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Rosen L, Plummer T, Sabet A, Lange ML, Livingstone R. RESNA position on the application of power mobility devices for pediatric users. Assist Technol 2023; 35:14-22. [PMID: 29232181 DOI: 10.1080/10400435.2017.1415575] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This paper serves as an update to the previous RESNA Position on the Application of Power Wheelchairs for Pediatric Users with more current and additional scientific literature. This document contains typical clinical applications and best evidence from the literature supporting the application of power mobility (PM) for young children and to assist practitioners in decision-making and justification. It is RESNA' s position that age, limited vision or cognition, behavioral issues, and the ability to walk or propel a manual wheelchair short distances should not, in and of themselves, be used as discriminatory factors against providing PM for children. RESNA recommends early utilization of PM for children with mobility limitations as medically necessary, to promote integration and psycho-social development, reduce passive dependency, and to enhance participation, function, and independence.
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Affiliation(s)
- Lauren Rosen
- St. Joseph's Children's Hospital, Motion Analysis Center, Tampa, Florida, USA
| | | | - Andrina Sabet
- School of Health Sciences, Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland State University, Cleveland, Ohio, USA
| | | | - Roslyn Livingstone
- Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
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2
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Gour-Provençal G, Costa C. Metabolic Syndrome in Children With Myelomeningocele and the Role of Physical Activity: A Narrative Review of the Literature. Top Spinal Cord Inj Rehabil 2022; 28:15-40. [PMID: 36017122 DOI: 10.46292/sci21-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives The purpose of this review is to describe the current scientific literature on the prevalence of metabolic syndrome in children with myelomeningocele and to gain insight into the baseline levels of aerobic fitness, endurance, and strength in this population in order to identify gaps in knowledge, suggest potential primary prevention strategies, and provide recommendations for future studies. Methods A literature review of articles published in English and French between 1990 and April 2020 was conducted. Results Obese adolescents with myelomeningocele have an increased prevalence of components of the metabolic syndrome. Children and adolescents with myelomeningocele have decreased aerobic fitness and muscular strength, decreased lean mass, and increased fat mass, all of which, when combined with higher levels of physical inactivity, put them at higher risk of developing metabolic syndrome and cardiovascular diseases. Conclusion Until more research is conducted, addressing weight-related challenges and promoting healthy habits (such as optimal activity levels) could be easily integrated into yearly myelomeningocele clinics. An actionable suggestion might be to systematically weigh and measure children in these clinics and utilize the results and trends as a talking point with the parents and children. The follow-up appointments could also be used to develop physical activity goals and monitor progress. We recommend that the health care practitioner tasked with this intervention (physician, nurse, etc.) should be aware of locally available accessible sports platforms and have knowledge of motivational interviewing to facilitate removal of perceived barriers to physical activity.
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Affiliation(s)
| | - Camille Costa
- Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
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Davoli GBDQ, Chaves TC, Lopes M, Martinez EZ, Sobreira CFDR, Graham HK, Mattiello-Sverzut AC. The cross-cultural adaptation, construct validity, and intra-rater reliability of the functional mobility scale in Brazilian Portuguese for children and adolescents with spina bifida. Disabil Rehabil 2021; 44:4862-4870. [PMID: 33879009 DOI: 10.1080/09638288.2021.1913650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to perform a cross-cultural adaptation of the Functional Mobility Scale (FMS) to Brazilian Portuguese and analyse its construct validity and intra-rater reliability in a sample of caregivers of children and adolescents with spina bifida (SB). MATERIAL AND METHODS The cross-cultural adaptation followed five stages: two forward translations, synthesis, back-translation, committee review and pre-testing (n = 20). Construct validity was assessed by comparing the FMS with the classifications of Hoffer and Schoenmakers (n = 40). Intra-rater reliability was assessed by comparing the ratings of 14 caregivers, on two occasions. Kendall's tau correlation coefficient was used to test the construct validity of the FMS, while the kappa coefficient was used to test intra-rater reliability. RESULTS Caregivers reported no difficulties with completing the FMS in Brazilian Portuguese. Construct validity tests showed positive correlations between the distances of 5 m (house), 50 m (school) and 500 m (community) in the FMS and the classifications of Hoffer (τ = 0.84; τ = 0.90; τ = 0.68; p < 0.01) and Schoenmakers (τ = 0.83; τ = 0.89; τ = 0.76; p < 0.01), respectively. Excellent intra-rater reliability (kappa = 0.9-1.0) was found for all three distances in the FMS. CONCLUSIONS The FMS in Brazilian Portuguese showed acceptable intra-rater reliability and construct validity when used to measure the mobility level of patients with SB. We recommend its use in clinical practice and research.Implications for RehabilitationA valid and reliable instrument for assessing the mobility of patients with SB;A cross-cultural and adapted FMS in Brazilian Portuguese;An instrument for therapeutic and functional approaches outside the clinicalsetting;The FMS in the Brazilian Portuguese online version shows mistranslations.
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Affiliation(s)
| | - Thais Cristina Chaves
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Mariane Lopes
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Edson Zangiacomi Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - H Kerr Graham
- Department of Orthopaedics, Royal Children's Hospital, University of Melbourne, Victoria, Australia
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Damen KMS, Takken T, de Groot JF, Backx FJG, Radder B, Roos ICPM, Bloemen MAT. 6-Minute Push Test in Youth Who Have Spina Bifida and Who Self-Propel a Wheelchair: Reliability and Physiologic Response. Phys Ther 2020; 100:1852-1861. [PMID: 32671398 PMCID: PMC7530576 DOI: 10.1093/ptj/pzaa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/21/2019] [Accepted: 06/09/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Despite the common occurrence of lower levels of physical activity and physical fitness in youth with spina bifida (SB) who use a wheelchair, there are very few tests available to measure and assess these levels. The purpose of this study was to determine reliability and the physiologic response of the 6-minute push test (6MPT) in youth with SB who self-propel a wheelchair. METHODS In this reliability and observational study, a sample of 53 youth with SB (5-19 years old; mean age = 13 years 7 months; 32 boys and 21 girls) who used a wheelchair performed 2 exercise tests: the 6MPT and shuttle ride test. Heart rate, minute ventilation, respiratory exchange ratio, and oxygen consumption were measured using a calibrated mobile gas analysis system and a heart rate monitor. For reliability, intraclass correlation coefficients (ICCs), SE of measurement, smallest detectable change for total covered distance, minute work, and heart rate were calculated. Physiologic response during the 6MPT was expressed as percentage of maximal values achieved during the shuttle ride test. RESULTS The ICCs for total distance and minute work were excellent (0.95 and 0.97, respectively), and the ICC for heart rate was good (0.81). The physiologic response during the 6MPT was 85% to 89% of maximal values, except for minute ventilation (70.6%). CONCLUSIONS For most youth with SB who use a wheelchair for mobility or sports participation, the 6MPT is a reliable, functional performance test on a vigorous level of exercise. IMPACT This is the first study to investigate physiologic response during the 6MPT in youth (with SB) who are wheelchair using. Clinicians can use the 6MPT to evaluate functional performance and help design effective exercise programs for youth with SB who are wheelchair using.
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Affiliation(s)
- Karlijn M S Damen
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Postbus 12011, 3501 AA Utrecht, the Netherlands; and Master Program Physiotherapy, Specialisation Paediatric Physiotherapy, HU University of Applied Sciences Utrecht
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Janke F de Groot
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht and Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht
| | - Frank J G Backx
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Center Utrecht
| | - Bob Radder
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht; and Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht
| | - Irene C P M Roos
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht and Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht
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Fatigue in Children and Young Adults With Physical Disabilities: Relation With Energy Demands of Walking and Physical Fitness. Pediatr Phys Ther 2020; 32:202-209. [PMID: 32604360 DOI: 10.1097/pep.0000000000000705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine whether general fatigue and fatigue during or after walking are related to energy demands during walking and physical fitness in children and young adults with physical disabilities. METHODS Sixty-eight individuals with physical disabilities participated. General fatigue (Checklist Individual Strength [CIS8R] questionnaire), walking-induced fatigue (OMNI [OMNIwalk] scale after walking for 6 min), gross and net energy costs (ECs) of walking, physical strain of walking, and aerobic and anaerobic fitness were measured. RESULTS Regression analyses showed no relations with the CIS8R. For all participants, a higher net EC was weakly related to an increased OMNIwalk. For teenagers only, low anaerobic fitness and high physical strain of walking values were moderately related to high OMNIwalk scores. CONCLUSION Low anaerobic fitness and high physical strain values partly explain fatigue after walking in teenagers with cerebral palsy, but not in younger children. General fatigue was not explained by low fitness levels or high energy demands of walking.
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Martins EJ, Gastaldi AC, Davoli GBQ, Leonardi-Figueiredo MM, Mattiello-Sverzut AC. Decreased respiratory performance of children and adolescents with myelomeningocele who use a wheelchair - preliminary data. ACTA ACUST UNITED AC 2019; 52:e8671. [PMID: 31389492 PMCID: PMC6686271 DOI: 10.1590/1414-431x20198671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 06/06/2019] [Indexed: 11/21/2022]
Abstract
Myelomeningocele (MMC) is a neural tube defect that often causes spinal cord injury at the thoracolumbar region, as well as sensory and motor paralysis in the lower limbs. This leads to continuous use of a wheelchair and, consequently, a sedentary lifestyle, predisposition to muscle weakness, cardiovascular and respiratory disorders, obesity, and structural alterations in the spine. We assessed the respiratory function and shoulder strength of MMC participants who were wheelchair-users and had no respiratory complaints and compared them to healthy children and adolescents. MMC (n=10) and healthy (n=25) participants of both genders with a mean age of 12.45 years (SD=2.1) were assessed for weight, height, respiratory performance, and isometric peak for shoulder flexors, extensors, abductors, and adductors, using an isokinetic dynamometer. Medullary lesion, functional levels, and abnormal curvatures of the spine were assessed for MMC participants. The level of spinal cord injury for the majority of the MMC participants was high lumbar and they had scoliosis. MMC showed lower values for forced vital capacity, forced expiratory volume at the first second, forced expiratory flow (25-75%), maximal voluntary ventilation, and isometric peak for shoulder flexors and adductors compared to healthy participants. This indicated a decreased vital capacity, respiratory muscle endurance, and shoulder muscle strength.
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Affiliation(s)
- E J Martins
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A C Gastaldi
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G B Q Davoli
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M M Leonardi-Figueiredo
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A C Mattiello-Sverzut
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Bloemen MAT, van den Berg-Emons RJG, Tuijt M, Nooijen CFJ, Takken T, Backx FJG, Vos M, de Groot JF. Physical activity in wheelchair-using youth with spina bifida: an observational study. J Neuroeng Rehabil 2019; 16:9. [PMID: 30642361 PMCID: PMC6332897 DOI: 10.1186/s12984-018-0464-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though typically developing youth are already at risk for physical inactivity, youth with spina bifida may be even at higher risk as a consequence of their reduced mobility. No objective data is available for youth with spina bifida who use a manual wheelchair, so the seriousness of the problem is unknown. The purpose of this observational study was to quantify physical activity in wheelchair-using youth with spina bifida and evaluate the intensity of activities. METHODS Fifty-three children and adolescents (5-19 years) with spina bifida who use a manual wheelchair for daily life, long distances or sports were included. To assess time spent in several types of activities VitaMove data of 34 participants were used and were presented as time spent sedentary and time spent physically active. This was compared to reference data of typically developing youth. To assess time spent in several intensities Actiheart data of 36 participants were used. The intensities were categorized according to the American College of Sports Medicine, ranging from very light intensity to near to maximal intensity. Data of 25 participants were used to combine type of activity and intensity. RESULTS Children and adolescents with spina bifida who use a manual wheelchair were more sedentary (94.3% versus 78.0% per 24 h, p < 0.000) and less physically active (5.0% versus 12.2% per 24 h, p < 0.000) compared to typically developing peers. Physical activity during weekend days was worse compared to school days; 19% met the Guidelines of Physical Activity during school days and 8% during weekend days. The intensities per activity varied extensively between participants. CONCLUSIONS Children and adolescents with spina bifida who use a manual wheelchair are less physically active and more sedentary than typically developing youth. The physical activity levels on school days seem to be more favorable than the physical activity levels on a weekend day. The low levels of physical activity need our attention in pediatric rehabilitation practice. The different intensities during activities indicate the importance of individually tailored assessments and interventions.
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Affiliation(s)
- Manon A T Bloemen
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
| | | | - Matthijs Tuijt
- Research Group Human Movement and Adaptation, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Carla F J Nooijen
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tim Takken
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J G Backx
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marleen Vos
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Janke F de Groot
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Quality and Organization of Care, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Crytzer TM, Keramati M, Anthony SJ, Cheng YT, Robertson RJ, Dicianno BE. Exercise Prescription Using a Group-Normalized Rating of Perceived Exertion in Adolescents and Adults With Spina Bifida. PM R 2018; 10:738-747. [PMID: 29408563 DOI: 10.1016/j.pmrj.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 01/12/2018] [Accepted: 01/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with spina bifida (SB) face personal and environmental barriers to exercise that contribute to physical inactivity, obesity, risk of cardiovascular disease, and poor aerobic fitness. The WHEEL rating of perceived exertion (RPE) Scale was validated in people with SB to monitor exercise intensity. However, the psycho-physiological link between RPE and ventilatory breakpoint (Vpt), the group-normalized perceptual response, has not been determined and would provide a starting point for aerobic exercise in this cohort. OBJECTIVES The primary objectives were to determine the group-normalized RPE equivalent to Vpt based on WHEEL and Borg Scale ratings and to develop a regression model to predict Borg Scale (conditional metric) from WHEEL Scale (criterion metric). The secondary objective was to create a table of interchangeable values between WHEEL and Borg Scale RPE for people with SB performing a load incremental stress test. DESIGN Cross-sectional observational. SETTING University laboratory. PARTICIPANTS Twenty-nine participants with SB. METHODS Participants completed a load incremented arm ergometer exercise stress test. WHEEL and Borg Scale ratings were recorded the last 15 seconds of each 1-minute test phase. OUTCOME MEASURES WHEEL and Borg Scale ratings, metabolic measures (eg, oxygen consumption, carbon dioxide production). Determined Vpt via plots of oxygen consumption and carbon dioxide production against time. RESULTS Nineteen of 29 participants achieved Vpt (Group A). The mean ± standard deviation peak oxygen consumption at Vpt for Group A was 61.76 ± 16.26. The WHEEL and Borg Scale RPE at Vpt were 5.74 ± 2.58 (range 0-10) and 13.95 ± 3.50 (range 6-19), respectively. A significant linear regression model was developed (Borg Scale rating = 1.22 × WHEEL Scale rating + 7.14) and used to create a WHEEL-to-Borg Scale RPE conversion table. CONCLUSION A significant linear regression model and table of interchangeable values was developed for participants with SB. The group-normalized RPE (WHEEL, 5.74; Borg, 13.95) can be used to prescribe and self-regulate arm ergometer exercise intensity approximating the Vpt. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Theresa M Crytzer
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mariam Keramati
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Steven J Anthony
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Yu-Ting Cheng
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Robert J Robertson
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Brad E Dicianno
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Bloemen MA, de Groot JF, Backx FJ, Benner J, Kruitwagen CL, Takken T. Wheelchair Shuttle Test for Assessing Aerobic Fitness in Youth With Spina Bifida: Validity and Reliability. Phys Ther 2017; 97:1020-1029. [PMID: 29029556 PMCID: PMC5803772 DOI: 10.1093/ptj/pzx075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/16/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Testing aerobic fitness in youth is important because of expected relationships with health. OBJECTIVE The purpose of the study was to estimate the validity and reliability of the Shuttle Ride Test in youth who have spina bifida and use a wheelchair for mobility and sport. DESIGN Ths study is a validity and reliability study. METHODS The Shuttle Ride Test, Graded Wheelchair Propulsion Test, and skill-related fitness tests were administered to 33 participants for the validity study (age = 14.5 ± 3.1 y) and to 28 participants for the reliability study (age = 14.7 ± 3.3 y). RESULTS No significant differences were found between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test for most cardiorespiratory responses. Correlations between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test were moderate to high (r = .55-.97). The variance in peak oxygen uptake (VO2peak) could be predicted for 77% of the participants by height, number of shuttles completed, and weight, with large prediction intervals. High correlations were found between number of shuttles completed and skill-related fitness tests (CI = .73 to -.92). Intraclass correlation coefficients were high (.77-.98), with a smallest detectable change of 1.5 for number of shuttles completed and with coefficients of variation of 6.2% and 6.4% for absolute VO2peak and relative VO2peak, respectively. CONCLUSIONS When measuring VO2peak directly by using a mobile gas analysis system, the Shuttle Ride Test is highly valid for testing VO2peak in youth who have spina bifida and use a wheelchair for mobility and sport. The outcome measure of number of shuttles represents aerobic fitness and is also highly correlated with both anaerobic performance and agility. It is not possible to predict VO2peak accurately by using the number of shuttles completed. Moreover, the Shuttle Ride Test is highly reliable in youth with spina bifida, with a good smallest detectable change for the number of shuttles completed.
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Affiliation(s)
- Manon A.T. Bloemen
- M.A.T. Bloemen, MSc, Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Bolognalaan 101, PO Box 85182 3508 AD, Utrecht, the Netherlands; Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, the Netherlands.,Address all correspondence to Ms Bloemen at:
| | - Janke F. de Groot
- J.F. de Groot, PhD, Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, and Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | - Frank J.G. Backx
- F.J.G. Backx, MD, PhD, Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht
| | - Joyce Benner
- J. Benner, MSc, Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht
| | - Cas L.J.J. Kruitwagen
- C.L.J.J. Kruitwagen, MSc, Department of Biostatistics and Research Support, Julius Center, University Medical Center Utrecht
| | - Tim Takken
- T. Takken, PhD, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht
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Bisaro DL, Bidonde J, Kane KJ, Bergsma S, Musselman KE. Past and current use of walking measures for children with spina bifida: a systematic review. Arch Phys Med Rehabil 2015; 96:1533-1543.e31. [PMID: 25944500 DOI: 10.1016/j.apmr.2015.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe walking measurement in children with spina bifida and to identify patterns in the use of walking measures in this population. DATA SOURCES Seven medical databases-Medline, PubMed, Embase, Scopus, Web of Science, CINAHL, and AMED-were searched from the earliest known record until March 11, 2014. Search terms encompassed 3 themes: (1) children; (2) spina bifida; and (3) walking. STUDY SELECTION Articles were included if participants were children with spina bifida aged 1 to 17 years and if walking was measured. Articles were excluded if the assessment was restricted to kinematic, kinetic, or electromyographic analysis of walking. A total of 1751 abstracts were screened by 2 authors independently, and 109 articles were included in this review. DATA EXTRACTION Data were extracted using standardized forms. Extracted data included study and participant characteristics and details about the walking measures used, including psychometric properties. Two authors evaluated the methodological quality of articles using a previously published framework that considers sampling method, study design, and psychometric properties of the measures used. DATA SYNTHESIS Nineteen walking measures were identified. Ordinal-level rating scales (eg, Hoffer Functional Ambulation Scale) were most commonly used (57% of articles), followed by ratio-level, spatiotemporal measures, such as walking speed (18% of articles). Walking was measured for various reasons relevant to multiple health care disciplines. A machine learning analysis was used to identify patterns in the use of walking measures. The learned classifier predicted whether a spatiotemporal measure was used with 77.1% accuracy. A trend to use spatiotemporal measures in older children and those with lumbar and sacral spinal lesions was identified. Most articles were prospective studies that used samples of convenience and unblinded assessors. Few articles evaluated or considered the psychometric properties of the walking measures used. CONCLUSIONS Despite a demonstrated need to measure walking in children with spina bifida, few valid, reliable, and responsive measures have been established for this population.
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Affiliation(s)
- Derek L Bisaro
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Julia Bidonde
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kyra J Kane
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shane Bergsma
- Department of Computer Science, College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kristin E Musselman
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Abstract
PURPOSE To determine exercise response during cardiopulmonary exercise testing in children and adolescents with dystrophinopathies. METHODS Exercise response on the cardiopulmonary exercise test (CPET) was compared with a standard care test protocol. RESULTS Nine boys (aged 10.8 ± 4.7 years) with Becker muscular dystrophy (n = 6) and Duchenne muscular dystrophy (n = 3) were included. The feasibility of the CPET was similar to a standard care test protocol, and no serious adverse events occurred. In 67% of the subjects with normal or only mildly impaired functional capacity, the CPET could be used to detect moderate to severe cardiopulmonary exercise limitations. CONCLUSIONS The CPET seems to be a promising outcome measure for cardiopulmonary exercise limitations in youth with mild functional limitations. Further research with larger samples is warranted to confirm current findings and investigate the additional value of the CPET to longitudinal follow-up of cardiomyopathy and the development of safe exercise programs for youth with dystrophinopathies.
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Oliveira A, Jácome C, Marques A. Physical fitness and exercise training on individuals with spina bifida: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1119-1136. [PMID: 24612860 DOI: 10.1016/j.ridd.2014.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/01/2014] [Accepted: 02/03/2014] [Indexed: 06/03/2023]
Abstract
Spina Bifida (SB) is characterized by several physical impairments; however, data on physical fitness and on the benefits of exercise training in individuals with SB are dispersed in the literature. Thus, this systematic review aimed to describe (i) physical fitness components (cardiorespiratory endurance, muscle strength, body composition, flexibility and neuromotor) and (ii) exercise training effects on the physical fitness of individuals with SB. CINAHL, MEDLINE and EMBASE were searched from January to March 2013 and updated in December 2013. Twenty-three studies were included. A summary of the results was performed using a best-evidence synthesis. Participants with SB had lower cardiorespiratory endurance (-32 to 54% in VO2 peak) and muscle strength (-58 to 90%) and higher body fat (159%) than their healthy peers. Mobility restrictions were present in 26.3-61% of participants. No data on neuromotor fitness were found. Aerobic and strength training improved participants' cardiorespiratory endurance (effect sizes 0.78-1.4) and muscle strength (effect sizes 0-0.59). Individuals with SB have impaired cardiorespiratory endurance, muscle strength, body composition and flexibility when compared to healthy peers. Exercise training seems to improve two of these fitness components (cardiorespiratory endurance and muscle strength). Nevertheless, the heterogeneity of the studies' designs, methods and instruments used limits the establishment of firm conclusions and highlights the need for further research.
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Affiliation(s)
- Ana Oliveira
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal.
| | - Cristina Jácome
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal.
| | - Alda Marques
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal; Unidade de Investigação e Formação sobre Adultos e Idosos (UniFAI), 4050-313 Porto, Portugal.
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13
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A review of the potential for cardiometabolic dysfunction in youth with spina bifida and the role for physical activity and structured exercise. Int J Pediatr 2012; 2012:541363. [PMID: 22778758 PMCID: PMC3384902 DOI: 10.1155/2012/541363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 04/05/2012] [Accepted: 04/20/2012] [Indexed: 11/28/2022] Open
Abstract
Children and adolescents who have decreased mobility due to spina bifida may be at increased risk for the components of metabolic syndrome, including abdominal obesity, insulin resistance, and dyslipidemia due to low physical activity. Like their nondisabled peers, adolescents with spina bifida that develop metabolic risk factors early in life have set the stage for adult disease. Exercise interventions can improve metabolic dysfunction in nondisabled youth, but the types of exercise programs that are most effective and the mechanisms involved are not known. This is especially true in adolescents with spina bifida, who have impaired mobility and physical function and with whom there have been few well-controlled studies. This paper highlights the current lack of knowledge about the role of physical activity and the need to develop exercise strategies targeting the reduction of cardiometabolic risk and improving quality of life in youth with spina bifida.
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14
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Cardiopulmonary exercise testing in congenital heart disease: (contra)indications and interpretation. Neth Heart J 2011; 17:385-92. [PMID: 19949648 DOI: 10.1007/bf03086289] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) in paediatric cardiology differs in many aspects from the tests performed in adult cardiology. Children's cardiovascular responses during exercise testing present different characteristics, particularly oxygen uptake, heart rate and blood pressure response, which are essential in interpreting haemodynamic data. Diseases that are associated with myocardial ischaemia are rare in children. The main indications for CPET in children are evaluation of exercise capacity and the identification of exercise-induced arrhythmias. In this article we will review the main indications for CPET in children with congenital heart disease, the contraindications for exercise testing and the indications for terminating an exercise test. Moreover, we will address the interpretation of gas exchange data from CPET in children with congenital heart disease. (Neth Heart J 2009;17:385-92.).
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de Groot JF, Takken T, van Brussel M, Gooskens R, Schoenmakers M, Versteeg C, Vanhees L, Helders P. Randomized controlled study of home-based treadmill training for ambulatory children with spina bifida. Neurorehabil Neural Repair 2011; 25:597-606. [PMID: 21415263 DOI: 10.1177/1545968311400094] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many ambulatory children with spina bifida (SB) decline in their walking despite stable or even improved motor function. OBJECTIVE The authors evaluated the effects of a home-based treadmill training program on both ambulatory function and aerobic fitness. METHODS This randomized clinical trial of 34 ambulatory children with SB allocated 18 to supervised treadmill training for 12 weeks at home and 14 to usual care. Patients in home training exercised twice a week at an intensity of 66% of HR(peak) (peak heart rate) and gradually progressed from 70% to 140% of their individual walking speed. Main outcome measures were obtained at baseline, after intervention, and 3 months postintervention. Ambulation was measured using the 6-minute walk test (6MWT), during which gross energy consumption (ECS(gross)) and energy cost were calculated. Maximal exercise capacity was measured using an incremental treadmill test. Both VO(2peak) and speed(peak) were recorded as outcome parameters. RESULTS After training, significant changes were seen between the groups for 6MWT (P = .002; d = 1.08), speed(peak) (P = .001; d = 1.14), VO(2peak) (P = .034; d = 0.78), and ECS(gross) (P = .004; d = 1.01). Long-term effects were recorded for 6MWT (P = .003; η = 0.34), speed(peak) (P = .003; η = 0.35), and ECS(gross) (P = .014; η = 0.29) but not for VO(2peak). CONCLUSION A home-based, progressive treadmill training program for ambulatory children with SB has a large long-term effect on ambulation, with a moderate short-term effect on VO(2peak).
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Reproducibility of maximal and submaximal exercise testing in "normal ambulatory" and "community ambulatory" children and adolescents with spina bifida: which is best for the evaluation and application of exercise training? Phys Ther 2011; 91:267-76. [PMID: 21212378 DOI: 10.2522/ptj.20100069] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND With emerging interest in exercise and lifestyle interventions for children and adolescents with spina bifida, there is a need for appropriate measurements in exercise testing. OBJECTIVE The purpose of this study was to assess both reliability and agreement of maximal and submaximal exercise measures in "normal ambulatory" and "community ambulatory" children and adolescents with spina bifida. DESIGN This was a reproducibility study. METHODS Twenty-three children and adolescents with spina bifida (10 normal ambulatory and 13 community ambulatory) participated in the study. Maximal exercise outcomes were measured using a graded treadmill test. Peak measures (peak oxygen uptake [V(O2)peak], peak heart rate [HRpeak], heart rate response [HRR], and oxygen pulse) were recorded. For submaximal measures, heart rate (HR) and oxygen uptake (V(O2)) at the ventilatory threshold and oxygen uptake efficiency slope (OUES) were derived from the maximal measures. Functional performance was measured as the 6-minute walking distance and the maximal speed during the treadmill test. After checking for normality and heteroscedasticity, paired t tests, intraclass correlation coefficients (ICCs), and the smallest detectable difference (SDD) or the coefficient of variation (CV) were calculated. RESULTS Performance measures showed good reliability and agreement. For maximal measures, acceptable ICCs were found for all measures. For submaximal measures, only HR at the ventilatory threshold showed an ICC of less than .80. Agreement showed a CV of less than 10% for all measures, except for V(O2) at the ventilatory threshold, HRR, and OUES. LIMITATIONS Limitations of the study include missing data due to equipment failure. Furthermore, the outcomes were limited to normal ambulatory and community ambulatory children and adolescents with spina bifida. CONCLUSIONS Both maximal and submaximal measures of exercise testing can be used for discriminative purposes in ambulatory children and adolescents with spina bifida. For evaluative purposes, HR measures are superior to V(O2) measures, while taking into account the individual variation of 5% to 8%. The SDD was 0.5 km/h for peak speed and 36.3 m for 6-minute walking distance. Heart rate response, oxygen pulse, and OUES are not recommended in the evaluation of exercise testing in this population.
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Abstract
PURPOSE To summarize and discuss current evidence and understanding of clinical pediatric exercise physiology focusing on the work the research group at Utrecht and others have performed in the last decade in a variety of chronic childhood conditions as a continuation of the legacy of Dr Bar-Or. KEY POINTS The report discusses current research findings on the cardiopulmonary exercise performance of children (and adolescents) with juvenile idiopathic arthritis, osteogenesis imperfecta, achondroplasia, hemophilia, cerebral palsy, spina bifida, cystic fibrosis, and childhood cancer. Exercise recommendations and contraindications are provided for each condition. Implications for clinical practice and future research in this area are discussed for each of the chronic conditions presented. CLINICAL IMPLICATIONS The authors provide a basic framework for developing an individual and/or disease-specific training program, introduce the physical activity pyramid, and recommend a core set of clinical measures to be used in clinical research.
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Abstract
PURPOSE To study whether peak oxygen uptake ((Equation is included in full-text article VO₂ peak), attained in traditional cardiopulmonary exercise testing (CPET) in adolescents with cystic fibrosis (CF), could be verified by a supramaximal exercise test. METHODS Sixteen adolescents with CF (forced expiratory volume in 1 second as % of predicted [range, 45%-117%]) volunteered and successively performed CPET and a supramaximal test (Steep Ramp Test [SRT] protocol). RESULTS Cardiopulmonary exercise testing and the SRT resulted in comparable cardiorespiratory peak values. We found no significant difference in oxygen uptake ((Equation is included in full-text article VO₂ peak/kg) between CPET and the SRT (38.9 ± 7.4 and 38.8 ± 8.5 mL min kg, respectively; P = .81). We found no systemic bias for CPET and SRT measurements of (Equation is included in full-text article VO₂ peak/kg and no differences between CPET and SRT (Equation is included in full-text article VO₂ peak values within and between the maximal and non-maximal effort groups (P > .4). CONCLUSION The (Equation is included in full-text article VO₂ peak measured in CPET seems to reflect the true (Equation is included in full-text article.)O2 peak in adolescents with CF.
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De Groot JF, Takken T, Schoenmakers MAGC, Tummers L, Vanhees L, Helders PJM. Reproducibility of energy cost of locomotion in ambulatory children with spina bifida. Gait Posture 2010; 31:159-63. [PMID: 19875289 DOI: 10.1016/j.gaitpost.2009.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 09/24/2009] [Accepted: 09/28/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Many ambulatory children with Spina Bifida (SB) experience functional decline in ambulation despite stable or even improving motor exams. Improving or maintaining low energy cost of locomotion during childhood and throughout the teenage years, could be an important goal for children and adolescents with SB. Purpose of this study was to determine reproducibility of energy expenditure measures during gait in ambulatory children with SB. DESIGN Reproducibility study. SETTING Child Development and Exercise Center of the University Children's Hospital in Utrecht, the Netherlands. PARTICIPANTS Fourteen ambulatory children (6 boys/8 girls) with SB. Mean age was 10.8 years (+ or - 3.4). INTERVENTIONS Net and gross energy expenditure measures during locomotion were determined during a six-minute walking test. These measures consisted of energy consumption (ECS), expressed in J/kg/min, and energy cost (EC), expressed in J/kg/m. For reliability, the intra-class coefficient (ICC) was determined. For agreement, the smallest detectable difference (SDD) was calculated. RESULTS ICCs vary from 0.86 to 0.96 for both EC and ECS. The SDD ranges from 18-24% for gross measures, up to over 30% for net values. CONCLUSION Reproducibility of energy expenditure during ambulation in children with SB should be considered carefully when using these measures in the evaluation of gait. High reliability of energy expenditure measurements makes these measurements appropriate to use as discriminative tools in children with SB, while agreement of only gross EC seems acceptable to use as a evaluative tool in children with SB. Overall, measures of reliability and agreement seem higher in young children when compared to adolescents. Further research is recommended to determine clinically relevant changes in energy expenditure in children with SB.
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Affiliation(s)
- J F De Groot
- Research Group Lifestyle and Health, University of Applied Sciences, Utrecht, The Netherlands.
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Treadmill testing of children who have spina bifida and are ambulatory: does peak oxygen uptake reflect maximum oxygen uptake? Phys Ther 2009; 89:679-87. [PMID: 19482903 DOI: 10.2522/ptj.20080328] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Earlier studies have demonstrated low peak oxygen uptake ((.)Vo(2)peak) in children with spina bifida. Low peak heart rate and low peak respiratory exchange ratio in these studies raised questions regarding the true maximal character of (.)Vo(2)peak values obtained with treadmill testing. OBJECTIVE The aim of this study was to determine whether the Vo(2)peak measured during an incremental treadmill test is a true reflection of the maximum oxygen uptake ((.)Vo(2)max) in children who have spina bifida and are ambulatory. DESIGN A cross-sectional design was used for this study. METHODS Twenty children who had spina bifida and were ambulatory participated. The (.)Vo(2)peak was measured during a graded treadmill exercise test. The validity of (.)Vo(2)peak measurements was evaluated by use of previously described guidelines for maximum exercise testing in children who are healthy, as well as differences between Vo(2)peak and (.)Vo(2) during a supramaximal protocol ((.)Vo(2)supramaximal). RESULTS The average values for (.)Vo(2)peak and normalized (.)Vo(2)peak were, respectively, 1.23 L/min (SD=0.6) and 34.1 mL/kg/min (SD=8.3). Fifteen children met at least 2 of the 3 previously described criteria; one child failed to meet any criteria. Although there were no significant differences between (.)Vo(2)peak and Vo(2)supramaximal, 5 children did show improvement during supramaximal testing. LIMITATIONS These results apply to children who have spina bifida and are at least community ambulatory. CONCLUSIONS The (.)Vo(2)peak measured during an incremental treadmill test seems to reflect the true (.)Vo(2)max in children who have spina bifida and are ambulatory, validating the use of a treadmill test for these children. When confirmation of maximal effort is needed, the addition of supramaximal testing of children with disability is an easy and well-tolerated method.
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