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Postural adjustments in infants at very high risk for cerebral palsy before and after developing the ability to sit
Anke G Boxum1, Lieke C van Balen1, Linze-Jaap Dijkstra1
1University of Groningen, University Medical Center Groningen, Dept. Paediatrics - Developmental Neurology, Groningen, The Netherlands.
Insights
Postural adjustments in infants at very high risk for cerebral palsy (CP) and typically developing infants do not change with independent sitting. However, successful reaching is linked to different postural control strategies in these groups.
Area of Science:
- Pediatric neurology
- Developmental motor control
- Biomechanics
Background:
- Children with cerebral palsy (CP) exhibit impaired postural control, affecting their ability to sit independently.
- Postural control involves direction-specificity and fine-tuning of adjustments like recruitment order.
- Direction-specificity is hypothesized as a prerequisite for independent sitting.
Purpose of the Study:
- To investigate the development of postural adjustments in infants at very high risk for CP (VHR-infants) as they acquire independent sitting skills.
- To compare postural control development between VHR-infants and typically developing (TD) infants.
Main Methods:
- A longitudinal study involving 11 VHR-infants and 11 TD infants.
- Surface electromyograms of neck, trunk, and arm muscles were recorded during reaching tasks.
- Data collection occurred before and after infants achieved unsupported sitting (VHR: 8.0 & 14.9 months; TD: 5.7 & 10.4 months).
Main Results:
- Direction-specific adjustments and recruitment order did not change with independent sitting in either VHR or TD infants.
- In VHR-infants, successful reaching correlated with bottom-up recruitment and less simultaneous recruitment, not direction-specificity.
- In TD-infants, successful reaching correlated with neck-level direction-specificity, but not recruitment order.
Conclusions:
- Postural adjustments related to direction-specificity and recruitment order are not linked to the development of independent sitting in VHR and TD infants.
- Postural adjustments are associated with reaching success, but the specific mechanisms differ between VHR and TD infants.
Background:
Children with cerebral palsy (CP) have impaired postural control. Posture is controlled in two levels: direction-specificity, and fine-tuning of direction-specific adjustments, including recruitment order. Literature suggests that direction-specificity might be a prerequisite for independent sitting.
Aim:
To study development of postural adjustments in infants at very high risk for CP (VHR-infants) during developing the ability to sit independently.
Method:
In a longitudinal study surface electromyograms of the neck-, trunk- and arm muscles of 11 VHR-infants and 11 typically developing (TD) infants were recorded during reaching in sitting before and after developing the ability to sit unsupported (median ages: VHR 8.0 and 14.9months; TD 5.7 and 10.4months). Sessions were video-recorded.
Results:
In VHR- and TD-infants the prevalence of direction-specific adjustments and recruitment order did not change when the infant learned to sit independently. In VHR-infants able to sit independently more successful reaching was associated with a higher frequency of bottom-up recruitment (Spearman's rho=0.828, p=0.006) and a lower frequency of simultaneous recruitment (Spearman's rho=-0.701, p=0.035), but not with more direction-specificity. In TD-infants not able to sit independently, more successful reaching was associated with higher rates of direction-specific adjustments at the neck level (Spearman's rho=0.778, p=0.014), but not with recruitment order.
Conclusions:
In VHR- and TD-infants postural adjustments during reaching in terms of direction-specificity and recruitment order are not related to development of independent sitting. Postural adjustments are associated with success of reaching, be it in a different way for VHR- and TD-infants.
Clinical Trial Registration Number:
NTR1428.
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