| 1. |
- Blomkvist, Annika, et al.
(författare)
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The effect of spinal bracing on sitting function in children with neuromuscular scoliosis
- 2018
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Ingår i: Prosthetics and Orthotics International. - : Ovid Technologies (Wolters Kluwer Health). - 0309-3646 .- 1746-1553. ; 42, s. 592-598
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Tidskriftsartikel (refereegranskat)abstract
- Background: Scoliosis is common in children with neuromuscular deficits. It is often associated with an asymmetric sitting position and with poor balance. Many children with neuromuscular scoliosis spend most of their day sitting. Objectives: To describe how sitting function is affected by treatment with a modified custom-moulded Boston brace in children with neuromuscular scoliosis. Study design: Retrospective review of medical records. Methods: A review of medical records from children fitted with scoliosis braces, including analysis of sitting, using a pressure-mapping system. Results: A total of 106 children with a median age of 11.3 (1.7–17.7) years were included. The most frequent diagnoses were cerebral palsy (n = 33) and myelomeningocele (n = 17). Around 56 children could sit without support and 24 children were independent walkers. The Cobb angle was between 19° and 126°. Sitting function as noted in medical records improved in 73/105 children and deteriorated in five. The pressure mapping showed that symmetry was improved in 44/86 children, while three deteriorated. Stability improved in 20/40 children and seven decreased. Conclusion: Bracing had a positive effect on sitting function in children with neuromuscular scoliosis. Clinical relevance: Bracing can reduce the need for support in sitting. Children with severe scoliosis can get a better sitting function with a brace. Sitting analysis with pressure mapping can identify sitting problems needing correction of the brace and adaptations of the chair.
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| 2. |
- Eek, Meta Nyström, et al.
(författare)
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Arm Muscle Strength in Children with Bilateral Spastic CP
- 2021
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Ingår i: Physical & Occupational Therapy in Pediatrics. - : Informa UK Limited. - 0194-2638 .- 1541-3144. ; 41:5, s. 529-539
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Tidskriftsartikel (refereegranskat)abstract
- Aims To assess arm-muscle strength related to motor function in children with bilateral spastic cerebral palsy, 5-15 years old. Methods Muscle strength was measured for shoulder abductors, elbow extensors and flexors, wrist extensors, and grip strength. The children were grouped according to the Manual Ability Classification Scale (MACS). Results Forty-two children were included. The majority of the children at MACS levels I-II were within the normal range; shoulder abductors were weakest (mean 60-80% of predicted value), and variation was greatest for wrist extensors. Children at MACS level II showed lower values than children at level I, with significant differences for shoulder abductors (p=.028) and wrist extensors (p<.001). Differences between the dominant and non-dominant side was greater in children at MACS level II and statistically significant for wrist extensors (p=.024). Of 15 children tested for grip strength, nine were within the 2 SD range. The three children at MACS level II, all walking with a walker, had a higher mean value than those at MACS level I. Conclusions Muscle strength was lower and differences were greater between sides in children at MACS level II. Wrist extensors showed a decreasing trend with age as compared with normal development.
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| 3. |
- Eek, Meta Nyström, et al.
(författare)
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Follow-up of brace-treated scoliosis in children with cerebral palsy and spina bifida
- 2022
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Ingår i: Journal of pediatric rehabilitation medicine. - 1875-8894. ; 15:4, s. 607-614
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study aimed to describe brace use, progression of scoliosis, and surgery in children with cerebral palsy (CP) and spina bifida (SB) who were initially treated with a brace. METHODS: Medical records were retrospectively analysed for brace compliance, treatment complications, curve size measurements with and without the brace at both start and at follow-up, and number of patients undergoing spine surgery. RESULTS: Sixty-eight children were included (CP 47, SB 21), 37 of whom were girls, with a mean age at start of treatment of 11.1 (CP) and 8.2 (SB) years. Most had severe motor problems; only four children with CP and five with SB were able to walk. Thirty-five in the group with CP and 11 in the group with SB had a curve size over 40°.Forty used the brace full-time, 19 half-time and nine for a varying proportion of time. Transient complications of brace treatment were seen in 28%. The yearly progression of curve-size was 4.2° in CP and 2.3° in SB.Twenty-eight patients underwent surgery and complications were present in 75% of these patients. Twenty-seven out of 46 patients with severe scoliosis did not undergo surgery. CONCLUSION: Brace treatment was possible, even in patients with severe scoliosis. Bracing can delay the progression of scoliosis.
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| 4. |
- Eek, Meta Nyström, et al.
(författare)
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Isometric muscle torque in children 5 to 15 years of age: normative data.
- 2006
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Ingår i: Archives of physical medicine and rehabilitation. - : Elsevier BV. - 0003-9993. ; 87:8, s. 1091-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To establish reference values of arm and leg muscle strength as measured by isometric torque production in healthy children. DESIGN: Measurement of isometric muscle strength in healthy children. SETTING: Public school. PARTICIPANTS: Healthy children (N=149; 76 boys, 73 girls) ages 5 to 15 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Isometric torque values of 12 arm and leg muscle groups of healthy children as measured by a handheld dynamometer. RESULTS: Normative data were obtained for children 5 to 15 years of age. There was an increase in torque with age and weight and a strong correlation with both age and weight. There were few differences between boys and girls. Equations for predicted torque taking into account age, weight, and sex were calculated. The agreement between examiners was excellent. CONCLUSIONS: Studies on growing children require comparison to healthy (normal) children to assess the amount of deviation from normal and to be able to draw conclusions of change over time. The reference values for torque in combination with a predicted value based on the child's age, weight, and sex make it possible to compare over time and between subjects and provide a tool for evaluation of physical status and efficacy of therapy.
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| 5. |
- Eek, Meta Nyström, et al.
(författare)
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Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole
- 2017
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Ingår i: Gait and Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 55, s. 150-156
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Tidskriftsartikel (refereegranskat)abstract
- The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0 cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe + sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.
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| 6. |
- Eek, Meta Nyström, et al.
(författare)
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Muscle strength and kinetic gait pattern in children with bilateral spastic CP.
- 2011
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Ingår i: Gait & posture. - : Elsevier BV. - 1879-2219 .- 0966-6362. ; 33:3, s. 333-7
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Tidskriftsartikel (refereegranskat)abstract
- Cerebral palsy is often associated with an abnormal gait pattern. This study put focus on relation between muscle strength and kinetic gait pattern in children with bilateral spastic cerebral palsy and compares them with a reference group. In total 20 children with CP and 20 typically developing children participated. They were all assessed with measurement of muscle strength in eight muscle groups in the legs and a 3-dimensional gait analysis including force data. It was found that children with CP were not only significantly weaker in all muscle groups but also walked with slower velocity and shorter stride length when compared with the reference group. Gait moments differed at the ankle level with significantly lower moments in children with CP. Gait moments were closer to the maximal muscle strength in the group of children with CP. Furthermore a correlation between plantarflexing gait moment and muscle strength was observed in six of the eight muscle groups in children with CP, a relation not found in the reference group. A similar pattern was seen between muscle strength and generating ankle power with a rho=0.582-0.766. The results of this study state the importance of the relationship of the overall muscle strength pattern in the lower extremity, not only the plantarflexors.
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| 7. |
- Eek, Meta Nyström
(författare)
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MUSCLE STRENGTH, GROSS MOTOR FUNCTION AND GAIT PATTERN IN CHILDREN WITH CEREBRAL PALSY
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim The main purpose was to explore the relationship between muscle strength and walking ability in children with bilateral spastic cerebral palsy (CP), and to analyse whether muscle strength training can improve walking ability. Another aim was to establish normative values for muscle strength in terms of torque in typically developing children and adolescents, and in relation to sex, age and body weight. Methods A total of 174 typically developing children and 63 children with CP between the ages of five and 15 years participated in the studies. Muscle strength was measured with a handheld myometer. Motor function in children with CP was classified with the Gross Motor Function Classification System (GMFCS), graded with the Gross Motor Function Measure (GMFM) and gait pattern was measured with computerised three dimensional gait analysis. Muscle strength training in 16 children was conducted during eight weeks, three times a week. Results Normative data for muscle strength showed an increase in torque with age and weight, and strong correlations with both. There were few differences between boys and girls. Equations for predicted torque based on age, weight and sex were developed. Muscle strength in the legs was below predicted values in children with CP. It was lowest in the ankle, followed by muscles around the hip. Weakness increased with severity of motor involvement, strength over 50% of the norm was needed for independent walking. Muscle strength was correlated to walking ability and gait pattern, most obvious at the ankle. The gait moments (torque) in the children with CP were closer to their maximal muscle strength than in typically developing children. With eight weeks of strength training there was an increase in muscle strength, walking ability and push off in gait. Conclusions Muscle weakness was found in children with CP, increasing with severity of gross motor impairment and most pronounced at the ankle. There were correlations between muscle strength and walking ability and between muscle strength and gait pattern, most obvious at the ankle. After training, there was an increase in muscle strength and in walking ability and gait pattern.
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| 8. |
- Eek, Meta Nyström, et al.
(författare)
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Muscle strength training to improve gait function in children with cerebral palsy.
- 2008
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Ingår i: Developmental medicine and child neurology. - : Wiley. - 1469-8749 .- 0012-1622. ; 50:10, s. 759-64
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to investigate the influence of muscle strength training on gait outcomes in children with cerebral palsy. Sixteen children (two females, 14 males, Gross Motor Function Classification System levels I-II, mean age 12y 6mo, range 9y 4mo-15y 4mo) underwent muscle strength measurement using a handheld device, Gross Motor Function Measure (GMFM) assessment, three-dimensional gait analysis, joint range of motion assessment, and grading of spasticity before and after 8 weeks of training. All participants had a diagnosis of spastic diplegia and could walk without aids. Training consisted of exercises for lower extremity muscles with free weights, rubber bands, and body weight for resistance, three times a week. Values for muscle strength below normal were identified in all children; this was most pronounced at the ankle, followed by the hip muscles. After training, muscle strength and GMFM scores increased, velocity was unchanged, stride length increased, and cadence was reduced. There was an increase in hip extensor moment and power generated at push off. Eight weeks of muscle strength training can increase muscle strength and improve gait function.
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| 9. |
- Eek, Meta Nyström, et al.
(författare)
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No Decrease in Muscle Strength after Botulinum Neurotoxin-A Injection in Children with Cerebral Palsy
- 2016
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Ingår i: Frontiers in Human Neuroscience. - : Frontiers Media SA. - 1662-5161. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Spasticity and muscle weakness is common in children with cerebral palsy (CP). Spasticity can be treated with botulinum neurotoxin-A (BoNT-A), but this drug has also been reported to induce muscle weakness. Our purpose was to describe the effect on muscle strength in the lower extremities after BoNT-A injections in children with CP. A secondary aim was to relate the effect of BoNT-A to gait pattern and range of motion. Twenty children with spastic CP were included in the study, 8 girls and 12 boys (mean age 7.7 years). All were able to walk without support, but with increased muscle tone interfering with motor function and gait pattern. Sixteen children had unilateral spastic CP and four bilateral spastic CP. Twenty-four legs received injections with BoNT-A in the plantar flexor muscles. The children were tested before treatment, around 6 weeks after at the peak effect of BoNT-A, and at 6 months after treatment, with measurement of muscle strength, gait analysis, and range of motion. There were no differences in muscle strength in plantar flexors of treated legs at peak effect compared to baseline. Six months after treatment, there was still no change in untreated plantar flexor muscles, but an increasing trend in plantar flexor strength in legs treated with BoNT-A. Parents reported positive effects in all children, graded as: small in three children, moderate in eight, and large in nine children. The gait analysis showed a small improvement in knee extension at initial contact, and there was a small increase in passive range of motion for ankle dorsiflexion. Two children had a period with transient weakness and pain. We found that voluntary force production in plantar flexor muscles did not decrease after BoNT-A, instead there was a trend to increased muscle strength at follow-up. The increase may be explained as an effect of the blocking of involuntary nerve impulses, leading to an opportunity to using and training the muscles with voluntary control. Adequate muscle strength is important for maintaining the ability to walk and knowledge of how a treatment affects muscle strength is useful when selecting interventions.
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| 10. |
- Eek, Meta Nyström, et al.
(författare)
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Objective measurement of sitting-Application in children with cerebral palsy
- 2022
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Ingår i: Gait & Posture. - : Elsevier BV. - 0966-6362. ; 96, s. 210-215
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Tidskriftsartikel (refereegranskat)abstract
- Background: Children with cerebral palsy (CP) and a severe motor impairment, have limited ability to perform volitional movements due to spasticity, involuntary postures and movements and reduced ability to maintain antigravity head and trunk control. A stable sitting position is a prerequisite for participation in daily life, but there is a lack of objective measurement methods for this population. Research question: Is it feasible to measure a stable sitting position with pressure mapping and 2D motion analysis, and can it detect differences to a) a reference group, b) between subgroups of CP and c) before and after treatment with intrathecal baclofen (ITB)? Methods: Pressure mapping, and a 2D motion analysis system, were used to capture movements of centre of pressure (CoP), and movements of head, hand and leg, sitting on a bench for 90 s. Twenty-two children with dyskinetic or bilateral spastic CP, GMFCS III-V, mean age 9.0, and 30 children with typical development (TD) mean age 10.7, were recruited between 2010 and 2019. Seventeen children were treated with ITB. Parents were interviewed regarding aspect of sitting. Non-parametric methods were used for statistical analysis. Results: Differences in CoP and kinematics were detected with more movements in children with CP compared to children with TD (p < 0.001). There were more movements in children with dyskinetic CP compared to children with bilateral spastic CP as captured with the pressure mapping system (CoP distance p = .005 and AnterioPosterior sway p = .014). After treatment with ITB, involuntary movements had decreased (CoP p = 0.006-0.035, kinematics p = 0.002-0.020). Parents reported improvement in sitting. The two measurement systems showed consistent results (rho 0.500-0.771, p = < 0.001-0.049). Significance: It was feasible to objectively measure sitting position in children with a moderate-to-severe motor impairment with differences to a reference group and after an intervention. CoP and head movements were the variables that were easiest to capture.
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