Agreement Between the Gross Motor Ability Estimator-2 and the Gross Motor Ability Estimator-3 in Young Children With Cerebral Palsy.

PURPOSE: The purpose of this study was to determine the agreement between Gross Motor Ability Estimator-2 (GMAE-2) and Gross Motor Ability Estimator-3 (GMAE-3) calculations of Gross Motor Function Measure-66 (GMFM-66) scores in infants and young children with cerebral palsy. METHODS: Data from 53 children 5 to 53 months of age were analyzed. Agreement between GMFM-66 scores using the GMAE-2 and the GMAE-3 was calculated using Bland-Altman plots and interclass correlation coefficients (ICCs). Eleven participants who had at least 1 GMFM-66 score of less than 25 using either method were identified for further analysis. RESULTS: The average difference between GMFM-66 scores was 0.27 for all participants and 0.63 for the subset of lower-scoring participants. Good agreement was found for GMFM-66 scores for all participants (ICC = 0.998) and for subset of lower-scoring participants (ICC = 0.879). CONCLUSIONS: High levels of agreement exist between the GMAE-2 and the GMAE-3, which suggests that scores are comparable using either algorithm.

Locomotor learning in infants at high risk for cerebral palsy: A study protocol.

Background: Physical disability in individuals with cerebral palsy (CP) creates lifelong mobility challenges and healthcare costs. Despite this, very little is known about how infants at high risk for CP learn to move and acquire early locomotor skills, which set the foundation for lifelong mobility. The objective of this project is to characterize the evolution of locomotor learning over the first 18 months of life in infants at high risk for CP. To characterize how locomotor skill is learned, we will use robotic and sensor technology to provide intervention and longitudinally study infant movement across three stages of the development of human motor control: early spontaneous movement, prone locomotion (crawling), and upright locomotion (walking). Study design: This longitudinal observational/intervention cohort study (ClinicalTrials.gov Identifier: NCT04561232) will enroll sixty participants who are at risk for CP due to a brain injury by one month post-term age. Study participation will be completed by 18 months of age. Early spontaneous leg movements will be measured monthly from 1 to 4 months of age using inertial sensors worn on the ankles for two full days each month. Infants who remain at high risk for CP at 4 months of age, as determined from clinical assessments of motor function and movement quality, will continue through two locomotor training phases. Prone locomotor training will be delivered from 5 to 9 months of age using a robotic crawl training device that responds to infant behavior in real-time. Upright locomotor training will be delivered from 9 to 18 months of age using a dynamic weight support system to allow participants to practice skills beyond their current level of function. Repeated assessments of locomotor skill, training characteristics (such as movement error, variability, movement time and postural control), and variables that may mediate locomotor learning will be collected every two months during prone training and every three months during upright training. Discussion: This study will develop predictive models of locomotor skill acquisition over time. We hypothesize that experiencing and correcting movement errors is critical to skill acquisition in infants at risk for CP and that locomotor learning is mediated by neurobehavioral factors outside of training.Project Number 1R01HD098364-01A1.ClinicalTrials.gov Identifier: NCT04561232.

The Impact of Cognition on Motor Learning and Skill Acquisition Using a Robot Intervention in Infants With Cerebral Palsy.

Background: Cerebral Palsy (CP) is a neurodevelopmental disorder that encompasses multiple neurological disorders that appear in infancy or early childhood and persist through the lifespan of the individual. Early interventions for infants with CP utilizing assisted-motion robotic devices have shown promising effects in rehabilitation of the motor function skills. The impact of cognitive function during motor learning and skill acquisition in infants using robotic technologies is unclear. Purpose: To assess the impact of cognitive function of infants with and without CP on their motor learning using the Self-Initiated Prone Progression Crawler (SIPPC) robot. Methods: Statistical analysis was conducted on the data obtained from a randomized control trial in which the movement learning strategies in infants with or at risk for CP was assessed during a 16-week SIPPC robot intervention. Cognitive function was measured by the Bayley scales of Infant and Toddler Development-Third edition (Bayley-III) and motor function was measured by the Movement Observation Coding Scheme (MOCS). The infants were categorized into three distinct groups based on their cognitive scores at baseline: "above average" (n1 = 11), "below average" (n2 = 10), and "average" (n3 = 26). Tri-weekly averages of the MOCS scores (observations at five time points) were used for the analyses. This study involved computing descriptive statistics, data visualization, repeated measures analysis of variances (rmANOVA), and survival analyses. Results: The descriptive statistics were calculated for the MOCS and Bayley III scores. The repeated measures ANOVAs revealed that there was a statistically significant effect of time (p < 0.0001) on scores of all subscales of the MOCS. A statistically significant effect of interaction between group and time (p < 0.05) was found in MOCS scores of subscales 1 and 2. The survival analyses indicated that infants in different cognition groups significantly differed (p < 0.0001) in their ability to achieve the crawling milestone within the 16-week intervention period. Conclusion: The findings in this study reveal the key movement strategies required to move the SIPPC robot, assessed by the MOCS, vary depending on the infants' cognition. The SIPPC robot is well-matched to cognitive ability of infants with CP. However, lower cognitive ability was related to delayed improvement in their motor skills.

Parents of Preterm and Very Low Birthweight Infants and Their Childrearing Practices.

Emerging research supports that early intervention leads to better health and higher functional status for infants with very low birthweight and/or low gestational age. Optimizing the transition from neonatal intensive care to early intervention programs relies heavily on parent engagement. The purpose of this descriptive correlational study was to investigate the relationship between parental characteristics, childrearing behaviors, and participation in early intervention. We used convenience sampling of 49 parents who participated in early intervention and the Parent Behavior Checklist to assess parent characteristics. Correlation coefficients between parenting behaviors, birthweight, and participation in early intervention were low. An important finding was that most parents in this study were within the "average" range for childrearing practices, despite the documented challenges associated with very low birthweight or gestational age. Despite documented challenges, parents of preterm infants with very low birthweight and parents of typical birthweight infants have similar parenting beliefs and behavior.

Concurrent Validity of the School Outcomes Measure and the School Function Assessment in Elementary Students.

PURPOSE: Examine the concurrent validity of the School Outcomes Measure (SOM) and the School Function Assessment (SFA) in students kindergarten through sixth grade. METHODS: Twenty-four school-based therapists completed the SOM and the SFA for 42 students, representing Gross Motor Function Classification System (GMFCS) levels I to V. RESULTS: Correlation coefficients between SOM Self-Care, Mobility, and Assuming Student's Role median total scores and the 21 SFA Activity Performance scale median criterion scores were statistically significant. There were significant correlation coefficients between SOM Expressing Learning and Behavior and SFA median criterion scores. The SOM differentiated between GMFCS groups for all physical tasks but not cognitive/behavioral tasks, and the SFA for half of the physical tasks. CONCLUSIONS: Overall, student performance on the SOM was consistent with participation on the SFA, which lends support to the preliminary validity of the SOM. The GMFCS analysis suggests that the SOM differentiates between the GMFCS levels for physical tasks.

Robot Reinforcement and Error-Based Movement Learning in Infants With and Without Cerebral Palsy.

BACKGROUND: Prone mobility, central to development of diverse psychological and social processes that have lasting effects on life participation, is seldom attained by infants with cerebral palsy (CP) and has no tested interventions. Reinforcement learning (RL) and error-based movement learning (EBL) offer novel intervention possibilities. OBJECTIVE: This study examined movement learning strategies in infants with or at risk for CP using RL and EBL during acquisition of prone locomotion. DESIGN: The study was a randomized trial that used repeated measures. SETTING: The study setting was a university physical therapy clinic in the United States. PATIENTS: Thirty infants aged 4.5 to 6.5 months participated in the study: 24 had or were at risk for CP, and 6 were typically developing. INTERVENTION: Infants with and at risk for CP were randomly assigned to a combination of RL and EBL (SIPPC-RE), or RL only (SIPPC-R) conditions. Infants with typical development comprised the RL-only reference group (SIPPC-TD). Infants trained in prone locomotion with the Self-Initiated Prone Progression Crawler (SIPPC) robotic system for three 5-minute trials, twice a week for 12 weeks in their homes or child care. All training sessions were videotaped for behavioral coding. MEASUREMENTS: The SIPPC gathered robot and infant trunk/limb movement data. Randomized 2-way analysis of variance with repeated measures and Pearson r to analyze the data was used. RESULTS: Results included the number of arm movements and trial-and-error activity distinguished between the SIPPC-RE and SIPPC-R groups. The mean change in arm movements from baseline for the SIPPC-RE and SIPPC-R groups was 4.8 m and -7.0 m, respectively. The mean differences in rotational amplitude (trial and error) from baseline to the end of the study were 278 degrees and 501 degrees, respectively. These changes were correlated with distance traveled and goal-directed movements. The latter increased over the 12 weeks for the SIPPC-RE and SIPPC-TD groups, but not the SIPPC-R group. LIMITATIONS: The CP groups were unequal due to reassignment and did not include a typically developing comparison group of a combination of RL and EBL. CONCLUSION: These findings suggest movement learning and retention in infants with CP is differentially affected by the use of RL and EBL, with a combination of both showing more promise than RL alone. The findings also implicate cognition, type of brain insult, emergence of reaching, and muscle force production, which must be explored in future studies.

Characterization of infant mu rhythm immediately before crawling: A high-resolution EEG study.

Crawling is an important milestone in infant motor development. However, infants with developmental motor disorders can exhibit delays, or even miss, in the acquisition of crawling skill. And little information is available from the neurodevelopmental domain about the changes in brain function with intervention. The mu rhythm can potentially play a substantial role in understanding human motor development at early ages in infants, as it has in adults. Studies about the mu rhythm in infants were in coarse temporal resolution with longitudinal samples taken months or years apart. Details about the infant mu rhythm at a fine age resolution has not been fully revealed, which leads to contradictory evidence about its formulation and developmental changes of its spectral origins and, therefore, impedes the full understanding of motor brain development before crawling skill acquisition. The present study aims to expand knowledge about the infant mu rhythm and its spatio-spectral pattern shifts along maturation immediately before crawling. With high-density EEG data recorded on a weekly basis and simultaneous characterization of spatio-spectral patterns of the mu rhythm, subtle developmental changes in its spectral peak, frequency range, and scalp topography are revealed. This mu rhythm further indicates a significant correlation to the crawling onset while powers from other frequency bands do not show such correlations. These details of developmental changes about the mu rhythm provide an insight of rapid changes in the human motor cortex in the first year of life. Our results are consistent with previous findings about the peak frequency shifting of the mu rhythm and further depict detailed developmental curves of its frequency ranges and spatial topographies. The infant mu rhythm could potentially be used to assess motor brain deficiencies at early ages and to evaluate intervention effectiveness in children with neuromotor disorders.

Spectra of infant EEG within the first year of life: A pilot study.

Rhythmic activities in electroencephalography (EEG) have been extensively studied in adults and classic rhythms are found to correlate with specific human brain functions. However, less has been investigated in infant EEG, and EEG rhythms in infants at early ages have not been well characterized in terms of their frequency ranges. In the present pilot study, we investigated rhythmic activities in infant EEG recorded weekly from 4-8 months using high-density EEG sensor nets. The developmental changes of EEG rhythms in different frequency bands along maturation were evaluated through spectral analysis. Their longitudinal scalp maps were also studied to understand their plausible functional correlates. The present study aims to enrich the sparse knowledge about the developing patterns of EEG rhythms within the first year of life from EEG recordings of high temporal and spatial resolutions.

Concurrent validity of the School Outcomes Measure (SOM) and Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children.

AIMS: The purpose of this study was to examine the concurrent validity of the School Outcomes Measure (SOM) compared with the Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children. This study also examined the consistency of children's motor performance across the home and school settings. METHODS: Five school-based physical therapists collected data on 44 preschool-age children with physical or combined physical and cognitive disability. Correlation coefficients analyzed the strength of association between SOM and PEDI subscale scores, while participant group mean scores analyzed agreement between measures regarding level of motor performance. RESULTS: Correlations between homologous PEDI and SOM subscale scores varied from rs = .53 to rs = .92 supporting concurrent validity. With some exceptions, group mean SOM scores showed agreement with group mean PEDI scores when children were categorized by age, gross motor function level, or PEDI cutoff score (1 or 2 SD below the mean). CONCLUSIONS: The results partially support concurrent validity between the SOM and PEDI, and suggest that the children's motor performance was similar across home and school settings. The findings also suggest that as a minimal database the SOM can reliably assess motor performance in the school setting; the disadvantage is difficulty interpreting SOM scores.

Early childrearing practices and their relationship to academic performance in Mexican American children.

PURPOSE: To examine whether parenting behaviors and childrearing practices in the first 3 years of life among Mexican American (MA) families predict children's academic performance at school age. METHODS: Thirty-six children were assessed using the Parent Behavior Checklist, Nursing Child Assessment Teaching Scale, Home Observation for Measurement of the Environment Inventory, and Bayley Scales of Infant Development II. Academic performance was measured with the Illinois Standards Achievement Test during third grade. RESULTS: Correlation between parents' developmental expectations, nurturing behaviors, discipline, and academic performance were statistically significant (P < .05). Developmental expectations and discipline strategies predicted 30% of the variance in the Illinois Standards Achievement Test of reading. CONCLUSIONS: The results of this study suggest that early developmental expectations that MA parents have for their children, and the nurturing and discipline behaviors they engage in, are related to how well the children perform on academic tests at school age.

A path model for evaluating dosing parameters for children with cerebral palsy.

Dosing of pediatric rehabilitation services for children with cerebral palsy (CP) has been identified as a national priority. Establishing dosing parameters for pediatric physical therapy interventions is critical for informing clinical decision making, health policy, and guidelines for reimbursement. The purpose of this perspective article is to describe a path model for evaluating dosing parameters of interventions for children with CP. The model is intended for dose-related and effectiveness studies of pediatric physical therapy interventions. The premise of the model is: Intervention type (focus on body structures, activity, or the environment) acts on a child first through the family, then through the dose (frequency, intensity, time), to yield structural and behavioral changes. As a result, these changes are linked to improvements in functional independence. Community factors affect dose as well as functional independence (performance and capacity), influencing the relationships between type of intervention and intervention responses. The constructs of family characteristics; child characteristics (eg, age, level of severity, comorbidities, readiness to change, preferences); plastic changes in bone, muscle, and brain; motor skill acquisition; and community access warrant consideration from researchers who are designing intervention studies. Multiple knowledge gaps are identified, and a framework is provided for conceptualizing dosing parameters for children with CP.

Predicting motor outcome at preschool age for infants tested at 7, 30, 60, and 90 days after term age using the Test of Infant Motor Performance.

BACKGROUND AND PURPOSE: Accurate and diagnostic measures are central to early identification and intervention with infants who are at risk for developmental delays or disabilities. The purpose of this study was to examine (1) the ability of infants' Test of Infant Motor Performance (TIMP) scores at 7, 30, 60 and 90 days after term age to predict motor development at preschool age and (2) the contribution of the home environment and medical risk to the prediction. SUBJECTS AND METHODS: Sixty-one children from an original cohort of 90 infants who were assessed weekly with the TIMP, between 34 weeks gestational age and 4 months after term age, participated in this follow-up study. The Peabody Developmental Motor Scales, 2nd edition (PDMS-2), were administered to the children at the mean age of 57 months (SD=4.8 months). The quality and quantity of the home environment also were assessed at this age using the Early Childhood Home Observation for Measurement of the Environment (EC-HOME). Pearson product moment correlation coefficients, multiple regression, sensitivity and specificity, and positive and negative predictive values were used to assess the relationship among the TIMP, HOME, medical risk, and PDMS-2 scores. RESULTS: The correlation coefficients between the TIMP and PDMS-2 scores were statistically significant for all ages except at 7 days. The highest correlation coefficient was at 90 days (r=.69, P=.001). The TIMP scores at 30, 60, and 90 days after term; medical risk scores; and EC-HOME scores explained 24%, 23%, and 52% of the variance in the PDMS-2 scores, respectively. The TIMP score at 90 days after term was the most significant contributor to the prediction. The TIMP cutoff score of -0.5 standard deviation below the mean correctly classified 80%, 79%, and 87% of the children using a cutoff score of -2 standard deviations on the PDMS-2 at 30, 60, and 90 days, respectively. DISCUSSION AND CONCLUSION: The results compare favorably with those of developmental tests administered to infants at 6 months of age or older. These findings underscore the need for age-specific test values and developmental surveillance of infants before making referrals.

Childrearing practices and developmental expectations for Mexican-American mothers and the developmental status of their infants.

BACKGROUND AND PURPOSE: The impact of parent education programs on early intervention programs is not thought to be uniform among children from majority and minority populations. This study examined the relationship between maternal childrearing practices and behaviors and the developmental status of Mexican-American infants. SUBJECTS: Participants were 62 Mexican-American mother-infant pairs. The infants' mean adjusted age was 12 months (SD=1.7, range=9-14). A third of the children were diagnosed with developmental delays and referred for early intervention by physicians or therapists when the children received their medical follow-up. The group was stratified according to socioeconomic status and acculturation using the Bidimensional Acculturation Scale for Hispanics. This scale uses cutoff points to classify individuals into 3 levels of acculturation. METHODS: Information on childrearing practices and behaviors was gathered using the Parent Behavior Checklist (PBC), the Home Observation for Measurement of the Environment (HOME) Inventory, and the Nursing Child Assessment Teaching Scale (NCATS). Infants' developmental status was assessed by use of the Bayley Scales of Infant Development II (BSID II). The Pearson product moment correlation, partial correlations, Fisher z transformation, and multiple regression analyses were used to examine the relationship between childrearing practices and parenting behaviors, demographic factors, and infants' developmental status. RESULTS: Maternal nurturing behaviors, parent-child interaction, and quality of the home environment were positively correlated with the infants' cognitive development. Maternal years of education modified the observed relationship between PBC and BSID II scores but not the observed relationship between HOME Inventory and NCATS scores. The childrearing practices, maternal socioeconomic status (SES) and age, and infants' gestational age at birth (GA) explained 45% of the variance in infants' cognitive scores. The infants' GA, maternal SES and age, and NCATS scores accounted for 32% of the motor scores on the BSID II. DISCUSSION AND CONCLUSION: The findings partially support a link between aspects of the mothers' childrearing behaviors and their infants' cognitive developmental status. For motor developmental status, the association appeared stronger with the infants' characteristics than with maternal childrearing practices and behaviors tested in this study.

Predictive validity of the test of infant motor performance as measured by the Bruininks-Oseretsky test of motor proficiency at school age.

BACKGROUND AND PURPOSE: As the survival rate of infants who are born prematurely increases, the need for accuracy in early identification and prediction of developmental outcome in these infants is imperative. This study examined the predictive validity of the Test of Infant Motor Performance (TIMP) and the relationship between perinatal risk and motor performance in children who are of school age. SUBJECTS AND METHODS: A stratified, random sample of 35 children was selected from subjects who had been examined using the TIMP and the Problem-Oriented Perinatal Risk Assessment System (POPRAS). The subjects were between 32 weeks gestational age and 4 months postterm (mean age=10 days postterm). The stratification was based on age at the time of TIMP administration (AGE) and on POPRAS scores. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) was administered to the children at a mean age of 5.75 years. Predictive values were calculated and correlation and regression analyses were conducted to examine the relationship between the TIMP and POPRAS scores and the BOTMP score. RESULTS: Using the receiver operating characteristic curve and a cutoff z score of -1.6, the TIMP's sensitivity, specificity, and positive and negative predictive values were.50, 1.00, 1.00, and.87, respectively. The correlation between TIMP and BOTMP scores, with AGE controlled, was.36, and the correlation between POPRAS and BOTMP scores was -.55. Thirty-seven percent of BOTMP variance was accounted for collectively by POPRAS scores, TIMP scores, and AGE. DISCUSSION AND CONCLUSION: The TIMP and POPRAS may be viable instruments that can be used together to identify infants who are at risk for poor long-term motor performance.

Validity of the Test of Infant Motor Performance for prediction of 6-, 9- and 12-month scores on the Alberta Infant Motor Scale.

The Test of Infant Motor Performance (TIMP) is a test of functional movement in infants from 32 weeks' post-conceptional age to 4 months postterm. The purpose of this study was to assess in 96 infants (44 females, 52 males) with varying risk, the relation between measures on the TIMP at 7, 30, 60, and 90 days after term age and percentile ranks (PR) on the Alberta Infant Motor Scale (AIMS). Correlation between scores on the TIMP and the AIMS was highest for TIMP tests at 90 days and AIMS testing at 6 months (r=0.67, p=0.0001), but all comparisons were statistically significant except those between the TIMP at 7 days and AIMS PR at 9 months. In a multiple regression analysis combining a perinatal risk score and 7-day TIMP measures to predict 12-month AIMS PR, risk, but not TIMP, predicted outcome (21% of variance explained). At older ages TIMP measures made increasing contributions to prediction of 12-month AIMS PR (30% of variance explained by 90-day TIMP). The best TIMP score to maximize specificity and correctly identify 84% of the infants above versus below the 10th PR at 6 months was a cut-off point of 1 SD below the mean. The same cut-off point correctly identified 88% of the infants at 12 months. A cut-off of -0.5 SD, however, maximized sensitivity at 92%. A negative test result, i.e. score above -0.5 SD at 3 months, carried only a 2% probability of a poor 12-month outcome. We conclude that TIMP scores significantly predict AIMS PR 6 to 12 months later, but the TIMP at 3 months of age has the greatest degree of validity for predicting motor performance on the AIMS at 12 months and can be used clinically to identify infants likely to benefit from intervention.