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Osteoporosis International
Published in: Osteoporosis International 4/2013

01-04-2013 | Original Article

Efficacy of home-based virtual cycling training on bone mineral density in ambulatory children with cerebral palsy

Authors: C.-L. Chen, C.-Y. Chen, M.-Y. Liaw, C.-Y. Chung, C.-J. Wang, W.-H. Hong

Published in: Osteoporosis International | Issue 4/2013

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Abstract

Summary

The 12-week home-based virtual cycling training (hVCT) improved lower limb muscle strength and areal bone mineral density (aBMD) than the control program in children with cerebral palsy (CP). A muscle strengthening program, rather than general physical activity, is more specific in enhancing aBMD for these children. A novel hVCT is an effective and efficient strategy that enhances lower limb bone density in these children.

Introduction

This is the first study to assess the efficacy of a novel hVCT program on bone density for children with spastic CP using a well-designed randomized controlled trial.

Methods

Twenty-seven ambulatory children with spastic CP, aged 6–12 years, were randomly assigned to the hVCT group (n = 13) or control group (n = 14). Outcome measures—motor function [Gross Motor Function Measure-66 (GMFM-66)], muscle strength (curl up scores and isokinetic torque of knee extensor and flexor muscle) and aBMD of the lumbar and distal femur—were administered before and immediately after the 12-week intervention.

Results

Analysis of covariance results show that the hVCT group had greater distal femur aBMD and isokinetic torques of knee extensor and flexor muscles than the control group at posttreatment (p < 0.05). However, curl up scores, GMFM-66, and lumbar aBMD at posttreatment did not differ between the two groups.

Conclusions

Analytical findings suggest that the muscle strengthening program is more specific in enhancing bone density for children with CP than general physical activity. Thus, the proposed 12-week hVCT protocol is an effective and efficient strategy for improving lower limb aBMD in these children.
Literature
1.
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B (2007) A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 109:8–14PubMed
2.
Chen CL, Ke JY, Wang CJ, Wu KP, Wu CY, Wong AM (2011) Factors associated with bone density in different skeletal regions in children with cerebral palsy of various motor severities. Dev Med Child Neurol 53:131–136PubMedCrossRef
3.
Henderson RC (1997) Bone density and other possible predictors of fracture risk in children and adolescents with spastic quadriplegia. Dev Med Child Neurol 39:224–227PubMedCrossRef
4.
Henderson RC, Kairalla J, Abbas A, Stevenson RD (2004) Predicting low bone density in children and young adults with quadriplegic cerebral palsy. Dev Med Child Neurol 46:416–419PubMedCrossRef
5.
Henderson RC, Kairalla JA, Barrington JW, Abbas A, Stevenson RD (2005) Longitudinal changes in bone density in children and adolescents with moderate to severe cerebral palsy. J Pediatr 146:769–775PubMedCrossRef
6.
Henderson RC, Lark RK, Gurka MJ, Worley G, Fung EB, Conaway M, Stallings VA, Stevenson RD (2002) Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy. Pediatrics 110:e5PubMedCrossRef
7.
Henderson RC, Lin PP, Greene WB (1995) Bone-mineral density in children and adolescents who have spastic cerebral palsy. J Bone Joint Surg Am 77:1671–1681PubMed
8.
Jekovec-Vrhovsek M, Kocijancic A, Prezelj J (2005) Quantitative ultrasound of the calcaneus in children and young adults with severe cerebral palsy. Dev Med Child Neurol 47:696–698PubMedCrossRef
9.
Chen CL, Ke JY, Lin KC, Wang CJ, Wu CY, Liu WY (2011) Anthropometric and fitness variables associated with bone mineral density and broadband ultrasound attenuation in ambulatory children with cerebral palsy. J Child Neurol 26:552–559PubMedCrossRef
10.
Chen CL, Lin KC, Wu CY, Ke JY, Wang CJ, Chen CY (2012) Relationships of muscle strength and bone mineral density in ambulatory children with cerebral palsy. Osteoporos Int 23:715–721PubMedCrossRef
11.
Lee JJ, Lyne ED (1990) Pathologic fractures in severely handicapped children and young adults. J Pediatr Orthop 10:497–500PubMed
12.
Ward KA, Caulton JM, Adams JE, Mughal MZ (2006) Perspective: cerebral palsy as a model of bone development in the absence of postnatal mechanical factors. J Musculoskelet Neuronal Interact 6:154–159PubMed
13.
Schoenau E, Fricke O (2008) Mechanical influences on bone development in children. Eur J Endocrinol 159 Suppl 1:S27–S31PubMedCrossRef
14.
Binkley TL, Specker BL (2008) Muscle–bone relationships in the lower leg of healthy pre-pubertal females and males. J Musculoskelet Neuronal Interact 8:239–243PubMed
15.
Chan DC, Lee WT, Lo DH, Leung JC, Kwok AW, Leung PC (2008) Relationship between grip strength and bone mineral density in healthy Hong Kong adolescents. Osteoporos Int 19:1485–1495PubMedCrossRef
16.
Schonau E (1998) The development of the skeletal system in children and the influence of muscular strength. Horm Res 49:27–31PubMedCrossRef
17.
Daly RM, Stenevi-Lundgren S, Linden C, Karlsson MK (2008) Muscle determinants of bone mass, geometry and strength in prepubertal girls. Med Sci Sports Exerc 40:1135–1141PubMedCrossRef
18.
Schoenau E (2005) From mechanostat theory to development of the “Functional Muscle-Bone-Unit”. J Musculoskelet Neuronal Interact 5:232–238PubMed
19.
Wilmshurst S, Ward K, Adams JE, Langton CM, Mughal MZ (1996) Mobility status and bone density in cerebral palsy. Arch Dis Child 75:164–165PubMedCrossRef
20.
Kaljumae U, Hanninen O, Airaksinen O (1994) Knee extensor fatigability and strength after bicycle ergometer training. Arch Phys Med Rehabil 75:564–567PubMed
21.
Snider L, Majnemer A, Darsaklis V (2010) Virtual reality as a therapeutic modality for children with cerebral palsy. Dev Neurorehabil 13:120–128PubMedCrossRef
22.
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223PubMedCrossRef
23.
Scholtes VA, Dallmeijer AJ, Rameckers EA, Verschuren O, Tempelaars E, Hensen M, Becher JG (2008) Lower limb strength training in children with cerebral palsy—a randomized controlled trial protocol for functional strength training based on progressive resistance exercise principles. BMC Pediatr 8:41PubMedCrossRef
24.
Russell DJ, Rosenbaum PL, Avery L, Lane M (2002) Gross Motor Function Measure (GMFM-66 and GMFM-88): User’s Manual. MacKeith Press, London
25.
Impellizzeri FM, Bizzini M, Rampinini E, Cereda F, Maffiuletti NA (2008) Reliability of isokinetic strength imbalance ratios measured using the Cybex NORM dynamometer. Clin Physiol Funct Imaging 28:113–119PubMedCrossRef
26.
Harcke HT, Taylor A, Bachrach S, Miller F, Henderson RC (1998) Lateral femoral scan: an alternative method for assessing bone mineral density in children with cerebral palsy. Pediatr Radiol 28:241–246PubMedCrossRef
27.
Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Hillsdale
28.
Wang HY, Yang YH (2006) Evaluating the responsiveness of 2 versions of the gross motor function measure for children with cerebral palsy. Arch Phys Med Rehabil 87:51–56PubMedCrossRef
29.
Ward K, Alsop C, Caulton J, Rubin C, Adams J, Mughal Z (2004) Low magnitude mechanical loading is osteogenic in children with disabling conditions. J Bone Miner Res 19:360–369PubMedCrossRef
30.
Fuchs RK, Bauer JJ, Snow CM (2001) Jumping improves hip and lumbar spine bone mass in prepubescent children: a randomized controlled trial. J Bone Miner Res 16:148–156PubMedCrossRef
31.
Lenchik L, Kiebzak GM, Blunt BA (2002) What is the role of serial bone mineral density measurements in patient management? J Clin Densitom 5 Suppl:S29–S38PubMedCrossRef
32.
Baim S, Wilson CR, Lewiecki EM, Luckey MM, Downs RW Jr, Lentle BC (2005) Precision assessment and radiation safety for dual-energy X-ray absorptiometry: position paper of the International Society for Clinical Densitometry. J Clin Densitom 8:371–378PubMedCrossRef
33.
El Maghraoui A, Do Santos Zounon AA, Jroundi I, Nouijai A, Ghazi M, Achemlal L, Bezza A, Tazi MA, Abouqual R (2005) Reproducibility of bone mineral density measurements using dual X-ray absorptiometry in daily clinical practice. Osteoporos Int 16:1742–1748PubMedCrossRef
34.
Chad KE, Bailey DA, McKay HA, Zello GA, Snyder RE (1999) The effect of a weight-bearing physical activity program on bone mineral content and estimated volumetric density in children with spastic cerebral palsy. J Pediatr 135:115–117PubMedCrossRef
35.
Fowler EG, Knutson LM, Demuth SK, Siebert KL, Simms VD, Sugi MH, Souza RB, Karim R, Azen SP (2010) Pediatric endurance and limb strengthening (PEDALS) for children with cerebral palsy using stationary cycling: a randomized controlled trial. Phys Ther 90:367–381PubMedCrossRef
36.
Macdonald HM, Kontulainen SA, Khan KM, McKay HA (2007) Is a school-based physical activity intervention effective for increasing tibial bone strength in boys and girls? J Bone Miner Res 22:434–446PubMedCrossRef
37.
McWhannell N, Henaghan JL, Foweather L, Doran DA, Batterham AM, Reilly T, Stratton G (2008) The effect of a 9-week physical activity programme on bone and body composition of children aged 10–11 years: an exploratory trial. Int J Sports Med 29:941–947PubMedCrossRef
38.
Reid D (2004) The influence of virtual reality on playfulness in children with cerebral palsy: a pilot study. Occup Ther Int 11:131–144PubMedCrossRef
39.
You SH, Jang SH, Kim YH, Kwon YH, Barrow I, Hallett M (2005) Cortical reorganization induced by virtual reality therapy in a child with hemiparetic cerebral palsy. Dev Med Child Neurol 47:628–635PubMed
40.
Henderson RC, Berglund LM, May R, Zemel BS, Grossberg RI, Johnson J, Plotkin H, Stevenson RD, Szalay E, Wong B, Kecskemethy HH, Harcke HT (2010) The relationship between fractures and DXA measures of BMD in the distal femur of children and adolescents with cerebral palsy or muscular dystrophy. J Bone Miner Res 25:520–526PubMedCrossRef
Metadata
Title
Efficacy of home-based virtual cycling training on bone mineral density in ambulatory children with cerebral palsy
Authors
C.-L. Chen
C.-Y. Chen
M.-Y. Liaw
C.-Y. Chung
C.-J. Wang
W.-H. Hong
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 4/2013
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-012-2137-0

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