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Source publication
[Purpose] The purpose of this study was to investigate the effects of task-oriented training (TOT) on hand dexterity and strength in children with spastic hemiplegic cerebral palsy. [Subjects and Methods] Twelve children with spastic hemiplegic cerebral palsy were randomly assigned to either the TOT group (n=6) or the control group (n=6). In both g...
Context in source publication
Similar publications
Background
The Multiple Sclerosis Spasticity Scale 88 (MSSS-88) is designed to capture the patient experience and impact of spasticity, but there is limited evaluation against clinician-rated measures of spasticity.
Objective
To evaluate the convergent validity and responsiveness of the MSSS-88.
Design
Longitudinal study.
Setting
University Labo...
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![Fig. 1-The clinical forms of cerebral paralysis [6]](profile/Ghitescu-Roxana-2/publication/330657895/figure/fig1/AS:719434465423361@1548537951944/The-clinical-forms-of-cerebral-paralysis-6_Q320.jpg)
![Fig. 2-Types of cerebral palsy [6]](profile/Ghitescu-Roxana-2/publication/330657895/figure/fig2/AS:719434469613568@1548537952012/Types-of-cerebral-palsy-6_Q320.jpg)
The complexity of the manifestation forms and the disorders of motric, physical, mental, sensorial, neuro-psychic origin met in the cerebral paralysis determines on the one hand, at the pacient's functional level an incapacity materialized under the social aspect in a bigger or smaller handicap, and on the other hand, regarding the family and the m...
Citations
... Our findings are in line with previous literature supporting the efficacy of task-oriented training based on motor learning principles for improving motor function in children with CP [57][58][59][60][61]. Task-oriented training emphasizes intensive, active practice of tasks that mimic functional daily activities rather than the mere repetition of so-called 'normal' movement patterns without purpose or meaning [62][63][64]. ...
... Such approaches provide children opportunities for agile problem solving, exploration and dynamic selection of movement patterns based on task and environmental constraints, as well as independent use of the affected UE for goal-directed meaningful activities within natural settings [65][66][67]. For example, Moon and colleagues compared the effects of a 4-week, 20-min/session, clinicbased task-oriented training program to usual care in children with hemiplegia, finding that the experimental group showed improvements in hand function measured using the box and blocks test, with no comparable improvements in the control group [58]. Along similar lines, our program was designed to promote gross and fine motor, multi-joint functional UE movement patterns involving push/pull, reach, throw/catch, grasp, release, and manipulation, which might have contributed to improvements in UE motor function. ...
The pilot study assessed the utility of a training program using modified, commercially available dual-joystick-operated ride-on toys to promote unimanual and bimanual upper extremity (UE) function in children with cerebral palsy (CP). The ride-on-toy training was integrated within a 3-week, intensive, task-oriented training camp for children with CP. Eleven children with hemiplegia between 4 and 10 years received the ride-on-toy training program 20–30 min/day, 5 days/week for 3 weeks. Unimanual motor function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the camp. During ride-on-toy training sessions, children wore activity monitors on both wrists to assess the duration and intensity of bimanual UE activity. Video data from early and late sessions were coded for bimanual UE use, independent navigation, and movement bouts. Children improved their total and subscale QUEST scores from pretest to post-test while increasing moderate activity in their affected UE from early to late sessions, demonstrating more equal use of both UEs across sessions. There were no significant changes in the rates of movement bouts from early to late sessions. We can conclude that joystick-operated ride-on toys function as child-friendly, intrinsically rewarding tools that can complement conventional therapy and promote bimanual motor functions in children with CP.
... Children with spastic cerebral palsy have difficulty controlling their movements and have ineffective gait patterns. Consequently, they move in large groups and have trouble executing certain tasks [5].Although there isn't much solid research to back up this strategy, splinting is a frequently used occupational therapy (OT) method in the treatment of children with neurological problems [6,7]. Assisting joints in biomechanically ideal postures and preventing contracture by giving prolonged stretch are the goals of hand splints, which are intended to improve motor task performance [18].Higgins et al, has also reported that task orientated training significantly increase UE's function in stroke patients [19]. ...
... Patients with neurological problems can function better with the afflicted arm when using the task-oriented approach (TOA). [5,8]. They advised additional methodologically sound studies evaluating the use of hand splints in conjunction with evidenced based practice (EBP) [9,10]. ...
To investigate the combined impact of splints and a task-Oriented approach (TOA) on Upper extremity (UE) skills in children with Motor learning and motor movement execution were both necessary for the development of upper extremity (UE) skills. The UEs' musculoskeletal stability was necessary for the execution of motor motions. Spasticity, a frequent issue in kids with cerebral palsy (CP), can hinder and limit participants ability and activity.In this study, we investigated how task-oriented approach (TOA) intervention and splints could benefit quadriplegic CP children with spastic upper limbs. To evaluate the combined impact of splints and TOA vs the individual effects of splints and TOA on UE's skills.Using a quasi-experimental design, 15 kids were chosen using inclusion and exclusion criteria and then randomly allocated to one of three groups, A, B, or C, each consisting of five kids. During the four-week intervention program, children in Group A received splints together with TOA, children in Group B received splints, and children in Group C received TOA. The results of the PDMS-2 Peabody Developmental Motor Scales, 2nd edition, standardized test evaluation were used to examine each kid one week before and immediately after the four-week intervention.The statistical findings showed that when the intervention was concentrated on TOA together with the use of splints and the full groups were compared to each other, there is a significant observable improvement in UE's abilities and function in children with spastic quadriplegic CP in group A compared to group B and group C children.This study found that the assumption of motor learning, which states that an adequate neuromotor system combined with repeated practice will develop motor skills, is true when the goal of a treatment plan for children with quadriplegic CP is to develop UE skills.
... Fine motor control involves fine motor precision (FMP) and fine motor integration (FMI) [2]. The literature shows that there are fine motor disabilities in pathologies such as Parkinson disease, acquired brain injury, cerebral palsy, and epileptic encephalopathy (EE) [3][4][5][6]. ...
Background
Epileptic encephalopathy (EE) is defined as the presence of frequent epileptiform activity that adversely impacts development, typically causing the slowing or regression of developmental skills, and is usually associated with frequent seizures. One of the main disturbances in EE is in the coordination of the upper extremities and hands. Traditional rehabilitation for this type of pathology focuses on the alleviation of gross or fine motor disability. In the last few years, the use of low-cost devices together with customized serious games has shown improvements in motor disorders and enrichments in activities of daily living.
Objective
This study aims to explore the feasibility of a new serious game for improving fine motor control in children with EE.
Methods
The participants were 4 children with EE (male: n=2, 50%; female: n=2, 50%) who were classified as belonging to level 1 in the Gross Motor Classification System. The children were tested over 10 sessions during the intervention period (before and after treatment). The clinical tests performed were the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition and Pittsburgh Rehabilitation Participation Scale. The subscales of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition were fine motor precision, fine motor integration, manual dexterity, and upper-limb coordination. At the end of the first session, we used the User Satisfaction Evaluation Questionnaire to analyze user satisfaction.
Results
The significance outcomes for a Student t test (1-tailed) were as follows: P=.009 for fine motor precision, P=.002 for fine motor integration, P=.56 for manual dexterity, and P=.99 for upper-limb coordination. The participation rate as measured using the Pittsburgh Rehabilitation Participation Scale was between good and very good, which means that, based on the therapist’s evaluation, interest, independence, and motivation were achieved by each participant. The mean User Satisfaction Evaluation Questionnaire score was close to 30, which is the maximum value.
Conclusions
The results support the use of the proposed serious game as a complement in therapeutic sessions during the rehabilitation processes for children with EE. Significant improvements in fine motor control and activities of daily living revealed that the proposed serious game is beneficial for fine motor disorders of this pathology.
... Limited mobility is a prevalent dysfunction that is observed in patients suffering from neurological diseases such as Stroke, Epileptic Encephalopathy, Cerebral Palsy or Parkinson diseases [1,2,3,4]. The importance of upper limb function rehabilitation is emphasized since upper limbs are used to manipulate objects and to interact physically in Activities of Daily Living (ADL) [5,6]. ...
... [6] According to individual abilities and training purposes, therapists design specific tasks or activities and guide children with CP to complete them to improve their motor skills. [7] In previous studies, TOT has been proved to be an effective method for improving function in stroke patients. [8] However, the application of TOT in the rehabilitation of children with CP is still in its early stages, and there is a lack of relevant evidence-based medical evidence. ...
Background:
To systematically evaluate task-oriented training (TOT) on the improvement of gross motor function, balance and activities of daily living in children with cerebral palsy (CP).
Methods:
A number of randomized controlled trials (RCTs) of TOT in children with CP were searched from Pubmed, Cochrane Library, Web of Science, EmBase, China National Knowledge Infrastructure, Chinese Biology Medicine, Chinese Scientific Journals Database and Wanfang data from the establishment of database to March 2022. The methodological quality of the included studies was evaluated, and meta-analysis was performed by RevMan5.4 software.
Results:
A total of 16 studies were included in the systematic review (n = 893). Meta-analysis showed that the gross motor function measure (GMFM) (MD = 11.05, 95%CI [8.26, 13.83], P < .00001), dimension D (MD = 3.05, 95%CI [1.58, 4.53], P < .0001) of the GMFM, dimension E (MD = 7.36, 95%CI [5.88, 8.84], P < .00001) of the GMFM, the Berg Balance Scale (BBS) (MD = 6.23, 95%CI [3.31, 9.15], P < .0001), the pediatric evaluation of disability inventory (PEDI) mobile function (MD = 6.44, 95%CI [3.85, 9.02], P < .00001) score improved significantly in the TOT group compared with the control group.
Conclusions:
Current evidence shows that TOT could effectively improve gross motor function, balance and activities of daily living in children with CP. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.
... Since age was related to the PEDI-CAS, rehabilitation should be implemented to ensure continuous improvement in self-care from childhood to adulthood. Task-oriented approaches to the treatment of the affected hand improve functional activities and basic daily activities of patients with spastic hemiplegia due to CP [44,45]. These activities require manual dexterity, fine motor performance, and grip strength. ...
Objective:
Manual ability is considered one of the factors that can predict functional independence in activities of daily living. For evaluating personal tasks such as self-care, the Pediatric Evaluation of Disability Inventory (PEDI) comprises/introduces/offers a set of useful measures that assist in enhancing the capability for self-care among children and adolescents with cerebral palsy (CP). The aim of this study was to investigate the relevant factors of self-care capability and performance in children and adolescents with spastic CP.
Methods:
This was a cross-sectional study. Seventy-six children and adolescents with spastic CP (between 5 and 18 years of age), representing levels I to IV of the Gross Motor Function Classification System-Expanded & Revised version (GMFCS), were analyzed. Multiple linear regression analysis with forward stepwise selection was conducted to examine which determinants were related to self-care capability and performance. Independent variables were age, CP type, GMFCS, Manual Ability Classification System, Box and Block Test, and grip strength in the dominant and non-dominant hands. Dependent variables were scores for the PEDI Functional Skills Scale and the PEDI Caregiver Assistance Scale.
Results:
Results of the multiple regression analysis showed that the PEDI Functional Skills scale scores were correlated with the Box and Block Test in the dominant hand and GMFCS (Adjusted R2 = 0.69). The PEDI Caregiver Assistance Scale scores were correlated with the Box and Block Test in the dominant hand, GMFCS, and age (adjusted R2 = 0.71).
Conclusion:
When considering self-care of children and adolescents with spastic CP, it is necessary to consider the evaluation of upper limb dysfunction in addition to GMFCS.
... Task-oriented training (TOT) consists of tasks that are specifically tailored to the user's needs. This type of training is necessary for motor rehabilitation as it utilizes repetition and difficulty scaling that can be adapted to the current state of the user [25,26,27]. TOT is meant to counter poor compliance with rehabilitation by building intrinsic (as opposed to extrinsic) motivation, which results in increased engagement and compliance with intervention. ...
With the increasing longevity that accompanies advances in medical technology comes a host of other age-related disabilities. Among these are neuro-degenerative diseases such as Alzheimer's disease, Parkinson's disease, and stroke, which significantly reduce the motor and cognitive ability of affected individuals. As these diseases become more prevalent, there is a need for further research and innovation in the field of motor rehabilitation therapy to accommodate these individuals in a cost-effective manner. In recent years, the implementation of social agents has been proposed to alleviate the burden on in-home human caregivers. Socially assistive robotics (SAR) is a new subfield of research derived from human-robot interaction that aims to provide hands-off interventions for patients with an emphasis on social rather than physical interaction. As these SAR systems are very new within the medical field, there is no standardized approach to developing such systems for different populations and therapeutic outcomes. The primary aim of this project is to provide a standardized method for developing such systems by introducing a modular human-robot interaction software framework upon which future implementations can be built. The framework is modular in nature, allowing for a variety of hardware and software additions and modifications, and is designed to provide a task-oriented training structure with augmented feedback given to the user in a closed-loop format. The framework utilizes the ROS (Robot Operating System) middleware suite which supports multiple hardware interfaces and runs primarily on Linux operating systems. These design requirements are validated through testing and analysis of two unique implementations of the framework: a keyboard input reaction task and a reaching-to-grasp task. These implementations serve as example use cases for the framework and provide a template for future designs. This framework will provide a means to streamline the development of future SAR systems for research and rehabilitation therapy.
... To improve manual abilities in the CP population, different approaches include treatments that attempt to reduce hand impairment by increasing hand dexterity and strength (Moon et al., 2017) and others that emphasize hand function with movement constraint or promoting bimanual activities (Tervahauta et al., 2017). According to the International Classification of Functioning Disability and Health, rehabilitation professionals should attend to both body and activity domains. ...
Manual dexterity has strongly predicted functional independence for daily life activities among children with cerebral palsy (CP). The Jebsen-Taylor Hand Function Test (JTHFT) is the most widely used assessment tool for exploring manual dexterity in the CP population, though no research has yet examined its psychometric properties for this use. This cross-sectional study explored the validity and internal consistency of the JTHFT in an Italian sample of inpatient and outpatient children with CP aged between 6-18 years (35 girls and 49 boys). We calculated internal consistency with Cronbach’s alpha and tested validity against the Manual Ability Classification System (MACS) using Pearson’s correlation coefficient. To better understand how the JTHFT compares with different levels of the MACS, we performed dominant hand timing variability for each test item. Results showed excellent internal consistency with a Cronbach’s alpha of .944 and .911, respectively, for nondominant and dominant hands. There was also a statistically significant positive linear Pearson’s correlation coefficient between the JTHFT and the MACS ( p < .01). We observed high variability in writing performance (Item 1 of the JTHFT) within this sample for each level of the MACS. This study confirms that the JTHFT is a valid assessment tool when used in children with CP aged 6-18 years.
... The functional training significantly improved GMFM scores and the ability to perform daily activities. Moon, Jung, Hahm and Cho (2017) showed the effect of 20 minutes of TOT twice a week for 4 weeks in 6 children with spastic hemiplegic CP (GMFCS level I-II). The tasks were carried out at a clinic and focused on improving upper limb functions: reaching, ring activity, and stacking cups to catch the target using a paretic hand. ...
... After the intervention, the TOT group showed a significant improvement of hand dexterity, but the comparison group did not. Prior study limitations included: (1) focusing on gross motor function only (Salem & Godwin, 2009), or gross motor function and ADL (Ahl et al., 2005;Ketelaar et al., 2001), or fine motor function (Moon et al., 2017); (2) a study by Ahl et al. (2005) did not have a control group; and (3) some studies (Ahl et al., 2005;Moon et al., 2017;Salem & Godwin, 2009) did not have follow-up evaluations. ...
... After the intervention, the TOT group showed a significant improvement of hand dexterity, but the comparison group did not. Prior study limitations included: (1) focusing on gross motor function only (Salem & Godwin, 2009), or gross motor function and ADL (Ahl et al., 2005;Ketelaar et al., 2001), or fine motor function (Moon et al., 2017); (2) a study by Ahl et al. (2005) did not have a control group; and (3) some studies (Ahl et al., 2005;Moon et al., 2017;Salem & Godwin, 2009) did not have follow-up evaluations. ...
Aims: To determine the effects of group-task-oriented training (group-TOT) on gross and fine motor function, activities of daily living (ADL) and social function of children with spastic cerebral palsy (CP).
Methods: Eighteen children with spastic CP (4–7.5 years, gross motor function classification system level I–III) were randomly assigned to the Group-TOT (9 children received group-TOT for 1 hour, twice a week for 8 weeks) or the comparison group (9 children received individualized traditional physical and occupational therapy). The Gross Motor Function Measure (GMFM)-88, the Bruininks-Oseretsky Test of Motor Proficiency 2nd edition (BOT-2), and the Pediatric Evaluation of Disability Inventory (PEDI) were administered before and after the intervention, and in the Group-TOT, 16 weeks after the intervention.
Results: Children in the Group-TOT showed significant improvements in the GMFM-88 standing and walking/running/jumping subscales, the BOT-2 manual dexterity subscale, and the PEDI social function subscale (p < 0.05); changes were maintained 16 weeks after the intervention ended. In contrast, the comparison group improved in only the BOT-2 fine motor integration subscale (p < 0.05).
Conclusions: The findings provide evidence of effectiveness of group-TOT in improving gross and fine motor function, and social function in children with CP.
Background: Ischemicstroke leads to the development of hemiplegia in the affected arm in more than 80% of the first-ever stroke cases, which impedes upper limb skills in performing daily living activities. Thus, this study aimed to determine the efficacies of two therapeuticexercise regimes in improving hand function in hemiplegic stroke patients after 12weeks of intervention. Methods: A total of 80 hemiplegic stroke patients were recruited and randomized into Group-A (n=40) and B (n=40), respectively. Group -A received Task-Oriented Training (TOT), while B received resistance training. Results: The findings revealed that both exercises were significantly useful (p<0.05) in improving the upper limb function of hemiplegic stroke patients on FMA-UE, ARAT, and DASH outcome measures. Conclusion: It was concluded that both strength training and TOT were effective in improving upper limb function for patients with hemiplegic stroke across all outcome measures and thus showed improved recovery. Keywords: Exercises, Hemiparesis, Stroke, Upper Limb.
