Sarah Foley

Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial.

OBJECTIVE To evaluate the efficacy of 9 weeks of twice-weekly partial body weight-supported treadmill training (PBWSTT) for children with cerebral palsy (CP) and moderate to severe walking difficulty compared with overground walking. DESIGN Randomized controlled trial. SETTING Metropolitan Specialist School for children with moderate to severe physical and/or intellectual disabilities. PARTICIPANTS Thirty-four children classified level III or IV by the Gross Motor Function Classification System were recruited and randomly allocated to experimental or control groups. Of these, 26 (15 girls, 11 boys; mean age 10 y, 10 mo +/- 3 y, 11 mo [range, 5-18 y]) completed training and testing. INTERVENTIONS Both groups completed 9 weeks of twice-weekly walking training. The experimental group completed PBWSTT, and the control group completed overground walking practice. MAIN OUTCOME MEASURES Ten-meter walk test (self-selected walking speed), 10-minute walk (walking endurance), School Function Assessment. RESULTS The overground walking group showed a trend for an increase in the distance walked over 10 minutes (F=3.004, P=.097). There was no statistically significant difference in self-selected walking speed over 10 meters or in walking function in the school environment as measured by the School Function Assessment. CONCLUSIONS PBWSTT is safe and feasible to implement in a special school setting; however, it may be no more effective than overground walking for improving walking speed and endurance for children with CP. Continued emphasis on progressive reduction of body weight support along with adding concurrent overground walking practice to a treadmill training protocol may increase the intensity of training and assist with carryover of improvements to overground walking. Treadmill training programs that include concurrent overground walking as an additional key feature of the training protocol need to be rigorously evaluated for children with CP.

Whose goal is it anyway? Self-directed goal setting for children with cerebral palsy

1200 consultations, Horridge et al. describe the great variability within our patient population and how the number of needs reflects complexity of care. As the data collection is embedded into the consultation, it generates meaningful information for the clinician and at the same time provides valuable administrative data about the complexity of the patient population that is being cared for. Needs as an indicator might seem subjective and difficult to account for in comparison to clearly established diagnostic criteria. But, even with clear diagnostic criteria we already observe a hunt for diagnoses in children with high needs if there is the impression that more services would become available with a certain label. We also see many children who definitively have high needs but no established diagnosis, lost outside the bureaucratic walls of the silos of funding agencies. For the future we can envision greater equitability if the number of needs or a similar approach get widely adopted. Services would be provided to children with disabilities and their families based on their needs, avoiding being locked out of specific diagnostic funding streams.