Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis.
BACKGROUND
Children with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear.


OBJECTIVE
The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP.


METHODS
MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014.


METHODS
The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure.


METHODS
Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded.


RESULTS
Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=-0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category.


CONCLUSIONS
Gait speed was the only outcome measure analyzed.


CONCLUSIONS
Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.
N.G. Moreau, PT, PhD, Department of Physical Therapy, Louisiana State University Health Sciences Center, 1900 Gravier St, 7th Floor, New Orleans, LA 70112 (USA). Nmorea@lsuhsc.edu.
Noelle G
NG
Moreau
A.W. Bodkin, PT, PhD, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Amy Winter
AW
Bodkin
K. Bjornson, PT, PhD, Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington.
Kristie
K
Bjornson
A. Hobbs, PT, DPT, Department of Physical Therapy, Louisiana State University Health Sciences Center.
Amy
A
Hobbs
M. Soileau, PT, DPT, Department of Physical Therapy, Louisiana State University Health Sciences Center.
Mallary
M
Soileau
K. Lahasky, PT, DPT, Department of Physical Therapy, Louisiana State University Health Sciences Center.
Kay
K
Lahasky
D000293:Adolescent; D001676:Biofeedback, Psychology; D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D006801:Humans; D026741:Physical Therapy Modalities; D055070:Resistance Training; D014732:Vibration; D000072797:Walking Speed / Q000502:physiology*