Dual task effect on gait in children with cerebral palsy; Edinburgh Visual Gait Score Article Review
“Dual-task training effect on gait parameters in children with spastic diplegic cerebral palsy: preliminary results of a self-controlled study”
The purpose of this study was to determine how dual task training effects gait, functional skills, and health related quality of life in children with spastic CP.
Eleven children aged 6-17 with spastic diplegic cerebral palsy an Gross Motor Function Classification level 1-2 took part in the study.
The children were screened for eligibility and were included if they were GMFCS level I or II aged 6-17 and obtained 27 or higher on the mini mental state exam. They were excluded if they used assistive devices, have a recent injury affecting lower extremities, undergone surgery or Botulinum Toxin application, have severe cardiopulmonary or systemic problems, seizures, or visual problems. The participants then were evaluated using GMFM and Edinburgh Visual Gait Scale. They then took part in an 8-week conventional physical therapy program and were evaluated again, and then took part in an 8 week physical therapy program consisting of dual tasking to determine if there was a difference.
The standardized gross Motor Function Measurement (GMFM-88)
Edinburgh Visual Gait score
1 min Walk Test (1MWT)
Pediatric Quality of Life Inventory- Cerebral Palsy (PedsQL-CP)
The conventional physical therapy program consisted of stretching for lower extremities, strengthening of core and upper and lower extremities and balance exercises. Session were 2x a week for 45 minutes. After the 8 weeks, children were evaluated again to determine if a change was made. The children then participated in an 8-week physical therapy dual-task training program conspiring of motor tasks consisting of balance, walking, changing base of support, softness of the ground and using obstacles. The addition of cognitive tasks such as attention, memory and problem solving were used. The Zebris FDM-2 was used for analysis during the dual task activities
The difference in step length, stride time, cadence, and gait speed of spatiotemporal parameters of gait were found to be statistically significant after the dual tasking program. After the dual task training, significant gains were also found in 1MWT, GMFM- D, GMFM-E, EVGS and the movement and balance subtitle of PedsQL-CP.
A strength of the study was the same physical therapist was used in both the conventional and the dual tasking sessions. That limits the amount of variability in treatment and keeps the results as uniform as possible.
Some limitations of the study were the small sample size. Also, there was a wide age range of participants. This could have influenced the results of the walking program. Also, only diplegic CP was used in the study so it cannot be generalized to other types of CP.
The use of dual tasking when added to conventional physical therapy provides more gains in terms of functionality in children with spastic diplegic CP.
Okur EO, Arik MI, Okur I, Gokpinar HH, Gunel MK. Dual-task training effect on gait parameters in children with spastic diplegic cerebral palsy: Preliminary results of a self-controlled study. Gait & Posture. 2022;94:45-50. doi:10.1016/j.gaitpost.2022.02.020