Abstract
Background and objectives: Ambulant children with cerebral palsy (CP) often develop impaired gait, and reduced active knee extension is often a part of the problem. This study aimed to evaluate the effect of a combined intervention program including stretching and progressive resistance exercise (PRE) targeting active knee extension on gait function, in children with spastic CP. Materials and methods: Thirty-seven children (21 boys, 16 girls, mean age 10.2 (±2.3) years), classified by Gross Motor Function Classification System I–III, were randomized to an intervention (n = 17) and a comparison group (n = 20). The intervention group received a 16-week combined exercise program (3 sessions per week) including stretching of hamstrings and PRE targeting the lower extremities, followed by a 16-week maintenance program (1 session per week). The comparison group received care as usual. Gait function was evaluated by three-dimensional gait analysis (3DGA); knee, hip and pelvic kinematics in the sagittal plane, step length and speed, Gait Deviation Index (GDI), and Six-Minute Walk test (6MWT) at 0, 16, and 32 weeks. Results: There were no statistically significant differences between the intervention group and the comparison group for any of the gait parameters measured at 16 and 32 weeks. There was a significant increase in gait distance measured by 6MWT within both groups; however, no differences between the groups were found. Conclusion: A 16-week combined stretching and PRE program followed by a 16-week maintenance program did not improve gait function in ambulant children with CP.
Highlights
Cerebral palsy (CP) is one of the most common causes of gait deviation in children
cerebral palsy (CP) start walking later than typically developed children and about 30% never walk independently [1,2]. This is caused by damage to the immature brain, which often results in primary impairments, like increased muscle tone, loss of selective motor control and impaired balance mechanisms, causing secondary impairments, such as muscle shortening, muscle weakness and decreased joint range of motion (ROM) [1,2]
The results from the present study showed that a 16-week hamstring stretching and progressive resistance exercise (PRE) program and a 16-week maintenance program did not result in any significant mean difference between the intervention group and the comparison group for any of the gait parameters measured (Table 3)
Summary
CP start walking later than typically developed children and about 30% never walk independently [1,2] This is caused by damage to the immature brain, which often results in primary impairments, like increased muscle tone, loss of selective motor control and impaired balance mechanisms, causing secondary impairments, such as muscle shortening, muscle weakness and decreased joint range of motion (ROM) [1,2]. Gait is a complex activity and Gage et al [1] describes the five prerequisites for normal gait as: stability in stands, foot clearance in swing, preposition of the foot in terminal swing, an adequate step length and energy conservation To achieve all these five prerequisites, there has to be adequate muscle strength, joint position and segment alignment [1], and stretching and muscle strength training are assumed to be important for the maintenance and improvement of gait function [1,6]. This study aimed to evaluate the effect of a combined intervention program including stretching and progressive resistance exercise (PRE) targeting active knee extension on gait function, in children with spastic CP
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