Applying Biomechanics to Evaluate the E ectiveness of an Aquatic Intervention Programme on Adults with Cerebral Palsy

Abstract

BACKGROUND/OBJECTIVES: Hydrotherapy has become a popular form of rehabilitation therapy for individuals affected by motor impairments. Several studies (for a review, see [1]) have reported the effectiveness of hydrotherapy programmes for individuals with cerebral palsy (CP); however, these studies have excluded the adult population. The objective of this research is to investigate the effectiveness of a hydrotherapy programme on three ambulatory adults (M&F, Ages 28-49, GMFCS I-II) with CP. Physiotherapy and biomechanical assessments were performed before and after an aquatic intervention programme to evaluate each participant's functional mobility. METHODS: Both before and after a ten week hydrotherapy programme, each participant was scored using the timed-up-and-go, 6 minute walk test, GMFM-66, and Berg's Balance. Motion trajectories using a Vicon Corp. infrared camera system were collected to calculate spatiotemporal and kinematic gait parameters. A Bertec force plate was synchronized to collect ground force reactions for the calculation of kinetics. Surface electromyography techniques were implemented during gait trials to collect muscle activation patterns. Sessions were held twice weekly at a community pool for 45 minutes. RESULTS: Anecdotally, all participants expressed enjoyment with the aquatic programme. One participant was removed from the programme due to adverse effects of unresolved cause. For the remaining two participants, spatiotemporal measures revealed no difference in one participant's pre and post therapy measures, but an increase in step length and walking speed for the other participant. Improvements were observed in the timed up and go, 6 minute walk test, and Berg's balance test, while the GMFM was maintained for one, and decreased slightly for the other. The kinematics of motion in the sagittal plane resulted in an increase in the range of motion at the ankle on the affected side of one participant, while the other participant increased range of motion at the hip of the affected side and both the affected and unaffected knee. DISCUSSION: This study is limited by the presence of only three adult participants, one of which was unable to complete the programme. Generally, both the physiotherapy results and the spatiotemporal results exhibited an increase in function for the two participants who completed the programme. The biomechanical analysis, however, showed very few consistencies in the sagittal plane. This suggests that each individual responded to the therapy differently, even though similar exercises were undertaken. CONCLUSION: While literature suggests that hydrotherapy is an effective treatment for children with CP, these benefits may depend on the individual, especially in the adult population. Although patient satisfaction is a key driver for increasing functional outcome measures, it is important to carefully monitor the participant, and reduce intensity if issues arise. Hydrotherapy appears to increase functional abilities for the participants who were able to complete the programme. However, the biomechanics reveal that the two participants have different methods of compensation to achieve this function. Larger studies are required to better assess the effectiveness of hydrotherapy on adults.