Analysis of a Group-Based Treadmill Program for Children with Neuromotor Delay Who Are Pre-Ambulatory.

PURPOSE: To analyze data from a prospective cohort study, a group-based treadmill program, administered twice weekly for 14 weeks, in regard to gross motor skills related to walking and walking attainment in young children with neuromotor delay who are pre-ambulatory. METHODS: Seventy children (F = 29), mean age 25.6 (SD 10.1) months participated in the program 2×/week for 14 weeks. The Gross Motor Function Measure-88 Dimensions D and E (GMFM D/E), Functional Mobility Scale for 5, 50, and 500 meters (FMS 5, 50, 500), the timed 10-m walk test (10MWT), and the Pediatric Evaluation of Disability Inventory Caregiver Mobility Scale (PEDI) were administered before and after the program. RESULTS: Statistically significant improvements were found in the GMFM D, GMFM E, FMS 5, 50, 500 and PEDI, but not in 10MWT. CONCLUSIONS: A group-based treadmill program was associated with improvements in motor skills related to walking in young children when administered in adjunct to ongoing physical therapy.

Intensive, functional training leads to optimal outcomes in a young woman post brain stem hemorrhage due to cerebral cavernous malformation.

PURPOSE: Cerebral cavernous malformations (CCMs) can cause intracranial hemorrhages and account for 5-15% of all cerebral vascular malformations. The purpose of this retrospective case report is to describe the unusual motor recovery of a young woman following a large hemorrhage of a previously unknown brainstem CCM, otherwise not reported in the literature. Case Description: The patient was a 29-year-old female who presented with severe hemiparesis on the left 6 weeks after a first-ever hemorrhage. She had demonstrated minimal improvement in her motor recovery to date, was dependent on a walker for ambulation, and had no distal left upper extremity function. An intensive evidence-based plan of care over 6 weeks included progressive task-specific strengthening, treadmill training, and dynamic balance training. Outcomes: The patient achieved complete motor recovery, indicated by improvement from 23/66 to 64/66 in the Fugl-Meyer Upper Extremity Subscale score and from 12/30 to 30/30 in the Functional Gait Assessment. She returned to independent ambulation with functional gait speeds and kinematics. Discussion: This case report demonstrates an unusual clinical course of unexpected full recovery in a young woman after a large brainstem CCM after an intensive 6-week course of physical therapy. Other patients with a similar presentation after CCM may benefit from an intensive plan of care. Clinicians should be aware of the possibility of unusual recovery in this population as not to limit expectations for recovery.

Low-Intensity vs High-Intensity Home-Based Treadmill Training and Walking Attainment in Young Children With Spastic Diplegic Cerebral Palsy.

OBJECTIVE: To compare the effect of low-intensity (LI) vs 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 14-32 months (N=19; male, n=8). INTERVENTIONS: The children were randomized to LI TT (2×/wk for 6wk) (n=10) and HI TT (10×/wk for 6wk) (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=.061), while children in the LI group did (P=.003), but no statistically significant differences were detected over time (P=.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 10×/wk program and can be more readily implemented into clinical practice.

Treadmill interventions in children under six years of age at risk of neuromotor delay.

BACKGROUND: Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development. OBJECTIVES: To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay. SEARCH METHODS: In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population. DATA COLLECTION AND ANALYSIS: Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model. MAIN RESULTS: This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45). AUTHORS' CONCLUSIONS: This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.

Effects of a Group-Based Treadmill Program on Children With Neurodevelopmental Impairment Who Are Not Yet Ambulating.

PURPOSE: To examine the effects of a group-based treadmill program on gross motor skills related to walking and the amount of support needed for ambulation in children with neuromotor impairment who are not yet walking. METHODS: Twelve children (mean age, 30.4 months; standard deviation, 7.9) participated in the program twice per week for 14 weeks. The Gross Motor Function Measure-88 Dimensions D and E (GMFM-88 D/E), the Functional Mobility Scale (FMS), the timed 10-m walk test, and the Pediatric Evaluation of Disability Inventory Mobility Scale (PEDI) were administered before and at the conclusion of the program. Data were analyzed using paired the t test and Wilcoxon matched-pairs signed rank test. RESULTS: Statistically significant improvements were found between pre- and posttests in the GMFM-88 D (P = .0005) and E (P = .001), in FMS scores (P = .039), and the PEDI (P = .001). CONCLUSIONS: A group-based treadmill program leads to positive changes in walking ability in children with neuromotor impairment.

Effects of home-based locomotor treadmill training on gross motor function in young children with cerebral palsy: a quasi-randomized controlled trial.

OBJECTIVE: To examine the effects of an intensive home-based program of treadmill training on motor skills related to walking in preambulatory children with cerebral palsy (CP). DESIGN: Quasi-randomized controlled trial. SETTING: Homes of the participants. PARTICIPANTS: Children with CP (N=12) with Gross Motor Function Classification System levels I and II were assigned to the intervention group (n=6; mean age ± SD, 21.76±6.50mo) and control group (n=6; 21.25±6.07mo). All children were tested preintervention, postintervention, at a 1-month follow-up, and at a 4-month follow-up. INTERVENTIONS: All children received their weekly scheduled physical therapy sessions at their homes. In addition, children in the intervention group walked on a portable treadmill in their homes 6 times per week, twice daily for 10- to 20-minute sessions, for 6 weeks. The intervention was carried out by the children's parents with weekly supervision by a physical therapist. MAIN OUTCOME MEASURES: Gross Motor Function Measure-66 Dimensions D/E, Peabody Developmental Motor Scales-2 (PDMS-2), Pediatric Evaluation of Disability Inventory (PEDI), timed 10-m walk test (10MWT), and Functional Mobility Scale (FMS). The Friedman test and Mann-Whitney U test were conducted for within-group and between-group differences, respectively. RESULTS: There was a significant between-group treatment effect for the PDMS-2 at posttest (P=.01) and 1-month postintervention follow-up (P=.09), as well as for the PEDI at posttest (P=.01), the 1-month postintervention follow-up (P=.009), and the 4-month postintervention follow-up (P=.04). The FMS was significant at the posttest (P=.04). CONCLUSIONS: Home-based treadmill training accelerates the attainment of walking skills and decreases the amount of support used for walking in young children with CP.

Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay.

BACKGROUND: 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. OBJECTIVES: 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. SEARCH METHODS: In March 2011 we searched CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE (1948 to March Week 2, 2011), EMBASE (1980 to Week 11, 2011), PsycINFO (1887 to current), CINAHL (1937 to current), Science Citation Index (1970 to 19 March 2011), PEDro (until 7 March 2011), CPCI-S (1990 to 19 March 2011) and LILACS (until March 2011). We also searched ICTRP, ClinicalTrials.gov, mRCT and CenterWatch. SELECTION CRITERIA: We included randomised controlled trials, quasi-randomised controlled trials 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. DATA COLLECTION AND ANALYSIS: Four authors independently extracted the data using standardised forms. Outcome parameters were structured according to the "Body functions" and "Activity and Participation" components of the International Classification of Functioning, Disability and Health, Children & Youth version (ICFCY), which was developed by the World Health Organization. MAIN RESULTS: We included five studies, which reported on treadmill intervention in 139 children. Of the 139 children, 73 were allocated to treadmill intervention groups, with the other children serving as controls. The studies varied in the type of population studied (children with Down syndrome, cerebral palsy or who were at risk for neuromotor delay); the type of comparison (for example, treadmill versus no intervention, high intensity treadmill versus low intensity); the time of evaluation (during the intervention or at various intervals after intervention), 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 (two studies; effect estimate -1.47; 95% confidence interval (CI): -2.97, 0.03), though these trials studied two different populations and 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. Another two studies, both in children with Down syndrome, compared different types of treadmill intervention: one compared treadmill intervention with and without orthotics, while the other compared high versus low intensity treadmill intervention. 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 (two studies; effect estimate 0.88; 95% CI: -4.54, 6.30). In the one study evaluating treadmill with and without orthotics, results suggested that adding orthotics might hinder gross motor progress (effect estimate -8.40; 95% CI: -14.55, -2.25).One study of children with Down syndrome measured the age of onset of assisted walking and reported those receiving the treadmill intervention were able to walk with assistance earlier than those who did not receive the intervention (effect estimate -74.00; 95% CI: -135.40, -12.60). Another study comparing high and low intensity treadmill was unable to conclude whether one was more effective than the other in helping children achieve supported walking at an earlier age (effect estimate -1.86; 95% CI: -4.09, 0.37).One study of children at high risk of neuromotor disabilities evaluated step quality and found a statistically significant benefit from treadmill intervention compared to no treadmill intervention (effect estimate at 16 months of age: -15.61; 95% CI: -23.96, -7.27), but was not able to conclude whether there was a beneficial effect from treadmill training on step frequency at the same age (effect estimate at 16 months of age: 4.36; 95% CI: -2.63, 11.35). Step frequency was also evaluated in children with Down syndrome in another study and those who received high intensity rather than low intensity treadmill training showed an increased number of alternating steps (effect estimate 11.00; 95% CI: 6.03, 15.97).Our other primary outcome, falls and injuries due to falls, was not measured in any of the included studies. AUTHORS' CONCLUSIONS: 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 (which would be usual treatment or no treatment). 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.

Effectiveness of a computer-aided neuroanatomy program for entry-level physical therapy students: anatomy and clinical examination of the dorsal column-medial lemniscal system.

The purpose of this study was to determine if a computer-aided instruction learning module improves students' knowledge of the neuroanatomy/physiology and clinical examination of the dorsal column-medial lemniscal (DCML) system. Sixty-one physical therapy students enrolled in a clinical neurology course in entry-level PT educational programs at two universities participated in the study. Students from University-1 (U1;) had not had a previous neuroanatomy course, while students from University-2 (U2;) had taken a neuroanatomy course in the previous semester. Before and after working with the learning module, students took a paper-and-pencil test on the neuroanatomy/physiology and clinical examination of the DCML system. Kruskal-Wallis one-way ANOVA and Mann-Whitney tests were used to determine if differences existed between neuroanatomy/physiology examination scores and clinical examination scores before and after taking the learning module, and between student groups based on university attended. For students from U1, neuroanatomy/physiology post-test scores improved significantly over pre-test scores (p < 0.001), while post-test scores of students from U2 did not (p = 0.60). Neuroanatomy/physiology pre-test scores from U2 were significantly better than those from U1 (p < 0.001); there was no significant difference in post-test scores (p = 0.062). Clinical examination pre-test and post-test scores from U2 were significantly better than those from U1 (p < 0.001). Clinical examination post-test scores improved significantly from the pre-test scores for both U1 (p < 0.001) and U2 (p < 0.001).

Locomotor treadmill training for children with cerebral palsy.

Due to a rise in the incidence of cerebral palsy, this diagnosis is increasingly encountered by orthopaedic nurses. The majority of children with cerebral palsy have difficulty with ambulation. Because ambulation is important for orthopaedic and cardiopulmonary development, as well as independence with activities of daily living, the achievement of ambulation is an important therapeutic goal for these children. Locomotor treadmill training is a relatively new method that is used to teach children how to walk and make their ambulation more efficient. This article reviews the underlying principles of locomotor treadmill training and examines related literature for children with cerebral palsy.

Effects of intensive locomotor treadmill training on young children with cerebral palsy.

PURPOSE: To examine whether an intensive, short-term locomotor treadmill training program helps children with cerebral palsy (CP) younger than 4 years of age improve their gross motor skills related to ambulation, walking speed, and endurance. METHODS: Six children with cerebral palsy, ages 2.5 to 3.9 years, participated in treadmill training 3 times per week for 1-hour sessions consisting of 2 individualized treadmill walks, for 4 weeks, and were tested before and after the intervention and at a 1-month follow-up. The outcome measures included the Gross Motor Function Measure-66, the Pediatric Evaluation of Disability Inventory, a timed 10-m walk test, and a 6-minute walk test. RESULTS: Significant differences were found in the Gross Motor Function Measure-66 Dimensions D and E, the Pediatric Evaluation of Disability Inventory Mobility Scales, over-ground walking speed, and walking distance. CONCLUSIONS: The results of this study provide preliminary evidence that children with CP younger than 4 years of age can improve their gross motor function, walking speed, and walking endurance after intensive locomotor treadmill training.

Effects of partial body weight supported treadmill training on children with cerebral palsy.

PURPOSE: The purpose of this literature review was to investigate the effects of partial body weight supported treadmill training (BWSTT) on gross motor function, balance, gait speed, and endurance in children with cerebral palsy (CP). SUMMARY OF KEY POINTS: Larger numbers of preschool and school-aged children have been studied compared with infants and toddlers. More evidence exists regarding the efficacy of BWSTT on endurance, gait speed, and gross motor function related to ambulation than on balance in children with CP. Longer and more intense BWSTT protocols may lead to better results. STATEMENT OF CONCLUSIONS: BWSTT has not been studied extensively in children with CP. Current evidence suggests that intensive and prolonged BWSTT may be a safe, effective, and beneficial treatment intervention for the attainment of walking, improvement of gait speed, and improvement of endurance for children with different types and degrees of CP.