Caregivers' Perceptions of a High Repetition Sit-To-Stand Exercise Program for Children with Cerebral Palsy Who Have Mobility Limitations.

AIMS: To explore caregiver perceptions about the outcomes and feasibility of a high repetition sit-to-stand home-based exercise program on themselves and their children with cerebral palsy who have mobility limitations. METHODS: Face-to-face semi-structured interviews were conducted with 19 caregivers (17 women, mean age 39 y 6 mo (SD 8 y 4 mo) of 19 children with cerebral palsy (10 males, mean age 7 y 2 mo (SD 2 y 1 mo) classified as level III (n = 8) or IV (n = 11) on the Gross Motor Function Classification System. The children had completed a 6-week task-specific sit-to-stand exercise program. Each week a physical therapist and caregivers supervised the program: twice by the physical therapist and three times by the caregivers. Interviews were completed immediately after program completion, and transcripts were analyzed using a process of inductive thematic analysis within an interpretive description framework. RESULTS: Themes were: (1) caregivers saw positive changes in their children from completing the program, (2) seeing positive changes gave caregivers hope that their child could develop with further training, and (3) the program was feasible to complete. CONCLUSIONS: Caregivers perceived positive changes in their children and expressed increased hope for their child's future after a high repetition sit-to-stand exercise program, suggesting the program is feasible with caregiver supervision.

Sit-to-stand training for self-care and mobility in children with cerebral palsy: a randomized controlled trial.

AIM: To investigate if a sit-to-stand exercise programme for children with cerebral palsy (CP) would improve self-care and mobility. METHOD: Thirty-eight children with CP (19 males, 19 females; mean age 8y 0mo, SD 2y 4mo, age range 4y 0mo-12y 4mo) classified in Gross Motor Function Classification System (GMFCS) levels III and IV and their caregivers were randomly allocated to sit-to-stand training plus routine physiotherapy (balance and gait training) or routine physiotherapy only (controls). Task-specific sit-to-stand training was completed five times a week for 6 weeks under physiotherapist (twice weekly) and caregiver (three times weekly) supervision. Blinded outcome assessments at week 7 were the self-care and mobility domains of the Functional Independence Measure for Children, Five Times Sit-to-Stand Test (FTSST), and Modified Caregiver Strain Index (MCSI). RESULTS: The sit-to-stand group self-care increased by 2.2 units (95% confidence interval [CI] 1.3-3.1) and mobility increased by 2.2 units (95% CI 1.4-3.0) compared to the control group. In the sit-to-stand group, the FTSST was reduced by 4.0 seconds (95% CI -4.7 to -3.2) and the MCSI was reduced by 0.8 units (95% CI -1.2 to -0.4) compared to the control group. INTERPRETATION: A sit-to-stand exercise programme for children with CP classified in GMFCS levels III and IV improved sit-to-stand performance and resulted in small improvements in self-care and mobility, while reducing caregiver strain. What this paper adds Sit-to-stand training improved independence in self-care and mobility for children with cerebral palsy (CP). Home-based sit-to-stand training programmes for children with CP can reduce the burden on supervising caregivers.

Barriers to and facilitators of physical activity for children with cerebral palsy in special education.

AIM: To explore the barriers to and facilitators of physical activity for young people with cerebral palsy in specialist schools. METHOD: Eleven focus groups involving 73 participants (10 young people with cerebral palsy, 13 parents of children with cerebral palsy, 27 teachers, 23 therapists) were held at two specialist schools. Focus groups were audio-recorded and transcribed verbatim. Transcripts were analysed using inductive thematic analysis by two researchers, independently. RESULTS: Four main themes emerged from the focus groups: school priorities; student factors; staffing and environment; and roles and relationships. Physical activity was promoted when academic work and physical activity were seen as equally important school priorities. Student factors that reduced physical activity included fluctuating health, school absences, and protracted rehabilitation after surgery. The staffing and environment unique to specialist schools played a pivotal role in assisting students to be active, as was the importance of collaborative, relationship-based care. INTERPRETATION: Physical activity programmes developed in specialist schools need to take into consideration complexities associated with the age, developmental stage, and academic requirements of young people with cerebral palsy. Particularly for adolescents, motivation was discussed as having a substantial influence on physical activity participation. These findings may assist school leadership teams, clinicians, and teachers in planning physical activity interventions. WHAT THIS PAPER ADDS: Specialist schools offer custom-built environments that promote physical activity and inclusion for students with physical impairments. Therapists and teaching staff work creatively and collaboratively to incorporate an 'all-day' approach to providing physical activity opportunities. Balancing time spent on physical activity versus academic work can cause tension.

Eccentric exercise in adults with cardiorespiratory disease: a systematic review.

OBJECTIVE: To determine if eccentric exercise is effective, tolerable and safe for adults with chronic cardiorespiratory disease. DATA SOURCES: We searched electronic databases from inception until January 2015 (Medline, CINAHL, Embase, SportDiscus, PEDro, Cochrane Central and AMED) supplemented by citation tracking and reference list scanning. REVIEW METHODS: Included articles had to report effects of eccentric exercise, alone or as a primary component of intervention, of any intensity and duration, on adults with chronic cardiorespiratory disease. Trials needed to be reported as full text in a peer-reviewed journal and include control data (randomised, quasi-randomised and single group cross-over design trials). Any outcomes or comparison interventions were accepted. Methodological rigor was assessed using the PEDro scale. RESULTS: Of 22 potentially relevant articles, 10 met inclusion criteria. They reported results from seven trials with a total of 112 participants across the diseases. PEDro scores were low (median 3). Eccentric exercise increased strength and mobility to comparable levels as concentric exercise, however, it did so with lower oxygen consumption (effect size as large as d = -3.07 (-4.12, -1.80)), and four-fold power output (effect size d = -3.60 (-5.03, -1.66)). There were no adverse events reported for eccentric exercise. Pain was avoided with familiarisation sessions and individual exercise prescription. CONCLUSION: Eccentric exercise is beneficial and at least comparable with traditional exercise in improving walking and strength for people with chronic cardiorespiratory disease. It was well tolerated and we identified no safety concerns for the use of this intervention for this population.

Gross motor function is an important predictor of daily physical activity in young people with bilateral spastic cerebral palsy.

AIM: The aim of the study was to describe daily physical activity levels of adolescents and young adults with bilateral spastic cerebral palsy (CP) and to identify factors that help predict these levels. METHOD: Daily physical activity was measured using an accelerometer-based activity monitor in 45 young people with bilateral spastic CP (23 males, 22 females; mean age 18y 6mo [SD 2y 5mo] range 16y 1mo-20y 11mo); classified as Gross Motor Function Classification System (GMFCS) level II or III and with contractures of <20° at hip and knee. Predictor variables included demographic characteristics (age, sex, weight) and physical characteristics (gross motor function, lower limb muscle strength, 6min walk distance). Data were analyzed using the information-theoretic approach, using the Akaike information criterion (AIC) and linear regression. RESULTS: Daily activity levels were low compared with published norms. Gross Motor Function Measure Dimension-E (GMFM-E; walking, running, and jumping) was the only common predictor variable in models that best predicted energy expenditure, number of steps, and time spent sitting/lying. GMFM Dimension-D (standing) and bilateral reverse leg press strength contributed to the models that predicted daily physical activity. INTERPRETATION: Adolescents and young adults with bilateral spastic CP and mild to moderate walking disabilities have low levels of daily activity. The GMFM-E was an important predictor of daily physical activity.

Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial.

AIM: The aim of this study was to investigate whether individualized resistance training improves the physical mobility of young people with cerebral palsy (CP). METHOD: Forty-eight participants with spastic diplegic CP (26 males, 22 females; mean age 18y 1mo, SD 1y 11mo) classified as level II or III on the Gross Motor Function Classification System were allocated randomly to progressive resistance training or usual-care control. Resistance training was completed twice weekly for 12 weeks at a community gymnasium under the supervision of a physiotherapist. Exercises were based on instrumented gait analysis and targeted muscles contributing to walking difficulties. Outcomes at 12 weeks and 24 weeks included objective measures of mobility (6-min walk test, instrumented gait analysis, and Gross Motor Function Measure dimensions D and E), participant-rated measures of mobility (Functional Mobility Scale and Functional Assessment Questionnaire), and muscle performance. RESULTS: The strength of targeted muscles increased by 27% (95% CI 8-46%) compared with control group. There were no between-group differences in any objective measure of mobility at 12 weeks (6-min walk test: mean difference 0.1m; 95% CI -21 to 21m) or at 24 weeks. Participant-rated mobility improved (Functional Mobility Scale at 5m: mean 0.6 units; 95% CI 0.1-1.1 units; Functional Assessment Questionnaire: 0.8 units; 95% CI 0.1-1.6 units) compared with control group at 12 weeks. INTERPRETATION: Individualized progressive resistance training increased strength in adolescents and young adults with spastic diplegic CP. Despite participant-rated benefits, the increased strength did not result in objective improvements in mobility.

Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer's disease: a pilot randomized controlled trial.

OBJECTIVE: To evaluate the feasibility and safety of a home-based exercise programme for people with Alzheimer's disease, and to provide preliminary evidence of programme effectiveness in improving balance and mobility and reducing falls risk. DESIGN: A randomized controlled trial. SETTING: Community. PARTICIPANTS: Forty people with mild to moderate Alzheimer's disease (mean age 81.9, SD 5.72; 62.5% female). INTERVENTIONS: Participants were randomized to a six-month home-based individually tailored balance, strengthening and walking exercise programme (physiotherapist) or a six-month home-based education programme (control) (occupational therapist). Both programmes provided six home-visits and five follow-up phone calls. MAIN MEASURES: Balance, mobility, falls and falls risk were measured at baseline and programme completion. Intention-to-treat analysis using a generalized linear model with group allocation as a predictor variable was performed to evaluate programme effectiveness. Feasibility and adverse events were systematically recorded at each contact. RESULTS: Fifty-eight per cent of the exercise group finished the programme, completing an average of 83% of prescribed sessions, with no adverse events reported. Functional Reach improved significantly (P = 0.002) in the exercise group (mean (SD), 2.28 (4.36)) compared to the control group (-2.99 (4.87)). Significant improvement was also observed for the Falls Risk for Older People - Community score (P = 0.008) and trends for improvement on several other balance, mobility, falls and falls risk measures for the exercise group compared to the control group. CONCLUSIONS: The exercise programme was feasible and safe and may help improve balance and mobility performance and reduce falls risk in people with Alzheimer's disease.

Impaired sit-to-stand is perceived by caregivers to affect mobility and self-care in children with cerebral palsy who had moderate to severe mobility limitations: A mixed methods analysis.

OBJECTIVE: To explore the effects that impaired ability to sit-to-stand has on upright mobility and self-care in children with cerebral palsy and how this in turn may affect their caregivers. METHODS: A mixed methods research design was conducted with 25 children who had cerebral palsy with moderate to high mobility limitations (GMFCS levels III and IV) and their caregivers. Caregivers were interviewed about their child's mobility and self-care. The independence of each child's activities was rated using the mobility and self-care domains of the Functional Independence Measure for Children (WeeFIM). RESULTS: Two themes were identified from qualitative analyses: Difficulty in sit-to-stand was perceived by caregivers to reduce their child's ability to independently and safely perform mobility and some self-care tasks; and negatively impacted the caregivers physically and psychologically. Mobility and self-care WeeFIM scores showed that these children required moderate assistance, and that self-care tasks involving sit-to-stand (toileting and bathing) required more assistance than self-care tasks that would not be expected to involve sit-to-stand (eating and grooming). Qualitative and quantitative findings were convergent. CONCLUSIONS: The ability to sit-to-stand independently may be an important precursor skill for independence in upright mobility and self-care for children with moderate to severe mobility limitations.

Factors influencing commencement and adherence to a home-based balance exercise program for reducing risk of falls: perceptions of people with Alzheimer's disease and their caregivers.

BACKGROUND: Balance exercise is an important component of falls-prevention interventions, with growing evidence that it can be beneficial for people with Alzheimer's disease (AD). However, to implement a balance exercise program successfully for people with AD it is important to consider factors that can affect commencement and adherence to the program. This qualitative study explored these factors. METHODS: Ten participants with AD, who had completed a six-month home-based balance exercise program, and their caregivers (n = 9) participated. A phenomenological theoretical framework with semi-structured interviews was used for data collection and analysis. RESULTS: Factors influencing the decision to commence the program were: possible benefits of the program, recommendations from health professionals, value of research, positive attitude towards exercise, and minimizing caregivers' burden. Factors influencing adherence to the program were grouped under 11 themes: six themes facilitated completion (program characteristics, physiotherapist, exercise recording sheet, caregivers' support, sense of commitment, and perceived benefit) and five themes were barriers (pre-existing conditions, dislike of structured exercise, absence from home, caregiver's health or commitment, and bad weather). CONCLUSIONS: A home-based exercise program with regular support from a physiotherapist and caregiver are key elements facilitating continuing program adherence in people with AD.

Effect of eccentric exercise on quality of life and function in people with chronic heart failure: a pilot randomised controlled trial.

PURPOSE: To determine if eccentric exercise was effective, safe and feasible in increasing function and quality of life in people with heart failure compared to usual care and a waitlist control group. METHODS: A prospective, three-armed, parallel-design, assessor-blind, pilot randomised controlled trial with 1:1:1 allocation. Forty-seven participants (16 female; mean age 66 years) with mild to moderate heart failure were randomly allocated to either eccentric exercise, concentric exercise or a waitlist control group. Participants in the exercise groups completed twice-weekly exercise for eight weeks. Primary outcome was walking capacity. Secondary outcomes were quality of life, leg strength and fatigue. Outcomes were assessed at baseline, post intervention and three-month follow-up. Attendance, tolerability and adverse events were used to determine safety and feasibility. RESULTS: Intention-to-treat analysis showed no differences between eccentric exercise and either concentric exercise or waitlist for any outcome. Per-protocol analysis found improvements identified by the Minnesota living with heart failure questionnaire were significantly greater post-intervention for eccentric exercise compared to concentric exercise (-17.99 units, 95% confidence interval -35.96 to -0.01). No major adverse events were reported. CONCLUSION: In this small trial, eccentric exercise did not demonstrate superior outcomes to concentric exercise or a waitlist control group. CLINICAL TRIAL REGISTRATION: The protocol for this trial was registered at clinicaltrials.gov, registration number: NCT02223624, registration date: 22 August 2014.IMPLICATIONS FOR REHABILITATIONRegular physical activity and referral to rehabilitation is recommended for people with chronic heart failure, however exercise can be challenging for this group.Eccentric exercise was safe and tolerable for participants with heart failure.Documentation of exercise progression is important to demonstrate a dose-response relationship.In this study there were no differences between groups who received eccentric exercise, concentric exercise or no exercise.

Retest reliability of balance and mobility measurements in people with mild to moderate Alzheimer's disease.

BACKGROUND: To interpret changes of balance and mobility in people with Alzheimer's disease (AD), we require measures of balance and mobility that have demonstrated reliability in this population. The aim of the study was to determine the safety, feasibility and retest reliability of clinical and forceplate balance and mobility measurements in people with AD. METHODS: Relative and absolute reliabilities were examined in 14 older people with mild to moderate AD. Relative reliability was calculated using the intraclass correlation coefficient, two-way mixed model (ICC3,1). Absolute reliability was calculated using the standard error of measurement (SEM), the minimum detectable change (MDC) and the coefficient of variation (CV). RESULTS: All measurements were clinically feasible and could be safely administered. ICC values were excellent and CVs were less than 11% in all clinical balance and mobility measures except the Timed Up & Go test with cognitive or manual task (ICC3,1 = 0.5 and 0.7, and CV = 14% and 10%, respectively). Most balance and mobility measures tested on the Neurocom™ forceplate (modified Clinical Test of Sensory Interaction on Balance, Walk Across (step width, step length parameters), and Sit to Stand (rising index parameter)) had excellent relative reliability (ICC3,1 ranging from 0.75 to 0.91). ICC values were fair to good for the other measures. CONCLUSIONS: Retest reliability of the balance and mobility measures used in this study ranged between fair to good, and good to excellent. Clinicians should consider retest reliability when deciding which balance and mobility measures are used to assess people with AD.

Habitual physical activity can be increased in people with cerebral palsy: a systematic review.

OBJECTIVE: To determine if habitual physical activity could be increased in people with cerebral palsy. DATA SOURCES: We searched electronic databases until February 2010 using key words related to concepts of cerebral palsy and physical activity. This search was supplemented with citation tracking. METHODS: Studies had to include participants with cerebral palsy who have habitual physical activity measured over at least one day after a therapy intervention. Two reviewers independently assessed study quality with the PEDro scale (quantitative studies) and Critical Appraisal Checklist for Qualitative Research (qualitative studies). For quantitative studies standardized mean differences were calculated and meta-analysis conducted. Qualitative data were synthesized thematically. RESULTS: Three randomized controlled trials (96 participants) and two qualitative studies (21 participants) were reviewed. Four studies evaluated exercise programmes, and one study an online educational and support programme. Meta-analysis showed that exercise programmes could increase habitual physical activity (δ = 1.0; 95% confidence interval (CI) 0.28 to 1.72). This result was reinforced by reports of increased daily activity in two qualitative studies. The online programme increased weekly minutes of moderate to vigorous physical activity (d = 0.81; 95% CI 0.17 to 1.45), and weekly step counts (d = 0.62; 95% CI 0.0 to 1.25). Positive effects were not maintained after programmes stopped. There was insufficient evidence to determine if demographic factors or programme characteristics, such as intensity and setting, were associated with outcomes. CONCLUSION: Preliminary evidence suggests that exercise programmes and online support programmes can increase habitual physical activity in people with cerebral palsy, but effects are not maintained when programmes stop.

Retest reliability of measuring hip extensor muscle strength in different testing positions in young people with cerebral palsy.

BACKGROUND: In young people with spastic diplegic cerebral palsy weakness of the hip extensor muscles are associated with limitations in activity. It is important that clinicians can reliably measure hip extensor muscle strength to monitor changes over time and the effects of any interventions. Previous research has demonstrated high reliability for measuring strength of all muscles of the lower limb, with the exception of the hip extensors. Therefore the aim of this study was to examine the retest reliability of measuring hip extensor strength in young people with cerebral palsy. METHODS: Using a test-retest reliability research design, 19 participants with spastic diplegic cerebral palsy (Gross Motor Function Classification System Levels II and III) (mean 19 y 2 mo [S D 2 y 5 mo]) attended two testing sessions held 12 weeks apart. Three trials with a hand-held dynamometer were taken at each testing session in supine, prone and standing. Retest reliability was calculated with Intraclass Correlation Coefficients (ICC(2,1)) and with units of measurement (kilograms) converted to a percentage strength change. RESULTS: ICC values ranged from .74 to .78 in supine, .75 to .80 in prone, and .73 to .75 in standing. To be 95% confident that real change had occurred, an individual's strength would need to increase 55 to 60% in supine, 86 to 102% in prone, and 102 to 105% in standing. To be 95% confident that real change had occurred across groups, strength would need to increase 4 to 8% in supine, 22 to 31% in prone, and 32% to 34% in standing. Higher ICC values were observed when three trials were used for testing. CONCLUSIONS: The supine testing position was more reliable than the prone or standing testing positions. It is possible to measure hip extensor strength with sufficient reliability to be able monitor change within groups using the supine position provided three trials are used during testing. However, there is insufficient reliability to monitor changes in hip extensor strength in individuals with cerebral palsy unless they exhibit very large strength increases.

Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of 9 weeks of twice-weekly partial body weight-supported treadmill training (PBWSTT) for children with cerebral palsy (CP) and moderate to severe walking difficulty compared with overground walking. DESIGN: Randomized controlled trial. SETTING: Metropolitan Specialist School for children with moderate to severe physical and/or intellectual disabilities. PARTICIPANTS: Thirty-four children classified level III or IV by the Gross Motor Function Classification System were recruited and randomly allocated to experimental or control groups. Of these, 26 (15 girls, 11 boys; mean age 10 y, 10 mo +/- 3 y, 11 mo [range, 5-18 y]) completed training and testing. INTERVENTIONS: Both groups completed 9 weeks of twice-weekly walking training. The experimental group completed PBWSTT, and the control group completed overground walking practice. MAIN OUTCOME MEASURES: Ten-meter walk test (self-selected walking speed), 10-minute walk (walking endurance), School Function Assessment. RESULTS: The overground walking group showed a trend for an increase in the distance walked over 10 minutes (F=3.004, P=.097). There was no statistically significant difference in self-selected walking speed over 10 meters or in walking function in the school environment as measured by the School Function Assessment. CONCLUSIONS: PBWSTT is safe and feasible to implement in a special school setting; however, it may be no more effective than overground walking for improving walking speed and endurance for children with CP. Continued emphasis on progressive reduction of body weight support along with adding concurrent overground walking practice to a treadmill training protocol may increase the intensity of training and assist with carryover of improvements to overground walking. Treadmill training programs that include concurrent overground walking as an additional key feature of the training protocol need to be rigorously evaluated for children with CP.

Sit-to-stand exercise programs improve sit-to-stand performance in people with physical impairments due to health conditions: a systematic review and meta-analysis.

Purpose: To determine the effects of sit-to-stand exercise programs on patient-related outcomes in people with physical impairments due to health conditions.Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively. Seven electronic databases were systematically searched for relevant articles. Inclusion and exclusion criteria were used to screen the titles and abstracts of articles identified using the key search terms of sit-to-stand and exercise. Only randomized controlled trials were included. The methodological quality of papers was assessed using the Cochrane risk of bias tool.Results: A total of eight trials were included. A meta-analysis was conducted using four of the trials that focused on patients with neurological conditions. There was moderate-quality evidence that sit-to-stand exercise programs improve sit-to-stand performance, but no evidence from another meta-analysis that sit-to-stand training improved balance for patients with neurological conditions. There was also no evidence from individual trials that positive changes occurred in the outcomes of gait speed and distance, lower limb muscle strength, falls, or participation.Conclusions: Sit-to-stand training could be a useful intervention when patients have limited sit-to-stand function and the aim of treatment is to improve this performance.IMPLICATIONS FOR REHABILITATIONSit-to-stand training could be a useful intervention for patients when the aim is to improve sit-to-stand performance.Sit-to-stand training may not be a useful intervention when the aim is to improve other functions such as balance.

Effectiveness of balance training exercise in people with mild to moderate severity Alzheimer's disease: protocol for a randomised trial.

BACKGROUND: Balance dysfunction and falls are common problems in later stages of dementia. Exercise is a well-established intervention to reduce falls in cognitively intact older people, although there is limited randomised trial evidence of outcomes in people with dementia. The primary objective of this study is to evaluate whether a home-based balance exercise programme improves balance performance in people with mild to moderate severity Alzheimer's disease. METHODS/DESIGN: Two hundred and fourteen community dwelling participants with mild to moderate severity Alzheimer's disease will be recruited for the randomised controlled trial. A series of laboratory and clinical measures will be used to evaluate balance and mobility performance at baseline. Participants will then be randomized to receive either a balance training home exercise programme (intervention group) from a physiotherapist, or an education, information and support programme from an occupational therapist (control group). Both groups will have six home visits in the six months following baseline assessment, as well as phone support. All participants will be re-assessed at the completion of the programme (after six months), and again in a further six months to evaluate sustainability of outcomes. The primary outcome measures will be the Limits of Stability (a force platform measure of balance) and the Step Test (a clinical measure of balance). Secondary outcomes include other balance and mobility measures, number of falls and falls risk measures, cognitive and behavioural measures, and carer burden and quality of life measures. Assessors will be blind to group allocation. Longitudinal change in balance performance will be evaluated in a sub-study, in which the first 64 participants of the control group with mild to moderate severity Alzheimer's disease, and 64 age and gender matched healthy participants will be re-assessed on all measures at initial assessment, and then at 6, 12, 18 and 24 months. DISCUSSION: By introducing a balance programme at an early stage of the dementia pathway, when participants are more likely capable of safe and active participation in balance training, there is potential that balance performance will be improved as dementia progresses, which may reduce the high falls risk at this later stage. If successful, this approach has the potential for widespread application through community based services for people with mild to moderate severity Alzheimer's disease. TRIAL REGISTRATION: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000040369).

Comparing the self concept of children with cerebral palsy to the perceptions of their parents.

PURPOSE: Understanding self concept is important for therapists treating children with cerebral palsy because knowing what children and parents think about perceived competencies and adequacies can be taken into account in determining treatment goals. This study investigated: (i) If differences existed between the self concept ratings of children with cerebral palsy compared to their parent's perception of their child's abilities and attributes, and (ii) the strength of association between the child and parent ratings. METHOD: Thirty children (14 females, 16 males; mean age 11 years 5 months, SD 2 years 6 months, range 8-16 years) with spastic hemiplegia or diplegia and gross motor skills classified as level I or II on the Gross Motor Function Classification System rated their self-concept using the Self-Perception Profile for Children questionnaire. Their parents completed the accompanying Parent Rating Scale. RESULTS: Group differences between the parents and children were found for the domains of Athletic Competence and Physical Appearance. There was either no relationship or a low level of association between the child and parent ratings in all five domains of self concept assessed. CONCLUSION: Parents were unable to evaluate their child's self concept accurately suggesting health professionals should gather such information from the child themselves.

A systematic review of the effectiveness of treadmill training for children with cerebral palsy.

PURPOSE: The development of efficient and independent walking is an important therapeutic goal for many children with cerebral palsy (CP). Consequently, there has been growing interest in determining the effects of treadmill training programs for these children. METHOD: A systematic review of the literature was conducted to evaluate the effectiveness of treadmill training for children with CP. Relevant trials were identified by searching electronic databases and by citation tracking. RESULTS: Of 125 papers initially identified, five met the criteria for review. Results showed that treadmill training is safe and feasible for children with CP across a wide range of ages and functional abilities. Children with more severely affected walking ability significantly increased their walking speed (d = 1.48, 95% CI: 0.49-2.40) and gross motor performance (d = 1.5, 95% CI: 0.50-2.50) after training. However, the results also suggested that treadmill speed and length of training sessions might need to be set to specifically match desired intervention goals such as increasing walking speed or endurance. CONCLUSIONS: The review suggests that treadmill training is safe and feasible for children with CP and indicates that there may be some positive benefits in walking speed over short distances and in general gross motor skills. The provision of PBWS may be particularly beneficial for children with more severe walking disability (GMFCS III and IV). Further research is necessary before it can be concluded that treadmill training is beneficial for children with CP.

Characteristics influencing participation of Australian children with cerebral palsy.

PURPOSE: To investigate the extent to which selected individual, family and environmental variables were associated with participation of children who have cerebral palsy in activities outside school. METHODS: Data were gathered through a population-based survey of 114 children born in 1994 or 1995 in Victoria, Australia. Participation was measured using the Children's Assessment of Participation and Enjoyment. Selected independent variables were classified as related to the child, family or environment. Linear regression analysis was used to identify variables associated with participation in informal (activities that require little planning) and formal (those with structure and leaders) activities. RESULTS: Participation in informal activities tended to be greater in children who preferred informal activities and who had higher manual ability (adjusted R(2) = 36.3%). Girls and those with better gross motor function also tended to participate in more activities. The explanatory power of the regression model for participation in formal activities was limited (adjusted R(2) = 4.2%). CONCLUSION: Knowing a child's activity preferences is critical to intervention planning. Being exposed to a range of activities within supportive environments may provide the opportunity to develop preferences, especially in activities where children with cerebral palsy have reduced participation, such as in physical activities.

Self-concept in children with spina bifida compared with typically developing children.

The literature was systematically reviewed to determine if children with spina bifida have lower self-concept compared with their peers with typical development. Relevant trials were identified by searching electronic databases, supplemented by citation tracking. Of 803 papers initially identified, 15 met the inclusion criteria. Meta-analysis revealed children with spina bifida scored significantly lower than children with typical development for the domains of global self-worth (d=-0.39, 95% confidence interval [CI] -0.65 to -0.12); physical appearance (d=-0.26, 95% CI -0.46 to -0.06); athletic competence (d=-0.45, 95% CI -0.67 to -0.22); social acceptance (d=-0.33, 95% CI -0.55 to -0.11); and scholastic competence (d=-0.43, 95% CI -0.66 to -0.21). There was no difference between the groups for the behavioural conduct domain. Children with spina bifida on average have a lower self-concept than their peers with typical development. Clinicians need to take account of this information in planning the assessment and treatment of this group.