Treadmill training in moderate risk preterm infants promotes stepping quality--results of a small randomised controlled trial.

Infants at risk for neuromotor delay (NMD) are associated with premature birth and low birth weight. These infants frequently exhibit tone, posture, and movement abnormalities. Therefore, it is important to identify potential interventions to facilitate early motor development within this population. The purpose of this study was to examine the potential benefits of treadmill (TM) training in infants at risk for NMD. Furthermore, relationships between TM stepping performance and onset of walking have been suggested, and therefore, were also explored. Twenty-eight infants at moderate risk for NMD were randomly assigned to one of two groups: (1) TM training (experimental) (N=15) or (2) control (N=13). Infants in the experimental group were trained for 8 min/day, five days/week from study entry until walking onset. Monthly, 5 min of TM stepping performance were videotaped and analysed for infants in both groups to obtain frequency and quality of TM stepping. Groups were different in terms of TM stepping performance with experimental group displaying better stepping. However, they did not differ in age of walking onset (experimental=15.1 months, control=14.6 months). In both groups, frequency of TM stepping was significantly related to onset of walking. Findings suggest that TM training as implemented impact the quality of TM stepping, but did not significantly improve walking onset. Given the significant relationship between stepping and walking onset, the moderate affection of the population, the relative low intensity and lack of individualisation of the training, we suggest future research should further explore the impact of TM training on gait-related variables and include individualised, more intense, and prolonged training.

Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay: a report of a Cochrane systematic review and meta-analysis.

UNLABELLED: Delayed motor development may occur in children with Down syndrome, cerebral palsy or children born preterm, which in turn may limit the child's opportunities to explore the environment. Neurophysiologic and early intervention literature suggests that task-specific training facilitates motor development. Treadmill intervention is a good example of locomotor task-specific training. AIM: The aim of this paper was to assess the effectiveness of treadmill intervention on locomotor motor development in pre-ambulatory infants and children under six years of age who are at risk for neuromotor delay. DESIGN: A Cochrane systematic review with meta-analysis. METHODS: We employed a comprehensive search strategy. We included randomised, quasi-randomised and controlled clinical trials that evaluated the effect of treadmill intervention in children up to six years of age with delays in gait development or the attainment of independent walking or who were at risk of neuromotor delay. We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, Science Citation Index, PEDro, CPCI-S and LILACS; and also ICTRP, ClinicalTrials.gov, mRCT and CenterWatch. Four authors independently extracted the data using standardized forms. RESULTS: We included five studies, which reported on treadmill intervention in 139 children. Of the 139 children, 73 were allocated to treadmill intervention groups. The studies varied in the type of population studied, the type of comparison, the time of evaluation and the parameters assessed. Due to the diversity of the studies, we were only able to use data from three studies in meta-analyses and these were limited to two outcomes: age of onset of independent walking and gross motor function. Evidence suggested that treadmill intervention could lead to earlier onset of independent walking when compared to no treadmill intervention (effect estimate -1.47; 95% CI: -2.97, 0.03), though these trials studied two different populations: Down syndrome and children at risk of neuromotor disabilities. Children with Down syndrome seemed to benefit while it was not clear if this was the case for children at high risk of neuromotor disabilities. Two other studies, both in children with Down syndrome, compared different types of treadmill intervention (high versus low intensity training). Both were inconclusive regarding the impact of these different protocols on the age at which children started to walk. There is insufficient evidence to determine whether treadmill intervention improves gross motor function (effect estimate 0.88; 95% CI: -4.54, 6.30). CONCLUSION: The current review provided only limited evidence of the efficacy of treadmill intervention in children up to six years of age. Few studies have assessed treadmill interventions in young children using an appropriate control group. The available evidence indicates that treadmill intervention may accelerate the development of independent walking in children with Down syndrome. Further research is needed to confirm this and should also address whether intensive treadmill intervention can accelerate walking onset in young children with cerebral palsy and high risk infants, and whether treadmill intervention has a general effect on gross motor development in the various subgroups of young children at risk for developmental delay.