BackgroundSleep quality is essential for maintaining health and work performance. However, it remains understudied among healthcare professionals, such as physiotherapists, who are exposed to occupational demands that may impair sleep, even without night shifts.ObjectiveThis pilot study aimed to assess sleep quality among physiotherapists and explore its associations with occupational and lifestyle factors.MethodsA cross-sectional study was conducted with 22 physiotherapists employed at the Clinic for Physical Medicine and Rehabilitation of Institute for Child and Youth Health Care of Vojvodina Novi Sad, Serbia. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and a custom questionnaire collected data on age, gender, work tenure, sport participation and commuting habits. Non-parametric statistical methods (Mann-Whitney U, Kruskal-Wallis, Spearman's correlation) were used. All participants provided informed consent, and ethical standards were followed.ResultsThe median age was 39.8 ± 10.9 years; 81.8% were female, with a mean work tenure of 15.7 ± 11.5 years. The average PSQI score was 7.0 ± 2.8, indicating poor sleep quality. Poorer sleep quality was significantly associated with longer work tenure (p = 0.003) and commuting by bicycle (p = 0.027). Gender and sport participation showed no significantly association with sleep quality (p > 0.05).ConclusionsDespite the absence of night shifts, physiotherapists in this study exhibited poor sleep quality. Longer work tenure and active commuting may contribute to this issue. Further research with larger samples is needed to clarify causal relationships and inform sleep-related interventions targeting healthcare professionals.

Background/Objectives: As adults spend about 30% of each day asleep, having a sleep disorder can negatively affect their functioning. The study objective was to determine the factors that influence sleep quality among patients and healthcare providers in the primary healthcare setting. Methods: This study included respondents of both sexes aged 18–90 years, comprising outpatients and the healthcare providers working in the General Medicine Service at the “Liman” Department of the “Novi Sad” Health Center in Novi Sad, Republic of Serbia. Demographic data along with factors related to lifestyle and sleep habits were collected using a demographic questionnaire specifically designed for this research. The standardized Pittsburgh Sleep Quality Questionnaire, Serbian version (PSQI), was used to assess sleep quality. Results: The study sample comprised 92 respondents (42 healthcare providers and 50 patients), 73.9% of whom were female, with an average age of 50.0 years. Although 50% of healthcare providers reported sleeping only 3–6 h the previous night, according to the PSQI results, patients had lower overall sleep quality (54.0% vs. 33.3%; p = 0.046) and achieved lower scores in the DISTB (sleep disturbances, p = 0.001), SLPQUAL (subjective sleep quality, p = 0.013) and MEDS (use of sleeping medication, p = 0.003) PSQI domains. Conclusions: Sleep quality is impaired in more than half of patients and more than a third of healthcare providers. By detecting and acting on the factors in the home and work environment that affect quality of sleep, and by changing lifestyle habits, sleep quality in adults can be improved.

IntroductionTraumatic brain injury (TBI) is one of the leading causes of morbidity, disability and mortality in all age groups. The functional disability left by TBI, is significant for the patient, family and society. Treatment and early rehabilitation are crucial to the overall level of recovery.ObjectiveTo compare the impact of extended early rehabilitation of patients with moderate and severe traumatic brain injury on the outcome of treatment.MaterialA prospective experimental study comprised 124 patients with moderate and severe TBI, randomly divided into two groups. The patients of the experimental group had kinesitherapy seven days a week, twice a day for 45 min, and the patients of the control group had kinesitherapy seven days a week, twice a day for 30 min. The follow-up parameters were: age, sex, mechanism of injury, associated injuries, comorbidities, Glasgow Coma Scale (GCS) on admission and discharge, early rehabilitation interruptions, presence of tracheostomy, decubitus ulcers, nasogastric tube, diapers and urinary catheter at the discharge from the Intensive Care Unit and discharge from the hospital, and mortality.Results124 patients were randomly divided into two groups of 62 patients each. The male gender dominated 95 (76.6%). The average age was Me = 62.00 (IQR = 36.0) years. There was no statistically significant difference between the groups in gender, age, mechanism of injury, associated injuries and comorbidities. GCS on admission; 68 (54.8%) patients had severe, 56 (46.2%) moderate TBI, at discharge: 22 (17.7%) had severe, 11 (8.9%) moderate and 91 (73.4%) mild TBI. At discharge from the ICU, the presence of tracheostomy was (13 vs. 19), (p = 0.218), nasogastric tube (33 vs. 45), (p = 0.026) and decubitus ulcers (0 vs. 4), (p = 0.042) were less in the experimental group. At discharge from the hospital, tracheostomy (6 vs. 16), (p = 0.019), urinary catheter (38 vs. 48), (p = 0.051), diapers (29 vs. 40), (p = 0.047) were less in the experimental group. There were 5 deaths in both groups. There was no statistically significant difference in early rehabilitation interruptions between groups (5 vs. 6).ConclusionExtended early TBI rehabilitation is safe, effective and contributes to a positive outcome of treatment.

BACKGROUND:De Quervain's tenosynovitis is upper-limb disorder, more frequent in women. It is rarely recognized as an occupational disease. OBJECTIVE:In this paper we reported work related de Quervain's tenosynovitis in cow milker. METHODS:Ergonomic risk factors were assessed by utilizing assessment of repetitive tasks (ART) of the upper limbs method. Physical examination and imaging exams were used. RESULTS:We presented a 36-year-old female agricultural worker (workplace cow milker) exposed to work factors (forceful hand/wrist exertions, repetition, extreme postures) for 14 years. She was suffering the pain in the right hand, mainly near the thumb for few years. She was treated conservatively and surgically, however disability was permanent. Clinical examination showed slight edema of the right hand, increased palm's sweating. Patient had reduced range of movements and grip strength. CONCLUSIONS:Report shows that work-related factors were strongly associated with diagnosed de Quervain's tenosynovitis. Hand function plays an essential role in carrying out activities of daily living and this disorder pose a relevant burden of disease. Exposure to biomechanical factors should be an important initial target for the prevention of De Quervain's tenosynovitis in the working population.

(1) Background: The influence of different factors on balance in adolescence is assessed by conducting functional balance tests that examine its different components. (2) Materials and methods: The study sample comprised 110 healthy adolescents of both sexes, aged 12–18 years. Single Leg Stance with Eyes Open (SLS-EO) and Eyes Closed (SLS-EC) tests were conducted to evaluate static balance, whereas the Functional Reach Test (FRT) and Lateral Reach Test (LRT) were performed to establish functional stability limits. The influence of sex, age, demographic factors, anthropometric characteristics, participation in sports activities, and trunk extensor muscle endurance (Biering–Sorensen test) on balance performance was determined through correlational and univariate linear regression analyses. (3) Results: Older age (Beta [β] = 0.247; 95% CI [0.75, 5.20]; p < 0.01) and better trunk extensor muscle endurance (β = 0.224; 95% CI [0.015, 0.13]; p < 0.05) were significant predictors of the SLS-EO results, while younger age (β = −0.219; 95% CI [−1.32, −0.11]; p < 0.05) and higher muscle percentage (β = 0.237; 95% CI [0.06, 0.48]; p < 0.05) emerged as significant predictors of LRT performance, and greater bone mass was a significant predictor of FRT results (β = 0.444; 95% CI [3.62, 8.17]; p < 0.01). However, none of the independent variables was a statistically significant predictor of the SLS-EC results. (4) Conclusions: The current study found that age, trunk extensor muscle endurance, muscle percentage, and bone mass are significant predictors of different balance components, suggesting that balance is task-specific.

This paper presents the development of a robotic system for the rehabilitation and quality of life improvement of children with cerebral palsy (CP). The system consists of four modules and is based on a virtual humanoid robot that is meant to motivate and encourage children in their rehabilitation programs. The efficiency of the developed system was tested on two children with CP. The effect of using the robot is an increase in the number of exercise repetitions, as well as the time spent on therapy, developing and strengthening the child’s musculature. Additionally, the children are able to produce socially acceptable gestures in the context of non-verbal communication for socialization. The main advantages of this system are its flexibility and ease of use. Besides the proposed use in CP rehabilitation, this system can be used in the rehabilitation of people recovering from surgery or injuries. Use of the proposed system significantly decreases the work load of the therapist who would be conducting the repetitive motion, allowing the therapist to see an increased number of patients. In the future, the number of different movements the robot is able to perform will be increased by way of domain-specific modelling and language.

BACKGROUND Neck pain (NP) is associated with high disability rates among healthcare workers. OBJECTIVE To determine the potential risk factors associated with disability due to NP among healthcare staff working in primary care settings. METHODS This 30-day prospective cross-sectional study involved a survey of 63 healthcare personnel (55 women and 8 men aged 45.30±12.34 years) of two primary healthcare centers in Serbia, who completed a general questionnaire developed for this purpose along with the Neck Disability Index (NDI), whereby the potential predictors of NP-related disability were assessed using the statistical package SPSS ver. 24. RESULTS Female healthcare workers achieved a higher score on the NDI scale (Me = 8.00, p < 0.05), as did older respondents (r = 0.260, p < 0.05), those with longer work experience (r = 0.323, p < 0.05), and those that wear prescription glasses (Me = 9.00, p < 0.01). Higher NDI scores were also achieved by respondents that suffered from neck pain at the time of the study (Me = 12.50, p < 0.001), especially if they relied on pain medication (Me = 13.00, p < 0.05), and topical analgesic creams (Me = 12.50, p < 0.05) for treating neck pain. CONCLUSION Female sex, older age, greater work experience, current neck pain, use of pain-relieving medications and creams, and need for prescription glasses to correct vision increase the risk of disability due to pain in the cervical spine among healthcare workers.

INTRODUCTION:The Coronavirus Disease 2019 (COVID-19) pandemic has caused considerable stress and anxiety in the general population, especially among students. The objective of this study was to determine the stress and anxiety levels among medical rehabilitation students induced by distance education during the COVID-19 pandemic.METHODOLOGY:The sample for this prospective cross-sectional study included 96 students pursuing the medical rehabilitation undergraduate degree at the Faculty of Medicine, University of Novi Sad, Serbia. All respondents took part in an online survey created on the Google Forms platform and accessed via the Facebook social network. The questionnaire included a sociodemographic section, the perceived stress scale (PSS), and the worry about online learning scale (WOLS). All data were analyzed using the IBM SPSS version 25.RESULTS:The study involved 96 students with an average age of 21.97 ± 1.55 years, 72.9% of whom were female. The total stress reported by the students during the COVID-19 pandemic was higher in females than in males (21.75 [SD = 7.50] vs. 17.84 [SD = 8.58]; p < 0.05). Younger students were more susceptible to experiencing stress during the pandemic (rho = -0.217, p < 0.05). Moreover, 57.3% of students suffered from moderate stress, while the WOLS scores indicated that distance education induced a high level of discomfort in this cohort (3.8 [IQR = 1.6]).CONCLUSIONS:Medical rehabilitation students showed a moderate level of stress and a high level of concern about distance education. This stress was more prevalent among younger students and females.

Background/Aim. Cerebral palsy (CP) etiology is multi-factorial and heterogeneous, manifesting as damage to the developing brain. The associated risk factors can arise in the prenatal, perinatal, or postnatal period. The aim of this study was to determine the risk factors for CP and examine the associations between CP type, gestational age, and perinatal risk factors. Methods. The study sample comprised 206 children with CP. Pertinent data were collected from medical records and included participants? gestational age at birth, medical history, and CP clinical characteristics. Risk factors were divided according to the timing of brain injury into prenatal, perinatal, and neonatal. Results. Hormonally maintained pregnancy (55.3%), twin pregnancy (28.9%), vaginal bleeding after the 20th week of gestation (21.1%), threatened abortion in the first half of pregnancy (13.2%), and maternal infection (10.5%) were identified as the main prenatal risk factors for CP. Prematurity (54.5%) was the leading perinatal risk factor, followed by low birthweight (50.8%), Apgar score < 7 (41.7%), assisted delivery (41.4%), and breech presentation (13.5%). Respiratory distress syndrome (16%), need for treatment in the Neonatal Intensive Care Unit (22.3%), assisted ventilation (18.4%), hypoxic-ischemic encephalopathy (11.2%), and neonatal convulsions (5.8%) were identified as the leading neonatal risk factors for CP. A statistically significant difference was found in the total number of perinatal risk factors in relation to gestational age (p < 0.001) and CP type (p = 0.006). Perinatal risk factors were most prevalent in preterm infants and children affected by the CP of spastic bilateral type. A statistically significant difference was noted in the distribution of CP types de-pending on the gestational age (p < 0.001). In particular, spastic bilateral CP type was most prevalent in the group of preterm-born children. Conclusion. CP is characterized by heterogeneous risk factors and is a result of interaction among multiple risk factors.

IntroductionThe COVID-19 pandemic has placed a tremendous burden on the healthcare system. Patients with traumatic brain injury (TBI) have to get fast track treatment which is independent of environmental conditions. The aim of this study was to investigate epidemiological and clinical outcomes of early rehabilitation and compare it with the literature data during the non-COVID-19 period.Materials and methodsA retrospective study included 174 patients with TBI, average 57 ± 19.08 years. They all underwent treatment in the University Clinical Center, Republic of Srpska, Bosnia and Herzegovina during the period January-December 2021. We have analyzed the epidemiological data and clinical course in 174 patients as well as the outcome of early rehabilitation in 107 patients. In clinical evaluation were used: Glasgow Coma Score (GCS), Functional Independence Measure (FIM) and Barthel Index on admission and at discharge, as well as Glasgow Outcome Scale (GOS) at discharge. ANOVA, SPANOVA, Student t-test and Pearson correlation coefficient were used in statistical analysis. The value (p < 0.05) was used for statistical significance.ResultsA total of 174 patients with TBI were included in this study. Most of the patients (n = 94) were older than 60, male (n = 125) and the most frequent cause of TBI was falling over (n = 88). About a half (n = 92) had a mild TBI, almost one third of the sample had moderate (n = 52), while only 30 patients had severe TBI. Total of 139 (80.3%) patients had the improved outcome, the worsening was registered in 2 (1.2%), while the fatal outcome was reported with 33 (18.5%) patients. When comparing the scores on admission and at discharge, the improvement of mean parameter values was reported for GCS (9.9 vs. 14.1), for Barthel Index (57.25 vs. 86.85), and for FIM (67.35 vs. 105.15), (p < 0.001). A complete recovery at discharge was found in 63.79%, a mild deficit in 8.62%, while serious deficit was found with 6.32%, and vegetative state with 2.29% patients.ConclusionThe COVID-19 pandemic had a significant effect on the epidemiological data but not on the clinical outcome of patients with TBI. Early rehabilitation proved to be effective and to contribute to positive treatment outcome.

Introduction. Osteoporosis is a metabolic bone disease characterized by reduced bone mineral density and damage to the bone microarchitecture, which leads to bone fragility, thus increasing the risk of osteoporotic fractures. While different diagnostic methods can be employed for detecting bone mineral density decrement in a timely manner, dual energy X-ray absorptiometry remains the gold standard in research and clinical practice. Bone mineral density estimation methods. Osteoporosis can be diagnosed through conventional radiography, quantitative ultrasonography, quantitative computed tomography, and magnetic resonance. Nonetheless, dual energy X-ray absorptiometry is the gold standard in the diagnosis of osteoporosis on which further treatment and monitoring are based. The dual energy X-ray absorptiometry apparatus is equipped with the Fracture Risk Assessment Tool, which estimates the 10- year probability of a major fracture and hip fracture due to osteoporosis. The use and interpretation of osteoporosis diagnostic evaluation modalities is based on the International Society for Clinical Densitometry guidelines for diagnosing osteoporosis in adults and children. According to the International Society for Clinical Densitometry recommendations, the aforementioned quantitative visualization modalities should be used alongside laboratory analyses of bone metabolism markers to supplement diagnostics and monitor treatment efficacy in patients suffering from osteoporosis. Conclusion. Assessment of risk factors and early diagnosis are prerequisites for timely treatment and effective monitoring, which is necessary for arresting the progression of bone mineral density loss and preventing the occurrence of osteoporotic fractures.

Introduction/Objective. Pain is often an underrecognized entity in children with cerebral palsy. The aim of this study was to determine whether there are differences in pain self-perception between children with cerebral palsy and their caregivers. Methods. This retrospective study included 70 children with cerebral palsy and 70 of their caregivers, treated at the Institute of Child and Youth Health Care of Vojvodina, Serbia. Pain intensity ratings on the Visual Analog Scale (VAS) provided by children and/or their caregivers were analyzed. Results. The research involved 70 children with cerebral palsy and the same number of their caregivers. While only 43 (61.4%) of these children were testable, all 70 caregivers participated. Pain was reported by 19 (44.2%) children and 42 (60%) caregivers, while 17 (39.5%) children suffered from musculoskeletal pain, which was noted by 39 (55.7%) caregivers. Average caregiver rating for musculoskeletal pain for children at Level V, I and III on the Gross Motor Function Classification System (GMFCS) was 6.20 ? 2.10, 2.67 ? 2.18, and 2.50 ? 2, respectively. Average self- and caregiver-reported VAS rating for headache/stomachache was 2.73 ? 1.86 and 2.35 ? 1.49, respectively (p > 0.05). Statistically significant differences were noted in the musculoskeletal pain VAS scores provided by the caregivers for children at different GMFCS levels (p < 0.01). Conclusion. Although no differences in pain perception between children with cerebral palsy and their caregivers have been established, in children with the most severe level of motor disability, caregivers report a statistically higher level of musculoskeletal pain.

Introduction. In 1897, the city government of the Free Royal City of Novi Sad proposed exploration for drinking water for adequate water supply in the city. Iodine Spa Novi Sad. An artesian well showed to have healing properties, which was a prerequisite for the development of the future spa that grew into the famous Iodine Spa Novi Sad. The Art Nouveau building of the Novi Sad City Spa was completed in 1910. In 1909, the city authorities issued a public notice to procure the necessary equipment and furnishing. In the turbulent years that followed, the City Iodine Spa has changed its name, exterior and interior appearance, as well as its equipment and furnishings, but kept its profile as an institution that fits the needs of every individual who may seek and find professional help under its auspices.

Introduction. Back pain is often present among health workers. The aim of the study was to determine the impact of gender and years of work experience on the incidence of low back pain. Material and Methods. A prospective cross-sectional study included 67 subjects of both genders, and it was conducted in the period between June 1 and 15, 2020, in two health centers in Serbia. The impact of gender, age, years of work experience on the incidence of low back pain was analyzed, measured by the Roland-Morris disability questionnaire. Results. In the examined sample (n = 67), the majority were females (55, 82.1%). The average age of the respondents was 45.5 ? 12.2 years, with an average work experience of 20.62 ? 12.03 years. Low back pain was present in 35 subjects (52.2%). There was no statistically significant difference between male and female subjects regarding the Roland-Morris disability score (3.83 ? 4.50 vs. 4.96 ? 4.53; p > 0.05). There was a statistically significant positive correlation between the age of subjects and the Roland-Morris disability score (r = 0.407; p < 0.01). Subjects with more years of work experience presented with a higher Roland-Morris disability score (r = 0.371; p < 0.01). Conclusion. Low back pain is common in older health workers with longer work experience, regardless of the level of formal education. Additional education of health workers on the application of protective attitudes, movements, and exercise, is needed in order to prevent the development of low back pain in the work environment.

Introduction. Artesian well drilling, water testing, obtaining all the necessary permits, as well as designing, equipping, and final organization of work, including hiring the necessary staff, is often time-consuming and complex, and so it was for the leaders of the Free Royal City of Novi Sad in establishing the future Novi Sad ?Jodna banja? (Iodine Spa). Spa House Rules. The paper gives an overview of the Rimanoczy Spa House Rules, which served as a model for creating similar house rules and shaping the work in the future spa. The success of the Novi Sad City Artesian Spa in the late 19th and early 20th century was attributed to visionaries, architects, city leaders, doctors, as well as numerous employees, who invested their knowledge and abilities to the people?s needs in order to improve the wellbeing and health of the Spa guests.

Introduction. Immunization is an important measure in the prevention of diseases that can seriously endanger health of the population. The aim of the study was to determine the attitudes of the adult population toward seasonal influenza immunization. Material and Methods. This cross-sectional prospective study including 160 adult subjects of both sexes was conducted from November 15, 2019 to December 15, 2019 at the General Medicine Department of the ?Liman? Health Center, Novi Sad, Serbia. The respondents filled out a questionnaire, specifically designed for this purpose. The collected data were used to analyze the influence of gender, age and employment status on personal attitudes toward seasonal influenza immunization. Results. The study included 160 examinees, 74 (46.2%) men and 86 (53.8%) women, average age of 63 years. There were 88 (55%) employed and 72 (45%) unemployed participants. Of 160 participants, 113 (72.4%) had a positive attitude toward vaccination, 20 (12.8%) had a negative attitude, while 23 (14.7%) respondents were undecided. No statistically significant difference was established between the sexes in attitudes toward immunization. Vaccination coverage was higher in unemployed compared to employed subjects (75% vs. 59.1%; p < .05). Unemployed respondents were more regularly vaccinated than the employed examinees (66.1% vs. 46.7%; p < .05). Conclusion. Higher vaccination coverage rates for planned immunizations against seasonal influenza can be achieved through better promotion strategies and health education of the population.

Introduction. Hand osteoarthritis is a joint degenerative disease characterized by hand deformities affecting the hand strength and function, leading to greater disability and increased healthcare utilization. The objective of this study was to estimate the impact of different risk factors on the incidence of hand osteoarthritis. Material and Methods. The study was a prospective cross-sectional study conducted at the Special Hospital for Rheumatic Diseases Novi Sad, Serbia, during a one year period (2017 - 2018). It included 100 postmenopausal women aged 60 to 70 years presenting with pain in the hands ? 3 according to the visual analogue scale. All respondents were divided into two groups, according to radiographic findings graded using the Kellgren-Lawrence scale. Risk factors responsible for the development of hand osteoarthritis were examined and the research procedure included medical history data, physical examination of the hand joints, anthropometric measurements, and laboratory tests. Statistical processing and analysis was performed using Statistical Package for the Social Sciences ver. 25. Results. Statistically significant differences were found between the two groups in relation to positive family history of degenerative changes in the hand joints (p = 0.000), as well as in relation to metabolic syndrome (p = 0.001). Conclusion. A positive family history of degenerative changes of the hands and presence of metabolic syndrome are significant risk factors for the development of hand osteoarthritis.

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Background/Aim. Children with cerebral palsy (CP) grow at a slower rate relative to their peers. Their body height, body weight and bone mineral density are significantly below those measured for healthy children of corresponding age. The aim of this work was to estimate bone mineral density in relation to the anthropometric parameters and the level of gross motor function in the children with cerebral palsy. Methods. This cross-sectional pilot study included 23 children with CP, aged 6 to 17 years, in whom the gross motor function level was estimated according to the Gross motor function classification system- expanded and revised (GMFCS-E&R), while the anthropometric parameters were established in relation to the developmental charts for healthy children as well as those pertaining to children with CP. Bone mineral density was measured by dual energy X-ray absorptiometry and the findings were interpreted in accordance with the International Society for Clinical Densitometry Official Positions of Adults & Pediatrics. Mean values with interquartile deviations, along with frequencies and percentages were the descriptive statistical measures employed in the analyses. Differences between groups were ascertained through the Kruskal-Wallis test. Results. Our sample of 23 children comprised of 56.5% boys and 43.5% girls, aged 13.00 +/- 3.56 years, of whom 3/4 had a severe form of gross motor dysfunction (GMFCS-E&R levels IV and V). All subjects had lower bone density in both regions of interest [spinal Z-score-1.60 +/- 1.40 standard devation (SD); hip Z-score-2.00 +/- 3.00 SD], as well as lower anthropometric parameters [height Z-score-2.74 +/- 4.28; body weight Z-score 3.22 +/- 6.96; body mass index (BMI) Z-score-2.64 +/- 6.03]. In the observed sample, bone mineral density in the spine (p < 0.01) and the hip (p < 0.05) was reduced in all subjects, and all children had a lower body weight (p < 0.01) and the BMI (p < 0.01), but not body height, in relation to the existing developmental charts for the CP children adopted from the US. Children with the CP Level IV on the GMFCS-E&R had a significantly lower bone density (spinal Z-score-1.90 SD; hip Z-score-3.40 SD), with the reduction even more pronounced at level V (spinal Z-score-3.80 SD; hip Z-score-2.30 SD). Conclusion. A significantly lower bone mineral density as well as the decreased values of all observed anthropometric parameters, were noted in the children with CP. In the observed sample, bone mineral density in both spine and hip was reduced in all subjects, all of whom also had lower body weight and the BMI, but not body height compared to the existing developmental charts for the children with CP adopted from the US. The children with severe forms of CP (GMFCS-E&R levels IV and V) had significantly lower bone mineral density.

Background/Aim. Children with cerebral palsy (CP) grow at a slower rate relative to their peers. Their body height, body weight and bone mineral density are significantly below those measured for healthy children of corresponding age. The aim of this work was to estimate bone mineral density in relation to the anthropometric parameters and the level of gross motor function in the children with cerebral palsy. Methods. This cross-sectional pilot study included 23 children with CP, aged 6 to 17 years, in whom the gross motor function level was estimated according to the Gross motor function classification systemexpanded and revised (GMFCS-E&R), while the anthropometric parameters were established in relation to the developmental charts for healthy children as well as those pertaining to children with CP. Bone mineral density was measured by dual energy X-ray absorptiometry and the findings were interpreted in accordance with the International Society for Clinical Densitometry Official Positions of Adults & Pediatrics. Mean values with interquartile deviations, along with frequencies and percentages were the descriptive statistical measures employed in the analyses. Differences between groups were ascertained through the Kruskal-Wallis test. Results. Our sample of 23 children comprised of 56.5% boys and 43.5% girls, aged 13.00 ± 3.56 years, of whom 3/4 had a severe form of gross motor dysfunction (GMFCS-E&R levels IV and V). All subjects had lower bone density in both regions of interest [spinal Z-score -1.60 ± 1.40 standard devation (SD); hip Z-score -2.00 ± 3.00 SD], as well as lower anthropometric parameters [height Z-score -2.74 ± 4.28; body weight Z-score 3.22 ± 6.96; body mass index (BMI) Z-score -2.64 ± 6.03]. In the observed sample, bone mineral density in the spine (p < 0.01) and the hip (p < 0.05) was reduced in all subjects, and all children had a lower body weight (p < 0.01) and the BMI (p < 0.01), but not body height, in relation to the existing developmental charts for the CP children adopted from the US. Children with the CP Level IV on the GMFCS-E&R had a significantly lower bone density (spinal Z-score -1.90 SD; hip Z-score -3.40 SD), with the reduction even more pronounced at level V (spinal Z-score -3.80 SD; hip Z-score -2.30 SD). Conclusion. A significantly lower bone mineral density as well as the decreased values of all observed anthropometric parameters, were noted in the children with CP. In the observed sample, bone mineral density in both spine and hip was reduced in all subjects, all of whom also had lower body weight and the BMI, but not body height compared to the existing developmental charts for the children with CP adopted from the US. The children with severe forms of CP (GMFCS-E&R levels IV and V) had significantly lower bone mineral density.