Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4-8 years.

OBJECTIVE: To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy. DESIGN: A nonrandomized ABA trial. SETTING: Sydney school. SUBJECTS: Eight children with cerebral palsy, aged 4-8 years, seven with diagnosis of spastic diplegia, one of spastic/ataxic quadriplegia. INTERVENTION: Four weeks of after-school exercise class, conducted for one hour twice weekly as group circuit training. Each work station was set up for intensive repetitive practice of an exercise. Children moved between stations, practising functionally based exercises including treadmill walking, step-ups, sit-to-stands and leg presses. MAIN OUTCOME MEASURES: Baseline test obtained two weeks before training, a pre-test immediately before and a post-test following training, with follow-up eight weeks later. Lower limb muscle strength was tested by dynamometry and Lateral Step-up Test; functional performance by Motor Assessment Scale (Sit-to-Stand), minimum chair height test, timed 10-m test, and 2-minute walk test. RESULTS: Isometric strength improved pre- to post-training by a mean of 47% (SD 16) and functional strength, on Lateral Step-up Test, by 150% (SD 15). Children walked faster over 10 m, with longer strides, improvements of 22% and 38% respectively. Sit-to-stand performance had improved, with a reduction of seat height from 27 (SD 15) to 17 (SD 11) cm. Eight weeks following cessation of training all improvements had been maintained. CONCLUSIONS: A short programme of task-specific strengthening exercise and training for children with cerebral palsy, run as a group circuit class, resulted in improved strength and functional performance that was maintained over time.

Inter-segmental co-ordination in sit-to-stand: an age cross-sectional study.

BACKGROUND AND PURPOSE: Being able to sit-to-stand (STS) effectively is an important functional skill, but there is little information available on the changes that occur with growth and maturity. This study aimed to investigate the inter-segmental co-ordination of STS in three different age groups (12-18 months, 4-5 years and 9-10 years). METHOD: The children studied wore reflective markers and were videotaped as they stood up from a height-adjustable seat that straddled a forceplate. Segmental kinematics and vertical ground reaction force were determined from the co-ordinate and forceplate data. RESULTS: Even at the earliest developmental stage the children had mastered the basic inter-segmental pattern observed in adults. The youngest children, however, were not able to end the movement in quiet standing; rather they raised up on their toes or took a step forward. Performance varied both within and between subjects. Although there was a similarity in the motor pattern used by the younger subjects to that of the older subjects, developmental trends were evident on the videotapes and on examination of the kinematic and kinetic variables. Movement time, amplitude and peak angular velocity of trunk flexion increased with age. Whereas the children in the older age groups displayed a pattern of vertical ground reaction force similar to that reported for adults, the youngest children tended to reach peak force gradually, often with fluctuations. Although there were characteristic trajectories in the phase-plane plots for each group, the overall trend was for the percentage of smooth plots representing a co-ordinated movement, to increase with age. CONCLUSIONS: Differences in inter-segmental co-ordination between the ages studied may relate to the child's ability to control horizontal momentum and to balance.

Influence of child diagnosis on family and parental functioning: Down syndrome versus other disabilities.

Although children with Down syndrome are popularly conceived of as having easy temperaments and agreeable personalities, conflicting reports exist as to whether they are easier to rear than are children with other developmental disabilities. To compensate for possibly biased samples in earlier studies, we employed three methodological strategies, including case-by-case matching of families raising children with Down syndrome and families raising children with other types of developmental disabilities. Results showed no differences between matched groups on various measures of functioning, a finding replicated with multiple regression techniques. However, in unmatched samples families of children with Down syndrome showed better functioning. Thus, previous research demonstrating better adjustment for families rearing children with Down syndrome should be re-examined for sampling biases.