The effect of pediatric neurology physiotherapy run technique on walking ability of children with cerebral palsy
Djohan Aras
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Department of Physiotherapy, Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
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"documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2020;30 Supl 2:332-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Patient experiences of nurse caring behaviors based on Swanson's theory in Indonesian hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "332" "paginaFinal" => "336" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Swastika Fadia Amalina, Rini Rachmawaty, Ilkafah Ilkafah, Erfina Erfina" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Swastika Fadia" "apellidos" => "Amalina" ] 1 => array:2 [ "nombre" => "Rini" "apellidos" => "Rachmawaty" ] 2 => array:2 [ "nombre" => "Ilkafah" "apellidos" => "Ilkafah" ] 3 => array:2 [ "nombre" => "Erfina" "apellidos" => "Erfina" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862119304760?idApp=UINPBA00004N" "url" => "/11308621/00000030000000S2/v2_202305161211/S1130862119304760/v2_202305161211/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "titulo" => "The effect of pediatric neurology physiotherapy run technique on walking ability of children with cerebral palsy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "337" "paginaFinal" => "340" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Djohan Aras" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Djohan" "apellidos" => "Aras" "email" => array:1 [ 0 => "djohanaras.da@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Physiotherapy, Faculty of Nursing, Hasanuddin University, Makassar, Indonesia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cerebral palsy is a common neurological condition that leads to walking problem and delay in children. It commonly causes childhood disability and estimated as many as 2.1 per 1000 births result in cerebral palsy.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> In Indonesia, it is estimated that 1–5 children per 1000 births suffer from cerebral palsy.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a> The most common symptom that affected children with CP is gait problem, especially in-toeing and equinus.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cerebral palsy is usually categorized according to the level of gait problem using the Gross Motor Function Classification System (GMFCS). Children who can walk independently without assistance are categorized into GMFCS levels I and II, whereas those who cannot walk independently and need assistance or gait assistive device for ambulation are categorized into levels III–V.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> This system is shown to be beneficial in identifying levels of motor ability, guiding treatment decisions, and allowing estimation of the development of motor performance.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although known as a non-progressive neurological disorder, CP motor impairment can still progress if left untreated and can lead to increased disability and complications in the long-term.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> It has been suggested that the activity of daily living exercise can improve function in children with cerebral palsy.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> Besides ADL, walking capacity of children with CP is a good indicator for prognosis of CP. Improving walking capacity is shown to improve social participation and achievement in children with CP.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The intervention for improving walking problems in children with CP comes in different methods that have been shown to be effective according to studies. A study has been shown that full weight-bearing treadmill training is effective in improving gait capacity of children with CP.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Not only the full weight-bearing support treadmill gait training, the partial weight-bearing also showed a significant improvement of walking ability in children with CP.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> A more advanced method such as robotic-assisted walking therapy also shows significant improvement of gait capacity of children with CP.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> This shows that the intervention to improve the gait capacity of children with CP can be used alternatively depends on what is available in the clinic or hospital and the convenience of the intervention according to health professionals, patients, and their families and caregivers.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The basic of PPRT is gait training for children aged two years old and above. It is the application of motor learning mechanisms that incorporate repetitively and task-specific exercise that has been shown to be useful in reconnection of motor pathways.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a> The repetitive and task-specific to improve motor function and skill is manifested into functional gait training.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">13,14</span></a> The aim of this study is to examine the effect of PPRT on improving walking capacity of children with CP.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This is a pre-experimental study with time-series design. This study was conducted at a private physiotherapy clinic in Makassar, Indonesia from January to April 2018. Children with CP who came to visit the clinic were recruited to participate in this study through their parents. The researchers explain the protocol of the study to their parents before they agree to join this study. Those who agreed to participate were offered informed consent to be signed. Those who refuse to participate did not lose their right to receive the standard treatment in the clinic. Subjects and researcher have no special relationship that can make the subjects join the study under special influence.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Subjects of this study consist of twenty children with cerebral palsy. The inclusion criteria were preschool children (below five years old) with cerebral palsy GMFCS level III and IV. The exclusion criteria were children who have other medical conditions that can restrict participation in this study. Participants were treated with PPRT, which consist of overground gait training preceded by stretching, resistance, balance, approximation and stabilization exercises, given simultaneously. During gait training, participants were supported by two physiotherapists. One physiotherapist provided body weight support and the other provided gait pattern correction. The total duration of treatment is 30<span class="elsevierStyleHsp" style=""></span>min. The treatment was given every day for two weeks.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The outcome measure used in this study was the Motor Gross Function Measure (MGFM) for walking dimension. One trained physiotherapist performed all measurement. The measurement was taken at baseline and each week after third and ninth treatments. The data were analyzed using Repeated Measure ANOVA test to test the difference between time and conduct post hoc analysis if found significant. The data of the subjects were stored in a secure way can guarantee the security of the private data of subjects to be misused by third party.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the general characteristics of the subjects. In this study, we recruited children who are two years or older because the focus of this study is the walking ability of children with CP who are supposed to acquire walking ability at their age. According to GMFCS level, we only involved children at level III and IV to examine the effectivity of PPRT in lowering the dependency level of children with CP.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The repeated measure ANOVA test was used because the normality test shows that data is normally distributed. It shows that there is a significant difference (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) of GMFM percentage between groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The post hoc analysis shows that the post nine times of PPRT was the highest improvement compared to others. There was no significant difference between baseline and 3 times. Between 3 times and 9 times there was a significant difference with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">This study aims to examine the effectivity of PPRT in improving the ability of children with cerebral palsy. Twenty people were recruited to participate in this study. All participants were treated with PPRT every day for two weeks. There is no control group in this study. The results of this study show an improvement in walking ability according to the GMFM walking dimension.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The basic principle of PPRT is to tackle the old concept of training children with motoric delay based on their current ability. For example, a 2-year-old boy who could not sit on his own need to train mainly on sitting activity. The new concept of PPRT is on how the 2-year-old child trained mainly on walking activity as the ability to walk should have been normally achieved by that age. By focus on gait training, the child can catch up with what motoric ability he missed on his age. This principle is similar to what has been proposed in the era of ICF which focus more on functional capacity and not structural capacity, especially in walking ability as it can determine the future social participation.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In PPRT, the gait training used is the overground gait training. It has been shown in several studies that overground gait training is an effective method in improving gait capacity of children with cerebral palsy. A study by Hamed and Abd-elwahab<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> showed that overground gait training is an effective method to improve gait capacity on children with cerebral palsy. Another study, by Kwak,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> examine the combination of Rhythmic auditory stimulation (RAS) and gait training and the result shows an improvement of the gait capacity of children with cerebral palsy. In line with those studies, Baram and Lenger<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> add visual and auditory cues into gait training and shows that children with cerebral palsy experience improvement in walking ability.</p><p id="par0070" class="elsevierStylePara elsevierViewall">A study by Eek et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a> shows that the muscle strengthening of lower extremity can improve the walking performance of children with CP. In this current study, the muscle strengthening of lower extremity was performed as part of the PPRT. The strengthening training was performed by improving the strength of quadriceps muscle of the hip. The quadriceps muscle increase in strength can improve the ability to walk properly such in the gait cycle of walking normally. The strengthening can be done manually by putting the holding on the quadriceps movement to increase the resistance of the physiotherapist toward the movement of the muscle such as flexion and extension of the knee. Other methods to be used are using TheraBand, rubber band, and dumbbell to provide resistance as needed to make the muscle much stronger.</p><p id="par0075" class="elsevierStylePara elsevierViewall">A study by Provost et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> shows that the walking training conducted intensively using treadmill in improving the gait performance of children with cerebral palsy. Besides the gait improvement, the endurance and balance of the children with CP participated in the study were also improved significantly. The treadmill was designed to support the bodyweight of the participants to make the training easier for the physiotherapist to be performed. In this current study, the treadmill was not used. However, the principle of body weight supported treadmill was provided in the form of supported by physiotherapist and in the ground, not on the treadmill. Both treadmills in the study and on the ground walking training in this current study showed their effectivity in improving the gait problem in people with CP. To decide which one to use in both techniques are based on the availability of the facility to perform the treadmill full-body support. In the current study research site, they did not have the full-body support treadmill to perform the machine-based training, so that the on the ground technique was chosen to be the alternative of the treadmill with the similar effect.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Besides the full-body supported treadmill training, the partial body supported treadmill training is also shown to significantly improve the walking ability of children with cerebral palsy. It is a study by Dodd and Foley<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> that found the partial body weight support treadmill training is beneficial in improving the walking capacity of children with CP. In this current study, the partial body supported was controlled by the physiotherapist who supported the patients during the on the ground gait training. It was the combination of full and partial body weight support during the training that depends on the need of the patients and their phase of training. Physiotherapists apply approximation while on the full body weight support standing position to improve the proprioceptive function the knee joints. This can improve the joint position detection in patients with CP that help them to determine the right position of the knee joint during walking.</p><p id="par0085" class="elsevierStylePara elsevierViewall">A more sophisticated way of walking training in children with CP is by utilizing the technology of robotic advancement. A study by Meyer-Heim et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> shows that gait training using robotic orthosis to assist the patient in walking pattern correction and guidance is effective in improving the walking capacity of children with cerebral palsy. This current study has not utilized the advancement of robotic technology in gait training of children with cerebral palsy. However, the result shows that the traditional way of gait training is also beneficial for improving the gait capacity of children with CP. It will be interesting to combine both on the ground gait training and robotic-assisted gait training to gain more benefit from gait training and improve the independence of children with cerebral palsy regarding with walking capacity.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The limitation of this study is no control group as a comparison with those who receive no treatment or other treatments. The other limitation is no measurement after the treatment stopped to measure the long-term effect after treatment in the clinic was stopped. The limited recall was performed regarding the improvement of the children at least three months before PPRT compared to two weeks after PPRT. Most subjects’ parents indicated that much improvement was experienced after PPRT compared to before PPRT. However, this recall is considered subjective as no proper measurement was performed before PPRT to indicate the rate of children development. Future study is recommended to make it into randomized controlled trial with more subjects involved and compared with standard physiotherapy or no treatment.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion, PPRT seems to be an effective treatment for children with the motoric delay because of cerebral palsy in improving the walking capacity.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1899019" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1642832" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 7 => array:2 [ "identificador" => "xack667142" "titulo" => "Acknowledgments" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-29" "fechaAceptado" => "2019-07-15" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1642832" "palabras" => array:3 [ 0 => "Pediatric neurology physiotherapy" 1 => "Walking problem" 2 => "Cerebral palsy" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cerebral palsy is one of the conditions that usually cause disability in children. One of its symptoms is the walking problem. The purpose of this study is to examine the effectivity of Pediatric Physiotherapy Run Technique (PPRT) in improving walking ability of children with cerebral palsy.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is a pre-experimental study with time-series design. Twenty participants were included in this study. The outcome measure used was motor gross function measure (MGFM) walking dimension, which measured at baseline and after three times and nine times of PPRT session. Data were analyzed using repeated measure ANOVA.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The results of this study showed that there is a significantly different (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) between pre, three times and nine times. The nine times is significantly higher than the baseline.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Children with cerebral palsy may benefit from the PPRT program to improve their walking capacity.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Peer-review under responsibility of the scientific committee of the International Conference on Women and Societal Perspective on Quality of Life (WOSQUAL-2019). Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (3.56) months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex, male (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weight, mean (SD) kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.33 (3.45) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Height, mean (SD) cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.5 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GMFCS level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III (8) IV (12) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3173506.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The general characteristics of participants.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GMFM percentage score for dimension E \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Range \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre-test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.6–89.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not significant \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-test 3 times \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.2–90.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not significant \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-test 9 times \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.5–94.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.011<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3173505.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Repeated Measure ANOVA.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Pre–post result of PPRT.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An update on the prevalence of cerebral palsy: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 February | 3 | 2 | 5 |
| 2023 September | 1 | 0 | 1 |
| 2023 March | 2 | 0 | 2 |
| 2022 June | 1 | 0 | 1 |
| 2021 February | 12 | 4 | 16 |
| 2020 August | 1 | 0 | 1 |
| 2020 April | 29 | 7 | 36 |
