Plyometric training: effectiveness and optimal duration for children with unilateral cerebral palsy

Effects of Therapies Involving Plyometric-Jump Training on Physical Fitness of Youth with Cerebral Palsy: A Systematic Review with Meta-Analysis

The aim of this systematic review was to assess the effects of plyometric-jump training (PJT) on the physical fitness of youth with cerebral palsy (CP) compared with controls (i.e., standard therapy). The PRISMA 2020 guidelines were followed. Eligibility was assessed using the PICOS approach. Literature searches were conducted using the PubMed, Web of Science, and SCOPUS databases. Methodological study quality was assessed using the PEDro scale. Data were meta-analyzed by applying a random-effects model to calculate Hedges' g effect sizes (ES), along with 95% confidence intervals (95% CI). The impact of heterogeneity was assessed (I2 statistic), and the certainty of evidence was determined using the GRADE approach. Eight randomized-controlled studies with low-to-moderate methodological quality were included, involving male (n = 225) and female (n = 138) youth aged 9.5 to 14.6 years. PJT interventions lasted between 8 and 12 weeks with 2-4 weekly sessions. Compared with controls, PJT improved the muscle strength (ES = 0.66 [moderate], 95% CI = 0.36-0.96, p < 0.001, I2 = 5.4%), static (ES = 0.69 [moderate], 95% CI= 0.33-1.04, p < 0.001, I2 = 0.0%) and dynamic balance (ES = 0.85 [moderate], 95% CI = 0.12-1.58, p = 0.023, I2 = 81.6%) of youth with CP. Therefore, PJT improves muscle strength and static and dynamic balance in youth with CP compared with controls. However, more high-quality randomized-controlled trials with larger sample sizes are needed to provide a more definitive recommendation regarding the use and safety of PJT to improve measures of physical fitness.

Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics

The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12-18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability-LoS), balance, and mobility (Community Balance and Mobility Scale-CB&M; Functional Walking Test-FWT; Timed Up and Down Stair test-TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP.

Efficacy of plyometric exercises on upper extremity function, selective motor control and hand grip strength in children with unilateral cerebral palsy: A randomized controlled study

BACKGROUND

Impairment in unimanual upper limb function is frequent among children with unilateral cerebral palsy (UCP), which affects their ability to perform functional activities.

AIM

To assess the efficacy of plyometric exercises on the function of upper extremity, selective motor control (SMC) and hand grip strength (HGS) in children with UCP.

DESIGN

This was a double-masked, randomized, controlled clinical trial.

SETTING

Outpatient Clinics of Faculty of Physical Therapy, Cairo University and Center for Physical Medicine, Rehabilitation and Rheumatology, Al-Agouza Hospital, Giza, Egypt.

POPULATION

Forty children with UCP, ranging in age from 8 to 12 years, were randomly allocated to two groups equal in numbers.

METHOD

Children were allocated to receive conventional therapy (CONV-group; n = 20) or plyometric exercises (PLYO-group; n = 20) for 45 min. In addition, children of both groups received selected physical and occupational therapy programs (each lasted for 30 min) twice a week over 3-month. The intervention was delivered on non-consecutive days. Upper extremity function, SMC and HGS were assessed by using quality of upper extremity skills test (QUEST), Test of arm selective control and pneumatic squeeze bulb dynamometer, respectively.

RESULTS

Overall, 35 children (18 in the CONV-group, 17 in the PLYO-group) completed data collection and treatment. With-in group comparison showed significant improvement in the study groups while post-treatment comparisons revealed a significant difference from mean difference in upper extremity function is 9.55 (8.71:10.39), SMC is 2.12 (1.51:2.72) and HGS is 2.91 (2.13:3.68) (p < 0.05; 95% Confidence interval) in favor of the PLYO-group.

CONCLUSIONS

Plyometric exercises have the capability to enhance upper extremity function and strength in children with UCP.

Effectiveness of virtual reality on activities of daily living in children with cerebral palsy: a systematic review and meta-analysis

Background

No meta-analysis has been conducted on the effect of specific virtual reality (VR) treatment modes on activities of daily living (ADL) in children with cerebral palsy (CP). Therefore, this study aimed to confirm whether VR therapy is effective in improving ADL in children with CP according to subgroups.

Methodology

Literature published in the Cumulated Index to Nursing and Allied Health Literature (CINAHL), Embase, the Physiotherapy Evidence Database (PEDro), and PubMed was reviewed, and Risk of Bias 2.0 (RoB 2) was used to evaluate the quality of the literature. A funnel plot was visually observed to confirm publication bias, supplemented with Egger's regression test. Data analysis was performed using R version 4.2.1. Subgroup analysis was performed according to the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), treatment minutes per week, treatment period, age, and RoB.

Results

Eleven of 2,978 studies were included, and the overall effect size was 0.37 (95% confidence interval = 0.17-0.57). Regarding GMFCS, effect sizes of 0.41 and 0.33 was observed for the low- and high-function groups, respectively. For MACS, 0.27 and 0.43 were observed for the low and high-function groups. Regarding treatment minutes per week, the values were 0.22, 0.44, and 0.27 in the 1-100, 101-200, and 201-300 min groups, respectively. In the classification according to age, 0.29 was observed for school-age children and 0.98 for preschool children. Lastly, in the classification according to the RoB, 0.52, -0.01, and 0.23 indicated studies with low risk, some concern, and high risk, respectively.

Conclusions

The highest effect was observed when VR was applied within 6 weeks of 101-200 per week. Therefore, it is suggested that if the results of this review are applied to children with cerebral palsy in the community, it will be an effective intervention method.

Systematic review registration

PROPEROS (registration number CRD42023409801).

Effect of a structured aqua-plyometric exercise program on postural control and functional ability in children with hemiparetic cerebral palsy: A two-arm randomized controlled trial

BACKGROUND: Individuals with hemiparetic cerebral palsy (h-CP) encounter postural control issues that largely interfere with activity and participation. So, there might be a need for improved, clearly effective rehabilitation protocols that target postural control dysfunction, which may, then, reduce activity limitations and participation restrictions. OBJECTIVE: This trial was undertaken to examine the effect of a structured, 12-week aqua-plyometric (Aqua-PLYO) exercise program on postural control and functional ability in children with h-CP. METHODS: Fifty-six children with h-CP took part in a two-arm, randomized single-blind controlled trial. They were randomly assigned to either receive the standard physical therapy (Control group; n = 28) or the Aqua-PLYO training program (Aqua-PLYO group; n = 28), three times/week over 12 consecutive weeks. The dynamic limit of stability [i.e., movement directional control (M-DC), reaction time (ReT), movement velocity (M-Vel), endpoint excursion (EP-Exc), and maximum excursion (M-Exc)] and functional ability [i.e., 30-second sit-to-stand test (30sec-STS), timed up and down stairs test (TUDS), and the dynamic gait index (DGI)] were assessed pre- and post-treatment. RESULTS: From the pre- to post-treatment occasion, the Aqua-PLYO group achieved greater improvement for the M-DC (P = 0.013), ReT (P = 0.004), M-Vel (P = 0.03), EP-Exc (P = 0.002), and M-Exc (P = 0.006), compared to controls. Besides, the Aqua-PLYO group showed more conducive changes in functional ability [as evidenced by the 30sec-STS (P = 0.005), TUDS (P = 0.002), and DGI (P = 0.004) scores]. CONCLUSION: Aqua-PLYO training is likely an effective training paradigm for enhancing postural control and functional ability in children with h-CP. Further studies are, however, recommended to substantiate the current evidence.

Block-sequence of plyometric and balance training is superior to the alternating-sequence for enhancing motor function in children with hemiplegic cerebral palsy: A comparative randomized clinical trial

BACKGROUND: Postural control deficits are prevalent in children with hemiplegic cerebral palsy (CwHCP). Therefore, the best rehabilitative strategies for remediating these deficits are warranted, which could then enhance function. OBJECTIVE: To examine effects of a block versus an alternating sequence of balance training (BT) and plyometric training (PT) on postural control in CwHCP. METHODS: Forty-eight CwHCP (812 years) were randomized to a block or an alternating BT/PT training. The block BT/PT group (n= 24) received a sixweek BT followed by a sixweek PT, twice/week over 12 consecutive weeks. The alternating BT/PT group (n= 24) received an interchanging sequence of BT and PT changed every two weeks for 12 weeks. Postural control [center-of-pressure reaction time (RT), movement velocity (MV), maximum excursion (ME), end-point excursion (EE), and directional control (DC)], functional balance (indicated by pediatric balance scale; PBS), and balance/risk-of-falls during walking (denoted by dynamic gait index; DGI) were assessed before and after training. RESULTS: The block BT/PT group showed greater enhancements in postural control variables [RT (P= 0.004), MV (P= 0.028), ME (P= 0.002), EE (P= 0.003), and DC (P= 0.012)] and functional balance (P= 0.006), and lesser risk-of-falls during walking (P= 0.018) when compared to the alternating BT/PT group. CONCLUSION: The block BT/PT sequence is more effective to enhance postural control than the alternating sequence in CwHCP.

International football players with cerebral palsy maintained their physical fitness after a self-training program during the COVID-19 lockdown

Background

The COVID-19 global pandemic caused a complete stop in sport participation which meant a detraining period for athletes. High-level athletes had to train at home guided by their coaches and conditioning trainers in an effort to maintain their physical fitness. The aim of maintaining the training adaptations and physical fitness during the COVID-19 mandatory lockdown was especially important for CP athletes, in which the detraining period was expected to cause early declines in motor function, poor coordination and muscle weakness due to their disability.

Methods

The present study assessed the effect of a guided self-training program on international CP football players' physical fitness during the COVID-19 mandatory lockdown. Fifteen CP football players from the Spanish National Team participated in the study. An experimental design with a pre- (T1) and a post-intervention (T2) assessment was carried out, with a 12-week period of players' self-training (divided in two periods of 6 weeks) which combined strength and endurance training. Physical performance assessment consisted in the free countermovement jump (CMJ), 5, 10 and 20-m sprint, the modified agility T-test (MAT) and a dribbling test. The Kruskal-Wallis test was used for between-group comparisons, while the Student's paired t test or the Fisher Pitman permutation test, based on the normality of the data, were used for within-group comparisons.

Results

The results showed no differences between sport classes (FT1, FT2 and FT3) in physical fitness change after the training program (Chi² = 0.16 to 1.73; p = 0.42 to 0.92). Within-group comparisons showed an increase of jump height in the CMJ (4.19 cm [2.46, 5.93]; p < 0.001) and a maintenance of the 5, 10 and 20-m sprint, MAT and dribbling ability (<0.01 to 0.09 s; p = 0.19 to 0.97).

Discussion

To the authors' knowledge, this is the first study that examined the physical fitness adaptations to a training program with CP football players. The results show that a 12-week guided self-training program without football-specific stimulus may be effective to maintain or even improve the specific physical performance of international CP football players during a non-competitive period (as the COVID-19 lockdown). This study reveals that CP football players are able to show adaptations to the strength and endurance training and this could be the basis for future research regarding training adaptations in CP football players.

Effects of Power Training on Gait, Power, and Function in Children with Cerebral Palsy

AIMS

This scoping review aims to: 1) examine available literature regarding the effects of power training on gait speed, power, and function in ambulatory children with CP and 2) identify the variations in exercise dosage and rehabilitation recommendations for power training and plyometrics in children with CP.

METHODS

Four databases (PubMed, CINAHL, Embase, and Cochrane) were searched for papers including power or plyometric training with outcome measures for gait, power or functional performance. ES was calculated for RCTs. Cohorts and case series/studies were evaluated qualitatively.

RESULTS

Ten articles fit search criteria: four RCTs, three cohort studies, one case series, and two case studies. Power training consistently demonstrated improvements in muscle power compared to its effects on gait and function. ES of mean MPST (W) ranged from 0.36-1.13. 1 MWT and SSGS ES were 1.31 and 1.15, respectively. TUG ES ranged from -0.33 to -2.42. ES for GMFM-66 was 0.13 and 1.11 for Dimension D and Dimension E, respectively.

CONCLUSIONS

There is limited, but promising evidence to support that power training may improve gait speed, power, and function in children with CP. Future, more robust research is required to examine effects in a larger, diverse population, to determine long-term effects and exercise prescription.

Effectiveness of a Multi-Modal Exercise Program Incorporating Plyometric and Balance Training in Children With Hemiplegic Cerebral Palsy: A Three-Armed Randomized Clinical Trial

AIM

To evaluate the effectiveness of a multimodal exercise program incorporating plyometric and balance training on muscle strength and postural stability in children with spastic hemiplegic cerebral palsy (SHCP).

METHODS

A total of 57 children with SHCP were enrolled in the study and randomly allocated into three treatment-based groups: plyometric exercises (PLYO group; n = 19), balance exercises (BAL group, n = 19), and combined plyometric and balance exercises (PLYO-BAL group; n = 19). The maximum isometric muscle strength (IMS_max) and postural stability [anterior-posterior stability index (AP-SI), mediolateral stability index (ML-SI), and overall stability index (O-SI)] were measured pre- and post-intervention.

RESULTS

By applying the intention-to-treat analysis, the PLYO-BAL group showed greater post-treatment IMS_max than the PLYO and BAL groups for the quadriceps (p=.03 and p=.0002 respectively), hamstrings (p=.018 and p<.0001 respectively), and dorsiflexors (p=.006 and p<.0001 respectively). Also, the PLYO-BAL group achieved better post-intervention stability scores as compared to PLYO and BAL groups regarding AP-SI (p<.0001 and p=.0001 respectively), ML-SI (p=.001 and p=.015 respectively), and O-SI (p=.011 and p=.04 respectively).

CONCLUSIONS

Incorporation of plyometric and balance exercises in a multimodal rehabilitation program could be an important consideration for enhancing muscle strength and boosting postural stability in children with SHCP.

Aqua-Plyometric Exercises: Potential Implications for Bone Mineral Density, Functional Capacity, and Quality of Life in Survivors of Childhood Acute Lymphoblastic Leukemia

OBJECTIVE

This study endeavored to explore the effect of an aquatic-based plyometric exercise program (Aqua-PLYO) on bone mineralization, functional capacity, and quality of life in survivors of childhood acute lymphoblastic leukemia (ALL).

DATA SOURCES

In a prospective, single-blinded quasi-experimental study, 30 survivors of childhood ALL (63.3% boys; age: 13.1 ± 2.8 years) were allocated to undergo the Aqua-PLYO exercise program (Aqua-PLYO group; n = 15) or the usual physical therapy (Control group; n = 15). Bone mineralization (bone mineral density [BMD], bone mineral content [BMC], BMD Z-score, and BMD volumetric [BMD_vol]), functional capacity, and quality of life were assessed prior to, and following 36 treatment sessions, which were undertaken over nonconsecutive days in a 12-week program. With controlling for the pretreatment values, all measures of bone mineralization, functional capacity, and quality of life showed more favorable posttreatment improvement in the Aqua-PLYO group as compared to the control group (all P < .05).

CONCLUSION

The Aqua-PLYO exercises, besides the usual physical therapy, can effectively improve bone health, increase functional capacity, and promote a better quality of life in long-term survivors of childhood ALL.

IMPLICATIONS FOR NURSING PRACTICE

Although survivors of childhood ALL experience reduced BMD, functional ability, and quality of life, Aqua-PLYO exercises can have positive effects on survivors' physical and functional disturbances and can, even more, be enjoyable and increase their motivation and interest in engaging in exercise interventions.

Post-exercise hypotension effects in response to plyometric training of 7- to 9-year-old boys with overweight/obesity: a randomized controlled study

BACKGROUND

Physical activity plays an important role on children with obesity. This study evaluated the effects of plyometric training on the anthropometry, body composition, and the blood pressure (BP) and heart rate (HR) of boys with obesity.

METHODS

Boys aged 7 to 9 years old were divided in: non-trained (N.=12) and trained (N.=29). The plyometric training program consisted of jumps on nonconsecutive days for twelve weeks. Anthropometry and body composition, BP and HR were evaluated. BP, HR and rate-pressure product were recorded at rest and 2 minutes after the section. Two-way repeated factors ANOVA was used.

RESULTS

Trained group had a reduction in skinfolds and an increase in free fat mass (within and between-groups) and a large effect size for most anthropometric and body composition variables. Late systolic response was reduced from 122±1.1 (immediately post-exercise at the first week) to 112±1.0 at the end of plyometric training period. Diastolic reduction was seen two minutes after each session of exercise (from 68±1.1 to 62±1.2). HR was reduced in response to plyometric training (108 bpm to 97 bpm).

CONCLUSIONS

Our findings strengthen previous studies that suggest that intense exercise has significant adaptive effects on BP and HR.

Stretch-shortening cycle exercises can efficiently optimize gait-symmetry and balance capabilities in children with unilateral cerebral palsy: A randomized controlled trial

BACKGROUND

Children with unilateral cerebral palsy (UCP) experience an asymmetrical gait pattern and poor balance capabilities. Effective interventions, therefore, are needed to facilitate remediation of these functional issues.

OBJECTIVE

This study was set out to investigate the emerging role of stretch-shortening cycle (SSC) exercises on gait-symmetry and balance in children with UCP.

METHODS

In this randomized controlled trial, 42 children with UCP (age; 8 -12 years) were enrolled and received either standard physical rehabilitation (control group; n = 21) or the SSC exercise program plus physical rehabilitation (SSC group; n = 21). Spatial- and temporal-gait symmetry index (GSI) and specific balance capabilities [reactive balance, directional control, movement synchronization, and sensory organization] were assessed before and after 16 sessions that were carried out twice/week over non-sequential days in an 8-week program.

RESULTS

Using the pre-treatment scores as covariates, the post-treatment spatial- (P = 0.006; ηp2= 0.17) and temporal- GSI (P < .001; ηp2= 0.46) scores reduced significantly in the SSC group as compared to the control group, suggesting favorable improvement of gait symmetry. Also, all measures of balance (P < 0.05; ηp2 ranged between 0.10 and 0.29) improved remarkably, post-treatment, in SSC group in comparison with the control group.

CONCLUSION

The evidence from this study suggests that SSC exercises besides standard physical rehabilitation appear to be effective for improving gait symmetry and boosting balance capabilities in children with UCP.

Efficacy of aqua-based plyometric exercises in the rehabilitation of patients with juvenile dermatomyositis: A randomized crossover pilot study

BACKGROUND

Patients with juvenile dermatomyositis (JDM) experience muscle weakness, tiredness, and loss of energy, which restrict their abilities in performance of their daily living activities.

OBJECTIVE

To explore the effect of aquatic-based plyometric (Aqua-PLYO) exercises on muscle strength, fatigue, and functional ability in patients with JDM.

METHODS

This was a randomized, single-blind, crossover pilot study that included 16 patients with JDM (age 13.44 ± 2.85 years). They were assigned randomly to receive either the Aqua-PLYO exercises (n = 8) or the standard outpatient care (SoC ; n = 8) first. After a 1-month washout, the treatment was reversed. Lower limb muscle strength, fatigue perception, functional ability, and disease activity were evaluated before and after each treatment period.

RESULTS

Irrespective of the treatment order, the Aqua-PLYO treatment yielded greater improvement in muscle strength (hip flexors and abductors [P < 0.001] or knee flexors [P < 0.001] and extensors [P = 0.0008]), fatigue perception (P < 0.001), functional ability (P = 0.009), and disease activity (P = 0.0001) than the SoC treatment. By using the shortest confidence intervals (100[1-2α]%) of the difference, the average bioequivalence of the Aqua-PLYO and SoC has not been established at P = 0.05, because the upper and lower confidence bounds of all outcomes were not between the acceptance limits. No period or carryover effects were detected in all outcomes.

CONCLUSION

The Aqua-PLYO exercise protocol as implemented in this study is safe, feasible, and well-tolerated in patients with JDM and seemingly useful to help increase muscle strength, reduce fatigue, and enhance functional ability in such a patient population.

Designing Exercise to Improve Bone Health Among Individuals With Cerebral Palsy

PURPOSE

Individuals with cerebral palsy (CP), ambulatory or not, have less bone strength and density than their peers. Aging individuals with CP are at a higher risk for nontraumatic fractures, progressive deformity, pain, and spinal stenosis. Critical periods for skeletal formation are during prepuberty and adolescence. Applying mechanostat theory to exercise design for individuals with CP may be beneficial.

METHODS

Principles of mechanostat theory, particularly the osteogenic index, is applied to guide the design of exercise programs based on varying levels of physical capacity.

RESULTS

Recommendations are made for optimizing dosing of a variety of interventions for improving bone health among individuals with CP based on mechanostat theory with specific type, number of repetitions, and frequency.

CONCLUSIONS

Researchers and clinicians are called to action to consider the role of exercise throughout the lifespan for all individuals with CP, regardless of level of severity.

Combined Effects of Mirror Therapy and Exercises on the Upper Extremities in Children with Unilateral Cerebral Palsy: A Randomized Controlled Trial

Purpose: This study investigated the combined effects of mirror therapy involving power and strength exercises of the upper extremities in children with Unilateral Spastic Cerebral Palsy (USCP).Methods: Thirty children were included in either an experimental group or a control group. All participants were evaluated with the Quality of Upper Extremity Skill Test (QUEST), Canadian Occupational Performance Measure (COPM), and a handheld dynamometer to measure isometric muscle strength.Results: Compared to the control group, greater improvement was found in dissociated movements (p < .001, d = 1.82), grasp (p < .001, d = 1.38), weight bearing (p = .006, d = 0.91), and total scores (p = .001, d = 1.16) of QUEST; performance (p < .001, d = 2.9), satisfaction (p < .001, d = 1.91), and total scores (p < .001, d = 2.87) of COPM; and isometric muscle strength of the biceps brachii (p < .001, d = 1.27) and triceps brachii (p = .002, d = 2.22) of the affected upper limbs in the experimental group.Conclusions: Mirror therapy combined with power and strength exercises is a promising intervention approach to improve activity performance and upper-limb function in children with USCP.

Single-case Design Studies in Children with Cerebral Palsy: A Scoping Review

Aim: To critically evaluate single-case design (SCD) studies performed within the population of children/adolescents with cerebral palsy (CP).Methods: A scoping review of SCD studies of children/adolescents with CP. Demographic, methodological, and statistical data were extracted. Articles were evaluated using the Risk of Bias in N-of-1 Trials (RoBiNT) Scale and the Consolidated Standards of Reporting Trials (CONSORT) extension for N-of-1 trials (CENT 2015). Comments regarding strengths and limitations were analyzed.Results: Studies investigated the effects of a wide range of interventions on various outcomes. Most SCD types were adopted in multiple studies. All studies used visual inspection rather than visual analysis, often complemented with basic statistical descriptives. Risk of bias was high, particularly concerning internal validity. Many CENT items were insufficiently reported. Several benefits and limitations of SCD were identified.Conclusions: The quality of evidence from results of SCD studies needs to be increased through risk of bias reduction.

The Effects of Functional Progressive Strength and Power Training in Children With Unilateral Cerebral Palsy

PURPOSE

The purpose of this study was to investigate the effects of a novel functional strength and power-training program on gait and gross motor function in participants with unilateral cerebral palsy.

METHODS

This 12-week trial of functional strength and power training included 30 participants with cerebral palsy, randomly assigned to the experimental or comparison group. The primary outcomes, 1-minute walk test, muscle power, and the Gross Motor Function Measure, were assessed at baseline and 12 weeks after the intervention. Secondary outcomes included dynamic balance as measured by Timed Up and Go, muscle strength, and 1-repetition maximum measures.

RESULTS

Significantly greater improvements were seen in the experimental group for muscle power, Gross Motor Function Measure E score, and 1-minute walk test (P < .05), as well as for dynamic balance, 1-repetition maximum, and muscle strength.

CONCLUSION

Functional strength training combined with plyometric exercises improved gait and gross motor function, dynamic balance, muscle strength, and power.

VIDEO ABSTRACT

For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A254.

Running in people with cerebral palsy: A systematic review

BACKGROUND

Running is a fundamental motor skill which is important for participation in recreational activities throughout the lifespan.

AIM

To identify, appraise, and synthesize the evidence related to running in people with cerebral palsy (CP).

METHOD

A search of electronic databases was conducted in April 2016. Articles were reviewed by two assessors and had to meet the following criteria: 1) population included people with CP; and 2) included information about running. Articles were assessed for quality using the Checklist for Measuring Study Quality by Downs and Black.

RESULTS

Of 2607 articles initially identified, 56 underwent full-text review and 17 were included. Quantitative analysis was not possible. The quality of descriptive studies was fair-good, while intervention studies scored poor-good. Four of the 12 descriptive studies reported kinematic and kinetic data. Five intervention studies included running as an outcome measure, although running was not the focus of intervention. A few studies showed that sprint speed, agility, and running efficiency are impaired in people with CP, but mechanisms underlying these impairments have yet to be reported.

INTERPRETATION

Research on running in people with CP is limited, methodology and findings are inconsistent and studies are generally fair quality. Further investigation is warranted.

Systematic review of high-level mobility training in people with a neurological impairment

AIM

The objective of this paper was to systematically review the efficacy of interventions targeting high-level mobility skills in people with a neurological impairment.

METHODS

A comprehensive electronic database search was conducted. Study designs were graded using the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) system and methodological quality was described using the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Twelve exploratory studies (AACPDM levels IV/V), of limited methodological quality (PEDro scores of 2-3 out of 10), were included. Interventions included treadmill training, a three-phase programme, a high-level mobility group, plyometric training, running technique coaching and walk training with blood flow restriction. Diagnoses included acquired brain injury, cerebral palsy, incomplete spinal cord injury and neurofibromatosis type 1. There were difficulties generalizing results from exploratory designs with a broad range of participants, interventions and outcome measures. However, it seems that people with a neurological impairment have the capacity to improve high-level mobility skills, running speed and distance with intervention. There were no adverse events that limited participation.

CONCLUSION

There is preliminary evidence to support the efficacy of interventions to improve high-level mobility skills in people with neurological impairments. Well-controlled research with a larger sample is required to provide sufficient evidence to change clinical practice.

Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy: a systematic review

PURPOSE

Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP).

METHOD

A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters.

RESULTS

Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II-IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n = 3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n = 2, all Evidence Level II) and Physical Fitness Training (n = 4, Evidence Level II-V). Weak positive evidence was available for Modified Sport (n = 3, Evidence Level IV-V) and Non-Immersive Virtual Reality (n = 12, Evidence Level II-V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n = 4, all Evidence Level II).

INTERPRETATION

Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP. Implications for rehabilitation Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy. Gross Motor Activity Training is the most common and effective intervention. Practice variability is essential to improve gross motor function. Participation was rarely measured and requires further research, particularly in interventions that embed real-world participation opportunities like Modified Sport.

Review of Therapeutic Interventions for the Upper Limb Classified by Manual Ability in Children with Cerebral Palsy

The aim of this literature review was to assemble an inventory of intervention strategies utilized for children diagnosed with cerebral palsy (CP) based on the Manual Ability Classification System (MACS). The purpose of the inventory is to guide physicians and therapists in intervention selection aimed at improving upper limb function in children with CP. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, ERIC (Educational Research Information Center), Google Scholar, OTSeeker (Occupational Therapy Systematic Evaluation of Evidence), OVID (Ovid Technologies, Inc.), and PubMed. Inclusion criteria were whether the study (1) identified MACS levels of participants, and (2) addressed the effectiveness of intervention on upper limb function. Overall, 74 articles met the inclusion criteria. The summarized data identified 10 categories of intervention. The majority of participants across studies were MACS level II. The most frequently cited interventions were constraint-induced movement therapy (CIMT), bimanual training, and virtual reality and computer-based training. Multiple interventions demonstrated effectiveness for upper limb improvement at each MACS level. However, there is a need for additional research for interventions appropriate for MACS levels IV and V. To fully develop an intervention inventory based on manual ability, future studies need to report MACS levels of participants, particularly for splinting and therapy interventions used in combination with surgery.

Relative fascicle excursion effects on dynamic strength generation during gait in children with cerebral palsy

Evaluation of muscle structure gives us a better understanding of how muscles contribute to force generation which is significantly altered in children with cerebral palsy (CP). While most muscle structure parameters have shown to be significantly correlated to different expressions of strength development in children with CP and typically developing (TD) children, conflicting results are found for muscle fascicle length. Muscle fascicle length determines muscle excursion and velocity, and contrary to what might be expected, correlations of fascicle length to rate of force development have not been found for children with CP. The lack of correlation between muscle fascicle length and rate of force development in children with CP could be due, on the one hand, to the non-optimal joint position adopted for force generation on the isometric strength tests as compared to the position of TD children. On the other hand, the lack of correlation could be due to the erroneous assumption that muscle fascicle length is representative of sarcomere length. Thus, the relationship between muscle architecture parameters reflecting sarcomere length, such as relative fascicle excursions and dynamic power generation, should be assessed. Understanding of the underlying mechanisms of weakness in children with CP is key for individualized prescription and assessment of muscle-targeted interventions. Findings could imply the detection of children operating on the descending limb of the sarcomere length-tension curve, which in turn might be at greater risk of developing crouch gait. Furthermore, relative muscle fascicle excursions could be used as a predictive variable of outcomes related to crouch gait prevention treatments such as strength training.