Paretic-Limb-Only Plyometric Training Outperforms Volume-Matched Double-Limb Training for Ameliorating Balance Capability and Gait Symmetry in Adolescents with Unilateral Cerebral Palsy: A Comparative Study

Abstract

Adolescents with unilateral cerebral palsy (U-CP) experience an asymmetrical posture because the less-affected lower limb is preferred for bodyweight support as a strategy of compensating for the paretic side’s muscular weakness. This study was designed to compare the effect of 12 weeks of paretic-limb-only plyometric training (PLPT) and volume-matched double-limb training (DLPT) on balance capability and gait symmetry in adolescents with U-CP. Sixty-nine adolescents with U-CP were randomly assigned to PLPT, DLPT, or a control group (n = 23 each). Treatment was delivered twice/week (with at least 48 h recovery intervals) for 12 weeks in succession. The directional (LoSdirectional) and overall (LoSoverall) limits of stability in addition to the temporal (T-GSI) and spatial (S-GSI) gait symmetry indicis were assessed pre- and post-treatment. The LoSdirectional improved significantly in the PLPT group compared to either the DLPT or control group (for the forward (p = 0.027 and <0.001, respectively), backward (p = 0.037 and <0.001, respectively), affected-side (p = 0.038 and 0.004, respectively), and less-affected-side (p = 0.018 and 0.016, respectively)), and this was also the case for the LoSoverall (p < 0.001). Additionally, The T-GSI and S-GSI scores decreased significantly in the PLPT group compared to the DLPT (p = 0.003 and 0.047, respectively) or control (p = 0.003 and 0.036, respectively) group, indicating the development more symmetrical gait patterns. In conclusion, PLPT is likely more effective for enhancing balance capabilities and promoting symmetrical gait patterns than DLPT. Thereupon, it is worthwhile for physical rehabilitation practitioners to include the PLPT paradigm into the intervention plans for adolescents with U-CP.

Effects of Therapies Involving Plyometric-Jump Training on Physical Fitness of Youth with Cerebral Palsy: A Systematic Review with Meta-Analysis

“…Subsequently, a thorough evaluation of 866 full texts was conducted. Ultimately, eight studies [ 55 , 67 , 70 , 71 , 72 , 117 , 118 , 119 ] were deemed eligible for inclusion in the systematic review with meta-analysis.…”

“…The eight included randomized-controlled studies that comprised ten intervention groups and eight control groups. Among the control groups, seven received standard therapy [ 67 , 70 , 71 , 72 , 117 , 118 , 119 ], and one control group received alternative therapy with a focus on balance training [ 55 ]. The standard therapy usually included a mix of strength, balance, gait, mobility, and stretching exercises.…”

“…One study reported that there were no adverse health events due to the intervention program [ 118 ]. Seven studies did not mention unwanted side effects due to the intervention, including injury, pain, delayed onset of muscle soreness, undue fatigue, or related adverse events.…”

“…Seven studies did not mention unwanted side effects due to the intervention, including injury, pain, delayed onset of muscle soreness, undue fatigue, or related adverse events. Drop-outs in the intervention groups were <14% [ 55 , 67 , 70 , 71 , 72 , 117 , 118 , 119 ], and none of the dropouts were associated with PJT-related adverse effects. When reported [ 55 , 118 ], compliance with the PJT interventions varied between 75–100% (mean values >90%) of the scheduled treatment sessions.…”

“…Drop-outs in the intervention groups were <14% [ 55 , 67 , 70 , 71 , 72 , 117 , 118 , 119 ], and none of the dropouts were associated with PJT-related adverse effects. When reported [ 55 , 118 ], compliance with the PJT interventions varied between 75–100% (mean values >90%) of the scheduled treatment sessions.…”