The effects of progressive functional training on lower limb muscle architecture and motor function in children with spastic cerebral palsy

Abstract

[Purpose] To investigate the effects of progressive functional training on lower limb muscle architecture and motor function of children with spastic cerebral palsy (CP). [Subjects] The subjects of this study were 26 children with spastic CP. [Methods] Thirteen subjects in the experimental group performed general neurodevelopmental treatment (NDT) and additional progressive functional trainings and 13 subjects in the control group performed only general NDT 3 times a week for 6 weeks. Ultrasonography, gross motor function measurement (GMFM) and the mobility questionnaire (MobQue) were evaluated. [Results] After the intervention, the muscle thickness of the quadriceps femoris (QF), cross-sectional area of the rectus femoris (RF), pennation angle of the gastrocnemius (GCM) and the MobQue score of the experimental group were significantly greater than those of the control group. The muscle thickness of QF correlated with the cross-sectional area (CSA) of RF and the pennation angle of GCM, and GMFM score correlated with the pennation angle of GCM. [Conclusion] Progressive functional training can increase muscle thickness, CSA, and the pennation angle of the lower limb muscles, and improve the mobility of spastic CP children making it useful as a practical adjunct to rehabilitation therapy.

The impact of strength training on skeletal muscle morphology and architecture in children and adolescents with spastic cerebral palsy: A systematic review

“…One single-blind randomised controlled trial (RCT) was included investigating the effects of neurodevelopmental treatment and functional movement training on the lower limbs (Lee et al, 2015). The remaining five studies were all prospective designs, including two randomised cohort studies (Moreau et al, 2013;Stackhouse et al, 2007), two cohort follow-up studies (Lee et al, 2013;McNee et al, 2009), and one cross-comparison study (Williams et al, 2013).…”

“…Adherence rates calculated by the proportion of enrolled participants completing baseline assessments, all training sessions, and post-intervention measures were not reported by three studies (Lee et al, 2013(Lee et al, , 2015Williams et al, 2013). The adherence rate was 70% for the study by McNee et al (2009), 94% for the randomised cohort study by Moreau et al (2013), and 100% for the home-based intervention conducted by Stackhouse et al (2007).…”

“…None of the included studies had a pure control group that received no intervention. The study by Lee et al (2015) had a control group that underwent neurodevelopmental treatment, whereas Williams et al (2013) utilised a within-subject control period before participants received the training intervention. Participants in the study by Moreau et al (2013) were allocated to different modes of training to form comparison groups.…”

“…For all six studies, the length of intervention ranged from 6 to 12 weeks, with a frequency of 3-4 training sessions per week, totalling 18-40 sessions. Of the five lower limb interventions, training load was highly variable across studies, utilising a range of exercise modes that included maximum isometric contractions (Stackhouse et al, 2007); combined neurodevelopmental treatment and loaded functional movements such as sit-to-stands, lateral step-ups, and half-knee rises (Lee et al, 2015); heel raises or Thera Band calf press (McNee et al, 2009); isokinetic knee extension on a dynamometer (Moreau et al, 2013); and a mix of manual resistance, Thera Band exercises and ankle weights (Williams et al, 2013). The upper limb intervention (Lee et al, 2013) targeted the proximal and distal arm musculature implementing 60 min of weightbearing treadmill arm stepping in each session.…”

“…A small number of recent investigations have focussed on the effects of strength training on morphological and architectural properties of muscle in individuals with CP (Lee et al, 2013;Lee, Ko, Shin, & Lee, 2015;McNee, Gough, Morrissey, & Shortland, 2009;Moreau, Holthaus, & Marlow, 2013;Stackhouse et al, 2007;Williams et al, 2013), however, no reviews have been published regarding these outcomes. The effects of strength training on muscle morphology and architecture is important, as any structural changes may influence the mechanical properties of the musculotendinous unit, reduce muscle stiffness, and alter the interaction of the muscle and tendon during functional tasks such as walking.…”