Strength Training for Adolescents with cerebral palsy (STAR): study protocol of a randomised controlled trial to determine the feasibility, acceptability and efficacy of resistance training for adolescents with cerebral palsy

Abstract

IntroductionGait is inefficient in children with cerebral palsy, particularly as they transition to adolescence. Gait inefficiency may be associated with declines in gross motor function and participation among adolescents with cerebral palsy. Resistance training may improve gait efficiency through a number of biomechanical and neural mechanisms. The aim of the Strength Training for Adolescents with cerebral palsy (STAR) trial is to evaluate the effect of resistance training on gait efficiency, activity and participation in adolescents with cerebral palsy. We also aim to determine the biomechanical and neural adaptations that occur following resistance training and evaluate the feasibility and acceptability of such an intervention for adolescents with cerebral palsy.Methods and analysis60 adolescents (Gross Motor Function Classification System level I–III) will be randomised to a 10-week resistance training group or a usual care control group according to a computer-generated random schedule. The primary outcome is gait efficiency. Secondary outcomes are habitual physical activity, participation, muscle–tendon mechanics and gross motor function. General linear models will be used to evaluate differences in continuous data between the resistance training and usual care groups at 10 and 22 weeks, respectively. A process evaluation will be conducted alongside the intervention. Fidelity of the resistance training programme to trial protocol will be quantified by observations of exercise sessions. Semistructured interviews will be conducted with participants and physiotherapists following the resistance training programme to determine feasibility and acceptability of the programme.Ethics and disseminationThis trial has ethical approval from Brunel University London's Department of Clinical Sciences' Research Ethics Committee and the National Research Ethics Service (NRES) Committee London—Surrey Borders. The results of the trial will be submitted for publication in academic journals, presented at conferences and distributed to adolescents, families and healthcare professionals through the media with the assistance of the STAR advisory group.Trial registration numberISRCTN90378161; Pre-results.

Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) as a measure of physical activity (PA) in young people with cerebral palsy: A cross-sectional study

“…This study was nested within a randomised controlled trial (RCT) examining the feasibility, acceptability and efficacy of resistance training for adolescents with cerebral palsy. The recruitment and selection criteria have already been previously reported elsewhere [15]. The data for this study was collected as part of the routine assessments of this larger RCT.…”

Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy

“…Single joint resistance training may be more effective for less functional children, particularly at the beginning phases of training, as well as for adults who tend to compensate when performing bilateral, multijoint exercises. 120 Children, adolescents, or adults with CP who are not able to walk independently might also benefit from strength training, but they may lack the selective motor control needed to perform single joint exercises. 118,120 The therapist chooses that position where the specific amplitude to be improved can be targeted.…”

“…120 Children, adolescents, or adults with CP who are not able to walk independently might also benefit from strength training, but they may lack the selective motor control needed to perform single joint exercises. 118,120 The therapist chooses that position where the specific amplitude to be improved can be targeted.…”

“…This implies that training the recruitment of specific muscle activity during a functional exercise is crucial, as physiological muscle strength is usually not sufficient. 120,121 The child also needs to learn to activate the muscles in a more functional exercise. Also, providing improved muscle length does not necessarily imply that the child will activate its muscle at the improved range.…”

“…Practical examples of functional strength training include sit to stand repetitions and climbing stairs and when the child is sufficiently functional, possibly with a weight belt. 119,120 Antagonists or Agonists…”