Purpose

Abstract by: Jeremy Karger

Blundell, S. W., Shephard, R. B., Dean, C. M., and Adams, R. D. (2003). Functional strength training in cerebral palsy: A pilot study of a group circuit training class for children aged 4-8 years. Clinical Rehabilitation, 17, 48-57.

Cerebral palsy impairs motor performance by reducing muscle strength and motor control. Movement and function are limited by increased muscle stiffness and soft tissue contracture. Over time, the deficits can negatively affect bone and muscle growth, range of motion, and the acquisition of motor skills.

Strength-training programs have gained increasing popularity as therapy for cerebral palsy. Therapy focuses on motor control and flexibility to limit or reduce muscle stiffness and soft tissue contracture. Training programs are aimed at improving strength, endurance, and overall physical fitness. Many previous studies focused on isometric strength training with success that does not equally translate to improvements in functional skills of daily activity. The purpose of this study was to test a lower-limb exercise program on the motor function of children with cerebral palsy in a group training class.

Participants

The study used eight children between 4 and 8 years old.

Method

The training program was 4 weeks long, with training sessions held twice a week for 1 hour each day. The goal of the sessions was to maximize functional improvement with exercises that were similar to daily tasks. Walking was performed in a variety of conditions such as on a treadmill and up and down ramps and stairs. Balance exercises included picking up objects in a crouched position. Step-ups and step-downs, sit-to-stand, and leg press were used as strength exercises. Intensity was increased with more repetitions, higher speed, or increased difficulty such as decreasing seat height in the sit-to-stand exercise.

Results

Results of the study showed improvement in muscle strength and functional ability tests. Muscle strength was measured isometrically and improved significantly, even though participants were not trained in this manner. Strength increases were noted in the hip extensors, hip flexors, knee extensors, and dorsiflexors. The functional tests, including the lateral step-up test, minimum chair height test, time to walk 10 m, and stride length all improved significantly by post-test. The improvements were also maintained 8 weeks after training ended.

Discussion

The functional strength training utilized in the study mimicked tasks the children encounter in daily activities. The repetitive practice of weight-bearing exercises increased isometric strength while focusing on essential motor skills. The children were able to walk at a higher velocity with larger steps and a quicker cadence, walk a farther distance, and rise out of a lower chair unaided. All are skills necessary for independence and activities of daily living. During the study, emphasis was placed on the group setting for training. The children found the setting fun and were motivated to participate, often having to be prompted to leave. Parents also played an active role as assistants to the therapists. The results emphasize the importance of the specificity of training to improve performance on functional motor skills and utilizing a training method that is enjoyable to encourage participation and adherence.

This fact sheet was last updated on 12-20-2005.

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