Valentín-Gudiol Marta, Mattern-Baxter Katrin, Girabent-Farrés Montserrat, Bagur-Calafat Caritat, Hadders-Algra Mijna, Angulo-Barroso Rosa Maria
Department of Physical Therapy, Universitat Internacional de Catalunya, Barcelona, Spain.
Cochrane Database Syst Rev. 2017 Jul 29;7(7):CD009242. doi: 10.1002/14651858.CD009242.pub3.
Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development.
To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay.
In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews.
We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population.
Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model.
This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45).
AUTHORS' CONCLUSIONS: This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.
唐氏综合征、脑瘫、全面发育迟缓的儿童或早产儿可能会出现运动发育迟缓。这限制了儿童对环境的探索，并可能阻碍认知和社会情感发展。文献表明，特定任务训练，如运动平板训练，有助于运动发育。
评估运动平板干预对6岁以下有行走延迟风险或处于非行走阶段的儿童（或两者皆有）运动发育的有效性。
2017年5月，我们检索了Cochrane系统评价数据库、MEDLINE、Embase、其他6个数据库以及多个试验注册库。我们还检索了相关研究和系统评价的参考文献列表。
我们纳入了评估运动平板干预对目标人群影响的随机对照试验（RCT）和半随机对照试验。
四位作者独立提取数据。结局参数根据国际功能、残疾和健康分类模型进行构建。
这是对2011年Cochrane综述的更新，该综述纳入了5项试验。本次更新纳入了7项关于运动平板干预175名儿童的研究：104名被分配到运动平板组，71名作为对照组。这些研究在研究对象（唐氏综合征、脑瘫、发育迟缓或有中度神经运动发育延迟风险的儿童）、比较类型（运动平板与无运动平板；有矫形器与无矫形器的运动平板；高强度与低强度训练）、研究持续时间和评估结局方面存在差异。由于研究的多样性，仅五项研究的数据用于五项结局的Meta分析：独立行走起始年龄、总体粗大运动功能、与站立和行走相关的粗大运动功能以及步速。证据质量的GRADE评估范围从高到极低。与无运动平板干预相比，运动平板干预对独立行走起始的影响因人群而异，但未显示出总体效果（平均差（MD）-2.08，95%置信区间（CI）-5.38至1.22，2项研究，58名儿童；中等质量证据）：30名唐氏综合征儿童从运动平板训练中受益（MD -4.00，95% CI -6.96至-1.04），但28名有中度发育延迟风险的儿童未受益（MD -0.60，95% CI -2.34至1.14）。在两项分别对17名儿童比较有矫形器与无矫形器的运动平板干预以及对30名唐氏综合征儿童比较高强度与低强度运动平板干预的研究中，我们未发现关于行走起始的证据（MD 0.10，95% CI -5.96至6.16；MD -2.13，95% -4.96至0.70）。运动平板干预未改善总体粗大运动功能（MD 0.88，95% CI -4.54至6.30，2项研究，36名儿童；中等质量证据）或与站立相关的粗大运动技能（MD 5.41，95% CI -1.64至12.43，2项研究，32名儿童；低质量证据），与行走相关的粗大运动技能改善可忽略不计（MD 4.51，95% CI 0.29至8.73，2项研究，32名儿童；低质量证据）。运动平板干预使20名有发育延迟的能行走儿童的行走技能得到改善（MD 7.60，95% CI 0.88至14.32，1项研究），并使12名脑瘫儿童的粗大运动技能得到改善（MD 8.00，95% CI 3.18至12.82）。一项对17名唐氏综合征儿童比较有矫形器与无矫形器的运动平板干预的研究表明，添加矫形器可能会阻碍总体粗大运动进展（MD -8.40，95% CI -14.55至-2.25）。总体而言，与无运动平板干预相比，运动平板干预显示步速有非常小的增加（MD 0.23，95% CI 0.08至0.37，2项研究，32名儿童；高质量证据）。运动平板干预使20名有发育延迟的能行走儿童的步速增加（MD 0.25，95% CI 0.08至0.42），但未使12名脑瘫儿童的步速增加（MD 0.18，95% CI -0.09至0.45）。
2011年综述的本次更新为运动平板干预对某些6岁以下儿童群体的疗效提供了更多证据，但发现显著结果的能力仍然有限。目前的研究结果表明，运动平板干预可能会加速唐氏综合征儿童独立行走的发展，并可能加速脑瘫和全面发育迟缓儿童运动技能的获得。未来的研究应首先通过更大规模和设计更好的研究来证实这些发现，特别是对于脑瘫和发育迟缓的婴儿。一旦确定了疗效，研究应探讨这些人群中运动平板干预的最佳剂量。
