Short- and Long-Term Changes in Balance After Active Video Game Training in Children With and Without Developmental Coordination Disorder: A Randomized Controlled Trial.

Active video games (AVG) have been used as training tools and are known to ameliorate balance performance in children with Developmental Coordination Disorder (DCD). Our aim was to evaluate balance using clinical tests and by measuring body sway using a force plate with a mixed design of vision (eyes open/eyes closed), surface (rigid/soft), and support (stance/semitandem) before, and after, training and 4 months later (follow-up). Thirty-six DCD children and 40 typically developing children participated in the study, of which 50 children (26 DCD; 24 typically developing) were retested after 4 months. Balance improved on the clinical measures after the training, which was independent of type of AVG (Wii-Fit and Xbox Kinect) used, and this effect was still present after 4 months. The AVG training did not influence general sway behavior, but only sway in the eyes-open condition, corresponding with task demands of the training and indicating a training-specific effect. Overall, DCD children and typically developing children responded comparably to the AVG training, thereby maintaining the gap in performance between the two groups. The changes in postural sway are interpreted as a sign of more confidence and less freezing of the joints, enabling greater flexibility of movements and balance strategies as supported by the improved performance on balance tests in the DCD children. This is the first study that showed long-term effects of AVG training on balance performance. However, these follow-up results should be interpreted with caution given that 35% of the children were lost in follow-up.

Association between Contextual Factors and Affordances in the Home Environment of Infants Exposed to Poverty.

Home environments of infants exposed to poverty exhibit fewer affordances for child development. This study aimed to investigate the association between contextual factors and affordances in the home environments of infants facing poverty. Term infants (n = 128) were divided into two groups: (1) exposed group (EG), comprising term infants exposed to poverty, and (2) comparison group (CG), consisting of term infants classified with medium and high socio-economic status. The main dependent variables were physical space, variety of stimulation, gross and fine motor toys, and the total score; measured using the Brazilian version of the Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) questionnaire, named Affordances no Ambiente Domiciliar para o Desenvolvimento Motor-Escala Bebê. Statistical analysis employed independent sample t-tests or Mann-Whitney tests, chi-square tests, and stepwise multiple linear regression models to evaluate predictors of less adequate home environments. The EG presented significantly fewer affordances in gross motor toys (Cohen's r = 0.353; p < 0.01); fine motor toys (Cohen's r = 0.327; p < 0.01); and total score (Cohen's r = 0.377; p < 0.01). Binary logistic regression analysis showed a significant association (r2 = 0.828, p < 0.01) between the less than adequate home environment category and maternal age (p = 0.043, OR: 0.829 (0.692-0.994)), revealing that maternal age was associated with better quantity and quality of affordances for child development.

Late preterm and very preterm infants differ in the acquisition time and quantity of reaches with grasping at reaching onset: an exploratory study.

Introduction: The onset of manual reaching allows the expansion of the infant's interaction with the environment. When born preterm, infants become vulnerable to problems in the development of reaching. However, it is still unknown whether there are differences in reaching according to the degree of prematurity. Objective: This study aimed to explore the differences in reaching acquisition and behavior between late preterm and very preterm infants, as well as whether age and clinical variables influence the results. Method: This is an exploratory, comparative, observational study. In total, 24 infants were included soon after reaching onset; 12 infants were born late preterm (35.55 ± 0.67 gestational weeks) and 12 very preterm (30.60 ± 0.05 gestational weeks). Infants were placed in a baby seat, and a toy was placed at a reachable distance for 2 min. Reaching behavior was the primary variable; birth weight and length of hospital stay were secondary variables. Results: The age of reaching onset was higher in the very preterm group. The proportion of reaches with grasping was higher in the late preterm group. These differences were affected by the lower birth weight and longer length of hospital stay in the very preterm group. The proportions of proximal and distal adjustments did not differ between groups. Conclusion: Very preterm infants presented disadvantages in the acquisition time and the number of reaches with grasping, but not in the proportions of proximal and distal adjustments of reaching, relative to late preterm infants. Group differences were influenced by clinical variables.

Health-related quality of life in children with developmental coordination disorder: a systematic review.

The aims of this study were (1) to synthesize evidence of the general health-related quality of life in children with DCD compared to their typically developing peers, and (2) to verify which domains of HRQOL are more compromised in children with DCD. A systematic search was carried out to identify cross-sectional studies that evaluated self-perception and/or the parent's perception of the HRQOL in children with and without DCD as an outcome. The methodological quality of the studies was assessed, and the effect size calculated. Initial searches in the databases identified 1092 articles. Of these, six were included. Most of the articles (5/6) included noted that children with DCD show a significantly lower HRQOL than their typically developing peers. Regarding the most compromised HRQOL domains, the results are heterogeneous. Most studies (3/6) had moderate methodological quality, and two studies were classified as high methodological quality. Effect sizes ranged from low to high.

Sticky Mittens Training to Improve Reaching Skills and Manual Exploration of Full-Term and At-Risk Infants: A Systematic Review.

AIM: To systematically review evidence of the effectiveness of sticky mittens training to improve reaching skills and manual exploration of full-term and at-risk infants and optimal training dosage. METHODS: The Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this systematic review. The electronic search was performed from September 2017 to August 2021 on PubMed, Scopus, Science Direct, and Cochrane databases. Eligibility criteria followed PICO terms: clinical trials investigating the effects of sticky mittens training on reaching skills and manual exploration of full-term and at-risk infants. PEDro scale and GRADE assessed methodological quality and quality of evidence, respectively. RESULTS: Eight studies (313 children) were included. Five studies found statistically significant differences between experimental and control groups (62.6%). One study presented high methodological quality. Evidence synthesis showed very low and low evidence of the beneficial effects of sticky mittens training in full-term and at-risk infants, respectively. CONCLUSIONS: Findings suggest that sticky mittens training facilitates reaching skills and manual exploration. However, results should interpretation with caution because studies targeted full-term infants. Future research should focus on infants at risk or with motor impairments since sticky mittens training seems to show positive effects and is easy to apply.

Active Video Games Performance and Heart Rate on the Wii or Kinect in Children with and without Developmental Coordination Disorder.

Our objective was to compare changes in game performance and intensity of heart rate (HR) between two types of active video game (AVG) in children with and without Developmental Coordination Disorder (DCD). Additionally, we assessed the level of improvement per game as well as the perceived exertion and enjoyment during training. Seventy-six children, 36 with DCD and 40 without (TD) were randomly assigned to a 5-week program of Wii-Fit or Xbox-Kinect training 2× a week. The steepness of the performance curves was not different between consoles, nor between groups. Playing Kinect games resulted in higher HR in both groups. Wii and Kinect seem to be comparable AVG consoles that can be used for children with and without DCD, with the Kinect reaching a higher intensity of training.

Psychometric properties of the Infant Motor Profile (IMP): A scoping review protocol.

INTRODUCTION: The IMP is a novel video-based instrument to assess motor behavior of infants. It evaluates gross and fine motor behavior in five domains: variation, adaptability, symmetry, fluency, and performance. The latter assesses motor milestones, the other four domains assess qualitative aspects of movements. Literature suggests that it is a promising tool for pediatric health care, as its assists early detection of neurodevelopmental disorders and facilitates the design and monitoring of early intervention. This, this scoping review (ScR) aims to evaluate the psychometric properties of the Infant Motor Profile (IMP). MATERIAL AND METHODS: A systematic search will be conducted to identify relevant studies up to October 15, 2022. All papers published in English that evaluated or used the IMP in children under two years of age will be included. The search will be performed in Pubmed, Lilacs, PEDro, Scielo, CINAHL, Embase, Web of Science, Ovid PsycINFO, Cochrane Database of Systematic Reviews, as well as in gray literature sources following the University of Toronto library guidelines. Standardized data extraction forms (Excel Tables) will be used to collect information. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the Scoping Reviews (PRISMA-ScR) Checklist and JBI guidelines will be taken into consideration for results analysis and reporting. DISCUSSION: This Scoping Review will summarize available knowledge on the psychometric properties of the IMP. By proving that IMP is a reliable tool, a valid predictor of neurodevelopmental outcomes and a responsive instrument to measure change induced by early intervention, this will facilitate the implementation of the IMP in pediatric health care. It will assist the detection of infants at high risk of neurodevelopmental disorders, and it will facilitate the design of the tailor-made early intervention. SCOPING REVIEW PROTOCOL REGISTRATION: This scoping review protocol has been registered at Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/4HYKZ).

Parental Practices and Environmental Differences among Infants Living in Upper-Middle and High-Income Countries: A Cross-Sectional Study.

Parental practices and environmental factors can impact a child's development and, consequently, functionality. The objective is to assess the parental practices and environmental differences in healthy and at-risk infants at 3-6 months of age living in upper-middle (Brazil) and high-income (Italy) countries. A total group of 115 infants was identified and classified into four groups: healthy Italian infants (H_IT); Italian infants exposed to biological risk factors (R_IT); healthy Brazilian infants (H_BR); and Brazilian infants exposed to environmental risk factors (L_BR). The dependent variables were parental practices and environmental factors, which were assessed through a semi-structured interview and the "variety of stimulation dimension" from the Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) questionnaire. Descriptive analyses, a multivariate analysis of variance (MANOVA), and correlation tests were applied. Regarding the environment and parental practices, the mother's age, maternal and paternal education, civil status, and variety of stimulation showed significant differences among the infants living in Brazil or in Italy. There were strong dissimilarities in parental practices and environmental factors among infants living in low/upper-middle and high-income countries. Since the home environment is the main stimulus for infant growth and development, our results are meaningful for providing knowledge about these two different cultures.

Reaching skills in six-month-old infants at environmental and biological risk.

OBJECTIVES: To assess kinematic parameters and proximal and distal reaching adjustments of infants at biological or environmental risk and compare with reaching performance of six-month-old full-term infants without known risk factors. METHODS: This blinded cross-sectional study included 62 infants at six months of age divided into three independent groups: Group with no known risk factor (NRF), 28 full-terms with no risk factors; Low SES group (LSES):19 full-terms classified as low socioeconomic status and no biological risk; Very preterm group (VPT), 15 very preterm infants at six months corrected age and no environmental risk. Infants were placed in a reclined baby chair at 45°, and a malleable and unfamiliar object was presented to the infant at 5-second intervals to elicit reaching movements. RESULTS: Infants from LSES presented reaching duration (p = 0.032, Cohen's f = 0.349) and movement unit (p = 0.033, Cohen's f = 0.351) significantly higher than VPT group. Horizontal hand orientation was moderately associated with infants at environmental risk (p = 0.031; Cramer's V = 0.30). CONCLUSION: Infants of low socioeconomic status perform less functional reaching movements than very preterm infants at six months corrected age. Socioeconomic status may impact more on reaching skills than biological risk. Given the importance of reaching for infant development, low-cost public health strategies are needed to identify possible delays.

Lower Limb Sensorimotor Training (LoSenseT) for Children and Adolescents with Cerebral Palsy: A Brief Report of a Feasibility Randomized Protocol.

Motor disorders in cerebral palsy (CP) are often accompanied by disturbances of sensation and impaired somatosensory functions have been reported in individuals with CP. To test the feasibility of a sensorimotor training protocol for lower limbs in children and adolescents with unilateral and bilateral CP, and to analyze the preliminary effects of this training on sensory and motor variables. This is a single-blind, prospective phase I feasibility randomized protocol. A total of twenty participants with uni or bilateral cerebral palsy, GMFCS level I-III, ages 5 to 20 years will be recruited. The LoSenseT protocol is composed of tactile and proprioceptive activities in a child-friendly format. An original qualitative feedback questionnaire was developed to assess the protocol feasibility. Additionally, proprioception, tactile discrimination, postural stability, and gait parameters will be assessed. The LoSenseT protocol can support the implementation of interventions targeting lower limbs somatosensory impairments in individuals with CP.

Symptoms of anxiety and depression in schoolchildren with and without developmental coordination disorder.

We examined whether reported higher frequencies of anxiety and depression symptoms are related to the presence of developmental coordination disorder in school-age Brazilian children. A total of 272 children were assigned to six groups according to age and motor performance. The Movement Assessment Battery for Children-Second Edition evaluated the motor performance. The Spence Children's Anxiety Scale and the Child Depression Inventory assessed anxiety and depression symptoms, respectively. Brazilian children are at high risk for anxiety, regardless of motor performance and age. However, children with developmental coordination disorder report significantly more depressive symptomatology in 10-12 years compared to typically developing children.

Symptoms of anxiety and depression in children with developmental coordination disorder: a systematic review / Sintomas de ansiedade e depressão em crianças com transtorno do desenvolvimentoda coordenação: uma revisão sistemática

Abstract Objective To find evidence of the symptoms of anxiety/depression in children with developmental coordination disorder as compared to their typically developing peers at both the group and individual level, and to identify how many different tools are used to measure anxiety and/or depression. Methods Electronic searches in eight databases (PubMed/MEDLINE, Scopus, Web of Science, ERIC, PsycINFO, Embase, SciELO and LILACS), using the following keywords: 'Developmental Coordination Disorder,' 'Behavioral Problems,' 'Child,' 'Anxiety,' 'Depression,' 'Mental Health,' and 'Mental Disorders.' The methodological quality was assessed by Newcastle-Ottawa Scale adapted for cross-sectional studies and the NOS for cohort studies. The studies were classified as low, moderate, or high quality. To provide clinical evidence, the effect size of the symptoms of anxiety and depression was calculated for each study. Results The initial database searches identified 581 studies, and after the eligibility criteria were applied, six studies were included in the review. All studies were classified as being of moderate to high quality, and the effect sizes for both anxiety and depression outcomes were medium. The evidence indicated that all of the assessed studies presented more symptoms of anxiety and depression in children with developmental coordination disorder than in their typically developing peers. On the individual level, this review found children with clinical symptoms of anxiety in 17-34% (developmental coordination disorder) and 0-23% (typically developing), and of depression in 9-15% (developmental coordination disorder) and 2-5% (typically developing) of the children. Conclusions Children with developmental coordination disorder are at higher risk of developing symptoms of anxiety and depression than their typically developing peers.

Resumo Objetivo Encontrar evidências dos sintomas de ansiedade/depressão em crianças com transtorno do desenvolvimento da coordenação em comparação com seus pares com desenvolvimento típico, a nível individual bem como em grupo, e identificar quantas ferramentas diferentes são utilizadas para medir a ansiedade e/ou depressão. Métodos Pesquisa eletrônica em oito bases de dados (PubMed/Medline, Scopus, Web of Science, Eric, PsycINFO, Embase, Scielo e Lilacs), utilizando as seguintes palavras-chave: 'Developmental Coordination Disorder', 'Behavioral Problems', 'Child', 'Anxiety', 'Depression', 'Mental Health' e 'Mental Disorders'. A qualidade metodológica foi avaliada pela escala de Newcastle-Ottawa (NOS) adaptada para estudos transversais e pela escala de Newcastle-Ottawa (NOS) para estudos de coorte. Os estudos foram classificados em: qualidade baixa, moderada e alta. Para fornecer evidência clínica, o tamanho do efeito dos sintomas de ansiedade e depressão foi calculado para cada estudo. Resultados As buscas iniciais nas bases de dados identificaram 581 estudos e, após a aplicação dos critérios de elegibilidade, seis estudos foram incluídos na revisão. Todos os estudos foram classificados como tendo qualidade moderada a alta e os tamanhos do efeito para os desfechos de ansiedade e depressão foram médios. As evidências indicaram que 100% dos estudos avaliados apresentaram mais sintomas de ansiedade e depressão em crianças com transtorno do desenvolvimento da coordenação do que em seus pares com desenvolvimento típico. No nível individual, encontramos crianças com sintomas clínicos de ansiedade em 17-34% (transtorno do desenvolvimento da coordenação) e 0-23% (desenvolvimento típico) e de depressão em 9-15% (transtorno do desenvolvimento da coordenação) e 2-5% (desenvolvimento típico) das crianças. Conclusões Crianças com transtorno do desenvolvimento da coordenação apresentam maior risco de desenvolver sintomas de ansiedade e depressão do que seus pares com desenvolvimento típico.

Is Wii-based motor training better than task-specific matched training for children with developmental coordination disorder? A randomized controlled trial.

Purpose: To evaluate in children with developmental coordination disorder (DCD) the effects of Wii-training compared with task-specific matched training (TST).Material and methods: A randomized controlled trial (RCT) was conducted with 32 children having DCD, aged 7-10 years. Children were randomly assigned to the Wii or task-specific training. Both interventions consisted of 16, 60-min sessions over an 8-week period. The primary outcome measure of movement skill was the Movement Assessment Battery for Children-2 (MABC-2), administered by blinded assessors. Measures included total standard scores (TSS), manual dexterity, aiming/catching, and balance component scores.Results: From pre- to post-test, both groups improved significantly on TSS and balance after intervention. The Wii intervention group also improved on manual dexterity. Neither group improved significantly on aiming/catching.Conclusions: Both the Wii and task-specific training improved overall motor performance and balance. On other MABC-2 component scores, treatment effects differed between groups: Task-specific training had more pronounced effects on balance skills, while Wii training had slightly stronger treatment effects than task-specific training on manual dexterity. It was concluded that task-specific training affords stronger benefits for general motor skill than Wii-based training. Whether Wii training can promote clinically significant benefits for upper-limb function remains to be seen.Trial Registration: This study is registered in a clinical trials registry platform (Protocol: RBR-89YDGJ). Available on the Brazilian Clinical Trials Registry Implications for rehabilitationWii-training and task-specific matched training programs afforded gains in motor performance in children with developmental coordination disorder, similarly;The selected Wii tasks were able to improve the motor performance in children with developmental coordination disorder, but should not be used as an exclusive strategy for these children;Our findings suggest caution in recommending Wii-based training as a viable alternative to more task-specific matched training for children with developmental coordination disorder.

Symptoms of anxiety and depression in children with developmental coordination disorder: a systematic review.

OBJECTIVE: To find evidence of the symptoms of anxiety/depression in children with developmental coordination disorder as compared to their typically developing peers at both the group and individual level, and to identify how many different tools are used to measure anxiety and/or depression. METHODS: Electronic searches in eight databases (PubMed/MEDLINE, Scopus, Web of Science, ERIC, PsycINFO, Embase, SciELO and LILACS), using the following keywords: 'Developmental Coordination Disorder,' 'Behavioral Problems,' 'Child,' 'Anxiety,' 'Depression,' 'Mental Health,' and 'Mental Disorders.' The methodological quality was assessed by Newcastle-Ottawa Scale adapted for cross-sectional studies and the NOS for cohort studies. The studies were classified as low, moderate, or high quality. To provide clinical evidence, the effect size of the symptoms of anxiety and depression was calculated for each study. RESULTS: The initial database searches identified 581 studies, and after the eligibility criteria were applied, six studies were included in the review. All studies were classified as being of moderate to high quality, and the effect sizes for both anxiety and depression outcomes were medium. The evidence indicated that all of the assessed studies presented more symptoms of anxiety and depression in children with developmental coordination disorder than in their typically developing peers. On the individual level, this review found children with clinical symptoms of anxiety in 17-34% (developmental coordination disorder) and 0-23% (typically developing), and of depression in 9-15% (developmental coordination disorder) and 2-5% (typically developing) of the children. CONCLUSIONS: Children with developmental coordination disorder are at higher risk of developing symptoms of anxiety and depression than their typically developing peers.

Is Segmental Trunk Control Related to Gross Motor Performance in Healthy Preterm and Full-Term Infants?

The authors' aim was to verify the correlation between segmental trunk control and gross motor performance in healthy preterm (PT) and full-term (FT) infants aged 6 and 7 months and to verify if there are differences between groups. All infants were assessed at 6 and 7 months by means of Segmental Assessment of Trunk Control (SATCo) to identify the exact level of segmental trunk control and Alberta Infant Motor Scale (AIMS) to measure gross motor performance. A significant correlation between segmental trunk control and gross motor performance was found in healthy PT infants at 7 months and FT infants at 6 months. PT infants showed a delay on segmental trunk control at 6 and 7 months and in supported standing posture at 6 months compared with FT infants. Segmental trunk control and gross motor performance showed an important relationship in healthy PT and FT infants, mainly in sitting posture.

Lifestyle of school-aged children with and without developmental coordination disorder

Abstract Aim: To analyze the association between lifestyle and signs of DCD in children aged 7 to 10. Methods: A total of 93 schoolchildren aged 7 to 10 were recruited for this study. Developmental Coordination Disorder Questionnaire (DCDQ), Movement Assessment Battery for Children - Second edition (MABC-2) and the Inventory of Lifestyle in Childhood and Adolescence (ILCA) were used. Lifestyle was analyzed with basis on specific tasks performed frequently or infrequently at home and outdoor, considering children with positive and negative DCD signs. Results: Only the item "performing household tasks" showed a significant association (p = 0.04) between groups. Children with DCD signs displayed a more infrequent behavior (73.1 %) in performing such tasks when compared to those without (26.9 %). Conclusion: Children with DCD signs presented a more sedentary behavior, expressed specifically in the less frequent performance of household tasks. The result may be explained by parental involvement in this sort of task. Further studies, however, are needed in order to broaden this understanding.

Motor intervention with and without Nintendo® Wii for children with developmental coordination disorder: protocol for a randomized clinical trial.

BACKGROUND: Despite the benefits highlighted by motor interventions based on virtual reality for children with Developmental Coordination Disorder (DCD), there are still doubts as to whether these are greater than those obtained with conventional interventions due to the absence of systematized protocols, and lack of evidence. Here, we present a protocol to systematically compare the effects of two motor-training programs (one Nintendo® Wii-based and the other no-Wii motor activities) on the motor learning in children with DCD. METHODS/DESIGN: Two intervention protocols (one based on Nintendo® Wii and the other no-Wii motor activities) will be carried out, with interventions occurring twice a week in 60-min sessions, with a minimum of 12 and a maximum of 16 sessions per child. The protocols were developed based on the domains of the Movement Assessment Battery for Children - Second Edition (MABC-2) (Manual Dexterity, Aiming and Catching, Balance), with two activities for each of the MABC - two domains. The study will include children aged 7 to 10 years with a total MABC-2 score ≤ 16, and a Developmental Coordination Disorder Questionnaire (DCDQ) score < 46 (age of 7 years), score < 55 (age group of 8 to 9 years and 11 months), or score < 57 (age of 10 years) as scored by the parents. Children will be randomly allocated by draw in one of the two intervention protocols. MABC-2 and DCDQ will be applied before and after intervention to evaluate the effects of the interventions on motor performance and parents' perception, respectively. Motor learning will be assessed by means of the scores obtained in the games. Evaluators and therapists will be trained and evaluators will be blind regarding the data of the children in the study. DISCUSSION: Owing to its motivating aspects, training with Nintendo® Wii may be particularly beneficial for children with DCD. The results of this study protocol should help researchers and therapists to better understand the benefits of Nintendo® Wii-based motor intervention over those obtained with no-Wii interventions in children with DCD. It should also create references about more systematized protocols for replication in clinical practice, seeking the improvement of the motor components of these children. TRIAL REGISTRATION: RBR-89ydgj.

Brief reaching training with "sticky mittens" in preterm infants: Randomized controlled trial.

OBJECTIVE: To examine whether a brief reaching training with sticky mittens was effective to improve reaching behavior in newly reaching preterm infants. METHODS: In this randomized controlled trial, twenty four 5-month-old (±16-week-old corrected age) preterm infants were randomly allocated into experimental or control groups. Infants were assessed three times in a single session: pretraining (immediately before training), posttraining (immediately after training), and retention (4 min after the posttraining). During training, infants in the experimental group wore open fingers Velcro covered mittens. Training consisted of one 4-minute session of stimulated reaching using Velcro covered toys. Controls did not receive the training. During assessments, infants were placed in a baby chair and toys without Velcro were offered at their midline for 2 min. Number of total reaches, proximal adjustments and distal adjustments of reaching were primary outcomes. Grasping was a secondary outcome. RESULTS: Groups were similar in the pretraining. In the posttraining, trained infants performed greater amount of total reaches and bimanual reaches than untrained infants. Greater amount of bimanual reaches in trained infants was maintained in the retention test. Distal adjustments and grasping outcome were not influenced by the training. CONCLUSIONS: A brief-term training with open fingers sticky mittens benefited reaching behavior and favored retention of increased bimanual reaches in newly reaching late preterm infants. However, it was not sufficient to influence hand openness and early grasping.

Influência do peso adicional no alcance manual de lactentes a termo e pré-termo: análise de variáveis categóricas do movimento / Influence of additional weight in the reaching behavior of full-term and preterm infants: analysis of categorical variables of movement

Resumo Objetivo: Investigar o efeito do peso adicional nos ajustes proximais e distais do alcance em lactentes a termo (AT) e pré-termo tardios (PTT). Método: Foram avaliados 10 lactentes AT e 9 PTT dos 5 aos 7 meses de idade. As variáveis analisadas foram: a) ajustes proximais: unimanuais ou bimanuais; b) ajustes distais: abertura das mãos (aberta, fechada ou semiaberta) e orientação das mãos (horizontalizada, verticalizada ou oblíqua). Os procedimentos analisados foram: P1 (linha de base) e P2 (acréscimo de 20% da massa do membro superior de peso adicional). Para verificar a associação entre os procedimentos e as variáveis dependentes utilizou-se o Teste Qui-quadrado (p<0,05). Resultados: O peso adicional proporcionou a diminuição de alcances bimanuais aos 5 e 7 meses no grupo PTT, o aumento da frequência de mão verticalizada e a diminuição da frequência de mão aberta no início do movimento, aos 6 meses. No grupo AT, o peso implicou no aumento da mão verticalizada no início e no fim do movimento, aos 5 meses, e ao final do movimento, aos 7 meses, e diminuiu a frequência de mão aberta no início e final do alcance, aos 6 meses. Conclusão: O peso adicional favoreceu um movimento mais maduro na maioria das variáveis analisadas e, de forma mais expressiva, no grupo prematuro. Assim, pode tornar-se um instrumento para o treino inicial do alcance, quando o objetivo for a estimulação de alcances unimanuais com a mão verticalizada.

Abstract Objective: The aim of this work is to investigate the effects of additional weight in the proximal and distal adjustments of the reaching behavior of full-term and preterm infants. Method: We evaluated 10 full-term and 9 low risk preterm infants from 5 to 7 months age. The following variables were analyzed: a) proximal adjustments: unimanual or bimanual; b) distal adjustments: hand opening (open, closed, semi-open) and hand orientation (horizontal, vertical, oblique). Variables were analyzed in two procedures: P1 (baseline) and P2 (addition of 20% of the total mass of the infant's upper limb). To verify the association between procedures and dependent variables was applied Chi-Square Test (p<0,05). Results: Additional weight decreased of bimanual frequency for the preterm group at 5 and 7 months old, increased vertical hand frequency and decreased open hand frequency at 6 months. In the full-term group, additional weight increased the vertical hand frequency at the initiation and at the end of the movement at 5 months and at the end of the movement at 7 months. It also decreased open hand frequency at the initiation and at the end of the reaching at 6 months. Conclusion: Additional weight favored a more mature movement in the majority of variables analyzed, more expressively in the preterm group. Therefore, it can become an instrument of training this skill in the beginning of the reaching, when looking for verticalized hand unimanual reaching stimulation.

Influence of Sitting Positions and Level of Trunk Control During Reaching Movements in Late Preterm and Full-Term Infants.

In order to acquire reaching and independent sitting, refinement of trunk control is needed by gradually and progressively incorporating the head, thoracic, lumbar, and sacral segments. Previous studies have evaluated trunk control in a segmental way, standardizing the level of manual support in the infants' trunk during reaching. The aim of this study was to identify the level of trunk control and to analyze the influence of the difference sitting positions in late preterm and full-term infants between 6 and 8 months of age during reaching. Therefore, 36 infants born full term (control group)-FTG and 20 late preterm infants at a corrected age (experimental group)-PTG were evaluated. Most of the infants started the study at 6 months and they were evaluated monthly until 8 months of age (longitudinal study) in a total of 1-3 visits. The Segmental Assessment of Trunk Control was used to identify the level of trunk control in a segmental way, as well as to verify the capacity of the infant to maintain or regain the vertical position while sitting. Kinematic analysis was used for reaching. The infants were in a ring sitting position and at 90° of flexion. To elicit reaching, an attractive object was presented at the infant's midline and at 45° to the right and left. We found that PTG infants presented lower trunk control scores, i.e., worse control. For both groups, the ring sitting position and at 90° of flexion did not influence most kinematic variables during reaching because accurate manual support was provided for the infants' trunk. The PTG group presented less trunk displacement when at 90° of flexion. Compared to the FTG, even with accurate trunk support, the PTG group presented more immature reaches. These results suggest that accurate manual trunk support favored more stability of the trunk during the reach. Thus, early intervention is suggested for PTG infants and reaching in this age group should be trained in the ring sitting position with their trunk accurately manually supported. SATCo is an effective tool for segmental trunk evaluation.