Short-Burst Interval Treadmill Training to Improve Community Walking Activity and Mobility in Cerebral Palsy

Project Summary/Abstract:
Ambulatory children with cerebral palsy (CP) walk predominately in low intensity stride rates with little
variability, thus limiting their walking activity and ability to participate in daily life. In contrast, typically
developing (TD) children engage in short bursts of intense walking activity interspersed with varying intervals of
low intensity walking within daily life. In order to optimize motor learning, active participation, task-specific
training and multiple repetitions or massed practice is required to learn new motor skills. Short bursts of
vigorous intensity locomotor treadmill training (SBLTT) alternating with low/moderate intensity was specifically
designed to mimic activity patterns of TD children in a massed practice format. Pilot data suggests that SBLTT
is feasible and enhances walking capacity and performance in daily life for children with CP. The objective of
this application is to examine the effect of SBLTT versus an equivalent dosage of traditional locomotor
treadmill training (TLTT) on the primary outcomes of walking capacity and performance in children with CP.
This protocol will also examine whether the effects of SBLTT on walking capacity and performance are
mediated by improvements in in muscle power generation. The scientific premise is that SBLTT, that
approximates the walking intensity patterns of typically developing (TD) children through a clinically feasible
massed practice protocol, will be more effective than TLTT in improving walking capacity and performance. We
hypothesize that SBLTT strategies for children with CP modeled on activity patterns in TD children, will be
positively mediated by muscle power generation and subsequently improve walking capacity and community
walking performance and mobility. We will test the following specific aims. Aim #1. Determine the immediate
and retention effects of short-burst interval LTT (SBLTT) on walking capacity in ambulatory children with CP.
Walking capacity will be measured by self-selected gait speed and the one minute walk test. Aim #2. Examine
the effects of treatment on community-based walking activity performance and mobility. Walking activity
performance will be captured by accelerometry. Community walking mobility individualized by home versus
community locations will be measured with a novel combination of global position system and accelerometry.
Aim #3. Explore whether the effects of SBLTT on walking capacity and performance are mediated by muscle
power generation. This project is innovative because it focuses novel task-specific approach for addressing
walking limitations in children with CP and implements an individualized community locations outcome. The
proposed research is significant because it will be the first step in a continuum of research that is expected to
direct locomotor training protocols and rehab strategies across pediatric disabilities and positively effecting the
community walking performance and mobility for children with CP. Increased understanding of the muscular
mechanisms by which children with CP respond to SBLTT are expected. Such knowledge has relevance to the
health and functional benefits of enhanced mobility and physical activity across the life span.

Grant Number: 5R01HD098270-05
NIH Institute/Center: NIH
Principal Investigator: KRISTIE BJORNSON