The Effect of Locomotor Assisted Therapy on Lower Extremity Motor Performance in Typically Developing Children and Children with Cerebral Palsy

Abstract

Background: Ambulation is critical to a child’s participation, development of selfconcept, and quality of life. Children with cerebral palsy (CP) frequently exhibit limitation in walking proficiency which has been identified as the primary physical disability. Traditional rehabilitative treatment techniques to improve ambulation for children with CP reveal inconsistent results. Driven gait orthosis (DGO) training is a novel approach focusing on motor learning principles that foster cortical neural plasticity. Objective: The objectives are to determine if: (i) the lower extremity muscle activation patterns of children with CP are similar to age-matched TD children in overground (OG) walking, (ii) DGO training replicates muscle activation patterns in OG ambulation in TD children, (iii) the lower extremity muscle activation patterns in OG walking of children with CP are similar to their muscle activation patterns with DGO assistance, and (iv) DGO training promotes unimpaired muscle activation patterns in children with CP. Methods: Muscle activity patterns of the rectus femoris, semitendinosus, gluteus maximus and gluteus medius were recorded in the OG and DGO walking conditions of children with CP and age-matched TD. The gait cycles were identified and the data was averaged to produce final average gait cycle time normalized values. Results: In comparing the variability of the muscle activation patterns within the subject groups, CP DGO walking was considerably lower than CP OG. In comparing the muscle activation patterns in each condition, consistent differences (p < .05) were noted in terminal stance, pre-swing and initial swing phases of gait with the DGO condition consistently revealing greater muscle unit recruitment. Conclusion: The results indicate that training in the DGO provided the ability to practice with measurably repetitive movement as evidenced by decreased variability. Consistent differences were noted in muscle activation patterns in the terminal stance, pre-swing and initial swing phases of gait when most of these muscles are primarily inactive. The alteration in ground reaction force within the DGO environment may play a role in this variance. With the goal of normalizing gait, it is important that the effect of these parameters on ground reaction forces be considered in the use of DGO rehabilitation.