the suit was 
 developed for the maintenance of muscle tone in a weightless environment , such as that of a 
 spaceship worker1 . it was designed to 
 create a normal framework of forces on the body for stabilizing the torso to allow for more 
 fluent and coordinated movement of all limbs . it uses a system of elastic bands and pulleys 
 that create artificial forces against which the body can work in order to prevent muscular 
 atrophy . the adeli suit treatment ( ast ) has been proposed as an intensive exercise protocol 
 for use in the management of cerebral palsy ( cp ) and other neuromuscular disorders1 . the suit is composed of a cap , a vest , 
 shorts , knee pads , shoes with attached auxiliary equipment , and a bungee cord to connect 
 auxiliary equipment . the cords are 
 adjustable for the application of varying degrees of tension to the child s different muscle 
 groups . the bungee cords are positioned to keep the body properly aligned and to forcibly 
 encourage movement within a normal range of motion2 . to reposition the limbs in order to correct for abnormal muscle 
 alignment , the bungee cords are adjusted by therapists to mimic normal flexor and extensor 
 patterns of the major muscle groups1 . the mechanism behind the adeli suit is that through active movement therapy , the brain is 
 stimulated and thus is retrained to recognize , and eventually initiate , correct movement of 
 the muscles . once the body is in proper alignment , aggressive movement therapy that will 
 reeducate the brain to recognize correct movement of the muscles can be performed . the suit 
 enhances communication between the brain and peripheral muscles , particularly , the head and 
 trunk control muscles , and the locomotor functions of the legs1 , 3 . rehabilitative gains in 
 motor control through adeli suit treatment are typically retained after the intensive course 
 is completed . studies on groups of children with ast have shown long - term retention of 
 skills after the completion of the therapy program . ast is often used as part of a 
 comprehensive physical therapy program and might improve mechanical efficiency without a 
 corresponding gain in gross motor skills , especially in children with higher levels of motor 
 function4 . in this study , we compared changes in gross motor function , spatiotemporal parameters , and 
 functional ambulation performance score ( faps ) in children with cp who were assigned to 
 receive ast and underwent training for a period of 4 weeks . the results suggest the 
 importance of the development of ast programs to improve gait ability in children with 
 cp . the subjects consisted of a 6-year - old boy ( height , 112  cm ; weight , 18  kg ; gross motor 
 function classification system [ gmfcs ] , level ii ) and a 3-year - old boy ( height , 89  cm ; 
 weight , 10  kg ; gmfcs , level ii ) with spastic diplegic cp recruited from an s rehabilitation 
 center in korea . the subjects with cp had no history of newly developed neurological 
 problems , musculoskeletal disorders , or botulinum toxin injections in the previous 6 months . the study was approved by the sahmyook university institutional review board 
 ( syuirb2015 - 109 ) . the objective of the study and its requirements were explained to the 
 subjects , and all of the participants parents provided written consent , in accordance with 
 the ethical principles of the declaration of helsinki . ast was applied in two subjects for a period of 4 weeks , 5 times per week , in 60-minute 
 sessions per day . ast included intensive multiple movements combined with the wearing of a 
 fitted garment ( adeli suit ) , which provided resistance during the multiple movements . this 
 suit comprised a vest , shorts , knee pads , and specially designed shoes . it was connected by 
 hooks , rings , and elastic bands that could be adjusted to provide pressure and support to 
 joints and muscle groups . the bungee - like cords were adjusted by a physical therapist to 
 mimic normal flexor and extensor patterns of the major muscle groups in an attempt to 
 reposition limbs in order to correct abnormal muscle alignment . each session included 
 multiple movements based on the children s abilities and included standing up , sitting , 
 playing with balls while standing , jumping on the trampoline , walking on different 
 geographical features , and climbing stairs or ladders5 . to assess gross motor function gmfm is 
 a tool for measuring and recording changes in exercise level during the process of treatment 
 or elapsed time . the gmfm-88 consists of 88 items grouped 
 into five domains as follows : domain a ( lying and rolling , 17 items ) , domain b ( sitting , 20 
 items ) , domain c ( crawling and kneeling , 14 items ) , domain d ( standing , 13 items ) , and 
 domain e ( walking , running , and jumping , 24 items)7 , 
 8 . each item is worth 3 points , and the 
 points earned from each domain are multiplied by 100 points to obtain a domain score . the 
 final score is obtained by adding each domain score and dividing the sum by 5 to obtain a 
 total score7 . to measure gait function , pa , usa ) , 
 which consists of an electronic walkway ( 90  460  cm ) . data were sampled from the walkway at 
 a frequency of 80  hz . the spatiotemporal characteristics of the gaitrite system have shown 
 excellent reliability with an intraclass correlation coefficient of between 0.82 and 
 0.929 . the procedure was explained and 
 demonstrated to the child . the child was then instructed to walk barefoot at a self - selected 
 walking speed , with the head facing forward and the eyes looking straight ahead10 . data on spatial ( step length and stride 
 length ) and temporal gait parameters ( walking speed and cadence ) were obtained by using 
 gaitritever 3.2b9 , 11 . velocity was calculated by dividing the distance by the ambulation 
 time and was expressed in centimeters per second . stride length was defined and measured on 
 the line of progression between the heel points of two consecutive footfalls of the same 
 foot and was expressed in centimeters . the faps is integrated within the gaitrite walkway and is considered to be the gold 
 standard for spatiotemporal gait parameter analysis . the measurement was performed 3 times , and to eliminate the fatigue of walking , 
 the subjects were allowed a 30-second rest after walking once12 . all measurements were performed twice , before intervention and after 4 weeks of 
 intervention . the spatiotemporal gait parameters and the faps for gait function were 
 measured three times , and the average of the three measurements was used in the analysis . all of the data were codified and analyzed with spss statistics for windows version 
 17.0 . the gross motor function of case a as assessed by gmfm increased from 87.2% at pretest to 
 94.37% at post - test ; for case b , gmfm increased from 71.17% at pretest to 73.0% at 
 post - test . the gait velocity of case a increased from 78.57  cm / s at pretest to 80.705  cm / s 
 at post - test , while the cadence increased from 135.63 to 136.97 steps / min , the right - sided 
 step length decreased from 39.01 to 37.03  cm , the left - sided step length increased from 
 31.76 to 37.27  cm , the right - sided stride length increased from 70.08 to 77.52  cm , the 
 left - sided stride length increased from 70.08 to 76.85  cm , and the faps increased from 81 to 
 84 ( table 1table 1.gross motor function and gait function scoresparametercase acase bpretestposttestpretestposttestgmfm ( % ) 87.294.471.273.0velocity ( cm / s)78.680.771.362.3cadence ( step / min)135.6137.0152.9157.6step length ( cm ) right side39.037.028.728.6left side31.837.323.522.1stride length ( cm)right side70.177.552.251.3left side70.176.952.352.9faps ( score)81847584values represent means . gmfm : gross motor function measure , faps : functional 
 ambulation performance score ) . gmfm : gross motor function measure , faps : functional 
 ambulation performance score the gait velocity of case b decreased from 71.26  cm / s at pretest to 62.27  cm / s at 
 post - test , while the cadence increased from 152.9 to 157.6 steps / min , the right - sided step 
 length decreased from 28.70 to 28.55  cm , the left - sided step length decreased from 23.50 to 
 22.11  cm , the right - sided stride length decreased from 52.18 to 51.25  cm , the left - sided 
 stride length increased from 52.27 to 52.94  cm , and the faps increased from 75 to 84 ( table 1 ) . the current neurodevelopmental treatment of cp focuses on maintaining or improving function 
 in patients with cp . various treatments may help children with cp to hold an upright body 
 alignment , strengthen muscles , prevent complications , and improve their daily functions . although several treatments of cp exist , adjustments to existing and new treatments are 
 still needed . many 
 families and clinicians are interested in the outcomes of treatment using the adeli suit , 
 but the rehabilitation community does not have adequate scientific support for its use as a 
 generally accepted treatment of cp1 . this study focused on children with cp who received ast for a period of 4 weeks , in order 
 to examine changes in gmfm , spatiotemporal parameters , and the faps . an important finding is 
 improvement in gross motor function , as assessed by gmfm , in both cases . the applied ast 
 involved multiple movements based on the children s abilities and included standing up , 
 sitting , playing with balls while standing , jumping on the trampoline , walking on different 
 geographical features , and climbing stairs or ladders . proprioceptive stimulation by 
 multiple movements has a profound effect in the treatment of cp because proprioception 
 stimulates the nervous system at the onset of damage , thus creating a better basis for 
 successful rehabilitation . for this reason , gross motor function was increased in both 
 cases . regarding gait function , the cadence and faps improved after the intervention in both 
 cases . step length increased on the left side and decreased on the right side in case a , 
 resulting in a decreasing tendency of asymmetries in step length after the intervention . the results of previous studies on ast suggest that the 
 subject relies on changes in proprioceptive information from muscles , tendons , and joints . an increase in the input of proprioception and significant information from the vestibular 
 organs can affect body position , balance , and posture tension . through active movement 
 therapy with ast , the brain is stimulated and , thus , is retrained to recognize , and 
 eventually initiate , the correct movement of the muscles , resulting in the improvement of 
 body alignment through trunk stability , along with improved walking patterns1 , 5 . body deformation due to a disability prevents patients from maintaining good posture or 
 weight support in comfortable standing positions . the location of the elastic bands in the 
 adeli suit is similar to the position of antagonistic muscle pairs . motor improvement of the 
 joints in the lower extremities in antigravity situations was associated with resistance to 
 the muscles that occurred when patients moved each part of their body that is connected to a 
 bungee cord . ast controls each movement in response to the constantly acting gravitational 
 force , particularly for the head , trunk , and locomotor functions of the legs . a limitation of this study is that only two children with cp participated in the study . however , the results show that ast improved gross motor function and functional ambulation 
 performance in these subjects . these findings suggest that ast should be recommended for 
 treatment of cp , as a properly executed intervention would bring more benefits , particularly 
 for functional improvements in cp .
[ purpose ] the purpose of this study was to determine the effects of adeli suit therapy 
 ( ast ) on gross motor function and gait function in children with cerebral palsy . 
 [ subjects 
 and methods ] two participants with spastic cerebral palsy were recruited to undergo ast . 
 ast was applied in 60-minute sessions , five times per week , with 20 sessions total over 4 
 weeks . 
 assessments of gross motor function , spatiotemporal parameters , and functional 
 ambulation performance for gait were conducted . 
 [ results ] gross motor function , cadence , 
 and functional ambulation performance improved after the intervention in both cases . 
 [ conclusion ] although additional follow - up studies are required , the results demonstrated 
 improved gross motor function and functional ambulation performance in the children with 
 cerebral palsy . 
 these findings suggest a variety of applications for conservative 
 therapeutic methods that require future clinical trials in children with cerebral 
 palsy .