Assessment of neuroplasticity of corticospinal tract induced by antigravity treadmill (AlterG) in cerebral palsy children

The aim of this study was to assess neuroplasticity that occurred in the corticospinal tract (CST) following antigravity treadmill (AlterG) training. AlterG can facilitate walking by having up to an 80% reduction of weight-bearing in patients. Systematic and intensive gait training for sufficient periods of time may lead to neuroplasticity and walking capacity improvement. AlterG gait training was done for eight weeks, 3 sessions per week, and 45 minutes each session. Three cerebral palsy (CP) children participated in this study. The function and structure of CST on the brain's more affected side were evaluated using Transcranial Magnetic Stimulation (TMS) and Diffusion Tensor Imaging (DTI). Also, some common clinical tests were performed to evaluate walking capacity and endurance. DTI features such as fractional anisotropy (FA) and mean diffusivity (MD) as well as some TMS features were extracted to estimate structural changes of the CST. The evaluations were performed before and after 8week AlterG training. The results showed an improvement in the DTI metrics of the CST following AlterG training. Also, TMS parameters were improved and these changes in CST function and structure were concurrent with changes in walking capacity. These results suggest that AlterG training can be used as a therapeutic tool to provide an effective and persistent gait improvement in CP children.