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Combined Ankle/Knee Stretching and Pivoting Stepping Training for Children With Cerebral Palsy
Insights
A new training program, Subject-specific Stretching and Pivoting Off-axis Neuromuscular control Training (SS-POINT), effectively reduced spasticity and intoeing gait in children with cerebral palsy. This individualized approach improved walking function and neuromuscular control.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Pediatric Orthopedics
Background:
- Cerebral palsy (CP) often involves spasticity and intoeing gait, impacting walking function.
- Current treatments lack methods to concurrently address intoeing gait, stiffness, and spasticity based on individual needs.
Purpose of the Study:
- To develop and evaluate a novel training program, SS-POINT, for children with CP.
- To improve walking function, transverse-plane (pivoting) neuromuscular control, and reduce spasticity and intoeing gait deviations.
Main Methods:
- Eight children with diplegic CP and intoeing gait underwent a 6-week SS-POINT program.
- SS-POINT combined robotic ankle/knee stretching with pivoting neuromuscular control training.
- Outcomes were compared to a previous study using pivoting neuromuscular control training (POINT) alone.
Main Results:
- SS-POINT significantly reduced knee stiffness and intoeing angle.
- Improvements were observed in ankle/knee range of motion, ankle strength, proprioception, walking speed, and balance.
- SS-POINT showed greater improvements in proprioceptive acuity and minimum pivoting angle compared to POINT.
Conclusions:
- The SS-POINT program is an effective subject-specific intervention for improving leg and walking functions in children with CP.
- This individualized approach maximizes intervention effects by tailoring training targets, sequences, and intensities.
Abstract:
Although various treatment methods have been investigated to reduce spasticity and intoeing gait in children with cerebral palsy (CP), methods to concurrently reduce an intoeing gait and associated ankle/knee stiffness and spasticity according to a child's specific needs are lacking. This study aimed to develop a training program to improve walking function and transverse-plane (pivoting) neuromuscular control and reduce spasticity and intoeing gait deviations. Eight children with diplegic CP and intoeing gait participated in this 6-week combined robotic ankle and/or knee intelligent stretching and pivoting neuromuscular control training program (Subject-specific Stretching and Pivoting Off-axis Neuromuscular control Training, [SS-POINT]). The effects of SS-POINT were evaluated using neuromechanical, functional, and clinical outcome measures and compared to those for eight children with CP and intoeing gait who participated in pivoting neuromuscular control training (POINT) alone in a previous study.
Results:
After the SS-POINT program, subjects with CP showed reduced knee stiffness and intoeing angle, and improvements in both joint and leg functions in terms of ankle and knee active range of motion, ankle dorsiflexor strength, proprioception, walking speed, balance, and minimum pivoting angle. Furthermore, improvements in proprioceptive acuity and minimum pivoting angle after the SS-POINT were greater than those after the POINT.
Conclusion:
The SS-POINT approach can be used as a subject-specific training program for improving leg and walking functions and reducing intoeing during gait.
Significance:
This approach can serve as an individualized intervention at the joint and walking levels to maximize intervention effects by adjusting training targets, sequences, and intensities to meet the individual needs of children with CP.
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