Arellano-Martínez IT, Rodríguez-Reyes G, Quiñones-Uriostegui I, Arellano-Saldaña ME

Language: Spanish
References: 17
Page: 14-20
PDF size: 183.73 Kb.

ABSTRACT

Introduction: Cerebral palsy is the most common cause of disability among children. Parent´s main concerns are the acquisition and improvement of gait. The aim of this study was to compare long term results of the effect of two modalities of gait training.
Methods: Quantitative measurement of gait and clinical assessment of the gross motor function classification system and Modified Ashworth Scale were perfomed in 14 patients with Cerebral palsy -spastic hemiplegia and randomizedly assigned into two groups of treatment: the first one using a driven gait orthosis (Lokomat^®) and the second a gait training a long a rail inside a hydrotherapy tank. Measurements and assessments, above described, were performed immediately and one year after the treatment concluded.
Results: Significant change was observed in the gross motor function classification system from II to I among children ((p= 0.042) and a positive correlation between the shape functional of the march and the gross motor function classification system (r = 0.54, p= 0.042). Patients on the Lokomat^® training improved on gait symmetry over patients on the conventional therapy (p≤ 0.05). A year after, this intervention showed tendency to kept the gait patterns only on patients treated with the Lokomat ^®.
Conclusion: Benefit obtained with either modality was evident for both groups. However, residual effects observed on the Lokomat group, either in clinical assessment or gait parameters, were more promising than in the conventional therapy. Due to the size of the sample used in this study the results are not conclusive and more research must be done on this subject in long term time horizon.

REFERENCES

1. Kerr Graham H, Selber P. Musculoskeletal aspects of cerebral palsy. J Bone Joint Surg Br 2003;85B(2):157-166.

2. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 2005;47(8):571-576.

3. Gage JR, Deluca PA, Renshaw TS. Gait analysis: Principles and Applications. Emphasis on its use in cerebral palsy. J Bone Joint Surg Am 1995;77A:1607-1623.

4. Molenaers G, Desloovere K, Fabry G, De Cock P. The effects of quantitative gait assessment and botulinum toxin A on musculoskeletal surgery in children with cerebral palsy. J Bone Joint Surg Am 2006;88(1):161-170.

5. Farmer SE. Key factors in the development of lower limb coordination: implications for the acquisition of walking in children with cerebral palsy. Disabil Rehabil 2003;25(14):807-816.

6. Allum, JH, Carpenter MG. A speedy solution for balance and gait analysis: angular velocity measured at the centre of body mass. Curr Opin Neurol 2005;18(1):15-21.

7. Ledebt A. Becher J, Kapper J, Rozendaal RM, Bakker R, Leenders IC, et al. Balance Training with Visual Feedback in Children with Hemiplegic Cerebral Palsy: Effect on Stance and Gait. Motor Control 2005;9(4):459-468.

8. Mauritz KH. Gait training in hemiplegia. Eur J Neurol 2002;9(Suppl 1):23-29.

9. Riener R, Lünenburger L, Colombo G. Human-centered robotics applied to gait training and assessment. J Rehabil Res Dev 2006;43(5):679-694.

10. Dursun E, Dursun N, Alican D. Effects of biofeedback treatment on gait in children with cerebral palsy. Disab Rehabil 2004;26(2):116-120.

11. Dodd KJ, Foley S. Partial body-weight-supported treadmill training can improve walking in children with cerebral palsy: a clinical controlled trial. Dev Med Child Neurol 2007;49(2):101-105.

12. Kerr C, Parkes J, Stevenson MBS, Cosgrove AP, McDowell BC. Energy efficiency in gait, activity, participation and health status in children with cerebral palsy. Dev Med Child Neurol 2008;50(3):204-210.

13. Meyer-Heim A, Borggraefe I, Ammann-Reiffer C, Berweck S, Sennhauser FH, Colombo G, et al. Feaseability of robotic-assisted locomotor training in children with central gait impairment. Dev Med Child Neurol 2007;49(12):900-906.

14. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39(4):214-223.

15. Rodda J, Graham HK. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol 2001;8(Suppl 5):98-108.

16. Hidler J, Hamm LF, Lichy A, Groah SL. Automating activitybased interventions: The role of robotics. J Rehabil Res Dev 2008;45(2):337-344.

17. Nilsson L, Carlsson J, Danielsson A, Fugl-Meyer A, Hellström K, Kristensen L, et al. Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground. Clin Rehabil 2001;15(5):515-527.