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Controlled Clinical Trial
. 2009 Jan;89(1):60-72.
doi: 10.2522/ptj.20080120. Epub 2008 Dec 4.

Stepping responses of infants with myelomeningocele when supported on a motorized treadmill

Caroline Teulier  1 , Beth A Smith, Masayoshi Kubo, Chia-Lin Chang, Victoria Moerchen, Karin Murazko, Beverly D Ulrich
Affiliations
Controlled Clinical Trial

Stepping responses of infants with myelomeningocele when supported on a motorized treadmill

Caroline Teulier et al. Phys Ther. 2009 Jan.

Abstract

Background and purpose: Infants with myelomeningocele (MMC) have difficulty with, and show delays in, acquiring functional skills, such as walking. This study examined whether infants with MMC will respond to treadmill practice by producing stepping patterns or at least motor activity during the first year after birth. This study also compared the stepping trajectories of infants with MMC across age with those of infants with typical development (TD) to analyze the characteristics of the development of stepping patterns in infants with MMC early in life.

Participants: Twelve infants with MMC (lumbar and sacral lesions) and 12 infants with TD were the participants in this study.

Methods: The infants were tested on a treadmill at ages 1, 3, 6, 9, and 12 months, with no treadmill practice between test sessions. Infants were supported on the treadmill for twelve 20-second trials. A digital camera and behavior coding were used to determine step rate, interlimb stepping patterns, step parameters, and motor activity level.

Results: Treadmill practice elicited steps in infants with MMC (14.4 steps/minute during the year) but less so than in infants with TD (40.8 steps/minute). Responsiveness was affected by lesion level but varied markedly among infants. Interlimb stepping was less readily alternating, but step parameters were similar to those produced by their peers with TD. Finally, holding infants with MMC on a moving treadmill resulted in greater motor activity (17% during the year) than holding infants on a nonmoving treadmill.

Discussion and conclusion: Infants with MMC responded to the treadmill by stepping (but less so than infants with TD) and showing increased motor activity, but they demonstrated a different developmental trajectory. Future studies are needed to explore the impact of enhancing sensory input during treadmill practice to optimize responses in infants with MMC.

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Figures

Figure 1.
Figure 1.
Photograph of a 1-month-old infant being held on the small motorized treadmill.
Figure 2.
Figure 2.
Number of steps taken per second across age, by groups and individuals: typical development (TD) (A), myelomeningocele (MMC) (B), and MMC with lesions at high (C), middle (D), and low (E) levels.
Figure 2.
Figure 2.
Number of steps taken per second across age, by groups and individuals: typical development (TD) (A), myelomeningocele (MMC) (B), and MMC with lesions at high (C), middle (D), and low (E) levels.
Figure 3.
Figure 3.
Distribution of stepping patterns produced by infants with typical development (TD) (A) and infants with myelomeningocele (MMC) (B) across age: alternating (AL), double (DO), parallel (PA), and single (SI).
Figure 4.
Figure 4.
Step parameters by group across age. (A) Normalized cycle duration, swing duration, stance duration, and percent stance. (B and C) Mean percentages of lateral or medial (L/M), heel (H), toe (T), or flat (F) part of foot making contact at touch-down for infants with typical development (TD) (B) and infants with myelomeningocele (MMC) (C). (D and E) Mean percentages of lateral or medial (L/M), heel (H), toe (T), or flat (F) part of foot in contact with belt during mid-stance (mid-ST) for infants with TD (D) and infants with MMC (E).
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