Functional outcomes of strength training in spastic cerebral palsy

Objective: To determine clinical effectiveness of strength training in children with spastic cerebral palsy. Design: Prospective before and after trial in which subjects participated in a 6-week strength training program. All received before and after isometric strength evaluation of eight muscle groups in both lower extremities with a hand-held dynamometer, 3-D gait analysis at free and fast speeds, administration of the Gross Motor Function Measure (GMFM), and assessment of energy expenditure during gait. Setting: Pediatric rehabilitation center at a tertiary care hospital. Patients: Eleven children met inclusion criteria for participation. Six had spastic diplegia, were limited community ambulators, and demonstrated less than 50% of normal muscle strength. Five had spastic hemiplegia and demonstrated a 20% strength asymmetry in at least two muscles across extremities. Results: Each group had significant strength gains in the muscles targeted. The entire cohort had higher gait velocity primarily as a result of increased cadence, with greater capacity to walk faster. GMFM Dimension S also improved, with no change in energy expenditure. Asymmetry in strength improved in hemiplegia, with no change in asymmetry in support times or joint motion across extremities. Conclusions: This study reinforced the relationship of strength to motor function in cerebral palsy and further demonstrated the effectiveness of strengthening in this population.