Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy I: Key Ingredients for Bone and Muscle Health

Physical activity of a sufficient amount and intensity is essential to health and the prevention of a sedentary lifestyle in all children as they transition into adolescence and adulthood. While fostering a fit lifestyle in all children can be challenging, it may be even more so for those with cerebral palsy (CP). Evidence suggests that bone and muscle health can improve with targeted exercise programs for children with CP. Yet, it is not clear how musculoskeletal improvements are sustained into adulthood. In this perspective, we introduce key ingredients and guidelines to promote bone and muscle health in ambulatory children with CP (GMFCS I–III), which could lay the foundation for sustained fitness and musculoskeletal health as they transition from childhood to adolescence and adulthood. First, one must consider crucial characteristics of the skeletal and muscular systems as well as key factors to augment bone and muscle integrity. Second, to build a better foundation, we must consider critical time periods and essential ingredients for programming. Finally, to foster the sustainability of a fit lifestyle, we must encourage commitment and self-initiated action while ensuring the attainment of skill acquisition and function. Thus, the overall objective of this perspective paper is to guide exercise programming and community implementation to truly alter lifelong fitness in persons with CP

Artificially extended photoperiod administered to pre-partum mares via blue light to a single eye : observations on gestation length, foal birth weight and foal hair coat at birth

In seasonally breeding animals, photoperiod perception is crucial for timing of important physiological events. In the horse, long day photoperiod influences the onset of ovulation and cyclicity, shedding of the heavier winter coat and the timing of parturition. In this compilation of studies, conducted across three breeding seasons and two countries, the impact of artificially extended day length was investigated on gestation length, foal birth weight and foal hair coat at birth. The light therapy was administered to pre-partum mares via mobile head worn masks which provided short wavelength blue light to a single eye. In Study 1, reductions in gestation lengths were observed following administration of artificially extended day length (124.8 ± 15.11 days) in the final months of pregnancy to a group of Thoroughbred mares compared to controls (P < 0.05; 339.7 ± 9.56 days vs 350.6 ± 9.13). Study 2 revealed that pre-partum exposure to artificially extended day length (104.6 ± 9.89 days) increased foal birth weight compared to controls (47.13 ± 2.93 kg vs 43.51 ± 6.14 kg; P < 0.05) in mares bred early in the year. In Study 3, artificially extended day length (87.53 ± 19.6 days) administered to pre-partum mares affected the coat condition of foals at birth with respect to hair weight (P < 0.0001) and hair length (P < 0.0001) compared to controls (0.34 ± 0.20 μg vs 0.59 ± 0.12 μg and 1.93 ± 0.56 cm vs 2.56 ± 0.32 cm, respectively). Collectively, these studies serve to highlight the influential role of the circa-annual changes in photoperiod length on the pre-partum mare for normal foetal development during the natural breeding season. It also emphasizes the potential that exists to improve breeding efficiency parameters by artificially simulating this important environmental cue in the latter stages of gestation against the backdrop of an economically driven early breeding season.Study 2 was supported by an Enterprise Ireland Commercialisation Fund grant to B. A. Murphy.http://www.theriojournal.com2018-09-15hj2017Production Animal Studie

Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy II: Influencing the Trajectory

Physical activity of at least moderate intensity in all children contributes to higher levels of physical and psychological health. While essential, children with cerebral palsy (CP) often lack the physical capacity, resources, and knowledge to engage in physical activity at a sufficient intensity to optimize health and well-being. Low levels of physical activity place them at risk for declining fitness and health, contributing to a sedentary lifestyle. From this perspective, we describe a framework to foster a lifelong trajectory of fitness in ambulatory children with CP (GMFCS I–III) as they progress into adolescence and adulthood, implemented in conjunction with a training program to augment bone and muscle health. First, we recommend that altering the fitness trajectory of children with CP will require the use of methods to drive behavioral change prior to adolescence. Second, to promote behavior change, we suggest embedding lifestyle intervention into fitness programming while including meaningful activities and peer socialization to foster self-directed habit formation. If the inclusion of lifestyle intervention to drive behavior change is embedded into fitness programs and found to be effective, it may guide the delivery of targeted programming and community implementation. Participation in comprehensive programming could alter the long-term trajectory of musculoskeletal health while fostering strong self-efficacy in persons with CP

Biomechanical Assessment of Stabilization of Simulated Type II Odontoid Fracture with Case Study

STUDY DESIGN: Researchers created a proper type II dens fracture (DF) and quantified a novel current posterior fixation technique with spacers at C1-C2. A clinical case study supplements this biomechanical analysis. PURPOSE: Researchers explored their hypothesis that spacers combined with posterior instrumentation (PI) reduce range of motion significantly, possibly leading to better fusion outcomes. OVERVIEW OF LITERATURE: Literature shows that the atlantoaxial joint is unique in allowing segmental rotary motion, enabling head turning. With no intervertebral discs at these joints, multiple ligaments bind the axis to the skull base and to the atlas; an intact odontoid (dens) enhances stability. The most common traumatic injury at these strong ligaments is a type II odontoid fracture. METHODS: Each of seven specimens (C0-C3) was tested on a custom-built six-degrees-of-freedom spine simulator with constructs of intact state, type II DF, C1-C2 PI, PI with joint capsulotomy (PIJC), PI with spacers (PIS) at C1-C2, and spacers alone (SA). A bending moment of 2.0 Nm (1.5°/sec) was applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). One-way analysis of variance with repeated measures was performed. RESULTS: DF increased motion to 320%, 429%, and 120% versus intact (FE, LB, and AR, respectively). PI significantly reduced motion to 41%, 21%, and 8%. PIJC showed negligible changes from PI. PIS reduced motion to 16%, 14%, and 3%. SA decreased motion to 64%, 24%, and 54%. Reduced motion facilitated solid fusion in an 89-year-old female patient within 1 year. CONCLUSIONS: Type II odontoid fractures can lead to acute or chronic instability. Current fixation techniques use C1-C2 PI or an anterior dens screw. Addition of spacers alongside PI led to increased biomechanical rigidity over intact motion and may offer an alternative to established surgical fixation techniques

Implementation of a new index to assess intertidal seaweed communities as bioindicators for the European Water Framework Directory

An index CCO (cover, characteristic species, opportunistic species) has been developed for the implementation of the European Water Framework Directory (WFD) in coastal waters, using intertidal macroalgal communities as bio-indicator (Biological Quality Element). CCO is based on the calculation of three metrics corresponding to the global cover of macroalgal communities (metric 1), the number of characteristic species per topographic level/seaweed community (metric 2) and the cover of opportunistic species (metric 3). The final rating is obtained by pooling the scores of the three metrics. Results are given for 32 sites in 29 water bodies, grouped into four biogeographic regions along the Channel–Atlantic coasts of France. Over the six-year study, most of sites were sampled twice each (every three years). CCO index revealed that 25 coastal water bodies of both the Channel and the Bay of Biscay were in good or high ecological quality status (EQS), whereas only 4 of them were moderate and none in poor to bad status. However, significant differences have been found between sites and between geographic regions, water bodies located in Brittany obtaining the best EQS. No significant change occurred between the three-year sampling sets. A significant correlation has been established between a three-component anthropogenic pressure index and CCO ratings, showing the accuracy of CCO to evaluate the impact of anthropic activities on the structure and development of macroalgal communities as indicator of the ecological quality of coastal water bodies

Motor abnormalities in premanifest persons with Huntington's disease: The PREDICT-HD study

The PREDICT-HD study seeks to identify clinical and biological markers of Huntington's disease in premanifest individuals who have undergone predictive genetic testing. We compared baseline motor data between gene-expansion carriers (cases) and nongene-expansion carriers (controls) using t-tests and Chi-square. Cases were categorized as near, mid, or far from diagnosis using a CAG-based formula. Striatal volumes were calculated using volumetric magnetic resonance imaging measurements. Multiple linear regression associated total motor score, motor domains, and individual motor items with estimated diagnosis and striatal volumes. Elevated total motor scores at baseline were associated with higher genetic probability of disease diagnosis in the near future (partial R(2) 0.14, P < 0.0001) and smaller striatal volumes (partial R(2) 0.15, P < 0.0001). Nearly all motor domain scores showed greater abnormality with increasing proximity to diagnosis, although bradykinesia and chorea were most highly associated with diagnostic immediacy. Among individual motor items, worse scores on finger tapping, tandem gait, Luria, saccade initiation, and chorea show unique association with diagnosis probability. Even in this premanifest population, subtle motor abnormalities were associated with a higher probability of disease diagnosis and smaller striatal volumes. Longitudinal assessment will help inform whether motor items will be useful measures in preventive clinical trials

The Trail Making Test in prodromal Huntington disease: contributions of disease progression to test performance.

We examined the Trail Making Test (TMT) in a sample of 767 participants with prodromal Huntington disease (prodromal HD) and 217 healthy comparisons to determine the contributions of motor, psychiatric, and cognitive changes to TMT scores. Eight traditional and derived TMT scores were also evaluated for their ability to differentiate prodromal participants closer to estimated age of diagnosis from those farther away and prodromal individuals from healthy comparisons. Results indicate that motor signs only mildly affected Part A, and psychiatric symptoms did not affect either part. Tests of perceptual processing, visual scanning, and attention were primarily associated with Part A, and executive functioning (response inhibition, set-shifting), processing speed, and working memory were associated with Part B. Additionally, TMT scores differentiated between healthy comparisons and prodromal HD individuals as far as 9-15 years before estimated diagnosis. In participants manifesting prodromal motor signs and psychiatric symptoms, the TMT primarily measures cognition and is able to discriminate between groups based on health status and estimated time to diagnosis

Estimating premorbid IQ in the prodromal phase of a neurodegenerative disease

Estimates of premorbid intellect are often used in neuropsychological assessment to make inferences about cognitive decline. To optimize the method of controlling for premorbid intellect in assessments of prodromal neurodegenerative disease, we examined performance on the American National Adult Reading Test (ANART; administered during Years 1 and 3) and the two-subtest version of the Wechsler Abbreviated Scale of Intelligence (WASI; administered in Years 2 and 4) in an ongoing prospective longitudinal study of 371 participants with prodromal Huntington disease and 51 participants with normal CAG repeats. Although both measures performed similarly, the ANART demonstrated slightly lower variability in performance over a two-year period and had slightly higher test-retest reliability than the WASI