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Relationships between Gross Motor Capacity and Neuromusculoskeletal Function in Children with Cerebral Palsy after Short-Term Intensive Therapy

  • Kim, Ki-Jeon (Department of Rehabilitation Medicine, St Vincent's Hospital, College of medicine, The Catholic University of Korea)
  • Received : 2018.05.09
  • Accepted : 2018.06.30
  • Published : 2018.06.29

Abstract

Purpose: To investigate the relationship between gross motor capacity and neuromuscular function in children with cerebral palsy (CP) through a short-term intensive intervention. Methods: Twenty-four children younger than 6 years of age (17 boys, 7 girls, mean $age{\pm}standard$ deviation, $42.71{\pm}14.43months$) who were diagnosed with CP underwent short-term intensive treatment for 8 weeks. An evaluation of gross motor function capacity using the gross motor function measure (GMFM-66 and GMFM-88) was performed to measure muscle strength, selective motor control (SMC), and spasticity, factors related to neuromusculoskeletal function. Changes in spasticity, strength, range of motion, selective motor function, and exercise intensity scores were evaluated in terms of the gross motor function classification system (GMFCS) and ages. Results: The GMFM-88 and GMFM-66 scores significantly increased, by $4.32{\pm}4.04$ and $2.41{\pm}1.51%$, respectively, following the 8-week intervention. The change in the GMFM-66 score did not reflect a statistically significant difference in the GMFCS level. However, there was a statistically significant difference in the GMFM-88 score change in individuals at GMFCS Level III, the strength and spasticity of subjects at GMFCS Levels I-II did not significantly differ (p<0.05). The changes in the GMFM-66 scores for strength, SMC, range of motion (ROM), and spasticity significantly differed according to age (p<0.05) in children aged 36 months and older. Overall, there was a statistically significant difference in strength, SMC, and spasticity (p<0.05) before and after intensive short-term treatment. Conclusion: The 8-week short-term intensive care intervention improved the motor function score of study participants, emphasizing the need for early intervention and additional research in this area.

Keywords

References

  1. Baxter P, Morris C, Rosenbaum P et al. The definition and classification of cerebral palsy. Dev Med Child Neurol. 2007;49:1-44.
  2. Sung IY, Shin YB, Park SS. Cerebral palsy: clinical features and management. In: Sung IY, eds, Pediatric rehabilitation. 2nd ed. Seoul, Koonja, 2013:383-418.
  3. Barry MJ. Physical therapy interventions for patients with movement disorders due to cerebral palsy. J Child Neurol. 1996;11:51-60. https://doi.org/10.1177/0883073896011001S08
  4. Gormly ME Jr. Treatment of neuromuscular and musculoskeletal problems in cerebral palsy. Pediatr Rehabi. 2001;4(1):5-16. https://doi.org/10.1080/13638490151068393
  5. Cherry DB. Review of physical therapy alternativies for reducing muscle contracture. Phys Ther. 1980;60(7):877-81. https://doi.org/10.1093/ptj/60.7.877
  6. Ballaz L, Plamomdon S, Lemay M. Ankle range of motion is key to gait efficiency in adolescents with cerebral palsy. Clinical Biomechanics. 2010;25(9):944-8. https://doi.org/10.1016/j.clinbiomech.2010.06.011
  7. McDowell BC, Salazar-Torres JJ, Kerr C et al. Passive range of motion in a population-based sample of children with spastic cerebral palsy who walk. Phys Occup Ther Pediatr. 2012;32(2):139-50. https://doi.org/10.3109/01942638.2011.644032
  8. Dodd KJ, Taylor NF, Graham HK. A randomized clinical trial of strength training in young people with cerebral palsy. Dev Med Child Neurol. 2003;45(10):652-57. https://doi.org/10.1111/j.1469-8749.2003.tb00866.x
  9. Mockford M, Caulton JM. Systematic review of progressive strength training in children and adolescents with cerebral palsy who are ambulatory. Pediatr Phys Ther. 2008;20(4):318-33. https://doi.org/10.1097/PEP.0b013e31818b7ccd
  10. Thompson N, Stebbins J, Seniorou M. Muscle strength and walking ability in diplegic cerebral palsy: implications for assessment and management. Gait Posture. 2011;33(3):321-25. https://doi.org/10.1016/j.gaitpost.2010.10.091
  11. Voorman JM, Dallmeijer AJ, Knol DL et al. Prospective longitudinal study of gross motor function in children with cerebral palsy. Arch Phys Med Rehabil. 2007;88(7):871-76. https://doi.org/10.1016/j.apmr.2007.04.002
  12. Goldberg EJ, Fowler EG, Oppenheim WL. Case report: the influence of selective voluntary motor control on gait after hamstring lengthening surgery. Clin Orthop Relat Res. 2012;470(5):1320-26. https://doi.org/10.1007/s11999-011-2028-2
  13. Ostensjo S, Carlberg EB, Vollestad NK. Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities. Dev Med Child Neurol. 2004;45(9):603-12. https://doi.org/10.1111/j.1469-8749.2003.tb00964.x
  14. Kim WH, Park EY. Causal relation between spasticity, strength, gross motor function, and functional outcome in children with cerebral palsy: a path analysis. Dev Med Child Neurol. 2011;53(1):68-73. https://doi.org/10.1111/j.1469-8749.2010.03777.x
  15. Ross SA, Engsberg JR. Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Arch Phys Med Rehabil. 2007;88(9):1114-20. https://doi.org/10.1016/j.apmr.2007.06.011
  16. Lister MJ. Contemporary management of motor control problems: proceedings of the II STEP conference. Alexandria, Foundation for Physical Therapy, 1991.
  17. Aisen ML, Kerkovich D, Mast J et al. Cerebral palsy: clinical care and neurological rehabilitation. Lancet Neurol. 2011;10(9):844-52. https://doi.org/10.1016/S1474-4422(11)70176-4
  18. Arpino C, Vescio MF, De Luca A et al. Efficacy of intensive versus non intensive physiotherapy in children with cerebral palsy: meta-analysis. Int J Rehabil Res. 2010;33(2):165-71. https://doi.org/10.1097/MRR.0b013e328332f617
  19. Rackauskaite G, Thorsen P, Uldall PV et al. Reliability of GMFCS family report questionnaire. Disabil Rehabil. 2012;34(9):721-4. https://doi.org/10.3109/09638288.2011.615881
  20. Morris C, Bartlett D. Gross motor function classification system: impact and utility. Dev Med Child Neurol. 2004;46(1):60-5. https://doi.org/10.1111/j.1469-8749.2004.tb00436.x
  21. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-07. https://doi.org/10.1093/ptj/67.2.206
  22. Klingels K, De Cook P, Molenaers G. Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy: can they be measured reliably? Disabil Rehabil. 2010;32(5):409-16. https://doi.org/10.3109/09638280903171469
  23. Park EY, Kim WH. Meta-analysis of the effect of strengthening interventions in individuals with cerebral palsy. Res Dev Disabil. 2014;35(2):239-49. https://doi.org/10.1016/j.ridd.2013.10.021
  24. Boyd RN, Graham HK. Objective measures of clinical findings in the use of botulinum toxin type A for the management of children with CP. Eur J Neurol. 1999;6(S4):523-35.
  25. Lowing K, Carlberg EB. Reliability of the selective motor control scale in children with cerebral palsy. Adv Physiother. 2009;11:58-63. https://doi.org/10.1080/14038190801999620
  26. Jeong DH. Reliability and validity of the CAP for computer access assessment of persons with physical disabilities. J Kor Phys Ther. 2015;27(1):30-7. https://doi.org/10.18857/jkpt.2015.27.1.30
  27. Kim MH, Weon JH. Intra-and inter-rater reliabilities of infrasternal angle measurement. J Kor Phys Ther. 2015;27(3):154-8. https://doi.org/10.18857/jkpt.2015.27.3.154
  28. Seo HJ, Kim JH. The reliability and validity of Korean pediatric functional muscle testing in children with motor disorder. J Kor Phys Ther. 2016;28(4):232-42. https://doi.org/10.18857/jkpt.2016.28.4.232
  29. Lundkvist Josenby A, Jarnlo GB, Gummesson C et al. Longitudinal construct validity of the GMFM-88 total score and goal total score and the GMFM-66 score in a 5 year follow-up study. Phys Ther. 2009;89(4):342-50. https://doi.org/10.2522/ptj.20080037
  30. Russell DJ, Avery LM, Rosenbaum PL et al. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther. 2000;80(9):873-85.
  31. Alotaibi M, Long T, Kennedy E et al. The efficacy of GMFM-88 and GMFM-66 to detect changes in gross motor function in children with cerebral palsy (CP): a literature review. Disabil Rehabil. 2014;36(8):617-27. https://doi.org/10.3109/09638288.2013.805820
  32. Gagliardi C, Maghini C, Germiniasi C et al. The effect of frequency of cerebral palsy treatment: a matched-pair pilot study. Pediatr Neurol. 2008;39(5):335-40. https://doi.org/10.1016/j.pediatrneurol.2008.07.021
  33. Reddihough DS, King J, Coleman G et al. Efficacy of programmes based on conductive education for young children with cerebral palsy. Dev Med Child Neurol. 1998;40(11):763-70. https://doi.org/10.1111/j.1469-8749.1998.tb12345.x
  34. Tsorlakis N, Evaggelinou C, Grouios G et al. Effect of frequency of cerebral palsy treatment: a matched-pair pilot study. Pediatr Neurol. 2004;39(5):335-40. https://doi.org/10.1016/j.pediatrneurol.2008.07.021
  35. Yi TI, Jin JR, Kim SH et al. Contributing factors analysis for the gross motor function in children with spastic cerebral palsy after physical therapy. Ann Rehabil Med. 2013;37(5):649-57. https://doi.org/10.5535/arm.2013.37.5.649
  36. Odman P, Oberg B. Effectiveness of intensive training for children with cerebral palsy-a comparison between child and youth rehabilitation and conductive education. J Rehabil Med. 2005;37(4):263-70. https://doi.org/10.1080/16501970510032622
  37. Harries N, Kassirer M, Amichai T et al. Changes over years in gross motor function of 3-8year old children with cerebral palsy: using the gross motor function measure (GMFM-88). Isr Med Assoc J. 2004;6(7):408-11.
  38. Rosenbaum P, Walter S, Hanna S et al. Prognosis for gross motor function in cerebral palsy. JAMA. 2002;288(11):1357-63. https://doi.org/10.1001/jama.288.11.1357
  39. Spittle A, Orton J, Anderson P et al. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev. 2015;24(11):CD005495.
  40. Fowler EG, Kolobe TH, Damiano DL. Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings. Phys Ther. 2007;87(11):1495-510. https://doi.org/10.2522/ptj.20060116
  41. Givon U. Muscle weakness in cerebral palsy. Acta Orthop Traumatol Turc. 2004;43(2):87-93. https://doi.org/10.3944/AOTT.2009.087