In medicine, the term “evidence-based” hold a lot of weight. It is how every doctor should make decisions. This means that the result of a certain intervention, may it be a drug, a therapy, or surgery, has been proven by research studies. You want your doctors to use this kind of medicine as it is most likely to lead to the best result.
The treadmill is one of these fantastic evidence-based tools and the article Treadmill Training of Infants with Down Syndrome: Evidence Based Developmental Outcomes gives us a method as well as expected results of this intervention. You may wonder why these babies are being put on treadmills long before even a typical child would be expected to walk…well this article shows that this intervention helps our children with Down syndrome walk a little sooner.
Why Walking Is Important
The average age of walking for a child with Down syndrome is 23 months, whereas a typical child is 12-13 months. Walking is an important part of development as it changes the way the child is able to interact in their environment, specifically with other people like playing with children. I have heard from other mothers that as soon as a child learned to walk they blossomed in many other areas including language. I am ok with Noah walking when he is ready to walk, but I also want to give him every opportunity to explore on his two feet. He is already a rolling adventurer…you gotta watch out for this kid or the next thing you know he is under a couch.
Our physical therapist brought up treadmill training to us and we got very excited. Her fabulous student Jill was doing research on the topic just for us. The idea behind treadmill training is to create the stepping reflex. The stepping reflex is making a stepping movement when the sole of the foot hits a hard surface. It is present at birth and is supposed to disappear around 2 months. Noah never had a stepping reflex when he was born which is common in children with hypotonia. There is research that shows that if a child has the stepping reflex continue past this point it can help them learn to walk a little bit sooner than expected. The baby learns a “practiced pattern” that he or she can apply once they are ready to walk.
When Can We Start?
The one hinderance to evidence based medicine is that you can only use the statistics if you fit the criteria that the article used. One of their criteria is that the child can sit for 30 seconds prior to starting treadmill training. The treadmill was dangled in front of us for a few weeks before we were able to use it. Thank you sitting marathon, you are paying off today! This was used as a measurement of time assuming that children were developmentally similar at this time and the next major milestones would be what was encouraged by the treadmill training. The average age was about 300 days when the kids started the study.
The article actually used parents as the treadmill trainers and provided treadmills in each of the parent’s homes. They were tiny treadmills made just for this study. The parents were to use it 5 times per week for 8 minutes at 0.2 meters per second which is almost 0.5 miles per hour. When first starting, the children were not walking consistently for 8 minutes. They would walk for 1 minutes, rest, and try again until they could achieve the full 8 minutes. The parent supports the child over the treadmill so that their feet touch the ground and are moved back by the treadmill. The hope being that when their foot is too far behind them they will lift it up and put it in front of them. Eventually this will become a practiced pattern that the child has mastered.
Now on to what we really care about…the results. The children getting the intervention were compared to children not getting treadmill training. This makes for the “perfect” study: a randomized
controlled trial. This is the best of the best when it comes to looking for evidence. Of the three outcomes, two were statistically significant meaning that the results were not by chance based on the statistical analysis. Raising self to stand occurred at day 134 (from enrollment in the study or from when they were sitting for 30 seconds), which was 60 days earlier than the control, this however was NOT statistically significant. Walking with help occurred at 166 days, 73 days earlier than the control. And lastly, walking independently occurred at 300 days, which was 101 days earlier than the control. Both of these were found to be statically significant.
Now that may not seem like a huge difference, but a little over 3 months is a huge difference when you are not even 2 yet. The average age of walking for those who went through treadmill training was 19.9 months and for the control group it was 23.9 month. The 4 months difference now is because we are not talking days from sitting anymore, but the actual age of the infants when they walk. The control group was slightly older.
Small Insight Seen In the Article
One of of my favorite things about this study were not just the results. Not one parent dropped out. Whether it was the control or the or treadmill training group they stuck it through to the end. Not many studies can boast that kind of result. I think that says a lot about the parents that raise children with Down syndrome; they don’t give up and they are willing to put in the work. Go team!
We Will Be Patient
We are far from following the method as we only have a treadmill at therapy and we go twice per week, but we are trying to help Noah learn to put one foot forward, and when he is ready may it be at 19 months or after his 2nd birthday we will celebrate him walking independently.
Have you used the treadmill for your little ones development? What are some of your favorite physical therapy tools / techniques / exercises?