A Perceptual Motor Intervention Improves Play Behavior in Children with Moderate to Severe Cerebral Palsy

I-MovE. An intervention to promote movement at childcare centers: Benefits for motor cognitive and socio-emotional development

The present contribution aimed to analyze the effects of a motor program intervention (i.e., I-MovE intervention) implemented indoors and outdoors at nursery school, on children's motor, socio-emotional, and cognitive skills. The study uses a non-randomized pre-post test design. Participants were children attending twenty nursery schools in the North of Italy. The intervention activities were adapted to age: Level 1 activities were addressed to children between 6 and 12 months, and Level 2 activities were addressed to children between 13 and 43 months. Within each level, one group of children developed the intervention indoors (IN-group; Level 1: n = 10; Level 2: n = 104) and another group developed the intervention outdoors (OUT-Group; Level 1: n = 12; Level 2: n = 66). Finally, one additional group was involved as the control group (CONT-Group; Level 1: n = 15; Level 2: n = 98). Children's motor, cognitive, and socio-emotional skills were assessed before and after the intervention by nursery school teachers. The main results showed that the motor intervention promoted children's motor skills development in both groups (i.e., groups implementing Levels 1 and 2 activities) and the cognitive and socio-emotional skills in the older group (i.e., group implementing Level 2 activities), especially the group that performed the intervention outdoors.

Manual Abilities and Cognition in Children with Cerebral Palsy: Do Fine Motor Skills Impact Cognition as Measured by the Bayley Scales of Infant Development?

Manual ability may be an important consideration when measuring cognition in children with CP because many items on cognitive tests require fine motor skills. This study investigated the association of fine motor dependent (FMD) and fine motor independent (FMI) items within the cognitive domain (COG) of the Bayley Scales of Infant Development-Third Edition (Bayley-III) and Manual Ability Classification System (MACS) in children with cerebral palsy. Children aged 2 to 8 (3.96 ± 1.68) years were included in this study. MACS levels were assigned at baseline. COG was administrated at baseline (n = 61) and nine months post-baseline (n = 28). The 91 items were classified into FMD (52) and FMI (39). Total raw score, FMD, and FMI scores were calculated. The association between MACS and cognitive scores (total, FMD, and FMI) were evaluated using linear regression and Spearman correlation coefficients. We found total, FMD, and FMI scores decrease significantly as the MACS level increases at the baseline. Both FMD and FMI scores decreased as MACS levels increased (worse function). There was a significant difference between the two slopes, with the FMD scores having a steeper slope. Similar patterns were observed nine months post-baseline. Children with lower manual ability scored lower in the cognitive domain at baseline and 9 months post-baseline. The significant difference in the performance of FMD items and FMI items across MACS levels with a steeper slope of changes in FMD items suggests fine motor skills impact cognition.

Effects of Body-Oriented Interventions on Preschoolers' Social-Emotional Competence: A Systematic Review

OBJECTIVE

A growing body of evidence supports the effectiveness of body-oriented interventions (BOI) in educational contexts, showing positive influences on social-emotional competence. Nevertheless, there is a lack of systematization of the evidence regarding preschool years. This is a two-part systematic review. In this first part, we aim to examine the effects of BOI on preschoolers' social-emotional competence outcomes.

DATA SOURCES

Searches were conducted in Pubmed, Scopus, PsycInfo, ERIC, Web of Science, Portal Regional da BVS and CINAHL.

ELIGIBILITY CRITERIA

English, French and Portuguese language articles published between January 2000 and October 2020, that evaluated the effects of BOI implemented in educational contexts on social-emotional competence of preschool children. Only randomized controlled trials (RCT) or quasi-RCT were included.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently completed data extraction and risk-of-bias assessment. The level of scientific evidence was measured through the Best Evidence Synthesis.

RESULTS

Nineteen studies were included. There was strong evidence that BOI do not improve anger/aggression, delay of gratification and altruism. Nevertheless, there was moderate evidence that BOI effectively improve other social-emotional outcomes, such as empathy, social interaction, social independence, general internalizing behaviors, and general externalizing behaviors. The lack of scientific evidence was compromised by the methodological quality of the studies.

CONCLUSION

BOI effectively improve specific social-emotional competences of preschool children.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier CRD42020172248.

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.

Sitting Matters! Differences Between Sitters and Nonsitters at 6 Months' Adjusted Age in Infants At-Risk and Born Preterm

PURPOSE

Sitting delays in infants born preterm compound cognitive and language deficits. This retrospective study examines differences in prematurity-related risk and compares developmental outcomes between sitters and nonsitters at 6 months' adjusted age.

METHODS

A total of 105 graduates of the neonatal intensive care unit met inclusion criteria. Infant demographic and medical risk profiles and 6-month Bayley Scales of Infant Development-3rd edition (BSID-III) cognitive and language scores were retrieved. Infants who sat with hands free greater than 60 seconds were classified as "sitters."

RESULTS

Sixty-nine percent of the sample were nonsitters and were born earlier, had lower birth weights, were chronologically older at follow-up, and spent more days with respiratory support. BSID-III scores were significantly higher in sitters but did not differ by gender, multiple birth, head ultrasound results, payment type, or race/ethnicity.

CONCLUSION

Sitting abilities at 6 months' adjusted age are associated with prematurity risk factors. Cognitive and language scores differ significantly between sitters and nonsitters.

Development Through the Lens of a Perception-Action-Cognition Connection: Recognizing the Need for a Paradigm Shift in Clinical Reasoning

Clinical assessment of movement and posture guides the decision-making process in designing interventions for infants and children with movement disorders. Clinical reasoning is influenced by the therapist's understanding of developmental processes. The views of development grounded in perception-action, dynamic systems, and neuronal group selection theories are well recognized in current literature and supported by a large body of research. Based on the available evidence, intervention must be task-specific, repetitive, and highly salient to the child. Furthermore, it must honor spontaneous exploration and active problem-solving, enhance the child's ability to perceive environmental affordances, and target optimal variability and adaptability of movement and posture. However, a neuromaturational approach to developmental assessment and intervention that relies on "teaching" motor milestones and emphasizes the importance of correcting movement patterns in infants and children developing atypically is still prevalent in the clinic. This perspective paper will: (1) examine evidence in support of a paradigm shift from neuromaturational views toward bringing the concepts of grounded cognition, variability, complexity, and adaptability to the forefront of clinical reasoning; and (2) introduce the Perception-Action Approach as a method of assessment and intervention that may serve as an agent of such a shift by augmenting knowledge translation for the clinician.

Sit Still and Pay Attention! Trunk Movement and Attentional Resources in Infants with Typical and Delayed Development

AIMS

(1) examine infant movement during an early posture (sitting) utilizing a novel video assessment technique; and (2) document the differences between infants with typical development (TD), premature infants with motor delay, and infants with cerebral palsy (CP) during focused and nonfocused attention (NFA).

METHODS

Infants were tested when they began to sit independently. We utilized Eulerian Video Magnification (EVM) to accentuate small trunk and pelvic movements for visual coding from video taken during a natural play task with and without focused attention (FA).

RESULTS

Trunk/pelvic movement varied as a function of both motor skill and attention. Infants with TD and CP made fewer trunk movements during periods of FA than NFA. Preterm infants exhibited more trunk/pelvic movement than the other groups and their movement did not differ based on attention type.

CONCLUSIONS

The EVM technique allowed for replicable coding of real-time "hidden" motor adjustments from video. The capacity to minimize extraneous movements in infants, or "sitting still" may allow greater attention to the task at hand, similar to older children and adults. Premature infants' excessive trunk/pelvic movement that did not adapt to task requirements could, in the long term, impact tasks requiring attentional resources.

Postural control strategies differ in normal weight and overweight infants

BACKGROUND

Evidence suggests obesity can have a negative influence on a child's motor development and postural control behavior. Little research has examined the impact of infant weight on gross motor behavior, particularly postural control at the onset of sitting.

OBJECTIVE

The purpose of this study was to determine whether normal weight and overweight infants differed in their postural control strategies at the onset of sitting and one-month post onset of sitting.

METHODS

29 infants (n=19 normal weight, n=10 overweight) were recruited to participate in this study. Infant's length and weight were measured at 3 months of age (visit 1). Infant's center of pressure (COP) was measured on an AMTI force platform at the onset of sitting (visit 2) and one-month post onset (visit 3). Data were analyzed using linear measures (range and RMS for the anterior/posterior (AP) and medial/lateral (ML) directions, sway path) and nonlinear measures (Sample Entropy in AP and ML directions).

RESULTS

Overweight infants had significantly greater RMS values in the ML direction at visit 2 and reduced Sway Path values in comparison to normal weight infants at visits 2 and 3. Further, there was a significant difference in Sample Entropy as overweight infants increased Sample Entropy from visit 2 to 3 while normal weight infants decreased Sample Entropy values during this time period.

CONCLUSIONS

These findings suggest that overweight infants adopt a different postural control strategy. This altered strategy may limit exploration early in development. More research is needed to determine if longitudinal differences continue to emerge.