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Task-Specific and Functional Effects of Speed-Focused Elliptical or Motor-Assisted Cycle Training in Children with Bilateral Cerebral Palsy: Randomized Clinical Trial

Diane L. Damiano, PhD, Christopher J. Stanley, MS, Laurie Ohlrich, MS, and Katharine E. Alter, MD

Background: Locomotor training using treadmills or robotic devices is commonly utilized to improve gait in cerebral palsy (CP); however, effects are inconsistent and fail to exceed those of equally intense alternatives. Possible limitations of existing devices include fixed non-variable rhythm and too much limb or body weight assistance.

Objective: To quantify and compare effectiveness of a motor-assisted cycle and a novel alternative, an elliptical, in CP to improve interlimb reciprocal coordination through intensive speed-focused leg training.

Methods: A total of 27 children with bilateral CP, 5 to 17 years old, were randomized to 12 weeks of 20 minutes, 5 days per week home-based training (elliptical = 14; cycle = 13) at a minimum of 40 revolutions per minute, with resistance added when speed target was achieved. Primary outcomes were self-selected and fastest voluntary cadence on the devices and gait speed. Secondary outcomes included knee muscle strength, and selective control and functional mobility measures.

Results: Cadence on trained but not non-trained devices increased, demonstrating task specificity of training and increased exercise capability. Mean gait speed did not increase in either group, nor did parent-reported functional mobility. Knee extensor strength increased in both. An interaction between group and time was seen in selective control with scores slightly increasing for the elliptical and decreasing for the cycle, possibly related to tighter limb coupling with cycling.

Conclusions: Task-specific effects were similarly positive across groups, but no transfer was seen to gait or function. Training dose was low (≤20 hours) compared with intensive upper limb training recommendations and may be insufficient to produce appreciable clinical change.

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