Cruz (2012) The Effects of Aquatic Exercise on Gait Parameters in Children with Cerebral Palsy

BACKGROUND: Cerebral palsy (CP) is defined as a group of disorders of the development of movement and posture, causing activity limitation that are attributed to non-progressive disturbances occurred in the developing fetal or infant brain (Gage, 2004). CP is known as one of the most common childhood disabilities with an incidence of about 2-3 per 1,000 live births each year (Chang et al., 2010). In most cases of CP, gait and balance play a key role in participating in activities of daily living and other physical activities. The effects of exercise programs on land have been well documented; however, there are very few studies that involved aquatic intervention in the CP population. Aquatic exercise is gradually gaining popularity among the CP rehabilitation field and has been viewed to be beneficial for children with neuromuscular impairments such as CP (Kelly & Darrah, 2005). Water properties can establish an intervention protocol that can help children with CP improve balance and gait function in a supportive environment. The unique quality of buoyancy can reduce joint impact and support postural control (Kelly & Darrah, 2005). Buoyancy enables initiation of independent movement possibilities that are less likely to be achieved on land-based exercise (Fragala-Pinkham et al., 2008). Water resistance can aid children with CP and improve muscular strength (Hutzler et al., 1998). Warm water temperatures have been known to be effective for decreasing muscle tone while exercising in the water (Getz et al. 2007). Few studies have examined the effects of aquatic exercise on gait and balance in children with CP.

OBJECTIVE: To examine the gait outcomes of children with CP after 6-week aquatic exercise program.

SETTING: All data collection and intervention procedures was held at the Center of Achievement, California State University, Northridge (CSUN).

PARTICIPANTS: A total of 4 children was recruited from local schools in the greater Los Angeles areas. Inclusion criteria are: a) diagnosis of spastic diplegic or hemiplegic CP, b) age between 7-17 years old, c) medical clearance for adapted exercise or aquatic exercise, d) ability to walk independently with or without an assistive device, e) Gross Motor Function Classification System (GMFCS) levels I-III, f) ability to follow verbal instructions and communicate in English, g) ability to participate in a exercise program in and out of the water for up to 30-40 minutes. INTERVENTION: The children participated in an aquatic exercise program in a 40-minute session, three times per week for 6 consecutive weeks. The aquatic exercise program consists of warm-up, gait and balance exercises, and cool-down.

MEASURES: The participants were measured on kinemtatic gait parameters (hip flexion and extension, knee flexion and extension, and ankle plantar-flexion and dorsi-flexion) x and spatial-temportal gait variables (% stance and swing phase, velocity, cadence, step width and stride length). RESULTS: There were no trends among participants as a whole. However, individual trends for improvement in kinematic and spatial-temporal variables was observed for each participant.

CONCLUSION: Although there were no systematic changes within the group after the 6-week intervention, individual changes in ankle, knee, and hip range of motion presented individual improvements based on each particpant’s deviation in gait pattern in which trends for improvements display that group aquatic exercise is a useful mode of exercise to maintain and improve gait parameters in children with CP.