Pandemic decrease of in-person physiotherapy as a factor in parent perceived decline in function in children with neuromuscular disorders.

PURPOSE: Restrictions related to the COVID-19 pandemic can negatively affect patients who require physiotherapy. This study aimed to analyze the consequences of limited physiotherapy on the functional state of children with neuromuscular diseases (NMD). In addition, the caregivers' well-being and caregiver opinions on physiotherapy were analyzed. METHODS: A questionnaire was shared with parents of children with NMD immediately after the COVID-19 lockdown. The survey included questions regarding the physical and mental condition of children and parents before the pandemic and during lockdown as well as their views on physiotherapy and telephysiotherapy. Statistical analysis was performed using the Wilcoxon Matched-Pairs Signed Ranks test, Spearman's Rank Correlation test, McNemar test, and Chi-square test. RESULTS: Parents of 235 children participated in the study. Results indicated that children devoted more time to physiotherapy before the pandemic than during the lockdown period, which was true for those living in cities and the countryside. The functional state of 50.2% of the children deteriorated during the lockdown, in the opinion of their parents. Significant correlations were found between limited physiotherapy time and the deterioration of children's functional condition, ability to maintain a standing position, and increased anxiety. The majority of parents reported increased levels of fear and anxiety (72.8%), fatigue (67.7%), and pain (53.2%). In-person physiotherapy was rated significantly higher than telephysiotherapy by parents. CONCLUSIONS: Limited access to physiotherapy and shorter therapy times may lead to functional deterioration in children with NMD, but this assumption needs to be objectively confirmed. According to the parents' opinions, telephysiotherapy is less beneficial than direct physiotherapy but may support therapy conducted directly by a physiotherapist. Results based on subjective parental opinions may be helpful in planning future projects.

Analysis of the prevalence of asymmetry and muscle tone disorders in the first year of life among youth with idiopathic scoliosis: A retrospective case-control study.

BACKGROUND: Not much is known about developmental motor disorders in the first year of life of children diagnosed with idiopathic scoliosis (IS). OBJECTIVE: This study aimed to compare the occurrence of asymmetry or muscle tone disorders in the first year of life in adolescents with IS and their healthy counterparts. METHODS: The parents of adolescents with IS and without scoliosis completed a survey on the occurrence of asymmetry, abnormal muscle tone, and physiotherapy in their children in the first year of life. Pearson's chi square test and Cramer's coefficient were used. RESULTS: The final analysis included 527 surveys completed by parents of adolescents with idiopathic scoliosis (150) and without scoliosis (377). A significantly higher frequency of asymmetry (p= 0.001) and muscle tone disorders (p= 0.001) was noted in adolescents with idiopathic scoliosis. The results also revealed a significant association between scoliosis and asymmetry (p= 0.001), as well as muscle tone (p= 0.001). CONCLUSIONS: Developmental asymmetry or improper muscle tone in the first year of life could be considered a potential factor in the development of scoliosis; however, this hypothesis should be confirmed in future studies. Infants diagnosed with developmental disorders require systematic observation.

Motor Function of Children with SMA1 and SMA2 Depends on the Neck and Trunk Muscle Strength, Deformation of the Spine, and the Range of Motion in the Limb Joints.

The purpose of this study was to investigate the functional relationships between selected ranges of motion of the neck, upper and lower limbs, the strength of the neck and trunk muscles, postural parameters, and the motor function of children with SMA1 and SMA2-27 children, aged 6 months-15 years, with genetically confirmed spinal muscular atrophy type 1 (19 children) and 2 (8 children) undergoing pharmacological treatment. All children were examined, according to the methodology, including the motor function evaluation, measurement of selected ranges of motion, assessment of postural parameters, and measurement of neck and trunk muscle strength. The functional status of 15 children was assessed with the CHOP INTEND (CHOP group) scale and of 12 children with the HFMSE (HFMSE group). The results obtained showed that, in children examined with the CHOP scale, greater limitation of flexion in the shoulder joints was observed. As the deformation of the chest increased, the functional abilities of children deteriorated. In participants examined with the CHOP group, the ranges of neck rotation decreased with the increase of the chest deformity. In the HFMSE group, the ranges of head rotation showed a strong relationship with some parameters of muscle strength and the sum of the R coefficients. Participants showed many significant relationships between the range of motion in the neck and joints of the limbs, with more significant relationships in the CHOP group. The following conclusions were made: motor skills of children with SMA depend on muscle strength, range of motion, and deformities of the spine and chest; the development of scoliosis adversely affects the motor function, ranges of motion, and muscle strength; and movement ranges are related to motor skills and strength values.

Neck and Trunk Muscle Strength in Children With Spinal Muscular Atrophy Is Lower Than in Healthy Controls and Depends on Disease Type.

Background: Neck and trunk muscle strength and relationship with motor function in individuals with spinal muscular atrophy (SMA) is not investigated well. Information on maximum muscle strength that children with SMA may develop considerably expands the possibilities of assessing the effectiveness of pharmacological treatment methods and therapeutic procedures. This study sought to assess neck and trunk muscle strength in patients with SMA and to compare it with values noted in healthy children. Methods: The study involved 56 individuals with SMA aged 5-16 not treated pharmacologically, including 9 patients with SMA type 1 (SMA1), 27 with SMA type 2 (SMA2), and 20 with SMA type 3 (SMA3). The control group included 111 healthy individuals aged 5-16. Neck and trunk muscle strength was assessed by means of a maximum voluntary isometric contraction method with the use of a handheld digital muscle tester MICROFET2. Moreover, relative strength was also calculated by standardising the maximum voluntary isometric contraction according to body mass. The Kruskal-Wallis test, Mann-Whitney U-test, and Spearman's rank correlation were used for statistical analysis. Results: The reliability of the neck and trunk muscle strength measurements with the handheld digital muscle tester was excellent with ICC > 0.9. The values of muscle strength in SMA groups were significantly lower than in the control group. The values of relative torque of the neck muscles expressed in percentage values calculated with regard to the control group were at the level of 47.6-51.6% in SMA1 group, 54.8-58.1% in SMA2 group and 80.6-90.3% in SMA3 group. The percentage values for upper and lower trunk muscle strength were at the level of 42.6-68.4% in SMA1 group, 56.9-75.4% in SMA2 group and 76.7-94.8% in SMA3 group. Conclusion: Handheld dynamometry provides reliable measures of neck and trunk muscle strength in SMA children. Neck and trunk muscle strength in children with SMA is lower than in healthy controls and depends on disease type, which confirms the theory based on clinical observations. Further, study is needed to investigate the effect of pharmacological treatment on the strength of the neck/trunk muscles, and relationship between neck and trunk muscle strength and motor capabilities.

Cervical rotation, chest deformity and pelvic obliquity in patients with spinal muscular atrophy.

BACKGROUND: Musculoskeletal disorders are often observed in patients with spinal muscular atrophy (SMA). The aim of the study was to assess passive ranges of rotation in the cervical spine, chest deformity and pelvic obliquity in SMA patients, and to compare these results to the norms obtained in the group of healthy individuals. The second aim was to review these measurements and Cobb angle values for correlations in SMA patients. METHODS: The study included 74 patients with SMA and 89 healthy individuals aged 2 to 18 years. Cervical Rotation (CR), Supine Angle of Trunk Rotation (SATR) and Pelvic Obliquity (PO) tests were carried out. RESULTS: Cervical rotation ranges were significantly higher in the control group than in SMA patients (p < 0.05). Differences between cervical rotation ranges to the left and to the right were significantly larger in SMA I and SMA II groups than in healthy individuals (p = 0.000). Chest asymmetry and pelvic obliquity were bigger in SMA groups than in the control (p < 0.05). Significant correlations between cervical rotation measurements, chest deformity, pelvic obliquity and Cobb angle were found in SMA individuals, depending on the type. CONCLUSIONS: The results of the study suggest that CR, SATR and PO tests may assist in the assessment of SMA patients in addition to the radiographic evaluation of the spine. Biomechanical relationships between disorders located in various skeletal structures should be taken into account in the treatment of SMA patients. Special attention should be given to assessing postural parameters in non- sitters and sitters. Treatment of patients with SMA and associated musculoskeletal disorders requires a multi-specialist approach.

Gross Motor Function Disorders in Patients with Alternating Hemiplegia of Childhood.

BACKGROUND: Alternating hemiplegia of Childhood (AHC) is a rare disease manifested by transient episodes of hemiplegia and other neurological disorders. Delayed motor development has been reported in patients with AHC, but detailed features of the motor impairment have not been described so far. AIM: The aim of the study was to evaluate gross motor function between attacks in a group of Polish patients with AHC. MATERIALS AND METHODS: The interictal gross motor function was assessed using the Gross Motor Function AHC scale, which consisted of 41 motor tasks. The study group consisted of 10 patients with AHC older than 2 years of age. The control group consisted of 30 age- and gender-matched subjects. The results achieved in each of the 41 tasks by the study subjects were compared to the results obtained with controls using the non-parametric Mann-Whitney U-test. In tasks 38-41, mean times were compared between the study subjects and controls. RESULTS: The study revealed gross motor function impairment in patients with AHC. The greatest differences compared to controls concerned such skills as standing on toes, walking on toes, walking on heels, as well as running and hopping on one leg and on alternate legs. Significant impairment of the motor function of the upper limbs was also found. CONCLUSIONS: The study confirmed motor function impairment between attacks in patients with AHC. The study findings may indicate the need to introduce individualised physiotherapy management of patients with AHC.

Reliability of four tests to assess body posture and the range of selected movements in individuals with spinal muscular atrophy.

BACKGROUND: The majority of individuals with spinal muscular atrophy (SMA) experience progressive skeletal deformities which may affect the quality of life and mobility. To date, no studies have evaluated the reliability of tests assessing body posture and joint mobility in SMA patients. The purpose of this study was to assess the reliability of Cervical Rotation test (CR), Supine Angle of Trunk Rotation test (SATR), Hip Extension test (HE) and Pelvic Obliquity test (PO) developed to evaluate the musculoskeletal system in SMA individuals. METHODS: Thirty individuals (12 girls and 18 boys) aged 4-15 with SMA type II (n = 24) and III (n = 6) confirmed by genetic examinations were qualified for the study. The participants were examined twice by three physiotherapists on the same day. The examination included four tests, i.e. CR, SATR, HE and PO tests aimed at assessing ranges of rotation in the cervical spine, chest deformities, ranges of hip extension and pelvis position while sitting. Statistical calculations were made with the use of statistical software IBM SPSS Statistics version 20. Reliability was assessed using the Intraclass Correlation Coefficient (ICC). RESULTS: Intraobserver reliability was excellent for CR (ICC range 0.839-0.911), SATR (ICC range 0.918-0.939 - the upper part of the sternum; ICC range 0.951-0.975 - the lower part of the sternum), HE (ICC range 0.988-0,991) and PO (ICC range 0.896-0.935) tests. The interobserver ICC reached the excellent values in CR (ICC range 0.912-0.920), SATR (ICC = 0.888 - the upper part of the sternum, ICC = 0.951 - the lower part of the sternum), HE (ICC range 0.922-0.923) and PO (ICC = 0.928) tests. CONCLUSIONS: CR, SATR, HE and PO tests are reliable and may be used for examining individuals with SMA. The application of these tests provides a possibility to detect early changes in the musculoskeletal system in children and adolescents and to assess the effectiveness of the implemented pharmacotherapy and rehabilitation.

Propriedades psicométricas da versão espanhola da Referee Self-Efficacy Scale (REFS) / Sistema de clasificación de voleibol sentado: La perspectiva de los atletas / Sistema de qualicação para o vôlei: a perspectiva dos atletas

The aim of this study was to evaluate the classiffication system in sitting volleyball (SV) based on athletes' opinions on different competitive level. During World Sitting Volleyball Championships in 2014, 187 participants and 35 players in Polish and Lithuanian SV leagues participated in this study. They completed the survey regarding the current classiffication system in SV. The classiffication procedure was assessed as positive by 74% of elite athletes and 94.1% league athletes. Elite athletes see a need to include functional procedures, and in contrast to league athletes, they assessed the current classification system positively. Many of the players see a need to change the current classiffication system from medical to functional or mixed procedures. League athletes in contrast to elite athletes agree to include able-bodied people to compete on the court with people with physical impairments

El objetivo de este estudio fue evaluar el sistema de clasificación en voleibol sentado (SV) en función de las opiniones de los atletas en diferentes niveles competitivos. Durante el Campeonato Mundial de Voleibol Sentado en 2014, 187 participantes y 35 jugadores de las ligas SV polacas y lituanas participaron en este estudio. Completaron la encuesta sobre el sistema de clasificación actual en SV. El procedimiento de clasificación fue evaluado como positivo por el 74% de los atletas de elite y el 94.1% de los atletas de liga. Los atletas de elite ven la necesidad de incluir procedimientos funcionales, y en contraste con los atletas de la liga, evaluaron positivamente el sistema de clasificación actual. Muchos de los jugadores ven la necesidad de cambiar el sistema de clasificación actual de procedimientos médicos a procedimientos funcionales o mixtos. Los atletas de la liga, en contraste con los atletas de elite, aceptan incluir personas sanas para competir en la cancha con personas con discapacidades físicas

O objetivo deste estudo foi avaliar o sistema de classificação em voleibol sentado (SV) baseado na opinião de atletas em diferentes níveis competitivos. Durante o Campeonato do Mundo de Voleibol em 2014, participaram neste estudo 187 participantes e 35 jogadores nas ligas da Polónia e da Lituânia. Eles completaram a pesquisa sobre o sistema de classificação atual em SV. O procedimento de classificação foi avaliado como positivo por 74% dos atletas de elite e 94,1% dos atletas da liga. Os atletas de elite veem a necessidade de incluir procedimentos funcionais e, em contraste com os atletas da liga, avaliaram positivamente o sistema de classificação atual. Muitos dos jogadores vêem a necessidade de mudar o sistema de classificação atual de procedimentos médicos para procedimentos funcionais ou mistos. Atletas da liga, em contraste com atletas de elite, concordam em incluir pessoas fisicamente capazes para competir na quadra com pessoas com deficiências físicas

Relationships Between Anaerobic Performance, Field Tests and Game Performance of Sitting Volleyball Players.

The aim of this study was to evaluate relationships between anaerobic performance, field tests, game performance and anthropometric variables of sitting volleyball players. Twenty elite Polish sitting volleyball players were tested using the 30 s Wingate Anaerobic Test for arm crank ergometer and participated in six physical field tests. Heights in position to block and to spike, as well as arm reach were measured. Players were observed during the game on the court in terms of effectiveness of the serve, block, attack, receive and defense. Pearson analysis and the Spearman's rank correlation coefficient were used. The strongest correlations were found between the chest pass test and mean power and peak power (r=.846; p=.001 and r=.708; p=.0005, respectively), and also between the T-test and peak power (r= -.718; p=.001). Mean power correlated with the 3 m test (r= -.540; p=.014), the 5 m test (r= -.592; p=.006), and the T-test (r= -.582; p=.007). Peak power correlated with the 3 m test (r= -.632; p=.003), the 5 m test (r= -.613; p=.004), speed & agility (r= -.552; p=.012) and speed & endurance (r=-.546; p=.013). Significant correlations were observed between anthropometric parameters and anaerobic performance variables (p≤.001), and also between anthropometric parameters and field tests (p≤.05). Game performance and physical fitness of sitting volleyball players depended on their anthropometric variables: reach of arms, the position to block and to spike. The chest pass test could be used as a non-laboratory field test of anaerobic performance of sitting volleyball players.