Effectiveness of a dose-graded aerobic exercise regimen on cardiopulmonary fitness and physical performance in pediatric survivors of acute lymphoblastic leukemia: a randomized clinical trial.

PURPOSE: To determine whether a 12-week supervised dose-graded aerobic exercise (D-GAE) training, when implemented in conjunction with traditional rehabilitation, could help pediatric survivors of acute lymphoblastic leukemia (ALL) enhance their cardiopulmonary capacity and improve their physical performance. METHODS: Fifty-eight pediatric survivors of ALL (age 13.78 ± 2.47 years; boys 60.34%) were assigned at random to either undergo the D-GAE in addition to the traditional physical rehabilitation (D-GAE group; n = 29) or the traditional physical rehabilitation solely (control group; n = 29). The cardiopulmonary fitness (peak oxygen uptake (VO2peak), ventilatory equivalent (VEq/VO2), minute ventilation (VE, L/min), oxygen pulse (O2P), maximum heart rate (HRmax), 1-min heart rate recovery (HRR1), and respiratory exchange ratio (RER)) and physical performance (6-min walk test (6-MWT), timed up and down stairs (TUDS), and 4 × 10-m shuttle run test (4 × 10mSRT)) were assessed on the pre- and post-intervention occasions. RESULTS: The mixed-model ANOVA revealed a meaningful increase of VO2peak (P = .002), VE (P = .026), O2P (P = .0009), HRmax (P = .004), and HRR1 (P = .011), and reduction of VEq/VO2 (P = .003) and RER (P = .003) in the D-GAE group compared with the control group. Besides, the analysis detected a favorable increase in the physical performance for the D-GAE group (6-MWT (P = .007), TUDS (P < .001), 4 × 10mSRT (P = .009)). CONCLUSION: A 12-week D-GAE program in conjunction with traditional rehabilitation holds promise in enhancing cardiopulmonary fitness and improving the physical performance of pediatric survivors of ALL. Clinicians and physical rehabilitation professionals can, therefore, integrate the D-GAE into the traditional rehabilitation protocols for such a patient population to optimize their cardiopulmonary fitness and physical function, while also facilitating a gradual transition to practice and adaption. IMPLICATIONS FOR CANCER SURVIVORS: The favorable outcomes of this study bolster the inclusion of D-GAE as a crucial element in the care and rehabilitation of pediatric survivors of ALL. By embracing these findings, healthcare professionals and oncologists can contribute to mitigating the long-term cardiopulmonary and physical complications associated with cancer treatments and fostering a state of enhanced well-being and increased physical activity among survivors.

Efficacy of plyometric exercises on upper extremity function, selective motor control and hand grip strength in children with unilateral cerebral palsy: A randomized controlled study.

BACKGROUND: Impairment in unimanual upper limb function is frequent among children with unilateral cerebral palsy (UCP), which affects their ability to perform functional activities. AIM: To assess the efficacy of plyometric exercises on the function of upper extremity, selective motor control (SMC) and hand grip strength (HGS) in children with UCP. DESIGN: This was a double-masked, randomized, controlled clinical trial. SETTING: Outpatient Clinics of Faculty of Physical Therapy, Cairo University and Center for Physical Medicine, Rehabilitation and Rheumatology, Al-Agouza Hospital, Giza, Egypt. POPULATION: Forty children with UCP, ranging in age from 8 to 12 years, were randomly allocated to two groups equal in numbers. METHOD: Children were allocated to receive conventional therapy (CONV-group; n = 20) or plyometric exercises (PLYO-group; n = 20) for 45 min. In addition, children of both groups received selected physical and occupational therapy programs (each lasted for 30 min) twice a week over 3-month. The intervention was delivered on non-consecutive days. Upper extremity function, SMC and HGS were assessed by using quality of upper extremity skills test (QUEST), Test of arm selective control and pneumatic squeeze bulb dynamometer, respectively. RESULTS: Overall, 35 children (18 in the CONV-group, 17 in the PLYO-group) completed data collection and treatment. With-in group comparison showed significant improvement in the study groups while post-treatment comparisons revealed a significant difference from mean difference in upper extremity function is 9.55 (8.71:10.39), SMC is 2.12 (1.51:2.72) and HGS is 2.91 (2.13:3.68) (p < 0.05; 95% Confidence interval) in favor of the PLYO-group. CONCLUSIONS: Plyometric exercises have the capability to enhance upper extremity function and strength in children with UCP.

Effect of laser acupuncture on monosymptomatic nocturnal enuresis in adolescent females: A randomized controlled trial.

BACKGROUND AND AIM: Nocturnal enuresis (NE) is prevalent in children and adolescents and affects their social life later. Therefore, the objective of this study was to ascertain laser acupuncture (LA) therapy's effect on NE in adolescent females. METHODS: Sixty adolescent females diagnosed with chronic monosymptomatic nocturnal enuresis (MNE) were randomly divided into two equal groups: The intervention group (received LA and desmopressin) and the control group (received desmopressin only) (n = 30 each). Treatment was delivered and LA was used three times a week for 12 successive weeks. Abdominal ultrasonography and voiding calendar were used to assess bladder capacity and maximum voiding volume (MVV), respectively. The frequency of bed wetness was assessed throughout the trial period in a diary. RESULTS: Statistically significant differences were reported in the intervention group. Bladder capacity significantly increased in the intervention group (LA and desmopressin) than in the control group. CONCLUSIONS: The results of this study suggest the beneficial influences of LA on MNE, despite the very poor quality of the literature's available evidence.

Effect of physical training on motor function of ambulant children with diplegia after selective dorsal rhizotomy: A randomized controlled study.

BACKGROUND: Children with spastic diplegia experience tonicity, lack of selective motor control, subnormal postural stability and delayed motor development. Selective dorsal rhizotomy followed by physical therapy is a permanent procedure aimed to alleviate hypertonicity. OBJECTIVE: To explore the efficacy of selective dorsal rhizotomy (SDR) followed by a physical training on gross motor function (GMF), functional balance, walking capacity, selective motor control (SMC) and energy cost of walking (ECW) of ambulant children with spastic diplegia. METHODS: Forty-two children with spastic diplegia aged 5 to 8 years were randomly assigned into the control or SDR-group. Both groups received a designed physical training of progressive functional strength training and standard orthotic management (SOM) 3 times a week for 6 months. GMF, functional balance, ECW, functional capacity and SMC were assessed by gross motor function measure (GMfM-88), pediatric balance scale (PBS), energy expenditure index (EEI), six-minute walking test (6MWT) and selective control assessment of lower extremity (SCALE), respectively. Assessment was carried out before the treatment (baseline), after 6 months (post I) and 1-year follow-up (post II). RESULTS: From baseline to post I and post II assessments, changes of GMF, functional balance, ECW, functional capacity and SMC within the control and SDR groups showed significant improvements (P < 0.001). Moreover, group comparison showed significant differences in favor of the SDR group. CONCLUSION: Integrated physical training followed SDR demonstrated qualitative changes and enhancement in motor function, achieved by spasticity reduction.

Paretic-Limb-Only Plyometric Training Outperforms Volume-Matched Double-Limb Training for Ameliorating Balance Capability and Gait Symmetry in Adolescents with Unilateral Cerebral Palsy: A Comparative Study.

Adolescents with unilateral cerebral palsy (U-CP) experience an asymmetrical posture because the less-affected lower limb is preferred for bodyweight support as a strategy of compensating for the paretic side's muscular weakness. This study was designed to compare the effect of 12 weeks of paretic-limb-only plyometric training (PLPT) and volume-matched double-limb training (DLPT) on balance capability and gait symmetry in adolescents with U-CP. Sixty-nine adolescents with U-CP were randomly assigned to PLPT, DLPT, or a control group (n = 23 each). Treatment was delivered twice/week (with at least 48 h recovery intervals) for 12 weeks in succession. The directional (LoSdirectional) and overall (LoSoverall) limits of stability in addition to the temporal (T-GSI) and spatial (S-GSI) gait symmetry indicis were assessed pre- and post-treatment. The LoSdirectional improved significantly in the PLPT group compared to either the DLPT or control group (for the forward (p = 0.027 and <0.001, respectively), backward (p = 0.037 and <0.001, respectively), affected-side (p = 0.038 and 0.004, respectively), and less-affected-side (p = 0.018 and 0.016, respectively)), and this was also the case for the LoSoverall (p < 0.001). Additionally, The T-GSI and S-GSI scores decreased significantly in the PLPT group compared to the DLPT (p = 0.003 and 0.047, respectively) or control (p = 0.003 and 0.036, respectively) group, indicating the development more symmetrical gait patterns. In conclusion, PLPT is likely more effective for enhancing balance capabilities and promoting symmetrical gait patterns than DLPT. Thereupon, it is worthwhile for physical rehabilitation practitioners to include the PLPT paradigm into the intervention plans for adolescents with U-CP.

Usage time of touch screens in relation to visual-motor integration and the quality of life in preschooler children.

OBJECTIVES: This study aims to examine the usage of touch screen time in relation to the visual-motor integration and the quality-of-life in preschool children. Additionally, we compare the difference between children who practiced sports and attended nursery with those who did not attend such activities. METHODS: This study includes a convenience sample of 100 preschool children aged between three and five years. The Peabody Developmental Motor Scale is used to assess visual-motor integration and the Arabic version of the Paediatric Quality of Life Inventory™ generic scale to assess the quality of life (QoL). RESULTS: The Pearson correlation coefficient equation reveals a negative significant correlation (p = 0.0001) between touch screen usage time and visual-motor integration (r = -0.37), physical (r = -0.38), psychosocial (r =--0.55) and the QoL total score (r = --0.48). Children who practiced sports showed lower visual-motor integration and higher QoL scores than those who did not. Children who attended nursery showed higher visual-motor integration and lower QoL scores than those who were not given the chance to attend these activities. CONCLUSION: Based on the results of the current study, it can be concluded that increased touch screen usage time was found to adversely affect visual-motor integration and the QoL in preschool children. Practicing sports and attending nursery influence the visual-motor integration and the QoL.

Clinical and radiological outcomes of corrective exercises and neuromuscular electrical stimulation in children with flexible flatfeet: A randomized controlled trial.

BACKGROUND: Flexible flatfeet are common among children being scarcely symptomatic requires no specific treatment and resolves spontaneously. However, flexible flatfoot tends to advance and deteriorate overtime and eventually resulting in significant impairments such as plantar fasciitis and patellofemoral pain syndrome. RESEARCH QUESTION: What is the effect of corrective exercises and neuromuscular electrical stimulation in children with flexible flatfeet? METHOD: This is a randomized controlled trial with 72 children, seven to twelve yearsold, randomly assigned to either intervention or control group (36 children for each group) and engaged in a four months (3 sessions/week) of corrective exercise and neuromuscular electrical stimulation or corrective exercise and sham neuromuscular electrical stimulation respectively. Assessments of Staheli's arch index (through foot print), navicular drop (through navicular drop test) and radiographic indexes (through anterior-posterior and medio-lateral X-ray) of both feet were performed before and after the intervention programs. RESULTS: Study groups were comparable with respect to all outcome measures at entry (P > 0.05). Within group comparison showed significant improvements in all measured variables. Further, between groups comparison revealed significant higher improvements (P < 0.05) in right and left feet Staheli's arch index, navicular drop as well as the radiographic indexes in favor of the intervention group. SIGNIFICANCE: Integration of corrective exercises and neuromuscular electrical stimulation is more effective than exercises alone for providing clinical and radiological improvements in children with flexible flatfeet.

Effect of oral sensorimotor stimulation on oropharyngeal dysphagia in children with spastic cerebral palsy: a randomized controlled trial.

BACKGROUND: Children with cerebral palsy show various degrees of dysphagia causing late development of oral motor skills AIM: The aim of this study is to investigate effect of oral sensorimotor stimulation on oropharyngeal dysphagia in children with spastic quadriplegia. DESIGN: This was a double-masked, randomized controlled clinical trial. SETTING: Outpatient Clinics of Faculty of Physical Therapy, Cairo University and Modern University of Technology and Information. POPULATION: A convenient sample of 71 children age ranged from 12 to 48 months diagnosed with spastic quadriplegia, were randomly assigned into two groups. METHODS: Children in the control group received 90 minutes conventional physical therapy training five times/week for four successive months while those in the experimental group received 20 minutes of oral sensorimotor stimulation before the same program as in control group. Oral motor function, body weight, segmental trunk control and gross motor function were assessed at base-line and after completing treatment. RESULTS: Overall, 64 (32 in the experimental group, 32 in the control group) children completed treatment and data collection. The baseline assessment showed non-significant difference regarding all measured variables while with-in group comparison showed significant improvement in the two groups. The post-treatment comparisons revealed significant difference the oral motor function and physical growth in favor of the experimental group (P<0.05). Finally, there was non-significant difference regarding segmental trunk control and gross motor function (P>0.05). CONCLUSIONS: Oral sensorimotor stimulation has the capability to improve feeding in children with spastic cerebral palsy diagnosed with oropharyngeal dysphagia. CLINICAL REHABILITATION IMPACT: OSMS has effect on some of the essential oral motor skills that contribute toward the improvement of feeding performance in children with spastic CP. The results of our study offer remarkable clinical importance for the children and their families.

Effects of progressive resistance exercises on quality of life and functional capacity in pediatric patients with chronic kidney disease: a randomized trail.

AIM: To investigate the effects of progressive resistance exercises on quality of life and functional capacity in pediatric patients with chronic kidney disease. METHODS: Thirty-two children with chronic kidney disease from both genders, age ranged from 8 to 12 years participated in this study. They were allocated randomly into two groups of equal numbers, standard medical care (SC) and exercise (EX) groups. The SC group received standard medical care with no change of their regular daily activities. The EX group received progressive resistance exercises for 60 minutes two times a week in addition to the standard medical care for six successive months. OUTCOME MEASURES: Included the pediatric quality of life inventory and six-minutes walking test to assess quality of life and functional capacity respectively. RESULTS: There were statistically significant improvements in the post-test quality of life and functional capacity in the EX group (p<0.05). The SC group showed significant decrease of quality of life and non-significant change was recorded regarding their functional capacity (p<0.05). The post-test comparison between the two groups revealed significant difference in favor of the EX group in all measured variables. CONCLUSION: Progressive resistance exercises contributed to the improvement of quality of life and functional capacity in pediatric patients with chronic kidney disease.

Effects of Radial Shockwave Therapy and Orthotics Applied with Physical Training on Motor Function of Children with Spastic Diplegia: A Randomized Trial.

Aims: To explore the effects of radial shockwave therapy (rSWT) combined with standard orthotic management (SOM) on spasticity, functional balance, and gait in children with spastic diplegia. Methods: Sixty children with diplegia were allocated to group I (rSWT, n = 20), group II (SOM, n = 20), or group III (rSWT + SOM, n = 20). All groups received a physical training program 3 times/week for 3 months. Assessments were completed before and immediately after the intervention and included the Hoffman reflex/Myogenic response ratio of the soleus muscle (H/M ratio), balance, and gait. Results: At a significance criterion adjusted to p ˂ .006, there were no between-group differences in balance or gait (p > .006). The rSWT + SOM group had a greater improvement of H/M ratio compared to rSWT alone (p = .001) but not to SOM alone (p = .04). Within-group analysis demonstrated significant improvement of all variables for rSWT + SOM (p ˂ .006). The H/M ratio and knee midstance angle exhibited clinically meaningful improvement for rSWT alone (p ˂ .006). No significant changes were observed in any variable for SOM alone (p > .006). Conclusions: Radial shockwave and orthotics together, or either of them along with physical training did not differ in improving balance or gait. Their combination was more effective than rSWT alone in reducing spasticity.