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Locomotor learning in infants at high risk for cerebral palsy: A study protocol
Laura A Prosser1,2, Julie Skorup3, Samuel R Pierce3
1Division of Rehabilitation Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Insights
This study tracks how infants at high risk for cerebral palsy (CP) learn to move using robotics and sensors. Understanding early motor skill acquisition can improve lifelong mobility for children with CP.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Robotics
Background:
- Cerebral palsy (CP) presents lifelong mobility challenges and significant healthcare costs.
- Early locomotor skill acquisition in infants at high risk for CP is poorly understood.
- These early skills form the foundation for lifelong mobility and functional independence.
Purpose of the Study:
- To characterize the evolution of locomotor learning in infants at high risk for CP during their first 18 months.
- To investigate the role of movement error correction in skill acquisition.
- To identify neurobehavioral factors mediating locomotor learning.
Main Methods:
- A longitudinal observational/intervention cohort study enrolling 60 high-risk infants.
- Utilizing inertial sensors to measure spontaneous leg movements from 1-4 months.
- Employing robotic-assisted prone (5-9 months) and upright (9-18 months) locomotor training with real-time feedback and dynamic weight support.
Main Results:
- Development of predictive models for locomotor skill acquisition over time.
- Hypothesis testing on the critical role of movement error correction in learning.
- Assessment of neurobehavioral mediators influencing motor skill development.
Conclusions:
- Movement error correction is hypothesized to be critical for skill acquisition in infants at risk for CP.
- Locomotor learning is influenced by factors beyond direct training interventions.
- This research aims to enhance early interventions for improved long-term outcomes in CP.
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.
