Sampling Therapeutic Effects and Progress in Cerebral Palsy (STEP-CP)

Participants will complete 3 tasks that will be used to quantify the neuroplastic changes in the brain areas that are involved in the control of a leg motor action, processing of somatosensory information and processing of basic visual information. The activity of the brain areas that are involved in the planning and generation of a leg motor action will be assessed with a visually cued task where the participant extends their right knee every time the cue is seen. The activity of the brain areas that process sensory information will be assessed with a paired-pulse, unilateral electrical stimulation that will be applied using electrodes that will be affixed to the skin overlying the right tibial nerve (DS7R; Digitimer, UK). The intensity of stimulation will be set to level that generates a subtle twitch in the toes. The activity of the brain areas that process basic visual information will be assessed by having the participant view a flickering dot on a screen.

Each participant's 10-meter preferred, and fast-as-possible walking speeds will be evaluated. Three trials will be completed at each speed, and the fastest of the respective trials will be the key metric. The respective assessments will occur on a digital mat (ProtoKinetics, Havertown PA) that will quantify the spatiotemporal gait kinematics.

This is a standard clinical test that is used to assess mobility and dynamic balance. The participant will start the test by sitting on a bench. The time it takes the participant to stand-up, walk to a line on the floor that is 3-meters away and return back to sitting on the bench will be the outcome measure.

Cones that are separated by 12.8 meters will be placed on opposite ends of the clinic and the participant is asked to complete laps around the cones as fast-as-possible.

Participants will wear an ActiGraph wrist monitor during the 8-weeks of physical therapy. The ActiGraph is a compact, wrist-worn, battery-operated monitor with physical characteristics that are similar to a wristwatch. The ActiGraph has an inertia measurement unit (IMU) that is used to quantify body motion in order to quantify an individual's sleep and wake patterns. Weekly, the study staff will download the data to a PC for analysis. The study staff will also send the participant daily text messages, e-mails or phone calls asking for a report on the participant's estimated sleep and wake times. The reported sleep/wake times will be used to streamline the post data processing.

This questionnaire is directed at quantifying the participant's sleep quality and disturbances. Each component score of the PSQI ranges from 0 to 3, with 3 indicating the greatest dysfunction or disturbance. The component scores are summed to obtain a global PSQI score, which ranges from 0 to 21. Higher scores indicate poorer sleep quality.

This survey evaluates how pain impacts and individual's physical, mental and social activities over the previous 7 days. Items are scored from 0-5 with higher scores indicating greater interference from pain. The component scores are summed to obtain a global pain inference score, which ranges from 0 to 30. Scores closer to 30 indicate that pain very much interferes.

Female participants will be asked to complete daily at-home urine testing throughout the 8-weeks of the physical therapy. The samples will be immediately tested using a Mira Hormone Monitor. This monitor is a lab-grade, app-based, secure and HIPPA-compliant device. It uses fluorescent-based technology and a calibrated optical analyzer to estimate hormone levels with clinical-level accuracy.

Female participants will complete this survey that contains 26 questions about mood, pain, cognitive status, health and timing of period. Each item is scored from 0-3, with higher scores indicating that the participant very much has the symptom. The component scores are summed to obtain a global daily menstrual distress score, which ranges from 0 to 78, with higher scores indicating greater menstrual distress.