Therapeutic Lower Extremity Power Training Alters the Sensorimotor Cortical Activity of Individuals With Cerebral Palsy.

Objective: To utilize magnetoencephalographic (MEG) brain imaging to examine potential changes in sensorimotor cortical oscillations after therapeutic power training in individuals with cerebral palsy (CP). Design: Cohort. Setting: Academic medical center. Participants: Individuals with CP (N=11; age=15.9±1.1 years; Gross Motor Function Classification System I- III) and neurotypical controls (NTs; N=16; age=14.6±0.8 years). Interventions: Participants with CP underwent 24 (8 weeks; 3 days a week) sessions of high-velocity lower extremity power training on a leg press. The NTs underwent single baseline MEG assessments. Main Outcome Measures: Pre-post bilateral leg press 1-repetition maximum and peak power production were used to assess the muscular performance changes. The 10-m walk and 1-minute walk tests were used to assess mobility changes. During MEG recordings, participants used their right leg to complete a goal-directed isometric target-matching task. Advanced beamforming methods were subsequently used to image the strength of the sensorimotor beta oscillatory power. Results: Before the therapeutic power training, the participants with CP had stronger beta sensorimotor cortical oscillations compared with the NT controls. However, the beta sensorimotor cortical oscillations were weaker and approximated the controls after the participants with CP completed the therapeutic power training protocol. There also was a link between the amount of improvement in leg peak power production and the amount of reduction in sensorimotor cortical oscillations seen after therapy. Conclusions: Therapeutic power training appears to optimize the sensorimotor cortical oscillations of individuals with CP, and these neuroplastic changes partly contribute to improvements in the leg peak power production of individuals with CP. Therapeutic power training might provide the key ingredients for beneficial neuroplastic change.

Power training alters somatosensory cortical activity of youth with cerebral palsy.

OBJECTIVE: Our prior magnetoencephalographic (MEG) investigations demonstrate that persons with cerebral palsy (CP) have weaker somatosensory cortical activity than neurotypical (NT) controls, which is associated with reduced muscular strength and mobility. Power training can improve lower extremity isokinetic strength, muscular power, and walking performance of youth with CP. Potentially, these clinically relevant improvements are partially driven by changes in somatosensory processing. The objective of this investigation was to determine if power training has complementary changes in muscular function and somatosensory cortical activity in youth with CP. METHODS: A cohort of youth with CP (N = 11; age = 15.90 ± 1.1 years) and NT controls (N = 10; Age = 15.93 ± 2.48 years) participated in this investigation. Youth with CP underwent 24 power training sessions. Pre-post bilateral leg press 1-repetition maximum (1RM), peak power production, 10-m walking speed, and distance walked 1-min were used as outcome measures. MEG neuroimaging assessed the changes in somatosensory cortical activity while at rest. NT controls only underwent a baseline MEG assessment. RESULTS: Youth with CP had a 56% increase in 1RM (p < 0.001), a 33% increase in peak power production (p = 0.019), and a 4% improvement in 1-min walk (p = 0.029). Notably, there was a 46% increase in somatosensory cortical activity (p = 0.02). INTERPRETATION: These results are the first to show that power training is associated with improvements in muscular function, walking performance, and the resting somatosensory cortical activity in individuals with CP. This treatment approach might be advantageous due to the potential to promote cortical and muscular plasticity, which appear to have carryover effects for improved walking performance.

Exploration of a novel physical therapy protocol that uses a sensory substitution device to improve the standing postural balance of children with balance disorders.

OBJECTIVE: To explore if an intensive balance training protocol that incorporated the BrainPort sensory substitution device improves the standing postural balance of children with balance disorders. METHODS: Eight children with balance disorders received 8-weeks of balance training while using the BrainPort device. Pre- and post-intervention changes in the Bruininks-Oseretsky Test of Motor Proficiency balance subtest (BOT-2) scores, standing duration on an unstable surface, and center of pressure (COP) sway were assessed. RESULTS: Post-intervention, the BOT-2 balance subtest scores increased by 29.6% and demonstrated clinically meaningful improvements. Overall, the standing duration with vision increased. The standing duration on the unstable surface without vision increased significantly from pre- to post-intervention. However, anterior-posterior (AP) and medial-lateral (ML) sway did not change post-intervention. The children also reported new functional activities (i.e. riding a bike, standing on unsteady or narrow surfaces). CONCLUSION: Balance training with the BrainPort sensory substitution device has the potential to result in clinically relevant improvements in the standing postural balance of children with balance disorders.

Neuromagnetic activity of the somatosensory cortices associated with body weight-supported treadmill training in children with cerebral palsy.

BACKGROUND AND PURPOSE: It has been previously shown that body weight-supported treadmill training (BWSTT) can improve the walking performance of children with cerebral palsy (CP). Potentially, the sensorimotor experience from BWSTT may facilitate reorganization of the brain areas that are involved in the control of the stepping pattern. We explored whether BWSTT has the potential to promote parallel changes in the motor behavior of children with CP and the activity of the somatosensory cortices. METHODS: Four children with spastic diplegic CP (age = 13.7 ± 2 years; 3 males and 1 female) who had Gross Motor Function Classification Scores that ranged from III to IV participated in this investigation. The body weight-supported treadmill training was performed twice a week for 6 weeks. Magnetoencephalography brain imaging was used to determine whether the amplitudes of the early latency somatosensory cortical responses changed after BWSTT. Motor behavioral outcomes included changes in walking speed, walking endurance, and lower extremity strength. RESULTS: The neuromagentic source amplitudes were attenuated after BWSTT and were accompanied by faster walking speeds and improved lower extremity strengths. DISCUSSION AND CONCLUSIOINS: These preliminary findings suggest that the BWSTT sensorimotor experience may result in neuroeconomical changes that reduce cortical processing demands in children with CP. Furthermore, these neuroplastic changes may be related to the parallel changes in the walking performance and lower extremity strength of children with CP.

Differences in the dynamic gait stability of children with cerebral palsy and typically developing children.

The aim of this investigation was to evaluate the differences in the dynamic gait stability of children with cerebral palsy (CP) and typically developing (TD) children. The participants walked on a treadmill for 2 min as a motion capture system assessed the walking kinematics. Floquet analysis was used to quantify the rate of dissipation of disturbances that were present in the walking kinematics, and the variability measures were used to assess the magnitude of the disturbances present in the step length and width. The Floquet multipliers, step width and length values were correlated with Sections D and E of the Gross Motor Function Measure (GMFM). The children with CP had a larger Floquet multiplier and used a wider step width than the TD children. The magnitude of the maximum Floquet multiplier was positively correlated with the step width. Furthermore, the magnitude of the maximum Floquet multiplier and the step width were negatively correlated with the score on Section E of the GMFM. Lastly, the children with CP used a more variable step length than the TD children. These results suggest that children with CP have poor dynamic gait stability because they require more strides to dissipate the disturbances that are present in their walking pattern. In effort to stabilize these disturbances, the children with CP appear to utilize a wider step width and modulate their step length. Overall the inability to effectively dissipate the gait disturbances may be correlated with the child's ability to perform a wide range of gross motor skills (e.g., step over obstacles, jump, walk up stairs).

Evaluation of lower body positive pressure supported treadmill training for children with cerebral palsy.

PURPOSE: To examine the feasibility of using lower body positive pressure supported (LBPPS) treadmill training to improve the walking abilities, balance and lower extremity strength of children with cerebral palsy (CP). METHODS: Nine children with CP (GMFCS II-IV) participated in LBPPS treadmill training 2 days per week for 6 weeks. Pre and post training measures of preferred walking speed, spatiotemporal kinematics, lower extremity strength, and the BESTest were used to assess potential improvements from LBPPS treadmill training. RESULTS: LBPPS treadmill training resulted in significantly faster walking speed, less time in double support, improved overall balance, and strength of the lower extremity antigravity musculature. CONCLUSIONS: It is feasible to use LBPPS treadmill training to improve the walking performance, balance, and strength of children with CP.