JMIR Publications

ABSTRACT

Background:

The magnitude of body weight support (BWS) alters the mechanical and neuromuscular demands of treadmill walking, but objective methods for selecting an individualized BWS level in children with cerebral palsy are lacking.

Objective:

This exploratory clinical study evaluated whether a multidomain framework could generate participant-specific rankings, assessed the within-session stability of those rankings, and descriptively characterized gait and functional outcomes associated with individualized BWS treadmill training.

Methods:

Children and adolescents with cerebral palsy completed treadmill walking under seven BWS conditions (0%-30% in 5-percentage-point increments). Plantar pressure metrics were summarized within four prespecified domains: temporal symmetry, temporal variability, center-of-pressure behavior, and bilateral loading symmetry. Metrics were normalized within participant, domain scores were equally weighted, and the BWS condition with the highest composite score was designated the best tested condition. Clinical mobility was assessed before and after the training period. Because conditions were tested in a fixed ascending order and the study had no control group, analyses were considered exploratory.

Results:

Seven participants completed the BWS assessment and participant-specific selection analysis, and 6 subsequently completed training and post-assessment. Primary selected conditions varied across the tested BWS range, demonstrating marked interparticipant heterogeneity. Selection stability differed between participants across sensitivity analyses. The primary selected condition was Pareto-optimal in all 7 participants with valid selections, although multiple non-dominated conditions were present for most participants. TOPSIS and the primary weighted-sum procedure produced agreement in 6 of 7 participants (85.7%).

Conclusions:

The multidomain framework generated participant-specific rankings of the tested BWS conditions, but the present data do not establish a physiological optimum or intervention efficacy. Prospective validation should use randomized BWS order, repeated assessments, and independent outcome data.