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Physical Therapy Feb 2021Our objective was to evaluate the efficacy of the Sitting Together and Reaching to Play (START-Play) intervention in young infants with neuromotor disorders. (Comparative Study)
Comparative Study Randomized Controlled 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.
Topics: Child Development; Cognitive Dysfunction; Disability Evaluation; Exercise Therapy; Female; Humans; Infant; Male; Motor Skills Disorders; Nervous System Diseases; Problem Solving; Surveys and Questionnaires
PubMed: 33382406
DOI: 10.1093/ptj/pzaa232 -
Medical Science Monitor : International... Jul 2015Children with Down syndrome (DS) present with delays in motor development. The reduced size of the cerebrum, brain maturation disorders, and pathophysiological processes...
BACKGROUND
Children with Down syndrome (DS) present with delays in motor development. The reduced size of the cerebrum, brain maturation disorders, and pathophysiological processes lead to motor development delay. The aim of this study was to examine the gross motor function and estimate what motor abilities are significantly delayed in children with Down syndrome even if they attend physical therapy sessions. Another purpose of the study was to assess the functional balance.
MATERIAL AND METHODS
The study group consisted of 79 children with DS (42 boys, 37 girls), average age 6 years and 3 months ± 4 years and 6 months. Participants were divided into 3 groups according to (i) age: <3 years old, 3-6 years old, and >6 years old; and (ii) motor impairment scale: mild (SNR 1), moderate (SNR 2), and severe (SNR 3). Children were assessed using the Gross Motor Function Measure-88 (GMFM-88) and Pediatric Balance Scale (PBS).
RESULTS
None of the assessed children developed all the functions included in GMFM-88. The standing position was achieved at the specified age by 10% of children in the first age group (<3 years old) and 95% of children aged 3-6 years. Similarly, the walking ability was performed by 10% of children under 3 years old and by 95% of children aged 3-6 years. The median score of PBS was 50 points (min. 34 p. - max. 56 p.). There was a statistically significant correlation between PBS scores and GMFM-88 scores, r=0.7; p<0.0001, and between balance scores and GMFM - 88 E (walking, running, jumping) (r=0.64; p<0.0001).
CONCLUSIONS
Motor development, especially standing position and walking ability, is delayed in children with Down syndrome. Balance and motor functions are correlated with each other, so both aspects of development should be consider together in physical therapy of children with Down syndrome.
Topics: Child; Developmental Disabilities; Down Syndrome; Female; Humans; Male
PubMed: 26132100
DOI: 10.12659/MSM.893377 -
FP Essentials Nov 2021Gross motor development in infants and children, including loss of cerebral neuromotor maturational markers (ie, primitive reflexes) and achievement of motor...
Gross motor development in infants and children, including loss of cerebral neuromotor maturational markers (ie, primitive reflexes) and achievement of motor developmental milestones, follows a predictable sequence as the central nervous system matures. Because of this predictability, routine well-child visits provide an opportunity to assess development and identify motor delays through physical examination and screening with standardized tools. Family physicians are well suited to evaluate for risk factors that may adversely affect motor development, including review of the medical and social history of the child and the parents or caregivers for such factors. After a gross motor delay is identified, the physician should determine the likely cause of the delay, identify any anatomic etiology, and assess for features that may require further evaluation. This may include laboratory tests, imaging, or referral to a subspecialist. The patient then should be referred for early intervention.
Topics: Child; Child Development; Developmental Disabilities; Humans; Infant; Motor Skills Disorders
PubMed: 34709024
DOI: No ID Found -
Journal of Paediatrics and Child Health Apr 2020Gross motor skills are important for children's health and development. Delays in these skills are a concern for healthy developmental trajectories and therefore early...
AIM
Gross motor skills are important for children's health and development. Delays in these skills are a concern for healthy developmental trajectories and therefore early identification of delay is important. This study screened for gross motor delay in children from low-income communities and investigated potential risk factors associated with gross motor delay.
METHODS
This cross-sectional study involved 701 pre-schoolers (M = 54.1 ± 8.6 months, 52.8% boys) from childcare services in low-income and remote communities in Australia. Gross motor delay was assessed using the Ages and Stages Questionnaire - third edition. Potential risk factors included: sex, age, birthweight, prematurity status, weight status, childcare service, postcode, parent's education, parent's marital status, parent's employment and family income.
RESULTS
Results showed 4.4% of the children were delayed in gross motor skills and 8.8% were at risk of delay. Logistic regression showed being a boy (odds ratio (OR) 1.78, 95% confidence interval (CI) 1.12-2.84), underweight (OR 2.72, 95% CI 1.18-6.30) or overweight (OR 1.83, 95% CI 1.00-3.33), and parental unemployment (OR 1.79, 95% CI 1.01-3.16) were factors associated with a higher odds of children being delayed or at risk of gross motor delay. A higher family income (OR 0.35, 95% CI 0.13-0.93) was associated with lower odds of delay.
CONCLUSION
This unique study demonstrated children in low-income communities, especially boys, underweight and overweight children, have higher odds of being at risk of gross motor delay. Therefore, early screening is vital in this population in order to identify delays and potentially intervene with appropriate motor skill interventions.
Topics: Australia; Child; Child, Preschool; Cross-Sectional Studies; Developmental Disabilities; Humans; Infant; Infant, Newborn; Male; Motor Skills; Prevalence; Risk Factors
PubMed: 31705779
DOI: 10.1111/jpc.14684 -
Canadian Family Physician Medecin de... Aug 2016To describe the Harris Infant Neuromotor Test (HINT), an infant neuromotor test using Canadian norms published in 2010 that could be used to screen for motor delay... (Review)
Review
OBJECTIVE
To describe the Harris Infant Neuromotor Test (HINT), an infant neuromotor test using Canadian norms published in 2010 that could be used to screen for motor delay during the first year of life.
QUALITY OF EVIDENCE
Extensive research has been published on the intrarater, interrater, and test-retest reliability and the content, concurrent, predictive, and known-groups validity of the HINT, as well as on the sensitivity, specificity, and positive and negative predictive values of parental concerns, as assessed by the HINT. Most evidence is level II.
MAIN MESSAGE
Diagnosing motor delays during the first year of life is important because these often indicate more generalized developmental delays or specific disabilities, such as cerebral palsy. Parental concerns about their children's motor development are strongly predictive of subsequent diagnoses involving motor delay.
CONCLUSION
Only through early identification of developmental motor delays, initially with screening tools such as the HINT, is it possible to provide referrals for early intervention that could benefit both the infant and the family.
Topics: Child Development; Child, Preschool; Early Diagnosis; Humans; Infant; Mass Screening; Motor Disorders; Practice Guidelines as Topic; Societies, Medical
PubMed: 27521388
DOI: No ID Found -
Research in Developmental Disabilities Sep 2020Autism and intellectual disability may coincide and be preceded by global developmental delay or by motor delay.
BACKGROUND
Autism and intellectual disability may coincide and be preceded by global developmental delay or by motor delay.
HYPOTHESIS
Motor delay in the context of global developmental delay is an initial "red flag" for ASD, with added risk in girls.
OBJECTIVE
To assess early developmental milestones in girls with ASD as compared to diagnosed boys, considering prematurity risk.
METHOD
Developmental milestones in a cohort of 467 children with ASD - diagnosed at mean age of 3.4 years (SD = 2.2) - were analyzed according to gender and prematurity risk.
RESULTS
111 girls (24 %), 356 boys (76 %), presented with motor milestones acquisition grossly within the normal range. However, there was a shift towards acquisition of walking being at the later end of the norm range, with this shift being more prominent in girls. 60 % of girls and 47 % of boys with ASD had motor delay and 49 % of girls and 36 % of boys had global developmental delay. The extent of the delays was greater in the prematurity subgroup.
CONCLUSION
Global delay of early milestones occurred in half of children with ASD and in 60 % of girls with ASD. Delayed acquisition of independent walking is relatively more common in girls subsequently diagnosed with ASD.
Topics: Apraxias; Autism Spectrum Disorder; Autistic Disorder; Child; Child, Preschool; Female; Humans; Male; Motor Skills Disorders
PubMed: 32570001
DOI: 10.1016/j.ridd.2020.103702 -
Neuroscience Oct 2020Perceiving the sensory consequences of our actions with a delay alters the interpretation of these afferent signals and impacts motor learning. For reaching movements,...
Perceiving the sensory consequences of our actions with a delay alters the interpretation of these afferent signals and impacts motor learning. For reaching movements, delayed visual feedback of hand position reduces the rate and extent of visuomotor adaptation, but substantial adaptation still occurs. Moreover, the detrimental effect of visual feedback delay on reach motor learning-selectively affecting its implicit component-can be mitigated by prior habituation to the delay. Auditory-motor learning for speech has been reported to be more sensitive to feedback delay, and it remains unknown whether habituation to auditory delay reduces its negative impact on learning. We investigated whether 30 min of exposure to auditory delay during speaking (a) affects the subjective perception of delay, and (b) mitigates its disruptive effect on speech auditory-motor learning. During a speech adaptation task with real-time perturbation of vowel spectral properties, participants heard this frequency-shifted feedback with no delay, 75 ms delay, or 115 ms delay. In the delay groups, 50% of participants had been exposed to the delay throughout a preceding 30-minute block of speaking whereas the remaining participants completed this block without delay. Although habituation minimized awareness of the delay, no improvement in adaptation to the spectral perturbation was observed. Thus, short-term habituation to auditory feedback delays is not effective in reducing the negative impact of delay on speech auditory-motor adaptation. Combined with previous findings, the strong negative effect of delay and the absence of an influence of delay awareness suggest the involvement of predominantly implicit learning mechanisms in speech.
Topics: Adaptation, Physiological; Feedback; Feedback, Sensory; Habituation, Psychophysiologic; Humans; Speech; Speech Perception
PubMed: 32738430
DOI: 10.1016/j.neuroscience.2020.07.041 -
Pediatric Transplantation May 2022Motor skill acquisition plays an important role in physical activity participation and overall social and physical health. Limited studies have examined motor...
BACKGROUND
Motor skill acquisition plays an important role in physical activity participation and overall social and physical health. Limited studies have examined motor development in children pre-and post-liver transplant (LT).
METHODS
Retrospective review of motor outcomes in children <6 years old with cholestatic liver disease assessed pre-and 1-year post-isolated LT. Measures include Alberta Infant Motor Scale and Peabody Developmental Motor Scales (gross motor quotient (GMQ), fine motor quotient (FMQ), and total motor quotient (TMQ)). Association of medical variables with motor outcomes was explored.
RESULTS
Participants included 33 (58% male) children with diagnoses of biliary atresia (70%), Alagille syndrome (21%), and others (9%). Median age at LT was 10 (IQR 7.0-20.5) months. Pre-LT >75% of children were at risk for motor delay (≤10 percentile on AIMS/ ≥1SD below mean GMQ). Post-LT, 52% scored ≥1 SD below the mean GMQ compared with 22% FMQ. Children at risk/delayed pre-LT had an increased risk of motor delay on GMQ post-LT (odds ratio 11.43, 95% CI 1.12-116.7, p = .017). Higher INR pre-LT correlated with lower TMQ post-LT (r = -.51, p = .003). Longer waitlist time correlated with lower FMQ post-LT (r = .41, p = .03). GMQ post-LT and height z-scores pre-LT (r = .46, p = .02) and post-LT (r = .45, p < .01) were positively correlated. There was no correlation with presence of ascites, weight z-score, length of hospitalization, and age at LT.
CONCLUSIONS
Young children have increased risk of motor delay pre-LT, which may persist post-LT. Severity of liver disease and growth delays may impact motor development, highlighting the need for ongoing rehabilitation pre- and post-LT.
Topics: Biliary Atresia; Child; Child, Preschool; Exercise; Female; Humans; Infant; Liver Transplantation; Longitudinal Studies; Male; Motor Skills
PubMed: 34874102
DOI: 10.1111/petr.14200 -
IScience May 2022Reward timing, that is, the delay after which reward is delivered following an action is known to strongly influence reinforcement learning. Here, we asked if reward...
Reward timing, that is, the delay after which reward is delivered following an action is known to strongly influence reinforcement learning. Here, we asked if reward timing could also modulate how people learn and consolidate new motor skills. In 60 healthy participants, we found that delaying reward delivery by a few seconds influenced motor learning. Indeed, training with a short reward delay (1 s) induced continuous improvements in performance, whereas a long reward delay (6 s) led to initially high learning rates that were followed by an early plateau in the learning curve and a lower performance at the end of training. Participants who learned the skill with a long reward delay also exhibited reduced overnight memory consolidation. Overall, our data show that reward timing affects the dynamics and consolidation of motor learning, a finding that could be exploited in future rehabilitation programs.
PubMed: 35573187
DOI: 10.1016/j.isci.2022.104290 -
Journal of Developmental and Behavioral... Jan 2017Deformational plagiocephaly (includes plagiocephaly and brachycephaly) is a common pediatric condition. Infants who present with altered head shape often experience... (Review)
Review
OBJECTIVE
Deformational plagiocephaly (includes plagiocephaly and brachycephaly) is a common pediatric condition. Infants who present with altered head shape often experience developmental delay. It is uncertain how common developmental delay is in infants with plagiocephaly and how sustained this is, when present. This review explores the association between plagiocephaly and developmental delay to guide clinical practice.
STUDY DESIGN
A systematic review was conducted. MEDLINE, EMBASE, CINAHL, and PEDro databases were searched. Data from relevant studies were extracted regarding study: sample, follow-up, design, and findings. Methodological quality of each study was rated using a critical appraisal tool.
RESULTS
The search recovered 1315 articles of which 19 met the inclusion criteria. In the included studies, the children's ages ranged from 3 months to 10 years. Study limitations included selection bias, nonblinding of assessors, and reuse of the same study population for multiple papers. Most papers (11/19) rated "moderate" on methodological quality. A positive association between plagiocephaly and developmental delay was reported in 13 of 19 studies, including 4 of 5 studies with "strong" methodological quality. Delay was more frequently in studies with children ≤24 months of age (9/12 studies) compared with >24 months of age (3/7 studies). Motor delay was the most commonly affected domain reported in high-quality papers (5/5 studies).
CONCLUSION
This review suggests plagiocephaly is a marker of elevated risk of developmental delays. Clinicians should closely monitor infants with plagiocephaly for this. Prompt referral to early intervention services such as physiotherapy may ameliorate motor delays and identify infants with longer term developmental needs.
Topics: Child; Child, Preschool; Developmental Disabilities; Humans; Infant; Plagiocephaly
PubMed: 28009719
DOI: 10.1097/DBP.0000000000000376