Commentary on “Evaluation of Lower Body Positive Pressure Supported Treadmill Training for Children With Cerebral Palsy”

Abstract

How should I apply this information?"This article demonstrates that lower body positive pressure supported (LBPPS) treadmill training can be used with positive outcomes in children with spastic diplegia, with ages ranging from 8 to 18 years, to improve strength, balance, and walking performance. The children improved their fitness as a side effect of this training. If children can walk for a longer period of time in addition to at a faster pace, they may become more functional in their home and community environments.If children with spastic diplegia are able to remain upright, push off during terminal stance, and clear their toe during swing, they would be candidates to use this modified body weight support system. This unique system is extremely appealing with respect to the increased comfort level for the child in comparison to using a harness system. There was 100% compliance with the training sessions with the children enjoying the experience. In addition to comfort, the LBPPS treadmill training offers the potential for a child to experiment with his/her stepping pattern to find the most effective means to walk. This increased freedom to play with the possible degrees of freedom approximates authentic active learning. The LBPPS treadmill training also allows the arms of the child to be free, which is ideal for a child who cannot hold on to bars or handles. Children in this setup can practice balancing more readily than when the upper torso is constrained with a chest corset and straps. The opportunity for self-exploration and the possibility for variation in some movement sequences such as "single leg stands, bouncing, kicking, jumping, and tall-kneeling to stand transfers" represent the potential of LBPPS treadmill training as a challenging and active learning experience for children. "What should I be mindful about in applying this information?"In applying this information to patients, the reader must be aware of some constraints in the design, implementation, and results, though not major ones as to cause harm to patients. This study was carried out on a small number of children, only one of each of several ages except for the 16-year-olds (3 of this age). The children were varied in their diagnoses and abilities. The children with the diagnosis of spastic diplegia made significant gains, while the child with spastic hemiplegic cerebral palsy (CP) did not. Therefore, LBPPS treadmill training must be further investigated with children with different types and classifications of abilities of CP. An important aspect of body weight-supported treadmill training is the manual support offered by the physical therapist, which is not possible with LBPPS treadmill training. This may be a deterrent to use for those children who are unable to elicit a step, have appropriate weight bearing, or who cannot clear the surface in swing phase. The dosing must be further investigated in terms of the most appropriate age to benefit from this intervention, the frequency of treatments per week, and the duration of treatment tim...

Acute and Chronic Effects of Lower Body Positive Pressure Exercise on the Very Elderly: A Pilot Study

“…LBPP exercise performed by the very elderly was effective for decreasing pain and increasing muscle strength in the short term and for increasing WS and 6MD in the long term Thus, LBPP exercise is safe gait training alternative in this population. LBPP trials have been reported for patients with several musculoskeletal conditions, including those who had undergone meniscectomy and anterior cruciate ligament reconstruction and those with lower extremity trauma [9][10][11]. Those studies used LBPP to create a low-load exercise regime that facilitated early and/or pain-free ambulation or allowed patients to walk further and for longer periods than was possible during walking (full weight bearing) before surgery, and without any symptom exacerbation [12].…”