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Development of postural adjustments during reaching in infants at risk for cerebral palsy from 4 to 18 months
Lieke C Van Balen1, Linze-Jaap Dijkstra1, Arend F Bos2
1Department of Paediatrics - Developmental Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Insights
Infants at high risk for cerebral palsy (CP) show delayed postural development by 18 months. They exhibit less specific postural adjustments and slower muscle activation, indicating a developing postural deficit.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Motor Control
Background:
- Cerebral palsy (CP) is a group of disorders affecting movement and posture.
- Understanding early motor development in high-risk infants is crucial for timely intervention.
- Postural adjustments are fundamental for effective reaching and motor control.
Purpose of the Study:
- To investigate postural adjustments during reaching in infants identified as high risk for cerebral palsy (CP).
- To compare motor control development between high-risk infants and typically developing infants.
Main Methods:
- An observational cohort study assessed 25 high-risk infants and 11 typically developing infants at 4, 6, and 18 months corrected age.
- Electromyography recorded arm, neck, and trunk muscle activity during reaching tasks in supported and unsupported sitting.
- Direction-specific adjustments, recruitment patterns, and anticipatory activation were quantified and statistically analyzed.
Main Results:
- At 4 months, postural activity was similar between high-risk and typically developing infants.
- By 18 months, high-risk infants demonstrated significantly less direction-specificity (20% vs 58%) in trunk and neck muscles.
- High-risk infants also showed longer latencies to trunk muscle activation and reduced anticipatory muscle activation compared to controls.
Conclusions:
- Infants at high risk for CP develop a significant postural deficit by 18 months of age.
- This deficit is characterized by delayed development of direction-specific postural control.
- Slower postural muscle recruitment and less anticipatory activation indicate functional motor impairments.
Aim:
To investigate postural adjustments during reaching in infants at high risk for cerebral palsy (CP).
Method:
Observational cohort study in which 25 infants at high risk (11 males, 14 females) and 11 infants with typical development (six males, five females) were assessed at 4, 6, and 18 months corrected age. Reaching movements were elicited during supported and unsupported sitting, while surface electromyography was recorded of arm, neck, and trunk muscles. Percentages of direction-specific adjustments (first level of control), and recruitment patterns and anticipatory activation (second level of control) were calculated. Statistical analyses were performed with a binomial generalized estimating equations model for dichotomous variables and a linear mixed model for continuous variables.
Results:
Postural activity of infants at high risk for CP at 4 months was virtually similar to that of infants with typical development. At 18 months, infants at high risk differed from infants with typical development with less direction-specificity (median values 20% vs 58% at trunk and neck level, OR 0.38, 95% CI 0.18-0.82); longer latencies to trunk muscle activation; and less anticipatory activation (41% vs 55%, in any direction-specific muscle, OR 0.53, 95% CI 0.32-0.89). In unsupported sitting, results were largely similar to those in supported sitting.
Interpretation:
Infants at high risk for CP grew into a postural deficit: at 18 months they showed delayed development of direction-specificity, and postural dysfunction as evidenced by slower recruitment of postural muscles and less frequent anticipatory activation.
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