Neuromuscular contributions to disability in children with cerebral palsy and the impact of dynamic stretching orthoses and therapeutic exercise interventions: a narrative review.

Background and Objective: Cerebral palsy (CP) is the most common motor disability in children. The initial lesion to the developing brain may result in a myriad of neuromuscular comorbidities, including mobility deficiencies. The neuromuscular contributions to disability and rehabilitative frameworks specific to children with CP have been investigated separately. However, few reviews have examined the relationship between neuromuscular pathophysiology and rehabilitative frameworks among children with CP. Therefore, the purpose of this review was to investigate the impact of dynamic stretching orthoses and therapeutic exercise on range of motion (ROM), aerobic capacity, and mobility in relation to the neuromuscular contributions to disability in children with CP. Methods: Reviews of PubMed, Google Scholar, and Web of Science were conducted to identify literature focusing on the neuromuscular pathophysiology contributing to disability in children with CP and rehabilitative frameworks associated with this population. The search used a combination of keywords and subject headings to include 'cerebral palsy', 'musculoskeletal', 'neuromuscular', 'spasticity', 'rehabilitation', 'exercise', 'aerobic', and 'orthosis'. Selected manuscripts featured original cross-sectional and longitudinal research and meta-analyses. Key Content and Findings: A total of 303 manuscripts were initially identified through search terms, with 182 articles excluded based on title and abstract evaluation, leaving 121 manuscripts for full-text analysis. Seven studies meeting the narrative review criteria were included. Evidence supporting the efficacy of dynamic stretching orthoses for improving lower extremity ROM is inconclusive. Aerobic and progressive resistive training may be beneficial for improving aerobic capacity and muscle strength in children with CP, which may result in enhanced mobility. Conclusions: Depending on the individual's clinical presentation, ROM and therapeutic exercise may be implemented to optimize function. Incorporating progressive resistive and aerobic exercises into a rehabilitation plan may improve mobility and aerobic capacity. As such, clinicians should consider resistance and aerobic exercise prescription as part of a long-term treatment plan for children with CP.

Comparison of daily step count between the Fitbit Inspire 3 and the activPAL 3 in adults with transtibial amputation.

Introduction: Physical activity has significant positive effects on health. Accelerometers can be used to track daily physical activity. The Fitbit Inspire 3 is a commercially available health and fitness tracker, but its validity for tracking steps among individuals with transtibial amputation has not been examined. Therefore, the purpose of this study was to evaluate the concurrent validity of the Fitbit Inspire 3 for assessing free-living daily steps in adults with transtibial amputation. Methods: Participants (n = 79) completed a general health survey and were provided with a Fitbit Inspire 3 and activPAL 3 accelerometer to wear concurrently for seven days in their home environment. Relationships between the activPAL and Fitbit Inspire 3 were examined using Pearson's Correlation. Paired samples t-tests, mean difference, mean absolute difference, and equivalence testing were used to compared daily step counts between Fitbit Inspire 3 and activPAL 3. Results: Average step counts were 5,768 ± 3,750 (mean ± SD) and 4,674 ± 3,081 by the Fitbit Inspire 3 and activPAL, respectively. A high correlation (r = 0.93) but significant mean difference was found between the activPAL 3 and Fitbit Inspire 3 (p < 0.001). The mean absolute difference between the devices was 1,347 ± 1,184 steps. On average, the Fitbit Inspire 3 counted 1,094 ± 1,423 more daily steps than the activPAL 3. Equivalency could not be claimed between the devices. Discussion: The Fitbit Inspire 3 counted more steps compared to the activPAL. Because of the significant mean differences and the large mean absolute difference between the devices, the activPAL 3 and Fitbit Inspire 3 are not interchangeable for estimating physical activity in individuals with transtibial amputation. However, due to the high correlation, the devices will produce similar classification rankings based on step counts.

Physical activity and mental health during the COVID-19 pandemic among individuals with amputation.

The isolating nature of various COVID-19 mandates may have reduced physical activity (PA) and increased mental health symptomology among individuals with amputation. However, an investigation of mental health across PA levels before and after the onset of COVID-19 among this group has not been conducted. Therefore, the objective of this study was to investigate group differences in depression, anxiety, and post-traumatic stress symptomology among individuals with amputation who reported being physically "active," "somewhat active," or "inactivate" before and during the pandemic. Individuals with an amputation at any level (n = 91; 51% female; age = 52.5±15.5) completed an online questionnaire to assess demographic information, PA levels, and mental health throughout the pandemic. Group differences in self-reported PA before and after COVID-19 onset were assessed by the PA Guidelines for Americans recommendations. The Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder (GAD-7), and Posttraumatic Stress Disorder Checklist (PCL-5) scales were used to assess group differences in mental health status. Before and after the onset of COVID-19, 33% and 42.9% of respondents reported that they were inactive, respectively. 58.2% of respondents reported decreased PA since the pandemic's onset. Prior to the pandemic, active individuals reported lower CES-D (14.21 vs. 19.07; Cohen's d: -0.414), GAD-7 (3.82 vs. 5.47; Cohen's d: -0.359), and PCL-5 (15.92 vs. 21.03; Cohen's d: -0.319) scores compared to inactive individuals. After the onset of COVID-19, scores remained lower for active respondents CES-D (12.67 vs. 20.03; Cohen's d: 0.-669), GAD-7 (3.17 vs. 5.87; Cohen's d: -0.598), and PCL-5 (13.39 vs. 19.90; Cohen's d: -0.430). Individuals with amputation reported decreased PA after the onset of COVID-19. Individuals reporting that they were "active" exhibited improved depression and anxiety symptomology scores compared to those reporting that they were "inactive."

Metabolic syndrome: Operational definitions and aerobic and resistance training benefits on physical and metabolic health in children and adolescents.

BACKGROUND: The variation in parameters for childhood metabolic syndrome (MetS) has hindered the development of a consensus for the diagnostic criteria in this group. Despite these inconsistencies, it is accepted that exercise can ameliorate the deleterious effects of MetS. However, direct comparison between aerobic versus resistance exercise on MetS symptomology in adolescents is lacking. AIM: Aim of this review was to discuss controversies associated with current MetS operation definitions in adolescents and present a review summarizing longitudinal studies relevant to the influence of aerobic and resistance training on children with MetS. METHODS: Reviews of PubMed and Web of Science were conducted to identify literature focusing on the influence of aerobic and resistance training on children with MetS. Selected manuscripts featured longitudinal research only. RESULTS: A universally accepted definition of MetS for the pediatric population has yet to be established. As such, consensus regarding diagnostic criteria for MetS among children is lacking despite the presence of various descriptions in the literature. Though studies support the importance of aerobic and resistance exercise to combat comorbidities associated with MetS, longitudinal studies investigating the benefits of each exercise type among adolescents are limited and inconsistent. CONCLUSION: An improved understanding of the impact of aerobic and resistance training on children with MetS is clinically relevant because it may facilitate more appropriate exercise recommendations for children with MetS. Additional large cohort studies are warranted to determine optimal exercise type.

A walking bout reveals altered foot thermodynamics associated with unilateral transtibial amputation among individuals with type 2 diabetes.

BACKGROUND: Increased foot temperature among individuals with type 2 diabetes can be predictive of diabetic foot ulcer development. A combination of physiological and mechanical deficiencies may contribute to elevations in intact foot temperature during gait for individuals with type 2 diabetes and transtibial amputation. OBJECTIVE: This study evaluated plantar foot temperature differences between individuals with type 2 diabetes with and without transtibial amputation. We hypothesized that individuals with transtibial amputation maintain increased foot temperature compared to those without amputation. STUDY DESIGN: Cross-sectional, case control. METHODS: A sample of 16 participants with type 2 diabetes and transtibial amputation, and 16 age- and sex-matched participants with type 2 diabetes without amputation were recruited. Foot temperatures were measured during resting, walking, and cooldown periods. Peak temperature, mean temperature, and rate of temperature change were analyzed for each period, and compared between cohorts. RESULTS: Participants with amputation exhibited increased mean foot temperature while at rest and during walking. Participants without amputation exhibited increased rate of change of foot temperature during walking. No differences in peak temperature or rate of temperature change were observed during the baseline or cooldown periods. CONCLUSION: The current findings of altered foot temperature for individuals with transtibial amputation and type 2 diabetes suggest a possible reason for the high rates of contralateral limb ulceration and amputation among this population.