decreased physical activity, increased sedentary behaviour, and deteriorating muscle morphology leading to greater cardiovascular and metabolic risk and early mortality.2 The study of Shkedy Rabani et al.3 confirms previous reports that physical activity levels of young people with CP are low compared with their typically developing peers.4 However, in addition to reporting physical activity levels, Shkedy Rabani et al. also report new and more detailed information about the sedentary behaviour of this population. Adolescents and young adults with CP are sedentary for between 82% and 96% of the day. These results are similar to sedentary behaviour reported for other populations with mobility disability, and indicate that young people with CP demonstrate substantially greater amounts of sedentary behaviour than people without health conditions.5 Of particular interest, Shkedy Rabani et al. reported other markers of sedentary behaviour such as the number of daily transitions from sit to stand, and the median duration of bouts of sedentary behaviour. As well as being sedentary for the majority of each day, these data suggests that adolescents and young adults with CP are sedentary for prolonged periods with few transitions or periods of light activity. Therefore, young people with CP may be at long-term risk of developing health problems not only

because they are not physically active enough, but also because they spend too long in sedentary postures. The issue is what to do about this problem. Attempts to increase levels of moderate to vigorous levels of physical activity in young people with CP have proven difficult to achieve and maintain, with only modest benefits found in a small number of trials. Another approach that is now being proposed for people with motor disabilities, and which may be applicable to people with CP, is to trial interventions that reduce sedentary behaviour.5 What is appealing about this approach is that these interventions are less intensive and so may be more achievable than interventions designed to increase moderate intensity physical activity. For example, designing and integrating standing work stations in classrooms, allocating time for students to walk or self-propel their wheelchairs between classes, and having limits on sustained screen time are practical strategies that could be trialled in future research. If strategies to reduce sedentary behaviour are going to be trialled, sedentary behaviour first needs to be measured. The study of Shkedy Rabani et al. is important because it is one of the first to measure and report detailed baseline information about sedentary behaviour in young people with CP.

REFERENCES 1. Dunstan DW, Howard B, Healy GN, Owen N. Too

3. Shkedy Rabani A, Harries N, Namoora I, Al-Jarrah

much sitting – a health hazard. Diabetes Res Clin Pract

MD, Karniel A, Bar-Haim S. Duration and patterns of

a systematic review. Disabil Rehabil 2013; 35: 647–55.

2012; 97: 369–76.

habitual physical activity of adolescents and young

5. Manns PJ, Dunstan DW, Owen N, Healy GN. Address-

adults with cerebral palsy. Dev Med Child Neurol 2014;

ing the nonexercise part of the activity continuum: a

56: 673–80.

more realistic and achievable approach to activity pro-

2. Peterson MD, Gordon PM, Hurvitz EA. Chronic disease risk among adults with cerebral palsy: the role of premature sarcopenia, obesity and sedentary behaviour. Obes Rev 2013; 14: 171–82.

4. Carlon SL, Taylor NF, Dodd KJ, Shields N. Differences in habitual physical activity levels of young people

with cerebral palsy and their typically developing peers:

gramming for adults with mobility disability? Phys Ther 2012; 92: 614–25.

Sleep: the other life of children with cerebral palsy CHRISTOPHER J NEWMAN Paediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland. doi: 10.1111/dmcn.12441 This commentary is on the original article by Atmawidjaja et al. on pages 681–685 of this issue.

Sleep is an all important part of childhood, not only in terms of the cumulative years a child spends asleep, but mainly because of its essential role in general health, body growth, brain development, and learning. Considering this, there has only been a belated interest in the ‘sleep life’ of children with cerebral palsy (CP), which has thankfully increased over the last decade. Studies in children with CP 610 Developmental Medicine & Child Neurology 2014, 56: 605–611

show some variation in the prevalence of sleep disorders, due to differences in population characteristics and in the tools used to identify these disorders, as well as the inherent difficulty in defining the cut-off point between good, poor, and pathological sleepers. However, there is overwhelming evidence that children with CP have a severalfold increase (seven to twelve times) in the frequency of sleep disorders, notably disorders of initiation and maintenance of sleep, when compared with their peers.1 Sleep, as a biological phenomenon, could be expected to transcend cultures; however, culture has a strong bearing on where we sleep, with whom we sleep, when we sleep, as well as on judgements of what we consider good sleep.2 Atmawidjaja et al.’s study makes a significant contribution to the literature on sleep in CP, by exploring sleep quality

in an ethnically and culturally distinct population of Malaysian children, compared with previous research performed in Western countries.3 From a sleep biology perspective their findings are in line with earlier results, with a high prevalence and similar typology of sleep difficulties in their population with CP. Atmawidjaja et al. elected to use healthy age-matched siblings as controls in order to decrease cultural confounding, since the norms of their sleep scale are those of Italian children.4 The extent to which siblings of children with CP (in particular when these children have sleep disorders) are representative of the general population may be questioned, especially in an environment where co-sleeping is the norm. Nevertheless, in this study children with CP significantly differed from their siblings in terms of sleep difficulties, along lines that are similar to previous reports using general population data as a control. Atmawidjaja et al. clearly demonstrated the effect of poor sleep in children with CP on their direct caregivers, who experienced significantly shorter sleep and more difficulty falling asleep. The results of the control population provide an additional insight into the possible consequences on the sleep quality of their siblings. Siblings in this study presented an 11% prevalence of disorders in initiating and maintaining sleep, clearly increased when compared with the expected 3% in the general childhood

population. This further underlines the importance of sleep ecology and of interactions between sleepers in the same home environment, as previously demonstrated with mothers of children with CP.5 If the daytime activities of children with CP are of concern (including such essential issues such as mobility and participation), then their night-time existence requires as much attention. First, because of the impact of sleep disorders at an individual level, that can stretch around the clock (e.g. effects on wakefulness, mood, learning), and second because of their ripple effect on the whole family. Sleep disorders become entrenched, families get used to them, and it is only by screening for these difficulties that help can be offered. For children with severe CP the treatment of a sleep disorder may be one of the rare opportunities to clearly improve their quality of life. Strategies to improve sleep rely mainly on clinical experience and include sleep hygiene improvements, behavioural interventions, and/or medication. As noted in a recent review, no studies on sleep interventions per se have been performed in children with CP.6 Rare studies including participants with CP amongst other neurological disabilities have shown some positive effect of melatonin on sleep quality. Research into this neglected field is now direly needed in order to implement appropriate and efficient interventions, which will allow children with CP and their families to get back to sleep.

REFERENCES R,

4. Bruni O, Ottaviano S, Guidetti V, et al. The Sleep Dis-

6. Galland BC, Elder DE, Taylor BJ. Interventions with a sleep

Brouillette RT, Shevell M. Sleep in children with

turbance Scale for Children (SDSC). Construction and

outcome for children with cerebral palsy or a post-traumatic

cerebral palsy: a review. J Child Neurol 2011; 26:

validation of an instrument to evaluate sleep disturbances

brain injury: a systematic review. Sleep Med Rev 2012; 16: 561–

1303–10.

in childhood and adolescence. J Sleep Res 1996; 5: 251–

73.

1. Simard-Tremblay

E,

Constantin

E,

Gruber

2. Glaskin K, Chenhall R, editors. Sleeping Around the World: Anthropological Perspectives. New York: Palgrave Macmillan, 2013. 3. Atmawidjaja RW, Wong SW, Yang WW, Choo LC. Sleep disturbances in Malaysian children with cerebral

61. 5. Wayte S, McCaughey E, Holley S, Annaz D, Hill CM. Sleep problems in children with cerebral palsy and their relationship with maternal sleep and depression. Acta Paediatr 2012; 101: 618–23.

palsy. Dev Med Child Neurol 2014; 56: 681–85.

Commentaries

611

Sleep: the other life of children with cerebral palsy.

Sleep: the other life of children with cerebral palsy. - PDF Download Free
46KB Sizes 0 Downloads 0 Views