Abstract
In recent years, orthopedic clinicians and researchers have reconsidered their approaches to delivering therapy to children with movement disorders such as cerebral palsy (CP). Research shows increasing both intensity and frequency of activities have helped patients surmount physical obstacles or move past functional plateaus. Climbing is a proposed activity that could address issues which children with CP commonly have: muscle weakness, muscle tightness, spasticity, and coordination. The purpose of this thesis was to study the kinematics and dynamics of rock climbing in CP and typically developed (TD) child populations and identify specific strength and stretch benefits of climbing. A custom 18-ft climbing wall instrumented with force sensors was constructed, and the climbing gait of three climbers with CP and five TD climbers was recorded via motion capture as they completed a variety of vertical and lateral climbing steps. Subjects with CP continued climbing weekly for a month, then repeated motion capture. To analyze this data, subject-specific biomechanical models were created using LifeMOD/MSC.Adams and OpenSim software.
Initial climbing sessions revealed the TD population was more adept at body weight support and muscle force generation on the climbing wall; however, the CP population improved with climb training by producing greater lower limb force. The TD population also had larger lower limb joint range of motion (ROM), although similar or greater normalized muscle-fiber lengths were observed for the CP population, suggesting climbers with CP can get the same stretch from climbing as their TD peers. Compared to walking results, ankle dorsiflexion, knee flexion, and hip abduction ROM and corresponding normalized muscle-fiber lengths were significantly more extensive. Functional benefits were compared before and after climbing with minor improvements in crouch gait, even with relatively low climb frequency.
As a therapy, climbing addresses the whole body and multiple CP issues at once, and it has the advantage of appealing to children and parents as a positive, fun experience. These results should justify further investigation into the benefits of climbing and encourage clinicians to incorporate climbing into patient treatment plans.
