Effectiveness of a low-cost body weight support training device in the rehabilitation of cerebral palsy

Deepak Sharan, Joshua Samuel Rajkumar, Rajarajeshwari Balakrishnan, Amruta Kulkarni, Kalpana Selvakumar, Sivakrishna Gampa, Mathankumar Mohandoss, Rameshkumar Ranganathan, Deepak Sharan, Joshua Samuel Rajkumar, Rajarajeshwari Balakrishnan, Amruta Kulkarni, Kalpana Selvakumar, Sivakrishna Gampa, Mathankumar Mohandoss, Rameshkumar Ranganathan

Abstract

Background: Body weight supported treadmill training (BWSTT) has been proven to be effective in rehabilitation of persons with cerebral palsy (CP). However, it has still not found widespread usage, especially in industrially developing countries, due to its high cost. Treadmill training promotes a rhythmical movement of the lower extremities through motor learning, which can be enhanced by BWSTT for persons with CP. Hence, the research and development team of a tertiary level neuromusculoskeletal rehabilitation center designed a low-cost body weight support training (BWST) device. The aim of this study was to evaluate the effectiveness of the BWST device on gait and ambulation in persons with CP post single-event multilevel surgery (SEMLS) of the lower extremities.

Method: A randomized controlled trial was conducted in 50 persons with CP aged between 5 and 20 years, who underwent a type of SEMLS called single-event multilevel lever arm restoration and anti-spasticity surgery (SEMLARASS). They were randomly assigned to two groups: group A (n = 25) received gait training and treadmill training with the BWST device, and group B (n = 25) received gait training and treadmill training without the BWST device. The designed BWST device was manually operated and based on an un-weighing principle in which a vest of different sizes un-weighed 10-30% of the individual's weight transmitted to the ground by means of adjustable counterweights fixed on a movable metallic frame which had an adjustable top lever (holding the vest) and a handle bar for the patient to hold. The entire cost for the finished BWST device was estimated around 700 USD. The study duration was 5 weeks with 1 h of intervention per day for 6 days per week. Physician Rating Scale (PRS), Dynamic Gait Index (DGI) and Functional Mobility Scale (FMS) were the primary outcome measures.

Results: Group A showed significant positive differences in the scores of PRS (p < 0.001), DGI (p < 0.001) and FMS (p < 0.01) when compared with group B, 5 weeks after the intervention, and the results were maintained at a follow-up of 12 months.

Conclusion: The low-cost BWST device was found to be clinically effective in improving gait and ambulation in persons with CP following SEMLARASS.

Keywords: Body weight support treadmill training; SEMLARASS; SEMLS; cerebral palsy; gait training.

Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Flowchart of the study participant selection process.
Figure 2.
Figure 2.
Lateral view of the BWST device with a suspended model.
Figure 3.
Figure 3.
Top view of the overhead system of the BWST device.

References

    1. Rosenbaum P, Paneth N, Leviton A, et al. A report: The definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007; 109: 8–14.
    1. LePage C, Noreau L, Bernard PM. Association between characteristics of locomotion and accomplishment of life habits in children with cerebral palsy. Phys Ther 1989; 78: 458–469.
    1. Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39: 214–223.
    1. Lovely RG, Gregor RJ, Roy RR, et al. Effects of training on the recovery of full weight-bearing stepping in the adult spinal cat. Exp Neurol 1986; 92: 421–435.
    1. Visintin M, Barbeau H, Korner-Bitensky N, et al. A new approach to retraining gait in stroke patients through body weight support and treadmill stimulation. Stroke 1998; 29: 1122–1128.
    1. Mutlu A, Krosschell K, Gaebler Spira D. Treadmill training with partial body-weight support in children with cerebral palsy: A systematic review. Dev Med Child Neurol 2009; 51: 268–275.
    1. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. J Speech Lang Hear Res 2008; 51: S225–S239.
    1. Damiano DL, DeJong SL. A systematic review of the effectiveness of treadmill training and body weight support in pediatric rehabilitation. J Neurol Phys Ther 2009; 33: 27–44.
    1. Mattern-Baxter K. Effects of intensive locomotor treadmill training on young children with cerebral palsy. Pediatr Phys Ther 2009; 21: 308–319.
    1. Angulo-Barroso RM, Wu J, Ulrich DA. Long-term effect of different treadmill interventions on gait development in new walkers with Down syndrome. Gait Posture 2008; 27: 231–238.
    1. Ulrich DA, Ulrich BD, Angulo-Kinzler RM, et al. Treadmill training of infants with Down syndrome: Evidence-based developmental outcomes. Pediatrics 2001; 108(5): E84.
    1. Ulrich DA, Lloyd MC, Tiernan CW, et al. Effects of intensity of treadmill training on developmental outcomes and stepping in infants with Down syndrome: A randomized trial. Phys Ther 2008; 88(1): 114–122.
    1. 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: 101–105.
    1. Provost B, Dieruf K, Burtner PA, et al. Endurance and gait in children with cerebral palsy after intensive body weight-supported treadmill training. Pediatr Phys Ther 2007; 19: 2–10.
    1. Schindl MR, Forstner C, Kern H, et al. Treadmill training with partial body weight support in nonambulatory patients with cerebral palsy. Arch Phys Med Rehab 2000; 81: 301–306.
    1. Begnoche D, Pitetti K. Effects of traditional treatment and partial body weight treadmill training on the motor skills of children with spastic cerebral palsy: A pilot study. Pediatr Phys Ther 2007; 19: 11–19.
    1. Mehrholz J, Pohl M, Elsner B. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev 2014; 1: CD002840.
    1. Graham HK, Selber P. Musculoskeletal aspects of cerebral palsy. J Bone Joint Surg 2003; 85-B(2): 157–166.
    1. Renshaw TS, Deluca P. Cerebral Palsy. In: Morrissy RT, Weinstein SL. (eds). Lovell and Winter’s Pediatric Orthopedics, Philadelphia: Lippincott, Williams and Wilkins, 2005, pp. 551–603.
    1. Sharan D. Neuromusculoskeletal Rehabilitation of Cerebral Palsy using SEMLARASS. In: Emira Svraka (ed). Cerebral Palsy – Challenges for the Future, Rijeka, Croatia: Intech, 2014, pp. 193–215.
    1. Hesse S, Konrad M, Uhlenbrock D. Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. Arch Phys Med Rehabil 1999; 80(4): 421–427.
    1. Ada L, Dean CM, Morris ME. Supported treadmill training to establish walking in non-ambulatory patients early after stroke. BMC Neurology 2007; 7: 29–34.
    1. Hesse S. Treadmill training with partial body weight support after stroke: A review. NeuroRehab 2008; 23: 55–65.
    1. Lubetzky-Vilnai A, Jirikowic TL, McCoy SW. Investigation of the Dynamic Gait Index in children: A pilot study. Pediatr Phys Ther 2011; 23(3): 268–273.
    1. Koman LA, Mooney JF, 3rd, Smith B, et al. Management of cerebral palsy with botulinum-A toxin: Preliminary investigation. J Pediatr Orthop 1993; 4: 489–495.
    1. Maathuis KGB, Van der Schans CP, Van Iperen AV, et al. Gait in children with cerebral palsy: Observer reliability of Physician Rating Scale and Edinburgh Visual Gait Analysis Interval Testing scale. J Pediatr Orthop 2005; 25: 268–272.
    1. Graham HK, Harvey A, Rodda J, et al. The Functional Mobility Scale (FMS). J Pediatr Orthop 2004; 24(5): 514–520.
    1. Chen G, Patten C. Treadmill training with harness support: Selection of parameters for individuals with post-stroke hemiparesis. J Rehabil Res Dev 2006; 43(4): 485–498.
    1. McNevin NH, Coraci L, Schafer J. Gait in adolescent CP: The effect of partial unweighting. Arch Phys Med Rehabil 2000; 81: 525–528.
    1. Mattern-Baxter K. Effects of partial body weight supported treadmill training on children with cerebral palsy. Pediatr Phys Ther 2009; 21: 12–22.
    1. Schindl MR, Forstner C, Kern H, et al. Treadmill training with partial body weight support in nonambulatory patients with CP. Arch Phys Med Rehabil 2000; 81: 301–306.
    1. Finch L, Barbeau H, Arsenault B. Influence of body weight support on normal human gait: Development of a gait retraining strategy. Phys Ther 1991; 71: 842–856.

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