Functional Mobility Improved After Intensive Progressive Resistance Exercise in an Adolescent With Spina Bifida

Purpose: To describe the use and effectiveness of a novel intensive progressive resistance exercise (PRE) approach to address the functional goals of a 14-year-old adolescent with a myelomeningocele. Summary of Key Points: The child had lower extremity weakness, knee and hip flexion contractures, impaired somatosensation, and cardiopulmonary deconditioning, affecting gait mechanics and functional ambulation. An 8-week intensive PRE-based intervention was designed to improve walking in the home by targeting both power-generating and stabilizing lower extremity musculature. Secondary intervention focused on cardiopulmonary endurance training. Conclusions: The child demonstrated improvements in gait speed, walking endurance, and functional lower extremity strength. Knee contracture was moderately responsive to sustained stretching and positioning. What This Case Adds to Evidence-Based Practice: This intensive PRE training approach had been effective for improving function among youth with cerebral palsy, and to our knowledge it had not yet been applied to youth with other neurological conditions.

[1]  Courtney G. E. Hilderman,et al.  Effectiveness of Stretch Interventions for Children With Neuromuscular Disabilities: Evidence-Based Recommendations , 2016, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[2]  G. Richardson,et al.  The patient-specific functional scale: psychometrics, clinimetrics, and application as a clinical outcome measure. , 2012, The Journal of orthopaedic and sports physical therapy.

[3]  Kathryn E. Smith,et al.  Factors Associated with Mobility Outcomes in a National Spina Bifida Patient Registry , 2015, American journal of physical medicine & rehabilitation.

[4]  K. Holthaus,et al.  Differential Adaptations of Muscle Architecture to High-Velocity Versus Traditional Strength Training in Cerebral Palsy , 2013, Neurorehabilitation and neural repair.

[5]  Helena Saraste,et al.  Kinetics of compensatory gait in persons with myelomeningocele. , 2005, Gait & posture.

[6]  M. Rapport,et al.  Functional Movement, Strength, and Intervention for an Adolescent With Cerebral Palsy , 2015, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[7]  Matt Brzycki,et al.  Strength Testing—Predicting a One-Rep Max from Reps-to-Fatigue , 1993 .

[8]  S. Amatachaya,et al.  Reliability and validity of three functional tests in ambulatory patients with spinal cord injury , 2012, Spinal Cord.

[9]  Roger Adams,et al.  Inter-Tester Reliability and Precision of Manual Muscle Testing and Hand-Held Dynamometry in Lower Limb Muscles of Children with Spina Bifida , 2009, Physical & occupational therapy in pediatrics.

[10]  D. Wolfe,et al.  A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. , 2009, Archives of physical medicine and rehabilitation.

[11]  T. Takken,et al.  Reproducibility of Maximal and Submaximal Exercise Testing in “Normal Ambulatory” and “Community Ambulatory” Children and Adolescents With Spina Bifida: Which Is Best for the Evaluation and Application of Exercise Training? , 2011, Physical Therapy.

[12]  Jessica Lewis,et al.  A Progressive Running Program for an Adolescent With Cerebral Palsy , 2017, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[13]  G. Borg.  Psychophysical bases of perceived exertion. , 1982, Medicine and science in sports and exercise.

[14]  A. Faigenbaum,et al.  Effect of rest interval length on bench press performance in boys, teens, and men. , 2008, Pediatric exercise science.

[15]  Å. Bartonek,et al.  Ambulation in patients with myelomeningocele: a 12-year follow-up. , 1999, Journal of pediatric orthopedics.

[16]  Jeremy A. Moody,et al.  Position statement on youth resistance training: the 2014 International Consensus , 2013, British Journal of Sports Medicine.

[17]  A. Marques,et al.  Physical fitness and exercise training on individuals with spina bifida: a systematic review. , 2014, Research in developmental disabilities.

[18]  S. Rose,et al.  Reliability and validity of goniometric measurements at the knee. , 1987, Physical therapy.