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Pedroza-García KA, Careaga-Cárdenas G, Díaz-Galindo C, Quintanar JL, Hernández-Jasso I, Ramírez-Orozco RE. Bioactive role of vitamins as a key modulator of oxidative stress, cellular damage and comorbidities associated with spinal cord injury (SCI). Nutr Neurosci 2023; 26:1120-1137. [PMID: 36537581 DOI: 10.1080/1028415x.2022.2133842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Spinal cord injury (SCI) cause significant disability and impact the quality of life of those affected by it. The nutritional status and diet are fundamental to diminish the progression of complications; vitamins modulate the inflammatory response and oxidative stress, promote blood-spinal cord barrier preservation and the prompt recovery of homeostasis. A deep knowledge of the benefits achieved from vitamins in patients with SCI are summarized. Information of dosage, time, and effects of vitamins in these patients are also displayed. Vitamins have been extensively investigated; however, more clinical trials are needed to clarify the scope of vitamin supplementation.Objective: The objective of this review was to offer relevant therapeutic information based on vitamins supplementation for SCI patients.Methods: Basic and clinical studies that have implemented the use of vitamins in SCI were considered. They were selected from the year 2000-2022 from three databases: PubMed, Science Direct and Google Scholar.Results: Consistent benefits in clinical trials were shown in those who were supplemented with vitamin D (prevents osteoporosis and improves physical performance variables), B3 (improves lipid profile) and B12 (neurological prophylaxis of chronic SCI damage) mainly. On the other hand, improvement related to neuroprotection, damage modulation (vitamin A) and its prophylaxis were associated to B complex vitamins supplementation; the studies who reported positive results are displayed in this review.Discussion: Physicians should become familiar with relevant information that can support conventional treatment in patients with SCI, such as the use of vitamins, a viable option that can improve outcomes in patients with this condition.
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Affiliation(s)
- Karina A Pedroza-García
- Departamento de Nutrición, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Gabriela Careaga-Cárdenas
- Biomedical Research, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Carmen Díaz-Galindo
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - J Luis Quintanar
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Irma Hernández-Jasso
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Ricardo E Ramírez-Orozco
- Departamento de Nutrición, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, México
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Cunha NSC, Malvea A, Sadat S, Ibrahim GM, Fehlings MG. Pediatric Spinal Cord Injury: A Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1456. [PMID: 37761417 PMCID: PMC10530251 DOI: 10.3390/children10091456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
A spinal cord injury (SCI) can be a devastating condition in children, with profound implications for their overall health and quality of life. In this review, we aim to provide a concise overview of the key aspects associated with SCIs in the pediatric population. Firstly, we discuss the etiology and epidemiology of SCIs in children, highlighting the diverse range of causes. We explore the unique anatomical and physiological characteristics of the developing spinal cord that contribute to the specific challenges faced by pediatric patients. Next, we delve into the clinical presentation and diagnostic methods, emphasizing the importance of prompt and accurate diagnosis to facilitate appropriate interventions. Furthermore, we approach the multidisciplinary management of pediatric SCIs, encompassing acute medical care, surgical interventions, and ongoing supportive therapies. Finally, we explore emerging research as well as innovative therapies in the field, and we emphasize the need for continued advancements in understanding and treating SCIs in children to improve their functional independence and overall quality of life.
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Affiliation(s)
| | - Anahita Malvea
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON M5T 2S8, Canada;
| | - Sarah Sadat
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - George M. Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada;
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON M5T 2S8, Canada;
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
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3
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Sadowsky CL. Targeting Sarcopenia as an Objective Clinical Outcome in the Care of Children with Spinal Cord-Related Paralysis: A Clinician's View. CHILDREN (BASEL, SWITZERLAND) 2023; 10:837. [PMID: 37238385 PMCID: PMC10217275 DOI: 10.3390/children10050837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023]
Abstract
Muscle loss is consistently associated with immobility and paralysis and triggers significant metabolic and functional changes. The negative effects of sarcopenia are amplified in children who are in the process of building their muscle mass as part of development. Because muscle mass loss is consistently associated with increased morbidity and mortality throughout life, optimizing the size and health of muscles following a neurologic injury is an objective target for therapeutic interventions. This review hypothesizes that muscle mass correlates with functional outcomes in children with paralysis related to spinal cord-related neurologic deficits. We propose that the measurement of muscle mass in this population can be used as an objective outcome for clinical long-term care. Finally, some practical clinical approaches to improving muscle mass are presented.
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Affiliation(s)
- Cristina L. Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD 21205, USA;
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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4
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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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5
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Gober J, Thomas SP, Gater DR. Pediatric Spina Bifida and Spinal Cord Injury. J Pers Med 2022; 12:jpm12060985. [PMID: 35743769 PMCID: PMC9225638 DOI: 10.3390/jpm12060985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022] Open
Abstract
Pediatric spina bifida (SB) and spinal cord injury (SCI) are unfortunately common in our society, and their unique findings and comorbidities warrant special consideration. This manuscript will discuss the epidemiology, pathophysiology, prevention, and management strategies for children growing and developing with these unique neuromuscular disorders. Growth and development of the maturing child places them at high risk of spinal cord tethering, syringomyelia, ascending paralysis, pressure injuries, and orthopedic abnormalities that must be addressed frequently and judiciously. Similarly, proper neurogenic bladder and neurogenic bowel management is essential not just for medical safety, but also for optimal psychosocial integration into the child’s expanding social circle.
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Affiliation(s)
- Joslyn Gober
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
- The Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- Correspondence:
| | - Sruthi P. Thomas
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
- The Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Chen S, Wang Z, Li Y, Tang J, Wang X, Huang L, Fang Z, Xu T, Xu J, Guo F, Wang Y, Long J, Wang X, Liu F, Luo J, Wang Y, Huang X, Jia Z, Shuai M, Li J. Safety and Feasibility of a Novel Exoskeleton for Locomotor Rehabilitation of Subjects With Spinal Cord Injury: A Prospective, Multi-Center, and Cross-Over Clinical Trial. Front Neurorobot 2022; 16:848443. [PMID: 35645758 PMCID: PMC9133609 DOI: 10.3389/fnbot.2022.848443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the safety, walking efficiency, physiological cost, don and doff time cost, and user satisfaction of Ai-robot. Design Prospective, multi-center, and cross-over trial. Subjects Paraplegic subjects (n = 40) with T6-L2 level spinal cord injury. Methods Subjects who could walk independently using Aiwalker, Ailegs, and hip knee ankle foot orthosis (HKAFO) for 6 min within 30 days of training underwent 10 sets of tests. In each set, they completed three 6-min walk test (6MWT) sessions using the three aids in random order. Results Skin lesions, pressure sores, and fractures, were the main adverse events, likely due to a lack of experience in using exoskeleton systems. The average 6MWT distances of the Aiwalker, Ailegs, and HKAFO groups were 134.20 ± 18.74, 79.71 ± 18.06, and 48.31 ± 19.87 m, respectively. The average heart rate increases in the Aiwalker (4.21 ± 8.20%) and Ailegs (41.81 ± 23.47%) groups were both significantly lower than that in the HKAFO group (62.33 ± 28.32%) (both p < 0.001). The average donning/doffing time costs for Ailegs and Aiwalker were significantly shorter than that of HKAFO (both p < 0.001). Satisfaction was higher in the Ailegs and Aiwalker groups (both p < 0.001). Conclusion Subjects with paraplegia below T6 level were able to ambulate safely and efficiently with Ai-robot. The use of Ai-robot should be learned under the guidance of experienced medical personnel.
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Affiliation(s)
- Sijing Chen
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| | - Zhanbin Wang
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Yongqiang Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| | - Jiashuai Tang
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| | - Xue Wang
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| | - Liping Huang
- Department of Rehabilitation, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhuangwei Fang
- Department of Rehabilitation, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tao Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Guo
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yizhao Wang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianjun Long
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaodong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Fang Liu
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaolin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zishan Jia
- Department of Rehabilitation, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mei Shuai
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Jianan Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
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7
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McIntyre A, Sadowsky C, Behrman A, Martin R, Augutis M, Cassidy C, Betz R, Ertzgaard P, Mulcahey MJ. A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With Pediatric-Onset Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:13-90. [PMID: 35521053 PMCID: PMC9009193 DOI: 10.46292/sci21-00046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) ≥50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at ≤21 years of age; and (3) sample was assessed for a rehabilitation/habilitation-related topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results One hundred seventy-six studies were included for review (1974-2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4-5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.
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Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Parkwood Institute, London, Canada
| | - Cristina Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Andrea Behrman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
,Kosair Charities Center for Pediatric Neurorecovery, Louisville, Kentucky
| | - Rebecca Martin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Solna, Sweden
| | - Caitlin Cassidy
- St. Joseph’s Health Care London, Parkwood Institute, London, Canada
| | - Randal Betz
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
,Department of Orthopedics, Mount Sinai Hospital, New York, New York
| | - Per Ertzgaard
- Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - MJ Mulcahey
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Woodbury, New Jersey
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8
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Stiles-Shields C, Garcia B, Villota K, Wartman E, Winning AM, Holmbeck GN. Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study. JMIR Pediatr Parent 2019; 2:e15153. [PMID: 31603432 PMCID: PMC6813487 DOI: 10.2196/15153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs. OBJECTIVE This study aimed to evaluate the usability of a high-quality, publicly available, weight management-focused mobile BIT (smartphone app) for AYA-SBs. METHODS Overall, 28 AYA-SBs attending a Young Men's Christian Association-based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app. RESULTS The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use. CONCLUSIONS AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs.
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Affiliation(s)
- Colleen Stiles-Shields
- Population Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Brittney Garcia
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Kimberly Villota
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Elicia Wartman
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Adrien M Winning
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Grayson N Holmbeck
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
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9
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Graham K, Yarar-Fisher C, Li J, McCully KM, Rimmer JH, Powell D, Bickel CS, Fisher G. Effects of High-Intensity Interval Training Versus Moderate-Intensity Training on Cardiometabolic Health Markers in Individuals With Spinal Cord Injury: A Pilot Study. Top Spinal Cord Inj Rehabil 2019; 25:248-259. [PMID: 31548792 PMCID: PMC6743747 DOI: 10.1310/sci19-00042] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Recent studies in nondisabled individuals have demonstrated that low-volume high-intensity interval training (HIIT) can improve cardiometabolic health similar to moderate-intensity training (MIT) despite requiring 20% of the overall time commitment. To date, there have been no studies assessing the effects of HIIT for improving cardiometabolic health in individuals with SCI. Objectives: The primary purpose of this pilot study was to compare the effects of 6 weeks of low-volume HIIT vs MIT using arm crank ergometer exercise to improve body composition, cardiovascular fitness, glucose tolerance, blood lipids, and blood pressure in a cohort of individuals with longstanding SCI. Methods: Participants were randomized to 6 weeks of HIIT or MIT arm crank exercise training. Aerobic capacity, muscular strength, blood lipids, glucose tolerance, blood pressure, and body composition were assessed at baseline and 6 weeks post training. Results: Seven individuals (6 male, 1 female; n = 3 in MIT and n = 4 in HIIT; mean age 51.3 ± 10.5 years) with longstanding SCI completed the study. The preliminary findings from this pilot study demonstrated that individuals with SCI randomized to either 6 weeks of HIIT or MIT displayed improvements in (a) insulin sensitivity, (b) cardiovascular fitness, and (c) muscular strength (p < .05). However, MIT led to greater improvements in arm fat percent and chest press strength compared to HIIT (p < .05). Conclusion: No differences between MIT and HIIT were observed. Both conditions led to improvements in insulin sensitivity, aerobic capacity, muscle strength, and blood lipids in individuals with SCI. Future larger cohort studies are needed to determine if the shorter amount of time required from HIIT is preferable to current MIT exercise recommendations.
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Affiliation(s)
- Kyle Graham
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ceren Yarar-Fisher
- Department of Physical Medicine and Rehabilitation Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jia Li
- Department of Physical Medicine and Rehabilitation Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kevin M McCully
- Department of Kinesiology, University of Georgia, Athens, Georgia
| | - James H Rimmer
- UAB/Lakeshore Foundation Research Collaborative, Birmingham, Alabama
| | - Danille Powell
- Department of Physical Medicine and Rehabilitation Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - C Scott Bickel
- Department of Physical Therapy, Samford University, Birmingham, Alabama
| | - Gordon Fisher
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, Alabama
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10
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Stiles-Shields C, Holmbeck GN. Health behaviors and disordered eating in adolescents and young adults with spina bifida: results from a national survey. Disabil Rehabil 2019; 42:2910-2916. [PMID: 30978107 DOI: 10.1080/09638288.2019.1575483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Youth with disabilities are at higher risk for obesity, disordered eating, and poor body image but are often excluded from research on these domains. The current study is the first to characterize health behaviors, body mass index, and disordered eating cognitions and behaviors in a national sample of adolescent and young adult males and females with spina bifida.Methods: Participants were recruited nationally through the support of a national spina bifida-related organization to complete an anonymous survey assessing health behaviors and disordered eating.Results: Participants were primarily Caucasian, had myelomeningocele, and were between 15-24 years of age. Body mass indices ranged from underweight to Class Three obesity. Health behaviors (e.g., healthy food consumption, physical activity) were often subthreshold compared to Centers for Disease Control recommendations made to the general public. Both male and female respondents endorsed higher purging and restricting behaviors than norms established with typically-developing college aged peers.Conclusions: Findings revealed that there are few sex-based differences. Additionally, the need for thorough assessment of disordered eating behaviors in this population is warranted, including those with a lower body mass index who might be overlooked for assessment of unhealthy attempts to lose or maintain their weight.Implications for rehabilitationAdolescents and young adults with spina bifida are often advised to lose weight without clear guidelines on how to do so, putting them at risk for disordered eating.Professionals should expect variable body mass indices in this population, with some health behaviors falling short of recommendations made for the general public by the Centers for Disease Control.Professionals should fully assess disordered eating behaviors in youth with disabilities, even when at a healthy weight.
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11
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Bigford G, Nash MS. Nutritional Health Considerations for Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 23:188-206. [PMID: 29339895 DOI: 10.1310/sci2303-188] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic spinal cord injury (SCI) often results in morbidity and mortality due to all-cause cardiovascular disease (CVD) and comorbid endocrine disorders. Several component risk factors for CVD, described as the cardiometabolic syndrome (CMS), are prevalent in SCI, with the individual risks of obesity and insulin resistance known to advance the disease prognosis to a greater extent than other established risks. Notably, adiposity and insulin resistance are attributed in large part to a commonly observed maladaptive dietary/nutritional profile. Although there are no evidence-based nutritional guidelines to address the CMS risk in SCI, contemporary treatment strategies advocate more comprehensive lifestyle management that includes sustained nutritional guidance as a necessary component for overall health management. This monograph describes factors in SCI that contribute to CMS risks, the current nutritional profile and its contribution to CMS risks, and effective treatment strategies including the adaptability of the Diabetes Prevention Program (DPP) to SCI. Establishing appropriate nutritional guidelines and recommendations will play an important role in addressing the CMS risks in SCI and preserving optimal long-term health.
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Affiliation(s)
- Gregory Bigford
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida.,The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Mark S Nash
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida.,Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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12
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Polfuss M, Sawin KJ, Papanek PE, Bandini L, Forseth B, Moosreiner A, Zvara K, Schoeller DA. Total energy expenditure and body composition of children with developmental disabilities. Disabil Health J 2017; 11:442-446. [PMID: 29329773 DOI: 10.1016/j.dhjo.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/05/2017] [Accepted: 12/26/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obesity prevalence is increased in children with developmental disabilities, specifically in children with spina bifida and Down syndrome. Energy expenditure, a critical aspect of weight management, has been extensively studied in the typically developing population, but not adequately studied in children with developmental disabilities. OBJECTIVE Determine energy expenditure, fat-free mass and body fat percentile and the impact of these findings on recommended caloric intake in children with spina bifida and Down syndrome. METHODS/MEASURES This pilot study included 36 children, 18 with spina bifida, 9 with Down syndrome and 9 typically developing children. Half of the children with spina bifida were non-ambulatory. Doubly labeled water was used to measure energy expenditure and body composition. Descriptive statistics described the sample and MANOVA and ANOVA methods were used to evaluate differences between groups. RESULTS Energy expenditure was significantly less for children with spina bifida who primarily used a wheelchair (p = .001) and children with Down syndrome (p = .041) when compared to children without a disability when adjusted for fat-free mass. However, no significant difference was detected in children with spina bifida who ambulated without assistance (p = .072). CONCLUSIONS Children with spina bifida and Down syndrome have a significantly decreased energy expenditure which directly impacts recommended caloric intake. No significant difference was detected for children with spina bifida who ambulated, although the small sample size of this pilot study may have limited these findings. Validating these results in a larger study is integral to supporting successful weight management of these children.
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Affiliation(s)
- Michele Polfuss
- University of Wisconsin-Milwaukee, College of Nursing, 1921 E. Hartford Avenue, Milwaukee, WI, 53211-3060, United States; Children's Hospital of Wisconsin, Department of Nursing Research, PO Box 1997, MS C140, Milwaukee, WI, 53201, United States.
| | - Kathleen J Sawin
- University of Wisconsin-Milwaukee, College of Nursing, 1921 E. Hartford Avenue, Milwaukee, WI, 53211-3060, United States; Children's Hospital of Wisconsin, Department of Nursing Research, PO Box 1997, MS C140, Milwaukee, WI, 53201, United States
| | | | - Linda Bandini
- Eunice Kennedy Shriver Center/UMASS Medical School and Boston University, Sargent College, Department of Health Sciences, USA
| | - Bethany Forseth
- University of Wisconsin - Milwaukee, Department of Kinesiology, USA
| | - Andrea Moosreiner
- Medical College of Wisconsin, Adult Translational Research Unit, USA
| | - Kimberley Zvara
- Medical College of Wisconsin and Children's Hospital of Wisconsin, Physical Medicine and Rehabilitation, USA
| | - Dale A Schoeller
- University of Wisconsin - Madison, Biotech Center and Nutritional Sciences, USA
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Abstract
PURPOSE OF REVIEW Obesity is a common comorbidity in individuals with spina bifida. Carrying excess weight exacerbates the inherent health challenges associated with spina bifida, impedes the individual's ability to self-manage their condition, and creates further challenges for family members and caregivers. This manuscript provides a narrative review of key issues for understanding and prevention of obesity in persons with spina bifida within the context of the social ecological model. RECENT FINDINGS Specific variables related to obesity and spina bifida include individual factors (i.e., body composition and measurement issues, energy needs, eating patterns, physical activity, and sedentary activity) family factors (i.e., parenting/family, peers), community factors (i.e., culture, built environment, healthcare and healthcare providers, and school), and societal factors (i.e., policy issues). Due to the complex etiology of obesity and its increased prevalence in individuals with spina bifida, it is critical to initiate prevention efforts early with a multifactorial approach for this at-risk population. Increased research is warranted to support these efforts.
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Affiliation(s)
- Michele Polfuss
- College of Nursing, University of Wisconsin-Milwaukee, 1921 E. Hartford Avenue, Milwaukee, WI, 53211, USA.
- Department of Nursing Research, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI, 53201-1997, USA.
| | - Linda G Bandini
- University of Massachusetts Medical School, 55 Lake Avenue North S3-324B, Worcester, MA, 01655, USA
- Department of Health Sciences, Boston University, 635 Commonwealth Ave, Boston, MA, 02115, USA
| | - Kathleen J Sawin
- Department of Nursing Research, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI, 53201-1997, USA
- Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, 1921 E. Hartford Avenue, Milwaukee, WI, 53211, USA
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García-Silva MT, Martín MA, Morán M. Understanding mitochondrial diseases. Clin Nutr 2017; 36:902. [PMID: 28343800 DOI: 10.1016/j.clnu.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Affiliation(s)
- M T García-Silva
- Mitochondrial and Neuromuscular Diseases Laboratory, Hospital Universitario 12 de Octubre Research Institute (i+12), Madrid, Spain; Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Spain; Unidad Pediátrica de Enfermedades Raras, Dpto Pediatría, Hospital Universitario 12 de Octubre, Madrid, C.S.U.R. Enfermedades Metabólicas Hereditarias, Spain
| | - M A Martín
- Mitochondrial and Neuromuscular Diseases Laboratory, Hospital Universitario 12 de Octubre Research Institute (i+12), Madrid, Spain; Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Spain
| | - M Morán
- Mitochondrial and Neuromuscular Diseases Laboratory, Hospital Universitario 12 de Octubre Research Institute (i+12), Madrid, Spain; Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Spain.
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A lifestyle intervention program for successfully addressing major cardiometabolic risks in persons with SCI: a three-subject case series. Spinal Cord Ser Cases 2017; 3:17007. [PMID: 28382218 DOI: 10.1038/scsandc.2017.7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/14/2016] [Accepted: 01/13/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION This study is a prospective case series analyzing the effects of a comprehensive lifestyle intervention program in three patients with chronic paraplegia having major risks for the cardiometabolic syndrome (CMS). CASE PRESENTATION Individuals underwent an intense 6-month program of circuit resistance exercise, nutrition using a Mediterranean diet and behavioral support, followed by a 6-month extension (maintenance) phase involving minimal support. The primary goal was a 7% reduction of body mass. Other outcomes analyzed insulin resistance using the HOMA-IR model, and plasma levels of fasting triglycerides and high-density lipoprotein cholesterol. All participants achieved the goal for 7% reduction of body mass and maintained the loss after the MP. Improvements were observed in 2/3 subjects for HOMA-IR and high-density lipoprotein cholesterol. All participants improved their risk for plasma triglycerides. DISCUSSION We conclude, in a three-person case series of persons with chronic paraplegia, a lifestyle intervention program involving circuit resistance training, a calorie-restrictive Mediterranean-style diet and behavioral support, results in clinically significant loss of body mass and effectively reduced component risks for CMS and diabetes. These results were for the most part maintained after a 6-month MP involving minimal supervision.
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Ribeiro Neto F, Guanais P, Lopes GH, Dornelas E, de Campos Barbetta D, Coutinho AC, Gonçalves CW, Gomes Costa RR. Influence of Relative Strength on Functional Independence of Patients With Spinal Cord Injury. Arch Phys Med Rehabil 2016; 98:1104-1112. [PMID: 27717738 DOI: 10.1016/j.apmr.2016.08.483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/29/2016] [Accepted: 08/25/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the influence of strength values and fat mass on functional independence of men with different spinal cord injury (SCI) levels. DESIGN Cross-sectional study. SETTING Hospital network. PARTICIPANTS Men with SCI (N=45). INTERVENTIONS Subjects were assessed in functional independence scales, a 1 repetition maximum (1RM) test, and body composition to detect absolute and relative strength: 1RM divided by body mass (BM) and lean body mass (LBM), respectively. MAIN OUTCOME MEASURES Stepwise multiple regression analysis was used to verify the influence of predictors on functional independence (FIM and Spinal Cord Independence Measure [SCIM] scale and subscales). Receiver operating characteristic curves were created to identify cutoff points of strength for functional independence. RESULTS The best models for FIM total, FIM mobility, and SCIM total used 1RM as the best predictor (adjusted R2=.75, .67, and .65, respectively; P<.05). Relative strength (1RM/LBM) was the best predictor for SCIM mobility (adjusted R2=.62, P<.05). A FIM score of 69 has a 1RM cutoff point of 50.1kg, and a FIM score of 76 has cutoff points of .73 for 1RM/BM and .91 for 1RM/LBM. A SCIM score of 68 has cutoff points for 1RM, 1RM/BM, and 1RM/LBM of 50.1kg, .77, and .92, respectively. CONCLUSIONS Cutoff points of relative strength should be used as determinant variables for independence, health, or sports performance. This study may contribute to more adequate guidance of physical activity during a rehabilitation program and after discharge.
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Affiliation(s)
| | | | - Guilherme H Lopes
- College of Physical Education, University of Brasília, Brasília/DF, Brazil
| | - Elisa Dornelas
- SARAH Rehabilitation Hospital Network, Brasília/DF, Brazil
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17
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Polfuss M, Simpson P, Stolzman S, Moerchen V, Hovis S, Zhang L, Miranda H, Sawin K. The measurement of body composition in children with spina bifida: Feasibility and preliminary findings. J Pediatr Rehabil Med 2016; 9:143-53. [PMID: 27285807 DOI: 10.3233/prm-160377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the feasibility of obtaining and comparing various methods of height and body composition (BC) measurements in children with spina bifida (SB). METHODS Fifteen children (7M/8F) with SB (4-18 years old) underwent weight, four height measurements (arm span, wall-mounted stadiometer, segmental and recumbent length) and five BC measurements: (BMI; BodPod®; DEXA; Bioelectrical Impedance Analysis; and skinfold). Data collectors, parents, and study participants evaluated procedures. The four heights as paired with the BC measurements were compared to the gold standard DEXA measurements. RESULTS Procedures were successfully completed in 14 of 15 children. Skinfolds and segmental length had a midlevel ranking of comfort. While no measures substituted for the DEXA scan, preliminary findings suggest that an algorithm may estimate BC in this high-risk population. Currently, arm span used within BodPod® measurements provided the closest agreement with the DEXA scan. CONCLUSION Study protocol was feasible and provided necessary information, including recommended modifications, for successful implementation of the planned subsequent study.
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Affiliation(s)
- Michele Polfuss
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.,Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee WI, USA.,Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Pippa Simpson
- Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stacy Stolzman
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Victoria Moerchen
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Susan Hovis
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee WI, USA
| | - Liyun Zhang
- Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Heidi Miranda
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee WI, USA
| | - Kathleen Sawin
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.,Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee WI, USA.,Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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18
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McPherson AC, Ball GD, Maltais DB, Swift JA, Cairney J, Knibbe TJ, Krog K. A Call to Action: Setting the Research Agenda for Addressing Obesity and Weight-Related Topics in Children with Physical Disabilities. Child Obes 2016; 12:59-69. [PMID: 26716496 PMCID: PMC4753575 DOI: 10.1089/chi.2015.0119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pediatric obesity is a world-wide challenge. Children with physical disabilities are particularly at risk of obesity, which is worrisome because obesity can result in serious secondary conditions that decrease health status, reduce independence, and increase impact on healthcare systems. However, the determinants of obesity and the health promotion needs of children with physical disabilities are relatively unexplored compared with their typically developing peers. METHODS This white paper describes a Canadian multi-stakeholder workshop on the topic of obesity and health in children with physical disabilities and provides recommendations for future research in this understudied area. RESULTS Seventy-one knowledge gaps identified by attendees using a modified nominal group technique clustered into six themes: (1) early, sustained engagement of families; (2) rethinking determinants of obesity and health; (3) maximizing impact of research; (4) inclusive integrated interventions; (5) evidence-informed measurement and outcomes; and (6) reducing weight biases. Attendees worked together to develop research plans in more detail for three areas identified through consensus as high priority: "early, sustained engagement of families;" "rethinking determinants of obesity and health;" and "evidence informed measurement and outcomes." CONCLUSIONS Using the workshop described here as a call to action, Canadian researchers are now well positioned to work toward a greater understanding of weight-related topics in children with physical disabilities, with the aim of developing evidence-based and salient obesity prevention and treatment approaches.
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Affiliation(s)
- Amy C. McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Geoff D.C. Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Désirée B. Maltais
- Department of Rehabilitation, Laval University, Québec City, Québec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, Québec, Canada
| | - Judy A. Swift
- School of Biosciences, The University of Nottingham, Nottingham, United Kingdom
| | - John Cairney
- Departments of Family Medicine, Psychiatry and Behavioral Neurosciences, and Kinesiology, Hamilton, Ontario, Canada
- CanChild Center for Studies in Childhood Disability, Hamilton, Ontario, Canada
- INCH Lab, McMaster University, Hamilton, Ontario, Canada
| | - Tara Joy Knibbe
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Kim Krog
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. Toronto, Ontario, Canada
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Mueske NM, Ryan DD, Van Speybroeck AL, Chan LS, Al Wren T. Fat distribution in children and adolescents with myelomeningocele. Dev Med Child Neurol 2015; 57:273-8. [PMID: 25251828 PMCID: PMC4323886 DOI: 10.1111/dmcn.12591] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 12/11/2022]
Abstract
AIM To evaluate fat distribution in children and adolescents with myelomeningocele using dual-energy X-ray absorptiometry (DXA). METHOD Cross-sectional DXA measurements of the percentage of fat in the trunk, arms, legs, and whole body were compared between 82 children with myelomeningocele (45 males, 37 females; mean age 9y 8mo, SD 2y 7mo; 22 sacral, 13 low lumbar, 47 mid lumbar and above) and 119 comparison children (65 males, 54 females; mean age 10y 4mo, SD 2y 4mo). Differences in fat distribution between groups were evaluated using univariate and multivariate analyses. RESULTS Children with myelomeningocele had higher total body fat (34% vs 31%, p=0.02) and leg fat (42% vs 35%, p<0.001) than comparison children, but no differences in trunk or arm fat after adjustment for anthropometric measures. INTERPRETATION Children with myelomeningocele have higher than normal total body and leg fat, but only children with higher level lesions have increased trunk fat, which may be caused by greater obesity in this group. Quantifying segmental fat distribution may aid in better assessment of excess weight and, potentially, the associated health risks.
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Affiliation(s)
- Nicole M Mueske
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Deirdre D Ryan
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Alexander L Van Speybroeck
- Departments of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Linda S Chan
- Departments of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tishya Al Wren
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
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20
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Foster KA, Lam S, Lin Y, Greene S. Putative height acceleration following tethered cord release in children. J Neurosurg Pediatr 2014; 14:626-34. [PMID: 25325420 DOI: 10.3171/2014.9.peds1417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Tethered cord (TC) is a neurological disorder caused by tissue attachments that limit the normal movement of the spinal cord. A TC can be unmasked by a cutaneous abnormality or manifest clinically in myriad neurological, urological, and orthopedic symptoms. The relationship between TC and height is previously unknown. This study investigates the association between TC release and changes in height profiles in the pediatric population. METHODS Fifty-two children undergoing first-time TC release at a single institution were examined retrospectively. Clinical symptoms, radiographic findings, pre- and postoperative height, and height-for-age percentiles were recorded and analyzed. RESULTS Children with TC experienced a statistically significant increase in age-adjusted height percentiles after TC release (p = 0.0028), with a mean increase of 7 percentile points (from 48.1st to 54.9th percentile). When stratified by age, children 5 years or older (5-18 years) demonstrated a mean percentile increase of 10 percentile points (from 46.7th to 56.4th percentile) (p = 0.0001). Among the same age group, this effect scaled significantly with age (p = 0.02, beta coefficient -1.3). There was no significant difference in height-for-age after detethering surgery in children younger than 5 years. There was no significant association between the presence of clinical symptoms or specific radiographic findings and height outcomes after surgery. Overall, 56% of TC-related clinical symptoms improved after detethering (mean follow-up 4.6 months). Among children younger than 5 years, 82% of TC-related clinical symptoms improved after detethering (average follow-up 4.5 months); in children 5-18 years, 47% of symptoms improved after detethering (average follow-up 4.8 months). CONCLUSIONS The authors observed a statistically significant gain in height-for-age percentiles in children undergoing surgical release of TC. The authors' data suggest that such gains may be more significant in older children (≥ 5 years) and the increase appears to scale positively with youth in the older cohort. In this study, postoperative height gains did not appear to correlate with the presence of TC-related clinical symptoms or radiographic findings. Further investigation is necessary to elucidate any potential correlation between release of TC and height changes in children postoperatively.
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Affiliation(s)
- Kimberly A Foster
- Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania; and
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21
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Ribeiro Neto F, Lopes GHR. Análise dos valores de composição corporal em homens com diferentes níveis de lesão medular. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000400004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A proporção entre massa corporal magra e de gordura é um preditor de doenças metabólicas. Assim, quantificar variáveis de composição corporal, iniciando uma análise de valores de referência de acordo com o nível da lesão medular (LM), tornou-se importante para o planejamento e monitoramento de atividades físicas. OBJETIVOS: 1) Determinar valores de referências de somatório de dobras cutâneas (ΣDC) e percentual de gordura em diferentes níveis de LM. 2) Detectar diferenças de composição corporal entre níveis de LM. 3) Correlacionar ΣDC com tempo de lesão e índice de massa corpórea (IMC). MATERIAIS E MÉTODOS: Setenta e quatro pacientes homens com LM, de 18 a 52 anos, foram divididos em tetraplegia (TT - C4 a C8), paraplegia alta (PPa - T1 a T6) e paraplegia baixa (PPb - T7 a L3). A composição corporal foi avaliada pelas dobras cutâneas. RESULTADOS: Não houve diferença significativa entre TT, PPa e PPb para as variáveis tempo de lesão, estatura, massa corporal total, ΣDC, percentual de gordura, massa corporal magra e IMC. Apenas a idade diferenciou entre os grupos TT e PPb (P < 0,05). A variável ΣDC não se correlacionou com o nível de lesão (rho = -0,08; IC95%: -0,537 a 0,420) ou com tempo de lesão (rho = 0,18; IC95%: -0,050 a 0,393). Não houve diferença significativa entre lesão completa e incompleta para todas as variáveis antropométricas. O ΣDC correlacionou-se positivamente com o IMC (rho = 0,68; IC95%: 0,539 a 0,739). CONSIDERAÇÕES FINAIS: TT, PPa e PPb não apresentaram diferenças significativas nos valores de composição corporal. O IMC apresentou boa correlação com ΣDC entre os grupos.
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Lindauer E, Dupuis L, Müller HP, Neumann H, Ludolph AC, Kassubek J. Adipose Tissue Distribution Predicts Survival in Amyotrophic Lateral Sclerosis. PLoS One 2013; 8:e67783. [PMID: 23826340 PMCID: PMC3694869 DOI: 10.1371/journal.pone.0067783] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/22/2013] [Indexed: 12/12/2022] Open
Abstract
Background amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that leads to death within a few years after diagnosis. Malnutrition and weight loss are frequent and are indexes of poor prognosis. Total body fat and fat distribution have not been studied in ALS patients. Objectives Our aim was to describe adipose tissue content and distribution in ALS patients. Design We performed a cross-sectional study in a group of ALS patients (n = 62, mean disease duration 22 months) along with age and gender matched healthy controls (n = 62) using a MRI-based method to study quantitatively the fat distribution. Results Total body fat of ALS patients was not changed as compared with controls. However, ALS patients displayed increased visceral fat and an increased ratio of visceral to subcutaneous fat. Visceral fat was not correlated with clinical severity as judged using the ALS functional rating scale (ALS-FRS-R), while subcutaneous fat in ALS patients correlated positively with ALS-FRS-R and disease progression. Multiple regression analysis showed that gender and ALS-FRS-R, but not site of onset, were significant predictors of total and subcutaneous fat. Increased subcutaneous fat predicted survival in male patients but not in female patients (p<0.05). Conclusions Fat distribution is altered in ALS patients, with increased visceral fat as compared with healthy controls. Subcutaneous fat content is a predictor of survival of ALS patients.
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Affiliation(s)
- Eva Lindauer
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Luc Dupuis
- Inserm U1118, Mécanismes centraux et périphériques de la neurodégénérescence, Strasbourg, France
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France
| | | | - Heiko Neumann
- Institute of Neural Information Processing, University of Ulm, Ulm, Germany (HN)
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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McPherson AC, Swift JA, Yung E, Lyons J, Church P. The assessment of weight status in children and young people attending a spina bifida outpatient clinic: a retrospective medical record review. Disabil Rehabil 2013; 35:2123-31. [PMID: 23510013 PMCID: PMC3857675 DOI: 10.3109/09638288.2013.771705] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 01/21/2013] [Accepted: 01/28/2013] [Indexed: 01/21/2023]
Abstract
PURPOSE Children with disabilities are two to three times more likely to become overweight or obese than typically developing children. Children with spina bifida (SB) are at particular risk, yet obesity prevalence and weight management with this population are under-researched. This retrospective chart review explored how weight is assessed and discussed in a children's SB outpatient clinic. METHOD Height/weight data were extracted from records of children aged 2-18 with a diagnosis of SB attending an outpatient clinic at least once between June 2009-2011. Body mass index was calculated and classified using Centers for Disease Control and Prevention cut-offs. Notes around weight, diet and physical/sedentary activities were transcribed verbatim and analysed using descriptive thematic analysis. RESULTS Of 180 eligible patients identified, only 63 records had sufficient data to calculate BMI; 15 patients were overweight (23.81%) and 11 obese (17.46%). Weight and physical activity discussions were typically related to function (e.g. mobility, pain). Diet discussions focused on bowel and bladder function and dietary challenges. CONCLUSIONS Anthropometrics were infrequently recorded, leaving an incomplete picture of weight status in children with SB and suggesting that weight is not prioritised. Bowel/bladder function was highlighted over other benefits of a healthy body weight, indicating that health promotion opportunities are being missed. Implications for Rehabilitation It is important to assess, categorise and record anthropometric data for children and youth with spina bifida as they may be at particular risk of excess weight. Information around weight categorisation should be discussed openly and non-judgmentally with children and their families. Health promotion opportunities may be missed by focusing solely on symptom management or function. Healthcare professionals should emphasise the broad benefits of healthy eating and physical activity, offering strategies to enable the child to incorporate healthy lifestyle behaviours appropriate to their level of ability.
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Affiliation(s)
- Amy C. McPherson
- Bloorview Research Institute, Dalla Lana School of Public
HealthToronto, ONCanada
| | - Judy Anne Swift
- Division of Nutritional Sciences, University of
NottinghamNottinghamUK
| | - Emily Yung
- Bloorview Research InstituteToronto, ONCanada
| | - Julia Lyons
- Holland Bloorview Kids Rehabilitation HospitalToronto, ONCanada
| | - Paige Church
- Holland Bloorview Kids Rehabilitation HospitalToronto, ONCanada
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Nash MS, Cowan RE, Kressler J. Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury. J Spinal Cord Med 2012; 35:278-92. [PMID: 23031165 PMCID: PMC3459557 DOI: 10.1179/2045772312y.0000000034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Component and coalesced health risks of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs). These CMS hazards are also co-morbid with physical deconditioning and elevated pro-atherogenic inflammatory cytokines, both of which are common after SCI and worsen the prognosis for all-cause cardiovascular disease. This article describes a systematic procedure for individualized CMS risk assessment after SCI, and emphasizes evidence-based and intuition-centered countermeasures to disease. A unified approach will propose therapeutic lifestyle intervention as a routine plan for aggressive primary prevention in this risk-susceptible population. Customization of dietary and exercise plans then follow, identifying shortfalls in diet and activity patterns, and ways in which these healthy lifestyles can be more substantially embraced by both stakeholders with SCI and their health care providers. In cases where lifestyle intervention utilizing diet and exercise is unsuccessful in countering risks, available pharmacotherapies and a preferred therapeutic agent are proposed according to authoritative standards. The over-arching purpose of the monograph is to create an operational framework in which existing evidence-based approaches or heuristic modeling becomes best practice. In this way persons with SCI can lead more active and healthy lives.
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Affiliation(s)
- Mark S. Nash
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA; and Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA,Correspondence to: Mark S. Nash, Miller School of Medicine, University of Miami, 1095 NW 14th Terrace, R-48, Miami, FL 33136, USA.
| | - Rachel E. Cowan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; and The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jochen Kressler
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; and The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA
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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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Vega-Sanchez R, de la Luz Gomez-Aguilar M, Haua K, Rozada G. Weight-based nutritional diagnosis of Mexican children and adolescents with neuromotor disabilities. BMC Res Notes 2012; 5:218. [PMID: 22559790 PMCID: PMC3392725 DOI: 10.1186/1756-0500-5-218] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 05/04/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Nutrition related problems are increasing worldwide but they have scarcely been evaluated in people with neuromotor disabilities, particularly in developing countries. In this study our aim was to describe the weight-based nutritional diagnoses of children and adolescents with neuromotor disabilities who attended a private rehabilitation center in Mexico City. METHODS Data from the first visit's clinical records of 410 patients who attended the Nutrition department at the Teleton Center for Children Rehabilitation, between 1999 and 2008, were analyzed. Sex, age, weight and height, length or segmental length data were collected and used to obtain the nutritional diagnosis based on international growth charts, as well as disability-specific charts. Weight for height was considered the main indicator. RESULTS Cerebral palsy was the most frequent diagnosis, followed by spina bifida, muscular dystrophy, and Down's syndrome. Children with cerebral palsy showed a higher risk of presenting low weight/undernutrition (LW/UN) than children with other disabilities, which was three times higher in females. In contrast, children with spina bifida, particularly males, were more likely to be overweight/obese (OW/OB), especially after the age of 6 and even more after 11. Patients with muscular dystrophy showed a significantly lower risk of LW/UN than patients with other disabilities. In patients with Down's syndrome neither LW/UN nor OW/OB were different between age and sex. CONCLUSIONS This is the first study that provides evidence of the nutritional situation of children and adolescents with neuromotor disabilities in Mexico, based on their weight status. Low weight and obesity affect a large number of these patients due to their disability, age and sex. Early nutritional diagnosis must be considered an essential component in the treatment of these patients to prevent obesity and malnutrition, and improve their quality of life.
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Affiliation(s)
- Rodrigo Vega-Sanchez
- Department of Nutrition Research, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
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Vogel LC, Betz RR, Mulcahey MJ. Spinal cord injuries in children and adolescents. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:131-48. [PMID: 23098710 DOI: 10.1016/b978-0-444-52137-8.00008-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This chapter provides an overview of spinal cord injuries (SCI) in children and adolescents, including epidemiology, medical and musculoskeletal complications, rehabilitation and psychosocial aspects. Males are more commonly affected than females during adolescence; however, as the age at injury decreases, the preponderance of males becomes less marked, and by 3 years of age the number of females with SCIs equals that of males. The neurologic level and degree of completeness varies with age; among children injured prior to 12 years of age approximately two-thirds are paraplegic and approximately two-thirds have complete lesions. Among adolescents, approximately 50% have paraplegia and 55% have complete lesions. Management of pediatric-onset SCI should be family centered and developmentally based, responsive to the dynamic changes that occur during growth and development. Distinctive anatomical and physiological features of children and adolescents, along with growth and development, are responsible for unique manifestations and complications of pediatric SCI. SCI without radiological abnormalities (SCIWORA), birth injuries, lap-belt injuries, upper cervical injuries, and the delayed onset of neurological deficits are relatively unique to pediatric SCI. Children who sustain their SCI before puberty experience a higher incidence of musculoskeletal complications, such as scoliosis and hip dislocation.
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Neto FR, Lopes GH. Body composition modifications in people with chronic spinal cord injury after supervised physical activity. J Spinal Cord Med 2011; 34:586-93. [PMID: 22330114 PMCID: PMC3237285 DOI: 10.1179/2045772311y.0000000038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Quantification of body composition variables is important for planning of better activities in relation to individuals with spinal cord injury (SCI). OBJECTIVES (1) To evaluate changes in body composition in patients with SCI after a supervised physical activity process; (2) To correlate total body fat with time since injury. DESIGN Pre-post intervention. SETTING Sarah Rehabilitation Hospital Network, Brazil. PARTICIPANTS Fifty-three men with SCI aged 18-52 years with duration of injury >3 years. INTERVENTIONS The subjects were divided into three groups: tetraplegia (TT) (C5-C8), high paraplegia (HP) (T1-T6), and low paraplegia (LP) (T7-L2). Body composition was estimated in the first and last weeks of hospitalization. OUTCOME MEASURES Body weight (kg), skinfolds sum (mm), absolute (kg), and relative (%) fat and lean body mass. RESULTS Body weight increased in TT and decreased in HP (0.8 kg, 95%CI 0.1-1.5; and -1.0 kg, 95%CI -2.0 to 0.0, respectively; P < 0.05). Skinfolds sum decreased only in HP (-13.1 mm, 95%CI -20.7 to -5.5; P < 0.05). Absolute and relative body fat decreased significantly in the paraplegia groups. Lean body mass (LBM) percentage increased significantly in the paraplegia groups. Absolute LBM increased in TT and LP (0.8 kg, 95%CI 0.3-1.3; and 1.3 kg, 95%CI 0.8 to 1.8, respectively; P < 0.05). There was no correlation between time since injury and skinfolds sum for the three groups (P < 0.05). CONCLUSION TT, HP, and LP demonstrated favorable changes in body composition after 29 days of supervised physical activity. However, these changes were different in direction and magnitude.
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Skinfold Measurements Enhance Nutrition Assessments and Care Planning for Children With Developmental Delays and Disabilities. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/1941406411403305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with developmental delays or disabilities (DDs) may differ from typically developing children in body composition. Alterations in muscle tone, delayed motor development, and impaired mobility may affect the development of lean muscle tissue in children with developmental challenges. Studies show that children with diverse developmental disorders such as cerebral palsy (CP), spina bifida, Prader-Willi syndrome (PWS), and premature birth have significant alterations in lean muscle mass, which may affect body weight and body mass index. Because lean muscle mass is a major determinant of resting energy expenditure and makes up a significant portion of body weight, the use of body composition measurements such as tricep skinfolds and subscapular skinfolds can clarify assessments of nutritional status, which in turn can facilitate goal setting and care planning for children with DDs. This article will review research on body composition in children with CP, spina bifida, PWS, and prematurity and will present 2 case studies to illustrate how using skinfold measurements in clinical practice can clarify nutritional diagnosis and care planning.
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Abstract
Resting energy expenditure of persons with a spinal cord injury (SCI) is generally lower than that seen in able-bodied (AB) individuals due to the reduced amounts of muscle mass and sympathetic nervous system available. However, outside of clinical studies, much less data is available regarding athletes with an SCI. In order to predict the energy expenditure of persons with SCI, the generation and validation of prediction equations in relation to specific levels of SCI and training status are required. Specific prediction equations for the SCI would enable a quick and accurate estimate of energy requirements. When compared with the equivalent AB individuals, sports energy expenditure is generally reduced in SCI with values representing 30-75% of AB values. The lowest energy expenditure values are observed for sports involving athletes with tetraplegia and where the sport is a static version of that undertaken by the AB, such as fencing. As with AB sports there is a lack of SCI data for true competition situations due to methodological constraints. However, where energy expenditure during field tests are predicted from laboratory-based protocols, wheelchair ergometry is likely to be the most appropriate exercise mode. The physiological and metabolic responses of persons with SCI are similar to those for AB athletes, but at lower absolute levels. However, the underlying mechanisms pertaining to substrate utilization appear to differ between the AB and SCI. Carbohydrate feeding has been shown to improve endurance performance in athletes with generally low levels of SCI, but no data have been reported for mid to high levels of SCI or for sport-specific tests of an intermittent nature. Further research within the areas reviewed may help to bridge the gap between what is known regarding AB athletes and athletes with SCI (and other disabilities) during exercise and also the gap between clinical practice and performance.
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Affiliation(s)
- Michael Price
- Department of Biomolecular and Sports Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
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Xu WP, Cao DX, Lin ZM, Wu GH, Chen L, Zhang JP, Zhang B, Yang ZA, Jiang Y, Han YS, Xu L, Zhu Y, Chen WF. Analysis of energy utilization and body composition in kidney, bladder, and adrenal cancer patients. Urol Oncol 2010; 30:711-8. [PMID: 20884257 DOI: 10.1016/j.urolonc.2010.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 07/30/2010] [Accepted: 07/30/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate resting energy expenditure (REE) and body composition and the relationship between substrate utilization and energy expenditure in urologic cancer patients. PATIENTS AND METHODS Measured resting energy expenditure (mREE) was detected by indirect calorimetry in 122 urologic cancer patients and 131 control subjects. Extracellular fluid (ECF), intracellular fluid (ICF), and total water (TW) were measured by bioelectrical impedance appliance. Fat oxidation rate (F-O), carbohydrate oxidation rate, fat mass (FM), and fat free mass (FFM) were further determined. RESULTS Compared with the controls, cancer patients showed significantly elevated mREE and mREE/FFM (P = 0.049; P < 0.001). Of all the cancer patients, 50% (n = 61) were hypermetabolic, 43.4% (n = 53) normometabolic, and 6.6% (n = 8) hypometabolic, whereas 35.1% (n = 46) of the controls were hypermetabolic, 56.5% (n = 74) normometabolic, and 8.4% (n = 11) hypometabolic. REE was correlated to substrate oxidation rate (R(2) = 0.710). Cancer patients exhibited no significant difference in FM, FM/body weight (BW) and FFM, compared with controls. Cancer patients presented no significant difference in TW compared with controls (P = 0.791), but they had increased ECF (P < 0.001) and decreased ICF (P < 0.001). CONCLUSION Aberrations in substrate utilization may contribute to the elevated energy expenditure in urologic cancer patients. Cancer type and pathologic stage are influential factors of REE.
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Affiliation(s)
- Wen P Xu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
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Casteels K, Fieuws S, van Helvoirt M, Verpoorten C, Goemans N, Coudyzer W, Loeckx D, de Zegher F. Metformin therapy to reduce weight gain and visceral adiposity in children and adolescents with neurogenic or myogenic motor deficit. Pediatr Diabetes 2010; 11:61-9. [PMID: 19496972 DOI: 10.1111/j.1399-5448.2009.00512.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this randomized, placebo-controlled study was to explore the effect of metformin in children with a neurogenic or myogenic motor deficit, who are therefore prone to develop overweight, adiposity, and insulin resistance. Study participants (n = 42) had a mean age of 15.5 yr, a short stature (height -2.4 SD), a relatively high BMI (+1.7 SD), and a high body fat fraction (41.9% or +2.8 SD). Abdominal CT confirmed the high fat mass and disclosed a high fraction of visceral fat. As expected, insulin resistance was increased. As compared to placebo, metformin intake for 6 months exerted an insulin sensitizing effect and lowered weight (mean difference of 2 kg within 6 months, p = 0.007) and BMI (p = 0.016). Weight loss appeared to be primarily due to loss of visceral fat ( approximately 20% vs. placebo; p < 0.0001). Results were similar across diagnostic subgroups. In conclusion, metformin treatment for 6 months was associated with a rise in insulin sensitivity and with a reduction of visceral adiposity in children and adolescents with a primary muscle disorder or with a neural tube defect. These findings suggest that insulin resistance underpins, at least partly, the overweight and visceral adiposity of these patients, who are not necessarily obese.
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Shurtleff DB, Walker WO, Duguay S, Peterson D, Cardenas D. Obesity and myelomeningocele: anthropometric measures. J Spinal Cord Med 2010; 33:410-9. [PMID: 21061901 PMCID: PMC2964030 DOI: 10.1080/10790268.2010.11689720] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 04/15/2010] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To evaluate the appropriate use of arm span measurements as a substitute for height/linear length to evaluate obesity in people with myelomeningocele by comparing calculated body mass indices (BMIs) with recently published BMI graphs by the Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics standards (NCHS) published in 2000. STUDY DESIGN Retrospective analysis of collected data on patients seen in the University of Washington Birth Defects Clinic from July 1, 1965, through June 1, 2008. Observations included degree of paralysis, presence of scoliosis, height (linear length), weight, and arm span. We compared published CDC/NCHS BMIs with our data using both height and arm span in place of height/linear length. There were 14,701 measures collected during 4968 visits from 709 patients. Mean values were calculated using age, gender, and lesion level as independent variables. RESULTS Comparison of BMI means of patients with myelomeningocele suggests that our observations using arm span and height are comparable with the CDC/NCHS BMI means using height for the 2 least paralyzed groups but not for those groups with paralysis from high-level lesions that are more likely to exhibit lower extremity deformities or scoliosis. CONCLUSIONS Published CDC/NCHS graphs, with their percentiles, are appropriate for estimating normal growth by BMI for children born with myelomeningocele when arm span is substituted for length if severe body differences due to high-level paralysis are taken into consideration.
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De Groot JF, Takken T, Schoenmakers MAGC, Vanhees L, Helders PJM. Limiting factors in peak oxygen uptake and the relationship with functional ambulation in ambulating children with Spina Bifida. Eur J Appl Physiol 2008; 104:657-65. [DOI: 10.1007/s00421-008-0820-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2008] [Indexed: 11/29/2022]
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Dopler Nelson M, Widman LM, Abresch RT, Stanhope K, Havel PJ, Styne DM, McDonald CM. Metabolic syndrome in adolescents with spinal cord dysfunction. J Spinal Cord Med 2007; 30 Suppl 1:S127-39. [PMID: 17874698 PMCID: PMC2031992 DOI: 10.1080/10790268.2007.11754591] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of components of the metabolic syndrome in adolescents with spinal cord injury (SCI) and spina bifida (SB), and their associations with obesity in subjects with and without SCI and SB. METHODS Fifty-four subjects (20 SCI and 34 SB) age 11 to 20 years with mobility impairments from lower extremity paraparesis were recruited from a hospital-based clinic. Sixty able-bodied subjects who were oversampled for obesity served as controls (CTRL). Subjects were categorized as obese if their percent trunk fat measured by dual x-ray absorptiometry (DXA) was > 30.0% for males and > 35.0% for females. Ten SCI, 24 SB, and 19 CTRL subjects were classified as obese. Fasting serum samples were collected to determine serum glucose, insulin, and lipid concentrations. Metabolic syndrome was defined as having > or =3 of the following components: (a) obesity; (b) high-density lipoprotein (HDL) <45 mg/dL for males; <50 mg/dL for females; (c) triglycerides 2100 mg/dL; (d) systolic or diastolic blood pressure > or =95th percentile for age/ height/gender, and (e) insulin resistance determined by either fasting serum glucose 100-125 mg/dL; fasting insulin > or =20 microU /mL; or homeostasis model assessment of insulin resistance > or = 4.0. RESULTS Metabolic syndrome was identified in 32.4% of the SB group and 55% of the SCI group. Metabolic syndrome occurred at a significantly higher frequency in obese subjects (SB = 45.8%, SCI = 100%, CTRL = 63.2%) than nonobese subjects (SB = 0%, SCI = 10%, CTRL = 2.4%). CONCLUSIONS The prevalence of metabolic syndrome in adolescents with SB/SCI is quite high, particularly in obese individuals. These findings have important implications due to the known risks of cardiovascular diseases and diabetes mellitus associated with metabolic syndrome in adults, particularly those with spinal cord dysfunction.
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Affiliation(s)
| | - Lana M Widman
- University of California Davis Department of Physical Medicine & Rehabilitation, Davis, California
| | - Richard Ted Abresch
- University of California Davis Department of Physical Medicine & Rehabilitation, Davis, California
- Please address correspondence to Richard T. Abresch, MS, Department of Physical Medicine and Rehabilitation, University of California, Davis, MED: PM&R, TB 191, One Shields Avenue, Davis, CA 95616; phone: 530.752.9085; fax: 530.752.3468 (e-mail: )
| | - Kimber Stanhope
- University of California Department of Nutrition, Davis, California
| | - Peter J Havel
- University of California Department of Nutrition, Davis, California
| | - Dennis M Styne
- University of California Davis Department of Pediatrics, Davis, California
| | - Craig M McDonald
- University of California Davis Department of Physical Medicine & Rehabilitation, Davis, California
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