Elnaggar RK, Ramirez-Campillo R, Azab AR, et al. "Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics." Children (Basel). 2024;11(2). Abstract

The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12-18 years) were randomized to PsCS ( = 27), PlyoML ( = 27), or a combined intervention ( = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability-LoS), balance, and mobility (Community Balance and Mobility Scale-CB&M; Functional Walking Test-FWT; Timed Up and Down Stair test-TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward ( = 0.006 and 0.033, respectively), forward ( = 0.015 and 0.036, respectively), paretic ( = 0.017 and 0.018, respectively), and non-paretic directions ( = 0.006 and 0.004, respectively)], and this was also the case for overall LoS ( < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M ( = 0.037 and = 0.002, respectively), FWT ( = 0.012 and = 0.038, respectively), and TUDS ( = 0.046 and = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP.

Elnaggar RK, Osailan AM, Alghadier M, et al. "Exercise strategies for reversing cardiopulmonary deconditioning in obese children with bronchial asthma: A randomized comparative effectiveness study of constant-load and graded aerobic training." Medicine (Baltimore). 2024;103(48):e40667. Abstract

BACKGROUND: This study evaluates the differential effects of constant-load (CL-AE) and graded (G-AE) aerobic exercise training approaches on cardiopulmonary fitness and functional capacity in obese children with bronchial asthma (BA).

METHODS: Seventy-eight obese children with moderate BA (age: 14.14 ± 2.31 years; body mass index: 31.93 ± 1.26 kg/m2) were randomly assigned to 3 intervention-based groups: control, CL-AE, or G-AE group (n = 26 in a group). The cardiorespiratory fitness (peak oxygen uptake, minute ventilation [VE], ventilation-oxygen uptake ratio, stroke volume of oxygen, oxygen/carbon-dioxide exchange ratio, heart rate maximum, and heart rate recovery at one minute) and functional capacity (6-minute walk test and perceived dyspnea and fatigue) were assessed at the baseline and posttreatment.

RESULTS: The G-AE group exhibited more favorable changes in cardiorespiratory fitness [VO2peak (P = .03), VE (P = .021), VE/VO2 (P = .032), SVO2 (P = .025), O2/CO2 ratio (P = .004), HRmax (P = .016), HRR1 (P = .046)] and functional capacity [6-minute walk test (P = .021), dyspnea (P = .041), fatigue (P = .04)] as compared to the CL-AE group.

CONCLUSION: The G-AE, compared to CL-AE, appears to be a more potent stimulus for enhancing cardiorespiratory fitness and functional capacity in obese children with BA. Further investigations are, however, required to corroborate the observed effects.

Elnaggar RK, Azab AR, Alrawaili SM, et al. "Efficacy of accommodating variable-resistance training on muscle architecture, peak torque, and functional performance in patients with juvenile idiopathic arthritis: A randomized controlled trial." Heliyon. 2024;10(6):e27693. Abstract

PURPOSE: This study sought to find out if a 6-week accommodating variable-resistance (AcVR) training might enhance muscle architecture, peak torque, and functional performance in patients with juvenile idiopathic arthritis (Juv-IA).

METHODS: Fifty-eight patients with polyarticular Juv-IA (aged 12-18 years) were involved in a randomized controlled trial. They were allocated into two groups: the AcVR group ( = 29; underwent AcVR training, and the control group ( = 29; received the usual exercise regimen). Interventions were applied three times a week over six consecutive weeks. Measurements were done at baseline and after the intervention. The primary outcome measures were muscle architecture and peak torque, with functional capacity being the secondary measure.

RESULTS: Compared to the control group, the AcVR group showed favorable pre-to-post changes in muscle architecture [fascicle length ( = 0.0007,  = .18), pennation angle ( = 0.0004,  = .20), and muscle thickness ( = 0.001,  = .17)]. Further, the AcVR group revealed a greater increase in peak concentric torque of knee extensors at angular speeds of 120°/sec [right side ( = 0.0032,  = .08); left side ( = 0.039,  = .07)] and 180°/sec [right side ( = 0.01,  = .11); left side ( = 0.014,  = .10)]. Furthermore, The AcVR group achieved more conducive changes in functional performance [6-min walk test ( = 0.003,  = .15), timed up and down stair test ( = 0.009,  = .12), and 4 × 10 m shuttle run test ( = 0.036,  = .08)].

CONCLUSION: A 6-week AcVR training is potentially effective for improving muscle architectural qualities, enhancing peak muscle torque, and boosting functional performance in patients with Juv-IA without experiencing any detrimental side effects.

Elnaggar RK, Azab AR, Alhowimel AS, Alotaibi MA, Abdrabo MS, Elfakharany MS. "Effects of Plyometric-Based Hydro-Kinesiotherapy on Pain, Muscle Strength, Postural Stability, and Functional Performance in Children with Hemophilic Knee Arthropathy: A Randomized Trial." Phys Occup Ther Pediatr. 2024;44(5):704-720. Abstract

AIM: To explore how plyometric-based hydro-kinesiotherapy (Plyo-HKT) would affect pain, muscle strength, postural stability, and functional performance in a convenience sample of children with hemophilic knee arthropathy (HKA).

METHODS: Forty-eight children with HKA (age: 8-16 years) were randomly allocated to the Plyo-HKT group ( = 24; underwent the Plyo-HKT for 45 min, twice/week over 12 wk in succession) or the comparison group ( = 24; performed the standard exercise rehabilitation at an equivalent frequency and duration). Pain, peak concentric torque of quadriceps and hamstring (produced at two angular velocities: 120 and 180 /sec), dynamic limits of postural stability (DLPS), and functional performance [Functional Independence Score in Hemophilia (FISH) and 6-Minute Walk Test (6-MWT)] were assessed pre- and post-intervention.

RESULTS: In contrast with the comparison group, the Plyo-HKT group achieved more favorable pre-to-post changes in pain ( = .028, = 0.10), peak torque of quadriceps [120°/sec ( = .007, = 0.15); 180°/sec ( = .011, = 0.13)] and hamstring [120°/sec ( = .024, = 0.11); 180°/sec ( = .036, = 0.09)], DLPS [forward ( = .007, = 0.15); backward ( = .013, = 0.12); affected side ( = .008, = 0.14); non-affected side ( = .002, = 0.20)], DLPS ( < .001, = 0.32), and functional performance [FISH ( < .001, = 0.26); 6-MWT ( = .002, = 0.19)].

CONCLUSION: Plyo-HKT is likely helpful for reducing pain, improving strength, enhancing postural stability, and boosting functional capabilities in children with HKA. Physical rehabilitation practitioners should, therefore, consider this intervention strategy.

Garcia-Carrillo E, Ramirez-Campillo R, Izquierdo M, et al. "Effects of Therapies Involving Plyometric-Jump Training on Physical Fitness of Youth with Cerebral Palsy: A Systematic Review with Meta-Analysis." Sports (Basel). 2024;12(6). Abstract

The aim of this systematic review was to assess the effects of plyometric-jump training (PJT) on the physical fitness of youth with cerebral palsy (CP) compared with controls (i.e., standard therapy). The PRISMA 2020 guidelines were followed. Eligibility was assessed using the PICOS approach. Literature searches were conducted using the PubMed, Web of Science, and SCOPUS databases. Methodological study quality was assessed using the PEDro scale. Data were meta-analyzed by applying a random-effects model to calculate Hedges' g effect sizes (ES), along with 95% confidence intervals (95% CI). The impact of heterogeneity was assessed ( statistic), and the certainty of evidence was determined using the GRADE approach. Eight randomized-controlled studies with low-to-moderate methodological quality were included, involving male (n = 225) and female (n = 138) youth aged 9.5 to 14.6 years. PJT interventions lasted between 8 and 12 weeks with 2-4 weekly sessions. Compared with controls, PJT improved the muscle strength (ES = 0.66 [moderate], 95% CI = 0.36-0.96, < 0.001, = 5.4%), static (ES = 0.69 [moderate], 95% CI= 0.33-1.04, < 0.001, = 0.0%) and dynamic balance (ES = 0.85 [moderate], 95% CI = 0.12-1.58, = 0.023, = 81.6%) of youth with CP. Therefore, PJT improves muscle strength and static and dynamic balance in youth with CP compared with controls. However, more high-quality randomized-controlled trials with larger sample sizes are needed to provide a more definitive recommendation regarding the use and safety of PJT to improve measures of physical fitness.

Alghamdi MS, Alenazi AM, Alghadier M, et al. "Demographic and clinical characteristics of children with limb loss in Saudi Arabia: A retrospective study." Prosthetics and Orthotics International. 2024;48(2):170-175.
Tourism