Stretching in Children and Adolescents With Spastic Cerebral Palsy

NCT04570358 | Completed

• 2 other identifiers: T1017T1017-B27
• Study Type: interventional
• Target: 24
• Locations: 1 country
• Sites: 1

Brief Summary

The primary aim of this study is to gain knowledge about both the effects of a single bout of static and proprioceptive neuromuscular facilitation (PNF) stretching and the effects of 8-week static and PNF stretching training on the calf muscle-tendon properties in children with spastic cerebral palsy (SCP). Furthermore, the effects on joint and muscle function, stretch reflexes, gait, and self-reported gait function and functional performance are examined to receive a comprehensive picture of potential changes. Further aims of this study are to identify which stretching technique might be more efficient by comparing the effects of both stretching interventions, and to gain information about the influence of foot flexibility on the stretch achieved by the spastic gastrocnemius muscle.

Conditions

Cerebral Palsy, Spastic

Keywords

Cerebral palsy; Stretching; Muscle-tendon unit; Spasticity; Gait

Outcome Measures

Primary Outcomes (4)

• Change in mechano-morphological muscle-tendon properties

  Gastrocnemius medialis muscle morphology, muscle stiffness, tendon-aponeurosis length and stiffness, muscle-tendon unit length and stiffness, elongations of the tissues

  baseline (T1), post-measurement (T2, 8 weeks), follow-up measurement (T3, 16 weeks)

• Change in spasticity/stretch hyperreflexia

  Stretch reflex responses assessed by a manually controlled instrumented spasticity assessment

  baseline (T1), post-measurement (T2, 8 weeks), follow-up measurement (T3, 16 weeks)

• Change in joint range of motion

  Ankle joint range of motion (maximal plantarflexion - maximal dorsiflexion)

  baseline (T1), post-measurement (T2, 8 weeks), follow-up measurement (T3, 16 weeks)

• Change in active moment-angle relationship

  Maximum isometric voluntary contractions at specific ankle joint angles (isokinetic dynamometry)

  baseline (T1), post-measurement (T2, 8 weeks), follow-up measurement (T3, 16 weeks)

Secondary Outcomes (3)

• Change in gait characteristics

  familiarisation session (T0, 1-week before T1), post-measurement (T2, 8 weeks), follow-up measurement (T3, 16 weeks)

• Change in self-reported gait, mobility, and functional performance

  familiarisation session (T0, 1-week before T1), post-measurement (T2, 8 weeks), follow-up measurement (T3, 16 weeks)

• Change in maximal isometric muscle strength

  baseline (T1), post-measurement (T2, 8 weeks), follow-up measurement (T3, 16 weeks)

Other Outcomes (1)

• Foot flexibility

  familiarisation session (T0, 1 week before baseline assessment)

Study Arms (4)

Static stretching

EXPERIMENTAL

An 8-week home-based static stretching training for the calf muscles will be performed by group A. Altogether, 10 stretches are performed per leg 4 times a week.

Other: Static stretching

Control

NO INTERVENTION

While group A performs the 8-week static stretching training, group B acts as control group performing its daily life activities as usual.

Proprioceptive neuromuscular facilitation stretching

EXPERIMENTAL

After group A has finished the 8-week static stretching training, group B starts with the 8-week home-based proprioceptive neuromuscular facilitation stretching training. Altogether, 10 stretches are performed per leg 4 times a week.

Other: Proprioceptive neuromuscular facilitation stretching

Follow-up

NO INTERVENTION

While group B performs the 8-week proprioceptive neuromuscular facilitation stretching, group A is in its follow-up period performing its daily life activities as usual.

Interventions

Static stretching OTHER

During the static stretching training for the calf muscles, the ankle joint is moved into maximal dorsiflexion until the point of discomfort is reached. The ankle joint is then held in this maximal position for 30 s followed by a rest period of 30 s. Afterwards, the procedure is repeated with the knee in flexed position to stretch the soleus muscle.

Static stretching

Proprioceptive neuromuscular facilitation stretching OTHER

During the proprioceptive neuromuscular facilitation stretching, the ankle joint is moved into maximal dorsiflexion. While the foot is kept in this position, the child will perform a (sub-) maximal isometric contraction of the plantar flexors against the resistance of their parents. Afterwards, the ankle joint will be moved further into greater dorsiflexion and is held there for the remaining seconds followed by 30 s of rest. Subsequently, the stretch will be applied with the knee flexed.

Also known as: PNF

Proprioceptive neuromuscular facilitation stretching

Eligibility Criteria

• Age: 6 Years - 15 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• spastic cerebral palsy
• ambulatory children and adolescents
• ability to accept and follow verbal instructions
• no severe contracture of the calf muscles (max. ankle dorsiflexion \>= 0°, with knees extended)
• classified as GMFCS level I, II, or III
• aged between 6 and 5 years
• willingness to participate

You may not qualify if:

• others than spastic forms of cerebral palsy
• severe mental retardation
• fixed muscle contractures (ankle equinus deformity = max. ankle dorsiflexion \<= 0°, with knees extended)
• oral anti-spastic and/or muscle relaxation medication in the last 6 months
• orthopaedic surgery and/or Botulinum toxin type A application in the last 12 months

Sponsors & Collaborators

• University of Graz: lead
• VU University of Amsterdam: collaborator

Study Sites (1)

Institute of Human Movement Science, Sport and Health; University of Graz

Graz, 8010, Austria

Location

Related Publications (8)

• Lee WY, Park GY, Kwon DR. Comparison of treatment effects between children with spastic cerebral palsy under and over five years after botulinum toxin type a injection. Ann Rehabil Med. 2014 Apr;38(2):200-8. doi: 10.5535/arm.2014.38.2.200. Epub 2014 Apr 29.

  PMID: 24855614 BACKGROUND

• Willerslev-Olsen M, Choe Lund M, Lorentzen J, Barber L, Kofoed-Hansen M, Nielsen JB. Impaired muscle growth precedes development of increased stiffness of the triceps surae musculotendinous unit in children with cerebral palsy. Dev Med Child Neurol. 2018 Jul;60(7):672-679. doi: 10.1111/dmcn.13729. Epub 2018 Mar 24.

  PMID: 29573407 BACKGROUND

• Barber L, Barrett R, Lichtwark G. Medial gastrocnemius muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic cerebral palsy. J Biomech. 2012 Oct 11;45(15):2526-30. doi: 10.1016/j.jbiomech.2012.07.018. Epub 2012 Aug 3.

  PMID: 22867763 BACKGROUND

• Wiart L, Darrah J, Kembhavi G. Stretching with children with cerebral palsy: what do we know and where are we going? Pediatr Phys Ther. 2008 Summer;20(2):173-8. doi: 10.1097/PEP.0b013e3181728a8c.

  PMID: 18480717 BACKGROUND

• Sharman MJ, Cresswell AG, Riek S. Proprioceptive neuromuscular facilitation stretching : mechanisms and clinical implications. Sports Med. 2006;36(11):929-39. doi: 10.2165/00007256-200636110-00002.

  PMID: 17052131 BACKGROUND

• Zhou Z, Sun Y, Wang N, Gao F, Wei K, Wang Q. Robot-Assisted Rehabilitation of Ankle Plantar Flexors Spasticity: A 3-Month Study with Proprioceptive Neuromuscular Facilitation. Front Neurorobot. 2016 Nov 14;10:16. doi: 10.3389/fnbot.2016.00016. eCollection 2016.

  PMID: 27895574 BACKGROUND

• Zhou Z, Zhou Y, Wang N, Gao F, Wang L, Wei K, Wang Q. Changes of Achilles tendon properties via 12-week PNF based robotic rehabilitation of ankle joints with spasticity and/or contracture. Annu Int Conf IEEE Eng Med Biol Soc. 2014;2014:1214-7. doi: 10.1109/EMBC.2014.6943815.

  PMID: 25570183 BACKGROUND

• Kruse A, Habersack A, Weide G, Jaspers RT, Svehlik M, Tilp M. Eight weeks of proprioceptive neuromuscular facilitation stretching and static stretching do not affect muscle-tendon properties, muscle strength, and joint function in children with spastic cerebral palsy. Clin Biomech (Bristol). 2023 Jul;107:106011. doi: 10.1016/j.clinbiomech.2023.106011. Epub 2023 Jun 7.

  PMID: 37329655 DERIVED

MeSH Terms

Conditions

Cerebral Palsy; Muscle Spasticity

Interventions

Muscle Stretching Exercises

Condition Hierarchy (Ancestors)

Brain Damage, Chronic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Muscular Diseases; Musculoskeletal Diseases; Muscle Hypertonia; Neuromuscular Manifestations; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Annika Kruse, Dr.rer.nat.

  University of Graz, Institute of Human Movement Science, Sport and Health

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal investigator

Study Record Dates

• First Submitted: September 14, 2020
• First Posted: September 30, 2020
• Study Start: September 11, 2020
• Primary Completion: September 23, 2021
• Study Completion: September 23, 2021
• Last Updated: October 12, 2021

Record last verified: 2021-10

Data Sharing

• IPD Sharing: Will not share

Locations

AU (1)