BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and 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 treadmill training (BWSTT) 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 series was to explore the impact of a 6-week BWSTT intervention on postural control and gross motor function in 3 young children with cerebral palsy in GMFCS levels IV and V.
CASE DESCRIPTION: Three children diagnosed with CP between the ages of 2 to 3 years participated in 6 weeks of BWSTT, 3 times per week. All children displayed decreased trunk control as measured by the Segmental Assessment of Trunk Control (SATCo) and decreased gross motor function as measured by the Gross Motor Function Measure (GMFM-66). One child was dependent for all mobility (GMFCS level V) and 2 children were able to belly crawl for short distances (GMFCS level IV). None of the children were able to walk without assistance. All 3 displayed spasticity in bilateral lower extremities. BWSTT consisted of an experienced pediatric physical therapist and 3 assistants facilitating the gait cycle on the treadmill. Facilitation was decreased when the child demonstrated improved motor control. Treadmill speed was systematically increased (average speed = 1.15mph) and body-weight support was systematically decreased (range: 50 to 33%). Total walking time averaged 20:04 minutes (in 2-10 minute bouts) and total standing time averaged 8:28 minutes (in 2-4 minute bouts). Average attendance was 94%.
OUTCOMES: Final scores revealed that all 3 children improved gross motor function and trunk control. Child 1 improved his SATCo score from Level 0 to Level 1, indicating improved head control. His GMFM-66 score increased from 20.5 to 26. The other 2 children showed greater improvements in trunk control. Child 2’s SATCo score increased from Level 2 to Level 3 and his GMFM-66 score increased from 36.8 to 42.4. Child 3 improved on the SATCo from Level 2 to Level 4 and on the GMFM from 31.8 to 40.9. Parents of all 3 children reported increased motivation to walk during physical therapy sessions.
DISCUSSION: The outcomes of this case series suggest that gross motor function and trunk control may improve through BWSTT 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. Parents of all 3 children expressed the desire to continue the intervention. 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 IV and V.
Flores M, da Silva C. Trunk control and gross motor outcomes after body-weight supported treadmill training in young children with severe cerebral palsy: A case series. 2018.