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Ewert KR, Semmelweis A, Heistermann J, Schafmeyer L, Schoenau E, Duran I. Body Fat Distribution in Children and Adolescents With Cerebral Palsy. J Clin Densitom 2022; 25:285-292. [PMID: 35710756 DOI: 10.1016/j.jocd.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022]
Abstract
To evaluate the body fat distribution in children with cerebral palsy (CP). The present study focusses on a monocentric retrospective analysis of body fat distribution from children diagnosed with CP. The children participated in a rehabilitation program. Reference centiles were calculated based on data from the National Health and Nutrition Examination Survey (NHANES, 1999-2004). Z-scores for trunk-to-leg fat ratio were calculated. Further, fat mass index (FMI) was evaluated based on percentiles that have already been published. 237 males and 194 females with CP were considered (mean age: 11 years and 11 months [SD 3 years]). These were compared to 1059 males and 796 females from the NHANES (mean age: 14 years and 7 months [SD 3 years and 4 months]). The z-scores for trunk-to-leg fat ratio showed the following values: mean -0.47 (SD 1.50) for males, -0.49 (SD 1.11), for females, -0.48 (SD 1.34) for all. The z-scores for FMI showed the following values: mean -0.29 (SD 0.70) for males, -0.88 (SD 2.0) for females, -0.55 (SD 1.46) for all. The results showed rather a gynoid fat distribution and a lower FMI in children with CP than in the reference population (NHANES 1999-2004).
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Affiliation(s)
- Kim Ramona Ewert
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Germany
| | - Alexandra Semmelweis
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Germany
| | - Johanna Heistermann
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Germany
| | - Leonie Schafmeyer
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Germany; Department of Neuropediatrics, University Children's Hospital Klinikum Oldenburg, Oldenburg, Germany
| | - Eckhard Schoenau
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Germany; Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Ibrahim Duran
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Germany.
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Silva T, de Queiroz JR, Turcio KHL, Tobelem DDC, Araújo TR, Coutinho KSL, Chavantes MC, Horliana ACRT, Deana AM, da Silva DDFT, Castelo PM, Fernandes KPS, Motta LJ, Mesquita-Ferrari RA, Kalil Bussadori S. Effect of photobiomodulation combined with physical therapy on functional performance in children with myelomeningocele: A protocol randomized clinical blind study. PLoS One 2021; 16:e0253963. [PMID: 34613973 PMCID: PMC8494316 DOI: 10.1371/journal.pone.0253963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/30/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Myelomeningocele is a severe type of spina bifida, resulting from improper closure of the neural tube. This condition drastically affects the structures of the spinal cord resulting in deficiencies. The combination of these deficiencies results in an overall decrease in mobility and functional participation amongst this population. Physiotherapy plays an essential role in rehabilitating people with MMC. The current literature shows that resources such as photobiomodulation (PBM) may support the rehabilitation of neurological conditions. The aim of the proposed study is to evaluate the effects of photobiomodulation (PBM) combined with physical therapy on functional performance in children with low lumbosacral myelomeningocele. MATERIALS AND METHODS This is a protocol randomized clinical blind study, that will include 30 individuals of both sexes, aged between 5 to 8 years, diagnosed with low and sacral lumbar myelomeningocele and capable of performing the sit-to-stand task. The participants will be randomly assigned into two treatment groups: PBM + physiotherapeutic exercises and sham PBM + physiotherapeutic exercises. Irradiation will be carried out with light emitting diode (LED) at a wavelength of 850 nm, energy of 25 J per point, 50 seconds per point and a power of 200 mW. The same device will be used in the placebo group but will not emit light. Muscle activity will be assessed using a portable electromyograph (BTS Engineering) and the sit-to-stand task will be performed as a measure of functioning. Electrodes will be positioned on the lateral gastrocnemius, tibialis anterior and rectus femoris muscles. The Pediatric Evaluation of Disability Inventory will be used to assess functional independence. Quality of life will be assessed using the Child Health Questionnaire-Parent Form 50. Changes in participation will be assessed using the Participation and Environment Measure for Children and Youth. The data will be analyzed with the aid of GraphPad PRISM. DISCUSSION The results of this study can contribute to a better understanding of the effectiveness of PBM on functioning and quality of life in children with myelomeningocele. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04425330.
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Affiliation(s)
- Tamiris Silva
- Universidade Nove de Julho, UNINOVE, São Paulo, SP, Brazil
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Domagalska-Szopa M, Szopa A, Siwiec A, Kwiecień-Czerwieniec I, Schreiber L, Dąbek J. Effects of Whole-Body Vibration Training on Lower Limb Blood Flow in Children with Myelomeningocele-A Randomized Trial. J Clin Med 2021; 10:jcm10184273. [PMID: 34575386 PMCID: PMC8472081 DOI: 10.3390/jcm10184273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of the present study was to determine the effectiveness of a three-week Whole-Body Vibration (WBV) training on the vascular blood flow of the lower limbs in children with myelomeningocele. The secondary goal was to evaluate the effect of WBV on the ROM of lower limb joints in this population. A total of 30 children with MMC (7-16 years old) were enrolled in the study. Children were randomly allocated to two groups of equal numbers, using an envelope code. The experimental group underwent a 3-week WBV training, while the control group received a 3-week conventional physiotherapy (PT) program. The examination consisted of two parts: (1) Doppler USG examination of the lower limb vascular blood flow; (2) evaluation of ROM. The results obtained revealed three main findings. First, WBV training effectively improved blood flow by increasing flow velocities in all tested arteries, while the impact of the PT program was limited to a single parameter. Second, WBV training effectively improved vascular resistance in arteries of the lower legs, while the PT program did not achieve any significant differences. Third, both types of treatment intervention significantly improved ROM in all joints of the lower limbs in MMC participants.
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Affiliation(s)
| | - Andrzej Szopa
- Department of Physiotherapy, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Correspondence: ; Tel.: +48-601-419-468
| | - Andrzej Siwiec
- John Paul II Pediatric Center in Sosnowiec, 41-218 Sosnowiec, Poland; (A.S.); (I.K.-C.)
| | | | - Lutz Schreiber
- Department of Neurosurgery Klinikum Vest, Academic Teaching Hospital, Ruhr-University Bochum, 44801 Bochum, Germany;
| | - Józefa Dąbek
- Department of Cardiology, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland;
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Szopa A, Domagalska-Szopa M, Siwiec A, Kwiecień-Czerwieniec I. Effects of Whole-Body Vibration-Assisted Training on Lower Limb Blood Flow in Children With Myelomeningocele. Front Bioeng Biotechnol 2021; 9:601747. [PMID: 33644013 PMCID: PMC7902517 DOI: 10.3389/fbioe.2021.601747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
This study investigated the effectiveness of whole-body vibration (WBV) training incorporated into a conventional physiotherapy (PT) program (WBV-assisted training) in improving blood flow in the lower limbs and range of motion in the lower limb joints of children with myelomeningocele (MMC). A total of 31 children with MMC (7–15 years old) underwent a 6 weeks treatment program consisting of 2 weeks of conventional PT followed by 4 weeks of WBV-assisted training. The assessment comprised two parts: evaluation of lower limb joint range of motion and Doppler ultrasonography of the superficial femoral, popliteal, and anterior tibial arteries and was performed three times for each of the participants (at baseline, after 10 sessions of PT but before WBV-assisted training, and after 20 sessions of WBV-assisted training). Our results showed that WBV-assisted training significantly improved lower limb circulation in patients with MMC, increasing velocity and reducing resistivity in all tested arteries. Moreover, WBV-assisted training alleviated lower-extremity contractures, especially of the knee. Thus, WBV-assisted training is effective as an adjunctive rehabilitation program for improving functional mobility in children with MMC.
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Affiliation(s)
- Andrzej Szopa
- Department of Physiotherapy, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Andrzej Siwiec
- John Paul II Pediatric Center in Sosnowiec, Sosnowiec, Poland
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Martakis K, Stark C, Rehberg M, Semler O, Duran I, Schoenau E. Reference Centiles to Monitor the 6-minute-walk Test in Ambulant Children with Cerebral Palsy and Identification of Effects after Rehabilitation Utilizing Whole-body Vibration. Dev Neurorehabil 2021; 24:45-55. [PMID: 32564635 DOI: 10.1080/17518423.2020.1770891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Children with cerebral palsy present age-driven development in gross motor skills and walking capacity. Aims: To precisely monitor the 6-minute walk test (6MWT) in children with CP, GMFCS levels 1 and 2 over 6 months and to assess the effect of a 6-month rehabilitation program including whole-body vibration. Methods: Retrospective analysis of data of 157 children with CP who received standardized rehabilitation (DRKS00011331). 6MWT was assessed at the start (M0) and end of the training (M6), as well as at a 6-month follow-up (M12). Centiles were created using the lambda-mu-sigma (LMS) method. Results: We created 6MWT percentiles using data of all 157 children (M0 data). A medium treatment effect size (Cohen's d = 0.69) was found (M6 and M12 data). Conclusions: The generated centiles may help monitor 6MWT changes over 6 months. Combining WBV and conventional physiotherapy can significantly improve 6MWT in children with CP. Abbreviations: 6MWT: 6-Minute Walk Test; CP: Cerebral palsy; ES: effect size; GMFCS: Gross Motor Function Classification System; GMFM-66: Gross Motor Function Measure 66; LOESS: locally weighted scatterplot smoothing; LMS: lambda-mu-sigma; MCID: minimal clinical important difference; SD: standard deviation; SRM: standardized response mean; WBV: whole-body vibration.
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Affiliation(s)
- Kyriakos Martakis
- Medical Faculty and University Hospital, Centre of Prevention and Rehabilitation , Cologne, Germany.,Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute, School CAPHRI, Maastricht University , Maastricht, The Netherlands.,Department of Pediatric Neurology, Social Pediatrics and Epileptology, Justus-Liebig-University Giessen and UKGM , Giessen, Germany
| | - Christina Stark
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne , Cologne, Germany
| | - Mirko Rehberg
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Centre for Rare Skeletal Diseases in Childhood, University of Cologne , Cologne, Germany
| | - Oliver Semler
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Centre for Rare Skeletal Diseases in Childhood, University of Cologne , Cologne, Germany
| | - Ibrahim Duran
- Medical Faculty and University Hospital, Centre of Prevention and Rehabilitation , Cologne, Germany
| | - Eckhard Schoenau
- Medical Faculty and University Hospital, Centre of Prevention and Rehabilitation , Cologne, Germany.,Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne , Cologne, Germany
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6
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Alriksson-Schmidt AI, Ong K, Reeder MR, Thibadeau JK, Feldkamp ML. Site, frequency, and duration of pain in young children with spina bifida. J Pediatr Rehabil Med 2021; 14:571-582. [PMID: 34776433 PMCID: PMC8764594 DOI: 10.3233/prm-190661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To investigate the: (1) percent of children with spina bifida (SB) complaining of pain, (2) frequency, duration, and cause of pain by sex, level of lesion type of SB, and ambulation status, (3) body sites reported to hurt, by variables in objective 2, and (4) associations between physical and mental/emotional health between caregiver and child. METHODS Cross-sectional study of 101 caregivers of children (3 to 6 years old) with SB. Survey data and information from medical records were included. Pearson chi-square, one-way ANOVA, Fisher's exact test, logistic regressions, and bivariate correlations were used. RESULTS Seventy percent reported that their child complained of pain, which did not significantly differ by sex, level of lesion, type of SB, or ambulation status. Most (86%) were reported to have experienced pain for less than 24 hours. The most frequently reported pain site was the head, followed by the abdomen and the lower body. Number of pain sites was moderately correlated with frequency of pain complaints. Correlations between how caregivers reported their own physical/mental/emotional health and how they rated that of their children ranged from weak (r = 0.22) to moderate (r = 0.55). CONCLUSION Almost seven of ten children reportedly complained of pain ranging from at least once a month to everyday. Pain needs to be routinely assessed and treated in this population.
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Affiliation(s)
- Ann I Alriksson-Schmidt
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden
| | - Katherine Ong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew R Reeder
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
| | | | - Marcia L Feldkamp
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
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Stark C, Duran I, Martakis K, Spiess K, Semler O, Schoenau E. Effect of Long-Term Repeated Interval Rehabilitation on the Gross Motor Function Measure in Children with Cerebral Palsy. Neuropediatrics 2020; 51:407-416. [PMID: 33065752 DOI: 10.1055/s-0040-1715489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The efficacy of interventions for cerebral palsy (CP) has been frequently investigated with inconclusive results and motor function measured by the Gross Motor Function Measure (GMFM-66) is common. OBJECTIVE In this observational analysis, we quantify the GMFM-66 change scores of the second and third year of a multimodal rehabilitation program (interval rehabilitation including home-based, vibration-assisted training) in children with CP. METHODS The study was a retrospective analysis of children with CP (2-13 years) participating for a second (n = 262) and third year (n = 86) in the rehabilitation program with GMFM-66 scores at start (M0), after 4 months (M4) of intensive training, and after 8 months of follow-up (M12). A method was previously developed to differentiate between possible treatment effects and expected development under standard of care for GMFM-66 scores using Cohen's d effect size (ES; size of difference). RESULTS After the treatment phase of 4 months (M4) in the second year, 125 of 262 children were responder (ES ≥ 0.2) and 137 children nonresponder (ES < 0.2); mean ES for nonresponder was -0.212 (trivial) and for responder 0.836 (large). After M4 in the third year, 43 children of 86 were responder (ES = 0.881 [large]) and 43 nonresponder (ES = -0.124 [trivial]). DISCUSSION AND CONCLUSION Repeated rehabilitation shows a large additional treatment effect to standard of care in 50% of children which is likely due to the intervention, because in the follow-up period (standard of care), no additional treatment effect was observed and the children followed their expected development.
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Affiliation(s)
- Christina Stark
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Center of Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Kyriakos Martakis
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Department of International Health, Maastricht University, School CAPHRI, Care and Public Health Research Institute, Maastricht, The Netherlands.,Department of Pediatric Neurology, University Children's Hospital (UKGM) and Medical Faculty, Justus Liebig University of Giessen, Giessen, Germany
| | - Karoline Spiess
- Center of Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Eckhard Schoenau
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Center of Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
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Rehberg M, Azim M, Martakis K, Winzenrieth R, Hoyer-Kuhn H, Schoenau E, Semler O, Duran I. Bone Microarchitecture Assessed by Trabecular Bone Score Is Independent of Mobility Level or Height in Pediatric Patients with Cerebral Palsy. J Bone Miner Res 2020; 35:1685-1694. [PMID: 32395832 DOI: 10.1002/jbmr.4047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/27/2022]
Abstract
Bone strength and fracture risk do not only depend on bone density, but also on bone structure. The trabecular bone score (TBS) evaluates homogeneity of bone microarchitecture indirectly by measuring gray-level variations of two-dimensional (2D) DXA images. Although TBS is well-established for adults, there have been only few publications in pediatrics. In this monocentric retrospective analysis, we investigated TBS in children and adolescents with cerebral palsy (CP), a patient group vulnerable to low bone mineral mass due to impaired mobility. The influence of different parameters on TBS and areal BMD (aBMD) were evaluated, as well as the relationship between TBS and aBMD. We compared TBS values of our study population to a reference population. A total of 472 lumbar spine-dual-energy X-ray absorptiometry (LS-DXA) scans of children and adolescents with CP (205 female), aged between 4 and 18 years, were analyzed. The DXA-scans were part of the routine examination. The children had no records of fractures or specific bone diseases. Our study population with CP had similar TBS as the reference population. TBS did not increase with age until an inflection point at 10 years in females, and 12 years in males. Girls had significantly higher TBS than boys (p = .049) and pubertal girls aged 8 to 13 years had significantly higher TBS than prepubertal girls (p = .009). TBS standard deviation score for age (SDS-TBS) and aBMD Z-scores correlated weakly (p < .001; R = 0.276 [males], R = 0.284 [females]). Other than for aBMD Z-scores, SDS-TBS was not influenced by age-adjusted height Z-scores and there was no significant difference in SDS-TBS when grouped by mobility levels, using the Gross Motor Function Classification System (GMFCS). Our results indicate that children with CP have a similar homogeneous distribution of trabecular microarchitecture as controls. Puberty initiation appears to be essential for increase of TBS with age and for sex differences. TBS seems less influenced by body composition, height, and mobility than aBMD. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- Mirko Rehberg
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Manuela Azim
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Kyriakos Martakis
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Department for Pediatric Neurology, Social Pediatrics and Epileptology, Justus-Liebig University Giessen and University Hospital of Giessen and Marburg (UKGM), Giessen, Germany.,Department of International Health, School Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Renaud Winzenrieth
- R&D Department, Medimaps Société par Actions Simplifiée Unipersonnelle (SASU), Merignac, France
| | - Heike Hoyer-Kuhn
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Eckhard Schoenau
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Center of Prevention and Rehabilitation, University Hospital Cologne, Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Cologne Centre for Rare Skeletal Dysplasia in Childhood, University Hospital Cologne, Cologne, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, University Hospital Cologne, Cologne, Germany
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Martakis K, Stark C, Rehberg M, Semler O, Duran I, Schoenau E. One-Minute Walk Test in Children with Cerebral Palsy GMFCS Level 1 and 2: Reference Values to Identify Therapeutic Effects after Rehabilitation. Dev Neurorehabil 2020; 23:201-209. [PMID: 31177878 DOI: 10.1080/17518423.2019.1625981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Children with cerebral palsy (CP) show age-driven development and individual fluctuations in walking capacity.Aim: 1. To precisely quantify 1MWT changes in children with CP, GMFCS level 1 and 2, generating 1MWT percentiles, depicting expected development over 6 months; 2. to assess the effect of a 6-month rehabilitation using whole-body vibration (WBV).Methods: Retrospective data analysis in 210 children with CP, GMFCS 1 and 2 who received standardized rehabilitation (DRKS00011331). 1MWT was assessed before (M0) and after treatment (M6), and at a 6-month follow-up (M12). Centiles were created using the lambda-mu-sigma method. Cohen's d was used to assess effect size.Results: We created 1MWT percentiles using data of all 210 children (M0 data). A small treatment effect size (d = 0.46) was found (M6 and M12 data).Conclusions: Using the generated centiles clinicians may monitor 1MWT changes over 6 months. Combining WBV and conventional physiotherapy may improve 1MWT in children with CP.Abbreviations: 1MWT: One-Minute Walk Test; 6MWT: Six-Minute Walk Test; CP: Cerebral palsy; ES: effect size; GMFCS: Gross Motor Function Classification System; GMFM-66: Gross Motor Function Measure 66; LOESS: Locally Estimated Scatterplot Smoothing; LMS: lambda-mu-sigma; SD: standard deviation; WBV: whole-body-vibration.
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Affiliation(s)
- Kyriakos Martakis
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Centre for Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Department for Pediatric Neurology, Justus-Liebig University of Giessen, Giessen, Germany.,Department for International Health, FHML, Maastricht University, Maastricht, The Netherlands
| | - Christina Stark
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Mirko Rehberg
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Ibrahim Duran
- Centre for Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Eckhard Schoenau
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Centre for Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
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10
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Reliability of a radiation-free, noninvasive and computer-assisted assessment of the spine in children with cerebral palsy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:937-942. [PMID: 32036426 DOI: 10.1007/s00586-020-06328-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/14/2019] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The radiation-free, noninvasive and computer-assisted Spinal Mouse® (SM) is a reliable and valid measuring instrument for functional analysis of the pediatric spine. The aim of this study was to examine the intra-rater reliability of the SM measurements in children with cerebral palsy (CP) and to investigate differences after a 1 week of the rehabilitation program. METHODS A total of 168 SM investigations in the sagittal plane and frontal plane at three measurement times from a sample of 28 children (n = 10 girls, age 9.7 ± 3.1 years) with CP were eligible for evaluation. For the verification of reliability, the measurement results from the first and second measurement times (t1, t2) were used at intervals of 1 day. In addition, differences after the rehabilitation program the patients underwent (t3) were evaluated using the measurement results of the first and third measurements (5-day interval). RESULTS The results show good to excellent intra-rater reliability for the SM measurements, both in the sagittal and in the frontal plane (ICC values = 0.69-0.99). Furthermore, significant changes may occur after only 1 week of therapeutic intervention for total spinal inclination (t1: 12.82 ± 5.40, t3: 11.11 ± 5.60, p = 0.014, Cohen's d = 0.43) and spine length (t1: 401.75 ± 69.05, t3: 409.25 ± 63.58, p = 0.030, Cohen's d = 0.43). CONCLUSIONS SM can be used to generate reliable values for functional analysis of the spine in children with CP. Furthermore, significant posture differences can be demonstrated by therapeutic interventions, especially in the spine inclination (Inc) and spine length (SL). These slides can be retrieved under Electronic Supplementary Material.
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La Starza S, Pazzaglia C, Santilli C, Rendeli C, Padua L. Neuromotor rehabilitation in spina bifida: the need of randomized controlled trials. Childs Nerv Syst 2018; 34:2351-2352. [PMID: 30310995 DOI: 10.1007/s00381-018-3987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/28/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Sara La Starza
- Geriatrics, Neuroscience, Orthopaedics, Head and Neck Department, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Largo F. Vito 1, 00168, Rome, Italy
| | - Costanza Pazzaglia
- Geriatrics, Neuroscience, Orthopaedics, Head and Neck Department, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Largo F. Vito 1, 00168, Rome, Italy.
| | | | - Claudia Rendeli
- Spina Bifida Center, Department of Science of the Health of Women and Children, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Luca Padua
- Geriatrics, Neuroscience, Orthopaedics, Head and Neck Department, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Largo F. Vito 1, 00168, Rome, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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12
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Individualized evaluation of lumbar bone mineral density in children with cerebral palsy. Arch Osteoporos 2018; 13:120. [PMID: 30397843 DOI: 10.1007/s11657-018-0531-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 09/04/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Lumbar spine bone mineral density (LS-BMD) assessed by dual-energy X-ray absorptiometry (DXA) is used in children with cerebral palsy (CP) to evaluate bone health. LS-BMD results in children with CP are influenced significantly by their height, BMI, and mobility level. An adjustment for these parameters might improve the clinical significance of the method. PURPOSE/INTRODUCTION DXA evaluation is considered useful in children with CP to assess bone health. For this purpose, LS-BMD is often used. The aim of the study was to estimate the effect of height, BMI, and reduced mobility level of children with CP on LS-BMD and to develop a method to adjust individual results of LS-BMD for these factors. METHODS We conducted a monocentric retrospective analysis of data collected in children and adolescents with CP, who participated in a rehabilitation program and had no history of recurrent fractures. The DXA scan was part of the routine examination for participants older than 4 years of age. The relationship between height and BMI for age Z-scores and age-adjusted LS-BMD Z-scores was analyzed. RESULTS LS-DXA scans of 500 children and adolescents with CP (Gross Motor Function Classification System levels I-V) were included in the statistical analysis (217 female). The mean age was 9.4 years (± 3.7 years). Children with moderate to severe CP had significantly (p < 0.001) lower LS-BMD Z-scores than children with mild CP. We provided nomograms to adjust individual LS-BMD results to their height, BMI, and mobility level. CONCLUSIONS LS-BMD results in children with CP were influenced significantly by their height, BMI, and mobility level. An adjustment of the LS-BMD results to height, BMI, and mobility level might improve the clinical significance of an individual result.
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Whole-body vibration in children with disabilities demonstrates therapeutic potentials for pediatric cancer populations: a systematic review. Support Care Cancer 2018; 27:395-406. [PMID: 30368670 DOI: 10.1007/s00520-018-4506-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Low levels of physical activity often observed in pediatric oncology might be attributed to various functional deficits, especially those of the lower limbs as these affect gait, mobility, and, consequently, physical activity. In the past few years, whole-body vibration (WBV) has emerged as a new therapy modality for improving physical functioning. Although WBV is increasingly applied in children with disabilities, its impact on lower limb function in pediatric cancer patients and survivors has not yet been investigated. METHODS To establish whether there is evidence that WBV may be beneficial for pediatric cancer patients and survivors, this review summarizes current data on WBV studies among children with disabilities and extracts relevant information for the pediatric cancer population. Two independent reviewers performed a systematic literature search following the PRISMA guidelines. RESULTS Nine studies were included in the analysis. Results demonstrate that WBV is a safe, highly compliant, and effective approach in cohorts of children with disabilities. The largest effects of WBV were observed in lower extremity muscle mass and strength, balance control, gait, and walking ability. Furthermore, we were able to develop first recommendations for WBV protocols. CONCLUSIONS WBV seems to be feasible and effective for improving parameters that may be relevant to the pediatric cancer population. Efforts are needed to conduct first WBV interventions in children with cancer proving the effects. The developed recommendations for WBV protocols might help to implement these intervention studies.
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Duran I, Schulze J, Martakis K, Stark C, Schoenau E. Diagnostic performance of body mass index to identify excess body fat in children with cerebral palsy. Dev Med Child Neurol 2018; 60:680-686. [PMID: 29512149 DOI: 10.1111/dmcn.13714] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 12/20/2022]
Abstract
AIM To assess the diagnostic performance of body mass index (BMI) cut-off values according to recommendations of the World Health Organization (WHO), the World Obesity Federation (WOF), and the German Society for Adiposity (DAG) to identify excess body fat in children with cerebral palsy (CP). METHOD The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation programme. Excess body fat was defined as a body fat percentage above the 85th centile assessed by dual-energy X-ray absorptiometry. RESULTS In total, 329 children (181 males, 148 females) with CP were eligible for analysis. The mean age was 12 years 4 months (standard deviation 2y 9mo). The BMI cut-off values for 'overweight' according to the WHO, WOF, and DAG showed the following sensitivities and specificities for the prediction of excess body fat in our population: WHO: sensitivity 0.768 (95% confidence interval [CI] 0.636-0.870), specificity 0.894 (95% CI 0.851-0.928); WOF: sensitivity 0.696 (95% CI 0.559-0.812), specificity 0.934 (95% CI 0.898-0.960); DAG: sensitivity 0.411 (95% CI 0.281-0.550), specificity 0.993 (95% CI 0.974-0.999). INTERPRETATION Body mass index showed high specificity, but low sensitivity in children with CP. Thus, 'normal-weight obese' children with CP were overlooked, when assessing excess body fat only using BMI. WHAT THIS PAPER ADDS Excess body fat in children with cerebral palsy (CP) is less common than previously reported. Body mass index (BMI) had high specificity but low sensitivity in detecting excess body fat in children with CP. BMI evaluation criteria of the German Society for Adiposity could be improved in children with CP.
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Affiliation(s)
- Ibrahim Duran
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Josefa Schulze
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - KyriakoS Martakis
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Department of International, Health Maastricht University, School CAPHRI, Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Christina Stark
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - Eckhard Schoenau
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany.,Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
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15
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Stark C, Duran I, Cirak S, Hamacher S, Hoyer-Kuhn HK, Semler O, Schoenau E. Vibration-Assisted Home Training Program for Children With Spinal Muscular Atrophy. Child Neurol Open 2018; 5:2329048X18780477. [PMID: 29977975 PMCID: PMC6024344 DOI: 10.1177/2329048x18780477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/17/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to determine the effect of a new method of vibration-assisted neuromuscular rehabilitation in patients with spinal muscular atrophy types II and III. In this retrospective observational study, 38 children (mean age: 4.64 ± 1.95 years) were analyzed. The physiotherapy program, Auf die Beine, combines 6 months of home-based side-alternating whole-body vibration with interval blocks of intensive, goal-directed rehabilitation: 13 days at the start and 6 days after 3 months. Assessments were applied at the beginning (M0), after 6 months of home-based training (M6), and after 6 months of follow-up (M12). Motor abilities were assessed by the Gross Motor Function Measure 66 and Hammersmith Functional Mobility Scale. The Gross Motor Function Measure showed an increase of 1.69 (3.73) points (P = .124) and the Hammersmith Functional Mobility Scale a significant increase of 2.73 ± 1.79 points (P = .007) after 12 months; however, whether this leads to a long-term clinical benefit requires further investigation.
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Affiliation(s)
- Christina Stark
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - Ibrahim Duran
- Centre of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Sebahattin Cirak
- Cologne Center for Molecular Medicine, Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | | | - Oliver Semler
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Centre for Rare Skeletal Diseases in Childhood, University of Cologne, Cologne Germany
| | - Eckhard Schoenau
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany.,Centre of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
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Högler W, Scott J, Bishop N, Arundel P, Nightingale P, Mughal MZ, Padidela R, Shaw N, Crabtree N. The Effect of Whole Body Vibration Training on Bone and Muscle Function in Children With Osteogenesis Imperfecta. J Clin Endocrinol Metab 2017; 102:2734-2743. [PMID: 28472303 DOI: 10.1210/jc.2017-00275] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/28/2017] [Indexed: 01/08/2023]
Abstract
CONTEXT Osteogenesis imperfecta (OI) is associated with reduced muscle size, dynamic muscle function, and mobility. OBJECTIVE To assess the effect of whole body vibration (WBV) on bone density and geometry, muscle size and function, mobility, and balance in children with OI. DESIGN Randomized controlled pilot trial. SETTING Tertiary pediatric research center. PARTICIPANTS Twenty-four children (5 to 16 years) with OI types 1, 4, and limited mobility [Child Health Assessment Questionnaire (CHAQ) score ≥ 0.13] recruited in sex- and pubertal stage-matched pairs. Incident fractures in two boys (WBV arm) led to exclusion of two prepubertal pairs. INTERVENTION Five months of WBV training (3 × 3 minutes twice daily) or regular care. MAIN OUTCOME MEASURES Bone and muscle variables measured by dual-energy X-ray absorptiometry (spine, hip, total body) and peripheral quantitative computed tomography (tibia). Mobility assessed by 6-minute walk tests and CHAQ; dynamic muscle function by mechanography. RESULTS All participants had reduced walking distances and muscle function (P < 0.001). Body mass index z score was associated with higher CHAQ scores (ρ + 0.552; P = 0.005) and lower walking and two-leg jumping performance (ρ - 0.405 to -0.654, P < 0.05). The WBV and control groups did not differ in the 5-month changes in bone. Total lean mass increased more in the WBV group [+1119 g (+224 to +1744)] compared with controls [+635 g (-951 to +1006)], P = 0.01, without improving mobility, muscle function, or balance. CONCLUSIONS The increase in lean mass without changes in muscle function or bone mass suggests reduced biomechanical responsiveness of the muscle-bone unit in children with OI.
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Affiliation(s)
- Wolfgang Högler
- Department of Endocrinology & Diabetes, Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Janis Scott
- Department of Endocrinology & Diabetes, Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - Nick Bishop
- Academic Unit of Child Health, Sheffield Children's Hospital, Sheffield S10 2TH, United Kingdom
| | - Paul Arundel
- Academic Unit of Child Health, Sheffield Children's Hospital, Sheffield S10 2TH, United Kingdom
| | - Peter Nightingale
- Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom
| | - M Zulf Mughal
- Department of Endocrinology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Raja Padidela
- Department of Endocrinology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Nick Shaw
- Department of Endocrinology & Diabetes, Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Nicola Crabtree
- Department of Endocrinology & Diabetes, Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
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Gandhi P, Chan K, Verrier MC, Pakosh M, Musselman KE. Training to Improve Walking after Pediatric Spinal Cord Injury: A Systematic Review of Parameters and Walking Outcomes. J Neurotrauma 2017; 34:1713-1725. [PMID: 27869534 DOI: 10.1089/neu.2016.4501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Walking or locomotor training is often initiated following pediatric spinal cord injury (SCI). There is no synthesis of the literature on interventions targeting walking for pediatric SCI, although this would assist future clinical trials and interventions. To address this need, we completed a systematic review to summarize the who, what, when, and how of walking interventions in children with SCI. Participant characteristics, training parameters, and walking outcomes with training in pediatric SCI were identified and compared with training parameters and outcomes in adults with SCI. The PubMed, Medline, AMED, Embase, PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL databases were searched for studies that included participants aged 1-17 years with a SCI acquired post-birth, physical interventions, and pre- and post-training walking measures. Two researchers evaluated each study's risk of bias using a domain-based approach. Training parameters and walking outcomes were extracted. Total training duration (duration × frequency × number of weeks) was calculated. Thirteen pediatric studies (n = 43 children) were included; all but one were case series/reports. Risk of bias was high in the pediatric studies. A 2012 adult review was updated (11 studies added). As with adults, the training durations, frequencies, and modes used with the children varied; however, overground walking practice was included in 10/13 pediatric studies. Improvements in walking capacity, speed, and distance were comparable between children and adults. There was a trend for greater gains with greater total training durations. There is a paucity of high-quality research examining interventions targeting walking after pediatric SCI; however, intensive training, including practice overground, results in notable improvements.
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Affiliation(s)
- Payal Gandhi
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Katherine Chan
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Mary C Verrier
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
- 2 Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto , Toronto, Ontario, Canada
| | - Maureen Pakosh
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Kristin E Musselman
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
- 2 Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto , Toronto, Ontario, Canada
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Goebel RT, Kleinöder H, Yue Z, Gosh R, Mester J. Effect of Segment-Body Vibration on Strength Parameters. SPORTS MEDICINE-OPEN 2015; 1:14. [PMID: 26258006 PMCID: PMC4526247 DOI: 10.1186/s40798-015-0022-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/21/2015] [Indexed: 12/19/2022]
Abstract
Background In this study, we examine the biomechanical advantage of combining localized vibrations to hamstring muscles involved in a traditional resistance training routine. Methods Thirty-six male and female participants with at least 2 years of experience in resistance training were recruited from the German Sport University Cologne. The participants were randomized into two training groups: vibration training group (VG) and traditional training group (TTG). Both groups underwent a 4-week training phase, where each participant worked out at 70 % of the individual 1 repeat maximum (RM—maximum load capacity of a muscle for one lift to fatigue) (4 sets with 12 repetitions each). For participants in the VG group, local vibration was additionally applied directly to hamstring muscles during exercise. A 2-week examination phase preceded the pretests. After the pretests, the subjects underwent a prescribed training for 4 weeks. At the conclusion of the training, a 2-week detraining was imposed and then the study concluded with posttests and retest. Results The measured parameters were maximum isometric force of the hamstrings and maximum range of motion and muscle tension at maximum knee angle. The study revealed a significant increase in maximum isometric force in both training groups (VG = 21 %, TTG = 14 %). However, VG groups showed an increase in their range of motion by approximately 2 %. Moreover, the muscle tension at maximum knee angle increased less in VG (approximately 35 %) compared to TG (approximately 46 %). Conclusions We conclude that segment-body vibrations applied in resistance training can offer an effective tool to increase maximum isometric force, compared to traditional training. The cause for these findings can be attributed to the additional local vibration stimulus.
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Affiliation(s)
| | - Heinz Kleinöder
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Zengyuan Yue
- The German Research Center, Center of Elite Sport, German Sport University Cologne, Cologne, Germany
| | - Ranajay Gosh
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA USA
| | - Joachim Mester
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
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