Browsing by Person "Marsico, Petra"

Now showing 1 - 9 of 9

Are tactile function and body awareness of the foot related to motor outcomes in children with upper motor neuron lesions?
(Frontiers Media, 2024-03-01) Marsico, Petra; Lea Meier; van der Linden, Marietta; Mercer, Tom; Van Hedel, Hubertus J.
Introduction: Somatosensory function can be reduced in children with Upper Motor Neuron (UMN) lesions. Therefore, we investigated relationships between somatosensory functions of the foot and motor outcomes in children with UMN lesions.In this cross-sectional study, we assessed the Tactile Threshold (TT) with monofilaments and body awareness with Tactile Localisation Tasks for spatial-related action (TLTaction) and structural-related perception (TLTperception) body representation at the foot sole. Furthermore, we assessed four motor outcomes: the Selective Control Assessment of the Lower Extremity (SCALE), the modified Timed Up and Go test (mTUG), the Gillette Functional Assessment Questionnaire (FAQ), and the Functional Mobility Scale (FMS). Spearman's correlations (ρ) were applied to assess relationships between the somatosensory function of the foot sole and the applied motor outcomes.Results: Thirty-five children with UMN lesions, on average 11.7 ± 3.4 years old, participated. TLTperception correlated significantly with all lower limb motor outcomes p<0.05),. TLTperception correlated strongly with the Gross Motor Function Classification System (|ρ|=0.62; p=0.001) in children with cerebral palsy (n=24).Discussion: Assessing structural body representation of the foot sole should be considered when addressing lower limb motor impairments, including gait, in children with upper motor neuron lesions. Our results suggest that the assessment of tactile function and spatial body representation may be less related to lower limb motor function.
ASSESSING LOWER LIMB SOMATOSENSORY FUNCTION OF CHILDREN WITH UPPER MOTOR NEURON LESIONS
(2024-12-11) Marsico, Petra
Through the somatosensory system, we receive information about the external and internal state of our body as the foundation of our feedback-control system for all motor activities. Therefore, somatosensory function is essential for motor control, and motor learning. Lower limb somatosensory function is particularly important for balance, gait and mobility. Different modalities of the somatosensory system can be impaired in children with Upper Motor Neuron (UMN) lesions. Therefore, we require child-friendly outcome measures to assess somatosensory function of the lower limbs that can be included in a toolbox for clinicians and researchers. Methods: An overview of the current state of knowledge was compiled on the basis of a systematic review. The systematic review analysed the psychometric properties of the available measures for assessing lower limb somatosensory function. Subsequently, an expert panel participated in a Delphi study to identify the most important modalities of lower limb somatosensory function in relation to motor outcomes. We developed standardised protocols to assess various somatosensory modalities and investigated validity, reliability, and feasibility in children with UMN lesions. We investigated the relationships between tactile function, body awareness, and motor outcomes. Finally, we developed a sensor-based tool to assess lower limb proprioception and assessed its validity, reliability, and feasibility. Results and conclusions: The toolbox provides outcome measures to assess six modalities of lower limb exteroception, proprioception, and body awareness in children with UMN lesions. The feasibility and psychometric properties of the investigated outcome measures are confirmed as good. The correlations between the individual somatosensory and motor function assessments vary greatly. Structural body awareness and joint position sense showed the highest relationship to motor activity and are included into the core toolbox. Further studies should investigate the validity, reliability, and feasibility of a tactile localisation tasks of the whole lower limb to assess body awareness.
Assessing Proprioception in Children with Upper Motor Neuron Lesions: Feasibility, validity, and reliability of the Proprioception Measurement Tool (ProMeTo)
(Frontiers Media, 2024-08-09) Marsico, Petra; Meier, Lea; Buchmann, Anke; Kläy, Andrina; van der Linden, Marietta; Mercer, Tom; Van Hedel, Hubertus J.
Introduction: To investigate the feasibility, discriminative and convergent validity, and reliability of a lower limb sensor-based proprioception measure in children with upper motor neuron (UMN) lesions. Method: We assessed three proprioception modalities (joint movement, joint position, and dynamic position sense) of the lower limbs in 49 children with UMN lesions and 50 typically developing (TD) peers (5-19y). Forty-three children with UMN lesion had a congenital and six an acquired brain lesion and 82% are able to walk without a walking aid. We evaluated the feasibility, compared the test results between children with UMN lesions and TD peers, and calculated Spearman correlations (rs) between the modalities. We quantified relative reliability with Intra-Class Correlation Coefficients (ICC) and absolute reliability with Smallest Detectable Changes (SDC). Results: Most children with UMN lesions (>88%) found the tests easy to perform. The children with UMN lesions had significantly (p<0.001) lower proprioceptive function than the TD children. The correlation between the three proprioceptive modalities was moderate to high (0.50 ≤ rs ≤ 0.79). The relative reliability for test-retest and the inter-rater reliability was moderate to high (ICCs=0.65-0.97), and SDC between 2° and 15°. Discussion: The three tests are feasible, and discriminative and convergent validity and reliability were confirmed. Further studies should investigate the influence on motor function and performance in children with UMN lesions.
Effectiveness of facilitation, arrangement of task and situation, (non-)verbal communication, and counseling of caregivers in children with neuromotor disorders: A systematic review
(Springer, 2021-10-29) Marsico, Petra; Graser, Judith V.; van Hedel, Hubertus J. A.
Objectives: The techniques facilitation of activities, arrangement of task or situation, verbal and non-verbal communication, and counseling and empowerment of parents and caregivers are applied in different therapy approaches to improve motor function in children with neuromotor disorders. This review quantitatively examines the effectiveness of these four techniques allocated to pre-defined age groups and levels of disability. Methods: We followed the systematic review methodology proposed by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM). The search was conducted on PubMed, Scopus, EMBASE, PEDro, OT Seeker, ERIC, and CINAHL. The main outcomes of the included articles were allocated to the framework of the International Classification of Functioning, Disability, and Health (body functions, activities, and participation). Results: The search yielded eleven studies for facilitation, 22 for arrangement of task or situation, three for verbal and non-verbal communication, and three studies for counseling and empowerment. The effect sizes indicated strong evidence for body function and activity outcomes for the use of facilitation in newborns until the age of 2 years and the arrangement of tasks in children between 2 and 5 years with cerebral palsy. Conclusions: Thus, while some evidence exist for facilitation and arrangement of task or situation, further research is needed on the effectiveness of verbal and non-verbal communication and counseling and empowerment of parents and caregivers to improve motor function, activities, and participation. Systematic review registration.: PROSPERO CRD42017048583.
Feasibility, validity, and reliability of lower limb tactile and body awareness assessments in children with upper motor neuron lesions
(Elsevier, 2023-03-17) Marsico, Petra; Meier, Lea; van der Linden, Marietta; Mercer, Tom; van Hedel, Prof. Hubertus J.A.
Objective: To investigated the feasibility, discriminative and convergent validity, and inter-rater reliability of a lower limb tactile function and two body awareness as-sessments in children with upper motor neuron (UMN) lesions. Design: Cross-sectional psychometric study Setting: Pediatric rehabilitation center Participants: Forty individuals with UMN lesions (mean age 11.7 years, SD 3.4 years; 27 girls) and 40 neurotypically developing children of the same age partici-pated. Interventions: Not applicable. Main Outcome Measures: We assessed the tactile threshold (TT) with monofila-ments and body awareness with tactile localization tasks (TLT) for structural (TLTaction) and spatial (TLTperception) body representation at the foot sole. We compared the test outcomes between children with UMN lesions and neurotypically develop-ing children with the Wilcoxon signed-rank test. Furthermore, we quantified the re-lationships between the three tests with Spearman correlations (rs) and the interrater reliability with quadratic weighted kappa (κQW). Results: About 80% of the children with UMN lesions perceived the tests easy to perform. The children with UMN lesions had significantly reduced somatosensory function compared to the neurotypically developing children. For the more affected leg, we found good relationships between the TT and the TLTaction (rs =0.71; p<0.001) and between the two TLTs (rs=0.66; p<0.001), and a fair relationship between the TT and the TLTperception (rs =0.31; p=0.06). The inter-rater reliability analyses for the sum scores showed almost perfect agreement for the TT (κQW more affected leg 0.86; less affected leg 0.81), substantial agreement for TLTaction (κQW more affected leg 0.76; less affected leg 0.63), and almost perfect agreement for TLTperception (κQW more af-fected leg 0.88; less affected leg 0.74). Conclusion: The three tests are feasible to assess lower limb somatosensory func-tion in children with UMN lesions. Discriminative and convergent validity and relia-bility of the three tests were confirmed. Further studies should investigate respon-siveness and association with motor function of these outcome measures.
Influence of trunk control and lower extremity impairments on gait capacity in children with cerebral palsy
(Taylor & Francis, 2017-09-24) Balzer, Julia; Marsico, Petra; Mitteregger, Elena; van der Linden, Marietta; Mercer, Tom; van Hedel, Hubertus J. A.
Purpose: We investigated the combined impact of trunk control and lower extremities impairments on predicting gait capacity in children with cerebral palsy (CP) and evaluated relationships between trunk control and lower extremities impairments. Methods: Data of 52 children with CP [29 boys, mean age 11 years 9 months (±4 years 6 months)] were included in this observational study. Gait capacity was measured by the “modified Time Up and Go test”. Experienced therapists performed the “Modified Ashworth Scale”, “Manual Muscle Test”, the “Selective Control Assessment of the Lower Extremity”, and the “Trunk Control Measurement Scale”. We calculated Spearman correlations coefficients (ρ) and performed regression analyses. Results: Trunk control was the strongest predictor (β = –0.624, p < 0.001) when explaining the variance of gait capacity and remained in the model together with spasticity (R2 = 0.67). Muscle strength and selectivity correlated moderately to strongly with the trunk control and gait capacity (–0.68 ≤ ρ ≤ –0.78), but correlations for the spasticity were low (ρ<–0.3). Conclusions: The interconnection between trunk control, leg muscle strength and selectivity for gait capacity in children with CP was shown. It indicates the significance of these impairments in gait assessment and, potentially, rehabilitation.Implications for RehabilitationTrunk control was the strongest predictor for gait capacity in a regression model with lower extremity spasticity, muscle strength and selectivity and age as independent variables.Lower extremity muscle strength, selectivity, and trunk control explained a similar amount of gait capacity variance which is higher than that explained by lower extremity spasticity.Lower extremity muscle strength and selectivity correlated strongly with trunk control.Therefore, we cautiously suggest that a combined trunk control and lower extremity training might be promising for improving gait capacity in children with CP (Gross Motor Function Classification System level I–III), which needed to be tested in future intervention-studies. © 2017 Informa UK Limited, trading as Taylor & Francis Group
Psychometric properties of lower limb somatosensory function and body awareness outcome measures in children with upper motor neuron lesions: A systematic review
(Taylor & Francis, 2021-12-06) Marsico, Petra; Egger, Lea; van der Linden, Marietta; Mercer, Tom; van Hedel, Hubertus J. A.
Purpose: A systematic review of the psychometric properties and feasibility of outcome measures assessing lower limb somatosensory function and body awareness in children with upper motor neuron lesion. Methods: We followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Two raters independently judged the quality and risk of bias of each study. Data synthesis was performed, and aspects of feasibility were extracted. Results: Twelve studies investigated eleven somatosensory function measures quantifying four modalities and eight body awareness measures quantifying two modalities. The best evidence synthesis was very low to low for somatosensory function modalities and low for body awareness modalities. Few feasibility aspects were reported (e.g., the percentage or minimum age of participants able to perform the tests). Conclusion: Current evidence on the psychometric characteristics of somatosensory function and body awareness outcome measures relatively sparse. Further research on psychometric properties and practical application is needed.
Velocity dependent measure of spasticity: Reliability in children and juveniles with neuromotor disorders
(IOS Press, 2021-04-28) Marsico, Petra; Frontzek-Weps, Victoria; van Hedel, Hubertus J. A.
PURPOSE: The purpose of this study was to create a clear, standardized test description to rate spasticity severity into four categories according to the definition given by Lance [1], referred to as the Velocity Dependent Measure of Spasticity (VDMS). METHOD: Muscle groups of the upper and lower limbs of children with neuromotor disorders were evaluated on their response to passive movement in a fast-versus slow-velocity test condition. The interrater and test-retest reliability were assessed using Gwet’s alpha one (95%-CI) and the percentage agreement. RESULTS: Two physiotherapists independently assessed 45 children and youths (age 4–19 years). The interrater reliability of the VDMS was substantial to almost perfect (Gwet’s alpha one: 0.66–0.99, n= 45) while the test-retest reliability was almost perfect as well (Gwet’s alpha one: 0.83–1.00, n= 42). CONCLUSION: The VDMS can be recommended as a reliable assessment with a standardized procedure to assess spasticity of the extremities in children with neuromotor disorders.
What are the relevant categories, modalities, and outcome measures for assessing lower limb somatosensory function in children with upper motor neuron lesions? A Delphi study.
(2022-07-29) Marsico, Petra; Mercer, Tom; van Hedel, Hubertus J A; van der Linden, Marietta
Somatosensory function of the lower limbs is rarely assessed in children with upper motor neuron lesions despite its potential relevance for motor function. We explored consensus regarding somatosensory categories (exteroception, proprioception, interoception, and body awareness), modalities, and outcome measures relevant to lower limb motor function. Fifteen international experts with experience of somatosensory function assessment participated in this Delphi study. Surveys of four rounds, conducted online, included questions on the relevance of somatosensory categories and modalities for motor function and on the use of potential outcome measures in clinical practice. The experts reached consensus on the relevance of six modalities of the categories exteroception, proprioception, and body awareness. Based on their feedback, we formulated three core criteria for somatosensory outcome measures, namely suitability for clinical practice, child-friendliness, and relevance for motor function. None of the nine available outcome measures fulfilled each criterion. The experts also highlighted the importance of using and interpreting the tests in relation to the child's activity and participation. There was expert consensus on three categories and six modalities of somatosensory function relevant for lower limb motor function. However, existing outcome measures will need to be adapted for use in paediatric clinical practice. IMPLICATION FOR REHABILITATIONConsensus was established for the categories and modalities of somatosensory function relevant for lower limb motor function of children with UMN lesion.Outcome measures should cover tactile function, joint movement and joint position and dynamic position sense, and spatial and structural body representation.None of the nine existing outcome measures fulfilled the core criteria: feasibility for clinical practice, child-friendliness, and relevance to motor function.