Efficacy of an activities-based locomotor training program in children with cerebral palsy

The National Institute of Child Health and Human Development (NICHD) awarded Baylor University a $542,102 Project Grant effective September 1, 2025, through August 31, 2028, under the Child Health and Human Development Extramural Research program (CFDA 93.865). The award supports a randomized crossover research study evaluating the efficacy of an activities-based locomotor training (AB-LT) program for non-ambulatory children aged 2-6 years with cerebral palsy. The primary deliverables include comparative efficacy data assessing hemodynamic shifts in the prefrontal cortex using functional near-infrared spectroscopy (fNIRS), gross motor functional improvements measured by the Gross Motor Function Measure (GMFM-66), and participation outcomes measured through the Child Engagement in Daily Life (CEDL) assessment. The study employs a 3-week intervention comparison design between AB-LT and usual therapeutic care protocols.

Beyond the clinical research products, the award includes a research training and mentorship component designed to develop the next generation of rehabilitation researchers. This educational component engages undergraduate and graduate-level PhD students in neuroimaging and rehabilitation research methodologies. The research is conducted at Baylor University in Texas and is expected to generate evidence-based findings to refine rehabilitation strategies for children with cerebral palsy, directly advancing NICHD's mission to improve therapeutic interventions for children with disabilities and influencing clinical practice through alternative and more efficient rehabilitation approaches.

Abstract

Cerebral palsy (CP) is a common lifelong neurological disorder affecting movement and posture, requiring ongoing physical therapy to achieve functional gains. This project aims to evaluate the efficacy of an activities- based locomotor training (AB-LT) program for young non-ambulatory children with CP, addressing the GAP in current research which primarily focuses on ambulatory children over six years old. AB-LT is designed to target all three components of the world health organization's international classification of functioning, disability, and health (ICF) framework, incorporating partial body weight-supported treadmill training, overground functional training, and play-based activities. This study will employ a randomized crossover design comparing 3 weeks of AB-LT with 3 weeks of usual therapeutic care in 19 children aged 2-6 years. Outcomes will be assessed across the ICF framework using functional near-infrared spectroscopy (fnirs) to measure hemodynamic shifts in the prefrontal cortex, the gross motor function measure (gmfm-66) for gross motor skills, and the child engagement in daily life (cedl) for participation. The proposed study aims to determine: 1) hemodynamic shifts in the prefrontal cortex during functional movements following AB-LT compared to usual care, hypothesizing improved regulation of the prefrontal cortex, and 2) changes in functional activity and participation, hypothesizing greater improvements following AB-LT. The project aligns with the nichd's mission to advance therapeutics for children with disabilities and will provide critical data to refine rehabilitation strategies, influencing clinical practice by offering alternative, more efficient therapies. The study includes a research mentoring component, engaging undergraduate and graduate-level PHD students, providing opportunities in neuroimaging and rehabilitation research in children with CP. This multidisciplinary program will involve up to four students over the project duration, enhancing their skills in clinical research and evidence-based practice. This project will strengthen the research environment at baylor university, preparing future clinicians and researchers to contribute to advancing therapeutic interventions for children with CP.