Category: Research and Articles

Posted on by — Leave a comment

Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy.

date: 09/01/2006
author: Ahlborg L, Andersson C, Julin P.
publication: J Rehabil Med. 2006 Sep;38(5):302-8.
pubmed_ID: 16931460

OBJECTIVE: The aim of this study was to evaluate the effect on spasticity, muscle strength and motor performance after 8 weeks of whole-body vibration training compared with resistance training in adults with cerebral palsy. METHODS: Fourteen persons with spastic diplegia (21-41 years) were randomized to intervention with either whole-body vibration training (n=7) or resistance training (n=7). Pre- and post-training measures of spasticity using the modified Ashworth scale, muscle strength using isokinetic dynamometry, walking ability using Six-Minute Walk Test, balance using Timed Up and Go test and gross motor performance using Gross Motor Function Measure were performed. RESULTS: Spasticity decreased in knee extensors in the whole-body vibration group. Muscle strength increased in the resistance training group at the velocity 30 degrees /s and in both groups at 90 degrees /s. Six-Minute Walk Test and Timed Up and Go test did not change significantly. Gross Motor Function Measure increased in the whole-body vibration group. CONCLUSION: These data suggest that an 8-week intervention of whole-body vibration training or resistance training can increase muscle strength, without negative effect on spasticity, in adults with cerebral palsy.

Posted on by — Leave a comment

Passive ankle dorsiflexion increases in patients after a regimen of tilt table-wedge board standing. A clinical report.

date: 11/01/1985
author: Bohannon RW, Larkin PA.
publication: Phys Ther. 1985 Nov;65(11):1676-8.
pubmed_ID: 4059330

We monitored the result of a tilt table-wedge board routine on the passive ankle dorsiflexion of 20 patients consecutively to determine the effectiveness of the treatment. The calculated frequency of the treatment, which was applied for 30 minutes on each of 5 to 22 treatment days, ranged from 2.3 to 6.4 treatments a week. All patients demonstrated increased passive ankle dorsiflexion. The increases ranged from 3 to 17 degrees and occurred at a calculated rate of 0.11 to 1.0 degrees a day. We believe the treatment is an effective clinical method for increasing passive ankle dorsiflexion in neurologically involved patients.

Posted on by — Leave a comment

Acute effects of whole-body vibration on muscle activity, strength, and power.

date: 05/20/2006
author: Cormie P, Deane RS, Triplett NT, McBride JM.
publication: J Strength Cond Res. 2006 May;20(2):257-61.
pubmed_ID: 16686550

The purpose of this study was to investigate the effects of a single bout of whole-body vibration on isometric squat (IS) and countermovement jump (CMJ) performance. Nine moderately resistance-trained men were tested for peak force (PF) during the IS and jump height (JH) and peak power (PP) during the CMJ. Average integrated electromyography (IEMG) was measured from the vastus medialis, vastus lateralis, and biceps femoris muscles. Subjects performed the 2 treatment conditions, vibration or sham, in a randomized order. Subjects were tested for baseline performance variables in both the IS and CMJ, and were exposed to either a 30-second bout of whole-body vibration or sham intervention. Subjects were tested immediately following the vibration or sham treatment, as well as 5, 15, and 30 minutes posttreatment. Whole-body vibration resulted in a significantly higher (p < or = 0.05) JH during the CMJ immediately following vibration, as compared with the sham condition. No significant differences were observed in CMJ PP; PF during IS or IEMG of the vastus medialis, vastus lateralis, or biceps femoris during the CMJ; or IS between vibration and sham treatments. Whole-body vibration may be a potential warm-up procedure for increasing vertical JH. Future research is warranted addressing the influence of various protocols of whole-body vibration (i.e., duration, amplitude, frequency) on athletic performance.

Posted on by — Leave a comment

A randomized controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy.

date: 02/01/2004
author: Caulton JM, Ward KA, Alsop CW, Dunn G, Adams JE, Mughal MZ.
publication: Arch Dis Child. 2004 Feb;89(2):131-5.
pubmed_ID: 14736627

BACKGROUND: Severely disabled children with cerebral palsy (CP) are prone to low trauma fractures, which are associated with reduced bone mineral density. AIMS: To determine whether participation in 50% longer periods of standing (in either upright or semi-prone standing frames) would lead to an increase in the vertebral and proximal tibial volumetric trabecular bone mineral density (vTBMD) of non-ambulant children with CP. METHODS: A heterogeneous group of 26 pre-pubertal children with CP (14 boys, 12 girls; age 4.3-10.8 years) participated in this randomised controlled trial. Subjects were matched into pairs using baseline vertebral vTBMD standard deviation scores. Children within the pairs were randomly allocated to either intervention (50% increase in the regular standing duration) or control (no increase in the regular standing duration) groups. Pre- and post-trial vertebral and proximal tibial vTBMD was measured by quantitative computed tomography (QCT). RESULTS: The median standing duration was 80.5% (9.5-102%) and 140.6% (108.7-152.2%) of the baseline standing duration in the control group and intervention group respectively. The mean vertebral vTBMD in the intervention group showed an increase of 8.16 mg/cm3 representing a 6% mean increase in vertebral vTBMD. No change was observed in the mean proximal tibial vTBMD. CONCLUSION: A longer period of standing in non-ambulant children with CP improves vertebral but not proximal tibial vTBMD. Such an intervention might reduce the risk of vertebral fractures but is unlikely to reduce the risk of lower limb fractures in children with CP.

Posted on by — Leave a comment

Effect of standing on spasticity, contracture, and osteoporosis in paralyzed males.

date: 01/01/1993
author: Kunkel CF, Scremin AM, Eisenberg B, Garcia JF, Roberts S, Martinez S.
publication: Arch Phys Med Rehabil. 1993 Jan;74(1):73-8.
pubmed_ID: 8420525

The effect of “standing” in a frame on spasticity (clinical assessment and H-reflex), contracture (lower extremity joint range of motion), and osteoporosis (dual photon absorptiometry) was studied in six paralyzed males (mean age 49 yr) who had been confined to wheelchairs for an average of 19 years. Standing time averaged 144 hours over a mean of 135 days. Clinical Assessment measured reflexes, tone, and clonus in the legs. Results revealed no important differences between initial and final scores for clinical assessment and joint range of motion. In three subjects for whom H-reflexes were found, latency and amplitude were not altered by “standing.” Bone density was normal in the lumbar spine but significantly reduced in the femoral neck. “Standing” did not modify the bone density in any site. A follow-up interview revealed that 67% of subjects continued to “stand” and felt healthier because of it. In summary, “standing” had no ill effects, did not alter measured variables, and had a positive psychological impact.

Posted on by — Leave a comment

Bone-mineral density in children and adolescents who have spastic cerebral palsy.

date:
author: Henderson RC, Lin PP, Greene WB.
publication: J Bone Joint Surg Am. 1995 Nov;77(11):1671-81.
pubmed_ID: 7593076

Bone-mineral density was studied in a heterogeneous group of 139 children (mean age, nine years; range, three to fifteen years) who had spastic cerebral palsy. The evaluation included serum analyses and a nutritional assessment based on a dietary history and anthropometric measurements. The bone-mineral density of the proximal parts of the femora and the lumbar spine was measured with dual-energy x-ray absorptiometry and was normalized for age against a series of ninety-five normal children and adolescents who served as controls. Bone-mineral density varied greatly but averaged nearly one standard deviation below the age-matched normal means for both the proximal parts of the femora (-0.92 standard deviation) and the lumbar spine (-0.80 standard deviation). Ambulatory status was the factor that best correlated with bone-mineral density. Nutritional status, assessed on the basis of caloric intake, skinfolds, and body-mass index, was the second most significant variable. The pattern of involvement, durations of immobilization in a cast, and a calcium intake of less than 500 milligrams per day were additional factors of less significance. The age when the child first walked, previous fractures, use of anticonvulsants, and serum vitamin-D levels did not correlate with bone-mineral density after adjustment for covariance with the ambulatory status and the nutritional status. Serum levels of calcium, phosphate, alkaline phosphatase, and osteocalcin were not reliable indicators of low bone-mineral density.

Posted on by — Leave a comment

Bisphosphonates to treat osteopenia in children with quadriplegic cerebral palsy: a randomized, placebo-controlled clinical trial.

date: 11/01/2002
author: Henderson RC, Lark RK, Kecskemethy HH, Miller F, Harcke HT, Bachrach SJ.
publication: J Pediatr. 2002 Nov;141(5):644-51.
pubmed_ID: 12410192

OBJECTIVE: To evaluate in a double-blind, placebo-controlled clinical trial the safety and efficacy of intravenous pamidronate to treat osteopenia in nonambulatory children with cerebral palsy. STUDY DESIGN: Six pairs of subjects generally matched within each pair for age, sex, and race completed the protocol. One member of each pair randomly received plain saline placebo, the other pamidronate. Drug/placebo was administered intravenously daily for 3 consecutive days, and this 3-day dosing session was repeated at 3-month intervals for one year. Evaluations were continued for 6 months after the year of treatment. Bone mineral density (BMD) was measured in the distal femur, a site specifically developed for use in this contracted population, and the lumbar spine. RESULTS: In the metaphyseal region of the distal femur, BMD increased 89% +/- 21% (mean +/- SEM) over the 18-month study period in the pamidronate group compared with 9% +/- 6% in the control group. Age-normalized z scores increased from -4.0 +/- 0.6 to -1.8 +/- 1.0 in the pamidronate group and did not significantly change in the control group (-4.2 +/- 0.3 to -4.0 +/- 0.3). The first dosing with pamidronate caused a transient drop in serum calcium that was asymptomatic and not treated. No other potentially adverse effects were noted. CONCLUSIONS: In this small controlled clinical trial, pamidronate was found to be a safe and very effective agent to increase BMD in nonambulatory children with cerebral palsy.

Posted on by — Leave a comment

Bone mineral content in preterm infants at age 4 to 16.

date: 03/01/1985
author: Helin I, Landin LA, Nilsson BE.
publication: Acta Paediatr Scand. 1985 Mar;74(2):264-7.
pubmed_ID: 3993373

Using photon absorptiometry the forearm bone mineral content (BMC) was determined in 75 children aged 4 to 16, who all had a low birth weight. Forty-five of them were born preterm AGA (27 boys, 18 girls, mean weight 1 580 g; range 920-2 060 g) and 30 preterm SGA (17 boys, 13 girls, mean weight 1510; range 940-2130 g). The results were compared with a control group of children of the same age, and analyses of covariance with age, height and weight as the covariant factors were performed. The BMC, weight and height did not differ between the children born AGA or SGA. Irrespective of AGA or SGA, the BMC was significantly decreased in boys but the difference was less pronounced and less significant when height and weight were used as covariant factors. Boys who had been born preterm had a less BMC than the control boys for their age but they were also somewhat shorter and lighter than expected with regard to their age.

Posted on by — Leave a comment

Cerebrovascular and cardiovascular responses to graded tilt in patients with autonomic failure.

date: 09/28/1997
author: Bondar RL, Dunphy PT, Moradshahi P, Kassam MS, Blaber AP, Stein F, Freeman R.
publication: Stroke. 1997 Sep;28(9):1677-85.
pubmed_ID: 9303009
BACKGROUND AND PURPOSE: Patients with autonomic nervous system failure often experience symptoms of orthostatic intolerance while standing. It is not known whether these episodes are caused primarily by a reduced ability to regulate arterial blood pressure or whether changes in cerebral autoregulation may also be implicated. METHODS: Eleven patients and eight healthy age- and sex-matched control subjects were studied during a graded-tilt protocol. Changes in their steady state middle cerebral artery mean flow velocities (MFV), measured by transcranial Doppler, brain-level mean arterial blood pressures (MABPbrain), and the relationship between the two were assessed. RESULTS: Significant differences between patients and control subjects (P < .05) were found in both their MFV and MABPbrain responses to tilt. Patients’ MFV dropped from 60 +/- 10.2 cm/s in the supine position to 44 +/- 14.0 cm/s at 60 degrees head-up tilt, whereas MABPbrain fell from 109 +/- 11.7 to 42 +/- 16.9 mm Hg. By comparison, controls’ MFV dropped from 54 +/- 7.8 cm/s supine to 51 +/- 8.8 cm/s at 60 degrees, whereas MABPbrain went from 90 +/- 11.2 to 67 +/- 8.2 mm Hg. Linear regression showed no significant difference in the MFV-MABPbrain relationship between patients and control subjects, with slopes of 0.228 +/- 0.09 cm.s-1.mm Hg-1 for patients and 0.136 +/- 0.16 cm.s-1.mm Hg-1 for control subjects. CONCLUSIONS: The present study found significant differences between patients and control subjects in their MFV and MABPbrain responses to tilt but no difference in the autoregulatory MFV-MABPbrain relationship. These results suggest that patients’ decreased orthostatic tolerance may primarily be the result of impaired blood pressure regulation rather than a deficiency in cerebral autoregulation.

Posted on by — Leave a comment

Quantifying weight-bearing by children with cerebral palsy while in passive standers.

date: 12/01/2007
author: Herman D, May R, Vogel L, Johnson J, Henderson RC.
publication: Pediatr Phys Ther. 2007 Winter;19(4):283-7.
pubmed_ID: 18004195

PURPOSE: Children who are nonambulatory are placed into standers with the goal of providing benefits from weight-bearing. The purpose of this study was to quantify weight-bearing loads by children with cerebral palsy while in standers. METHODS: Electronic load-measuring footplates were fabricated specifically for this study. Weight-bearing loads were continuously measured in 19 children who were nonambulatory during routine 30-minute standing sessions (3-6 sessions/child, total 110 sessions). RESULTS: Weight-bearing ranged widely (23%-102%) with a mean of 68% of body weight. There was some variation over the course of a session and between different sessions, but more variance was noted between subjects. CONCLUSIONS: Actual weight borne in a stander is quite variable, and in some instances only a fraction of actual body weight. Further studies are required to delineate relevant factors and identify ways to maximize weight-bearing loads while in a stander.