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To explore how plyometric-based hydro-kinesiotherapy (Plyo-HKT) would affect pain, muscle strength, postural stability, and functional performance in a convenience sample of children with hemophilic knee arthropathy (HKA). Forty-eight children with HKA (age: 8–16 years) were randomly allocated to the Plyo-HKT group (n = 24; underwent the Plyo-HKT for 45 min, twice/week over 12 wk in succession) or the comparison group (n = 24; performed the standard exercise rehabilitation at an equivalent frequency and duration). Pain, peak concentric torque of quadriceps and hamstring (produced at two angular velocities: 120 and 180 o/sec), dynamic limits of postural stability (DLPS), and functional performance [Functional Independence Score in Hemophilia (FISH) and 6-Minute Walk Test (6-MWT)] were assessed pre- and post-intervention. In contrast with the comparison group, the Plyo-HKT group achieved more favorable pre-to-post changes in pain (p =.028, η2p = 0.10), peak torque of quadriceps [120°/sec (p =.007, η2P = 0.15); 180°/sec (p =.011, η2P = 0.13)] and hamstring [120°/sec (p =.024, η2P = 0.11); 180°/sec (p =.036, η2P = 0.09)], DLPSdirectional [forward (p =.007, η2P = 0.15); backward (p =.013, η2P = 0.12); affected side (p =.008, η2P = 0.14); non-affected side (p =.002, η2P = 0.20)], DLPSoverall (p <.001, η2P = 0.32), and functional performance [FISH (p <.001, η2p = 0.26); 6-MWT (p =.002, η2p = 0.19)]. Plyo-HKT is likely helpful for reducing pain, improving strength, enhancing postural stability, and boosting functional capabilities in children with HKA. Physical rehabilitation practitioners should, therefore, consider this intervention strategy. [ABSTRACT FROM AUTHOR]

To investigate the effects of a 12-week split-belt treadmill walking (Sb-TW) practice using an error augmentation strategy on temporospatial gait asymmetries, dynamic balance, and locomotor capacity in adolescents with unilateral cerebral palsy (ULCP). Fifty-two adolescents with ULCP (age: 10–16 years) were randomized into either the Sb-TW group (n = 26; underwent repeated Sb-TW practice, with exaggeration of the initial step-length asymmetry, three times/week, for 12 sequential weeks) or control group (n = 26; received equivalent dosages of traditional single-belt treadmill training). Step-length and swing-time asymmetries, directional (LoSdirectional) and overall (LoSoverall) limits of stability, and locomotor capacity [6-minute walk test (6-MWT), Timed Up and Down Stair test (TUDS), and 10-m Shuttle Run Test (10mSRT)] were assessed pre- and post-intervention. The Sb-TW group demonstrated more favorable changes in step-length asymmetry (p <.001, η2partial = 0.27), LoSdirectional [affected side direction (p =.033, η2partial = 0.09), forward direction (p =.004, η2partial = 0.16), and backward direction (p =.01, η2partial = 0.12)], and LoSoverall (p <.001, η2partial = 0.31) than the control group. Also, the Sb-TW group showed significantly higher locomotor capacity [6-MWT (p <.001, η2partial = 0.38), TUDS (p =.032, η2partial = 0.09), 10mSRT (p =.021, η2partial = 0.10)] as compared to the control group. The Sb-TW-induced adaptations can be capitalized on for remediating spatial gait asymmetry, dynamic balance deficits, and impaired locomotor performance in adolescents with ULCP. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes mellitus (DM) has grown globally including Saudi Arabia. However, there are no recent national and regional reports about DM in Saudi Arabia. Therefore, this study aimed to explore the national and regional prevalence rates of DM among the Saudi population. Methods: Data from an ongoing household health survey that was carried out by the General Authority for Statistics in 2017 was utilized in this study. The study sample was selected by including 24,012 households which was representative of the population and distributed according to the 13 administrative regions. A self-reported diagnosis of DM was collected by asking subjects if they have been diagnosed by a doctor. Results: The proportion of DM was 8.5% among the Saudi Arabia population (≥ 15 years) and was higher in male (10.3%) than female (9.9%). The prevalence of DM among the age group ≥ 60 years was the highest (49.2%), followed by the age group 45–64 years (38.9%) while the lowest prevalence was found among the younger group < 40 years (15.3%). There was a large difference between regions ranging from 7.3% in Najran to 11% in Makkah. Conclusion: This study showed the recent national and regional prevalence rates of DM among Saudi populations. The high prevalence of DM in Saudi Arabia requires an urgent public health call to improve early detection program and lifestyle interventions. This study urges to minimize the health and economic burden of DM by establishing and implementing a national diabetes prevention program. [ABSTRACT FROM AUTHOR]

To investigate how plyometric exercise (PLYO-Ex) affects mechanics and morphometrics of the plantar flexor musculotendinous unit in children with unilateral cerebral palsy, 38 participants (aged 10–16 years) were allocated at random to either the PLYO-Ex group (n = 19; received 24 sessions of plyometric muscle loading, conducted 2 times a week for 3 months in succession) or the control group (n = 19; underwent traditional physical therapy for the same frequency and duration). Measurements were taken pre- and post-intervention. Standard ultrasound imaging was applied to evaluate morphometrics of the gastrocnemius muscle and Achilles tendon unit and an isokinetic dynamometer was used to evaluate maximum voluntary isometric plantar flexors contraction (IVCmax). With controlling for pre-treatment values, significant post-treatment changes favoring the PLYO-Ex group were observed for morphological (tendon (p = 0.003, η2p = 0.23) length; belly length (p = 0.001, η2p = 0.27); tendon thickness (p = 0.035, η2p = 0.35); muscle thickness (p = 0.013, η2p = 0.17); fascicle length (p = 0.009, η2p = 0.18); pennation angle (p = 0.015, η2p = 0.16)) and mechanical and material properties (IVCmax (p = 0.009, η2p = 0.18); tendon's elongation (p = 0.012, η2p = 0.17), stiffness (p = 0.027, η2p = 0.13); stress (p = 0.006, η2p = 0.20); strain (p = 0.004, η2p = 0.21)). In conclusion, plyometric exercise induces significant adaptations within the musculotendinous unit of the plantar flexors in children with unilateral cerebral palsy. These adaptations could improve muscular efficiency and consequently optimize physical/functional performance. [ABSTRACT FROM AUTHOR]

Adolescents with unilateral cerebral palsy (U-CP) experience an asymmetrical posture because the less-affected lower limb is preferred for bodyweight support as a strategy of compensating for the paretic side's muscular weakness. This study was designed to compare the effect of 12 weeks of paretic-limb-only plyometric training (PLPT) and volume-matched double-limb training (DLPT) on balance capability and gait symmetry in adolescents with U-CP. Sixty-nine adolescents with U-CP were randomly assigned to PLPT, DLPT, or a control group (n = 23 each). Treatment was delivered twice/week (with at least 48 h recovery intervals) for 12 weeks in succession. The directional (LoSdirectional) and overall (LoSoverall) limits of stability in addition to the temporal (T-GSI) and spatial (S-GSI) gait symmetry indicis were assessed pre- and post-treatment. The LoSdirectional improved significantly in the PLPT group compared to either the DLPT or control group (for the forward (p = 0.027 and <0.001, respectively), backward (p = 0.037 and <0.001, respectively), affected-side (p = 0.038 and 0.004, respectively), and less-affected-side (p = 0.018 and 0.016, respectively)), and this was also the case for the LoSoverall (p < 0.001). Additionally, The T-GSI and S-GSI scores decreased significantly in the PLPT group compared to the DLPT (p = 0.003 and 0.047, respectively) or control (p = 0.003 and 0.036, respectively) group, indicating the development more symmetrical gait patterns. In conclusion, PLPT is likely more effective for enhancing balance capabilities and promoting symmetrical gait patterns than DLPT. Thereupon, it is worthwhile for physical rehabilitation practitioners to include the PLPT paradigm into the intervention plans for adolescents with U-CP. [ABSTRACT FROM AUTHOR]

BACKGROUND: Individuals with hemiparetic cerebral palsy (h-CP) encounter postural control issues that largely interfere with activity and participation. So, there might be a need for improved, clearly effective rehabilitation protocols that target postural control dysfunction, which may, then, reduce activity limitations and participation restrictions. OBJECTIVE: This trial was undertaken to examine the effect of a structured, 12-week aqua-plyometric (Aqua-PLYO) exercise program on postural control and functional ability in children with h-CP. METHODS: Fifty-six children with h-CP took part in a two-arm, randomized single-blind controlled trial. They were randomly assigned to either receive the standard physical therapy (Control group; n = 28) or the Aqua-PLYO training program (Aqua-PLYO group; n = 28), three times/week over 12 consecutive weeks. The dynamic limit of stability [i.e., movement directional control (M-DC), reaction time (ReT), movement velocity (M-Vel), endpoint excursion (EP-Exc), and maximum excursion (M-Exc)] and functional ability [i.e., 30-second sit-to-stand test (30sec-STS), timed up and down stairs test (TUDS), and the dynamic gait index (DGI)] were assessed pre- and post-treatment. RESULTS: From the pre- to post-treatment occasion, the Aqua-PLYO group achieved greater improvement for the M-DC (P = 0.013), ReT (P = 0.004), M-Vel (P = 0.03), EP-Exc (P = 0.002), and M-Exc (P = 0.006), compared to controls. Besides, the Aqua-PLYO group showed more conducive changes in functional ability [as evidenced by the 30sec-STS (P = 0.005), TUDS (P = 0.002), and DGI (P = 0.004) scores]. CONCLUSION: Aqua-PLYO training is likely an effective training paradigm for enhancing postural control and functional ability in children with h-CP. Further studies are, however, recommended to substantiate the current evidence. [ABSTRACT FROM AUTHOR]

Children with hemiplegic cerebral palsy (hCP) experience a disorganized muscle activation pattern that adversely affect their ability to respond to balance perturbations. This study examined the effect of plyometric exercises on muscle-activation strategies and response-capacity to balance threats in children with hCP. In a pre-, posttest control-group study, 34 children with hCP were allocated randomly to either the control group (n = 17; received a traditional physical rehabilitation program, lasted for 45 minutes/session, twice/week for three successive months) or the plyometric group (n = 17; received a progressive plyometric training program in three blocks, twice/week over three months plus the traditional physical rehabilitation). Quadriceps/hamstring co-contraction ratio (Q/H Co-CR) and response-capacity to balance threats were assessed pre- and post-treatment. Post-treatment, the Q/H Co-CR and balance control improved significantly in the control (P =.03, P =.0003 respectively) and plyomteric group (P =.001, P ˂ 0.001 respectively). However, the plyometric group showed better improvements in Q/H Co-CR (P =.0001) and balance control (P =.027) when compared to the control group. Incorporation of plyometric exercises into traditional physical rehabilitation could improve muscle-activation strategies and enhance balance control in children with hCP. [ABSTRACT FROM AUTHOR]

BACKGROUND: Postural control deficits are prevalent in children with hemiplegic cerebral palsy (CwHCP). Therefore, the best rehabilitative strategies for remediating these deficits are warranted, which could then enhance function. OBJECTIVE: To examine effects of a block versus an alternating sequence of balance training (BT) and plyometric training (PT) on postural control in CwHCP. METHODS: Forty-eight CwHCP (812 years) were randomized to a block or an alternating BT/PT training. The block BT/PT group (n = 24) received a six-week BT followed by a six-week PT, twice/week over 12 consecutive weeks. The alternating BT/PT group (n = 24) received an interchanging sequence of BT and PT changed every two weeks for 12 weeks. Postural control [center-of-pressure reaction time (RT), movement velocity (MV), maximum excursion (ME), end-point excursion (EE), and directional control (DC)], functional balance (indicated by pediatric balance scale; PBS), and balance/risk-of-falls during walking (denoted by dynamic gait index; DGI) were assessed before and after training. RESULTS: The block BT/PT group showed greater enhancements in postural control variables [RT (P = 0.004), MV (P = 0.028), ME (P = 0.002), EE (P = 0.003), and DC (P = 0.012)] and functional balance (P = 0.006), and lesser risk-of-falls during walking (P = 0.018) when compared to the alternating BT/PT group. CONCLUSION: The block BT/PT sequence is more effective to enhance postural control than the alternating sequence in CwHCP. [ABSTRACT FROM AUTHOR]

BACKGROUND: Children with unilateral cerebral palsy (UCP) experience an asymmetrical gait pattern and poor balance capabilities. Effective interventions, therefore, are needed to facilitate remediation of these functional issues. OBJECTIVE: This study was set out to investigate the emerging role of stretch-shortening cycle (SSC) exercises on gait-symmetry and balance in children with UCP. METHODS: In this randomized controlled trial, 42 children with UCP (age; 8 –12 years) were enrolled and received either standard physical rehabilitation (control group; n = 21) or the SSC exercise program plus physical rehabilitation (SSC group; n = 21). Spatial- and temporal-gait symmetry index (GSI) and specific balance capabilities [reactive balance, directional control, movement synchronization, and sensory organization] were assessed before and after 16 sessions that were carried out twice/week over non-sequential days in an 8-week program. RESULTS: Using the pre-treatment scores as covariates, the post-treatment spatial- (P = 0.006; η p 2 = 0.17) and temporal- GSI (P <.001; η p 2 = 0.46) scores reduced significantly in the SSC group as compared to the control group, suggesting favorable improvement of gait symmetry. Also, all measures of balance (P < 0.05; η p 2 ranged between 0.10 and 0.29) improved remarkably, post-treatment, in SSC group in comparison with the control group. CONCLUSION: The evidence from this study suggests that SSC exercises besides standard physical rehabilitation appear to be effective for improving gait symmetry and boosting balance capabilities in children with UCP. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to identify the major determining factors among ankle dysfunctions for walking speed and symmetry in children with hemiplegic cerebral palsy. Design: This was a prospective analysis that included 52 children with hemiplegic cerebral palsy, aged between 5 and 8 yrs, had mild spasticity, and were functioning at Gross Motor Function Classification System level I or II. The dorsiflexor and plantar flexor strength, dynamic spasticity (represented by gastrocnemius muscle lengthening velocity during stance phase), plantar flexors stiffness, ankle joint position sense, and walking performance (spatiotemporal parameter) were assessed. Results: The least absolute shrinkage and selection operator regression analyses showed that the dorsiflexor strength of the paretic limb was the major determining factor of walking speed (R 2 = 0.38, P < 0.001). Dynamic spasticity of the plantar flexors explained a portion of the variance in walking speed (R 2 = 0.15, P < 0.001) and the highest portion of the variance in spatial walking symmetry (R 2 = 0.18, P = 0.002). In addition, the ankle joint position sense was the primary determinant of temporal walking symmetry (R 2 = 0.10, P = 0.021). Conclusions: In children with hemiplegic cerebral palsy, walking speed is mostly influenced by dorsiflexor muscle strength, temporal walking symmetry is associated with the joint position sense, whereas spatial walking symmetry is explicated by the dynamic spasticity of the plantar flexor muscles. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to verify the effects of combined resistive underwater exercises and interferential current on the peak torque of the quadriceps and hamstrings and pain levels in patients with juvenile idiopathic arthritis. Design: This is a randomized controlled study; 30 children with polyarticular juvenile idiopathic arthritis were randomly distributed into two groups: the control group (n = 15) received the traditional physical therapy program and the study group (n = 15) received resistive underwater exercises and interferential current therapy. Peak torque of the quadriceps and hamstrings and pain levels were evaluated before treatment, 1 mo later, and after 3 mos using the HUMAC NORM, CSMI Testing and Rehabilitation Isokinetic System and visual analog scale, respectively. Results: In the control group, all measures showed significant differences (P < 0.05) after 1 mo except peak torque of left quadriceps and pain levels, and significant differences were found after 3 mos (P < 0.05) in all. In the study group, all measures showed significant differences after 1 and 3 mos (P G 0.05) and there were significant differences between groups after 1 and 3 mos in favor of the study group (P < 0.05). Conclusion: The combination of resistive underwater exercises and interferential current therapy is a potentially valuable treatment for patients with juvenile idiopathic arthritis. [ABSTRACT FROM AUTHOR]