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Immediate effect of maximal treadmill walking on muscle fatigue and postural stability in children with cerebral palsy
Bulletin of Faculty of Physical Therapy volume 24, pages 79–84 (2019)
Postural instability and muscle fatigue are from elementary causes of deteriorations in children with cerebral palsy (CP). The aim of this study was to investigate the immediate effect of maximal treadmill walking on muscle fatigue and postural stability in children with hemiplegic CP.
Patients and methods
Thirty (17 boys and 13 girls) children with hemiplegic CP of both sexes, aged from 5 to 11years, participatedin this study. Muscle fatigue and postural stability were assessed for every child by using isokinetic dynamometer and pediatric reaching test, respectively, before and after maximal treadmill walking at two separated sessions.
The results showed that there were no significant differences in fatigue index (P=0.33 and 0.1), peak torque of quadriceps and hamstring muscles (P=0.52 and 0.14), and anterior and lateral reaching tests of postural stability (P=0.46 and 0.63) before and after maximal treadmill walking.
Maximal treadmill walking does not cause muscle fatigue or postural instability in children with hemiplegic CP.
Novak I, Mcintyre S, Morgan C, Campbell L, Dark L, Morton N, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 2013; 55:885–910.
Nooijen C, Slaman J, van der Slot W, Stam HJ, Roebroeck ME, van den Berg-Emons R, et al. Health-related physical fitness of ambulatory adolescents and young adults with spastic cerebral palsy. J Rehabil Med 2014; 46:642–647.
Kulak W, Sobaniec W. Comparisons of right and left hemiparetic cerebral palsy. Pediatr Neurol 2004; 31:101–108.
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsyApril 2006. Dev Med Child Neurol Suppl 2007; 109:8–14.
Duarte M, Freitas SM. Revision of posturography based on force plate for balance evaluation. Braz J Phys Ther 2010; 14:183–192.
Hadders-Algra M, Carlberg EB. Postural control: a key issue in developmental disorders. London: Mac Keith; 2008.
Näslund A, Sundelin G, Hirschfeld H. Reach performance and postural adjustments during standing in children with severe spastic diplegia using dynamic ankle-foot orthoses. J Rehabil Med 2008; 39:715–723.
Kenis-Coskun O, Giray E, Eren B, Ozkok O, Karadag-Saygi E. Evaluation of postural stability in children with hemiplegic cerebral palsy. J Phys Ther Sci 2016; 28:1398–1402.
Leunkeu A, Keefer D, Ahmaidi S. Electromyographic (EMG) analysis of quadriceps muscle fatigue in children with cerebral palsy during a sustained isometric contraction. J Child Neurol 2010; 25:287–293.
Stackhouse SK, Binder Macleod SA, Lee SC. Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy. Muscle Nerve 2005; 31:594–601.
Lindström B, Lexell J, Gerdle B, Downham D. Skeletal muscle fatigue and endurance in young and old men and women. J Gerontol A Biol Sci Med Sci 1997; 52:B59–B66.
Van der Dussen L, Nieuwstraten W, Roebroeck M, Stam H. Functional level of young adults with cerebral palsy. Clin Rehabil 2001; 15:84–91.
Jahnsen R, Villien L, Stanghelle JK, Holm I. Fatigue in adults with cerebral palsy in Norway compared with the general population. Dev Med Child Neurol 2003; 45:296–303.
Hilberink SR, Roebroeck ME, Nieuwstraten W, Jalink L, Verheijden J, Stam HJ. Health issues in young adults with cerebral palsy: towards a life-span perspective. J Rehabil Med 2007; 39:605–611.
Verschuren O, Ketelaar M, Keefer D, Wright V, Butler J, Ada L, et al. Identification of a core set of exercise tests for children and adolescents with cerebral palsy: a Delphi survey of researchers and clinicians. Dev Med Child Neurol 2011; 53:449–456.
Armstrong N, Welsman JR. Aerobic fitness: what are we measuring. Med Sport Sci 2007; 50:5–25.
Hoofwijk M, Unnithan V, Bar-Or O. Maximal treadmill performance of children with cerebral palsy. Pediatr Exerc Sci 1995; 7:305–313.
Lauglo R, Vik T, Lamvik T, Stensvold D, et al. High-intensity interval training to improve fitness in children with cerebral palsy. BMJ Open Sport Exerc Med 2016; 2:1–6.
Paulson A, Vargus-Adams J. Overview of four functional classification systems commonly used in cerebral palsy. Children 2017; 4:30–40.
Yam WKL, Leung MSM. Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy. J Child Neurol 2006; 21:1031–1035.
Hong WH, Chen HC, Shen IH, Chen CY, Chen CL, Chung CY. Knee muscle strength at varying angular velocities and associations with gross motor function in ambulatory children with cerebral palsy. Res Dev Disabil 2012; 33:2308–2316.
Carusoa J, Brownb L, Tufanob J. The reproducibility of isokineti dynamometry data. Isokinet Exerc Sci 2012; 20:239–253.
Moreau N, Li L, Damiano DL. A feasible and reliable muscle fatigue assessment protocol for individuals with cerebral palsy. Pediatr Phys Ther 2008; 20:59–65.
Bartlett D, Birmingham T. Validity and reliability of a pediatric reach test. Pediatr Phys Ther 2003; 15:84–92.
Volkman KG, Stergiou N, Stuberg W, Blanke D, Stoner J. Methods to improve the reliability of the functional reach test in children and adolescents with typical development. Pediatr Phys Ther 2007; 19:20–27.
Deshmukh AA, Ganesan S, Tedla JS. Normal values of functional reach and lateral reach tests in Indian school children. Pediatr Phys Ther 2011; 23:23–30.
Eken MM, Dallmeijer AJ, Houdijk H, Doorenbosch C. Muscle fatigue during repetitive voluntary contractions: a comparison between children with cerebral palsy, typically developing children and young healthy adults. Gait Posture 2013; 38:962–967.
Van der Cammen-van MH, IJsselstijn H, Takken T, Willemsen SP, Tibboel D, Stam HJ, et al. Exercise testing of pre-school children using the Bruce treadmill protocol: new reference values. Eur J Appl physiol 2010; 108:393–399.
Gumming GR, Everatt D, Hastman L. Bruce treadmill test in children: normal values in a clinic population. Am J Cardiol 1978; 41:69–75.
Bruno Messmer B, Bernuth G. Results of the Bruce treadmill test in children after arterial switch operation for simple transposition of the great arteries. Am J Cardiol 1998; 81:56–60.
Gorter H, Holty L, Rameckers EE, Elvers HJ, Oostendorp RA. Changes in endurance and walking ability through functional physical training in children with cerebral palsy. Pediatr Phys Ther 2009; 21:31–37.
Armstrong N, van Mechelen W. Paediatric exercise science and medicine. 2nd ed. New York: Oxford University Press; 2008.
Ratel S, Duché P, Williams CA. Muscle fatigue during high-intensity exercise in children. Sports Med 2006; 36:1031–1065.
Peterson MD, Gordon PM, Hurvitz EA, Burant CF. Secondary muscle pathology and metabolic dysregulation in adults with cerebral palsy. Am J Physiol Endocrinol Metab 2012; 303:E1085–E1093.
Riner WF, Sellhorst SH. Physical activity and exercise in children with chronic health conditions. J Sport Health Sci 2013; 2:12–20.
Smith LR, Lee KS, Ward SR, Chambers HG, Lieber RL. Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length. J Physiol 2011; 589:2625–2639.
Booth CM, Cortina-Borja M, Theologis T. Collagen accumulation in muscles of children with cerebral palsy and correlation with severity of spasticity. Dev Med Child Neurol 2001; 43:314–320.
Fridén J, Lieber R. Spastic muscle cells are shorter and stiffer than normal cells. Muscle Nerve 2003; 27:157–164.
Stephenson DG, Lamb GD, Stephenson GM. Events of the excitation-contraction-relaxation (E-C-R) cycle in fast- and slow-twitch mammalian muscle fibres relevant to muscle fatigue. Acta Physiol Scand 1998; 162:229–245.
Grecco LA, Tomita SM, Christovão TC, Pasini H, Sampaio LM, Oliveira CS. Effect of treadmill gait training on static and functional balance in children with cerebral palsy: a randomized controlled trial. Braz J Phys Ther 2013; 17:17–23.
Damiano DL, Alter KE, Chambers H. New clinical and research trends in lower extremity management for ambulatory children with cerebral palsy. Phys Med Rehabil Clin N Am 2009; 20:469–491.
Smith GV, Forrester LW, Silver KH, et al. Effect of treadmill training on translational balance perturbation response in chronic hemiparetic stroke patients. J Stroke Cerebrovasc Dis 2000; 9:238–245.
Dimitrijevic MR, Gerasimenko Y, Pinter MM. Evidence for a spinal central pattern generator in humans. Ann N Y Acad Sci 1998; 860:360–376.
Silva MS, Daltrário SM. Cerebral palsy: functional performance after gait training treadmill. Fisioter Mov 2008; 21:109–115.
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Abd El-Nabie, W., Attia, M. Immediate effect of maximal treadmill walking on muscle fatigue and postural stability in children with cerebral palsy. Bull Fac Phys Ther 24, 79–84 (2019). https://doi.org/10.4103/bfpt.bfpt_26_18
- cerebral palsy
- maximal treadmill walking
- muscle fatigue
- posture stability