Pediatric Physical Therapy:
Section Information: Abstracts of Platform and Poster Presentations for the 2005 Combined Sections Meeting: Poster Presentations
OTC Pediatrics, Mary Free Bed Hospital & Rehabilitation Center, Grand Rapids, MI, USA (Beard)
Physical Therapy Department, Grand Valley State University, Allendale, MI, USA (Harro)
Motion Analysis Center, Mary Free Bed Hospital & Rehabilitation Center, Grand Rapids, MI, USA (Bothner)
BACKGROUND AND PURPOSE: Previous research provides evidence that Body Weight Support Treadmill Training (BWSTT) improves gait function in individuals with stroke or spinal cord injuries, however applicability and efficacy of BWSTT in children with cerebral palsy (CP) is lacking. The purpose of these case reports were to examine the effect of BWSTT, using systematic progression of treadmill speed and level of body weight support, on gait function in children with CP.
CASE DESCRIPTION: Two subjects, both 13 year old males with tetraplegic cerebral palsy, participated in 30 minutes of BWSTT, three times a week for nine weeks. Subject one ambulated using a reverse wheeled walker, but used his wheelchair as his primary means of mobility prior to this study. Subject two ambulated using a Rifton gait trainer for therapy and used his power wheelchair as his primary means of mobility. Within each training session, subjects completed three ten-minute BWSTT trails. Treadmill speed was started at child’s overground walking speed with 30% BWS. A systematic progression of treadmill speed was based on the subject’s ability to maintain a rhythmic gait pattern for 60 seconds following facilitation given by the primary researcher for weight shift and hip extension for several minutes. Pre- and post-intervention measures included a computerized gait analysis to determine spatiotemporal parameters and the Normalcy Index, using the Vicon 512 motion capture system. Additionally, the following tests of walking function were administered: the Energy Expenditure Index (EEI), the six-minute walk test, and the Gillette Functional Assessment Questionnaire (FAQ). During this study neither subject received any physical therapy services other than school-based therapy weekly.
OUTCOMES: Subject one demonstrated increased cadence, a 55.6% increase in overground walking speed (53.1 cm/s to 82.6 cm/sec), and increased walking endurance, as evidenced by a 48.2 ft. increase in the 6-minute walk test. Subject two also demonstrated gains in walking endurance with a 60.9 ft. increase in 6-minute walk test. No measurable changes were noted in NI. Changes in functional walking level (FAQ) were also reported for both subjects.
DISCUSSION: These two case reports provide support that BWSTT has the potential to improve gait function in children with CP. Improvements in these two subjects included improved walking speed, cadence and endurance. These are the first case studies in which advancement of treadmill speed was controlled by specific, measurable criteria and type of facilitation was operationally defined. Potential applicability and treatment parameters of BWSTT need to be carefully considered for use by clinicians who treat children with CP. These case studies demonstrated beneficial effects of BWSTT in two children with CP. Further research is needed examine treatment parameters and the long-term effects of BWSTT on gait function in children with CP.