Siobhan Reid

Running Biomechanics and Lower Limb Strength Associated with Prior Hamstring Injury

PURPOSE Hamstrings injury/reinjury is common, but functional reasons for this remain unclear. This study identified bilateral differences in swing phase running biomechanics and isokinetic strength, between the previously hamstring-injured and uninjured limbs of male athletes involved in sprint-based sports. METHODS Athletes, injury-free during testing, underwent three-dimensional motion analyses to determine bilateral joint kinematics and kinetics during submaximal sprinting. Various hip and knee isokinetic strength tests were performed bilaterally using a Biodex dynamometer. Peak torque (PT) and total work (TW; normalized to body mass) were collected isokinetically from concentric hamstrings (CH), concentric quadriceps (CQ), concentric hip flexors (CHF), and eccentric hamstrings (EH). Three PT and TW ratios were created, namely, CH/CQ, EH/CQ, and EH/CHF, and were compared between the previously injured and uninjured limbs. RESULTS Lower limb swing phase kinematics and kinetics were similar. Only peak hip flexion angle in late swing was significantly reduced (1.9°) in the previously injured limb. EH PT was decreased (26.2 N·m·kg(-1)) and occurred at shorter hamstring lengths on the previously injured side, whereas CQ TW was increased by 13.6 J·kg(-1). EH/CQ and EH/CHF ratios for PT and TW were reduced on the previously injured limbs. CONCLUSIONS Although swing phase biomechanics of submaximal sprinting were similar between limbs, the previously injured hamstrings did display significant weakness eccentrically. Residual eccentric weakness may predispose this muscle group to reinjury during late swing, compared with the uninjured limb, because the functional eccentric demand on both limbs was similar. Furthermore, the EH/CHF ratios may better reflect muscle function during sprinting, having the potential to influence rehabilitation to prevent reinjury.

Repeatability of upper limb kinematics for children with and without cerebral palsy

BACKGROUND There is increasing demand for a standardised and reliable protocol for the objective assessment of upper limb motion in clinical populations. This paper describes the repeatability of a three-dimensional (3D) kinematic model and protocol to assess upper limb movement for children with and without cerebral palsy (CP). METHODS Ten typically developing (TD) children (m=10.5years+/-1.18) and seven children with CP (spastic hemiplegia) (m=11.14years+/-1.86) completed upper limb motion analysis on two occasions separated by at least one week. Participants performed three trials of four functional tasks, where 3D joint angles were calculated at the thorax, shoulder, elbow and wrist. Within and between-day repeatability was assessed using coefficients of multiple determination (CMD). FINDINGS There were distinct kinematic patterns for both groups for each functional task. In relation to their peers, children with CP consistently displayed reduced elbow extension, and compensatory patterns at the shoulder and thorax. High within and between-day CMD scores were revealed for specific rotations, with the highest being obtained at joints with large ranges of motion. INTERPRETATION The chosen tasks delineate the upper limb kinematic patterns of those with and without CP. The model has high within and between-day repeatability particularly where joint rotations demonstrate a large range of movement. 3D motion analysis is a feasible assessment tool for use with clinical populations.

Neuromuscular adaptations to eccentric strength training in children and adolescents with cerebral palsy.

Aim  To determine the neuromuscular outcomes of an eccentric strength‐training programme for children and adolescents with cerebral palsy (CP).

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.

Combining strength training and botulinum neurotoxin intervention in children with cerebral palsy: the impact on muscle morphology and strength

Purpose: Investigate the combination effects of strength training and Botulinum Toxin Type-A (BoNT-A) on muscle strength and morphology in children with Cerebral Palsy (CP). Methods: Fifteen children receiving BoNT-A, classified as Spastic Diplegic CP, GMFCS I-II, and aged 5–12 years were recruited for this study. Randomly allocated to 10 weeks of strength training either before or after BoNT-A, children were assessed over 6 months. Eight of the 15 children also completed a control period. The Modified Ashworth Scale measured spasticity. The Goal Attainment Scale (GAS) assessed achievement of functional goals. Magnetic Resonance Imaging assessed muscle volume (MV). Instrumented dynamometry assessed strength. Results: Spasticity was significantly reduced following BoNT-A injection (p = 0.033). Children made significant isokinetic strength gains (mean p = 0.022, ES = 0.57) in the intervention period compared to the control period (mean p = 0.15, ES = 0.56). Irrespective of timing, significant strength improvements were seen immediately (10 weeks) and over 6 months for all children. This was also the case for improvements in the GAS (immediately: mean p = 0.007, ES = 4.17, 6 months: mean p = 0.029, ES = 0.99), and improvements in MV in all assessed muscles. Conclusion: The simultaneous use of BoNT-A and strength training was successful in spasticity reduction, improving strength and achieving functional goals, over and above treatment with BoNT-A alone. Muscles targeted for BoNT-A injection should be included in strength training. Implications for Rehabilitation Cerebral Palsy Botulinum toxin type-A (BoNT-A) and strength training are available interventions that, on their own have found success in managing spasticity and muscle weakness (both significant motor impairments), respectively in children with Cerebral Palsy (CP). This study has demonstrated that the concurrent treatment of BoNT-A and strength training can achieve positive outcomes in terms of strength, spasticity and for the achievement of set functional goals. The results of this study show that the improved muscle strength can be associated with hypertrophy, which could indicate the potential role of strength training in altering the rate of muscle growth, in an aim to improve the failure of muscle growth associated with CP. Home based strength training, based on a child’s individual goals is shown to be successful in improving strength and goal attainment for children with CP.

Muscle volume alterations in spastic muscles immediately following botulinum toxin type-A treatment in children with cerebral palsy.

With evidence for an atrophic effect of botulinum toxin type A (BoNT‐A) documented in typically developing muscles, this study investigated the immediate morphological alterations of muscles in children with cerebral palsy (CP) after BoNT‐A treatment.

A comparison of activity, participation and quality of life in children with and without spastic diplegia cerebral palsy

Purpose: To measure activity, participation and QoL in children with CP and to determine how these differ from a comparable group of typically developing (TD) children.Method: A total of eleven males and eight females with CP ranging in age from 5 to 12 years (mean age 7 years 10 months, SD 1 year 10 months; GMFCS level I–II) and 19 age and sex matched TD peers were recruited. Activity was measured using Paediatric Activity Card Sort (PACS), 6-Minute Walk Test and Timed Up and Go Test (TUG). Participation was measured using the assessment of Life Habits (LIFE-H) and quality of life was measured using the Cerebral Palsy Quality of Life Questionnaire (CP-QoL).Results: TD children performed more activities of personal care than children with CP, as assessed via the PACS, t(40) = 3.266, p = 0.002. TD children participate in more life habits than children with CP across all the LIFE-H domains except that of relationships. Results from the CP-QoL indicate that TD children experience a greater QoL in the domains of functioning, t(40) = 2.824, p = 0.007, and participation and physical health, t(40) = 3.543, p = 0.001, than children with CP.Conclusions: These findings encourage the development of therapeutic interventions that aim to reduce these imbalances at all levels of the International Classification of Functioning, Disability and Health. Implications for Rehabilitation This paper offers a comprehensive approach to assessment of children with cerebral palsy using the ICF framework. It offers insight into the significant differences that children with mild to moderate CP experience when compared to their typically developing peers and identifies key areas to direct interventions.

Exercise training to improve health related quality of life in long term survivors of major burn injury: A matched controlled study

OBJECTIVE Patients often experience reduced health-related quality of life (HRQOL) following burn injury. Exercise training has been demonstrated to improve HRQOL in a number of clinical populations, yet it is unknown whether exercise can improve HRQOL in burns patients. PROCEDURES Nine burn-injured participants (42±18.38%TBSA: 6.56±3.68 years after injury) and 9 matched controls participated in a 12-week exercise programme. HRQOL was assessed via the Burn Specific Health Scale-Brief (BSHS-B) and the Medical Outcomes Study 36-Item Short Form (SF-36). Activity limitation was measured using the quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). RESULTS The burns group had decreased HRQOL compared to the controls at baseline, as reported by the BSHS-B (t (16)=3.51, p=0.003) and some domains of the SF-36 including role physical (t (16)=3.79, p=0.002). Burned participants reported decreased activity levels compared to the controls as measured by the QuickDASH (t (16)=2.19, p=0.044). Exercise training improved SF-36 scores in both burn (t (8)=3.77, p=0.005) and control groups (t (8)=2.71, p=0.027). Following training there was no difference between the groups on the SF-36 or QuickDASH. CONCLUSION Exercise training improves HRQOL and activity limitations in burn-injured patients to a level that is equivalent to that of their uninjured counterparts.

Cognitive Orientation to (Daily) Occupational Performance intervention leads to improvements in impairments, activity and participation in children with Developmental Coordination Disorder

Abstract Introduction: Children diagnosed with Developmental Coordination Disorder (DCD) present with a variety of impairments in fine and gross motor function, which impact on their activity and participation in a variety of settings. This research aimed to determine if a 10-week group-based Cognitive Orientation to Daily Occupational Performance (CO-OP) intervention improved outcome measures across the impairment, activity and participation levels of the International Classification of Functioning, Disability and Health (ICF) framework. Methods: In this quasi-experimental, pre–post-test, 20 male children aged 8–10 years (9y1m ± 9 m) with a confirmed diagnosis of DCD participated in either the 10 week group intervention based on the CO-OP framework (n = 10) or in a control period of regular activity for 10 weeks (n = 10). Outcome measures relating to impairment (MABC-2, motor overflow assessment), activity (Handwriting Speed Test) and participation [Canadian Occupational Performance Measure, (COPM) and Goal Attainment Scale) were measured at weeks 0 and 10 in the intervention group. Results: Children who participated in the CO-OP intervention displayed improvements in outcome measures for impairment, activity and participation, particularly a reduction in severity of motor overflow. Parent and child performance and satisfaction ratings on the COPM improved from baseline to week 10 and all goals were achieved at or above the expected outcome. No significant changes were reported for the control group in impairment and activity (participation was not measured for this group). Conclusion: The strategies implemented by children in the CO-OP treatment group, targeted towards individualised goal attainment, show that CO-OP, when run in a group environment, can lead to improvements across all levels of the ICF. Implications for Rehabilitation Development Coordination Disorder is a condition which has significant physical, academic and social impacts on a child and can lead to activity limitations and participation restrictions. Cognitive Orientation to Daily Occupational Performance is an approach which uses cognitive-based strategies to improve performance of specific tasks based on child chosen goals. The intervention program had a positive effect on self-perceived levels of performance which may lead to changes in quality of life. Parents felt the intervention enhanced socialisation, peer modelling and encouragement and felt that this increased confidence and independence.

The effect of exercise training on pulmonary function and aerobic capacity in adults with burn

PURPOSE Pulmonary function (PF) is compromised in some individuals following burn, which may result in impaired aerobic capacity. Exercise training improves PF and exercise capacity in children recovering from burns, yet it is unknown if adults will demonstrate the same response. PROCEDURES 9 burn injured participants (%TBSA 42 ±18.38, 6.56 years ±3.68 post injury) and 9 matched controls participated in a 12-week goal directed interval training and resistance exercise programme. PF was measured using spirometry, and a graded exercise test quantified peak oxygen consumption (Vo(2peak)), both prior to and following the exercise training. The Canadian Occupational Performance Measure assessed the participants goal attainment. RESULTS Burn injured participants had significantly lower PF (FEV(1)/FVC ratio) than the healthy controls both prior to and following the exercise intervention (F(1,16)=8.93, p=0.009). Exercise training did not improve PF in either group, however both groups had a significant improvement in their Vo(2peak), maximal minute ventilation, and work achieved on a graded exercise test (F(1,16)=19.325, p<0.001), (F(1,16)=51.417, p<0.001) and (F(1,16)=36.938, p<0.001), respectively, following the exercise training. All participants achieved their occupational performance goals. CONCLUSION Although the exercise training did not alter PF, both aerobic capacity and occupational performance were improved.