The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy. Functional outcomes of strength training in spastic cerebral palsy. Partial body‐weight‐supported treadmill training can improve walking in children with cerebral palsy: a clinical controlled trial Effects of task-oriented training on mobility function in children with cerebral palsy. Randomized controlled trial of physiotherapy in 56 children with cerebral palsy followed for 18 months. A randomized clinical trial of strength training in young people with cerebral palsy. Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4–8 years Effect of Treadmill Training with Body Weight Support on Gait and Gross Motor Function in Children with Spastic Cerebral Palsy A randomised controlled trial of different intensities of physiotherapy and different goal-setting procedures in 44 children with cerebral palsy. Treadmill training with partial body weight support in nonambulatory patients with cerebral palsy. Group-Based Task-Related Training for Children with Cerebral Palsy Comparison of Motor Outcomes after Selective Dorsal Rhizotomy with and without Preoperative Intensified Physiotherapy in Children with Spastic Diplegic Cerebral Palsy Intermittent versus continuous physiotherapy in children with cerebral palsy Effects of a static bicycling programme on the functional ability of young people with cerebral palsy who are non‐ambulant The effects of progressive resistance training for children with cerebral palsy Effects of a functional therapy program on motor abilities of children with cerebral palsy. Effects of a postoperative strength-training program on the walking ability of children with cerebral palsy: a randomized controlled trial. Therapeutic effects of strengthening exercise on gait function of cerebral palsy Use of physiotherapy and alternatives by children with cerebral palsy: a population study. Effectiveness of Loaded Sit-to-Stand Resistance Exercise for Children With Mild Spastic Diplegia: A Randomized Clinical Trial Increasing Ankle Strength to Improve Gait and Function in Children with Cerebral Palsy: A Pilot Study Effects of a postoperative resistive exercise program on the knee extension and flexion torque in children with cerebral palsy: a randomized clinical trial. Effect of intensive neurodevelopmental treatment in gross motor function of children with cerebral palsy. Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy.
BACKGROUND AND PURPOSE The Bobath neurodevelopmental treatment approach advised against the use of resistive exercise , as proponents felt that increased effort would increase spasticity . The purpose of this study was to test the premise that the performance of exercises with maximum efforts will increase spasticity in people with cerebral palsy ( CP ) . Spasticity , in the present study , was defined as a velocity-dependent hyperexcitability of the muscle stretch reflex . SUBJECTS Twenty-four subjects with the spastic diplegic form of CP ( mean age=11.4 years , SD=3.0 , range=7 - 17 ) and 12 subjects without known neurological impairments ( mean age=11.6 years , SD=3.5 , range=7 - 17 ) were assessed . METHODS Knee muscle spasticity was assessed bilaterally using the pendulum test to elicit a stretch reflex immediately before and after 3 different forms of right quadriceps femoris muscle exercise ( isometric , isotonic , and isokinetic ) during a single bout of exercise training . Pendulum test outcome measures were : ( 1 ) first swing excursion , ( 2 ) number of lower leg oscillations , and ( 3 ) duration of the oscillations . RESULTS There were no changes in spasticity following exercise between the 2 groups of subjects . DISCUSSION AND CONCLUSION These results do not support the premise that exercises with maximum efforts increase spasticity in people with CP OBJECTIVE To determine clinical effectiveness of strength training in children with spastic cerebral palsy . DESIGN Prospect i ve before and after trial in which subjects participated in a 6-week strength training program . All received before and after isometric strength evaluation of eight muscle groups in both lower extremities with a h and -held dynamometer , 3-D gait analysis at free and fast speeds , administration of the Gross Motor Function Measure ( GMFM ) , and assessment of energy expenditure during gait . SETTING Pediatric rehabilitation center at a tertiary care hospital . PATIENTS Eleven children met inclusion criteria for participation . Six had spastic diplegia , were limited community ambulators , and demonstrated less than 50 % of normal muscle strength . Five had spastic hemiplegia and demonstrated a 20 % strength asymmetry in at least two muscles across extremities . RESULTS Each group had significant strength gains in the muscles targeted . The entire cohort had higher gait velocity primarily as a result of increased cadence , with greater capacity to walk faster . GMFM Dimension 5 also improved , with no change in energy expenditure . Asymmetry in strength improved in hemiplegia , with no change in asymmetry in support times or joint motion across extremities . CONCLUSIONS This study reinforced the relationship of strength to motor function in cerebral palsy and further demonstrated the effectiveness of strengthening in this population This matched‐pairs , clinical controlled trial evaluated the effects of a school‐based , partial body‐weight‐supported treadmill training ( PBWSTT ) programme , conducted twice a week for 6 weeks , on the walking speed and endurance of children with cerebral palsy ( CP ) . Pairs of children ( 10 males , four females ; mean age 8y 10mo [ SD 2y 6mo ] , range 5–14y ) matched for sex , age , type of CP ( athetoid quadriplegia , n=6 ; spastic quadriplegia , n=6 ; spastic diplegia , n=2 ) , and Gross Motor Function Classification System level ( 10 at Level I V , four at Level III ) were allocated to the experimental or control group . Compared with the control group , the seven treadmill‐training participants  increased their self‐selected walking speed over 10 metres ( Mann‐Whitney U=9.00 , z=−1.98 , p=0.048 ; mean difference 4.21m/min ) . A trend was also found for increased distance walked over ground in 10 minutes ( t[12]=1.88 , p=0.083 ; mean difference 19.81 m ) . A relatively short PBWSTT programme can improve the walking speed of children with CP and moderate to severe disabilities . Walking endurance might also improve in some children . Treadmill training seems to be a useful gait training option for children with C P , and it seems feasible to conduct such a programme within a school environment BACKGROUND / PURPOSE Improvement in mobility function has been the primary goal in the rehabilitation of children with cerebral palsy . Few studies have examined the effectiveness of task-oriented strength training for children with cerebral palsy . The purpose of this study was to examine the effects of task-oriented strength training on mobility function in children with cerebral palsy . STUDY DESIGN A single-blind , r and omized controlled trial with pre-training and post-training evaluations . MATERIAL S AND METHODS Ten children with cerebral palsy ( GMFCS levels I-III ) were r and omly assigned to an experimental group ( N = 5 ) or control group ( N = 5 ) . Mobility function was assessed using the Gross Motor Function Measure ( GMFM ) and the Timed " Up and Go " ( TUG ) test . Participants in the control group received conventional physical therapy focused on improving walking and balance through facilitation and normalization of movement patterns . Participants in the experiment group received task-oriented strength training focused on strengthening the lower extremities and practicing functional tasks similar to those the child performs during daily activities . RESULTS After the 5-week training period there were significant improvements in the experimental group for dimension D ( p = 0.009 ) , and dimension E ( p = 0.009 ) of the GMFM . The experimental group significantly reduced the time taken to complete the TUG ( p = 0.017 ) . CONCLUSION / SIGNIFICANCE This study supports the efficacy of task-oriented strength training for improving mobility function in children with cerebral palsy . The findings demonstrate that the application of a task-oriented strength training program is linked to positive functional outcomes . The results suggest that children with cerebral palsy may benefit from a task-oriented strength training program . Further studies with a larger r and omized sample and longer post-intervention follow-up are necessary to document the long-term effects of participation in task-oriented strength training programs in the cerebral palsy population This study aim ed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal - setting in children with cerebral palsy ( CP ) . Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System ( GMFCS ) , aged between 3 and 12 years . A 2 x 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts , and to compare the use of generalized aims set by the child 's physiotherapist with the use of specific , measurable goals negotiated by the child 's physiotherapist with each child , carer , and teacher . Following the six-month treatment period there was a further six-month period of observation . Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure ( GMFM ) and the Gross Motor Performance Measure ( GMPM ) at three-month intervals . There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim -directed and goal -directed therapy  in either function or performance . Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period . This advantage declined over the subsequent six months during which therapy had reverted to its usual amount . Differences in goal - setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance This r and omized clinical trial evaluated the effects of a home-based , six-week strength-training programme on lower limb strength and physical activity of 21 young people ( 11 females , 10 males ; mean age 13 years 1 month , SD 3 years 1 month ; range 8 to 18 years ) with spastic diplegic cerebral palsy ( CP ) with independent ambulation , with or without gait aids ; ( Gross Motor Function Classification System levels I to III ) . Compared with the 10 controls , the 11 participants in the strength-training programme increased their lower limb strength ( combined ankle plantarflexor and knee extensor strength as measured by a h and -held dynamometer ) at 6 weeks ( F(1,19)=4.58 , p=0.046 ) and at a follow-up 12 weeks later ( F(1,18)=6.25 , p=0.041 ) . At 6 weeks , trends were also evident for improved scores in Gross Motor Function Measure dimensions D and E for st and ing , running and jumping , and faster stair climbing . A relatively short clinical ly feasible home-based training programme can lead to lasting changes in the strength of key lower-limb muscles that may impact on the daily function of young people with CP Objective : To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy . Design : A nonr and omized ABA trial . Setting : Sydney school . Subjects : Eight children with cerebral palsy , aged 4–8 years , seven with diagnosis of spastic diplegia , one of spastic/ataxic quadriplegia . Intervention : Four weeks of after-school exercise class , conducted for one hour twice weekly as group circuit training . Each work station was set up for intensive repetitive practice of an exercise . Children moved between stations , practising functionally based exercises including treadmill walking , step-ups , sit-to-st and s and leg presses . Main outcome measures : Baseline test obtained two weeks before training , a pre-test immediately before and a post-test following training , with follow-up eight weeks later . Lower limb muscle strength was tested by dynamometry and Lateral Step-up Test ; functional performance by Motor Assessment Scale ( Sit-to-St and ) , minimum chair height test , timed 10-m test , and 2-minute walk test . Results : Isometric strength improved pre- to post-training by a mean of 47 % ( SD 16 ) and functional strength , on Lateral Step-up Test , by 150 % ( SD 15 ) . Children walked faster over 10 m , with longer strides , improvements of 22 % and 38 % respectively . Sit-to-st and performance had improved , with a reduction of seat height from 27 ( SD 15 ) to 17 ( SD 11 ) cm . Eight weeks following cessation of training all improvements had been maintained . Conclusions : A short programme of task-specific strengthening exercise and training for children with cerebral palsy , run as a group circuit class , result ed in improved strength and functional performance that was maintained over time Cherng R-J , Liu C-F , Lau T-W , Hong R-B : Effect of treadmill training with body weight support on gait and gross motor function in children with spastic cerebral palsy . Am J Phys Med Rehabil 2007;86:548–555 . Objective : To examine the effect of treadmill training with body weight support ( TBWS ) on gait and gross motor function in children with spastic cerebral palsy ( CP ) . Design : Eight children with spastic CP participated in the study . Their temporal-distance gait parameters , Gross Motor Function Measure , muscle tone , and selective motor control were assessed three times : two times under their regular therapeutic treatment ( condition A ) , and one time after receiving the TBWS treatment in addition to their regular therapeutic treatments ( condition B ) . There were two treatment schedules , AAB and ABA . Except for the first one ( taken at study entry ) , the assessment s were always taken after 12 wks of treatment . The children were equally divided into two groups and r and omly assigned to the two schedules . The two groups were matched according to category of the Gross Motor Function Classification System . Results : The TBWS treatment significantly improved the children ’s gait ( increases in stride length and decreases in double-limb support percentage of gait cycle ) and their Gross Motor Function Measure ( dimension D and E scores as well as the total score ) . No significant improvements on muscle tone or selective motor control were noted . Conclusions : The TBWS treatment improved some gait parameters and gross motor functions in children with spastic CP Forty-four children aged 3 to 11 years with quadriplegic cerebral palsy were prospect ively stratified and r and omised into four treatment groups . The acquisition of motor skills was assessed in a 2 x 2 factorial design using the Gross Motor Function Measure . The two factors were conventional amounts of physiotherapy vs intensive amounts of physiotherapy , and the use of broad , generalised aims vs the use of specific measurable goals directed at motor skill acquisition . 82 % of the children improved . Over the two-week period , intensive physiotherapy produced a slightly greater effect than conventional physiotherapy but the factor more strongly associated with increased motor skill acquisition was the use of specific measurable goals OBJECTIVE To examine the potential role of treadmill training with partial body weight support in nonambulatory children with cerebral palsy . STUDY DESIGN Open , nonr and omized , baseline-treatment study . SETTING An outpatient rehabilitation clinic . SUBJECTS Ten children with cerebral palsy . Six children ( group A ) were nonambulatory , and four children ( group B ) either required continuous physical help ( two cases ) or were able to walk short distances with a st and -by or independently ( one case each ) . INTERVENTION Three months of additional treadmill training , three times a week , 25 minutes a session . MAIN OUTCOME MEASURES Functional Ambulation Categories , st and ing and walking section of the Gross Motor Function Measure , assessed at two baseline measurements 6 and 3 weeks before the study onset , at the beginning , and at the end of therapy . RESULTS Measurements during baseline and at the study onset did not differ . During therapy , the mean Functional Ambulation Category improved significantly from 1.1 to 1.9 ( p<.05 ) . The sum score of the st and ing section of the Gross Motor Function Measure increased by 47 % ( p<.05 ) . The walking section score increased by 50 % ( p<.01 ) . Of the six nonambulant children in group A , transfer abilities improved in four , one child could walk short distances independently , and two children could walk with continuous physical support after therapy . Of group B , one child could climb stairs independently , three children only needed verbal support while walking , and all subjects could then st and up arm-free after therapy . CONCLUSIONS Treadmill training with partial body weight support is a promising treatment technique in nonambulatory children with cerebral palsy This pilot study examined the feasibility of a 6-week group-based , task-related training program in children 6 to 14 years-old with spastic diplegia . Eight children were r and omized to lower limb training and seven to an upper limb dexterity training program .  There were no statistically significant differences in lower limb outcomes between children who received the lower limb training and children who received the upper limb dexterity training after completion of the interventions or at a 6-week follow-up . Children who received the upper limb training demonstrated a greater improvement on measures of manual dexterity compared with children who received the lower limb training program . Children who received the lower limb training demonstrated a trend toward walking a longer distance in 10 minutes immediately following intervention , that was not sustained at the 6-week followup . The group setting appeared to motivate the children and enhance their participation in the training programs . The pilot study provides data for the calculation of effect size and sample estimates for future studies A previous r and omized clinical trial compared selective dorsal rhizotomy ( SDR ) plus postoperative intensified physiotherapy ( group 1 ) with intensified physiotherapy alone ( group 2 ) for children with spastic diplegic cerebral palsy . At the end of this trial , all patients in group 2 had an SDR , followed by further  intensified physiotherapy . This study was performed to determine if the additional intensified physiotherapy before SDR , as occurred in group 2 , improved long-term motor outcome . Outcomes were compared in the two groups , i.e. group 1 without intensified physiotherapy before SDR and group 2 with intensified physiotherapy before SDR . The primary outcome measure was the Gross Motor Function Measure ( GMFM ) . Lower-limb spasticity , range and strength were secondary outcome measures . Baseline assessment s had been done for the prior clinical trial . For this study , patients were reassessed by physiotherapists blinded to the treatment group . Thirteen children in each group were studied at a mean follow-up of 53 months . The mean improvement in GMFM was 10.0 in group 1 and 10.4 in group 2 ( p = 0.9 ) . Improvements in spasticity and range were similar in the two groups . There was no significant change in muscle strength in either group . It was concluded that in this relatively small series of patients , additional intensified physiotherapy before SDR did not improve motor outcomes The aim of this study was to compare the effect of the delivery of the same amount of intermittent versus continuous physiotherapy given to children with cerebral palsy ( CP ) . This was organized either in an intermittent regime four times a week for 4 weeks alternating with a 6‐week treatment pause , or a continuous once or twice a week regime , both for a total of 30 weeks . Therapy was administered according to generally accepted physiotherapeutic principles . A prospect i ve , r and omized controlled design was used . Twenty‐five children ( 16 males , nine females ; median age 3y , range 1y‐8y 1mo ) participated . The children were stratified by age and function level ( all levels represented ) using the Gross Motor Function Classification System and assigned to continuous or intermittent treatment . The Gross Motor Function Measure 66 ( GMFM‐66 ) was used as the outcome measure before and after intervention . Statistical analysis revealed that both groups increased their GMFM scores during intervention ( intermittent group p=0.028 ; continuous group p=0.038 ) , while there was no significant difference comparing delta scores between groups ( p=0.81 ) . Compliance was significantly higher in the intermittent group ( p=0.005 ) , but there was no association between GMFM score and compliance . The study shows that organizing physiotherapy in two markedly different ways yields identical outcome measures for children with CP This study investigated the effects of exercise on the motor function of 11 young people ( 10 females , one male ; age range 11‐15y ; mean age 12y 7mo [ SD 1y 4mo ] ) with cerebral palsy ( CP ) who were non‐ambulant ( Gross Motor Function Classification System Levels IV or V ) , using an adapted static bicycle .  Three participants had dyskinetic quadriplegia , seven had spastic quadriplegia , had spastic quadriplegia , and one had spastic diplegia . The study used an ABA design with participants acting as their own controls with 6‐week baseline , 6‐week exercise ( three sessions a week ) , and 6‐week follow‐up periods . Outcomes were assessed with the Gross Motor Function Measure (GMFM)‐66 and GMFM‐88 . A ‘ grade d exercise test’determined pedalling resistance ‘ overload’was ensured by increasing the duration and speed of pedalling . Results showed significant improvements in GMFM‐66 ( p=0.010 ) and in GMFM‐88 dimensions D ( St and ing ; P=0.012 ) and E ( Walking , Running , and Jumping ; p=0.011 ) over the interventio period , but not over the baseline or follow‐up periods . Significant improvements were found in ‘ cycling’ability for duration of pedalling ( p<0.001 ) , speed ( p=0.01 ) , and resistance ( p=0.001 ) . This study demonstrates that a relatively short , clinical ly feasible training programme on a static bicycle can lead to valuable improvements in functional ability in young people with CP . The static bicycle provided a safe , effective means of exercise to a population with very limited opportunities for activity Objectives : To investigate the effects of progressive resistance training of quadriceps and hamstrings muscles in children with cerebral palsy ( CP ) . Design : Pilot study using a repeated measures design with measurements at baseline , immediately after six weeks training then at four-week follow-up . Setting : The project was undertaken within the physiotherapy department of two special schools in Glasgow . Subjects : A convenience sample of eight children aged between six and 12 years , with hypertonic CP . Intervention : The subjects participated three times per week in a six-week , progressive , free-weight , strengthening programme . Outcome measures : Maximum isometric muscle strength and resistance to passive stretch were measured with a h and -held myometer . The Gross Motor Function Measure and a 10-metre timed walking test , were used to assess function and gait parameters respectively . Results : Muscle strength increased , with the quadriceps to hamstrings strength ratio moving towards normal . These changes were retained at follow-up . Muscle tone decreased and continued to decrease to follow-up . The st and ing ( D ) and walking , running and jumping ( E ) goal areas of the Gross Motor Function Measure showed improvement that continued towards follow-up . Walking speed and step rate increased . Conclusions : A future large-scale r and omized controlled study would be of value to substantiate these results as the small convenience sample and lack of control group limit this study . However , the finding that no adverse effect accompanied the positive outcomes in strength and function may encourage clinicians to consider resistance training alongside st and ard therapeutic interventions BACKGROUND AND PURPOSE The purpose of this study was to determine whether the motor abilities of children with spastic cerebral palsy who were receiving functional physical therapy ( physical therapy with an emphasis on practicing functional activities ) improved more than the motor abilities of children in a reference group whose physical therapy was based on the principle of normalization of the quality of movement . SUBJECTS The subjects were 55 children with mild or moderate cerebral palsy aged 2 to 7 years ( median=55 months ) . METHODS A r and omized block design was used to assign the children to the 2 groups . After a pretest , the physical therapists for the functional physical therapy group received training in the systematic application of functional physical therapy . There were 3 follow-up assessment s : 6 , 12 , and 18 months after the pretest . Both basic gross motor abilities and motor abilities in daily situations were studied , using the Gross Motor Function Measure ( GMFM ) and the self-care and mobility domains of the Pediatric Evaluation of Disability Inventory ( PEDI ) , respectively . RESULTS Both groups had improved GMFM and PEDI scores after treatment . No time x group interactions were found on the GMFM . For the PEDI , time x group interactions were found for the functional skills and caregiver assistance scales in both the self-care and mobility domains . DISCUSSION AND CONCLUSION The groups ' improvements in basic gross motor abilities , as measured by the GMFM in a st and ardized environment , did not differ . When examining functional skills in daily situations , as measured by the PEDI , children in the functional physical therapy group improved more than children in the reference group OBJECTIVE To investigate the effect of a postoperative strength-training program on the walking of children with cerebral palsy ( CP ) . DESIGN R and omized controlled trial . SETTING Hospital rehabilitation department . PARTICIPANTS Thirty-nine children with CP ( age range , 6 - 16 y ) . After orthopedic surgery , the control group ( n=20 ) followed a conventional physiotherapy ( PT ) program , and the strength-training group ( n=19 ) followed a strength-training program in addition to the conventional PT .  Twenty-nine age-matched healthy children were used as references . INTERVENTION A 9-month strength-training program . MAIN OUTCOME MEASURES Spatiotemporal , kinematic , and kinetic parameters during gait analysis were analyzed before ( E0 ) and 1 year after ( E1 ) the surgery . For 22 children , a 2-year postoperative gait analysis ( E2 ) took place as well . RESULTS At E1 , several kinematic and kinetic parameters improved , although there was no significant difference between the groups . Spatiotemporal parameters showed a worsening at E1 and a recovery to preoperative values at E2 . CONCLUSIONS The examined parameters may be more substantially influenced by factors such as the surgery outcome and the variability of pathologic characteristics than by the strength-training program per se . However , a more significant effect of the strength-training may appear if more intense and short-term training protocol s are used , considering factors such as patients ' motivations , ages , and postoperative statuses Purpose . To assess the effectiveness of strengthening exercises of the lower limbs on improvement of muscle strength and gait function . Method . Those included were diagnosed as spastic diplegic or hemiplegic type of cerebral palsy ( CP ) and verified as grade 2 or 3 of the Gross Motor Function Classification System ( GMFCS ) . Participants were divided into an experimental group ( n = 9 ) or a  control group ( n = 8) . The experimental group completed a 5-week strengthening program and the control group took part in conventional physical therapy .  Muscle tone and strength of lower limb , Gross Motor Function Measure , lateral step up , squat to st and , and three dimensional gait analysis were tested at pre-training , post-training , and 6 week follow up . Results . Maximal hip extensor strength , and number of squat to st and were significantly increased at post-training and 6 weeks follow up in the experimental group compared with the control group . GMFM score D and E significantly improved in the experimental group at post-training . The experimental group demonstrated significant increase of gait speed and stride length and decrease of double support phase at post-training and 6 weeks follow up . Conclusions . Strengthening exercises could be a useful method to improve gait function of patients with spastic CP OBJECTIVES To describe the use of physiotherapy services and alternative therapies by a population of children with moderate to severe cerebral palsy ( CP ) . DESIGN Descriptive cross-sectional survey . SUBJECTS A total of 212 parents of children aged 4 - 14 years with moderate to severe CP were identified from the Northern Irel and Cerebral Palsy Register ( NICPR ) and a r and om sub sample of their paediatric physiotherapists . MAIN MEASURES A st and ardized description of motor impairment or assessment form ; a postal question naire to parents and paediatric physiotherapists ( to vali date parents ' reports of service use ) . RESPONSE RATES : In total , 85 % of parent question naires were returned and 100 % of paediatric physiotherapists responded . RESULTS Service use among families was high ; on average the families had contact with approximately seven services in a 6-month time interval . The overwhelming majority of children ( 96 % ) received  physiotherapy  during the school term and most ( 59 % ) received treatment at least twice a week for 30 min ; 43 % of children had their physiotherapy discontinued over the summer holidays . Over one-quarter ( 28 % ) of families had opted out of the NHS and bought alternatives like conductive education ( 21 % ) or private forms of conventional physiotherapy ( 16 % ) . Children with more severe forms of CP , in special education , particularly at schools for physical disability , were high-intensity users of the physiotherapy service . Despite this , 74 % of parents wanted more physiotherapy  for their child . CONCLUSIONS AND IMPLICATION S The dem and for physiotherapy services is likely to continue given the relatively stable prevalence rate of CP , the proportion of children with disabling CP and the level of parent interest in the service . A number of quality aspects and gaps in the service have been identified Abstract Liao H-F , Liu Y-C , Liu W-Y , Lin Y-T. Effectiveness of loaded sit-to-st and resistance exercise for children with mild spastic diplegia : a r and omized clinical trial . Objective To investigate effectiveness of a functional strengthening program , the loaded sit-to-st and ( STS ) resistance exercise , for children with cerebral palsy ( CP ) . Design A single-blind , r and omized block design . Setting STS exercises were carried out at the children ’s homes . Participants Twenty children ( 12 boys , 8 girls ; age range , 5−12y ) with spastic diplegia CP and classified by the Gross Motor Function Classification System as level I or II were stratified by their severity and age and r and omly allocated into either the experimental or control group . Intervention Both groups received their regular physical therapy . The experimental group underwent loaded STS exercise 3 times a week for 6 weeks . Main Outcome Measures Goal dimension scores of the Gross Motor Function Measure ( GMFM ) , gait speed , 1 repetition maximum ( 1-RM ) of the loaded STS , isometric strength of knee extensor , and Physiological Cost Index ( PCI ) . The outcome measures were conducted at the beginning and end of the 6-week study . Results After loaded STS exercise , the experimental group showed statistically significant differences in GMFM goal dimension scores , 1-RM STS , and PCI from the control group . The changes in gait speed and isometric strength of the knee extensor did not differ significantly between the 2 groups . Conclusions After the loaded STS exercise , children with mild spastic diplegia improved their basic motor abilities , functional muscle strength , and walking efficiency Purpose : This pilot study was design ed to determine whether increases in ankle strength could improve gait and function in children with spastic diplegia . Methods : Data were obtained from 12 children with spastic diplegia who were assigned r and omly to a dorsiflexor group , a plantarflexor group , a dorsi- and plantarflexor group , or a control group .  Training group subjects participated in a 12-week strength program using an isokinetic dynamometer . Results : The majority of subjects increased their strength in the trained muscles ; the strength of untrained muscles was unchanged . The Gross Motor Function Measure ( GMFM ) walk-run-jump dimension and a quality of life measure ( ie , Peds QL ) improved significantly for the entire training group . Gait speed was not significantly increased for the entire training group but varied among training groups . Gait kinematics significantly improved or showed trends for improvement for the entire training group . Conclusion : This pilot investigation indicates that ankle strength increases may lead to improved function , gait speed , and quality of life in children with spastic diplegia OBJECTIVE To investigate the effects of resistive exercise on the knee extension and flexion torque production during the rehabilitation period after multilevel orthopedic surgery . DESIGN R and omized clinical trial . SETTING Hospital rehabilitation department . PARTICIPANTS Thirty-nine children with spastic diplegic cerebral palsy ( CP ) ( age range , 6 - 16 y ) , r and omly allocated to an exercise group ( n=19 ) and a control group ( n=20 ) . All received conventional physiotherapy ( PT ) , and the exercise group also followed a resistive exercise program . INTERVENTION A 9-month st and ardized home-based resistive exercise program , which started about 3 months after the surgery . MAIN OUTCOME MEASURES The Gross Motor Functional Measurement ( GMFM ) assessed before ( E(0 ) ) and 1 year ( E(1 ) ) after the surgery . The Modified Ashworth Scale and the isometric and isokinetic torque of the knee extensors and flexors were evaluated at E(0 ) , E(1 ) , and 6 months after the surgery . RESULTS The knee extension and flexion moments had decreased 6 months after the surgery and recovered to the preoperative level 1 year after surgery . These changes were not group dependent . CONCLUSIONS Additional long-term , home-based , low-cost resistive exercise that starts soon after the operation of patients with CP was not more beneficial than conventional PT only , in terms of strength and GMFM This study examined the effect of neurodevelopmental treatment ( NDT ) and differences in its intensity on gross motor function of children with cerebral palsy ( CP ) . Participants were 34 children ( 12 females , 22 males ; mean age 7y 3mo [ SD 3y 6mo ] , age range 3 to 14y ) with mild to moderate spasticity and hemiplegia ( n=10 ) , diplegia ( n=12 ) , and tetraplegia ( n=12 ) . Gross Motor Function Classification System levels were : I ( n=10 ) , II ( n=10 ) , and III ( n=14 ) . The paired sample , which was obtained by ratio stratification and matching by sex , age , and distribution of impairment from a total of 114 children with CP , was assigned r and omly to two groups : group A underwent NDT twice a week and group B five times a week for 16 weeks . The outcome measure used was the Gross Motor Function Measure , which assessed the performance of the children before and after intervention . The paired- sample t-test revealed that gross motor function of children from both groups improved significantly after intervention ( p<0.05 ) . Children in group B performed better and showed significantly greater improvement than those in group A ( p<0.05 ) . Results support the effectiveness of NDT and underline the need for intensive application of the treatment Muscle strength changes following multi-level surgery in cerebral palsy and the impact of rehabilitation on functional recovery are largely unknown . The aim of this study was to quantify lower limb muscle strength changes in children with spastic diplegia after multi-level orthopaedic surgery  and to compare the efficacy of progressive resistance strengthening ( RS ) versus active exercise ( AE ) .  Twenty children with spastic diplegia ( mean age 12.5 years ) participated in this prospect i ve r and omised controlled trial . Participants underwent multi-level orthopaedic surgery . Routine physiotherapy commenced immediately after surgery . At 6 months post-operatively , children were r and omly assigned to the resistance strengthening RS ( n=11 ) or active exercise AE ( n=9 ) group and received intensive physiotherapy for 6 weeks . Gait , motor function and maximum isometric muscle strength in five lower limb muscle groups were measured pre-operatively and at 6 months ( before and after intensive physiotherapy ) and 12 months . As part of the study , we developed and vali date d a myometry protocol . Despite kinematic improvements , there was significant reduction of muscle strength ( p<0.05 ) in all muscle groups at 6 months post-operatively . Following 6 weeks of intensive physiotherapy , both groups showed significant improvement in muscle strength , GMFM scores and gait parameters . Resistance training showed some advantages over active exercise . At 1 year after surgery , strength did not reach pre-operative values in some muscle groups but the benefit from physiotherapy was maintained . In conclusion , we quantified objective ly the reduction in muscle strength 6 and 12 months following multi-level surgery . Furthermore , we demonstrated significant improvement in muscle strength , gait and function following post-operative strength training
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