Olaf Verschuren

Exercise Training Program in Children and Adolescents With Cerebral Palsy: A Randomized Controlled Trial

OBJECTIVES To delineate the natural history of pityriasis rosea in black children and to compare our findings with those of the American, European, and African literature on pityriasis rosea. Textbook and journal article descriptions of pityriasis rosea usually offer information about the presentation and clinical course of this condition in white patients. DESIGN Prospective observational study. SETTING The general pediatric clinic, adolescent clinic, and emergency department of Childrens Hospital of Michigan, Detroit, from June 2003 through May 2005. PATIENTS We followed up 50 black children with pityriasis rosea from the time of diagnosis through follow-up visits at 1, 2, and 4 weeks. Detailed observations were made and digital photographs taken at each visit. MAIN OUTCOME MEASURES Duration of illness and pigmentary sequelae. RESULTS Similarities with the medical literature were found regarding season of onset and prevalence of pruritus and of a herald patch. Our patients had more frequent facial involvement (30%) and more scalp lesions (8%) than usually described in white populations. One third had papular lesions. The disease resolved in nearly one half of patients within 2 weeks. Residual hyperpigmentation was seen in 48% of patients. Hypopigmentation developed in 29% of patients with purely papular or papulovesicular lesions. CONCLUSIONS Pityriasis rosea in black children differs in several ways from textbook descriptions. Physicians may use this information to better counsel patients about the course and potential sequelae of this condition.

Exercise programs for children with cerebral palsy: a systematic review of the literature.

Verschuren O, Ketelaar M, Takken T, Helders PJM, Gorter JW: Exercise programs for children with cerebral palsy: a systematic review of the literature. Am J Phys Med Rehabil 2008;87:404–417.The purpose of this literature review, regarding all types of exercise programs focusing on cardiovascular fitness (aerobic and anaerobic capacity) and/or lower-extremity muscle strength in children with cerebral palsy (CP), was to address the following questions: (1) what exercise programs focusing on muscle strength, cardiovascular fitness, or a combination are studied, and what are the effects of these exercise programs in children with CP? (2) What are the outcome measures that were used to assess the effects of the exercise programs? (3) What is the methodological quality of the studies?We systematically searched the literature in electronic databases up to October 2006 and included a total of 20 studies that were evaluated. The methodological quality of the included trials was low. However, it seems that children with CP may benefit from improved exercise programs that focused on lower-extremity muscle strength, cardiovascular fitness, or a combination. The outcome measures used in most studies were not intervention specific and often only focused on the International Classification of Function, Disability and Health body function and activity level. There is a need to determine the efficacy of exercise programs to improve the daily activity and participation level of children with CP and increase their self-competence or quality of life.

Reliability of hand-held dynamometry and functional strength tests for the lower extremity in children with Cerebral Palsy

Purpose. To evaluate the intertester reliability of two methods for measuring lower-limb strength in children with cerebral palsy (CP). Method. Twenty-five subjects with CP (7 – 17 years of age) participated in this study. Lower-limb muscle strength was measured on 2 occasions using a Hand-held Dynamometer (HHD; break-method and make-method) and a 30-sec Repetition Maximum (RM) during three functional strength tests for the lower extremities. Reliability was measured using the intraclass correlation coefficients (ICCs), the standard error of measurement (SEM) and the coefficient of variation (CV). Results. The intertester reliability of strength measurement using a HHD was questionable with ICC values ranging from 0.42 – 0.73 for the break-method, and from 0.49 – 0.82 for the make-method. The SEM and CV (%) values ranged from 27.9 – 58.9 and 22.2 – 35.3% for the break-method, and from 30.6 – 52.7 and 16.2 – 56.2% for make-method. The intertester reliability of strength measurement using the 30-sec RM was acceptable with ICC values ranging from 0.91 – 0.96, and SEM and CV (%) values ranging from 1.1 – 2.6 and 10.9 – 39.9% for the functional exercises. Conclusion. The intertester reliability of measuring muscle strength of the lower extremities using a hand-held dynamometer is questionable. The intertester reliability of the 30-sec RM for the lower extremity is acceptable.

Identification of facilitators and barriers to physical activity in children and adolescents with cerebral palsy.

OBJECTIVE To explore facilitators and barriers to participation in physical activity and sport in youth with cerebral palsy (CP). STUDY DESIGN This was a qualitative study involving in-depth focus group interviews with 33 ambulatory youth with CP and their parents. The interviews were conducted until informational redundancy was achieved. RESULTS Youth with CP and their parents reported personal and environmental facilitators and barriers to participation in physical activity. Seven major themes related to personal and environmental factors were identified. CONCLUSIONS This study suggests that various personal and environmental factors play a key role in determining the extent to which youth with CP participate in physical activity. The facilitators and barriers identified provide important theoretical insights into how and why youth with CP and their parents might change their physical activity behavior.

Muscle Strengthening in Children and Adolescents With Spastic Cerebral Palsy: Considerations for Future Resistance Training Protocols

Resistance training of the lower limbs is now commonly used in clinical practice in children and adolescents with spastic cerebral palsy (CP). However, the effectiveness of this type of training is still disputed. The most recently published systematic review with meta-analysis included interventions such as electrical stimulation and resistance training and found insufficient evidence to support or refute the efficacy of these exercises in children with CP. Thus, the aim of this article is to evaluate the extent to which training protocols from the most recent randomized controlled trials are in keeping with the evidence for effective resistance training in children who are developing typically, as reflected in the training guidelines of the National Strength and Conditioning Association. Recommendations for resistance training protocols, based on this evidence and appropriate to children with CP, are provided to help guide both future research and clinical practice for resistance training in children with CP.

Reliability for Running Tests for Measuring Agility and Anaerobic Muscle Power in Children and Adolescents with Cerebal Palsy

Purpose: We investigated reliability, construct validity, and feasibility of two sprint tests for children with cerebral palsy (CP). Methods: Twenty-six children with CP participated (7–18 years of age; Gross Motor Function Classification System [GMFCS] level I or II). On different occasions, the 10 × 5-Meter Sprint Test and the Muscle Power Sprint Test were scored by different assessors. Results: Excellent interobserver reliability (intraclass correlation [ICC] = 1.0 and ICC ≥ 0.97) and test−retest reliability (ICC = 0.97 and ICC ≥ 0.97) were obtained. Scores differed significantly on both sprint tests for children classified at GMFCS level I and level II. Mean scores for feasibility ranged from 8.8 to 9.2 on a 10-cm visual analog scale (10 = the best). Conclusions: Both exercise tests are reliable and have good feasibility for children and adolescents with CP (GMFCS level I or II). Construct validity is supported for both sprint tests in children classified at GMFCS level I and level II.

Lower limb strength training in children with cerebral palsy--a randomized controlled trial protocol for functional strength training based on progressive resistance exercise principles.

BackgroundUntil recently, strength training in children with cerebral palsy (CP) was considered to be inappropriate, because it could lead to increased spasticity or abnormal movement patterns. However, the results of recent studies suggest that progressive strength training can lead to increased strength and improved function, but low methodological quality and incomplete reporting on the training protocols hampers adequate interpretation of the results. This paper describes the design and training protocol of a randomized controlled trial to assess the effects of a school-based progressive functional strength training program for children with CP.Methods/ResultsFifty-one children with Gross Motor Function Classification Systems levels I to III, aged of 6 to 13 years, were recruited. Using stratified randomization, each child was assigned to an intervention group (strength training) or a control group (usual care). The strength training was given in groups of 4–5 children, 3 times a week, for a period of 12 weeks. Each training session focussed on four exercises out of a 5-exercise circuit. The training load was gradually increased based on the childs maximum level of strength, as determined by the 8 Repetition Maximum (8 RM). To evaluate the effectiveness of the training, all children were evaluated before, during, directly after, and 6 weeks after the intervention period. Primary outcomes in this study were gross motor function (measured with the Gross Motor Function Measure and functional muscle strength tests) and walking ability (measured with the 10-meter, the 1-minute and the timed stair test). Secondary outcomes were lower limb muscle strength (measured with a 6 RM test, isometric strength tests, and a sprint capacity test), mobility (measured with a mobility questionnaire), and sport activities (measured with the Childrens Assessment of Participation and Enjoyment). Spasticity and range of motion were assessed to evaluate any adverse events.ConclusionRandomized clinical trials are considered to present the highest level of evidence. Nevertheless, it is of utmost importance to report on the design, the applied evaluation methods, and all elements of the intervention, to ensure adequate interpretation of the results and to facilitate implementation of the intervention in clinical practice if the results are positive.Trial RegistrationTrial Register NTR1403

Relation between physical fitness and gross motor capacity in children and adolescents with cerebral palsy

Aim  To examine the relation between physical fitness and gross motor capacity in children with cerebral palsy (CP) who were classified in Gross Motor Function Classification System levels I or II.

Exercise and physical activity recommendations for people with cerebral palsy

Physical activity and its promotion, as well as the avoidance of sedentary behaviour, play important roles in health promotion and prevention of lifestyle‐related diseases. Guidelines for young people and adults with typical development are available from the World Health Organisation and American College of Sports Medicine. However, detailed recommendations for physical activity and sedentary behaviour have not been established for children, adolescents, and adults with cerebral palsy (CP). This paper presents the first CP‐specific physical activity and exercise recommendations. The recommendations are based on (1) a comprehensive review and analysis of the literature, (2) expert opinion, and (3) extensive clinical experience. The evidence supporting these recommendations is based on randomized controlled trials and observational studies involving children, adolescents, and adults with CP, and buttressed by the previous guidelines for the general population. These recommendations may be used to guide healthcare providers on exercise and daily physical activity prescription for individuals with CP.

Health-Enhancing Physical Activity in Children With Cerebral Palsy: More of the Same Is Not Enough

Physical activity is important for young peoples health. The emphasis over the last 2 decades has been on moderate to vigorous exercise when designing activity and exercise programs for children and adolescents with cerebral palsy (CP). Emerging evidence suggests that sedentary behavior is distinctly different from a lack of moderate to vigorous physical activity and has independent and different physiological mechanisms. The concept of concurrently increasing moderate to vigorous physical activity and replacing sedentary behavior with light physical activity may be beneficial for children and adolescents with CP. This article is a summary of the evidence for what works and what does not work for improving the physical activity of children and adolescents with CP. It also discusses what is known about sedentary behavior of children and adolescents with CP and what research directions are needed to build foundational knowledge in this area with this population.