Increases in muscle volume after plantarflexor strength training in children with spastic cerebral palsy

Abstract

Children with spastic cerebral palsy (CP) have small, weak muscles. However, change in muscle size due to resistance training in this group is unknown. We investigated the effect of plantarflexor strengthening on muscle volume, gait, and function in 13 ambulant children with spastic CP (seven males, six females; mean age 10y 11mo, SD 3y 0mo, range 6y 11mo–16y 11mo; eight with diplegia, five with hemiplegia; Gross Motor Function Classification System level I, six; level II, five; level III, two). Assessments were performed before training, 5 and 10 weeks into training, and at a 3‐month follow‐up. Medial and lateral gastrocnemius volumes were computed from three‐dimensional ultrasound images. The number of unilateral heel raises able to be achieved on each side was assessed. Function was measured using three‐dimensional gait analysis, the ‘timed up and go’ test, the Gillette Functional Assessment Questionnaire, and the Functional Mobility Scale. Training involved heel raises or Thera‐Band resistance, 4 times a week for 10 weeks. Medial and lateral gastrocnemius volumes increased by 17 and 14% at week 5 (p=0.03, p=0.028). This increase was maintained at week 10 and follow‐up (medial gastrocnemius p=0.001, p<0.001; lateral gastrocnemius p=0.006, p=0.007). Heel raises (mean number) increased by week 5 (p=0.002). This was maintained at week 10 and follow‐up (p<0.001; p<0.001). No significant change in measured function was observed. Muscle volume increased in response to training in children with spastic CP. The role of progressive strength training in maintaining long‐term function is discussed.

The effects of botulinum toxin injection frequency on calf muscle growth in young children with spastic cerebral palsy: A 12-month prospective study

“…A deficit in voluntary muscle activation in individuals with CP [44,45] may limit the contractile stimulus to induce normal muscle growth, and may also reduce muscle growth factor release for protein synthesis [46]. Further, individuals with spastic CP may also have lower physical activity levels [47][48][49] and, therefore, may experience reduced stimulus for muscle growth than the TD group [50,51]. Although there was significant growth of the MG muscle from baseline to 12 months follow-up in both CP groups, the proportion of contractile and non-contractile material which composes the muscle was not determined.…”

Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?

“…Several groups have reported muscle volume correlates with strength and muscle strengthening is possible in patients with CP [2,3,6,15,18]. Published studies are few and vary greatly in terms of outcomes; thus, it is difficult to compare the effects of different muscle-strengthening strategies.…”

Effect of a single session of transcranial direct current stimulation combined with virtual reality training on functional mobility in children with cerebral palsy: A randomized, controlled, double-blind trial.

“…In a study involving 13 children with CP submitted to a training protocol and evaluated on four separate occasions, McNee et al (26) found no significant intra-group differences in the time required to complete the TUG test among any of the evaluations.…”