The impact of an eight-week progressive resisted exercise program in adolescents with spastic cerebral palsy

Unger, Marianne (2004-04)

Thesis (MScPhysio)--Stellenbosch University, 2004.

Thesis

ENGLISH ABSTRACT: Muscle weakness is a problem for many young people with spastic cerebral palsy (CP). Many studies have reported that selective strength-training programs can improve muscle strength. However, most of these studies are of single group design and do not adequately control for confounding variables. Objective: To determine the impact of a comprehensive strength training program targeting multiple muscle groups on adolescents with CP, using basic inexpensive free weights and resistance devices. Method: A randomised clinical trial evaluated the effects of an eight-week strength-training program on 31 independently ambulant adolescents with spastic CP, with or without walking aids, from Eros School (19 males, 12 females; mean age 16 years 1 month; range 13 - 18 years). The Kin-Com dynamometer, 3-D gait analysis, the Economy of Movement test and a questionnaire was used to evaluate selected muscle strength, the degree of crouch gait, free walking velocity and stride length, energy consumption during walking and perceptions of body image and functional competence. Twenty one subjects took part in the strength-training program and were compared with 10 control subjects. Results were analysed using repeated measures ANOVA and bootstrap analysis. Results: Compared with the control, significant improvement in the degree of crouch as measured by the sum of the ankle, knee and hip angles at midstance (p=0.05) and perceptions of body image (p=0.01) were noted for the experimental group. Significant trends were also noted for isometric knee extension muscle strength at 30° as well as for hip abduction at 10° and 20°. Walking efficiency, -velocity and stride length remained unchanged as well as perceptions of functional ability. Conclusion: A strength-training program targeting multiple muscle groups including upper and lower limbs as well as the trunk, can lead to changes in muscle strength and improve the degree of crouch gait with improved perception of body image. Successful participation in such a program at school may motivate children with CP to continue with home-based basic strength training. Strength training alone did not decrease oxygen consumption during walking and inclusion of aerobic exercise is recommended.

AFRIKAANSE OPSOMMING: Spierswakheid is 'n probleem vir baie jong mense met serebrale verlamming (SV). Navorsing het getoon dat selektiewe versterkende oefenprogramme selektiewe spiere kan versterk, maar die meeste studies bestaan uit 'n enkel groep met onvoldoende beheer oor verstrengelde veranderlikes. Doel: Om die impak van 'n omvattende versterkende oefenprogram met basiese, goedkoop gewigte en weerstandsaparaat wat vele spiergroepe teiken, op adolesente met spastiese SV te evalueer. Metodologie: Die effekte van 'n agt weke lang versterkende oefenprogram is op 31 onafhanklik mobiel adolesente met spastiese SV, met of sonder loophulpmiddel, van Eros Skool deur middel van 'n ewekansige kliniese proef geevalueer (19 manlike, 12 vroulike deelnemers; gemiddelde ouderdom 16 jaar 1 maand; omvang 13 - 18 jaar). Die Kin-Com dinamometer, "3-D gait analysis", die "Economy of Movement" toets en 'n vraelys is gebruik om geselekteerde spiersterkte, die hoeveelheid knie fleksie gesien in die onderste ledemaat tydens loop, loopspoed en treelengte, energieverbruik tydens loop asook persepsies van liggaamsbeeld en funksionelevermoë te evalueer. Een en twintig het in die versterkende oefenprogram deelgeneem en is met 10 kontrole deelnemers vergelyk. Resultate is met behulp van herhaalde metings "ANOVA" en "bootstrap analysis" geanaliseer. Resultate: In vergelyking met die kontrole groep, het die experimentele groep betekenisvolle verbetering getoon in die hoeveelheid fleksie gesien in die ondersteledemaat (p=0.05) soos bereken deur die som van die enkel-, knie- en heuphoek in midstaan fase tydens loop, asook in liggaamspersepsie (p=0.01). Beduidenisvolle tendense is ook gesien by die experimentele groep vir isometriese knie ekstensie spiersterkte by 30° asook vir heup abduksie by 10° en 20°. Energieverbruik tydens loop asook loopspoed en treelengte was onveranderd asook persepsie van funksionele vermoë. Gevolgtrekking: 'n Versterkende oefenprogram wat verskeie spiergroepe teiken, insluitende die onderste en boonste ledemate asook die romp, kan lei tot In verbetering in spiersterkte, minder fleksie in die onderste ledemate tydens loop asook 'n verbetering in ligaamspersepsie. Suksesvolle deelname aan so 'n program op skool, mag kinders dalk motiveer om In basiese versterkende oefenprogram tuis voort te sit. Versterkende oefening alleen het geen vermindering in suurstofverbruik tydens loop veroorsaak en die insluit van aerobiese oefening word aanbeveel.

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