First published on July 22, 2010

Physical Therapy 2010;90:1265.

Physical Therapy
DOI: 10.2522/ptj.20090281
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Research Reports

Effects of Various Treadmill Interventions on the Development of Joint Kinematics in Infants With Down Syndrome

Jianhua Wu, Julia Looper, Dale A. Ulrich and Rosa M. Angulo-Barroso

J. Wu, PhD, is Assistant Professor, Department of Kinesiology and Health, Georgia State University, Atlanta, Georgia.
J. Looper, PT, MSPT, PhD, is Assistant Professor, School of Physical Therapy, University of Puget Sound, Tacoma, Washington.
D.A. Ulrich, PhD, is Professor, School of Kinesiology, University of Michigan, Ann Arbor, Michigan.
R.M. Angulo-Barroso, PhD, is Research Associate Professor, Center for Human Growth and Development, University of Michigan, Ann Arbor, MI 48109-5406 (USA).

rangulo{at}umich.edu

Background: Infants with Down syndrome (DS) have delayed walking and produce less-coordinated walking patterns.

Objective: The aim of this study was to investigate whether 2 treadmill interventions would have different influences on the development of joint kinematic patterns in infants with DS.

Design: Thirty infants with DS were randomly assigned to a lower-intensity, generalized (LG) treadmill training group (LG group) or a higher-intensity, individualized (HI) treadmill training group (HI group) and trained until walking onset. Twenty-six participants (13 in each group) completed a 1-year gait follow-up assessment.

Methods: During the gait follow-up assessment, reflective markers were placed bilaterally on the participants to measure the kinematic patterns of the hip, knee, and ankle joints. Both the timing and the magnitude of peak extension and flexion at the hip, knee, and ankle joints, as well as peak adduction and abduction at the hip joint, in the 2 groups were compared.

Results: Both the LG group and the HI group showed significantly advanced development of joint kinematics at the gait follow-up. In the HI group, peak ankle plantar flexion occurred at or before toe-off, and the duration of the forward thigh swing after toe-off increased.

Limitations: Joint kinematics in the lower extremities were evaluated in this study. It would be interesting to investigate the effect of treadmill intervention on kinematic patterns in the trunk and arm movement.

Conclusions: The timing of peak ankle plantar flexion (before toe-off) in the HI group implies further benefits from the HI intervention; that is, the HI group may use mechanical energy transfer better at the end of stance and may show decreased hip muscle forces and moments during walking. It was concluded that the HI intervention can accelerate the development of joint kinematic patterns in infants with DS within 1 year after walking onset.


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