Embodied Cognition in Practice: Exploring Effects of a Motor-Based Problem-Solving Intervention

Effect of goal-directed perceptual-motor exercise on children with specific learning difficulties: a randomized controlled trial

BACKGROUND

Although perceptual interventions focus on sensory and cognitive skills, they significantly enhance the effectiveness of motor interventions by improving coordination, decision-making, and overall engagement in physical activities. A comprehensive literature review has demonstrated that incorporating perceptual interventions into motor exercises is beneficial. While there are several treatment strategies for SLD-diagnosed children, the potential role of goal-directed perceptual-motor exercises has not been studied. This study examined the effectiveness of goal-directed perceptual-motor training on attention, motor skills, and quality of life in children with Specific Learning Disorder (SLD).

METHODS

This was a randomized clinical study with 38 children diagnosed with SLD between September 2021 and April 2022. The control group (n = 19) received a standard intervention protocol, and the intervention group (n = 19) additionally received a perceptual-motor training program. Bourdon Attention Test, the Bruininks-Oseretsky Test 2-Short Form (BOT2- SF), and the Pediatric Quality of Life Inventory (PEDSQL) were used as outcome measures.

RESULTS

The intervention significantly improved attention, fine and gross motor skills, and life quality as evidenced by the within- and between-group comparisons at the end of therapy.

CONCLUSIONS

Goal-directed perceptual-motor physical training with cognitive aspects may enhance academic performance, social participation, and life quality for children with SLD by improving basic motor skills. Therefore, the inclusion of physical and task-specific perceptual-motor exercises in educational programs may offer several avenues for cognitive skill development in SLD children.

TRIAL REGISTRATION

The protocol is retrospectively registered with http://clinicaltrials.gov/ (16/August/2023, Clinical Trial, NCT05998083).

Upper Limb Therapy for Infants and Young Children with Unilateral Cerebral Palsy: A Clinical Framework

Early detection and rehabilitation interventions are essential to optimise motor function in infants and young children with unilateral cerebral palsy. In this paper we report a clinical framework aimed at enhancing upper limb therapy for infants and young children with unilateral cerebral palsy during a sensitive period of brain development. We describe two major therapeutic approaches based on motor learning principles and evidence: constraint-induced movement therapy and bimanual therapy. These two therapies have demonstrated efficacy in older children and emerging evidence is available for their application to infants younger than 2 years of age. To provide clinicians with guidance as to when to implement these therapies, we discuss the key consideration when undertaking upper limb therapy programs. In addition, we describe the factors to consider when choosing which approach may be suitable for an individual child and family. Detailed strategies for implementing these therapies in infants and young children of different ability levels are given.

Relationship Between Prone Skills and Motor-Based Problem-Solving Abilities in Full-Term and Preterm Infants During the First 6 Months of Life

Motor experiences shape cognitive development in infancy, with the prone position being one such crucial motor experience in the first 6 months of life. Although the motor benefits of the prone position are well-documented, its influence on early cognitive abilities remains insufficiently explored. This study quantified the relationship between prone motor skills and motor-based problem-solving abilities in 48 full-term and preterm infants aged 3-6 months. Prone skills were assessed using the Alberta Infant Motor Scale's prone domain. The Assessment of Problem-Solving in Play was utilized to measure motor-based problem-solving by observing how motor actions were used to solve toys. Advanced prone motor skills were correlated with an increase in sophisticated exploration skills and a concurrent decline in lower order exploration skills in all infants, with correlations being stronger in preterm infants. Notably, a 1-point increase in prone skills was associated with a 1.3-point increase in total motor-based problem-solving abilities in all infants. Our findings provide preliminary evidence for the contribution of prone play to cognitive development in infants, prompting considerations for assessment and intervention strategies. Further research is needed to ascertain if the delayed acquisition of prone motor skills is indicative of poor early problem-solving abilities in preterm infants.

Focused attention as a new sitter: How do infants balance it all?

This study investigated the impact of postural control on infants' Focused Attention (FA). Study 1 examined whether and how sitting independently versus with support impacted 6- to 8-month-old infants' ability to focus attention during object exploration. FA measures did not depend on support condition. However, sitting experience was significantly negatively correlated with FA measures in the supported condition, suggesting that infants with more sitting experience performed fewer exploratory movements, possibly due to faster information processing ability compared to infants with less sitting experience. These unexpected findings prompted an exploration of more subtle looking behaviors during FA in Study 2-a case study of three infants who wore a head-mounted eye-tracker during an FA task. The ability to rapidly shift visual attention was key to gathering environmental information useful for problem solving-an interpretation that is supported by prior findings of the relationship between fast looks and faster information processing.

The impact of severity of motor delay, timing of task mastery, and START-play intervention on the development of means-end problem solving in young children

BACKGROUND

Children with motor delays are at increased risk for delayed means-end problem-solving (MEPS) performance.

OBJECTIVES

To evaluate children with motor delays: 1) the impact of motor delay severity and MEPS mastery timing on developmental trajectories of MEPS; and 2) the effectiveness of Sitting Together And Reaching To Play (START-Play) intervention for improving MEPS.

METHODS

This represents a secondary analysis from a multi-site randomized controlled trial, with blinded assessors and prospective registration. Children with mild or significant motor delays (n = 112, mean age=10.80, SD=2.59 months at baseline) were randomly assigned to START-Play or usual care early intervention (UC-EI) and assessed at five visits across one year using the Means-End Problem-Solving Assessment Tool that included three 30-second MEPS trials per visit. Task mastery occurred at the first visit the child achieved the highest level of performance in at least two of the three trials. Multilevel analyses evaluated trajectories of MEPS outcomes dependent upon the timing of MEPS mastery, motor delay severity, and intervention group.

RESULTS

At baseline, children with mild motor delays demonstrated better MEPS than children with significant delays, but this difference was only observed for children who achieved mastery late. Children with significant delays demonstrated greater improvements in MEPS in the post-intervention phase compared to children with mild delays. No MEPS differences were found between START-Play and UC-EI.

CONCLUSION

Motor delay severity and timing of task mastery impacted MEPS trajectories, whereas START-Play intervention did not impact MEPS for children with motor delays.

CLINICAL TRIALS REGISTRY IDENTIFIER

NCT02593825 (https://clinicaltrials.gov/ct2/show/NCT02593825).

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.

Holistic Functioning from a Developmental Perspective: A New Synthesis with a Focus on a Multi-tiered System Support Structure

While research in specific academic disciplines has individually advanced knowledge and practice for promoting multiple aspects of health and well-being in children and adolescents, still missing is an understanding of the interconnectedness of many critical aspects of development and how to intentionally weave these factors to advance a more holistic approach. The need for a more holistic and inclusive approach to child and adolescent development is increasingly evident to promote long-term health and well-being as the overall percentage of children, adolescents, and adults who suffer from mental health disorders is increasing. To address this issue, our authorship team consists of researchers in the areas of developmental psychology, neuroscience, motor development, exercise science, and mental health. The collective ideas outlined in this paper are aligned to address the need to remove disciplinary-specific boundaries and elucidate synergistic linkages across multiple research domains that support holistic development and lifespan health and wellness. We propose a conceptual framework that comprehensively addresses the integration of physical, cognitive, psychological, social, and emotional domains of child and adolescent development. In addition, we also provide a holistic preventative approach that is aligned with a contemporary intervention structure (i.e., Multi-tiered Systems of Support) to promote, from a developmental perspective, positive trajectories of health and well-being across childhood and adolescence.

Gait Variability Relates to Prosocial, Emotional and Risk-Taking Behavior in Typically Developing Children

Motor skills enable multi-facetted interactions with the environment and allow children to develop social skills and respond appropriately to situational social demands when interacting with peers and adults. Previous research with clinical samples (e.g., children diagnosed with Developmental Coordination Disorder) showed that children's motor skills are closely linked to their psychosocial behavior (e.g., prosocial, hyperactive, inattentive, interpersonal), but studies with typically developing children are rare. We sought to fill this research gap by examining relationships between gait variability as an indicator of motor skills and prosocial behavior, problem behavior, and risk-taking behavior in typically developing children. Participants were a large cross-section of 7-13-year-olds (N = 221). They were asked to walk normally across an electronic pathway (GAITRite). We assessed their gait variability (i.e., stride time, stride length and stride velocity). Their parents completed the Strengths and Difficulties Questionnaire that assessed their child's prosocial behavior, hyperactivity, emotional symptoms, and any conduct or peer relationship problems. Parents also provided information on an adapted scale of the Tridimensional Personality Questionnaire assessing risk-taking behavior. We used multilevel modeling to account for individual interdependence and to analyze the maximum number of strides for each participant. Children with greater stride length variability and velocity showed significantly less prosocial behavior, had more emotional symptoms and demonstrated less risk-taking behavior. Stride time variability was not significantly related to any variables. These results align with past findings that gait is sensitive to motor skill differences, and they extend past findings of these associations between gait and facets of intra- and interpersonal characteristics among children within clinical disorders to typically developing children.

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.

The SIT-PT Trial Protocol: A Dose-Matched Randomized Clinical Trial Comparing 2 Physical Therapist Interventions for Infants and Toddlers With Cerebral Palsy

OBJECTIVE

Although early intervention for infants at risk for cerebral palsy is routinely recommended, the content of intervention is poorly described, varies widely, and has mixed supporting evidence. The purpose of this study was to compare efficacy of 2 interventions grounded in differing domains of the International Classification of Functioning, Disability and Health on developmental outcomes of infants with or at high risk of cerebral palsy.

METHODS

Infants who meet inclusion criteria will be randomized into either Sitting Together and Reaching To Play or Movement, Orientation, Repetition, Exercise Physical Therapy groups. Both groups will receive intervention twice weekly for 3 months and follow-up at 3, 6, 9, and 12 months from baseline. The primary objectives compare changes over time and between groups in sitting, gross motor, and cognitive development. The setting is the infant's home unless the caregiver requests otherwise. One hundred and fifty infants between 8 and 24 months of age will be enrolled in 3 geographically, racially, and ethnically diverse sites: Los Angeles, California; Omaha, Nebraska; and Seattle, Washington. Enrolled infants will demonstrate motor delays, emerging sitting skills, and signs of neurologic impairment. Sitting Together and Reaching To Play targets activities including sitting, reaching, and motor-based problem solving to improve global development. In contrast, Movement, Orientation, Repetition, Exercise Physical Therapy focuses on strengthening and musculoskeletal alignment while encouraging repeated movement practice. Outcome measures include the Gross Motor Function Measure, Bayley Scales of Infant Development-IV, Assessment of Problem Solving in Play, and a Parent Child Interaction assessment. Enrolled children will maintain usual intervention services due to ethical concerns with intervention withdrawal.

IMPACT

This will be the first study, to our knowledge, comparing efficacy of early physical therapy with dose-matched interventions and well-defined key principles. The outcomes will inform selection of key principle of intervention in this population.

Effect of Contingency Paradigm-Based Interventions on Developmental Outcomes in Young Infants: A Systematic Review

PURPOSE

The purpose of this systematic review was to identify controlled trials evaluating the efficacy of contingency paradigm-based interventions to improve feeding, motor, or cognitive outcomes during the first year of life.

SUMMARY OF KEY POINTS

Seventeen studies, including 10 randomized controlled trials, incorporating contingency paradigm-based interventions were identified. Three of 3 trials reported improvements in nutritive sucking using pacifier-activated lullaby in preterm infants before term age. Seven of 12 trials reported improvements in reaching, manual exploration, and kicking behaviors in term and preterm infants; and 6 of 10 trials reported gains in early cognition using sticky mittens and contingent toys.

CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE

Contingency paradigm-based interventions can improve feeding outcomes in the neonatal intensive care unit in very preterm infants, and increase reaching, and perceptual-cognitive behaviors in term infants. Future research is needed to establish contingency paradigms as an effective early intervention strategy.

WHAT THIS ADDS TO THE EVIDENCE

This review synthesizes a body of literature on contingency paradigm-based interventions and highlights its potential paradigm-based interventions to improve developmental outcomes in infants.

A model for using developmental science to create effective early intervention programs and technologies to improve children's developmental outcomes

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.

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews

IMPORTANCE

Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years.

OBJECTIVE

To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support.

EVIDENCE REVIEW

The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument.

FINDINGS

Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5).

CONCLUSIONS AND RELEVANCE

When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.

Movement Matters! Understanding the Developmental Trajectory of Embodied Planning

Human motor skills are exceptional compared to other species, no less than their cognitive skills. In this perspective paper, we suggest that "movement matters!," implying that motor development is a crucial driving force of cognitive development, much more impactful than previously acknowledged. Thus, we argue that to fully understand and explain developmental changes, it is necessary to consider the interaction of motor and cognitive skills. We exemplify this argument by introducing the concept of "embodied planning," which takes an embodied cognition perspective on planning development throughout childhood. From this integrated, comprehensive framework, we present a novel climbing paradigm as the ideal testbed to explore the development of embodied planning in childhood and across the lifespan. Finally, we outline future research directions and discuss practical applications of the work on developmental embodied planning for robotics, sports, and education.

Relations between fine motor skills and intelligence in typically developing children and children with attention deficit hyperactivity disorder

BACKGROUND

The embodied cognition hypothesis implies a close connection between motor and cognitive development. Evidence for these associations is accumulating, with some studies indicating stronger relations in clinical than typically developing samples.

AIMS

The present study extends previous research and investigates relations between fine motor skills and intelligence in typically developing children (n = 139, 7-13 years) and same-aged children with attention deficit hyperactivity disorder (ADHD, n = 46). In line with previous findings, we hypothesized stronger relations in children with ADHD than in typically developing children.

METHODS AND PROCEDURE

Fine motor skills were assessed using the standardized Movement Assessment Battery for Children. Intelligence was measured with the standardized Wechsler Intelligence Scale for Children.

OUTCOMES AND RESULTS

Regression analyses indicated significant relations between fine motor skills and full-scale IQ, perceptual reasoning, working memory, and processing speed. Moderation analyses identified stronger relations between fine motor skills and full-scale IQ, perceptual reasoning, and verbal comprehension in children with ADHD compared to typically developing children.

CONCLUSIONS AND IMPLICATIONS

Results suggest a close relation between fine motor skills and intelligence in children with and without ADHD, with children diagnosed with ADHD showing stronger relations. Findings support combined motor-cognitive interventions in treating children with ADHD.

Targeted Physical Therapy Combined with Spasticity Management Changes Motor Development Trajectory for a 2-Year-Old with Cerebral Palsy

Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7–16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader START-Play intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The follow-up data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and START-Play, further research is needed to generalize these findings.

Cortical oscillations that underlie working memory are altered in adults with cerebral palsy

OBJECTIVE

This investigation used magnetoencephalography (MEG) to identify the neurophysiological mechanisms contributing to the altered cognition seen in adults with cerebral palsy (CP).

METHODS

Adults with CP (GMFCS levels I-IV) and demographically-matched controls completed a Sternberg-type working memory task during MEG. Secondarily, they completed the National Institutes of Health (NIH) cognitive toolbox. Beamforming was used to image the significant MEG oscillatory responses and the resulting images were examined using statistical parametric mapping to identify cortical activity that differed between groups.

RESULTS

Both groups had a left-lateralized decrease in alpha-beta (11-16 Hz) power across the occipital, temporal, and prefrontal cortices during encoding, as well as an increase in alpha (9-13 Hz) power across the occipital cortices during maintenance. The strength of alpha-beta oscillations in the prefrontal cortices were weaker in those with CP during encoding. Weaker alpha-beta oscillation within the prefrontal cortex was associated with poorer performance on the NIH toolbox and a higher GMFCS level.

CONCLUSIONS

Alpha-beta aberrations may impact the basic encoding of information in adults with CP, which impacts their overall cognition. Altered alpha-beta oscillation might be connected with gross motor function.

SIGNIFICANCE

This experimental work highlights the aberrant alpha-beta during encoding as possible neurophysiological mechanism of the cognitive deficiencies.

Measuring Early Problem-Solving in Young Children with Motor Delays: A Validation Study

AIM

There is a lack of evidence-based tools for measuring problem-solving in young children with motor delays. The purpose of this study was to evaluate the construct validity and responsiveness of the Assessment of Problem-Solving in Play.

METHODS

125 young children (10.72, SD 2.62 months) with mild, moderate, and severe motor delays were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition Cognitive Scale and the Assessment of Problem-Solving in Play up to 4 times over 12 months. The baseline and change over time assessment scores were compared.

RESULTS

The Assessment of Problem-Solving in Play was strongly, positively correlated with the Bayley Scales of Infant and Toddler Development, Third Edition Cognitive Scale raw scores at baseline (r=.83, p<.001) and for changes in scores across time (r=.64, p<.001). On average, participants demonstrated positive change in problem-solving scores across time. Participants with severe motor delay scored lower at baseline and changed less as compared to other participants.

CONCLUSIONS

Results provide evidence for the construct validity and responsiveness of the Assessment of Problem-Solving in Play scores in quantifying problem-solving in young children with motor delays 7-27 months of age.

START-Play Physical Therapy Intervention Impacts Motor and Cognitive Outcomes in Infants With Neuromotor Disorders: A Multisite Randomized Clinical Trial

OBJECTIVE

Our objective was to evaluate the efficacy of the Sitting Together and Reaching to Play (START-Play) intervention in young infants with neuromotor disorders.

METHOD

This randomized controlled trial compared usual care early intervention (UC-EI) with START-Play plus UC-EI. Analyses included 112 infants with motor delay (55 UC-EI, 57 START-Play) recruited at 7 to 16 months of age across 5 sites. START-Play included twice-weekly home visits with the infant and caregiver for 12 weeks provided by physical therapists trained in the START-Play intervention; UC-EI was not disrupted. Outcome measures were the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley); the Gross Motor Function Measure; reaching frequency; and the Assessment of Problem Solving in Play (APSP). Comparisons for the full group as well as separate comparisons for infants with mild motor delay and infants with significant motor delay were conducted. Piecewise linear mixed modeling estimated short- and long-term effects.

RESULTS

For infants with significant motor delay, positive effects of START-Play were observed at 3 months for Bayley cognition, Bayley fine motor, and APSP and at 12 months for Bayley fine motor and reaching frequency outcomes. For infants with mild motor delay, positive effects of START-Play for the Bayley receptive communication outcome were found. For the UC-EI group, the only difference between groups was a positive effect for the APSP outcome, observed at 3 months.

CONCLUSION

START-Play may advance reaching, problem solving, cognitive, and fine motor skills for young infants with significant motor delay over UC-EI in the short term. START-Play in addition to UC-EI may not improve motor/cognitive outcomes for infants with milder motor delays over and above usual care.

IMPACT

Concepts of embodied cognition, applied to early intervention in the START-Play intervention, may serve to advance cognition and motor skills in young infants with significant motor delays over usual care early intervention.

LAY SUMMARY

If you have a young infant with significant delays in motor skills, your physical therapist can work with you to develop play opportunities to enhance your child's problem solving, such as that used in the START-Play intervention, in addition to usual care to help your child advance cognitive and motor skills.

GEARing smart environments for pediatric motor rehabilitation

BACKGROUND

There is a lack of early (infant) mobility rehabilitation approaches that incorporate natural and complex environments and have the potential to concurrently advance motor, cognitive, and social development. The Grounded Early Adaptive Rehabilitation (GEAR) system is a pediatric learning environment designed to provide motor interventions that are grounded in social theory and can be applied in early life. Within a perceptively complex and behaviorally natural setting, GEAR utilizes novel body-weight support technology and socially-assistive robots to both ease and encourage mobility in young children through play-based, child-robot interaction. This methodology article reports on the development and integration of the different system components and presents preliminary evidence on the feasibility of the system.

METHODS

GEAR consists of the physical and cyber components. The physical component includes the playground equipment to enrich the environment, an open-area body weight support (BWS) device to assist children by partially counter-acting gravity, two mobile robots to engage children into motor activity through social interaction, and a synchronized camera network to monitor the sessions. The cyber component consists of the interface to collect human movement and video data, the algorithms to identify the children's actions from the video stream, and the behavioral models for the child-robot interaction that suggest the most appropriate robot action in support of given motor training goals for the child. The feasibility of both components was assessed via preliminary testing. Three very young children (with and without Down syndrome) used the system in eight sessions within a 4-week period.

RESULTS

All subjects completed the 8-session protocol, participated in all tasks involving the selected objects of the enriched environment, used the BWS device and interacted with the robots in all eight sessions. Action classification algorithms to identify early child behaviors in a complex naturalistic setting were tested and validated using the video data. Decision making algorithms specific to the type of interactions seen in the GEAR system were developed to be used for robot automation.

CONCLUSIONS

Preliminary results from this study support the feasibility of both the physical and cyber components of the GEAR system and demonstrate its potential for use in future studies to assess the effects on the co-development of the motor, cognitive, and social systems of very young children with mobility challenges.