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Cerebral PalsyRCMsNCT07650370

Pilot Study on the Validity, Tolerability, and Impact of a Walking Rehabilitation Intervention Using Cruro-Malleolar Cast in Children With Cerebral Palsy

A study testing Cruro-Malleolar Cast Walking Training in people with Cerebral Palsy, run by Centre Médico-Chirurgical de Réadaptation des Massues Croix Rouge Française.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

This pilot study investigates whether walking training using cruro-malleolar casts (CMCs) - rigid leg splints extending from the thigh to the ankle - can safely improve gait quality in children with bilateral cerebral palsy (CP). Read more about this study

Who is it for?
Ages 7 to 14 years
Conditions the study is for
Cerebral Palsy
What is being tested?
Cruro-Malleolar Cast Walking Training
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
6 participants
Where
No sites listed yet
Study dates
1 Sep 2026to Sep 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 7 to 14 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Children aged 7 to 14 years
  • Pubertal development at Tanner stage 1 or 2
  • Bilateral cerebral palsy (diplegia or quadriplegia)
  • Ambulatory with or without assistive device (GMFCS levels I, II, or III)
  • Clinical indication for walking training
  • Ability to use an adapted visual analogue scale to rate perceived pain
Show all 9Show fewer
  • No botulinum toxin injection in the 4 months preceding study entry
  • Affiliated to or beneficiary of a French social security scheme
  • Not currently enrolled in another biomedical research study (not in an exclusion period from the national registry)

Who cannot join

  • Pubertal development at Tanner stage greater than 2
  • Refusal to wear cruro-malleolar casts (CMCs)
  • Inability to walk on a treadmill
  • Refusal to participate in the repeated assessment sessions required by the study protocol
  • Refusal to delay the next scheduled botulinum toxin injection series until after completion of study participation

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

About this study

This pilot study investigates whether walking training using cruro-malleolar casts (CMCs) - rigid leg splints extending from the thigh to the ankle - can safely improve gait quality in children with bilateral cerebral palsy (CP). CMCs are already used in routine clinical care at our center, but their biomechanical effects and therapeutic value have never been formally studied.Children aged 7 to 14 with bilateral spastic CP (diplegia or quadriplegia, GMFCS levels I-III) will participate in a 4-week treadmill walking program wearing CMCs, preceded by a 1-month observation baseline and followed by a 6-month follow-up. The investigators will use motion capture technology and surface electromyography to measure how the CMCs immediately change the way children walk - particularly at the hip and pelvis - and whether the training program leads to lasting improvements in walking speed, quality, and endurance.The study also carefully monitors pain and effort perceived by children during each training session, so that tolerance of the intervention can be rigorously assessed. Six participants will be enrolled. The study uses a Single-Case Experimental Design (SCED), which allows rigorous conclusions to be drawn from a small number of patients through repeated measurements over time.

Read the detailed description

Background and rationale Cerebral palsy is the most common cause of motor disability in children. Among its clinical forms, spastic diplegia is characterized by predominant lower limb involvement and progressive gait deterioration during growth, driven by musculotendinous contractures and secondary orthopedic complications. From Rodda and Graham's gait classification Group II ("jump gait") onward, hamstring overactivity plays a central role - contributing to excessive knee flexion and limited hip extension in late stance. Interventions targeting active hamstring stretching in a controlled gait pattern may therefore have significant clinical value.

Cruro-malleolar casts (CMCs) are knee-extension orthoses molded over the child's walking ankle-foot orthosis. In current clinical practice at our center, they are used both for passive stretching postures and as a gait rehabilitation tool. The hypothesized mechanisms during CMC-assisted walking include: active hamstring stretch at initial contact; increased hip extensor (gluteus maximus) activation during loading response and mid-stance; improved pelvic belt mobility and trunk extension in the frontal plane; increased eccentric hip flexor activity and posterior step in late stance - effects that are expected to be amplified when training is performed on a treadmill. Despite their use in clinical practice, no published study has evaluated the biomechanical, muscular, or functional effects of CMCs during walking training.

Study design This study uses a nested Single-Case Experimental Design (SCED), combining an A-B-Follow-up series with an Alternating Treatments Design (ATD) embedded within Phase B.

Phase A (Baseline, 1 month): Three repeated measurement sessions (every 15 days), with no intervention. Establishes each participant's individual baseline trajectory.

Phase B (Intervention, 1 month): Four weekly measurement sessions. Participants perform 4 sessions per week of treadmill walking training with CMCs (20 minutes per session, with verbal and/or manual guidance from a physiotherapist, and music chosen by the child to support motivation). At each of the 4 measurement time points within Phase B, participants are assessed in 4 randomized conditions: walking on ground with ankle-foot orthoses (AFO) alone; walking on ground with AFO + CMCs; walking on the instrumented treadmill (DIG) with AFO alone; walking on DIG with AFO + CMCs. Randomization of condition order is restricted by practical and safety constraints (ground assessments must precede treadmill assessments; treadmill speed is capped at ground walking speed).

Phase FU (Follow-up, 6 months): Three measurement sessions at 1, 3, and 6 months post-intervention.

The per-patient protocol lasts 8 months. Inclusion will span 30 months, for a total study duration of 3 years, starting from CPP approval.

Conditions
Cerebral Palsy
Being tested
Cruro-Malleolar Cast Walking Training
Keywords
Cerebral Palsy, Gait rehabilitation, Knee-extension orthosis, Treadmill training, Single-case experimental design
Medical subject headings
Cerebral Palsy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cruro-Malleolar Cast Walking TrainingDevice

    Cruro-malleolar casts (CMCs) are rigid bivalved knee-extension orthoses molded over the child's existing functional ankle-foot orthosis. Fabricated by a nurse-plaster technician and physiotherapist, they include protective padding, corrective felt inserts promoting knee extension, and supra-condylar fixation hooks. Windows are cut in the CMCs to allow surface EMG electrode and reflective marker placement during gait analysis. CMCs are worn during treadmill walking training (16 sessions over 4 weeks, 4 sessions/week, 20 minutes/session) on an instrumented treadmill (DIG system) with physiotherapist guidance. They are also worn during ground and treadmill gait analysis sessions. CMC walking is compared to walking with ankle-foot orthoses alone, both on ground and on the instrumented treadmill, within each participant across repeated assessment sessions.

Study groups in NCT07650370
Study groupRoleWhat they receive
Assisted Treadmill Walking TrainingExperimentalChildren with bilateral spastic cerebral palsy undergo a 4-week treadmill walking program wearing cruro-malleolar casts (CMCs) - rigid bivalved knee-extension orthoses molded over their existing ankle-foot orthoses. Training consists of 16 sessions (4/week) of 20-minute treadmill walking with physiotherapist guidance and self-selected music. At 4 weekly assessment time points, participants are evaluated in 4 randomized conditions: ground walking with AFO alone, ground walking with AFO + CMCs, instrumented treadmill with AFO alone, and treadmill with AFO + CMCs, using 3D motion capture, surface EMG, and force platforms. Pain (Faces VAS) and perceived exertion (modified Borg scale) are recorded after each session. This phase is preceded by a 1-month baseline (3 sessions) and followed by a 6-month follow-up (at 1, 3, and 6 months).
Receives: Device: Cruro-Malleolar Cast Walking Training

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Hip and Lumbopelvic 3D Kinematics during CMC-assisted Walking

    Three-dimensional kinematic curves of the hip and lumbopelvic complex recorded by motion capture (Qualisys optoelectronic system, IOR Full Body Gait Model) during walking with and without CMCs, on ground and on treadmill (DIG). Mean joint angles are extracted at key gait cycle events (initial contact, loading response ~10%, mid-stance, terminal stance, peak swing ~70%).

    Measured: Assessed at each of the 4 weekly measurement sessions during Phase B (weeks 5, 6, 7, and 8 from study start).

Secondary outcomes (13)
  1. Surface EMG Muscle Activation Timing

    Activation timing (onset and offset, expressed as % of gait cycle) of hamstrings (semitendinosus), rectus femoris, vastus lateralis, and gluteus maximus, recorded by surface EMG (Cometa Pico) during walking with and without CMCs, on ground and on treadmill.

    Measured: Assessed at each of the 4 weekly measurement sessions during Phase B (weeks 5-8).

  2. Walking Speed

    Walking speed is defined as the velocity at which an individual walks, recorded with and without CMCs, on ground and on treadmill.

    Measured: Assessed at all 10 measurement time points: 3 baseline sessions (Phase A, weeks 1-4), 4 intervention sessions (Phase B, weeks 5-8), and 3 follow-up sessions (1, 3, and 6 months post-intervention).

  3. Pain Perception during CMC Training

    Child-reported pain perception related to CMC wearing, measured by the Faces Visual Analogue Scale (0-10, 0 = no pain, 10 = unbearable pain) after each training session.

    Measured: Recorded after each of the 16 training sessions during Phase B (weeks 5-8).

  4. Hip Extensor and Flexor Muscle Strength

    Isometric strength of hip extensor and flexor muscles measured by dynamometry, and active hip extension range of motion, assessed in prone position at the edge of the table.

    Measured: Assessed at all 10 measurement time points across Phase A (weeks 1-4), Phase B (weeks 5-8), and Phase FU (1, 3, and 6 months post-intervention).

  5. Gait Quality - 3D Kinematic and Kinetic Curves without CMCs

    Full lower limb 3D kinematic curves and joint moments/powers (hip, knee, ankle) recorded without CMCs, on ground and on treadmill., used to assess changes in overall gait pattern over time including sagittal plane locomotor profile, anterior knee vector positioning, and trunk/pelvic alignment.

    Measured: Assessed at all 10 measurement time points across Phase A (weeks 1-4), Phase B (weeks 5-8), and Phase FU (1, 3, and 6 months post-intervention).

  6. Walking Endurance - 6-Minute Walk Test (6MWT)

    Distance covered in 6 minutes (meters) on a 30-meter indoor corridor with standardized instructions and encouragements, performed with the participant's habitual walking aids and orthoses. A validated functional walking capacity test widely used in pediatric cerebral palsy populations.

    Measured: Assessed at all 10 measurement time points across Phase A (weeks 1-4), Phase B (weeks 5-8), and Phase FU (1, 3, and 6 months post-intervention).

  7. Cadence

    Cadence is a measure of speed calculated as the total number of full cycles (of both a right and left foot strike) taken within a given period of time, often expressed in steps per minute or cycles per minute recorded with and without CMCs, on ground and on treadmill.

    Measured: Assessed at all 10 measurement time points: 3 baseline sessions (Phase A, weeks 1-4), 4 intervention sessions (Phase B, weeks 5-8), and 3 follow-up sessions (1, 3, and 6 months post-intervention)

  8. Step Length

    Step length is the distance between the point of initial contact of one foot and the point of initial contact of the opposite foot. Recorded with and without CMCs, on ground and on treadmill.

    Measured: Assessed at all 10 measurement time points: 3 baseline sessions (Phase A, weeks 1-4), 4 intervention sessions (Phase B, weeks 5-8), and 3 follow-up sessions (1, 3, and 6 months post-intervention)

  9. Stride Length

    Stride length is defined as the distance between two points where the same foot strikes the ground sequentially, encompassing the sum of left and right step lengths. Recorded with and without CMCs, on ground and on treadmill.

    Measured: Assessed at all 10 measurement time points: 3 baseline sessions (Phase A, weeks 1-4), 4 intervention sessions (Phase B, weeks 5-8), and 3 follow-up sessions (1, 3, and 6 months post-intervention)

  10. Step Width

    The mediolateral space between the two feet (the difference between right and left heels during gait). Recorded with and without CMCs, on ground and on treadmill.

    Measured: Assessed at all 10 measurement time points: 3 baseline sessions (Phase A, weeks 1-4), 4 intervention sessions (Phase B, weeks 5-8), and 3 follow-up sessions (1, 3, and 6 months post-intervention)

  11. Single Support Duration

    The period of time when only one foot is in contact with the ground recoreded with and without CMCs, on ground and on treadmill.

    Measured: Assessed at all 10 measurement time points: 3 baseline sessions (Phase A, weeks 1-4), 4 intervention sessions (Phase B, weeks 5-8), and 3 follow-up sessions (1, 3, and 6 months post-intervention)

  12. Double Support Time

    The period of time when both feet are in contact with the ground recorded with and without CMCs, on ground and on treadmill.

    Measured: Assessed at all 10 measurement time points: 3 baseline sessions (Phase A, weeks 1-4), 4 intervention sessions (Phase B, weeks 5-8), and 3 follow-up sessions (1, 3, and 6 months post-intervention)

  13. Stance ratio

    The ratio between the entire gait cycle and stance phase recoreded with and without CMCs, on ground and on treadmill.

    Measured: Assessed at all 10 measurement time points: 3 baseline sessions (Phase A, weeks 1-4), 4 intervention sessions (Phase B, weeks 5-8), and 3 follow-up sessions (1, 3, and 6 months post-intervention)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Jun 2026
  2. Study start1 Sep 2026 (estimated)
  3. Primary completionSep 2028 (estimated)
  4. Study completionSep 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
6 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07650370
Sponsor's protocol ID
2026_01_RCMs_RIPH2
Acronym
RCMs
Status last verified
Jun 2026
First submitted
21 May 2026
Last updated
22 Jun 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Cruro-Malleolar Cast Walking Training in people with Cerebral Palsy, run by Centre Médico-Chirurgical de Réadaptation des Massues Croix Rouge Française.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 22 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Julie Rozaire, PhD (+334 72 38 11 43, lab.massues@croix-rouge.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Hip and Lumbopelvic 3D Kinematics during CMC-assisted Walking (time frame: Assessed at each of the 4 weekly measurement sessions during Phase B (weeks 5, 6, 7, and 8 from study start).). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jun 2026.

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