Barbara Sargent1, Kathryn L Havens2, Jessica L Wisnowski3, Tai-Wei Wu4, Masayoshi Kubo5, Linda Fetters2. 1. Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1540 E. Alcazar St, CHP 155, Los Angeles, CA 90033 (USA). 2. Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California. 3. Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California; Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles; and Department of Pediatrics, Keck School of Medicine, University of Southern California. 4. Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles; and Department of Pediatrics, Keck School of Medicine, University of Southern California. 5. Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan.
Abstract
OBJECTIVE: Children with spastic cerebral palsy (CP) have gait impairments resulting from decreased selective motor control, an inability to move the leg joints independently of one another, relying on excessive flexion or extension coupling across the 3 joints. Infants with white matter injury are at high risk of CP and have decreased selective motor control as early as 1 month corrected age. An in-home kicking-activated mobile task was developed to motivate more selective hip-knee control of infants at high risk of CP. The purposes of this study were to determine the feasibility of the in-home mobile task and to determine whether infants at high risk of CP and infants with typical development (TD) learn the association between their leg movements and mobile activation. METHODS: Ten infants at high risk of CP based on neuroimaging and 11 infants with TD participated in this cohort study at 3.5 to 4.5 months corrected age. Each infant participated in the in-home kicking-activated mobile task for 8 to 10 min/d, 5 d/wk, for 6 weeks. Learning was assessed weekly based on an increase in the time that the infant demonstrated the reinforced leg actions when interacting with the kicking-activated mobile compared with spontaneous kicking. RESULTS: With regard to feasibility, participation averaged 92% for infants at high risk of CP and 99% for infants with TD. With regard to learning, the group at high risk of CP demonstrated learning of the task for 2 of 6 weeks, whereas the group with TD demonstrated learning for all 6 weeks. CONCLUSIONS: Infants at high risk of CP demonstrated learning of the kicking-activated mobile task but at a reduced amount compared with infants with TD. Further research is necessary to determine whether the kicking-activated mobile task has potential as an intervention to motivate more selective hip-knee control and improve walking outcomes of infants at high risk of CP. IMPACT: This study investigated the feasibility of an in-home kicking-activated mobile task, a discovery learning task designed to motivate infants at high risk of CP to engage in the intensive task practice necessary to promote their learning abilities and selective motor control. LAY SUMMARY: CP is a lifelong disorder of movement caused by abnormal development or early damage to the brain. If an in-home infant kicking-activated mobile task could be used to motivate certain types of age-appropriate leg movements of infants who are at high risk of CP, the task could help improve walking outcomes, which eventually could contribute to improving children's ability to participate in daily life. This study showed that infants at high risk of CP did learn the infant kicking-activated mobile task but at a much reduced amount compared with infants who are developing typically; so, this is a first step in determining whether the task has potential to motivate more age-appropriate leg movements in infants at high risk of cerebral palsy.
OBJECTIVE: Children with spastic cerebral palsy (CP) have gait impairments resulting from decreased selective motor control, an inability to move the leg joints independently of one another, relying on excessive flexion or extension coupling across the 3 joints. Infants with white matter injury are at high risk of CP and have decreased selective motor control as early as 1 month corrected age. An in-home kicking-activated mobile task was developed to motivate more selective hip-knee control of infants at high risk of CP. The purposes of this study were to determine the feasibility of the in-home mobile task and to determine whether infants at high risk of CP and infants with typical development (TD) learn the association between their leg movements and mobile activation. METHODS: Ten infants at high risk of CP based on neuroimaging and 11 infants with TD participated in this cohort study at 3.5 to 4.5 months corrected age. Each infant participated in the in-home kicking-activated mobile task for 8 to 10 min/d, 5 d/wk, for 6 weeks. Learning was assessed weekly based on an increase in the time that the infant demonstrated the reinforced leg actions when interacting with the kicking-activated mobile compared with spontaneous kicking. RESULTS: With regard to feasibility, participation averaged 92% for infants at high risk of CP and 99% for infants with TD. With regard to learning, the group at high risk of CP demonstrated learning of the task for 2 of 6 weeks, whereas the group with TD demonstrated learning for all 6 weeks. CONCLUSIONS: Infants at high risk of CP demonstrated learning of the kicking-activated mobile task but at a reduced amount compared with infants with TD. Further research is necessary to determine whether the kicking-activated mobile task has potential as an intervention to motivate more selective hip-knee control and improve walking outcomes of infants at high risk of CP. IMPACT: This study investigated the feasibility of an in-home kicking-activated mobile task, a discovery learning task designed to motivate infants at high risk of CP to engage in the intensive task practice necessary to promote their learning abilities and selective motor control. LAY SUMMARY: CP is a lifelong disorder of movement caused by abnormal development or early damage to the brain. If an in-home infant kicking-activated mobile task could be used to motivate certain types of age-appropriate leg movements of infants who are at high risk of CP, the task could help improve walking outcomes, which eventually could contribute to improving children's ability to participate in daily life. This study showed that infants at high risk of CP did learn the infant kicking-activated mobile task but at a much reduced amount compared with infants who are developing typically; so, this is a first step in determining whether the task has potential to motivate more age-appropriate leg movements in infants at high risk of cerebral palsy.
Authors: Aurelie Pascal; Paul Govaert; Ann Oostra; Gunnar Naulaers; Els Ortibus; Christine Van den Broeck Journal: Dev Med Child Neurol Date: 2018-01-19 Impact factor: 5.449
Authors: Suzann K Campbell; Deborah Gaebler-Spira; Laura Zawacki; April Clark; Kara Boynewicz; Raye-Ann deRegnier; Maxine M Kuroda; Rama Bhat; Jinsheng Yu; Rose Campise-Luther; Dipti Kale; Michelle Bulanda; Xiaohong Joe Zhou Journal: J Pediatr Rehabil Med Date: 2012
Authors: Catherine Morgan; Johanna Darrah; Andrew M Gordon; Regina Harbourne; Alicia Spittle; Robert Johnson; Linda Fetters Journal: Dev Med Child Neurol Date: 2016-03-29 Impact factor: 5.449