Feasibility of foot and ankle strength training in paediatric CMT

[Guest guest]

(Oral presentation at Antwerp Consortium July 2009)

Feasibility of foot and ankle strength training in paediatric CMT.

J. Burns1,J. 2 and R. Ouvrier1

Discipline of Paediatrics and Child Health, Faculty of Medicine, Ihe University

of Sydney! Institute for Neuromuscular Research, Ihe Children's Hospital at

Westmead, Sydney, NSW, Australia, 'Discipline of Exercise and Sport Science,

Exercise, Health and Performance Research Group, The University of Sydney, NSW,

Australia

Weakness of ankle dorsiflexion is the cardinal manifestation of

Charcot-Marie-Tooth disease (CMT) and contributes to foot deformity, ankle

contracture, poor motor function and walking difficulty in affected patients.

Strength training is a commonly used intervention for reversing muscle weakness

and atrophy in a range of patient populations and has also been shown to be

effective for improving capacity to undertake functional tasks.. To determine

the safety and

efficacy of a dorsiflexion strengthening program, a 15 year old girl with a

hereditary autosomal recessive axonal form of CMT, volunteered to participate in

a 12-week, homebased, high intensity progressive resistance training proglam,

completed on 3 nonconsecutive

days each week.

The patient performed ankle dorsiflexion exercises while sitting

on the edge of a table, with the hip and knee flexed and the lower leg hanging

freely so that the foot was not in contact with the floor. Adjustable ankle

weights contained in a neoprene

sleeve were attached with velcro around the midfoot. Training load was based on

a dose escalating percentage of one-repetition maximum.

Outcomes included foot strength, ankle flexibility, motor function, walking

ability, compliance and adverse events. At 12-weeks,

dorsiflexion strength improved 56-72% and plantarflexion str·ength by 15-20%

Inversion also improved, while eversion did not Of the motor function measures,

standing long jump (power) increased by 17%, while balance and endurance did

not. Walking ability improved

for speed, cadence, step time, step and stlide length. Compliance with therapy

was high, there were no adverse events or muscle complaints, and the patient

felt it 'really made a difference'.

The results suggest that progressive resisted exercise may improve strength of

affected foot muscles in CMT. It's now worth investigating safety and efficacy

of progressive resistance training in a larger sample of people with CMT of

different types and ages.