Article

Treadmill training in supported stepping has been used as part of
rehabilitation programs for children with neurodevelopmental problems to
facilitate earlier onset of walking. However, information concerning the
developmental continuity between supported stepping and walking is limited.
OBJECTIVE: The aims of this study were to longitudinally examine supported
stepping in preterm and full-term infants and to explore the step parameters
associated with walking attainment. DESIGN: A cohort study with a longitudinal
follow-up design was used. METHODS: Twenty-nine preterm infants and 20 full-term
infants were examined bimonthly with supported stepping on a treadmill from 7
months of age until walking attainment or 18 months of corrected age. The
associations between step variables and walking outcome were examined using Cox
proportional hazard regression and logistic regression. RESULTS: Walking
attainment for preterm infants was later than for full-term infants (median =
12.8 versus 11 months, respectively). The percentage of alternating steps,
hip-knee correlation, hip-ankle correlation, and asymmetry ratio (AR) of stance
time of stepping movement from 7 to 9 months of corrected age were found to be
associated with age of walking attainment in all infants. Manifestation of at
least 3 of 4 step features (ie, > or = 80% alternating steps, < or = .37 hip-knee
correlation, > or = .73 hip-ankle correlation, and < or = 1.40 AR of stance time)
at 7 months predicted walking attainment prior to 11 months of corrected age
(accuracy = 75%-77%). Failure to achieve such competencies at 7 or 9 months of
corrected age was predictive of failure in walking attainment by 15 months
(accuracy = 72%-98%). Limitations The limitations of this study included a small
sample size and commencement of stepping assessment as early as 7 months of
corrected age. CONCLUSIONS: The emergence of walking may involve cooperation of
alternating pattern generation, interjoint coordination, and interlimb
coordination in supported stepping in preterm and full-term infants. The
identified step predictors may assist clinicians in designing appropriate
treadmill training programs for those infants with delayed walking.

Langue : ANGLAIS