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A "motor learning based intervention for lower extremities (MOBILE)" to target walking performance in ambulant
Caitríona O'Shaughnessy1,2, Raymond McCarthy2, Dereena Minehane2
1Physiotherapy, CP Life Research Centre, Royal College of Surgeons in Ireland, Dublin, Leinster, D02YN77, Ireland.
Insights
This study explores a new Motor Learning-based Intervention for lower extremities (MOBILE) to improve walking in children with Cerebral Palsy (CP). It assesses the intervention
Area of Science:
- Pediatric Rehabilitation
- Motor Learning Science
- Disability Studies
Background:
- Cerebral Palsy (CP) is a leading cause of childhood physical disability, often characterized by abnormal gait patterns like toe walking.
- The International Classification of Functioning (ICF) framework highlights body structure, activity, and participation domains impacted by disability.
- Interventions targeting activity and participation using Motor Learning Theory (MLT) have shown promise in improving walking and motor skills in children with CP.
Purpose of the Study:
- To determine the feasibility and acceptability of a novel, motor learning-based intervention (MOBILE) for lower extremities in ambulant children with CP.
- To gather data to inform the design of a future randomized controlled trial (RCT) for this intervention.
- To assess the potential of the MOBILE intervention to improve walking performance and its long-term retention.
Main Methods:
- Recruitment of fourteen ambulant children with CP (aged 6-17) with specific walking goals.
- Implementation of a tailored, intensive 30-hour MOBILE intervention delivered over 6 weeks or less.
- Evaluation of feasibility (recruitment, adherence, retention) and acceptability, alongside clinical outcomes (Gait Outcomes Assessment List, Six Minute Walk Test, etc.).
Main Results:
- Feasibility outcomes, including recruitment rates, adherence, and retention, will be reported using descriptive statistics.
- Acceptability of the MOBILE intervention by participants and caregivers will be assessed.
- Clinical outcome measures will provide preliminary data on the intervention's impact on walking performance and related functional abilities.
Conclusions:
- The study will provide crucial data on the feasibility and acceptability of the MOBILE intervention for children with CP.
- Findings will inform the design of a definitive RCT, potentially leading to improved walking performance and participation in daily activities.
- The MLT-based approach may offer a more effective strategy for long-term walking improvements compared to traditional body-structure focused interventions.
Background:
Cerebral Palsy (CP) is the largest contributor to childhood physical disability with abnormal gait pattern such as toe walking commonly reported. The International Classification of Functioning (ICF) in disabilities framework outlines three domains to consider when looking at impact of a disability on a child; body/structure, activity and participation. Activity and participation targeted interventions using Motor Learning Theory (MLT) have shown positive results on walking performance, gross motor skills and upper limb rehabilitation in CP. MLT encompasses multiple concepts that shape our understanding of how motor skills are acquired and developed. This study aims to determine feasibility and acceptability of a novel motor learning-based intervention for lower extremities (MOBILE) targeting walking performance in ambulant children with CP to inform a future randomized controlled trial (RCT).
Methods:
Fourteen ambulant children with CP, aged 6-17, with a walking goal will be recruited from community disability services. They will undergo a tailored intensive MOBILE intervention to target walking goals amounting to 30 hours practice in 6 weeks or less. Outcomes will include feasibility of recruitment, adherence, retention and outcome measures, and acceptability of the intervention. Clinical outcome measures will include the Gait Outcomes Assessment List, Six Minute Walk Test, modified Timed Up and Go, Ten metre walk test, Range of Motion and the Child Health Utility instrument. Feasibility outcomes will be reported using descriptive statistics such as percentages and confidence intervals.
Discussion:
Long-term retention of walking improvements in CP following interventions targeting the body/structure domain of the ICF are reportedly poor. The MOBILE intervention based on its theoretical framework could lead to improvements in walking performance with a possibility of long-term retention and impact on activity and participation. The feasibility of the study design and acceptability of the intervention needs to be investigated to inform a future definitive trial.
