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Published on: June 12, 2019
Influence of Immobilization, Stretching, and Activity on Isometric Muscle Strength and Gait in Young People with
Martin Svehlik1, Andreas Habersack1,2, Bernhard Guggenberger1,3
1Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria.
Insights
Combining immobilization with daily activity did not significantly improve muscle strength or gait in children with Cerebral Palsy (CP) compared to immobilization alone. Time-related gait improvements were observed, but further research is needed.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Orthopedics
Background:
- Children with Cerebral Palsy (CP) often experience calf muscle contractures due to neurological impairments.
- Orthotic immobilization is used to lengthen muscle-tendon units but risks disuse atrophy.
- The study compares continuous immobilization versus combined immobilization and activity.
Purpose of the Study:
- To investigate the effects of combined immobilization and daily activity versus immobilization alone on muscle strength and gait in children with spastic CP.
- To assess changes in muscle strength, joint range of motion, and functional outcomes.
- To determine if a combined approach offers advantages over immobilization alone.
Main Methods:
- A 12-week randomized controlled trial involving 14 children with spastic CP and equinus deformity.
- Two groups: continuous immobilization (23 h/day) vs. combined protocol (14 h immobilization + 10 h activity).
- Outcomes measured included isometric muscle strength, range of motion, gait parameters, and functional questionnaires (GOAL, PODCI).
Main Results:
- Significant time-related improvements were observed in knee and ankle angles at initial contact and during swing, and in maximum dorsiflexion.
- A significant group × time interaction was found for the hindfoot-tibia angle at initial contact.
- No significant changes were found in muscle strength or most questionnaire subscales; within-group improvements noted in daily living and mobility.
Conclusions:
- Time-related improvements in gait parameters were observed, irrespective of the intervention group.
- The combined immobilization and activity protocol did not demonstrate a consistent advantage over continuous immobilization alone.
- Larger sample sizes and longer follow-up periods are recommended to explore potential long-term effects of these interventions in CP management.
Abstract:
Background/Objectives: Neurological impairments in children with Cerebral Palsy (CP) often lead to altered muscle architecture and function, resulting in calf muscle contractures. Orthotic immobilization aims to promote muscle-tendon unit lengthening through sustained stretch but may also induce disuse atrophy. This study investigated whether combining immobilization with daily activity yields different effects on muscle strength and gait function compared with immobilization alone. Methods: Fourteen ambulant children with spastic CP and equinus deformity (8 unilateral, 6 bilateral; mean age 9.93 ± 3.0 years; GMFCS I: 10, GMFCS II: 4) participated in a 12-week randomized controlled trial. Participants were assigned to either continuous immobilization (23 h/day) using a dynamic ankle-foot orthosis or a combined protocol consisting of 14 h/day immobilization and 10 h/day of activity involving ankle mobility and calf muscle activation. Outcomes included isometric muscle strength, joint range of motion, gait parameters, and functional measures (Gait Outcomes Assessment List (GOAL) and the Paediatric Outcome Data Collection Instrument (PODCI)). Data were analyzed using linear mixed models with Bonferroni correction. Results: Significant time effects were observed for the knee angle at initial contact (IC), the ankle angle at IC, maximum dorsiflexion, and maximum dorsiflexion during swing. A significant group × time interaction was found only for hindfoot-tibia angle at IC. Within-group improvements were noted in activities of daily living, body image and self-esteem, and basic mobility. No significant changes were found for muscle strength or for most questionnaire subscales. Conclusions: The findings indicate time-related improvements in gait, with no consistent advantage of the combined intervention. Further studies with larger samples are needed to evaluate potential long-term effects.
