Training to enhance walking in children with cerebral palsy: are we missing the window of opportunity?
The objective of this paper is to (1) identify from the literature a potential critical period for the maturation of the corticospinal tract (CST) and (2) report pilot data on an intensive, activity-based therapy applied during this period, in children with lesions to the CST. The best estimate of the CST critical period for the legs is when the child is younger than 2 years of age. Previous interventions for walking in children with CST damage were mainly applied after this age. Our preliminary results with training children younger than 2 years showed improvements in walking that exceeded all previous reports. Further, we refined techniques for measuring motor and sensory pathways to and from the legs, so that changes can be measured at this young age. Previous activity-based therapies may have been applied too late in development. A randomized controlled trial is now underway to determine if intensive leg therapy improves the outcome of children with early stroke.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada. Jaynie.yang@ualberta.ca
Jaynie F
JF
Yang
Donna
D
Livingstone
Kelly
K
Brunton
Dasom
D
Kim
Barbara
B
Lopetinsky
Francois
F
Roy
Ephrem
E
Zewdie
Susan K
SK
Patrick
John
J
Andersen
Adam
A
Kirton
Joe-Man
JM
Watt
Jerome
J
Yager
Monica
M
Gorassini
D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation*; D003423:Critical Period, Psychological; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D011712:Pyramidal Tracts / Q000254:growth & development* / Q000502:physiology; D012026:Reflex, Stretch / Q000502:physiology; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*