PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2014

Clinical Scenario

I am a DPT student who is doing a clinical internship at Khayelitsha Special School, a school in a South African township for children with learning disabilities. There are many ambulatory children with cerebral palsy (CP) at the school who are either receiving no physical therapy interventions or are only given stretching and range of motion exercises for treatment. I would like to know if these children could make strength gains and improve motor function if their treatment included a lower extremity strengthening program.

Clinical Question

Can lower extremity strengthening exercises increase strength and improve motor function, particularly gait, in ambulatory children with CP?

Clinical Bottom Line

Based on the studies done by Dodd et al. and Lee et al., there are mixed results as to whether exercise programs focused on lower extremity strengthening significantly improve strength and motor function in children with cerebral palsy. Dodd et al. found no effect of a home-based strengthening exercise program on subjects’ GMFM scores or the strength of ankle plantarflexors, knee extensors, hip extensors and total extensors. The authors did find a significant increase in combined ankle plantarflexor and knee extensor strength. Lee et al. found that a strengthening physical therapy program resulted in increased GMFM D and E scores, increased hip extensor strength, increased gait speed, increased stride length and decreased double support in ambulation. By contrast, no effect on total GMFM score, strength of other lower extremity muscles, or cadence and single support in ambulation was found. The fair internal validity of the studies, use of subjects from areas other than South African townships, and use of subjects without learning disabilities limited the generalizability of these results to my patient population. More research needs to be done to determine the effectiveness of strengthening exercise in increasing strength and improving motor function in ambulatory school-age children with cerebral palsy. Future research should include larger study populations for adequate power, exercise programs that can be implemented in a school setting, a focus on determining if there is a difference in effectiveness between individual therapy, group therapy, or home exercise, as well as exploring exercise protocols that can be done with children with intellectual disabilities.

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