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Minghetti A, Widmer M, Viehweger E, Roth R, Gysin R, Keller M. Translating scientific recommendations into reality: a feasibility study using group-based high-intensity functional exercise training in adolescents with cerebral palsy. Disabil Rehabil 2024; 46:4787-4796. [PMID: 38042988 DOI: 10.1080/09638288.2023.2290204] [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] [Received: 06/25/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE To examine the feasibility and effects of a functional high-intensity exercise intervention performed in a group-setting on functionality, cardiovascular health and physical performance in adolescents with cerebral palsy (CP). METHODS Ten adolescents with a diagnosis of CP (2 females; 16.6 ± 3.4 years; GMFCS: I-II) participated in a 12-week training intervention, containing progressive resistance training using free weights and high-intensity workouts twice a week. The six-minute walking test, arterial stiffness and physical performance (strength and power tests) were measured before and after the intervention. RESULTS No adverse events were reported. We measured small increases in the six-minute walking test (Δ = 28.8 m, 95% CI [-1.78;52.7]; g = 0.34 [-0.04;0.72]) and a small reduction in arterial stiffness (Δ = -4.65% [-10.90;1.25]; g = -0.46 [-1.36;0.21]). All measures of physical performance increased (0.24 ≤ g ≤ 0.88). CONCLUSION Functional training with free weights in high-functioning adolescents with CP is safe and effective in increasing parameters of physical performance and cardiovascular health. Positively influenced indicators of everyday independence (i.e. strength parameters) showed a transfer into movements of daily life. Concerns about adverse events through high-intensity training in adolescents with CP appear unjustified when training is performed progressively, following basic training principles.
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Affiliation(s)
- Alice Minghetti
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Michèle Widmer
- Neuroorthopaedics and Motion Analysis Unit, Department of Orthopaedics, University Children's Hospital beider Basel, Basel, Switzerland
| | - Elke Viehweger
- Neuroorthopaedics and Motion Analysis Unit, Department of Orthopaedics, University Children's Hospital beider Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Ralf Roth
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Martin Keller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Feldner HA, Gaebler-Spira D, Awasthi V, Bjornson KK. Supportive mobility devices across the lifespan in Cerebral Palsy: a modified Delphi study to establish stakeholder research priorities. Disabil Rehabil Assist Technol 2024; 19:1739-1747. [PMID: 37452575 PMCID: PMC10883137 DOI: 10.1080/17483107.2023.2233564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The aim of this study was to co-develop research priorities and identify meaningful research questions with a diverse group of stakeholders representing the CP community for implementation in subsequent research activities. The overarching aim of this research was to 1) Understand the mobility experiences, supported mobility device (SMD) use, and desired participation outcomes of people with cerebral palsy (CP) across the lifespan; and 2) Describe how perspectives of rehabilitation care and professional resources may influence mobility decision-making processes and outcomes. MATERIALS AND METHODS A three-round modified Delphi consensus study was conducted with a stakeholder advisory panel consisting of three adults with CP, two parents of children with CP, and four SMD providers. RESULTS The advisory panel identified 11 unique topical categories focused on SMD selection and use, stratified by age group and stakeholder role. Questions or statements within each category were ranked, and top consensus and concordance statements were retained, reviewed, and refined for use in a co-developed focus group guide. Priorities were identified in three main groupings: (1) Age/GMFCS level/Environment-related; (2) Individual with CP/Caregiver need-related; and (3) Clinician/provider partnership-related. DISCUSSION A modified Delphi process was a useful tool for stakeholders in co-developing research priorities related to SMD use across the lifespan. Drawing on the lived expertise of stakeholders is important in facilitating improved research translation in the CP community.
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Affiliation(s)
- Heather A Feldner
- Department of Rehabilitation Medicine, University of WA, Seattle, WA, USA
| | | | - Varun Awasthi
- Seattle Children's Research Institute, Seattle, WA, USA
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Lai B, Wadsworth D, Spring K, Jones CS, Mintz M, Malone LA, Kim Y, Wilroy J, Lee H. Validity and Reliability of a Telehealth Physical Fitness and Functional Assessment Battery for Ambulatory Youth With and Without Mobility Disabilities: Observational Measurement Study. JMIR Rehabil Assist Technol 2024; 11:e50582. [PMID: 38345838 PMCID: PMC10897795 DOI: 10.2196/50582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Youth (age 15-24 years) with and without disability are not adequately represented enough in exercise research due to a lack of time and transportation. These barriers can be overcome by including accessible web-based assessments that eliminate the need for on-site visitations. There is no simple, low-cost, and psychometrically sound compilation of measures for physical fitness and function that can be applied to youth with and without mobility disabilities. OBJECTIVE The first purpose was to determine the statistical level of agreement of 4 web-modified clinical assessments with how they are typically conducted in person at a laboratory (convergent validity). The second purpose was to determine the level of agreement between a novice and an expert rater (interrater reliability). The third purpose was to explore the feasibility of implementing the assessments via 2 metrics: safety and duration. METHODS The study enrolled 19 ambulatory youth: 9 (47%) with cerebral palsy with various mobility disabilities from a children's hospital and 10 (53%) without disabilities from a university student population. Participants performed a battery of tests via videoconferencing and in person. The test condition (teleassessment and in person) order was randomized. The battery consisted of the hand grip strength test with a dynamometer, the five times sit-to-stand test (FTST), the timed up-and-go (TUG) test, and the 6-minute walk test (6MWT) either around a standard circular track (in person) or around a smaller home-modified track (teleassessment version, home-modified 6-minute walk test [HM6MWT]). Statistical analyses included descriptive data, intraclass correlation coefficients (ICCs), and Bland-Altman plots. RESULTS The mean time to complete the in-person assessment was 16.9 (SD 4.8) minutes and the teleassessment was 21.1 (SD 5.9) minutes. No falls, injuries, or adverse events occurred. Excellent convergent validity was shown for telemeasured hand grip strength (right ICC=0.96, left ICC=0.98, P<.001) and the TUG test (ICC=0.92, P=.01). The FTST demonstrated good agreement (ICC=0.95, 95% CI 0.79-0.98; P=.01). The HM6MWT demonstrated poor absolute agreement with the 6MWT. However, further exploratory analysis revealed a strong positive correlation between the tests (r=0.83, P<.001). The interrater reliability was excellent for all tests (all ICCs>0.9, P<.05). CONCLUSIONS This study suggests that videoconference assessments are convenient and useful measures of fitness and function among youth with and without disabilities. This paper presents operationalized teleassessment procedures that can be replicated by health professionals to produce valid and reliable measurements. This study is a first step toward developing teleassessments that can bypass the need for on-site data collection visitations for this age group. Further research is needed to identify psychometrically sound teleassessment procedures, particularly for measures of cardiorespiratory endurance or walking ability.
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Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Danielle Wadsworth
- Exercise Adherence and Obesity Prevention Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Katherine Spring
- Exercise Adherence and Obesity Prevention Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
- Pennington Biomedical Research Center, Division of Population and Public Health Science, Pediatric Obesity and Health Behavior Laboratory, Baton Rouge, LA, United States
| | - Chloe S Jones
- Exercise Adherence and Obesity Prevention Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Madison Mintz
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Laurie A Malone
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yumi Kim
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jereme Wilroy
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Holim Lee
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
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Sugiyama T, Whitney DG, Schmidt M, Haapala H, Bowman A, Peterson MD, Hurvitz EA. Measuring grip strength in adolescents and adults with cerebral palsy in a clinic setting: Feasibility, reliability, and clinical associations. Dev Med Child Neurol 2024; 66:87-94. [PMID: 37277918 DOI: 10.1111/dmcn.15662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
AIM To determine the feasibility and reliability of measuring grip strength and its association with anthropometrics and diseases among adolescents and adults (≥16 years old) with cerebral palsy (CP). METHOD In this cross-sectional study, individuals with CP, classified in Gross Motor Function Classification System (GMFCS)/Manual Ability Classification System (MACS) levels I to V, were recruited to measure grip strength, anthropometrics, and self-reported current/history of disease during a routine clinical visit. Feasibility was determined as the proportion recruited/consented/completed testing. Test-retest reliability of three maximal effort trials per side was assessed. Linear regression determined associations of grip strength with anthropometrics after adjusting for age, sex, and GMFCS. The predictive ability of GMFCS alone, grip strength alone, GMFCS + grip strength, and GMFCS × grip strength for diseases was compared. RESULTS Of 114 individuals approached, 112 participated and 111 successfully completed all tasks. There was good to excellent reliability of test-retest grip strength between trials for dominant and non-dominant sides for the entire cohort and when stratified by each GMFCS and MACS level (intraclass correlation coefficient range 0.83-0.97). Sex, GMFCS, MACS, body mass, and waist circumference were associated with grip strength (p < 0.05), but not hip circumference, waist:hip ratio, or triceps skinfold thickness. Modeling grip strength with GMFCS had a higher predictive value for relevant diseases than GMFCS alone. INTERPRETATION Grip strength is a feasible and reliable measurement for CP, and is associated with some demographics and anthropometric measures. Grip strength, in addition to the GMFCS, enhanced prediction of disease outcomes. WHAT THIS PAPER ADDS Measurement of hand grip strength is clinically feasible for adolescents/adults with cerebral palsy. Grip strength has good to excellent test-retest reliability across Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels. Grip strength is associated with sex, weight, waist circumference, GMFCS, and especially MACS. Grip strength, in addition to GMFCS, shows promise for enhancing disease prediction in this cohort.
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Affiliation(s)
- Tomoko Sugiyama
- Department of Physical Medicine and Rehabilitation, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA
- Department of Physical Medicine and Rehabilitation, Showa University, Tokyo, Japan
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA
| | - Mary Schmidt
- Department of Physical Medicine and Rehabilitation, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA
| | - Heidi Haapala
- Department of Physical Medicine and Rehabilitation, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA
| | - Angeline Bowman
- Department of Physical Medicine and Rehabilitation, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA
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Pontiff ME, Moreau NG. Age-Related Differences in Muscle Size and Strength between Individuals with Cerebral Palsy and Individuals with Typical Development. Phys Occup Ther Pediatr 2023; 44:572-585. [PMID: 38037369 DOI: 10.1080/01942638.2023.2287463] [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: 03/13/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
AIM Examine age-related differences in muscle size and strength of the knee extensors in individuals with cerebral palsy (CP) and individuals with typical development (TD). METHODS 54 individuals with CP (14.5 ± 4.5 years, GMFCS I-V) and 33 individuals with TD (16.2 ± 5.5 years) were included. Relationships between rectus femoris (RF) and vastus lateralis (VL) muscle volume and isokinetic knee extensor strength with age were examined with linear regression and ANCOVA to test age-related differences between groups. RESULTS Linear regression for muscle volume with age was statistically significant in TD (VL: r2 = 0.48, RF: r2 = 0.56, p < .05) and those with CP (VL: r = 0.36, RF: r2 = 0.27, p < .05) with no differences in regression slopes between groups (p > .05). Age-related strength differences were observed in TD (r2 = 0.66, p < .001) and those with CP (r2 = 0.096, p = .024), but the slopes were significantly different between CP and TD (p < .001). CONCLUSION Age-related linear differences in muscle volume and strength were observed in both groups. The linear slope of the age-related differences in knee extensor muscle strength and strength-to-body mass ratio were significantly lower in individuals with CP compared to individuals with TD, suggesting that strength is insufficient to keep up with gains in body mass during growth.
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Affiliation(s)
- Mattie E Pontiff
- Department of Physical Therapy, LSUHSC-New Orleans, New Orleans, LA, USA
| | - Noelle G Moreau
- Department of Physical Therapy, LSUHSC-New Orleans, New Orleans, LA, USA
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Relative contribution of sensory and motor impairments to mobility limitations in children with cerebral palsy: an observational study. Sci Rep 2023; 13:3229. [PMID: 36828863 PMCID: PMC9957987 DOI: 10.1038/s41598-023-30293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
The purpose of this study was to determine the relative contribution of sensory and motor impairments to mobility limitations in cerebral palsy. An observational study was carried out in 83 children with all types of cerebral palsy with a mean age of 10.8 years (SD 1.2). Five impairments (coordination, strength, spasticity, contracture, proprioception) and three aspects of mobility (standing up from a chair, short and long distance walking) were measured. Standard multiple regression was used to determine the relative contribution of impairments to mobility as well as the relative contribution of strength of individual muscle groups (dorsiflexors, plantarflexors, knee extensors, hip abductors and hip extensors) to mobility. Five impairments accounted for 48% of the variance in overall mobility (p < 0.001): coordination independently accounted for 9%, contracture for 4% and strength for 3% of the variance. Five muscle groups accounted for 53% of the variance in overall mobility (p < 0.001): hip extensors independently accounted for 9%, knee extensors for 4%, dorsiflexors for 4% and plantarflexors for 3% of the variance. Our findings demonstrate that the impairments making a significant independent contribution to mobility in pre-adolescent cerebral palsy were loss of coordination, loss of strength and contracture.
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Moll F, Kessel A, Bonetto A, Stresow J, Herten M, Dudda M, Adermann J. Safety and Feasibility of Robot-assisted Gait Training in Adults with Cerebral Palsy in an Inpatient Setting - an Observational Study. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2023; 35:1-16. [PMID: 36817800 PMCID: PMC9918396 DOI: 10.1007/s10882-023-09895-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To investigate the safety and feasibility of six sessions of Hybrid Assistive Limb (HAL) robot-assisted gait training (RAGT) integrated into an inpatient therapy concept and their influence on walking speed and gait parameters in adult CP patients. METHODS Eleven subjects (male = 8, female = 3, mean age: 23 years and 2 months, ± 4.5 years) with spastic CP underwent six 20-minute RAGT sessions with the HAL during an 11-day hospital stay. Additionally, physiotherapy, physician-performed manual medicine, massage and exercise therapy were provided. Pre- (T1) and post- (T2) intervention assessments were: 10-metre walking test (10MWT), 6-minute walking test (6MWT), Gross Motor Function Measure (GMFM-88) and lower extremities passive range of motion (pROM). RESULTS All subjects completed the study. No adverse events were noted. Walking speed in the 10MWT test increased from 32.5 s (± 24.5 s) at T1 to 27.5 s (± 21.4 s) at T2, without significance. Slight, but non-significant improvements were detected in the 6MWT, GMFM and pROM. Confounding factors did not significantly affect the results. Conclusion: Intensive therapy including HAL training leads to non-significant improvements. Further studies with more patients and longer intervention time could provide further insights into the RAGT therapy of adult patients with CP. Registration DRKS-ID: DRKS00020275.
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Affiliation(s)
- Fabian Moll
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Axel Kessel
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
| | - Anna Bonetto
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
| | - Johanna Stresow
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
| | - Monika Herten
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Marcel Dudda
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Hufelandstraße 55, 45147 Essen, Germany
| | - Jens Adermann
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
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Conner BC, Fang Y, Lerner ZF. Under pressure: design and validation of a pressure-sensitive insole for ankle plantar flexion biofeedback during neuromuscular gait training. J Neuroeng Rehabil 2022; 19:135. [PMID: 36482447 PMCID: PMC9732996 DOI: 10.1186/s12984-022-01119-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electromyography (EMG)-based audiovisual biofeedback systems, developed and tested in research settings to train neuromuscular control in patient populations such as cerebral palsy (CP), have inherent implementation obstacles that may limit their translation to clinical practice. The purpose of this study was to design and validate an alternative, plantar pressure-based biofeedback system for improving ankle plantar flexor recruitment during walking in individuals with CP. METHODS Eight individuals with CP (11-18 years old) were recruited to test both an EMG-based and a plantar pressure-based biofeedback system while walking. Ankle plantar flexor muscle recruitment, co-contraction at the ankle, and lower limb kinematics were compared between the two systems and relative to baseline walking. RESULTS Relative to baseline walking, both biofeedback systems yielded significant increases in mean soleus (43-58%, p < 0.05), and mean (68-70%, p < 0.05) and peak (71-82%, p < 0.05) medial gastrocnemius activation, with no differences between the two systems and strong relationships for all primary outcome variables (R = 0.89-0.94). Ankle co-contraction significantly increased relative to baseline only with the EMG-based system (52%, p = 0.03). CONCLUSION These findings support future research on functional training with this simple, low-cost biofeedback modality.
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Affiliation(s)
- Benjamin C. Conner
- grid.134563.60000 0001 2168 186XCollege of Medicine–Phoenix, University of Arizona, Phoenix, AZ USA
| | - Ying Fang
- grid.261120.60000 0004 1936 8040Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR Bldg 69, Flagstaff, AZ 86011 USA
| | - Zachary F. Lerner
- grid.134563.60000 0001 2168 186XCollege of Medicine–Phoenix, University of Arizona, Phoenix, AZ USA ,grid.261120.60000 0004 1936 8040Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR Bldg 69, Flagstaff, AZ 86011 USA
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Feldner HA, Gaebler-Spira D, Awasthi V, Bjornson K. Supportive mobility device use across the life span by individuals with cerebral palsy: A qualitative study. Dev Med Child Neurol 2022; 64:1392-1401. [PMID: 35426449 PMCID: PMC10883136 DOI: 10.1111/dmcn.15243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 02/05/2023]
Abstract
AIM To understand the mobility experiences, supportive mobility device (SMD) use, and desired participation outcomes of individuals with cerebral palsy (CP) across the life span, and describe how perspectives of rehabilitation care and professional resources may influence mobility decision-making processes and outcomes. METHOD In the second phase of an overarching study, focus groups were conducted with 164 participants (68 individuals with CP; 32 females, 36 males; mean age 17y 8mo, SD 11y 11mo, range 3-68y), 74 caregivers (50 females, 24 males), and 22 healthcare providers (14 females, eight males) across four US cities. Sessions were audio-recorded, transcribed, and analysed using constant comparison. RESULTS Six themes emerged. Five presented across all stakeholder groups: (1) the system is broken; (2) equipment is simultaneously liberating and restricting; (3) adaptation across the life span; (4) designed for transport, not for living; and (5) sharing our stories and sharing resources. One theme (theme 6) was specific to healthcare providers: caught in the middle. INTERPRETATION This qualitative study underscores the simultaneous value and frustration associated with SMDs as described by the community with CP, and recognition among all stakeholders of the need to improve connections and resource networks within the community with CP to improve SMD design and provision processes across device types and across the life span for individuals with CP. WHAT THIS PAPER ADDS Supportive mobility devices (SMDs) were most often equated with freedom, participation, and independence. Frustration with SMDs across the life span persisted with regard to design, function, cost, and maintenance. Stakeholders in the community with cerebral palsy are seeking greater networking and resource sharing to enhance SMD provision processes. Access to appropriate SMDs across the life span and the need for system improvement are critical.
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Affiliation(s)
- Heather A Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Varun Awasthi
- Seattle Children's Research Institute, Seattle, WA, USA
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MacCarthy M, Heyn P, Tagawa A, Carollo J. Walking speed and patient-reported outcomes in young adults with cerebral palsy. Dev Med Child Neurol 2022; 64:1281-1288. [PMID: 35366333 DOI: 10.1111/dmcn.15225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
AIM To examine the relationship between quantitative gait measurements and self-reported physical, psychological, cognitive, and social function status in young adults with cerebral palsy (CP). METHOD Seventy-two adults with CP (range 18-48y; median age 23y [interquartile range 21-27y]; 34 males, 38 females), in Gross Motor Function Classification System levels I to IV, who previously underwent an instrumented gait analysis (IGA) at our center as children were recruited. Participants underwent a repeated IGA. National Institutes of Health Patient-Reported Outcomes Information System (PROMIS) instruments including the PROMIS-57, Applied Cognition - General Concerns (Short Form), and Applied Cognition - Executive Function (Short Form) were administered. Data derived from current and prior IGA were compared via non-parametric correlation analysis with PROMIS subscores. RESULTS Subscores for anxiety, depression, sleep, and fatigue did not significantly correlate with any IGA data. Walking speed, adjusted for stature, correlated strongly with multiple subscores: physical function (p<0.001, rs =0.708); participation in social roles (p=0.007, rs =0.319); executive function (p=0.005, rs =0.335). Pain interference correlated with longitudinal change in adjusted walking speed (p=0.032, rs =-0.259). The Applied Cognition - General Concerns (Short Form) correlated with prior absolute walking speed, but not adjusted values. INTERPRETATION This study underscores the importance of walking speed and its association with a variety of functional domains in adults with CP. WHAT THIS PAPER ADDS Patient-Reported Outcomes Information System measures provide useful clinical data in young adults with cerebral palsy. Temporospatial gait parameters have wide-reaching functional influence in this population. Walking speed is strongly correlated with physical, social, and executive function.
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Affiliation(s)
- Matthew MacCarthy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Department of Pediatrics, University of South Carolina and Prisma Health Children's Hospital, Columbia, SC, USA
| | - Patricia Heyn
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alex Tagawa
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA
| | - James Carollo
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Badina A, du Cluzel de Remaurin X, Khouri N. Long-term outcomes of hip reconstruction surgery in children with GMFCS III diplegic cerebral palsy. Orthop Traumatol Surg Res 2022; 109:103344. [PMID: 35660081 DOI: 10.1016/j.otsr.2022.103344] [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] [Received: 02/23/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The results of hip reconstruction surgery are known for non-walking (GMFCS IV and V) and walking (GMFCS I and II) patients. Few studies deal with GMFCS III patients in isolation. Their intermediate functional status can be deteriorated by asymmetrical contractures, hip dislocation, multi-level deformities of the lower limbs, leading to motor function degradation, and possibly losing their ability to walk. The aim of our study was to establish whether surgical results were maintained over time and whether the functional status changed. MATERIAL AND METHODS Fifteen patients with GMFCS III spastic diplegia, treated for hip subluxation, were reviewed. The mean age at the time of surgery was 10 years old. The mean follow-up after surgery was 11 years. Reconstructive surgery was performed on 21 hips including pelvic osteotomy in all cases, with associated femoral osteotomy in 19 cases. Clinical (pain, joint mobility, walking aids, walking distance, GMFCS level) and radiological data (Melbourne Cerebral Palsy Hip Classification, standard coxometry) were recorded preoperatively and at the last follow-up. RESULTS Preoperatively, 6 patients were losing their ability to walk due to pain and flexion-adduction contracture. At the last follow-up, no patients had pain and joint mobility was improved in all cases. For one patient, recovery to their previous functional state required a period of two years. In the long term, 14 patients were GMFCS III and only one patient was GMFCS IV due to reasons unrelated to hip surgery. The radiological parameters improved significantly. The Melbourne score was IV preoperatively for all patients. At the last follow-up, 10 hips were grade I, 6 hips were grade II and 5 hips were grade III. DISCUSSION Correction of architectural disorders of the subluxed hip by pelvic osteotomy, in most cases associated with femoral osteotomy, improves functional and radiological status for GMFCS III patients. This improvement is maintained in the long-term. Complementary surgeries correcting the other deformities of the lower limbs were necessary in more than half of the patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alina Badina
- Service de chirurgie orthopédique pédiatrique, Hôpital Necker Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - Xavier du Cluzel de Remaurin
- Service de chirurgie orthopédique pédiatrique, Hôpital Necker Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - Nejib Khouri
- Service de chirurgie orthopédique pédiatrique, Hôpital Necker Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
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12
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Whitney DG, Rabideau ML, McKee M, Hurvitz EA. Preventive Care for Adults With Cerebral Palsy and Other Neurodevelopmental Disabilities: Are We Missing the Point? Front Integr Neurosci 2022; 16:866765. [PMID: 35464602 PMCID: PMC9021436 DOI: 10.3389/fnint.2022.866765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/11/2022] [Indexed: 11/29/2022] Open
Abstract
Preventive care techniques are cornerstones of primary care for people with neurodevelopmental disabilities such as cerebral palsy (CP). However, well-established methods evaluating health constructs may not be applied in the same way for adults with CP, as compared to the general population, due to differences in anatomy/physiology, leading to missed opportunities for interventions, medication modifications, and other primary/secondary prevention goals. One barrier to care prevention comes from misinterpretation of values to capture health constructs, even when measurements are accurate. In this Perspective, we emphasize the need for differential interpretation of values from commonly used clinical measures that assess for well-known medical issues among adults with CP obesity risk, bone health, and kidney health. We provide technical, but simple, evidence to showcase why the underlying assumptions of how some measures relate to the health construct being assessed may not be appropriate for adults with CP, which may apply to other neurodevelopmental conditions across the lifespan.
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Affiliation(s)
- Daniel G. Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Daniel G. Whitney
| | - Michelle L. Rabideau
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Edward A. Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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13
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Liou YL, Lee WC, Kao HK, Yang WE, Chang CH. Genu Valgum After Distal Femur Extension Osteotomy in Children With Cerebral Palsy. J Pediatr Orthop 2022; 42:e384-e389. [PMID: 35132017 DOI: 10.1097/bpo.0000000000002076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distal femur extension osteotomy (DFEO) is a common treatment for knee flexion contracture and crouch gait in patients with cerebral palsy (CP), but skeletally immature patients tend to develop genu valgum deformities after DFEO. This study aimed to report the tendency of valgus changes after DFEO and determine the risk factors for subsequent surgery for excessive genu valgum. METHODS This retrospective case-control study included 25 children with CP who underwent DFEO in 44 limbs for knee flexion contractures ≥15 degrees at a mean age of 11.0 years. Radiologic measurements included the anatomic lateral distal femoral angle (aLDFA), anatomic tibiofemoral angle (aTFA), medial proximal tibia angle, and plate-condyle angle, postoperatively and at the latest follow-up. Age, sex, preoperative knee flexion contracture angle, Gross Motor Function Classification System level, and radiographic measurements were compared between children with and without subsequent guided growth for genu valgum. RESULTS A significant valgus change was observed at the distal femur in the first postoperative year (aLDFA from 83.6 to 80.1 degrees, P<0.001; aTFA from 176.1 to 172.5 degrees, P<0.01; plate-condylar angle from 5.3 to 9.5 degrees, P<0.001). Valgus changes occurred in 36 of the 44 limbs (82%) by an average of -4.6 degrees in the aLDFA, and subsequent guided growth was performed in 5 patients (20%). Guided growth for genu valgum was associated with a greater postoperative valgus angle (aLDFA: 78.0 vs. 84.9 degrees, P<0.01) but not with age, Gross Motor Function Classification System level, or preoperative flexion contracture. CONCLUSIONS Distal metaphyseal osteotomies and distally placed angled plates near the physis are associated with valgus changes following growth. We recommend making a slight varus alignment during DFEO to compensate for subsequent valgus changes. LEVEL OF EVIDENCE Level III-therapeutic, retrospective comparative study.
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Affiliation(s)
- Yen-Lyin Liou
- Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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14
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Handsfield GG, Williams S, Khuu S, Lichtwark G, Stott NS. Muscle architecture, growth, and biological Remodelling in cerebral palsy: a narrative review. BMC Musculoskelet Disord 2022; 23:233. [PMID: 35272643 PMCID: PMC8908685 DOI: 10.1186/s12891-022-05110-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy (CP) is caused by a static lesion to the brain occurring in utero or up to the first 2 years of life; it often manifests as musculoskeletal impairments and movement disorders including spasticity and contractures. Variable manifestation of the pathology across individuals, coupled with differing mechanics and treatments, leads to a heterogeneous collection of clinical phenotypes that affect muscles and individuals differently. Growth of muscles in CP deviates from typical development, evident as early as 15 months of age. Muscles in CP may be reduced in volume by as much as 40%, may be shorter in length, present longer tendons, and may have fewer sarcomeres in series that are overstretched compared to typical. Macroscale and functional deficits are likely mediated by dysfunction at the cellular level, which manifests as impaired growth. Within muscle fibres, satellite cells are decreased by as much as 40-70% and the regenerative capacity of remaining satellite cells appears compromised. Impaired muscle regeneration in CP is coupled with extracellular matrix expansion and increased pro-inflammatory gene expression; resultant muscles are smaller, stiffer, and weaker than typical muscle. These differences may contribute to individuals with CP participating in less physical activity, thus decreasing opportunities for mechanical loading, commencing a vicious cycle of muscle disuse and secondary sarcopenia. This narrative review describes the effects of CP on skeletal muscles encompassing substantive changes from whole muscle function to cell-level effects and the effects of common treatments. We discuss growth and mechanics of skeletal muscles in CP and propose areas where future work is needed to understand these interactions, particularly the link between neural insult and cell-level manifestation of CP.
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Affiliation(s)
- Geoffrey G Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand.
| | - Sîan Williams
- Liggins Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
- School of Allied Health, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Stephanie Khuu
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
| | - Glen Lichtwark
- School of Human Movement and Nutrition Sciences, University of Queensland, QLD, St Lucia, 4072, Australia
| | - N Susan Stott
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
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15
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Leb S, Marciniak C, Gaebler-Spira D, Chen L, Garrett A. ASSOCIATION BETWEEN DAILY PHYSICAL ACTIVITY AND CLINICAL ANTHROPOMORPHIC MEASURES IN ADULTS WITH CEREBRAL PALSY. Arch Phys Med Rehabil 2022; 103:1777-1785. [PMID: 35202580 DOI: 10.1016/j.apmr.2022.01.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the relationship between activity level and cardiovascular risk measures as well as describe general activity patterns of adults with cerebral palsy Design: Cross-Sectional Setting: Academic Outpatient Rehabilitation Clinic. PARTICIPANTS 47 adults with cerebral palsy (CP) Interventions: Not applicable Main Outcome Measures: Gross Motor Functional Classification System (GMFCS) level was determined by validated self-report questionnaire. Activity (daily step count, walk time, sitting time, standing time, and transitional movements) over 6 days recorded using an activPAL. Weight, body mass index (BMI), and waist to hip ratio (WHR) were measured. Bivariate relationships between anthropomorphic and activity measures were assessed. RESULTS 38 participants completed all measurements. Nine were excluded due to incomplete activPAL data. The median age was 28.50 years [interquartile range 24.25,47.00], range 18-77 years. Participants' GMFCS levels were I:13%, II:16%, III:21%, IV:34%, and V:16%. Median steps/day for GMFCS I/II participants were 5258.3[3606.8, 6634.7], while median steps/day were 1681.3 [657.2, 2751.8] and 30.0 [6.8, 54.2] for GMFCS level III and IV/V participants, respectively. Significantly greater steps/day were found for GMFCS I/II or III participants compared to those GMFCS IV/V (p<0.001 and p=0.0074, respectively). 60.5% of the subjects had a BMI in the normal range, 10.5% were obese, 23.6% were overweight, and 5.3% were underweight. For subjects with GMFCS I/II, the Spearman's rank correlation coefficient for time standing and waist circumference was -0.73 (0.01). Subjects GMFCS III and GMFCS IV/V had respective correlations of -0.16 (0.71) and -0.01 (0.98). For subjects with GMFCS I/II, the Spearman's rank correlation coefficient for standing time and BMI was -0.55 (p= 0.08). For the GMFCS III and GMFCS IV/V groups the respective correlation was -0.19 (0.67) and 0.00 (1.00). CONCLUSIONS Subjects with GMFCS level I or II who engaged in more activity tended to have more favorable anthropometric profiles. Subjects GMFCS III, IV, or V did not have a similar trend. Our findings suggest factors beyond activity patterns affect anthropometrics to a greater degree in those with higher GMFCS levels.
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Affiliation(s)
- Stephen Leb
- Shirley Ryan AbilityLab, Chicago, IL; McGaw Medical Center of Northwestern University, Chicago, IL.
| | - Christina Marciniak
- McGaw Medical Center of Northwestern University, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Deborah Gaebler-Spira
- Shirley Ryan AbilityLab, Chicago, IL; McGaw Medical Center of Northwestern University, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatric Rehabilitation, Shirley Ryan AbilityLab, Chicago, IL
| | - Liqi Chen
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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16
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Physical and occupational therapy utilization and associated factors among adults with cerebral palsy: Longitudinal modelling to capture distinct utilization groups. Disabil Health J 2022; 15:101279. [DOI: 10.1016/j.dhjo.2022.101279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/13/2022] [Accepted: 02/08/2022] [Indexed: 11/20/2022]
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Conner BC, Remec NM, Michaels CM, Wallace CW, Andrisevic E, Lerner ZF. Relationship between ankle function and walking ability for children and young adults with cerebral palsy: A systematic review of deficits and targeted interventions. Gait Posture 2022; 91:165-178. [PMID: 34736095 PMCID: PMC8671343 DOI: 10.1016/j.gaitpost.2021.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 09/30/2021] [Accepted: 10/17/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND A primary goal of treatment for children with cerebral palsy is improved walking ability to allow for a more active and independent lifestyle. With the importance of ankle function to walking ability, and the deficits in ankle function associated with cerebral palsy, there is good rationale for targeting this joint in an effort to improve walking ability for this population. RESEARCH QUESTION How do deficits and targeted interventions of the ankle joint influence walking ability in children with cerebral palsy? METHODS A specific search criteria was used to identify articles that either (1) provided information on the relationship between ankle function and walking ability or (2) investigated the effect of a targeted ankle intervention on walking ability in cerebral palsy. PubMed, Embase, CINAHL, and Web of Science databases were searched from 1980-April, 2020. Resulting citations were compared against a prospective set of inclusion and exclusion criteria. Data relevant to the original research question was extracted, and the level of evidence for each intervention study was scored. Interpretation was focused on specific, pre-determined mobility measures. RESULTS Sixty-one citations met all criteria for data extraction, six of which were observational, and fifty-five of which were interventional. Level of evidence ranged from 2 to 4. Self-selected walking speed was the most common measure of walking ability, while physical activity level was the least common. SIGNIFICANCE Ankle function is an important contributor to the walking ability of children with cerebral palsy, and most interventions targeting the ankle seem to demonstrate a benefit on walking ability, but future higher-powered and/or controlled studies are necessary to confirm these findings.
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Affiliation(s)
| | | | - Cassidy M. Michaels
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Chase W. Wallace
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | | | - Zachary F. Lerner
- College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA,Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA
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18
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Green MM, Kim H, Gauden R, Scheinberg A, Schroeder AS, Heinen F, Berweck S, Hong BY, Gormley M. Needlepoints: Clinical approach to child living with cerebral palsy. J Pediatr Rehabil Med 2022; 15:91-106. [PMID: 35275576 DOI: 10.3233/prm-220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Heakyung Kim
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ruth Gauden
- The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Adam Scheinberg
- The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | | | | | | | - Bo Young Hong
- St. Vincent's Hospital, Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Mark Gormley
- Gillette Children's Specialty Healthcare, St.Paul, MN, USA
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19
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Whitney DG, Schmidt M, Hurvitz EA. Shared Physiologic Pathways Among Comorbidities for Adults With Cerebral Palsy. Front Neurol 2021; 12:742179. [PMID: 34671312 PMCID: PMC8520916 DOI: 10.3389/fneur.2021.742179] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Aging with cerebral palsy is accompanied by a declining health and function status across neurological and non-neurological systems. There is a need to understand the shared pathophysiology among comorbidities for adults with cerebral palsy, to inform clinical assessment and guidelines for interventions to improve healthful aging. To begin defining multimorbidity, this study identified the most common comorbidity combinations and their association with mortality among a representative sample of adults with cerebral palsy. Methods: Data from 2016 to 2018 were used from a random 20% sample from the fee-for-service Medicare database. Adults ≥18 years with cerebral palsy and 25 neurological and non-neurological comorbidities were obtained from 2016. Principal component (PC) analysis identified the most common comorbidity combinations, defined as individual PCs. Cox regression estimated the hazard ratio (HR) of 2-year mortality including all PCs and demographics in a single model. To facilitate comparisons, PC scores were transformed into quintiles (reference: lowest quintile). Results: Among the 16,728 adults with cerebral palsy, the most common comorbidity combinations (PCs) in order were: cardiorespiratory diseases, dysphagia, and fluid/electrolyte disorders; metabolic disorders (e.g., diabetes, renal disease, hypertension); neurologic-related disorders (e.g., dementia, cerebrovascular disease); gastrointestinal issues; and orthopedic-related disorders. During the 2-year follow-up, 1,486 (8.9%) died. In the adjusted model, most PCs were associated with an elevated mortality rate, especially the first PC (5th quintile HR = 3.91; 95%CI = 3.29–4.65). Discussion: This study identified the most common comorbidity combinations for adults with cerebral palsy, many of them were deadly, which may inform on the underlying pathophysiology or shared characteristics of multimorbidity for this population.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Mary Schmidt
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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20
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Brown MC, Marciniak CM, Garrett AM, Gaebler-Spira DJ. Diet quality in adults with cerebral palsy: a modifiable risk factor for cardiovascular disease prevention. Dev Med Child Neurol 2021; 63:1221-1228. [PMID: 33959958 DOI: 10.1111/dmcn.14913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 12/13/2022]
Abstract
AIM To assess diet quality and its relationship with cardiovascular health measures for adults with cerebral palsy (CP). METHOD A convenience sample of 45 adults with CP (26 females, 19 males; mean age 35y 10mo [SD 14y 9mo]). were recruited for this cross-sectional study. Demographic, medical, and Gross Motor Function Classification System (GMFCS) information were obtained through in-person visits. Participants completed two 24-hour dietary recalls using the Automated Self-Administered 24-hour Dietary Assessment Tool. Specific macronutrient intake was compared to 2015 to 2020 US Department of Agriculture (USDA) guidelines. Other data included body mass index (BMI), waist-to-hip ratio (WHR), blood pressure, and hemoglobin A1c (HgA1c;n=43). RESULTS Adults across GMFCS levels I to V were enrolled, 20 participants were in GMFCS levels IV or V. Mean calorie intake was 1777.91/day (SD 610.54), while sodium intake was 3261.75mg/day (SD 1484.92). Five participants met USDA vegetable and seven fruit guidelines. None met whole grain targets. Sixteen were overweight/obese by BMI. Sixteen participants without hypertension diagnoses had elevated blood pressure and nine had abnormal HgA1c without prediabetes/diabetes history. Percent calories from saturated fat was inversely associated with WHR in unadjusted and adjusted models (p=0.002 and p=0.003 respectively); all other dietary recommendations assessed (total calories, sodium, and sugar) were non-significant. Post hoc analyses were unchanged using 2020 to 2025 USDA guidelines. INTERPRETATION Assessment of nutrient intake and diet quality is feasible and warrants further study in adults with CP, as USDA guidelines are largely unmet. What this paper adds Adults with cerebral palsy (CP) do not meet US Department of Agriculture dietary quality recommendations. Prediabetes and hypertension may be common, but unrecognized, in adults with CP. Screening for nutrient intake and diet quality should be performed to facilitate nutritional counseling.
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Affiliation(s)
- Meagan C Brown
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Christina M Marciniak
- Department of Physical Medicine and Rehabilitation, Feinberg Medical School, Northwestern University, Chicago, IL, USA.,Department of Neurology, Feinberg Medical School, Northwestern University, Chicago, IL, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA
| | | | - Deborah J Gaebler-Spira
- Department of Physical Medicine and Rehabilitation, Feinberg Medical School, Northwestern University, Chicago, IL, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Pediatrics, Feinberg Medical School, Northwestern University, Chicago, IL, USA
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Johansen M, Rasmussen HM, Lauruschkus K, Laugesen B. Measurement of physical activity in children and adolescents with cerebral palsy: a scoping review protocol. JBI Evid Synth 2021; 19:2339-2349. [PMID: 33769334 DOI: 10.11124/jbies-20-00283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify and map subjective instruments that have been developed for children and adolescents with cerebral palsy from birth to 18 years to measure physical activity and sedentary behavior. INTRODUCTION Children and adolescents with cerebral palsy often do not meet the recommended levels of physical activity, even though regular physical activity is an important determinant of good health. Considering the importance of physical activity, there is a need for systematic collection of data on daily activity and sedentary behavior of children and adolescents with cerebral palsy. Subjective instruments with clinical utility for use in quality registers are needed to evaluate interventions and investigate the relationship between activity and health outcomes. INCLUSION CRITERIA This review will consider studies that include children and adolescents from birth to 18 years with cerebral palsy across levels I to V of the Gross Motor Function Classification System. Specifically, this scoping review will report on subjective instruments used to measure physical activity and sedentary behavior and that distinguish between physical activity performance and physical activity capability. METHODS This scoping review will be conducted in accordance with the JBI methodology for scoping reviews and will search the following databases: MEDLINE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, Embase, and PEDro, as well as specific journals relating to physical activity assessment.
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Affiliation(s)
- Mette Johansen
- Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Britt Laugesen
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark, Danish Centre of Systematic Reviews: A JBI Centre of Excellence, Centre of Clinical Guidelines - Danish National Clearing House, Aalborg University, Denmark
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22
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Hsu PJ, Yeh HL, Tsai CL, Chu CH, Chen FC, Pan CY. Effects of a Floor Hockey Intervention on Motor Proficiency, Physical Fitness, and Adaptive Development in Youths with Mild Intellectual Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137059. [PMID: 34280994 PMCID: PMC8297291 DOI: 10.3390/ijerph18137059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022]
Abstract
This study examined the effects of a 12-week floor hockey training program on the motor proficiency, physical fitness, and adaptive development of youths with mild intellectual disabilities (IDs). A total of 54 youths with IDs were divided into two groups: a floor hockey exercise group (EG; n = 27; age, 16.59 ± 0.56 years) and a control group (CG; n = 27; age, 16.65 ± 0.63 years). The participants in the EG attended sessions of a floor hockey training program 3 times per week over a 12-week period. The CG group maintained their standard activities of daily living. The participants' scores on the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, Brockport Physical Fitness Test, and traditional Chinese version of the teacher form of the Adaptive Behavior Assessment System, Second Edition, were obtained before and after the intervention. The results of the study indicate that the 12-week floor hockey training program significantly increased the participants' scores for most indicators of motor proficiency (p < 0.01), physical fitness (p < 0.01), and adaptive development (p < 0.01). The findings provide evidence that physical activity interventions focusing on floor hockey training are a viable therapeutic option for treating youths with IDs.
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Affiliation(s)
- Po-Jen Hsu
- Graduate Institute of Physical Education, National Taiwan Sport University, Taoyuan City 333, Taiwan;
| | - Hung-Ling Yeh
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan; (H.-L.Y.); (C.-H.C.); (F.-C.C.)
| | - Chia-Liang Tsai
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan City 701, Taiwan;
| | - Chia-Hua Chu
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan; (H.-L.Y.); (C.-H.C.); (F.-C.C.)
| | - Fu-Chen Chen
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan; (H.-L.Y.); (C.-H.C.); (F.-C.C.)
| | - Chien-Yu Pan
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan; (H.-L.Y.); (C.-H.C.); (F.-C.C.)
- Correspondence: ; Tel.: +886-7-7172930
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Chiu HC, Ada L, Bania TA. Mechanically assisted walking training for walking, participation, and quality of life in children with cerebral palsy. Cochrane Database Syst Rev 2020; 11:CD013114. [PMID: 33202482 PMCID: PMC8092676 DOI: 10.1002/14651858.cd013114.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cerebral palsy is the most common physical disability in childhood. Mechanically assisted walking training can be provided with or without body weight support to enable children with cerebral palsy to perform repetitive practice of complex gait cycles. It is important to examine the effects of mechanically assisted walking training to identify evidence-based treatments to improve walking performance. OBJECTIVES To assess the effects of mechanically assisted walking training compared to control for walking, participation, and quality of life in children with cerebral palsy 3 to 18 years of age. SEARCH METHODS In January 2020, we searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers. We handsearched conference abstracts and checked reference lists of included studies. SELECTION CRITERIA Randomized controlled trials (RCTs) or quasi-RCTs, including cross-over trials, comparing any type of mechanically assisted walking training (with or without body weight support) with no walking training or the same dose of overground walking training in children with cerebral palsy (classified as Gross Motor Function Classification System [GMFCS] Levels I to IV) 3 to 18 years of age. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 17 studies with 451 participants (GMFCS Levels I to IV; mean age range 4 to 14 years) from outpatient settings. The duration of the intervention period (4 to 12 weeks) ranged widely, as did intensity of training in terms of both length (15 minutes to 40 minutes) and frequency (two to five times a week) of sessions. Six studies were funded by grants, three had no funding support, and eight did not report information on funding. Due to the nature of the intervention, all studies were at high risk of performance bias. Mechanically assisted walking training without body weight support versus no walking training Four studies (100 participants) assessed this comparison. Compared to no walking, mechanically assisted walking training without body weight support increased walking speed (mean difference [MD] 0.05 meter per second [m/s] [change scores], 95% confidence interval [CI] 0.03 to 0.07; 1 study, 10 participants; moderate-quality evidence) as measured by the Biodex Gait Trainer 2™ (Biodex, Shirley, NY, USA) and improved gross motor function (standardized MD [SMD] 1.30 [postintervention scores], 95% CI 0.49 to 2.11; 2 studies, 60 participants; low-quality evidence) postintervention. One study (30 participants) reported no adverse events (low-quality evidence). No study measured participation or quality of life. Mechanically assisted walking training without body weight support versus the same dose of overground walking training Two studies (55 participants) assessed this comparison. Compared to the same dose of overground walking, mechanically assisted walking training without body weight support increased walking speed (MD 0.25 m/s [change or postintervention scores], 95% CI 0.13 to 0.37; 2 studies, 55 participants; moderate-quality evidence) as assessed by the 6-minute walk test or Vicon gait analysis. It also improved gross motor function (MD 11.90% [change scores], 95% CI 2.98 to 20.82; 1 study, 35 participants; moderate-quality evidence) as assessed by the Gross Motor Function Measure (GMFM) and participation (MD 8.20 [change scores], 95% CI 5.69 to 10.71; 1 study, 35 participants; moderate-quality evidence) as assessed by the Pediatric Evaluation of Disability Inventory (scored from 0 to 59), compared to the same dose of overground walking training. No study measured adverse events or quality of life. Mechanically assisted walking training with body weight support versus no walking training Eight studies (210 participants) assessed this comparison. Compared to no walking training, mechanically assisted walking training with body weight support increased walking speed (MD 0.07 m/s [change and postintervention scores], 95% CI 0.06 to 0.08; 7 studies, 161 participants; moderate-quality evidence) as assessed by the 10-meter or 8-meter walk test. There were no differences between groups in gross motor function (MD 1.09% [change and postintervention scores], 95% CI -0.57 to 2.75; 3 studies, 58 participants; low-quality evidence) as assessed by the GMFM; participation (SMD 0.33 [change scores], 95% CI -0.27 to 0.93; 2 studies, 44 participants; low-quality evidence); and quality of life (MD 9.50% [change scores], 95% CI -4.03 to 23.03; 1 study, 26 participants; low-quality evidence) as assessed by the Pediatric Quality of Life Cerebral Palsy Module (scored 0 [bad] to 100 [good]). Three studies (56 participants) reported no adverse events (low-quality evidence). Mechanically assisted walking training with body weight support versus the same dose of overground walking training Three studies (86 participants) assessed this comparison. There were no differences between groups in walking speed (MD -0.02 m/s [change and postintervention scores], 95% CI -0.08 to 0.04; 3 studies, 78 participants; low-quality evidence) as assessed by the 10-meter or 5-minute walk test; gross motor function (MD -0.73% [postintervention scores], 95% CI -14.38 to 12.92; 2 studies, 52 participants; low-quality evidence) as assessed by the GMFM; and participation (MD -4.74 [change scores], 95% CI -11.89 to 2.41; 1 study, 26 participants; moderate-quality evidence) as assessed by the School Function Assessment (scored from 19 to 76). No study measured adverse events or quality of life. AUTHORS' CONCLUSIONS Compared with no walking, mechanically assisted walking training probably results in small increases in walking speed (with or without body weight support) and may improve gross motor function (with body weight support). Compared with the same dose of overground walking, mechanically assisted walking training with body weight support may result in little to no difference in walking speed and gross motor function, although two studies found that mechanically assisted walking training without body weight support is probably more effective than the same dose of overground walking training for walking speed and gross motor function. Not many studies reported adverse events, although those that did appeared to show no differences between groups. The results are largely not clinically significant, sample sizes are small, and risk of bias and intensity of intervention vary across studies, making it hard to draw robust conclusions. Mechanically assisted walking training is a means to undertake high-intensity, repetitive, task-specific training and may be useful for children with poor concentration.
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Affiliation(s)
- Hsiu-Ching Chiu
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Lidcombe, Australia
| | - Theofani A Bania
- Department of Physiotherapy, School of Health Rehabilitation Science, University of Patras, Myrtia, Greece
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Etter JP, Kannikeswaran S, Hurvitz EA, Peterson MD, Caird MS, Jepsen KJ, Whitney DG. The respiratory disease burden of non-traumatic fractures for adults with cerebral palsy. Bone Rep 2020; 13:100730. [PMID: 33195765 PMCID: PMC7645631 DOI: 10.1016/j.bonr.2020.100730] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/07/2020] [Accepted: 10/25/2020] [Indexed: 12/27/2022] Open
Abstract
Background Individuals with cerebral palsy (CP) are vulnerable to non-trauma fracture (NTFx) and premature mortality due to respiratory disease (RD); however, very little is known about the contribution of NTFx to RD risk among adults with CP. The purpose of this study was to determine if NTFx is a risk factor for incident RD and if NTFx exacerbates RD risk in the adult CP population. Methods Data from 2011 to 2016 Optum Clinformatics® Data Mart and a random 20% sample Medicare fee-for-service were used for this retrospective cohort study. Diagnosis codes were used to identify adults (18+ years) with and without CP, NTFx, incident RD at 3-, 6-, 12-, and 24-month time points (pneumonia, chronic obstructive pulmonary disease, interstitial/pleura disease), and comorbidities. Crude incidence rates per 100 person years of RD were estimated. Cox regression estimated hazard ratios (HR and 95% confidence interval [CI]) for RD measures, comparing: (1) CP and NTFx (CP + NTFx); (2) CP without NTFx (CP w/o NTFx); (3) without CP and with NTFx (w/o CP + NTFx); and (4) without CP and without NTFx (w/o CP w/o NTFx) after adjusting for demographics and comorbidities. Results The crude incidence rate was elevated for CP + NTFx vs. CP w/o NTFx and w/o CP + NTFx for each RD measure. After adjustments, the HR was elevated for CP + NTFx vs. CP w/o NTFx for pneumonia and interstitial/pleura disease at all time points (all P < 0.05), but not chronic obstructive pulmonary disease (e.g., 24-month HR = 1.07; 95%CI = 0.88-1.31). The adjusted HR was elevated for CP + NTFx vs. w/o CP + NTFx for pneumonia at all time points, interstitial/pleura disease at 12- and 24-month time points, and chronic obstructive pulmonary disease at 24-months (all P < 0.05). There is evidence of a time-dependent effect of NTFx on pneumonia and interstitial/pleura disease for CP + NTFx as compared to CP w/o NTFx. Conclusions Study findings suggest that NTFx is a risk factor for incident RD, including pneumonia and interstitial/pleura disease, among adults with CP and that NTFx exacerbates RD risk for adults with vs. without CP.
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Affiliation(s)
- Jonathan P Etter
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Sanjana Kannikeswaran
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Whitney DG, Oliverio AL, Kamdar NS, Viglianti BL, Naik A, Schmidt M. Advanced CKD Among Adults With Cerebral Palsy: Incidence and Risk Factors. Kidney Med 2020; 2:569-577.e1. [PMID: 33094275 PMCID: PMC7568081 DOI: 10.1016/j.xkme.2020.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Rationale & Objective Recent evidence suggests that adults with cerebral palsy have an elevated risk for developing advanced chronic kidney disease (CKD). To develop effective interventions, the objective was to identify whether demographics and preexisting medical conditions are risk factors for advanced CKD among adults with cerebral palsy. Study Design Retrospective cohort study. Setting & Participants Data were from the Optum Clinformatics Data Mart. Adults 18 years or older with cerebral palsy and without advanced CKD (CKD stage 4 or later) were identified from 2013 and subsequently followed up from January 1, 2014, to the development of advanced CKD, death, loss to follow-up, or end of the study period (December 31, 2017), whichever came first. Diagnostic, procedure, and diagnosis-related group codes were used to identify cerebral palsy, incident cases of advanced CKD, comorbid intellectual disability, and 10 preexisting medical conditions. Exposures Demographic variables and 10 preexisting medical conditions: CKD stages 1-3, hypertension, diabetes, heart and cerebrovascular disease, non-CKD urologic conditions, bowel conditions, respiratory disease, skeletal fragility, arthritis, and dysphagia. Outcome Incidence of advanced CKD. Analytic Approach Crude incidence rate (IR) of advanced CKD and IR ratios with 95% CIs were estimated. Cox proportional hazards regression models that were adjusted for demographics, intellectual disability, and preexisting medical conditions were used to evaluate the adjusted independent effect of predictor variables. Results 237 of the 8,011 adults with cerebral palsy developed advanced CKD during follow-up (IR, 10.16/1,000 person years; 95% CI, 8.87-11.46). In the crude analysis, all preexisting medical conditions were associated with an elevated IR and IR ratio of advanced CKD. In the fully adjusted Cox proportional hazards regression model, the HR was elevated for older age, CKD stages 1-3 (HR, 3.32; 95% CI, 2.39-4.61), diabetes (HR, 2.69; 95% CI, 2.03-3.57), hypertension (HR, 1.54; 95% CI, .10-2.16), heart and cerebrovascular disease (HR, 1.53; 95% CI, 1.12-2.07), and non-CKD urologic conditions (HR, 1.39; 95% CI, 1.05-1.84). Limitations Private insurance database, short follow-up period, and lack of laboratory values, such as albuminuria/proteinuria. Conclusions Advanced CKD was common among adults with cerebral palsy and its development was associated with both traditional and nontraditional urologic risk factors.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Andrea L Oliverio
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.,Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Neil S Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.,Department of Surgery, University of Michigan, Ann Arbor, MI.,Emergency Medicine, University of Michigan, Ann Arbor, MI
| | - Benjamin L Viglianti
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI.,Nuclear Medicine Service, Veterans Administration Ann Arbor Health System (506), Ann Arbor, MI
| | - Abhijit Naik
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Mary Schmidt
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Abe H, Inoue K, Kozuka N. A Preliminary Evaluation of Energy Efficiency for Children with Cerebral Palsy for Driving A Manual Wheelchair and Walking: Use of the Total Heart Beat Index. Dev Neurorehabil 2020; 23:383-389. [PMID: 31739713 DOI: 10.1080/17518423.2019.1692947] [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: 10/25/2022]
Abstract
Aims: This study aims to compare the total heart beat index (THBI) in evaluating energy efficiency between using a manual wheelchair and walking for children with cerebral palsy (CP). Methods: The energy efficiency was measured in 21 participants with CP (mean age, 13.6 ± 3.4 years) who walk or drive a manual wheelchair using a square course. THBI was calculated as total number of heart beats during the exercise period/total distance traveled. Results: Significant differences in the THBI were observed between Gross Motor Function Classification System (GMFCS) levels III and IV (p = .049, effect size = 1.60). No significant differences in THBI were observed between GMFCS levels II and III or between GMFCS levels II and IV (p > .05). Conclusions: The energy efficiency of children with CP who use a manual wheelchair in this study was equal to or better than that for walking.
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Affiliation(s)
- Hirokazu Abe
- Department of Health Care and Child Development, Saitama Children's Medical Center , Saitama, Japan.,Master Course of Health Sciences, Department of Physical Therapy, Graduate School, Sapporo Medical University , Sapporo, Japan
| | - Kazuhiro Inoue
- Division of Rehabilitation Medicine, Hokkaido Medical Center for Child Health and Rehabilitation , Sapporo, Japan
| | - Naoki Kozuka
- Department of First Division of Physical Therapy, School of Health Sciences, Sapporo Medical University , Sapporo, Japan
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Whitney DG, Bell S, Whibley D, van der Slot WM, Hurvitz EA, Haapala H, Peterson MD, Warschausky SA. Effect of pain on mood affective disorders in adults with cerebral palsy. Dev Med Child Neurol 2020; 62:926-932. [PMID: 32388867 PMCID: PMC7955588 DOI: 10.1111/dmcn.14559] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 12/13/2022]
Abstract
AIM To determine if pain is associated with 12-month incidence of mood affective disorders (MAD) in adults with cerebral palsy (CP). METHOD Data from Optum Clinformatics® Data Mart (2013-2016) were used for this retrospective cohort study. Diagnostic codes were used to identify adults (≥18y) with CP, incident cases of MAD, and covariates (other neurodevelopmental conditions, sleep disorders, arthritis). Pain (any type, location) was identified between 1st October 2014 and 30th September 2015. The pain group was divided into new or consistent pain if they had a history of pain (i.e. consistent) in the 12 months before their first pain claim date. Crude incidence rates of MAD (expressed per 100 person-years) were estimated. Cox regression was used to estimate hazard ratio (95% confidence interval [CI]) of MAD after adjusting for covariates. RESULTS Adults that had new pain (n=859; incidence rate=15.5) or consistent pain (n=1303; incidence rate=17.9) had greater crude incidence rate of MAD compared to adults without pain (n=3726; incidence rate=5.9). The elevated rate of MAD remained after adjusting for covariates, for new pain (hazard ratio=2.4; 95% CI=1.9-3.0) and consistent pain (hazard ratio=2.1; 95% CI=1.7-2.7). INTERPRETATION Pain is associated with greater incidence of MAD in adults with CP. This association remained after accounting for potential confounding factors. WHAT THIS PAPER ADDS What this paper adds Pain was associated with higher 12-month incidence of mood affective disorders (MAD). The 12-month MAD incidence was similar between new and consistent pain groups. The MAD incidence remained higher adjusting for neurodevelopmental comorbidities, sleep disorders, and arthritis.
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Affiliation(s)
- Daniel G. Whitney
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA,University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Sarah Bell
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Daniel Whibley
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA,University of Aberdeen, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Wilma M.A. van der Slot
- Rijndam Rehabilitation, Rotterdam, The Netherlands,Erasmus MC University Medical Center, Department of Rehabilitation Medicine, Rotterdam, The Netherlands
| | - Edward A. Hurvitz
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Heidi Haapala
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Mark D. Peterson
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA,University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Seth A. Warschausky
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
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Chiu HC, Ada L, Chen C. Changes in Walking Performance between Childhood and Adulthood in Cerebral Palsy: A Systematic Review. Dev Neurorehabil 2020; 23:343-348. [PMID: 31366265 DOI: 10.1080/17518423.2019.1648579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To examine the changes in walking performance between childhood and adulthood in cerebral palsy. Methods: Cohort studies were included if the participants were children with cerebral palsy at Gross Motor Function Classification System (GMFCS) Level I-IV, initial measurement of walking by 13 years of age and follow-up measurement by 30 years of age. Results: At GMFCS Level I+ II, 7% (95% CI 6-8) had declined to GMFCS Level III. At GMFCS Level III, 4% (95% CI 3-6) had declined to GMFCS Level IV and 31% (95% CI 27-34) had improved to GMFCS Level I+ II. At GMFCS Level IV, 2% (95% CI 1-4) had improved to GMFCS Level III and 3% (95% CI 2-4) had improved to GMFCS Level I+ II. Discussion: The results suggest that walking performance is stable from childhood to adulthood at either end of the spectrum of ability but is more changeable for intermediate walkers.
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Affiliation(s)
| | - Louise Ada
- The University of Sydney , Sydney, Australia
| | - Chiehfeng Chen
- School of Public Health, Taipei Medical University , Taipei, Taiwan
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Whitney DG, Singh H, Zhang C, Miller F, Modlesky CM. Greater Visceral Fat but No Difference in Measures of Total Body Fat in Ambulatory Children With Spastic Cerebral Palsy Compared to Typically Developing Children. J Clin Densitom 2020; 23:459-464. [PMID: 30425006 PMCID: PMC8081403 DOI: 10.1016/j.jocd.2018.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Individuals with cerebral palsy (CP) are at increased risk for obesity and obesity-related complications. Studies of total body fat in those with CP are inconsistent and studies of abdominal fat are lacking in children with CP. The objective of this study was to determine if ambulatory children with spastic CP have greater central adiposity compared to typically developing children. METHODOLOGY Eighteen ambulatory children with spastic CP (n = 5 girls; 8.6 ± 2.9 yr) and 18 age-, sex-, and race-matched typically developing children (controls; 8.9 ± 2.1 yr) participated in this cross-sectional study. Children with CP were classified as I or II using the Gross Motor Function Classification System. Dual-energy X-ray absorptiometry assessed body composition, including total body, trunk and abdominal fat mass, fat-free mass, fat mass index (FMI), and fat-free mass index (FFMI). RESULTS There were no group differences in fat mass, fat-free mass, FMI, and FFMI in the total body, fat mass, fat-free mass, and FFMI in the trunk, or fat mass, visceral fat mass, and subcutaneous fat mass in the abdomen (p > 0.05). Compared to controls, children with CP had higher trunk FMI, abdominal FMI, and visceral FMI (p < 0.05). Although marginally insignificant (p = 0.088), children with CP had higher subcutaneous FMI. CONCLUSIONS Ambulatory children with spastic CP have elevated central adiposity, especially in the visceral region, despite no differences in measures of total body fat. How this relates to cardiometabolic disease progression in those with CP requires further investigation.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Harshvardhan Singh
- Department of Physical Therapy, University of Alabama, Birmingham, AL, USA
| | - Chuan Zhang
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Freeman Miller
- Department of Orthopedics, Nemours AI duPont Hospital for Children, Wilmington, DE, USA
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Research Trends and Recommendations for Physical Activity Interventions Among Children and Youth With Disabilities: A Review of Reviews. Adapt Phys Activ Q 2020; 37:211-234. [PMID: 32131052 DOI: 10.1123/apaq.2019-0081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/31/2022] Open
Abstract
This scoping review synthesized reviews of physical activity (PA) interventions for children and youth with disabilities to highlight promising elements of effective interventions, research methodological limitations, and research priorities. Twenty studies were eligible and underwent three rounds of review by an expert panel. Rich and diverse PA programs derived potential short-term benefits toward health, function, and PA. Strategies to increase sample sizes included embedding programs in the community and using information communication technology to deliver exercise programs. Methodological limitations of interventions included a lack of generalizability, transferability, and scientific rigor. Three research priorities were identified: develop and report precision-based intervention strategies, identify strategies that promote both long-term and sustainable PA participation and outcomes, and develop scalable interventions and recruitment strategies. If addressed, these areas could enhance the impact of PA interventions for children and youth with disabilities.
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Whitney DG, Caird MS, Jepsen KJ, Kamdar NS, Marsack-Topolewski CN, Hurvitz EA, Peterson MD. Elevated fracture risk for adults with neurodevelopmental disabilities. Bone 2020; 130:115080. [PMID: 31655219 PMCID: PMC8065344 DOI: 10.1016/j.bone.2019.115080] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/13/2019] [Accepted: 09/25/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Fracture is a high-burden condition that accelerates unhealthful aging and represents a considerable economic burden. Adults with neurodevelopmental disabilities (NDDs) may be susceptible for fracture at younger ages compared to adults without NDDs; and yet, very little is known about the burden of fracture for these underserved populations. The purpose of this study was to determine the sex-stratified prevalence of all-cause fracture among adults with NDDs, as compared to adults without NDDs, and if comorbidity of NDDs is associated with greater risk of fracture. METHODS Data from 2016 were extracted from Optum Clinformatics® Data Mart (private insurance) and a random 20% sample from Medicare fee-for-service (public insurance). ICD-10-CM diagnosis codes were used to identify adults with NDDs, including intellectual disabilities, autism spectrum disorders, and cerebral palsy. Age-standardized prevalence of any fracture and fracture by anatomical location was compared between adults with and without NDDs, and then for adults with 1 NDD vs. 2 and 3 NDDs. RESULTS Adults with intellectual disabilities (n=69,456), autism spectrum disorders (n=21,844), and cerebral palsy (n=29,255) had a higher prevalence of any fracture compared to adults without NDDs (n=8.7 million). For women, it was 8.3%, 8.1%, and 8.5% vs. 3.5%, respectively. For men, it was 6.6%, 5.9%, and 6.7% vs. 3.0%, respectively. Women with NDDs had a higher prevalence of fracture of the head/neck, thoracic, lumbar/pelvis, upper extremities, and lower extremities compared to women without NDDs. A similar pattern was observed for men, except for no difference for lumbar/pelvis for all NDDs and thoracic for autism spectrum disorders. For women and men, increasing comorbidity of NDDs was associated with a higher prevalence of any fracture: 1 NDD (women, 7.7%; men, 5.7%); 2 NDDs (women, 9.4%; men, 7.2%); all 3 NDDs (women, 11.3%; men, 13.7%). CONCLUSIONS Study findings suggest that adults with NDDs have an elevated prevalence of fracture compared to adults without NDDs, with the fracture risk being higher with greater numbers of comorbid NDD conditions for most anatomical locations. Our study findings indicate a need for earlier screening and preventive services for musculoskeletal frailty for adults with NDDs.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Ann Arbor, MI 48109, USA.
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, 1540 E Hospital Dr., Ann Arbor, MI 48109, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, 1540 E Hospital Dr., Ann Arbor, MI 48109, USA
| | - Neil S Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Ann Arbor, MI 48109, USA; Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA; Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA; Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | | | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Ann Arbor, MI 48109, USA
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Whitney DG, Whibley D, Jepsen KJ. The effect of low-trauma fracture on one-year mortality rate among privately insured adults with and without neurodevelopmental disabilities. Bone 2019; 129:115060. [PMID: 31494304 PMCID: PMC8065338 DOI: 10.1016/j.bone.2019.115060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Individuals with neurodevelopmental disabilities (NDDs) have poor development and preservation of skeletal health throughout the lifespan, and are especially vulnerable to low-trauma fracture and post-fracture health complications. However, no studies have examined if adults with NDDs have greater post-fracture mortality risk compared to adults without NDDs. The purpose of this study was to determine whether adults with NDDs have greater 12-month mortality rates following a low-trauma fracture compared to adults without NDDs. METHODS Data from 2011 to 2017 was leveraged from Optum Clinformatics® Data Mart; a nationwide claims database from a single private payer in the U.S. Data were extracted from adults (18+ years) with and without NDDs that sustained a low-trauma fracture between 01/01/2012-12/31/2016, as well as pre-fracture chronic diseases (i.e., cardiovascular diseases, cerebrovascular diseases, diabetes, chronic obstructive pulmonary diseases, cancer). Mortality rate was estimated for adults with and without NDDs, and the mortality rate ratio (RR) and 95% confidence interval (CI) was calculated. Cox regression was used to estimate hazard ratio (HR) and 95% CI for 1-, 3-, 6-, and 12-month post-fracture mortality rates between adults with and without NDDs after adjusting for age, sex, race, U.S. region, and pre-fracture chronic diseases. RESULTS Mean age (SD) at baseline was 56.7 (20.6) for adults with NDDs (n = 3749; 45.2% men) and 63.9 (19.2) for adults without NDDs (n = 585,910; 34.4% men). During the 12-month follow-up period, 182 adults with NDDs (mean age [SD] = 69.8 [14.7]; 46.2% men) and 25,456 adults without NDDs (mean age [SD] = 78.9 [9.8]; 38.3% men) died. Crude mortality rate was not different between adults with and without NDDs for any time points (e.g., 12-months: 5.40 vs. 4.96 per 100 person years; RR = 1.09; 95% CI = 0.94-1.26); however, it was greater for adults with intellectual disabilities compared to adults without NDDs (RR = 1.46; 95% CI = 1.23-1.79). After adjustments, adults with NDDs had greater post-fracture mortality rates for 3-, 6-, and 12-month time points (e.g., 12-months: HR = 1.46; 95% CI = 1.27-1.69). When stratified by the type of NDD, adults with intellectual disabilities and adults with autism spectrum disorders, but not adults with cerebral palsy, had greater 12-month post-fracture mortality risk. When stratified by fracture location, lower extremities were associated with greater crude mortality rate (RR = 1.69; 95% CI = 1.22-2.35) and adjusted mortality risk (HR = 2.41; 95% CI = 1.73-3.35), while upper extremities were associated with greater adjusted mortality risk (HR = 1.76; 95% CI = 1.23-2.50) for adults with vs. without NDDs. CONCLUSIONS Among privately insured adults with NDDs, low-trauma fracture is associated with greater mortality risk within 1 year of the fracture event, even after adjusting for pre-fracture chronic diseases. Study findings suggest the need for earlier fracture prevention strategies and improved post-fracture healthcare management.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Ann Arbor, MI 48109, United States of America.
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States of America; Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, 1540 E Hospital Dr., Ann Arbor, MI 48109, United States of America
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French ZP, Caird MS, Whitney DG. Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data. JBMR Plus 2019; 3:e10231. [PMID: 31768490 PMCID: PMC6874176 DOI: 10.1002/jbm4.10231] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/25/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Individuals with cerebral palsy (CP) have an increased risk for the early development of osteoporosis; however, little is known about the epidemiology of osteoporosis for adults with CP, which is vital to inform clinical practice for osteoporosis prevention, treatment, and management. The purpose of this cross-sectional study was to determine sex-stratified prevalence of osteoporosis among adults with CP, as compared with adults without CP. Data from 2016 were extracted from Optum Clinformatics Data Mart (private insurance administrative claims data) and a random 20% sample from the fee-for-service Medicare (public insurance administrative claims data). Diagnostic codes were used to identify CP and osteoporosis diagnoses. Sex-stratified prevalence of osteoporosis was compared between adults with and without CP for the following age groups: 18 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, and >70 years of age. The overall prevalence of osteoporosis was 4.8% for adults without CP (n = 8.7 million), 8.4% for privately insured adults with CP (n = 7,348), and 14.3% for publicly insured adults with CP (n = 21,907). Women and men with CP had a higher prevalence of osteoporosis compared with women and men without CP for all age groups. Finally, publicly insured women and men with CP had a higher prevalence of osteoporosis compared with privately insured women and men with CP for all age groups, except for the similar prevalence among the 18- to 30-year age group. These findings suggest that osteoporosis is more prevalent among adults with CP compared with adults without CP. Study findings highlight the need for earlier screening and preventive medical services for osteoporosis management among adults with CP. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Zachary P French
- Department of Physical Medicine and Rehabilitation, Michigan MedicineUniversity of MichiganAnn ArborMIUSA
- Department of Orthopedic Surgery, Michigan MedicineUniversity of MichiganAnn ArborMIUSA
| | - Michelle S Caird
- Department of Orthopedic Surgery, Michigan MedicineUniversity of MichiganAnn ArborMIUSA
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan MedicineUniversity of MichiganAnn ArborMIUSA
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMIUSA
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Whitney DG, Gross-Richmond P, Hurvitz EA, Peterson MD. Total and regional body fat status among children and young people with cerebral palsy: A scoping review. Clin Obes 2019; 9:e12327. [PMID: 31237080 DOI: 10.1111/cob.12327] [Citation(s) in RCA: 6] [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: 03/26/2019] [Revised: 05/07/2019] [Accepted: 06/03/2019] [Indexed: 12/14/2022]
Abstract
The purpose of our scoping review was to determine if children and young people with cerebral palsy (CP) have elevated total or regional body fat compared to children and young people without CP. Databases (Ovid MEDLINE, Embase Ovid, CINHAL and Scopus) were systematically searched from 1 January 1993 to 7 December 2018 in order to identify articles that compared weight status, total body fat or regional body fat (eg, abdominal) between children and young people (0-21 years) with and without CP. Extracted data included country, subject characteristics, group sample sizes and matching strategies, methods/measures for weight status/fat depot, fat depot(s) assessed and key findings. Twenty-two studies were included. Of these, 19 studies examined total body fat; the most common method was use of anthropometrics and the more common measures were body mass index and skin-fold thickness. Twelve studies examined at least one regional fat depot; the most common method was use of anthropometrics and the most common measure was skin-fold thickness. Findings were inconsistent across studies. Further, among 10 studies that examined total and regional body fat depots, 8 found differences across fat depots within the same children and young people (eg, no difference in total body fat but higher abdominal fat). This review provides a summary of inconsistent findings from published studies on body fat comparisons between children and young people with vs without CP, highlights limitations for evaluating body fat for children with CP and discusses future research directions.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Penina Gross-Richmond
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
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Whitney DG, Warschausky SA, Whibley D, Kratz A, Murphy SL, Hurvitz EA, Peterson MD. Clinical factors associated with mood affective disorders among adults with cerebral palsy. Neurol Clin Pract 2019; 10:206-213. [PMID: 32642322 DOI: 10.1212/cpj.0000000000000721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/25/2019] [Indexed: 12/21/2022]
Abstract
Objective To determine individual and aggregated associations of cerebral palsy (CP)-related symptoms and the effect of comorbid neurodevelopmental conditions on mood (affective) disorders among adults with CP. Methods Cross-sectional data from 2016 were extracted from a random 20% sample of the Medicare fee-for-service database. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes were used to identify 18- to -64-year-old beneficiaries with CP, as well as mood (affective) disorders, pain, sleep disorders, fatigue, and comorbid neurodevelopmental conditions (intellectual disabilities [ID], autism spectrum disorders [ASD], and epilepsy). Results Four thousand eight hundred twenty-three of the 17,212 adults with CP had mood (affective) disorders (28.0%). After adjusting for age, sex, and race, pain (odds ratio [OR] = 2.15; 99.5% confidence interval [CI] = 1.94-2.39), sleep disorders (OR = 2.43; 99.5% CI = 2.13-2.77), fatigue (OR = 1.38; 99.5% CI = 1.18-1.60), ID (OR = 1.47; 99.5% CI = 1.31-1.63), ASD (OR = 1.44; 99.5% CI = 1.16-1.80), and epilepsy (OR = 0.81; 99.5% CI = 0.73-0.91) were each associated with mood (affective) disorders. When pain, sleep disorders, and fatigue were presented as a count variable, the adjusted odds of mood (affective) disorders increased with the number of factors: 1 factor (OR = 1.99; 99.5% CI = 1.79-2.22), 2 factors (OR = 4.18; 99.5% CI = 3.58-4.89), and all 3 factors (OR = 7.38; 99.5% CI = 5.17-10.53). Conclusions Among young and middle-aged adults with CP, mood (affective) disorders were associated with pain, sleep disorders, and fatigue, and increasing co-occurrence of these factors further increased the likelihood of mood (affective) disorders. Further, comorbid neurodevelopmental conditions were also associated with mood (affective) disorders among adults with CP. Study findings could be used to improve screening strategies for mood (affective) disorders among adults with CP in the clinical setting.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Seth A Warschausky
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Anna Kratz
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Susan L Murphy
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK
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Whitney DG. Racial differences in skeletal fragility but not osteoarthritis among women and men with cerebral palsy. Bone Rep 2019; 11:100219. [PMID: 31417943 PMCID: PMC6690429 DOI: 10.1016/j.bonr.2019.100219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 02/04/2023] Open
Abstract
Background Adults with cerebral palsy (CP) have increased risk for skeletal fragility and osteoarthritis. However, racial differences in these outcomes have not been examined. Such knowledge could improve patient-specific clinical care for the prevention and management of these conditions. The purpose of this study was to determine if there were racial differences in the prevalence of osteoporosis, all-cause fracture, and osteoarthritis among young and middle-aged adults with CP. Methods Data from 2016 were extracted from a random 20% sample of the Medicare fee-for-service database. International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to identify 18-64 year olds with CP, as well as osteoporosis, all-cause fracture, osteoarthritis, and neurodevelopmental and noncommunicable disease comorbidities. Results Of the 16,488 adults with CP, 13,334 were White, 2477 were Black, and 677 were Hispanic. The age-standardized prevalence of osteoporosis (women: 12.9%, 9.0%, 8.3%, respectively; men: 9.2%, 4.8%, 7.9%, respectively) and fracture (women: 7.4%, 4.2%, 9.9%; men: 6.0%, 2.3%, 6.0%) was lower for Black adults with CP compared to White adults with CP (all p < 0.005). No racial differences were observed for age-standardized prevalence of osteoarthritis (women: 13.6%, 14.4%, 9.6%; men: 10.7%, 10.4%, 12.7%). The racial differences between Black and White adults with CP remained even after adjusting for age, U.S. region, neurodevelopmental comorbidities, and several noncommunicable diseases for osteoporosis (women: OR = 0.66, 99.5% CI = 0.48-0.91; men: OR = 0.51, 99.5% CI = 0.35-0.75) and fracture (women: OR = 0.57, 99.5% CI = 0.37-0.89; men: OR = 0.39, 99.5% CI = 0.23-0.68). Conclusions Study findings suggest racial differences in skeletal fragility among young and middle-aged adults with CP, with White women and men with CP having greater risk compared to Black women and men with CP. This study found no evidence of racial differences in the prevalence of osteoarthritis.
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Affiliation(s)
- Daniel G. Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI, United States of America
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Whitney DG, Alford AI, Devlin MJ, Caird MS, Hurvitz EA, Peterson MD. Adults with Cerebral Palsy have Higher Prevalence of Fracture Compared with Adults Without Cerebral Palsy Independent of Osteoporosis and Cardiometabolic Diseases. J Bone Miner Res 2019; 34:1240-1247. [PMID: 30730595 DOI: 10.1002/jbmr.3694] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/14/2019] [Accepted: 02/03/2019] [Indexed: 02/06/2023]
Abstract
Individuals with cerebral palsy (CP) have an increased risk of fracture throughout their lifespan based on an underdeveloped musculoskeletal system, excess body fat, diminished mechanical loading, and early development of noncommunicable diseases. However, the epidemiology of fracture among adults with CP is unknown. The purpose of this cross-sectional study was to determine the prevalence of fracture among a large sample of privately insured adults with CP, as compared with adults without CP. Data were from the Optum Clinformatics Data Mart (Eden Prairie, MN, USA), a deidentified nationwide claims database of beneficiaries from a single private payer. Diagnostic codes were used to identify 18- to 64-year-old beneficiaries with and without CP and any fracture that consisted of osteoporotic pathological fracture as well as any type of fracture of the head/neck, thoracic, lumbar/pelvic, upper extremity, and lower extremity regions. The prevalence of any fracture was compared between adults with (n = 5,555) and without (n = 5.5 million) CP. Multivariable logistic regression was performed with all-cause fracture as the outcome and CP group as the primary exposure. Adults with CP had a higher prevalence of all-cause fracture (6.3% and 2.7%, respectively) and fracture of the head/neck, thoracic, lumbar/pelvic, upper extremity, and lower extremity regions compared with adults without CP (all p < 0.01). After adjusting for sociodemographic and socioeconomic variables, adults with CP had higher odds of all-cause fracture compared with adults without CP (OR 2.5; 95% CI, 2.2 to 2.7). After further adjusting for cardiometabolic diseases, adults with CP had higher odds of all-cause fracture compared with adults without CP (OR 2.2; 95% CI, 2.0 to 2.5). After further adjusting for osteoporosis, adults with CP still had higher odds of all-cause fracture compared with adults without CP (OR 2.0; 95% CI, 1.8 to 2.2). These findings suggest that young and middle-aged adults with CP have an elevated prevalence of all-cause fracture compared with adults without CP, which was present even after accounting for cardiometabolic diseases and osteoporosis. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andrea I Alford
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Maureen J Devlin
- Department of Anthropology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Whitney DG, Kamdar NS, Ng S, Hurvitz EA, Peterson MD. Prevalence of high-burden medical conditions and health care resource utilization and costs among adults with cerebral palsy. Clin Epidemiol 2019; 11:469-481. [PMID: 31417318 PMCID: PMC6592066 DOI: 10.2147/clep.s205839] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/14/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose: Individuals with cerebral palsy (CP) are susceptible to early development of high-burden medical conditions, which may place a considerable strain on health care resources. However, little is known about the prevalence of high-burden medical conditions or health care resource utilization among adults with CP. The purpose of this study was to determine the prevalence of high-burden medical conditions and health care resource utilization and costs among adults with CP, as compared to adults without CP. Patients and methods: Cross-sectional data from the 2016 Optum Clinformatics® Data Mart, a de-identified nationwide claims database of beneficiaries from a single private payer in the US. ICD-10-CM diagnosis codes were used to identify all medical conditions among beneficiaries with and without CP who were between 18 and 64 years of age. Medical and outpatient pharmacy claims were used to identify annual all-cause health care resource utilization and health care costs as standardized reimbursement and patient out-of-pocket costs. Results: Adults with CP (n=5,555) had higher prevalence and odds of all medical conditions compared to adults without CP (OR=1.3–5.8; all P<0.05), except cancer (OR=1.1; 95% CI=0.9–1.3). Adults with CP had greater annual mean counts of all health care service types (eg, inpatient, emergency department) compared to adults without CP (all P<0.01). Adults with CP had higher unadjusted standardized reimbursement (mean difference=$16,288; cost ratio [CR]=3.0; 95% CI=2.9–3.1) and patient out-of-pocket (mean difference=$778; CR=1.7; 95% CI=1.6–1.7) costs compared to adults without CP. After adjusting for all prevalent medical conditions, adults with CP still had higher standardized reimbursement (CR=2.5; 95% CI=2.5–2.6) and patient out-of-pocket (CR=1.8; 95% CI=1.7–1.8) costs. Conclusion: Adults with CP have a higher prevalence of high-burden medical conditions, health care resource utilization, and health care costs compared to adults without CP. Study findings suggest the need for earlier screening strategies and preventive medical services to quell the disease and economic burden attributable to adults with CP.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Neil S Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sophia Ng
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Zarkou A, Lee SCK, Prosser LA, Hwang S, Jeka J. Stochastic resonance stimulation improves balance in children with cerebral palsy: a case control study. J Neuroeng Rehabil 2018; 15:115. [PMID: 30526617 PMCID: PMC6288963 DOI: 10.1186/s12984-018-0467-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background Stochastic Resonance (SR) Stimulation has been used to enhance balance in populations with sensory deficits by improving the detection and transmission of afferent information. Despite the potential promise of SR in improving postural control, its use in individuals with cerebral palsy (CP) is novel. The objective of this study was to investigate the immediate effects of electrical SR stimulation when applied in the ankle muscles and ligaments on postural stability in children with CP and their typically developing (TD) peers. Methods Ten children with spastic diplegia (GMFCS level I- III) and ten age-matched TD children participated in this study. For each participant the SR sensory threshold was determined. Then, five different SR intensity levels (no stimulation, 25, 50, 75, and 90% of sensory threshold) were used to identify the optimal SR intensity for each subject. The optimal SR and no stimulation condition were tested while children stood on top of 2 force plates with their eyes open and closed. To assess balance, the center of pressure velocity (COPV) in anteroposterior (A/P) and medial-lateral (M/L) direction, 95% COP confidence ellipse area (COPA), and A/P and M/L root mean square (RMS) measures were computed and compared. Results For the CP group, SR significantly decreased COPV in A/P direction, and COPA measures compared to the no stimulation condition for the eyes open condition. In the eyes closed condition, SR significantly decreased COPV only in M/L direction. Children with CP demonstrated greater reduction in all the COP measures but the RMS in M/L direction during the eyes open condition compared to their TD peers. The only significant difference between groups in the eyes closed condition was in the COPV in M/L direction. Conclusions SR electrical stimulation may be an effective stimulation approach for decreasing postural sway and has the potential to be used as a therapeutic tool to improve balance. Applying subject-specific SR stimulation intensities is recommended to maximize balance improvements. Overall, balance rehabilitation interventions in CP might be more effective if sensory facilitation methods, like SR, are utilized by the clinicians. Trial registration ClinicalTrials.gov identifier NCT02456376; 28 May 2015 (Retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT02456376.
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Affiliation(s)
- Anastasia Zarkou
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, 2020 Peachtree Rd NW, Atlanta, GA, 30309, USA.
| | - Samuel C K Lee
- Program in Biomechanics and Movement Science & Department of Physical Therapy, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA.,Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA, 19140, USA
| | - Laura A Prosser
- University of Pennsylvania & The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Sungjae Hwang
- Department of Kinesiology, University of Maryland Eastern Shore, William P. Hytche Center Room 1124, Princess Anne, MD, 21853, USA
| | - John Jeka
- Department of Kinesiology, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
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Taflampas G, Kilbride C, Levin W, Lavelle G, Ryan JM. Interventions to Improve or Maintain Lower-Limb Function Among Ambulatory Adolescents with Cerebral Palsy: A Cross-Sectional Survey of Current Practice in the UK. Phys Occup Ther Pediatr 2018; 38:355-369. [PMID: 29220616 DOI: 10.1080/01942638.2017.1400490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe physiotherapy management to improve or maintain lower-limb function among adolescents with cerebral palsy, classified in Gross Motor Function Classification System levels I-III, in the United Kingdom (UK). METHODS A list of interventions was identified using a nominal group technique and developed into a survey, which was distributed to approximately 2,100 pediatric physiotherapists in the UK through the Association of Pediatric Chartered Physiotherapists and a private physiotherapy clinic in London between April and June 2015. One-hundred and thirty-five physiotherapists completed the survey. Survey respondents indicated how frequently they used each intervention (i.e., "frequently," "sometimes," "rarely," and "never") in the past year. RESULTS Provision of explanations to the child, liaison with families, liaison with health professionals, provision of advice to schools, and stretching were the most frequently used interventions with 90%, 90%, 86%, 79%, and 76% of respondents, respectively, reporting that they frequently used each. The interventions most commonly reported as "never" used were conductive education (88%), MOVE programme (85%), functional electrical stimulation (82%), body-weight supported treadmill training (80%), and rebound therapy (71%). CONCLUSIONS This study suggests that a large number of interventions are used by physiotherapists in the United Kingdom to improve or maintain lower-limb function among adolescents with CP, not all of which are evidence-based.
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Affiliation(s)
- Gerasimos Taflampas
- a Department of Clinical Sciences , Brunel University London , Kingston Lane, Uxbridge , UK
| | - Cherry Kilbride
- a Department of Clinical Sciences , Brunel University London , Kingston Lane, Uxbridge , UK
| | - Wendy Levin
- b Swiss Cottage School Development and Research Centre, Royal Free London NHS Foundation Trust , Camden , UK
| | - Grace Lavelle
- a Department of Clinical Sciences , Brunel University London , Kingston Lane, Uxbridge , UK
| | - Jennifer M Ryan
- a Department of Clinical Sciences , Brunel University London , Kingston Lane, Uxbridge , UK
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Whitney DG, Hurvitz EA, Devlin MJ, Caird MS, French ZP, Ellenberg EC, Peterson MD. Age trajectories of musculoskeletal morbidities in adults with cerebral palsy. Bone 2018; 114:285-291. [PMID: 29981509 DOI: 10.1016/j.bone.2018.07.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/29/2018] [Accepted: 07/04/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Individuals with cerebral palsy (CP) are at an increased risk for age-related morbidities due to functional impairments, maladapted growth, and altered body composition. While musculoskeletal (MSK) deficits are present in children, little is understood about MSK morbidity throughout the lifespan in those with CP. The purpose of this study was to examine the age-related trajectories of MSK morbidity and multimorbidity throughout adulthood in those with CP. METHODS A clinic-based sample of adults with CP (n = 1395; ≥18 years) was examined to determine prevalence of MSK morbidities at the University of Michigan Medical Center. Logistic regression was used to determine the effects of age on individual MSK morbidities and multimorbidity (i.e., ≥2 morbidities) after adjusting for sex, race, weight, and smoking. RESULTS With the 18-30 year age group as the reference, the adjusted odds of osteopenia was lower in the 41-50 and >50 year age groups, the odds of osteoporosis and rheumatoid arthritis was higher in 41-50 and >50 year age groups, and the odds of osteoarthritis was higher in 31-40, 41-50, and >50 year age groups. The adjusted odds of MSK multimorbidity increased substantially with increasing age for 31-40 year olds (OR: 1.919; 95% CI 1.05-3.52), 41-50 year olds (OR: 4.30; 95% CI 2.40-7.69), and >50 year olds (OR: 6.05; 95% CI 3.56-10.27). CONCLUSIONS Adults with CP are at high risk for MSK morbidities across all ages. Future studies are needed to examine the global aging trajectories of MSK health among adults with CP. Study findings highlight the importance of maximizing MSK accretion, and developing programs to assist individuals with CP and their caregivers to maintain MSK mass and function throughout the lifespan.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Maureen J Devlin
- Department of Anthropology, University of Michigan, 101 West Hall, 1085 S. University Ave., Ann Arbor, MI 48109, United States
| | - Michelle S Caird
- Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, 1540 E Hospital Dr., Ann Arbor, MI 48109, United States
| | - Zachary P French
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Elie C Ellenberg
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States.
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Chiu HC, Ada L, Bania TA, Johnston LM. Mechanically-assisted walking training for children with cerebral palsy. Hippokratia 2018. [DOI: 10.1002/14651858.cd013114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hsiu-Ching Chiu
- I-Shou University; Department of Physical Therapy; Kaohsiung Taiwan
| | - Louise Ada
- The University of Sydney; Discipline of Physiotherapy; Cumberland Campus PO Box 170 Lidcombe New South Wales Australia 1825
| | - Theofani A Bania
- TEI of Western Greece; Department of Physiotherapy; Psaron 6 Myrtia Aigio Greece 25100
| | - Leanne M Johnston
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Australia 4072
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Verschuren O, Smorenburg AR, Luiking Y, Bell K, Barber L, Peterson MD. Determinants of muscle preservation in individuals with cerebral palsy across the lifespan: a narrative review of the literature. J Cachexia Sarcopenia Muscle 2018; 9:453-464. [PMID: 29392922 PMCID: PMC5989853 DOI: 10.1002/jcsm.12287] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/23/2017] [Accepted: 01/07/2018] [Indexed: 12/16/2022] Open
Abstract
In individuals with cerebral palsy (CP), smaller muscle and atrophy are present at young age. Many people with CP also experience a decline in gross motor function as they age, which might be explained by the loss of muscle mass. The clinical observation of muscle wasting has prompted a comparison with sarcopenia in older adults, and the term accelerated musculoskeletal ageing is often used to describe the hallmark phenotype of CP through the lifespan. However, there has been very little research emphasis on the natural history of ageing with CP and even less with respect to the determinants or prevention of muscle loss with CP. Considering the burgeoning interest in the science of muscle preservation, this paper aims to (i) describe the characteristics of accelerated musculoskeletal ageing in people with CP, (ii) describe the pathophysiology of sarcopenia and parallels with CP, and (iii) discuss possible therapeutic approaches, based on established approaches for sarcopenia.
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Affiliation(s)
- Olaf Verschuren
- Brain Center Rudolf Magnus, Center of Excellence for Rehabilitation Medicine, De Hoogstraat RehabilitationUniversity Medical Center UtrechtRembrandtkade 10Utrecht3583TMThe Netherlands
| | | | - Yvette Luiking
- Nutricia ResearchAdvanced Medical NutritionUtrechtThe Netherlands
| | - Kristie Bell
- Child Health Research CentreThe University of QueenslandBrisbaneAustralia
- Lady Cilento Children's HospitalSouth BrisbaneQueenslandAustralia
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Mark D. Peterson
- Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMIUSA
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Abstract
OBJECTIVES To investigate whether balance and mobility training at home using Wii Fit is feasible and can provide clinical benefits. DESIGN Single-group, pre-post intervention study. SETTING Participants' home. PARTICIPANTS 20 children with cerebral palsy (6-12 years). INTERVENTION Participants undertook 8 weeks of home-based Wii Fit training in addition to usual care. MAIN MEASURES Feasibility was determined by adherence, performance, acceptability and safety. Clinical outcomes were strength, balance, mobility and participation measured at baseline (preintervention) and 8 weeks (postintervention). RESULTS The training was feasible with 99% of training completed; performance on all games improved; parents understood the training (4/5), it did not interfere in life (3.8/5), was challenging (3.9/5) and would recommend it (3.9/5); and there were no injurious falls. Strength increased in dorsiflexors (Mean Difference (MD) 2.2 N m, 95% CI 1.1 to 3.2, p<0.001), plantarflexors (MD 2.2 N m, 95% CI 1.3 to 3.1, p<0.001) and quadriceps (MD 7.8 N m, 95% CI 5.2 to 10.5, p<0.001). Preferred walking speed increased (MD 0.25 m/s, 95% CI 0.09 to 0.41, p<0.01), fast speed increased (MD 0.24 m/s, 95% CI 0.13 to 0.35, p<0.001) and distance over 6 min increased (MD 28 m, 95% CI 10 to 45, p<0.01). Independence in participation increased (MD 1.4 out of 40, 95% CI 0.0 to 2.8, p=0.04). CONCLUSIONS Balance and mobility training at home using Wii Fit was feasible and safe and has the potential to improve strength and mobility, suggesting that a randomised trial is warranted. TRIAL REGISTRATION NUMBER ACTRN12616001362482.
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Affiliation(s)
- Hsiu-Ching Chiu
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Shin-Da Lee
- Department of Occupational Therapy, Asia University, Taichung, Taiwan
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
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Whitney DG, Hurvitz EA, Ryan JM, Devlin MJ, Caird MS, French ZP, Ellenberg EC, Peterson MD. Noncommunicable disease and multimorbidity in young adults with cerebral palsy. Clin Epidemiol 2018; 10:511-519. [PMID: 29750055 PMCID: PMC5935087 DOI: 10.2147/clep.s159405] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Individuals with cerebral palsy (CP) are at increased risk for frailty and chronic disease due to factors experienced throughout the lifespan, such as excessive sedentary behaviors and malnutrition. However, little is known about noncommunicable diseases (NCDs) and multimorbidity profiles in young adults with CP. The study objective was to compare NCD and multimorbidity profiles between young adults with and without CP. Methods A clinic-based sample of adults (18-30 years) with (n=452) and without (n=448) CP was examined at the University of Michigan Medical Center. The prevalence and predictors of 13 NCDs were evaluated, including existing diagnoses or historical record of musculoskeletal, cardiometabolic, and pulmonary morbidities. The level of motor impairment was determined by the Gross Motor Function Classification System (GMFCS) and stratified by less vs more severe motor impairment (GMFCS I-III vs IV-V). Logistic regression was used to determine the odds of NCD morbidity and multimorbidity in adults with CP compared to adults without CP, and for GMFCS IV-V compared to GMFCS I-III in those with CP, after adjusting for age, sex, body mass index, and smoking. Results Adults with CP had a higher prevalence of osteopenia, osteoporosis, hypertension, myocardial infarction, hyperlipidemia, asthma, and multimorbidity compared to adults without CP, and higher odds of musculoskeletal (odds ratio [OR]: 6.97) and cardiometabolic morbidity (OR: 1.98), and multimorbidity (OR: 2.67). Adults with CP with GMFCS levels IV-V had a higher prevalence of osteopenia/osteoporosis, osteoarthritis, hypertension, other cardiovascular conditions, pulmonary embolism, and multimorbidity, and higher odds of musculoskeletal (OR: 3.41), cardiometabolic (OR: 2.05), pulmonary morbidity (OR: 1.42), and multimorbidity (OR: 3.45) compared to GMFCS I-III. Conclusion Young adults with CP have a higher prevalence of chronic NCDs and multimorbidity compared to young adults without CP, which is pronounced in those with more severe motor impairment. These findings reiterate the importance of early screening for prevention of NCDs in CP.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer M Ryan
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Clinical Sciences, Brunel University London, Uxbridge, UK
| | - Maureen J Devlin
- Department of Anthropology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Zachary P French
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elie C Ellenberg
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Lundh S, Nasic S, Riad J. Fatigue, quality of life and walking ability in adults with cerebral palsy. Gait Posture 2018; 61:1-6. [PMID: 29277025 DOI: 10.1016/j.gaitpost.2017.12.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/12/2017] [Accepted: 12/15/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Few studies on fatigue, quality of life and walking ability in adults with cerebral palsy (CP) are available. It is unclear whether these variables are associated. AIM The aim was to study the influence of CP on fatigue, quality of life, and gait of adult patients. MATERIAL AND METHODS Three-dimensional gait analysis was performed on 24 women and 26 men, mean age 32.1 (range 21.7-67.2), 23 with unilateral and 27 with bilateral CP. The Gait Profile Score was calculated; Fatigue Severity and EQ Visual Analogue scales were used. RESULTS Fatigue severity was higher than in controls, mean 3.8 (SD 1.8) vs 3.0 (p = 0.012). Fatigue in the unilateral group was 3.3 (SD 1.8) and in the bilateral 4.2 (SD 1.7), (p = 0.07). EQ Visual Analogue scale in the unilateral group was mean 79.5 (21.9) and in the bilateral 64.0 (20.8), p = 0.007. The group with bilateral CP tended toward crouch gait, decreased balance and low walking speed. Muscle work was shifted from the ankle to hip muscles. Fatigue correlated with the Gait Profile Score, CC = 0.31 (p = 0.038), and with knee flexion deviation, CC = 0.31 (p = 0.037). DISCUSSION Crouch gait, increased knee flexion in stance, contributes to increased deviation in the lower extremity associated with high fatigue and low quality of life in adults with CP, effects more pronounced in those with bilateral CP. Compensation mechanisms in gait were noted. CONCLUSION Rational follow-up programs for CP, ideally identifying risk factors early, should be established to prevent development of fatigue and deterioration of gait in adulthood.
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Affiliation(s)
- Sofia Lundh
- Skaraborg Gait Analysis Laboratory, Skaraborg Hospital Skövde, 541 85 Skövde, Sweden.
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital Skövde, 541 85 Skövde, Sweden.
| | - Jacques Riad
- Dept Orthopaedics, Skaraborg Hospital Skövde, 541 85 Skövde, Sweden.
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de la Torre-Olivares R, Moreno-Lorenzo C, Pérez-Mármol JM, Cabrera-Martos I, Villaverde-Gutierrez C, Sánchez AMC, Aguilar-Ferrándiz ME. Evaluation of Functional Status Associated With Overweight in Adults With Cerebral Palsy. Rehabil Nurs 2018. [DOI: 10.1002/rnj.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Noble JJ, Chruscikowski E, Fry NRD, Lewis AP, Gough M, Shortland AP. The relationship between lower limb muscle volume and body mass in ambulant individuals with bilateral cerebral palsy. BMC Neurol 2017; 17:223. [PMID: 29284423 PMCID: PMC5747099 DOI: 10.1186/s12883-017-1005-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/11/2017] [Indexed: 12/25/2022] Open
Abstract
Background Individuals with cerebral palsy have smaller muscle volumes normalised to body mass than their typically developing peers. The aim of this study is to investigate the relationship between lower limb muscle volume and body mass in young people with bilateral cerebral palsy and their typically developing peers. Methods Twenty-five participants with bilateral cerebral palsy (aged 14.7±3.0 years, GMFCS level I-III) and 25 of their typically developing peers (aged 16.8±3.3 years) took part in this study. None of the participants had undergone orthopaedic surgery, botulinum toxin injections, or serial casting in the previous year. All participants underwent magnetic resonance imaging of both lower limbs. Nine major muscles of each lower limb were individually manually segmented and the muscle volumes calculated. Results Body mass and total lower limb muscle volume were significantly linearly related in both the cerebral palsy (R2 = 0.75, p<0.001) and typically developing (R2 = 0.77, p<0.001) groups. The slope of the relationship between muscle volume and body mass was significantly shallower in the cerebral palsy group compared to the typically developing group (p=0.007). Conclusions This cross-sectional study suggests that the increase in size of lower limb muscles relative to body mass is reduced in adolescents and young adults with cerebral palsy. Longitudinal studies are required to further investigate altered muscle growth trajectories in this group and their impact on long-term mobility. Electronic supplementary material The online version of this article (10.1186/s12883-017-1005-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan J Noble
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK. .,Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK.
| | - Emily Chruscikowski
- Department of Medical Engineering and Physics, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Nicola R D Fry
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK
| | - Andrew P Lewis
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Martin Gough
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK
| | - Adam P Shortland
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
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Daunter AK, Kratz AL, Hurvitz EA. Long-term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case-control study. Dev Med Child Neurol 2017; 59:1089-1095. [PMID: 28617943 PMCID: PMC5610610 DOI: 10.1111/dmcn.13481] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
Abstract
AIM Selective dorsal rhizotomy (SDR) is a surgical treatment for spasticity in children with cerebral palsy (CP). Studies suggest long-lasting effects of SDR on spasticity; long-term effects on symptoms and function are not clear. This study tested whether adults with CP (average 22y after SDR) report less pain, fatigue, and functional decline than a retrospectively assessed non-surgical comparison group. METHOD This was a case-control study. Eighty-eight adults with CP (mean age 27y; SDR=38 male/female/missing=20/16/2; non-surgical [comparison]=50, male/female=19/31) recruited from a tertiary care center and the community completed a battery of self-reported outcome measures. Regression models were used to test whether SDR status predicted pain, fatigue, functional change, and hours of assistance (controlling for Gross Motor Function Classification System level). RESULTS SDR status did not significantly predict pain interference (p=0.965), pain intensity (p=0.512), or fatigue (p=0.404). SDR related to lower decline in gross motor functioning (p=0.010) and approximately 6 fewer hours of daily assistance than for those in the comparison group (p=0.001). INTERPRETATION Adults with CP who had SDR in childhood reported less gross motor decline and fewer daily assistance needs than non-surgically treated peers, suggesting the functional impact of SDR persists long after surgery.
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Affiliation(s)
- Alecia K Daunter
- Department of Physical Medicine & Rehabilitation University of Michigan Medical School Ann Arbor MI USA
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation University of Michigan Medical School Ann Arbor MI USA
| | - Edward A Hurvitz
- Department of Physical Medicine & Rehabilitation University of Michigan Medical School Ann Arbor MI USA
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Himuro N, Nishibu H, Abe H, Mori M. The criterion validity and intra-rater reliability of the Japanese version of the Functional Mobility Scale in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 68:20-26. [PMID: 28735158 DOI: 10.1016/j.ridd.2017.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/21/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The purpose of this study was to develop a Japanese version of the Functional Mobility Scale (FMS), and examine the criterion validity and intra-rater reliability of the FMS in Japan. METHODS The translation of the FMS was performed according to international standards for the translation of measurements. For criterion validity, 111 children with cerebral palsy (mean age; 12year 1mo±3year 7mo; range 5-18) were rated the Japanese version of the FMS and Gross Motor Function Classification System (GMFCS). For intra-rater reliability, the Japanese version of the FMS was rated twice by 24 parents of children with cerebral palsy by interview and/or telephone with a one- to two-week interval between assessments. RESULTS The criterion validity was confirmed with a strong correlation between GMFCS level and FMS scores (r2=-0.71 to -0.75). For intra-rater reliability, there was a substantial to excellent level of agreement (kappa=0.72-0.87). CONCLUSION The study provides evidence of the criterion validity and intra-rater reliability of the Japanese version of the FMS as a measurement of mobility in children with cerebral palsy.
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Affiliation(s)
- Nobuaki Himuro
- Department of Public Health, School of Medicine, Sapporo Medical University, Sapporo, Japan.
| | - Hisato Nishibu
- Division of Rehabilitation Medicine, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Hirokazu Abe
- Department of Health Care and Child Development, Saitama Children's Medical Center, Saitama, Japan
| | - Mitsuru Mori
- Department of Public Health, School of Medicine, Sapporo Medical University, Sapporo, Japan
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