Excursion In Children Research Articles

Effect of Chest Resistance and Expansion Exercises on Respiratory Muscle Strength, Lung Function, and Thoracic Excursion in Children with a Post-Operative Congenital Diaphragmatic Hernia.

Background. Congenital diaphragmatic hernia (CDH) is a life-threatening condition with long-term complications including respiratory tract infections, respiratory muscle weakness, and abnormal lung functions. This study was designed to ascertain the effects of chest resistance and chest expansion exercises on respiratory muscle strength, lung function, and chest mobility in children with post-operative CDH. Methods. This randomized controlled clinical study was conducted in the outpatient physiotherapy clinic at Prince Sattam bin Abdulaziz University. Thirty-two children with CDH aged 10–14 years between May 2020 and February 2021 were randomly allocated to the study group (n = 16) and the control group (n = 16). The control group underwent a usual chest physiotherapy program; however, the study group underwent a 12-week chest resistance exercise combined with chest expansion exercise in addition to usual chest physiotherapy, with three sessions per week. Respiratory muscle strength, lung function, and thoracic excursion were assessed pre- and post-treatment. Results. Using the 2 × 2 repeated ANOVA, significant time × group interactions were detected in favor of the study group, FVC (F = 4.82, 95% CI = −15.6 to −0.97, p = 0.005, and η2 = 0.16), FEV1 (F = 4.54, 95% CI = −11.99 to −2.8, p ˂ 0.001, and η2 = 0.14), PImax (F = 5.12, 95% CI = −15.71 to −5.3, p ˂ 0.001, and η2 = 0.15), and thoracic excursion (F = 4.41, 95% CI = −2.04 to −0.16, p = 0.036, and η2 = 0.17). Conclusions. Concurrent chest resistance and expansion exercises may improve respiratory muscle strength, lung function, and thoracic excursion in children with post-operative CDH. The study findings suggest that concurrent chest and chest expansion exercises be part of an appropriate pulmonary rehabilitation program in children with a history of CDH.

Color tissue doppler imaging of tricuspid annular plane systolic and diastolic excursion in children: A comparison of normal, volume-overloaded and pressure overloaded right ventricles.

Tricuspid annular plane (TAP) systolic excursion (TAPSE) is a reproducible M-mode parameter for the measurement of longitudinal shortening of the right ventricle (RV). To date, all attention has been focused on the systolic excursion of TAP and the diastolic excursion of the annular plane back to the base has been ignored. This study aims to compare the quantitative (excursion, slope, and duration) and qualitative (velocity, acceleration, and indentation) characteristics of TAP systolic and diastolic excursion, using color tissue Doppler imaging, in three groups of children with normal RV (NORV), volume overloaded RV (VORV), and pressure overloaded RV (PORV) and normal pulmonary arterial pressure. A prospective case-control study was performed in three groups of children with normal heart, VORV and PORV. TAPSE and tricuspid annular plane diastolic excursion (TAPDE) were quantitatively and qualitatively analyzed and compared between the three groups. Statistical analysis was performed using IBM SPSS Statistics for Windows. TAPSE, TAPDE, TAPSE slope, TAPSE slope/TAPDE slope, TAPDE duration and TAPDE duration/RR interval were lower in PORV (TAPSE: PORV: 14.45±4.30, NORV: 20.45±5.46, P=.003, TAPDE:PORV: 14.39±4.61, NORV: 20.28±5.65, P=.004, TAPSE slope:PORV: 4.79±1.40, NORV: 7.15±1.98, P=.001, .001, TAPDE duration:PORV: 201.1±87.9 ms, NORV: 292.1±97.9, P=.006, TAPDE duration/RR interval: PORV: .37±.09, NORV: .48±.08, P=.0002). Pressure-overload on RV produced more impairment of TAPSE and TAPDE patterns than volume overload. Values of TAPSE and TAPDE in patients with VORV and PORV stay in two ends of the normal spectrum. The harmful impact of pre-tricuspid volume overload seems to be less than the post-tricuspid volume overload.

Tricusped Annular Plane Systolic Excursion in Children with ASD

Tricusped Annular Plane Systolic Excursion in Children with ASD

Tricusped Annular Plane Systolic Excursion in Children with ASD

Background: the complexity of estimating RV geometry and function was well documented and Tricusped Annular Plane Systolic Excursion (TAPSE) is one of the assessment tools of the right ventricle in adults. Aim Of the work: this study aimed to evaluate right ventricular (RV) function in children with atrial septal defect (ASD) and to determine whether TAPSE is an accurate marker of right ventricular (RV) systolic function in patients with atrial septal defect (ASD). Patients and methods: This retrospective study was conducted on 30 Egyptian children with age ranged from 2 months to 18 years of both sexes and they were categorized into two groups, 20 patients group with ASD and 10 control group; they were referred to Cardiology Unit of Al-Azhar University Hospitals in the period from December 2016 to December 2018. The ethics committee of Faculty of Medicine, Al-Azhar University approved this study after verbal and written consents from the parents of these children. All children were subjected to the clinical history, general examination, local examination, chest radiograph, electrocardiogram (ECG) and transthorathic echocardiography examination. Results: there was statistical significant difference in TAPSE results between ASD and non-ASD children, statistical significant difference in ECG finding between ASD and nonASD children, there was a statistical significant positive correlation between TAPSE and right ventricular fractional area changes (RVFAC) in the control group and a statistical significant negative correlation between TAPSE and left ventricle ejection fraction (LVEF). Conclusion: TAPSE is a good indicator for the right ventricular function in children with ASD and a good predictor for development of complications.

Contractile behavior of the medial gastrocnemius in children with bilateral spastic cerebral palsy during forward, uphill and backward-downhill gait

BackgroundPlantarflexor tightness due to muscle degenerations has been frequently documented in children with spastic cerebral palsy but the contractile behavior of muscles during ambulation is largely unclear. Especially the adaptability of gastrocnemius muscle contraction on sloped surface could be relevant during therapy. MethodsMedial gastrocnemius contractions were measured during flat-forward, uphill (+12% incline) and backward-downhill (−12% decline) treadmill gait in 15 children with bilateral cerebral palsy, walking in crouch, and 17 typically developing controls (age: 7–16years) by means of ultrasound and motion analysis. Tracked fascicle and calculated series elastic element length during gait were normalized on seated rest length. Additionally electromyography of the medial gastrocnemius, soleus and tibialis anterior was collected. FindingsDuring forward gait spastic gastrocnemii reached 10% shorter relative fascicle length, 5% shorter series elastic element length and showed 37% less concentric fascicle excursion than controls. No difference in eccentric fascicle excursion existed. Uphill gait increased concentric fascicle excursion in children with cerebral palsy and controls (by 23% and 41%) and tibialis anterior activity during swing (by 33% and 48%). Backward downhill gait more than doubled (+112%) eccentric fascicle excursion in cerebral palsy patients. InterpretationApart from having innately shorter fascicles at rest, flat-forward walking showed that spastic gastrocnemius fascicles work at shorter relative length than those of controls. Uphill gait may be useful to concentrically train push-off skills and foot lift. During backward-downhill gait the gastrocnemius functions as a brake and displays more eccentric excursion which could potentially stimulate sarcomere-genesis in series with repeated training.

Muscle and fascicle excursion in children with cerebral palsy

BackgroundFascicle length and fascicle excursion measurements in children with cerebral palsy have yielded inconsistent results. The purpose of this study was to measure in vivo passive fascicle lengths and fascicle excursions in the Medial Gastrocnemius muscle of children with cerebral palsy and typically developing controls. MethodsWe measured 11 children with spastic cerebral palsy and 14 controls between the ages of 9 and 16years. Ultrasound imaging was used to measure fascicle lengths while a dynamometer moved the ankle joint through the range of motion. A common range of motion for all subjects was used for analysis of fascicle excursion. FindingsFascicle lengths in children with cerebral palsy were 43% smaller than those for control subjects throughout the range of motion. The relative fascicle excursion was 92% greater on average for the cerebral palsy compared to the control group children. The muscle excursion for the control group children was greater than for the cerebral palsy group children. InterpretationSince the fascicles in children with spastic cerebral palsy are shorter, but they go through the same excursion as fascicles in typically developing children, sarcomeres within the medial gastrocnemius muscle must be working over a larger range of sarcomere lengths. Combined with findings of overstretched sarcomeres in spastic muscles reported in the literature, our results suggest that the increased passive forces and the weakness found in spastic muscles may be caused by a decrease in contractile filament overlap as sarcomeres are pulled to extreme lengths in children with cerebral palsy.

Both Dietary Protein and Fat Increase Postprandial Glucose Excursions in Children With Type 1 Diabetes, and the Effect Is Additive

OBJECTIVETo determine the separate and combined effects of high-protein (HP) and high-fat (HF) meals, with the same carbohydrate content, on postprandial glycemia in children using intensive insulin therapy (IIT).RESEARCH DESIGN AND METHODSThirty-three subjects aged 8–17 years were given 4 test breakfasts with the same carbohydrate amount but varying protein and fat quantities: low fat (LF)/low protein (LP), LF/HP, HF/LP, and HF/HP. LF and HF meals contained 4 g and 35 g fat. LP and HP meals contained 5 g and 40 g protein. An individually standardized insulin dose was given for each meal. Postprandial glycemia was assessed by 5-h continuous glucose monitoring.RESULTSCompared with the LF/LP meal, mean glucose excursions were greater from 180 min after the LF/HP meal (2.4 mmol/L [95% CI 1.1–3.7] vs. 0.5 mmol/L [−0.8 to 1.8]; P = 0.02) and from 210 min after the HF/LP meal (1.8 mmol/L [0.3–3.2] vs. −0.5 mmol/L [−1.9 to 0.8]; P = 0.01). The HF/HP meal resulted in higher glucose excursions from 180 min to 300 min (P < 0.04) compared with all other meals. There was a reduction in the risk of hypoglycemia after the HP meals (odds ratio 0.16 [95% CI 0.06–0.41]; P < 0.001).CONCLUSIONSMeals high in protein or fat increase glucose excursions in youth using IIT from 3 h to 5 h postmeal. Protein and fat have an additive impact on the delayed postprandial glycemic rise. Protein had a protective effect on the development of hypoglycemia.

Comparison of the Effect of Insulin Glulisine to Insulin Aspart on Breakfast Postprandial Blood Glucose Levels in Children with Type 1 Diabetes Mellitus on Multiple Daily Injections

ObjectiveRapid-acting insulins, including insulin aspart (NovoLog) and lispro (Humalog), do not seem to effectively control postprandial glycemic excursions in children with type 1 diabetes mellitus (T1DM). The objective of this study was to determine if insulin glulisine (Apidra), another rapid-acting insulin analog, would be superior in controlling postprandial hyperglycemia in children with T1DM. MethodsThirteen prepubertal children ages 4 to 11 years completed this study. Inclusion criteria included T1DM ≥6 months, glycosylated hemoglobin (HbAlC) 6.9 to 10%, blood glucose (BG) levels in adequate control for 1 week prior to study start, multiple daily injections (MDI) with insulin glargine or determir once daily and aspart or lispro premeal. If fasting BG was 70 to 180 mg/dL, subjects received insulin glulisine alternating with aspart prior to a prescribed breakfast with a fixed amount of carbohydrate (45, 60, or 75 g) for 20 days. Postprandial BG values were obtained at 2 and 4 hours. ResultsMean baseline BG values for insulin glulisine (136.4 ± 15.7 mg/dL; mean ± SD) and aspart (133.4 ± 14.7 mg/dL) were similar (P = .34). Mean increase in 2-hour postprandial BG was higher in glulisine (+113.5 ± 65.2 mg/dL) than aspart (+98.6 ± 66.9 mg/dL), (P = .01). BG remained higher at 4 hours (glulisine: 141.9 ± 36.5 mg/ dL, aspart: 129.0 ± 37.0 mg/dL) (P = .04). Although statistically insignificant, more hypoglycemic events occurred at 2-and 4-hours postprandial with insulin aspart. ConclusionInsulin aspart appears to be more effective than insulin glulisine in controlling 2-and 4-hour postprandial BG excursions in prepubertal children with T1DM. (Endocr Pract. 2013;19:614-619)

Effect of ankle-foot orthoses on trunk sway and lower limb intersegmental coordination in children with bilateral cerebral palsy

Ankle-foot orthoses may significantly improve lower limb kinematics in the gait of children with cerebral palsy. Here we aimed to analyze the effect of ankle-foot orthoses on trunk postural control and lower limb intersegmental coordination in children with mild spastic diplegia (GMFCS I or II). We recorded tridimensional trunk kinematics and thigh, shank, and foot elevation angles in 20 4-12 year-old children born preterm with spastic diplegia and 20 typically developing children while walking either barefoot or with ankle-foot orthoses. We found significantly greater trunk excursions in children with cerebral palsy compared to typically developing children in both conditions. When wearing ankle-foot orthoses cerebral palsy children showed increased trunk frontal angular velocity. No significant changes in trunk displacement and angular velocity were recorded in the sagittal plane in either group. Typically developing children wearing orthoses showed increased trunk frontal displacement. Wearing orthoses induced significant changes in shank and foot elevation in both groups. Ankle-foot orthoses affect postural control and intersegmental coordination in children with cerebral palsy. This should be taken into account when planning therapeutic management.

Impact of videogame playing on glucose metabolism in children with type 1 diabetes

Time spent playing videogames (VG) occupies a continually increasing part of children's leisure time. They can generate an important state of excitation, representing a form of mental and physical stress. This pilot study aimed to assess whether VG influences glycemic balance in children with type 1 diabetes. Twelve children with type 1 diabetes were subjected to two distinct tests at a few weeks interval: (i) a 60-min VG session followed by a 60-min rest period and (ii) a 60-min reading session followed by a 60-min rest period. Heart rate, blood pressure, glycemia, epinephrine (E), norepinephrine (NE), cortisol (F), and growth hormone (GH) were measured at 30 min intervals from -60 to +120 min. Non-parametric Wilcoxon tests for paired data were performed on Δ-values computed from baseline (0 min). Rise in heart rate (p = 0.05) and NE increase (p = 0.03) were shown to be significantly higher during the VG session when compared to the reading session and a significant difference of Δ-glycemic values was measured between the respective rest periods. This pilot study suggests that VG playing could induce a state of excitation sufficient to activate the sympathetic system and alter the course of glycemia. Dietary and insulin dose recommendations may be needed to better control glycemic excursion in children playing VG.

Change in Occlusal Contacts during Lateral Excursion in Children with Mixed Dentition

Change in Occlusal Contacts during Lateral Excursion in Children with Mixed Dentition

The Role of Amylin and Glucagon in the Dampening of Glycemic Excursions in Children With Type 1 Diabetes

Postprandial hyperglycemia and preprandial hypoglycemia contribute to poor glycemic control in type 1 diabetes. We hypothesized that postprandial glycemic excursions could be normalized in type 1 diabetes by suppressing glucagon with pramlintide acetate in the immediate postprandial period and supplementing glucagon in the late postprandial period. A total of 11 control subjects were compared with 8 type 1 diabetic subjects on insulin pump therapy, using the usual insulin bolus-to-carbohydrate ratio during a standard liquid meal. Type 1 diabetic subjects were then randomized to two open-labeled studies. On one occasion, type 1 diabetic subjects received a 60% increase in the insulin bolus-to-carbohydrate ratio with minidose glucagon rescue injections, and on the other occasion type 1 diabetic subjects received 30-45 microg pramlintide with their usual insulin bolus-to-carbohydrate ratio. Glucose, glucagon, amylin (pramlintide), and insulin concentrations were measured for 420 min. The plasma glucose area under the curve (AUC) for 0-420 min was lower in control versus type 1 diabetic subjects (316 +/- 5 vs. 929 +/- 18 mg x h(-1) x dl(-1), P < 0.0001). Pramlintide, but not an increase in insulin, reduced immediate postprandial hyperglycemia (AUC(0-180 min) 470 +/- 43 vs. 434 +/- 48 mg x h(-1) x dl(-1), P < 0.01). Pramlintide administration suppressed glucagon (P < 0.02), and glucagon injections prevented late hypoglycemia with increased insulin. In summary, in type 1 diabetes, glucagon modulation with pramlintide as an adjunct to insulin therapy may prove beneficial in controlling postmeal glycemic swings.

Characteristics of condylar movement during lateral excursion in children with early mixed dentition

Evaluation of the function of the temporomandibular joint in healthy children is important. The purpose of this study was to investigate characteristics of condylar movement during lateral excursion in children in consideration of the differences of jaw length and jaw width between children and adults. Eighteen healthy subjects (thirty-six joints total) with normal occlusion were divided into two age groups: early mixed dentition group (4 boys, 5 girls, 8-10 years old, mean 8 years 11 months) and permanent dentition group (2 men, 7 women, 23-28 years old, mean 25 years 9 months) . Jaw movements were measured with 6 degrees of freedom jaw tracking device. Characteristics of condylar movement in children were investigated by three-dimensional condylar path distance during lateral excursion. The lateral excursion was done from the intercuspal position. The distance of condylar path was calculated at 1.0 mm interval from 1.0 to 5.0 mm of incisal path (D100%) . Furthermore, the distance of condylar path was calculated at 0.9 mm interval from 0.9 to 4.5 mm of incisal path (in children only, D90%) in consideration of the differences of jaw length and jaw width between children and adults. The distance between incisal point and anatomical center point of condyle (IP-CP) and the distance between left side anatomical center point of condyle and right side anatomical center point of condyle (LCP-RCP) were significantly smaller in children than in adults. IP-CP and LCP-RCP in children were about 90% of those in adults. The distance of working condylar path was significantly larger in children than in adults when the distance of incisal path was at D100% and D90%. The distance of working condylar path did not show significant correlation with both the jaw length and the jaw width in children. These results suggest that the working condylar movement during lateral excursion in children has higher mobility than that of adults without it is influenced by difference of jaw size between children and adults.

Occlusal contacts during lateral excursions in children with primary dentition.

The presence of non-working occlusal contacts in adults is considered abnormal and may initiate parafunctional activity. Few studies have looked for non-working occlusal contacts in children with primary dentition. The purposes of this study were (1) to prove the existence of non-working-side occlusal contacts, and (2) to quantify their area during lateral excursion in children with primary dentition. To achieve this purpose, we developed a measurement system that combined a tracking system for mandibular movements with a three-dimensional digitizer for tooth shape. Ten children were selected for this study. Estimated occlusal contact area of the primary second molar on the non-working side was 0.8 mm2, in contrast to 2.0 mm2 on the working side, at 3.0 mm of movement of the lower incisor. All children examined had some occlusal contacts on the non-working side during the first part of lateral excursion.

The Development of An Analyzing System of Multiple Points for Mandibular Movements using Selspot and Its Application to Lateral Excursions in Children with Primary Dentition

The Development of An Analyzing System of Multiple Points for Mandibular Movements using Selspot and Its Application to Lateral Excursions in Children with Primary Dentition