Combining Intensive Rehabilitation With a Nonfunctional Isokinetic Strengthening Program in Adolescents With Cerebral Palsy: Protocol for a Randomized Controlled Trial

Overview

Journal JMIR Res Protoc

Publisher JMIR Publications

Specialty General Medicine

Date 2023 Feb 15

PMID 36790338

Authors

Mathias Guerin

Benoit Sijobert

Benjamin Zaragoza

Flore Cambon

Laurence Boyer

Karine Patte

Affiliations

Soon will be listed here.

Abstract

Background: Cerebral palsy is the most common brain injury in the pediatric population. Patients with cerebral palsy present different affectations such as decreased muscle strength, gait deviations, impaired proprioception, and spasticity. Isokinetic strengthening programs combined with intensive rehabilitation may improve muscle strength and therefore gait efficiency.

Objective: The primary aim of this randomized controlled trial is to compare the effect of an intensive rehabilitation combined with a nonfunctional isokinetic progressive strengthening program to an intensive rehabilitation alone on gait parameters and muscle strength in patients with cerebral palsy. Another goal of this study is to determine whether adding an isokinetic program to intensive rehabilitation is more effective than intensive rehabilitation alone at decreasing spasticity and improving joint position sense in patients with cerebral palsy.

Methods: A total of 30 adolescents with spastic diplegia cerebral palsy (Gross Motor Function Classification System levels I to III) will be randomized, by an independent researcher, into a 3-week intensive rehabilitation and isokinetic progressive strengthening group or an intensive rehabilitation control group. Gait parameters, muscle strength, spasticity, and knee joint position sense will be assessed. These variables will be evaluated at baseline (T0) and at the end of the intervention (T1). The intensive rehabilitation will consist of physiotherapy sessions twice a day and hydrotherapy and virtual reality gait training once a day. The isokinetic training group will have a total of 9 supervised isokinetic strength training sessions focusing on knee flexors and extensors with different execution speeds.

Results: The protocol has been accepted by the French National Ethics Committee in October 2022. The inclusion of patients will start in November 2022.

Conclusions: The combination of intensive rehabilitation with an isokinetic program on knee flexors and extensors has not been studied yet. The findings of this study may determine if an isokinetic strength training program of knee flexors and extensors is beneficial for the improvement of gait parameters, muscle strength, spasticity, and joint position sense in adolescents with spastic diplegia.

International Registered Report Identifier (irrid): PRR1-10.2196/43221.

References

Engardt M, KNUTSSON E, Jonsson M, Sternhag M . Dynamic muscle strength training in stroke patients: effects on knee extension torque, electromyographic activity, and motor function. Arch Phys Med Rehabil. 1995; 76(5):419-25. DOI: 10.1016/s0003-9993(95)80570-2. View

OShea T . Diagnosis, treatment, and prevention of cerebral palsy. Clin Obstet Gynecol. 2008; 51(4):816-28. PMC: 3051278. DOI: 10.1097/GRF.0b013e3181870ba7. View

Aguiar L, Martins J, Brito S, Mendes C, Teixeira-Salmela L, de Morais Faria C . Knee extensor muscles strength indicates global lower-limb strength in individuals who have suffered a stroke: A cross-sectional study. Braz J Phys Ther. 2018; 23(3):221-227. PMC: 6531629. DOI: 10.1016/j.bjpt.2018.08.001. View

MacPhail H, Kramer J . Effect of isokinetic strength-training on functional ability and walking efficiency in adolescents with cerebral palsy. Dev Med Child Neurol. 1995; 37(9):763-75. DOI: 10.1111/j.1469-8749.1995.tb12060.x. View

Eken M, Braendvik S, Bardal E, Houdijk H, Dallmeijer A, Roeleveld K . Lower limb muscle fatigue during walking in children with cerebral palsy. Dev Med Child Neurol. 2018; 61(2):212-218. PMC: 7379556. DOI: 10.1111/dmcn.14002. View

Aye T, Thein S, Hlaing T . Effects of strength training program on hip extensors and knee extensors strength of lower limb in children with spastic diplegic cerebral palsy. J Phys Ther Sci. 2016; 28(2):671-6. PMC: 4793031. DOI: 10.1589/jpts.28.671. View

van Vulpen L, Groot S, Rameckers E, Becher J, Dallmeijer A . Improved parent-reported mobility and achievement of individual goals on activity and participation level after functional power-training in young children with cerebral palsy: a double-baseline controlled trial. Eur J Phys Rehabil Med. 2018; 54(5):730-737. DOI: 10.23736/S1973-9087.18.04921-3. View

van Vulpen L, Groot S, Rameckers E, Becher J, Dallmeijer A . Improved Walking Capacity and Muscle Strength After Functional Power-Training in Young Children With Cerebral Palsy. Neurorehabil Neural Repair. 2017; 31(9):827-841. DOI: 10.1177/1545968317723750. View

Moreau N, Bodkin A, Bjornson K, Hobbs A, Soileau M, Lahasky K . Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis. Phys Ther. 2016; 96(12):1938-1954. PMC: 5131187. DOI: 10.2522/ptj.20150401. View

10.

Kim C, Eng J, MacIntyre D, Dawson A . Effects of isokinetic strength training on walking in persons with stroke: a double-blind controlled pilot study. J Stroke Cerebrovasc Dis. 2007; 10(6):265-73. PMC: 3349651. DOI: 10.1053/jscd.2001.123775. View

11.

Munoz-Bermejo L, Perez-Gomez J, Manzano F, Collado-Mateo D, Villafaina S, Adsuar J . Reliability of isokinetic knee strength measurements in children: A systematic review and meta-analysis. PLoS One. 2019; 14(12):e0226274. PMC: 6917261. DOI: 10.1371/journal.pone.0226274. View

12.

Ratel S, Dore E, Duche P . Measuring levels of muscle fatigue in spastic cerebral palsy. Dev Med Child Neurol. 2018; 61(2):118-119. DOI: 10.1111/dmcn.14046. View

13.

Knoop J, Steultjens M, van der Leeden M, van der Esch M, Thorstensson C, Roorda L . Proprioception in knee osteoarthritis: a narrative review. Osteoarthritis Cartilage. 2011; 19(4):381-8. DOI: 10.1016/j.joca.2011.01.003. View

14.

Ryan J, Theis N, Kilbride C, Baltzopoulos V, Waugh C, Shortland A . Strength Training for Adolescents with cerebral palsy (STAR): study protocol of a randomised controlled trial to determine the feasibility, acceptability and efficacy of resistance training for adolescents with cerebral palsy. BMJ Open. 2016; 6(10):e012839. PMC: 5073599. DOI: 10.1136/bmjopen-2016-012839. View

15.

Fosdahl M, Jahnsen R, Kvalheim K, Holm I . Effect of a Combined Stretching and Strength Training Program on Gait Function in Children with Cerebral Palsy, GMFCS Level I & II: A Randomized Controlled Trial. Medicina (Kaunas). 2019; 55(6). PMC: 6630432. DOI: 10.3390/medicina55060250. View

16.

Liu W, Meijer K, Delbressine J, Willems P, Franssen F, Wouters E . Reproducibility and Validity of the 6-Minute Walk Test Using the Gait Real-Time Analysis Interactive Lab in Patients with COPD and Healthy Elderly. PLoS One. 2016; 11(9):e0162444. PMC: 5015964. DOI: 10.1371/journal.pone.0162444. View

17.

Pierce S, Lauer R, Shewokis P, Rubertone J, Orlin M . Test-retest reliability of isokinetic dynamometry for the assessment of spasticity of the knee flexors and knee extensors in children with cerebral palsy. Arch Phys Med Rehabil. 2006; 87(5):697-702. DOI: 10.1016/j.apmr.2006.01.020. View

18.

El Shemy S . Effect of Treadmill Training With Eyes Open and Closed on Knee Proprioception, Functional Balance and Mobility in Children With Spastic Diplegia. Ann Rehabil Med. 2019; 42(6):854-862. PMC: 6325311. DOI: 10.5535/arm.2018.42.6.854. View

19.

Armand S, Decoulon G, Bonnefoy-Mazure A . Gait analysis in children with cerebral palsy. EFORT Open Rev. 2017; 1(12):448-460. PMC: 5489760. DOI: 10.1302/2058-5241.1.000052. View

20.

Ahlborg L, Andersson C, Julin P . Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy. J Rehabil Med. 2006; 38(5):302-8. DOI: 10.1080/16501970600680262. View