The impact of an anti-gravity treadmill (AlterG) training on walking capacity and corticospinal tract structure in children with cerebral palsy

Abstract

We studied the effects of an anti-gravity treadmill (AlterG) training on walking capacity and corticospinal tract structure in children with Cerebral Palsy (CP). AlterG can help CP children walk on the treadmill by reducing their weights up to 80% and maintain their balance during locomotion. AlterG training thus has the potential to improve walking capacity permanently as it can provide systematic and intense locomotor training for sufficiently long period of time and produce brain neuroplasticity. AlterG training was given for 45 minutes, three times a week for two months. The neuroplasticity of corticospinal tract was evaluated using Diffusion Tensor Imaging (DTI). The fractional Anisotropy (FA) feature was extracted to quantify structural changes of the corticospinal tract. Walking capacity was evaluated using popular clinical measurements of gait; i.e., walking speed, mobility and balance. The evaluations were done before and after training. Our results revealed that AlterG training resulted in an increase in average FA value of the corticospinal tract following the training. The outcome measures of clinical assessments of gait presented enhanced walking capacity of the CP subjects. Our findings indicated that the improved walking capacity was concurrent with the enhancement of the corticospinal tract structure. The clinical implication is that AlterG training may be considered as a therapeutic tool for permanent gait improvement in CP children.

High Intensity Jump Exercise Preserves Posture Control, Gait, and Functional Mobility During 60 Days of Bed-Rest: An RCT Including 90 Days of Follow-Up

“…We therefore assume that the preservation of muscle mass and function achieved through the countermeasure is sufficient to trigger side effects, with an overlap with the control of gait and posture. We expect that the outcomes of the present study are of major relevance in various scenarios, including Astronauts (Kramer et al, 2017a), orthopedic and neurodegenerative patients (Azizi et al, 2017), the elderly (McGregor et al, 2014) and sedentary populations (Pavy-Le Traon et al, 2007) suffering from physical deconditioning due to chronic inactivity.…”

“…Areas of application for JUMP may range from space-related operations for Astronauts during long-term space missions (Kramer et al, 2017a) to the interface of geriatrics (McGregor et al, 2014), clinical orthopedics (Bugbee et al, 2016), and neurodegeneration (Azizi et al, 2017). Importantly, JUMP can be executed with a wide range of impact loads induced by the sledge's acceleration profile as the equivalent to gravitation within boundaries of 0.5 g up to 1.3 g (Kramer et al, 2017b).…”

Maturation of the Locomotor Circuitry in Children With Cerebral Palsy

“…This may include advances in biotechnology to unveil new information about the impaired locomotor output or infant general movements for the early diagnosis of CP (Zhu et al, 2015;Redd et al, 2019;Airaksinen et al, 2020;Sylos-Labini et al, 2020), to develop central pattern generatormodulating therapies (Solopova et al, 2017) and to enhance walking. For example, initially shown to be effective for mammalian gait retraining (e.g., Barbeau and Rossignol, 1987;van den Brand et al, 2015;von Zitzewitz et al, 2016), a therapeutic intervention for gait retraining with partial body weight support using a harness system (McNevin et al, 2000) or water immersion (Oliveira et al, 2014) may improve walking capacity in children with CP (Day et al, 2004;Azizi et al, 2017). Given a positive effect of repetitive locomotor exercise on gait characteristics in CP (Smania et al, 2011;Willerslev-Olsen et al, 2015), also with the use of wearable exoskeleton (Lerner et al, 2017), the rehabilitative protocol may further focus on improving the locomotor output, e.g., by providing a feedback on specific features of the spinal locomotor output (Figures 3, 4) or implementing gait training program with realtime feedback of the body's center-of-mass vertical displacement to restore the pendulum mechanism and decrease the walking energy cost (Massaad et al, 2010).…”

Neuroplasticity in children and adolescents in response to treatment intervention: A systematic review of the literature

“…Ten studies in the C-Inj category examined experience-dependent plasticity among children and adolescents using a sensory-motor intervention. 26,27,35,[46][47][48][49][50][51][52] The type of intervention appeared to be closely correlated with the clinical population that was being studied (see Figure 2). For example, children and adolescent participants that had a motor impairment such as speech apraxia were treated with a sensory-motor intervention which focused on improved motor function, while individuals with a learning disability were treated with a cognitivebased intervention focused on those skills (i.e.…”

“…This included diagnoses of apraxia, traumatic brain injury, and cerebral palsy including spastic hemiplegia. [26][27][28]35,[46][47][48][49][50][51][52]…”