Stationary cycling and children with cerebral palsy: case reports for two participants

Aerobic Responses to FES-Assisted and Volitional Cycling in Children with Cerebral Palsy

Recumbent stationary cycling is a potential exercise modality for individuals with cerebral palsy (CP) that lack the postural control needed for upright exercises. Functional electrical stimulation (FES) of lower extremity muscles can help such individuals reach the cycling intensities that are required for aerobic benefits. The aim of this study was to examine the effect of cycling with and without FES assistance to that of a no-intervention control group on the cardiorespiratory fitness of children with CP. Thirty-nine participants were randomized to a FES group that underwent an 8-week FES-assisted cycling program, the volitional group (VOL), who cycled without FES, or a no-intervention control group (CON) (15 FES, 11 VOL, 13 CON). Cadence, peak VO₂, and net rise in heart rate were assessed at baseline, end of training, and washout (8-weeks after cessation of training). Latent growth curve modeling was used for analysis. The FES group showed significantly higher cycling cadences than the VOL and CON groups at POST and WO. There were no differences in improvements in the peak VO₂ and peak net HR between groups. FES-assisted cycling may help children with CP attain higher cycling cadences and to retain these gains after training cessation. Higher training intensities may be necessary to obtain improvements in peak VO₂ and heart rate.

Characterizing Cycling Smoothness and Rhythm in Children With and Without Cerebral Palsy

Stationary cycling is a practical exercise modality in children with cerebral palsy (CP) that lack the strength for upright exercises. However, there is a lack of robust, sensitive metrics that can quantitatively assess the motor control during cycling. The purpose of this brief report was to characterize the differences in motor control of cycling in children with CP and with typical development by developing novel metrics to quantify cycling smoothness and rhythm. Thirty one children with spastic diplegic CP and 10 children with typical development cycled on a stationary cycle. Cycling smoothness was measured by cross-correlating the crank angle with an ideal cycling pattern generated from participant-specific cadence and cycling duration. Cycling rhythmicity was assessed by evaluating the revolution-to-revolution variability in the time required to complete a revolution. Statistically significant differences (p < 0.001) using the Wilcoxon Rank Sum test were found between the two groups for both the metrics. Additionally, decision tree analysis revealed thresholds of smoothness <0.01 and rhythm <0.089-0.115 s for discriminating a less smooth, irregular cycling pattern characteristic of CP from typical cycling. In summary, the objective measures developed in this study indicate significantly less smoothness and rhythm of cycling in children with CP compared to children with typical development, suggestive of altered coordination and poor motor control. Such quantitative assessments of cycling motion in children with CP provide insights into neuromotor deficits that prevent them from cycling at intensities required for aerobic benefits and for participating in cycling related physical activities with their peers.

Relationship between sensorimotor cortical activation as assessed by functional near infrared spectroscopy and lower extremity motor coordination in bilateral cerebral palsy

Background

Evaluation of task-evoked cortical responses during movement has been limited in individuals with bilateral cerebral palsy (CP), despite documented alterations in brain structure/function and deficits in motor control.

Objective

To systematically evaluate cortical activity associated with lower extremity tasks, and relate activation parameters to clinical measures in CP.

Methods

28 ambulatory participants (14 with bilateral CP and 14 with typical development) completed five motor tasks (non-dominant ankle dorsiflexion, hip flexion and leg cycling as well as bilateral dorsiflexion and cycling) in a block design while their sensorimotor cortex was monitored using functional near infrared spectroscopy (fNIRS), in addition to laboratory and clinical measures of performance.

Results

Main effects for group and task were found for extent of fNIRS activation (number of active channels; p < 0.001 and p = 0.010, respectively), magnitude of activation (sum of beta values; p < 0.001 for both), and number of active muscles (p = 0.001 and p < 0.001, respectively), but no group by task interactions. Collectively, subgroups with CP and especially those with greater impairments, showed higher extent and magnitude of cortical sensorimotor activation as well as higher amounts of concurrent activity in muscles not required for task performance. Magnitude of fNIRS activation during non-dominant dorsiflexion correlated with validated measures of selective control (r = −0.60, p = 0.03), as well as mobility and daily activity (r = −0.55, p = 0.04 and r = −0.52, p = 0.05, respectively) and self-reported gait function (r = −0.68, p = 0.01) in those with CP.

Conclusions

The association between higher activity in the sensorimotor cortex and decreased selectivity in cortical organization suggests a potential neural mechanism of motor deficits and target for intervention.

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First fNIRS comparison of a range of lower extremity tasks in children with and without bilateral CP.

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FNIRS showed a greater amount and extent of activation of sensorimotor cortices in CP.

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Greater activation correlated with a greater number of muscles involved in the task.

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fNIRS results correlated to clinical measures of motor control and function.

Bike skills training for children with cerebral palsy: protocol for a randomised controlled trial

INTRODUCTION

Two-wheel bike riding can be a goal for children with cerebral palsy (CP) and a means of participating in physical activity. It is possible for some children with CP to ride a two-wheel bike; however, currently far fewer can ride compared with their typically developing peers. Evidence supports training targeted towards goals of the child with CP and their family; yet there is little evidence to guide best-practice bike skills training. Task-specific training may lead to attainment of two-wheel bike-specific goals. This study aims to determine if a novel task-specific approach to training two-wheel bike skills is more effective than a parent-led home programme for attaining individualised two-wheel bike-specific goals in independently ambulant children with CP aged 6-15 years.

METHODS AND ANALYSIS

Sixty eligible children with CP (Gross Motor Function Classification System levels I-II) aged 6-15 years with goals relating to riding a two-wheel bike will be randomised to either a novel task-specific centre-based group programme (intervention) or a parent-led home-based programme (comparison), both involving a 1-week intervention period. The primary outcome is goal attainment in the week following the intervention period (T1). Secondary outcomes include: goal attainment and participation in physical activity at 3 months postintervention (T2) and bike skills, attendance and involvement in bike riding, self-perception and functional skills at T1 and T2. Economic appraisal will involve cost-effectiveness and cost-utility analyses. Adherence of clinicians and parents to the intervention and comparison protocols will be assessed. Linear and logistic regression will be used to assess the effect of the intervention, adjusted for site as used in the randomisation process.

ETHICS AND DISSEMINATION

This study was approved by the Human Research and Ethics Committees at The Royal Children's Hospital (#36209). Results will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT03003026; Pre-results.

Cardiorespiratory endurance in children with and without cerebral palsy as measured by an ergometer: a case series study

[Purpose] This preliminary study aimed to determine the cardiorespiratory endurance of children with cerebral palsy (CP) using a case series study in order to provide the reference data required for interventions appropriate for South Korean CP sufferers, since aerobic ability evaluation and interventions for children with CP are not well recognized in South Korea. [Subjects and Methods] Four children and adolescents with CP GMFCS (Gross Motor Function Classification System) level I and II and two normally developing children (ND) (age: 7–15 years) were studied. Cycle ergometer testing was performed to determine their VO₂ peak and RER peak concentrations as well as VE peak and 6MWT distance. [Results] The VO₂ peak was lower in subject E (CP) at 44.5 than in subject B (ND), and it was lower in subject A (ND) at 22.9 than in subject C (CP). The 6MWT distance was longer in subjects A and B (ND) than in age-matched CP subjects. [Conclusion] This case report demonstrates that the cardiorespiratory parameters values of CP children were similar to those reported previously. Further research is required to evaluate the normative values of CP and the optimal cardiorespiratory parameters.

Optimization of electric bicycle for youths with disabilities

Cerebral palsy is a group of neurodevelopmental disorders that affect a person’s ability to move and to maintain balance and posture. People with cerebral palsy have also perception and space orientation deficits so that special assistance devices should be developed to compensate these handicaps. The objective was to optimize an adapted electric bicycle (E-bike) for youths with neurodevelopmental disorders. An adapted E-bike was provided with ultrasonic sensors that measure distances to objects. If the distance to other objects reduces, an acoustic signal is sent. Additionally, a self-created force plate was fixed on the pedal to evaluate the muscle performances during biking. An experiment with the ultrasound warning system confirmed that acoustic feedback was helpful in avoiding obstacles. The measurement of the blood pressure, the heart frequency and the pedaling force during biking approved that the training condition of the test person can be registered and enables tuning the power of the electric motor to individual requirements. The results demonstrate that an adapted E-bike can be improved to provide better space orientation for people with perceptual disorders and to measure training conditions of patients. Moreover, these enable individual adjustment of the electric motor power to optimize comfort and therapy effect.

The PEDALS stationary cycling intervention and health-related quality of life in children with cerebral palsy: a randomized controlled trial

AIM

The aim of this study was to assess health-related quality of life (HRQOL) following a stationary cycling intervention in children with cerebral palsy (CP).

METHOD

This was a phase I multisite randomized controlled trial with single blinding. HRQOL was evaluated using the Pediatric Quality of Life Inventory SF15 (PedsQL; children) and Pediatric Outcomes Data Collection Instrument (PODCI; parent proxy) before and after a 3-month stationary cycling intervention. Sixty-two children (29 male, 33 female; mean age 11y; range 7-18y) with spastic diplegic CP, classified as levels I to III on the Gross Motor Function Classification System, were enrolled. Paired and independent t-tests were used to evaluate within- and between-group differences respectively.

RESULTS

Between-group differences, favoring the cycling group, were found for PedsQL emotional functioning (p=0.046) and Parental PODCI treatment expectations scores (p=0.006). Between-group differences were not found for other scales. Within-group improvements were found in the cycling group: PedsQL total score (+5.8; p=0.006), psychosocial health summary (+6.9; p=0.008), and school functioning (+8.0; p=0.038). PODCI satisfaction with symptoms decreased significantly only in the control group (-12.0; p=0.046).

INTERPRETATION

A beneficial influence of exercise on pediatric emotional well-being and parental treatment expectations was found. The evidence was not strong for other aspects of HRQOL. Results support the positive relationship between physical fitness and emotional well-being in the general population. A child's perception is important when examining change in his or her emotional well-being due to intervention.