Optimizing treadmill training to improve onset and quality of gait in infants with Down syndrome
Contact: Dale Ulrich (email@example.com)br>
Rosa Angulo Barroso (firstname.lastname@example.org)
Infants with Down syndrome (DS) start walking about one year later than typically
developing infants because of several neurophysiological and physical abnormalities.
As walking has an impact on further motor, cognitive, and social development, it is
thus highly desirable to minimize early motor delays to ultimately enhance the physical
activity and quality of life of these children. A generalized, low-intensity treadmill
training program has been shown to improve the onset of walking in infants with DS in our
previous research. This study investigated the impact of two different treadmill training
protocols, generalized-low versus individualized-high, on both, the onset of walking and
the quality of gait in infants with DS.
Twelve infants with DS (trisomy 21), recruited about ten months of age, were randomly
assigned to two treadmill training groups: generalized-low intensity group and
individualized-high intensity group. A small motorized treadmill was used to provide
intervention in the home until the child walked independently. In the low intensity group,
infants were trained for 8 minutes per day, 5 days per week. In the high intensity group a
small amount of weight was attached around the infants' ankles. The attached weight, training
duration, and treadmill speed were sequentially increased when the infants could produce 10,
20, and 30 alternating steps per minute.
The onset of independent walking was determined when an infant could walk 3 steps
independently. Then, we brought the infant to our lab four times (1, 4, 7 and 13 months
after the onset of walking). A computerized GaitRite® mat and a Peak® motion analysis
system were used to collect data. Gait parameters examined included average velocity,
cadence, normalized step length and width (with respect to leg length and hip width,
respectively), single and double support percentage obtained from the GaitRite®, and
dynamic base angle from the Peak® system.
Results indicated that the low and high intensity groups were able to walk independently
3.6 and 5.9 months earlier, respectively, than infants with DS without treadmill training.
Both training protocols are thus able to promote earlier onset of walking in infants with DS.
When examining the long-lasting effects of treadmill training, infants showed an improvement
even after the training is stopped as revealed by the significant visit effect in all gait
parameters. However, these results might be due to a training effect and a developmental
The high intensity group started walking independently 2.3 months earlier than the low
intensity group, and maintained an advantage in the development of gait quality up to 7
months after the onset of walking. These results imply that an individualized and higher
intensity protocol promotes further improvements in independent gait. Such an earlier onset
of independent walking and a better quality of gait may enhance the development of other
motor, cognitive and social skills.
Infants with DS, and potentially infants with other developmental disabilities, can
benefit from treadmill training because an enhanced onset of walking and a better gait
quality can be obtained via such type of early intervention. Therefore, the need for further
therapeutic intervention may be reduced.
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