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Purpose: To determine whether a 12-week, lower body-targeted aqua-plyometric (AquaPlyo) exercise program could improve muscle strength, bone mineral properties, and physical fitness in patients with juvenile idiopathic arthritis. Methods: A randomized controlled trial was adopted and included 48 patients with polyarticular juvenile idiopathic arthritis (age: 12–18 y). Patients were assigned to undergo either AquaPlyo exercises (AquaPlyo group, n = 24) or standard exercises (control group, n = 24). The outcome measures were assessed pretreatment and posttreatment and included concentric quadriceps peak torque, bone mineral properties (areal bone mineral density [BMD], volumetric BMD, bone mineral content, and BMD Z score), and physical fitness. Results: A significant posttreatment increase in the concentric quadriceps peak torque was detected in the AquaPlyo group compared with the control group (either at an angular velocity of 90°/s [right side: P =.016, left side: P =.025] or 180°/s [right side: P =.007, left side: P =.029]). Besides, a considerably greater improvement in the areal BMD (P =.0006), volumetric BMD (P =.027), bone mineral content (P =.002), and BMD Z score (P =.0004) was observed in the AquaPlyo group. Moreover, a remarkably greater rise in the physical fitness (P <.001) was revealed in the AquaPlyo group. Conclusion: AquaPlyo training can efficiently enhance muscle strength, improve bone mineral properties, and boost physical fitness in patients with juvenile idiopathic arthritis. [ABSTRACT FROM AUTHOR]

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]

The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12–18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability—LoS), balance, and mobility (Community Balance and Mobility Scale—CB&M; Functional Walking Test—FWT; Timed Up and Down Stair test—TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP. [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]

Purpose: To appraise the effects of incremental aerobic training (IAT) on systemic inflammatory mediators, cardiorespiratory indices, and functional capacity in obese children with bronchial asthma. Methods: This study included 30 children with asthma (age = 8–16 y) allocated randomly into either the control group (n = 15; received the traditional pulmonary rehabilitation program) or IAT group (n = 15; engaged in 8 weeks of IAT in addition to the traditional pulmonary rehabilitation program). The systemic inflammatory mediators (high-sensitivity C-reactive protein and interleukin-6), cardiorespiratory indices (peak oxygen uptake, minute ventilation, maximum heart rate, heart rate recovery at 1 min after exercises, and oxygen pulse), and functional capacity (represented by 6-min walk test) were analyzed pretreatment and posttreatment. Results: A significant reduction in the level of high-sensitivity C-reactive protein and interleukin-6 and increase in peak oxygen uptake, minute ventilation, maximum heart rate, and heart rate recovery at 1 minute after exercises was observed among the IAT group as compared with the control group. In addition, the IAT group covered a longer distance in the 6-minute walk test than the control group, suggesting favorable functional capacity. Conclusion: The study results imply that IAT has the potential to improve the inflammatory profile, cardiorespiratory fitness, and functional capacity of obese children with bronchial asthma. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hamstring shortening altered joint reaction forces during activities of daily living (ADL), causing knee pain. Moreover, weak quadriceps may negatively distribute the compressive and shear forces at the knee joint. PURPOSE: The study examined the effect of adding hamstring stretching to quadriceps strengthening exercises on joint space narrowing (JSN), medial joint space width (mJSW), and physical abilities in patients with knee osteoarthritis (KOA). METHODS: A total of 42 osteoarthritis patients, aged from 50 to 65 years, were randomized and assigned into 2 groups: the study and the control groups. Quadriceps strengthening exercises were given to both groups, while static hamstring stretching was applied to only the study group. Patients of both groups were screened with a weight-bearing x-ray beam to investigate the JSN, mJSW, and functional abilities measured in the WOMAC scale. The Outcomes were evaluated at the baseline and immediately after 6 weeks of treatment. RESULTS: The mJSW improved in the study group (p < 0.001) compared to the control group (p = 0.07). The OARSI JSN was enhanced significantly in both groups, but in favor of the study group (p < 0.001) over the control group (p = 0.046). Both MVIC and total score of WOMAC were significantly improved in both groups (p < 0.001). CONCLUSION: Adding static hamstring stretching to quadriceps strengthening exercises provided a substantial effect on mJSW, JSN, and functional abilities in KOA patients. [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]

To evaluate the effectiveness of a multimodal exercise program incorporating plyometric and balance training on muscle strength and postural stability in children with spastic hemiplegic cerebral palsy (SHCP). A total of 57 children with SHCP were enrolled in the study and randomly allocated into three treatment-based groups: plyometric exercises (PLYO group; n = 19), balance exercises (BAL group, n = 19), and combined plyometric and balance exercises (PLYO-BAL group; n = 19). The maximum isometric muscle strength (IMSmax) and postural stability [anterior-posterior stability index (AP-SI), mediolateral stability index (ML-SI), and overall stability index (O-SI)] were measured pre- and post-intervention. By applying the intention-to-treat analysis, the PLYO-BAL group showed greater post-treatment IMSmax than the PLYO and BAL groups for the quadriceps (p=.03 and p=.0002 respectively), hamstrings (p=.018 and p<.0001 respectively), and dorsiflexors (p=.006 and p<.0001 respectively). Also, the PLYO-BAL group achieved better post-intervention stability scores as compared to PLYO and BAL groups regarding AP-SI (p<.0001 and p=.0001 respectively), ML-SI (p=.001 and p=.015 respectively), and O-SI (p=.011 and p=.04 respectively). Incorporation of plyometric and balance exercises in a multimodal rehabilitation program could be an important consideration for enhancing muscle strength and boosting postural stability in children with SHCP. [ABSTRACT FROM AUTHOR]

BACKGROUND: Knee osteoarthritis (KOA) is one of the most common chronic diseases impacting millions of elderly people. OBJECTIVES: The study compared the effects of two intensities of partial blood flow restriction (BFR) with low-intensity resistance training on quadriceps strength and cross-sectional area (CSA), and pain in people with knee osteoarthritis (PwKOA). METHODS: Thirty-five PwKOA, aged 50–65, participated. Quadriceps CSA was measured by ultrasonography, quadriceps strength – by isokinetic dynamometry and pain by VAS. These outcome variables were obtained at the beginning of the study and re-evaluated eight weeks after the intervention. RESULTS: An interaction effect was present for quadriceps CSA (P = 0.042) and quadriceps strength (P = 0.006), showing that using 70% of total occlusion pressure with 30% 1RM had a more significant effect. Knee pain improved significantly through the main effect of BFR (P < 0.001), and low-intensity resistance training (P = 0.011). Pain improved more at 70% of total occlusion pressure, with 30% of 1RM (2.5 ± 1.06) than 50% total occlusion pressure with 10% of 1RM (5.77 ± 1.46). CONCLUSION: A combination of 70% of total occlusion pressure with 30% 1RM could be beneficial in PwKOA in improving pain, and increasing the quadriceps strength. The changes in the quadriceps strength could be a predictor for knee pain. [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]

Background: The integration of therapeutic approaches is increasingly recommended for children with cerebral palsy, to enhance outcomes. Nevertheless, clinicians still opt for separate or combined therapies based on little credible knowledge. Objective: This study endeavored to evaluate the effect of botulinum neurotoxin-A (BoNT-A) injection and reciprocal neuromuscular electrical stimulation (rNMES) and their combination on the upper extremity function in children with spastic hemiplegia. Methods: Sixty-four children with spastic hemiplegia (aged 6– 10 years) were randomly assigned to four treatment-based groups [group I (BoNT-A), group II (rNMES), group III (combined BoNT-A and rNMES), and group IV (Control)]. All children received a physical rehabilitation program, thrice/week over three months. Unilateral upper-limb function, bimanual hand function, and real-time arm-hand function were assessed using Melbourne Assessment (MA), Assisting Hand Assessment (AHA), and Pediatric Motor Activity Log (PMAL) scales respectively pre-treatment, post-treatment, and at 6 months follow-up. Results: Post-treatment, group III achieved greater improvement in MA, AHA, and PMAL compared to other groups (all P < 0.05), and the difference remained in favor of group III at the follow-up (all P < 0.05). Conclusions: This study suggests that BoNT-A and rNMES combined are more effective than either of them alone to enhance upper-extremity function in children with spastic hemiplegia. [ABSTRACT FROM AUTHOR]

Aims: To explore the effects of radial shockwave therapy (rSWT) combined with standard orthotic management (SOM) on spasticity, functional balance, and gait in children with spastic diplegia. Methods: Sixty children with diplegia were allocated to group I (rSWT, n = 20), group II (SOM, n = 20), or group III (rSWT + SOM, n = 20). All groups received a physical training program 3 times/week for 3 months. Assessments were completed before and immediately after the intervention and included the Hoffman reflex/Myogenic response ratio of the soleus muscle (H/M ratio), balance, and gait. Results: At a significance criterion adjusted to p ˂.006, there were no between-group differences in balance or gait (p >.006). The rSWT + SOM group had a greater improvement of H/M ratio compared to rSWT alone (p =.001) but not to SOM alone (p =.04). Within-group analysis demonstrated significant improvement of all variables for rSWT + SOM (p ˂.006). The H/M ratio and knee midstance angle exhibited clinically meaningful improvement for rSWT alone (p ˂.006). No significant changes were observed in any variable for SOM alone (p >.006). Conclusions: Radial shockwave and orthotics together, or either of them along with physical training did not differ in improving balance or gait. Their combination was more effective than rSWT alone in reducing spasticity. [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]