Performance of Children on the Community Balance and Mobility Scale

ABSTRACT

This study describes the performance of children 8–11 years of age on the Community Balance and Mobility Scale (CB&M) and associations between performance and age, body mass index (BMI), and sex. A convenience sample of 84 was recruited. The CB&M was administered using instructions we developed for children. Mean CB&M total scores (95% confidence intervals) for age groups were 8: 70.1 (64.2, 76.1); 9: 72.8 (68.7, 76.8); 10: 79.2 (76.6, 81.7); and 11: 82.9 (79.2, 86.5). None of the children achieved the maximum score. Scores increased with age, and overweight/obese children had relatively lower scores. There were no significant differences between males and females. A regression analysis found 28.1% of the variation in the CB&M total scores was explained by age (p < .001), BMI (p < .01), and sex (p = .25) suggesting that other factors contribute to variation in balance and mobility proficiency. The modified instructions and scoring patterns from this study can assist in using the CB&M in children of ages 8–11 years.     

Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

ABSTRACT

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.     

Concurrent Validity of Two Gait Performance Measures in Children with Neuromotor Disorders

Aims: To investigate the concurrent validity of two mobility performance measures, the Functional Mobility Scale (FMS) and the Gillette Functional Assessment Questionnaire – walking scale (FAQ) in an inpatient pediatric neurorehabilitation setting. Methods: Cross-sectional data were collected on 71 children (mean age 12.7 years) with neuromotor gait impairments who participated in an inpatient rehabilitation program to evaluate aspects of concurrent validity of the FMS and FAQ. Physiotherapists independently performed ratings. Comparator instruments included the walking item of the Functional Independence Measure for children, 10-m and 6-minute walking tests, and Gross Motor Function Measure-88 dimension E. All tests were completed within 7 days. Spearman correlation coefficients were calculated to test a priori formulated hypotheses regarding the strength and direction of the measures relationships. Results: The children had a broad spectrum of mobility levels, including all levels of FMS and levels 2–10 of FAQ. Spearman correlation coefficients with comparator measures varied between 0.58–0.79 for the FMS and 0.69–0.73 for the FAQ. Hypotheses concerning correlation strengths and directions were met for FMS and FAQ. Conclusions: The findings demonstrate that the FMS and FAQ are valid to evaluate functional mobility in pediatric inpatient neurorehabilitation.     

The Effect of Therapeutic Horseback Riding on Gross Motor Function and Gait Speed in Children Who Are Developmentally Delayed

The purpose of this study was to measure the effects of a seven-week therapeutic horseback riding program and to determine if changes were retained after therapeutic riding was discontinued. A repeated-measures within-participants design was used to assess performance on the Gross Motor Function Measure and timed 10-meter walk in seven developmentally delayed children. A statistically significant improvement in gross motor function was found in post-intervention measures. Improvements were maintained seven weeks after therapeutic riding had ended. No considerable difference in gait speed was noted. This study indicates that therapeutic riding may lead to improvement in gross motor function in developmentally delayed children and that these improvements remain once therapeutic riding ceases.     

Sitting and Looking: A Comparison of Stability and Visual Exploration in Infants with Typical Development and Infants with Motor Delay

ABSTRACT

This longitudinal study focused on the interaction of developing sitting postural control with look time, which served as a measure for cognitive processing. Twenty-eight typically developing infants and 16 infants with motor delays were evaluated using center-of-pressure measures to assess stability of sitting postural control and videography to assess look time at objects, at three progressive stages of sitting development. Results indicated that look time decreased significantly (p < .001) in conjunction with a significant increase in postural stability (p < .001) in both groups as sitting progressed to independence. Infants with motor delays showed significantly longer looks when compared to typical infants (p = .02) at the middle stage of sitting. We conclude that developmental changes in look time are related to changes in sitting postural control, and infants with motor delay may have greater difficulty looking during emerging postural control skills in sitting. Early interventionists may use look time as an indicator of sitting effort and cognitive processing during assessment and program planning.     

Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II

Aims: To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP). Method: A consecutive selection of 40 children, ages 4–12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I–II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections. 3D gait analysis, goal-attainment scaling, and body function assessments were performed before and at 3, 12, and 24 months after initial injections. Results: A significant but clinically small long-term improvement in gait was observed. Plantarflexor spasticity was reduced after three months and remained stable, while passive ankle dorsiflexion increased after 3 months but decreased slightly after 12 months. Goal-attainment gradually increased, reached the highest levels at 12 months, and levels were maintained at 24 months. Conclusion: The treatments’ positive effect on spasticity reduction was identified, but did not relate to improvement in gait or goal-attainment. No long-term positive change in passive ankle dorsiflexion was observed. Goal attainment was achieved in all except four children. The clinical significance of the improved gait is unclear. Further studies are recommended to identify predictors for positive treatment outcome.     

Mild Anaemia in African School Children: Effect on Running Performance and an Intervention Trial

ABSTRACT. Blood haemoglobin concentrations and reticulocyte counts were determined in 430 school children in grades 1, 3 and S in a small township in rural Zambia at the end of the rainy season. Running capacity was estimated by the 12-min running test. Age, sex, height, weight, social and nutritional indicators were recorded. Mean haemoglobin was 125.3 g/l ± T2.3 SD. Low haemoglobin was associated with indicators of a traditional way of life. After a controlled trial of iron, folic acid, tetrachlorethylene and chloroquine lasting for 6 weeks, mean haemoglobin in all the children was 128.8 g/l ± 10.0 SD. The mean haemoglobin was significantly higher in the 218 children who received iron than in the 212 children who did not receive iron. There were no other significant differences among the treatment grops. In a subgroup of 377 children who completed two running tests, those with lower haemoglobin ran significantly shorter distances, even when possible confounding factors were partialled out. The effect was reduced by excluding 12 children with haemoglobin less than 100 g/1 or 48 children with reticulocyte counts of 15%_± or more, but remained statistically significant.     

The Effect of Bimanual Training with or Without Constraint on Hand Functions in Children with Unilateral Cerebral Palsy: A Non-Randomized Clinical Trial

Aim: To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP). Methods: Seventeen children aged 6–11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint (“Hybrid”) or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post- and 3-months post-intervention. Results: A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p < 0.01); Bimanual (F2; 16 = 15.4, p < 0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p < 0.01]. Conclusion: Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.     

The Influence of a Constraint and Bimanual Training Program Using a Variety of Modalities,on Upper Extremity Functions and Gait Parameters Among Children with Hemiparetic Cerebral Palsy: A Case Series

Aim: To assess the influence of an intensive combined constraint and bimanual upper extremity (UE) training program using a variety of modalities including the fitness room and pool, on UE functions as well as the effects of the program on gait parameters among children with hemiparetic cerebral palsy. Methods: Ten children ages 6–10 years participated in the program for 2 weeks, 5 days per week for 6 hr each day. Data from the Assisting Hand Assessment (AHA) for bimanual function , the Jebsen–Taylor Test of Hand Function (JTTHF) for unimanual function, the six-minute walk test (6MWT), and the temporal-spatial aspects of gait using the GAITRite walkway were collected prior to, immediately post and 3-months post-intervention. Results: A significant improvement was noted in both unimanual as well as bimanual UE performance; A significant improvement in the 6MWT was noted, from a median of 442 meter [range: 294–558] at baseline to 466 [432–592] post intervention and 528 [425–609] after 3 months (p = .03). Conclusion: Combining intensive practice in a variety of modalities, although targeting to the UE is associated with substantial improvement both in the upper as well as in the lower extremity function.     

高脂血症对儿童颈动脉弹性功能的影响

目的探讨儿童颈动脉弹性功能的影响因素及高脂血症对其影响。方法采用Aloka超声血管回声跟踪技术,测定57例正常儿童和23例高脂血症儿童的颈动脉弹性系数(Eρ)、硬度指数(β)及顺应性(AC),并对可能的影响因素进行相关分析。结果在正常健康儿童中,性别对于颈动脉的弹性功能没有影响,年龄、收缩压、脉压与颈动脉Eρ、β呈正相关,而与AC呈负相关。高脂血症组与正常组儿童比较,Eρ、β明显增高,AC值明显降低。结论高脂血症可以导致儿童颈动脉弹性功能的降低,年龄和血压也是儿童颈动脉弹性功能的影响因素。     

孟鲁司特对儿童哮喘炎症因子的影响

目的探讨孟鲁司特对儿童哮喘炎症因子的影响。方法将80例6～14岁中度哮喘患儿随机分口服孟鲁司特5mg/d、吸入布地奈德200μg/d、孟鲁司特5mg/d口服并吸入布地奈德100μg/d3组,持续治疗12周。于治疗开始和第12周进行临床评估和肺功能检查,同步进行外周血嗜酸性粒细胞(Eos)计数、血及痰液嗜酸性粒细胞阳离子蛋白(ECP)、IL5和TNFα水平的检测。结果哮喘患儿治疗后临床和肺功能明显改善;治疗开始患儿血ECP、IL5、TNFα水平和Eos计数均显著高于正常对照组(P均<0.01);血Eos计数与ECP浓度呈显著正相关(P<0.01),血IL5水平与ECP浓度呈显著正相关(P<0.01);治疗后血ECP、IL5、TNFα水平和Eos计数较治疗前明显降低(P<0.01);痰液ECP、TNFα和IL5含量显著低于治疗前(P<0.01)。结论孟鲁司特可抑制哮喘中Eos引起的呼吸道炎症,降低血和痰液ECP、IL5、TNFα水平。抑制效应可能是孟鲁司特抗哮喘呼吸道炎症的重要机制。     

The Effect of Reduction of Maintenance Treatment on Circadian Variation in Peak Expiratory Flow Rate Values in Asthmatic Children

ABSTRACT. We investigated in well controlled asthmatic children whether it is possible to predict by measuring daytime forced expiratory volume in one second, the decline in nocturnal peak expiratory flow rate values after withdrawal of maintenance medication. Forced expiratory volume in one second and peak expiratory flow rate were measured in the outpatient clinic, on the last day with medication. Peak expiratory flow rates were then measured every four hours on days 4, 5 and 6 without medication. Seventeen children showed an amplitude in circadian peak expiratory flow rate values of more than 20% (group I) and nine children showed an amplitude of 20% or less on the three study days (group II). Mean values ± SEM were 34.7±2.1% and 10.5±1.5%, respectively. Forced expiratory volume in one second values were comparable in both groups. Daytime peak expiratory flow rate values before and after withdrawal, remained on the same level in both groups. In group I peak expiratory flow rate values of 24.00 and 08.00 hours on day 6 were significantly lower ( p <0.05) than on day 4. The results indicate that history and daytime pulmonary function measurements alone, are insufficient to assess the clinical situation and suggest that a decrease in early morning peak expiratory flow rate value (08.00 hours) is an early sign of deterioration of the disease state, after reduction of medication.     

银杏叶提取物对肾病综合征炎症细胞因子的影响

目的　探讨银杏叶提取物对原发性肾病综合征 (NS)患儿外周血单个核细胞 (PBMC)中炎症细胞因子的影响。方法　将我科 2 0 0 0年 10月～ 2 0 0 4年 10月收治的小儿NS 3 5例 ,随机采用泼尼松加银杏叶提取物和单用泼尼松两种方法治疗 ,共分为 3组 ,治疗前组 3 5例 ,未治疗的患儿 ;银杏叶组 2 0例 ,采用泼尼松加银杏叶提取物治疗 ;激素组 15例仅给强的松治疗 ,3 0d为1个疗程 ,疗程结束后观察疗效。分别于治疗前后观察临床和生化检验指标 ,同时应用酶联免疫吸附试验 (ELISA)方法检测PBMC培养上清液中IL 1、IL 6、IL 8和TNF α蛋白水平的变化。结果　治疗 1个月后 ,临床症状及血液生化指标等明显改善 ,治疗前组与银杏叶组比较有显著差异 (P均 <0 .0 1) ;银杏叶组明显优于激素组 ,两组有显著差异 (P <0 .0 1)。对 3组IL 1、IL 6、IL 8和TNF α变化进行比较 ,银杏叶组和激素组均较治疗前组明显降低 ,有显著性差异 (均P <0 .0 1) ;银杏叶组较激素组也降低 ,有显著性差异 (P <0 .0 1)。结论　银杏叶提取物对NS患儿外周血中多种炎症细胞因子有抑制作用 ,对NS治疗有明显疗效 ,可用于辅助激素治疗。     

Effect of Open Heart Surgery with Cardiopulmonary Bypass on Peripheral Blood Lymphocyte Apoptosis in Children

Children undergoing cardiopulmonary bypass (CPB) operations have an increased risk for the development of immunosuppression and severe infection. Lymphocyte apoptosis plays an important role in regulating immune responses. This study aimed to investigate the effect of open heart surgery with CPB on peripheral blood lymphocyte (PBL) apoptosis and the possible mechanism of lymphocyte apoptosis in infants and young children. This study enrolled 20 consecutive infants and children as a CPB group and 20 age-matched children who underwent patent arterial duct closure without CPB as control subjects. Samples were taken from peripheral blood after induction of anesthesia (preoperatively) and again 24 h after the operations. The degree of apoptosis and the expression level of Fas (CD95) on PBL were measured using flow cytometry. The percentage of lymphocyte apoptosis significantly increased after surgery in both groups, but it was much higher in the children with CPB than in those without CPB (14.46% ± 4.83% vs. 7.33% ± 1.43%; p < 0.01). The expression level of Fas in the individuals with CPB was significantly higher than in those without CPB (52.80% ± 8.80% vs. 37.82% ± 6.32%; p < 0.01). As shown by the study findings, both surgical stress and CPB can induce PBL apoptosis, which may lead to lymphopenia after open heart surgery with CPB for infants and young children.     

幽门螺杆菌感染对慢性胃炎患儿胃动力功能的影响

目的探讨幽门螺杆菌(Hp)感染对慢性胃炎患儿胃动力功能的影响。方法通过Hp检测及组织病理检查,将47例慢性胃炎患儿分为Hp阳性和阴性组。对各组进行固体餐放射性核素胃排空检查和胃电图(EGG)检测。Hp阳性患儿予克拉霉素15mg/(kg.d)、阿莫西林50 mg/(kg.d)、奥美拉唑0.8 mg/(kg.d)三联抗Hp治疗2周。其中Hp根除者再行EGG检测。结果Hp阳性组胃半排空时间(GET1/2)明显高于Hp阴性组(t=6.403 P<0.01)。二组EGG参数值比较无明显差异,但Hp阳性组存在餐前振幅不规则现象,且Hp阳性组根除Hp前餐前主功率明显低于根除后(t=2.197 P<0.05)。结论Hp感染影响患儿胃排空及胃肌电活动,导致慢性胃炎患儿胃动力功能低下。     

Short-Term Effect of Low and High Protein Intake on Renal Function in Children with Renal Disease

ABSTRACT. The short-term effect of different levels of protein intake on renal function was investigated in 18 children with moderately (51–85 ml/min/1.73 m² BSA) or severely (9–50 ml/min/1.73 m² BSA) reduced glomerular filtration rates (GFR). The GFR and effective renal plasma flow (ERPF), estimated as the clearances of respectively inulin and para-aminohippuric acid during uncontrolled (2-2.5 g/kg bw), low (1.2 g/kg bw for 12 days) and high (3–5 g/kg bw for 24 h) protein intake were determined by a standard clearance method employing continuous infusion and spontaneous voiding. There were no significant differences in GFR or ERPF during uncontrolled and low protein intake. During high protein intake the GFR and ERPF increased significantly in patients with GFRs above 50 ml/min/1.73 m² BSA and ERPFs above 150 ml/min/1.73 m² BSA. It is concluded that these findings might indicate a functional reserve capacity in children with only moderately reduced renal function.     

Effect of Hippotherapy on Motor Proficiency and Function in Children with Cerebral Palsy Who Walk

Aims: To evaluate the effects of hippotherapy on physical capacities of children with cerebral palsy. Methods: Thirteen children (4–12 years old) with cerebral palsy classified in Gross Motor Function Classification System Level I or II were included in this prospective quasi-experimental ABA design study. Participants received 10 weeks of hippotherapy (30 min per week). Gross motor function and proficiency were measured with the Bruininks–Oseretski Motor Proficiency short form [BOT2-SF]) and the Gross Motor Function Measure-88 [GMFM-88] (Dimension D and E) twice before the program (T1 and T1′), immediately after (T2), and 10 weeks following the end of the program (T3). Results: Mean scores for dimensions D and E of the GMFM-88 Dimension scores (p = .005) and three out of the eight items of the BOT2-SF (fine motor precision (p = .013), balance (p = .025), and strength (p = .012) improved between baseline and immediately after intervention; mean scores immediately following and 10 weeks following intervention did not differ. Conclusions: Hippotherapy provided by a trained therapist who applies an intense and graded session for 10 weeks can improve body functions and performance of gross motor and fine motor activities in children with cerebral palsy.