Quadriceps Muscle Plasticity in Children With Cerebral Palsy

NCT ID: NCT00629070

Last Updated: 2018-05-17

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 16 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2009-01-31
• Study Completion Date: 2010-12-13

Brief Summary

Our primary aim is to determine whether and how muscle architecture of the quadriceps muscles in cerebral palsy (CP) adapts to two separate training programs: traditional strength training (ST) vs. velocity-enhanced training (VT). For the ST group, we hypothesize that muscle size will increase in conjunction with strength. For the VT group, in addition to the above, we hypothesize that fiber length will increase with measures of muscle power. We also hypothesize that walking velocity will improve in both groups but that knee motion and step length will improve only with VT.

Detailed Description

Cerebral palsy (CP) is the most common physical disability originating in childhood, occurring in 2-3 per 1,000 live births. Although the primary deficit in CP is injury to the brain, secondary impairments affecting muscle function such as weakness, contractures, and spasticity are often far more debilitating and lead to worsening disability throughout the lifespan. Some have suggested that these muscle changes in CP may be irreversible; however, it is now known that muscles are one of the most 'plastic' tissues in the body. In fact, recent evidence suggests that gross muscle hypertrophy and architectural changes within muscle fibers can occur as early as 3-5 weeks after resistance training in healthy adults. It is also unknown how effectively muscles in CP can adapt to training stimuli that target specific muscle architectural parameters, such as fascicle length and cross-sectional area. These parameters have been observed to be decreased in CP, suggesting loss of sarcomeres in-series (fiber shortening) and in-parallel (muscle atrophy). We propose here that specific training-induced muscle architectural adaptations can occur in CP, leading to improved motor function.

Conditions

Cerebral Palsy

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

ST

Traditional strength training

Group Type: EXPERIMENTAL

Traditional strength training

Intervention Type: OTHER

Performed 3 x week for 8 weeks on an isokinetic dynamometer (knee extension exercise)at 30 degrees/second; 6 sets of 5 maximum-effort concentric actions

VT

Velocity-enhanced training

Group Type: EXPERIMENTAL

Velocity-enhanced training

Intervention Type: OTHER

Performed 3 x week for 8 weeks on an isokinetic dynamometer (knee extension exercise). Subjects will perform 2 sets of 5 concentric exertions at 30°/second. The following 4 sets of 5 repetitions will be performed at a faster speed, starting at 60° /second. The velocity will be increased weekly in 15° /second increments up to a maximum of 120°/second.

Interventions

Traditional strength training

Performed 3 x week for 8 weeks on an isokinetic dynamometer (knee extension exercise)at 30 degrees/second; 6 sets of 5 maximum-effort concentric actions

Intervention Type: OTHER

Velocity-enhanced training

Performed 3 x week for 8 weeks on an isokinetic dynamometer (knee extension exercise). Subjects will perform 2 sets of 5 concentric exertions at 30°/second. The following 4 sets of 5 repetitions will be performed at a faster speed, starting at 60° /second. The velocity will be increased weekly in 15° /second increments up to a maximum of 120°/second.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Diagnosis of cerebral palsy
• Gross motor function classification system levels I, II, or III
• Ages 7 to 17

Exclusion Criteria

• Orthopedic or neurosurgery within the past year
• Botulinum toxin injections within the 4 months prior to the study

• Minimum Eligible Age: 7 Years
• Maximum Eligible Age: 17 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Medical University of South Carolina

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Noelle G Moreau, PhD, PT

Role: PRINCIPAL_INVESTIGATOR

Medical University of South Carolina

Locations

Neuromuscular Assessment Laboratory

Charleston, South Carolina, United States

Countries

United States

References

Mohagheghi AA, Khan T, Meadows TH, Giannikas K, Baltzopoulos V, Maganaris CN. Differences in gastrocnemius muscle architecture between the paretic and non-paretic legs in children with hemiplegic cerebral palsy. Clin Biomech (Bristol). 2007 Jul;22(6):718-24. doi: 10.1016/j.clinbiomech.2007.03.004. Epub 2007 May 1.

Reference Type: BACKGROUND

PMID: 17475377 (View on PubMed)

Shortland AP, Harris CA, Gough M, Robinson RO. Architecture of the medial gastrocnemius in children with spastic diplegia. Dev Med Child Neurol. 2002 Mar;44(3):158-63. doi: 10.1017/s0012162201001864.

Reference Type: BACKGROUND

PMID: 12005316 (View on PubMed)

Damiano DL, Vaughan CL, Abel MF. Muscle response to heavy resistance exercise in children with spastic cerebral palsy. Dev Med Child Neurol. 1995 Aug;37(8):731-9. doi: 10.1111/j.1469-8749.1995.tb15019.x.

Reference Type: BACKGROUND

PMID: 7672470 (View on PubMed)

Moreau NG, Li L, Geaghan JP, Damiano DL. Contributors to fatigue resistance of the hamstrings and quadriceps in cerebral palsy. Clin Biomech (Bristol). 2009 May;24(4):355-60. doi: 10.1016/j.clinbiomech.2009.01.012. Epub 2009 Mar 5.

Reference Type: BACKGROUND

PMID: 19264384 (View on PubMed)

Moreau NG, Teefey SA, Damiano DL. In vivo muscle architecture and size of the rectus femoris and vastus lateralis in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2009 Oct;51(10):800-6. doi: 10.1111/j.1469-8749.2009.03307.x. Epub 2009 Apr 21.

Reference Type: BACKGROUND

PMID: 19459913 (View on PubMed)

Other Identifiers

PDS 087657

Identifier Type: -

Identifier Source: org_study_id