“How could I apply this information?”
In our current medical model of episodes of care and medical acuity, understanding the most optimal age and effective approach for the promotion of bone health and development in children with cerebral palsy (CP) is critical. The studies examined in this review suggest that the clinician should incorporate a multimodal approach using multiple muscle groups to improve bone health. Given that the effect of these interventions on bone density is greatest in prepubescent children, it is particularly critical that the clinician consider principles to enhance bone density in these younger children. This review highlighted the need to consider dosing of interventions specifically high ground reaction forces, high frequency, and long duration to achieve gains in bone density. Consideration of the mechanostat theory and principles by physical therapists can have a lasting and meaningful effect on individuals with CP as they age.
“What should I be mindful about when applying this information?”
This review identified limited evidence, small treatment effects, and a need for high-frequency intervention. While the reviewed articles support the efficacy of weight-bearing activities, articles that included activities that provide mechanical stress to bones without full weight-bearing were not reviewed. For children with GMFCS (Gross Motor Function Classification System) grades IV and V, these activities are more common and reproducible in clinical practice. Given that high frequency of therapy visits is not always possible due to financial and programmatic limitations, the inclusion of home program participation and appropriate community-based activity to increase frequency of exercise should be considered. Researchers should consider these small effects, the mechanostat theory and principles, and activities without full weight-bearing in designing future studies on the effect of exercise programs and activities on bone in individuals with CP.
Andrea Fergus, PT, PhD
Division of Physical Therapy
Jodi Burgett, PT, DPT
Board Certified Specialist in Pediatrics
Cook Children's Medical Center
Fort Worth, Texas