Progressive Supervised Home-based Strength Training in Children With Spastic Cerebral Palsy
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|ClinicalTrials.gov Identifier: NCT03863197|
Recruitment Status : Recruiting
First Posted : March 5, 2019
Last Update Posted : March 5, 2019
|Condition or disease||Intervention/treatment||Phase|
|Cerebral Palsy, Spastic||Behavioral: Progressive strength training||Not Applicable|
Background: The alterations of morphological muscle and tendon properties are a primary determinant of the pathological muscle behavior in spastic cerebral palsy (SCP). As treatments aim to reduce the progressive secondary problems, they are mainly directed at the muscle level. Muscle morphology features like volume, fascicle architecture and tendon properties are all responsive to treatment, but these treatment responses seem to be both patient and muscle specific. Therefore, objective tools and protocols are needed for the evaluation of morphological muscle and tendon (MMT) properties in routine clinical practice. These are required to guide patient-specific selection of appropriate, rationalized treatment choices and to determine the impact of these treatments on the MMT properties, the muscular impairment and function in children with SCP.
This intervention study is one out of three intervention studies focused on defining the effects of conservative treatments (strengthening, stretching and botulinum toxin injections) on muscle and tendon architecture. In this phase of the Treatment Algorithms based on Muscle and Tendon Morphology (TAMTA) project, we aim to develop specific guidelines for these treatment options linked to the MMT evaluation protocol. To achieve this goal, prediction models based on baseline MMT parameters for the prognosis of specific treatment outcomes will be developed from the data of the three intervention studies.
Aim: (1) determine whether the 12-week program of targeted progressive strengthening of the plantar and dorsiflexors, and the knee flexors and extensors leads to changes in the MMT properties of medial gastrocnemius, tibialis anterior, semitendinosus and rectus femoris, in the muscle strength and in gross motor function; and (2) determine the correlation between baseline MMT properties and the changes in the outcome parameters.
Methods/Design: A randomized controlled trial will be conducted in 30 ambulatory children with confirmed diagnosis of SCP between 5 and 11 years of age. Participants will be randomized to the intervention group (who will additionally receive the strengthening program while continuing their usual care) or to the control group (who will continue their usual care without additional treatment) using the randomization by minimization method (with influencing characteristics age and GMFCS level). The MMT parameters of the medial gastrocnemius, tibialis anterior, semitendinosus and rectus femoris and the isometric and functional strength for the 4 related lower limb muscle groups (plantar flexors, dorsiflexors, knee flexors and knee extensors) as well as the gross motor function will be assessed before and after the 12-week program. After 6 weeks a short evaluation of the MMT parameters, isometric and functional strength will take place.
The change in primary outcome parameters before and after treatment of the intervention group will be compared to the data behavior of the control group. Secondly, to explore the predictive value of specific baseline MMT parameters on treatment effect, both univariate and multivariate linear regression analyses will be conducted to identify significant predictive variables for the primary outcome parameters. Finally, selected parameters of impairment at baseline will be used to define the goal of the treatment following the approach of the 'Goal Attainment Score' (GAS). The GAS of the intervention group will be predicted by means of multiple, multinomial logistic regression using the primary MMT parameters as input for the regression model.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||30 participants|
|Intervention Model:||Crossover Assignment|
|Intervention Model Description:||randomized crossover- and delayed intervention|
|Masking:||None (Open Label)|
|Official Title:||Treatment Algorithms Based on Muscle and Tendon Morphology - Progressive Supervised Home-based Strength Training in Children With Spastic Cerebral Palsy|
|Actual Study Start Date :||August 1, 2018|
|Estimated Primary Completion Date :||June 1, 2019|
|Estimated Study Completion Date :||August 1, 2019|
Experimental: Intervention group
During a 12-week period children receive 3-4 session of progressive strength training per week on top of the usual care. All children will be provided with an individualized training program and supporting equipment. One or 2 session per week will be performed under supervision of the physical therapist, whilst the other 2 session will be performed at home. Progression is closely monitored by the principal investigator and training programs are adjusted if necessary. In total 40 session of progressive strength training should be fulfilled.
Behavioral: Progressive strength training
Progressive Supervised Home-based Strength Training
No Intervention: Delayed intervention, control group
The delayed-intervention group will continue their usual care without additional treatment for 12-weeks, followed by a 12-week period of progressive supervised home-based strength training.
- Change in muscle volume [ Time Frame: baseline, 6-weeks, post-intervention (12-weeks) ]Estimation of muscle volume by 3D freehand ultrasonography.
- Change in echogenicity intensity [ Time Frame: baseline, 6-weeks, post-intervention (12-weeks) ]Estimation of echogenicity intensity by 3D freehand ultrasonography on an 8‐bit greyscale (256 values).
- Change in isometric muscle strength [ Time Frame: baseline, 6-weeks, post-intervention (12-weeks) ]Evaluation of isometric muscle strength by Instrumented Weakness Assessment.
- Change in functional muscle strength [ Time Frame: baseline, 6-weeks, post-intervention (12-weeks) ]Evaluation of functional muscle strength by the Adapted Functional Strength measure.
- Change in gross motor function [ Time Frame: baseline, post-intervention (12-weeks) ]Evaluation of gross motor function by the Gross Motor Function Measure.
- Change in quality of life [ Time Frame: baseline, post-intervention (12-weeks) ]Evaluation of quality of life by the CP Quality of Life (CP QOL-Child) questionnaire for children. This questionnaire evaluates quality of life over various domains on a 1-9 scale. A higher score indicates more happiness.
- Change in level of participation [ Time Frame: baseline, post-intervention (12-weeks) ]Level of participation is assessed by the CAPE (Children's Assessment of Participation and Enjoyment) questionnaire. The self-reported level of enjoyment is rated on a five pint scale.
- Change in Functionality [ Time Frame: baseline, post-intervention (12-weeks) ]The level of functionality and activity is assessed by the Gillette Functional Assessment questionnaire. This parent-reported questionnaire consists of 22 items (0 low function - 10 high function).
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03863197
|Contact: Britta Hanssen, MScemail@example.com|
|Gent, Belgium, 9000|
|Contact: Christine Van den Broeck, Dr +32 9 332 69 21 Christine.firstname.lastname@example.org|
|Contact: Patrick Calders, Dr +32 9 332 69 15 email@example.com|
|Leuven, Belgium, 3000|
|Contact: Britta Hanssen, MSc +32 16 3 41295 firstname.lastname@example.org|
|Contact: Kaat Desloovere, Dr +32 16 37 65 07 email@example.com|
|Study Director:||Kaat Desloovere, Dr||KU Leuven|