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Purpose: Power training (PT) is a promising training modality to improve functional abilities in children with cerebral palsy (CP). This study aimed to implement PT in an adapted school and to assess its effect on locomotion capacities in children with Gross Motor Function Classification System (GMFCS) level III-IV., Materials and Methods: Nine children with CP (GMFCS level III-IV) were trained three times/week for 12 weeks. The training sessions took place during the 50-minute physical activity classes and included high intensity exercise. The outcome measures were the performance on the 10-meter comfortable and fast walking tests, the 50-meter sprint test (50M-ST), and the energy expenditure index (EEI)., Results: Participants spent 12 ± 7 and 7 ± 9 min per session at an intensity superior to 40% and 60% of the heart rate reserve, respectively. Performance in the 10-meter walking test (13.5 ± 7.8 to 9.9 ± 4.6 s, p  < 0.05), the 10-meter fast walking test (8.8 ± 3.1 to 7.0 ± 3.2 s, p  < 0.05), the 6-minute walking exercise (199.0 ± 48.6 to 316.6 ± 107.2 m, p  < 0.05), and in 50M-ST (53.8 ± 29.5 to 42.3 ± 16.2 s, p  < 0.05) increased after training. The EEI was reduced after training ( p  = 0.01), resulting in a more efficient gait., Conclusions: PT was successfully implemented in children with CP with GMFCS level III-IV. Results suggest that PT increases walking capacities.Implications for rehabilitationPower training (PT) is feasible with children with bilateral cerebral palsy with GMFCS level III and IV.Physical education course in specialist school is a valuable environment to implement PT in children with poor gross motor function.Power training results in locomotion capacities improvement.

Purpose: Evaluate the relationship between different walking capacities and muscle strength in children with bilateral cerebral palsy (BCP) and assess these relationships in stronger and weaker children., Materials and Methods: Thirty-two children with spastic BCP were included. All participants walked under three speed conditions: comfortable, fast, and for a longer period (6 min). Walking speeds, Energy Expenditure Index (EEI), and lower limb muscle strength were measured. A global strength index (GSI) was computed as the sum of each muscle group strength. Pearson's coefficient and regression models were computed between walking capacities and the GSI., Results: GSI was correlated with the EEI and all walking speeds. Logarithmic regressions models explained between 24 and 34% of the variance of walking capacities. Then, the group was divided in two subgroups (weaker and stronger children). GSI was correlated with comfortable and endurance waking speed in weaker children, but not in stronger children., Conclusion: This study reports logarithmic relationship between muscle strength and walking capacities in children with BCP. The subgroup analysis implies that muscle strength has an impact on walking capacities solely in weaker children, suggesting that muscle strength must be preserved and reinforced in interventions targeting motor function in weaker children with BCP.Implications for rehabilitationIn a sample of children with spastic bilateral cerebral palsy, this study shows that global muscle strength is associated with walking capacities and the relationship seems more complex than linear.Based on the results, interventions should focus on maintaining or improving muscle strength in weaker children as no association was observed between muscle strength and walking capacities in stronger children.In stronger children, intervention should focus on factors other than muscle strength as it does not influence walking capacities.Based on this study, a more accurate screening of children who could benefit from strength training could be completed by initial global muscle strength.

Purpose: Cerebral palsy is a neurological disorder not only affecting motor functions but also cognitive and psychosocial dimension. Multispecialty therapies are needed to address these dimensions. Dance practice provides multidimensional benefits for people with various neurological disorders and may present a real potential for people with cerebral palsy. A scoping review is conducted to evaluate the impact of dance in children and adults with cerebral palsy, based on the Human Development Model-Disability Creation Process 2 and its three key concepts: personal factors, environmental factors and life habits. Materials and methods: Studies were selected based on a systematic search of published literature in the following databases PubMed, Medline, EBM Reviews, EMBASE and CINAHL. Studies addressing any concepts on the impact of dance training on motor, cognitive and psychosocial dimensions in people with cerebral palsy were included. Results: Seven studies representing 45 children and 12 adults with cerebral palsy were selected. They had heterogeneous populations, protocols and outcomes measures, but overall covered the three main concepts of the model. Dance may have both motor and social benefits although the evidence remains weak. Conclusions: Dance appears to be a promising activity for people with cerebral palsy. Recommendations are proposed for future studies.Implications for rehabilitationCerebral palsy affects motor and cognitive functions and has social repercussions.Dance can be a promising activity for people with a cerebral palsy.Dance may have both motor and social benefits although the evidence remains weak.

Aims: Cerebral palsy (CP) impacts motor functions such as balance, limits of stability and walking, and may also affect other functions such as attention and rhythm production. Motor and non-motor deficits lead to difficulties in daily life activities. The main objective of this study was to evaluate the effects of a dance intervention on balance in adolescents with CP. The secondary objectives were to evaluate the effects of this intervention on walking speed, attention, and rhythm production., Methods: A pre-post design study with a double baseline was conducted on ten adolescents with CP in order to assess the effects of a 10-week dance intervention. The dance intervention focused on improving balance and limits of stability. Outcomes on static and dynamic balance were evaluated with clinical and laboratory tests before and after the intervention. Walking speed, attention, and rhythm production were also evaluated before and after the intervention., Results: Balance improved after the dance intervention as assessed with both the clinical tests and a laboratory test. Rhythm production also improved after the dance intervention., Conclusions: Results suggest that a 10-week dance intervention is an effective activity to improve static and dynamic balance as well as rhythmic production in adolescents with CP.

The ability to control voluntary weight shifting is crucial in many functional tasks. To our knowledge, weight shifting ability in response to a visual stimulus has never been evaluated in children with cerebral palsy (CP). The aim of the study was (1) to propose a new method to assess visually guided medio-lateral (M/L) weight shifting ability and (2) to compare weight-shifting ability in children with CP and typically developing (TD) children. Ten children with spastic diplegic CP (Gross Motor Function Classification System level I and II; age 7-12 years) and 10 TD age-matched children were tested. Participants played with the skiing game on the Wii Fit game console. Center of pressure (COP) displacements, trunk and lower-limb movements were recorded during the last virtual slalom. Maximal isometric lower limb strength and postural control during quiet standing were also assessed. Lower-limb muscle strength was reduced in children with CP compared to TD children and postural control during quiet standing was impaired in children with CP. As expected, the skiing game mainly resulted in M/L COP displacements. Children with CP showed lower M/L COP range and velocity as compared to TD children but larger trunk movements. Trunk and lower extremity movements were less in phase in children with CP compared to TD children. Commercially available active video games can be used to assess visually guided weight shifting ability. Children with spastic diplegic CP showed impaired visually guided weight shifting which can be explained by non-optimal coordination of postural movement and reduced muscular strength., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Children with cerebral palsy (CP) are prone to secondary complications related to physical inactivity and poor cardiorespiratory capacity. This problem could be greatly attenuated through the use of video games that incorporate physical activity for 2 reasons: Video games already represent an important component of leisure time in younger people, and such games can lead to a high level of exercise intensity in people who are healthy., Objective: The study objective was to evaluate exercise intensity in children with spastic diplegic CP and children who were typically developing while playing with an active video game console., Design: This was a cross-sectional study., Methods: Ten children (7-12 years old) with spastic diplegic CP (Gross Motor Function Classification System level I or II) and 10 children who were age matched and typically developing were evaluated in a movement analysis laboratory. Four games were played with the active video game console (jogging, bicycling, snowboarding, and skiing) for 40 minutes. Heart rate was recorded during the entire playing period with a heart rate belt monitor. Exercise intensity was defined as the percentage of heart rate reserve (HRR). In addition, lower extremity motion analysis was carried out during the final minute of the playing period for the jogging and bicycling games., Results: No difference between groups was observed for any variables. A main effect of games was observed for the amount of time spent at an intensity greater than 40% of HRR. Specifically, more than 50% of the playing time for the jogging game and more than 30% of the playing time for the bicycling game were spent at an intensity greater than 40% of HRR. In addition, the jogging game produced a larger range of motion than the bicycling game., Limitations: A limitation of this study was the relatively small and heterogeneous sample., Conclusions: For all 4 games, similar exercise intensity levels were observed for children who were typically developing and children with CP, suggesting that children with CP could obtain exercise-related benefits similar to those obtained by children without CP while playing with an active video game console.

Objective: To evaluate the impact of forced use therapy on posture in children with hemiplegic cerebral palsy., Design: Single group pre- and post-training assessments., Subjects: Eight children (mean age 10.5 years (standard deviation 1.26 years)) with hemiplegic cerebral palsy Levels I and II on the gross motor function classification scale., Methods: All participants underwent 12 days (6 h/day) of forced use therapy. Postural asymmetry as well as the centre of pressure range and peak velocity during quiet standing were evaluated before and after the therapy. Upper limb functional level was also assessed using the Bruininks Oseretsky test of Motor Proficiency and the Assisting Hand Assessment., Results: Before forced use therapy, postural asymmetry tended to decrease when the participants wore the upper limb constraint. After forced use therapy, upper limb functional scores improved significantly, and postural asymmetry tended to decrease, compared with the pre-therapy values. Postural improvement was correlated with postural asymmetry before forced use therapy. No significant differences were observed on the centre of pressure displacement parameters during the quiet standing tests in all conditions., Conclusion: This pilot study showed that forced use therapy may be an efficient way to improve postural asymmetry in children with hemiplegic cerebral palsy.

Objective: To evaluate sustained attention in adolescents with cerebral palsy (CP). CP affects motor control as well as certain cognitive processes such as attention, but its influence on the latter remains largely unexplored., Methods: Manual (Experiment 1) and oculomotor (Experiment 2) versions of the Continuous Performance Test were performed by adolescents with spastic CP and healthy age-matched controls (n = 10 per group in each experiment)., Results: In both experiments, patients with CP showed more omissions and their reaction time was more variable than controls. In Experiment 2, patients also showed more commissions. This problem was not observed in Experiment 1, possibly because of the presence of a hand movement deficit in CP., Conclusion: Taken together, the results show that sustained attention and inhibition capabilities are affected in CP. The present study also proposes that eye movements could constitute an interesting alternative for measuring sustained attention when hand movement is affected.

Purpose: To evaluate the effect and feasibility of a 10-week group aquatic training programme on gait efficiency in adolescents with cerebral palsy (CP). The secondary purpose was to determine the exercise intensity during aquatic training in a heterogeneous group of adolescents with CP and to investigate the impact of the training programme on the musculoskeletal system., Method: Twelve ambulatory adolescents with spastic CP were recruited. They participated in 20 aquatic training sessions (45 min twice a week). Three physical therapists and a sports teacher supervised the training sessions. Participants wore a heart rate monitor to assess sessions' intensity and a floatation device as appropriate. The primary outcome measure was gait efficiency as measured by the gait energy expenditure index (EEI). The secondary measures were (1) gait spatiotemporal parameters, (2) maximal isometric knee strength and (3) gross motor function., Results: Ten adolescents completed the training programme. No adverse effect was reported. Average exercise intensity was mild to moderate for more than half of the training session. A significant reduction of the EEI and the heart rate during walking was observed following the training programme. No significant change was observed on secondary outcome measures., Conclusions: Group aquatic training increases gait efficiency in adolescents with CP. This improvement is related to systemic cardiorespiratory adaptations. Group aquatic training programme is feasible in adolescents presenting CP at different levels of severity.

Background: Gait in young people with cerebral palsy is inefficient and there is a lack of relevant indicators for monitoring the problem. In particular, the impact of gait kinematics on gait efficiency is not well documented. The aim of this study is to examine the relationship between gait efficiency, gait kinematics, lower limb muscle strength, and muscular spasticity in adolescents with cerebral palsy., Methods: Ten ambulatory adolescents with spastic cerebral palsy were recruited. The energy expenditure index during gait, gait kinematics, flexion and extension knee isometric muscle strength, and quadriceps spasticity were assessed., Findings: Energy expenditure index (1.5 (0.7) beats/m) was strongly correlated with the ankle and knee flexion/extension ranges of motion (r= -0.82, P<0.01 and r= -0.70, P<0.02, respectively) and also with maximal plantar flexion (r=0.74, P<0.05) during gait. Knee flexion strength was the only strength measurement correlated with energy expenditure index (r= -0.85; P<0.01)., Interpretation: This study suggests that ankle and knee flexion/extension ranges of motion during gait are key kinematics factors in gait efficiency in adolescents with cerebral palsy., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

AbstractAimMethodResultsConclusionTo co-construct a dance class adapted for adolescents with cerebral palsy (CP).A three phase co-construction process with study collaborators was used to (1) define the objectives and the obstacles and opportunities related to offering a dance class in the community through three focus groups with adolescents, their parents and study partners; (2) co-create the dance class based on the results of step 1, the expertise of the research team and the logic model of the dance class; and (3) test the dance class to evaluate its effects in relation to the defined objectives.Three objectives were identified: to have fun, promote movement, and social interaction. A weekly dance class (60 min./10 wk) was continuously tested on the adolescents and adapted by the dance facilitators.To improve practices and support the implementation of dance classes for young people with CP, eight recommendations are proposed relating to the creation of adapted classes and the evaluation of their desired effects. [ABSTRACT FROM AUTHOR]

In children with cerebral palsy (CP), lower muscle strength and cardiorespiratory fitness are associated with lower locomotion capacities, especially in children with poor gross motor function (GMFCS II-IV). Cycling exercise could be a promising approach to improve walking efficiency, due to its potential impact on these physiological systems. The objectives of this study were: – to assess if tricycle cycling exercise is in accordance with Verschuren's recommendations, in terms of intensity and duration; – to report the physical limitations which could impact training feasibility. Thirteen children with spastic CP, who were able to ride a tricycle (Trivel, Montréal, Canada) were included (aged 5–11 years; GMFCS level II-IV). A 9-week training program (2 sessions/week) was implemented on stationary tricycle in a school for children with motor disabilities (Victor-Doré, Montreal, Canada). Four bouts of 5-minute exercise, with standardized encouragement, were planned for each session. Intensity and duration of exercise were evaluated during each session. Lower limb range of motion (RoM), muscle strength, and walking % heart rate reserve were assessed before training. The mean intensity and the duration while cycling were 45.2 ± 9.8% of reserve heart rate and 18.0 ± 2.3 min, respectively. Children performed 12.8 ± 2.9 training sessions. Two participants were not able to achieve the targeted minimal exercise recommendations (Both with GMFCS II). Muscle strength is related to exercise duration whereas walking % heart rate reserve is related to exercise intensity and duration. The achievement of tricycle training is possible in children with poor motor function, even in those with low muscle strength. However, physical limitations could impact exercise performance if not properly considered. [ABSTRACT FROM AUTHOR]