Effectiveness of a Multi-Modal Exercise Program Incorporating Plyometric and Balance Training in Children With Hemiplegic Cerebral Palsy: A Three-Armed Randomized Clinical Trial

Abstract

Aim

To evaluate the effectiveness of a multimodal exercise program incorporating plyometric and balance training on muscle strength and postural stability in children with spastic hemiplegic cerebral palsy (SHCP).

Methods

A total of 57 children with SHCP were enrolled in the study and randomly allocated into three treatment-based groups: plyometric exercises (PLYO group; n = 19), balance exercises (BAL group, n = 19), and combined plyometric and balance exercises (PLYO-BAL group; n = 19). The maximum isometric muscle strength (IMS_max) and postural stability [anterior-posterior stability index (AP-SI), mediolateral stability index (ML-SI), and overall stability index (O-SI)] were measured pre- and post-intervention.

Results

By applying the intention-to-treat analysis, the PLYO-BAL group showed greater post-treatment IMS_max than the PLYO and BAL groups for the quadriceps (p=.03 and p=.0002 respectively), hamstrings (p=.018 and p<.0001 respectively), and dorsiflexors (p=.006 and p<.0001 respectively). Also, the PLYO-BAL group achieved better post-intervention stability scores as compared to PLYO and BAL groups regarding AP-SI (p<.0001 and p=.0001 respectively), ML-SI (p=.001 and p=.015 respectively), and O-SI (p=.011 and p=.04 respectively).

Conclusions

Incorporation of plyometric and balance exercises in a multimodal rehabilitation program could be an important consideration for enhancing muscle strength and boosting postural stability in children with SHCP.

KEYWORDS:

• Cerebral palsy
• stretch-shortening cycle exercises
• balance exercises
• maximum voluntary contraction
• postural control

Acknowledgments

The authors of this work are grateful for the children and their caregivers for willingly participating in this work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Ragab K. Elnaggar

Ragab K. Elnaggar, PT, PhD, Assistant Professor, Physical Therapy for Pediatrics.

Waleed S. Mahmoud

Waleed S. Mahmoud, PT, PhD, Assistant Professor, Basic Sciences of Physical Therapy.

Saud F. Alsubaie

Saud F. Alsubaie, PT, PhD, Assistant Professor, Neurological Physical Therapy.

Walaa A. Abd El-Nabie

Walaa A. Abd El-Nabie, PT, PhD, Assistant Professor, Physical Therapy for Pediatrics.