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Ryan JM, Kilbride C, Noorkoiv M, Theis N, Shortland A, Levin W, Lavelle G. Acceptability of a progressive resistance training programme for ambulatory adolescents with spastic cerebral palsy in England: a qualitative study. Disabil Rehabil 2024; 46:1832-1840. [PMID: 37154619 DOI: 10.1080/09638288.2023.2208377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE The aim of this study was to explore the acceptability of a 10-week progressive resistance training programme from the perspective of ambulatory adolescents with CP and physiotherapists. MATERIAL AND METHODS Semi-structured interviews were conducted with 32 adolescents with spastic CP, aged 10-19 years in Gross Motor Function Classification System (GMFCS) levels I-III, and 13 physiotherapists. Adolescents had completed a 10-week progressive resistance training programme and physiotherapists had delivered the programme. The Framework Method was used to analyse data. RESULTS The analysis identified four themes. "It's do-able" described the acceptability of the programme structure, including the frequency of sessions and the duration of the programme. "They were difficult but I did it" described the acceptability of the exercises. "It is completely different," explored the experience of using equipment to progress the programme and "I wish I could do it on a permanent basis" discussed continuing to participate in resistance training. CONCLUSIONS Findings suggest that resistance training is largely acceptable to adolescents and physiotherapists. Acceptability was enhanced by having a weekly supervised session and being able to adapt and progress the exercises to meet the individual's ability. However, there are challenges to implementing progressive resistance training as part of routine practice.Clinical trial registration number: ISRCTN90378161.
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Affiliation(s)
- Jennifer M Ryan
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
| | - Cherry Kilbride
- College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
| | - Marika Noorkoiv
- College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, London, United Kingdom
| | - Wendy Levin
- Department of Physiotherapy, Swiss Cottage School and Development and Research Centre, London, United Kingdom
| | - Grace Lavelle
- College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Pamboris GM, Noorkoiv M, Baltzopoulos V, Powell DW, Howes T, Mohagheghi AA. Influence of dynamic stretching on ankle joint stiffness, vertical stiffness and running economy during treadmill running. Front Physiol 2022; 13:948442. [PMID: 36277222 PMCID: PMC9583136 DOI: 10.3389/fphys.2022.948442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of the present study was to investigate whether and how dynamic stretching of the plantarflexors may influence running economy. A crossover design with a minimum of 48 h between experimental (dynamic stretching) and control conditions was used. Twelve recreational runners performed a step-wise incremental protocol to the limit of tolerance on a motorised instrumented treadmill. The initial speed was 2.3 m/s, followed by increments of 0.2 m/s every 3 min. Dynamic joint stiffness, vertical stiffness and running kinematics during the initial stage of the protocol were calculated. Running economy was evaluated using online gas-analysis. For each participant, the minimum number of stages completed before peak O2 uptake (V̇O2peak) common to the two testing conditions was used to calculate the gradient of a linear regression line between V̇O2 (y-axis) and speed (x-axis). The number of stages, which ranged between 4 and 8, was used to construct individual subject regression equations. Non-clinical forms of magnitude-based decision method were used to assess outcomes. The dynamic stretching protocol resulted in a possible decrease in dynamic ankle joint stiffness (−10.7%; 90% confidence limits ±16.1%), a possible decrease in vertical stiffness (−2.3%, ±4.3%), a possibly beneficial effect on running economy (−4.0%, ±8.3%), and very likely decrease in gastrocnemius medialis muscle activation (−27.1%, ±39.2%). The results indicate that dynamic stretching improves running economy, possibly via decreases in dynamic joint and vertical stiffness and muscle activation. Together, these results imply that dynamic stretching should be recommended as part of the warm-up for running training in recreational athletes examined in this study.
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Affiliation(s)
- George M. Pamboris
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
- Division of Sport, Health, and Exercise Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Marika Noorkoiv
- Division of Sport, Health, and Exercise Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, United Kingdom
| | - Douglas W. Powell
- School of Health Studies, University of Memphis, Memphis, TN, United States
| | - Tom Howes
- Division of Sport, Health, and Exercise Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Amir A. Mohagheghi
- Division of Sport, Health, and Exercise Sciences, Brunel University London, Uxbridge, United Kingdom
- *Correspondence: Amir A. Mohagheghi,
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Theis N, Noorkoiv M, Lavelle G, Ryan J. Predictors of Treatment Response to Progressive Resistance Training for Adolescents With Cerebral Palsy. Phys Ther 2021; 101:6358614. [PMID: 34473304 DOI: 10.1093/ptj/pzab202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/28/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of the study was to examine the variability in plantar-flexor muscle strength changes after progressive resistance training for adolescents with cerebral palsy (CP) and to identify baseline variables associated with change in muscle strength. METHODS Thirty-three adolescents with CP were randomized to a 10-week progressive resistance training program as part of a randomized controlled trial (STAR trial). The associations between muscle strength at 10 weeks (n = 30 adolescents) and 22 weeks (n = 28 adolescents) and biomechanical and neuromuscular baseline characteristics, motor function, and fidelity to the program were examined with multivariable linear regression. RESULTS Changes in plantar-flexor muscle strength from baseline ranged from -47.7% to 192.3% at 10 weeks and -54.3% to 198.4% at 22 weeks. Muscle activation was the only variable associated with change in strength at 10 weeks and 22 weeks. A model containing peak muscle activity and baseline muscle strength explained 49.1% of the variation in change in muscle strength (R2 = 0.491) at 10 weeks and 49.2% of the variation in change muscle strength at 22 weeks (R2 = 0.492). CONCLUSION Assessing levels of muscle activation may be able to identify responders to a progressive resistance training program for adolescents with CP. These findings are a first step toward developing tools that can inform decision making in the clinical setting. IMPACT Due to the heterogenous nature of CP, it is challenging to assess the efficacy of strength training programs in individuals with CP and to understand the variability in outcomes among participants. This study provides a better understanding of the factors that predict response to an exercise program so that resistance training can be directed to those who will potentially benefit from it. LAY SUMMARY There is wide variability in how well young people with CP respond to resistance training. If you are a young person with CP, your physical therapist can measure the amount of gastrocnemius muscle activity you have, so as to get an indication of how well you will respond.
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Affiliation(s)
- Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucestershire, UK
| | - Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Grace Lavelle
- College of Health and Life Sciences, Brunel University London, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jennifer Ryan
- College of Health and Life Sciences, Brunel University London, London, UK.,Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Ryan JM, Lavelle G, Theis N, Kilbride C, Noorkoiv M. Patterns of Health Service Use Among Young People With Cerebral Palsy in England. Front Neurol 2021; 12:659031. [PMID: 34054701 PMCID: PMC8153484 DOI: 10.3389/fneur.2021.659031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Although the provision of healthcare for people with cerebral palsy (CP) is typically focussed on childhood, many people with CP require access to services periodically throughout their life. Few studies have examined patterns of health service use among young people with CP in England. Understanding patterns of use may inform future service development. Objective: To describe patterns of visits to rehabilitation and medical professionals among ambulatory young people with CP living in England, and identify factors associated with service use. Methods: Sixty-two young people with CP aged 10–19 years [mean (SD) age 13.7 (2.5) years] in Gross Motor Function Classification System (GMFCS) levels I-III reported visits to a range of health professionals, hospital admissions and visits to the emergency department over a median duration of 34 weeks (min–max: 12–34 weeks). Negative binomial models were used to examine factors associated with number of visits. Results: Physiotherapists were the most commonly used professional, with 67.7% of participants visiting a physiotherapist at least once, followed by dentists (66.1%), general practitioners (48.4%), occupational therapists (40.3%) and orthopaedic surgeons (40.3%). Physiotherapists were also the most frequently visited professional with a total of 473 visits (13.3 visits per person-year). Speech and language therapists (5.0 visits per person-year), occupational therapists (4.5 visits per person-year) and nurses (4.3 per person-year) were the next most frequently visited professionals. Age, GMFCS level, and speech impairment were associated with rate of visits to a physiotherapist. Conclusions: The proportion of young people who visited medical and rehabilitation professionals during the study period varied considerably depending on the profession. Generally, the proportion of young people using services was low. In the context of limited resources, data on service use in combination with data on unmet need, may support the reorganisation of services to maximise benefits to young people with CP.
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Affiliation(s)
- Jennifer M Ryan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland.,College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Grace Lavelle
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Cherry Kilbride
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Marika Noorkoiv
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
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Ryan JM, Lavelle G, Theis N, Noorkoiv M, Kilbride C, Korff T, Baltzopoulos V, Shortland A, Levin W. Progressive resistance training for adolescents with cerebral palsy: the STAR randomized controlled trial. Dev Med Child Neurol 2020; 62:1283-1293. [PMID: 32588919 DOI: 10.1111/dmcn.14601] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the effect of progressive resistance training of the ankle plantarflexors on gait efficiency, activity, and participation in adolescents with cerebral palsy (CP). METHOD Sixty-four adolescents (10-19y; 27 females, 37 males; Gross Motor Function Classification System [GMFCS] levels I-III) were randomized to 30 sessions of resistance training (10 supervised and 20 unsupervised home sessions) over 10 weeks or usual care. The primary outcome was gait efficiency indicated by net nondimensional oxygen cost (NNcost). Secondary outcomes included physical activity, gross motor function, participation, muscle strength, muscle and tendon size, and muscle and tendon stiffness. Analysis was intention-to-treat. RESULTS Median attendance at the 10 supervised sessions was 80% (range 40-100%). There was no between-group difference in NNcost at 10 (mean difference: 0.02, 95% confidence interval [CI] -0.07 to 0.11, p=0.696) or 22 weeks (mean difference: -0.08, 95% CI -0.18 to 0.03, p=0.158). There was also no evidence of between-group differences in secondary outcomes at 10 or 22 weeks. There were 123 adverse events reported by 27 participants in the resistance training group. INTERPRETATION We found that 10 supervised sessions and 20 home sessions of progressive resistance training of the ankle plantarflexors did not improve gait efficiency, muscle strength, activity, participation, or any biomechanical outcome among adolescents with CP. WHAT THIS PAPER ADDS Thirty sessions of progressive resistance training of the ankle plantarflexors over 10 weeks did not improve gait efficiency among ambulatory adolescents with cerebral palsy. Resistance training did not improve muscle strength, activity, or participation. Ninety percent of participants experienced an adverse event. Most adverse events were expected and no serious adverse events were reported.
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Affiliation(s)
- Jennifer M Ryan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,College of Health and Life Sciences, Brunel University London, London, UK
| | - Grace Lavelle
- College of Health and Life Sciences, Brunel University London, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London, London, UK
| | | | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercises Sciences, Liverpool John Moores University, Liverpool, UK
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, London, UK
| | - Wendy Levin
- Department of Physiotherapy, Swiss Cottage School and Development and Research Centre, London, UK
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Abstract
OBJECTIVE To compare the performance of the EuroQol 5D youth (EQ-5D-Y) and child health utility 9D (CHU-9D) for assessing health-related quality of life (HRQoL) in children and young people (CYP) with cerebral palsy (CP). DESIGN Cross-sectional study. SETTING England. PARTICIPANTS Sixty-four CYP with CP aged 10-19 years in Gross Motor Function Classification System (GMFCS) levels I-III. MAIN OUTCOME MEASURES Missing data were examined to assess feasibility. Associations between utility values and individual dimensions on each instrument were examined to assess convergent validity. Associations between utility values and GMFCS level were examined to assess known-group differences. RESULTS Missing data were <5% for both instruments. Twenty participants (32.3%) and 11 participants (18.0%) reported full health for the EQ-5D-Y and CHU-9D, respectively. There was poor agreement between utilities from the two instruments (intraclass correlation coefficient=0.62; 95% limits of agreement -0.58 to 0.29). Correlations between EQ-5D-Y and CHU-9D dimensions were weak to moderate (r=0.25 to 0.59). GMFCS level was associated with EQ-5D-Y utility values but not CHU-9D utility values. CONCLUSION The EQ-5D-Y and CHU-9D are feasible measures of HRQoL in CYP with CP. However, the two instruments demonstrate poor agreement and should not be used to measure and value HRQoL in CYP with CP interchangeably. We propose that the CHU-9D may be preferable to use in this population as it assesses concepts that influence HRQoL among CYP with CP and provides less extreme utility values than the EQ-5D-Y.
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Affiliation(s)
- Jennifer M Ryan
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, Middlesex, UK
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ellen McKay
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nana Anokye
- Health Economics Research Group, Brunel University London, London, Middlesex, UK
| | - Marika Noorkoiv
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, Middlesex, UK
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Cheltenham, Gloucestershire, UK
| | - Grace Lavelle
- Institute of Psychiatry, King's College London, London, UK
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Lawson A, Noorkoiv M, Masci L, Mohagheghi AA. Ankle Joint Position and the Reliability of Ultrasound Tissue Characterization of the Achilles Tendon: A Pilot Study. Med Sci Monit 2019; 25:6884-6893. [PMID: 31516131 PMCID: PMC6755937 DOI: 10.12659/msm.915685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Imaging of the Achilles tendon using ultrasound tissue characterization (UTC) involves taking up the slack of the tendon by including dorsiflexion of the ankle. This pilot study aimed to determine whether different longitudinal tension applied to the Achilles tendon during imaging affected the reliability of UTC. Material/Methods Nine asymptomatic active volunteers, aged between 23–49 years underwent imaging of 17 Achilles tendons. Three positions of tension included plantar grade, 50%, and 100% of maximal dorsiflexion, with a range of 18–32°. Ranges were established and standardized using an isokinetic dynamometer. A test and re-test process was conducted at each position to determine the intraclass correlation coefficients (ICCs) and minimum detectable change (MDC) per echotype. Images were analyzed using UTC software. Results Plantar grade positioning images could not be obtained. ICCs for each echotype I–IV between test 1 and test 2 were 0.965, 0.962, 0.858, 0.739 at 100% dorsiflexion (95% CI, 0.86–0.99, 0.84–0.99, 0.51–0.97, and 0.2–0.94), and 0.771, 0.551, 0.569, 0.429 at 50% dorsiflexion (95% CI, 0.29–0.94, −0.09–0.88, −0.01–0.88, and −0.15–0.82). The MDC per echotype I–IV ranged between 4.1–1.0% of echotype data at 100% dorsiflexion, and 17.2–6.3% at 50% dorsiflexion. Conclusions Testing at maximum dorsiflexion provided improved reliability when using UTC in healthy individuals. The ICC at 100% dorsiflexion was increased, and the MDC was reduced for all echotypes. Therefore, standardizing test positions when using UTC is advisable for reliable comparison of results between studies.
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Affiliation(s)
- Arturo Lawson
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University, London, United Kingdom
| | - Marika Noorkoiv
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University, London, United Kingdom
| | | | - Amir A Mohagheghi
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University, London, United Kingdom
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Lavelle G, Noorkoiv M, Theis N, Korff T, Kilbride C, Baltzopoulos V, Shortland A, Levin W, Ryan JM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) as a measure of physical activity (PA) in young people with cerebral palsy: A cross-sectional study. Physiotherapy 2019; 107:209-215. [PMID: 32026822 DOI: 10.1016/j.physio.2019.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/24/2019] [Accepted: 08/20/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to examine the validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) as a measure of physical activity (PA) in young people with cerebral palsy (CP). DESIGN Cross-sectional. SETTING Participants were recruited through 8 National Health Service (NHS) trusts, one school, one university and through organisations that provide services for people with disabilities in England. PARTICIPANTS Sixty-four, ambulatory young people aged 10-19 years with CP [Gross Motor Function Classification System (GMFCS) levels I-III] participated in this study. MAIN OUTCOME MEASURE The IPAQ-SF was administered to participants. Participants were then asked to wear a wGT3X-BT triaxial accelerometer (ActiGraph, Pensacola, FL) for 7 days to objectively assess PA. Time spent in sedentary behaviour, in moderate to vigorous PA (MVPA) and in total PA (TPA) was compared between measures. RESULTS Young people with CP self-reported less time in sedentary behaviour and underestimated the time spent in TPA, when compared to accelerometer measurements. Bland-Altman plots demonstrated poor agreement between the measures for MVPA, with upper and lower 95% limits of agreement of -147 to 148.9minute. After adjusting for gender and GMFCS level, age was a predictor of the difference between measures for MVPA (P<0.001) and TPA (P<0.001). CONCLUSIONS These findings suggest that the IPAQ-SF is not a valid method of measuring TPA or sedentary behaviour in young people with CP and it is not appropriate for use when assessing an individual's time in MVPA. Therefore, where feasible, an objective measure of PA should be used. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN90378161.
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Affiliation(s)
- Grace Lavelle
- College of Health and Life Sciences, Brunel University London, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucestershire, United Kingdom
| | | | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, London, United Kingdom
| | - Wendy Levin
- Department of Physiotherapy, Swiss Cottage School and Development and Research Centre, London, United Kingdom
| | - Jennifer M Ryan
- College of Health and Life Sciences, Brunel University London, London, United Kingdom; Department of Epidemiology and Public Health Medicine, RCSI, Dublin, Ireland
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Noorkoiv M, Lavelle G, Theis N, Korff T, Kilbride C, Baltzopoulos V, Shortland A, Levin W, Ryan JM. Predictors of Walking Efficiency in Children With Cerebral Palsy: Lower-Body Joint Angles, Moments, and Power. Phys Ther 2019; 99:711-720. [PMID: 31155663 PMCID: PMC10468027 DOI: 10.1093/ptj/pzz041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 03/01/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND People with cerebral palsy (CP) experience increased muscle stiffness, muscle weakness, and reduced joint range of motion. This can lead to an abnormal pattern of gait, which can increase the energy cost of walking and contribute to reduced participation in physical activity. OBJECTIVE The aim of the study was to examine associations between lower-body joint angles, moments, power, and walking efficiency in adolescents with CP. DESIGN This was a cross-sectional study. METHODS Sixty-four adolescents aged 10 to 19 years with CP were recruited. Walking efficiency was measured as the net nondimensional oxygen cost (NNcost) during 6 minutes of overground walking at self-selected speed. Lower-body kinematics and kinetics during walking were collected with 3-dimensional motion analysis, synchronized with a treadmill with integrated force plates. The associations between the kinematics, kinetics, and NNcost were examined with multivariable linear regression. RESULTS After adjusting for age, sex, and Gross Motor Function Classification System level, maximum knee extension angle (β = -0.006), hip angle at midstance (β = -0.007), and maximum hip extension (β = -0.008) were associated with NNcost. Age was a significant modifier of the association between the NNcost and a number of kinematic variables. LIMITATIONS This study examined kinetic and kinematic variables in the sagittal plane only. A high interindividual variation in gait pattern could have influenced the results. CONCLUSIONS Reduced knee and hip joint extension are associated with gait inefficiency in adolescents with CP. Age is a significant factor influencing associations between ankle, knee, and hip joint kinematics and gait efficiency. Therapeutic interventions should investigate ways to increase knee and hip joint extension in adolescents with CP.
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Affiliation(s)
- Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, Uxbridge UB8 3PH, United Kingdom
| | - Grace Lavelle
- College of Health and Life Sciences, Brunel University London
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucester, Gloucestershire, United Kingdom
| | | | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, London, United Kingdom
| | - Wendy Levin
- Department of Physiotherapy, Swiss Cottage School and Development and Research Centre, London, United Kingdom
| | - Jennifer M Ryan
- College of Health and Life Sciences, Brunel University London; and Department of Public Health and Epidemiology, RCSI, Dublin, Ireland
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Noorkoiv M, Theis N, Lavelle G. A comparison of 3D ultrasound to MRI for the measurement and estimation of gastrocnemius muscle volume in adults and young people with and without cerebral palsy. Clin Anat 2019; 32:319-327. [DOI: 10.1002/ca.23314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/31/2018] [Accepted: 11/14/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Marika Noorkoiv
- Institute of Environment, Health and Societies, Ageing Studies Research Theme, Brunel University London; Uxbridge United Kingdom
- Centre for Human Performance; Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London; Uxbridge United Kingdom
- Division of Physiotherapy, Department of Clinical Sciences; Brunel University London; Uxbridge United Kingdom
| | - Nicola Theis
- Faculty of Applied Sciences; Oxstalls Campus, University of Gloucestershire; Gloucester United Kingdom
| | - Grace Lavelle
- Institute of Environment, Health and Societies, Ageing Studies Research Theme, Brunel University London; Uxbridge United Kingdom
- Centre for Human Performance; Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London; Uxbridge United Kingdom
- Division of Physiotherapy, Department of Clinical Sciences; Brunel University London; Uxbridge United Kingdom
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Lavelle G, Noorkoiv M, Theis N, Kilbride C, Korff T, Baltzopoulos B, Levin W, Shortland A, Ryan J. Sociodemographic and physical correlates of physical activity and gross motor function, in young people with cerebral palsy. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lavelle G, Noorkoiv M, Theis N, Kilbride C, Korff T, Baltzopoulos B, Shortland A, Levin W, Ryan J. Health service use among young people with cerebral palsy in England. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ryan J, Lavelle G, Noorkoiv M, Theis N, Levin W, Shortland A, Korff T, Baltzopoulos B, Kilbride C. A qualitative analysis of the feasibility and acceptability of a progressive resistance training programme for young people with cerebral palsy. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pamboris GM, Noorkoiv M, Baltzopoulos V, Mohagheghi AA. Response to letter to the editor by Diong 2018 "Confidence intervals that cross zero must be interpreted correctly". Scand J Med Sci Sports 2018; 29:478-479. [PMID: 30506603 DOI: 10.1111/sms.13351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- George M Pamboris
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UK
| | - Marika Noorkoiv
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UK.,Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - Amir A Mohagheghi
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UK.,Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK.,University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Pamboris GM, Noorkoiv M, Baltzopoulos V, Mohagheghi AA. Dynamic stretching is not detrimental to neuromechanical and sensorimotor performance of ankle plantarflexors. Scand J Med Sci Sports 2018; 29:200-212. [PMID: 30326551 PMCID: PMC7379928 DOI: 10.1111/sms.13321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 01/01/2023]
Abstract
The acute effects of two dynamic stretching (DS) protocols on changes in the ankle range of motion (RoM), neuromechanical, and sensorimotor properties of the plantarflexor muscle group were examined. Eighteen participants received slow (SDS) or fast dynamic stretching (FDS) on two separate days. Outcome measures were assessed pre- and 2 minutes post-interventions, and included maximum dorsiflexion angle, maximum isometric torque at neutral ankle position, maximum concentric and eccentric torques, force matching capacity, joint position sense and medial gastrocnemius muscle and tendon strain. Possibly and likely small increases in dorsiflexion RoM were observed after SDS (mean ± 90% confidence intervals; 1.8 ± 1.2°) and FDS (2.1 ± 1.2°), respectively. Very likely moderate decreases in muscle strain after SDS (-38.0 ± 20.6%) and possibly small decrease after FDS (-13.6 ± 21.2%) were observed. SDS resulted in a likely beneficial small increase in tendon strain (25.3 ± 29.7%) and a likely beneficial moderate increase after FDS (41.4 ± 44.9%). Effects on strength were inconsistent. Possibly small effect on positional error after SDS (-27.1 ± 37.5%), but no clear effect after FDS was observed. Both DS protocols increased RoM, and this was more due to an increase in tendon elongation rather than the muscle. However, SDS showed greater improvement than FDS in both neuromechanical and sensorimotor performance, and hence, SDS can be recommended as part of warm-up in sporting contexts.
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Affiliation(s)
- George M Pamboris
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UK
| | - Marika Noorkoiv
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UK.,Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - Amir A Mohagheghi
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UK.,Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK.,University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Pamboris GM, Noorkoiv M, Baltzopoulos V, Gokalp H, Marzilger R, Mohagheghi AA. Effects of an acute bout of dynamic stretching on biomechanical properties of the gastrocnemius muscle determined by shear wave elastography. PLoS One 2018; 13:e0196724. [PMID: 29723229 PMCID: PMC5933711 DOI: 10.1371/journal.pone.0196724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/18/2018] [Indexed: 01/01/2023] Open
Abstract
AIMS The aim of this study was to examine the acute effects of dynamic stretching (DS) exercise on passive ankle range of motion (RoM), resting localized muscle stiffness, as measured by shear wave speed (SWS) of medial gastrocnemius muscle, fascicle strain, and thickness. METHODS/RESULTS Twenty-three participants performed a DS protocol. Before and after stretching, SWS was measured in the belly of the resting medial gastrocnemius muscle (MGM) using shear wave elastography. DS produced small improvements in maximum dorsiflexion (+1.5° ±1.5; mean difference ±90% confidence limits) and maximum plantarflexion (+2.3° ±1.8), a small decrease in fascicle strain (-2.6% ±4.4) and a small increase in SWS at neutral resting angle (+11.4% ±1.5). There was also a small increase in muscle thickness (+4.1mm ±2.0). CONCLUSIONS Through the use of elastography, this is the first study to suggest that DS increases muscle stiffness, decreases fascicle strain and increases muscle thickness as a result of improved RoM. These results can be beneficial to coaches, exercise and clinical scientists when choosing DS as a muscle conditioning or rehabilitation intervention.
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Affiliation(s)
- George M. Pamboris
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, United Kingdom
| | - Marika Noorkoiv
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, United Kingdom
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, United Kingdom
| | - Vasilios Baltzopoulos
- Liverpool John Moores University, Research Institute for Sport and Exercise Sciences (RISES), Liverpool, United Kingdom
| | - Hulya Gokalp
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, United Kingdom
| | - Robert Marzilger
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Amir A. Mohagheghi
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, United Kingdom
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, United Kingdom
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Ryan JM, Theis N, Kilbride C, Baltzopoulos V, Waugh C, Shortland A, Lavelle G, Noorkoiv M, Levin W, Korff T. Strength Training for Adolescents with cerebral palsy (STAR): study protocol of a randomised controlled trial to determine the feasibility, acceptability and efficacy of resistance training for adolescents with cerebral palsy. BMJ Open 2016; 6:e012839. [PMID: 27707836 PMCID: PMC5073599 DOI: 10.1136/bmjopen-2016-012839] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gait is inefficient in children with cerebral palsy, particularly as they transition to adolescence. Gait inefficiency may be associated with declines in gross motor function and participation among adolescents with cerebral palsy. Resistance training may improve gait efficiency through a number of biomechanical and neural mechanisms. The aim of the Strength Training for Adolescents with cerebral palsy (STAR) trial is to evaluate the effect of resistance training on gait efficiency, activity and participation in adolescents with cerebral palsy. We also aim to determine the biomechanical and neural adaptations that occur following resistance training and evaluate the feasibility and acceptability of such an intervention for adolescents with cerebral palsy. METHODS AND ANALYSIS 60 adolescents (Gross Motor Function Classification System level I-III) will be randomised to a 10-week resistance training group or a usual care control group according to a computer-generated random schedule. The primary outcome is gait efficiency. Secondary outcomes are habitual physical activity, participation, muscle-tendon mechanics and gross motor function. General linear models will be used to evaluate differences in continuous data between the resistance training and usual care groups at 10 and 22 weeks, respectively. A process evaluation will be conducted alongside the intervention. Fidelity of the resistance training programme to trial protocol will be quantified by observations of exercise sessions. Semistructured interviews will be conducted with participants and physiotherapists following the resistance training programme to determine feasibility and acceptability of the programme. ETHICS AND DISSEMINATION This trial has ethical approval from Brunel University London's Department of Clinical Sciences' Research Ethics Committee and the National Research Ethics Service (NRES) Committee London-Surrey Borders. The results of the trial will be submitted for publication in academic journals, presented at conferences and distributed to adolescents, families and healthcare professionals through the media with the assistance of the STAR advisory group. TRIAL REGISTRATION NUMBER ISRCTN90378161; Pre-results.
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Affiliation(s)
- Jennifer M Ryan
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Nicola Theis
- School of Sport, Health and Applied Science, St. Mary's University, Twickenham, UK
| | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London, London, UK
| | | | - Charlie Waugh
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Grace Lavelle
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Wendy Levin
- Department of Physiotherapy, Royal Free London NHS Foundation Trust, Swiss Cottage School Development and Research Centre, London, UK
| | - Thomas Korff
- College of Health and Life Sciences, Brunel University London, London, UK
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Noorkoiv M, Nosaka K, Blazevich A. Knee extension torque elicited by electrical versus magnetic stimulation. J Sci Med Sport 2011. [DOI: 10.1016/j.jsams.2011.11.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Finni T, Noorkoiv M, Pöllänen E, Ronkainen PH, Alén M, Kaprio J, Kovanen V, Sipilä S. Muscle function in monozygotic female twin pairs discordant for hormone replacement therapy. Muscle Nerve 2011; 44:769-75. [DOI: 10.1002/mus.22162] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Noorkoiv M, Stavnsbo A, Aagaard P, Blazevich AJ. In vivo assessment of muscle fascicle length by extended field-of-view ultrasonography. J Appl Physiol (1985) 2010; 109:1974-9. [PMID: 20884841 DOI: 10.1152/japplphysiol.00657.2010] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study examined the reliability and validity of in vivo vastus lateralis (VL) fascicle length ( Lf) assessment by extended field-of-view ultrasonography (EFOV US). Intraexperimenter and intersession reliability of EFOV US were tested. Further, Lf measured from EFOV US images were compared to Lf measured from static US images (6-cm FOV) where out-of-field fascicle portions were trigonometrically estimated (linear extrapolation). Finally, spatial accuracy of the EFOV technique was assessed by comparing Lf measured on swine VL by EFOV US to actual measurements from digital photographs. The difference between repeated VL Lf measurements by the same experimenter was 2.1 ± 1.7% with an intraclass correlation (ICC) of 0.99 [95% confidence interval (CI) = 0.95–1.00]. In terms of intersession reliability, no difference ( P = 0.48) was observed between Lf measured on two different occasions, with ICC = 0.95 (CI = 0.80–0.99). The average absolute difference between Lf measured by EFOV US and using linear extrapolation was 12.6 ± 8.1% [ICC = 0.76 (CI = −0.20–0.94)]; EFOV Lf was always longer than extrapolated Lf. The relative error of measurement between Lf measured by EFOV US and by dissective assessment (digital photographs) in isolated swine VL was 0.84% ± 2.6% with an ICC of 0.99 (CI = 0.94–1.00). These results show that EFOV US is a reliable and valid method for the measurement of long muscle fascicle in vivo. Thus EFOV US analysis was proven more accurate for the assessment of skeletal muscle fascicle length than conventional extrapolation methods.
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Affiliation(s)
- M. Noorkoiv
- School of Exercise, Biomedical, and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; and
| | - A. Stavnsbo
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - P. Aagaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - A. J. Blazevich
- School of Exercise, Biomedical, and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; and
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Noorkoiv M, Nosaka K, Blazevich AJ. Assessment of quadriceps muscle cross-sectional area by ultrasound extended-field-of-view imaging. Eur J Appl Physiol 2010; 109:631-9. [DOI: 10.1007/s00421-010-1402-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2010] [Indexed: 11/29/2022]
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