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Veerbeek BE, Lamberts RP, Fieggen AG, Mankahla N, de Villiers RVP, Botha E, Langerak NG. A long-term follow-up study of spinal abnormalities and pain in adults with cerebral palsy and spastic diplegia more than 25 years after selective dorsal rhizotomy. J Neurosurg Spine 2020; 34:228-235. [PMID: 33065536 DOI: 10.3171/2020.6.spine20751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The main purpose of selective dorsal rhizotomy (SDR) is to reduce spasticity in the lower extremities of children diagnosed with cerebral palsy (CP) and spastic diplegia. The potential for developing spinal abnormalities and pain is a concern, especially in the aging CP population. Therefore, the aim of this study was to evaluate spinal abnormalities, level of pain, and disability (due to back or leg pain) in adults with CP, and associations with participant characteristics, more than 25 years after SDR. METHODS This is a 9-year follow-up study with data collection conducted in 2008 and 2017. Radiographs were assessed for the degree of scoliosis, thoracic kyphosis and lumbar lordosis curvatures, and prevalence of spondylolysis and spondylolisthesis, while level of pain and disability was determined with a self-developed questionnaire and the Oswestry Disability Index (ODI) questionnaire, respectively. RESULTS Twenty-five participants were included (15 males; median age 35.9 years, IQR 34.3-41.5 years), with a follow-up time after SDR ranging from 25 to 35 years. No clinically relevant changes were found for spinal curvatures, spondylolysis and spondylolisthesis, perceived pain frequency, and ODI scores between 2008 and 2017. While the prevalence of spondylolysis was 44%, spondylolisthesis was found in 20% (of whom 15% were grade I and 5% grade II), lumbar hyperlordosis was found in 32%, thoracic hyperkyphosis in 4%, and scoliosis in 20%. The Cobb angle was < 25°, and no patient required surgery for scoliosis. In addition, the low back was reported as the most common site of pain, with 28% of the adults with CP having daily pain. This resulted in 80% of the cohort indicating none or minimal disability due to pain based on the ODI. The only correlation found was between hyperkyphosis and female gender. CONCLUSIONS At follow-up more than 25 years after SDR, no progression in spinal abnormalities, level of pain, and disability was found when compared with findings 15 years after SDR. The prevalence of scoliosis, thoracic hyperkyphosis, and lumbar hyperlordosis was within the range reported for adults with CP, while spondylolysis and spondylolisthesis occurred more often than would be expected. It is difficult, however, to establish the role of SDR in this finding, given the limited data on the natural history of CP. Despite the encouraging outcome of this long-term follow-up study after SDR, it is important to continue monitoring adults with CP during the aging process.
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Affiliation(s)
- Berendina E Veerbeek
- 1Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town
| | - Robert P Lamberts
- 2Department of Surgical Sciences, Division of Orthopaedic Surgery, Stellenbosch University, Cape Town; and
| | - A Graham Fieggen
- 1Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town
| | - Ncedile Mankahla
- 1Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town
| | - Richard V P de Villiers
- 3Winelands Radiology, Institute of Orthopaedics and Rheumatology, Winelands Orthopaedic Hospital, Stellenbosch, Western Cape, South Africa
| | - Elsabe Botha
- 3Winelands Radiology, Institute of Orthopaedics and Rheumatology, Winelands Orthopaedic Hospital, Stellenbosch, Western Cape, South Africa
| | - Nelleke G Langerak
- 1Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town
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Eken MM, Lamberts RP, Du Toit J, Verkoeijen PPJL, Kosel E, Langerak NG. The level of accomplishment and satisfaction in activity and participation of adults with cerebral palsy and spastic diplegia. J Orthop Sci 2020; 25:507-512. [PMID: 31262451 DOI: 10.1016/j.jos.2019.05.023] [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] [Received: 11/30/2018] [Revised: 04/24/2019] [Accepted: 05/30/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Orthopaedic surgery is commonly performed in children with cerebral palsy (CP) and spastic diplegia to improve functional mobility. However, no research has quantified levels of accomplishment and satisfaction in daily activities and participation long-term after surgery. Therefore, this study aimed to investigate 1) the level of accomplishment and satisfaction of life habits in adults with CP, 2) whether there were differences between Gross Motor Function Classification System (GMFCS) levels, and 3) associations with contextual factors, functional level and frequency of pain. METHODS Levels of accomplishment and satisfaction in activity and participation were assessed using the Life-Habits 3.1 questionnaire in 30 adults with CP and spastic diplegia who received the first orthopaedic intervention more than 15 years ago (age: median [interquartile range (IQR)] = 27:8 [21:7-33:8] y:mo; GMFCS level I/II/III: n = 15/11/4). GMFCS and Functional Mobility Scale (FMS) assessed mobility over 5 m, 50 m and 500 m. Participants reported frequency of back pain and pain in the lower and upper limb. RESULTS On average 63% of the participants were independent and faced no difficulties in the accomplishment of all life habits. Difficulties were mostly experienced for 'mobility', 'housing' and 'recreation' (all 61%). Participants were overall satisfied, with lowest scores for 'employment' (13% dissatisfied). Between the GMFCS levels, accomplishment scores of participants with level I were significantly higher than level II. In addition, negative associations were found between accomplishment of life habits and GMFCS level, FMS, and pain on spinal level. CONCLUSION Levels of accomplishment and satisfaction were relatively high among adults with CP who underwent orthopaedic interventions during childhood. However, negative associations between accomplishment levels and level of functioning and back pain argue for rehabilitation programs specialized on these factors. This information is imperative for physicians and allied health care professionals to guide adults with CP during ageing.
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Affiliation(s)
- Maaike M Eken
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg, South Africa
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg, South Africa; Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg, South Africa
| | - Jacques Du Toit
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg, South Africa
| | - Peter P J L Verkoeijen
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands; Learning and Innovation Center, Avans University of Applied Sciences, Breda, the Netherlands
| | - Elisa Kosel
- Department of Biomechanics in Sports, Technical University Munich, Munich, Germany
| | - Nelleke G Langerak
- Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Eken MM, Lamberts RP, Koschnick S, Du Toit J, Veerbeek BE, Langerak NG. Lower Extremity Strength Profile in Ambulatory Adults with Cerebral Palsy and Spastic Diplegia: Norm Values and Reliability for Hand-Held Dynamometry. PM R 2019; 12:573-580. [PMID: 31585499 DOI: 10.1002/pmrj.12257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/17/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The handheld dynamometer (HHD) is a well-accepted tool to assess muscle strength in children with cerebral palsy (CP), though reliability is not tested for adults with CP and no normative data are available. OBJECTIVES To present strength levels of lower extremity muscle groups and test-retest reliability of HHD measurements in ambulatory adults with CP and typically developed (TD) adults. DESIGN Case-control study. SETTING Human motion laboratory. PARTICIPANTS Fifty-four adults with CP (28 men; Gross Motor Function Classification System [GMFCS] level I/II/III: n = 25/20/9; mean age (SD) = 38 (7) year) and 62 TD adults (31 men; mean age (SD) = 37 (5) year). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Maximum strength levels were obtained during voluntary isometric contraction of eight lower extremity muscle groups in adults with CP and spastic diplegia and TD adults using HHD. Three trials were performed per muscle group per leg. Test-retest reliability was investigated by calculating intraclass correlation coefficient (ICC), coefficient of variation (CV), and typical error of measurement (TEM). RESULTS Force and torque levels were significantly lower in all eight lower extremity muscle groups. Excellent ICC levels were observed in TD, GMFCS I and II (>0.90), and moderate to excellent (0.82-0.97) in GMFCS III. CV and TEM were higher in adults with CP compared to TD adults, especially in GMFCS III. LIMITATIONS No subtypes other than adults with CP and spastic diplegia were included. CONCLUSIONS Lower extremity strength profiles demonstrate substantial muscle weakness in ambulatory adults with CP compared to TD adults, which highlights the importance to address muscle weakness in this population group. These strength profiles may serve as norm values for clinicians and researchers. In addition, HHD showed to be reliable to assess lower extremity strength in adults with CP.
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Affiliation(s)
- Maaike M Eken
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg, South Africa
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg, South Africa
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg, South Africa
- Institute of Sport and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Susanne Koschnick
- Institute of Sport and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Jacques Du Toit
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg, South Africa
| | - Berendina E Veerbeek
- Neuroscience Institute and Division of Neurosurgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nelleke G Langerak
- Neuroscience Institute and Division of Neurosurgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Veerbeek BE, Lamberts RP, Fieggen AG, Verkoeijen PPJL, Langerak NG. Daily activities, participation, satisfaction, and functional mobility of adults with cerebral palsy more than 25 years after selective dorsal rhizotomy: a long-term follow-up during adulthood. Disabil Rehabil 2019; 43:2191-2199. [PMID: 31815556 DOI: 10.1080/09638288.2019.1695001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine changes in level of accomplishment and satisfaction in daily activities and social participation, and functional mobility in adults with cerebral palsy (CP) more than 25 years after selective dorsal rhizotomy (SDR). MATERIALS AND METHODS This long-term observational nine-year follow-up study included 26 adults (median age 35 years) with CP and spastic diplegia, and 26 matched typically developing adults. Assessment tools used were the Life-Habits questionnaire and the Functional Mobility Scale. RESULTS Most of the adults with CP were independent and satisfied with accomplishing life habits and no changes were determined, except for a small change in the Housing accomplishment level. Compared to typically developing adults, the CP cohort was more dependent in accomplishing Mobility and Recreation. However, the level of satisfaction was similar for most life habits except for Mobility. Functional mobility did not change, but correlated with Life-Habits results. CONCLUSIONS Adults with CP showed high and stable levels of accomplishment and satisfaction in daily activities and social participation more than 25 years after SDR. This is in contrast with the literature, where functional decline was shown for individuals with CP as they age. The relation with functional mobility highlights the importance to focus the rehabilitation on maintaining walking ability in order to enable high level of daily activities and social participation in adults with CP.Implications for rehabilitationSelective dorsal rhizotomy (SDR) is a valuable treatment option for a selective group of children with cerebral palsy (CP) in order to reduce spasticity.The long-term outcomes of SDR on level of accomplishment and satisfaction in daily activities and social participation as well functional mobility in adults with CP are not clear.More than 25 years after SDR adults with CP experienced stable and lasting high levels of functioning regarding daily activities and social participation and were satisfied with the way they accomplished life habits.Functional mobility was correlated to level of accomplishment and satisfaction in daily activities and social participation, which highlights the importance to focus rehabilitation programs on maintaining functional mobility in order to enable daily activities and social participation in adults with CP.
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Affiliation(s)
- Berendina E Veerbeek
- Department of Surgery, Faculty of Health Sciences, Neuroscience Institute and Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
| | - Robert P Lamberts
- Department of Surgical Sciences, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Department of Surgical Sciences, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Institute of Sport and Exercise Medicine, Stellenbosch University, Tygerberg, South Africa
| | - A Graham Fieggen
- Department of Surgery, Faculty of Health Sciences, Neuroscience Institute and Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
| | - Peter P J L Verkoeijen
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Learning and Innovation Center, Avans University of Applied Sciences, Breda, The Netherlands
| | - Nelleke G Langerak
- Department of Surgery, Faculty of Health Sciences, Neuroscience Institute and Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
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Incidence of spinal deformities and the relationship with physical status and back pain in ambulant adults with cerebral palsy and spastic diplegia. 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 2019; 29:1416-1423. [DOI: 10.1007/s00586-019-06235-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/25/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
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Langerak NG, Tam N, du Toit J, Fieggen AG, Lamberts RP. Gait Pattern of Adults with Cerebral Palsy and Spastic Diplegia More Than 15 Years after Being Treated with an Interval Surgery Approach: Implications for Low-Resource Settings. Indian J Orthop 2019; 53:655-661. [PMID: 31488936 PMCID: PMC6699209 DOI: 10.4103/ortho.ijortho_113_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Single-event multilevel surgery (SEMLS) approach is regarded as the golden standard in developed countries to improve gait and functional mobility in children with cerebral palsy (CP). However, this approach is not always feasible in developing countries. Therefore, orthopedic surgery based on an interval surgery approach (ISA) is still commonly used in developing countries, although little is known about the long term outcomes of an ISA. Therefore, the aim of this study was to describe the gait patterns of adults with CP, who have been treated with ISA, which started more than 15 years ago. MATERIALS AND METHODS Thirty adults with CP and spastic diplegia, who received ISA treatment 21.6-33.7 years ago, were recruited for this study and participated in three-dimensional gait analysis. Twenty kinematic and nondimensional temporal-distance parameters were captured, while the overall gait deviation index (GDI) was also calculated. Data of the adults with CP were compared to normative data of typically developing (TD) adults. RESULTS Although all adults with CP were still ambulant, their gait parameters significantly differed from TD adults, with a lower GDI in the adults with CP. The CP gait patterns were characterized by excessive hip flexion and hip internal rotation as well as a stiff-knee gait. CONCLUSION Although different to TD adults, the gait patterns observed in the adult with CP treated with ISA is in line with other studies. Gait patterns suggest that derotation osteotomies potentially could have improved the long term gait patterns. Although SEMLS might be the preferred treatment method, potentially resulting in better outcomes, ISA can also be used to treat children with CP in developing countries as India and South Africa, where a SEMLS approach is not always feasible.
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Affiliation(s)
- Nelleke Gertrude Langerak
- Department of Surgery, Division of Neurosurgery & Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Tygerberg, South Africa,Department of Interdisciplinary Health Services, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Nicholas Tam
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Bilbao, Spain,Department of Human Biology, Division of Exercise Science and Sport Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jacques du Toit
- Department of Surgical Sciences, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa,Department of Interdisciplinary Health Services, Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A Graham Fieggen
- Department of Surgery, Division of Neurosurgery & Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Tygerberg, South Africa
| | - Robert Patrick Lamberts
- Department of Human Biology, Division of Exercise Science and Sport Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Department of Surgical Sciences, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa,Address for correspondence: Prof. Robert Patrick Lamberts, Department of Surgical Sciences, Division of Orthopaedic Surgery, Stellenbosch University, Tygerberg, South Africa. E-mail:
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Mann TN, Donald KA, Laughton B, Lamberts RP, Langerak NG. HIV encephalopathy with bilateral lower limb spasticity: upper limb motor function and level of activity and participation. Dev Med Child Neurol 2017; 59:412-419. [PMID: 27573542 DOI: 10.1111/dmcn.13236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
Abstract
AIM To describe upper limb motor function and level of activity and participation in children with HIV encephalopathy (HIVE) and bilateral lower limb (BLL) spasticity. METHOD Thirty ambulant children with HIVE and BLL spasticity and 20 typically developing children, between 5 years and 12 years, were recruited. Upper limb motor function was assessed using the Purdue Pegboard and level of activity and participation using the Computer-Adapted Pediatric Evaluation of Disabilities Inventory (PEDI-CAT). RESULTS The HIVE group comprised 14 males and 16 females (mean age [SD] 8y 8mo [2y 2mo], Gross Motor Function Classification System (GMFCS) level I [n=10], II [n=11], and III [n=9]) and the typically developing group comprised 11 males and 9 females (mean age 8y 8mo [2y 3mo]). The HIVE group had lower scores than the typically developing group for all pegboard tasks and three of the four PEDI-CAT domains (p≤0.001). However, individual outcome scores varied substantially within each GMFCS level. INTERPRETATION Children with HIVE and BLL spasticity may have significantly poorer upper limb motor performance and lower levels of activity and participation than typically developing children. These findings suggest that an assessment of upper limb motor function should form part of optimal care for this population.
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Affiliation(s)
- Theresa N Mann
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa.,Division of Orthopedic Surgery, Department of Surgical Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Kirsten A Donald
- Division of Developmental Pediatrics, Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Children's Infectious Diseases Clinical Research Unit, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Robert P Lamberts
- Division of Orthopedic Surgery, Department of Surgical Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Nelleke G Langerak
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
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Mann TN, Laughton B, Donald KA, Langerak NG. HIV encephalopathy with bilateral lower limb spasticity: gross motor function and antiretroviral therapy. Dev Med Child Neurol 2017; 59:407-411. [PMID: 28111750 DOI: 10.1111/dmcn.13377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/29/2022]
Abstract
AIM To describe gross motor function in children with bilateral lower limb (BLL) spasticity due to human immunodeficiency virus encephalopathy (HIVE), and to investigate the association between age, CD4 percentage, and viral load at initiation of antiretroviral therapy (ART) and current gross motor function. METHOD Thirty ambulant children with HIVE and BLL spasticity were recruited. Clinical parameters, including ART, were obtained from medical records. Gross motor function was assessed using the 88-item Gross Motor Function Measure (GMFM-88). RESULTS The participant group was comprised of 14 males and 16 females (median age 8y; interquartile range [IQR] 7-11y). ART was initiated at a median age of 7 months (IQR 5-11mo) with a median CD4 percentage of 4.7% (IQR 2.3-8.0) and viral load of log10 6.0 (IQR 5.6-6.4). The median total GMFM-88 score was 89% (IQR 78-94%), with a wide range of scores in the 'Standing' domain (26-97%) and 'Walking, Running, and Jumping' domain (8-99%). No associations were detected between age at initiation of ART, CD4 percentage, or viral load and total GMFM-88 score. INTERPRETATION Limitations in gross motor function in children with HIVE and BLL spasticity range from mild to severe. ART initiation factors were not able to predict functional status in this sample.
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Affiliation(s)
- Theresa N Mann
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa.,Division of Orthopedic Surgery, Department of Surgical Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Barbara Laughton
- Children's Infectious Diseases Clinical Research Unit, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Kirsten A Donald
- Division of Developmental Pediatrics, Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Nelleke G Langerak
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
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Langerak NG, du Toit J, Burger M, Cotton MF, Springer PE, Laughton B. Spastic diplegia in children with HIV encephalopathy: first description of gait and physical status. Dev Med Child Neurol 2014; 56:686-94. [PMID: 24182356 DOI: 10.1111/dmcn.12319] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to explore the physical status and gait patterns of children with spastic diplegia secondary to human immunodeficiency virus encephalopathy (HIVE). METHOD A cross-sectional study was conducted on children diagnosed with HIVE and spastic diplegia. Sociodemographic and clinical background information was obtained, followed by three-dimensional gait analysis (3DGA) and a physical examination including assessments of muscle tone, strength, motor control, contractures, and bony deformities of the lower extremities. RESULTS Fourteen children (eight males, six females; mean age 5 y 8 mo [SD 9 mo], range 4 y 4 mo-6 y 10 mo) were studied. The cohort was divided into two groups based on distinctive gait patterns. Nine participants in group I showed only limited abnormalities. Group II displayed a more pathological gait pattern including stiff knee and equinus ankle abnormalities. Results of 3DGA, as with the physical examination outcomes, showed increased impairments from proximal to distal (except for hip extension). INTERPRETATION This study provides a first description of distinctive gait patterns and related physical characteristics of children with HIVE and spastic diplegia. Further research is necessary.
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Affiliation(s)
- Nelleke G Langerak
- Neurosurgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Physiotherapy Division, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Muthuri SK, Francis CE, Wachira LJM, LeBlanc AG, Sampson M, Onywera VO, Tremblay MS. Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review. PLoS One 2014; 9:e92846. [PMID: 24676350 PMCID: PMC3968060 DOI: 10.1371/journal.pone.0092846] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 02/27/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts. OBJECTIVE This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa. METHODS Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included. RESULTS A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status. CONCLUSIONS This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions. PROSPERO REGISTRATION NUMBER CRD42013004399.
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Affiliation(s)
- Stella K. Muthuri
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E. Francis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Allana G. LeBlanc
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Vincent O. Onywera
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Kenyatta University, Nairobi, Kenya
| | - Mark S. Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Kenyatta University, Nairobi, Kenya
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Muthuri SK, Wachira LJM, Leblanc AG, Francis CE, Sampson M, Onywera VO, Tremblay MS. Temporal trends and correlates of physical activity, sedentary behaviour, and physical fitness among school-aged children in Sub-Saharan Africa: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:3327-59. [PMID: 24658411 PMCID: PMC3987037 DOI: 10.3390/ijerph110303327] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/07/2014] [Accepted: 03/10/2014] [Indexed: 11/16/2022]
Abstract
Recent physical activity (PA) and fitness transitions, identified as behavioural shifts from traditionally active lifestyles to more industralised and sedentary lifestyles, have been observed among school-aged children. There is a wealth of supporting evidence of such behavioural transitions in high income countries; however, a paucity of data on lower income countries exists. These transitions pose a particular threat to the welfare of children by accelerating the onset of chronic diseases. This systematic review investigated the evidence for a PA and fitness transition among Sub-Saharan Africa's school-aged children. Temporal trends and correlates of PA, SB, and fitness were examined. Studies were identified by searching the Medline, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases, and were included if they measured outcomes of interest in apparently healthy samples of children (5‒17 years). A total of 71 articles met the inclusion criteria (40 informed PA, 17 informed SB, and 37 informed fitness). Vast heterogeneity in study methodology complicated analysis of transitions over time and no temporal trends were immediately discernible. However, higher socioeconomic status, urban living, and female children were found to engage in lower levels of PA, higher SB, and performed worse on aerobic fitness measures compared to lower socioeconomic status, rural living, and male children. Data revealed that urbanization was associated with a trend towards decreased PA, increased SB, and decreased aerobic fitness over time. Representative, temporally sequenced data examining a PA and fitness transition are lacking in this region (PROSPERO Registration Number: CRD42013004399).
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Affiliation(s)
- Stella K Muthuri
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.
| | - Lucy-Joy M Wachira
- Department of Recreation Management and Exercise Science, Kenyatta University, P.O. Box 43844, Nairobi, 00100, Kenya.
| | - Allana G Leblanc
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.
| | - Claire E Francis
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.
| | - Vincent O Onywera
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.
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Van den Bussche K, Michels N, Gracia-Marco L, Herrmann D, Eiben G, De Henauw S, Sioen I. Influence of birth weight on calcaneal bone stiffness in Belgian preadolescent children. Calcif Tissue Int 2012; 91:267-75. [PMID: 22911000 DOI: 10.1007/s00223-012-9636-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/03/2012] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the relation between birth weight and calcaneal bone stiffness in a large sample of Belgian, healthy, preadolescent children. Participants were 827 children (3.6-11.2 years, 51.6 % boys) from the Belgian cohort of the IDEFICS study. Birth weight was obtained using a parental questionnaire, and quantitative ultrasound (QUS) measurements were performed to determine calcaneal broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI) using the Lunar Achilles device. Average birth weights were 3435.7 ± 512.0 g for boys and 3256.9 ± 471.1 g for girls. Average calcaneal QUS measurements were 89.6 ± 24.0 (23.3-153.9) dB/MHz for BUA, 1621.4 ± 49.6 (1516.3-1776.5) m/s for SOS, and 92.8 ± 15.6 (49.0-163.0) for SI. Birth weight was positively associated with BUA (r = 0.13, p = 0.002) and SOS (r = -0.16, p < 0.001). The associations remained after correcting for age and sex in multiple regression analyses but disappeared after correcting for anthropometric covariates. Our findings suggest that birth weight, as a rough proxy indicator for genetic and environmental influences during intrauterine life, is associated with BUA and SOS in preadolescent children and may therefore influence the risk of osteoporosis later in life. Further studies using QUS are needed to investigate the consistency of the results of this study.
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Gait status 17-26 years after selective dorsal rhizotomy. Gait Posture 2012; 35:244-9. [PMID: 22050972 DOI: 10.1016/j.gaitpost.2011.09.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/07/2011] [Accepted: 09/14/2011] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to use three-dimensional gait analysis to describe the gait status of adults with spastic diplegia who underwent selective dorsal rhizotomy (SDR) in childhood. Outcome measures were the gait deviation index (GDI), non-dimensional temporal-distance parameters, and kinematics of the lower limbs. A total of 31 adults with spastic diplegia who had previously undergone SDR were eligible and participated in current study (SDR group). These participants had a median age of 26.8 years (range 21-44 years) with a mean time between surgery and assessment of 21.2±2.9 years (range 17-26 years). For comparison purposes, 43 typically developed adults also participated (CONTROL group), with a median age of 28.3 years (range 21-45 years). More than 17 years after SDR 58% of the SDR group showed improved GMFCS levels, while none of them deteriorated. The participants in the SDR group walked with a mild crouch gait, although there was a loading response, adequate swing-phase knee flexion, adequate swing-phase plantarflexion, reasonable speed and cadence. The gait status of the SDR group more than 17 years after SDR was similar to what has been reported in short-term follow-up studies, as well as our earlier 20 year follow-up study that did not include 3D gait analysis. Appropriate orthopaedic intervention was required in 61% of the study cohort. Whether the types and numbers of orthopaedic interventions are positively affected by SDR remains an open question. Further studies examining this question are warranted. In addition, long-term follow-up studies focused on other interventions would also be of clinical relevance.
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Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Wang Y, Wluka AE. Association between socioeconomic status and bone mineral density in adults: a systematic review. Osteoporos Int 2011; 22:517-27. [PMID: 20449573 DOI: 10.1007/s00198-010-1261-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED For most causes of mortality and morbidity, a socioeconomic gradient exists; however, this systematic review identified limited evidence for the role of education on bone mineral density (BMD). Further research is required to build upon the current paucity of data examining influences of socioeconomic status (SES) on BMD, especially in men. INTRODUCTION For most causes of mortality and morbidity, a socioeconomic gradient exists, although little is understood of the relationship between BMD and SES. We systematically evaluated evidence of SES as a risk factor for low BMD at the clinically relevant sites of hip and spine in adults. METHODS We conducted a computer-aided search of Medline, EMBASE, CINAHL, and PsychINFO from January 1, 1966 until December 31, 2008. Reviewed studies investigated the relationship between SES parameters of income, education, and occupation, and the level of BMD. Studies were rated based on their methodological quality, and a best-evidence synthesis was used to summarise the results. RESULTS One case-control and seven cross-sectional studies were identified for inclusion, of which four cross-sectional studies were high-quality. Best-evidence analysis identified consistent, yet limited, evidence for a positive association between educational attainment and BMD in women. No evidence was available regarding an association between income or occupation and BMD in either gender, or education and BMD in men. CONCLUSIONS Limited good quality evidence exists for the role that education level may play in BMD levels. Cohort studies are required to examine the relationship between individual SES parameters and BMD in order to identify potential intervention targets.
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Affiliation(s)
- S L Brennan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Hospital, Monash University, Commercial Road, Melbourne, 3004, Victoria, Australia.
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