AIM To test the efficacy of functional electrical stimulation (FES) cycling, goal-directed training, and adapted cycling, compared with usual care, to improve function in children with cerebral palsy (CP). METHOD The intervention was delivered between 2017 and 2019 and included three sessions per week for 8 weeks (291h sessions at a children's hospital, and 1h home programme/ week). Hospital sessions included 30 minutes of FES cycling and 30 minutes of goal-directed training. Home programmes included goal-directed training and adapted cycling. The comparison group continued usual care. Primary outcomes were gross motor function assessed by the Gross Motor Function Measure (GMFM) and goal performance/satisfaction assessed using the Canadian Occupational Performance Measure (COPM). Secondary outcomes were sit-to-stand and activity capacity, participation in home, school, and community activities, and power output. Linear regression was used to determine the between-group mean difference immediately post-training completion after adjusting for baseline scores. RESULTS This randomized controlled trial included 21 participants (mean age=10y 3mo, standard deviation [SD]=3y; Gross Motor Function Classification System level: II=7, III=6, IV=8) who were randomized to the intervention (n=11) or usual care group (n=10). Betweengroup differences at T2 favoured the intervention group for GMFM-88 (mean difference=7.4; 95% confidence interval [CI]: 2.3-12.6; p=0.007), GMFM-66 (mean difference=5.9; 95% CI: 3.1-8.8; p<0.001), COPM performance (mean difference=4.4; 95% CI: 3.9-5.3; p<0.001) and satisfaction (mean difference=5.2; 95% CI: 4.0-6.4; p<0.001). INTERPRETATION Children with CP achieved meaningful functional improvements after FES cycling, goal-directed training, and adapted cycling training. Cycling programmes for children with CP should be individualized and goal directed.
IntroductionChildren with cerebral palsy (CP) experience declines in gross motor ability as they transition from childhood to adolescence, which can result in the loss of ability to perform sit-to-stand transfers, ambulate or participate in leisure activities such as cycling. Functional electrical stimulation (FES) cycling is a novel technology that may provide opportunities for children with CP to strengthen their lower limbs, improve functional independence and increase physical activity participation. The proposed randomised controlled trial will test the efficacy of a training package of FES cycling, adapted cycling and goal-directed functional training to usual care in children with CP who are susceptible to functional declines.Methods and analysisForty children with CP (20 per group), aged 6–8 years and classified as Gross Motor Function Classification System (GMFCS) levels II–IV will be recruited across South East Queensland. Participants will be randomised to either an immediate intervention group, who will undertake 8 weeks of training, or a waitlist control group. The training group will attend two 1 hour sessions per week with a physiotherapist, consisting of FES cycling and goal-directed, functional exercises and a 1 hour home exercise programme per week, consisting of recreational cycling. Primary outcomes will be the gross motor function measure and Canadian occupational performance measure, and secondary outcomes will include the five times sit-to-stand test, habitual physical activity (accelerometry), power output during cycling and Participation and Environment Measure-Children and Youth. Outcomes will be assessed at baseline, postintervention (8 weeks) and 8 weeks following the intervention (retention).Ethics and disseminationEthical approval has been obtained from Griffith University (2018/037) and the Children’s Health Queensland Hospital and Health Service (CHQHHS) Human Research Ethics Committee (HREC/17/QRCH/88). Site-specific approval was obtained from CHQHHS research governance (SSA/17/QRCH/145). Results from this trial will be disseminated via publication in relevant peer-reviewed journals.Trial registration numberACTRN12617000644369p.
Aim To investigate whether activity‐monitors and machine learning models could provide accurate information about physical activity performed by children and adolescents with cerebral palsy (CP) who use mobility aids for ambulation. Method Eleven participants (mean age 11y [SD 3y]; six females, five males) classified in Gross Motor Function Classification System (GMFCS) levels III and IV, completed six physical activity trials wearing a tri‐axial accelerometer on the wrist, hip, and thigh. Trials included supine rest, upper‐limb task, walking, wheelchair propulsion, and cycling. Three supervised learning algorithms (decision tree, support vector machine [SVM], random forest) were trained on features in the raw‐acceleration signal. Model‐performance was evaluated using leave‐one‐subject‐out cross‐validation accuracy. Results Cross‐validation accuracy for the single‐placement models ranged from 59% to 79%, with the best performance achieved by the random forest wrist model (79%). Combining features from two or more accelerometer placements significantly improved classification accuracy. The random forest wrist and hip model achieved an overall accuracy of 92%, while the SVM wrist, hip, and thigh model achieved an overall accuracy of 90%. Interpretation Models trained on features in the raw‐acceleration signal may provide accurate recognition of clinically relevant physical activity behaviours in children and adolescents with CP who use mobility aids for ambulation in a controlled setting. What this paper adds Machine learning may assist clinicians in evaluating the efficacy of surgical and therapy‐based interventions. Machine learning may help researchers better understand the short‐ and long‐term benefits of physical activity for children with more severe motor impairments.
Objectives: The aim of this study was to determine the efficacy of cycling to improve function and reduce activity limitations in children with cerebral palsy; the optimal training parameters for improved function; and whether improvements in function can be retained. Method: Six databases were searched (until February 2019) and articles were screened in duplicate. Randomized or quasi-randomized controlled trials and pre–post studies were included. Methodological quality was assessed using the Downs and Black scale. Outcomes were reported under the International Classification of Functioning, Disability and Health domains of body functions and activity limitations. Quantitative analyses were completed using RevMan V5.3. Results: A total of 533 articles were identified and 9 studies containing data on 282 participants met full inclusion criteria. Methodological quality ranged from low (14 of 32) to high (28 of 32). Significant improvements were reported for hamstring strength (effect size = 0.77–0.93), cardiorespiratory fitness (effect size = 1.13–1.77), balance (effect size = 1.03–1.29), 3-minute walk test distance (effect size = 1.14) and gross motor function (effect size = 0.91). Meta-analysis suggested that cycling can improve gross motor function (standardized mean difference = 0.35; 95% confidence interval = (−0.01, 0.70); P = 0.05); however, the effect was insignificant when a poor-quality study was omitted. Conclusion: Cycling can improve muscle strength, balance and gross motor function in children with cerebral palsy; however, optimal training doses are yet to be determined. There was insufficient data to determine whether functional improvements can be retained. Conclusions were limited by small sample sizes, inconsistent outcome measures and a lack of follow-up testing.
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