Virginia Wright

Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial.

OBJECTIVE To determine the feasibility of conducting a randomized controlled trial of a 12-week exercise intervention in children with fibromyalgia (FM) and to explore the effectiveness of aerobic exercise on physical fitness, function, pain, FM symptoms, and quality of life (QOL). METHODS FM patients ages 8-18 years were randomized to a 12-week exercise intervention of either aerobics or qigong. Both groups participated in 3 weekly training sessions. Program adherence and safety were monitored at each session. Data were collected at 3 testing sessions, 2 prior to and 1 after the intervention, and included FM symptoms, function, pain, QOL, and fitness measures. RESULTS Thirty patients participated in the trial. Twenty-four patients completed the program; 4 patients dropped out prior to training and 2 dropped out of the aerobics program. Better adherence was reported in the aerobics group than in the qigong group (67% versus 61%). Significant improvements in physical function, functional capacity, QOL, and fatigue were observed in the aerobics group. Anaerobic function, tender point count, pain, and symptom severity improved similarly in both groups. CONCLUSION It is feasible to conduct an exercise intervention trial in children with FM. Children with FM tolerate moderate-intensity exercise without exacerbation of their disease. Significant improvements in physical function, FM symptoms, QOL, and pain were demonstrated in both exercise groups; the aerobics group performed better in several measures compared with the qigong group. Future studies may need larger sample sizes to confirm clinical improvement and to detect differences in fitness in childhood FM.

Active Video Game Play in Children With Cerebral Palsy: Potential for Physical Activity Promotion and Rehabilitation Therapies

OBJECTIVE To evaluate the potential of active video game (AVG) play for physical activity promotion and rehabilitation therapies in children with cerebral palsy (CP) through a quantitative exploration of energy expenditure, muscle activation, and quality of movement. DESIGN Single-group, experimental study. SETTING Human movement laboratory in an urban rehabilitation hospital. PARTICIPANTS Children (N=17; mean age ± SD, 9.43±1.51y) with CP. INTERVENTION Participants played 4 AVGs (bowling, tennis, boxing, and a dance game). MAIN OUTCOME MEASURES Energy expenditure via a portable cardiopulmonary testing unit; upper limb muscle activations via single differential surface electrodes; upper limb kinematics via an optical motion capture system; and self-reported enjoyment via the Physical Activity Enjoyment Scale (PACES). RESULTS Moderate levels of physical activity were achieved during the dance (metabolic equivalent for task [MET]=3.20±1.04) and boxing (MET=3.36±1.50) games. Muscle activations did not exceed maximum voluntary exertions and were greatest for the boxing AVG and for the wrist extensor bundle. Angular velocities and accelerations were significantly larger in the dominant arm than in the hemiplegic arm during bilateral play. A high level of enjoyment was reported on the PACES (4.5±0.3 out of 5). CONCLUSIONS AVG play via a low-cost, commercially available system can offer an enjoyable opportunity for light to moderate physical activity in children with CP. While all games may encourage motor learning to some extent, AVGs can be strategically selected to address specific therapeutic goals (eg, targeted joints, bilateral limb use). Future research is needed to address the challenge of individual variability in movement patterns/play styles. Likewise, further study exploring home use of AVGs for physical activity promotion and rehabilitation therapies, and its functional outcomes, is warranted.

The ICF model of functioning and disability: incorporating quality of life and human development.

Objective: Since its 2001 publication, a number of issues have been raised about the ICF. The World Health Organization anticipated the ICF would undergo a continuous process of revision. This paper adds to this process. Method: This article describes how the ICF framework shares a number of tenets with a systems perspective. An argument is built for why the ICF model of functioning and disability should be expanded to include the concepts of quality of life and human development. A modified model is presented that depicts a persons life quality and his/her potential for development as the outcomes and processes that arise from the interconnected, ever-changing influences of health, functioning and contextual factors. Conclusions: A modified ICF model based on a systems perspective depicts a holistic view that acknowledges health, functioning, life quality and development are intertwined and are essential concepts to consider in the lives of all people.

Measures of dynamic stability: Detecting differences between walking overground and on a compliant surface

Numerous measures of dynamic stability have been proposed to gauge fall risk in the elderly, including stride interval variability and variability of the center of mass. However, these measures have been deemed inadequate because they do not take into account temporal information. Therefore, research on the measurement of dynamic stability has turned to other analysis methods such as stride interval dynamics and the maximum Lyapunov exponent. Stride interval dynamics reflect the statistical persistence of an individuals stride interval time series and the Lyapunov exponent quantifies local dynamic stability - the sensitivity of the system to infinitesimal perturbations. In this study, we compare the ability of these measurement tools to detect changes between overground and compliant-surface walking, a condition known to affect stability, to determine their aptness as measures of dynamic stability. Fourteen able-bodied participants completed three 15 min walks, two overground and one on a compliant surface. Our results show that the Lyapunov exponent may be more sensitive to gait changes than stride interval dynamics and gait variability measures.

Paediatric Application of Individualised Client-Centred Outcome Measures: A Literature Review

A literature review was conducted to identify and compare the clinical utility of client-centred, individualised outcome measures for paediatric rehabilitation. Five measures were identified: the Canadian Occupational Performance Measure (COPM) (28 studies); Goal Attainment Scaling (GAS) (34 studies); Perceived Efficacy and Goal Setting System (PEGS) (2 studies); Target Complaints (TC) (1 study); and the Paediatric Activity Card Sort (PACS) (instruction manual only). The COPM and GAS have been used with children across a wide age range and variety of clinical settings. The PEGS and PACS provided young children direct involvement in the goal-setting process. Little evidence supports the use of TC in paediatrics. Clinicians need to use individualised measures in a way that facilitates the maximal participation of children and families in goal setting and outcome evaluation. Clinicians should document their own role in goal setting. The use of individualised and client-centred measures can motivate children and families and focus their attention on therapy goals.

Applying the ICF framework to study changes in quality-of-life for youth with chronic conditions

Objective: The objective of this paper is to describe how the ICF framework was applied as the foundation for a longitudinal study of changes in quality-of-life (QoL) for youth with chronic conditions. Method: This article will describe the studys aims, methods, measures and data analysis techniques. It will point out how the ICF framework was used—and expanded upon—to provide a model for studying the impact of factors on changes in QoL for youth with chronic conditions. Further, it will describe the instruments that were chosen to measure the components of the ICF framework and the data analysis techniques that will be used to examine the impact of factors on changes in youths’ QoL. Conclusions: Qualitative and longitudinal designs for studying QoL based on the ICF framework can be useful for unraveling the complex ongoing inter-relationships among functioning, contextual factors and individuals’ perceptions of their QoL.

Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease

Background/Objectives:The purpose of this study was to develop an activity energy expenditure (AEE) prediction equation for the Actiheart activity monitor for use in children with chronic disease.Subjects/Methods:In total, 63 children, aged 8–18 years with different types of chronic disease (juvenile arthritis, hemophilia, dermatomyositis, neuromuscular disease, cystic fibrosis or congenital heart disease) participated in an activity testing session, which consisted of a resting protocol, working on the computer, sweeping, hallway walking, steps and treadmill walking at three different speeds. During all activities, actual AEE was measured with indirect calorimetry and the participants wore an Actiheart on the chest. Resting EE and resting heart rate were measured during the resting protocol and heart rate above sleep (HRaS) was calculated.Results:Mixed linear modeling produced the following prediction equation: This equation results in a nonsignificant mean difference of 2.1 J/kg/min (limits of agreement: −144.2 to 148.4 J/kg/min) for the prediction of AEE from the Actiheart compared with actual AEE.Conclusions:The Actiheart is valid for the use of AEE determination when using the new prediction equation for groups of children with chronic disease. However, the prediction error limits the use of the equation in individual subjects.

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.

The application of motor learning strategies within functionally based interventions for children with neuromotor conditions.

Purpose: To identify and describe the application of 3 motor learning strategies (verbal instructions, practice, and verbal feedback) within 4 intervention approaches (cognitive orientation to daily occupational performance, neuromotor task training, family-centered functional therapy, and activity-focused motor interventions). Methods: A scoping review of the literature was conducted. Two themes characterizing the application of motor learning strategies within the approaches are identified and described. Results: Application of a motor learning strategy can be a defining component of the intervention or a means of enhancing generalization and transfer of learning beyond the intervention. Often, insufficient information limits full understanding of strategy application within the approach. Conclusions: A greater understanding of the application, and perceived nonapplication, of motor learning strategies within intervention approaches has important clinical and research implications.

Identification of a core set of exercise tests for children and adolescents with cerebral palsy

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.