Thesis (Ph.D.) - Cairo University -Faculty of Physical Therapy - Department of Growth and Development Disorders in Pediatrics

Background: Poor endurance and early fatigue are factors contributing to an ambulatory decline in spastic cerebral palsy that was associated with low level of physical activity and general health problems, so it is vital to develop effective strategies to reduce excessive energy cost during walking to improve participation. Purpose: This study aimed to investigate the effect of goal-directed training on gait and energy expenditure index, and to examine the relation between changes in energy expenditure index and changes in gait related gross motor functions and gait pattern in children with spastic CP. Methods: Thirty children with spastic cerebral palsy were randomly allocated to either study or control group.Children in the study group participated in goal-directed conditioning training program with heart rate biofeedback for 30 minutes, 3 days per week, for 8 weeks in addition to a traditional physical therapy program, whereas children in the control group received the same traditional physical therapy program only. Measured variables were: gross motor function scores for standing (GMFM-D), walking, running and jumping (GMFM-E), two kinematic gait parameters: the angle of the knee at initial contact (ic-knee) and the angle of the hip at terminal stance (ts-hip), through 2 dimension gait analysis, in addition to, energy expenditure index (EEI) and the corresponding walking speed on a treadmill. Results: Post-treatment results showed significant improvements within both groups in all measured variables except for the kinematic gait parameters, significant improvements were found only in the study group. No statistically significant difference was found between study group and control group post-treatment; in spite of that, there was clinical difference and higher percentage of improvement in favor to study group compared to control group regarding all measured variables

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