Physical, Functional and Neurological Effects of Exercise in Children with CP

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Major Findings: We have closed enrollment and have submitted the main results of the study. In the past year, we have established a new Collaboration Agreement with our collaborators at Kennedy Krieger Institute/ Johns Hopkins who will reanalyze our MRI data with newer techniques and who will also be using these data for a project relating pain to structural brain findings. We are preparing a manuscript at present on the brain imaging results in the subset of children who were able to complete the MRI and for whom the data quality was acceptable. The major findings which have been reported were a significant and marked change in the speed with which children were able to perform the reciprocal leg exercise with approximately a third of those also having a clinically significant improvement in gait speed with the most positive results seen in the elliptical group. However, the mean change in gait speed for the group was not significant. The duration of the intervention may not have been long enough for significant transfer of greater reciprocal leg speed to improving gait function. Another important funding is that this group of patients showed greater than normal functional connectivity across the two sensorimotor hemispheres. After the exercise we found a correlation between the change in voluntary speed and the change in connectivity, such that those who had a greater change in speed, had a greater reduction of connectivity suggesting that the brain pathways improved and became more reciprocal instead of synchronized as a result of training. A manuscript is currently in preparation for submission. Project Impact Statement: This is the first reported efficacy trial of both motor-assisted cycling and elliptical training in CP. Since reciprocal coordination improved as a result of training,these findings warrant further comparison with existing treatments such as BWSTT through clinical trials. This is also one of the few studies with pre-post intervention brain imaging results in children with bilateral cerebral palsy.