Skorup Julie C, Pierce Samuel R, Paremski Athylia C, Alcott Morgan, Prosser Laura A
Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Division of Rehabilitation Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Front Pediatr. 2024 Sep 30;12:1457329. doi: 10.3389/fped.2024.1457329. eCollection 2024.
The delivery of precision medicine in rehabilitation will require not only precise measurement of participant response, but also precise measurement of the "ingredients" of intervention and their dose. As an example, we report the measurement of motor error in two treatment groups from a randomized controlled trial in toddlers (mean age 26.3 months) with cerebral palsy (CP). Our objective was to measure the type and amount of motor error during physical therapy sessions in young children with CP.
Participants were stratified by motor function and age and randomly allocated to "conventional" physical therapy that generally prevented falls or to an intervention that encouraged error experience by not preventing falls (experimental group). Baseline motor and cognitive function were measured using the Gross Motor Function Measure-66 (GMFM-66) and Bayley 3 cognitive subscale (B3-C) prior to randomization. Randomly selected video recorded therapy sessions were manually coded to identify losses of balance defined as (child contacted floor), (therapist prevented fall) or saves (child recovered their balance independently).
Average number of losses of balance per session were higher in the experimental group than the conventional group due to significantly greater falls. Saves were infrequent in both groups but were also significantly higher in the experimental group. Average number of rescues did not differ between groups. In the experimental group, greater frequency of falls was significantly related to GMFM-66. In both groups, greater frequency of saves was related to GMFM-66. Neither total losses of balance per session nor rescues were related to GMFM-66 in either group. There were no significant relationships between losses of balance and baseline cognition in either group, except greater frequency of saves was related to higher cognitive ability in the experimental group.
Our observations suggest that motor error experience is lower in toddlers with CP compared to peers with typical development but can be manipulated to higher doses of error during therapy sessions. Future work should investigate the relationship between type and amount of error experience and rehabilitation outcomes, as well as other "ingredients" of rehabilitation therapy. Tools to automate the precise measurement of intervention content are necessary for broad scale implementation.
在康复领域提供精准医疗不仅需要精确测量参与者的反应，还需要精确测量干预的“要素”及其剂量。例如，我们报告了一项针对患有脑瘫（CP）的幼儿（平均年龄26.3个月）的随机对照试验中两个治疗组的运动误差测量情况。我们的目标是测量患有CP的幼儿在物理治疗过程中运动误差的类型和数量。
参与者根据运动功能和年龄进行分层，并随机分配到“传统”物理治疗组（通常预防跌倒）或通过不预防跌倒来鼓励错误体验的干预组（实验组）。在随机分组之前，使用粗大运动功能测量量表-66（GMFM-66）和贝利婴幼儿发展量表第3版认知分量表（B3-C）测量基线运动和认知功能。随机选择的视频记录治疗过程进行人工编码，以识别定义为跌倒（儿童接触地面）、预防跌倒（治疗师防止跌倒）或自行恢复平衡（儿童自行恢复平衡）的平衡丧失情况。
由于跌倒次数显著增加，实验组每次治疗的平均平衡丧失次数高于传统组。两组自行恢复平衡的情况都很少，但实验组也显著更高。两组的平均救援次数没有差异。在实验组中，跌倒频率增加与GMFM-66显著相关。在两组中，自行恢复平衡频率增加与GMFM-66相关。两组中每次治疗的总平衡丧失次数和救援次数均与GMFM-66无关。两组中平衡丧失与基线认知之间均无显著关系，但实验组中自行恢复平衡频率增加与较高的认知能力相关。
我们的观察结果表明，与发育正常的同龄人相比，患有CP的幼儿的运动误差体验较低，但在治疗过程中可以将其调整为更高剂量的误差。未来的工作应研究误差体验的类型和数量与康复结果之间的关系，以及康复治疗的其他“要素”。实现干预内容精确测量自动化的工具对于大规模实施是必要的。
