Physiotherapy - Theses
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ItemGait Outcomes in Preschool-aged Children Born Very Preterm( 2021)Children born very preterm (VP; less than 32 weeks’ gestation) have a higher risk of motor impairment and poorer motor outcomes than their term-born peers. The underlying mechanisms of motor impairment and the motor developmental trajectory for infants born preterm are unclear, and the evidence investigating gait characteristics in children born VP is sparse. Four studies were designed to fill this knowledge gap by comprehensively investigating the gait of children born VP in various walking conditions at preschool age: preferred speed, cognitive dual-task, motor dual-task and tandem walking. Study 1 is a systematic review of the evidence on walking onset and gait characteristics in children born preterm (less than 37 weeks’ gestation) compared with term-born peers. The walking onset of infants born VP is delayed by over two months compared with term-born peers. Limited evidence is available about their subsequent gait development and whether these children ‘catch up’ to the typical gait patterns of their peers. The systematic review revealed that the gait of preschool-age children born VP had not yet been investigated. Study 2 is a cross-sectional study which compared the gait variables and step to step gait variability of children born VP with their term-born peers at 4–5 years of age. While the gait of preschool-age children born VP did not differ from their term-born peers when they walked at their preferred speed, differences occurred when walking complexity increased. Key differences included a wider base of support (BOS) in cognitive dual-task, motor dual-task and tandem walking, and higher BOS variability in preferred speed and tandem walking. The wider BOS might indicate an adaptation to maintain balance while walking. Study 3 is a cross-sectional study which examined the gait of preschool-age children born VP at risk for developmental coordination disorder (DCD) compared with their VP peers not at risk. Children at risk for DCD walked with minimal gait differences from those not at risk in preferred speed walking; however, differences emerged when walking demands increased in the other three more challenging walking conditions. This study also found that children at risk for DCD walk with higher gait variability in all four conditions. Similarly to Study 2, one of the key differences included wider BOS in motor dual-task and tandem walking and higher BOS variability in preferred speed, cognitive dual-task and tandem walking, which might reflect greater balance challenges. Finally, a longitudinal study, Study 4, examined the associations between the Alberta Infant Motor Scale (AIMS) and walking ability at 12 months, and motor and gait outcomes at 4–5 years in children born VP. The AIMS total score was associated with poorer balance, wider tandem BOS and higher rates of preschool-age motor impairment. Children with a motor delay at 12 months had lower balance skills and longer double-limb support, but not higher odds of non-cerebral palsy motor impairment at preschool age. Furthermore, this study reveals that early independent walking at 12 months is associated with better balance skills but not gait characteristics at preschool age in children born VP. Overall, the studies undertaken in this thesis demonstrate that preschool-age children born VP are at risk of greater walking impairments than term-born children when walking demand increases. This thesis makes a novel contribution to the understanding of gait development, identifying a high-risk subgroup and predictors of neurodevelopmental outcomes at preschool age in the VP population. Understanding the gait of children born VP is essential to minimising the negative impact on motor development and potential secondary impacts on physical activity, participation, academic achievement and self-esteem. The studies in this thesis establish a foundation for future research exploring walking performance in preschool-age children born VP.