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Wang B, Huang H. Effects of various exercise interventions on motor function in cerebral palsy patients: a systematic review and network meta-analysis. Neurol Sci 2024:10.1007/s10072-024-07741-z. [PMID: 39190170 DOI: 10.1007/s10072-024-07741-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE A network meta-analysis was utilized to compare the rehabilitative effectiveness of different exercise interventions on motor function in cerebral palsy(CP) patients. METHODS Computer searches were conducted across 9 databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase, and others, to identify randomized controlled trials focusing on different exercise interventions aimed at enhancing motor function in CP patients. The search spanned from the inception of the databases to January 31, 2024. RESULTS 20 articles, encompassing 570 patients and evaluating three types of exercise interventions, were included in the analysis. Results showed that aerobic training, resistance training, and mixed training exhibited superior outcomes compared to the control group, as evidenced by improvements in Gross Motor Function Measure scores, muscle strength, gait speed, and 10-Meter Walk Test scores (P < 0.05). Furthermore, the network meta-analysis revealed that resistance training ranked highest in enhancing gross motor function and gait speed among CP patients, while mixed training was deemed most effective in improving muscle strength and 10-Meter Walk Test scores. CONCLUSION Exercise interventions have been shown to significantly improve motor function in CP patients. Among these, resistance training and mixed training stand out for their effectiveness in enhancing walking capabilities. Resistance training is specifically aimed at improving gross motor function, while mixed training focuses on increasing muscle strength.
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Affiliation(s)
- Bingjie Wang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, No 4655, University Road, Guyunhu Street, Changqing District, Jinan City, Shandong Province, 250355, China
| | - Hailiang Huang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, No 4655, University Road, Guyunhu Street, Changqing District, Jinan City, Shandong Province, 250355, China.
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Abo-Zaid NA, El-Gendy AM, Hewidy I, Essam Ali M, Sabbahi A. Influence of aerobic exercise on inhibitory control of executive functions in children with hemiplegic cerebral palsy: A randomized controlled trial. Clin Rehabil 2024; 38:337-346. [PMID: 37885221 DOI: 10.1177/02692155231208578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVE This study investigates the influence of aerobic exercise training on inhibitory control of executive functions in children with hemiplegic cerebral palsy. DESIGN Single-blind randomized controlled trial. SETTING Outpatient Physical Therapy Clinic. PARTICIPANTS Children aged 7-11 with left-sided hemiplegic cerebral palsy with emotional and behavioral dysregulation evidenced by scores >28 on Paediatric Symptom Checklist and GMFCS I or II (n = 60). INTERVENTION Participants were randomly allocated into two equal groups. The control group received standard-of-care physical therapy for 1 h, and the aerobic exercise group received standard-of-care physical therapy for 30 min and moderate-intensity continuous exercise on a bicycle ergometer for 30 min. All groups received treatment three times a week for 12 weeks. MAIN MEASURES The Eriksen Flanker test and Stroop Color-Word test were used to assess inhibitory control of executive function at the baseline and after 12 weeks. RESULTS Differences between pre- and post-treatment values in the exercise group showed significant improvement in Flanker response accuracy and Stroop response accuracy (p = 0.001) and significant decreases in Flanker congruent reaction time and Stroop congruent reaction time (p < 0.05). However, there were no significant differences between both groups in Flanker incongruent reaction time and Stroop incongruent reaction time (p > 0.05). CONCLUSIONS Aerobic exercise has a promising effect on inhibitory control of executive function in children with left-sided hemiplegic cerebral palsy.
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Affiliation(s)
- Nehad A Abo-Zaid
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, South Valley University, Qena, Egypt
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Badr University, Assuit, Egypt
| | - Amira M El-Gendy
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Islam Hewidy
- Department of Physical Therapy, School of Health Sciences and Practice, New York Medical College, Valhalla, NY, USA
| | - Mohammed Essam Ali
- Department of Physical Therapy for Integumentary System Disorders and Burns, Faculty of Physical Therapy, South Valley University, Qena, Egypt
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- School of Physical Therapy, South College, Knoxville, TN, USA
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Soares EG, Gusmão CHV, Souto DO. Efficacy of aerobic exercise on the functioning and quality of life of children and adolescents with cerebral palsy: A systematic review and meta-analysis. Dev Med Child Neurol 2023; 65:1292-1307. [PMID: 36895173 DOI: 10.1111/dmcn.15570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/11/2023]
Abstract
AIM To investigate the efficacy of aerobic exercise on the functioning (participation, activities, and body functions and structures) and quality of life (QoL) of children and adolescents with cerebral palsy (CP). METHOD A systematic review with meta-analysis was performed. A comprehensive search of articles was performed using the electronic databases Embase, PubMed, PEDro, and CINAHL. Methodological quality and certainty of evidence were evaluated with the PEDro and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scales respectively. The effects of aerobic exercise on functioning were assessed using meta-analytic techniques. However, given the broad nature of outcomes related to functioning and QoL, different instruments can be used to measure them; this made it impossible to synthesize results in a meta-analysis for some of the outcomes. RESULTS Fifteen randomized controlled trials with 414 participants with CP were included. Analysis of the methodological quality of the studies revealed a low risk of bias. The effect of aerobic exercise compared to usual care or other interventions was significant for aerobic capacity (standardized mean difference [SMD] = 0.81; 95% confidence interval [CI] = 0.16-1.47; p < 0.002; I2 = 68%), gross motor function (SMD = 0.70; 95% = CI 0.21-1.19; p = 0.005; I2 = 49%), mobility (SMD = 0.53; 95% CI = 0.05-1.05; p = 0.03; I2 = 27%), balance, and participation (SMD = 0.74; 95% CI = 0.10-1.39; p = 0.02; I2 = 0%). Aerobic exercise was not effective for muscle strength, spasticity, gait parameters, and QoL (p > 0.05). The certainty of evidence for most comparisons was moderate to low. INTERPRETATION This review provides the most up-to-date evidence on the efficacy of aerobic exercise on the functioning and QoL of children and adolescents with CP. WHAT THIS PAPER ADDS Aerobic exercise improves gross motor function but not gait parameters in cerebral palsy (CP). It improves participation but not quality of life in children and adolescents with CP. It is more effective than usual care or other interventions in improving mobility, aerobic capacity, and balance in CP. It is no more effective than usual care or other interventions in improving muscle strength and spasticity.
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Affiliation(s)
- Esther G Soares
- Department of Physiotherapy, College of Santa Luzia, Santa Luzia, Brazil
| | - Cláudio H V Gusmão
- Department of Physiotherapy, College of Santa Luzia, Santa Luzia, Brazil
| | - Deisiane O Souto
- Department of Physiotherapy, College of Santa Luzia, Santa Luzia, Brazil
- Graduate Program in Rehabilitation Sciences, Physical Therapy Department, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Santos KP, SiIva VMMD, Reis IFD, Aquino MRCD, Lana MRV, Teixeira CMMDF. Physical conditioning in children and adolescents with cerebral palsy: Systematic review and meta-analysis. J Bodyw Mov Ther 2023; 35:158-163. [PMID: 37330763 DOI: 10.1016/j.jbmt.2023.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/01/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Cerebral palsy (CP) can be described as a group of permanent non-progressive disorders that occur in the developing fetal or infant brain. Studies have shown that children and adolescents with CP have low cardiorespiratory fitness and higher energy expenditure during daily activities when compared to typical children. Therefore, interventions focused on the physical conditioning of this population could be critical. OBJECTIVE To evaluate the effect of physical conditioning training on distance walked and maximum oxygen consumption (VO₂ max) in individuals with CP, through a systematic review. METHOD Two independent researchers performed systematic searches in the PUBMED, SciELO, PEDro, ERIC, and Cochrane databases using the search terms "physical fitness", "aerobic training" or "endurance" combined with "cerebral palsy". INCLUSION CRITERIA (1) population (children and adolescents with CP between 5 and 18 years old); (2) type of study (experimental studies); (3) type of intervention (physical conditioning protocols); (4) outcome (distance walked in the 6 min walking test - 6MWT, and VO₂ max). RESULTS 386 studies were identified and 5 articles were considered eligible. After physical conditioning training, there was an increase of 46.34 m (p = 0.07) and 5.93. ml. kg-1. min -1 (p < 0.001) in the 6MWT and VO₂ max, respectively. CONCLUSION Physical conditioning training appears to be clinically beneficial to the cardiorespiratory fitness of children and adolescents with CP.
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Affiliation(s)
- Kamilla Passini Santos
- Physiotherapist Graduated from the Newton Paiva University Center, Belo Horizonte, MG, Brazil.
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5
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Anand B, Karthikbabu S. Effects of additional inspiratory muscle training on mobility capacity and respiratory strength for school-children and adolescents with cerebral palsy: a randomized controlled trial. Braz J Phys Ther 2021; 25:891-899. [PMID: 34810107 DOI: 10.1016/j.bjpt.2021.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 06/21/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Children and adolescents with cerebral palsy often have poor respiratory function, which is often not addressed. OBJECTIVE To examine if adding inspiratory muscle training to sensorimotor exercises would improve mobility capacity and respiratory function in children and adolescents with cerebral palsy. METHODS Forty school-children and adolescents with cerebral palsy aged 8-15 years with Gross Motor Function Classification System I-III, participated in this randomized controlled trial. The experimental group received 45 min of sensorimotor physical therapy in addition to 15 min of inspiratory muscle training for 18 sessions over six weeks. In contrast, the control group received 45 min of sensorimotor training session, three times a week over six weeks. The primary outcome measure was the six-minute walk test. The secondary outcome measures were maximal inspiratory and maximal expiratory pressure, as well as pulmonary function tests. RESULTS Time by group interaction showed no statistical significance between the groups in any outcome measures except for peak expiratory flow. The mean difference of 9.6 cm H2O (95% CI: 2.3, 16.8) in the MIP from baseline to 2-month follow-up supports the experimental intervention. Post-training, the between-group mean difference was 19.8 (95% CI: -18.0, 57.6) meter in the six-minute walk test. CONCLUSION Adding inspiratory muscle training to sensorimotor physical therapy did not impact mobility capacity in children and adolescents with cerebral palsy.
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Affiliation(s)
- Bhuvaneshwari Anand
- Department of Physical Therapy, Manipal Hospital, Bangalore Campus, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Suruliraj Karthikbabu
- Department of Physical Therapy, Manipal Hospital, Bangalore Campus, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
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Rutka M, Adamczyk WM, Linek P. Effects of Physical Therapist Intervention on Pulmonary Function in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6275368. [PMID: 33989407 DOI: 10.1093/ptj/pzab129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/12/2021] [Accepted: 03/28/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of physical therapy on pulmonary function and respiratory muscle strength in children with cerebral palsy (CP). METHODS A search of 10 databases was conducted for this systematic review. Initially, there were no language, study design, or time frame restrictions. All studies assessing the effect of physical therapy on the respiratory system in children with CP were included. Two reviewers independently extracted and documented data. The data extracted included description of the intervention (duration, therapeutic method) and study results (change of spirometric parameters, respiratory muscle strength). The effects of physical therapist treatment were calculated using software. RESULTS A total of 269 children aged 5 to 18 years from 10 studies were included. The included studies consisted of 5 different therapeutic methods (inspiratory muscle training [IMT], aerobic training, swimming, respiratory exercise, exercise with elastic bands). Physical therapist intervention led to a significant increase in the maximal expiratory pressure (MEP) (I2 = 0%), peak expiratory flow (I2 = 0%), and maximum oxygen consumption (I2 = 37%). A separate analysis of the most frequently used therapy (IMT) showed a positive effect on MEP (I2 = 0%) and maximal inspiratory pressure (I2 = 35%). CONCLUSION Various forms of physical therapy have potential to demonstrate a positive effect on maximal inspiratory pressure, MEP, and peak expiratory flow in children with CP. There is no possibility to recommend the best method and duration of the physical therapy; however, it can be suggested that physical therapy should be applied for at least 4 weeks and include IMT. IMPACT CP is one of the most common causes of physical disabilities in children, and pulmonary dysfunction is the leading cause of death in people with CP. Thus, it is warranted to seek different approaches that may improve pulmonary function in people with CP. This review has shown that various forms of physical therapy have potential to improve the pulmonary function of children with CP.
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Affiliation(s)
- Magdalena Rutka
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | - Waclaw M Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland.,Department of Physiotherapy, Institute of Health Sciences, Pain and Exercise, Research Luebeck (P.E.R.L.), University of Luebeck, Luebeck,Germany
| | - Paweł Linek
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
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Fleeton JRM, Sanders RH, Fornusek C. Strength Training to Improve Performance in Athletes With Cerebral Palsy: A Systematic Review of Current Evidence. J Strength Cond Res 2020; 34:1774-1789. [PMID: 31904719 DOI: 10.1519/jsc.0000000000003232] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fleeton, JRM, Sanders, RH, and Fornusek, C. Strength training to improve performance in athletes with cerebral palsy: A systematic review of current evidence. J Strength Cond Res 34(6): 1774-1789, 2020-Persons with cerebral palsy (CP) can partake in many different forms of organized sport including elite competition at state and international levels. There is limited evidence on how CP athletes should train to enhance performance. The purposes of this article were to conduct a systematic review of the current evidence on ambulatory individuals with CP for (a) strength and functional improvement through strength training; (b) potential sports performance improvement through strength training; (c) the identification of risk and special considerations associated with strength and conditioning for this population, and; (d) the identification of future research foci to educate strength and conditioning coaches on specific program design for elite CP athletes. Seven electronic databases were searched for studies investigating resistance training interventions. The databases were also searched for training interventions or investigations into sports performance in athletes with CP competing at regional level or above. Thirty articles were included in the systematic review of strength training, and 23 articles included in the narrative review of training for sports performance. High-quality evidence indicates that resistance training can improve muscular strength in individuals with CP, with some preliminary evidence of structural and neurological adaptations. However, there is limited evidence for functional improvements. Limited research has examined the performance capacity of athletes with CP, and no training interventions have been conducted. Coaches should employ existing guidelines when designing programs while considering specific athlete limitations. Initially, the focus should be increasing athlete muscular strength before considering specific sport demands.
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Affiliation(s)
- Jennifer R M Fleeton
- Faculty of Health Sciences, Discipline of Exercise and Sport Science, The University of Sydney, Lidcombe, New South Wales, Australia
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8
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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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Collado-Garrido L, Parás-Bravo P, Calvo-Martín P, Santibáñez-Margüello M. Impact of Resistance Therapy on Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4513. [PMID: 31731636 PMCID: PMC6888121 DOI: 10.3390/ijerph16224513] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/03/2019] [Accepted: 11/11/2019] [Indexed: 11/16/2022]
Abstract
Cerebral palsy is one of the main causes of disability in childhood. Resistance therapy shows benefits in increasing strength and gait in these patients, but its impact on motor function is not yet clear. The objective was to analyze the impact of resistance therapy on the improvement in the motor function using a review and meta-analysis. A comprehensive literature research was conducted in Medline (PubMed), Institute for Scientific Information (ISI) Web of Knowledge, and Physiotherapy Evidence Database (PEDro) in relation to clinical trials in which resistance therapy was used and motor function was assessed. Twelve controlled clinical trials and three non-controlled clinical trials (only one intervention arm) studies were identified. In terms of pre-post difference, the overall intra-group effect was in favor of resistance therapy intervention: standardized mean difference (SMD) = 0.37, 95% confidence interval (CI) = 0.21 to 0.52, p < 0.001 (random-effects model), with moderate heterogeneity (I2 = 59.82%). SMDs were also positive by restricting to each of the analyzed scales: SMD = 0.37, 1.33, 0.10, and 0.36 for Gross Motor Function Measure (GMFM), Lateral Step Up (LSU), Time Up and Go (TUG), and Mobility Questionnaire (MobQue) scales, respectively. Regarding the difference between groups, the results showed a high heterogeneity (I2 < 99%), with the mean difference (MD) also favorable for the GMFM scale: MD = 1.73, 95% CI = 0.81 to 2.64, p < 0.001 (random-effects model). Our results support a positive impact of resistance therapy on motor function. Further studies should delve into the clinical relevance of these results.
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Affiliation(s)
- Luisa Collado-Garrido
- Rehabilitation Service, The Marqués de Valdecilla University Hospital, Valdecilla Avenue s/n. C.P.: 39008 Santander, Cantabria, Spain; (L.C.-G.); (P.C.-M.)
| | - Paula Parás-Bravo
- Faculty of Nursing, University of Cantabria, Valdecilla Avenue s/n., 39008 Santander, Cantabria, Spain;
- Research Nursing Group IDIVAL; Cardenal Herrera Oria Street s/n. C.P., 3901 Cantabria, Spain
| | - Pilar Calvo-Martín
- Rehabilitation Service, The Marqués de Valdecilla University Hospital, Valdecilla Avenue s/n. C.P.: 39008 Santander, Cantabria, Spain; (L.C.-G.); (P.C.-M.)
| | - Miguel Santibáñez-Margüello
- Faculty of Nursing, University of Cantabria, Valdecilla Avenue s/n., 39008 Santander, Cantabria, Spain;
- Research Nursing Group IDIVAL; Cardenal Herrera Oria Street s/n. C.P., 3901 Cantabria, Spain
- Global Health Research Group, University of Cantabria, 39008 Santander, Cantabria, Spain
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Plasschaert VFP, Vriezekolk JE, Aarts PBM, Geurts ACH, Van den Ende CHM. Interventions to improve upper limb function for children with bilateral cerebral palsy: a systematic review. Dev Med Child Neurol 2019; 61:899-907. [PMID: 30632139 PMCID: PMC6850353 DOI: 10.1111/dmcn.14141] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 01/19/2023]
Abstract
AIM To systematically review the efficacy of interventions on upper limb function in children 0 to 19 years of age with bilateral cerebral palsy on the basis of outcome measures of upper limb function and measures of activities and/or participation according to the International Classification of Functioning, Disability and Health. METHOD Cochrane, PubMed, Embase, CINAHL, and Web of Science were searched from inception to September 2017. Methodological quality and strength of evidence were analysed by two independent raters using Sackett's level of evidence and the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines. RESULTS Fifteen studies with a large variety of interventions and heterogeneity in outcome measures met the inclusion criteria. Twelve studies provided level IV evidence according to AACPDM guidelines. For three small randomized controlled trials the level of evidence was II. Only one of these trials showed strong methodological quality: a study on hand-arm bimanual intensive therapy including lower extremities. INTERPRETATION We identified a large variety of interventions, heterogeneity in outcome measures, and generally weak to moderate methodological quality for most studies. We recommend further research specifically aimed at bimanual-intensive, goal-directed, and task-specific training programmes for the upper limb in children with bilateral cerebral palsy, using either high-quality (multicentre) trials or well-designed single-case trials. WHAT THIS PAPER ADDS There is a large variety of interventions on upper limb function in children with bilateral cerebral palsy. Heterogeneity of outcome measures and interventions impeded firm conclusions about intervention efficacy. Most studies had low-level evidence and weak to moderate methodological quality. The strongest evidence from a small randomized controlled trial was for hand-arm bimanual intensive therapy including lower extremities.
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Affiliation(s)
- Véronique F P Plasschaert
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands,Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenthe Netherlands
| | | | - Pauline B M Aarts
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands,Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenthe Netherlands
| | - Cornelia H M Van den Ende
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands,Department of RheumatologySint MaartenskliniekNijmegenthe Netherlands
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11
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Cesar GM, Buster TW, Burnfield JM. Cardiorespiratory fitness, balance and walking improvements in an adolescent with cerebral palsy (GMFCS II) and autism after motor-assisted elliptical training. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1536764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Guilherme M. Cesar
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Thad W. Buster
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Judith M. Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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12
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Clutterbuck G, Auld M, Johnston L. Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy: a systematic review. Disabil Rehabil 2018; 41:1131-1151. [PMID: 29303007 DOI: 10.1080/09638288.2017.1422035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP). METHOD A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters. RESULTS Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II-IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n = 3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n = 2, all Evidence Level II) and Physical Fitness Training (n = 4, Evidence Level II-V). Weak positive evidence was available for Modified Sport (n = 3, Evidence Level IV-V) and Non-Immersive Virtual Reality (n = 12, Evidence Level II-V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n = 4, all Evidence Level II). INTERPRETATION Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP. Implications for rehabilitation Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy. Gross Motor Activity Training is the most common and effective intervention. Practice variability is essential to improve gross motor function. Participation was rarely measured and requires further research, particularly in interventions that embed real-world participation opportunities like Modified Sport.
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Affiliation(s)
- Georgina Clutterbuck
- a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia.,b The Cerebral Palsy League , Brisbane , Australia
| | - Megan Auld
- a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia.,b The Cerebral Palsy League , Brisbane , Australia
| | - Leanne Johnston
- a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia
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Cleary SL, Taylor NF, Dodd KJ, Shields N. A qualitative evaluation of an aerobic exercise program for young people with cerebral palsy in specialist schools. Dev Neurorehabil 2017; 20:339-346. [PMID: 28152322 DOI: 10.1080/17518423.2016.1277798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the perceived effects of an aerobic exercise program delivered in specialist schools for young people with cerebral palsy with high support needs. METHODS In-depth interviews were completed with 8 students with cerebral palsy, 10 parents, 8 teachers and 7 physiotherapists. Interviews were audio-recorded, transcribed verbatim and independently coded by two researchers. Data were analyzed using thematic analysis. RESULTS Two themes emerged: one about program impact and the second about influential design features. Exercise was perceived as important, and participants indicated that the program had resulted in positive physical (e.g., improved ease of mobility, fitness and stamina) and psychosocial (e.g., happiness, social experience, challenge) impacts. The school setting, program staff and student attitudes were key features of the program. CONCLUSIONS These data converge with those from a randomized controlled trial and attribute physical and psychosocial benefits to a specialist school-based exercise program for young people with cerebral palsy.
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Affiliation(s)
- Stacey L Cleary
- a School of Allied Health , La Trobe University , Victoria , Australia
| | - Nicholas F Taylor
- a School of Allied Health , La Trobe University , Victoria , Australia.,b Allied Health Clinical Research Office, Eastern Health , Victoria , Australia
| | - Karen J Dodd
- c College of Science, Health and Engineering , La Trobe University , Victoria , Australia
| | - Nora Shields
- a School of Allied Health , La Trobe University , Victoria , Australia.,d Northern Health , Victoria , Australia
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Quinn L, Morgan D. From Disease to Health: Physical Therapy Health Promotion Practices for Secondary Prevention in Adult and Pediatric Neurologic Populations. J Neurol Phys Ther 2017; 41 Suppl 3:S46-S54. [PMID: 28628596 PMCID: PMC5477649 DOI: 10.1097/npt.0000000000000166] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Over the last decade there has been a substantial increase in efforts to better understand how targeted physical activity and exercise interventions can be used to minimize secondary consequences arising from neurological damage in both adult and pediatric populations. This article offers an overview of contemporary research that addresses mediators of functional and neuroplastic adaptations associated with physical activity and exercise. We emphasize the important role that physical therapists can play to increase participation and improve well-being in adults and children with neurological disorders. We further highlight potential strategies to foster translation of evidence-based findings for use by clinicians and consumers. SUMMARY OF KEY POINTS Engagement in physical activity can serve as a powerful promoter of health and well-being in adults and youth with neurologic disease, and has the potential to alter the course of disease processes. Physical therapists can play a key role in promoting fitness and wellness by encouraging active living, providing early diagnosis of disease and prescribing targeted activity interventions to improve fitness and participation, and helping individuals overcome personal and environmental barriers to an active lifestyle. RECOMMENDATIONS FOR CLINICAL PRACTICE Physical therapists must adopt a model of rehabilitation that emphasizes secondary prevention in adults and youth with neurologic diseases. Physical therapists have a unique role in developing forward-thinking approaches in using innovative health and wellness strategies to promote positive changes in activity and exercise behaviors.
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Affiliation(s)
- Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York (L.Q.); and Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro (D.M.)
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Abstract
BACKGROUND Cerebral palsy (CP) is a neurodevelopmental disorder resulting from an injury to the developing brain. It is the most common form of childhood disability with prevalence rates of between 1.5 and 3.8 per 1000 births reported worldwide. The primary impairments associated with CP include reduced muscle strength and reduced cardiorespiratory fitness, resulting in difficulties performing activities such as dressing, walking and negotiating stairs.Exercise is defined as a planned, structured and repetitive activity that aims to improve fitness, and it is a commonly used intervention for people with CP. Aerobic and resistance training may improve activity (i.e. the ability to execute a task) and participation (i.e. involvement in a life situation) through their impact on the primary impairments of CP. However, to date, there has been no comprehensive review of exercise interventions for people with CP. OBJECTIVES To assess the effects of exercise interventions in people with CP, primarily in terms of activity, participation and quality of life. Secondary outcomes assessed body functions and body structures. Comparators of interest were no treatment, usual care or an alternative type of exercise intervention. SEARCH METHODS In June 2016 we searched CENTRAL, MEDLINE, Embase, nine other databases and four trials registers. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of children, adolescents and adults with CP. We included studies of aerobic exercise, resistance training, and 'mixed training' (a combination of at least two of aerobic exercise, resistance training and anaerobic training). DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and potentially relevant full-text reports for eligibility; extracted all relevant data and conducted 'Risk of bias' and GRADE assessments. MAIN RESULTS We included 29 trials (926 participants); 27 included children and adolescents up to the age of 19 years, three included adolescents and young adults (10 to 22 years), and one included adults over 20 years. Males constituted 53% of the sample. Five trials were conducted in the USA; four in Australia; two in Egypt, Korea, Saudi Arabia, Taiwan, the Netherlands, and the UK; three in Greece; and one apiece in India, Italy, Norway, and South Africa.Twenty-six trials included people with spastic CP only; three trials included children and adolescents with spastic and other types of CP. Twenty-one trials included people who were able to walk with or without assistive devices, four trials also included people who used wheeled mobility devices in most settings, and one trial included people who used wheeled mobility devices only. Three trials did not report the functional ability of participants. Only two trials reported participants' manual ability. Eight studies compared aerobic exercise to usual care, while 15 compared resistance training and 4 compared mixed training to usual care or no treatment. Two trials compared aerobic exercise to resistance training. We judged all trials to be at high risk of bias overall.We found low-quality evidence that aerobic exercise improves gross motor function in the short term (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.02 to 1.04, N = 65, 3 studies) and intermediate term (mean difference (MD) 12.96%, 95% CI 0.52% to 25.40%, N = 12, 1 study). Aerobic exercise does not improve gait speed in the short term (MD 0.09 m/s, 95% CI -0.11 m/s to 0.28 m/s, N = 82, 4 studies, very low-quality evidence) or intermediate term (MD -0.17 m/s, 95% CI -0.59 m/s to 0.24 m/s, N = 12, 1 study, low-quality evidence). No trial assessed participation or quality of life following aerobic exercise.We found low-quality evidence that resistance training does not improve gross motor function (SMD 0.12, 95% CI -0.19 to 0.43, N = 164, 7 studies), gait speed (MD 0.03 m/s, 95% CI -0.02 m/s to 0.07 m/s, N = 185, 8 studies), participation (SMD 0.34, 95% CI -0.01 to 0.70, N = 127, 2 studies) or parent-reported quality of life (MD 12.70, 95% CI -5.63 to 31.03, n = 12, 1 study) in the short term. There is also low-quality evidence that resistance training does not improve gait speed (MD -0.03 m/s, 95% CI -0.17 m/s to 0.11 m/s, N = 84, 3 studies), gross motor function (SMD 0.13, 95% CI -0.30 to 0.55, N = 85, 3 studies) or participation (MD 0.37, 95% CI -6.61 to 7.35, N = 36, 1 study) in the intermediate term.We found low-quality evidence that mixed training does not improve gross motor function (SMD 0.02, 95% CI -0.29 to 0.33, N = 163, 4 studies) or gait speed (MD 0.10 m/s, -0.07 m/s to 0.27 m/s, N = 58, 1 study) but does improve participation (MD 0.40, 95% CI 0.13 to 0.67, N = 65, 1 study) in the short-term.There is no difference between resistance training and aerobic exercise in terms of the effect on gross motor function in the short term (SMD 0.02, 95% CI -0.50 to 0.55, N = 56, 2 studies, low-quality evidence).Thirteen trials did not report adverse events, seven reported no adverse events, and nine reported non-serious adverse events. AUTHORS' CONCLUSIONS The quality of evidence for all conclusions is low to very low. As included trials have small sample sizes, heterogeneity may be underestimated, resulting in considerable uncertainty relating to effect estimates. For children with CP, there is evidence that aerobic exercise may result in a small improvement in gross motor function, though it does not improve gait speed. There is evidence that resistance training does not improve gait speed, gross motor function, participation or quality of life among children with CP.Based on the evidence available, exercise appears to be safe for people with CP; only 55% of trials, however, reported adverse events or stated that they monitored adverse events. There is a need for large, high-quality, well-reported RCTs that assess the effectiveness of exercise in terms of activity and participation, before drawing any firm conclusions on the effectiveness of exercise for people with CP. Research is also required to determine if current exercise guidelines for the general population are effective and feasible for people with CP.
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Affiliation(s)
- Jennifer M Ryan
- Brunel University LondonInstitute of Environment, Health and SocietiesKingston LaneUxbridgeMiddlesexUKUB8 3PH
| | | | - Stephen G Noorduyn
- McMaster UniversityCanChild Centre for Childhood Disability Research1280 Main Street West, Rm. 2C1McMaster UniversityHamiltonONCanadaL8S 4L8
| | - Neil E O'Connell
- Brunel UniversityDepartment of Clinical Sciences/Health Economics Research Group, Institute of Environment, Health and SocietiesKingston LaneUxbridgeMiddlesexUKUB8 3PH
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O'Brien TD, Noyes J, Spencer LH, Kubis HP, Hastings RP, Whitaker R. Systematic review of physical activity and exercise interventions to improve health, fitness and well-being of children and young people who use wheelchairs. BMJ Open Sport Exerc Med 2016; 2:e000109. [PMID: 27900176 PMCID: PMC5125427 DOI: 10.1136/bmjsem-2016-000109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 01/21/2023] Open
Abstract
AIM To perform a systematic review establishing the current evidence base for physical activity and exercise interventions that promote health, fitness and well-being, rather than specific functional improvements, for children who use wheelchairs. DESIGN A systematic review using a mixed methods design. DATA SOURCES A wide range of databases, including Web of Science, PubMed, BMJ Best Practice, NHS EED, CINAHL, AMED, NICAN, PsychINFO, were searched for quantitative, qualitative and health economics evidence. ELIGIBILITY participants: children/young people aged >25 years who use a wheelchair, or parents and therapists/carers. Intervention: home-based or community-based physical activity to improve health, fitness and well-being. RESULTS Thirty quantitative studies that measured indicators of health, fitness and well-being and one qualitative study were included. Studies were very heterogeneous preventing a meta-analysis, and the risk of bias was generally high. Most studies focused on children with cerebral palsy and used an outcome measure of walking or standing, indicating that they were generally designed for children with already good motor function and mobility. Improvements in health, fitness and well-being were found across the range of outcome types. There were no reports of negative changes. No economics evidence was found. CONCLUSIONS It was found that children who use wheelchairs can participate in physical activity interventions safely. The paucity of robust studies evaluating interventions to improve health and fitness is concerning. This hinders adequate policymaking and guidance for practitioners, and requires urgent attention. However, the evidence that does exist suggests that children who use wheelchairs are able to experience the positive benefits associated with appropriately designed exercise. TRIAL REGISTRATION NUMBER CRD42013003939.
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Affiliation(s)
- Thomas D O'Brien
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jane Noyes
- Health and Social Services Research and Child Health, School of Social Sciences, Bangor University, Bangor, UK
| | | | - Hans-Peter Kubis
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Richard P Hastings
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
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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: 207] [Impact Index Per Article: 25.9] [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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Lauglo R, Vik T, Lamvik T, Stensvold D, Finbråten AK, Moholdt T. High-intensity interval training to improve fitness in children with cerebral palsy. BMJ Open Sport Exerc Med 2016; 2:e000111. [PMID: 27900177 PMCID: PMC5117070 DOI: 10.1136/bmjsem-2016-000111] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2016] [Indexed: 11/28/2022] Open
Abstract
Aim To evaluate effects of high-intensity interval training (HIT) on aerobic exercise capacity, quality of life, and body composition in children with cerebral palsy (CP). Methods This was a baseline control trial. Children with CP, Gross Motor Function Classification System (GMFCS) levels I–IV, and age 10–17 years were included. The primary outcome, peak, and submaximum oxygen uptake (VO2peak, VO2submax) were measured at enrolment to the study (T0), after a pretraining period (T1), and after HIT (T2). Secondary outcomes were quality of life assessed with the KINDL questionnaire, and body composition measured using whole body dual-energy X-ray absorptiometry scanning. The exercise was performed on treadmills and consisted of 24 sessions, each with a total of 16 min of exercise at >85% of maximal heart rate. Results 20 children were included and 6 children dropped out. VO2peak increased by 10%, from a median of 37.3 (31.0–40.1) to 41.0 (36.6–48.5) mL/kg/min from T1 to T2 (p<0.01). VO2submax did not change; thereby, the percentage oxygen utilisation was reduced. Body composition was unchanged. Parent-reported quality of life improved, whereas quality of life reported by the children did not improve. Conclusions Aerobic exercise capacity improved and per cent utilisation of VO2max declined after HIT in children with CP. Therefore, HIT can be a time efficient way to improve maximal capacity, and increase energy reserve in this patient group. Trial registration number NCT00965133.
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Affiliation(s)
| | - Torstein Vik
- Department of Laboratory Medicine , Children and Women's Health , NTNU, Norwegian University of Science and Technology , Trondheim, Norway
| | - Torarin Lamvik
- Department of Orthopedic Surgery , St. Olav's Hospital , Trondheim , Norway
| | - Dorthe Stensvold
- Department of Circulation and Medical Imaging , NTNU, Norwegian University of Science and Technology , Trondheim , Norway
| | - Ane-Kristine Finbråten
- Department of Laboratory Medicine , Children and Women's Health , NTNU, Norwegian University of Science and Technology , Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Women's Clinic, St. Olav's Hospital, Trondheim, Norway
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Baque E, Sakzewski L, Barber L, Boyd RN. Systematic review of physiotherapy interventions to improve gross motor capacity and performance in children and adolescents with an acquired brain injury. Brain Inj 2016; 30:948-59. [PMID: 27119733 DOI: 10.3109/02699052.2016.1147079] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To systematically review the efficacy of physiotherapy interventions to improve gross motor capacity, performance and societal participation in children aged 5-17 years with an acquired brain injury (ABI). METHODS Randomized and non-randomized controlled trials, cohort, case series, case-control and case studies were included and classified according to grades of evidence. Methodological quality of studies was assessed using the Downs and Black (D&B) scale and quantitative data was analysed using effect sizes. RESULTS Two home-based studies investigated functional strength training (one randomized controlled trial, n = 20, level 2b, D&B = 16/32 and one non-randomized self-control study, n = 19, level 4, D&B = 15/32). Four studies evaluated virtual reality including: one pilot study, n = 50, level 4, D&B = 22/32; one single-subject, non-concurrent, randomized multiple baseline study, n = 3, level 4, D&B = 15/32; one case series study, n = 2, level 4, D&B = 15/32; one case study, n = 1, level 4, D&B = 15/32. Effect sizes for the randomized controlled trial ranged between 0.30-1.29 for the Functional Reach and Timed Up and Go outcome measures. CONCLUSION There is preliminary evidence to support the efficacy of physiotherapy interventions to improve gross motor outcomes in children with an ABI. Both functional strength training and virtual-reality based therapy are potential treatment options for clinicians to prescribe in either home or clinical settings.
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Affiliation(s)
- Emmah Baque
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine , The University of Queensland , Brisbane , Australia
| | - Leanne Sakzewski
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine , The University of Queensland , Brisbane , Australia
| | - Lee Barber
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine , The University of Queensland , Brisbane , Australia
| | - Roslyn N Boyd
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine , The University of Queensland , Brisbane , Australia
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Lennon N, Thorpe D, Balemans AC, Fragala-Pinkham M, O'Neil M, Bjornson K, Boyd R, Dallmeijer AJ. The clinimetric properties of aerobic and anaerobic fitness measures in adults with cerebral palsy: A systematic review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 45-46:316-328. [PMID: 26296079 DOI: 10.1016/j.ridd.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To analyze the clinimetric properties of maximal aerobic and anaerobic fitness measurement protocols in adults with cerebral palsy (CP). DATA SOURCES A systematic search through March 2015 of databases PubMed, Embase, SPORTDiscus and PsycINFO was performed with medical subject heading terms for 'cerebral palsy' combined with search terms adults or adolescents and multiple text words for fitness and exercise tests that yielded 864 articles. STUDY SELECTION Abstracts were screened by two reviewers to identify use of maximal fitness measurements in adolescents (14-18yrs) or adults (>18yrs) with CP of all abilities. Ninety-four articles were reviewed. No studies of adolescent (14-18yrs) qualified. Eight articles reported clinimetric properties for adults with CP who walk or propel a wheelchair independently. Five articles reported on aerobic capacity, one reported on anaerobic capacity and two reported on both. DATA EXTRACTION Methodological quality of the studies was rated using portions of the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. Quality of the measurement protocols was evaluated based on statistical strength of the clinimetrics. Synthesis of the overall evidence was based on the Cochrane review group guidelines which combine methodological quality and statistical strength. DATA SYNTHESIS Eight articles reported on 4 aerobic and 1 anaerobic protocols. Overall synthesis revealed that for ambulatory adults with CP there is (i) moderate evidence for good reliability and good construct validity of maximal aerobic and anaerobic cycle tests, (ii) moderate evidence for good criterion validity of sub-maximal aerobic cycle tests, and (iii) strong evidence for poor criterion validity of the six-minute walk test as a maximal aerobic test. And for adults who propel a wheelchair there is limited evidence of good reliability for maximal aerobic wheelchair ergometer tests. CONCLUSIONS Limited quality research exists on the clinimetric properties of aerobic and anaerobic capacity measures for adults with CP who have independent mobility. Quality aerobic and anaerobic measures for adults with more severe mobility impairments are absent.
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Affiliation(s)
- Nancy Lennon
- Nemours Biomedical Research, The duPont Hospital for Children, Wilmington, DE, USA.
| | - Deborah Thorpe
- Division of Physical Therapy, Center for Human Movement Science, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Astrid C Balemans
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Margaret O'Neil
- Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Kristie Bjornson
- Pediatrics/Genetics and Developmental Medicine, University of Washington, Seattle, WA, USA
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Queensland, QLD, Australia
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Jung JW, Woo JH, Ko J, Kim H. Cardiorespiratory endurance in children with and without cerebral palsy as measured by an ergometer: a case series study. J Phys Ther Sci 2015; 27:1571-5. [PMID: 26157265 PMCID: PMC4483443 DOI: 10.1589/jpts.27.1571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/31/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This preliminary study aimed to determine the cardiorespiratory endurance of
children with cerebral palsy (CP) using a case series study in order to provide the
reference data required for interventions appropriate for South Korean CP sufferers, since
aerobic ability evaluation and interventions for children with CP are not well recognized
in South Korea. [Subjects and Methods] Four children and adolescents with CP GMFCS (Gross
Motor Function Classification System) level I and II and two normally developing children
(ND) (age: 7–15 years) were studied. Cycle ergometer testing was performed to determine
their VO2 peak and RER peak concentrations as well as VE peak and 6MWT
distance. [Results] The VO2 peak was lower in subject E (CP) at 44.5 than in
subject B (ND), and it was lower in subject A (ND) at 22.9 than in subject C (CP). The
6MWT distance was longer in subjects A and B (ND) than in age-matched CP subjects.
[Conclusion] This case report demonstrates that the cardiorespiratory parameters values of
CP children were similar to those reported previously. Further research is required to
evaluate the normative values of CP and the optimal cardiorespiratory parameters.
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Affiliation(s)
- Jee Woon Jung
- Department of Rehabilitation Therapy, Graduate School of Hallym University, Republic of Korea
| | - Ji-Hea Woo
- Department of Physical Therapy, Hallym College: Janghak-ri, Dong-myeon, Chuncheon-si, Gangwon-do 200-711, Republic of Korea
| | - Jooyeon Ko
- Department of Physical Therapy, Daegu Health College, Republic of Korea
| | - Heesoo Kim
- Department of Physical Therapy, Hallym College: Janghak-ri, Dong-myeon, Chuncheon-si, Gangwon-do 200-711, Republic of Korea
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Balemans ACJ, Van Wely L, Becher JG, Dallmeijer AJ. Associations between fitness and mobility capacity in school-aged children with cerebral palsy: a longitudinal analysis. Dev Med Child Neurol 2015; 57:660-667. [PMID: 25582163 DOI: 10.1111/dmcn.12677] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to determine the longitudinal associations among fitness components and between fitness and mobility capacity in children with cerebral palsy (CP). METHOD Forty-six children (26 males, 20 females; mean age 9y 7mo [SD 1y 8mo]) with a bilateral (n=24) or a unilateral spastic CP (n=22) participated in aerobic and anaerobic fitness measurements on a cycle ergometer and isometric muscle strength tests (Gross Motor Function Classification System [GMFCS] level I [n=26], level II [n=12], level III [n=8]). Mobility capacity was assessed with the gross motor function measure (GMFM) and a walking capacity test. Associations over longitudinal measurements (three or four measurements over 1y) were determined since longitudinal data allow a more accurate estimation. The associations were determined using a mixed model with fixed effects (mobility capacity as dependent variables and fitness components as independent variables) and a random intercept. RESULTS In children with bilateral CP, changes in aerobic fitness were associated with changes in anaerobic fitness (p<0.001), and changes in aerobic fitness showed an association with changes in muscle strength (p<0.05). Anaerobic fitness was not associated with muscle strength. No associations between fitness components were found in unilateral CP. Anaerobic fitness and muscle strength were significant determinants for GMFM and walking capacity in bilateral but not in unilateral CP. INTERPRETATION The longitudinal associations between aerobic and anaerobic fitness and mobility indicate that increasing either aerobic or anaerobic fitness is associated with improvements in mobility in children with bilateral CP. While increasing anaerobic fitness might be beneficial for mobility capacity in children with bilateral CP, this is less likely for children with unilateral CP.
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Affiliation(s)
- Astrid C J Balemans
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Leontien Van Wely
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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Rameckers EAA, Janssen-Potten YJM, Essers IMM, Smeets RJEM. Efficacy of upper limb strengthening in children with Cerebral Palsy: A critical review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:87-101. [PMID: 25462469 DOI: 10.1016/j.ridd.2014.09.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/09/2014] [Accepted: 09/10/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This review focuses on the effects of strengthening interventions of the upper limb in children with Cerebral Palsy (CP). The strengthening intervention studies were divided in two categories: those based on stand-alone strength training, and those on strength training combined with other interventions. DATA SOURCES AND EXTRACTION A search in all relevant databases was performed. DATA SYNTHESIS Six articles were included: three randomized controlled trials (RCTs), two clinical trial (CT) and one case study. Effect sizes of strength training on muscle strength and function of the upper limb were calculated. CONCLUSION There are no coherent recommendations for strength training, based on these studies. The causes include too much variety of types of training, level of intensity and duration. All of the reported upper limb strength training studies found an increase in muscle strength. In addition, the quality of these studies was not high. More RCTs on strength training according to the official strength training guidelines are necessary to assess the impact and potential of strength training of the upper limb to improve the daily activities and participation in children with CP.
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Affiliation(s)
- E A A Rameckers
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Valkenburg and Hoensbroek, The Netherlands; University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, The Netherlands.
| | - Y J M Janssen-Potten
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Valkenburg and Hoensbroek, The Netherlands
| | - I M M Essers
- Department of Rheumatology, Maastricht University Medical Center and Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - R J E M Smeets
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Valkenburg and Hoensbroek, The Netherlands
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Abstract
BACKGROUND AND PURPOSE This case report describes the examination, intervention, and outcome of a 3-month episode of physical therapy (PT) using combined functional training and progressive resistance exercise for an adolescent with cerebral palsy. SUMMARY OF KEY POINTS The patient presented with a long history of PT intervention and strength impairments that limited functional and transitional movement, agility, and peer-level participation in school and the community. Functional strength, aerobic conditioning, and anaerobic power were examined and addressed during intervention. STATEMENT OF CONCLUSIONS Lower extremity strength was improved. Improvements in functional strength, agility, and anaerobic power generation were clinically insignificant. Most importantly, patient defined participation improved and was accompanied by achievement of new transitional and functional movements. RECOMMENDATIONS FOR CLINICAL PRACTICE Outcomes described support the use of progressive resistance exercise and functional training to improve strength and functional mobility in an adolescent with cerebral palsy.
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Maltais DB, Wiart L, Fowler E, Verschuren O, Damiano DL. Health-related physical fitness for children with cerebral palsy. J Child Neurol 2014; 29:1091-100. [PMID: 24820339 PMCID: PMC4227954 DOI: 10.1177/0883073814533152] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 11/17/2022]
Abstract
Low levels of physical activity are a global health concern for all children. Children with cerebral palsy have even lower physical activity levels than their typically developing peers. Low levels of physical activity, and thus an increased risk for related chronic diseases, are associated with deficits in health-related physical fitness. Recent research has provided therapists with the resources to effectively perform physical fitness testing and physical activity training in clinical settings with children who have cerebral palsy, although most testing and training data to date pertains to those who walk. Nevertheless, on the basis of the present evidence, all children with cerebral palsy should engage, to the extent they are able, in aerobic, anaerobic, and muscle-strengthening activities. Future research is required to determine the best ways to evaluate health-related physical fitness in nonambulatory children with cerebral palsy and foster long-term changes in physical activity behavior in all children with this condition.
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Affiliation(s)
- Désirée B Maltais
- Department of Rehabilitation, Laval University, and Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
| | - Lesley Wiart
- Glenrose Rehabilitation Hospital, Alberta Health Services and Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Eileen Fowler
- Center for Cerebral Palsy, Orthopaedic Institute for Children, Department of Orthopaedic Surgery, Tarjan Center, University of California, Los Angeles, CA, USA
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, the Netherlands
| | - Diane L Damiano
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Thomas RE, Johnston LM, Boyd RN, Sakzewski L, Kentish MJ. GRIN: "GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial": study protocol. BMC Pediatr 2014; 14:35. [PMID: 24502231 PMCID: PMC3926674 DOI: 10.1186/1471-2431-14-35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years. METHODS/DESIGN An assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child's occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health. DISCUSSION This paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised comparison trial comparing group versus individual models of physiotherapy following intramuscular injections of Botulinum Toxin-A to the lower limbs for ambulant children with cerebral palsy. TRIAL REGISTRATION ACTRN12611000454976.
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Affiliation(s)
- Rachel E Thomas
- Queensland Cerebral Palsy Health Service, The Royal Children's Hospital, Brisbane, Australia.
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Park EY, Kim WH. Meta-analysis of the effect of strengthening interventions in individuals with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:239-249. [PMID: 24291625 DOI: 10.1016/j.ridd.2013.10.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 06/02/2023]
Abstract
This study aimed to investigate the evidence that strengthening interventions can improve muscle strength and activity in individuals with cerebral palsy. The search focused on studies that employed strength training for children with cerebral palsy for which six electronic databases were used to extract literature published from 2001 to 2012. The key terms used in these searches were combined strength training, strengthening, weight training, weight lifting, resistance, and cerebral palsy. The quality of each study was assessed using the PEDro (Physiotherapy Evidence Database) scale. Thirteen randomized controlled trial studies were selected and divided into categories according to program type, mode, and outcome measures. The overall effect sizes of each study and types of strengthening were large. Strengthening exercise improved muscle strength to a greater degree, when practiced 3 times per week in 40-50 min sessions than in other categories of session length, and greater improvement was observed in younger children than in older. The effect size of the activities and variables related to gait, except for gait endurance, were medium to large. The effect size of individual muscles was large, but the effect sizes for ankle plantar flexor, hip abductor/adductor, and extensor were insignificant. Strengthening interventions are useful for increasing muscle strength in individuals with cerebral palsy, specifically in youth and children, and optimal exercise consisted of 40- to 50-min sessions performed 3 times per week. Although strengthening interventions may improve activities, including gait, more studies that are rigorous are needed to determine the contributions to gross motor function.
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Affiliation(s)
- Eun-Young Park
- Department of Secondary Special Education, College of Education, Jeonju University, 45 Baengma-gil, Wansan-gu, Jeonju, Jeollabuk-do, Republic of Korea.
| | - Won-Ho Kim
- Department of Physical Therapy, Ulsan College, PO Box 682-715, 101 Bongsuro, Dong-gu, Ulsan, Republic of Korea.
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Abstract
Physical activity is important for young people's health. The emphasis over the last 2 decades has been on moderate to vigorous exercise when designing activity and exercise programs for children and adolescents with cerebral palsy (CP). Emerging evidence suggests that sedentary behavior is distinctly different from a lack of moderate to vigorous physical activity and has independent and different physiological mechanisms. The concept of concurrently increasing moderate to vigorous physical activity and replacing sedentary behavior with light physical activity may be beneficial for children and adolescents with CP. This article is a summary of the evidence for what works and what does not work for improving the physical activity of children and adolescents with CP. It also discusses what is known about sedentary behavior of children and adolescents with CP and what research directions are needed to build foundational knowledge in this area with this population.
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Macías-Cervantes MH, Arriola-Nuñez MS, Díaz-Cisneros FJ, Rivera-Cisneros AE, de la Roca-Chiapas JM, Pérez-Vázquez V. Dyslipidaemias and Physical Activity in Children with Cerebral Palsy. Health (London) 2014. [DOI: 10.4236/health.2014.610129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chrysagis N, Skordilis EK, Koutsouki D. Validity and clinical utility of functional assessments in children with cerebral palsy. Arch Phys Med Rehabil 2013; 95:369-74. [PMID: 24239880 DOI: 10.1016/j.apmr.2013.10.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/21/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the validity and clinical utility of functional assessments (1-minute walk test, 10-meter walk test, Timed Up & Go [TUG] test, Timed Up and Down Stairs [TUDS] test, sit-to-stand [STS] test, and lateral step-up [LSU] test). DESIGN Cross-sectional study. SETTING Four special schools for adolescents with physical disabilities. PARTICIPANTS Adolescents with spastic tetraplegia and diplegia (at levels I-III) were selected through convenience sampling (N=35; mean age, 14.97±2.03y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES GMFM-88 (dimensions D and E), 1-minute walk, 10-meter walk, TUG, TUDS, STS, and LSU tests. Data were analyzed using Pearson intercorrelations, multiple regression analysis, and multivariate analysis of variance (MANOVA). RESULTS Significant moderate to high intercorrelations were found. Three significant positive predictors emerged (1-minute walk, 10-meter walk, and LSU) with the following regression equation: YGMFM-88 (dimensions D and E) = 5.708 + .402 × X1-minute walk + .920 × XLSU + .404 × X10-meter walk The MANOVA was significant (Λ=.163, F=14.732, P<.001, η(2)=.596), and post hoc comparisons revealed significant differences across Gross Motor Function Classification System Expanded and Revised levels in all paired comparisons for the 1-minute walk and LSU tests. For the 10-meter walk test, significant differences were evident in the level I versus level III and level II versus level III comparisons. No significant differences were found in the 10-meter walk test between levels I and II. CONCLUSIONS These functional assessments (1-minute walk, LSU, and 10-meter walk tests) are simple to administer, quick, low cost, and user-friendly. Although these assessments are not a substitute for the criterion standard (GMFM-88), they may be used for a quick assessment in adolescents with cerebral palsy (levels I-III) either at school or during rehabilitation, especially when time is limited.
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Affiliation(s)
- Nikolaos Chrysagis
- Department of Physical Therapy, Technological Educational Institute of Athens, Athens, Greece; Laboratory of Adapted Physical Activity/Developmental and Physical Disabilities, Athens, Greece
| | - Emmanouil K Skordilis
- Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece.
| | - Dimitra Koutsouki
- Laboratory of Adapted Physical Activity/Developmental and Physical Disabilities, Athens, Greece; Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Jeng SC, Yeh KK, Liu WY, Huang WP, Chuang YF, Wong AMK, Lin YH. A physical fitness follow-up in children with cerebral palsy receiving 12-week individualized exercise training. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4017-4024. [PMID: 24036390 DOI: 10.1016/j.ridd.2013.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/19/2013] [Accepted: 08/19/2013] [Indexed: 06/02/2023]
Abstract
Physical fitness in children with cerebral palsy (CP) is lower than in their peers. A 12-week individualized home-based exercise program completed by 11 children with CP 10 years earlier showed a favorable effect on physical fitness performance. We follow-up the physical fitness of those 11 children with CP, and compare their physical fitness and health-related quality of life (HRQoL) to children with CP without exercise training matched with age and motor levels. Eleven children with CP in the 2003 program as a follow-up group (FUG) and 12 volunteers recruited as a control group (CG) participated in this study. Physical fitness measures, including cardiopulmonary endurance, muscle strength, body mass index (BMI), flexibility, agility, balance, and the SF-36 Taiwan version, were assessed in both groups. After 10 years, the FUG showed better physical fitness in cardiopulmonary endurance and muscle strength (p<.05). Compared to the CG, the FUG demonstrated better muscle strength, agility, and balance (p<.05). However, the HRQoL did not show a significant difference between the FUG and the CG. Individualized home-based exercise training is beneficial for children with CP. Over 10 years, the FUG was more devoted to physical activity than was the CG. Physical exercise may not directly affect the HRQoL in this study.
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Affiliation(s)
- Shiau-Chian Jeng
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan
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Nsenga Leunkeu A, Shephard RJ, Ahmaidi S. Six-minute walk test in children with cerebral palsy gross motor function classification system levels I and II: reproducibility, validity, and training effects. Arch Phys Med Rehabil 2012; 93:2333-9. [PMID: 22721868 DOI: 10.1016/j.apmr.2012.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/16/2012] [Accepted: 06/06/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the reproducibility and validity of the 6-minute walk test (6MWT) with gas collection, and to evaluate effectiveness of a walking program in children with cerebral palsy (CP). DESIGN Assessment and controlled training study. SETTING Rehabilitation service. PARTICIPANTS Children/adolescents with CP (N=24; 12 boys, 12 girls; mean age, 14.2±2.0 y, Gross Motor Function Classification System levels I and II). INTERVENTION After a cycle-ergometer stress test and the 6MWT, subjects were assigned to training (n=12, 40 min of moderate walking exercise 3 times per week for 8 wk) or a matched control group (n=12). MAIN OUTCOME MEASURES Peak oxygen consumption (VO(2)peak), peak ventilation, peak heart rate, and 6MWT distance. RESULTS Test-retest correlations for the 6MWT were good (VO(2)peak: r=.90, P<.001, intraclass correlation coefficient [ICC]=.85; peak ventilation: r=.88, P<.001, ICC=.83; peak heart rate: r=.86, P<.001, ICC=.82; distance walked: r=.87, P=.007, ICC=.80). Mean scores for the 6MWT also closely matched corresponding cycle-ergometer data. Significant improvements in 6MWT VO(2)peak, peak ventilation, and peak heart rate were found after 8 weeks of training (P<.05). CONCLUSIONS The 6MWT appears reproducible and valid relative to cycle-ergometer assessments of cardiorespiratory responses, and offers a simple method of clinical assessment. An 8-week moderate walking program improves the cardiopulmonary fitness of children with CP, as measured by 6MWT.
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Affiliation(s)
- Angeline Nsenga Leunkeu
- EA 3300, Adaptations Physiologiques à l'Exercice et Réadaptation à l'Effort, Université de Picardie Jules Verne, Amiens, France
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Getz M, Hutzler Y, Vermeer A, Yarom Y, Unnithan V. The Effect of Aquatic and Land-Based Training on the Metabolic Cost of Walking and Motor Performance in Children with Cerebral Palsy: A Pilot Study. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/657979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aim. To evaluate the effects of aquatic (AQ) compared to a land-based (LB) intervention programs on metabolic cost of walking (MCW), gross motor function and locomotor performance in children with cerebral palsy (CP). Methods. Eleven children with spastic diplegic CP completed this study, six in the AQ (5.2 ± 1.45 yrs) and five in the LB group (4.1 ± 1.33 yrs). MCW derived from Oxygen uptake (VO2) measured with a Cosmed K4 device and walking speed at steady state. Additional measures included the 10-m test, Gross Motor Function Measure (GMFM), and Pediatric Evaluation Developmental Inventory (PEDI). Non-parametric statistics were used to analyze change in each group. Results. The AQ group significantly decreased MCW (Z=−2.2; P<.05) and increased steady state walking speed (Z=−2.2; P<.05). Both groups significantly increased 10-m walking speed (Z=−2.2; P<.03, and Z=−2.02; P<.05, resp.). The LB group exhibited moderate to large effect sizes in 10-m self-selected and fast walking speeds (Cohen's d=1.07 and 0.73, resp.). Conclusion. Our findings suggest that Both AQ and LB programs were effective in improving 10-m speed, while the AQ training also improved the MCW of walking at steady state in children with spastic diplegic CP.
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Affiliation(s)
- Miriam Getz
- Department of Physical Education, Kibbutzim College of Education Technology & Arts, 149 Namir Road, Tel Aviv 62507, Israel
- Israel Sports Center for the Disabled, 123 Rokach Street, Ramat-Gan 52535, Israel
| | - Yeshayahu Hutzler
- Department of Physical Education, Kibbutzim College of Education Technology & Arts, 149 Namir Road, Tel Aviv 62507, Israel
- Zinman College of Physical Education and Sport Sciences, Netanya, Israel
| | - Adri Vermeer
- Faculty of Social Sciences, University of Utrecht, P.O. Box 80125, 3508 TC Utracht, The Netherlands
| | - Yoni Yarom
- Department of Sport Medicine, Medical Center, Medix Life, Shitrit Street, Hadar Yosef, Tel Aviv 69482, Israel
| | - Viswanath Unnithan
- Centre for Sport, Health and Exercise Research, Faculty of Health, Staffordshire University, Brindley Building Leek Road, Stoke-on-Trent ST4 2DF, UK
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DiBiasio PA, Lewis CL. Exercise training utilizing body weight-supported treadmill walking with a young adult with cerebral palsy who was non-ambulatory. Physiother Theory Pract 2012; 28:641-52. [DOI: 10.3109/09593985.2012.665983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Verschuren O, Ketelaar M, Keefer D, Wright V, Butler J, Ada L, Maher C, Reid S, Wright M, Dalziel B, Wiart L, Fowler E, Unnithan V, Maltais DB, van den Berg-Emons R, Takken T. Identification of a core set of exercise tests for children and adolescents with cerebral palsy: a Delphi survey of researchers and clinicians. Dev Med Child Neurol 2011; 53:449-56. [PMID: 21309764 DOI: 10.1111/j.1469-8749.2010.03899.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Evidence-based recommendations regarding which exercise tests to use in children and adolescents with cerebral palsy (CP) are lacking. This makes it very difficult for therapists and researchers to choose the appropriate exercise-related outcome measures for this group. This study aimed to identify a core set of exercise tests for children and adolescents with CP. METHOD Fifteen experts (10 physical therapists/researchers and five exercise physiologists; three from the Netherlands, two from the USA, one from the UK, five from Canada, and four from Australia) participated in a Delphi survey which took four stages to achieve a consensus. Based on the information that was collected during the survey, a core set of measures was identified for levels I to IV of the Gross Motor Function Classification System (GMFCS). RESULTS For children with CP classified at GMFCS levels I and II, tests were identified for two motor skills (walking and cycling). For the subgroup of children with CP classified at GMFCS level III, the tests that were identified related to walking, cycling, and arm cranking. For children with CP classified at GMFCS level IV, the tests included in the core set were related to cycling and arm cranking. INTERPRETATION The core set will help physical therapists, exercise physiologists, and other health professionals who work with children and adolescents with CP to decide which test(s) to use in clinical practice or research. This will facilitate comparability of results across studies and clinical programmes.
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Affiliation(s)
- Olaf Verschuren
- Centre of Excellence, Rehabilitation Centre 'De Hoogstraat, Utrecht, the Netherlands.
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Batista KG, Lopes PDO, Serradilha SM, Souza GAFD, Bella GP, Souza RCTD. Benefícios do condicionamento cardiorrespiratório em crianças ou adolescentes com paralisia cerebral. FISIOTERAPIA EM MOVIMENTO 2010. [DOI: 10.1590/s0103-51502010000200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O treinamento cardiorrespiratório tem mostrado efeitos positivos para a população com paralisia cerebral, melhorando a capacidade funcional e reduzindo o gasto energético e os riscos cardiovasculares. OBJETIVO: Investigar os efeitos do treinamento aeróbico na pressão arterial, distância percorrida e no consumo máximo de oxigênio. MÉTODOS: Participaram do estudo oito crianças e adolescentes com paralisia cerebral do tipo hemiparética e diparética espástica (G1) e oito do grupo controle (G2), pareados por sexo e idade. Todos foram avaliados pelo teste de Cooper, no qual foi aferida a pressão arterial inicial e final, distância percorrida e cálculo do VO2 máx. O G1 participou de um programa que constava de alongamentos e treinamento em esteira durante 24 sessões. RESULTADOS: Houve melhora significativa após o treinamento do G1 na distância percorrida, VO2 máx e pressão arterial sistólica inicial. Na comparação entre grupos observou-se diferença estatisticamente significativa na distância percorrida e VO2 máx pré e pós-tratamento, pressão arterial sistólica (PAS) inicial pós e PAS final pós-tratamento. Após o período de destreinamento, não houve perda significativa da melhora nas variáveis do G1, exceto do VO2 máx. CONCLUSÃO: O treinamento aeróbico pode trazer benefícios cardiorrespiratórios para a população com paralisia cerebral do tipo hemiparética e diparética espástica, podendo ser incluído dentro de um programa de reabilitação.
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Effect of cardiorespiratory training on aerobic fitness and carryover to activity in children with cerebral palsy: a systematic review. Int J Rehabil Res 2010; 33:97-103. [DOI: 10.1097/mrr.0b013e328331c555] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Siebert KL, DeMuth SK, Knutson LM, Fowler EG. Stationary cycling and children with cerebral palsy: case reports for two participants. Phys Occup Ther Pediatr 2010; 30:125-38. [PMID: 20367517 DOI: 10.3109/01942630903578399] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
These case reports describe a stationary cycling intervention and outcomes for two child participants (P1 and P2) with spastic diplegic cerebral palsy. Each child completed a 12-week, 30-session cycling intervention consisting of strengthening and cardiorespiratory fitness phases. P1 exhibited higher training intensities, particularly during the cardiorespiratory phase. Average training heart rates were 59% and 35% of maximum heart rate for P1 and P2, respectively. Lower extremity peak knee flexor and extensor moments, gross motor function (Gross Motor Function Measure (GMFM-66)), preferred walking speed (thirty-second walk test), and walking endurance (600-yard walk-run test) were measured pre- and postintervention. Changes in outcome measurements corresponded with differences in exercise intensity. Greater gains in peak knee extensor moments, GMFM-66 scores (+4.2 versus +0.9), 600-yard walk-run test (-29% versus 0%) occurred for P1 versus P2, respectively. Preferred walking speeds did not increase substantially for P1 and decreased for P2.
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Affiliation(s)
- Kara L Siebert
- South Bay Medical Therapy Unit, California Children's Services of Los Angeles County, USA
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Pediatric endurance and limb strengthening (PEDALS) for children with cerebral palsy using stationary cycling: a randomized controlled trial. Phys Ther 2010; 90:367-81. [PMID: 20093327 DOI: 10.2522/ptj.20080364] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Effective interventions to improve and maintain strength (force-generating capacity) and endurance are needed for children with cerebral palsy (CP). OBJECTIVE This study was performed to examine the effects of a stationary cycling intervention on muscle strength, locomotor endurance, preferred walking speed, and gross motor function in children with spastic diplegic CP. DESIGN This was a phase I randomized controlled trial with single blinding. SETTING The interventions were performed in community-based outpatient physical therapy clinics. Outcome assessments were performed in university laboratories. PARTICIPANTS Sixty-two ambulatory children aged 7 to 18 years with spastic diplegic CP and Gross Motor Function Classification System levels I to III participated in this study. INTERVENTION AND MEASUREMENTS Participants were randomly assigned to cycling or control (no-intervention) groups. Thirty intervention sessions occurred over 12 weeks. Primary outcomes were peak knee extensor and flexor moments, the 600-Yard Walk-Run Test, the Thirty-Second Walk Test, and the Gross Motor Function Measure sections D and E (GMFM-66). RESULTS Significant baseline-postintervention improvements were found for the 600-Yard Walk-Run Test, the GMFM-66, peak knee extensor moments at 120 degrees /s, and peak knee flexor moments at 30 degrees /s for the cycling group. Improved peak knee flexor moments at 120 degrees/s were found for the control group only, although not all participants could complete this speed of testing. Significant differences between the cycling and control groups based on change scores were not found for any outcomes. Limitations Heterogeneity of the patient population and intrasubject variability were limitations of the study. CONCLUSIONS Significant improvements in locomotor endurance, gross motor function, and some measures of strength were found for the cycling group but not the control group, providing preliminary support for this intervention. As statistical differences were not found in baseline-postintervention change scores between the 2 groups; the results did not demonstrate that stationary cycling was more effective than no intervention. The results of this phase I study provide guidance for future research.
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Abstract
PURPOSE This case report provides an overview of surgical procedures, including single-event multiple level surgery (SEMLS) used in the management of secondary conditions in cerebral palsy (CP). Physical therapy (PT) management over 35 months following SEMLS is described for an adolescent (Gross Motor Function Classification System level II) with CP. SUMMARY OF KEY POINTS When conservative management is not sufficient to manage secondary complications, SEMLS, combined with PT and family support, may provide the foundation for greater functional improvement than surgical correction of a single impairment. The outcome measures used following SEMLS included the Gross Motor Function Measure-66, Activity Scale for Kidsperformance38, goniometry, manual muscle testing, and Numerical Pain Rating Scale. STATEMENT OF CONCLUSIONS Preoperative functional level can be exceeded and sustained beyond 24 months following surgery. RECOMMENDATIONS FOR CLINICAL PRACTICE Rehabilitation following a SEMLS requires teamwork and a long-term commitment to maximize outcomes.
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Sport-specific fitness testing and intervention for an adolescent with cerebral palsy: a case report. Pediatr Phys Ther 2010; 22:234-40. [PMID: 20473110 DOI: 10.1097/pep.0b013e3181dba5e5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE This case report describes the development, implementation, and outcomes of a fitness-related intervention program that addressed the sport-specific goals of an adolescent with cerebral palsy. CASE DESCRIPTION The participant in this case was a 16-year-old African American male with spastic diplegia. The participant joined his high school wrestling team and asked to focus his physical therapy on interventions that would improve his wrestling performance. An examination was performed using the muscle power sprint test, the 10 x 5-m sprint test, strength tests, the 10-m shuttle run test, and the Gross Motor Function Measure. The intervention consisted of interval training, which focused on the demands of wrestling. OUTCOMES Scores on all tests and measures were higher after the intervention. DISCUSSION The outcomes of this case report seem to support the use of a fitness-related intervention program for addressing the sport-specific goals of an adolescent with cerebral palsy.
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Abstract
Physical activity has significant health benefits and is positively associated with health-related quality of life and psychosocial functioning. Persons with disability are at particular risk of inactivity. For adults with cerebral palsy (CP), impaired health and function typically impede participation in physical activity, setting into motion a downward spiral of prolonged inactivity. Adults with CP may not be engaging in sufficient physical activity to produce the improvements in fitness required to experience associated health benefits. However, the literature related to physical activity and fitness in adults with CP is sparse. As more and more persons with CP lead productive lives into their golden years, it is imperative that the scientific community provide definitive information to help guide decisions related to the type and extent of fitness-related activities most beneficial to these individuals. This information will facilitate development of physical training programs that promote maintenance of function and fitness while preventing the onset of secondary conditions. This presentation will address the state-of-the-science regarding physical activity and fitness for adults with CP and how fitness training relates to physical activity and health in this population. Gaps in the evidence, as well as possible directions for future research, will be presented.
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Affiliation(s)
- Deborah Thorpe
- Center for Human Movement Science, The University of North Carolina at Chapel Hill, 27599-7135, USA.
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Morris PJ. Physical activity recommendations for children and adolescents with chronic disease. Curr Sports Med Rep 2009; 7:353-8. [PMID: 19005359 DOI: 10.1249/jsr.0b013e31818f0795] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Youth with low physical activity and fitness levels and high body fat levels are more likely to develop additional risk factors for cardiovascular disease, such as elevated blood pressure and serum cholesterol levels. Participation in daily physical activity can reduce body fat, encourage weight loss, and improve aerobic fitness in youth without disabilities. Recent research involving youth with cerebral palsy, spinal cord injury, cystic fibrosis, asthma, diabetes, juvenile idiopathic arthritis, and hemophilia suggest positive effects of exercise therapy upon the aerobic capacity, functional ability, and quality of life of children and adolescents with disabilities and chronic diseases. Strategies exist for introducing exercise as a lifelong intervention in pediatric populations with chronic diseases.
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Affiliation(s)
- Patrick J Morris
- Department of Orthopedic Sports Medicine and Family Medicine, University of Minnesota, Minneapolis, MN 55455-0341, USA.
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