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Intensive gait training in toddlers with cerebral palsy: A pilot study

Anna Herskind, Maria Willerslev-Olsen, Anina Ritterband-Rosenbaum, Line Zacho Greve, Jakob Lorentzen, Jens Bo Nielsen

Background: Reduced muscle growth may be involved in the development of contractures in children with cerebral palsy (CP). Here, we report data from a pilot study of intensive gait training in CP toddlers. Methods: Five children with CP aged 8-30 months performed activity-based gait training for one hour/day, five days/week for three consecutive months. Included children were diagnosed with spastic CP, had a Gross Motor Function Classification System (GMFCS) score of I–II, and were not epileptic. All children wore pedometers during training. Before and after the training period, kinematic and qualitative gait analysis, clinical and objective evaluation of spasticity, Gross Motor Function Measure-66 (GMFM-66), and ultrasound of the affected medial gastrocnemius (MG) muscle were performed. Two children were also tested before and after three months of receiving only standard care (SC). Results: On average 1410 steps/session were logged during 63 days of training. More steps were achieved at home than at a central facility. During training, MG muscle volume increased significantly, while it decreased for SC children. Gait improved qualitatively in all children, and GMFM-66 score improved in four of the five children. Similar improvements were seen among the SC children. Two children had pathologically increased muscle stiffness prior to training, which was reduced during training. Reflex stiffness was unchanged in all five children. Conclusions: This pilot study suggests that intensive gait training may increase muscle volume, improve walking skills and reduce passive muscle stiffness in toddlers with CP.