The effects of different types of gait training on gait performance in children and young adults with cerebral palsy

Cerebral Palsy (CP) is considered a neurological disorder caused by a non-progressive brain injury or malformation that occurs while the child’s brain is under development. CP primarily affects body movement and muscle coordination (Rosenbaum et al., 2007). As a result of impairments such as spasticity, muscle weakness, and postural instability, many children with CP have difficulty in walking presenting functional problems such as reduced walking speed and endurance. The development, therefore, of an efficient and independent walking is an important therapeutic goal. Some of the treatments that is used by physiotherapists are the Neurodevelopmental Therapy (NDT), Constrained Induced Movement Therapy (CIMT), hydrotherapy and functional gait treatments based on technology such as virtual reality (VR) games, treadmills, robotic exoskeletons and combination of the above. (Levitt, 2010). Many studies have showed the beneficial impact of using functional gait treatments separately or in combination in addition to traditional physiotherapy programs. The present study was designed to summarize the effects of the different types of gait training interventions and to evaluate which types are most effective in improving gait performance in children and young adults with CP. Search in four databases was conducted (PubMed, CINAHIL, MEDLINE and Science Direct) and four systematic reviews were chosen. Inclusion criteria were 1) studies published in English, 2) since 2010, 3) sampling children and young adults (5-25 years) with CP, 4) a gait related outcome measure and 5) gait treatments were robotic exoskeletons, partial body-weight treadmill training (PBWTT) and treadmill training enhanced, or not, with VR games. Most of the studies included in the systematic reviews had medium to high methodological quality. The conclusion of the reviews was that all gait training interventions had positive impact in gait related outcomes, mainly in walking speed and gait endurance. The researchers observed improvement in gross motor function, especially in dimensions D and E of the Gross Motor Function Measure (GMFM), in children and young adults with CP that had been classified as I or II in the Gross Motor Function Classification System (GMFCS), compared to those of III or IV. In addition, robotic exoskeletons seemed to be the most effective gait training intervention followed by the PBWTT, enhanced or not with VR games, treadmill training in combination with VR games, while the least effective was simple treadmill training. In conclusion, functional gait treatments can improve walking ability and have a beneficial effect on the functioning of children with CP, with robotic exoskeletons to be the most effective way. More research may be conducted in the future to determine the duration and the frequency that each intervention offers the maximum improvement.