Bimanual Movement Characteristics and Real-World Performance Following Hand-Arm Bimanual Intensive Therapy in Children with Unilateral Cerebral Palsy.

The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand-arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using standardized hand function tests. We found that accelerometer variables increased significantly during HABIT, indicating increased bimanual symmetry and intensity. Post-HABIT, children demonstrated significant improvements in all accelerometer metrics, reflecting real-world performance gains. Children also achieved significant and clinically relevant changes in hand capacity following HABIT. Therefore, our findings suggest that accelerometers can objectively quantify bimanual movement intensity during HABIT. Moreover, HABIT enhances hand function as well as activities and participation in real-world situations in children with UCP.

Associations of Percent Body Fat and Motor Skill Development in Preschool-Aged Children: National Youth Fitness Survey.

Background: Body composition and motor skill development are important for the engagement in physical activity and healthy development of children. This study examined the associations between body composition and motor skill development in 3- to 5-year-old children. Methods: Data from preschool-aged children (N = 342, 51% males) who participated in the 2012 National Youth Fitness Survey were analyzed. Skinfold measurements (subscapular, calf, and triceps) were taken and percent body fat (%BF) was calculated using sex-specific equations. Lean muscle mass and fat mass were also calculated. Motor skill development was determined by the Test of Gross Motor Development-2nd Edition. Regression analyses were performed to determine the associations among %BF and locomotor skills, object control skills, and overall gross motor quotient (GMQ), controlling for sex, race, and poverty index ratio. Results: Most children were classified as with underweight/healthy weight (69%) and 31% were either with overweight or obesity. Average %BF was 17.02% ± 0.27%. The standard scores for locomotor skills, object control skills, and GMQ were 9.99 ± 0.16, 8.52 ± 0.14, and 95.57 ± 0.68, respectively. These scores were considered average. Regression analyses indicated that neither the %BF nor sum of skinfolds was associated with locomotor skills (ß = -0.07 ± 0.05, p = 0.63; ß = -0.03 ± 0.03, p = 0.22), object control skills (ß = 0.03 ± 0.04, p = 0.55; ß = 0.00 ± 0.02, p = 0.87), or GMQ (ß = -0.13 ± 0.28, p = 0.63; ß = -0.09 ± 0.14, p = 0.52). Furthermore, neither lean muscle mass nor fat mass was related with any motor skill measure (p > 0.05). Conclusions: Using different measures of body composition may provide additional insight into associations between obesity and motor skill development in preschool-aged children. Given the inconsistent findings in the literature, additional research is needed to elucidate these associations.

Physical activity types and motor skills in 3-5-year old children: National Youth Fitness Survey.

OBJECTIVE: This study examined relationships between specific types of physical activity (PA) and motor skill development in preschool-aged children. DESIGN: This study was completed using a cross-sectional study design. METHODS: Data from children 3-5years old (N=342, 51% males) who participated in the 2012 National Youth Fitness Survey were analyzed. PA was measured using a questionnaire by parent report and motor skill development determined by Test of Gross Motor Development-2nd Edition (TGMD-2). Multiple regression analyses were conducted to examine the relationship between PA type and overall Gross Motor Quotient (GMQ) controlling for age, sex, race, and parental socioeconomic status. RESULTS: Commonly reported activities were running (43%), playing outdoor games (35%), and riding a bike (34%). Based on the standard scores, participants' motor skill development for Locomotor, Object Control, and overall GMQ were considered average. Participation in the following physical activities were positively associated with GMQ: riding a bike (ß (SE)=5.27 (2.02), p=0.02), scooter riding (ß (SE)=9.83 (2.59), p=0.002), swimming (ß (SE)=4.01 (1.17), p=0.004), and jumping on a trampoline (ß (SE)=7.45 (3.09), p=0.03). With the exception of riding a bike, the physical activities positively related to GMQ had a reported range of participation between 7-12%. CONCLUSIONS: Participation in specific physical activities was related to higher GMQ in preschool-aged children. Also, with the exception of riding a bike, the activities that the children participated in the most were not the same as the activities that were positively related to motor skill development.

Effects of Aerobic Exercise during Pregnancy on 1-Month Infant Neuromotor Skills.

PURPOSE: To determine the effects of exercise during pregnancy on the neuromotor development of 1-month-old offspring. We hypothesized that aerobic exercise during pregnancy would be associated with higher neuromotor scores in infants at 1 month of age, based on standard pediatric assessment of neuromotor skills. METHODS: Seventy-one healthy, pregnant women between 18 and 35 yr were randomly assigned to either aerobic exercise intervention or no exercise (control) group. Women in the exercise group performed 50 min of moderate-intensity, supervised aerobic exercise, three times per week; those in control group maintained usual activity. Neuromotor skills were measured at 1 month of age using the Peabody Developmental Motor Scales, 2nd Edition (PDMS-2). Unpaired t-tests were used to compare infants' PDMS-2 subtest percentiles, Gross Motor Quotients, and Gross Motor Quotient percentile between groups. RESULTS: Infants of women in the exercise group had higher PDMS-2 scores on four of the five variables analyzed relative to infants of nonexercisers. Female infants tended to have improved scores relative to male infants of controls; this difference was attenuated in infants of exercisers. CONCLUSIONS: Exercise during pregnancy can positively influence developing systems allowing for improved neuromotor development, thus leading to infants who are more adept at movement, and presumably more likely to be active. Because physical activity is a modifiable risk factor of childhood obesity, these findings suggest that exercise during pregnancy may potentially reduce childhood risk of obesity.

Influence of aerobic exercise on maternal lipid levels and offspring morphometrics.

BACKGROUND: Maternal BMI, lipid levels (cholesterol, triglyceride, LDL, HDL), and exercise amount are interrelated and each influence offspring body size. This study proposed to determine the influence of exercise on maternal lipid levels and infant body size. METHODS: We had 36 participants complete these measures. Participants in the aerobic exercise intervention (n = 14) completed three 50-min sessions weekly from 16 weeks gestation to delivery and were compared with a non-exercise control group (n = 22). Maternal lipid profiles were assessed at 16 and at 36 weeks gestation. Fetal body size was measured at 36 weeks gestational age using ultrasound assessment. Neonatal body size measures were acquired from birth records. Statistical analysis included two-sample t-tests, correlations, and regression models. RESULTS: Participants were similar in age, pre-pregnancy BMI, gravida, parity, education, and gestational weight gain (GWG). There were no differences in gestational age, Apgar scores at 1 and 5 min for infants of exercisers relative to controls. Exercisers had higher pre-training triglycerides (p = 0.004) and pregnancy change in triglycerides (p = 0.049) compared to controls. Head circumference was significantly larger in exercise exposed infants relative to infants of controls. Pregnancy METs had a positive relationship with birth length (r = .445, p = .006) and birth weight (r = .391, p = .02). GWG had a moderate, positive relationship with fetal abdominal circumference (r = .570, p = .004). Regression analysis indicated 5 predictors explained 61.7% of the variance in birth weight (Adj.R2 = 0.469, F(5,13) = 5,13, p = 0.02); it was found that pregnancy METs (ß = .724, p = .007), 36 week cholesterol (ß = 1.066, p = .02), and 36 week LDL (ß = -1.267, p = .006) significantly predict birth weight. Regression analysis indicated 4 predictors explained 43.8% of the variance in birth length (Adj.R2 = 0.306, F(4,17) = 3.32, p = 0.04); it was found that pregnancy METs (ß = .530, p = .03), and 36 week LDL (ß = -.891, p = .049) significantly predict birth length. CONCLUSION: The primary association and predictors of infant body size was related to pregnancy exercise and late pregnancy cholesterol and LDL levels. Considering these relationships, it is essential that women maintain aerobic exercise during pregnancy, but should also be cognizant of lipid levels during their pregnancy. Therefore intervention during pregnancy focused on infant body size should involve exercise and and quality nutritional intake foods during pregnancy.

Body Weight Support Treadmill Training for Children With Developmental Delay Who Are Ambulatory.

PURPOSE: To examine the effect of body weight-supported treadmill training (BWSTT) on gait and gross motor skill development in children (2-5 years old) with developmental delay who are ambulatory. METHODS: Twenty-four subjects (12 control and 12 BWSTT) were enrolled in this randomized control trial. All subjects continued to receive physical therapy. Subjects were tested at baseline, 4 weeks, 6 weeks, and at 6 weeks after completion of BWSTT. Outcomes were assessed using the 10-m walk test and Gross Motor Function Measure-D and E. RESULTS: Significant improvements were seen in gait velocity and gross motor skill attainment. With positive interactions in both the 10-m walk test and Gross Motor Function Measure-E, the BWSTT group as compared with the control group demonstrated functional gains in gait velocity and gross motor skills, P = .033 and .017, respectively. CONCLUSIONS: A 6-week high-intensity BWSTT program can improve gait velocity and influence functional gains.

Camp-based immersion treatment for obese, low socioeconomic status, multi-ethnic adolescents.

BACKGROUND: Immersion treatment (IT) provided in a camp setting has been shown to promote short-term improvements in weight and health status in obese adolescents. However, evidence of IT's long-term efficacy and efficacy for multi-ethnic and lower socioeconomic status (SES) adolescents is limited. METHODS: This was a cohort study with a pre/post design and longitudinal follow-up. The intervention was a 19-day camp-based IT program comprising (1) a nutrition curriculum and ad-lib access to a nutritious diet, (2) several hours of physical activity daily, (3) group therapy, and (4) cognitive-behavioral therapy (CBT). This analysis included 52 low-SES adolescents that participated in 2009 and 2010. A subgroup of 33 campers and their families was offered follow-up monthly for 10 months. Primary outcome measures were change in weight-related parameters immediately postcamp and after 10 months of follow-up. RESULTS: Campers had significant short-term improvements in mean waist circumference (mean [M], 2.6; standard deviation [SD], 3.2 cm), weight (M, 2.6; SD, 1.9 kg), BMI (M, 1.1; SD, 0.9 kg/m2), BMI z-score (M, 0.06; SD, 0.07), and percent overweight (M, 6.1; SD, 4.7). Campers offered follow-up had a modest increase in mean percent overweight (M, 2.0; SD, 8.4) during 10 months of follow-up. However, 33% experienced continuing decline in percent overweight during follow-up, and long-term follow-up was associated with significant overall (precamp vs. end of follow-up) improvements in percent overweight (M, 4.9; SD, 7.2). CONCLUSIONS: Camp-based IT with CBT is a promising intervention for improving short- and long-term weight status of low-SES adolescents. Additional research is needed to increase long-term efficacy.

Frontal and sagittal plane biomechanics during drop jump landing in boys who are obese.

PURPOSE: To investigate the frontal and sagittal plane lower extremity biomechanics during drop jump landings in boys who were obese and boys who were of healthy weight. METHODS: Twelve boys participated, 6 were considered as healthy weight (body mass index for age <85%, age 11.0 +/- 0.8 years), and 6 were considered as obese (body mass index for age >95%, age 12.1 +/- 0.7 years). Three-dimensional data were collected during landing from a drop jump. Group means were compared using Student t tests (alpha = 0.05). RESULTS: Significant differences were found in peak hip adduction moment, timing of peak dorsiflexion and knee flexion angles, and timing of peak knee extension and abduction moments. CONCLUSIONS: Boys who were obese exhibited significant differences in frontal and sagittal plane biomechanics when landing from a jump compared with healthy weight peers. These differences could place boys who are obese at greater risk for lower extremity injuries when they engage in jump-landing activities.

Effects of prolonged standing on gait in children with spastic cerebral palsy.

The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0-9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period. During phase A, the children received their usual physical therapy treatment. During phase B, children received the prolonged standing program three times per week, in addition to their usual physical therapy treatment. During phase A2, children received their usual physical therapy treatment. Gait analysis and clinical assessment of spasticity were performed before and after each phase. Analysis of variance (ANOVA) for repeated measurements was used to test for changes in gait measures across the four measurement sessions. Friedman's was used to test for changes in muscle tone (Modified Ashworth Scale) across the four measurement sessions. Stride length (p <.001), gait speed (p <.001), stride time (p <.001), stance phase time (p <.001), double support time (p <.003), muscle tone (p <.02), and peak dorsiflexion angle during midstance (p <.004) improved significantly following the intervention phase. The results of this study demonstrate that the gait pattern of children with cerebral palsy classified as level II or III on the Gross Motor Functional Classification System (GMFCS) improved by a prolonged standing program. However, these improvements were not maintained at 3 weeks. Further research is necessary with larger sample sizes to replicate these findings and determine specific "dosing" for standing programs to create long-lasting functional effects on gait.

Frontal plane lower extremity biomechanics during walking in boys who are overweight versus healthy weight.

PURPOSE: To compare frontal plane lower extremity biomechanics during walking in adolescent boys who were overweight (OW) versus healthy weight (HW). METHODS: Fourteen boys (7 considered HW, body mass index for age <85th percentile; age 10.8 +/- 0.7 years; 7 considered OW, body mass index for age >95th percentile; age 12.0 +/- 0.7 years) participated. Three-dimensional kinematic data were collected during walking at self-selected speeds. Group means were compared using Student's t tests (alpha = 0.05). RESULTS: Significant differences were found in timing of rearfoot motions and moments, amplitude of knee motion peaks, timing of knee moment peaks, and timing and amplitudes of peak hip motion and moments. CONCLUSION: Boys who were OW collapsed into hip adduction and knee valgus during stance and attempted to compensate with rearfoot inversion. Observed differences in frontal plane kinematics during walking suggest that boys who are OW have increased risk of lower extremity musculoskeletal injuries and dysfunction.