Disability spiritual well being and Fitness.

A study done by Scholtes et al. (2010) evaluated functional progressive resistance exercise strength training on mobility and muscle strength in children with cerebral palsy. Fifty-one children with uni- and bilateral spastic cerebral palsy were placed in either the intervention group, which consisted of 12 weeks of progressive circuit training, or the control group, receiving usual care. Muscle strength and mobility were all measured before, during, directly after, and six weeks after the training had ended. The results showed a significant change in muscle strength.

Knee extensor strength increased by 12 percent and hip abductor strength increased by 11 percent, while six-repetition leg-press maximum increased by 14 percent. Despite all the significant increases in strength, no changes were observed in mobility. The researchers stated that a probable cause for not observing an increase in mobility was because the improvements in strength weren't enough in order to improve mobility. Another suggestion may have been that the number of each individual muscle that increased in strength was too limited (Scholtes et al.).

To some extent the results of the Scholtes et al. 2010 study coincide with the findings of Damiano, Arnold, Steele, & Delp (2010). The aim of this study was to determine if strength training could decrease the extent of crouched, internally rotated gait in children with cerebral palsy. Eight children followed an eight-week progressive resistance program. Measures were taken before and after the program in three-dimensional gait analysis and isokinetic testing. The results showed that the left hip extensors had significant changes in strength going from 10.7 ft-lb to 19.2 ft-lb (p=0.01), which is a 79.4% change. The right hip extensors and right and left knee extensors all increased as well, but non-significantly. In terms of gait kinematics, some but not all of the children improved with hip and knee extension.

Stride length, cadence, and gait speed were not significantly different from the pre measures, and the increases that were seen varied among each individual. The researchers concluded that strength training may have the ability to improve walking function and alignment in some people with cerebral palsy when weakness is a big contributor to the deficits in gait. Furthermore, there may also be no change or even undesired results in other patients. A larger sample size is needed in order to determine validity of this study.

These findings contradict the findings of Morton, Brownlee, & McFadyn (2005), Eagleton et al. (2004), Blundell, Shephard, Dean, & Adams (2003), Nystrom Eek, Tranberg, Zugner, Alkema, & Beckung (2008) and Andersson, Grooten, Hellsten, Kaping, & Mattsson (2003). In the pilot study by Morton et al., eight children with cerebral palsy underwent a six-week progressive training session, which included strength training three times a week.
Measurements were taken at the beginning, immediately after, and again after a four-week follow up. There was a statistically significant result in the quadriceps and hamstrings mean strength. As far as the gait results, self-selected mean walking speed went from 0.55 m/s to 0.67 m/s post training and then to 0.62 m/s at the follow-up. Fast walking speed also increased going from 0.55 m/s to 0.67 m/s after the training to 0.62 m/s. Self-selected cadence increased from 93.96 steps/min to 108.87 steps/min to 105.64 steps/min. Fast cadence also increased after the strength training intervention, and then decreased following four weeks. Self-selected step length went from 0.34 m to 0.37 m back down to 0.34 m at the follow-up. Fast step length also showed the same changes of an increase followed by a decrease at the follow-up. Eagleton et al. examined trunk and lower body muscle strength as well as gait velocity, step length, and cadence.

The researchers recruited seven adolescents with cerebral palsy to participate in a six-week intervention of strength training. The findings showed that all five variables increased significantly. As a result, the researchers concluded that resistance raining is an important form of physical therapy for children with cerebral palsy.

Blundell et al. (2003) examined eight children between the ages of four and eight, with cerebral palsy, who participated in a training program that lasted four weeks. The participants underwent exercises that were similar to daily tasks in order to increase functional ability. The activities included picking up objects from a couched position to increase balance, step-ups and step-downs, sit-to-stand and leg press for strength, and walking on treadmills, as well as up and down ramps and stairs. Each session of strength training was an hour long and two times a week, with intensity being increased gradually. After four weeks, not only were there improvements in muscle strength, but in functional ability as well. Hip flexors and extensors, dorsiflexors, and knee extensors all showed significant increases in strength and the functional test in the step-ups, minimum chair height test, timed walk, and stride length increased significantly as well. Eight weeks following the training period, the improvements were still visible.

Nystrom Eek et al. (2008) investigated the influence of strength training on gait in children with cerebral palsy. Three days a week for eight weeks, sixteen children participated in lower body resistance training including free weights, rubber bands, and body weight. At the beginning of training, measurements were taken in Gross Motor Function Measure (GMFM) assessment, joint range of motion assessment, as well as three-dimensional gait analysis. After the training period, there were significant increases in muscle strength in the knee flexors and hip muscle groups. There was also a significant increase in GMFM as well as stride length, but no significance in gait velocity and a decrease in cadence after training.

The researchers concluded that a resistance-training program increased strength and improved gait function in children with cerebral palsy. Andersson et al. (2003) examined the effects of progressive strength training on seven individuals with cerebral palsy, while three were placed in the control group. After ten weeks of training twice a week, significant improvements were seen in isometric strength (hip extensors p=0.006; hip abductor p=0.01), isokinetic concentric work (knee extensors p=0.02). There were also statistically significant increases in GMFM (p=0.005) Timed "Up and Go" test (p=0.01), and walking velocity (p=0.005). Ross & Engsberg (2007) found that spasticity was not related to gait and motor function, but strength was highly related to motor function.
Salem & Godwin (2009) also went against the findings by Scholtes et al. (2010), but along with Blundall et al (2003). Salem & Godwin examined ten children with cerebral palsy to assess mobility after task-oriented strength training. Five children were assigned to the experimental group, and five were in the control group. The children placed in the experimental group received task-oriented resistance training focusing on lower body strengthening, while the children in the control group focused on improving balance through reinforcement and normalization of movement patterns through conventional physical therapy (Salem & Godwin). Mobility was measured using the Gross Motor Function Measure and the Timed "Up and Go" test.
After the five-week session came to an end the researchers found there were significant improvements in mobility in the experimental group. The experimental group significantly lowered the time to complete the Timed "Up and Go" test (p=0.017). Along those same experimental lines, a study by Andersson et al. (2003) showed that there were significant improvements not only in strength, but GMFM and Timed "Up and Go" test as well.

A similar study done by Yan, Wang, Lin, Chu, & Chan (2006) examined task-oriented progressive resistance strength and mobility in people with stroke. Stroke in children often results in a movement disorder very similar to that resulting from cerebral palsy ("Cerebral Palsy," n.d.). The two are quite similar to each other, making it important to analyze the studies done with individuals with stroke as well. Forty- eight individuals, a year following a stroke, were either placed in a control group or the experimental group. The experimental group underwent four weeks of task-oriented progressive strength training while the control group didn't do any kind of rehabilitation. After the four weeks, measures were taken in lower body muscle strength, cadence, stride, gait velocity, length of the stride, step test, six-minute walk test, as well as the Timed "Up and Go" test.
In the experimental group, muscle strength significantly in the strong side, which ranged from 23.9% to 36.5% as well as the paretic side, ranging from 10.1% to 77.9%. The control group had changes ranging from a 6.7% increase to 11.2% decline. In all of the measures that were examined, the experimental group showed significant improvements, while the control group showed no changes in the measures except for a significant decline of 20.3% in the step test. There was a significant association between the strength gain and the gain in all the functional tests in the experimental group. The results from this study show that task-oriented strength training may have the potential to increase lower body strength as well as functional mobility for people with stroke, which could translate to people with cerebral palsy.

Based on this evidence, the evidence shows that strength training it may need to be task-oriented or progressive in nature in order to see any improvement in mobility function. Functional training that is done to mimic everyday tasks, or strength exercises specific for increasing muscles used daily, seems to have the best result according to Blundell et al. (2003) and Salem & Godwin (2009).