R. Albesher1,2,3,4, T. FitzGerald1,2,3, K. Cameron1,2,3, B. Mentiplay1,5, J. Cheong1,3,6, L. Doyle1,3,6,7, E. Josev1,7, D. Zannino1, F. Dobson2, J. McGinley2, A. Spittle1,2,3
1Murdoch Children’s Research Institute, Victorian Infant Brain Studies, Parkville, Australia, 2The University of Melbourne, Department of Physiotherapy, Parkville, Australia, 3The Royal Women’s Hospital, Neonatal Research, Parkville, Australia, 4Princess Nourah Bint Abdulrahman University, Department of Rehabilitation Science, Riyadh, Saudi Arabia, 5La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Australia, 6The University of Melbourne, Department of Obstetrics and Gynaecology, Parkville, Australia, 7The University of Melbourne, Department of Paediatrics, Parkville, Australia

Background: Children born very preterm (VPT; < 32 weeks’ gestation) are at a higher risk of motor impairment compared with term-born peers; however, little is known about how functional tasks such as gait may be affected by preterm birth. Dual-task activities required executive and attention functions involvement. As preterm children are at higher risk of executive and attention dysfunction compared with children born at term, the addition of a concurrent task may be challenging to their gait.

Purpose: This study aimed to examine the gait of preschool-aged children born VPT compared with term controls in preferred-speed, dual-task, and tandem walking conditions.

Methods: 301 infants (150 VPT, 151 terms) were recruited at birth from the Royal Women’s Hospital, Melbourne and followed-up at 4.5-5 years corrected age for motor assessment. Four walking conditions were assessed using GAITRite system; 1) preferred walk where the child walked at self-selcted speed, 2) cognitive dual-task where the child walked while answering a different question for each trial, 3) motor dual-task where the child walked while balancing four table tennis balls on a plate, and 4) tandem line-walk where the child walked on a 5 cm wide, nonslip line. Spatiotemporal gait variables and variability were extracted and compared between children born VPT and term using linear regressions adjusting for leg length, corrected age at assessment and number of trials the child performed, with clustering for multiple births. The gait variables compared were speed (cm/s), cadence (steps/min), step length (cm), step time (s), base of support (BOS; cm), single limb support per cent of the gait cycle (%),  and double limb support per cent of the gait cycle (%).

Results: 224 children were assessed including 112 VPT (female n=58; mean gestational age (GA) 27.8, SD=1.4 weeks), and 112 term (female n=59; GA 39.9 SD=1.2 weeks). Children born VPT walked faster with longer step length and wider BOS in motor dual-task walking condition compared with their term peers - mean difference (95% Confidence Interval); speed 3.06 (0.14, 5.97), p=0.04; step length 1.10 cm (0.19, 2.01), p=0.018; BOS 0.36 cm (0.06, 0.67), p=0.02). Children born VPT also walked with wider BOS during cognitive dual-task and tandem walking conditions - cognitive dual-task 0.43 cm (0.04, 0.81), p=0.028; and tandem walk 0.3 cm (0.09, 0.51), p=0.005. There was little evidence for differences between the groups for the other gait variables.

Conclusion(s): While the gait of children born VPT did not differ to their term peers when they walked at their self-selected speed, differences occurred when they performed a concurrent dual-task or narrowed their base of support.

Implications: Assessing the performance of children born VPT in dual-tasking and line walking may help to identify preventative strategies, which could facilitate their transition to school. These findings help support health professionals in structuring intervention activities involving dual-tasking for preschool children born VPT and help guide future research on the gait of children born VPT.

Funding, acknowledgements: National Health and Medical Research Council of Australia, and the Victorian Government’s Operational Infrastructure Support Program. 

Keywords: Children born very preterm, Gait, Dual-task paradigm

Topic: Paediatrics

Did this work require ethics approval? Yes
Institution: The Royal Children's Hospital
Committee: The Royal Children's Hospital Human Research Ethics Committee
Ethics number: RCH HREC Reference Number: 34147E

All authors, affiliations and abstracts have been published as submitted.

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