Effects of climbing therapy on gait function in children and adolescents with cerebral palsy – A randomized, controlled crossover trial

Abstract Climbing therapy combines the challenge of height with strength, flexibility and coordination training. The typical climbing posture with abducted and external rotated hips, extended knees and ankle dorsiflexion might be ideally suited to improve typical intoeing, crouch and equinus gait pathologies in cerebral palsy. Therefore, the objective was to evaluate the effect of climbing therapy on gait function in children and adolescents with cerebral palsy. The study design was a single-blind randomized, controlled crossover trial that was carried out in a school for children with disabilities. Eight pupils with bilateral spastic cerebral palsy, Gross Motor Function Classification System level I–III, aged 7–18 years, participated. Six weeks of climbing therapy were compared with physical therapy of two sessions of 1.5 h per week each. Outcome measures were walking speed, step length, step time, Gait Profile Score, internal hip rotation, knee flexion at initial contact and peak ankle dorsiflexion. The results showed an improvement in walking speed, step length, step time in both therapies. Gait Profile Score, ankle dorsiflexion and knee flexion was improved in physical therapy, whereas it did not improve in climbing therapy. However, the difference between therapies was only significant in knee flexion. In conclusion, the use of climbing therapy instead of physical therapy must be critically discussed, as it may deteriorate crouch gait. Future climbing therapy protocols might be improved including more exercises aiming to strengthen the knee extensors in an upright body posture with extended hips and knees.