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Journal of NeuroEngineering and Rehabilitation
Published in: Journal of NeuroEngineering and Rehabilitation 1/2018

Open Access 01-12-2018 | Review

Why orthotic devices could be of help in the management of Movement Disorders in the young

Authors: Lorenzo Garavaglia, Emanuela Pagliano, Giovanni Baranello, Simone Pittaccio

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2018

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Abstract

Background

Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities. Nowadays, the general management of patients with MD is based on rehabilitation, pharmacological treatments, surgery, and traditional splints. Although some attempts have been made to devise specific orthoses for the rehabilitation of patients affected by MD, especially the younger ones, those devices have received limited attention.

Main body

This paper will principally discuss the case of upper limb rehabilitation in Childhood Dyskinesia (CD), a complex motor disease that affects paediatric patients. Through a critical review of the present solutions and a discussion about the neurophysiological characteristics of the disease, the study will lead to the formulation of desirable features of a possible new upper-limb orthosis.

Conclusions

Design principles will be derived to provide specialised orthoses for the dynamic control of posture and the stabilisation of voluntary movements: those include using biomechanical actions and enhanced proprioception to support the sensorimotor rehabilitation of the children affected by CD. A similar approach could be advantageously applied in other MD-related conditions, especially with hyperkinetic and/or hypertonic traits.
Literature
1.
Jankovic J. Treatment of hyperkinetic movement disorders. The Lancet Neurology. 2009;8(9):844–56.PubMedCrossRef
2.
Singer HS, Mink J, Gilbert DL, Jankovic J. Movement disorders in childhood. Academic Press. 2015;22:1159–85.
3.
Sanger TD. Arm trajectories in dyskinetic cerebral palsy have increased random variability. Journal of Child Neurology. 2006;21(7):551–7.PubMedCrossRef
4.
Koy A, Lin JP, Sanger TD, Marks WA, Mink JW, Timmermann L. Advances in management of movement disorders in children. The Lancet Neurology. 2016;15(7):719–35.PubMedCrossRef
5.
Levitt S. Treatment of cerebral palsy and motor delay. John Wiley & Sons. 5th Ed, 2010.
6.
Bertucco M, Sanger TD. Current and emerging strategies for treatment of childhood dystonia. Journal of Hand Therapy. 2015;28(2):185–94.PubMedCrossRef
7.
Morris C, Bowers R, Ross K, Stevens P, Phillips D. Orthotic management of cerebral palsy: recommendations from a consensus conference. Neuro Rehabilitation. 2011;28(1):37–46.PubMed
8.
Sanger TD, Chen D, Fehlings DL, Hallett M, Lang AE, Mink JW, Chen R. Definition and classification of hyperkinetic movements in childhood. Movement Disorders. 2010;25(11):1538–49.PubMedPubMedCentralCrossRef
9.
Butler EE, Rose J. The Pediatric Upper Limb Motion Index and a temporal–spatial logistic regression: Quantitative analysis of upper limb movement disorders during the Reach & Grasp Cycle. Journal of biomechanics. 2012;45(6):945–51.PubMedPubMedCentralCrossRef
10.
Sanger TD. Pathophysiology of pediatric movement disorders. Journal of child neurology. 2003;18(1):S9–S24.PubMedCrossRef
11.
Sanger TD. Toward a definition of childhood dystonia. Current opinion in pediatrics. 2004;16(6):623–7.PubMedCrossRef
12.
Albanese A, Bhatia K, Bressman SB, DeLong MR, Fahn S, Fung VS, Lang AE. Phenomenology and classification of dystonia: a consensus update. Movement Disorders. 2013;28(7):863–73.PubMedPubMedCentralCrossRef
13.
14.
Law M, Darrah J. Emerging Therapy Approaches: an Emphasis on Function. J Child Neurol. 2014;29(8):1101–7.PubMedCrossRef
15.
Rizzolatti G, Sinigaglia C. The mirror mechanism: a basic principle of brain function. Nat Rev Neurosci. 2016;17(12):757–65.PubMedCrossRef
16.
Bloom R, Przekop A, Sanger TD. Prolonged electromyogram biofeedback improves upper extremity function in children with cerebral palsy. Journal of child neurology. 2010;25(12):1480–4.PubMedCrossRef
17.
Novak I, Mcintyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson S, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental Medicine & Child Neurology. 2013;55(10):885–910.CrossRef
18.
Fedrizzi E. I disordini dello siluppo motorio. 2009; EDS Piccin.
19.
Rodríguez MI, Gajardo C. Dystonia and Rehabilitation in Children. In: Rosales, editor. Dystonia – The Many Facets. Rijeka: INTECH; 2012.
20.
Autti-Ramo I, Suoranta J, Anttila H, Malmivaara A, Makela M. Effectiveness of upper and lower limb casting and orthoses in children with cerebral palsy: An overview of review articles. Am J Phys Med Rehabil. 2006;85:89–103.PubMedCrossRef
21.
Sanger TD, Kaiser J, Placek B. Reaching movements in childhood dystonia contain signal-dependent noise. Journal of child neurology. 2005;20(6):489–96.PubMedCrossRef
22.
Mink JW. The basal ganglia and involuntary movements: impaired inhibition of competing motor patterns. Archives of neurology. 2003;60(10):1365–8.PubMedCrossRef
23.
Bizzi E, Dev P, Morasso P, Polit A. Effect of load disturbances during centrally initiated movements. Journal of Neurophysiology. 1978;41(3):542–56.PubMedCrossRef
24.
Milner TE, Cloutier C. The effect of antagonist muscle co-contraction on damping of the wrist joint during voluntary movement In: Engineering in Medicine and Biology Society, IEEE 17th Annual Conference, vol. 2; 1995. p. 1247–8.
25.
Milner TE. Adaptation to destabilizing dynamics by means of muscle cocontraction. Experimental brain research. 2002;143(4):406–16.PubMedCrossRef
26.
Winters JM, Stark L. Estimated mechanical properties of synergistic muscles involved in movements of a variety of human joints. Journal of biomechanics. 1988;21(12):1027–41.PubMedCrossRef
27.
Milner TE, Cloutier C. Damping of the wrist joint during voluntary movement. Experimental brain research. 1998;122(3):309–17.PubMedCrossRef
28.
Heitmann S, Breakspear M, Ferns N. Muscle co-contraction modulates damping and joint stability in a three-link biomechanical limb. Frontiers in neurorobotics. 2012;5:10–3.CrossRef
29.
van Doornik J, Kukke S, Sanger TD. Hypertonia in childhood secondary dystonia due to cerebral palsy is associated with reflex muscle activation. Movement Disorders. 2009;24(7):965–71.PubMedCrossRef
30.
Katz RT, Rymer WZ. Spastic hypertonia: mechanisms and measurement. Arch Phys Med Rehabil. 1989;70(2):144–55.PubMed
31.
Katz RT, Rovai GP, Brait C, Rymer WZ. Objective quantification of spastic hypertonia: correlation with clinical findings. Arch Phys Med Rehabil. 1992;73(4):339–47.PubMedCrossRef
32.
Gordon LM, Keller JL, Stashinko EE, Hoon AH, Bastian AJ. Can spasticity and dystonia be independently measured in cerebral palsy? Pediatric neurology. 2006;35(6):375–81.PubMedCrossRef
33.
Taylor JL. Proprioception. In: Squire LR, editor. Encyclopedia of Neuroscience. Oxford: Academic Press; 2009.
34.
35.
Abbruzzese G, Berardelli A. Sensorimotor integration in movement disorders. Movement disorders. 2003;18(3):231–40.PubMedCrossRef
36.
Wissel J, Heinen F, Schenkel A, Doll B, Ebersbach G, Müller J, Poewe W. Botulinum Toxin A in the Management of Spastic Gait Disorders in Children and Young Adults with Cerebral Palsy: A Randomized, Double-Blind Study. Neuropediatrics. 1999;30(03):120–4.PubMedCrossRef
37.
Berardelli A, Rothwell JC, Hallett M, Thompson PD, Manfredi M, Marsden CD. The pathophysiology of primary dystonia. Brain. 1998;121(7):1195–212.PubMedCrossRef
38.
Amadio S, Houdayer E, Bianchi F, Tesfaghebriel Tekle H, Urban IP, Butera C, Del Carro U. Sensory tricks and brain excitability in cervical dystonia: a transcranial magnetic stimulation study. Movement Disorders. 2014;29(9):1185–8.PubMedCrossRef
39.
Müller J, Wissel J, Masuhr F, Ebersbach G, Wenning GK, Poewe W. Clinical characteristics of the geste antagoniste in cervical dystonia. Journal of neurology. 2001;248(6):478–82.PubMedCrossRef
40.
Deuschl G, Heinen F, Kleedorfer B, Wagner M, Lücking CH, Poewe W. Clinical and polymyographic investigation of spasmodic torticollis. J Neurol. 1992;239:9–15.PubMedCrossRef
41.
Grünewald RA, Yoneda Y, Shipman JM, Sagar HJ. Idiopathic focal dystonia: a disorder of muscle spindle afferent processing? Brain. 1997;120(12):2179–85.PubMedCrossRef
42.
Trompetto C, Currà A, Buccolieri A, Suppa A, Abbruzzese G, Berardelli A. Botulinum toxin changes intrafusal feedback in dystonia: a study with the tonic vibration reflex. Movement disorders. 2006;21(6):777–82.PubMedCrossRef
43.
Grünewald R. Dystonia and Muscle Spindles: The Link in Idiopathic Focal Dystonias. In: Dystonia – The Many Facets. Rijeka: INTECH; 2012.
44.
Kanovsky P, Bhatia KP, Rosales RL. Dystonia and Dystonic Syndromes: Springer Vienna; 2015.
45.
Priori A, Pesenti A, Cappellari A, Scarlato G, Barbieri S. Limb immobilization for the treatment of focal occupational dystonia. Neurology. 2001;57(3):405–9.PubMedCrossRef
46.
El-Maksoud GMA, Gharib NM, El-Shemy SA. Influence of Elbow Immobilizer on Hand Function in Children with Athetoid Cerebral Palsy. Bull Fac Ph Th Cairo Univ. 2009;14(2):75.
47.
Coghill JE, Simkiss DE. Do lycra garments improve function and movement in children with cerebral palsy? Archives of disease in childhood. 2010;95(5):393–5.PubMedCrossRef
48.
Almeida KM, Fonseca ST, Figueiredo PR, Aquino AA, Mancini MC. Effects of interventions with therapeutic suits (clothing) on impairments and functional limitations of children with cerebral palsy: a systematic review. Brazilian journal of physical therapy. 2017.
49.
Leis AA, Dimitrijevic MR, Delapasse JS, Sharkey PC. Modification of cervical dystonia by selective sensory stimulation. Journal of the neurological sciences. 1992;110(1):79–89.PubMedCrossRef
50.
Casellato C, Maggioni S, Lunardini F, Bertucco M, Pedrocchi A, Sanger TD. Dystonia: altered sensorimotor control and vibro-tactile EMG-based biofeedback effects. In: XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013; 2014. p. 1742–6.CrossRef
51.
Lunardini F, Casellato C, Bertucco M, Sanger TD, Pedrocchi A. Muscle synergies in children with dystonia capture “healthy” patterns regardless the altered motor performance. In: Engineering in Medicine and Biology Society (EMBC), 2015 37th Annual International Conference of the IEEE; 2015. p. 2099–102.
52.
Casellato C, Lunardini F, Pedrocchi A. EMG-Based Biofeedback to Improve Motor Control in Children with Dystonia. Computer Engineering & Information Technology. 2016.
53.
Kabat H, McLeod M, Holt C. The practical application of proprioceptive neuromuscular facilitation. Physiotherapy. 1959;45:87.PubMed
54.
Knott M, Voss DE. Proprioceptive Neuromuscular Facilitation Patterns and Techniques. 2nd ed. New York: Harper & Row; 1968.
55.
Voss DE. Proprioceptive neuromuscular facilitation. In: Physical Therapy Services in the Developmental Disabilities (Eds PH Pearson & CE Williams), Ch. Illinois: Thomas, Springfield; 1972. p. 5.
56.
Voss DE, Jonta M, Meyers B. Proprioceptive Neuromuscular Facilitation Patterns and Techniques, 3rd eds Harper & Row. New York; 1985.
57.
Frucht S, Fahn S, Ford B, Gelb M. A geste antagoniste device to treat jaw-closing dystonia. Movement disorders. 1999;14(5):883–6.PubMedCrossRef
58.
Stoeckmann TM, Sullivan KJ, Scheidt RA. Elastic, viscous, and mass load effects on post stroke muscle recruitment and co-contraction during reaching: a pilot study. Physical therapy. 2009.
59.
Angel RW. Electromyographic patterns during ballistic movement of normal and spastic limbs. Brain research. 1975;99(2):387–92.PubMedCrossRef
60.
Gottlieb GL. A computational model of the simplest motor program. Journal of motor behavior. 1993;25(3):153–61.PubMedCrossRef
61.
Gottlieb GL, Corcos DM, Agarwal GC. Strategies for the control of voluntary movements with one mechanical degree of freedom. Behavioral and brain sciences. 1989;12(02):189–210.CrossRef
62.
Smeets JBJ, Erkelens CJ, Denier Van Der Gon JJ. Adjustments of fast goal-directed movements in response to an unexpected inertial load. Exp Brain Res. 1990;81:303–12.PubMedCrossRef
63.
Sanes JN. Kinematics and end-point control of arm movements are modified by unexpected changes in viscous loading. Journal of Neuroscience. 1986;6(11):3120–7.PubMedCrossRef
64.
Stein RB, Cody FWJ, Capaday C. The trajectory of human wrist movements. J Neurophysiol. 1988;59:1814–30.PubMedCrossRef
65.
Lestienne F. Effects of inertial load and velocity on the braking process of voluntary limb movements. Experimental Brain Research. 1979;35(3):407–18.PubMedCrossRef
66.
Richardson C, Simmons RW. Electromyographic and neuromuscular force patterns associated with unexpectedly loaded rapid movements. Brain Res. 1985;343:246–51.
67.
Gottlieb GL. On the voluntary movement of compliant (inertial-viscoelastic) loads by parcellated control mechanisms. Journal of neurophysiology. 1996;76(5):3207–29.
68.
Garavaglia L, Pagliano E, Arnoldi MT, LoMauro A, Zanin R, Baranello G, Aliverti A, Pittaccio S. Two single cases treated by a new pseudoelastic upper-limb orthosis for secondary dystonia of the young. In Rehabilitation Robotics (ICORR), 2017 International Conference on 2017 Jul 17 (pp. 1260-1265). IEEE.
69.
Taş N, Karataş GK, Sepici V. Hand orthosis as a writing aid in writer's cramp. Movement disorders. 2001;16(6):1185–9.PubMedCrossRef
70.
Law M, Cadman D, Rosenbaum P, Walter S, Russell D, De Matteo C. Neurodevelopmental therapy and upper-extremity inhibitive casting for children with cerebral palsy. Developmental Medicine & Child Neurology. 1991;33(5):379–87.CrossRef
71.
Law M, Russell D, Pollock N, Rosenbaum P, Walter S. King G. A comparison of intensive neurodevelopmental therapy plus casting and a regular occupational therapy program for children with cerebral palsy. Developmental Medicine & Child Neurology. 1997;39(10):664–70.CrossRef
72.
Candia V, Elbert T, Altenmüller E, Rau H, Schäfer T, Taub E. Constraint-induced movement therapy for focal hand dystonia in musicians. The Lancet. 1999;353(91):42–6.CrossRef
73.
Crocker MD, MacKay-Lyons M, McDonnell E. Forced use of the upper extremity in cerebral palsy: a single-case design. American Journal of Occupational Therapy. 1997;51(10):824–33.CrossRef
74.
Sakzewski L, Gordon A, Eliasson AC. The state of Evidence for intensive Upper Limb Therapy Approaches for children with Unilateral Cerebral Palsy. J Child Neurol. 2014;29(8):1077–90.PubMedCrossRef
75.
Nicholson JH, Morton RE, Attfield S, Rennie D. Assessment of upper-limb function and movement in children with cerebral palsy wearing lycra garments. Developmental Medicine & Child Neurology. 2001;43(6):384–91.CrossRef
76.
Shvarkov SB, Davydov OS, Kuus RA, Aipova TR, Vein AM. New approaches to the rehabilitation of patients with neurological movement defects. Neurosci Behav Physiol. 1997;27:644–7.PubMedCrossRef
77.
Bar-Haim S, Harries N, Belokopytov M. Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy. Dev Med Child Neurol. 2006;48(5):325–30.PubMedCrossRef
78.
Bailes AF, Greve K, Burch CK. The effect of suit wear during an intensive therapy programme in children with cerebral palsy. Pediatr Phys Ther. 2011;23:136–42.PubMedCrossRef
Metadata
Title
Why orthotic devices could be of help in the management of Movement Disorders in the young
Authors
Lorenzo Garavaglia
Emanuela Pagliano
Giovanni Baranello
Simone Pittaccio
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2018
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/s12984-018-0466-8

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