Evidence Based Practice

Evidence Update

Early Intervention Stepping Practice

April 04, 2016 by Elena Noble, MPT

A young child with spina bifida practices early intervention stepping using a gait trainer with assistance from a therapistBecause bone is dynamic and responds to positive stresses and forces placed on it through weight-bearing activity, the authors of a recent study set out to examine the effects of early upright supported stepping on bone mineral content in a population of infants (1-18 months) with a form of spina bifida called myelomeningocele (MMC). They chose patients with MMC because this condition presents with delayed or undeveloped motor skills of the lower extremities, and in childhood this impacts bone growth and results in decreased bone mineral content, osteopenia/osteoporosis and fractures.

The study drew comparisons from three groups:

  • 14 typically developing infants
  • 9 infants with MMC as controls
  • 13 infants with MMC receiving intervention


The intervention group, termed upright supported stepping practice (USSP), involved the infants being held over a pediatric treadmill for stepping practice 10 minutes a day, 5 days a week. This intervention spanned the course of a year and bone mineral content was tested using dual-energy x-ray absorptiometry at 0, 6 and 12 months.

Results of the Study 

Intervention test results showed that the infants with spina bifida receiving USSP had improved rates of bone mineralization compared to their controls. This was especially evident in the infants’ lower extremities.

While the authors point out that this is a pilot study and that the topic will need further research and validation, previous research certainly indicates the importance of early intervention as part of the therapy continuum. So this study adds to that existing research and emphasizes the importance of early intervention and gait training for children with developmental disabilities in lessening the impact of secondary impairments and improving quality of life.    


Lee DK, Muraszko K, Ulrich B. Bone mineral content in infants with myelomeningocele, with and without treadmill stepping practice. Pediatr Phys Ther. 2016;28:24-32.

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