OBJECTIVE: To compare the effect of low-intensity (LI) versus high-intensity (HI) treadmill training (TT) on walking attainment and overall walking activity in children with cerebral palsy (CP). DESIGN: Prospective, multisite, randomized controlled trial. SETTING: Homes of the participants. PARTICIPANTS: Children with spastic diplegic CP, Gross Motor Function Classification System level I and II, ages 14 to 32 months (N = 19; male, n = 8). INTERVENTIONS: The children were randomized to LI TT (2x/wk for 6 wk) (n = 10) and HI TT (10x/wk for 6 wk) (n = 9). The TT was carried out by the families with weekly instruction by the researchers. MAIN OUTCOME MEASURES: Children were assessed at study onset, post intervention, and 1 and 4 months post intervention with the Gross Motor Function Measure Dimension D/E (GMFM D/E), average strides per day and percentage of time spent walking with accelerometers, the Peabody Developmental Motor Scales-2 (PDMS-2), Pediatric Evaluation of Disability Index Mobility Scale, timed 10-m and 1-minute walk test, and Functional Mobility Scale. Blinding was conducted for GMFM D/E and PDMS-2. Linear mixed effects regression models were applied to all outcomes. RESULTS: No significant between-group differences were found in any outcome measure at any of the time points. Children in the HI group did not show significant improvement immediately following the intervention in GMFM E (p = 0.061), while children in the LI group did (p = 0.003), but no statistically significant differences were detected over time (p = 0.71). Children in the HI group showed better walking independence on the Functional Mobility Scale at all postintervention assessments. CONCLUSIONS: A twice-weekly dosage was equally effective in improving skills related to walking compared with a 10x/wk program and can be more readily implemented into clinical practice.

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