Bike skills training for children with cerebral palsy: protocol for a randomised controlled trial

Subjective measurement of physical activity and sedentary behaviour in children and adolescents with cerebral palsy: a scoping review

PURPOSE

Physical activity is essential for maintaining overall health. Cost-effective and easily administered outcome instruments are valuable for clinical practice and large-scale population studies. The scoping review aimed to identify and map subjective instruments developed or validated to measure habitual physical activity and/or sedentary behaviour in children and adolescents with cerebral palsy aged 0-18 years across all levels of the GMFCS-E&R.

MATERIALS AND METHODS

This scoping review was conducted in accordance with the JBI methodology for scoping reviews and searched the databases PubMed, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, JBI Database of Systematic Reviews and Implementation Reports, Embase and Pedro to identify articles.

RESULTS

From 288 full-text references, 13 studies met the inclusion criteria. Nine instruments measured habitual physical activity and/or sedentary behaviour in children and adolescents with cerebral palsy aged 18 months to 18 years. Six subjective instruments were tested for ambulatory children, while three instruments were tested in children and adolescents at GMFCS-E&R level I-V.

CONCLUSION AND IMPLICATIONS

Reporting of the psychometric properties were found on reliability in three instruments, while data on validity were reported in all instruments. Further studies assessing the psychometric properties of subjective instruments in the target population are needed.

Task-specific training for bicycle-riding goals in ambulant children with cerebral palsy: a randomized controlled trial

AIM

To determine whether a task-specific physiotherapist-led training approach is more effective than a non-specific parent-led home programme for attaining bicycle-riding goals in ambulant children with cerebral palsy (CP).

METHOD

Sixty-two ambulant children with CP aged 6 to 15 years (33 males, 29 females, mean age 9y 6mo) with bicycle-riding goals participated in this multi-centre, assessor-blind, parallel-group, superiority randomized controlled trial. Children in the task-specific group participated in a physiotherapist-led, group-based, intensive training programme. Children in the parent-led home group were provided with a practice schedule, generic written information, and telephone support. Both programmes involved a 1-week training period. The primary outcome was goal attainment at 1 week after training measured using the Goal Attainment Scale. Secondary outcomes included bicycle skills, participation in bicycle riding, functional skills, self-perception, physical activity, and health-related quality of life at 1 week and 3 months after training.

RESULTS

Children in the task-specific training group had greater odds of goal attainment than those in the parent-led home programme at 1 week after intervention (odds ratio [OR] 10.4, 95% confidence interval [CI] 2.8-38.6), with evidence for superiority retained at 3 months (OR 4.0, 95% CI 1.3-12.5).

INTERPRETATION

The task-specific physiotherapist-led training approach was more effective for attaining bicycle-riding goals than a non-specific parent-led home programme in ambulant children with CP.

Effect of Physical Guidance on Learning a Tracking Task in Children with Cerebral Palsy

The purpose of this study was to investigate the effect of physical guidance (PG) frequency on learning a tracking task in children with hemiplegic spastic cerebral palsy (CP). For this purpose, 25 children, aged 7–15 years with CP affecting the left side of the body, who were classified in levels II–III of Manual Abilities Classification System (MACS) and levels III–IV of Gross Motor Function Classification System (GMFCS), were recruited from 10 clinical centers. A pre-test including two blocks of 12 trials of the tracking task without any PG was performed by all participants, after that they were assigned into five homogenous groups (with 100%, 75%, 50%, 25%, and 0% of PG) through blocked randomization according to their age. All participants involved in an intervention consisted of eight sessions (four blocks of 12 trials in each session) practicing a tracking task. The 0% PG group received no PG, the 25% PG group received PG for three trials, the 50% PG group received PG for six trials, the 75% PG group received PG for nine trials, and the 100% PG group received PG for all twelve trials. PG consisted of placing the experimenter’s hand around the child’s less-involved hand guiding to stay on the track and complete the task. Learning was inferred by acquisition and delayed retention tests. The results showed that the higher frequency of PG led to more accurate performance during practice phase. However, the group that received 75% PG had significantly better performance compared to the other groups in the retention phase. It is concluded that optimum level of PG, about 75% of trials, can be helpful for learning a tracking task in children with spastic hemiplegic CP, supporting the challenge point framework.

Intensive treadmill training promotes cognitive recovery after cerebral ischemia-reperfusion in juvenile rats

Rehabilitation training is routine for children who experience stroke, but its protective mechanism remains unclear. To study the effect of treadmill training intensity on hippocampal synaptic plasticity after cerebral ischemia, a model of middle cerebral artery occlusion (MCAO)/reperfusion was established in young rats to simulate childhood ischemic stroke. The rats were randomly allocated into five groups: sham operation, MCAO, low-intensity exercise and MCAO (5 m/min), medium-intensity exercise and MCAO (10 m/min), and high-intensity exercise and MCAO (15 m/min). Intervention was continued for 14 days, and a series of experimental tests were conducted. After MCAO, the juvenile rats exhibited a series of morphological and functional alterations, including changes in their neurobehavior and cerebral infarct volumes. Compared with control rats, MCAO rats had a longer escape latency and crossed fewer platforms in the water maze test and exhibited decreased hippocampal neuron density and Synapsin I and PSD95 expression. Furthermore, MCAO rats exhibited synapse morphology changes and abnormal serum levels of lactic acid and corticosterone. Treadmill training effectively reduced the neurobehavioral scores and cerebral infarction volumes, with medium-intensity training showing the best effect. Treadmill training shortened the escape latency, increased the number of platform crossings, and improved the spatial cognitive abilities of the rats, with the medium intensity training having the best effect on spatial learning/memory efficiency. Treadmill training increased the neuron density in the hippocampus, with the medium-intensity training resulting in the highest density. Treadmill training had a positive effect on the expression of Synapsin I and PSD95, with the medium-intensity training showing the strongest effect. Treadmill training improved the sub-microstructure synapse morphology, with the medium-intensity training demonstrating the best effect. Treadmill training increased the plasma levels of lactic acid and corticosterone, with the high-intensity training having the most obvious effect. Treadmill training can provide neuroprotection by promoting hippocampal synaptic plasticity, with medium-intensity training showing the most optimal effects.