Exergaming improves balance in children with spastic cerebral palsy with low balance performance: results from a multicenter controlled trial.

PURPOSE: Previous studies investigating the effectiveness of exergame balance-training (using video-games) in children with cerebral palsy (CP) yielded inconsistent results that could be related to underpowered studies. Therefore, in this multicenter intervention study, we investigated whether exergaming improves balance clinically in spastic CP. MATERIALS AND METHODS: In total, 35 children with unilateral or bilateral spastic CP (GMFCS-level I-II) were included (age-range: 7-16 years); 16 at VUMC (trial: NTR6034), 19 at UHG (trial: NCT03219112). All participants received care as usual. The intervention group (n = 24) additionally performed exergame-training; 6-8 weeks home-based X-box One Kinect training focused on balance. Balance performance was assessed with the pediatric balance scale (PBS) and two subscales of the Bruininks-Oseretsky Test of Motor Proficiency-2nd edition ("balance" [BOTbal] and "running speed and agility" [BOTrsa]). Mixed model ANOVAs with between and within factors were used to test differences between and within groups. RESULTS: On group level, no post-intervention differences were found between the intervention and control group (PBS: p = 0.248, ηp2 = 0.040; BOTbal: p = 0.374, ηp2 = 0.024; BOTrsa: p = 0.841, ηp2 = 0.001). Distribution of CP-symptoms (unilateral versus bilateral) did not affect training (PBS: p = 0.373, ηp2 = 0.036; BOTbal: p = 0.127, ηp2 = 0.103; BOTrsa: p = 0.474, ηp2 = 0.024). Children with low baseline balance performance (based on PBS) in the intervention group showed improvements in balance performance after training (PBS: p = 0.003, ηp2 = 0.304; BOTbal: p = 0.008, ηp2 = 0.258), whereas children with high baseline balance performance did not. CONCLUSIONS: This exergame-training resulted in balance improvements for the current population of CP that had a low baseline function.IMPLICATIONS FOR REHABILITATIONExergame-training (training using video-games) shows mixed results in children with cerebral palsy (CP).Children with spastic CP (GMFCS level I-II) with a high baseline balance-level did not show functional balance improvements after this home-based exergame-training, suggesting that these children should not be enrolled in this type of exergame-training protocol.Children with spastic CP (GMFCS level I-II) with a low baseline balance-level showed clinically relevant functional balance improvements after this home-based exergame-training, suggesting that these children can benefit from enrolment in this type of exergame-training protocol to improve their balance.The distribution of CP-symptoms did not affect the effectiveness of this balance exergame-training in children with spastic CP with GMFCS-level I and II.

Effect of static and ballistic stretching on the muscle-tendon tissue properties.

PURPOSE: Many studies have been undertaken to define the effects of static and ballistic stretching. However, most researchers have focused their attention on joint range-of-motion measures. The objective of the present study was to investigate whether static- and ballistic-stretching programs had different effects on passive resistive torque measured during isokinetic passive motion of the ankle joint and tendon stiffness measured by ultrasound imaging. METHODS: Eighty-one healthy subjects were randomized into three groups: a static-stretch group, a ballistic-stretch group, and a control group. Both stretching groups performed a 6-wk stretching program for the calf muscles. Before and after this period, all subjects were evaluated for ankle range of motion, passive resistive torque of the plantar flexors, and the stiffness of the Achilles tendon. RESULTS: The results of the study reveal that the dorsiflexion range of motion was increased significantly in all groups. Static stretching resulted in a significant decrease of the passive resistive torque, but there was no change in Achilles tendon stiffness. In contrast, ballistic stretching had no significant effect on the passive resistive torque of the plantar flexors. However, a significant decrease in stiffness of the Achilles tendon was observed in the ballistic-stretch group. CONCLUSION: These findings provide evidence that static and ballistic stretching have different effects on passive resistive torque and tendon stiffness, and both types of stretching should be considered for training and rehabilitation programs.