Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial

Volkan Yazıcı, Melek; COBANOGLU, GAMZE; Yazici, Gokhan; Elbasan, Bulent

doi:10.55730/1300-0144.5682

Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial

Melek VOLKAN YAZICI, (Yüksek İhtisas Üniversitesi, Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Bölümü, Ankara, Türkiye)

Gamze ÇOBANOĞLU, (Gazi Üniversitesi, Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Bölümü, Ankara, Türkiye)

Gökhan YAZICI, (Gazi Üniversitesi, Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Bölümü, Ankara, Türkiye)

Bülent ELBASAN (Gazi Üniversitesi, Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Bölümü, Ankara, Türkiye)

Turkish Journal of Medical Sciences

8 0

Yıl: 2023 Cilt: 53 Sayı: 5 Sayfa Aralığı: 1166 - 1177 Metin Dili: İngilizce DOI: 10.55730/1300-0144.5682 İndeks Tarihi: 24-11-2023

Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial

Öz:

Background/aim: Children with cerebral palsy (CP), even those who have very mild impairment, have lower muscle strength than their typically developing peers. The ankle dorsiflexors (DFs) and plantarflexors (PFs) of children with CP are especially weak. Weakness in the ankle muscles causes problems in functional skills, mobility, and balance in spastic CP (SCP). The aim of this study was to investigate the effects of progressive functional exercises (PFEs) on the DF, PF, or dorsi-plantar flexor (DPF) muscles in children with SCP, specifically, the functional mobility, balance, and maximum voluntary contraction (MVC), and compare the effects of strengthening these muscles individually or combined. Materials and methods: This randomized trial was conducted between December 1st, 2018, and May 15th, 2019, at Gazi University, Department of Physiotherapy and Rehabilitation. Randomly assigned into groups were 27 independently ambulant patients with unilateral/bilateral SCP, where PFEs were applied to the DF, PF, or DPF muscles. Muscle tone, balance, and functional mobility were assessed. The MVC was evaluated by surface electromyography. PFEs were performed 4 times a week, for 6 weeks. Results: The spasticity of the PF muscles decreased in all of the groups. PFE of the DF muscles led to an increase in ankle joint range of motion (ROM) and improved functional mobility (p < 0.05). PFE of the PF muscles resulted in improvements in balance and functional mobility (p < 0.05). PFE of the DPF muscles brought about improvements in balance but not in functional mobility (p < 0.05). No significant difference in the MVC was observed in any of the groups (p > 0.05). Conclusion: Gains are obtained according to the function of a muscle group. By training the DF muscles, it is possible to improve function and ROM. Furthermore, training the PF muscles led to improvements in balance and functional mobility, indicating that it is possible to bring about positive changes in spastic muscles. This study showed that muscle groups must be exercised according to the intended goal.

Anahtar Kelime: Cerebral palsy exercise gastrocnemius muscle anterior tibial muscle posture balance surface electromyography

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Jan MM. Cerebral palsy: comprehensive review and update. Annals of Saudi Medicine 2006; 26 (2): 123-132. https://doi. org/10.5144/0256-4947.2006.123
2. Wimalasundera N, Stevenson VL. Cerebral palsy. Practical Neurology 2016; 16 (3): 184-194. https://doi.org/10.1136/ practneurol-2015-001184
3. Hanssen B, Peeters N, Vandekerckhove I, De Beukelaer N, Bar- On L et al. The contribution of decreased muscle size to muscle weakness in children with spastic cerebral palsy. Frontiers in Neurology 2021; 26 (12): 692582. https://doi.org/10.3389/ fneur.2021.692582
4. Mockford M, Caulton JM. The pathophysiological basis of weakness in children with cerebral palsy. Pediatric Physical Therapy 2010; 22 (2): 222-233. https://doi.org/10.1097/ PEP.0b013e3181dbaf96
5. Givon U. Muscle weakness in cerebral palsy. Acta Orthopaedica et Traumatologica Turcica 2009; 43 (2): 87-93. https://doi. org/10.3944/AOTT.2009.087
6. Elder GC, Kirk J, Stewart G, Cook K, Weir D et al. Contributing factors to muscle weakness in children with cerebral palsy. Developmental Medicine and Child Neurology 2003; 45 (8): 542-550. https://doi.org/10.1017/s0012162203000999
7. Kara OK, Gursen C, Cetin SY, Tascioglu EN, Muftuoglu S et al. The effects of power exercises on body structure and function, activity and participation in children with cerebral palsy: an ICF-based systematic review. Disability and Rehabilitation 2022; 1-14. https://doi.org/10.1080/09638288.2022.2138575
8. Michelsen JS, Lund MC, Alkjær T, Finni T, Nielsen JB et al. Wearable electromyography recordings during daily life activities in children with cerebral palsy. Developmental Medicine and Child Neurology 2020; 62 (6): 714-722. https:// doi.org/10.1111/dmcn.14466
9. Damiano DL, Vaughan CL, Abel ME. Muscle response to heavy resistance exercise in children with spastic cerebral palsy. Developmental Medicine and Child Neurology 1995; 37 (8): 731-739. https://doi.org/10.1111/j.1469-8749.1995.tb15019.x
10. Fowler EG, Staudt LA, Greenberg MB. Lower extremity selective voluntary motor control in patients with spastic cerebral palsy: Increased distal motor impairment. Developmental Medicine and Child Neurology 2010; 52 (3): 264-269. https://doi. org/10.1111/j.1469-8749.2009.03586.x
11. Burtner P, Qualls C, Woollacott M. Muscle activation characteristics of stance balance control in children with spastic cerebral palsy. Gait & Posture 1998; 8 (3): 163-174. https://doi. org/10.1016/s0966-6362(98)00032-0
12. Moreau NG, Lieber RL. Effects of voluntary exercise on muscle structure and function in cerebral palsy. Developmental Medicine and Child Neurology 2022; 64 (6): 700-708. https:// doi.org/10.1111/dmcn.15173
13. Kara OK, Livanelioglu A, Yardımcı BN, Soylu AR. The effects of functional progressive strength and power training in children with unilateral cerebral palsy. Pediatric Physical Therapy 2019; 31 (3): 286-295. https://doi.org/10.1097/ PEP.0000000000000628
14. Merino-Andres J, Garcia de Mateos-Lopez A, Damiano DL, Sanchez-Sierra A. Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis. Clinical Rehabilitation 2022; 36 (1): 4-14. https://doi.org/10.1177/02692155211040199
15. Bland DC, Prosser LA, Bellini LA, Alter KE, Damiano DL. Tibialis anterior architecture, strength, and gait in individuals with cerebral palsy. Muscle & Nerve 2011; 44 (4): 509-517. https://doi.org/10.1177/02692155211040199
16. Di Giulio I, Maganaris CN, Baltzopoulos V, Loram ID. The proprioceptive and agonist roles of gastrocnemius, soleus and tibialis anterior muscles in maintaining human upright posture. The Journal of Physiology 2009; 587 (10): 2399-2416. https:// doi.org/10.1113/jphysiol.2009.168690
17. Howard JJ, Herzog W. Skeletal muscle in cerebral palsy: from belly to myofibril. Frontiers in Neurology 2021; 12: 620852. https://doi.org/10.3389/fneur.2021.620852
18. Handsfield GG, Williams S, Khuu S, Lichtwark G, Stott NS. Muscle architecture, growth, and biological Remodelling in cerebral palsy: a narrative review. BMC Musculoskeletal Disorders 2022; 23 (1): 233. https://doi.org/10.1186/s12891- 022-05110-5
19. Wiley ME, Damiano DL. Lower extremity strength profiles in spastic cerebral palsy. Developmental Medicine and Child Neurology 1998; 40 (2): 100-107. https://doi. org/10.1111/j.1469-8749.1998.tb15369.x
20. Damiano DL, Kelly LE, Vaughn CL. Effects of quadriceps femoris muscle strengthening on crouch gait in children with spastic diplegia. Physical Therapy 1995; 75 (8): 658-667. https:// doi.org/10.1093/ptj/75.8.658
21. Dodd KJ, Taylor NF, Graham HK. A randomized clinical trial of strength training in young people with cerebral palsy. Developmental Medicine and Child Neurology 2003; 45 (10): 652-657. https://doi.org/10.1017/s0012162203001221
22. Heo SG, Lee HS, Park SW. Effects of strengthening exercise on gait ability and GMFM in cerebral palsy: A systematic review and meta-analysis. Journal of the Korean Society of Physical Medicine 2018; 13 (3): 39-47. https://doi.org/10.13066/ kspm.2018.13.3.39
23. Engsberg JR, Ross SA, Collins DR. Increasing ankle strength to improve gait and function in children with cerebral palsy: A pilot study. Pediatric Physical Therapy 2006; 18 (4): 266-275. https://doi.org/10.1097/01.pep.0000233023.33383.2b
24. Jung JW, Her JG, Ko J. Effect of strength training of ankle plantarflexors on selective voluntary motor control, gait parameters, and gross motor function of children with cerebral palsy. Journal of Physical Therapy Science 2013; 25 (10): 1259- 1263. https://doi.org/10.1589/jpts.25.1259
25. O’Sullivan SB, Schmitz TJ. Physical Rehabilitation. 5th ed. Philadelphia, PA, USA: F.A. Davis Company; 2006.
26. Blundell S, Shepherd R, Dean C, Adams R, Cahill B. Functional strength training in cerebral palsy: A pilot study of a group circuit training class for children aged 4–8 years. Clinical Rehabilitation 2003; 17 (1): 48-57. https://doi. org/10.1191/0269215503cr584oa
27. Cho HJ, Lee BH. Effect of functional progressive resistance exercise on lower extremity structure, muscle tone, dynamic balance and functional ability in children with spastic cerebral palsy. Children 2020; 7 (8): 85. https://doi.org/10.3390/ children7080085
28. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E et al. Gross motor function classification system for cerebral palsy. Developmental Medicine and Child Neurology 1997; 39 (4): 214-223. https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
29. Gracies JM, Burke K, Clegg NJ, Browne R, Rushing C et al. Reliability of the Tardieu scale for assessing spasticity in children with cerebral palsy. Archives of Physical Medicine and Rehabilitation 2010; 91 (3): 421-428. https://doi.org/10.1016/j. apmr.2009.11.017
30. Tardieu G. A la recherche d’une technique de mesure de la spasticite (in French). Revista de Neurologia 1954; 91: 143-144.
31. Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Archives of Physical Medicine and Rehabilitation 1992; 73 (11): 1073-1080.
32. Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: A modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatric Physical Therapy 2003; 15 (2): 114-128. https://doi. org/10.1097/01.PEP.0000068117.48023.18
33. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: A new clinical measure of balance. Journal of Gerontology 1990; 45 (6): 192-197. https://doi.org/10.1093/ geronj/45.6.m192
34. Bartlett D, Birmingham T. Validity and reliability of a pediatric reach test. Pediatric Physical Therapy 2003; 15 (2): 84-92. https://doi.org/10.1097/01.PEP.0000067885.63909.5C
35. Chrysagis N, Skordilis EK, Koutsouki D. Validity and clinical utility of functional assessments in children with cerebral palsy. Archives of Physical Medicine and Rehabilitation 2014; 95 (2): 369-374. https://doi.org/10.1016/j.apmr.2013.10.025
36. Carey H, Martin K, Combs-Miller S, Heathcock JC. Reliability and responsiveness of the timed up and go test in children with cerebral palsy. Pediatric Physical Therapy 2016; 28 (4): 401-408. https://doi.org/10.1097/PEP.0000000000000301
37. Stegeman D, Hermens H. Standards for surface electromyography: The European project Surface EMG for non-invasive assessment of muscles (SENIAM). Enschede Roessingh Research and Development 2007: 108-112.
38. Cho C, Hwang W, Hwang S, Chung Y. Treadmill training with virtual reality improves gait, balance, and muscle strength in children with cerebral palsy. Tohoku Journal of Experimental Medicine 2016; 238 (3): 213-218. https://doi.org/10.1620/ tjem.238.213
39. Dos Santos AN, Pavao SL, Rocha NACF. Sit-to-stand movement in children with cerebral palsy: A critical review. Research in Developmental Disabilities 2011; 32 (6): 2243-2252. https://doi. org/10.1016/j.ridd.2011.05.001
40. Sahrmann AS, Stott NS, Besier TF, Fernandez JW, Handsfield GG. Soleus muscle weakness in cerebral palsy: Muscle architecture revealed with diffusion tensor imaging. PloS One 2019; 14 (2): e0205944. https://doi.org/10.1371/journal. pone.0205944
41. Schranz C, Kruse A, Belohlavek T, Steinwender G, Tilp M et al. Does home-based progressive resistance or high- intensity circuit training improve strength, function, activity or participation in children with cerebral palsy? Archives of Physical Medicine and Rehabilitation 2018; 99 (12): 2457-2464. e2454. https://doi.org/10.1016/j.apmr.2018.06.010
42. Agarwal A, Verma I. Cerebral palsy in children: An overview. Journal of Clinical Orthopaedics and Trauma 2012; 3 (2): 77- 81. https://doi.org/10.1016/j.jcot.2012.09.001
43. Lorentzen J, Kirk H, Fernandez-Lago H, Frisk R, Scharff Nielsen N et al. Treadmill training with an incline reduces ankle joint stiffness and improves active range of movement during gait in adults with cerebral palsy. Disability and Rehabilitation 2017; 39 (10): 987-993. https://doi.org/10.1080/09638288.2016 .1174745
44. Ryan JM, Lavelle G, Theis N, Noorkoiv M, Kilbride C et al. Progressive resistance training for adolescents with cerebral palsy: The STAR randomized controlled trial. Developmental Medicine and Child Neurology 2020; 62 (11): 1283-1293. https://doi.org/10.1111/dmcn.14601
45. Surana BK, Ferre CL, Dew AP, Brandao M, Gordon AM et al. Effectiveness of lower-extremity functional training (LIFT) in young children with unilateral spastic cerebral palsy: A randomized controlled trial. Neurorehabilitation and Neural Repair 2019; 33 (10): 862-872. https://doi. org/10.1177/1545968319868719
46. Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE et al. Interventions to improve physical function for children and young people with cerebral palsy: International clinical practice guideline. Developmental Medicine and Child Neurology 2022; 64 (5): 536-549. https://doi.org/10.1111/dmcn.15055
47. Tedroff K, Knutson LM, Soderberg GL. Synergistic muscle activation during maximum voluntary contractions in children with and without spastic cerebral palsy. Developmental Medicine and Child Neurology 2006; 48 (10): 789-796. https:// doi.org/10.1017/S0012162206001721
48. Stackhouse SK, Binder Macleod SA, Lee SC. Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy. Muscle & Nerve 2005; 31 (5): 594-601. https://doi.org/10.1002/mus.20302
49. Rose J, McGill KC. Neuromuscular activation and motor- unit firing characteristics in cerebral palsy. Developmental Medicine and Child Neurology 2005; 47 (5): 329-336. https:// doi.org/10.1017/s0012162205000629
50. Smith LR, Lee KS, Ward SR, Chambers HG, Lieber RL. Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length. The Journal of Physiology 2011; 589 (10): 2625-2639. https://doi.org/10.1113/jphysiol.2010.203364
51. Rose J, McGill KC. The motor unit in cerebral palsy. Developmental Medicine and Child Neurology 1998; 40 (4): 270-277. https://doi.org/10.1016/S1836-9553(12)70111-X

APA	Volkan Yazıcı M, COBANOGLU G, Yazici G, Elbasan B (2023). Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. , 1166 - 1177. 10.55730/1300-0144.5682
Chicago	Volkan Yazıcı Melek,COBANOGLU GAMZE,Yazici Gokhan,Elbasan Bulent Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. (2023): 1166 - 1177. 10.55730/1300-0144.5682
MLA	Volkan Yazıcı Melek,COBANOGLU GAMZE,Yazici Gokhan,Elbasan Bulent Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. , 2023, ss.1166 - 1177. 10.55730/1300-0144.5682
AMA	Volkan Yazıcı M,COBANOGLU G,Yazici G,Elbasan B Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. . 2023; 1166 - 1177. 10.55730/1300-0144.5682
Vancouver	Volkan Yazıcı M,COBANOGLU G,Yazici G,Elbasan B Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. . 2023; 1166 - 1177. 10.55730/1300-0144.5682
IEEE	Volkan Yazıcı M,COBANOGLU G,Yazici G,Elbasan B "Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial." , ss.1166 - 1177, 2023. 10.55730/1300-0144.5682
ISNAD	Volkan Yazıcı, Melek vd. "Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial". (2023), 1166-1177. https://doi.org/10.55730/1300-0144.5682

APA	Volkan Yazıcı M, COBANOGLU G, Yazici G, Elbasan B (2023). Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. Turkish Journal of Medical Sciences, 53(5), 1166 - 1177. 10.55730/1300-0144.5682
Chicago	Volkan Yazıcı Melek,COBANOGLU GAMZE,Yazici Gokhan,Elbasan Bulent Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. Turkish Journal of Medical Sciences 53, no.5 (2023): 1166 - 1177. 10.55730/1300-0144.5682
MLA	Volkan Yazıcı Melek,COBANOGLU GAMZE,Yazici Gokhan,Elbasan Bulent Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. Turkish Journal of Medical Sciences, vol.53, no.5, 2023, ss.1166 - 1177. 10.55730/1300-0144.5682
AMA	Volkan Yazıcı M,COBANOGLU G,Yazici G,Elbasan B Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. Turkish Journal of Medical Sciences. 2023; 53(5): 1166 - 1177. 10.55730/1300-0144.5682
Vancouver	Volkan Yazıcı M,COBANOGLU G,Yazici G,Elbasan B Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial. Turkish Journal of Medical Sciences. 2023; 53(5): 1166 - 1177. 10.55730/1300-0144.5682
IEEE	Volkan Yazıcı M,COBANOGLU G,Yazici G,Elbasan B "Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial." Turkish Journal of Medical Sciences, 53, ss.1166 - 1177, 2023. 10.55730/1300-0144.5682
ISNAD	Volkan Yazıcı, Melek vd. "Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial". Turkish Journal of Medical Sciences 53/5 (2023), 1166-1177. https://doi.org/10.55730/1300-0144.5682