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Strength, function and gait changes following a supported speed treadmill training exercise program (SSTTEP) for marginally ambulatory children with cerebral palsy: a preliminary report

TE JOHNSTON PT PHD MBA 1, 2, KE WATSON PT DPT 2,
J ENGSBERG PT PHD 4, S A ROSS PT DPT 5, PE GATES MD 3,
CA TUCKER PT PHD 6, RR BETZ MD 2

1. University of the Science in Philadelphia, Philadelphia, PA, USA;
2. Shriners Hospitals for Children, Philadelphia, PA, USA
3. Shriners Hospitals for Children, Shreveport, LA, USA;
4. Washington University, St. Louis, MO, USA;
5. Maryville University, St.Louis, MO, USA;
6. Temple University, Philadelphia, PA, USA

Background/Objectives: While several studies have demonstrated that body weight supported treadmill training can improve strength, function, and gait in adults with disabilities, no randomized control studies exist that investigate its effects for children with cerebral palsy (CP). Scientific evidence is needed to support and guide its use as a rehabilitation intervention to improve ambulation in children with CP. The purpose of this study was to investigate the effects of a supported speed treadmill training exercise program (SSTTEP) versus an exercise program on strength, function and gait spatiotemporal parameters for marginally ambulatory children with cerebral palsy.

Design: Randomized controlled trial.

Participants and Setting: Sixteen children, ages 6 to 13 years, were randomized to the treatment [treadmill ™, n=9] or control group [exercise (EX), n=7] across three clinical sites. Children had spastic diplegic or quadriplegic CP, and were classified as levels II, III, or IV on the Gross Motor Function Classification System.

Materials/Methods: The intervention lasted 12 weeks. The first phase, an intense, clinic-based induction, was 2 weeks, with two 30 minute sessions, twice daily, 5 days/week. Goals were to establish each child’s program and parent education. The second phase was a 10 week home program (30 minutes, once/day, 5 days/week). TM training goals were to decrease body weight support to 30% and then increase walking speed to age/height appropriate values. The EX group participated in functional strengthening exercises. Data collected pre/post intervention included isokinetic strength of the thigh and shank muscles, the Pediatric Outcomes Data Collection Instrument (PODCI), and gait spatiotemporal parameters.

Results: Children in the TM group showed a trend (p>.05) toward strength improvements in the hamstrings (14.3%) and plantarflexor (38.4%) muscles, but declines in the quadriceps (12.8%) and dorsiflexor (36.3%) muscles. Children in the EX group showed a trend (p>.05) toward strength improvements in the quadriceps (37.2%), hamstring (35.7%) and plantarflexor (55.3%) muscles, but declines in the dorsiflexor muscles (2.3%). In the PODCI transfers and mobility section, the TM group showed trends (p>.05) for improvements (9.8%), while the EX group showed a decline (3.3%). Finally, both groups showed improvements in gait speed (TM 25.8%, EX 39.1%, p=.003), stride length (TM 12.3%, EX 19.5%, p=.007), and cadence (TM 25.8%, EX 39.1%, p=.025). Of note, at baseline, the EX group had a slower mean overground gait speed (0.23m/s) than the TM group (0.50 m/s), but had similar post-intervention increases (TM 0.13m/s, EX 0.11 m/s).

Conclusions/Significance: Preliminary results indicate trends for improvement in strength and gait spatiotemporal parameters for both groups and in function for the TM group. Due to the small sample size, the data contain high variability and additional subjects are being enrolled.

 
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