Cerebral Palsy
Muscle Spasticity
Resistance Training
Spastic Diplegia
Lower Limb

How to Cite



OBJECTIVE: To assess the effect of progressive strength training on gross motor function in children with cerebral palsy.

METHODS: This quasi experimental study was performed in Children Hospital Lahore Pakistan. Convenient sampling technique was used in this study. Data was collected from 45 cerebral palsy patients with Gross Motor Function Classification System (GMFCS) 1-3. Three sessions of strength training in one week for 12 consecutive weeks was given. The resistance was increased according to level of strength of each child calculated by one repetition maximum (1RM). Gross Motor Function Measure 88 was used as outcome measure. Pre and post intervention mean score was compared by using Wilcoxon signed rank test.

RESULTS: Out of 45 cerebral palsy children 31 were males and 14 were females. A difference was observed between pre and post intervention mean score which was 4.2 after the 12 weeks strength training program. There were 17(37.8%) patients with age less than 10 years and 28(62.2%) patients with greater than 10 years of age. Out of 45 participants 1 had a GMFCS score of 1 and 16 had a GMFCS score of 2. Remaining 28 participants had a GMFCS score of 3 amounting to 62.2% of the total participants. P value > 0.05 showed that there was significant increase in post training score.

CONCLUSION: It is concluded that progressive strength training on gross motor function in children with cerebral palsy is helpful in improving the strength and physical ability of children.


Quinby JM, Abraham A. Musculoskeletal problems in cerebral palsy. Curr Paediatr 2005;15(1):9-14. DOI: 10.1016/j.cupe.2004.10.002.

Colver A, Gibson M, Hey E, Jarvis S, Mackie P, Richmond S. Increasing rates of cerebral palsy across the severity spectrum in north-east England 1964–1993. Arch Dis Child Fetal Neonatal Ed 2000;83(1):F7-F12. DOI: 10.1136/fn.83.1.f7.

Loo M. Integrative Medicine for Children: Saunders/Elsevier; 2009.

Scholtes VA, Dallmeijer AJ, Rameckers EA, Verschuren O, Tempelaars E, Hensen M, et al. Lower limb strength training in children with cerebral palsy–a randomized controlled trial protocol for functional strength training based on progressive resistance exercise principles. BMC Pediatr 2008 Oct 8;8:41. DOI: 10.1186/1471-2431-8-41.

Nordmark E, Hägglund G, Lagergren J. Cerebral palsy in southern Sweden II. Gross motor function and disabilities. Acta Paediatr 2001 Nov;90(11):1277-82. DOI: 10.1080/080352501317130326.

Alshryda S, Wright J. Development and Reliability of a System to Classify Gross Motor Function in Children with Cerebral Palsy. Classic Papers in Orthopaedics: Springer; 2014. p. 575-7. DOI: 10.1007/978-1-4471-5451-8_152.

Beckung E, Hagberg G. Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Dev Med Child Neurol 2002 May;44(5):309-16. DOI: 10.1017/s0012162201002134.

Liao HF, Jeny SF, Lai JS, Cheng CK, Hu MH. The relation between standing balance and walking function in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 1997 Feb;39(2):106-12. DOI: 10.1111/j.1469-8749.1997.tb07392.x.

Bell KJ, Ounpuu S, DeLuca PA, Romness MJ. Natural progression of gait in children with cerebral palsy. J Pediatr Orthop 2002 Sep-Oct;22(5):677-82.

Bottos M, Feliciangeli A, Sciuto L, Gericke C, Vianello A. Functional status of adults with cerebral palsy and implications for treatment of children. Dev Med Child Neurol 2001 Aug;43(8):516-28. DOI: 10.1017/s0012162201000950.

Hirtz D, Thurman D, Gwinn-Hardy K, Mohamed M, Chaudhuri A, Zalutsky R. How common are the “common” neurologic disorders? Neurology 2007;68(5):326-37. DOI: 10.1212/01.wnl.0000252807.38124.a3.

Damiano DL, Abel MF. Relation of gait analysis to gross motor function in cerebral palsy. Dev Med Child Neurol 1996;38(5):389-96. DOI: 10.1111/j.1469-8749.1996.tb15097.x.

Rodda J, Graham HK. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol 2001;8 Suppl 5:98-108.

Franki I, Desloovere K, De Cat J, Feys H, Molenaers G, Calders P, et al. The evidence-base for conceptual approaches and additional therapies targeting lower limb function in children with cerebral palsy: a systematic review using the ICF as a framework. J Rehab Med 2012;44(5):396-405. DOI: 10.2340/16501977-0984

Damiano DL, Kelly LE, Vaughn CL. Effects of quadriceps femoris muscle strengthening on crouch gait in children with spastic diplegia. Phys Ther 1995;75(8):658-67. DOI: 10.1093/ptj/75.8.658.

Blundell S, Shepherd R, Dean C, Adams R, Cahill B. Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4–8 years. Clin Rehab 2003;17(1):48-57. DOI: 10.1191/0269215503cr584oa.

Dodd KJ, Taylor NF, Graham HK. A randomized clinical trial of strength training in young people with cerebral palsy. Dev Med Child Neurol 2003 Oct;45(10):652-7. DOI: 10.1017/s0012162203001221.

Ross SA, Engsberg JR. Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Arch Phys Med Rehabil 2007;88(9):1114-20. DOI: 10.1016/j.apmr.2007.06.011

Guy JA, Micheli LJ. Strength training for children and adolescents. J Am Acad Orthop Surg 2001;9(1):29-36.

Kraemer WJ, Adams K, Cafarelli E, Dudley GA, Dooly C, Feigenbaum MS, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2002;34(2):364-80. DOI: 10.1097/00005768-200202000-00027.

Morton JF, Brownlee M, McFadyen AK. The effects of progressive resistance training for children with cerebral palsy. Clin Rehabil 2005;19(3):283-9. DOI: 10.1191/0269215505cr804oa.

Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Arch Phys Med Rehabil 2002;83(8):1157-64. DOI: 10.1053/apmr.2002.34286.

Verschuren O, Ada L, Maltais DB, Gorter JW, Scianni A, Ketelaar M. Muscle Strengthening in Children and Adolescents With Spastic Cerebral Palsy: Considerations for Future Resistance Training Protocols. Phys Ther 2011 Jul;91(7):1130-9. DOI: 10.2522/ptj.20100356.

Liao HF, Liu YC, Liu WY, Lin YT. Effectiveness of loaded sit-to-stand resistance exercise for children with mild spastic diplegia: a randomized clinical trial. Arch Phys Med Rehabil 2007;88(1):25-31. DOI: 10.1016/j.apmr.2006.10.006.

Myer GD, Quatman CE, Khoury J, Wall EJ, Hewett TE. Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms. J Strength Cond Res 2009;23(7):2054-60. DOI: 10.1519/JSC.0b013e3181b86712.

Ramsay JA, Blimkie CJ, Smith K, Garner S, MacDougall JD, Sale DG. Strength training effects in prepubescent boys. Med Sci Sports Exerc 1990;22(5):605-14. DOI: 10.1249/00005768-199010000-00011.

Verschuren O, Ketelaar M, Takken T, Helders PJ, Gorter JW. Exercise programs for children with cerebral palsy: a systematic review of the literature. Am J Phys Med Rehabil 2008;87(5):404-17. DOI: 10.1097/PHM.0b013e31815b2675.

Ko J, Kim M. Reliability and responsiveness of the gross motor function measure-88 in children with cerebral palsy. Phys Ther 2013;93(3):393-400. DOI: 10.2522/ptj.20110374.


Blundell SW, Shepherd RB, Dean CM, Adams RD, Cahill BM. Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4–8 years. Clin Rehabil 2003 Feb;17(1):48-57. DOI: 10.1191/0269215503cr584oa

Scholtes VA, Dallmeijer AJ, Knol DL, Speth LA, Maathuis CG, Jongerius PH. Effect of multilevel botulinum toxin a and comprehensive rehabilitation on gait in cerebral palsy. Pediatr Neurol 2007 Jan;36(1):30-9. DOI: 10.1016/j.pediatrneurol.2006.09.010.

Copyright (c) 2019 Khyber Medical University Journal