Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team

PURPOSE

The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D).

MATERIALS AND METHODS

An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation.

RESULTS

EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings.

CONCLUSIONS

RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.

A proposal for a universal physical therapy diagnostic concept

BACKGROUND

In Canada, as in other countries, the physical therapist (PT) must make a diagnosis to comply with direct access responsibilities. This means making a diagnosis is an entry-to-practice essential competency. However, there is no consensus across physical therapy practice domains and contexts regarding the diagnostic concept, i.e., the classification system, labelling and diagnostic format that should be used.

OBJECTIVE

To propose a universal diagnostic concept, one a PT could use regardless of their practice domain or context.

METHODS

The relevant scientific and grey literature (1986-2022) were searched and key information was synthesized.

RESULTS

Information from 194 retained documents (8506 identified) was synthesized to a list of seven essential criteria that were then used to develop a universal physical therapy diagnostic concept (PT-Dx-C). The PT-Dx-C format consists of three labels in the following order: (1) health problem, (2) primary impairment, and (3) primary activity limitation or participation restriction. Label definitions are those used by the World Health Organization. The specific health problem, impairment, and limitation or restriction making up the diagnosis are determined for each patient using valid tests and measures.

CONCLUSIONS

The PT-Dx-C is consistent with best practices and could be applied to all patients, in all PT practice domains and contexts. It reflects the PT's expertise in the human movement system and their unique contribution to health care. Furthermore, its use may allow for communication of the PT's conclusions in a manner that can be understood by others thereby facilitating collaborative practice.

A Clinical Practice Guide to Enhance Physical Activity Participation for Children with Developmental Coordination Disorder in Canada

Purpose

This clinical practice guide (CPG) aims to provide evidence-based recommendations for promoting and enhancing the participation and integration of children with developmental coordination disorder (DCD) into physical activities that take place in the home, school, community, or rehabilitation clinic contexts.

Methods

A panel of key stakeholders relevant to these contexts (parents, instructors, rehabilitation professionals) developed evidence-based recommendations using a consensus methodology after reviewing results from a recent systematic review of relevant literature. The quality of the evidence on which the recommendations were based was evaluated (2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence scale) as was the strength of the final CPG recommendations (American Society of Plastic Surgeons Grade Recommendation Scale).

Results

Recommendations (n = 50; 36% supported by robust, empirically derived evidence) for the different stakeholder groups fell into three categories: 1) Choose an appropriate activity for your child, 2) Harmonize the activity with the child's interests and abilities, and 3) Help the child learn new movements prior to the activity.

Conclusions

This comprehensive CPG provides concrete recommendations, based on the currently available evidence, that can be used by stakeholders to address the physical activity participation and integration needs of children with DCD in a variety of contexts.

Reliability of Selected Health-Related Fitness Tests for Children With Developmental Coordination Disorder

Aim: To quantify test-retest reliability and minimal detectable change for 90 and 95% confidence levels (90MDC, 95MDC) for health-related fitness tests in children with developmental coordination disorder (DCD). Methods: Lower limb muscle strength [hand-held dynamometry (HHD), unilateral heel rise test (UHRT), standing broad jump (SBJ)], muscle endurance [Muscle Power Sprint Test (MPST)] and cardiorespiratory endurance [20-metre Shuttle Run Test (20mSRT)] were evaluated twice (2-7 day interval) in 31 children with DCD (20 males, 9.4 years old ± 2.0). Results: Test-retest reliability was reported as intraclass correlation coefficient (ICC) (2, 1) 95% confidence interval lower bounds. Values were excellent for MPST (peak and mean power: 0.93, 0.95), good for HHD (0.81-0.88), SBJ (0.82), and the 20mSRT (0.87) and moderate for UHRT (0.74). For HHD, the 90MDC and 95MDC were the largest for hip extensors (14.47, 12.14 Nm) and the smallest for ankle dorsiflexors (1.55, 1.30 Nm). For UHRT, SBJ, MPST and the 20mSRT, these MDC values were 11.90, 9.98 repetitions; 25.49, 21.38 cm; 4.70, 3.94 W (mean power), and 6.45, 5.42 W (peak power) and 0.87, 0.73 (number of stages), respectively. Conclusion: These tests yield reliable test-retest results that can be used to evaluate fitness changes in this group.

Systematic review of the psychometric properties of cultural adaptations and translations of the Children's Assessment of Participation and Enjoyment (CAPE)

BACKGROUND

The Children's Assessment of Participation and Enjoyment (CAPE) is the most widely used questionnaire for the assessment of children participation. While several cultural adaptations and translations exist, the quality of the methods used to produce them, as well as their psychometric properties, remains unclear. The aim of this systematic review was to evaluate the different translated and/or culturally adapted versions of the CAPE for children and youth with and without disabilities.

METHOD

A search was performed in five electronic databases CINAHL (EBSCO), MEDLINE (OVID), EMBASE (ELSEVIER), PSYCINFO (OVID), and WEB OF SCIENCE Core Collection (CLARIVATE), for articles available in French or English with the last update in July 2022. All studies related to a cultural adaptation and/or translation of the CAPE were retained and evaluated based on established guidelines for cross-cultural adaptations and measurement properties. The extraction was done independently by two authors. A critical appraisal of translation and psychometric properties methods was performed. Critical appraisal of the articles was done using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures tool and the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology.

RESULTS

The search identified 642 studies (321 duplicates removed), 16 of which underwent full-text review. Nine studies met all inclusion criteria and underwent analysis. According to the recommended steps for cross-cultural adaptations, one study performed 100% of the steps and two others performed 80%. None of the studies met all the recommendations for the evaluation of psychometric properties. A full evaluation of reliability and internal consistency were reported by 74% of studies. None of the studies reported a full evaluation of responsiveness, agreement and/or construct validity.

CONCLUSIONS

This review demonstrated limitations in the robustness of the methods used to develop and evaluate translated and culturally adapted versions of CAPE. To ensure valid and reliable results when conducting future research using the CAPE, it is recommended to fully evaluate the psychometric properties of the existing versions and to produce other translated and culturally adapted versions of the questionnaire.

Growth and muscle strength development in children with developmental coordination disorder

AIM

To assess effects of growth on lower limb maximal isometric muscle strength (MIMS) development in children with developmental coordination disorder (DCD).

METHOD

This observational study used hand-held dynamometry to evaluate MIMS (hip abductors, flexors, extensors; knee flexors and extensors; ankle dorsiflexors) in children with DCD (n=33, 12 females, 21 males, 6-12y, mean [SD] age 9y [2y]). Regression analysis compared changes in MIMS for similar changes in growth (height or body mass) for children with DCD and typically developing children (pre-existing database, n=183), controlling for age and sex.

RESULTS

For the same height gain, the gain in muscle strength was 37.3% to 69.2% less in children with DCD compared with typically developing children, with significantly lower slopes (p-value between <0.001-0.042) in all muscle groups tested except knee extensors and ankle dorsiflexors in females. Strength gains related to body mass gains were not different for children with DCD compared to typically developing children.

INTERPRETATION

Even when growing at a similar rate, children with DCD do not develop muscle strength gains at the same rate as their typically developing peers.

WHAT THIS PAPER ADDS

Strength gains with growth (height) may be reduced in children with developmental coordination disorder.

Participation in leisure activities in adolescents with congenital heart defects

AIM

To describe leisure participation in adolescents with congenital heart defects (CHD) and identify factors associated with intensity of participation.

METHOD

Eighty adolescents with CHD were recruited (39 males, 41 females; mean age [SD] 15y 8mo [1y 8mo] range 11y 5mo-19y 11mo) of whom 78 completed the Children's Assessment of Participation and Enjoyment (CAPE) outcome measure of leisure participation. The measure has five subscales: recreational, active-physical, social, skill-based, and self-improvement. Associations between the CAPE and age, sex, and development were examined. Motor ability (Movement Assessment Battery for Children, Second Edition), cognition (Leiter International Performance Scale-Revised), behavior (Strengths and Difficulties Questionnaire), and motivation (Dimensions of Mastery Questionnaire) were assessed.

RESULTS

Participants exhibited impaired motor (43.5%), behavioral (23.7%), and cognitive (29.9%) development. The most intense participation was in social (mean [SD] 3.3 [0.99]) and recreational (2.9 [0.80]) activity types on the CAPE. Male sex (p<0.05) and younger age were associated with greater physical activity (<15y: 1.87; ≥15y: 1.31, p<0.05). Greater engagement in social activities was related to better cognition (r=0.28, p<0.05), higher motor function (r=0.30-0.36, p<0.01), and fewer behavioral difficulties (r=-0.32 to -0.47, p<0.01). Cognitive ability (r=0.27, p<0.05), dexterity and aiming/catching (r=0.27-0.33, p<0.05), and behavior problems (r=0.38-0.49, p=0.001) were correlated with physical activity participation. Persistence in tasks, an aspect of motivation, correlated with physical (r=0.45, p<0.001) and social activity involvement (r=0.28, p<0.05).

INTERPRETATION

Ongoing developmental impairments in adolescents with CHD are associated with decreased active-physical and social engagement, putting them at risk of poor physical and mental health. Health promotion strategies should be considered.

WHAT THIS PAPER ADDS

Adolescents with congenital heart defects (CHD) have limited engagement in active-physical leisure activities. Cognitive, motor, and behavioral impairments are associated with decreased participation in leisure in children with CHD. Female sex and older age are associated with less engagement in leisure. Mastery motivation correlates with participation, suggesting an avenue for intervention.

Recruitment, use, and satisfaction with a web platform supporting families of children with suspected or diagnosed developmental coordination disorder: a randomized feasibility trial

Objectives. To determine the feasibility of recruiting families of children with suspected or diagnosed developmental coordination disorder (sdDCD) and explore their satisfaction with a web-based intervention Design. A feasibility randomized trial was conducted. Participants were the parents of 5-12-year-old children with sdDCD. The intervention group had access to online resources, group and private forums, and videoconferencing with a therapist. Main outcomes were recruitement and retention rates. Satisfaction was documented through a post-intervention survey and interview. Results. The recruitment rate was seven participants per month (n = 28 participants) and retention rate was 68%. Satisfaction was moderate. No differences in use and satisfaction were observed between groups. Participants formulated recommendations for improving the intervention, including targeting families earlier in the diagnosis process, and pre-scheduling meetings with therapists. Conclusions. This study demonstrated the feasibility of future trials, and highlighted avenues for improvement. Parent involvement during the development of the intervention is discussed at length. Abbreviations: DCD: Developmental Coordination Disorder; sdDCD: suspected or diagnosed Developmental Coordination Disorder; RCT: randomized-controled trial.

Expérimentation d’une formation sur le trouble développemental de la coordination destinée aux enseignants en éducation physique

Purpose: Best DCD practices include developing the ability of teachers to promote the participation of children in physical activities. The purpose of this study is to assess the impact of a one-day training session, including short lectures and workshops on developmental coordination disorder (DCD), on the perceptions that physical education teachers (PET) have of the knowledge, skills, and pedagogical practices. Methods: cohort study with a mixed pre-post-follow-up design that included a questionnaire before, immediately after, and three months after the training. Descriptive analyses, Wilcoxon tests, and a thematic analysis were performed. Results: 38, 35, and 22 PET respectively filled out the questionnaires at the three time-point. The perceptions of the knowledge, skills, and pedagogical practices of the PET were higher after the training compared to the initial perceptions (p < 0.006). At first, the PETs reported using certain general pedagogical strategies (e.g., modifying the task). After the training, the PETs gave more concrete examples and reported using new strategies (e.g., offering feedback after the task), which seems to have decreased behavioural problems. Conclusions: training can favourably modify the PETs' perceptions on their knowledge, skills, and practices. More research is necessary to assess the impact of the participation of children with a DCD.

A Comparison of Developmental Outcomes of Adolescent Neonatal Intensive Care Unit Survivors Born with a Congenital Heart Defect or Born Preterm

OBJECTIVE

To compare cognitive, motor, behavioral, and functional outcomes of adolescents born with a congenital heart defect (CHD) and adolescents born preterm.

STUDY DESIGN

Adolescents (11-19 years old) born with a CHD requiring open-heart surgery during infancy (n = 80) or born preterm ≤29 weeks of gestational age (n = 128) between 1991 and 1999 underwent a cross-sectional evaluation of cognitive (Leiter International Performance Scale-Revised), motor (Movement Assessment Battery for Children-II), behavioral (Strengths and Difficulties Questionnaire), and functional (Vineland Adaptive Behavior Scale-II) outcomes. Independent samples t tests and Pearson χ² or Fisher exact tests were used to compare mean scores and proportions of impairment, respectively, between groups.

RESULTS

Adolescents born with a CHD and adolescents born preterm had similar cognitive, motor, behavioral, and functional outcomes. Cognitive deficits were detected in 14.3% of adolescents born with a CHD and 11.8% of adolescents born preterm. Motor difficulties were detected in 43.5% of adolescents born with a CHD and 50% of adolescents born preterm. Behavioral problems were found in 23.7% of adolescents in the CHD group and 22.9% in the preterm group. Functional limitations were detected in 12% of adolescents born with a CHD and 7.3% of adolescents born preterm.

CONCLUSIONS

Adolescents born with a CHD or born preterm have similar profiles of developmental deficits. These findings highlight the importance of providing long-term surveillance to both populations and guide the provision of appropriate educational and rehabilitation services to better ameliorate long-term developmental difficulties.

Reliability of Inclinometer-Derived Passive Range of Motion Measures in Youth with Cerebral Palsy

Aims: This study evaluated, for youth with cerebral palsy (CP), the reliability of passive range of motion (PROM) measures taken with an inclinometer, a device that may be simpler to use than a goniometer. Methods: The PROM for elbow and wrist extension, ankle dorsal flexion (knee flexed 90° and fully extended), and the knee popliteal angle of 30 youth with CP (18 boys, 12 girls, 7.0 ± 3.8 years old, classified in Gross Motor Function Classification levels I-V) was measured using an inclinometer. Two physical therapists took the measures during two different sessions, a maximum of 1 week apart. Results: Good mean intra-rater inter-session, inter-rater intra-session, and inter-rater inter-session reliability (ICC = 0.75-0.89), was found for the elbow, ankle, and knee sites. Absolute reliability for these sites and conditions was 7-14° (90% confident) and 10-16° (95% confident). Reliability values for wrist extension were comparable, albeit slight lower. Conclusions: Similar to published values for goniometry, inclinometery yields reliable upper and lower limb PROM measures from ambulatory and non-ambulatory youth with CP whether measures are carried out by different evaluators within or across sessions or whether measures are performed by the same evaluator across sessions.

Rehabilitation Interventions to modify endocrine-metabolic disease risk in Individuals with chronic Spinal cord injury living in the Community (RIISC): A systematic review and scoping perspective

CONTEXT

Endocrine-metabolic disease (EMD) risk following spinal cord injury (SCI) is associated with significant multi-morbidity (i.e. fracture, diabetes, heart disease), mortality, and economic burden. It is unclear to what extent rehabilitation interventions can modify EMD risk and improve health status in community-dwelling adults with chronic SCI.

OBJECTIVES

To characterize rehabilitation interventions and summarize evidence on their efficacy/effectiveness to modify precursors to EMD risk in community-dwelling adults with chronic SCI.

METHODS

Systematic searches of MEDLINE PubMed, EMBASE Ovid, CINAHL, CDSR, and PsychInfo were completed. All randomized, quasi-experimental, and prospective controlled trials comparing rehabilitation/therapeutic interventions with control/placebo interventions in adults with chronic SCI were eligible. Two authors independently selected studies and abstracted data. Mean differences of change from baseline were reported for EMD risk outcomes. The GRADE approach was used to rate the quality of evidence.

RESULTS

Of 489 articles identified, 16 articles (11 studies; n=396) were eligible for inclusion. No studies assessed the effects of rehabilitation interventions on incident fragility fractures, heart disease, and/or diabetes. Individual studies reported that exercise and/or nutrition interventions could improve anthropometric indices, body composition/adiposity, and biomarkers. However, there were also reports of non-statistically significant between-group differences.

CONCLUSIONS

There was very low-quality evidence that rehabilitation interventions can improve precursors to EMD risk in community-dwelling adults with chronic SCI. The small number of studies, imprecise estimates, and inconsistency across studies limited our ability to make conclusions. A high-quality longitudinal intervention trial is needed to inform community-based rehabilitation strategies for EMD risk after chronic SCI.

A Call to Action: Setting the Research Agenda for Addressing Obesity and Weight-Related Topics in Children with Physical Disabilities

BACKGROUND

Pediatric obesity is a world-wide challenge. Children with physical disabilities are particularly at risk of obesity, which is worrisome because obesity can result in serious secondary conditions that decrease health status, reduce independence, and increase impact on healthcare systems. However, the determinants of obesity and the health promotion needs of children with physical disabilities are relatively unexplored compared with their typically developing peers.

METHODS

This white paper describes a Canadian multi-stakeholder workshop on the topic of obesity and health in children with physical disabilities and provides recommendations for future research in this understudied area.

RESULTS

Seventy-one knowledge gaps identified by attendees using a modified nominal group technique clustered into six themes: (1) early, sustained engagement of families; (2) rethinking determinants of obesity and health; (3) maximizing impact of research; (4) inclusive integrated interventions; (5) evidence-informed measurement and outcomes; and (6) reducing weight biases. Attendees worked together to develop research plans in more detail for three areas identified through consensus as high priority: "early, sustained engagement of families;" "rethinking determinants of obesity and health;" and "evidence informed measurement and outcomes."

CONCLUSIONS

Using the workshop described here as a call to action, Canadian researchers are now well positioned to work toward a greater understanding of weight-related topics in children with physical disabilities, with the aim of developing evidence-based and salient obesity prevention and treatment approaches.

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Foot Care in the Management of Juvenile Idiopathic Arthritis

OBJECTIVE

To create evidence-based guidelines evaluating foot care interventions for the management of juvenile idiopathic arthritis (JIA).

DATA SOURCES

An electronic literature search of the following databases from database inception to May 2015 was conducted: MEDLINE (Ovid), EMBASE (Ovid), Cochrane CENTRAL, and clinicaltrials.gov.

STUDY SELECTION

The Ottawa Panel selection criteria targeted studies that assessed foot care or foot orthotic interventions for the management of JIA in those aged 0 to ≤18 years. The Physiotherapy Evidence Database scale was used to evaluate study quality, of which only high-quality studies were included (score, ≥5). A total of 362 records were screened, resulting in 3 full-text articles and 1 additional citation containing supplementary information included for the analysis.

DATA EXTRACTION

Two reviewers independently extracted study data (intervention, comparator, outcome, time period, study design) from the included studies by using standardized data extraction forms. Directed by Cochrane Collaboration methodology, the statistical analysis produced figures and graphs representing the strength of intervention outcomes and their corresponding grades (A, B, C+, C, C-, D+, D, D-). Clinical significance was achieved when an improvement of ≥30% between the intervention and control groups was present, whereas P>.05 indicated statistical significance. An expert panel Delphi consensus (≥80%) was required for the endorsement of recommendations.

DATA SYNTHESIS

All included studies were of high quality and analyzed the effects of multidisciplinary foot care, customized foot orthotics, and shoe inserts for the management of JIA. Custom-made foot orthotics and prefabricated shoe inserts displayed the greatest improvement in pain intensity, activity limitation, foot pain, and disability reduction (grades A, C+).

CONCLUSIONS

The use of customized foot orthotics and prefabricated shoe inserts seems to be a good choice for managing foot pain and function in JIA.

Health-related physical fitness for children with cerebral palsy

Low levels of physical activity are a global health concern for all children. Children with cerebral palsy have even lower physical activity levels than their typically developing peers. Low levels of physical activity, and thus an increased risk for related chronic diseases, are associated with deficits in health-related physical fitness. Recent research has provided therapists with the resources to effectively perform physical fitness testing and physical activity training in clinical settings with children who have cerebral palsy, although most testing and training data to date pertains to those who walk. Nevertheless, on the basis of the present evidence, all children with cerebral palsy should engage, to the extent they are able, in aerobic, anaerobic, and muscle-strengthening activities. Future research is required to determine the best ways to evaluate health-related physical fitness in nonambulatory children with cerebral palsy and foster long-term changes in physical activity behavior in all children with this condition.

Participation and enjoyment of leisure activities in adolescents born at ≤ 29 week gestation

BACKGROUND AND OBJECTIVES

Motor, cognitive, social and behavioral problems have been found to persist in adolescents born extremely preterm. Leisure participation has been associated with health benefits; however, few studies have explored leisure participation in this population. The aim of this study was to describe leisure participation in adolescents born at ≤29week gestation. Secondary aims were to identify potential differences in participation related to sex, age, motor competence, and cognitive ability, and between adolescents born preterm and their siblings born at term.

METHODS

This cross-sectional study included 128 adolescents (mean age: 16.0years; 67 females) with a mean gestational age of 26.5weeks. All participants, as well as 22 siblings born at term, completed the Children's Assessment of Participation and Enjoyment.

RESULTS

Participation levels were highest in social and recreational activities, and lowest in active-physical and skill-based activities. Boys participated in more active-physical activities (p=0.01) and more often (p<0.001) than girls, whereas girls had higher participation levels in social and self-improvement activities (p<0.05) than boys. Older adolescents engaged in more social activities (p=0.01) and more frequently (p=0.002) than younger adolescents. Overall, participants with poor motor and cognitive skills had lower participation levels in active-physical and social activities. Adolescents born preterm participated in fewer recreational activities compared to term-born siblings (p=0.013).

CONCLUSIONS

Engagement in active-physical and skill-based leisure activities needs to be promoted in boys, and especially in girls with a history of prematurity. Activities should be adapted to sex and individual skill level in order to promote participation.

Translation, cross-cultural adaptation and validation of the French version of the Knee Outcome Survey-Activities of Daily Living Scale

PURPOSE

The Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS) is a joint-specific questionnaire measuring functional limitation experienced by individuals with knee disorders. The original English version of the KOS-ADLS has been shown to be highly reliable and responsive to change. The purpose of this study was to perform a translation and cross-cultural adaptation of the original version of the KOS-ADLS questionnaire into French and to validate this French version of the questionnaire.

METHOD

In accordance with standard procedure, the original version of the KOS-ADLS was translated and cross-culturally adapted into French. Once the final French version of the KOS-ADLS was developed, it was subjected to further psychometric evaluation with 76 individuals with knee disorders. Each participant completed the KOS-ADLS on three occasions: at baseline, two days later to evaluate test-retest reliability, and four weeks later to evaluate responsiveness. Symptoms and function-oriented construct questions were also completed to evaluate construct-convergent and known-group validity.

RESULTS

The cross-cultural adaptation procedure revealed no major problems with content or language. The French version of the KOS-ADLS showed excellent test-retest reliability with low measurement error (intraclass correlation coefficient = 0.92, minimal detectable change = 8.3), as well as high responsiveness (standardized response mean = 1.41; clinically important difference = 13.6). Further, it discriminates between different levels of self-rated or clinician-rated knee function.

CONCLUSIONS

The French version of the KOS-ADLS is a reliable, valid and responsive questionnaire for the assessment of functional limitation in individuals with musculoskeletal knee disorders.

Motor measures: a moving target?

Outcome measures may be used for a variety of reasons by clinicians and researchers. This paper provides an overview on motor measures that can be used in research or practice and are classified within the International Classification of Functioning, Disability and Health or ICF. Specifically, body function measures of neuromusculoskeletal and movement-related functions are presented, as are mobility measures within the activity and participation domain of the ICF. Descriptions of measures within these categories and their psychometric properties are provided. Current challenges and future directions for motor measurement are delineated.

Relationships between lower limb muscle strength and locomotor capacity in children and adolescents with cerebral palsy who walk independently

This study aimed to quantify relationships between lower limb muscle strength and locomotor capacity for children and adolescents with cerebral palsy (CP) to identify key muscle groups for strength training. Fifty 6- to 16-year-olds with CP (Gross Motor Function Classification System level I or II) participated. Isometric muscle strength of hip flexor and abductor, knee flexor and extensor, and ankle dorsiflexor muscles was measured using hand-held dynamometry. Ankle plantar flexor concentric muscle strength was assessed as the maximal number of unilateral heel rises. Locomotor capacity was evaluated by the 6-min walk test (6MWT), 10-meter Shuttle Run Test (10mSRT), and Timed Up and Down Stairs Test (TUDS). With control for age, sex, and height, hip flexor and ankle plantar flexor strength explained 47.8% of the variance in the 6MWT and 32.9% of variance in the TUDS and hip abductor isometric strength explained 43.5% of the variance in the 10mSRT. Avenues for future research include randomized controlled trials that specifically target hip flexor muscles, as this has not previously been done, and determining factors other than strength that are likely related to locomotor capacity of children and adolescents with CP.

The 220-age equation does not predict maximum heart rate in children and adolescents

Our primary purpose was to provide maximum heart rate (HR(max) ) values for ambulatory children with cerebral palsy (CP). The secondary purpose was to determine the effects of age, sex, ambulatory ability, height, and weight on HR(max) . In 362 ambulatory children and adolescents with CP (213 males and 149 females; age range 6-19y; 195 spastic unilateral, 162 spastic bilateral, and five ataxic CP), HR(max) was measured during a 10-m (Gross Motor Function Classification System [GMFCS] levels I and II) or 7.5 m (GMFCS level III) shuttle run test. The mean HR(max) was 194 (SD 9.9) beats per minute (bpm), with a 95% prediction interval between 174 and 214 bpm. No associations were found in HR(max) related to age, sex, ambulatory ability, height, and weight. Since the HR(max) did not vary with age, equations such as 220-age are not appropriate. When direct evaluation of HR(max) with exercise testing is not feasible, we suggest the mean value of 194 bpm be considered as an estimate of HR(max) at the individual level.

Identification of a core set of exercise tests for children and adolescents with cerebral palsy: a Delphi survey of researchers and clinicians

AIM

Evidence-based recommendations regarding which exercise tests to use in children and adolescents with cerebral palsy (CP) are lacking. This makes it very difficult for therapists and researchers to choose the appropriate exercise-related outcome measures for this group. This study aimed to identify a core set of exercise tests for children and adolescents with CP.

METHOD

Fifteen experts (10 physical therapists/researchers and five exercise physiologists; three from the Netherlands, two from the USA, one from the UK, five from Canada, and four from Australia) participated in a Delphi survey which took four stages to achieve a consensus. Based on the information that was collected during the survey, a core set of measures was identified for levels I to IV of the Gross Motor Function Classification System (GMFCS).

RESULTS

For children with CP classified at GMFCS levels I and II, tests were identified for two motor skills (walking and cycling). For the subgroup of children with CP classified at GMFCS level III, the tests that were identified related to walking, cycling, and arm cranking. For children with CP classified at GMFCS level IV, the tests included in the core set were related to cycling and arm cranking.

INTERPRETATION

The core set will help physical therapists, exercise physiologists, and other health professionals who work with children and adolescents with CP to decide which test(s) to use in clinical practice or research. This will facilitate comparability of results across studies and clinical programmes.

Physical Activity Level is Associated with the O2 Cost of Walking in Cerebral Palsy

PURPOSE

To determine, in children and adolescents with cerebral palsy (CP), the relationship between physical activity level (PAL) and i) oxygen cost of walking, and ii) peak VO2.

METHODS

In 11 subjects (10.6-16.3 yr) with mild CP, PAL, the ratio of total energy expenditure to resting energy expenditure, was determined from 3 d of heart rate (HR) monitoring (field), with individual HR-VO2 calibrations done in the lab. The oxygen cost of walking was measured during three 3-min walks on a treadmill at 60, 75, and 90% of each subject's fastest treadmill walking speed (FWS). Subjects also performed a maximal treadmill exercise test. Alpha was set at 0.05.

RESULTS

One subject was an outlier and eliminated from all simple linear regression analyses. For the remaining 10 subjects, PAL (1.37+/-0.18) was related (r=-0.70 to -0.84) to net VO2 at 60 and 75% FWS (13.1+/-4.1 and 16.2+/-4.2 mL.kg.min), net VO2.m, averaged across the three speeds (0.32+/-0.23 mL.kg.m), and percent peak VO2 at all three speeds (54.5+/-21.5, 63.5+/-20.9, and 75.5+/-15.1%). PAL was not significantly related to net VO2 at 90% FWS (20.8+/-5.3 mL.kg.min) or to peak VO2 (34.0+/-9.2 mL.kg.min).

CONCLUSION

For this population, those with low PAL may also have a high oxygen cost of walking. These individuals' PAL was not related to their peak VO2. Further research is required to determine whether interventions that decrease the oxygen cost of walking also affect PAL and whether changes in PAL affect the oxygen cost of walking.

Habitual Physical Activity Levels Are Associated with Biomechanical Walking Economy in Children with Cerebral Palsy

OBJECTIVE

To evaluate in children and adolescents with cerebral palsy the relationship between habitual physical activity and biomechanical treadmill walking economy and whether treadmill belt speed or walking time affect economy.

DESIGN

Physical activity was measured in 11 subjects (10.6-16.3 yrs) with mild cerebral palsy using a triaxial accelerometer. To determine biomechanical walking economy, subjects' stride lengths and vertical sacral excursions were measured during each minute of three 3-min walks on a treadmill (at 60%, 75%, and 90% of individually determined fastest treadmill walking speed).

RESULTS

Biomechanical walking economy at 60%, 75%, and 90% of (their) fastest speed each explained about half of the intersubject variance in daily physical activity (movement counts). A similar relationship was found between these biomechanical walking economy variables and movement counts at or above the 80th and 90th percentile (total minutes per day, number of 5-min bouts per day). Walking economy was 23.9% higher when subjects walked at 90% than when they walked at 60% of their fastest walking speed. No other speed-related effects on economy were found, nor did time affect economy.

CONCLUSIONS

Within this population, those with high biomechanical treadmill walking economy are the more habitually physically active. Treadmill belt speed, but not walking time, affects biomechanical walking economy.

Minute-by-minute differences in co-activation during treadmill walking in cerebral palsy

The primary purpose of this study was to determine, in children and adolescents with mild spastic cerebra palsy (CP); 1) minute-by-minute differences in lower limb antagonist muscle co-activation and stride length (SL) during treadmill walking following 12-15 minutes of treadmill walking practice, and 2) if the minute-by-minute pattern of co-activation is affected by site (thigh or lower leg) and lower limb dominance. A secondary purpose was to determine if overall there is a difference in co-activation between the dominant and non-dominant lower limbs. Eight independently ambulatory children and adolescents with mild spastic CP (9.2-15.7 yr) participated in the study. Minute-by-minute lower limb antagonist muscle co-activation and SL were measured during a 3-minute treadmill walk at 90% of individually determined fastest treadmill walking speed. Non-dominant thigh (quadriceps, hamstring muscles) co-activation decreased between minute 1 and a) minute 2 (6%), b) minute 3 (7.2%). Co-activation for the dominant lower leg (tibialis anterior, triceps surae muscles) decreased between minute 1 and minute 3 (11.3%). Non-dominant thigh co-activation was on average 27.3% higher than for the dominant thigh. Thigh co-activation was on average 27.7% higher than for the lower leg, independent of dominance or time. SL increased between minute 1 and minute 3 by 2.1%. Twelve to 15 minutes of treadmill walking practice may be sufficient time to obtain stable co-activation and SL values by minute 2 of a fast treadmill walk. Dominance and site affect the magnitude of co-activation.