Introduction Cerebral palsy (CP) is a condition resulting from damage to the brain. This damage can occur either in-utero, during childbirth, or after birth in the first months of life. The causes of brain damage range from uterine infection, trauma during or after childbirth, to illness or infection as an infant. Current research estimates that 70% of CP cases originate in-utero, while 20% are due to trauma incurred during childbirth and 10% due to infection, illness or trauma after birth.
CP presents differently between patients depending on which areas of the brain have been damaged. One of the major deficiencies seen in children with CP is muscle weakness. "CP is characterized by insufficient force generation by affected muscle groups, which is consistent.with low levels of electromyographic (EMG) activity and decreased movement of force output. When an activity leads to an active contraction, this impairment may be expressed as a deficiency in power, or when considered over time, in work."
Muscle weakness can present in many forms including difficulty with ambulation, fine motor control of the arms and hands, and trouble swallowing and speaking. Another major characteristic of CP is tone abnormality. This can either present in hypertonicity (spasticity), or hypotonicity (flaccidity). Originally, the perspective on strengthening in the CP population was led by advocates of neurodevelopmental treatment (NDT). This school of thought believed that strengthening in this population and other upper motor neuron conditions was detrimental because it could increase the spasticity in the strengthened muscles. This concept is falling out of favor as new research is showing that children with CP can benefit from strengthening their weakened muscles. "As a consequence, there, are currently no accepted treatment techniques which have been documented to be effective for improving muscle strength in these children."
The goal of this evidence-based capstone project is to look at the current literature and best determine whether strengthening of the lower extremities will improve muscle strength and quality of ambulation, without increasing the spasticity in children with cerebral palsy.
Clinical Scenario: A mother comes to physical therapy with her 8 year old who has spastic diplegic cerebral palsy. She is wondering if strength training would be a good treatment tool to use to improve his gait without increasing spasticity in his lower extremities.
Our Clinically Answerable Question Population: Children with cerebral palsy Intervention: Strengthening of the lower extremities Comparison: Pretest measures (subjects used as own control) Outcome: Increased strength in LEs, improved gait quality
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