Impact of Idiopathic Scoliosis on the Cardiopulmonary Capacity of Adolescents.

Chest deformities in children with scoliosis may result in cardiopulmonary disorders, lowering cardiopulmonary capacity levels. However, results regarding the dependence of cardiopulmonary capacity on the severity level of scoliosis remain controversial. We aimed to use dynamic cardiopulmonary exercise testing (CPET) to investigate exercise capacity in reference to spinal deformity in patients with mild or moderate idiopathic scoliosis by means of multivariate analyses. Methods: We included 92 children and adolescents aged 10-17 years with mild and moderate idiopathic scoliosis and 94 healthy peers. The study consisted of three parts: (1) medical record analyses; (2) anthropometric measurements; and (3) CPET. Results: Our results revealed that the mean VO2peak and VO2peak/kg values of the participants with scoliosis were 0.27 L/min and 0.37 mL/min/kg lower than their healthy peers, respectively, regardless of age and gender. Furthermore, the occurrence of scoliosis correlates with a mean decrease in minute ventilation volume by 10.10 L/min, tidal volume by 0.11 L, breathing frequency by 3.78 bpm, and breathing reserve by 14.34%, regardless of the age and gender of the participants. Children and adolescents with mild-to-moderate scoliosis during CPET exhibit a lower ventilation capacity and lower VO2 max than healthy adolescents matched in age but their cardiorespiratory fitness parameters do not depend on the Cobb angle value and the angle rotation of the primary spinal curvature. Conclusions: Physical therapy and activity should be recommended to prevent cardiorespiratory failure in later life in patients with scoliosis. This study may also provide CPET reference values for healthy children and adolescents with scoliosis.

The Effect of the Direction of Primary Lateral Spinal Curvature on Postural Stability in Children with Scoliosis.

Background: The purpose of the present study was to determine the impact of the direction and magnitude of primary lateral spinal curvature in children with scoliosis. Methods: Ninety-six children diagnosed with scoliosis were included in the study group, and fifty healthy peers were included in the control group. Posturographic measurements of body weight distribution and posturometric tests with eyes open and closed were performed. Results: Based on the symmetry index values, the study group was divided into children with symmetrical and asymmetrical body weight distributions on the basis of support. Then, taking into account the direction of the primary curvature, children with asymmetrical body weight distributions were divided into: (1) children with left-sided or right-sided scoliosis with overload on the same side of the body; and (2) children with left-sided or right-sided scoliosis with overload on the opposite side of the body. According to both posturometric tests, increased CoP spatial displacement was observed in the children with scoliosis compared to the healthy controls. The obtained results showed that increased asymmetry index and Cobb angle values significantly increase medial-lateral postural instability in children with scoliosis. Conclusions: These findings suggest that treatment to restore symmetric body weight distribution may prevent the progression of postural instability; however, this requires confirmation through further investigation.

Body Composition in Outpatient Children with Cerebral Palsy: A Case-Control Study.

Purpose: The purpose of this study was to identify quantitative (BMI z-score and BMI percentile) and qualitative (BC) differences between high functioning outpatient children with CP (GMFCS levels I/II) vs TD children, using BIA. We hypothesized that: 1) BMI z-score and BMI percentile will be lower in children with CP compared with their TD peers; and 2) body components (BC) directly associated with muscle mass (including fat free mass (FFM%) and skeletal muscle mass (SMM) and predicted muscle mass (PMM)) in children with CP will be lower than in their TD peers. Patients and Methods: Ninety children with CP (GMFCS levels I/II) aged 8-16 years were enrolled in this study. Due to the fact that there is lack of normative values of particular body components in the pediatric population, ninety typically developing (TD) peers were used as references. The examination consisted of two parts: 1) the height measurement and 2) body composition assessments, both using the bioelectric impedance analysis (BIA). Results: Average values for height, weight, BMI z-score, and BMI percentile in children with CP were significantly statistically lower than in the reference group. BC's directly associated with muscle mass (including FFM%, SMM, and PMM) in children with CP were lower than those in their TD peers. Conclusion: Altered body compositions were evident in children with CP.

Body Composition and Spasticity in Children with Unilateral Cerebral Palsy-A Case-Control Study.

The aim of this study was to identify the correlations between segmental body composition and the spasticity level of the affected lower limb in children with unilateral cerebral palsy (spastic hemiplegia). Additionally, an attempt was made to identify the differences in composition between the affected and unaffected lower limbs using segmental body composition analysis. This case-control study included 31 children with spastic hemiplegia aged 8 to 16 years with differing severities of spasticity in the lower limbs. The reference group consisted of a control group which included 31 peers with corresponding age and sex to the tested group. Negative correlations obtained in the statistical analysis showed that higher spasticity level in the iliopsoas muscle is associated with lower limb fat-free mass and lower limb muscle mass. Our results showed that children with spastic hemiplegia have worse parameters of body composition in the affected limb than in the unaffected one. To confirm the importance of these results, further studies are needed in a larger population which includes non-ambulatory children.

Effects of Whole-Body Vibration Training on Lower Limb Blood Flow in Children with Myelomeningocele-A Randomized Trial.

The objective of the present study was to determine the effectiveness of a three-week Whole-Body Vibration (WBV) training on the vascular blood flow of the lower limbs in children with myelomeningocele. The secondary goal was to evaluate the effect of WBV on the ROM of lower limb joints in this population. A total of 30 children with MMC (7-16 years old) were enrolled in the study. Children were randomly allocated to two groups of equal numbers, using an envelope code. The experimental group underwent a 3-week WBV training, while the control group received a 3-week conventional physiotherapy (PT) program. The examination consisted of two parts: (1) Doppler USG examination of the lower limb vascular blood flow; (2) evaluation of ROM. The results obtained revealed three main findings. First, WBV training effectively improved blood flow by increasing flow velocities in all tested arteries, while the impact of the PT program was limited to a single parameter. Second, WBV training effectively improved vascular resistance in arteries of the lower legs, while the PT program did not achieve any significant differences. Third, both types of treatment intervention significantly improved ROM in all joints of the lower limbs in MMC participants.

Cardiopulmonary Capacity in Overweight and Obese Children and Adolescents: A Cross-Sectional Study.

Background: One of the objective methods of assessing the level of cardiopulmonary capacity in overweight and obese children and adolescents is cardiopulmonary exercise testing (CPET). Aims: The purpose of present study is an evaluation of aerobic capacity in high body mass index (BMI) children and adolescents by comparing them with a normal weight control group by CPET. Methods and Procedures: The subjects were recruited from participants of the Program of Treatment for Overweight and Obese Children organized by a local pediatric rehabilitation center in Poland. Based on BMI for age and gender, two validation groups were selected: (1) a group of overweight children (n = 49) and (2) a group of obese children (n = 48). The study included also 53 normal weight participants as a reference group (REF). The study consisted of two parts: anthropometric measurements and CPET. The Godfrey protocol for CPET was applied. Outcomes and Results: In this study, obese children and adolescents showed similar absolute VO2peak values in liters per minute (1.64 L/min) compared to overweight children (1.48 L/min), but significantly higher than children with normal body weight (1.39 L/min). The obese children and adolescents presented lower VO2peak in relation to body weight (25.44 ml/kg/min) compared to their peers with normal body weight (36.5 ml/kg/min), and overweight children (29.18 ml/kg/min). Conclusion and Implications: The main finding of our study was recognition of significant differences between cardiopulmonary capacity parameters in obese children in comparison not only to normal weight peers, but to overweight, too.

Effects of Whole-Body Vibration-Assisted Training on Lower Limb Blood Flow in Children With Myelomeningocele.

This study investigated the effectiveness of whole-body vibration (WBV) training incorporated into a conventional physiotherapy (PT) program (WBV-assisted training) in improving blood flow in the lower limbs and range of motion in the lower limb joints of children with myelomeningocele (MMC). A total of 31 children with MMC (7-15 years old) underwent a 6 weeks treatment program consisting of 2 weeks of conventional PT followed by 4 weeks of WBV-assisted training. The assessment comprised two parts: evaluation of lower limb joint range of motion and Doppler ultrasonography of the superficial femoral, popliteal, and anterior tibial arteries and was performed three times for each of the participants (at baseline, after 10 sessions of PT but before WBV-assisted training, and after 20 sessions of WBV-assisted training). Our results showed that WBV-assisted training significantly improved lower limb circulation in patients with MMC, increasing velocity and reducing resistivity in all tested arteries. Moreover, WBV-assisted training alleviated lower-extremity contractures, especially of the knee. Thus, WBV-assisted training is effective as an adjunctive rehabilitation program for improving functional mobility in children with MMC.

Canonical correlation between body-posture deviations and gait disorders in children with cerebral palsy.

Children with Cerebral Palsy (CP) show the postural constraints while standing, and gait disorders, resulting from both primary and secondary impairments of brain injury. In our previous studies, several characteristic postural and gait patterns in children with unilateral as well as with bilateral CP were defined, and the relationship between these patterns was demonstrated. The purpose of present study was to identify which features of body posture deviation during standing were strongly related to gait deviations in independently ambulatory children with CP. For this aim we explored the cross-relationship between features of body posture while standing examined by surface topography and the selected gait parameters from three-dimensional instrumented gait analysis in one hundred twenty children with cerebral palsy, aged between 7 and 13 years, who were able to walk independently. First, our study documented that that sagittal misalignment of the spine curvature was significantly related to kinematic deviations such as deviations of pelvic tilt, inadequate swing phase and knee flexion, and peak dorsiflexion in stance. Second, the study shows that the static asymmetry of pelvis and trunk was significantly associated with kinematic deviations during gait cycle such as pelvic rotation, hip abduction in swing, ROM of knee flexion, peak dorsiflexion in stance. Based on obtained results and referring to our previous findings it can be assumed that the first model of the relationship between postural deviation and gait disturbances, called 'postural and gait complex of disorders in sagittal plane', is related to children with bilateral CP, whereas the second model 'postural and gait complex of disorders in coronal plane' to children with unilateral CP. The clinical applications of this study relate to the early recognition of particular features of postural deviation using surface topography, instead of more difficult and demanding expensive tools 3-D gait analysis.

[Influence of toxin botulin on walk stereotype of children with juvenile cerebral palsy. The functional examination performed by BTS, comprehensive movement analysis system. A preliminary report]. / Wplyw toksyny botulinowej na stereotyp chodu dzieci z mózgowym porazeniem dzieciecym. Analiza funkcjonalna z wykorzystaniem systemu do kompleksowej oceny chodu - BTS. Doniesienie wstepne.

INTRODUCTION: Juvenile Cerebral Palsy--is caused by damage of the motor control centers of the developing brain (cerebral refers to the cerebrum, which is the affected area of the brain, although the disorder probably involves connections between the cortex and other parts of the brain and palsy refers to disorder of movement). The clinical symptoms of juvenile cerebral palsy are very diversified and include gross and fine motor-coordination disorders, manual ability, locomotion, perception and response, speech, psychomotor retardation, emotional disorders. The primary therapeutic problem in children with cerebral palsy is learning to move in a lower position and learning to walk. The aim of this research is evaluation the action of the botulinum toxin on gait pattern of children with cerebral palsy. Application of a comprehensive BTS analysis of gait will get accurate, consistent EBM (Evidence Base Medicine) results. MATERIAL AND METHODS: The children with pyramidal syndrome of juvenile cerebral palsy have been included in the examinations. The children have been divided into 2 random groups: group I--children treated with standard therapy a neurodevelopmental rehabilitation and classic kinesiotherapy, group II--hildren treated with standard therapy --eurodevelopmental rehabilitation, classic kinesiotherapy and a botulinum toxin. The children were examined three times: before the therapy, after 6 weeks of treatment and after 3 months of treatment. In the research BTS comprehensive motion analysis system have been used where influence of toxin botulin on walk stereotype of children was assessed. RESULTS: The treatment connected with standard rehabilitation and using botulinum toxin brings quicker walk improvement. Comparing the above treatment methods of influence on the walk stereotype of children with juvenile cerebral palsy, we can confirm, that standard treatment brings regular improvement, still, it requires longer period of time, often even 3 months. Using botulinum toxin brings quicker walk improvement, after 6 weeks only, which is a clear, but short-term result. CONCLUSIONS: Botulinum toxin has a positive effect on gait parameters in children, especially until 3 months, after this time parameters are not better..Concomitant treatment with standard therapy and botulinum toxin should be used becouse it is possitive treatment for locomotion of children with cerebral palsy.

[Analgesic efficacy of magnetoledotherapy in patients with low back pain syndromes]. / Ocena skutecznosci przeciwbólowej magnetoledoterapii u chorych z zespolami bólowymi kregoslupa ledzwiowo-krzyzowego.

INTRODUCTION: Low back pain syndromes most often occur due to overloading of the musculoskeletal system. The cause is a frequent, improper lifting of heavy objects, most commonly by those working physically, with repetitive movements of bending and straightening of the trunk (turning and bending with load). This problem affects not only adults but also children and adolescents. There is a growing interest in new forms of analgesic therapy nowadays, especially in those that exhibit synergistic therapeutic effects. The aim of this work is to evaluate the analgesic efficacy of magnetoledotherapy in patients with lumbar--sacrum spinal pain syndromes caused by joints degenerative changes. MATERIAL AND METHODS: The examination was carried out in 66 patients of both sexes aged 30 to 76 (average 54.7 +/- 13.8) with low back pain syndrome caused by spinal degenerative changes. The patients were divided into three groups according to the applied analgesic therapy (magnetoledotherapy, magnetostimulation, TENS currents). Level of pain has been evaluated four times in all patients--before the start of therapy and after 5, 10 and 15 applications with the use of the modified Laitinen Questionnaire and Visual-Analoque Scale (VAS). RESULTS: Post therapy levels of pain in the studied patients decreased significantly. According to Laitinen questionnaire, the greatest improvement was observed in the group treated with magnetoledotherapy and TENS currents and the smallest improvement was observed in the group treated with magnetostimulation. CONCLUSIONS: 1. Magnetoledotherapy shows significant analgesic efficacy in patients with low back pain syndrome and shows no side effects. 2. Concurrent application of both the infrared radiation generated by LED's and magnetostimulation synergistically reinforces analgesic effect in patients with low back pain syndrome, especially in level of pain and frequency of its occurrence, which results in the increase of movement activity and decrease in administration of analgesics.