limb and gait recovery.

• Non-invasive brain stimulation can be used to modulate excitability of lower limb muscle representations and can lead to improvements in motor performance in stroke survivors.

• Non-invasive brain stimulation for gait recovery needs further investigation before translation to clinical practice is possible.

     

The effect of ice skating on psychological well-being and sleep quality of children with visual or hearing impairment

Abstract

Purpose: Physical exercise and sports have a key role in preventing physical and psychiatric problems in children. However, children with a disability often experience difficulty participating in physical activity due to a lack of suitable opportunities. Participation in an accessible sport is particularly important for these children, but studies examining which sports are beneficial for which disability groups are rare. In this study, we assessed the effects of ice skating on the psychological well-being, self-concept, and sleep quality of children with hearing or visual impairment. Method: Forty students (20 visually impaired and 20 hearing impaired) aged 8–16 were included in a regular ice skating programme for three months. We examined the sleep quality, self-concept, and behavioural and emotional states of the children before and after participating in the programme. Results: There was a significant improvement in self-concept, behavioural and emotional problems, and sleep quality (p?<?0.05 for each) of the children with hearing impairment. Although the sleep quality (p?=?0.019) and emotional problem scores (p?=?0.000) of the visually impaired children improved; self-concept, peer relations and hyperactivity scores of these children worsened (p?<?0.05 for each). Conclusion: Ice skating is one of the popular sport alternatives that gives children the opportunity to exercise and have fun together. The results of this study revealed that regular ice skating programmes may have positive effects on the psychological well-being of children with hearing impairment. Despite some positive effects, caution must be use when including visually impaired children in ice skating programmes. Generalization of the study's outcomes is limited as the study group were residential students enrolled in special education institutions for children who are blind or deaf.

• Implications for Rehabilitation

• Ice skating is a community-based sport and a popular leisure activity that can also have benefits for people with disabilities.

• Ice skating and children with hearing impairment:

• Self-concept, behavioural and emotional problems, and sleep quality of the children with hearing impairment significantly improved after ice skating.

• Ice skating programmes may be considered as a rehabilitation alternative for children with hearing impairment.

• Ice skating and children with visual impairment:

• Caution must be use when including children with visual impairment in ice skating programmes because of possible negative psychological outcomes.

• Balance exercises before starting the practices on ice should be considered for preventing some possible negative outcomes in children with visual impairment.

     

What does the literature say about using robots on children with disabilities?

Purpose: The purpose of this study is to examine the extent and type of robots used for the rehabilitation and education of children and young people with CP and ASD and the associated outcomes.

Methods: The scholarly literature was systematically searched and analyzed. Articles were included if they reported the results of robots used or intended to be used for the rehabilitation and education of children and young people with CP and ASD during play and educative and social interaction activities.

Results: We found 15 robotic systems reported in 34 studies that provided a low level of evidence. The outcomes were mainly for children with ASD interaction and who had a reduction in autistic behaviour, and for CP cognitive development, learning, and play.

Conclusion: More research is needed in this area using designs that provide higher validity. A centred design approach is needed for developing new low-cost robots for this population.

• Implications for rehabilitation

• In spite of the potential of robots to promote development in children with ASD and CP, the limited available evidence requires researchers to conduct studies with higher validity.

• The low level of evidence plus the need for specialized technical support should be considered critical factors before making the decision to purchase robots for use in treatment for children with CP and ASD.

• A user-entered design approach would increase the chances of success for robots to improve functional, learning, and educative outcomes in children with ASD and CP. We recommend that developers use this approach.

• The participation of interdisciplinary teams in the design, development, and implementation of new robotic systems is of extra value.

• We recommend the design and development of low-cost robotic systems to make robots more affordable.

     

A systematic review of study results reported for the evaluation of robotic rollators from the perspective of users

Purpose: To evaluate the effectiveness and perception of robotic rollators (RRs) from the perspective of users.

Methods: Studies identified in a previous systematic review published on 2016 on the methodology of studies evaluating RRs by the user perspective were re-screened for eligibility based on the following inclusion criteria: evaluation of the human–robot interaction from the user perspective, use of standardized outcome measurements, and quantitative presentation of study results.

Results: Seventeen studies were eligible for inclusion. Due to the clinical and methodological heterogeneity across studies, a narrative synthesis of study results was conducted. We found conflicting results concerning the effectiveness of the robotic functionalities of the RRs. Only a few studies reported superior user performance or reduced physical demands with the RRs compared to unassisted conditions or conventional assistive mobility devices; however, without providing statistical evidence. The user perception of the RRs was found to be generally positive.

Conclusions: There is still no sufficient evidence on the effectiveness of RRs from the user perspective. More well-designed, high-quality studies with adequate study populations, larger sample sizes, appropriate assessment strategies with outcomes specifically tailored to the robotic functionalities, and statistical analyses of results are required to evaluate RRs at a higher level of evidence.

• Implications for Rehabilitation

• RRs cover intelligent functionalities that focus on gait assistance, obstacle avoidance, navigation assistance, sit-to-stand transfer, body weight support or fall prevention.

• The evaluation from the user perspective is essential to ensure that RRs effectively address users’ needs, requirements and preferences.

• The evidence on the effectiveness of RRs is severely hampered by the low methodological quality of most of the available studies.

• RRs seem generally to be perceived as positive by the users.

• There is very limited evidence on the effectiveness and benefits of RRs compared to conventional assistive mobility devices.

• Further research with high methodological quality needs to be conducted to reach more robust conclusions about the effectiveness of RRs.

     

Six-minute walking test in children

• Implications for Rehabilitation

• Six-minute walking test.

• The six-minute walking test is safe and widely performed in the world because of its easy implementation and low cost.

• Many countries have established normal values to the six-minute walking test in healthy children.

• However, the applicability of this test also gains popularity among children with other disease conditions.

     

Using virtual robot-mediated play activities to assess cognitive skills

Abstract

Purpose: To evaluate the feasibility of using virtual robot-mediated play activities to assess cognitive skills. Method: Children with and without disabilities utilized both a physical robot and a matching virtual robot to perform the same play activities. The activities were designed such that successfully performing them is an indication of understanding of the underlying cognitive skills. Results: Participants' performance with both robots was similar when evaluated by the success rates in each of the activities. Session video analysis encompassing participants’ behavioral, interaction and communication aspects revealed differences in sustained attention, visuospatial and temporal perception, and self-regulation, favoring the virtual robot. Conclusions: The study shows that virtual robots are a viable alternative to the use of physical robots for assessing children’s cognitive skills, with the potential of overcoming limitations of physical robots such as cost, reliability and the need for on-site technical support.

• Implications for Rehabilitation

• Virtual robots can provide a vehicle for children to demonstrate cognitive understanding.

• Virtual and physical robots can be used as augmentative manipulation tools allowing children with disabilities to actively participate in play, educational and therapeutic activities.

• Virtual robots have the potential of overcoming limitations of physical robots such as cost, reliability and the need for on-site technical support.

     

Lucy Montoro Rehabilitation Network mobile unit: an alternative public healthcare policy

Purpose: The aim is to analyze rehabilitation services provided by a mobile rehabilitation clinic (MU) in nine regions of the State of São Paulo, demonstrating the distribution of orthoses, prostheses and other mobility aids for persons with physical disabilities according to age groups and impairments, as well as the number of persons with physical disabilities as estimated by Brazilian official data sources. Method: The number of persons with disabilities in each region was obtained through estimations from the 2010 Brazilian IBGE Census. The number of assistive technologies suppliers and technicians were provided by the Brazilian Technical Orthopedics Association (ABOTEC). Patients were referred to the MU by Regional Health Departments. After examination of a multidisciplinary team, assistive devices are prescribed and delivered according to patients' needs. Data on patients were also assessed according to questionnaires on their age, diagnosis, gender, marital status and education level. Results: From 2009 to 2011, the MU went through 15?000 km providing rehabilitation services through the Public Health System to 1801 patients. Additionally, 3328 devices were delivered in this period. Different age, diagnosis, gender, marital status and schooling profiles are highlighted in each of the analyzed regions. Conclusion: Data on patients' profiles were made available through services provided by the MU – including the average index of 1.85 devices delivered to each patient and demand projections – which can be used in the planning of public policies. The MU made rehabilitation services more accessible, trained professionals, raised awareness on the correct delivery and use of assistive devices, and identified and organized people's demand in each region.

• Implications for Rehabilitation

• Delivering prostheses, orthoses and other mobility aids fulfills the rights of persons with disabilities to personal mobility with the greatest possible independence, as foreseen by the Convention on the Rights of Persons with Disabilities, increasing their participation in society on an equal basis with others.

• The direct impact of actively reaching out into the community to provide quality rehabilitation services and assistive devices increases the level of access of persons with disabilities to health services and equalizes opportunities.

• Outreach initiatives to deliver rehabilitation services in the community must include a capacity-building component. Building the capacities of local practitioners and health personnel will further empower both these professionals and persons with disabilities, diminishing attitudinal barriers.

• Reaching out into the community allows gathering data on the prevalence of health conditions, local need and demand for assistive devices and rehabilitation services, and informs decision-making.

     

Adaptation for participation!

Abstract

Purpose: To explore children’s experiences with testing, acquiring and using assistive devices.

Methods: Nine children (six boys, three girls, 9–12?years old, with different physical disability and activity experience, participated in semistructured interviews. The interviews were audio-taped, transcribed and analysed using Systematic text condensation.

Results: Assistive devices were reported to contribute to cope activities that the children otherwise would not have participated in. Several subjects listed the need for a shielded environment when adapting to new equipment. The children highlighted “independence in activities” and “having the opportunity to participate in activities with family and friends” as important for frequent use. Need for assistance and lack of localizations to perform the activities were listed as reasons for less frequent use.

Conclusions: This study reveals that it is useful to map each child’s opportunities for independency, appropriate locations for performing the activity and participation with friends, when considering obtaining assistive devices.

• Implications for Rehabilitation

• The use of assistive devices gives many children with physical disabilities the opportunity to participate in physical activity.

• Improving availability to assistive devices for physical activity should be a priority to help facilitate participation.

• Having opportunities to develop perceptions of competence may be essential for a child’s long term participation in physical activity.

     

Access to hands-on mathematics measurement activities using robots controlled via speech generating devices: three case studies

Abstract

Purpose: To examine how using a robot controlled via a speech generating device (SGD) influences the ways students with physical and communication limitations can demonstrate their knowledge in math measurement activities. Method: Three children with severe physical disabilities and complex communication needs used the robot and SGD system to perform four math measurement lessons in comparing, sorting and ordering objects. The performance of the participants was measured and the process of using the system was described in terms of manipulation and communication events. Stakeholder opinions were solicited regarding robot use. Results: Robot use revealed some gaps in the procedural knowledge of the participants. Access to both the robot and SGD was shown to provide several benefits. Stakeholders thought the intervention was important and feasible for a classroom environment. Conclusions: The participants were able to participate actively in the hands-on and communicative measurement activities and thus meet the demands of current math instruction methods.

• Implications for Rehabilitation

• Current mathematics pedagogy encourages doing hands-on activities while communicating about concepts.

• Adapted Lego robots enabled children with severe physical disabilities to perform hands-on length measurement activities.

• Controlling the robots from speech generating devices (SGD) enabled the children, who also had complex communication needs, to reflect and report on results during the activities.

• By using the robots combined with SGDs, children both exhibited their knowledge of and experienced the concepts of mathematical measurements.

     

Fatigue in the mothers of children with cerebral palsy

Purpose: To evaluate fatigue in the mothers of children with cerebral palsy (CP), and to determine its associations with clinical parameters of CP, depression and quality of life (QoL). Method: Ninety children (50 girls and 40 boys) with spastic CP and their mothers were included. Control group comprised mothers of healthy children. Gross motor function classification system (GMFCS) was used for determining functional status. Spasticity was evaluated by using modified Ashworth scale. Fatigue symptom inventory (FSI) was used for assessing maternal fatigue, Nottingham health profile (NHP) for maternal QoL, and Beck Depression Scale (BDS) for maternal depression. Results: Mothers of children with CP scored significantly higher in all FSI subgroups (intensity of fatigue, duration of fatigue and interference with QoL), all NHP subgroups and BDS (p?p?< 0.01). No association was found between FSI and clinical parameters of children with CP including age, gender, type of CP, tonus and functional impairment (p?>?0.05). Conclusions: Our findings indicate that fatigue levels of mothers with CP children are higher than those with healthy children and associated with depression and deterioration in QoL in terms of physical, social and emotional functioning. This should be considered while designing a family centred rehabilitation programme for children with CP.

• Implications for Rehabilitation

• Caring for a child with cerebral palsy has psychological, social and financial impacts on familiesand is associated with increased levels of fatigue among mothers.

• The capacity of current programs and services needs to be strengthened to accommodate theneeds of children with CP and their mothers in order to reduce fatigue of mothers.

• New programs need to be developed to provide psychosocial support for the mothers andto reduce their fatigue as they continue to care for their children.

• Provision of assistive technology devices (particularly suitable wheelchairs) will be useful inreduction of fatigue levels of mothers.

     

What is the evidence for managing tone in young children with,or at risk of developing,cerebral palsy: a systematic review

Background and objectives: To conduct a systematic review of the evidence for the management of tone in infants 0–24 months of age, with or at risk of developing cerebral palsy. Method: This review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. The Cochrane Central Register of Controlled Trials, Embase, MEDLINE, CINAHL Plus and PsycINFO databases were systematically searched for relevant articles. Inclusion criteria were: children aged 0–24 months, identified as at risk of, or having cerebral palsy; ≥25% of participants ≤24 months, and included a standardized assessment of tone. Only peer reviewed journal articles were considered. Eligible studies were coded using the Oxford Levels of Evidence. Methodological quality was assessed using the PEDro scale for randomized controlled trials and the checklist for assessing the quality of quantitative studies of Kmet, Cook and Lee for non-randomized control trials. Results: A total of 4838 studies were identified. After removing duplicates and unrelated studies, a total of 56 full text studies were reviewed. A total of five studies met inclusion criteria, two of which were RCTs, two pre-/post-test designs and one retrospective case audit. Interventions included BoNT-A, Oral Baclofen, Neurofacilitation of Developmental Reaction and Neurodevelopmental Therapy. The quality of evidence ranged from limited to moderate. Conclusion: The management of tone in infants and young children is not well described, with a dearth of high-level evidence to support intervention in the 0–24 month age-range. This is in contrast to a recent review completed by Novak et al. (2013) who report high levels of evidence of interventions for children with cerebral palsy, over 2 years of age.

• Implications for Rehabilitation

• High level of evidence to support clinical decision making for the management of tone in young children 0–24 months is not available.

• The lack of available evidence in the management of tone of young children underpins service delivery and intervention and impacts on patient outcomes.

• In the absence of clear research evidence, the systematic application of sensitive outcome measures is required to confirm treatment effects and generate new evidence.

• Hypertonia should not be managed in isolation. Consideration needs to be given to all components of the ICF-CY.

     

Application and outcomes of therapy combining transcranial direct current stimulation and virtual reality: a systematic review

Purpose: To evaluate the methods and major outcomes of transcranial direct current stimulation (tDCS) combined with virtual reality (VR) therapy in randomized controlled trials.

Method: A systematic review was performed following PRISMA guidelines using PubMed, PubMed Central, Web of Science and CAPES periodic databases, with no time restriction. The studies were screened for the following inclusion criteria: human subjects, combination of VR and tDCS methods, and randomized controlled study design. All potentially relevant articles were independently reviewed by two researchers, who reached a consensus on which articles met the inclusion criteria. The PEDro scale was used to evaluate the studies.

Results: Eleven studies were included, all of which utilized a variety of tDCS and VR application methods. The main outcomes were found to be beneficial in intervention groups of different populations, including improvements in body sway, gait, stroke recovery, pain management and vegetative reactions.

Conclusions: The use of tDCS combined with VR showed positive results in both healthy and impaired patients. Future studies with larger sample sizes and homogeneous participants are required to confirm the benefits of tDCS and VR.

• Implications for Rehabilitation

• tDCS with VR intervention can be an alternative to traditional rehabilitation programs.

• tDCS with VR is a promising type of intervention with a variety of positive effects.

• Application of tDCS with VR is appropriated to both healthy and impaired patients.

• There is no consensus of tDCS with VR application.

     

Hospital rehabilitation for patients with obesity: a scoping review

Purpose: To explore the evidence on rehabilitation for hospitalized patients with obesity.

Methods: Medline, Embase, CENTRAL, CINAHL, and PubMed were searched from 1994 to May 2016. Grey literature was hand-searched. Two reviewers independently selected studies examining patients with obesity receiving hospital-based therapy for a physical impairment. One reviewer extracted the data and a second reviewer verified a random sample.

Results: Thirty-nine studies (two trials, 37 observational) were included. Patients underwent rehabilitation following orthopaedic surgery (n?=?25), neurological conditions (n?=?7), acute medical illnesses (n?=?3), or various procedures (n?=?4). Three studies investigated the effectiveness of a specific rehabilitation program in patients with obesity; however, two lacked a control group, precluding inferences of causal associations. Most studies compared functional outcomes across patients in different BMI categories (n?=?33). There was much variability in the rehabilitation components, intensity, and providers used across the studies. The most frequent components were gait training and mobility (n?=?17) and training in assistive devices (n?=?12). Across the 50 outcomes measured, length of hospital stay (n?=?24) and Functional Independence Measure (n?=?15) were assessed most frequently.

Conclusions: Evidence to guide rehabilitation for patients with obesity is sparse and weak. Rigorous comparative studies with clearly defined interventions and consensus outcome measures are needed.

• Implications for Rehabilitation

• Obesity rates have dramatically increased among patients requiring rehabilitation following joint arthroplasty, stroke, injury, or an acute medical event.

• There are currently no guidelines by which to define best practice for rehabilitating patients with obesity and comparative studies on rehabilitation programs are needed.

• Professional development focused on patient-centered rehabilitation and sensitivity training is known to promote quality care, reduce weight bias, and improve patient satisfaction.

• Access to and knowledge about equipment is necessary to promote patient and health care provider safety.

     

Perspectives on tactile intervention for children with cerebral palsy: a framework to guide clinical reasoning and future research

Purpose: Many children with cerebral palsy (CP) are known to experience tactile impairments. Research evaluating specific interventions to manage this is, however, minimal. This paper seeks to consolidate current literature and provide a framework to help clinicians and researchers think strategically about tactile treatment selection and future research planning.

Method: The framework is described via a novel analogy – “The Apartment Block Theory”. The theory describes the relative effectiveness of three intervention strategies aimed at overcoming a poorly responsive tactile system: (1) Pressing the buzzer – providing repeated passive tactile stimulation at the periphery; (2) Sneaking in the door – providing active tactile-enhanced motor training that capitalises on the opportunity to provide high-dose tactile input during motor interventions; and (3) Connecting another way – providing visually enhanced touch strategies with the aim of enhancing tactile function, which can be compared to phoning the apartment as an alternative to using the buzzer.

Results: Using this theory, the paper describes which sub-groups of children with CP may benefit from each intervention strategy when considering their capabilities in visual, motor, and attention domains.

Conclusions: This theory can assist clinicians to provide effective interventions and researchers to make informed future research decisions to optimise tactile function for children with CP.

• Implications for Rehabilitation

• Although tactile impairments are reported to be common in children with cerebral palsy, very few successful interventions are reported in the literature.

• Visually enhanced touch is a successful strategy for treating tactile impairments in children with cerebral palsy who have sufficient vision and attention.

• Combining intentional tactile input with upper limb movement training may improve tactile function in children with cerebral palsy who have sufficient movement and attention.

• In children who have complex co-morbidities, including both visual and movement impairments, it may be necessary to consider providing passive tactile stimulation in tactile intervention.