No stable arm preference during the pre-reaching period: a comparison of right and left hand kinematics with and without a toy present

Task-Related Differences in End-Point Kinematics in School-Age Children with Typical Development

Understanding whether and how children with typical development adapt their reaches for different functional tasks could inform a more targeted design of rehabilitation interventions to improve upper extremity function in children with motor disabilities. This prospective study compares timing and coordination of a reach-to-drink, reach-to-eat, and a bilateral reaching task in typically developing school-aged children. Average speed, straightness, and smoothness of hand movements were measured in a convenience sample of 71 children, mean age 8.77 ± 0.48 years. Linear mixed models for repeated measures compared the variables by task, phases of the reach, task x phase interactions, and dominant versus non-dominant hands. There were significant main effects for task and phase, significant task x phase interactions (p < 0.05), and a significant difference between the dominant and non-dominant hand for straightness. Hand movements were fastest and smoothest for the reach-to-eat task, and least straight for the bilateral reaching task. Hand movements were also straighter in the object transport phases than the prehension and withdrawal phases. These results indicate that children with typical development change their timing and coordination of reach based on the task they are performing. These results can inform the design of rehabilitation interventions targeting arm and hand function.

Outcomes and Hand Use of Reaching Attempts: Comparison of Infants at Risk for Developmental Disability and Infants With Typical Development

Background

Infants at risk for developmental disabilities often show signs of motor delay. Reaching is a skill that can help us identify atypical motor trajectories in early infancy. Researchers have studied performance after onset of reaching, but none have followed infants at risk from pre-reaching to skilled reaching.

Aims

We assessed differences in reaching outcomes and hand use as reaching skill emerged in infants at risk for developmental disabilities and with typical development.

Methods and Procedures

We followed infants at risk for developmental disabilities (n = 11) and infants with typical development (n = 21) longitudinally as they developed reaching skill. Infants reached for a toy at midline while sitting in the caregiver's lap. Video data were coded for reach outcome (miss, touch, partial grasp, and whole-hand grasp) and hand use (right, left, and bilateral).

Outcomes and Results

Infants at risk had a larger proportion of missed reaches across visits compared to infants with typical development. Infants at risk also showed less variability in hand use when grasping over the study period.

Conclusion and Implications

Our results provide information to support early differences in reaching performance to inform identification of typical and atypical developmental trajectories. Future studies should assess how the missed reaches are different and consider other quantitative measures of movement variability in infants at risk.

Neonatal manual specialization in language and music conditions: Consistency with the hemispheric specialization adult model

The main purpose of this study was to test in neonates the influence of the sound environment, i.e., language versus music, on asymmetric hand movement activity in the presence of a target object. Based on hemispheric specialization, our hypothesis was that infants would use their right hand more in the speech context (left hemisphere) and their left hand more in the music context (right hemisphere). The study involved 19 full-term 3-day-old neonates. An object was presented successively in the two sound environments in counterbalance order for 120 s each. Left and right movements and mouth activity were scored during the target object presentation. Results show that neonates moved their left hand twice as much as their right hand in the music condition than in the language condition, and they moved their right hand a longer time in the language condition than in the music condition. The average number of sucking bursts was significantly higher in the language condition than in the music condition. We discuss the results in terms of manual specialization in relation to the development of hemispheric specialization.

Hammersmith Infant Neurological Examination Clinical Use to Recommend Therapist Assessment of Functional Hand Asymmetries

PURPOSE

To determine whether asymmetry scores derived from the Hammersmith Infant Neurological Examination (HINE) can provide cutoff scores for recommending in-depth assessment of upper extremity functional deficits by therapists using the Hand Assessment for Infants (HAI).

METHODS

Observational study in a clinical laboratory with the HINE and the HAI administered concurrently to 101 infants 3 to 12 months corrected age developing typically or atypically. Predictive value of HINE asymmetry scores for atypical HAI was determined.

RESULTS

Total HINE asymmetry scores of 4 or greater had 100% sensitivity and 88% or greater specificity for identifying infants with an asymmetric HAI score of 3 or greater point difference between hands.

CONCLUSIONS

For infants receiving a total HINE asymmetry score of 4 or greater, referral to therapists for HAI assessment may be beneficial to precisely evaluate function and determine the need for targeted upper extremity interventions.

Hand Movements in Communicative and Noncommunicative Situations in Very Young Infants: A Preliminary Study

As a step toward understanding the developmental relationship between handedness and language lateralization, this longitudinal study investigated how infants (N = 21) move their hands in noncommunicative and communicative situations at 2 weeks and at 3 months of age. The authors looked at whether left-right asymmetry in hand movements and in duration of self-touch appeared across conditions and whether the direction of asymmetry depended on the communicative nature of the situation. The authors found that asymmetries appeared less consistently than suggested in literature and did not only depend on the communicative nature of the situation. Instead, hand activity and self-touch patterns depended on age, the presence of the mother, the degree of novelty of the situation, and the presence of an object. The results partly support previous studies that pointed out an early differentiation of communicative hand movements versus noncommunicative ones in infants. It is in terms of the amount of global hand activity, rather than in those of the laterality of hand movements that this differentiation emerged in this study. At 3 months, infants moved their hands more in the communicative conditions than in the noncommunicative conditions and this difference appeared as a tendency already at 2 weeks of age.

3D Motion Capture May Detect Spatiotemporal Changes in Pre-Reaching Upper Extremity Movements with and without a Real-Time Constraint Condition in Infants with Perinatal Stroke and Cerebral Palsy: A Longitudinal Case Series

Perinatal stroke (PS), occurring between 20 weeks of gestation and 28 days of life, is a leading cause of hemiplegic cerebral palsy (HCP). Hallmarks of HCP are motor and sensory impairments on one side of the body—especially the arm and hand contralateral to the stroke (involved side). HCP is diagnosed months or years after the original brain injury. One effective early intervention for this population is constraint-induced movement therapy (CIMT), where the uninvolved arm is constrained by a mitt or cast, and therapeutic activities are performed with the involved arm. In this preliminary investigation, we used 3D motion capture to measure the spatiotemporal characteristics of pre-reaching upper extremity movements and any changes that occurred when constraint was applied in a real-time laboratory simulation. Participants were N = 14 full-term infants: N = six infants with typical development; and N = eight infants with PS (N = three infants with PS were later diagnosed with cerebral palsy (CP)) followed longitudinally from 2 to 6 months of age. We aimed to evaluate the feasibility of using 3D motion capture to identify the differences in the spatiotemporal characteristics of the pre-reaching upper extremity movements between the diagnosis group, involved versus uninvolved side, and with versus and without constraint applied in real time. This would be an excellent application of wearable sensors, allowing some of these measurements to be taken in a clinical or home setting.

Measuring infant handedness reliably from reaching: A systematic review

Researchers have utilized reaching paradigms to measure infant handedness for more than a century. However, methods vary widely. Recent research has identified that the number of trials used in assessment is critical with the recommendation that at least 15 trials are necessary to reliably classify infants into handedness categories via statistical cutoffs. As a first step towards establishing best practices for the field, we identified, categorized, and synthesized findings according to trial number from studies that utilized reaching to index handedness in infants across the first two years of life using PRISMA guidelines. Database searches were conducted in PsycINFO, PubMed, and Ovid MEDLINE®. All articles published through May 2018 were included. Additional records were identified through other sources. After removing duplicates, 1,116 records were screened using the online software program Abstrackr. Of these records, 125 full-text articles were further assessed for eligibility, and 87 articles were included in the qualitative synthesis. Results revealed that the majority of papers published since 1890 (70%) do not meet the 15-trial minimum criterion for statistically reliable measurement of infant handedness. Broad themes from articles meeting the measurement criterion and implications for future research are discussed.

Differences in coordination and timing of pre-reaching upper extremity movements may be an indicator of cerebral palsy in infants with stroke: A preliminary investigation

BACKGROUND

Neonatal stroke is a leading cause of hemiplegic cerebral palsy that occurs around the time of birth. Infants are diagnosed with cerebral palsy when motor impairments become clinically apparent, months or years after the stroke. Tools/methods for identifying high risk or diagnosis of cerebral palsy in infancy are improving.

METHODS

We measured spatial and temporal kinematics of pre-reaching upper extremity movements in 2-3 month old infants with neonatal stroke and typical development. We aimed to evaluate the feasibility of applying kinematics in this population and collect preliminary data to explore (1) if asymmetries are present in the infants with neonatal stroke, particularly those with a later diagnosis of cerebral palsy, and (2) to compare differences in the timing and coordination of their movements to infants with typical development, and infants with stroke and no cerebral palsy. Participants were 21 full-term infants, 10 with stroke (4 who later received a cerebral palsy diagnosis) age 72.1 (SD 9.3) days, and 11 typically developing, age 74.3 (SD 9.3) days.

FINDINGS

Results showed that infants with stroke and cerebral palsy demonstrated significant asymmetry in the average movement length (p = 0.0089) and hand path length (p = 0.0275) between their involved and uninvolved sides and moved less frequently (p = 0.09) and slower (p = 0.041) than infants with stroke and no cerebral palsy.

INTERPRETATION

Results suggest that kinematic analysis might detect asymmetries and motor impairment indicative of hemiplegic cerebral palsy earlier than current assessments and that asymmetry in speed, length and frequency of arm movements may be early indicators. This study is preliminary, limiting interpretation of the results.

A Naturalistic Observation of Spontaneous Touches to the Body and Environment in the First 2 Months of Life

Self-generated touches to the body or supporting surface are considered important contributors to the emergence of an early sense of the body and self in infancy. Both are critical for the formation of later goal-directed actions. Very few studies have examined in detail the development of these early spontaneous touches during the first months of life. In this study, we followed weekly four infants in two naturalistic 5-min sessions (baseline and toys-in-view) as they laid alert in supine from the age of 3 weeks until they acquired head control. We found that throughout the 2 months of observation, infants engaged in a high rate of touch and spent about 50% of the time moving their hands from one touch location to the next. On most sessions, they produced up to 200 body/surface contacts and touched as many as 18 different areas (mainly upper body and floor) both hands combined. When we did not consider the specific areas touched, the rates of touches were higher to the body than to the floor, but the duration of contacts and the most touched areas were higher for the supporting surface than for the body. Until the age of 9 weeks, we found no consistent differences in the rate of touch between head and trunk. Infants also did not display significant differences in their rate of touch between right and left hand or between conditions. However, we discovered that in the earlier weeks, infants engaged more often in what we called “complex touches.” Complex touches were touches performed across several body/floor areas in one continuous bout while the hand maintained contact with the body or floor. Single touches, in contrast, corresponded to one touch to one single body or floor area at a time. We suggest that infants are active explorers of their own body and peripersonal space from day 1 and that these early self-generated and deeply embodied sensorimotor experiences form the critical foundation from which future behaviors develop.

Developmental Trajectories of Hand Movements in Typical Infants and Those at Risk of Developmental Disorders: An Observational Study of Kinematics during the First Year of Life

Highlights

The kinematics of hand movements (spatial use, curvature, acceleration, and velocity) of infants with their mothers in an interactive setting

are significantly associated with age in cohorts of typical and at-risk infants

differ significantly at 5–6 months of age, depending on the context: relating either with an object or a person.

Environmental and developmental factors shape the developmental trajectories of hand movements in different cohorts: environment for infants with VIMs; stage of development for premature infants and those with West syndrome; and both factors for infants with orality disorders.

The curvature of hand movements specifically reflects atypical development in infants with West syndrome when developmental age is considered.

We aimed to discriminate between typical and atypical developmental trajectory patterns of at-risk infants in an interactive setting in this observational and longitudinal study, with the assumption that hand movements (HM) reflect preverbal communication and its disorders. We examined the developmental trajectories of HM in five cohorts of at-risk infants and one control cohort, followed from ages 2 to 10 months: 25 West syndrome (WS), 13 preterm birth (PB), 16 orality disorder (OD), 14 with visually impaired mothers (VIM), 7 early hospitalization (EH), and 19 typically developing infants (TD). Video-recorded data were collected in three different structured interactive contexts. Descriptors of the hand motion were used to examine the extent to which HM were associated with age and cohort. We obtained four principal results: (i) the kinematics of HM (spatial use, curvature, acceleration, and velocity) were significantly associated with age in all cohorts; (ii) HM significantly differed at 5–6 months of age in TD infants, depending on the context; (iii) environmental and developmental factors shaped the developmental trajectories of HM in different cohorts: environment for VIM, development for PB and WS, and both factors for OD and; (iv) the curvatures of HM showed atypical development in WS infants when developmental age was considered. These findings support the importance of using kinematics of HM to identify very early developmental disorders in an interactive context and would allow early prevention and intervention for at-risk infants.

Handedness and Reach-to-Place Kinematics in Adults: Left-Handers Are Not Reversed Right-Handers

The primary goal of this study was to examine the relations between limb control and handedness in adults. Participants were categorized as left or right handed for analyses using the Edinburgh Handedness Inventory. Three-dimensional recordings were made of each arm on two reach-to-place tasks: adults reached to a ball and placed it into the opening of a toy (fitting task), or reached to a Cheerio inside a cup, which they placed on a designated mark after each trial (cup task). We hypothesized that limb control and handedness were related, and we predicted that we would observe side differences favoring the dominant limb based on the dynamic dominance hypothesis of motor lateralization. Specifically, we predicted that the dominant limb would be straighter and smoother on both tasks compared with the nondominant limb (i.e., right arm in right-handers and left arm in left-handers). Our results only partially supported these predictions for right-handers, but not for left-handers. When differences between hands were observed, the right hand was favored regardless of handedness group. Our findings suggest that left-handers are not reversed right-handers when compared on interlimb kinematics for reach-to-place tasks, and reaffirm that task selection is critical when evaluating manual asymmetries.

Perinatal stroke causes abnormal trajectory and laterality in reaching during early infancy

The developmental progression of reaching and early signs of upper extremity neglect is common concern for infants at risk for hemiparesis and cerebral palsy. We investigated the emergence of reaching and laterality in infants at risk for hemiplegic cerebral palsy. Eight infants with perinatal stroke (PS) and thirteen infants with typical development (TD) were assessed bimonthly from 2 to 7 months of age for 10 visits per infant. Reaching number and hand-toy contact duration were measured. Infants with PS demonstrated a linear trajectory of reaching behaviors with asymmetrical upper extremity performance. Infants with TD demonstrated a linear and quadratic trajectory of reaching behaviors and symmetrical upper extremity performance over the same age range. These results suggest that infants with PS have delay reaching and early signs of neglect not currently accounted for in clinical practice.

Hand preference status and reach kinematics in infants

Infants show age-related improvements in reach straightness and smoothness over the first years of life as well as a decrease in average movement speed. This period of changing kinematics overlaps the emergence of handedness. We examined whether infant hand preference status is related to the development of motor control in 53 infants ranging from 11 to 14 months old. Hand preference status was assessed from reaching to a set of 5 objects presented individually at the infant's midline; infants were classified into 'right preference' or 'no preference' groups. Three-dimensional (3-D) recordings were made of each arm for reaches under two distinct conditions: pick up a ball and fit it into the opening of a toy (grasp-to-place task) or pick up a Cheerio® and consume it (grasp-to-eat task). Contrary to expectations, there was no effect of hand preference status on reach smoothness or straightness for either task. On the grasp-to-eat task only, average speed of the left hand differed as a function of hand preference status. Infants in the no preference group exhibited higher left hand average speeds than infants in the right preference group. Our results suggest that while behavioral differences in the use of the two hands may be present in some infants, these differences do not appear to be systematically linked to biases in motor control of the arms early in development.

Lateral manual asymmetries: a longitudinal study from birth to 24 months

Longitudinal studies tracking the early development of manual asymmetries are fairly rare compared to the large number of studies assessing hand preference in infancy. Moreover, most prior longitudinal studies have performed behavioral observation over relatively short-time spans considering the celerity of early development. This study aims (i) to investigate the direction and consistency of manual lateral asymmetries over a longer period, from birth to 24 months of age, and (ii) to compare individual and group trajectories to better understand discrepancies between prior studies. Nineteen healthy infants were observed eight times in tasks that were adjusted progressively as infants manual skills developed. Results suggested two distinct periods in terms of the direction, strength, and consistency of manual preference. First, infants went through an initial phase characterized by a lack of lateral manual asymmetries. From 9 months of age, however, group analyses revealed an emerging and steadily growing right lateral bias over time, while individual trajectories revealed that the group-level right-bias formed progressively from a background of highly fluctuating and highly variable developmental trajectories.

Longitudinal changes in muscle activity during infants' treadmill stepping

Previous research has described kinetic characteristics of treadmill steps in very stable steppers, in cross-sectional designs. In this study we examined, longitudinally, muscle activation patterns during treadmill stepping, without practice, in 12 healthy infants at 1, 6, and 12 mo of age. We assessed lateral gastrocnemius, tibialis anterior, rectus femoris, and biceps femoris as infants stepped on a treadmill during twelve 20-s trials. Infants showed clear changes in kinematics, such as increased step frequency, increased heel contact at touch down, and more flat-footed contact at midstance. Electromyographic data showed high variability in muscle states (combinations), with high prevalence of all muscles active initially, reducing with age. Agonist-antagonist muscle coactivation also decreased as age increased. Probability analyses showed that across step cycles, the likelihood a muscle was on at any point tended to be <50%; lateral gastrocnemius was the exception, showing an adultlike pattern of probability across ages. In summary, over time, healthy infants produce a wide variety of muscle activation combinations and timings when generating stepping patterns on a treadmill, even if some levels of muscle control arose with time. However, the kinematic stability improved much more clearly than the underlying kinetic strategies. We conclude that although innate control of limb movement improves as infants grow, explore, and acquire functional movement, stepping on a treadmill is a novel and unpracticed one. Hence, developing stable underlying neural activations will only arise as functional practice ensues, similarly to that observed for other functional movements in infancy.

Early manifestations of manual specialisation in infants: a longitudinal study from 20 to 30 weeks

This longitudinal study examined lateral differences between latency time of the two hands during the development of prehension in 12 infants from 20 to 30 weeks. Latency time (LT) is defined as the delay between the visual localisation of a reachable target and the beginning of the movement and could be considered as a phase in the preparation of action. If LT varies with the hand used and the type of movement, this would suggest differences in information processing (nature and/or quantity). Results show that the latency time is shorter for the left hand approach movements and shorter for the right hand grasping movements. These findings are in favour of a manual specialisation--clearly present from 20 weeks--and are discussed in a possible hemispheric specialisation perspective.

Kinematics of reaching and implications for handedness in rhesus monkey infants

Kinematic studies of reaching in human infants using two-dimensional (2-D) and three-dimensional (3-D) recordings have complemented behavioral studies of infant handedness by providing additional evidence of early right asymmetries. Right hand reaches have been reported to be straighter and smoother than left hand reaches during the first year. Although reaching has been a popular measure of handedness in primates, there has been no systematic comparison of left and right hand reach kinematics. We investigated reaching in infant rhesus monkeys using the 2-D motion analysis software MaxTRAQ Lite+ (Innovision Systems). Linear mixed-effects models revealed that left hand reaches were smoother, but not straighter, than right hand reaches. An early left bias matches previous findings of a left hand preference for reaching in adult rhesus monkeys. Additional work using this kind of kinematic approach will extend our understanding of primate handedness beyond traditional studies measuring only frequency or bouts of hand use.

On a multistable dynamic model of behavioral and perceptual infant development

In this theoretical work, we treat behavioral and perceptual issues on an equal footing and examine the emergence of mutually exclusive behavioral patterns and perceptual variables during infant development from the perspective of multistable competitive dynamic systems. Accordingly, behavioral modes and modes of perception compete with each other for activation. One and only one mode survives the mode-mode competition, which accounts for the incompatibility of modes being considered. However, the winning behavioral or perceptual state is not predefined. Rather, we argue that during particular stages of maturation multiple modes coexist for the same set of developmental, body-scaled, and environmental parameters or constraints. The winning behavioral or perceptual state depends on these parameters as well as on initial conditions as operationalized in terms of previously performed behaviors or utilized perceptual stimuli. We give explicit examples of our approach and address the emergence of two-handed grasping and catching movements and the emergence of monocular and binocular vision during infant development. In particular, we propose that the emergence of midline crossing movements in 3- to 6-month-old infants involves two independent but interaction control parameters: a body-scaled and a developmental one. Likewise, we argue that the onset of binocularity in infants involves two independent but interaction control parameters: a developmental and an environmental one.