Walking Ability In Children Research Articles

High-Intensity Gait Training Intervention for Children With Cerebral Palsy: A Case Series.

The purpose of this pilot case series was to describe participation in high-intensity gait training (HIGT) and changes in (1) gait speed/endurance, (2) aerobic capacity, and (3) walking ability in children diagnosed with cerebral palsy (CP). Three children with CP participated in HIGT for 5weeks in lieu of their routine physical therapy. Outcome measures were collected at baseline and post-intervention. Post-intervention, all had at or above the minimal clinically important difference for 10-m walk test speed and 6-minute walk test distance. Two participants performed above the minimal clinically important difference in 7.5-m shuttle run test level and Gross Motor Function Measure-88 Dimension E score. This case series demonstrates short-term improvements in the walking outcome measures with participation in HIGT. Further research is needed with a larger and more diverse randomized controlled trial to determine parameters and long-term effects of HIGT in this population.

The Impact of Botulinum Toxin Combined with Robot-Assisted Gait Training on Spasticity and Gross Motor Function on Children with Spastic Cerebral Palsy

ABSTRACT Objective To evaluate the impact of combining botulinum toxin-A (BoNT-A) injection with robot-assisted gait training (RAGT) on lower limb spasticity and motor function in children with cerebral palsy. Methods A prospective study was conducted from January 2020 to January 2023, including 68 patients. Twenty patients received the combination of BoNT-A injection and RAGT, while 48 received BoNT-A injection alone. Assessments were performed before the intervention and at 1, 3, and 6 months post-injection using the Modified Tardieu Scale (MTS), sections D and E of the Gross Motor Function Measure-88 (GMFM-88), 6-minute walk test (6MWT), and 10-meter walk test (10MWT). Results Compared to the control group receiving BoNT-A alone, the combination of BoNT-A and RAGT did not significantly improve spasticity-related outcomes, including MTS scores, R1, and R2 angles (p > .05). However, the combination group demonstrated significantly improved gross motor function, particularly in walking, running (GMFM-E), short-term walking endurance (6MWT), and walking speed (10MWT) in children with cerebral palsy after the intervention (p < .05). Conclusion While the addition of RAGT did not enhance the anti-spasticity effects of BoNT-A, it significantly improved gross motor function and walking abilities in children with cerebral palsy.

Different Protocols for Low Whole-Body Vibration Frequency for Spasticity and Physical Performance in Children with Spastic Cerebral Palsy.

Whole-body vibration (WBV) is a therapeutic exercise tool that can be used in children with cerebral palsy (CP). A low vibration frequency with different protocols has been suggested, but no optimal dose has been explicitly indicated. We aimed to determine the superiority of a gradually increased 7-18 Hz WBV protocol over a static 11 Hz WBV and the immediate and short-term effects of WBV training on improving spasticity, functional strength, balance, and walking ability in children with spastic CP. Twenty-four participants with CP (mean age: 11.5 ± 2.9 years) were randomly allocated into protocols of a static 11 Hz vibration frequency group (SVF) or one that increased from a 7 to an 18 Hz vibration frequency (IVF) (n = 12/group). The WBV programmes were completed for 30 min/session/day to identify immediate effects, and the short-term programme then continued for four days/week for eight weeks. Modified Ashworth Scale scores significantly and immediately improved in the IVF group (hip adductor and knee extensor, p < 0.05), and after eight weeks showed significant improvement in the SVF group (ankle plantar flexor, p < 0.05). Within groups, the Five Times Sit to Stand Test (FTSTS), the Time Up and Go Test and the Functional Reach Test significantly improved in the SVF group, whereas only the FTSTS improved in the IVF group (p < 0.05). There were no significant between-group differences at the eight-week postintervention, except reduced spasticity. A protocol of 7-18 Hz WBV seems to offer superior immediate results in terms of improved spasticity; however, a static 11 Hz protocol appears to offer superior results after eight weeks, although the two protocols did not differ significantly in effects on physical performance. This finding may facilitate preparations to normalise muscle tone before functional mobility therapy. The study results may support future studies about the dose-response of WBV frequency.

Walking Ability, Participation, and Quality of Life in Children with Spastic Diplegic Cerebral Palsy: A Path Analysis Study.

This study aims to design a conceptual model for the effect of various factors on walking ability, participation, and quality of life in children with spastic diplegic cerebral palsy (SDCP) and test it based on field data using path analysis. This cross-sectional study was performed on 181 children with SDCP. The following were used to measure each of the variables: the Modified Ashworth Scale, the Micro Manual Muscle Tester, the Timed Up and Go Test (TUG), the Boyd and Graham test, the goniometer, weight and height, the Gross Motor Function Classification System, the Life Habits Questionnaire, and cerebral palsy Quality of Life Questionnaire for Children. The structural model was tested in Amos 17. All paths of the proposed model were significant (P <0.05). Among evaluated variables, muscle strength (B = -0.466), balance (B = 0.326), and spasticity (B = 0.143) affected walking ability. Moreover, as an intermediate factor, walking ability affected the subjects' participation (B = -0.819) and quality of life (B = -0.183). Muscle strength, balance, and spasticity are the most influential factors in the walking ability of children with SDCP. Furthermore, walking ability and participation are two critical factors in promoting the quality of life of these children.

Anti-gravity treadmill training for children with cerebral palsy

Background: Walking dysfunction in children with cerebral palsy (CP) contributes to significant limitations in participating properly in daily living activities. Various types of treadmills have emerged to address this obstacle such as the antigravity treadmill (AGT) which aims towards reducing the effect of gravity on its users. Aim: This systematic review examines the literature on the effectiveness of (AGT) on walking abilities in children with CP. Methods: Protocol registration (CRD42020164202) in April 2020 was followed by six electronic database searches for randomized clinical trials (RCTs), examining the effectiveness of AGT on walking and balancing abilities in children with CP. The included studies were assessed for quality using the Physiotherapy Evidence Database (PEDro) scale. Results: Three studies of good quality met the inclusion criteria. AGT was significantly associated with improved walking velocity and cadence, while stride length showed insignificant difference between groups (SMD= 0.07, 95%CI 0.06 to 0.08, p&lt; 0.00001),(SMD= 12.29, 95%CI 9.58 to 14.99, p&lt; 0.00001) and (SMD= 0.07, 95%CI -0.08 to 0.23, p&lt; 0.36).

Prognostic factors for mobility in children with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by bone fragility. Although the disease severity is known to influence the ability to walk, little is known about how children with severe OI can achieve practical ambulation (PA). This study aimed to determine the early predictors of future mobility in children with OI. Thirty OI patients with an average age of 12.1 years were classified into the PA group (22 patients) and nonambulator group (NA group: 8 patients) on the basis of the Hoffer classification. Various clinical parameters related to mobility were compared between the PA and NA groups. Therapeutic interventions were also compared between the 2 groups. The mean age at diagnosis and initial fracture were significantly lower in the NA group than in the PA group. The height was significantly smaller in the NA group than in the PA group at all ages examined (at birth, 3 years, and 6 years). The number of patients with respiratory failure was significantly higher in the NA group than in the PA group. The age at initial corrective osteotomy of the lower extremities in the PA group was significantly lower than that in the NA group, although there was no significant difference in the disease severity in infancy between the groups. Height during infancy, age at initial fracture, and neonatal respiratory status could be prognostic factors for mobility in OI. Surgical interventions at an early age may influence walking ability in children with moderate OI.

Effects of scalp acupuncture plus acupuncture exercise therapy on walking ability in children with spastic cerebral palsy

Effects of scalp acupuncture plus acupuncture exercise therapy on walking ability in children with spastic cerebral palsy

Effects of 12-week aquatic exercises on gross motor function, swimming skills and walking ability in children with cerebral palsy.

Cerebral palsy (CP) is the most common cause of physical disability in childhood defined as a group of permanent disorders of movement. The aim of this study was to determine the effects of 12-week aquatic exercise program on gross motor function, swimming skills, and walking ability in children with cerebral palsy. Eighteen children (mean±SD age: 12.3±3 years) with cerebral palsy classified at levels I, II and III on the Gross Motor Function Classification System were allocated to one group, where the first 12 weeks were a control period while another 12 weeks were an experimental period. The participants underwent the same battery of tests focusing gross motor function, swimming skills, and walking ability on three occasions. Control period was stable with no significant changes in any of measurements. After the 12-week experimental program, a statistically significant improvement was determined in gross motor function (P=0.005), swimming skills (P=0.000), walking endurance and walking velocity (P=0.000). No significant differences (P>0.05) were observed for walking efficiency. The 12-week aquatic exercise program (3/week, 60 minutes), combining Halliwick method, swimming and walking activities may improve the gross motor function, swimming skills, walking endurance and velocity in ambulatory children with cerebral palsy.

Wearable Adaptive Resistance Training Improves Ankle Strength, Walking Efficiency and Mobility in Cerebral Palsy: A Pilot Clinical Trial.

Goal: To determine the efficacy of wearable adaptive resistance training for rapidly improving walking ability in children with cerebral palsy (CP). Methods: Six children with spastic CP (five males, one female; mean age 14y 11mo; three hemiplegic, three diplegic; Gross Motor Function Classification System [GMFCS] levels I and II) underwent ten, 20-minute training sessions over four weeks with a wearable adaptive resistance device. Strength, speed, walking efficiency, timed up and go (TUG), and six-minute walk test (6MWT) were used to measure training outcomes. Results: Participants showed increased average plantar flexor strength (17 ± 8%, p = 0.02), increased preferred walking speed on the treadmill (39 ± 25%, p = 0.04), improved metabolic cost of transport (33 ± 9%, p = 0.03), and enhanced performance on the timed up and go (11 ± 9%, p = 0.04) and six-minute walk test (13 ± 9%, p = 0.04). Conclusions: The observed increase in preferred walking speed, reduction in metabolic cost of transport, and improved performance on clinical tests of mobility highlights the potentially transformative nature of this novel therapy; the rate at which this intervention elicited improved function was 3 – 6 times greater than what has been reported previously.

Effects of robot-assisted gait training on walking abilities of children with cerebral palsy

Introduction Cerebral palsy (CP) is the most common cause of movement disorders in childhood and is associated with abnormal muscle tone, low range of motion, and muscle weakness. These impairments reduce walking ability. Robotic-assisted gait training (RAGT; e.g. Lokomat) are considered as a promising approach for gait rehabilitation in patients with neurologic impairment. However, the evidence on its effectiveness in pediatric rehabilitation is still scarce. This study aimed to evaluate whether gait training using the RAGT can improve walking abilities in children with CP. Material and method Twenty-three children (age: 10 ± 3 yrs, GMFCS: II-IV) with CP completed a RAGT program (2 sessions/week of 30–45 min for 12 weeks). RAGT sessions included oriented task exercises (e.g., pass an obstacle). Lokomat settings were individually set according to each participant's functional level. Outcome measures were spatiotemporal parameters, lower limb isometric strength (i.e., hip flexors, extensors and abductors and knee flexors and extensors) and the distance traveled during a 6-min walking exercise (6mwe). GLM repeated measures and Tukey post-hoc tests were used to compare outcomes in pre-, post-training and 6-month follow-up. Results All outcomes (except single support duration and hip flexors strength) were improved in post-training and maintained after 6-months. Comfortable walking speed increased by +21.6% (+0.14 m/s, P = 0.012), mainly explained by step length (+0.06 m, P ≤ 0.01). Muscle strength increased by 27 to 68% in post-training. The endurance measured by 6mwe increased by +22.3% (P ≤ 0.01). Conclusion RAGT increases global walking capacities in children with CP. Lokomat training could be viewed as a valuable training modality for children with CP.

The immediate influence of various whole-body vibration frequency on balance and walking ability in children with cerebral palsy: a pilot study.

The purpose of this pilot study is to examine the immediate effect of interventions based on the frequency of whole-body vibration on children with cerebral palsy’s balance and walking abilities. A total of 12 were selected as subjects. All subjects measured 10-m walking test (10MWT), Timed Up and Go (TUG) test and measured sway length (SL) and limit of stability (LOS) by bio-rescue. And those were performed again after the frequencies of the 12, 18, and 26 Hz were applied respectively. To check the immediate effect, all subjects performed only one frequency of interventions per day and no other treatment was performed in parallel to control the foreign variables. After intervention, 10MWT were significantly increased in the 12 and 18 Hz groups (P<0.05). TUG test and LOS were significantly increased in the 18 Hz group (P<0.05). There were no significant differences on TUG, SL, and LOS in the 12 Hz group. There were no significant differences on 10MWT, TUG, SL, and LOS in the 26 Hz group. Looking at the results of this study, the immediate effect of whole-body vibration shows that the frequency of the 18 Hz group is the most effective interventions in promoting walking and balancing abilities in children with cerebral palsy than frequencies of the 12 and 26 Hz groups.

Impact of Long-Term Hippotherapy on the Walking Ability of Children With Cerebral Palsy and Quality of Life of Their Caregivers.

Background: Cerebral palsy (CP) is a permanent motor disorder that occurs at birth or during early infancy. Despite advances in fetal and maternal medicine, the incidence of CP remains high. Hippotherapy has gradually been recognized as an excellent rehabilitation tool for children with CP. However, a scientific basis for how it achieves long-term functional improvements or provides additional benefits to patients' caregivers remains unknown.Objectives: We performed a prospective trial to determine how hippotherapy affects the gross motor and gait functions in children with CP and how it may also impact the quality of life (QOL) of patients' caregivers.Methods: In total, 24 children with CP (11 boys, 13 girls; age: 4–14 years; Gross Motor Function Classification System [GMFCS] II-III) underwent a program (30 min/day, once a week) of hippotherapy or day-care recreation (control) over a 1-year intervention and a 3-month follow-up period. Assessment measures used for the children were gait parameters for a 5-m walk test, Gross Motor Function Measure (GMFM)-66, and GMFM dimension-E (GMFM-E). The QOL of the caregivers was estimated using a brief version of the World Health Organization Quality Of Life (WHOQOL-BREF) self-assessment questionnaire.Results: In addition to better GMFM-66 and GMFM-E scores, hippotherapy was associated with increased cadence, step length, and mean acceleration; stabilized horizontal/vertical displacement of patients; and better relationship between the psychological status and QOL of the caregivers than those seen in the control group (p < 0.05). Additionally, the initially improved children's step length and their caregivers' psychological QOL domain (particularly in the “positive feeling” facet) tended to be preserved up to the 3-month follow-up.Conclusion: These data suggest that compared with common day-care recreational activities, a 1-year program of once-weekly hippotherapy can improve not only the walking ability of children with CP but also the psychological health and QOL of their caregivers.Clinical Trial Registration:: www.umin.ac.jp/ctr/, identifier: UMIN000022986

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

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.

Cross-Cultural Validation Study of the Japanese Version of the ABILOCO-Kids in Ambulatory Children With Cerebral Palsy Using Rasch Analysis

Aims: To determine the structural validity, construct validity, cross-cultural validity, internal consistency and test–retest reliability of the Japanese version of the ABILOCO-Kids in children with cerebral palsy. Methods: One-hundred sixteen parents of children with cerebral palsy (Gross Motor Function Classification System level I [n = 66], II [n = 32], and III [n = 18]) reported on walking ability using the Japanese version of the ABILOCO-Kids. For test–retest reliability, 23 participants were evaluated. Results: The mean ABILOCO-Kids logit score was 2.48 (range –7.44 to 5.83). Rasch analysis and principal component analysis were used to determine the structural validity. The construct validity was confirmed on the basis of differences in the ABILOCO-Kids scores among the Gross Motor Function Classification System levels. Cronbach’s α and the item-to-total correlation coefficient supported the internal consistency. The intra-class correlation coefficient was 0.96, standard error of measurement 0.56 and minimal detectable change 1.55. The cross-cultural validity analyses showed differential item functioning according to the analyses of the invariance of item difficulty and person’s ability estimates. Conclusions: The ABILOCO-Kids is a reliable and valid measure of walking ability in children with cerebral palsy in Japan. The lack of evidence on cross-cultural validity indicates we should interpret results cautiously in cases of international comparison.

Improved motor function in a pre-ambulatory child with spastic bilateral cerebral palsy, using a custom rigid ankle-foot orthosis–footwear combination

Ankle-foot orthoses may be used in pre-ambulatory children with cerebral palsy; however, their effect on the acquisition of walking is unknown. This case report aims to evaluate the effect of an ankle-foot orthosis-footwear combination on the acquisition of walking in a single subject with cerebral palsy. This study reports the orthotic management of a single child with spastic bilateral cerebral palsy over a 15-month period, during which time the ability to independently stand and walk was acquired. Custom rigid ankle-foot orthoses were prescribed. Gait speed and Edinburgh Visual Gait Score were assessed with and without the orthoses. The subject developed the ability to stand and walk using an ankle-foot orthosis-footwear combination with a walker frame, and to a limited extent without a walker frame. The subject remained unable to take independent steps unless wearing the ankle-foot orthosis-footwear combination. Clinically significant differences in gait speed and Edinburgh Visual Gait Score were observed. An ankle-foot orthosis-footwear combination may aid the development of independent walking in some children with cerebral palsy. Further research on the effects of orthoses on the acquisition of walking ability in children with cerebral palsy is needed. Custom rigid ankle-foot orthoses combined with footwear may aid the development of independent standing and walking in some children with bilateral spastic cerebral palsy. This intervention may be considered in clinical practice and future research in this patient group.

Is parent perception of walking ability in children with cerebral palsy appropriately identified on the Gillette functional assessment questionnaire?

Is parent perception of walking ability in children with cerebral palsy appropriately identified on the Gillette functional assessment questionnaire?

P 175 - Robotic-assisted locomotion training improves walking abilities in children with bilateral cerebral palsy

P 175 - Robotic-assisted locomotion training improves walking abilities in children with bilateral cerebral palsy

Effect of power training on walking abilities in children with CP with poor gross motor function

Power training (PT) has recently been raised as a promising training modality to improve functional abilities in children with cerebral palsy (CP). Nevertheless, its effect on walking ability in CP children with poor gross motor function has never been investigated. The present study aimed to evaluate the feasibility to implement PT in an adapted school and its effect on walking abilities. Eleven children with CP [6–11 years old, Gross Motor Function Classification System (GMFCS) level I–V, including 9 children with GMFCS level III–V] were included. They were trained three times a week during 12 weeks. The training session took place during the 50-minute physical activity courses and included 20 minutes of high intensity exercise (i.e. running, fast walking with appropriated technical aids, including weight bearing walker), as well as a warm up and cool down period. Heart rate was monitored during three training sessions for each participant. A kinesiologist, a physical therapist, and the sport teacher, supervised the training sessions. Self-selected comfortable and fast walking speed, gait efficiency, as evaluated with the Energy Expenditure Index (EEI), as well as running speed were assessed before and after the training period. Ten children completed the whole training period. Participants spent 19 ± 7 min and 6 ± 7 min at an intensity superior to 40% and 60% of the heart rate reserve, respectively. The EEI was reduced after training ( P = 0.01), resulting in a more efficient gait. Comfortable and fast walking speed also increased after training ( P < 0.05). Greater improvements were observed in children with higher GMFCS level. PT is feasible in adapted school environment with children with CP with GMFCS level III–V. These data suggested that PT increases walking capacities. More studies are needed to assess the impact of PT in children with poor walking abilities.

The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis.

The aim of this systematic review was to investigate the effects of functional gait training on walking ability in children and young adults with cerebral palsy (CP). The review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Web of Science) for relevant literature published between January 1980 and January 2017. Included studies involved training with a focus on actively practising the task of walking as an intervention while reporting outcome measures relating to walking ability. Forty-one studies were identified, with 11 randomized controlled trials included. There is strong evidence that functional gait training results in clinically important benefits for children and young adults with CP, with a therapeutic goal of improved walking speed. Functional gait training was found to have a moderate positive effect on walking speed over standard physical therapy (effect size 0.79, p=0.04). Further, there is weaker yet relatively consistent evidence that functional gait training can also benefit walking endurance and gait-related gross motor function. There is promising evidence that functional gait training is a safe, feasible, and effective intervention to target improved walking ability in children and young adults with CP. The addition of virtual reality and biofeedback can increase patient engagement and magnify effects. Functional gait training is a safe, feasible, and effective intervention to improve walking ability. Functional gait training shows larger positive effects on walking speed than standard physical therapy. Walking endurance and gait-related gross motor function can also benefit from functional gait training. Addition of virtual reality and biofeedback shows promise to increase engagement and improve outcomes.

Factors associated with the severity of motor impairment in children with cerebral palsy seen in Enugu, Nigeria

Background . Cerebral palsy (CP) is a heterogeneous condition that is well known to cause impairments with varying degrees of severity. The gross motor function classification system (GMFCS) is widely used to assess ambulatory function in CP, but little is known about the factors that account for the variations in gross motor function in children. The purpose of this study was to assess the relation between the severity of gross motor dysfunction (GMD) and certain factors such as the type of CP, aetiology of CP, nutrition, socioeconomic class (SEC), and the frequency of these accompanying impairments like visual, auditory, cognitive and speech impairments. Methods . This was a cross-sectional observational study of 100 consecutively recruited CP patients aged 9 - 96 months, who attended the paediatric neurology clinics (PNCs) in Enugu between April and October 2010. Each patient’s clinical history was recorded, a neurological examination conducted and GMFCS level ascertained. Statistical analyses were done to determine the association between the categorical variables. Results. The type of CP ( p =0.000), aetiological factors ( p =0.016), the presence of malnutrition ( p =0.004) and the frequency of accompanying impairments ( p =0.001) were significantly associated with the severity of GMD, while SEC ( p =0.649) had no significant association. Conclusion . The type of CP, aetiological factors, the presence of malnutrition and the number of accompanying physical, mental or physiological impairments, were positively associated with the severity of GMD and walking ability in children with CP.