Low-energy laser therapy application on knee joints as an auxiliary treatment in patients with polyarticular juvenile idiopathic arthritis: a dual-arm randomized clinical trial.

Patients with juvenile idiopathic arthritis (JIA) always experience persistent pain and stiffness which induces muscle weakness, fatigue, and functional limitations. This study evaluated whether applying low-energy laser therapy (LLT) on the knee joint could be an effective adjuvant intervention for patients with JIA. Sixty children with polyarticular JIA participated and were randomly allocated to receive either LLT (wavelength λ = 903 nm; power output of 50 mW; and energy of 1.5 J) plus exercises (LLT group) or exercises alone (control group). Pain, peak concentric torque of quadriceps muscles, fatigue, and functional status were measured by the visual analogue scale, isokinetic testing system, Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, and Childhood Health Assessment Questionnaire, respectively pre- and post-intervention, and at 6-month follow-up. Per the mixed-model analysis of variance, the LLT group showed a statistically more favorable improvement in pain (P = .003, ηp2 = .014), fatigue perception (P = .004, ηp2 = .015), and functional status (P = .022, ηp2 = .09) across the three assessment occasions, as compared to the control group. However, no significant difference was demonstrated between both groups concerning peak concentric torque (all P > .05). Incorporation of LLT into the standard physical rehabilitation program for patients with JIA has the potential to induce more conducive improvements in pain, fatigue, and functional performance, but is not effective for improving muscle performance.

Effectiveness of a Multi-Modal Exercise Program Incorporating Plyometric and Balance Training in Children With Hemiplegic Cerebral Palsy: A Three-Armed Randomized Clinical Trial.

AIM: To evaluate the effectiveness of a multimodal exercise program incorporating plyometric and balance training on muscle strength and postural stability in children with spastic hemiplegic cerebral palsy (SHCP). METHODS: A total of 57 children with SHCP were enrolled in the study and randomly allocated into three treatment-based groups: plyometric exercises (PLYO group; n = 19), balance exercises (BAL group, n = 19), and combined plyometric and balance exercises (PLYO-BAL group; n = 19). The maximum isometric muscle strength (IMSmax) and postural stability [anterior-posterior stability index (AP-SI), mediolateral stability index (ML-SI), and overall stability index (O-SI)] were measured pre- and post-intervention. RESULTS: By applying the intention-to-treat analysis, the PLYO-BAL group showed greater post-treatment IMSmax than the PLYO and BAL groups for the quadriceps (p=.03 and p=.0002 respectively), hamstrings (p=.018 and p<.0001 respectively), and dorsiflexors (p=.006 and p<.0001 respectively). Also, the PLYO-BAL group achieved better post-intervention stability scores as compared to PLYO and BAL groups regarding AP-SI (p<.0001 and p=.0001 respectively), ML-SI (p=.001 and p=.015 respectively), and O-SI (p=.011 and p=.04 respectively). CONCLUSIONS: Incorporation of plyometric and balance exercises in a multimodal rehabilitation program could be an important consideration for enhancing muscle strength and boosting postural stability in children with SHCP.

Effect of adding plyometric training to physical education sessions on specific biomechanical parameters in primary school girls.

OBJECTIVES: The study aimed to determine the effect of adding a school-based plyometric training program (PMT) to physical education (PE) sessions on the strength, balance, and flexibility in primary school girls. METHODS: Students from grades 3-6 were randomized equally to a plyometric or control group. In the control group, students took their regular PE classes twice a week. In the plyometric group, students performed PMT twice a week during the initial 20 minutes of every PE session. The Lido Linea closed kinetic chain isokinetic dynamometer, Star excursion balance test (SEBT), and sit-and-reach test were used to assess muscle strength, balance, and flexibility, respectively, before and after nine weeks of training. RESULTS: The improvement in extension peak force (p=0.04) and extension total work (p<0.001) was more prevalent in the PMT group than in the control group. SEBT scores had improved significantly (p<0.05) for all directions in the PMT group, except in the anterior direction, which was highly significant (p<0.001). Hamstring and lower back flexibility had improved more in the PMT group than in the control group (p<0.001). CONCLUSION: Adding PMT to regular PE classes has a positive and notable effect on muscle strength, balance, and flexibility in primary school students.

The Hemodynamic Response of the Vertebral Artery to 3 Time Durations of the Static Stretching Exercise in the End Position of Contralateral Cervical Rotation.

OBJECTIVES: To evaluate the effect of 3 different time durations of sustained end-range cervical rotation during static stretching exercises on the hemodynamics of the vertebral artery. METHODS: This observational study used Doppler ultrasonography to measure the average vertebral artery hemodynamics at the sustained end-range cervical rotation after 3 time durations of static stretching exercise: 10 seconds, 30 seconds, and 60 seconds. The sustained end-range cervical rotation was applied to 30 asymptomatic male participants. RESULTS: The peak systolic velocity 35.2 ± 6.9 cm/s and the end systolic velocity 12.7 ± 1.6 cm/s reduced significantly, while resistive index 0.74 ± 0.03 increased after 60 seconds of sustained end-range contralateral cervical rotation by 39.1%, 32.4%, and 8.8%, respectively, compared with the neutral position. There were no significant differences found between peak systolic velocity and resistive index after a stretching duration of 60 and 30 seconds. Similarly, there were no notable changes in end systolic velocity when comparing 10 seconds with 30 seconds. CONCLUSION: The static stretching exercise using sustained end-range cervical rotation for 60 seconds induced marked changes in the hemodynamics of the vertebral artery.

Plyometric exercises: subsequent changes of weight-bearing symmetry, muscle strength and walking performance in children with unilateral cerebral palsy.

OBJECTIVE: To evaluate the subsequent effects of plyometric training on weight-bearing symmetry, muscle strength, and gait performance in children with unilateral cerebral palsy. METHODS: Thirty-nine children with spastic hemiplegia (age 8-12 years) were randomly divided into either the PLYO group (n=19, received a 30-minute plyometric exercise program plus the traditional physical rehabilitation, twice/week for eight consecutive weeks) or Non-PLYO group (n=20, received the traditional physical rehabilitation only). The weight-bearing symmetry index (WB-SI), maximum isometric muscle strength (MIMS) of quadriceps and hamstring muscles, and spatial-temporal gait parameters were assessed pre and post-intervention. RESULTS: From pre- to post-intervention, changes of WB-SI among PLYO and Non-PLYO groups did not differ significantly (P=.81; hindfoot and P=.23; forefoot). MIMS of quadriceps and hamstring muscles at 90° knee flexion (P=.008 and .013 respectively) increased significantly in PLYO compared to Non-PLYO group. Walking speed (P=.033), stride length (P=.002), and step time (P<.001) improved markedly in PLYO group more than in Non-PLYO group. The proportion of single leg support (P=.14) among PLYO and Non-PLYO groups did not differ significantly. CONCLUSION: Addition of plyometric exercises to the physical rehabilitation programs of children with unilateral CP could achieve greater improvement in muscles strength and walking performance, but not in WB-SI.

Effect of blood flow restriction as a stand-alone treatment on muscle strength, dynamic balance, and physical function in female patients with chronic ankle instability.

BACKGROUND: Blood Flow Restriction (BFR) training has gained popularity as a novel training strategy in athletes and rehabilitation settings in recent years. OBJECTIVE: To investigate whether BFR as a stand-alone treatment would affect muscle strength, dynamic balance, and physical function in female patients with chronic ankle instability (CAI). METHODS: Thirty-nine patients with CAI were randomly allocated into 1 of 3 groups: BFR as a stand-alone (BFR) group, BFR with rehabilitation (BFR+R) group, and rehabilitation (R) group. All groups trained 3 times per week for 4 weeks. One week before and after the intervention, strength of muscles around ankle joint, 3 dynamic balance indices: Overall Stability Index, Anterior-Posterior Stability Index, and Medial-Lateral Stability Index, and physical function were assessed via an isokinetic dynamometer, the Biodex Balance System, and the Foot and Ankle Disability Index, respectively. RESULTS: The strength of muscles around ankle and dynamic balance indices improved significantly in BFR + R and R groups (P < .006), but not in BFR group (P > .006). All dynamic balance indices showed improvement in BFR + R and R groups except the Medial-Lateral Stability Index (P > .006). Foot and Ankle Disability Index increased significantly in BFR + R and R groups (P < .006), however; no improvement occurred in BFR group (P > .006). CONCLUSIONS: The BFR as a stand-alone treatment hasn't the ability to improve the strength of muscles around the ankle, dynamic balance, and physical function in females with CAI compared to the BFR + R or the R program. In addition, the strength of muscles around the ankle correlated significantly with both dynamic balance and physical function in BFR + R and R groups.

Comparison of two periods of Schroth exercises for improving postural stability indices and Cobb angle in adolescent idiopathic scoliosis.

BACKGROUND: Adolescents with idiopathic scoliosis present postural instability when compared with healthy subjects. Although Schroth exercises therapy (SET) is broadly utilized, its effect on postural stability is still not clear. OBJECTIVES: To compare the two treatment periods of the SET for improving the postural stability indices and Cobb angle, and to examine the correlation between the Cobb angle and stability indices in adolescent idiopathic scoliosis (AIS). METHODS: Twenty girls aged 10-16 years with AIS (study group) and 20 age-matched girls without AIS (control group) were examined. The Biodex Balance System was used to evaluate the overall stability index (OSI), anteroposterior index (APSI), and mediolateral stability index (MLSI) in the study group before SET and one and three months after the therapy. A plain X-ray was used to measure the Cobb angle before and three months after SET. Stability indices and Cobb angle were measured only once for the control group. RESULTS: One-way repeated-measures ANOVA revealed that the three-month duration of SET was the most effective for improving OSI, APSI, and MLSI (p< 0.001). The significant proximities of OSI, APSI, and MLSI to the normal values post three months of SET were 29.65%, 24.07, and 20% respectively. The MLSI was robust and correlated with the Cobb angle (r= 0.85) three months post intervention. CONCLUSION: Stability indices and Cobb angles were highly improved after three months of SET compared to one month among AIS patients. The MLSI is the most substantial index correlated with the Cobb angle.

Beyond the Acute Phase: Understanding Relationships Among Cardiorespiratory Response to Exercises, Physical Activity Levels, and Quality of Life in Children After Burn Injuries.

The long-term cardiorespiratory function in burn-injured children can be jeopardized due to complications brought on by the injury. This study sought to assess the cardiorespiratory responses to maximal exercise in children who sustained a burn injury and explore the relationships among cardiorespiratory response, physical activity levels (PALs), and health-related quality of life (HRQL). Forty-five burn-injured children (age: 13.89 ± 2.43 years; duration since burn injury: 3.13 ± 0.93 years) and 52 age- and gender-matched healthy children (14.15 ± 2.27 years) participated in this study. Both cohorts were evaluated for the maximal exercise capacity (defined by peak oxygen uptake [VO2peak], maximum heart rate [HRmax], minute ventilation [VE], ventilatory equivalent [VEq], respiratory rate [RR], and respiratory exchange ratio [RER]), PALs, and HRQL. The burn-injured children had significantly lower VO2peak (P = .0001) and VE (P = .003) and higher VEq (P < .0001) and RR (P = .007) than their healthy controls, indicating less-efficient cardiorespiratory capacity. However, the HRmax (P = .092) and RER (P = .251) were similar. The burn-injured children reported significantly lower PALs (P = .014) and HRQL (P < .0001). The PALs (r [95% CI] = .411 [0.132-0.624]; P = .005) and HRQL (r [95% CI] = .536 [0.284-0.712]; P = .0001) were significantly correlated with the cardiorespiratory capacity represented by VO2peak in burn-injured group. The variations in VO2peak explained ~17% and 28.7% of the variations in PALs and HRQL, respectively. In conclusion, the cardiorespiratory efficiency of the burn-injured children may remain limited, even up to a few years following the injury. The limited cardiorespiratory capacity accounts in part for the reduced PALs and HRQL.

Effect of Wii-habilitation on spatiotemporal parameters and upper limb function post-burn in children.

BACKGROUND: Limb burns can cause different functional disorders that greatly impact one's quality of life. AIM: The purpose of the current study was to compare the effect of Nintendo Wii sports intervention, and traditional treatment methods on spatiotemporal parameters and upper limb function post-burn in children. METHODS: Thirty children their age ranging from 7-12 years, with dominant side upper limb burn participated in the study.Vicon3-D motion analysis system and Jebsen hand function test were used to evaluate spatiotemporal parameters (movement duration, peak velocity, and time to peak velocity percentage in three functional tasks) and upper limb function respectively. The children were randomly divided into study and control groups. The study group was rehabilitated with Wii training in addition to traditional therapy, while the control group rehabilitated only with the traditional therapy program. For the study group, the games selected were Wii Bowling, Baseball, and Tennis. Both groups were trained for 60 min daily, three times/week for six weeks. The outcomes were measured pre and post the treatment period. RESULTS: The whole-time duration and peak velocity improved significantly in the study group across the hand to head task (p = 0.001, p < 0.001, respectively), hand to mouth (p = 0.001), and hand to shoulder (p < 0.001, p = 0.0018, respectively) compared with the control group. The time to peak velocity percentage was enhanced significantly in the study group (p < 0.001) than the control group in all three-measured tasks. Moreover, the Jebsen hand function test improved significantly (p < 0.001) in the study group than in the control group. CONCLUSION: Wii-habilitation could be advised as an effective tool in the rehabilitation program of children with post-burn injuries.

Impact of core stability exercises on bone mineralization and functional capacity in children with polyarticular juvenile idiopathic arthritis: a randomized clinical trial.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most prevalent rheumatic disease in children. The core stability exercises ensure proper muscular strength and balance around the lumbo-pelvic-hip complex. OBJECTIVE: This study evaluated whether the use of core stability exercises would increase the effectiveness of conventional physical therapy (PT) in enhancing bone mineralization and improving functional capacity in children with polyarticular JIA. METHODS: Thirty-three children with polyarticular JIA (age; 10-14 years) assigned randomly into two groups: the control group (n = 16) received the conventional PT, and the study group (n = 17) received the core stability exercises in addition to the same conventional PT program. Both core stability and conventional PT exercises continued for 3 months. The measures of bone mineralization and functional ability were investigated by dual-energy X-ray absorptiometry (DXA) device and 6-min walk test (6MWT), respectively, at baseline and immediately post-treatment. RESULTS: Analysis of covariance (ANCOVA) revealed significant differences between groups in favor of the study group regarding measures of bone mineralization of lumbar spine and femoral neck regions as P < 0.05, except for volumetric bone mineral density of lumbar spine the P > 0.05. There was a significant difference between the two groups concerning functional capacity measured in 6MWT (P < 0.05), where children in the study group walked 531.71 ± 90.59 m compared with the control group 509.31 ± 73.10 m. CONCLUSION: Core stability exercises are an effective adjunctive therapy to enhance bone health status and improve functional capacity in children with polyarticular JIA. Key Points • In addition to conventional physical therapy, core stability exercises had a definite effect on improving bone health status and quality of life in children with polyarticular juvenile idiopathic arthritis. • Improved bone mineralization and functional capacity due to core stability exercises contain two parts: strengthening training and controlling equilibrium.