Strengthening Versus Balance Exercises for Juvenile Idiopathic Arthritis

The American Journal of Physical Medicine and Rehabilitation published research on 30 children with juvenile idiopathic arthritis (JIA) comparing the effects of muscle strengthening exercises versus proprioceptive-balance exercises on lower extremity function.

Each child was evaluated for pain, passive range of motion, muscle strength, balance, and functional abilities using the Numeric Rating Scale, goniometer, handheld dynamometer, Flamingo Balance Test, Functional Reach Test, 10-meter walking test, 10-stair climbing test, and Childhood Health Assessment Questionnaire. The participants were randomly assigned to the strengthening exercise group or the proprioceptive-balance exercise group.

The results indicated the following:

1.  statistically significant improvements in all outcome measures were recorded except muscle strength in the hip and ankle after strengthening exercises.

2.  statistically significant improvements were found in all outcome measures after the proprioceptive-balance exercises.

3.  Intergroup analysis showed statistically significant improvement in all outcome measures in the proprioceptive-balance exercise group except for the Numeric Rating Scale, Childhood Health Assessment Questionnaire, and passive range of motion scores and hip extension and knee flexion muscle strengths.

The researchers concluded that exercise treatment significantly improves musculoskeletal symptoms in children with juvenile idiopathic arthritis. Balance-proprioceptive exercises were shown to be more effective than strengthening exercises for improving lower extremity function such as walking, climbing stairs, and balance in children with juvenile idiopathic arthritis.

Reference:  Baydogan, Saime Nilay MSc, PT; Tarakci, Ela PhD, PT; Kasapcopur, Ozgur MD.  Effect of Strengthening Versus Balance-Proprioceptive Exercises on Lower Extremity Function in Patients with Juvenile Idiopathic Arthritis: A Randomized, Single-Blind Clinical Trial. American Journal of Physical Medicine & Rehabilitation.  Published ahead on print on 3/24/15. doi: 10.1097/PHM.0000000000000279

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Foot Orthotics in Children with Juvenile Idiopathic Arthritis

Archives of Disease in Childhood published randomized controlled trial research on the use of foot orthoses in children with juvenile idiopathic arthritis (JIA).   Sixty children randomly received  either ‘fitted’ foot orthotics with customized chair-side corrections or ‘control’ foot orthotics made without corrections.  Changes in pain and quality of life for the children with JIA was assessed at baseline, 3 months and 6 months.

The following results were recorded:

1.  a statistically significant greater difference in pain reduction (baseline—6 months) was seen for the group with fitted foot orthotics

2.  the reduction in pain in the fitted foot orthotics group was clinically important (8 mm).

3.  significant differences in quality of life was seen in the fitted foot orthotic group as measured by the children and independently by their parents/carers.

The researchers concluded that fitted foot orthotics may reduce pain and improve quality of life in selected children with JIA.

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Reference:  Andrea Coda, Peter W Fowlie, Joyce E Davidson, Jo Walsh, Tom Carline, Derek Santos. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Arch Dis Child archdischild-2013-305166Published Online First: 17 March 2014 doi:10.1136/archdischild-2013-305166

Exercise Participation: Juvenile Idiopathic Arthritis

To continue on with yesterday's topic, promoting participation in recreational activities for children with disabilities, today's topic will discuss specific recommendations for children with juvenile idiopathic arthritis (JIA). Research has shown that children with JIA can participate in exercise regimens without exacerbating the disease. In addition, research has shown that exercise for at least 6 weeks decreases disease activity, improves quality of life and decreases pain. In general, it is recommended that children with JIA participate in moderate fitness and strengthening activities.

There are precautions necessary to consider when recommending exercise or sports participation for children with JIA. Depending upon where the JIA is located, various risks may be present. For example, cervical arthritis makes a child at greater risk for neck injuries and temporomandibular joint disease may result in dental injuries. JIA may results in visual impairments making a child more susceptible to eye injury. If children have been diagnosed long term with JIA, research has shown aerobic fitness to be lower than typically developing peers.

In addition to the precautions, the following recommendations should be considered when suggesting exercise programs for children with JIA:
1. participation in contact sports or impact activities are permitted if the disease is well managed and the child has the physical capacity to participate in the sport (cervical spine should be screened with x-ray prior to contact sports)
2. activities should be pain free
3. if the JIA flares up, return to regular activity should be gradual
4. jaw protection and proper eye protection should be utilized

Overall, children with JIA may benefit from moderate fitness, flexibility and strengthening activities and may participate in exercise and sports without exacerbating the JIA.

Reference: Philpott, John F MD, Dip Sport Med; Houghton, Kristin MD, Dip Sport Med; Luke, Anthony MD, MPH, Dip Sport Med Physical Activity Recommendations for Children With Specific Chronic Health Conditions: Juvenile Idiopathic Arthritis, Hemophilia, Asthma, and Cystic Fibrosis Clinical Journal of Sport Medicine: May 2010 - Volume 20 - Issue 3 - pp 167-172 doi: 10.1097/JSM.0b013e3181d2eddd