The purpose of this study is to determine the associations between changes in neural activity and structure, advanced gross motor skills, gait characteristics, and physical activity participation following a gait-related intervention that is based on motor learning principles for ambulatory children and youth with hemiplegic and diplegic cerebral palsy. The investigators' hypothesis is that in conjunction with a program of motor learning based training, functional neuroplastic changes in the involved motor areas will be strongly associated with changes in gait and advanced gross motor skills, moderately associated with physical activity based participation changes, and will have a fair association with structural neuroplastic change.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
9
The motor learning (ML)-based functional gait-related training program is designed to improve advanced gross motor skills and athleticism. It will involve 45-min sessions twice to three times weekly over 6 weeks for a total of 16 active sessions. A maximum of 7 weeks will be permitted. Each session will consist of 35-min of active training along with a 10-min active warm-up/cool-down that incorporates ML. Scheduling flexibility will promote adherence, with a minimum one day between sessions to provide opportunity for rest. Children will be given a 3- to 5-min mental motor imagery script to practice on days when they do not have active training sessions. The total number of sessions (combined active/imagery) will be five per week.
Holland Bloorview Kids Rehabilitation Hospital
Toronto, Ontario, Canada
Change from baseline in functional activity in lower-limb related cortical areas, assessed using functional MRI (fMRI)
Time frame: 7 days pre/7 days post training intervention
Change from baseline in advanced motor skills on the Challenge Module
The Challenge Module is a new published measure of advanced motor skills.
Time frame: 7 days pre/7 days post/4-months post training intervention
Change from baseline in resting state activity, assessed using resting state fMRI
Time frame: 7 days pre/7 days post training intervention
Change from baseline in microstructure of brain, assessed using diffusion tensor imaging (DTI)
Time frame: 7 days pre/7 days post training intervention
Change from baseline in Physical Activity self-efficacy
Participant-report measure of Task efficacy and Barrier efficacy for physical activity.
Time frame: 7 days pre/7days post/4-months post training intervention
Change from baseline in walking activity, assessed using a StepWatch accelerometer
Participants will wear the StepWatch for 5 days.
Time frame: 7 days pre/7days post/4-months post training intervention
Change from baseline in gait kinematics as measured using an electronic walkway
Time/distance parameters of footsteps via GAITRite system.
Time frame: 7 days pre/7days post/4-months post training intervention
Change from baseline in gait kinetics/kinematics as measured using 3D motion capture system
Whole body gait analysis via Vicon motion capture and Bertec force plates.
Time frame: 7 days pre/7days post/4-months post training intervention
Change from baseline in physical activity participation, as measured using the Participation and Environment Measure for Children/Youth (PEM-CY)
Parent-report measure of participation in the home, school and community, as well as environmental factors within each setting.
Time frame: 7 days pre/7days post/4-months post training intervention
Change from baseline in walk speed on the Six-minute walk test
Standardized 6 minute walk test (with shoes, orthoses, walking devices as required) to determine distance covered (capability measure). Well-validated in pediatric CP.
Time frame: 7 days pre/7days post/4-months post training intervention
Change from baseline in targeted goal abilities and satisfaction with performance as measured by the Canadian Occupational Performance Measure
Three to five individualized walking-based activity/participation set at baseline with assessor and child/parent, and re-evaluated by child/parent at post-intervention assessments
Time frame: 7 days pre/7days post/4-months post training intervention
Change from baseline in targeted goal abilities as measured by Goal Attainment Scaling (GAS)
Three to five individualized walking-based activity/participation set at baseline with assessor and child/parent, and re-evaluated by child/parent at post-intervention assessments
Time frame: 7 days pre/7days post/4-months post training intervention
Motor learning content of interventions, as assessed using the Motor Learning Strategy Rating Instrument (MLSRI)
The MLSRI is used to assess the extent to which motor learning strategies are used within an intervention session
Time frame: Week 2, 4, 6
Motor learning as evaluated using retention and transfer tests
Individualized skills will be identified to practice at every session (retention) and only at sessions 5/10/15 (transfer) to evaluate motor learning
Time frame: Week 2, 4, 6
Change from baseline in lower-limb proprioception
Lower limb joint-sense position and kinesthesia will be assessed using a semi-goniometer (protocol modified from Wingert et al, 2009)
Time frame: 7 days pre/7days post/4-months post intervention
Mental chronometry: walking
Participants will be timed while walking a 10-meter distance, and then timed while imagining walking the same distance.
Time frame: 7 days pre/7days post/4-months post intervention
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