Department of Physical Therapy, Universitat International de Catalunya, Sant Cugat del Vallès, Spain.
Eur J Phys Rehabil Med. 2013 Feb;49(1):67-91.
Delayed motor development may occur in children with Down syndrome, cerebral palsy or children born preterm, which in turn may limit the child's opportunities to explore the environment. Neurophysiologic and early intervention literature suggests that task-specific training facilitates motor development. Treadmill intervention is a good example of locomotor task-specific training.
The aim of this paper was to assess the effectiveness of treadmill intervention on locomotor motor development in pre-ambulatory infants and children under six years of age who are at risk for neuromotor delay.
A Cochrane systematic review with meta-analysis.
We employed a comprehensive search strategy. We included randomised, quasi-randomised and controlled clinical trials that evaluated the effect of treadmill intervention in children up to six years of age with delays in gait development or the attainment of independent walking or who were at risk of neuromotor delay. We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, Science Citation Index, PEDro, CPCI-S and LILACS; and also ICTRP, ClinicalTrials.gov, mRCT and CenterWatch. Four authors independently extracted the data using standardized forms.
We included five studies, which reported on treadmill intervention in 139 children. Of the 139 children, 73 were allocated to treadmill intervention groups. The studies varied in the type of population studied, the type of comparison, the time of evaluation and the parameters assessed. Due to the diversity of the studies, we were only able to use data from three studies in meta-analyses and these were limited to two outcomes: age of onset of independent walking and gross motor function. Evidence suggested that treadmill intervention could lead to earlier onset of independent walking when compared to no treadmill intervention (effect estimate -1.47; 95% CI: -2.97, 0.03), though these trials studied two different populations: Down syndrome and children at risk of neuromotor disabilities. Children with Down syndrome seemed to benefit while it was not clear if this was the case for children at high risk of neuromotor disabilities. Two other studies, both in children with Down syndrome, compared different types of treadmill intervention (high versus low intensity training). Both were inconclusive regarding the impact of these different protocols on the age at which children started to walk. There is insufficient evidence to determine whether treadmill intervention improves gross motor function (effect estimate 0.88; 95% CI: -4.54, 6.30).
The current review provided only limited evidence of the efficacy of treadmill intervention in children up to six years of age. Few studies have assessed treadmill interventions in young children using an appropriate control group. The available evidence indicates that treadmill intervention may accelerate the development of independent walking in children with Down syndrome. Further research is needed to confirm this and should also address whether intensive treadmill intervention can accelerate walking onset in young children with cerebral palsy and high risk infants, and whether treadmill intervention has a general effect on gross motor development in the various subgroups of young children at risk for developmental delay.
本研究旨在评估在有神经运动发育迟缓风险的 6 岁以下的、有运动发育迟缓或开始独立行走的预步行婴儿和儿童中，跑步机干预对行走运动发育的有效性。
Cochrane 系统评价和荟萃分析。
我们采用了全面的检索策略。我们纳入了随机、半随机和对照临床试验，评估了在有步态发育迟缓或独立行走的儿童中，或在有神经运动发育迟缓风险的儿童中，跑步机干预对儿童的影响。我们检索了 CENTRAL、MEDLINE、EMBASE、PsycINFO、CINAHL、Science Citation Index、PEDro、CPCI-S 和 LILACS；以及 ICTRP、ClinicalTrials.gov、mRCT 和 CenterWatch。四位作者使用标准化表格独立提取数据。
我们纳入了 5 项研究，共纳入了 139 名儿童的跑步机干预。在 139 名儿童中，73 名被分配到跑步机干预组。这些研究在研究人群、对照组、评估时间和评估参数方面存在差异。由于研究的多样性，我们只能在荟萃分析中使用 3 项研究的数据，且这些数据仅限于 2 个结果：独立行走的起始年龄和粗大运动功能。证据表明，与无跑步机干预相比，跑步机干预可使儿童更早开始独立行走（效应估计值-1.47；95%CI：-2.97，0.03），尽管这些试验研究了两种不同的人群：唐氏综合征和有神经运动障碍风险的儿童。唐氏综合征儿童似乎受益，而对于高危神经运动障碍的儿童是否如此尚不清楚。另外两项研究均在唐氏综合征儿童中比较了不同类型的跑步机干预（高强度训练与低强度训练）。这两项研究都没有确定这些不同方案对儿童开始行走的年龄的影响。目前还没有足够的证据来确定跑步机干预是否能改善粗大运动功能（效应估计值 0.88；95%CI：-4.54，6.30）。
目前的综述仅提供了跑步机干预在 6 岁以下儿童中的疗效的有限证据。很少有研究使用适当的对照组评估对幼儿进行的跑步机干预。现有证据表明，跑步机干预可能加速唐氏综合征儿童独立行走的发展。需要进一步的研究来证实这一点，并且还应该解决是否强化跑步机干预可以加速脑瘫和高危婴儿幼儿的行走起始，以及跑步机干预是否对各种有发育迟缓风险的幼儿亚组的粗大运动发育有普遍影响。
