Effects of Therapeutic Music Combined with Loaded Sit-to-Stand Resistance Exercise for Children with Spastic Diplegia
Date Issued
2009
Date
2009
Author(s)
Wang, Tze-Hsuan
Abstract
Background and Purpose: Children with spastic diplegia (SD) usually have limitations in mobility functions and daily participation due to muscle weakness and poor motor control. Previous study proved that a home-based loaded sit-to-stand (STS) resistance exercise program could improve their functional muscle strength and gross motor function. However, the exercise motivation for resistance training is usually poor in children. Previous study has reported that music can be used to increase adherence. Also, the Patterned Sensory Enhancement (PSE) technique of music therapy uses different elements of music to cue body movements and could improve motor control immediately. However, no studies investigated the effects of PSE music with resistance exercise for children with CP. The purpose of this study was to investigate the effects of the loaded STS resistance exercise with PSE music on body functions, activities, participation, and exercise involvement for children with SD. Methods: Twenty-two children with SD who could stand up independently were recruited for this study. Participants were stratified by their age and severity and then randomly assigned to the PSE music (PSE) group (n=12) and the non-music (NM) group (n=10). A blinded tester evaluated the children to obtain data of one-repetition maximum (1-RM) of the loaded STS test, Gross Motor Function Measure (GMFM) goal score, scaled scores of Pediatric Evaluation of Disability Inventory (PEDI) Mobility and Self-Care domains, and walking parameters at pre- and post-training. The motion analysis of the STS movement was also conducted to gather motor control variables, such as jerk index, directness, and movement time of STS. Children in the PSE group received a home-based loaded STS exercise combined with PSE music, 3 times a week for 6 weeks. The individualized PSE music was designed by the physical therapist and the music therapist, and composed by music therapist based on the recorded video of loaded STS movement. This PSE music was aiming to increase fun and promote the exercise performance and was renewed every 2 weeks. Children in the NM group received the 6-week loaded STS exercise without music. The exercise adherence and volume were gathered by logbook. The motivation was assessed by the Intrinsic Motivation Inventory after training. The above 3 variables were compared between groups with independent t test or Mann-Whitney U test. Other outcome measures were compared between groups using two-way mixed analysis of variance. The alpha level was set at 0.05 for one-tailed test. Results: Children in the PSE group improved more in the 1-RM of the loaded STS test and goal score of GMFM than the NM group after 6-week training (P = .038 and .026, respectively). There were no time × group interaction effects for scores of PEDI, walking parameters, and motor control variables of STS, but there were significant main time effects while considered all subjects as a whole. The exercise motivation did not differ significantly between groups. However, children in the PSE group tended to complete more loaded STS repetitions than the NM group (P = .057) during the training period. Discussion and conclusion: In the present study, we successfully incorporate PSE music with the home-based loaded STS exercise for children with SD. The PSE music significantly improved the functional muscle strength and gross motor function, and had a tendency to increase the exercise volume. For all subjects as a whole, improvements were found in daily participation, walking speed, and motor control of STS. Future studies might combine PSE music with various functional activities in order to improve the performance in daily activities for children with CP.
Subjects
Cerebral palsy
Resistance training
Music therapy
Motivation
Motor control
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