Mobility-Related Outcomes of Aquatic Training Programs in Children with Cerebral Palsy: A Randomized Trial
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 12, Issue 3
Abstract
Objective: To compare the outcomes of an aquatic interval training program (AITP) and a Halliwick training program (HTP) in young children with cerebral palsy (CP). Methods: Seventeen children aged 3-6 years participated after randomized allocation to either an AITP or HTP. Land-based functional tests: Pediatric Berg Balance Scale (BBS), the 10-meter test, Timed Up and Go (TUG), and the Energy Expenditure Index (EEI), as well as an aquatic skill test (WOTA), were assessed by blinded assessors prior to and after interventions lasting four months (two weekly 30-min sessions). Results: Significant improvement with a large effect size (ES; Cohen’s d >0.8) was observed in the EEI only in the AITP group. TUG performance time and WOTA scores significantly improved, with a large ES in both training groups. Conclusion: AITP appears to be more effective for increasing efficiency while walking. Participants in both training protocols similarly improved in balance and aquatic skill.Cerebral palsy (CP) is the most common physical disability in childhood (2.6-2.9/1000 children) [1], and second to intellectual disability in terms of lifetime costs, with an average cost per person approaching a million dollars in 2003 [2], mostly during childhood and adolescence. The ability to walk is most often delayed and restricted, or even unattained, thus causing a primary concern to parents and therapists of children with CP [3-4]. A survey across Europe suggested that at five years of age 30% of children with CP still don’t walk, and unaided walking was accomplished by only 54% at age five [5]. A similar trend has been reported in the USA, whereby 58.1 % of children with CP are able to walk independently at eight years [6]. Children with CP appear to have decreased levels of physical fitness that result in a decrease of functional abilities [7] and poor walking economy, which can lead to an early onset of fatigue [8]. Consequently, several therapeutic programs for children with CP have, since the late 1990s, increasingly incorporated exercise training components such as muscle strength [7,9] and cardiovascular endurance [10-12]. A combination of these training modalities has been specifically recommended for children with CP [13].Interval or circuit training is a modality often preferred in exercise training, due to its benefits to muscle and connective tissue as well as to the participant’s cardiovascular system during the recovery phases [14]. This training modality has been developed from body building programs and usually includes a series of cycles in identified exercise activities with a scaling of the load and volume of repetitions in each cycle, depending on the type of energy source targeted [15]. This exercise modality has gained popularity in the general exercise literature [16], as well as with individuals with cerebral palsy [11]. For example, Unnithan and colleagues showed reductions in the energy cost of arm cranking and an improvement in peak VO2 with a combined strength and aerobicinterval training program, in children with CP [13]. Blundel and associates conducted a non-randomized ABA time series design in a group of eight children with CP aged 4-8 using circuit strength training, and reported significant and substantial (up to 150%) functional increases [17]. Vershuren and colleagues reported significant differences in physical fitness components, including muscle strength and aerobic and anaerobic capacity in children and adolescents with CP who participated in an eight-month circuit training program [11].
Authors and Affiliations
Yeshayahu Hutzler, Miriam Getz
Keywords
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- EP ID EP592744
- DOI 10.26717/BJSTR.2018.12.002247
- Views 181
- Downloads 0
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