Advertisement

Functional Capacity in Adults With Cerebral Palsy: Lower Limb Muscle Strength Matters

  • Jarred G. Gillett
    Correspondence
    Corresponding author Jarred G. Gillett, BExSc, Queensland Cerebral Palsy and Rehabilitation Research Centre, Level 6, Centre for Children’s Health Research (LCCH), The University of Queensland, 62 Graham St, South Brisbane, QLD, Australia, 4101.
    Affiliations
    Queensland Cerebral Palsy and Rehabilitation Research Center, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
    Search for articles by this author
  • Glen A. Lichtwark
    Affiliations
    Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
    Search for articles by this author
  • Roslyn N. Boyd
    Affiliations
    Queensland Cerebral Palsy and Rehabilitation Research Center, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
    Search for articles by this author
  • Lee A. Barber
    Affiliations
    Queensland Cerebral Palsy and Rehabilitation Research Center, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
    Search for articles by this author
Published:February 10, 2018DOI:https://doi.org/10.1016/j.apmr.2018.01.020

      Abstract

      Objective

      To investigate the relation between lower limb muscle strength, passive muscle properties, and functional capacity outcomes in adults with cerebral palsy (CP).

      Design

      Cross-sectional study.

      Setting

      Tertiary institution biomechanics laboratory.

      Participants

      Adults with spastic-type CP (N=33; mean age, 25y; range, 15–51y; mean body mass, 70.15±21.35kg) who were either Gross Motor Function Classification System (GMFCS) level I (n=20) or level II (n=13).

      Interventions

      Not applicable.

      Main Outcome Measures

      Six-minute walk test (6MWT) distance (m), lateral step-up (LSU) test performance (total repetitions), timed up-stairs (TUS) performance (s), maximum voluntary isometric strength of plantar flexors (PF) and dorsiflexors (DF) (Nm.kg−1), and passive ankle joint and muscle stiffness.

      Results

      Maximum isometric PF strength independently explained 61% of variance in 6MWT performance, 57% of variance in LSU test performance, and 50% of variance in TUS test performance. GMFCS level was significantly and independently related to all 3 functional capacity outcomes, and age was retained as a significant independent predictor of LSU and TUS test performance. Passive medial gastrocnemius muscle fascicle stiffness and ankle joint stiffness were not significantly related to functional capacity measures in any of the multiple regression models.

      Conclusions

      Low isometric PF strength was the most important independent variable related to distance walked on the 6MWT, fewer repetitions on the LSU test, and slower TUS test performance. These findings suggest lower isometric muscle strength contributes to the decline in functional capacity in adults with CP.

      Keywords

      List of abbreviations:

      6MWT (6-minute walk test), CP (cerebral palsy), DF (dorsiflexor), GMFCS (Gross Motor Function Classification System), GMFM-66 (Gross Motor Function Measure-66), LSU (lateral step-up), MG (medial gastrocnemius), PF (plantar flexor), TD (typically developed), TUS (timed up-stairs)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Geertsen S.S.
        • Kirk H.
        • Lorentzen J.
        • Jorsal M.
        • Johansson C.B.
        • Nielsen J.B.
        Impaired gait function in adults with cerebral palsy is associated with reduced rapid force generation and increased passive stiffness.
        Clin Neurophysiol. 2015; 126: 2320-2329
        • Opheim A.
        • McGinley J.L.
        • Olsson E.
        • Stanghelle J.K.
        • Jahnsen R.
        Walking deterioration and gait analysis in adults with spastic bilateral cerebral palsy.
        Gait Posture. 2013; 37: 165-171
        • Nieuwenhuijsen C.
        • van der Slot W.M.
        • Dallmeijer A.J.
        • et al.
        Physical fitness, everyday physical activity, and fatigue in ambulatory adults with bilateral spastic cerebral palsy.
        Scand J Med Sci Sports. 2011; 21: 535-542
        • Ryan J.M.
        • Crowley V.E.
        • Hensey O.
        • Broderick J.M.
        • McGahey A.
        • Gormley J.
        Habitual physical activity and cardiometabolic risk factors in adults with cerebral palsy.
        Res Dev Disabil. 2014; 35: 1995-2002
        • Morgan P.
        • McGinley J.
        Gait function and decline in adults with cerebral palsy: a systematic review.
        Disabil Rehabil. 2014; 36: 1-9
        • Neyroud D.
        • Armand S.
        • De Coulon G.
        • et al.
        Plantar flexor muscle weakness and fatigue in spastic cerebral palsy patients.
        Res Dev Disabil. 2017; 61: 66-76
        • Wiley M.E.
        • Damiano D.L.
        Lower-extremity strength profiles in spastic cerebral palsy.
        Dev Med Child Neurol. 1998; 40: 100-107
        • Barber L.
        • Barrett R.
        • Lichtwark G.
        Passive mechanical properties of the medial gastrocnemius muscle in young adults with cerebral palsy.
        J Biomech. 2011; 44: 2496-2500
        • Ross S.A.
        • Engsberg J.R.
        Relation between spasticity and strength in individuals with spastic diplegic cerebral palsy.
        Dev Med Child Neurol. 2002; 44: 148-157
        • Eek M.N.
        • Beckung E.
        Walking ability is related to muscle strength in children with cerebral palsy.
        Gait Posture. 2008; 28: 366-371
        • Ferland C.
        • Lepage C.
        • Moffet H.
        • Maltais D.
        Relationships between lower limb muscle strength and locomotor capacity in children and adolescents with cerebral palsy who walk independently.
        Phys Occup Ther Pediatr. 2012; 32: 320-332
        • Ross S.A.
        • Engsberg J.R.
        Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy.
        Arch Phys Med Rehabil. 2007; 88: 1114-1120
        • Dallmeijer A.J.
        • Rameckers E.A.
        • Houdijk H.
        • de Groot S.
        • Scholtes V.A.
        • Becher J.G.
        Isometric muscle strength and mobility capacity in children with cerebral palsy.
        Disabil Rehabil. 2017; 39: 135-142
        • Engsberg J.R.
        • Ross S.A.
        • Collins D.R.
        Increasing ankle strength to improve gait and function in children with cerebral palsy: a pilot study.
        Pediatr Phys Ther. 2006; 18: 266-275
        • Kirk H.
        • Geertsen S.S.
        • Lorentzen J.
        • Krarup K.B.
        • Bandholm T.
        • Nielsen J.B.
        Explosive resistance training increases rate of force development in ankle dorsiflexors and gait function in adults with cerebral palsy.
        J Strength Cond Res. 2016; 30: 2749-2760
        • Barber L.
        • Hastings-Ison T.
        • Baker R.
        • Barrett R.
        • Lichtwark G.
        Medial gastrocnemius muscle volume and fascicle length in children aged 2 to 5 years with cerebral palsy.
        Dev Med Child Neurol. 2011; 53: 543-548
        • Willerslev-Olsen M.
        • Lorentzen J.
        • Sinkjær T.
        • Nielsen J.B.
        Passive muscle properties are altered in children with cerebral palsy before the age of 3 years and are difficult to distinguish clinically from spasticity.
        Dev Med Child Neurol. 2013; 55: 617-623
        • Gough M.
        • Shortland A.P.
        Could muscle deformity in children with spastic cerebral palsy be related to an impairment of muscle growth and altered adaptation?.
        Dev Med Child Neurol. 2012; 54: 495-499
        • Verschuren O.
        • Ketelaar M.
        • Keefer D.
        • et al.
        Identification of a core set of exercise tests for children and adolescents with cerebral palsy: a Delphi survey of researchers and clinicians.
        Dev Med Child Neurol. 2011; 53: 449-456
        • Maher C.A.
        • Williams M.T.
        • Olds T.S.
        The six-minute walk test for children with cerebral palsy.
        Int J Rehabil Res. 2008; 31: 185-188
        • Thompson P.H.
        • Beath T.B.
        • Bell J.B.
        • et al.
        Test-retest reliability of the 10-metre fast walk test and 6-minute walk test in ambulatory school-aged children with cerebral palsy.
        Dev Med Child Neurol. 2008; 50: 370-376
        • Maanum G.
        • Jahnsen R.
        • FrøSlie K.F.
        • Larsen K.L.
        • Keller A.
        Walking ability and predictors of performance on the 6-minute walk test in adults with spastic cerebral palsy.
        Dev Med Child Neurol. 2010; 52: e126-e132
        • Taylor N.F.
        • Dodd K.J.
        • Baker R.J.
        • Willoughby K.
        • Thomason P.
        • Graham H.K.
        Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial.
        Dev Med Child Neurol. 2013; 55: 806-812
        • Palisano R.
        • Rosenbaum P.
        • Walter S.
        • Russell D.
        • Wood E.
        • Galuppi B.
        Development and reliability of a system to classify gross motor function in children with cerebral palsy.
        Dev Med Child Neurol. 1997; 39: 214-223
        • Jahnsen R.
        • Aamodt G.
        • Rosenbaum P.
        Gross Motor Function Classification System used in adults with cerebral palsy: agreement of self-reported versus professional rating.
        Dev Med Child Neurol. 2006; 48: 734-738
        • ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories
        ATS statement: guidelines for the six-minute walk test.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Barber L.
        • Barrett R.
        • Lichtwark G.
        Medial gastrocnemius muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic cerebral palsy.
        J Biomech. 2012; 45: 2526-2530
        • Gillett J.G.
        • Lichtwark G.A.
        • Boyd R.N.
        • Barber L.A.
        FAST CP: protocol of a randomised controlled trial of the efficacy of a 12-week combined functional anaerobic and strength training programme on muscle properties and mechanical gait deficiencies in adolescents and young adults with spastic-type cerebral palsy.
        BMJ Open. 2015; 5e008059
        • Gillett J.G.
        • Barrett R.S.
        • Lichtwark G.A.
        Reliability and accuracy of an automated tracking algorithm to measure controlled passive and active muscle fascicle length changes from ultrasound.
        Comput Methods Biomech Biomed Engin. 2013; 16: 678-687
        • Cronin N.J.
        • Carty C.P.
        • Barrett R.S.
        • Lichtwark G.
        Automatic tracking of medial gastrocnemius fascicle length during human locomotion.
        J Appl Physiol. 2011; 111: 1491-1496
        • Farris D.J.
        • Lichtwark G.A.
        UltraTrack: software for semi-automated tracking of muscle fascicles in sequences of B-mode ultrasound images.
        Comput Methods Programs Biomed. 2016; 128: 111-118
        • Challis J.H.
        Aging, regularity and variability in maximum isometric moments.
        J Biomech. 2006; 39: 1543-1546
        • Reid S.L.
        • Pitcher C.A.
        • Williams S.A.
        • et al.
        Does muscle size matter? The relationship between muscle size and strength in children with cerebral palsy.
        Disabil Rehabil. 2014; 37: 579-584
        • Barrett R.
        • Lichtwark G.
        Gross muscle morphology and structure in spastic cerebral palsy: a systematic review.
        Dev Med Child Neurol. 2010; 52: 794-804
        • Noble J.J.
        • Charles-Edwards G.D.
        • Keevil S.F.
        • Lewis A.P.
        • Gough M.
        • Shortland A.P.
        Intramuscular fat in ambulant young adults with bilateral spastic cerebral palsy.
        BMC Musculoskelet Disord. 2014; 15: 236
        • Hussain A.W.
        • Onambele G.L.
        • Williams A.G.
        • Morse C.I.
        Muscle size, activation, and coactivation in adults with cerebral palsy.
        Muscle Nerve. 2014; 49: 76-83
        • Camarri B.
        • Eastwood P.R.
        • Cecins N.M.
        • Thompson P.J.
        • Jenkins S.
        Six minute walk distance in healthy subjects aged 55–75 years.
        Respir Med. 2006; 100: 658-665
        • Farris D.J.
        • Sawicki G.S.
        The mechanics and energetics of human walking and running: a joint level perspective.
        J R Soc Interface. 2012; 9: 110-118
        • Lord S.R.
        • Menz H.B.
        Physiologic, psychologic, and health predictors of 6-minute walk performance in older people.
        Arch Phys Med Rehabil. 2002; 83: 907-911
        • Ross S.M.
        • MacDonald M.
        • Bigouette J.P.
        Effects of strength training on mobility in adults with cerebral palsy: a systematic review.
        Disabil Health J. 2016; 9: 375-384
        • Gillett J.G.
        • Boyd R.N.
        • Carty C.P.
        • Barber L.A.
        The impact of strength training on skeletal muscle morphology and architecture in children and adolescents with spastic cerebral palsy: a systematic review.
        Res Dev Disabil. 2016; 56: 183-196
        • Cremer N.
        • Hurvitz E.A.
        • Peterson M.D.
        Multimorbidity in middle-aged adults with cerebral palsy.
        Am J Med. 2017; 130: 744.e9-744.e15