Cerebral palsy (FS-03)

Muscle strength in cerebral palsy treatment: current issues and developments

Annet J. Dallmeijer (Netherlands), Karen J. Dodd (Australia), Diane L. Damiano (United States of America), Desiree B. Maltais (Canada), Nicholas F. Taylor (Australia)

Focused symposium

Saturday 2 May 2015, 16:00-17:30, Hall 404

Muscle strength in cerebral palsy treatment: current issues and developments

Dallmeijer A.J. 1, Dodd K.J. 2, Damiano D.L. 3, Maltais D.B. 4, Taylor N.F. 5

1VU University Medical Center, Rehabilitation Medicine, Amsterdam, Netherlands, 2La Trobe University, Faculty of Health Sciences, Melbourne, Australia, 3National Institutes of Health, Bethesda MD, United States of America, 4Université Laval, Québec QC, Canada, 5La Trobe University - Eastern Health, Department of Physiotherapy, Melbourne, Australia

Learning objectives

  1. To provide insight into the consequences of muscle strength deficits in children and young adults with cerebral palsy
  2. To describe current evidence for the effectiveness of resistance training and their implications for clinical practice
  3. To discuss new developments in resistance training in this population and give directions for future research

Description

Cerebral palsy (CP) is the most common form of childhood physical disability, and, despite the non-progressive nature of the primary neurological impairment, the condition will impact daily life activities across the lifespan. The most apparent features of CP are motor impairments including spasticity, impaired motor control, and muscle weakness. These motor impairments cause limitations in mobility related activities like walking on different surfaces, running, or climbing stairs. Over the last decade there has been an increased interest in resistance training to strengthen the affected muscles with the aim to reduce the impact of muscle weakness on functional outcomes. The reason for this interest was that supposed adverse effects of resistance training on spasticity appeared to be untrue, and pilot studies showed promising effects on both muscle strength and functional outcomes. Nonetheless, these results could not be confirmed in recent randomized clinical trials (RCTs) that showed no consistent effects of resistance training on functional measures in both children and young people with CP, despite improvements in muscle strength. Results from other studies suggest that protocols other than those used in these RCTs, like high velocity training or training of specific muscle groups may be more effective in improving function. Together, these different results have raised questions about the use of resistance training in this population: What type of training should be performed? Which muscles should be targeted? What are relevant outcomes? Which individuals are likely to benefit?

Implications / Conclusions

The present focused symposium provides insight into the consequences of CP on the skeletal lower limb muscles, describes its impact on mobility, and presents current evidence about the differing effects of resistance training protocols in this population. In addition, new developments in resistance training strategies and outcomes will be presented and discussed. Five experts in the field who were all involved in several strength related studies and publications in children and adults with CP, will present their work and discuss these issues with the audience.

Keywords

Muscle strength; Resistance training; Cerebral palsy

Funding acknowledgements

Intramural Research Program at the NIH Clinical Center, Bethesda MD USA (Damiano), Fonds de la Recherche en Santé du Québec (20844), Réseau Provincial de Recherche en Adaptation-Réadaptation (09-10DMS-13), Institut de Réadaptation en Déficience Physique de Québec, Ordre professionnel de la physiothérapie du Québec, Chaire de recherche en paralysie cérébrale de l'Université Laval Quebec Canada (Maltais), National Health and Medical Research Council of Australia (ID 487321) (Dodd and Taylor), The Johanna Kinder-Fonds (2005?0123-357), the Adriaanstichting, and the Phelps Stichting (2006016), the Netherlands (Dallmeijer).

Relevance to WCPT and expected audience

Muscle weakness is one of the major motor impairments in cerebral palsy, the most common childhood physical disability. Resistance training is a promising treatment in this population, but there is still debate about treatment strategy and gains to be expected. Evidence and current issues will be discussed, with a strong focus on the clinical implications. The presentations and discussion will also add to understanding of the role of strength training in other disabled populations.

Target audience

Target audience are physical therapists, researchers, and other clinical professionals who work with children and adults with cerebral palsy.