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Exercise in Pediatric Medicine

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Front. Public Health | doi: 10.3389/fpubh.2019.00137

A Six Week Therapeutic Ballet Intervention Improved Gait and Inhibitory Control in Children with Cerebral Palsy – A Pilot Study

 Kimberley D. Lakes1*,  Kelli Sharp1,  Marybeth Grant-Beuttler2,  Ross Neville3,  Fadia Haddad1,  Rachel Sunico1, Daniel Ho1,  Melinda Schneider1, Sofia Sawitz2, Janine Paulsen2, Kim Caputo2, Kim Lu1, Afshin Aminian4,  Citlali Lopez-Ortiz5 and  Shlomit Radom-Aizik1
  • 1University of California, Irvine, United States
  • 2Chapman University, United States
  • 3University College Dublin, Ireland
  • 4Children's Hospital of Orange County, United States
  • 5University of Illinois at Urbana-Champaign, United States

Children with cerebral palsy (CP) have motor impairments that make it challenging for them to participate in standard physical activity (PA) interventions. There is a need to evaluate adapted PA interventions for this population. Dance can promote coordination, posture, muscle strength, motor learning, and executive functioning. This pilot study evaluated the feasibility and the effects of a new therapeutic ballet intervention specifically designed for children with CP on physiological and executive functions outcomes. 8 children with CP (9-14y/o; 75% female) participated in a six-week therapeutic ballet intervention. Outcomes were measured in multiple domains, including body composition (DXA), muscle strength (hand-grip dynamometer), habitual physical activity, gait and selective motor control functions, and executive functioning. Follow-up assessments of habitual physical activity, gait and executive functioning were completed four to five weeks post-intervention. Five out of the eight participants were overfat or obese based on DXA percentage of body fat. All participants were below the 50th percentile for their age and gender for bone density. Four participants showed a trend to improve hand-grip strength in one hand only, while one improved in both hands. There were significant improvements in gait across time points (pre, post, and follow-up), specifically in time of ambulation (X ̅pre = 4.36, X ̅post = 4.22, X ̅follow-up = 3.72, d = 0.056, p = 0.02), and in step length (cm) on the right:X ̅pre = 48.29, X ̅post = 50.77, X ̅follow-up = 52.11, d = 0.22, p = 0.027, and left stride; X ̅pre = 96.29, X ̅post =102.20, X ̅follow-up =104.20, d=0.30, p = 0.027, indicating gait changes in bilateral lower extremities. There was improvement in inhibitory control (d = 0.78; 95% Confidence Limit = ±0.71, p < .05) with large individual responses primarily among those above the mean at baseline.
Therapeutic ballet may prove to be a useful intervention to promote physiological and cognitive functions in children with CP. Results demonstrated feasibility of the physical, physiological, and cognitive assessments and suggested improvements in participants’ gait and inhibitory control with large individual responses. Modifications to personalize the intervention may be needed to to optimize positive outcomes.

Keywords: pediatric, rehabilitation, dance, exercise-medicine, executive functions , dance - study and teaching, Exercise medicine, Executive Function, executive functions (EF), music and movement, Arts, physical activity, Cerebral Palsy

Received: 02 Aug 2018; Accepted: 13 May 2019.

Edited by:

Tim Takken, University Medical Center Utrecht, Netherlands

Reviewed by:

Figen Cavusoglu, Faculty of Health Sciences, Ondokuz Mayıs University, Turkey
Shahanawaz Syed, Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Saudi Arabia  

Copyright: © 2019 Lakes, Sharp, Grant-Beuttler, Neville, Haddad, Sunico, Ho, Schneider, Sawitz, Paulsen, Caputo, Lu, Aminian, Lopez-Ortiz and Radom-Aizik. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Kimberley D. Lakes, University of California, Irvine, Irvine, United States,