The Pathophysiological Basis of Weakness in Children With Cerebral Palsy

Mockford, Margaret; Caulton, Janette M.

doi:10.1097/pep.0b013e3181dbaf96

Cited by 81 publications

(93 citation statements)

References 53 publications

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“…The clinical manifestations of CP most commonly observed are: changes in posture and balance (4), muscle tone (5), spasticity (6), muscle weakness (7) and low resistance to physical activity. These changes result in lack of control over movements, leading to adaptive changes of muscle length, and in some cases can result in bone deformities (8).…”

Section: Introductionmentioning

confidence: 99%

A case study of the effect of cardiovascular training on cerebral palsy

Teixeira

Santos

et al. 2016

Fisioter. mov.

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A case study of the effect of cardiovascular training on cerebral palsy [I] Estudo do condicionamento cardiovascular na paralisia cerebral -um estudo de caso [A] Jéssica Silva Teixeira, Luiza Mayara Lima de Jesus Santos, Nayhara Lemos dos Santos, Carla Cristine Cunha Casali, Carolina Marques Carvalho Mitre Chaves * Universidade de Itaúna (UI), Itaúna, MG, Brazil [R] Abstract Introduction: Cerebral palsy (CP) is a non-progressive disorder characterized by changes in muscle tone and voluntary movement, leading to adaptive changes in muscle length and in some cases, resulting in bone deformities and increased energy expenditure while performing activities of daily living. Objective: The aim of this study was to investigate the effects of cardiovascular training by an adult with athetoid CP. Methods: The sample was composed of one patient with athetoid CP. The instruments used were the timed ten-meter walk test; the SF-36 quality of life questionnaire, a six-minute walk test and the Timed Up and Go test. Using an exercise bike and resistance exercises for the upper limbs, the patient underwent 24 sessions lasting ifty minutes each during eight weeks. Results: In all tests, signi icant improvement was observed at four and eight weeks, especially in the irst four, and progressed in the following four weeks. In the post-training period, improvement was observed when compared to pre-training values. The SF-36 questionnaire on quality of life showed increase in some areas and decrease in others. Conclusion: Patients with CP can bene it from a physical training program, which can improve their quality of life and be included in their rehabilitation protocol. IntroductionCerebral palsy (CP) is a group of permanent postural and movement development disorders that limit activities, and are attributed to a non-progressive disorder that occurs during fetal development of the brain or childhood (1). Studies have shown the increased prospect of life of these patients when they do not present signi icant pathologies and receive appropriate medical care (2, 3).The clinical manifestations of CP most commonly observed are: changes in posture and balance (4), muscle tone (5), spasticity (6), muscle weakness (7) and low resistance to physical activity. These changes result in lack of control over movements, leading to adaptive changes of muscle length, and in some cases can result in bone deformities (8).The low resistance to physical activity observed in these individuals can be attributed to reduced oxidative capacity of the paretic muscles, overall decrease of aerobic resistance, and recruitment of motor units with increased energy expenditure during activities of daily living and sub-maximal exercise (9). The combination of these factors can lead to functional and social losses, and these patients tend to become increasingly sedentary (10).According to Batista et al. (10), patients with CP bene it from aerobic training, which should be included in rehabilitation programs. Gains in functional ability were observed in CP p...

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Section: Introductionmentioning

confidence: 99%

A case study of the effect of cardiovascular training on cerebral palsy

Teixeira

Santos

et al. 2016

Fisioter. mov.

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“…Children with spastic CP present spasticity, impaired selective motor control, impaired postural control, and muscle weakness as primary problems associated with a central nervous system lesion occurring in the immature brain [2]. In general, strength assessments of children with CP highlight their weakness relative to TD children [3][4][5]. Muscle weakness has been related to impaired neural control mechanisms, intrinsic muscle mechanics, and altered muscle architecture [6].…”

Section: Introductionmentioning

confidence: 99%

“…Because weakness in children with CP is usually treated at the muscle level, treatment goals and effects should as well be addressed at the muscle [7]. Evaluation of muscle structure gives us a better understanding of how muscles contribute to force generation [8][9][10] in children with CP, and in turn, to gait ability [4,5] and should therefore be assessed in detail [3,7,11,12].…”

Section: Introductionmentioning

confidence: 99%

Relative fascicle excursion effects on dynamic strength generation during gait in children with cerebral palsy

et al. 2015

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Evaluation of muscle structure gives us a better understanding of how muscles contribute to force generation which is significantly altered in children with cerebral palsy (CP). While most muscle structure parameters have shown to be significantly correlated to different expressions of strength development in children with CP and typically developing (TD) children, conflicting results are found for muscle fascicle length. Muscle fascicle length determines muscle excursion and velocity, and contrary to what might be expected, correlations of fascicle length to rate of force development have not been found for children with CP. The lack of correlation between muscle fascicle length and rate of force development in children with CP could be due, on the one hand, to the non-optimal joint position adopted for force generation on the isometric strength tests as compared to the position of TD children. On the other hand, the lack of correlation could be due to the erroneous assumption that muscle fascicle length is representative of sarcomere length. Thus, the relationship between muscle architecture parameters reflecting sarcomere length, such as relative fascicle excursions and dynamic power generation, should be assessed. Understanding of the underlying mechanisms of weakness in children with CP is key for individualized prescription and assessment of muscle-targeted interventions. Findings could imply the detection of children operating on the descending limb of the sarcomere length-tension curve, which in turn might be at greater risk of developing crouch gait. Furthermore, relative muscle fascicle excursions could be used as a predictive variable of outcomes related to crouch gait prevention treatments such as strength training.

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“…In children with cerebral palsy, walking is characterized by neuromuscular and musculoskeletal impairments such as reduced force-production, muscle co-activation, and excessive biomechanical forces though joints, contributing to a high energy cost. [3][4][5] In my opinion, this precludes using guidelines for the number of steps to walk per day developed for children without physical impairments as a standard for children with cerebral palsy, especially where joint protection is a consideration. Low impact or non-impact physical activities such as swimming and cycling may be more appropriate and enjoyable for some children.…”

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confidence: 99%

“…Personal factors (including sex, age, coping styles, attitude, and motivation), in addition to environmental factors and comorbid conditions, can have an impact upon actual performance of tasks in daily life. Two articles 3,4 There was an a priori decision to drop numerous questions from the PODCI, especially from the sports and physical function subscale, due to the different question structure. Several of the current authors published another paper 5 which included the dropped questions, using confirmatory factor analysis and item response theory in children with cerebral palsy, results showing that the sports and physical function subscale covers upper-range mobility, which Stout et al indicate is covered by the FAQ-22, though their discussion section concedes upper-range function coverage would improve with inclusion of these questions.…”

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confidence: 99%