The effects of treadmill training on postural control and balance in children with spastic diplegic cerebral palsy: A cross-over controlled study

Background & Objective: Treadmill training (TT) is used for several targets as in walking speed and endurance in rehabilitation programs of children with cerebral palsy (CP). However, its effects on postural stability have not been fully explored. The aim of this study was to investigate the effects of unsupported TT on postural control (PC) parameters and balance in children with spastic diplegic CP. Methods: Twelve children with CP, level I-II according to Gross-Motor-Function-Classification System (GMFCS) were included. Participants were divided into two groups using randomized-sampling method. The study was designed as a cross-over study. In the first phase, the first group underwent routine physiotherapy-rehabilitation program (PTR) 3 sessions/week, 45 minutes per session, for 12 weeks. In the second group, 20 minutes of TT starting with 0.5 km/h speed, was added to the same PTR (n=6). At the end of 12 week, 4-week-long wash-out period was given. After this 4 weeks period, both groups crossed-over for another 12 weeks at the second phase of therapy. All tests was applied at baseline and at end of the first and second phases. PC was evaluated with Balance-Master computerized posturography (Neurocom Inc.) which consisted of tests of modified-clinical-sensory balance-interaction (MCSBT), weight-shifting-in-standing (WSST), limits-of-stability (LoST) and rhythmic-weight-shifting (RWST). Results: The two groups were similar in age, body composition, GMFCS Levels and spasticity levels before the treatment and after the wash-period (p>0,05). After TT, there were significant improvements in PC parameters, MCSBT: composite-balance-score (p=0.02), center of gravity alignment (p=0.02); WSST: symmetry (p=0.03); LoST: backward weight-shifting (p=0,02), end point reaching (p=0.02-0.04), maximum-orientation (p=0.02-0.04); RWST: direction control (p=0.02-0.04), on-axis-velocity (p=0.02-0.04).Conclusion: Including TT in PTR treatment program can enhance PC and balance in children with CP.