Cyntia Rogean de Jesus Alves de Baptista

Normative data for hand grip strength in healthy children measured with a bulb dynamometer: a cross-sectional study

OBJECTIVE To present the normative hand grip strength values measured with a bulb dynamometer for children, by gender and age, and to correlate the findings with weight, height, body composition and handedness. DESIGN Cross-sectional study. PARTICIPANTS Data from 295 healthy children of both genders aged 6 to 13 years were analysed. METHODS Weight, height, body composition (Biodynamics model 450 bioimpedance analyser), handedness (Edinburgh scale) and grip strength measured with a bulb dynamometer (North Coast) were obtained. RESULTS Grip strength of both hands increased with age in the two genders. Grip strength was similar in boys and girls between 6 and 13 years of age. The dominant hand was stronger than the non-dominant hand [mean (standard deviation) 7.0 (2.3)psi vs 6.5 (2.1)psi], with a mean difference of 0.52psi (95% confidence interval of the difference 0.46 to 0.58). Grip strength was positively correlated with fat-free mass and height (r≥0.75). CONCLUSION This study provides normative values for hand grip strength measured with a bulb dynamometer in children aged 6 to 13 years. This dynamometer provides a simple method to measure grip strength, and the results of this study provide further evidence of its performance in the measurement of grip strength.

Beneficial effects of ankle–foot orthosis daytime use on the gait of Duchenne muscular dystrophy patients

BACKGROUND Orthosis use prevents muscle contracture and prolongs ambulation in patients with Duchenne muscular dystrophy (DMD). However, its biomechanical effects on gait are unclear. This study assessed the effects of daytime and night-time use of Articulated Ankle Foot Orthosis (AFO) on kinematic, kinetic and spatial/temporal gait parameters of DMD patients. METHODS Twenty ambulatory patients (4-12years of age) were assigned to one of three groups: no orthosis (NoO; n=7), night-time orthosis (NiO; n=7), day-time orthosis (DO; n=6). All subjects were evaluated once (Ev1) and five of them were re-evaluated between five and seven months after Ev1 (Ev2). FINDINGS Cross-sectional analysis with linear mixed-effects models (ANOVA) showed increased peak dorsiflexion angle and dorsiflexor moment and decreased plantar flexion angle and ankle joint power generation for the DOwith group when compared to the NoO group (P<0.05). The DOwith group also showed decreased peak hip flexion angle, hip power absorption, plantar flexion angle and increased peak dorsiflexion moment when compared to the NoO group (P<0.05). Analysis of gait cycle curves showed significant and clinically relevant changes in kinematic and kinetic parameters for the DOwith group when compared to the other experimental groups. Longitudinal analysis suggest that night-time use of Articulated AFO can promote positive changes in gait parameters of DMD patients, when used before the functional deficit is too advanced. INTERPRETATION Early daytime and night-time use of Articulated AFO changed gait and minimized typical compensations seen in DMD patients, thus it is recommended in order to prolong gait ability.

Postural alignment in children with Duchenne muscular dystrophy and its relationship with balance

Background In Duchenne muscular dystrophy, functional deficits seem to arise from body misalignment, deconditioning, and obesity secondary to weakness and immobility. The question remains about the effects of postural deviations on the functional balance of these children. Objectives To identify and quantify postural deviations in children with DMD in comparison to non-affected children (eutrophic and overweight/obese), exploring relationships between posture and function. Method This case-control study evaluated 29 participants aged 6 to 11 years: 10 DMD (DG), 10 eutrophic (EG), and 9 overweight/obese (OG). Digital photogrammetry and SAPo program were used to measure postural alignment and the Pediatric Balance Scale (PBS) was used to measure balance. The Kruskall-Wallis and Dunn post-hoc tests were used for inter-group comparison of posture and balance. Spearmans coefficient tested the correlation between postural and balance variables. Results The horizontal pelvic alignment data indicated that the anteversion of the DG was similar to that of the OG and twice that of the EG (p<0.05). Compared to the EG, the DG and OG showed an increased forward position of the center of mass (p<0.05). There was a moderate and weak correlation between the PBS score and horizontal pelvic alignment (0.58 and 0.47-left/right). The PBS showed a weak correlation with asymmetries in the sagittal plane (-0.39). The PBS scores for the OG and EG suggest that obesity did not have a deleterious effect on balance. Conclusions The balance deficit in children with DMD was accompanied by an increased forward position of the center of mass and significant pelvic anteversion that constitutes a compensatory strategy to guarantee similar performance to the children not affected by the disease.

Balance and muscle power of children with Charcot-Marie-Tooth

BACKGROUND: In certain diseases, functional constraints establish a greater relationship with muscle power than muscle strength. However, in hereditary peripheral polyneuropathies, no such relationship was found in the literature. OBJECTIVE: In children with Charcot-Marie-Tooth (CMT), to identify the impact of muscle strength and range of movement on the static/dynamic balance and standing long jump based on quantitative and functional variables. METHOD: The study analyzed 19 participants aged between 6 and 16 years, of both genders and with clinical diagnoses of CMT of different subtypes. Anthropometric data, muscle strength of the lower limbs (hand-held dynamometer), ankle and knee range of movement, balance (Pediatric Balance Scale) and standing long jump distance were obtained by standardized procedures. For the statistical analysis, Pearson and Spearman correlation coefficients were used. RESULTS: There was a strong positive correlation between balance and the muscle strength of the right plantar flexors (r=0.61) and dorsiflexors (r=0.59) and a moderate correlation between balance and the muscle strength of inversion (r=0.41) and eversion of the right foot (r=0.44). For the long jump and range of movement, there was a weak positive correlation with right and left plantar flexion (r=0.20 and r=0.12, respectively) and left popliteal angle (r=0.25), and a poor negative correlation with left dorsiflexion (r=-0.15). CONCLUSIONS: The data on the patients analyzed suggests that the maintenance of distal muscle strength favors performance during balance tasks, while limitations in the range of movement of the legs seem not to be enough to influence the performance of the horizontal long jump.

Longitudinal assessment of grip strength using bulb dynamometer in Duchenne Muscular Dystrophy

BACKGROUND: Grip strength is used to infer functional status in several pathological conditions, and the hand dynamometer has been used to estimate performance in other areas. However, this relationship is controversial in neuromuscular diseases and studies with the bulb dynamometer comparing healthy children and children with Duchenne Muscular Dystrophy (DMD) are limited. OBJECTIVE: The evolution of grip strength and the magnitude of weakness were examined in boys with DMD compared to healthy boys. The functional data of the DMD boys were correlated with grip strength. METHOD: Grip strength was recorded in 18 ambulant boys with DMD (Duchenne Group, DG) aged 4 to 13 years (mean 7.4±2.1) and 150 healthy volunteers (Control Group, CG) age-matched using a bulb dynamometer (North Coast- NC70154). The follow-up of the DG was 6 to 33 months (3-12 sessions), and functional performance was verified using the Vignos scale. RESULTS: There was no difference between grip strength obtained by the dominant and non-dominant side for both groups. Grip strength increased in the CG with chronological age while the DG remained stable or decreased. The comparison between groups showed significant difference in grip strength, with CG values higher than DG values (confidence interval of 95%). In summary, there was an increment in the differences between the groups with increasing age. Participants with 24 months or more of follow-up showed a progression of weakness as well as maintained Vignos scores. CONCLUSIONS: The amplitude of weakness increased with age in the DG. The bulb dynamometer detected the progression of muscular weakness. Functional performance remained virtually unchanged in spite of the increase in weakness.

Characterizing postural oscillation in children and adolescents with hereditary sensorimotor neuropathy

Charcot Marie Tooth disease (CMT) has negative functional impact on postural control of children; however, it has not been widely studied. Stabilometry can provide insights about postural control and guide preventive interventions in immature perceptual and musculoskeletal systems as those seen in children with CMT. This cross-sectional study aimed to identify and interpret stabilometric variables that reflect the postural control of children with CMT. 53 subjects (age 6–17) were assigned to one of the two groups: CMT (15 males and 14 females with CMT) or Control (13 males and 11 females healthy). Quiet standing was tested in different conditions: with open and closed eyes on regular surface (open-regular, closed-regular) and foam surface (open-foam, closed-foam) using a force platform. The minimum of 2 and maximum of 3 trials of 30 seconds for each test condition provided the classical stabilometric variables and Romberg Quotient (RQv). CMT group showed increase of confidence ellipse area, mean velocity, mediolateral and anteroposterior velocities associated with decreased mean body oscillation frequency, as the complexity of tasks increased. CMT postural deficit was identified by greater and faster sway associated with these lower frequencies, when compared to Control.

Is it possible to stabilize the trunk using rhythmic stabilization in the upper limb? A cross-sectional study of asymptomatic individuals

Abstract Objective: The study aim was to evaluate the immediate effect of rhythmic stabilization on local and distant muscles involved in a functional reach. Method: Prospective, observational cross-sectional study. Eight right-handed and non-impaired individuals (4 females and 4 males) aged 18–24 years (21.5 ± 1.58 years) were evaluated. Bilateral electromyographic recording of the biceps brachii, triceps brachii, multifidus lumbar, and rectus abdominis muscles was performed during three different tasks. Task 1 involved functional reach, while Task 2 involved rhythmic stabilization followed by a functional reach. Task 3 was similar to Task 2, but with 3 repetitions before a functional reach. Results: The results showed no difference between the tasks or sides. However, an interaction was observed between each side and muscles, with greater activation of the right multifidus lumbar muscle. Conclusion: Rhythmic stabilization during the task of reaching promotes an increase of multifidus activity ipsilateral to its application. Thus, this particular technique of proprioceptive neuromuscular facilitation can be useful for improving stability of the trunk and can be used in clinical practice for this purpose. Level of Evidence: 5.

Prediction of Loss of Gait in Duchenne Muscular Dystrophy Using the TenMeter Walking Test Rates

Objective: To evaluate the performance of boys with DMD in the ten-meter walking test (10MWT) in order to predict gait loss. Method: This longitudinal study consisted of consecutive evaluations, minimum of 3 and maximum of 12, conducted every 4 months, during 33 months, depending on time of inclusion in the study. Ambulant boys with DMD (n=18), ages 4 to 13 yrs, mean 7 (sd=2.22), were assigned to Ambulatory group (A; n=11) or Non-Ambulatory group (NA; n=7) according to their status at the end of the study. Diagnosis was based on the absence of dystrophin in a muscle biopsy and/or identification of a mutation of the dystrophin-gene. The main outcome measures were: 10MWT total time and rates between two consecutive sessions. Secondary measures included: functional status and muscle strength of the hip, knee and ankle. Results: The 10MWT total time for the NA group oscillated over time, while remaining steady for the A group. The NA group showed mean of 16.18 seconds (CI 95% 14.38–17.98) and the A group showed mean of 10.2 seconds (CI 95% 9.08–11.24). The difference between groups was estimated as -5.98 seconds (CI 95%-8.11; -3.89). The linear model of mixed effects identified significant increase in 10MWT time for the NA group and decrease for the A group. The rates were>1.25 for participants who became wheelchair users, indicating increased time to perform 10MWT overtime. Conclusions: Rates ≥ 1.25 indicate the borderline between independent gait and wheelchair confinement and are useful for predicting gait loss.

Gait energy expenditure in children with Duchenne muscular dystrophy: case study

Este estudio de caso tuvo como objetivo verificar si el modelo de Rose et al es factible para evaluar el gasto de energia en la marcha de ninos con distrofia muscular de Duchenne (DMD). Participaron tres ninos con DMD con edades de 6, 7 y 8 anos. Fueron evaluados peso, altura, longitud de las extremidades inferiores (LEI), frecuencia cardiaca (FC) en reposo y la marcha realizada en el circuito ovalado de 55 m durante un examen de 2 minutos en cada velocidad. El gasto energetico fue calculado por la FC. Se realizo un analisis descriptivo de los datos (media) y estos fueron comparados de forma individual con los datos normativos. La velocidad media (VM) de la marcha de los tres pacientes fue igual a los datos normativos en la etapa velocidad lenta y menor en las etapas de velocidad confortable y rapida. El gasto de energia en la velocidad lenta de los pacientes 2 y 3 fue similar a la normalidad, y menor para el paciente 1; en la velocidad confortable, el gasto de energia de todos los pacientes fue similar; en la velocidad rapida, los pacientes 1 y 2 tuvieron valores similares a lo normal, pero el paciente 3 tuvo mayor gasto energetico. Se concluyo que la evaluacion del gasto energetico por la FC se llevo a cabo facilmente en la clinica, y pudo ayudar en la eleccion de conductas. Para el paciente 3 podria ser indicado un entrenamiento aerobico y para los demas mantener ese protocolo de evaluacion en las visitas siguientes.

Gasto energético na marcha de crianças com distrofia muscular de Duchenne: estudo de caso

Este estudio de caso tuvo como objetivo verificar si el modelo de Rose et al es factible para evaluar el gasto de energia en la marcha de ninos con distrofia muscular de Duchenne (DMD). Participaron tres ninos con DMD con edades de 6, 7 y 8 anos. Fueron evaluados peso, altura, longitud de las extremidades inferiores (LEI), frecuencia cardiaca (FC) en reposo y la marcha realizada en el circuito ovalado de 55 m durante un examen de 2 minutos en cada velocidad. El gasto energetico fue calculado por la FC. Se realizo un analisis descriptivo de los datos (media) y estos fueron comparados de forma individual con los datos normativos. La velocidad media (VM) de la marcha de los tres pacientes fue igual a los datos normativos en la etapa velocidad lenta y menor en las etapas de velocidad confortable y rapida. El gasto de energia en la velocidad lenta de los pacientes 2 y 3 fue similar a la normalidad, y menor para el paciente 1; en la velocidad confortable, el gasto de energia de todos los pacientes fue similar; en la velocidad rapida, los pacientes 1 y 2 tuvieron valores similares a lo normal, pero el paciente 3 tuvo mayor gasto energetico. Se concluyo que la evaluacion del gasto energetico por la FC se llevo a cabo facilmente en la clinica, y pudo ayudar en la eleccion de conductas. Para el paciente 3 podria ser indicado un entrenamiento aerobico y para los demas mantener ese protocolo de evaluacion en las visitas siguientes.