unilateral versus bilateral lower-limb plyometric training in children with cerebral palsy

Conditions: Cerebral Palsy

Summary: this study was set out to compare the effect of paretic-limb-only plyometric training versus double-limb training on balance capability and gait symmetry in adolescents with unilateral cerebral palsy (u-cp). sixty-nine children with u-cp were randomly allocated to the paretic-limb-only plyometric training group (n = 23; performed plyometric movements/exercises unilaterally using the paretic leg only), the double-limb plyometric training group (n = 23; performed plyometric movements/exercises bilaterally through both lower legs), or the control group (n =23, received standard rehabilitation plus ssc exercises). all groups were assessed for gait-symmetry and balance capability pre and post-treatment.

sixty-nine children with u-cp were recruited from the physical therapy outpatient clinic of college of applied medical sciences, prince sattam bin abdulaziz university, king khalid hospital, and a tertiary referral hospital, al-kharj, saudi arabia. their age ranged between 12 and 18 years, were functioning at levels i or ii according to the gross motor function classification system, and had spasticity level 1 or 1+ per the modified ashworth scale. children were excluded if they had fixed deformities, underwent neuromuscular or orthopedic surgery in the last 12 months, submitted to botox injection in the past 6 months, had attentional neglect, and if they had cardiopulmonary problems preventing them from performing high-intense exercise training. outcome measures * gait-symmetry indices: gait symmetry indices (spatial and temporal) were measured through the portable gaitrite system. * dynamic balance: the directional dynamic limit of stability (forward, backward, paretic, and non-paretic) and overall limit of stability were assessed using the biodex balance system. all groups were trained for 45 minutes, twice per week, for 12 successive weeks. the paretic-limb-only plyometric training group performed plyometric movements/exercises unilaterally using the paretic leg only. the double-limb plyometric training group performed plyometric movements/exercises bilaterally through both lower legs. the plyometric training program consisted of five unilateral and five bilateral lower limb plyometrics in the form of hopping/bounding/jumping activities. the plyometric training was preceded by a warm-up for 5 minutes and ended up with a 5-min cooldown. the control group received the standard rehabilitation program, which comprised advanced balance training, and gait training exercises, postural and flexibility exercises, strength training exercises.

Eligibility criteria:
inclusion criteria: * unilateral cerebral palsy * age 12-18 years * motor function level i or ii according to the gross motor function classification system. * spasticity level 1 or 1+ according to the modified ashworth scale exclusion criteria: * structural deformities/contractures * musculoskeletal or neural surgery in the last year * botox injection in the last 6 months. * cardiopulmonary disorders that interfere with the ability to engage in exercise training. * perceptual and/or behavioral disorders.