Background and Purpose: The efficacy of two commonly used options for gait training for children with Cerebral Palsy (CP), over-ground gait training and body-weight support treadmill training (BWSTT), have been characterized in the literature. However, there has been limited research into the effectiveness of another promising option, underwater treadmill training (UWTT), in children with CP. The purpose of this case study was to utilize single-subject experiment design (SSED) to assess the effects of BWSTT and UWTT on functional mobility and gross motor ability in an ambulatory child with CP.
Case Description: One participant, a 4-year old female diagnosed with spastic diplegic cerebral palsy GFMCS III was recruited from a hospital-based outpatient pediatric physical therapy clinic in St. Paul, MN. The patient was identified as a child with emerging ability to ambulate, as per parent and primary physical therapist report. The patient participated in a 9-week intervention period including baseline assessment followed by 3 phases of intervention including 1) 3-weeks of BWSTT, 2) 3-weeks of UWTT, and 3) 3-weeks of BWSTT. The patient received physical therapy treatment 2-3 times/week for a total of 8 45-minute sessions of gait training during each intervention phase.
Outcomes: The patient participated in a baseline assessment including the following measures: gait speed via 10-Meter Walk Test (10MWT), gross motor skills via the Gross Motor Function Measure-66 Basal & Ceiling (GMFM B&C), endurance via the 6-Minute Walk Test (6MWT), functional mobility and participation via the Pediatric Evaluation of Disability Index-Computer Adaptive Test (PEDI-CAT), and quality of life and participation via the Pediatric Outcomes Data Collection Instrument (PODCI). The primary outcome of this study was gait speed, as measured by the 10MWT. The primary outcome was assessed during a baseline phase and during each visit as a repeated measure for trend analysis as part of SSED. The secondary measures—GMFM B&C, 6MWT, PEDI-CAT, and PODCI—were assessed at baseline and every 3 weeks, following each phase of intervention. Following intervention, the patient had significant improvement in gait speed. While the patient had a higher average rate of increase in gait speed during the UWTT phase of intervention, there was no statistically significant difference in gait speed between the UWTT phase and BWSTT phases of intervention. There was no statistically significant difference in the secondary measures.
Discussion: Gait speed was statistically improved during the intervention phases of the case study. There was no statistical difference between gait speed in the UWTT and BWSTT phases of intervention. Thus, as BWSTT has been documented in research as an effective intervention method to improve walking in children with CP, this may indicate that UWTT is also an effective intervention in this population.