THE EFFECT OF BODY WEIGHT SUPPORTED TREADMILL TRAINING ON GAIT FUNCTION IN CHILDREN WITH CEREBRAL PALSY

Purpose/Hypothesis: Research has demonstrated that Body Weight Supported Treadmill Training (BWSTT) is a feasible treatment environment for children with cerebral palsy (CP) and may be beneficial for improving ambulation skills. The purpose of this study was to examine the effects of BWSTT using a systematic progression of treadmill speed and level of body weight support (BWS) on gait function in children with cerebral palsy. The researchers hypothesized that subjects would improve in gait function following intensive BWSTT. Number of Subjects: Six subjects with CP, four with spastic diplegia and two with spastic tetraplegia, ages 7 to 11 years, participated in this study. All subjects were classified as limited community ambulators, four used assistive devices and four used orthotics for walking. Materials/Methods: Subjects were assessed before and after an eight-week control period during which they received only school physical therapy services. Following the control period subjects participated in eight weeks of BWSTT, three times per week. During training, facilitation was provided for weight shift and hip extension. Subjects completed three 10-minute bouts of BWSTT each session. A systematic progression of treadmill speed was used during the intervention, with advancement of speed based on ability to maintain a rhythmic gait pattern for 60 seconds following facilitation for several minutes. Level of BWS began at 30% and was decreased in 5% increments when subjects reached a speed of 0.8 m/s (1.7 mph). Pre- and post-training dependent measures included a computerized gait analysis to determine spatiotemporal parameters, the Normalcy Index, the Energy Expenditure Index, the six-minute walk test, and the Gillette Functional Assessment Questionnaire. Results: All subjects completed 8 weeks of training and progressed in treadmill speed. Four subjects decreased BWS during intervention (5–30%). No significant changes were found in dependent measures during control period, supporting a stable baseline. Paired t test (P < 0.01) revealed no significant group differences between pre-and post-training gait measures. However, some individual subjects did show isolated gains in gait measures following BWSTT. There was high variability between subjects in response to BWSTT. Conclusions: This study demonstrated methodology for progression of BWSTT parameters in children with CP where advancement of treadmill speed and decrease of BWS were controlled by specific, measurable criteria. Due to the small sample and high inter-subject variability, no significant changes in gait measures were evident for this sample. Clinical Relevance: Children in this study tolerated intensive BWSTT and were able to progress in treadmill speed and level of BWS. Effectiveness of BWSTT on the subjects' gait function was variable. Further research is needed to examine this systematic application of BWSTT to determine which children with CP are ideal candidates, in terms of level of severity and age at treatment, and to examine immediate and long-term effects on gait function.