Task-Specific and Functional Effects of Speed-Focused Elliptical or Motor-Assisted Cycle Training in Children With Bilateral Cerebral Palsy: Randomized Clinical Trial

Abstract

Background Locomotor training using treadmills or robotic devices is commonly utilized to improve gait in cerebral palsy (CP); however, effects are inconsistent and fail to exceed those of equally intense alternatives. Possible limitations of existing devices include fixed non-variable rhythm and too much limb or body weight assistance. Objective Quantify and compare effectiveness of a motor-assisted cycle and a novel alternative, an elliptical, in CP to improve interlimb reciprocal coordination through intensive speed-focused leg training. Methods 27 children with bilateral CP, 5–17 years, were randomized to 12 weeks of 20 minutes, 5 days per week home-based training (elliptical =14; cycle =13) at a minimum 40 RPMs with resistance added when speed target achieved. Primary outcomes were self-selected and fastest voluntary cadence on the devices and gait speed. Secondary outcomes included knee muscle strength, selective control and functional mobility measures. Results Cadence on trained but not non-trained devices increased, demonstrating task specificity of training and increased exercise capability. Mean gait speed did not increase in either group nor did parent-reported functional mobility. Knee extensor strength increased in both. An interaction between group and time was seen in selective control with scores slightly increasing for the elliptical and decreasing for the cycle, possibly related to tighter limb coupling with cycling. Conclusions Task-specific effects were similarly positive across groups, but no transfer was seen to gait or function. Training dose was low (≤20 hours) compared to intensive upper limb training recommendations and may be insufficient to produce appreciable clinical change. NCT01086670: Physical, functional and neural effects of two lower extremity exercise programs in children with cerebral palsy

Relationship between sensorimotor cortical activation as assessed by functional near infrared spectroscopy and lower extremity motor coordination in bilateral cerebral palsy

“…4 C. One explanation for this difference between those with and without CP is that while unilateral cycling was likely a novel activity for all participants (TD and CP), bilateral cycling may have also been relatively novel as well to those with greater impairment. Additionally, children with bilateral CP often have difficulty with inter-limb reciprocal coordination needed for asynchronous bilateral activities ( Damiano et al, 2017 ) that is more pronounced in those with greater involvement. Because cycling is used as an intervention in clinics and in research studies ( Siebert et al, 2010 ; Damiano et al, 2017 ), it would also be interesting to evaluate if a cycling intervention would reduce cortical activity and increase the contrast between unilateral and bilateral cycling as seen in TD.…”

“…In conclusion, the overflow of unwanted muscle activity noted in the lower extremities of participants with CP was largely explained by the overflow of neural activity in the sensorimotor cortex, pointing to inefficient cortical organization as a potential and even primary culprit in the lack of selective voluntary motor control in the lower extremities. More effective rehabilitation strategies that progressively train more precise motor control aiming to reduce unwanted intralimb synergistic movements or improve interlimb coordination are needed ( Damiano et al, 2017 ). Further, greater use of techniques such as fNIRS or EEG in combination with EMG measures are recommended for inclusion as outcome measures to determine whether the intervention succeeded first at the level of impairment, with improvement in functional activity and participation in those with bilateral CP the ultimate goal.…”

A Systematic Review of Training Methods That May Improve Selective Voluntary Motor Control in Children With Spastic Cerebral Palsy

“…Assistance was either weight support (47) or physical support of the desired movements (48,49). Further technological interventions encompassed: (i) electrical stimulation applied peripherally to muscles of the lower extremities while walking (36), (ii) an exergame (50), i.e., game controlled by body movements without any physical support, and therefore, it does not fall into the first group of assisted therapies, (iii) a study that compared indoor cycling to exercising on an elliptical trainer (51), and (iv) one investigating acoustic stimulation (52).…”

Efficacy of cycling interventions to improve function in children and adolescents with cerebral palsy: a systematic review and meta-analysis

“…Downs and Black scores are presented in Supplemental Table S1. Study quality ranged from low (14 of 32) 24 to moderate (⩾16–23) 22,23,25–27 to high (⩾24) 18,19 according to Downs and Black scores. Participants could not be blinded due to the nature of cycling interventions; however, only three RCTs ensured adequate blinding of the assessors.…”