Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Brain Injury; Neuroplasticity (includes neuroscience)
Objective : To examine the effects of retrowalking episodes on the efficiency of gait and transfers in children with Cerebral Palsy, 8-week retrowalking protocols focused on varying components such as endurance, speed, and strength training were implemented in two children with spastic cerebral palsy.
Design : A single-subject design (A-B-A-B with follow-up) was used. The study, consisted of two episodes of 1-week baseline testing, 8-week intervention, 1-week post-intervention testing, and follow-up at 6 weeks. Each child received 2 sessions of retrowalking for a total of 2 to 3 hours of treatment per week, while maintaining their usual therapy schedule outside of the study.
Setting : Completed at Bellarmine University outpatient physical therapy clinic
Participants (or Animals, Specimens, Cadavers) : 2 children age 10 years old diagnosised with spastic diaplegia Cerebral Palsy GMFM-FC level II and III
Interventions : The first protocol focused on increasing duration, with an initial 35 minutes progressing up to a total of 65 consecutive minutes in a single session. The second protocol combined speed and strength training, with time kept consistent. Following 30-minute of treadmill walking at a pre-selected speed, increasing by .1 mph each week, participants completed strengthening exercises targeting trunk musculature and lower extremity extensors
Main Outcome Measure(s) : The outcome measures included the Timed Up and Go (TUG), Five-repetition sit-to-stand, 6 Minute Walk Test (6MWT), Gross Motor Function Measure – 88 (GMFM), and gait analysis via the GaitRite.
Results : Both children demonstrated improvements in the TUG (11% change), five-repetition sit-to-stand (20.7% change), and the 6MWT (3% change). There were similar changes in gait kinematics including step length, velocity, and cadence.
Episodes of retrowalking appeared to have a positive effect on the efficiency of gait and transfers in children with CP. Including protocols that focus on varying components, encourages the principals of neuroplasticity and appears to benefit participants through demonstration of endurance, core stability, and a more appropriate activation of agonist-antagonist musculature.
Elizabeth Seewer– Doctor of Physical Therapy Student, Bellarmine University, Louisville, Kentucky
Thomas Wiseman– Student Physical Therapist, Bellarmine University, Columbus, Ohio
Candace Ridley– Student, Bellarmine University, Louisville, Kentucky
Elizabeth Klem– Student, Bellarmine University, Louisville, Kentucky
Leann Kerr– Assistant Professor, Bellarmine University, Louisville, Kentucky