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Critical Reviews™ in Physical and Rehabilitation Medicine
SJR: 0.121 SNIP: 0.228 CiteScore™: 0.5

ISSN Imprimer: 0896-2960
ISSN En ligne: 2162-6553

Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.v28.i4.50
pages 283-304

Exercise Programs Designed and Dosed to Improve Bone Mineral Density in Children with Cerebral Palsy

Mary E. Gannotti
University of Hartford, Department of Rehabilitation Sciences, Shriners Hospital for Children, Springfield, MA, USA
Erica L. Breive
University of Hartford, Westfield, MA
Kristen Miller
University of Hartford, Westfield, MA
Robert Mobyed
University of Hartford, Westfield, MA
Rebecca A. Cameron
University of Hartford, West Hartford, CT 06117

RÉSUMÉ

Cerebral palsy (CP) is one of the most common causes of motor deficiency in children. CP is a group of disorders causing permanent damage to the brain during development. This affects physical function, motor control, and the ability to maintain balance and posture, resulting in decreased physical activity, muscle mass, and bone mineral density (BMD). Low BMD is related to many factors such as decreased mobility, the use of anticonvulsants, feeding problems leading to impaired nutrition, and genetic variables. These individuals have a high risk of fracture occurrence with minimal trauma due to impaired bone structure and are at risk for progressive bone deformity in adulthood. We review bone development and bone response to exercise and propose innovations in dosing interventions to optimize osteogenic potential. We focus on weight-bearing exercises producing ground reaction forces and active muscle contractions that influence bone development. Such exercises are known to have a positive osteogenic effect on bone density during the first few decades of life. The proposed exercise programs include dosing of treadmill training and standing and seated plyometrics for mildly to moderately impaired individuals and dosing recumbent cycling and seated whole-body vibration for moderately to severely impaired individuals. With proper dosing and applications of these interventions, improvements in BMD and bone accrual may be achieved through exercise. Rehabilitation professionals should use current knowledge about the mechanostatic therapeutics to dose interventions to optimize skeletal health for prevention risks and to minimize progressive deformity.


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