Electromyographic analysis of a human powered stepper cycle during seated and standing riding

This study examined the muscular activation patterns produced while riding the Step 'n Go, a tricycle powered by a reciprocating vertical motion and typically used by individuals with cognitive, orthopedic, and neuromuscular conditions. Seven normal, adult subjects were tested at three power levels (75, 100, and 125 W) during seated and standing riding. Eight lower extremity muscles were examined with surface electromyography. Results showed that the major power producing muscles for this device were the gluteus maximus, vastis lateralis and medialis, rectus femoris, and tibialis anterior. At the highest power level, peak and mean muscular activation in these muscles were substantially lower (17–38%) while riding standing compared to seated, and seems to reflect the benefit of body weight for power production while standing. At the lowest power level, the peak and mean muscle activation differences between positions were less remarkable, and in some cases the standing values were greater than seated. This suggests that significant muscular effort was required to maintain standing posture and balance when riding at low power levels. Individuals able to perform vastis lateralis and medialis intensive activities, such as the concentric portion of a squat or using a stepping machine (Stair Master), should be able to comfortably ride the Step 'n Go at low power levels.     

Analysis of the neuromuscular activity during rising from a chair in water and on dry land

PurposeThe purpose of the present study was to analyze the neuromuscular responses during the performance of a sit to stand [STS] task in water and on dry land.Scope10 healthy subjects, five males and five females were recruited for study. Surface electromyography sEMG was used for lower limb and trunk muscles maximal voluntarty contraction [MVC] and during the STS task.ResultsMuscle activity was significantly higher on dry land than in water normalized signals by MVC from the quadriceps-vastus medialis [17.3%], the quadriceps – rectus femoris [5.3%], the long head of the biceps femoris [5.5%], the tibialis anterior [13.9%], the gastrocnemius medialis [3.4%], the soleus [6.2%]. However, the muscle activity was higher in water for the rectus abdominis [?26.6%] and the erector spinae [?22.6%].ConclusionsThis study for the first time describes the neuromuscular responses in healthy subjects during the performance of the STS task in water. The differences in lower limb and trunk muscle activity should be considered when using the STS movement in aquatic rehabilitation.     

脑瘫伴癫痫儿童肠道菌群变化

目的 探讨脑瘫伴癫痫儿童肠道菌群的变化。方法 选择龙岗区社会福利中心诊断为脑瘫伴癫痫的31例患儿作为疾病组;另外选取同龄健康儿童30例作为健康组。留取受试者的粪便标本,提取总DNA,并对16S rRNA基因的V3‒V4可变区进行扩增,并在Illumina MiSeq平台进行高通量测序。结果 与健康儿童相比,疾病组儿童肠道内微生物多样性出现明显差异。在门水平优势菌群中,疾病组儿童放线菌的相对丰度明显高于健康组（32.87% vs 3.56%）,而拟杆菌的相对丰度明显低于健康组（22.66% vs 53.59%）。在属水平优势菌群中,疾病组儿童双歧杆菌属、副拟杆菌属的相对丰度均明显高于健康组（26.94% vs 2.61%,5.72% vs 1.90%）,其中肠杆菌属的相对丰度达6.00%,而拟杆菌属、粪杆菌属的相对丰度明显低于健康组（11.38% vs 45.16%,0.63% vs 12.78%）,普雷沃菌属的相对丰度也低于健康组（3.11% vs 5.30%）。结论 与同龄健康儿童相比,脑瘫伴癫痫儿童肠道菌群改变明显,菌群门水平和属水平均有明显差异。     

Serum trace element and amino acid profile in children with cerebral palsy

BackgroundThe existing data demonstrate that both trace elements and amino acids play a significant role in neurodevelopment and brain functioning. Certain studies have demonstrated alteration of micronutrient status in children with cerebral palsy, although multiple inconsistencies exist.The objectiveof the present study was to assess serum trace element and mineral, as well as amino acid levels in children with cerebral palsy.Methods71 children with cerebral palsy (39 boys and 32 girls, 5.7 ± 2.3 y.o.) and 84 healthy children (51 boys and 33 girls, 5.4 ± 2.3 y.o.) were enrolled in the present study. Serum trace element and mineral levels were assessed using inductively-coupled plasma mass-spectrometry (ICP-MS). Amino acid profile was evaluated by means of high-pressure liquid chromatography (HPLC).ResultsChildren with cerebral palsy are characterized by significantly lower Cu and Zn levels by 6% and 8%, whereas serum I concentration exceeded the control values by 7%. A tendency to increased serum Mn and Se levels was also observed in patients with cerebral palsy. Serum citrulline, leucine, tyrosine, and valine levels were 15 %, 23 %, 15 %, and 11 % lower than those in healthy controls. Nearly twofold lower levels of serum proline were accompanied by a 44 % elevation of hydroxyproline concentrations when compared to the control values. In multiple regression model serum I, Zn, and hydroxyproline levels were found to be independently associated with the presence of cerebral palsy. Correlation analysis demonstrated a significant correlation between Cu, Mn, Se, I, and Zn levels with hydroxyproline and citrulline concentrations.ConclusionThe observed alterations in trace element and amino acid metabolism may contribute to neurological deterioration in cerebral palsy. However, the cross-sectional design of the study does not allow to estimate the causal trilateral relationships between cerebral palsy, altered trace element, and amino acid metabolism.     

The severity of chewing disorders is related to gross motor function and trunk control in children with cerebral palsy

Abstract

Purpose: The frequency of chewing disorders increases with decreasing level of gross motor function in children with cerebral palsy (CP). Besides its frequency, the severity of chewing disorders is also important. The aim of this study was to determine the relationship between chewing performance level and gross motor function, and trunk postural control in children with CP.

Materials and methods: The study included 119 children with CP (age 2–10 years). Chewing performance level was determined by the Karaduman Chewing Performance Scale (KCPS). The Gross Motor Function Classification System (GMFCS) was used to determine the level of gross motor function. Segmental Assessment of Trunk Control (SATCo) was used to measure trunk control.

Results: Children with spastic CP with a median age of 4?years were evaluated, of which 50.4% were male. The percentages of patients classified to GMFCS levels I to V were 43.7%, 6.7%, 9.2%, 5.0%, and 35.3%, respectively. The median KCPS score was 3 (min?=?0, max?=?4). A good correlation was found between KCPS and GMFCS (p?<?.001, r?=?0.70). Negative, excellent correlations between KCPS and SATCo static, SATCo active, and SATCo reactive postural controls were found (p?<?.001, r?=?–0.75, r?=?–0.77, r?=?–0.79; respectively).

Conclusions: The severity of chewing disorders is related to the level of gross motor function and trunk postural control in children with CP.

Clinical trial number: NCT03241160     

Effects of seat surface inclination on respiration and speech production in children with spastic cerebral palsy

Background

Respiratory and speech problems are commonly observed in children with cerebral palsy (CP). The purpose of this study was to identify if inclination of seat surface could influence respiratory ability and speech production in children with spastic diplegic CP.

Methods

Sixteen children with spastic diplegic CP, ages 6 to 12 years old, participated in this study. The subjects’ respiratory ability (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), and maximum phonation time (MPT)) were measured in three sitting conditions: a seat surface inclined 0°, anterior 15°, and posterior 15°.

Results

FVC was significantly different across three inclinations of seat surface, F(2, 45) = 3.81, P = 0.03. In particular, the subjects’ FVC at a seat surface inclined anterior 15° was significantly greater than at a seat surface inclined posterior 15° (P < 0.05). However, FEV1, PEF, and MPT were not significantly affected by seat surface inclination (P > 0.05).

Conclusions

The results suggest that anterior inclination of seat surface may provide a positive effect on respiratory function in children with spastic diplegic CP.     

Stiffness of hip adductor myofibrils is decreased in children with spastic cerebral palsy

Cerebral palsy (CP) is the result of a static brain lesion which causes spasticity and muscle contracture. The source of the increased passive stiffness in patients is not understood and while whole muscle down to single muscle fibres have been investigated, the smallest functional unit of muscle (the sarcomere) has not been. Muscle biopsies (adductor longus and gracilis) from pediatric patients were obtained (CP n = 9 and control n = 2) and analyzed for mechanical stiffness, in-vivo sarcomere length and titin isoforms. Adductor longus muscle was the focus of this study and the results for sarcomere length showed a significant increase in length for CP (3.6 µm) compared to controls (2.6 µm). Passive stress at the same sarcomere length for CP compared to control was significantly lower in CP and the elastic modulus for the physiological range of muscle was lower in CP compared to control (98.2 kPa and 166.1 kPa, respectively). Our results show that CP muscle at its most reduced level (the myofibril) is more compliant compared to normal, which is completely opposite to what is observed at higher structural levels (single fibres, muscle fibre bundles and whole muscle). It is noteworthy that at the in vivo sarcomere length in CP, the passive forces are greater than normal, purely as a functional of these more compliant sarcomeres operating at long lengths. Titin isoforms were not different between CP and non-CP adductor longus but titin:nebulin was reduced in CP muscle, which may be due to titin loss or an over-expression of nebulin in CP muscles.     

Human isometric force production and electromyogram activity of knee extensor muscles in water and on dry land

This study was designed to determine trial-to-trial and day-to-day reproducibility of isometric force and electromyogram activity (EMG) of the knee extensor muscles in water and on dry land as well as to make comparisons between the two training conditions in muscle activity and force production. A group of 20 healthy subjects (12 women and 8 men) were tested three times over 2 weeks. A measurement session consisted of recordings of maximal and submaximal isometric knee extension force with simultaneous recording of surface EMG from the vastus medialis, vastus lateralis and biceps femoris muscles. To ensure identical measurement conditions the same patient elevator chair was used in both the dry and the wet environment. Intraclass correlation coefficients (ICC) and coefficients of variation (CV) showed high trial-to-trial (ICC = 0.95-0.99, CV = 3.5%-11%) and day-to-day reproducibility (ICC=0.85-0.98, CV=11%-19%) for underwater and dry land measurements of force and EMG in each muscle during maximal contractions. The day-to-day reproducibility for submaximal contractions was similar. The interesting finding was that underwater EMG amplitude decreased significantly in each muscle during maximal (P < 0.01-P < 0.001) and submaximal contractions (P < 0.05-P < 0.001). However, the isometric force measurements showed similar values in both wet and dry conditions. The water had no disturbing effect on the electrodes as shown by slightly lowered interelectrode resistance values, the absence of artefacts and low noise levels of the EMG signals. It was concluded that underwater force and EMG measurements are highly reproducible. The significant decrease of underwater EMG could have electromechanical and/or neurophysiological explanations.     

The role of co-activation in strength and force modulation in the elbow of children with unilateral cerebral palsy

To study the role of coactivation in strength and force modulation in the elbow joint of children and adolescents with cerebral palsy (CP), we investigated the affected and contralateral arm of 21 persons (age 8-18) with spastic unilateral CP in three tasks: maximal voluntary isokinetic concentric contraction and passive isokinetic movement during elbow flexion and extension, and sub-maximal isometric force tracing during elbow flexion. Elbow flexion-extension torque and surface electromyography (EMG) of the biceps brachii (BB) and triceps brachii (TB) muscles were recorded. During the maximal contractions, the affected arm was weaker, had decreased agonist and similar antagonist EMG amplitudes, and thus increased antagonist co-activation (% of maximal activity as agonist) during both elbow flexion and extension, with higher coactivation levels of the TB than the BB. During passive elbow extension, the BB of the affected arm showed increased resistance torque and indication of reflex, and thus spastic, activity. No difference between the two arms was found in the ability to modulate force, despite increased TB coactivation in the affected arm. The results indicate that coactivation plays a minor role in muscle weakness in CP, and does not limit force modulation. Moreover, spasticity seems particularly to increase coactivation in the muscle antagonistic to the spastic one, possibly in order to increase stability.     

Electromyographic analysis of the serratus anterior and trapezius muscles during push-ups on stable and unstable bases in subjects with scapular dyskinesis

The present study was performed to assess the electromyographic activity of the scapular muscles during push-ups on a stable and unstable surface, in subjects with scapular dyskinesis. Muscle activation (upper trapezius [UT]; lower trapezius [LT]; upper serratus anterior [SA_5th]; lower serratus anterior [SA_7th]) and ratios (UT/LT; UT/SA_5th; UT/ SA_7th) levels were determined by surface EMG in 30 asymptomatic men with scapular dyskinesis, during push-up performed on a stable and unstable surface. Multivariate analysis of variance with repeated measures was used for statistical analyses. The unstable surface caused a decrease in the EMG activity of the serratus anterior and an increase in EMG activity of the trapezius (p = 0.001). UT/SA_5th and UT/ SA_7th ratios were higher during unstable push-ups (p = 0.001). The results suggest that, in individuals with scapular dyskinesis, there is increased EMG activity of the trapezius and decreased EMG activity of the serratus anterior in response to an unstable surface. These results suggest that the performance of the push up exercise on an unstable surface may be more favorable to produce higher levels of trapezius activation and lower levels of serratus anterior activation. However, if the goal of the exercise program is the strengthening of the SA muscle, it is suggested to perform the push up on a stable surface.     

Vitamin D deficiency in children with cerebral palsy: A narrative review of epidemiology,contributing factors,clinical consequences and interventions

Sufficient vitamin D levels are necessary, not only for mineralization, normal growth and development of bones, but also for the prevention of fatal chronic diseases like diabetes mellitus, metabolic syndrome and cancer. This is of particular importance in children with neuro- and musculoskeletal disorders, especially cerebral palsy (CP). CP is a heterogeneous group of childhood developmental disability disorders described by uncharacteristic posture, balance, and movement. Patients with CP are at an increased risk of vitamin D deficiency and as a result reduced bone mineral density, bone fragility, osteopenia, and rickets. The present review aims to combine and summarize available evidence, regarding the epidemiology, underlying contributing factors, clinical consequences, and treatment interventions of vitamin D deficiency in children with CP.     

Influence of patellar position on the knee extensor mechanism in normal and crouched walking

Patella alta is common in cerebral palsy, especially in patients with crouch gait. Correction of patella alta has been advocated in the treatment of crouch, however the appropriate degree of correction and the implications for knee extensor function remain unclear. Therefore, the goal of this study was to assess the impact of patellar position on quadriceps and patellar tendon forces during normal and crouch gait. To this end, a lower extremity musculoskeletal model with a novel 12 degree of freedom knee joint was used to simulate normal gait in a healthy child, as well as mild (23 deg min knee flexion in stance), moderate (41 deg), and severe (67 deg) crouch gait in three children with cerebral palsy. The simulations revealed that quadriceps and patellar tendon forces increase dramatically with crouch, and are modulated by patellar position. For example with a normal patellar tendon position, peak patellar tendon forces were 0.7 times body weight in normal walking, but reached 2.2, 3.2 and 5.4 times body weight in mild, moderate and severe crouch. Moderate patella alta acted to reduce quadriceps and patellar tendon loads in crouch gait, due to an enhancement of the patellar tendon moment arms with alta in a flexed knee. In contrast, patella baja reduced the patellar tendon moment arm in a flexed knee and thus induced an increase in the patellar tendon loads needed to walk in crouch. Functionally, these results suggest that patella baja could also compromise knee extensor function for other flexed knee activities such as chair rise and stair climbing. The findings are important to consider when using surgical approaches for correcting patella alta in children who exhibit crouch gait patterns.     

The morphology of the medial gastrocnemius in typically developing children and children with spastic hemiplegic cerebral palsy

We collected 3D ultrasound images of the medial gastrocnemius muscle belly (MG) in 16 children with spastic hemiplegic cerebral palsy (SHCP) (mean age: 7.8 years; range: 4–12) and 15 typically-developing (TD) children (mean age: 9.5 years; range: 4–13). All children with SHCP had limited passive dorsiflexion range on the affected side with the knee extended (mean ± 1SD: −9.3° ± 11.8). Scans were taken of both legs with the ankle joint at its resting angle (RA) and at maximum passive dorsiflexion (MD), with the knee extended. RA and MD were more plantar flexed (p < 0.05) in children with SHCP than in TD children.

We measured the volumes and lengths of the MG bellies. We also measured the length of muscle fascicles in the mid-portion of the muscle belly and the angle that the fascicles made with the deep aponeurosis of the muscle. Volumes were normalised to the subject’s body mass; muscle lengths and fascicle lengths were normalised to the length of the fibula.

Normalised MG belly lengths in the paretic limb were shorter than the non-paretic side at MD (p = 0.0001) and RA (p = 0.0236). Normalised muscle lengths of the paretic limb were shorter than those in TD children at both angles (p = 0.0004; p = 0.0003). However, normalised fascicle lengths in the non-paretic and paretic limbs were similar to those measured in TD children (p > 0.05). When compared to the non-paretic limb, muscle volume was reduced in the paretic limb (p < 0.0001), by an average of 28%, and normalised muscle volume in the paretic limb was smaller than in the TD group (p < 0.0001).

The MG is short and small in the paretic limb of children with SHCP. The altered morphology is not due to a decrease in fascicle length. We suggest that MG deformity in SHCP is caused by lack of cross-sectional growth.     

Reliability and sources of variability of 3D kinematics and electromyography measurements to assess newly-acquired gait in toddlers with typical development and unilateral cerebral palsy

The aim was to 1) determine intersession and intertrial reliability and 2) assess three sources of variability (intersubject, intersession and intertrial) of lower limb kinematic and electromyographic (EMG) variables during gait in toddlers with typical development (TD) and unilateral cerebral palsy (UCP) (age <3 years, independent walking experience ≤6 months). Gait kinematics and surface EMG were recorded in 30 toddlers (19 TD and 11 UCP), during two, 3D-motion capture sessions. Standard error of measurement (SEM) between trials (gait cycles) of the same session and between sessions was calculated to assess reliability. Standard deviations (SD) between subjects, sessions and trials were calculated to estimate sources of variability. Sixty-four percent of kinematic SEM-values were acceptable (2°-5°). Frontal plane measurements were most reliable (SEM 2°-4.6°). In toddlers with UCP, EMG variables were most reliable for affected side, distal muscles. Intrinsic (intertrial and intersubject) variability was high, reflecting both motor immaturity and the high variability of toddler gait patterns. In toddlers with UCP, variability was amplified by motor impairment and delayed motor development. 3D gait analysis and surface EMG are partially reliable tools to study individual gait patterns in toddlers in clinical practice and research, although some variables must be interpreted with caution.     

The impact of centre of pressure error on predicted joint kinetics during cerebral palsy and typically developed gait: A clinical perspective

Centre of Pressure (CoP) location error is common when using kinematic and kinetic data to predict intersegmental forces and net joint moments during gait. Changes in peak moments due to CoP error have been reported in the literature. However, debate exists as to what levels of error are acceptable. The aim of this study was to examine the impact of CoP error on the kinetic profiles of children with typical development (TD) and children with cerebral palsy (CP) during gait. Three-dimensional kinematic and kinetic data were recorded and simulated CoP errors were applied at 3 mm, 6 mm, 9 mm, 12 mm increments in both positive and negative anteroposterior and mediolateral directions. Absolute differences in maximum kinetic parameters between increments were assessed in conjunction with changes in the Gait Deviation Index-Kinetic (GDI-Kinetic). Changes in GDI-Kinetic above 3.6 points were considered clinically significant. Maximum peak changes of up to 24.8% (CP) and 34.7% (TD) (sagittal plane) and up to 36.8% (CP) and 61.5% (TD) (coronal plane) were demonstrated at the knee. While absolute percentage differences were high at some error increments, GDI-Kinetic results suggested that such large percentage differences may still be clinically acceptable. Children with TD demonstrated clinically significant changes in GDI-Kinetic for CoP displacements of 9 mm and 12 mm, corresponding to 23% and 35% absolute differences in maximum moments. In contrast, the clinically significant threshold was not reached for children with CP that may be related to a slower walking speed. The findings of this study highlight the need for laboratories to consider the thresholds currently used for CoP error, which will help guide quality assurance procedures.     

Safety and tolerability of intrathecal delivery of autologous bone marrow nucleated cells in children with cerebral palsy: an open-label phase I trial

Background aimsCerebral palsy (CP) is related to severe perinatal hypoxia with permanent brain damage in nearly 50% of surviving preterm infants. Cell therapy is a potential therapeutic option for CP by several mechanisms, including immunomodulation through cytokine and growth factor secretion.MethodsIn this phase I open-label clinical trial, 18 pediatric patients with CP were included to assess the safety of autologous bone marrow–derived total nucleated cell (TNC) intrathecal and intravenous injection after stimulation with granulocyte colony-stimulating factor. Motor, cognitive, communication, personal-social and adaptive areas were evaluated at baseline and 1 and 6 months after the procedure through the use of the Battelle Developmental Inventory. Magnetic resonance imaging was performed at baseline and 6 months after therapy. This study was registered in ClinicaTrials.gov (NCT01019733).ResultsA median of 13.12 × 10⁸ TNCs (range, 4.83–53.87) including 10.02 × 10⁶ CD34+ cells (range, 1.02–29.9) in a volume of 7 mL (range, 4–10.5) was infused intrathecally. The remaining cells from the bone marrow aspirate were administered intravenously; 6.01 × 10⁸ TNCs (range, 1.36–17.85), with 3.39 × 10⁶ cells being CD34+. Early adverse effects included headache, vomiting, fever and stiff neck occurred in three patients. No serious complications were documented. An overall 4.7-month increase in developmental age according to the Battelle Developmental Inventory, including all areas of evaluation, was observed (±SD 2.63). No MRI changes at 6 months of follow-up were found.ConclusionsSubarachnoid placement of autologous bone marrow–derived TNC in children with CP is a safe procedure. The results suggest a possible increase in neurological function.     

Effect of changes in orientation and position of external loads on trunk muscle activity and kinematics in upright standing

Forces at different heights and orientations are often carried by hands while performing occupational tasks. Trunk muscle activity and spinal loads are likely dependent on not only moments but also the orientation and height of these forces. Here, we measured trunk kinematics and select superficial muscle activity of 12 asymptomatic subjects while supporting forces in hands in upright standing. Magnitude of forces in 5 orientations (−25°, 0°, 25°, 50° and 90°) and 2 heights (20 cm and 40 cm) were adjusted to generate flexion moments of 15, 30 and 45 N m at the L5-S1 disc centre. External forces were of much greater magnitude when applied at lower elevation or oriented upward at 25°. Spinal kinematics remained nearly unchanged in various tasks.Changes in orientation and elevation of external forces substantially influenced the recorded EMG, despite similar trunk posture and identical moments at the L5-S1. Greater EMG activity was overall recorded under larger forces albeit constant moment. Increases in the external moment at the L5-S1 substantially increased EMG in extensor muscles (p < 0.001) but had little effect on abdominals; e.g., mean longissimus EMG for all orientations increased by 38% and 75% as the moment level altered from 15 N m to 30 N m and to 45 N m while that in the rectus abdominus increased only by 2% and 4%, respectively. Under 45 N m moment and as the load orientation altered from 90° to 50°, 25°, 0° and −25°, mean EMG dropped by 3%, 12%, 12% and 1% in back muscles and by 17%, 17%, 19% and 13% in abdominals, respectively. As the load elevation increased from 20 cm to 40 cm, mean EMG under maximum moment decreased by 21% in back muscles and by 17% in abdominals.Due to the lack of EMG recording of deep lumbar muscles, changes in relative shear/compression components and different net moments at cranial discs despite identical moments at the caudal L5-S1 disc, complementary model studies are essential for a better comprehension of neuromuscular strategies in response to alterations in load height and orientation.     

Efficacy of transcutaneous electrical nerve stimulation combined with therapeutic exercise on hand function in children with hemiplegic cerebral palsy

Purpose: Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological method used to reduce spasticity. It was also assumed that TENS reduces pain and therefore improves limb function. Most of the previous studies about the effect of TENS were done in the lower limb and in stroke patients. There is a lack of enough literature about the direct and indirect effects of TENS in the upper limb. Hence, our study aimed to determine whether TENS combined with therapeutic exercises helps to improves hand function by reducing spasticity in children with hemiplegic cerebral palsy (CP).

Materials and methods: Twenty-nine children with hemiplegic CP were randomly assigned to the TENS group (n?=?15) or the control group (n?=?14). The TENS group received traditional physical therapy with the adjunct application of conventional TENS for 30?minutes (pulse duration, 250 µs; pulse rate, 100?Hz) on the wrist extensors, once daily, 3?days a week, for 8?weeks, while the control group received traditional physical therapy.

Results: The results showed a significant intergroup difference in handgrip strength over the 8-week period. The time to accomplish the Jebsen Taylor Hand Function Test (JTHFT) task decreased by 48% and the ABILHAND-Kids questionnaire scores improved by 23% in the TENS group.

Conclusions: The use of TENS in combination with therapeutic exercise may improve strength and hand function.     

The effects of whole body vibration on mobility and balance in children with cerebral palsy: a systematic review with meta-analysis

Objective:

We performed a meta-analysis to evaluate the effects of whole-body vibration on physiologic and functional measurements in children with cerebral palsy.

Design and methods:

We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, Scielo, CINAHL (from the earliest date available to November 2014) for randomized controlled trials, that aimed to investigate the effects of whole-body vibration versus exercise and/or versus control on physiologic and functional measurements in children with cerebral palsy. Two reviewers independently selected the studies. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated.

Results:

Six studies with 176 patients comparing whole-body vibration to exercise and/or control were included. Whole-body vibration resulted in improvement in: gait speed WMDs (0.13 95% CI:0.05 to 0.20); gross motor function dimension E WMDs (2.97 95% CI:0.07 to 5.86) and femur bone density (1.32 95% CI:0.28 to 2.36). The meta-analysis also showed a nonsignificant difference in muscle strength and gross motor function dimension D for participants in the whole-body vibration compared with control group. No serious adverse events were reported.

Conclusions:

Whole-body vibration may improve gait speed and standing function in children with cerebral palsy and could be considered for inclusion in rehabilitation programs.