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. 2025 Oct 16.
doi: 10.1097/PEP.0000000000001257. Online ahead of print.

Lower Limb Training Threshold Dose and Motor Learning Strategy Reporting in Children With Cerebral Palsy

Matthew Haddon  1 , Isabella Pessóta Sudati, Jizelle Kenworthy-Groen, Dayna Pool, Lauren O'Connor, Robert Ware, Cristina Lee, Kate Dolling, Leanne Sakzewski
Affiliations

Lower Limb Training Threshold Dose and Motor Learning Strategy Reporting in Children With Cerebral Palsy

Matthew Haddon et al. Pediatr Phys Ther. .

Abstract

Purpose: This systematic review investigated the threshold dose of active lower limb training required to improve outcomes in children with cerebral palsy (CP) and to evaluate the reporting of motor learning strategies.

Methods: Five databases were searched for randomized controlled trials on active lower limb training in children with CP. Independent assessors conducted study selection, data extraction, and risk of bias assessment. Clinically significant mean group changes established dose thresholds, while motor learning strategies were assessed based on 11 common strategies.

Results: One hundred and one studies (3566 participants, mean age 8.8 years) met inclusion criteria. Threshold doses were 12 hours for walking speed, 7.5 hours for walking endurance, 23.33 hours for gross motor function, and 21 hours for goal performance. Motor learning strategy reporting was low. Most studies had a high risk of bias.

Conclusions: These results provide preliminary guidance for optimizing therapy time to improve walking speed and endurance, gross motor function, and goal performance. More high-quality studies with detailed intervention reporting are needed.

Keywords: cerebral palsy; motor learning; systematic review; threshold dose.

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Conflict of interest statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Author IPS is supported by the Cerebral Palsy Alliance Research Foundation scholarship (PHD0221). Otherwise, the authors received no financial support for the research, authorship, and/or publication of this article.

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