ABSTRACT
This pilot study examined the feasibility of a 6-week group-based, task-related training program in children 6 to 14 years-old with spastic diplegia. Eight children were randomized to lower limb training and seven to an upper limb dexterity training program. There were no statistically significant differences in lower limb outcomes between children who received the lower limb training and children who received the upper limb dexterity training after completion of the interventions or at a 6-week follow-up. Children who received the upper limb training demonstrated a greater improvement on measures of manual dexterity compared with children who received the lower limb training program. Children who received the lower limb training demonstrated a trend toward walking a longer distance in 10 minutes immediately following intervention, that was not sustained at the 6-week follow-up. The group setting appeared to motivate the children and enhance their participation in the training programs. The pilot study provides data for the calculation of effect size and sample estimates for future studies.
Subject(s)
Cerebral Palsy/rehabilitation , Adolescent , Child , Feasibility Studies , Female , Group Processes , Humans , Male , Physical Therapy Modalities , Pilot Projects , Statistics, Nonparametric , Treatment OutcomeABSTRACT
The aim of this study was to investigate the reliability of hand-held dynamometry for measuring isometric lower-limb muscle strength in children with cerebral palsy (CP). Twenty-three children (14 males, nine females) with CP (spastic diplegia; Gross Motor Function Classification System Levels I-III) aged 5 years 7 months to 14 years 5 months (mean 9 y 6 mo [SD 2 y 8 mo]) attended two test sessions 1 week apart. A 'make' test, using a gradual build-up of force to a maximum isometric contraction, was employed and peak values were normalized to body weight for analyses. Within-session reliability was high with an intraclass correlation coefficient (ICC) of 1,1>0.79 for all muscle groups, and there was acceptable between-session reliability ICC>0.70 and measurement errors for hip flexors and extensors (measured in supine), knee flexors and extensors, and ankle dorsiflexors (with stabilization). Within- and between-session reliability was poor (ICC<0.70) for hip extensors (in prone), knee extensors (20 degrees flexion), ankle dorsiflexors (without stabilization), and ankle plantarflexors. Measurement error differed in each test and across limbs, with stabilization producing inconsistent reliability outcomes. Changes in strength measurements in children with CP should take into account measurement error for particular muscle groups. Changes should be determined for separate muscle groups and limbs, and reported relative to body weight. Different testing positions may be required for greater reliability.
