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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]

The aim of this study was to investigate the prevalence and level of disability due to pain, health-related quality of life (HRQoL) and mental health in adolescents and adults with cerebral palsy (CP), living in a low-to-middle income country (LMIC), compared to matched typically developing (TD) peers, and to explore associations with individual characteristics. This case-control study included 31 adolescents and 30 adults with CP (gross motor function classification system [GMFCS] Level I–V) and matched TD peers. Assessment tools used were a pain questionnaire, the Oswestry Disability Index (ODI), Short-Form Health Survey (SF-36v2), Hospital Anxiety and Depression Scale (HADS), and General Self Efficacy (GSE) scale. Both CP cohorts reported more frequent pain in their lower limbs, higher level of disability due to pain (total ODI score) and lower perceived physical HRQoL compared to TD peers, while their mental health (mental HRQoL, HADS, and GSE) was not different. Despite the physical challenges faced by adolescents and adults with CP living in urban South Africa, the mental health scores showed no difference compared to TD peers. Care should be taken to maintain this positive mental state during ageing across their lifespan. The prognosis of individuals with cerebral palsy (CP) has improved over the last three decades and CP should therefore be considered as a lifelong condition. Adolescents and adults with CP living in urban South Africa reported a higher level of disability due to pain and lower physical health-related quality of life compared to typically developing peers, while their level of depression, anxiety, and self-esteem was not different. These results were similar to findings of studies conducted in high-income countries, though it cannot be generalised to other low to middle-income countries with different cultural and government systems. In order to promote healthy ageing across their lifespan, intervention programmes should be considered to improve physical well-being, and care should be taken to maintain their positive mental health. [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]

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]