Browsing by Author "Condliffe, Elizabeth G."
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Item Open Access The Effect of Transcranial Direct Current Stimulation on GABA and Glx in Children During Motor Learning(2019-06-07) Nwaroh, Chidera; Harris, Ashley D.; Kirton, Adam; Bray, Signe L.; Condliffe, Elizabeth G.; Dunn, Jeffrey F.Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that safely modulates brain activity. Several studies have shown that anodal tDCS of the primary motor cortex (M1) facilitates motor learning and plasticity but there is little information about the underlying mechanisms. Additionally, studies have shown that tDCS can affect local levels of GABA and glutamate both of which are associated with skill acquisition and plasticity. This study aimed to quantify changes in GABA and Glx in response to 5 consecutive days of anodal tDCS or high definition tDCS targeting the M1 in children. Our results suggest HD-tDCS elicits a neurochemical response that is different from anodal tDCS despite resulting in similar motor enhancements. Additionally, we identified a relationship between left sensorimotor cortex GABA and improvements in motor performance. Overall, our results suggest that the developing brain responds differently to tDCS when compared to adult literature.Item Open Access Muscle length adaptations to high-velocity training in young adults with Cerebral Palsy(2019-07-08) Gallinger, Tessa Leigh; MacIntosh, Brian R.; Condliffe, Elizabeth G.; Fletcher, Jared R.; Syme, Douglas A.Fascicle length is an important determinant of a muscle’s shortening velocity and excursion. Changes in fascicle length have been shown in typically developing adults following a period of high-velocity training (HVT); however, studies confirming this adaptation in Cerebral Palsy (CP) muscle are lacking. Improvements in fascicle length may allow these individuals to improve their muscular power output and therefore enhance functional movements including those used in sport performance. The purpose of this study was to evaluate high-velocity training as an intervention strategy to increase medial gastrocnemius (MG) muscle fascicle length and improve peak power outputs in CP. 12 young adults with CP (GMFCS I or II, 15-30 years) were randomly allocated to no training (CP-NT)(n=8), or training (CP-T) (n=8) for 10 weeks. 10 typically developing (TD) recreationally trained young adults (17-26 years) were also recruited for the study. The training consisted of 1-hour sessions bi-weekly for 10 weeks (20 sessions), with exercises involving sprints, plyometrics and agility tasks. Triceps surae muscle force-power-velocity and force-length relationships were quantified pre- and post-training using dynamometry and ultrasound. Triceps surae muscle moment arm was significantly different between TD (35.4 ± 3.6) and CP (29.1 5.5mm, p=0.002). The CP-T group had a significant increase in resting fascicle length (+4.1 mm, p<0.002) at a common ankle angle of 105°, but no significant change in power output and peak velocity. High velocity training was able to increase fascicle length, but additional training may be needed to enhance power output.Item Open Access Parent-therapist partnership to ELEVATE gross motor function in children with perinatal stroke: protocol for a mixed methods randomized controlled trial(2022-08-10) Hurd, Caitlin L.; Barnes, Michelle; Diot, Christa M.; Condliffe, Elizabeth G.; Alazem, Hana; Pritchard, Lesley; Zwicker, Jennifer D.; McCormick, Anna; Watt, Man-Joe; Andersen, John; Kirton, Adam; Yang, Jaynie F.Abstract Background There is increasing evidence for early, active rehabilitation to enhance motor function following early brain injury. This is clear for interventions targeting the upper extremity, whereas passive treatment approaches for the lower extremity persist. The purpose of this trial is to evaluate the effectiveness of early, intensive rehabilitation targeting the lower extremity and delivered in a parent-therapist partnership model for children with perinatal stroke. Methods We describe a protocol for a waitlist-control, single-blind, mixed methods effectiveness randomized controlled trial, with an embedded qualitative study using interpretative description. Participants are children with perinatal stroke aged eight months to three years with signs of hemiparesis. Participants will be randomly allocated to an immediate ELEVATE (Engaging the Lower Extremity Via Active Therapy Early) intervention group, or a waitlist-control group, who will receive usual care for six months. The ELEVATE intervention involves one hour of training four days per week for 12 weeks, with a pediatric therapist and a parent or guardian each delivering two sessions per week. The intervention targets the affected lower extremity by progressively challenging the child while standing and walking. The primary outcome measure is the Gross Motor Function Measure-66. Secondary outcomes include the Pediatric Quality of Life Inventory™, Young Children's Participation and Environment Measure, and an instrumented measure of spasticity. A cost-effectiveness analysis and qualitative component will explore benefit to costs ratios and parents’ perspectives of early, intensive rehabilitation, and their role as a partner in the rehabilitation, respectively. Discussion This study has the potential to change current rehabilitation for young children with perinatal stroke if the ELEVATE intervention is effective. The parent interviews will provide further insight into benefits and challenges of a partnership model of rehabilitation. The mixed methods design will enable optimization for transfer of this collaborative approach into physical therapy practice. Trial registration ClinicalTrials.gov NCT03672864 . Registered 17 September 2018.Item Open Access The PSTIM Trial: Pediatric Transcranial Static Magnetic Field Stimulation to Improve Motor Learning(2019-05-30) Hollis, Asha; Kirton, Adam; Zewdie, Ephrem Takele; Condliffe, Elizabeth G.; Dukelow, Sean P.Non-invasive neuromodulation is an emerging therapy for children with early brain injury but is difficult to apply to preschoolers where windows of developmental plasticity are optimal. Transcranial static magnetic field stimulation (tSMS) decreases motor cortex excitability in adults but effects on the developing brain are unstudied. We aimed to determine the effects of tSMS on primary motor cortex (M1) excitability and motor learning in healthy children. Our randomized, sham-controlled, double-blinded, 3-arm, cross-over interventional trial enrolled 24 typically developing school-aged children. We used a linear mixed effects model to examine intervention effects over time. Our results demonstrated that tSMS modulates motor learning. Contralateral (right) tSMS inhibited early motor learning in the trained hand (p<0.01) while ipsilateral (left) tSMS facilitated later stages of motor learning (p<0.01). We did not observe changes in cortical excitability as assessed by transcranial magnetic stimulation (TMS) generated motor-evoked potential (MEP) amplitudes and intracortical neurophysiology paradigms. We demonstrated the feasibility, safety, and favourable tolerability of tSMS in a pediatric population. We conclude that tSMS over motor cortex can modulate motor learning in children with effects specific to both the hemisphere of stimulation and stage of learning. Our findings suggest therapeutic potential for tSMS neuromodulation in young children with cerebral palsy (CP).Item Open Access Quantitative Assessment of Gait During Rehabilitation Using an Instrumented Treadmill(2023-09-22) Fitzsimons, Karson; Bertram, John E.A.; Dukelow, Sean P.; Condliffe, Elizabeth G.; Schroeder, Ryan T.; Manocha, Ranita H.Kinetic gait analysis of subacute stroke is a relatively unexplored area of study. Chronic stroke literature on the subject is extensive but does not capture the time period where the extent of recovery is greatest. Translating methods of gait analysis seen in research to a clinical setting is subject to many additional requirements which have previously prevented such investigations. The work presented in this thesis represents the first investigation using NeuroRecoVR, a new instrumented treadmill facility located within an inpatient rehabilitation gym. Working directly with inpatient physiotherapists, this study examines kinetic based gait parameters to quantify levels of impairment in subacute stroke. Recovery is most readily seen in changes in the walking speed of an individual, with many other gait parameters changing alongside walking speed. Therefor the relationships for all parameters of interest to walking speed are investigated in both neurologically intact controls (n = 14) and those undergoing rehabilitation for subacute stroke (n = 15). Parameters including spatiotemporal measures, forces, impulses, center of mass trajectory, center of pressure variability, and measures of symmetry were calculated for both groups. Subacute stroke participants have higher levels of asymmetry, increased instability, and altered gait dynamics compared to neurologically intact controls. The extent of recovery for each parameter was examined in a subset of stroke patients who took part in instrumented treadmill training over 1-2 months of rehabilitation (n = 4; mean ±SD age = 65 ±17; mean ±SD days post stroke at first session = 79 ±67). These participants showed improvements in stability, walking speed, and symmetry over the course of rehabilitation. These results show the benefit and potential for the use of kinetic analysis for aspects of both research and rehabilitationItem Open Access Usability of Markerless Motion Capture for Conducting 3D Instrumented Gait Analysis with Children(2024-09-12) Rande, Amanda; Condliffe, Elizabeth G.; Kuntze, Gregor; Whelan, Patrick J.; Manocha, Ranita H.Three-dimensional gait analysis (3DGA) provides important data for informing clinical decisions for children living with cerebral palsy and other mobility impairments. However, marker-based motion capture —the current clinical standard for conducting 3DGA— may be uncomfortable or even intolerable for many children. Marker-based assessments require the accurate placement of reflective markers on bony landmarks, which requires participants to wear tight clothing or clothing with a waistband that can be rolled down enabling markers to be placed on the pelvis. Marker placement can be time-consuming, especially for participants with non-typical anatomical development, increasing their fatigue level throughout the assessment. Markerless motion capture technologies that utilize computer vision to identify key landmarks may increase the patient-friendliness of 3DGA. The purposes of this research were to a) compare markerless technologies with marker-based technologies for 3DGA with pediatric populations including those with mobility impairments, and b) to determine the factors that impact the usability of markerless motion capture for clinical gait assessments. The first study concurrently compared a markerless motion capture system to a marker-based system. Our results indicated that markerless and marker-based motion capture had good agreement in the sagittal plane for pediatric populations with and without mobility impairments. The second study investigated the impact of clothing on kinematic data when markerless systems are used, explored participant and caregiver perceptions of 3DGA, and assessed the time required to complete a markerless assessment. We found that many clothing styles had minimal impact on the kinematic data; however, clothing that was baggy or obstructed the joints reduced data quality. Our participants preferred completing markerless assessments as they could wear their own clothing, did not have to have markers placed, and appreciated the brevity of the assessment. This study combined with the literature, provides good evidence that markerless motion capture is an accurate method of assessing joint angles in the sagittal plane of children with and without mobility impairments that enables a more participant-friendly assessment.Item Embargo “We’re stronger as a family”: Family experiences and relationships in an adapted physical activity camp(Elsevier, 2023-11-30) Youngblood, Jessica; McDonough, Meghan H.; Condliffe, Elizabeth G.; Legg, David; Emery, Carolyn A.Adapted recreation programs involving the entire family may offer ways to enhance relationships in families with a child living with a disability because they enable participating together in new and potentially empowering experiences. This study examined family members’ perspectives on their lived experiences with their relationships within their family and how they perceived they were affected by their participation in an adapted summer camp for families with a child living with a disability. We conducted a collective case study with five families who participated in a week-long camp. A focus group was conducted with each family and analyzed using reflexive thematic analysis. Participation in the camp impacted family relationships by reducing isolation for mothers; alleviating stress and anxiety which helped families bond; providing shared experience which led to mutual understanding, communication, and support; improving independence and confidence of the child living with a disability; facilitating sibling bonding and parent comfort with giving siblings more responsibility; and enhancing families’ confidence to participate in family activities beyond the camp. These findings elucidate how participation in this type of program can impact relationships in families that include a child living with a disability and inform future program design.