Pediatric Physical Therapy:
Section Information: Abstracts of Platform and Poster Presentations for the 2005 Combined Sections Meeting: Poster Presentations
Motion Analysis Lab and Dept. of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
PURPOSE/HYPOTHESIS: This study evaluated the effects of a treadmill training program with partial body weight support (PBWS) to improve walking endurance in children with cerebral palsy (CP).
NUMBER OF SUBJECTS: This study included six children (4 males, 2 females) with a mean age of 10.2 (sd 4.3) years. Diagnoses included spastic diplegia (4), spastic hemiplegia (1) and athetoid quadriplegia (1). All subjects could walk at the start of the study, two with walkers, two with forearm crutches and two with no device. Four wore orthoses. Four were classified as Level 3 on the Gross Motor Function Classification System, one as Level 2, and one as Level 1.
MATERIALS/METHODS: Subjects walked on a treadmill using a Biodex Unweighing System for 20 minutes, three times per week for 12 weeks. PBWS of 40% of body weight was provided initially and weaned to 15% by the end of the study. Each session included a three minute warm-up and a 17 minute training phase. Speed was increased each minute, as tolerated. No physical assistance was provided. Heart rate (HR) was monitored continuously. Average HR during the training phase was calculated for each session. During the second week of training and during the last week, a graded treadmill exercise testing protocol was used to assess endurance. Computerized 3D gait analysis was also completed during over-ground walking, before and after the training. Outcome variables included over-ground walking speed, mean walking speed on the treadmill, and energy expenditure index [EEI = (HR walking-HR rest)/walking speed in m/min].
RESULTS: The subjects completed an average of 33.5 (sd 1.2) sessions over a period of 83 (sd 12.5) days. Average HR during the training phase ranged from 65% to 82% of estimated maximum HR (220 minus age in years). Pre vs post training comparisons revealed significant increases in over-ground walking velocity (41.8 (sd 20.6) m/min pre vs 45.9 (sd 19.1) m/min post, t = -2.14, P < 0.05). Mean treadmill walking speed increased significantly from a mean of 31.9 (sd 10.4) m/min during the second week of training to 43.8 (sd 12.9) m/min during the final week of training (t = 12.93, P < 0.02). The change in mean EEI scores was not significant with pre EEI of 1.91 (sd 0.92) beats/m vs post EEI score of 1.86 (sd 0.89) beats/m (t = 0.34, P = 0.38). Improvement in EEI scores was seen in four of the six children.
CONCLUSIONS: This study demonstrated an effective protocol using PBWS treadmill training to increase walking speed and endurance in children with CP. Although no significant change in EEI scores was noted, the sample size was small with a low level of power (P = 0.95).
CLINICAL RELEVANCE: Treadmill training with PWBS was found to be an effective intervention to improve cardiovascular endurance and walking speed in a cohort of children with CP. This gait training method provides a safe and controlled environment for children to perform continuous walking at a cardiovascular training intensity to improve their gait and fitness.