What are the effects, if any, of lower-extremity strength training on gait in children with cerebral palsy?

Abstract

The purpose of “Evidence in Practice” is to illustrate the literature search process to obtain evidence that can guide clinical decision making. This article is not a case report. The examination, evaluation, and intervention sections are purposely abbreviated. A 7-year-old boy with cerebral palsy who enjoyed fishing, hiking, and playing baseball was referred to our outpatient clinic for reexamination. He reported that he was having new difficulties playing baseball in a specialized community league. These difficulties included maintaining an upright stance while batting and getting to the bases quickly enough after hitting the ball. He was born at 30 weeks gestational age, and his ability to reach developmental milestones has always been delayed. His pediatrician diagnosed him with spastic diplegic cerebral palsy at 18 months corrected age. Since he was 18 months old, he was a regular patient of another physical therapist at our outpatient clinic, visiting once a week. The boy originally worked on developmental sequencing, transitions, and gait, and he consistently met his goals, including his goal of ambulating in the home and community. Physical therapy visits were cut back to once every other week to continue working on increasing range of motion (ROM), muscle strengthening, and gait, and to remedy new problems as they arose. Therapy eventually was put on hold because he became more involved in community programs and he consistently missed appointments. He recently began attending physical therapy again because of his difficulties playing baseball. Our patient ambulated all distances wearing bilateral solid ankle-foot orthoses (AFOs) and using Loftstrand crutches. Active and passive ROM was normal for all 4 extremities, with the exception of decreased hip extension (0°–10°), knee extension (−15°), and ankle dorsiflexion (0°–10°) bilaterally, with active ROM more limited than passive ROM.1 Manual muscle tests of the bilateral lower extremities revealed weakness …