Pre-school-based behaviour change intervention to increase physical activity levels amongst young children: a feasibility cluster randomised controlled trial.

Background: A significant rise in childhood obesity worldwide over the past three decades highlights the urgent need for early interventions, especially in preschools as key settings for child development. This study aimed to assess the feasibility and fidelity of a randomised controlled trial of "I'm an Active Hero" (IAAH), a theory- and evidence-based multi-component behaviour change intervention targeting physical activity and sedentary behaviour amongst preschool-aged children. Methods: Two preschools in Taif city, Saudi Arabia were randomly assigned to either the intervention (n = 3 classrooms) or the usual curriculum control group (n = 3 classrooms). The intervention ran for 10 weeks from February to April 2023 and consisted of teacher-led physical activity and sedentary behaviour sessions in preschools, with an additional interactive home component. Primary outcome measures included intervention fidelity, recruitment rates, attrition rates, and compliance with trial procedures. Secondary outcomes included body mass index (BMI), objectively measured physical activity, and sedentary time via the ActiGraph GT3X accelerometer. Outcomes were measured at baseline and at 10 weeks in both study arms. Results: The preschool intervention component had high fidelity (93.3%), but the home component fidelity was lower (74%). A cluster-level recruitment rate of 12% (13/112 centres) was attained, whilst the individual-level recruitment rate stood at 36% (52/143 children, mean age of 4.16 years; 23 girls). Attrition was 10%. Compliance varied with 90% for BMI, 71% for accelerometery, and 45% for questionnaires. The intervention group showed small decreases in BMI, slight increases in physical activity, and decreases in sedentary time at follow-up compared to the control group. Parents, facilitators, and assistant teachers considered the intervention to be feasible and beneficial. Conclusion: The IAAH intervention was feasible to implement in Saudi Arabian preschools. Facilitators showed high fidelity in delivering it. However, preliminary data did not demonstrate effectiveness. A more comprehensive evaluation across a broader population is warranted. The intervention could be revised to optimise recruitment, compliance, and fidelity of the home-based component. Successful elements from this pilot should be retained whilst adaptations to implementation are made to strengthen key areas.Clinical trial registration: ClinicalTrials.gov, NCT05754359.

Walking capacity and its association with quality of life among children with down syndrome in Saudi Arabia.

BACKGROUND: Walking ability, which has been connected to better health and independence, is one of the daily activities that is negatively impacted by Down syndrome. Thus, the objective of this study was to examine the walking capacity and its association with the quality of life of children who have Down syndrome compared to those who do not have Down syndrome in Saudi Arabia. METHODS: For this cross-sectional study, we recruited 68 Arabic-speaking children aged 6 to 12 using a convenience sampling method from August to November 2021. Children were divided into two groups: those who do not have Down syndrome (n = 38) and those who have Down syndrome (n = 30). Children in the Riyadh region of Saudi Arabia who do not have Down syndrome were chosen randomly from two schools. Children who have Down syndrome were selected from multiple associations and centers in the same region. A 6-minute walk test was used to measure the child's walking capacity. The Arabic version of the Pediatric Quality of Life Inventory scale was used to assess the child's or parent's perceptions of the child's quality of life and its physical, emotional, social, and school functioning domains. RESULTS: The difference in the mean 6-minute walk test scores between children who have and who do not have Down syndrome was statistically significant, with a mean difference = 105.6, 95% confidence limit = 57.2-154.0, p < .0001. The linear regression analysis after adjusting for age, height, weight, and body mass index revealed that walking capacity was found to be significantly associated with the worst score on the Pediatric Quality of Life Inventory scale (ß = -2.71, SE = 0.49, p < .0001) and its domains of physical, social, and school functioning (ß = -2.29, SE = 0.54, p < .0001; ß = -2.40, SE = 0.58; p = .001; ß = -3.71, SE = 0.56, p = .002, respectively) in children who have Down syndrome, but they had better emotional functioning than children who do not have Down syndrome. CONCLUSIONS: Children who have Down syndrome were less able to walk and were highly associated with the worst possible quality of life, which included the lowest levels of physical, social, and school functioning. Early interventions with techniques must be developed to improve the quality of life for these children.

Cross-cultural adaptation and validation of the Arabic version of oxford ankle foot questionnaire for children.

PURPOSE: The purpose of this study was to translate and cross-culturally adapt the original English version of the Oxford Ankle Foot Questionnaire (OxAFQ-c) into the Arabic language, and to evaluate its psychometric properties among Arabic speaking children aged from 5 to 16 years in Saudi Arabia. MATERIALS AND METHODS: An Arabic OxAFQ-c for children was developed according to established guidelines (ISPOR). The Arabic OxAFQ-c version was completed by eighty-seven patients with foot and ankle problems and their caregivers. Construct validity of the Arabic OxAFQ-c was also examined. RESULTS: The reliability analysis of OxAFQ-Ar exhibited good internal consistency in both children's and parent's versions for all domains (α = 0.80-0.89) and excellent test-retest reliability in both versions for all domains. (ICC = 0.87-0.94). A moderate correlation between the OxAFQ-Ar and PedsQL 4.0 was observed indicating moderate construct validity. CONCLUSIONS: The OxAFQ-c was successfully translated and cross-cultural adapted into the Arabic language. The OxAFQ-Ar is a valid, reliable and useful quality of life questionnaire for evaluating children's ankle foot problems.IMPLICATION OF REHABILITATION OF OxAFQ-c ARABIC VERSIONThe Arabic version of the OxAFQ-c is an acceptable, clear and comprehensible outcome measure.The Arabic version of the OxAFQ-c demonstrated evidence supporting its internal consistency, test-retest reliability and construct validity as a measure to evaluate foot and ankle pathologies in patients aged 5-16 years.The Arabic OxAFQ-c has very good internal consistency, test-retest reliability, and acceptable measurement error with no floor and ceiling effects.The Arabic version of the OxAFQ-c can be used in daily clinical practice and in research studies to assess children aged from 5 to 16 years in Arabic speakers with ankle-foot conditions.

The Arabic version of the ABILOCO-Kids scale is valid and reliable in children with cerebral palsy.

Background: The ABILOCO-Kids is a parent-reported outcome measure that quantifies locomotion ability and has been reported to have satisfactory measurement properties. An Arabic version of the scale is needed for Arabic-speaking population.Objective: To cross-culturally adapt the ABILOCO-Kids into Arabic and to examine its measurement properties in children with cerebral palsy.Methods: Forward and backward translations, then expert committee followed by preliminary testing were conducted to produce the Arabic ABILOCO-Kids. Structural validity of the scale as a unidimensional measure was examined using Rasch analysis. Internal consistency, test-retest reliability, and construct validity of the adapted scale were examined in children with cerebral palsy (N = 154).Results: Rasch analysis supported the structural validity of the Arabic ABILOCO-Kids after combining two items (χ2 = 18.17, p = .44). The scale had excellent internal consistency (person separation index = 0.88), excellent test-retest reliability (intraclass correlation coefficient = 0.98) but had a floor effect (24% reaching the minimum score). Eighty percent of the predefined hypotheses regarding the correlation between the Arabic ABILOCO-Kids and the Gross Motor Function Classification System (GMFCS) (r = -0.65) and the Functional Independence Measure for Children (WeeFIM) subscales (r = 0.34 to 0.70) were supported by the results.Conclusion: The Arabic ABILOCO-Kids is a unidimensional interval-level measure of walking ability in children with cerebral palsy with evidence supporting its structural validity, internal consistency, test-retest reliability and construct validity.

Associations among Body Mass Index, sedentary behavior, physical activity, and academic performance in schoolchildren.

BACKGROUND: Physical inactivity and sedentary behavior are common among middle and high school grade children. This study aimed to determine the relationship among Body Mass Index (BMI), sedentary behavior, physical activity (PA), and overall academic performance of students. METHODS: This is a cross sectional study; 357 students of mean age 12.65±1.68 years were enrolled. PA was subjectively assessed using the Physical Activity Questionnaire for Children (PAQ-C) and Godin Leisure-Time Exercise Questionnaire (GLTEQ). Sedentary behavior was assessed as hours spent on watching television, playing video games, computer use, and homework. Grade point average (GPA) was calculated to determine their overall academic performance. Participants were divided into two groups based on their GPA. Independent t-test was used to analyze BMI, sedentary time, and PA between the groups. Correlation analysis was performed to determine the associations among BMI, sedentary time, physical activity, and academic grades. RESULTS: There was no significant difference in BMI and the level of PA between the two groups. However, significant differences were observed in sedentary time (ST) spent watching television (P=0.04), total screen time (P=0.02), and total ST (P=0.002). There were weak negative correlations among BMI (r=-0.14, P<0.05), total screen time (r=-0.12, P<0.05), and academic scores; however, there was no association with any PA measures. CONCLUSIONS: A weak correlation was noted between BMI and sedentary characteristics, with respect to academic performance. As academic performance is negatively associated with body mass index and screen time, public health interventions are needed to reduce their time spent on leisure time sedentary activity, watching television, and computer use.

Cross-Cultural Variation in BMI, Sedentary Behavior, and Physical Activity in International School Girls Residing in Saudi Arabia.

BACKGROUND: The current study was done to assess the cross-cultural difference in physical activity and sedentary behavior among girls from culturally, environmentally, and geographically diverse countries residing in Saudi Arabia. METHODS: This was a comparative cross-sectional study conducted among expatriate girls (N = 275), aged 9-16 years. Participants were from India (n = 65), Pakistan (n = 88), Egypt (n = 50), Sudan (n = 49), and other nationals (n = 23). They were randomly selected from different schools in Riyadh and their Body Mass Index (BMI) and screen time was assessed. Physical activity (PA) and leisure-time activity was assessed using Physical Activity Questionnaire for Older Children (PAQ-C) and the Godin-Shephard Leisure-Time Exercise Questionnaire (GSLTPAQ) respectively. RESULTS: Out of 275, 65.8% were active and 34.2% were insufficiently active as per the GSLTPAQ, and half of them were moderately active and only 22.2% were extremely active as per PAQ-C. No statistical significant differences in their BMI status, screen time, or the levels of PA among expatriate girls. CONCLUSIONS: This study shows that the expatriate female school children in Saudi Arabia demonstrated a similar pattern in their BMI, sedentary time spent, and PA levels.

Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey.

BACKGROUND: Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia. AIM: To determine the current standard of ICU PT practice, attitude, and barriers. METHODS: A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU. RESULTS: The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n = 111, 89%) and stroke (n = 102, 82.3%) as compared to congestive heart failure (n = 20, 16.1%) and pulmonary infections (n = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n = 102, 82.2%) and positioning (n = 73, 58.8%), whereas functional electrical stimulation (n = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n = 89, 71.7%) followed by inadequate training (n = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (n = 8, 6.4%). CONCLUSION: PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.

Cross-cultural adaptation and measurement properties of the Arabic version of the ABILHAND-Kids scale.

Purpose: To cross-culturally adapt the ABILHAND-Kids into Arabic and to examine its measurement properties in children with cerebral palsy.Materials and methods: The Cross-cultural adaption of the ABILHAND-Kids into Arabic language included forward translation, backward translation, expert committee followed by preliminary testing. Structural validity using Rasch analysis, internal consistency, test-retest reliability, measurement error, and construct validity of the Arabic ABILHAND-Kids were examined in children with cerebral palsy (N = 154; 54% male, mean age 7.4 years).Results: Rasch analysis did not support the structural validity of the Arabic ABILHAND-Kids mainly due to response dependency. Removal of two items addressed the issue of the response dependency and resulted in a unidimensional scale meeting the requirement of the Rasch model. The scale had excellent internal consistency (Person Separation Index = 0.93) and excellent test-retest reliability (intraclass correlation coefficient = 0.98). The results supported 86% of the predefined hypotheses regarding correlation of the Arabic ABILHAND-Kids with the manual ability classification system, gross motor function classification system and the functional independence measure for children.Conclusion: The Arabic ABILHAND-Kids demonstrated adequate evidence supporting its structural validity as a unidimensional measure along with evidence supporting its internal consistency, test-retest reliability and construct validity as a measure of manual ability in children with cerebral palsy.Implications for rehabilitationThe Arabic ABILHAND-Kids is a reliable and valid measure of manual ability in children with cerebral palsy.The Arabic ABILHAND-Kids can be used to quantify manual ability in children with cerebral palsy in clinical practice and for research purposes.

Efficacy of transcutaneous electrical nerve stimulation combined with therapeutic exercise on hand function in children with hemiplegic cerebral palsy.

PURPOSE: Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological method used to reduce spasticity. It was also assumed that TENS reduces pain and therefore improves limb function. Most of the previous studies about the effect of TENS were done in the lower limb and in stroke patients. There is a lack of enough literature about the direct and indirect effects of TENS in the upper limb. Hence, our study aimed to determine whether TENS combined with therapeutic exercises helps to improves hand function by reducing spasticity in children with hemiplegic cerebral palsy (CP). MATERIALS AND METHODS: Twenty-nine children with hemiplegic CP were randomly assigned to the TENS group (n = 15) or the control group (n = 14). The TENS group received traditional physical therapy with the adjunct application of conventional TENS for 30 minutes (pulse duration, 250 µs; pulse rate, 100 Hz) on the wrist extensors, once daily, 3 days a week, for 8 weeks, while the control group received traditional physical therapy. RESULTS: The results showed a significant intergroup difference in handgrip strength over the 8-week period. The time to accomplish the Jebsen Taylor Hand Function Test (JTHFT) task decreased by 48% and the ABILHAND-Kids questionnaire scores improved by 23% in the TENS group. CONCLUSIONS: The use of TENS in combination with therapeutic exercise may improve strength and hand function.

Instruction prioritization in task-based balance training for individuals with idiopathic Parkinson's disease.

The objective of the study was to evaluate the effect of prioritization of instruction in balance training for individuals with Parkinson's disease (PD). Thirty-six participants were evaluated before and after the training using the Berg Balance Scale, Dynamic Gait Index, and Geriatric Depression Scale. Results show that dual task training with variable priority instruction is as effective as single task training in improving the balance performance of individuals with idiopathic PD.

Pedometer-determined physical activity levels of healthy children and children with Down's syndrome.

PURPOSE: Children with Down's syndrome (DS) are considered sedentary and less engaged in recommended physical activity (PA) levels. This study compared the PA levels between children with DS and healthy children in Saudi Arabia. METHODS: The study included 85 children divided into two groups. The DS group comprised 37 children with DS aged 8-12 years recruited from the Down Syndrome Charitable Association and Al-Nahda Schools for DS. The healthy group comprised 41 healthy children aged 8-12 years recruited from regular schools in the same region. PA levels were measured over 7 days using a pedometer. RESULTS: The healthy group was more active than the DS group (p < 0.05). The total PA steps per minute had significant differences between the DS (M = 7.979, SD = 2.21) and healthy groups (M = 17.512, SD = 3.08; p < 0.05). The daily step count differed significantly on weekdays and weekends between the groups (p < 0.05). CONCLUSIONS: The DS group had a high body mass index and physical inactivity compared with the second group. Obesity and physical inactivity among Saudi Arabian children with and without DS are major health concerns. Therefore, concerted efforts are needed to combat childhood obesity, promote PA, improve patient quality of life, and reduce the sedentary lifestyle among Saudi children and adolescents.

Effect of complete decongestive therapy and home program on health- related quality of life in post mastectomy lymphedema patients.

BACKGROUND: Secondary lymphedema is common in women treated for breast cancer. It may be a result of surgery or radiotherapy. Edema commonly affects the arm, leading to discomfort, reduced arm movements, pain and diminished quality of life. Therefore, the relationship between post mastectomy lymphedema and quality of life has evolved as an important criteria in treatment of breast cancer survivors. METHODS: Sixty breast cancer survivors who developed post mastectomy lymphedema were recruited. Patients were divided into 2 groups (n = 30) according to the treatment they received; Conventional therapy (CT) and Complete Decongestive Therapy (CDT) groups. Measurements were taken at baseline, 4 and 6 weeks. Health related Quality of Life was evaluated with the EORTC QLQ C30 and EORTC QLQ-BR23 questionnaires. Pain was measured using the Visual Analogue Scale. Descriptive statistics were used to analyze participant demographics and repeated measures of ANOVA was used for within and between group comparisons. RESULTS: Both groups showed improved quality of life and diminished pain after 6 weeks of treatment. However, greater improvement was observed in CDT group compared to the CT group. CONCLUSION: In this study, remedial exercises and home program in addition to manual lymphatic drainage and compression bandaging resulted in improved quality of life. Early identification of lymphedema and incorporation of remedial exercises and a home program improve the quality of life for breast cancer survivors. TRIAL REGISTRATION: Trial registry ID: ISRCTN13242080 , Date of registration: 7 April 2016.

Short-term sensorimotor-based intervention for handwriting performance in elementary school children.

BACKGROUND: Handwriting problems in childhood can have lifelong repercussions, affecting learning and career. Sensorimotor intervention therefore helps to alleviate these problems. METHODS: Thirty-one students (16 boys, 15 girls) underwent Minnesota Handwriting Assessment (MHA) to assess legibility, form, alignment, size, and spacing (the primary variables in this subject) as well as rate. Finally, 10 students (seven boys, three girls) aged 6-8 years (mean age, 77.1 ± 1.45 months) participated in an intervention program. Baseline MHA, Handwriting Proficiency Screening Questionnaire (HPSQ), and grip strength were measured. The same group of students acted as their own controls and were analyzed before the interventions and later after completion of the protocol. RESULTS: There was a significant improvement in MHA scores for legibility, form, alignment, size and spacing (P < 0.05), with the exception of rate. There were also significant changes in legibility, time performance and physical and emotional wellbeing domains in the HPSQ, and grip strength (P < 0.05, paired t-test). CONCLUSION: Short-term sensorimotor-based intervention produced significant improvements in the handwriting performance of elementary school children.

Impact of brisk walking and aerobics in overweight women.

[Purpose] Lack of physical activity and an uncontrolled diet cause excessive weight gain, which leads to obesity and other metabolic disorders. Studies have indicated that brisk walking and aerobics are the best methods for controlling and reducing weight and body mass composition. [Subjects and Methods] In this study, 45 overweight women were enrolled and divided into 3 groups. Women not involved in brisk walking or aerobics were included in group A (n = 15) as control subjects; women involved in brisk walking were in group B (n = 15); and those involved in aerobics were in group C (n = 15). [Results] This program was carried out 5 days/week for 10 weeks. Pre- and post-measurements of body mass index, waist and hip circumference, and skinfold thickness of the abdomen, subscapular area, biceps, and triceps were recorded for the women in all 3 groups. All values decreased in women who participated in brisk walking and aerobics for 10 weeks. [Conclusion] These results indicate that aerobics with diet therapy is a more effective intervention program for controlling and reducing body mass index and skinfold thickness than brisk walking with diet therapy in North Indian women.

Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema.

[Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compression garment, received glenohumeral mobilization, and performed deep breathing exercises, and the complete decongestive therapy group received CDT from a trained physiotherapist and a daily home program along with the conventional treatment, 5 days a week for 6 weeks. [Results] Arm circumference measurements were taken at five levels: the wrist, mid forearm, elbow, mid-upper arm, and axilla. The upper extremity function was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and pain was assessed using the visual analogue scale. Measurements were taken at baseline, and at 4th and 6th weeks after the start of intervention. Within and between group comparisons showed significant improvements in the CDT group. [Conclusion] Complete decongestive therapy and a home program assists breast cancer related lymphedema survivors in regaining their lost functions. It also helps to improve their independence in daily activities, reduce their need for caregivers, and thereby improving their quality of life. Therefore, the results of this study showed that the CDT with a home program is an effective treatment for reducing post mastectomy lymphedema.

Association of postural balance and isometric muscle strength in early- and middle-school-age boys.

OBJECTIVE: The purpose of this study was to evaluate the isometric muscle strength (IMS) and dynamic balance in early- and middle-school-age boys and to assess the strength of association between the dynamic balance scores and 6 different IMS indexes. METHODS: This is a cross-sectional study of a convenience sample of 94 boys who were 6 to 10 years of age and classified into an early school age (6-8 years) group (n = 50) and a middle school age (8-10 years) group (n = 44). Balance was tested using a Biodex Balance System. Anteroposterior Stability Index, Mediolateral Stability Index, and Overall Stability Index were recorded. IMS of 11 muscle groups was measured with a handheld dynamometer and categorized into 6 different muscle strength indices. RESULTS: The mean (SD) values of anteroposterior, mediolateral, and overall stability indexes observed for all study boys were 1.9 ± 1.0, 1.2 ± 0.7, and 2.5 ± 1.2 respectively. In the middle school age group, strong positive relationships were detected between the overall stability index and trunk, lower limb, anti-gravity, pro-gravity, and total strength indexes (r = -0.86/P < .001, r = -0.91/P < .001, r = -0.88/P < .001, r = -0.83/P < .001, and r = -0.84/P < .001 respectively), while no significant relationship was detected with the upper limb strength index (r = 0.159/P = .303). In the early school age group, moderate positive relationships were detected between the overall stability index and anti-gravity, lower limb, and total strength indexes (r = -0.404/P = .004, r = -0.356/P = .011, and r = -0.350/P = .013 respectively). CONCLUSION: Dynamic balance did not appear to be mature by the age of 10 years. Better balance skills were recorded in the mediolateral direction than in the anteroposterior direction. In the middle school age group, the overall stability index had positive relationships with almost all examined muscle strength indexes excepting the upper limb strength index.

Effectiveness of foot wedge and carrying weighted bag on loading the paretic lower limb in children with hemiparetic cerebral palsy.

AIMS: To investigate the effect of foot wedge and carrying weighted bag on loading the paretic lower limb in children with hemiparetic CP. DESIGN: Cross-sectional study. PARTICIPANTS: A convenient sample of 18 ambulant children with spastic hemiparetic CP was evaluated. Fifteen matched normal children acted as a control group. METHODS: Using two calibrated scales, measurements of weight supported on each lower limb were obtained under four different standing conditions. RESULTS: During quiet standing, the percentage of weight supported on the paretic limb was 35.59% with symmetry index equals 0.57. Standing with the non-paretic foot is placed on a lateral foot wedge, was the best condition that increased the percentage of weight supported on the paretic limb to 47.18% and improved the symmetry index to 0.90. Non-significant improvement of symmetry index 0.61 was recorded when carrying a weighted bag with the paretic hand, but carrying with the non-paretic hand unnecessarily loads the non-paretic limb and further decreases the symmetry index to 0.49. CONCLUSIONS: Using a lateral foot wedge beneath the non-paretic foot and carrying a weighted bag with the paretic hand improve the loading function of the paretic limb and relief the non-paretic limb from overloading.

Plantarflexor muscle and spatiotemporal gait characteristics of children with hemiplegic cerebral palsy: an observational study.

OBJECTIVE: The study investigated associations between the active and passive mechanical properties of the calf muscle in children with cerebral palsy and the spatiotemporal features of their gait on both level ground and over stairs. METHODS: 26 children with hemiplegic cerebral palsy (age 4 - 10 years) walked barefoot across a level ten metre pathway and a staircase. Walking speed, stride length and cadence were calculated and spasticity, maximum isometric strength, stiffness and hysteresis of the affected side calf muscle measured. Multiple linear regression was used to determine the associations among variables. RESULTS: Walking speed and stride length were significantly associated with dorsiflexor muscle strength and the stiffness of the calf muscle, while stair ascent and descent speeds were significantly and inversely related to the amount of hysteresis displayed by the calf muscle. CONCLUSION: Passive mechanical properties of the calf muscle are influential in gait performance in these children.

No change in calf muscle passive stiffness after botulinum toxin injection in children with cerebral palsy.

AIM: Stiffness and shortening of the calf muscle due to neural or mechanical factors can profoundly affect motor function. The aim of this study was to investigate non-neurally mediated calf-muscle tightness in children with cerebral palsy (CP) before and after botulinum toxin type A (BoNT-A) injection. METHOD: Sixteen children with spastic CP (seven females, nine males; eight at Gross Motor Function Classification System level I, eight at level II; age range 4-10 y) and calf muscle spasticity were tested before and during the pharmaceutically active phase after injection of BoNT-A. Measures of passive muscle compliance and viscoelastic responses, hysteresis, and the gradient of the torque-angle curve were computed and compared before and after injection. RESULTS: Although there was a slight, but significant increase in ankle range of motion after BoNT-A injection and a small, significant decrease in the torque required to achieve plantigrade and 5° of dorsiflexion, no significant difference in myotendinous stiffness or hysteresis were detected after BoNT-A injection. INTERPRETATION: Despite any effect on neurally mediated responses, the compliance of the calf muscle was not changed and the muscle continued to offer significant resistance to passive motion of the ankle. These findings suggest that additional treatment approaches are required to supplement the effects of BoNT-A injections when managing children with calf muscle spasticity.

Evaluation of spasticity in children with cerebral palsy using Ashworth and Tardieu Scales compared with laboratory measures.

The content validity of the Tardieu Scale and the Ashworth Scale was assessed in 27 independently ambulant children with cerebral palsy (gender: 17 males, 10 females; age: 5-9 years; Gross Motor Function Classification: level I and II). Ashworth and Tardieu Scale scores and laboratory measures of spasticity and contracture were collected from the plantarflexor muscles by 2 examiners who were blinded to the results. The Tardieu Scale was more effective than the Ashworth Scale in identifying the presence of spasticity (88.9%, kappa = 0.73; P = .000), the presence of contracture (77.8%, kappa = 0.503; P = .008) and the severity of contracture (r = 0.49; P = .009). However, neither scale was able to identify the severity of spasticity. The Tardieu Scale can provide useful information in children with cerebral palsy because it differentiates spasticity from contracture. However, a more comprehensive clinical method of testing neural and non-neural contributions to impairments and function is needed.