Clinical Bottom Line
“How could I apply this information?”
This study begins to explore options for gait training for infants with spina bifida, emphasizing the importance of early intervention and neuroplasticity. Providing objective and specific information on how to use a variety of sensory inputs during supported treadmill stepping—visual flow, unload, load, and friction, as well as parameters on manual assistance/facilitation—may, in the future, assist physical therapists in applying this intervention. But as the authors point out, much more research is needed before the effectiveness of this intervention can be determined. From this study, it appears that the best results were with the combination of friction and load and slower treadmill speeds during manual assistance. In addition, it appears that short, intensive bursts of intervention may be effective, which is beneficial when working with infants. And, although the cost of the custom treadmill used in the study needs to be considered, the compact size makes it portable for multisite or home-based interventions.
“What should I be mindful about when applying this information?”
This is a preliminary study with a small sample size of infants with varying ages, levels of lesions, and histories of shunt revision, which limits statistical power and ability to apply to all children with spina bifida. In addition, the very brief intervention time (3 sessions each with short amount of time on treadmill) does not allow for study of treatment accommodation or long-term training effects. And although the authors' purpose was only to see the immediate response to the sensory or manual input, the question remains “What does this mean functionally in the long run with respect to motor learning and achievement of walking skill?” Does this immediate stepping response fade out after initial sensory input or strengthen with repetition and time? In addition, it is important to keep in mind infant variability when facilitating new motor skills; as infants often use a variety of movement patterns when achieving developmental milestones such as walking. So although this intervention does offer hope and direction, further research is needed to develop clinical guidelines for use in the clinic.
Deborah Nervik, PT, MHS, DPT, DHS, PCS
California State University, Fresno
Stephanie Yu, PT, MSPT, PCS
California Children's Services, County of Los Angeles, Long Beach