1. The introduction of Petra running-bikes (race runners) to
non-ambulant children with cerebral palsy: a pilot study
Liz Bryant1, Donna Cowan1 and Karen Walker-Bone2
1Chailey Heritage Clinical Services (Sussex Community NHS Trust), 2MRC Lifecourse Epidemiology Unit (University of Southampton)
Contact
Background
During childhood, weight-bearing activities are required to promote the normal development of bone density.
Research has demonstrated a relationship between bone density and mobility status in children with cerebral palsy (CP). Children with moderate to severe CP are prone to low trauma fracture, predominantly in the lower limb, associated with low bone density.
There are limited modes of exercise for non-ambulant children with CP. This pilot study introduced a novel mobility device, Petra running-bikes, to a group of non-ambulant children with CP to investigate if it was a feasible and enjoyable mode of weight-bearing exercise.
Results
Ability to use the running-bikes significantly improved over 12 weeks as shown in Figure 2. At the start of the trial 31% of children were unable to initiate walking with assistance from their physiotherapist. At the end of the trial all children could initiate walking.
Figure 2: Running bike ability at each assessment
The qualitative data confirmed the children enjoyed using the running bikes. Additionally as the running-bikes were found to be easy to use, they are now being used regularly in both schools.
The average standing ability scores (GMFM-88D) increased from 1 to 2, although the difference was not statistically significant (p=0.076).
No change was observed in the CP QoL-Child questionnaire scores between baseline and end trial (p>=0.05 for each domain).
The ultrasound bone densitometer bone quality index (BQI) scores significantly improved over the 12 weeks, as shown in Figure 3.
Figure 3: Ultrasound bone quality index scores
The Petra running-bike consists of a 3 wheeled frame with handlebars , saddle and trunk support. As opposed to a pedalling system the user sits on the saddle and propels themselves forward by contact of his/her feet on the ground.
Figure 1. Children trialling the Petra running-bikes
p=0.037 *
Method
Fifteen children with CP (7 boys, 8 girls; aged 4-12 years ; GMFCS levels IV n=10 and V n=5) were recruited from two specialist schools in the South East, UK. Eleven of the children had spastic bilateral CP and four children had dyskinetic CP.
The physiotherapy department in each school were provided with running-bikes and additional items of postural support (body supports; gripping aids and leg separator plates).
The children trialled the running-bikes with assistance from their physiotherapist or carer, three times a week, for twelve weeks.
Conclusion
This pilot study has shown that running-bikes offer an enjoyable way for non-ambulant children with CP to exercise.
Whilst only a small number of children were actually “running” with the running bikes at the end of the trial, all children were able to propel themselves forward using their legs, some completely independently, which was a novel experience for some children.
Positive signs of improvement were observed in the bone quality index scores over the short follow up period which is very encouraging.
Following the success of the pilot study we are now seeking funding to undertake a large scale study investigating the impact of running-bike use on bone density.
Outcome measures
The following outcome measures were recorded at baseline (week 0) and at the end of the trial (week 12).
Ability to use the running bike (rated on a 5 point scale)
Feedback from the users (children & physiotherapists)
Standing ability (GMFM-88D)
Ultrasound bone densitometer of the calcaneus
Quality of Life questionnaire (CP-QoL Child)
Acknowledgements
We wish to thank all the children and the physiotherapy staff
at Chailey Heritage School and Valence School who participated
in this study.
This study was funded by Sparks, the children’s
medical research charity.