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Commentary on “Early Treadmill Practice in Infants Born With Myelomeningocele

A Pilot Study”

Bossola, Kelly, PT, MSPT, PCS; Barnhill, Jamie, PT, DPT

Pediatric Physical Therapy: January 2019 - Volume 31 - Issue 1 - p 75
doi: 10.1097/PEP.0000000000000570
RESEARCH REPORTS: CLINICAL BOTTOM LINE

UPMC Children's Hospital of Pittsburgh Pittsburgh, Pennsylvania

The authors declare no conflicts of interest.

“How should I apply this information?”

Treadmill training and its positive effects on motor outcomes have been documented in the literature. Many of these studies have linked treadmill training to improved anthropometrics, developmental skills, and quality of life. There is evidence to support the benefits to the infants in this pilot study.

Participants acquired developmental gross motor skills approximately 1.5 to 2 months earlier than similar children with myelomeningocele (MMC). These additional weeks of upright play can create more opportunities for exploring the environment and social interactions, promoting cognitive and social development. Pediatric physical therapists treating children with MMC should consider introducing early, intensive lower extremity weight-bearing (be it supported bouncing or stepping) to maximize the rate of overall development in the first years of life.

“What should I be mindful about when applying this information?”

While early intervention is typically preferred, step training an infant at 1 month of age is more intensive than typical therapy programs. The difference in outcomes between participants starting intervention at 1 versus 2 months may indicate that there is a period of “too soon.” Proper assessment should be made of the infant's head control and postural stability before implementing a similar program. Education on safety and correct ergonomics, both of the child and the parent, should be part of the training. Compliance might improve if the parent had an alternative method for supporting the child on the treadmill. Stepping was allowed to be spontaneous. Outcomes might improve if tactile or sensory cues were provided similar to traditional locomotor training.

Further research is needed for long-term follow-up to see whether this intense treatment impacts quality of life and independence for children with MMC at the lumbar-level involvement and higher.

Kelly Bossola, PT, MSPT, PCS

Jamie Barnhill, PT, DPT

UPMC Children's Hospital of Pittsburgh

Pittsburgh, Pennsylvania

Copyright © 2019 Academy of Pediatric Physical Therapy of the American Physical Therapy Association