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Ultramarathons are a unique model to study the effects of systemic fatigue in athletes. This investigation applied the spring-mass template to study runners before and 2 days after a road ultramarathon to characterize the effects of fatigue on systemic gait patterns. Overground kinetics were captured 7 days before and 2 days after the event in 14 runners. Traditional kinetic and spring-mass parameters were calculated, along with nonlinear regression-derived parameters and spring-mass model fit metrics. After the ultramarathon, vertical force magnitudes and loading rates were unchanged, but impact peaks increased (1.88 ± 0.08–1.95 ± 0.10 bodyweight). Ground contact times were modestly shorter (−3 ± 1 ms), resulting in increased leg stiffness (10.0 ± 0.5–10.3 ± 0.5 kN/m) with equivocal vertical stiffnesses. The deviation from the modeled spring-mass kinetics also increased (171.3 ± 15.0–181.4 ± 16.5 N). Overall, the systemic mechanical behaviors of the runners persisted despite the fatigue and stress induced by a road ultramarathon. These findings support previous observations that runners maintain gross mechanical behavior when fatigued with small compensatory changes in spatiotemporal and traditional spring-mass characteristics. However, these findings also suggest that the variability within that gross behavior may increase after stress, suggesting new opportunities for quantifying those deviations. [ABSTRACT FROM AUTHOR]

Socioeconomic status (SES) tends to influence an individual's access to health care. It is commonly assumed that a poorer SES is associated with a weaker physical health status, especially in disadvantaged populations such as people with cerebral palsy (CP). However, to our knowledge, no study has looked at this assumption. Therefore, the aim of this study was to describe and compare the physical health status of ambulant adults with bilateral CP with different SES backgrounds. In addition, the physical health status of the ambulatory adults with CP was compared to well‐matched, typically developing adults. Twenty‐eight ambulatory adults with CP (gross motor functional classification system Level I/II/III: n = 11/12/5; SES low/middle/high: n = 10/9/9), and 28 matched typically developing adults were recruited for this study. No differences were observed between adults with CP from different SES backgrounds. Differences in physical health status between typically developing adults and ambulatory adults with CP in all SES backgrounds were found in passive range of motion (p < 0.05), muscle strength (p < 0.001), selectivity (p < 0.001), and muscle tone (p < 0.001) and balance (p < 0.05). The main finding of this study is that physical health status did not differ between ambulatory adults with CP from different SES backgrounds. This finding shows that SES does not always directly impact physical health status in ambulatory adults with CP and highlights the importance of an individual approach. Future research should determine the impact of SES on nonambulatory adults with CP. [ABSTRACT FROM AUTHOR]

The investigators aimed to understand the unmet needs of adults with cerebral palsy (CP) living in urban South Africa and to ascertain similarities or differences to typically developing (TD) adults in the same community. Participants were interviewed with an adapted version of the Southampton Needs Assessment Questionnaire (SNAQ). Non-parametric statistical analysis was utilised for quantitative data and qualitative data were analysed using free coding to identify themes. Thirty adults with CP (median age 34.8 years; GMFCS levels I/II/III/IV/V: n = 6/6/5/7/6; socio-economic status (SES) low/average/high: n = 8/17/5) were matched for gender, age, and SES. Adults with CP reported a higher unemployment rate and lower level of satisfaction with access to health services than TD peers. Core themes identified by the participants with CP that made community participation more difficult were physical capacity, poor access to accommodation, transport and health services, lack of socialising opportunities, poor universal design, and lack of financial independence. Adults with CP reported experiencing many challenges in their communities. Improved access to health care services and transport, and the universal design of housing and community buildings to accommodate individuals with a disability should be made a priority. Adults with cerebral palsy (CP) reported that their disability had an impact on their social life, home life, and work life. Accessibility issues have been identified as a major factor affecting adults with CP in a variety of areas, including access to and use of health services, housing, transportation, and community buildings. Adults with CP reported the need for support during the transition to adulthood, especially with developing life skills that will promote living independently in the community as adults with disabilities. [ABSTRACT FROM AUTHOR]

Aim: To report on the results of the online international consensus process to develop the comprehensive and brief International Classification of Functioning, Disability and Health (ICF) Core Sets for adults with cerebral palsy (CP). Method: An online iterative decision‐making and consensus process involved 25 experts, including clinicians and researchers working with adults with CP, an adult with CP, and the parents of adults with CP from all six regions of the World Health Organization. The most relevant categories were selected from a list of 154 unique second‐level candidate categories to develop the ICF Core Sets for adults with CP. This list resulted from evidence gathered during four preparatory studies, that is, a systematic literature review, a qualitative study, an expert survey, and an empirical study. Results: The consensus process resulted in the comprehensive ICF Core Set containing 120 second‐level ICF categories: 33 body functions; eight body structures; 50 activities and participation; and 29 environmental factors, from which the most essential categories, 33 in total, were selected for the brief ICF Core Set. For body functions, most of the categories were mental functions and neuromusculoskeletal and movement‐related functions. Body structures were mostly related to movement. All the chapters of the activities and participation component were represented, with mobility and self‐care as the most frequently covered chapters. For environmental factors, most of the categories addressed products and technology and services, systems, and policies. Interpretation: The comprehensive and brief ICF Core Sets for adults with CP were created using a new online version of an established ICF Core Set consensus process. These Core Sets complement the age‐specific ICF Core Sets for children and young people with CP and will promote standardized data collection worldwide. This original article is commented on by Pathak and Sharma on page 533 of this issue. [ABSTRACT FROM AUTHOR]

To determine changes in level of accomplishment and satisfaction in daily activities and social participation, and functional mobility in adults with cerebral palsy (CP) more than 25 years after selective dorsal rhizotomy (SDR). This long-term observational nine-year follow-up study included 26 adults (median age 35 years) with CP and spastic diplegia, and 26 matched typically developing adults. Assessment tools used were the Life-Habits questionnaire and the Functional Mobility Scale. Most of the adults with CP were independent and satisfied with accomplishing life habits and no changes were determined, except for a small change in the Housing accomplishment level. Compared to typically developing adults, the CP cohort was more dependent in accomplishing Mobility and Recreation. However, the level of satisfaction was similar for most life habits except for Mobility. Functional mobility did not change, but correlated with Life-Habits results. Adults with CP showed high and stable levels of accomplishment and satisfaction in daily activities and social participation more than 25 years after SDR. This is in contrast with the literature, where functional decline was shown for individuals with CP as they age. The relation with functional mobility highlights the importance to focus the rehabilitation on maintaining walking ability in order to enable high level of daily activities and social participation in adults with CP. Selective dorsal rhizotomy (SDR) is a valuable treatment option for a selective group of children with cerebral palsy (CP) in order to reduce spasticity. The long-term outcomes of SDR on level of accomplishment and satisfaction in daily activities and social participation as well functional mobility in adults with CP are not clear. More than 25 years after SDR adults with CP experienced stable and lasting high levels of functioning regarding daily activities and social participation and were satisfied with the way they accomplished life habits. Functional mobility was correlated to level of accomplishment and satisfaction in daily activities and social participation, which highlights the importance to focus rehabilitation programs on maintaining functional mobility in order to enable daily activities and social participation in adults with CP. [ABSTRACT FROM AUTHOR]

Background: The handheld dynamometer (HHD) is a well-accepted tool to assess muscle strength in children with cerebral palsy (CP), though reliability is not tested for adults with CP and no normative data are available.Objectives: To present strength levels of lower extremity muscle groups and test-retest reliability of HHD measurements in ambulatory adults with CP and typically developed (TD) adults.Design: Case-control study.Setting: Human motion laboratory.Participants: Fifty-four adults with CP (28 men; Gross Motor Function Classification System [GMFCS] level I/II/III: n = 25/20/9; mean age (SD) = 38 (7) year) and 62 TD adults (31 men; mean age (SD) = 37 (5) year).Interventions: Not applicable.Main Outcome Measure(s): Maximum strength levels were obtained during voluntary isometric contraction of eight lower extremity muscle groups in adults with CP and spastic diplegia and TD adults using HHD. Three trials were performed per muscle group per leg. Test-retest reliability was investigated by calculating intraclass correlation coefficient (ICC), coefficient of variation (CV), and typical error of measurement (TEM).Results: Force and torque levels were significantly lower in all eight lower extremity muscle groups. Excellent ICC levels were observed in TD, GMFCS I and II (>0.90), and moderate to excellent (0.82-0.97) in GMFCS III. CV and TEM were higher in adults with CP compared to TD adults, especially in GMFCS III.Limitations: No subtypes other than adults with CP and spastic diplegia were included.Conclusions: Lower extremity strength profiles demonstrate substantial muscle weakness in ambulatory adults with CP compared to TD adults, which highlights the importance to address muscle weakness in this population group. These strength profiles may serve as norm values for clinicians and researchers. In addition, HHD showed to be reliable to assess lower extremity strength in adults with CP. [ABSTRACT FROM AUTHOR]

The regular monitoring of athletes is important to fine-tune training and detect early symptoms of overreaching. Therefore the aim of this study was to determine if a noninvasive submaximal running test could reflect a state of overreaching. 14 trained runners completed a noninvasive Lamberts Submaximal Running Test, one week before and 2 days after finishing an ultramarathon, and delayed onset of muscle soreness and the daily analysis of life demands for athletes questionnaire were also captured. After the ultramarathon, submaximal heart rate was lower at 70 % (-3 beats) and 85 % of peak treadmill running speed (P < 0.01). Ratings of perceived exertion were higher at 60 % (2 units) and 85 % (one unit) of peak treadmill running speed, while 60-second heart rate recovery was significantly faster (7 beats, P < 0.001). Delayed Onset of Muscle Soreness scores and the number of symptoms of stress (Daily Analysis of Life Demands for Athletes) were also higher after the ultramarathon (P < 0.01). The current study shows that the Lamberts Submaximal Running Test is able to reflect early symptoms of overreaching. Responses to acute fatigue and overreaching were characterized by counterintuitive responses, such as lower submaximal heart rates and faster heart rate recovery, while ratings of perceived exertion were higher. [ABSTRACT FROM AUTHOR]

Aim: To describe upper limb motor function and level of activity and participation in children with HIV encephalopathy (HIVE) and bilateral lower limb (BLL) spasticity.Method: Thirty ambulant children with HIVE and BLL spasticity and 20 typically developing children, between 5 years and 12 years, were recruited. Upper limb motor function was assessed using the Purdue Pegboard and level of activity and participation using the Computer-Adapted Pediatric Evaluation of Disabilities Inventory (PEDI-CAT).Results: The HIVE group comprised 14 males and 16 females (mean age [SD] 8y 8mo [2y 2mo], Gross Motor Function Classification System (GMFCS) level I [n=10], II [n=11], and III [n=9]) and the typically developing group comprised 11 males and 9 females (mean age 8y 8mo [2y 3mo]). The HIVE group had lower scores than the typically developing group for all pegboard tasks and three of the four PEDI-CAT domains (p≤0.001). However, individual outcome scores varied substantially within each GMFCS level.Interpretation: Children with HIVE and BLL spasticity may have significantly poorer upper limb motor performance and lower levels of activity and participation than typically developing children. These findings suggest that an assessment of upper limb motor function should form part of optimal care for this population. [ABSTRACT FROM AUTHOR]

Objective: The primary purpose of selective dorsal rhizotomy (SDR) is to ameliorate spasticity in the lower extremities of children with cerebral palsy (CP). In correctly selected patients, this neurosurgical procedure has been shown to have a beneficial effect on many aspects of the child's life. However, given the challenges faced by adults with CP, it would be valuable to document the status of this population compared to their peers later in adulthood. Therefore, the aim of this study was to determine the physical status, mental health, and health-related quality of life (HRQoL) of adults with CP who underwent SDR at least 25 years ago, compared to matched typically developing (TD) individuals. The second aim was to investigate relationships between physical status and the other outcome measures., Methods: Adults with CP were recruited from a database of children who had undergone SDR performed using the technique introduced by Professor Warwick Peacock at Red Cross War Memorial Children's Hospital in Cape Town, South Africa, between 1981 and 1991. These individuals were matched for age, sex, body mass index, and socioeconomic status to a TD adult cohort from a similar background. The parameters assessed were lower-extremity muscle tone, passive range of motion, muscle strength, selectivity, functional mobility and dynamic balance (Timed Up and Go [TUG] test), HRQoL (SF-36), and anxiety and depression levels., Results: Twenty-six adults with CP who had a median age of 35.8 years (interquartile range 34.2-41.4 years) (female/male: n = 10/16; Gross Motor Function Classification System level I/II/III: n = 13/10/3), were compared to 26 TD adults. Muscle tone was similar, whereas passive range of motion, muscle strength, selectivity, TUG, and SF-36 physical functioning (concept and summary) scores differed between the cohorts. Other SF-36 parameters, anxiety levels, and depression levels were not different. Strong correlations were found between the muscle strength and TUG scores., Conclusions: Normalized lower-extremity muscle tone was sustained 25-35 years after SDR. Whereas the lower scores for physical assessments are in line with findings in other CP populations, remarkably, relatively good mental health and HRQoL scores were reported in this CP group despite their physical limitations. The strong correlation between muscle strength and TUG suggests that strength training after SDR may have value in improving functional mobility and balance.

Objective: The main purpose of selective dorsal rhizotomy (SDR) is to reduce spasticity in the lower extremities of children diagnosed with cerebral palsy (CP) and spastic diplegia. The potential for developing spinal abnormalities and pain is a concern, especially in the aging CP population. Therefore, the aim of this study was to evaluate spinal abnormalities, level of pain, and disability (due to back or leg pain) in adults with CP, and associations with participant characteristics, more than 25 years after SDR., Methods: This is a 9-year follow-up study with data collection conducted in 2008 and 2017. Radiographs were assessed for the degree of scoliosis, thoracic kyphosis and lumbar lordosis curvatures, and prevalence of spondylolysis and spondylolisthesis, while level of pain and disability was determined with a self-developed questionnaire and the Oswestry Disability Index (ODI) questionnaire, respectively., Results: Twenty-five participants were included (15 males; median age 35.9 years, IQR 34.3-41.5 years), with a follow-up time after SDR ranging from 25 to 35 years. No clinically relevant changes were found for spinal curvatures, spondylolysis and spondylolisthesis, perceived pain frequency, and ODI scores between 2008 and 2017. While the prevalence of spondylolysis was 44%, spondylolisthesis was found in 20% (of whom 15% were grade I and 5% grade II), lumbar hyperlordosis was found in 32%, thoracic hyperkyphosis in 4%, and scoliosis in 20%. The Cobb angle was < 25°, and no patient required surgery for scoliosis. In addition, the low back was reported as the most common site of pain, with 28% of the adults with CP having daily pain. This resulted in 80% of the cohort indicating none or minimal disability due to pain based on the ODI. The only correlation found was between hyperkyphosis and female gender., Conclusions: At follow-up more than 25 years after SDR, no progression in spinal abnormalities, level of pain, and disability was found when compared with findings 15 years after SDR. The prevalence of scoliosis, thoracic hyperkyphosis, and lumbar hyperlordosis was within the range reported for adults with CP, while spondylolysis and spondylolisthesis occurred more often than would be expected. It is difficult, however, to establish the role of SDR in this finding, given the limited data on the natural history of CP. Despite the encouraging outcome of this long-term follow-up study after SDR, it is important to continue monitoring adults with CP during the aging process.