Innovative approach to improve walking in children with CP

The National Institutes of Health has awarded a $2.5 million translational research grant over five years to Noelle Moreau, PhD PT, Associate Professor of Physical Therapy at LSU Health New Orleans School of Allied Health Professions, to study the effectiveness of a highly innovative approach to improve the ability of children with cerebral palsy to walk.

Dr. Moreau will investigate the effects of Power Training combined with Interval Treadmill Training, known as PT3, on functional walking capacity, muscle performance and architecture. PT3 is a combined impairment and task-specific approach, which targets muscle power deficits specifically.

Gait Analysis Lab, Shriners Hospital in Sacramento

Leslie Capo, LSU Health Sciences Center New Orleans 27 August 2018

“Current rehabilitation practice uses motor learning principles related to specificity of practice, or task-specific training, for improving walking in those with neurological disorders, such as cerebral palsy,” notes Moreau. “This traditional singular approach fails to address the underlying muscular mechanisms responsible for the walking limitations and has not been shown to be more effective than other therapies in people with spinal cord injury, stroke, and cerebral palsy. In this intervention, we will address muscle power, a key ingredient that is missing from current clinical practice for children with cerebral palsy, and combine it in a package of care with a task-specific training protocol that allows the participants to practice using muscle power generation during the functional task of walking.”

The study, funded by the NIH National Institute of Child Health and Human Development, seeks to determine the immediate and retention effects of PT3 on functional walking capacity in ambulatory children with cerebral palsy; quantify the effects of treatment on muscle architecture and performance; and directly capture the effect of treatment on community-based walking activity and participation using novel, mobile-sensing technology.

The LSU Health New Orleans site of the multi-center clinical trial will enroll 24 ambulatory children with cerebral palsy who are between the ages of 10 and 17. Participants will be randomly assigned to receive either PT3 or an equivalent dosage of traditional strength training combined with traditional treadmill training for 24 sessions, 3 times per week for 8 weeks.

Cerebral palsy (CP) is a non-progressive developmental disorder of movement and posture that leads to activity limitation caused by damage to the immature brain before, during, or shortly after birth. CP occurs in 3.6 per 1,000 live births or 1 in 278 children, according to the Centers for Disease Control and Prevention, and is the most common physical disability originating in childhood. The CDC reports the incidence of CP is higher than childhood cancer, hearing and vision loss, spina bifida, hemophilia, fetal alcohol syndrome, and cystic fibrosis.

Although the initial brain insult is non-progressive, CP is a lifelong disorder due to secondary musculoskeletal problems and associated activity limitations that progress into adulthood. Gait disturbances are an activity limitation that is a hallmark characteristic of CP. Walking ability significantly deteriorates in 50% of ambulatory children with CP beginning in childhood/adolescence. Of those who stop walking, 75% will lose the ability to walk before the age of 25, severely impacting their ability to participate in daily life.

“This intervention represents a paradigm shift in clinical practice by addressing the specific underlying muscular mechanisms responsible for walking limitations in this group, incorporating task-specific training of walking, and focusing on developmentally appropriate pediatric walking activity patterns, rather than adult patterns, that require muscle power to be generated through high-speed intervals,” says Moreau.

Moreau plans to begin enrolling participants in the next month or so. For more information and to get on a waiting list, contact Dr. Noelle Moreau at 504-568-4291 or Nmorea@lsuhsc.edu

Source LSU Health Sciences Center New Orleans
via EurekAlert! American Association for the Advancement of Science AAAS

Effect of short‐burst interval treadmill training on muscle architecture and gait speed in cerebral palsy, N Moreau, K Bjornson, A Bodkin, S Poliachik. (2017) Dev Med Child Neurol, 59: 19-20. doi:10.1111/dmcn.25_13511

Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis, Moreau NG, Bodkin AW, Bjornson K, Hobbs A, Soileau M, Lahasky K. Phys Ther. 2016 Dec;96(12):1938-1954. Epub 2016 Jun 16.

The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis, Booth ATC, Buizer AI, Meyns P, Oude Lansink ILB, Steenbrink F, van der Krogt MM. Dev Med Child Neurol. 2018 Sep;60(9):866-883. doi: 10.1111/dmcn.13708. Epub 2018 Mar 7

Can strength training predictably improve gait kinematics? A pilot study on the effects of hip and knee extensor strengthening on lower-extremity alignment in cerebral palsy, Damiano DL, Arnold AS, Steele KM, Delp SL. Phys Ther. 2010 Feb;90(2):269-79. doi: 10.2522/ptj.20090062. Epub 2009 Dec 18.

Are clinic-based walking measures associated with community walking activity in children with cerebral palsy?
Wittry S, Tsao E, Bjornson K. J Pediatr Rehabil Med. 2018;11(1):23-30. doi: 10.3233/PRM-160425

Walking Aid Use in Canada: Prevalence and Demographic Characteristics Among Community-Dwelling Users, Charette C, Best KL, Smith EM, Miller WC, Routhier F. Phys Ther. 2018 Jul 1;98(7):571-577. doi: 10.1093/ptj/pzy038.

Also see
Power Training Combined With Interval Treadmill Training (PT³) in NIH
Muscle Performance and Walking in Cerebral Palsy: Short-burst Interval Training in NIH
Cerebral Palsy: Short-burst Interval Training in NIH

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