Clinical Bottom Line
“How should I apply this information?”
This study suggests that the use of a treadmill as a modality for postsurgical rehabilitation for children with cerebral palsy is feasible whether that surgery involves bone or soft tissue. In spite of longer immobilization times, children who underwent bone and soft tissue surgery did not differ in outcomes from those with soft tissue surgery alone. However, the treadmill training was only 1 aspect of the overall postsurgical rehabilitation program.
“What should I be mindful about in applying this information?”
The authors accurately indicate a limitation of the study as a lack of control group. All children who participated in the treadmill training were participating in physical therapy before initiating treadmill training and continued this therapy during the 12-week training. Therefore, the study cannot support the value of the treadmill training for the functional improvements of the children in the study or inform us of the unique effect of the treadmill as a component of the effect of the postsurgical physical therapy already underway.
Clinicians use the treadmill as a therapeutic tool for various reasons. This study supports the use of the treadmill as a tool to increase speed and endurance postsurgery without negative effects. A recent study by Kurz et al1 demonstrates the neuroplastic effects of treadmill training in correlation with motor behavior changes. The therapeutic use of the treadmill in that case was directed toward motor learning using varying cues, motivation, and stepping strategies, while walking on the treadmill. Importantly, when deciding to use the treadmill during an episode of care, the goals of therapy should directly relate to activities completed on the device. The treadmill in itself is not the intervention; the application of therapeutic principles, while using the treadmill, embeds value in the intervention. Clinicians and researchers must employ sound clinical rationale and evidence-based principles when designing interventions, and use devices such as the treadmill with those principles in mind. In addition, these children did not report distress or pain, which is always a factor to consider with each individual child, even though the children in this small study had no adverse effects.
Brad Corr, DPT
Regina Harbourne, PT, PhD
University of Nebraska Medical Center
1. Kurz MJ, Wilson TW, Corr B, Volkman KG. Neuromagnetic activity of the somatosensory cortices associated with body weight–supported treadmill training in children with cerebral palsy. J Neurol Phys Ther. 2012;36(4):166–172.