Thank you for considering the revised version of our manuscript “Objective Evaluation of Fatigue for The Local Muscle in Children with Cerebral Palsy Using Gait Corrector” that we wish to resubmit for publication in the Journal of Rehabilitation Practices and Research.
The reviewers' comments helped us improve our paper, which we have revised accordingly by addressing the questions raised and by taking the advice given in the following way:
In Response to Reviewer 1’s Comments:
1. The participants are referred to as children even though they range in age from 8 -36 years. To refer to adults with cerebral palsy as children may come across as demeaning to the reader.
Response: We made an error regarding the age of the subjects, and we have corrected the age range accordingly. Also, we have changed the word ‘children’ to "individuals" and the title of this manuscript as recommended by the reviewer.
2. Is the intended terminology on page 3, paragraph 3, "triceps" femoris?
Response: We have corrected this to "lateral gastrocnemius muscle" because it was misspelled as triceps femoris.
In Response to Reviewer 2’s Comments:
Thank you for considering our manuscript.
The comments made by Reviewer 2 helped us to improve our research in the future.
We would like to attempt to use the advice provided in the comments in our future research.
1. The methodology section, while methodical, could benefit from a more explicit articulation of the selection criteria for participants, thereby fortifying the study's internal validity. Additionally, the utilization of perceived exertion ratings for load determination introduces a subjective element that might warrant discussion regarding its potential impact on the results.
Response: We recruited outpatients with spastic cerebral palsy from two institutes; however, the number of subjects was limited because of their resistance to electrical stimulation in the evoked potential test.
The limitations of our study include the small number of subjects and the fact that the age range and walking ability could not be regulated. We think that it is possible that our use rating of perceived exertion (RPE) as a measure of exercise intensity may have influenced our results.
2. I would encourage a more in-depth reflection on the broader implications of the research, potential limitations, and avenues for future exploration to ensure a robust contribution to the field.
Response: We have added the following statement at the end of the Discussion section to ensure a robust contribution to the field. “In addition to being small, lightweight, and easy to operate, NIRS can noninvasively observe fatigue in local muscles and objectively capture the effects of clinical training. In addition, NIRS can measure post-exercise conditions that cannot be captured using electromyography, and it is easy to evaluate fatigue recovery after training using blood oxygen dynamics, which is expected to be useful in the field of rehabilitation.”
In Response to Reviewer 3’s Comments:
1. However, I have doubts about publishing it as a research article due to the following points, so I would like you to consider changing the type of publication (case report etc.) and the revise the manuscript.
Response: We have changed the type of presentation to a "case report" as recommended by the reviewer.
2. [Title] It seems that the title and research content do not match.
Response: We have changed the title of this manuscript, as requested by the reviewer.
3. Some parts emphasize the effectiveness of gait correction devices (e.g., conclusions), while others emphasize the usefulness of objective evaluation of local muscle fatigue (e.g., title, purpose, etc.). Which is the main purpose of this research?
Response: We apologize for not describing our primary research objectives. We have now added that the main research purpose of this manuscript was to determine the effectiveness of the Gait Corrector.
4. [Ethic] I could not find any description of the process such as explanation to subjects and consent.
Response: We have added the following sentence at the end of the Methods section: “This study was conducted after explaining the study content to the subjects in writing and obtaining their consent”.
5. [Participants] There is no description of how to recruit subjects. Also, I didn't understand why they decided to request measurements from a wide range of age groups.
Response: We recruited outpatients from two institutes; however, the number of subjects was limited because of their resistance to electrical stimulation in the evoked potential test.
6. [Sample size] There was no description of the basis for determining the sample size.
Response: The number of subjects was calculated as a large effect size (d=0.8) using the effect size G-power with an alpha error of 0.05 and a beta error of 0.8, resulting in nine subjects.
7. [Instrument] I could not find any descriptions regarding gait correction devices (product name, compatibility method, etc.).
Response: We have added descriptions of the Gait Correction device (product name, method of adaptation, etc.) to the appropriate section of this manuscript.
8. [Measurement environment] I could not find any description regarding the measurement environment (floor shape, direction of walking, etc.).
Response: We have added "Subjects were asked to walk back and forth on a 10 m flat surface using the gait corrector" to the Materials and Methods section.
9. [Results] ? There is no description regarding the target person's attributes (physique, activity ability index, etc.)
Response: The subjects were required to be able to walk, and their height and weight were not measured; however, their age, sex, and walking ability are shown in Table 1.
10. [Results] ? There is no description regarding the tone state of the lateral gastrocnemius muscle (using an evoked potential testing device).
Response: The average F/M ratio as the muscle tone state of the lateral gastrocnemius before and after walking for each participant is shown in Table 2.
Other Revisions
A table showing the attributes (Table 1) and a table showing the average F/M ratios before and after walking (Table 2) are included