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Determining the most effective exercise for gluteal muscle activation in children with cerebral palsy using surface

Colm Daly¹, Emer Lafferty², Marie Joyce¹

¹Central Remedial Clinic, Vernon Avenue, Clontarf, Dublin 3, Ireland.

|March 27, 2019

Insights

For children with Cerebral Palsy (CP), single leg bridge and step-up exercises are most effective for activating gluteal muscles. This research guides targeted hip strengthening programs for improved lumbo-pelvic control in CP.

Area of Science:

Pediatric Physical Therapy
Neuromuscular Rehabilitation
Biomechanics

Background:

Children with Cerebral Palsy (CP) often exhibit reduced lumbo-pelvic postural control during gait.
This deficit is frequently linked to hip muscle weakness and altered hip joint geometry.
Current hip strengthening exercises for CP lack evidence for optimal gluteal muscle activation.

Purpose of the Study:

To identify the most effective exercises for stimulating gluteal muscle activation in children with Cerebral Palsy.
To provide evidence-based guidance for gluteal strengthening program design in pediatric CP.

Main Methods:

A cross-sectional study involving ten children diagnosed with Cerebral Palsy.
Surface electromyography (EMG) measured gluteus medius (GMed) and gluteus maximus (GMax) activation during six common gluteal exercises.
EMG data were normalized to functional reference values to assess peak muscle activation.

Main Results:

The single leg bridge and step-up exercises demonstrated the highest gluteal muscle activation.
Statistical analysis revealed significant differences in activation for both GMax (p<0.0001) and GMed (p<0.0023).
Exercises involving single limb weight-bearing were superior to double limb support or open-chain exercises.

Conclusions:

This study is the first to quantify gluteal muscle activation differences across exercises in children with CP.
Single limb weight-bearing exercises, specifically the single leg bridge and step-up, are recommended for targeted gluteal strengthening.
These findings are crucial for optimizing exercise prescription and informing future research on hip strengthening interventions for children with CP.

Read full analysis

Abstract

Background:

Reduced lumbo-pelvic postural control is a common feature of gait in children with Cerebral Palsy (CP). These features are commonly attributed to insufficiency of the hip musculature as well as underlying bony geometry. Exercises aimed at strengthening the hip muscles are frequently prescribed in children with Cerebral Palsy (CP). There is a lack of evidence indicating the most effective exercises in targeting gluteal muscle activation in this population.

Research Question:

To determine the most effective exercise for gluteal muscle activation in children with CP.

Methods:

This was a cross-sectional study of children with CP. Surface EMG data from the gluteus medius (GMed) and maximus (GMax) on the more involved limb were recorded as participants completed 6 commonly prescribed gluteal strengthening exercises. EMG was assessed for peak activation, normalised to functional reference values.

Results:

Data from ten children (5 males, 5 females; mean +- SD age, 13+-3 years) were included for final analysis. The single leg bridge and step up were the most effective exercises for gluteal muscle activation. Differences in activation were found to be statistically significant using Friedman's rank test (GMax p = 0.0001, GMed p = 0.0023).

Significance:

This study is the first to show clear differences in activation across gluteal strengthening exercises in a CP population. Exercises which involve weight bearing through a single limb appear most effective in activating the target muscles i.e the single leg bridge and the step up. Exercises involving double limb support or open-chain movements were less effective. The results of this study indicate that careful exercise selection is required to achieve targeted muscle activation in a paediatric CP population. The results of this study will provide guidance for exercise prescription for gluteal strengthening in this population and will inform future research studies on the effectiveness hip muscle strengthening programmes in CP.

Keywords:

Cerebral palsy EMG Exercise prescription Muscle activation Strengthening

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