Muscle Strength In Children Research Articles

The relationship between the backward walking and proprioception, trunk control, and muscle strength in children with cerebral palsy.

This study was planned to determine the factors affecting backward walking in children with cerebral palsy (CP). The study included 30 children with CP, with a mean age of 10.43 ± 2.76years. Backward walking abilities were evaluated with the 3-Meter Back Walk Test (3MBWT). A digital goniometer was used to evaluate proprioception, the Trunk Control Measurement Scale (TCMS) was used for trunk control, a digital muscle dynamometer was used for muscle strength, and the Gillette Functional Assessment Questionnaire (FAQ) was used for gait evaluation. When the spasticity of children at levels I and II according to the Gross Motor Function Classification System (GMFCS) was compared, a significant difference was found in favor of level I in hamstring, gastro-soleus, and gastrocnemius spasticity (p < 0.05). When the results of the 3MBWT, TCMS, and FAQ were compared, a significant difference was found in favor of level I (p < 0.05). No significant relationship was revealed between the 3MBWT and lower extremity proprioception and TCMS (p > 0.05). A significant negative correlation was observed between the 3MBWT and FAQ (p < 0.05). No significant correlation was found between the 3MBWT and lower extremity muscle strengths (p > 0.05). A significant positive correlation was found only between hip extension proprioception and iliopsoas muscle strength (p = 0.023). There was no significant correlation between the FAQ and lower extremity muscle strength (p > 0.05). It was revealed that the backward walking ability increased as the forward walking function improved in children with CP, but it was not affected by proprioception, trunk control, and muscle strength. NCT05088629 (10/11/2021).

The Effect of Eight Weeks of Aquatic Exercises on Muscle Strength in Children with Cerebral Palsy: A Case Study.

Cerebral palsy in children is considered a non-progressive brain injury due to abnormal brain development. The aim of this study was to investigate the effect of eight weeks of aquatic exercises on muscle strength in children with cerebral palsy. This study was performed on three boys with cerebral palsy with a mean age of 6.5 years. In this research, a single case study method with A1-B-A2 design has been used. After determining the position of the baseline, the intervention began and during 24 sessions of individual intervention, aquatic exercises were presented to the subjects and all three subjects were followed up for 2 consecutive weeks and one month after the end of the intervention. The strength of the flexor muscles of the arms and legs was measured by a power track dynamometer made by JTECK with a threshold of 4.4 N. Based on the indicators of descriptive statistics and visual analysis, the intervention was effective for all three participants in muscle strength, and the strength of individuals after the intervention has improved compared to the baseline stage (percentage). Information overlap for the first and second participant in the strength of right thigh flexors was 75% and for the third participant was 100%. The strength of the upper and lower torso muscles improved after the end of the training compared to the basic stage. Aquatic exercises can increase the strength of children with cerebral palsy and provide a favorable environment for children with cerebral palsy.

Effects of Exercise Training on Peripheral Muscle Strength in Children and Adolescents with Cystic Fibrosis: A Meta-Analysis.

Background: Exercise training is a cornerstone of care for people with cystic fibrosis (pwCF); it improves exercise capacity and health-related physical fitness, but no meta-analysis has investigated its effects on muscle function in young pwCF. The objective of this meta-analysis was to assess the effects of exercise on peripheral muscle strength in young pwCF. Methods: An electronic search was conducted in four databases (Pubmed, Science Direct, CENTRAL, and PEDRO) from their inception to July 2022. Grey literature databases (OpenGrey, the European Respiratory Society, the American Thoracic Society, and the European Cystic Fibrosis Society) were also consulted. Randomized controlled trials comparing any type of exercise with standard care in young pwCF (5 to 19 years old) were included. Two authors independently selected the relevant studies, extracted the data, assessed the risk of bias (using the Rob2 tool), and rated the quality of the evidence. Results: Ten studies met the inclusion criteria, involving 359 pwCF. Exercise training improved both lower and upper limb muscle strength (SMD 1.67 (95%CI 0.80 to 2.53), I2 = 76%, p < 0.001 and SMD 1.30 (95%CI 0.66 to 1.93), I2 = 62%, p < 0.001, respectively). Improvements were also reported in muscle mass and maximal oxygen consumption. Results regarding physical activity levels were inconclusive. The overall risk of bias for the primary outcome was high. Conclusions: Exercise training may have a positive effect on peripheral muscle strength in young pwCF. The evidence quality is very low and the level of certainty is poor. There is a need for high-quality randomized controlled studies to confirm these results.

Concurrent Validity of Lower Limb Muscle Strength by Handheld Dynamometry in Children 7 to 11 Years Old.

The assessment of pediatric muscle strength is necessary in a range of applications, including rehabilitation programs. Handheld dynamometry (HHD) is considered easy to use, portable, and low cost, but validity to measure lower limb muscle strength in children has not been assessed. To determine the concurrent validity of lower limb torque from HHD compared with isokinetic dynamometry (ID) in children aged from 7 to 11years old. A descriptive assessment of concurrent validity of lower limb joint torques from HHD compared with ID. Sixty-one typically developing children underwent assessment of maximal hip, knee, and ankle isometric torque by HHD and ID using standardized protocols. Joint positions were selected to represent maximal strength and were replicated between devices. Concurrent validity was determined by Pearson correlation, limits of agreement, and Bland-Altman plots. Correlations between HHD and ID were moderate to large for knee extension (r 95% CI, .39 to .73), small to large for plantar flexion (r 95% CI, .29 to .67), knee flexion (r 95% CI, .16 to .59), hip flexion (r 95% CI, .21 to .57), hip extension (r 95% CI, .18 to .54), and hip adduction (r 95% CI, .12 to .56), and small to moderate for dorsiflexion (r 95% CI, -.11 to .39) and hip abduction (r 95% CI, -.02 to .46). Limits of agreement for all joint torques were greater than 10% indicating large error in HHD measured torque compared with ID. A positive proportional bias was detected for plantarflexion, indicating that HHD underestimated torque to a greater extent in participants with higher torque values. Maximal torque values from HHD and ID are consistent with those previously reported in the literature. Poor concurrent validity of HHD may have arisen from issues around joint position, joint stabilization, and the experience of the tester to prevent an isokinetic contraction. Pediatric lower limb muscle strength assessed by HHD should be interpreted with caution.

Peripheral and respiratory muscle strength in children and adolescents with CHD: systematic review and meta-analysis.

Patients with CHD are less active if compared with controls and have limited functional capacity, related to muscle weakness and fatigue. The aim of this study was to evaluate the peripheral and respiratory muscle strength of children and adolescents with CHD with systematic review and meta-analysis. The review included observational and randomised control trial studies which evaluated peripheral and respiratory muscle strength in children and adolescents with CHD under 18 years old. The peripheral muscle strength was evaluated through dynamometry and respiratory muscle strength through manovacuometry. In studies that compared patients with CHD and respective control groups, it was possible to perform a meta-analysis. A total of 5634 articles met the criteria of eligibility, 15 were included in the systematic review, and 4 were included in the meta-analysis. Twelve studies assessed peripheral muscle strength with a reduction in patients with CHD. In the meta-analysis, patients with CHD had lower muscle strength than controls (-34.07 nm; 95% CI, -67.46 to -0.68; I2 47%; p for heterogeneity = 0.05), and the meta-analysis of the handgrip muscle strength showed no significant difference between patients with CHD and controls (0.08 nm; 95% CI, -6.39 to 6.55; I2 98%; p for heterogeneity <0.00001). The meta-analysis in the present study showed lower limb muscle strength in patients with CHD in comparison to controls. In contrast, no difference was found regarding hand grip strength. Also, the review showed lower respiratory muscle strength in patients with CHD, yet no meta-analysis was possible to perform.

Progressive resistance training for children with cerebral palsy: A randomized controlled trial evaluating the effects on muscle strength and morphology.

Children with spastic cerebral palsy often present with muscle weakness, resulting from neural impairments and muscular alterations. While progressive resistance training (PRT) improves muscle weakness, the effects on muscle morphology remain inconclusive. This investigation evaluated the effects of a PRT program on lower limb muscle strength, morphology and gross motor function. Forty-nine children with spastic cerebral palsy were randomized by minimization. The intervention group (nparticipants = 26, age: 8.3 ± 2.0 years, Gross Motor Function Classification System [GMFCS] level I/II/III: 17/5/4, nlegs = 41) received a 12-week PRT program, consisting of 3-4 sessions per week, with exercises performed in 3 sets of 10 repetitions, aiming at 60%–80% of the 1-repetition maximum. Training sessions were performed under supervision with the physiotherapist and at home. The control group (nparticipants = 22, age: 8.5 ± 2.1 year, GMFCS level I/II/III: 14/5/3, nlegs = 36) continued usual care including regular physiotherapy and use of orthotics. We assessed pre- and post-training knee extension, knee flexion and plantar flexion isometric strength, rectus femoris, semitendinosus and medial gastrocnemius muscle morphology, as well as functional strength, gross motor function and walking capacity. Data processing was performed blinded. Linear mixed models were applied to evaluate the difference in evolution over time between the control and intervention group (interaction-effect) and within each group (time-effect). The α-level was set at p = 0.01. Knee flexion strength and unilateral heel raises showed a significant interaction-effect (p ≤ 0.008), with improvements in the intervention group (p ≤ 0.001). Moreover, significant time-effects were seen for knee extension and plantar flexion isometric strength, rectus femoris and medial gastrocnemius MV, sit-to-stand and lateral step-up in the intervention group (p ≤ 0.004). Echo-intensity, muscle lengths and gross motor function showed limited to no changes. PRT improved strength and MV in the intervention group, whereby strength parameters significantly or close to significantly differed from the control group. Although, relative improvements in strength were larger than improvements in MV, important effects were seen on the maintenance of muscle size relative to skeletal growth. In conclusion, this study proved the effectiveness of a home-based, physiotherapy supervised, PRT program to improve isometric and functional muscle strength in children with SCP without negative effects on muscle properties or any serious adverse events. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03863197.

Reduction of Exercise Capacity, Respiratory and Peripheral Muscle Strength in Severe Asthma

Background: Patients with severe asthma need to be studied separately due to differences from less severe asthma. This is the first study to carry out a wide physical evaluation of children and adolescents with severe asthma. The objective was to evaluate maximal and submaximal exercise capacity, respiratory and peripheral muscle strength in children and adolescents with severe asthma. Methods: The study included children and adolescents (6 to 18 years) diagnosed with severe asthma, controlled in the last 4 weeks. The maximal exercise capacity was measured by the modified shuttle test (MST) and submaximal by the 6-min walk test. Respiratory muscle strength was evaluated by measuring maximal respiratory pressures and the peripheral strength through a handgrip. Results: Thirty patients were included, with mean age of 10.3 years, 63% female and 46.7% overweight or obese. Patients underperformed but reached more than 80% of expected in all evaluations. There was a moderate correlation between age and body mass index (BMI) with MST, maximal expiratory pressure and peripheral muscle strength. The correlation between MST and BMI was negative. There was a strong correlation between peripheral muscle strength and age. Peripheral muscle strength also correlated moderately with respiratory muscle strength and lung function. Conclusion: Children and adolescents with severe asthma had lower maximal and submaximal exercise capacity and reduced peripheral and respiratory muscle strength. These results are slightly below normal and very similar to patients with less severe asthma, allowing us to infer that patients with severe asthma have a good functional condition when the disease is controlled. Int J Clin Pediatr. 2022;11(3):76-84 doi: https://doi.org/10.14740/ijcp477

Virtual reality versus whole body vibration on quadriceps muscle strength in children with thigh burn

Background: Burn is an injury caused by biological, chemical, electrical and physical agents with local and systemic repercussions. It is one of the most significant health problems throughout the world, leading to prolonged hospitalization and hence increased expense for the patients, their families and society. Today, the prognosis of patients with burn is dependent, apart from adequate treatment, upon the health-care system and health-care professionals, regarding not only survival, but also lifelong quality. Objective: this study was conducted to compare between the effect of virtual reality and whole body vibration as two methods of proprioceptive stimulation on quadriceps muscle strength in children with thigh burn. Subjects and procedures: forty children with unilateral thermal burn of the thigh ranged in age from six to twelve years participated in this study. They were divided randomly into two study groups I and II respectively. Study group I was treated by whole body vibration program in addition to conventional physical therapy program while the study group II was treated by a Wii-fit therapy program (as a form of virtual reality treatment program) in addition to the same conventional physical therapy program given to study group I.

Functional progressive resistance exercise versus eccentric muscle control in children with hemiplegia: a randomized controlled trial

BackgroundHistorically, strength exercise in children with CP is not recommended, because it may develop spasticity, which results in difficulty with walking. But, recently increasing studies and systemic reviews have reported that strength exercise can promote muscle strength in children with CP with no negative impact on spasticity. The study is aiming to compare the effect of functional resistance exercise and functional eccentric training on dynamic balance and functional ability in children with hemiplegia. For this purpose, forty participating children diagnosed with spastic hemiplegia were included and their ages ranged from 6 to 13 years. They were randomly allocated into two groups: functional resistance exercise (group I) or eccentric muscle control exercise (group II). The training was conducted three times a week for 6 weeks for both groups. Each group received one of the interventions in addition to designed physical therapy programs. Functional ability and dynamic balance were measured before and after 6 weeks of the intervention by gross motor function measure and functional reach test.ResultsComparison between the two groups before treatment revealed no significant difference in all values of functional ability and dynamic balance. But comparison after treatment in values showed significant improvement in both groups with greater improvements in favor of group I (p < 0.01).ConclusionAdding both functional resistance exercise and eccentric muscle control exercise is beneficial for improving functional ability and dynamic balance with more recommendation for adding functional resistance exercise that showed more significant improvement than eccentric muscle control in children with hemiplegia.

Effects of a Whole-body General Movement Intervention on Functional Muscle Strength of Children With Autism Spectrum Disorder: Results From a Comparison of Face-to-face Versus Telehealth-Based Intervention Delivery

Background Children with autism spectrum disorder (ASD) demonstrate impairments in postural strength and control, both of which are important for activities of daily living. With the onset of the COVID-19 pandemic, more focus has been placed on telehealth interventions. Objective Our randomized controlled trial assessed the effects of a general movement (GM) intervention compared to a standard-of-care seated play (SP) intervention delivered via face-to-face (F2F) and telehealth (TH)-based modes of intervention delivery in children with ASD. Methods Thirty 5- to 14-year-old children were matched at baseline and randomly assigned to the GM or SP groups. Children participated in a 10-week study with pretests and posttests conducted during the first and last weeks and training in the intermediate 8 weeks (2 sessions/week at 1.5 hours/session). The strength subtest of the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) and a custom-developed functional strength test were administered at pretest and posttest. In addition, we assessed functional strength using 15 upper and lower body exercises that were administered during early and late training sessions. All strength tests were coded for errors in movement form and movement quality during execution. Results On the BOT-2, the GM group (pretest: mean 8.3, SE 1.1; posttest: mean 10.31, SE 1.3; P=.007) but not the SP group showed improvements in scaled scores on the strength subtest. There were no differences in the amount of change for children seen F2F versus TH in the GM group (F2F: mean 2.3, SE 0.8; TH: mean 1.8, SE 0.9; P=.70). In the GM group, 77% of participants showed improvement in front raises and 50% improved on both sumo squats and donkey kicks. Of the 15 upper and lower body functional strength exercises performed, 7 provided significant results at a significance level of P=.05. For the upper body, these included back row (early: mean 81.3, SE 4.6; late: mean 57.0, SE 7.8; P=.01), spread your wings (early: mean 55.5, SE 6.0; late: mean 32.1, SE 5.4; P=.008), press ups (early: mean 72.1, SE 5.3; late: mean 46.8, SE 8.0; P=.01), and superman reach (early: mean 74.4, SE 2.8; late: mean 58.9, SE 6.8; P=.009). For the lower body, these included donkey kicks (early: mean 69.2, SE 2.9; late: mean 40.2, SE 6.0; P&lt;.001), do-a-dot (early: mean 77.4, SE 3.3; late: mean 56.3, SE 6.3; P=.008), and superman kick (early: mean 71.9, SE 2.9; late: mean 49.8, SE 6.8; P=.008). Across all 7 moves, a comparable or higher proportion of children seen via TH showed improvement in movement performance scores compared to children seen F2F. For 6 of 7 movements, the mean reduction in percent movement performance errors (early vs late) was greater for children seen via TH compared to children seen via F2F. In addition, for superman kick (sk), donkey kick (dk), press ups (pu), and superman reach (sr) exercises, a higher proportion of children seen via TH compared to F2F improved movement performance error scores with training (sk: 80% TH vs 50% F2F; dk: 90% TH vs 60% F2F; pu: 100% TH vs 50% F2F; sr: 90% TH vs 25% F2F). Conclusions Although preliminary, our data suggest that TH is an effective mode of delivery of gross motor interventions and can be used to promote functional upper and lower body muscle strength in children with ASD.

Alterations of hand muscle strength in children due to schoolbag carriage

BACKGROUND: Heavy schoolbag carriage induces pain and fatigue in children. It can alter the handgrip strength (HGS) in children – an important parameter given that most activities in school curriculum require hand dexterity. The purpose of this study is to explore if and how schoolbag carriage influence HGS in children. MATERIALS AND METHODS: Twenty-five healthy male participants (10–15 years) walked without schoolbag (0% load of bodyweight) or with schoolbags (weighing 4%, 8%, 12%, or 16% of their bodyweight) for 20 min on plane surface at preferred pace. The number of steps taken during walk was measured using pedometer. HGS was measured before and after each walk using dynamometer. The heart rate during walk was measured using Polar HR monitor. Pain occurrence in the entire body was mapped. RESULTS: HGS averaged for both hand decreased from 17.8 (±6.72) kg to 17.3 (±6.28) kg after 20-min walk (P = 0.033, paired sample t-test). The adopted speed and heart rate was higher when carrying a schoolbag but it portrayed no significant association with HGS. Occurrence of shoulder pain significantly associated with increasing in HGS of right hand after walking (Phi coefficient = 0.21[P = 0.030]). If shoulder pain was perceived during walk, there was a 2.5 times higher likelihood that the participants' HGS for right hand increased (odd's ratio = 2.515, 95% confidence interval = 1.086–5.825). CONCLUSION: Schoolbag carriage reduces HGS in children. Therefore, performing upper body conditioning exercises may help ameliorate the ill effects of heavy backpack carriage.

Exposure to mixture of heavy metals and muscle strength in children and adolescents: a population-based study

Human beings are exposed to heavy metals through various ways in daily life. However, the effect of heavy metal mixtures on muscle strength in children and adolescents remains unclear. We aimed to investigate the relationship of exposure to heavy metal mixtures (barium, cadmium, cobalt, manganese, molybdenum, lead, antimony, strontium, tin, thallium, tungsten, uranium, and cesium) with muscle strength in children and adolescents. A total of 1357 (boys, 50.8%) participants aged between 8 and 17 were extracted from the National Health and Nutrition Examination Surveys 2011-2014. Urine metals were measured by inductively coupled plasma-mass spectrometry. Muscle strength was measured through a grip test using a handgrip dynamometer. Weighted quantile sum regression was performed to estimate the mixture effect of urinary metals on muscle strength. After adjusting for potential confounders, comparing participants in the highest versus lowest quartiles of cobalt, molybdenum, lead, antimony, strontium, thallium, and cesium, the handgrip strength decreased by - 4.48kg (95% CI: - 6.93, - 2.03), - 6.13kg (- 8.76, - 3.51), - 2.26kg (- 4.22, - 0.30), - 2.38kg (- 4.68, - 0.08), - 2.29kg (- 4.45, - 0.13), - 4.78kg (- 7.13, - 2.44), and - 5.68kg (- 9.20, - 2.17), respectively. Furthermore, exposure to a mixture of metals were also significantly associated with decreased muscle strength (β: - 2.62kg; 95% CI: - 3.71, - 1.54). Findings from the present study suggest that higher heavy metal exposure and the exposure levels of a mixture of metals in urine are inversely related to handgrip strength, implying that children's grip strength is not entirely explained by energy intake or lack of exercise, but may be related to environmental pollutants.

Effects of Augmented Reality Intervention on the Range of Motion and Muscle Strength of Upper Extremity in Children with Spastic Hemiplegic Cerebral Palsy: A Randomized Clinical Trial.

Objective: To determine the effects of augmented reality (AR) interventions on the upper extremity's (UE's) range of motion (ROM) and muscle strength in children with spastic hemiplegic cerebral palsy (SHCP). Materials and Methods: Thirty children with SHCP, aged 6 to 12 years, were randomly divided into three interventional groups. Each group received an AR game that is, Balance It, Bubble Pop, or Scoop'd (WonderTree, Pakistan). The UE's ROM and muscle strength were assessed at the baseline and after 8 weeks of intervention through goniometer and manual muscle testing, respectively. Paired-sample t-test and Wilcoxon signed-rank test were used for analyzing the changes in ROM and muscle strength within the groups respectively. One-way analysis of variance (ANOVA) and Tukey's test were used for the differences in ROM, whereas the Kruskal-Wallis test was used for the differences in muscle strength, between the groups. Results: Within-group analysis revealed that all the groups significantly improved in ROM of the majority of joints and in the strength of various muscles of UE (P < 0.05). The elbow extension ROM was significantly different when a comparison was made between the interventional groups (P < 0.05). Balance It group showed more significant improvement in the elbow extension ROM as compared with the Scoop'd group. However, the comparison between the groups showed no significant difference in the muscle strength of UE (P > 0.05). Conclusion: The AR games intervention was beneficial and effective for improving the ROM of majority of the joints and strength of various muscles of UE in children with SHCP. Clinical Trial Registration number: NCT04171232.

Effect of Integrated sensory-motor Training on muscular strength in Educable Mental Retardation Students

Today, in all human societies, exceptional people, especially people with intellectual disability are regarded. Students and children mentally retarded in physical skills such as strength have serious shortcomings. This study aimed town to investigate the effect of sensory-motor training on muscle strength in children with educable mental retardation. A quasi-experimental study was conducted. Thirty mentally retarded girls from primary school were selected through purposive sampling. Then, they were homogenized based on their pretest scores and were divided into two groups: fifteen experimental & fifteen control. That because of the evaluating reduction, the number of the control group reached ten. In this research, A Dynamometer and vertical jump test- was used to test physical strength. Sensory stimulation and physical exercises were practiced by the experimental group during twenty-four sessions. Each session was forty-five minutes long and was held three times a week. The control group performed the class programs. After twenty-four sessions both groups were tested. To investigate the research hypothesis Paired T-test and ANOVA2 × 2 and by SPSS software (version 21) were used. There were no significant differences between the two groups with regard to improving the muscle strength (p>0.05). Statistical results showed no significant differences between the two groups with regard to improving the muscle strength. Although applying the integrated sensory- motor is common among occupational therapists, it does not yield satisfactory results for muscle strength, according to the results of this study. Simultaneous utilization of other reference frames beside the sensory-motor Integration may result in better outcomes.

Does antiretroviral therapy change the relationship between body composition and muscle strength in children and adolescents diagnosed with HIV?

Background: HIV infection and prolonged use of antiretroviral therapy (ART) can impact the body composition and muscle strength of HIV-infected children and adolescents. Therefore, the aim was to verify the association between lean soft tissue mass (LSTM) and handgrip strength (HGS) in children and adolescents diagnosed with HIV using or not using ART (with or without protease inhibitors [PI]). Method: Cross-sectional study with 65 children and adolescents diagnosed with HIV aged 8–15 years of both sexes. LSTM was obtained through dual X-ray absorptiometry (DXA) and HGS using hydraulic dynamometer. Information on viral load, CD4+ T lymphocytes and type of ART (with or without [PI]) were obtained from medical records. Simple and multiple linear regression (adjusted for viral load and CD4+ T lymphocytes) was used, with p < 0.05. Results: For children and adolescents diagnosed with HIV using ART without PI, the model (LSTM, viral load and CD4+ T lymphocytes) explained 68% of HGS variability. For group with ART and PI, the model explained 73%. For group that did not use ART, the model was not associated with HGS. Conclusion: The magnitude of the association between LSTM and HGS was greater than in children and adolescents using ART with PI. Impact It is recognized that in the long-term antiretroviral drugs can negatively impact the body composition of children and adolescents diagnosed with HIV. However, few studies have investigated the short-term impact of drug use. The use of antiretroviral therapy (ART) with protease inhibitor (PI) increased the explanatory power of lean soft tissue mass with muscle strength in children and adolescents diagnosed with HIV. These results demonstrate the importance of antiretroviral drugs in the short term. Further studies are needed to identify how and when interventions are needed to reduce the negative effects of drugs in the long term.

The Effectiveness of Physical Therapy in Improving Muscle Strength in Children with Down Syndrome

Increasing muscle strength in the treatment of Down syndrome represents an important stage of the intervention plan, because one of the symptoms of this disorder is a generalized hypotonia. The study was conducted on 13 patients diagnosed with Down syndrome, the physical therapy strategy envisaging the improvement of muscle strength, both analytically, on muscle groups, and globally, by using therapeutic physical exercises. At the end of the physical therapy, all of the manually tested muscles (the biceps brachii, the triceps brachii, the latissimus dorsi, the rhomboids, the quadratus lumborum, the pectoralis major, the gluteus maximus, the iliopsoas, the pelvitrochanteric muscles, the adductor muscles, the tensor fascia lata, the quadriceps, the hamstrings, the sartorius, the triceps surae, the tibialis anterior, and the peroneus muscles) changed their scores, from some initial values between 3.08 and 3.77 points, to final values between 4-02 and 4.50 points, which showed a good muscle tonicity, the children succeeding in performing their usual activities with better precision and coordination.

Correlation between age, muscle architecture, and muscle strength in children with Erb\u2019s palsy

BackgroundMuscle weakness is a widespread problem in children with Erb’s palsy as it can cause changes in muscle architecture parameters, which can be detected by ultrasonography. This study was conducted to determine the relation between age, muscle architecture, and muscle strength in children with Erb’s palsy. A total of 40 children with Erb’s palsy from both sexes aged 1–2.5 years were included in this study. Muscle thickness and pennation angle were measured by ultrasonography, and muscle strength was measured using the active movement scale.ResultsA significant relation was found between age, muscle thickness, pennation angle, and muscle strength (P < 0.05). Moreover, a significant difference was found in muscle architecture parameters during relaxation and contraction in both study groups and in each study group (P < 0.05).ConclusionMuscle weakness in children with Erb’s palsy has an effect on muscle architecture parameters, and these parameters also increase with age.

Effect of Laser Acupuncture on the Power of Lower Limb Muscles in Children with Spastic Cerebral Palsy

Abstract Background: Cerebral palsy (CP) is defined asneurode-velopmental disorder that occurs due to disturbance in the development of the central nervous system. Laser acupuncture is a technique with minimal side effects and safe for chil-drenand can be used as an alternative line of treatment in several chronic pediatric diseases. Aim of Study: To assess the efficacy of using a six weeks course of laser acupuncture on muscle strength in children with diplegic or quadriplegic cerebral palsy. Patients and Methods: A randomized controlled trial; that was conducted in the neuropediatric clinic of the National Research Centre, Egypt and Outpatient Clinic of Ain Shams Children Hospital from 2018 to February 2020. It included 40 children with spastic CP. They were randomly assigned to two equal groups (n=20), laser acupuncture group and control group. Both groups received physiotherapy for successive 6 weeks; while only the study group also received low-level laser 650nm with 50mW powers that was applied at each acupoint for 30s giving an energy density of 1.8J/cm2). Results: Power of hip flexors and knee extensors were significantly increased in laser acupuncture group compared to the control group, p < 0.001. Conclusion: Laser acupuncture has a beneficial effect on hip flexors and knee extensors muscles strength compared with the control group in children with spastic cerebral palsy.

Effects of Physical Therapist Intervention on Pulmonary Function in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis.

The purpose of this study was to evaluate the effects of physical therapy on pulmonary function and respiratory muscle strength in children with cerebral palsy (CP). A search of 10 databases was conducted for this systematic review. Initially, there were no language, study design, or time frame restrictions. All studies assessing the effect of physical therapy on the respiratory system in children with CP were included. Two reviewers independently extracted and documented data. The data extracted included description of the intervention (duration, therapeutic method) and study results (change of spirometric parameters, respiratory muscle strength). The effects of physical therapist treatment were calculated using software. A total of 269 children aged 5 to 18 years from 10 studies were included. The included studies consisted of 5 different therapeutic methods (inspiratory muscle training [IMT], aerobic training, swimming, respiratory exercise, exercise with elastic bands). Physical therapist intervention led to a significant increase in the maximal expiratory pressure (MEP) (I2 = 0%), peak expiratory flow (I2 = 0%), and maximum oxygen consumption (I2 = 37%). A separate analysis of the most frequently used therapy (IMT) showed a positive effect on MEP (I2 = 0%) and maximal inspiratory pressure (I2 = 35%). Various forms of physical therapy have potential to demonstrate a positive effect on maximal inspiratory pressure, MEP, and peak expiratory flow in children with CP. There is no possibility to recommend the best method and duration of the physical therapy; however, it can be suggested that physical therapy should be applied for at least 4 weeks and include IMT. CP is one of the most common causes of physical disabilities in children, and pulmonary dysfunction is the leading cause of death in people with CP. Thus, it is warranted to seek different approaches that may improve pulmonary function in people with CP. This review has shown that various forms of physical therapy have potential to improve the pulmonary function of children with CP.

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.