Leg Movement Rate before and after a Caregiver-Provided Intervention for Infants at Risk of Developmental Disability: A Pilot Study.

AIM: Our purpose was to assess daily leg movement rate before and after a caregiver-provided in-home intervention for infants at risk for developmental disability. We also assessed adherence and quality of caregiver-child interaction. METHODS: Twelve infants, at risk for developmental disabilities, and their caregivers participated in an intervention focused on increasing leg movements. Intervention started between 3- and 6-months corrected age and ended once the infant was able to sit independently or at 9 months corrected age, whichever occurred first. Infants were assessed monthly. RESULTS: Infants at risk for developmental disabilities who were moving less than 1200 leg movements per hour awake at the start of the intervention increased their daily leg movement rate following the intervention (Median [range]: pre-1047 [506-1056], post- 1104 [655-1359], p = 0.040). Additionally, the caregivers had a high adherence (Median: 89%, Range: 11.43%-329.17%) and good quality of caregiver-child interaction (Median NCAST total: 46, Range: 34-59); and maintained similar amounts of adherence (p = 0.575) and quality of caregiver-child interaction (p = 0.432) throughout the intervention. CONCLUSION: This study provides preliminary evidence that leg movement rate has the potential to be used as an outcome measure to assess an infant's progress and motor practice during an intervention.

Electroencephalography measures of relative power and coherence as reaching skill emerges in infants born preterm.

Electroencephalography (EEG) measures of relative power and coherence are associated with motor experience in infants with typical development, but these relationships have not been assessed in infants born preterm. The goal of our study was to investigate the changing patterns of relative power and coherence in the alpha band during resting state EEG in infants born preterm as they developed the skill of reaching. We collected monthly longitudinal data from fourteen infants born preterm between the adjusted ages of 56 and 295 days for a total of 37 sessions of EEG data. Alpha band power at motor cortices and cross-regional connectivity do not present consistent changing trends at the group level in infants born preterm. Individual level analysis reveals that infants born preterm are a heterogeneous group with subtypes of neural function development, some presenting similar changing trends as observed in the typically developing group while others present atypical patterns. This may be linked to the variability in developmental outcomes in infants born preterm. This study was a critical first step to support EEG as a potential tool for identifying and quantifying the developmental trajectories of neuromotor control in infants born preterm.

How Many Days are Necessary to Represent Typical Daily Leg Movement Behavior for Infants at Risk of Developmental Disabilities?

BACKGROUND: Movement characteristics can differentiate between infants at risk and infants with typical development. However, it is unknown how many days are needed to accurately represent typical daily behavior for infants at risk of developmental disabilities when using wearable sensors. To consider the balance between participant burden and the amount of data collected and optimizing the efficiency of data collection, our study determined (1) how many days were necessary to represent typical movement behavior for infants at risk of developmental disabilities and (2) whether movement behavior was different on weekend days and weekdays. METHODS: We used Opal wearable sensors to collect at least 5 days of 11 infants' leg movement data. The standard (average of 5 days) was compared with four methods (average of the first 1/2/3/4 days) using the Bland-Altman plots and the Spearman correlation coefficient. We also compared the data from the average of 2 weekend days to the average of the first 2 weekdays for 8 infants. RESULTS: The Spearman correlation coefficient comparing the average of the first 2 days of data and the standards were all above 0.7. The absolute differences between them were all below 10% of the standards. The Bland-Altman plots showed more than 90% of the data points comparing the average of 2 days and the standards fell into the limit of agreement for each variable. The absolute difference between weekend days and weekdays for the leg movement rate, duration, average acceleration, and peak acceleration was 15.2%, 1.7%, 6.8% and 6.3% of the corresponding standard, respectively. CONCLUSION: Our results suggest 2 days is the optimal amount of data to represent typical daily leg movement behavior of infants at risk of developmental disabilities while minimizing participant burden. Further, leg movement behavior did not differ distinctly across weekend days and weekdays. These results provide supportive evidence for an efficient amount of data collections when using wearable sensors to evaluate movement behavior in infants at risk of developmental disabilities.

Obstetric Brachial Plexus Palsy: Can a Unilateral Birth Onset Peripheral Injury Significantly Affect Brain Development?

Purpose: Examine brain structure and function in OBPP and relate to clinical outcomes to better understand the effects of decreased motor activity on early brain development. Methods: 9 OBPP, 7 controls underwent structural MRI scans. OBPP group completed evaluations of upper-limb function and functional near-infrared spectroscopy (fNIRS) during motor tasks. Results: Mean primary motor area volume was lower in both OBPP hemispheres. No volume differences across sides seen within groups; however, Asymmetry Ratio in supplementary motor area differed between groups. Greater asymmetry in primary somatosensory area correlated with lower ABILHAND-Kids scores. fNIRS revealed more cortical activity in both hemispheres during affected arm reach. Conclusion: Cortical volume differences or asymmetry were found in motor and sensory regions in OBPP that related to clinical outcomes. Widespread cortical activity in fNIRS during affected arm reach suggests reorganization in both hemispheres and is relevant to rehabilitation of those with developmental peripheral and brain injuries.

fNIRS: An Emergent Method to Document Functional Cortical Activity during Infant Movements.

The neural basis underlying the emergence of goal-directed actions in infants has been severely understudied, with minimal empirical evidence for hypotheses proposed. This was largely due to the technological constraints of traditional neuroimaging techniques. Recently, functional near-infrared spectroscopy (fNIRS) technology has emerged as a tool developmental scientists are finding useful to examine cortical activity, particularly in young children and infants due to its greater tolerance to movements than other neuroimaging techniques. fNIRS provides an opportunity to finally begin to examine the neural underpinnings as infants develop goal-directed actions. In this methodological paper, I will outline the utility, challenges, and outcomes of using fNIRS to measure the changes in cortical activity as infants reach for an object. I will describe the advantages and limitations of the technology, the setup I used to study primary motor cortex activity during infant reaching, and example steps in the analyses processes. I will present exemplar data to illustrate the feasibility of this technique to quantify changes in hemodynamic activity as infants move. The viability of this research method opens the door to expanding studies of the development of neural activity related to goal-directed actions in infants. I encourage others to share details of techniques used, as well, including analyticals, to help this neuroimaging technology grow as others, such as EEG and fMRI have.

Developmental changes in motor cortex activity as infants develop functional motor skills.

Despite extensive research examining overt behavioral changes of motor skills in infants, the neural basis underlying the emergence of functional motor control has yet to be determined. We used functional near-infrared spectroscopy (fNIRS) to record hemodynamic activity of the primary motor cortex (M1) from 22 infants (11 six month-olds, 11 twelve month-olds) as they reached for an object, and stepped while supported over a treadmill. Based on the developmental systems framework, we hypothesized that as infants increased goal-directed experience, neural activity shifts from a diffused to focal pattern. Results showed that for reaching, younger infants showed diffuse areas of M1 activity that became focused by 12 months. For elicited stepping, younger infants produced much less M1 activity which shifted to diffuse activity by 12 months. Thus, the data suggest that as infants gain goal-directed experience, M1 activity emerges, initially showing a diffuse area of activity, becoming refined as the behavior stabilizes. Our data begin to document the cortical activity underlying early functional skill acquisition.

The Use of Cuff Weights for Aquatic Gait Training in People Post-Stroke with Hemiparesis.

BACKGROUND AND PURPOSE: This study aimed to examine how spatiotemporal and kinematic gait variables are influenced by the application of a cuff weight during aquatic walking in people post-stroke. The secondary purpose was to compare the differences in gait responses between the placements of cuff weights on the proximal (knee weight) and distal end (ankle weight) of the shank. METHODS: Twenty-one participants post-stroke with hemiparesis aged 66.3 ± 11.3 years participated in a cross-sectional comparative study. Participants completed two aquatic walking trials at their self-selected maximum walking speed across an 8-m walkway under each of the three conditions: 1) walking with a knee weight; 2) walking with an ankle weight; and 3) walking with no weight. Cuff weights were worn on the paretic leg of each participant. Gait speed, cadence, step width and joint kinematics of the hip, knee and ankle joints were recorded by a customized three-dimensional underwater motion analysis system. RESULTS: Mean aquatic walking speeds significantly increased with the use of cuff weights when compared to walking with no weight. Changes in gait variables were found in the non-paretic leg with the addition of weight, while no significant changes were found in the paretic leg. CONCLUSION: The results suggest that the use of additional weight can be helpful if the goal of gait training is to improve walking speed of people post-stroke during pool floor walking. However, it is interesting to note that changes in gait variables were not found in the paretic limb where favourable responses were expected to occur.

Motor Cortex Activity During Functional Motor Skills: An fNIRS Study.

Assessments of brain activity during motor task performance have been limited to fine motor movements due to technological constraints presented by traditional neuroimaging techniques, such as functional magnetic resonance imaging. Functional near-infrared spectroscopy (fNIRS) offers a promising method by which to overcome these constraints and investigate motor performance of functional motor tasks. The current study used fNIRS to quantify hemodynamic responses within the primary motor cortex in twelve healthy adults as they performed unimanual right, unimanual left, and bimanual reaching, and stepping in place. Results revealed that during both unimanual reaching tasks, the contralateral hemisphere showed significant activation in channels located approximately 3 cm medial to the C3 (for right-hand reach) and C4 (for left-hand reach) landmarks. Bimanual reaching and stepping showed activation in similar channels, which were located bilaterally across the primary motor cortex. The medial channels, surrounding Cz, showed significantly higher activations during stepping when compared to bimanual reaching. Our results extend the viability of fNIRS to study motor function and build a foundation for future investigation of motor development in infants during nascent functional behaviors and monitor how they may change with age or practice.