Gross motor function
A high level RCT (Chrysagis et al, 2012) examined the effect of a treadmill training program on gross motor function and self-selected walking speed in adolescents with spastic cerebral palsy as compared to conventional physical therapy. Both gross motor function as measured by the GMFM and self-selected walking speed improved more in the experimental group. However, effect size was less for gross motor function which may be explained by the fact that the control group received training for dimension D and E of the GMFM.
A fair RCT (Willoughby et al, 2010) studied the safety and feasibility of a partial body-weight supported program held in special school environment and investigated if partial body weight supported treadmill training can increase walking endurance, speed and function at school as compared to overground training. Both groups improved after intervention. Results indicated that improvements made in speed and endurance during treadmill training are not necessarily transferable to overground walking. Results demonstrate that partial body weight supported treadmill training is probably just as effective as practicing overground walking.
A pre-post study (Greco et al, 2013) evaluated the effect of treadmill training on gross motor function and functional mobility in children and adolescents with cerebral palsy in a physical therapy program following orthopedic surgery in the lower limbs. Statistically significant improvements were noted post treadmill training for GMFM-88 subscale B, subscale C, subscale D, subscale E and total GMFM-88 score. Significant positive results with respect to distance travelled in 6-minute walk test and time tolerated on treadmill test. The results indicate that treadmill training is effective regardless if orthopedic surgery involved soft tissue only or soft tissue and bony structures.
A pre-post study (Borggraeft et al, 2010) investigated the effect of robotic-assisted treadmill training in children with cerebral palsy. It was found that robotic assisted gait training improves stabilization in standing and helps improve task specific walking activities as measured by the GMFM. However it is generally less effective for more severe cases of cerebral palsy.
A pre-post study (Mattern-Baxter et al, 2009) examined the effects of an intensive, short-term locomotor treadmill training program on gross motor skills in young children with cerebral palsy. Statistically significant improvements were made in dimension D and E of the GMFM. Largest improvements were demonstrated between pre-testing and 1 month post intervention suggesting that that children take a longer time to show improvements, but can also suggesting that improvements were made second to maturation.
A pre-post study (Provost et al, 2007) investigated the effects of a 2 week intensive body weight supported treadmill training program on endurance, functional gait and balance in children with cerebral palsy who are ambulatory. Results indicated that intensive body-weight supported treadmill training increases endurance and walking velocity. Each child performed differently but generally children with lowest scores initially benefitted most from program.
A matched-pairs controlled clinical trial (Dodd et al, 2007) studied whether a partial body weight supported treadmill training program at school could increase self-selected walking speed and endurance in children with moderate-severe cerebral palsy. There were statistically significant differences on self-selected 10-metre walk test after treadmill training (p=0.048). Experimental group demonstrated a mean increased of 4.21m/min in speed (68% increase) with large effect size (d=1.84, 95% CI=0.49-2,94). In terms of distance, trend towards longer distances with large effect size but not statistically significant.
A pre-post study (Krux et al, 2011) examined the effects of body weight supported treadmill training in children with cerebral palsy. After therapy, statistically significant findings were found regarding increased walking speed (p=0.02, d=0.86), step length (p=0.03, d=0.96), and dimension E of the GMFM (p=0.01, d=1.01).
A systematic review of the evidence (Damiano et al, 2009) indicated that the current level of evidence suggests that body weight supported treadmill training may be beneficial but it has not yet been sufficiently compared to other treatment approaches and so the relative benefits and costs cannot be accurately assessed. Protocols vary widely and there is not standardized protocol that can yet be applied or assumed.
A systematic review (Mutlu et al, 2009) reveals that the current evidence of partial body weight supported treadmill training is inconclusive due to methodological flaws in studies and significant heterogeneity in samples, intervention and outcomes. Future studies should compare partial body weight supported treadmill training to other commonly used physical therapy approaches, avoid cross-contamination from other intervention, include more functional outcomes and include fMRI.
A systematic review (Willoughby et al, 2009) suggests that treadmill training in children with cerebral palsy has a positive effect on overground walking, no effect on walking endurance or amount of physical support required, a positive impact on improving general gross skills, no change on muscle tone. No studies reported on effect of participation and no adverse effects were reported.
Conclusion: There is moderate evidence (level 1b) from one high quality RCT demonstrating that treadmill training has a positive effect on gross motor function but further research should be conducted to compare it to conventional therapy.
