Improving Functional Dynamic Balance In Adolescents With Cerebral Palsy And Spina Bifida

PURPOSE: Deficits in lower extremity muscle strength and neuromotor control may negatively impact dynamic balance explaining the increased risk of losing independent mobility in adolescents with cerebral palsy and spina bifida. Thus, our primary objective was to assess the feasibility of a novel functionally loaded high-intensity circuit training (FOLIC) and a typical high-intensity circuit training (HIIT) protocol, as well as participant responses to these interventions on dynamic balance (Four-Square Step Test; FSST), muscle strength (Lateral Step-Up Test), and mobility (Timed Up and Go test; TUG). METHODS: Participants performed a 4-week training program (2 sessions/week) incorporating functional resistance and high-intensity circuit training to primarily enhance dynamic balance. The FOLIC protocol is designed to improve enhanced control of a moving center of mass over moving base of support, while also enhancing muscle strength via weighted vest. FOLIC consists of five exercises: chair squat, side-step, split squat, heel rise, and jump. Each exercise was performed in 3 sets, with participants completing as many repetitions as possible in 30 seconds, with 30-60 seconds of rest between sets and 90 seconds between exercises. The repetition goals were progressively increased each week. Of the 3 participants, participants 1 and 2 wore weighted vests with progressively increasing weight reaching to 10% of their body weight by the last exercise session, while Participant 3 performed the same exercises without the vest. Cohen's d was calculated by dividing the difference between baseline and post-intervention means by the pooled standard deviation for each test. RESULTS: All three participants completed the 4-week program with 100% adherence for all the exercise sessions and durations. We observed moderate-large effect size values for improvements in FSST (Cohen’s d = 0.44), TUG (Cohen’s d = 0.30), TUG with carrying a cup (Cohen’s d = 1.1), and Lateral Step-Up Test (Cohen’s d = 1.31) for all the 3 participants. CONCLUSIONS: FOLIC and HIIT were feasible and led to preliminary positive response in functional dynamic balance in adolescents with cerebral palsy and spina bifida. Further studies with larger sample sizes are needed to evaluate comparative efficacy of these interventions more thoroughly. Supported by: Funded by NIH C-progress award