PARENT ADMINISTERED HOME EXERCISE PROGRAM

Effects of Parent Administered Home Exercise Program on Walking Ability in Children with Cerebral Palsy

Introduction

Cerebral (Cerebral- Of or relating to the brain or cerebrum) Palsy (Palsy- A weakening or debilitating influence) is a disorder usually caused by brain damage occurring at or before birth and marked by muscular impairment. Often it is accompanied by poor coordination. It sometimes involves speech and learning difficulties. There are no actual problems with the muscles or nerves; it is the damage to the motor portions of the brain which disrupt the control movement and posture.

The signs and symptoms of Cerebral Palsy will often vary from patient to patient. Individuals with cerebral palsy often have difficulties with fine motor tasks, such as writing. They will often experience trouble with maintaining balance and walking. Some patients will also be affected by involuntary movements, such as uncontrollable motions of the hand, and in some cases drooling(Schindl 2000). These symptoms will often differ from person to person, and may even change over time. Some cerebral palsy patients will also be affected by other medical disorders, such as mental impairment and seizures.

Research Background

With a growing body of research evaluating the efficacy of treadmill training for adults with neurologic disorders, most notably after spinal cord injury, clinicians and researchers in the field of pediatric CP have begun to turn their attention to the potential benefits of treadmill training for improving walking in children with CP. This interest is based on the principle that task-specific and repetitive practice is required to develop and improve a motor skill such as walking. Use of a mechanical treadmill, with or without body weight support, may improve walking in children with CP because it provides an opportunity to repetitively and intensively train the whole gait cycle and facilitate an improved gait pattern during walking. Preliminary work suggests that PBWSTT (Partial Body-Weight-Supported Treadmill Training) is feasible in children with CP and may improve their walking speed, walking endurance, and general gross motor skills. However, it is difficult to draw strong conclusions from existing studies or determine guidelines for clinicians because of limitations within existing studies.

These limitations include small heterogeneous samples, lack of control or comparison groups, no randomization of participants or allocation concealment, and assessors not blinded to group allocation. Although the results reported in previous studies and systematic reviews are promising, the potential benefits of treadmill training for children with CP need to be (Mattern 2009)investigated for children with specific levels of disability and through rigorously designed trials with large sample sizes that ensure greater statistical power (Meyer-Heim 2007).

Aim and Objective

Thus, the aims of this single-blind randomized controlled trial were to (1) determine the safety and feasibility of a PBWSTT (Partial Body-Weight-Supported Treadmill Training) program for parents held in a special school environment and (2) investigate if PBWSTT (Partial Body-Weight-Supported Treadmill Training)can increase the walking endurance, walking speed, and walking function at school of children and adolescents with CP and moderate to severe walking difficulty (GMFCS III and IV) ...