Changing Practice: Clinical Application of Resistance Training Evidence for Children With Cerebral Palsy.

PURPOSE: Describe the development and application of a progressive resistance exercise (PRE) program for children with cerebral palsy (CP), which became a standard care model at an urban specialty hospital network. SUMMARY OF KEY POINTS: Muscle structure and performance have been shown to impact function and participation in children with CP. Use of PRE to achieve function and participation goals is supported by a growing body of evidence. A novel guideline, focused on individualized, goal-focused PRE dosing, professional development, program monitoring, and outcome measures use, facilitated application of a new clinical practice. CONCLUSIONS: Practice change was accomplished by translating evidence using a clinical guideline resulting in positive child function and participation outcomes. RECOMMENDATIONS FOR CLINICAL PRACTICE: This Special Communication provides an example of addressing goal-related muscle performance impairments in children with CP. Clinicians should consider updating long-standing physical therapy intervention strategies by incorporating goal-specific PRE into practice.

Collaborative Therapist-Patient Decision Making: A Power-Based Exercise Program for an Adolescent With CMT1A.

PURPOSE: The purpose of this case report is to describe an episode of care for an adolescent with Charcot Marie Tooth disease (CMT) using a power-based progressive resistance exercise (PRE) and balance program to improve performance of participant-defined goals with added description through the voice of the patient as "participant lived experience." SUMMARY OF KEY POINTS: Participant discussion demonstrates improvement of functional performance for an adolescent with CMT subtype 1A (CMT1A), a progressive neuromuscular disorder. Function and participation-specific movement observation, clinical evaluation, and resistance training fostered appropriate program design and intervention dosing. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE: A power-based progressive resistance exercise and balance program with design based on participant-defined goals was feasible, well tolerated, and successful for an adolescent with CMT1A. Inclusion of viewpoints of the "lived experience" provides deeper insight into patient perspective and clinical outcomes. Outcomes may improve when intervention is specifically dosed to participant goals and individual muscle performance requirements for targeted tasks.

Functional Mobility Improved After Intensive Progressive Resistance Exercise in an Adolescent With Spina Bifida.

PURPOSE: To describe the use and effectiveness of a novel intensive progressive resistance exercise (PRE) approach to address the functional goals of a 14-year-old adolescent with a myelomeningocele. SUMMARY OF KEY POINTS: The child had lower extremity weakness, knee and hip flexion contractures, impaired somatosensation, and cardiopulmonary deconditioning, affecting gait mechanics and functional ambulation. An 8-week intensive PRE-based intervention was designed to improve walking in the home by targeting both power-generating and stabilizing lower extremity musculature. Secondary intervention focused on cardiopulmonary endurance training. CONCLUSIONS: The child demonstrated improvements in gait speed, walking endurance, and functional lower extremity strength. Knee contracture was moderately responsive to sustained stretching and positioning. WHAT THIS CASE ADDS TO EVIDENCE-BASED PRACTICE: This intensive PRE training approach had been effective for improving function among youth with cerebral palsy, and to our knowledge it had not yet been applied to youth with other neurological conditions.

Associations of Gross Motor Delay, Behavior, and Quality of Life in Young Children With Autism Spectrum Disorder.

Background: Young children with autism spectrum disorder (ASD) often have gross motor delays that may accentuate problem daytime behavior and health-related quality of life (QoL). Objective: The objective of this study was to describe the degree of gross motor delays in young children with ASD and associations of gross motor delays with problem daytime behavior and QoL. The primary hypothesis was that Gross motor delays significantly modifies the associations between internalizing or externalizing problem daytime behavior and QoL. Design: This study used a cross-sectional, retrospective analysis. Methods: Data from 3253 children who were 2 to 6 years old and who had ASD were obtained from the Autism Speaks Autism Treatment Network and analyzed using unadjusted and adjusted linear regression. Measures included the Vineland Adaptive Behavior Scales, 2nd edition, gross motor v-scale score (VABS-GM) (for Gross motor delays), the Child Behavior Checklist (CBCL) (for Problem daytime behavior), and the Pediatric Quality of Life Inventory (PedsQL) (for QoL). Results: The mean VABS-GM was 12.12 (SD = 2.2), representing performance at or below the 16th percentile. After adjustment for covariates, the internalizing CBCL t score decreased with increasing VABS-GM (ß = - 0.64 SE = 0.12). Total and subscale PedsQL scores increased with increasing VABS-GM (for total score: ß = 1.79 SE = 0.17; for subscale score: ß = 0.9-2.66 SE = 0.17-0.25). CBCL internalizing and externalizing t scores decreased with increasing PedsQL total score (ß = - 0.39 SE = 0.01; ß = - 0.36 SE = 0.01). The associations between CBCL internalizing or externalizing t scores and PedsQL were significantly modified by VABSGM (ß = - 0.026 SE = 0.005]; ß = - 0.019 SE = 0.007). Limitations: The study lacked ethnic and socioeconomic diversity. Measures were collected via parent report without accompanying clinical assessment. Conclusions: Cross motor delay was independently associated with Problem daytime behavior and QoL in children with ASD. Gross motor delay modified the association between Problem daytime behavior and QoL. Children with ASD and co-occurring internalizing Problem daytime behavior had greater Gross motor delays than children without internalizing Problem daytime behavior; therefore, these children may be most appropriate for early physical therapist evaluation.

Functional movement, strength, and intervention for an adolescent with cerebral palsy.

BACKGROUND AND PURPOSE: This case report describes the examination, intervention, and outcome of a 3-month episode of physical therapy (PT) using combined functional training and progressive resistance exercise for an adolescent with cerebral palsy. SUMMARY OF KEY POINTS: The patient presented with a long history of PT intervention and strength impairments that limited functional and transitional movement, agility, and peer-level participation in school and the community. Functional strength, aerobic conditioning, and anaerobic power were examined and addressed during intervention. STATEMENT OF CONCLUSIONS: Lower extremity strength was improved. Improvements in functional strength, agility, and anaerobic power generation were clinically insignificant. Most importantly, patient defined participation improved and was accompanied by achievement of new transitional and functional movements. RECOMMENDATIONS FOR CLINICAL PRACTICE: Outcomes described support the use of progressive resistance exercise and functional training to improve strength and functional mobility in an adolescent with cerebral palsy.

Corticospinal and intracortical excitability of the quadriceps in active older and younger healthy adults.

Age-related declines in neuromuscular function are well-documented, though the mechanisms underlying these deficits are unclear. Specific changes in corticospinal and intracortical neurophysiology may contribute, but have not been well studied, especially in lower extremity muscles. Furthermore, variations in physical activity levels may potentially confound the interpretation of neurophysiologic findings. Therefore, the purpose of this study was to quantify differences in transcranial magnetic stimulation (TMS) measures of corticospinal and intracortical excitability of the quadriceps between healthy, active older and younger adults. Twenty younger (age: 25.2 ± 2.4 years; body mass index [BMI]: 22.1 ± 3.0 kg/m(2); 11 males and 9 females) and twenty older (age: 67.7 ± 5.5 years; BMI: 26.8 ± 3.8 kg/m(2); 11 males and 9 females) subjects who exercised regularly (at least 30 min, 3 times/week) completed testing. Motor evoked potentials (MEPs) were measured by superficial electromyographic recordings of the vastus lateralis (VL). Measures of corticospinal excitability using a double cone TMS coil included resting motor thresholds (RMT), resting recruitment curves (RRCs) and silent periods (SP). Intracortical excitability was measured using paired pulse paradigms for short interval intracortical inhibition (SICI) and intracortical facilitation (ICF). No statistically significant differences between older and younger adults were found for RMT, RRC slopes, SP, SICI or ICF measures (p>0.05). The physically active nature of the older adults included in this study may have contributed to the lack of differences in corticospinal and intracortical excitability since physical activity in older adults attenuates age-related declines in neuromuscular function.