Mattern-Baxter K1, Looper J2, Bjornson K3
1California State University, Physical Therapy, Sacramento, United States, 2University of the Puget Sound, Physical Therapy, Tacoma, United States, 3Seattle Children's Research Institute, University of Washington, Pediatrics, Seattle, United States
Background: Home-based treadmill training (TT) on small treadmills can be successfully carried out by parents of children with cerebral palsy (CP). In small studies, intensive TT has been shown to accelerate walking acquisition in pre-ambulatory children with various types of CP compared to no TT. However, the optimal dosing of home-based TT protocols remains unknown.
Purpose: The purpose of this study was to determine optimal parameters for dosing home-based TT by comparing the effects of a low-intensity (LI) to a high-intensity (HI) protocol on walking skills and walking performance in children with spastic diplegic CP.
Methods: 19 pre-ambulatory toddlers with spastic diplegic CP, Gross Motor Function Classification System (GMFCS) Level I and II, ages 14-32 months (male n=8) were randomly assigned to LI and HI groups at 3 geographical sites. The LI group received TT 2 days/week, once/day for 10-20 minutes for 6 weeks and the HI group received TT 5 days/week, twice/day for 10-20 min for 6 weeks in their homes. Children were assessed at study onset, post intervention, and 1 and 4 months post intervention. The Gross Motor Function Measure Dimension D/ E (GMFM-D/E), average strides/day and percentage of time spent walking were primary outcome measures. The Peabody Developmental Motor Scales-2 (PDMS-2), Pediatric Evaluation of Disability Index Mobility Scale (PEDI), 10-meter and 1-minute walk test, and Functional Mobility Scale were used as secondary outcome measures. GMFM-D/E and PDMS-2 were scored via blinded assessor from videotapes. Linear mixed effects regression models were applied to all outcomes. The main hypothesis was addressed by testing the time-by-group interaction using likelihood ratio tests.
Results: No significant between-group differences were found in any outcome measure at the different time points, except for the PEDI at the 4-month follow-up favoring the HI group (p=0.01). Children in both the LI and HI group made significant within-group improvements at each assessment with p-values ranging from 0.00 to 0.01, but strides/day and walking activity did not reach significance until the 4-month follow-up. Children in the HI group did not show significant improvement immediately following the intervention in GMFM-E regardless of GMFCS level, while children in the LI group did.
Conclusion(s): A twice-weekly home-based TT program showed similar outcomes compared to a 10x/week TT program in pre-ambulatory children with spastic diplegic CP in GMFCS level I/II. Children in both groups made significant improvements at each time point. Children in the HI group had less skill attainment for walking outcomes compared to children in the LI group immediately following the intervention.
Implications: TT is an effective intervention for children with spastic diplegic CP who are not yet ambulatory. A twice-weekly dosage was equally effective in improving skills related to walking compared to a high-dosage protocol and can be more readily implemented into clinical practice. Larger studies are needed to confirm these results.
Keywords: treadmill training, cerebral palsy, walking activity
Funding acknowledgements: Thrasher Research Fund
Purpose: The purpose of this study was to determine optimal parameters for dosing home-based TT by comparing the effects of a low-intensity (LI) to a high-intensity (HI) protocol on walking skills and walking performance in children with spastic diplegic CP.
Methods: 19 pre-ambulatory toddlers with spastic diplegic CP, Gross Motor Function Classification System (GMFCS) Level I and II, ages 14-32 months (male n=8) were randomly assigned to LI and HI groups at 3 geographical sites. The LI group received TT 2 days/week, once/day for 10-20 minutes for 6 weeks and the HI group received TT 5 days/week, twice/day for 10-20 min for 6 weeks in their homes. Children were assessed at study onset, post intervention, and 1 and 4 months post intervention. The Gross Motor Function Measure Dimension D/ E (GMFM-D/E), average strides/day and percentage of time spent walking were primary outcome measures. The Peabody Developmental Motor Scales-2 (PDMS-2), Pediatric Evaluation of Disability Index Mobility Scale (PEDI), 10-meter and 1-minute walk test, and Functional Mobility Scale were used as secondary outcome measures. GMFM-D/E and PDMS-2 were scored via blinded assessor from videotapes. Linear mixed effects regression models were applied to all outcomes. The main hypothesis was addressed by testing the time-by-group interaction using likelihood ratio tests.
Results: No significant between-group differences were found in any outcome measure at the different time points, except for the PEDI at the 4-month follow-up favoring the HI group (p=0.01). Children in both the LI and HI group made significant within-group improvements at each assessment with p-values ranging from 0.00 to 0.01, but strides/day and walking activity did not reach significance until the 4-month follow-up. Children in the HI group did not show significant improvement immediately following the intervention in GMFM-E regardless of GMFCS level, while children in the LI group did.
Conclusion(s): A twice-weekly home-based TT program showed similar outcomes compared to a 10x/week TT program in pre-ambulatory children with spastic diplegic CP in GMFCS level I/II. Children in both groups made significant improvements at each time point. Children in the HI group had less skill attainment for walking outcomes compared to children in the LI group immediately following the intervention.
Implications: TT is an effective intervention for children with spastic diplegic CP who are not yet ambulatory. A twice-weekly dosage was equally effective in improving skills related to walking compared to a high-dosage protocol and can be more readily implemented into clinical practice. Larger studies are needed to confirm these results.
Keywords: treadmill training, cerebral palsy, walking activity
Funding acknowledgements: Thrasher Research Fund
Topic: Paediatrics: cerebral palsy; Disability & rehabilitation
Ethics approval required: Yes
Institution: California State University, Sacramento
Ethics committee: Institutional Review Board
Ethics number: 13-14-156
All authors, affiliations and abstracts have been published as submitted.
