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Begnoche, D; Sanders, E; Pitetti, K H.

Pediatric Physical Therapy: April 2005 - Volume 17 - Issue 1 - p 73
doi: 10.1097/01.PEP.0000155630.54603.B6
Section Information: Abstracts of Platform and Poster Presentations for the 2005 Combined Sections Meeting: Poster Presentations

Heartspring, Wichita, KS, USA (Begnoche, Sanders)

Physical Therapy, Wichita State University, Wichita, KS, USA (Pitetti)

PURPOSE/HYPOTHESIS: To examine the effects of an intensive physical therapy program using traditional treatment methods with partial body weight treadmill training (PBWTT) on functional motor capacity and ambulatory skills of a 2 year-old child with spastic quadriplegic cerebral palsy (CP).

NUMBER OF SUBJECTS: Participant was a female child (2.3 yrs) with spastic quadriplegic CP, GMFCS Level IV, subsequent to premature birth at 29.5 weeks gestation with complication of periventricular leukomalacia.

MATERIALS/METHODS: Intensive physical therapy consisted of 4 sessions per week for 4 weeks, two hours per session, for a total of 16 sessions, including traditional PT (e.g. neurodevelopmental treatment, myofascial release, stretching, gait training) combined with PBWTT. Child’s body weight was partially supported by a harness attached to an overhead structure to allow facilitation of gait pattern while stepping over a treadmill. PBWTT consisted of three, 5-minute bouts at 0.4 to 0.5 mph, followed by manually facilitated gait training in walker wearing Theratogs and DAFO’s. The Gross Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory (PEDI), Timed 10-Meter Walk Test, and Doc-U-Prints pedographs were completed within 3 days of treatment.

RESULTS: GMFM scores improved in the following dimensions: lying & rolling (76% to 84%); sitting (35% to 42%); crawling & kneeling (10% to 14%); walking, running, & jumping (2% to 4%); standing scores were unchanged. Total score improved from 25% to 29%. PEDI standard scores improved in two functional skills domains: self-care (27.7 to 31.2), social function (48.4 to 63.3). Mobility standard scores remained below 10, however, scaled score improved (25 to 32). PEDI score improved in caregiver assistance domain: self-care (21.8 to 34.5); standard scores in mobility and social function showed minimal improvement, however, scaled scores increased in mobility (11.7 to 20.3) and social (55.3 to 59.3) domains. Mean spatial gait parameters measured on Doc-U-Prints with walker and trunk assist improved: stride length, +4.5 in; step length, +1.9 in; base of support, +4.1 in (negative to positive). Average time on Timed 10-M Walk Test decreased by 25 seconds.

CONCLUSIONS: Results indicate that the 4-week intensive physical therapy program produced positive outcomes in functional motor performance and development of walking skills. Documented increases in base of support and stride length indicate improvement in scissoring pattern. Speed of assisted ambulation improved, however, post-test pedograph showed increased toe walking.

CLINICAL RELEVANCE: An intensive physical therapy program using traditional therapy and PBWTT may be effective in developing assisted walking in pre-ambulatory children with CP,GMFCS Level IV.

© 2005 Lippincott Williams & Wilkins, Inc.