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Ruiz JJB, Perez-Cruzado D, Llanes RP. Immediate effects of lumbar fascia stretching on hamstring flexibility: A randomized clinical trial. J Back Musculoskelet Rehabil 2023; 36:619-627. [PMID: 36872764 DOI: 10.3233/bmr-210274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The hamstring muscles have a great tendency to decrease their extensibility, a phenomenon that presents a distinct clinical entity called short hamstring syndrome (SHS), in addition to problems with adjacent structures. OBJECTIVE The objective of this study was to evaluate the immediate effect of lumbar fascia stretching on the flexibility of the hamstring musculature. METHODS A randomized controlled trial was carried out. Forty-one women between 18 and 39 years old were divided into two groups: the experimental group received a technique of fascial stretching in the lumbar area while the control group participated in a magnetotherapy machine that was turned off. Hamstring flexibility in both lower limbs was measured by the straight leg raising test (SLR) and the passive knee extension test (PKE). RESULTS The results showed statistically significant improvements (p< 0.05) in the SLR and the PKE for both groups. There was a large effect size (Cohen's d) for both tests. There was a statistically significant correlation between the International Physical Activity Questionnaire (IPAQ) and the SLR. CONCLUSION The inclusion of lumbar fascia stretching might be an effective part of a treatment protocol to increase the flexibility of the hamstring muscle observing an immediate result in healthy participants.
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Affiliation(s)
- Juan Javier Bru Ruiz
- Department of Physiotherapy, San Antonio Catholic University of Murcia, Murcia, Spain
| | - David Perez-Cruzado
- Department of Occupational Therapy, San Antonio Catholic University of Murcia, Murcia, Spain
| | - Raúl Pérez Llanes
- Department of Physiotherapy, San Antonio Catholic University of Murcia, Murcia, Spain
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2
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Foster BA, Lane JE, Massey E, Noelck M, Green S, Austin JP. The Impact of Malnutrition on Hospitalized Children With Cerebral Palsy. Hosp Pediatr 2020; 10:1087-1095. [PMID: 33154081 PMCID: PMC7684553 DOI: 10.1542/hpeds.2020-0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Children with cerebral palsy (CP) and other medical complexity comprise an outsized proportion of health care use. In this review, we describe the current science of assessment of nutritional status for children with CP, outline a systematic approach to assessing their nutritional status, delineate ramifications of malnutrition on hospitalization-associated outcomes, and identify knowledge gaps and means of addressing those gaps using quality improvement and clinical research tools. Methods to accurately assess body composition and adiposity in this population by using skinfolds, age, sex, and activity level are available but are not widely used. There are limitations in our current method of estimating energy needs in children with CP, who are at higher risk of both obesity and micronutrient deficiencies. There is some evidence of an association between malnutrition, defined as either underweight or obesity, and hospitalization-associated outcomes in children generally, although we lack specific data for CP. The gaps in our current understanding of optimal nutritional status and between current science and practice need to be addressed to improve health outcomes for this vulnerable patient population.
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Affiliation(s)
| | - Jennifer E Lane
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth Massey
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Michelle Noelck
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Sarah Green
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Jared P Austin
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
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Ryan JM, Allen E, Gormley J, Hurvitz EA, Peterson MD. The risk, burden, and management of non-communicable diseases in cerebral palsy: a scoping review. Dev Med Child Neurol 2018; 60:753-764. [PMID: 29572812 DOI: 10.1111/dmcn.13737] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 12/26/2022]
Abstract
AIM To examine the risk, burden, and management of non-communicable diseases (NCDs) among people with cerebral palsy (CP). METHOD Databases (Ovid MEDLINE, Embase Ovid, CINAHL Plus) were systematically searched up to August 2017. Data on the prevalence of risk factors for, and the burden and management of, cardiovascular diseases, diabetes, cancers, and respiratory diseases were extracted. RESULTS Thirty-six studies that examined the prevalence of risk factors among people with CP were identified. There was inconsistent evidence that people with CP had higher prevalence of metabolic risk factors such as hypertension, hyperlipidaemia, and obesity, but strong evidence that they participated in low levels of physical activity, compared with people without CP. Seven studies reported on the burden of NCDs. Adults with CP had a higher risk of NCDs, including stroke, chronic obstructive pulmonary disease, and other heart conditions, and death due to NCDs, including cancers, chronic obstructive pulmonary disease, stroke, and ischaemic heart disease, compared with the general population. Only one study reported on the management of NCD, specifically the uptake of breast cancer screening among females. INTERPRETATION The burden of NCDs is higher among adults with CP compared with the general population. Further research is required to determine the prevalence of metabolic risk factors and management of NCDs among people with CP. WHAT THIS PAPER ADDS Adults with cerebral palsy (CP) have an increased risk of non-communicable diseases (NCDs) and increased risk of death because of NCDs. Evidence is inconsistent about the elevated prevalence of metabolic risk factors for NCDs. Evidence is consistent that people with CP participate in reduced physical activity. Only one study reported on management of NCD among people with CP. Available evidence suggests people with CP are less likely to receive preventive medicine.
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Affiliation(s)
- Jennifer M Ryan
- College of Health and Life Sciences, Brunel University, London, UK.,Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - John Gormley
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Meyns P, Van Gestel L, Bar-On L, Goudriaan M, Wambacq H, Aertbeliën E, Bruyninckx H, Molenaers G, De Cock P, Ortibus E, Desloovere K. Children with Spastic Cerebral Palsy Experience Difficulties Adjusting Their Gait Pattern to Weight Added to the Waist, While Typically Developing Children Do Not. Front Hum Neurosci 2016; 10:657. [PMID: 28123360 PMCID: PMC5226450 DOI: 10.3389/fnhum.2016.00657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/09/2016] [Indexed: 11/13/2022] Open
Abstract
The prevalence of childhood overweight and obesity is increasing in the last decades, also in children with Cerebral Palsy (CP). Even though it has been established that an increase in weight can have important negative effects on gait in healthy adults and children, it has not been investigated what the effect is of an increase in body weight on the characteristics of gait in children with CP. In CP, pre and post three-dimensional gait analyses are performed to assess the effectiveness of an intervention. As a considerable amount of time can elapse between these measurements, and the effect of an alteration in the body weight is not taken into consideration, this effect of increased body weight is of specific importance. Thirty children with the predominantly spastic type of CP and 15 typically developing (TD) children were enrolled (age 3-15 years). All children underwent three-dimensional gait analysis with weight-free (baseline) and weighted (10% of the body weight added around their waist) trials. Numerous gait parameters showed a different response to the added weight for TD and CP children. TD children increased walking velocity, step- and stride length, and decreased double support duration with a slightly earlier timing of foot-off, while the opposite was found in CP. Similarly, increased ranges of motion at the pelvis (coronal plane) and hip (all planes), higher joint angular velocities at the hip and ankle, as well as increased moments and powers at the hip, knee and ankle were observed for TD children, while CP children did not change or even showed decreases in the respective measures in response to walking with added weight. Further, while TD children increased their gastrocnemius EMG amplitude during weighted walking, CP children slightly decreased their gastrocnemius EMG amplitude. As such, an increase in weight has a significant effect on the gait pattern in CP children. Clinical gait analysts should therefore take into account the negative effects of increased weight during pre-post measurements to avoid misinterpretation of treatment results. Overweight and obesity in CP should be counteracted or prevented as the increased weight has detrimental effects on the gait pattern.
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Affiliation(s)
- Pieter Meyns
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center Amsterdam, Netherlands
| | - Leen Van Gestel
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences KU Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation SciencesKU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital LeuvenLeuven, Belgium
| | - Marije Goudriaan
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation SciencesKU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital LeuvenLeuven, Belgium
| | - Hans Wambacq
- Division of Production Engineering, Machine Design and Automation, Faculty of Engineering, Department of Mechanical Engineering, KU Leuven Leuven, Belgium
| | - Erwin Aertbeliën
- Division of Production Engineering, Machine Design and Automation, Faculty of Engineering, Department of Mechanical Engineering, KU Leuven Leuven, Belgium
| | - Herman Bruyninckx
- Division of Production Engineering, Machine Design and Automation, Faculty of Engineering, Department of Mechanical Engineering, KU Leuven Leuven, Belgium
| | - Guy Molenaers
- Clinical Motion Analysis Laboratory, University Hospital LeuvenLeuven, Belgium; Department of Pediatric Orthopaedics, University Hospital LeuvenLeuven, Belgium; Faculty of Medicine, Department of Musculoskeletal SciencesKU Leuven, Leuven, Belgium
| | - Paul De Cock
- Centre for Developmental Disabilities, University Hospital Leuven Leuven, Belgium
| | - Els Ortibus
- Centre for Developmental Disabilities, University Hospital Leuven Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation SciencesKU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital LeuvenLeuven, Belgium
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Pinto VV, Alves LAC, Mendes FM, Ciamponi AL. The nutritional state of children and adolescents with cerebral palsy is associated with oral motor dysfunction and social conditions: a cross sectional study. BMC Neurol 2016; 16:55. [PMID: 27117791 PMCID: PMC4847222 DOI: 10.1186/s12883-016-0573-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the main cause of severe physical impairment during childhood and has commonly shown oral motor association. It has been considered as the main cause of the high prevalence of problems in children's nutrition. Respiration, chewing, swallowing, speaking and facial expressionare part of the orofacial motor functions and when affected they can interfere in children's well-being. The aim of this study was to correlate two methods of orofacial motor evaluation, analyze the influence of orofacial motor functional impairment on the nutritional status of children and adolescents with CP, and the association between socioeconomic factors. METHODS Seventy children and adolescents with CP were selected, age range 6-16 years and following the exclusion criteria previously determined; 129 normoreactive children (control group), sex and age-matched to patients with CP. For the orofacial motor analysis two evaluation instruments were applied, the "Oral Motor Assessment Scale" (OMAS) and "Nordic Orofacial Test-Screening" (NOT-S). The anthropometric evaluation was based on the World Health Organization (WHO) and followed the criteria recommended by the Brazilian Ministry of Health. RESULTS There was statistically significant correlation between the oral motor methods of evaluation (r = -0.439, p < 0.0001). Concerning the nutritional status evaluation, being overweight was associated with dystonic and mixed CP forms variables (p = 0.034), mother with no partnership (p = 0.045) and mild oral motor impairment (p = 0.028). CONCLUSION It could be concluded that, the weight's gain by children and adolescents might be favored by a better functional oral motor performance and social factors.
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Affiliation(s)
- Vanessa Vieira Pinto
- Department of Orthodontics and Paediatric Dentistry, School of Dentistry, University of São Paulo (USP), Avenida Professor Lineu Prestes 2227, SP, São Paulo, 05508-000, Brazil
| | - Levy Anderson César Alves
- Department of Orthodontics and Paediatric Dentistry, School of Dentistry, University of São Paulo (USP), Avenida Professor Lineu Prestes 2227, SP, São Paulo, 05508-000, Brazil
| | - Fausto M Mendes
- Department of Orthodontics and Paediatric Dentistry, School of Dentistry, University of São Paulo (USP), Avenida Professor Lineu Prestes 2227, SP, São Paulo, 05508-000, Brazil
| | - Ana Lídia Ciamponi
- Department of Orthodontics and Paediatric Dentistry, School of Dentistry, University of São Paulo (USP), Avenida Professor Lineu Prestes 2227, SP, São Paulo, 05508-000, Brazil.
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Pascoe J, Thomason P, Graham HK, Reddihough D, Sabin MA. Body mass index in ambulatory children with cerebral palsy: A cohort study. J Paediatr Child Health 2016; 52:417-21. [PMID: 27145505 DOI: 10.1111/jpc.13097] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 09/14/2015] [Accepted: 10/26/2015] [Indexed: 11/26/2022]
Abstract
AIM Children with cerebral palsy (CP) have reduced levels of physical activity compared with children without physical disability and experience risk factors for becoming overweight or obese. In the Australian CP population, there is little information available about the weight status of children with CP. The aims of this study were to compare the distribution of body mass index (BMI) in a cohort of ambulant children with CP with the BMI distribution of Australian children and explore the relationship between BMI and gross motor function. METHODS A retrospective cohort study of 587 children with CP Gross Motor Function Classification System (GMFCS) levels I-III who attended a Gait Laboratory between July 1995 and January 2012 was carried out. The BMI and Z-score were calculated at each assessment. Data were grouped into the categories of underweight, healthy, overweight and obese according to age-specific and sex-specific percentiles. RESULTS There were 348 boys and 240 girls with a mean age 11.2 (standard deviation 3.2) years. Mean BMI Z-score was 0.11 (standard deviation 1.33). Seven percent of children were underweight, 73.6% healthy, 7.3% overweight and 12.1% obese. This was similar to the distribution of children without disability. The largest percentage of children in the healthy group were classified GMFCS I. The largest percentage of children in the obese group were classified GMFCS III. CONCLUSIONS In this cohort, 19.4% of ambulant children with CP were overweight or obese. This is of concern as BMI may impact on the outcomes of surgical intervention and rehabilitation. Further research is needed to determine the consequences of obesity for children with CP.
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Affiliation(s)
- Jessica Pascoe
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia
| | - Pam Thomason
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - H Kerr Graham
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Dinah Reddihough
- Murdoch Childrens Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Department of Developmental Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Matthew A Sabin
- Murdoch Childrens Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia
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Şimşek TT, Tuç G. Examination of the relation between body mass index, functional level and health-related quality of life in children with cerebral palsy. TURK PEDIATRI ARSIVI 2014; 49:130-7. [PMID: 26078648 PMCID: PMC4462285 DOI: 10.5152/tpa.2014.1238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 12/05/2013] [Indexed: 01/26/2023]
Abstract
AIM The aim of this study was to examine the relation between body mass index (BMI) and functional level and health-related quality of life in children with cerebral palsy (CP). MATERIAL AND METHODS Two hundred seventy-eight children with CP aged between 2 and 18 years were included in the study. The sociodemographic properties of the children were recorded. Their functional independence levels were assessed with WeeFIM and their health-related quality of life levels were assessed with the Child Health Questionnaire-Parent Form (PF-50). Approval was obtained from the ethics committee of Abant İzzet Baysal University Medical Faculty for this study (Number: 2008/100-77). RESULTS When classified by body mass index, 26.3% of the children had a normal body weight, 5.4% were overweight, 11.5% were obese and 56.8% had a low body weight. The rate of low body weight was higher in children with moderate and severe CP (52.7% and 53.8%, respectively), while the rate of obesity was higher in children with mild CP who could walk (7.1%). A significant difference was found in children with CP with a normal body weight, overweight children with CP, obese children with CP and children with CP with a low body weight in terms of the total WeeFIM score and the variables of quality of life including physical functionality and role/social limitations because of physical health (p<0.05). In the correlation analysis, a positive correlation was found between WeeFIM and BMI and the subdimensions of role/social limitations because of emotional or behavioral difficulties, pain and discomfort and self-esteem (p<0.05). CONCLUSIONS Our results showed that BMI affected functional independence and health-related quality of life in children with CP and this was more prominent in children who had severe CP and low BMI values. More studies are needed in this area.
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Affiliation(s)
| | - Gamze Tuç
- Private Keşan Public Hospital, Tekirdağ, Turkey
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