Hemiparetik Serebral Palsi’Li Çocuklarda Alt Ekstremite Fonksiyonel Kuvvetlendirme Eğitiminin Kas Kuvvetine ve Performansına Etkisi

Abstract

This study was aimed to investigate the effects of 12- weeks lower extremity progressive functional strength training with keeping isometric, concentric and eccentric training together on muscle strength and performance related physical fitness in children with hemiparetic Cerebral Palsy (CP) with evidence-based randomize controlled trial. Thirty-three patients were randomized two groups. Treatment group (n=15, age: 11.8±2.95, BMI: 19.27±3.73) was included 12-weeks progressive functional strength training combined with virtual reality based functional squat and plyometric exercises. Control group (n=15, age: 11.26±3.28, BMI: 18.70±3.57) continued routine conventional physiotherapy programme. According to "National Strength and Conditioning Association (NSCA)" criteria, strength training was completed 90 minutes a session and three times weekly for 12 weeks. Gross motor function was assessed with Gross Motor Function Measurement (GMFM) D and E, 10-meter walking and 1-minute walking test. Dynamic balance was assessed with Time up & go (TUG) and functional reaching test. Functional muscle strength and muscle performance were assessed with muscle power sprint test, 10x5 meter sprint test, lateral step up, sit to stand and attained stand half knee tests. Muscle strength of affected and unaffected lower extremities was evaluated with 1 maximum repetition (MT) in leg-press, hand-held dynamometer and surface electromyography (sEMG). Mann-Whitney U and Wilcoxon non-parametric tests were used data analysis. In baseline, there were no significant differences between groups (p>0.05). After 12 weeks, in control group, there were no statistically significant differences in all parameters (p>0.05). However, in treatment group, GMFM score increased 2.31%, 1-minute walk test was 7.76 cm, R1 and R2 values of muscle tone were 6-110, functional reaching test was 7.16cm, muscle power sprint test was 15.28 watt, functional muscle strength tests 2.6-4.71 units, 1 MT was 43.66-51.33 kg, muscle strength was 4.55-11.17 N/kg, yEMG (RMS) values were 0.03-1.14 units and TUG was decreased 1.02s (p<0.05). But there were no statistically differences in 10x5 metre sprint and 10-meter walking test (p>0.05). As a conclusion, progressive functional strength training compared with routine physiotherapy increased gross motor function, performance related physical fitness and improved dynamic balance and decreased muscle tone in children with spastic hemiparetic CP. It was therefore useful to include progressive functional strength training protocol in treatment of children with hemiparetic CP.