Research Report
Population: Pediatric
Laura A Prosser, PT, PhD, Assistant Professor, The Children’s Hospital of Philadelphia prosserl@email.chop.edu
Karah Bush, PT, Graduate student, The Ohio State University, Columbus OH bush.354@buckeyemail.osu.edu
Julie Cort, PT, DPT, Physical therapist, The Children’s Hospital of Philadelphia cortj@email.chop.edu
Meghan Tubridy, PT, DPT, Physical therapist, The Children’s Hospital of Philadelphia tubridym@email.chop.edu
Keywords: Prevention, Cerebral Palsy, Motor Function, Rehabilitation
Purpose/Hypothesis: Typical toddler movement is characterized by self-generated motor exploration. Children with cerebral palsy (CP) often cannot create for themselves experiences that challenge their current motor function, and as a result lose natural opportunities to learn and refine more advanced motor skills. We have developed a novel treatment program for children with CP using new, dynamic (rather than static) body weight support technology to facilitate these important natural learning opportunities. This technology provides children with support without constraining movement or preventing falls, allowing practice of skills they may otherwise never learn. The purpose of this study was to examine motor behavior with and without dynamic body weight support in children with and without CP.
Subjects: Twelve toddlers with CP (n=6, mean age=22.9 months) and infants with typical development (TD, n=6, mean age=10.0 months) have been studied to date. All participants had the ability to initiate pulling to stand (score of 1 on Gross Motor Function Measure, GMFM, item 52), but were not able to take 3 independent steps. Data collection is ongoing.
Methods: Participants with CP were enrolled in a rehabilitation clinical trial. One physical therapy session was randomly selected and videotaped. To determine if children performed motor skills beyond their current ability level, motor activities were first coded (Datavyu v:1.2.2, NYU) for whether or not the therapist provided assistance. All unassisted movements were then scored on the corresponding GMFM item, if applicable. A GMFM-66 score for the treatment session was calculated and compared to the preceding evaluation. Participants with TD attended one session that included weight support and no weight support conditions, in random order. GMFM-66 scores were obtained with similar video coding procedures. The current analysis includes data from all participants receiving 40% weight support.
Results: An average of 13.3 and 11.2 GMFM items were scored by video in the CP and TD groups, respectively. With dynamic support, children with CP demonstrated a 5.2 (SEM 1.2) average increase in gross motor ability (range -2.2-15.5, p=0.079) and children with TD demonstrated a 4.5 (SEM 1.2) average increase (range 0.2-9.0, p=0.029). Five of six children in each group demonstrated an increase that exceeds the test’s minimal clinically important difference.
Conclusions: Prewalking infants with TD and toddlers with CP both demonstrated self-initiated performance of motor skills beyond their current level of function with dynamic weight support.
Clinical Relevance: Postural control and lower extremity strength are recognized as the rate limiting factors in the achievement of independent walking. These data suggest that dynamic weight support may “unmask” motor skills that children are not yet, or may never be, able to generate on their own. Providing weight support without restricting movement may allow children with CP to practice and refine more advanced motor skills. This hypothesis will be tested in the ongoing clinical trial.
Citation:
Prosser, Laura A, PT, PhD; Bush, Karah , PT; Cort, Julie , PT, DPT; Tubridy, Meghan , PT, DPT. Dynamic body weight support allows toddlers with and without cerebral palsy to perform motor skills beyond their current level of function.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/109_prosser-et-al/