Comparison of self-selected speed and dual-task gait parameters in preterm and term children and examination of the relationship with neurodevelopmental outcomes

This study aimed to investigate self-selected speed and dual-task gait spatiotemporal characteristics, variations in plantar pressure distributions, and their relationship with neurodevelopmental assessment parameters at 3 years of age before kindergarten in children born preterm. The 81 preterm children included in the study were divided into two groups extremely-very preterm (<32) and moderately-late preterm (32≤ and <37) according to their gestational weeks. In addition, 31-term children aged 3 years were included in the study for normalization of gait parameters. A walking platform GAITRite was used for the spatiotemporal characteristics and dynamic plantar base pressure distributions of preterm and term children aged between 30-42 months at self-selected speed and dual-task while carrying a ball with a diameter of a 22 cm and weight of 180 gr in their hands, and the Bayley Scales of Infant and Toddler Development-III (Bayley-III) was used for neurodevelopmental evaluations of preterm children. Moderately-late preterm children were found to walk with increased stride width compared to term children (p=0.024) and with increased stride length variability compared to extremely-very preterm children (p=0.038), and term children (p=0.003) during self-selected speed walking. There was no difference between the groups in terms of spatiotemporal characteristics during dual-task walking (p>0,05). In extremely-very preterm children, medial foot dynamic plantar peak pressure increased (p=0.004) and lateral foot dynamic plantar peak pressure decreased (p=0.005) during dual-task walking compared to self-selected speed walking. No difference was found between the groups in terms of dynamic plantar peak pressure and time during self-selected speed and dual-task walking (p>0,05). The step factor of extremely-very preterm children during self-selected speed walking was found to be associated with cognitive composite, motor composite, fine and gross motor, and during dual-task walking with receptive language scale and language composite (p<0,05). Fine motor outcomes of extremely-very preterm children during self-selected speed walking were negatively related to forefoot dynamic plantar peak pressure and positively related to hindfoot dynamic plantar peak pressure (p<0,05). In conclusion, it is important to evaluate 3-year-old pre-kindergarten preterm children in terms of neurodevelopmental function as well as their performance during self-selected speed and dual-task walking. In particular,while the moderate-late preterm children had an impaired gait performance compared to their term peers during self-selected speed walking, this difference disappeared during dual-task walking. The gait performances and dynamic plantar pressure distributions of extremely-very preterm children, who were found to be more at risk for neurodevelopmental problems, may be impaired. In conclusion, the moderately-late preterm children, who were found to be at risk for neurodevelopmental problems, should be followed up with age-specific evaluations and follow-ups like extremely-very preterm children to refer to early intervention programs when necessary.