Motricite Cerebrale最新文献

Practice of regular physical activities improve the physical and mental health of children and adults. Numerous studies on children, teenagers and adults with normal growth have seen the light of day for over 10 years and have enabled the establishment of a national and international public health policy in favor of daily physical activity. For children and teenagers with cerebral palsy, we currently do not find recommendations for the physical activities. In order to support cerebral paralyzed children and teenagers as closely as possible to their health needs, an initial assessment of their physical condition seems essential. Thus, this article shows the results of the current publications and studies concerning field tests of physical condition, validated and reliable, in children and/or teenagers with cerebral palsy.

Purpose

Cerebral palsy is the most common motor impairment in children, with a prevalence ranging from 1.5 to 3.8 per 1000 births from one country to another. Many studies highlight the benefits of physical activity in cerebral palsy. Here we study its impact on the spatio-temporal parameters of walking.

Material and methods

The search was conducted on PubMed with the keywords « Cerebral Palsy », « Exercises » and « Walking ». Fourty-nine articles were studied and 5 were selected to be analysed in depth. The study population comprises of children and teenagers with spastic cerebral palsy aged 6 to 16. The targeted intervention is the strengthening of lower body muscles through various exercises with and without specific equipment.

Results

Samples range from 15 to 30 children aged 6 to 16. GMFCS scores range from I to IV. The exercises are offered 3 to 5 times a week with an exercise duration of 25 to 70 min per session. The studies were conducted for 6 to 12 weeks. Different measurement scales were used, one before and one after the intervention. Two studies used a third measure one month before the intervention.

Conclusion

An improvement in the spatio-temporal parameters of walking was observed in all studies; more specifically in walking speed, step length and walking rate. The limitations of these studies are that the samples are small and very heterogeneous. The long-term benefits of these interventions would also be interesting to study.

The lifelong follow up of the adults with cerebral palsy, especially regarding the aging problematics, is a major challenge. There is indeed in this population, an early mobility decline, of which the mechanisms are complex and multifactorial. Among those mechanisms, because of their prevalence and incidence on the quality of life the falls are a main public health concern for the walking cerebral palsy population. As a matter of fact, the falls are both an accelerator of the mobility decline and an indicator of an already deteriorated scheme. Investigating the risk factors of falls within adults with cerebral palsy would be necessary to point out the most at risk individuals, to develop specific strategies to fight against this phenomenon and by doing that, prevent the loss of mobility. The variation of reeducation propositions is fundamental to stimulate the investment in their care project and aim at improving their quality of life, as these patients often are jaded by the traditional physical therapy.

Hip eccentricity (EH) is a common musculoskeletal deformity in children with cerebral palsy (CP), with severe and multiple consequences. The risk of EH increases with young age, functional limitation, spasticity, and if the condition is quadriplegic. Prevention of EH is therefore a public health issue from an early age. The standing program with hip abduction (VAH) is commonly used for this purpose, but it is highly controversial. Based on a review of the literature and external sources, only seven clinical trials in relation to the subject were found. There is a great disparity in methodology between the articles. VAH may have an effect on EH in children with CP, both preventively and after soft tissue surgery, but the level of evidence is moderate. This device seems to be more effective if the management is more comprehensive. Younger age and less advanced CP are indications where VAH seems to be effective, especially when started early. Confirming this effect with larger numbers is necessary as well as studying the long-term effect, especially in adolescence.

Literature about the use of intermittent positive pressure breathing is scarce, mainly old and with a low evidence level. There is no specific study about the use of this therapy in severe cerebral palsy. This literature review doesn’t allow clear-cut conclusions but let us think that, in severe cerebral palsy, the use of Intermittent Positive Pressure Breathing at suitable pressure levels could improve and maintain over time lung compliance. It could also mobilize the patient's rib cage, ventilating poorly ventilated lung areas and even removing atelectasis caused by spinal deformities in particular. This therapy could also facilitate bronchial drainage by increasing the volume of air mobilized when using chest physiotherapy techniques. Expert's reports and clinical practice also point in this direction.