Children with cerebral palsy have lesser cardiorespiratory endurance (or aerobic capacity) and less physical activity than children who are developing normally. Cardiorespiratory problems are linked to a higher risk of noncommunicable diseases and premature aging. The goal of this research is to discover aspects that can be added in physiotherapy practice to ensure a long-term improvement in aerobic capacity in children with cerebral palsy while engaging in physical activity. Also investigated is the effect of aerobic capacity on functional abilities. A systematic review of the literature was undertaken utilizing the PubMed, Cochrane Library, ScienceDirect, and PEDro databases. The child's cardiorespiratory fitness appears to improve when they engage in high- intensity, goal-directed physical activity. The child's adherence appears to be aided by a motivating intervention and the removal of environmental barriers to the activity's practice. This allows for a long-term increase in aerobic capacity. It was impossible to draw a direct link between this improvement and functional capacity. Few studies have incorporated cerebral palsy and low global motor skills in recent years. Despite the importance of the findings, their heterogeneity prevents generalizable suggestions for all children with cerebral...

<p> The effectiveness of auditory frontalis EMG feedback as a means of teaching general relaxation to spastic and athetoid cerebral palsy individuals was investigated in a pilot study. It was hypothesized that an increase in voluntary ability to reduce levels of muscle activity would translate into improved functional skills and act as an effective coping response in dealing with stress and anxiety.</p> <p> Two subjects - one athetoid (female; 16 years old) and the other spastic (male; 19 years old were studied in depth, each through the use of an A-B-A single-subject design, where the B phase consisted of ten 15-minute sessions of auditory feedback of the frontalis muscle. Generalization of relaxation was assessed by monitoring forearm flexor and extensor muscle activity, peripheral skin temperature, and respiration rate. A Tektronix 4051 desktop computer was utilized to facilitate data management. In addition to the physiological measures, functional evaluations were conducted prior to and after training and a questionnaire was answered by the subject's relatives. Although there was no clear tendency for either subject to reduce absolute levels of EMG, one subject demonstrated a striking reduction in variability of muscle activity across sessions. Functional assessments for these subjects indicated mild to moderate improvements.</p> / Thesis / Master of Engineering (MEngr)

Introduction: Cerebral Palsy (CP) is the most common cause of disability in children. Healthcare providers aim to facilitate optimal function and participation by working with children and their families. The success of this endeavor depends on shared understanding, collaboration, and contextual factors that affect resource availability. The aim of this thesis was to understand parents’ perspectives in Indian and North American cultures towards management of CP using an ICF lens, to evaluate the extent to which this lens is evident in literature conducted in an Indian context and to evaluate a Knowledge Translation (KT) resource to inform parents and healthcare professionals (HCP). Methods: In the five thesis papers: study 1 explored parents’ perspectives towards the management of their children with CP (qualitative design); study 2 described the contextual factors shaping parents’ perspective in India (reflective design); study 3 and 4, described the research trends in the management of CP in India (scoping review); and study 5 describes the development and evaluation of a KT resource created to inform parents about incorporating the ICFconcepts into management of CP. Results: The qualitative study identified that Indian parents focus more on Body Structure and Function (BSF) challenges and have more resource limitations, as compared to the Canadian context. The scoping review identified that research also focuses on BSF, with less research addressing activity and participation, or its environmental determinants. KT resources showing the application of the ICF concepts into CP management received widespread uptake and were perceived as helpful by parents and HCP. Discussion and Conclusion: ICF was useful for understanding and informing parents and HCP about management of CP. Despite the importance of environmental considerations and contextual factors, these were insufficiently addressed in the literature and in stakeholder perspectives. To optimize CP management across contexts, further research and KT is needed. / Thesis / Doctor of Philosophy (PhD) / Cerebral Palsy (CP) is the most common cause of physical disability in children. Parents and professionals from multiple disciplines work together to provide developmental support for children with CP. This thesis explored parents’ views about management of CP in India and Canada; assessed the scope of the scientific literature from India addressing CP; and developed and evaluated educational videos to inform parents and professionals about the use of the International Classification of Functioning, Disability and Health (ICF) in the management of CP. Parents’ views towards their children in both countries are influenced by the availability of resources, professional attitudes, and cultural beliefs. Research in India focuses on ‘fixing’ the child’s impairments. The videos developed to encourage parents and doctors to focus on increasing activity and participation in children, were judged to be useful in creating awareness about the use of the ICF in the management of CP.

Yes / Cerebral Palsy (CP) is the most common childhood disorder affecting four percent of children born in the UK. It is common for children with CP to have reduced range of movement (ROM) due to spasticity and contractures. Stretching is commonly used in physiotherapy programmes to manage this. This critical review aims to evaluate the evidence base behind the use of stretching for children with CP. Methods: A systematic literature search of AMED, CINAHL, MEDLINE and Cochrane Library Trials was conducted. Returned searches were assessed against strict criteria according to a predefined PICOS (Population, Intervention, Comparison, Outcome, Study). These studies were then critically appraised to assess the validity, reliability and clinical relevance. Findings: There is evidence supporting the use of stretching in children with CP. However there is also some evidence to suggest very little or no positive change. All of the included studies have methodological limitations, which questions the validity of the results. Conclusions/Recommendations: The research suggests some positive outcomes for the use of stretching in CP, studies that did not find positive outcomes found no adverse effects; however further research in the area is required to validate the effectiveness of stretching to maintain ROM in children with CP.

Thesis (Ph.D. )- McMaster University, 2005. / " Health Research Methodology" Includes bibliographical references. Also available via World Wide Web.

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 66-77).

Hyperbaric Oxygenation Therapy (HBOT) has a successive history for treating very specific groups of physical conditions. Research by Neubauer and colleagues states that HBOT's ability to increase cerebral metabolism in the brain regenerates dormant neural tissue (Neubauer, Gottlieb, & Pevsner 1994). According to this research, the increase of cerebral metabolism levels restores mental capacity from the neurological insult. Despite promise, uncertainty exists as to whether this is a viable treatment option for people suffering from neural damage. The research results for this experiment will examine the effect of HBOT on cerebral metabolism levels in adults and pediatrics with chronic neurological problems. Fifty individuals diagnosed as having a neurological impairment whom met criteria for the study were analyzed from an archival data set. Criterion required chronic impairment, baseline SPECT, followed by HBOT exposures, and a post SPECT scan. Statistical analyses consisted of a Pearson correlation that examined pre-metabolism rates with total change, a Pearson correlation that examined total change and number of treatments, and a one way ANOVA analysis that examined cerebral metabolism change in patients under 18 and over 18. Results indicated change

Thesis (MSc)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: Although the neurodevelopmental therapy (NDT) treatment approach is used extensively in the management of children with cerebral palsy, there is currently very little documented research to support its efficacy. The purpose of this study was to evaluate the efficacy of NDT in terms of its effect on motor function in a group of 10 cerebral palsy children. A multiple simple single-subject design was used in which the children each acted as their own controls. A 5 week baseline period, during which no intervention was received by the children, was followed by a 5 week intervention phase during which the children received twice weekly NDT treatment. The children were assessed at the beginning and end of each phase using the Gross Motor Function Measure (GMFM), and an assessment tool, which allowed the establishment of individualised outcome measures, called TELER. The group of children demonstrated no statistically significant gains in motor function on either of the outcome measures during the baseline phase of the study. However during the intervention phase the overall improvements demonstrated by the group on both the GMFM and TELER were statistically significant. Nine out of the ten children achieved greater improvements in their goal total GMFM scores during the intervention phase than during the baseline phase. Similarly all of the children achieved a greater number of clinically significant improvements on the TELER outcome measures. NDT was beneficial and useful in promoting motor function in this group of cerebral palsy children. / AFRIKAANSE OPSOMMING: Alhoewel die Neuro-ontwikkelingsterapie (NOT) behandelingsbenadering wydeverspreid gebraik word in die behandeling van kinders met serebrale verlamming, is daar huidiglik baie min gedokumenteerde navorsing om die effektiwiteit daarvan te staaf. Die doel van hierdie studie was om die effektitiwiteit van NOT te evalueer met betrekking tot die impak daarvan op die motoriese funksie van ‘n groep van 10 kinders met serebrale verlamming. ‘n Veelvuldige eenvoudige enkeling -subjek raamwerk is gebruik waarvolgens die kinders elk as hul eie kontrolegoep ageer het. ‘n 5-weke basislyn fase, waartydens die kinders aan geen intervensies onderwerp is nie, is gevolg deur ‘n 5-weke intervensie fase waartydens die kinders twee keer per week NOT behandeling ontvang het. Die kinders is geevalueer aan die begin en einde van elke fase met die Oorhoofse Motoriese Funksie Maatstaf (OMFM)/Gross Motor Function Measure (GMFM), asook ‘n evalueringsmaatstaf genaamd TELER, wat die bepaling van geindivualiseerde resultate moontlik gemaak het. Die groep kinders het geen statistics bewese vordering in motoriese fiinksies getoon volgens beide die evalueringsmaatstawwe tydens die basislyn fase van die studie nie. Daarteenoor het die groep tydens die intervensie fase oorhoofs gesproke statistics bewese vordering getoon met betrekking tot beide die OMFM en die TELER. Nege uit die 10 kinders het groter vordering getoon met hul totale OMFM resultate tydens die intervensie fase as gedurende die basislyn fase. A1 die kinders het tegelykertyd ‘n groter hoeveelheid substantiewe kliniese verbeterings getoon met betrekking tot hul TELER uitkomste. NOT was voordelig en nuttig in terme van die verbetering van motoriese funksie in die groep van serebraal verlamde kinders.

Dysarthria is one of the most common signs of speech impairment in the cerebral palsy (CP) population. Facilitating strategies for speech enhancement in this population often include training on speech breathing. Treatment efficacy studies with cross-system measures in this population are needed for improved understanding and management of the interrelationship between respiratory, phonatory, and articulatory systems. The purpose of this study was to investigate the effect of breath group control on the coordination of articulatory and phonatory muscles and the acoustic measures related to speech and voice quality. A simultaneous acoustic, electroglottographic (EGG), and marker-based facial tracking recording system was employed to monitor the speech production behaviors of four adults with CP and 16 neurologically healthy controls. Subjects were instructed to perform three tasks, each containing speech targets with a voiceless plosive (/p/, /t/, or /k/) preceding a vowel (/i/, /a/, /u/, or /ɔ/). Task 1 consisted of a short reading passage embedded with target vowels without cueing from breath group markers. Task 2 included reading a series of monosyllabic and 3-syllable or 5-syllable non-speech words with the speech targets. Task 3 included reading the same short passage from Task 1 with cueing from breath group markers separating the passage into phrases with no more than five syllables per phrase. Measures from the acoustic, EGG and facial tracking recordings of the first and last syllable of all syllable trains produced in the non-speech task and the target vowels in the passage reading task were examined. Acoustic measures included voice onset time (VOT), vowel duration, fundamental frequency (F0), percent jitter (%jitter), percent shimmer (%shimmer), signal-to-noise ratio (SNR), and frequencies of Formants one and two (F1 and F2). EGG measures included speed quotient (SQ) and open quotient (OQ). Facial tracking measures consisted of maximum jaw displacement. Individual and averaged data were submitted to a series of two-way Analysis of Variances (ANOVAs) or two-way Repeated Measures ANOVAs to determine the effects of the relative position of an utterance in the breath group and the place of articulation of the consonants involved. In addition, mean vowel spaces derived from all three tasks were examined. Results revealed significant changes of VOT, F1, F2, SNR and SQ as a function of position. Significant changes of VOT, vowel duration, F2, F0, %jitter, %shimmer, and maximum jaw displacement as a function of place of articulation were also evident. In particular, breath group control was found to result in expansion of vowel space, especially for individuals with CP. These findings suggest that proper phrasing enhances articulatory and phonatory stability, providing empirical evidences in support of its usage in treating individuals with CP.

<p>Istraživanje je obuhvatilo primenu generičkog upitnika (Kiddy-KINDL, Kid-KINDL, Kiddo-KINDL i verzije za roditelje Kiddy-KINDL i KINDL), bolest-specifičnog upitnika (CPQOL-Child i CPQOL-verzija za roditelje), kao i upitnika za procenu porodičnog kvaliteta života dece sa cerebralnom paralizom (Family quality of life survey. Main caregivers of people with intellectual or developmental disabilities). Analizom je obuhvaćeno 70. dece i omladine sa cerebralnom paralizom i njihovih roditelja. Kvalitet života dece sa CP uzrasta 4-17 godina, ispitan generičkim upitnikom ne pokazuje statistički značajne razlike u svim ispitivanim domenima bez obzira na nivo motoričkog onesposobljenja prema GMFCS. Kvalitet života sa aspekta roditelja ispitan generičkim upitnikom pokazuje da deca uzrasta 3-6 godina sa CP nivoa I-II prema GMFCS, imaju statistički značajno bolji kvalitet života u domenu zdravstvenog i emocionalnog stanja, samopo&scaron;tovanja i socijalnog života, dok deca uzrasta 7-17 godina imaju statistički značajno bolji kvalitet života samo u domenu emocionalnog stanja. Ova razlika se može objasniti činjenicom da su roditelji starije dece sa CP pro&scaron;li kroz proces prihvatanja bolesti tokom vremena. Kvalitet života dece sa CP uzrasta 8-12 godina, ispitan bolest-specifičnim upitnikom ne pokazuje statistički značajne razlike u svim ispitivanim domenima bez obzira na nivo motoričkog onesposobljenja prema GMFCS. Kvalitet života sa aspekta roditelja ispitan bolest-specifičnim upitnikom pokazuje da deca uzrasta 4-12 godina sa CP nivoa I-II prema GMFCS, imaju statistički značajno bolji kvalitet života u domenima: socijalno blagostanje i prihvatanje, osećanje o funkcionisanju, uče&scaron;će i fizičko zdravlje, kao i bol i uticaj invalidnosti. Nema razlike u stavu deteta i roditelja u domenima kvaliteta života mereno generičkim upitnikom. Međutim, upotrebom bolest-specifičnog upitnika dobija se podatak da roditelji ocenjuju kvalitet života deteta značajno lo&scaron;ije u domenima: osećaj o funkcionisanju, kao i uče&scaron;će i fizičko zdravlje. Roditelji dece sa CP nivoa I-II prema GMFCS navode bolji kvalitet porodičnog života u odnosu na roditelje dece nivoa III-V prema GMFCS, ali bez statističke značajnosti. Analizom ispitivanih dimenzija domena u sumarnoj skali utvrđeno je da je roditeljima najvažnija dimenizija značaj porodičnog kvaliteta života. Ostale ispitivane dimenzije domena (mogućnost, inicijativa, postignuće, stabilnost i zadovoljstvo) bile su niže ocenjene u odnosu na dimenziju značaj, a međusobno su bile ujednačene. Za procenu kvaliteta života kod dece sa CP ipak se preporučuje upotreba bolest-specifičnog upitnika u cilju detektovanja domena od interesa, kako bi se pravovremenom akcijom zdravstenih profesionalaca, podr&scaron;kom na nivou zajednice, kao i dru&scaron;tva u celini, uklonile pote&scaron;koće i omogućio kvalitetan život detetu sa cerebralnom paralizom i njegovoj porodici.</p> / <p>The study included the use of generic questionnaire (Kiddy-KINDL, Kid-KINDL, Kiddo-KINDL versions for parents Kiddy-KINDL and KINDL), a disease-specific questionnaire (CPQOL-Child and CPQOL-version for parents), as well as the questionnaire for evaluation of family quality of life of children with cerebral palsy (FQOL-DD). The analysis included 70 children and youth with cerebral palsy and their parents. The quality of life of children with CP aged 4-17 years, examined by a generic questionnaire, shows no statistically significant differences in any investigated domains regardless of the level of motor disability according to GMFCS. The quality of life from the parent aspect obtained by the generic questionnaire shows that children aged 3-6 years with CP levels I-II GMFCS, had a significantly better quality of life related to health and emotional status, self-esteem and social life, while children aged 7-17 years had a significantly better quality of life only in the domain of emotional state. This difference can be explained by the fact that parents of older children with CP had the time to pass through the process of accepting the disease. The quality of life of children with CP aged 8-12 years, examined by the disease-specific questionnaire, shows no statistically significant differences in any investigated domains regardless of the level of motor disability according to GMFCS. The quality of life from the parent aspect according to the disease-specific questionnaire shows that children aged 4 -12 years with CP levels I-II GMFCS had a significantly better quality of life in following domains: social well-being and acceptance, feeling of functioning, participation and physical health, as well as the pain impact and disability. There is no difference in the attitude of the child and parents in the domains of quality of life as measured by the generic questionnaire. However, by using disease-specific questionnaires it is clear that parents assess the quality of life of the child significantly worse in the following domains: a sense of functioning, of participation and physical health. Parents of children with CP levels I-II GMFCS report better quality of family life in comparison to the parents of children with level III-V GMFCS, but without statistical significance. By the analysis of the dimensions of domains tested in the aggregate scale it was found that for parents the most important dimension was the family quality of life. Other tested dimensions of domains (the ability, initiative, achievement, stability and satisfaction) were assessed lower in comparison to the dimension of the importance, and they were equable. For assessment of the quality of life in children with CP the use of disease-specific questionnaires is recommended in order to detect domains of interest, with the aim to introduce timely action of health professionals, support at the community level and in a society as a whole, as well as to remove difficulties and facilitate quality of life for the children with cerebral palsy and their families.</p>