Adults with cerebral palsy benefit from participating in a strength training programme at a community gymnasium

PURPOSE: This study examined whether a community-based progressive resistance strength training programme could improve muscle strength and functional activity in a group of adults with cerebral palsy with high support needs. METHOD: Using a single group pre-post clinical design, 10 adults (7 males, 3 females; mean age 47.8 SD 5.7 years) with cerebral palsy and high support needs completed 4 weeks of introduction and familiarization, followed by a 10-week progressive resistance strength training programme in a community gymnasium. Participants were measured for muscle strength, locomotion speed and timed sit-to-stand. RESULTS: After establishment of a stable baseline from weeks 2 to 5 with no systematic change and a high degree of association (r>0.86), participants increased leg strength by 22.0% (p=0.02), arm strength by 17.2% (p=0.01) and improved performance of sit-to-stand (p=0.02) during the 10-week strength training intervention. CONCLUSIONS: This study adds to the accumulating evidence that strength training can be beneficial for people with cerebral palsy by demonstrating benefits for adults with cerebral palsy and high support needs who are subject to decline in physical function associated with the ageing process.     

功能性肌力训练在痉挛型脑瘫儿童中的应用

目的:观察功能性、闭链的肌力训练对痉挛型脑瘫儿童下肢的运动功能及步行能力的影响。方法:痉挛型脑瘫患儿20例,根据年龄、痉挛分型、运动功能评分进行配对,每对随机分成治疗组和对照组,对照组进行常规的神经发育技术治疗,治疗组在此基础上进行功能性肌力训练,治疗前和治疗6周后评估两组脑瘫患儿粗大运动功能、肌张力、关节活动度、步行能力。结果:治疗组粗大运动功能C、D、E区得分高于对照组(C区58.69±12.85,D区49.74±19.38,E区33.50±17.13,P<0.05),步行能力的改善优于对照组(10m步行时间13.90±5.28s,1min步行距离43.0±12.5m,P<0.05),关节活动度的改善大于对照组(踝背屈角度13.9±3.8°,P<0.05),而肌张力没有明显增加(肌张力平均秩10.50,P>0.05)。结论:功能性下肢肌力训练计划有助于改善脑瘫患儿的运动功能。     

脑瘫患儿的平衡功能训练

平衡功能训练是脑瘫患儿康复训练的一项内容 ,对提高患儿的康复效果有重要作用。1维持平衡的决定因素维持人体平衡的因素主要有 :①支持面 (ｓｕｐｐｏｒｔｓｕｒｆａｃｅ) ;②稳定极限 (ｌｉｍｉｔｏｆｓｔａｂｉｌｉｔｙ ,ＬＯＳ) ;③平衡感觉组织 (ｓｅｎｓｏｒｙｏｒｇａｎｉｚａｔｉｏｎ) :ａ.前庭系 :提供有关身体在一个不动的参照系统中的定位以及身体运动时的加速情况 ;ｂ .视觉 :提供周围环境的信息以及身体运动和方向信息 ;ｃ .本体觉 :由肌肉、关节、肌腱等处的感受器产生 ,传递各有关效应器发出的状态信息。2平衡功能评定2 .1平…     

Combining strength training and botulinum neurotoxin intervention in children with cerebral palsy: the impact on muscle morphology and strength

Purpose: Investigate the combination effects of strength training and Botulinum Toxin Type-A (BoNT-A) on muscle strength and morphology in children with Cerebral Palsy (CP). Methods: Fifteen children receiving BoNT-A, classified as Spastic Diplegic CP, GMFCS I-II, and aged 5–12 years were recruited for this study. Randomly allocated to 10 weeks of strength training either before or after BoNT-A, children were assessed over 6 months. Eight of the 15 children also completed a control period. The Modified Ashworth Scale measured spasticity. The Goal Attainment Scale (GAS) assessed achievement of functional goals. Magnetic Resonance Imaging assessed muscle volume (MV). Instrumented dynamometry assessed strength. Results: Spasticity was significantly reduced following BoNT-A injection (p = 0.033). Children made significant isokinetic strength gains (mean p = 0.022, ES = 0.57) in the intervention period compared to the control period (mean p = 0.15, ES = 0.56). Irrespective of timing, significant strength improvements were seen immediately (10 weeks) and over 6 months for all children. This was also the case for improvements in the GAS (immediately: mean p = 0.007, ES = 4.17, 6 months: mean p = 0.029, ES = 0.99), and improvements in MV in all assessed muscles. Conclusion: The simultaneous use of BoNT-A and strength training was successful in spasticity reduction, improving strength and achieving functional goals, over and above treatment with BoNT-A alone. Muscles targeted for BoNT-A injection should be included in strength training.

Implications for Rehabilitation

Cerebral Palsy

• Botulinum toxin type-A (BoNT-A) and strength training are available interventions that, on their own have found success in managing spasticity and muscle weakness (both significant motor impairments), respectively in children with Cerebral Palsy (CP).

• This study has demonstrated that the concurrent treatment of BoNT-A and strength training can achieve positive outcomes in terms of strength, spasticity and for the achievement of set functional goals.

• The results of this study show that the improved muscle strength can be associated with hypertrophy, which could indicate the potential role of strength training in altering the rate of muscle growth, in an aim to improve the failure of muscle growth associated with CP.

• Home based strength training, based on a child’s individual goals is shown to be successful in improving strength and goal attainment for children with CP.

     

Characteristics associated with improved knee extension after strength training for individuals with cerebral palsy and crouch gait

Muscle weakness may contribute to crouch gait in individuals with cerebral palsy, and some individuals participate in strength training programs to improve crouch gait. Unfortunately, improvements in muscle strength and gait are inconsistent after completing strength training programs. The purpose of this study was to examine changes in knee extensor strength and knee extension angle during walking after strength training in individuals with cerebral palsy who walk in crouch gait and to determine subject characteristics associated with these changes. A literature review was performed of studies published since January 2000 that included strength training, three-dimensional motion analysis, and knee extensor strength measurements for individuals with cerebral palsy. Three studies met these criteria and individual subject data was obtained from the authors for thirty crouch gait subjects. Univariate regression analyses were performed to determine which of ten physical examination and motor performance variables were associated with changes in strength and knee extension during gait. Change in knee extensor strength ranged from a 25% decrease to a 215% increase, and change in minimum knee flexion angle during gait ranged from an improvement of 9° more knee extension to 15° more knee flexion. Individuals without hamstring spasticity had greater improvement in knee extension after strength training. Hamstring spasticity was associated with an undesired increase in knee flexion during walking. Subject-specific factors such as hamstring spasticity may be useful for predicting which subjects will benefit from strength training to improve crouch gait.     

Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy.

OBJECTIVE: The aim of this study was to evaluate the effect on spasticity, muscle strength and motor performance after 8 weeks of whole-body vibration training compared with resistance training in adults with cerebral palsy. METHODS: Fourteen persons with spastic diplegia (21-41 years) were randomized to intervention with either whole-body vibration training (n=7) or resistance training (n=7). Pre- and post-training measures of spasticity using the modified Ashworth scale, muscle strength using isokinetic dynamometry, walking ability using Six-Minute Walk Test, balance using Timed Up and Go test and gross motor performance using Gross Motor Function Measure were performed. RESULTS: Spasticity decreased in knee extensors in the whole-body vibration group. Muscle strength increased in the resistance training group at the velocity 30 degrees /s and in both groups at 90 degrees /s. Six-Minute Walk Test and Timed Up and Go test did not change significantly. Gross Motor Function Measure increased in the whole-body vibration group. CONCLUSION: These data suggest that an 8-week intervention of whole-body vibration training or resistance training can increase muscle strength, without negative effect on spasticity, in adults with cerebral palsy.     

Strength training in adolescent learners with cerebral palsy: a randomized controlled trial

OBJECTIVE: To evaluate the impact of an eight-week strength training program targeting multiple muscle groups using basic inexpensive free weights and resistance devices, on gait and perceptions of body image and functional competence. DESIGN: A randomized control trial. SETTING: A school for children with special needs in a disadvantaged suburb in Cape Town. SUBJECTS: Thirty-one independently ambulant senior learners with spastic cerebral palsy (19 males, 12 females; aged 13-18 years; 15 diplegics and 16 hemiplegics). Intervention: Eight-week strength training programme in circuit format executed during school hours, one to three times per week for 40-60 min per session. Programmes were individually designed and included 8-12 exercises selected from a 28-station circuit to target upper and lower limbs and trunk. Twenty-one subjects took part in the strength training programme and were compared with 10 control subjects. MAIN OUTCOME MEASURES: Three-dimensional gait analysis and a questionnaire were used to evaluate the various parameters of gait and perceptions of body image and functional competence respectively. Results were analysed using repeated measures ANOVA and bootstrap analysis. RESULTS: The experimental group differed significantly from the control group for measure of crouch gait (sum of the ankle, knee and hip angles at midstance) (P= 0.05) and perceptions of body image (P= 0.01). Walking velocity, cadence and stride length as well as perceptions of functional ability did not change significantly after training. CONCLUSION: Participation in a school-based strength training programme targeting multiple muscle groups can lead to improved degree of crouch gait and improve perception of body image.     

Enhancement of isokinetic muscle strength with a combined training programme in chronic heart failure

BACKGROUND: Patients with congestive heart failure (CHF) exhibit an impaired exercised tolerance that dramatically limits their functional capacity and alters their quality of life. DESIGN: The aim of this study was to compare the effects of two types of training programmes on isokinetic muscle strength and aerobic capacities in patients with CHF. METHODS: A group of 23 stable CHF patients included consecutively followed an exercise training programme, 3 days a week for 8 weeks. The first group (P1, n=11) exercised on a cycloergometer for 45 min at 65% of peak VO2. The second group (P2, n=12) followed a 45-min combined bicycle and quadricipital strength training. Strength training consisted of 10 series of 10 repetitions at 70% of maximal voluntary force. Incremental maximal cardiopulmonary exercise tests as well as an isokinetic quadricipital dynamometry evaluation were performed before and after training. RESULTS AND CONCLUSIONS: In P1, peak VO2 increased by 20% (22.3+/-4.9 versus 17.8+/-4.5 ml min(-1) kg(-1); P<0.05) without any significant change in isokinetic muscle strength. In P2, peak VO2 improved within the same range (20.5+/-2.8 versus 18.6+/-3.7 ml min(-1) kg(-1); P<0.01). This last rehabilitation programme significantly increased isokinetic muscle strength at each angular velocities (+10.5+/-13.5%, P<0.04; +5.6+/-7.0%, P<0.03; for 180 degrees s(-1) and 60 degrees s(-1) respectively). Only the combined endurance/strength training programme was associated with an improvement in both peak VO2 and peripheral muscle strength, two significant parameters of outcome and quality of life in CHF.     

Isometric muscle strength and mobility capacity in children with cerebral palsy

Purpose: To determine the relationship between isometric leg muscle strength and mobility capacity in children with cerebral palsy (CP) compared to typically developing (TD) peers. Method: Participants were 62 children with CP (6–13 years), able to walk with (n?=?10) or without (n?=?52) walking aids, and 47 TD children. Isometric muscle strength of five muscle groups of the leg was measured using hand-held dynamometry. Mobility capacity was assessed with the 1-min walk, the 10-m walk, sit-to-stand, lateral-step-up and timed-stair tests. Results: Isometric strength of children with CP was reduced to 36–82% of TD. When adjusted for age and height, the percentage of variance in mobility capacity that was explained by isometric strength of the leg muscles was 21–24% (walking speed), 25% (sit-to-stand), 28% (lateral-step-up) and 35% (timed-stair) in children with CP. Hip abductors and knee flexors had the largest contribution to the explained variance, while knee extensors showed the weakest correlation. Weak or no associations were found between strength and mobility capacity in TD children. Conclusion: Isometric strength, especially hip abductor and knee flexor strength, is moderately related to mobility capacity in children with CP, but not in TD children. To what extent training of these muscle groups will lead to better mobility capacity needs further study.

• Implications for Rehabilitation

• Strength training in children with cerebral palsy (CP) may be targeted more specifically at hip abductors and knee flexors.

• The moderate associations imply that large improvements in mobility capacity may not be expected when strength increases.

     

脑瘫患儿照顾者获益感的现象学研究

目的:了解脑瘫患儿照顾者获益感的内容,为临床护理提供新思路.方法:2019年11月—2019年12月选取辽宁省某三级甲等医院儿科康复中心12名脑瘫患儿照顾者,对其进行半结构式访谈,采用现象学研究Colaizzi 7步分析法进行资料分析.结果:脑瘫患儿照顾者存在照顾获益感,并可归纳为4个主题:能力提升(处理问题能力、与他人交往能力、学习知识能力)、个人成长(懂得换位思考、主动承担照顾责任、学会接受现实)、照顾价值(感觉自己更加有用、收获肯定与称赞)及感知多方支持(感知社会支持、感知医护人员支持、感知家人及朋友支持).结论:脑瘫患儿照顾者能够在照顾孩子的过程中感知照顾获益感.临床护理人员应引导脑瘫患儿照顾者发现照顾的积极意义,对其进行针对性的指导,使其感知照顾获益感,从而维持长期照顾.     

Group aquatic training improves gait efficiency in adolescents with cerebral palsy

Purpose.?To evaluate the effect and feasibility of a 10-week group aquatic training programme on gait efficiency in adolescents with cerebral palsy (CP). The secondary purpose was to determine the exercise intensity during aquatic training in a heterogeneous group of adolescents with CP and to investigate the impact of the training programme on the musculoskeletal system.

Method.?Twelve ambulatory adolescents with spastic CP were recruited. They participated in 20 aquatic training sessions (45?min twice a week). Three physical therapists and a sports teacher supervised the training sessions. Participants wore a heart rate monitor to assess sessions' intensity and a floatation device as appropriate. The primary outcome measure was gait efficiency as measured by the gait energy expenditure index (EEI). The secondary measures were (1) gait spatiotemporal parameters, (2) maximal isometric knee strength and (3) gross motor function.

Results.?Ten adolescents completed the training programme. No adverse effect was reported. Average exercise intensity was mild to moderate for more than half of the training session. A significant reduction of the EEI and the heart rate during walking was observed following the training programme. No significant change was observed on secondary outcome measures.

Conclusions.?Group aquatic training increases gait efficiency in adolescents with CP. This improvement is related to systemic cardiorespiratory adaptations. Group aquatic training programme is feasible in adolescents presenting CP at different levels of severity.