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Kids with Cerebral Palsy to Be Tested on Underwater Treadmill
Newswise — Dr. Don Morgan is anxious to test his underwater treadmill, because he believes it will help children with cerebral palsy gain greater strength in their lower extremities, lessen their level of fatigue, and perhaps raise their level of mobility.
Morgan, a professor in the health and human performance department at Middle Tennessee State University (MTSU), in Murfreesboro, and expert in exercise science, has always been fascinated by the energy demands of locomotion. He began his work with athletes, primarily long-distance runners. With funding partially provided by the U.S. Olympic Committee, he conducted research on the design and construction of athletic shoes.
"I realized, however, that it wasn't just athletes who have to move—everybody has to move in order to function in society," Morgan said. "I looked at a study funded by the National Institutes of Health that examined how physical growth impacted the energy demands of walking and running in children.
"I realized that the NIH was interested in helping kids with disabilities become more economical in their movements," he said. "No one had ever done a longitudinal study in this area."
Morgan studied 40 typically developing six-year-olds with the idea that if he could understand the relationship between physical growth and improved locomotion efficiency, perhaps some of those findings could be applied to physically challenged children.
Pilot studies that he and associates conducted with children with cerebral palsy suggested that their energy demands are much higher, which creates greater fatigue and contributes to their not being as mobile as non-physically challenged children.
"We started wondering, what could we do to improve these kids' locomotion deficiency? The data suggested that they had a much higher energy cost of walking. Since their maximum aerobic capacity was less to begin with, that meant that walking at any speed resulted in a higher energy draw. It was no problem for an able-bodied child walking at the same speed."
Morgan said that's when he thought about using an underwater treadmill.
"It's relatively new technology, but it's been used by athletic teams to rehabilitate athletes and for older folks with arthritis and even used to rehabilitate horses," he said. "But it had never been used with this particular population. Although water therapy had been used with physically challenged children in swimming pools, you can't control the water height in pools," he continued. "And when you walk in a pool, you tend to lean forward, and it's not the same sort of normal walking motion. With a treadmill, you can control the speed."
The water also helps develop leg strength, and the buoyancy of the water creates less joint stress, Morgan explained, resulting in more range of motion and less pain.
Morgan submitted a proposal to NIH and received funding ($310,000) the first time around. He is now in the first year of a two-year project, and he just received his 'refurnished' treadmill a few weeks ago.
It took months of obtaining permits to move the treadmill down from the sixth floor of a clinic in Manhattan. The operation literally stopped traffic, Morgan said.
"We hope to begin the project in the next couple of months," he said. "We're in the process of subject recruitment." It will be a 10-week study.
"We'll study 60 children with spastic cerebral palsy who are affected on both sides of their bodies—but their legs more than their arms. They will have to be independent ambulators so that they don't have to walk with crutches or other devices."
Morgan explained that the children will be assigned to a control group and an experimental group. He will test them for muscle strength and cardiovascular function, and he will measure how efficient they are when walking on a land treadmill.
"The children will wear a specialized step-activity monitor around their ankles, which will record their walking activities. That device can then be plugged into a computer, which will produce all these printouts."
"During the 10 weeks, we will increase the treadmill speed," Morgan continued. "We'll lower the body weight support so that as they get stronger, they'll have to support more and more of their body weight as they walk faster. We'll increase the duration of the exercise. So there are a number of parameters that we'll be varying. At the end of the 10 weeks, we hope that the cardiovascular and leg strength are better—and that they're taking more steps and are more mobile.
"We hope this underwater treadmill training program will not only help them become healthier but more active," Morgan said. "We know that when these kids become adults, they typically are less active. When these kids are young, they get a lot of support services. As they get older, those services are less and less. What happens is that they become less mobile, and thus, more fatigued, thus, less fit. It's a downward spiral."
Older disabled people tend to rely on wheelchairs and other devices, he said. Studies indicate that these adults stop walking because they tire easily.
"We want to affect that trajectory from childhood into adulthood," Morgan said. "Maybe we can affect that decline as they grow older. "¦ When I go to conferences, I discover this kind of water therapy is right on the cutting edge of what physical therapists are interested in."
There also is an emotional payoff, Morgan believes.
"We hope to add quality-of-life issues to the study," he pointed out. "Are the children more confident? How will that impact other areas in their lives? They know they have a disabling condition, but to the extent that they can keep up and do the things that other kids are doing, that has to help them feel better about themselves."
The underwater treadmill is located in MTSU's Human Performance Lab. It is made of fiberglass and steel and is powered by electricity. It holds 270 gallons of water and has electronic panels underneath, which help determine the percentage of body weight that is being supported.
"I can tell you that the reason why I'm here at MTSU is that when I told President [Sidney A.] McPhee about this, he said if we can do this, we'll try to make it happen."
Morgan came to MTSU from Arizona State University, where "there are so many proposals, it probably was going to take years before it was acted upon. At MTSU it's going to happen." Assisting him in his research are an orthopedic surgeon, who will help recruit the 60 children, and a pediatric physical therapist, both at Vanderbilt University in Nashville.
A music education graduate of Northwestern University, Morgan received his M.S. degree in physical education from the University of Tennessee-Knoxville, and his Ph.D. in exercise science from ASU in Tempe. He joined the faculty at MTSU in 2004. He is certified by the American College of Sports Medicine as an exercise test technologist and health/fitness instructor.
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