Browsing by Person "van Hedel, Hubertus J. A."

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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.
First validation of a novel assessgame quantifying selective voluntary motor control in children with upper motor neuron lesions
(SpringerNature, 2019-12-30) Keller, Jeffrey W.; Balzer, Julia; Fahr, Annina; Lieber, Jan; Keller, Urs; van Hedel, Hubertus J. A.
The question whether novel rehabilitation interventions can exploit restorative rather than compensatory mechanisms has gained momentum in recent years. Assessments measuring selective voluntary motor control could answer this question. However, while current clinical assessments are ordinal-scaled, which could affect their sensitivity, lab-based assessments are costly and time-consuming. We propose a novel, interval-scaled, computer-based assessment game using low-cost accelerometers to evaluate selective voluntary motor control. Participants steer an avatar owl on a star-studded path by moving the targeted joint of the upper or lower extremities. We calculate a target joint accuracy metric, and an outcome score for the frequency and amplitude of involuntary movements of adjacent and contralateral joints as well as the trunk. We detail the methods and, as a first proof of concept, relate the results of select children with upper motor neuron lesions (n = 48) to reference groups of neurologically intact children (n = 62) and adults (n = 64). Linear mixed models indicated that the cumulative therapist score, rating the degree of selectivity, was a good predictor of the involuntary movements outcome score. This highlights the validity of this assessgame approach to quantify selective voluntary motor control and warrants a more thorough exploration to quantify changes induced by restorative interventions.
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.
Selective voluntary motor control measures of the lower extremity in children with upper motor neuron lesions: a systematic review
(Wiley, 2017-03-08) Balzer, Julia; van der Linden, Marietta; Mercer, Tom; van Hedel, Hubertus J. A.
Aim: Recovery and trainability of impaired selective voluntary motor control (SVMC) of the lower extremity in children with upper motor neuron lesions has received little attention. To facilitate an evidence-based debate about this topic, this review evaluates the evidence level of the psychometric properties of SVMC measures. Method: MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Cochrane and PEDro databases were systematically searched up to July 2016. Two independent raters scored the methodological quality in accordance to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The overall level of evidence was scored according to Cochrane criteria. Results: We identified 3590 studies, of which 17 were included. COSMIN scores ranged from 'poor' to 'excellent' for studies investigating measurement properties of the Selective Motor Control test, modified Trost test, Gillette's Selective Motor Control test, Selective Control Assessment of the Lower Extremity (SCALE), kinematic measures, electromyography, and torque steadiness. Studies assessing the SCALE scored highest on COSMIN items. Evidence levels for SCALE's validity and reliability properties were moderate, while for the other SVMC measures these ranged from unknown to moderate. Responsiveness was not assessed. Interpretation: Further psychometric studies of SVMC measures are needed to provide a scientific contribution to the ongoing debate of SVMC trainability. 2017 Mac Keith Press.
Validity and reliability of an accelerometer-based assessgame to quantify upper limb selective voluntary motor control
(BioMed Central, 2020-07-13) Keller, Jeffrey W.; Fahr, Annina; Balzer, Julia; Lieber, Jan; van Hedel, Hubertus J. A.; The Swiss National Science Foundation supported this work (grant numbers 32003B_156646 und 32003B_179471). The funding body did not have a role in designing the study, analyzing or interpreting the data, or writing the manuscript.
Introduction: Current clinical assessments measure selective voluntary motor control (SVMC) on an ordinal scale. We introduce a playful, interval-scaled method to assess SVMC in children with brain lesions and evaluate its validity and reliability. Methods: Thirty-one neurologically intact children (median [1st-3rd quartile]: 11.6 years [8.5–13.9]) and 33 patients (12.2 years [8.8–14.9]) affected by upper motor neuron lesions with mild to moderate impairments participated. Using accelerometers, they played a movement tracking game (assessgame) with isolated joint movements (shoulder, elbow, lower arm [pro−/supination], wrist, and fingers), yielding an accuracy score. Involuntary movements were recorded simultaneously and resulted in an involuntary movement score. Both scores were normalized to the performance of 33 neurologically intact adults (32.5 years [27.9; 38.3]), which represented physiological movement patterns. We correlated the assessgame outcomes with the Manual Ability Classification System, Selective Control of the Upper Extremity Scale, and a therapist rating of involuntary movements. Furthermore, a robust ANCOVA was performed with age as covariate, comparing patients to their healthy peers at the age levels of 7.5, 9, 10.5, 12, and 15 years. Intraclass correlation coefficients and smallest real differences indicated relative and absolute reliability. Results: Correlations (Kendall/Spearman) for the accuracy score were τ = 0.29 (p = 0.035; Manual Ability Classification System), ρ = − 0.37 (p = 0.035; Selective Control of the Upper Extremity Scale), and ρ = 0.64 (p < 0.001; therapist rating). Correlations for the involuntary movement metric were τ = 0.37 (p = 0.008), ρ = − 0.55 (p = 0.001), and ρ = 0.79 (p < 0.001), respectively. The robust ANCOVAs revealed that patients performed significantly poorer than their healthy peers in both outcomes and at all age levels except for the dominant/less affected arm, where the youngest age group did not differ significantly. Robust intraclass correlation coefficients and smallest real differences were 0.80 and 1.02 (46% of median patient score) for the accuracy and 0.92 and 2.55 (58%) for involuntary movements, respectively. Conclusion: While this novel assessgame is valid, the reliability might need to be improved. Further studies are needed to determine whether the assessgame is sensitive enough to detect changes in SVMC after a surgical or therapeutic intervention.
Validity and reliability of an electromyography-based similarity index to quantify lower extremity selective voluntary motor control in children with cerebral palsy
(Elsevier, 2022-03-28) Balzer, Julia; Fahr, Annina; Keller, Jeffrey W.; van der Linden, Marietta; Mercer, Tom; van Hedel, Hubertus J. A.
OBJECTIVE To quantify selective voluntary motor control (SVMC) objectively and more precisely, we combined the “Selective Control Assessment of the Lower Extremity” (SCALE) with surface electromyography. The resulting Similarity Index (SI) measures the similarity of muscle activation patterns. This study evaluated the preliminary validity and reliability of this novel SISCALE measure in children with cerebral palsy (CP).
Validity and reliability of an electromyography-based upper limb assessment quantifying selective voluntary motor control in children with upper motor neuron lesions
(SAGE, 2021-04-19) Keller, Jeffrey W.; Fahr, Annina; Balzer, Julia; Lieber, Jan; van Hedel, Hubertus J. A.
Current clinical assessments evaluating selective voluntary motor control are measured on an ordinal scale. We combined the Selective Control of the Upper Extremity Scale (SCUES) with surface electromyography to develop a more objective and interval-scaled assessment of selective voluntary motor control. The resulting Similarity Index (SI) quantifies the similarity of muscle activation patterns. We aimed to evaluate the validity and reliability of this new assessment named SISCUES (Similarity Index of the SCUES) in children with upper motor neuron lesions. Thirty-three patients (12.2 years [8.8;14.9]) affected by upper motor neuron lesions with mild to moderate impairments and 31 typically developing children (11.6 years [8.5;13.9]) participated. We calculated reference muscle activation patterns for the SISCUES using data of 33 neurologically healthy adults (median [1st; 3rd quantile]: 32.5 [27.9; 38.3]). We calculated Spearman correlations (ρ) between the SISCUES and the SCUES and the Manual Ability Classification System (MACS) to establish concurrent validity. Discriminative validity was tested by comparing scores of patients and healthy peers with a robust ANCOVA. Intraclass correlation coefficients2,1 and minimal detectable changes indicated relative and absolute reliability. The SISCUES correlates strongly with SCUES (ρ = 0.76, p < 0.001) and moderately with the MACS (ρ = −0.58, p < 0.001). The average SISCUES can discriminate between patients and peers. The intraclass correlation coefficient2,1 was 0.90 and the minimal detectable change was 0.07 (8% of patients’ median score). Concurrent validity, discriminative validity, and reliability of the SISCUES were established. Further studies are needed to evaluate whether it is responsive enough to detect changes from therapeutic interventions.
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.