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Dutia IM, Connick M, Beckman E, Johnston L, Wilson P, Macaro A, O'Sullivan J, Tweedy S. The power of Para sport: the effect of performance-focused swimming training on motor function in adolescents with cerebral palsy and high support needs (GMFCS IV) - a single-case experimental design with 30-month follow-up. Br J Sports Med 2024; 58:777-784. [PMID: 38729630 DOI: 10.1136/bjsports-2023-107689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study aims to evaluate the effect of a performance-focused swimming programme on motor function in previously untrained adolescents with cerebral palsy and high support needs (CPHSN) and to determine whether the motor decline typical of adolescents with CPHSN occurred in these swimmers. METHODS A Multiple-Baseline, Single-Case Experimental Design (MB-SCED) study comprising five phases and a 30-month follow-up was conducted. Participants were two males and one female, all aged 15 years, untrained and with CPHSN. The intervention was a 46-month swimming training programme, focused exclusively on improving performance. Outcomes were swim performance (velocity); training load (rating of perceived exertion min/week; swim distance/week) and Gross Motor Function Measure-66-Item Set (GMFM-66). MB-SCED data were analysed using interrupted time-series simulation analysis. Motor function over 46 months was modelled (generalised additive model) using GMFM-66 scores and compared with a model of predicted motor decline. RESULTS Improvements in GMFM-66 scores in response to training were significant (p<0.001), and two periods of training withdrawal each resulted in significant motor decline (p≤0.001). Participant motor function remained above baseline levels for the study duration, and, importantly, participants did not experience the motor decline typical of other adolescents with CPHSN. Weekly training volumes were also commensurate with WHO recommended physical activity levels. CONCLUSIONS Results suggest that adolescents with CPHSN who meet physical activity guidelines through participation in competitive swimming may prevent motor decline. However, this population is clinically complex, and in order to permit safe, effective participation in competitive sport, priority should be placed on the development of programmes delivered by skilled multiprofessional teams. TRIAL REGISTRATION NUMBER ACTRN12616000326493.
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Affiliation(s)
- Iain Mayank Dutia
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
- School of Allied Health, Australian Catholic University - Brisbane Campus, Banyo, Queensland, Australia
| | - Mark Connick
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Emma Beckman
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
| | - Leanne Johnston
- The University of Queensland School of Health and Rehabilitation Sciences, Saint Lucia, Queensland, Australia
| | - Paula Wilson
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
| | - Angelo Macaro
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
| | - Jennifer O'Sullivan
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
| | - Sean Tweedy
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
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Oudenhoven LM, Van Der Krogt MM, Ettema S, Roeleveld K, Brehm MA, Buizer AI. Fatigue-related gait adaptations in children with cerebral palsy. Dev Med Child Neurol 2023; 65:1629-1638. [PMID: 37243486 DOI: 10.1111/dmcn.15660] [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] [Received: 06/19/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
AIM To obtain insights into the effects of fatigue on the kinematics, kinetics, and energy cost of walking (ECoW) in children with cerebral palsy (CP). METHOD In this prospective observational study, 12 children with CP (mean age 12 years 9 months, SD 2 years 7 months; four females, eight males) and 15 typically developing children (mean age 10 years 8 months, SD 2 years 4 months; seven females, eight males) followed a prolonged intensity-based walking protocol on an instrumented treadmill, combined with gas analysis measurements. The protocol consisted of consecutive stages, including a 6-minute walking exercise (6MW) at comfortable speed, 2 minutes of moderate-intensity walking (MIW) (with a heart rate > 70% of its predicted maximal), and 4 minutes walking after MIW. If necessary, the speed and slope were incremented to reach MIW. Outcomes were evaluated at the beginning and end of the 6MW and after MIW. RESULTS With prolonged walking, Gait Profile Scores deteriorated slightly for both groups (p < 0.01). Knee flexion increased during early stance (p = 0.004) and ankle dorsiflexion increased during late stance (p = 0.034) in children with CP only. Negligible effects were found for kinetics. No demonstrable change in ECoW was found in either group (p = 0.195). INTERPRETATION Kinematic deviations in children with CP are progressive with prolonged walking. The large variation in adaptations indicates that an individual approach is recommended to investigate the effects of physical fatigue on gait in clinical practice.
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Affiliation(s)
- Laura M Oudenhoven
- Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Marjolein M Van Der Krogt
- Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Sanne Ettema
- Research and Development, Heliomare, Wijk aan Zee, the Netherlands
- Center for Human Movement Sciences, University of Groningen, UMCG, Groningen, the Netherlands
| | - Karin Roeleveld
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Merel A Brehm
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
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Algabbani MF, Shaheen AAM, Almurdi M, Al-Rushud AS, Almore A, Alobaidallah L, Almutairi O, Alharthi S, Alkaldi W, AlMaymoni H, Rodríguez Núñez I. Psychometric Properties of the Arabic Version of the EPInfant Scale among Typically Developing Children Aged 6-16 Years. Phys Occup Ther Pediatr 2023; 43:725-740. [PMID: 37016547 DOI: 10.1080/01942638.2023.2197050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023]
Abstract
AIMS The EPInfant scale is a self-assessment for children that measures perceived exertion (PE) during physical exercise. This study aimed to translate the scale into Arabic (EPInfant-Ar) and test its psychometric properties. METHODS The revised version was tested for face and content validity. Oxygen saturation, heart rate (HR), and ratings of perceived exertion were measured during a 3-minute step test with a sample of 93 children. PE and HR were examined using the Pearson correlation coefficient (r) to assess the concurrent validity. Internal consistency and test-retest reliability were calculated using Cronbach's alpha (α), intraclass correlation coefficient (ICC2,1), and r coefficient. A minimum detectable change with 95% confidence interval (MDC95) and percentage of change (MDC%) was also measured. RESULTS Content validity showed an excellent level of expert agreement. There was a moderate correlation between PE rated by the scale and HR (r = 0.47, p < .001). The internal consistency and test-retest reliability were acceptable (α = 0.89; ICC2,1= 0.81; 95%Cl: 0.71-0.87, r = 0.81) with low measurement error (MDC95 = 2.66 and MDC% = 61.10%). CONCLUSIONS The EPInfant-Ar scale was considered valid and reliable for assessing PE after physical exercises in typically developing children aged 6-16 years.
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Affiliation(s)
- Maha F Algabbani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Afaf A M Shaheen
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Muneera Almurdi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Asma S Al-Rushud
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Amjad Almore
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Linah Alobaidallah
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ohud Almutairi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Shurug Alharthi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Waad Alkaldi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hala AlMaymoni
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Iván Rodríguez Núñez
- Department of Kinesiology, Physiology of Movement Laboratory, University of Concepción, Concepción, Chile
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Harrington JW, Anguiano-Hernandez JG, Kingston DC. Muscle activation and rating of perceived exertion of typically developing children during DRY and aquatic treadmill walking. J Electromyogr Kinesiol 2023; 68:102737. [PMID: 36549263 PMCID: PMC9868073 DOI: 10.1016/j.jelekin.2022.102737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/21/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Aquatic treadmill gait training is a poorly understood rehabilitation method that alters bodyweight support, increases lower limb resistance, and assists with postural stability. This training could be an attractive tool for clinical populations with balance control issues or limited weight-bearing prescriptions for the lower limb. As a first step, the purpose of this study was to quantify differences in mean muscle activity of the tibialis anterior, rectus femoris, medial gastrocnemius, and semitendinosus, and perceived exertion (RPE) in typically developing children (7:8 M:F, age = 11.3 ± 4.1 years, 1.46 ± 0.18 m, and 44.2 ± 16.8 kg) during dry and aquatic treadmill walking at 75 %, 100 %, and 125 % self-selected speed. We hypothesized that the greatest mean muscle activity, normalized to percent maximum voluntary contraction and averaged across all strides, would be observed during 125 % dry treadmill walking and that aquatic treadmill walking would produce lower RPE. Overall, aquatic treadmill walking reduced mean medial gastrocnemius activity by 50.2 % (padj < 0.001), increased mean rectus femoris activity at least 32.8 % (padj < 0.006), and produced 78.0 % (padj = 0.007) greater RPE compared to dry treadmill walking. This study provides normative pediatric data for future aquatic treadmill walking studies in clinical populations to help inform gait rehabilitation protocols.
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Affiliation(s)
- Joseph W Harrington
- Department of Biomechanics, University of Nebraska Omaha, 6001 Dodge St, Omaha, Nebraska 68182, USA.
| | - Jose G Anguiano-Hernandez
- Department of Biomechanics, University of Nebraska Omaha, 6001 Dodge St, Omaha, Nebraska 68182, USA.
| | - David C Kingston
- Department of Biomechanics, University of Nebraska Omaha, 6001 Dodge St, Omaha, Nebraska 68182, USA.
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Reedman SE, Sakzewski L, McNamara L, Sherrington C, Beckman E, West K, Trost SG, Thomas R, Chatfield MD, Dutia I, Gennen A, Dodds B, Cotton Z, Boyd RN. Study protocol for Running for health (Run4Health CP): a multicentre, assessor-blinded randomised controlled trial of 12 weeks of two times weekly Frame Running training versus usual care to improve cardiovascular health risk factors in children and youth with cerebral palsy. BMJ Open 2022; 12:e057668. [PMID: 35487751 PMCID: PMC9058783 DOI: 10.1136/bmjopen-2021-057668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Children and youth with moderate-severe (Gross Motor Function Classification System (GMFCS) levels II-V) cerebral palsy (CP) participate less frequently in physical activities compared with peers without CP and have elevated risk of cardiorespiratory morbidity and mortality in adulthood. Frame Running (RaceRunning) is a new athletics discipline that is an accessible option for physical activity participation for people with moderate-severe CP. There is no high-quality evidence for the effect of Frame Running on cardiovascular disease in children and young people with CP. The primary aim of this study is to conduct a randomised controlled trial of the effect of 12 weeks of Frame Running training on risk factors for cardiovascular disease. METHODS AND NALYSIS Sixty-two children and youth with CP (age 8-20 years) in GMFCS levels II-V will be recruited across four sites and randomised to receive either 12 weeks of Frame Running training two times weekly for 60 min, or usual care. Outcomes will be measured at baseline, immediately postintervention (primary endpoint) and 12 weeks later for retention of training effects. The primary outcome is cardiorespiratory fitness as measured by distance covered on Six Minute RaceRunner Test with 1 min heart rate recovery. Other outcomes include blood pressure, objectively measured physical activity, body mass index, waist circumference, percentage body fat, gross motor function capacity, community participation, feasibility, tolerability and safety. Adverse events will be monitored, and participants and their caregivers will be interviewed to discern their experiences of participation in Frame Running. ETHICS AND DISSEMINATION The Children's Health Queensland Hospital and Health Service and the University of Queensland Human Research Ethics Committees have approved this study. Results will be disseminated in peer-reviewed journals and scientific conferences; through professional and athletic organisations; and to people with CP and their families. TRIAL REGISTRATION NUMBER ACTRN12621000317897; Australian New Zealand Clinical Trials Registry number.
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Affiliation(s)
- Sarah E Reedman
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lynda McNamara
- Physiotherapy Department, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Emma Beckman
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kerry West
- Physiotherapy Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Stewart G Trost
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel Thomas
- Queensland Paediatric Rehabilitation Service, Department of Rehabilitation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Iain Dutia
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Alix Gennen
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bridget Dodds
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Zoë Cotton
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Sukal-Moulton T, Egan T, Johnson L, Lein C, Gaebler-Spira D. Use of Frame Running for Adolescent Athletes With Movement Challenges: Study of Feasibility to Support Health and Participation. Front Sports Act Living 2022; 4:830492. [PMID: 35356095 PMCID: PMC8959752 DOI: 10.3389/fspor.2022.830492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/28/2022] [Indexed: 12/18/2022] Open
Abstract
Children and adolescents with movement challenges have lower instances of physical activity and longer time spent in sedentary behaviors compared to children with typical development. The purpose of this study was to investigate the feasibility of a sport-based youth development running program modified for accessibility using a running frame and to evaluate initial evidence for its efficacy on endurance and functional strength. We completed four 8-week seasons (2–3 times per week) in a combination of 3 different formats by season: online remote (winter and spring), in person in a community park (winter, spring, and summer), and in person in an afterschool setting (autumn). Participants included 13 athletes (average age 14.46 years, range 8–18 years, 4 females), who collectively completed 22 season blocks. Diagnoses included cerebral palsy (n = 10), arthrogryposis (n = 1), Dandy-Walker malformation (n = 1), and transverse myelitis (n = 1). In all settings, participants engaged in activities of social emotional learning, cardiovascular endurance, and muscle strengthening in a progressive manner. We found that each season format was feasible to administer with high attendance rates (76–97%) and positive qualitative feedback from athletes. In addition, promising average improvements in motor performance across a season (6 min frame running test, 170 m; timed up and go test, 8.44 s; five times sit to stand, 14.1 s; and Goal Attainment Scale, t = 65.01) were identified in the pilot data of this non-randomized cohort. Training in any of the proposed settings with an overall goal of completing a community race in a running frame is feasible and warrants further study.
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Affiliation(s)
- Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- *Correspondence: Theresa Sukal-Moulton
| | - Tara Egan
- Office of Diverse Learner Supports and Services, Chicago Public Schools, Chicago, IL, United States
| | | | | | - Deborah Gaebler-Spira
- Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Lurie Children's Hospital, Chicago, IL, United States
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Moll I, Marcellis RGJ, Coenen MLP, Fleuren SM, Willems PJB, Speth LAWM, Witlox MA, Meijer K, Vermeulen RJ. A randomized crossover study of functional electrical stimulation during walking in spastic cerebral palsy: the FES on participation (FESPa) trial. BMC Pediatr 2022; 22:37. [PMID: 35027013 PMCID: PMC8756646 DOI: 10.1186/s12887-021-03037-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Spastic cerebral palsy is the most common cause of motor disability in children. It often leads to foot drop or equinus, interfering with walking. Ankle-foot orthoses (AFOs) are commonly used in these cases. However, AFOs can be too restrictive for mildly impaired patients. Functional electrical stimulation (FES) of the ankle-dorsiflexors is an alternative treatment as it could function as a dynamic functional orthosis. Despite previous research, high level evidence on the effects of FES on activities and participation in daily life is missing. The primary aim of this study is to evaluate whether FES improves the activity and participation level in daily life according to patients, and the secondary aim is to provide evidence of the effect of FES at the level of body functions and activities. Furthermore, we aim to collect relevant information for decisions on its clinical implementation. Methods A randomized crossover trial will be performed on 25 children with unilateral spastic cerebral palsy. Patients aged between 4 and 18 years, with Gross Motor Functioning Classification System level I or II and unilateral foot drop of central origin, currently treated with AFO or adapted shoes, will be included. All participants will undergo twelve weeks of conventional treatment (AFO/adapted shoes) and 12 weeks of FES treatment, separated by a six-week washout-phase. FES treatment consists of wearing the WalkAide® device, with surface electrodes stimulating the peroneal nerve during swing phase of gait. For the primary objective, the Goal Attainment Scale is used to test whether FES improves activities and participation in daily life. The secondary objective is to prove whether FES is effective at the level of body functions and structures, and activities, including ankle kinematics and kinetics measured during 3D-gait analysis and questionnaire-based frequency of falling. The tertiary objective is to collect relevant information for clinical implementation, including acceptability using the device log file and side effect registration, cost-effectiveness based on quality adjusted life years (QALYs) and clinical characteristics for patient selection. Discussion We anticipate that the results of this study will allow evidence-based use of FES during walking in children with unilateral spastic cerebral palsy. Trial registration ClinicalTrials.gov: NCT03440632. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-03037-9.
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Snir Melamed M, Silberg T, Bar O, Brezner A, Landa J, Gliboa Y. Online Awareness among Adolescents with Acquired Brain Injury: Preliminary Findings following Performance of Motor, Cognitive and Functional Tasks. Phys Occup Ther Pediatr 2022; 42:451-464. [PMID: 35109745 DOI: 10.1080/01942638.2022.2035038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aims: Online awareness is an ongoing ability to monitor performance within the stream of action. It involves the ability to detect errors emerging during actual performance, as well as to anticipate potential problems. This preliminary within-subject study aimed to evaluate emergent and anticipatory online awareness among adolescents with Acquired Brain Injury (ABI) during performance of motor, cognitive and functional tasks.Methods: 14 adolescents (11-18 years) following ABI were recruited. Before and after completion of the tasks, participants fulfilled task-related awareness questionnaires.Results: In the motor task, no significant correlations were found between heart rate and the subjective perceived exertion scale (emergent awareness). In the cognitive task, no significant correlations were found between the estimated difficulty before the task (anticipatory awareness) and actual performance, however a significant correlation was found between performance and the self-evaluation of performance (emergent awareness), in the easiest item of the task. In the functional task, two main patterns of online awareness were recognized: accurate and overestimation of performance.Conclusions: Online awareness deficits in adolescents after ABI, vary as a function of task characteristics. Clinicians who aim to improve online awareness should direct interventions to mainly include functional tasks, as compared to cognitive and motor tasks.
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Affiliation(s)
- Miranda Snir Melamed
- Pediatric Rehabilitation Department, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.,School of Occupational Therapy, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamar Silberg
- Pediatric Rehabilitation Department, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.,Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Orly Bar
- Pediatric Rehabilitation Department, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Amichai Brezner
- Pediatric Rehabilitation Department, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Janna Landa
- Pediatric Rehabilitation Department, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yafit Gliboa
- School of Occupational Therapy, The Hebrew University of Jerusalem, Jerusalem, Israel
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Germano Maciel D, Santos Cerqueira M, Gabbett TJ, Elsangedy HM, de Brito Vieira WH. Should We Trust Perceived Effort for Loading Control and Resistance Exercise Prescription After ACL Reconstruction? Sports Health 2021; 14:764-769. [PMID: 34486455 DOI: 10.1177/19417381211041289] [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: 11/15/2022] Open
Abstract
CONTEXT The rating of perceived effort (RPE) is a common method used in clinical practice for monitoring, loading control, and resistance training prescription during rehabilitation after rupture and anterior cruciate ligament reconstruction (ACLR). It is suggested that the RPE results from the integration of the afferent feedback and corollary discharge in the motor and somatosensory cortex, and from the activation of brain areas related to emotions, affect, memory, and pain (eg, posterior cingulate cortex, precuneus, and prefrontal cortex). Recent studies have shown that rupture and ACLR induce neural adaptations in the brain commonly associated with the RPE. Therefore, we hypothesize that RPE could be affected because of neural adaptations induced by rupture and ACLR. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS RPE could be directly altered by changes in the activation of motor cortex, posterior cingulate cortex, and prefrontal cortex. These neural adaptations may be induced by indirect mechanisms, such as the afferent feedback deficit, pain, and fear of movement (kinesiophobia) that patients may feel after rupture and ACLR. CONCLUSION Using only RPE for monitoring, loading control, and resistance training prescription in patients who had undergone ACLR could lead to under- or overdosing resistance exercise, and therefore, impair the rehabilitation process. STRENGTH-OF-RECOMMENDATION TAXONOMY 3C.
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Affiliation(s)
- Daniel Germano Maciel
- Department of Physical Therapy, Laboratory of Neuromuscular Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Mikhail Santos Cerqueira
- Department of Physical Therapy, Laboratory of Neuromuscular Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, Queensland, Australia.,University of Southern Queensland, Institute for Resilient Regions, Ipswich, Queensland, Australia
| | - Hassan Mohamed Elsangedy
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Wouber Hérickson de Brito Vieira
- Department of Physical Therapy, Laboratory of Neuromuscular Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Adaikina A, Hofman PL, Gusso S. The effect of side-alternating vibration therapy on mobility and health outcomes in young children with mild to moderate cerebral palsy: design and rationale for the randomized controlled study. BMC Pediatr 2020; 20:508. [PMID: 33153439 PMCID: PMC7643348 DOI: 10.1186/s12887-020-02377-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background Cerebral palsy (CP) is the most common cause of physical disability in early childhood. Vibration therapy (VT) is a promising rehabilitation approach for children with CP with potential to impact mobility, bone and muscle health as demonstrated by extant research. However, it is still unclear how long therapy must be conducted for and what the optimal vibration frequency is in order to gain health benefits. Methods/design The study is a randomized clinical trial evaluating and comparing the effects of two vibration frequency (20 Hz vs 25 Hz) and duration protocols (12 weeks vs 20 weeks) of side-alternating VT on mobility and other health parameters in children with CP. Children aged 5–12 years old with CP and GMFCS level I-III who are able to understand instruction and safely stand are eligible for the study. Exclusion criteria include bone fracture within 12 weeks of enrolment; acute conditions; the history of significant organic disease; the history of taking anabolic agents, glucocorticoids, growth hormone, and botulinum toxin injection into lower limbs within 3 months of enrolment. All participants will act as their own control with a 12-week lead-in period prior to intervention. The intervention period will consist of 20 weeks of home- or school-based VT 9 min per day, 4 times a week. After the baseline assessment, participants will be randomized to either a 20 Hz or 25 Hz vibration-frequency group. The primary outcome is mobility measured by a 6-min walking test, with analysis performed on the principle of intention to treat. Secondary outcomes include body composition, muscle strength, physical activity level, balance, gross motor function, respiratory function, and quality of life. Participants will undergo four assessment visits over the study period: baseline, at weeks 12, 24, and 32. Discussion The results of the study will provide evidence-based insights into the health benefits of side-alternating VT as a therapeutic tool in young children with cerebral palsy. The investigation of different vibration training protocols will help define the optimal parameters of intervention protocols (duration, frequency) of side-alternating VT to maximize outcomes on the health of 5–12-year-old children with CP. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): 12618002026202 (Registration date 18/12/2018).
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Affiliation(s)
- Alena Adaikina
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Silmara Gusso
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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Enright E, Beckman EM, Connick MJ, Dutia IM, Macaro A, Wilson PJ, O'Sullivan J, Lavalliere JM, Block T, Johnston LM, Panagoda G, Tweedy SM. Competitive sport, therapy, and physical education: voices of young people with cerebral palsy who have high support needs. Br J Sports Med 2020; 55:bjsports-2020-102276. [PMID: 32988931 DOI: 10.1136/bjsports-2020-102276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Eimear Enright
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Emma M Beckman
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark J Connick
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Iain Mayank Dutia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Angelo Macaro
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Paula J Wilson
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jennifer O'Sullivan
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jean-Michel Lavalliere
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Turner Block
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- The Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Leanne M Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gaj Panagoda
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Sean M Tweedy
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Fatigue in Children and Young Adults With Physical Disabilities: Relation With Energy Demands of Walking and Physical Fitness. Pediatr Phys Ther 2020; 32:202-209. [PMID: 32604360 DOI: 10.1097/pep.0000000000000705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine whether general fatigue and fatigue during or after walking are related to energy demands during walking and physical fitness in children and young adults with physical disabilities. METHODS Sixty-eight individuals with physical disabilities participated. General fatigue (Checklist Individual Strength [CIS8R] questionnaire), walking-induced fatigue (OMNI [OMNIwalk] scale after walking for 6 min), gross and net energy costs (ECs) of walking, physical strain of walking, and aerobic and anaerobic fitness were measured. RESULTS Regression analyses showed no relations with the CIS8R. For all participants, a higher net EC was weakly related to an increased OMNIwalk. For teenagers only, low anaerobic fitness and high physical strain of walking values were moderately related to high OMNIwalk scores. CONCLUSION Low anaerobic fitness and high physical strain values partly explain fatigue after walking in teenagers with cerebral palsy, but not in younger children. General fatigue was not explained by low fitness levels or high energy demands of walking.
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Evaluating the Effects of Performance-Focused Swimming Training on People with Cerebral Palsy Who Have High Support Needs – A Study Protocol Using Single-Case Experimental Design. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:People with cerebral palsy (CP) are less physically active than the general population and, consequently, are at increased risk of preventable disease. Evidence indicates that low-moderate doses of physical activity can reduce disease risk and improve fitness and function in people with CP. Para athletes with CP typically engage in ‘performance-focused’ sports training, which is undertaken for the sole purpose of enhancing sports performance. Anecdotally, many Para athletes report that participation in performance-focused sports training confers meaningful clinical benefits which exceed those reported in the literature; however, supporting scientific evidence is lacking. The aim of this paper is to describe the protocol for an 18-month study evaluating the clinical effects of a performance-focused swimming training programme for people with CP who have high support needs.Methods:This study will use a concurrent multiple-baseline, single-case experimental design across three participants with CP who have high support needs. Each participant will complete a five-phase trial comprising: baseline (A1); training phase 1 (B1); maintenance phase 1 (A2); training phase 2 (B2); and maintenance phase 2 (A3). For each participant, measurement of swim velocity, health-related quality of life and gross motor functioning will be carried out a minimum of five times in each of the five phases.Discussion:The study described will produce Level II evidence regarding the effects of performance-focused swimming training on clinical outcomes in people with CP who have high support needs. Findings are expected to provide an indication of the potential for sport to augment outcomes in neurological rehabilitation.
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Fauzi AA, Khayat MM, Sabirin S, Haron N, Mohamed MNA, Davis GM. Structured home-based exercise program for improving walking ability in ambulant children with cerebral palsy. J Pediatr Rehabil Med 2019; 12:161-169. [PMID: 31227664 DOI: 10.3233/prm-180538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate outcomes after 8 weeks of a structured home-based exercise program (SHEP) for improving walking ability in ambulant children with cerebral palsy (CP). METHOD Eleven children participated in this study (7 males and 4 females, mean age 10 years 3 months, standard deviation (SD) 3y) with Gross Motor Function Classification System (GMFCS) I-III. This study used a prospective multiple assessment baseline design to assess the effect of SHEP upon multiple outcomes obtained in three different phases. Exercise intensity was quantified by OMNI-RPE assessed by caregivers and children. Outcome assessments of walking speed, GMFM-66 and physiological cost index (PCI) were measured four times at pre-intervention (Phase 1) and at 3-weekly intervals over eight weeks during intervention (Phase 2). Follow-up assessments were performed at one month and three months after intervention (Phase 3). Statistical analyses were repeated measures ANOVA and Wilcoxon signed-rank test. RESULTS SHEP improved walking ability in children with CP, particularly for their walking speed (p= 0.01, Cohen's d= 1.9). The improvement of GMFM-66 scores during Phase 2 and Phase 3 had a large effect size, with Cohen's d of 1.039 and 1.054, respectively, compared with that during Phase 1 (p< 0.017). No significant change of PCI was observed (Cohen's d= 0.39). CONCLUSION SHEP can be a useful intervention tool, given as a written, structured, and practical exercise program undertaken at home to achieve short term goals for improving walking ability when added to standard care.
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Affiliation(s)
- Aishah Ahmad Fauzi
- Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Masyitah Mohammad Khayat
- Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Sakinah Sabirin
- Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Norazah Haron
- Department of Rehabilitation Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Nahar Azmi Mohamed
- Department of Sports Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Glen M Davis
- Clinical Exercise and Rehabilitation Unit, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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15
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Brændvik SM, Roeleveld K, Andersen GL, Raftemo AER, Ramstad K, Majkic-Tajsic J, Lamvik T, Lund B, Follestad T, Vik T. The WE-Study: does botulinum toxin A make walking easier in children with cerebral palsy?: Study protocol for a randomized controlled trial. Trials 2017; 18:58. [PMID: 28166806 PMCID: PMC5294730 DOI: 10.1186/s13063-016-1772-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intramuscular injections of botulinum toxin A (BoNT-A) have been a cornerstone in the treatment of spasticity for the last 20 years. In Norway, the treatment is now offered to two out of three children with spastic cerebral palsy (CP). However, despite its common use, the evidence for its functional effects is limited and inconclusive. The objective of this study is to determine whether BoNT-A makes walking easier in children with CP. We hypothesize that injections with BoNT-A in the calf muscles will reduce energy cost during walking, improve walking capacity, increase habitual physical activity, reduce pain and improve self-perceived performance and satisfaction. METHODS/DESIGN This randomized, double-blinded, placebo-controlled, multicenter trial is conducted in a clinical setting involving three health regions in Norway. Ninety-six children with spastic CP, referred for single-level injections with BoNT-A in the calf muscles, will be invited to participate. Those who are enrolled will be randomized to receive either injections with BoNT-A (Botox®) or 0.9% saline in the calf muscles. Stratification according to age and study center will be made. The allocation ratio will be 1:1. Main inclusion criteria are (1) age 4 - 17.5 years, (2) Gross Motor Function Classification System levels I and II, (3) no BoNT-A injections in the lower limbs during the past 6 months and (4) no orthopedic surgery to the lower limbs during the past 2 years. The outcome measures will be made at baseline and 4, 12 (primary endpoint) and 24 weeks after injections. Primary outcome is change in energy cost during walking. Secondary outcomes are change in walking capacity, change in activity, perceived change in performance and satisfaction in mobility tasks, and pain. The primary analysis will use a linear mixed model to test for difference in change in the outcome measures between the groups. The study is approved by the Regional Ethical Committee and The Norwegian Medicines Agency. Recruitment started in September 2015. DISCUSSION The evaluation of effect is comprehensive and includes objective standardized tests and measures on both impairment and activity level. Results are to be expected by spring 2019. TRIAL REGISTRATION ClinicalTrials.gov, NCT02546999 . Registered on 9 September 2015.
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Affiliation(s)
- Siri Merete Brændvik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Clinical Services, St. Olav’s University Hospital, Trondheim, Norway
| | - Karin Roeleveld
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Guro Lillemoen Andersen
- Children’s Center, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Kjersti Ramstad
- Department of Clinical Neurosciences for children, Oslo University Hospital, Oslo, Norway
| | - Jasmina Majkic-Tajsic
- Division of Child and Adolescents Health, University Hospital of North Norway, Tromsø, Norway
| | - Torarin Lamvik
- Department of Orthopedics, St. Olav’s University Hospital, Trondheim, Norway
| | - Bendik Lund
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Pediatrics, St. Olav’s University Hospital, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and General Practice, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Torstein Vik
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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