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Remo Russo

Bio: Remo Russo is an academic researcher from Flinders University. The author has contributed to research in topics: Cerebral palsy & Population. The author has an hindex of 14, co-authored 27 publications receiving 771 citations. Previous affiliations of Remo Russo include Boston Children's Hospital & University of Adelaide.

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Journal ArticleDOI
TL;DR: There is weak and inconsistent evidence regarding the use of RAGT for children with gait disorders, and clinicians and clients should monitor individual progress closely with appropriate outcome measures including monitoring of adverse events.
Abstract: Robotic-assisted gait training (RAGT) affords an opportunity to increase walking practice with mechanical assistance from robotic devices, rather than therapists, where the child may not be able to generate a sufficient or correct motion with enough repetitions to promote improvement. However the devices are expensive and clinicians and families need to understand if the approach is worthwhile for their children, and how it may be best delivered. The objective of this review was to identify and appraise the existing evidence for the effectiveness of RAGT for paediatric gait disorders, including modes of delivery and potential benefit. Six databases were searched from 1980 to October 2016, using relevant search terms. Any clinical trial that evaluated a clinical aspect of RAGT for children/adolescents with altered gait was selected for inclusion. Data were extracted following the PRISMA approach. Seventeen trials were identified, assessed for level of evidence and risk of bias, and appropriate data extracted for reporting. Three randomized controlled trials were identified, with the remainder of lower level design. Most individual trials reported some positive benefits for RAGT with children with cerebral palsy (CP), on activity parameters such as standing ability, walking speed and distance. However a meta-analysis of the two eligible RCTs did not confirm this finding (p = 0.72). Training schedules were highly variable in duration and frequency and adverse events were either not reported or were minimal. There was a paucity of evidence for diagnoses other than CP. There is weak and inconsistent evidence regarding the use of RAGT for children with gait disorders. If clinicians (and their clients) choose to use RAGT, they should monitor individual progress closely with appropriate outcome measures including monitoring of adverse events. Further research is required using higher level trial design, increased numbers, in specific populations and with relevant outcome measures to both confirm effectiveness and clarify training schedules.

145 citations

Journal ArticleDOI
TL;DR: Botulinum toxin A injection combined with a low-intensity occupational therapy program achieves significant improvements in body structure, activity participation, and self-perception in children with hemiplegic cerebral palsy.
Abstract: OBJECTIVES. The purpose of this work was to assess the effect of botulinum toxin A and occupational therapy compared with occupational therapy alone on body structure, activities participation, and self-perception in a sample of children (aged 3–16 years) with hemiplegic cerebral palsy recruited from a statewide register. PATIENTS AND METHODS. Participants of this single-blind, randomized, controlled trial identified from a population-based cerebral palsy register received either an individually prescribed and localized injection of botulinum toxin A with 4 sessions of occupational therapy over 4 weeks (intervention) or occupational therapy alone (control). Outcomes were assessed from 2 domains of the World Health Organization International Classification of Functioning, Disability, and Health: body structure (Modified Ashworth Scale and Tardieu Scale) and activities participation (Assessment of Motor and Process Skills, Goal Attainment Scale, Pediatric Evaluation of Disability Inventory, and Pediatric Quality of Life Inventory). Self-perception was also measured. RESULTS. All of the participants (intervention: n = 21; control: n = 22) provided data at baseline and 3 and 6 months. Mean age was 8.6 years; 23 were boys and 20 were girls. At 3 months, children allocated to receive the intervention performed significantly better in terms of body structure and activities participation. They reported improvements in self-perception for the global self-worth domain. At 6 months, the differences between the intervention and control groups persisted for the measures of body structure but not for activities participation or self-perception. CONCLUSION. Botulinum toxin A injection combined with a low-intensity occupational therapy program achieves significant improvements in body structure, activity participation, and self-perception.

103 citations

Journal ArticleDOI
TL;DR: In this article, the authors evaluated the published evidence of efficacy and safety of botulinum neurotoxin (BoNT) injections in paediatric upper limb hypertonia (PULH).
Abstract: The primary objective of this paper was to evaluate the published evidence of efficacy and safety of botulinum neurotoxin (BoNT) injections in paediatric upper limb hypertonia (PULH). Secondary objectives included the provision of clinical context, based on evidence and expert opinion, in the areas of assessment, child and muscle selection, dosing, and adjunctive treatment. A multidisciplinary panel of authors systematically reviewed, abstracted, and classified relevant literature. Recommendations were based on the American Academy of Neurology (AAN) evidence classification. Following a literature search, 186 potential articles were screened for inclusion, and 15 of these met the criteria and were reviewed. Grade A evidence was found to support the use of BoNT to reach individualized therapeutic goals for PULH. There is grade B evidence (probably effective) for tone reduction following BoNT injections and grade U evidence (inconclusive) for improvement in upper limb (UL) activity and function. BoNT injections were generally found to be safe and well tolerated with the most common side effect identified as a transient decrease in grip strength.

91 citations

Journal ArticleDOI
TL;DR: Children with HCP experience reduced quality of life and self-concept compared with typically developing peers, and this study found that self-esteem/concept is significantly lower in children with hemiplegic cerebral palsy.

81 citations

Journal ArticleDOI
TL;DR: This study reviewed interventions suitable for treating tactile dysfunction in children with cerebral palsy and found them to be satisfactory.
Abstract: AIM This study reviewed interventions suitable for treating tactile dysfunction in children with cerebral palsy (CP).

73 citations


Cited by
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TL;DR: The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP) and to propose a treatment strategy based on this evidence.
Abstract: Aim The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP). Method This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health. Results Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded ‘do it’ (green go); 58% (76 out of 131) ‘probably do it’ (yellow measure); 20% (26 out of 131) ‘probably do not do it’ (yellow measure); and 6% (8 out of 131) ‘do not do it’ (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red). Interpretation Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.

1,046 citations

Journal ArticleDOI
TL;DR: The aim of this study was to provide a comprehensive update on the overall prevalence of cerebral palsy, the prevalence of CP in relation to birthweight, and the prevalence in comparison to gestational age.
Abstract: Aims The aim of this study was to provide a comprehensive update on (1) the overall prevalence of cerebral palsy (CP); (2) the prevalence of CP in relation to birthweight; and (3) the prevalence of CP in relation to gestational age. Method A systematic review and meta-analysis was conducted and reported, based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Population-based studies on the prevalence of CP in children born in 1985 or after were selected. Statistical analysis was carried out using computer package R, version 2.14. Results A total of 49 studies were selected for this review. The pooled overall prevalence of CP was 2.11 per 1000 live births (95% confidence interval [CI] 1.98–2.25). The prevalence of CP stratified by gestational age group showed the highest pooled prevalence to be in children weighing 1000 to 1499g at birth (59.18 per 1000 live births; 95% CI 53.06–66.01), although there was no significant difference on pairwise meta-regression with children weighing less than 1000g. The prevalence of CP expressed by gestational age was highest in children born before 28 weeks' gestation (111.80 per 1000 live births; 95% CI 69.53–179.78; p<0.0327). Interpretation The overall prevalence of CP has remained constant in recent years despite increased survival of at-risk preterm infants.

1,007 citations

DOI
27 Apr 2007
TL;DR: The Assessment of Motor and Process Skills (AMPS) is an innovative observational assessment that is used to measure the quality of a person’s performance of domestic or basic activities of daily living (ADL).
Abstract: The Assessment of Motor and Process Skills (AMPS) is an innovative observational assessment that is used to measure the quality of a person’s performance of domestic (instrumental) or basic (personal) activities of daily living (ADL). The quality of the person’s ADL performance is assessed by rating the effort, efficiency, safety, and independence of 16 ADL motor and 20 ADL process skill items. The ADL motor and ADL process skill are analogous to the goal-directed actions defined under the Activities and Participation domains of the International Classification of Functioning, Disability and Health (World Health Organization [WHO], 2001), and are thus the small units of performance that when carried out, one by one, result in the overall task being completed.

477 citations

Journal ArticleDOI
TL;DR: To summarize evidence on the rates of co-occurring impairments, diseases, and functional limitations with cerebral palsy into succinct clinical messages, a search was conducted of the databases PubMed, Medline, CINAHL, and PsycINFO.
Abstract: OBJECTIVE: To summarize evidence on the rates of co-occurring impairments, diseases, and functional limitations with cerebral palsy into succinct clinical messages. METHODS: A search was conducted of the databases PubMed, Medline, CINAHL, and PsycINFO, and the results were supplemented with hand searches. Two independent reviewers determined whether retrieved abstracts met the following inclusion criteria: human subjects; >90% were children or adults with cerebral palsy; published after 1999; and population-based data. Articles were appraised, analyzing design, participants, level of evidence, rates of impairments, and functional implications. Methodologic quality was rated by using a standardized checklist. RESULTS: A total of 1366 papers were identified in the search; 82 were appraised and 30 were included in the meta-analyses. High-level evidence existed, as rated on the Oxford 2011 Levels of Evidence: 97% of prevalence studies were level 1. The data were of a moderate to high quality grade (with the exception of sleep disorders), allowing plain English clinical messages to be developed. CONCLUSIONS: Among children with cerebral palsy, 3 in 4 were in pain; 1 in 2 had an intellectual disability; 1 in 3 could not walk; 1 in 3 had a hip displacement; 1 in 4 could not talk; 1 in 4 had epilepsy; 1 in 4 had a behavior disorder; 1 in 4 had bladder control problems; 1 in 5 had a sleep disorder; 1 in 5 dribbled; 1 in 10 were blind; 1 in 15 were tube-fed; and 1 in 25 were deaf.

425 citations