BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) level V present with decreased gross motor function and trunk control that impacts their functional activities and participation in family activities. Research indicates body-weight supported locomotor training (BWSLT) may improve motor control for children with neuromotor disabilities. The toddler years present a window of opportunity for developmental changes. The purpose of this case study was to explore the impact of a 6-week BWSLT intervention on postural control, gross motor function, and quality of life in a young child with cerebral palsy in GMFCS level V.
CASE DESCRIPTION: A 3 year-old male child diagnosed with CP was recruited from a local pediatric home health agency. He presented with spasticity in all four extremities, gross motor delay, truncal ataxia, and decreased head control. The child was dependent for all functional mobility and activities of daily living. The child attended BWSLT sessions 3 times per week for 6 weeks. An experienced pediatric physical therapist and 3 assistants facilitated the gait cycle on the treadmill. Facilitation was decreased when the child demonstrated improved motor control. Throughout the 6 weeks, treadmill speed was systematically increased from 0.7mph to 1.8mph and body-weight support was systematically decreased from 50 to 33%. Total walking time varied between 11 and 26 minutes (in 3-5 minute bouts) and total standing time ranged from 4 to 13 minutes (in 2-5 minute bouts). The child attended 17 of the 18 sessions, missing 1 due to respiratory illness.
OUTCOMES: At the initial assessment, the child received a total Gross Motor Function Measure (GMFM-66) score of 20.5, SE = 2.2, 95%CI [16.3, 24.8]. He scored 1/20 on the Segmental Assessment of Trunk Control (SATCo) and his total standardized score was 61.5 on the CPCHILD, an assessment of quality of life for children with CP in GMFCS levels IV and V. After 6-weeks of BWSLT, the child improved his GMFM-66 score by 30% to 26, SE = 2, 95%CI [22.1, 29.9]. He also showed a slight improvement in the SATCo, 2/20, and the CPCHILD, 61.91. His school physical therapist reported he was able to hold his head up more during the day and showed increased endurance with improved lower extremity control with walking in his gait trainer.
DISCUSSION: The outcomes of this case study suggest that gross motor function and trunk control may improve through body-weight supported locomotor training in young children with severe CP. The 6 week time frame was chosen based on previous literature, but a longer time frame may have produced greater results. Future research is needed to determine if this type of intervention can improve function across a larger population of toddlers with CP in GMFCS levels V. Additionally, dosage requirements for this population should be explored.
Flores, Megan and Da Silva, Carolyn, "The Impact of Body-Weight Supported Locomotor Training in a Toddler with GMFCS Level V Cerebral Palsy: A Case Study" (2018). Physical Therapy. 10.