Pediatric Physical Therapy:
Section Information: Abstracts of Poster and Platform Presentations for the 2004 Combined Sections Meeting: Platform Presentations
W.A. Stuberg, S.L. DeJong, K.L. Spady, Physical Therapy, Munroe-Meyer Institute, Omaha, NE, G.M. Ginsburg, Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, NE, J.A. Stoner, Preventative and Societal Medicine, University of Nebraska Medical Center, Omaha, NE.
PURPOSE/HYPOTHESIS: This study evaluated a treadmill training program with partial body weight support (PBWS) to improve gait in children with developmental disabilities.
NUMBER OF SUBJECTS: Nineteen children (8, 11) were included, age 4 to 17 years (9.6 4.3). Diagnoses included cerebral palsy (17), congenital myotonia (1), and Angelman s syndrome (1). All subjects showed gait deviations and impaired walking performance. Eleven walked with walkers, 2 with forearm crutches, 6 with no device. Sixteen wore orthoses. Five were classified as Level 2 on the Gross Motor Function Classification System, 8 as Level 3 and 6 as Level 4.
MATERIALS/METHODS: Subjects walked on a treadmill for 20 minutes two times-per-week (Group1) or three times-per-week (Group 2) for 12 weeks, with PBWS of 40% of body weight initially, decreased by 5% every two weeks. Speed was increased as tolerated, not exceeding 75% of maximum predicted heart rate. Physical assistance was provided only if necessary to elicit stepping. Pre, post, and follow up tests included lower extremity range of motion (ROM) and strength, Gross Motor Function Measure GMFM) sections D and E, the Supported Walker Ambulation Performance Scale (SWAPS) and the Physician Rating Scale (PRS). Computerized 3D gait analysis was completed during over ground walking, before and after the training. For selected variables, repeated measures ANOVA was used to compare mean outcome measures across time and between treatment groups, age groups (10 yrs vs 10yrs) and genders. Interactions were analyzed. Tukey post-hoc comparisons were used.
RESULTS: Pre vs post training comparisons revealed significant increases in walking velocity (54.5 cm/sec pre vs 64.2 post, P < 0.001), step length, cadence, GMFM score, SWAPS score, and extensor strength at the hips and knees. No significant changes occurred in ROM (hip and knee extension, ankle dorsiflexion), ankle plantarflexion strength, or PRS score. Knee flexion during mid and terminal stance phase did not change significantly. Improvements in GMFM and strength were maintained at follow up. Temporal-distance measures were not repeated at follow up.
CONCLUSIONS: Improvements in temporal-distance gait parameters, strength and functional ability were seen after 12 weeks of treadmill training with PBWS. No changes were evident in kinematic parameters or ROM.
CLINICAL RELEVANCE: This study demonstrated an effective protocol for PBWS treadmill training for children with developmental disabilities.