Neuromuscular Adaptations to Training in Children with Cerebral Palsy

Cerebral palsy (CP) is the most common cause of physical disability in children. Children with CP often require lifelong therapy to improve physical mobility or to prevent development of secondary complications. While previous research has investigated the effect of various therapeutic approaches on motor function in children with CP, the neuromuscular mechanisms that underpin motor function improvements remain poorly understood. The overarching goal of this PhD was therefore to enhance the understanding of the underlying neuromuscular adaptations to training in children with CP. This thesis includes 3 systematic reviews, a survey study and pilot and feasibility study. Two systematic reviews synthesised the literature on neuromuscular adaptations to upper (UL) and lower limb (LL) training in children with CP and revealed a knowledge gap on alterations in cortical excitability following LL training in children with CP, specifically following strength training. There was limited data regarding any association between neuromuscular function changes and motor function improvements following training in children with CP. A cross-sectional study surveyed paediatric physiotherapists in the United Kingdom and Saudi Arabia to explore clinical practice and identify the most common approach used to improve LL motor function in children with CP. Strength training was one of the most commonly used approaches to improve LL motor function. Study three was a pilot study that investigated the feasibility of assessing the effect of an 8-week home-based progressive functional strength training programme on cortical excitability, muscle structure, strength, and gross motor function in children with CP. Several challenges were encountered including participant recruitment, employing transcranial magnetic stimulation in this population to obtain cortical excitability data, adherence to training protocol, and collecting physical activity data from children with CP with recommendations made for future studies. In a final systematic review to compare the effect of home-based vs supervised strength training, only supervised strength training programme had a favourable effect of muscle structure, while similar magnitude of effects on motor function and strength was found for home-based and supervised strength training. In conclusion, the findings of this thesis enhance our understanding of neuromuscular adaptations to training in children with CP, highlights knowledge gaps, and suggests that further studies are required to provide a robust and firm conclusion on the effect of strength training on neuromuscular function in children with CP.<p></p>

Author dc:creator

• Fatema Shamsaddin (21038843)

• Cerebral palsy
• Neuromuscular function
• physiotherapy
• strength training
• muscle structure

Statement dc:rights

• All rights reserved
• Open Access after 2028-01-13

Identifier

10779/exe.32973095.v1

OAI identifier oai:identifier

oai:figshare.com:article/32973095