FUNCTIONAL OUTCOMES OF STRENGTH TRAINING IN SPASTIC CEREBRAL-PALSY

Objective: To determine clinical effectiveness of strength training in children with spastic cerebral palsy. Design: Prospective before and after trial in which subjects participated in a 6-week strength traini ng program. All received before and after isometric strength evaluatio n of eight muscle groups in both lower extremities with a hand-held dy namometer, 3-D gait analysis at free and fast speeds, administration o f the Gross Motor Function Measure (GMFM), and assessment of energy ex penditure during gait. Setting: Pediatric rehabilitation center at a t ertiary care hospital. Patients: Eleven children met inclusion criteri a for participation. Six had spastic diplegia, were limited community ambulators, and demonstrated less than 50% of normal muscle strength. Five had spastic hemiplegia and demonstrated a 20% strength asymmetry in at least two muscles across extremities. Results: Each group had si gnificant strength gains in the muscles targeted. The entire cohort ha d higher gait velocity primarily as a result of increased cadence, wit h greater capacity to walk faster. GMFM Dimension 5 also improved, wit h no change in energy expenditure. Asymmetry in strength improved in h emiplegia, with no change in asymmetry in support times or joint motio n across extremities. Conclusions: This study reinforced the relations hip of strength to motor function in cerebral palsy and further demons trated the effectiveness of strengthening in this population. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.