Motor-based priming: isokinetic outcomes of aerobic exercise in children with spastic diplegia
More details
Hide details
Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
Submission date: 2020-06-04
Acceptance date: 2020-08-19
Publication date: 2022-05-31
Physiother Quart. 2022;30(2):64-68
Priming is a behavioural change generated by preceding stimuli. Priming physical activities with aerobic exercise could improve performance and function. The study aimed to investigate the effect of aerobic exercise before a rehabilitation program on quadriceps peak torque in children with cerebral palsy of spastic diplegia.

Overall, 32 patients participated in this study; they were randomly assigned to 2 groups. Patients in the control group (A) engaged in a selected physical therapy program, while those in the experimental group (B) performed aerobic exercise by using a bicycle ergometer followed by application of the same selected physical therapy program as received by group A. The treatment programs were conducted 3 times per week for 12 successive weeks. Measurements obtained included concentric peak torque of quadriceps muscle at 30° as well as 90°. These measures were recorded 2 times: before and after the application of the treatment program.

There were statistically significant differences when comparing pre- and post-treatment mean values in each group. Also, there was a significant difference in favour of group B with regard to post-treatment mean values.

In accordance with the applied procedures, aerobic exercise is effective in improving quadriceps peak torque in children with cerebral palsy of spastic diplegia when applied before a physical therapy rehabilitation program.

Zhou J, Butler EE, Rose J. Neurologic correlates of gait abnormalities in cerebral palsy: implications for treatment. Front Hum Neurosci. 2017;11:103; doi: 10.3389/fnhum.2017.00103.
Hoon AH Jr, Vasconcellos Faria A. Pathogenesis, neuroimaging and management in children with cerebral palsy born preterm. Dev Disabil Res Rev. 2010;16(4):302–312; doi: 10.1002/ddrr.127.
Colver AF, Sethumadhavan T. The term diplegia should be abandoned. Arch Dis Child. 2003;88(4):286–290; doi: 10.1136/adc.88.4.286.
Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW, Task Force on Childhood Motor Disorders. Classification and definition of disorders causing hypertonia in childhood. Pediatrics. 2003;111(1):89–97; doi: 10.1542/peds.111.1.e89.
Wren TAL, Rethlefsen S, Kay RM. Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. J Pediatr Orthop. 2005;25(1):79–83; doi: 10.1097/00004694-200501000-00018.
Abbasi L, Rojhani-Shirazi Z, Razeghi M, Raeisi Shahraki H. Trunk kinematic analysis during gait in cerebral palsy children with crouch gait pattern. J Biomed Phys Eng. 2018;8(3):281–288; doi: 10.22086/jbpe.v0i0.659.
Mahmudul Hasan SM, Rancourt SN, Austin MW, Ploughman M. Defining optimal aerobic exercise parameters to affect complex motor and cognitive outcomes after stroke: a systematic review and synthesis. Neural Plast. 2016;2016:2961573; doi: 10.1155/2016/2961573.
Stoykov ME, Madhavan S. Motor priming in neurorehabilitation. J Neurol Phys Ther. 2015;39(1):33–42; doi: 10.1097/NPT.0000000000000065.
Stinear CM, Barber PA, Coxon JP, Fleming MK, Byblow WD. Priming the motor system enhances the effects of upper limb therapy in chronic stroke. Brain. 2008;131(Pt 5):1381–1390; doi: 10.1093/brain/awn051.
Ziemann U, Paulus W, Nitsche MA, Pascual-Leone A, Byblow WD, Berardelli A, et al. Consensus: motor cortex plasticity protocols. Brain Stimul. 2008;1(3):164–182; doi: 10.1016/j.brs.2008.06.006.
Stoykov ME, Corcos DM, Madhavan S. Movement-based priming: clinical applications and neural mechanisms. J Mot Behav. 2017;49(1):88–97; doi: 10.1080/00222895.2016.1250716.
Ofori EK, Frimpong E, Ademiluyi A, Olawale OA. Ergometer cycling improves the ambulatory function and cardiovascular fitness of stroke patients – a randomized controlled trial. J Phys Ther Sci. 2019;31(3):211–216; doi: 10.1589/jpts.28.211.
Dinomais M, Marret S, Vuillerot C. Brain plasticity and early rehabilitative care for children after neonatal arterial cerebral infarction [in French]. Arch Pediatr. 2017;24(9S):9S61–9S68; doi: 10.1016/S0929-693X(17)30333-0.
Van den Berg-Emons RJ, van Baak MA, de Barbanson DC, Speth L, Saris WH. Reliability of tests to determine peak aerobic power, anaerobic power and isokinetic muscle strength in children with spastic cerebral palsy. Dev Med Child Neurol. 1996;38(12):1117–1125; doi: 10.1111/j.1469-8749.1996.tb15075.x.
Ayalon M, Ben-Sira D, Hutzler Y, Gilad T. Reliability of isokinetic strength measurements of the knee in children with cerebral palsy. Dev Med Child Neurol. 2000;42(6):398–402; doi: 10.1017/s0012162200000724.
Pierce SR, Lauer RT, Shewokis PA, Rubertone JA, Orlin MN. Test-retest reliability of isokinetic dynamometry for the assessment of spasticity of the knee flexors and knee extensors in children with cerebral palsy. Arch Phys Med Rehabil. 2006;87(5):697–702; doi: 10.1016/j.apmr.2006.01.020.
Armand S, Decoulon G, Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy. EFORT Open Rev. 2016;1(12):448–460; doi: 10.1302/2058-5241.1.000052.
Brunner R, Rutz E. Biomechanics and muscle function during gait. J Child Orthop. 2013;7(5):367–371; doi: 10.1007/s11832-013-0508-5.
Noble JJ, Fry NR, Lewis AP, Keevil SF, Gough M, Shortland AP. Lower limb muscle volumes in bilateral spastic cerebral palsy. Brain Dev. 2014;36(4):294–300; doi: 10.1016/j.braindev.2013.05.008.
Verschuren O, Ketelaar M, Takken T, Helders PJM, Gor­ter JW. Exercise programs for children with cerebral palsy: a systematic review of the literature. Am J Phys Med Rehabil. 2008;87(5):404–417; doi: 10.1097/PHM.0b013e31815b2675.
Tsiros MD, Grimshaw PN, Schield AJ, Buckley JD. Test-retest reliability of the Biodex System 4 Isokinetic Dynamometer for knee strength assessment in paediatric populations. J Allied Health. 2011;40(3):115–119.
Fowler EG, Knutson LM, DeMuth SK, Sugi M, Siebert K, Simms V, et al. Pediatric endurance and limb strengthening for children with cerebral palsy (PEDALS) – a randomized controlled trial protocol for a stationary cycling intervention. BMC Pediatr. 2007;7:14; doi: 10.1186/1471-2431-7-14.
Franki I, Desloovere K, De Cat J, Feys H, Molenaers G, Calders P, et al. The evidence-base for basic physical therapy techniques targeting lower limb function in children with cerebral palsy: a systematic review using the International Classification of Functioning, Disability and Health as a conceptual framework. J Rehabil Med. 2012;44(5):385–395; doi: 10.2340/16501977-0983.
Ali SSM, Abdel Azim FH, El Sobky MAM. Effect of strength training on upper extremity function in children with hemiparesis. Int J Sci Healthcare Res. 2016;1(3):1–7.
Karadağ-Saygı E, Giray E. The clinical aspects and effectiveness of suit therapies for cerebral palsy: a systematic review. Turk J Phys Med Rehabil. 2019;65(1):93–110; doi: 10.5606/tftrd.2019.3431.
Roig M, Skriver K, Lundbye-Jensen J, Kiens B, Nielsen JB. A single bout of exercise improves motor memory. PLoS One. 2012;7(9):e44594; doi: 10.1371/journal.pone.0044594.
Knaepen K, Goekint M, Heyman EM, Meeusen R. Neuroplasticity – exercise-induced response of peripheral brain-derived neurotrophic factor: a systematic review of experimental studies in human subjects. Sports Med. 2010;40(9):765–801; doi: 10.2165/11534530-000000000-00000.
Ploughman M. Exercise is brain food: the effects of physical activity on cognitive function. Dev Neurorehabil. 2008;11(3):236–240; doi: 10.1080/17518420801997007.
Ploughman M, Austin MW, Glynn L, Corbett D. The effects of poststroke aerobic exercise on neuroplasticity: a systematic review of animal and clinical studies. Transl Stroke Res. 2015;6(1):13–28; doi: 10.1007/s12975-014-0357-7.
Kitago T, Krakauer JW. Motor learning principles for neurorehabilitation. Handb Clin Neurol. 2013;110:93–103; doi: 10.1016/B978-0-444-52901-5.00008-3.
Da Silva ESM, Santos GL, Catai AM, Borstad A, Duarte Furtado NP, Verzola Aniceto IA, et al. Effect of aerobic exercise prior to modified constraint-induced movement therapy outcomes in individuals with chronic hemiparesis: a study protocol for a randomized clinical trial. BMC Neurol. 2019;19(1):196; doi: 10.1186/s12883-019-1421-4 [erratum in: BMC Neurol. 2019;19(1):225; doi: 10.1186/s12883-019-1454-8.
Journals System - logo
Scroll to top