Accommodating variable-resistance exercise enhance weight-bearing/gait symmetry and balance capability in children with hemiparetic cerebral palsy: a parallel-group, single-blinded randomized clinical trial.

Abstract

Children with hemiparetic cerebral palsy (HCP) tend preferentially to bear their body weight on the non-paretic side, which leads to the emergence of asymmetrical walking patterns and limited ability to maintain balance. Therefore, improved and clearly effective intervention strategies to remedy these impairments are needed. This study endeavored to evaluate the efficacy of an accommodating variable-resistance exercise (AVr-Ex) program on weight-bearing symmetry, gait symmetry, and dynamic balance in children with HCP. This study employed a parallel-group, single-blinded randomized controlled design. Physical Therapy Outpatient Clinic and University Hospital, and a tertiary referral hospital. Thirty-six children with HCP aged between eight and 16 years were assigned randomly to the AVr-Ex group (N.=18) or control group (N.=18). Children in the AVr-Ex group undergone an AVr-Ex program, three sessions/week over eight consecutive weeks, besides the usual physical therapy while children in the Control group received the usual physical therapy alone. Outcome measures were evaluated before and after intervention and included weight-bearing symmetry indices [rearfoot (RF-WbSI), and forefoot (FF-WbSI)], gait symmetry indices (spatial [GSI<inf>spatial</inf>], and temporal [GSI<inf>temporal</inf>]), and dynamic balance. The post-treatment RF-WbSI (P<0.001; η<inf>p</inf>2=0.41), GSI<inf>spatial</inf> (P<0.001; η<inf>p</inf>2=0.42), GSI<inf>temporal</inf> (P<0.001; η<inf>p</inf>2=0.52), and dynamic balance variables (all P<0.05; η<inf>p</inf>2 ranged from 0.21 to 0.51) improved significantly in the AVr-Ex group compared to the control group, when controlled for the pre-treatment scores. This study suggests that AVr-Ex can improve weight-bearing symmetry, gait symmetry, and dynamic balance in children with HCP when incorporated into the usual physical rehabilitation program. AVr-Ex is likely an effective training paradigm to address weight-bearing/gait asymmetry and balance issues in children with HCP, which provides the basis for its incorporation in rehabilitation programs for such a patient population.