Treadmill training with partial body‐weight support in children with cerebral palsy: a systematic review

Developmental Medicine & Child Neurology (Impact Factor: 3.51). 01/2009; 51(4):268 - 275. DOI: 10.1111/j.1469-8749.2008.03221.x

ABSTRACT Aim The aim of this systematic review was to examine the literature on the effects of partial body-weight support treadmill training (PBWSTT) in children with cerebral palsy (CP) on functional outcomes and attainment of ambulation.
Method We searched the relevant literature from 1950 to July 2007. We found eight studies on the use of PWSBTT on functional outcomes in children with CP. The methodology to develop systematic reviews of treatment interventions as suggested by the American Academy of Cerebral Palsy and Developmental Medicine and the Critical Review Form-Quantitative Studies Methodological Quality was used to evaluate each article.
Results As two of the eight published articles reported on different outcomes of the same study, this review reports on seven studies with a total of 41 children. The evidence for the functional effects is limited. Statistical significance is not demonstrated in several of the studies, despite reported improvements in gross motor function, functional status, walking performance, and gait parameters.
Interpretation This systematic review is limited by the small number of participants, the heterogeneous level of abilities of participants from Gross Motor Function Classification System levels I to IV, and the low quality of trials. Because of these limitations, we cannot conclude that PBWSTT results in improvements for children with CP. Additional studies and well-established randomized controlled (or clinical) trials are clearly needed before determining the benefits and efficacy that would support continued use of this intervention in the clinical setting.

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Available from: Kristin J Krosschell, Sep 28, 2015
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    • "Rehabilitation in children with delayed neuro-psychomotor development has been the focus of a number of scientific studies1, 2). When such delays are caused by a neurological lesion, the rehabilitation team seeks methods to train subjects in specific tasks with the aim of optimizing the reorganization of the cerebral cortex and improving motor skills. "
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    ABSTRACT: [Purpose] The aim of the present study was to describe the results of transcranial direct current stimulation combined with treadmill training in a child with delayed neuro-psychomotor development. [Subject and Methods] Transcranial direct current stimulation (intensity: 1 mA) was applied over the primary motor cortex for 20 minutes during simultaneous treadmill training (2.5 km/h) in ten sessions. [Results] Clinically significant improvement was found in motor development (fine motor subscale, 23 to 25; gross motor subscale, 32 to 41). Reductions in mean oscillation of the center of pressure were found in the anteroposterior (239.2 to 146.5 mm) and mediolateral (177.4 to 149.2 mm) directions. Increases occurred in cadence (106 to 123 steps/minute), step length (0.16 to 0.23 m), step width (0.09 to 0.14 m) and gait velocity with support (0.3 to 0.7 m/s). [Conclusion] After treatment, the child was able to initiate the standing position for the first time and walk without support.
    Journal of Physical Therapy Science 06/2014; 26(6):945-50. DOI:10.1589/jpts.26.945 · 0.39 Impact Factor
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    • "In patients with neuromuscular disorders, such as stroke, spinal cord injury (SCI), or cerebral palsy (CP), treadmill exercise is a frequently used rehabilitation training model that has been shown to yield functional improvements [1–4]. Clinical investigations showed that in patients with CP, treadmill training can improve walking endurance, walking speed, and standing performance [5, 6]. In stroke rehabilitation, partial-support treadmill training is also a widely used training mode for gait correction [7, 8]. "
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    ABSTRACT: Botulinum toxin A (BoNT-A) is a bacterial zinc-dependent endopeptidase that acts specifically on neuromuscular junctions. BoNT-A blocks the release of acetylcholine, thereby decreasing the ability of a spastic muscle to generate forceful contraction, which results in a temporal local weakness and the atrophy of targeted muscles. BoNT-A-induced temporal muscle weakness has been used to manage skeletal muscle spasticity, such as poststroke spasticity, cerebral palsy, and cervical dystonia. However, the combined effect of treadmill exercise and BoNT-A treatment is not well understood. We previously demonstrated that for rats, following BoNT-A injection in the gastrocnemius muscle, treadmill running improved the recovery of the sciatic functional index (SFI), muscle contraction strength, and compound muscle action potential (CMAP) amplitude and area. Treadmill training had no influence on gastrocnemius mass that received BoNT-A injection, but it improved the maximal contraction force of the gastrocnemius, and upregulation of GAP-43, IGF-1, Myo-D, Myf-5, myogenin, and acetylcholine receptor (AChR) subunits α and β was found following treadmill training. Taken together, these results suggest that the upregulation of genes associated with neurite and AChR regeneration following treadmill training may contribute to enhanced gastrocnemius strength recovery following BoNT-A injection.
    Neural Plasticity 11/2013; 2013:593271. DOI:10.1155/2013/593271 · 3.58 Impact Factor
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    ABSTRACT: Hintergrund. Ziel der Studie war es, die Anwendbarkeit einer robotergestützten Laufbandtherapie für Kinder ab 4Jahren mit zentralen Gangstörungen zu überprüfen und erste Ergebnisse über den Therapieerfolg zu erlangen. Patienten und Methoden. 24Patienten zwischen 4 und 21Jahren mit zentralen Gangstörungen wurden im Rahmen einer klinischen Kontrollstudie mit Prä-/Post-Design rekrutiert. Ergebnisse. 23 von 24Patienten beendeten das Training. Es zeigten sich Verbesserungen in den Dimensionen Geschwindigkeit und Ausdauer sowie in den motorischen Funktionsbereichen „Stehen“ und „Gehen“. Schlussfolgerungen. Die robotergestütze Laufbandtherapie ist bei Kindern mit zentralen Gangstörungen ab einem Alter von 4Jahren gut durchführbar, zeigt signifikante Verbesserung von Geschwindigkeit und Ausdauer des Gehens und scheint ein neuer, viel versprechender Therapieansatz zum Erwerb motorischer Funktionen zu sein. Background. The aims of this study were to test the feasibility of treadmill training with a robotic assisted gait orthosis in children from 4years of age with central gait impairment and to obtain preliminary results on the efficacy of this intervention. Patients and Methods. A total of 24 patients with central gait impairment aged between 4 and 21years were included in a clinically controlled trial with a pre-post design. Results. Of the 24 patients, 23 were able to complete the training. There were improvements in velocity, endurance and motor skills such as “standing” and “walking”. Conclusions. Robotic assisted treadmill training in children with central gait impairment is feasible from 4years of age and leads to significant improvement in velocity, endurance and motor function. This technique may develop to a relevant therapy for regaining motor function.
    Monatsschrift Kinderheilkunde 06/2007; 155(6):529-534. DOI:10.1007/s00112-007-1539-0 · 0.23 Impact Factor
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