Walking In Children Research Articles

Walking effects on memory in children: Implications for individual differences in BMI

BackgroundRecent evidence suggests improvements in memory performance following a single bout of physical activity in young children. However, few investigations have explored individual differences associated with these activity-induced changes in memory performance. ObjectivesThe present study investigated the effects of acute physical activity on recognition memory during and after treadmill walking in preadolescent children (n = 39; 24 females) with further exploration of individual differences in body mass index (BMI). MethodsWord recognition memory performance was assessed during and after the cessation of a moderate bout of walking (60% heart rate max; 20-min duration) or seated rest on separate days. ResultsChildren demonstrated unaltered word recall performance during walking compared to seated rest. Additionally, performance after walking revealed greater improvements in primacy accuracy (probability of correctly identifying the first ten words) relative to during walking and after seated rest. Additionally, evaluating only children who are overweight/obese (≥85th BMI percentile) revealed greater improvements in primacy accuracy following the walking bout with no effect observed for the normal weight group. ConclusionsTogether, these findings demonstrate that single bouts of walking are more effective for improving memory performance than non-active rest periods of a similar duration and may be enhanced to a greater degree among children who are overweight/obese. Such findings add to the growing body of literature supporting the need for active opportunities among all youth and further indicate the importance of advancing such opportunities among overweight/obese children to improve memory performance along with physical health.

Flip-flops do not alter the neuromuscular function of the gastrocnemius muscle and tendon during walking in children

Introduction/Aim: Flip-flops are a popular choice of footwear for children. However, their inherent design provides minimal support to the foot and ankle and has been suggested to increase the work performed by muscle and tendon structures, potentially predisposing them to injury. Therefore, the aim of this study was to compare the length change behaviour of the medial gastrocnemius (MG) muscle fascicles and muscle tendon unit (MTU) and their mechanical function at the ankle and subtalar joints in children during walking with and without flip-flop. Methods: Eight healthy children walked barefoot and with flip-flops whilst 3D gait analysis and simultaneous B-mode ultrasound images of the MG fascicles during level walking were collected. Joint kinematics, kinetics and MTU lengths were analysed using musculoskeletal modelling and fascicle lengths using a semi-automated tracking algorithm. Results: The muscles and tendons across the ankle absorbed greater amounts of power during barefoot walking compared to flip-flop walking. The muscle activations of the lateral gastrocnemius, soleus and tibialis anterior remained invariant across the conditions as did the activation, and fascicle length change behaviour of the medial gastrocnemius. In the barefoot condition, there was a trend of greater MTU lengthening, to potentially absorb greater amounts of power, although no differences in shortening was observed during late stance. Conclusion: Walking with flip-flops does not increase the mechanical work performed by the MG muscle at the ankle and subtalar joints, suggesting that flip-flops do not increase the stresses and strains of the Achilles tendon and hence its predisposition to strain induced injury. Instead, our results suggest that flip-flops, act as a compliant surface and absorb energy during contact and hence the strain experienced by the Achilles tendon.

Evaluation of CTEV Management in Children's Walking Ability Assessed by "BANGLA" Club Foot Tool Score System

Abstract
 Congenital talipes equinovarus (CTEV) or clubfoot is a congenital deformity that involves an abnormal position of the calcaneonaviculare complex. "Bangla clubfoot tool score system" is an assessment that indicates the effectiveness of CTEV management. The purpose of this study was to evaluate the management of CTEV on children's ability to walk as assessed by the Bangla clubfoot tool score system.
 A cross sectional study was conducted at the Hospital Dr. Mohammad Hoesin Palembang. There were 24 CTEV patients who received CTEV management before the age of 3 years and were not associated with a neurological disorder. A comparison of the average total Bangla clubfoot score tool system was analyzed by assessing parental satisfaction, walking ability and clinical examination.
 The majority of CTEV patients were women (58.3%) with and mostly being treated before 1 year old (79.2%). The most types of CTEV were bilateral (70.8%), and most of them performed surgery (66.7%). Assessment with the Bangla clubfoot tool system shows that the level of parental satisfaction is sufficient, gait is good, but physical foot examination is poor (20%). The score is influenced by age at first therapy and compliance using the brace.
 Parents must continue to support their children to undergo integrated management after therapy to maintain their walking ability.

Differential Effects of Extracorporeal Shockwave Therapy and Botulinum Toxin-A Injection on Postburn Contractures and Gait Kinematics in Burn Children.

Postburn contracture is a complex and multifactorial problem that requires intensive inputs from the burn care staff. This study endeavored to evaluate the effectiveness of extracorporeal shockwave therapy and botulinum toxin-A for treating the postburn plantar flexion contracture and optimizing ankle kinematics in burn children. Thirty-eight children with burns and plantar flexion contracture were randomized to receive the standard physical rehabilitation program (control group; n = 13), unfocused extracorporeal shockwave therapy (0.2 mJ/mm2) once a week over four consecutive weeks in addition to the standard physical rehabilitation (n = 12), or botulinum toxin-A injection (0.5-2 U/kg/muscle group with maximum dose of 12 U/kg/body weight) once at entry besides the standard physical rehabilitation (n = 13). Dorsiflexion active range of motion and ankle kinematics were measured before and immediately after treatment. The posttreatment dorsiflexion active range of motion increased significantly in the extracorporeal shockwave therapy group (P = .025) and botulinum toxin-A group (P = .04) when compared to the control group. Likewise, the initial stance-dorsiflexion, stance-maximum dorsiflexion, and swing-peak dorsiflexion angle improved significantly in the extracorporeal shockwave therapy group (P ˂ .001, P = .005, and P = .002, respectively) and botulinum toxin-A group (P = .004, P = .012, and P ˂ .001, respectively) compared to the control group. No significant differences were observed between the extracorporeal shockwave therapy and botulinum toxin-A groups with respect to any of the measured variables. To conclude, extracorporeal shockwave therapy and botulinum toxin-A injection could be effectively used to treat postburn plantar flexion contracture and to optimize the ankle kinematics during walking in children, without preference for either of them.

Understanding the role of urban form in explaining transportation and recreational walking among children in a logistic GWR model: A spatial analysis in Istanbul, Turkey

This study aims to examine associations between urban form factors generally, and street network configuration in particular, and walking for different purposes among children in Istanbul, Turkey. Parents of randomly selected students (ages 12–16) at 20 middle schools (N = 917) completed questionnaires about their socio-economic characteristics and the frequency of their children's walking for recreational and for transportation purposes in their neighbourhood during a typical day. The environment around 400 m of participants' homes was evaluated through GIS-based parcel-level land-use data and segment-based street connectivity measures calculated using space syntax techniques. Logistic geographically weighted regression models were estimated to measure the desired associations while adjusting for socio-economic characteristics. Results demonstrate a marginal association between urban form measures and walking behaviour but only in certain peripheral parts of the city. More importantly, increased directional accessibility, which identifies the extent to which more street length is accessible within few direction changes, is associated with higher odds of recreational walking in particular areas where a strong differentiation between scales of street connectivity structure is evident such as a supergrid of primary roads with inserted organic local streets. In addition, children residing in neighbourhoods with reduced residential density and increased commercial and recreational activities are more likely to walk for transportation purposes. The findings of this study demonstrate that the one-size-fits-all approach may not effectively encourage walking. Urban areas tend to have varying qualities that need to be handled uniquely, and therefore targeted rather than blanket interventions regarding the design of neighbourhoods around schools and homes may be beneficial in supporting walking behaviour of children.

Intrinsic group behaviour II: On the dependence of triad spatial dynamics on social and personal features; and on the effect of social interaction on small group dynamics.

In a follow-up to our work on the dependence of walking dyad dynamics on intrinsic properties of the group, we now analyse how these properties affect groups of three people (triads), taking also in consideration the effect of social interaction on the dynamical properties of the group. We show that there is a strong parallel between triads and dyads. Work-oriented groups are faster and walk at a larger distance between them than leisure-oriented ones, while the latter move in a less ordered way. Such differences are present also when colleagues are contrasted with friends and families; nevertheless the similarity between friend and colleague behaviour is greater than the one between family and colleague behaviour. Male triads walk faster than triads including females, males keep a larger distance than females, and same gender groups are more ordered than mixed ones. Groups including tall people walk faster, while those with elderly or children walk at a slower pace. Groups including children move in a less ordered fashion. Results concerning relation and gender are particularly strong, and we investigated whether they hold also when other properties are kept fixed. While this is clearly true for relation, patterns relating gender often resulted to be diminished. For instance, the velocity difference due to gender is reduced if we compare only triads in the colleague relation. The effects on group dynamics due to intrinsic properties are present regardless of social interaction, but socially interacting groups are found to walk in a more ordered way. This has an opposite effect on the space occupied by non-interacting dyads and triads, since loss of structure makes dyads larger, but causes triads to lose their characteristic V formation and walk in a line (i.e., occupying more space in the direction of movement but less space in the orthogonal one).

Estimation of Time-Course Core Temperature and Water Loss in Realistic Adult and Child Models with Urban Micrometeorology Prediction.

Ambient conditions may change rapidly and notably over time in urban areas. Conventional indices, such as the heat index and wet bulb globe temperature, are useful only in stationary ambient conditions. To estimate the risks of heat-related illness, human thermophysiological responses should be followed for ambient conditions in the time domain. We develop a computational method for estimating the time course of core temperature and water loss by combining micrometeorology and human thermal response. We firstly utilize an urban micrometeorology prediction to reproduce the environment surrounding walkers. The temperature elevations and sweating in a standard adult and child are then estimated for meteorological conditions. With the integrated computational method, we estimate the body temperature and thermophysiological responses for an adult and child walking along a street with two routes (sunny and shaded) in Tokyo on 7 August 2015. The difference in the core temperature elevation in the adult between the two routes was 0.11 °C, suggesting the necessity for a micrometeorology simulation. The differences in the computed body core temperatures and water loss of the adult and child were notable, and were mainly characterized by the surface area-to-mass ratio. The computational techniques will be useful for the selection of actions to manage the risk of heat-related illness and for thermal comfort.

A Preliminary Evaluation of Energy Efficiency for Children with Cerebral Palsy for Driving A Manual Wheelchair and Walking: Use of the Total Heart Beat Index

ABSTRACT Aims: This study aims to compare the total heart beat index (THBI) in evaluating energy efficiency between using a manual wheelchair and walking for children with cerebral palsy (CP). Methods: The energy efficiency was measured in 21 participants with CP (mean age, 13.6 ± 3.4 years) who walk or drive a manual wheelchair using a square course. THBI was calculated as total number of heart beats during the exercise period/total distance traveled. Results: Significant differences in the THBI were observed between Gross Motor Function Classification System (GMFCS) levels III and IV (p = .049, effect size = 1.60). No significant differences in THBI were observed between GMFCS levels II and III or between GMFCS levels II and IV (p > .05). Conclusions: The energy efficiency of children with CP who use a manual wheelchair in this study was equal to or better than that for walking.

Effect of Virtual Reality Therapy on Balance and Walking in Children with Cerebral Palsy: A Systematic Review

ABSTRACT Aim: To investigate the effect of Virtual Reality Therapy (VRT) on balance and walking in children with cerebral palsy (CP). Method: A systematic search in Pubmed and Embase was performed until the 9th of July 2019. Articles were included if the population consisted of children with CP and data on balance and/or walking were reported. Results were pooled in two meta-analyses. Results: 26 articles were included. For ‘balance’ 5 and for ‘walking’ 4 were used for the meta-analyses. The meta-analyses showed a significant result in favor of VRT for balance, SMD 0.89 [95% CI, SD 0.14, 1.63] and for walking, SMD 3.10 [95% Cl, SD 0.78, 5.35]. Interpretation: VRT seems a promising intervention for rehabilitation in children with CP. The meta-analysis confirmed this positive effect. These results must be interpreted with caution due to differences in the interventions used, the lack of randomized-controlled trials, and the relatively small groups.

Migrant shoes and forced walking in children’s literature about refugees: Material testimony and embodied simulation

AbstractIncreasing numbers of children’s books on the topic of refugees are appearing in publishers’ catalogues around the world, raising awareness of diverse contexts of forced migration and of the hardships faced by children and their families in this situation. Yet, few studies have analysed in depth how aesthetic and literary strategies work to engage readers with the refugee experience in these well-intentioned attempts. Drawing on a corpus of refugee texts which draw attention to the material, the corporeal and the symbolic aspects of shoes and forced walking, in this article, I look at materiality and mobility (or immobility) and analyse how text and image create three main points of connection between the narrative and the reader: appropriate footwear; physical discomfort/pain and what I have termed as ‘the chronotope of forced migration’. I discuss how calling attention to these connections is used as a strategy to create an ‘embodied simulation’ (Bergen 2016) which encourages readers to ‘walk in refugee shoes’ and adopt a more empathetic stance. Examining these strategies shows how it is possible to engender an understanding of the refugee situation through text and/or image in ways that allow a level of emotional engagement even when young readers have not experienced these circumstances directly. Understanding how these aesthetic and literacy strategies work can help to support the claims made for the role of children’s literature in fostering empathy as well as the pedagogical use of this literature by teachers and other professionals.

Family support and family and child-related outcomes among families impacted by disability in low- and middle-income countries: A scoping review.

There is a growing interest in understanding the relationship between family support and family or child-related outcomes in high-income countries. However, this has received little attention in low- and middle-income countries. The purpose of this review was to explore the relationship between family support and family and child-related outcomes among families affected by disability in low- and middle-income countries. We conducted a scoping review of five databases using search terms related to 'family', 'support', 'child', and 'disability'. A total of 13 articles met the inclusion criteria. Families of children with disabilities received most of their support from informal sources (e.g. immediate family members, friends, and parents support groups). Parental stress was most often evaluated as the family outcome and was negatively linked to emotional support and childcare assistance from immediate family members. Movement and mobility therapy offered by rehabilitation professionals was found to improve children's walking patterns. Positive attitudes from community members were key facilitators to participation of children with disabilities in social activities. The review calls for urgent attention to research in low- and middle-income countries, particularly the extent of support families are receiving from government-led support systems.

Reproducibility and smallest real differences of walking and Energy Expenditure Index in children and adolescents with an acquired brain injury.

Reliable evaluation is of utmost importance to the therapist and the patient. There is no data about the test-retest reproducibility of 6-Minute Walk Test (6MWT) and Energy Expenditure Index (EEI) for children and adolescents with an Acquired Brain Injury (ABI) in the sub-acute phase. To determine test-retest reproducibility and smallest real differences (SRDs) of the 6MWT and EEI in children and adolescents with an ABI during rehabilitation in the sub-acute phase. Our second aim was to assess the correlation between the objective measure, the EEI, and the subjective perception of physical exertion obtained by using the pictorial children's effort rating scale (PCERT). Twenty eight participants (12.5±4.3 years; 10 females) with an ABI in the sub-acute phase were asked to perform the 6MWT twice during their hospitalization. Heart rate was monitored during rest and throughout the 6MWT to calculate the EEI. Intra-class correlation coefficients (ICCs) and SRDs of the 6MWT and EEI were determined. Test-retest reproducibility was excellent for the 6MWT (ICC = 0.98, SRD = 65.73 m) and EEI tests (ICC = 0.99, SRD = 0.65 beats/m). Excluding one participant who walked extremely slowly resulted in ICC = 0.97, SRD = 67.01 m for the 6MWT, and ICC = 0.91, SRD = 0.25 beats/m for the EEI. No significant correlations were found between the EEI and PCERT. 6MWT and EEI are reliable measures in children and adolescents with an ABI during hospitalization in the sub-acute phase.

Effect of long term use of arch support foot orthoses on walking ground reaction force asymmetry index in children with flexible flat feet: A cohort study

Background: Foot orthoses are often used to correct altered gait patterns. However, effect of long term use of arch support foot orthoses on walking mechanics is not well understood. The aim of this study was to evaluate the effects of long term use of arch support foot orthoses on the asymmetry indices of ground reaction forces during stance phase of walking in male children with flexible flat feet. Methods: Fifteen male volunteered children (with their parents’ permission) with flexible flat feet were evaluated. Walking ground reaction forces and kinematic data before and after four months use of foot orthoses were recorded by force plate and Vicon motion system, respectively. Then, the asymmetry indices of ground reaction force components were calculated. Results: The results show that asymmetry index of the medio-lateral component of ground reaction force in loading response and push off phases during pre-test were higher than 4% (normal value). Also asymmetry index of its time to peak during the mid-stance phase in the pre-test were higher than normal value. Moreover, findings did not show any significant differences in asymmetry indices of other ground reaction force components and their time to peak, impulses and vertical loading rate between pre-test and post-test conditions. Conclusion: Despite the high asymmetry values of the peak medio-lateral component and it’s time to peak in children with flexible flat feet during pre-test; long-term use of the foot orthoses did not show any significant effect on the improvement of the asymmetry index of these components. However, long-term wearing of the foot orthoses reduced asymmetry index of the peak positive free moment amplitude.

Effect of Whole Body Vibration with Stretching Exercise on Active and Passive Range of Motion in Lower Extremities in Children with Cerebral Palsy: A Randomized Clinical Trial

Background: Increasing the range of motion in joints is considered to be one of the most long term concerns in the treatment of cerebral palsy (CP). Objectives: The purpose of this study was to investigate the effect of using whole body vibration (WBV) as a new therapeutic approach, with stretching exercises on the range of motion in lower extremities in children with CP. Methods: In this single-blind clinical trial, 20 children aged 4 to 12 years were enrolled. Participants were randomly divided into experimental and control groups. Control group received only passive static stretching exercise and experimental group received passive static stretching with WBV. Exercises were performed 3 times a week for 6 weeks. To collect data, Goniometry, modified Ashworth scale and 6 Minute Walk Test were used. Results: The results of this study indicated that, stretching with WBV, increases active range of motion in hip flexion, abduction and ankle dorsal flexion and also can improve speed of walking in children with CP. Conclusions: According to the findings, the use of WBV can be considered as an effective treatment in increasing the range of motion and walking speed in CP children.

Running and Walking Foot Loading in Children Aged 4-10 Years.

Although previous reports have provided normative plantar pressure data for walking in children, evaluation during running is lacking. This study aimed to compare foot loading patterns during running and walking in children aged 4-10 years. Furthermore, the relationship between running baropodometric parameters and anthropometric measures was investigated. Foot loading of 120 volunteers was evaluated during running and walking using an Emed AT-4 pressure platform. Analyses were performed for 5 anatomical regions (rearfoot, midfoot, forefoot, hallux, and lesser toes). Higher peak pressure and maximum force values were seen under most foot regions during running in comparison with walking, whereas relative contact area tended to increase only in the midfoot. Data for running indicated that aging explained less than 23% of the variance of plantar loads and contact area. Running foot loads were more associated with height, body mass, and foot length. This study's data described plantar loads under the feet of children were greater during running. Aging was associated with little increase in running plantar loads and larger contact areas. Results may be useful as reference to characterize foot loading during running and in the development of orthoses in clinical applications or products such as sport shoes for children.

Passive range of motion changes in young children with spastic diplegia. A study during the initial stages of independent walking.

To investigate how the onset of independent walking in children with Cerebral Palsy (CP) influences the Passive Range of Motion (PROM) of lower limb joints. Sixteen children with CP, GMFCS levels I and II, and 16 Typical Development (TD) children who had just begun independent walking participated in the study. The PROM of the hip abduction and external rotation, knee extension, popliteal angle, and ankle dorsiflexion was recorded with a goniometer at the onset of independent walking and 8months later. A repeated-measures two-way ANOVA was conducted to compare the main effects of "walking experience" and "group of children" and the interaction effect between them on PROM of lower extremities' joints. The effect of "group of children" in the PROM was significant; differences were observed between children with CP and TD children for all joints (p< 0.05). The effect of "walking experience" did not have a significant impact on PROM changes and the interaction effect of "group of children" and "walking experience" was also not significant for all the variables. The alternative gait pattern spontaneously adopted by children with CP does not significantly impact their PROM during the initial stages of walking development. The lower PROM in highly functional children with CP compared to TD children cannot be attributed to gait initiation with an "atypical" pattern, but possibly to other factors such as reduced voluntary movement and age.

The effects of pediatric obesity on patellofemoral joint contact force during walking

BackgroundObesity increases a child’s risk of developing knee pain across the lifespan, potentially through elevated patellofemoral joint loads that occur during habitual weight-bearing activities. Research questionDo obese children have greater absolute and patellar-area-normalized patellofemoral joint forces compared to healthy weight children during walking? MethodsWe utilized a cross-sectional design to address the aims of this study. Experimental biomechanics data were collected during treadmill walking in 10 healthy-weight and 10 obese 8–12 year-olds. We used radiographic images to develop subject-specific musculoskeletal models, generated walking simulations from the experimental data, and predicted patellofemoral joint contact force using established techniques. ResultsWe found that the obese children had 1.98 times greater absolute (p = 0.002) and 1.81 times greater patellar-area-normalized (p = 0.008) patellofemoral joint contact forces compared to the healthy-weight children. We observed a stronger relationship between absolute patellofemoral joint contact force and BMI (r2=0.58) than between patellofemoral joint contact force and body fat percentage (r2=0.38). SignificanceOur results indicate that obese children walk with increased patellofemoral loads in absolute terms and also relative to the area of the articulating surfaces, which likely contributes to the increased risk of knee pain in this pediatric population. This information, which provides a baseline comparison for future longitudinal studies, also informs the type and frequency of physical activity prescription aimed at reducing the risk of knee injury and improving long-term outcomes.

Comparison of verbal encouragement and avatar-based virtual reality feedback on treadmill walking in children with cerebral palsy.

Morbid obesity is a barrier to kidney transplant in patients with end-stage renal disease (ESRD). Laparoscopic sleeve gastrectomy (SG) is an increasingly considered intervention, but the safety and long-term outcomes are uncertain. We reviewed prospectively collected data on patients with ESRD and chronic kidney disease (CKD) undergoing SG from 2011 to 2018. There were 198 patients with ESRD and 45 patients with CKD (stages 1-4) who met National Institutes of Health guidelines for bariatric surgery and underwent SG; 72% and 48% achieved a body mass index of ≤ 40 and ≤ 35 kg/m2, respectively. The mean percentages of total weight loss and excess weight loss were 18.9 ± 10.8% and 38.2 ± 20.3%, respectively. SG reduced hypertension (85.8% vs 52.1%), decreased antihypertensive medication use (1.6 vs 1.0) (P < .01 each), and reduced incidence of diabetes (59.6% vs 32.5%, P < .01). Of the 71 patients with ESRD who achieved a body mass index of ≤ 40 kg/m2, 45 were waitlisted and received a kidney transplant, whereas 10 remain on the waitlist. Mortality rate after SG was 1.8 per 100 patient-years, compared with 7.3 for non-SG. Patients with stage 3a or 3b CKD exhibited improved glomerular filtration rate (43.5 vs 58.4 mL/min, P = .01). In conclusion, SG safely improves transplant candidacy while providing significant, sustainable effects on weight loss, reducing medical comorbidities, and possibly improving renal function in stage 3 patients.

Does an enhanced axial rehabitation improve both axial postural control and walking in children with cerebral palsy ?

Does an enhanced axial rehabitation improve both axial postural control and walking in children with cerebral palsy ?

Gait Characteristics of Children Born Preterm.

Walking is a central skill of daily living. A delay in the onset of walking can be a sign of abnormal motor development. Further, abnormalities in gait can also affect physical functioning. Children born preterm are at significant risk for neurodevelopmental impairments; however, little is known about how preterm birth affects walking. This review describes current evidence of walking in children born preterm with a focus on the age at onset of walking and comparisons of gait characteristics of children born preterm with those born full-term.