Purpose

Abstract By: Sheila Swann-Guerrero

Dodd, K. J., Taylor, N. F., & Graham, H. K. (2003). A randomized clinical trial of strength training in young people with cerebral palsy. Developmental Medicine and Child Neurology, 45, 652-657

Purpose

Cerebral palsy is a condition that affects body movement and muscle coordination. It is caused by damage to the brain during fetal development; before, during, or shortly after birth; or during infancy. Muscle weakness can be a primary concern for people with spastic diplegic cerebral palsy (Damiano et al. 1995; Wiley & Damiano, 1998). Typically, people with spastic diplegic cerebral palsy walk slowly and have difficulty walking up and down stairs and running (Abel & Damiano, 1996; Damiano & Abel, 1998). The purpose of this study was to determine if a home-based strength training program could improve the lower limb muscle strength and daily physical activity functioning of young people with spastic diplegic cerebral palsy.

Participants

Twenty-one people between 8 and 18 years (11 female and 10 male) with spastic diplegic cerebral palsy with independent ambulation with or without assistive devices and able to follow directions were randomized into a strength training group (11 participants) and a control group (10 participants). Participants were not involved in a strength training program within 3 months, did not have fixed flexion deformity at the knee and hip greater than 25 degrees or fixed equinus of more than 10 degrees, and had not participated in management strategies, such as serial casting, botulinum, or surgery within 12 months.

Method

Baseline measures were taken for all participants. The control groups were told to resume normal activities. The strength-training group was taught three strength-training exercises by a physiotherapist (physical therapist). The exercises chosen were bilateral heel raises, bilateral half squats, and step-ups. Participants completed 8 to 12 repetitions of the exercise with good form until fatigue occurred (ACSM, 2002) to determine training loads. A training load was determined for each participant who then wore a backpack containing free weights while performing the exercises. Participants completed three sets of 8 to 10 repetitions of each exercise three times a week for 20 to 30 minutes each session for 6 weeks. The therapist visited the participants at home at the second and fourth week to evaluate the exercise techniques and to adjust the training load. Each participant received an exercise diary to record the weight used and the number of sets and repetitions of each exercise performed for each session. After the 6 weeks of training, both groups were told to resume normal daily activities for 12 weeks. Participants in both groups were assessed at 6 weeks and 18 weeks.

Results

Participants in the strength-training group increased their combined plantar flexor-knee extensor strength more than the control group at 6 weeks (F(1.19)=4.58., p=0.046) and 18 weeks (F(1.18)=6.25, p=0.041). The strength of these muscles is important for erect posture and for providing support during standing and walking (Winter, 1991; Rodda & Graham, 2001). There was not a significant change in activity using the dimensions of D & E of the Gross Motor Function Measure (Russell et al. 1993). There was a trend for the strength-training group to improve walking, running, jumping, and stair climbing more than the control group.

Conclusion

Muscle weakness can be a primary concern for individuals with cerebral palsy. Strength training can improve the strength and function of muscles, resulting in positive changes in physical activity and functional ability for people with spastic diplegic cerebral palsy. The results of this study demonstrate that participation in a home-based strength-training program can be instrumental in improving muscle strength. In addition, strength-training benefits may lead to more permanent changes in daily activities. Incorporating a strength-training program at home requires simple, inexpensive equipment, parental supervision, and, possibly, a consultation with a physical therapist. The effects of this type of program can improve the daily life of children with spastic diplegic cerebral palsy and be part of a comprehensive management plan.

This fact sheet was last updated on 01-30-2006.

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