Accommodating variable-resistance exercise enhance weight-bearing/gait symmetry and balance capability in children with hemiparetic cerebral palsy: a parallel-group, single-blinded randomized clinical trial.

BACKGROUND: Children with hemiparetic cerebral palsy (HCP) tend preferentially to bear their body weight on the non-paretic side, which leads to the emergence of asymmetrical walking patterns and limited ability to maintain balance. Therefore, improved and clearly effective intervention strategies to remedy these impairments are needed. AIM: This study endeavored to evaluate the efficacy of an accommodating variable-resistance exercise (AVr-Ex) program on weight-bearing symmetry, gait symmetry, and dynamic balance in children with HCP. DESIGN: This study employed a parallel-group, single-blinded randomized controlled design. SETTINGS: Physical Therapy Outpatient Clinic and University Hospital, and a tertiary referral hospital. POPULATION: Thirty-six children with HCP aged between eight and 16 years were assigned randomly to the AVr-Ex group (N.=18) or control group (N.=18). METHODS: Children in the AVr-Ex group undergone an AVr-Ex program, three sessions/week over eight consecutive weeks, besides the usual physical therapy while children in the Control group received the usual physical therapy alone. Outcome measures were evaluated before and after intervention and included weight-bearing symmetry indices [rearfoot (RF-WbSI), and forefoot (FF-WbSI)], gait symmetry indices (spatial [GSIspatial], and temporal [GSItemporal]), and dynamic balance. RESULTS: The post-treatment RF-WbSI (P<0.001; ηp2=0.41), GSIspatial (P<0.001; ηp2=0.42), GSItemporal (P<0.001; ηp2=0.52), and dynamic balance variables (all P<0.05; ηp2 ranged from 0.21 to 0.51) improved significantly in the AVr-Ex group compared to the control group, when controlled for the pre-treatment scores. CONCLUSIONS: This study suggests that AVr-Ex can improve weight-bearing symmetry, gait symmetry, and dynamic balance in children with HCP when incorporated into the usual physical rehabilitation program. CLINICAL REHABILITATION IMPACT: AVr-Ex is likely an effective training paradigm to address weight-bearing/gait asymmetry and balance issues in children with HCP, which provides the basis for its incorporation in rehabilitation programs for such a patient population.

Differential Effects of Extracorporeal Shockwave Therapy and Botulinum Toxin-A Injection on Postburn Contractures and Gait Kinematics in Burn Children.

Postburn contracture is a complex and multifactorial problem that requires intensive inputs from the burn care staff. This study endeavored to evaluate the effectiveness of extracorporeal shockwave therapy and botulinum toxin-A for treating the postburn plantar flexion contracture and optimizing ankle kinematics in burn children. Thirty-eight children with burns and plantar flexion contracture were randomized to receive the standard physical rehabilitation program (control group; n = 13), unfocused extracorporeal shockwave therapy (0.2 mJ/mm2) once a week over four consecutive weeks in addition to the standard physical rehabilitation (n = 12), or botulinum toxin-A injection (0.5-2 U/kg/muscle group with maximum dose of 12 U/kg/body weight) once at entry besides the standard physical rehabilitation (n = 13). Dorsiflexion active range of motion and ankle kinematics were measured before and immediately after treatment. The posttreatment dorsiflexion active range of motion increased significantly in the extracorporeal shockwave therapy group (P = .025) and botulinum toxin-A group (P = .04) when compared to the control group. Likewise, the initial stance-dorsiflexion, stance-maximum dorsiflexion, and swing-peak dorsiflexion angle improved significantly in the extracorporeal shockwave therapy group (P ˂ .001, P = .005, and P = .002, respectively) and botulinum toxin-A group (P = .004, P = .012, and P ˂ .001, respectively) compared to the control group. No significant differences were observed between the extracorporeal shockwave therapy and botulinum toxin-A groups with respect to any of the measured variables. To conclude, extracorporeal shockwave therapy and botulinum toxin-A injection could be effectively used to treat postburn plantar flexion contracture and to optimize the ankle kinematics during walking in children, without preference for either of them.

Effects of Combined Resistive Underwater Exercises and Interferential Current Therapy in Patients with Juvenile Idiopathic Arthritis: A Randomized Controlled Trial.

OBJECTIVE: The objective of this study was to verify the effects of combined resistive underwater exercises and interferential current on the peak torque of the quadriceps and hamstrings and pain levels in patients with juvenile idiopathic arthritis. DESIGN: This is a randomized controlled study; 30 children with polyarticular juvenile idiopathic arthritis were randomly distributed into two groups: the control group (n = 15) received the traditional physical therapy program and the study group (n = 15) received resistive underwater exercises and interferential current therapy. Peak torque of the quadriceps and hamstrings and pain levels were evaluated before treatment, 1 mo later, and after 3 mos using the HUMAC NORM, CSMI Testing and Rehabilitation Isokinetic System and visual analog scale, respectively. RESULTS: In the control group, all measures showed significant differences (P < 0.05) after 1 mo except peak torque of left quadriceps and pain levels, and significant differences were found after 3 mos (P < 0.05) in all. In the study group, all measures showed significant differences after 1 and 3 mos (P < 0.05) and there were significant differences between groups after 1 and 3 mos in favor of the study group (P < 0.05). CONCLUSION: The combination of resistive underwater exercises and interferential current therapy is a potentially valuable treatment for patients with juvenile idiopathic arthritis.