Abstract

Background/Purpose: Cerebral Palsy is caused by a lesion in the brain, and can result in many impairments, including, but not limited to, spasticity, decreased strength and ROM, and musculoskeletal malalignment. It is crucial to intervene with these children at a young age to prevent or minimize these impairments to improve quality of life. Young children with cerebral palsy vary greatly in their mobility and function, and determining treatment protocols can be difficult. Specifically, children with spastic diplegia who are ambulatory can prove to be challenging to treat effectively because much of the evidence is based on children with varying demographics from GMFCS levels to spasticity, strength and ROM. The purpose of this paper is to analyze the following PICO question: In young children with spastic diplegia, is context-focused therapy more effective than child-focused therapy to improve lower extremity function, including gait? Case Description: The patient is an ambulatory 3 year-old female with a medical diagnosis of spastic diplegia. The patient ambulates with a severe crouch gait pattern with and without orthotics, demonstrating hip and knee flexion, hip internal rotation as well as plantar flexion/toe walking. This has resulted in the patient walking and transitioning unsafely in her environment. Outcomes: The current research shows more statistical evidence for strength training to improve gait and function in children with spastic diplegia. To a lesser extent, the research also shows statistical evidence for the use of functional training to improve gait and function (Table 1). Discussion: Statistical evidence is one piece of this puzzle. Not to be ignored are clinical experience as well as patient values. Clinical experience shows a strong correlation between functional training to improve function. A combination of strength and functional training may be in the best interest of a young child with spastic diplegia to improve gait and function, which are crucial to patient and parent values. More high level research is needed that directly examines the effectiveness of strength training versus functional training to improve function and gait in children with spastic diplegia.

Provenance

Submitted by Dana Merhege (dmerge86@salud.unm.edu) on 2014-06-25T19:25:41Z No. of bitstreams: 1 DMerhege-Capstone Project.pdf: 815452 bytes, checksum: 5bad45b816900907a7bef4a5241e3a91 (MD5), Made available in DSpace on 2014-06-25T19:25:41Z (GMT). No. of bitstreams: 1 DMerhege-Capstone Project.pdf: 815452 bytes, checksum: 5bad45b816900907a7bef4a5241e3a91 (MD5)

Document Type

Capstone

Comments

Advisor James "Bone" Dexter, P.T., MA and Marybeth Barkocy, P.T., DPT

Keywords

spastic diplegia, physical therapy, mobility function, strength, gait

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