Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Pediatric Rehabilitation; Brain Injury
Objective : To examine the effects of dynamic abdominal strengthening through sports participation on the efficiency of gait and transfers in children with Cerebral Palsy, an 8-week hitting protocol was implemented in two children with spastic cerebral palsy.
Design : A single-subject design (A-B with follow-up) was used. The study, completed at Bellarmine University, consisted of a 1-week baseline testing, 8-week intervention, 1-week post-intervention testing, and follow-up at 6 weeks.
Setting : Bellarmine University outpatient physical therapy service learning clinic
Participants (or Animals, Specimens, Cadavers) : Two children with spastic cerebral palsy GMFM-FC level II-III
Interventions : 1-week baseline testing, 8-week intervention, 1-week post-intervention testing, and follow-up at 6 weeks. Each child received 2 sessions of softball hitting lessons for a total of 2 to 3 hours of treatment per week. The softball hitting protocol included swinging a bat in four different developmental positions (i.e. tall-kneeling, right and left half-kneeling, and standing) with decreased levels of support and increased swinging resistance as the intervention progressed. During the entire intervention peroid scheduled outpatient tranditional therapy was maintained.
Main Outcome Measure(s) : The outcome measures included the Timed Up and Go (TUG), Five-repetition sit-to-stand, 6 Minute Walk Test (6MWT), Gross Motor Function Measure – 88 (GMFM), and gait analysis via the GaitRite.
Results : Both children demonstrated improvements in the TUG (15.6% change), five-repetition sit-to-stand (29.7% change), and the 6MWT (10% change). The gait kinematic improvements demonstrated from the intervention were partially maintained during follow-up, and some were even improved such as velocity and stride length.
Conclusions : An 8-week dynamic abdominal strengthening program accomplished through sports participation appeared to have a positive effect on the efficiency of gait and transfers in children with CP. By increasing abdominal strength, a more upright posture is encouraged which allows for greater hip range of motion, made apparent by gait kinematics such as stride length. The longer stride length allows for more distance to be covered and less energy to be expended on community ambulation.