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Pirinu M.1, Rocchi F.R.2, Marchettini M.3, Amadeo B.4, Paoli S.1
1Meyer Children's Hospital, Pediatric Rehabilitation, Florence, Italy, 2Terranuova Bracciolini Rehabilitation Center, Pediatric Physiotherapy, Valdarno, Italy, 3ASL Tuscany Center, Pediatric Rehabilitation, Prato, Italy, 4Gaslini Children's Hospital, Pediatric Rehabilitation, Genova, Italy
Background: Muscle weakness is one of the main impairments in cerebral palsy and affects mobility and independence. Previous studies have shown that an intensive muscle strengthening program leads to an increase in muscle strength. The decision to propose standardized programs for all children and the small number of enrolled subjects in the studies have failed to clarify whether the increase in strength can also result in an improvement of functional activities.
Purpose: The aim of the study was to determine if an individualized and intensive muscle strengthening program of lower limbs can result in an improvement of functional activities measured by the Goss Motor Function Measure and with the use of the Goal Attainment Scale.
Methods: Walking children with cerebral palsy were selected, 6-17 years, belonging to Classes II and III of the Gross Motor Function Classification System, in charge at four rehabilitation centers in Tuscany, Italy. Children were assessed using manual muscle test for hip extensors, hip abductors and knee extensors, Six Minute Walking Test, Gross Motor Function Measure dimensions C (item 48-52), D and E, Goal Attainment Scale. The first subjects enrolled in the study were assigned to the intervention group and the others to the control group. The control group maintained usual physiotherapy for 8 weeks, twice a week in sessions of 60 minutes. The intervention group performed a muscle strengthening cycle with the same frequency. The reinforcement treatment consisted of an intensive training program of the lower limbs, the training program was customized by choosing the exercises from a list of 20, which included single joint and multi-joint exercises, more or less complex depending on the child´s ability to perform selective movements. The treatment was also individualized for number of repetitions (minimum 8 maximum 12, 3 series) and external load (maximum 1 kg). At the end of eight weeks, all the children were re-assessed using the initial evaluation test by an evaluator blinded respect to the allocation in the groups. The Wilcoxon test and the Mann-Whitney Test were used to analyze the data using the SPSS version 20.0.
Results: 30 children were recruited, 4 females, mean age 11.5 years, 19 assigned to the intervention group. No difference at baseline was found in all clinical and demographic variables. There was a significant difference in favor of the intervention group with regard to the increase in muscle strength in all muscle groups (P 0.011) and for the GMFM dimensions D (P=0.009) and E (P=0.002).
Conclusion(s): The study shows an improvement both in muscle strength and gross motor activities. All children and families showed a strong adherence to the program. More, also patients with lower functional capacity showed improvement in outcome measure. We can argue that it could be due to the individualization of the treatment.
Implications: These findings support the use of muscle strengthening within the rehabilitation settings and could be also performed as in daily contexts (e.g. school, home).
Funding acknowledgements: None
Topic: Paediatrics
Ethics approval: The study was approved by the Pediatric Ethics Committee of Tuscany, Italy.
All authors, affiliations and abstracts have been published as submitted.
