G5 Doctoral dissertation (article)
The EXECP project : a neuromechanical examination of hyper-resistance within an exercise intervention for children and young adults with cerebral palsy (2024)
EXECP-projekti : lihasjäykkyyden neuromekaaninen tarkastelu liikunnallisessa kuntoutuksessa lapsilla ja nuorilla, joilla on CP-vamma

Valadão, P. F. (2024). The EXECP project : a neuromechanical examination of hyper-resistance within an exercise intervention for children and young adults with cerebral palsy [Doctoral dissertation]. University of Jyväskylä. JYU dissertations, 751. https://urn.fi/URN:ISBN:978-951-39-9943-8

JYU authors or editors

Publication details

All authors or editors: Valadão, Pedro Frederico

eISBN: 978-951-39-9943-8

Journal or series: JYU dissertations

eISSN: 2489-9003

Publication year: 2024

Number in series: 751

Number of pages in the book: 1 verkkoaineisto (108 sivua, 39 sivua useina numerointijaksoina, 4 numeroimatonta sivua)

Publisher: University of Jyväskylä

Place of Publication: Jyväskylä

Publication country: Finland

Publication language: English

Persistent website address: https://urn.fi/URN:ISBN:978-951-39-9943-8

Publication open access: Openly available

Publication channel open access: Open Access channel

Abstract

Spastic cerebral palsy (CP) is characterized by muscle weakness, limited joint flexibility, motor incoordination and hyper-resistance (i.e., increased resistance to passive muscle stretch). All these symptoms hinder motor function, resulting in reduced physical activity levels, which increases many cardiometabolic risk factors. The purpose of this thesis was to develop a combined strength, flexibility and gait training intervention (EXECP intervention) to address the debilitating symptoms above-mentioned. The EXECP intervention was successful in increasing motor function measured by a gait performance test (six minutes walking test) and the gross motor function measure. Furthermore, muscle strength and joint flexibility improved with the EXECP intervention for most muscles, except the ankle plantarflexors and dorsiflexors. Overall, the results showed that the EXECP intervention was safe and efficient in improving motor function, without any adverse effects. Importantly, three months after the EXECP intervention ceased and the CP participants were re-evaluated, most of the improvements induced by the intervention regressed back to pre-intervention levels. The deadaptation after the intervention suggests that training should be a life-long choice for people with CP. The present study also proposed a correction to a hyperreflexia (i.e., exacerbated stretch reflex responses) assessment method called the stretch reflex threshold (SRT). The proposed correction had a significant effect on the evaluation of the SRT and the new approach is recommended for future studies. Furthermore, this study performed a thorough comparison between individuals with CP and typically developed (TD) controls regarding hyper-resistance, hyperreflexia and joint neuromechanical variables. The comparison between groups showed several significant differences in most studied variables. Ankle joint neuromechanical variables and neurophysiological variables of hyperreflexia were not useful in explaining the neuromechanical variables of hyperreflexia or peak torque during stretch. The SRT of both muscles had a good positive correlation with peak torque at high stretch velocities and was significantly different between CP and TD groups, suggesting it is a useful diagnostic variable.

Keywords: cerebral palsied; children (age groups); young people; ability to move; motor functions; walking (motion); muscles; coordination; stiffness; rehabilitation; muscle strength; mobility; training; neurophysiology; biomechanics; doctoral dissertations

Free keywords: EXECP intervention

Contributing organizations

Related projects

Ministry reporting: Yes

VIRTA submission year: 2024