Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Estimation Body Height according to Tibia Length in Children with Cerebral Palsy Aged 6-12 Years in Bandung, Indonesia

Tika Ermawati*, Eddy Fadlyana, Dwi Prasetyo

Department of Paediatrics Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital Bandung, Indonesia

Abstract: Background and Objective. Children with Cerebral Palsy (CP) have a risk of contracture or hypotonia causing difficulty in measuring their standardized height hence it requires height estimation based on the tibial length as an alternative measurement. Estimation body height formula is not available yet in Indonesia. We aim to determine the estimation body height according to tibia length in children with cerebral palsy aged 6-12 years in Bandung, Indonesia. Methods. The subjects are children 6-12 years old with CP who attended Special School, Growth and Development Clinic, Neuropediatric, and Medical Rehabilitation Outpatient Department at Hasan Sadikin General Hospital in Bandung, Indonesia between March until May 2019. This research performed a cross-sectional study. The height, body length, and tibia length of subjects who met the inclusion criteria were measured concomitantly. Data analysis was performed using linear regression. Results. We found 68 CP patients who met the inclusion criterion. Patients could be measured using the standard method are 36 children which then analyzed statistically. There were 36 subjects consisting of 22 boys (61,1%) and 14 girls (38,9%). The new calculation formula for body height estimation based on the tibia length in CP children aged 6-12 years is = 32,01 + 2,90 * tibia length (Standard error of the estimate ±1,85). Conclusion. Measurement of tibia length is important in determining the height estimation in children with CP so growth could still be monitored in the patients. There is a new calculation formula that we can use for height estimation based on the tibial length in children with CP aged 6-12 years.

Keywords: cerebral palsy, estimation body height, tibia length

Received August 18, 2019; Revised September 26, 2019; Accepted October 17, 2019

Citation: Tika Ermawati, Eddy Fadlyana, Dwi Prasetyo, Estimation Body Height according to Tibia Length in Children with Cerebral Palsy Aged 6-12 Years in Bandung, Indonesia. American Journal of Clinical Medicine Research, 7 (2). 48-52. January 2019. doi:10.12691/ajcmr-7-2-3

1. Introduction

Growth is an important aspect to determine children’s health status [1]. Physical growth in children has been measured using anthropometry classic, which includes body height or length [1,2]. Height measurement is very important for growth monitor, identifying nutrition disturbance, an endocrine disorder, metabolic disorder, genetic disorder, psychosocial disorder, chronic disease, caused by other diseases, measure and determine nutritional needs and drug dosage calculation [3]. Impaired growth is an indicator of linear growth failure, which leads to short stature [4]. These numbers had been increased from 2010 data with 35.6%. The possible causes were nutritional intake, chronic disease, iron deficiency anemia, poverty, and low birth weight [5]. World Health Organization (WHO) target is to decrease short stature as much as 40% in 2010 and 2025 [6]. Asia is still considered as a continent with most short stature children [7]. Short stature can be complicated with a higher rate of morbidity and mortality caused by infection, especially pneumonia and diarrhea [8]. Therefore, body height measurement is very important to be done correctly and accurately [8]. Body length or height is commonly measured using a length board or height board (stadiometer ) [1,9].

Children with Cerebral Palsy (CP) have a higher risk of growth disorder so that they have a better body height monitoring system [10]. These cases in the world are found between 1.5-4 per 1,000 live births [11]. A number of events in countries with middle to lower income are reported a higher case with 10 per 1,000 live birth [12]. The population of premature babies leads to much higher CP events [13,14,15]. Children with contracture or hypotonus condition usually are difficult to be measured with standard body height measurement [2,16,17]. Children with this condition need the alternative measurement method, therefore the growth monitoring still can be done using body height estimation by measuring the segmental height, which is by measuring the upper arm length, tibia length, or knee-length [2,16,17]. Long bones are found as the best indicator for body height measurement [17]. Basically, Height growth averages approximately 5 to 6 cm per year throughout childhood [18,19]. The adolescent growth spurt is the fast and intense increase in the rate of growth in height and weight that occurs during the adolescent stage of the human life cycle. This growth practically occurs in all of the long bones and most other skeletal elements. Growth spurt begins on average at 9-10 years for girls and 11-12 years for boys [20].

The measurement of the knee, upper arm, and tibia length had been studied before with a significant result in Cheng study in 1998 which created a formula for height estimation according to tibia length. Height estimation = 41.05+ (.64x age) + (0.84x gender) + (2.55x tibia length), girls = 0, boys = 1. This formula is used for children and adolescents aged 3-18 years old in China [2]. Other study by Gauld in 2004 in Australia also resulted in height estimation formula which were divided into for girls = (2.771 x tibia length) + (1.457 x age) + 37.748 and for boys = (2.758 x tibia length) + (1.717x age) + 21.818 for healthy children with 5-19 years old [2]. In 1995, Stevenson mentioned that his formula for height estimation according to the segmental length of CP children below 12 years old can be done using height estimation = (3.26 x tibia length) + 30.8 ± 1.7. According to the previous studies, segmental length measurement is valid and can be relied on for height estimation and recommends to use tibia length measurement as the routine monitoring in CP children if standard height measurement cannot be done and can be plotted in standard growth curve [2,16,17]. Height estimation formula according to tibia length measurement has been developed in several countries, but not in Indonesia. The objective of this research is determining the estimation body height according to tibia length in children with cerebral palsy aged 6-12 years in Bandung Indonesia.

2. Method

This study was performed CP children aged 6-12 years old who had been positively diagnosed with CP and studied in a special school (Sekolah Luar Biasa/SLB) in Bandung, neuropediatric and medical rehabilitation outpatient department at Hasan Sadikin Hospital Bandung at March - May 2019. The sample selection was done by consecutive sampling. The sample size was measured using linear regression with a minimum of 28 children. Sample who met the inclusion criteria children 6-12 years old with CP who attended Special School, Growth and Development, Neuropediatric, and Medical Rehabilitation Outpatient Department at Hasan Sadikin General Hospital in Bandung, Indonesia. Before performing the study, researchers had collected informed consent from the parents. The exclusion criterion was children with spinal abnormalities (scoliosis). This research performed a cross sectional study. The procedure for measuring height and body length based on WHO standards use a General Care stadiometer with accuracy 0.1 cm while the body length uses a length board. The Length board is only for measuring the body length in children less than 2 years, therefore for this study, we created a 2 meter-modified length board using Ikoala ruler which had been calibrated by Management National Standard Measuring Unit, Directorate of Metrology, Indonesia Ministry Of Trade with an accuracy 0.1 cm. Measurement of tibia length based on the CDC (Centers for Disease Control and Prevention) standard. The tibial length was measured from the left superomedial edge of the tibia to the inferior edge of the medial malleolus using SECA plastic measuring tape with an accuracy of 0.1 cm. In children with hemiplegia or asymmetry, a healthier side is taken to be measured. The tool has been calibrated by the Management National Standard Measuring, Directorate of Metrology, Indonesia Ministry Of Trade. Tools and procedures of tibia length measurement performed in this study in Figure 1. The measurement procedure is carried out by 3 trained doctors.

Figure 1. Tools and procedures of tibia length measurement performed in this study (Source: WHO, CDC [1,10])

Collected data was processed and analyzed descriptively and analytically. For descriptive was performed by providing total statistical measure and percentage for categorical data, while for numeric data was performed by providing the mean, median, and range. The next step for analytic was by performing a linear regression to determine the formula for estimation body height according to tibia length in children with CP aged 6-12 years old. This study has received permission from the Research Ethics Committee of Dr. Hasan Sadikin Hospital in Bandung, Indonesia.

3. Results

We found 68 CP patients who met the inclusion criterion. Patients could be measured using the standard method are 36 children which then analyzed statistically. The remainder was not included in the analysis because of the spastic condition which made measuring using the standard method was not possible. The procedure of sample size collection in Figure 2.

Figure 2. Sample size collection

Table 1 showed a total of 36 children, with 22 males (61,1%) and 14 females (38,9%). The age range was 6-12 years old with the mean age was 10 years old.

Table 1. Characteristics of research subjects

In Table 2 showed the regression analysis of the correlation between the tibia length and the actual height.

Table 2. Linear regression analysis of the correlation between tibia length and actual height

From the regression analysis, we found that:

- The determination coefficient (R²) was 0.806 means we found Body Height variability which could be explained by tibia length with 80.6%.

- Constanta coefficient was found as 32.01 which mean the average tibia length in CP patients aged 6-12 years old was 32.01 cm.

- The regression coefficient of tibia length was 2.90 which mean every 1 cm increment will result in 2.90 cm additional height.

The formula of body height estimation based on tibia length in CP children aged 6-12 years old was body height estimation (cm) = 32.01 + 2.90 * tibia length (Error standard of the estimation ±1.85).

Figure 3. The correlation between tibia length and the actual height of cerebral palsy children aged 6-12 years

Table 3. Distribution of mean actual height and estimation height based on tibia length according to regression analysis results

Table 3 shows the mean actual height and Estimation height based on regression analysis Results were 124.1 (18.2) cm and 124.1 (16.3) cm.

Table 4. Comparison between estimation height based on of tibia length according to regression analysis results and actual height

From the results of paired t-test in Table 4 showed no significant difference between the mean estimation height based on formula regression analysis results and actual body height.

Table 5. Accuracy of estimation body height according to tibia length based on a regression analysis result

Conformity analysis according to concordance correlation showed that the concordance correlation coefficient in estimation body height according to tibia length based on the regression analysis result was 0.893 with 0.898 precision and 0.994 accuracy.

4. Discussion

Cerebral palsy is motoric development disorders that are not progressive and cause limited activities, resulting from brain damage that occurs when the brain has not reached maturation. This population is considered to have contracture joints, weak muscle, scoliosis, or uncontrollable movement in CP children which leads to difficulties in keeping the standing position or straighten the joints, therefore the standard measurement method is usually hard to be done [2,17,22,23]. Linear growth disorder can lead to short stature [24]. The equation or formula to determine the estimation of body height using segmental length has been developed and found an accurate body height especially in CP children. In Stevenson study in 1995 from Virginia, America found a formula from segmental length including tibia length from CP children population aged below 12 years old [2,17]. The formula for estimating body height according to tibia length measurement in CP children aged 2-12 years old is body height estimation (cm) = (3.26 x tibia length) + 30.8. SEE: ± 1.7. This body height estimation could be plotted in a standard growth curve [17].

In this study, we found more males than the female with an average age of 10 years old. According to linear regression analysis measurement, we found a new formula that could be used to estimate CP children body height based on the tibia length in 6-12 years old, which was: Body height estimation (cm) = 32.01 + 2.90* tibia length (standard error of the estimation ±1.85). The mean between actual body height and body height estimation result according to tibia length based on the regression analysis formula showed a closer number to the actual body height. Different tests using a paired t-test on the mean of body height estimation result according to tibia length based on the regression analysis formula showed no significant difference with actual body height, with an average difference was 0.0 cm (p=1.000). Conformity analysis result using Concordance Correlation showed that the estimation of body height according to tibia length on the regression analysis formula had good accuracy and precision.

This study was the first to estimating body height based on tibia length on cerebral palsy children age 6-12 years in Indonesia. The limitation of this study is not to distinguish the estimated body height based on the tibia length between boy and girl. Further study with the same method is needed in the CP population with a bigger sample size in other cities in Indonesia to improve the precision result and differentiate the gender. Further study also should be performed to determine the comparison between body height estimation formula according to tibia length in CP children which already available with body height estimation according to this regression analysis result.

5. Conclusion

Tibia length measurement is crucial to estimating body height in CP children. This study was found a new formula to estimating body height according to tibia length in CP children aged 6-12 years old with Body height estimation (cm) = 32.01 + 2.90 * tibia length (Standard error of the estimation ±1.85). This body height estimation showed no difference with actual body height.

Conflicts of Interest

The authors have no conflicts of interest relevant to this article to disclose.

References

[1]   | World Health Organization. Training course on child growth assessments. WHO child growth standards: 15-28.
[2]   | Bell KL, Davies PS, Boyd RN, Stevenson RD. Use of segmental lengths for the assessment of growth in children with cerebral palsy. Handbook of Anthropometry. Edisi: Springer; 2012. P: 1279 -97.
[3]   | Carey A, McCarthy H, Gill J, Thompson A, McNulty H. Novel segmental proxy measures for estimating weight and height in healthy school children aged 11-18 years. Clinical nutrition ESPEN. 2015; 10(5):e211.
[4]   | Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental Potential in the First 5 Years for Children in Developing Countries. Lancet. 2007; 369: 60-70.
[5]   | RI BPPKKK. Riset Kesehatan Dasar. 2013:1-306.
[6]   | Organization WHO. Global Targets 2025. http://www.who.int/nutrition/topics/nutritionglobaltargets20252010. [accessed Oktober 2017].
[7]   | Onis Md, Blossner M, Borghi E. Global Prevalence and Trends of Overweight and Obesity among Preschool Children. Am J Clin Nutr. 2010; 92: 1257-64.
[8]   | Prendergast AJ, Humphrey JH. The Stunting Syndrome in Developing Countries. Paediatrics and International Child Health. 2014; 34(4): 250-65.
[9]   | Haapala H, Peterson MD, Daunter A, Hurvitz EA. Agreement between actual height and estimated height using segmental limb lengths for individuals with cerebral palsy. American journal of physical medicine & rehabilitation/Association of Academic Physiatrists. 2015; 94(7): 539.
[10]   | CDC. The CDC Growth Charts for Children Special Need 2009: 1-28.
[11]   | Stavsky M, Mor O, Mastrolia S, Greenbaum S, Than N, Erez O. Cerebral Palsy trends in epidemiology and recent development in prenatal mechanisms of disease, treatment, and prevention. Frontiers in Pediatrics. 2017; 5: 1-10.
[12]   | Donald K, Samia P, Mwesige A, Bearden D. Pediatric cerebral palsy in Africa: A systematic review. Seminars in Pediatric Neurology. 2014; 21(1): 30-35.
[13]   | Oskoui M, Countinho F, Dykeman J, Jette N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Developmental Medicine & Child Neurology. 2013; 55: 509-19.
[14]   | Hirvonen M, Ojala R, Korhonen P, Haataja P, Erisson K, Gissler M, et al. Cerebral palsy among children born moderately and late preterm. Pediaric. 2014; 134(6): 1584-93.
[15]   | Risan A. Nelly. Keterlambatan motorik atau palsi serebral? IDAI cabang DKI Jakarta. UKK Neurologi IDAI. 2010: 101-8.
[16]   | Stevenson RD. Use of segmental measures to estimate stature in children with cerebral palsy. Archives of pediatrics & adolescent medicine. 1995;149(6):658-62.
[17]   | Duyar I, Pelin C. Body height estimation based on tibia length in different stature groups. American Journal of Physical Anthropology: The Official Publication of the American Association of Physical Anthropologists. 2003; 122(1): 23-7.
[18]   | Chulani V, Gordon Loona, Adolescent growth and development. Prim Care Clin Office Pract. 2014; 41:465-87.
[19]   | Soliman A, Sanctis V, Elalaily R, Bedair S. Advances in pubertal growth and factors influencing it: Can we increase pubertal growth? Indian Journal of Endocrinology and Metabolism. 2014; 18: S54-62.
[20]   | Rosen D. Physiologic growth and development during adolescence. Pediatric in review. 2004; 25(6): 194-99.
[21]   | Stevenson R, Conaway M, Chumlea C, Rosebaum P, Fung E, Henderson R. Growth and health in children with moderate-to-severe cerebral palsy. PEDIATRICS. 2006; 118(3): 1010-18.
[22]   | Fang S, Bell KL. Assessment of growth ang nutrition in children with cerebral palsy. European journal of clinical nutrition. 2013; 67: s5-s8.
[23]   | Fang Samson L, Stevenson R. Linear growth velocity in children with cerebral palsy. Developmental medicine and child neurology. 1998; 40: 689-92.
[24]   | Prendergast AJ, Humphrey JH. The Stunting Syndrome in Developing Countries. Paediatrics and International Child Health. 2014; 34(4): 250-65.