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Effects of a postoperative strength-training program on the walking ability of children with cerebral palsy: a
Dimitrios Patikas1, Sebastian I Wolf, Katrin Mund
1Department of Orthopaedic Surgery, University of Heidelberg, Germany. Dimitrios.Patikas@ok.uni-hd.de
Insights
A postoperative strength-training program did not significantly improve walking in children with cerebral palsy (CP) compared to conventional physiotherapy alone. Further research into more intense training protocols may be beneficial for children with CP.
Area of Science:
- Rehabilitation Medicine
- Pediatric Orthopedics
- Movement Science
Background:
- Children with cerebral palsy (CP) often experience impaired gait following orthopedic surgery.
- Conventional physiotherapy is standard post-surgical care, but its impact on gait parameters can vary.
- The potential benefits of supplementary strength-training programs for improving gait in pediatric CP populations remain under investigation.
Purpose of the Study:
- To evaluate the efficacy of a 9-month postoperative strength-training program in enhancing walking ability in children with cerebral palsy (CP).
- To compare gait parameters between children with CP receiving conventional physiotherapy versus those receiving additional strength training post-surgery.
Main Methods:
- A randomized controlled trial was conducted in a hospital rehabilitation setting.
- Thirty-nine children with CP (ages 6-16) were randomized into a control group (conventional physiotherapy) or an intervention group (physiotherapy + strength training).
- Gait analysis, including spatiotemporal, kinematic, and kinetic parameters, was performed pre-surgery (E0), one year post-surgery (E1), and for a subset, two years post-surgery (E2).
Main Results:
- At one year post-surgery (E1), while some kinematic and kinetic gait parameters showed improvement, no significant differences were observed between the strength-training and control groups.
- Spatiotemporal gait parameters initially worsened at E1 but demonstrated a recovery trend towards preoperative values by E2 (two-year follow-up).
- The study found no significant difference in gait improvements between children who received additional strength training and those who received only conventional physiotherapy.
Conclusions:
- Postoperative gait improvements in children with CP may be more influenced by surgical outcomes and individual pathological characteristics than by the strength-training program itself.
- The study suggests that the chosen strength-training protocol might not have been intense or tailored enough to elicit significant gait changes.
- Future research could explore more intensive, shorter-term strength-training protocols, considering patient motivation, age, and postoperative status for potentially greater effects.
Objective:
To investigate the effect of a postoperative strength-training program on the walking of children with cerebral palsy (CP).
Design:
Randomized controlled trial.
Setting:
Hospital rehabilitation department.
Participants:
Thirty-nine children with CP (age range, 6-16 y). After orthopedic surgery, the control group (n=20) followed a conventional physiotherapy (PT) program, and the strength-training group (n=19) followed a strength-training program in addition to the conventional PT. Twenty-nine age-matched healthy children were used as references.
Intervention:
A 9-month strength-training program.
Main Outcome Measures:
Spatiotemporal, kinematic, and kinetic parameters during gait analysis were analyzed before (E0) and 1 year after (E1) the surgery. For 22 children, a 2-year postoperative gait analysis (E2) took place as well.
Results:
At E1, several kinematic and kinetic parameters improved, although there was no significant difference between the groups. Spatiotemporal parameters showed a worsening at E1 and a recovery to preoperative values at E2.
Conclusions:
The examined parameters may be more substantially influenced by factors such as the surgery outcome and the variability of pathologic characteristics than by the strength-training program per se. However, a more significant effect of the strength-training may appear if more intense and short-term training protocols are used, considering factors such as patients' motivations, ages, and postoperative statuses.
