Mechanical efficiency and balance in adolescents and young adults with cerebral palsy.

Mechanical efficiency (ME) during stair-climbing measures ambulation ability. This study investigated the relationship between ME and age, anthropometric, functional walking, and balance parameters in 52 adolescents with cerebral palsy (CP), age 13.5-23.3 yrs, who participated in an intervention study to improve walking. Measurements included ME, 6-min and 10-m walk tests and the Berg balance scale (BBS). Walk test measures correlated significantly with ME, as expected, as did BBS (r=0.68) and age (r=0.51). The multiple correlation coefficient with both age and BBS increased to 0.80. The measurements were divided into two groups of low (<40, n=19) and high (>40, n=33) BBS scores. Repeating regression analyses, demonstrated that in the low BBS group ME was significantly related to BBS, but not age, in contrast to opposite results in the high BBS group. Regressions were calculated for each of the 14 items of the BBS with ME. For the whole group, 12 items correlated significantly, but only three in the high BBS group (one leg standing, reach while standing and tandem standing). In the low BBS group 10 of the items correlated significantly, with the former three ranking near the top. Balance is an important component of ambulation in children with CP. Mobility in those scoring>40 is related to age, but in those more deficient in balance (<40) mobility is more closely associated with balance than age. Effective therapy to improve walking in younger children might incorporate more balance-focused exercises, similar to those related to BBS items strongly associated with ME.

Random perturbation: a potential aid in treatment of children with cerebral palsy.

BACKGROUND AND PURPOSE: The motor behaviour of children with cerebral palsy (CP) can be viewed in terms of a stable mode with very little flexibility that prevents adaptation to tasks. We hypothesized that the use of random perturbations (RP) would weaken excessive stability, introduce flexibility and enhance the effects of physical treatment. The objective was to evaluate the contribution of RP to gross motor function and mechanical efficiency (MEg) during intensive physiotherapy in children with CP. METHODS: A convenience sample of 20 children with CP (mean age 8.2, range: 5.9-12.9 yrs) were matched by age and GMFCS level, and randomly assigned to structured intensive treatment (SIT) or to SIT + RP groups. Groups received one month of daily treatment. RP was applied by engine-induced random passive cycling for upper and lower limbs for up to 10 min in a 90-min treatment session. Gross Motor Function Measure (GMFM)-66 and gross mechanical efficiency (MEg) during stair climbing (MEg) were measured before and after treatment. RESULTS: GMFM-66 scores increased by about 1.0 in both groups. However, external work and MEg increased significantly more in SIT + RP than SIT. The increase in MEg in SIT + RP was independent of the level of motor function at baseline. CONCLUSION: The addition of RP in treatment of children with CP may have weakened previously established stereotypical motor patterns and introduced flexibility, thereby improving mechanical efficiency of a complex motor task. RP may enhance the effects of intensive treatment.

Method of analysing the performance of self-paced and engine induced cycling in children with cerebral palsy.

PURPOSE: To develop a method of quantifying the features of cycling in children with CP by comparing them to typically developed children, and to demonstrate the applications of this tool for evaluating treatment effects in children with CP. METHODS: Twenty-seven typically developed children and 51 with CP, classified by their gross motor function levels, were studied. Angular velocities were measured during self-paced active cycling and during passive cycling imposed by an electrically powered stationary cycle. Angular velocities were compared with the gross motor function levels, Modified Ashworth Scale and the Adductor Tone Rating. RESULTS: Significant differences between children with CP and those typically developed demonstrated in passive mode that the cycling task is sensitive to differences in resistance offered by the subjects. Active and passive cycling velocities differ significantly between groups classified by their functional levels (p < 0.01). Children with CP in the mild group showed no differences from typically developed children. The correlations between passive cycling and clinical tests were significant and higher at higher speeds (r = 0.62). Correlations with anthropometric measurements for the typically developed group associated the cycling task with growth and development, and for children with CP with motor control adjustments and impairments. CONCLUSIONS: Measuring of these two cycling modes could be applicable in assessing lower extremity function in children with CP and changes following interventions.

Musculoskeletal deformities in Behr syndrome.

SUMMARY: Seventeen children with Behr syndrome were investigated, focusing on the musculoskeletal deformities and long-term outcome. Behr syndrome is characterized by optic atrophy beginning in early childhood associated with ataxia, spasticity, mental retardation, and posterior column sensory loss. The ataxia, spasticity, and muscle contractures, mainly of the hip adductors, hamstrings, and soleus, are progressive and become more prominent in the second decade. In 70% of the patients, contractures developed in the lower limbs, requiring surgery mainly for the Achilles tendon, hamstrings, and adductor longus. At last follow-up at an average age of 21.7 years (range, 8-31 years), 13 of the patients are housebound walkers, 2 are nonfunctional walkers, and 2 are nonwalkers.