dc.description.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. | en |
dc.description.tableofcontents | 口試委員會審定書 i謝 ii文摘要 ivbstract vihapter 1. Introduction 1.1 Research Problem 3.2 Define Research Questions 3.3 Study Hypotheses 5.4 Operational Definitions 7.4.1 Children with Spastic Diplegia (SD) 7.4.2 Loaded Sit-to-Stand (STS) Resistance Exercise Program 8.4.3 The PSE Music (PSE) Group 8.4.4 The Non-Music (NM) Group 8.4.5 PSE Music 9.4.6 One-Repetition Maximum of the Loaded Sit-to-Stand (1-RM STS) 9.4.7 Gross Motor Function Measure (GMFM) Goal Total Score 9.4.8 Pediatric Evaluation of Disability Inventory (PEDI) Mobility and Self-Care Domains 10.4.9 Exercise Motivation 11.4.10 Exercise Adherence 11.4.11 Exercise Volume 11.4.12 Kinematic Motor Control Related Variables (Smoothness, Directness, and Movement Time of STS Movement) 11.4.13 Gait Parameters 12hapter 2. Literature Review 14.1 Children with Cerebral Palsy (CP) 14.2 Lower Extremity (LE) Muscle Resistance Exercise for Children with CP 16.2.1 Effect of LE Resistance Training for Children with CP 17.2.2 Prescription of LE Resistance Exercise for Children with CP 19.2.3 Effects of Load on STS Performance for Children with CP 21.2.4 Summary 23.3 Effects of Therapeutic Music when Combining with Exercise 23.3.1 Psychological Effect of Music when Combining with Exercise 24.3.2 Motor Effect of Music when Combining with Exercise 27.3.3 Musical Information Processing and Movement Synchronization 30.3.4 Guiding STS Movement with Music for Children with CP 32.3.5 Summary 34.4 Factors Influencing the Effects of Resistance Exercise 34.5 Measurements of the Effects of PSE Music 36.5.1 Loaded Sit-to-Stand (Loaded STS) Test 36.5.2 Gross Motor Function Measure (GMFM) Dimension D and E 37.5.3 Pediatric Evaluation of Disability Inventory (PEDI) Mobility and Self-Care Domains 37.5.4 Intrinsic Motivation Inventory-Chinese Version (IMI-C) 38.5.5 Exercise Adherence and Volume 39.5.6 Motor Control Variables of the STS Movement 40hapter 3. Methods 42.1 Experimental Design 42.2 Participants 42.3 Experimental Procedures 43.3.1. Loaded STS Resistance Exercise Program 46.3.2. PSE Music 47.4 Experimental Equipments 51.4.1 Equipments for the Loaded STS Test and the Loaded STS Exercise 51.4.2 Equipments for Designing, Producing and Playing Music 51.4.3 Motion Analysis System for STS Movement 52.5 Experimental Measures 53.5.1 The Loaded STS Test 53.5.2 Gross Motor Function Measure (GMFM) Dimension D and E 54.5.3 Pediatric Evaluation of Disability Inventory (PEDI) Mobility and Self-Care Domains 55.5.4 Intrinsic Motivation Inventory-Chinese Version (IMI-C) 55.5.5 Exercise Adherence and Exercise Volume 56.5.6 Motor Analysis of STS Movement 56.5.7 Ten-Meter Walking Test 57.5.8 Gross Motor Function Classification System (GMFCS) 58.6 Data Reductions 58.7 Statistical Analysis 60hapter 4. Results 62.1 Effects of PSE Music on Functional Strength 64.2 Effects of PSE Music on Gross Motor Capacity 65.3 Effects of PSE Music on Functional Capabilities and Performance (PEDI) 65.4 Effects of PSE Music on Exercise Involvement 66.4.1 Motivation 66.4.2 Adherence 66.4.3 Volume 67.6 Effects of PSE Music on Motor Control Variables of STS 67.7 Effects of PSE Music on Gait Parameters 69hapter 5. Discussion 70.1 Effects of PSE Music on Functional Strength 71.2 Effects of PSE Music on Gross Motor Capacity 73.3 Effects of PSE Music on Functional Capabilities and Performance (PEDI) 74.4 Effects of PSE Music on Exercise Involvement 76.4.1 Motivation 76.4.2 Exercise Adherence 77.4.3 Exercise Volume 77.5 Effects of PSE Music on Motor Control Variables of STS 78.6 Effects of PSE Music on Gait Parameters 80.7 Study Limitations 82.9 Recommendations for Future Studies 83hapter 6. Conclusion 85eferences 86ables 99igures 115ppendices 120ppendix 1: Permission of Institutional Review Board and Consent Form 120ppendix 2: The Loaded STS Home Exercise Guideline for the PSE Group 127ppendix 3: The Loaded STS Home Exercise Guideline for the Non-Music Group 128ppendix 4: Logbook for the Loaded STS Home Exercise 129ppendix 5: The Intrinsic Motivation Inventory-Chinese Version 130ppendix 6: Principle Components of PSE Music Design for Children in the PSE Group 132 | en |