Structured home-based exercise program for improving walking ability in ambulant children with cerebral palsy.

Abstract

To investigate outcomes after 8weeks of a structured home-based exercise program (SHEP) for improving walking ability in ambulant children with cerebral palsy (CP). Eleven children participated in this study (7males and 4females, mean age 10years 3months, standard deviation (SD) 3y) with Gross Motor Function Classification System (GMFCS) I-III. This study used a prospective multiple assessment baseline design to assess the effect of SHEP upon multiple outcomes obtained in three different phases. Exercise intensity was quantified by OMNI-RPE assessed by caregivers and children. Outcome assessments of walking speed, GMFM-66 and physiological cost index (PCI) were measured four times at pre-intervention (Phase 1) and at 3-weekly intervals over eight weeks during intervention (Phase 2). Follow-up assessments were performed at one month and three months after intervention (Phase 3). Statistical analyses were repeated measures ANOVA and Wilcoxon signed-rank test. SHEP improved walking ability in children with CP, particularly for their walking speed (p= 0.01, Cohen's d= 1.9). The improvement of GMFM-66 scores during Phase 2 and Phase 3 had a large effect size, with Cohen's d of 1.039 and 1.054, respectively, compared with that during Phase 1 (p< 0.017). No significant change of PCI was observed (Cohen's d= 0.39). SHEP can be a useful intervention tool, given as a written, structured, and practical exercise program undertaken at home to achieve short term goals for improving walking ability when added to standard care.