Timing, duration, and severity of iron deficiency in early development and motor outcomes at 9 months.

BACKGROUND/OBJECTIVES: Poorer motor development is reported in infants with iron deficiency (ID). The role of timing, duration and severity is unclear. We assessed relations between ID timing, duration, and severity and gross motor scores, neurological integrity, and motor behavior quality at 9 months. SUBJECTS/METHODS: Iron status was determined at birth and 9 months in otherwise healthy term Chinese infants. The 9-month motor evaluation included the Peabody Developmental Motor Scale (PDMS-2), Infant Neurological International Battery (INFANIB), and motor quality factor. Motor outcomes were analyzed by ID timing (fetal-neonatal, infancy), duration, and severity. For severity, we also considered maternal iron status. RESULTS: The data were available for 1194 infants. Iron status was classified as fetal-neonatal and infancy ID (n = 253), fetal-neonatal ID (n = 256), infancy ID (n = 288), and not ID (n = 397). Compared with not ID, infants with fetal-neonatal or infancy ID had lower locomotion scores (effect size ds = 0.19, 0.18) and those with ID in both periods (longer duration) had lower locomotion and overall PDMS-2 gross motor scores (ds = 0.20, 0.18); ID groups did not differ. More severe ID in late pregnancy was associated with lower INFANIB Vestibular function (p = 0.01), and total score (p = 0.03). More severe ID in infancy was associated with lower scores for locomotion (p = 0.03), overall gross motor (p = 0.05). CONCLUSIONS: Fetal-neonatal and/or infancy ID was associated with lower overall gross motor development and locomotion test scores at 9 months. Associations with ID severity varied by ID timing: more severe ID in late pregnancy, poorer neurological integrity; more severe ID in infancy, poorer gross motor development.

Implicit learning and emotional responses in nine-month-old infants.

To study the interplay between motor learning and emotional responses of young infants, we developed a contingent learning paradigm that included two related, difficult, operant tasks. We also coded facial expression to characterise emotional response to learning. In a sample of nine-month-old healthy Chinese infants, 44.7% achieved learning threshold during this challenging arm-conditioning test. Some evidence of learning was observed at the beginning of the second task. The lowest period of negative emotions coincided with the period of maximum movement responses after the initiation of the second task, and movement responses negatively correlated with the frequency of negative emotions. Positive emotions, while generally low throughout the task, increased during peak performance especially for learners. Peak frequency of movement responses was positively correlated with the frequency of positive emotions. Despite the weak evidence of learning this difficult task, our results from the learners would suggest that increasing positive emotions, and perhaps down-regulating negative emotional responses, may be important for improving performance and learning a complex operant task in infancy. Further studies are necessary to determine the role of emotions in learning difficult tasks in infancy.

Iron Supplementation in Pregnancy or Infancy and Motor Development: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: Insufficient iron levels for optimal fetal and infant development is a concern during pregnancy and infancy. The goal of this study was to assess the effects of iron supplementation in pregnancy and/or infancy on motor development at 9 months. METHODS: The study was a randomized controlled trial (RCT) of infancy iron supplementation linked to an RCT of pregnancy iron supplementation, conducted in Hebei, China. A total of 1482 infants were randomly assigned to receive placebo (n = 730) or supplemental iron (n = 752) from 6 weeks to 9 months. Gross motor development (assessed by using the Peabody Developmental Motor Scale, Second Edition, instrument) was the primary outcome. Neurologic integrity and motor quality were secondary outcomes. RESULTS: Motor outcome was available for 1196 infants, divided into 4 supplementation period groups: (1) placebo in pregnancy/placebo in infancy (n = 288); (2) placebo in pregnancy/iron in infancy (n = 305); (3) iron in pregnancy/placebo in infancy (n = 298); and (4) iron in pregnancy/iron in infancy (n = 305). Using the Peabody Developmental Motor Scale, instrument, iron supplementation in infancy but not pregnancy improved gross motor scores: overall, P < .001; reflexes, P = .03; stationary, P < .001; and locomotion, P < .001. Iron supplementation in infancy improved motor scores by 0.3 SD compared with no supplementation or supplementation during pregnancy alone. Effects of iron supplementation in infancy alone were similar to effects with iron in both pregnancy and infancy. CONCLUSIONS: The RCT design supports the causal inference that iron supplementation in infancy, with or without iron supplementation in pregnancy, improved gross motor test scores at 9 months.

Strength, Static Balance, Physical Activity, and Age Predict Maximal Gait Speed in Healthy Older Adults From a Rural Community: A Cross-Sectional Study.

PURPOSE: Gait speed is related to physical function in older adults. This cross-sectional study examined the best predictors of maximal gait speed (MGS) among physical abilities, and general factors in healthy, rural community-dwelling older adults. METHODS: MGS, muscle strength, and postural sway were measured in 55 community-dwelling participants (age, 72.1 ± 6.8, range 61-87 years; 72.7% women). Two stepwise regressions were used to find MGS predictors in two models: physical abilities and global. RESULTS: Strength of knee extensors with 60° of knee flexion (KStrength60°) and maximal distance in the anterior-posterior direction with eyes closed explained 50.2% of MGS variance (p < .05) in the physical abilities model. KStrength60°, age, and level of physical activity explained 63.9% of MGS variance (p < .05) in the global model. CONCLUSIONS: Regardless of the model, KStrength60° was the best predictor of MGS in rural female older adults. Future research should examine the generalization of these findings to rural male older adults.

Comparative effects of horse exercise versus traditional exercise programs on gait, muscle strength, and body balance in healthy older adults.

This study evaluates the separate effect and retention of 12-week traditional (TE) and horse (HE) exercise programs on physical function in healthy older participants (61 to 87 years old). Thirty-eight participants were randomly assigned to three groups: TE (n = 17), HE (n = 10), and control group (n = 11). TE and HE underwent a supervised exercise program (3 day/week). Maximal gait speed, muscle strength, and body balance were assessed at weeks 0, 12, and 16. Only TE and HE displayed significant improvements (P < .05) in knee extensor strength, and only HE had faster gait speed. Marginal balance improvements were found only in HE in the medial-lateral direction. However, TE showed larger improvements in handgrip than HE. The largest retention was in knee extensor strength but most of the exercise effects were lost in the follow-up. Besides TE, exercise with a horse may be an alternative option to older adults, provided that they want to interact with the animal.

Effect of Achilles tendon vibration on posture in children.

This study investigated the effect of unilateral Achilles tendon vibration on postural response in children and young adults during standing. Thirty healthy subjects participated in this study including ten 6-year-old children (YC group), ten 10-year-old children (OC group), and ten young adults (YA group). Eight-second vibration was elicited in each trial from a small vibrator attached above the right Achilles tendon when participants stood barefoot on a force platform. Three 40-s trials were collected under both eyes-open and eyes-closed conditions. Center of pressure (COP) was calculated to examine postural response during the pre-vibration, vibration and post-vibration phases. Results show that both the YC and OC groups had a greater COP average velocity than the YA group in all three phases. Tendon vibration induced a directionally specific postural response in all three groups such that the onset of vibration induced a posterior and medial COP shift during the vibration phase, and the offset of vibration induced an anterior and lateral COP shift during the post-vibration phase. Timing of the maximal COP shift was comparable among three groups in both anterior-posterior (AP) and medial-lateral (ML) directions. However, only the OC group showed an adult-like magnitude of the maximal COP shift during the post-vibration phase in the AP direction. These results suggest that 6-year-old children may start showing an adult-like directionally specific response and temporal parameter to tendon vibration during standing; however, the development of an adult-like spatial postural response to tendon vibration may take more than 10 years.

New biomechanical model for clinical evaluation of the upper extremity motion in subjects with neurological disorders: an application case.

Cervical spinal cord injury and acquired brain injury commonly imply a reduction in the upper extremity function which complicates, or even constrains, the performance of basic activities of daily living. Neurological rehabilitation in specialised hospitals is a common treatment for patients with neurological disorders. This study presents a practical methodology for the objective and quantitative evaluation of the upper extremity motion during an activity of daily living of those subjects. A new biomechanical model (with 10 rigid segments and 20 degrees of freedom) was defined to carry out kinematic, dynamic and energetic analyses of the upper extremity motion during a reaching task through data acquired by an optoelectronic system. In contrast to previous upper extremity models, the present model includes the analysis of the grasp motion, which is considered as crucial by clinicians. In addition to the model, we describe a processing and analysis methodology designed to present relevant summaries of biomechanical information to rehabilitation specialists. As an application case, the method was tested on a total of four subjects: three healthy subjects and one pathological subject suffering from cervical spinal cord injury. The dedicated kinematic, dynamic and energetic analyses for this particular case are presented. The resulting set of biomechanical measurements provides valuable information for clinicians to achieve a thorough understanding of the upper extremity motion, and allows comparing the motion of healthy and pathological cases.

Coordination Analysis Reveals Differences in Motor Strategies for the High Bar Longswing among Novice Adults.

Coordination between arm-trunk and trunk-leg is important for effective longswing performance. This research describes inter-segmental coordination changes after a practice period of longswing on high bar in a novice cohort. Novices were divided by initial skill level (talent) into two groups: spontaneously-talented, (ST, n = 10, closer to expert performance) and non-spontaneously-talented (NST, n = 15). Additionally, post-practice longswing coordination was compared to expert gymnasts (n = 9). Longswing amplitude and coordination (inter-joint reversal points and continuous relative phase, CRP) were assessed for pre- and post-practice sessions. ANOVAs showed similar practice effects in swing enlargements for the ST (11%) and NST (18%), but inter-joint reversal points and positive area in CRP during the downswing were different. Due to practice, the ST group paired shoulder and hip reversal points (events) during the downswing closer and with larger velocity of the arm in relation to the trunk than the NST group. The NST failed to modify coordination probably due to a large variability at the beginning of the downswing. Given a similar amount of practice, talent could help to achieve the right temporal events' sequence during downswing, which would allow the exploration of different segmental coordination. However, upswing coordination of the novice groups (ST and NST) requires more focused practice to achieve expert levels than downswing, especially the arm-trunk coordination.

High bar swing performance in novice adults: effects of practice and talent.

An individual's a priori talent can affect movement performance during learning. Also, task requirements and motor-perceptual factors are critical to the learning process. This study describes changes in high bar swing performance after a 2-month practice period. Twenty-five novice participants were divided by a priori talent level (spontaneous-talented [ST] and nonspontaneous-talented [NST]) and compared to experienced gymnasts. Additionally, we assessed their perception of their performance level before and after practice. We defined three events independently for hip (H) and shoulder (S) angle joints and for the lag between consecutive events (phases [P]): the smallest angle during downswing (P1H, P1S), the largest angle after P1 (P2H, P2S), and the smaller angle during upswing (P3H, P3S). Movement performance variables were the maximum elevation on the downswing (Pi) and the upswing (Pf), and the total path between both (swing amplitude). Data were collected during pre- and postpractice sessions by two video cameras. At the end of both sessions, participants drew a sketch to represent their perception of their performance level relative to the Pi, Pf and the hip events. Results showed a similar practice effect in the swing amplitude in both novice groups. However the ST group 's performance and perception variables on the downswing improved more than the NST group due to practice. This study suggests that (a) downswing improvements were easier than in the upswing, possibly due to familiarity of the visual reference in combination with proprioceptive feedback; and (b) being ST may involve a better orfaster gain in perception of self-action compared to NST.

Motor development in 9-month-old infants in relation to cultural differences and iron status.

Motor development, which allows infants to explore their environment, promoting cognitive, social, and perceptual development, can be influenced by cultural practices and nutritional factors, such as iron deficiency. This study compared fine and gross motor development in 209 9-month-old infants from urban areas of China, Ghana, and USA (African-Americans) and considered effects of iron status. Iron deficiency anemia was most common in the Ghana sample (55%) followed by USA and China samples. Controlling for iron status, Ghanaian infants displayed precocity in gross motor development and most fine-motor reach-and-grasp tasks. US African-Americans performed the poorest in all tasks except bimanual coordination and the large ball. Controlling for cultural site, iron status showed linear trends for gross motor milestones and fine motor skills with small objects. Our findings add to the sparse literature on infant fine motor development across cultures. The results also indicate the need to consider nutritional factors when examining cultural differences in infant development.

Effects of various treadmill interventions on the development of joint kinematics in infants with Down syndrome.

BACKGROUND: Infants with Down syndrome (DS) have delayed walking and produce less-coordinated walking patterns. OBJECTIVE: The aim of this study was to investigate whether 2 treadmill interventions would have different influences on the development of joint kinematic patterns in infants with DS. DESIGN: Thirty infants with DS were randomly assigned to a lower-intensity, generalized (LG) treadmill training group (LG group) or a higher-intensity, individualized (HI) treadmill training group (HI group) and trained until walking onset. Twenty-six participants (13 in each group) completed a 1-year gait follow-up assessment. METHODS: During the gait follow-up assessment, reflective markers were placed bilaterally on the participants to measure the kinematic patterns of the hip, knee, and ankle joints. Both the timing and the magnitude of peak extension and flexion at the hip, knee, and ankle joints, as well as peak adduction and abduction at the hip joint, in the 2 groups were compared. RESULTS: Both the LG group and the HI group showed significantly advanced development of joint kinematics at the gait follow-up. In the HI group, peak ankle plantar flexion occurred at or before toe-off, and the duration of the forward thigh swing after toe-off increased. LIMITATIONS: Joint kinematics in the lower extremities were evaluated in this study. It would be interesting to investigate the effect of treadmill interventions on kinematic patterns in the trunk and arm movement. CONCLUSIONS: The timing of peak ankle plantar flexion (before toe-off) in the HI group implies further benefits from the HI intervention; that is, the HI group may use mechanical energy transfer better at the end of stance and may show decreased hip muscle forces and moments during walking. It was concluded that the HI intervention can accelerate the development of joint kinematic patterns in infants with DS within 1 year after walking onset.

Treadmill responses and physical activity levels of infants at risk for neuromotor delay.

PURPOSE: This study described developmental changes in treadmill (TM) stepping and physical activity (PA) of infants at risk for neuromotor delay (ND) and explored these changes by diagnosis of cerebral palsy (CP). Relationships of stepping and PA with walking onset were examined. METHOD: Fifteen infants at risk for ND (9.9 +/- 2.4 months) were tested every 2 months on a TM until walking onset or 24 months of corrected age. We recorded PA profiles using an activity monitor. Throughout the study, 6 of the 15 infants received a CP diagnosis. RESULTS: Infants increased alternating steps (AltStp), decreased toe contacts, and increased high-level PA. Infants with CP showed less AltStp, more toe contacts, and less high-level PA than those without CP. Infants' AltStp and high-level PA revealed a positive correlation to earlier onset of walking. CONCLUSION: Future studies should examine whether a TM intervention could improve mobility in infants at risk for ND.

Constrained motor-perceptual task in infancy: effects of sensory modality.

The authors examined the relative success of varying sensory stimulation modalities that they presented via a mobile reinforcement procedure for promoting left-knee extensions in 3-month-old infants. They separated 53 infants into 5 groups. Four groups received contingent unimodal auditory, enhanced auditory, or visual reinforcement or contingent bimodal auditory plus visual (aud + vis) reinforcement. One group (controls) received aud + vis noncontingent reinforcement. The group that received aud + vis contingent reinforcement was most successful in learning the motor task and maintained the highest attention levels. The authors observed few differences in learning and attention within the unimodal groups. The present findings confirm the effectiveness of contingent multisensory stimulation for promoting perception-action coupling in infancy.

Effects of intensity of treadmill training on developmental outcomes and stepping in infants with Down syndrome: a randomized trial.

BACKGROUND AND PURPOSE: Infants with Down syndrome (DS) are consistently late walkers. The purpose of this investigation was to test the effects of individualized, progressively more intense treadmill training on developmental outcomes in infants with DS. SUBJECTS: Thirty infants born with DS were randomly assigned to receive lower-intensity, generalized treadmill training or higher-intensity, individualized training implemented by their parents in their homes. METHODS: Research staff members monitored implementation of training, physical growth, and onset of motor milestones of all infants on a monthly basis. RESULTS: Infants in the higher-intensity, individualized training group increased their stepping more dramatically over the course of training. Infants in the higher-intensity training group attained most of the motor milestones at an earlier mean age. DISCUSSION AND CONCLUSION: Treadmill training of infants with DS is an excellent supplement to regularly scheduled physical therapy intervention for the purpose of reducing the delay in the onset of walking.

Long-term effect of different treadmill interventions on gait development in new walkers with Down syndrome.

This longitudinal study investigated the long-term effect of different treadmill interventions on the development of gait patterns in infants with Down syndrome (DS). Thirty infants with DS (mean age 10.0 months, S.D. 1.9 months) were randomly assigned to either a "low intensity-generalized" (LG) training group, or a "high intensity-individualized" (HI) training group. Treadmill intervention was conducted in infants' homes until they walked three steps independently. Twenty-five participants completed a 1-year gait follow-up after the treadmill intervention. Six basic gait parameters were examined: normalized velocity, cadence, step length, step width, double support percentage, and dynamic base. Principal component analysis (PCA) conducted for the set of the six basic gait parameters demonstrated that the first principal component (PC1) accounted for 83.8% of the variance. A two-way ANOVA with repeated measures conducted with PC1 scores revealed a significant visit effect and group difference; both groups significantly increased PC1 scores over time, and the HI group produced significantly higher PC1 scores than the LG group. Specifically, the HI group produced significantly higher normalized velocity and cadence, and lower double support percentage than the LG group. In addition, both groups significantly reduced foot rotation asymmetry over time although no difference was found between the two groups. We concluded that the HI treadmill intervention provided a better long-term effect on the development of basic gait parameters than the LG training, and the reduction of foot rotation asymmetry over time was not differentially affected by the different training protocols.

Strategy adoption and locomotor adjustment in obstacle clearance of newly walking toddlers with Down syndrome after different treadmill interventions.

This study investigated how newly walking toddlers with Down syndrome (DS), after different treadmill interventions, adopted clearance strategies and modified anticipatory locomotor adjustment patterns to negotiate an obstacle in their travel path. Thirty infants with DS (about 10 months of age) were recruited and randomly assigned to either a lower-intensity, generalized (LG) treadmill training group, or a higher-intensity, individualized (HI) treadmill training group. Thirteen in each group completed a one-year-gait follow-up after the treadmill intervention. Initially, both groups chose to either crawl or walk over an obstacle. However, walking over the obstacle became their preferred clearance strategy over the course of the gait follow-up even though the height of the obstacle increased from visit to visit. The HI group used the strategy of walking over the obstacle at a considerably higher percentage than the LG group within 6 months after the training. When approaching the obstacle, both groups started to show consistent anticipatory locomotor adjustments about 6 months after the training. Both groups decreased velocity, cadence and step length, and increased step width at the last three pre-obstacle steps. It was concluded that the retention of the HI training effects led the HI group to predominantly walk over an obstacle earlier than the LG group within 6 months after treadmill intervention, and the two groups produced similar anticipatory locomotor adjustments in the last three steps before negotiating the obstacle.

Exploring effects of different treadmill interventions on walking onset and gait patterns in infants with Down syndrome.

Two cohorts of participants were included to investigate the effects of different treadmill interventions on walking onset and gait patterns in infants with Down syndrome (DS). The first cohort included 30 infants with DS (17 males, 13 females; mean age 10 mo [SD 1.9 mo]) who were randomly assigned to either a lower-intensity-generalized (LG) training group, or a higher-intensity-individualized (HI) training group. A control (C) group from another study, who did not receive treadmill training, served as the control (eight males, seven females; mean age 10.4 mo [SD 2.2 mo]). Mean age at walking onset was 19.2, 21.4, and 23.9 months for the HI, LG, and C groups respectively. At walking onset the HI group was significantly younger than the C group (p=0.011). At the gait follow-up that was conducted between 1 and 3 months after walking onset, three groups significantly different in overall gait patterns (p=0.037) were examined by six basic gait parameters including average velocity, stride length, step width, stride time, stance time, and dynamic base. Post-hoc analyses demonstrated that stride length was the gait parameter largely contributing to this overall group difference (p=0.033), and the HI group produced a significantly longer stride length than the C group (p=0.030). In conclusion, the HI treadmill intervention significantly promoted earlier walking onset and elicited more advanced gait patterns (particularly in stride length) in infants with DS.