Search

Objective Chronic neurological disorders (CNDs) generally produce deleterious effects on the musculoskeletal system and can affect physical activity and increase sedentary behavior in children, hindering the execution of training programs and the attainment of a correct dose of exercise. The purpose of this systematic review was to analyze the effect of neuromuscular electrical stimulation (NMES) on skeletal muscle and then on biomechanics of movement, functional mobility, strength, spasticity, muscle architecture, and body composition of children and adolescents with CNDs and chronic diseases. Methods The search was conducted in April 2020 in PubMed, MEDLINE, Scopus, the Cochrane Library, and Web of Science, without publication period restriction. Publications investigating the effect of NMES on children and adolescents with CNDs and other chronic diseases were independently selected by 2 researchers. One author independently extracted data from the studies selected, and a second author cross-checked. Results Eighteen studies with 595 participants aged between 3 and 14 years were included. Quality assessment showed that 50% of the studies presented a low risk of bias. The pooled effect of NMES on gross motor functional measure, calculated as a standardized mean difference using a random effects model, was 0.41 (95% CI = 0.19–0.64). Conclusion The use of NMES programs for children diagnosed with cerebral palsy, spinal muscular atrophy, and obstetric injury of the brachial plexus was effective in improving muscle strength, biomechanics of movement, and functional mobility. Impact NMES can be a useful tool to prevent the reduction of mobility that results from CNDs. [ABSTRACT FROM AUTHOR]

This study analyzed the effects of physical training programs on heart rate variability, as a measure of sympathovagal balance, in children and adolescents with chronic diseases. Relevant articles were systematically searched in Pubmed, Science Direct, Web of Science, Scopus, Google Scholar and Embase scientific databases. We performed a meta-analysis using an inverse variance heterogeneity model. Effect size calculation was based on the standardized mean differences between pre- and post-intervention assessments, assuring at least a single-group repeated-measures model for each extracted group. Ten studies (252 participants) were included, seven in obese subjects, two in type-1 diabetes, and one in cerebral palsy. When time-domain variables were analyzed, exercise was found to moderately increase RMSSD (SMD=0.478; 95%CI: 0.227 to 0.729; p <0.001), SDNN (SMD=0.367; 95%CI: 0.139 to 0.595; p =0.002) and pNN50 (SMD=0.817; 95%CI: 0.139 to 0.595; p =0.002). As for frequency-domain variables, exercise presented a moderate increasing effect on HF (SMD=0.512; 95%CI: 0.240 to 0.783; p <0.001), a negligible effect for LF (SMD=0.077; 95%CI: –0.259 to 0.412; p <0.001) and a non-significant reduction for LF/HF (SMD=–0.519; 95%CI: -1.162 to 0.124; p =0.114). In conclusion, physical training programs are able to modulate heart rate variability in children and adolescents with chronic diseases, affecting mainly the time-domain variables. [ABSTRACT FROM AUTHOR]