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儿童脑瘫使用固定自行车进行耐力和肢体强化训练(PEDALS):一项随机对照试验。

Pediatric endurance and limb strengthening (PEDALS) for children with cerebral palsy using stationary cycling: a randomized controlled trial.

机构信息

Department of Orthopaedic Surgery, UCLA/Orthopaedic Hospital Center for Cerebral Palsy, University of California at Los Angeles, CA, USA.

出版信息

Phys Ther. 2010 Mar;90(3):367-81. doi: 10.2522/ptj.20080364. Epub 2010 Jan 21.

Abstract

BACKGROUND

Effective interventions to improve and maintain strength (force-generating capacity) and endurance are needed for children with cerebral palsy (CP).

OBJECTIVE

This study was performed to examine the effects of a stationary cycling intervention on muscle strength, locomotor endurance, preferred walking speed, and gross motor function in children with spastic diplegic CP.

DESIGN

This was a phase I randomized controlled trial with single blinding.

SETTING

The interventions were performed in community-based outpatient physical therapy clinics. Outcome assessments were performed in university laboratories.

PARTICIPANTS

Sixty-two ambulatory children aged 7 to 18 years with spastic diplegic CP and Gross Motor Function Classification System levels I to III participated in this study.

INTERVENTION AND MEASUREMENTS

Participants were randomly assigned to cycling or control (no-intervention) groups. Thirty intervention sessions occurred over 12 weeks. Primary outcomes were peak knee extensor and flexor moments, the 600-Yard Walk-Run Test, the Thirty-Second Walk Test, and the Gross Motor Function Measure sections D and E (GMFM-66).

RESULTS

Significant baseline-postintervention improvements were found for the 600-Yard Walk-Run Test, the GMFM-66, peak knee extensor moments at 120 degrees /s, and peak knee flexor moments at 30 degrees /s for the cycling group. Improved peak knee flexor moments at 120 degrees/s were found for the control group only, although not all participants could complete this speed of testing. Significant differences between the cycling and control groups based on change scores were not found for any outcomes. Limitations Heterogeneity of the patient population and intrasubject variability were limitations of the study.

CONCLUSIONS

Significant improvements in locomotor endurance, gross motor function, and some measures of strength were found for the cycling group but not the control group, providing preliminary support for this intervention. As statistical differences were not found in baseline-postintervention change scores between the 2 groups; the results did not demonstrate that stationary cycling was more effective than no intervention. The results of this phase I study provide guidance for future research.

摘要

背景

需要有效的干预措施来提高和维持脑瘫(CP)儿童的力量(产生力量的能力)和耐力。

目的

本研究旨在探讨固定自行车干预对痉挛性双瘫 CP 儿童肌肉力量、运动耐力、最佳行走速度和粗大运动功能的影响。

设计

这是一项具有单盲的 I 期随机对照试验。

设置

干预措施在社区门诊物理治疗诊所进行。在大学实验室进行结果评估。

参与者

62 名年龄在 7 至 18 岁之间、患有痉挛性双瘫 CP 和粗大运动功能分类系统 I 至 III 级的可走动儿童参加了这项研究。

干预措施和测量

参与者被随机分配到自行车组或对照组(无干预组)。30 次干预课程在 12 周内进行。主要结果是峰值膝关节伸肌和屈肌力矩、600 码步行跑测试、30 秒步行测试和粗大运动功能测量的 D 和 E 部分(GMFM-66)。

结果

自行车组在 600 码步行跑测试、GMFM-66、120 度/秒时峰值膝关节伸肌力矩和 30 度/秒时峰值膝关节屈肌力矩方面均有显著的基线后干预改善。仅控制组发现峰值膝关节屈肌力矩在 120 度/秒时有所改善,尽管并非所有参与者都能完成此速度测试。基于变化分数,自行车组和对照组之间没有发现任何结果的显著差异。

局限性

患者人群的异质性和个体内变异性是研究的局限性。

结论

自行车组在运动耐力、粗大运动功能和一些力量测量方面有显著的改善,但对照组没有,为这种干预提供了初步支持。由于两组在基线后干预变化分数之间没有发现统计学差异;结果并未表明固定自行车比无干预更有效。该 I 期研究的结果为未来的研究提供了指导。

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