TOAST-CP bimanual activities of daily life upper limb strength. manual skill learning
Conditions
Interventions
Participants assigned to the experimental group will perform an individualized TOAST-CP program. The exercises in TOAST-CP will be based on 1) the three defined goals, 2) the outcome of the analysis o
Sponsors
Adelante zorggroep
Eligibility
Inclusion criteria
Inclusion criteria: - Age 8-18 years - Spastic Cerebral Palsy (according to the Surveillance of Cerebral Palsy in Europe (SCPE) - Gross Motor Function Classification System (GMFCS) I-IV - Manual Ability Classification System (MACS) I-III - Hand function impairment Zancolli grade I- IIB - Children have to be able to comprehend tasks and perform the measurements and training, judged by the rehabilitation physician of the project team. The clinical data of the children regarding cognitive deficits and learning difficulties are available for this study. - Able to communicate in Dutch or English. - Realistic problems performing manual activities. - Reduced upper limb strength. - Strength difference between the left and right arm of at least 20%. - Children and their parents indicate the necessity for improvement of the children's manual abilities
Exclusion criteria
Exclusion criteria: - Severe impairment of hand function: no active hand function (Zancolli III) - Upper limb hand surgery within the last six months - Botulinum toxin-A injection of the upper limb within the last three months - Have undertaken an upper limb specific strength training program within the last three months
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Measurements across all domains of the ICF-CY are used. All measures are administered and scored by raters blinded for group assignment. Primary outcome measures will be as follows: - Activity Level - At the activity level, measures of hand skills, bimanual performance and manual ability will be used. Based on the aim of the study - to improve the ability of the use of both hands - the primary outcome measure will be the Assisting Hand Assessment (AHA). Furthermore, the children with CP in an earlier study (Botulinum Bimanual Skills Study) prioritized problems in performing the manual tasks and mention the ability to use both hands and amount of use of both hands, the speed of performance and quality of performance. Based on these issues the next tests are selected: The Assisting Hand Assessment (AHA) measures the typical performance of a child’s assisting hand in a range of bimanual activities. The AHA measures ability and performance of use of the affected hand in bimanual play by standardized video observation. It is validated for children with unilateral CP, aged 1.5 to 12 years.The interrater reliability of the sum scores is excellent (0.97 (0.91-0.99) | — |
Secondary
| Measure | Time frame |
|---|---|
| Activity Level 1. The Observation and Scoring of Arm hand Skills (OSAS) is a video-based observation system to observe the spontaneous use of the affected limb in standardized bimanual fine and gross motor tasks (threading beads task, construction tasks small and large, making a sandwich tasks and stacking cylinder tasks). These tasks have shown a very good intrarater reliability of 87% -91% agreement and interrater reliability of 72% -84% agreement in children with unilateral CP (prepared to submit). The OSAS will be scored by one blinded assessor. Duration of the use of the affected hand in these bimanual skills will be scored. 2. The ABILHAND-Kids is a 21-item questionnaire based on existing scales and expert advice 40. The ABILHAND-kids is a functional scale specifically developed to measure manual ability in children with CP (up to 12 years). A high reliability (R = 0.94), and a good reproducibility over time (R = 0.91) have been shown. The original ABILHAND will be used for the adolescents (12-18 years), which has shown a good reliability and reproducibility. 3. The Jebsen Taylor test will be used to score the velocity of the use of the affected hand in functional standardized tasks. For the dominant hand, the test-retest reliability in patients with stable hand disorders is high (R=0.89 to 0.99), except for the writing subtest (R=0.67). With the non-dominant hand the simulated feeding subtest is the least reproducible (r=0.60). The test seems to be sensitive enough to detect changes in hand function in patients with different impairments. Participation Level 1. The domain frequency of use of the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities for Children (PAC) will be used to document this outcome. The CAPE/PAC has been developed to determine the outcome on participation once per three months. This aims to evaluate the effect of training in a child’s typical environment (in the family, with friends, at home, | — |
Contacts
Public ContactEugene Rameckers
Outcome results
None listed