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Dutia IM, Connick M, Beckman E, Johnston L, Wilson P, Macaro A, O'Sullivan J, Tweedy S. The power of Para sport: the effect of performance-focused swimming training on motor function in adolescents with cerebral palsy and high support needs (GMFCS IV) - a single-case experimental design with 30-month follow-up. Br J Sports Med 2024; 58:777-784. [PMID: 38729630 DOI: 10.1136/bjsports-2023-107689] [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] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study aims to evaluate the effect of a performance-focused swimming programme on motor function in previously untrained adolescents with cerebral palsy and high support needs (CPHSN) and to determine whether the motor decline typical of adolescents with CPHSN occurred in these swimmers. METHODS A Multiple-Baseline, Single-Case Experimental Design (MB-SCED) study comprising five phases and a 30-month follow-up was conducted. Participants were two males and one female, all aged 15 years, untrained and with CPHSN. The intervention was a 46-month swimming training programme, focused exclusively on improving performance. Outcomes were swim performance (velocity); training load (rating of perceived exertion min/week; swim distance/week) and Gross Motor Function Measure-66-Item Set (GMFM-66). MB-SCED data were analysed using interrupted time-series simulation analysis. Motor function over 46 months was modelled (generalised additive model) using GMFM-66 scores and compared with a model of predicted motor decline. RESULTS Improvements in GMFM-66 scores in response to training were significant (p<0.001), and two periods of training withdrawal each resulted in significant motor decline (p≤0.001). Participant motor function remained above baseline levels for the study duration, and, importantly, participants did not experience the motor decline typical of other adolescents with CPHSN. Weekly training volumes were also commensurate with WHO recommended physical activity levels. CONCLUSIONS Results suggest that adolescents with CPHSN who meet physical activity guidelines through participation in competitive swimming may prevent motor decline. However, this population is clinically complex, and in order to permit safe, effective participation in competitive sport, priority should be placed on the development of programmes delivered by skilled multiprofessional teams. TRIAL REGISTRATION NUMBER ACTRN12616000326493.
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Affiliation(s)
- Iain Mayank Dutia
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
- School of Allied Health, Australian Catholic University - Brisbane Campus, Banyo, Queensland, Australia
| | - Mark Connick
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Emma Beckman
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
| | - Leanne Johnston
- The University of Queensland School of Health and Rehabilitation Sciences, Saint Lucia, Queensland, Australia
| | - Paula Wilson
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
| | - Angelo Macaro
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
| | - Jennifer O'Sullivan
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
| | - Sean Tweedy
- The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
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Testani D, McMorris CA, Clark CA, Sanguino H, Condliffe EG, Noel ME, Kopala Sibley DC, Brunton LK. Investigating physiological symptoms associated with mental health symptoms in youth with cerebral palsy: An observational study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 151:104783. [PMID: 38924954 DOI: 10.1016/j.ridd.2024.104783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/29/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
Over 50 % of children and youth with cerebral palsy (CP) experience mental health challenges, with anxiety and depression most common. Youth with CP also experience several physiological symptoms such as fatigue, pain, sedentary lifestyle, and sleep disturbances that impact their daily living; however, little is known about the impact of these symptoms on mental health outcomes in these youth. This study addressed this gap and examined the individual and cumulative impacts of physiological symptoms on anxiety and depression symptoms in youth with CP. Forty youth with CP aged 8 to 18 years, and their caregiver, participated in this cross-sectional observational study. Pain, fatigue, anxiety, and depressive symptoms were measured using caregiver- and self-reported questionnaires and participants wore accelerometers for seven consecutive days, providing non-invasive physical activity and sleep pattern data. Youth with CP experienced substantial physiological symptoms and elevated anxiety and depression symptoms. Linear regression models determined that all physiological factors were predictive of caregiver-reported youth anxiety (R2 = 0.23) and youth depressive symptoms (R2 = 0.48). Fatigue, pain severity, sleep efficiency, and physical activity outcomes individually and cumulatively contributed to caregiver-reported youth anxiety and depression symptoms. These findings highlight the important role of physiological symptoms as potential risk factors and potential targets for intervention for mental health issues for in youth with CP.
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Affiliation(s)
- D Testani
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - C A McMorris
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute & Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - C A Clark
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute & Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - H Sanguino
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute & Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - E G Condliffe
- Alberta Children's Hospital Research Institute & Hotchkiss Brain Institute, Calgary, Alberta, Canada; Departments of Clinical Neurosciences & Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - M E Noel
- Alberta Children's Hospital Research Institute & Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - D C Kopala Sibley
- Alberta Children's Hospital Research Institute & Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - L K Brunton
- School of Physical Therapy, Western University, London, Ontario, Canada; CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada.
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Petersen BA, Erickson KI, Kurowski BG, Boninger ML, Treble-Barna A. Emerging methods for measuring physical activity using accelerometry in children and adolescents with neuromotor disorders: a narrative review. J Neuroeng Rehabil 2024; 21:31. [PMID: 38419099 PMCID: PMC10903036 DOI: 10.1186/s12984-024-01327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Children and adolescents with neuromotor disorders need regular physical activity to maintain optimal health and functional independence throughout their development. To this end, reliable measures of physical activity are integral to both assessing habitual physical activity and testing the efficacy of the many interventions designed to increase physical activity in these children. Wearable accelerometers have been used for children with neuromotor disorders for decades; however, studies most often use disorder-specific cut points to categorize physical activity intensity, which lack generalizability to a free-living environment. No reviews of accelerometer data processing methods have discussed the novel use of machine learning techniques for monitoring physical activity in children with neuromotor disorders. METHODS In this narrative review, we discuss traditional measures of physical activity (including questionnaires and objective accelerometry measures), the limitations of standard analysis for accelerometry in this unique population, and the potential benefits of applying machine learning approaches. We also provide recommendations for using machine learning approaches to monitor physical activity. CONCLUSIONS While wearable accelerometers provided a much-needed method to quantify physical activity, standard cut point analyses have limitations in children with neuromotor disorders. Machine learning models are a more robust method of analyzing accelerometer data in pediatric neuromotor disorders and using these methods over disorder-specific cut points is likely to improve accuracy of classifying both type and intensity of physical activity. Notably, there remains a critical need for further development of classifiers for children with more severe motor impairments, preschool aged children, and children in hospital settings.
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Affiliation(s)
- Bailey A Petersen
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Kirk I Erickson
- AdventHealth Research Institute Department of Neuroscience, AdventHealth, Orlando, FL, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brad G Kurowski
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - M L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - A Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Fonvig CE, Troelsen J, Holsgaard-Larsen A. Recreational screen time behaviour among ambulatory children and adolescents diagnosed with cerebral palsy: A cross-sectional analysis. Child Care Health Dev 2024; 50:e13221. [PMID: 38265132 DOI: 10.1111/cch.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/25/2024]
Abstract
AIM To describe the recreational screen time behaviour of 8-16-year-olds diagnosed with cerebral palsy (CP) and explore associations between health-related quality of life, sleep duration and physical activity behaviour versus screen time. METHODS This cross-sectional study used proxy-reported questionnaire data of 381 ambulatory (with or without assistance) 8-16-year-olds diagnosed with CP corresponding to Gross Motor Function Classification System (GMFCS) levels I-III. Descriptive statistics were used to report age, sex and the GMFCS level. The potential associations of health-related quality of life, physical activity behaviour and sleep duration (dependent variables) versus screen time (independent variable) were determined using multiple linear regression. Health-related quality of life was evaluated using the Pediatric Quality of Life Inventory, including seven dimensions: Daily Activities; School Activities; Movement and Balance; Pain and Hurt; Fatigue; Eating Activities; and Speech and Communication. RESULTS The participants spent a median screen time of 3.9 h daily. The boys spent a longer screen time during weekends than the girls (p = 0.003). Boys spent more time on games (p < 0.001), whereas girls spent more time on social media and video calls (p < 0.001). Increasing age (p < 0.001) was associated with increased screen time but did not differ between the GMFCS levels. Sleep duration, perceived fatigue and perceived movement and balance correlated negatively with screen time. CONCLUSION This study sheds light on the recreational screen time habits of ambulatory children and adolescents diagnosed with CP. Further investigation into the observed associations is warranted to investigate potential causation and relationships between sleep behaviour, quality of life and screen time behaviour.
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Affiliation(s)
- Christina Esmann Fonvig
- The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
| | - Jens Troelsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anders Holsgaard-Larsen
- The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
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Janzen L, Toomey CM, Brunton LK, Condliffe EG, Esau S, Kirton A, Emery CA, Kuntze G. Physical Activity Levels and Adiposity in Ambulant Children and Adolescents With Cerebral Palsy Compared With Their Typically Developing Peers. Pediatr Exerc Sci 2023; 35:225-231. [PMID: 36944367 DOI: 10.1123/pes.2022-0064] [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: 05/17/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 03/23/2023]
Abstract
PURPOSE This study assessed physical activity (PA) and body composition of ambulatory children and adolescents with cerebral palsy (CP) and their typically developing peers. METHODS Participants included youth with CP (ages 8-18 y and Gross Motor Function Classification System [GMFCS] levels I-III) and their typically developing peers. Outcomes included PA (actigraphy) and fat/lean mass index (FMI/LMI; dual-energy X-ray absorptiometry). Statistical analyses included linear mixed effects models with Bonferroni adjustment. Fixed effects were study group (CP and typically developing); random effects were participant clusters (sex and age). Exploratory analyses included association of body composition and PA, GMFCS level, and CP involvement (unilateral and bilateral). RESULTS Seventy-eight participants (CP: n = 40, girls: n = 29; GMFCS I: n = 20; GMFCS II: n = 14; GMFCS III: n = 6) met inclusion criteria. Individuals with CP had lower moderate to vigorous PA (MVPA; β = -12.5; 98.3% confidence interval, -22.6 to -2.5 min; P = .004) and lower LMI (β = -1.1; 97.5% confidence interval, -2.1 to -0.0 kg/m2; P = .020). Exploratory analyses indicated increased LMI with greater MVPA (P = .001), reduced MVPA for GMFCS II (P = .005) and III (P = .001), increased sedentary time for GMFCS III (P = .006), and greater fat mass index with unilateral motor impairment (P = .026). CONCLUSIONS The findings contribute to the knowledge base of increasing MVPA and LMI deficits with the greater functional impact of CP. Associations of increasing LMI with greater MVPA support efforts targeting enhanced PA participation to promote independent mobility.
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Affiliation(s)
- Leticia Janzen
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB,Canada
- Vi Riddell Pediatric Rehabilitation Research Program, Alberta Children's Hospital Research Institute, Calgary, AB,Canada
| | - Clodagh M Toomey
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB,Canada
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick,Ireland
| | - Laura K Brunton
- School of Physical Therapy, Western University, London, ON,Canada
| | - Elizabeth G Condliffe
- Vi Riddell Pediatric Rehabilitation Research Program, Alberta Children's Hospital Research Institute, Calgary, AB,Canada
- Departments of Clinical Neurosciences and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB,Canada
| | - Shane Esau
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB,Canada
- Vi Riddell Pediatric Rehabilitation Research Program, Alberta Children's Hospital Research Institute, Calgary, AB,Canada
| | - Adam Kirton
- Vi Riddell Pediatric Rehabilitation Research Program, Alberta Children's Hospital Research Institute, Calgary, AB,Canada
- Departments of Clinical Neurosciences and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB,Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB,Canada
- Vi Riddell Pediatric Rehabilitation Research Program, Alberta Children's Hospital Research Institute, Calgary, AB,Canada
- Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB,Canada
| | - Gregor Kuntze
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB,Canada
- Vi Riddell Pediatric Rehabilitation Research Program, Alberta Children's Hospital Research Institute, Calgary, AB,Canada
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Folostina R, Iacob CI, Syriopoulou-Delli CK. Physical activity, sedentary behaviour and quality of life in children with autism: insights from Romania and Greece. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:432-441. [PMID: 37213593 PMCID: PMC10198000 DOI: 10.1080/20473869.2023.2204574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/15/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023]
Abstract
Background The COVID-19 pandemic has accentuated sedentarism in children, including those with autism. Given the importance of the topic for long-term health, this study aimed to explore the post-pandemic relationship between physical activity, sedentary behaviours and quality of life (QOL) in children with autism from Romania and Greece. Methods An online questionnaire collected information regarding physical activity levels in children and their parents, children's sedentary behaviours and QOL from 83 Romanian parents (m1age = 40.1; sd1age = 6.37) and 42 Greek parents (m2age = 39.5; sd2age = 5.45) between March and July 2022. Results Most Greek children (95%) had 2 or 3 weekly hours of physical education at school/kindergarten, while only 64% of Romanian children had the same level of physical education. Romanian parents reported being more active (χ2weekdays= 33.7, df = 3, p < .001; (χ2leisure= 41.8, df = 2, p < .001) than the Greek counterparts. Contrary to expectations, the parents' physical activity did not correlate with the child's physical activity. Sedentary behaviour time was significantly higher in Greek than Romanian children during working days and the weekends. Sedentary behaviour during weekdays predicted the child' QOL. Conclusions This exploratory study offers insight into Romanian and Greek children's patterns of physical and sedentary activities. The results stress the need to increase physical activity and decrease sedentary behaviours in children with autism from Romania and Greece. The practical implications and limits of this exploratory approach were further discussed.
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Affiliation(s)
- Ruxandra Folostina
- Department of Special Education, University of Bucharest, Bucharest, Romania
| | - Claudia Iuliana Iacob
- Department of Applied Psychology and Psychotherapy, University of Bucharest, Bucharest, Romania
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Whitney DG. 5-year risk of “adult-onset” chronic diseases during childhood and adolescent transitioning for individuals with cerebral palsy. Prev Med Rep 2022; 29:101933. [PMID: 35928595 PMCID: PMC9344024 DOI: 10.1016/j.pmedr.2022.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 12/01/2022] Open
Abstract
“Adult-onset” chronic diseases may begin in childhood for individuals with CP. 5-year disease risk was < 64.3-fold higher for < 1–13 year olds with vs without CP. 5-year chronic disease risks were elevated for CP across all developmental stages. Patient factors impacted disease risk variably for children with CP. Findings may inform when to implement prevention efforts and who is more at-risk.
Epidemiologic evidence documenting risk of chronic diseases as children with cerebral palsy age throughout growth is lacking to inform prevention strategies. The objective was to characterize the 5-year risk of chronic diseases that are typically associated with advanced aging among < 1–13 year olds with cerebral palsy and effects by patient-level factors. This retrospective cohort study used nationwide commercial administrative claims from 01/01/2001–12/31/2018 from children < 1–13 years old with ≥ 5 years of mostly continuous insurance enrollment. The 5-year risk of chronic diseases was examined for the entire cohort with and without cerebral palsy and then by baseline age group (<1–2, 3–5, 6–8, 9–11, 12–13 years old), including cardiorespiratory, metabolic, kidney, and liver diseases, cancer, depression, and osteoarthritis. For cerebral palsy, the association between 5-year chronic disease rate and patient-level factors was assessed using Cox regression. Children with (n = 5,559) vs without (n = 2.3 million) cerebral palsy had a higher 5-year risk of all chronic diseases when comparing the entire cohorts (relative risk, 1.19 to 64.26, all P < 0.05) and most chronic diseases when comparing cohorts for each age group. Among children with cerebral palsy, there were effects by gender, co-occurring intellectual disabilities and/or epilepsy, and wheelchair use for some chronic diseases, which can help to identify at-risk children. This study provides novel epidemiologic evidence of 5-year risk of “adult-onset” chronic diseases for children with cerebral palsy during important developmental stages, and associated patient-level factors (to enhance clinical detection). Findings may inform when to implement prevention strategies and who may be more at risk.
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8
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McPhee PG, Benner JL, Sanvido L, Roebroeck ME, van den Berg-Emons RJ, van der Slot WM, Verschuren O, Hurvitz EA, Peterson MD, Gorter JW. A core outcome set for multimorbidity risk in individuals with cerebral palsy. Dev Med Child Neurol 2022; 64:881-889. [PMID: 35174883 DOI: 10.1111/dmcn.15181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Abstract
AIM To: (1) investigate the importance of outcome measurement instruments (OMIs) within a core outcome set (COS) for multimorbidity (at least two chronic health conditions) risk in individuals with cerebral palsy (CP); (2) investigate the feasibility of OMIs within the COS in international clinical research settings in adolescents and adults with CP; and (3) describe the associations between the COS data and Gross Motor Function Classification System (GMFCS) levels. METHOD Eighty-three individuals with CP completed a survey on health outcomes: physical behaviour, nutrition, sleep, endurance, body composition, blood pressure, blood lipids, and glucose. A cross-sectional study assessed the feasibility of the COS in 67 adolescents and adults with CP (mean age 30y, SD 15y 1mo, min-max: 14-68y, 52.2% male) at four centres. Prevalence of multimorbidity risk and associations with GMFCS levels are described. RESULTS Most participants rated physical behaviour, nutrition, sleep, and endurance as very important. Body composition, blood pressure, nutrition, and sleep were highly feasible since data were collected in 88% or more participants who consented to having the assessments. Physical behaviour, cardiorespiratory endurance, and blood draws were collected in less than 60% of participants. Total time sedentary (ρ=0.53, p<0.01) and endurance (ρ=-0.46, p<0.01) were significantly associated with GMFCS level. INTERPRETATION The COS identified that most participants had poor sleep quality and endurance, did not have healthy diets, and showed increased sedentary behaviour. Individuals with CP valued these outcomes as most important, suggesting a need to assess these modifiable behaviours in this population. Objective measures of physical behaviour and cardiorespiratory endurance in the COS required additional personnel, time, and participant burden. We recommend that healthcare providers should perform a simpler first screen using questionnaire-based assessments and then focus the use of the remainder of the COS if required for the patient.
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Affiliation(s)
- Patrick G McPhee
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Joyce L Benner
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Liam Sanvido
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Rita J van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Wilma M van der Slot
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Olaf Verschuren
- Brain Center Rudolph Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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Dayanidhi S. Skeletal Muscle Mitochondrial Physiology in Children With Cerebral Palsy: Considerations for Healthy Aging. Front Neurol 2021; 12:735009. [PMID: 34589051 PMCID: PMC8473886 DOI: 10.3389/fneur.2021.735009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Skeletal muscle contractile proteins require a constant supply of energy to produce force needed for movement. Energy (ATP) is primarily produced by mitochondrial organelles, located within and around muscle fibers, by oxidative phosphorylation that couples electron flux through the electron transport chain to create a proton gradient across the inner mitochondrial membrane that is in turn used by the ATP synthase. Mitochondrial networks increase in size by biogenesis to increase mitochondrial abundance and activity in response to endurance exercise, while their function and content reduce with constant inactivity, such as during muscle atrophy. During healthy aging, there is an overall decline in mitochondrial activity and abundance, increase in mitochondrial DNA mutations, potential increase in oxidative stress, and reduction in overall muscular capacity. Many of these alterations can be attenuated by consistent endurance exercise. Children with cerebral palsy (CP) have significantly increased energetics of movement, reduced endurance capacity, and increased perceived effort. Recent work in leg muscles in ambulatory children with CP show a marked reduction in mitochondrial function. Arm muscles show that mitochondrial protein content and mitochondria DNA copy number are lower, suggesting a reduction in mitochondrial abundance, along with a reduction in markers for mitochondrial biogenesis. Gene expression networks are reduced for glycolytic and mitochondrial pathways and share similarities with gene networks with aging and chronic inactivity. Given the importance of mitochondria for energy production and changes with aging, future work needs to assess changes in mitochondria across the lifespan in people with CP and the effect of exercise on promoting metabolic health.
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Affiliation(s)
- Sudarshan Dayanidhi
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation and Physical Therapy and Human Movement Science, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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10
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Rutka M, Adamczyk WM, Linek P. Effects of Physical Therapist Intervention on Pulmonary Function in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6275368. [PMID: 33989407 DOI: 10.1093/ptj/pzab129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/12/2021] [Accepted: 03/28/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of physical therapy on pulmonary function and respiratory muscle strength in children with cerebral palsy (CP). METHODS A search of 10 databases was conducted for this systematic review. Initially, there were no language, study design, or time frame restrictions. All studies assessing the effect of physical therapy on the respiratory system in children with CP were included. Two reviewers independently extracted and documented data. The data extracted included description of the intervention (duration, therapeutic method) and study results (change of spirometric parameters, respiratory muscle strength). The effects of physical therapist treatment were calculated using software. RESULTS A total of 269 children aged 5 to 18 years from 10 studies were included. The included studies consisted of 5 different therapeutic methods (inspiratory muscle training [IMT], aerobic training, swimming, respiratory exercise, exercise with elastic bands). Physical therapist intervention led to a significant increase in the maximal expiratory pressure (MEP) (I2 = 0%), peak expiratory flow (I2 = 0%), and maximum oxygen consumption (I2 = 37%). A separate analysis of the most frequently used therapy (IMT) showed a positive effect on MEP (I2 = 0%) and maximal inspiratory pressure (I2 = 35%). CONCLUSION Various forms of physical therapy have potential to demonstrate a positive effect on maximal inspiratory pressure, MEP, and peak expiratory flow in children with CP. There is no possibility to recommend the best method and duration of the physical therapy; however, it can be suggested that physical therapy should be applied for at least 4 weeks and include IMT. IMPACT CP is one of the most common causes of physical disabilities in children, and pulmonary dysfunction is the leading cause of death in people with CP. Thus, it is warranted to seek different approaches that may improve pulmonary function in people with CP. This review has shown that various forms of physical therapy have potential to improve the pulmonary function of children with CP.
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Affiliation(s)
- Magdalena Rutka
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | - Waclaw M Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland.,Department of Physiotherapy, Institute of Health Sciences, Pain and Exercise, Research Luebeck (P.E.R.L.), University of Luebeck, Luebeck,Germany
| | - Paweł Linek
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
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Xiong JSP, Reedman SE, Kho ME, Timmons BW, Verschuren O, Gorter JW. Operationalization, measurement, and health indicators of sedentary behavior in individuals with cerebral palsy: a scoping review. Disabil Rehabil 2021; 44:6070-6081. [PMID: 34334077 DOI: 10.1080/09638288.2021.1949050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the operationalization and measurement of sedentary behavior (SB) in individuals with cerebral palsy (CP). MATERIALS AND METHODS We searched five databases from 2011 to 2020 for primary studies of experimental, qualitative, longitudinal, or observational designs measuring SB or postures typically characterized as sedentary (sitting, reclining, lying). RESULTS We screened 1112 citations and selected 47 studies. SB was operationalized through muscle activation, energy expenditure or oxygen consumption in typically sedentary postures (n = 9), and through thresholds and postures used by accelerometers, activity monitors, and a questionnaire to measure time spent in SB (n = 25). Seven out of the eight studies that measured energy expenditure found ≤1.5 metabolic equivalents of task (METs) for sitting and lying. While different accelerometer thresholds were used to measure SB, the behavior (SB) was consistently operationalized as sitting and lying. Little consistency existed in the subpopulation, instruments and cut-points for studies on validity or reliability of tools for measuring SB (n = 19). CONCLUSIONS Sitting and lying are considered sedentary postures, which is defined as ≤1.5 METs in individuals with CP. There is variability in the tools used to measure SB in individuals with CP. Therefore, consensus on the definition and reporting of SB is needed.Implications for rehabilitationAlthough sedentary behavior (SB) is increased in individuals with cerebral palsy (CP) compared to the typically developing population, there is no standard definition for SB for these individuals; this makes it difficult to synthesize data across studies.Sitting and lying are ≤1.5 METs in individuals with CP, suggesting we only need to measure posture to show change in SB.The commonly used accelerometer cut-point in the typically developing population of ≤100 counts per minute generally has excellent reliability across multiple devices in ambulatory children with CP.
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Affiliation(s)
- Julia Shi-Peng Xiong
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Canada
| | - Sarah E Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Michelle E Kho
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Canada.,Department of Physiotherapy, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Brian W Timmons
- Department of Pediatrics, Child Health and Exercise Medicine Program, McMaster University, Hamilton, Canada.,Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine, Utrecht University, Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Jan Willem Gorter
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Canada.,Department of Pediatrics, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,Department of Pediatrics, McMaster University, Hamilton, Canada
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12
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Valencia-Peris A, Lizandra J, Moya-Mata I, Gómez-Gonzalvo F, Castillo-Corullón S, Escribano A. Comparison of Physical Activity and Sedentary Behaviour between Schoolchildren with Cystic Fibrosis and Healthy Controls: A Gender Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105375. [PMID: 34070042 PMCID: PMC8158139 DOI: 10.3390/ijerph18105375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 01/18/2023]
Abstract
The purpose of this study was to examine differences in sports participation and the levels of physical activity (PA) and sedentary behaviour (SB) between schoolchildren with cystic fibrosis (CF) and a healthy control group (CG) taking into account the gender variable. PA and SB were measured with an accelerometer for 7 consecutive days in 44 children (24 girls; 11.0 (3.2) years) with CF and 45 age-, sex-, and socioeconomic status-matched controls (24 girls; 11.1 (3.0) years). CF patients and CG did not differ in moderate-to-vigorous PA (54 (31) vs. 59 (27) min/day respectively) or in SB (558 (106) vs. 553 (92) min/day respectively). There were no differences in meeting the PA guidelines between both groups (CF: 36.4% vs. CG: 42.4%). Gender analysis revealed that boys were more active and met more PA guidelines than girls regardless of the group (CF or CG), girls with CF being the least active group (only 16.7% met PA guidelines). A possible compensatory effect was found between SB and PA only in the CF sample, as for each minute/day spent in SB the odds of meeting PA guidelines decreased by 34%. These findings suggest that promoting a reduction in SB is as important as promoting PA in the CF population, especially in girls. Health caregivers, coaches, teachers, or parents could offer appealing supervised and unsupervised physical activities, foster the adoption of active lifestyles, or incorporate PA into daily routines to improve the health of CF schoolchildren.
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Affiliation(s)
- Alexandra Valencia-Peris
- Department of Teaching of Musical, Visual and Corporal Expression, University of Valencia, 46022 Valencia, Spain; (J.L.); (I.M.-M.)
- Correspondence: ; Tel.: +34-963828920
| | - Jorge Lizandra
- Department of Teaching of Musical, Visual and Corporal Expression, University of Valencia, 46022 Valencia, Spain; (J.L.); (I.M.-M.)
| | - Irene Moya-Mata
- Department of Teaching of Musical, Visual and Corporal Expression, University of Valencia, 46022 Valencia, Spain; (J.L.); (I.M.-M.)
| | | | - Silvia Castillo-Corullón
- Pediatric Pulmonology Unit, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.C.-C.); (A.E.)
| | - Amparo Escribano
- Pediatric Pulmonology Unit, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.C.-C.); (A.E.)
- Department of Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain
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13
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Hammam N, Becher H, Andersen J, Manns PJ, Whittaker JL, Pritchard L. Early indicators of cardiovascular disease are evident in children and adolescents with cerebral palsy. Disabil Health J 2021; 14:101112. [PMID: 34016565 DOI: 10.1016/j.dhjo.2021.101112] [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] [Received: 01/11/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of early mortality among young adults with cerebral palsy. While low physical activity in childhood has been hypothesized as a potential contributor to increased CVD risk in early adulthood, little is known about timing of vascular disease progression and the presence of subclinical atherosclerosis has not been extensively evaluated in children with cerebral palsy. OBJECTIVE The aim of this study was to determine if measures of vascular structure and function are different between children and adolescents with and without cerebral palsy. METHODS In this cross-sectional study, we measured carotid intima-media thickness (CIMT), and brachial artery flow-mediated dilation (FMD) of children with and without cerebral palsy. Group means for CIMT and brachial artery FMD absolute (FMDA) and percent of relative change (FMDR%) were compared using Wilcoxon rank-sum tests. RESULTS A total of 26 children and adolescents with cerebral palsy (46.1% girls, mean age = 15.0 ± 2.0 years) and 19 controls (68.4% girls, mean age = 13.3 ± 2.6 years) participated. Children with cerebral palsy had significantly greater average CIMT (0.43 ± 0.02 mm) than children without cerebral palsy (0.41 ± 0.01 mm, p = 0.04), and lower FMDA (0.16 ± 0.15 mm vs. 0.29 ± 0.20 mm; respectively, p = 0.03). CONCLUSIONS Children and adolescents with cerebral palsy may exhibit impairments in vascular structure and function which represent an increased risk of premature atherosclerosis compared to children without cerebral palsy. Additional research to identify risk factors specific to children with cerebral palsy that would support the development of effective screening processes for early identification would enable clinicians to implement targeted preventive strategies.
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Affiliation(s)
- Nevin Hammam
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Rheumatology, University of California San Francisco, CA, USA
| | - Harald Becher
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada; Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - John Andersen
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada
| | - Lesley Pritchard
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
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14
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Reedman SE, Boyd RN, Ziviani J, Elliott C, Ware RS, Sakzewski L. Participation predictors for leisure-time physical activity intervention in children with cerebral palsy. Dev Med Child Neurol 2021; 63:566-575. [PMID: 33386633 DOI: 10.1111/dmcn.14796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
AIM To determine the predictors of magnitude of change in response to a participation-focused leisure-time physical activity intervention in children with cerebral palsy (CP) using the ParticiPAte CP protocol. METHOD We included 33 children (16 males, 17 females) aged 8 to 12 years (mean age=10y, SD=1y 6mo) with CP with pre/postintervention data from a wait-list randomized trial. The hypothesized linear predictors of change in primary outcomes (Canadian Occupational Performance Measure [COPM]-performance and COPM-satisfaction, Belief in Goal Self-Competence Scale (BiGSS), and minutes per day moderate-to-vigorous physical activity [MVPA]) were: age; Gross Motor Function Classification System level; comorbid autism spectrum disorder (ASD); Goal Attainment Scaling T score; Problems in Schools Questionnaire; Physical Activity Climate Questionnaire; Motives for Physical Activities Measure-Revised; and stage of behaviour change. Multivariable models were selected using the Bayesian information criterion. RESULTS Overcoming barriers to participation, age, and comorbid ASD explained 49% of the variance in change in COPM-performance. Being motivated by interest and/or enjoyment and age explained 32% of the variance in change in COPM-satisfaction. Being motivated by physical activity competence or appearance (extrinsic motivation) explained 24% of the variance in change in BiGSS. Parental autonomy supportiveness, overcoming barriers to participation, appearance motivation, and baseline MVPA explained 59% of the variance in change in MVPA. INTERPRETATION These findings support a behaviour paradigm for conceptualizing physical activity in children with CP. WHAT THIS PAPER ADDS Children who met their treatment goals showed a greater increase in physical activity participation. Children who were more intrinsically motivated by physical activity at baseline improved more. Being older and having a comorbid diagnosis of autism spectrum disorder were associated with an attenuated effect of the therapy.
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Affiliation(s)
- Sarah E Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Catherine Elliott
- Faculty of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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15
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Hornáček K, Kujawa J, Varela Donoso E, Dincer F, Ilieva E, Takáč P, Petronic Markovic I, Votava J, Vetra A, Nikolic D, Christodoulou N, Zampolini M, Kiekens C. Evidence Based Position Paper on Physical and Rehabilitation Medicine professional practice for persons with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:1020-1035. [PMID: 33861040 DOI: 10.23736/s1973-9087.21.06983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. AIM The aim of this study was to improve Physical and Rehabilitation Medicine physician´s professional practice for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. MATERIAL AND METHODS A systematic review of the literature including an eighteen-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. RESULTS As the result of a Consensus Delphi procedure process 74 recommendations are presented together with the systematic literature review. CONCLUSIONS The PRM physician´s role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM programme developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients´ health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions.
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Affiliation(s)
- Karol Hornáček
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Jolanta Kujawa
- Department of Physical and Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University of School of Medicine, Madrid, Spain
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Peter Takáč
- Department of Physical and Rehabilitation Medicine, L. Pasteur University Hospital, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic -
| | - Ivana Petronic Markovic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jiří Votava
- Faculty of Health Studies, University of J. E. Purkyně, Ústí nad Labem, Czech Republic
| | - Anita Vetra
- Rehabilitation Department, Riga Stradins University, Riga, Latvia
| | - Dejan Nikolic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Zampolini
- Department of Rehabilitation, Foligno Hospital, USL Umbria 2, Perugia, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola Bologna, Italy
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16
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Bailes AF, Greve K, Long J, Kurowski BG, Vargus-Adams J, Aronow B, Mitelpunkt A. Describing the Delivery of Evidence-Based Physical Therapy Intervention to Individuals With Cerebral Palsy. Pediatr Phys Ther 2021; 33:65-72. [PMID: 33770793 PMCID: PMC10141519 DOI: 10.1097/pep.0000000000000783] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize by evidence grades and examine variation in type of physical therapy intervention delivered in routine clinical care in individuals with cerebral palsy (CP). METHODS Retrospective data collection from the electronic record over 1 year at a tertiary care pediatric outpatient therapy division. RESULTS Four hundred sixty-five individuals with CP received 28 344 interventions during 4335 treatment visits. Sixty-six percent of interventions were evidence-based interventions (EBIs). Significant variation was demonstrated across Gross Motor Function Classification System levels, with children classified as level V receiving the least and level III the most. The most frequent EBIs delivered were caregiver education, motor control, functional strengthening, ankle-foot orthoses, treadmill training, and fit of adaptive equipment. CONCLUSIONS Further work is needed to determine whether amount of EBI is related to better outcomes. Combining this information with other aspects of dose (intensity, time, and frequency) may elucidate the contribution of each with outcomes.
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Affiliation(s)
- Amy F Bailes
- Division of Occupational Therapy and Physical Therapy (Drs Bailes, Greve, and Long), Division of Orthopaedic Surgery Motion Analysis Laboratory (Dr Long), and Division of Biomedical Informatics (Drs Aronow and Mitelpunkt), Cincinnati Children's Hospital, Cincinnati, Ohio; Department of Rehabilitation Science (Dr Bailes), University of Cincinnati, Cincinnati, Ohio; Division of Pediatric Rehabilitation Medicine (Drs Kurowski and Vargus-Adams), Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Sackler Faculty of Medicine (Dr Mitelpunkt), Tel Aviv University, Tel Aviv, Israel
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17
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Lai B, Lee E, Kim Y, Matthews C, Swanson-Kimani E, Davis D, Vogtle L, Rimmer JH. Leisure-time physical activity interventions for children and adults with cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:162-171. [PMID: 33241561 DOI: 10.1111/dmcn.14751] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/08/2023]
Abstract
AIM To summarize current evidence on the effects and reach of leisure-time physical activity (LTPA) interventions among children and adults with cerebral palsy (CP). METHOD Systematic searches were conducted in PubMed, CINAHL, and Google Scholar to identify randomized controlled trials (RCTs) of LTPA interventions in CP. Data from eligible studies were extracted for qualitative synthesis. RESULTS Forty-nine studies enrolled a total of 1513 participants (mean [SD] age 13y [7y], range 5-43y; 818 males, 655 females, 40 not reported) and primarily included ambulatory children. RCTs underrepresented adults and people in Gross Motor Function Classification System (GMFCS) levels IV and V. Forty-one studies reported at least one favorable benefit from LTPA. Benefits included improvements to musculoskeletal strength, cardiorespiratory fitness, quality of life, spasticity, participation, and core aspects of physical function. Regarding reach, only 34% of people that were contacted to participate enrolled within a study. A smaller percentage of participants dropped out from intervention (8%) and follow-up periods (3%). INTERPRETATION Study findings highlight effective interventions to improve health, fitness, and function. To enhance the reach and generalizability of LTPA trials for CP, future studies should examine how to increase study sample sizes and aim to include a better representation of adults and people in GMFCS levels IV and V. WHAT THIS PAPER ADDS People with cerebral palsy (CP) may experience improvements in health, fitness, and physical function from leisure-time physical activity (LTPA) interventions. Effective interventions include exercise training, active video games, recreation activities, behavioral coaching, and motor skills training. Interventions that incorporate telehealth technology, behavioral coaching, and community resources may enhance LTPA. Interventions primarily include children in Gross Motor Functional Classification System (GMFCS) levels I to III. Adults, wheelchair users, and those in GMFCS levels IV and V are underrepresented.
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Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eunbi Lee
- The Rehabilitation Science Program, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yumi Kim
- The Rehabilitation Science Program, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Coke Matthews
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VI, USA
| | - Erin Swanson-Kimani
- Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Drew Davis
- Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Vogtle
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James H Rimmer
- School of Health Professions, Dean's Office, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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O'Sullivan R, French HP, Van Rossom S, Jonkers I, Horgan F. The association between gait analysis measures associated with crouch gait, functional health status and daily activity levels in cerebral palsy. J Pediatr Rehabil Med 2021; 14:227-235. [PMID: 33896854 DOI: 10.3233/prm-200676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to examine the relationship between gait analysis measures associated with crouch gait, functional health status and daily activity in ambulant cerebral palsy (CP). METHODS Three-dimensional gait analysis was carried out on 35 ambulant participants with bilateral CP crouch gait (knee flexion at mid-stance (KFMS) ⩾ 190). KFMS, knee-flexion at initial contact, gait speed and step-lengths were extracted for analysis. Steps/day and sedentary time/day were assessed using an ActivPAL accelerometer. Functional health status was assessed using the five relevant domains of the Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire. Associations between variables were assessed with correlation coefficients and multivariable linear regression. RESULTS There were no significant correlations between KFMS and PODCI domains (ρ=-0.008-0.110) or daily activity (ρ=-0.297-0.237) variables. In contrast, multivariable analysis found that step-length was independently associated with the Sports and Physical Function (p= 0.030), Transfers and Basic Mobility (p= 0.041) and Global Function (< 0.001) domains of the PODCI assessment. Gait speed was independently associated with mean steps/day (p< 0.001). CONCLUSIONS Step length and gait speed are more strongly associated with functional health status and daily activity than knee flexion during stance in children and adolescents with CP crouch gait.
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Affiliation(s)
- Rory O'Sullivan
- Gait Analysis Laboratory, Central Remedial Clinic, Dublin, Ireland.,School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sam Van Rossom
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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19
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D'Souza A, Bolsterlee B, Lancaster A, Herbert RD. Intramuscular fat in children with unilateral cerebral palsy. Clin Biomech (Bristol, Avon) 2020; 80:105183. [PMID: 33096341 DOI: 10.1016/j.clinbiomech.2020.105183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/18/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many children with cerebral palsy develop muscle contractures. The mechanisms of contracture are not well understood. We investigated the possibility that, because fat is stiffer than passive muscle, elevated intramuscular fat contributes to contracture. In this cross-sectional study, we compared the quantity and distribution of intramuscular fat in muscles from typically developing children and children with cerebral palsy who have contractures. METHODS mDixon magnetic resonance images were obtained from the legs of 20 ambulant children with unilateral spastic cerebral palsy who had ankle contractures (mean age 11 SD 3 years, 13 male, mean moderate level contracture) and 20 typically developing children (mean age 11 SD 4 years, 13 male). The images were analyzed to quantify the intramuscular fat fraction of the medial gastrocnemius muscles. The amount and distribution of intramuscular fat were compared between muscles of children with cerebral palsy and typically developing children. FINDINGS In typically developing children, the medial gastrocnemius muscles had a mean intramuscular fat fraction of 4.7% (SD 1.6%). In children with cerebral palsy, the mean intramuscular fat fractions in the more- and less-affected medial gastrocnemius muscle were 11.4% (8.1%) and 6.9% (3.4%) respectively. There were small but statistically significant regional differences in the distribution of intramuscular fat. There was no evidence of a relationship between intramuscular fat fraction and severity of contracture. INTERPRETATION Children with cerebral palsy have higher proportions of intramuscular fat than typically developing children. There is no clear relationship between intramuscular fat fraction and dorsiflexion range of motion in children with cerebral palsy.
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Affiliation(s)
- Arkiev D'Souza
- Neuroscience Research Australia (NeuRA), 139 Barker St, Randwick, 2031, NSW, Australia; School of Medical Sciences, University of New South Wales (UNSW), Randwick, NSW, Australia.
| | - Bart Bolsterlee
- Neuroscience Research Australia (NeuRA), 139 Barker St, Randwick, 2031, NSW, Australia; Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Randwick, NSW, Australia.
| | - Ann Lancaster
- Rehab2Kids, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), 139 Barker St, Randwick, 2031, NSW, Australia; School of Medical Sciences, University of New South Wales (UNSW), Randwick, NSW, Australia.
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20
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Abstract
PURPOSE To determine longitudinal change in sedentary behavior in children with cerebral palsy (CP) from 1.5 to 12 years. METHODS Ninety-one children, Gross Motor Function Classification System (GMFCS) levels I to III, who participated in a large longitudinal cohort study were participants. Longitudinal change was analyzed in objectively measured sedentary behavior and associations with sex, body mass index Z score, and socioeconomic status. Moderate-vigorous intensity physical activity (MVPA) was estimated at 8 to 12 years. RESULTS Average sedentary minutes/day peaked at 4 years in children at GMFCS I and 5 years in children at GMFCS II to III, then plateaued. Male sex was associated with increased sedentary behavior. At 8 to 12 years, children at GMFCS I, II, and III accumulated on average 54, 47, and 14 minutes/day, respectively, of MVPA. CONCLUSIONS When measured to 12 years, sedentary behavior peaks by 5 years for children with CP who are walking with differences in trajectory according to GMFCS.
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21
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Guinet AL, Néjib K, Eric D. Clinical gait analysis and physical examination don't correlate with physical activity of children with cerebral palsy. Cross-sectional study. Int Biomech 2020; 7:88-96. [PMID: 33998383 PMCID: PMC8130723 DOI: 10.1080/23335432.2020.1812429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Gait analysis and physical clinical measures are usually performed in children with cerebral palsy to help the surgeons make therapeutic decision. However, the level of physical activity in daily life is not systematically assessed. The aim of this cross sectional study was to examine the correlations between: three-dimensional gait analysis kinematic and spatiotemporal parameters, clinical measures and physical activity. Participants were 30 children with cerebral palsy (10–18 y), with GMFCS I–III. Daily physical activity was measured with an Actigraph GT3X accelerometer in free living environment during seven consecutive days. The percent of time spent in sedentary, in moderate to vigorous physical activity and the number of steps per day were computed from the accelerometer data. Kinematics parameters did not correlate with physical activity. Moderate correlations were found between spatio-temporal parameters and physical activity, for instance timing of toe-off (r = −0.40, p = 0.03). Few physical examination parameters were correlated with physical activity, such as the hip flexors selective motor control (r = 0.69 with moderate to vigorous activity and r = 0.70 with steps per day, p < 0.05). The physical activity profile cannot be sufficiently determined by a combination of clinical measures.
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Affiliation(s)
- Anne-Laure Guinet
- Informatics, Bioinformatics, Complex Systems Lab, University of Paris-Saclay , Gif-sur-Yvette, France.,Pôle Recherche et Innovation, Fondation Ellen Poidatz, Ellen Poidatz Research Lab , Saint Fargeau-Ponthierry, France
| | - Khouri Néjib
- Pôle Recherche et Innovation, Fondation Ellen Poidatz, Ellen Poidatz Research Lab , Saint Fargeau-Ponthierry, France.,Chirurgie orthopédique pédiatrique, Centre Hospitalier Universitaire Necker-Enfants Malades Hospital , Paris, France
| | - Desailly Eric
- Pôle Recherche et Innovation, Fondation Ellen Poidatz, Ellen Poidatz Research Lab , Saint Fargeau-Ponthierry, France
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Ganz F, Hammam N, Pritchard L. Sedentary behavior and children with physical disabilities: a scoping review. Disabil Rehabil 2020; 43:2963-2975. [DOI: 10.1080/09638288.2020.1723720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Felipe Ganz
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Nevin Hammam
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Lesley Pritchard
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Abstract
PURPOSE This project aimed to determine whether change occurs over time for impairments of balance, range of motion, endurance, and strength of children with cerebral palsy, by Gross Motor Function Classification System (GMFCS) levels. METHODS Measurements were completed in 77 children at 2 sessions (T1, T2) on average 5.8 years apart. Mean ages were 2.9 years (SD = 0.9) and 8.7 years (SD = 1.1) at T1 and T2, respectively. RESULTS There were significant differences from T1 to T2 for some children (GMFCS levels I, II, and III/IV: balance increased; GMFCS levels I and II: strength increased; and GMFCS levels III/IV and V: range of motion decreased). Endurance scores were not different and did not change. CONCLUSIONS Longitudinal changes in most impairments occurred in children with cerebral palsy. Monitoring and targeted interventions should support each child's development.
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Sala DA, Grissom HE, Delsole EM, Chu ML, Godfried DH, Bhattacharyya S, Karamitopoulos MS, Chu A. Measuring ambulation with wrist-based and hip-based activity trackers for children with cerebral palsy. Dev Med Child Neurol 2019; 61:1309-1313. [PMID: 30883727 DOI: 10.1111/dmcn.14207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 11/30/2022]
Abstract
AIM To assess the accuracy of consumer available wrist-based and hip-based activity trackers in quantitatively measuring ambulation in children with cerebral palsy (CP). METHOD Thirty-nine children (23 males, 16 females; mean age [SD] 9y 7mo [3y 5mo]; range 4-15y) with CP were fitted with trackers both on their wrist and hip. Each participant stood for 3 minutes, ambulated in a hallway, and sat for 3 minutes. The number of steps and distance were recorded on trackers and compared to manually counted steps and distance. Pearson correlation coefficients were determined for the number of steps during ambulation from each tracker and a manual count. Mean absolute error (MAE) and range of errors were calculated for steps during ambulation for each tracker and a manual count and for distance for each tracker and hallway distance. RESULTS For the number of steps, a weak inverse relationship (r=-0.033) was found for the wrist-based tracker and a strong positive relationship (r=0.991) for the hip-based tracker. The MAE was 88 steps for the wrist-based and seven steps for the hip-based tracker. The MAE for distance was 0.06 miles for the wrist-based and 0.07 miles for the hip-based tracker. INTERPRETATION Only the hip-based tracker provided an accurate step count; neither tracker was accurate for distance. Thus, ambulation of children with CP can be accurately quantified with readily available trackers. WHAT THIS PAPER ADDS Consumer available activity trackers accurately measure ambulation in children with cerebral palsy (CP). The hip-based tracker is more accurate than the wrist-based tracker for children with CP. The hip-based Fitbit activity tracker accurately measures step counts of children with CP during ambulation.
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Affiliation(s)
- Debra A Sala
- Center for Children, Hassenfeld Children's Hospital at New York University Langone, New York, NY, USA
| | | | | | - Mary Lynn Chu
- Center for Children, Hassenfeld Children's Hospital at New York University Langone, New York, NY, USA
| | - David H Godfried
- Center for Children, Hassenfeld Children's Hospital at New York University Langone, New York, NY, USA
| | - Surjya Bhattacharyya
- Center for Children, Hassenfeld Children's Hospital at New York University Langone, New York, NY, USA
| | - Mara S Karamitopoulos
- Center for Children, Hassenfeld Children's Hospital at New York University Langone, New York, NY, USA
| | - Alice Chu
- Center for Children, Hassenfeld Children's Hospital at New York University Langone, New York, NY, USA.,Department of Orthopaedic Surgery, Rutgers-New Jersey Medical Center, Newark, NJ, USA
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Informal Dance Intervention Improves BMI and Functional Gait in an Adolescent With Cerebral Palsy: A Case Report. Pediatr Phys Ther 2019; 31:E26-E31. [PMID: 31469773 DOI: 10.1097/pep.0000000000000653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This case study examined the effects of incorporating Informal Dance Intervention into traditional therapy sessions on body mass index and functional walking in an adolescent girl with cerebral palsy. CASE DESCRIPTION A 15-year-old adolescent girl, Gross Motor Function Classification System Level II, participated in Informal Dance Intervention twice weekly in 2, 16 session phases. Sixty-minute sessions focused on waltzing, contra dancing, square dancing, and belly dancing to improve timing, endurance, vestibular functioning, and core strength. CONCLUSIONS Waist circumference decreased, walking speed increased on the 6-Minute Walk Test and Timed Up and Down Stairs, balance confidence increased per the Activities-specific Balance Confidence Scale, and vestibular functioning improved per changes in the Functional Gait Assessment. RECOMMENDATIONS FOR CLINICAL PRACTICE Incorporating Informal Dance Intervention, in conjunction with therapy, may be motivating and improve overall health for adolescents with cerebral palsy to combat their tendency of increased sedentary lifestyle.
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Lavelle G, Noorkoiv M, Theis N, Korff T, Kilbride C, Baltzopoulos V, Shortland A, Levin W, Ryan JM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) as a measure of physical activity (PA) in young people with cerebral palsy: A cross-sectional study. Physiotherapy 2019; 107:209-215. [PMID: 32026822 DOI: 10.1016/j.physio.2019.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/24/2019] [Accepted: 08/20/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to examine the validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) as a measure of physical activity (PA) in young people with cerebral palsy (CP). DESIGN Cross-sectional. SETTING Participants were recruited through 8 National Health Service (NHS) trusts, one school, one university and through organisations that provide services for people with disabilities in England. PARTICIPANTS Sixty-four, ambulatory young people aged 10-19 years with CP [Gross Motor Function Classification System (GMFCS) levels I-III] participated in this study. MAIN OUTCOME MEASURE The IPAQ-SF was administered to participants. Participants were then asked to wear a wGT3X-BT triaxial accelerometer (ActiGraph, Pensacola, FL) for 7 days to objectively assess PA. Time spent in sedentary behaviour, in moderate to vigorous PA (MVPA) and in total PA (TPA) was compared between measures. RESULTS Young people with CP self-reported less time in sedentary behaviour and underestimated the time spent in TPA, when compared to accelerometer measurements. Bland-Altman plots demonstrated poor agreement between the measures for MVPA, with upper and lower 95% limits of agreement of -147 to 148.9minute. After adjusting for gender and GMFCS level, age was a predictor of the difference between measures for MVPA (P<0.001) and TPA (P<0.001). CONCLUSIONS These findings suggest that the IPAQ-SF is not a valid method of measuring TPA or sedentary behaviour in young people with CP and it is not appropriate for use when assessing an individual's time in MVPA. Therefore, where feasible, an objective measure of PA should be used. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN90378161.
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Affiliation(s)
- Grace Lavelle
- College of Health and Life Sciences, Brunel University London, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucestershire, United Kingdom
| | | | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, London, United Kingdom
| | - Wendy Levin
- Department of Physiotherapy, Swiss Cottage School and Development and Research Centre, London, United Kingdom
| | - Jennifer M Ryan
- College of Health and Life Sciences, Brunel University London, London, United Kingdom; Department of Epidemiology and Public Health Medicine, RCSI, Dublin, Ireland
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Orlando JM, Pierce S, Mohan M, Skorup J, Paremski A, Bochnak M, Prosser LA. Physical activity in non-ambulatory toddlers with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 90:51-58. [PMID: 31063871 DOI: 10.1016/j.ridd.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/21/2018] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Children with cerebral palsy are less likely to be physically active than their peers, however there is limited evidence regarding self-initiated physical activity in toddlers who are not able, or who may never be able, to walk. AIMS The aim of this study was to measure self-initiated physical activity and its relationship to gross motor function and participation in non-ambulatory toddlers with cerebral palsy. METHODS AND PROCEDURES Participants were between the ages of 1-3 years. Physical activity during independent floor-play at home was recorded using a wearable tri-axial accelerometer worn on the child's thigh. The Gross Motor Function Measure-66 and the Child Engagement in Daily Life, a parent-reported questionnaire of participation, were administered. OUTCOMES AND RESULTS Data were analyzed from the twenty participants who recorded at least 90 min of floor-play (mean: 229 min), resulting in 4598 total floor-play minutes. The relationship between physical activity and gross motor function was not statistically significant (r = 0.20; p = 0.39), nor were the relationships between physical activity and participation (r = 0.05-0.09; p = 0.71-0.84). CONCLUSIONS AND IMPLICATIONS The results suggest physical activity during floor-play is not related to gross motor function or participation in non-ambulatory toddlers with cerebral palsy. Clinicians and researchers should independently measure physical activity, gross motor function, and participation.
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Affiliation(s)
- Julie M Orlando
- The Children's Hospital of Philadelphia, Department of Physical Therapy, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Samuel Pierce
- The Children's Hospital of Philadelphia, Department of Physical Therapy, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Mayumi Mohan
- University of Pennsylvania, School of Engineering and Applied Science, 220 S 33rd St, Philadelphia, PA 19104, United States
| | - Julie Skorup
- The Children's Hospital of Philadelphia, Department of Physical Therapy, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Athylia Paremski
- The Children's Hospital of Philadelphia, Division of Rehabilitation Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Megan Bochnak
- The Children's Hospital of Philadelphia, Department of Physical Therapy, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Laura A Prosser
- The Children's Hospital of Philadelphia, Division of Rehabilitation Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; University of Pennsylvania, School of Medicine, Department of Pediatrics, 220 S 33rd St, Philadelphia, PA 19104, United States
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28
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Milićević M. Home participation of children with and without cerebral palsy in Serbia: an exploratory study. Disabil Rehabil 2019; 42:3696-3706. [DOI: 10.1080/09638288.2019.1610506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Milena Milićević
- Institute of Criminological and Sociological Research, Belgrade, Serbia
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Walker A, Colquitt G, Elliott S, Emter M, Li L. Using participatory action research to examine barriers and facilitators to physical activity among rural adolescents with cerebral palsy. Disabil Rehabil 2019; 42:3838-3849. [DOI: 10.1080/09638288.2019.1611952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ashley Walker
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Gavin Colquitt
- Waters College of Health Professions, Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - Steve Elliott
- College of Health and Human Services, School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Morgan Emter
- Magellan Health/AFSC, R2 Performance Center, Fort Polk, LA, USA
| | - Li Li
- Waters College of Health Professions, Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA
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McPhee PG, Benner JL, Balemans ACJ, Verschuren O, van den Berg-Emons RJG, Hurvitz EA, Peterson MD, van der Slot WMA, Roebroeck ME, Gorter JW. Multimorbidity risk assessment in adolescents and adults with cerebral palsy: a protocol for establishing a core outcome set for clinical research and practice. Trials 2019; 20:176. [PMID: 30890152 PMCID: PMC6425572 DOI: 10.1186/s13063-019-3265-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/27/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Estimates of multimorbidity, defined as the presence of at least two chronic conditions, some of which attributable to modifiable behaviours, are high in adults with cerebral palsy (CP). An assessment protocol evaluating multimorbidity risk is needed in order to develop and evaluate effective interventions to optimize lifelong health in individuals with CP. The aim of this protocol paper is to describe the development of a core outcome set (COS) for assessing multimorbidity risk in adolescents and adults with CP, to be used in clinic and research. METHODS The expert consortium will first define the target population and outcomes to be measured. Through a process of literature review and an international Delphi survey with expert clinicians and researchers, we will then determine which outcome measurement instruments (OMIs) can best measure those outcomes. The resulting OMIs will be used in a feasibility study with adolescents and adults with CP from an international clinical research network. Finally, a face-to-face stakeholder meeting with adolescents and adults with CP, their families/caregivers and researchers and clinicians who are experts in CP, will be organized to reach final agreement on the COS. DISCUSSION This COS will guide clinicians and researchers in assessing multimorbidity risk in adolescents and adults with CP. The inclusion of experts and individuals with CP from international locations for establishing the COS lends strong support to its generalizability. Evidence of its feasibility and approval from all stakeholders will enable implementation in clinical practice, and guide future research using the COS in individuals with CP.
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Affiliation(s)
- Patrick G McPhee
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Joyce L Benner
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Astrid C J Balemans
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Public Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Parkway, Ann Arbor, MI, 48108, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Parkway, Ann Arbor, MI, 48108, USA
| | - Wilma M A van der Slot
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
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Jeffries LM, LaForme Fiss A, Westcott McCoy S, Bartlett D, Avery L, Hanna S. Developmental Trajectories and Reference Percentiles for Range of Motion, Endurance, and Muscle Strength of Children With Cerebral Palsy. Phys Ther 2019; 99:329-338. [PMID: 30602008 DOI: 10.1093/ptj/pzy160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/13/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Children with cerebral palsy (CP) frequently present with secondary impairments in spinal alignment and extremity range of motion, endurance for activity, and muscle strength. Creation of developmental trajectories for these impairments will help guide clinical decision-making. OBJECTIVE For children in each level of the Gross Motor Function Classification System (GMFCS) this study aimed to: (1) create longitudinal developmental trajectories for range of motion (Spinal Alignment and Range of Motion Measures [SAROMM]), endurance (Early Activity Scale for Endurance [EASE]), and functional strength (Functional Strength Assessment [FSA]); and (2) develop age-specific reference percentiles and amount of change typical over 1 year for these outcomes. DESIGN This study used a longitudinal cohort design. METHODS Participants comprised 708 children with CP across GMFCS levels, aged 18 months up to the 12th birthday, and their families. In 2 to 5 assessments every 6 months over 2 years, trained therapists performed the SAROMM and FSA, and parents completed the EASE questionnaire. For children in each GMFCS level, longitudinal trajectories using linear and nonlinear mixed-effects models from all visits, and reference percentiles using quantile regression from the first, 12-month, and 24-month visits were created for each measure. RESULTS Longitudinal trajectories and percentile graphs for SAROMM, FSA, and EASE were primarily linear, with different performance scores among GMFCS levels. There was much variability in both longitudinal trajectories and percentiles within GMFCS levels. LIMITATIONS Limitations included a convenience sample and varying numbers of participants assessed at each visit. CONCLUSIONS The longitudinal trajectories and percentile graphs have application for monitoring how children with CP are performing and changing over time compared with other children with CP. The resources presented allow therapists and families to collaboratively make decisions about intervention activities targeted to children's unique needs.
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Affiliation(s)
- Lynn M Jeffries
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117 (USA)
| | | | | | - Doreen Bartlett
- School of Physical Therapy, Elborn College, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Lisa Avery
- Avery Information Services Ltd, Orillia, Ontario, Canada
| | - Steven Hanna
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
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Jung J, Leung W, Schram BM, Yun J. Meta-Analysis of Physical Activity Levels in Youth With and Without Disabilities. Adapt Phys Activ Q 2018; 35:381-402. [PMID: 30376716 DOI: 10.1123/apaq.2017-0123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to explore the current levels of physical activity among youth with disabilities using meta-analysis. The search identified 11 publications including 729 participants (age 4-20 yr). The overall effect size for 11 studies was Hedges g = 0.60 (SE = 0.18, 95% confidence interval [CI] [0.24, 0.96], p < .05, k = 11) using a random-effects model. The findings suggest that differences in physical activity levels between youth with and without disabilities are complex. Results indicated that youth without disabilities engaged in higher levels of physical activity of moderate to vigorous intensity (g = 0.66, SE = 0.18, p < .05). However, no differences were found in light-intensity physical activity (g = -0.03, SE = 0.16, p > .85). Results also suggested that the differences in physical activity between youth with and without disabilities were affected by age (<12 yr, g = 0.83, SE = 0.24, 95% CI [0.37, 1.29], p < .05, and >13 yr, g = 0.37, SE = 0.10, 95% CI [0.18, 0.57], p < .05; Q value = 3.20, df = 1, p < .05), with children with disabilities engaging in less physical activity than children without disabilities in younger ages. Differences in physical activity level between youth with and without disabilities are functions of intensity of physical activity and age but may not be of type of disability (Q value = 0.22, df = 1, p > .6).
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Relationship between habitual physical activity, motor capacity, and capability in children with cerebral palsy aged 4–5 years across all functional abilities. Disabil Health J 2018; 11:632-636. [DOI: 10.1016/j.dhjo.2018.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 11/20/2022]
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Riquelme I, do Rosário RS, Vehmaskoski K, Natunen P, Montoya P. Influence of chronic pain in physical activity of children with cerebral palsy. NeuroRehabilitation 2018; 43:113-123. [DOI: 10.3233/nre-172409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Inmaculada Riquelme
- University Institute of Health Sciences Research (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | | | - Kari Vehmaskoski
- JAMK University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland
| | - Pekka Natunen
- JAMK University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland
| | - Pedro Montoya
- University Institute of Health Sciences Research (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain
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Ryan JM, Allen E, Gormley J, Hurvitz EA, Peterson MD. The risk, burden, and management of non-communicable diseases in cerebral palsy: a scoping review. Dev Med Child Neurol 2018; 60:753-764. [PMID: 29572812 DOI: 10.1111/dmcn.13737] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 12/26/2022]
Abstract
AIM To examine the risk, burden, and management of non-communicable diseases (NCDs) among people with cerebral palsy (CP). METHOD Databases (Ovid MEDLINE, Embase Ovid, CINAHL Plus) were systematically searched up to August 2017. Data on the prevalence of risk factors for, and the burden and management of, cardiovascular diseases, diabetes, cancers, and respiratory diseases were extracted. RESULTS Thirty-six studies that examined the prevalence of risk factors among people with CP were identified. There was inconsistent evidence that people with CP had higher prevalence of metabolic risk factors such as hypertension, hyperlipidaemia, and obesity, but strong evidence that they participated in low levels of physical activity, compared with people without CP. Seven studies reported on the burden of NCDs. Adults with CP had a higher risk of NCDs, including stroke, chronic obstructive pulmonary disease, and other heart conditions, and death due to NCDs, including cancers, chronic obstructive pulmonary disease, stroke, and ischaemic heart disease, compared with the general population. Only one study reported on the management of NCD, specifically the uptake of breast cancer screening among females. INTERPRETATION The burden of NCDs is higher among adults with CP compared with the general population. Further research is required to determine the prevalence of metabolic risk factors and management of NCDs among people with CP. WHAT THIS PAPER ADDS Adults with cerebral palsy (CP) have an increased risk of non-communicable diseases (NCDs) and increased risk of death because of NCDs. Evidence is inconsistent about the elevated prevalence of metabolic risk factors for NCDs. Evidence is consistent that people with CP participate in reduced physical activity. Only one study reported on management of NCD among people with CP. Available evidence suggests people with CP are less likely to receive preventive medicine.
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Affiliation(s)
- Jennifer M Ryan
- College of Health and Life Sciences, Brunel University, London, UK.,Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - John Gormley
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Abstract
BACKGROUND AND PURPOSE The IV STEP conference challenged presenters and participants to consider the state of science in rehabilitation, highlighting key area of progress since the previous STEP conference related to prediction, prevention, plasticity, and participation in rehabilitation. KEY POINTS Emerging from the thought-provoking discussions was recognition of the progress we have made as a profession and a call for future growth. In this summary article, we present a recap of the key points and call for action. We review the information presented and the field at large as it relates to the 4 Ps: prediction, prevention, plasticity, and participation. RECOMMENDATIONS FOR PRACTICE Given that personalized medicine is an increasingly important approach that was clearly woven throughout the IV STEP presentations, we took the liberty of adding a fifth "P," Personalized, in our discussion of the future direction of the profession.
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37
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Whitney DG, Hurvitz EA, Ryan JM, Devlin MJ, Caird MS, French ZP, Ellenberg EC, Peterson MD. Noncommunicable disease and multimorbidity in young adults with cerebral palsy. Clin Epidemiol 2018; 10:511-519. [PMID: 29750055 PMCID: PMC5935087 DOI: 10.2147/clep.s159405] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Individuals with cerebral palsy (CP) are at increased risk for frailty and chronic disease due to factors experienced throughout the lifespan, such as excessive sedentary behaviors and malnutrition. However, little is known about noncommunicable diseases (NCDs) and multimorbidity profiles in young adults with CP. The study objective was to compare NCD and multimorbidity profiles between young adults with and without CP. Methods A clinic-based sample of adults (18-30 years) with (n=452) and without (n=448) CP was examined at the University of Michigan Medical Center. The prevalence and predictors of 13 NCDs were evaluated, including existing diagnoses or historical record of musculoskeletal, cardiometabolic, and pulmonary morbidities. The level of motor impairment was determined by the Gross Motor Function Classification System (GMFCS) and stratified by less vs more severe motor impairment (GMFCS I-III vs IV-V). Logistic regression was used to determine the odds of NCD morbidity and multimorbidity in adults with CP compared to adults without CP, and for GMFCS IV-V compared to GMFCS I-III in those with CP, after adjusting for age, sex, body mass index, and smoking. Results Adults with CP had a higher prevalence of osteopenia, osteoporosis, hypertension, myocardial infarction, hyperlipidemia, asthma, and multimorbidity compared to adults without CP, and higher odds of musculoskeletal (odds ratio [OR]: 6.97) and cardiometabolic morbidity (OR: 1.98), and multimorbidity (OR: 2.67). Adults with CP with GMFCS levels IV-V had a higher prevalence of osteopenia/osteoporosis, osteoarthritis, hypertension, other cardiovascular conditions, pulmonary embolism, and multimorbidity, and higher odds of musculoskeletal (OR: 3.41), cardiometabolic (OR: 2.05), pulmonary morbidity (OR: 1.42), and multimorbidity (OR: 3.45) compared to GMFCS I-III. Conclusion Young adults with CP have a higher prevalence of chronic NCDs and multimorbidity compared to young adults without CP, which is pronounced in those with more severe motor impairment. These findings reiterate the importance of early screening for prevention of NCDs in CP.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer M Ryan
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Clinical Sciences, Brunel University London, Uxbridge, UK
| | - Maureen J Devlin
- Department of Anthropology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Zachary P French
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elie C Ellenberg
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Akkerman M, Mouton LJ, Disseldorp LM, Niemeijer AS, van Brussel M, van der Woude LHV, Nieuwenhuis MK. Physical activity and sedentary behavior following pediatric burns - a preliminary investigation using objective activity monitoring. BMC Sports Sci Med Rehabil 2018; 10:4. [PMID: 29449948 PMCID: PMC5807851 DOI: 10.1186/s13102-018-0093-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 01/25/2018] [Indexed: 11/10/2022]
Abstract
Background Adequate levels of regular physical activity (PA) are crucial for health and well-being. Pediatric burn injuries can have major physiological consequences in both the short and long term. The question is whether these consequences affect post burn PA levels. This study therefore aimed to describe PA and sedentary behavior (SB) in children and adolescents 1–5 years after burn injury. Methods Daily PA and SB were monitored in 20 children and adolescents (12 boys and 8 girls, aged 6–17 years, with burns covering 10–37% of total body surface area, 1–5 years post burn) for 1 week using the ActiGraph GTX3+ accelerometer. Activity counts were categorized into SB, light PA, moderate PA, vigorous PA, moderate-to-vigorous PA (MVPA), and total PA. Outcomes were compared with non-burned reference values and PA levels recommended by the World Health Organization (WHO). Results The participants spent about 5.1 h per day on total PA and 7.4 h on SB. Most of the active time (~ 83%) was categorized as light PA. Thirty-five percent of the group, especially the young boys, spent on average ≥ 60 min on MVPA per day. The boys, although with large interindividual differences, spent more time on MVPA than the girls (p < .005). Older age was associated with less PA time, while more time was spent sedentary. No trends were found indicating an effect of burn characteristics, time post burn, or length of hospital stay, and no differences were found with non-burned peers. Conclusion Duration and intensity of PA and SB in children and adolescents 1–5 years after burn injury were similar to non-burned peers. However, only 35% of the group met the WHO physical activity recommendation. Given the increased long term risk for physical conditions following pediatric burns, physical activity should be encouraged in this vulnerable population. Trial registration The study is registered in the National Academic Research and Collaborations Information System of the Netherlands (OND1348800). Electronic supplementary material The online version of this article (10.1186/s13102-018-0093-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moniek Akkerman
- 1Association of Dutch Burn Centres, Burn Centre Martini Hospital, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Leonora J Mouton
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Laurien M Disseldorp
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Anuschka S Niemeijer
- 1Association of Dutch Burn Centres, Burn Centre Martini Hospital, Groningen, The Netherlands.,3Martini Academy, Martini Hospital, Groningen, The Netherlands
| | - Marco van Brussel
- 4Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucas H V van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Marianne K Nieuwenhuis
- 1Association of Dutch Burn Centres, Burn Centre Martini Hospital, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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Physical Activity and Sedentary Time Patterns in Children and Adolescents With Cystic Fibrosis and Age- and Sex-Matched Healthy Controls. J Phys Act Health 2017; 15:82-88. [PMID: 28872398 DOI: 10.1123/jpah.2017-0011] [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: 11/18/2022]
Abstract
BACKGROUND Regular physical activity (PA) is increasingly recognized as important in the care of patients with cystic fibrosis (CF), but there is a dearth of evidence regarding physical activity levels or how these are accrued in those with CF. METHODS PA was measured by a hip-worn accelerometer for 7 consecutive days in 18 children [10 boys; 12.4 (2.8) y] with mild to moderate CF and 18 age- and sex-matched controls [10 boys; 12.5 (2.7) y]. RESULTS Both children with CF and healthy children demonstrated similar physical activity levels and patterns of accumulation across the intensity spectrum, with higher levels of PA during weekdays in both groups. Forced expiratory volume in 1 second was predicted by high light PA in children with CF compared with low light PA in healthy children. CONCLUSION These findings highlight weekends and light PA as areas warranting further research for the development of effective intervention strategies to increase PA in the youth CF population.
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Stahlhut M, Downs J, Aadahl M, Leonard H, Bisgaard AM, Nordmark E. Patterns of sedentary time and ambulatory physical activity in a Danish population of girls and women with Rett syndrome. Disabil Rehabil 2017; 41:133-141. [PMID: 28969435 DOI: 10.1080/09638288.2017.1381181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rett syndrome (RTT) is a rare neurodevelopmental disorder leading to multiple disabilities and high dependency on caregivers. This study aimed to: (1) describe the patterns of sedentary time and daily steps and (2) identify the association of individual and environmental characteristics with sedentary time. METHODS All Danish females with RTT older than 5 years of age and with a MECP2 mutation were invited to participate. The activPAL and StepWatch Activity Monitor (SAM) were worn by participants for at least four days. Sedentary time and step counts were plotted by time to examine daily activity patterns. Associations between sedentary time and individual and environmental covariates were assessed with linear regression models. RESULTS The median (interquartile range) age of participants was 22.0 (14.3-36.5) years. On average 83.3% (standard deviation 13.9%) of waking hours were spent in sedentary behaviours (n = 48) and the median (interquartile range) daily step count was 5128 (2829-7704) (n = 28). Females older than 33.5 years, and those unable to walk independently were more sedentary. CONCLUSIONS This study demonstrated high levels of sedentary time and low daily step counts in a Danish population of females with RTT. Advancing age and lower walking skills were associated with higher levels of sedentary time. Implications for Rehabilitation Sedentary lifestyles in individuals with disabilities have a negative impact on health and quality of life. High levels of sedentary time and low daily step counts were demonstrated in a Danish population of females with Rett syndrome. Advancing age and inability to walk independently were strongly associated with higher levels of sedentary time in females with Rett syndrome. Understanding patterns of sedentary behaviour and physical activity can aid health care professionals in developing health-promoting physical activity interventions.
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Affiliation(s)
- Michelle Stahlhut
- a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden.,b Department of Clinical Genetics, Center for Rett syndrome, Kennedy Center , Rigshospitalet , Glostrup , Denmark
| | - Jenny Downs
- c Telethon Kids Institute , University of Western Australia , Perth , Australia.,d School of Physiotherapy and Exercise Science , Curtin University , Perth , Australia
| | - Mette Aadahl
- e Research Center for Prevention and Health , Capital Region of Denmark , Glostrup , Denmark
| | - Helen Leonard
- c Telethon Kids Institute , University of Western Australia , Perth , Australia
| | - Anne-Marie Bisgaard
- b Department of Clinical Genetics, Center for Rett syndrome, Kennedy Center , Rigshospitalet , Glostrup , Denmark
| | - Eva Nordmark
- a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden
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Quinn L, Morgan D. From Disease to Health: Physical Therapy Health Promotion Practices for Secondary Prevention in Adult and Pediatric Neurologic Populations. J Neurol Phys Ther 2017; 41 Suppl 3:S46-S54. [PMID: 28628596 PMCID: PMC5477649 DOI: 10.1097/npt.0000000000000166] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Over the last decade there has been a substantial increase in efforts to better understand how targeted physical activity and exercise interventions can be used to minimize secondary consequences arising from neurological damage in both adult and pediatric populations. This article offers an overview of contemporary research that addresses mediators of functional and neuroplastic adaptations associated with physical activity and exercise. We emphasize the important role that physical therapists can play to increase participation and improve well-being in adults and children with neurological disorders. We further highlight potential strategies to foster translation of evidence-based findings for use by clinicians and consumers. SUMMARY OF KEY POINTS Engagement in physical activity can serve as a powerful promoter of health and well-being in adults and youth with neurologic disease, and has the potential to alter the course of disease processes. Physical therapists can play a key role in promoting fitness and wellness by encouraging active living, providing early diagnosis of disease and prescribing targeted activity interventions to improve fitness and participation, and helping individuals overcome personal and environmental barriers to an active lifestyle. RECOMMENDATIONS FOR CLINICAL PRACTICE Physical therapists must adopt a model of rehabilitation that emphasizes secondary prevention in adults and youth with neurologic diseases. Physical therapists have a unique role in developing forward-thinking approaches in using innovative health and wellness strategies to promote positive changes in activity and exercise behaviors.
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Affiliation(s)
- Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York (L.Q.); and Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro (D.M.)
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Kimberley TJ, Novak I, Boyd L, Fowler E, Larsen D. Stepping Up to Rethink the Future of Rehabilitation: IV STEP Considerations and Inspirations. Pediatr Phys Ther 2017; 29 Suppl 3:S76-S85. [PMID: 28654481 PMCID: PMC6013833 DOI: 10.1097/pep.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The IV STEP conference challenged presenters and participants to consider the state of science in rehabilitation, highlighting key area of progress since the previous STEP conference related to prediction, prevention, plasticity, and participation in rehabilitation. KEY POINTS Emerging from the thought-provoking discussions was recognition of the progress we have made as a profession and a call for future growth. In this summary article, we present a recap of the key points and call for action. We review the information presented and the field at large as it relates to the 4 Ps: prediction, prevention, plasticity, and participation. RECOMMENDATIONS FOR PRACTICE Given that personalized medicine is an increasingly important approach that was clearly woven throughout the IV STEP presentations, we took the liberty of adding a fifth "P," Personalized, in our discussion of the future direction of the profession.
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Affiliation(s)
- Teresa Jacobson Kimberley
- Department of Physical Medicine, Division of Physical Therapy and Rehabilitation Science, University of Minnesota, Minneapolis (T.J.K.); Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, Australia (I.N.); Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia (L.B.); Department of Orthopaedic Surgery, Center for Cerebral Palsy, University of California, Los Angeles (E.F.); and School of Health and Rehabilitation Sciences, The Ohio State University, Columbus (D.L.)
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Effects of Participation in Sports Programs on Walking Ability and Endurance Over Time in Children With Cerebral Palsy. Am J Phys Med Rehabil 2017. [PMID: 28644242 DOI: 10.1097/phm.0000000000000767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children with cerebral palsy may benefit from maintaining a high level of physical fitness similar to typically developing children especially in terms of long-term physical performance, although in practice this is often difficult. The purpose of this study was to determine the effect of participation in sports programs on walking ability and endurance over time. DESIGN A retrospective cohort study included participants with cerebral palsy, aged 6 to 20 yrs, who attended a summer sports program from 2004 to 2012. There were 256 participant sessions with pre/post data recorded. The participants consisted of a total of 97 children (mean age [SD] = 11.4 [3.1] yrs), many of whom attended multiple programs throughout the years. Programs were held 6 hrs/d, 5 d/wk for up to 4 wks. Outcome measures included the Timed Up and Go, modified 6-min walk, and 25-ft walk/run. RESULTS The results showed significant improvements in the Timed Up and Go, modified 6-min walk distance and 25-ft walk/run over time. Children in Gross Motor Classification System level III made the largest gains. CONCLUSIONS Walking ability and endurance seem to improve after participation in an intensive summer sports programs. Higher frequency of program attendance resulted in significant improvements in the Timed Up and Go. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Discuss the importance of physical activity at the participation level (sports programs) for children with cerebral palsy; (2) Contrast the changes in walking ability and endurance for children in Gross Motor Function Classification System level I, II, and III after sports programs; and (3) Identify the impact of higher frequency of sports program attendance over time on walking ability. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Schram Christensen M, Jensen T, Voigt CB, Nielsen JB, Lorentzen J. To be active through indoor-climbing: an exploratory feasibility study in a group of children with cerebral palsy and typically developing children. BMC Neurol 2017; 17:112. [PMID: 28619011 PMCID: PMC5472985 DOI: 10.1186/s12883-017-0889-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 05/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral Palsy (CP) is the most common cause of motor disabilities in children and young adults and it is also often associated with cognitive and physiological challenges. Climbing requires a multifaceted repertoire of movements, participants at all levels of expertise may be challenged functionally and cognitively, making climbing of great potential interest in (re)habilitation settings. However, until now only few research projects have investigated the feasibility of climbing as a potential activity for heightening physical activity in children with CP and the possible beneficial effects of climbing activities in populations with functional and/or cognitive challenges. The aim of this study was therefore to test the feasibility of an intensive 3 weeks indoor-climbing training program in children with CP and typically developing (TD) peers. In addition we evaluated possible functional and cognitive benefits of 3 weeks of intensive climbing training in 11 children with cerebral palsy (CP) aged 11-13 years and six of their TD peers. METHOD The study was designed as a feasibility and interventional study. We evaluated the amount of time spent being physically active during the 9 indoor-climbing training sessions, and climbing abilities were measured. The participants were tested in a series of physiological, psychological and cognitive tests: two times prior to and one time following the training in order to explore possible effects of the intervention. RESULTS The children accomplished the training goal of a total of nine sessions within the 3-week training period. The time of physical activity during a 2:30 h climbing session, was comparably high in the group of children with CP and the TD children. The children with CP were physically active on average for almost 16 h in total during the 3 weeks. Both groups of participants improved their climbing abilities, the children with CP managed to climb a larger proportion of the tested climbing route at the end of training and the TD group climbed faster. For the children with CP this was accompanied by significant improvements in the Sit-to-stand test (p < 0.01), increased rate of force development in the least affected hand during an explosive pinch test and increased muscular-muscular coherence during a pinch precision test (p < 0.05). We found no improvements in maximal hand or finger strength and no changes in cognitive abilities or psychological well-being in any of the groups. CONCLUSIONS These findings show that it is possible to use climbing as means to make children with CP physically active. The improved motor abilities obtained through the training is likely reflected by increased synchronization between cortex and muscles, which results in a more efficient motor unit recruitment that may be transferred to daily functional abilities. TRIAL REGISTRATION ISRCTN18006574; day of registration: 09/05/2017; the trial is registered retrospectively.
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Affiliation(s)
- Mark Schram Christensen
- Center for Neuroscience, Section for Integrative Neuroscience, University of Copenhagen, Panum Institute, Building 33.3, Nørre Allé 20, DK-2200, Copenhagen N, Denmark.,DTU Compute, Department of Applied Mathematics and Computer Science, Technical University of Denmark, Richard Petersens Plads, Building 324, DK-2800, Kgs. Lyngby, Denmark
| | - Thor Jensen
- Center for Neuroscience, Section for Integrative Neuroscience, University of Copenhagen, Panum Institute, Building 33.3, Nørre Allé 20, DK-2200, Copenhagen N, Denmark
| | - Camilla B Voigt
- Elsass Instituttet, Holmegårdsvej 28, DK-2920, Charlottenlund, Denmark
| | - Jens Bo Nielsen
- Center for Neuroscience, Section for Integrative Neuroscience, University of Copenhagen, Panum Institute, Building 33.3, Nørre Allé 20, DK-2200, Copenhagen N, Denmark.,Elsass Instituttet, Holmegårdsvej 28, DK-2920, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Center for Neuroscience, Section for Integrative Neuroscience, University of Copenhagen, Panum Institute, Building 33.3, Nørre Allé 20, DK-2200, Copenhagen N, Denmark. .,Elsass Instituttet, Holmegårdsvej 28, DK-2920, Charlottenlund, Denmark.
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DOWNS JENNY, LEONARD HELEN, WONG KINGSLEY, NEWTON NIKKI, HILL KYLIE. Quantification of walking-based physical activity and sedentary time in individuals with Rett syndrome. Dev Med Child Neurol 2017; 59:605-611. [PMID: 28164278 PMCID: PMC5413421 DOI: 10.1111/dmcn.13398] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2016] [Indexed: 11/28/2022]
Abstract
AIM To quantify, in individuals with Rett syndrome with the capacity to walk, walking-based activity and sedentary time, and to analyse the influences of age, walking ability, scoliosis, and the severity of epilepsy. METHOD Sixty-four participants with a mean age of 17 years and 7 months (standard deviation [SD] 9y) were recruited from the Australian Rett Syndrome Database for this cross-sectional study. Each participant wore a StepWatch Activity Monitor for at least 4 days. Linear regression models were used to assess relationships between daily step count and the proportion of waking hours spent in sedentary time with the covariates of age group, walking ability, presence of scoliosis, and frequency of seizures. RESULTS On average, 62% (SD 19%) of waking hours were sedentary and 20% (SD 8%) was at cadences lower than or equal to 20 steps in a minute. The median daily steps count was 5093 (interquartile range 2026-8602). Compared with females younger than 13 years of age and accounting for the effects of covariates, adults took fewer steps, and both adolescents and adults had more sedentary time. INTERPRETATION Adolescents and adults led the least active lives and would appear to be in particular need of interventions aiming to optimize slow walking-based physical activity and reduce sedentary time.
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Affiliation(s)
- JENNY DOWNS
- Telethon Kids Institute, The University of Western Australia, Perth, WA,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - HELEN LEONARD
- Telethon Kids Institute, The University of Western Australia, Perth, WA
| | - KINGSLEY WONG
- Telethon Kids Institute, The University of Western Australia, Perth, WA
| | - NIKKI NEWTON
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - KYLIE HILL
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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SIT CINDYHP, MCKENZIE THOMASL, CERIN ESTER, CHOW BIKC, HUANG WENDYY, YU JIE. Physical Activity and Sedentary Time among Children with Disabilities at School. Med Sci Sports Exerc 2017; 49:292-297. [DOI: 10.1249/mss.0000000000001097] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Habitual Physical Activity in Children With Cerebral Palsy Aged 4 to 5 Years Across All Functional Abilities. Pediatr Phys Ther 2017; 29:8-14. [PMID: 27984458 DOI: 10.1097/pep.0000000000000327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare ambulatory status in children with cerebral palsy aged 4 to 5 years with their habitual physical activity and time spent sedentary, and to compare their activity with physical activity guidelines. METHODS Sixty-seven participants-independently ambulant, marginally ambulant, and nonambulant-wore accelerometers for 3 days. Time spent sedentary as a percentage of wear time and activity counts were compared between groups. RESULTS There were significant differences in time spent sedentary and activity counts between groups. Children who were independently ambulant were more likely to meet physical activity guidelines. CONCLUSION Children with cerebral palsy spent more than half of their waking hours in sedentary time. Interventions to reduce sedentary behavior and increase habitual physical activity are needed in children with cerebral palsy at age 4 to 5 years.
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Abstract
PURPOSE To derive and validate triaxial accelerometer cut-points in children with cerebral palsy (CP) and compare these with previously established cut-points in children with typical development. METHODS Eighty-four children with CP aged 4 to 5 years wore the ActiGraph during a play-based gross motor function measure assessment that was video-taped for direct observation. Receiver operating characteristic and Bland-Altman plots were used for analyses. RESULTS The ActiGraph had good classification accuracy in Gross Motor Function Classification System (GMFCS) levels III and V and fair classification accuracy in GMFCS levels I, II, and IV. These results support the use of the previously established cut-points for sedentary time of 820 counts per minute in children with CP aged 4 to 5 years across all functional abilities. CONCLUSIONS The cut-point provides an objective measure of sedentary and active time in children with CP. The cut-point is applicable to group data but not for individual children.
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