Effectiveness of Treadmill Training on Walking Ability in Adults with Cerebral Palsy: A Systematic Review and Meta-Analysis

Nikolaos Chrysagis, Georgios Theotokatos, Emmanouil Skordilis, Vasiliki Sakellari, Eirini Grammatopoulou, George A Koumantakis

Abstract


Background: Patients with cerebral palsy (CP) may necessitate long-term treatment and monitoring of their condition, not only during the period of development but also during adulthood. Objectives: This systematic review aimed to analyze evidence from randomized controlled trials (RCTs) that have investigated the effect of treadmill training on walking ability in adults with cerebral palsy. Methods: RCTs were identified and selected systematically, with appropriate keywords applied in four scientific databases (Medline, Scopus, the Cochrane Library, and the Physiotherapy Evidence Database) and one bibliographic search engine (Google Scholar) from January 1980 to September 2021. Two assessors extracted and analyzed data from relevant RCTs published in English and then independently rated those studies for risk of bias with the Risk of Bias (RoB 2) tool. Results: Out of the 96 studies that were initially identified, 93 were excluded, as these either did not meet the inclusion criteria or were duplicates. Three clinical trials were finally included, characterized by some concerns and a high risk of bias (RoB 2). Meta-analysis was only performed for the maximum distance in the ‘6-minute walk for distance test’, due to differences in the remaining outcomes utilized between studies. Overall, there was evidence of some concerns and high risk of bias that treadmill training did not significantly improve the walking ability in adult patients with CP relative to the control conditions. Conclusion: More high-quality RCTs are required, examining the effectiveness of treadmill training on different aspects of walking ability such as gait speed, endurance, and energy expenditure.

Keywords


Cerebral Palsy, Adults, Treadmill, Exercise, Physical Therapy, Walking, Gait

Full Text:

PDF

References


Azizi, S., Birgani, P. M., Marzbani, H., Nourian, R., Kohanpour, M., & Mirbagheri, M. M. (2018). Assessment of neuroplasticity of corticospinal tract induced by antigravity treadmill (AlterG) in cerebral palsy children. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference, 2018, 2495–2498. https://doi.org/10.1109/EMBC.2018.8512730

Bahrami, F., Noorizadeh Dehkordi, S., & Dadgoo, M. (2019). The Efficacy of Treadmill Training on Walking and Quality of Life of Adults with Spastic Cerebral Palsy: A Randomized Controlled Trial. Iranian Journal of Child Neurology, 13(4), 121–133. https://doi.org/10.22037/ijcn.v13i4.16207

Booth, A., Buizer, A. I., Meyns, P., Oude Lansink, I., Steenbrink, F., & van der Krogt, M. M. (2018). The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis. Developmental Medicine and Child Neurology, 60(9), 866–883. https://doi.org/10.1111/dmcn.13708

Chrysagis, N., Skordilis, E. K., Stavrou, N., Grammatopoulou, E., & Koutsouki, D. (2012). The effect of treadmill training on gross motor function and walking speed in ambulatory adolescents with cerebral palsy: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation, 91(9), 747–760. https://doi.org/10.1097/PHM.0b013e3182643eba

Damiano, D. L., & DeJong, S. L. (2009). A systematic review of the effectiveness of treadmill training and body weight support in pediatric rehabilitation. Journal of Neurologic Physical Therapy: JNPT, 33(1), 27–44. https://doi.org/10.1097/NPT.0b013e31819800e2

Ericsson, K. A., Krampe, R. T., & Heizmann, S. (1993). Can we create gifted people? Ciba Foundation Symposium, 178, 222–249. https://doi.org/10.1002/9780470514498.ch14

Geertsen, S. S., Kirk, H., Lorentzen, J., Jorsal, M., Johansson, C. B., & Nielsen, J. B. (2015). Impaired gait function in adults with cerebral palsy is associated with reduced rapid force generation and increased passive stiffness. Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology, 126(12), 2320–2329. https://doi.org/10.1016/j.clinph.2015.02.005

Gjesdal, B. E., Jahnsen, R., Morgan, P., Opheim, A., & Mæland, S. (2020). Walking through life with cerebral palsy: reflections on daily walking by adults with cerebral palsy. International Journal of Qualitative Studies on Health and Well-Being, 15(1), 1746577. https://doi.org/10.1080/17482631.2020.1746577

Graham, D., Paget, S. P., & Wimalasundera, N. (2019). Current thinking in the health care management of children with cerebral palsy. The Medical Journal of Australia, 210(3), 129–135. https://doi.org/10.5694/mja2.12106

Hadders-Algra M. (2000). The neuronal group selection theory: promising principles for understanding and treating developmental motor disorders. Developmental Medicine and Child Neurology, 42(10), 707–715. https://doi.org/10.1017/s0012162200001316

Halliday, M. R., Abeydeera, D., Lundquist, A. J., Petzinger, G. M., & Jakowec, M. W. (2019). Intensive treadmill exercise increases expression of hypoxia-inducible factor 1α and its downstream transcript targets: a potential role in neuroplasticity. Neuroreport, 30(9), 619–627. https://doi.org/10.1097/WNR.0000000000001239

Han, Y. G., & Yun, C. K. (2020). Effectiveness of treadmill training on gait function in children with cerebral palsy: meta-analysis. Journal of Exercise Rehabilitation, 16(1), 10–19. https://doi.org/10.12965/jer.1938748.374

Hesse S. (2001). Locomotor therapy in neurorehabilitation. NeuroRehabilitation, 16(3), 133–139. https://doi.org/10.3233/NRE-2001-16302

Higgins J. P. T., Eldridge S., & Li T. (2019). Chapter 23: Including variants on randomized trials. In: J. P. T. Higgins, J. Thomas, J. Chandler, M. Cumpston, T. Li, M. J. Page, V. A. Welch (Eds.). Cochrane Handbook for Systematic Reviews of Interventions. (2nd ed.) (pp. 569-593). Chichester (UK): John Wiley & Sons. https://doi.org/10.1002/9781119536604.ch23

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (2019). Cochrane Handbook for Systematic Reviews of Interventions. (2nd ed.) Chichester (UK): John Wiley & Sons. https://doi.org/10.1002/9781119536604

Horsman, M., Suto, M., Dudgeon, B., & Harris, S. R. (2010). Ageing with cerebral palsy: psychosocial issues. Age and Ageing, 39(3), 294–299. https://doi.org/10.1093/ageing/afq018

Hüche Larsen, H., Frisk, R. F., Willerslev-Olsen, M., & Nielsen, J. B. (2021). Motor-learning based activities may improve functional ability in adults with severe cerebral palsy: A controlled pilot study. NeuroRehabilitation, 48(3), 273–283. https://doi.org/10.3233/NRE-201581

Jahnsen, R., Villien, L., Aamodt, G., Stanghelle, J. K., & Holm, I. (2004). Musculoskeletal pain in adults with cerebral palsy compared with the general population. Journal of Rehabilitation Medicine, 36(2), 78–84. https://doi.org/10.1080/16501970310018305

Johnston, T. E., Watson, K. E., Ross, S. A., Gates, P. E., Gaughan, J. P., Lauer, R. T., Tucker, C. A., & Engsberg, J. R. (2011). Effects of a supported speed treadmill training exercise program on impairment and function for children with cerebral palsy. Developmental Medicine and Child Neurology, 53(8), 742–750. https://doi.org/10.1111/j.1469-8749.2011.03990.x

Kim, O. Y., Shin, Y. K., Yoon, Y. K., Ko, E. J., & Cho, S. R. (2015). The effect of treadmill exercise on gait efficiency during overground walking in adults with cerebral palsy. Annals of Rehabilitation Medicine, 39(1), 25–31. https://doi.org/10.5535/arm.2015.39.1.25

Lorentzen, J., Kirk, H., Fernandez-Lago, H., Frisk, R., Scharff Nielsen, N., Jorsal, M., & Nielsen, J. B. (2017). Treadmill training with an incline reduces ankle joint stiffness and improves active range of movement during gait in adults with cerebral palsy. Disability and Rehabilitation, 39(10), 987–993. https://doi.org/10.1080/09638288.2016.1174745

Maestro-Gonzalez, A., Bilbao-Leon, M. C., Zuazua-Rico, D., Fernandez-Carreira, J. M., Baldonedo-Cernuda, R. F., & Mosteiro-Diaz, M. P. (2018). Quality of life as assessed by adults with cerebral palsy. PloS One, 13(2), e0191960. https://doi.org/10.1371/journal.pone.0191960

Moreau, N. G., Bodkin, A. W., Bjornson, K., Hobbs, A., Soileau, M., & Lahasky, K. (2016). Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children with Cerebral Palsy: Systematic Review and Meta-analysis. Physical Therapy, 96(12), 1938–1954. https://doi.org/10.2522/ptj.20150401

Morgan, P., & McGinley, J. (2014). Gait function and decline in adults with cerebral palsy: a systematic review. Disability and Rehabilitation, 36(1), 1–9. https://doi.org/10.3109/09638288.2013.775359

Mutlu, A., Krosschell, K., & Spira, D. G. (2009). Treadmill training with partial body-weight support in children with cerebral palsy: a systematic review. Developmental Medicine and Child Neurology, 51(4), 268–275. https://doi.org/10.1111/j.1469-8749.2008.03221.x

Nascimento, L. R., Boening, A., Galli, A., Polese, J. C., & Ada, L. (2021). Treadmill walking improves walking speed and distance in ambulatory people after stroke and is not inferior to overground walking: a systematic review. Journal of Physiotherapy, 67(2), 95–104. https://doi.org/10.1016/j.jphys.2021.02.014

Opheim, A., Jahnsen, R., Olsson, E., & Stanghelle, J. K. (2009). Walking function, pain, and fatigue in adults with cerebral palsy: a 7-year follow-up study. Developmental Medicine and Child Neurology, 51(5), 381–388. https://doi.org/10.1111/j.1469-8749.2008.03250.x

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Journal of Clinical Epidemiology, 134, 178–189. https://doi.org/10.1016/j.jclinepi.2021.03.001

Petersen, T. H., Kliim-Due, M., Farmer, S. F., & Nielsen, J. B. (2010). Childhood development of common drive to a human leg muscle during ankle dorsiflexion and gait. The Journal of Physiology, 588(Pt 22), 4387–4400. https://doi.org/10.1113/jphysiol.2010.195735

Polese, J. C., Ada, L., Dean, C. M., Nascimento, L. R., & Teixeira-Salmela, L. F. (2013). Treadmill training is effective for ambulatory adults with stroke: a systematic review. Journal of Physiotherapy, 59(2), 73–80. https://doi.org/10.1016/S1836-9553(13)70159-0

Shih, S. T. F., Tonmukayakul, U., Imms, C., Reddihough, D., Graham, H. K., Cox, L., & Carter, R. (2018). Economic evaluation and cost of interventions for cerebral palsy: a systematic review. Developmental Medicine and Child Neurology, 60(6), 543–558. https://doi.org/10.1111/dmcn.13653

Slaman, J., Roebroeck, M., Dallmijer, A., Twisk, J., Stam, H., Van Den Berg-Emons, R., & Learn 2 Move Research Group (2015). Can a lifestyle intervention programme improve physical behaviour among adolescents and young adults with spastic cerebral palsy? A randomized controlled trial. Developmental Medicine and Child Neurology, 57(2), 159–166. https://doi.org/10.1111/dmcn.12602

Steuer, I., & Guertin, P. A. (2019). Central pattern generators in the brainstem and spinal cord: an overview of basic principles, similarities and differences. Reviews in the Neurosciences, 30(2), 107–164. https://doi.org/10.1515/revneuro-2017-0102

Tonmukayakul, U., Shih, S., Bourke-Taylor, H., Imms, C., Reddihough, D., Cox, L., & Carter, R. (2018). Systematic review of the economic impact of cerebral palsy. Research in Developmental Disabilities, 80, 93–101. https://doi.org/10.1016/j.ridd.2018.06.012

Tosi, L. L., Maher, N., Moore, D. W., Goldstein, M., & Aisen, M. L. (2009). Adults with cerebral palsy: a workshop to define the challenges of treating and preventing secondary musculoskeletal and neuromuscular complications in this rapidly growing population. Developmental Medicine and Child Neurology, 51 Suppl 4, 2–11. https://doi.org/10.1111/j.1469-8749.2009.03462.x

van der Slot, W. M., Nieuwenhuijsen, C., van den Berg-Emons, R. J., Wensink-Boonstra, A. E., Stam, H. J., Roebroeck, M. E., & Transition Research Group South West Netherlands (2010). Participation and health-related quality of life in adults with spastic bilateral cerebral palsy and the role of self-efficacy. Journal of Rehabilitation Medicine, 42(6), 528–535. https://doi.org/10.2340/16501977-0555

Verhoef, J. A., Bramsen, I., Miedema, H. S., Stam, H. J., Roebroeck, M. E., & Transition and Lifespan Research Group South West Netherlands (2014). Development of work participation in young adults with cerebral palsy: a longitudinal study. Journal of Rehabilitation Medicine, 46(7), 648–655. https://doi.org/10.2340/16501977-1832

Willoughby, K. L., Dodd, K. J., & Shields, N. (2009). A systematic review of the effectiveness of treadmill training for children with cerebral palsy. Disability and Rehabilitation, 31(24), 1971–1979. https://doi.org/10.3109/09638280902874204

Willoughby, K. L., Dodd, K. J., Shields, N., & Foley, S. (2010). Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 91(3), 333–339. https://doi.org/10.1016/j.apmr.2009.10.029

Yu, P., Zhang, W., Liu, Y., Sheng, C., So, K. F., Zhou, L., & Zhu, H. (2019). The effects and potential mechanisms of locomotor training on improvements of functional recovery after spinal cord injury. International Review of Neurobiology, 147, 199–217. https://doi.org/10.1016/bs.irn.2019.08.003




DOI: https://doi.org/10.7575/aiac.ijkss.v.9n.4p.34

Refbacks

  • There are currently no refbacks.


Bookmark and Share


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

2013-2024 (CC-BY) Australian International Academic Centre PTY.LTD.

International Journal of Kinesiology and Sports Science

You may require to add the 'aiac.org.au' domain to your e-mail 'safe list’ If you do not receive e-mail in your 'inbox'. Otherwise, you may check your 'Spam mail' or 'junk mail' folders.