Improved ankle function in children with cerebral palsy after computer‐assisted motor learning

The effect of biofeedback training on ankle function was studied in young children with cerebral palsy (CP) during a pilot study and a 6‐week follow‐up study. Patients underwent range of motion (ROM) and ankle dorsiflexor (DF) strength training in a laboratory 3 days per week, receiving auditory and visual feedback. An at‐home programme used portable EMG units to help train DF muscle recruitment on the remaining days. Independent outcome measures included DF strength, active ROM. and tapping ability pretraining and 6 weeks and 14 months posttraining. Tapping ability increased significantly in the trained leg posttraining. It then fell significantly at the 6‐weeks posttraining test, but remained significantly higher than pretest levels, and returned to pretraining levels by 14 months. Passive ROM was unchanged, but active ROM increased significantly in the trained leg. DF strength increased in most children posttraining in both the pilot and main study. Increased motor‐unit recruitment is believed to explain the increases in DF strength and active ROM. These results suggest that biofeedback training can improve ankle function, and the implications for gait are discussed.

[1]  D G Sale,et al.  Neural adaptation to resistance training. , 1988, Medicine and science in sports and exercise.

[2]  T. Moritani,et al.  Neural factors versus hypertrophy in the time course of muscle strength gain. , 1979, American journal of physical medicine.

[3]  F. Harris,et al.  Electronic sensory aids as treatment for cerebral-palsied children. Inapproprioception: Part II. , 1974, Physical therapy.

[4]  S Andreassen,et al.  Impaired regulation of force and firing pattern of single motor units in patients with spasticity. , 1980, Journal of neurology, neurosurgery, and psychiatry.

[5]  M Kassover,et al.  Auditory biofeedback in spastic diplegia , 1986, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[6]  G. Goldspink,et al.  Connective tissue changes in immobilised muscle. , 1984, Journal of anatomy.

[7]  D. C. Brown,et al.  Recurrence after Achilles tendon lengthening in cerebral palsy. , 1993, Journal of pediatric orthopedics.

[8]  N. O'dwyer,et al.  REDUCTION OF SPASTICITY IN cérébral PALSY USING FEEDBACK OF THE TONIC STRE1CH REFLEX; A CONTROLLED STUDY , 1994, Developmental medicine and child neurology.

[9]  B R Seeger,et al.  Biofeedback therapy to achieve symmetrical gait in hemiplegic cerebral palsied children. , 1981, Archives of physical medicine and rehabilitation.

[10]  A A Catanese,et al.  HEAD‐POSITION TRAINING THROUGH BIOFEEDBACK: PROSTHETIC OR CURE? , 1984, Developmental medicine and child neurology.

[11]  C. Gabbard,et al.  Foot-Tapping Speed in Children Ages 4 to 6 Years , 1993, Perceptual and motor skills.

[12]  E. Bleck,et al.  Augmented Auditory Feedback in the Treatment of Equinus Gait in Children , 1980, Developmental medicine and child neurology.

[13]  C Tardieu,et al.  Muscle hypoextensibility in children with cerebral palsy: I. Clinical and experimental observations. , 1982, Archives of physical medicine and rehabilitation.

[14]  A. McComas,et al.  Influence of joint position on ankle dorsiflexion in humans. , 1981, Journal of applied physiology: respiratory, environmental and exercise physiology.

[15]  L R Osternig,et al.  Effects of electromyographic feedback training on motor control in spastic cerebral palsy. , 1978, Physical therapy.

[16]  C. Tabary,et al.  Experimental rapid sarcomere loss with concomitant hypoextensibility , 1981, Muscle & nerve.

[17]  C P Wooldridge,et al.  Head position training with the cerebral palsied child: an application of biofeedback techniques. , 1976, Archives of physical medicine and rehabilitation.

[18]  S Naumann,et al.  Feedback of triceps surae EMG in gait of children with cerebral palsy: a controlled study. , 1994, Archives of physical medicine and rehabilitation.

[19]  Biofeedback therapy to achieve symmetrical gait in children with hemiplegic cerebral palsy: long-term efficacy. , 1983 .

[20]  AUGMENTED AUDITORY FEEDBACK AS AN AID IN GAIT TRAINING OF THE CEREBRAL‐PALSIED CHILD , 1986, Developmental medicine and child neurology.

[21]  C. Tardieu,et al.  Muscle hypoextensibility in children with cerebral palsy: II. Therapeutic implications. , 1982, Archives of physical medicine and rehabilitation.

[22]  J. Perry.  Determinants of Muscle Function in the Spastic Lower Extremity , 1993, Clinical orthopaedics and related research.

[23]  M. Law,et al.  PARENT COMPLIANCE WITH THERAPEUTIC INTERVENTIONS FOR CHILDREN WITH CEREBRAL PALSY , 1993, Developmental medicine and child neurology.

[24]  P. Neilson,et al.  REDUCING SPASTICITY TO CONTROL MUSCLE CONTRACTURE OF CHILDREN WITH CEREBRAL PALSY , 1989, Developmental medicine and child neurology.

[25]  Pate Rr,et al.  Effects of arm training on retention of training effects derived from leg training. , 1977 .

[26]  C Tabary,et al.  FOR HOW LONG MUST THE SOLEUS MUSCLE BE STRETCHED EACH DAY TO PREVENT CONTRACTURE? , 1988, Developmental medicine and child neurology.