550566
research-article2014
CRE0010.1177/0269215514550566Clinical Rehabilitation
CLINICAL REHABILITATION Clinical Rehabilitation 2014, Vol. 28(10) 938 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269215514550566 cre.sagepub.com
Introductory paragraph – Volume 28, Issue 10
This special issue focused on paediatric rehabilitation recognises the large and increasing number of high quality studies, primarily randomised controlled studies that we are receiving. This is a selection of recently submitted studies. Unsurprisingly most of the studies, in this issue and generally concern children with cerebral palsy. But one systematic review studying the benefits of supplying a child with a powered wheelchair concludes, with a nice turn of phrase, that “research in this area is still in its infancy.” One might conclude that it is obvious that a wheelchair will improve quality of life, but many obvious interventions turn out to be misguided and I hope that more research occurs to provide strong evidence of the degree of benefit; refusing funding will then be more difficult. Constraint-induced movement therapy is a much more researched intervention 27 RCTs in children with cerebral palsy investigating arm recovery - and interestingly although it is effective, once the time involved is controlled for the difference is quite small. Technology is now being used as well, probably acting by increasing actual use, but a reasonably sized study (n = 62) of the Wii Sports Resort only identified favourable trends - more patients are needed in a definitive study. Technology that is used widely and is simply adapted for use in rehabilitation is more likely to motivate but specially made technology is often not used or useful. In a study on the use of a knee-ankle-foot orthosis in children with foot equinus, a low level of wearing was found and no beneficial effect detected. However simpler technology, such as an ankle-foot orthosis alone did benefit children with rotational
deformation of the leg (but TheraTogs did not give benefit). The last technology evaluated in this issue was microcurrent treatment in children with congenital torticollis; in a small study (n = 20) the treated group got better more quickly. However as the first systematic review shows, it is probably time spent learning that is most important. Immediate feedback encourages learning and a study on feedback respiratory training in children with cerebral palsy showed significant beneficial effects. A comprehensive programme aimed at increasing physical activity had mixed effects on social participation, with beneficial effects only found in domestic activities. However the study was small and probably underpowered (n = 49), especially given the findings of a large exploratory study (n = 377) that showed, perhaps unsurprisingly but very importantly, that physical activity (strength and gait) only account for a limited amount of variance in participation and activities. Another small but interesting study compared a ‘standard programme’ approach (much loved by those who manage and pay for services) with a tailored programme approach. This suggests that a trial including 70-90 children with cerebral palsy would generate an answer to the question, “Is personalised rehabilitation more effective?” I hope someone undertakes this soon. Last, in a small study (n = 22) on children with Developmental Coordination Disorder it was notable that the relationship between improvement in coordination and adherence was reasonably strong in the taskoriented group; and I suspect that task-oriented practice is more engaging than core stability exercise (the alternative treatment).
Downloaded from cre.sagepub.com at FLORIDA INTL UNIV on June 4, 2015
research-article2014
CRE0010.1177/0269215514550566Clinical Rehabilitation
CLINICAL REHABILITATION Clinical Rehabilitation 2014, Vol. 28(10) 938 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269215514550566 cre.sagepub.com
Introductory paragraph – Volume 28, Issue 10
This special issue focused on paediatric rehabilitation recognises the large and increasing number of high quality studies, primarily randomised controlled studies that we are receiving. This is a selection of recently submitted studies. Unsurprisingly most of the studies, in this issue and generally concern children with cerebral palsy. But one systematic review studying the benefits of supplying a child with a powered wheelchair concludes, with a nice turn of phrase, that “research in this area is still in its infancy.” One might conclude that it is obvious that a wheelchair will improve quality of life, but many obvious interventions turn out to be misguided and I hope that more research occurs to provide strong evidence of the degree of benefit; refusing funding will then be more difficult. Constraint-induced movement therapy is a much more researched intervention 27 RCTs in children with cerebral palsy investigating arm recovery - and interestingly although it is effective, once the time involved is controlled for the difference is quite small. Technology is now being used as well, probably acting by increasing actual use, but a reasonably sized study (n = 62) of the Wii Sports Resort only identified favourable trends - more patients are needed in a definitive study. Technology that is used widely and is simply adapted for use in rehabilitation is more likely to motivate but specially made technology is often not used or useful. In a study on the use of a knee-ankle-foot orthosis in children with foot equinus, a low level of wearing was found and no beneficial effect detected. However simpler technology, such as an ankle-foot orthosis alone did benefit children with rotational
deformation of the leg (but TheraTogs did not give benefit). The last technology evaluated in this issue was microcurrent treatment in children with congenital torticollis; in a small study (n = 20) the treated group got better more quickly. However as the first systematic review shows, it is probably time spent learning that is most important. Immediate feedback encourages learning and a study on feedback respiratory training in children with cerebral palsy showed significant beneficial effects. A comprehensive programme aimed at increasing physical activity had mixed effects on social participation, with beneficial effects only found in domestic activities. However the study was small and probably underpowered (n = 49), especially given the findings of a large exploratory study (n = 377) that showed, perhaps unsurprisingly but very importantly, that physical activity (strength and gait) only account for a limited amount of variance in participation and activities. Another small but interesting study compared a ‘standard programme’ approach (much loved by those who manage and pay for services) with a tailored programme approach. This suggests that a trial including 70-90 children with cerebral palsy would generate an answer to the question, “Is personalised rehabilitation more effective?” I hope someone undertakes this soon. Last, in a small study (n = 22) on children with Developmental Coordination Disorder it was notable that the relationship between improvement in coordination and adherence was reasonably strong in the taskoriented group; and I suspect that task-oriented practice is more engaging than core stability exercise (the alternative treatment).
Downloaded from cre.sagepub.com at FLORIDA INTL UNIV on June 4, 2015
