The Journal of Korean Academy of Sensory Integration (대한감각통합치료학회지)

Korean Academy of Sensory Integration (대한감각통합치료학회)
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The Effects of Weighted Vest During Task-Oriented Training on Gross Motor Performance and Balance Abilities of Children With Spastic Diplegia : A Randomized Clinical Trial Study

경직형 양마비 아동의 과제지향훈련 시 무게조끼 적용이 대동작 수행력과 균형 능력에 미치는 영향: 무작위배정 위약비교 연구

  • Kwon, Hae-Yeon (Department of Physical Therapy, Dong-Eui University)
  • 권해연 (동의대학교 물리치료학과)
  • Received : 2017.11.06
  • Accepted : 2017.12.15
  • Published : 2017.12.31
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Abstract

Objective : The purpose of this research is to find clinical effects of application of weighted vest during task-oriented training focused on gross motor performance and balance abilities of children with spastic diplegia. Methods : 34 subjects were divided by simple random sampling into two groups; experimental group (male : 9, female : 8, average age : 8.12) and placebo group (male : 9, female : 9, average age : 7.53). Both two groups underwent to 40 minute intervention, twice a week for 12 weeks. The intervention was task-oriented training focused on facilitating closed kinematic chain and multi-joint functional movement pattern. During the training, the experimental group received loaded-resistance weighted vest and placebo group also received weighted vest but without loaded-resistance. Participants in both groups underwent 8 to 10 reps of the task-oriented training and there were 3 minutes break time between tasks. There were pre-test of gross motor performance and balance abilities, and two times of post-tests were performed upon 6 weeks and 12 weeks after the intervention completed. And in final, an additional follow-up test was performed 12 weeks after the evaluation was finished in order to find any difference between the two groups over time. Results : There was significant difference in Gross Motor Performance Measure (GMPM) between two groups. It is found that average score of the experimental group increased more than the placebo group after 6 weeks and 12 weeks intervention (p<.05). There was significant difference in Pediatric Berg's Balance Scale (PBS) between two groups. It is found that average score of the experimental group increased more than the placebo group after 6 weeks and 12 weeks intervention (p<.05). Conclusion : Based on the results in this study, it is proposed that application of weighted vest into task-oriented training to facilitating closed kinematic chain and multi-joint movement can improve gross motor performance and balance abilities of children with cerebral palsy.

목적 : 본 연구는 경직형 양마비 아동에게 과제지향훈련을 시행할 때 무게조끼 적용이 대동작 수행력과 균형 능력에 미치는 영향을 알아보며 뇌성마비 아동을 치료하기 위한 중재방법으로 임상적으로 유용한지 제안하고자 시도되었다. 연구방법 : 연구 대상자를 단순 무작위 표본추출법으로 실험군(남자 : 9명, 여자 : 8명, 평균연령 : 8.12세)과 위약군(남자 : 9명, 여자 : 8명, 평균연령 : 7.53세) 각각 18명씩 배분한 후 두 중재군 모두에게 1회 40분, 주 2회 과제지향훈련을 12주 동안 실시하였다. 실험군은 무게저항을 제공하는 무게조끼를 착용하고, 위약군은 무게저항 없이 무게조끼만 착용하였다. 두 중재군 모두에게 닫힌 운동사슬과 다관절의 기능적인 움직임 패턴을 촉진하는 과제지향훈련을 각각 8~10회 실시하며 과제 사이에 약 3분간 휴식 하였다. 두 중재군의 대동작 수행력, 균형 능력에 대한 사전검사는 중재 전에 측정하였고, 사후검사는 중재 6주후와 12주후 총 2회 시행하였으며 마지막으로 추적검사는 실험종료 12주후에 실시한 후 두 중재군 사이의 시간경과에 따른 변화량을 분석하였다. 결과 : 대동작 수행평가는 중재 6주후와 12주후에는 실험군이 위약군보다 평균 점수가 더 증가하였으며 유의한 차이가 나타났다(p<.05). 아동용 균형척도는 중재 6주후와 12주후에는 실험군이 위약군보다 평균 점수가 더 증가하였으며 유의한 차이가 있었다(p<.05). 결론 : 그러므로 닫힌 운동사슬과 다관절의 기능적인 움직임을 촉진시키는 과제지향훈련 시 무게조끼 적용은 경직형 양마비 아동의 대동작 수행력과 균형 능력을 향상시키는 유용한 중재 방법으로 고려될 수 있다.

Keywords

References

  1. Ahl, L. E., Johanssonv, E., Granat, T., & Carlberg, E. B. (2005). Functional therapy for children with cerebral palsy: An ecological approach. Developmental Medicine and Child Neurology, 47(9), 613-619. https://doi.org/10.1111/j.1469-8749.2005.tb01213.x
  2. Anttila, H., Autti-Ramo, I., Suoranta, J., Makela, M., & Malmivaara, A. (2008). Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatrics, 1471-2431-8-14.
  3. Ashton-Miller, J. A., Wojtys, E. M., & Huston, L. J. (2001). Can proprioception really be improved by exercises? Knee Surgery, Sports Traumatology, Arthroscopy, 9(3), 128-136. https://doi.org/10.1007/s001670100208
  4. Assaiante, C., & Amblard, B. (1995). An ontogenetic model for the sensorimotor organization of balance control in humans. Human Movement Science, 14(1), 13-43. https://doi.org/10.1016/0167-9457(94)00048-J
  5. Bandholm, T., Rose, M. T., Slok, R., Sonne-Holm, S., & Jensen, B. R. (2009). Ankle torque steadiness is related to muscle activation variability and co activation in children with cerebral palsy. Muscle and Nerve, 40(3), 402- 410. https://doi.org/10.1002/mus.21348
  6. Bartlett, D., & Birmingham, T. (2003). Validity and reliability of a pediatric reach test. Pediatric Physical Therapy, 15(2), 84-92. https://doi.org/10.1097/01.PEP.0000067885.63909.5C
  7. Beckung, E., Carlsson, G., Carlsdotter, S., & Uvebrant, P. (2007). The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years. Developmental Medicine and Child Neurology, 49(10), 751-756. https://doi.org/10.1111/j.1469-8749.2007.00751.x
  8. Behm, D. G., Faigenbaum, A. D., Falk, B., & Klentrou, P. (2008). Canadian Society for exercise physiology position paper: Resistance training in children and adolescents. Applied Physiology, Nutrition, and Metabolism, 33(3), 547-661. https://doi.org/10.1139/H08-020
  9. Blundell, S. W., Shepherd, R. B., Dean, C. M., Adams, R. K., & Cahill, B. M. (2003). Functional strength training in cerebral palsy: A pilot study of a group circuit training class for children aged 4-8 years. Clinical Rehabilitation, 17(1), 48-57. https://doi.org/10.1191/0269215503cr584oa
  10. Boyce, W. F., Gowland, C., Rosenbaum, P. L., Lane, M., Plews. N,, Goldsmith, C. H., et al. (1995). The Gross Motor Performance Measure: Validity and responsiveness of a measure of quality of movement. Physical Therapy, 75(7), 603-613. https://doi.org/10.1093/ptj/75.7.603
  11. Boyce, W. F., Gowland, C., Russell, D. J., Goldsmith, C., Rosenbaum, P., Plews, N., et al. (1993). Consensus methodology in the development and content validation of a gross motor performance measure. Physiotherapy Canada, 45(2), 94-100.
  12. Boyd, R. N. (2012). Functional Progressive resistance training improves muscle strength but not walking ability in children with cerebral palsy. Journal of Physiother, 58(3), 197. http://dx.doi.org/10.1016/ S1836-9553(12)70111-X
  13. Bryant, C. X., Peterson, J. A., & Graves, J. E. (2001). Muscular strength and endurance. In J. L. Roitamn (Ed.), ACSM's Resource manual for exercise testing and prescription (4th ed., pp. 460). Philaelphia: Lippincott Williams & Wilkins.
  14. Cans, C. (2002). Prevalance and characteristics of children with cerebral palsy in Europe. Developmental Medicine and Child Neurology, 44(9), 633-640. https://doi.org/10.1111/j.1469-8749.2002.tb00848.x
  15. Carr, J. H., & Shephard, R. B. (1999). Neurological rehabilitation: Optimizing motor performance. Butterworth-Heinemann, Churchill Livingstone
  16. Cherng, R. J., Su, F. C., Chen, J. J., & Kuan, T. S. (1999). Performance of static standing balance in children with spastic diplegic cerebral palsy under altered sensory environments. American Journal of Physical Medicine and Rehabilitation, 78(4), 336-343. https://doi.org/10.1097/00002060-199907000-00008
  17. Choi, Y. J., & Choi, J. D. (2015). Effects of task oriented training of trunk stability on a swiss ball in sitting position on trunk stability and balance in children with spastic cerebral palsy. Journal of Korean Academy of Neural Rehabilitation, 5(2), 22-33.
  18. Clanchy, K. M., Tweedy, S. M., & Boyd, R. (2011). Measurement of habitual physical activity performance in adolescents with cerebral palsy: A systematic review. Developmental Medicine and Child Neurology, 53(6), 599-505. https://doi.org/10.1111/j.1469-8749.2010.03910.x
  19. Crompton, J., Imms, C., McCoy, A. T., Randall, M., Eldridge, B., & Scoullar B., et al. (2007). Group-based task related training for children with cerebral palsy: A pilot study. Physical and Occupational Therapy in Pediatrics, 27(4), 43-65.
  20. Damiano, D. L., & Abel, M. F. (1996). Relation of gait analysis to gross motor function in cerebral palsy. Developmental Medicine and Child Neurology, 38(5), 389-396. https://doi.org/10.1111/j.1469-8749.1996.tb15097.x
  21. Damiano, D. L., & Abel M. F. (1998). Functional outcome of strength training in spastic cerebral palsy. Archives of Physical Medicine and Rehabilitation, 79(2), 119-125. https://doi.org/10.1016/S0003-9993(98)90287-8
  22. Damiano, D. L. (2006). Activity, activity, activity: Rethinking our physical therapy approach to cerebral palsy. Physical Therapy, 86(11), 1534-1540. https://doi.org/10.2522/ptj.20050397
  23. Davis, T. N., Dacus, S., Strickland, E., Copeland, D., Chan, J. M., Blenden, K., et al. (2013). The effects of a weighted vest on aggressive and self-injurious behavior in a child with autism. Developmental Neurorehabilitation, 16(3), 210-215. https://doi.org/10.3109/17518423.2012.753955
  24. DeGangi, G. A., Wietlisbach, S., Goodin, S., & Shirley, W. (1993). A comparison of structured sensorimotor therapy and child-centered activity in the treatment of preschool children with sensorimotor problems. American Journal of Occupational Therapy, 47(9), 777-786. https://doi.org/10.5014/ajot.47.9.777
  25. Dodd, K. J., Taylor, N. F., & Damiano, D. L. (2002). A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 83(8), 1157-1164. https://doi.org/10.1053/apmr.2002.34286
  26. Dodd, K. J., Taylor, N. F., & Graham, H. K. (2003). A randomized clinical trial of strength training in young people with cerebral palsy. Developmental Medicine and Child Neurology, 45(10), 652-657. https://doi.org/10.1111/j.1469-8749.2003.tb00866.x
  27. Donker, S. F., Ledebt, A., Roerdink, M., Savelsbergh, G. J., & Beek, P. J. (2008). Children with cerebral palsy exhibit greater and more postural sway than typically developing children. Experimental Brain Research, 184(3), 363-370. https://doi.org/10.1007/s00221-007-1105-y
  28. Dunn, W., Brown, C., & McGuign, A. (1994). The ecology of human performance: A framework for considering the effect of context. American Journal of Occupational Therapy, 4(7), 595-607.
  29. Durstine, J. L., Painter, P., Franklin, B. A., Morgan, D., Pitetti, K. H., Roberts, S. O., et al. (2000). Physical activity for the chronically ill and disabled. Sports Medicine, 30(3), 207-219. https://doi.org/10.2165/00007256-200030030-00005
  30. Eek, M. N., Tranberg, R., Zügner, R., Alkema, K., & Beckung, E. (2008). Muscle strength training to improve gait function in children with cerebral palsy. Developmental Medicine and Child Neurology, 50(10), 759-764. https://doi.org/10.1111/j.1469-8749.2008.03045.x
  31. Faigenbaum, A. D., Kraemer, W. J., Blimkie, C. J., Jeffreys, I., Micheli, L. J., & Nitka, M., et al. (2009). Youth resistance training: Updated position statement paper from the national strength and conditioning association. Journal of Strength and Conditioning Research, 23(5 Suppl), S60-S79. https://doi.org/10.1519/JSC.0b013e31819df407
  32. Faigenbaum, A. D., Kraemer, W. J., Cahill, B., Chandle, J., Dziados, J., Elfrink, L. D., et al. (1996). Youth resistance training: Position statement paper and literature review. Strength and Conditioning Journal, 18(6), 62-76.
  33. Faigenbaum, A. D., & Bradley, D. F. (1998). Strength training for the young athlete. Orthopedic Physical Therapy Clinics of North America, 7, 67.
  34. Fertel-Daly, D., Bedell, G., & Hinojosa, J. (2001). Effects of a weighted vest on attention to task and self-stimulatory behaviors in preschools with pervasive developmental disorder. American Journal of Occupational Therapy, 55(6), 629-640. https://doi.org/10.5014/ajot.55.6.629
  35. Fowler, E. G., Ho, T. W., Nwigwe, A. I., & Dorey, F, J. (2001). The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy. Physical Therapy, 81(6), 1215-1223.
  36. Franjoine, M. R., Darr, N., Held, S. L., Kott, K., & Young, B. L. (2010). The performance of children developinng typically on the pediatric balance scale. Pediatric Physical Therapy, 22(4), 350-359. https://doi.org/10.1097/PEP.0b013e3181f9d5eb
  37. Franjoine, M. R., Gunther, J. S., & Taylor, M. J. (2003). Pediatric balance scale: A modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatric Physical Therapy, 15(2), 114-128. https://doi.org/10.1097/01.PEP.0000068117.48023.18
  38. Gan, S. M., Tung, L. C., Tang, Y. H., & Wang, C. H. (2008). Psychometric properties of functional balance assessment in children with cerebral palsy. Neurorehabilitation and Neural Repair, 22(6), 745-753. https://doi.org/10.1177/1545968308316474
  39. Himmelmann, K., Hagberg, G., Beckung, E., Hagberg, B., & Uverbrant, P. (2005). The changing panorama of cerebral palsy in Sweden IX. Prevalance and origin in the birth year period 1995-1998. Acta Paediatrica, 94(3), 287-294. https://doi.org/10.1111/j.1651-2227.2005.tb03071.x
  40. Han, M. Y., Kim, J. Y., Chang, K. Y., & Park, M. J. (2010). The effect of a weighted vest in behavioral problem for the sensory modulation disorder. Journal of Korean Academy of Sensory Integration, 8(1), 1-13.
  41. Hodgetts, S., Magill-Evans, J., & Misiaszek, J. E. (2011). Weighted vests, stereotyped behaviors and arousal in children with autism. Journal of Autism Developmental Disorders, 41(6), 805-814. https://doi.org/10.1007/s10803-010-1104-x
  42. Hubbard, I. J., Parsons, M. W., Neilson, C., & Carey, L. M. (2009). Task-specific training: Evidence for and translation to clinical practice. Occupational Therapy International, 16(3-4), 175-189. https://doi.org/10.1002/oti.275
  43. Ketelaar, M., Vermeer, A., Hart, H., van Petegem-van, Beeek. E., & Helders, P. J. (2001). Effects of a functional therapy program on motor abilities of children with cerebral palsy. Physical Therapy, 81(9), 1534-1545. https://doi.org/10.1093/ptj/81.9.1534
  44. Kim, J. (2012). Impact of the weight transfer training using weighted vest in standing poisition on standing balance in children with cerebral palsy. Master's thesis, Dan-Kook University, Yongin-si, Gyeonggi-do.
  45. Kim, Y., & Lee, B. H. (2013). Clinical usefulness of child-centered task-oriented training on balance ability in cerebral palsy. Journal of Physical Therapy Science, 25(8), 947-951. https://doi.org/10.1589/jpts.25.947
  46. Kramer, J. F., & MacPhail, H. E. (1994). Relationship among measures of walking efficiency, gross motor ability, and isokinetic strength in adolescents with cerebral palsy. Pediatric Physical Therapy, 6(1), 3-8.
  47. Lee, J. H., Sung, I. Y., & Yoo, J. Y. (2008). Therapeutic effects of strengthening exercise on gait function of cerebral palsy. Disability and Rehabilitation, 30(19), 1439-1444. https://doi.org/10.1080/09638280701618943
  48. Lee, H. S., & Song, C. S. (2015). Effects of therapeutic climbing activities wearing a weighted vest on a child with attention deficit hyperactivity disorder: A case study. Journal of Physical Therapy Science, 27(10), 3337-3339. https://doi.org/10.1589/jpts.27.3337
  49. Lee, M. S., & Choi, J. D. (2013). Research article: The effects of task oriented training with suspension device on trunk stability and gross motor function of children with spastic diplegia cerebral palsy. Journal of the Korean Society of Physical Medicine, 8(4), 637-645. https://doi.org/10.13066/kspm.2013.8.4.637
  50. Lehman, G. J., MacMillan, B., MacIntyre, I., Chivers, M., & Fluter, M. (2006). Shoulder muscle EMG activity during push up variations on and off a Swiss ball. Dynamic Medicine, 5, 7. https://doi.org/10.1186/1476-5918-5-7
  51. Leroux, A., Pinet, H., & Nadeau, S. (2006). Task-oriented intervention in chronic stroke: Changes in clinical and laboratory measures of balance and mobility. American Journal of Physical Medicine and Rehabilitation, 85(10), 820-830. https://doi.org/10.1097/01.phm.0000233179.64769.8c
  52. Liao, H. F., Liu, Y. C., Liu, W. Y., & Lin, Y. T. (2007). Effectiveness of loaded sit-to-stand resistance exercise for children with mild spastic diplegia: A randomized clinical trial. Archives of Physical Medicine and Rehabilitation, 88(1), 25- 31. https://doi.org/10.1016/j.apmr.2006.10.006
  53. Lin, H, Y., Lee, P., Chang, W. D., & Hong, F. Y. (2014). Effects of weighted vests on attention, impulse control, and on-task behavior in children with attention deficit hyperactivity disorder. American Journal of Occupational therapy, 68(2), 149-158. https://doi.org/10.5014/ajot.2014.009365
  54. MacPhail, H. E., & Kramer, J. F. (1995). Effect of isokinetic strength-training on functional ability and walking efficiency in adolescents with cerebral palsy. Developmental Medicine and Child Neurology, 37(9), 763-775. https://doi.org/10.1111/j.1469-8749.1995.tb12060.x
  55. McBurney, H., Taylor, N. F., Dodd, K. J., & Graham, H. K. (2003). A qualitative analysis of the benefits of strength training for young people with cerebral palsy. Developmental Medicine and Child Neurology, 45(10), 658-663. https://doi.org/10.1111/j.1469-8749.2003.tb00867.x
  56. Miller, F. & Browne, E. (2007). Physical therapy of cerebral palsy. Springer Science & Business Media.
  57. Morton, J. F., Brownlee, M., & McFadyen, A. K. (2005). The effects of progressive resistance training for children with cerebral palsy. Clinical Rehabilitation, 19(3), 283-289. https://doi.org/10.1191/0269215505cr804oa
  58. Naughton, K., Adams, L., & Maher, H. (2005). Upper-body wobbleboard training effects on the post-dislocation shoulder. Physical Therapy in Sport, 6(1), 31-37. https://doi.org/10.1016/j.ptsp.2004.05.005
  59. Peng, Y. C., Lu, T. W., Wang, T. H., Chen, Y. L., Liao, H. F., & Lin, K. H., et al. (2011). Immediate effects of therapeutic music on loaded sit-to-stand movement in children with spastic diplegia. Gait Posture, 33(2), 274-278. https://doi.org/10.1016/j.gaitpost.2010.11.020
  60. Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano D., et al. (2007). A report: The definition and classification of cerebral palsy April 2006. Developmental Medicine and Child Neurology Supplement, 109, 8-14.
  61. Ross, S. A., & Engsberg, J. R. (2007). Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Archives of Physical Medicine and Rehabilitation, 88(9), 1114-1120 https://doi.org/10.1016/j.apmr.2007.06.011
  62. Salbach, N. M., Mayo, N. E., Wood-Dauphinee, S., Hanley, J. A., Richards, C. L., & Cote, R. (2004). A task-orientated intervention enhances walking distance and speed in the first year post stroke: A randomized controlled trial. Clinical Rehabilitation, 18(5), 509-519. https://doi.org/10.1191/0269215504cr763oa
  63. Salem, Y., & Godwin, E. M. (2009). Effects of task-oriented training on mobility function in children with cerebral palsy. NeuroRehabilitation, 24(4), 307-313.
  64. Schneigerg, S., McKinley, P. A., Sveistrup, H., Gisel, E., Mayo, N. E., & Levin, M. F. (2010). The effectiveness of task-oriented intervention and trunk restraint on upper limb movement quality in children with cerebral palsy. Developmental Medicine and Child Neurology, 52(11), e245-253. https://doi.org/10.1111/j.1469-8749.2010.03768.x
  65. Scholtes, V. A., Becher, J. G., Janssen-Potten, Y. J., Dekkers, H., Smallerbroek, L., & Dallmeijer, A. J. (2012). Effectiveness of functional progressive resistance exercise training on walking ability in children with cerebral palsy. Research in Developmental Disabilities, 33(1), 181-188. https://doi.org/10.1016/j.ridd.2011.08.026
  66. Sekendiz, B., Cug, M., & Korkusuz, F. (2010). Effects of swissball core strength training on strength, endurance, flexibility, and balance in sedentary women. Journal of Strength and Conditioning Reserach, 24(11), 3032-3040. https://doi.org/10.1519/JSC.0b013e3181d82e70
  67. Shaw, J. M., & Snow, C. M. (1998). Weighted vest exercise improves indices of fall risk in older women. Journals of Gerontollgy Series A Biological Sciences and Medical Sciences, 53(1), M53-58.
  68. Sheth, P., Yu, B., Laskowski, E. R., & An, K. N. (1997). Ankle disk training influences reaction times of selected muscles in a simulated ankle sprain. American Journal of Sports Medicine, 25(4), 538-543. https://doi.org/10.1177/036354659702500418
  69. Shin, E. K., & Song, B. H. (2012). The effects of task-oriented circuit program on motor function for the children with cerebral palsy. Journal of Korean Society for Neurotherapy, 16(2), 25-36.
  70. Shin, H. K., & Chung, B. I. (2001). The effect of functional strengthening exercise on standing balance in a child with cerebral palsy. Korean Research Society of Physical Therapy, 8(3), 97-105.
  71. Shin, S. H., Lee, K. J., & Song, C. H. (2011). The effect of weight based gait training using weighted vest on static balance and dynamic balance with stroke. Journal of Special Education and Rehabilitation Science, 50(3), 413-431.
  72. Shnha, G., Corry, P., & Subesinghe, D. (1997). Prevalence and type of cerebral palsy in a british ethnic community: The role of consanguinity. Developmental Medicine and Child Neurology, 39(4), 259-262. https://doi.org/10.1111/j.1469-8749.1997.tb07422.x
  73. Shumway-cook, A., & Woollacott, H. (1995). Motor control: Theory and practical applications. Baltimore: Williams & Wilkins.
  74. Shumway-Cook, A., Hutchinson, S., Kartin, D., Price, R., & Woollacott, M. (2003). Effect of balance training on recovery of stability in children with cerebral palsy. Developmental Medicine and Child Neurology, 45(9), 591-602. https://doi.org/10.1111/j.1469-8749.2003.tb00963.x
  75. Snow, C. M., Shaw, J. M., Winters, K. M., & Witzke, K. A. (2000). Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. Journals of Gerontollgy Series A Biological Sciences and Medical Sciences, 55(9), M489-491. https://doi.org/10.1093/gerona/55.9.M489
  76. Telama, R., Yang, X., Viikari, J., Valimaki, I., Wanne, O., & Raitakari, O. (2005). Physical activity from childhood to adulthood: A 21-year tracking study. American Journal of Preventive Medicine, 28(3), 267-273. https://doi.org/10.1016/j.amepre.2004.12.003
  77. Unger, M., Faure, M., & Frieg, A. (2006). Strength training in adolescent learners with cerebral palsy: A randomized controlled trial. Clinical Rehabilitation, 20(6), 469-477. https://doi.org/10.1191/0269215506cr961oa
  78. van den Berg-Emons, R. J., van Baak, M. A., De Barbanson, D. C., Speth, L., & Saris W. H. (1996). Reliability of tests to determine peak aerobic power, anaerobic power and isokinetic muscle strength in children with spastic cerebral palsy. Developmental Medicine and Child Neurology, 38(12), 1117-1125. https://doi.org/10.1111/j.1469-8749.1996.tb15075.x
  79. Vandenberg, N. L. (2001). The use of a weighted vest to increase on-task Behavior in children with attention difficulties. American Journal of Occupational Therapy, 55(6), 621-628. https://doi.org/10.5014/ajot.55.6.621
  80. Verschuren, O., Ketelaar, M., Gorter, J. W., Helders, P. J. M., Uiterwaal, C. S. P. M., & Takken, T. (2007). Exercise training program in children and adolescents with cerebral palsy: A randomized controlled trial. Archives of Pediatrics and Adolescent Medicine, 161(11), 1075 -1081. https://doi.org/10.1001/archpedi.161.11.1075
  81. Woollacott, M. H., & Shumway-Cook, A. (2005). Postural dysfunction during standing and walking in children with cerebral palsy: What are the underlying problems and what new therapies might improve balance? Neural Plasticity, 12(2-3), 211-219, discussion 263-272. http://dx.doi.org/10.1155/NP.2005.211
  82. Yokochi, K. (2001). Motor functions in nonambulatory children with spastic diplegia and periventricular leukomalacia, Brain and Development, 23(5), 327-332. https://doi.org/10.1016/S0387-7604(01)00232-7