Évaluation fonctionnelle de la marche par l'index de dépense énergétique. Valeurs de référence chez l'enfant

Efficiency of flexible derotator in walking cerebral palsy children

INTRODUCTION

The flexible derotator is one of the therapeutic resources used to combat primary and secondary abnormalities in walking cerebral palsy children. It was developed to reduce abnormal femoral and tibial torsions and lessen the latter's negative functional impact.

OBJECTIVE

To determine the effect of wearing a flexible derotator on anatomic and functional parameters in walking cerebral palsy children.

METHODS

We performed a retrospective study of walking cerebral palsy children by gathering data on bone-related parameters (femoral and tibial torsion) and functional parameters (distance and speed gait, and the energy expenditure index (EEI)). Fifteen walking cerebral palsy children were treated with the flexible derotator for one year and 15 untreated walking cerebral palsy children were included as controls. The two groups were compared in terms of the various parameters' change over time between the initial examination (the last examination prior to the start of the study or prior to use of the flexible derotator) and the final examination (after one year of follow-up).

RESULTS

Right femoral anteversion and right and left external tibial torsion improved. There was a significant increase in distance and speed gait and a decrease in the EEI in walking cerebral palsy children.

CONCLUSION

Our retrospective study revealed a significant improvement in functional parameters in children with cerebral palsy, as a result of wearing the flexible derotator for at least 6 hours a day for a year. Bone parameters only improved slightly. Use of the flexible derotator could improve these children's quality of life.

Actigraph-defined moderate-to-vigorous physical activity cut-off points among children: statistical and biobehavioural relevance

AIM

To compare Actigraph-defined moderate-to-vigorous physical activity (MVPA) cutpoints among children, combining statistical and biobehavioural analyses.

METHODS

One hundred and thirteen children aged 10.0 +/- 0.8 years wore accelerometer for three days. The time they spent in MVPA was estimated using 10 thresholds ranged from 3000 to 3900 cpm. A statistical construct including 45 Bland and Altman pairwise analyses was used to compare the 10 estimates of MVPA. A regression was performed to develop an equation relating mean differences to the between-cutpoint gaps.

RESULTS

Mean differences in the MVPA estimates ranged from 1.6 to 12.8 min as a function of increment. Raw estimates of MVPA decreased according to an arithmetic sequence with a common difference of 200 cpm. This difference translates into a drop of 12% in MVPA and a misclassification of up to 5% of children. Mean differences (Y) could be predicted from increments (X) using: Y= 0.02 X (R(2)= 0.99, SEE = 0.72, p < 0.0001).

CONCLUSION

When a lack of agreement should be assumed as the between-cutpoint gap exceeds 200 cpm, statistical differences may occur earlier at 90 cpm. Yet, the current equation makes it possible to compare and adjust results from studies/interventions using diverse cutpoints for MVPA among children.

Multidimensional outcome assessment in cerebral palsy: is it feasible and relevant?

BACKGROUND

To examine feasibility and relevance of a multidimensional outcome assessment approach using instrumented 3-dimensional gait analysis, via the Gillette Gait Index (GGI), and a set of validated functional and health-related quality of life tools in diplegic cerebral palsy children, before introduction as a nationwide evaluation set.

METHODS

A 3-year prospective government-funded multicenter study was conducted, recruiting patients during a 9-month period classified using the Gross Motor Function Classification System and the Rodda et al sagittal walking patterns. The Gross Motor Classification System Dimensions D and E, the 10-level Gillette Functional Assessment Questionnaire, the Energy Expenditure Index (EEI), the GGI out of 3D gait analysis, and health-related quality of life, assessed by self or proxy with the questionnaire "Vècu et Santè Perçu de l'Adolescent," were selected for the study.

RESULTS

Cross-sectional data subset at inclusion of 160 spastic diplegic cerebral palsy patients, the largest series in our country, 6 to 18 years old (mean age, 11.0 years), are reported. The GGI correlated significantly (P < 0.001) with the Gross Motor Classification System, the Functional Assessment Questionnaire, and the EEI for all the patients, and all but one (EEI) correlated if grouped according to Gross Motor Function Classification System or Rodda. No systematic correlation was found between the quality of life scores and the other outcome tools.

CONCLUSIONS

The outcome evaluation instrument set tested in our study helps to adopt common tools, to be integrated in an evidence-based practice and to compare health status and treatment outcome between countries, specifically in different linguistic environments like in European countries.