The Effect of an Upper Extremity Power Training Intervention on Pain and Power Among Young People With Cerebral Palsy

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Developmental Medicine & Child Neurology




Background/Objectives: Recent evidence suggests that lower extremity function can be improved by exercises following power training protocols due to underlying neurophysiological changes.1 Limited upper extremity function can interfere with the performance of activities of daily living and negatively affect health-related quality of life (HRQOL). The purpose of this study was to investigate the effects of a dynamic, upper extremity power training intervention on pain, function, and HRQOL among young people with cerebral palsy (CP). We hypothesize that upper extremity power training will improve HRQOL by reducing pain and increasing power output.

Study Design: Prospective randomized crossover design.

Study Participants and Setting: Twelve participants with CP were recruited (age range 7yr 10m–24yr 2m; GMFCS levels I–V).

Materials/Methods: Participants were randomly assigned to either a rest-training (RT) or training-rest (TR) group. Participants in the TR group underwent a 6-week training program, 3 days per week followed by six weeks rest while the RT group underwent 6 weeks rest followed by 6 weeks training. We used the Skierg to simulate a unilateral, overhand throwing exercise following power training guidelines for frequency, volume, intensity, duration and velocity.2 Participants were classified with the Bimanual Fine Motor Function (BFMF) grading system. Average power output (Pavg) measured in watts (W) of each training session was recorded over the 6-week training period. The Pediatric Outcomes Data Collection Instrument (PODCI) were administered before and after rest and before and after training. Repeated measures MANOVA were used to examine training effect on the PODCI subscales. A response surface regression analysis and paired t-test was used to examine the effects of training on Pavg.

Results: Each training session corresponded with a 5.8% linear increase in Pavg and changes over time were significant (p = 0.001). Only the pain subscale of the PODCI showed significant differences over time. Results showed significant group differences indicating individuals with lower functioning experienced significantly different changes in pain (p = 0.007). Significant interaction effects showed that pain scores improved after training with greater pain while resting with the exception of two individuals in the RT group in BMFM levels II–V (p = 0.012; Table 1).

Conclusions/Significance: Limited upper-extremity function and high levels of pain can have a significant effect on HRQOL among young people with CP. The Concept 2 Skierg is a wheelchair accessible device for that can be used by young people with CP- regardless of functionality- for resistance training. Upper extremity power training was shown to be an effective modality in improving pain symptoms and power output even in those with moderate to severe CP. Future research is needed to investigate the effects of upper extremity power training on spasticity and spasticity-related pain.