Commentary on “Gait Training With Visual Feedback and Proprioceptive Input to Reduce Gait Asymmetry in Adults With Cerebral Palsy: A Case Series”
A clinical physical therapist whose caseload includes adults with cerebral palsy has much to gain from Levin's innovative study. Improving function in people with chronic stroke is not new,1 but extending the potential to adults who ambulate and with cerebral palsy is novel. The fact that 2 of the 5 subjects in her case series reduced their risk for falls within 18 sessions is an important finding that will improve the health and quality of life for patients and challenges the concept that the walking abilities of adults with cerebral palsy remain stable and inevitably decline with age.2 Achieving these results with lower tech equipment remains a goal, but knowing the potential for improvement exists is a beginning.
“What should I be mindful about when applying this information?”
There are limitations to the study including the wide age range of subjects (age 18-65 years) and use of the Four-Square Step Test (FSST). Although the FSST is a quick test of dynamic balance and easy to implement in the clinic, it lacks depth in terms of functional tasks compared with the Functional Gait Assessment (FGA) or mini Balance Evaluation Systems Test (mini BEST).3 These measures need validation for adults with cerebral palsy. Treatment included a combination of virtual reality, split-belt treadmill training, and high intensity; thus, it is not clear whether this combination is necessary to achieve the outcomes, or whether individual components would achieve the same outcomes. Clinicians need to be aware of emerging virtual reality therapies that have the potential to improve the health and quality of life of adults with cerebral palsy.