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

Impact of a resistive exercise program on muscle strength and energy efficiency in individuals with spastic diplegia.

CE BUCKON MS, S SIENKO THOMAS MA, MD AIONA MD,
B S RUSSMAN MD, M D SUSSMAN MD

Shriners Hospitals for Children, Portland, OR, USA

Objective: To determine if a resistive home exercise program results in significant gains in muscle strength and the energy efficiency of gait in individuals with spastic diplegia.

Design: Prospective cohort

Setting: Outpatient clinics at a children’s hospital.

Participants: Sixteen individuals with spastic diplegia (Gross Motor Function Classification system Levels I and II): eight individuals were more than 5 yearsw post selective dorsal rhizotomy (SDR; mean age 15y 3mo) and eight age-matched individuals with spastic diplegia (SD; mean age 14y). Eight peers (PR;mean age 15y) were recruited from the community.

Method: Muscle strength of the extensors and flexors of the elbow, knee, and ankle were assessed using a Biodex System 3 Pro isokinetic dynamometer (Table A:2). Energy efficiency was assessed using a Cosmed K4b2. Individuals were assessed at baseline, 3 and 6 months. At 6 months a 6-week weight lifting program (3days/week) was implemented. Assessments

Table A:2 Assessment protocol by type of contraction, Position, and joint

Joint
Isometric
(degs)
Concentric
(degs/s)

Eccentric
(degs/s)

Elbow  

45, 100
60, 120 
45

Knee

30, 60, 90
30, 60, 120
45

Ankle

5 dorsi, 10 plantar
30,   60
45

Dorsi, dorsiflexion; plantar, plantarflexion.

were repeated following the strengthening program and at 1 year post baseline. The first three assessments were combined to form the baseline for analysis. Peak torque values (normalized by mass), V02, velocity, and cost were used for analysis. Repeated measures analyses of variance and linear contrasts (p<0.05) were used to determine differences within the three groups across time.

Results:

Elbow: The only significant increase in strength was seen in the SDR group for isometric extension 100 0 (p<_0.002) from baseline to 1 year. Knee: No significant gain in concentric or eccentric muscle strength was seen within the groups. Significant gains in isometric extensor (30 0, 90 0; p<_0.01, 0.0004) and flexor (90 0; p<_0.04) strength were seen in the PR group from baseline to 1 year, while the SDR group made significant gains in extensor (90 0; p<_0.04) strength at 1 year. Ankle: The SDR group demonstrated a significant decrease in concentric dorsiflexor strength (30 ), 60 0; p<_0.03), while the SD group demonstrated a significant increase (30 0; p<_0.02) from baseline to 1 year. Isometric dorsiflexor strength increased in the SDR (10 0; p<-0.02) and PR groups (10 0; p<_0.001) from baseline to 1 year. Energy: No significant change in energy efficiency was noted within the three groups.

Conclusion: Muscle strength gains and improvements in energy efficiency of walking, in individuals with spastic diplegia and their peers were minimal, following a 6-week home exercise program. Factors contributing to the lack of significant change may include small group size, inconsistent compliance, and the need to alter program design to include incremental changes in the amount of weight lifted. Although home programs are considered cost effective, this study may indicate the need to re-evaluate the efficacy of home programs for strengthening in the novice weightlifter, and consider the important of a motivational source and the feedback regarding technique that can be provided by an instructor.

Acknowledgments: Shriners Hospitals for Children, grant no. 8630.

 
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