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Development of the quality of reaching in infants with cerebral palsy: a kinematic study
Anke G Boxum1, Sacha La Bastide-Van Gemert2, Linze-Jaap Dijkstra1
1University of Groningen, University Medical Center Groningen, Department of Paediatrics - Developmental Neurology, Groningen, the Netherlands.
Insights
Infants with cerebral palsy (CP) exhibit poorer reaching quality and different head stability strategies from early infancy. These kinematic deficits persist and do not emerge later, highlighting early intervention needs.
Area of Science:
- Pediatric neurology
- Developmental motor control
- Infant biomechanics
Background:
- Cerebral palsy (CP) impacts motor development in infants.
- Understanding early kinematic differences in high-risk infants is crucial for timely diagnosis and intervention.
- Reaching and head stability are key indicators of neurodevelopmental progress.
Purpose of the Study:
- To compare the development of reaching and head stability in infants at very high risk (VHR) for CP, differentiating between those who developed CP and those who did not.
- To identify early kinematic markers associated with CP development.
Main Methods:
- A longitudinal study of 37 VHR-infants (18 with CP) assessed reaching and head sway kinematics.
- Data were collected 1-4 times between 4.7 and 22.6 months corrected age.
- Linear mixed-effects models analyzed developmental trajectories; the Infant Motor Profile (IMP) evaluated motor function.
Main Results:
- VHR-infants with CP demonstrated significantly worse reaching quality (e.g., more movement units) compared to those without CP.
- Head sway was similar in total magnitude, but infants with CP used more head movements for stability.
- Developmental rates were similar, but kinematic deficits were present from early infancy.
Conclusions:
- Infants who develop CP exhibit poorer kinematic reaching quality and altered head stability strategies from early infancy.
- These kinematic deficits are present early and do not emerge later, suggesting a persistent developmental trajectory.
- Early kinematic assessments of reaching and head control are interrelated with overall motor function (IMP scores) around 13 months.
Aim:
To assess development of reaching and head stability in infants at very high risk (VHR-infants) of cerebral palsy (CP) who did and did not develop CP.
Method:
This explorative longitudinal study assessed the kinematics of reaching and head sway in sitting in 37 VHR-infants (18 CP) one to four times between 4.7 months and 22.6 months corrected age. Developmental trajectories were calculated using linear mixed effect models. Motor function was evaluated with the Infant Motor Profile (IMP) around 13 months corrected age.
Results:
Throughout infancy, VHR-infants with CP had a worse reaching quality than infants without CP, reflected for example by more movement units (factor 1.52, 95% CI 1.16-1.99) and smaller transport movement units (factor 1.86, 95% CI 1.20-2.90). Total head sway of infants with and without CP was similar, but infants with CP used more head movement units to achieve stability. The rate of developmental change in infants with and without CP was similar. Around 13 months, head control and reaching quality were interrelated; both were associated with IMP-scores.
Interpretation:
Infants with CP showed a worse kinematic reaching quality and head stability throughout infancy from early age onwards than VHR-infants without CP, implying that kinematically they do not grow into a deficit, but exhibit deficits from early infancy on.
What This Paper Adds:
Reaching quality improves throughout infancy in all infants at high risk (VHR-infants). Infants with cerebral palsy (CP) show a worse reaching quality than VHR-infants without CP. Infants with CP achieve head stability differently from infants without CP. Infants with CP exhibit kinematic reaching problems from early age onwards.
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