Article

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 nonvariable rhythm and too much
limb or body weight assistance. OBJECTIVE: To 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: A total of 27 children with bilateral CP, 5 to 17 years old,
were randomized to 12 weeks of 20 minutes, 5 days per week home-based training
(elliptical = 14; cycle = 13) at a minimum of 40 revolutions per minute, with
resistance added when speed target was achieved. Primary outcomes were
self-selected and fastest voluntary cadence on the devices and gait speed.
Secondary outcomes included knee muscle strength, and selective control and
functional mobility measures. RESULTS: Cadence on trained but not nontrained
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 with intensive upper-limb
training recommendations and may be insufficient to produce appreciable clinical change.

Langue : ANGLAIS