Training for people with CP Flashcards
Structure of muscle in ppl with CP:
people with CP have inherently different muscles than ppl without
much less functional reserve of muscle strength
Training can cause increases in muscle strength/body weight
Ambulatory children with CP exhibit upwards of ___ strength deficit in key muscles for ambulation
50%
MOST AFFECTED: hamstrings, DFs, PFs, hip abductors
** if an individual has <50% age expected strength–> walking with assistance
What is the muscle composition of children with CP?
high proportions of fat, collagen, and scar tissue
What muscles are extremely fatigue resistant in people with CP?
knee flexors and extensors
** although, type I fiber composition (increased muscular endurance) may not facilitate common functional movement performance –> HOWEVER, likely working at higher intensity level that other children for same task
What happens to functional task performance with decreases in strength?
decrease in functional task performance
**even when controlling for spasticity
At what level of velocity is power maximized?
MODERATE LEVELS OF VELOCITY
** muscles change the force they produce depending on the speed of contraction
What is the equation for power?
F x d / time
How much is the rate of force development diminished in ppl with CP?
upwards of 70% in quad
200% in the gastrocnemius
What are the changes in muscle structure in ppl with CP?
DECREASED:
-muscle fascicle length
-speed of contraction
-muscle volume
-muscle belly length
-myofiber number
-fascicle angle
-fast twitch fiber predominance
INCREASED:
-non-contractile tissue percentage
-MTU stiffness
OVERALL LEADS TO: reduced force production capability –> activity limitation and participation restriction
Based on a study in a population with CP, which led to more functional gains, strength training or power training?
power training
Power training compared to standard of care improvements:
improvements in mobility and goal attainment scores
improvement in functional mobility scale 500 meter (increased level of independence during ambulation)
Key points from studies on CP and power training:
- Muscular weakness is a
primary driver of functional
limitation in people with CP - Individualization of
treatment with respect to
known impairments will
impact my patients - The dose of my intervention
will make or break the
success of my patient - Power-based strength
training will make
improvements in strength
and function more than
regular training or what I
usually do
How to harness plasticity and make the intervention participation driven:
-functional context
-many reps
-active engagement
-focus on time spent performing the intervention
Dosing parameters for power training:
LOAD: 40-80% of 1 RM
REPS: 6 sets of 5-6 reps
SPEED: concentric fast as possible, return slow and controlled
2-3 times/week (nonconsecutive)
8-20 weeks duration
rest period: 2-5 min
Work within or slightly above 1 RM guides 7-9/10 RPE
PROGRESS: advance weight 5-10% when efforts become easier
Safety concerns for weight lifting in children at least 3 years of age:
-must be able to follow instruction
-volitional control of selected joint
CONTRAS:
-recent ortho surgery
-unable to follow directions or complete action safely
-< 3 years
-unhealed wound around moving joint
-muscular dystrophies or similar muscle disease
