Functional Reach Test
The following study aimed to investigate how a combined strength and endurance training program for 8 weeks, effected functional performance in individuals with spastic Cerebral Palsy. Functional performance was determined by outcome measures such as the 6-minute walk test, 30 second sit-to-stand, 10-m walk, TUGT and the functional reach test. Researchers found that individuals who performed the 8-week combined exercise program improved in nearly all of the tested parameters. Improvements exceeded the post-test results seen in the control group, who simply continued with their Physical therapy. Researchers specifically wanted to target changes in balance, flexibility, walking ability, endurance, and lower limb strength and predicted that all of the above parameters would be positively influenced.
The study was a randomized controlled trial and exclusion criteria included receiving any surgical or chemical treatment for spasticity within 3 months of the study intervention. There was an exercise group and a control group. The exercise group’s functionally based endurance training program was in the style of a group circuit and consisted of leg stationary bicycles and elliptical machines. Ample warm-up and cool-down time were given, as well as, time to self-muscle stretch. The session would last for 70 minutes, and was performed 3 days a week, under a pediatric Physical Therapist’s supervision. Along with functional endurance training, participants also went through a functional strength training regimen. Participants performed a step-up step-down activity and sit-to-stands. Participants also participated in recreational fast walking or running, depending on their ability. Pertaining to functional reach test, researchers used it as a clinical measure of balance, among the participants. The functional reach test was averaged after 4 trials and a 5-second rest interval.
Researchers found that baseline between the exercise and control group were not significantly different. After the 8-week program, the exercise group demonstrated significant improvement in all functional measures, except for the TUGT. It was noted that the exercise program did not include specific balance training, which may explain the lack of significance in post test scores for the TUGT. It was found that participants had difficulty turning around during the test due to limitations in balance and agility, which impacted the timing. The study also did not have a large sample size which in turn effects the power of the study. As a result, the findings of this study should be viewed with healthy skepticism, especially when applying conclusions to the population.
In conclusion, the study further bolstered initial findings that both functional strength and endurance training can induce positive changes in those with CP. These changes do not only occur when these programs are separate but also when combined. Future studies should aim to replicate this study with a larger sample size and lengthen the study. Efforts could also be made to collect more data a few months later, to see if there is any carryover. Overall, this was a detailed study with valuable data, that laid a foundation for future studies in this area.
Reference:
Peungsuwan P, Parasin P, Siritaratiwat W, Prasertnu J, Yamauchi J. Effects of Combined Exercise Training on Functional Performance in Children With Cerebral Palsy. Pediatric Physical Therapy. 2017;29(1):39-46. doi:10.1097/pep.0000000000000338.
4 responses to “Functional Reach Test”
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It is pretty well known that in most populations we treat in PT would benefit from endurance and strength training, in adjunct with more conventional PT. PTs normally get about 45 minute sessions. Do you think it is a time constraint that inhibits us from being able to implement all these things in our sessions? Or are most PTs implementing these things in patients’ HEPs and then because the lack of adherence or supervision, the goals are not always met. In research studies, patients are more closely monitored and adhering to the protocol therefore more likely to see results?
That is a great question Monica, I think it’s most likely a little bit of both. We often talk about how it is the PT’s responsibility to find an HEP that can be integrated into a patient’s everyday activities, especially in the case of children, to increase adherence and decrease caregiver burden. With that being said, at certain ages, children’s states of mood/being can be variable and therefore there can be so much variability in the sessions that sometimes 45 minutes may be enough and other times it may not. It is also possible that being around other participants who were doing the same regimen formed this sense of social accountability as well as motivation to stay the course and increase intensity in exercises when needed, leading to these results.
This article provides good information on treatment modalities for children with cerebral palsy. One further study I would like to see research on is not WHAT exercises to do, but how INTENSE. Strength and endurance training are important for kids with CP, but how hard should we push them? PTs work with these kids year round for their entire childhood. If they are coming to PT 2-3 times a week and we push them really hard at the beginning of the week, are they going to be too tired the next session to even do anything? Realizing all children with CP are different, we may have to adjust our plan, but it is important to keep in mind how long and how often we see these kids!
Very good point, as we’ve learned in many of our classes, intensity matters, so that would absolutely be valuable information. A quick search for clinical practice guidelines revealed to me that there is not much information available, and that what is available is not very current. I feel as if that would be helpful to have handy in the school PT setting.