Effect of a Combined Stretching and Strength Training Program on Gait Function in Children with Cerebral Palsy, GMFCS Level I & II: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Intervention
- Five-minute warm-up on a treadmill or a stationary bicycle.
- Physiotherapist assisted stretches:
- Hamstring stretch was performed bilaterally with the child positioned supine, one leg flat on the bench and the contra lateral hip joint flexed to 90°. The physiotherapist supported the thigh and the child performed an active extension of the knee. Voluntary active knee extension was held for 5 s followed by the physiotherapist supporting and keeping the stretch, with constant stretching force as tolerated by the child at the end position for additional 40 s; 5 repetitions were performed.
- If a short psoas was registered at baseline (≤5° extension) a psoas- stretch was performed with the child positioned prone. The child preformed an assisted active extension of one hip for 5 s, followed by the physiotherapist who supported and kept the hip extension at the end position for additional 40 s; 5 repetitions. There was 10–15 s rest between the stretches.
- Four PRE exercises:
- Three multi-joint exercises with a loaded back-pack: (1) squats, (2) heel rise and (3) step-up on a stair.
- One single-joint exercise was performed with the child positioned supine on a bench performed maximum knee-extension over a bolster. The physiotherapist applied manual resistance on the distal leg. It was therefore not possible to objectively control the load and progression applied.
- The exercises were performed bilaterally with 2 min. breaks between the exercises
- Passive hamstring stretch: sitting on a chair with one knee extended and the heel on the floor, leaning the trunk forward from the hip joint. The stretch was held for 45 s × 5, bilaterally.
- Strength exercise: squats (1) with a loaded back-pack. To familiarize with the two home exercises, the child was instructed by the physiotherapist the first three weeks. The following weeks the exercises were performed at home without guidance
2.4. Outcome Measures
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | Intervention Group (n = 17) | Comparison Group (n = 20) |
---|---|---|
Gender (boys/girls) | 7/10 | 14/6 |
Age (years) | 10.4 ± 2.3 | 10.0 ± 2.3 |
Height (cm) | 141.3 ± 16.5 | 141.4 ± 12.8 |
Body weight (kg) | 37.6 ± 13.3 | 39.9 ± 12.9 |
BMI (kg/m2) | 17.8 ± 3.6 | 19.7 ± 4.7 |
GMFCS I/II/III | 10/7/0 | 12/7/1 |
Gait Parameters | Intervention Group | |||||
---|---|---|---|---|---|---|
n | T0 | T1 | T0–T1 | T2 | T0–T2 | |
Mean ± SD | Mean ± SD | Mean Diff ± SD | Mean ± SD | Mean Diff ± SD | ||
Knee angle, foot strike (deg) | 16 | 16.1 ± 6.8 | 16.1 ± 8.5 | −0.01 ± 4.4 | 17.5 ± 10.5 | −1.4 ± 6.1 |
Hip angle, foot strike (deg) | 16 | 41.1 ± 12.1 | 42.6 ± 11.7 | −1.5 ± 4.7 | 41.7 ± 10.2 | −0.6 ± 5.6 |
Pelvic angle, foot strike (deg) | 16 | 16.8 ± 7.3 | 16.9 ± 7.6 | 0.5 ± 3.1 | 15.6 ± 7.8 | 0.3 ± 3.1 |
Min knee angle, stands (deg) | 16 | 5.7 ± 8.7 | 6.0 ± 8.9 | −0.3 ± 4.8 | 6.4 ± 9.8 | −0.7 ± 6.1 |
Step length (cm) | 16 | 52.7 ± 8.2 | 54.0 ± 9.8 | −1.3 ± 5.5 | 55.8 ± 10.6 | −3.2 ± 5.1 |
Speed (m/s) | 16 | 1.05 ± 0.2 | 1.1 ± 0.2 | −0.05 ± 0.1 | 1.04 ± 0.3 | 0.18 ± 0.3 |
Six-Minute Walk Test (m) | 15 | 390.5 ± 106.9 | 436.2 ± 114.8 | −45.7 ± 55.4 * | 441.6 ± 121.6 | −51.1 ± 72.8 * |
Gait deviation index | 16 | 78.8 ± 11.1 | 79.2 ± 11.2 | −0.4 ± 4.4 | 79.5 ± 11.7 | −0.7 ± 6.0 |
Comparison Group | ||||||
n | T0 | T1 | T0–T1 | T2 | T0–T2 | |
Mean ± SD | Mean ± SD | Mean Diff ± SD | Mean ± SD | Mean Diff ± SD | ||
Knee angle, foot strike (deg) | 18 | 17.5 ± 9.0 | 15. 0 ± 10.6 | 2.6 ± 5.2 | 14.8 ± 10.9 | 2.6 ± 6.4 |
Hip angle, foot strike (deg) | 18 | 39.9 ± 7.5 | 37.8 ± 7.7 | 2.1 ± 7.2 | 38.0 ± 8.6 | 1.9 ± 6.5 |
Pelvic angle, foot strike (deg) | 18 | 14.3 ± 5.3 | 13.2 ± 3.9 | 1.1 ± 3.9 | 14.2 ± 3.9 | 0.1 ± 4.1 |
Min knee angle, stands (deg) | 18 | 5.9 ± 9.3 | 4.0 ± 10.7 | 1.8 ± 5.0 | 3.4 ± 11.5 | 2.4 ± 5.2 |
Step length (cm) | 18 | 51.6 ± 9.5 | 51.2 ± 9.8 | 0.4 ± 5.4 | 51.3 ± 10.4 | 0.3 ±7.4 |
Speed (m/s) | 18 | 1.02 ± 0.2 | 0.97 ± 0.3 | 0.05 ± 0.2 | 1.03 ± 0.2 | −0.01 ± 0.2 |
Six-Minute Walk Test (m) | 16 | 349.9 ± 112.7 | 405.2 ± 123.5 | −55.4 ± 55.5 * | 406.5 ± 133.9 | −56.6 ± 59.6 * |
Gait deviation index | 18 | 80.0 ±9.7 | 79.1 ± 15.2 | 0.8 ± 7.14 | 79.0 ± 11.6 | 1.01 ±5.9 |
Gait Parameters | T0–T1 | T0–T2 | ||||
---|---|---|---|---|---|---|
n | Mean Difference (95% CI) | p Value | n | Mean Difference (95% CI) | p Value | |
Knee angle, foot strike (deg) Hip angle, foot strike (deg) Pelvic angle foot strike (deg) Minimum knee angle in stands (deg) Step length (cm) Speed (m/s) Six-Minute Walk Test (m) Gait deviation index | 34 34 34 34 34 34 31 34 | −2.4 (−5.8 to 1.0) −3.7 (−7.9 to 0.5) −1.6 (−3.9 to 0.7) −2.2 (−5.7 to1.4) −1.5 (−5.3 to 2.2) −0.1 (−0.2 to 0.05) 10.6 (−29.3 to 50.6) −1.0 (−5.3 to3.3) | 0.161 0.081 0.172 0.228 0.408 0.188 0.590 0.650 | 34 34 34 34 34 34 31 34 | −3.9 (−8.5 to 0.6) −2.8 (−6.9 to 1.3) 0.6 (−1.8 to 2.9) −3.2 (−7.3 to 1.0) −3.3 (−7.9 to 1.2) −0.02 (−0.02 to 0.2) 7.2 (−43.3 to 57.7) −1.4 (−5.6 to 2.8) | 0.088 0.175 0.638 0.128 0.149 0.778 0.772 0.504 |
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Fosdahl, M.A.; Jahnsen, R.; Kvalheim, K.; Holm, I. Effect of a Combined Stretching and Strength Training Program on Gait Function in Children with Cerebral Palsy, GMFCS Level I & II: A Randomized Controlled Trial. Medicina 2019, 55, 250. https://doi.org/10.3390/medicina55060250
Fosdahl MA, Jahnsen R, Kvalheim K, Holm I. Effect of a Combined Stretching and Strength Training Program on Gait Function in Children with Cerebral Palsy, GMFCS Level I & II: A Randomized Controlled Trial. Medicina. 2019; 55(6):250. https://doi.org/10.3390/medicina55060250
Chicago/Turabian StyleFosdahl, Merete Aarsland, Reidun Jahnsen, Kristin Kvalheim, and Inger Holm. 2019. "Effect of a Combined Stretching and Strength Training Program on Gait Function in Children with Cerebral Palsy, GMFCS Level I & II: A Randomized Controlled Trial" Medicina 55, no. 6: 250. https://doi.org/10.3390/medicina55060250