The Changes of Gross Motor Function and Balance Ability in Children with Spastic Diplegic Cerebral Palsy by Trunk Muscle Strengthening Exercise : Single Group Repeated Measure Study

체간근력 강화운동에 의한 경직성 양하지 뇌성마비 아동의 대단위 운동 및 균형 능력 변화: 단일그룹 반복측정 연구

  • Lee, Eun-Jung (Ulsan Community Rehabilitation Center) ;
  • Kim, Jong-Soon (Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan)
  • 이은정 (울산광역시장애인종합복지관) ;
  • 김종순 (부산가톨릭대학교 보건과학대학 물리치료학과)
  • Received : 2011.04.13
  • Accepted : 2011.05.08
  • Published : 2011.05.31

Abstract

Purpose: Trunk muscle weakness in the children with cerebral palsy can lead to postural and alignment problems, breathing difficulties, and so on. Therefore, children with cerebral palsy can benefit from exercises that strengthen the muscles in their trunks. The purpose of this study was to investigate the effects of trunk muscle strengthening exercise on functional gross movement and balance ability in children with spastic diplegic cerebral palsy. Methods: We used single group repeated measure design in 8 children(four males, four females; aged 6~12 years; mean 8.3 years) with diplegia. The functional gross motor outcome measured by using the GMFM and balance ability of all children was measured by pediatric balance scale. All participants were alternately received trunk strengthening exercise and neurodevelopment treatment for 40 minutes twice per week during 8 weeks. Results: Significant and clinical meaningful improvement in functional gross motor and balance ability were shown. Conclusion: The results indicate that trunk strengthening exercise has a positive effect on both functional gross motor and balance ability in children with spastic diaplegic cerebral palsy.

Keywords

References

  1. Ashton-Miller JA, Wojtys EM, Huston LJ et al. Can proprioception really be improved by exercises? Knee Surg Sports Traumatol Arthrosc. 2001;9(3):128-36. https://doi.org/10.1007/s001670100208
  2. Behm DG, Leonard AM, Young WB et al. Trunk muscle electromyographic activity with unstable and unilateral exercises. J Strength Cond Res. 2005;19(1):193-201.
  3. Bobath B. The treatment of neuromuscular disorders by improving patterns of co-ordination. Physiotherapy. 1969;55(1):18-22.
  4. Burtner PA, Qualls C, Woollacott MH. Muscle activation characteristics of stance balance control in children with spastic cerebral palsy. Gait Posture. 1998;8(3):163-74. https://doi.org/10.1016/S0966-6362(98)00032-0
  5. Coluccini M, Maini ES, Martelloni C et al. Kinematic characterization of functional reach to grasp in normal and in motor disabled children. Gait Posture. 2007;25(4):493-501. https://doi.org/10.1016/j.gaitpost.2006.12.015
  6. Cosio-Lima LM, Reynolds KL, Winter C et al. Effects of physioball and conventional floor exercises on early phase adaptations in back and abdominal core stability and balance in women. J Strength Cond Res. 2003;17(4):721-5.
  7. Damiano DL, Abel MF. Relation of gait analysis to gross motor function in cerebral palsy. Dev Med Child Neurol. 1996;38(5):389-96.
  8. Damiano DL, Abel MF. Functional outcomes of strength training in spastic cerebral palsy. Arch Phys Med Rehabil. 1998;79(2):119-25. https://doi.org/10.1016/S0003-9993(98)90287-8
  9. Damiano DL, Quinlivan J, Owen BF et al. Spasticity versus strength in cerebral palsy: relationships among involuntary resistance, voluntary torque, and motor function. Eur J Neurol. 2001;8(Suppl 5):40-9. https://doi.org/10.1046/j.1468-1331.2001.00037.x
  10. Dodd KJ, Taylor NF, Graham HK. A randomized clinical trial of strength training in young people with cerebral palsy. Dev Med Child Neurol. 2003;45(10):652-7.
  11. Eek MN, Tranberg R, Zugner R et al. Muscle strength training to improve gait function in children with cerebral palsy. Dev Med Child Neurol. 2008;50(10):759-64. https://doi.org/10.1111/j.1469-8749.2008.03045.x
  12. Elder GC, Kirk J, Stewart G et al. Contributing factors to muscle weakness in children with cerebral palsy. Dev Med Child Neurol. 2003;45(8):542-50.
  13. Fetters L. Measurement and treatment in cerebral palsy: an argument for a new approach. Phys Ther. 1991;71(3):244-7.
  14. Fosano VA, Broggi G, Barolat-Romana G et al. Surgical treatment of spasticity in cerebral palsy. Childs Brain. 1978;4(5):289-305.
  15. Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther. 2003;15(2):114-28. https://doi.org/10.1097/01.PEP.0000068117.48023.18
  16. Harris FA. Inapproprioception: a possible sensory basis for athetoid movements. Phys Ther. 1971;51(7):761-70.
  17. Hodgkinson I, Bérard C, Jindrich ML et al. Selective dorsal rhizotomy in children with cerebral palsy. Results in 18 cases at one year postoperatively. Stereotact Funct Neurosurg. 1997;69(1-4 Pt 2):259-67. https://doi.org/10.1159/000099885
  18. Hulme JB, Poor R, Schulein M et al. Perceived behavioral changes observed with adaptive seating devices and training programs for multihandicapped, developmentally disabled individuals. Phys Ther. 1983;63(2):204-8.
  19. Ikeda AJ, Abel MF, Granata KP et al. Quantification of cocontraction in spastic cerebral palsy. Electromyogr Clin Neurophysiol. 1998;38(8):497-504.
  20. Lee JH, Sung IY, Yoo JY. Therapeutic effects of strengthening exercise on gait function of cerebral palsy. Disabil Rehabil. 2008;30(19):1439-44. https://doi.org/10.1080/09638280701618943
  21. Lehman GJ, MacMillan B, MacIntyre I et al. Shoulder muscle EMG activity during push up variations on and off a Swiss ball. Dyn Med. 2006;5:7. https://doi.org/10.1186/1476-5918-5-7
  22. Liao HF, Jeng SF, Lai JS et al. The relation between standing balance and walking function in children with spastic diplegic cerebral palsy. Dev Med Child Neurol. 1997;39(2):106-12.
  23. Liao HF, Liu YC, Liu WY et al. Effectiveness of loaded sit-to-stand resistance exercise for children with mild spastic diplegia: a randomized clinical trial. Arch Phys Med Rehabil. 2007;88(1):25-31. https://doi.org/10.1016/j.apmr.2006.10.006
  24. MacPhail HEA, Kramer JF. Effect of isokinetic strength training on functional ability and walking efficiency in adolescents with cerebral palsy. Dev Med Child Neurol. 1995;37(9):763-75.
  25. Marshall PW, Murphy BA. Core stability exercises on and off a Swiss ball. Arch Phys Med Rehabil. 2005;86(2):242-9. https://doi.org/10.1016/j.apmr.2004.05.004
  26. Marshall P, Murphy B. Changes in muscle activity and perceived exertion during exercises performed on a swiss ball. Appl Physiol Nutr Metab. 2006;31(4):376-83. https://doi.org/10.1139/h06-006
  27. McNee AE, Gough M, Morrissey MC et al. Increases in muscle volume after plantarflexor strength training in children with spastic cerebral palsy. Dev Med Child Neurol. 2009;51(6):429-35. https://doi.org/10.1111/j.1469-8749.2008.03230.x
  28. Naughton K, Adams L, Maher H. Upper-body wobbleboard training effects on the post-dislocation shoulder. Phys Ther Sport 2005;6(1):31-7. https://doi.org/10.1016/j.ptsp.2004.05.005
  29. Palisano RJ, Hanna SE, Rosenbaum PL et al. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther. 2000;80(10):974-85.
  30. Papavasiliou AS. Management of motor problems in cerebral palsy: A critical update for the clinician. Eur J Paediatr Neurol. 2009;13(5):387-96. https://doi.org/10.1016/j.ejpn.2008.07.009
  31. Park ES, Park CI, Lee HJ et al. The effect of electrical stimulation on the trunk control in young children with spastic diplegic cerebral palsy. J Korean Med Sci. 2001;16(3):347-50.
  32. Redstone F, West JF. The importance of postural control for feeding. Pediatr Nurs. 2004;30(2):97-100.
  33. Rose J, McGill KC. Neuromuscular activation and motor-unit firing characteristics in cerebral palsy. Dev Med Child Neurol. 2005;47(5):329-36. https://doi.org/10.1017/S0012162205000629
  34. Ross SA, Engsberg JR. Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Arch Phys Med Rehabil. 2007;88(9):1114-20. https://doi.org/10.1016/j.apmr.2007.06.011
  35. Sekendiz B, Cuğ M, Korkusuz F. Effects of Swissball core strength training on strength, endurance, flexibility, and balance in sedentary women. J Strength Cond Res. 2010;24(11):3032-40. https://doi.org/10.1519/JSC.0b013e3181d82e70
  36. Sheth P, Yu B, Laskowski ER et al. Ankle disk training influences reaction times of selected muscles in a simulated ankle sprain. Am J Sports Med. 1997;25(4):538-43. https://doi.org/10.1177/036354659702500418
  37. Shumway-Cook A, Woollacott M.. Motor control theory and practical applications. 2nd ed. Baltimore. Lippincott Williams and Wilkins. 2001.
  38. Snider L, Korner-Bitensky N, Kammann C et al. Horseback riding as therapy for children with cerebral palsy: is there evidence of its effectiveness? Phys Occup Ther Pediatr. 2007;27(2):5-23.
  39. Stackhouse SK, Binder-Macleod SA, Lee SC. Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy. Muscle Nerve. 2005;31(5):594-601. https://doi.org/10.1002/mus.20302
  40. Stackhouse SK, Binder-Macleod SA, Stackhouse CA et al. Neuromuscular electrical stimulation versus volitional isometric strength training in children with spastic diplegic cerebral palsy: a preliminary study. Neurorehabil Neural Repair. 2007;21(6):475-85. https://doi.org/10.1177/1545968306298932
  41. Sterba JA, Rogers BT, France AP et al. Horseback riding in children with cerebral palsy: effect on gross motor function. Dev Med Child Neurol. 2002;44(5):301-8.
  42. Sterba JA. Does horseback riding therapy or therapist-directed hippotherapy rehabilitate children with cerebral palsy? Dev Med Child Neurol. 2007;49(1):68-73.
  43. Styer-Acevedo J. Physical therapy for the child with cerebral palsy. In: Techlin JS, eds, Pediatric physical therapy. 2nd ed. Philadelphia. JB Lippincott. 1994.
  44. van der Linden ML, Hazlewood ME, Hillman SJ et al. Functional electrical stimulation to the dorsiflexors and quadriceps in children with cerebral palsy. Pediatr Phys Ther. 2008;20(1):23-9. https://doi.org/10.1097/PEP.0b013e31815f39c9
  45. Wiley ME, Damiano DL. Lower-extremity strength profiles in spastic cerebral palsy. Dev Med Child Neurol. 1998;40(2):100-7.