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Does the use of home-based assistive rehabilitation technology enhance the functional benefits of botulinum toxin in children with cerebral palsy who have upper limb movement difficulties: a single-blind randomised controlled trial.

Preston, Nicholas John (2014) Does the use of home-based assistive rehabilitation technology enhance the functional benefits of botulinum toxin in children with cerebral palsy who have upper limb movement difficulties: a single-blind randomised controlled trial. PhD thesis, University of Leeds.

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Abstract

Background. Spastic cerebral palsy is a common cause of childhood activity limitation that restricts children’s personal development. Botulinum toxin is a spasticity treatment that can improve upper limb activity limitation when combined with rehabilitation therapy. We investigated whether use of a computer-assisted arm rehabilitation (CAAR) device enhanced the benefits of botulinum toxin treatment of the upper limb of children with cerebral palsy. Method. Fifteen children with cerebral palsy aged 5 – 12 years old undergoing botulinum toxin treatment for spasticity of the upper limb were randomly allocated into a CAAR group and a control group using minimisation, a procedure that balances groups for prognostic factors e.g. age and disability. Children used CAAR at home for 6 weeks. Assessments were carried out by blinded assessor at baseline, six and twelve weeks. Primary outcome measure. ABILHAND-kids. Secondary outcome measure. Canadian Occupational Performance Measure (COPM). Results. ABILHAND-kids. Activity limitation worsened following botulinum toxin treatment. An ANCOVA revealed that this was not significant (median scores, all participants: baseline, 0.8084; six weeks, 0.145; twelve weeks, 0.334; p=0.462) and that there was no difference between groups (p=0.699). COPM. A Friedman’s ANOVA revealed a statistically significant improvement that was clinically non-significant (baseline score, 4/10; six week score, 4.6/10; twelve week score, 4.6/10; p=0.031). A Kruskal-Wallis ANOVA revealed no difference in scores between groups at each time point. CAAR use. Mean daily use, 7 minutes. Maximum use, 256 minutes (played over 24 days, mean daily use 10.667 minutes). Sample size. This sample size was underpowered by 75%. Conclusion. This study potentially supports evidence that botulinum treatment should be used only in combination with rehabilitation therapy but it was not adequately powered and a Type II error cannot be ruled out. The CAAR device did not engage the children enough to promote sufficient intensity and repetition of arm movements.

Item Type: Thesis (PhD)
Additional Information: This thesis presents independent research funded by the National Institute for Health Research (NIHR) under a Clinical Doctoral Research Fellowship. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Keywords: paediatrics, cerebral palsy, outcome measure, activity limitation, upper limb, Rasch analysis, robotics, assistive technology, rehabilitation
Academic Units: The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds)
Identification Number/EthosID: uk.bl.ethos.635395
Depositing User: NJ Preston
Date Deposited: 17 Feb 2015 13:20
Last Modified: 25 Nov 2015 13:47
URI: http://etheses.whiterose.ac.uk/id/eprint/8075

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