Reaching and grasping movements in infants at risk: a review

Biological and environmental factors may affect children's executive function through motor and sensorimotor development: Preterm birth and cerebral palsy

Disruptive biological and environmental factors may undermine the development of children's motor and sensorimotor skills. Since the development of cognitive skills, including executive function, is grounded in early motor and sensorimotor experiences, early delays or impairments in motor and sensorimotor processing often trigger dynamic developmental cascades that lead to suboptimal executive function outcomes. The purpose of this perspective paper is to link early differences in motor/sensorimotor processing to the development of executive function in children born preterm or with cerebral palsy. Uncovering such links in clinical populations would improve our understanding of developmental pathways and key motor and sensorimotor skills that are antecedent and foundational for the development of executive function. This knowledge will allow the refinement of early interventions targeting motor and sensorimotor skills with the goal of proactively improving executive function outcomes in at-risk populations.

The Effect of START-Play Intervention on Reaching-Related Exploratory Behaviors in Children with Neuromotor Delays: A Secondary Analysis of a Randomized Controlled Trial

AIMS

Children with neuromotor delays are at risk for reaching and object exploration impairments, which may negatively affect their cognitive development and daily activity performance. This study evaluated the effectiveness of the Sitting Together And Reaching To Play (START-Play) intervention on reaching-related exploratory behaviors in children with neuromotor delays.

METHODS

In this randomized controlled clinical trial, 112 children (Mean = 10.80, SD = 2.59 months old at baseline) with motor delays were randomly assigned to receive START-Play intervention or usual care-early intervention. Performance for ten reaching-related exploratory behaviors was assessed at baseline and 1.5, 3, 6, 12 months post-baseline. Piecewise linear mixed-effects modeling was used to evaluate short- and long-term effects of the intervention.

RESULTS

Benefits of START-Play were observed for children with significant motor delays, but not for those with mild delays. START-Play was especially beneficial for children with significant motor delays who demonstrated early mastery in the reaching assessment (i.e., object contact ≥65% of the time within 3 months after baseline); these children showed greater improvements in manual, visual, and multimodal exploration, as well as intensity of exploration across time.

CONCLUSIONS

START-Play advanced the performance of reaching-related exploratory behaviors in children with significant motor delays.

Sit-to-stand movement in childrenwith cerebral palsy and relationships with the International classification of functioning, disability and health: A systematic review

BACKGROUND

Studying sit-to-stand (STS) in children with Cerebral Palsy addressing the domains of ICF allows determining the factors influencing STS in this population.

AIMS

To systematically review the literature on STS in children with CP, identifying which ICF domains have been assessed and how they relate to sit-to-stand.

METHODS AND PROCEDURES

A literature search was conducted in electronic databases by combining the keywords (child OR children OR adolescent) AND ("Cerebral Palsy") AND (sit-to-stand). We included cross-sectional articles published in English, that assessed STS movements in children with CP up to 18 years old.

OUTCOMES AND RESULTS

25 articles met the inclusion criteria. All of them assessed Body Functions and Structure. According to them, body alignment, muscle strength and postural sway affect STS movement. Six studies related Activity and Participation with STS, demonstrating that worse scores in scales that evaluate activities and participation are related to the poorer STS execution. Contextual factors were addressed in 15 studies: children's age, bench height, manipulation of sensory information and mechanical restriction impact the way children execute STS.

CONCLUSION AND IMPLICATIONS

Contextual factors and Body Functions and Structure impact the STS in children with CP. However, few studies have evaluated the participation of these children. Based on the theoretical framework of the ICF, it is important that future studies evaluate functional tasks in children with CP and the components that can affect them. The adoption of the biopsychosocial model strengthens the understanding of functioning, which can contribute to rehabilitation planning.

Goal-directed action planning in infants with Down syndrome

BACKGROUND

Down syndrome (DS) is a neurogenetic disorder associated with risk for executive dysfunction, or difficulties with the cognitive processes required for planning volitional, goal-directed behaviour. This study examines the developmental origins of difficulties with goal-directed action planning in infants with DS to inform our understanding of the cognitive phenotype associated with DS and its implications for intervention.

METHOD

First, the study compared the performance of infants with DS (n = 44, mean chronological age = 7.5 months, SD = 2.3) and typically developing infants (n = 31, mean chronological age = 7.5 months, SD = 2.9) on plan production and planning efficiency during an early planning task. Next, potential sources of variability in planning behaviour (motor performance and sensory processing) within the DS sample were examined. All infants completed an early planning laboratory task and the Bayley Scales of Infant Development-III Cognitive Scale. The motor and sensory skills of infants with DS were assessed by the motor scales of the Bayley Scales of Infant Development-III and the Infant Sensory Profile-2. DS-related biomedical history information was provided by caregivers for the infants with DS.

RESULTS

Between-group differences in planning were observed on the dimensions of strategy production and completion, such that infants with DS were less efficient in their strategy execution than typically developing infants. In the DS group, motor skills and sensory processing were associated with planning efficiency on all components of the early planning task.

CONCLUSIONS

Less efficient action planning in infants with DS may disrupt the shaping of goal-directed behaviour, and the identification of early risk factors associated with planning efficiency has important implications for early intervention.

Object exploration in extremely preterm infants between 6 and 9 months and relation to cognitive and language development at 24 months

Although early object exploration is considered a key ability for subsequent achievements, very few studies have analyzed its development in extremely low gestational age infants (ELGA- GA <28 weeks), whose early motor skills are delayed. Moreover, no studies have examined its developmental relationship with cognitive and language skills. The present study examined developmental change in Motor Object Exploration (MOE) and different types of MOE (Holding, Oral, Manual and Manual Rhythmic Exploration) in 20 ELGA and 20 full term (FT) infants observed during mother-infant play interaction at 6 and 9 months. It also explored whether specific types of MOE were longitudinally related to 24-month language and cognitive abilities (GMDS-R scores). ELGA infants increased MOE duration from 6 to 9 months, eliminating the initial difference with FT infants. In addition, ELGA infants showed a different pattern of Oral Exploration, that did not increase at 6 months and decrease at 9 months. Oral and Manual Exploration durations at 6 months were longitudinally related to 24-month GMDS-R language and cognitive performance scores respectively. We discuss the relevance of assessing early exploratory abilities in ELGA infants in order to implement customized intervention programs for supporting the development of these skills.

Alterations in white matter microstructure are associated with goal-directed upper-limb movement segmentation in children born extremely preterm

Altered white matter microstructure is commonly found in children born preterm (PT), especially those born at an extremely low gestational age (GA). These children also commonly show disturbed motor function. This study explores the relation between white matter alterations and upper-limb movement segmentation in 41 children born PT (19 girls), and 41 children born at term (18 girls) at 8 years. The PT group was subdivided into extremely PT (E-PT; GA = 25-27 weeks, N = 10), very PT (V-PT; GA = 28-32 weeks, N = 13), and moderately PT (M-PT; GA = 33-35 weeks, N = 18). Arm/hand preference (preferred/non-preferred) was determined through object interactions and the brain hemispheres were designated accordingly. White matter alterations were assessed using diffusion tensor imaging in nine areas, and movement segmentation of the body-parts head, shoulder, elbow, and wrist were registered during a unimanual goal-directed task. Increased movement segmentation was demonstrated consistently on the preferred side in the E-PT group compared with the term born group. Also compared with the term born peers, the E-PT group demonstrated reduced fractional anisotropy (FA) in the cerebral peduncle (targeting the corticospinal tract) in the hemisphere on the non-preferred side and in the splenium of corpus callosum. In contrast, in the anterior internal capsule on the preferred side, the E-PT group had increased FA. Lower FA in the cerebral peduncle, but higher FA in the anterior internal capsule, was associated with increased movement segmentation across body-parts in a contralateral manner. The results suggest that impaired development of sensorimotor tracts in E-PT children could explain a sub-optimal spatiotemporal organization of upper-limb movements. Hum Brain Mapp 38:5051-5068, 2017. © 2017 Wiley Periodicals, Inc.

Characterization and intervention for upper extremity exploration & reaching behaviors in infancy

This article aims to: 1) highlight general exploration, reaching, and object exploration behaviors as key activities of daily living in infancy, 2) describe how knowledge of early warning signs for these behaviors may improve early assessment, and 3) discuss interventions that may advance performance of these behaviors. Early intervention should focus on improving performance of these behaviors because: a) these early, interrelated upper extremity behaviors serve an integral role in global learning and development in infancy, b) among at-risk populations, differences have been observed in the quantity and quality of performance of these behaviors and, in many cases, these differences are associated with related perceptual-motor and cognitive delays. This article highlights how early assessment and intervention can target these key early behaviors in populations at risk for upper extremity disabilities, such as those born preterm, with Down syndrome, brachial plexus palsy, or arthrogryposis multiplex congentia.

Effects of parenting role and parent-child interaction on infant motor development in Taiwan Birth Cohort Study

BACKGROUND

Previous studies have rarely focused on healthy infants' motor development, and nationwide birth cohort studies in Taiwan are limited. It has been shown that parent-child interactions significantly influence infant motor development and the effect of mother-infant attachment on infant development is stronger than father-infant attachment. However, it is not well understood that whether the mother-infant or father-infant interaction has the confounding effect on infant motor development.

AIMS

To understand healthy infant motor development in Taiwan; and to investigate the effects of parenting roles and parent-child interactions on infant motor development.

METHODS

Data were derived from the 1st through the 2nd waves of the Taiwan Birth Cohort Study-Pilot Database. Infants were classified into two categories (complete or incomplete development) according to their developmental milestones. Generalized estimating equations (GEE) and random effects models were used to clarify the possible long-term effects.

RESULTS

The rate of infants who completed development in 6 months was 30.50%; however the rate was increased in 18 month-old children (80.01%). A mother's perceived infant care competence was the most important factor for infant motor development. "Whether or not the infant was the only baby in the family" and "parent-child interaction" had slightly significant effect on infant motor development.

CONCLUSIONS

In conclusion, the mother's perceived competence must be strengthened and parent-infant interactions should be emphasized on a daily basis.

Evaluation and characterization of manual reaching in children with cerebral palsy: A systematic review

Manual reaching is used daily to perform manipulative tasks and activities of daily routine. Children with cerebral palsy (CP) have limitations in this activity, with functional loss as a possible consequence. This review aimed to gather studies that evaluated and characterized manual reaching in children with CP, with the purpose of identifying the aspects analyzed, as well as review and discuss the results in the studies and its relationship to the children's level of functionality. 17 studies were selected for this systematic review from the search in electronic databases. The studies showed that children with CP show deficits in several spatio-temporal variables of reaching compared to typical children, such as longer time to perform the activity, higher peak velocity, lower index of curvature, and greater number of units of motion, which indicates lower smoothness and linearity of the movements of upper limbs. The performance is influenced by the level of motor impairment and various manipulations of the task. However, more studies are needed that help translating these results into treatment strategies that facilitate the performance of manual activities in children with CP.

School function in students with Down syndrome

People with Down syndrome (DS) are predisposed to specific areas of relative developmental strength and challenge, but it is unclear whether and how this profile affects participation in school and community settings. In this study we characterized the nature of school participation and performance of functional tasks in the school context for 26 elementary students with DS (mean age = 7.86 yr; standard deviation = 1.75). Students participated in assessments of cognitive status and language development. Their teachers completed the School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998) questionnaire and a standardized questionnaire on executive functioning (EF). Students demonstrated a pronounced pattern of assistance- and adaptation-related needs across various domains of school function. The strongest predictor of school function was EF skills, as reported by teachers (adjusted R² = .47, p = .003). Findings from this study should inform future intervention and school-related planning for elementary school students with DS.

Ajustes nos movimentos de alcançar e apreender objetos: impacto da Síndrome de Down

OBJETIVOS: verificar a influência das propriedades dos objetos nos ajustes realizados por lactentes típicos e com Síndrome de Down (SD) dos quatro aos oito meses de idade ao alcançar e apreender objetos. MÉTODOS: 16 lactentes, avaliados uma vez ao mês dos 4 aos 8 meses, sendo oito típicos e oito com SD. Quatro objetos esféricos (maleável grande, maleável pequeno, rígido grande e rígido pequeno) foram apresentados, e os cinco primeiros movimentos válidos foram registrados para análise das variáveis: ajuste proximal (uni e bimanual), ajuste distal (orientação da palma, abertura da mão) e apreensão do objeto. RESULTADOS: os lactentes típicos apresentaram mais ajuste bimanual para objetos grandes aos seis e oito meses e os com SD aos sete meses. Quanto aos ajustes distais, os lactentes típicos variaram seu comportamento enquanto os com SD apresentaram uso predominante da posição oblíqua. Em geral, o grupo típico apresentou maior sucesso na apreensão dos objetos rígidos e maleável pequeno quando comparados aos lactentes com SD. CONCLUSÕES: Os lactentes com SD apresentaram menor variedade de ajustes o que levou a um menor sucesso na apreensão, possivelmente devido a restrições intrínsecas da SD.

International Classification of Functioning, Disability and Health in children with cerebral palsy

PURPOSE

We intended to describe how concepts from recent models of disability have been studied for evaluation of children with cerebral palsy (CP) and their clinical implications.

METHOD

We revised studies that focused on the components of the International Classification of Functioning, Disability and Health (ICF) in children with CP.

RESULTS

Researchers have reported that children with CP exhibit impairments in various body functions/structures, limitations in functional activities performance and experience poorer participation outcomes than their typical peers. Moreover, it has been showed that participation of children with CP was affected by environmental factors.

CONCLUSION

Therefore, evaluation and rehabilitation processes should be focused on the quality of life improvement by emphasizing what a child can and wants to execute within the environment. Also, environmental factors should be recognized so that barriers could be minimized and adaptations to the environment achieved. However, few studies have verified the interrelationship between contextual factors and the functioning and disability domains in children with CP. This would allow us to know about approaches specifically designed for these children's needs.

Prenatal Cocaine Exposure and Motor Performance at 4 Months

OBJECTIVE

The relation between prenatal cocaine exposure and quality of movement was studied at 4 mo using the Posture and Fine Motor Assessment of Infants (PFMAI-I).

METHOD

Posture and fine motor scores of 4-month-old infants exposed to cocaine in utero (n = 370) were compared with an unexposed group (n = 533) within the context of gestational age, medical and demographic characteristics, and level of prenatal substance exposure using the PFMAI-I.

RESULTS

Infants prenatally exposed to cocaine had significantly lower posture scores than infants in the unexposed group. There was no main effect of cocaine exposure on fine motor scores; however, there were independent effects of gestational age at birth on both posture and fine motor scores at 4-mo corrected age.

CONCLUSION

These findings demonstrate independent contributions of prenatal cocaine exposure and prematurity to risk of motor delay and support the validity of the PFMAI-I as a measure of motor competence in early infancy.

Influência da textura na preensão de indivíduos com Síndrome de Down

INTRODUÇÃO: Diversos estudos disponibilizam evidências sobre características do desempenho motor e cognitivo de indivíduos com Síndrome de Down (SD), porém poucos estudos analisam a força muscular nestes indivíduos. As alterações apresentadas por indivíduos com SD podem manifestar-se funcionalmente e interferir na sua capacidade de desempenhar de forma independente diversas atividades e tarefas da rotina diária. OBJETIVO: O presente estudo teve como objetivo analisar a influência da textura do objeto na força de preensão palmar em indivíduos com Síndrome de Down. Participaram do estudo dez indivíduos com SD, com idade entre 4 e 30 anos. MÉTODO: A análise da força de preensão palmar foi mensurada por meio de um transdutor de força. A tarefa proposta para a coleta dos dados foi realizar a preensão do transdutor, revestido com diferentes texturas, transportá-lo até um ponto previamente demarcado, e posteriormente o retorno à posição inicial. Os dados obtidos foram analisados por meio de estatística descritiva e não-paramétrica. RESULTADOS: Os dados da estatística descritiva permitiram observar que a textura áspera foi a que exigiu menor força de preensão palmar dos participantes neste estudo, no entanto a análise não-paramétrica indicou não haver diferença estatisticamente significativa. CONCLUSÃO: Os resultados deste estudo indicam que textura do objeto não influenciou a força de preensão palmar executada pelos indivíduos com Síndrome de Down.