1
|
Tomita H, Takahashi S, Kawaguchi D, Aoki Y, Yamamoto Y, Asai H. How Does Standing Anteroposterior Stability Limits Correlate to Foot/ankle Functions in Bilateral Spastic Cerebral Palsy? Pediatr Phys Ther 2024:00001577-990000000-00098. [PMID: 38995638 DOI: 10.1097/pep.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
PURPOSE To determine whether foot and ankle functions are correlated with the limits of stability (LoS) while standing in individuals with bilateral spastic cerebral palsy (BSCP). METHODS Eighteen people who could walk and with BSCP and 18 people without disability participated. Anteroposterior LoS was measured using a force platform. To quantify ankle and foot functions, spasticity, isometric muscle strength, passive range of motion, and plantar light touch-pressure sensation were assessed. RESULTS In the BSCP group, anteroposterior LoS was significantly decreased, and anterior LoS reduction was correlated with decreases in plantar flexor and toe flexor strength and in sensitivity of the forefoot to light touch-pressure sensation, whereas the posterior LoS reduction was correlated with reduced dorsiflexor strength. CONCLUSIONS The present findings suggest that improvement in these foot and ankle functions in BSCP may increase LoS while standing.
Collapse
Affiliation(s)
- Hidehito Tomita
- Department of Rehabilitation, Graduate School of Health Sciences, Toyohashi SOZO University, Toyohashi, Aichi, Japan (Dr Tomita); Department of Rehabilitation, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Aichi, Japan (MessrsTakahashi and Kawaguchi, and Ms Aoki, and Mr Yamamoto); Department of Physical Therapy, Graduate Course of Rehabilitation Science, Kanazawa University, Kanazawa, Ishikawa, Japan (Dr Asai)
| | | | | | | | | | | |
Collapse
|
2
|
Tomita H, Kawaguchi D, Takahashi S, Asai H. Quiet standing and anteroposterior limits of stability in adolescents and young adults with bilateral spastic cerebral palsy. Hum Mov Sci 2024; 95:103215. [PMID: 38552561 DOI: 10.1016/j.humov.2024.103215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/30/2023] [Accepted: 03/22/2024] [Indexed: 06/15/2024]
Abstract
Stance stability in individuals with bilateral spastic cerebral palsy (BSCP) in various standing postures including the quiet standing (QS) and limits of stability (LoS) has been widely studied. However, the relationships between the QS and LoS remain unclear. This study aimed to determine the relationships between the positions and postural sway in the QS and anteroposterior LoS in individuals with BSCP. It included 27 adolescents and young adults with BSCP (BSCP group) and 27 adolescents and young adults without disability (control group). The position of center of pressure in the anteroposterior direction (CoPy position) and the path length of center of pressure (CoP path length) during the QS and the anterior and posterior LoS (A-LoS and P-LoS, respectively) were measured using a force platform. The CoPy positions in the A-LoS and P-LoS in the BSCP group were limited compared with those in the control group. In the BSCP group, the more anterior the CoPy position in the QS, the more anterior (i.e., limited) it was in the P-LoS. Although the CoP path length in the QS was larger in the BSCP group, those in the A-LoS and P-LoS were larger in the control group. The BSCP group also showed that the more anterior the CoPy position or the longer the CoP path length in the QS, the more decreased the anteroposterior LoS range was. Therefore, assessing various standing postures, including QS and anteroposterior LoS, is important to manage balance impairments in individuals with BSCP.
Collapse
Affiliation(s)
- Hidehito Tomita
- Graduate School of Health Sciences, Toyohashi SOZO University, 20-1 Matsushita, Ushikawa-cho, Toyohashi 440-8511, Japan.
| | - Daisuke Kawaguchi
- Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, 9-3 Koyaba, Koryuji-cho, Okazaki 444-0002, Japan
| | - Shuhei Takahashi
- Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, 9-3 Koyaba, Koryuji-cho, Okazaki 444-0002, Japan
| | - Hitoshi Asai
- Graduate Course of Rehabilitation Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa 920-0942, Japan
| |
Collapse
|
3
|
Hobbs SJ, Alexander J, Wilkins C, St. George L, Nankervis K, Sinclair J, Penhorwood G, Williams J, Clayton HM. Towards an Evidence-Based Classification System for Para Dressage: Associations between Impairment and Performance Measures. Animals (Basel) 2023; 13:2785. [PMID: 37685049 PMCID: PMC10487214 DOI: 10.3390/ani13172785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
This study follows a previously defined framework to investigate the impact of impairment on performance in Para dressage athletes. Twenty-one elite Para dressage athletes (grades I to V) and eleven non-disabled dressage athletes (competing at Prix St. Georges or Grand Prix) participated. Data were collected in two phases: performing a two minute custom dressage test on a riding simulator while kinematic data were synchronously collected using inertial measurement units (2000 Hz) and optical motion capture (100 Hz), and clinically assessed using a battery of impairment assessment tools administered by qualified therapists. Impairment and performance measures were compared between Para and non-disabled athletes. Significant differences between athlete groups were found for all impairment measures and two performance measures: simulator trunk harmonics (p = 0.027) and athlete trunk dynamic symmetry (p < 0.001). Impairment assessments of sitting function and muscle tone could predict 19 to 35% of the impact of impairment on performance in Para athletes but not in non-disabled athletes. These findings provide the basis for a robust, scientific evidence base, which can be used to aid in the refinement of the current classification system for Para dressage, to ensure that it is in line with the International Paralympic Committee's mandate for evidence-based systems of classification.
Collapse
Affiliation(s)
- Sarah Jane Hobbs
- Research Centre for Applied Sport, Physical Activity and Performance, University of Central Lancashire, Preston PR1 2HE, UK; (J.A.); (L.S.G.); (J.S.)
| | - Jill Alexander
- Research Centre for Applied Sport, Physical Activity and Performance, University of Central Lancashire, Preston PR1 2HE, UK; (J.A.); (L.S.G.); (J.S.)
| | - Celeste Wilkins
- Sport and Exercise Department, Hartpury University, Hartpury, Gloucester GL19 3BE, UK;
| | - Lindsay St. George
- Research Centre for Applied Sport, Physical Activity and Performance, University of Central Lancashire, Preston PR1 2HE, UK; (J.A.); (L.S.G.); (J.S.)
| | - Kathryn Nankervis
- Equine Department, Hartpury University, Hartpury, Gloucester GL19 3BE, UK; (K.N.); (J.W.); (H.M.C.)
| | - Jonathan Sinclair
- Research Centre for Applied Sport, Physical Activity and Performance, University of Central Lancashire, Preston PR1 2HE, UK; (J.A.); (L.S.G.); (J.S.)
| | - Gemma Penhorwood
- Department of Animal and Agriculture, Hartpury University, Hartpury, Gloucester GL19 3BE, UK;
| | - Jane Williams
- Equine Department, Hartpury University, Hartpury, Gloucester GL19 3BE, UK; (K.N.); (J.W.); (H.M.C.)
| | - Hilary M. Clayton
- Equine Department, Hartpury University, Hartpury, Gloucester GL19 3BE, UK; (K.N.); (J.W.); (H.M.C.)
| |
Collapse
|
4
|
Pontiff M, Moreau NG. Safety and Feasibility of 1-Repetition Maximum (1-RM) Testing in Children and Adolescents With Bilateral Spastic Cerebral Palsy. Pediatr Phys Ther 2022; 34:472-478. [PMID: 35960137 PMCID: PMC9532379 DOI: 10.1097/pep.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to standardize 1-repetition maximum (1-RM) testing procedures and evaluate the safety and feasibility of these procedures in youth with cerebral palsy (CP). METHODS Youth with CP completed 1-RM testing on a leg press. RESULTS Mean absolute, adjusted, and normalized 1-RM loads were 262.4 ± 161.3 lb, 127.0 ± 80.2 lb, and 1.28 ± 0.51, respectively, and 67% were able to successfully lift the same or heavier load after a single failure. Cessation of testing after 1 failed attempt resulted in a 19.0% underestimation of the 1-RM. CONCLUSIONS 1-RM testing in youth with CP is safe and feasible. Multiple attempts at a failed load should be provided to prevent underestimation in strength. The 1-RM test provides a more accurate strength assessment, which will improve the dosing for resistance training in youth with CP.
Collapse
Affiliation(s)
- Mattie Pontiff
- Departments of Cell Biology and Anatomy (Dr Pontiff) and Physical Therapy (Drs Pontiff and Moreau), LSU Health Sciences Center, New Orleans, Louisiana
| | | |
Collapse
|
5
|
Veerbeek BE, Lamberts RP, Kosel E, Fieggen AG, Langerak NG. More than 25 years after selective dorsal rhizotomy: physical status, quality of life, and levels of anxiety and depression in adults with cerebral palsy. J Neurosurg 2021; 136:689-698. [PMID: 34507281 DOI: 10.3171/2021.3.jns204096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The primary purpose of selective dorsal rhizotomy (SDR) is to ameliorate spasticity in the lower extremities of children with cerebral palsy (CP). In correctly selected patients, this neurosurgical procedure has been shown to have a beneficial effect on many aspects of the child's life. However, given the challenges faced by adults with CP, it would be valuable to document the status of this population compared to their peers later in adulthood. Therefore, the aim of this study was to determine the physical status, mental health, and health-related quality of life (HRQoL) of adults with CP who underwent SDR at least 25 years ago, compared to matched typically developing (TD) individuals. The second aim was to investigate relationships between physical status and the other outcome measures. METHODS Adults with CP were recruited from a database of children who had undergone SDR performed using the technique introduced by Professor Warwick Peacock at Red Cross War Memorial Children's Hospital in Cape Town, South Africa, between 1981 and 1991. These individuals were matched for age, sex, body mass index, and socioeconomic status to a TD adult cohort from a similar background. The parameters assessed were lower-extremity muscle tone, passive range of motion, muscle strength, selectivity, functional mobility and dynamic balance (Timed Up and Go [TUG] test), HRQoL (SF-36), and anxiety and depression levels. RESULTS Twenty-six adults with CP who had a median age of 35.8 years (interquartile range 34.2-41.4 years) (female/male: n = 10/16; Gross Motor Function Classification System level I/II/III: n = 13/10/3), were compared to 26 TD adults. Muscle tone was similar, whereas passive range of motion, muscle strength, selectivity, TUG, and SF-36 physical functioning (concept and summary) scores differed between the cohorts. Other SF-36 parameters, anxiety levels, and depression levels were not different. Strong correlations were found between the muscle strength and TUG scores. CONCLUSIONS Normalized lower-extremity muscle tone was sustained 25-35 years after SDR. Whereas the lower scores for physical assessments are in line with findings in other CP populations, remarkably, relatively good mental health and HRQoL scores were reported in this CP group despite their physical limitations. The strong correlation between muscle strength and TUG suggests that strength training after SDR may have value in improving functional mobility and balance.
Collapse
Affiliation(s)
- Berendina E Veerbeek
- 1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Robert P Lamberts
- 2Department of Sport Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; and
| | - Elisa Kosel
- 3Department of Biomechanics in Sports, Technical University of Munich, Germany
| | - A Graham Fieggen
- 1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Nelleke G Langerak
- 1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
| |
Collapse
|
6
|
Graber L, Senesac C. Upper Extremity Strengthening for an Individual With Dyskinetic Cerebral Palsy: A Case Report. Pediatr Phys Ther 2021; 33:E88-E93. [PMID: 33653985 DOI: 10.1097/pep.0000000000000785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this case is to describe an exercise program designed for an individual with athetoid cerebral palsy who had difficulties with fine motor control and shoulder girdle stability. SUMMARY OF KEY POINTS ET is a 19-year-old man with dyskinetic-type cerebral palsy with rapidly fluctuating muscle tone and movements that preclude trunk and extremity control necessary for the effective performance of functional activities. The participant underwent a 6-week intense physical therapy program aimed at strength and stability at the shoulder girdle and fine motor movements of the hand. CONCLUSIONS ET had improvements on the Performance of Upper Limb Scale, myometry, and from family report after 6 weeks. RECOMMENDATIONS A progressive exercise program aimed at improving proximal stability and fine motor function might be an appropriate intervention for persons with athetoid cerebral palsy. VIDEO ABSTRACT For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A315.
Collapse
Affiliation(s)
- Laura Graber
- Department of Physical Therapy, College of Public Health and Health Professions, and Pediatric Physical Therapy-Kids on the Move, Gainesville, Florida
| | | |
Collapse
|
7
|
Darras N, Nikaina E, Tziomaki M, Gkrimas G, Papavasiliou A, Pasparakis D. Development of Lower Extremity Strength in Ambulatory Children With Bilateral Spastic Cerebral Palsy in Comparison With Typically Developing Controls Using Absolute and Normalized to Body Weight Force Values. Front Neurol 2021; 12:617971. [PMID: 33815249 PMCID: PMC8017198 DOI: 10.3389/fneur.2021.617971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
This cross-sectional study aimed to examine the development of lower limb voluntary strength in 160 ambulatory patients with bilateral spastic cerebral palsy (CP) (106 diplegics/54 quadriplegics) and 86 typically developing (TD) controls, aged 7–16 years. Handheld dynamometry was used to measure isometric strength of seven muscle groups (hip adductors and abductors, hip extensors and flexors, knee extensors and flexors, and ankle dorsiflexors); absolute force (AF) values in pounds were collected, which were then normalized to body weight (NF). AF values increased with increasing age (p < 0.001 for all muscle groups), whereas NF values decreased through adolescence (p < 0.001 for all muscle groups except for hip abduction where p = 0.022), indicating that increases in weight through adolescence led to decreases in relative force. Both AF and NF values were significantly greater in TD subjects when compared with children with CP in all muscle and all age groups (p < 0.001). Diplegics and quadriplegics demonstrated consistently lower force values than TD subjects for all muscle groups, except for the hip extensors where TD children had similar values with diplegics (p = 0.726) but higher than quadriplegics (p = 0.001). Diplegic patients also exhibited higher values than quadriplegics in all muscles, except for the knee extensors where their difference was only indicative (p = 0.056). The conversion of CP subjects' force values as a percentage of the TD subjects' mean value revealed a pattern of significant muscle strength imbalance between the CP antagonist muscles, documented from the following deficit differences for the CP muscle couples: (hip extensors 13%) / (hip flexors 32%), (adductors 27%) / (abductors 52%), and (knee extensors 37%) / (knee flexors 53%). This pattern was evident in all age groups. Similarly, significant force deficiencies were identified in GMFCS III/IV patients when compared with TD children and GMFCS I/II patients. In this study, we demonstrated that children and adolescents with bilateral CP exhibited lower strength values in lower limb muscles when compared with their TD counterparts. This difference was more prevalent in quadriplegic patients and those with a more severe impairment. An important pattern of muscle strength imbalance between the antagonist muscles of the CP subjects was revealed.
Collapse
Affiliation(s)
| | - Eirini Nikaina
- First Department of Pediatrics, "Aghia Sophia" Children's Hospital, University of Athens, Athens, Greece
| | | | - Georgios Gkrimas
- Gait & Motion Analysis Center, ELEPAP, Athens, Greece.,Laboratory of Neuromuscular and Cardiovascular Study of Motion - LANECASM, Athens, Greece
| | | | - Dimitrios Pasparakis
- Gait & Motion Analysis Center, ELEPAP, Athens, Greece.,Pediatric Orthopaedic Department, Athens Medical Center, Athens, Greece
| |
Collapse
|