Mobile Device-Based Video Screening for Infant Head Lag: An Exploratory Study.

INTRODUCTION: Video-based automatic motion analysis has been employed to identify infant motor development delays. To overcome the limitations of lab-recorded images and training datasets, this study aimed to develop an artificial intelligence (AI) model using videos taken by mobile phone to assess infants' motor skills. METHODS: A total of 270 videos of 41 high-risk infants were taken by parents using a mobile device. Based on the Pull to Sit (PTS) levels from the Hammersmith Motor Evaluation, we set motor skills assessments. The videos included 84 level 0, 106 level 1, and 80 level 3 recordings. We used whole-body pose estimation and three-dimensional transformation with a fuzzy-based approach to develop an AI model. The model was trained with two types of vectors: whole-body skeleton and key points with domain knowledge. RESULTS: The average accuracies of the whole-body skeleton and key point models for level 0 were 77.667% and 88.062%, respectively. The Area Under the ROC curve (AUC) of the whole-body skeleton and key point models for level 3 were 96.049% and 94.333% respectively. CONCLUSIONS: An AI model with minimal environmental restrictions can provide a family-centered developmental delay screen and enable the remote monitoring of infants requiring intervention.

Perceived security of BYOD devices in medical institutions.

BACKGROUND: Like other computing devices mobile devices have inherent security risks. With today's wider use of mobile devices in medical institutions, particularly the practice of 'bring-your-own-device' (BYOD), the risk of medical data breaches is concerning. PURPOSE: To investigate security risk perception and safeguard adoption of mobile devices among medical practitioners and IT administrators. Furthermore, to comprehend the perceived costs that practitioners feel these safeguards impose on them. BASIC PROCEDURES: We conducted both quantitative and qualitative studies investigating whether age, gender and occupation have an impact on the perceived security of patient information and the behavior intentions formed when adopting BYOD. In the quantitative component, a survey was completed by 264 healthcare practitioners from three hospitals and affiliated clinics in New York City. In the qualitative component, we interviewed 36 of 264 subjects from the first study, including twelve physicians, twelve nurses, and twelve IT administrators. All participants had direct experience with BYOD devices. The length of each interview averaged forty-five minutes to an hour. MAIN FINDINGS: We found that physicians have a significantly higher intent to comply with safeguards, compared to nurses. IT administrators prefer an encrypted network connection and Two Factor Authentication (2FA), or a biometric authentication method for accessing Electronic Medical records (EMR). All medical practitioners believe that the biggest threat to the security of medical information is theft or misplacement of the device. Physicians and IT administrators have a better understanding of malware and Wi-Fi threats than nurses. PRINCIPAL CONCLUSIONS: This research provides valuable data regarding the healthcare practitioner's safeguard cost, attitudes and intended behaviors regarding the risks and use of mobile devices in healthcare. By understanding a user's perceptions, we can be better aware of how to educate healthcare practitioners, and how to develop policies that will reduce costs and achieve better productivity. We can also see how these processes may be improved by accessing patient information faster and by designing technology more effectively.

Child and family factors that predict participation attendance in daily activities of toddlers with global developmental delay.

PURPOSES: Enhancing children's daily participation is the optimal goal of early childhood intervention. This study aimed to identify child and family predictors of participation for toddlers with global developmental delay. METHODS: Fifty-nine toddlers with global developmental delay (aged 24-43 months) and their mothers participated in a 6-month longitudinal study. Predictors for participation were child factors [age, gender, delay severity, mastery motivation (perceived persistence and task persistence), and withdrawal behavior], and family factors (socioeconomic status, family income, maternal education, stress, and maternal teaching behavior). Dependent variables were participation diversity and intensity of four activity types measured 6-month later using the Assessment of Preschool Children's Participation (Chinese version). Correlation and hierarchical regression statistical methods were used. RESULTS: Older children with higher persistence had higher overall participation. Different factors predicted different participation dimensions and different activity types. Older age, higher perceived persistence, and being less withdrawn predicted higher diversity and intensity for play participation. For skill development participation, older age, less severity, higher mastery motivation, and better maternal teaching behaviors predicted higher diversity; and age, mastery motivation and maternal teaching predicted intensity. CONCLUSIONS: Different factors predict participation attendance differently. Supporting parents to enhance toddlers' mastery motivation may optimize children's participation in daily activities.Implications for rehabilitationBased on the child and their caregiver preferences, applicability and/or engagement for different activity types, interventionists could collaborate further with caregivers to find strategies to increase children's participation attendance in daily life.Interventionists could consult with caregivers: (a) to observe the persistence and positive affect (mastery motivation) of children during different activities, (b) to figure out the possible barriers to participation in those activities, and (c) to demonstrate appropriate caregiver-child interactions.Interventionists are encouraged to support children's mastery motivation and quality of maternal teaching behaviors to enhance participation in daily activities.

Postural Control and Interceptive Skills in Children With Autism Spectrum Disorder.

BACKGROUND: Increasing evidence shows common motor deficits associated with autism spectrum disorder (ASD) that can relate to impaired planning and control processes of the sensorimotor system. Catching is a fundamental motor skill that requires coordination between vision, posture, and arm movements. Although postural control and ball catching have been shown to be impaired in children with ASD, previous studies have not investigated how these components are integrated. OBJECTIVE: The objective of this study was to investigate the sensorimotor control of arm movements and postural adjustments during ball catching in children with and without ASD. DESIGN: This study employed a cross-sectional design. METHODS: Fifteen children with ASD (mean [SD] age = 8.8 [1.2] years; 12 boys) and 15 age- and sex-matched typically developing children participated in this study. Children were asked to catch a ball rolling down a ramp in 6 test conditions in which visual inputs and ramp direction were manipulated to provide different sensory conditions and postural demands. RESULTS: Compared with their typically developing peers, children with ASD had increased difficulties catching balls, especially those from lateral directions. They less often used visual information to plan for catching motion, demonstrated fewer and delayed anticipatory postural adjustments, and exhibited increased corrective control. LIMITATIONS: The sample excluded children with intellectual disability and attention deficit and hyperactivity disorders that might reduce the generalizability to the whole ASD population. CONCLUSIONS: Our results suggest that motor difficulties present in children with ASD can result from compromised sensorimotor integration in planning and control of movements.

Physical activity and objectively assessed sleep in 6-month-old infants in Taiwan.

Adequate physical activity is associated with improved sleep in adults. Such associations, however, vary greatly across studies in pediatric populations, with no studies involving infants found in the literature. This prospective observational study was designed, therefore, to examine the association between physical activity and sleep patterns in infants. A total of 183 healthy infants aged 6 months wore an actigraph for 7 days to measure physical activity and sleep. Parents and caregivers completed a sleep-activity diary over the same period documenting the different types of infant activities. Daily mean time spent in screen-time-or-limited physical activity, including screen-based (e.g., watching television or other electronic devices) and non-screen based activity (e.g., quiet play or restricted infant movement when carried by caregivers or seated in high chairs, swings, or bouncer seats), was 6.68 hr (SD = 1.99), which represented 47.50% of daytime waking hours (SD = 13.73). We found that 65 (35.5%) infants engaged in some screen time during the study, with 10 (5.5%) infants having an average daily screen time >30 min. In our multivariate linear regression model, more hours of screen-time-or-limited physical activity per day were significantly associated with a decrease in total daily 24 hr sleep duration (p < 0.01). Findings from our study suggest that reducing screen-time-or-limited physical activity might be an approach for promoting adequate sleep and lengthening infant daily sleep duration.

Is Mastery Motivation a Mediator of Relations between Maternal Teaching Behavior and Developmental Abilities in Children with Global Developmental Delay?

Aims: Mastery motivation refers to a child's persistent attempts to solve problems and learn skills. The purpose of this longitudinal study was to examine whether children's mastery motivation-mediated relationships between early maternal teaching behavior and later developmental abilities in children with global developmental delay (GDD). Methods: Fifty-six dyads of mothers and their children with GDD (aged 24-42 months) were assessed two times, at study entry and 6-months later. Maternal teaching behaviors were assessed using the Nursing Child Assessment Teaching Scale. Children's developmental abilities and mastery motivation were measured using the Comprehensive Developmental Inventory for Infants and Toddlers and the revised Individualized Moderately Challenging Mastery Tasks, respectively. A Pearson correlation matrix was used to propose hypothetical models, and path analysis was used to examine the mediation effect. Results: Mastery motivation significantly mediated the relationship between maternal teaching behavior and children's cognitive, fine motor, and gross motor abilities 6 months later. Conclusions: Mothers' teaching predicted their children's development directly and also indirectly through the child's mastery motivation. The findings support the importance of the quality of mothers teaching behaviors and the mastery motivation of children with GDD on development.

Infant sleep problems: The sleep characteristics of the "Don't Know" response.

AIMS: To examine the sleep characteristics of infants with parentally reported sleep problems, with parentally reported no sleep problems and with parentally reported uncertain sleep conditions. BACKGROUND: Infant sleep problems are recognized as a major health issue worldwide. However, in our daily clinical practices, it is not uncommon for parents not to know whether their infant sleep is problematic. DESIGN AND METHODS: A prospective study conducted between 2012 - 2015 where 219 parents completed questionnaires and infants wore an actigraph monitor for 7 days. Multinomial logistic regression models were used to evaluate the actigraphic and parentally reported infant sleep behaviours between the groups. RESULTS: Thirty-two (14.61%) parents did not know whether their infant sleep was problematic and 118 (53.88%) parents considered their infant sleep a problem. Compared with infants without sleep problems, infants with uncertain sleep conditions had significantly increased odds of having shortened longest sleep duration according to parental report. A significant association was found for infants without sleep problems compared with those with sleep problems who had significantly more wake after sleep onset as measured by actigraphy, as well as reduced longest sleep duration according to parental report. CONCLUSION: Infants with uncertain sleep conditions have the same problematic sleep behaviours resembling those of children with reported sleep problems. Healthcare professionals should actively disseminate sleep knowledge to help parents interpret infant sleep behaviours and consider possible intervention strategies for improving parental sleep-related knowledge and infant sleep.

Gross Motor Trajectories During the First Year of Life for Preterm Infants With Very Low Birth Weight.

Background: Early identification of motor dysfunction in preterm infants with very low birth weight (VLBW) is important in order to provide early intervention. Objective: This study was to examine the motor trajectories of preterm infants with VLBW during their first year of life and to investigate the predictive ability and influencing factors of the trajectories. Design and Methods: A total of 342 preterm infants with VLBW were prospectively assessed for motor development by the Alberta Infant Motor Scales at 4, 6, 9, and 12 months and for developmental outcomes using the Bayley Scales of Infant and Toddler Development, second edition, at 24 months. Perinatal and socio-environmental factors were collected at baseline. Growth mixture modeling was used to explore the patterns of infants' motor trajectories during their first year of life. Logistic regression analyses were applied to examine the influencing factors associated with motor trajectories and their predictability of 24-month developmental outcomes. Results: Preterm infants with VLBW showed 3 distinct motor trajectories: stably normal (55%), deteriorating (32%), and persistently delayed (13%). Furthermore, the motor trajectories were predictive of 24-month cognitive and motor outcomes. Perinatal factors including lower birth weight, male gender, moderate to severe bronchopulmonary dysplasia, stage III to IV retinopathy of prematurity, and major brain damage were associated with a risk of deteriorating and persistently delayed trajectories (all P < .05). Socio-environmental factors had no association with motor trajectories. Limitations: The small sample size of the infants with a persistently delayed trajectory may have limited the assessment of some influencing factors. Conclusion: The identified early motor trajectories, predictive values, and influencing factors provide insightful implications for early detection and prevention of motor -disorders in preterm infants with VLBW.

Development of adaptive sensorimotor control in infant sitting posture.

A reliable and adaptive relationship between action and perception is necessary for postural control. Our understanding of how this adaptive sensorimotor control develops during infancy is very limited. This study examines the dynamic visual-postural relationship during early development. Twenty healthy infants were divided into 4 developmental groups (each n=5): sitting onset, standing alone, walking onset, and 1-year post-walking. During the experiment, the infant sat independently in a virtual moving-room in which anterior-posterior oscillations of visual motion were presented using a sum-of-sines technique with five input frequencies (from 0.12 to 1.24 Hz). Infants were tested in five conditions that varied in the amplitude of visual motion (from 0 to 8.64 cm). Gain and phase responses of infants' postural sway were analyzed. Our results showed that infants, from a few months post-sitting to 1 year post-walking, were able to control their sitting posture in response to various frequency and amplitude properties of the visual motion. Infants showed an adult-like inverted-U pattern for the frequency response to visual inputs with the highest gain at 0.52 and 0.76 Hz. As the visual motion amplitude increased, the gain response decreased. For the phase response, an adult-like frequency-dependent pattern was observed in all amplitude conditions for the experienced walkers. Newly sitting infants, however, showed variable postural behavior and did not systemically respond to the visual stimulus. Our results suggest that visual-postural entrainment and sensory re-weighting are fundamental processes that are present after a few months post sitting. Sensorimotor refinement during early postural development may result from the interactions of improved self-motion control and enhanced perceptual abilities.

Do maternal interactive behaviors correlate with developmental outcomes and mastery motivation in toddlers with and without motor delay?

BACKGROUND: Maternal interactive behaviors theoretically affect developmental outcomes and mastery motivation in young children. However, these associations are inconsistent in the literature. OBJECTIVE: The purposes of this study were: (1) to examine the differences in maternal behaviors between toddlers with motor delay (MD) and those with typical development (TD), (2) to investigate the correlation of maternal behaviors and developmental quotients (DQs) in toddlers with MD and TD, and (3) to examine the correlation of maternal behaviors and mastery motivation in toddlers with MD and TD. DESIGN: This was a sex- and mental age-matched case-control study. METHODS: Twenty-two mother-child dyads of toddlers with MD (ages 23-47 months) and 22 dyads of sex- and mental age-matched toddlers with TD (ages 15-29 months) were recruited. Maternal scores from the Nursing Child Assessment Teaching Scale, 2 indicators of motivation (persistence and mastery pleasure) from individualized mastery tasks and the Dimensions of Mastery Questionnaire, and DQs from the Comprehensive Developmental Inventory for Infants and Children were assessed. RESULTS: Mothers of children in the MD group showed significantly lower cognitive growth fostering scores than mothers of children in the TD group. Maternal total scores were significantly correlated with whole DQs in both groups. In the MD group, maternal total scores correlated significantly with DMQ mastery pleasure but not with mastery task motivation. LIMITATIONS: The study design makes it impossible to know the causal relationships between maternal behaviors and children's DQs and motivation. CONCLUSIONS: Mothers of toddlers with MD exhibited less adequate interactive behaviors than mothers of toddlers with TD. Because higher-quality maternal behaviors correlated with higher DQs in the MD group, clinicians should encourage parents to participate in early intervention programs and model high-quality parenting behavior to enhance parents' and children's outcomes.

A randomized controlled trial of clinic-based and home-based interventions in comparison with usual care for preterm infants: effects and mediators.

This study examined the effects and mediators of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with usual care in very-low-birth-weight (VLBW) preterm infants on developmental and behavioral outcomes at 24 months of age (corrected for prematurity). In this randomized controlled trial, VLBW preterm infants received either CBIP (n=57), HBIP (n=63), or usual care (n=58) from hospitalization to 12 months. At 12 months, infant emotional regulation was assessed using the toy-behind-barrier procedure and dyadic interaction was observed during free play. At 24 months, infant developmental and behavioral outcomes were assessed using the Bayley Scales of Infant and Toddler Development- 3rd edition and the Child Behavior Checklist for Ages 1.5-5, respectively. Compared with infants under usual care, the CBIP-group infants showed higher cognitive composite scores (difference, 95% confidence interval (CI)=4.4, 0.8-7.9) and a lower rate of motor delay (odds ratio (OR), 95% CI=0.29, 0.08-0.99); the HBIP-group infants had lower sleep problem scores (difference, 95% CI=-1.4, -2.5 to -0.3) and a lower rate of internalizing problems at 24 months (OR, 95% CI=0.51, 0.28-0.93) (all p<.05). The CBIP's effect on cognitive outcome was attenuated when maternal or dyadic interactive behavior was considered; whereas the HBIP's effect on sleep and internalizing behavior was attenuated when duration of orientation to a toy or object was considered. In conclusions, interventions enhanced the cognitive, motor, and behavioral outcomes of VLBW preterm infants. The effects on cognitive and behavioral outcomes might be mediated by early-improved mother-infant interaction and infant emotional regulation, respectively.

A psychometric study of the Bayley Scales of Infant and Toddler Development - 3rd Edition for term and preterm Taiwanese infants.

The Bayley Scales of Infant and Toddler Development - 3rd Edition (Bayley-III) was updated to enhance its usefulness for contemporary child developmental assessment. However, recent data in Western countries have implicated the overestimation of child development by the new instrument. This study aimed to investigate the psychometric features of the Bayley-III for term and preterm infants in Taiwan. Forty-seven term infants and 167 preterm infants were prospectively examined with the Bayley Scales of Infant Development - 2nd Edition (BSID-II) and the Bayley-III at 6, 12, 18, and 24 months of age (corrected for prematurity). The psychometric properties examined included reliability, construct validity, and known-group validity. The intra- and inter-rater reliabilities of the Bayley-III were good to excellent. The correlations between the BSID-II and Bayley-III raw scores were good to excellent for the cognitive and motor items and low to excellent for the language items. Term infants achieved higher composite scores than preterm infants on all of the Bayley-III scales (p<0.05). However, their rates of developmental delay were lower than the previously established prevalence estimates. The Bayley-III cut-off composite score was adjusted 10-20, 1-13, and 12-24 points higher than 70 for optimal prediction of cognitive, language, and motor delay, respectively, as defined by the BSID-II index score<70. The Bayley-III is a reliable instrument that extends its previous edition, especially in early language assessment. However, the upward adjustment of its cut-off score is recommended for the accurate identification of developmental delay in term and preterm Taiwanese infants.

The effect of in-hospital developmental care on neonatal morbidity, growth and development of preterm Taiwanese infants: a randomized controlled trial.

INTRODUCTION: Intervention studies of developmental care for preterm infants in Western societies have shown early but unsustainable effects on child outcomes, however only a limited of studies have examined if developmental care interventions produce similar effects in Eastern cultural contexts. AIMS: To examine the effectiveness of in-hospital developmental care on neonatal morbidity, growth and development of preterm infants with very low birth weight (VLBW; birth weight<1500 g) in Taiwan. METHODS: One hundred and seventy-eight VLBW preterm infants were randomly assigned to the clinical trial during hospitalization at three hospitals in Taiwan; the control group received five sessions of standard child-focused developmental care and the intervention group received five sessions of child- and parent-focused developmental care. Sixty-two normal term infants were also included as a comparison group. Infants were examined for morbidity, growth and developmental outcomes at term age. RESULTS: At study entry, more infants in the intervention group were twins or multiples than those in the control group (29% vs. 16%, p=0.05). After adjusting for birth set, the intervention group had lower incidences of stage II-III retinopathy (odds ratio [OR]=0.34 [95% confidence interval (CI): 0.15-0.79]; p=0.01) and feeding desaturation (OR=0.32 [95% CI: 0.10-1.00]; p=0.05) and had greater daily weight gains (difference=2.0 g/day [95% CI: 0-4.0 g/day]; p=0.05) as compared with the control group. However, the intervention and control groups did not differ in any of the neurodevelopmental measures. CONCLUSIONS: In-hospital developmental care has short-term benefits for Taiwanese VLBW preterm infants in reducing the risk of retinopathy and feeding desaturation as well as in enhancing weight gains at term age.

Treadmill responses and physical activity levels of infants at risk for neuromotor delay.

PURPOSE: This study described developmental changes in treadmill (TM) stepping and physical activity (PA) of infants at risk for neuromotor delay (ND) and explored these changes by diagnosis of cerebral palsy (CP). Relationships of stepping and PA with walking onset were examined. METHOD: Fifteen infants at risk for ND (9.9 +/- 2.4 months) were tested every 2 months on a TM until walking onset or 24 months of corrected age. We recorded PA profiles using an activity monitor. Throughout the study, 6 of the 15 infants received a CP diagnosis. RESULTS: Infants increased alternating steps (AltStp), decreased toe contacts, and increased high-level PA. Infants with CP showed less AltStp, more toe contacts, and less high-level PA than those without CP. Infants' AltStp and high-level PA revealed a positive correlation to earlier onset of walking. CONCLUSION: Future studies should examine whether a TM intervention could improve mobility in infants at risk for ND.

The development of infant upright posture: sway less or sway differently?

Postural control is an important factor for early motor development; however, compared with adults, little is known about how infants control their unperturbed upright posture. This lack of knowledge, particularly with respect to spatial and temporal characteristics of infants' unperturbed independent standing, represents a significant gap in the understanding of human postural control and its development. Therefore, our first analysis offers a thorough longitudinal characterization of infants' quiet stance through the 9 months following the onset of independent walking. Second, we examined the influence of sensory-mechanical context, light touch contact, on infants' postural control. Nine typically developing infants were tested monthly as they stood on a small pedestal either independently or with the right hand lightly touching a stationary contact surface. In addition to the longitudinal study design, an age-constant sample was analyzed to verify the influence of walking experience in infant postural development without the confounding effect of chronological age. Center of pressure excursions were recorded and characterized by distance-related, velocity, and frequency domain measures. The results indicated that, with increasing experience in the upright, as indexed by walk age, infants' postural sway exhibited shifts in rate-related characteristics toward lower frequency and slower, less variable velocity oscillations without changing the spatial characteristics of sway. Additional touch contact stabilized infants' postural sway as revealed by decrease in sway position variance, amplitude, and area as well as lower frequency and velocity. These results were confirmed by the age-constant analysis. Taken together, our findings suggest that instead of progressively reducing the sway magnitude, infants sway differently with increasing upright experience or with additional somatosensory information. These differences suggest that early development of upright stance, particularly as it relates to increasing postural and locomotor experience, involves a refinement of sensorimotor dynamics that enhances estimation of self-motion for controlling upright stance.

Two steps forward and one back: Learning to walk affects infants' sitting posture.

The transition from sitting to walking is a major motor milestone for the developing postural system. This study examined whether this transition to walking impacts the previously established posture (i.e., sitting). Nine infants were examined monthly from sitting onset until 9 months post-walking. Infants sat on a saddle-shape chair either independently or with their right hand touching a stationary contact surface. Postural sway was measured by sway amplitude, variability, area, and velocity of the center of pressure trajectory. The results showed that for all the postural measures in the no-touch condition, a peak before or at walk onset was observed in all the infants. At the transition age, when peak sway occurred, infants' postural sway measures were significantly greater than at any other age. Further, infants' postural sway was attenuated by touch only at this transition. We suggest that this transient disruption in sitting posture results from a process involving re-calibration of an internal model for the sensorimotor control of posture so as to accommodate the newly emerging bipedal behavior of independent walking.

The impact of countermeasure propagation on the prevalence of computer viruses.

Countermeasures such as software patches or warnings can be effective in helping organizations avert virus infection problems. However, current strategies for disseminating such countermeasures have limited their effectiveness. We propose a new approach, called the Countermeasure Competing (CMC) strategy, and use computer simulation to formally compare its relative effectiveness with three antivirus strategies currently under consideration. CMC is based on the idea that computer viruses and countermeasures spread through two separate but interlinked complex networks-the virus-spreading network and the countermeasure-propagation network, in which a countermeasure acts as a competing species against the computer virus. Our results show that CMC is more effective than other strategies based on the empirical virus data. The proposed CMC reduces the size of virus infection significantly when the countermeasure-propagation network has properties that favor countermeasures over viruses, or when the countermeasure-propagation rate is higher than the virus-spreading rate. In addition, our work reveals that CMC can be flexibly adapted to different uncertainties in the real world, enabling it to be tuned to a greater variety of situations than other strategies.

Relationship between spontaneous kicking and age of walking attainment in preterm infants with very low birth weight and full-term infants.

BACKGROUND AND PURPOSES: Although early kicking differences have been reported for preterm infants without overt cranial sonographic abnormalities, their functional importance remains unclear because no outcomes have been measured. Therefore, the first purpose of this prospective study was to examine the age of walking attainment in preterm infants who had very low birth weight (VLBW) but no overt neurosonographic abnormalities and full-term infants without known impairments or pathology. The second purpose was to examine the relationship between spontaneous kicking and age of walking attainment in these infants. SUBJECTS AND METHODS: Twenty-two preterm infants and 22 full-term infants were examined for kicking movements at 2 and 4 months corrected age and were followed up for age of walking attainment until 18 months corrected age. RESULTS: Survival analysis showed that infants with VLBW attained walking ability at older ages than full-term infants after correction for prematurity. Cox proportional-hazards regression analyses for all infants revealed that a high hip-knee correlation at 2 months corrected age, a high kick frequency at 4 months corrected age, and a short intra-kick pause together with a low variability in interlimb coordination at 2 and 4 months corrected age were all associated with a decreased rate of walking attainment. DISCUSSION AND CONCLUSION: The results indicated that preterm infants who had VLBW but no overt neurosonographic abnormalities had an increased risk of delayed walking attainment compared with full-term infants. Alterations of spontaneous kicking may predict a decreased rate of walking attainment in both preterm and full-term infants.

Kinematic analysis of kicking movements in preterm infants with very low birth weight and full-term infants.

BACKGROUND AND PURPOSE: Study of kicking development provides important information to understand how early spontaneous movements change in infants as they acquire voluntary control. Researchers have investigated the kicking movements of preterm infants; however, the movement patterns that they have described were inconsistent. The purpose of this study, therefore, was to examine the development of kicking movements with kinematic analysis in preterm infants with very low birth weight (VLBW) and full-term infants. SUBJECTS AND METHODS: Twenty-two infants with VLBW who were divided into low gestational age (gestational age of <30 weeks, n=9) and high gestational age (gestational age of >or=30 weeks, n=13) classes and 22 full-term infants were evaluated during kicking movements using 4 synchronized cameras and 3-dimensional kinematic analysis when the infants were 2 and 4 months of corrected age. RESULTS: The infants with VLBW and a high gestational age showed similar kicking movements compared with the full-term infants. In contrast, the infants with VLBW and a low gestational age exhibited a higher kick frequency and a shorter flexion phase at 4 months of corrected age. They also exhibited a higher hip-knee correlation and lower variability in the interlimb coordination pattern at 2 and 4 months of corrected age. DISCUSSION AND CONCLUSION: The findings indicate that infants with VLBW, particularly those with a low gestational age, have age-related differences in movement organization and coordination of kicking compared with full-term infants.