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Pontiff ME, Moreau NG. Age-Related Differences in Muscle Size and Strength between Individuals with Cerebral Palsy and Individuals with Typical Development. Phys Occup Ther Pediatr 2023; 44:572-585. [PMID: 38037369 DOI: 10.1080/01942638.2023.2287463] [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: 03/13/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
AIM Examine age-related differences in muscle size and strength of the knee extensors in individuals with cerebral palsy (CP) and individuals with typical development (TD). METHODS 54 individuals with CP (14.5 ± 4.5 years, GMFCS I-V) and 33 individuals with TD (16.2 ± 5.5 years) were included. Relationships between rectus femoris (RF) and vastus lateralis (VL) muscle volume and isokinetic knee extensor strength with age were examined with linear regression and ANCOVA to test age-related differences between groups. RESULTS Linear regression for muscle volume with age was statistically significant in TD (VL: r2 = 0.48, RF: r2 = 0.56, p < .05) and those with CP (VL: r = 0.36, RF: r2 = 0.27, p < .05) with no differences in regression slopes between groups (p > .05). Age-related strength differences were observed in TD (r2 = 0.66, p < .001) and those with CP (r2 = 0.096, p = .024), but the slopes were significantly different between CP and TD (p < .001). CONCLUSION Age-related linear differences in muscle volume and strength were observed in both groups. The linear slope of the age-related differences in knee extensor muscle strength and strength-to-body mass ratio were significantly lower in individuals with CP compared to individuals with TD, suggesting that strength is insufficient to keep up with gains in body mass during growth.
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Affiliation(s)
- Mattie E Pontiff
- Department of Physical Therapy, LSUHSC-New Orleans, New Orleans, LA, USA
| | - Noelle G Moreau
- Department of Physical Therapy, LSUHSC-New Orleans, New Orleans, LA, USA
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Grosse L, Schnabel JF, Börner-Schröder C, Späh MA, Meuche AC, Sollmann N, Breuer U, Warken B, Hösl M, Heinen F, Berweck S, Schröder SA, Bonfert MV. Safety and Feasibility of Functional Repetitive Neuromuscular Magnetic Stimulation of the Gluteal Muscles in Children and Adolescents with Bilateral Spastic Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1768. [PMID: 38002859 PMCID: PMC10670153 DOI: 10.3390/children10111768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background: For children and adolescents affected by bilateral spastic cerebral palsy (BSCP), non-invasive neurostimulation with repetitive neuromuscular magnetic stimulation (rNMS) combined with physical exercises, conceptualized as functional rNMS (frNMS), represents a novel treatment approach. Methods: In this open-label study, six children and two adolescents (10.4 ± 2.5 years) with BSCP received a frNMS intervention targeting the gluteal muscles (12 sessions within 3 weeks). Results: In 77.1% of the sessions, no side effects were reported. In 16.7%, 6.3% and 5.2% of the sessions, a tingling sensation, feelings of pressure/warmth/cold or very shortly lasting pain appeared, respectively. frNMS was highly accepted by families (100% adherence) and highly feasible (97.9% of treatment per training protocol). A total of 100% of participants would repeat frNMS, and 87.5% would recommend it. The Canadian Occupational Performance Measure demonstrated clinically important benefits for performance in 28% and satisfaction in 42% of mobility-related tasks evaluated by caregivers for at least one follow-up time point (6 days and 6 weeks post intervention). Two patients accomplished goal attainment for one mobility-related goal each. One patient experienced improvement for both predefined goals, and another participant experienced improvement in one and outreach of the other goal as assessed with the goal attainment scale. Conclusions: frNMS is a safe and well-accepted neuromodulatory approach that could improve the quality of life, especially in regard to activity and participation, of children and adolescents with BSCP. Larger-scaled studies are needed to further explore the effects of frNMS in this setting.
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Affiliation(s)
- Leonie Grosse
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Julian F. Schnabel
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Corinna Börner-Schröder
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Malina A. Späh
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Anne C. Meuche
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany
| | - Ute Breuer
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Birgit Warken
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Florian Heinen
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Steffen Berweck
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Sebastian A. Schröder
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Michaela V. Bonfert
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany (S.B.)
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
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Katırcı E, Adıgüzel H, Katırcı Kırmacı Zİ, Ergun N. The relationship between the backward walking and proprioception, trunk control, and muscle strength in children with cerebral palsy. Ir J Med Sci 2023; 192:2391-2399. [PMID: 36604372 DOI: 10.1007/s11845-022-03270-w] [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: 09/01/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study was planned to determine the factors affecting backward walking in children with cerebral palsy (CP). METHODS The study included 30 children with CP, with a mean age of 10.43 ± 2.76 years. Backward walking abilities were evaluated with the 3-Meter Back Walk Test (3MBWT). A digital goniometer was used to evaluate proprioception, the Trunk Control Measurement Scale (TCMS) was used for trunk control, a digital muscle dynamometer was used for muscle strength, and the Gillette Functional Assessment Questionnaire (FAQ) was used for gait evaluation. RESULTS When the spasticity of children at levels I and II according to the Gross Motor Function Classification System (GMFCS) was compared, a significant difference was found in favor of level I in hamstring, gastro-soleus, and gastrocnemius spasticity (p < 0.05). When the results of the 3MBWT, TCMS, and FAQ were compared, a significant difference was found in favor of level I (p < 0.05). No significant relationship was revealed between the 3MBWT and lower extremity proprioception and TCMS (p > 0.05). A significant negative correlation was observed between the 3MBWT and FAQ (p < 0.05). No significant correlation was found between the 3MBWT and lower extremity muscle strengths (p > 0.05). A significant positive correlation was found only between hip extension proprioception and iliopsoas muscle strength (p = 0.023). There was no significant correlation between the FAQ and lower extremity muscle strength (p > 0.05). CONCLUSION It was revealed that the backward walking ability increased as the forward walking function improved in children with CP, but it was not affected by proprioception, trunk control, and muscle strength. CLINICAL TRIALS NCT05088629 (10/11/2021).
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Affiliation(s)
- Enver Katırcı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, SANKO University, 27090, Gaziantep, Turkey
| | - Hatice Adıgüzel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kahramanmaras Sutcu Imam University, 46100, Kahramanmaras, Turkey
| | - Zekiye İpek Katırcı Kırmacı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kahramanmaras Sutcu Imam University, 46100, Kahramanmaras, Turkey.
| | - Nevin Ergun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, SANKO University, 27090, Gaziantep, Turkey
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Grosse L, Späh MA, Börner C, Schnabel JF, Meuche AC, Parzefall B, Breuer U, Warken B, Sitzberger A, Hösl M, Heinen F, Berweck S, Schröder SA, Bonfert MV. Addressing gross motor function by functional repetitive neuromuscular magnetic stimulation targeting to the gluteal muscles in children with bilateral spastic cerebral palsy: benefits of functional repetitive neuromuscular magnetic stimulation targeting the gluteal muscles. Front Neurol 2023; 14:1161532. [PMID: 37564737 PMCID: PMC10410564 DOI: 10.3389/fneur.2023.1161532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023] Open
Abstract
Background Impaired selective motor control, weakness and spasticity represent the key characteristics of motor disability in the context of bilateral spastic cerebral palsy. Independent walking ability is an important goal and training of the gluteal muscles can improve endurance and gait stability. Combining conventional physical excercises with a neuromodulatory, non-invasive technique like repetitive neuromuscular magnetic stimulation probably enhances effects of the treatment. This prospective study aimed to assess the clinical effects of repetitive neuromuscular magnetic stimulation in combination with a personalized functional physical training offered to children and adolescents with bilateral spastic cerebral palsy. Methods Eight participants Gross Motor Function Classification System level II and III (10.4 ± 2y5m; 50% Gross Motor Function Classification System level II) received a personalized intervention applying functional repetitive neuromuscular magnetic stimulation (12 sessions within 3 weeks; 12,600 total stimuli during each session). At baseline and follow up the following assessments were performed: 10-m-walking-test, 6-min-walking-test, GMFM-66. Six weeks after the end of treatment the patient-reported outcome measure Gait Outcome Assessment List was completed. Results GMFM-66 total score improved by 1.4% (p = 0.002), as did scoring in domain D for standing (1.9%, p = 0.109) and domain E for walking, jumping and running (2.6%, p = 0.021). Gait speed or distance walked during 6 min did not improve from baseline to follow up. Patient-reported outcome showed improvement in 4 patients in altogether 14 ratings. Caregiver-reported outcome reported benefits in 3 participants in altogether 10 ratings. Conclusion Repetitive neuromuscular magnetic stimulation promises to be a meaningful, non-invasive treatment approach for children and adolescents with bilateral spastic cerebral palsy that could be offered in a resource-efficient manner to a broad number of patients. To further investigate the promising effects of repetitive neuromuscular magnetic stimulation and its mechanisms of action, larger-scaled, controlled trials are needed as well as comprehensive neurophysiological investigations.
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Affiliation(s)
- Leonie Grosse
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Malina A. Späh
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Corinna Börner
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julian F. Schnabel
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne C. Meuche
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Barbara Parzefall
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ute Breuer
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Birgit Warken
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexandra Sitzberger
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Florian Heinen
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Steffen Berweck
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Sebastian A. Schröder
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michaela V. Bonfert
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
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Guízar-Sánchez C, Hernández-Díaz C, Guízar-Sánchez D, Meza-Sánchez AV, Torres-Serrano A, Camacho Cruz ME, Ventura-Ríos L. Ultrasound findings in painful spastic hip. Muscle thickness in children with cerebral palsy. BMC Musculoskelet Disord 2023; 24:512. [PMID: 37349815 DOI: 10.1186/s12891-023-06610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In cerebral palsy (CP), spasticity is the dominant symptom and hip pain is one of the most common secondary conditions. Aetiology is not clear. Musculoskeletal ultrasound (MSUS) is a low-cost, non-invasive imaging technique that allows assessment of structural status, dynamic imaging, and quick contralateral comparison. OBJECTIVE A retrospective case-matched-control study. To investigate associated factors with painful spastic hip and to compare ultrasound findings (focusing on muscle thickness) in children with CP vs. typically developing (TD) peers. SETTING Paediatric Rehabilitation Hospital in Mexico City, from August to November 2018. PARTICIPANTS 21 children (13 male, 7 + 4.26 years) with CP, in Gross Motor Function Classification System (GMFCS) levels IV to V, with spastic hip diagnosis (cases) and 21 children age- and sex-matched (7 + 4.28 years) TD peers (controls). CHARACTERISTICALLY DATA Sociodemographic data, CP topography, degree of spasticity, mobility arch, contractures, Visual Analog Scale (VAS), GMFCS, measurements of the volumes of eight major muscles of the hip joint and MSUS findings of both hips. RESULTS All children with CP group reported chronic hip pain. Associated factors for hip pain (high VAS hip pain score) were degree of hip displacement (percentage of migration), Ashworth Level, GMFCS level V. No synovitis, bursitis or tendinopathy was found. Significant differences (p < 0.05) were found in muscle volumes in all hip muscles (right and left) except in the right and left adductor longus. CONCLUSION Though possibly the most important issue with diminished muscle growth in CP children is the influence on their long-term function, it is likely that training routines that build muscle size may also increase muscle strength and improve function in this population. To improve the choice of treatments in this group and maintain muscle mass, longitudinal investigations of the natural history of muscular deficits in CP as well as the impact of intervention are needed.
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Affiliation(s)
- Claudia Guízar-Sánchez
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | | | - Diana Guízar-Sánchez
- Physiology Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, México, Av. Universidad 3004, Col. Copilco Universidad, Alcaldía Coyoacán, Cd. Universitaria.
| | - Ana Victoria Meza-Sánchez
- Radiology and Imaging Department, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubirán., Ciudad de México, México
| | - Alejandra Torres-Serrano
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - María Elena Camacho Cruz
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - Lucio Ventura-Ríos
- Rheumatology Department, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, México
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Harrington JW, Anguiano-Hernandez JG, Kingston DC. Muscle activation and rating of perceived exertion of typically developing children during DRY and aquatic treadmill walking. J Electromyogr Kinesiol 2023; 68:102737. [PMID: 36549263 PMCID: PMC9868073 DOI: 10.1016/j.jelekin.2022.102737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/21/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Aquatic treadmill gait training is a poorly understood rehabilitation method that alters bodyweight support, increases lower limb resistance, and assists with postural stability. This training could be an attractive tool for clinical populations with balance control issues or limited weight-bearing prescriptions for the lower limb. As a first step, the purpose of this study was to quantify differences in mean muscle activity of the tibialis anterior, rectus femoris, medial gastrocnemius, and semitendinosus, and perceived exertion (RPE) in typically developing children (7:8 M:F, age = 11.3 ± 4.1 years, 1.46 ± 0.18 m, and 44.2 ± 16.8 kg) during dry and aquatic treadmill walking at 75 %, 100 %, and 125 % self-selected speed. We hypothesized that the greatest mean muscle activity, normalized to percent maximum voluntary contraction and averaged across all strides, would be observed during 125 % dry treadmill walking and that aquatic treadmill walking would produce lower RPE. Overall, aquatic treadmill walking reduced mean medial gastrocnemius activity by 50.2 % (padj < 0.001), increased mean rectus femoris activity at least 32.8 % (padj < 0.006), and produced 78.0 % (padj = 0.007) greater RPE compared to dry treadmill walking. This study provides normative pediatric data for future aquatic treadmill walking studies in clinical populations to help inform gait rehabilitation protocols.
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Affiliation(s)
- Joseph W Harrington
- Department of Biomechanics, University of Nebraska Omaha, 6001 Dodge St, Omaha, Nebraska 68182, USA.
| | - Jose G Anguiano-Hernandez
- Department of Biomechanics, University of Nebraska Omaha, 6001 Dodge St, Omaha, Nebraska 68182, USA.
| | - David C Kingston
- Department of Biomechanics, University of Nebraska Omaha, 6001 Dodge St, Omaha, Nebraska 68182, USA.
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Mendez-Rebolledo G, Guzman-Muñoz E, Valdés-Badilla P, Ramirez-Campillo R, Cruz-Montecinos C, Núñez-Cortés R, Cabrera-Aguilera I, Calatayud J. Influence of lower limb muscle isometric strength and cardiovascular parameters on locomotor capacity in children and adolescents. J Back Musculoskelet Rehabil 2023; 36:1435-1446. [PMID: 37545211 DOI: 10.3233/bmr-230049] [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] [Indexed: 08/08/2023]
Abstract
BACKGROUND Although measures of exercise performance and physical activity are known to be related to 6-minute walk test (6mWT), the role of the strength of each muscle group of the lower limb in the locomotor capacity during the development period is unknown. OBJECTIVE To identify the role of the isometric strength of lower limb muscles and cardiovascular parameters on the locomotor capacity in children and adolescents, controlling for participants sex, age, and height. METHODS Participants (7 to 15 years old; female, n= 113; male, n= 128) were assessed for isometric strength (seven lower limb muscles), cardiovascular parameters (diastolic pressure, oxygen saturation, resting heart rate, respiratory rate), and 6mWT. Participants were split into nine age groups and separated by 1-year intervals. RESULTS Hip flexors-controlled for sex, age, and height-explained a meaningful percentage of the variance (R=2 0.45; p< 0.001) for 6mWT distance, and the resting heart rate explained a change in R2 of only 2% (p= 0.008). CONCLUSIONS Isometric strength of hip flexors explained ∼ 50% of the 6mWT distance, suggesting the importance of strength from an early age. Other factors, such as cardiovascular parameters, while relevant, may exert a secondary role on youth's capacity.
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Affiliation(s)
- Guillermo Mendez-Rebolledo
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Eduardo Guzman-Muñoz
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences Universidad Católica del Maule, Talca, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Valparaíso, Chile
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ignacio Cabrera-Aguilera
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Concepción, Chile
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
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Feasibility of Functional Repetitive Neuromuscular Magnetic Stimulation (frNMS) Targeting the Gluteal Muscle in a Child with Cerebral Palsy: A Case Report. Phys Occup Ther Pediatr 2022; 43:338-350. [PMID: 37016574 DOI: 10.1080/01942638.2022.2138732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Motor impairment due to spasticity, weakness, and insufficient selective motor control is a key feature of cerebral palsy (CP). For standing and walking, the gluteal muscles play an important role. Physical therapy represents an evidence-based treatment to promote strength and endurance but may be limited to address selective motor control. Treatment incorporating neurostimulating techniques may increase the therapeutic benefits in these situations. PURPOSE The aim of this case report was to evaluate the feasibility, safety and clinical effects of a customized protocol of functional repetitive neuromuscular magnetic stimulation (frNMS). METHODS This case report describes a frNMS protocol applied to the gluteal muscles in an 8-year old boy with bilateral spastic CP. The protocol combines 12 sessions of customized physiotherapeutic exercises with simultaneous electromagnetic stimulation. RESULTS frNMS protocol was adhered to as planned, no relevant adverse events were observed. At day fourafter the intervention the patient reported clinical benefits and improvements of standing and walking assessed by Gross Motor Function Measure dimensions D (+5.1%) and E (+4.2%) were documented. Body sway as measured by center of pressure displacement during posturography decreased. CONCLUSION Clinical studies are warranted to assess effects of frNMS and its mechanisms of action in a controlled setting.
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Verreydt I, Vandekerckhove I, Stoop E, Peeters N, van Tittelboom V, Van de Walle P, Van den Hauwe M, Goemans N, De Waele L, Van Campenhout A, Hanssen B, Desloovere K. Instrumented strength assessment in typically developing children and children with a neural or neuromuscular disorder: A reliability, validity and responsiveness study. Front Physiol 2022; 13:855222. [PMID: 36338500 PMCID: PMC9627606 DOI: 10.3389/fphys.2022.855222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/27/2022] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to determine the clinimetric properties, i.e., reliability, validity and responsiveness of an instrumented strength assessment in typically developing (TD) children and children with cerebral palsy (CP) and Duchenne muscular dystrophy (DMD). Force (N), torque (Nm) and normalized torque (Nm/kg) were defined for maximal voluntary isometric contractions (MVICs) of the lower limb muscles using a pre-established protocol. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) of TD children (n = 14), children with CP (n = 11) and DMD (n = 11) were used to evaluate intra-rater reliability for the three cohorts and the inter-rater intersession as well as inter-rater intrasession reliability for TD children. Construct validity was assessed by comparing MVICs in TD children (n = 28) to children with CP (n = 26) and to children with DMD (n = 30), using the Kruskal Wallis and post-hoc Mann-Whitney U tests. Responsiveness was investigated by assessing changes in MVICs following a strength intervention in CP (n = 26) and a 1 and 2 year follow-up study in DMD (n = 13 and n = 6, respectively), using the Wilcoxon Signed-Rank test. The overall intra-rater reliability, was classified as good to excellent for 65.1%, moderate for 27.0% and poor for 7.9% of the measures (47.6%, 76.2%, and 66.7% good-excellent; 28.6%, 23.8%, and 33.7% moderate; 23.8%, 0%, and 0% poor in TD, CP, and DMD, respectively), while ICC values for TD children were slightly lower for inter-rater intrasession reliability (38.1% good-excellent, 33.3% moderate and 26.6% poor) and for inter-rater intersession reliability (47.6% good-excellent, 23.8% moderate and 28.6% poor). Children with CP and DMD were significantly weaker than TD children (p < 0.001) and the majority of these strength differences exceeded the MDC. Children with CP significantly improved strength after training, with changes that exceeded the SEMs, whereas only limited strength decreases over time were observed in the DMD cohort. In conclusion, the investigated instrumented strength assessment was sufficiently reliable to confirm known-group validity for both cohorts and could detect the responsiveness of children with CP after a strength intervention. However, more research is necessary to determine the responsiveness of this assessment in children with DMD regarding their natural decline.
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Affiliation(s)
- Ineke Verreydt
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Elze Stoop
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Patricia Van de Walle
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerpen, Belgium
- Heder, Laboratory of Clinical Movement Analysis Antwerp, Antwerpen, Belgium
| | - Marleen Van den Hauwe
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Goemans
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Liesbeth De Waele
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Pediatric Orthopedics, Department of Orthopedics, University Hospitals, Leuven, Leuven, Belgium
| | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
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10
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Pontiff M, Moreau NG. Safety and Feasibility of 1-Repetition Maximum (1-RM) Testing in Children and Adolescents With Bilateral Spastic Cerebral Palsy. Pediatr Phys Ther 2022; 34:472-478. [PMID: 35960137 PMCID: PMC9532379 DOI: 10.1097/pep.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to standardize 1-repetition maximum (1-RM) testing procedures and evaluate the safety and feasibility of these procedures in youth with cerebral palsy (CP). METHODS Youth with CP completed 1-RM testing on a leg press. RESULTS Mean absolute, adjusted, and normalized 1-RM loads were 262.4 ± 161.3 lb, 127.0 ± 80.2 lb, and 1.28 ± 0.51, respectively, and 67% were able to successfully lift the same or heavier load after a single failure. Cessation of testing after 1 failed attempt resulted in a 19.0% underestimation of the 1-RM. CONCLUSIONS 1-RM testing in youth with CP is safe and feasible. Multiple attempts at a failed load should be provided to prevent underestimation in strength. The 1-RM test provides a more accurate strength assessment, which will improve the dosing for resistance training in youth with CP.
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Affiliation(s)
- Mattie Pontiff
- Departments of Cell Biology and Anatomy (Dr Pontiff) and Physical Therapy (Drs Pontiff and Moreau), LSU Health Sciences Center, New Orleans, Louisiana
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11
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Fang Y, Orekhov G, Lerner ZF. Adaptive ankle exoskeleton gait training demonstrates acute neuromuscular and spatiotemporal benefits for individuals with cerebral palsy: A pilot study. Gait Posture 2022; 95:256-263. [PMID: 33248858 PMCID: PMC8110598 DOI: 10.1016/j.gaitpost.2020.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait abnormalities from neuromuscular conditions like cerebral palsy (CP) limit mobility and negatively affect quality of life. Increasing walking speed and stride length are essential clinical goals in the treatment of gait disorders from CP. RESEARCH QUESTION How does over-ground gait training with an untethered ankle exoskeleton providing adaptive assistance affect mobility-related spatiotemporal outcomes and lower-extremity muscle activity in people with CP? METHODS A diverse cohort of individuals with CP (n = 6, age 9-31, Gross Motor Function Classification System Level I - III) completed four over-ground training sessions (98 ± 17 min of assisted walking) and received pre- and post-training assessments. On both assessments, participants walked over-ground with and without the exoskeleton while we recorded spatiotemporal outcomes and muscle activity. We used two-tailed paired t-tests to compare all parameters pre- and post-training, and between assisted and unassisted conditions. RESULTS Following training, walking speed increased 0.24 m/s (p = 0.006) and stride length increased 0.17 m (p = 0.013) during unassisted walking, while walking speed increased 0.28 m/s (p = 0.023) and stride length increased 0.15 m (p = 0.002) during exoskeleton-assisted walking. Exoskeleton training improved stride-to-stride repeatability of soleus and vastus lateralis muscle activation by up to 51 % (p ≤ 0.046), while the amount of integrated stance-phase muscle activity was similar across visits and conditions. Relative to baseline, post-training walking with the exoskeleton resulted in a soleus activity pattern that was 39 % more similar to the typical pattern from unimpaired individuals (p < 0.001). SIGNIFICANCE This study demonstrates acute spatiotemporal and neuromuscular benefits from over-ground training with adaptive ankle exoskeleton assistance, and provides rationale for completion of a longer randomized controlled training protocol.
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Affiliation(s)
- Ying Fang
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Greg Orekhov
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Zachary F. Lerner
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA,Department of Orthopedics, the University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
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12
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Daly C, McKeating H, Kiernan D. Age related progression of clinical measures and gait in ambulant children and youth with bilateral cerebral palsy without a history of surgical intervention. Gait Posture 2022; 95:141-148. [PMID: 35489226 DOI: 10.1016/j.gaitpost.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/26/2022] [Accepted: 04/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Age related progression needs to be considered when assessing current status and treatment outcomes in cerebral palsy (CP). RESEARCH QUESTION What is the association between age, gait kinematics and clinical measures in children with bilateral CP? METHOD A retrospective database review was conducted. Subjects with bilateral CP with baseline and follow-up 3D gait analyses, but no history of intervening surgery were identified. Clinical and summary kinematic measures were examined for age related change using repeat measures correlation. Interactions with GMFCS classification and whether surgery was recommended were examined using robust linear regression. Timeseries kinematic data for baseline and most recent follow-up analyses were analysed using statistical parametric mapping. RESULTS 180 subjects were included. 75% of participants were classified as GMFCS I or II at baseline. Mean time to follow-up was 4.89 (2.8) years (range 1-15.9 years) with a mean age of 6.4 (2.4) at baseline and 11.3 (3.4) at final follow-up. 15.5% of subjects demonstrated an improvement in GMFCS classification while GDI remained stable. Age related progression was noted across many clinical measures with moderate correlations (r ≥ 0.5) noted for reduced popliteal angle, long lever hip abduction and internal hip rotation range. In gait, there was reduced hip extension in late stance (p < 0.001), increased knee flexion in mid-stance (p < 0.001), reduced peak knee flexion in swing (p < 0.001) and increased ankle dorsiflexion in stance (p < 0.001). In the coronal plane, there was reduced hip abduction in swing (p < 0.001). In the transverse plane, increased external rotation of the knee (p < 0.001) and reduced external ankle rotation were noted in early stance and through swing (p < 0.001). There were no changes in foot progression or hip rotation. SIGNIFICANCE Individuals with CP show age related progression of clinical and kinematic variables. Treatment can only be deemed successful if outcomes exceed or match these age-related changes.
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Affiliation(s)
- C Daly
- Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - H McKeating
- Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - D Kiernan
- Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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13
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Drumm M, Fabiano J, Lee E, Jezequel J, Rao AK, Yoon L. Effects of Power Training on Gait, Power, and Function in Children with Cerebral Palsy. Phys Occup Ther Pediatr 2022; 42:227-241. [PMID: 34753380 DOI: 10.1080/01942638.2021.1995098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS This scoping review aims to: 1) examine available literature regarding the effects of power training on gait speed, power, and function in ambulatory children with CP and 2) identify the variations in exercise dosage and rehabilitation recommendations for power training and plyometrics in children with CP. METHODS Four databases (PubMed, CINAHL, Embase, and Cochrane) were searched for papers including power or plyometric training with outcome measures for gait, power or functional performance. ES was calculated for RCTs. Cohorts and case series/studies were evaluated qualitatively. RESULTS Ten articles fit search criteria: four RCTs, three cohort studies, one case series, and two case studies. Power training consistently demonstrated improvements in muscle power compared to its effects on gait and function. ES of mean MPST (W) ranged from 0.36-1.13. 1 MWT and SSGS ES were 1.31 and 1.15, respectively. TUG ES ranged from -0.33 to -2.42. ES for GMFM-66 was 0.13 and 1.11 for Dimension D and Dimension E, respectively. CONCLUSIONS There is limited, but promising evidence to support that power training may improve gait speed, power, and function in children with CP. Future, more robust research is required to examine effects in a larger, diverse population, to determine long-term effects and exercise prescription.
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Affiliation(s)
- Michaella Drumm
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia Fabiano
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Evelyn Lee
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer Jezequel
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Department of Rehabilitation and Performance, Hospital for Special Surgery, New York, NY, USA
| | - Ashwini K Rao
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.,G.H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Yoon
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
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14
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Elnaggar RK, Mahmoud WS, Alsubaie SF, Abd El-Nabie WA. Effectiveness of a Multi-Modal Exercise Program Incorporating Plyometric and Balance Training in Children With Hemiplegic Cerebral Palsy: A Three-Armed Randomized Clinical Trial. Phys Occup Ther Pediatr 2022; 42:113-129. [PMID: 34396891 DOI: 10.1080/01942638.2021.1964674] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the effectiveness of a multimodal exercise program incorporating plyometric and balance training on muscle strength and postural stability in children with spastic hemiplegic cerebral palsy (SHCP). METHODS A total of 57 children with SHCP were enrolled in the study and randomly allocated into three treatment-based groups: plyometric exercises (PLYO group; n = 19), balance exercises (BAL group, n = 19), and combined plyometric and balance exercises (PLYO-BAL group; n = 19). The maximum isometric muscle strength (IMSmax) and postural stability [anterior-posterior stability index (AP-SI), mediolateral stability index (ML-SI), and overall stability index (O-SI)] were measured pre- and post-intervention. RESULTS By applying the intention-to-treat analysis, the PLYO-BAL group showed greater post-treatment IMSmax than the PLYO and BAL groups for the quadriceps (p=.03 and p=.0002 respectively), hamstrings (p=.018 and p<.0001 respectively), and dorsiflexors (p=.006 and p<.0001 respectively). Also, the PLYO-BAL group achieved better post-intervention stability scores as compared to PLYO and BAL groups regarding AP-SI (p<.0001 and p=.0001 respectively), ML-SI (p=.001 and p=.015 respectively), and O-SI (p=.011 and p=.04 respectively). CONCLUSIONS Incorporation of plyometric and balance exercises in a multimodal rehabilitation program could be an important consideration for enhancing muscle strength and boosting postural stability in children with SHCP.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Waleed S Mahmoud
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Saud F Alsubaie
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Walaa A Abd El-Nabie
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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15
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Fang Y, Orekhov G, Lerner ZF. Improving the Energy Cost of Incline Walking and Stair Ascent with Ankle Exoskeleton Assistance in Cerebral Palsy. IEEE Trans Biomed Eng 2021; 69:2143-2152. [PMID: 34941495 DOI: 10.1109/tbme.2021.3137447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Many individuals with cerebral palsy (CP) experience gait deficits resulting in metabolically-inefficient ambulation that is exacerbated by graded walking terrains. The primary goal of this study was to clinically-validate the accuracy and efficacy of adaptive ankle exoskeleton assistance during steady-state incline walking and stair ascent in individuals with CP. Exploratory goals were to assess safety and feasibility of using adaptive ankle exoskeleton assistance in real-world mixed-terrain settings. METHODS We used a novel battery-powered ankle exoskeleton to provide adaptive ankle plantar-flexor assistance during stance phase. Seven ambulatory individuals with CP completed the study. RESULTS Adaptive controller accuracy was 85% for incline walking and 81% for stair-stepping relative to the biological ankle moment. Assistance improved energy cost of steady-state incline walking by 14% (p = 0.004) and stair ascent by 21% (p = 0.001) compared to walking without the device. Assistance reduced the muscular demand for the soleus and vastus lateralis during both activities. All participants were able to safely complete the real-world mixed-terrain route, with adaptive ankle assistance resulting in improved outcomes compared to walking with the device providing zero-torque; no group-level differences were found compared to walking without the device, yet individuals with more impairment exhibited a marked improvement. CONCLUSION Adaptive ankle exoskeleton assistance can improve the energy cost of steady-state incline walking and stair ascent in individuals with CP. SIGNIFICANCE As the first study to demonstrate safety and performance benefits of ankle assistance on graded terrains in CP, these findings encourage further investigation in free-living settings.
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16
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Orekhov G, Fang Y, Cuddeback CF, Lerner ZF. Usability and performance validation of an ultra-lightweight and versatile untethered robotic ankle exoskeleton. J Neuroeng Rehabil 2021; 18:163. [PMID: 34758857 PMCID: PMC8579560 DOI: 10.1186/s12984-021-00954-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Ankle exoskeletons can improve walking mechanics and energetics, but few untethered devices have demonstrated improved performance and usability across a wide range of users and terrains. Our goal was to design and validate a lightweight untethered ankle exoskeleton that was effective across moderate-to-high intensity ambulation in children through adults with and without walking impairment. METHODS Following benchtop validation of custom hardware, we assessed the group-level improvements in walking economy while wearing the device in a diverse unimpaired cohort (n = 6, body mass = 42-92 kg). We also conducted a maximal exertion experiment on a stair stepping machine in a small cohort of individuals with cerebral palsy (CP, n = 5, age = 11-33 years, GMFCS I-III, body mass = 40-71 kg). Device usability metrics (device don and setup times and System Usability Score) were assessed in both cohorts. RESULTS There was a 9.9 ± 2.6% (p = 0.012, range = 0-18%) reduction in metabolic power during exoskeleton-assisted inclined walking compared to no device in the unimpaired cohort. The cohort with CP was able to ascend 38.4 ± 23.6% (p = 0.013, range = 3-132%) more floors compared to no device without increasing metabolic power (p = 0.49) or perceived exertion (p = 0.50). Users with CP had mean device don and setup times of 3.5 ± 0.7 min and 28 ± 6 s, respectively. Unimpaired users had a mean don time of 1.5 ± 0.2 min and setup time of 14 ± 1 s. The average exoskeleton score on the System Usability Scale was 81.8 ± 8.4 ("excellent"). CONCLUSIONS Our battery-powered ankle exoskeleton was easy to use for our participants, with initial evidence supporting effectiveness across different terrains for unimpaired adults, and children and adults with CP. Trial registration Prospectively registered at ClinicalTrials.gov (NCT04119063) on October 8, 2019.
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Affiliation(s)
- Greg Orekhov
- Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR Bldg 69, Flagstaff, AZ, 86011, USA
| | - Ying Fang
- Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR Bldg 69, Flagstaff, AZ, 86011, USA
| | - Chance F Cuddeback
- Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR Bldg 69, Flagstaff, AZ, 86011, USA
| | - Zachary F Lerner
- Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR Bldg 69, Flagstaff, AZ, 86011, USA.
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA.
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17
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Darras N, Nikaina E, Tziomaki M, Gkrimas G, Papavasiliou A, Pasparakis D. Development of Lower Extremity Strength in Ambulatory Children With Bilateral Spastic Cerebral Palsy in Comparison With Typically Developing Controls Using Absolute and Normalized to Body Weight Force Values. Front Neurol 2021; 12:617971. [PMID: 33815249 PMCID: PMC8017198 DOI: 10.3389/fneur.2021.617971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
This cross-sectional study aimed to examine the development of lower limb voluntary strength in 160 ambulatory patients with bilateral spastic cerebral palsy (CP) (106 diplegics/54 quadriplegics) and 86 typically developing (TD) controls, aged 7–16 years. Handheld dynamometry was used to measure isometric strength of seven muscle groups (hip adductors and abductors, hip extensors and flexors, knee extensors and flexors, and ankle dorsiflexors); absolute force (AF) values in pounds were collected, which were then normalized to body weight (NF). AF values increased with increasing age (p < 0.001 for all muscle groups), whereas NF values decreased through adolescence (p < 0.001 for all muscle groups except for hip abduction where p = 0.022), indicating that increases in weight through adolescence led to decreases in relative force. Both AF and NF values were significantly greater in TD subjects when compared with children with CP in all muscle and all age groups (p < 0.001). Diplegics and quadriplegics demonstrated consistently lower force values than TD subjects for all muscle groups, except for the hip extensors where TD children had similar values with diplegics (p = 0.726) but higher than quadriplegics (p = 0.001). Diplegic patients also exhibited higher values than quadriplegics in all muscles, except for the knee extensors where their difference was only indicative (p = 0.056). The conversion of CP subjects' force values as a percentage of the TD subjects' mean value revealed a pattern of significant muscle strength imbalance between the CP antagonist muscles, documented from the following deficit differences for the CP muscle couples: (hip extensors 13%) / (hip flexors 32%), (adductors 27%) / (abductors 52%), and (knee extensors 37%) / (knee flexors 53%). This pattern was evident in all age groups. Similarly, significant force deficiencies were identified in GMFCS III/IV patients when compared with TD children and GMFCS I/II patients. In this study, we demonstrated that children and adolescents with bilateral CP exhibited lower strength values in lower limb muscles when compared with their TD counterparts. This difference was more prevalent in quadriplegic patients and those with a more severe impairment. An important pattern of muscle strength imbalance between the antagonist muscles of the CP subjects was revealed.
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Affiliation(s)
| | - Eirini Nikaina
- First Department of Pediatrics, "Aghia Sophia" Children's Hospital, University of Athens, Athens, Greece
| | | | - Georgios Gkrimas
- Gait & Motion Analysis Center, ELEPAP, Athens, Greece.,Laboratory of Neuromuscular and Cardiovascular Study of Motion - LANECASM, Athens, Greece
| | | | - Dimitrios Pasparakis
- Gait & Motion Analysis Center, ELEPAP, Athens, Greece.,Pediatric Orthopaedic Department, Athens Medical Center, Athens, Greece
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18
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Short walking exercise leads to gait changes and muscle fatigue in children with cerebral palsy who walk with jump gait. Am J Phys Med Rehabil 2021; 100:1093-1099. [PMID: 33587452 DOI: 10.1097/phm.0000000000001713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate kinematic changes and muscle fatigue in jump gait during a walking exercise, and the relationship between kinematic changes and muscle fatigue and strength. DESIGN This preliminary study included ten children with cerebral palsy (CP) who walk with jump gait. Hip and knee maximal isometric muscle strength were measured using a dynamometer. Then, lower-limb kinematics and electromyography were collected while children walked continuously for 6-min at their self-selected speed. Electromyography median frequency and lower-limb joint angles were compared between the first and the sixth minute of the walking exercise using T-test and Wilcoxon rank test. Relationship between kinematic changes and muscle strength and changes in electromyography median frequency were assessed using correlation analyses. RESULTS During stance, maximal knee flexion significantly increased at the sixth minute (P=0.01) and was associated with knee extensor muscle weakness (rho=-0.504, P=0.03). Muscle fatigue was only observed in gluteus medius muscle (P=0.01). CONCLUSIONS Children with CP who walked with jump gait and who had knee extensor weakness were more prone to an increase in knee flexion during a continuous walk. The fatigue in the gluteus medius muscle suggests that physical intervention should target the endurance of this muscle to improve jump gait.
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19
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Improvements in Muscle Strength Are Associated With Improvements in Walking Capacity in Young Children With Cerebral Palsy: A Secondary Analysis. Pediatr Phys Ther 2021; 33:24-30. [PMID: 33273255 DOI: 10.1097/pep.0000000000000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate whether changes in lower-limb muscle strength explain changes in walking capacity during 14-week periods of usual care, power training and follow-up for children with spastic cerebral palsy. METHODS Secondary analysis of a previously conducted double-baseline controlled trial of 22 children with spastic cerebral palsy. Generalized estimating equations were used to evaluate the relationships between within-subject changes in isometric muscle strength and walking capacity over 3 periods. RESULTS Changes in hip abductor strength were associated with changes in the Muscle Power Sprint Test, changes in gastrocnemius and hip abductor strength were associated with changes in the Shuttle Run Test, and changes in gastrocnemius strength were associated with changes in the 1-minute walk test. All associations supported better walking capacity with increased strength. CONCLUSION Walking capacity, especially sprint capacity, can be improved by increasing strength by functional power training in this population.
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20
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Martakis K, Stark C, Rehberg M, Semler O, Duran I, Schoenau E. Reference Centiles to Monitor the 6-minute-walk Test in Ambulant Children with Cerebral Palsy and Identification of Effects after Rehabilitation Utilizing Whole-body Vibration. Dev Neurorehabil 2021; 24:45-55. [PMID: 32564635 DOI: 10.1080/17518423.2020.1770891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Children with cerebral palsy present age-driven development in gross motor skills and walking capacity. Aims: To precisely monitor the 6-minute walk test (6MWT) in children with CP, GMFCS levels 1 and 2 over 6 months and to assess the effect of a 6-month rehabilitation program including whole-body vibration. Methods: Retrospective analysis of data of 157 children with CP who received standardized rehabilitation (DRKS00011331). 6MWT was assessed at the start (M0) and end of the training (M6), as well as at a 6-month follow-up (M12). Centiles were created using the lambda-mu-sigma (LMS) method. Results: We created 6MWT percentiles using data of all 157 children (M0 data). A medium treatment effect size (Cohen's d = 0.69) was found (M6 and M12 data). Conclusions: The generated centiles may help monitor 6MWT changes over 6 months. Combining WBV and conventional physiotherapy can significantly improve 6MWT in children with CP. Abbreviations: 6MWT: 6-Minute Walk Test; CP: Cerebral palsy; ES: effect size; GMFCS: Gross Motor Function Classification System; GMFM-66: Gross Motor Function Measure 66; LOESS: locally weighted scatterplot smoothing; LMS: lambda-mu-sigma; MCID: minimal clinical important difference; SD: standard deviation; SRM: standardized response mean; WBV: whole-body vibration.
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Affiliation(s)
- Kyriakos Martakis
- Medical Faculty and University Hospital, Centre of Prevention and Rehabilitation , Cologne, Germany.,Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute, School CAPHRI, Maastricht University , Maastricht, The Netherlands.,Department of Pediatric Neurology, Social Pediatrics and Epileptology, Justus-Liebig-University Giessen and UKGM , Giessen, Germany
| | - Christina Stark
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne , Cologne, Germany
| | - Mirko Rehberg
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Centre for Rare Skeletal Diseases in Childhood, University of Cologne , Cologne, Germany
| | - Oliver Semler
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Centre for Rare Skeletal Diseases in Childhood, University of Cologne , Cologne, Germany
| | - Ibrahim Duran
- Medical Faculty and University Hospital, Centre of Prevention and Rehabilitation , Cologne, Germany
| | - Eckhard Schoenau
- Medical Faculty and University Hospital, Centre of Prevention and Rehabilitation , Cologne, Germany.,Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne , Cologne, Germany.,Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne , Cologne, Germany
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Abstract
ABSTRACT Cerebral palsy (CP) is a group of debilitating motor disorders that carries a wide array of clinical presentations ranging from isolated physical or cognitive impairment to global loss of function. Despite the prevalence of CP, recommendations and benefits of physical activity/exercise have historically not been clearly defined. The research on the subject has several limitations, including small sample size, power, standardized measures/outcomes, and poor classification regarding severity of the disease. Nonetheless, the general consensus and new research shows that individuals with CP who participate in sports and exercise regimens, even at reduced frequency and intensity, exhibit improvements in health care benefits, including cardiorespiratory endurance, gross motor function, gait stability, and reduction in pain. These regimens can be prescribed safely and individualized by health care providers to improve morbidity and mortality in patients suffering from CP.
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Affiliation(s)
- James Toldi
- Institute for Brain Protection Sciences, Division of Sports Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Joseph Escobar
- Department of Family Medicine, University of South Alabama, Mobile, AL
| | - Austin Brown
- Department of Family Medicine, University of South Alabama, Mobile, AL
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Cherni Y, Ballaz L, Lemaire J, Dal Maso F, Begon M. Effect of low dose robotic-gait training on walking capacity in children and adolescents with cerebral palsy. Neurophysiol Clin 2020; 50:507-519. [DOI: 10.1016/j.neucli.2020.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/01/2022] Open
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Intraobserver Reliability and Construct Validity of the Squat Test in Children With Cerebral Palsy. Pediatr Phys Ther 2020; 32:399-403. [PMID: 32991569 DOI: 10.1097/pep.0000000000000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study evaluated intraobserver reliability and construct validity of the squat test to assess lower extremity strength in children with cerebral palsy (CP) and spastic diplegia. METHODS Children with CP performed 2 trials of the squat test and calculated the intraclass correlation coefficient to evaluate intraobserver reliability. Correlations between outcomes of hand-held dynamometry (HHD) of knee extensor strength and an 8-repetition maximum (8RM) leg press test and the squat test were calculated to evaluate construct validity. RESULTS Excellent intraobserver reliability was observed for the squat test. Correlations between squat test performance and HHD knee extension and 8RM leg press test demonstrated good construct validity. CONCLUSIONS The squat test is a reliable and valid tool to assess lower extremity strength in children with CP and spastic diplegia. The squat test is inexpensive and less time-consuming, and therefore particularly suitable for clinicians.
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Pouliot-Laforte A, Parent A, Hamdy R, Marois P, Lemay M, Ballaz L. Relationship between lower limb strength and walking capacities in children with spastic bilateral cerebral palsy. Disabil Rehabil 2020; 44:1916-1922. [DOI: 10.1080/09638288.2020.1813819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Annie Pouliot-Laforte
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
- Department of Biological Sciences, Université du Québec à Montréal (UQAM), Montreal, Canada
| | - Audrey Parent
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
- Department of Biological Sciences, Université du Québec à Montréal (UQAM), Montreal, Canada
| | - Reggie Hamdy
- Shriners Hospital for Children-Canada, Montreal, Canada
| | - Pierre Marois
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Martin Lemay
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
- Department of Physical Activity Sciences, Université du Québec à Montréal (UQAM), Montreal, Canada
| | - Laurent Ballaz
- Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada
- Department of Physical Activity Sciences, Université du Québec à Montréal (UQAM), Montreal, Canada
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Heitzmann DWW, Leboucher J, Block J, Günther M, Putz C, Götze M, Wolf SI, Alimusaj M. The influence of hip muscle strength on gait in individuals with a unilateral transfemoral amputation. PLoS One 2020; 15:e0238093. [PMID: 32877428 PMCID: PMC7467296 DOI: 10.1371/journal.pone.0238093] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION A unilateral transfemoral amputation (TFA) has a major impact on function. A leg-length discrepancy is the primary structural change, accompanied by the loss of lower-limb muscle volume and function. Prostheses can help individuals with a TFA to regain function, but such individuals still do not reach the functional level of unimpaired peers and exhibit gait deviations. This study gives insight into the causality between residual limb strength and gait deviations in individuals with a TFA. METHODS A convenient sample of 13 male individuals with a TFA (38.0 ± 12.6y; 179.7cm ± 6.5cm; 82.9kg ± 12.4kg) was recruited for this study. One participant with TFA was excluded, as he differed from the rest of the cohort, in residual limb length and the use of walking aids. A cohort of 18 unimpaired subjects served as a reference group (REF; nine females; 44y ± 13y; 174cm ± 9cm; 71kg ± 12kg). All participants underwent a conventional clinical gait analysis using a marker based 3D motion capture system and force platforms. Kinematics and kinetics were determined utilizing standard modelling methods. All subjects underwent a strength test, using a custom-made device to determine isometric moments of the hip joint in abduction, adduction, extension, and flexion. Peak values for maximum isometric moments for each movement direction and selected kinematic and kinetic values were derived from the results. Differences between subjects with TFA and unimpaired were compared using a Mann-Whitney U Test and associations between groups by Spearman's rank correlation. RESULTS The participants with a TFA showed a significantly lower maximum isometric moment for hip abduction (0.85 vs. 1.41 Nm/kg p < .001), adduction (0.87 vs. 1.37 Nm/kg p = .001) and flexion (0.93 vs. 1.63 Nm/kg p = .010) compared to the reference group. Typically reported gait deviations in people with a TFA were identified, i.e. significant lower cadence and increased step width. We further identified altered coronal plane hip and trunk kinematics, with significantly higher ranges of motion during involved side stance-phase. Gait kinetics of individuals with a TFA showed significantly lower peak values during stance for hip abduction, adduction and extension moments in comparison to the reference group. We identified a moderate negative correlation between maximum isometric moment for hip abduction and trunk obliquity range of motion (ρ = -0.45) for participants with a TFA, which was not significant (p = 0.14). CONCLUSION We showed that there are strength deficits in individuals with TFA and, that there are moderate correlations between gait deviations, i.e. lateral trunk lean during involved side stance and isometric hip abductor moment. The relation between maximum moments during gait and the corresponding maximum isometric moment may therefore be helpful to detect strength related compensation mechanisms. However, the moderate, non-significant correlation between lateral trunk lean and isometric hip abductor moment was the only one which corresponded directly to a gait deviation. Thus results must be interpreted with care. This study suggests that gait deviations in individuals with TFA are multifactorial and cannot be exclusively explained by their strength deficits. Future studies should explore the relationship between strength with kinematics and kinetics during gait in this population.
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Affiliation(s)
- Daniel Walter Werner Heitzmann
- Motion Analysis Lab, Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Orthopaedics and Trauma Surgery, Prosthetics and Orthotics Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Julien Leboucher
- Motion Analysis Lab, Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Block
- Motion Analysis Lab, Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Orthopaedics and Trauma Surgery, Prosthetics and Orthotics Department, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Cornelia Putz
- Motion Analysis Lab, Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Orthopaedics and Trauma Surgery, Prosthetics and Orthotics Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Götze
- Motion Analysis Lab, Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Immanuel Wolf
- Motion Analysis Lab, Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Merkur Alimusaj
- Motion Analysis Lab, Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Orthopaedics and Trauma Surgery, Prosthetics and Orthotics Department, Heidelberg University Hospital, Heidelberg, Germany
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Martakis K, Stark C, Rehberg M, Semler O, Duran I, Schoenau E. One-Minute Walk Test in Children with Cerebral Palsy GMFCS Level 1 and 2: Reference Values to Identify Therapeutic Effects after Rehabilitation. Dev Neurorehabil 2020; 23:201-209. [PMID: 31177878 DOI: 10.1080/17518423.2019.1625981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Children with cerebral palsy (CP) show age-driven development and individual fluctuations in walking capacity.Aim: 1. To precisely quantify 1MWT changes in children with CP, GMFCS level 1 and 2, generating 1MWT percentiles, depicting expected development over 6 months; 2. to assess the effect of a 6-month rehabilitation using whole-body vibration (WBV).Methods: Retrospective data analysis in 210 children with CP, GMFCS 1 and 2 who received standardized rehabilitation (DRKS00011331). 1MWT was assessed before (M0) and after treatment (M6), and at a 6-month follow-up (M12). Centiles were created using the lambda-mu-sigma method. Cohen's d was used to assess effect size.Results: We created 1MWT percentiles using data of all 210 children (M0 data). A small treatment effect size (d = 0.46) was found (M6 and M12 data).Conclusions: Using the generated centiles clinicians may monitor 1MWT changes over 6 months. Combining WBV and conventional physiotherapy may improve 1MWT in children with CP.Abbreviations: 1MWT: One-Minute Walk Test; 6MWT: Six-Minute Walk Test; CP: Cerebral palsy; ES: effect size; GMFCS: Gross Motor Function Classification System; GMFM-66: Gross Motor Function Measure 66; LOESS: Locally Estimated Scatterplot Smoothing; LMS: lambda-mu-sigma; SD: standard deviation; WBV: whole-body-vibration.
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Affiliation(s)
- Kyriakos Martakis
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Centre for Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Department for Pediatric Neurology, Justus-Liebig University of Giessen, Giessen, Germany.,Department for International Health, FHML, Maastricht University, Maastricht, The Netherlands
| | - Christina Stark
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Mirko Rehberg
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Ibrahim Duran
- Centre for Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Eckhard Schoenau
- Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.,Centre for Prevention and Rehabilitation, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
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Bostock EL, O'Dowd DN, Payton CJ, Smith D, Orme P, Edwards BT, Morse CI. The Effects of Resistance Exercise Training on Strength and Functional Tasks in Adults With Limb-Girdle, Becker, and Facioscapulohumeral Dystrophies. Front Neurol 2019; 10:1216. [PMID: 31803134 PMCID: PMC6877715 DOI: 10.3389/fneur.2019.01216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/01/2019] [Indexed: 01/10/2023] Open
Abstract
Background: The inclusion of resistance training in the treatment and management of muscular dystrophy has previously been discouraged, based on mainly anecdotal evidence. There remains a lack of experimental investigation into resistance training in individuals with muscular dystrophy. The aim of the current study was therefore, to determine the effect of a 12-week resistance training programme on muscle strength and functional tasks in ambulatory adults with muscular dystrophy. Methods: Seventeen ambulatory adults with muscular dystrophy (Facioscapulohumeral muscular dystrophy: n = 6, Limb-Girdle muscular dystrophy: n = 6, Becker muscular dystrophy: n = 5) were recruited for this study. Participants attended three testing sessions: one session at baseline, one session after a 12-week control period and one session after a 12-week resistance training period. Each testing session consisted of measurements of isometric knee extensor and knee flexor maximum voluntary contraction (MVC) torque (Cybex dynamometer). Participants also completed a timed sit-to-stand, a four steps-stair ascent, and a four steps-stair decent. The 12-week resistance training period consisted of two supervised sessions a week. Each training session included a 5-min warm-up, a step-up exercise, free-standing or assisted squats, knee flexion and knee extension exercises, and an additional 6 single-joint exercises specific to each individual's needs. Results: Knee flexor MVC torque increased by 13% after the 12-week resistance training programme (p < 0.05), with no change over the control period. Knee extensor MVC torque did not significantly change after the training programme or the control period. Time taken to complete sit-to-stand, stair ascent and stair descent all decreased (improved) following the 12-week training programme (p < 0.05). Conclusions: A twice-a-week, 12-week, resistance training programme resulted in increased knee flexion strength and improvements in functional tasks in ambulatory adults with muscular dystrophy. This provides support for the inclusion of resistance training in the treatment programmes for these forms of muscular dystrophy.
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Affiliation(s)
- Emma L Bostock
- Musculoskeletal Physiology Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Dawn N O'Dowd
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Carl J Payton
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Dave Smith
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Paul Orme
- The Neuromuscular Centre, Winsford, United Kingdom
| | | | - Christopher I Morse
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
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Cherni Y, Girardin-Vignola G, Ballaz L, Begon M. Reliability of maximum isometric hip and knee torque measurements in children with cerebral palsy using a paediatric exoskeleton – Lokomat. Neurophysiol Clin 2019; 49:335-342. [DOI: 10.1016/j.neucli.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 01/01/2023] Open
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Evaluation of a method to scale muscle strength for gait simulations of children with cerebral palsy. J Biomech 2019; 83:165-173. [DOI: 10.1016/j.jbiomech.2018.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 11/22/2022]
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Hegarty AK, Kurz MJ, Stuberg W, Silverman AK. Strength Training Effects on Muscle Forces and Contributions to Whole-Body Movement in Cerebral Palsy. J Mot Behav 2018; 51:496-510. [PMID: 30351246 DOI: 10.1080/00222895.2018.1519691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Strength training is often prescribed for children with cerebral palsy (CP); however, links between strength gains and mobility are unclear. Nine children (age 14 ± 3 years; GMFCS I-III) with spastic CP completed a 6-week strength-training program. Musculoskeletal gait simulations were generated for four children to assess training effects on muscle forces and function. There were increases in isometric joint strength, but no statistical changes in fast-as-possible walking speed or endurance after training. The walking simulations revealed changes in muscle forces and contributions to body center of mass acceleration, with greater forces from the hip muscles during walking most commonly observed. A progressive strength-training program can result in isometric and dynamic strength gains in children with CP, associated with variable mobility outcomes.
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Affiliation(s)
- Amy K Hegarty
- a Department of Mechanical Engineering , Colorado School of Mines , Golden , CO , USA
| | - Max J Kurz
- b Department of Physical Therapy , Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center , Omaha , NE , USA
| | - Wayne Stuberg
- b Department of Physical Therapy , Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center , Omaha , NE , USA
| | - Anne K Silverman
- a Department of Mechanical Engineering , Colorado School of Mines , Golden , CO , USA
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van Vulpen LF, de Groot S, Rameckers EA, Becher JG, Dallmeijer AJ. Improved parent-reported mobility and achievement of individual goals on activity and participation level after functional power-training in young children with cerebral palsy: a double-baseline controlled trial. Eur J Phys Rehabil Med 2018. [DOI: 10.23736/s1973-9087.18.04921-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Verschuren O, Smorenburg AR, Luiking Y, Bell K, Barber L, Peterson MD. Determinants of muscle preservation in individuals with cerebral palsy across the lifespan: a narrative review of the literature. J Cachexia Sarcopenia Muscle 2018; 9:453-464. [PMID: 29392922 PMCID: PMC5989853 DOI: 10.1002/jcsm.12287] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/23/2017] [Accepted: 01/07/2018] [Indexed: 12/16/2022] Open
Abstract
In individuals with cerebral palsy (CP), smaller muscle and atrophy are present at young age. Many people with CP also experience a decline in gross motor function as they age, which might be explained by the loss of muscle mass. The clinical observation of muscle wasting has prompted a comparison with sarcopenia in older adults, and the term accelerated musculoskeletal ageing is often used to describe the hallmark phenotype of CP through the lifespan. However, there has been very little research emphasis on the natural history of ageing with CP and even less with respect to the determinants or prevention of muscle loss with CP. Considering the burgeoning interest in the science of muscle preservation, this paper aims to (i) describe the characteristics of accelerated musculoskeletal ageing in people with CP, (ii) describe the pathophysiology of sarcopenia and parallels with CP, and (iii) discuss possible therapeutic approaches, based on established approaches for sarcopenia.
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Affiliation(s)
- Olaf Verschuren
- Brain Center Rudolf Magnus, Center of Excellence for Rehabilitation Medicine, De Hoogstraat RehabilitationUniversity Medical Center UtrechtRembrandtkade 10Utrecht3583TMThe Netherlands
| | | | - Yvette Luiking
- Nutricia ResearchAdvanced Medical NutritionUtrechtThe Netherlands
| | - Kristie Bell
- Child Health Research CentreThe University of QueenslandBrisbaneAustralia
- Lady Cilento Children's HospitalSouth BrisbaneQueenslandAustralia
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Mark D. Peterson
- Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMIUSA
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Gillett JG, Lichtwark GA, Boyd RN, Barber LA. Functional Capacity in Adults With Cerebral Palsy: Lower Limb Muscle Strength Matters. Arch Phys Med Rehabil 2018; 99:900-906.e1. [DOI: 10.1016/j.apmr.2018.01.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/03/2018] [Accepted: 01/17/2018] [Indexed: 11/17/2022]
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Effects of the Integration of Dynamic Weight Shifting Training Into Treadmill Training on Walking Function of Children with Cerebral Palsy: A Randomized Controlled Study. Am J Phys Med Rehabil 2017. [PMID: 28644244 DOI: 10.1097/phm.0000000000000776] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether applying an assistance force to the pelvis and legs during treadmill training can improve walking function in children with cerebral palsy. DESIGN Twenty-three children with cerebral palsy were randomly assigned to the robotic or treadmill only group. For participants who were assigned to the robotic group, a controlled force was applied to the pelvis and legs during treadmill walking. For participants who were assigned to the treadmill only group, manual assistance was provided as needed. Each participant trained 3 times/wk for 6 wks. Outcome measures included walking speed, 6-min walking distance, and clinical assessment of motor function, which were evaluated before, after training, and 8 wks after the end of training, and were compared between two groups. RESULTS Significant increases in walking speed and 6-min walking distance were observed after robotic training (P = 0.03), but no significant change was observed after treadmill training only. A greater increase in 6-min walking distance was observed after robotic training than that after treadmill only training (P = 0.01). CONCLUSIONS Applying a controlled force to the pelvis and legs, for facilitating weight-shift and leg swing, respectively, during treadmill training may improve walking speed and endurance in children with cerebral palsy. 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 GMFCS level I, II and III following 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 0.5 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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van Vulpen LF, de Groot S, Rameckers E, Becher JG, Dallmeijer AJ. Improved Walking Capacity and Muscle Strength After Functional Power-Training in Young Children With Cerebral Palsy. Neurorehabil Neural Repair 2017; 31:827-841. [DOI: 10.1177/1545968317723750] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background. Strength training programs for children with cerebral palsy (CP) showed inconclusive evidence for improving walking, despite improvements in strength. Recent studies have suggested that strength training with high movement velocity is more effective for improving walking than traditional resistance training. Objective. The purpose of this study was to evaluate the effect of functional high-velocity resistance training (power-training) to improve muscle strength and walking capacity of children with CP. Method. Twenty-two children with spastic CP participated (13 bilateral, Gross Motor Function Classification System [GMFCS] level I [n = 10] and II [n = 12], 7.5 years [SD 1.8, range 4-10 years]). Within-subjects changes in a 14-weeks usual care period were compared with changes in a 14-week functional power-training period (in groups, 3×/wk). Outcome measures were the muscle power sprint test (MPST), 1-minute walk test (1MWT), 10-m shuttle run test (SRT), gross motor function (GMFM-66), isometric strength of lower-limb muscles and dynamic ankle plantar flexor strength. Results. Changes during the training period were significantly larger than changes in the usual care period for all outcome measures ( P < .05). Large improvements were found during the training period for walking capacity (ΔMPST [mean]: 27.6 W [95%CI 15.84-39.46, 83% increase], Δ1MWT: 9.4 m [95% CI 4.17-14.68, 13%], ΔSRT: 4.2 [95%CI 2.57-5.83, 56%], ΔGMFM-66: 5.5 [95% CI 3.33-7.74, 7%]) and muscle strength (18%-128%), while outcomes remained stable in the usual care period. Conclusions. The results indicate that functional power-training is an effective training for improving walking capacity in young children with cerebral palsy.
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Affiliation(s)
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
- University of Groningen, University Medical Center Groningen, the Netherlands
| | - Eugene Rameckers
- School for Public Health and Primary Care (CAPHRI), Maastricht University, the Netherlands
- University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, the Netherlands
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36
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Qiu A, Yang Z, Li Z. Recent perspectives of cerebral palsy in children. Minerva Pediatr 2017; 71:297-303. [PMID: 28353322 DOI: 10.23736/s0026-4946.17.04880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The movement and posture disorder of cerebral palsy (CP) is presumed to mainly be a consequence of the motor disorder, but accompanying disturbances with sensations and perception have also been suggested to influence motor function. The heterogeneous condition of CP is caused by an injury to the immature brain affecting movement and posture development. The attainment of standing and walking can be difficult and an assistive device to accomplish the tasks may be required for some children with CP. In this review, we enlightened the role of possible sensory and perceptual disturbances for standing difficulties in children with CP.
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Affiliation(s)
- Aizhen Qiu
- Department of Rehabilitation, Xuzhou Children's Hospital, Xuzhou, China
| | - Zhongxiu Yang
- Department of Rehabilitation, Xuzhou Children's Hospital, Xuzhou, China -
| | - Zhilin Li
- Department of Rehabilitation, Xuzhou Children's Hospital, Xuzhou, China
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37
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Houdijk H, Janssen TWJ. Disability and rehabilitation on the move: mobility, exercise and sports for people with physical disabilities. Disabil Rehabil 2016; 39:113-114. [DOI: 10.1080/09638288.2016.1217079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Han Houdijk
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
- Heliomare Research and Development, Wijk Aan Zee, The Netherlands
| | - Thomas W. J. Janssen
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
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38
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Gillett JG, Boyd RN, Carty CP, Barber LA. The impact of strength training on skeletal muscle morphology and architecture in children and adolescents with spastic cerebral palsy: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 56:183-196. [PMID: 27337690 DOI: 10.1016/j.ridd.2016.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/27/2016] [Accepted: 06/03/2016] [Indexed: 06/06/2023]
Abstract
AIM The aim of this study was to systematically review the current literature to determine the impact of strength training on skeletal muscle morphology and architecture in individuals aged 4-20 years with spastic type cerebral palsy. METHODS A comprehensive search for randomised and non-randomised controlled trials, cohort studies and cross-comparison trials was performed on five electronic databases. Included studies were graded according to level of evidence and assessed for methodological quality using the Downs and Black scale. Quantitative data was analysed using effect sizes. RESULTS Six of 304 articles met the inclusion criteria. Methodological quality of the included papers ranged from 14 to 19 (out of 32). A large effect was found on muscle cross-sectional area following strength training, with small to moderate effects on muscle volume and thickness. CONCLUSION AND IMPLICATIONS There is preliminary evidence that strength training leads to hypertrophy in children and adolescents with CP. A paucity of studies exist measuring morphological and architectural parameters following strength training in these individuals. Overall low study methodological quality along with heterogeneous study design, dissimilar outcome measures, and lack of adequate control groups, indicated that care is needed when interpreting the results of these studies in isolation.
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Affiliation(s)
- Jarred G Gillett
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, South Brisbane, Queensland, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, South Brisbane, Queensland, Australia
| | - Christopher P Carty
- Queensland Children's Motion Analysis Service, Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lee A Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, South Brisbane, Queensland, Australia
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39
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Kinematic and EMG Responses to Pelvis and Leg Assistance Force during Treadmill Walking in Children with Cerebral Palsy. Neural Plast 2016; 2016:5020348. [PMID: 27651955 PMCID: PMC5019900 DOI: 10.1155/2016/5020348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022] Open
Abstract
Treadmill training has been used for improving locomotor function in children with cerebral palsy (CP), but the functional gains are relatively small, suggesting a need to improve current paradigms. The understanding of the kinematic and EMG responses to forces applied to the body of subjects during treadmill walking is crucial for improving current paradigms. The objective of this study was to determine the kinematics and EMG responses to the pelvis and/or leg assistance force. Ten children with spastic CP were recruited to participate in this study. A controlled assistance force was applied to the pelvis and/or legs during stance and swing phase of gait through a custom designed robotic system during walking. Muscle activities and spatial-temporal gait parameters were measured at different loading conditions during walking. In addition, the spatial-temporal gait parameters during overground walking before and after treadmill training were also collected. Applying pelvis assistance improved step height and applying leg assistance improved step length during walking, but applying leg assistance also reduced muscle activation of ankle flexor during the swing phase of gait. In addition, step length and self-selected walking speed significantly improved after one session of treadmill training with combined pelvis and leg assistance.
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