Study Objectives: the objective of this study was to evaluate the effectiveness of a sufficiently long and intensive 12-week functional PRE strength training programme, by applying current guidelines. Design: Single-blind randomized controlled design. Methods: This study was conducted at Physiotherapy OPD of Jaipur Physiotherapy College, Mahraj vinayak global University, Jaipur on spastic unilateral or bilateral Cerebral Palsy children with physical disabilities. Full written informed consent was obtained from all parents and 12-year-old children before enrolment. The total 51 children were pre-stratified according to three stratification variables: sex, GMFCS level (I, II–III), age (youngest: 6–9y; oldest 10–13y), and subsequently randomized to one of two groups using sealed envelopes. Assessments were at baseline (T0), during training (T1; a subset of outcomes), directly after training (T2), and at the 6-week follow-up (T3). The measurement points of main interest were T2 and T3. The control group continued their conventional physical therapy programme. Children in the control group received one to three sessions a week. The training group followed a 12-week progressive functional task training programme for the lower extremities. This replaced their conventional physical-therapy programme. Training was given three times a week for 45 to 60 minutes at Neuro Physioherapy unit of OPD in small groups (four or five children). Each training session consisted of one exercise on a child-adapted leg-press (Enraf Nonius, Delft, the Netherlands) and three functional exercises (sit-to-stand, lateral step-up, half knee-rise), loaded with a weighted vest. During the training, intensity progressively increased, based on repeated estimation of the eight-repetition maximum. Outcome Measure: Gross Motor Function Measure (GMFM- 66), the Sit-To-Stand (STS) test, and the Lateral Step-Up (LSU) test. Result: Sixty-one patients were asked to participate; four turned out to be ineligible. Of the remaining 57 eligible patients, six did not give consent. The remaining 51 children were randomized. Of these, one dropped out before T0 (GMFCS level III, female, age 13y 1m, training) owing to a hip injury that made pretesting and training impossible, and one was lost to follow up at T1 (GMFCS level II, female, age 12y 1mo, training) owing to an unexpected long-term stay abroad. Analyses were performed for 49 participants. There was no statistically significant difference between the groups for personal characterstics. Training compliance and intensity of the 36 scheduled training sessions, three to six sessions were cancelled because of school-related activities. After correction for these, the mean compliance was 92.3% (range 71– 100%). A mean of 32 training sessions (range 30–33) were attended. Reasons for absence were illness (41.4%), medical appointment (8.6%), vacation (6.9%), or other ⁄ unknown (43.1%). Every 2 weeks, starting from week four, eight-repetition maximum tests were performed for leg-press and loaded STS exercises. Based on these eight-repetition maximum test values the training load progressed. During the last 8 weeks of training, the mean eight-repetition maximum strength increased from 116 to 149% on the leg-press, and from 28 to 41% on the loaded STS. Each week, one to six children reported mild to moderate muscle soreness. Conclusion: In conclusion, 12 weeks of functional PRE strength training is effective in increasing isometric muscle strength of the knee extensors and hip abductor by 11 to 12%, and increasing six repetition maximum leg-press strength by 14%. However, this does not result in an increase in mobility. Consequently, functional PRE strength training is indicated for a child with CP when the aim is to improve leg muscle strength. It could also be included in a more extensive treatment regime, addressing several elements of fitness including muscle strength, or used as a target treatment specifically anticipating temporary muscle weakness, such as before or after botulinum-toxin-A or surgical treatment.
