Harnessing Mobility: A Medically Complex Child's Home Program Utilizing an In-Home Body Weight Support System.

PURPOSE: To describe a home program for a child with medical complexity using an over-ground body weight support (BWS) system. SUMMARY OF KEY POINTS: Children with medical complexity often use home programs due to challenges with regular therapy attendance. In this case, effective home program components including child centered design, family leadership, and best practice principles were prioritized around the PUMA (portable mobility aid for children). This BWS system was to be used for 1 hour per day to support mobility and active play. STATEMENT OF CONCLUSIONS: The CMC and family demonstrated high adherence, using over-ground BWS 87% of the 135 days it was accessible with an average daily usage of 59 min spread across 1-3 bouts per day. The average daily fun index during usage was 7/10. RECOMMENDATIONS FOR CLINICAL PRACTICE: This home program demonstrated over-ground BWS technology as a feasible, fun platform for functional mobility and socialization in a child with significant medical and physical limitations.

ON Time Mobility: Advocating for Mobility Equity.

Mobility is a human right. The traditional definition of mobility in physical therapy practice is centered on translocation and, while accurate, is not comprehensive. In this article, we propose the ON Time Mobility framework: that all children have the right to be mobile throughout their development to explore, engage in relationships, and develop agency to cocreate their lives. This perspective highlights interconnected principles of timing, urgency, multimodal, frequency, and sociability to begin discussions on supporting the right to hours of active mobility each day for all children. We propose critical evaluation and discussion of these principles followed by a call to action to shift our conceptualization and enactment of mobility. This mobility rights perspective challenges current medical systems, industry, and government to collaborate with children with disabilities, their families and communities to support mobility as a source of physical and social interactions that define and develop individuals (see Supplemental Digital Content 1, the Video Abstract, available at: http://links.lww.com/PPT/A398 ).

Early exploration of one's own body, exploration of objects, and motor, language, and cognitive development relate dynamically across the first two years of life.

Early exploratory behaviors have been proposed to facilitate children's learning, impacting motor, cognitive, language, and social development. This study related the performance of behaviors used to explore oneself to behaviors used to explore objects, and then related both types of exploratory behaviors to motor, language, and cognitive measures longitudinally from 3 through 24 months of age via secondary analysis of an existing dataset. Participants were 52 children (23 full-term, 29 preterm). Previously published results from this dataset documented delays for preterm relative to full-term infants in each assessment. The current results related performance among the assessments throughout the first 2 years of life. They showed that the developmental trajectories of behaviors children used for self-exploration closely related to the trajectories of behaviors they employed to explore objects. The trajectories of both self and object exploration behaviors significantly related to trajectories of children's motor, language, and cognitive development. Specifically, significant relations to global development were observed for self-exploratory head lifting, midline head and hand positioning, hand opening, and behavioral variability, as well as for object-oriented bimanual holding, mouthing, looking, banging, manipulating, transferring of objects, and behavioral intensity and variability. These results demonstrate continuity among the early exploratory behaviors infants perform with their bodies alone, exploratory behaviors with portable objects, and global development. The findings identify specific self- and object-exploration behaviors that may serve as early indicators of developmental delay and could be targeted by interventions to advance motor, language, and cognitive outcomes for infants at risk for delay. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

User-centred assistive technology assessment of a portable open-area body weight support system for in-home use.

PURPOSE: Current paediatric technology lacks mobility devices that support early, high-dose and variable movement that can be managed by professionals and parents outside of the lab or clinic. Parent acceptability of the technology is a critical piece to the continued use of devices by their infants. The purpose of this study was to determine the level of feasibility of an in-home application of a novel portable body weight support system (PBWSS), designed for community use. METHOD: Sixteen typically and atypically developing infants used the system for four sessions at the home and lab. Parents assisted with the in-home system setup and completed a questionnaire on their: (a) infant's behavioural change, (b) infant's enjoyment, (c) own satisfaction, need and predicted use of the device, and (d) recommendations for future modifications. RESULTS: Parents and their infants successfully used the device during a wide range of activities. Parents noted positive changes in their infants' behaviour including their infants initiating certain behaviours for the first time. Parents quickly learned to setup and use the device and were satisfied with its current structure. Future modifications included increasing the wearable harness comfort. CONCLUSION: Infant performance and parent perceptions support the development of devices that place body-weight supported activity in real-world environments to promote high-dose, enriched experiences for young infants with mobility challenges.Implications for rehabilitationAssistive technology that can support multiple aspects of mobility in developing infants is limited.The in-home application of open-area body weight support systems has the potential to support early, enriched, high-dose mobility.Users of this technology, infants and their parents, were meaningfully involved throughout the assessment process.Preliminary findings support that: (1) this device was successfully implemented in these homes, (2) parents and infants enjoyed using the device, (3) parents noted positive changes in their infant's behavior, and (4) parents perceived the device to be safe and easy to use.Future studies can now determine the optimal use of this device with a range of pediatric populations.

Infants Born Preterm Demonstrate Impaired Exploration of Their Bodies and Surfaces Throughout the First 2 Years of Life.

BACKGROUND: Non-object-oriented exploratory behaviors infants perform with their bodies and surfaces have been proposed to be key precursors of infants' object exploration, early learning, and future cognitive development. Little is known about the developmental trajectories of these behaviors, especially for infants born preterm. OBJECTIVE: The purpose of the study was to longitudinally compare non-object-oriented exploratory behaviors performed by full-term and preterm infants. DESIGN: The study followed 24 full-term and 30 preterm infants (6 with significant brain injury) performing non-object-oriented exploratory behaviors in prone, supine, and sitting from birth through 24 months. METHODS: Infants were observed without objects or direct social interaction for 3 minutes in prone and supine (0 through 9 months) and in sitting (3 through 24 months). Behavioral coding produced data that were analyzed using hierarchical linear modeling. Developmental trajectories of behaviors were compared among full-term infants, preterm infants without significant brain injury, and preterm infants with significant brain injury. RESULTS: Compared to full-term peers, preterm infants showed poorer postural control (less head lifting in prone), midline behavior (holding the head in midline, holding both hands in midline), hand-to-mouth and visual-motor behaviors against gravity, and more asymmetrical one-handed fisting. Preterm infants performed fewer bouts of non-object-oriented exploratory behaviors, and their behaviors were less variable with fewer combinations. LIMITATIONS: There was a limited sample of infants born preterm with significant brain injury. CONCLUSIONS: Non-object-oriented exploratory behaviors are important for early perceptual-motor development. Key differences were noted in these behaviors for infants born preterm. These differences may lead to impaired reaching, object exploration, and cognition. Early intervention programs should utilize assessments and interventions that target these very early non-object-oriented exploratory behaviors.

Power-Up: Exploration and Play in a Novel Modified Ride-On Car for Standing.

PURPOSE: The purpose of this study was to compare the physical activity and play behaviors of preschoolers without disabilities and 1 preschooler with physical disability. METHODS: Participants were 42 preschoolers without disabilities and 1 preschooler with physical disability (Child A). Child A used either crutches or a modified ride-on car while in the gymnasium and playground. RESULTS: In the gymnasium, Child A engaged in less solitary play and more parallel play while using the modified ride-on car compared with crutches. On the playground, Child A engaged in more sitting and less running while using crutches compared with preschoolers without disabilities. On the playground, Child A engaged in more peer interaction and less teacher interaction when using the modified ride-on car compared with crutches. CONCLUSIONS: For children with disabilities who may use assistive devices, clinicians, families, and teachers are encouraged to embrace a "right device, right time, right place" approach.

Feasibility and Effectiveness of a Novel Exoskeleton for an Infant With Arm Movement Impairments.

PURPOSE: To determine whether a novel exoskeletal device (Pediatric-Wilmington Robotic Exoskeleton [P-WREX]) is feasible and effective for intervention to improve reaching and object interaction for an infant with arm movement impairments. METHODS: An 8-month old infant with arthrogryposis was followed up every 2 weeks during a 1-month baseline, 3-month intervention, and 1-month postintervention. At each visit, reaching and looking behaviors were assessed. RESULTS: Within sessions, the infant spent more time contacting objects across a larger space, contacting objects with both hands, and looking at objects when wearing the P-WREX. Throughout intervention, the infant increased time contacting objects both with and without the device and increased bilateral active shoulder flexion. CONCLUSIONS: (1) It may be feasible for families to use exoskeletons for daily intervention, (2) exoskeletons facilitate immediate improvements in function for infants with impaired upper extremity mobility, and (3) interventions using exoskeletons can improve independent upper extremity function across time.

Real-World Performance: Physical Activity, Play, and Object-Related Behaviors of Toddlers With and Without Disabilities.

PURPOSE: To describe and compare the occurrence and co-occurrence of physical activity (PA), play, and object-related behaviors in toddlers with and without disabilities. METHODS: Participants included 23 toddlers (21 with typical development (TD) and 2 with disabilities). Direct observation was used to describe the type and level of PA, play interactions, and object-related behaviors through video recordings. RESULTS: Toddlers demonstrated high variability, occurrence, and co-occurrence of all behaviors. Toddlers with disabilities displayed less variability, occurrence, and co-occurrence of several behaviors. CONCLUSION: Toddlers with TD engage simultaneously in PA, play, and object-related behaviors for about 3 hours in a typical day. This same level of co-occurrence of behaviors may not be observed for children with disabilities. Intervention providers are encouraged to consider the behaviors of toddlers with TD, beyond the findings of this pilot study, as the reference standard when implementing technology and intervention strategies for children with disabilities.

Infants born preterm demonstrate impaired object exploration behaviors throughout infancy and toddlerhood.

BACKGROUND: Object exploration behaviors form the foundation for future global development, but little is known about how these behaviors are exhibited by infants born preterm. OBJECTIVE: The study objective was to longitudinally compare a comprehensive set of object exploration behaviors in infants born preterm and infants born full-term from infancy into toddlerhood. DESIGN: Twenty-two infants born full-term and 28 infants born preterm were monitored as they interacted with objects throughout their first 2 years. METHODS: Infants were provided up to 30 seconds to interact with each of 7 objects across 9 visits. Experimenters coded videos of infants' behaviors. Growth modeling and t tests were used to compare how much infants exhibited behaviors and how well they matched their behaviors to the properties of objects. RESULTS: Infants born preterm explored objects less in the first 6 months, exhibited less visual-haptic multimodal exploration, displayed reduced variability of exploratory behavior in a manner that reflected severity of risk, and were less able to match their behaviors to the properties of objects in a manner that reflected severity of risk. Infants born preterm with significant brain injury also had impaired bimanual abilities. LIMITATIONS: There was a limited sample of infants born preterm with significant brain injury. CONCLUSIONS: Infants born preterm have impaired abilities to interact with objects even in the first months of life. This impairment likely limits the knowledge they acquire about objects and about how they can act on them; this limited knowledge may, in turn, impair their early learning abilities. These results highlight the need for assessment and intervention tools specific for object exploration in young infants.

Postural complexity influences development in infants born preterm with brain injury: relating perception-action theory to 3 cases.

BACKGROUND AND PURPOSE: Perception-action theory suggests a cyclical relationship between movement and perceptual information. In this case series, changes in postural complexity were used to quantify an infant's action and perception during the development of early motor behaviors. CASE DESCRIPTION: Three infants born preterm with periventricular white matter injury were included. OUTCOMES: Longitudinal changes in postural complexity (approximate entropy of the center of pressure), head control, reaching, and global development, measured with the Test of Infant Motor Performance and the Bayley Scales of Infant and Toddler Development, were assessed every 0.5 to 3 months during the first year of life. All 3 infants demonstrated altered postural complexity and developmental delays. However, the timing of the altered postural complexity and the type of delays varied among the infants. For infant 1, reduced postural complexity or limited action while learning to control her head in the midline position may have contributed to her motor delay. However, her ability to adapt her postural complexity eventually may have supported her ability to learn from her environment, as reflected in her relative cognitive strength. For infant 2, limited early postural complexity may have negatively affected his learning through action, resulting in cognitive delay. For infant 3, an increase in postural complexity above typical levels was associated with declining neurological status. DISCUSSION: Postural complexity is proposed as a measure of perception and action in the postural control system during the development of early behaviors. An optimal, intermediate level of postural complexity supports the use of a variety of postural control strategies and enhances the perception-action cycle. Either excessive or reduced postural complexity may contribute to developmental delays in infants born preterm with white matter injury.

Sit happens: Does sitting development perturb reaching development, or vice versa?

The development of reaching and of sitting during the first year of life is typically studied as separate yet related behaviors. Interestingly, very soon after learning to reach, 4-7-month-old infants start coordinating their arms with their trunk and legs for sitting. In this longitudinal study, we focused, for the first time, on how infants learn to use their arms for the dual tasks of reaching for objects while providing arm support as they learn to sit. We hypothesized that the use of arms for support during sitting development would be a temporary perturbation to reaching and result in a nonlinear progression of reaching skill. Eleven infants were studied monthly from the time they began to prop sit to the time of sitting independence (5-8 months of age). Behavioral coding, kinematics, and electromyography (EMG) characterized reaching and posture while infants sat as independently as possible. Results revealed significant changes across time in trunk movement and hand use as infants transitioned through three stages of sitting: with arm support, sitting briefly without arm support, and sitting independently. Infants used their hands more for contacting objects and less for posture support linearly across time. In contrast, changes in posture control as indicated by pelvis and trunk movement demonstrated a U-shaped curve with more movement of these two body segments during the middle stage of sitting than in the first or last stage. During the middle stage of sitting infants reached persistently even though posture control, measured by pelvis and trunk movement, appeared to be significantly challenged. Muscle activation consisted of tonic and variable combinations of muscle pairings in early sitting. As infants progressed to sitting without hand support, variable but successful strategies utilizing lower extremity muscles in a tight linkage with reach onset emerged to provide prospective control for reaching. Our findings support the contention that reaching both drives the development of sitting in infancy as well as perturbs sitting posture, factoring into the assembly of the complex dual sit-reach behavior that supports and expands flexible interaction with the environment.

Intervention in the first weeks of life for infants born late preterm: a case series.

Infants born late preterm (34-36 weeks of gestation) account for 350 000 US births per year, are at risk for developmental delays, and are rarely included in intervention studies. PURPOSE: To describe a novel parent-delivered movement intervention program for very young infants and outcomes following intervention and to evaluate the feasibility of using a comprehensive set of outcome measures. SUMMARY OF KEY POINTS: Two infants born late preterm received intervention from 0.5 to 2.0 months of adjusted age. Development, postural control, reaching, and object exploration assessments were completed at 3 time points. The intervention was well tolerated by the family. Improvements in developmental outcomes, postural control, and object exploration are presented. STATEMENT OF CONCLUSION: Very early movement experience provided daily by parents may improve development. In combination, norm-referenced and behavioral measures appear sensitive to changes in infant behaviors.

Early intensive postural and movement training advances head control in very young infants.

BACKGROUND: Daily experiences are thought to play an important role in motor development during infancy. There are limited studies on the effect of postural and movement experiences on head control. OBJECTIVE: The purpose of this study was to quantify the effects of postural and movement experiences on head control through a comprehensive set of measurements beginning when infants were 1 month old. DESIGN: This was a prospective, longitudinal, 2-cohort study. METHODS: Twenty-two full-term infants who were healthy were randomly assigned to either a training group or a control group. Infants were observed every other week from 1 to 4 months of age. Head control was assessed using a standardized developmental assessment tool, the Test of Infant Motor Performance (TIMP), as well as behavioral coding and kinematics of infants' head postures and movements in a supported sitting position. Caregivers performed at least 20 minutes of daily postural and movement activities (training group), or social interaction (control group) for 4 weeks. RESULTS: The training group had higher TIMP scores on head control-related items during the training period and after training stopped compared with the control group. Starting from the during training phase, the training group infants had their heads in a vertical and midline position longer compared with the control group infants. After training stopped, the training group infants actively moved their heads forward more often and for larger distances. LIMITATIONS: The experiences outside daily training were not monitored, and the results may be specific to the experimental setup for infants with typical development. CONCLUSIONS: Young infants are able to take advantage of postural and movement experiences to rapidly advance their head control as early as 4 to 6 weeks of postnatal life. Infant positioning, caregiver handling, and caregiver-infant interactions were likely contributing factors. This database of comprehensive measures may be useful in future trials focused on head control in infants with special needs.

Short-term, early intensive power mobility training: case report of an infant at risk for cerebral palsy.

PURPOSE: This case report describes the feasibility of quantifying short-term, intensive power mobility training for an infant soon after a diagnosis of cerebral palsy. KEY POINTS: An 11-month-old infant with significant mobility impairments and her parents were filmed during 14 consecutive daily training sessions. The infant moved the power chair with hand-over-hand assistance and performed open exploration of the joystick and toys. Mobility measures, coded from video, were compared across training. Frequency and combination of looking at and interacting with the joystick, percentage of time of moving independently, and average percentage of success in moving when prompted, all increased across the training. CLINICAL IMPLICATIONS: Quantifying short-term, intensive power mobility training for infants is feasible and may have yielded positive short-term effects for this infant. The "who," "when," and "how" of early power mobility training, as well as the critical need for paradigm shifts in power mobility training, are discussed.

Power mobility and socialization in preschool: follow-up case study of a child with cerebral palsy.

PURPOSE: Our previous study found it feasible for a preschooler with cerebral palsy (CP) to use a power mobility device in his classroom but noted a lack of typical socialization. The purpose of this follow-up study was to determine the feasibility of providing mobility and socialization training for this child. METHODS: Will, a 3-year-old with CP, 1 comparison peer, 2 preschool teachers, and 2 therapists were filmed daily during a training and posttraining phase. Adult-directed training was provided in the classroom by therapists and teachers during the training phase. Mobility and socialization measures were coded from video. OUTCOMES: During training, Will demonstrated greater socialization but less mobility than the comparison peer. Posttraining, Will socialized less but was more mobile, though less mobile than the comparison peer. DISCUSSION: Short-term, adult-directed power mobility and socialization training appear feasible for the preschool classroom. Important issues regarding socialization and power mobility are discussed.

Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders.

Autism spectrum disorders (ASDs) are the most common pediatric diagnoses in the United States. In this perspective article, we propose that a diverse set of motor impairments are present in children and adults with ASDs. Specifically, we will discuss evidence related to gross motor, fine motor, postural control, and imitation/praxis impairments. Moreover, we propose that early motor delays within the first 2 years of life may contribute to the social impairments of children with ASDs; therefore, it is important to address motor impairments through timely assessments and effective interventions. Lastly, we acknowledge the limitations of the evidence currently available and suggest clinical implications for motor assessment and interventions in children with ASDs. In terms of assessment, we believe that comprehensive motor evaluations are warranted for children with ASDs and infants at risk for ASDs. In terms of interventions, there is an urgent need to develop novel embodied interventions grounded in movement and motor learning principles for children with autism.

Power mobility and socialization in preschool: a case study of a child with cerebral palsy.

PURPOSE: Power mobility training for young children and infants appears feasible under controlled conditions. Dynamic, natural environments provide the ultimate test of training. The purpose of this case study was to determine whether it was feasible for Will, a 3-year-old boy with cerebral palsy, to use a power mobility device (UD2) in his preschool classroom and to quantify his classroom mobility and socialization. METHODS: Will, 2 peers (typically developing), and 2 teachers were filmed daily in class during a baseline phase without UD2, followed by a mobility phase with UD2. We coded socialization and mobility measures from video recordings. RESULTS: Will was more mobile and interactive when driving UD2 than during the baseline phase; however, he remained notably less mobile and interactive than his peers. CONCLUSIONS: The use and assessment of power mobility in a preschool classroom appear feasible. Issues important to maximizing children's use of power mobility for classroom participation are discussed.