Postural variability and sensorimotor development in infancy

Relationship Between Dental Trauma and Orthostatic Balance in Children

BACKGROUND

Dental trauma (DT) and falls have shown to be associated. On the other hand, postural balance is associated with falls and depends on the integration of the body's regulatory systems. The aim of this study was to investigate the potential relationship between DT and alteration of orthostatic balance in children.

METHODS

This was a population-based case-control study involving 296 six-year-old schoolchildren. The case group included children with previous history of DT. The control group included children with no previous history of DT. Stabilometric measurements were the main exposure of this study. Logistic regression analyzes were performed to estimate potential differences in terms of chance of occurrence.

RESULTS

The cases reviewed showed a 4.37 times chance of reduced balance in the measurement of the anteroposterior trajectory speed of the orthostatic center of pressure (COP), when children had their eyes closed. It also presented a chance of 3.06 times reduced balance in the measurement of the orthostatic center of pressure latero-lateral sway, with children with open eyes and stepping on a foam pad, and 4.00 times of reduced balance in the width of the latero-lateral sway of the orthostatic center of pressure, with children with open eyes and stepping on a foam pad.

CONCLUSION

Children with previous history of DT showed a higher chance of experiencing a reduced orthostatic balance in different conditions when compared to children without the occurrence of trauma.

Postural control depends on early visual experience

The present study investigated the role of early visual experience in the development of postural control (balance) and locomotion (gait). In a cross-sectional design, balance and gait were assessed in 59 participants (ages 7-43 years) with a history of (a) transient congenital blindness, (b) transient late-onset blindness, (c) permanent congenitally blindness, or (d) permanent late-onset blindness, as well as in normally sighted controls. Cataract-reversal participants who experienced a transient phase of blindness and gained sight through cataract removal surgery showed worse balance performance compared with sighted controls even when tested with eyes closed. Individuals with reversed congenital cataracts performed worse than individuals with reversed developmental (late emerging) cataracts. Balance performance in congenitally cataract-reversal participants when tested with eyes closed was not significantly different from that in permanently blind participants. In contrast, their gait parameters did not differ significantly from those of sighted controls. The present findings highlight both the need for visual calibration of proprioceptive and vestibular systems and the crossmodal adaptability of locomotor functions.

Measuring spatial navigation during locomotion in children: A systematic review

Spatial navigation allows us to move around our environment, walking being the most advanced form of human locomotion. Over the years, a range of tools has been developed to study spatial navigation in children. Aim. To describe the role of locomotion during the assessment of spatial navigation in children, providing an overview of the instruments available for assessing spatial navigation in typically developing children and those with neurodevelopmental disorders. Methods and Procedures. A systematic search was performed in six electronic databases between December 2022 and February 2023, then updated in July 2023. Cross-sectional and observational studies were included. Outcomes and results. Of the 3,385 studies screened, 47 were selected for this review. Five studies described the influence of locomotion on spatial navigation, and seven studies included locomotion as an explanatory variable in this area. Most studies focused on children from five to twelve years old, whereas only nine were centred on infants and preschoolers. Just eight assessed spatial abilities in individuals with neurodevelopmental disorders. Conclusions and implications. Children with or at risk of neurodevelopmental impairments show poorer spatial navigation skills. Having the choice to actively explore the space is more important than the way they locomote. It is necessary to have tools to assess spatial navigation during locomotion early in infancy.

Early infantile spontaneous movement in very low birthweight infants is associated with sensory characteristics at the corrected age of 3 years

AIM

To clarify the relationship between early infantile spontaneous movement of very-low-birth-weight infants (VLBWIs) and sensory characteristics in childhood.

STUDY DESIGN

Prospective cohort study. We investigated the association between the Motor Optimality Score-Revised (MOS-R), a detailed assessment of general movements (GMs) at the corrected age of 9-17 weeks and the Infant/Toddler Sensory Profile Japanese version (ITSP-J) at the corrected age of 3 years. A multiple regression analysis was performed to examine the correlation of ITSP-J and MOS-R with patient clinical background factors.

SUBJECTS

Fifty-three VLBWIs (median gestational age: 28 weeks, 6 days; median birth weight: 997 g) who were managed at the NICU of Oita University from September 2013 to June 2019.

RESULTS

A multiple regression analysis revealed that the ITSP-J subscale in the sensory section of visual score was significantly correlated with the age-adequate movement repertoire subscore of MOS-R, and in the sensory section of vestibular score was correlated with the fidgety subscore of MOS-R. For both visual and vestibular section scores, intraventricular hemorrhage (IVH) showed an independent association with the MOS-R subscore.

CONCLUSION

Spontaneous movement characteristics in early infancy were associated with sensory characteristics in early childhood.

Postural Control Measurements to Predict Future Motor Impairment in Preterm Infants: A Systematic Review

Preterm infants are more likely to demonstrate developmental delays than fullterm infants. Postural measurement tools may be effective in measuring the center of pressure (COP) and asymmetry, as well as predicting future motor impairment. The objective of this systematic review was to evaluate existing evidence regarding use of pressure mats or force plates for measuring COP and asymmetry in preterm infants, to determine how measures differ between preterm and fullterm infants and if these tools appropriately predict future motor impairment. The consulted databases included PubMed, Embase, Scopus, and CINAHL. The quality of the literature and the risk of bias were assessed utilizing the ROB2: revised Cochrane risk-of bias tool. Nine manuscripts met the criteria for review. The postural control tools included were FSA UltraThin seat mat, Conformat Pressure-Sensitive mat, Play and Neuro-Developmental Assessment, and standard force plates. Studies demonstrated that all tools were capable of COP assessment in preterm infants and support the association between the observation of reduced postural complexity prior to the observation of midline head control as an indicator of future motor delay. Postural measurement tools provide quick and objective measures of postural control and asymmetry. Based on the degree of impairment, these tools may provide an alternative to standardized assessments that may be taxing to the preterm infant, inaccessible to therapists, or not sensitive enough to capture motor delays.

Optimising motor development in the hospitalised infant with CHD: factors contributing to early motor challenges and recommendations for assessment and intervention

BACKGROUND

Neurodevelopmental challenges are the most prevalent comorbidity associated with a diagnosis of critical CHD, and there is a high incidence of gross and fine motor delays noted in early infancy. The frequency of motor delays in hospitalised infants with critical CHD requires close monitoring from developmental therapies (physical therapists, occupational therapists, and speech-language pathologists) to optimise motor development. Currently, minimal literature defines developmental therapists' role in caring for infants with critical CHD in intensive or acute care hospital units.

PURPOSE

This article describes typical infant motor skill development, how the hospital environment and events surrounding early cardiac surgical interventions impact those skills, and how developmental therapists support motor skill acquisition in infants with critical CHD. Recommendations for healthcare professionals and those who provide medical or developmental support in promotion of optimal motor skill development in hospitalised infants with critical CHD are discussed.

CONCLUSIONS

Infants with critical CHD requiring neonatal surgical intervention experience interrupted motor skill interactions and developmental trajectories. As part of the interdisciplinary team working in intensive and acute care settings, developmental therapists assess, guide motor intervention, promote optimal motor skill acquisition, and support the infant's overall development.

Charting infants' motor development at home using a wearable system: validation and comparison to physical growth charts

BACKGROUND

Early neurodevelopmental care and research are in urgent need of practical methods for quantitative assessment of early motor development. Here, performance of a wearable system in early motor assessment was validated and compared to developmental tracking of physical growth charts.

METHODS

Altogether 1358 h of spontaneous movement during 226 recording sessions in 116 infants (age 4-19 months) were analysed using a multisensor wearable system. A deep learning-based automatic pipeline quantified categories of infants' postures and movements at a time scale of seconds. Results from an archived cohort (dataset 1, N = 55 infants) recorded under partial supervision were compared to a validation cohort (dataset 2, N = 61) recorded at infants' homes by the parents. Aggregated recording-level measures including developmental age prediction (DAP) were used for comparison between cohorts. The motor growth was also compared with respective DAP estimates based on physical growth data (length, weight, and head circumference) obtained from a large cohort (N = 17,838 infants; age 4-18 months).

FINDINGS

Age-specific distributions of posture and movement categories were highly similar between infant cohorts. The DAP scores correlated tightly with age, explaining 97-99% (94-99% CI 95) of the variance at the group average level, and 80-82% (72-88%) of the variance in the individual recordings. Both the average motor and the physical growth measures showed a very strong fit to their respective developmental models (R² = 0.99). However, single measurements showed more modality-dependent variation that was lowest for motor (σ = 1.4 [1.3-1.5 CI 95] months), length (σ = 1.5 months), and combined physical (σ = 1.5 months) measurements, and it was clearly higher for the weight (σ = 1.9 months) and head circumference (σ = 1.9 months) measurements. Longitudinal tracking showed clear individual trajectories, and its accuracy was comparable between motor and physical measures with longer measurement intervals.

INTERPRETATION

A quantified, transparent and explainable assessment of infants' motor performance is possible with a fully automated analysis pipeline, and the results replicate across independent cohorts from out-of-hospital recordings. A holistic assessment of motor development provides an accuracy that is comparable with the conventional physical growth measures. A quantitative measure of infants' motor development may directly support individual diagnostics and care, as well as facilitate clinical research as an outcome measure in early intervention trials.

FUNDING

This work was supported by the Finnish Academy (314602, 335788, 335872, 332017, 343498), Finnish Pediatric Foundation (Lastentautiensäätiö), Aivosäätiö, Sigrid Jusélius Foundation, and HUS Children's Hospital/HUS diagnostic center research funds.

Interventions for Executive Function in High-Risk Infants and Toddlers

This review summarizes the current state of evidence regarding interventions for executive function in high-risk infants and toddlers. Currently, there is a paucity of data in this area, with the interventions that have been studied highly variable in their content, dosage, target, and results. Self-regulation is the executive function construct targeted the most, with mixed results. The few studies that report later child outcomes in prekindergarten/school-aged children are encouraging, overall indicating improved cognition and behavior in the children of parents who received a parenting style intervention.

Adaptations of the Walking Corsi Test (WalCT) for 2- and 3-year-old preterm and term-born toddlers: A preliminary study

Introduction

Topographical memory is crucial for navigation and environmental representation. The Walking Corsi Test (WalCT) has been used to evaluate topographical memory in children from 4 years upward. The present study aims to determine whether adapted versions of the WalCT- by simplifying instructions and increasing motivation- can be adopted to test topographical memory in 2- and 3-year-old toddlers born at term and preterm. Assessing this skill in such young children is important in light of recent studies that have shown how spatial cognition underlies the development of skills in other cognitive domains as well. Methods: For this purpose, 47 toddlers (27.39 ± 4.34 months, 38.3% females), 20 born at term and 27 preterm, performed two aimed-designed versions of WalCT.

Results

The results showed better performance of the term groups with increasing age and for both versions. On the other hand, performance was better in 2-year-old term toddlers vs. preterm. When rising motivation, 2-year-old preterm toddlers improve their performance but differences between both groups were still significant. The preterm group showed lower performance related to lower levels of attention.

Discussion

This study provides preliminary data on the suitability of the adapted versions of WalCT in early ages and prematurity conditions.

Differences in Body Balance According to Body Mass Classification among Brazilian Jiu-Jitsu Athletes

Background: Body weight is an important aspect in the development of components of physical fitness that can affect athletic performance. The purpose of this study was to examine the differences in body balance of Brazilian Jiu-Jitsu (BJJ) athletes according to body mass classification: underweight/normal weight (UW/NW); overweight/obese (OW/OB). Material and Methods: The study was conducted among 69 BJJ athletes (age 23.26 ± 3.53) and 93 non-practicing adults (age 21.73 ± 2.32). This study was based on a quantitative assessment of body balance on the Zebris PDM platform during two tests, i.e., with eyes open and closed. Results: The total path of the center of pressure (COP TTL) was significantly higher in participants with UW/NW compared to those with OW/OB, both in participants from the study group and control group (p < 0.001). COP TTL was significantly lower in UW/NW BJJ athletes than in participants in the control group with the same BMI category (987.4 mm vs. 1238.5 mm and 1080.59 mm vs. 1280.70 mm, respectively) (p < 0.001). Conclusions. BJJ training is associated with a better balance in terms of COP TTL in the case of people with normal or underweight. The presence of excess body weight has a positive effect on lower COP TTL values in both practicing and non-practicing people.

Intelligent wearable allows out-of-the-lab tracking of developing motor abilities in infants

Background

Early neurodevelopmental care needs better, effective and objective solutions for assessing infants' motor abilities. Novel wearable technology opens possibilities for characterizing spontaneous movement behavior. This work seeks to construct and validate a generalizable, scalable, and effective method to measure infants' spontaneous motor abilities across all motor milestones from lying supine to fluent walking.

Methods

A multi-sensor infant wearable was constructed, and 59 infants (age 5-19 months) were recorded during their spontaneous play. A novel gross motor description scheme was used for human visual classification of postures and movements at a second-level time resolution. A deep learning -based classifier was then trained to mimic human annotations, and aggregated recording-level outputs were used to provide posture- and movement-specific developmental trajectories, which enabled more holistic assessments of motor maturity.

Results

Recordings were technically successful in all infants, and the algorithmic analysis showed human-equivalent-level accuracy in quantifying the observed postures and movements. The aggregated recordings were used to train an algorithm for predicting a novel neurodevelopmental measure, Baba Infant Motor Score (BIMS). This index estimates maturity of infants' motor abilities, and it correlates very strongly (Pearson's r = 0.89, p < 1e-20) to the chronological age of the infant.

Conclusions

The results show that out-of-hospital assessment of infants' motor ability is possible using a multi-sensor wearable. The algorithmic analysis provides metrics of motility that are transparent, objective, intuitively interpretable, and they link strongly to infants' age. Such a solution could be automated and scaled to a global extent, holding promise for functional benchmarking in individualized patient care or early intervention trials.

Gait performance in toddlers born preterm: A sensor based quantitative characterization

BACKGROUND AND OBJECTIVES

Preterm children have an increased risk of motor difficulties. Gait analysis and wearable technologies allow the assessment of motor performance in toddlers, identifying early deviations from typical development. Using a sensor-based approach, gait performance of full-term and preterm toddlers at different risk of motor delay was analysed. The aim was to measure quantitative differences among groups.

METHODS

Twenty-nine two-year old children born preterm (≤36 gestational weeks) and 17 full-term controls, matched for age and walking experience, participated in the study. Preterm children were further divided based on risk of motor delay: preterm at high risk (n = 8, born at ≤28 gestational weeks or with ≤1000 g of body weight), and at moderate risk (n = 21). Children were asked to walk along a corridor while wearing 3 inertial sensors on the lower back and on the ankles. Gait temporal parameters, their variability, and nonlinear metrics of trunk kinematics (i.e. recurrence quantification analysis, multiscale entropy) were extracted from the collected data and compared among groups.

RESULTS

Children born preterm showed significantly longer stance and double support phases, higher variability of temporal parameters, and lower multiscale entropy values than peers born full-term. No difference was found for the other parameters when comparing preterm and full-term children. When comparing children grouped according to risk of delay, with increasing risk, children showed longer stride-, stance- and double-support-time, higher variability of temporal parameters, higher recurrence- and lower multiscale entropy values.

CONCLUSIONS

Sensor-based gait analysis allowed differentiating the gait performance of preterm from full-term toddlers, and of preterm toddlers at different risk of motor delay. When analysing the present results with respect to the expected trajectory of locomotor development, children born preterm, in particular those at higher risk of motor delay, exhibited a less mature motor control performance during gait: lower stability (i.e. longer support phases), and higher variability, although not structured towards the exploration of more complex movements (i.e. higher recurrence- and lower multiscale entropy values). These indexes can serve as biomarkers for monitoring locomotor development and early detecting risk to develop persistent motor impairments.

Quantitative Characterization of Motor Control during Gait in Dravet Syndrome Using Wearable Sensors: A Preliminary Study

Dravet syndrome (DS) is a rare and severe form of genetic epilepsy characterized by cognitive and behavioural impairments and progressive gait deterioration. The characterization of gait parameters in DS needs efficient, non-invasive quantification. The aim of the present study is to apply nonlinear indexes calculated from inertial measurements to describe the dynamics of DS gait. Twenty participants (7 M, age 9-33 years) diagnosed with DS were enrolled. Three wearable inertial measurement units (OPAL, Apdm, Portland, OR, USA; Miniwave, Cometa s.r.l., Italy) were attached to the lower back and ankles and 3D acceleration and angular velocity were acquired while participants walked back and forth along a straight path. Segmental kinematics were acquired by means of stereophotogrammetry (SMART, BTS). Community functioning data were collected using the functional independence measure (FIM). Mean velocity and step width were calculated from stereophotogrammetric data; fundamental frequency, harmonic ratio, recurrence quantification analysis, and multiscale entropy (τ = 1...6) indexes along anteroposterior (AP), mediolateral (ML), and vertical (V) axes were calculated from trunk acceleration. Results were compared to a reference age-matched control group (112 subjects, 6-25 years old). All nonlinear indexes show a disruption of the cyclic pattern of the centre of mass in the sagittal plane, quantitatively supporting the clinical observation of ataxic gait. Indexes in the ML direction were less altered, suggesting the efficacy of the compensatory strategy (widening the base of support). Nonlinear indexes correlated significantly with functional scores (i.e., FIM and speed), confirming their effectiveness in capturing clinically meaningful biomarkers of gait.

Early motor development in infants with moderate or severe bronchopulmonary dysplasia

BACKGROUND

Timely development of early motor skills is essential for later skill development in multiple domains. Infants with severe bronchopulmonary dysplasia (BPD) have significant risk for developmental delays. Early motor skill development in this population has not been described. The aim of the present study was to characterize motor skill acquisition at 3 and 6 months corrected age (CA) and assess trajectories of skill development over this time period in infants with severe BPD.

METHODS

We performed a single-center, retrospective descriptive study. Motor skills were categorized as present and normal, present but atypical, or absent at 3 and 6 months CA. Logistic regression was used to identify clinical characteristics associated with negative trajectories of skill acquisition.

RESULTS

Data were available for 232 infants and 187 infants at 3 and 6 months CA, respectively. Ten motor skills were present and normal in 5-44%(range) of subjects at 3 months. Nineteen motor skills were present and normal in 1-63%(range) of subjects at 6 months. Significant postural asymmetry was noted throughout the study period. Loss of skills and worsening asymmetries over time were common. Exposure to sedating medications was significantly associated with poor development.

CONCLUSION

We report delays in motor skill acquisition and postural asymmetries in infants with severe BPD at both 3 and 6 months CA. The association between sedating medications and poor development suggests that efforts to limit these exposures may lead to improved development. Targeted interventions to facilitate early motor development may improve outcomes of this high-risk population.

Self-Feeding Kinematics in an Ecological Setting: Typically Developing Children and Children With Cerebral Palsy

Assessment of self-feeding kinematics is seldom performed in an ecological setting. In preparation for development of an instrumented spoon for measurement of self-feeding in children with cerebral palsy (CP), the current work aimed to evaluate upper extremity kinematics of self-feeding in young children with typical development (TD) and a small, age-matched group of children with CP in a familiar setting, while eating with a spoon.

METHODS

Sixty-five TD participants and six children diagnosed with spastic CP, aged 3-9 years, fed themselves while feeding was measured using miniature three-dimensional motion capture sensors (trakStar). Kinematic variables associated with different phases of self-feeding cycle (movement time, curvature, time to peak velocity and smoothness) were compared across age-groups in the TD sample and between TD children and those with CP.

RESULTS

Significant between-age group differences were identified in movement times, time to peak velocity and curvature. Children with CP demonstrated slower, less smooth self-feeding movements, potentially related to activity limitations.

CONCLUSIONS

The identified kinematic variables form a basis for implementation of self-feeding performance assessment in children of different ages, including those with CP, which can be deployed via an instrumented spoon.

Age-Related Changes in Standing Balance in Preschoolers Using Traditional and Nonlinear Methods

Considerable disagreement exists on the linearity of the development of standing balance in children. This study aimed to use different traditional and nonlinear methods to investigate age-related changes in standing balance in preschoolers. A sample of 118 preschoolers took part in this study. A force platform was used to record the center of pressure during standing balance over 15 s in three conditions: eyes open, eyes closed, and/or head extended backward. Detrended fluctuation analysis (DFA), recurrence quantification analysis (RQA), and traditional measures were used to evaluate standing balance. The main results are as follows: (1) Higher range and SD in the anterior-posterior (AP) direction were observed for 5-year-old than for 4-year-old children, while higher DFA coefficient (at shorter time scales) and higher determinism and laminarity in the AP direction were found for 5-year-old children compared to 3- and 4-year-old children; and (2) as sensory conditions became more challenging, all traditional measures increased and DFA coefficients (at shorter and longer time scales) decreased in the AP and mediolateral directions, while determinism and laminarity significantly declined in the AP direction. In conclusion, although increased postural sway, 5-year-old preschool children's balance performance improved, and their control strategy changed significantly compared with the younger preschoolers. Sensory perturbation (eye closure and/or head extension) changed preschoolers' balance performance and control strategy. Moreover, both traditional and nonlinear methods provided complementary information on the control of standing balance in preschoolers.

Assessing Child Postural Variability: Development, Feasibility, and Reliability of a Video Coding System

AIMS

Postural variability is central to children's locomotion, motor control, and environmental exploration, and lacks standardized methods for systematic assessment. The purpose of this study was to develop and evaluate the feasibility and interrater reliability of Child Posture Variability Coding (CPVC), a method of quantifying postural variability in young children.

METHOD

Videos of parent-child play interactions obtained from a longitudinal study investigating language acquisition in typically developing (TD) children and children with autism spectrum disorder (ASD) were used to develop 33 codes for children's voluntary changes in static and dynamic postures. Interrater reliability was calculated for three raters who independently coded 10 randomly selected videos of children aged 23 to 48 months (TD: n = 5, median = 35, IQR = 12.5; ASD: n = 5, median = 35, IQR = 6.75).

RESULTS

Overall, CPVC demonstrated excellent interrater reliability (Krippendorff's α > 0.90). Among all codes developed, five codes (i.e., sit-half, sit-other, crawl, cruise, and supported walk) were not observed by any coders in the sample, but were kept in the coding scheme to reflect normal developmental milestones.

CONCLUSIONS

CPVC is a reliable, feasible method of quantifying postural variability in young children with and without neurodevelopmental disorders in naturalistic contexts.

Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation

Autism spectrum disorders (ASD) are an emergent public health problem, placing significant burden upon the individual, family and health system. ASD are polygenetic spectrum disorders of neural connectome development, in which one or more feedback loops amplify small genetic, structural, or functional variations in the very early development of motor and sensory-motor pathways. These perturbations trigger a 'butterfly effect' of unpredictable cascades of structural and functional imbalances in the global neuronal workspace, resulting in atypical behaviors, social communication, and cognition long-term. The first 100 days post-term are critically neuroplastic and comprise an injury-sensitive developmental window, characterized by a neural biomarker, the persistence of the cortical subplate, and a behavioral biomarker, the crying diathesis. By the time potential diagnostic signs are identified, from 6 months of age, ASD neuropathy is already entrenched. The International Society for Autism Research Special Interest Group has called for pre-emptive intervention, based upon rigorous theoretical frames, and real world translation and evaluation. This paper responds to that call. It synthesizes heterogenous evidence concerning ASD etiologies from both psychosocial and biological research literatures with complexity science and evolutionary biology, to propose a theoretical framework for pre-emptive intervention. This paper hypothesizes that environmental factors resulting from a mismatch between environment of evolutionary adaptedness and culture initiate or perpetuate early motor and sensory-motor lesions, triggering a butterfly effect of multi-directional cascades of atypical developmental in the complex adaptive system of the parent and ASD-susceptible infant. Chronic sympathetic nervous system/hypothalamic-pituitary-adrenal axis hyperarousal and disrupted parent-infant biobehavioral synchrony are the key biologic and behavioral mechanisms perpetuating these atypical developmental cascades. A clinical translation of this evidence is proposed, for application antenatally and in the first 6 months of life, as pre-emptive intervention for ASD.

Knowledge Translation Lecture: Providing Best Practice in Neonatal Intensive Care and Follow-up: A Clinician-Researcher Collaboration

Knowledge translation is the process by which we take new information that is evidence based and incorporate it into our practice. While we can each incorporate evidence into our practice, the collaboration between a researcher and a clinician can advance the implementation of evidence-based practice. We highlight the use of the Plan-Do-Study-Act cycle that includes a researcher and clinical partner on a journey of research question development, knowledge generation, clinical implementation, and policy change that advances the care to infants in the neonatal intensive care unit and in a developmental follow-up clinic. The team provides examples of implementation and highlights the clinical care differences following a decade of collaboration. Pediatric physical therapists have a responsibility to embrace and support knowledge translation to advance our profession and the care of infants, children, and families.

Age-related Assessment of Postural Control Development: A Cross-sectional Study in Children and Adolescents

The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4-18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant (p < 0.025) increase in surface and length, when compared to healthy adults, increased values within the low/middle frequency domain and within the high frequency domain were also observed in 4-13 and 4-7-year-old children, respectively. In conclusion, although the nature of postural control development remains largely undetermined, this study represents a first attempt to outline an age-dependent normal range of the relative contribution of inputs in typically developing children.

"Choose Physical Therapy" for Neonatal Abstinence Syndrome: Clinical Management for Infants Affected by the Opioid Crisis

In response to the opioid crisis, the American Physical Therapy Association has strongly advocated for physical therapy as a safe alternative to pharmacological pain management through the "#ChoosePT" campaign and the dedication of a PTJ special issue to the nonpharmacological management of pain. Physical therapists not only play an important role in the rehabilitation of the nearly 2 million adolescents and adults addicted to prescription opioids but also provide care to infants born to mothers with various drug addictions. This Perspective article explores the incidence, pathophysiology, and risk factors for neonatal abstinence syndrome and describes the clinical presentations of withdrawal and neurotoxicity in infants. Discipline-specific recommendations for the physical therapist examination and plan of care, including pharmacological management considerations, are outlined. Nonpharmacological management, including supportive care, feeding, parent education, social aspects of care, and follow-up services, are discussed from a physical therapy perspective. Finally, this article reviews developmental outcomes in infants with neonatal abstinence syndrome and reflects on challenges and future directions of research in this area.

Toward a motor signature in autism: Studies from human-machine interaction

BACKGROUND

Autism spectrum disorder (ASD) is a heterogeneous group of neurodevelopmental disorders which core symptoms are impairments in socio-communication and repetitive symptoms and stereotypies. Although not cardinal symptoms per se, motor impairments are fundamental aspects of ASD. These impairments are associated with postural and motor control disabilities that we investigated using computational modeling and developmental robotics through human-machine interaction paradigms.

METHOD

First, in a set of studies involving a human-robot posture imitation, we explored the impact of 3 different groups of partners (including a group of children with ASD) on robot learning by imitation. Second, using an ecological task, i.e. a real-time motor imitation with a tightrope walker (TW) avatar, we investigated interpersonal synchronization, motor coordination and motor control during the task in children with ASD (n=29), TD children (n=39) and children with developmental coordination disorder (n=17, DCD).

RESULTS

From the human-robot experiments, we evidenced that motor signature at both groups' and individuals' levels had a key influence on imitation learning, posture recognition and identity recognition. From the more dynamic motor imitation paradigm with a TW avatar, we found that interpersonal synchronization, motor coordination and motor control were more impaired in children with ASD compared to both TD children and children with DCD. Taken together these results confirm the motor peculiarities of children with ASD despite imitation tasks were adequately performed.

DISCUSSION

Studies from human-machine interaction support the idea of a behavioral signature in children with ASD. However, several issues need to be addressed. Is this behavioral signature motoric in essence? Is it possible to ascertain that these peculiarities occur during all motor tasks (e.g. posture, voluntary movement)? Could this motor signature be considered as specific to autism, notably in comparison to DCD that also display poor motor coordination skills? We suggest that more work comparing the two conditions should be implemented, including analysis of kinematics and movement smoothness with sufficient measurement quality to allow spectral analysis.

Standing balance in preschoolers using nonlinear dynamics and sway density curve analysis

The aim of the present study was to investigate how age and sensory deprivation affect the temporal organization of CoP sway variability and the postural corrective commands during standing balance in typically developing preschoolers. A sample of 57 children aged 3-5 years participated in the study. Structural stabilometric descriptors of sample entropy (SEn), detrended fluctuation analysis (DFA), and sway density curve (SDC) analysis were employed to assess features of center of pressure sway. A force platform was used to collect center of pressure data during standing balance over 40 s in four conditions: standing on rigid and foam surfaces with eyes open and closed. The main results are as follows: (1) sample entropy decreased and DFA_coefficient increased with age, while the SDC variables remained unaltered among the 3-, 4-, and 5-year-old children; (2) as sensory conditions became more challenging, sample entropy decreased and DFA_coefficient increased, while MT and MD decreased and MD increased; age did not influence the responses to sensorial deprivation. In conclusion, 5-year-old children showed decreased variability of CoP sway during standing balance compared with the younger children, but all children used the same corrective torques to control for perturbations. More challenging sensory deprivation conditions resulted in decreased variability of postural sway, higher amplitudes and more frequent correcting torques for stabilization, but age did not influence these behaviors.

Cognition-Action Trade-Offs Reflect Organization of Attention in Infancy

This chapter discusses what cognition-action trade-offs in infancy reveal about the organization and developmental trajectory of attention. We focus on internal attention because this aspect is most relevant to the immediate concerns of infancy, such as fluctuating levels of expertise, balancing multiple taxing skills simultaneously, learning how to control attention under variable conditions, and coordinating distinct psychological domains. Cognition-action trade-offs observed across the life span include perseveration during skill emergence, errors and inefficient strategies during decision making, and the allocation of resources when attention is taxed. An embodied cognitive-load account interprets these behavioral patterns as a result of limited attentional resources allocated across simultaneous, taxing task demands. For populations where motor errors could be costly, like infants and the elderly, attention is typically devoted to motor demands with errors occurring in the cognitive domain. In contrast, healthy young adults tend to preserve their cognitive performance by modifying their actions.

Does stabilizing input pressure orthosis vest, lycra-based compression orthosis, improve trunk posture and prevent hip lateralization in children with cerebral palsy?

Objectives

This study aims to investigate whether the use of a lycra-based compression orthosis known as stabilizing input pressure orthosis (SPIO) vest improves trunk posture and hip lateralization in children with cerebral palsy (CP) and to compare the effects of two- and six-hours daily wear of the orthosis.

Patients and methods

Between December 2013 and July 2015, a total of 24 children with CP (5 boys, 19 girls; mean age 61.1 months; range 35 to 105 months) with impaired trunk control were included in this single-blind, randomized-controlled study. All were randomized to either of the three groups as the control group (received only conventional exercise therapy), the SPIO 2-hour group (worn orthosis two hours during therapy), and the SPIO 6-hour group (worn orthosis four hours in addition to two hours of wear during therapy). The Sitting Assessment Scale (SAS), Cobb angle, kyphotic angle, and Migration Index were used to evaluate the trunk posture and hip lateralization before treatment and at six months after treatment.

Results

The SAS scores improved compared to baseline in all groups. The Cobb angle and kyphotic angle showed a significant decrease at six months after treatment only in the SPIO groups, while intra-group analysis of the Migration Index did not show a statistically significant difference. Changes in the radiographic assessments were similar among the groups, except for the kyphotic angles. The kyphotic angle showed less change in the control group. Comparison of the SPIO groups showed no significant differences in terms of the variables assessed.

Conclusion

The SPIO vest improves the kyphotic posture, but not scoliosis and hip lateralization in children with CP with impaired trunk control when used in combination with the conventional therapy. Using the SPIO vest for two and six hours also yields similar outcomes.

Development of postural control and maturation of sensory systems in children of different ages a cross-sectional study

OBJECTIVE

To evaluate the stability, postural adjustments and contributions of sensory information for postural control in children.

METHODS

40 boys and 40 girls were equally divided into groups of 5, 7, 9 and 12 years (G5, G7, G9 and G12). All children were submitted to dynamic posturography using a modified sensory organization test, using four sensory conditions: combining stable or sway referencing platform with eyes opened, or closed. The area and displacements of the center of pressure were used to determine stability, while the adjustments were used to measure the speed of the center of pressure displacements. These measurements were compared between groups and test conditions.

RESULTS

Stability tends to increase with age and to decrease with sensory manipulation with significant differences between G5 and G7 in different measures. G7 differed from G12 under the conditions of stable and sway platform with eyes open. G9 did not differ from G12. Similar behavior was observed for adjustments, especially in anterior-posterior directions.

CONCLUSION

Postural stability and adjustments were associated with age and were influenced by sensory manipulation. The ability to perform anterior-posterior adjustments was more evident and sensory maturation occurred firstly on the visual system, then proprioceptive system, and finally, the vestibular system, reaching functional maturity at nine years of age. Seven-year-olds seem to go through a period of differentiated singularity in postural control.