the effects of core strengthening on the gait pattern of ...exercises performed by the case patient...
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The Effects of Core Strengthening on the Gait Pattern of an Obese
Middle School Child Joanne Mikaiel,,SPT, NSCA-CPT; Ellen Donald, MS, PT; Stephen Black, DSc, PT, ATC, CSCS
College of Health Professions, Florida Gulf Coast University, Ft Myers, FL
Exercises Performed by the Case Patient
REFERENCES The purpose of this case study is to observe the effects
of a core strengthening program on the gait pattern of
an obese thirteen year old female.
This case report details the use of a core
strengthening program on an obese middle school
child with impaired gait mechanics,. Research has
established that obese children ambulate with a
slower walking velocity, longer double leg stance,
wider stance width, and a greater degree of
asymmetry. The child was referred to physical
therapy with an acute low back sprain, treatment was
focus toward improving the low back sprain and gait
abnormality via a core strengthening program. This
case provides an example of how providing a core
strengthening program to an obese child in middle
school can help improve the impaired gait mechanics
found in obese children.
Colne, P., Frelut, M. L., Peres, G., & Thoumie, P. (2008). Postural control in obese adolescents assessed by limits of stability and gait initiation. Gait & Posture, 28(1), 164-169.
D Hondt, E., Deforche, B., De Bourdeaudhuij, I., & Lenoir, M. (2009). Relationship between motor skill and body mass index in 5- to 10-year-old children. Adapted Physical Activity Quarterly : APAQ, 26(1), 21-37.
Dufek, J. S., Currie, R. L., Gouws, P. L., Candela, L., Gutierrez, A. P., Mercer, J. A., et al. (2011). Effects of overweight and obesity on walking characteristics in adolescents. Human Movement Science,
Epstein, L. H., Paluch, R. A., & Raynor, H. A. (2001). Sex differences in obese children and siblings in family-based obesity treatment. Obesity Research, 9(12), 746-753.
McEwen, J. (2006). Obesity: the prevention, identification,. England: Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0041751/pdf/TOC.pdf
McGill, S.M. Low back stability: from formal description to issues for performance and rehabilitation. Exerc. Sport Sci. Rev. 2001.
Olds, T. S., Ferrar, K. E., Schranz, N. K., & Maher, C. A. (2011). Obese adolescents are less active than their normal-weight peers, but wherein lies the difference? The Journal of Adolescent Health : Official Publication of
the Society for Adolescent Medicine, 48(2), 189-195.
Portney, L. G., & Watkins, M. P. (2009). Foundations of clinical research applications to practice. (3 ed., pp. 235-262). Upper Saddle River: Pearson.
Vander Wal, J. S., & Mitchell, E. R. (2011). Psychological complications of pediatric obesity. Pediatric Clinics of North America, 58(6), 1393-1401.
World health organization (WHO). (2011, December 13). Retrieved from http://www.who.int/en/
Wrotniak, B. H., Epstein, L. H., Dorn, J. M., Jones, K. E., & Kondilis, V. A. (2006). The relationship between motor proficiency and physical activity in children. Pediatrics, 118(6), e1758-65.
Background
Abstract
• 13-year-old obese female with a BMI of 30.7
• The patient sustained a low back sprain while assisting her family move.
• The patient referred to physical therapy to strengthen her core stabilizers to
decrease her current low back pain and to prevent a reoccurrence of low back
pain.
• Patient presented with decreased core and hip girdle stabilization strength,
decreased muscle length, decreased balance, impaired gait, impaired posture, and
increased pain.
• Pt required physical therapy 2x/wk for 8 weeks to return patient to prior level
of function.
Case Patient Description
• During the eight week core strengthening program the
case patient demonstrated significant improvement in:
• Single leg stance time
• Core strength
• Bilateral lower extremity strength
• Gait parameters
• Hamstring and gastroc flexibility.
• After the core strengthening program patient gait pattern
demonstrated: increased stability of the trunk, increased
stride length, and increased cadence.
• The patient demonstrated these improvements despite her
weight remaining unchanged.
• This case study suggests that a core strengthening
program should be performed when a goal for therapy
includes improve the gait mechanics of an obese child.
• In the future, the body composition and the child’s self
efficacy in physical activity should be measured.
Conclusion
Purpose
• Obesity is currently the most common disease in
adolescence
• 16.9% of adolescents are considered obese
• Children who are obese are less likely than
normal weight children to participate in physical
activities
• Children who are obese require a higher energy
cost, as compared to normal weight and overweight
children
• The most fundamental and challenging motor
skill that a child develops is ambulation
• Ambulation is an important skill to master
because it is the prerequisite to all of the motor skills
required for physical activity.
• It is believed that if physical therapists make
physical activity enjoyable to children who are obese,
the children will be more inclined continuing their
participation in physical activities
Results Evaluation Discharge
Single Leg Stance R= 3 secs, L= 4 secs. B trendelenburg
and instability R= 35 secs, L= 34 secs with minimal
sway Gait antalgic, increased BOS, Lateral shifting
B, decreased stride length, B hip hike,
ER hips B, decreased heel strike and
push off
increased BOS, ER hips B, increased
cadence, decreased heel strike and
push off
Posture forward flexed trunk, hips in slight ER,
increased lumbar lordosis, B pas planas hips in slight ER, increased lumbar
lordosis, B pas planas
BLE Strength R: hip flexion: 4-/5, hip extension:
2+/5, hip abd: 3-/5, knee flexion: 4/5,
knee extension: 4+/5, dorsiflexion: 4-/5,
plantar flexion: 2+/5 L: hip flexion: 3+/5, hip extension:
2+/5, hip abd: 3/5, knee flexion: 4/5,
knee extension: 4/5, dorsiflexion: 3+/5,
plantar flexion: 2+/5
R: hip flexion: 4/5, hip extension:
3/5, hip abd: 3/5, knee flexion: 5/5,
knee extension: 5/5, dorsiflexion:
4+/5, plantar flexion: 4/5 L: hip flexion: 4/5, hip extension:
3/5, hip abd: 3/5, knee flexion: 5/5,
knee extension: 5/5, dorsiflexion:
4+/5, plantar flexion: 4/5
flexibility: (Hamstrings at
90 deg of hip flex)
R: 76 deg, L: 80 deg Gastroc R: -5 R, L:-2
R: 86 deg, L: 85 deg Gastroc R: 5 R, L:2
Prone plank test 6 secs before she lost the correct posture * Plank assessed on 3rd visit. Plank
was not evaluated on first visit due to
acuity of pain
Plank test: 20 secs before she lost the
correct posture
:
Balance Strengthening Core Stabilization
This table demonstrates a few of the exercises performed by the case patient during
her core strengthening program.