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Low-Intensity vs High-Intensity Home-Based Treadmill Training and Walking Attainment in Young Children With Spastic Diplegic Cerebral Palsy

Published:October 31, 2019DOI:https://doi.org/10.1016/j.apmr.2019.09.015

      Abstract

      Objective

      To compare the effect of low-intensity (LI) vs high-intensity (HI) treadmill training (TT) on walking attainment and overall walking activity in children with cerebral palsy (CP).

      Design

      Prospective, multisite, randomized controlled trial.

      Setting

      Homes of the participants.

      Participants

      Children with spastic diplegic CP, Gross Motor Function Classification System Level I and II, ages 14-32 months (N=19; male, n=8).

      Interventions

      The children were randomized to LI TT (2×/wk for 6wk) (n=10) and HI TT (10×/wk for 6wk) (n=9). The TT was carried out by the families with weekly instruction by the researchers.

      Main Outcome Measures

      Children were assessed at study onset, post intervention, and 1 and 4 months post intervention with the Gross Motor Function Measure Dimension D/E (GMFM D/E), average strides per day and percentage of time spent walking with accelerometers, the Peabody Developmental Motor Scales-2 (PDMS-2), Pediatric Evaluation of Disability Index Mobility Scale, timed 10-m and 1-minute walk test, and Functional Mobility Scale. Blinding was conducted for GMFM D/E and PDMS-2. Linear mixed effects regression models were applied to all outcomes.

      Results

      No significant between-group differences were found in any outcome measure at any of the time points. Children in the HI group did not show significant improvement immediately following the intervention in GMFM E (P=.061), while children in the LI group did (P=.003), but no statistically significant differences were detected over time (P=.71). Children in the HI group showed better walking independence on the Functional Mobility Scale at all postintervention assessments.

      Conclusions

      A twice-weekly dosage was equally effective in improving skills related to walking compared with a 10×/wk program and can be more readily implemented into clinical practice.

      Keywords

      List of abbreviations:

      CP (cerebral palsy), DS (down syndrome), FMS (Functional Mobility Scale), GMFCS (Gross Motor Function Classification System), GMFM D/E (Gross Motor Function Measure-66 Dimensions D and E), HI (high-intensity), LI (low-intensity), MCID (minimally clinically important difference), PDMS-2 (Peabody Developmental Motor Scales-2), PEDI (Pediatric Evaluation of Disability Inventory), TT (treadmill training), 1MWT (1-minute walk test), 10MWT (10-m walk test)
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