Journal Club CEU Approval
Contact Hours: 1
AR | FL CE26-803266 | ID
Over ground walking and body weight supported walking improve mobility equally in cerebral palsy: A randomized controlled trial
JC15Q3
On-demand
$10
On-demand
$10
Webinar Description
Swe NN, Sendhilnnathan S, van Den Berg M, Barr C (2015).Over ground walking and body weight supported walking improve mobility equally in cerebral palsy: A randomized controlled trial. Clin Rehabil 0269215514566249, first published on January 30 2015 doi:10.1177/0269215514566249 Introduction: This study compared walking speed and endurance outcomes, as well as functional gross motor outcomes following 8 weeks of either body weight, supported treadmill training or over-ground gait training in school-aged children with cerebral palsy (CP). While children who underwent body weight supported treadmill training demonstrated greater walking speed improvements at 4 weeks, there was no difference between groups on any outcome measure at the end of treatment (8 weeks). As the authors did not find a significant difference in any of this study’s outcome measures based on intervention, clinician’s choice of whether to use over-ground or treadmill training would depend on other factors: to maximize amount of practice while minimizing physical exertion of the therapist, body weight supported treadmill training would be preferable. As greater improvement in walking speed was demonstrated in the body weight supported treadmill training participants at the 4-week mark, this intervention might be indicated when restricted to a shorted episode of care. Over-ground training might be indicated when equipment portability/space requirements dominate, or for immediate functional carryover, particularly for populations in which generalization is limited. Study Question: Is one method (body weight supported treadmill training) of gait training superior to another (over-ground gait training) method of gait training in children with cerebral palsy and mild-to-moderate disability? Does prolonged intervention further improve short-term gains made with gait training interventions? Hypothesis: One method of gait training will yield superior outcomes in walking speed, endurance and gross motor function in children with CP and mild-to-moderate disability. STRENGTHS: Block randomization of participants yielded equal allocation (by gender, age-range and GMFCS level) to each intervention group. Intervention designed to coincide with school term. Systematic reduction” of body weight support in intervention protocol (reported, not described). Progressive increase of treadmill speed during each training session as tolerated in intervention protocol. Emphasis on upright standing posture, facilitation of normal kinematic components of gait cycle in body weight supported treadmill training intervention. Use of treadmill with low minimum speed (.1kph) Progressive grading of treadmill training as determined by each participant’s ability and progress. Experienced PTs facilitated as required to initiate weight shift or during swing phase of gait. Initial treadmill training speed: comfortable walking speed. Rest periods allowed during training as needed. Over-ground gait training using usual assistive device performed in school corridors, facilitation provided similar to treadmill intervention group. Encouraged over-ground participants to walk faster and for longer duration then previous training session. Matched maximum walking time across groups to 30 minutes. Blinded evaluators: experienced PTs. Power analysis using acceptable change in walking speed of .1m/s and SD of .09 (derived from literature) used to calculate sample size needed (power of .8, significance: α = .05). Well-matched groups for demographics, baseline outcome measures. WEAKNESSES: Heterogeneous groups of children with CP Lack of follow-up Poor description of technique, particularly for measuring BWS Lack of no-treatment control group Poor description of “tolerance” to increase walking speeds during training. Lack of qualitative outcome measures. Poor adherence to standardized methodology in outcome measures THE BOTTOM LINE: What we know BWSTT is congruent with contemporary models of motor control and motor learning, which recommend a task-specific approach with emphasis on repetition and practice. Amount of practice is a significant factor in motor learning. New Information All outcome measures (walking speed, walking endurance and gross motor function) showed a significant change with time, improving at 4 weeks and further improving at 8 weeks of treatment; BWSTT resulted in greater gains in walking speed following 4 weeks of intervention than over-ground training, a difference which resolved at 8 weeks of intervention. What this means to you Short intervention programs may be feasible and effective. Only the treadmill group displayed a meaningful change in walking speed after 4 weeks of intervention, both groups demonstrated similar outcomes in all other outcome measures. Improvements can be seen after a short 4-week intervention; continuing the intervention for a further 4 weeks yields further significant improvements in these measures. PURPOSE: To investigate if partial body weight supported treadmill training is superior to over-ground gait retraining for children with cerebral palsy and mild to moderate disability. To compare outcome measures at 4 and 8 weeks of interventions to assess whether any short-term gains can be further improved with prolonged intervention.
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Webinar Information
Contact Hours: 1
Price: $10
Instructor: Nechama Karman
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