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Rubsam M, Hohl K, Smaller K, Lopez G, Rafferty M. Integrating Heart Rate Monitoring Into a Camp for Children With Neuromotor Disorders: A Case Series. Pediatr Phys Ther 2024:00001577-990000000-00103. [PMID: 39074207 DOI: 10.1097/pep.0000000000001134] [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] [Indexed: 07/31/2024]
Abstract
PURPOSE This case series investigated the implementation fidelity, feasibility, and effectiveness of integrating continuous heart rate monitoring with visual feedback into an established, intensive physical therapy camp for children with neuromotor disorders. SUMMARY OF KEY POINTS The provision of continuous visual feedback through color-coded, individually calculated heart rate zones was a feasible and effective intervention, encouraging pediatric gait camp participants to exercise at intensities that produced aerobic and functional gains. The use of technology facilitated participation with peers, an outcome equally as important as their endurance and functional improvements. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE Pediatric physical therapists play a crucial role in enhancing the well-being and physical fitness of children with disabilities. Encouraging regular exercise in a social environment fosters enjoyable, inclusive experiences while promoting overall health. It is important for clinicians in various pediatric rehabilitation settings to establish programs that offer such opportunities for children with neuromotor disorders.
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Affiliation(s)
- Meaghan Rubsam
- Shirley Ryan AbilityLab (Dr Rubsam, Dr Hohl, Mr Smaller, Dr Lopez, and Dr Rafferty), Chicago, Illinois; Ph.D. Program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences (Dr Rubsam), University of Illinois, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science (Dr Rafferty), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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de Sousa Junior RR, Sousa AB, de Lima AFB, de Barros Santos-Rehder R, Simão CR, Fischer G, Camargos ACR, Clutterbuck GL, Leite HR. Intervenções de esportes modificados para crianças e adolescentes com deficiência: Uma revisão de escopo. Dev Med Child Neurol 2024. [PMID: 38831546 DOI: 10.1111/dmcn.15963] [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: 11/28/2024] [Accepted: 04/05/2024] [Indexed: 06/05/2024]
Abstract
Resumo gráfico: Intervenções de esportes modificados para crianças e adolescentes com deficiência: Uma revisão de escopo.
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Affiliation(s)
| | - Alice Bustamante Sousa
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Arthur Felipe Barroso de Lima
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | | | - Gabriela Fischer
- Departamento de Educação Física, Universidade Federal de Santa Catarina, Florianopolis, SC, Brasil
| | - Ana Cristina Resende Camargos
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Georgina L Clutterbuck
- Escola de Ciências da Saúde e Reabilitação, The University of Queensland, Brisbane, QLD, Australia
| | - Hércules Ribeiro Leite
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Tauro R, Ganesh S, Vincent JG. Effect of Cardiovascular Endurance Training on the Exercise Capacity and Endurance in Children With Cerebral Palsy. Cureus 2024; 16:e61595. [PMID: 38962640 PMCID: PMC11221492 DOI: 10.7759/cureus.61595] [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] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Cerebral palsy (CP) is non-progressive brain damage that occurs before, during, or shortly after birth. CP is associated with poor physical fitness, which is linked to health problems and the development of secondary illnesses like obesity, cardiovascular disease, and diabetes. Compared to healthy peers without CP, children with CP have considerably lower VO2 peaks, which reduces their performance and aerobic capacity. OBJECTIVE This study aimed to evaluate changes in exercise capacity and endurance among children with CP, as well as fatigue levels among their parents and caregivers, after participation in cardiovascular endurance training. METHODOLOGY This study included 16 children aged 7-12 years with CP (Gross Motor Function Classification System levels I, II, or III). Participants completed a 12-week cardiovascular endurance program consisting of 60-minute sessions three times weekly designed to achieve 64-95% of their heart rate maximum,based on the American College of Sports Medicine guidelines. Pre- and post-intervention measurements were recorded for the following: distance covered in a six-minute walk, maximal oxygen consumption (VO2 max) level, Early Activity Scale for Endurance rating, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Fatigue Scale score and PROMIS Parent Proxy Scale and Fatigue Scale scores. Result: Upon completing the cardiovascular endurance training, the distance covered during a six-minute walk improved by 20.95 points, resting heart rate by 5.19 points, VO2 max by 0.06 points, Early Activity Scale for Endurance by 4.06 points, PROMIS Pediatric Fatigue Scale by 7.29 points, PROMIS Parent Proxy Scale by 6.81 points, and PROMIS Fatigue Scale by 5.07 points. The maximum heart rate also showed a slight improvement of 0.33 points (p<0.01). CONCLUSION A structured exercise protocol aimed at improving cardiovascular endurance can benefit children with CP by improving their exercise capacity and endurance, which in turn can help decrease fatigue levels among their parents and caregivers.
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Affiliation(s)
- Rochelle Tauro
- Physiotherapy, St. John's Medical College, Bangalore, IND
| | - Sankar Ganesh
- Physiotherapy, St. John's Medical College, Bangalore, IND
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de Sousa Junior RR, Sousa AB, de Lima AFB, de Barros Santos-Rehder R, Simão CR, Fischer G, Camargos ACR, Clutterbuck GL, Leite HR. Modified sports interventions for children and adolescents with disabilities: A scoping review. Dev Med Child Neurol 2024. [PMID: 38736257 DOI: 10.1111/dmcn.15952] [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: 11/28/2023] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 05/14/2024]
Abstract
AIM To establish the scope of the literature on modified sports interventions for children and adolescents with disabilities. METHOD For this scoping review, articles were screened and the characteristics of studies were extracted. The modified sports interventions were described in terms of their structure, using the items of the Template for Intervention Description and Replication. Components of intervention treatment were described by using the language of the Rehabilitation Treatment Specification System. Results were analysed and validated by a group of professionals, using the Public and Patient Involvement strategy. RESULTS Twelve studies were eligible for inclusion, investigating interventions for children with autism spectrum disorder, cerebral palsy, and other conditions. Most studies presented a moderate level of evidence. Active ingredients were repeated sports-related motor training and introduction to the sport through a 'learning by action' mechanism. The intervention target was gross motor skills performance, and intervention aims (indirect outcomes) were physical activity participation and different body functions. INTERPRETATION The inclusion of stakeholders in this review helped to validate our findings about the characteristics and structure of modified sports interventions, to identify research gaps, and to provide a step process for clinical implementation. Future investigations are warranted of the effectiveness of modified sports investigations with better quality studies, including participation outcomes and studies with non-ambulant children.
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Affiliation(s)
- Ricardo Rodrigues de Sousa Junior
- School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alice Bustamante Sousa
- School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Arthur Felipe Barroso de Lima
- School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Gabriela Fischer
- Department of Physical Education, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Ana Cristina Resende Camargos
- School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Georgina L Clutterbuck
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Hércules Ribeiro Leite
- School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Valadão P, Cenni F, Piitulainen H, Avela J, Finni T. Effects of the EXECP Intervention on Motor Function, Muscle Strength, and Joint Flexibility in Individuals with Cerebral Palsy. Med Sci Sports Exerc 2024; 56:1-12. [PMID: 37565430 DOI: 10.1249/mss.0000000000003273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
PURPOSE Numerous exercise interventions to enhance motor function in cerebral palsy (CP) have been proposed, with varying degrees of effectiveness. Because motor function requires a combination of muscle strength, joint flexibility, and motor coordination, we designed a supervised multicomponent exercise intervention (EXErcise for Cerebral Palsy, or EXECP) for individuals with CP. Our aim was to evaluate the effects of the EXECP intervention and its retention after it ceased. METHODS The EXECP intervention combined strength training for the lower limbs and trunk muscles, passive stretching for the lower limb muscles, and inclined treadmill gait training. Eighteen participants with CP (mean age, 14 yr; 13 were male) were tested twice before the 3-month intervention and twice after the intervention, each test separated by 3 months. Seventeen typically developing age- and sex-matched controls were tested twice. Motor function was assessed with the 6-min walking test (6MWT) and the gross motor function measure dimensions D and E. Passive joint flexibility was measured with goniometry. Isometric and concentric muscle strength were assessed at the knee, ankle, and trunk joints. RESULTS The EXECP intervention successfully increased 6MWT ( P < 0.001), gross motor function measure ( P = 0.004), and muscle strength for knee and trunk muscles ( P < 0.05), although no changes were observed for ankle joint muscles. Hip and knee joint flexibility also increased ( P < 0.05). After the retention period, all tested variables except the 6MWT and knee joint flexibility regressed and were not different from the pretests. CONCLUSIONS The improvements in strength, flexibility, and possibly motor coordination brought by the EXECP intervention were transferred to significant functional gains. The regression toward baseline after the intervention highlights that training must be a lifelong decision for individuals with CP.
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Affiliation(s)
- Pedro Valadão
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - Francesco Cenni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | | | - Janne Avela
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - Taija Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
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Abid M, Cherni Y, Batcho CS, Traverse E, Lavoie MD, Mercier C. Facilitators and barriers to participation in physical activities in children and adolescents living with cerebral palsy: a scoping review. Disabil Rehabil 2023; 45:4322-4337. [PMID: 36447398 DOI: 10.1080/09638288.2022.2150327] [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: 05/27/2022] [Accepted: 11/05/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE This scoping review aimed to synthetize personal and environmental facilitators and barriers to participation in physical activities among youths living with cerebral palsy. METHODS A systematic literature search was performed in five databases: CINAHL, EMBASE, MEDLINE, PsycINFO, Cochrane, WEB OF SCIENCE. The studies were selected by two independent researchers based on inclusion and exclusion criteria. A semi-quantitative evaluation assessed the consistency of results for a given variable. Variables displaying consistent associations were classified based on the Physical Activity for people with Disability Model. RESULTS The electronic search yielded 10 795 articles, of which 57 were included. The main barriers to physical activity identified were motor impairments (30 studies), older age (15 studies), pain (6 studies), attendance in regular school (6 studies), and communication problems (4 studies). Barriers such as upper limb impairment and visual deficit were less frequently studied, while cognitive attributes, adapted physical environments and positive attitude, and family support were identified as facilitators. CONCLUSION Personal and environmental factors influencing physical activities behaviors among youths living with cerebral palsy are multiple and complex since they interact with each other. Rehabilitation interventions need to adopt a person-based approach to address barriers and reinforce facilitators.IMPLICATIONS FOR REHABILITATION:Physical activity participation among youths with cerebral palsy is a multidimensional phenomenon, dependent on different personal and environmental factors.Gross motor impairments, communication problems, and pain were the most common personal factors limiting physical activity participation.Environmental factors consistently associated with physical activity participation were school settings, physical environment such as transportation, and social and family support and attitude.Rehabilitation interventions to promote an active lifestyle should consider not only personal factors but their interaction with the child's environment.
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Affiliation(s)
- Manel Abid
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Yosra Cherni
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Charles Sèbiyo Batcho
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Elodie Traverse
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
| | | | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
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Ye B, Zhang J, Tan Z, Chen J, Pan X, Zhou Y, Wang W, Liu L, Zhu W, Sun Y, Ning K, Xie Q, Liu R. Association of liver function with health-related physical fitness: a cross-sectional study. BMC Public Health 2023; 23:1797. [PMID: 37715140 PMCID: PMC10503162 DOI: 10.1186/s12889-023-16701-9] [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: 02/14/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND In this study, by analyzing the correlation between various components of health-related physical fitness (HPF) and liver function indicators, the indicators of physical fitness that were highly correlated with liver function and could be monitored at home were screened to prevent more serious liver disease in the future, and to provide experimental basis for prescribing personalized exercise. METHODS A total of 330 faculties (female = 198) of a university were recruited. The indicators of HPF and liver function were measured. Spearman correlation analysis, multivariate linear regression, and cross-lagged panel model was used to data statistics. RESULTS In males, body fat (BF) was positively correlated with alanine aminotransferase (ALT); vital capacity and the vital capacity index were positively correlated with albumin; and vertical jump was positively correlated with globulin and negatively correlated with the albumin-globulin ratio (P < 0.05). However, there was no significant correlation among all indicators controlled confounding factors. In females, BF was negatively correlated with direct bilirubin; VO2max was positively correlated with indirect bilirubin; and vertical jump was positively correlated with the albumin-globulin ratio and significantly negatively correlated with globulin (P < 0.05). Controlled confounding factors, body fat percentage was positively correlated with globulin (β = 0.174) and negatively correlated with direct bilirubin (β = -0.431), and VO2max was positively correlated with indirect bilirubin (β = 0.238, P < 0.05). Cross-lagged panel analysis showed that BF percentage can negatively predict direct bilirubin levels with great significance (β = -0.055, P < 0.05). CONCLUSIONS HPF may play a crucial role in liver function screening, particularly for female faculty members. For males, BF, vertical jump, vital capacity and vital capacity index could be associated with liver function but are susceptible to complex factors such as age, smoking, diabetes, and hypertension. In females, BF percentage is an important predictor of abnormal liver function in addition to VO2max and vertical jump, which are not affected by complex factors.
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Affiliation(s)
- Bo Ye
- School of Physical Education, Shaanxi Normal University, Xi'an, China
| | - Jing Zhang
- School of Physical Education, Shaanxi Normal University, Xi'an, China.
| | - Zeyu Tan
- Department of Life Sciences, University of California Los Angeles, Los Angeles, USA
| | - Jiangang Chen
- School of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Xinliang Pan
- School of Kinesiology, Beijing Sport University, Beijing, China
| | - Yuan Zhou
- School of Physical Education, Shaanxi Normal University, Xi'an, China
| | - Wanwan Wang
- School of Physical Education, Shaanxi Normal University, Xi'an, China
| | - Longlong Liu
- School of Physical Education, Shaanxi Normal University, Xi'an, China
| | - Wenfei Zhu
- School of Physical Education, Shaanxi Normal University, Xi'an, China
| | - Yuliang Sun
- School of Physical Education, Shaanxi Normal University, Xi'an, China
| | - Ke Ning
- School of Physical Education, Shaanxi Normal University, Xi'an, China
| | - Qian Xie
- School of Physical Education, Shaanxi Normal University, Xi'an, China
| | - Ronghua Liu
- School of Physical Education, Shaanxi Normal University, Xi'an, China
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Kerem-Günel M, Arslan UE, Seyhan-Bıyık K, Özal C, Numanoğlu-Akbaş A, Üneş S, Tunçdemir M, Çankaya Ö, Özcebe H, Green D. Evaluation of daily and social participation of children with Cerebral Palsy across different age groups with a focus on the 'F'-words: Function, family, fitness, fun, friends and future. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 140:104588. [PMID: 37562097 DOI: 10.1016/j.ridd.2023.104588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 06/09/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The impact of disability differs across cultures. This study aimed to determine the predictors of participation in children with cerebral palsy (CP) in Turkey, based on the six F-words. METHODS Cross-sectional study exploring participation profiles of 450 children with CP, aged between 2 and 18 years. Pediatric Evaluation of Disability Inventory (PEDI) evaluated functional skills, and Assessment of Life Habits (LIFE-H) version 3.0 assessed daily and social participation. Hierarchical linear regression models were done to determine the predictors of participation in daily activities (PDA) and social roles (PSR) in three age groups (2-4, 5-13 and 14-18 years) based on the 6 F-words (mobility of PEDI for 'fitness'; four classification systems and self-care of PEDI for 'functioning'; social functions of PEDI for 'friends'; demographic information by parents for 'family'; the recreation of LIFE-H for 'fun'; and different stages of development for 'future'). RESULTS The most important predictors for total PDA by age group were: self-care (p = 0.012) of PEDI in 2-4 y; self-care (p = 0.001) and mobility (p = 0.005) of PEDI in 5-13 y; GMFCS (p = 0.006) and mobility (p = 0.002) of PEDI in 14-18 y. Significant predictors for PSR differed by age group: self-care (p = 0.001) of PEDI in 2-4 y; self-care (p = 0.023) and mobility (p = 0.006) of PEDI in 5-13 y; and GMFCS (p = 0.004) and MACS (p = 0.003) in 14-18 y. CONCLUSIONS Six F-words of function and fitness focussed on self-care in younger children with an increasing emphasis on mobility and ability levels according to age. Therefore, rehabilitation for different aspects of the functional levels is needed to improve participation in life across the six F-words framework; plus take into consideration context, age-differences, family's expectations, life requirements, environmental needs, and cultural differences.
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Affiliation(s)
- Mintaze Kerem-Günel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Umut Ece Arslan
- Department of Health Research, Institue of Public Health, Hacettepe University, Ankara, Turkey
| | - Kübra Seyhan-Bıyık
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cemil Özal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayşe Numanoğlu-Akbaş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| | - Sefa Üneş
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Merve Tunçdemir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Özge Çankaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kütahya Health Sciences University, Kütahya, Turkey
| | - Hilal Özcebe
- Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dido Green
- Department of Rehabilitation, Oxford Brookes University, Oxford, England, UK
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Grodon C, Bassett P, Shannon H. The 'heROIC' trial: Does the use of a robotic rehabilitation trainer change quality of life, range of movement and function in children with cerebral palsy? Child Care Health Dev 2023. [PMID: 36788457 DOI: 10.1111/cch.13101] [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: 09/29/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Children with severe cerebral palsy (CP) (GMFCS IV/V) can find it difficult to access equipment that allows them to exercise effectively, potentially impacting their quality of life. Physiotherapists working within special schools are well placed to facilitate increased physical activity as part of the school day. This study explored whether the Innowalk Pro, a robotic rehabilitation trainer, could influence quality of life (measured by the CPCHILD questionnaire), in children with CP, alongside, joint range of movement, spasticity and functional goals of the lower limbs, measured by goniometry, modified Tardieu scale and goal attainment scoring, GAS, respectively. METHODS A prospective single-arm, pre-post trial was undertaken. The Innowalk Pro was used four times a week for 30 min alongside usual physiotherapy care in a school setting over a 6-week period. Outcomes were evaluated immediately pre/post intervention and at 6 weeks and 3 months post intervention. Analysis also explored differences between primary and secondary age participants. RESULTS Twenty-seven participants aged 5-18 years with a diagnosis of CP GMFCS IV/V (10 female, 17 male, mean age 12 years) were included from a convenience sample in a special school. Quality of life improved in 36% of participants, the majority of these being secondary aged. Knee extension reduced significantly 3 months post intervention. There were no meaningful changes in spasticity. GAS goals improved in 88% of participants after using the Innowalk Pro. GAS goals tended to decline after a break from using the equipment, with 21% declining by two or more units at 3 months post intervention. CONCLUSION A 6-week course of the Innowalk Pro can improve quality of life and functional goals for children with CP aged 5-18 years. After a break of 6-12 weeks, functional goals tend to return to baseline. Further research is needed to explore different prescriptions of the Innowalk Pro, to see if increasing the time used/increasing the frequency or number of weeks it is used for can provide longer lasting benefits.
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Affiliation(s)
| | | | - Harriet Shannon
- UCL Great Ormond Street Institute of Child Health, London, UK
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Kaya Ciddi P, Yilmaz Ö. Exercise intensity of active video gaming in cerebral palsy: hip- versus wrist-worn accelerometer data. Dev Neurorehabil 2022; 25:479-484. [PMID: 35815544 DOI: 10.1080/17518423.2022.2099028] [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: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to compare exercise intensity of active video games (AVGs) between hip- and wrist-worn accelerometer data in cerebral palsy (CP). METHODS Twenty children and adolescents (9.35 ± 3.71 years) with CP performed two exercise sessions, completing a standardized series of AVGs. Exercise intensity was collected, while one accelerometer was fitted to wrist and hip in separate, counterbalanced sessions. RESULTS Accelerometer counts per minute and cut-points determined were significantly different between the wrist- and hip-worn outputs (p < .001). Metabolic equivalents (METs) of performing AVGs exceeded the three METs moderate intensity threshold in wrist-worn (3.12 ± 0.86) accelerometer and hip-worn data tend to underestimate intensity (1.16 ± 0.08). CONCLUSIONS Previous studies showed METs required to perform AVGs were related to moderate intensity (3-6 METs) in CP with mild deficits. Wrist-worn accelerometer, exceeding 3 METs, seem to have higher accuracy in measuring exercise intensity of AVGs than hip-worn.
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Affiliation(s)
- Pınar Kaya Ciddi
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Istanbul Medipol University, Istanbul, Turkey
| | - Öznur Yilmaz
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Hacettepe University, Ankara, Turkey
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Effectiveness of Modified Sports for Children and Adolescents With Cerebral Palsy: A Pragmatic Study Protocol. Pediatr Phys Ther 2022; 34:81-87. [PMID: 34958337 DOI: 10.1097/pep.0000000000000852] [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] [Indexed: 11/27/2022]
Abstract
PURPOSE Sports Stars is a modified sports intervention that aims to prepare individuals with cerebral palsy for the transition from usual physical therapy care to community sports participation. This is a pragmatic randomized controlled trial protocol of a Brazilian applicability of this intervention. METHOD This study will compare the effectiveness of Sports Stars Brazil with standard care. Seventy-six children who walk and adolescents with cerebral palsy will be randomly assigned into an intervention or control group. The intervention group will receive 8 weekly group sessions. Each session will include 1 hour of sports-focused gross motor activity training and teamwork development, centered on popular Brazilian sports. Participation, levels of physical activity and, physical literacy domains will be measured at baseline, postintervention, and at 12-weeks of follow-up. DISCUSSION The investigation of Sports Stars Brazil will provide high-quality evidence regarding the effectiveness of modified sports intervention to support participation in sports in this population.
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Beight LJ, Helton G, Avery M, Dussel V, Wolfe J. Parent and Adolescent Perspectives on the Impact of COVID on the Care of Seriously Ill Children. J Pain Symptom Manage 2022; 63:52-60. [PMID: 34333095 PMCID: PMC8319041 DOI: 10.1016/j.jpainsymman.2021.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Few studies have explored the impact of the Coronavirus Pandemic (COVID-19) on the care of seriously ill children which may be especially affected due to the child's vulnerability, complexity of care, and high reliance on hospital-based care. OBJECTIVE To explore parental and adolescent perspectives on the impact of COVID-19 on care of seriously children. METHODS We recruited a convenience sample of families of seriously ill children between September and December 2020. The study involved a semi-structured interview through Zoom followed by an online sociodemographic survey. Interviews were transcribed and coded using the constant comparison method. The sample intended to represent diversity in child age and diagnoses, and family sociodemographic characteristics. RESULTS Sixty-four families were approached; 29 enrolled (response rate 45%), including 30 parents and three AYAs. Most parents and AYAs identified as white (62%). Some families reported new financial hardships, with 17.2% having difficulty paying bills after March 2020 compared to 6.9% before. Emerging themes from interviews included additional roles parents managed due to cancelled services or shifting to telehealth, increased isolation, high emotional distress due increased in-home demands, uncertainty, and visitor restrictions in medical facilities, and benefits and challenges to telehealth. One positive outcome was the use of a hybrid care model whereby families choose telehealth appointments and in-person services, when necessary. CONCLUSION Families caring for seriously ill children during COVID-19 face increased challenges. Health systems should consider long-term telehealth/in-person hybrid care models that have potential to improve access to and satisfaction with care.
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Affiliation(s)
- Leah J Beight
- Department of Psychosocial Oncology and Palliative Care (L.J.B., G.H., M.A., V.D., J.W.), Dana-Farber Cancer Institute. Boston, MA, USA
| | - Gabrielle Helton
- Department of Psychosocial Oncology and Palliative Care (L.J.B., G.H., M.A., V.D., J.W.), Dana-Farber Cancer Institute. Boston, MA, USA
| | - Madeline Avery
- Department of Psychosocial Oncology and Palliative Care (L.J.B., G.H., M.A., V.D., J.W.), Dana-Farber Cancer Institute. Boston, MA, USA
| | - Veronica Dussel
- Pediatric Palliative Care (V.D.), Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA; Center for Research and Implementation in Palliative Care (CII-CP) (V.D.), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires Argentina
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care (L.J.B., G.H., M.A., V.D., J.W.), Dana-Farber Cancer Institute. Boston, MA, USA; Department of Pediatrics (J.W.), Boston Children's Hospital. Boston, MA, USA.
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13
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Merino-Andrés J, García de Mateos-López A, Damiano DL, Sánchez-Sierra A. Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis. Clin Rehabil 2021; 36:4-14. [PMID: 34407619 DOI: 10.1177/02692155211040199] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function, activity, and participation. DATA SOURCES Five electronic databases (MEDLINE-Pubmed, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were systematically searched for full-text articles published from inception to 30 June 2021. REVIEW METHODS Randomized controlled trials were included, who compared: (i) child population with spastic cerebral palsy population between 0 and 22 years; (ii) studies in which a muscle strength training program was performed and included dosing information; (iii) studies comparing strength training with other physical therapy technique(s) or untreated control group. Studies with similar outcomes were pooled by calculating standardized mean differences. Risk of bias was assessed with Cochrane Collaboration's tool for assessing the risk of bias and PROSPERO's registration number ID: CRD42020193535. RESULTS Twenty-seven studies, comprising 847 participants with spastic cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of strength training program compared to other physical therapy technique(s) or untreated control group(s) for muscle strength at the knee flexors, at the knee extensor, at the plantarflexors, maximum resistance, balance, gait speed, GMFM (global, D and E dimension) and spasticity. CONCLUSION A strength training program has positive functional and activity effects on muscle strength, balance, gait speed, or gross motor function without increasing spasticity for children and adolescents with cerebral palsy in Gross Motor Function Classification System levels I, II, and III when adequate dosage and specific principles are utilized.
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Affiliation(s)
- Javier Merino-Andrés
- PedPT Research Lab, Toledo, Spain.,Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO), Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain
| | | | - Diane L Damiano
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | - Alberto Sánchez-Sierra
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO), Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain.,Department of Physiotherapy, Camilo José Cela University, Madrid, Spain.,Department of Physiotherapy, European University, Madrid, Spain
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14
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Kilgour G, Adair B, Stott NS, Steele M, Hogan A, Imms C. Do physical activity interventions influence subsequent attendance and involvement in physical activities for children with cerebral palsy: a systematic review. Disabil Rehabil 2021; 44:1682-1698. [PMID: 34097836 DOI: 10.1080/09638288.2021.1909151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate if children with cerebral palsy have sustained attendance and involvement in physical activities after completing physical activity interventions. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Seven databases were searched for the period 2001-2020 with hand-searching of pertinent reference lists. Criteria for study inclusion were participants aged 0-18 years and ≥50% with cerebral palsy; follow-up ≥1 month beyond completion of the physical activity intervention; and measurement of attendance and/or involvement in any physical activity post-intervention. Study selection, data extraction, and risk of bias assessments (Physiotherapy Evidence Database (PEDro) or tool for non-randomised studies) were completed independently by paired reviewers. Results were compiled by narrative synthesis. RESULTS Thirteen studies were included (11 randomised controlled trials (RCTs), two non-randomised case series; intervention sample sizes: 6-34). All study participants had cerebral palsy and were aged 4-16.7 years. PEDro scores for the RCTs ranged from 5 to 10; 10 did not blind one or more therapist, participant, or assessor. Two case series showed high risk of bias. Twelve studies reported on attendance, with positive changes in three studies. At 4-14 weeks post-intervention, two studies demonstrated positive changes were maintained. Four studies included involvement outcomes; one reporting positive changes in physical activity involvement four weeks after intervention completion. CONCLUSIONS Physical activity attendance may be influenced by physical activity interventions in the short term, but more robust research designs are required to investigate whether gains can be sustained. Activity involvement, which may influence ongoing participation, is under-researched.Implications for RehabilitationPositive changes in attendance and involvement following physical activity interventions appear short term at best.Physical activity interventions should have longer follow-up periods to determine the effect on sustained physical activity participation.Careful selection and reporting of attendance and involvement outcome measures is required.The optimal physical activity intervention to increase attendance or involvement in physical activities remains uncertain.
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Affiliation(s)
- Gaela Kilgour
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Brooke Adair
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | - Amy Hogan
- Cerebral Palsy Society, Auckland, New Zealand
| | - Christine Imms
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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15
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Kim SK, Park D, Yoo B, Shim D, Choi JO, Choi TY, Park ES. Overground Robot-Assisted Gait Training for Pediatric Cerebral Palsy. SENSORS 2021; 21:s21062087. [PMID: 33809758 PMCID: PMC8002375 DOI: 10.3390/s21062087] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
The untethered exoskeletal robot provides patients with the freest and realistic walking experience by assisting them based on their intended movement. However, few previous studies have reported the effect of robot-assisted gait training (RAGT) using wearable exoskeleton in children with cerebral palsy (CP). This pilot study evaluated the effect of overground RAGT using an untethered torque-assisted exoskeletal wearable robot for children with CP. Three children with bilateral spastic CP were recruited. The robot generates assistive torques according to gait phases automatically detected by force sensors: flexion torque during the swing phase and extension torque during the stance phase at hip and knee joints. The overground RAGT was conducted for 17~20 sessions (60 min per session) in each child. The evaluation was performed without wearing a robot before and after the training to measure (1) the motor functions using the gross motor function measure and the pediatric balance scale and (2) the gait performance using instrumented gait analysis, the 6-min walk test, and oxygen consumption measurement. All three participants showed improvement in gross motor function measure after training. Spatiotemporal parameters of gait analysis improved in participant P1 (9-year-old girl, GMFCS II) and participant P2 (13-year-old boy, GMFCS III). In addition, they walked faster and farther with lower oxygen consumption during the 6-min walk test after the training. Although participant P3 (16-year-old girl, GMFCS IV) needed the continuous help of a therapist for stepping at baseline, she was able to walk with the platform walker independently after the training. Overground RAGT using a torque-assisted exoskeletal wearable robot seems to be promising for improving gross motor function, walking speed, gait endurance, and gait efficiency in children with CP. In addition, it was safe and feasible even for children with severe motor impairment (GMFCS IV).
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Affiliation(s)
- Seung Ki Kim
- Department and Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Korea;
| | - Dongho Park
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.P.); (B.Y.); (D.S.); (J.-O.C.); (T.Y.C.)
| | - Beomki Yoo
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.P.); (B.Y.); (D.S.); (J.-O.C.); (T.Y.C.)
| | - Dain Shim
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.P.); (B.Y.); (D.S.); (J.-O.C.); (T.Y.C.)
| | - Joong-On Choi
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.P.); (B.Y.); (D.S.); (J.-O.C.); (T.Y.C.)
| | - Tae Young Choi
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.P.); (B.Y.); (D.S.); (J.-O.C.); (T.Y.C.)
| | - Eun Sook Park
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.P.); (B.Y.); (D.S.); (J.-O.C.); (T.Y.C.)
- Correspondence: ; Tel.: +82-2-2228-3712
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16
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Akbari Fard L, Zehsaz F, Farhangi N. Concurrent exercise training effect on salivary immunoglobulin A and alpha-amylase in children with cerebral palsy. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2021. [DOI: 10.1007/s12662-020-00696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Valadão P, Piitulainen H, Haapala EA, Parviainen T, Avela J, Finni T. Exercise intervention protocol in children and young adults with cerebral palsy: the effects of strength, flexibility and gait training on physical performance, neuromuscular mechanisms and cardiometabolic risk factors (EXECP). BMC Sports Sci Med Rehabil 2021; 13:17. [PMID: 33637124 PMCID: PMC7908003 DOI: 10.1186/s13102-021-00242-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
Background Individuals with cerebral palsy (CP) have problems in everyday tasks such as walking and climbing stairs due to a combination of neuromuscular impairments such as spasticity, muscle weakness, reduced joint flexibility and poor coordination. Development of evidence-based interventions are in pivotal role in the development of better targeted rehabilitation of CP, and thus in maintaining their motor function and wellbeing. Our aim is to investigate the efficacy of an individually tailored, multifaceted exercise intervention (EXECP) in children and young adults with CP. EXECP is composed of strength, flexibility and gait training. Furthermore, this study aims to verify the short-term retention of the adaptations three months after the end of the EXECP intervention. Methods Twenty-four children and young adults with spastic CP will be recruited to participate in a 9-month research project with a 3-month training intervention, consisting of two to three 90-min sessions per week. In each session, strength training for the lower limbs and trunk muscles, flexibility training for the lower limbs and inclined treadmill gait training will be performed. We will evaluate muscle strength, joint flexibility, neuromuscular and cardiometabolic parameters. A nonconcurrent multiple baseline design with two pre-tests and two post-tests all interspaced by three months is used. In addition to the CP participants, 24 typically developing age and sex-matched participants will perform the two pre-tests (i.e. no intervention) to provide normative data. Discussion This study has a comprehensive approach examining longitudinal effects of wide variety of variables ranging from physical activity and gross motor function to sensorimotor functions of the brain and neuromuscular and cardiometabolic parameters, providing novel information about the adaptation mechanisms in cerebral palsy. To the best of our knowledge, this is the first intervention study providing supervised combined strength, flexibility and gait training for young individuals with CP. Trial registration number ISRCTN69044459, prospectively registered (21/04/2017).
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Affiliation(s)
- Pedro Valadão
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Harri Piitulainen
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Eero A Haapala
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiina Parviainen
- Centre for Interdisciplinary Brain Research, University of Jyväskylä, Jyväskylä, Finland
| | - Janne Avela
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Taija Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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18
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Abstract
ABSTRACT Cerebral palsy (CP) is a group of debilitating motor disorders that carries a wide array of clinical presentations ranging from isolated physical or cognitive impairment to global loss of function. Despite the prevalence of CP, recommendations and benefits of physical activity/exercise have historically not been clearly defined. The research on the subject has several limitations, including small sample size, power, standardized measures/outcomes, and poor classification regarding severity of the disease. Nonetheless, the general consensus and new research shows that individuals with CP who participate in sports and exercise regimens, even at reduced frequency and intensity, exhibit improvements in health care benefits, including cardiorespiratory endurance, gross motor function, gait stability, and reduction in pain. These regimens can be prescribed safely and individualized by health care providers to improve morbidity and mortality in patients suffering from CP.
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Affiliation(s)
- James Toldi
- Institute for Brain Protection Sciences, Division of Sports Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Joseph Escobar
- Department of Family Medicine, University of South Alabama, Mobile, AL
| | - Austin Brown
- Department of Family Medicine, University of South Alabama, Mobile, AL
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19
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Stark C, Duran I, Martakis K, Spiess K, Semler O, Schoenau E. Effect of Long-Term Repeated Interval Rehabilitation on the Gross Motor Function Measure in Children with Cerebral Palsy. Neuropediatrics 2020; 51:407-416. [PMID: 33065752 DOI: 10.1055/s-0040-1715489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The efficacy of interventions for cerebral palsy (CP) has been frequently investigated with inconclusive results and motor function measured by the Gross Motor Function Measure (GMFM-66) is common. OBJECTIVE In this observational analysis, we quantify the GMFM-66 change scores of the second and third year of a multimodal rehabilitation program (interval rehabilitation including home-based, vibration-assisted training) in children with CP. METHODS The study was a retrospective analysis of children with CP (2-13 years) participating for a second (n = 262) and third year (n = 86) in the rehabilitation program with GMFM-66 scores at start (M0), after 4 months (M4) of intensive training, and after 8 months of follow-up (M12). A method was previously developed to differentiate between possible treatment effects and expected development under standard of care for GMFM-66 scores using Cohen's d effect size (ES; size of difference). RESULTS After the treatment phase of 4 months (M4) in the second year, 125 of 262 children were responder (ES ≥ 0.2) and 137 children nonresponder (ES < 0.2); mean ES for nonresponder was -0.212 (trivial) and for responder 0.836 (large). After M4 in the third year, 43 children of 86 were responder (ES = 0.881 [large]) and 43 nonresponder (ES = -0.124 [trivial]). DISCUSSION AND CONCLUSION Repeated rehabilitation shows a large additional treatment effect to standard of care in 50% of children which is likely due to the intervention, because in the follow-up period (standard of care), no additional treatment effect was observed and the children followed their expected development.
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Affiliation(s)
- Christina Stark
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Center of Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Kyriakos Martakis
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Department of International Health, Maastricht University, School CAPHRI, Care and Public Health Research Institute, Maastricht, The Netherlands.,Department of Pediatric Neurology, University Children's Hospital (UKGM) and Medical Faculty, Justus Liebig University of Giessen, Giessen, Germany
| | - Karoline Spiess
- Center of Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Eckhard Schoenau
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Center of Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
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20
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Cacioppo M, Bouvier S, Bailly R, Houx L, Lempereur M, Mensah-Gourmel J, Kandalaft C, Varengue R, Chatelin A, Vagnoni J, Vuillerot C, Gautheron V, Dinomais M, Dheilly E, Brochard S, Pons C. Emerging health challenges for children with physical disabilities and their parents during the COVID-19 pandemic: The ECHO French survey. Ann Phys Rehabil Med 2020; 64:101429. [PMID: 32818674 PMCID: PMC7434423 DOI: 10.1016/j.rehab.2020.08.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The daily lives of children with physical disabilities and their families have been significantly affected by the COVID-19 pandemic. The children face health risks, especially mental, behavioral, social and physical risks. OBJECTIVE This study aimed to identify potential healthcare issues relating to the wellbeing of disabled children, continuity of rehabilitation and medical care, and parental concerns during the COVID-19 lockdown. METHODS The Enfant Confinement Handicap besOins (ECHO [child lockdown disability needs]) national survey was developed by a multidisciplinary group and disseminated in France from April 6, 2020 via email and social networks. This online survey was addressed to the parents of children with physical disabilities aged 0 to 18 years. It explored the experiences of children and their families during the lockdown. Information regarding children's wellbeing, rehabilitation and family organization was collected. The first 1000 eligible surveys were analyzed. RESULTS The children (mean [SD] age 9.5 [4.8] years) mostly had cerebral palsy (42%) or neuromuscular diseases (11%). The lockdown had negative effects on morale (44% of children), behaviour (55% of children) and social interactions (55% no contact with other children). Overall, 44% of children stopped physical activities; 76% were educated at home; 22% maintained medical follow-up, and 48% and 27% continued physiotherapy and occupational therapy respectively. For more than 60% of children, parents performed the therapy. The main parental concern was rehabilitation (72%) and their main difficulty was the mental load (50%); parents complained of lack of help and support (60%). CONCLUSIONS This study highlighted substantial effects on the health of children with physical disabilities and loss of opportunity, with a massive interruption of medical follow-up and rehabilitation, during the lockdown. Regular assessment of the health benefit/risk is essential to support families and ensure continuity of care during a pandemic.
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Affiliation(s)
- Marine Cacioppo
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France.
| | - Sandra Bouvier
- Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France; CHRU de Brest, Brest, France
| | - Rodolphe Bailly
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | - Laetitia Houx
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | - Mathieu Lempereur
- Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | | | | | - Roxane Varengue
- Département de neurologie pédiatrique, CHU d'Angers, Angers, France
| | | | - Jacky Vagnoni
- Fédération française des associations d'infirmes moteurs cérébraux, France
| | - Carole Vuillerot
- Service de médecine physique et de réadaptation pédiatrique, hôpital Mère-Enfant, hospices civils de Lyon, 69500 Bron, France; Institut neuromyogène CNRS UMR 5310 inserm U1217, Université de Lyon, Lyon, France
| | - Vincent Gautheron
- Service de médecine physique et de réadaptation pédiatrique, CHU de Saint-Étienne, Saint-Étienne, France; Université de Lyon, UJM Saint-Étienne, laboratoire interuniversitaire de biologie de la motricité, EA7424, 42023, Saint-Étienne, France
| | - Mickael Dinomais
- Service de médecine physique et de réadaptation, CHU d'Angers, Les-Capucins, Angers, France; Laboratoire Angevin de recherche en ingénierie des systèmes (LARIS) EA7315, université d'Angers, Angers, France
| | - Elea Dheilly
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | - Sylvain Brochard
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | - Christelle Pons
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
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Fatigue in Children and Young Adults With Physical Disabilities: Relation With Energy Demands of Walking and Physical Fitness. Pediatr Phys Ther 2020; 32:202-209. [PMID: 32604360 DOI: 10.1097/pep.0000000000000705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine whether general fatigue and fatigue during or after walking are related to energy demands during walking and physical fitness in children and young adults with physical disabilities. METHODS Sixty-eight individuals with physical disabilities participated. General fatigue (Checklist Individual Strength [CIS8R] questionnaire), walking-induced fatigue (OMNI [OMNIwalk] scale after walking for 6 min), gross and net energy costs (ECs) of walking, physical strain of walking, and aerobic and anaerobic fitness were measured. RESULTS Regression analyses showed no relations with the CIS8R. For all participants, a higher net EC was weakly related to an increased OMNIwalk. For teenagers only, low anaerobic fitness and high physical strain of walking values were moderately related to high OMNIwalk scores. CONCLUSION Low anaerobic fitness and high physical strain values partly explain fatigue after walking in teenagers with cerebral palsy, but not in younger children. General fatigue was not explained by low fitness levels or high energy demands of walking.
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22
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Daly C, Moore CL, Johannes S, Middleton J, Kenyon LK. Pilot Evaluation of a School-Based Programme Focused on Activity, Fitness, and Function among Children with Cerebral Palsy at GMFCS Level IV: Single-Subject Research Design. Physiother Can 2020; 72:195-204. [PMID: 32494103 DOI: 10.3138/ptc-2018-0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Children with cerebral palsy (CP) who function at Gross Motor Function Classification System (GMFCS) Level IV have difficulty achieving sufficient levels of physical activity to promote fitness. The purpose of this pilot evaluation was to investigate the practicability and impact of a school-based supported physical activity programme, using adaptive bicycles, on cardiorespiratory fitness and gross motor function among children with CP at GMFCS Level IV. Method: We used a single-subject, A-B-A-B research design replicated across three participants aged 8-14 years with CP at GMFCS Level IV who attended three different schools. Cardiorespiratory fitness was assessed weekly during all study phases using the energy expenditure index (EEI). Gross motor function was assessed using the Gross Motor Function Measure-66 (GMFM-66) and goal attainment scaling (GAS). During the intervention phases, an adaptive bicycle-riding programme was carried out daily at school for up to 30 minutes. Results: One participant demonstrated significant improvement on the EEI. All participants demonstrated improvement in gross motor function as determined by the GMFM-66 and GAS. Insights were garnered pertaining to the design for large-scale future studies. Conclusions: This pilot evaluation supports further investigation of school-based adaptive bicycle-riding programmes for children who have CP at GMFCS Level IV.
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Affiliation(s)
- Carol Daly
- Witwer Children's Therapy, St. Luke's Unity Point Hospital
| | - Connie L Moore
- Physical Therapy Department, Grant Wood Area Education Agency, Cedar Rapids, Iowa
| | - Suzanne Johannes
- Physical Therapy Department, Grant Wood Area Education Agency, Cedar Rapids, Iowa
| | | | - Lisa K Kenyon
- Department of Physical Therapy, Grand Valley State University, Grand Valley, Mich
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Gąsior JS, Zamunér AR, Silva LEV, Williams CA, Baranowski R, Sacha J, Machura P, Kochman W, Werner B. Heart Rate Variability in Children and Adolescents with Cerebral Palsy-A Systematic Literature Review. J Clin Med 2020; 9:jcm9041141. [PMID: 32316278 PMCID: PMC7230809 DOI: 10.3390/jcm9041141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/04/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022] Open
Abstract
Cardiac autonomic dysfunction has been reported in patients with cerebral palsy (CP). The aim of this study was to assess the existing literature on heart rate variability (HRV) in pediatric patients with CP and a special attention was paid to the compliance of the studies with the current HRV assessment and interpretation guidelines. A systematic review was performed in PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases searched for English language publications from 1996 to 2019 using Medical Subject Headings (MeSH) terms “heart rate variability” and “cerebral palsy” in conjunction with additional inclusion criteria: studies limited to humans in the age range of 0–18 years and empirical investigations. Out of 47 studies, 12 were included in the review. Pediatric patients with CP presented a significantly higher resting heart rate and reduced HRV, different autonomic responses to movement stimuli compared to children with normal development, but also reduced HRV parameters in the children dependent on adult assistance for mobility compared to those generally independent. None of the included studies contained the necessary details concerning RR intervals acquisition and HRV measurements as recommended by the guidelines. Authors of HRV studies should follow the methodological guidelines and recommendations on HRV measurement, because such an approach may allow a direct comparison of their results.
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Affiliation(s)
- Jakub S. Gąsior
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities, 26-600 Radom, Poland
- Correspondence: ; Tel.: +48-793-199-222
| | | | - Luiz Eduardo Virgilio Silva
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil;
| | - Craig A. Williams
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK;
| | - Rafał Baranowski
- Department of Heart Rhythm Disorders, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland;
- Department of Cardiology, University Hospital in Opole, University of Opole, 45-401 Opole, Poland
| | - Paulina Machura
- Department of Gynaecological Endocrinology, Medical University of Warsaw, 00-950 Warsaw, Poland;
| | - Wacław Kochman
- Clinical Department of Cardiology at Bielanski Hospital, National Institute of Cardiology, 01-809 Warsaw, Poland;
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland;
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Han YG, Yun CK. Effectiveness of treadmill training on gait function in children with cerebral palsy: meta-analysis. J Exerc Rehabil 2020; 16:10-19. [PMID: 32161730 PMCID: PMC7056486 DOI: 10.12965/jer.1938748.374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/30/2020] [Indexed: 11/22/2022] Open
Abstract
The purpose of this review was to analysis the effects of treadmill training on gait function in children with cerebral palsy. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science were searched. Investigating the effects of treadmill training on gait endurance, gait speed, limb support time, cadence, and step length in children with cerebral palsy. Similar outcomes were pooled by calculating the standardized mean difference. Of the eight studies, 179 participants were included. The average PEDro score was 6.25/10. The results of the sensitivity test for bias evaluation using the duval and tweedie's trim and fill method showed low publication bias. The test regarding the effect of treadmill training on overall gait function yielded a moderate effect size of 0.53, which was a statistically significant effect as its confidence interval did not include. The overall effect size of gait endurance was 0.85. The overall effect size of gait speed and limb support time were 0.52 and 0.73. The overall effect size of cadence and step length were 0.14 and 0.21, indicating a nonsignificant improvement. These findings suggested that treadmill training on cerebral palsy was effective for gait endurance, gait speed and limb support time than cadence and step length.
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Affiliation(s)
- Yong-Gu Han
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Gyeongsan, Korea
| | - Chang-Kyo Yun
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Gyeongsan, Korea
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25
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Orlando JM, Pierce S, Mohan M, Skorup J, Paremski A, Bochnak M, Prosser LA. Physical activity in non-ambulatory toddlers with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 90:51-58. [PMID: 31063871 DOI: 10.1016/j.ridd.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/21/2018] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Children with cerebral palsy are less likely to be physically active than their peers, however there is limited evidence regarding self-initiated physical activity in toddlers who are not able, or who may never be able, to walk. AIMS The aim of this study was to measure self-initiated physical activity and its relationship to gross motor function and participation in non-ambulatory toddlers with cerebral palsy. METHODS AND PROCEDURES Participants were between the ages of 1-3 years. Physical activity during independent floor-play at home was recorded using a wearable tri-axial accelerometer worn on the child's thigh. The Gross Motor Function Measure-66 and the Child Engagement in Daily Life, a parent-reported questionnaire of participation, were administered. OUTCOMES AND RESULTS Data were analyzed from the twenty participants who recorded at least 90 min of floor-play (mean: 229 min), resulting in 4598 total floor-play minutes. The relationship between physical activity and gross motor function was not statistically significant (r = 0.20; p = 0.39), nor were the relationships between physical activity and participation (r = 0.05-0.09; p = 0.71-0.84). CONCLUSIONS AND IMPLICATIONS The results suggest physical activity during floor-play is not related to gross motor function or participation in non-ambulatory toddlers with cerebral palsy. Clinicians and researchers should independently measure physical activity, gross motor function, and participation.
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Affiliation(s)
- Julie M Orlando
- The Children's Hospital of Philadelphia, Department of Physical Therapy, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Samuel Pierce
- The Children's Hospital of Philadelphia, Department of Physical Therapy, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Mayumi Mohan
- University of Pennsylvania, School of Engineering and Applied Science, 220 S 33rd St, Philadelphia, PA 19104, United States
| | - Julie Skorup
- The Children's Hospital of Philadelphia, Department of Physical Therapy, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Athylia Paremski
- The Children's Hospital of Philadelphia, Division of Rehabilitation Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Megan Bochnak
- The Children's Hospital of Philadelphia, Department of Physical Therapy, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Laura A Prosser
- The Children's Hospital of Philadelphia, Division of Rehabilitation Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; University of Pennsylvania, School of Medicine, Department of Pediatrics, 220 S 33rd St, Philadelphia, PA 19104, United States
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26
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Schmidt-Lucke C, Käferle J, Rydh Berner BM, Ahlborg L, Hansen HM, Skjellvik Tollefsen U, Thon T, Damkjær Moen R, Pekanovic A, Tornberg ÅB, Lauruschkus K. Effect of assisted walking-movement in patients with genetic and acquired neuromuscular disorders with the motorised Innowalk device: an international case study meta-analysis. PeerJ 2019; 7:e7098. [PMID: 31249736 PMCID: PMC6587941 DOI: 10.7717/peerj.7098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/08/2019] [Indexed: 12/31/2022] Open
Abstract
People with physical disabilities (PD) suffer from consequences due to lack of physical activity and consequently, are at increased risk of chronic diseases. We aimed to evaluate the ability of a motorised assistive device for dynamic standing with weight-bearing in addition to standard state-of-the-art therapy to improve clinical outcome in a meta-analysis of available studies. A total of 11 studies were identified from different European countries analysing the effect of the dynamic device Innowalk. Raw data of nine studies were pooled including a total of 31 patients observed between 2009 and 2017. Standardised questionnaires and physical outcomes were examined in this exploratory meta-analysis. We recorded patients' characteristics, duration, intensity, and location of usage as well as general clinical outcomes and improvement of passive range of motion (PROM). The analysed population consisted in 90% cases of patients younger than 18 years of age. Patients were severely disabled individuals (aged 8 (6-10) years; 58% male; 67% non-ambulatory, 86% cerebral palsy). A total of 94% used the Innowalk in a home-based or day-care setting. For nearly all individuals (94%), improvements were recorded for: walking or weight-bearing transfer (n = 13), control/strength of the trunk or head (n = 6), joint mobility (n = 14), sleep (n = 4 out of 6/67%), or muscle strength (n = 17), vital functions (n = 16), bowel function (n = 10), attention/orientation (n = 2). PROM of the hip (flexion, abduction, and adduction) significantly (p < 0.001 for multiple comparisons) increased after 1 month (p < 0.05 flexion, adduction) and further after 5 months (p < 0.05 each) in contrast (p < 0.05 each) to a control group with state-of-the-art therapy. Similarly, PROM showed a trend towards improvement in dorsal extension of the ankle (p = 0.07). In summary, this is the first report of a novel device with additional benefit to standard therapy for severe PD. These intriguing results warrant the planned prospective randomised controlled trial to prove the concept and mechanism of action of this device.
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Affiliation(s)
- Caroline Schmidt-Lucke
- Charité University Berlin, Berlin, Germany.,Medico-academic Consultings, Berlin, Germany
| | | | - Britt-Marie Rydh Berner
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
| | - Lotta Ahlborg
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
| | | | | | - Tonje Thon
- Municipality of Porsgrunn, Posgrunn, Norway
| | | | | | - Åsa B Tornberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Katarina Lauruschkus
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Digiacomo F, Tamburin S, Tebaldi S, Pezzani M, Tagliafierro M, Casale R, Bartolo M. Improvement of motor performance in children with cerebral palsy treated with exoskeleton robotic training: A retrospective explorative analysis1. Restor Neurol Neurosci 2019; 37:239-244. [DOI: 10.3233/rnn-180897] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Fabio Digiacomo
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tebaldi
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
| | - Marco Pezzani
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
| | - Mario Tagliafierro
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
| | - Roberto Casale
- Scientific Direction, Habilita, Zingonia (Bergamo), Italy
| | - Michelangelo Bartolo
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
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Viñals-Labañino CP, Velazquez-Bustamante AE, Vargas-Santiago SI, Arenas-Sordo ML. Usefulness of Cerebral Palsy Curves in Mexican Patients: A Cross-Sectional Study. J Child Neurol 2019; 34:332-338. [PMID: 30854918 DOI: 10.1177/0883073819830560] [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: 11/16/2022]
Abstract
Cerebral palsy describes a group of movement and posture disorders that cause activity limitation, and are attributable to nonprogressive disorders that occur in the fetal or infant brain. The growth of these children should not be compared with those of the healthy population. We studied 452 children, 186 female and 266 male. We compared the results in 2 growth charts, Centers for Disease Control and Prevention (CDC) and cerebral palsy, and the results were statistically significant ( P = .00001). With the CDC charts, 40.71% of the patients were below the 5th percentile and only 5.5% of them when we used the charts for cerebral palsy patients. The Mexican cerebral palsy patients were similar to US cerebral palsy patients when we compared height ( P = .4075) and body mass index (BMI) ( P = .4075). Only the weight was found to be different ( P = .00001). All the correlation indexes were negative: Eating and Drinking Ability Classification System (EDACS)-BMI (rho = -0.4798) ( P = .00001), Communication Function Classification System (CFCS)-BMI (rho = -0.4353) ( P = .00001), and Gross Motor Function Classification System (GMFCS)-BMI (rho = -0.3584) ( P = .00001). The growth charts of the healthy pediatric population tend to overestimate the underweight. We propose to use cerebral palsy charts as a reference in our patients. It is possible to determine a functional profile (communication, gross motor function and safety, and feed efficiency) for the cerebral palsy population based on their BMI.
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Affiliation(s)
- Carlos P Viñals-Labañino
- 1 Pediatric Rehabilitation Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
| | - Ana E Velazquez-Bustamante
- 1 Pediatric Rehabilitation Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
| | - Silvia I Vargas-Santiago
- 1 Pediatric Rehabilitation Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
| | - Maria L Arenas-Sordo
- 2 Genetics Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
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McPherson AC, Biddiss E, Chen L, Church PT, de Groot JF, Keenan S, King G, Lui T, Maltais DB, Mérette C, Moffet H, Moola F, Schwellnus H. Children and Teens in Charge of their Health (CATCH): A protocol for a feasibility randomised controlled trial of solution-focused coaching to foster healthy lifestyles in childhood disability. BMJ Open 2019; 9:e025119. [PMID: 30837255 PMCID: PMC6429893 DOI: 10.1136/bmjopen-2018-025119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Children with physical disabilities are rarely included in interventions to promote healthy lifestyles, despite being at higher risk for suboptimal dietary and physical activity behaviours. The Children and Teens in Charge of their Health study explores the feasibility and acceptability of conducting a randomised controlled trial (RCT) of a strengths-based, solution-focused coaching intervention for improving and sustaining physical activity and healthy dietary habits in children and young people with physical disabilities. METHODS AND ANALYSIS Thirty children aged 10-18 years with a diagnosis of spina bifida or cerebral palsy who are able to set healthy lifestyle goals will be recruited from two children's rehabilitation hospitals in Ontario, Canada. Participants will be enrolled in the study for twelve months. All participants will receive standard care and printed information about healthy lifestyles. Of the 30 participants, 15 will be randomised to receive a coaching intervention for the first 6 months. Health indicators and psychosocial outcomes will be assessed by blinded assessors four times: at the start of the trial, immediately postintervention (6 months after randomisation), and at 3 and 6 months postintervention (9 and 12 months after randomisation, respectively). Predefined success criteria will be used to assess the feasibility of trial processes such as recruitment, attrition, stratification and intervention fidelity. Acceptability and perceived impact of the intervention will be explored qualitatively. ETHICS AND DISSEMINATION The study has been approved by Holland Bloorview Kids Rehabilitation Hospital's Research Ethics Board (Ref: 17-752). A knowledge translation planning template will be used to ensure our findings have maximum reach. TRIAL REGISTRATION NUMBER NCT03523806.
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Affiliation(s)
- Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Institute of Biomaterials & Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Lorry Chen
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Paige Terrien Church
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janke F de Groot
- Child Development and Exercise Center, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Sarah Keenan
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Toni Lui
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Desiree B Maltais
- Center for Interdisciplinary Research in Rehabilita, CIUSSS-CN, Quebec City, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Chantal Mérette
- Department of Psychiatry and Neuroscience, Laval University, Quebec City, Quebec, Canada
| | - Hélène Moffet
- Center for Interdisciplinary Research in Rehabilita, CIUSSS-CN, Quebec City, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Fiona Moola
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Heidi Schwellnus
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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Bjornson K, Fiss A, Avery L, Wentz E, Kerfeld C, Cicirello N, Hanna SE. Longitudinal trajectories of physical activity and walking performance by gross motor function classification system level for children with cerebral palsy. Disabil Rehabil 2019; 42:1705-1713. [PMID: 30616403 DOI: 10.1080/09638288.2018.1534995] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose: This study aims to present developmental trajectories for physical activity (PA) and walking performance for children with cerebral palsy (CP).Materials and methods: Seventy-nine children with CP, 39 (49%) female, Gross Motor Functional Classification System levels I-V, and mean age 91.3 months (+/-27.7 SD) participated. Participants in levels I-V wore the Actigraph to capture PA and children in levels I-II also wore a StepWatch (SW) (n = 43) to measure walking performance. Trajectories for average PA counts/minute and number of minutes of moderate to vigorous PA were generated for levels I, II, and III/IV/V (aggregate). Single leg strides/day and average strides faster than 30 strides/min trajectories were generated for levels I-II.Results: Participants did not display plateaus in PA or walking performance based on functional level. Children in all levels showed a decrease in amount and intensity of PA from 3.0 to 12 years old, with participants in level I demonstrating the steepest decline. Children in level I decreased slightly, and level II increased slightly in both walking performance measures from 3.0 to 12 years old.Conclusions: Longitudinal curves demonstrate variations in PA and walking performance by functional level and provide prognostic information as to what changes may be anticipated for children with CP.Implications for rehabilitationLongitudinal developmental trajectories for physical activity and walking performance for children with cerebral palsy across functional levels are documented.Trajectories have potential to support collaborative intervention planning between therapists and families relative to physical activity and walking performance.
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Affiliation(s)
- Kristie Bjornson
- Department of Rehabilitation Medicine, Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
| | - Alyssa Fiss
- Department of Physical Therapy, Mercer University, Atlanta, GA, USA
| | - Lisa Avery
- Avery Information Services Ltd., Orillia, Canada
| | - Erin Wentz
- Department of Physical Therapy, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | | | - Steven E Hanna
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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31
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Cesar GM, Buster TW, Burnfield JM. Cardiorespiratory fitness, balance and walking improvements in an adolescent with cerebral palsy (GMFCS II) and autism after motor-assisted elliptical training. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1536764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Guilherme M. Cesar
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Thad W. Buster
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Judith M. Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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Walking and Fitness Improvements in a Child With Diplegic Cerebral Palsy Following Motor-Assisted Elliptical Intervention. Pediatr Phys Ther 2018; 30:E1-E7. [PMID: 30277973 DOI: 10.1097/pep.0000000000000541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantify effects of motor-assisted elliptical (Intelligently Controlled Assistive Rehabilitation Elliptical [ICARE]) training on walking and fitness of a child with cerebral palsy (CP). KEY POINTS A 12-year-old boy with walking limitations due to spastic diplegic CP (Gross Motor Function Classification System II) participated in 24 sessions of primarily moderate- to vigorous-intensity ICARE exercise. Fitness improvements were evidenced clinically across sessions by the child's capacity to train for longer periods, at faster speeds, and while overriding motor's assistance. Postintervention, the child walked faster with greater stability and endurance and more rapidly completed the modified Time Up and Go test. CONCLUSION The child's fitness and gait improved following engagement in a moderate- to vigorous-intensity gait-like exercise intervention. RECOMMENDATIONS FOR CLINICAL PRACTICE Integration of moderate- to vigorous-intensity motor-assisted elliptical training can promote simultaneous gains in fitness and function for children with CP.
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33
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Guzik A, Drużbicki M, Kwolek A, Przysada G, Bazarnik-Mucha K, Szczepanik M, Wolan-Nieroda A, Sobolewski M. The paediatric version of Wisconsin gait scale, adaptation for children with hemiplegic cerebral palsy: a prospective observational study. BMC Pediatr 2018; 18:301. [PMID: 30219044 PMCID: PMC6139123 DOI: 10.1186/s12887-018-1273-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 08/31/2018] [Indexed: 11/24/2022] Open
Abstract
Background In clinical practice there is a need for a specific scale enabling detailed and multifactorial assessment of gait in children with spastic hemiplegic cerebral palsy. The practical value of the present study is linked with the attempts to find a new, affordable, easy-to-use tool for gait assessment in children with spastic hemiplegic cerebral palsy. The objective of the study is to evaluate the Wisconsin Gait Scale (WGS) in terms of its inter- and intra-rater reliability in observational assessment of walking in children with hemiplegic cerebral palsy. Methods The study was conducted in a group of 34 patients with hemiplegic cerebral palsy. At the first stage, the original version of the ordinal WGS was used. The WGS, consisting of four subscales, evaluates fourteen gait parameters which can be observed during consecutive gait phases. At the second stage, a modification was introduced in the kinematics description of the knee and weight shift, in relation to the original scale. The same video recordings were rescored using the new, paediatric version of the WGS. Three independent examiners performed the assessment twice. Inter and intra-observer reliability of the modified WGS were determined. Results The findings show very high inter- and intra-observer reliability of the modified WGS. This was reflected by a lack of systematically oriented differences between the repeated measurements, very high value of Spearman’s rank correlation coefficient 0.9 ≤ |R| < 1, very high value of ICC > 0.9, and low value of CV < 2.5% for the specific physical therapists. Conclusions The new, ordinal, paediatric version of WGS, proposed by the authors, seems to be useful as an additional tool that can be used in qualitative observational gait assessment of children with spastic hemiplegic cerebral palsy. Practical dimension of the study lies in the fact that it proposes a simple, easy-to-use tool for a global gait assessment in children with spastic hemiplegic cerebral palsy. However, further research is needed to validate the modified WGS by comparing it to other observational scales and objective 3-dimensional spatiotemporal and kinematic gait parameters. Trial registration anzctr.org.au, ID: ACTRN12617000436370. Registered 24 March 2017.
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Affiliation(s)
- Agnieszka Guzik
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland.
| | - Mariusz Drużbicki
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland
| | - Andrzej Kwolek
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland
| | - Grzegorz Przysada
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland
| | | | - Magdalena Szczepanik
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26 a, 35-205, Rzeszów, Poland
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Clutterbuck G, Auld M, Johnston L. Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy: a systematic review. Disabil Rehabil 2018; 41:1131-1151. [PMID: 29303007 DOI: 10.1080/09638288.2017.1422035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP). METHOD A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters. RESULTS Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II-IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n = 3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n = 2, all Evidence Level II) and Physical Fitness Training (n = 4, Evidence Level II-V). Weak positive evidence was available for Modified Sport (n = 3, Evidence Level IV-V) and Non-Immersive Virtual Reality (n = 12, Evidence Level II-V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n = 4, all Evidence Level II). INTERPRETATION Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP. Implications for rehabilitation Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy. Gross Motor Activity Training is the most common and effective intervention. Practice variability is essential to improve gross motor function. Participation was rarely measured and requires further research, particularly in interventions that embed real-world participation opportunities like Modified Sport.
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Affiliation(s)
- Georgina Clutterbuck
- a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia.,b The Cerebral Palsy League , Brisbane , Australia
| | - Megan Auld
- a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia.,b The Cerebral Palsy League , Brisbane , Australia
| | - Leanne Johnston
- a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia
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Zwinkels M, Takken T, Ruyten T, Visser-Meily A, Verschuren O. Body mass index and fitness in high-functioning children and adolescents with cerebral palsy: What happened over a decade? RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 71:70-76. [PMID: 29024824 DOI: 10.1016/j.ridd.2017.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/15/2017] [Accepted: 09/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In recent decades, improving fitness has become an important goal in rehabilitation medicine in children and adolescents with cerebral palsy (CP). AIMS To compare body mass index (BMI), performance-related fitness, and cardiorespiratory fitness of children with CP measured in 2014 with a comparable sample from 2004. METHODS AND PROCEDURES In total, 25 high-functioning children with CP (i.e., GMFCS I-II) measured in 2004 (13 boys; mean age 13.2 (2.6) years) were matched to 25 children measured in 2014. Outcomes included body mass and BMI, muscle power sprint test (MPST), 10×5m sprint test, and a shuttle run test (SRT). Data of 15 participants from 2004 (10 boys; mean age 12.6 (2.5) years) were matched and analysed for VO2peak. OUTCOMES AND RESULTS Body mass and BMI were higher (both: p<0.05) in the 2014 cohort compared to the 2004 cohort. Further, performance-related fitness was better for the 2014 cohort on the MPST (p=0.004), the 10×5m sprint test (p=0.001), and the SRT (p<0.001). However, there were no differences for VO2peak. CONCLUSIONS AND IMPLICATIONS In high-funcitoning children with CP, there are positive ecological time trends in performance-related fitness, but not in VO2peak between 2004 and 2014. The substantial higher body mass and BMI is alarming and requires further investigation.
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Affiliation(s)
- Maremka Zwinkels
- Center of Excellence for Rehabilitation Medicine and Brain Center Rudolf Magnus, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Tim Takken
- Child Development and Exercise Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thijs Ruyten
- Center of Excellence for Rehabilitation Medicine and Brain Center Rudolf Magnus, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne Visser-Meily
- Center of Excellence for Rehabilitation Medicine and Brain Center Rudolf Magnus, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine and Brain Center Rudolf Magnus, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Utrecht, The Netherlands.
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Stahlhut M, Downs J, Aadahl M, Leonard H, Bisgaard AM, Nordmark E. Patterns of sedentary time and ambulatory physical activity in a Danish population of girls and women with Rett syndrome. Disabil Rehabil 2017; 41:133-141. [PMID: 28969435 DOI: 10.1080/09638288.2017.1381181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rett syndrome (RTT) is a rare neurodevelopmental disorder leading to multiple disabilities and high dependency on caregivers. This study aimed to: (1) describe the patterns of sedentary time and daily steps and (2) identify the association of individual and environmental characteristics with sedentary time. METHODS All Danish females with RTT older than 5 years of age and with a MECP2 mutation were invited to participate. The activPAL and StepWatch Activity Monitor (SAM) were worn by participants for at least four days. Sedentary time and step counts were plotted by time to examine daily activity patterns. Associations between sedentary time and individual and environmental covariates were assessed with linear regression models. RESULTS The median (interquartile range) age of participants was 22.0 (14.3-36.5) years. On average 83.3% (standard deviation 13.9%) of waking hours were spent in sedentary behaviours (n = 48) and the median (interquartile range) daily step count was 5128 (2829-7704) (n = 28). Females older than 33.5 years, and those unable to walk independently were more sedentary. CONCLUSIONS This study demonstrated high levels of sedentary time and low daily step counts in a Danish population of females with RTT. Advancing age and lower walking skills were associated with higher levels of sedentary time. Implications for Rehabilitation Sedentary lifestyles in individuals with disabilities have a negative impact on health and quality of life. High levels of sedentary time and low daily step counts were demonstrated in a Danish population of females with Rett syndrome. Advancing age and inability to walk independently were strongly associated with higher levels of sedentary time in females with Rett syndrome. Understanding patterns of sedentary behaviour and physical activity can aid health care professionals in developing health-promoting physical activity interventions.
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Affiliation(s)
- Michelle Stahlhut
- a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden.,b Department of Clinical Genetics, Center for Rett syndrome, Kennedy Center , Rigshospitalet , Glostrup , Denmark
| | - Jenny Downs
- c Telethon Kids Institute , University of Western Australia , Perth , Australia.,d School of Physiotherapy and Exercise Science , Curtin University , Perth , Australia
| | - Mette Aadahl
- e Research Center for Prevention and Health , Capital Region of Denmark , Glostrup , Denmark
| | - Helen Leonard
- c Telethon Kids Institute , University of Western Australia , Perth , Australia
| | - Anne-Marie Bisgaard
- b Department of Clinical Genetics, Center for Rett syndrome, Kennedy Center , Rigshospitalet , Glostrup , Denmark
| | - Eva Nordmark
- a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden
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Quinn L, Morgan D. From Disease to Health: Physical Therapy Health Promotion Practices for Secondary Prevention in Adult and Pediatric Neurologic Populations. J Neurol Phys Ther 2017; 41 Suppl 3:S46-S54. [PMID: 28628596 PMCID: PMC5477649 DOI: 10.1097/npt.0000000000000166] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Over the last decade there has been a substantial increase in efforts to better understand how targeted physical activity and exercise interventions can be used to minimize secondary consequences arising from neurological damage in both adult and pediatric populations. This article offers an overview of contemporary research that addresses mediators of functional and neuroplastic adaptations associated with physical activity and exercise. We emphasize the important role that physical therapists can play to increase participation and improve well-being in adults and children with neurological disorders. We further highlight potential strategies to foster translation of evidence-based findings for use by clinicians and consumers. SUMMARY OF KEY POINTS Engagement in physical activity can serve as a powerful promoter of health and well-being in adults and youth with neurologic disease, and has the potential to alter the course of disease processes. Physical therapists can play a key role in promoting fitness and wellness by encouraging active living, providing early diagnosis of disease and prescribing targeted activity interventions to improve fitness and participation, and helping individuals overcome personal and environmental barriers to an active lifestyle. RECOMMENDATIONS FOR CLINICAL PRACTICE Physical therapists must adopt a model of rehabilitation that emphasizes secondary prevention in adults and youth with neurologic diseases. Physical therapists have a unique role in developing forward-thinking approaches in using innovative health and wellness strategies to promote positive changes in activity and exercise behaviors.
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Affiliation(s)
- Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York (L.Q.); and Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro (D.M.)
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Gorter JW, Galuppi BE, Gulko R, Wright M, Godkin E. Consensus Planning Toward a Community-Based Approach to Promote Physical Activity in Youth with Cerebral Palsy. Phys Occup Ther Pediatr 2017; 37:35-50. [PMID: 26865106 DOI: 10.3109/01942638.2015.1127868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To engage researchers and knowledge-users in six Ontario communities in knowledge translation initiatives to identify community-informed elements to guide the development of an optimal physical activity program for youth with cerebral palsy (CP) and to support research efforts. METHODS The project included three iterative steps, i.e., an environmental scan of five communities, six regional planning meetings, and a member-checking survey, followed by a Delphi survey to reach consensus on the elements deemed most important. RESULTS Twenty-four elements were identified to include in programs promoting physical activity in youth with CP, which were organized in five categories: raise awareness of the options and opportunities (n = 4); pique interest and motivate youth to become and stay active (n = 9); ensure community programs are ready for youth with a disability (n = 2); be fit, fit in, and finding the best fit (n = 5); and explore the layers of physical activity and how they interact (n = 4). CONCLUSIONS The 24 elements established characterize the key concepts that families and community stakeholders value when developing physical activity programs for youth with CP. When incorporated into clinical practice, each of the elements may be used to evaluate key aspects of outcome for individuals with CP.
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Affiliation(s)
- Jan Willem Gorter
- a CanChild Centre for Childhood Disability Research , McMaster University , Hamilton , Ontario , Canada
| | - Barbara E Galuppi
- a CanChild Centre for Childhood Disability Research , McMaster University , Hamilton , Ontario , Canada
| | - Roman Gulko
- a CanChild Centre for Childhood Disability Research , McMaster University , Hamilton , Ontario , Canada
| | - Marilyn Wright
- b Children's Developmental Rehabilitation Program , McMaster Children`s Hospital , Hamilton , Ontario , Canada
| | - Erin Godkin
- a CanChild Centre for Childhood Disability Research , McMaster University , Hamilton , Ontario , Canada
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Trost SG, Fragala-Pinkham M, Lennon N, O'Neil ME. Decision Trees for Detection of Activity Intensity in Youth with Cerebral Palsy. Med Sci Sports Exerc 2017; 48:958-66. [PMID: 26673127 DOI: 10.1249/mss.0000000000000842] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To develop and test decision tree (DT) models to classify physical activity (PA) intensity from accelerometer output and Gross Motor Function Classification System (GMFCS) classification level in ambulatory youth with cerebral palsy (CP) and compare the classification accuracy of the new DT models to that achieved by previously published cut points for youth with CP. METHODS Youth with CP (GMFCS levels I-III) (N = 51) completed seven activity trials with increasing PA intensity while wearing a portable metabolic system and ActiGraph GT3X accelerometers. DT models were used to identify vertical axis (VA) and vector magnitude (VM) count thresholds corresponding to sedentary (SED) (<1.5 METs), light-intensity PA (LPA) (≥1.5 and <3 METs) and moderate-to-vigorous PA (MVPA) (≥3 METs). Models were trained and cross-validated using the "rpart" and "caret" packages within R. RESULTS For the VA (VA_DT) and VM DT (VM_DT), a single threshold differentiated LPA from SED, whereas the threshold for differentiating MVPA from LPA decreased as the level of impairment increased. The average cross-validation accuracies for the VC_DT were 81.1%, 76.7%, and 82.9% for GMFCS levels I, II, and III. The corresponding cross-validation accuracies for the VM_DT were 80.5%, 75.6%, and 84.2%. Within each GMFCS level, the DT models achieved better PA intensity recognition than previously published cut points. The accuracy differential was greatest among GMFCS level III participants, in whom the previously published cut points misclassified 40% of the MVPA activity trials. CONCLUSIONS The GMFCS-specific cut points provide more accurate assessments of MVPA levels in youth with CP across the full spectrum of ambulatory ability.
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Affiliation(s)
- Stewart G Trost
- 1Institute of Health and Biomedical Innovation at the Queensland Centre for Children's Health Research, School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, AUSTRALIA; 2Research Center, Franciscan Hospital for Children, Brighton, MA; 3Gait Analysis Laboratory, AI duPont Hospital for Children, Wilmington, DE; 4Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA
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Mitchell LE, Ziviani J, Boyd RN. A randomized controlled trial of web-based training to increase activity in children with cerebral palsy. Dev Med Child Neurol 2016; 58:767-73. [PMID: 26877078 DOI: 10.1111/dmcn.13065] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 11/28/2022]
Abstract
AIM To determine the efficacy of web-based training on activity capacity and performance in children with unilateral cerebral palsy (CP). METHOD In a matched-pairs randomized waitlist controlled trial, independently ambulant children and adolescents with unilateral CP were allocated to receive 30 minutes of training (intervention) 6 days per week, or usual care (waitlist control) for 20 weeks. Activity capacity was assessed using maximal repetitions of functional strength tasks and 6-minute walk test (6MWT); performance using 4-day ActiGraph GT3X+ accelerometer records at baseline and 20 weeks. Data were analysed by intention to treat comparing between groups using hierarchical linear modelling. RESULTS Participants were n=101, 52 males, mean age 11 years 3 months (SD 2y 4mo). Intervention participants completed a mean 32.4 hours (SD 17.2) of training, associated with significant improvements in functional strength (mean difference 19.3 repetitions; 95% confidence interval [CI] 10.8-27.7; p<0.001) and 6MWT distance (mean difference 38.9m; 95% CI 12.3-51.9; p<0.001) compared with the control group at 20 weeks, although not activity performance (p>0.05). INTERPRETATION Training was effective at increasing functional strength and walking endurance in independently ambulant children with unilateral CP. This did not translate into improvements in activity performance.
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Affiliation(s)
- Louise E Mitchell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, Qld, Australia
| | - Jenny Ziviani
- Children's Health Queensland, Brisbane, Qld, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Qld, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, Qld, Australia
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Dallmeijer AJ, Rameckers EA, Houdijk H, de Groot S, Scholtes VA, Becher JG. Isometric muscle strength and mobility capacity in children with cerebral palsy. Disabil Rehabil 2015; 39:135-142. [DOI: 10.3109/09638288.2015.1095950] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Annet J. Dallmeijer
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research and MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands,
| | - Eugene A. Rameckers
- Rehabilitation Center UM Maastricht and Adelante Center of Expertise in Rehabilitation and Audiology, Valkenburg and Hoensbroek, The Netherlands,
| | - Han Houdijk
- Heliomare Rehabilitation, Wijk Aan Zee, The Netherlands,
- Faculty of Human Movement Sciences, MOVE Research Institute, VU University, Amsterdam, The Netherlands,
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands,
- Center of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, and
| | - Vanessa A. Scholtes
- Department of Orthopaedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Jules G. Becher
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research and MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands,
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Masaracchio M, Comet S. Commentary on "Hand-Held Dynamometry Isometric Torque Reference Values for Children and Adolescents". Pediatr Phys Ther 2015; 27:424. [PMID: 26397090 DOI: 10.1097/pep.0000000000000190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael Masaracchio
- Long Island University and Masefield and Cavallaro Physical Therapy, Brooklyn, New York
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Abstract
PURPOSE To establish hand-held dynamometry (HHD) maximal isometric muscle torque (MIT) reference values for children and adolescents who are developing typically. METHODS The MIT of 10 upper and lower limb muscle groups was assessed in 351 Caucasian youth (4 years 2 months to 17 years) using a standardized HHD protocol, previously shown to be feasible, valid, and reliable. RESULTS The mean MIT and 95% confidence interval of the mean for all muscle groups, for each of the 14 age groups (1 year age span for each group), and for each sex, were reported in both absolute (Nm) and normalized (Nm/kg) values. CONCLUSION These HHD reference values may be helpful in the identification of muscle strength impairments in several pediatric populations, especially when bilateral impairments are present.
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