Overground gait training improves the sensorimotor cortical dynamics and mobility of persons with cerebral palsy

Persons with cerebral palsy (CP) exhibit aberrant sensorimotor cortical oscillations linked to uncharacteristic motor actions and mobility, but the key physical therapy ingredients needed to offset these aberrations and drive improvements in cortical function remain unclear. This study evaluated whether overground gait training results in mobility gains that are coupled to beneficial changes in sensorimotor cortical oscillations in persons with CP. 34 persons with CP (Age = 20.58 ± 7.61yrs; Gross Motor Functional Classification Scores I-III) and 32 neurotypical (NT) controls (Age = 23.06 ± 3.79yrs) participated. Persons with CP completed 24 overground gait training sessions (3 days/week for 8 weeks). A battery of clinical assessments were used to examine changes in functional mobility. Magnetoencephalographic (MEG) imaging was used to quantify sensorimotor cortical oscillations while performing a knee extension motor task pre- and post-therapy in the CP group. Only one MEG measurement was completed by NTs. Persons with CP improved their Functional Gait Assessment scores by 8.77 % (p < 0.001), dynamic range by 38.94 % (p < 0.001), and Timed Up-and-Go (TUG) time by 15.97 % (p < 0.001). Post-training, sensorimotor beta oscillations during movement planning and execution became 19.95 % stronger (p < 0.001), approaching NT levels. Movement-related gamma oscillations became 37.88 % weaker (p = 0.003) and no longer differed from NTs post-therapy (ps > 0.05). Notably, the persons with CP who exhibited the largest increases in sensorimotor beta oscillations tended to have greater improvements in the TUG (p = 0.025). Overground gait training enhanced sensorimotor cortical oscillations and yielded clinically meaningful mobility gains. These neuroplastic and functional improvements may stem from gait-related tasks emphasizing movement planning, execution, and problem-solving.