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Published on: September 18, 2020
Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a
Melek Volkan Yazici1, Gamze Çobanoğlu2, Gökhan Yazici2
1Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Yüksek İhtisas University, Ankara, Turkiye.
Insights
Progressive functional exercises targeting specific ankle muscles improved mobility and balance in children with spastic cerebral palsy (SCP). Training dorsiflexors enhanced range of motion, while training plantarflexors improved balance and mobility.
Area of Science:
- Physiotherapy and Rehabilitation
- Pediatric Neurology
- Movement Science
Background:
- Children with spastic cerebral palsy (SCP) exhibit reduced muscle strength, particularly in ankle dorsiflexors (DFs) and plantarflexors (PFs).
- Ankle muscle weakness in SCP significantly impacts functional skills, mobility, and balance.
- Targeted strengthening may offer therapeutic benefits for children with SCP.
Purpose of the Study:
- To investigate the effects of progressive functional exercises (PFEs) on DF, PF, or combined dorsi-plantar flexor (DPF) muscles in children with SCP.
- To assess the impact of PFEs on functional mobility, balance, and maximum voluntary contraction (MVC).
- To compare the outcomes of individually targeted versus combined muscle group strengthening.
Main Methods:
- A randomized trial involving 27 independently ambulant children with unilateral/bilateral SCP.
- PFEs were administered 4 times weekly for 6 weeks, targeting DF, PF, or DPF muscles.
- Assessments included muscle tone, balance, functional mobility, and MVC via surface electromyography.
Main Results:
- Spasticity in PF muscles decreased across all groups.
- PFE of DF muscles improved ankle range of motion and functional mobility.
- PFE of PF muscles enhanced balance and functional mobility.
- PFE of DPF muscles improved balance but not functional mobility.
- No significant changes in MVC were observed in any group.
Conclusions:
- Therapeutic gains from PFEs are muscle-group specific.
- Targeted training of DF muscles can improve ankle range of motion and function.
- Training PF muscles positively influences balance and functional mobility in children with SCP.
- Exercise prescription should align with specific functional goals for optimal outcomes in spastic muscles.
Background/Aim:
Children with cerebral palsy (CP), even those who have very mild impairment, have lower muscle strength than their typically developing peers. The ankle dorsiflexors (DFs) and plantarflexors (PFs) of children with CP are especially weak. Weakness in the ankle muscles causes problems in functional skills, mobility, and balance in spastic CP (SCP). The aim of this study was to investigate the effects of progressive functional exercises (PFEs) on the DF, PF, or dorsi-plantar flexor (DPF) muscles in children with SCP, specifically, the functional mobility, balance, and maximum voluntary contraction (MVC), and compare the effects of strengthening these muscles individually or combined.
Materials And Methods:
This randomized trial was conducted between December 1st, 2018, and May 15th, 2019, at Gazi University, Department of Physiotherapy and Rehabilitation. Randomly assigned into groups were 27 independently ambulant patients with unilateral/bilateral SCP, where PFEs were applied to the DF, PF, or DPF muscles. Muscle tone, balance, and functional mobility were assessed. The MVC was evaluated by surface electromyography. PFEs were performed 4 times a week, for 6 weeks.
Results:
The spasticity of the PF muscles decreased in all of the groups. PFE of the DF muscles led to an increase in ankle joint range of motion (ROM) and improved functional mobility (p < 0.05). PFE of the PF muscles resulted in improvements in balance and functional mobility (p < 0.05). PFE of the DPF muscles brought about improvements in balance but not in functional mobility (p < 0.05). No significant difference in the MVC was observed in any of the groups (p > 0.05).
Conclusion:
Gains are obtained according to the function of a muscle group. By training the DF muscles, it is possible to improve function and ROM. Furthermore, training the PF muscles led to improvements in balance and functional mobility, indicating that it is possible to bring about positive changes in spastic muscles. This study showed that muscle groups must be exercised according to the intended goal.
