The Effect of Treadmill Training and Supramalleolar Orthoses on Gait and Upright Play Development in Infants with Down Syndrome.

Abstract

This study explores whether the use of supramalleolar orthoses (SMO) in combination with treadmill training (TT) leads to improved age at walking onset, improved upright play skills, and improved gait parameters in infants with Down syndrome (DS) when compared to TT alone. Infants entered the study when they could pull to stand but not yet cruise and were randomly assigned into the control (n=7) or experimental group (n=10). Infants in the control group received TT 5 days/wk for 8 min/day at a speed of 0.2 m/s. Infants in the experimental group wore SMOs for 8 hours/day in addition to TT. During the study, researchers visited the infants’ homes monthly. At these visits, 3 minutes of treadmill stepping were videotapes and each child’s motor development was updated via administration of the GMFM and PEDI. A 20-minute upright play session at an infant activity table was also videotaped during the odd numbered visits. The TT portion of the study ended when each child took 3-independent steps. At that point, infants in the control group were measured for orthoses, which they received 1-2 weeks later. One month after walking onset, each infant came to the lab for gait analysis with and without orthoses. Results show that while the long-term orthotic use led to improved gait parameters at walking onset and improved balance in upright play, it also led to negative effects on other developmental outcomes including poorer performance on adaptive motor skills and decreased exploratory play in upright. This negative effect on overall development outweighs the positive effects of orthoses in this young population. SMO use should be postponed in children with DS until they have an established gait pattern and adaptive motor skills.