The effects of treadmill training in children with cerebral palsy: a systematic review

ambulant school aged children with CP. The secondary aim is to identify motor learning strategies reported and describe how these relate to outcomes when possible. Study Design: Systematic review. Study Participants & Setting: N/A. Materials/Methods: Relevant databases including Medline, EMBASE, CINAHL, PsycINFO, SPORTDiscus and Pubmed were searched for studies involving; (1) Children with CP (mean age >4y, >60% of the sample ambulant); (2) TST targeting gross motor skills; and (3) Activity outcomes related to specific skill performance, gross motor function and functional skills, and participation-related outcomes. Included studies were assessed using the American Academy of CP and Development Medicine levels of evidence and Cochrane Risk of Bias tool. Within outcomes of interest, continuous data were summarized for each study using standardized mean difference (SMD) and 95% confidence intervals (CI) and the Grades of Recommendation, Assessment, Development and Evaluation system was used to assess the quality of evidence. Results: Thirteen studies met inclusion criteria including eight randomised controlled trials, three comparative studies, one repeated measures study and one single subject design study. Risk of bias was low in four studies, unclear in seven and high in two. Evidence synthesis was limited by intervention and comparison group heterogeneity. There is moderate quality evidence for positive effects of TST on specific skill performance (one study: ABILOCO Kids SMD=0.96, 95% CI=0.11–1.81, p=0.003; six minute walk test SMD=0.87, 95% CI 0.02–1.71, p=0.002) and functional skills (two studies: Pediatric Evaluation of Disability Inventory (PEDI) Self Care SMD=1.07, 95% CI 0.21–1.94, p<0.001; PEDI mobility skills SMD=0.58, 95% CI 0.04–1.12, p<0.05) and low quality evidence for positive effects on participation-related outcomes (one study: Life-HABITS performance SMD=1.19, 95% CI 0.3–2.07, p<0.001; Life-HABITS satisfaction SMD=1.29, 95% CI 0.40–2.18, p=0.001), generally immediately following the intervention. However, any evidence effect of TST on overall gross motor function, or longer-term improvements in the other outcomes, is minimal and low in quality. Components of TST, including dosage and motor learning strategies were varied and often poorly reported. This limited assessment of relationship to outcome, however, dosage, feedback and goals emerged as components warranting further investigation. Conclusions/Significance: While limited evidence for TST to improve activity and participation-related outcomes in the short-term exists, clear recommendations for use are limited by poor study methodology and heterogeneous interventions. Future high quality studies with longer follow up are essential. SP 52 The effects of treadmill training in children with cerebral palsy: a systematic review R RODRIGUES DE SOUSA, P FIGUEIREDO, C TEIXEIRA, L VENTURI, M BRANDAO Associac ~ao Mineira de Reabilitac ~ao, Belo Horizonte, Minas Gerais, Brazil; Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil