Progressive Functional Strength Training in Unilateral Spastic Cerebral Palsy
Condition: Spastic Hemiplegic Cerebral Palsy
MeSH terms: Muscle Spasticity; Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      This study is aimed to investigate effectiveness of progressive functional strength training
      protocol (functional squat system with virtual reality in leg press, plyometric exercises,
      exercises with Bosu ball & heel-rise exercises) on Body Functions and activity in children
      with unilateral spastic Cerebral Palsy (CP) by applying current guidelines. According to
      literature, there are studies that investigate the effects of functional strength training in
      children with CP. But there is no randomized controlled trial, explore the effects of
      progressive functional strength training protocol on body functions and activity on
      unilateral spastic CP. Hypothesis of this study is that progressive functional strength
      training protocol improves performance-related physical fitness, gross motor function,
      dynamic, balance, muscle tone and muscle strength in unilateral spastic CP.
    

Detailed description: 
      Cerebral palsy (CP) describes a group of disorders in the development of movement and
      posture, causing activity limitations, which are attributed to non-progressive disturbances
      that occurred in the developing brain. It is the most common cause of movement disability in
      childhood. Children with CP may experience a variety of impaired muscle functions, such as
      spasticity, muscle weakness, and loss of selective motor control. Muscle structural changes
      are caused to activate of mechanisms that are limited function with growing and maturation.
      The weakness found in children with CP is attributable to both altered neural mechanisms and
      muscle tissue changes. Several factors affect the level of weakness found in the muscles of
      children with CP. First, weakness may differ between proximal and distal limb muscles.
      Stackhouse et al. found that the maximum voluntary contraction (MVC) was more impaired in the
      plantar flexors than the quadriceps of children with mild CP compared with controls. Second,
      the peak torque may vary according to the velocity of limb movement. Peak torque of the knee
      flexors and extensors in 24 children with CP was found to decrease with increasing velocity
      on an isokinetic machine. Third, peak torque may vary according to muscle length. An
      isokinetic study of 44 children and young people with CP found that peak torque in the hip
      abductors occurred when the muscle was in a lengthened position with the leg still in
      adduction. Fourth, the type of contraction was found to consistently affect the peak torque
      in both children with CP and those who are typically developing, with eccentric force being
      greater than concentric force in the same muscle. Although all impaired muscle functions
      limit the performance of daily life activities and participation in a child with CP, a recent
      study has shown that muscle weakness showed a stronger association with mobility limitations
      in children with CP than spasticity. Strength training for these children is, therefore,
      expected to improve or maintain their strength and functional performance.
    

Intervention name(s): traditional physiotherapy; progressive functional strength training
Intervention type(s): Other; Other
Intervention description(s): We are applying routine traditional physiotherapy consisted of neurodevelopmental treatment (stretching, weight bearing, functional reaching & walking so on).; Participants allocated to the experimental group completed three times a week, 12-week progressive resistance training protocol. This protocol consisted of functional squat system with virtual reality in leg press, plyometric exercises, exercises with Bosu ball & heel-rise exercises. This intensity of training is approximately equal to training at an intensity of 60% to 80% of one-repetition maximum according to "National Strength and Conditioning Association (NSCA)" protocols. Intensity of exercise is gradually increased 10% bi-weekly.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: strength training; virtual reality; plyometric exercises; cerebral palsy; hemiplegic