Effects of the progressive walking-to-running technique on gait kinematics, ultrasound imaging, and motor function in spastic diplegic cerebral palsy – an experimenter-blind case study

Abstract

PURPOSE: The purpose of this study was to investigate the effects of the progressive walking-to-running technique (PWRT) in a child with spastic diplegic cerebral palsy (CP). DESIGN: A single case study with pre-/post-test. SUBJECT: An 11-year-old male, diagnosed with spastic diplegic CP. METHODS: The PWRT was provided for 60 minutes a day, 2 times a week for 12 weeks. Gross motor function tests, ultrasound imaging, hand-held dynamometer, and the Vicon motion capture system were used to determine motor function, muscle size and strength, and gait kinematics. RESULTS: Gross motor function was improved after the intervention. The size of right and left rectus femoris and tibialis anterior muscles in their contracted states were enhanced by 1.36, 5.09, 83.74, and 54.37%, respectively. Associated muscle strength was also increased by 58.8, 30.8, 28.0, and 118.2% in both rectus femoris and tibialis anterior muscles. Left stride length, walking speed, maximal flexion-extension angular excursion of the hip joint were enhanced by 95.7, 87.8, and 100.4% after PWRT, respectively. CONCLUSIONS: Our novel walking-running training paradigm was effective for restoring gait and running ability in a child with spastic diplegic CP.

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

“…Consequently 57 articles were selected for full‐text review. Of these, 41 articles were deemed to meet the inclusion/exclusion criteria; reasons for exclusion of 16 articles are noted in Figure . One study population was reported in two articles; to avoid duplicates, results were reported as Provost et al .…”

“…Training intensity varied from as little as 15 minutes gait training three times per week, up to 1‐hour sessions five times per week . One study was not clear about the training intensity provided …”

“…In total, 453 participants were included in level I to III studies; sample size ranged from 14 participants 40 to 95 participants. 32 A further 166 participants were included within level IV and V studies, ranging from individual case reports [37][38][39]42,59 to a sample size of 17. 67 The reported diagnosis of all patients was CP, most commonly described as spastic, while other studies reported athetoid 40,43 and ataxic 64 CP.…”

“…Fifteen of these studies reported walking speed, with nine reporting an increase over the MCID. 33,34,50,51,55,57,59,60,63 One further study reported no change after a brief period of gait training with added ankle load. 69 Persisting positive effects were noted in Full-text review (n=41) Review 869 Review 873 studies with follow-up measurements from 1 month 31,47,52 up to 6 months 32 after cessation of intervention; however, one study was contrary to this trend, showing a decline in walking speed at 14 weeks follow-up after resuming normal activities.…”

“…28 Supporting the trend of improved GMFM dimension E, nine studies in levels IV and V showed improvements in gross motor function surpassing the MCID. 36,38,42,48,54,55,59,63,64 One study reported a significant improvement below the MCID, 57 while Crowley et al 37 found no change in score in a single patient case report. Four studies reported lasting positive effects in gross motor function retained in follow-up from 1 month 31,46,47 up to 6 months after intervention.…”