Physiotherapy - Theses
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ItemThe use of a smartphone app, Baby Moves, and the assessment of early spontaneous movements in infants born extremely preterm and/or extremely low birthweight( 2019)Infants born extremely preterm (EP, <28 weeks’ gestational age) and/or extremely low birthweight (ELBW, <1000 g) are at higher risk of developmental delay and/or disabilities, such as cerebral palsy (CP), compared with infants born at term. Early detection is paramount to ensure that infants who are at the highest risk of developmental delays are identified early to commence intervention and improve functional outcomes. The General Movements Assessment (GMA) involves visual clinical recognition of patterns of spontaneous infant movement from video recordings and is a key assessment for the diagnosis of high-risk CP but is not universally accessible due to resource constraints, such as limited out-patient follow-up services. The Baby Moves smartphone application (app) offers a novel method of allowing clinicians to partner with parents by providing them with a tool to record their infant’s movements via their smartphone to be used for a remote GMA. This thesis explores the feasibility of Baby Moves in a geographical sample of infants born EP/ELBW and at term, and whether there is a relationship between perinatal clinical history, GMA, and motor outcome at 4 months’ corrected age. Furthermore, this thesis investigates the nuances of the GMA in relation to preterm birth. Study 1 is a systematic review of the literature investigated the reported predictive validity of spontaneous infant movements for later CP. Forty-seven studies were identified, with fidgety movements assessed according to the Prechtl GMA found to be the most accurate spontaneous movement for predicting CP. Study 2 is a cohort study, which was conducted within a geographical sample of infants born EP/ELBW and term-matched controls. Of the 226 infants born EP/ELBW and 225 infants born at term who were recruited to the study, at least one video was received from 158 and 188 families of infants born EP/ELBW or at term respectively. This thesis found that families tended to use Baby Moves less if they were of lower sociodemographic status, regardless of whether the infants were born EP/ELBW. Families found Baby Moves easy to use and considered it a secure way to transmit videos. Study 3 analysed the data from infants’ GMA further and the occurrence and trajectories of fidgety movements was explored. Infants tended to have more normal fidgety movements with increasing age within a window of 12-16+6 weeks’ corrected age regardless of birth group (EP/ELBW vs term). More infants born EP/ELBW had absent/abnormal fidgety movements than term-born controls. Study 4 explored the relationships of perinatal variables with absent/abnormal fidgety movements within the EP/ELBW cohort. Brain injury was independently associated with absent/abnormal fidgety movements. Finally, Study 5 assessed 4-month motor outcomes in a sample of 56 infants born EP/ELBW. There was a high rate of motor impairment within this sample. Brain injury was strongly related to poorer 4-month motor outcome and neonatal surgery was independently related to a poorer AIMS score. Absent/abnormal fidgety movements were not associated with 4-month motor outcomes. Findings from this thesis provide insight into the GMA and confirm that smartphone technology can be used with the GMA in a population of infants born EP/ELBW and at term.
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ItemBike skills training for children with cerebral palsy( 2019)Training targeted towards goals that are meaningful to children with cerebral palsy (CP) and their families is needed to improve function and support participation in physical activities in this population. Riding a two-wheel bike is a common goal for ambulant children with CP, yet little specific evidence exists to guide clinicians and families. This thesis developed and tested a task-specific approach to training bike skills in this population through three studies: 1) a systematic review, 2) a practice survey, and 3) a randomised controlled trial (RCT). Each study used the International Classification of Functioning, Health and Disability (ICF) as a framework. While strong evidence exists for task-specific training (TST) for improved upper limb (UL) function in this population, prior to this thesis the literature regarding TST for gross motor skills, including bike riding, in ambulant children with CP had not been systematically appraised. Thus, Study 1 aimed to systematically evaluate the effectiveness of task-specific gross motor skills training for improving activity and participation outcomes in ambulant school-aged children with CP. This review involved 13 studies of low-to-moderate overall quality and found effects of TST were positive for participation-related outcomes, and mixed for specific skill performance and functional skills, while little or negative effects were found for general gross motor skills. This study identified the need for higher quality studies and reporting that enables evidence synthesis. Given the importance of understanding current practice when designing effectiveness studies, Study 2 involved a survey of 95 physiotherapists (PTs) and occupational therapist (OTs) in Australia about their practices when training two-wheel bike skills in children with CP. This study found that while functional approaches to training and goal-based assessment and evaluation were predominant, overall practices appear highly variable. Moreover, the need to develop and test bike-specific measures and interventions in this population was highlighted. The findings from Studies 1 and 2 informed the design of Study 3. This multi-site assessor-blind RCT aimed to determine if a task-specific approach was more effective than a parent-led home program for attaining individualised two-wheel bike riding goals in ambulant children with CP. Sixty-two children were randomly allocated to either the task-specific approach (n=31) or home program (n=31). The primary finding was that the task-specific program was more effective than the home program for goal attainment at one week post-intervention. Greater odds of goal attainment were retained at three months and evidence of better outcomes following the task-specific program were found for some outcomes related to participation in bike riding, physical activity and self-perception. In addition, there was evidence of mixed effects for functional skills, and little difference in bike skills and health-related quality of life. While each of these studies provides an original contribution to the literature, together they form a significant foundation for evidence on training bike skills in ambulant children with CP. Use of the ICF across the thesis meant findings could be synthesised and enhanced the clinical relevance of the research. Given that an effective approach for attaining two-wheel bike riding goals in this population now exists, training for clinicians to optimise knowledge translation should be developed. Future research should seek to understand relationships between bike skills training and a broader range of ICF domains and levels of function in CP, tailor interventions to individuals and determine longer-term outcomes.
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ItemNeurobehavioural development of infants born <30 weeks' gestational age between birth and one year corrected age( 2016)Background: Prematurity has become the second leading cause of mortality in children under 5 years worldwide. Very preterm infants who survive are at greater risk of both minor and major long-term neurodevelopmental dysfunction in areas including sensory and motor than infants born at term. Standardised assessments were developed in response to pioneering research that discovered the importance of infant's early movement patterns. Their use in the exploration of very preterm infants' individual movement and behavioural differences in the preterm period helps to inform clinical decision-making at a critical time of development. Early detection of at-risk very preterm infants is recommended; however little is known regarding the predictive validity of standardised neurobehavioural assessments in the neonatal nursery for long-term neurodevelopmental outcome. Aims: This thesis addresses three primary aims: 1) To evaluate which standardised neurobehavioural assessments are currently used in Neonatal Intensive Care Units (NICU) and Special Care Nurseries (SCN) throughout Australia and New Zealand. 2) To compare the physiological stress in infants born <30 weeks' gestation when undergoing clustered nursing cares versus standardised neurobehavioural assessments. 3) To examine the predictive relationship of standardised neurobehavioural assessments of infants born <30 weeks' gestation prior to term equivalent age and at term equivalent age for neurosensory-motor outcome at one year corrected age. Methods: This thesis involved three separate studies to address the aforementioned aims. Study 1 involved an electronic survey emailed to nurse unit managers of 179 Australian and New Zealand neonatal intensive care units and special care nurseries. Study 2 required extraction of heart rate and oxygen saturation data at 5 second intervals from videos of 34 infants' at 29-32 weeks' postmenstrual age that contained both standardised neurobehavioural assessments and clustered nursing cares. Study 3 was a prospective observational cohort study of 100 very preterm infants born <30 weeks' gestation. Serial standardised neurobehavioural assessments (General Movements; Premie-Neuro; Hammersmith Neonatal Neurological Examination; and Neonatal Intensive Care Unit Network Neurobehavioural Scale) were conducted in the neonatal nursery; initially weekly from birth to 32 weeks' postmenstrual age, and then fortnightly until term. At term equivalent age, infants were assessed using General Movements, the Hammersmith Neonatal Neurological Examination, and the Neonatal Intensive Care Unit Network Neurobehavioural Scale. At one year corrected age, infants were assessed using the Alberta Infant Motor Scale, the Neurosensory Motor Developmental Assessment, and the Touwen Infant Neurological Examination. A cohort of 100 term control infants were also assessed soon after birth and at one year of age. Results were compared between preterm and term children. The relationships at the preterm assessments and perinatal variables with one year outcome were determined. Results: Neonatal intensive care units were more likely to provide standardised neurobehavioural assessments and neurodevelopmental therapy than special care nurseries. Standardised neurobehavioural assessments caused less physiological stress than clustered nursing cares. Very preterm infants performed consistently lower on term and one year assessments than term controls. General Movements was the only assessment in the preterm period to predict outcome on one year assessments. Few perinatal variables were related to assessments at one year corrected age. Conclusions: Standardised neurobehavioural assessments are safe to use in medically stable infants from 29 weeks' postmenstrual age. General Movements in the preterm period were predictive of neurosensory-motor outcomes at one year corrected age. Future research is required to explore the predictive validity of preterm assessments at later ages in childhood for neurosensory-motor outcome.