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Down Syndrome Abstract
of the Month: Nov 2001

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Treadmill training of infants with Down syndrome: evidence-based developmental outcomes.

Ulrich DA, Ulrich BD, Angulo-Kinzler RM, Yun J
Pediatrics 2001 Nov;108(5):84

Division of Kinesiology, Univ. of Michigan, Ann Arbor, MI; and the Dept. of Exercise and Sport Science, Oregon State Univ., Corvallis, OR.

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Objective: On average, infants with Down syndrome (DS) learn to walk about 1 year later than nondisabled (ND) infants. The purpose of this study was to determine if practice stepping on a motorized treadmill could help reduce the delay in walking onset normally experienced by these infants.
Methods: Thirty families of infants with DS were randomly assigned to the intervention or control group. All infants were karyotyped trisomy 21 and began participation in the study when they could sit alone for 30 seconds (Bayley Scales of Infant Development, Second Edition 1993, item 34). Infants received traditional physical therapy at least every other week. In addition, intervention infants received practice stepping on a small, motorized treadmill, 5 days per week, for 8 minutes a day, in their own homes. Parents were trained to support their infants on these specially engineered miniature treadmills. Every 2 weeks research staff went into the homes and tested infants' overall motor progress by administering the Bayley Scales of Infant Development, Second Edition, monitored growth status via a battery of 11 anthropometric measures, and checked parents' compliance with physical therapy and treadmill intervention. The primary measures of the intervention's effectiveness were comparisons between the groups on the length of time elapsed between sitting for 30 seconds (entry into the study) and 1) raising self to stand; 2) walking with help; and 3) walking independently.
Results: The experimental group learned to walk with help and to walk independently significantly faster (73.8 days and 101 days, respectively) than the control group, both of which also produced large effect size statistics for the group differences. The groups were not statistically different for rate of learning to raise self to stand but there was a moderate effect size statistic suggesting that the groups were meaningfully different in favor of the experimental group.
Conclusions: These results provide evidence that, with training and support, parents can use these treadmills in their homes to help their infants with DS learn to walk earlier than they normally would. Current research is aimed at 1) improving the protocol to maximize outcome; 2) determining the impact of treadmill practice on walking gait patterns; 3) testing the application to other populations with a history of delays in walking; and 4) determining the long-term benefits that may accrue from this form of activity.

My comments:

This abstract needs little explanation. By taking advantage of the infant's innate ability to step, this study shows how physical intervention programs can be effective at treating delayed motor development.

Two warnings here: first, these are not ordinary treadmills but special ones designed for these children. Putting small children on regular treadmills is a safety hazard, as scrapes and severe abrasions may result. Second, there is some concern that attempting to get a child with low muscle tone to walk before he or she is ready might cause some abnormal posturing to compensate during the walking process.

I don't think we'll be seeing state Early Intervention programs passing out infant treadmills anytime soon. The take home message here is that the right physical therapy programs can aid infants with DS, which is a concept that is still a topic of debate in some circles.

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