Journal of the Korean Society of Physical Medicine (대한물리의학회지)

The Korean Society of Physical Medicine (대한물리의학회)
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Effects of High-Intensity Muscle Strength Training and Stretching Exercises on Strength, Spasticity, Postural Alignment, and Participation in an Adolescent with Spastic Diplegic Cerebral Palsy: A Single-Subject Design

  • Chang-Ho Kim (Developmental Rehabilitation Department, Yonsei Child Development Center )
  • Received : 2024.03.29
  • Accepted : 2024.05.21
  • Published : 2024.08.31
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Abstract

PURPOSE: This study examined the effects of high-intensity (HI) muscle strength training and stretching exercises on muscle strength, spasticity, postural alignment, and participation in the activities of daily living (ADL) in an adolescent with cerebral palsy (CP). METHODS: The study used a single-subject design with a 16-week follow-up. After a three-week intervention-free period, a participant underwent five data collection sessions for the baseline measurements. Subsequently, stretching and HI strength training occurred three times weekly for 48 sessions, with the outcome measures collected weekly post-treatment. Final measurements were taken the day after the last session, and a follow-up assessment occurred six weeks post-study to assess the learning effects. RESULTS: After 16 weeks of treatment, the participant exhibited improved targeted muscle strength and postural alignment without increased spasticity. On the other hand, no significant change in participation in the ADL was observed. CONCLUSION: The research findings suggest that HI strength training and stretching exercises may contribute to improvements in muscle strength and body alignment without increased spasticity in an adolescent with CP, but it may not have a significant impact on participation in ADL.

Keywords

Acknowledgement

The author would like to extend heartfelt gratitude to the participant and all of his family members, particularly his mother, for their invaluable contribution and support throughout this study. Their dedication and cooperation were indispensable to the successful completion of this research.

References

  1. Rosenbaum P, Paneth N, L eviton A, et al. A report: the definition and classification of cerebral palsy April 2006 [published correction appears in Dev Med Child Neurol. 2007 Jun;49(6):480]. Dev Med Child Neurol Suppl. 2007;109:8-14. 
  2. Fulford FE, Brown JK. Position as a cause of deformity in children with cerebral palsy. Dev Med Child Neurol. 1976;18(3):305-14.  https://doi.org/10.1111/j.1469-8749.1976.tb03652.x
  3. Porter D, Michael S, Kirkwood C. Is there a relationship between preferred posture and positioning in early life and the direction of subsequent asymmetrical postural deformity in non ambulant people with cerebral palsy?. Child Care Health Dev. 2008;34(5):635-41.  https://doi.org/10.1111/j.1365-2214.2008.00852.x
  4. Morrell DS, Pearson JM, Sauser DD. Progressive bone and joint abnormalities of the spine and lower extremities in cerebral palsy. Radiographics. 2002;22(2):257-68.  https://doi.org/10.1148/radiographics.22.2.g02mr19257
  5. Tardieu C, Lespargot A, Tabary C, et al. For how long must the soleus muscle be stretched each day to prevent contracture?. Dev Med Child Neurol. 1988;30(1):3-10.  https://doi.org/10.1111/j.1469-8749.1988.tb04720.x
  6. Zarkou A, Lee SCK, Prosser LA, et al. Foot and Ankle Somatosensory Deficits Affect Balance and Motor Function in Children With Cerebral Palsy. Front Hum Neurosci. 2020;14:45. 
  7. Wingert JR, Sinclair RJ, Dixit S, et al. Somatosensory-evoked cortical activity in spastic diplegic cerebral palsy. Hum Brain Mapp. 2010;31(11):1772-85.  https://doi.org/10.1002/hbm.20977
  8. Kerr Graham H, Selber P. Musculoskeletal aspects of cerebral palsy. J Bone Joint Surg Br. 2003;85(2):157-66.  https://doi.org/10.1302/0301-620X.85B2.14066
  9. Bouisset S, Do MC. Posture, dynamic stability, and voluntary movement. Neurophysiol Clin. 2008;38(6):345-62.  https://doi.org/10.1016/j.neucli.2008.10.001
  10. Sahrmann S, Azevedo DC, Dillen LV. Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Ther. 2017;21(6):391-9.  https://doi.org/10.1016/j.bjpt.2017.08.001
  11. Schranz C, Kruse A, Belohlavek T, et al. Does Home-Based Progressive Resistance or High-Intensity Circuit Training Improve Strength, Function, Activity or Participation in Children With Cerebral Palsy?. Arch Phys Med Rehabil. 2018;99(12):2457-64.e4.  https://doi.org/10.1016/j.apmr.2018.06.010
  12. Schoenfeld BJ. The mechanisms of muscle hypertrophy and their application to resistance training. J Strength Cond Res. 2010;24(10):2857-72.  https://doi.org/10.1519/JSC.0b013e3181e840f3
  13. Simic L, Sarabon N, Markovic G. Does pre-exercise static stretching inhibit maximal muscular performance? A meta-analytical review. Scand J Med Sci Sports. 2013;23(2):131-48.  https://doi.org/10.1111/j.1600-0838.2012.01444.x
  14. Behm DG, Alizadeh S, Daneshjoo A, et al. Potential Effects of Dynamic Stretching on Injury Incidence of Athletes: A Narrative Review of Risk Factors. Sports Med. 2023;53(7):1359-73.  https://doi.org/10.1007/s40279-023-01847-8
  15. Moreau NG, Bodkin AW, Bjornson K, et al. Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis. Phys Ther. 2016;96(12):1938-54.  https://doi.org/10.2522/ptj.20150401
  16. Taylor NF, Dodd KJ, Baker RJ, et al. Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial. Dev Med Child Neurol. 2013;55(9):806-12.  https://doi.org/10.1111/dmcn.12190
  17. Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23.  https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
  18. Association W M. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373. 
  19. Willemse L, Brehm MA, Scholtes VA, et al. Reliability of isometric lower-extremity muscle strength measurements in children with cerebral palsy: implications for measurement design. Phys Ther. 2013;93(7):935-41.  https://doi.org/10.2522/ptj.20120079
  20. Yam WK, Leung MS. Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy. J Child Neurol. 2006; 21(12):1031-5.  https://doi.org/10.1177/7010.2006.00222
  21. Rodby-Bousquet E, Persson-Bunke M, Czuba T. Psychometric evaluation of the Posture and Postural Ability Scale for children with cerebral palsy. Clin Rehabil. 2016;30(7):697-704.  https://doi.org/10.1177/0269215515593612
  22. Ko J, Kim M. Inter-rater Reliability of the K-GMFM-88 and the GMPM for Children with Cerebral Palsy. Ann Rehabil Med. 2012;36(2):233-9.  https://doi.org/10.5535/arm.2012.36.2.233
  23. Pouchot J, Ecosse E, Coste J, et al. Validity of the childhood health assessment questionnaire is independent of age in juvenile idiopathic arthritis. Arthritis Rheum. 2004;51(4):519-26.  https://doi.org/10.1002/art.20529
  24. Park E. Exploration of utility for Korean translation of the childhood health assessment questionnaire in children with cerebral palsy. The Journal of Special Children Education. 2010;12(4):335-53.  https://doi.org/10.21075/KACSN.2010.12.4.335
  25. Verschuren O, Peterson MD, Balemans AC, et al. Exercise and physical activity recommendations for people with cerebral palsy. Dev Med Child Neurol. 2016;58(8):798-808.  https://doi.org/10.1111/dmcn.13053
  26. Faigenbaum AD, Myer GD. Pediatric resistance training: benefits, concerns, and program design considerations. Curr Sports Med Rep. 2010;9(3):161-8.  https://doi.org/10.1249/JSR.0b013e3181de1214
  27. Fosdahl MA, Jahnsen R, Kvalheim K, et al. Stretching and Progressive Resistance Exercise in Children With Cerebral Palsy: A Randomized Controlled Trial. Pediatr Phys Ther. 2019;31(3):264-71.  https://doi.org/10.1097/PEP.0000000000000616
  28. Scholtes VA, Dallmeijer AJ, Rameckers EA, et al. Lower limb strength training in children with cerebral palsy--a randomized controlled trial protocol for functional strength training based on progressive resistance exercise principles. BMC Pediatr. 2008;8:41. 
  29. Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Arch Phys Med Rehabil. 2002;83(8):1157-64.  https://doi.org/10.1053/apmr.2002.34286
  30. Anttila H, Autti-Ramo I, Suoranta J, et al. Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review. BMC Pediatr. 2008;8:14. 
  31. Mockford M, Caulton JM. Systematic review of progressive strength training in children and adolescents with cerebral palsy who are ambulatory. Pediatr Phys Ther. 2008;20(4):318-33.  https://doi.org/10.1097/PEP.0b013e31818b7ccd
  32. Taylor NF, Dodd KJ, Damiano DL. Progressive resistance exercise in physical therapy: a summary of systematic reviews. Phys Ther. 2005;85(11):1208-23.  https://doi.org/10.1093/ptj/85.11.1208
  33. Verschuren O, Ketelaar M, Takken T, et al. Exercise programs for children with cerebral palsy: a systematic review of the literature. Am J Phys Med Rehabil. 2008;87(5):404-17.  https://doi.org/10.1097/PHM.0b013e31815b2675
  34. Park EY, Kim WH. Meta-analysis of the effect of strengthening interventions in individuals with cerebral palsy. Res Dev Disabil. 2014;35(2):239-49.  https://doi.org/10.1016/j.ridd.2013.10.021
  35. Scianni A, Butler JM, Ada L, et al. Muscle strengthening is not effective in children and adolescents with cerebral palsy: a systematic review. Aust J Physiother. 2009;55(2):81-7.  https://doi.org/10.1016/S0004-9514(09)70037-6
  36. Kraemer WJ, Adams K, Cafarelli E, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2002;34(2):364-80.  https://doi.org/10.1097/00005768-200202000-00027
  37. Livingston MH, Rosenbaum PL, Russell DJ, et al. Quality of life among adolescents with cerebral palsy: what does the literature tell us?. Dev Med Child Neurol. 2007;49(3):225-31.  https://doi.org/10.1111/j.1469-8749.2007.00225.x
  38. Soares EG, Gusmao CHV, Souto DO. Efficacy of aerobic exercise on the functioning and quality of life of children and adolescents with cerebral palsy: A systematic review and meta-analysis. Dev Med Child Neurol. 2023;65(10):1292-307.  https://doi.org/10.1111/dmcn.15570
  39. Merino-Andres J, Garcia de Mateos-Lopez A, Damiano DL, et al. Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis. Clin Rehabil. 2022;36(1):4-14.  https://doi.org/10.1177/02692155211040199
  40. Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Arch Phys Med Rehabil. 2002;83(8):1157-64. https://doi.org/10.1053/apmr.2002.34286