Walking with cerebral palsy : task-specific strength training and reflections on daily walking in adults with cerebral palsy
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Background: Adults with cerebral palsy (CP) have impaired walking, affecting their activity and participation in social life. Still, little is known about how walking is experienced as adults. Effective strength training to improve walking in CP is not established. Ballistic plantar flexor exercises are suggested as task-specific in strength training to improve walking but have not been studied in adults with CP. Aims: The main goal of this thesis was to explore walking in adults with CP, and the secondary goals were A) To explore daily walking in adults with CP from a subjective perspective and B) To explore whether ballistic strength training is feasible and improves walking and potential muscle adaptations. Methods: Subjective perspective of daily walking was explored with semi-structured interviews and analysed with systematic text condensation. The feasibility of eight weeks of supervised ballistic strength training of ankle plantar flexors was investigated with semi-structured interviews, physical performance, and self-reported outcome measures. Walking kinematics was assessed with three-dimensional gait analysis (3DGA), and muscle adaptations were evaluated with ultrasound and a dynamometer. Results: Intrinsic factors, such as reduced functional capacity and reduced balance and extrinsic environmental factors, such as walking anomalies attracting onlookers’ attention and seasonal changes, were associated with daily walking. The participants could perform ballistic exercises on ankle plantar flexors after four weeks. Preferred walking speed increased in two of eight participants, decreased in one, and stayed unchanged for five participants. Five of six participants improved muscle strength, but muscle architecture remained unchanged. Conclusion: Daily walking was influenced by intrinsic embodied, and extrinsic environmental factors, and walking changes through adulthood calls for lifelong follow-up. Ballistic strength training of ankle plantar flexors was feasible and improved muscle strength in most participants, but walking kinematics and performance mainly remained unchanged. Ballistic strength training and physiological adaptation in spastic muscles need further investigation before the effects on walking can be determined. This conclusion is based on findings from underpowered studies.
Has partsPaper I: Gjesdal BE, Jahnsen R, Morgan P, Opheim A, Mæland S. Walking through life with cerebral palsy: reflections on daily walking by adults with cerebral palsy. International Journal of Qualitative Studies on Health and Well-being. 2020;15(1):1746577. The article is available at: https://hdl.handle.net/11250/2728452
Paper II: Gjesdal BE, Mæland S, Williams G, Aaslund MK, Rygh CB, Cumming KT. Can adults with cerebral palsy perform and benefit from ballistic strength training to improve walking outcomes? A mixed methods feasibility study. BMC Sports Science, Medicine and Rehabilitation. 2021;13:160. The article is available at: https://hdl.handle.net/11250/2926416
Paper III: Gjesdal, B.E., Mæland, S., Bogen, B., Cumming, K.T., Nesse, V.C., Torberntsson, S.M.R., and Rygh, C.B. Ballistic strength training in adults with cerebral palsy may increase rate of force development in plantar flexors, but transition to walking remains unclear. The article is not available in BORA.