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Benfer KA, Whittingham K, Ware RS, Ghosh AK, Chowdhury S, Moula G, Samanta S, Khan NZ, Bell KL, Oftedal S, Bandaranayake S, Salt AT, Bhattacharya A, Maiti P, Tripathi SK, Morgan C, Novak I, Boyd RN. Efficacy of Early Intervention for Infants With Cerebral Palsy in an LMIC: An RCT. Pediatrics 2024; 153:e2023063854. [PMID: 38516717 DOI: 10.1542/peds.2023-063854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE To test efficacy of a parent-delivered multidomain early intervention (Learning through Everyday Activities with Parents [LEAP-CP]) for infants with cerebral palsy (CP) compared with equal-dose of health advice (HA), on (1) infant development; and (2) caregiver mental health. It was hypothesized that infants receiving LEAP-CP would have better motor function, and caregivers better mental health. METHODS This was a multisite single-blind randomized control trial of infants aged 12 to 40 weeks corrected age (CA) at risk for CP (General Movements or Hammersmith Infant Neurologic Examination). Both LEAP-CP and HA groups received 15 fortnightly home-visits by a peer trainer. LEAP-CP is a multidomain active goal-directed intervention. HA is based on Key Family Practices, World Health Organization. Primary outcomes: (1) infants at 18 months CA: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT mobility); and (2) caregiver: Depression Anxiety and Stress Scale. RESULTS Of eligible infants, 153 of 165 (92.7%) were recruited (86 males, mean age 7.1±2.7 months CA, Gross Motor Function Classification System at 18 m CA: I = 12, II = 25, III = 9, IV = 18, V = 32). Final data were available for 118 (77.1%). Primary (PEDI-CAT mobility mean difference = 0.8 (95% CI -1.9 to 3.6) P = .54) and secondary outcomes were similar between-groups. Modified-Intention-To-Treat analysis on n = 96 infants with confirmed CP showed Gross Motor Function Classification System I and IIs allocated to LEAP-CP had significantly better scores on PEDI-CAT mobility domain (mean difference 4.0 (95% CI = 1.4 to 6.5), P = .003) compared with HA. CONCLUSIONS Although there was no overall effect of LEAP-CP compared with dose-matched HA, LEAP-CP lead to superior improvements in motor skills in ambulant children with CP, consistent with what is known about targeted goal-directed training.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Sayak Chowdhury
- Indian Institute of Cerebral Palsy, Kolkata, India
- SSKM Postgraduate Institute of Medical Education and Research, Kolkata, India
| | | | - Sandip Samanta
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Kristie L Bell
- Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Sasaka Bandaranayake
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Australia
| | | | | | - Pradip Maiti
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Cathy Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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França ALN, Teruia PM, de Oliveira Arguelho A, Tudella E, Soares-Marangoni DA. Late preterm and very preterm infants differ in the acquisition time and quantity of reaches with grasping at reaching onset: an exploratory study. Front Psychol 2023; 14:1278774. [PMID: 37965660 PMCID: PMC10641779 DOI: 10.3389/fpsyg.2023.1278774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/03/2023] [Indexed: 11/16/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Amanda de Oliveira Arguelho
- Graduate Program in Movement Sciences, Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Eloisa Tudella
- Graduate Program of Physical Therapy, Department of Physical Therapy, Federal University of Sao Carlos, São Carlos, Brazil
| | - Daniele Almeida Soares-Marangoni
- Graduate Program in Health and Development, Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Graduate Program in Movement Sciences, Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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Righetto Greco AL, Sato NTDS, Moreira RDFC, Cavalcante Neto JL, Tudella E. Sticky Mittens Training to Improve Reaching Skills and Manual Exploration of Full-Term and At-Risk Infants: A Systematic Review. Phys Occup Ther Pediatr 2023; 43:182-195. [PMID: 36195977 DOI: 10.1080/01942638.2022.2128973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
| | | | | | | | - Eloisa Tudella
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Jordan EJ, Völter CJ, Seed AM. Do capuchin monkeys ( Sapajus apella) use exploration to form intuitions about physical properties? Cogn Neuropsychol 2022; 38:531-543. [PMID: 35732407 DOI: 10.1080/02643294.2022.2088273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Humans' flexible innovation relies on our capacity to accurately predict objects' behaviour. These predictions may originate from a "physics-engine" in the brain which simulates our environment. To explore the evolutionary origins of intuitive physics, we investigate whether capuchin monkeys' object exploration supports learning. Two capuchin groups experienced exploration sessions involving multiple copies of two objects, one object was easily opened (functional), the other was not (non-functional). We used two within-subject conditions (enrichment-then-test, and test-only) with two object sets per group. Monkeys then underwent individual test sessions where the objects contained rewards, and they choose one to attempt to open. The monkeys spontaneously explored, performing actions which yielded functional information. At test, both groups chose functional objects above chance. While high performance of the test-only group precluded us from establishing learning during exploration, this study reveals the promise of harnessing primates' natural exploratory tendencies to understand how they see the world.
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Affiliation(s)
- Eleanor Jade Jordan
- School of Psychology & Neuroscience, University of St Andrews, St Andrews, UK
| | - Christoph J Völter
- Comparative Cognition, Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University of Vienna, University of Vienna, Wien, Austria
| | - Amanda M Seed
- School of Psychology & Neuroscience, University of St Andrews, St Andrews, UK
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Babik I, Cunha AB, Lobo MA. A model for using developmental science to create effective early intervention programs and technologies to improve children's developmental outcomes. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2022; 62:231-268. [PMID: 35249683 DOI: 10.1016/bs.acdb.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Children born with a variety of environmental or medical risk factors may exhibit delays in global development. Very often, such delays are identified at preschool or school age, when children are severely overdue for effective early interventions that can alleviate the delays. This chapter proposes a conceptual model of child development to inform the creation of interventions and rehabilitative technologies that can be provided very early in development, throughout the first year of life, to optimize children's future developmental outcomes. The model suggests that early sensorimotor skills are antecedent and foundational for future motor, cognitive, language, and social development. As an example, this chapter describes how children's early postural control and exploratory movements facilitate the development of future object exploration behaviors that provide enhanced opportunities for learning and advance children's motor, cognitive, language, and social development. An understanding of the developmental pathways in the model can enable the design of effective intervention programs and rehabilitative technologies that target sensorimotor skills in the first year of life with the goal of minimizing or ameliorating the delays that are typically identified at preschool or school age. Specific examples of early interventions and rehabilitative technologies that have effectively advanced children's motor and cognitive development by targeting early sensorimotor skills and behaviors are provided.
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Affiliation(s)
- Iryna Babik
- Department of Psychological Science, Boise State University, Boise, ID, United States
| | - Andrea B Cunha
- Department of Physical Therapy, Biomechanics & Movement Science Program, University of Delaware, Newark, DE, United States
| | - Michele A Lobo
- Department of Physical Therapy, Biomechanics & Movement Science Program, University of Delaware, Newark, DE, United States.
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6
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From Hemispheric Asymmetry through Sensorimotor Experiences to Cognitive Outcomes in Children with Cerebral Palsy. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent neuroimaging studies allowed us to explore abnormal brain structures and interhemispheric connectivity in children with cerebral palsy (CP). Behavioral researchers have long reported that children with CP exhibit suboptimal performance in different cognitive domains (e.g., receptive and expressive language skills, reading, mental imagery, spatial processing, subitizing, math, and executive functions). However, there has been very limited cross-domain research involving these two areas of scientific inquiry. To stimulate such research, this perspective paper proposes some possible neurological mechanisms involved in the cognitive delays and impairments in children with CP. Additionally, the paper examines the ways motor and sensorimotor experience during the development of these neural substrates could enable more optimal development for children with CP. Understanding these developmental mechanisms could guide more effective interventions to promote the development of both sensorimotor and cognitive skills in children with CP.
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Khurana S, Rao BK, Lewis LE, Kumaran SD, Kamath A, Einspieler C, Dusing SC. Neonatal PT Improves Neurobehavior and General Movements in Moderate to Late Preterm Infants Born in India: An RCT. Pediatr Phys Ther 2021; 33:208-216. [PMID: 34618744 DOI: 10.1097/pep.0000000000000824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine whether a structured neonatal physical therapy program (SNP) improves neurobehavior and general movements in moderate to late preterm (MLP) infants. METHODS Sixty MLP infants participated in this clinical trial. After baseline assessment using the Neurobehavioral Assessment of Preterm Infant (NAPI) and Prechtl General Movements (GMs) Assessment, infants were randomly allocated to a usual care (n = 30) or an SNP group (n = 30) and continued receiving usual care. The SNP group received intervention for 90 minutes/day, 6 days/week until discharge. Changes in neurobehavior and GMs were assessed at hospital discharge. RESULTS Changes in scores on scarf sign and motor development and vigor clusters of NAPI document an improvement in the SNP group. The proportion of infants with poor repertoire GMs also decreased more in the SNP group than in the usual care group. CONCLUSION The SNP may be effective in improving some aspects of neurobehavior and quality of GMs in MLP infants. WHAT THIS ADDS TO THE EVIDENCE The addition of a structured neonatal physical therapy program to usual care can promote neurobehavioral organization and improve the quality of general movements in moderate and late preterm infants in India.
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Affiliation(s)
- Sonia Khurana
- Department of Physical Therapy (Dr Khurana), Motor Development Lab, Virginia Commonwealth University, Richmond, Virginia; Department of Physiotherapy (Drs Rao and Kumaran), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Department of Paediatrics (Drs Lewis), Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India; Department of Data Science (Dr Kamath), Manipal Academy of Higher Education, Manipal, Karnataka, India; Division of Phoniatrics (Dr Einspieler), Medical University of Graz, Graz, Austria; Division of Biokinesiology and Physical Therapy (Dr Dusing), University of Southern California, Los Angeles, California
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Reaching skills in six-month-old infants at environmental and biological risk. PLoS One 2021; 16:e0254106. [PMID: 34197565 PMCID: PMC8248732 DOI: 10.1371/journal.pone.0254106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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9
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Sato NTDS, Cunha AB, Antonio GLN, Tudella E. Does late preterm birth impact trunk control and early reaching behavior? Infant Behav Dev 2021; 63:101556. [PMID: 33819770 DOI: 10.1016/j.infbeh.2021.101556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
The aims of the study were to 1) verify the level of trunk control longitudinally and reaching behavior while sitting in two positions in late preterm (LPT) and full-term (FT) infants, 2) determine whether the level of trunk control relates to reaching outcomes. Twenty LPT infants and 36 infants born FT were assessed via three in-lab visits: at 6, 7, and 8 months. At each visit, the Segmental Assessment of Trunk Control (SATCo) and reaching assessment were performed, where the infants were positioned sitting in the ring and at 90° of flexion of hips, knees, and ankles. Accurate manual support to the trunk was provided in each visit. LPT infants presented a lower level of trunk control over time. LPT infants presented a higher percentage of unimanual reaches and successful grasping at 7 months' visit, and a higher number of reaches at 8 months' visit compared to FT infants. The sitting positions did not influence reaching performance. The level of trunk control relates to functional reaching strategies only in FT infants. This study might provide insights for clinicians for understanding the level of trunk control, the importance of reaching behaviors for exploration, and considering these behaviors as strategies for intervention.
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Affiliation(s)
- Natalia Tiemi da Silva Sato
- Department of Physical Therapy, Federal University of Sao Carlos, Rodovia Washington Luís, km 235, Sao Carlos, SP, 13565-905, Brazil.
| | - Andréa Baraldi Cunha
- Department of Physical Therapy, University of Delaware (UD), 540 S College Ave, Newark, DE, 19713, USA
| | - Giovanna Laura Neves Antonio
- Department of Physical Therapy, Federal University of Sao Carlos, Rodovia Washington Luís, km 235, Sao Carlos, SP, 13565-905, Brazil
| | - Eloisa Tudella
- Department of Physical Therapy, Federal University of Sao Carlos, Rodovia Washington Luís, km 235, Sao Carlos, SP, 13565-905, Brazil
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Righetto Greco AL, Sato NTDS, Cazotti AM, Tudella E. Is Segmental Trunk Control Related to Gross Motor Performance in Healthy Preterm and Full-Term Infants? J Mot Behav 2019; 52:666-675. [PMID: 31631791 DOI: 10.1080/00222895.2019.1673694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
| | | | | | - Eloisa Tudella
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil
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11
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Kubicek C, Gehb G, Jovanovic B, Schwarzer G. Training of 7-month-old infants' manual object exploration skills: Effects of active and observational experience. Infant Behav Dev 2019; 57:101353. [PMID: 31499397 DOI: 10.1016/j.infbeh.2019.101353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/21/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
In the present study, a fine motor training was developed and evaluated in which infants were trained to manually explore objects in an advanced manner. Fifty 7-month-old infants were randomly assigned to three different training conditions: (1) to an active manual exploration training, in which they learned to explore objects efficiently, (2) to an observational manual exploration training, in which they observed how an adult performed sophisticated actions on objects, or (3) to a control group receiving no training. The results impressively indicate that infants with a low level of object exploration skill prior to the training showed the most training effects as compared to infants with proficient object exploratory actions. Interestingly, this differential training effect was true for both the active and observational training, highlighting the role of social learning in infancy. Importantly, our study shows for the first time the impact of normal individual variation in infants' manual object exploration skills on the effects of a fine motor training.
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Affiliation(s)
- Claudia Kubicek
- Developmental Psychology, Justus-Liebig-University, Giessen, Germany.
| | - Gloria Gehb
- Developmental Psychology, Justus-Liebig-University, Giessen, Germany
| | - Bianca Jovanovic
- Developmental Psychology, Justus-Liebig-University, Giessen, Germany
| | - Gudrun Schwarzer
- Developmental Psychology, Justus-Liebig-University, Giessen, Germany
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12
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Nascimento AL, Toledo AM, Merey LF, Tudella E, Soares-Marangoni DDA. Brief reaching training with "sticky mittens" in preterm infants: Randomized controlled trial. Hum Mov Sci 2018; 63:138-147. [PMID: 30537626 DOI: 10.1016/j.humov.2018.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
| | | | - Leila Foerster Merey
- Physical Therapy Section, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Eloisa Tudella
- Departament of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
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13
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Gliga T. Telling Apart Motor Noise and Exploratory Behavior, in Early Development. Front Psychol 2018; 9:1939. [PMID: 30369897 PMCID: PMC6194153 DOI: 10.3389/fpsyg.2018.01939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 09/20/2018] [Indexed: 11/13/2022] Open
Abstract
Infants' minutes long babbling bouts or repetitive reaching for or mouthing of whatever they can get their hands on gives very much the impression of active exploration, a building block for early learning. But how can we tell apart active exploration from the activity of an immature motor system, attempting but failing to achieve goal directed behavior? I will focus here on evidence that infants increase motor activity and variability when faced with opportunities to gather new information (about their own bodies or the world) and propose this as a guiding principle for separating variability generated for exploration from noise. I will discuss mechanisms generating movement variability, and suggests that, in the various forms it takes, from deliberate hypothesis testing to increasing environmental variability, it could be exploited for learning. However, understanding how variability in motor acts contributes to early learning will require more in-depth investigations of both the nature of and the contextual modulation of this variability.
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Affiliation(s)
- Teodora Gliga
- School of Psychology, University of East Anglia, Norwich, United Kingdom.,Centre for Brain and Cognitive Development, Birkbeck, University of London, London, United Kingdom
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14
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Sato NTDS, Tudella E. Influence of Sitting Positions and Level of Trunk Control During Reaching Movements in Late Preterm and Full-Term Infants. Front Pediatr 2018; 6:185. [PMID: 29988593 PMCID: PMC6026931 DOI: 10.3389/fped.2018.00185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/04/2018] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Natália T da Silva Sato
- Movement Analysis and Research Laboratory, Department of Physiotherapy, Federal University of São Carlos, São Paulo, Brazil
| | - Eloisa Tudella
- Movement Analysis and Research Laboratory, Department of Physiotherapy, Federal University of São Carlos, São Paulo, Brazil
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15
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Moreira da Silva ES, Lopes dos Santos G, Righetto Greco AL, Tudella E. Influence of Different Sitting Positions on Healthy Infants' Reaching Movements. J Mot Behav 2016; 49:603-610. [DOI: 10.1080/00222895.2016.1247034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Gabriela Lopes dos Santos
- Laboratory of Neurological Physiotherapy Research, Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Eloisa Tudella
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
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Hughes AJ, Redsell SA, Glazebrook C. Motor Development Interventions for Preterm Infants: A Systematic Review and Meta-analysis. Pediatrics 2016; 138:peds.2016-0147. [PMID: 27638931 DOI: 10.1542/peds.2016-0147] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXTS Preterm infants are at an increased risk of neurodevelopmental delay. Some studies report positive intervention effects on motor outcomes, but it is currently unclear which motor activities are most effective in the short and longer term. OBJECTIVE The aim of the study was to identify interventions that improve the motor development of preterm infants. DATA SOURCES An a priori protocol was agreed upon. Seventeen electronic databases from 1980 to April 2015 and gray literature sources were searched. STUDY SELECTION Three reviewers screened the articles. DATA EXTRACTION The outcome of interest was motor skills assessment scores. All data collection and risk of bias assessments were agreed upon by the 3 reviewers. RESULTS Forty-two publications, which reported results from 36 trials (25 randomized controlled trials and 11 nonrandomized studies) with a total of 3484 infants, met the inclusion criteria. A meta-analysis was conducted by using standardized mean differences on 21 studies, with positive effects found at 3 months (mean 1.37; confidence interval 0.48-2.27), 6 months (0.34; 0.11-0.57), 12 months (0.73; 0.20-1.26), and 24 months (0.28; 0.07-0.49). At 3 months, there was a large and significant effect size for motor-specific interventions (2.00; 0.28-3.72) but not generic interventions (0.33; -0.03 to -0.69). Studies were not excluded on the basis of quality; therefore, heterogeneity was significant and the random-effects model was used. LIMITATIONS Incomplete or inconsistent reporting of outcome measures limited the data available for meta-analysis beyond 24 months. CONCLUSIONS A positive intervention effect on motor skills appears to be present up to 24 months' corrected age. There is some evidence at 3 months that interventions with specific motor components are most effective.
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Affiliation(s)
- Anita J Hughes
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; and
| | - Sarah A Redsell
- School of Nursing and Midwifery, Anglia Ruskin University, Cambridge, United Kingdom
| | - Cris Glazebrook
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; and
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Williams JL, Corbetta D. Assessing the Impact of Movement Consequences on the Development of Early Reaching in Infancy. Front Psychol 2016; 7:587. [PMID: 27199822 PMCID: PMC4846662 DOI: 10.3389/fpsyg.2016.00587] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/08/2016] [Indexed: 11/13/2022] Open
Abstract
Prior research on infant reaching has shown that providing infants with repeated opportunities to reach for objects aids the emergence and progression of reaching behavior. This study investigated the effect of movement consequences on the process of learning to reach in pre-reaching infants. Thirty-five infants aged 2.9 months at the onset of the study were randomly assigned to 1 of 3 groups. Two groups received a 14-day intervention to distinct reaching tasks: (1) in a contingent group, a toy target moved and sounded upon contact only, and (2) in a continuous group, the toy moved and sounded continuously, independent of hand-toy contact. A third control group did not receive any intervention; this group's performance was assessed only on 2 days at a 15-day interval. Results revealed that infants in the contingent group made the most progress over time compared to the two other groups. Infants in this group made significantly more overall contacts with the sounding/moving toy, and they increased their rate of visually attended target contacts relative to non-visually attended target contacts compared to the continuous and control groups. Infants in the continuous group did not differ from the control group on the number of hand-toy contacts nor did they show a change in visually attended target versus non-visually attended target contacts ratio over time. However, they did show an increase in movement speed, presumably in an attempt to attain the moving toy. These findings highlight the importance of contingent movement consequences as a critical reinforcer for the selection of action and motor learning in early development. Through repeated opportunities to explore movement consequences, infants discover and select movements that are most successful to the task-at-hand. This study further demonstrates that distinct sensory-motor experiences can have a significant impact on developmental trajectories and can influence the skills young infants will discover through their interactions with their surroundings.
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Affiliation(s)
- Joshua L Williams
- Department of Psychology, Armstrong State University Savannah, GA, USA
| | - Daniela Corbetta
- Department of Psychology, The University of Tennessee Knoxville, TN, USA
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18
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Wu YC, Hsieh WS, Hsu CH, Chang JH, Chou HC, Hsu HC, Chiu NC, Lee WT, Chen WJ, Ho YW, Jeng SF. Intervention effects on emotion regulation in preterm infants with very low birth weight: A randomize controlled trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 48:1-12. [PMID: 26524725 DOI: 10.1016/j.ridd.2015.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
Preterm infants are at risk for emotional difficulties and behavioral problems. This study was aimed to investigate the effects of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with a usual care program (UCP) on emotion regulation to stress in preterm infants with very low birth weight (VLBW, birth weight <1500 g). A total of 178 VLBW preterm infants had been previously randomly assigned to receive one of three interventions (57 in CBIP, 63 in HBIP and 58 in UCP). The CBIP and HBIP contained identical child-, parent- and dyad-focused interventions that were provided to infants during hospitalization and were respectively delivered at clinics and at home at PMA 36-38 and 40 weeks, and 1, 2, 4, 6, 9, 12 months of corrected age. All infants were prospectively observed for behavioral reactivity and regulation in response to experimentally evoke stress evoked by a toy-behind-barrier procedure at 12, 18, and 24 months of corrected age. Their cognitive and language abilities, and mothers' responsiveness were also assessed at 12 months as potential covariates. Compared to the UCP-group infants, the HBIP-group infants exhibited shorter durations of visual orientation to a toy (adjusted difference [95% CI]=-1.60 [-3.07 to -0.13], p=0.03), and the CBIP-group infants exhibited shorter durations of avoidance (adjusted difference [95% CI]=-0.84 [-1.57 to -0.10], p=0.03) from 12 to 24 months of corrected age. The CBIP and HBIP showed no difference in the stress reactivity from the UCP, however. These results suggest that comprehensive interventions incorporating child-, parent- and dyad-focused services enhanced VLBW preterm infants' emotion regulation in response to stress at toddler age.
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Affiliation(s)
- Ying-Chin Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Chin Hsu
- Department of Child and Family Development, University of Georgia, GA, USA
| | - Nan-Chang Chiu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-J Chen
- Graduate Institute of Epidemiology, National Taiwan University, Taipei, Taiwan
| | - Yu-Wen Ho
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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19
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Passive movement and active exercise for very young infants with congenital heart disease: a study protocol for a randomized controlled trial. Trials 2015; 16:288. [PMID: 26122088 PMCID: PMC4485354 DOI: 10.1186/s13063-015-0816-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/22/2015] [Indexed: 12/21/2022] Open
Abstract
Background Delayed motor development is reported in patients with congenital heart disease (CHD). Exercise is widely used to facilitate motor development and improve motor ability. Exercise for adolescents and adults with CHD has been extensively studied. However, the evidence of exercise for infants with CHD is sparse. This study aims to identify the effect of passive movement and active exercise on motor development within very young CHD infants with cardiac catheterization. Methods/Design A prospective and randomized controlled trial will be conducted in very young CHD infants with cardiac catheterization. A total of 147 infants with CHD will be randomized by a 1:1:1 allocation ratio by computer to an exercise intervention group, a home-based intervention group and a control group. The exercise intervention group will receive passive movement and active exercise from experienced physiotherapists in pediatrics three times a week for 12 weeks. The home-based intervention group will receive passive movement and active exercise from their parents or caregivers at home three times a week for 12 weeks. The control group will receive follow up only. The follow-up duration is 20 months. The primary outcome measures are the motor quotient measured by the Peabody Developmental Motor Scales-II. The secondary outcome measures are the Ross score, ventricular function, bone quality, body length, weight, head circumference, upper arm circumference, and adverse events. Discussion This study has several important features, including the randomization process, the long follow-up duration, the control group, and the large sample size. The aim of this study is to determine whether 12-week passive movement and active exercise promotes motor development and produces other beneficial effects for very young CHD infants with cardiac catheterization. Therefore, this study will contribute new knowledge regarding the rehabilitation program in very young CHD infants with cardiac catheterization. Trial registration Current Controlled Trials ChiCTR-IOR-15005909 (January 31, 2015).
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Cunha AB, Lobo MA, Kokkoni E, Galloway JC, Tudella E. Effect of Short-Term Training on Reaching Behavior in Infants: A Randomized Controlled Clinical Trial. J Mot Behav 2015; 48:132-42. [DOI: 10.1080/00222895.2015.1050549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Guimarães EL, Tudella E. Immediate Effect of Training at the Onset of Reaching in Preterm Infants: Randomized Clinical Trial. J Mot Behav 2015; 47:535-49. [PMID: 25893978 DOI: 10.1080/00222895.2015.1022247] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The authors' aim was to investigate the immediate effect of a single specific training session (serial varied practice), of short duration on the kinematic parameters of reaching, in the period of the emergence of the skill in preterm and low birth weight infants. The study included 16 infants of both sexes, born at a mean gestational age of 32.13 (±1.36) weeks and mean birth weight of 1720.94 (±358.46) g. The infants were randomly divided into 2 groups: experimental and control. The experimental group was given a 5-min training session in reaching, while the control group received no training. The results showed significant differences in peak velocity in the intra (Z = -2.10, p = .036) and intergroup (U = 9.00, p = .016) evaluations, which decreased in the experimental group after training. Cohen's d test for clinical relevance suggested that the specific, short duration training proved effective in promoting slower reaches, with greater adjustment and lower number of units of movement. These results are positive for preterm infants given that these parameters more closely resemble the typical development of mature reaching behaviors in term infants, which suggests that this protocol of reaching training (serial varied practice) could be used as an evidence-based intervention strategy.
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Affiliation(s)
- Elaine Leonezi Guimarães
- a Department of Applied Physiotherapy , Health Sciences Institute, Federal University of Triangulo Mineiro , Uberaba , Minas Gerais , Brazil
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Lobo M, Galloway J, Heathcock J. Characterization and intervention for upper extremity exploration & reaching behaviors in infancy. J Hand Ther 2015; 28:114-24; quiz 125. [PMID: 25835251 PMCID: PMC4424113 DOI: 10.1016/j.jht.2014.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/23/2014] [Accepted: 12/03/2014] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- M.A. Lobo
- Physical Therapy Department, University of Delaware, 540 South College Ave., Newark, DE 19713, USA
| | - J.C. Galloway
- Physical Therapy & Psychology Departments, University of Delaware, 540 South College Ave., Newark, DE 19713, USA
| | - J.C Heathcock
- Physical Therapy Department, 516 Atwell Hall, The Ohio State University, 453 West tenth Avenue, Columbus, OH 43210, USA
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de Almeida Soares D, Cunha AB, Tudella E. Differences between late preterm and full-term infants: comparing effects of a short bout of practice on early reaching behavior. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3096-3107. [PMID: 25134076 DOI: 10.1016/j.ridd.2014.07.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/17/2014] [Accepted: 07/22/2014] [Indexed: 06/03/2023]
Abstract
This study compared the effects of a short bout of practice on reaching behavior between late preterm and full-term infants at the onset of goal-directed reaching. Twelve late preterm infants and twelve full-term infants received reaching practice based on a serial schedule. Late preterm and full-term infants were assessed in 3.3±1.4 and 2.6±1.0 days after the onset of goal-directed reaching in two measures in a single day: immediately before practice (pre-test) and immediately after practice (post-test). During the assessments, the infants were placed in a baby chair and a rubber toy was presented at their midline within reaching distance for 2 min. Between assessments, the infants received practice of toy-oriented reaching in 3 activities repeated for approximately 4 min. The activities were elicited in a pre-established serial sequence and were applied by a physical therapist. During the pre-test, late preterm infants presented lower range of proximal adjustments, greater proportion of reaches with semi-open hand, and greater proportion of reaches without grasping than the full-term infants. During the post-test, late preterm infants presented greater motor variability of proximal adjustments, but explored and selected distal control and grasping outcomes less compared to the full-term group. Differences in reaching and gross motor behavior between late preterm and full-term infants can be found at the age of reaching onset. Practice provided new opportunities for late preterm infants to improve perception-action coupling to reach; however, relative to full-terms, they seemed less advanced in benefiting from the experience for more refined manual tasks.
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Affiliation(s)
- Daniele de Almeida Soares
- Department of Physical Therapy, Neuropediatrics Section, Federal University of São Carlos (UFSCar), Rod Washington Luis, km 235, 13565-905 São Carlos, SP, Brazil; Physical Therapy, Center of Biological and Health Sciences, Federal University of Mato Grosso do Sul (UFMS), Postal Box 549, 79070900 Campo Grande, MS, Brazil.
| | - Andréa Baraldi Cunha
- Department of Physical Therapy, Neuropediatrics Section, Federal University of São Carlos (UFSCar), Rod Washington Luis, km 235, 13565-905 São Carlos, SP, Brazil
| | - Eloisa Tudella
- Department of Physical Therapy, Neuropediatrics Section, Federal University of São Carlos (UFSCar), Rod Washington Luis, km 235, 13565-905 São Carlos, SP, Brazil
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