Can Strength Training Predictably Improve Gait Kinematics? A Pilot Study on the Effects of Hip and Knee Extensor Strengthening on Lower-Extremity Alignment in Cerebral Palsy
ABSTRACT Computer simulations have demonstrated that excessive hip and knee flexion during gait, as frequently seen in ambulatory children with cerebral palsy (CP), can reduce the ability of muscles to provide antigravity support and increase the tendency of hip muscles to internally rotate the thigh. These findings suggest that therapies for improving upright posture during gait also may reduce excessive internal rotation.
The goal of this study was to determine whether strength training can diminish the degree of crouched, internally rotated gait in children with spastic diplegic CP.
This was a pilot prospective clinical trial.
Eight children with CP participated in an 8-week progressive resistance exercise program, with 3-dimensional gait analysis and isokinetic testing performed before and after the program. Secondary measures included passive range of motion, the Ashworth Scale, and the PedsQL CP Module. To identify factors that may have influenced outcome, individual and subgroup data were examined for patterns of change within and across variables.
Strength (force-generating capacity) increased significantly in the left hip extensors, with smaller, nonsignificant mean increases in the other 3 extensor muscle groups, yet kinematic and functional outcomes were inconsistent. The first reported subject-specific computer simulations of crouch gait were created for one child who showed substantial benefit to examine the factors that may have contributed to this outcome.
The sample was small, with wide variability in outcomes.
Strength training may improve walking function and alignment in some patients for whom weakness is a major contributor to their gait deficits. However, in other patients, it may produce no change or even undesired outcomes. Given the variability of outcomes in this and other strengthening studies in CP, analytical approaches to determine the sources of variability are needed to better identify those individuals who are most likely to benefit from strengthening.
SourceAvailable from: Daiane Lazzeri De Medeiros[Show abstract] [Hide abstract]
ABSTRACT: The effects of an intervention program with global postural reeducation (GPR) and a period of no treatment (8 weeks) were evaluated by kinematic analysis and evaluation of static and dynamic balance of an adult with cerebral palsy (CP). Evaluations of balance were made using the Berg Balance Scale, as well as gait kinematics evaluations, in which spatiotemporal and angular variables were analyzed. These assessments were made at the beginning and at the end of each intervention period. To characterize the parameters examined, descriptive statistics (mean and standard deviation) was used. The studied subject showed improvement of balance after the intervention period and, regarding angular variables, decreased hip extension and less trunk tilt were found. With the improvement of balance, hip extension and alignment of the trunk of the treated patient, it is suggested that the GPR intervention method can be effective as a practice of physical therapy for CP; however, more effective results may be associated with continuous treatment with this method, since during the intervals of the intervention, there was a reduction in balance.
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ABSTRACT: This article presents a critical review of the literature concerning the use of the lower limb strength training in improving the mobility of children and adolescents with cerebral palsy (CP). We also focus on the effectiveness and safety of the training. Medical databases were searched using keywords sequence: cerebral palsy, strength training, progressive strength training or resistance training. The 41 identified publications had been selected for the analysis; 19 of the studies met our inclusion criteria. Accepted studies were divided on randomized and non-randomized controlled trials. Level of evidence was rated. The results were presented according to the International Classification of Functioning, Disability and Health at three levels: structure, activity and participation. The strength training in children and adolescents with CP results in an increased muscle strength in the the lower limbs and improves patient’s activity and participation without adverse effects such as the increase of spasticity or of a passive range of motion decline. Due to many limitations and differences in the analyzed studies it still remains necessary to determine the characteristics of young patients with CP and a training protocol which enables to achieve the maximum benefits of the strength training.
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ABSTRACT: The primary goal of lower extremity management in children with cerebral palsy is to improve activity and participation or maintain motor function and minimize future deformity or disability. Concurrent or sequential administration of multiple types of interventions is the mainstay of treatment. This integrated treatment approach is provided by a multidisciplinary healthcare team. The goal of surgical management is to treat as many problems as possible with a single-event multilevel surgery. The purpose of this review is to explore the current strategies in lower extremity management, including tone management, therapy modalities, orthotics, and surgical interventions.Current Orthopaedic Practice 01/2013; 24(3):334-339. DOI:10.1097/BCO.0b013e31828d614c