START-Play Physical Therapy Intervention Indirectly Impacts Cognition Through Changes in Early Motor-Based Problem-Solving Skills.

PURPOSE: This study tested whether the Sitting Together and Reaching to Play (START-Play) physical therapy intervention indirectly impacts cognition through changes in perceptual-motor skills in infants with motor delays. METHODS: Participants were 50 infants with motor delays randomly assigned to START-Play plus Usual Care Early Intervention (UC-EI) or UC-EI only. Infants' perceptual-motor and cognitive skills were assessed at baseline and 1.5, 3, 6, and 12 months post-baseline. RESULTS: Short-term changes in sitting, fine motor skills, and motor-based problem-solving, but not reaching, predicted long-term changes in cognition. START-Play indirectly impacted cognition through motor-based problem-solving but not sitting, reaching, or fine motor skills. CONCLUSIONS: This study provided preliminary evidence that early physical therapy interventions that blend activities across developmental domains and are supported by an enriched social context can place infants on more optimal developmental trajectories.

Assistive and Rehabilitative Effects of the Playskin LiftTM Exoskeletal Garment on Reaching and Object Exploration in Children With Arthrogryposis.

IMPORTANCE: Children with arthrogryposis multiplex congenita are often delayed in their development of reaching and object exploration, which can place them at risk for associated delays in motor and cognitive development. OBJECTIVE: To evaluate the longitudinal assistive and rehabilitative effects of the Playskin Lift™ (hereinafter Playskin), a novel exoskeletal garment, on reaching and object exploration abilities in children with arthrogryposis. DESIGN: Single-case ABA design with a 1-mo baseline, 4-mo intervention, and 1-mo postintervention. SETTING: Home environment. PARTICIPANTS: Seventeen children with arthrogryposis (ages 6-35 mo at first visit; 5 boys). INTERVENTION: Participants used the Playskin daily for 30 to 45 min while participating in structured intervention activities to encourage reaching for objects across play spaces larger than they were typically able to. OUTCOMES AND MEASURES: Participants were tested biweekly throughout the study with and without the Playskin using a systematic reaching assessment. Coding of reaching and object exploration behavior was performed using OpenSHAPA software; statistical analyses were conducted using Hierarchical Linear and Nonlinear Modeling software. Feasibility of the Playskin for daily home intervention was evaluated with a parent perception questionnaire. RESULTS: Positive assistive effects (improved performance when wearing the Playskin within sessions) and rehabilitative effects (improved independent performance after the Playskin intervention) were observed with increased active range of motion, expanded reaching space, improved grasping with the ventral side of the open hand, and greater complexity and multimodality and intensity of object exploration. CONCLUSIONS AND RELEVANCE: The Playskin may be a feasible, effective assistive and rehabilitative device to advance object interaction and learning in young children with arthrogryposis. WHAT THIS ARTICLE ADDS: The novel exoskeletal Playskin garment improves reaching and object exploration in young children with arthrogryposis.

A Novel Means-End Problem-Solving Assessment Tool for Early Intervention: Evaluation of Validity, Reliability, and Sensitivity.

PURPOSE: To evaluate validity, reliability, and sensitivity of the novel Means-End Problem-Solving Assessment Tool (MEPSAT). METHODS: Children with typical development and those with motor delay were assessed throughout the first 2 years of life using the MEPSAT. MEPSAT scores were validated against the cognitive and motor subscales of the Bayley Scales of Development. Intra- and interrater reliability, developmental trends, and differences among groups were evaluated. RESULTS: Changes in MEPSAT scores positively related to changes in Bayley scores across time for both groups of children. Strong intra- and interrater reliability was observed for MEPSAT scoring across all children. The MEPSAT was sensitive to identify change across time and differences in problem-solving among children with varying levels of motor delay. CONCLUSIONS: The MEPSAT is supported by validity and reliability evidence and is a simple tool for screening early problem-solving delays and evaluating change across time in children with a range of developmental abilities. What this adds to the evidence: The novel MEPSAT is supported by validity and reliability evidence. It is sensitive to detect problem-solving differences among young children with varying motor ability and to capture changes in problem-solving across time. It requires minimal equipment and time to administer and score and, thus, is a promising tool for clinicians to screen for early problem-solving delays or to track intervention progress in young children with or at risk for problem-solving delays.

Assessing the Validity and Reliability of a New Video Goniometer App for Measuring Joint Angles in Adults and Children.

OBJECTIVE: To assess the convergent validity and reliability of joint angle measurements from a new video goniometer iPhone/iPad application separately in adults, older and young children. DESIGN: Cross-sectional. SETTING: Child care and university environments. PARTICIPANTS: Fifty-four adults (mean ± SD=22.5±4.5y), 20 older children (mean ± SD=10.9±2.2y), 20 younger children (mean ± SD=1.6±0.8y) (N=94). INTERVENTIONS: Adults and older children performed both standardized static positions and functional activities. Younger children performed only a functional activity protocol. MAIN OUTCOME MEASURES: Joint angle measurements using the app were validated against a commercially validated two-dimensional goniometric software program. In addition, validity of the app was compared to a standard mechanical goniometer for the measurement of angles drawn on a white board. Intra- and interrater reliability were assessed through independent rescoring of videos. RESULTS: Correlations between joint angle estimates obtained from the app and goniometer software or a mechanical goniometer were positive and very strong (r>.900; P<.0001). The intraclass correlation coefficient (ICC) for repeated scoring from the app indicated excellent intra- and interrater reliability (ICC>.900). CONCLUSIONS: High correlations for repeated measures and comparison to gold standard angle measurement instruments suggest that the new app is a valid and reliable tool for assessing joint angles during functional activity. This tool may provide clinicians an inexpensive yet accurate method for quantification of movements and immediate feedback on range of motion during tasks in a natural environment.

Means-end problem solving in infancy: Development, emergence of intentionality, and transfer of knowledge.

Behaviors and performance of 23 typically developing infants were assessed longitudinally at 6, 9, 12, 18, and 24 months in two means-end tasks: pulling a towel or rotating a turntable to obtain a supported object. With age, infants performed more goal-directed behaviors, leading to increased problem-solving success. Intentionality emerged earlier in the towel task than in the turntable task (6.9 vs. 10.8 months). Potential knowledge transfer between the tasks was first observed at 9 months. This study provides insight into the development of means-end learning, the emergence of intentionality, and potential transfer of knowledge in tasks involving a similar concept (support) but requiring different modes of action for success (pulling vs. rotating).

Does late preterm birth impact trunk control and early reaching behavior?

The aims of the study were to 1) verify the level of trunk control longitudinally and reaching behavior while sitting in two positions in late preterm (LPT) and full-term (FT) infants, 2) determine whether the level of trunk control relates to reaching outcomes. Twenty LPT infants and 36 infants born FT were assessed via three in-lab visits: at 6, 7, and 8 months. At each visit, the Segmental Assessment of Trunk Control (SATCo) and reaching assessment were performed, where the infants were positioned sitting in the ring and at 90° of flexion of hips, knees, and ankles. Accurate manual support to the trunk was provided in each visit. LPT infants presented a lower level of trunk control over time. LPT infants presented a higher percentage of unimanual reaches and successful grasping at 7 months' visit, and a higher number of reaches at 8 months' visit compared to FT infants. The sitting positions did not influence reaching performance. The level of trunk control relates to functional reaching strategies only in FT infants. This study might provide insights for clinicians for understanding the level of trunk control, the importance of reaching behaviors for exploration, and considering these behaviors as strategies for intervention.

Motor affordance at home for infants living in poverty: A feasibility study.

PURPOSE: To determine the feasibility of completing a randomized clinical trial of motor affordance program at home for infants living in poverty. METHODS: Fourteen infants living in poverty were randomized assigned to groups: intervention at 1st month (G-1), and at 2nd month (G-2). They were assessed into 3 visits: Visit 1 (baseline), Visit 2 (after 4 weeks), and Visit 3 (after 8 weeks). The motor affordance program was provided at home by parents/caregivers. To determine feasibility of the program, descriptive data was used. Effect sizes and non-parametric analysis were performed for motor and affordances at home. RESULTS: The motor affordance program was considered feasible and showed improvement on affordances at home and motor performance only for G-2. CONCLUSION: Amplifying motor affordance at home may be considered appropriate for future clinical trials. It may be an efficient/low-cost early intervention strategy for infants at environmental risk.

Effects of elastic therapeutic taping on motor function in children with motor impairments: a systematic review.

BACKGROUND: The elastic therapeutic taping has been considered a promising resource for disabled children. OBJECTIVE: To systematically review the evidence of the effects of elastic therapeutic taping on motor function in children with motor impairments. METHOD: Three independent evaluators conducted searches in electronic databases (MEDLINE/PubMed, Scopus, LILACS, BIREME/BVS, Science Direct, SciELO, and PEDro). Clinical studies design, published until 2016, involving elastic therapeutic taping and children aged 0-12 years with motor impairments were included. The variables considered were the methodological aspects (study design, participants, outcome measurements, and experimental conditions); results presented in the studies, and also the methodological quality of studies. RESULTS: Final selection was composed by 12 manuscripts (five randomized controlled trials), published in the last 10 years. Among them, cerebral palsy (CP) was the most recurrent disorder (n = 7), followed by congenital muscular torticollis (n = 2) and brachial plexus palsy (n = 2). Positive results were associated with taping application: improvement in the upper limb function, gross motor skills, postural control, muscular balance, and performance in the dynamics functional and daily activities. LIMITATIONS: Lower quality of the studies, clinical and population heterogeneity existed across studies. CONCLUSIONS: The elastic therapeutic taping has been shown to be a promising adjunct resource to the conventional rehabilitation in children with motor impairments. However, high methodological studies about its efficacy in this population are already scarce. Implications for Rehabilitation Elastic therapeutic taping has been shown to be a promising adjunct resource to the conventional rehabilitation in disabled children. Clinical trials have indicated improvement in the postural control and functional activities with both, upper and lower limbs, and increase in the functional independency resulting from the taping use. Randomized control trials and well-established protocols are needed to increase the confidence in applying elastic therapeutic taping to specific clinical conditions.

Prematurity may negatively impact means-end problem solving across the first two years of life.

Preterm infants are at risk for delays in motor, perceptual, and cognitive development. While research has shown preterm infants may exhibit learning delays in the first months of life, these delays are commonly under-diagnosed. The purpose of this study was to longitudinally evaluate behavioral performance and learning in two means-end problem-solving tasks for 30 infants born preterm (PT) and 23 born full-term (FT). Infants were assessed at 6, 9, 12, 18, and 24 months-old in tasks that required towel pulling or turntable rotation to obtain a distant object. PT infants performed more non-goal-directed and less goal-directed behavior than FT infants throughout the study, resulting in a lower success rate among PT infants. PT infants showed delayed emergence of intentionality (prevalence of goal-directed behaviors) compared to FT infants in both tasks. Amount and variability of behavioral performance significantly correlated with task success differentially across age. The learning differences documented between PT and FT infants suggest means-end problem-solving tasks may be useful for the early detection of learning delays. The identification of behaviors associated with learning and success across age may be used to guide interventions aimed at advancing early learning for infants at risk.

Effect of Short-Term Training on Reaching Behavior in Infants: A Randomized Controlled Clinical Trial.

The purpose of this study was to test the effect of short-term training on reaching behavior in infants at the onset of reaching. The study was a single-blind, parallel group design, randomized controlled clinical trial. Thirty healthy infants were randomly assigned to a social control group (n = 15) or a reaching training group (n = 15). Infants began the study up to 3 days after the onset of reaching and were assessed three times across 2 days: pretraining (before training), posttraining 1 (after 1 session of training), and posttraining 2 (after 3 sessions of training). The reaching training group received 3 sessions of training by a physical therapist while the control group received a similar amount of time sitting in the therapist's lap. The data were analyzed using repeated-measures analyses of variance, and independent-samples tests with Bonferroni adjustments. Short-term training resulted in increased frequency of object contacts, shorter and smoother reaches, and improved hand positioning. The few short training sessions likely provided opportunities for infants to explore and learn to select movements from their existing movement repertoire. These results demonstrate that adaptive changes in infants' novel behaviors can emerge rapidly, and highlight the need for increased understanding of how to most effectively time early interventions.

Infants born preterm demonstrate impaired object exploration behaviors throughout infancy and toddlerhood.

BACKGROUND: Object exploration behaviors form the foundation for future global development, but little is known about how these behaviors are exhibited by infants born preterm. OBJECTIVE: The study objective was to longitudinally compare a comprehensive set of object exploration behaviors in infants born preterm and infants born full-term from infancy into toddlerhood. DESIGN: Twenty-two infants born full-term and 28 infants born preterm were monitored as they interacted with objects throughout their first 2 years. METHODS: Infants were provided up to 30 seconds to interact with each of 7 objects across 9 visits. Experimenters coded videos of infants' behaviors. Growth modeling and t tests were used to compare how much infants exhibited behaviors and how well they matched their behaviors to the properties of objects. RESULTS: Infants born preterm explored objects less in the first 6 months, exhibited less visual-haptic multimodal exploration, displayed reduced variability of exploratory behavior in a manner that reflected severity of risk, and were less able to match their behaviors to the properties of objects in a manner that reflected severity of risk. Infants born preterm with significant brain injury also had impaired bimanual abilities. LIMITATIONS: There was a limited sample of infants born preterm with significant brain injury. CONCLUSIONS: Infants born preterm have impaired abilities to interact with objects even in the first months of life. This impairment likely limits the knowledge they acquire about objects and about how they can act on them; this limited knowledge may, in turn, impair their early learning abilities. These results highlight the need for assessment and intervention tools specific for object exploration in young infants.

Maturational and situational determinants of reaching at its onset.

At 3 months of age, reaching behavior was measured in a group of 10 girls and 10 boys born at term. The assessments were carried out on the average 2 days after reaching onset. Reaching kinematics was measured in both supine and reclined positions. Girls reached more than boys, had straighter reaching trajectories and movements of shorter durations as well as fewer movement units. The reclined position gave rise to straighter trajectories in both girls and boys. Several anthropometric parameters were measured. Girls had less length and volume of the forearm than boys but similar upper arm volumes. There was a weak relation between kinematic and anthropometric variables.

Differences between late preterm and full-term infants: comparing effects of a short bout of practice on early reaching behavior.

This study compared the effects of a short bout of practice on reaching behavior between late preterm and full-term infants at the onset of goal-directed reaching. Twelve late preterm infants and twelve full-term infants received reaching practice based on a serial schedule. Late preterm and full-term infants were assessed in 3.3±1.4 and 2.6±1.0 days after the onset of goal-directed reaching in two measures in a single day: immediately before practice (pre-test) and immediately after practice (post-test). During the assessments, the infants were placed in a baby chair and a rubber toy was presented at their midline within reaching distance for 2 min. Between assessments, the infants received practice of toy-oriented reaching in 3 activities repeated for approximately 4 min. The activities were elicited in a pre-established serial sequence and were applied by a physical therapist. During the pre-test, late preterm infants presented lower range of proximal adjustments, greater proportion of reaches with semi-open hand, and greater proportion of reaches without grasping than the full-term infants. During the post-test, late preterm infants presented greater motor variability of proximal adjustments, but explored and selected distal control and grasping outcomes less compared to the full-term group. Differences in reaching and gross motor behavior between late preterm and full-term infants can be found at the age of reaching onset. Practice provided new opportunities for late preterm infants to improve perception-action coupling to reach; however, relative to full-terms, they seemed less advanced in benefiting from the experience for more refined manual tasks.

Effect of training at different body positions on proximal and distal reaching adjustments at the onset of goal-directed reaching: a controlled clinical trial.

The objectives of this study were to verify the influence of a short-duration training session on proximal and distal adjustments at the onset of goal-directed reaching and to verify whether these adjustments change in specificity with the body position trained. Twenty-four infants aged 3-4 months were assessed in supine and reclined during pre and posttraining conditions. During the interval (4 min), 8 infants received reaching training in supine, 8 infants received reaching training in reclined, and 8 infants received no training. The frequencies of reaches, unimanual reaches and reaches with semiopen and oblique hand increased in the posttraining condition for all infants except control infants. Infants trained in the reclined position increased the frequencies of variables in the reclined position. Infants trained in the supine position increased the frequencies of variables in both positions. Few minutes of reaching training are effective to facilitate reaching behavior in infants at the onset of reaching. The effects are specific to the body position trained. As the training in supine requires higher torque to initiate reaching movements, it is more effective to facilitate reaches in both supine and reclined positions.

Reaching behavior in preterm infants during the first year of life: a systematic review.

The aim of this systematic literature review was to examine and discuss studies that investigated reaching in preterm infants during the first year of life. Databases were searched using keywords such as reaching, grasping, preterm, and premature, in addition to specific terms from the Medical Subject Headings (MeSH) (motor skills, infant, movement, premature birth, hands) regardless of year of publication. One hundred thirty-five studies were identified, 9 of which were selected. The results showed that preterm infants adopt strategies (bimanual reaches and reaches with less rectilinear trajectories toward an object in motion, reaches with semi-open and open hand, reaches at lower speeds, with increased movement units, and variable postural muscle activity) compared with full-term infants. However, the results on how intrinsic factors (e.g., prematurity) and extrinsic factors (e.g., body position, physical properties of the object) influence early reaching are still limited.

The influence of motor impairment on autonomic heart rate modulation among children with cerebral palsy.

The study of heart rate variability is an important tool for a noninvasive evaluation of the neurocardiac integrity. The present study aims to evaluate the autonomic heart rate modulation in supine and standing positions in 12 children diagnosed with cerebral palsy and 16 children with typical motor development (control group), as well as to relate the level of motor impairment in children with cerebral palsy, as classified by to the Gross Motor Function Classification System, to the heart rate variability indices. The heart rate variability was analyzed by linear model in the frequency domain, at low and high frequency bands in normalized units and low and high frequency ratio. The results indicate that children with cerebral palsy present lower heart rate variability indices, indicating sympathovagal imbalance. The decrease of heart rate variability in children with cerebral palsy is related to the motor impairment level.

Influence of short-term training on the distal adjustments of reaching in preterm infants

OBJECT: The purpose of the study was to investigate the influence of short-term training on distal adjustments of reaching in preterm infants with low birth weight and compare them with full-term infants METHODS: Sixteen infants at the onset of reaching were equally allocated to a: preterm group (<34 weeks of gestational age) with a low birth weight (<2.5kg), and control group (full-term infants). The infants were submitted to two assessments carried out on a single day: pre-training (2 minutes) and post-training (2 minutes). The preterm group received one training session under a serial practice condition and the control group received one session of social training. It was used the repeated-measures analysis of variance, with Bonferroni adjustments RESULTS: The preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and the short-term training increased more reaches and reaches with dorsal hand CONCLUSION: We conclude that the preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and that the short-term training was effective in providing more reaches, observed in the increase in the number of hand contacts with the object...

OBJETIVO: O objetivo do estudo foi investigar a influência do treino de curta duração nos ajustes distais do alcance em lactentes pré-termo e baixo peso ao nascimento, e compará-los com lactentes a termo MÉTODOS: Dezesseis lactentes na emergência do alcance foram igualmente alocados em: grupo pré-termo (< 34 semanas de idade gestacional), e baixo peso ao nascimento (< 2,5 kg), e grupo controle (lactentes a termo). Os lactentes foram submetidos a duas avaliações realizadas em um único dia: pré-treino (2 minutos) e pós-treino (2 minutos). O grupo pré-termo recebeu uma sessão de treino (prática variada seriada) e o grupo controle recebeu uma sessão de treino social. Foi utilizada a análise de medidas repetidas de variância, com ajustes de Bonferroni RESULTADOS: Os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em comparação com os lactentes a termo. O treino de curta duração aumentou a frequência de alcances CONCLUSÃO: Conclui-se que os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em relação aos lactentes a termo e que o treino de curta duração foi efetivo na emergência do alcance, observando o aumento do número de contatos da mão do lactente com o objeto...

Relação entre alinhamento postural e desempenho motor em crianças com paralisia cerebral / Relationship between postural alignment and motor performance in children with cerebral palsy

O objetivo deste estudo foi verificar se há correlação entre alinhamento postural e desempenho motor em crianças com paralisia cerebral (PC), além de compará-las com crianças de desenvolvimento motor típico. Participaram 14 crianças com PC tipo espástico, entre 4 e 12 anos, classificadas nos níveis III, IV e V no sistema de classificação de função motora ampla (GMFCS); e 20 com idades entre 4 e 8 anos e desenvolvimento motor adequado, que constituíram o grupo controle. Foi avaliado o alinhamento de lordose cervical e cifose torácica na postura sentada por meio de fotometria; o desempenho motor foi avaliado pelo índice de função motora ampla (Gross motor function measure, GMFM) apenas nas dimensões sentar (B) e ficar em pé (D). O subgrupo de PC nível III obteve maiores escores no GMFM do que o dos níveis IV e V, com diferença significativa nas dimensôes B (p=0,00) e D (p=0,016). Quanto ao alinhamento postural, os dois subgrupos de PC apresentaram menor angulação da lordose cervical do que o GC, com diferença significativa; também foram medidos ãngulos menores da cifose torácica nos subgrupos PC, sendo que o subgrupo dos níveis IV e V apresentou diferença significativa tanto em relação ao outro subgrupo PC quanto ao controle...

The purpose was to search for a correlation between postural alignment and motor performance of children with cerebral palsy (CP), and to compare them to typical development children. Twenty of these, aged 4 to 8 years old, formed the control group (CG); and 14 children with CP, aged 4 to 12 years old, were divided into two subgroups (level III, and levels IV and V) according to their classification by the Gross Motor Function Classification System. Cervical lordosis and thoracic kyphosis angles in sitting posture were assessed by photometry; motor performance was assessed at dimensions B (sitting) and D (standing) of the Gross motor function measure (GMFM). PC level III subgroup had higher GMFM scores than levels IV and V subgroup, with significant differences at the B (p=0.00) and D (p=0.016) dimensions. As to posture alignment...

Efeito de um programa de fisioterapia funcional em crianças com paralisia cerebral associado a orientações aos cuidadores: estudo preliminar / Effect of a functional physical therapy program on cerebral palsy children, associated to guidance for their caregivers: a preliminary study

O objetivo foi verificar o efeito de um programa de fisioterapia funcional para crianças com paralisia cerebral, associado a orientações aos pais e/ou cuidadores; e verificar a correlação entre as habilidades funcionais e a assistência do cuidador, utilizando o Inventário de Avaliação Pediátrica de Incapacidade (PEDI). Participaram quatro crianças entre 24 e 43 meses de idade, hemiplégicas, espásticas e nível I no sistema de classificação da função motora ampla (GMFCS). Foram realizadas quatro avaliações – uma antes do início do programa, as demais aos 30, 60 e 90 dias após a primeira –, empregando-se as partes I (Habilidades funcionais) e II (Assistência do cuidador) do PEDI. As crianças foram submetidas a sessões de uma hora de fisioterapia funcional três vezes por semana, durante três meses: duas vezes a sessão era de fisioterapia com base no conceito neuroevolutivo Bobath e uma vez, treino de atividades da vida diária. Também foram dadas orientações por escrito aos pais e/ou cuidadores quanto à assistência à criança, incentivando-os a praticá-la em casa. A análise dos resultados mostrou que, na última avaliação, as crianças obtiveram escores significativamente maiores que na primeira...

The purpose was to verify the effect of a functional physical therapy program on children with cerebral palsy, associated to guidance to parents and/or caregivers; and to search for correlations between the child’s functional abilities and caregivers’ assistance, by means of the Pediatric Evaluation Disability Inventory (PEDI). Four hemiplegic, spastic children between 24 and 43 months old, classified at the Gross Motor Function Classification System level I, were submitted to four evaluations, the first prior to program onset, and the others 30, 60, and 90 days after the first one. PEDI parts I (Functional abilities) and II (Caregivers’ assistance) were used. Caregivers were provided with written instructions on how to best deliver care at home. The physical therapy program consisted of three weekly 1-hour sessions for three months; two sessions were of physical therapy based on Bobath concept, and one, of daily activities training. The analysis of results showed children obtained a significantly higher score at the last assessment as compared to the first. A high, significant correlation was found between PEDI parts I and II (r=1.0; p=0.083). The functional physical therapy program associated to instructions to caregivers proved thus effective to improve the functional performance of level-I children with spastic hemiplegia...