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Czamara A1, Domagalska-Szopa M2, Krolikowska A1, Hagner-Derengowska M3, Szopa A4
1College of Physiotherapy in Wroclaw, Wroclaw, Poland, 2Medical University of Silesia in Katowice, Department of Medical Rehabilitation, School of Health Sciences, Katowice, Poland, 3Nicolaus Copernicus University in Torun, Torun, Poland, 4Medical University of Silesia in Katowice, Department of Physiotherapy, School of Health Sciences, Katowice, Poland
Background: It is difficult to find data on the impact of the Nordic Walking training (NWT) on patients with cerebral palsy (CP).
Purpose: The study investigated the effect of the 14-week-long NWT on a march distance, spirometry parameters, a heart rate, knee muscles strength and active range of motion (ROM) in a diplegic CP patient.
Methods: The patient was a 16 years-old male with spastic diplegia, with neurological signs in both lower limbs, but without functional involvement of upper limbs and no mental retardations. For 14 weeks with a frequency five times per week, the patient performed 40-minutes NWT. The training was being monitored using application installed on a smartphone and saved on the user account, to which access was allowed to the researchers. The measurements of march distance (km) during NWT, bilateral maximal isometric torque (MIT) knee extensor and flexor muscles (UPR-1 dynamometer) and knee active ROM were measured. In addition, the spirometry parameters and heart rate (HR) values during march on the treadmill using the Meta Lyzer 3B-R3 device measurements were performed twice: before (PRE training) and after (POST training) the 14-week-long training. The obtained values of walking time (min), distance (km), maximal walking speed (km/h), MIT (N*m) of the knees extensor and flexor muscles and active knees ROM. Also Maximal Oxygen Consumption (V02 max) in l/min, Oxygen normalized to body mass (V02 /kg) in ml/min/kg, Carbon Dioxide Production (VC02 ) in l/min, Pulmonary Ventilation (VE) in L/min, Heart Rate (HR) values (bit/min) were analysed. The differences in studied parameters between the first and the second measurement were expressed in percenters (%).
Results: In the POST-training evaluation in comparison to the POST-training assessment, the patient has achieved a long Nordic Walking distance (25%) and higher speed (15%), maximal isometric torque of the knee flexor muscles (19%) and active extension of the knees. The patient has achieved a long time walking on treadmill (20%), gait speed (10%) and the angle on the treadmill (33%). In addition in the second study the patient has reached the higher pulmonary ventilation (14%), oxygen normalized to body mass absorption of oxygen per kilogram of body mass (12.5 %) and maximal oxygen consumption (V02 max ) compared to test first.
Conclusion(s): The applied 14-week-long NWT improved a march distance, the knee flexor muscles strength and extension of the knees as well as the spirometry parameters with HR max remaining on the same level, as an effect of positive adaptation to an exercise. On the other hand, there has been a reduction to the right knee extensor muscle strength. Perhaps the use of the in NWT causes relief of lower extremity and reduce the load of this muscle group during stance phase of the gait cycle while walking or is it a compensatory effect of asymmetry needed to enforce locomotion. We need more research and confirm these behaviours on a larger group of test cases.
Implications: It seems reasonable to introduce NWT is as a form of physical activity for patients with diplegic CP.
Keywords: Physiotherapy, physical capacity, endurance
Funding acknowledgements: The study was unfunded
Purpose: The study investigated the effect of the 14-week-long NWT on a march distance, spirometry parameters, a heart rate, knee muscles strength and active range of motion (ROM) in a diplegic CP patient.
Methods: The patient was a 16 years-old male with spastic diplegia, with neurological signs in both lower limbs, but without functional involvement of upper limbs and no mental retardations. For 14 weeks with a frequency five times per week, the patient performed 40-minutes NWT. The training was being monitored using application installed on a smartphone and saved on the user account, to which access was allowed to the researchers. The measurements of march distance (km) during NWT, bilateral maximal isometric torque (MIT) knee extensor and flexor muscles (UPR-1 dynamometer) and knee active ROM were measured. In addition, the spirometry parameters and heart rate (HR) values during march on the treadmill using the Meta Lyzer 3B-R3 device measurements were performed twice: before (PRE training) and after (POST training) the 14-week-long training. The obtained values of walking time (min), distance (km), maximal walking speed (km/h), MIT (N*m) of the knees extensor and flexor muscles and active knees ROM. Also Maximal Oxygen Consumption (V02 max) in l/min, Oxygen normalized to body mass (V02 /kg) in ml/min/kg, Carbon Dioxide Production (VC02 ) in l/min, Pulmonary Ventilation (VE) in L/min, Heart Rate (HR) values (bit/min) were analysed. The differences in studied parameters between the first and the second measurement were expressed in percenters (%).
Results: In the POST-training evaluation in comparison to the POST-training assessment, the patient has achieved a long Nordic Walking distance (25%) and higher speed (15%), maximal isometric torque of the knee flexor muscles (19%) and active extension of the knees. The patient has achieved a long time walking on treadmill (20%), gait speed (10%) and the angle on the treadmill (33%). In addition in the second study the patient has reached the higher pulmonary ventilation (14%), oxygen normalized to body mass absorption of oxygen per kilogram of body mass (12.5 %) and maximal oxygen consumption (V02 max ) compared to test first.
Conclusion(s): The applied 14-week-long NWT improved a march distance, the knee flexor muscles strength and extension of the knees as well as the spirometry parameters with HR max remaining on the same level, as an effect of positive adaptation to an exercise. On the other hand, there has been a reduction to the right knee extensor muscle strength. Perhaps the use of the in NWT causes relief of lower extremity and reduce the load of this muscle group during stance phase of the gait cycle while walking or is it a compensatory effect of asymmetry needed to enforce locomotion. We need more research and confirm these behaviours on a larger group of test cases.
Implications: It seems reasonable to introduce NWT is as a form of physical activity for patients with diplegic CP.
Keywords: Physiotherapy, physical capacity, endurance
Funding acknowledgements: The study was unfunded
Topic: Paediatrics: cerebral palsy
Ethics approval required: Yes
Institution: Medical University of Silesia, Katowice, Poland
Ethics committee: The Bioethical Committee of the Medical University of Silesia
Ethics number: NN-013-350/I/03/09
All authors, affiliations and abstracts have been published as submitted.
