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Kruse A, Imery I, Corell L, Hjalmarsson E, Fernandez-Gonzalo R, Von Walden F, Reitzner SM. Circulating immune cell populations at rest and in response to acute endurance exercise in young adults with cerebral palsy. Dev Med Child Neurol 2024; 66:902-909. [PMID: 38111130 DOI: 10.1111/dmcn.15835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023]
Abstract
AIM The aim of this observational study was to determine the immune status and function in young adults with cerebral palsy (CP) in comparison to typically developing individuals. METHOD Blood samples from 12 individuals with CP (five males, seven females; mean age: 25 years 1 month (5 years 9 months); age range: 19-38 years) and 17 typically developing individuals (eight males, nine females; mean age: 31 years 4 months (6 years 2 months); age range: 20-40 years) were collected before, immediately after, and 1 hour after 45 minutes of frame running or running respectively. Independent t-tests were used to compare heart rate, level of exertion, and baseline cell proportions between groups. Mixed model analysis of variance was utilized to investigate immune cell responses to exercise across groups. RESULTS Baseline levels of gamma delta (TCRγδ+) T-cells were significantly higher (absolute percentage: +2.65, p = 0.028) in the individuals with CP. Several cell populations showed similar significant changes after exercise in both CP and typically developing groups. Cytotoxic (CD8+) T-cells were only significantly elevated immediately after exercise in the typically developing participants (p < 0.01). Individuals with CP exhibited significantly lower heart rates (-11.1%, p < 0.01), despite similar ratings of perceived exertion. INTERPRETATION Elevated baseline TCRγδ+ T-cells may indicate low-grade inflammation in adults with CP. Although most of the cell populations showed typical responses to endurance exercise, the absence of response in CD8+ T-cells in individuals with CP may indicate the need for higher intensity during exercise. WHAT THIS PAPER ADDS TCRγδ+ T-cell baseline levels are elevated in adults with cerebral palsy (CP). The CD8+ T-cell response to exercise was blunted in adults with CP. Exercise intensity is decisive for CD8+ T-cell responses in individuals with CP.
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Affiliation(s)
- Annika Kruse
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Institute of Human Movement Science, Sport and Health, University of Graz, Austria
| | - Ian Imery
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Linnéa Corell
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Emma Hjalmarsson
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Rodrigo Fernandez-Gonzalo
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
- Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ferdinand Von Walden
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan M Reitzner
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Novosel IB, Ritterband-Rosenbaum A, Zampoukis G, Nielsen JB, Lorentzen J. Accurate Monitoring of 24-h Real-World Movement Behavior in People with Cerebral Palsy Is Possible Using Multiple Wearable Sensors and Deep Learning. SENSORS (BASEL, SWITZERLAND) 2023; 23:9045. [PMID: 38005433 PMCID: PMC10675169 DOI: 10.3390/s23229045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Monitoring and quantifying movement behavior is crucial for improving the health of individuals with cerebral palsy (CP). We have modeled and trained an image-based Convolutional Neural Network (CNN) to recognize specific movement classifiers relevant to individuals with CP. This study evaluates CNN's performance and determines the feasibility of 24-h recordings. Seven sensors provided accelerometer and gyroscope data from 14 typically developed adults during videotaped physical activity. The performance of the CNN was assessed against test data and human video annotation. For feasibility testing, one typically developed adult and one adult with CP wore sensors for 24 h. The CNN demonstrated exceptional performance against test data, with a mean accuracy of 99.7%. Its general true positives (TP) and true negatives (TN) were 1.00. Against human annotators, performance was high, with mean accuracy at 83.4%, TP 0.84, and TN 0.83. Twenty-four-hour recordings were successful without data loss or adverse events. Participants wore sensors for the full wear time, and the data output were credible. We conclude that monitoring real-world movement behavior in individuals with CP is possible with multiple wearable sensors and CNN. This is of great value for identifying functional decline and informing new interventions, leading to improved outcomes.
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Affiliation(s)
- Ivana Bardino Novosel
- Department of Pediatric Neurology 5003, University Hospital Copenhagen, Rigshospitalet, 2100 Copenhagen, Denmark;
- Department of Neuroscience, Faculty of Health and Medical Sciences, The Panum Institute, Copenhagen University, 2200 Copenhagen, Denmark; (G.Z.); (J.B.N.)
| | | | - Georgios Zampoukis
- Department of Neuroscience, Faculty of Health and Medical Sciences, The Panum Institute, Copenhagen University, 2200 Copenhagen, Denmark; (G.Z.); (J.B.N.)
| | - Jens Bo Nielsen
- Department of Neuroscience, Faculty of Health and Medical Sciences, The Panum Institute, Copenhagen University, 2200 Copenhagen, Denmark; (G.Z.); (J.B.N.)
- The Elsass Foundation, 2920 Charlottenlund, Denmark;
| | - Jakob Lorentzen
- Department of Pediatric Neurology 5003, University Hospital Copenhagen, Rigshospitalet, 2100 Copenhagen, Denmark;
- Department of Neuroscience, Faculty of Health and Medical Sciences, The Panum Institute, Copenhagen University, 2200 Copenhagen, Denmark; (G.Z.); (J.B.N.)
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Sato Y, Tashiro H, Fukumoto K, Hirosaki S, Toki M, Kozuka N. Physical activity is associated with walking and balance ability but not fatigue, knee extension strength, or body composition in adults with cerebral palsy: a pilot cross-sectional study. Int J Rehabil Res 2023; 46:277-283. [PMID: 37417810 DOI: 10.1097/mrr.0000000000000593] [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: 07/08/2023]
Abstract
Common secondary impairments associated with aging in adults with cerebral palsy (CP) decrease physical functions, including walking and balance ability, and increase the sense of fatigue. This motor dysfunction results in decreased physical activity (PA) and could be associated with obesity and sarcopenia. This study examined the association of daily PA levels with fatigue, physical function, and body composition in 22 adults with CP (age, 37.4 ± 14.7 years; Gross Motor Function Classification System level, I: 6, II: 16). The level of daily PA was divided into percent of sedentary behavior, light PA, and moderate-to-vigorous PA (%MVPA) per day. These outcomes were examined for correlation with the Fatigue Severity Scale, knee extension strength, comfortable and maximum walking speed, Timed-Up-and-Go-Test (TUG), and body fat percentage and skeletal muscle mass using Spearman's rank correlation coefficient. An additional partial correlation analysis with sex and age adjustment was performed. The %MVPA correlated positively with comfortable walking speed (rs = 0.424, P = 0.049) and negatively with TUG (rs = -0.493, P = 0.020). The partial correlation revealed associations of %MVPA with maximum walking speed (r = 0.604, P = 0.022) and TUG (r = -0.604, P = 0.022). The results show that among adults with CP, increased PA is associated with improvements in mobility but not in perceived fatigue or body composition, regardless of sex and age. Maintaining and improving %MVPA and walking and balance ability in adults with CP have a positive impact on each other, and potentially on overall health management.
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Affiliation(s)
- Yui Sato
- Graduate School of Health Sciences, Sapporo Medical University
| | - Hideyuki Tashiro
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University
| | - Kanta Fukumoto
- Department of Rehabilitation, National Hospital Organization Hokkaido Medical Center
| | - Sota Hirosaki
- Graduate School of Health Sciences, Sapporo Medical University
| | - Megumi Toki
- Department of Rehabilitation Medicine, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Naoki Kozuka
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University
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Seasonal variations in vitamin D do not change the musculoskeletal health of physically active ambulatory men with cerebral palsy: a longitudinal cross-sectional comparison study. Nutr Res 2023; 111:24-33. [PMID: 36812881 DOI: 10.1016/j.nutres.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/03/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
Increased levels of vitamin D in the summer months from natural seasonal variations in sun exposure have been linked to improvements in musculoskeletal health and function in UK populations; however, studies have shown that differences in lifestyles because of disability can inhibit the natural vitamin D increase in these populations. We hypothesized that men with cerebral palsy (CP) will experience smaller increases in 25-hydroxyvitamin D (25(OH)D) from winter to summer and men with CP will not experience any improvements in musculoskeletal health and function during the summer. A longitudinal observational study in 16 ambulant men with CP aged 21.0 ± 1.3 years and 16 healthy, physical activity matched, typically developed controls aged 25.4 ± 2.6 years, completed assessments of serum 25(OH)D and parathyroid hormone during winter and summer. Neuromuscular outcomes included vastus lateralis size, knee extensor strength, 10-m sprint, vertical jumps, and grip strength. Bone ultrasounds were performed to obtain radius and tibia T and Z scores. Men with CP and typically developed controls showed a 70.5% and 85.7% increase in serum 25(OH)D from winter to summer months, respectively. Neither group showed seasonal effect on neuromuscular outcomes muscle strength, size, vertical jump, or tibia and radius T and Z scores. A seasonal interaction effect was seen in the tibia T and Z scores (P < .05). In conclusion, there were similar seasonal increases in 25(OH)D observed in men with CP and typically developed controls, but serum 25(OH)D levels were still considered insufficient to improve bone or neuromuscular outcomes.
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Vechetti IJ, Norrbom J, Alkner B, Hjalmarsson E, Palmcrantz A, Pontén E, Pingel J, von Walden F, Fernandez-Gonzalo R. Extracellular vesicle characteristics and microRNA content in cerebral palsy and typically developed individuals at rest and in response to aerobic exercise. Front Physiol 2022; 13:1072040. [PMID: 36620222 PMCID: PMC9811128 DOI: 10.3389/fphys.2022.1072040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
In this study, the properties of circulating extracellular vesicles (EVs) were examined in cerebral palsy (CP) and typically developed (TD) individuals at rest and after aerobic exercise, focusing on the size, concentration, and microRNA cargo of EVs. Nine adult individuals with CP performed a single exercise bout consisting of 45 min of Frame Running, and TD participants completed either 45 min of cycling (n = 10; TD EX) or were enrolled as controls with no exercise (n = 10; TD CON). Blood was drawn before and 30 min after exercise and analyzed for EV concentration, size, and microRNA content. The size of EVs was similar in CP vs. TD, and exercise had no effect. Individuals with CP had an overall lower concentration (∼25%, p < 0.05) of EVs. At baseline, let-7a, let-7b and let-7e were downregulated in individuals with CP compared to TD (p < 0.05), while miR-100 expression was higher, and miR-877 and miR-4433 lower in CP compared to TD after exercise (p < 0.05). Interestingly, miR-486 was upregulated ∼2-fold in the EVs of CP vs. TD both at baseline and after exercise. We then performed an in silico analysis of miR-486 targets and identified the satellite cell stemness factor Pax7 as a target of miR-486. C2C12 myoblasts were cultured with a miR-486 mimetic and RNA-sequencing was performed. Gene enrichment analysis revealed that several genes involved in sarcomerogenesis and extracellular matrix (ECM) were downregulated. Our data suggest that circulating miR-486 transported by EVs is elevated in individuals with CP and that miR-486 alters the transcriptome of myoblasts affecting both ECM- and sarcomerogenesis-related genes, providing a link to the skeletal muscle alterations observed in individuals with CP.
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Affiliation(s)
- Ivan J. Vechetti
- Department of Nutrition and Health Sciences, College of Education and Human Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Jessica Norrbom
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Björn Alkner
- Department of Orthopaedics, Eksjö, Region Jönköping County and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Emma Hjalmarsson
- Division of Pediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Alexandra Palmcrantz
- Division of Pediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Eva Pontén
- Division of Pediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Pediatric Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jessica Pingel
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Ferdinand von Walden
- Division of Pediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Rodrigo Fernandez-Gonzalo
- Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden,Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden,*Correspondence: Rodrigo Fernandez-Gonzalo,
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Leb S, Marciniak C, Gaebler-Spira D, Chen L, Garrett A. ASSOCIATION BETWEEN DAILY PHYSICAL ACTIVITY AND CLINICAL ANTHROPOMORPHIC MEASURES IN ADULTS WITH CEREBRAL PALSY. Arch Phys Med Rehabil 2022; 103:1777-1785. [PMID: 35202580 DOI: 10.1016/j.apmr.2022.01.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the relationship between activity level and cardiovascular risk measures as well as describe general activity patterns of adults with cerebral palsy Design: Cross-Sectional Setting: Academic Outpatient Rehabilitation Clinic. PARTICIPANTS 47 adults with cerebral palsy (CP) Interventions: Not applicable Main Outcome Measures: Gross Motor Functional Classification System (GMFCS) level was determined by validated self-report questionnaire. Activity (daily step count, walk time, sitting time, standing time, and transitional movements) over 6 days recorded using an activPAL. Weight, body mass index (BMI), and waist to hip ratio (WHR) were measured. Bivariate relationships between anthropomorphic and activity measures were assessed. RESULTS 38 participants completed all measurements. Nine were excluded due to incomplete activPAL data. The median age was 28.50 years [interquartile range 24.25,47.00], range 18-77 years. Participants' GMFCS levels were I:13%, II:16%, III:21%, IV:34%, and V:16%. Median steps/day for GMFCS I/II participants were 5258.3[3606.8, 6634.7], while median steps/day were 1681.3 [657.2, 2751.8] and 30.0 [6.8, 54.2] for GMFCS level III and IV/V participants, respectively. Significantly greater steps/day were found for GMFCS I/II or III participants compared to those GMFCS IV/V (p<0.001 and p=0.0074, respectively). 60.5% of the subjects had a BMI in the normal range, 10.5% were obese, 23.6% were overweight, and 5.3% were underweight. For subjects with GMFCS I/II, the Spearman's rank correlation coefficient for time standing and waist circumference was -0.73 (0.01). Subjects GMFCS III and GMFCS IV/V had respective correlations of -0.16 (0.71) and -0.01 (0.98). For subjects with GMFCS I/II, the Spearman's rank correlation coefficient for standing time and BMI was -0.55 (p= 0.08). For the GMFCS III and GMFCS IV/V groups the respective correlation was -0.19 (0.67) and 0.00 (1.00). CONCLUSIONS Subjects with GMFCS level I or II who engaged in more activity tended to have more favorable anthropometric profiles. Subjects GMFCS III, IV, or V did not have a similar trend. Our findings suggest factors beyond activity patterns affect anthropometrics to a greater degree in those with higher GMFCS levels.
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Affiliation(s)
- Stephen Leb
- Shirley Ryan AbilityLab, Chicago, IL; McGaw Medical Center of Northwestern University, Chicago, IL.
| | - Christina Marciniak
- McGaw Medical Center of Northwestern University, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Deborah Gaebler-Spira
- Shirley Ryan AbilityLab, Chicago, IL; McGaw Medical Center of Northwestern University, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatric Rehabilitation, Shirley Ryan AbilityLab, Chicago, IL
| | - Liqi Chen
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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A Study on Physical Exercise and General Mobility in People with Cerebral Palsy: Health through Costless Routines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179179. [PMID: 34501769 PMCID: PMC8430775 DOI: 10.3390/ijerph18179179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022]
Abstract
Sedentary behavior (SB) is a common problem that may produce health issues in people with cerebral palsy (CP). When added to a progressive reduction in motor functions over time, SB can lead to higher percentages of body fat, muscle stiffness and associated health issues in this population. Regular physical activity (RPA) may prevent the loss of motor skills and reduce health risks. In this work, we analyzed data collected from 40 people (20 children and teenagers, and 20 adults) who attend two specialist centers in Seville to obtain an up-to-date picture regarding the practice of RPA in people with CP. Roughly 60% of the participants showed mostly mid/severe mobility difficulties, while 38% also had communicative issues. Most of the participants performed light-intensity physical activity (PA) at least once or twice a week and, in the majority of cases, had a neutral or positive attitude to exercising. In the Asociación Sevillana de Parálisis Cerebral (ASPACE) sample test, the higher the International Classification of Functioning, Disability and Health (ICF), the higher the percentage of negative responses to doing exercise. Conversely, in the Centro Específico de Educación Especial Mercedes Sanromá (CEEEMS), people likes PA but slightly higher ratios of positive responses were found at Gross Motor Function Classification System (GMFCS) levels V and II, agreeing with the higher personal engagement of people at those levels. We have also performed a literature review regarding RPA in CP and the use of low-cost equipment. As a conclusion, we found that RPA produces enormous benefits for health and motor functions, whatever its intensity and duration. Costless activities such as walking, running or playing sports; exercises requiring low-cost equipment such as elastic bands, certain smartwatches or video-games; or therapies with animals, among many others, have all demonstrated their suitability for such a purpose.
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Xiong JSP, Reedman SE, Kho ME, Timmons BW, Verschuren O, Gorter JW. Operationalization, measurement, and health indicators of sedentary behavior in individuals with cerebral palsy: a scoping review. Disabil Rehabil 2021; 44:6070-6081. [PMID: 34334077 DOI: 10.1080/09638288.2021.1949050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the operationalization and measurement of sedentary behavior (SB) in individuals with cerebral palsy (CP). MATERIALS AND METHODS We searched five databases from 2011 to 2020 for primary studies of experimental, qualitative, longitudinal, or observational designs measuring SB or postures typically characterized as sedentary (sitting, reclining, lying). RESULTS We screened 1112 citations and selected 47 studies. SB was operationalized through muscle activation, energy expenditure or oxygen consumption in typically sedentary postures (n = 9), and through thresholds and postures used by accelerometers, activity monitors, and a questionnaire to measure time spent in SB (n = 25). Seven out of the eight studies that measured energy expenditure found ≤1.5 metabolic equivalents of task (METs) for sitting and lying. While different accelerometer thresholds were used to measure SB, the behavior (SB) was consistently operationalized as sitting and lying. Little consistency existed in the subpopulation, instruments and cut-points for studies on validity or reliability of tools for measuring SB (n = 19). CONCLUSIONS Sitting and lying are considered sedentary postures, which is defined as ≤1.5 METs in individuals with CP. There is variability in the tools used to measure SB in individuals with CP. Therefore, consensus on the definition and reporting of SB is needed.Implications for rehabilitationAlthough sedentary behavior (SB) is increased in individuals with cerebral palsy (CP) compared to the typically developing population, there is no standard definition for SB for these individuals; this makes it difficult to synthesize data across studies.Sitting and lying are ≤1.5 METs in individuals with CP, suggesting we only need to measure posture to show change in SB.The commonly used accelerometer cut-point in the typically developing population of ≤100 counts per minute generally has excellent reliability across multiple devices in ambulatory children with CP.
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Affiliation(s)
- Julia Shi-Peng Xiong
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Canada
| | - Sarah E Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Michelle E Kho
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Canada.,Department of Physiotherapy, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Brian W Timmons
- Department of Pediatrics, Child Health and Exercise Medicine Program, McMaster University, Hamilton, Canada.,Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine, Utrecht University, Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Jan Willem Gorter
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Canada.,Department of Pediatrics, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,Department of Pediatrics, McMaster University, Hamilton, Canada
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Musculoskeletal Health in Active Ambulatory Men with Cerebral Palsy and the Impact of Vitamin D. Nutrients 2021; 13:nu13072481. [PMID: 34371988 PMCID: PMC8308596 DOI: 10.3390/nu13072481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose: (1) To determine the contribution of diet, time spent outdoors, and habitual physical activity (PA) on vitamin D status in men with cerebral palsy (CP) compared to physical activity matched controls (TDC) without neurological impairment; (2) to determine the role of vitamin D on musculoskeletal health, morphology, and function in men with CP compared to TDC. Materials and methods: A cross-sectional comparison study where 24 active, ambulant men with CP aged 21.0 ± 1.4 years (Gross Motor Function Classification Score (I–II) and 24 healthy TDC aged 25.3 ± 3.1 years completed in vivo assessment of musculoskeletal health, including: vastus lateralis anatomical cross-sectional area (VL ACSA), isometric knee extension maximal voluntary contraction (KE iMVC), 10 m sprint, vertical jumps (VJ), and radius and tibia bone ultrasound (US) Tus and Zus scores. Assessments of vitamin D status through venous samples of serum 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone, dietary vitamin D intake from food diary, and total sun exposure via questionnaire were also taken. Results: Men with CP had 40.5% weaker KE iMVC, 23.7% smaller VL ACSA, 22.2% lower VJ, 14.6% lower KE iMVC/VL ACSA ratio, 22.4% lower KE iMVC/body mass (BM) ratio, and 25.1% lower KE iMVC/lean body mass (LBM) ratio (all p < 0.05). Radius Tus and Zus scores were 1.75 and 1.57 standard deviations lower than TDC, respectively (p < 0.05), whereas neither tibia Tus nor Zus scores showed any difference compared to TDC (p > 0.05). The 25(OH)D was not different between groups, and 90.9% of men with CP and 91.7% of TDC had low 25(OH)D levels when compared to current UK recommendations. The 25(OH)D was positively associated with KE iMVC/LBM ratio in men with CP (r = 0.500, p = 0.020) but not in TDC (r = 0.281, p = 0.104). Conclusion: Musculoskeletal outcomes in men with CP were lower than TDC, and despite there being no difference in levels of 25(OH)D between the groups, 25 (OH)D was associated with strength (KE iMVC/LBM) in the CP group but not TDC. The findings suggest that vitamin D deficiency can accentuate some of the condition-specific impairments to musculoskeletal outcomes.
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Bailes AF, Greve K, Long J, Kurowski BG, Vargus-Adams J, Aronow B, Mitelpunkt A. Describing the Delivery of Evidence-Based Physical Therapy Intervention to Individuals With Cerebral Palsy. Pediatr Phys Ther 2021; 33:65-72. [PMID: 33770793 PMCID: PMC10141519 DOI: 10.1097/pep.0000000000000783] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize by evidence grades and examine variation in type of physical therapy intervention delivered in routine clinical care in individuals with cerebral palsy (CP). METHODS Retrospective data collection from the electronic record over 1 year at a tertiary care pediatric outpatient therapy division. RESULTS Four hundred sixty-five individuals with CP received 28 344 interventions during 4335 treatment visits. Sixty-six percent of interventions were evidence-based interventions (EBIs). Significant variation was demonstrated across Gross Motor Function Classification System levels, with children classified as level V receiving the least and level III the most. The most frequent EBIs delivered were caregiver education, motor control, functional strengthening, ankle-foot orthoses, treadmill training, and fit of adaptive equipment. CONCLUSIONS Further work is needed to determine whether amount of EBI is related to better outcomes. Combining this information with other aspects of dose (intensity, time, and frequency) may elucidate the contribution of each with outcomes.
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Affiliation(s)
- Amy F Bailes
- Division of Occupational Therapy and Physical Therapy (Drs Bailes, Greve, and Long), Division of Orthopaedic Surgery Motion Analysis Laboratory (Dr Long), and Division of Biomedical Informatics (Drs Aronow and Mitelpunkt), Cincinnati Children's Hospital, Cincinnati, Ohio; Department of Rehabilitation Science (Dr Bailes), University of Cincinnati, Cincinnati, Ohio; Division of Pediatric Rehabilitation Medicine (Drs Kurowski and Vargus-Adams), Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Sackler Faculty of Medicine (Dr Mitelpunkt), Tel Aviv University, Tel Aviv, Israel
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Multidimensional Measures of Physical Activity and Their Association with Gross Motor Capacity in Children and Adolescents with Cerebral Palsy. SENSORS 2020; 20:s20205861. [PMID: 33081346 PMCID: PMC7589543 DOI: 10.3390/s20205861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/06/2023]
Abstract
The current lack of adapted performance metrics leads clinicians to focus on what children with cerebral palsy (CP) do in a clinical setting, despite the ongoing debate on whether capacity (what they do at best) adequately reflects performance (what they do in daily life). Our aim was to measure these children’s habitual physical activity (PA) and gross motor capacity and investigate their relationship. Using five synchronized inertial measurement units (IMU) and algorithms adapted to this population, we computed 22 PA states integrating the type (e.g., sitting, walking, etc.), duration, and intensity of PA. Their temporal sequence was visualized with a PA barcode from which information about pattern complexity and the time spent in each of the six simplified PA states (PAS; considering PA type and duration, but not intensity) was extracted and compared to capacity. Results of 25 children with CP showed no strong association between motor capacity and performance, but a certain level of motor capacity seems to be a prerequisite for the achievement of higher PAS. Our multidimensional performance measurement provides a new method of PA assessment in this population, with an easy-to-understand visual output (barcode) and objective data for clinical and scientific use.
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Postma K, Bussmann JBJ, van Diemen T, Post MWM, Dekkers J, van Nes IJW, Osterthun R, van den Berg-Emons RJG. Physical Activity and Sedentary Behavior From Discharge to 1 Year After Inpatient Rehabilitation in Ambulatory People With Spinal Cord Injury: A Longitudinal Cohort Study. Arch Phys Med Rehabil 2020; 101:2061-2070. [PMID: 32750374 DOI: 10.1016/j.apmr.2020.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/23/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate changes in duration of physical activity (PA) and sedentary behavior (SB) from discharge to 1 year after inpatient rehabilitation in ambulatory people with spinal cord injury (SCI). DESIGN Longitudinal cohort study with objective measurements of physical behavior at discharge and at 6 and 12 months post discharge. SETTING Three rehabilitation centers and the participant's home environment. PARTICIPANTS Participants (N=47) with ambulatory function were consecutively recruited from the self-management and self-efficacy in patients with SCI cohort (age 18 years or older, recent SCI, expected inpatient stay ≥4wk). Mean age was 54.5±12.9 years, all had incomplete lesions, 53% were men, 49% had tetraplegia, and 51% were community ambulators at discharge. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Duration (min) of PA (summed duration of walking, cycling, running, and wheeling) and SB (sitting/lying). RESULTS Mean duration of PA increased by 21 min/d (95% confidence interval, 7-35) and SB decreased by 64 min/d (95% confidence interval, -94 to -35) from discharge to 6 months after inpatient rehabilitation. No changes were found in the second half-year. One year after discharge mean PA was 116±59 min/d and mean SB was 665±121 min/d. The increase in PA was the result of an almost doubling of time spent walking. Variability in physical behavior and its change was large. Older age and lower ambulation level were associated with lower PA, lower ambulation level with higher SB, and tetraplegia was associated with a reduced increase in PA. CONCLUSIONS At group level, duration of PA and SB improved following inpatient rehabilitation in ambulatory people with SCI. However, there were large differences between individuals. Levels 1 year after discharge were still unfavorable, particularly regarding SB.
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Affiliation(s)
- Karin Postma
- Rijndam Rehabilitation, Rotterdam; Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam.
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam
| | - Tijn van Diemen
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen; Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen
| | - Jos Dekkers
- Dutch Spinal Cord Injury Association, Nijkerk, The Netherlands
| | | | - Rutger Osterthun
- Rijndam Rehabilitation, Rotterdam; Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam
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McPhee PG, Verschuren O, Peterson MD, Tang A, Gorter JW. The Formula for Health and Well-Being in Individuals With Cerebral Palsy: Cross-Sectional Data on Physical Activity, Sleep, and Nutrition. Ann Rehabil Med 2020; 44:301-310. [PMID: 32721989 PMCID: PMC7463117 DOI: 10.5535/arm.19156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/23/2019] [Indexed: 01/02/2023] Open
Abstract
Objective To determine physical activity, sleep, and nutrition patterns in individuals with cerebral palsy (CP) and investigate the association of Gross Motor Function Classification System (GMFCS) and age with these health behaviors. Methods A cross-sectional study was conducted in an outpatient setting. Participants included adolescents and adults with CP (n=28; GMFCS level I–V; mean age 35.1±14.4 years). An Exercise Questionnaire or Leisure Time Physical Activity Questionnaire was used to measure physical activity in adolescents and adults, respectively. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). An adapted version of the PrimeScreen questionnaire was used to assess nutrition. Linear regression analyses were performed to investigate the association between GMFCS and age with physical activity, sleep, and nutrition. Results The average total physical activity was 29.2±30.0 min/day. Seventy-five percent of the participants had poor sleep quality (PSQI score >5). Seventy-one percent reported “fair” eating behaviors; none reported “excellent” eating behaviors. Neither GMFCS nor age were significantly associated with PSQI score, PrimeScreen score, or total physical activity. A negative correlation existed between sleep quantity (hr/night) and PSQI score (r=-0.66, p=0.01). Conclusion The triad of health components, consisting of physical activity, sleep, and nutrition, was not associated with GMFCS or age in our sample of 28 individuals with CP, suggesting that these three health behaviors should be assessed during clinical encounters of CP in adolescents and adults at all levels of the GMFCS.
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Affiliation(s)
- Patrick G McPhee
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan-Medicine, Ann Arbor, MI, USA
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Ahmadi MN, O’Neil ME, Baque E, Boyd RN, Trost SG. Machine Learning to Quantify Physical Activity in Children with Cerebral Palsy: Comparison of Group, Group-Personalized, and Fully-Personalized Activity Classification Models. SENSORS 2020; 20:s20143976. [PMID: 32708963 PMCID: PMC7411900 DOI: 10.3390/s20143976] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 11/16/2022]
Abstract
Pattern recognition methodologies, such as those utilizing machine learning (ML) approaches, have the potential to improve the accuracy and versatility of accelerometer-based assessments of physical activity (PA). Children with cerebral palsy (CP) exhibit significant heterogeneity in relation to impairment and activity limitations; however, studies conducted to date have implemented “one-size fits all” group (G) models. Group-personalized (GP) models specific to the Gross Motor Function Classification (GMFCS) level and fully-personalized (FP) models trained on individual data may provide more accurate assessments of PA; however, these approaches have not been investigated in children with CP. In this study, 38 children classified at GMFCS I to III completed laboratory trials and a simulated free-living protocol while wearing an ActiGraph GT3X+ on the wrist, hip, and ankle. Activities were classified as sedentary, standing utilitarian movements, or walking. In the cross-validation, FP random forest classifiers (99.0–99.3%) exhibited a significantly higher accuracy than G (80.9–94.7%) and GP classifiers (78.7–94.1%), with the largest differential observed in children at GMFCS III. When evaluated under free-living conditions, all model types exhibited significant declines in accuracy, with FP models outperforming G and GP models in GMFCS levels I and II, but not III. Future studies should evaluate the comparative accuracy of personalized models trained on free-living accelerometer data.
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Affiliation(s)
- Matthew N. Ahmadi
- Institute of Health and Biomedical Innovation at Queensland Centre for Children’s Health Research, Queensland University of Technology, South Brisbane 4101, Australia; (M.N.A.); (E.B.)
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove 4059, Australia
| | - Margaret E. O’Neil
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Emmah Baque
- Institute of Health and Biomedical Innovation at Queensland Centre for Children’s Health Research, Queensland University of Technology, South Brisbane 4101, Australia; (M.N.A.); (E.B.)
- School of Allied Health Sciences, Griffith University, Gold Coast 4215, Queensland, Australia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane 4101, Australia;
| | - Stewart G. Trost
- Institute of Health and Biomedical Innovation at Queensland Centre for Children’s Health Research, Queensland University of Technology, South Brisbane 4101, Australia; (M.N.A.); (E.B.)
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove 4059, Australia
- Correspondence: ; Tel.: +61-7-3069-7301
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Hjalmarsson E, Fernandez-Gonzalo R, Lidbeck C, Palmcrantz A, Jia A, Kvist O, Pontén E, von Walden F. RaceRunning training improves stamina and promotes skeletal muscle hypertrophy in young individuals with cerebral palsy. BMC Musculoskelet Disord 2020; 21:193. [PMID: 32220246 PMCID: PMC7102439 DOI: 10.1186/s12891-020-03202-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/11/2020] [Indexed: 01/26/2023] Open
Abstract
Background Individuals with cerebral palsy (CP) are less physically active, spend more time sedentary and have lower cardiorespiratory endurance as compared to typically developed individuals. RaceRunning enables high-intensity exercise in individuals with CP with limited or no walking ability, using a three-wheeled running bike with a saddle and a chest plate for support, but no pedals. Training adaptations using this type of exercise are unknown. Methods Fifteen adolescents/young adults (mean age 16, range 9–29, 7 females/8 males) with CP completed 12 weeks, two sessions/week, of RaceRunning training. Measurements of cardiorespiratory endurance (6-min RaceRunning test (6-MRT), average and maximum heart rate, rate of perceived exertion using the Borg scale (Borg-RPE)), skeletal muscle thickness (ultrasound) of the thigh (vastus lateralis and intermedius muscles) and lower leg (medial gastrocnemius muscle) and passive range of motion (pROM) of hip, knee and ankle were collected before and after the training period. Results Cardiorespiratory endurance increased on average 34% (6-MRT distance; pre 576 ± 320 m vs. post 723 ± 368 m, p < 0.001). Average and maximum heart rate and Borg-RPE during the 6-MRT did not differ pre vs. post training. Thickness of the medial gastrocnemius muscle increased 9% in response to training (p < 0.05) on the more-affected side. Passive hip flexion increased (p < 0.05) on the less-affected side and ankle dorsiflexion decreased (p < 0.05) on the more affected side after 12 weeks of RaceRunning training. Conclusions These results support the efficacy of RaceRunning as a powerful and effective training modality in individuals with CP, promoting both cardiorespiratory and peripheral adaptations.
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Affiliation(s)
- Emma Hjalmarsson
- Neuropediatrics Unit, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden.,Allied Health Professionals Function, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Rodrigo Fernandez-Gonzalo
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Lidbeck
- Neuropediatrics Unit, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden.,Department of Pediatric Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Alexandra Palmcrantz
- Allied Health Professionals Function, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Angel Jia
- Neuropediatrics Unit, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden
| | - Ola Kvist
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden.,Clinical Pediatrics Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eva Pontén
- Neuropediatrics Unit, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden.,Department of Pediatric Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ferdinand von Walden
- Neuropediatrics Unit, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden.
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Claridge EA, Bloemen MAT, Rook RA, Obeid J, Timmons BW, Takken T, Van Den Berg-Emons RJG, De Groot JF, Gorter JW. Physical activity and sedentary behaviour in children with spina bifida. Dev Med Child Neurol 2019; 61:1400-1407. [PMID: 31468507 DOI: 10.1111/dmcn.14333] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 01/10/2023]
Abstract
AIM To describe active and sedentary time in children with spina bifida and to compare their physical activity on weekdays versus weekends. METHOD In this exploratory cross-sectional study, data from 13 Canadian and 22 Dutch children with spina bifida (14 females, 21 males; mean age 10y 11mo, standard deviation [SD] 3y 6mo, range 5y 6mo-18y; Hoffer classification distribution: community [n=28], household [n=3], non-functional [n=3], and non-ambulator [n=1]) were analysed. Objective measures of physical activity and sedentary behaviour were obtained by using ActiGraph or Actiheart activity monitors. Data for the participants wearing the ActiGraph were compared with age- and sex-matched controls that were developing typically using independent-samples t-tests. Activity data collected on weekdays was compared to those on weekends. RESULTS ActiGraph data demonstrated children with spina bifida spent more time sedentary (mean [SD] 49.5min/h [5.78]) and less time in moderate to vigorous physical activity (mean [SD] 2.33min/h [1.61]) compared with the typically developing group (mean [SD] 41.0min/h [5.76] and 5.46min/h [2.13], p=0.001 and p<0.001 respectively). For both ActiGraph- and Actiheart-derived data, physical activity and sedentary time were not significantly different between weekdays and weekends. INTERPRETATION Children with spina bifida have reduced levels of physical activity and increased sedentary behaviour, with no statistical differences seen between weekdays and weekends. Several methodological issues related to activity monitoring warrant consideration when choosing the appropriate method to quantify physical activity and sedentary behaviour. WHAT THIS PAPER ADDS Reduced levels of physical activity and sedentary time were quantified in children with spina bifida. Objective quantification of physical behaviour in ambulatory and non-ambulatory school-aged children with spina bifida is possible.
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Affiliation(s)
- Everett A Claridge
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Manon A T Bloemen
- Research Group Lifestyle and Health, HU University of Applied Health Sciences Utrecht, Utrecht, the Netherlands.,Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rosanne A Rook
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joyce Obeid
- Child Health & Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Brian W Timmons
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,Child Health & Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Tim Takken
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Janke F De Groot
- Research Group Lifestyle and Health, HU University of Applied Health Sciences Utrecht, Utrecht, the Netherlands.,Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
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Effects of Exercise Interventions on Habitual Physical Activity and Sedentary Behavior in Adolescents With Cerebral Palsy. Pediatr Exerc Sci 2019; 31:416-424. [PMID: 30922152 DOI: 10.1123/pes.2018-0254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/05/2019] [Accepted: 01/24/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Exercise interventions have been shown to increase motor capacities in adolescents with cerebral palsy; however, how they affect habitual physical activity (HPA) and sedentary behavior is unclear. The main objective was to correlate changes in HPA with changes in mobility capacity following exercise interventions. METHODS A total of 54 participants (aged 12-20 y) with bilateral spastic cerebral palsy at Gross Motor Function Classification System (GMFCS) levels II and III received 4 months of group progressive resistance training or treadmill training. Mobility measurements and HPA (averaged over 96 h) were made before and after interventions. RESULTS Averaged baseline mobility and HPA measures and improvements in each after both interventions were positively correlated in all participants. Percentage of sedentary/awake time decreased 2%, with significant increases in HPA measures of step count (16%), walk time (14%), and upright time (9%). Mobility measures and HPA changes were quite similar between Gross Motor Function Classification System levels, but improvement in HPA after group progressive resistance training was greater than after treadmill training (12% vs 4%) and correlated with mobility improvement. CONCLUSIONS Mobility capacity improved after these interventions and was clearly associated with improved HPA. The group progressive resistance training intervention seems preferable to improve HPA, perhaps related to greater social interaction and motivation provided by group training.
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19
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A Comparison of the Physiology of Sedentary Behavior and Light Physical Activity in Adults With and Without a Physical Disability. J Phys Act Health 2019; 16:894-901. [DOI: 10.1123/jpah.2019-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/16/2019] [Accepted: 06/17/2019] [Indexed: 11/18/2022]
Abstract
Background: It is questionable whether postures that are regarded as sedentary behavior in able-bodied persons evoke comparable physiological responses in adults with stroke or cerebral palsy (CP). This study aimed to compare metabolic demand and muscle activity in healthy controls, adults with stroke, and adults with CP during sedentary behavior and light physical activities. Methods: Seventy-one adults (45.6 [18.9] y, range 18–86) participated in this study, of which there were 18 controls, 31 with stroke, and 22 with CP. The metabolic equivalent of task (MET) and level of muscle activation were assessed for different sedentary positions (sitting supported and unsupported) and light physical activities (standing and walking). Results: During sitting supported and unsupported, people with mild to moderate stroke and CP show comparable MET and electromyographic values as controls. While sitting unsupported, people with severe stroke show higher METs and electromyographic values (P < .001), and people with severe CP only show higher METs compared with controls (P < .05) but all below 1.5 METs. Standing increased electromyographic values in people with severe stroke or CP (P < .001) and reached values above 1.5 METs. Conclusions: Physiologic responses during sedentary behavior are comparable for controls and adults with mild to moderate stroke and CP, whereas higher metabolic demands and muscle activity (stroke only) were observed in severely affected individuals.
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Lavelle G, Noorkoiv M, Theis N, Korff T, Kilbride C, Baltzopoulos V, Shortland A, Levin W, Ryan JM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) as a measure of physical activity (PA) in young people with cerebral palsy: A cross-sectional study. Physiotherapy 2019; 107:209-215. [PMID: 32026822 DOI: 10.1016/j.physio.2019.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/24/2019] [Accepted: 08/20/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to examine the validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) as a measure of physical activity (PA) in young people with cerebral palsy (CP). DESIGN Cross-sectional. SETTING Participants were recruited through 8 National Health Service (NHS) trusts, one school, one university and through organisations that provide services for people with disabilities in England. PARTICIPANTS Sixty-four, ambulatory young people aged 10-19 years with CP [Gross Motor Function Classification System (GMFCS) levels I-III] participated in this study. MAIN OUTCOME MEASURE The IPAQ-SF was administered to participants. Participants were then asked to wear a wGT3X-BT triaxial accelerometer (ActiGraph, Pensacola, FL) for 7 days to objectively assess PA. Time spent in sedentary behaviour, in moderate to vigorous PA (MVPA) and in total PA (TPA) was compared between measures. RESULTS Young people with CP self-reported less time in sedentary behaviour and underestimated the time spent in TPA, when compared to accelerometer measurements. Bland-Altman plots demonstrated poor agreement between the measures for MVPA, with upper and lower 95% limits of agreement of -147 to 148.9minute. After adjusting for gender and GMFCS level, age was a predictor of the difference between measures for MVPA (P<0.001) and TPA (P<0.001). CONCLUSIONS These findings suggest that the IPAQ-SF is not a valid method of measuring TPA or sedentary behaviour in young people with CP and it is not appropriate for use when assessing an individual's time in MVPA. Therefore, where feasible, an objective measure of PA should be used. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN90378161.
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Affiliation(s)
- Grace Lavelle
- College of Health and Life Sciences, Brunel University London, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucestershire, United Kingdom
| | | | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, London, United Kingdom
| | - Wendy Levin
- Department of Physiotherapy, Swiss Cottage School and Development and Research Centre, London, United Kingdom
| | - Jennifer M Ryan
- College of Health and Life Sciences, Brunel University London, London, United Kingdom; Department of Epidemiology and Public Health Medicine, RCSI, Dublin, Ireland
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McPhee PG, Benner JL, Balemans ACJ, Verschuren O, van den Berg-Emons RJG, Hurvitz EA, Peterson MD, van der Slot WMA, Roebroeck ME, Gorter JW. Multimorbidity risk assessment in adolescents and adults with cerebral palsy: a protocol for establishing a core outcome set for clinical research and practice. Trials 2019; 20:176. [PMID: 30890152 PMCID: PMC6425572 DOI: 10.1186/s13063-019-3265-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/27/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Estimates of multimorbidity, defined as the presence of at least two chronic conditions, some of which attributable to modifiable behaviours, are high in adults with cerebral palsy (CP). An assessment protocol evaluating multimorbidity risk is needed in order to develop and evaluate effective interventions to optimize lifelong health in individuals with CP. The aim of this protocol paper is to describe the development of a core outcome set (COS) for assessing multimorbidity risk in adolescents and adults with CP, to be used in clinic and research. METHODS The expert consortium will first define the target population and outcomes to be measured. Through a process of literature review and an international Delphi survey with expert clinicians and researchers, we will then determine which outcome measurement instruments (OMIs) can best measure those outcomes. The resulting OMIs will be used in a feasibility study with adolescents and adults with CP from an international clinical research network. Finally, a face-to-face stakeholder meeting with adolescents and adults with CP, their families/caregivers and researchers and clinicians who are experts in CP, will be organized to reach final agreement on the COS. DISCUSSION This COS will guide clinicians and researchers in assessing multimorbidity risk in adolescents and adults with CP. The inclusion of experts and individuals with CP from international locations for establishing the COS lends strong support to its generalizability. Evidence of its feasibility and approval from all stakeholders will enable implementation in clinical practice, and guide future research using the COS in individuals with CP.
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Affiliation(s)
- Patrick G McPhee
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Joyce L Benner
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Astrid C J Balemans
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Public Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Parkway, Ann Arbor, MI, 48108, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Parkway, Ann Arbor, MI, 48108, USA
| | - Wilma M A van der Slot
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
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Comparison of Habitual Physical Activity and Sedentary Behavior in Adolescents and Young Adults With and Without Cerebral Palsy. Pediatr Exerc Sci 2019; 31:60-66. [PMID: 30272530 DOI: 10.1123/pes.2017-0285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The comparison of habitual physical activity and sedentary time in teenagers and young adults with cerebral palsy (CP) with typically developed (TD) peers can serve to quantify activity shortcomings. METHODS Patterns of sedentary, upright, standing, and walking components of habitual physical activity were compared in age-matched (16.8 y) groups of 54 youths with bilateral spastic CP (38 who walk with limitations and 16 who require mobility devices) and 41 TD youths in the Middle East. Activity and sedentary behavior were measured over 96 hours by activPAL3 physical activity monitors. RESULTS Participants with CP spent more time sedentary (8%) and sitting (37%) and less time standing (20%) and walking (40%) than TD (all Ps < .01). These trends were enhanced in the participants with CP requiring mobility devices. Shorter sedentary events (those <60-min duration) were similar for TD and CP groups, but CP had significantly more long sedentary events (>2 h) and significantly fewer upright events (taking <30, 30-60, and >60 min) and less total upright time than TD. CONCLUSION Ambulant participants with CP, as well as TD youth must be encouraged to take more breaks from being sedentary and include more frequent and longer upright events.
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Williams SA, McFadden LM, Blackmore AM, Davey P, Gibson N. Do adolescents with cerebral palsy meet recommendations for healthy weight and physical activity behaviours? Disabil Rehabil 2019; 42:1227-1232. [DOI: 10.1080/09638288.2018.1519043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Sîan A. Williams
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Lottie M. McFadden
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | | | - Paul Davey
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Noula Gibson
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Ability Centre, Perth, Australia
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Canadian-French adaptation and test-retest reliability of the leisure time physical activity questionnaire for people with disabilities. Ann Phys Rehabil Med 2019; 62:161-167. [PMID: 30639580 DOI: 10.1016/j.rehab.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/27/2018] [Accepted: 12/01/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The Leisure Time Physical Activity Questionnaire (LTPAQ) measures the duration of physical activities performed during the past 7 days, and results are expressed in minutes. This study aimed to translate this questionnaire into Canadian-French and to evaluate the content validity and its test-retest reliability in people with physical disabilities. METHODS The LTPAQ was translated from English to French by forward and backward translation. To assess content validity, 9 adults with physical disabilities read and provided comments regarding the relevance, wording and understanding of the items of the preliminary Canadian-French version of the questionnaire. For test-retest reliability, 37 adults with physical disabilities completed the questionnaire 2 or 3 times at T1 (baseline), T2 (2 days from baseline) and T3 (7 days from baseline). The test-retest reliability was investigated by intra-class correlation coefficients (ICCs), paired t test and Bland and Altman tests. RESULTS The translation and the content validation process resulted in a Canadian-French version of the LTPAQ (LTPAQ-CF). Total LTPAQ-CF scores between T1-T2 and T1-T3 featured strong ICCs, 0.90 and 0.75 (P≤0.01). Paired t tests and Bland and Altman analyses confirmed the good reproducibility of results. CONCLUSION The LTPAQ-CF has good test-retest reliability when self-administered or administered by interview to people with physical disabilities.
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Bloemen MAT, van den Berg-Emons RJG, Tuijt M, Nooijen CFJ, Takken T, Backx FJG, Vos M, de Groot JF. Physical activity in wheelchair-using youth with spina bifida: an observational study. J Neuroeng Rehabil 2019; 16:9. [PMID: 30642361 PMCID: PMC6332897 DOI: 10.1186/s12984-018-0464-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though typically developing youth are already at risk for physical inactivity, youth with spina bifida may be even at higher risk as a consequence of their reduced mobility. No objective data is available for youth with spina bifida who use a manual wheelchair, so the seriousness of the problem is unknown. The purpose of this observational study was to quantify physical activity in wheelchair-using youth with spina bifida and evaluate the intensity of activities. METHODS Fifty-three children and adolescents (5-19 years) with spina bifida who use a manual wheelchair for daily life, long distances or sports were included. To assess time spent in several types of activities VitaMove data of 34 participants were used and were presented as time spent sedentary and time spent physically active. This was compared to reference data of typically developing youth. To assess time spent in several intensities Actiheart data of 36 participants were used. The intensities were categorized according to the American College of Sports Medicine, ranging from very light intensity to near to maximal intensity. Data of 25 participants were used to combine type of activity and intensity. RESULTS Children and adolescents with spina bifida who use a manual wheelchair were more sedentary (94.3% versus 78.0% per 24 h, p < 0.000) and less physically active (5.0% versus 12.2% per 24 h, p < 0.000) compared to typically developing peers. Physical activity during weekend days was worse compared to school days; 19% met the Guidelines of Physical Activity during school days and 8% during weekend days. The intensities per activity varied extensively between participants. CONCLUSIONS Children and adolescents with spina bifida who use a manual wheelchair are less physically active and more sedentary than typically developing youth. The physical activity levels on school days seem to be more favorable than the physical activity levels on a weekend day. The low levels of physical activity need our attention in pediatric rehabilitation practice. The different intensities during activities indicate the importance of individually tailored assessments and interventions.
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Affiliation(s)
- Manon A T Bloemen
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
| | | | - Matthijs Tuijt
- Research Group Human Movement and Adaptation, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Carla F J Nooijen
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tim Takken
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J G Backx
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marleen Vos
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Janke F de Groot
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Quality and Organization of Care, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Riquelme I, do Rosário RS, Vehmaskoski K, Natunen P, Montoya P. Influence of chronic pain in physical activity of children with cerebral palsy. NeuroRehabilitation 2018; 43:113-123. [DOI: 10.3233/nre-172409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Inmaculada Riquelme
- University Institute of Health Sciences Research (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | | | - Kari Vehmaskoski
- JAMK University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland
| | - Pekka Natunen
- JAMK University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland
| | - Pedro Montoya
- University Institute of Health Sciences Research (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain
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Ryan JM, Allen E, Gormley J, Hurvitz EA, Peterson MD. The risk, burden, and management of non-communicable diseases in cerebral palsy: a scoping review. Dev Med Child Neurol 2018; 60:753-764. [PMID: 29572812 DOI: 10.1111/dmcn.13737] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 12/26/2022]
Abstract
AIM To examine the risk, burden, and management of non-communicable diseases (NCDs) among people with cerebral palsy (CP). METHOD Databases (Ovid MEDLINE, Embase Ovid, CINAHL Plus) were systematically searched up to August 2017. Data on the prevalence of risk factors for, and the burden and management of, cardiovascular diseases, diabetes, cancers, and respiratory diseases were extracted. RESULTS Thirty-six studies that examined the prevalence of risk factors among people with CP were identified. There was inconsistent evidence that people with CP had higher prevalence of metabolic risk factors such as hypertension, hyperlipidaemia, and obesity, but strong evidence that they participated in low levels of physical activity, compared with people without CP. Seven studies reported on the burden of NCDs. Adults with CP had a higher risk of NCDs, including stroke, chronic obstructive pulmonary disease, and other heart conditions, and death due to NCDs, including cancers, chronic obstructive pulmonary disease, stroke, and ischaemic heart disease, compared with the general population. Only one study reported on the management of NCD, specifically the uptake of breast cancer screening among females. INTERPRETATION The burden of NCDs is higher among adults with CP compared with the general population. Further research is required to determine the prevalence of metabolic risk factors and management of NCDs among people with CP. WHAT THIS PAPER ADDS Adults with cerebral palsy (CP) have an increased risk of non-communicable diseases (NCDs) and increased risk of death because of NCDs. Evidence is inconsistent about the elevated prevalence of metabolic risk factors for NCDs. Evidence is consistent that people with CP participate in reduced physical activity. Only one study reported on management of NCD among people with CP. Available evidence suggests people with CP are less likely to receive preventive medicine.
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Affiliation(s)
- Jennifer M Ryan
- College of Health and Life Sciences, Brunel University, London, UK.,Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - John Gormley
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Mus-Peters CTR, Huisstede BMA, Noten S, Hitters MWMGC, van der Slot WMA, van den Berg-Emons RJG. Low bone mineral density in ambulatory persons with cerebral palsy? A systematic review. Disabil Rehabil 2018; 41:2392-2402. [PMID: 29783868 DOI: 10.1080/09638288.2018.1470261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Purpose: Non-ambulatory persons with cerebral palsy are prone to low bone mineral density. In ambulatory persons with cerebral palsy, bone mineral density deficits are expected to be small or absent, but a consensus conclusion is lacking. In this systematic review bone mineral density in ambulatory persons with cerebral palsy (Gross Motor Function Classification Scales I-III) was studied. Materials and methods: Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as Z-score ≤ -2.0. In addition, we focused on Z-score ≤ -1.0 because this may indicate a tendency towards low bone mineral density. Results: We included 16 studies, comprising 465 patients aged 1-65 years. Moderate and conflicting evidence for low bone mineral density (Z-score ≤ -2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (Z-score ≤ -1.0) for several body parts. Conclusions: Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy. Implications for Rehabilitation Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP. Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view. If indicated, medication and fall prevention training should be prescribed.
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Affiliation(s)
| | - Bionka M A Huisstede
- b Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neurosciences , University Medical Centre Utrecht, Utrecht University , Utrecht , The Netherlands
| | - Suzie Noten
- c Department of Rehabilitation Medicine , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | | | - Wilma M A van der Slot
- c Department of Rehabilitation Medicine , Erasmus University Medical Centre , Rotterdam , The Netherlands.,d Rijndam Rehabilitation , Rotterdam , The Netherlands
| | - Rita J G van den Berg-Emons
- a Libra Rehabilitation & Audiology , Eindhoven/Tilburg , The Netherlands.,c Department of Rehabilitation Medicine , Erasmus University Medical Centre , Rotterdam , The Netherlands
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Accelerometer-Assessed Physical Activity and Sedentary Time in Youth With Disabilities. Adapt Phys Activ Q 2018; 35:1-19. [PMID: 29072484 DOI: 10.1123/apaq.2015-0065] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study compared accelerometer-assessed habitual physical activity (PA), sedentary time, and meeting PA recommendations among 102 youth with disabilities (7-20 years) in four subgroups-physical/visual impairments, intellectual disability, autism spectrum disorders, and hearing impairment-and 800 youth with typical development (8-16 years). Low proportions of youth with disabilities met PA recommendations, and they generally were less physically active and more sedentary than youth with typical development. The hearing impairment and autism spectrum disorder groups were the most and least physically active, respectively. Older age and to some extent female sex were related to less PA and more sedentary time. Considering the suboptimal levels of PA in youth with disabilities, effective interventions directed at factors associated with PA among them are needed.
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Harmsen WJ, Ribbers GM, Heijenbrok-Kal MH, Bussmann JBJ, Sneekes EM, Khajeh L, van Kooten F, Neggers SJCMM, van den Berg-Emons RJ. Inactive lifestyles and sedentary behavior in persons with chronic aneurysmal subarachnoid hemorrhage: evidence from accelerometer-based activity monitoring. J Neuroeng Rehabil 2017; 14:120. [PMID: 29169368 PMCID: PMC5701368 DOI: 10.1186/s12984-017-0331-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 10/31/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (a-SAH) is a potential life-threatening stroke. Because survivors may be at increased risk for inactive and sedentary lifestyles, this study evaluates physical activity (PA) and sedentary behavior (SB) in the chronic phase after a-SAH. METHODS PA and SB were objectively measured at six months post a-SAH with an accelerometer-based activity monitor, with the aim to cover three consecutive weekdays. Total time spent in PA (comprising walking, cycling, running and non-cyclic movement) and SB (comprising sitting and lying) was determined. Also, in-depth analyses were performed to determine the accumulation and distribution of PA and SB throughout the day. Binary time series were created to determine the mean bout length and the fragmentation index. Measures of PA and SB in persons with a-SAH were compared to those in sex- and age-matched healthy controls. RESULTS The 51 participants comprised 33 persons with a-SAH and 18 controls. None of the participants had signs of paresis or spasticity. Persons with a-SAH spent 105 min/24 h being physically active, which was 35 min/24 h less than healthy controls (p = 0.005). For PA, compared with healthy controls, the mean bout length was shorter in those with a-SAH (12.0 vs. 13.5 s, p = 0.006) and the fragmentation index was higher (0.053 vs. 0.041, p < 0.001). Total sedentary time during waking hours showed no significant difference between groups (514 min vs. 474 min, p = 0.291). For SB, the mean bout length was longer in persons with a-SAH (122.3 vs. 80.5 s, p = 0.024), whereas there was no difference in fragmentation index between groups (0.0032 vs 0.0036, p = 0.396). CONCLUSIONS Persons with a-SAH are less physically active, they break PA time into shorter periods, and SB periods last longer compared to healthy controls. Since inactive lifestyles and prolonged uninterrupted periods of SB are independent risk factors for poor cardiovascular health, interventions seem necessary and should target both PA and SB. STUDY REGISTRATION Dutch registry number: NTR 2085.
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Affiliation(s)
- Wouter J Harmsen
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands. .,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Gerard M Ribbers
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Majanka H Heijenbrok-Kal
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Johannes B J Bussmann
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Emiel M Sneekes
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Ladbon Khajeh
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fop van Kooten
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sebastian J C M M Neggers
- Department of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rita J van den Berg-Emons
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, 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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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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Verschuren O, Peterson MD, Balemans AC, Hurvitz EA. Exercise and physical activity recommendations for people with cerebral palsy. Dev Med Child Neurol 2016; 58:798-808. [PMID: 26853808 PMCID: PMC4942358 DOI: 10.1111/dmcn.13053] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 12/19/2022]
Abstract
Physical activity and its promotion, as well as the avoidance of sedentary behaviour, play important roles in health promotion and prevention of lifestyle-related diseases. Guidelines for young people and adults with typical development are available from the World Health Organisation and American College of Sports Medicine. However, detailed recommendations for physical activity and sedentary behaviour have not been established for children, adolescents, and adults with cerebral palsy (CP). This paper presents the first CP-specific physical activity and exercise recommendations. The recommendations are based on (1) a comprehensive review and analysis of the literature, (2) expert opinion, and (3) extensive clinical experience. The evidence supporting these recommendations is based on randomized controlled trials and observational studies involving children, adolescents, and adults with CP, and buttressed by the previous guidelines for the general population. These recommendations may be used to guide healthcare providers on exercise and daily physical activity prescription for individuals with CP.
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Affiliation(s)
- Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, Rembrandtkade 10, 3583TM, Utrecht, The Netherlands, Phone: +3130-2561211
| | - Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Astrid C.J. Balemans
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands and Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Edward A. Hurvitz
- Chair, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Claridge EA, McPhee PG, Timmons BW, Martin Ginis KA, Macdonald MJ, Gorter JW. Quantification of Physical Activity and Sedentary Time in Adults with Cerebral Palsy. Med Sci Sports Exerc 2016; 47:1719-26. [PMID: 25423446 DOI: 10.1249/mss.0000000000000589] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to determine objective and subjective quantification of habitual physical activity (HPA) and sedentary time in ambulatory and nonambulatory adults with cerebral palsy (CP). METHODS We recruited a clinical sample of adults with CP (N = 42; 21 women; mean (SD) age, 33.5 (12.3) yr; Gross Motor Function Classification System (GMFCS) distribution: level I (n = 5), level II (n = 9), level III (n = 10), level IV (n = 11), and level V (n = 7). Objective measures of HPA and sedentary time were obtained by using ActiGraph GT3X accelerometers at both hip and wrist sites. Three previously established cut-point values distinguishing light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) were evaluated across GMFCS levels. The concurrent validity of the self-report Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) was assessed for LPA and MVPA intensities in GMFCS levels II-V. RESULTS Participants showed little reluctance to wearing accelerometers; one participant reported discomfort. Nonambulatory adults (GMFCS levels IV-V) differed from ambulatory adults (GMFCS levels I-III) for recorded activity counts (hip and wrist sites), minutes of MVPA with each cut-point value, and breaks from sedentary time (all P < 0.05). For the same measures, adults in GMFCS level III also differed from GMFCS level I (all P < 0.05). The PARA-SCI correlated significantly with accelerometer-derived minutes of MVPA per day (r = 0.396; P = 0.014) and per hour of monitoring time (r = 0.356; P = 0.027). CONCLUSIONS Our findings support the use of accelerometers to objectively measure HPA and sedentary behavior in adults with CP across the severity spectrum, regardless of cut-point implementation. The PARA-SCI is a valid tool to capture subjectively reported patterns of MVPA in adults with CP who are GMFCS levels II-V.
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Affiliation(s)
- Everett A Claridge
- 1CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, CANADA; 2Department of Kinesiology, McMaster University, Hamilton, Ontario, CANADA; and 3Child Health & Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, Ontario, CANADA
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Comparison of Patterns of Physical Activity and Sedentary Behavior Between Children With Cerebral Palsy and Children With Typical Development. Phys Ther 2015; 95:1609-16. [PMID: 26023216 DOI: 10.2522/ptj.20140337] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reduced participation in physical activity and increased time spent in sedentary behavior are associated with overweight, chronic disease, and disability. In order to optimize recommendations and interventions to increase physical activity and reduce sedentary behavior in children with cerebral palsy (CP), knowledge of their physical activity and sedentary behavior is needed. OBJECTIVES The aim of this study was to describe light, moderate, and vigorous physical activity and sedentary behavior in preadolescent children with and without CP and compare physical activity and sedentary behavior between the 2 groups. DESIGN This was a cross-sectional study of 33 children, aged 6 to 10 years, with CP (Gross Motor Function Classification System [GMFCS] levels I-III) and 33 age- and sex-matched children with typical development. METHODS Physical activity was measured using the RT3 accelerometer over 7 days. RESULTS Children with CP spent more time in sedentary behavior and accumulated less total activity, moderate activity, vigorous activity, and sustained bouts of moderate-to-vigorous activity (MVPA). They also accumulated a fewer number of bouts of MVPA and vigorous activity, despite spending a similar amount of time in each bout. LIMITATIONS The small number of children in GMFCS levels II and III did not allow for adjustment for GMFCS level when comparing physical activity between children with and without CP. CONCLUSIONS Preadolescent children with CP spent less time in moderate and vigorous activity and more time in sedentary behavior than children with typical development. Children with CP also accumulated less continuous MVPA and vigorous activity as a result of achieving fewer sustained bouts of MVPA and vigorous activity throughout the day.
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Peterson MD, Zhang P, Haapala HJ, Wang SC, Hurvitz EA. Greater Adipose Tissue Distribution and Diminished Spinal Musculoskeletal Density in Adults With Cerebral Palsy. Arch Phys Med Rehabil 2015; 96:1828-33. [PMID: 26140740 PMCID: PMC4601929 DOI: 10.1016/j.apmr.2015.06.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/12/2015] [Accepted: 06/13/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine differences in adipose tissue distribution, lumbar vertebral bone mineral density (BMD), and muscle attenuation in adults with and without cerebral palsy (CP), and to determine the associations between morphologic characteristics. DESIGN Cross-sectional, retrospective analyses of archived computed tomography scans. SETTING Clinical treatment and rehabilitation center. PARTICIPANTS Adults (N=352) with CP (age, 38.8±14.4y; body mass, 61.3±17.1kg; Gross Motor Function Classification System levels, I-V) and a matched cohort of neurotypical adults. Of the 41 adults with CP included in the study, 10 were not matchable because of low body masses. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Computed tomography scans were assessed for visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas, psoas major area and attenuation in Hounsfield units (Hu), and cortical and trabecular BMDs. RESULTS Adults with CP had lower cortical (β=-63.41 Hu, P<.001) and trabecular (β=-42.24 Hu, P<.001) BMDs and psoas major areas (β=-374.51mm(2), P<.001) and attenuation (β=-9.21 Hu, P<.001) after controlling for age, sex, and body mass. Adults with CP had greater VAT (β=3914.81mm(2), P<.001) and SAT (β=4615.68mm(2), P<.001). Muscle attenuation was significantly correlated with trabecular (r=.51, P=.002) and cortical (r=.46, P<.01) BMD, whereas VAT was negatively associated with cortical BMD (β=-.037 Hu/cm(2), r(2)=.13, P=.03). CONCLUSIONS Adults with CP had lower BMDs, smaller psoas major area, greater intermuscular adipose tissue, and greater trunk adiposity than neurotypical adults. VAT and cortical BMD were inversely associated.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Peng Zhang
- Department of Surgery, University of Michigan, Ann Arbor, MI; Morphomic Analysis Group, University of Michigan, Ann Arbor, MI
| | - Heidi J Haapala
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Stewart C Wang
- Department of Surgery, University of Michigan, Ann Arbor, MI; Morphomic Analysis Group, University of Michigan, Ann Arbor, MI
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
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Bania TA, Dodd KJ, Baker RJ, Graham HK, Taylor NF. The effects of progressive resistance training on daily physical activity in young people with cerebral palsy: a randomised controlled trial. Disabil Rehabil 2015; 38:620-6. [PMID: 26056856 DOI: 10.3109/09638288.2015.1055376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine if individualised resistance training increases the daily physical activity of adolescents and young adults with bilateral spastic cerebral palsy (CP). METHOD Young people with bilateral spastic CP were randomly assigned to intervention or to usual care. The intervention group completed an individualised lower limb progressive resistance training programme twice a week for 12 weeks in community gymnasiums. The primary outcome was daily physical activity (number of steps, and time sitting and lying). Secondary outcomes included muscle strength measured with a one-repetition maximum (1RM) leg press and reverse leg press. Outcomes were measured at baseline, 12 weeks and 24 weeks. RESULTS From the 36 participants with complete data at 12 weeks, there were no between-group differences for any measure of daily physical activity. There was a likely increase in leg press strength in favour of the intervention group (mean difference 11.8 kg; 95% CI -1.4 to 25.0). No significant adverse events occurred during training. CONCLUSIONS A short-term resistance training programme that may increase leg muscle strength was not effective in increasing daily physical activity. Other strategies are needed to address the low-daily physical activity levels of young people with bilateral spastic CP. IMPLICATIONS FOR REHABILITATION Progressive resistance training may increase muscle strength but does not lead to increases in daily physical activity of young people with bilateral spastic cerebral palsy (CP) and mild to moderate walking disabilities. Other strategies apart from or in addition to resistance training are needed to address the low daily physical activity levels of young people with bilateral spastic CP and mild to moderate walking disabilities.
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Affiliation(s)
- Theofani A Bania
- a Faculty of Health Sciences , La Trobe University , Bundoora, Melbourne , VIC , Australia
| | - Karen J Dodd
- a Faculty of Health Sciences , La Trobe University , Bundoora, Melbourne , VIC , Australia
| | - Richard J Baker
- b Clinical Gait Analysis, University of Salford , Salford , UK , and
| | - H Kerr Graham
- c Department Orthopaedic Surgery , Royal Children's Hospital , Melbourne , VIC , Australia
| | - Nicholas F Taylor
- a Faculty of Health Sciences , La Trobe University , Bundoora, Melbourne , VIC , Australia
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Slaman J, Roebroeck M, Dallmijer A, Twisk J, Stam H, Van Den Berg-Emons R. Can a lifestyle intervention programme improve physical behaviour among adolescents and young adults with spastic cerebral palsy? A randomized controlled trial. Dev Med Child Neurol 2015; 57:159-66. [PMID: 25303096 DOI: 10.1111/dmcn.12602] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
Abstract
AIM Optimal physical behaviour is important, as physical inactivity contributes to functional deterioration and reduced social participation. Nevertheless, research showed that persons with cerebral palsy (CP) have low physical activity levels. The objective of this study is to evaluate the effectiveness of a lifestyle intervention programme on physical behaviour. METHOD Fifty-seven persons (36 completed the total study) with spastic CP (age range 16 to 25y; 27 males, 30 females), classified as Gross Motor Function Classification System levels I-IV were included in this randomized controlled trial. Twenty-nine participants had a unilateral CP and 27 had a bilateral CP. A 6-month lifestyle intervention consisting of fitness training and counselling on physical behaviour and sports participation was evaluated. Physical behaviour was objectively measured using ambulatory activity monitors. Self-reported physical activity was determined using the Physical Activity Scale for Individuals with Physical Disabilities. RESULTS The intervention did not affect the objectively measured physical activity during the intervention (beta=0.34, CI=-1.70 to 2.37) or at follow-up (beta=0.30, CI=-1.99 to 2.59). Self-reported physical activity was positively affected during the intervention period (beta=7.61, CI=0.17-15.05); however, this effect was not present at follow-up (beta=3.65, CI=-3.05 to 10.36). INTERPRETATION The lifestyle intervention was ineffective in eliciting a behavioural change towards more favourable physical behaviour in adolescents and young adults with spastic CP.
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Affiliation(s)
- Jorrit Slaman
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Habitual physical activity of independently ambulant children and adolescents with cerebral palsy: are they doing enough? Phys Ther 2015; 95:202-11. [PMID: 25278338 DOI: 10.2522/ptj.20140031] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Despite the health benefits of regular physical activity, children with cerebral palsy (CP) are thought to participate in reduced levels of physical activity. OBJECTIVE The study objective was to assess physical activity and determine the proportion adhering to the recommended 60 minutes of moderate-to-vigorous physical activity (MVPA) daily in independently ambulant children and adolescents with unilateral CP. DESIGN This was a cross-sectional study. METHOD Children (N=102; 52 boys, 50 girls; mean age=11 years 3 months, SD=2 years 4 months) with spastic hemiplegia classified at Gross Motor Function Classification System (GMFCS) levels I (n=44) and II (n=58) recorded physical activity over 4 days using an accelerometer. Activity counts were converted to daily and hourly time spent inactive and in light physical activity or MVPA using uniaxial cutpoints (inactive: ≤100 vertical counts·min(-1), light: 101 to 2,295 vertical counts·min(-1), MVPA: ≥2,296 vertical counts·min(-1)) and recorded step counts. Differences between groups were examined using t tests. RESULTS Of a potential 396 days, 341 days (86%) were recorded. The average wear time was 11:44 (SD=1:56) hours. On a typical day, participants recorded 438 (SD=234) counts·min(-1), took 7,541 (SD=3,894) steps, spent 8:36 (SD=1:09) hours inactive, spent 2:38 (SD=0:51) hours in light activity, and spent 0:44 (SD=0:26) hours in MVPA. Only 25% of participants met the recommended level of MVPA on at least one day. Physical activity was highest in boys (versus girls), in children (versus adolescents), and on weekdays (versus weekends). LIMITATIONS Participants were limited to children with unilateral spasticity who were classified at GMFCS levels I and II. CONCLUSIONS The majority of independently ambulant children with unilateral CP did not perform sufficient physical activity to meet public health recommendations.
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Russchen HA, Slaman J, Stam HJ, van Markus-Doornbosch F, van den Berg-Emons RJ, Roebroeck ME. Focus on fatigue amongst young adults with spastic cerebral palsy. J Neuroeng Rehabil 2014; 11:161. [PMID: 25495688 PMCID: PMC4274699 DOI: 10.1186/1743-0003-11-161] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 12/05/2014] [Indexed: 11/14/2022] Open
Abstract
Background This study aimed to assess fatigue amongst young adults with spastic cerebral palsy (CP), to determine subgroups at risk for fatigue and to explore the relationship between fatigue and cardiopulmonary fitness and daily physical activity level. Participants Young adults with spastic CP, Gross Motor Function Classification System (GMFCS) levels I to III, aged 16 to 24 years. Methods Fatigue (Fatigue Severity Scale) and self-reported daily physical activity (Physical Activity Scale for Individuals with Physical Disabilities) were assessed for 56 participants using questionnaires. Daily physical activity was objectively measured using accelerometry (Vitamove system) over 72 hours. Progressive maximal aerobic cycling was used to measure cardiopulmonary fitness. Results The mean Fatigue Severity Scale (FSS) score was 3.7 (SD 1.4). Forty percent of participants were fatigued, including 12.5% who were severely fatigued. Participants with bilateral CP (FSS = 4.2 (SD 1.4)) were more fatigued compared to those with unilateral CP (FSS = 3.1 (SD 1.3)) (p < 0.01). Levels of cardiopulmonary fitness (2.4 L/min (SD 0.8)) and daily physical activity (8.5% (SD 3.0)) were not significantly related to fatigue (respectively p = 0.10 and p = 0.55), although for cardiopulmonary fitness a trend was found. Conclusions Fatigue is already present at a relatively young age amongst adults with CP, and CP subtype is a determinant of fatigue. We did not find significant evidence for a cross-sectional relation of fatigue with cardiopulmonary fitness or daily physical activity. Trial registration Nederland’s trial register: NTR1785.
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Affiliation(s)
| | | | | | | | - Rita J van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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