Editorial

We hope you enjoy this edition of our "In step with" Newsletter. We would like to thank LiteGait® clinical trainer Jennifer Rosen for taking the time to review this issue's research report.
Looper and Ulrich, Effect of Treadmill Training and Supramalleolar Orthotsis Use on Motor Skill Development in Infants With Down Syndrome; a Randomized Clinical Study, March 2010

Introduction by Jennifer Rosen, PT

This article made me begin to think more about when I recommend SMOs, or other orthotics, for kids with low tone and Down Syndrome. I am interested in the fact that the kids wearing the SMOs started walking sooner than without, and would be interested in a larger study to look into this, with and without the treadmill training. Also, I would like a longer term study. As was noted, though the kids without the SMOs gained some of the gross motor skills faster, their gains plateaued, while the kids with the SMOs continued a slower steady gain. I would like to know if these kids would continue to improve their skills this way if we assess them again later. Although, as with most research, more studies need to be done for more definite information, I think this study begins to help us as pediatric therapists to think more critically about the use of orthotics with our clients and when to recommend them.

Research

Effect of Treadmill Training and Supramalleolar Orthotsis Use on Motor Skill Development in Infants With Down Syndrome

Julia Looper, ,Dale A.Ulrich
Physical Therapy, March 2010; 90:382-390.

Summary by Jennifer Rosen

This research article was very pertinent due to the fact that most of the children on my caseload wear some sort of orthotic, and there has been a lot of discussion between therapists about when to start using orthotics with our children presenting with low tone. Many of these children are delayed in attaining gross motor skills like sitting and walking by at least 6-12 months. There have been studies done showing that using orthotics improved balance and gait, and this is when many therapists begin to recommend them. This group of researchers wanted to look at the use of orthotics prior to walking. There have been studies done with children and how they attained the goal of walking. When they practiced supported stepping they started walking independently sooner than without this practice. These researchers decided to see if independent walking would begin sooner if they used the orthotics along with the supported stepping prior to independent ambulation. They randomly split study volunteers, all with Down Syndrome, into a control and an experimental group. The study began for each child when he or she was able to pull themselves to stand independently. The kids were evaluated using the Gross Motor Functional Measure (GMFM) at the beginning and end of the study. The kids in the experimental group were fitted with SureStep SMOs immediately and wore them 8 hours a day 5 days a week for the duration of the experiment. The families in both groups were given a small home use treadmill and were taught how to support their child when practicing. The kids used the treadmills for 8 minutes a day at a speed of .2, 5 days a week. They children in both groups used the treadmills until they could take 3 independent steps off the treadmill. The kids in the control group were then fitted for SMOs and used them 5 days a week for 8 hours a day. One month after the child took 3 steps independently, both the child was re-tested using the GMFM but without SMOs.

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Meet Nikki Warner, PT MR: Why/How did you choose to become a LiteGait Trainer? Nikki: After attending an MR gait inservice by Phil Koch... I was instantly intrigued by the evidenced-based research that is positive about body weight support treadmill training.. I wanted to learn more about it and use it to improve my patients abilities. This is a modality that actually works. MR: What would you consider the most rewarding aspect of being a trainer? Nikki:I am most rewarded when I see the therapists work with their patients during the training and there are instant improvements in their patients gait and balance... I love to learn different treatment techniques from other therapists with the lite gait and hope to inspire other therapists to increase their knowledge in neurology interview cont'd

Phillip and Jackie Myers From Phillip Myers    In September 2007, my wife, Jackie was diagnosed with PSP (Progressive SupraNuclear Palsy).    Due to the balance issue that results from PSP, any physical therapy must be done with the primary consideration of safety. Any form of walking is fraught with danger of falling and hurting the patient. The only solution that worked at all was a Body Weight Support Treadmill that we used at the Oregon Health and Science University (where Jackie had been diagnosed). We live in a rural county in northern California and found that none of the hospitals or physical therapy centers in the county owned such a machine or offered the service. We were able to locate a LiteGait product owned by a private individual who very graciously loaned it to us. So we are now able to get Jackie on it whenever it makes sense.    For seven months we (the physical therapy assistant Ed and I) tried to push her to walk as far as she could each time (nominally 30 minutes a day). This usually exhausted her and we were only able to do it once or maybe twice a week. Upon advice of a physical therapist associated with Lite Gait, we have limited her use to 10 minutes a day, but more frequent. Now for the last 3 months she is on the treadmill 4 to 5 times a week.    The result is that she gets exercise almost every day (either on the treadmill or at Clearlake Physical Therapy), which really increases her blood flow, overall health and general attitude. The LiteGait and the prayers of all of those around us have allowed us to maintain her at the same level and delay progress of the disease.

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