Upper Limb Functional Strengthening Exercises versus Conventional Exercises in Treatment of Children and Adolescents with Hemiplegic Cerebral Palsy

Abstract

Background:Muscle weakness, Spasticity, motor control problems, abnormal movement synergies,limited range of motion and other complications are all examples of common motorimpairments in children with hemiplegic CP. All contribute to the limitation of theaffected UL functional activities in children with hemiplegic CP. Strengthening exerciseis one of the most recommended therapeutic interventions for individuals with CP.However, studies related to ULs strengthening exercises and its effect are very limitedcompared with studies related to LLs strengthening exercises. More studies are neededto determine the strength training procedures and guidelines and to further examine itseffect on muscle strength, ROM, and function.Objectives:The objective of this study was to compare the effects of a designed program of ULFunctional Strengthening Exercises (FSE) with free weights and the ConventionalExercises (CE) on the UL isometric muscle strength, active range of motion (AROM)and functional activities in children and adolescents with hemiplegic CP.Materials and Methods:We conducted a randomized unblinded controlled trial in which 26 children with spastichemiplegic CP participated in this study. They were recruited from the Maternity andChildren Hospital in Dammam. Children were randomly assigned to either the CEgroup or the FSE group. The treatment interventions in both groups were conducted 3times weekly over an 8-weeks treatment period. Children were evaluated at baseline andafter the 8-weeks treatment period. The hand-held dynamometer was used to evaluatethe IMS of selected UL musculatures. The universal goniometer was used to evaluatethe AROM of selected UL joint ranges. Box and blocks test was used to evaluate theaffected UL function.Results:Both FSE and CE groups showed significant improvements in almost all the recordedoutcome measures (IMS, AROM, and UL function) after the 8-weeks treatment period when compared to the baseline measurements. When comparing the percentage ofimprovement in the CE group to that in the FSE group, the percentage of improvementof IMS of some musculatures (shoulder flexors p = 0.001, shoulder external rotators p =0.001, shoulder abductors p = 0.00, elbow flexors p = 0.03, and strength index p = 0.00)were significantly higher in the FSE group. However, no significant difference wasdetected between the two groups with respect to the percentage of improvement of IMSof shoulder adductors (p = 0.16) and elbow extensors (p = 0.19). On the other hand, nosignificant difference was detected between the two groups with respect to thepercentage of improvement of all AROM (p>0.05) and the UL function (p = 0.70).Conclusions:The FSE program was as effective as the CE program in improving the IMS of shoulderadductors and elbow extensors, all AROM parameters, and the affected UL function.However, the FSE program was more effective than the CE program in improving theIMS of shoulder flexors, shoulder external rotators, shoulder abductors, elbow flexors,and strength index.