Format follows the Guide to Physical Therapist Practice, 2nd Edition so you become familiar with the terminology used in therapy practice. Clinical Pearls highlight key information.
Full-color illustrations clearly demonstrate pathologies and interventions. Case studies with discussion questions guide you through specific patient interactions to build your clinical reasoning skills. Glossaries in each chapter define key terms to build your clinical vocabulary. Student resources on the companion Evolve website enhance your learning with vocabulary-building exercises, boards-style practice test questions, examples of commonly used forms, and references from the book linked to Medline.
Nowadays, cerebral palsy CP rehabilitation, along with medical and surgical interventions in children with CP, leads to better motor and postural control and can ensure ambulation and functional independence.
In achieving these improvements, many modern practices may be used, such as comprehensive multidisciplinary assessment, clinical decision making, multilevel surgery, botulinum toxin applications, robotic ambulation applications, treadmill, and other walking aids to increase the quality and endurance of walking. Trainings are based on neurodevelopmental therapy, muscle training and strength applications, adaptive equipment and orthotics, communication, technological solves, and many others beyond the scope of this book.
In the years of clinical and academic experiences, children with cerebral palsy have shown us that the world needs a book to give clinical knowledge to health professionals regarding these important issue.
This book is an attempt to fulfill and to give ''current steps'' about CP. We focus on the recent concepts in the treatment of body and structure problems and describe the associated disability, providing suggestions for further reading.
All authors presented the most frequently used and accepted treatment methods with scientifically proven efficacy and included references at the end of each chapter. Using a problem-solving approach based on clinical evidence, Neurological Rehabilitation, 6th Edition covers the therapeutic management of people with functional movement limitations and quality of life issues following a neurological event.
It reviews basic theory and covers the latest screening and diagnostic tests, new treatments, and interventions commonly used in today's clinical practice. This edition includes the latest advances in neuroscience, adding new chapters on neuroimaging and clinical tools such as virtual reality, robotics, and gaming.
Written by respected clinician and physical therapy expert Darcy Umphred, this classic neurology text provides problem-solving strategies that are key to individualized, effective care. A section on neurological problems accompanying specific system problems includes hot topics such as poor vision, pelvic floor dysfunction, and pain. A problem-solving approach helps you apply your knowledge to examinations, evaluations, prognoses, and intervention strategies.
Evidence-based research sets up best practices, covering topics such as the theory of neurologic rehabilitation, screening and diagnostic tests, treatments and interventions, and the patient's psychosocial concerns Information. Case studies use real-world examples to promote problem-solving skills. Non-traditional approaches to neurological interventions in the Alternative and Complementary Therapies chapter include the movement approach, energy approach, and physical body system approaches therapies.
Updated illustrations provide current visual references. NEW chapters on imaging and robotics have been added. Updated chapters incorporate the latest advances and the newest information in neuroscience and intervention strategies. Umphred; with section editors, Gordon U. Burton, Rolando T. Lazaro, Margaret L.
Utilizes a family-centered perspective, using the terminology of the AOTA Practice Framework, which focuses on tailoring the OT approach to meet the needs of children within the context of their own environments. Includes evidence-based content such as clinical trials and outcome studies that demonstrate the basis for OTA best practices. Presents case examples that show how key concepts apply to real-life situations.
Features expert advice and tips from the authors and contributors in highlighted Clinical Pearls boxes. Addresses cultural diversity and sensitivity to introduce you to the wide groups of people that OTAs treat. Contains suggested activities in each chapter that help bridge the gap between the classroom and the clinic. Evolve website offers a variety of video clips and learning activities to help reinforce the material you learn in the text. Demonstrates how concepts apply to practice with video clips on the Evolve website that exhibit pediatric clients involved in a variety of occupational therapy interventions.
Prepares you for new career opportunities with content on emerging practice areas such as community systems.
Provides the latest information on current trends and issues such as childhood obesity, documentation, neurodevelopmental treatment NDT , and concepts of elongation.
Focusing on children from infancy to adolescence, Occupational Therapy for Children and Adolescents, 7th Edition provides comprehensive, full-color coverage of pediatric conditions and treatment techniques in all settings.
Its emphasis on evidence-based practice includes updated references, research notes, and explanations of the evidentiary basis for specific interventions. And coverage of new research and theories, new techniques, and current trends, with additional case studies, keeps you in step with the latest advances in pediatric OT practice.
Case studies help you apply concepts to actual situations you may encounter in practice. Research Notes boxes and evidence-based summary tables help you interpret evidence and strengthen your clinical decision-making skills. Learning resources on Evolve include video clips, review activities, and additional case studies. Learning objectives indicate what you will be learning in each chapter and serve as checkpoints in studying for examinations.
A glossary makes it easy to look up key terms. NEW video clips and case studies on the Evolve website demonstrate important concepts and rehabilitation techniques. NEW Neuromotor: Cerebral Palsy chapter addresses the most prevalent cause of motor dysfunction in children.
NEW Adolescent Development chapter helps you manage the special needs of teenagers and young adults. NEW contemporary design includes full-color photos and illustrations. UPDATED content and references ensure you have access to the comprehensive, research-based information that will guide you in making optimal decisions in practice.
When a study assesses the same outcome using different tools e. In other words, we will not pool the data from these tools in the same analysis. When a study measures an outcome more than once during the same time interval, we will consider the last measure for analysis, in order to avoid double counting of participants e. If we are unable to obtain the individual participant data to allow us to calculate an estimate of the ICC, we will use external estimates obtained from similar studies.
If this information is not available, we will analyse the results of cluster studies using a general summary considering each cluster as the unit of analysis. When this strategy precludes exploration of potential causes of heterogeneity, we will assess each NTD approach individually versus a common control group , and split the sample size for common comparator groups proportionately for each comparison Higgins , Section We will try to contact the study authors to request any unreported data e.
We will describe missing data and attrition for each study in the 'Risk of bias' table, and discuss the extent to which any missing data might affect the results or conclusions of the review.
For the included studies, we will conduct a Sensitivity analysis to explore the impact of including studies with high levels of missing data in the overall assessment of treatment effect. We will consider clinical and methodological heterogeneity by examining factors such as similarity among participants and methodological aspects of the trial, which could lead to differences in the observed intervention effects.
We will interpret a P value lower than 0. If we include a sufficient number of studies more than 10 , we will draw funnel plots to explore any small study effects, including publication bias. If we find any visual asymmetry of the funnel plot, we will discuss possible reasons e. If we suspect or find direct evidence for selective outcome reporting, we will contact study authors for additional information.
If the average treatment effect is not clinically meaningful, we will not combine trials and we will present a narrative description of the results. We will categorise RCTs and qRCTs as high quality evidence and downgrade them according to the following criteria: risk of bias; inconsistency; indirectness; imprecision; and publication bias.
Type of neuromotor abnormality spastic, ataxic, and dyskinetic , since response to treatment may vary according to the type of abnormality.
Topographical distribution hemiplegia, diplegia, and quadriplegia , since hemiplegia has a higher probability of responding to treatment than diplegia or quadriplegia. Coexistence of postural deformities e. We will perform sensitivity analyses to assess the impact of the following. Overall risk of bias, by comparing the results of studies deemed at high and unclear risk of bias with the results of studies at low risk of bias only.
Missing data for primary outcomes, by comparing the results of studies with imputed data to those without. Correspondence has been edited for length. A summary of substantive comments from Virginia Knox over many months, and responses from the authors, are presented below:. The original version had limitations in responsiveness when used as an evaluative measure in children with cerebral palsy and therefore is not recommended for this purpose Palisano They are not outcome measures and not validated for that purpose, yet the authors Current practice of the Bobath approach.
The commenter is This may lead to significant difficulties determining the fidelity of the therapy as described in research articles identified in their search was it or was it not therapy using the Bobath approach as it is applied now. For example:. So the definition was conceded as out of date in the reference the authors cite, and not how Bobath is currently practised within the adult stroke population or with children. In this position, the child is free to use his or her hands and develop various ways to explore the objects to figure out how things 'work' by stacking, nesting, and combining various items.
With this positioning, the therapist can encourage appropriate body alignment, trunk stability and weight shifting, and at the same time guide shoulder protraction by limiting scapular retraction so that the child can reach and play using her hands. Measures of Treatment effect. The commenter was concerned on looking at the protocol again about the accuracy of text relating to Kollen and work by Lennon The commenter was concerned that Franki was misattributed as a source review, asserted that the work contained no relevant studies of neurodevelopmental treatment approaches, and wondered if Desloovere were, in fact, meant instead.
Singhi states there is no evidence to state there is superiority of one method over another he does not state to which methods he is referring or on what evidence this statement is based. Using this reference to suggest there is no evidence to suggest that the Bobath approach can promote functional improvement in children is very misleading. I agree with the conflict of interest statement below: I certify that I have no affiliations with or involvement in any organization or entity with a financial interest in the subject matter of my feedback.
Thank you for this comment. We agree with you. We removed PDMS tool as an option for assessing global motor function. We understand your concern. We had already discussed this amongst ourselves and the peer reviewers at protocol stage. We are aware that these tools were originally developed as classification systems.
However, over time, they became useful methods to assess the effects of physical therapy interventions on motor function in children with cerebral palsy both in practice and clinical trials settings. So, at protocol phase, we decided to include them as tools for assessing motor function. Nevertheless, we acknowledge these remain unvalidated classification systems and have changed the text in the protocol to indicate this fact for both instruments.
We updated the references and clarified the concept of Bobath approach as follows:. We have exchanged the existing reference with a section from a more recent textbook, thus:. We have included the following examples of adverse events: pain, discomfort and tonus impairment.
We rewrote the text and removed the reference to Kollen at this point, as this study is related to the Bobath approach as used for adult stroke rehabilitation. We cited a new and more specific reference dos Santos to support the text. We believe that Franki does indeed include relevant NDT studies, and have retained it in the text. We have replaced the Singhi reference with one to a more recent and comprehensive work, Novak Email: virginia. Email: manzanon msn. Email: gustavo. Email: rachelriera hotmail.
Email: analuizacabrera hotmail. We thank Swati Kale for her contribution to the initial version of the protocol. Taken from: Palisano Taken from: Ryan MAZ was the contact person with the editorial base and has overall responsibility for the review. National Center for Biotechnology Information , U. Cochrane Database Syst Rev.
Published online Nov 5. Author information Copyright and License information Disclaimer. Corresponding author. This article has been updated. Abstract This is a protocol for a Cochrane Review Intervention. The objectives are as follows: To evaluate the effectiveness of neurodevelopmental treatment approaches NDT for the treatment of children with cerebral palsy. Background Description of the condition Cerebral palsy, with its primary features of movement limitation and impairment of postural control, is a complex condition that results from damage to the immature brain.
Description of the intervention Historically, the movement disorders of children with cerebral palsy has been treated with different rehabilitation interventions, including the Bobath Concept dos Santos How the intervention might work During NDT evaluation and treatment sessions, the therapist interacts with the child in a dynamic and reciprocal way ndta.
Objectives To evaluate the effectiveness of neurodevelopmental treatment approaches NDT for the treatment of children with cerebral palsy. Any adverse outcomes, for example, pain, discomfort and tonus impairment.
OpenGrey opengrey. PEDro pedro. Searching other resources We will handsearch reference lists of relevant studies and will contact study authors and organisations about any ongoing or unpublished studies. Data collection and analysis Selection of studies Two authors MAZ and GJMP will independently screen all titles and abstracts retrieved by the search strategy for eligibility. Data extraction and management MAZ and GJMP will independently extract data from the included studies on participant characteristics age, gender, and type of cerebral palsy ; intervention type of intervention, frequency of treatment, and duration ; methods study design, randomisation, blinding, sample size, and unit of analysis ; and outcomes including motor function; upper limb function; hand function; quality of life; and participation.
Assessment of risk of bias in included studies Using the Cochrane 'Risk of bias' tool Higgins , Section 8. Random sequence generation For each included study we will describe the method used to generate the allocation sequence and assess whether it was reported in sufficient detail to allow an assessment of whether it should produce comparable groups.
We will categorise the method as: low risk of bias any truly random process, e. Allocation concealment For each included study we will describe the method used to conceal allocation to interventions prior to assignment and will assess whether intervention allocation could have been foreseen in advance of, or during recruitment, or changed after assignment. We will categorise the methods as: low risk of bias e.
Blinding of participants and personnel For each included study we will describe the methods used, if any, to blind study participants and personnel from knowledge of which intervention a participant received. We will categorise the methods as: low risk of bias participants and personnel are blinded, or we judge that the lack of blinding would be unlikely to affect results ; high risk of bias some participants or some key study personnel are not blinded, and the lack of blinding is likely to introduce bias; or blinding of key study participants and personnel attempted, but it is likely that the blinding could have been broken ; or unclear risk of bias insufficient information to permit a judgement of high or low risk of bias.
Blinding of outcome assessment For each included study we will describe the methods used, if any, to blind outcome assessors from knowledge of which intervention a participant received. We will categorise the methods as: low risk of bias blinding of participants and key study personnel ensured, and it is unlikely that the blinding could have been broken ; high risk of bias no blinding or incomplete blinding, and the outcome or outcome measurement is likely to be influenced by lack of blinding ; or unclear risk of bias e.
Incomplete outcome data For each included study and for each outcome or class of outcomes, we will describe the completeness of data, including attrition and exclusions from the analysis. Selective outcome reporting For each included study we will describe how we investigated the possibility of selective outcome reporting bias and what we found.
Other potential sources of bias For each included study we will describe any important concerns that we have about other possible sources of bias. Multiple outcome measures When a study assesses the same outcome using different tools e.
Dealing with missing data We will try to contact the study authors to request any unreported data e. Assessment of heterogeneity We will consider clinical and methodological heterogeneity by examining factors such as similarity among participants and methodological aspects of the trial, which could lead to differences in the observed intervention effects.
Assessment of reporting biases If we include a sufficient number of studies more than 10 , we will draw funnel plots to explore any small study effects, including publication bias. Subgroup analysis and investigation of heterogeneity We will perform the following subgroup analyses: Type of neuromotor abnormality spastic, ataxic, and dyskinetic , since response to treatment may vary according to the type of abnormality. Sensitivity analysis We will perform sensitivity analyses to assess the impact of the following.
Feedback Feedback on protocol of 'Neurodevelopmental treatment approaches for children with cerebral palsy' Summary Correspondence has been edited for length.
Comment 3 Current practice of the Bobath approach. Comment 5 Measures of Treatment effect. Comment 6 The commenter was concerned on looking at the protocol again about the accuracy of text relating to Kollen and work by Lennon Comment 7 The commenter was concerned that Franki was misattributed as a source review, asserted that the work contained no relevant studies of neurodevelopmental treatment approaches, and wondered if Desloovere were, in fact, meant instead.
Reply Comment 1 Thank you for this comment. Comment 2 We understand your concern. Comment 3a We updated the references and clarified the concept of Bobath approach as follows: "Historically, the movement disorders of children with cerebral palsy has been treated with different rehabilitation interventions, including the Bobath Concept dos Santos Comment 3b We agree.
We have deleted the term. Comment 4 We have included the following examples of adverse events: pain, discomfort and tonus impairment. Comment 6 We rewrote the text and removed the reference to Kollen at this point, as this study is related to the Bobath approach as used for adult stroke rehabilitation. Comment 7 We believe that Franki does indeed include relevant NDT studies, and have retained it in the text.
Comment 8 We have replaced the Singhi reference with one to a more recent and comprehensive work, Novak Appendices Appendix 1. Description of gross motor function for children aged 6 to 12 years by Gross Motor Function Classification System GMFCS level Level Expected gross motor function between 6 and 12 years of age Level I Children walk indoors and outdoors, and climb stairs without limitations.
Children perform gross motor skills including running and jumping, but speed, balance, and coordination are reduced. Level II Children walk indoors and outdoors, and climb stairs holding onto a rail, but experience limitations walking on uneven surfaces and inclines, and walking in crowds or confined spaces. Children have at best only minimal ability to perform gross motor skills such as running and jumping. Level III Children walk indoors or outdoors on a level surface with an assistive mobility device.
Children may climb stairs holding onto a rail. Level IV Children may maintain levels of function achieved before age 6 years or rely more on wheeled mobility at home, school, and in the community. Level V Physical impairments restrict voluntary control of movement and the ability to maintain antigravity head and trunk postures.
All areas of motor function are limited. Functional limitations in sitting and standing are not fully compensated for through the use of adaptive equipment and assistive technology. Children have no means of independent mobility and are transported pushed by another person. Appendix 2. Infants crawl on hands and knees, pull to stand, and take steps holding onto furniture. Infants walk between 18 months and 2 years of age without the need for any assistive mobility device.
From age 2 to 4th birthday Children floor sit with both hands free to manipulate objects. Children perform movements in and out of floor sitting and standing without adult assistance. Children walk as the preferred method of mobility without the need for any assistive mobility device. From age 4 to 6th birthday Children get into and out of and sit in a chair without the need for hand support.
Children move from floor and chair sitting to standing without the need for objects for support. Children walk indoors and outdoors, and climb stairs. Emerging ability to run and jump. From age 6 to 12th birthday Children walk at home, school, outdoors, and in the community.
Children are able to walk up and down curbs without physical assistance and stairs without the use of a railing. Children perform gross motor skills, such as running and jumping, but speed, balance, and coordination are limited. Children may participate in physical activities and sports depending on personal choices and environmental factors. From age 12 Youth walk at home, school, outdoors, and in the community. Youth are able to walk up and down curbs without physical assistance and stairs without the use of a railing.
Youth perform gross motor skills, such as running and jumping, but speed, balance, and coordination are limited. Youth may participate in physical activities and sports depending on personal choices and environmental factors.
Level II: Walks without assistive devices; limitations walking outdoors and in the community Before 2nd birthday Infants maintain floor sitting but may need to use their hands for support to maintain balance. Infants creep on their stomach or crawl on hands and knees. Infants may pull to stand and take steps holding onto furniture.
From age 2 to 4th birthday Children floor sit but may have difficulty with balance when both hands are free to manipulate objects. Children perform movements in and out of sitting without adult assistance. Children pull to stand on a stable surface. Children crawl on hands and knees with a reciprocal pattern, cruise holding onto furniture, and walk using an assistive mobility device as preferred methods of mobility.
From age 4 to 6th birthday Children sit in a chair with both hands free to manipulate objects. Children move from the floor to standing and from chair sitting to standing but often require a stable surface to push or pull up on with their arms. Children walk without needing any assistive mobility device indoors and for short distances on level surfaces outdoors.
Children climb stairs holding onto a railing but are unable to run or jump. From age 6 to 12th birthday Children walk in most settings. Children may experience difficulty walking long distances and balancing on uneven terrain, on inclines, in crowded areas, in confined spaces, or when carrying objects.
Children walk up and down stairs holding onto a railing or with physical assistance if there is no railing. Limitations in performance of gross motor skills may necessitate adaptations to enable participation in physical activities and sports. From age 12 Youth walk in most settings. Environmental factors such as uneven terrain, inclines, long distances, time demands, weather, and peer acceptability and personal preference influence mobility choices.
Outdoors and in the community, youth may use wheeled mobility when travelling long distances. Youth walk up and down stairs holding a railing or with physical assistance if there is no railing.
Distinctions between Levels I and II: Compared with children in Level I, children in Level II have limitations in the ease of performing movement transitions; walking outdoors and in the community; the need for assistive mobility devices when beginning to walk; quality of movement; and the ability to perform gross motor skills such as running and jumping.
Level III: Walks with assistive mobility devices; limitations walking outdoors and in the community Before 2nd birthday Infants maintain floor sitting when the low back is supported. Infants roll and creep forward on their stomachs. Children creep on their stomach or crawl on hands and knees often without reciprocal leg movements as their primary methods of self mobility.
Children may pull to stand on a stable surface and cruise short distances. Children may walk short distances indoors using an assistive mobility device and adult assistance for steering and turning.
From age 4 to 6th birthday Children sit on a regular chair but may require pelvic or trunk support to maximise hand function. Children move in and out of chair sitting using a stable surface to push on or pull up with their arms. Children walk with an assistive mobility device on level surfaces and climb stairs with adult assistance. Children are frequently transported when travelling for long distances or outdoors on uneven terrain.
When seated, children may require a seat belt for pelvic alignment and balance. When travelling long distances, children use some form of wheeled mobility. Children may walk up and down stairs holding onto a railing with supervision or physical assistance.
Limitations in walking may necessitate adaptations to enable participation in physical activities and sports, including a self propelling manual wheelchair or powered mobility. In comparison with individuals in other levels, youth in Level III demonstrate more variability in methods of mobility depending on physical ability and environmental and personal factors.
When seated, youth may require a seat belt for pelvic alignment and balance. At school, youth may self propel a manual wheelchair or use powered mobility.
Outdoors and in the community, youth are transported in a wheelchair or use powered mobility. Youth may walk up and down stairs holding onto a railing with supervision or physical assistance. Limitations in walking may necessitate adaptations to enable participation in physical activities and sports, including self propelling a manual wheelchair or powered mobility.
Children in Level III need assistive mobility devices and frequently orthoses to walk, while children in Level II do not require assistive mobility devices after age 4. Level IV: Self mobility with limitations; children are transported or use power mobility outdoors and in the community Before 2nd birthday Infants have head control but require trunk support for floor sitting.
Infants can roll to supine and may roll to prone. From age 2 to 4th birthday Children floor sit when placed but are unable to maintain alignment and balance without using their hands for support.
Children frequently require adaptive equipment for sitting and standing. Children achieve self mobility for short distances within a room through rolling, creeping on stomach, or crawling on hands and knees without reciprocal leg movement.
From age 4 to 6th birthday Children sit on a chair but need adaptive seating for trunk control and to maximise hand function.
Children move in and out of chair sitting with assistance from an adult or a stable surface to push or pull up on with their arms. Children may at best walk short distances with a walker and adult supervision but have difficulty turning and maintaining balance on uneven surfaces.
Children are transported in the community. Children may achieve self mobility using a power wheelchair. From age 6 to 12th birthday Children use methods of mobility that require physical assistance or powered mobility in most settings.
Children require adaptive seating for trunk and pelvic control and physical assistance for most transfers. At home, children use floor mobility roll, creep, or crawl , walk short distances with physical assistance, or use powered mobility. When positioned, children may use a body support walker at home or school. At school, outdoors and in the community, children are transported in a manual wheelchair or use powered mobility. Limitations in mobility necessitate adaptations to enable participation in physical activities and sports, including physical assistance or powered mobility, or both.
From age 12 Youth use wheeled mobility in most settings. Youth require adaptive seating for pelvic and trunk control. Youth require physical assistance from one or two persons for transfers. Youth may support weight with their legs to assist with standing transfers. Indoors, youth may walk short distances with physical assistance, use wheeled mobility, or, when positioned, use a body support walker. Youth are physically capable of operating a powered wheelchair. When a powered wheelchair is not feasible or available, youth are transported in a manual wheelchair.
Distinctions between Levels III and IV: Differences in sitting ability and mobility exist, even allowing for extensive use of assistive technology. Children in Level III sit independently, have independent floor mobility, and walk with assistive mobility devices. Children in Level IV function in sitting usually supported , but independent mobility is very limited. Children in Level IV are more likely to be transported or to use power mobility.
Infants are unable to maintain antigravity head and trunk postures in prone and sitting. Infants require adult assistance to roll. From age 2 to 12th birthday Children are transported in a manual wheelchair in all settings. Children are limited in their ability to maintain antigravity head and trunk postures and control arm and leg movements.
Transfers require complete physical assistance of an adult. At home, children may move short distances on the floor or may be carried by an adult.
Children may achieve self mobility using powered mobility with extensive adaptations for seating and control access. Limitations in mobility necessitate adaptations to enable participation in physical activities and sports, including physical assistance and using powered mobility.
From age 12 Youth are transported in a manual wheelchair in all settings. Youth are limited in their ability to maintain antigravity head and trunk postures and control arm and leg movements. Assistive technology is used to improve head alignment, seating, standing, and mobility, but limitations are not fully compensated for by equipment.
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