Megan Thorley - Academia.edu (original) (raw)

Papers by Megan Thorley

Pediatric Physical Therapy, Sep 1, 2023

The Cochrane library, Apr 1, 2019

Constraint-induced movement therapy in children with unilateral cerebral palsy.

Developmental Medicine & Child Neurology

ResumoOBJETIVOFornecer recomendações de intervenções para promoção da função física de crianças e... more ResumoOBJETIVOFornecer recomendações de intervenções para promoção da função física de crianças e jovens com paralisia cerebral.MÉTODOUm painel de especialistas priorizou perguntas e desfechos importantes para o paciente. Usando o Grading of Recommendations Assessment, Development and Evaluation (GRADE), o painel avaliou a certeza das evidências e fez recomendações, com consultoria de especialistas internacionais e consumidores.RESULTADOSA diretriz compreende 13 recomendações (informadas por três revisões sistemáticas, 30 estudos randomizados e cinco estudos pré‐pós). Para alcance de objetivos funcionais, recomenda‐se que a intervenção inclua objetivos escolhidos pelo cliente, prática completa da tarefa em ambientes da vida real, suporte para empoderar as famílias e uma abordagem em equipe. Idade, habilidade e preferências da criança/família precisam ser consideradas. Para melhora da habilidade da marcha, recomenda‐se marcha no solo, que pode ser complementada com treinamento em est...

Archives of Physical Medicine and Rehabilitation, 2013

OBJECTIVE: To systematically evaluate the level of evidence of the clinimetric properties of meas... more OBJECTIVE: To systematically evaluate the level of evidence of the clinimetric properties of measures of aerobic and anaerobic capacity used for children with cerebral palsy (CP). DATA SOURCES: A systematic search of databases PubMed, Embase, SPORTDiscus and PsycINFO through April 2011 was performed. STUDY SELECTION: Two independent raters identified and examined studies that reported laboratory or field-based measures of maximal aerobic or anaerobic capacity in children with CP aged 5-14 years. DATA EXTRACTION: The COSMIN checklist was used by two independent raters to evaluate the methodological quality of the included clinimetric studies and identify measures used in these studies. DATA SYNTHESIS: Twenty-four studies that used a maximal aerobic or anaerobic capacity measure were identified. Five studies reported clinimetric properties for five measures (2 aerobic and 3 anaerobic measures). Methodological quality was excellent in 3 studies showing good validity and reliability of field-based aerobic (Shuttle Run Test) and anaerobic (Muscle Power Sprint Test) measures. The studies on laboratory-based measures were rated fair, mainly due to inadequate statistics. The level of evidence was strong for good validity and reliability of the field-based tests. The level of evidence was unknown for validity and low to moderate for good reliability of laboratory-based tests. CONCLUSIONS: There is a paucity of research on the clinimetric properties of measurement instruments to assess aerobic and anaerobic capacity for children with cerebral palsy. Further clinimetric studies of laboratory-based measures in children with CP at all GMFCS levels and clinimetric studies of field-based measures in children who are classified at GMFCS levels III to V are required.

Australian Occupational Therapy Journal, Jun 22, 2021

Developmental Medicine & Child Neurology, 2022

1 Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, University o... more 1 Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia. 2 John Hunter Children’s Hospital, Newcastle, New South Wales, Australia. 3 Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia. 4 School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia. 5 Perth Children’s Hospital, Perth, Western Australia, Australia. 6 Physiotherapy Department, University of Melbourne, Melbourne, Victoria, Australia. 7 Occupational Therapy Department, Royal Children’s Hospital, Melbourne, Victoria, Australia. 8 Queensland Paediatric Rehabilitation Service, Brisbane, Queensland, Australia. 9 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

BMC Pediatrics, 2021

Background Gabapentin is often used to manage pain in children with dystonic cerebral palsy, howe... more Background Gabapentin is often used to manage pain in children with dystonic cerebral palsy, however the evidence for its effectiveness in this population is limited. The primary objective of this feasibility pilot study was to assess the factors which might impact on a future randomised controlled trial including the ability to recruit and retain participants, assess adherence/compliance to the prescribed intervention, and ability to complete all outcome assessments. The secondary objective was to gather preliminary evidence for the effectiveness of gabapentin at reducing pain, improving comfort and reducing dystonia in children with dystonic cerebral palsy. Methods This open label pilot study recruited children aged 5–18 years with dystonic cerebral palsy and accompanying pain affecting daily activities from four centres around Australia. Children were prescribed gabapentin for 12 weeks and were assessed at baseline, 6 weeks and 12 weeks. The primary outcome was feasibility of the...

Developmental Medicine & Child Neurology, 2021

AIM To provide recommendations for interventions to improve physical function for children and yo... more AIM To provide recommendations for interventions to improve physical function for children and young people with cerebral palsy. METHOD An expert panel prioritized questions and patient-important outcomes. Using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods, the panel assessed the certainty of evidence and made recommendations, with international expert and consumer consultation. RESULTS The guideline comprises 13 recommendations (informed by three systematic reviews, 30 randomized trials, and five before-after studies). To achieve functional goals, it is recommended that intervention includes client-chosen goals, whole-task practice within real-life settings, support to empower families, and a team approach. Age, ability, and child/family preferences need to be considered. To improve walking ability, overground walking is recommended and can be supplemented with treadmill training. Various approaches can facilitate hand use goals: bimanual therapy, constraint-induced movement therapy, goal-directed training, and cognitive approaches. For self-care, whole-task practice combined with assistive devices can increase independence and reduce caregiver burden. Participation in leisure goals can combine whole-task practice with strategies to address environmental, personal, and social barriers. INTERPRETATION Intervention to improve function for children and young people with cerebral palsy needs to include client-chosen goals and whole-task practice of goals. Clinicians should consider child/family preferences, age, and ability when selecting specific interventions.

Developmental Medicine & Child Neurology, 2020

Developmental Medicine & Child Neurology, 2019

BMC neurology, Jan 8, 2018

Motor outcomes of children with unilateral cerebral palsy are clearly documented and well underst... more Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child's ability to use their two hands to perform bimanual tasks. This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6-12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; an...

Pediatrics, 2015

To determine safety of intramuscular botulinum toxin A (BoNT-A) injections to reduce spasticity a... more To determine safety of intramuscular botulinum toxin A (BoNT-A) injections to reduce spasticity and improve care and comfort of nonambulatory children with cerebral palsy (CP). Nonambulatory children with CP were randomly allocated to receive either BoNT-A (n = 23) or sham procedure (n = 18) in Cycle 1. In Cycle 2, the BoNT-A group received a second episode of BoNT-A (n = 20) and sham group received their first episode of BoNT-A (n = 17). A pediatric rehabilitation specialist masked to group allocation graded each adverse event (AE) according to system, severity (mild, moderate, serious, sentinel) and causality (unlikely/unrelated; possible; probable/definite). There was no difference for all moderate/serious AEs between the BoNT-A and sham/control groups in either Cycle 1 (incident rate ratio = 1.30, 95% confidence interval = 0.43-4.00; P = .64) or Cycle 2 (incident rate ratio = 0.72, 95% confidence interval = 0.30-1.75; P = .47). In Cycle 2, 1 serious, 3 moderate (single-episode g...

Physical & Occupational Therapy In Pediatrics, 2011

The Journal of Pediatrics, 2014

To examine the efficacy and safety of intramuscular botulinum toxin A (BoNT-A) to reduce spastici... more To examine the efficacy and safety of intramuscular botulinum toxin A (BoNT-A) to reduce spasticity and improve comfort and ease of care in nonambulant children with cerebral palsy (CP). Nonambulant children with CP (n = 41; Gross Motor Function Classification System level IV = 3, level V = 38; mean age 7.1 years, range 2.3-16 years, 66% male) were randomly allocated to receive either intramuscular BoNT-A injections (n = 23) or sham procedure (n = 18) combined with therapy. The analysis used generalized estimating equations with primary outcome the Canadian Occupational Performance Measure (COPM) at 4 weeks postintervention and retention of effects at 16 weeks. Adverse events (AE) were collected at 2, 4, and 16 weeks by a physician masked to group allocation. There were significant between group differences favoring the BoNT-A-treated group on COPM performance at 4 weeks (estimated mean difference 2.2, 95% CI 0.8, 3.5; P = .002) and for COPM satisfaction (estimated mean difference 2.2, 95% CI 0.5, 3.9; P = .01). These effects were retained at 16 weeks for COPM satisfaction (estimated mean difference 1.8, 95% CI 0.1, 3.5; P = .04). There were more mild AE at 4 weeks for the BoNT-A group (P = .002), however, there were no significant between-group differences in the reporting of moderate and serious AE. In a double-blind randomized sham-controlled trial, intramuscular BoNT-A and therapy were effective for improving ease of care and comfort for nonambulant children with CP. There was no increase in moderate and severe AE in the children who had BoNT-A injections compared with the sham group.

Developmental Medicine & Child Neurology, 2012

The aim of the study was to investigate the construct validity of the Quality of Upper Extremity ... more The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP). A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD 2y 11mo, range 2-16y; Gross Motor Function Classification System levels I-V) were reviewed. The QUEST was not unidimensional; many items demonstrated poor fit when total scores were analysed; goodness of fit improved when domains were considered independently and limbs separately examined. QUEST items involving elbow flexion and/or forearm in pronation were easily achieved, thus reducing test sensitivity. Postures items in the grasp domain behaved erratically, with little total score relationship. Calculating total scores is discouraged. Reporting QUEST results separately for domains and each limb is recommended. Posture items in the grasp domain had little relationship with total scores and it is recommended that they be removed from the test.

BMC Pediatrics, 2012

Background: Children with cerebral palsy (CP) whom are non-ambulant are at risk of reduced qualit... more Background: Children with cerebral palsy (CP) whom are non-ambulant are at risk of reduced quality of life and poor health status. Severe spasticity leads to discomfort and pain. Carer burden for families is significant. This study aims to determine whether intramuscular injections of botulinum toxin A (BoNT-A) combined with a regime of standard therapy has a positive effect on care and comfort for children with CP whom are non-ambulant (GMFCS IV/V), compared with standard therapy alone (cycle I), and whether repeated injections with the same regime of adjunctive therapy results in greater benefits compared with a single injecting episode (cycle II). The regime of therapy will include serial casting, splinting and/or provision of orthoses, as indicated, combined with four sessions of goal directed occupational therapy or physiotherapy. Method/design: This study is a double blind randomized controlled trial. Forty participants will be recruited. In cycle I, participants will be randomized to either a treatment group who will receive BoNT-A injections into selected upper and/or lower limb muscles, or a control group who will undergo sham injections. Both groups will receive occupational therapy and /or physiotherapy following injections. Groups will be assessed at baseline then compared at 4 and 16 weeks following injections or sham control. Parents, treating clinicians and assessors will be masked to group allocation. In cycle II, all participants will undergo intramuscular BoNT-A injections to selected upper and/or lower limb muscles, followed by therapy. The primary outcome measure will be change in parent ratings in identified areas of concern for their child's care and comfort, using the Canadian Occupational Performance Measure (COPM). Secondary measures will include the Care and Comfort Hypertonicity Scale (ease of care), the Cerebral Palsy Quality of Life Questionnaire (CP QoL-Child) (quality of life), the Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire (CPCHILD©) (health status) and the Paediatric Pain Profile (PPP) (pain). Adverse events will be carefully monitored by a clinician masked to group allocation. Discussion: This paper outlines the theoretical basis, study hypotheses and outcome measures for a trial of BoNT-A injections and therapy for children with non-ambulant CP.

BMJ Open, 2021

IntroductionYoung children with bilateral cerebral palsy (BCP) often experience difficulties with... more IntroductionYoung children with bilateral cerebral palsy (BCP) often experience difficulties with gross motor function, manual ability and posture, impacting developing independence in daily life activities, participation and quality of life. Hand Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training that has been developed and tested in older school-aged children with unilateral and BCP. This study aims to compare an adapted preschool version of HABIT-ILE to usual care in a randomised controlled trial.Methods and analysis60 children with BCP aged 2–5 years, Gross Motor Function Classification System (GMFCS) II–IV will be recruited. Children will be stratified by GMFCS and randomised using concealed allocation to either receive Preschool HABIT-ILE or usual care. Preschool HABIT-ILE will be delivered in groups of four to six children, for 3 hours/day for 10 days (total 30 hours). Ch...

Physical & Occupational Therapy in Pediatrics, 2012

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