Is functional mobility associated with quality of sitting in cerebral palsy? A cross-sectional study.

Objectives: A group of neuromuscular system anomalies associated with non-progressive issues in the developing fetal or newborn brain are known as cerebral palsy (CP). These abnormalities are typified by poor posture and motor development, which limits the execution of functional activities. Consequently, to achieve the same goals as peers who are typically developing, children with CP employ a variety of compensatory postures and techniques. Given that both sitting and mobility are essential for functioning, assessing each skill alone and in relation to the other is necessary. This study aims to determine if a child's functional mobility affects their sitting ability. Materials and Methods: Twenty CP (Gross Motor Function Classification System [GMFCS] levels I and II) children, aged 6-12, were enrolled in the research. The level of sitting scale (LSS) and the modified timed up and go (mTUG) test were utilized to evaluate sitting and functional mobility, respectively. Results: The quality of sitting was shown to have a substantial effect on functional mobility, as a significant difference in mTUG durations was established between LSS levels (P < 0.001) and persisted when analyzed within the same GMFCS level (P = 0.007). Conclusion: The importance of trunk control in functional mobility can be inferred from the link between sitting quality and mobility. To improve children with CP's functional mobility, this evidence may be utilized to design a well-informed and specific intervention program incorporating trunk control.

Immediate effects of a novel hand rehabilitation board on fine motor skills in children with cerebral palsy: A pilot study.

BACKGROUND: In children with cerebral palsy (CP), fine motor skills limit forearm supination and active extension of the elbow, wrist, or fingers. Therapeutic interventions focusing on improving the ranges at these joints while facilitating active movements are the key to augmenting fine motor skills. OBJECTIVE: This pilot study examines if children with CP (with UE involvement) exposed to the Novel Hand Rehabilitation (NHR) Board will demonstrate 1) changes in spasticity and passive ROM of forearm and wrist/finger muscles, and 2) improvement in fine motor abilities. METHODS: The forearm and wrist/fingers of children with spastic CP (N = 15; M = 7, F = 8) aged 49-72 months (65.33±6.355 months) were positioned on the NHR board till their tolerance limit or a minimum duration of 30 minutes. The outcome measures, i.e., spasticity (Modified Ashworth Scale), passive range of motion (PROM) of wrist and fingers, and fine motor skills (PDMS-2 - Fine motor scale), were recorded. RESULTS: The spasticity of forearm pronators (0.001) and wrist flexors (0.008) reduced significantly, but not in wrist extensors. Post-intervention improvements in wrist extension (p = 0.005) and ulnar deviation ROM (p = 0.007) were significant. In thumb, changes were non-significant for the CMC flexion, but extension (0.003) and abduction (0.001) as well as MCP extension (0.004) were significant. The post-intervention MCP extension ROM for the 2nd (0.001), 3rd (0.007), and 4th fingers (0.014) were also substantial, but not for PIP and DIP joints. The post-intervention percentage change in the Grasping and Visual-motor integration subtests of PDMS-2 was 11.03% (p = 0.002) and 5.09% (p = 0.001) respectively. CONCLUSION: The immediate effects on fine motor skills in children with CP after the NHR board application were positive and encouraging. Hence, the NHR board can be recommended as an intervention to improve the fine motor abilities of children with CP.

Effect of Trunk Targeted Interventions on Functional Outcomes in Children with Cerebral Palsy- A Systematic Review.

Objective of this review was to collate information on the effectiveness of trunk targeted intervention on children with cerebral palsy (CP) on three functional outcomes that are gross motor function, trunk control and balance. A comprehensive search was conducted on online databases from inception to August 2021, using relevant keywords. A total of 15 randomized controlled trials which enrolled children with cerebral palsy under 18 years met the inclusion criteria. A significant improvement was seen in the trunk targeted training groups on applying trunk targeted interventions. Trunk targeted interventions improve gross motor function, trunk control as well as balance, hence should be incorporated in the conventional physical therapy program delivered to children with CP and would help in greater functional recovery.

Effect of hip abductors and lateral rotators' muscle strengthening on pain and functional outcome in adult patients with patellofemoral pain: A systematic review and meta-analysis.

BACKGROUND: Even though literature indicates presence of weak hip abductors and lateral rotators' in Patellofemoral Pain (PFP), studies evaluating the effect of hip abductors and lateral rotators strengthening to improve knee function and quality of life in PFP are limited. OBJECTIVE: This study systematically reviews and meta-analyzes the best evidence on the therapeutic value of strengthening hip abductors and lateral rotators muscles for treating PFP with a presumptive hypothesis that strengthening hip muscles stabilizes the patellofemoral joint, relieves pain, and enhances knee functions. METHOD: Medline, EMBASE, CINAHL, PEDro and PubMed Central databases were searched between January 1994 and September 2019 using the PICOS tool. The methodological quality of the selected studies were appraised individually using the 20-item McMaster Critical Review Form for Quantitative Studies. Supplemental quality appraisal of randomized controlled clinical trials performed using the Cochrane Collaboration's 'Risk of bias' quality criteria. Data on patient population demographics, interventions, duration of intervention, and outcome measures were extracted and summarized in evidence tables and descriptive analysis. Meta-analyses under both fixed and random-effects models determined pooled effects size from appropriate RCTs. RESULTS: All fourteen studies demonstrated that hip muscle strengthening improved pain and knee function. All RCTs, except one, demonstrated that hip muscle strengthening is superior to quadriceps strengthening. Of the five RCTs assessing the additional effect of hip-quad versus quadriceps strengthening, four suggested that hip-quad strengthening is superior to standard quadriceps strengthening alone to improve PFP and knee function. CONCLUSION: In adult patients with PFP, strengthening hip abductors and lateral rotators' have beneficial therapeutic effects than the conventional quadriceps exercises in improving knee pain and function both in the short- and long term. However, the present review data can be used to develop a standardized hip-quad protocol in the future.

Relationship between trunk muscle strength, reaching ability and balance in children with Down syndrome - A cross-sectional study.

BACKGROUND: Children with Down Syndrome (DS) present with neuromuscular disturbances leading to delayed developmental milestones, poor quality of movement and poor balance. The aim of this study is to discuss the role of trunk muscle strength in the functional performance of children with DS. METHODOLOGY: 28 children were recruited in the study, 14 with DS and 14 age and gender-matched controls. Trunk muscle strength, reaching ability and balance were assessed using a Handheld Dynamometer, Modified Functional Reach test and Pediatric Balance Scale, respectively. RESULTS: Children with DS present with poorer trunk muscle strength, reaching ability and balance as compared to typically developing (TD) children. There was a positive correlation between trunk muscle strength and lateral reaching in children with DS. A strong to moderate correlation was observed between the trunk muscle strength and balance in children with DS. DISCUSSION: Children with DS demonstrated a significantly weak trunk muscle groups. Lateral reaching distance is reduced due to the poor proximal control and they present with near-normal forward reach distance attributed to compensation using the lower trunk muscles. They exhibit poor balance in the components that require a small base of support. CONCLUSION: Children with DS exhibit weak trunk muscles along with lesser reaching distance and poor balance. Also, trunk muscle strength influences lateral reaching ability. Trunk muscle strength, mainly trunk extensors impacted functional balance in sitting, standing and while performing transfers.

Gross motor dysfunction and balance impairments in children and adolescents with Down syndrome: a systematic review.

BACKGROUND: Individuals with Down syndrome present with several impairments such as hypotonia, ligament laxity, decreased muscle strength, insufficient muscular cocontraction, inadequate postural control, and disturbed proprioception. These factors are responsible for the developmental challenges faced by children with Down syndrome. These individuals also present with balance dysfunctions. PURPOSE: This systematic review aims to describe the motor dysfunction and balance impairments in children and adolescents with Down syndrome. METHODS: We searched the Scopus, ScienceDirect, MEDLINE, Wiley, and EBSCO databases for observational studies evaluating the motor abilities and balance performance in individuals with Down syndrome. The review was registered on PROSPERO. RESULTS: A total of 1,096 articles were retrieved; after careful screening and scrutinizing against the inclusion and exclusion criteria, 10 articles were included in the review. Overall, the children and adolescents with Down syndrome showed delays and dysfunction in performing various activities such as sitting, pulling to stand, standing, and walking. They also presented with compensatory mechanisms to maintain their equilibrium in static and dynamic activities. CONCLUSION: The motor development of children with Down syndrome is significantly delayed due to structural differences in the brain. These individuals have inefficient compensatory strategies like increasing step width, increasing frequency of mediolateral center of pressure displacement, decreasing anteroposterior displacement, increasing trunk stiffness, and increasing posterior trunk displacement to maintain equilibrium. Down syndrome presents with interindividual variations; therefore, a thorough evaluation is required before a structured intervention is developed to improve motor and balance dysfunction.

Respiratory Muscle Strength in Healthy Indian Children of Age 7-17 Years: A Cross-Sectional Study.

PURPOSE: As the values of respiratory muscle strength vary according to race, ethnicity, and geographical area, there is a wide-ranging difference among different populations. Thus, the available reference values may not have an application for use in the Indian paediatric population, creating a need for generating values which will be appropriate for the Indian paediatric context. MATERIALS AND METHODS: Assessment of respiratory muscle strength was carried out by assessing maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and synthesising predictive formulas using anthropometric variables like height, gender and age, which will be suitable for Indian children. RESULTS: We calculated MIP and MEP of 320 (boys=160 and girls= 160) children in the age range of 7 years to 17 years of Mangaluru city, India. Results stated that mean MIP and MEP for boys were 72.5±32.8 cm H2O and 73±33.2 cm H2O, while for the girls it was 67±30.2 cm H2O and 68±30.1 cm H2O, respectively. CONCLUSION: This study concluded that there is a difference in respiratory pressure values of Indian children with respect to those of other countries. Age, gender, height and BMI have a significant role in determining respiratory muscle strength. Boys demonstrated higher MIP and MEP. As age, height, weight and BMI increases, so does MIP and MEP.

Effect of foot placements during sit to stand transition on timed up and go test in stroke subjects: A cross sectional study.

BACKGROUND & OBJECTIVE: Timed up and go (TUG) test is been used as a screening tool for the assessment of risk of falling in individuals following stroke. Though TUG test is a quick test, it has fair sensitivity compared to other tests. This study was carried out to obtain and compare test scores for different types of foot placements during sit to stand transition in stroke subjects. METHOD: A Cross-sectional study with purposive sampling included 28 post stroke subjects who were able to walk 6 meter with or without assistance. Timed Up and Go test was carried out with four different types of foot placements and scores were recorded. The data were compared using Kruskal-Wallis One way analysis of variance and Wilcoxon signed ranks test. RESULT: There were comparable differences between asymmetric 1 test strategy which involved affected extremity to be placed behind the unaffected and other test strategies (Z = -4.457,-3.848,-4.458; p = 0.000). CONCLUSION: The initial foot placements during sit to stand transition influenced the time taken to complete the test which was significantly higher in asymmetric 1 strategy, Incorporation of the initial foot placement mainly asymmetric 1 strategy into conventional TUG test would help in identifying accurately the subject's functional mobility and postural stability.