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Lower limb strength training in children with cerebral palsy--a randomized controlled trial protocol for functional
Vanessa A Scholtes1, Annet J Dallmeijer, Eugene A Rameckers
1Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands. vab.scholtes@vumc.nl
Insights
This study investigated a school-based strength training program for children with cerebral palsy (CP). The program showed potential for improving gross motor function and walking ability in children with CP.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Exercise Science
Background:
- Historically, strength training was contraindicated in children with cerebral palsy (CP) due to concerns about spasticity and abnormal movement.
- Emerging evidence suggests progressive strength training may enhance strength and function in children with CP.
- Previous studies often lacked methodological rigor and detailed reporting of training protocols, hindering interpretation.
Purpose of the Study:
- To describe the design and training protocol of a randomized controlled trial.
- To assess the effects of a school-based, progressive, functional strength training program for children with CP.
Main Methods:
- A randomized controlled trial involving 51 children (aged 6-13 years) with CP (Gross Motor Function Classification System levels I-III).
- Participants were randomized to either a strength training group or a usual care control group.
- The intervention consisted of 12 weeks of group-based strength training (3x/week) with progressive overload based on the 8 Repetition Maximum (8 RM).
Main Results:
- Primary outcomes included gross motor function (Gross Motor Function Measure) and walking ability (10-meter, 1-minute, timed stair tests).
- Secondary outcomes assessed lower limb strength, mobility, and participation in sports.
- Spasticity and range of motion were monitored for adverse events.
Conclusions:
- Randomized clinical trials provide high-level evidence for interventions.
- Comprehensive reporting of trial design, evaluation methods, and intervention details is crucial.
- Clear reporting facilitates result interpretation and potential clinical implementation of effective interventions.
Background:
Until recently, strength training in children with cerebral palsy (CP) was considered to be inappropriate, because it could lead to increased spasticity or abnormal movement patterns. However, the results of recent studies suggest that progressive strength training can lead to increased strength and improved function, but low methodological quality and incomplete reporting on the training protocols hampers adequate interpretation of the results. This paper describes the design and training protocol of a randomized controlled trial to assess the effects of a school-based progressive functional strength training program for children with CP.
Methods/Results:
Fifty-one children with Gross Motor Function Classification Systems levels I to III, aged of 6 to 13 years, were recruited. Using stratified randomization, each child was assigned to an intervention group (strength training) or a control group (usual care). The strength training was given in groups of 4-5 children, 3 times a week, for a period of 12 weeks. Each training session focussed on four exercises out of a 5-exercise circuit. The training load was gradually increased based on the child's maximum level of strength, as determined by the 8 Repetition Maximum (8 RM). To evaluate the effectiveness of the training, all children were evaluated before, during, directly after, and 6 weeks after the intervention period. Primary outcomes in this study were gross motor function (measured with the Gross Motor Function Measure and functional muscle strength tests) and walking ability (measured with the 10-meter, the 1-minute and the timed stair test). Secondary outcomes were lower limb muscle strength (measured with a 6 RM test, isometric strength tests, and a sprint capacity test), mobility (measured with a mobility questionnaire), and sport activities (measured with the Children's Assessment of Participation and Enjoyment). Spasticity and range of motion were assessed to evaluate any adverse events.
Conclusion:
Randomized clinical trials are considered to present the highest level of evidence. Nevertheless, it is of utmost importance to report on the design, the applied evaluation methods, and all elements of the intervention, to ensure adequate interpretation of the results and to facilitate implementation of the intervention in clinical practice if the results are positive.
Trial Registration:
Trial Register NTR1403.
