Efficacy of a Long Term, High Intensity and Long Time Stretch Training Program on Viscoelasticity Plantarflexors Muscle in Children With Cerebral Palsy (CP).

Study Overview
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Brief Summary
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Children with cerebral palsy present early in the childhood altered muscular properties, as soon as structural or stiffness. In the gastrocnemius muscle, altered muscular properties are characterized by short muscle belly length and increased stiffness which contribute to contracture and limiting joint range of motion.

Detailed Description
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This study assess efficacy of a long term stretching program of plantarflexors muscle on their viscoelasticity properties and maximal dorsiflexion angle gain. Stretching program is characterized by 3 phases: baseline, intervention and follow-up.

Official Title
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Efficacy of a Long Term, High Intensity and Long Time Stretch Training Program on Viscoelasticity Plantarflexors Muscle in Children With Cerebral Palsy (CP).

Conditions
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Cerebral Palsy, Spastic, Children, Only

Intervention / Treatment
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* Diagnostic Test: isokinetic dynamometer with ultrasound
* Other: Visual Analog Scale (VAS)
* Diagnostic Test: Stretching


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children aged 8 to 16 years Children diagnosed spastic cerebral palsy Children with decrease maximal dorsiflexion angle under +5° in the last four weeks Children who don't understand instructions Exclusion Criteria: Children who had damage orthopedics or surgical operation contraindicating realization of the experimental protocol Hospitalization incompatible with the progress of the protocol. Children who had botulinum injection, extensions casts or the implementation of new equipment (night or day orthosis) for less than three months or the progress of the protocol. Children having analgesic treatment in progress

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Interventional Model Description: The methodology used is : Single Case Experimental Design (SCED).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Children with spastic cerebral palsy<br>Children with spastic cerebral palsy will be included. They will have 3 phases: Baseline: 4, 5 or 6 evaluations Intervention: 9 evaluations before and after every stretching session Follow-up: 4, 5 or 6 evaluations The evaluation part will be composed of isokinetic dynamometer with ultrasound and Visual Analog Scale (VAS). The number of evaluations at baseline and follow-up will be randomized before the study by Single Case Experimental Design (SCED) methodology. | Diagnostic Test: isokinetic dynamometer with ultrasound<br>* children are lying prone on a isokinetic dynamometer with ultrasound which stretches spastic and paretic plantarflexors muscles very slowly until maximal torque tolerated. The parameters can be measured.<br>Other: Visual Analog Scale (VAS)<br>* the discomfort level will be measured by Visual Analog Scale (VAS) completed by children. 0 = no discomfort and 10 = maximum discomfort<br>Diagnostic Test: Stretching<br>* the ankle of children will be mobilized for 5 minutes (first two weeks) to 10 minutes (last two weeks).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| slope of the torque-angle curve | Analysis of the slope of the torque-angle curve in Nm/°. It is measured by isokinetic dynamometer with ultrasound. | up to 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximal dorsiflexion angle | Analysis of the maximal dorsiflexion angle in degrees. It is measured by isokinetic dynamometer with ultrasound. | up to 12 weeks | 
| Slope of the torque- MyoTendinous Junction (MTJ) displacement | Analysis of the Slope of the torque- MyoTendinous Junction (MTJ) displacement in cm/°. It is measured by isokinetic dynamometer with ultrasound. | up to 12 weeks | 
| MyoTendinous Junction (MTJ) displacement of muscle triceps sural | Analysis of the MyoTendinous Junction (MTJ) displacement of muscle triceps sural in cm. It is measured by isokinetic dynamometer with ultrasound. | up to 12 weeks | 
| muscle triceps sural, muscle body of the medial gastrocnemius muscle and Achilles tendon | Correlation of the length of Musculo-Tendinous Unit (MTU) of muscle triceps sural, muscle body of the medial gastrocnemius muscle and Achilles tendon. It is measured by isokinetic dynamometer with ultrasound. | up to 12 weeks | 
| discomfort level | Analysis of the discomfort level. It is measured by Visual Analog Scale (VAS) completed by children. 0 = no discomfort and 10 = maximum discomfort | up to 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cerebral palsy, stretching, isokinetic dynamometer, ultrasound, ankle, children