Ambulatory children with cerebral palsy (CP) experience walking limitations which negatively influence their ability to physically participate in day to day life. The investigators propose that impaired muscle power generation is the key limiting factor affecting walking activity and participation. This proposal represents a combined approach where participants undergo resistance training for muscle power generation in combination with locomotor treadmill training that is based on typical pediatric walking and activity patterns rather than adult protocols, which are endurance or time-based. Therefore, the primary objective of this randomized controlled trial is to determine the effect of lower extremity Power Training combined with interval Treadmill Training (PT³) on functional walking capacity and community-based activity and participation in children with CP. We hypothesize that remediating the most pronounced muscle performance impairment (i.e., muscle power) with power training combined with a task- specific approach to walking that is developmentally appropriate will have a significant effect on walking capacity and performance.

Brief Title

Power Training Combined With Interval Treadmill Training

Official Title

Power Training Combined With Interval Treadmill Training to Improve Walking Activity in Cerebral Palsy (PT³)

Brief Summary

Ambulatory children with cerebral palsy (CP) experience walking limitations which negatively <br /> influence their ability to physically participate in day to day life. The investigators <br /> propose that impaired muscle power generation is the key limiting factor affecting walking <br /> activity and participation. This proposal represents a combined approach where participants <br /> undergo resistance training for muscle power generation in combination with locomotor <br /> treadmill training that is based on typical pediatric walking and activity patterns rather <br /> than adult protocols, which are endurance or time-based. Therefore, the primary objective of <br /> this randomized controlled trial is to determine the effect of lower extremity Power Training <br /> combined with interval Treadmill Training (PT³) on functional walking capacity and <br /> community-based activity and participation in children with CP. We hypothesize that <br /> remediating the most pronounced muscle performance impairment (i.e., muscle power) with power <br /> training combined with a task- specific approach to walking that is developmentally <br /> appropriate will have a significant effect on walking capacity and performance.

Detailed Description

The primary purpose of this randomized controlled trial is to test the effect of Power
Training combined with interval Treadmill Training (PT³) on walking capacity and performance
in children with CP with walking limitations. To identify key muscular mechanisms associated
with improved walking mobility, the effects of PT³ on muscle performance and architecture
will be examined. The premise of the PT³ protocol is that a combined impairment and
task-specific approach that is developmentally appropriate and targets muscle power deficits
specifically, is necessary to drive changes in both clinic and community-based walking
activity.

In this randomized multi-site clinical trial, 48 ambulatory participants with CP will receive
either PT³ or an equivalent dosage of traditional strength training combined with traditional
treadmill training (comparison group) for 24 sessions, 3 times per week for 8 weeks. Outcomes
will be collected at baseline and immediately post-treatment. Short and long-term retention
effects will be assessed at 2 and 6 months post.

Outcome Measures

Outcome measures are the tests that investigators perform to prove whether or not a treatment being tested in a clinical trial is having any effect.

Inclusion Criteria:

  -  Diagnosis of bilateral spastic Cerebral Palsy (CP)

  -  Age 10 to 17 years inclusive

  -  GMFCS levels I, II, or III

Exclusion Criteria:

  -  Orthopedic or neurosurgery less than 12 months prior to enrollment

  -  Injection therapies (phenol, botulinum toxin) less than 3 months prior to enrollment

  -  Lacking greater than 25 degrees of knee extension