Cerebral Palsy (CP) is the most common condition leading to severe motor impairment in children. Children with CP must go through extensive therapy. Current therapy approaches are coming to use computer games therapeutic tools. However children with CP often have trouble using many of these virtual systems due to equipment challenges. This thesis uses the Kinect to design and create two therapeutic games (DODGEWALL and Reach+) that are tailored to be used in therapy for children with CP. It evaluates the usefulness of the system in a therapeutic context for children with CP through a study involving 6 therapists and 8 children with CP. It was found that overall, children were engaged and enjoyed playing the games. Further, the games developed were judged therapeutically relevant and will be included in a newly constructed VRT suite at Holland Bloorview Kids Rehabilitation Hospital and used in therapy with appropriate children.

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Cerebral Palsy (CP) is the most common condition leading to severe motor impairment in children. Children with CP must go through extensive therapy. Current therapy approaches are coming to use computer games therapeutic tools. However children with CP often have trouble using many of these virtual systems due to equipment challenges. This thesis uses the Kinect to design and create two therapeutic games (DODGEWALL and Reach+) that are tailored to be used in therapy for children with CP. It evaluates the usefulness of the system in a therapeutic context for children with CP through a study involving 6 therapists and 8 children with CP. It was found that overall, children were engaged and enjoyed playing the games. Further, the games developed were judged therapeutically relevant and will be included in a newly constructed VRT suite at Holland Bloorview Kids Rehabilitation Hospital and used in therapy with appropriate children.

The purpose of this study was to establish an influence on static and dynamic postural control in sitting for voluntary arm movement for children with diplegic cerebral palsy. The investigation was fulfilled with control and experimental groups. The control group included ten healthy children and the experimental group included ten children with cerebral palsy. The age of the children was from 10 to 13 years. Subjects had to perform the same task with a single arm for four times. Every time the demands of postural control were increasing – the distance between objects and outward stability was changing. Task performing time was measured and visual estimation of the quality of postural control was done. The study showed that children with cerebral palsy performed the task slower than healthy ones (P < 0.05). The task performance time in the experimental group increased depending on growing distance between objects (p <0.05) and increased depending on decreasing outward stability (p < 0.05). The task’s time in the control group increased only when the distance was increasing between objects (p < 0.05), though when outward stability was decreasing the task’s performance time decreased (p < 0.05). A connection between task’s performance speed in standard conditions and task’s performance speed when the distance between objects was increased (r = 0.8), outward stability was decreased (r = 0.79), the distance between objects was increased and outward stability was decreased (r = 0... [to full text]

The objective of the research is to examine the impact of auditory stimulus on improving reaching performance in children with cerebral palsy. A form of auditory stimulus, called rhythmic auditory stimulation (RAS), is well-established in neurological fields as well as in music-based rehabilitation and therapy. RAS is a method in which the rhythm functions as a sensory cue to induce temporal stability and enhancement of movement patterns by what is believed to be a temporal constraint of the patient’s internal optimized path of motion. In current neurological studies, it is suggested that activity in the premotor cortex may represent the integration of auditory information with temporally organized motor action during rhythmic cuing. Based on this theory, researchers have shown that rhythmic auditory stimulation can produce significant improvement in mean gait velocity, cadence, and stride length in patients with Parkinson’s disease. Evidence validating this observation was also seen in a study on hemiparetic stroke wherein patients displayed improvements in spatio-temporal arm control, reduction in variability of timing and reaching trajectories, and kinematic smoothing of the wrist joint during rhythmic entrainment. Lastly, studies have suggested an accompaniment of sound feedback in addition to visual feedback can result in a positive influence and higher confidence in patients who have had a stroke or spinal cord injury. Although an effect of rhythmic cuing on upper extremity therapy has been explored in areas where brain injury has occurred (such as patients who have incurred stroke, spinal injury, traumatic brain injury, etc.), what has not been explored is the effect of rhythmic cuing on upper extremity therapy for individuals with neurological movement disorders, such as cerebral palsy. Thus, in this research, we set out to explore the effect of RAS in therapeutic interventions for children with cerebral palsy. Through this investigation, we examine its effect on reaching performance as measured through range of motion, peak angular velocity, movement time, path length, spatio-temporal variability, and movement units. For this assessment, we created a virtual system to test the aforementioned principles. We established clinically based angular measurements that include elbow flexion, shoulder flexion, and shoulder abduction using a 3D depth sensor to evaluate relevant metrics in upper extremity rehabilitation. We validated the output of our measurements through a comparison with a Vicon Motion Capture System. We then confirmed the trends of the metrics between groups of adults, children, and children with cerebral palsy. Through testing our system with adults, children, and children with cerebral palsy, we believe we have constructed a system that may induce engagement, which is critical to physical therapy, and may also have a positive impact on the metrics. Although we see trends indicative of an effect through use of the system on children with cerebral palsy, we believe further testing is needed in order to establish or refute the effect and also to definitively establish or refute the effect of rhythmic auditory stimulation. The system, the angular measurements, and the metrics we employ could provide an excellent foundation for future research in this space.

This thesis evaluated energy levels, muscle activity, and upper limb kinematics during AVG play in children with cerebral palsy (CP). For context, a systematic review was conducted, which found that AVGs elicited light to moderate physical activity in typically developing children. In children with CP, moderate levels of physical activity were achieved for Dance Dance Revolution and Wii Boxing, while light levels of physical activity were achieved for Wii Bowling and Wii Tennis. Muscle activity was highest during Wii Boxing, but remained below the maximum voluntary effort for all games and muscles. Angular velocities and accelerations were significantly larger in the dominant limb compared to the hemiplegic limb. When children played against a real opponent, dominant arm activity increased, while hemiplegic arm activity decreased. The results of this thesis indicate that AVGs may be an enjoyable and relatively safe option for children with CP to attain moderate physical activity.

This thesis evaluated energy levels, muscle activity, and upper limb kinematics during AVG play in children with cerebral palsy (CP). For context, a systematic review was conducted, which found that AVGs elicited light to moderate physical activity in typically developing children. In children with CP, moderate levels of physical activity were achieved for Dance Dance Revolution and Wii Boxing, while light levels of physical activity were achieved for Wii Bowling and Wii Tennis. Muscle activity was highest during Wii Boxing, but remained below the maximum voluntary effort for all games and muscles. Angular velocities and accelerations were significantly larger in the dominant limb compared to the hemiplegic limb. When children played against a real opponent, dominant arm activity increased, while hemiplegic arm activity decreased. The results of this thesis indicate that AVGs may be an enjoyable and relatively safe option for children with CP to attain moderate physical activity.

INTRODUCTION AND BACKGROUND: Cerebral palsy (CP) is the most common physical disability in childhood with a prevalence of approximately 2-2.5 per 100 live births. Improvements in paediatric care have increased the survival of individuals with CP. Overall 90% are expected to grow into adulthood yet little is known about the outcomes of young adults with this condition. In order to provide holistic services for this population, an understanding of various aspects of their lives is required. / AIMS: To examine the outcome of young adults with CP from the perspective of perceived health status, functional ability, pain, quality of life (QOL), social participation, and healthcare service utilizations, compared with their able-bodied peers. To explore the determinants that contribute to the variation of these outcomes in the context of impairments, activity, participation, and personal and environmental factors. / METHODS: This is a population based cross sectional study of young adults with CP based on the WHO International Classification of Functioning, Disability and Health (ICF) model. A cohort of 335 young adults with cerebral palsy born in Victoria, aged 20 to 30 years, was recruited from the Victorian Cerebral Palsy Register. Data of typically developed peers selected from the Household, Income and Labour Dynamics in Australia Survey 2004 were used for comparison for the outcomes of perceived health, pain, and social participation. Data from a population-based sample of 751 young adults in U.S. were used for comparative analyses of QOL. Participants were asked to complete a multidimensional questionnaire by self report, or proxy report by parents or carers for those with intellectual or severe physical impairments. The questionnaire was comprised of the Quality of Life Instrument for Young Adults, the Short Form-36 Health Survey Questionnaire version 2, the Gross Motor Function Classification System, the Barthel Index, and a demographic section. / RESULTS: A total of 335 young adults with CP participated; 207 (62%) were able to self report and 128 (38%) were proxy reported. Compared with their able-bodied peers, self reported physical health in this population was lower but mental health was similar. Gross motor function, independence in self care, and limb distribution together explained 60% of the variance in the physical health data. They experienced more pain, impaired function, and reduced social participation, but despite this, their contact with medical and allied health professionals was low. Pain was linked with limb distribution and had a negative impact on functional ability, employment participation and QOL. Impaired functional ability, intellectual disability, and communication impairments had major effects in reducing social participation. Self reported QOL was similar to their peers in social relationship and environmental context domains, but was lower in the domains of physical health, psychological well-being, and role function. The impact of CP on the individuals’ QOL was on physical and functional aspects, and sometimes on social relationships, but not on psychological well-being. / CONCLUSION: This study has demonstrated that greater efforts are needed to improve the health, function, QOL, and social participation in individuals with CP, accompanied by more research to monitor the effectiveness of interventions for them.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, 2006. / Bibliyografya var.

Diss. (sammanfattning) Linköping : Univ., 2005. / Härtill 5 uppsatser.