Journal Club CEU Approval
Contact Hours: 1
AR | FL CE26-803266 | ID
Body Weight Support Treadmill Training for Children With Developmental Delay Who Are Ambulatory
JC16Q1
On-demand
$10
On-demand
$10
Webinar Description
Lowe, Leah, Amy Gross McMillan, and Charlotte Yates Body Weight Support Treadmill Training for Children With Developmental Delay Who Are Ambulatory. Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association 27.4 (2015): 386. The pediatric literature regarding BWSTT has shown improved endurance, gross motor function, self-selected walking speed, gait kinematics, gait symmetry, and safety in a variety of populations. Although body weight supported treadmill training (BWSTT) is typically used to encourage the development of independent walking, this study used BWSTT to facilitate the refinement of existing gait characteristics in children who were already independently ambulatory. The authors considered current theories of motor learning and recommended practice for children with hypotonia to employ a “top-down” method combining cognitive processes and functional activities to improve children’s strength and postural control while allowing required practice of specific gross motor skills. This embraces a paradigm shift from traditional pediatric PT for children with developmental delay (DD) in which a “bottom-up” approach interventions employed aim at changing underlying deficits in order to improve functional performance. Just as athletes who are capable of running independently gained speed and efficiency in an established skill through BWSTT, Lowe and colleagues demonstrated that BWSTT can be used to enhance existing gait skills (walking speed) in children who are ambulatory. BWSTT provides the child with more sustained practice than can be provided over-ground (OG) while providing the therapist greater ease for providing feedback (visual, tactile and verbal) while allowing the child to experience the consequences/rewards of varied performance. The results of this study suggest that BWSTT is a safe, efficient and clinically practical intervention for ambulatory children with DD, and can be used in conjunction with typical PT treatment to improve their walking speed and functional gross motor skills in 6 weeks or less. Study Question: Do ambulatory children with DD show similar response to BWSTT as children with similar qualities (children with DS)? Can BWSTT refine skill in children with DD and established independent gait? Hypothesis: As in children with DS, BWSTT will hasten the onset of motor skill acquisition in ambulatory children diagnosed with DD. BWSTT will improve walking speed in ambulatory children with DD. STRENGTHS: Inclusion of age groups that represent developing gait patterns, in which a training program could potentially have the greatest impact. Consideration of effects of error and challenge in refinement of gait pattern in ambulatory children with DD. Well-matched groups Exclusion of outliers (neurological referral, high-performers) from statistical analyses. Inclusion of a second (blinded) tester to avoid unblinded-tester bias while accommodating participant comfort via presence of a familiar tester. Established inter-rater reliability of testers. • Use of non-validated (for this population of children with DD) measure as a criterion-referenced (only) outcome measure. Selection of GMFM dimensions D and E as outcome measure- most likely to be sensitive to expected change with study interventions. Scheduling of testing/intervention to minimize participant fatigue impacting test results. Follow-up testing after washout period that was as long as the study intervention period. Primary investigator familiar with equipment usage guidelines. Initial training speed matched to participant’s measured OG walking speed. Achieved adult “full-community” walking speeds during training interventions. Focus on quality of gait during study interventions. Focus on hands-free treadmill walking. Comparison of participant walking speed to reported norms for TD age group. Reported on qualitative outcomes Progressive nature of intervention Application of BWSTT to ambulatory population. Continued use of harness without BWS for safety once BWS no longer necessary during TT. WEAKNESSES: Single baseline testing for all participants: failure to establish stable baseline (unlikely feasible) 1 tester not blinded to group assignment. Failure to measure qualitative or endurance outcomes Absence of “no treatment” control. Failure to standardize “regular PT sessions.” THE BOTTOM LINE: What we know 46% of children diagnosed with DD at 5 years of age demonstrate motor and perceptual differences from their undiagnosed peers at 15 years of age. Children with motor delays demonstrate reduced exploration of their environment and dependence in ADLs. BWSTT will hasten the onset of walking and motor milestone achievement in children with down syndrome. New Information Participants who received BWSTT exhibited statistically-significant and clinically-meaningful improvements in self-selected average gait velocity. Although all subjects improved in GMFM-E scores, BWSTT participants showed greater improvement. What this means to you Task-specific training, such as treadmill-based gait training, translates to improvements in that task. BWSTT, in addition to appropriate PT treatment, can accelerate acquisition of gross motor skills, potentially decreasing the length of a PT episode of care. PURPOSE: To determine the effects of a 6-week, high-intensity BWSTT program on gait velocity and gross motor skill development in a group of children with DD aged 2-5 years, who are ambulatory.
CEU Information
Webinar Information
Contact Hours: 1
Price: $10
Instructor: Leah Lowe
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