HIGH INTENSITY GAIT TRAINING IN CHILDREN WITH BRAIN INJURY: A CASE SERIES

Background & Purpose: Pediatric brain injury is one of the leading causes of disability in children ages 5-18 and studies have shown that 75% of injured children have an associated head injury. Research has attempted to determine the most effective and efficient interventions to address these deficits and improve overall quality of life. This is quite different from the adult neurological patient population, in which a recent consensus has been reached that high intensity gait training (HIT) is the preferred treatment intervention to yield the greatest mobility gain. It is hypothesized that HIT aligns with a child's natural pattern of movement and play, with periods of high intensity activity throughout the day. This report will describe the feasibility and outcomes of a high intensity gait training protocol completed with five pediatric patients diagnosed with pediatric brain injury.

Case Description: Five pediatric patients, all males ages 6-17, were admitted to inpatient rehabilitation following a neurological event resulting in impaired functional mobility. Children 1, 2 and 3 had AVM ruptures, children 4 and 5 had anoxic brain injuries. All five children participated in HIT for one hour, 4-5 days per week, for an average of 11 sessions. Interventions included treadmill ambulation, overground ambulation, and stair climbing, and targeted a heart rate (HR) range of 75-85% age-predicted HR maximum. Outcome measures were performed at admission, weekly, and at discharge. All five children also participated in occupational therapy, therapeutic recreation, and speech therapy (as needed).

Outcomes: All children participated in HIT for one hour per day, with an average of 35 minutes of active time per treatment session, and an average of 22 minutes in the target HR zone. All children demonstrated improvements in the Pediatric Balance Scale (PBS) and 10 Meter Walk Test (10 MWT) from admission to discharge. The mean improvement in the PBS was 43 points, four children met the MCD score, and all children scored as low risk for falls at discharge. The mean improvement in the 10 MWT was 0.63 m/s for self-selected speed, and all five children met the MCD score. All children participated in HIT without adverse events.

Discussion: This case series demonstrated that HIT is an effective and feasible treatment to be implemented in pediatric inpatient physical therapy rehabilitation. The structure of HIT sessions mirror a child’s typical play integrating short, high intensity intervals with HR reaching up to 90% HR max. This enhanced the therapists’ overall goal of utilizing mass repetition, variable tasks, trial/error, and error-based learning strategies to improve outcomes. Four out of five children that participated discharged at an independent level, an outcome that superseded the treating clinicians’ expectations. Ongoing research to determine feasibility and effectiveness on a larger scale is required. This shows a promising outlook for the future for high intensity gait training and an ever-growing increasing population of children that endure a brain injury throughout childhood and adolescence.