# Exercise as it relates to Disease/Treadmills and Infants: Do Stepping Machines work for infants with Down syndrome?

This is an analysis of the text Treadmill Training of Infants With Down Syndrome: Evidence-Based Developmental Outcomes by Dale A. Ulrich, Beverly D. Ulrich, Rosa M. Angulo-Kinzler, Joonkoo Yun.

## The background to this Research.

Mobilization is a key for a child’s independence. While crawling and a shuffle can suffice for a while, walking is true freedom for a toddler. Most children reach this step of independence around ages 13–15 months, infants and children with Trisomy 21 (more commonly known as Down syndrome) tend to not walk until ages 1–4 years. Early intervention is defined as any form of therapy, exercise and activity that helps a child reach development milestones. Generally, occupational therapy, speech therapy and physical therapy are ‘go tos’ for parents of a child with Down syndrome, however through the late 90’s and early 00’s Treadmill Training was tried as a valid way to encourage walking for infants with Down syndrome.
Why Down syndrome?
Down syndrome is caused at conception when the cell is developed with 47 chromosomes, instead of 46. Around 500-700 babies are born a year worldwide with Down syndrome, and its not something new to our planet. Children and Infants with Down syndrome tend to have certain characteristics, not only physical but also developmental and intellectual. Throughout history many children with Down syndrome have not been given an opportunity to flourish in their community, however with more modern research and a changing vision for people with Disability children with Down syndrome are receiving more intervention earlier on in life.

## Where this is Research from?

This article was published by the American Academy of Pediatrics. The authors and respective universities are as follows.
* Dale A. Ulrich (PhD), University of Michigan, Department of Kinesiology
* Beverly D. Ulrich (PhD), University of Michigan, Department of Kinesiology
* Rosa M. Angulo-Kinsler (PhD), University of Michigan, Department of Kinesiology
* Joonkoo Yun (PhD), Oregon State University, Department of Exercise and Sport Science
All authors have continued their research in disability and articles can be found in Further Information

## What kind of research is this?

This research is a longitudinal observational study. It used quantitative measures to test progress of infants throughout the time it took them to take to walk.

## What did the research involve?

Prior studies have shown a vital milestone to spontaneously step on a treadmill for infants with Down syndrome is being able to sit independently for 30 seconds. All infants entered the study being capable to doing this. Researchers randomly separated the infants into a control group or a Treadmill Intervention group. Both groups received biweekly physical therapy sessions, and were prescribed homework for parents to undertake in their own time. On top of this the Treadmill Intervention group were given a small treadmill set at a speed of 0.2 m/s. Parents were to hold their infants over the treadmill for intervals of 1 minute work and 1 minute rest. Parents were to increase the time of work until infants were on the treadmill for 8 minutes 5 days a week. Researchers then visited biweekly to monitor progress. The intervention was measured in specific time lengths as follows;
1. Sitting for 30 seconds
2. Raising self to stand
3. Walking with help
4. Walking 3 steps independently

## What were the results?

All 30 infants who began the program completed the study. It was found that infants with a treadmill intervention achieved not only walking earlier than the control group, but also reached all other measurements taken for the study, earlier than the control group.
Table 1: Time taken to achieve study measures
| | Intervention Group | Control Group | Difference |
| Raises Self to Stand | 134 days | 194 days | 60 days |
| Walks with Help | 166 days | 240 days | 73 days |
| Walks independently | 300 days | 401 days | 101 days |

## What conclusions can be drawn from this research?

From this research we can conclude that treadmill training is a successful way to reduce the delay in walking onset for infants with Down syndrome. Part of the success of outcomes of treadmill training could be attributed to the targeted skill. Gross motor skills practice and muscle stimulation is vital for any infant to master a certain skill, so practicing walking with the assistance of a treadmill is a similar and targeted skill enough to stimulate infants to walk earlier.

## What advice can be taken?

Children with Down syndrome tend to have delayed development, and through this research we can find new ways to reduce these delays. This research has had an enormous impact on the Disability world, with this paper sparking new research and more developed research. Some of the authors from this paper went on to further their research and find if high intensity work or low intensity work could affect the time taken for an infant with Down syndrome to walk. It was found high intensity work was most effective, but along with this was the discovery that gait patterns were more advanced at a younger age than a control group or low intensity intervention group.

## Further information

For financial support in Australia for persons with Disability visit; National Disability Insurance Scheme: https://ndis.gov.au/
For Australian information about Down syndrome visit http://www.downsyndrome.org.au/
For more information about Dr DA. Ulrich view his University page at; http://www.kines.umich.edu/directory/faculty/dale-ulrich
For more information about Dr BD. Ulrich view her publications at; https://www.researchgate.net/profile/Beverly_Ulrich/publications

## References

* 1 2 3 4 Ulrich et al, (2001) Treadmill Training of Infants With Down Syndrome: Evidence-Based Developmental Outcomes. Pediatrics, Volume 108 (Issue 5)
* ↑ NDSS. Early Intervention [Internet]. National Down syndrome Society. 2016. Available from: https://www.ndss.org/Resources/Therapies-Development/Early-Intervention/
* 1 2 Ulrich BD, Ulrich DA, (1995)Spontaneous Leg Movements of Infants with Down syndrome and nondisabled Infants. Child Development, Volume 66 (Issue 6)
* ↑ DSA. What is Down syndrome [Internet]. Down Syndrome Association. 2016. Available from http://www.downsyndrome.org.au/what_is_down_syndrome.html
* ↑ NDIS. People With Disability [Internet]. National Disability Insurance Scheme. 2016. Available from https://ndis.gov.au/people-disability.html
* ↑ KSCD Gross Motor Development [Internet]. Kids Sense Child Development Available from http://www.childdevelopment.com.au/images/Resources/Charts/GROSS_MOTOR_DEVELOPMENT.pdf
* ↑ Lloyd et al, (2010)Physical Activity and Walking Onset in Infants With Down syndrome. Adapted Physical Activity Quarterly, Volume 27 (Issue 1)
* ↑ Alton et al, (1998) A kinematic comparison of overground and treadmill walking. Clinical Biomechanics, Volume 13 (Issue 6)
* ↑ Wu J et al (2007)Exploring effects of different treadmill interventions on walking onset and gait patterns in infants with Down syndrome. Developmental Medicine and Child Neurology. Volume 49 (Issue 11)