Aim
To summarize the literature on the prevalence of cardiovascular disease (CVD), risk factors of CVD, and CVD‐related mortality in adults with cerebral palsy (CP).
Method
A systematic review was ...conducted by searching the PubMed, Embase, MEDLINE (Ovid), Cochrane, and CINAHL databases. Selection criteria included adults with CP aged 18 years or over. Methodological quality was assessed using the Newcastle–Ottawa scale for observational studies. Data were reported descriptively.
Results
Nineteen studies met the inclusion criteria. Only one study reported directly on the presence of CVD in adults with CP, which found adults with CP reported greater CVD conditions than adults without CP (15.1 vs 9.1%, p<0.001). The most commonly reported risk factor of CVD in adults with CP was overweight/obesity. Five studies included data on CVD‐related mortality in persons with CP, where CVD‐related and circulatory system‐related deaths were elevated and more common at a younger age in adults with CP than in the general population.
Interpretation
The prevalence of CVD and the risk of death because of CVD in this population seems increased, though the knowledge base is fragmented by studies that are small in size and geographically isolated. Further research is required to understand prevalence of risk factors among adults with CP, in particular overweight/obesity.
What this paper adds
Overweight and obesity are risk factors of cardiovascular disease (CVD) that are commonly reported in adults with cerebral palsy (CP).
CVD‐related and circulatory system‐related deaths are elevated in individuals with CP compared to the general population.
Resumen
Enfermedad cardiovascular y factores de riesgo relacionados en adultos con parálisis cerebral: una revisión sistemática
Objetivo
Análisis de la literatura publicada sobre la prevalencia de la enfermedad cardiovascular (ECV), los factores de riesgo de ECV y la mortalidad relacionada con ECV en adultos con parálisis cerebral (PC).
Método
Se realizó una revisión sistemática buscando en las bases de datos de PubMed, Embase, Medline (Ovid), Cochrane y CINAHL. Los criterios de selección incluyeron adultos con PC de 18 años o más. La calidad metodológica se evaluó mediante la Escala de Newcastle Ottawa para estudios observacionales. Los datos se presentan descriptivamente.
Resultados
Diecinueve estudios cumplieron los criterios de inclusión. Solo un estudio informó directamente sobre la presencia de ECV en adultos con PC, el cual encontró mayor frecuencia de ECV en adultos con PC que en los adultos sin PC (15,1 % vs. a 9,1%, p <0,001). El sobrepeso / obesidad fue el factor de riesgo de ECV reportado más frecuentemente en adultos con PC. Cinco estudios que incluyeron datos sobre la mortalidad relacionada con ECV en personas con PC encontraron que el número de muertes relacionadas con ECV y con el sistema circulatorio fue más alto, y a una edad más temprana en adultos con PC que en la población general.
Interpretación
La prevalencia de ECV y el riesgo de muerte por ECV está elevado en personas con PC. Sin embargo, el conocimiento sobre este tema es incompleto, compuesto por estudios de tamaño pequeño y geográficamente aislados. Se necesita más investigación para comprender la prevalencia de ECV y los factores de riesgo en adultos con PC, en particular sobrepeso / obesidad.
Resumo
Doença cardiovascular e fatores de risco relacionados em adultos com paralisia cerebral: uma revisão sistemática
Objetivo
Sintetizar a literatura sobre a prevalência de doença cardiovascular (DCV), fatores de risco para DCV, e mortalidade relacionada a DCV em adultos com paralisia cerebral (PC).
Método
Uma revisão sistemática foi conduzida por meio de pesquisa nas bases de PubMed, Embase, Medline (Ovid), Cochrane, e CINAHL. Critérios de seleção incluíram adultos com PC com idade a partir de 18 anos. A qualidade metodológica foi avaliada usando a Escala Newcastle Ottawa para estudos observacionais. Os dados foram reportados descritivamente.
Resultados
Dezenove estudos atenderam aos critérios de inclusão. Apenas um estudo reportou diretamente a presença de DCV em adultos com PC, e encontrou que adultos com PC relataram mais DCV do que adultos sem PC (15,1 vs 9,1%, p<0,001). O fator de risco mais comumente relatado em adultos com PC foi sobrepeso/obesidade. Cinco estudos incluíram dados sobre a mortalidade relativa a DCV em pessoas com PC, em que mortes relacionadas a DCV e ao sistema circulatório foram elevadas e mais comuns em idade mais jovem em adultos com PC do que na populacão em geral.
Interpretação
A prevalência de DCV e o risco de morte causada por DCV nesta população parecem ser aumentados, embora o conhecimento seja fragmentado em esudos que são pequenos e geograficamente isolados. Mais pesquisas são necessárias para compreender a prevalência de fatores de risco entre adultos com PC, em particular a obesidade/sobrepeso.
What this paper adds
Overweight and obesity are risk factors of cardiovascular disease (CVD) that are commonly reported in adults with cerebral palsy (CP).
CVD‐related and circulatory system‐related deaths are elevated in individuals with CP compared to the general population.
This article is commented on by Edwards on pages 859–860 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
Return to School (RTS) and Return to Activity/Play (RTA) protocols are important in concussion management. Minimal evidence exists as to sequence and whether progression can occur simultaneously. ...Experts recommend that children/youth fully return to school before beginning RTA protocols. This study investigates recovery trajectories of children/youth while following RTA and RTS protocols simultaneously, with the following objectives: (1) to compare rates and patterns of progression through the stages of both protocols; (2) to evaluate symptom trajectories of youth post-concussion while progressing through stages of RTS and RTA; and (3) to propose a new model for concussion management in youth that involves the integration of Return to Activity and Return to School protocols.
In a 3-year prospective-cohort study of 139 children/youth aged 5-18 years with concussive injury, self-reported symptoms using PCSS and stage of protocols were evaluated every 48 h using electronic surveys until full return to school and activity/sport were attained. Information regarding school accommodation and achievement was collected.
Sample mean age is 13 years, 46% male. Youth are returning to school with accommodations significantly quicker than RTA (
= 0.001). Significant negative correlations between total PCSS score and stage of RTS protocol were found at: 1-week (
= -0.376,
< 0.0001;
= -0.317,
= 0.0003), 1-month (
= -0.483,
< 0.0001;
= -0.555,
< 0.0001), and 3-months (
= -0.598,
< 0.0001;
= -0.617,
< 0.0001); indicating lower symptom scores correlated with higher guideline stages. Median full return to school time is 35 days with 21% of youth symptomatic at full return. Median return time to full sport competition is 38 days with 15% still symptomatic. Sixty-four percent of youth reported experiencing school problems during recovery and 30% at symptom resolution, with 31% reporting a drop in their grades during recovery and 18% at study completion.
Children/youth return to school faster than they return to play in spite of the self-reported, school-related symptoms they experience while moving through the protocols. Youth can progress simultaneously through the RTS and RTA protocols during stages 1-3. Considering the numbers of youth having school difficulties post-concussion, full contact sport, stage 6, of RTA, should be delayed until full and successful reintegration back to school has been achieved. In light of the huge variability in recovery, determining how to resume participation in activities despite ongoing symptoms is still the challenge for each individual child. There is much to be learned with further research needed in this area.
The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. ...This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA.
Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion.
Participants had a mean ± SD symptom duration of 6.3 ± 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion.
Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth.
Aim
To describe active and sedentary time in children with spina bifida and to compare their physical activity on weekdays versus weekends.
Method
In this exploratory cross‐sectional study, data from ...13 Canadian and 22 Dutch children with spina bifida (14 females, 21 males; mean age 10y 11mo, standard deviation SD 3y 6mo, range 5y 6mo–18y; Hoffer classification distribution: community n=28, household n=3, non‐functional n=3, and non‐ambulator n=1) were analysed. Objective measures of physical activity and sedentary behaviour were obtained by using ActiGraph or Actiheart activity monitors. Data for the participants wearing the ActiGraph were compared with age‐ and sex‐matched controls that were developing typically using independent‐samples t‐tests. Activity data collected on weekdays was compared to those on weekends.
Results
ActiGraph data demonstrated children with spina bifida spent more time sedentary (mean SD 49.5min/h 5.78) and less time in moderate to vigorous physical activity (mean SD 2.33min/h 1.61) compared with the typically developing group (mean SD 41.0min/h 5.76 and 5.46min/h 2.13, p=0.001 and p<0.001 respectively). For both ActiGraph‐ and Actiheart‐derived data, physical activity and sedentary time were not significantly different between weekdays and weekends.
Interpretation
Children with spina bifida have reduced levels of physical activity and increased sedentary behaviour, with no statistical differences seen between weekdays and weekends. Several methodological issues related to activity monitoring warrant consideration when choosing the appropriate method to quantify physical activity and sedentary behaviour.
What this paper adds
Reduced levels of physical activity and sedentary time were quantified in children with spina bifida.
Objective quantification of physical behaviour in ambulatory and non‐ambulatory school‐aged children with spina bifida is possible.
Resumen
Actividad física y comportamiento sedentario en niños con espina bífida
Objetivo
Describir el tiempo activo y sedentario en niños con espina bífida y comparar su actividad física entre semana y fines de semana.
Método
En este estudio exploratorio de corte transversal, datos de 13 niños canadienses y 22 holandeses con espina bífida (14 mujeres, 21 varones; edad media 10 años 11 meses, desviación estándar DE 3 años 6 meses, rango 5 años 6 meses – 18 años; se analizaron en base a la distribución basada en la clasificación de Hoffer: comunidad n = 28, hogar n = 3, no funcional n = 3 y no ambulatorios n = 1). Se obtuvieron medidas objetivas de actividad física y comportamiento sedentario mediante el uso de monitores de actividad ActiGraph o Actiheart. Los datos de los participantes que usaban el ActiGraph se compararon con los niños con desarrollo típicos como controles, apareados por edad y sexo usando pruebas t de muestras independientes. Los datos de actividad recopilados durante la semana se compararon con los de los fines de semana.
Resultados
Los datos de ActiGraph demostraron que los niños con espina bífida pasaron más tiempo sedentarios (media DE 49,5min / h 5,78) y menos tiempo en actividades físicas moderadas a intensas (media DE 2,33min / h 1,61) en comparación con el grupo control (media DE 41,0min / h 5,76 y 5,46min / h 2,13, p = 0,001 y p <0,001 respectivamente). Tanto para los datos derivados de ActiGraph como de Actiheart, la actividad física y el tiempo sedentario no fueron significativamente diferentes entre semana y fines de semana.
Interpretación
Los niños con espina bífida tienen niveles reducidos de actividad física y un mayor comportamiento sedentario, sin diferencias estadísticas observadas entre semana y fines de semana. Al elegir un método apropiado para cuantificar la actividad física y el comportamiento sedentario se deben considerar varios problemas metodológicos relacionados con el monitoreo de la actividad en esta población.
Resumo
Atividade física e comportamento sedentário em crianças com espinha bífida
Objetivo
Descrever o tempo ativo e sedentário de crianças com espinha bífida e comparar sua atividade física durante a semana versus fins de semana.
Método
Neste estudo exploratório transversal, dados de 13 crianças canadenses e 22 crianças holandesas com espinha bífida (14 do sexo feminino, 21 do sexo masculino; médida de idade 10a 11m, desvio padrão DP 3a 6m, variação 5a 6m–18a; Distribuição da classificação de Hoffer: comunidade n=28, domiciliar n=3, não funcional n=3, e não ambulatório n=1) foram analisados. Medidas objetivas de atividade física e comportamento sedentário foram obtidas por meio de monitores de atividade ActiGraph ou Actiheart. Dados para os participantes que usaram ActiGraph foram comparados com controles pareados por idade e sexo que tinha desenvolvimento típico usando testes t para amostras independentes. Dados de atividade coletados durante a semana foram comparados com os dados de finais de semana.
Resultados
Os dados do ActiGraph demonstraram que crianças com espinha bífida passaram mais tempo sedentário (média DP 49,5min/h 5,78) e menos tempo em atividade física vigorosa (média DP 2,33min/h 1,61) comparados com o grupo com desenvolvimento típico (média DP 41,0min/h 5,76 e 5,46min/h 2,13, p=0,001 and p<0,001 respectivamente). Para os dados derivados do ActiGraph‐ e Actiheart, a atividade física e o tempo sedentário não foram significativamente diferentes comparando os dias da semana com os fins de semana.
Interpretação
Crianças com espinha bífida têm níveis reduzidos de atividade física e comportamento sedentário aumentado, sem diferenças estatísticas quando comparados os dias da semana. Várias questões metodológicas relacionadas ao monitoramento de atividades indicam necessidade de refletir quanto à escolha do método apropriado para quantificar a ativiade física e comportamento sedentário.
What this paper adds
Reduced levels of physical activity and sedentary time were quantified in children with spina bifida.
Objective quantification of physical behaviour in ambulatory and non‐ambulatory school‐aged children with spina bifida is possible.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
Editor's Choice
Evidence for an effect of physical activity on health has been accumulating for more than 60 years, while evidence for an independent, inverse effect of sedentary behaviour has emerged more recently. But studies have been scarce in populations with neurodevelopmental disorders. In this issue, three studies address various aspects of physical activity in children with epilepsy, cerebral palsy, and spina bifida. My Editor's Choice for the December 2019 issue, describing active and sedentary time in children with spina bifida, provides important results and illustrates methodological challenges in measuring behaviour in children who can walk and those who cannot. I encourage readers to view the recently published long‐term follow‐up study in this light.1 The next research steps in this field should provide insights into dose–response relationships, various health outcomes, specific health risks, and realistic and effective intervention programmes. Meanwhile, it is prudent to recommend minimization of time spent in sedentary behaviours, including in children with neurodevelopmental disorders.
1. Oakeshott P, Poulton A, Hunt GM, Reid F. Walking and living independently with spina bifida: a 50‐year prospective cohort study. Dev Med Child Neurol 2019; 61: 1202–7.
The purpose of this study was to determine objective and subjective quantification of habitual physical activity (HPA) and sedentary time in ambulatory and nonambulatory adults with cerebral palsy ...(CP).
We recruited a clinical sample of adults with CP (N = 42; 21 women; mean (SD) age, 33.5 (12.3) yr; Gross Motor Function Classification System (GMFCS) distribution: level I (n = 5), level II (n = 9), level III (n = 10), level IV (n = 11), and level V (n = 7). Objective measures of HPA and sedentary time were obtained by using ActiGraph GT3X accelerometers at both hip and wrist sites. Three previously established cut-point values distinguishing light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) were evaluated across GMFCS levels. The concurrent validity of the self-report Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) was assessed for LPA and MVPA intensities in GMFCS levels II-V.
Participants showed little reluctance to wearing accelerometers; one participant reported discomfort. Nonambulatory adults (GMFCS levels IV-V) differed from ambulatory adults (GMFCS levels I-III) for recorded activity counts (hip and wrist sites), minutes of MVPA with each cut-point value, and breaks from sedentary time (all P < 0.05). For the same measures, adults in GMFCS level III also differed from GMFCS level I (all P < 0.05). The PARA-SCI correlated significantly with accelerometer-derived minutes of MVPA per day (r = 0.396; P = 0.014) and per hour of monitoring time (r = 0.356; P = 0.027).
Our findings support the use of accelerometers to objectively measure HPA and sedentary behavior in adults with CP across the severity spectrum, regardless of cut-point implementation. The PARA-SCI is a valid tool to capture subjectively reported patterns of MVPA in adults with CP who are GMFCS levels II-V.
Accurate measurement of physical behaviour is paramount to better understand lifestyle, health, and functioning, particularly in adults with physical disability as they may be at higher risk of ...sedentary lifestyle and subsequent negative health consequences. This study aimed: 1) to evaluate the criterion validity of a novel and clinically applicable activity monitor (AM, Activ8), in the detection of body postures and movements in adults with spastic cerebral palsy (CP); and 2) to evaluate the extent that the AM's positioning affects validity.
In this cross-sectional study, 14 ambulatory adults with CP 9 men; mean (SD) age, 35.4 (13.1) years performed standardized activities while wearing three Activ8 monitors - frontolateral thigh (primary position), frontal thigh, and pant pocket - and being video recorded (criterion measure). AM activity output was compared to synchronized video recordings. Absolute (seconds) and relative (video time-AM time)/mean time, % time differences between methods were calculated. Relative time differences of < 10% were indicative of good validity. Comparison of AM attachment positions was completed using Spearman Rho correlation coefficients and Meng's tests.
Criterion validity of the AM (frontolateral thigh) was good (average relative time differences: 0.25% for sitting, 4.69% for standing, 2.46% for walking, 1.96% for upright activity, 3.19% for cycling), except for running (34.6%). Spearman Rho correlation coefficients were greater between video/frontolateral thigh position than video/frontal thigh position and video/pant pocket position for body posture and movement categories sitting, standing, walking, and upright activity (p < 0.01 for all).
The AM, positioned on the frontolateral thigh, demonstrated good criterion validity in ambulatory adults with CP. Though the Activ8 offers potential as an objective measure of physical activity, appropriate positioning is paramount for valid measurement.
Aim: To determine the criterion validity of the Activ8a and VitaMoveb activity monitors (AM) in measuring body postures and movements (P&M) in adults with spastic cerebral palsy (CP) with different ...gross motor functional abilities in a simulated free-living environment. ;
Methods: In this observational validation study participants were included between March and June 2016. Participants were divided into two groups: ambulatory and non-ambulatory adults (wheelchair users). For ambulatory adults, three Activ8 monitors (attached to the frontal thigh, lateral thigh, and in the pant pocket) and three synchronized VitaMove monitors (attached to the chest and each leg) were worn while participants were video recorded when performing a standardized activity protocol. For non-ambulatory adults, two synchronized Activ8 monitors (attached to the dominant wrist and wheelchair wheel) and three VitaMove monitors (attached to the chest and each wrist) were worn while participants were video recorded when performing a standardized wheelchair protocol. A native Dutch student provided standardized instructions while the author video recorded participants. Activities were performed in a movement laboratory and simulated free-living environment. Output data of the Activ8 and the VitaMove monitors were compared with video observation as a criterion measure. Absolute and relative time differences were calculated for each detected body P&M and for total measurement time for each participant. The following body P&M categories were detected: sitting, standing, walking, running, cycling, wheelchair driving, active upper body (stable wheelchair), and assisted driving. Agreement between the Activ8 and VitaMove during activity measurement was determined for each activity using Spearman Rho correlation coefficients, which were then compared with Meng’s test. Adapted Bland-Altman plots were completed to determine agreement at an individual level and Wilcoxon Signed-Rank tests were calculated to evaluate differences between detected P&M time across measures. Relative time differences of <10% between measures were indicative of acceptable validity.;
Results: Fifteen adults with spastic CP 10 men; mean(SD) age, 35.7(13) years; Gross Motor Function Classification System distribution: level I (n=6), level II (n=5), level III (n=3), level IV (n=1) were included. For ambulatory adults (n=14), criterion validity of the Activ8 at the lateral thigh location during basic and complex daily life activities was moderate to good (average relative time differences: 0.25% for sitting, 4.69% for standing, 2.46% for walking, 3.19% for cycling, and 1.96% for light-to-moderate upright activity), except for running (34.6% average difference) The criterion validity of the VitaMove was acceptable, with the exception of standing and running (average relative time differences: 1.69% for sitting, 12.3% for standing, 4.84% for walking, 9.70% for cycling, 23.8% for running, and 0.91% for light-to-moderate upright activity). Spearman Rho correlation coefficients were significantly greater between video/lateral thigh Activ8 than video/frontal thigh Activ8 and video/pant pocket Activ8 for P&M categories sitting, basic standing, basic walking, and light-to-moderate upright activity (p<0.01 for all). Moreover, Spearman Rho correlation coefficients were significantly greater between video/Activ8 than video/VitaMove for basic walking and light-to-moderate upright activity P&M categories (p<0.01). In non-ambulatory, wheelchair users (n=3), the Wheelchair Activ8 demonstrated greater validity than the VitaMove monitor, when compared to video observation, for the detection of sedentary upper body and active upper body behaviours. ;
Conclusion: The Activ8, positioned on the lateral thigh, demonstrates adequate validity as a tool for monitoring of body P&M during free-living activities in ambulatory adults with spastic CP. The Activ8 demonstrated superior validity as a direct measure of body P&M compared to the VitaMove AM. The sample size of non-ambulatory adults was small (n=3) and allowed for descriptive and exploratory analysis only; therefore, validity of the Wheelchair Activ8 for has to be further examined in a larger number of participants.;
Clinical relevance: The Activ8 and Wheelchair Activ8 shows promise as a clinical measurement tool of physical behaviour for adults with CP across GMFCS levels I-IV. The Activ8 could be used in the future development of health promotion initiatives, due to the features of goal setting and user feedback, while providing researchers greater insight in activity data than consumer-grade AMs.;
;
Suppliers:;
a. Activ8, trademark of Remedy Distribution Ltd. (original equipment manufacturer is 2M Engineering Ltd.), John F Kennedylaan 3, 5555XC, Valkenswaard, The Netherlands;
b. VitaMove, 2M Engineering Ltd., John F Kennedylaan 3, 5555XC, Valkenswaard, The Netherlands
Thesis
Master of Science (MSc)
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