Advisor(s)

Gordon Fisher
Harshvardhan Singh

Committee Member(s)

Byron Lai
Christopher Hurt
Christopher Modlesky

Document Type

Dissertation

Date of Award

6-18-2026

Degree Name

Doctor of Philosophy (PhD)

School

School of Health Professions

Department

Physical Therapy

Abstract

Cerebral Palsy (CP) and Spina Bifida (SB) are among the most prevalent pediatric neuromotor impairments, posing significant challenges to independent mobility and dynamic balance. Although arising from different neurological origins, CP from non-progressive brain disruptions during development and SB from lower motor neuron lesions in the neural tube, both the conditions often lead to similar functional limitations, including muscle weakness, impaired gait and limited mobility. Affected children typically exhibit compromised postural control and an increased dependence on assistive devices. Over time, this decline in independent physical activity often triggers secondary health issues, such as early onset of osteoporosis, hypertension, and obesity. These secondary issues create a deleterious feedback loop, leading to a gradual loss of independent mobility and a progressive decline in overall physical functioning. While early childhood interventions to promote muscle strength and postural balance are well-documented, there is a critical knowledge gap concerning adolescents with CP and SB. Adolescence period is vital, as neuromotor difficulties often exacerbate, leading nearly 25% of independently ambulatory adolescents with CP or SB to lose their walking status between the ages 19 to 21 years. Furthermore, existing rehabilitation programs frequently rely on expensive, high-end technology including exercise equipment that limits community accessibility. Consequently, there is an urgent need for affordable, low-cost technology, and machine-free exercise interventions that are both feasible and safe for independent use. Such rehabilitation programs have potential for better implementation and thus targeting population health in individuals with CP and SB. Thus, we have designed Functionally Loaded High-Intensity Circuit Training (FUNHIT) which integrates the principles of High-Intensity Training (HIT) and Progressive Resistance Training (PRT). This approach, without the need for specialized machinery, specifically emphasizes maintaining center-of-mass control over a moving base of support, which is a critical factor for improving dynamic balance and independent mobility. Thus, the primary objectives of my dissertation are to conduct a systematic review identifying current evidence-based interventions for adolescents with cerebral palsy, to evaluate the feasibility and effectiveness of a novel training program known as FUNHIT, and probe neuromotor mechanisms of FUNHIT in adolescents with CP and SB. The results of my research, presented across three distinct chapters describe the (i) prevailing knowledge on effectiveness of various interventions promoting dynamic balance in adolescents with CP, (ii) provide preliminary evidence regarding the feasibility and positive response of FUNHIT on enhancing muscle strength, independent mobility, and dynamic balance, and (iii) inform the preliminary results on neuromotor control as the mechanism through which the positive response of FUNHIT may be understood. By demonstrating the feasibility and preliminary positive response of FUNHIT in improving independent mobility and dynamic balance, my study establishes an important foundation for future research to design larger studies to determine efficacy and effectiveness of FUNHIT for improving physical activity in adolescents with CP/SB. Ultimately, my work supports the development of accessible, low-cost technology exercise interventions that can be implemented in community settings, helping individuals with movement disorders transition more smoothly into adulthood via maintenance and enhancement of independent physical activity.

Keywords

Balance;Cerebral palsy;Exercise;Movement disorder;Rehabilitation;Spina bifida

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