Effects of adding load to the gait of children with cerebral palsy: a three-case report

Our purpose in this study was to analyze the immediate effects of locomotor gait training with different loads on a treadmill on the kinematic parameters of gait in children with Spastic Hemiparetic Cerebral Palsy (SHCP), as well as investigating which load prompted the most adequate motor responses to promote the propulsion of the Paretic Lower Limb (PLL). This case report included 3 children of both sexes, aged 8-12 years. The children walked on the treadmill with loads on their ankles that corresponded to 40, 50 and 60% of the weight of the Lower Limb (LL), on 3 different non-consecutive days. The kinematic parameters were assessed during the pre-training phase (PTPH) and immediately after training (PHI). The spatiotemporal variables did not change immediately after gait training with the aforementioned loads. On the other hand, we observed wider joint angles in the hip and knee during the swing phase immediately after training, especially with a load of 60% of the weight of the lower limb. These findings indicate that the 60% load is the most appropriate to prompt immediate changes in the joint kinematics of the PLL. These alterations can be important in improving propulsion during the swing phase of gait in children with SHCP.本研究旨在探究不同负重跑台步行步态训练对痉挛性偏瘫型脑瘫（Spastic Hemiparetic Cerebral Palsy, SHCP）患儿步态运动学参数的即时影响，并明确可诱导最优运动反应以促进偏瘫侧下肢（Paretic Lower Limb, PLL）推进功能的负重方案。本病例报告纳入3名年龄介于8~12岁的男女患儿，受试者分别于3个非连续的实验日内，在踝部佩戴相当于下肢（Lower Limb, LL）体重40%、50%及60%的负重装置进行跑台步行训练。分别于训练前阶段（PTPH）及训练后即刻（PHI）对步态运动学参数进行评估。采用上述负重进行步态训练后，时空参数未出现即时变化。与之相对，训练后即刻的步态摆动相中，患儿髋、膝关节活动角度显著增大，其中以下肢体重60%负重组的改变最为突出。上述研究结果表明，60%负重是诱导偏瘫侧下肢关节运动学产生即时改变的最优负重方案，此类运动学改变对于改善痉挛性偏瘫型脑瘫患儿步态摆动相的推进功能具有重要的临床意义。