Influence of gait analysis on decision-marketing for lower extremity surgery

Enchancing fun, fitness, and participation in adolescents with cerebral palsy


  1. 1. Center for Human Movement Science;
  2. 2. Department of Orthopaedics and Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC;
  3. 3. Shared Movement Assessment Center, Washington Universtiy, St.Louis, MO, USA

Objectives: To determine the effects of an aquatic exercise program versus a treadmill program on function, fitness, and health-related quality of life (HRQOL) in ambulatory adolescents with cerebral palsy (CP).

Design: Prospective interventional study (ongoing).

Participants: Fifteen adolescents (mean age 14y 8mo[SD 2y 8mo]) with CP classified at Gross Motor Function Classification System (GMFCS) Levels I to III were randomized into either an aquatic (n=8) or treadmill (n=7) training group and exercised at a local
Wellness facility. Data is representative of the 14 participants who have presently completed the entire study.

Method: Participants were pre-tested for : (1) body composition using a dual-energy X-ray absorptiometry scan; (2) gross motor function using the Gross Motor Function Measure (GMFM)-66; (3) gait speed using the 6-minute walk; (4) energy efficiency index (EEI) during the 6-minute walk; (5) leg strength using hand-held dynamometry; (6) self- perception using the Child/Adolescent Self-Perception Profile; (7) physical activity using the Physical Activity and Disability Scale; and (8) HRQOL using the Pediatric Quality of Life Inventory (CP Module). Particpants trained for 30, 45-minute sessions in water or on the treadmill. Post testing immediately followed the intervention phase, with follow-up testing at 6 months postintervention. The main analysis was between groups repeated-measures analysis of variance.

Results: There was no significant difference in group characteristics before intervention. No difference between groups was found following intervention for any measure. Both groups improved GMFM-66 dimensions  E scores (p=0.01); gait velocity (p=0.02); gait distance (p=0.01); lean muscle mass (p=0.001); strength in left knee extensors (p=0.02), right knee extensors (p=0.01), and left hip abductors (p=0.03) but declined in Global self-perception (p=0.04) and EEI (p=0.02).

Conclusions: Our finding indicate that structured aquatic resistive exercise and treadmill training equally improved strength, function, and lean muscle mass and that many improvements were still evident at 6-month follow-up in adolescents with CP. Future studies should address effects of aquatic versus land-based exercise on joint integrity, pain, and HRQOL in this population.

Acknowledgements: United Cerebral Palsy Association (grant no. EH-006-03) and the University of North Carolina – Chapel Hill, General Clinical Research Center (grant no.RR00046).

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