Targeted Training in Managing Children With Poor Trunk Control: 4 Case Reports

2022 APTA Pediatrics Knowledge Translation Lecture: Clinicians and Researchers Collaborate to Implement a Segmental Approach to Trunk Control

The aim of this special communication is to describe a clinician/researcher collaboration that supported implementation of the segmental approach to trunk control into physical therapy practice at a large, multisite, pediatric hospital. A 6-phase, multifaceted iterative process including use of educational strategies, the knowledge-to-action (KTA) cycle, the Consolidated Framework for Implementation Research, and the Theoretical Domains Framework was used. The total number of Segmental Assessments of Trunk Control (SATCos) completed increased from 0 to 57. Fifteen of 23 physical therapists representing 7 clinic locations referred a child for a SATCo. Using education alone or education plus the KTA cycle resulted in minimal uptake. Using more formal contextual assessments and mapping of barriers to strategies using implementation frameworks, collaborative goal setting, and planning resulted in more effective strategies and increase in uptake of the segmental approach in later phases.

Longitudinal Development of Segmental Trunk Control in Full Term and Preterm Infants- a Pilot Study: Part II

Purpose: To explore the relationship between segmental trunk control and specific gross motor skills at 4, 8 and 12 months of (corrected) age in young infants.Methods: Thirty-one preterm infants and 30 full-term infants were recruited by convenience. All infants were tested using the Segmental Assessment of Trunk Control and the Alberta Infant Motor Scale at 4, 8 and 12 months of age.Results: The gross motor function in supine at 4 months and in the standing position at 12 months was significantly delayed in the preterm infants. Positive correlations were found between segmental trunk control levels and specific motor skills in prone, supine, sitting and standing positions at 8 and 12 months of age.Conclusion: This report was the first to demonstrate the association between segmental trunk control and specific gross motor skills in young infants. This new information provides clinicians with greater understanding about infant development.

Longitudinal Development of Segmental Trunk Control in Full Term and Preterm Infants- a Pilot Study: Part I

Purpose: No previous study examined trunk control development in preterm infants. The present study examined the longitudinal development of segmental trunk control from 4 to 12 months of (corrected) age in preterm infants in comparison with full-term infants.Methods: Thirty-one preterm infants and 30 full-term infants were recruited. All infants were tested monthly using the Segmental Assessment of Trunk Control and the Alberta Infant Motor Scale at 4, 8 and 12 months of age.Results: Segmental trunk control development was significantly delayed in the preterm infants. Statistically significant positive correlations were found between trunk control status and gross motor skills.Conclusion: This was first study showing that segmental trunk control development was significantly different in preterm infants. Segmental trunk control and gross motor performance were coupled in young infants. A dual focus on training upright trunk control and specific motor skills may maximise therapy outcomes for infants with motor delay.

Relationship between segmental trunk control and gross motor development in typically developing infants aged from 4 to 12 months: a pilot study

Background

Trunk control is generally considered to be related to gross motor development. However, this assumption has not been validated with clinical data. This pilot study was the first of its kind to examine the longitudinal development of segmental trunk control and gross motor development from 4 to 12 months of age in typically developing full-term infants.

Methods

A convenience cohort of 20 healthy full-term infants (mean gestation = 39.0 weeks, SD 1.2; mean birthweight = 2975.0 g, SD 297.0; males = 10) was recruited. All study infants were tested and scored monthly by independent assessors using the Segmental Assessment of Trunk Control and the Alberta Infant Motor Scale from 4 to 12 months of age.

Results

A developmental trend of segmental trunk control was found in the infants. Static vertical upright trunk control developed prior to active and reactive control. Statistically significant correlations were found between trunk control status and gross motor development mainly in prone and sitting positions from 8 months of age onwards (all p < 0.004, Spearman’s r ranged from 0.644 to 0.798).

Conclusions

This pilot study provides preliminary clinical evidence to support the inter-dependency between vertical upright trunk control and gross motor development in young infants, particularly as upright functional skills are gained. This suggests that a dual focus on training upright trunk control alongside gross motor skills could be of benefit in the treatment of infants with movement disorders.

The effect of interactive computer play on balance and functional abilities in children with moderate cerebral palsy: a pilot randomized study

OBJECTIVES:

To investigate the feasibility and potential efficacy of a six-week interactive computer play training on balance and gross motor function in children with moderate cerebral palsy.

DESIGN:

A pilot single-blinded matched randomized controlled study.

SETTING:

Community.

PARTICIPANTS:

In total, 18 children with moderate cerebral palsy were recruited, paired according to age and severity of cerebral palsy and randomized into intervention group or control group.

INTERVENTION:

The intervention group received additional trunk control training using the interactive computer play in sitting four times per week, 20 minutes per session for six weeks. All study children continued their usual physiotherapy programme.

MEASUREMENTS:

All study children were assessed at baseline, week 3, week 6 (completion of intervention) and week 12 using the Pediatric Reach Test, Gross Motor Function Measure-66-Item Set and 2-Minute Walk Test.

RESULTS:

All intervention children completed and enjoyed the training with no reported adverse event. All children were assessed at all time points. No significant difference was found between the two groups in all assessments. In both groups of children, significant improvements were found in the Gross Motor Function Measure-66-Item Set between week 3 (intervention group: mean 53.41, SD 5.34; control group: mean 52.86, SD 8.33) and week 6 (intervention group: mean 55.00, SD 6.32; control group: mean 54.20, SD 8.35).

CONCLUSION:

The intervention protocol of a six-week interactive computer play training was feasible and safe for children with moderate cerebral palsy in special school settings. Future studies with larger sample sizes or using single-subject designs are recommended.

Effect of the severity of manual impairment and hand dominance on anticipatory and compensatory postural adjustments during manual reaching in children with cerebral palsy

AIM

To investigate the role of the severity of manual impairment and of hand dominance on postural sway during anticipatory [APA] and compensatory [CPA] postural adjustments in a seated manual reaching task performed by children with cerebral palsy (CP) and typical children (TC).

METHODS

We tested 26 TC (mean age 9.5 ± 2.1 years) and 29 children with CP (age 9.6 ± 3 years) classified based on manual impairment levels as mild (Manual Ability Classification System [MACS] I; n = 18) or moderate-to-severe (MACS II-III, n = 11). Participants were instructed to reach towards a target using their dominant vs. non-dominant arm while sitting on a force-plate. Center of pressure (CoP) sway was analyzed during APA and CPA.

RESULTS

For all groups, using the non-dominant arm determined greater amplitude and velocity of CoP sway in CPA. Children with moderate-to-severe manual impairment showed greater sway during APA and CPA compared to mild impairment and TC groups.

CONCLUSION

More severe manual impairment resulted in higher sway during the anticipatory and compensatory phases of the reaching task. Using the non-dominant arm resulted in greater compensatory adjustments during reaching.

Working towards an objective segmental assessment of trunk control in children with cerebral palsy

BACKGROUND

Physical therapy evaluations of motor control are currently based on subjective clinical assessments. Despite validation, these can still be inconsistent between therapists and between clinics, compromising the process of validating a therapeutic intervention and the subsequent generation of evidence-based practice (EBP) guidelines. EBP benefits from well-defined objective measurements that complement existing subjective assessments.

RESEARCH QUESTION

The aim of this study was to develop an objective measure of head/trunk control in children with Cerebral Palsy (CP) using previously developed video-based methods of head/trunk alignment and absence of external support and compare these with the existing subjective Segmental Assessment of Trunk Control (SATCo).

METHODS

Twelve children with CP were recruited and an average of 3 (±1.1) SATCo tests performed per child. The full SATCo was concurrently video-recorded from a sagittal view; markers were placed on specific landmarks of the head, trunk and pelvis to track and estimate head/trunk segment position. A simplified objective rule was created for control and used on videos showing no external support. This replicated the clinical parameters and enabled identification of the segmental-loss-of-control. The subjectively and objectively identified segmental-loss-of-control were compared using a Pearson Correlation Coefficient.

RESULTS

An angular-threshold of 17° from alignment showed the minimum bias between the subjectively and the objectively measured segmental-loss-of-control (mean error =-0.11 and RMSE = 1.5) and a significant correlation (r = 0.78, r² = 0.61, p < .01).

SIGNIFICANCE

This study showed that simple objective video-based measurements can be used to reconstruct the subjective assessment of segmental head/trunk control. This suggests that a clinically-friendly video-based objective measure has future potential to complement subjective assessments and to assist in the generation of EBP guidelines. Further development will increase the information that can be extracted from video images and enable generation of a fully automated objective measure.