Paretic-Limb-Only Plyometric Training Outperforms Volume-Matched Double-Limb Training for Ameliorating Balance Capability and Gait Symmetry in Adolescents with Unilateral Cerebral Palsy: A Comparative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Experimental Design
2.2. Ethical Considerations
2.3. Participants
2.3.1. Sample Size Calculation
2.3.2. Assignment Procedure
2.4. Outcome Measures
2.4.1. Balance Capability
2.4.2. Gait Symmetry
2.5. Interventions
2.5.1. Plyometric Training Paradigms
2.5.2. Standard Physical Therapy
2.6. Statistical Analyses
3. Results
3.1. Participants’ Flow and Retention
3.2. Treatment Compliance, Tolerability and Safety
3.3. Baseline Characteristics
3.4. Pre-to-Post Change Differences between Groups
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Exercise | Exercise Characterization and Directives for Performance | 1st Block (Wk. 1–4) | 2nd Block (Wk. 5–8) | 3rd Block (Wk. 9–12) |
Paretic-limb-only plyometric training paradigm | ||||
Single-leg push-off |
| 2 sets—10 reps | 3 sets—15 reps | 4 sets—15 reps |
Lateral push-off |
| 2 sets—10 reps | 3 sets—15 reps | 4 sets—15 reps |
Jump split squat |
| 1 set—10 reps | 2 sets—15 reps | 3 sets—15 reps |
Single-leg vertical jump |
| 3 sets—5 reps | 4 sets—5 reps | 5 sets—10 reps |
Single-leg tuck jump |
| 3 sets—5 reps | 4 sets—5 reps | 5 sets—10 reps |
Double-limb plyometric training paradigm | ||||
Double-leg hop |
| 2 sets—10 reps | 3 sets—15 reps | 4 sets—15 reps |
Side-to-side jump |
| 2 sets—10 reps | 3 sets—15 reps | 4 sets—15 reps |
Reciprocal stride-jump |
| 1 set—10 reps | 2 sets—15 reps | 3 sets—15 reps |
Double-leg vertical jump |
| 3 sets—5 reps | 4 sets—5 reps | 5 sets—10 reps |
Double-leg tuck jump |
| 3 sets—5 reps | 4 sets—5 reps | 5 sets—10 reps |
|
PLPT Group (n = 23) | DLPT Group (n = 23) | Control Group (n = 23) | p- Value | |
---|---|---|---|---|
Age, year | 14.61 ± 1.70 | 14.52 ± 1.38 | 15.26 ± 1.81 | 0.26 ‡ |
Gender (M/F), n (%) | 17 (73.9)/6 (26.1) | 13 (56.5)/10 (43.5) | 15 (65.2)/8 (34.8) | 0.52 § |
Weight, Kg | 50.26 ± 6.87 | 51.74 ± 6.52 | 53.87 ± 7.01 | 0.2 ‡ |
Height, m | 1.52 ± 0.11 | 1.54 ± 0.10 | 1.57 ± 0.11 | 0.36 ‡ |
BMI, Kg/m2 | 21.63 ± 1.45 | 21.82 ± 1.33 | 21.91 ± 1.29 | 0.77 ‡ |
Side affected (RT/LT), n (%) | 5 (21.7)/18 (78.3) | 4 (17.4)/20 (82.6) | 7 (30.4)/16 (69.6) | 0.68 § |
MAS level (1/1+), n (%) | 12 (52.2)/11 (47.8) | 14 (60.9)/9 (39.1) | 13 (56.5)/10 (43.5) | 0.95 § |
GMFCS level (I/II), n (%) | 18 (78.3)/5 (21.7) | 11 (47.8)/12 (52.2) | 16 (69.6)/7 (30.4) | 0.1 § |
PLPT Group (n = 23) | DLPT Group (n = 23) | Control Group (n = 23) | Interaction Effect | ||
---|---|---|---|---|---|
p-Value | η2Partial | ||||
LoSaffected | |||||
Pre | 47.61 ± 10.86 | 45.22 ± 9.16 | 43.96 ± 8.89 | <0.001 | 0.27 |
Post | 58.87 ± 9.29 | 48.91 ± 8.41 | 46.35 ± 6.37 | ||
p-value | <0.001 | 0.002 | 0.06 | ||
Hedges’ g (95% CI) | 1.07 (0.64–1.58) | 0.41 (0.16–0.67) | –– | ||
LoSnon-affected | |||||
Pre | 55.30 ± 6.59 | 53.48 ± 6.01 | 54.17 ± 6.10 | <0.001 | 0.36 |
Post | 64.22 ± 7.29 | 56.69 ± 4.67 | 55.83 ± 5.27 | ||
p-value | <0.001 | .0001 | .002 | ||
Hedges’ g (95% CI) | 1.23 (0.75–1.80) | 0.58 (0.29–0.90) | 0.28 (0.11–0.47) | ||
LoSforward. | |||||
Pre | 43.39 ± 6.61 | 42.74 ± 3.92 | 40.74 ± 4.49 | 0.0001 | 0.24 |
Post | 52.10 ± 7.77 | 45.35 ± 4.30 | 43.13 ± 4.04 | ||
p-value | <0.001 | 0.0003 | <0.001 | ||
Hedges’ g (95% CI) | 1.17 (0.61–1.78) | 0.61 (0.28–0.97) | 0.54 (0.28–0.83) | ||
LoSbackward | |||||
Pre | 42.52 ± 4.32 | 41.22 ± 5.96 | 40.48 ± 3.30 | 0.0002 | 0.23 |
Post | 49.57 ± 5.61 | 44.87 ± 4.15 | 41.87 ± 3.42 | ||
p-value | <0.001 | 0.001 | 0.058 | ||
Hedges’ g (95% CI) | 1.36 (0.83–1.97) | 0.69 (0.27–1.13) | - | ||
LoSoverall | |||||
Pre | 47.21 ± 4.42 | 45.66 ± 3.40 | 44.84 ± 3.44 | <0.001 | 0.54 |
Post | 56.18 ± 3.95 | 48.96 ± 2.74 | 46.79 ± 3.10 | ||
p-value | <0.001 | <0.001 | 0.0005 | ||
Hedges’ g (95% CI) | 2.10 (1.40–2.87) | 1.03 (0.64–1.49) | 0.57 (0.25–0.93) |
PLPT Group (n = 23) | DLPT Group (n = 23) | Control Group (n = 23) | Interaction Effect | ||
---|---|---|---|---|---|
p-Value | η2Partial | ||||
StepLaffected, m | |||||
Pre | 0.44 ± 0.06 | 0.45 ± 0.06 | 0.44 ± 0.05 | <0.001 | 0.39 |
Post | 0.53 ± 0.07 | 0.46 ± 0.05 | 0.45 ± 0.04 | ||
p-value | <0.001 | 0.19 | 0.002 | ||
Hedges’ g (95% CI) | 1.33 (0.76–1.98) | - | 0.21 (0.05–0.38) | ||
StepLnon-affected, m | |||||
Pre | 0.50 ± 0.06 | 0.49 ± 0.05 | 0.51 ± 0.04 | 0.018 | 0.11 |
Post | 0.56 ± 0.06 | 0.51 ± 0.04 | 0.52 ± 0.06 | ||
p-value | 0.001 | 0.23 | 0.49 | ||
Hedges’ g (95% CI) | 0.97 (0.42–1.56) | - | - | ||
SLStaffected, sec. | |||||
Pre | 0.41 ± 0.05 | 0.39 ± 0.07 | 0.38 ± 0.10 | 0.014 | 0.12 |
Post | 0.50 ± 0.09 | 0.44 ± 0.05 | 0.43 ± 0.07 | ||
p-value | <0.001 | 0.001 | <0.001 | ||
Hedges’ g (95% CI) | 1.19 (0.72–1.74) | 0.79 (0.35–1.28) | 0.56 (0.31–0.84) | ||
SLStnon-affected, sec. | |||||
Pre | 0.62 ± 0.14 | 0.61 ± 0.15 | 0.65 ± 0.16 | 0.39 | - |
Post | 0.54 ± 0.08 | 0.56 ± 0.07 | 0.59 ± 0.11 | ||
p-value | <0.001 | 0.018 | 0.0002 | ||
Hedges’ g (95% CI) | 0.68 (0.36–1.03) | 0.41 (0.06–0.78) | 0.42 (0.19–0.67) | ||
S-GSI | |||||
Pre | 0.11 ± 0.09 | 0.12 ± 0.08 | 0.14 ± 0.11 | 0.023 | 0.11 |
Post | 0.04 ± 0.03 | 0.11 ± 0.05 | 0.13 ± 0.07 | ||
p-value | <0.001 | 0.64 | 0.74 | ||
Hedges’ g (95% CI) | 1.01 (0.41–1.66) | - | - | ||
T-GSI | |||||
Pre | 0.32 ± 0.11 | 0.33 ± 0.15 | 0.39 ± 0.17 | <0.001 | 0.21 |
Post | 0.10 ± 0.05 | 0.23 ± 0.09 | 0.22 ± 0.15 | ||
p-value | <0.001 | 0.007 | <0.001 | ||
Hedges’ g (95% CI) | 2.49 (1.62–3.51) | 0.78 (0.22–1.38) | 1.02 (0.68–1.43) |
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Elnaggar, R.K.; Diab, R.H.; Abonour, A.A.; Alsubaie, S.F.; Alrawaili, S.M.; Alghadier, M.; Mohamed, E.H.; Abd-Elmonem, A.M. Paretic-Limb-Only Plyometric Training Outperforms Volume-Matched Double-Limb Training for Ameliorating Balance Capability and Gait Symmetry in Adolescents with Unilateral Cerebral Palsy: A Comparative Study. Children 2022, 9, 1563. https://doi.org/10.3390/children9101563
Elnaggar RK, Diab RH, Abonour AA, Alsubaie SF, Alrawaili SM, Alghadier M, Mohamed EH, Abd-Elmonem AM. Paretic-Limb-Only Plyometric Training Outperforms Volume-Matched Double-Limb Training for Ameliorating Balance Capability and Gait Symmetry in Adolescents with Unilateral Cerebral Palsy: A Comparative Study. Children. 2022; 9(10):1563. https://doi.org/10.3390/children9101563
Chicago/Turabian StyleElnaggar, Ragab K., Reham H. Diab, Asmaa A. Abonour, Saud F. Alsubaie, Saud M. Alrawaili, Mshari Alghadier, Elsayed H. Mohamed, and Amira M. Abd-Elmonem. 2022. "Paretic-Limb-Only Plyometric Training Outperforms Volume-Matched Double-Limb Training for Ameliorating Balance Capability and Gait Symmetry in Adolescents with Unilateral Cerebral Palsy: A Comparative Study" Children 9, no. 10: 1563. https://doi.org/10.3390/children9101563