ISRCTN - ISRCTN69044459: Exercise therapy intervention for children and young adults with cerebral palsy

Plain English Summary

Background and study aims
Cerebral palsy (CP) is a term for a number of conditions that affect movement and co-ordination. It occurs when there is a problem in the parts of the brain responsible for controlling muscles. This can be due to abnormal development of the brain or damage caused before, during or after birth. CP leads to a range of symptoms, including muscle stiffness or weakness, random and uncontrolled body movements and balance and coordination problems. Problems with walking (gait) are the most common problems seen in children with CP. It has been shown that children and adults with CP are less physically active than those who have developed normally. This in turn leads to lower physical fitness, and risks of developing a range of health conditions. There is a lot of evidence to show that exercise programmes (e.g. strength training, aerobic training, functional skill training) are able to enhance physical capacity, functionality and wellbeing in people with CP. The aim of this study is to look at the effects of an individualised exercise programme on children and young people with CP.

Who can participate?
People with CP aged 10 to 23 years old and typically developing people of the same age.

What does the study involve?
There are three parts to this study. Firstly, there is a three month “control period”, in which participants continue as normal. Secondly, there is a three month “intervention period”, in which participants take part in the exercise programme. Thirdly, there is a three month “maintenance period” during which participants continue as normal. Those with CP take part in all three periods, and typically developing participants take part in only the control period. The exercise programme involves two to three supervised exercise sessions per week for 12 weeks. These sessions involve strength and flexibility training for the legs; skill and functional training, such as balancing and climbing stairs; treadmill walking; and various sport activities, such as swimming, football and volleyball. Before and after the three month control period and the three month maintenance period, participants complete a range of assessments and questionnaires to look at their physical capacity, functionality and wellbeing. In addition, for one week during each study period, participants wear a special device to record their physical activity.

What are the possible benefits and risks of participating?
Participants may benefit from an improvement to their physical abilities, which could help them exercise more and decrease their risk of developing further health problems. There are no notable risks involved with taking part other than the general risks associated with exercising such as muscle soreness, tiredness or increased risk of falling.

Where is the study run from?
University of Jyväskylä (Finland)

When is the study starting and how long is it expected to run for?
September 2016 to August 2020

Who is funding the study?
University of Jyväskylä (Finland)

Who is the main contact?
Mr Pedro Valadao
pedro.valadao@jyu.fi

Trial website

Contact information

Type

Public

Primary contact

Mr Pedro Valadao

ORCID ID

http://orcid.org/0000-0003-0720-7103

Contact details

University of Jyväskylä
Faculty of Sport and Health Sciences
Jyväskylä
40014
Finland
+358 40 145 9280
pedro.valadao@jyu.fi

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

8U/2017

Study information

Scientific title

Effects of a tailored exercise therapy intervention on physical capacity and function, neuromuscular mechanisms and cardiometabolic risk factors of children and young adults with cerebral palsy

Acronym

EXECP

Study hypothesis

1. The intervention will enhance gait performance, increase muscle strength, neuromuscular coordination and joint range of motion.
2. The intervention will increase daily physical activity levels and improve cardiometabolic risk factors

Ethics approval

Central Finland Central Hospital Ethics Committee, 13/04/2017, ref: 8u/2017

Study design

Single-centre non-randomised study with multiple baselines

Primary study design

Interventional

Secondary study design

Non randomised study

Trial setting

Other

Trial type

Quality of life

Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet

Condition

Cerebral Palsy

Intervention

For participants with Cerebral Palsy (CP), there is a three month control period, followed by a three month intervention period, followed by a three month maintenance period. For participants in the control group (typically developing participants), there is a three month control period only (at the same time as those in the CP group undergo their control period.

The exercise therapy intervention will have two to three supervised sessions per week during 12 weeks. The intervention will be tailored to address deficits identified by instrumented gait analysis, strength and flexibility tests. The intervention will include:
1. Strength and flexibility training for the main lower limb muscles (quadriceps, hamstrings, triceps surae, tibialis anterior, hip flexors, extensors and abductors)
2. Skill and functional training (e.g. balancing and force matching exercises, climbing stairs)
3. Treadmill walking
4. Various sport activities (e.g. swimming, football, volleyball)
All sessions will have 60 to 90 minutes of duration and will be interspaced by a minimum of 48 hours

For participants with CP, the study starts with a familiarization session, then 1 week later the pre-test 1. After the control period (3 months), the pre-test 2 is done and the intervention period (three months) starts. At the end of the intervention period, post-test 1 is done, and after the end of the maintenance period (3 months) the study is finalized with post-test 2. There is no intervention on the control and maintenance periods. Pre-tests 1 and 2, and Post-tests 1 and 2 are similar, consisting of three testing sessions in which most research variables will be collected (only exception is Post-test 2, in which there will be no magnetoencephalography measurements). Physical activity data will be collected in each of the three periods, during normal daily living.

For control participants, only the control period will be performed, meaning one familiarization session, and two testing sessions three month apart (Pre-tests 1 and 2). Physical activity data will be collected during this period.

Intervention type

Other

Phase

Drug names

Primary outcome measure

Gait performance is assessed using a 6 minutes walking test at baseline (pre-test 1), 3 (pre-test 2), 6 (post-test 1) and 9 (post-test 2) months for participants with CP and at baseline and 3 months for control participants.

Secondary outcome measures

1. Physical activity levels are measured using electromyography and accelerometry during 7 days of normal daily living at all three periods (control, intervention and maintenance)
2. Muscle strength is assessed using Isokinetic dynamometry at baseline (pre-test 1), 3 (pre-test 2), 6 (post-test 1) and 9 (post-test 2) months for participants with CP and at baseline and 3 months for control participants
3. Gait kinetics/kinematics/mechanical efficiency is assessed using Vicon cameras, force plates and a heart rate monitor at baseline (pre-test 1), 3 (pre-test 2), 6 (post-test 1) and 9 (post-test 2) months for participants with CP and at baseline and 3 months for control participants
4. Body composition is assessed using Inbody at baseline, 3, 6 and 9 months for participants with CP and at baseline and 3 months for control participants
5. Blood biomarkers, arterial stiffness is assessed through blood sampling and arteriography at baseline, 3, 6 and 9 months for participants with CP and at baseline and 3 months for control participants
6. H-reflex, Post-activation depression is assessed through nerve stimulation and Electromyography at baseline, 3, 6 and 9 months for participants with CP and at baseline and 3 months for control participants
7. Proprioceptive responses and corticomuscular coherence is assessed through Magnetoencephalography at baseline, 3, 6 and 9 months for participants with CP and at baseline and 3 months for control participants
8. Spasticity is assessed using the tonic stretch reflex threshold at baseline, 3, 6 and 9 months for participants with CP and at baseline and 3 months for control participants
9. Joint Flexibility is assessed using a Isokinetic dynamometer coupled with a linear potentiometer at baseline, 3, 6 and 9 months for participants with CP and at baseline and 3 months for control participants
10. Motor Function is assessed using the Gross Motor Function Measure (GMFM-66) at baseline, 3, 6 and 9 months for participants with CP
11. Perceived competence, relatedness and autonomy are assessed using questionnaires at the familiarization session, 6 and 9 months
12. Parent’s intentions and attitudes towards physical activity of their children are assessed using a questionnaire at the familiarization session and 6 months

Overall trial start date

12/09/2016

Overall trial end date

25/08/2020

Reason abandoned (if study stopped)

Eligibility

Participant inclusion criteria

Experimental group:
1. Spastic CP (diplegic or hemiplegic)
2. Male and Female
3. Age range of 10 to 23 years old
4. Gross Motor Function Classification System (Palisano et al. 2008) levels 1 to 3

Control group:
1. Typically developing
2. Male and Female
3. Age range of 10 to 23 years old

Participant type

Mixed

Age group

Mixed

Gender

Both

Target number of participants

24 in each group.

Participant exclusion criteria

1. Pharmacological treatments (e.g. intrathecal baclofen, botullinum toxin) in the last 6 months
2. Surgical procedures in the last 6 months
3. Selective dorsal rhyzotomy
4. Dystonia
5. Inability to understand basic instructions
6. Current utilization of serial casting
7. Inability to stand with the sole of the foot flat on the floor
8. Participation in the past 3 months in a structured physical training program

Recruitment start date

24/04/2017

Recruitment end date

05/11/2019

Locations

Countries of recruitment

Finland

Trial participating centre

University of Jyväskylä
Neuromuscular Research Center Faculty of Sport and Health Sciences
Jyväskylä
40014
Finland

Sponsor information

Organisation

University of Jyväskylä

Sponsor details

Faculty of Sport and Health Sciences
Jyväskylä
40014
Finland
+358 14 260 2011
taija.m.juutinen@jyu.fi

Sponsor type

University/education

Website

https://www.jyu.fi/sport/en/

Funders

Funder type