Functional Power Training May Help Improve Gait Patterns in Children with Cerebral Palsy, Study Suggests

Functional power training may help improve gait patterns in children with cerebral palsy, but the effects may be small and only detectable at higher walking speeds, a small study has found.

The study, “Effects of functional power training on gait kinematics in children with cerebral palsy,” was published in the journal Gait & Posture.

Muscle weakness is one of the most common and debilitating motor symptoms that affects children with cerebral palsy. This is often due to weakness of the ankle plantar flexors — a group of muscles that helps point the foot downwards — which are associated with gait stability and forward propulsion.

In children with spastic cerebral palsy, which is characterized by uncontrolled movement and muscle contraction control, these problems can be addressed by weakening muscles through interventions such as denervation (i.e., eliminating the nerve supply to a specific area of the body).

Recent therapeutic approaches have changed significantly, moving towards more activating forms of therapy such as strength training exercises.

Although strength training could help reduce muscle weakness, evidence is limited that it can improve walking ability in children with cerebral palsy.

Recent data suggests that functional power training — which is based on exercises that prepare the body for real-life movements and activities — might have a greater impact on physical performance in this patient population.

Therefore, a team of Dutch researchers conducted a study to explore the potential of functional power training to improve gait performance in children with cerebral palsy.

The study recruited 10 children with spastic cerebral palsy, who were from 5 to 10 years old. All were ambulatory. Three had impaired muscle movement on one side of their bodies (hemiplegia), and seven had diplegic cerebral palsy — characterized by tense muscles and spasms.

All participants were given a training protocol that consisted of 60-minute sessions, three times a week, for a total of 14 weeks. The progressive power training was with a personal supervising therapist and specifically designed to promote strengthening of ankle movement (plantar flexors).

Training included progressively loaded multi-joint exercises done at a high speed. All exercises were translatable to the children’s daily activities, such as running and walking, with a focus on the ankle push-off.

The training protocol was found to have a general positive effect at a comfortable walking speed (CWS), but the differences before and after the training protocol were small and remained below a clinically meaningful threshold.

However, the researchers noted significant and meaningful improvements in knee and hip movements at faster walking speeds. In particular, the children showed better knee and hip extension after the training program.

“Since walking speed in children with cerebral palsy is often impaired to 75% of CWS in typically developing children, changes as found at faster speeds might be a good representative of daily life activities in children,” the researchers wrote.

Therefore, analysis of gait patterns in children with cerebral palsy that’s based solely on comfortable walking speed may “lead to an underestimation of improvement,” they said.

The study “demonstrates that gait kinematics can improve after functional power training, although the magnitude of improvement is smaller than effects on functional outcomes,” the researchers said.

“Improvements after training were only visible when walking at faster speeds, and therefore effects of training may be underestimated when evaluating gait at comfortable walking speed alone,” they concluded.