Affiliations: [a] Department of Biomechanics and Sport injuries, Kharazmi University, Tehran, Republic of Iran
| [b] Department of Applied Physiology, Health, and Clinical Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| [c] Department of Motor Behavior, Kharazmi University, Tehran, Republic of Iran
| [d]
Department of Occupational therapy, Shahid Beheshti University, Tehran, Republic of Iran
Correspondence:
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Corresponding author: Abbey Thomas, PhD, ATC, University of North Carolina at Charlotte, 9201 University City Blvd, 231 Belk Gym, Charlotte, NC 28223, USA. Tel.: +1 7046878628; Fax: +7046870930; E-mail: [email protected].
Abstract: PURPOSE:This study investigated the effects of the challenge point framework (CPF) to improve stepping reactions and enhance balance in children with hemiplegic cerebral palsy (HCP). The CPF relates practice variables to the skill level of the individual and task difficulty. METHODS:Nine children with HCP (age: 7.7±2.4 years) completed six weeks (12 sessions) of a CPF intervention which consisted of progressively fewer sets and repetitions of a stepping reaction task wherein participants sought to improve both step length and reaction rate. Stepping reaction (step length and reaction rate) to a balance perturbation in the anterior, posterior, and lateral directions and static and dynamic balance (via the Pediatric Balance Scale) were measured at baseline, a second baseline 3 weeks later, and post-intervention. Repeated measures ANOVAs determined within-group changes. Cohen’s d effect sizes were calculated. RESULTS:Participants improved balance (d = 0.948, p = 0.010), step length (forward d = 0.938, p = 0.002; backward d = 0.839, p = 0.001; and lateral d = 0.876, p = 0.002), and reaction rate (forward d = 0.249, p = 0.042; backward d = 0.21, p = 0.047; and lateral d = 0.198, p = 0.049). CONCLUSION:These findings indicate that children with HCP may benefit from completing a CPF program with a motor learning approach. This approach of retraining stepping reactions helped to improve static and dynamic balance. The CPF may aid progression of functional task training in children with HCP aged 4–12, though more studies with a long-term follow-up analysis are needed to confirm this result.
Keywords: Cerebral palsy, challenge point framework, balance
