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Minghetti A, Widmer M, Viehweger E, Roth R, Gysin R, Keller M. Translating scientific recommendations into reality: a feasibility study using group-based high-intensity functional exercise training in adolescents with cerebral palsy. Disabil Rehabil 2024; 46:4787-4796. [PMID: 38042988 DOI: 10.1080/09638288.2023.2290204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE To examine the feasibility and effects of a functional high-intensity exercise intervention performed in a group-setting on functionality, cardiovascular health and physical performance in adolescents with cerebral palsy (CP). METHODS Ten adolescents with a diagnosis of CP (2 females; 16.6 ± 3.4 years; GMFCS: I-II) participated in a 12-week training intervention, containing progressive resistance training using free weights and high-intensity workouts twice a week. The six-minute walking test, arterial stiffness and physical performance (strength and power tests) were measured before and after the intervention. RESULTS No adverse events were reported. We measured small increases in the six-minute walking test (Δ = 28.8 m, 95% CI [-1.78;52.7]; g = 0.34 [-0.04;0.72]) and a small reduction in arterial stiffness (Δ = -4.65% [-10.90;1.25]; g = -0.46 [-1.36;0.21]). All measures of physical performance increased (0.24 ≤ g ≤ 0.88). CONCLUSION Functional training with free weights in high-functioning adolescents with CP is safe and effective in increasing parameters of physical performance and cardiovascular health. Positively influenced indicators of everyday independence (i.e. strength parameters) showed a transfer into movements of daily life. Concerns about adverse events through high-intensity training in adolescents with CP appear unjustified when training is performed progressively, following basic training principles.
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Affiliation(s)
- Alice Minghetti
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Michèle Widmer
- Neuroorthopaedics and Motion Analysis Unit, Department of Orthopaedics, University Children's Hospital beider Basel, Basel, Switzerland
| | - Elke Viehweger
- Neuroorthopaedics and Motion Analysis Unit, Department of Orthopaedics, University Children's Hospital beider Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Ralf Roth
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Martin Keller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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2
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Fowler EG, Vuong A, Staudt LA, Greenberg MB, Mesler SA, Chen K, Stearns-Reider KM. Selective voluntary motor control influences knee joint torque, work and power in children with spastic cerebral palsy. Gait Posture 2024; 113:151-157. [PMID: 38901387 DOI: 10.1016/j.gaitpost.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/12/2024] [Accepted: 06/06/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Children with spastic cerebral palsy (CP) have damage to the corticospinal tracts that are responsible for selective motor control (SMC). Force, velocity and timing of joint movement are related biomechanical features controlled by the corticospinal tracts (CSTs) that are important for skilled movement. RESEARCH QUESTION Does SMC influence knee joint biomechanics in spastic CP? METHODS In this prospective study, relationships between SMC and knee biomechanics (peak torque, total work, average power) across a range of velocities (0-300 deg/s) were assessed using an isokinetic dynamometer in 23 children with spastic CP. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Logistic and linear regression models were used to evaluate relationships between SCALE and biomechanical measures. RESULTS The ability to produce knee torque diminished with increasing velocity for both Low (0-4 points) and High (5-10 points) SCALE limb score groups (p < 0.01). More knees in the High group produced extension torque at 300 deg/s (p < 0.05) and flexion torque at 30, 90,180, 240 and 300 deg/s (p < 0.05). The ability to produce torque markedly decreased above 180 deg/s for Low group flexion. For knees that produced torque, significant positive correlations between SCALE limb scores and joint torque (0 and 120 deg/s), work (120 deg/s) and power (120 deg/s) were found (p < 0.05). Greater knee torque, work and power for the High group was found for the extensors at most velocities and the flexors for up to 120 deg/s (p < 0.05). Few Low group participants generated knee flexor torque above 120 deg/s limiting comparisons. SIGNIFICANCE Biomechanical impairments found for children with low SMC are concerning as skilled movements during gait, play and sport activities occur at high velocities. Differences in SMC should be considered when designing individualized assessments and interventions.
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Affiliation(s)
- Eileen G Fowler
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA; Tarjan Center at UCLA, USA.
| | - Andy Vuong
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
| | - Loretta A Staudt
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
| | - Marcia B Greenberg
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
| | - Sophia A Mesler
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
| | - Keren Chen
- Department of Medicine Statistics Core, David Geffen School of Medicine, UCLA, USA.
| | - Kristen M Stearns-Reider
- Center for Cerebral Palsy at UCLA/Orthopaedic Institute for Children, Department of Orthopaedic Surgery, 22-70 Rehab Center, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave, Los Angeles, CA 90095-1795, USA.
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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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Hummer ET, Porter J, Cates H, Zhang S. Feasibility of Stationary Cycling with Pedal Force Visual Feedback Post-Total Knee Arthroplasty: Implications for Inter-Limb Deficits in Knee Joint Biomechanics. Bioengineering (Basel) 2024; 11:850. [PMID: 39199807 PMCID: PMC11351697 DOI: 10.3390/bioengineering11080850] [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: 06/20/2024] [Revised: 07/27/2024] [Accepted: 08/16/2024] [Indexed: 09/01/2024] Open
Abstract
The purpose of this study was to assess the biomechanical adaptations prompted by stationary cycling paired with visual feedback of vertical pedal reaction forces during both stationary cycling and overground walking for patients who underwent a total knee arthroplasty (TKA). Specifically, an emphasis on the inter-limb deficits in knee joint biomechanics were examined. Ten patients who underwent a TKA took part in an acute intervention with pre- and post-testing measurements of kinematics (240 Hz) and kinetics (1200 Hz) during stationary cycling and overground walking. The intervention phase consisted of six cycling sessions during which participants were provided with visual feedback of their bilateral peak vertical pedal reaction force, with instructions to maintain a symmetrical loading between limbs. A 2 × 2 (work rate/speed × time) repeated measures ANOVA (α = 0.05) was conducted on key outcome variables. Peak knee extension moment asymmetry during stationary cycling significantly improved (p = 0.038, η2p = 0.610) following the acute intervention. Walking velocities for both preferred (p = 0.001, d = 0.583) and fast (p = 0.002, d = 0.613) walking speeds displayed improvements from pre- to post-testing. Significant improvements in the total score (p = 0.009, d = 0.492) and ADL subscale score (p = 0.041, d = 0.270) for the Knee Injury and Osteoarthritis Outcome Score were present following the acute intervention. Stationary cycling with visual feedback may be beneficial post-TKA; however, further investigation is merited.
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Affiliation(s)
- Erik T. Hummer
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Jared Porter
- Department of Kinesiology, Recreation and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA; (J.P.); (S.Z.)
| | - Harold Cates
- Tennessee Orthopedic Clinics, Knoxville, TN 37923, USA;
| | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA; (J.P.); (S.Z.)
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Gannotti ME, O’Neil ME, Fragala-Pinkham M, Gorton GE, Whitney DG. Policy brief: adaptive cycling equipment for individuals with neurodevelopmental disabilities as durable medical equipment. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1160948. [PMID: 37342677 PMCID: PMC10277568 DOI: 10.3389/fresc.2023.1160948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023]
Abstract
- Durable medical equipment (DME) policies require that the equipment be medically necessary; however, adaptive cycling equipment (bicycles and tricycles) are usually not deemed medically necessary. - Individuals with neurodevelopmental disabilities (NDD) are at high risk for secondary conditions, both physical and mental, that can be mitigated by increasing physical activity. - Significant financial costs are associated with the management of secondary conditions. - Adaptive cycling can provide improved physical health of individuals with NDD potentially reducing costs of comorbidities. - Expanding DME policies to include adaptive cycling equipment for qualifying individuals with NDD can increase access to equipment. - Regulations to ensure eligibility, proper fitting, prescription, and training can optimize health and wellbeing. - Programs for recycling or repurposing of equipment are warranted to optimize resources.
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Affiliation(s)
- Mary E. Gannotti
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, United States
| | - Margaret E. O’Neil
- Department of Physical Therapy & Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
| | - Maria Fragala-Pinkham
- Department of Physical and Occupational Therapy, Boston Children’s Hospital, Boston, MA, United States
| | - George E. Gorton
- Department of Research, Shriners Hospitals for Children, Springfield, MA, United States
| | - Daniel G. Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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Türker D, Yakut Y, Yaşar E, Kerem Günel M, Yılmaz B, Tan AK. The effects of functional electrical stimulation cycling on gait parameters in diplegic cerebral palsy: a single-blind randomized controlled trial. Somatosens Mot Res 2023; 40:62-71. [PMID: 36645809 DOI: 10.1080/08990220.2022.2157393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the effects of functional electrical stimulation cycling (FES-C) training in addition to conventional physical therapy on gait, muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic diplegic cerebral palsy. MATERIALS AND METHODS Twenty children with diplegic cerebral palsy were randomly assigned to FES-C group (n = 10) or control group (n = 10). Subjects trained 3 days/week for 8 weeks. Control group received conventional physical therapy. The FES-C group additionally received FES-C training. The functional muscle test was used for muscle strength assessment. Vicon-3D system was used for gait analysis. Gross Motor Function Measure (GMFM-88) was used for motor function assessment and calorimeter was used for energy expenditure. Measurements were performed at the baseline, at the eight week and at the sixteenth week. RESULTS Functional muscle strength, gross motor function, and energy expenditure improved more in the FES-C group after training and follow up (p < 0.05). There was no significant difference found between the changes in gait parameters of the two groups after treatment and follow up (p > 0.05). Pelvic tilt while walking decreased after training in the FES-C group (p < 0.05). CONCLUSIONS FES-C applied in addition to conventional physical therapy in children with diplegic cerebral palsy is more effective than conventional physical therapy for increasing functional muscle strength, improving gross motor function functions, and reducing energy expenditure.HighlightsFES-C improves lower extremity functional muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic dCP.The use of FES-C in combination with conventional physiotherapy methods may be beneficial in outpatients with spastic dCP.
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Affiliation(s)
- Duygu Türker
- Faculty of Gülhane Physiotherapy and Rehabilitation, Department of Pediatric Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Yavuz Yakut
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Evren Yaşar
- Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Ankara City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Mintaze Kerem Günel
- Faculty of Physical Therapy Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Bilge Yılmaz
- Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Ankara City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey.,Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital, Ankara, Turkey.,Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital
| | - Arif Kenan Tan
- Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Ankara City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey.,Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital, Ankara, Turkey.,Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital
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Ochandorena-Acha M, Terradas-Monllor M, Nunes Cabrera TF, Torrabias Rodas M, Grau S. Effectiveness of virtual reality on functional mobility during treadmill training in children with cerebral palsy: a single-blind, two-arm parallel group randomised clinical trial (VirtWalkCP Project). BMJ Open 2022; 12:e061988. [PMID: 36328390 PMCID: PMC9639079 DOI: 10.1136/bmjopen-2022-061988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Treadmill training and virtual reality have been investigated in children with cerebral palsy. However, few studies have assessed the effectiveness of the combination of both treatments on children's functional and balance activities. The project aims to compare the effects of treadmill training with and without virtual reality on walking endurance and speed, static and dynamic balance, gross motor function, functional independence, quality of life and occupational participation in children with spastic cerebral palsy between the ages of 4 and 12 years classified at levels I, II and III of the Gross Motor Function Classification System. METHODS AND ANALYSIS This study is a single-blind, two-arm parallel group, randomised, controlled clinical trial. Participants will be recruited at the Pediatric Department of the Vic Hospital Consortium, and the research will be conducted at the University of Vic - Central University of Catalonia. The participants will be randomly allocated into two groups: (1) the experimental group, which will receive the treadmill training at the same time as the virtual reality; and (2) the control group, which will undertake treadmill gait training alone. The training will be provided in 10 sessions over 2 weeks with 30 min for each session. Assessments will be performed on three occasions: 1 week before the intervention, 1 week following the intervention and 1 month after the end of the intervention. The evaluations will involve the 6 min walk test, stabilometry, the Berg Balance Scale, the 10 m walk test, the Gross Motor Function Measure, the Functional Independence Measure, the paediatric quality of life inventory and the Children Participation Questionnaire. For between-within group comparison, a mixed-effect linear model will be used. ETHICS AND DISSEMINATION The study has been approved by the Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (2021061). Results will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT05131724.
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Affiliation(s)
- Mirari Ochandorena-Acha
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), C.Sagrada Família, 7, 08500 Vic, Spain
- Neurology department, Sant Joan de Deu Barcelona Children's Hospital, Barcelona, Catalonia, Spain
| | - Marc Terradas-Monllor
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), C.Sagrada Família, 7, 08500 Vic, Spain
- Pain Medicine Section, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Tania Fabiola Nunes Cabrera
- Neurology department, Sant Joan de Deu Barcelona Children's Hospital, Barcelona, Catalonia, Spain
- Pediatric Department, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
| | | | - Sergi Grau
- Faculty of Science and Technology, University of Vic - Central University of Catalonia, Vic, Spain
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Selph SS, Skelly AC, Wasson N, Dettori JR, Brodt ED, Ensrud E, Elliot D, Dissinger KM, McDonagh M. Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury. Arch Phys Med Rehabil 2021; 102:2464-2481.e33. [PMID: 34653376 DOI: 10.1016/j.apmr.2021.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI). DATA SOURCES Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020). STUDY SELECTION Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI. DATA EXTRACTION We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant. DATA SYNTHESIS No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT. CONCLUSIONS Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.
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Affiliation(s)
- Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.
| | | | - Ngoc Wasson
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Erik Ensrud
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Diane Elliot
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Kristin M Dissinger
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
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Sansare A, Harrington AT, Wright H, Alesi J, Behboodi A, Verma K, Lee SCK. Aerobic Responses to FES-Assisted and Volitional Cycling in Children with Cerebral Palsy. SENSORS 2021; 21:s21227590. [PMID: 34833666 PMCID: PMC8622737 DOI: 10.3390/s21227590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
Recumbent stationary cycling is a potential exercise modality for individuals with cerebral palsy (CP) that lack the postural control needed for upright exercises. Functional electrical stimulation (FES) of lower extremity muscles can help such individuals reach the cycling intensities that are required for aerobic benefits. The aim of this study was to examine the effect of cycling with and without FES assistance to that of a no-intervention control group on the cardiorespiratory fitness of children with CP. Thirty-nine participants were randomized to a FES group that underwent an 8-week FES-assisted cycling program, the volitional group (VOL), who cycled without FES, or a no-intervention control group (CON) (15 FES, 11 VOL, 13 CON). Cadence, peak VO2, and net rise in heart rate were assessed at baseline, end of training, and washout (8-weeks after cessation of training). Latent growth curve modeling was used for analysis. The FES group showed significantly higher cycling cadences than the VOL and CON groups at POST and WO. There were no differences in improvements in the peak VO2 and peak net HR between groups. FES-assisted cycling may help children with CP attain higher cycling cadences and to retain these gains after training cessation. Higher training intensities may be necessary to obtain improvements in peak VO2 and heart rate.
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Affiliation(s)
- Ashwini Sansare
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE 19713, USA; (A.S.); (K.V.)
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
| | | | - Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
| | - James Alesi
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
| | - Ahad Behboodi
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Khushboo Verma
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE 19713, USA; (A.S.); (K.V.)
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
| | - Samuel C. K. Lee
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE 19713, USA; (A.S.); (K.V.)
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
- Correspondence: ; Tel.: +1-302-831-2450
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10
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Owusu Ansa EO, Mprah WK, Moses MO, Owusu I, Acheampong E. Effect of Community-Based Functional Aerobic Training on Motor Performance and Quality of Life of Children with Spastic Cerebral Palsy. Ethiop J Health Sci 2021; 31:505-516. [PMID: 34483607 PMCID: PMC8365498 DOI: 10.4314/ejhs.v31i3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022] Open
Abstract
Background Efficacies of community-based exercise programmes have been well reported but there is scarce information on the expediency of community-based rehabilitation in a society where many of children with disabilities live in poorly resourced settings with extremely limited rehabilitative services. The study investigated the effects of community-based functional aerobic exercise (CBFAE) on gross motor function, walking distance, and quality of life of children with cerebral palsy (CP). Methods Quasi-experimental design was used. Children with gross motor function classification system (GMFCS) levels I – II participated in eight weeks CBFAE training four times/week, 50 minutes/day at 40–80% maximum heart rate. Gross motor function (GMF), walk distance and quality of life were assessed pre and post CBFAE training. Results Significant improvement observed in GMF (Dstanding) (8.2%, P=.000), GMF (E-walking+running+jumping (5.12%, P=.004), walking distance (6.09%, P=.009). Higher significant positive effects of CBFAE observed in Social wellbeing and acceptance (107.10%, P=.000), and participation and physical health (105.04%, P=.005) by children parent proxy. Self-reported results showed that for CBFAE, significant positive improvements were higher in Pain and impact of disability (67.93%, P=.049) and Participation and physical health (60.00%, P=.042). Conclusion CBFAE training contributes majorly to improved standing, walking, jumping and running and selfesteem, quality of life of children with spastic CP. Clinicians and exercise therapists should essentially incorporate CBFAE training and activities into the management of children with CP for improved mobility and functional performances.
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Affiliation(s)
- Evans Osei Owusu Ansa
- Department of Health Education, Promotion and Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Physiotherapy and Sports Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Kwadwo Mprah
- Department of Health Education, Promotion and Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Monday Omoniyi Moses
- Department of Physiotherapy and Sports Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Owusu
- Department of Health Education, Promotion and Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Enoch Acheampong
- Department of Health Education, Promotion and Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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11
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Ansa OEO, Mprah KW, Moses MO, Owusu I, Acheampong E. Effect of Community-Based Functional Aerobic Training on Motor Performance and Quality of Life of Children with Spastic Cerebral Palsy. Ethiop J Health Sci 2021; 31:381-392. [PMID: 34158790 PMCID: PMC8188077 DOI: 10.4314/ejhs.v31i2.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Efficacies of community-based exercise programmes have been well reported, but there is scarce information on the expediency of community-based rehabilitation in a society where many children with disabilities live in poorly resourced settings with extremely limited rehabilitative services. This study investigated the effects of community-based functional aerobic exercise (CBFAE) on gross motor function, walking distance, and quality of life of children with cerebral palsy (CP). Methods Quasi-experimental design was used. Children with gross motor function classification system (GMFCS) levels I – II participated in eight weeks CBFAE training four times/week, 50 minutes/day at 40–80% maximum heart rate. Gross motor function (GMF), walking distance and quality of life were assessed pre and post CBFAE training. Results Significant improvement was observed in GMF (Dstanding) (8.2%, P=.000), GMF (E-walking + running+ jumping (5.12%, P=.004), walking distance (6.09%, P=.009). Higher significant positive effects of CBFAE were observed in Social wellbeing and acceptance (107.10%, P=.000), and participation and physical health (105.04%, P=.005) by children parent proxy. Self-reported results showed that for CBFAE, significant positive improvements were higher in pain and impact of disability (67.93%, P=.049) and participation and physical health (60.00%, P=.042). Conclusion CBFAE training contributes majorly to improved standing, walking, jumping and running and self-esteem, quality of life of children with spastic CP. Clinicians and exercise therapists should essentially incorporate CBFAE training and activities into the management of children with CP for improved mobility and functional performances.
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Affiliation(s)
- Osei Evans Owusu Ansa
- Department of Health Education, Promotion and Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Physiotherapy and Sports Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwadwo Wisdom Mprah
- Department of Health Education, Promotion and Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Monday Omoniyi Moses
- Department of Physiotherapy and Sports Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Owusu
- Department of Health Education, Promotion and Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Enoch Acheampong
- Department of Health Education, Promotion and Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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12
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Bulthuis R, Tabak M, Schaake L, Hermens H. Outdoor E-trike cycling: A low intensity physical activity. Assist Technol 2021; 34:429-436. [PMID: 33300833 DOI: 10.1080/10400435.2020.1858995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
For people with disabilities or chronic diseases, an electrically supported tricycle (e-trike) could facilitate independence and participation in physical activity, and improve health conditions. This study investigates the exercise intensity and perceived exertion of e-trike cycling. Twenty healthy participants cycled on an e-trike with different speeds (12 and 18 km/h) and different levels of electric pedal support at an outdoor athletics track. Exercise intensity was measured with oxygen consumption (V˙O2) using a Cosmed K4B2 analysis unit, perceived exertion was measured with the Borg Rating of Perceived Exertion scale, pedaling power, and engine power were measured with a torque sensor. The effect of speed and support was analyzed with a Linear Mixed Effects model. V˙O2 was 18.67 ± 3.13 ml/kg/min without support, with electric support the exercise intensity was significantly below moderate intensity (i.e. 10.5 ml/kg/min) at t = 11.37, p < .001, 95% CI: 1.90, 2.77. The Borg score without support was 9.79 ± 1.72 and all other conditions below this, which were significantly below moderate intensity (i.e. 11) at t = -3.07, p = .007, 95% CI: -2.04, -0.38. Speed and support significantly affected V˙O2 (F = 185.49, p < .001). E-trike cycling is a low intensity activity, but intensity can be influenced by changing speed and support level.
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Affiliation(s)
- Roos Bulthuis
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.,eHealth Group, Roessingh Research & Development, Enschede, Netherlands
| | - Monique Tabak
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.,eHealth Group, Roessingh Research & Development, Enschede, Netherlands
| | - Leendert Schaake
- eHealth Group, Roessingh Research & Development, Enschede, Netherlands
| | - Hermie Hermens
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.,eHealth Group, Roessingh Research & Development, Enschede, Netherlands
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13
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Armstrong EL, Boyd RN, Horan SA, Kentish MJ, Ware RS, Carty CP. Functional electrical stimulation cycling, goal-directed training, and adapted cycling for children with cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 2020; 62:1406-1413. [PMID: 33146438 DOI: 10.1111/dmcn.14648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
AIM To test the efficacy of functional electrical stimulation (FES) cycling, goal-directed training, and adapted cycling, compared with usual care, to improve function in children with cerebral palsy (CP). METHOD The intervention was delivered between 2017 and 2019 and included three sessions per week for 8 weeks (2×1h sessions at a children's hospital, and 1h home programme/week). Hospital sessions included 30 minutes of FES cycling and 30 minutes of goal-directed training. Home programmes included goal-directed training and adapted cycling. The comparison group continued usual care. Primary outcomes were gross motor function assessed by the Gross Motor Function Measure (GMFM) and goal performance/satisfaction assessed using the Canadian Occupational Performance Measure (COPM). Secondary outcomes were sit-to-stand and activity capacity, participation in home, school, and community activities, and power output. Linear regression was used to determine the between-group mean difference immediately post-training completion after adjusting for baseline scores. RESULTS This randomized controlled trial included 21 participants (mean age=10y 3mo, standard deviation [SD]=3y; Gross Motor Function Classification System level: II=7, III=6, IV=8) who were randomized to the intervention (n=11) or usual care group (n=10). Between-group differences at T2 favoured the intervention group for GMFM-88 (mean difference=7.4; 95% confidence interval [CI]: 2.3-12.6; p=0.007), GMFM-66 (mean difference=5.9; 95% CI: 3.1-8.8; p<0.001), COPM performance (mean difference=4.4; 95% CI: 3.9-5.3; p<0.001) and satisfaction (mean difference=5.2; 95% CI: 4.0-6.4; p<0.001). INTERPRETATION Children with CP achieved meaningful functional improvements after FES cycling, goal-directed training, and adapted cycling training. Cycling programmes for children with CP should be individualized and goal directed.
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Affiliation(s)
- Ellen L Armstrong
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,The Queensland Cerebral Palsy Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
| | - Roslyn N Boyd
- The Queensland Cerebral Palsy Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
| | - Sean A Horan
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Megan J Kentish
- The Queensland Cerebral Palsy Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia.,Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Christopher P Carty
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Gold Coast Orthopaedic Research Engineering and Education Alliance, Griffith University, Gold Coast, QLD, Australia
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14
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Daly C, Moore CL, Johannes S, Middleton J, Kenyon LK. Pilot Evaluation of a School-Based Programme Focused on Activity, Fitness, and Function among Children with Cerebral Palsy at GMFCS Level IV: Single-Subject Research Design. Physiother Can 2020; 72:195-204. [PMID: 32494103 DOI: 10.3138/ptc-2018-0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Children with cerebral palsy (CP) who function at Gross Motor Function Classification System (GMFCS) Level IV have difficulty achieving sufficient levels of physical activity to promote fitness. The purpose of this pilot evaluation was to investigate the practicability and impact of a school-based supported physical activity programme, using adaptive bicycles, on cardiorespiratory fitness and gross motor function among children with CP at GMFCS Level IV. Method: We used a single-subject, A-B-A-B research design replicated across three participants aged 8-14 years with CP at GMFCS Level IV who attended three different schools. Cardiorespiratory fitness was assessed weekly during all study phases using the energy expenditure index (EEI). Gross motor function was assessed using the Gross Motor Function Measure-66 (GMFM-66) and goal attainment scaling (GAS). During the intervention phases, an adaptive bicycle-riding programme was carried out daily at school for up to 30 minutes. Results: One participant demonstrated significant improvement on the EEI. All participants demonstrated improvement in gross motor function as determined by the GMFM-66 and GAS. Insights were garnered pertaining to the design for large-scale future studies. Conclusions: This pilot evaluation supports further investigation of school-based adaptive bicycle-riding programmes for children who have CP at GMFCS Level IV.
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Affiliation(s)
- Carol Daly
- Witwer Children's Therapy, St. Luke's Unity Point Hospital
| | - Connie L Moore
- Physical Therapy Department, Grant Wood Area Education Agency, Cedar Rapids, Iowa
| | - Suzanne Johannes
- Physical Therapy Department, Grant Wood Area Education Agency, Cedar Rapids, Iowa
| | | | - Lisa K Kenyon
- Department of Physical Therapy, Grand Valley State University, Grand Valley, Mich
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15
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Low-Intensity vs High-Intensity Home-Based Treadmill Training and Walking Attainment in Young Children With Spastic Diplegic Cerebral Palsy. Arch Phys Med Rehabil 2020; 101:204-212. [DOI: 10.1016/j.apmr.2019.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022]
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16
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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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17
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Leblanc V, Tubez F, Loge C, Abdi E, Verstraete I, Jacquemin D, Dorban G, Taiar R. Influence of an adapted dynamic cycling activity on the motor function of children with cerebral palsy (CP). Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- V. Leblanc
- Physiotherapy Department, Haute École Robert Schuman of Libramont, Libramont, Belgium
| | - F. Tubez
- Physiotherapy Department, Haute École Robert Schuman of Libramont, Libramont, Belgium
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium
| | - C. Loge
- Physiotherapy Department, Haute École Robert Schuman of Libramont, Libramont, Belgium
| | - E. Abdi
- Montclair State University, Montclair, NJ, USA
| | - I. Verstraete
- Eclore center, Centre Hospitalier de l’Ardenne (CHA) Vivalia, Libramont, Belgium
| | - D. Jacquemin
- Physiotherapy Department, Haute École Robert Schuman of Libramont, Libramont, Belgium
| | - G. Dorban
- Physiotherapy Department, Haute École Robert Schuman of Libramont, Libramont, Belgium
| | - R. Taiar
- GRESPI/Université de Reims Champagne, Grand Est, France
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18
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Armstrong EL, Spencer S, Kentish MJ, Horan SA, Carty CP, Boyd RN. Efficacy of cycling interventions to improve function in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Clin Rehabil 2019; 33:1113-1129. [DOI: 10.1177/0269215519837582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Ellen L Armstrong
- Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
- Queensland Paediatric Rehabilitation Service, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Sian Spencer
- Queensland Paediatric Rehabilitation Service, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Megan J Kentish
- Queensland Paediatric Rehabilitation Service, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Health, The University of Queensland, South Brisbane, QLD, Australia
| | - Sean A Horan
- Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Christopher P Carty
- Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
- Queensland Paediatric Rehabilitation Service, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Health, The University of Queensland, South Brisbane, QLD, Australia
| | - Roslyn N Boyd
- Queensland Paediatric Rehabilitation Service, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Health, The University of Queensland, South Brisbane, QLD, Australia
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19
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Catelli AM, Gattino LAF, Campo LAD, Corrêa PS, Cechetti F. Cicloergômetro na melhora da função motora grossa de crianças comparalisia cerebral: uma revisão sistemática com meta-anális. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18011026012019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A paralisia cerebral é um grupo de desordens neurológicas causadora de inúmeros déficits, principalmente relacionados à função motora, comprometendo os movimentos e o seu controle seletivo. Dentre as diversas terapias disponíveis para tentar amenizar esse processo, o cicloergômetro aparece como um aparato estacionário que tem por finalidade facilitar a movimentação dos membros inferiores. Portanto, o objetivo deste estudo foi analisar os efeitos do cicloergômetro na função motora grossa de crianças com paralisia cerebral através da escala Gross Motor Function Measure (GMFM-66). Trata-se de uma revisão sistemática, com inclusão de ensaios clínicos randomizados publicados até julho de 2017. A busca foi realizada nas bases de dados: MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), SciELO e Embase. Para a avaliação da qualidade metodológica das investigações foi utilizada a escala da Cochrane Handbook. Foram selecionados artigos que aplicaram o cicloergômetro em crianças com paralisia cerebral, comparadas a crianças com paralisia cerebral no grupo-controle ou em outra intervenção, e que avaliaram a função motora grossa com a GMFM. A revisão incluiu três artigos e um total de 127 pacientes. Os resultados mostraram um aumento nos valores da GMFM-66, porém não significativo estatisticamente nem relevantes para uma melhora clínica. Por meio desta revisão sistemática, verificou-se uma grande heterogeneidade nos estudos que abordam esta área e que, apesar do incremento de valores no grupo que realizou o cicloergômetro, não houve diferença estatística quando comparado ao grupo-controle, demonstrando não beneficiar a função motora grossa dessa população quando avaliada pela GMFM66.
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20
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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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21
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Burnfield JM, Buster TW, Pfeifer CM, Irons SL, Cesar GM, Nelson CA. Adapted Motor-Assisted Elliptical for Rehabilitation of Children With Physical Disabilities. J Med Device 2018. [DOI: 10.1115/1.4041588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Many children with physical disabilities experience difficulty using traditional exercise equipment for gait rehabilitation and fitness training, and the clinician resources required to deliver intensive overground or treadmill-based therapies are infrequently available in most clinics, hospitals, and school settings. This work describes design and testing of a comprehensive set of modifications that enabled children to use a commercially available robotic exercise device (i.e., Intelligently Controlled Assistive Rehabilitation Elliptical (ICARE)) initially developed to address walking and fitness goals of adults with physical disabilities and chronic conditions. Fifteen children (3–11 years old) concurrently enrolled in physical therapy due to varied neurologic conditions were recruited with their parent(s) to evaluate the safety, comfort, and usability of the adult ICARE and pediatric-modified ICARE. After children tried each device, feedback was recorded. To assess feasibility, each child then participated in up to ten sessions (two to five sessions per week; average session length: 38 min, range 21–66 min) using the pediatric-modified ICARE. Parents, on average, perceived that the pediatric-modified ICARE was significantly safer, more comfortable and usable than the adult ICARE. Children's perceptions of the pediatric-modified ICARE were similar, although not statistically significant. Children used the prototype device during 133 sessions for over 3800 min and more than 162,000 cycles. In conclusion, this study demonstrated the feasibility of using the pediatric-modified ICARE with children as young as 3 years old as an adjunct to ongoing therapy.
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Affiliation(s)
- Judith M. Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Thad W. Buster
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Chase M. Pfeifer
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Sonya L. Irons
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Guilherme M. Cesar
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Carl A. Nelson
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, W316 Nebraska Hall, P.O. Box: 880526, Lincoln, NE 68588 e-mail:
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22
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Multimodale Komplexbehandlungen und Funktionstherapien für Kinder und Jugendliche mit Zerebralparese. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-018-0382-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Toovey R, Harvey AR, McGinley JL, Lee KJ, Shih STF, Spittle AJ. Bike skills training for children with cerebral palsy: protocol for a randomised controlled trial. BMJ Open 2018; 8:e019898. [PMID: 29431140 PMCID: PMC5829908 DOI: 10.1136/bmjopen-2017-019898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/28/2017] [Accepted: 12/06/2017] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Two-wheel bike riding can be a goal for children with cerebral palsy (CP) and a means of participating in physical activity. It is possible for some children with CP to ride a two-wheel bike; however, currently far fewer can ride compared with their typically developing peers. Evidence supports training targeted towards goals of the child with CP and their family; yet there is little evidence to guide best-practice bike skills training. Task-specific training may lead to attainment of two-wheel bike-specific goals. This study aims to determine if a novel task-specific approach to training two-wheel bike skills is more effective than a parent-led home programme for attaining individualised two-wheel bike-specific goals in independently ambulant children with CP aged 6-15 years. METHODS AND ANALYSIS Sixty eligible children with CP (Gross Motor Function Classification System levels I-II) aged 6-15 years with goals relating to riding a two-wheel bike will be randomised to either a novel task-specific centre-based group programme (intervention) or a parent-led home-based programme (comparison), both involving a 1-week intervention period. The primary outcome is goal attainment in the week following the intervention period (T1). Secondary outcomes include: goal attainment and participation in physical activity at 3 months postintervention (T2) and bike skills, attendance and involvement in bike riding, self-perception and functional skills at T1 and T2. Economic appraisal will involve cost-effectiveness and cost-utility analyses. Adherence of clinicians and parents to the intervention and comparison protocols will be assessed. Linear and logistic regression will be used to assess the effect of the intervention, adjusted for site as used in the randomisation process. ETHICS AND DISSEMINATION This study was approved by the Human Research and Ethics Committees at The Royal Children's Hospital (#36209). Results will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03003026; Pre-results.
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Affiliation(s)
- Rachel Toovey
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Melbourne, Australia
| | - Adrienne R Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia
- Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Katherine J Lee
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children's Trials Centre, Melbourne Children's Campus, Melbourne, Australia
| | - Sophy T F Shih
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
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24
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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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Effect of Transcranial Direct Current Stimulation of Motor Cortex in Cerebral Palsy: A Study Protocol. Pediatr Phys Ther 2018; 30:67-71. [PMID: 29252842 DOI: 10.1097/pep.0000000000000467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the best electrode position of transcranial direct current stimulation combined with treadmill training in children with unilateral spastic cerebral palsy. METHODS Thirty children with cerebral palsy were randomly allocated to 3 groups: (1) treadmill training combined with anodal electrode positioned over the primary motor cortex in the region of the dominant hemisphere and the cathode positioned in the supraorbital region contralateral to anode; (2) sham anodal transcranial direct current stimulation over the primary motor cortex and sham cathode over the contralateral supraorbital region combined with treadmill training; (3) treadmill training combined with the anodal electrode positioned over the primary motor cortex in the region of the injured hemisphere and the cathode positioned contralateral to anode over the primary motor cortex. Evaluations of gait, balance, quality of life, and electromyographic activity were performed. DISCUSSION This is the protocol for an intervention study investigating electrode position to achieve improved function.
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Damiano DL, Stanley CJ, Ohlrich L, Alter KE. Task-Specific and Functional Effects of Speed-Focused Elliptical or Motor-Assisted Cycle Training in Children With Bilateral Cerebral Palsy: Randomized Clinical Trial. Neurorehabil Neural Repair 2017; 31:736-745. [PMID: 28691601 DOI: 10.1177/1545968317718631] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Locomotor training using treadmills or robotic devices is commonly utilized to improve gait in cerebral palsy (CP); however, effects are inconsistent and fail to exceed those of equally intense alternatives. Possible limitations of existing devices include fixed nonvariable rhythm and too much limb or body weight assistance. OBJECTIVE To quantify and compare effectiveness of a motor-assisted cycle and a novel alternative, an elliptical, in CP to improve interlimb reciprocal coordination through intensive speed-focused leg training. METHODS A total of 27 children with bilateral CP, 5 to 17 years old, were randomized to 12 weeks of 20 minutes, 5 days per week home-based training (elliptical = 14; cycle = 13) at a minimum of 40 revolutions per minute, with resistance added when speed target was achieved. Primary outcomes were self-selected and fastest voluntary cadence on the devices and gait speed. Secondary outcomes included knee muscle strength, and selective control and functional mobility measures. RESULTS Cadence on trained but not nontrained devices increased, demonstrating task specificity of training and increased exercise capability. Mean gait speed did not increase in either group, nor did parent-reported functional mobility. Knee extensor strength increased in both. An interaction between group and time was seen in selective control with scores slightly increasing for the elliptical and decreasing for the cycle, possibly related to tighter limb coupling with cycling. CONCLUSIONS Task-specific effects were similarly positive across groups, but no transfer was seen to gait or function. Training dose was low (≤20 hours) compared with intensive upper-limb training recommendations and may be insufficient to produce appreciable clinical change.
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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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Toovey R, Reid SM, Rawicki B, Harvey AR, Watt K. Ability of independently ambulant children with cerebral palsy to ride a two-wheel bicycle: a case-control study. Dev Med Child Neurol 2017; 59:395-401. [PMID: 27901269 DOI: 10.1111/dmcn.13340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2016] [Indexed: 11/30/2022]
Abstract
AIM Limited information exists on the ability of children with cerebral palsy (CP) to ride a two-wheel bicycle, an activity that may improve health and participation. We aimed to describe bicycle-riding ability and variables associated with ability to ride in children with CP (Gross Motor Functional Classification System [GMFCS] levels I-II) compared with children with typical development. METHOD This case-control study surveyed parents of 114 children with CP and 87 children with typical development aged 6 to 15 years (115 males, mean age 9y 11mo, standard deviation [SD] 2y 10mo). Kaplan-Meier methods were used to compare proportions able to ride at any given age between the two groups. Logistic regression was used to assess variables associated with ability to ride for children with CP and typical development separately. RESULTS The proportion of children with CP able to ride at each level of bicycle-riding ability was substantially lower at each age than peers with typical development (p<0.001). While most children with typical development were able to ride independently by 10 years of age, 51% of children with CP classified as GMFCS level I and 3% of those classified as GMFCS level II had obtained independent riding in the community by 15 years of age. Variables associated with ability to ride for children classified as GMFCS level I were age and parent-rated importance of their child being able to ride. INTERPRETATION Some independently ambulant children with CP can learn to ride a bicycle, in particular if they are classified as GMFCS level I. Variables associated with ability to ride deserve consideration in shaping future efforts for the majority of this population who are not yet able to ride.
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Affiliation(s)
- Rachel Toovey
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Melbourne, Australia
| | - Susan M Reid
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Barry Rawicki
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Melbourne, Australia
| | - Adrienne R Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Developmental Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Zhou J, Butler EE, Rose J. Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment. Front Hum Neurosci 2017; 11:103. [PMID: 28367118 PMCID: PMC5355477 DOI: 10.3389/fnhum.2017.00103] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/20/2017] [Indexed: 01/17/2023] Open
Abstract
Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.
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Affiliation(s)
- Joanne Zhou
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
| | - Erin E Butler
- Thayer School of Engineering, Dartmouth CollegeHanover, NH, USA; Neukom Institute for Computational Sciences, Dartmouth CollegeHanover, NH, USA
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
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Grainger K, Dodson Z, Korff T. Predicting bicycle setup for children based on anthropometrics and comfort. APPLIED ERGONOMICS 2017; 59:449-459. [PMID: 27890157 DOI: 10.1016/j.apergo.2016.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/17/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
Bicycling is a popular activity for children. In order for children to enjoy cycling and to minimize injury, it is important that they are positioned appropriately on the bicycle. The purpose of this study was therefore to identify a suitable bicycle setup for children aged between 7 and 16 years which accommodates developmental differences in anthropometrics, flexibility and perceptions of comfort. Using an adjustable bicycle fitting rig, we found the most comfortable position of 142 children aged 7 to 16. In addition, a number of anthropometric measures were recorded. Seat height and the horizontal distance between seat and handlebars were strongly predictable (R2 > 0.999, p < 0.001 and R2 = 0.649, p < 0.001 respectively), whilst the predictability of the vertical distance between seat and handlebars was weaker (R2 = 0.231, p < 0.001). These results have practical implications for children and parents, paediatric researchers and clinicians as well as bicycle manufacturers.
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Affiliation(s)
- Karl Grainger
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UB8 3PH, United Kingdom.
| | - Zoe Dodson
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UB8 3PH, United Kingdom.
| | - Thomas Korff
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UB8 3PH, United Kingdom.
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Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis. Phys Ther 2016; 96:1938-1954. [PMID: 27313240 PMCID: PMC5131187 DOI: 10.2522/ptj.20150401] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 06/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Children with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear. PURPOSE The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP. DATA SOURCES MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014. STUDY SELECTION The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure. DATA EXTRACTION Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded. DATA SYNTHESIS Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=-0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category. LIMITATIONS Gait speed was the only outcome measure analyzed. CONCLUSIONS Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.
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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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Cho C, Hwang W, Hwang S, Chung Y. Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy. TOHOKU J EXP MED 2016; 238:213-8. [PMID: 26947315 DOI: 10.1620/tjem.238.213] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Chunhee Cho
- Department of Physical Therapy, The Graduate School, Sahmyook University
| | - Wonjeong Hwang
- Department of Physical Therapy, The Graduate School, Sahmyook University
| | - Sujin Hwang
- Department of Physical Therapy, Baekseok University
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University
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Lazzari RD, Politti F, Santos CA, Dumont AJL, Rezende FL, Grecco LAC, Braun Ferreira LA, Oliveira CS. Effect of a single session of transcranial direct-current stimulation combined with virtual reality training on the balance of children with cerebral palsy: a randomized, controlled, double-blind trial. J Phys Ther Sci 2015; 27:763-8. [PMID: 25931726 PMCID: PMC4395710 DOI: 10.1589/jpts.27.763] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/21/2014] [Indexed: 01/13/2023] Open
Abstract
[Purpose] The aim of the present study was to investigate the effects of a single session of transcranial direct current stimulation combined with virtual reality training on the balance of children with cerebral palsy. [Subjetcs and Methods] Children with cerebral palsy between four and 12 years of age were randomly allocated to two groups: an experimental group which performed a single session of mobility training with virtual reality combined with active transcranial direct current stimulation; and a control group which performed a single session of mobility training with virtual reality combined with placebo transcranial direct current stimulation. The children were evaluated before and after the training protocols. Static balance (sway area, displacement, velocity and frequency of oscillations of the center of pressure on the anteroposterior and mediolateral axes) was evaluated using a force plate under four conditions (30-second measurements for each condition): feet on the force plate with the eyes open, and with the eyes closed; feet on a foam mat with the eyes open, and with the eyes closed. [Results] An increase in sway velocity was the only significant difference found. [Conclusion] A single session of anodal transcranial direct current stimulation combined with mobility training elicited to lead to an increase in the body sway velocity of children 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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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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McPherson AC, Keith R, Swift JA. Obesity prevention for children with physical disabilities: a scoping review of physical activity and nutrition interventions. Disabil Rehabil 2013; 36:1573-87. [DOI: 10.3109/09638288.2013.863391] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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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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Grecco LAC, Duarte NDAC, de Mendonça ME, Pasini H, Lima VLCDC, Franco RC, de Oliveira LVF, de Carvalho PDTC, Corrêa JCF, Collange NZ, Sampaio LMM, Galli M, Fregni F, Oliveira CS. Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial. BMC Pediatr 2013; 13:168. [PMID: 24112817 PMCID: PMC3852945 DOI: 10.1186/1471-2431-13-168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. METHODS/DESIGN A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. DISCUSSION This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. TRIAL REGISTRATION ReBEC RBR-9B5DH7.
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Affiliation(s)
- Luanda André Collange Grecco
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Rua Diogo de Faria 775, Vila Mariana, CEP 04037-000 São Paulo, SP, Brazil
| | | | | | - Hugo Pasini
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Vânia Lúcia Costa de Carvalho Lima
- Master’s and Doctoral Programs in Communication disordes: Speech area, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Renata Calhes Franco
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | | | | | - João Carlos Ferrari Corrêa
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Nelci Zanon Collange
- 4th Pediatric Neurosurgery, University of São Paulo and the Federal Pediatric Neurosurgical Center (CENEPE), São Paulo, Brazil
| | - Luciana Maria Malosá Sampaio
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Manuela Galli
- Associate professor of Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Felipe Fregni
- Laboratory of Neuromodulation & Center of Clinical Research Learning, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Claudia Santos Oliveira
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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Verweij BGF, Stoner L, Shultz SP. Exercise modality and metabolic efficiency in children. Eur J Pediatr 2013; 172:1191-6. [PMID: 23644651 DOI: 10.1007/s00431-013-2025-4] [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: 02/24/2013] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Current exercise prescription guidelines for children recommend at least 60 min of moderate-to-vigorous physical activity every day. However, little is known about the efficacy of different cardiorespiratory exercise modalities prescribed to the pediatric cohort. Sixteen healthy children (8-12 years) completed 5-min trials of treadmill walking, cycling, and elliptical training in a randomized order. The treadmill walking speed was determined from measurements collected during a self-selected walking trial. The workloads for treadmill walking, cycling, and elliptical training were matched (40.3 W). Mechanical efficiency (ME%), perceived exertion (RPE), oxygen uptake, metabolic equivalents, and net energy expenditure were measured. ME% in walking was significantly higher than in cycling (P = 0.001) and elliptical training (P < 0.001), and cycling was significantly higher than elliptical training (P = 0.003). RPE in walking was significantly lower than in elliptical training (P = 0.006) but not from cycling (P = 0.314), and cycling resulted in significantly lower RPE than elliptical training (P = 0.021). CONCLUSION Treadmill walking appears to be the most efficacious exercise prescription for otherwise healthy children; however, longitudinal studies need to be implemented to investigate the long-term benefits of each exercise modality.
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Affiliation(s)
- Bob G F Verweij
- Department of Medicine, Utrecht University, Utrecht, Netherlands
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Abstract
Outcome measures may be used for a variety of reasons by clinicians and researchers. This paper provides an overview on motor measures that can be used in research or practice and are classified within the International Classification of Functioning, Disability and Health or ICF. Specifically, body function measures of neuromusculoskeletal and movement-related functions are presented, as are mobility measures within the activity and participation domain of the ICF. Descriptions of measures within these categories and their psychometric properties are provided. Current challenges and future directions for motor measurement are delineated.
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Chen CL, Chen CY, Liaw MY, Chung CY, Wang CJ, Hong WH. Efficacy of home-based virtual cycling training on bone mineral density in ambulatory children with cerebral palsy. Osteoporos Int 2013; 24:1399-406. [PMID: 23052930 DOI: 10.1007/s00198-012-2137-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 08/07/2012] [Indexed: 11/24/2022]
Abstract
UNLABELLED The 12-week home-based virtual cycling training (hVCT) improved lower limb muscle strength and areal bone mineral density (aBMD) than the control program in children with cerebral palsy (CP). A muscle strengthening program, rather than general physical activity, is more specific in enhancing aBMD for these children. A novel hVCT is an effective and efficient strategy that enhances lower limb bone density in these children. INTRODUCTION This is the first study to assess the efficacy of a novel hVCT program on bone density for children with spastic CP using a well-designed randomized controlled trial. METHODS Twenty-seven ambulatory children with spastic CP, aged 6-12 years, were randomly assigned to the hVCT group (n=13) or control group (n=14). Outcome measures-motor function [Gross Motor Function Measure-66 (GMFM-66)], muscle strength (curl up scores and isokinetic torque of knee extensor and flexor muscle) and aBMD of the lumbar and distal femur-were administered before and immediately after the 12-week intervention. RESULTS Analysis of covariance results show that the hVCT group had greater distal femur aBMD and isokinetic torques of knee extensor and flexor muscles than the control group at posttreatment (p<0.05). However, curl up scores, GMFM-66, and lumbar aBMD at posttreatment did not differ between the two groups. CONCLUSIONS Analytical findings suggest that the muscle strengthening program is more specific in enhancing bone density for children with CP than general physical activity. Thus, the proposed 12-week hVCT protocol is an effective and efficient strategy for improving lower limb aBMD in these children.
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Affiliation(s)
- C-L Chen
- Physical Medicine and Rehabilitation, Chang Gung Memorial hospital, Linkou, and Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, 5 Fu-Hsing St. Kwei-Shan, Tao-Yuan, 333, Taiwan
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Treadmill training following orthopedic surgery in lower limbs of children with cerebral palsy. Pediatr Phys Ther 2013; 25:187-92; discussion 193. [PMID: 23542199 DOI: 10.1097/pep.0b013e3182888495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the effect of treadmill training on gross motor function and functional mobility in children with cerebral palsy (CP) receiving physical therapy following orthopedic surgery for the lower limbs. METHODS Children with CP between 8 and 15 years of age participated and were divided into 2 groups: those having undergone soft tissue surgery and those having undergone both soft tissue and bone surgery. The program consisted of 12 weeks of treadmill training without partial weight support at a frequency of one 30-minute session per week. RESULTS Significant improvements were found on the gross motor function measure-88 after treadmill training; distance traveled on the 6 meter walk test; and time tolerated on the treadmill. CONCLUSIONS Treadmill training during physical therapy is beneficial for children with CP who undergo orthopedic surgery in the lower limbs.
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45
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Hong WH, Chen HC, Shen IH, Chen CY, Chen CL, Chung CY. Knee muscle strength at varying angular velocities and associations with gross motor function in ambulatory children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:2308-2316. [PMID: 22853889 DOI: 10.1016/j.ridd.2012.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 07/09/2012] [Indexed: 06/01/2023]
Abstract
The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n=17) or level II (n=16) according to Gross Motor Function Classification System (GMFCS) levels. All children underwent curl-up test and isokinetic tests of the knee extensor and flexor muscle. Children with CP underwent the gross motor function assessments, including the Gross Motor Function Measure (GMFM-66) and the gross motor subtests of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The hamstring-quadriceps ratio (HQ ratio) was calculated as 100%×(isokinetic peak torque of hamstring (knee flexor)/isokinetic peak torque of quadriceps (knee extensor)). Children with GMFCS level II had lower BOTMP and GMFM-66 scores, curl-up scores, HQ ratio, and knee muscle strength, especially knee flexor, compared to those with GMFCS level I. The regression analysis showed that knee flexor torques at 60 and 90°/s are mainly related to balance (r(2)=0.167, p=0.011) and strength (r(2)=0.243, p=0.002) while knee flexor torques at 120°/s mainly contribute to running speed and agility (r(2)=0.372, p<0.001). These findings suggest that children with CP had knee strength deficits, especially knee flexor. Postural muscle (knee flexor) strength dominated gross motor function than antigravity muscle strength (knee extensor). The knee flexor strength at different angular velocities was associated with various gross motor tasks. The HQ ratio may be used as a potential biomarker to probe the therapeutic effectiveness for muscle strengthening in these children. These data may allow clinician for formulating effective muscle strengthening strategies for these children.
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Affiliation(s)
- Wei-Hsien Hong
- Department of Sports Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung 40402, Taiwan
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Scheeren EM, Mascarenhas LPG, Chiarello CR, Costin ACMS, Oliveira L, Neves EB. Description of the Pediasuit ProtocolTM. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000300002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: PediaSuit ProtocolTM is an intensive therapy with a holistic approach to the treatment of individuals with neurological disorders like cerebral palsy (CP), developmental delays, traumatic brain injuries, autism and other conditions which affect a child's motor and/or cognitive functions. OBJECTIVE: The aim of the present work is to describe the PediaSuit ProtocolTM. METHODS: The authors team remained two months observing the care provided in a clinic with physical therapists trained by the PediaSuit ProtocolTM team (USA). RESULTS: The PediaSuitTM is a therapeutic protocol which uses a suit combined with intensive physical therapy and consists of up to four hours of therapy a day, five days a week, during three or four weeks. The PediaSuit ProtocolTM is customized to fit the needs of each child, with specific functional goals, and usually involves an intensive rehabilitation program. It combines the best elements of various techniques and methods, and has a sound rationale based on exercise physiology. CONCLUSION: This protocol anticipates results obtained only with long periods of conventional physical therapy.
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Bryant E, Pountney T, Williams H, Edelman N. Can a six-week exercise intervention improve gross motor function for non-ambulant children with cerebral palsy? A pilot randomized controlled trial. Clin Rehabil 2012; 27:150-9. [DOI: 10.1177/0269215512453061] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine the effect of a six-week exercise intervention on gross motor function for non-ambulant children with cerebral palsy. Design: A parallel arm randomized controlled trial. Setting: Four special schools. Participants: Thirty-five children aged 8–17 with bilateral cerebral palsy; Gross Motor Function Classification System levels IV–V. Method: Participants were randomly allocated to a static bike group, a treadmill group or control group. Participants in the bike and treadmill groups received exercise training sessions, three times weekly for six weeks. The control group received their usual care. Blinded assessments were performed at baseline and six weeks and followed up at 12 and 18 weeks. Outcome measures: Gross Motor Function Measures GMFM-66, GMFM-88D and GMFM-88E. Results: At six weeks significant differences were found in GMFM-88D scores between the bike group and the control group, and the treadmill group and the control group ( P < 0.05). The mean change (SD) in GMFM-88D score was 5.9 (6.8) for the bike group; 3.7 (4.4) for the treadmill group and 0.5 (1.9) for the control group. No significant differences were found for GMFM-66 or GMFM-88E scores between the bike group and control group, or the treadmill group and control group, although trends of improvement were observed for both exercise groups. The improvements observed declined during the follow-up period. Conclusion: This study provides preliminary evidence that exercising on a bike or treadmill may provide short-term improvements in gross motor function for non-ambulant children with cerebral palsy. This needs to be tested in a large-scale randomized trial.
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Affiliation(s)
- Elizabeth Bryant
- Chailey Heritage Clinical Services, Sussex Community NHS Trust, East Sussex, UK
- Clinical Research Centre for Health Professions, University of Brighton, East Sussex, UK
| | - Terry Pountney
- Chailey Heritage Clinical Services, Sussex Community NHS Trust, East Sussex, UK
- Clinical Research Centre for Health Professions, University of Brighton, East Sussex, UK
| | - Heather Williams
- Chailey Heritage Clinical Services, Sussex Community NHS Trust, East Sussex, UK
| | - Natalie Edelman
- Centre for Health Research, University of Brighton, Falmer, Brighton, East Sussex, UK
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Chen CL, Hong WH, Cheng HYK, Liaw MY, Chung CY, Chen CY. Muscle strength enhancement following home-based virtual cycling training in ambulatory children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1087-1094. [PMID: 22502833 DOI: 10.1016/j.ridd.2012.01.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 01/30/2012] [Indexed: 05/31/2023]
Abstract
This study is the first well-designed randomized controlled trial to assess the effects of a novel home-based virtual cycling training (hVCT) program for improving muscle strength in children with spastic cerebral palsy (CP). Twenty-eight ambulatory children with spastic CP aged 6-12 years were randomly assigned to an hVCT group (n=13) or a control group (n=15). Outcome measures, including gross motor function of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) and muscle strength (isokinetic torque of knee extensor and flexor muscle), were administered before and immediately after the 12-week intervention. Analysis of covariance (ANCOVA) at post-treatment showed that, compared to the control group, the hVCT group had significantly higher isokinetic torque in the knee extensor and flexor muscles at 60°/s and 120°/s angular velocities (p<0.05). At post-treatment, the hVCT group also showed greater isokinetic strength improvement in the knee flexor than in the knee extensor at 60°/s (knee flexor: 41%; knee extensor: 19%) and at 120°/s (knee flexor: 36%; knee extensor: 30%). However, the BOTMP scores at post-treatment did not differ between the two groups. Although the proposed 12-week hVCT protocol does not improve gross motor function, it enhances knee muscle strength in children with CP. The protocol obtains larger gains in the knee flexor than in the knee extensor at different angular velocities. The study findings will help clinicians to provide more effective and efficient strategies for muscle strength training in children with CP.
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Affiliation(s)
- Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5 Fu-Hsing St., Kwei-Shan, Tao-Yuan 333, Taiwan.
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Demuth SK, Knutson LM, Fowler EG. The PEDALS stationary cycling intervention and health-related quality of life in children with cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 2012; 54:654-61. [PMID: 22582760 DOI: 10.1111/j.1469-8749.2012.04321.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to assess health-related quality of life (HRQOL) following a stationary cycling intervention in children with cerebral palsy (CP). METHOD This was a phase I multisite randomized controlled trial with single blinding. HRQOL was evaluated using the Pediatric Quality of Life Inventory SF15 (PedsQL; children) and Pediatric Outcomes Data Collection Instrument (PODCI; parent proxy) before and after a 3-month stationary cycling intervention. Sixty-two children (29 male, 33 female; mean age 11y; range 7-18y) with spastic diplegic CP, classified as levels I to III on the Gross Motor Function Classification System, were enrolled. Paired and independent t-tests were used to evaluate within- and between-group differences respectively. RESULTS Between-group differences, favoring the cycling group, were found for PedsQL emotional functioning (p=0.046) and Parental PODCI treatment expectations scores (p=0.006). Between-group differences were not found for other scales. Within-group improvements were found in the cycling group: PedsQL total score (+5.8; p=0.006), psychosocial health summary (+6.9; p=0.008), and school functioning (+8.0; p=0.038). PODCI satisfaction with symptoms decreased significantly only in the control group (-12.0; p=0.046). INTERPRETATION A beneficial influence of exercise on pediatric emotional well-being and parental treatment expectations was found. The evidence was not strong for other aspects of HRQOL. Results support the positive relationship between physical fitness and emotional well-being in the general population. A child's perception is important when examining change in his or her emotional well-being due to intervention.
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Affiliation(s)
- Sharon K Demuth
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Taylor NF. Stationary cycling for children with cerebral palsy: does it get them anywhere? Dev Med Child Neurol 2012; 54:587-8. [PMID: 22607398 DOI: 10.1111/j.1469-8749.2012.04343.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nicholas F Taylor
- Department of Physiotherapy, La Trobe University, Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
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