[Truncated abstract] Cerebral palsy is the most common physical disability in childhood (Reddihough & Collins, 2003). The most characteristic features of those with cerebral palsy are the physical disabilities that arise as a result of the brain lesion, including; spasticity, muscle weakness and atrophy, soft-tissue contracture and joint deformity. Strength training for young people with cerebral palsy aims to negate the debilitating effects of muscle weakness and improve function. Research need now be dedicated to investigating the mechanisms of strength-training, in an effort to optimise training routines and the prescription of strengthening protocols. The principal goal of the present research was to investigate the impact of eccentric strength training. A novel eccentrically based exercise intervention for the upper limb was implemented to ascertain the benefits on: (i) isokinetic torque development, (ii) the length-tension relationship of muscle (iii) EMG activity, (iv) 3D movement kinematics and (v) psychosocial benefits for children and their families. The analysis of changes in movement kinematics required the development of a reliable and repeatable upper limb 3D biomechanical model for clinical use, constituting chapter three of this thesis. ... This paper advocates the inclusion of measures of work/bodymass and width of the torque-angle relationship as important determinates of the functional integrity of muscle, and the use of EMG activation patterns to characterise neuromuscular mechanisms of training induced changes. The sixth paper aims to determine the effects of the eccentric training programme on upper limb 3D kinematics during functional tasks and to determine if these improvements were also evident on the Melbourne Assessment. Little change was evident in upper arm kinematics following the short-term eccentric training programme, however there was evidence in support of a decrease in compensatory movements at the thorax. The Melbourne Assessment failed to detect any significant changes in performance of functional upper limb tasks following the training programme. The results suggest that 3D kinematic analysis of upper body movement is a sensitive tool for the assessment of interventions for pathological populations. The aim of the seventh paper presented within this body of work was to ascertain the psychosocial outcomes for children with cerebral palsy and their families following the eccentric training programme. This study identified four main themes in the parent and participant responses to the programme; changes in physical health, psychosocial health, changes in activity and participation, and the impact of the psychosocial health of the child on the family were important to participants and their families. This paper reinforces the multi-dimensional nature of the benefits of strength-training, and advocates the assessment of interventions from perspective of the ICF (WHO, 2001). This work has established the reliability of an upper limb 3D biomechanical model for clinical use, and determined the neuromuscular, kinematic, functional and psychosocial outcomes of an upper limb eccentric training programme for adolescents with cerebral palsy and their families.
|Qualification||Doctor of Philosophy|
|Publication status||Unpublished - 2007|