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Thompson SE, Whitten SVW, Campbell KS, Singh T, Singh H, Li LI, Vova J, Modlesky CM. Jump Performance and Its Relationship with Lower Body Joint Kinetics and Kinematics in Children with Cerebral Palsy. Med Sci Sports Exerc 2024; 56:1213-1224. [PMID: 38686962 DOI: 10.1249/mss.0000000000003421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE The aim was to quantify jump performance in children with cerebral palsy (CP) and determine if the expected deficit is related to their lower body joint kinetics and kinematics. METHODS Twenty-four ambulatory ( n = 17 level I and 7 level II in the Gross Motor Function Classification System) children with spastic CP ( n = 13 unilateral and 11 bilateral) and 24 age-, sex-, and race-matched typically developing controls were studied. Jump height and peak power and range of motion at the hip, knee, and ankle of the more affected limb in children with CP and the nondominant limb in controls were assessed during a countermovement jump using three-dimensional motion capture and a force platform. RESULTS Compared with controls, children with CP had lower jump height (33%, Cohen's d ( d ) = 1.217), peak power at the knee (39%, d = 1.013) and ankle (46%, d = 1.687), and range of motion at the hip (32%, d = 1.180), knee (39%, d = 2.067), and ankle (46%, d = 3.195; all P < 0.001). Jump height was positively related to hip, knee, and ankle power and range of motion in children with CP ( rs range = 0.474-0.613, P < 0.05), and hip and ankle power and knee and ankle range of motion in controls ( rs range = 0.458-0.630, P < 0.05). The group difference in jump height was no longer detected when ankle joint power, ankle range of motion, or knee range of motion was statistically controlled ( P > 0.15). CONCLUSIONS Jump performance is compromised in children with CP and is associated with low power generation and range of motion in the lower limb, especially at the ankle.
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Affiliation(s)
| | | | | | - Tarkeshwar Singh
- Department of Kinesiology, Pennsylvania State University, State College, PA
| | - Harshvardhan Singh
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - L I Li
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA
| | - Joshua Vova
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
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Garcia-Carrillo E, Ramirez-Campillo R, Izquierdo M, Elnaggar RK, Afonso J, Peñailillo L, Araneda R, Ebner-Karestinos D, Granacher U. Effects of Therapies Involving Plyometric-Jump Training on Physical Fitness of Youth with Cerebral Palsy: A Systematic Review with Meta-Analysis. Sports (Basel) 2024; 12:152. [PMID: 38921846 PMCID: PMC11207881 DOI: 10.3390/sports12060152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
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.
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Affiliation(s)
- Exal Garcia-Carrillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Navarra Institute for Health Research (IdiSNA), Universidad Pública de Navarra (UPNA), 31008 Pamplona, Spain;
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Navarra Institute for Health Research (IdiSNA), Universidad Pública de Navarra (UPNA), 31008 Pamplona, Spain;
| | - Ragab K. Elnaggar
- Department of Physical Therapy and Health Rehabilitation, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - José Afonso
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4200450 Porto, Portugal;
| | - Luis Peñailillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
| | - Rodrigo Araneda
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
| | - Daniela Ebner-Karestinos
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.G.-C.); (R.R.-C.); (L.P.); (R.A.); (D.E.-K.)
| | - Urs Granacher
- Department of Sport and Sport Science, Exercise and Human Movement Science, University of Freiburg, 79102 Freiburg, Germany
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Valadão P, Cenni F, Piitulainen H, Avela J, Finni T. Effects of the EXECP Intervention on Motor Function, Muscle Strength, and Joint Flexibility in Individuals with Cerebral Palsy. Med Sci Sports Exerc 2024; 56:1-12. [PMID: 37565430 DOI: 10.1249/mss.0000000000003273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
PURPOSE Numerous exercise interventions to enhance motor function in cerebral palsy (CP) have been proposed, with varying degrees of effectiveness. Because motor function requires a combination of muscle strength, joint flexibility, and motor coordination, we designed a supervised multicomponent exercise intervention (EXErcise for Cerebral Palsy, or EXECP) for individuals with CP. Our aim was to evaluate the effects of the EXECP intervention and its retention after it ceased. METHODS The EXECP intervention combined strength training for the lower limbs and trunk muscles, passive stretching for the lower limb muscles, and inclined treadmill gait training. Eighteen participants with CP (mean age, 14 yr; 13 were male) were tested twice before the 3-month intervention and twice after the intervention, each test separated by 3 months. Seventeen typically developing age- and sex-matched controls were tested twice. Motor function was assessed with the 6-min walking test (6MWT) and the gross motor function measure dimensions D and E. Passive joint flexibility was measured with goniometry. Isometric and concentric muscle strength were assessed at the knee, ankle, and trunk joints. RESULTS The EXECP intervention successfully increased 6MWT ( P < 0.001), gross motor function measure ( P = 0.004), and muscle strength for knee and trunk muscles ( P < 0.05), although no changes were observed for ankle joint muscles. Hip and knee joint flexibility also increased ( P < 0.05). After the retention period, all tested variables except the 6MWT and knee joint flexibility regressed and were not different from the pretests. CONCLUSIONS The improvements in strength, flexibility, and possibly motor coordination brought by the EXECP intervention were transferred to significant functional gains. The regression toward baseline after the intervention highlights that training must be a lifelong decision for individuals with CP.
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Affiliation(s)
- Pedro Valadão
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - Francesco Cenni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | | | - Janne Avela
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - Taija Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
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Pontiff ME, Moreau NG. Age-Related Differences in Muscle Size and Strength between Individuals with Cerebral Palsy and Individuals with Typical Development. Phys Occup Ther Pediatr 2023; 44:572-585. [PMID: 38037369 DOI: 10.1080/01942638.2023.2287463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
AIM Examine age-related differences in muscle size and strength of the knee extensors in individuals with cerebral palsy (CP) and individuals with typical development (TD). METHODS 54 individuals with CP (14.5 ± 4.5 years, GMFCS I-V) and 33 individuals with TD (16.2 ± 5.5 years) were included. Relationships between rectus femoris (RF) and vastus lateralis (VL) muscle volume and isokinetic knee extensor strength with age were examined with linear regression and ANCOVA to test age-related differences between groups. RESULTS Linear regression for muscle volume with age was statistically significant in TD (VL: r2 = 0.48, RF: r2 = 0.56, p < .05) and those with CP (VL: r = 0.36, RF: r2 = 0.27, p < .05) with no differences in regression slopes between groups (p > .05). Age-related strength differences were observed in TD (r2 = 0.66, p < .001) and those with CP (r2 = 0.096, p = .024), but the slopes were significantly different between CP and TD (p < .001). CONCLUSION Age-related linear differences in muscle volume and strength were observed in both groups. The linear slope of the age-related differences in knee extensor muscle strength and strength-to-body mass ratio were significantly lower in individuals with CP compared to individuals with TD, suggesting that strength is insufficient to keep up with gains in body mass during growth.
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Affiliation(s)
- Mattie E Pontiff
- Department of Physical Therapy, LSUHSC-New Orleans, New Orleans, LA, USA
| | - Noelle G Moreau
- Department of Physical Therapy, LSUHSC-New Orleans, New Orleans, LA, USA
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5
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Kara OK, Gursen C, Cetin SY, Tascioglu EN, Muftuoglu S, Damiano DL. The effects of power exercises on body structure and function, activity and participation in children with cerebral palsy: an ICF-based systematic review. Disabil Rehabil 2023; 45:3705-3718. [PMID: 36314560 DOI: 10.1080/09638288.2022.2138575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 10/12/2022] [Accepted: 10/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To systematically review the literature for evidence of effectiveness of power exercises on physical, physiological, and functional outcomes in children and adolescents with cerebral palsy (CP). MATERIALS AND METHODS Methodological quality and evidence synthesis were assessed with using the Cochrane Risk of Bias (RoB) Tools and Modified Bakker Scale. Using the International Classification of Functioning (ICF), outcome measures for muscle agriculture, gait, balance, motor function, aerobic/anaerobic fitness, daily living, mobility, and school participation were categorised. RESULTS The overall RoB of four randomised clinical trials was low, one had some concerns and two were rated as high. Moderate evidence was found that power exercises increased walking speed, activities of daily living, muscle strength, and enhanced gross motor function more than a routine physical therapy program. CONCLUSIONS The lack of stronger evidence for power training interventions to improve muscle architecture, muscle function, walking capacity, and mobility in children with CP might be explained by the differences in training protocols and degree to which these meet the physiological definition of power, different methods of measuring power, limited durations of training, and the relative effectiveness of control interventions. Future studies should include a stronger focus on child and family-centred participation goals.Implications For RehabilitationPower training can improve gross motor function, walking speed, muscle strength, and activities of daily living more than routine physical therapy.Results comparing power training versus traditional strength training were less pronounced likely because both are intensive and may have positive effects.More research is needed to investigate effects of power training on participation.
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Affiliation(s)
- Ozgun Kaya Kara
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Ceren Gursen
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Sebahat Yaprak Cetin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Elif Nur Tascioglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Seda Muftuoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Diane L Damiano
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
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Moreau NG, Friel KM, Fuchs RK, Dayanidhi S, Sukal-Moulton T, Grant-Beuttler M, Peterson MD, Stevenson RD, Duff SV. Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy I: Key Ingredients for Bone and Muscle Health. Behav Sci (Basel) 2023; 13:539. [PMID: 37503986 PMCID: PMC10376586 DOI: 10.3390/bs13070539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023] Open
Abstract
Physical activity of a sufficient amount and intensity is essential to health and the prevention of a sedentary lifestyle in all children as they transition into adolescence and adulthood. While fostering a fit lifestyle in all children can be challenging, it may be even more so for those with cerebral palsy (CP). Evidence suggests that bone and muscle health can improve with targeted exercise programs for children with CP. Yet, it is not clear how musculoskeletal improvements are sustained into adulthood. In this perspective, we introduce key ingredients and guidelines to promote bone and muscle health in ambulatory children with CP (GMFCS I-III), which could lay the foundation for sustained fitness and musculoskeletal health as they transition from childhood to adolescence and adulthood. First, one must consider crucial characteristics of the skeletal and muscular systems as well as key factors to augment bone and muscle integrity. Second, to build a better foundation, we must consider critical time periods and essential ingredients for programming. Finally, to foster the sustainability of a fit lifestyle, we must encourage commitment and self-initiated action while ensuring the attainment of skill acquisition and function. Thus, the overall objective of this perspective paper is to guide exercise programming and community implementation to truly alter lifelong fitness in persons with CP.
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Affiliation(s)
- Noelle G. Moreau
- Department of Physical Therapy, School of Allied Health Professions, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Kathleen M. Friel
- Burke Neurological Institute, Weill Cornell Medicine, White Plains, NY 10605, USA;
| | - Robyn K. Fuchs
- Division of Biomedical Science, College of Osteopathic Medicine, Marian University, Indianapolis, IN 46222, USA;
| | | | - Theresa Sukal-Moulton
- Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL 60611, USA;
| | - Marybeth Grant-Beuttler
- Department of Physical Therapy, Oregon Institute of Technology, Klamath Falls, OR 97601, USA;
| | - Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Richard D. Stevenson
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA;
| | - Susan V. Duff
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA;
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Mack DE, Anzovino D, Sanderson M, Dotan R, Falk B. Reporting of Adverse Events in Muscle Strengthening Interventions in Youth: A Systematic Review. Pediatr Exerc Sci 2023:1-17. [PMID: 37105544 DOI: 10.1123/pes.2021-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/05/2022] [Accepted: 05/31/2022] [Indexed: 04/29/2023]
Abstract
Clear definition, identification, and reporting of adverse event (AE) monitoring during training interventions are essential for decision making regarding the safety of training and testing in youths. PURPOSE To document the extent to which AEs, resulting from intervention studies targeting muscle strengthening training (MST) in youth, are reported by researchers. METHODS Electronic databases (CINAHL, PubMed, SPORTDiscus, and Web of Science) were searched for English peer-reviewed articles published before April 2018. Inclusion criteria were: (1) average age <16 years, (2) use of MST, (3) statement(s) linked to the presence/absence of AEs, and (4) randomized controlled trials or quasi-experimental designs. Risk of reporting bias for AEs followed recommendations by the Cochrane Collaboration group. RESULTS One hundred and ninety-one full-text articles were screened. One hundred and thirty met all MST criteria, out of which only 44 (33.8%; n = 1278, age = 12.1 [1.1] y) included a statement as to the presence/absence of adverse events. The 86 other studies (66.2%) included no such statement. Of the reporting 44 studies, 18 (40.1%) indicated one or more adverse events. Of the 93 reported adverse events, 55 (59.1%) were linked to training or testing. CONCLUSIONS Most MST studies in youth do not report presence/absence of adverse events, and when reported, adverse events are not well defined.
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Affiliation(s)
- Diane E Mack
- Behavioral Health Sciences Research Lab, Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharines, ON,Canada
| | - Daniel Anzovino
- Behavioral Health Sciences Research Lab, Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharines, ON,Canada
| | - Malcolm Sanderson
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharines, ON,Canada
| | - Raffy Dotan
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharines, ON,Canada
| | - Bareket Falk
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharines, ON,Canada
- Center for Bone and Muscle Health, Brock University, St Catharines, ON,Canada
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8
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Hanssen B, Peeters N, Dewit T, Huyghe E, Dan B, Molenaers G, Van Campenhout A, Bar-On L, Van den Broeck C, Calders P, Desloovere K. Reliability of 3D freehand ultrasound to assess lower limb muscles in children with spastic cerebral palsy and typical development. J Anat 2023; 242:986-1002. [PMID: 36807218 PMCID: PMC10184546 DOI: 10.1111/joa.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/29/2022] [Accepted: 01/20/2023] [Indexed: 02/22/2023] Open
Abstract
This study investigated the reliability of 3-dimensional freehand ultrasound (3DfUS) to quantify the size (muscle volume [MV] and anatomical cross-sectional area [aCSA]), length (muscle length [ML], tendon length [TL], and muscle tendon unit length [MTUL]), and echo-intensity (EI, whole muscle and 50% aCSA), of lower limb muscles in children with spastic cerebral palsy (SCP) and typical development (TD). In total, 13 children with SCP (median age 14.3 (7.3) years) and 13 TD children (median age 11.1 (1.7) years) participated. 3DfUS scans of rectus femoris, semitendinosus, medial gastrocnemius, and tibialis anterior were performed by two raters in two sessions. The intra- and inter-rater and intra- and inter-session reliability were defined with relative and absolute reliability measures, that is, intra-class correlation coefficients (ICCs) and absolute and relative standard error of measurement (SEM and SEM%), respectively. Over all conditions, ICCs for muscle size measures ranged from 0.818 to 0.999 with SEM%s of 12.6%-1.6%. For EI measures, ICCs varied from 0.233 to 0.967 with SEM%s of 15.6%-1.7%. Length measure ICCs ranged from 0.642 to 0.999 with SEM%s of 16.0%-0.5%. In general, reliability did not differ between the TD and SCP cohort but the influence of different muscles, raters, and sessions was not constant for all 3DfUS parameters. Muscle length and muscle tendon unit length were the most reliable length parameters in all conditions. MV and aCSA showed comparable SEM%s over all muscles, where tibialis anterior MV was most reliable. EI had low-relative reliability, but absolute reliability was better, with better reliability for the distal muscles in comparison to the proximal muscles. Combining these results with earlier studies describing muscle morphology assessed in children with SCP, 3DfUS seems sufficiently reliable to determine differences between cohorts and functional levels. The applicability on an individual level, for longitudinal follow-up and after interventions is dependent on the investigated muscle and parameter. Moreover, the semitendinosus, the acquisition, and processing of multiple sweeps, and the definition of EI and TL require further investigation. In general, it is recommended, especially for longitudinal follow-up studies, to keep the rater the same, while standardizing acquisition settings and positioning of the subject.
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Affiliation(s)
- Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Tijl Dewit
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Ester Huyghe
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Bernard Dan
- Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Orthopaedic surgery, University Hospitals Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Orthopaedic surgery, University Hospitals Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
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9
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Pontiff M, Li L, Moreau NG. Reliability, Validity and Minimal Detectable Change of a Power Leg Press Test in Individuals with Cerebral Palsy. Phys Occup Ther Pediatr 2023; 43:582-595. [PMID: 36722739 PMCID: PMC10390647 DOI: 10.1080/01942638.2023.2173039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower extremity muscle power influences walking ability in individuals with Cerebral Palsy (CP). AIM Determine the reliability, validity, and minimal detectable change (MDC) of a novel power leg press (PLP) test to measure muscle power in individuals with CP. METHODS Individuals with spastic CP (n = 26 (10 adults, 16 children); mean (SD) age = 19.3 (7.8) years(all); 27.9 (4.89) years (adults); 13.85(2.68) years (children)) performed 2 sessions of the PLP test, 2-10 days apart. A linear position transducer and custom computer code were used to calculate mean and peak power in watts (W). Intraclass correlation coefficients (ICC), standard error of measurement, MDC, and percent change of MDC (MDC%) were calculated for 4 power measures (average and maximum of mean and peak powers) for all participants (AP) and separately for adults (A) and children (C). Validity was evaluated against isokinetic knee extensor power. RESULTS Test-retest reliability was excellent for all measures of power (ICC = 0.94-0.99). Ranges for MDC/MDC% by the group for power measures were between 33.7-80.7W/15.5-29.4% (AP), 41.1-65.3W/10.7-22.3% (A), and 27.6-79.8W/19-34.3% (C). Correlations were good to excellent between PLP and isokinetic power at all speeds (r = 0.75-0.88, p < .001). CONCLUSIONS The PLP test demonstrates excellent validity, reliability, and precision for measuring muscle power in those with CP.
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Affiliation(s)
- Mattie Pontiff
- Department of Cell Biology and Anatomy 1901 Perdido St. New Orleans, LA 70112, USA
- Department of Physical Therapy, LSU Health Sciences Center; 1900 Gravier St. New Orleans, LA 70112, USA
| | - Li Li
- Department of Health Sciences and Kinesiology, Georgia Southern University, 1332 Southern Dr. Statesboro, GA 30458
| | - Noelle G. Moreau
- Department of Physical Therapy, LSU Health Sciences Center; 1900 Gravier St. New Orleans, LA 70112, USA
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10
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Masaki M, Isobe H, Uchikawa Y, Okamoto M, Chiyoda Y, Katsuhara Y, Mino K, Aoyama K, Nishi T, Ando Y. Association of gross motor function and activities of daily living with muscle mass of the trunk and lower extremity muscles, range of motion, and spasticity in children and adults with cerebral palsy. Dev Neurorehabil 2023; 26:115-122. [PMID: 36717387 DOI: 10.1080/17518423.2023.2171149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We examined the association of gross motor function and activities of daily living (ADL) with muscle mass of the trunk and lower extremity muscles in children and adults with cerebral palsy (CP). METHODS The subjects were 32 children and adults with CP. Muscle thickness of the trunk and lower extremity muscles was measured using an ultrasound imaging device. RESULTS Stepwise regression analysis revealed that the thoracic erector spinae muscle thickness was a significant and independent factor of gross motor function. Stepwise regression analysis also showed that the thickness of the rectus abdominis and vastus lateralis muscles were significant and independent factors of ADL. CONCLUSIONS Our findings suggest that declined gross motor function is associated with decreased thoracic erector spinae muscle mass in children and adults with CP. The results also indicate that declined ADL is associated with decreased muscle mass of the rectus abdominis and vastus lateralis muscles.
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Affiliation(s)
- Mitsuhiro Masaki
- Department of Physical Therapy, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Honoka Isobe
- Department of Rehabilitation, Ibaraki Seinan Medical Center Hospital, Sashimagun, Japan
| | - Yuki Uchikawa
- Department of Rehabilitation, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Mami Okamoto
- Midori-no Kodomokan, Musashino City Development Support Center for Children, Musashino, Japan
| | - Yoshie Chiyoda
- Department of Rehabilitation, Gunma Seishi Ryougoen, Takasaki, Japan
| | - Yuki Katsuhara
- Department of Rehabilitation, Nikoniko-house Medical Welfare Center, Kobe, Japan
| | - Kunio Mino
- Department of Rehabilitation, Asahigawasou Rehabilitation & Medical Center, Kita-ku, Japan
| | - Kaori Aoyama
- Department of Rehabilitation, Asahigawasou Rehabilitation & Medical Center, Kita-ku, Japan
| | - Tatsuya Nishi
- Department of Rehabilitation, Asahigawasou Rehabilitation & Medical Center, Kita-ku, Japan
| | - Yasushi Ando
- Department of Rehabilitation, Asahigawasou Rehabilitation & Medical Center, Kita-ku, Japan
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11
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Pimenta R, Antunes H, Lopes T, Veloso A. Do Repeated Sprints Affect the Biceps Femoris Long Head Architecture in Football Players with and without an Injury History?-A Retrospective Study. BIOLOGY 2023; 12:biology12010096. [PMID: 36671788 PMCID: PMC9855802 DOI: 10.3390/biology12010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
The aim of this study was to compare the biceps femoris long head (BFlh) architecture between football players with (twelve) and without (twenty) history of BFlh injury before and after a repeated sprint task. Fascicle length (FL), pennation angle (PA) and muscle thickness (MT) were assessed at rest and in the active condition before and after the repeated sprint protocol. Athletes with previous BFlh injury showed shorter FL at rest (p = 0.014; η2p = 0.196) and active state (p < 0.001; η2p = 0.413), and greater PA at rest (p = 0.002; η2p = 0.307) and active state (p < 0.001; η2p = 0.368) before and after the task. Intra-individual comparisons showed that injured limbs have shorter FL at rest (p = 0.012; η2p = 0.519) and in the active state (p = 0.039; η2p = 0.332), and greater PA in passive (p < 0.001; η2p = 0.732) and active conditions (p = 0.018; η2p = 0.412), when compared with contralateral limbs. Injured players, at rest and in the active condition, display shorter BFlh FL and greater PA than contralateral and healthy controls after repeated sprints. Moreover, the BFlh of injured players presented a different architectural response to the protocol compared with the healthy controls.
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Affiliation(s)
- Ricardo Pimenta
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1649-004 Cruz Quebrada-Dafundo, Portugal
- Correspondence: ; Tel.: +35-19-1885-2877
| | - Hugo Antunes
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1649-004 Cruz Quebrada-Dafundo, Portugal
| | - Tomás Lopes
- Department of Biochemistry, King’s College London, London WC2R 2LS, UK
| | - António Veloso
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1649-004 Cruz Quebrada-Dafundo, Portugal
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12
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Collaborative Therapist-Patient Decision Making: A Power-Based Exercise Program for an Adolescent With CMT1A. Pediatr Phys Ther 2023; 35:101-107. [PMID: 36638038 DOI: 10.1097/pep.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this case report is to describe an episode of care for an adolescent with Charcot Marie Tooth disease (CMT) using a power-based progressive resistance exercise (PRE) and balance program to improve performance of participant-defined goals with added description through the voice of the patient as "participant lived experience." SUMMARY OF KEY POINTS Participant discussion demonstrates improvement of functional performance for an adolescent with CMT subtype 1A (CMT1A), a progressive neuromuscular disorder. Function and participation-specific movement observation, clinical evaluation, and resistance training fostered appropriate program design and intervention dosing. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE A power-based progressive resistance exercise and balance program with design based on participant-defined goals was feasible, well tolerated, and successful for an adolescent with CMT1A. Inclusion of viewpoints of the "lived experience" provides deeper insight into patient perspective and clinical outcomes. Outcomes may improve when intervention is specifically dosed to participant goals and individual muscle performance requirements for targeted tasks.
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13
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Hanssen B, Peeters N, De Beukelaer N, Vannerom A, Peeters L, Molenaers G, Van Campenhout A, Deschepper E, Van den Broeck C, Desloovere K. Progressive resistance training for children with cerebral palsy: A randomized controlled trial evaluating the effects on muscle strength and morphology. Front Physiol 2022; 13:911162. [PMID: 36267577 PMCID: PMC9577365 DOI: 10.3389/fphys.2022.911162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Children with spastic cerebral palsy often present with muscle weakness, resulting from neural impairments and muscular alterations. While progressive resistance training (PRT) improves muscle weakness, the effects on muscle morphology remain inconclusive. This investigation evaluated the effects of a PRT program on lower limb muscle strength, morphology and gross motor function. Forty-nine children with spastic cerebral palsy were randomized by minimization. The intervention group (nparticipants = 26, age: 8.3 ± 2.0 years, Gross Motor Function Classification System [GMFCS] level I/II/III: 17/5/4, nlegs = 41) received a 12-week PRT program, consisting of 3-4 sessions per week, with exercises performed in 3 sets of 10 repetitions, aiming at 60%–80% of the 1-repetition maximum. Training sessions were performed under supervision with the physiotherapist and at home. The control group (nparticipants = 22, age: 8.5 ± 2.1 year, GMFCS level I/II/III: 14/5/3, nlegs = 36) continued usual care including regular physiotherapy and use of orthotics. We assessed pre- and post-training knee extension, knee flexion and plantar flexion isometric strength, rectus femoris, semitendinosus and medial gastrocnemius muscle morphology, as well as functional strength, gross motor function and walking capacity. Data processing was performed blinded. Linear mixed models were applied to evaluate the difference in evolution over time between the control and intervention group (interaction-effect) and within each group (time-effect). The α-level was set at p = 0.01. Knee flexion strength and unilateral heel raises showed a significant interaction-effect (p ≤ 0.008), with improvements in the intervention group (p ≤ 0.001). Moreover, significant time-effects were seen for knee extension and plantar flexion isometric strength, rectus femoris and medial gastrocnemius MV, sit-to-stand and lateral step-up in the intervention group (p ≤ 0.004). Echo-intensity, muscle lengths and gross motor function showed limited to no changes. PRT improved strength and MV in the intervention group, whereby strength parameters significantly or close to significantly differed from the control group. Although, relative improvements in strength were larger than improvements in MV, important effects were seen on the maintenance of muscle size relative to skeletal growth. In conclusion, this study proved the effectiveness of a home-based, physiotherapy supervised, PRT program to improve isometric and functional muscle strength in children with SCP without negative effects on muscle properties or any serious adverse events.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03863197.
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Affiliation(s)
- Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- *Correspondence: Britta Hanssen, ; Kaat Desloovere,
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Astrid Vannerom
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Leen Peeters
- CP Reference Center, University Hospitals Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Pediatric Orthopedics, Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Pediatric Orthopedics, Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
- *Correspondence: Britta Hanssen, ; Kaat Desloovere,
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14
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Fleeton JRM, Sanders RH, Fornusek C. Impact of maximal strength training on countermovement jump phase characteristics in athletes with cerebral palsy. J Sports Sci 2022; 40:2118-2127. [PMID: 36273245 DOI: 10.1080/02640414.2022.2137303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Analysis of the countermovement jump (CMJ) force-time curve phases provides insight into athlete neuromuscular function and methods by which jump height improves in response to training. A CMJ phase analysis and the dynamic strength index (DSI) have yet to be explored in athletes with cerebral palsy (CP). This study aimed to address this knowledge gap. Eleven state- to international-level athletes with CP completed a pre-post maximal strength training intervention with waitlist control. CMJ was assessed via force plate pre/post baseline and after the 12-week intervention. Following the intervention, CMJ height, takeoff velocity, and concentric phase peak and mean force, impulse and mean acceleration improved significantly (p = 0.006-0.001). No changes were observed in any eccentric braking phase variable (p = 0.79-0.13), while DSI lowered (p = 0.03). In athletes with CP, strength training increased CMJ concentric phase peak and mean force and impulse, increasing velocity and acceleration and therefore jump height. DSI lowered due to moderate and small increases in isometric mid-thigh pull and CMJ peak force, respectively. Unlike in non-disabled athletes, strength training did not alter any eccentric phase variable; therefore, other modalities may be required to further optimize jumping performance in athletes with CP.
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Affiliation(s)
- Jennifer R M Fleeton
- The University of Sydney School of Health Sciences, Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Ross H Sanders
- The University of Sydney School of Health Sciences, Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Ché Fornusek
- The University of Sydney School of Health Sciences, Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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15
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Gjesdal BE, Mæland S, Bogen B, Cumming KT, Nesse VC, Torberntsson SMR, Rygh CB. Ballistic strength training in adults with cerebral palsy may increase rate of force development in plantar flexors, but transition to walking remains unclear: a case series. BMC Sports Sci Med Rehabil 2022; 14:101. [PMID: 35659348 PMCID: PMC9166478 DOI: 10.1186/s13102-022-00487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 05/13/2022] [Indexed: 11/16/2022]
Abstract
Background Persons with cerebral palsy (CP) walk with reduced ankle plantar flexor power compared to typically developing. In this study, we investigated whether a ballistic strength-training programme targeting ankle plantar flexors could improve muscle strength, muscle architecture and walking function in adults with CP. Methods Eight adults (mildly affected CP) underwent eight weeks of ballistic strength training, with two sessions per week. Before and after the intervention preferred walking speed, ankle plantar flexion rate of force development (RFD), maximal voluntary contraction (MVC), muscle thickness, pennation angle and fascicle length were measured. Data are presented for individuals, as well as for groups. Group changes were analysed using the Wilcoxon signed-rank test. Results Data were analysed for eight participants (five women, mean age 37.9 years; six GMFCS I and two GMFCS II). Two participants increased their walking speed, but there were no significant group changes. In terms of muscle strength, there were significant group changes for RFD at 100 ms and MVC. In the case of muscle architecture, there were no group changes. Conclusion In this study, we found that eight weeks of ballistic strength training improved ankle plantar flexor muscle strength but walking function and muscle architecture were unchanged. Larger studies will be needed to obtain conclusive evidence of the efficacy of this training method. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00487-1.
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Affiliation(s)
- Beate Eltarvåg Gjesdal
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway. .,Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - S Mæland
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - B Bogen
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
| | - K T Cumming
- Faculty of Health, Welfare and Organisation, Østfold University College, Fredrikstad, Norway
| | - V C Nesse
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
| | - S M R Torberntsson
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - C B Rygh
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
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16
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MOREAU NOELLEG, LIEBER RICHARDL. Effects of voluntary exercise on muscle structure and function in cerebral palsy. Dev Med Child Neurol 2022; 64:700-708. [PMID: 35142371 PMCID: PMC9086177 DOI: 10.1111/dmcn.15173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/16/2022]
Abstract
Skeletal muscles are required for functional movement and force production. While it is clear that cerebral palsy (CP) results in loss of muscle strength and bodily function, and that much of this loss is caused by injury to the central nervous system, muscle is a very plastic tissue that is also dramatically affected. In many studies, it is assumed that voluntary exercise will cause the muscle to respond in the same way that typically developing muscle does, but there are scarce data demonstrating that this is true. The purpose of this review is to briefly describe muscle architectural adaptation to various forms of exercise with specific reference to voluntary exercise performed in children with CP. Exercise itself is not generic but can vary by intensity, duration, and the exact nature of the muscle length change and velocity imposed during the exercise. Our goal is to stimulate discussion in this area by pointing out salient experimental variables and, ultimately, to improve activity and participation in children with CP.
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Affiliation(s)
- NOELLE G MOREAU
- Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA
| | - RICHARD L LIEBER
- Shirley Ryan AbilityLab and Department of Physiology, Northwestern University, Hines VA Medical Center, Chicago IL, USA
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17
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Cha SM, Shin HD, Shin JW. Primary repair of extensor pollicis longus rupture after volar locking plating for distal radial fracture. HAND SURGERY & REHABILITATION 2022; 41:500-507. [DOI: 10.1016/j.hansur.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/26/2022] [Accepted: 05/07/2022] [Indexed: 12/01/2022]
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18
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Bergwell H, Trevarrow M, Corr B, Baker S, Reelfs H, Wilson TW, Moreau NG, Kurz MJ. Power training alters somatosensory cortical activity of youth with cerebral palsy. Ann Clin Transl Neurol 2022; 9:659-668. [PMID: 35297546 PMCID: PMC9082383 DOI: 10.1002/acn3.51545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Our prior magnetoencephalographic (MEG) investigations demonstrate that persons with cerebral palsy (CP) have weaker somatosensory cortical activity than neurotypical (NT) controls, which is associated with reduced muscular strength and mobility. Power training can improve lower extremity isokinetic strength, muscular power, and walking performance of youth with CP. Potentially, these clinically relevant improvements are partially driven by changes in somatosensory processing. The objective of this investigation was to determine if power training has complementary changes in muscular function and somatosensory cortical activity in youth with CP. METHODS A cohort of youth with CP (N = 11; age = 15.90 ± 1.1 years) and NT controls (N = 10; Age = 15.93 ± 2.48 years) participated in this investigation. Youth with CP underwent 24 power training sessions. Pre-post bilateral leg press 1-repetition maximum (1RM), peak power production, 10-m walking speed, and distance walked 1-min were used as outcome measures. MEG neuroimaging assessed the changes in somatosensory cortical activity while at rest. NT controls only underwent a baseline MEG assessment. RESULTS Youth with CP had a 56% increase in 1RM (p < 0.001), a 33% increase in peak power production (p = 0.019), and a 4% improvement in 1-min walk (p = 0.029). Notably, there was a 46% increase in somatosensory cortical activity (p = 0.02). INTERPRETATION These results are the first to show that power training is associated with improvements in muscular function, walking performance, and the resting somatosensory cortical activity in individuals with CP. This treatment approach might be advantageous due to the potential to promote cortical and muscular plasticity, which appear to have carryover effects for improved walking performance.
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Affiliation(s)
- Hannah Bergwell
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Mike Trevarrow
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Brad Corr
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Sarah Baker
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Heidi Reelfs
- Department of Physical Therapy, Munroe‐Meyer InstituteUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Tony W. Wilson
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
- Department of Pharmacology and Neuroscience, School of MedicineCreighton UniversityOmahaNebraskaUSA
| | - Noelle G. Moreau
- Department of Physical Therapy, School of Allied Health ProfessionsLouisiana State UniversityNew OrleansLouisianaUSA
| | - Max J. Kurz
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
- Department of Pharmacology and Neuroscience, School of MedicineCreighton UniversityOmahaNebraskaUSA
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19
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Handsfield GG, Williams S, Khuu S, Lichtwark G, Stott NS. Muscle architecture, growth, and biological Remodelling in cerebral palsy: a narrative review. BMC Musculoskelet Disord 2022; 23:233. [PMID: 35272643 PMCID: PMC8908685 DOI: 10.1186/s12891-022-05110-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy (CP) is caused by a static lesion to the brain occurring in utero or up to the first 2 years of life; it often manifests as musculoskeletal impairments and movement disorders including spasticity and contractures. Variable manifestation of the pathology across individuals, coupled with differing mechanics and treatments, leads to a heterogeneous collection of clinical phenotypes that affect muscles and individuals differently. Growth of muscles in CP deviates from typical development, evident as early as 15 months of age. Muscles in CP may be reduced in volume by as much as 40%, may be shorter in length, present longer tendons, and may have fewer sarcomeres in series that are overstretched compared to typical. Macroscale and functional deficits are likely mediated by dysfunction at the cellular level, which manifests as impaired growth. Within muscle fibres, satellite cells are decreased by as much as 40–70% and the regenerative capacity of remaining satellite cells appears compromised. Impaired muscle regeneration in CP is coupled with extracellular matrix expansion and increased pro-inflammatory gene expression; resultant muscles are smaller, stiffer, and weaker than typical muscle. These differences may contribute to individuals with CP participating in less physical activity, thus decreasing opportunities for mechanical loading, commencing a vicious cycle of muscle disuse and secondary sarcopenia. This narrative review describes the effects of CP on skeletal muscles encompassing substantive changes from whole muscle function to cell-level effects and the effects of common treatments. We discuss growth and mechanics of skeletal muscles in CP and propose areas where future work is needed to understand these interactions, particularly the link between neural insult and cell-level manifestation of CP.
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Affiliation(s)
- Geoffrey G Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand.
| | - Sîan Williams
- Liggins Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand.,School of Allied Health, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Stephanie Khuu
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
| | - Glen Lichtwark
- School of Human Movement and Nutrition Sciences, University of Queensland, QLD, St Lucia, 4072, Australia
| | - N Susan Stott
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
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20
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Drumm M, Fabiano J, Lee E, Jezequel J, Rao AK, Yoon L. Effects of Power Training on Gait, Power, and Function in Children with Cerebral Palsy. Phys Occup Ther Pediatr 2022; 42:227-241. [PMID: 34753380 DOI: 10.1080/01942638.2021.1995098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Michaella Drumm
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia Fabiano
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Evelyn Lee
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer Jezequel
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Department of Rehabilitation and Performance, Hospital for Special Surgery, New York, NY, USA
| | - Ashwini K Rao
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.,G.H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Yoon
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
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21
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Busboom M, Corr B, Reelfs A, Trevarrow M, Reelfs H, Baker S, Bergwell H, Wilson TW, Moreau NG, Kurz MJ. Therapeutic Lower Extremity Power Training Alters the Sensorimotor Cortical Activity of Individuals with Cerebral Palsy. Arch Rehabil Res Clin Transl 2022; 4:100180. [PMID: 35282149 PMCID: PMC8904886 DOI: 10.1016/j.arrct.2022.100180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Individuals with cerebral palsy underwent therapeutic power training. Magnetoencephalography brain imaging was used to assess the neurophysiological changes. Clinical assessments included leg extension strength, power, and mobility. After therapy, participants with cerebral palsy had improved sensorimotor cortical activity. Participants also had improved leg extension strength, power, and mobility.
Objective To utilize magnetoencephalographic (MEG) brain imaging to examine potential changes in sensorimotor cortical oscillations after therapeutic power training in individuals with cerebral palsy (CP). Design Cohort. Setting Academic medical center. Participants Individuals with CP (N=11; age=15.9±1.1 years; Gross Motor Function Classification System I- III) and neurotypical controls (NTs; N=16; age=14.6±0.8 years). Interventions Participants with CP underwent 24 (8 weeks; 3 days a week) sessions of high-velocity lower extremity power training on a leg press. The NTs underwent single baseline MEG assessments. Main Outcome Measures Pre-post bilateral leg press 1-repetition maximum and peak power production were used to assess the muscular performance changes. The 10-m walk and 1-minute walk tests were used to assess mobility changes. During MEG recordings, participants used their right leg to complete a goal-directed isometric target-matching task. Advanced beamforming methods were subsequently used to image the strength of the sensorimotor beta oscillatory power. Results Before the therapeutic power training, the participants with CP had stronger beta sensorimotor cortical oscillations compared with the NT controls. However, the beta sensorimotor cortical oscillations were weaker and approximated the controls after the participants with CP completed the therapeutic power training protocol. There also was a link between the amount of improvement in leg peak power production and the amount of reduction in sensorimotor cortical oscillations seen after therapy. Conclusions Therapeutic power training appears to optimize the sensorimotor cortical oscillations of individuals with CP, and these neuroplastic changes partly contribute to improvements in the leg peak power production of individuals with CP. Therapeutic power training might provide the key ingredients for beneficial neuroplastic change.
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22
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Changing the Paradigm of School-Based Physical Therapist Service Delivery: Using Evidence to Support Intensive Intervention. Pediatr Phys Ther 2022; 34:73-80. [PMID: 34958336 DOI: 10.1097/pep.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article is to highlight the paradigm shift away from the typical model of direct service delivery of consistent frequency and duration in the school setting to accommodate an intensive progressive resistive exercise intervention. School-based physical therapists describe how they applied an evidence-based intensive intervention with multiple students in an urban public school district. SUMMARY OF KEY POINTS The school-based physical therapists had to modify the typical service delivery model and overcome other challenges to implement this intensive intervention approach. Substantial improvements in strength and functional activities were observed in multiple students and measured across several months. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE An intensive intervention model appears effective and feasible in the school setting. Evidence-based intervention approaches should be considered when the student could benefit. VIDEO ABSTRACT For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A339.
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23
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Gjesdal BE, Mæland S, Williams G, Aaslund MK, Rygh CB, Cumming KT. Can adults with cerebral palsy perform and benefit from ballistic strength training to improve walking outcomes? A mixed methods feasibility study. BMC Sports Sci Med Rehabil 2021; 13:160. [PMID: 34922592 PMCID: PMC8684268 DOI: 10.1186/s13102-021-00382-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Power bursts of hips and ankle plantar flexors are prerequisites to walking propulsion. However, these power bursts are reduced during gait for persons with cerebral palsy (CP) and mainly in the ankle plantar flexors. Hence, task specific training, such as ballistic strength training, is suggested to increase muscle power in walking but not investigated in adults with CP. Therefore, the aim was to investigate if adults with CP could perform and benefit from ballistic strength training to improve walking, evaluated through physical measures and self-reported measures and interviews. METHODS In this mixed methods feasibility study, eight ambulatory adults (aged 24-56) with spastic CP conducted ballistic strength training on a glideboard targeting the ankle plantarflexors two times a week for eight weeks. The feasibility of the training was assessed through objectives described by Orsmond and Cohn. Before and after the intervention, physical measures (6-Minute Walk Test and the eight-item High-level Mobility Assessment Tool) and self-reported measures (Patient Global Impression of Change, Numeric Pain Rating Scale, Fatigue Impact and Severity Self-Assessment, and Walk-12) were collected. After the intervention, semi-structured interviews explored experiences of this training. RESULTS The participants experienced training the ankle plantar flexor as relevant but reported it took about four weeks to coordinate the exercises successfully. Although we observed no changes in the physical performance measures, most participants reported improvements; some felt steadier when standing, walking, and hopping. CONCLUSION This study demonstrated that ballistic strength training was feasible and suitable in adults with CP. However, guidance and a long (4 weeks) familiarization time were reported necessary to master the exercises. Most participants reported self-experienced improvements, although no physical performance measures improved. Thus, prolonged intervention may be required for perceived physical improvements to emerge. Also, other outcome measures sensitive to power output remains to be investigated.
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Affiliation(s)
- Beate Eltarvåg Gjesdal
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway.
- Department of Global Public Health and Primary Care, Faculty of Medicine, The University of Bergen, Bergen, Norway.
| | - Silje Mæland
- Department of Global Public Health and Primary Care, Faculty of Medicine, The University of Bergen, Bergen, Norway
- Research Unit for General Practice in Bergen, Norwegian Research Centre, NORCE, Bergen, Norway
| | - Gavin Williams
- Department of Physiotherapy, Epworth Hospital, Richmond, Melbourne, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Mona Kristin Aaslund
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
| | - Cecilie Brekke Rygh
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
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Veerbeek BE, Lamberts RP, Kosel E, Fieggen AG, Langerak NG. More than 25 years after selective dorsal rhizotomy: physical status, quality of life, and levels of anxiety and depression in adults with cerebral palsy. J Neurosurg 2021; 136:689-698. [PMID: 34507281 DOI: 10.3171/2021.3.jns204096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The primary purpose of selective dorsal rhizotomy (SDR) is to ameliorate spasticity in the lower extremities of children with cerebral palsy (CP). In correctly selected patients, this neurosurgical procedure has been shown to have a beneficial effect on many aspects of the child's life. However, given the challenges faced by adults with CP, it would be valuable to document the status of this population compared to their peers later in adulthood. Therefore, the aim of this study was to determine the physical status, mental health, and health-related quality of life (HRQoL) of adults with CP who underwent SDR at least 25 years ago, compared to matched typically developing (TD) individuals. The second aim was to investigate relationships between physical status and the other outcome measures. METHODS Adults with CP were recruited from a database of children who had undergone SDR performed using the technique introduced by Professor Warwick Peacock at Red Cross War Memorial Children's Hospital in Cape Town, South Africa, between 1981 and 1991. These individuals were matched for age, sex, body mass index, and socioeconomic status to a TD adult cohort from a similar background. The parameters assessed were lower-extremity muscle tone, passive range of motion, muscle strength, selectivity, functional mobility and dynamic balance (Timed Up and Go [TUG] test), HRQoL (SF-36), and anxiety and depression levels. RESULTS Twenty-six adults with CP who had a median age of 35.8 years (interquartile range 34.2-41.4 years) (female/male: n = 10/16; Gross Motor Function Classification System level I/II/III: n = 13/10/3), were compared to 26 TD adults. Muscle tone was similar, whereas passive range of motion, muscle strength, selectivity, TUG, and SF-36 physical functioning (concept and summary) scores differed between the cohorts. Other SF-36 parameters, anxiety levels, and depression levels were not different. Strong correlations were found between the muscle strength and TUG scores. CONCLUSIONS Normalized lower-extremity muscle tone was sustained 25-35 years after SDR. Whereas the lower scores for physical assessments are in line with findings in other CP populations, remarkably, relatively good mental health and HRQoL scores were reported in this CP group despite their physical limitations. The strong correlation between muscle strength and TUG suggests that strength training after SDR may have value in improving functional mobility and balance.
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Affiliation(s)
- Berendina E Veerbeek
- 1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Robert P Lamberts
- 2Department of Sport Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; and
| | - Elisa Kosel
- 3Department of Biomechanics in Sports, Technical University of Munich, Germany
| | - A Graham Fieggen
- 1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Nelleke G Langerak
- 1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
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Hanssen B, De Beukelaer N, Schless SH, Cenni F, Bar-On L, Peeters N, Molenaers G, Van Campenhout A, Van den Broeck C, Desloovere K. Reliability of Processing 3-D Freehand Ultrasound Data to Define Muscle Volume and Echo-intensity in Pediatric Lower Limb Muscles with Typical Development or with Spasticity. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2702-2712. [PMID: 34112554 DOI: 10.1016/j.ultrasmedbio.2021.04.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
This investigation assessed the processer reliability of estimating muscle volume and echo-intensity of the rectus femoris, tibialis anterior and semitendinosus. The muscles of 10 typically developing children (8.15 [1.40] y) and 15 children with spastic cerebral palsy (7.67 [3.80] y; Gross Motor Function Classification System I = 5, II = 5, III = 5) were scanned with 3-D freehand ultrasonography. For the intra-processer analysis, the intra-class correlations coefficients (ICCs) for muscle volume ranged from 0.943-0.997, with relative standard errors of measurement (SEM%) ranging from 1.24%-8.97%. For the inter-processer analysis, these values were 0.853 to 0.988 and 3.47% to 14.02%, respectively. Echo-intensity had ICCs >0.947 and relative SEMs <4% for both analyses. Muscle volume and echo-intensity can be reliably extracted for the rectus femoris, semitendinosus and tibialis anterior in typically developing children and children with cerebral palsy. The need for a single processer to analyze all data is dependent on the size of the expected changes or differences.
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Affiliation(s)
- Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Nathalie De Beukelaer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Simon-Henri Schless
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Motion Analysis and Biofeedback Laboratory, ALYN Paediatric and Rehabilitation Hospital, Jerusalem, Israel
| | - Francesco Cenni
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Department of Mechanical Engineering, KU Leuven, Leuven, Belgium; Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | | | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
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26
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Nelson JA, Boyer ER. Perceived Limitations of Walking in Individuals With Cerebral Palsy. Phys Ther 2021; 101:6184953. [PMID: 33764475 DOI: 10.1093/ptj/pzab102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Impairments associated with cerebral palsy (CP) can affect gait quality and limit activity and participation. The purpose of this study was to quantify (1) which of 6 factors (pain, weakness, endurance, mental ability, safety concerns, balance) were perceived to limit walking ability the most in individuals with CP and (2) whether age or Gross Motor Function Classification System (GMFCS) level is related to that perception. METHODS This cross-sectional study queried data from a gait laboratory database. Perceived walking limitation was quantified using a 5-point Likert scale ("never" to "all of the time"). Included were 1566 children and adults (mean age = 10.9 y [SD = 6.8]; range = 3.0-72.1 y) with CP (GMFCS level I: 502; II: 564; III: 433; IV: 67). RESULTS Patients or caregivers perceived balance to limit walking ability to the greatest extent, followed by endurance, weakness, safety, mental ability, and pain. Balance was perceived to always limit walking ability in 8%, 22%, 30%, and 34% of individuals in GMFCS levels I through IV, respectively. Endurance was perceived to always limit walking ability in 5%, 13%, 13%, and 27% of individuals in GMFCS levels I through IV, respectively. There were minor differences in the perceived extent of limitation caused by the factors by GMFCS level. Only weak associations between age and pain, mental ability, safety, and balance were observed (Spearman rho = -0.13 to 0.24). CONCLUSION Patients or caregivers perceived decreased balance and endurance to most strongly limit walking ability. Efforts should be made to clinically track how both perceived and objective measures of these limiting factors change with age and intervention. IMPACT Following a patient- and family-centered care model, therapy that places greater emphasis on balance and cardiovascular endurance may have the greatest effect on walking ability for individuals with CP. Future research should quantify which therapeutic, surgical, and pharmacologic interventions minimize these impairments and optimize activity and participation. LAY SUMMARY Balance and endurance are perceived to be the greatest factors limiting walking in people with CP. If you have CP, your physical therapist might emphasize balance and cardiovascular endurance to improve your walking ability.
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Affiliation(s)
- Jennifer A Nelson
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, Minnesota, USA
| | - Elizabeth R Boyer
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, Minnesota, USA.,Department of Orthopedic Surgery, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
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Williams SA, Stott NS, Valentine J, Elliott C, Reid SL. Measuring skeletal muscle morphology and architecture with imaging modalities in children with cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:263-273. [PMID: 33107594 DOI: 10.1111/dmcn.14714] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/22/2022]
Abstract
AIM To investigate the use of ultrasound and magnetic resonance imaging (MRI) methodologies to assess muscle morphology and architecture in children with cerebral palsy (CP). METHOD A scoping review was conducted with systematic searches of Medline, Embase, Scopus, Web of Science, PubMed, and PsycInfo for all original articles published up to January 2019 utilizing ultrasound and/or MRI to determine morphological and architectural properties of lower limb skeletal muscle in children with CP. RESULTS Eighty papers used ultrasound (n=44), three-dimensional ultrasound (n=16), or MRI (n=20) to measure at least one muscle parameter in children and adolescents with CP. Most research investigated single muscles, predominantly the medial gastrocnemius muscle, included children classified in Gross Motor Function Classification System levels I (n=62) and II (n=65), and assessed fascicle length (n=35) and/or muscle volume (n=35). Only 21 papers reported reliability of imaging techniques. Forty-six papers assessed measures of Impairment (n=39), Activity (n=24), and Participation (n=3). INTERPRETATION Current research study design, variation in methodology, and preferences towards investigation of isolated muscles may oversimplify the complexities of CP muscle but provide a foundation for the understanding of the changes in muscle parameters in children with CP. WHAT THIS PAPER ADDS Current evidence is biased towards the medial gastrocnemius muscle and more functionally able children with cerebral palsy (CP). Variations in imaging techniques and joint positioning limit comparisons between studies. Clinimetric testing of parameters of CP muscle is not always considered. Assessment of parameter(s) of muscle with measures of participation is sparse.
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Affiliation(s)
- Sîan A Williams
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Starship Child Health, Auckland, New Zealand
| | - Jane Valentine
- Kids Rehab WA, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Catherine Elliott
- Kids Rehab WA, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Siobhán L Reid
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
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Walhain F, Desloovere K, Declerck M, Van Campenhout A, Bar-On L. Interventions and lower-limb macroscopic muscle morphology in children with spastic cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:274-286. [PMID: 32876960 DOI: 10.1111/dmcn.14652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/24/2022]
Abstract
AIM To identify and map studies that have assessed the effect of interventions on lower-limb macroscopic muscle-tendon morphology in children with spastic cerebral palsy (CP). METHOD We conducted a literature search of studies that included pre- and post-treatment measurements of lower-limb macroscopic muscle-tendon morphology in children with spastic CP. Study quality was evaluated and significant intervention effects and effect sizes were extracted. RESULTS Twenty-eight articles were identified. They covered seven different interventions including stretching, botulinum neurotoxin A (BoNT-A), strengthening, electrical stimulation, whole-body vibration, balance training, and orthopaedic surgery. Study quality ranged from poor (14 out of 28 studies) to good (2 out of 28). Study samples were small (n=4-32) and studies were variable regarding which muscles and macroscopic morphological parameters were assessed. Inconsistent effects after intervention (thickness and cross-sectional area for strengthening, volume for BoNT-A), no effect (belly length for stretching), and small effect sizes were reported. INTERPRETATION Intervention studies reporting macroscopic muscle-tendon remodelling after interventions are limited and heterogeneous, making it difficult to generalize results. Studies that include control groups and standardized assessment protocols are needed to improve study quality and data synthesis. Lack or inconclusive effects at the macroscopic level could indicate that the effects of interventions should also be evaluated at the microscopic level. WHAT THIS PAPER ADDS Muscle-targeted interventions to remodel muscle morphology are not well understood. Studies reporting macroscopic muscle remodelling following interventions are limited and heterogeneous. Passive stretching may preserve but does not increase muscle length. The effects of isolated botulinum neurotoxin A injections on muscle volume are inconsistent. Isolated strengthening shows no consistent increase in muscle volume or thickness.
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Affiliation(s)
- Fenna Walhain
- Department of Anatomy, Anton de Kom University of Suriname, Paramaribo, Suriname.,Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | - Marlies Declerck
- Department of Physical Therapy, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Anja Van Campenhout
- Department of Development and Regeneration, University Hospital Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Valadão P, Piitulainen H, Haapala EA, Parviainen T, Avela J, Finni T. Exercise intervention protocol in children and young adults with cerebral palsy: the effects of strength, flexibility and gait training on physical performance, neuromuscular mechanisms and cardiometabolic risk factors (EXECP). BMC Sports Sci Med Rehabil 2021; 13:17. [PMID: 33637124 PMCID: PMC7908003 DOI: 10.1186/s13102-021-00242-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
Background Individuals with cerebral palsy (CP) have problems in everyday tasks such as walking and climbing stairs due to a combination of neuromuscular impairments such as spasticity, muscle weakness, reduced joint flexibility and poor coordination. Development of evidence-based interventions are in pivotal role in the development of better targeted rehabilitation of CP, and thus in maintaining their motor function and wellbeing. Our aim is to investigate the efficacy of an individually tailored, multifaceted exercise intervention (EXECP) in children and young adults with CP. EXECP is composed of strength, flexibility and gait training. Furthermore, this study aims to verify the short-term retention of the adaptations three months after the end of the EXECP intervention. Methods Twenty-four children and young adults with spastic CP will be recruited to participate in a 9-month research project with a 3-month training intervention, consisting of two to three 90-min sessions per week. In each session, strength training for the lower limbs and trunk muscles, flexibility training for the lower limbs and inclined treadmill gait training will be performed. We will evaluate muscle strength, joint flexibility, neuromuscular and cardiometabolic parameters. A nonconcurrent multiple baseline design with two pre-tests and two post-tests all interspaced by three months is used. In addition to the CP participants, 24 typically developing age and sex-matched participants will perform the two pre-tests (i.e. no intervention) to provide normative data. Discussion This study has a comprehensive approach examining longitudinal effects of wide variety of variables ranging from physical activity and gross motor function to sensorimotor functions of the brain and neuromuscular and cardiometabolic parameters, providing novel information about the adaptation mechanisms in cerebral palsy. To the best of our knowledge, this is the first intervention study providing supervised combined strength, flexibility and gait training for young individuals with CP. Trial registration number ISRCTN69044459, prospectively registered (21/04/2017).
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Affiliation(s)
- Pedro Valadão
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Harri Piitulainen
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Eero A Haapala
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiina Parviainen
- Centre for Interdisciplinary Brain Research, University of Jyväskylä, Jyväskylä, Finland
| | - Janne Avela
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Taija Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Improvements in Muscle Strength Are Associated With Improvements in Walking Capacity in Young Children With Cerebral Palsy: A Secondary Analysis. Pediatr Phys Ther 2021; 33:24-30. [PMID: 33273255 DOI: 10.1097/pep.0000000000000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate whether changes in lower-limb muscle strength explain changes in walking capacity during 14-week periods of usual care, power training and follow-up for children with spastic cerebral palsy. METHODS Secondary analysis of a previously conducted double-baseline controlled trial of 22 children with spastic cerebral palsy. Generalized estimating equations were used to evaluate the relationships between within-subject changes in isometric muscle strength and walking capacity over 3 periods. RESULTS Changes in hip abductor strength were associated with changes in the Muscle Power Sprint Test, changes in gastrocnemius and hip abductor strength were associated with changes in the Shuttle Run Test, and changes in gastrocnemius strength were associated with changes in the 1-minute walk test. All associations supported better walking capacity with increased strength. CONCLUSION Walking capacity, especially sprint capacity, can be improved by increasing strength by functional power training in this population.
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The mechanisms of adaptation for muscle fascicle length changes with exercise: Implications for spastic muscle. Med Hypotheses 2020; 144:110199. [PMID: 33254508 DOI: 10.1016/j.mehy.2020.110199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/10/2020] [Accepted: 08/15/2020] [Indexed: 11/23/2022]
Abstract
We are proposing optimal training conditions that can lead to an increase in the number of serial sarcomeres (SSN) and muscle fascicle length (FL) in spastic muscles. Therapeutic interventions for increasing FL in clinical populations with neurological origin, in whom relative shortness of muscle fascicles contributed to the presentation of symptoms such as spasticity, contracture, and limited functional abilities, do not generally meet these conditions, and therefore, result in less than satisfactory outcomes. Based on a review of literature, we argue that protocols of exercise interventions that led to sarcomerogenesis, and increases in SSN and FL in healthy animal and human models satisfied three criteria: 1) all involved eccentric exercise at appropriately high velocity; 2) resulted in positive strain of muscle fascicles; and 3) momentary deactivation in the stretched muscle. Accordingly, to increase FL in spastic muscles, new exercise protocols in which the three presumed criteria are satisfied, must be developed, and long-term muscle architectural and functional adaptations to such trainings must be examined.
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Fleeton JRM, Sanders RH, Fornusek C. Strength Training to Improve Performance in Athletes With Cerebral Palsy: A Systematic Review of Current Evidence. J Strength Cond Res 2020; 34:1774-1789. [PMID: 31904719 DOI: 10.1519/jsc.0000000000003232] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fleeton, JRM, Sanders, RH, and Fornusek, C. Strength training to improve performance in athletes with cerebral palsy: A systematic review of current evidence. J Strength Cond Res 34(6): 1774-1789, 2020-Persons with cerebral palsy (CP) can partake in many different forms of organized sport including elite competition at state and international levels. There is limited evidence on how CP athletes should train to enhance performance. The purposes of this article were to conduct a systematic review of the current evidence on ambulatory individuals with CP for (a) strength and functional improvement through strength training; (b) potential sports performance improvement through strength training; (c) the identification of risk and special considerations associated with strength and conditioning for this population, and; (d) the identification of future research foci to educate strength and conditioning coaches on specific program design for elite CP athletes. Seven electronic databases were searched for studies investigating resistance training interventions. The databases were also searched for training interventions or investigations into sports performance in athletes with CP competing at regional level or above. Thirty articles were included in the systematic review of strength training, and 23 articles included in the narrative review of training for sports performance. High-quality evidence indicates that resistance training can improve muscular strength in individuals with CP, with some preliminary evidence of structural and neurological adaptations. However, there is limited evidence for functional improvements. Limited research has examined the performance capacity of athletes with CP, and no training interventions have been conducted. Coaches should employ existing guidelines when designing programs while considering specific athlete limitations. Initially, the focus should be increasing athlete muscular strength before considering specific sport demands.
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Affiliation(s)
- Jennifer R M Fleeton
- Faculty of Health Sciences, Discipline of Exercise and Sport Science, The University of Sydney, Lidcombe, New South Wales, Australia
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Effects of High-Velocity Strength Training on Movement Velocity and Strength Endurance in Experienced Powerlifters with Cerebral Palsy. J Hum Kinet 2020; 73:235-243. [PMID: 32774555 PMCID: PMC7386148 DOI: 10.2478/hukin-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The present study aimed to evaluate the effects of a 6-week high-velocity strength training (HVST) intervention on movement velocity and strength endurance in experienced powerlifters with cerebral palsy (CP). Eleven experienced powerlifters with CP and seven from a control group (CON), were subjected to 6-week HVST. An assessment of movement velocity and strength endurance was conducted one week before (T1) and one week after (T2) the 6-week training intervention. During testing, athletes performed a maximum number of bench press repetitions possible within 5 sets of 15 s each, with 1-min passive rest intervals in-between. The indicator of movement velocity was the weight pressed in the first 5 s (5sW) in all performed sets. Strength endurance was described by the total weight (TW) pressed during the test. 5sW in T2 was significantly higher as compared with T1 in the CP group only (T1 928.9 ± 342.9 kg vs. T2 1007.3 ± 324.6 kg; p = 0.016). TW in T2 was significantly higher as compared with T1, both in the CP group (T1 2550.5 ± 843.9 kg vs. T2 2809.8 ± 981.3 kg; p < 0.001) and in the CON group (T1 2300.7 ± 845.1 kg vs. T2 2468.9 ± 890.1 kg; p = 0.049). A 6-week program of HVST increased movement velocity in resistance trained CP athletes. The gains of strength endurance were observed in both groups.
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Chappell A, Allison GT, Williams G, Gibson N, Morris S. The effect of a running training intervention on ankle power generation in children and adolescents with cerebral palsy: A randomized controlled trial. Clin Biomech (Bristol, Avon) 2020; 76:105024. [PMID: 32416406 DOI: 10.1016/j.clinbiomech.2020.105024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children and adolescents with cerebral palsy who are classified as Gross Motor Function Classification Scale level I or II are usually able to run but lack ankle power generation for push-off. The aim of this study was to analyze the efficacy of a running training program in improving ankle power generation in children and adolescents with cerebral palsy. METHODS This randomized controlled trial compared kinematic and spatiotemporal data collected during running from 38 children and adolescents with unilateral or bilateral cerebral palsy before and after a 12-week running program. Normalized speed, stride length, cadence, foot strike pattern, peak ankle power generation, peak hip flexor power generation in swing and propulsion strategy were calculated. Linear mixed models were developed to analyze differences between groups. FINDINGS At follow-up the intervention group had increased normalized speed of running (t = -3.68 p < .01) while the control group got slower (t = 3.17 p < .01). In running, children in Gross Motor Function Classification Scale level II in the intervention group increased ankle power (t = 2.49 p = .01) while the control group did not change (t = 0.38 p = .71). In sprinting, children in Gross Motor Function Classification Scale levels I and II in the intervention group maintained ankle power (level I t = 0.32 p = .75; level II t = 1.56 p = .12) while those in the control group decreased ankle power (level I t = 4.69 p < .01; level II t = 2.52 p = .01). Most within-group differences did not result in significant between-group differences at follow-up. INTERPRETATION Power generation for running may be responsive to targeted intervention in children with cerebral palsy.
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Affiliation(s)
- A Chappell
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia; Ability Centre, Coolbinia, Western Australia, Australia.
| | - G T Allison
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - G Williams
- School of Health Sciences, University of Melbourne, Victoria, Australia; Epworth HealthCare, Victoria, Australia.
| | - N Gibson
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia; Ability Centre, Coolbinia, Western Australia, Australia; Perth Children's Hospital, Perth, Western Australia, Australia.
| | - S Morris
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
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Kara OK, Yardimci BN, Sahin S, Orhan C, Livanelioglu A, Soylu AR. Combined Effects of Mirror Therapy and Exercises on the Upper Extremities in Children with Unilateral Cerebral Palsy: A Randomized Controlled Trial. Dev Neurorehabil 2020; 23:253-264. [PMID: 31514564 DOI: 10.1080/17518423.2019.1662853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
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.
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Low-Intensity vs High-Intensity Home-Based Treadmill Training and Walking Attainment in Young Children With Spastic Diplegic Cerebral Palsy. Arch Phys Med Rehabil 2020; 101:204-212. [DOI: 10.1016/j.apmr.2019.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022]
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Abstract
PURPOSE OF REVIEW The goal of this review is to highlight the deficits in muscle and bone in children with cerebral palsy (CP), discuss the muscle-bone relationship in the CP population, and identify muscle-based intervention strategies that may stimulate an improvement in their bone development. RECENT FINDINGS The latest research suggests that muscle and bone are both severely underdeveloped and weak in children with CP, even in ambulatory children with mild forms of the disorder. The small and low-performing muscles and limited participation in physical activity are likely the major contributors to the poor bone development in children with CP. However, the muscle-bone relationship may be complicated by other factors, such as a high degree of fat and collagen infiltration of muscle, atypical muscle activation, and muscle spasticity. Muscle-based interventions, such as resistance training, vibration, and nutritional supplementation, have the potential to improve bone development in children with CP, especially if they are initiated before puberty. Studies are needed to identify the muscle-related factors with the greatest influence on bone development in children with CP. Identifying treatment strategies that capitalize on the relationship between muscle and bone, while also improving balance, coordination, and physical activity participation, is an important step toward increasing bone strength and minimizing fractures in children with CP.
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Affiliation(s)
- Christopher M Modlesky
- Department of Kinesiology, University of Georgia, 330 River Road, Room 353, Athens, GA, 30602, USA.
| | - Chuan Zhang
- Department of Kinesiology, University of Georgia, 330 River Road, Room 353, Athens, GA, 30602, USA
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Colquitt G, Kiely K, Caciula M, Li L, Vogel RL, Moreau NG. Community-Based Upper Extremity Power Training for Youth with Cerebral Palsy: A Pilot Study. Phys Occup Ther Pediatr 2020; 40:31-46. [PMID: 31282292 DOI: 10.1080/01942638.2019.1636924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: To examine the effects of an upper-extremity, community-based, and power-training intervention.Methods: Twelve participants with cerebral palsy (CP) [8 males, 4 females; mean age 14 years 6 months (SD 5 years 4 months), range 7-24] were randomly assigned to a rest-training (RT; n = 6) or training-rest (n = 6) group in this randomized, cross-over design. Training took place in participants' home or school, three times per week for 6 weeks. We examined changes in upper extremity average power output (Pavg) in watts (W) and changes in function via the Pediatric Outcomes Data Collection Instrument (PODCI).Results: Each participant completed at least 15 of the 18 total training sessions (91.2% adherence). Pavg increased 92.2% on average among participants (p < .05). There was a significant three-way interaction among treatment, sequence, and period with the data stratified by (Bimanual Fine Motor Function [BFMF]) level on the pain subscale of the PODCI (p = 0.0118). All participants decreased pain after training with the exception of individuals with lower functioning (BFMF II-V) in the RT group.Conclusion: A community-based upper extremity power-training intervention was feasible and effective at improving power among young people with CP and has the potential to improve pain.
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Affiliation(s)
- Gavin Colquitt
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - Keagan Kiely
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - Manuela Caciula
- Department of Fitness, Exercise and Sports, New Jersey City University, Jersey City, NJ, USA
| | - Li Li
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - Robert L Vogel
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Noelle G Moreau
- Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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The Effects of Functional Progressive Strength and Power Training in Children With Unilateral Cerebral Palsy. Pediatr Phys Ther 2019; 31:286-295. [PMID: 31220015 DOI: 10.1097/pep.0000000000000628] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Chappell A, Gibson N, Williams G, Allison GT, Morris S. Propulsion strategy in running in children and adolescents with cerebral palsy. Gait Posture 2019; 70:305-310. [PMID: 30927640 DOI: 10.1016/j.gaitpost.2019.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/11/2019] [Accepted: 02/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Running is a fundamental movement skill important for participation in physical activity. Children with cerebral palsy (CP) who are classified at Gross Motor Function Classification Scale (GMFCS) level I and II are able to run but may be limited by neuromuscular impairments. RESEARCH QUESTION To describe the propulsion strategy (PS) during running of children and adolescents with CP. METHODS This cross-sectional study used kinematic and kinetic data collected during running from 40 children and adolescents with unilateral or bilateral CP and 21 typically developing (TD) children. Maximum speed, peak ankle power generation (A2), peak hip flexor power generation in swing (H3) and PS (PS = A2/(A2 + H3)) were calculated. Linear mixed models were developed to analyze differences between groups. RESULTS Maximum speed, A2 and PS were significantly less in children with CP GMFCS level I than in TD children and significantly less in children in GMFCS level II than level I. For children with CP, A2 and PS were significantly smaller in affected legs than non-affected legs. In affected legs, H3 was significantly larger in children in GMFCS level II than GMFCS level I but not different between TD children and children in GFMCS level II. SIGNIFICANCE The contribution of ankle plantarflexor power to forward propulsion in running is reduced in young people with CP and is related to GMFCS level. This deficit appears to be compensated in part by increased hip flexor power generation but limits maximum sprinting speed.
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Affiliation(s)
- A Chappell
- School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia.
| | - N Gibson
- Perth Children's Hospital, Locked Bag 2010, Nedlands, Western Australia 6909, Australia
| | - G Williams
- School of Health Sciences, University of Melbourne, Victoria 3010, Australia
| | - G T Allison
- School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia
| | - S Morris
- School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia
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The Effect of Functional Home-Based Strength Training Programs on the Mechano-Morphological Properties of the Plantar Flexor Muscle-Tendon Unit in Children With Spastic Cerebral Palsy. Pediatr Exerc Sci 2019; 31:67-76. [PMID: 30424684 DOI: 10.1123/pes.2018-0106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of functional progressive resistance training (PRT) and high-intensity circuit training (HICT) on the mechano-morphological properties of the plantar flexor muscle-tendon unit in children with spastic cerebral palsy. METHODS Twenty-two children (12.8 [2.6] y old, Gross Motor Function Classification System levels I/II = 19/3) were randomly assigned to either a PRT group or an HICT group. The interventions consisted of functional lower limb exercises, which were performed at home 3 times per week for 8 weeks. Measurements at baseline, preintervention, postintervention, and follow-up were taken to assess ankle joint range of motion and the properties of the gastrocnemius medialis, vastus lateralis, rectus femoris, and Achilles tendon (eg, thickness, strength, stiffness). RESULTS Despite a nonsignificant increase in active torque in the HICT group, neither gastrocnemius medialis morphology nor Achilles tendon properties were significantly altered after the interventions. Vastus lateralis thickness increased following PRT only. CONCLUSIONS Functional home-based strength training did not lead to significant changes at the muscular level in children with cerebral palsy. We therefore assume that a more specific stimulus of higher intensity combined with a longer training duration might be necessary to evoke changes in muscles and tendons in individuals with cerebral palsy.
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Bjornson KF, Moreau N, Bodkin AW. Short-burst interval treadmill training walking capacity and performance in cerebral palsy: a pilot study. Dev Neurorehabil 2019; 22:126-133. [PMID: 29658831 PMCID: PMC7894036 DOI: 10.1080/17518423.2018.1462270] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To examine the effect of short-burst interval locomotor treadmill training (SBLTT) on walking capacity and performance in cerebral palsy (CP). METHODS Twelve children with spastic diplegic CP (average 8.6 years) across Gross Motor Function Classification System levels II (8) and III (4) were randomized to 20 SBLTT sessions over 4 or 10 weeks. SBLTT consisted of alternating 30 seconds of slow and fast walking for 30 minutes/session. Outcomes included the 10 m walk test, one-minute walk test (1MWT), and timed-up-and go (TUG) (capacity) and StepWatch (performance) collected at baseline, post, and 6 weeks post. RESULTS Fast speed (+.11, p = .04; +.11 m/s, p = .006), 1MWT (+11.2; +11.7 m, p = .006) and TUG (-1.7; -1.9 seconds, p = .006) improved post SBLTT and 6 weeks, respectively. Walking performance increased: average strides/day (+948; +1712, p < .001) and percent time in high strides rates (+0.4, p = 0.07; +0.2, p = .008). CONCLUSIONS Pilot study suggests SBLTT may improve short-term walking capacity and performance.
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Affiliation(s)
- Kristie F. Bjornson
- Seattle Children’s Research Institute, University of Washington, Seattle, WA, United States of America
| | - Noelle Moreau
- Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Amy Winter Bodkin
- Physical Medicine and Rehabilitation, University of Colorado, Denver, CO, United States of America
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Adjenti SK, Louw G, Jelsma J, Unger M. An electromyographic study of abdominal muscle activity in children with spastic cerebral palsy. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2018; 73:341. [PMID: 30135898 PMCID: PMC6093119 DOI: 10.4102/sajp.v73i1.341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/18/2017] [Indexed: 11/03/2022] Open
Abstract
Background Inadequate knowledge in the recruitment patterns of abdominal muscles in individuals with spastic-type cerebral palsy (STCP). Objectives To determine whether there is any difference between the neuromuscular activity (activation pattern) of the abdominal muscles in children with STCP and those of their typically developing (TD) peers. Method The NORAXAN® electromyography (EMG) was used to monitor the neuromuscular activity in abdominal muscles of individuals with STCP (n = 63), and the results were compared with the findings from age-matched TD individuals (n = 82). Results EMG frequencies were recorded during rest and during active states and compared using repeated measures ANOVA. Spearman's rank order correlation was used to explore relationships between age, body mass index and abdominal muscle activity. With the exception of the rectus abdominis (RA) muscle, the pattern of neuromuscular activity in children with STCP differs significantly from that of their TD peers. Three of the muscles - external oblique abdominis (EO), internal oblique abdominis (IO) and RA - in both groups showed significant changes (p < 0.001) in the frequency of EMG activity between the resting and active states. An elevated EMG activity at rest in the EO and IO was recorded in the STCP group, whereas the RA during resting and active stages showed similar results to TD individuals. Conclusion The findings from this study suggest that the RA could be targeted during rehabilitation regimens; however, the force generated by this muscle may not be sufficient for the maintenance of trunk stability without optimal support from the EO and IO muscles.
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Affiliation(s)
- Saviour K Adjenti
- Department of Anatomy, School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Ghana
| | - Graham Louw
- Division of Clinical Anatomy & Biological Anthropology, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Jennifer Jelsma
- Division of Physiotherapy, Department of Health & Rehabilitation Sciences, University of Cape Town, South Africa
| | - Marianne Unger
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Functional Mobility Improved After Intensive Progressive Resistance Exercise in an Adolescent With Spina Bifida. Pediatr Phys Ther 2018; 30:E1-E7. [PMID: 29579008 DOI: 10.1097/pep.0000000000000497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the use and effectiveness of a novel intensive progressive resistance exercise (PRE) approach to address the functional goals of a 14-year-old adolescent with a myelomeningocele. SUMMARY OF KEY POINTS The child had lower extremity weakness, knee and hip flexion contractures, impaired somatosensation, and cardiopulmonary deconditioning, affecting gait mechanics and functional ambulation. An 8-week intensive PRE-based intervention was designed to improve walking in the home by targeting both power-generating and stabilizing lower extremity musculature. Secondary intervention focused on cardiopulmonary endurance training. CONCLUSIONS The child demonstrated improvements in gait speed, walking endurance, and functional lower extremity strength. Knee contracture was moderately responsive to sustained stretching and positioning. WHAT THIS CASE ADDS TO EVIDENCE-BASED PRACTICE This intensive PRE training approach had been effective for improving function among youth with cerebral palsy, and to our knowledge it had not yet been applied to youth with other neurological conditions.
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van Vulpen LF, de Groot S, Rameckers E, Becher JG, Dallmeijer AJ. Improved Walking Capacity and Muscle Strength After Functional Power-Training in Young Children With Cerebral Palsy. Neurorehabil Neural Repair 2017; 31:827-841. [DOI: 10.1177/1545968317723750] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background. Strength training programs for children with cerebral palsy (CP) showed inconclusive evidence for improving walking, despite improvements in strength. Recent studies have suggested that strength training with high movement velocity is more effective for improving walking than traditional resistance training. Objective. The purpose of this study was to evaluate the effect of functional high-velocity resistance training (power-training) to improve muscle strength and walking capacity of children with CP. Method. Twenty-two children with spastic CP participated (13 bilateral, Gross Motor Function Classification System [GMFCS] level I [n = 10] and II [n = 12], 7.5 years [SD 1.8, range 4-10 years]). Within-subjects changes in a 14-weeks usual care period were compared with changes in a 14-week functional power-training period (in groups, 3×/wk). Outcome measures were the muscle power sprint test (MPST), 1-minute walk test (1MWT), 10-m shuttle run test (SRT), gross motor function (GMFM-66), isometric strength of lower-limb muscles and dynamic ankle plantar flexor strength. Results. Changes during the training period were significantly larger than changes in the usual care period for all outcome measures ( P < .05). Large improvements were found during the training period for walking capacity (ΔMPST [mean]: 27.6 W [95%CI 15.84-39.46, 83% increase], Δ1MWT: 9.4 m [95% CI 4.17-14.68, 13%], ΔSRT: 4.2 [95%CI 2.57-5.83, 56%], ΔGMFM-66: 5.5 [95% CI 3.33-7.74, 7%]) and muscle strength (18%-128%), while outcomes remained stable in the usual care period. Conclusions. The results indicate that functional power-training is an effective training for improving walking capacity in young children with cerebral palsy.
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Affiliation(s)
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
- University of Groningen, University Medical Center Groningen, the Netherlands
| | - Eugene Rameckers
- School for Public Health and Primary Care (CAPHRI), Maastricht University, the Netherlands
- University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, the Netherlands
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Damiano DL, Stanley CJ, Ohlrich L, Alter KE. Task-Specific and Functional Effects of Speed-Focused Elliptical or Motor-Assisted Cycle Training in Children With Bilateral Cerebral Palsy: Randomized Clinical Trial. Neurorehabil Neural Repair 2017; 31:736-745. [PMID: 28691601 DOI: 10.1177/1545968317718631] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Locomotor training using treadmills or robotic devices is commonly utilized to improve gait in cerebral palsy (CP); however, effects are inconsistent and fail to exceed those of equally intense alternatives. Possible limitations of existing devices include fixed nonvariable rhythm and too much limb or body weight assistance. OBJECTIVE To quantify and compare effectiveness of a motor-assisted cycle and a novel alternative, an elliptical, in CP to improve interlimb reciprocal coordination through intensive speed-focused leg training. METHODS A total of 27 children with bilateral CP, 5 to 17 years old, were randomized to 12 weeks of 20 minutes, 5 days per week home-based training (elliptical = 14; cycle = 13) at a minimum of 40 revolutions per minute, with resistance added when speed target was achieved. Primary outcomes were self-selected and fastest voluntary cadence on the devices and gait speed. Secondary outcomes included knee muscle strength, and selective control and functional mobility measures. RESULTS Cadence on trained but not nontrained devices increased, demonstrating task specificity of training and increased exercise capability. Mean gait speed did not increase in either group, nor did parent-reported functional mobility. Knee extensor strength increased in both. An interaction between group and time was seen in selective control with scores slightly increasing for the elliptical and decreasing for the cycle, possibly related to tighter limb coupling with cycling. CONCLUSIONS Task-specific effects were similarly positive across groups, but no transfer was seen to gait or function. Training dose was low (≤20 hours) compared with intensive upper-limb training recommendations and may be insufficient to produce appreciable clinical change.
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van Vulpen LF, de Groot S, Rameckers EAA, Becher JG, Dallmeijer AJ. Effectiveness of Functional Power Training on Walking Ability in Young Children With Cerebral Palsy: Study Protocol of a Double-Baseline Trial. Pediatr Phys Ther 2017; 29:275-282. [PMID: 28654503 DOI: 10.1097/pep.0000000000000424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect of functional high-velocity resistance (power) training to improve walking ability of young children with cerebral palsy. METHODS Twenty-two children with bi- or unilateral spastic cerebral palsy, Gross Motor Function Classification System levels I and II, aged 4 to 10 years will be recruited. A double-baseline design will be used to compare a 14-week functional power training (3 times a week) program with a 14-week usual care period and a 14-week follow-up period. The power exercises will be loaded and performed at 50% to 70% of the maximum unloaded speed. Load will be increased when exercises are performed faster than 70% of the unloaded speed. Primary outcomes will be sprinting capacity (15-m Muscle Power Sprint Test) and goal attainment scaling score of walking-related treatment goals. Secondary outcomes will be walking speed (1-min walk test), endurance (10-m shuttle run test), gross motor function, lower-limb strength, and parent-reported mobility.
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Affiliation(s)
- Liesbeth F van Vulpen
- Amsterdam Rehabilitation Research Center (Ms van Vulpen and Dr de Groot), Reade, Amsterdam, the Netherlands; Centre for Human Movement Sciences (Dr de Groot), University Medical Center, University of Groningen, the Netherlands; Department of Rehabilitation Medicine (Dr Rameckers), School for Public Health and Primary Care (CAPHRI), Maastricht University, the Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology (Dr Rameckers), Valkenburg and Hoensbroek, the Netherlands; University for Professionals for Pediatric Physical Therapy (Dr Rameckers), AVANSplus, Breda, the Netherlands; Department of Rehabilitation Medicine (Drs Becher and Dallmeijer), Research Institute MOVE and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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Abstract
PURPOSE To describe the physical therapy intervention and outcomes for a 20-week progressive running program. SUMMARY OF KEY POINTS A 12-year-old boy with spastic diplegic cerebral palsy, Gross Motor Function Classification System level II, participated in a 20-week running program. The 6-minute walk test and the 88-item and 66-item versions of the Gross Motor Function Measure (GMFM) were administered at baseline and program completion. After completion of the program, the participant exceeded thresholds for minimally clinically important differences on the GMFM-66 total score and GMFM-88 Dimension D and E scores. He improved gait speed and distance walked during the 6-minute walk test. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE Participation in a progressive running program is a feasible intervention to promote improvements in walking speed and gross motor function in some adolescents with spastic diplegic cerebral palsy in Gross Motor Function Classification System level II.
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Martín Lorenzo T, Albi Rodríguez G, Rocon E, Martínez Caballero I, Lerma Lara S. Relationship of medial gastrocnemius relative fascicle excursion and ankle joint power and work performance during gait in typically developing children: A cross-sectional study. Medicine (Baltimore) 2017; 96:e7572. [PMID: 28723790 PMCID: PMC5521930 DOI: 10.1097/md.0000000000007572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Muscle fascicles lengthen in response to chronic passive stretch through in-series sarcomere addition in order to maintain an optimum sarcomere length. In turn, the muscles' force generating capacity, maximum excursion, and contraction velocity is enhanced. Thus, longer fascicles suggest a greater capacity to develop joint power and work. However, static fascicle length measurements may not be taking sarcomere length differences into account. Thus, we considered relative fascicle excursions through passive ankle dorsiflexion may better correlate with the capacity to generate joint power and work than fascicle length. Therefore, the aim of the present study was to determine if medial gastrocnemius relative fascicle excursions correlate with ankle joint power and work generation during gait in typically developing children. A sample of typically developing children (n = 10) were recruited for this study and data analysis was carried out on 20 legs. Medial gastrocnemius relative fascicle excursion from resting joint angle to maximum dorsiflexion was estimated from trigonometric relations of medial gastrocnemius pennation angle and thickness obtained from B-mode real-time ultrasonography. Furthermore, a three-dimensional motion capture system was used to obtain ankle joint work and power during the stance phase of gait. Significant correlations were found between relative fascicle excursion and peak power absorption (-) r(14) = -0.61, P = .012 accounting for 31% variability, positive work r(18) = 0.56, P = .021 accounting for 31% variability, and late stance positive work r(15) = 0.51, P = .037 accounting for 26% variability. The large unexplained variance may be attributed to mechanics of neighboring structures (e.g., soleus or Achilles tendon mechanics) and proximal joint kinetics which may also contribute to ankle joint power and work performance, and were not taken into account. Further studies are encouraged to provide greater insight on the relationship between relative fascicle excursions and joint function.
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Affiliation(s)
- Teresa Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón
| | - Gustavo Albi Rodríguez
- Servicio de Radiodiagnóstico, Hospital Infantil Universitario Niño Jesús
- Departamento de Anatomía, Histología y Neurociencia, Facultad de Medicina, Universidad Autónoma de Madrid
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Arganda del Rey
| | | | - Sergio Lerma Lara
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, CSEU La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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Gannotti ME. Coupling Timing of Interventions With Dose to Optimize Plasticity and Participation in Pediatric Neurologic Populations. Pediatr Phys Ther 2017; 29 Suppl 3:S37-S47. [PMID: 28654476 PMCID: PMC5488702 DOI: 10.1097/pep.0000000000000383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this article is to propose that coupling of timing of interventions with dosing of interventions optimizes plasticity and participation in pediatric neurologic conditions, specifically cerebral palsy. Dosing includes frequency, intensity, time per session, and type of intervention. Interventions focus on body structures and function and activity and participation, and both are explored. Known parameters for promoting bone, muscle, and brain plasticity and evidence supporting critical periods of growth during development are reviewed. Although parameters for dosing participation are not yet established, emerging evidence suggests that participation at high intensities has the potential for change. Participation interventions may provide an additional avenue to promote change through the life span. Recommendations for research and clinical practice are presented to stimulate discussions and innovations in research and practice.
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Affiliation(s)
- Mary E Gannotti
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut
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