Short and Long-Term Effects of Whole-Body Vibration on Spasticity and Motor Performance in Children With Hemiparetic Cerebral Palsy

This study aimed to investigate the short and long-term effects of Whole-Body Vibration (WBV) therapy on spasticity and motor performance in children with hemiparetic cerebral palsy. We recruited 26 patient participants from among children undergoing conventional physiotherapy in a private rehabilitation center. We randomly assigned 22 participants to equally sized treatment (n = 11) and control (n = 11) groups. We evaluated the participants at the beginning of the study with the Gross Motor Function Measure-88, LEGSys™ Spatio-Temporal Gait Analyzer, SportKAT550™ Portable Computerized Kinesthetic Balance Device and the Modified Ashworth Scale. While children in the treatment group were treated with Compex-Winplate™ to administer WBV in three 15-minute sessions per week for eight weeks, children in the control group received continued conventional physiotherapy during this period. We then re-evaluated all participants both immediately after the treatment and again 12 weeks after the treatment. Following WBV, both gross motor functions and gait and balance skills were significantly improved (p < 0.05), and spasticity in lower and upper extremity muscles was significantly inhibited (p < 0.05). These improvements were preserved even after 12 weeks. We conclude that WBV is an effective incremental approach to conventional physiotherapy in children with hemiparetic cerebral palsy for inhibiting spasticity and improving motor performance.

FRI0636-HPR COMPARING THE EFFECTS OF YOGA AND HOME EXERCISE PROGRAMS ON FUNCTIONAL STATUS IN CHILDREN WITH ENTHESITIS RELATED ARTHRITIS

Background:

Enthesitis-Related Arthritis (ERA), also referred as the juvenile ankylosing spondylitis, is a subtype of Juvenile Idiopathic Arthritis (JIA). However, ERA patients were reported as having higher pain levels, lower functional status and lower quality of life level compared to other JIA subtypes. Yoga is used as an exercise method in adult patients with rheumatic diseases and positive effects on physical and psychosocial symptoms were reported. However, no study was conducted related to yoga in pediatric population with rheumatic diseases.

Objectives:

The aim of this study was to investigate effects of performing yoga or home exercises on functional status in children with ERA.

Methods:

Twenty-one children with ERA were allocated into two groups as yoga group (n=11) and home exercise group (n=10). Yoga group performed yoga exercises supervised by a physiotherapist for twice a week, for eight weeks, while the home exercise group performed video-based home exercises for the same period. Pain in rest and activity (Numeric Rating Pain Scale), functional status (Six-Minute Walk Distance, Stair Climb Test), and quality of life (PedsQL Children and Parent Form) were evaluated at baseline and following eight weeks.

Results:

The groups were similar regarding to physical characteristics, pain, functional status, and quality of life at baseline (p>0.05, Table 1). While, all the parameters (except PEDSQL Parent Form) in yoga group significantly improved at the end of the study (p<0.05, Table 2), only stair climb test results significantly improved in home exercise group (p<0.05, Table 2).

Table 1.

Comparison of the groups at baseline

Yoga Group(n:11)Median (IQR 25/75)Home Exercise Group (n:10)Median (IQR 25/75)p*Physical parametersAge (year)15.0 (13.0/15.5)16.0 (14.0/17.0)0.099BMI (kg/m2)20.7 (18.3/23.1)21.2 (19.9/22.0)0.756PainRest pain (score)0 (0/5.0)1.0 (0/3.0)0.705Activity pain (score)4.0 (1.0/6.5)2.0 (0/7.0)0.387Functional StatusSix-minute walk distance (m)600.0 (552.5/664.5)626.0 (556.0/650.0)1.000Stair climb test (sec)7.6 (6.8/8.3)7.4 (7.0/8.0)1.000Quality of LifePedsQL Children (score)13.0 (10.0/23.5)12.5 (6.0/20.0)0.654PedsQL Parent (score)21.0 (8.5/31.5)26,0 (15.0/39.0)0.387

*: Mann-Whitney U test; IQR 25/75: Interquartile Range 25/75, PedsQL: Pediatric Quality of Life Inventory, p<0.05

Table 2.

Changes in the Groups

BeforeMedian(IQR 25/75)AfterMedian(IQR 25/75)p*Yoga GroupPainRest pain (score)0 (0/5.0)0 (0/2.5)0.039Activity pain (score)4.0 (1.0/6.5)0 (0/1.5)0.012Functional StatusSix-minute walk distance (m)600.0 (552.5/664.5)692.0 (595.0/705.5)0.011Stair climb test (sec)7.6 (6.8/8.3)6.2 (6.0/7.0)0.008Quality of LifePedsQL Children (score)13.0 (10.0/23.5)9.0 (4.0/17.0)0.021PedsQL Parent (score)21.0 (8.5/31.5)18.0 (8.0/22.0)0.169Home Exercise GroupPainRest pain (score)1.0 (0/3.0)0 (0/3.0)0.715Activity pain (score)2.0 (0/7.0)2.0 (0/7.0)0.892Functional StatusSix-minute walk distance (m)626.0 (556.0/650.0)601.5 (585.0/707.0)0.093Stair climb test (sec)7.4 (7.0/8.0)7.0 (6.5/7.8)0.028Quality of LifePedsQL Children (score)12.5 (6.0/20.0)8.5 (7.0/18.0)0.475PedsQL Parent (score)26.0 (15.0/39.0)22.5 (14.0/30.0)0.192

*: Wilcoxon Signed Rank Test, IQR 25/75: Interquartile Range 25/75, PedsQL: Pediatric Quality of Life Inventory, p<0.05

Conclusion:

Yoga seems promising for improving functional status in children with ERA compared to a home-based exercise program. Therefore, yoga can be implemented as an exercise intervention in rehabilitation programs in children with ERA.

Disclosure of Interests:

None declared

Investigation of the relationship between quality of life, activity participation and environmental factors in adolescents with cerebral palsy

BACKGROUND AND OBJECTIVE

The aim of this study is to examine the relationship between quality of life, activity-participation and environmental factors in adolescents with cerebral palsy.

METHODS

Seventy-five (75) adolescents (M:45, F:30) aged between 14-18 years (mean: 15.52±1.60 yrs) were included in the study. Participants were divided into three groups: Level I, Level II and Level III according to the Gross Motor Function Classification System. Gross Motor Function Classification System, Gross Motor Function Measure, Functional Independence Scale, Manual Ability Classification System, Pediatric Quality of Life Inventory and International Classification of Functioning, Disability and Health Child-Youth version Short Form (ICF-CY) (14-18 yrs) were used for assessments.

RESULTS

It is found that there is a moderate and high level of correlation between quality of life and activity participation and body functions, a moderate and high level of correlation between quality of life and activity participation and body functions with gross motor function levels, and a moderate and low level correlation between environmental factors and gross motor function levels (p < 0.05).

CONCLUSIONS

The fact that the ICF-CY short form used for cerebral palsied children is compatible with other assessment scales suggests that the use of ICF-CY short forms may be useful in assessing the health status of individuals.

The efficacy of botulinum toxin A lower limb injections in addition to physiotherapy approaches in children with cerebral palsy: A systematic review

BACKGROUND

To assess treatment effect of lower limb botulinum toxin type A (BTX-A) in combination with physiotherapy approaches on gross motor functions in children with cerebral palsy compared with only physiotherapy treatment.

OBJECTIVE

The purpose of this review was to analyze the efficacy botulinum toxin a lower limb injections in addition to physiotherapy approaches in children with cerebral palsy.

METHODS

A literature search was conducted in the following databases: Cochrane, PEDro, PubMed, MEDLINE, AMED and EMBASE. The searches were limited to the period from July 2009 to July 2015. The intervention had to contain BTX-A into the lower limb plus physiotherapy approaches and be compared with only physiotherapy. The methodological quality and clinical relevance were independently assessed by the authors.

RESULTS

The database search resulted in a total of 1521 studies, of which 4 (Level II of evidence) trials were included in this review. The population represented by were age between from 11 month to 15 years. Overall there were 153 children all diagnosed with CP (87 Male, 66 Female).

CONCLUSIONS

The use of BTX-A injections in addition to physiotherapy approaches seems to have positive effect on spasticity and ROM. However, the question of whether the treatment of BTX-A plus physiotherapy has a greater improvement on functional capacity, such as gross motor function or gait parameter than only physiotherapy treatments, was inconclusive. Further investigation by rigorous studies is required.

Examining various factors affecting communication skills in children with cerebral palsy

BACKGROUND AND OBJECTIVE

Cerebral palsied children may have difficulties in acting as senders and/or receivers in the communication process. The aim of this study is examining that which maternal and child-related factors affect the communication skills of cerebral palsied children.

METHODS

188 cerebral palsy diagnosed children ages between 2-18 years were assessed by Communication Function Classification System for communication skills. Maternal factors such as occupation, and educational status, and child-related factors such as gender, time of birth, clinical type of cerebral palsy, origin period of cerebral palsy; also daily living activities and gross motor functions of children were included in the assessment for examining how they affect the communication skills of cerebral palsied children.

RESULTS

Lower maternal age, higher gross motor function level, ataxic type and hemiparetic involvement (p < 0,05); educational status, maternal unemployment, female gender, and premature birth (p > 0,05) affected positively on the communication skills. There were no effects of delivery method (p > 0,05).

CONCLUSIONS

Communication skills of cerebral palsied children are affected by maternal age, educational status, occupation, and child's gender, birth term, origin period of cerebral palsy, clinical type of cerebral palsy, extremity involvement, motor development level and gross motor function. But the method of delivery has no effect on the communication functions of cerebral palsied children.

Investigation of the relationship between kinesiophobia, physical activity level and quality of life in patients with chronic low back pain1

OBJECTIVE

The aim of our study is to examine the relationship between kinesiophobia (fear of movement), physical activity level and quality of life.

METHODS

In this study, we assessed 112 patients consulting for low back pain (LBP) of ≥ 3 month's duration. We used Visual Analog Scale (VAS) for pain intensity, the International Physical Activity Questionnaire (IPAQ) for physical activity level, Tampa Kinesiophobia Scale for perception of kinesiophobia, Oswestry Disability Index for disability status of low back.

RESULTS

The results of this study, there was no statistically significant correlation between International Physical Activity Questionnaire, duration of pain, intensity of pain at rest and Tampa Kinesiophobia Scale (p> 0.05). It was found a statistically significant correlation between pain intensity at activity (p= 0.009), disability level (p= 0.000) and Tampa Kinesiophobia Scale. Tampa Kinesiophobia Scale were highly negative correlated with sub-scale of SF-36 Quality of Life Index (general health, physical function, social status, bodily pain, role limitations due to physical health) (p= 0.000).

CONCLUSION

The kinesiophobia adversely affect the quality of life limiting the physical activity status of patients with chronic low back pain.

Musculoskeletal system problems and quality of life of mothers of children with cerebral palsy with different levels of disability

OBJECTIVE

The objective of this study is to investigate musculoskeletal system problems and quality of life of mothers of children with cerebral palsy with different levels of disability.

METHODS

100 children (37 girls and 63 boys) with cerebral palsy (CP) and their mothers were included in this study. Functional levels of children with CP were assessed by using the Gross Motor Function Classification System (GMFCS) and the Pediatric Functional Independence Measure (WeeFIM). Quality of life of mothers regarding health was assessed by using the Nottingham Health Profile (NHP). Musculoskeletal system problems of mothers were assessed by using the Neck Disability Index (NDI) and the Roland-Morris Disability Questionnaire (RMDQ).

RESULTS

No statistical significance was found when GMFCS levels of children with CP and the NHP, DASH-T, RMDQ, NDI and the BAE values of mothers were compared in an inter-group way (p> 0.05). When the NHP parameters and the existence of lower and arm pains of mothers were compared with their BAI, NDI, RMDQ and DASH-T scores, a statistically significant relationship was found among them (p< 0.05).

CONCLUSION

As functional levels of children with CP get worse, upper extremity, lower back and neck problems and anxiety levels of mothers increase and this situation negatively affects mothers' quality of life.

Comparison of pain intensity, emotional status and disability level in patients with chronic neck and low back pain

OBJECTIVE

This study was planned to compare of pain, emotional status and disability level in patients with chronic neck pain and low back pain.

METHODS

In this study, fifty patients with chronic low back pain (Group I) and fifty patients with chronic neck pain (Group II) at least 6 months were evaluated. A Visual Analog Scale was used to describe pain intensity. To determine emotional status of the subjects, the Beck Depression Scale was used The Oswestry Disability Index and the Neck Disability Index were used to evaluate disability level.

RESULTS

The mean age of the patients with low back pain and neck pain were 39.70 ± 9.71 years, 45.44 ± 10.39 years, respectively. It was not found a significant difference between in low back pain (Group I) and neck pain (Group II) in results of pain intensity (p= 0.286) and pain duration (p= 0.382). It was found a significant difference between group I and group II in results of emotional status (p= 0.000) and disability level (p= 0.000). The emotional status and disability level scores were found highest in patient's with low back pain.

CONCLUSION

Chronic low back pain is affect in patients than chronic neck pain as a emotional status and disability level.

Comparison of effects of supervised physiotherapy and a standardized home program on functional status in patients with total knee arthroplasty: a prospective study

[Purpose] The aim of this study was to determine the functional differences between total knee arthroplasty (TKA) patients who were treated with supervised physiotherapy or a standardized home program and perform a cost analysis. [Subjects and Methods] Patients who received total knee arthroplasty between January 2009 and June 2011 were enrolled in this study; those with mean ages of 64.25±3.86 (60-68) years (n=18) and 68.08±6.25 (61-79) years (n=16) were placed in the supervised physiotherapy and standardized home program groups, respectively. All patients were evaluated by the same researcher before and after surgery, and the therapy programs were applied by another physiotherapist. All patients were evaluated for joint range of motion (ROM), pain, functional status (WOMAC), overall quality of life (SF-36), and depressive symptoms (BECK Depression Scale). [Results] A significant clinical improvement was observed in postoperative assessments. A statistically significant difference could not be found between ROM and functional levels of the patients in both groups. [Conclusion] No difference was found between the patients performing supervised or standardized home program with respect to the effects on functional status. A home exercise program can be used in the rehabilitation of patients with TKA, and implementation of home exercise programs can also reduce health-care spending.

Effects of pulsed electromagnetic field and swimming exercise on rats with experimental sciatic nerve injury

[Purpose] The current study aimed to reveal the therapeutic effects of a pulsed electromagnetic field and swimming exercises on rats with experimental sciatic nerve injury, which was induced with crush-type neuropathy model damage, using electrophysiological methods. [Subjects] In the current study, the sample consisted of 28 adult male Wistar albino rats. [Methods] The rats were randomized into four groups (n=7). Swimming exercise and PEMF (2 Hz and 0.3 MT) were applied one hour a day, five days a week, for four weeks. Electroneuromyographic (ENMG) measurements were taken on day 7. [Results] When the data were evaluated, it was found that the 4 weeks of PEMF and swimming exercises led to an increase in motor conduction rates and a decrease in latency values, but the changes were not significant in comparison with the control and injury groups. The compound muscle action potential (CMAP) values of the left leg were lower in weeks 2, 3, and 4 in the swimming exercise group in comparison with the control group, although for the PEMF group, the CMAP values of the left leg reached the level observed in the control group beginning in week 3. [Conclusion] PEMF and swimming exercise made positive contributions to nerve regeneration after week 1, and regeneration was enhanced.

Expectations from Rehabilitation of Children with Cerebral Palsy: The Agreement between the Physiotherapists and Mothers

[Purpose] The aim of this study was to examine the agreement between physiotherapists (PTs) and mothers (Ms) about the treatment of children with cerebral palsy (CP) who received treatment in special education and rehabilitation centers. [Subjects] Ms of 130 children with CP (75 boys, 55 girls) and 130 PTs who applied rehabilitation programs were interviewed. [Methods] Clinical types and gross motor function levels of the children were recorded. A questionnaire consisting of 6 open-ended questions was used to describe the expectations and views of the PTs and Ms about the physiotherapy and rehabilitation programs for the children. [Results] The mean age of the children was 89.80±52.05 months. The mean treatment period for the children was 73.62±42.11 months. The mean age of the mothers was 35.47±5.79 years, and the mean age of the PTs was 28.07±7.28 years. We found a statistically moderate level of agreement between the PTs and Ms regarding the appropriateness of the treatment provided to the children. There was statistically insignificant agreement regarding the applied treatment methods and the appropriateness of the applied rehabilitation programs. [Conclusion] We believe that the views and expectations of the Ms should be taken into account by the PTs when preparing a treatment program for children with CP.