Aim To compare the effects of a supported speed treadmill training exercise program (SSTTEP) with exercise on spasticity, strength, motor control, gait spatiotemporal parameters, gross motor skills, and physical function.
Method Twenty-six children (14 males, 12 females; mean age 9y 6mo, SD 2y 2mo) with spastic cerebral palsy (CP; diplegia, n=12; triplegia, n=2; quadriplegia n=12; Gross Motor Function Classification System levels II–IV) were randomly assigned to the SSTTEP or exercise (strengthening) group. After a twice daily, 2-week induction, children continued the intervention at home 5 days a week for 10 weeks. Data collected at baseline, after 12-weeks’ intervention, and 4 weeks after the intervention stopped included spasticity, motor control, and strength; gait spatiotemporal parameters; Gross Motor Function Measure (GMFM); and Pediatric Outcomes Data Collection Instrument (PODCI).
Results Gait speed, cadence, and PODCI global scores improved, with no difference between groups. No significant changes were seen in spasticity, strength, motor control, GMFM scores, or PODCI transfers and mobility. Post-hoc testing showed that gains in gait speed and PODCI global scores were maintained in the SSTTEP group after withdrawal of the intervention.
Interpretation Although our hypothesis that the SSTTEP group would have better outcomes was not supported, results are encouraging as children in both groups showed changes in function and gait. Only the SSTTEP group maintained gains after withdrawal of intervention.
JOHNSTON, T. E., WATSON, K. E., ROSS, S. A., GATES, P. E., GAUGHAN, J. P., LAUER, R. T., TUCKER, C. A. and ENGSBERG, J. R. (2011), Effects of a supported speed treadmill training exercise program on impairment and function for children with cerebral palsy. Developmental Medicine & Child Neurology, 53: 742–750. doi: 10.1111/j.1469-8749.2011.03990.x
This study provides more information to the therapist and parent choosing the most appropriate therapeutic approach for a child with cerebral palsy. The key question is what method of intervention is going to create lasting functional change. This study compares a treadmill training protocol with a strengthening routine. Both approaches were effective, but only the treadmill group had lasting results. In my experience, intense, functional training is more effective than isolated strengthening exercises to make change in children with neurological conditions.