Sedentary behavior and children with physical disabilities: a scoping review

Perspectives of children with physical disabilities, parents and physiotherapists on use of walkers and their potential to increase physical activity. A qualitative exploration

Children with physical disabilities are less physically active than children with typical development. How children's experiences of using walkers relates to their physical activity has not been studied previously. This study aimed to explore perspectives of walker use and their potential to increase physical activity. Four focus groups were conducted with children aged 7-10 (n = 3; 12.5%), aged 9-12 (n = 4; 16.7%), parents (n = 7; 29.2%) and paediatric physiotherapists (n = 10; 41.7%). Groups were audio recorded and transcribed. Data were analysed using framework analysis. An overarching concept of walkers needing flexibility to accommodate individual, interpersonal and environmental variability was underpinned by three themes: (a) contrasting drivers for use/non-use of walkers, (b) trade-offs, (c) acceptance of technology within walkers to increase physical activity. Participants were motivated by differing drivers: social for children, emotional for parents and professional for physiotherapists. These contrasting drivers create trade-offs, for example between quality of movement and independence. To maximise physical activity, walker prescribers and designers should prioritise drivers that motivate children and parents, ensuring goal setting is family-centred and participation orientated. Involving families in co-designing walkers is therefore important. Individual clinical assessment allows for identification of children's specific needs and how a child's, parent's and physiotherapist's goals may differ.

Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus

Children functioning at Gross Motor Function Classification System (GMFCS) levels IV-V cannot maintain an aligned standing position or take steps without support. Upright positioning and mobility devices have psycho-social significance for these children and their families, enhancing use of vision, communication, functioning and emotional well-being. Standers and supported stepping devices facilitate opportunities for biomechanical loading, potentially helping to build and maintain muscle and bone integrity, and they promote physical development. However, families are often required to choose between these two devices for their young child. This study aims to synthesize evidence for use and benefits of both supported standing and stepping devices through the lens of two contemporary theoretical frameworks to support clinical reasoning and implementation. The F-words for childhood development (functioning, family, fitness, fun, friends, future) and the interdependence-Human Activity Assistive Technology (iHAAT) models were combined to illustrate the complex interactions between the child, family, caregivers, peers and contextual factors when implementing standing and stepping devices with children at GMFCS levels IV and V. Supported standing and stepping devices provide complementary benefits, and both may be necessary starting at 9-15 months. We propose they both be included ON-Time, along with other age-appropriate positioning and mobility devices, to promote more equitable developmental opportunities for children with non-ambulant cerebral palsy.

A co-designed mixed methods study on community-based gym exercise for non-ambulant adults with childhood onset disability

PURPOSE

Explore community-based gym exercise for non-ambulant adults with childhood-onset disability.

MATERIALS AND METHODS

Non-ambulant adults with childhood-onset disability participated in four, weekly gym sessions co-facilitated by physiotherapists and exercise professionals. Practicalities of participating in the sessions were recorded via uptake and attrition, weekly surveys, and focus groups. Perspectives of those who designed/delivered the study were gathered via weekly debrief meetings. Quantitative data were analysed descriptively, qualitative data were analysed thematically.

RESULTS

Ten non-ambulant adults with childhood-onset disability participated; 70% completed all exercise sessions. Focus groups identified three themes. "I wouldn't be able to exercise…there's no option for a community-based setting" described the lack of opportunities for exercise in gyms. "You don't realise the benefit of coming here" highlighted benefits of exercise. "We can do better" had two sub-themes: problem solving and ingredients for community-based gym exercise. Weekly feedback and debrief meetings identified practicalities related to equipment, exercises, and collaborative working between facilitators.

CONCLUSIONS

Whilst there is an interest in community-based gym exercise for non-ambulant adults with childhood-onset disability, there remains a lack of inclusive gyms. Co-design of inclusive gym guidelines and condition-specific physical activity referral scheme may enhance opportunities for participation in gym exercise for adults with childhood-onset disability.

Emerging methods for measuring physical activity using accelerometry in children and adolescents with neuromotor disorders: a narrative review

BACKGROUND

Children and adolescents with neuromotor disorders need regular physical activity to maintain optimal health and functional independence throughout their development. To this end, reliable measures of physical activity are integral to both assessing habitual physical activity and testing the efficacy of the many interventions designed to increase physical activity in these children. Wearable accelerometers have been used for children with neuromotor disorders for decades; however, studies most often use disorder-specific cut points to categorize physical activity intensity, which lack generalizability to a free-living environment. No reviews of accelerometer data processing methods have discussed the novel use of machine learning techniques for monitoring physical activity in children with neuromotor disorders.

METHODS

In this narrative review, we discuss traditional measures of physical activity (including questionnaires and objective accelerometry measures), the limitations of standard analysis for accelerometry in this unique population, and the potential benefits of applying machine learning approaches. We also provide recommendations for using machine learning approaches to monitor physical activity.

CONCLUSIONS

While wearable accelerometers provided a much-needed method to quantify physical activity, standard cut point analyses have limitations in children with neuromotor disorders. Machine learning models are a more robust method of analyzing accelerometer data in pediatric neuromotor disorders and using these methods over disorder-specific cut points is likely to improve accuracy of classifying both type and intensity of physical activity. Notably, there remains a critical need for further development of classifiers for children with more severe motor impairments, preschool aged children, and children in hospital settings.

Comparing Physical Activity and Quality of Life of Caregivers of Children With Physical Disabilities and Typically Developing Children

There are conflicting reports of the level of physical activity (PA) and its relationship to quality of life (QoL) among caregivers of children with physical disabilities (CwPD). In this cross-sectional study, we aimed to compare the PA levels and QoL of two groups of caregivers - a CwPD group and caregivers of typically developing children (CwTD). We included 32 family caregivers in the CwPD group (22 women, 10 men; M age = 42.1, SD = 6.2 years) and 32 caregivers in the CwTD group (24 women, 8 men; M age = 42.3, SD = 6.1 years). We assessed PA with the International Physical Activity Scale-Short Form (IPAQ-SF) and self-reported activity diaries, and we assessed QoL with the Short-Form 36 (SF-36) questionnaire. Although the IPAQ scores and sitting times of caregivers in these two groups were not statistically different (p > .05), many parameters of self-reported activity diary data and total energy expenditure were significantly higher in the CwPD than the CwTD group (p < .05, effect size = .53-1.10). The CwPD group reported a lower QoL according to the SF-36 and its sub-scores (p < .05, effect size = .54-.77), and higher PA levels than those in the CwTD group. In the CwPD group, moderate, vigorous, and total PA scores were mildly to moderately associated with the total Qol score, and many of its subscores (r = .36 to .60, p < .05). The lower quality of life observed in CwPD, despite high-intensity physical activity levels, suggested that investigators and care providers should consider QoL in the CwPD group to be multifactorial and that here is a need for caregiver interventions to enhance QoL in this underserved population.

Physical Activity Levels and Adiposity in Ambulant Children and Adolescents With Cerebral Palsy Compared With Their Typically Developing Peers

PURPOSE

This study assessed physical activity (PA) and body composition of ambulatory children and adolescents with cerebral palsy (CP) and their typically developing peers.

METHODS

Participants included youth with CP (ages 8-18 y and Gross Motor Function Classification System [GMFCS] levels I-III) and their typically developing peers. Outcomes included PA (actigraphy) and fat/lean mass index (FMI/LMI; dual-energy X-ray absorptiometry). Statistical analyses included linear mixed effects models with Bonferroni adjustment. Fixed effects were study group (CP and typically developing); random effects were participant clusters (sex and age). Exploratory analyses included association of body composition and PA, GMFCS level, and CP involvement (unilateral and bilateral).

RESULTS

Seventy-eight participants (CP: n = 40, girls: n = 29; GMFCS I: n = 20; GMFCS II: n = 14; GMFCS III: n = 6) met inclusion criteria. Individuals with CP had lower moderate to vigorous PA (MVPA; β = -12.5; 98.3% confidence interval, -22.6 to -2.5 min; P = .004) and lower LMI (β = -1.1; 97.5% confidence interval, -2.1 to -0.0 kg/m2; P = .020). Exploratory analyses indicated increased LMI with greater MVPA (P = .001), reduced MVPA for GMFCS II (P = .005) and III (P = .001), increased sedentary time for GMFCS III (P = .006), and greater fat mass index with unilateral motor impairment (P = .026).

CONCLUSIONS

The findings contribute to the knowledge base of increasing MVPA and LMI deficits with the greater functional impact of CP. Associations of increasing LMI with greater MVPA support efforts targeting enhanced PA participation to promote independent mobility.

Sedentary behaviour in non-ambulant children and young people with physical disabilities: a systematic search and review protocol

INTRODUCTION

Non-ambulant children and young people with physical disabilities are at high risk of experiencing negative health outcomes associated with sedentary time. A previous scoping review summarising evidence relating to sedentary behaviours of children with physical disabilities identified the need for validated methods of measuring physical activity of children who use wheelchairs and evaluation of interventions to reduce sedentary time. The scoping review did not assess the quality of evidence relating to this topic, therefore its validity remains unclear. No reviews focussing on non-ambulant children and young people up to the age of 25 years have been undertaken.The objectives of this systematic search and review are to:Identify all peer-reviewed articles relating to sedentary behaviour of non-ambulant children and young people.Categorise the articles according to study design and four subquestions relating to (i) measurement, (ii) patterns, (iii) associated risks and (iv) interventions to reduce sedentary time or behaviour.Critically appraise quality of the articles using established critical appraisal tools.Summarise the evidence for each subquestion. Describe its cumulative strength and identify knowledge gaps.

METHODS AND ANALYSIS

This protocol was developed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. The research questions, inclusion/exclusion criteria and search terms have been developed a priori using the 'Population, Concept and Context' framework. Online databases will be systematically searched to identify peer-reviewed articles published between 1996 and 2021. Two reviewers will screen, categorise and critically appraise the articles. Data extraction and analysis will be verified by the second reviewer.Results will be reported as a best evidence synthesis, with reference to the PRISMA checklist.

ETHICS AND DISSEMINATION

Ethical approval is not required. The review will be submitted to an appropriate peer-reviewed journal.

REGISTRATION

The review is registered on the Open Science Framework database. DOI: https://doi.org/10.17605/OSF.IO/SQXJB. Any protocol amendments will be recorded in the Open Science Framework database.

Operationalization, measurement, and health indicators of sedentary behavior in individuals with cerebral palsy: a scoping review

PURPOSE

To explore the operationalization and measurement of sedentary behavior (SB) in individuals with cerebral palsy (CP).

MATERIALS AND METHODS

We searched five databases from 2011 to 2020 for primary studies of experimental, qualitative, longitudinal, or observational designs measuring SB or postures typically characterized as sedentary (sitting, reclining, lying).

RESULTS

We screened 1112 citations and selected 47 studies. SB was operationalized through muscle activation, energy expenditure or oxygen consumption in typically sedentary postures (n = 9), and through thresholds and postures used by accelerometers, activity monitors, and a questionnaire to measure time spent in SB (n = 25). Seven out of the eight studies that measured energy expenditure found ≤1.5 metabolic equivalents of task (METs) for sitting and lying. While different accelerometer thresholds were used to measure SB, the behavior (SB) was consistently operationalized as sitting and lying. Little consistency existed in the subpopulation, instruments and cut-points for studies on validity or reliability of tools for measuring SB (n = 19).

CONCLUSIONS

Sitting and lying are considered sedentary postures, which is defined as ≤1.5 METs in individuals with CP. There is variability in the tools used to measure SB in individuals with CP. Therefore, consensus on the definition and reporting of SB is needed.Implications for rehabilitationAlthough sedentary behavior (SB) is increased in individuals with cerebral palsy (CP) compared to the typically developing population, there is no standard definition for SB for these individuals; this makes it difficult to synthesize data across studies.Sitting and lying are ≤1.5 METs in individuals with CP, suggesting we only need to measure posture to show change in SB.The commonly used accelerometer cut-point in the typically developing population of ≤100 counts per minute generally has excellent reliability across multiple devices in ambulatory children with CP.

Meeting physical activity and screen time among Colombian adolescents with or without sensory-related problems

The aim of this study was to assess the extent to which adolescents with and without visual and hearing-related problems meet physical activity (PA) and recreational screen time (ST) recommendations in a representative Colombian sample. A total of 35,404 adolescents aged 13-17 years were included from the Encuesta Nacional de Salud Escolar (ENSE) (Colombia). Sociodemographic-related information, anthropometric variables, PA, ST, and both visual- and hearing-related problems were collected by self-administered questionnaires. The prevalence of adolescents meeting with PA, ST, and both recommendations was 14.8%, 53.4%, and 7.8%, respectively. Both sexes with visual- (males: OR=0.70, 95%CI 0.59-0.83; females: OR=0.73, 95%CI 0.61-0.88) and hearing-related problems (males, OR=0.75, 95%CI 0.61-0.93; females, OR=0.76, 95%CI 0.61-0.94) are less likely to meet combined recommendations. Sensory problems such as vision- and hearing-related problems could be considered key barriers to engagement in PA and facilitators of recreational ST in Colombian adolescents.

Design and Implementation of a Position, Speed and Orientation Fuzzy Controller Using a Motion Capture System to Operate a Wheelchair Prototype

The design and implementation of an electronic system that involves head movements to operate a prototype that can simulate future movements of a wheelchair was developed here. The controller design collects head-movements data through a MEMS sensor-based motion capture system. The research was divided into four stages: First, the instrumentation of the system using hardware and software; second, the mathematical modeling using the theory of dynamic systems; third, the automatic control of position, speed, and orientation with constant and variable speed; finally, system verification using both an electronic controller test protocol and user experience. The system involved a graphical interface for the user to interact with it by executing all the controllers in real time. Through the System Usability Scale (SUS), a score of 78 out of 100 points was obtained from the qualification of 10 users who validated the system, giving a connotation of “very good”. Users accepted the system with the recommendation to improve safety by using laser sensors instead of ultrasonic range modules to enhance obstacle detection.

The effects of wheelchair mobility skills and exercise training on physical activity, fitness, skills and confidence in youth using a manual wheelchair

PURPOSE

To evaluate the effects of a combination of wheelchair mobility skills (WMS) training and exercise training on physical activity (PA), WMS, confidence in wheelchair mobility, and physical fitness.

METHODS

Youth using a manual wheelchair (n = 60) participated in this practice-based intervention, with a waiting list period (16 weeks), exercise training (8 weeks), WMS training (8 weeks), and follow-up (16 weeks). Repeated measures included: PA (Activ8), WMS (Utrecht Pediatric Wheelchair Mobility Skills Test), confidence in wheelchair mobility (Wheelchair Mobility Confidence Scale), and physical fitness (cardiorespiratory fitness, (an)aerobic performance) and were analysed per outcome parameter using a multilevel model analyses. Differences between the waiting list and training period were determined with an unpaired sample t-test.

RESULTS

Multilevel model analysis showed significant positive effects for PA (p = 0.01), WMS (p < 0.001), confidence in wheelchair mobility (p < 0.001), aerobic (p < 0.001), and anaerobic performance (p < 0.001). Unpaired sample t-tests underscored these effects for PA (p < 0.01) and WMS (p < 0.001). There were no effects on cardiorespiratory fitness. The order of training (exercise before WMS) had a significant effect on confidence in wheelchair mobility.

CONCLUSIONS

A combination of exercise and WMS training appears to have significant positive long-term effects on PA, WMS, confidence in wheelchair mobility, and (an)aerobic performance in youth using a manual wheelchair.Implications for rehabilitationExercise training and wheelchair mobility skills (WMS) training can lead to a sustained improvement in physical activity (PA) in youth using a manual wheelchair.These combined trainings can also lead to a sustained increase in WMS, confidence in wheelchair mobility, and (an)aerobic performance.More attention is needed in clinical practice and in research towards improving PA in youth using a manual wheelchair.