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Dussault-Picard C, Pouliot-Laforte A, Cherriere C, Houle E, Ballaz L. Locomotion Efficiency in Children With Cerebral Palsy Experiencing Limited Gross Motor Function: Walking Versus Cycling. Pediatr Phys Ther 2024; 36:274-277. [PMID: 38460146 DOI: 10.1097/pep.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
PURPOSE This study compares cycling and walking efficiency, and energy expenditure in children with bilateral spastic cerebral palsy (CP). In children with CP, locomotion with body weight support aids such as a tricycle is a potential alternative for less exhausting movements. METHODS Nine children with CP traveled at comfortable speed for 6 minutes by cycling and walking. The energy expenditure index (EEI) and the percentage of the reserve heart rate (%HRR) were calculated. RESULTS The EEI was lower while cycling than walking, the traveled distance was higher while cycling than walking, and %HRR remained similar between cycling and walking. CONCLUSION Cycling appears an efficient alternative to walking for children with CP for adapted school environments and in the community.
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Affiliation(s)
- Cloé Dussault-Picard
- Department Of Physical Activity Sciences (Mss Dussault-Picard and Pouliot-Laforte and Mr Ballaz), Université du Québec à Montréal, Montreal, Canada; Center of Research of Sainte-Justine University Hospital Center (Mss Dussault-Picard, Pouliot-Laforte, Cherrière, and Houle and Mr Ballaz), Montreal, Canada
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Bailly R, Pons C, Haes AC, Nguyen L, Thepaut M, Houx L, Lempereur M, Brochard S. Bone Deformities through the Prism of the International Classification of Functioning, Disability and Health in Ambulant Children with Cerebral Palsy: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:257. [PMID: 38397369 PMCID: PMC10888000 DOI: 10.3390/children11020257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
(1) Aim: The aim of this study was to determine the relationship between lower limb bone deformities and body functions, activity, and participation in ambulant children with CP and whether changing bone morphology affects outcomes in these domains. (2) Methods: A systematic literature search (PROSPERO CRD42020208416) of studies reporting correlations between measures of lower limb bone deformities and measures of body function, activity or participation, or post-surgical outcomes in these domains was conducted from 1990 to 2023 in Medline, Scopus, and Cochrane Library. We assessed study quality with the Checklist for Case Series (CCS) and a quality assessment developed by Quebec University Hospital. Meta-analysis was not possible; therefore, descriptive synthesis was performed. (3) Results: A total of 12 of 3373 screened articles were included. No studies evaluated the relationships between bone deformities and activity or participation, or the effect of isolated bone surgery on these domains. Correlations between bone deformities and body functions were poor-to-moderate. Internal hip rotation during gait improved after femoral derotation osteotomy. (4) Conclusions: A shift in paradigm is urgently required for the research and management of bone deformities in children with CP to include the activity and participation domains of the ICF, as well as consider more psychological aspects such as self-image.
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Affiliation(s)
- Rodolphe Bailly
- Pediatric Rehabilitation Department, Fondation Ildys, Rue Alain Colas, 29200 Brest, France; (L.H.); (S.B.)
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
| | - Christelle Pons
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
- Faculty of Medicine, Western Britany University, 29238 Brest, France
| | - Anne-Charlotte Haes
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- School of Physiotherapy (IFMK), CHRU Morvan, 29200 Brest, France
| | - Lisa Nguyen
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- School of Physiotherapy (IFMK), CHRU Morvan, 29200 Brest, France
| | - Matthias Thepaut
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Faculty of Medicine, Western Britany University, 29238 Brest, France
- Pediatric Surgery Department, University Hospital of Brest, 29200 Brest, France
| | - Laëtitia Houx
- Pediatric Rehabilitation Department, Fondation Ildys, Rue Alain Colas, 29200 Brest, France; (L.H.); (S.B.)
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
| | - Mathieu Lempereur
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
| | - Sylvain Brochard
- Pediatric Rehabilitation Department, Fondation Ildys, Rue Alain Colas, 29200 Brest, France; (L.H.); (S.B.)
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
- Faculty of Medicine, Western Britany University, 29238 Brest, France
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Smati S, Pouliot-Laforte A, Chevalier M, Lemay M, Ballaz L. Effect of power training on locomotion capacities in children with cerebral palsy with GMFCS level III-IV. Disabil Rehabil 2022:1-7. [PMID: 35737476 DOI: 10.1080/09638288.2022.2090623] [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: 11/03/2022]
Abstract
PURPOSE Power training (PT) is a promising training modality to improve functional abilities in children with cerebral palsy (CP). This study aimed to implement PT in an adapted school and to assess its effect on locomotion capacities in children with Gross Motor Function Classification System (GMFCS) level III-IV. MATERIALS AND METHODS Nine children with CP (GMFCS level III-IV) were trained three times/week for 12 weeks. The training sessions took place during the 50-minute physical activity classes and included high intensity exercise. The outcome measures were the performance on the 10-meter comfortable and fast walking tests, the 50-meter sprint test (50M-ST), and the energy expenditure index (EEI). RESULTS Participants spent 12 ± 7 and 7 ± 9 min per session at an intensity superior to 40% and 60% of the heart rate reserve, respectively. Performance in the 10-meter walking test (13.5 ± 7.8 to 9.9 ± 4.6 s, p < 0.05), the 10-meter fast walking test (8.8 ± 3.1 to 7.0 ± 3.2 s, p < 0.05), the 6-minute walking exercise (199.0 ± 48.6 to 316.6 ± 107.2 m, p < 0.05), and in 50M-ST (53.8 ± 29.5 to 42.3 ± 16.2 s, p < 0.05) increased after training. The EEI was reduced after training (p = 0.01), resulting in a more efficient gait. CONCLUSIONS PT was successfully implemented in children with CP with GMFCS level III-IV. Results suggest that PT increases walking capacities.Implications for rehabilitationPower training (PT) is feasible with children with bilateral cerebral palsy with GMFCS level III and IV.Physical education course in specialist school is a valuable environment to implement PT in children with poor gross motor function.Power training results in locomotion capacities improvement.
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Affiliation(s)
- Sofia Smati
- Department of Physical Activity Sciences, UQAM, Montreal, Canada.,Sainte-Justine UHC Research Center, Montreal, Canada
| | - Annie Pouliot-Laforte
- Department of Physical Activity Sciences, UQAM, Montreal, Canada.,Sainte-Justine UHC Research Center, Montreal, Canada
| | | | - Martin Lemay
- Department of Physical Activity Sciences, UQAM, Montreal, Canada.,Sainte-Justine UHC Research Center, Montreal, Canada.,Groupe de Recherche en Activité Physique Adaptée (GRAPA), Montreal, Canada
| | - Laurent Ballaz
- Department of Physical Activity Sciences, UQAM, Montreal, Canada.,Sainte-Justine UHC Research Center, Montreal, Canada.,Groupe de Recherche en Activité Physique Adaptée (GRAPA), Montreal, Canada
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Washabaugh EP, Krishnan C. Functional resistance training methods for targeting patient-specific gait deficits: A review of devices and their effects on muscle activation, neural control, and gait mechanics. Clin Biomech (Bristol, Avon) 2022; 94:105629. [PMID: 35344781 DOI: 10.1016/j.clinbiomech.2022.105629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injuries to the neuromusculoskeletal system often result in weakness and gait impairments. Functional resistance training during walking-where patients walk while a device increases loading on the leg-is an emerging approach to combat these symptoms. However, there are many methods that can be used to resist the patient, which may alter the biomechanics of the training. Thus, all methods may not address patient-specific deficits. METHODS We performed a comprehensive electronic database search to identify articles that acutely (i.e., after a single training session) examined how functional resistance training during walking alters muscle activation, gait biomechanics, and neural plasticity. Only articles that examined these effects during training or following the removal of resistance (i.e., aftereffects) were included. FINDINGS We found 41 studies that matched these criteria. Most studies (24) used passive devices (e.g., weighted cuffs or resistance bands) while the remainder used robotic devices. Devices varied on if they were wearable (14) or externally tethered, and the type of resistance they applied (i.e., inertial [14], elastic [8], viscous [7], or customized [12]). Notably, these methods provided device-specific changes in muscle activation, biomechanics, and spatiotemporal and kinematic aftereffects. Some evidence suggests this training results in task-specific increases in neural excitability. INTERPRETATION These findings suggest that careful selection of resistive strategies could help target patient-specific strength deficits and gait impairments. Also, many approaches are low-cost and feasible for clinical or in-home use. The results provide new insights for clinicians on selecting an appropriate functional resistance training strategy to target patient-specific needs.
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Affiliation(s)
- Edward P Washabaugh
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA; Michigan Medicine Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Michigan Medicine Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Michigan Robotics, University of Michigan, Ann Arbor, MI, USA.
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Elnaggar RK, Mahmoud WS, Alsubaie SF, Abd El-Nabie WA. Effectiveness of a Multi-Modal Exercise Program Incorporating Plyometric and Balance Training in Children With Hemiplegic Cerebral Palsy: A Three-Armed Randomized Clinical Trial. Phys Occup Ther Pediatr 2022; 42:113-129. [PMID: 34396891 DOI: 10.1080/01942638.2021.1964674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the effectiveness of a multimodal exercise program incorporating plyometric and balance training on muscle strength and postural stability in children with spastic hemiplegic cerebral palsy (SHCP). METHODS A total of 57 children with SHCP were enrolled in the study and randomly allocated into three treatment-based groups: plyometric exercises (PLYO group; n = 19), balance exercises (BAL group, n = 19), and combined plyometric and balance exercises (PLYO-BAL group; n = 19). The maximum isometric muscle strength (IMSmax) and postural stability [anterior-posterior stability index (AP-SI), mediolateral stability index (ML-SI), and overall stability index (O-SI)] were measured pre- and post-intervention. RESULTS By applying the intention-to-treat analysis, the PLYO-BAL group showed greater post-treatment IMSmax than the PLYO and BAL groups for the quadriceps (p=.03 and p=.0002 respectively), hamstrings (p=.018 and p<.0001 respectively), and dorsiflexors (p=.006 and p<.0001 respectively). Also, the PLYO-BAL group achieved better post-intervention stability scores as compared to PLYO and BAL groups regarding AP-SI (p<.0001 and p=.0001 respectively), ML-SI (p=.001 and p=.015 respectively), and O-SI (p=.011 and p=.04 respectively). CONCLUSIONS Incorporation of plyometric and balance exercises in a multimodal rehabilitation program could be an important consideration for enhancing muscle strength and boosting postural stability in children with SHCP.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Waleed S Mahmoud
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Saud F Alsubaie
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Walaa A Abd El-Nabie
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Hilderley AJ, Fehlings D, Chen JL, Wright FV. Comparison of sports skills movement training to lower limb strength training for independently ambulatory children with cerebral palsy: a randomised feasibility trial. Disabil Rehabil 2020; 44:3039-3047. [DOI: 10.1080/09638288.2020.1851779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Alicia J. Hilderley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Joyce L. Chen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Hospital, Toronto, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
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