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Abid M, Cherni Y, Batcho CS, Traverse E, Lavoie MD, Mercier C. Facilitators and barriers to participation in physical activities in children and adolescents living with cerebral palsy: a scoping review. Disabil Rehabil 2023; 45:4322-4337. [PMID: 36447398 DOI: 10.1080/09638288.2022.2150327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/05/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE This scoping review aimed to synthetize personal and environmental facilitators and barriers to participation in physical activities among youths living with cerebral palsy. METHODS A systematic literature search was performed in five databases: CINAHL, EMBASE, MEDLINE, PsycINFO, Cochrane, WEB OF SCIENCE. The studies were selected by two independent researchers based on inclusion and exclusion criteria. A semi-quantitative evaluation assessed the consistency of results for a given variable. Variables displaying consistent associations were classified based on the Physical Activity for people with Disability Model. RESULTS The electronic search yielded 10 795 articles, of which 57 were included. The main barriers to physical activity identified were motor impairments (30 studies), older age (15 studies), pain (6 studies), attendance in regular school (6 studies), and communication problems (4 studies). Barriers such as upper limb impairment and visual deficit were less frequently studied, while cognitive attributes, adapted physical environments and positive attitude, and family support were identified as facilitators. CONCLUSION Personal and environmental factors influencing physical activities behaviors among youths living with cerebral palsy are multiple and complex since they interact with each other. Rehabilitation interventions need to adopt a person-based approach to address barriers and reinforce facilitators.IMPLICATIONS FOR REHABILITATION:Physical activity participation among youths with cerebral palsy is a multidimensional phenomenon, dependent on different personal and environmental factors.Gross motor impairments, communication problems, and pain were the most common personal factors limiting physical activity participation.Environmental factors consistently associated with physical activity participation were school settings, physical environment such as transportation, and social and family support and attitude.Rehabilitation interventions to promote an active lifestyle should consider not only personal factors but their interaction with the child's environment.
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Affiliation(s)
- Manel Abid
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Yosra Cherni
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Charles Sèbiyo Batcho
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Elodie Traverse
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
| | | | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
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Michelsen JS, Lund MC, Alkjaer T, Finni T, Nielsen JB, Lorentzen J. Wearable electromyography recordings during daily life activities in children with cerebral palsy. Dev Med Child Neurol 2020; 62:714-722. [PMID: 31989593 DOI: 10.1111/dmcn.14466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 01/27/2023]
Abstract
AIM To test whether wearable textile electromyography (EMG) recording systems may detect differences in muscle activity levels during daily activities between children with cerebral palsy (CP) and age-matched typically developing children. METHOD Wearable textile EMG recording systems were used to obtain leg muscle activity in 10 children with spastic CP (four females, six males; mean age 9y 6mo, standard deviation [SD] 2y 4mo, range: 6-13y; Gross Motor Function Classification System [GMFCS] level I and II) and 11 typically developing children (four females, seven males; mean age 9y 9mo, SD 1y 11mo, 7-12y) at rest and while performing seven daily activities. RESULTS Children with CP showed significantly lower absolute EMG levels during maximal voluntary contractions (MVCs) of muscles on the most affected side as compared to the least affected side and to typically developing children. None of the typically developing children or children with CP showed detectable EMG activity in resting situations. EMG activity relative to MVC was greater in children with CP during walking, jumping, and kicking on the most affected side as compared to the least affected side and to typically developing children. INTERPRETATION Wearable textile EMG recording systems may be used to determine differences in muscle activity during daily activities in children with CP. Children with CP showed reduced muscle activity during daily activities compared to their peers, but used a significantly larger part of their maximal voluntary muscle strength to perform these activities. WHAT THIS PAPER ADDS Wearable textile electromyography (EMG) systems are feasible for measurement of daily muscle activity in children with cerebral palsy (CP). Children with CP showed reduced EMG levels during maximal voluntary contractions. Neither typically developing children or children with CP showed EMG activity in resting situations. Children with CP used a larger part of their voluntary muscle strength during daily activities.
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Affiliation(s)
| | - Mai C Lund
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Elsass Foundation, Charlottenlund, Denmark
| | - Tine Alkjaer
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Taija Finni
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jens B Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Elsass Foundation, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Elsass Foundation, Charlottenlund, Denmark
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Gait Analysis Parameters and Walking Activity Pre- and Postoperatively in Children With Cerebral Palsy. Pediatr Phys Ther 2018; 30:203-207. [PMID: 29924068 DOI: 10.1097/pep.0000000000000512] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examined the relationship between the Gait Deviation Index (GDI) and walking activity preoperatively and postoperatively. METHODS The GDI and walking activity from 74 youth with cerebral palsy (CP) were included in the analysis. The preoperative GDI was calculated using gait parameters collected during a clinical gait analysis 1 to 16 months prior to surgery. The postoperative GDI was calculated using gait parameters collected during a clinical gait analysis 10 to 26 months following surgery. RESULTS A weak correlation was present between the change in the average GDI and the change in strides. A moderate correlation was found between the change in the Surgery GDI and the change in strides. CONCLUSION Single-event multilevel surgery improves gait deviations in children with CP. However, the improvement in gait pattern has limited correlation with postoperative change in walking activity. Our results demonstrate a need to pair surgical with additional intervention to affect long-term improvements in walking activity.
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Stevens WR, Tulchin-Francis K. Interval setting selection affects ambulatory activity outputs in children with cerebral palsy. Gait Posture 2017; 57:69-73. [PMID: 28578136 DOI: 10.1016/j.gaitpost.2017.05.020] [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: 02/22/2017] [Revised: 04/28/2017] [Accepted: 05/18/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Accelerometer based devices have been widely used to assess the ambulatory activity of children with and without functional disabilities. Many researchers who utilize the StepWatch Activity Monitor (SAM) collect at a 60second (60sec) interval setting. The purpose of this study was to assess the effect of SAM interval settings on ambulatory activity outputs in children with cerebral palsy (CP) and typically developing youth. METHODS Participants wore a SAM which recorded the number of strides every 10seconds (10s) for one week. Raw 10s data was downsampled to combine strides into 60sec intervals. Strides were ensembled into walking bouts with the Intensity/Duration calculated as a percentage of Total Ambulatory Time (TAT). RESULTS Twenty-eight children with CP (14 boys; avg. 12 yrs. 4 mths.; GMFCS Level I n=4, Level II n=19, Level III n=5) completed testing and 28 age matched typically developing youth (14 boys; avg. 12 yrs. 6 mths.) were included. Using the 10sec interval, ∼80% of walking bouts in both groups were less than or equal to 60s. Data recorded at 60sec intervals had higher daily TAT but fewer walking bouts. In children with CP, daily steps were higher using the 60sec interval. At the Easy intensity, the 60sec interval reported an increased volume of Long duration walking, and it rarely identified any Moderate+ intensity activity. CONCLUSIONS 60sec interval data overestimated low intensity and long duration ambulatory activity. It is imperative that investigators choose a finer interval setting (10sec) to maximize the detection of gait transitions and rest periods which are critical in describing community ambulation of patients with cerebral palsy.
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Abstract
PURPOSE The StepWatch (SW) has been used to monitor physical activity (PA) in youth with cerebral palsy; however, there is no standard collection protocol. The goal was to develop such a protocol. METHODS Data were examined from patients who wore the SW for 8 to 14 days. The Spearman-Brown prediction formula determined the minimum number of days for reliable PA. Weekdays were compared to weekends and 10- and 60-second collection intervals were examined. RESULTS The PA data were collected from 98 youth with cerebral palsy. Results showed 3 days would provide reliable representation of PA, participants took significantly more steps during school days compared with weekends, and there were no differences between collection intervals. CONCLUSIONS We recommend setting the SW for 7 days at 10-second collection rate. Data should be analyzed if at least 3 days of data are present. Weekdays and weekend days should be noted, and both included when possible.
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Wilson NC, Mudge S, Stott NS. Variability of total step activity in children with cerebral palsy: influence of definition of a day on participant retention within the study. BMC Res Notes 2016; 9:411. [PMID: 27544209 PMCID: PMC4992568 DOI: 10.1186/s13104-016-2218-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Activity monitoring is important to establish accurate daily physical activity levels in children with cerebral palsy (CP). However, few studies address issues around inclusion or exclusion of step count data; in particular, how a valid day should be defined and what impact different lengths of monitoring have on retention of participant data within a study. This study assessed how different 'valid day' definitions influenced inclusion of participant data in final analyses and the subsequent variability of the data. RESULTS Sixty-nine children with CP were fitted with a StepWatch™ Activity Monitor and instructed to wear it for a week. Data analysis used two broad definitions of a day, based on either number of steps in a 24 h monitoring period or the number of hours of recorded activity in a 24 h monitoring period. Eight children either did not use the monitor, or used it for only 1 day. The remaining 61 children provided 2 valid days of monitoring defined as >100 recorded steps per 24 h period and 55 (90 %) completed 2 valid days of monitoring with ≥10 h recorded activity per 24 h period. Performance variability in daily step count was lower across 2 days of monitoring when a valid day was defined as ≥10 h recorded activity per 24 h period (ICC = 0.765) and, higher when the definition >100 recorded steps per 24 h period (ICC = 0.62). Only 46 participants (75 %) completed 5 days of monitoring with >100 recorded steps per 24 h period and only 23 (38 %) achieved 5 days of monitoring with ≥10 h recorded activity per 24 h period. Datasets of participants who functioned at GMFCS level II were differentially excluded when the criteria for inclusion in final analysis was 5 valid days of ≥10 h recorded activity per 24 h period, leaving datasets available for only 8 of 32 participant datasets retained in the study. CONCLUSION We conclude that changes in definition of a valid day have significant impacts on both inclusion of participant data in final analysis and measured variability of total step count.
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Affiliation(s)
- Nichola C Wilson
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. .,Paediatric Orthopaedic Department, Auckland City Hospital, Auckland, New Zealand.
| | - Suzie Mudge
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Paediatric Orthopaedic Department, Auckland City Hospital, Auckland, New Zealand
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Orendurff MS, Raschke SU, Winder L, Moe D, Boone DA, Kobayashi T. Functional level assessment of individuals with transtibial limb loss: Evaluation in the clinical setting versus objective community ambulatory activity. J Rehabil Assist Technol Eng 2016; 3:2055668316636316. [PMID: 31186900 PMCID: PMC6453096 DOI: 10.1177/2055668316636316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/20/2016] [Indexed: 11/16/2022] Open
Abstract
The functional level (K level) of prosthetic users is used to choose appropriate
prosthetic components, but ratings may highly subjective. A more objective and
robust method to determine K level may be appealing. The aim of this study was
to determine the relationship between K level determined in the clinic to K
level based on real world ambulatory activity data collected by StepWatch.
Twelve individuals with transtibial limb loss gave informed consent to
participate. K level assessments performed in the clinic by a single treating
prosthetist were compared with a calculated estimate based on seven days of real
world ambulatory activity patterns using linear regression. There was good
agreement between the two methods of determining K level with
R2 = 0.775 (p < 0.001). The
calculated estimate of K level based on actual ambulatory activity in real world
settings appears to be similar to the treating prosthetist’s assessment of K
level based on gait observation and patient responses in the clinic.
Clinic-based ambulatory capacity in transtibial prosthetic users appears to
correlate with real world ambulatory behavior in this small cohort. Determining
functional level based on real world ambulatory activity may supplement
clinic-based tests of functional capacity.
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Affiliation(s)
| | - Silvia U Raschke
- MAKE+, CREATE Laboratory, British Columbia Institute of Technology, Burnaby, Canada
| | | | - David Moe
- Barber Prosthetics, Vancouver, Canada
| | - David A Boone
- Biomechanics Laboratory, Orthocare Innovations, Mountlake Terrace, USA
| | - Toshiki Kobayashi
- Biomechanics Laboratory, Orthocare Innovations, Mountlake Terrace, USA.,Department of Prosthetics and Orthotics, Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan
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Personal and environmental factors to consider when aiming to improve participation in physical activity in children with Spina Bifida: a qualitative study. BMC Neurol 2015; 15:11. [PMID: 25886148 PMCID: PMC4336512 DOI: 10.1186/s12883-015-0265-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/20/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Youth with spina bifida (SB) are less fit and active than other groups with childhood disability. While recent studies have shown benefits of exercise training, the increased fitness levels do not sustain or lead to increased levels of physical activity (PA) in these children. Therefore, it seems important to explore which factors are associated with participation in PA (or lack of) in youth with SB. The objective of this study is to describe both personal and environmental factors that are important for participation in physical activity as experienced by these children and their parents, in order to better develop intervention strategies to improve participation in PA in youth with SB. METHODS Eleven semi-structured interviews with parents of children with SB aged 4-7 years, nine focus groups with youth with SB (n = 33, age 8-18 years) and eight focus groups with their parents (n = 31) were conducted, recorded and transcribed verbatim. Two independent researchers analyzed the data. Central themes for physical activity were constructed, using the model for Physical Activity for Persons with a Disability (PAD model) as a background scheme. RESULTS Data showed that youth with SB encountered both personal and environmental factors associated with participation in PA on all levels of the PAD model. Bowel and bladder care, competence in skills, sufficient fitness, medical events and self-efficacy were important personal factors. Environmental factors that were associated with physical activity included the contact with and support from other people, the use of assistive devices for mobility and care, adequate information regarding possibilities for adapted sports and accessibility of playgrounds and sports facilities. CONCLUSIONS Our findings suggest that a variety of both personal and environmental factors were either positively or negatively associated with participation in PA. An individual approach, assessing possibilities rather than overcoming barriers within and surrounding the child may be a good starting point when setting up intervention programs to improve participation in PA. Therefore, assessment of both personal and environmental factors associated with physical activity should be standard care within multidisciplinary intervention programs aimed to encourage healthy active lifestyles in youth with SB.
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