A systematic review of the effectiveness of treadmill training and body weight support in pediatric rehabilitation.
OBJECTIVE
Given the extensive literature on body weight-supported treadmill training (BWSTT) in adult rehabilitation, a systematic review was undertaken to explore the strength, quality, and conclusiveness of evidence supporting use of treadmill training and body weight support in those with pediatric motor disabilities. A secondary goal was to ascertain whether protocol guidelines for BWSTT are available to guide pediatric physical therapy practice.


METHODS
The database search included MEDLINE, EMBASE, CINAHL Plus, PEDro, Cochrane Library databases, and ERIC from January 1, 1980 to May 31, 2008 for articles that included treadmill training and body weight support for individuals under 21 years of age, with or at risk for a motor disability. We identified 277 unique articles from which 29 met all inclusion criteria.


RESULTS
Efficacy of treadmill training in accelerating walking development in Down syndrome has been well demonstrated. Evidence supporting efficacy or effectiveness of BWSTT in pediatric practice for improving gait impairments and level of activity and participation in those with cerebral palsy, spinal cord injury, and other central nervous system disorders remains insufficient, although many studies noted positive effects.


CONCLUSIONS
The original evidence demonstrates efficacy of BWSTT in children with Down syndrome, but large-scale controlled trials are needed to support the use of BWSTT in other pediatric subgroups. Increased use of randomized designs, studies with treadmill training-only groups, and dosage studies are needed before practice guidelines can be formulated. Neural changes in response to training warrant exploration, especially given the capacity for change in developing nervous systems.
Damiano
Diane L
DL
Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, USA. damianod@cc.nih.gov
DeJong
Stacey L
SL
D001927:Brain Diseases / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D019988:Children with Disabilities / Q000534:rehabilitation*; D004314:Down Syndrome / Q000150:complications / Q000534:rehabilitation; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D017408:Guidelines as Topic; D006801:Humans; D009989:Orthotic Devices; D010372:Pediatrics; D016138:Walking; D016474:Weight-Bearing