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Garcia-Carrillo E, Ramirez-Campillo R, Izquierdo M, Elnaggar RK, Afonso J, Peñailillo L, Araneda R, Ebner-Karestinos D, Granacher U. Effects of Therapies Involving Plyometric-Jump Training on Physical Fitness of Youth with Cerebral Palsy: A Systematic Review with Meta-Analysis. Sports (Basel) 2024; 12:152. [PMID: 38921846 PMCID: PMC11207881 DOI: 10.3390/sports12060152] [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: 04/22/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of this systematic review was to assess the effects of plyometric-jump training (PJT) on the physical fitness of youth with cerebral palsy (CP) compared with controls (i.e., standard therapy). The PRISMA 2020 guidelines were followed. Eligibility was assessed using the PICOS approach. Literature searches were conducted using the PubMed, Web of Science, and SCOPUS databases. Methodological study quality was assessed using the PEDro scale. Data were meta-analyzed by applying a random-effects model to calculate Hedges' g effect sizes (ES), along with 95% confidence intervals (95% CI). The impact of heterogeneity was assessed (I2 statistic), and the certainty of evidence was determined using the GRADE approach. Eight randomized-controlled studies with low-to-moderate methodological quality were included, involving male (n = 225) and female (n = 138) youth aged 9.5 to 14.6 years. PJT interventions lasted between 8 and 12 weeks with 2-4 weekly sessions. Compared with controls, PJT improved the muscle strength (ES = 0.66 [moderate], 95% CI = 0.36-0.96, p < 0.001, I2 = 5.4%), static (ES = 0.69 [moderate], 95% CI= 0.33-1.04, p < 0.001, I2 = 0.0%) and dynamic balance (ES = 0.85 [moderate], 95% CI = 0.12-1.58, p = 0.023, I2 = 81.6%) of youth with CP. Therefore, PJT improves muscle strength and static and dynamic balance in youth with CP compared with controls. However, more high-quality randomized-controlled trials with larger sample sizes are needed to provide a more definitive recommendation regarding the use and safety of PJT to improve measures of physical fitness.
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Affiliation(s)
- Exal Garcia-Carrillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Navarra Institute for Health Research (IdiSNA), Universidad Pública de Navarra (UPNA), 31008 Pamplona, Spain;
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Navarra Institute for Health Research (IdiSNA), Universidad Pública de Navarra (UPNA), 31008 Pamplona, Spain;
| | - Ragab K. Elnaggar
- Department of Physical Therapy and Health Rehabilitation, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - José Afonso
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4200450 Porto, Portugal;
| | - Luis Peñailillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
| | - Rodrigo Araneda
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
| | - Daniela Ebner-Karestinos
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
| | - Urs Granacher
- Department of Sport and Sport Science, Exercise and Human Movement Science, University of Freiburg, 79102 Freiburg, Germany
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Elnaggar RK, Azab AR, Alhowimel AS, Alotaibi MA, Abdrabo MS, Elfakharany MS. Effects of Plyometric-Based Hydro-Kinesiotherapy on Pain, Muscle Strength, Postural Stability, and Functional Performance in Children with Hemophilic Knee Arthropathy: A Randomized Trial. Phys Occup Ther Pediatr 2024; 44:704-720. [PMID: 38463004 DOI: 10.1080/01942638.2024.2327363] [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: 07/30/2023] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
AIM To explore how plyometric-based hydro-kinesiotherapy (Plyo-HKT) would affect pain, muscle strength, postural stability, and functional performance in a convenience sample of children with hemophilic knee arthropathy (HKA). METHODS Forty-eight children with HKA (age: 8-16 years) were randomly allocated to the Plyo-HKT group (n = 24; underwent the Plyo-HKT for 45 min, twice/week over 12 wk in succession) or the comparison group (n = 24; performed the standard exercise rehabilitation at an equivalent frequency and duration). Pain, peak concentric torque of quadriceps and hamstring (produced at two angular velocities: 120 and 180 o/sec), dynamic limits of postural stability (DLPS), and functional performance [Functional Independence Score in Hemophilia (FISH) and 6-Minute Walk Test (6-MWT)] were assessed pre- and post-intervention. RESULTS In contrast with the comparison group, the Plyo-HKT group achieved more favorable pre-to-post changes in pain (p = .028, η2p = 0.10), peak torque of quadriceps [120°/sec (p = .007, η2P = 0.15); 180°/sec (p = .011, η2P = 0.13)] and hamstring [120°/sec (p = .024, η2P = 0.11); 180°/sec (p = .036, η2P = 0.09)], DLPSdirectional [forward (p = .007, η2P = 0.15); backward (p = .013, η2P = 0.12); affected side (p = .008, η2P = 0.14); non-affected side (p = .002, η2P = 0.20)], DLPSoverall (p < .001, η2P = 0.32), and functional performance [FISH (p < .001, η2p = 0.26); 6-MWT (p = .002, η2p = 0.19)]. CONCLUSION Plyo-HKT is likely helpful for reducing pain, improving strength, enhancing postural stability, and boosting functional capabilities in children with HKA. Physical rehabilitation practitioners should, therefore, consider this intervention strategy.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Health and Rehabilitation Sciences, 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
| | - Alshimaa R Azab
- Department of Health and Rehabilitation Sciences, 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
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mazyad A Alotaibi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohamed S Abdrabo
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Mahmoud S Elfakharany
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Elnaggar RK, Ramirez-Campillo R, Azab AR, Alrawaili SM, Alghadier M, Alotaibi MA, Alhowimel AS, Abdrabo MS, Elbanna MF, Aboeleneen AM, Morsy WE. Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics. CHILDREN (BASEL, SWITZERLAND) 2024; 11:243. [PMID: 38397355 PMCID: PMC10887404 DOI: 10.3390/children11020243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12-18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability-LoS), balance, and mobility (Community Balance and Mobility Scale-CB&M; Functional Walking Test-FWT; Timed Up and Down Stair test-TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP.
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Affiliation(s)
- Ragab K. Elnaggar
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
| | - Alshimaa R. Azab
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Saud M. Alrawaili
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mshari Alghadier
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mazyad A. Alotaibi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Ahmed S. Alhowimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mohamed S. Abdrabo
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Mohammed F. Elbanna
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahmed M. Aboeleneen
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Walaa E. Morsy
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
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Elnaggar RK, Elfakharany MS. Aqua-Plyometric Exercises-Induced Changes in Muscle Strength, Bone Mineral Properties, and Physical Fitness in Patients With Juvenile Idiopathic Arthritis: A 12-Week, Randomized Controlled Trial. Pediatr Exerc Sci 2023; 35:198-205. [PMID: 36535274 DOI: 10.1123/pes.2022-0044] [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: 04/03/2022] [Revised: 10/08/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine whether a 12-week, lower body-targeted aqua-plyometric (AquaPlyo) exercise program could improve muscle strength, bone mineral properties, and physical fitness in patients with juvenile idiopathic arthritis. METHODS A randomized controlled trial was adopted and included 48 patients with polyarticular juvenile idiopathic arthritis (age: 12-18 y). Patients were assigned to undergo either AquaPlyo exercises (AquaPlyo group, n = 24) or standard exercises (control group, n = 24). The outcome measures were assessed pretreatment and posttreatment and included concentric quadriceps peak torque, bone mineral properties (areal bone mineral density [BMD], volumetric BMD, bone mineral content, and BMD Z score), and physical fitness. RESULTS A significant posttreatment increase in the concentric quadriceps peak torque was detected in the AquaPlyo group compared with the control group (either at an angular velocity of 90°/s [right side: P = .016, left side: P = .025] or 180°/s [right side: P = .007, left side: P = .029]). Besides, a considerably greater improvement in the areal BMD (P = .0006), volumetric BMD (P = .027), bone mineral content (P = .002), and BMD Z score (P = .0004) was observed in the AquaPlyo group. Moreover, a remarkably greater rise in the physical fitness (P < .001) was revealed in the AquaPlyo group. CONCLUSION AquaPlyo training can efficiently enhance muscle strength, improve bone mineral properties, and boost physical fitness in patients with juvenile idiopathic arthritis.
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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
| | - Mahmoud S Elfakharany
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza,Egypt
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Elnaggar RK, Alhowimel A, Alotaibi M, Abdrabo MS, Elfakharany MS. Exploring Temporospatial Gait Asymmetry, Dynamic Balance, and Locomotor Capacity After a 12-Week Split-Belt Treadmill Training in Adolescents with Unilateral Cerebral Palsy: A Randomized Clinical Study. Phys Occup Ther Pediatr 2023; 43:660-677. [PMID: 37038368 DOI: 10.1080/01942638.2023.2196334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
AIM To investigate the effects of a 12-week split-belt treadmill walking (Sb-TW) practice using an error augmentation strategy on temporospatial gait asymmetries, dynamic balance, and locomotor capacity in adolescents with unilateral cerebral palsy (ULCP). METHODS Fifty-two adolescents with ULCP (age: 10-16 years) were randomized into either the Sb-TW group (n = 26; underwent repeated Sb-TW practice, with exaggeration of the initial step-length asymmetry, three times/week, for 12 sequential weeks) or control group (n = 26; received equivalent dosages of traditional single-belt treadmill training). Step-length and swing-time asymmetries, directional (LoSdirectional) and overall (LoSoverall) limits of stability, and locomotor capacity [6-minute walk test (6-MWT), Timed Up and Down Stair test (TUDS), and 10-m Shuttle Run Test (10mSRT)] were assessed pre- and post-intervention. RESULTS The Sb-TW group demonstrated more favorable changes in step-length asymmetry (p < .001, η2partial = 0.27), LoSdirectional [affected side direction (p = .033, η2partial = 0.09), forward direction (p = .004, η2partial = 0.16), and backward direction (p = .01, η2partial = 0.12)], and LoSoverall (p < .001, η2partial = 0.31) than the control group. Also, the Sb-TW group showed significantly higher locomotor capacity [6-MWT (p < .001, η2partial = 0.38), TUDS (p = .032, η2partial = 0.09), 10mSRT (p = .021, η2partial = 0.10)] as compared to the control group. CONCLUSION The Sb-TW-induced adaptations can be capitalized on for remediating spatial gait asymmetry, dynamic balance deficits, and impaired locomotor performance in adolescents with ULCP.
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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, Cairo University, Giza, Egypt
| | - Ahmed Alhowimel
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mazyad Alotaibi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohamed S Abdrabo
- Department of Basic Sciences, Cairo University, Giza, Egypt
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
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Elnaggar RK, Alghamdi MS, Alenazi AM, Alghadier M, Mahmoud MZ, Elsayed AEA, Hassan IAM, Abonour AA. Mechanical and Morphological Changes of the Plantar Flexor Musculotendinous Unit in Children with Unilateral Cerebral Palsy Following 12 Weeks of Plyometric Exercise: A Randomized Controlled Trial. CHILDREN 2022; 9:children9111604. [PMID: 36360332 PMCID: PMC9688148 DOI: 10.3390/children9111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
To investigate how plyometric exercise (PLYO-Ex) affects mechanics and morphometrics of the plantar flexor musculotendinous unit in children with unilateral cerebral palsy, 38 participants (aged 10–16 years) were allocated at random to either the PLYO-Ex group (n = 19; received 24 sessions of plyometric muscle loading, conducted 2 times a week for 3 months in succession) or the control group (n = 19; underwent traditional physical therapy for the same frequency and duration). Measurements were taken pre- and post-intervention. Standard ultrasound imaging was applied to evaluate morphometrics of the gastrocnemius muscle and Achilles tendon unit and an isokinetic dynamometer was used to evaluate maximum voluntary isometric plantar flexors contraction (IVCmax). With controlling for pre-treatment values, significant post-treatment changes favoring the PLYO-Ex group were observed for morphological (tendon (p = 0.003, η2p = 0.23) length; belly length (p = 0.001, η2p = 0.27); tendon thickness (p = 0.035, η2p = 0.35); muscle thickness (p = 0.013, η2p = 0.17); fascicle length (p = 0.009, η2p = 0.18); pennation angle (p = 0.015, η2p = 0.16)) and mechanical and material properties (IVCmax (p = 0.009, η2p = 0.18); tendon’s elongation (p = 0.012, η2p = 0.17), stiffness (p = 0.027, η2p = 0.13); stress (p = 0.006, η2p = 0.20); strain (p = 0.004, η2p = 0.21)). In conclusion, plyometric exercise induces significant adaptations within the musculotendinous unit of the plantar flexors in children with unilateral cerebral palsy. These adaptations could improve muscular efficiency and consequently optimize physical/functional performance.
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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 16278, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Correspondence:
| | - Mohammed S. Alghamdi
- Department of Physical Therapy, College of Applied Medical Sciences, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Aqeel M. Alenazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Mshari Alghadier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Mustafa Z. Mahmoud
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Abbas Elbakry A. Elsayed
- Pediatric Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
- Pediatric Department, Faculty of Medicine, Alazhar University, Assiut 71524, Egypt
| | - Ismail Abdelfattah M. Hassan
- Pediatric and Neonatology Specialist, New Medical Center, Royal hospital, Khalifa City, Abu Dhabi 35233, United Arab Emirates
| | - Asmaa A. Abonour
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
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Paretic-Limb-Only Plyometric Training Outperforms Volume-Matched Double-Limb Training for Ameliorating Balance Capability and Gait Symmetry in Adolescents with Unilateral Cerebral Palsy: A Comparative Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101563. [PMID: 36291499 PMCID: PMC9600218 DOI: 10.3390/children9101563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
Adolescents with unilateral cerebral palsy (U-CP) experience an asymmetrical posture because the less-affected lower limb is preferred for bodyweight support as a strategy of compensating for the paretic side’s muscular weakness. This study was designed to compare the effect of 12 weeks of paretic-limb-only plyometric training (PLPT) and volume-matched double-limb training (DLPT) on balance capability and gait symmetry in adolescents with U-CP. Sixty-nine adolescents with U-CP were randomly assigned to PLPT, DLPT, or a control group (n = 23 each). Treatment was delivered twice/week (with at least 48 h recovery intervals) for 12 weeks in succession. The directional (LoSdirectional) and overall (LoSoverall) limits of stability in addition to the temporal (T-GSI) and spatial (S-GSI) gait symmetry indicis were assessed pre- and post-treatment. The LoSdirectional improved significantly in the PLPT group compared to either the DLPT or control group (for the forward (p = 0.027 and <0.001, respectively), backward (p = 0.037 and <0.001, respectively), affected-side (p = 0.038 and 0.004, respectively), and less-affected-side (p = 0.018 and 0.016, respectively)), and this was also the case for the LoSoverall (p < 0.001). Additionally, The T-GSI and S-GSI scores decreased significantly in the PLPT group compared to the DLPT (p = 0.003 and 0.047, respectively) or control (p = 0.003 and 0.036, respectively) group, indicating the development more symmetrical gait patterns. In conclusion, PLPT is likely more effective for enhancing balance capabilities and promoting symmetrical gait patterns than DLPT. Thereupon, it is worthwhile for physical rehabilitation practitioners to include the PLPT paradigm into the intervention plans for adolescents with U-CP.
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Elnaggar RK, Alghadier M, Abdrabo MS, Abonour AA. Effect of a structured aqua-plyometric exercise program on postural control and functional ability in children with hemiparetic cerebral palsy: A two-arm randomized controlled trial. NeuroRehabilitation 2022; 51:247-258. [DOI: 10.3233/nre-220020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Individuals with hemiparetic cerebral palsy (h-CP) encounter postural control issues that largely interfere with activity and participation. So, there might be a need for improved, clearly effective rehabilitation protocols that target postural control dysfunction, which may, then, reduce activity limitations and participation restrictions. OBJECTIVE: This trial was undertaken to examine the effect of a structured, 12-week aqua-plyometric (Aqua-PLYO) exercise program on postural control and functional ability in children with h-CP. METHODS: Fifty-six children with h-CP took part in a two-arm, randomized single-blind controlled trial. They were randomly assigned to either receive the standard physical therapy (Control group; n = 28) or the Aqua-PLYO training program (Aqua-PLYO group; n = 28), three times/week over 12 consecutive weeks. The dynamic limit of stability [i.e., movement directional control (M-DC), reaction time (ReT), movement velocity (M-Vel), endpoint excursion (EP-Exc), and maximum excursion (M-Exc)] and functional ability [i.e., 30-second sit-to-stand test (30sec-STS), timed up and down stairs test (TUDS), and the dynamic gait index (DGI)] were assessed pre- and post-treatment. RESULTS: From the pre- to post-treatment occasion, the Aqua-PLYO group achieved greater improvement for the M-DC (P = 0.013), ReT (P = 0.004), M-Vel (P = 0.03), EP-Exc (P = 0.002), and M-Exc (P = 0.006), compared to controls. Besides, the Aqua-PLYO group showed more conducive changes in functional ability [as evidenced by the 30sec-STS (P = 0.005), TUDS (P = 0.002), and DGI (P = 0.004) scores]. CONCLUSION: Aqua-PLYO training is likely an effective training paradigm for enhancing postural control and functional ability in children with h-CP. Further studies are, however, recommended to substantiate the current evidence.
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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
| | - Mshari Alghadier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohamed S. Abdrabo
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Asmaa A. Abonour
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Elnaggar RK, Alhowimel A, Alotaibi M, Abdrabo MS, Elshafey MA. Accommodating variable-resistance exercise enhance weight-bearing/gait symmetry and balance capability in children with hemiparetic cerebral palsy: a parallel-group, single-blinded randomized clinical trial. Eur J Phys Rehabil Med 2022; 58:378-386. [PMID: 34870387 PMCID: PMC9980524 DOI: 10.23736/s1973-9087.21.07324-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with hemiparetic cerebral palsy (HCP) tend preferentially to bear their body weight on the non-paretic side, which leads to the emergence of asymmetrical walking patterns and limited ability to maintain balance. Therefore, improved and clearly effective intervention strategies to remedy these impairments are needed. AIM This study endeavored to evaluate the efficacy of an accommodating variable-resistance exercise (AVr-Ex) program on weight-bearing symmetry, gait symmetry, and dynamic balance in children with HCP. DESIGN This study employed a parallel-group, single-blinded randomized controlled design. SETTINGS Physical Therapy Outpatient Clinic and University Hospital, and a tertiary referral hospital. POPULATION Thirty-six children with HCP aged between eight and 16 years were assigned randomly to the AVr-Ex group (N.=18) or control group (N.=18). METHODS Children in the AVr-Ex group undergone an AVr-Ex program, three sessions/week over eight consecutive weeks, besides the usual physical therapy while children in the Control group received the usual physical therapy alone. Outcome measures were evaluated before and after intervention and included weight-bearing symmetry indices [rearfoot (RF-WbSI), and forefoot (FF-WbSI)], gait symmetry indices (spatial [GSIspatial], and temporal [GSItemporal]), and dynamic balance. RESULTS The post-treatment RF-WbSI (P<0.001; ηp2=0.41), GSIspatial (P<0.001; ηp2=0.42), GSItemporal (P<0.001; ηp2=0.52), and dynamic balance variables (all P<0.05; ηp2 ranged from 0.21 to 0.51) improved significantly in the AVr-Ex group compared to the control group, when controlled for the pre-treatment scores. CONCLUSIONS This study suggests that AVr-Ex can improve weight-bearing symmetry, gait symmetry, and dynamic balance in children with HCP when incorporated into the usual physical rehabilitation program. CLINICAL REHABILITATION IMPACT AVr-Ex is likely an effective training paradigm to address weight-bearing/gait asymmetry and balance issues in children with HCP, which provides the basis for its incorporation in rehabilitation programs for such a patient population.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, Collage 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 -
| | - Ahmed Alhowimel
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mazyad Alotaibi
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohamed S Abdrabo
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mohammed A Elshafey
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Elnaggar RK, Diab RH, Alghadier M, Azab AR. Block-sequence of plyometric and balance training is superior to the alternating-sequence for enhancing motor function in children with hemiplegic cerebral palsy: A comparative randomized clinical trial. ISOKINET EXERC SCI 2022. [DOI: 10.3233/ies-220005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND: Postural control deficits are prevalent in children with hemiplegic cerebral palsy (CwHCP). Therefore, the best rehabilitative strategies for remediating these deficits are warranted, which could then enhance function. OBJECTIVE: To examine effects of a block versus an alternating sequence of balance training (BT) and plyometric training (PT) on postural control in CwHCP. METHODS: Forty-eight CwHCP (812 years) were randomized to a block or an alternating BT/PT training. The block BT/PT group (n= 24) received a sixweek BT followed by a sixweek PT, twice/week over 12 consecutive weeks. The alternating BT/PT group (n= 24) received an interchanging sequence of BT and PT changed every two weeks for 12 weeks. Postural control [center-of-pressure reaction time (RT), movement velocity (MV), maximum excursion (ME), end-point excursion (EE), and directional control (DC)], functional balance (indicated by pediatric balance scale; PBS), and balance/risk-of-falls during walking (denoted by dynamic gait index; DGI) were assessed before and after training. RESULTS: The block BT/PT group showed greater enhancements in postural control variables [RT (P= 0.004), MV (P= 0.028), ME (P= 0.002), EE (P= 0.003), and DC (P= 0.012)] and functional balance (P= 0.006), and lesser risk-of-falls during walking (P= 0.018) when compared to the alternating BT/PT group. CONCLUSION: The block BT/PT sequence is more effective to enhance postural control than the alternating sequence in CwHCP.
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Affiliation(s)
- Ragab K. Elnaggar
- Department of Physical Therapy and Health Rehabilitation, Collage 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
| | - Reham H. Diab
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University, Madina, Saudi Arabia
| | - Mshari Alghadier
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Alshimaa R. Azab
- Department of Physical Therapy and Health Rehabilitation, Collage 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
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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: 1] [Impact Index Per Article: 0.5] [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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Elnaggar RK, Mohamed RR. Aqua-Plyometric Exercises: Potential Implications for Bone Mineral Density, Functional Capacity, and Quality of Life in Survivors of Childhood Acute Lymphoblastic Leukemia. Semin Oncol Nurs 2021; 37:151225. [PMID: 34753640 DOI: 10.1016/j.soncn.2021.151225] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study endeavored to explore the effect of an aquatic-based plyometric exercise program (Aqua-PLYO) on bone mineralization, functional capacity, and quality of life in survivors of childhood acute lymphoblastic leukemia (ALL). DATA SOURCES In a prospective, single-blinded quasi-experimental study, 30 survivors of childhood ALL (63.3% boys; age: 13.1 ± 2.8 years) were allocated to undergo the Aqua-PLYO exercise program (Aqua-PLYO group; n = 15) or the usual physical therapy (Control group; n = 15). Bone mineralization (bone mineral density [BMD], bone mineral content [BMC], BMD Z-score, and BMD volumetric [BMDvol]), functional capacity, and quality of life were assessed prior to, and following 36 treatment sessions, which were undertaken over nonconsecutive days in a 12-week program. With controlling for the pretreatment values, all measures of bone mineralization, functional capacity, and quality of life showed more favorable posttreatment improvement in the Aqua-PLYO group as compared to the control group (all P < .05). CONCLUSION The Aqua-PLYO exercises, besides the usual physical therapy, can effectively improve bone health, increase functional capacity, and promote a better quality of life in long-term survivors of childhood ALL. IMPLICATIONS FOR NURSING PRACTICE Although survivors of childhood ALL experience reduced BMD, functional ability, and quality of life, Aqua-PLYO exercises can have positive effects on survivors' physical and functional disturbances and can, even more, be enjoyable and increase their motivation and interest in engaging in exercise interventions.
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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.
| | - Rania R Mohamed
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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13
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Elnaggar RK. Acute responses to locomotor tasks differ according to gait-asymmetry patterns in children with hemiplegic cerebral palsy: An exploratory analysis. Hum Mov Sci 2021; 79:102860. [PMID: 34385053 DOI: 10.1016/j.humov.2021.102860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
This study aimed at determining if differential responses to locomotor tasks in children with spastic hemiplegia occur on account of step-length asymmetry patterns [symmetrical step-length (S-SL); affected side short (AFFshort), and non-affected short (Non-AFFshort)] observed during on-ground walking. Thirty-two children (5-8 years) were assessed for spatial/temporal measures of gait while walking on the ground with self-selected speed. Data from on-ground walking were compared against three locomotor tasks that were examined on a treadmill: self-imposed walking velocity with bodyweight support of 0% (BWS-0%), self-imposed walking velocity with a BWS of 20% (BWS-20%), and fastest walking velocity with a BWS of 20% and a manually-guided response of the non-affected leg (MGRnon-affected). The primary outcome measures were the spatial (step length) and temporal (single-limb support time) symmetry indices. The step-length asymmetry subgroups responded differently to the locomotor tasks. The MGRnon-affected produced spatial symmetry in the S-SL and Non-AFFshort groups and temporal symmetry in the AFFshort group. The BWS-0% and BWS-20% treadmill walking conditions were insufficient to remediate either spatial or temporal walking asymmetry. In conclusion, acute responses to locomotor tasks are not consistent among asymmetry subgroups, suggesting that they might need individual treatment plans. In spite of the differences in walking characteristics between asymmetry subgroups, the improvement in gait-symmetry arose out of changes in affected and non-affected sides together.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, Collage 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.
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