Impact of anti-gravity locomotion (AlterG) training on structure and function of corticospinal tract and gait in children with cerebral palsy

We aimed to characterize the impact of anti-gravity locomotion training on the structure and function of the corticospinal tract (CST) in cerebral palsy (CP). Fourteen CP children participated. Nine children were trained with an antigravity treadmill (Alter-G) and five children received occupational therapy (OT). Treatments were provided for 45 min each session, 3 sessions per week for 8 weeks.Diffusion tensor imaging (DTI) was used, and fractional anisotropy (FA), mean diffusivity (MD), radial (RD) and axial (AD) diffusivity was extracted to characterize the structure of the CST. Transcranial magnetic stimulation (TMS) was used and threshold, latency, and peak-peak amplitude of the MEP signal, elicited by the TMS, were used to quantify the function of the CST. Walking ability was evaluated by measuring gait speed, endurance, balance, and mobility. The evaluations were performed before and after the interventions. The results showed that FA improved in both sides of the brain for the AlterG group, but enhanced only in the less affected side of the OT group. MD, RD, and AD mostly improved in the more affected side of the AlterG group. The enhancement of the CST function was similar in both groups. Walking speed and endurance also enhanced in both groups, but the improvement was greater in the AlterG group.Our findings demonstrate that AlterG training can improve gait ability, and simultaneously result in brain neuroplasticity. The clinical implication is that AlterG training can be used as an effective rehabilitation approach to improve gait persistently.