Functional Anaerobic and Strength Training in Young Adults with Cerebral Palsy

Gillett, Jarred G.; Lichtwark, Glen A.; Boyd, Roslyn N.; Barber, Lee

doi:10.1249/mss.0000000000001614

Cited by 49 publications

(77 citation statements)

References 39 publications

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“…Improvements in functional capacity outcomes measured in the same sample have been reported in our previous study 180 indicating that controlled treadmill gait analysis may not detect meaningful differences in functional capacity for individuals already of a high functional level. There was a mix of bilateral and unilateral limb involvement within our study's sample, as well as different treatments and therapies reported during participants' development.…”

Section: Limitationssupporting

confidence: 65%

“…The mechanisms for improving functional capacity may therefore be multiple in origin, and not related to discrete changes in preferred-speed walking kinematics or kinetics. The FAST intervention did improve overground 6MWT performance in the training group compared to the control group, 180 and hence while treadmill gait kinematics did not differ between groups after training in our study, overground walking capacity did.…”

Section: Discussioncontrasting

confidence: 44%

“…Participants' walking speeds on the treadmill were approximately 45% slower than their average walking speeds during the overground baseline 6MWT, 180 and approximately 30% slower than previously reported preferred walking speeds on a treadmill in typically developing young adults. 186 It is possible that the treadmill familiarisation time was insufficient prior to gait analysis which may have resulted in participants' selecting a slower than typical walking speed.…”

Section: Discussionmentioning

confidence: 53%

“…The FAST intervention was designed to address the muscle size, muscle weakness, and anaerobic capacity deficits, without any specific treadmill gait training. The training stimulus was successful at addressing the primary training goal, 180 but may not have been sufficient or specific enough to change treadmill gait kinematics or kinetics at preferred walking speed. 60 If improving treadmill gait kinematics is the primary training goal, then the components of the training intervention should be designed specifically for that outcome.…”

Section: Discussionmentioning

confidence: 99%

“…The lack of change in ankle kinematics and GPS after training compared to the control group is consistent with findings by Taylor et al, 43 who reported no change in GPS or preferred walking speed following a well-designed PRT intervention targeting individual lower limb strength deficits in adolescents and young adults with CP. Our FAST intervention specifically trained the distal lower limb muscles, including the TA, 180 43 was that participants were required to lift with "full intentional acceleration"…”

Section: Discussionmentioning

confidence: 99%

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FAST CP: The effect of Functional Anaerobic and Strength Training on muscle properties, functional capacity, and gait in adolescents and young adults with Cerebral Palsy

Gillett¹

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Cerebral palsy (CP) is the largest single cause of childhood physical disability. While the brain lesion responsible for CP is static, there is a cascade of secondary musculoskeletal adaptations including reduced muscle size, reduced joint range of motion, increased joint stiffness, and muscle weakness. These secondary alterations progress with age and contribute to a gradual loss of functional capacity into adulthood. Strength training has been used to increase muscle strength in individuals with CP, however it may not be an effective intervention for improving gross mobility-related measures, such as walking performance. It is also unknown whether skeletal muscle in young adults with CP can undergo hypertrophy or architectural adaptations in response to different exercise modes.The general aim of this thesis was to examine the effect of combined functional anaerobic and strength training (FAST) on muscle properties, functional capacity, and gait in adolescents and young adults with CP.A systematic review was undertaken (Chapter 2) to determine the effects of muscle strengthening interventions on skeletal muscle morphology and architecture in children and adolescents with CP. The analysis revealed preliminary evidence that strength training leads to increased muscle size in children and adolescents with CP, accompanied by an increase in muscle strength. Muscle hypertrophy findings may, however, be confounded by factors such as natural growth and concurrent therapies. The findings of this review informed the design of the FAST program and outcome measures used in the following studies to better understand the muscular responses to exercise training in this population.The full study protocol for the FAST intervention is described in Chapter 3. There have been no previous exercise trials conducted in young adults with CP using training parameters that meet established guidelines, that have measured muscle morphology and architecture outcomes. Details of the functional anaerobic and resistance training parameters and progressions according to established guidelines are set out, as well as establishing a-priori outcome measures and the data analysis plan for implementation of the intervention. iii A cross-sectional study was undertaken (Chapter 4) to investigate the relationships between muscle strength, stiffness, and functional capacity in a larger sample of adults with CP. The results of this study demonstrated that maximum isometric plantar flexion strength independently explained 50 -61% of variance in functional capacity outcome measures. Passive medial gastrocnemius muscle fascicle stiffness and ankle joint stiffness were not related to functional capacity measures. These findings suggest lower isometric muscle strength of the plantar flexor muscles contributes to the decline in functional capacity in adults with CP. Chapter 5 investigated the impact of the FAST intervention on lower limb muscle volumes, joint and muscle stiffness, muscle strength, and functional capacity in a sample of 17 young adults with CP...

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Section: Limitationssupporting

confidence: 65%

Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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FAST CP: The effect of Functional Anaerobic and Strength Training on muscle properties, functional capacity, and gait in adolescents and young adults with Cerebral Palsy

Gillett¹

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Automatic quadriceps and patellae segmentation of MRI with cascaded U²‐Net and SASSNet deep learning model

et al. 2021

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Purpose Automatic muscle segmentation is critical for advancing our understanding of human physiology, biomechanics, and musculoskeletal pathologies, as it allows for timely exploration of large multi‐dimensional image sets. Segmentation models are rarely developed/validated for the pediatric model. As such, autosegmentation is not available to explore how muscle architectural changes during development and how disease/pathology affects the developing musculoskeletal system. Thus, we aimed to develop and validate an end‐to‐end, fully automated, deep learning model for accurate segmentation of the rectus femoris and vastus lateral, medialis, and intermedialis using a pediatric database. Methods We developed a two‐stage cascaded deep learning model in a coarse‐to‐fine manner. In the first stage, the U2‐Net roughly detects the muscle subcompartment region. Then, in the second stage, the shape‐aware 3D semantic segmentation method SASSNet refines the cropped target regions to generate the more finer and accurate segmentation masks. We utilized multifeature image maps in both stages to stabilize performance and validated their use with an ablation study. The second‐stage SASSNet was independently run and evaluated with three different cropped region resolutions: the original image resolution, and images downsampled 2× and 4× (high, mid, and low). The relationship between image resolution and segmentation accuracy was explored. In addition, the patella was included as a comparator to past work. We evaluated segmentation accuracy using leave‐one‐out testing on a database of 3D MR images (0.43 × 0.43 × 2 mm) from 40 pediatric participants (age 15.3 ± 1.9 years, 55.8 ± 11.8 kg, 164.2 ± 7.9 cm, 38F/2 M). Results The mid‐resolution second stage produced the best results for the vastus medialis, rectus femoris, and patella (Dice similarity coefficient = 95.0%, 95.1%, 93.7%), whereas the low‐resolution second stage produced the best results for the vastus lateralis and vastus intermedialis (DSC = 94.5% and 93.7%). In comparing the low‐ to mid‐resolution cases, the vasti intermedialis, vastus medialis, rectus femoris, and patella produced significant differences (p = 0.0015, p = 0.0101, p < 0.0001, p = 0.0003) and the vasti lateralis did not (p = 0.2177). The high‐resolution stage 2 had significantly lower accuracy (1.0 to 4.4 dice percentage points) compared to both the mid‐ and low‐resolution routines (p value ranged from < 0.001 to 0.04). The one exception was the rectus femoris, where there was no difference between the low‐ and high‐resolution cases. The ablation study demonstrated that the multifeature is more reliable than the single feature. Conclusions Our successful implementation of this two‐stage segmentation pipeline provides a critical tool for expanding pediatric muscle physiology and clinical research. With a relatively small and variable dataset, our fully automatic segmentation technique produces accuracies that matched or exceeded the current state of the art. The two‐stage segmentation avoids memor...

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Sports Medicine

Murphy¹

2019

Pediatric Board Study Guide

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Functional Anaerobic and Strength Training in Young Adults with Cerebral Palsy

Abstract: Combined functional anaerobic and strength training increased muscle size, strength, and functional capacity in young adults with cerebral palsy. The addition of anaerobic training to progressive resistance training programs assists in the transfer to improved functional capacity.

Cited by 49 publications

References 39 publications

FAST CP: The effect of Functional Anaerobic and Strength Training on muscle properties, functional capacity, and gait in adolescents and young adults with Cerebral Palsy

FAST CP: The effect of Functional Anaerobic and Strength Training on muscle properties, functional capacity, and gait in adolescents and young adults with Cerebral Palsy

Automatic quadriceps and patellae segmentation of MRI with cascaded U²‐Net and SASSNet deep learning model

Sports Medicine

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Functional Anaerobic and Strength Training in Young Adults with Cerebral Palsy

Abstract: Combined functional anaerobic and strength training increased muscle size, strength, and functional capacity in young adults with cerebral palsy. The addition of anaerobic training to progressive resistance training programs assists in the transfer to improved functional capacity.

Cited by 49 publications

References 39 publications

FAST CP: The effect of Functional Anaerobic and Strength Training on muscle properties, functional capacity, and gait in adolescents and young adults with Cerebral Palsy

FAST CP: The effect of Functional Anaerobic and Strength Training on muscle properties, functional capacity, and gait in adolescents and young adults with Cerebral Palsy

Automatic quadriceps and patellae segmentation of MRI with cascaded U2‐Net and SASSNet deep learning model

Sports Medicine

Contact Info

Product

Resources

About

Automatic quadriceps and patellae segmentation of MRI with cascaded U²‐Net and SASSNet deep learning model