Abstract Objective Childhood standing height has been estimated from arm span-related (heightAS) models. The authors aimed to develop and cross-validate a heightAS model in individuals with spina bifida (SB) and examine the accuracy of existing heightAS models. Methods Participants were individuals with sacral and low-lumbar SB (n = 14) and non-SB (n = 83), 7-16 years old. Arm span, age, sex, and group (SB vs. non-SB) were candidate height predictors. Sequential regression and leave-one-out cross-validation approaches were used for the model development (M1) and cross-validation (M1-M5). Existing models were: an SB-specific model from Polfuss et al. (M2) and non-SB specific models from Gauld et al. (M3), Mulu et al. (M4), and Zverev et al. (M5) studies. Results Arm span and group explained 95 % of the variance in height (R2 = 0.95; p < 0.001; SEE = 3.666 cm) and were included in the M1. Mean differences between actual and estimated height were 0.0 cm (M1), 0.4 cm (M2), and 0.5 cm (M5), all not significant (p > 0.05). However, Bland-Altman analysis revealed some variability in the predictability of the models across participants with limits of agreement ranging from 7.4 to 10.9 cm. Considerable errors were observed with M3 (mean diff: −5.58 cm, 95 % CI: −1.6, −20.2 cm), and M4 (mean diff: 10.5 cm, 95 % CI: −13.8, −27.3 cm). Conclusions Models (M1, M2 and M5) may accurately estimate standing height in groups of children with SB. However, due to the wide limits of agreement, caution is recommended when applying these models for individual height estimations. spanrelated related (heightAS crossvalidate cross validate lowlumbar low lumbar n 14 nonSB non 83, 83 , 83) 716 7 16 7-1 old age sex vs predictors leaveoneout leave one out crossvalidation validation M1 M (M1 M1M5. M1M5 MM M5 . (M1-M5) SBspecific al (M2 M3, (M3) M4, (M4) (M5 studies 9 R2 R (R 0.95 095 0 0.001 0001 001 3666 3 666 3.66 00 0. M1, 04 4 M2, 05 5 M5, 0.05. 005 0.05 0.05) However BlandAltman Bland Altman 74 7. 109 10 10. mean diff 558 58 −5.5 CI 1 6 −1.6 202 20 2 −20. 105 138 13 8 −13.8 273 27 −27. estimations 71 7- (M M1M (M1-M5 (M3 (M4 0.9 09 0.00 000 366 66 3.6 55 −5. −1. −20 −13. −27 (M1-M 36 3. −5 −1 −2 −13 −

Abstract Objective Children with spina bifida (SB) are at risk for stunting and overweight. However, height and Body Mass Index (BMI) z-score distribution in children and adolescents with SB are unclear. The aim of this study was to examine height and BMI z-score distribution in Brazilian children and adolescents with and without SB. This study further aimed to examine whether height and BMI z-scores differ between individuals with and without SB. Method This study included 101 participants (SB: n= 18; non-SB: n= 83, aged 7-16 years). The World Health Organization (WHO) AnthroPlus software was used to calculate height and BMI z-scores. AnthroPlus z-score distribution graphs were used to examine individual z-scores based on the 2007 WHO normal distribution curve. Effects of the group (SB vs non-SB) on height and BMI z-scores were examined with sequential regression. Results In the WHO distribution graph analysis, height z-scores of participants with SB were slightly left-shifted compared to the WHO normal distribution curve. In the regression analysis, group (SB vs non-SB) was a significant predictor of height z-scores after controlling for sex and age (ΔR2= 0.064, p= 0.010). BMI z-scores of participants with SB were right-shifted compared to the WHO normal curve. However, there was no contribution of the group to BMI z-scores (ΔR2= 0.011, p= 0.301). Conclusions These findings suggest that Brazilian children and adolescents with SB may be at risk for reduced height and increased BMI. overweight However (BMI zscore z score unclear zscores scores 10 n 18 nonSB non non-SB 83 716 7 16 7-1 years. years . years) (WHO zscores. scores. 200 curve analysis leftshifted left shifted ΔR2= ΔR2 ΔR (ΔR2 0064 0 064 0.064 p 0.010. 0010 0.010 010 0.010) rightshifted right 0011 011 0.011 0.301. 0301 0.301 301 0.301) 1 8 71 7- 20 (ΔR 006 06 0.06 001 0.01 01 030 0.30 30 2 00 0.0 03 0.3 3 0.

Este estudo de caso objetivou verificar se o modelo de Rose et al. 1 é factível para avaliar o gasto energético na marcha em crianças com distrofia muscular de Duchenne (DMD). Participaram três crianças com DMD e idades de 6, 7 e 8 anos. Foram avaliados peso, altura, comprimento dos membros inferiores (CMMII), frequência cardíaca (FC) de repouso e de marcha realizada em circuito oval de 55 m durante um teste de 2 minutos em cada velocidade. O gasto energético foi calculado pela FC. Foi realizada análise descritiva dos dados (média) e estes foram comparados, individualmente, com dados normativos. A velocidade média (Vm) da marcha dos três pacientes foi igual aos dados normativos na etapa velocidade lenta e menor nas etapas de velocidade confortável e rápida. O gasto energético na velocidade lenta dos pacientes 2 e 3 foi similar à normalidade, e menor para o paciente 1; na velocidade confortável, o gasto energético de todos os pacientes foi similar; na velocidade rápida, os pacientes 1 e 2 apresentaram valores similares ao normal, porém o paciente 3 teve maior gasto energético. Concluiu-se que a avaliação do gasto energético pela FC foi facilmente executada na clínica, podendo auxiliar na eleição de condutas. Para o paciente 3 poderia ser indicado um treinamento aeróbio e para os demais manter esse protocolo de avaliação nas visitas subsequentes.

This case study aimed to verify the model of Rose et al.1 as a feasible to assess energy expenditure in gait of children with Duchenne muscular dystrophy (DMD). Three DMD patients aged 6, 7 and 8 years old participated of this study. It was obtained weight, height, leg length measurement (LLM), resting and gait heart rate (HR) held on as 55-meter oval circuit performed during a two-minute test at each speed. Energy expenditure was calculated using the HR. It was performed a descriptive analysis (average) and these were compared, individually, to normative data. The average gait speed of these three patients was similar to the normative data for slow speed and lower considering comfortable and fast speed. The energy expenditure to slow speed of the patients 2 and 3 was similar to the normality, and lowest for patient 1; at comfortable speed, the energy expenditure obtained for all patients was similar; at fast speed, the patients 1 and 2 presented similar to normal values, but the patient 3 presented higher energy expenditure. It was concluded that the energy expenditure evaluation using HR was easily executed in the clinical practice and it can help therapeutic choices. For patient 3, an aerobic training could be indicated and for the others, they could keep the routine assessments.

Este estudio de caso tuvo como objetivo verificar si el modelo de Rose et al es factible para evaluar el gasto de energía en la marcha de niños con distrofia muscular de Duchenne (DMD). Participaron tres niños con DMD con edades de 6, 7 y 8 años. Fueron evaluados peso, altura, longitud de las extremidades inferiores (LEI), frecuencia cardiaca (FC) en reposo y la marcha realizada en el circuito ovalado de 55 m durante un exámen de 2 minutos en cada velocidad. El gasto energético fue calculado por la FC. Se realizó un análisis descriptivo de los datos (media) y éstos fueron comparados de forma individual con los datos normativos. La velocidad media (VM) de la marcha de los tres pacientes fue igual a los datos normativos en la etapa velocidad lenta y menor en las etapas de velocidad confortable y rápida. El gasto de energía en la velocidad lenta de los pacientes 2 y 3 fue similar a la normalidad, y menor para el paciente 1; en la velocidad confortable, el gasto de energía de todos los pacientes fue similar; en la velocidad rápida, los pacientes 1 y 2 tuvieron valores similares a lo normal, pero el paciente 3 tuvo mayor gasto energético. Se concluyó que la evaluación del gasto energético por la FC se llevó a cabo fácilmente en la clínica, y pudo ayudar en la elección de conductas. Para el paciente 3 podría ser indicado un entrenamiento aeróbico y para los demás mantener ese protocolo de evaluación en las visitas siguientes.