Joint range of motion limitations in children and young adults with spinal muscular atrophy

Objectives
To elicit descriptive data about limited joint range of motion (ROM) in subjects with type II or III spinal muscular atrophy (SMA) and to examine the relation between the number of motions with limited range and both age and functional ability.
Design
Descriptive cross-sectional study.
Setting
Neurologic pediatric outpatient clinic at a hospital in Taiwan.
Participants
Twenty-seven subjects with SMA type II (mean age, 9.8±6.5y) and 17 with SMA type III (mean age, 12.2±8.7y).
Intervention
Measurement with transparent goniometers of joint ROM bilaterally of the shoulder, elbow, wrist, hip, knee, and ankle.
Main outcome measures
The proportion of participants with each ROM limitation compared with all participants with the same SMA type, age distribution of the participants with each ROM limitation, mean range loss of each motion limitation, and the contracture index (risk index of joint contracture).
Results
Eighty-nine percent of the participants with SMA type II experienced knee extension limitation. Approximately 50% of the participants with both types of SMA had ankle dorsiflexion limitation. The motions of knee and hip extension and ankle dorsiflexion also had a relatively high contracture index. The number of motions with limited range positively correlated (P<.001) with age and upper-extremity functional grade (the higher the functional grade, the poorer the functional ability) for SMA type II.
Conclusions
We found varying degrees of joint ROM limitation. Certain motions were noted to be high risks for the development of contractures. This risk was higher mostly in younger children.

Efficacy of neuromuscular electrical stimulation in improving ankle kinetics during walking in children with cerebral palsy

Neuromuscular electrical stimulation (NMES) applied to the triceps surae muscle is claimed to be effective in improving gait in children with cerebral palsy. The main aim of this study was to determine the effect of NMES on the triceps surae muscle in improving the gait and function of children with cerebral palsy. Twelve children with spastic diplegia or hemiplegia were recruited and randomly assigned to the two experimental groups. The period of the study was 8 weeks (2-4-2 week design). The initial 2 weeks was the control period, in which usual treatment was given to both groups of patients with a pre- and post-treatment assessment. The middle 4 weeks was the experimental period, in which the Treadmill+NMES group received NMES plus treadmill walking training and the Treadmill group underwent treadmill walking training only. Assessment was performed at 2-week intervals. The final 2 weeks was the carryover period, in which treatment to be tested was stopped and reassessment performed again at the end of week 8. An additional treatment and post-treatment assessment were given at weeks 2, 4 and 6 to test for the immediate effect of treatment. Altogether, eight repeated measures with three-dimensional gait analysis and five clinical measurements using the gross motor function measure (GMFM) were performed. Kinetic changes in ankle moment quotient (AMQ) and ankle power quotient (APQ) were not significant either immediately or cumulatively in both groups. Improvement in trend was observed in both groups immediately but not cumulatively. Using the GMFM, functional changes were detected in standing (GMST, p < 0.001) and in walking (GMWK, p = 0.003) using a 'time' comparison. Significant interaction was also detected in GMWK using 'treatment by time' (p = 0.035). The difference between the two groups was not significant on 'treatment' comparison of both GMST and GMWK. Both groups showed improvement in GMST and GMWK cumulatively but there was no difference between the two groups. The effects in both groups could be carried over to 2 weeks after interventions stopped. Both the Treadmill+NMES and Treadmill groups showed improvement in functional outcomes. The trend in the changes of the GMFM score suggested that improvements were greater in the Treadmill+NMES group. There was also a trend showing some immediate improvement in AMQ and APQ.

Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents

Objective:
To assess from a health sector perspective the incremental cost-effectiveness of cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of major depressive disorder (MDD) in children and adolescents, compared to ‘current practice’.
Method:
The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analysis of randomised controlled trials. An assessment on second stage filter criteria (‘equity’; ‘strength of evidence’, ‘feasibility’ and ‘acceptability to stakeholders’) is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are tracked for the duration of a new episode of MDD arising in eligible children (age 6–17 years) in the Australian population in the year 2000. Simulation-modelling techniques are used to present a 95% uncertainty interval (UI) around the cost-effectiveness ratios.
Results:
Compared to current practice, CBT by public psychologists is the most costeffective intervention for MDD in children and adolescents at A$9000 per DALY saved (95% UI A$3900 to A$24 000). SSRIs and CBT by other providers are less cost-effective but likely to be less than A$50 000 per DALY saved (> 80% chance). CBT is more effective than SSRIs in children and adolescents, resulting in a greater total health benefit (DALYs saved) than could be achieved with SSRIs. Issues that require attention for the CBT intervention include equity concerns, ensuring an adequate workforce, funding arrangements and acceptability to various stakeholders.
Conclusions:
Cognitive behavioural therapy provided by a public psychologist is the most
effective and cost-effective option for the first-line treatment of MDD in children and adolescents. However, this option is not currently accessible by all patients and will require change in policy to allow more widespread uptake. It will also require ‘start-up’ costs and attention to ensuring an adequate workforce.

Peripheral quantitative computed tomography in children and adolescents : the 2007 ISCD pediatric official positions

Peripheral quantitative computed tomography (pQCT) has mainly been used as a research tool in children. To evaluate the clinical utility of pQCT and formulate recommendations for its use in children, the International Society
of Clinical Densitometry (ISCD) convened a task force to review the literature and propose areas of consensus and future research. The types of pQCT technology available, the clinical application of pQCT for bone health assessment in children, the important elements to be included in a pQCT report, and quality control monitoring techniques were evaluated. The review revealed a lack of standardization of pQCT techniques, and a paucity of data regarding differences between pQCT manufacturers, models and software versions and their impact in pediatric assessment. Measurement sites varied across studies. Adequate reference data, a critical element for interpretation of pQCT results, were entirely lacking, although some comparative data on healthy children were available. The elements of the
pQCT clinical report and quality control procedures are similar to those recommended for dual-energy X-ray absorptiometry. Future research is needed to establish evidence-based criteria for the selection of the measurement site, scan acquisition and analysis parameters, and outcome measures. Reference data that sufficiently characterize the normal range of variability in the population also need to be established.

Reducing unhealthy weight gain in children through community capacity−building: results of a quasi−experimental intervention program, Be Active Eat Well

Background:
Be Active Eat Well (BAEW) was a multifaceted community capacity-building program promoting healthy eating and physical activity for children (aged 4–12 years) in the Australian town of Colac.
Objective:
To evaluate the effects of BAEW on reducing children's unhealthy weight gain.
Methods:
BAEW had a quasi-experimental, longitudinal design with anthropometric and demographic data collected on Colac children in four preschools and six primary schools at baseline (2003, n=1001, response rate: 58%) and follow-up (2006, n=839, follow-up rate: 84%). The comparison sample was a stratified random selection of preschools (n=4) and primary schools (n=12) from the rest of the Barwon South Western region of Victoria, with baseline assessment in 2003–2004 (n=1183, response rate: 44%) and follow-up in 2006 (n=979, follow-up rate: 83%).
Results:
Colac children had significantly lower increases in body weight (mean: -0.92 kg, 95% CI: -1.74 to -0.11), waist (-3.14 cm, -5.07 to -1.22), waist/height (-0.02, -0.03 to -0.004), and body mass index z-score (-0.11, -0.21 to -0.01) than comparison children, adjusted for baseline variable, age, height, gender, duration between measurements and clustering by school. In Colac, the anthropometric changes were not related to four indicators of socioeconomic status (SES), whereas in the comparison group 19/20 such analyses showed significantly greater gains in anthropometry in children from lower SES families. Changes in underweight and attempted weight loss were no different between the groups.
Conclusions:
Building community capacity to promote healthy eating and physical activity appears to be a safe and effective way to reduce unhealthy weight gain in children without increasing health inequalities.

Pretend play, social competence and involvement in children aged 5-7 years : the concurrent validity of the child-initiated pretend play assessment

Background and aims: The aims of this study were to investigate the relationship between pretend play, social competence and involvement in school-based activities in children aged 5–7 years and to determine whether children's social competence and level of involvement could be inferred from their scores on the Child-Initiated Pretend Play Assessment.
Procedure: The pretend play skills of 41 primary school-aged children aged 5–7 years were assessed on a one-on-one basis. Classroom teachers of the children assessed the children's social competence using the Penn Interactive Peer Play Scale and their involvement in school based activities using the Leuven Involvement Scale for Young Children.
Main findings: Significant positive relationships were found between elaborate pretend play and object substitution scores, involvement scores and peer play interaction scores (P < 0.05, P < 0.01). A significant negative relationship was found between elaborate pretend play scores, and social disconnection and social disruption scores (P < 0.05). Play deficit indicators were significantly negatively related to involvement scores (P < 0.01). This suggests that children with proficient pretend play skills are socially competent with peers and are able to engage in classroom activity. Children who scored poorly on the play assessment were more likely to have difficulty interacting with their peers and engaging in school activities.
Conclusion: Social competence and involvement skills are related to a child's ability to engage in pretend play. A child's social skills and ability to engage in school activities as assessed by teachers can be inferred from their scores on the Child-Initiated Pretend Play Assessment.

Is dog ownership or dog walking associated with weight status in children and their parents?

Issue addressed: Several studies have shown that dog owners do more physical activity than non-owners; however, associations with weight status are unknown. This study examined associations between dog ownership, frequency of dog walking and weight status among children and their parents. Methods: Height and weight were measured for 281 children aged 5-6 years and 864 children aged 10-12 years. One parent reported their own and their partner's height and weight (n=1,108), dog ownership, usual frequency their child walks a dog, and usual frequency of walking the dog as a family. Logistic regression analyses were adjusted for sex (children only), physical activity, education, neighbourhood SES, parental weight status (children only) and clustering by school. Results: Dog ownership ranged from 45-57% in the two age groups. Nearly one in four 5-6 year-olds and 37% of 10-12 year- olds walked a dog at least once/week. Weekly dog walking as a family was reported by 24-28% of respondents. The odds of being overweight or obese were lower among younger children who owned a dog (OR=0.5, 95% CI 0.3-0.8) and higher among mothers whose family walked the dog together (OR--1.3, 95% CI 1.0-1.7). Conclusions: Dog ownership may offer some protection from overweight among young children. It is important that families with a dog are encouraged to walk or play with it regularly. Associations with weight status may depend on the type of dog owned, length of ownership and the nature of walks or interaction.

Family physical activity and sedentary environments and weight change in children

Objective. To examine associations between family physical activity and sedentary environment and changes in body mass index (BMI) z-scores among 10-12-year-old children over three years.
Method. Design. Longitudinal (three-year follow-up). Subjects. In total, 152 boys and 192 girls aged 10-12 years at baseline.
Measurements. Measured height and weight at baseline and follow-up (weight status, BMI z-scores); aspects of the family physical activity and sedentary environment (parental and sibling modelling, reinforcement, social support, family-related barriers, rules/restrictions, home physical environment) measured with a questionnaire completed by parents at baseline.
Results. At baseline, 29.6% of boys and 21.9% of girls were overweight or obese, and mean (standard deviation, SD) BMI z-scores were 0.44 (0.99) and 0.28 (0.89), respectively. There was a significant change in BMI z-score among girls (mean change=0.19, SD=0.55, p<0.001), but not boys. Among boys, the number of items at home able to be used for sedentary behaviour (B=0.11, p=0.037) was associated with relatively greater increases in BMI z-score. Among girls, sibling engagement in physical activity at least three times/wk (B=-0.17, p=0.010) and the number of physical activity equipment items at home (B=-0.05, p=0.018) were associated with relatively greater decreases in BMI z-score.
Conclusion. Sibling physical activity and environmental stimuli for sedentary behaviours and physical activity within the home may be important targets for prevention of weight gain during the transition from childhood to adolescence.