Spatial and temporal postural analysis in children born prematurely

Assessing Postural Control From Birth to Adulthood Among Individuals Born Preterm: A Systematic Review

Premature life exposure, meaning an immature central nervous system, presents a significant challenge for the development of postural control and, in turn, overall motor development. Preventing motor delay thus requires identifying, characterizing, and quantifying deficit in postural control as early as possible. In our study, we reviewed the procedures used in past studies to assess postural control among individuals born preterm, specifically the characterization of participants, the instruments and motor tasks involved, the types of data collected and analyzed, and the outcomes. To that end, we performed a literature search on PubMed, Wiley Online Library, Web of Science, and Scopus using Boolean logic and assessed the quality of the studies with a standardized assessment based on the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Of 35 potential studies, 24 were included; all evaluated infants born preterm, but six did not include a control group of full-term infants. Although the heterogeneity of measurements, variability of instruments, and divergence in motor tasks examined limit definitive conclusions based on quantitative synthesis and the generalization of the results, most studies revealed dysfunctional postural control among individuals born preterm.

Early spontaneous movements and spatiotemporal gait characteristics in preterm children

This study aimed to analyze spatiotemporal gait characteristics of preterm children from 3 to 4 years of age according to different gestational age groups and to examine the relationship between the detailed general movements assessment and spatiotemporal gait characteristics. A total of 74 preterm children, 32 extremely preterm and very preterm (EP-VP, < 32 weeks gestational age) and 42 moderate to late preterm (MLP, 32 to < 37 weeks gestational age), were included in this prospective study, along with 38 term children. Early spontaneous movements of preterm children were assessed from videos at 9-20 weeks post-term according to the general movements assessment, which determines the Motor Optimality Score-Revised (MOS-R). The spatiotemporal gait characteristics of all children were evaluated using the GAITRite^®electronic walkway at self-selected walking speeds. EP-VP children walked with shorter step lengths (p = 0.039), and MLP children walked with greater step length variability (p = 0.003) than their term peers. The MOS-R results were related to step length (r = 0.36, p = 0.042), step length variability (r =  -0.56, p = 0.001), and base of support (r =  -0.37, p = 0.038) in EP-VP children. The MOS-R subcategories, age-adequate movement repertoire, and postural patterns were related to some of the spatiotemporal gait characteristics, including step length, step length variability, and base of support (p < 0.05).  Conclusion: EP-VP and MLP children might catch up to their term peers at 3 to 4 years of age in terms of most gait parameters. In addition to the MOS-R, age-adequate movement repertoire and postural patterns of preterm children without cerebral palsy in early life may be a marker of later neurodevelopmental dysfunction. What is Known: • Preterm children walk with a wider step width, a greater step length asymmetry and step time, and a shorter stride length at 18 to 22 months of age compared with term children at a self-selected speed, while these differences disappear in children 4.5-5 years old and older. What is New: • Early spontaneous movements were related to some spatiotemporal gait characteristics. • Preterm children might catch up to term children at 3-4 years of age in spatiotemporal gait characteristics while walking at a self-selected speed.

Assessment of the perception of vertical subjectivity in children born preterm

Children born preterm have increased rates of paediatric mortality and morbidity. Prematurity has been associated with impaired visual perception and visuo-motor integration. The alteration of the perception of verticality translates into alterations of the vestibular system at central and/or peripheral level, which may manifest itself in symptoms such as imbalance, dizziness or even vertigo. The aim of this study was to compare subjective visual vertical (SVV) test scores in children born preterm with those of children born at term at ages between 7 and 10. One hundred ten children with no neurodevelopmental disorder of 7 to 10 years of age were studied using a mobile application on a smartphone attached to a wall by means of a rotating plate. The SVV test was compared between two groups: a group of 55 preterm children (53 very preterm children born under 32 weeks of gestational age and 2 preterm with very low birth weight) and another group of 55 children born at term (after 37 weeks of gestational age). The SVV results were analysed for comparison with respect to prematurity, sex and age. We found no significant differences in the SVV study in the comparison between preterm and term children. In addition, no significant differences were observed regarding sex or age between 7 and 10 years.  Conclusion: We found no alterations in the perception of vertical subjectivity in children between 7 and 10 years of age, with antecedents of very preterm birth and/or very low birth weight. What is Known: • The different studies published so far suggest the existence of balance disorders in premature children, although in most of these studies the children are examined at an age when the vestibular system is not mature and with non-specific tests for the study of the vestibular system. What is New: • We compared the results of the subjective visual vertical (SVV) test in a group of 55 preterm children (53 very preterm children born under 32 weeks of gestational age and 2 preterm with very low weight at birth) and in a group of 55 children born at term (after 37 weeks of gestational age), at the ages of 7 to 10 years and observed no differences. • We conclude that, if there had been any vestibular alterations due to very premature birth, these must have been compensated by the age of 7.

Influence of body mobility on attention networks in school-aged prematurely born children: A controlled trial

School-aged prematurely born children (PC) have a higher risk of academic difficulties, which may be partly explained by attention difficulties. It has been suggested that children's attentional performance might be influenced by their body posture and spontaneous body motion. The aim of this study (ClinicalTrials.gov - NCT03125447) was to test the influence of three body mobility conditions on the three functions of attention (alertness, orienting, and executive control) among school-aged PC vs. term-born children (TC). Notably, 21 PC and 21 TC performed the Attention Network Test for Children in three body mobility conditions, namely, sitting and standing imposed fixed postures and a free-to-move condition. The children's median reaction times were compared between trials (1) with and without alerting cues, (2) with valid and invalid orienting cues, and (3) with and without distracting information, to calculate the performance of alertness, orienting, and executive control, respectively. Results showed that with distracting information, PC exhibited significantly slower responses in the standing-still posture than in the sitting-still posture (1,077 ± 240 vs. 1,175 ± 273 ms, p < 0.05), but not TC. No difference was observed with the free-to-move condition. PC and TC did not significantly differ in alertness or orienting, regardless of body mobility condition. These data suggest that PC must use executive resources to stand still and maintain position, which impairs their performance during executive tasks. We speculate that these results may be related to less developed postural control and motor inhibition in PC.

The influence between gestational age and postural control, a systematic review

The central nervous system (CNS) of preterm infants might have some peculiarities which distinguish it from that of full term infants. The difficulties associated with prematurity are the main cause of deaths all over the world during the new-born period after community-acquired pneumonia, and the second cause of deaths worldwide in children under five years old. Early recognition of signs indicating fragile postural control in premature infants can support understanding and help prevent and early intervention on possible future neuromotor dysfunctions in these subjects. The purpose of this paper is to determine if there is a qualitatively different development of postural control in premature infants without neurological involvement and infants born at term. We conducted a systematic review of longitudinal and cross-sectional case-control studies published between 2010 and March 2020 on this topic. The evaluation of parameters related to postural control was also included. The methodological quality of the selected works was evaluated using the CASPe critical reading programme for cases and controls. PRISMA guidelines for systematic reviews were followed for prematurity and postural control. 16 articles were included. The total sample amounted to 3,460 participants, of which 1,860 in the preterm group, and 1,600 in the control group. All the studies found show a poorer postural control by the group of children born preterm compared to the group of children born at term and one study indicating more limited postural control with higher prematurity. Regarding the methodological quality according to CASPe, those studies exceeding half of the total score were considered of adequate quality.

What Do We Know About Motor Development of Preterm Children Without Major Neurological Damage and Disorder? A Narrative Review

This review addresses the question of a possible specificity of motor development of preterm children with no diagnosis of neurological impairment or major cerebral lesion. With that goal, we proceed with a narrative review on the basis of nine studies. All the studies used standardized assessments of motor abilities with a comparison methodology of preterm and full-term groups aged between 3 and 8 years. The review stresses three major findings in the preterm groups as compared with the full-term groups: (a) inferior fine motor abilities; (b) heterogeneity in motor skills; and (c) differences in efficiency of cognitive, perceptual, and mobilization of perceptual motor processes, which do not necessarily result in lower scores in global performances. These findings suggest the need of long-term medical follow-up for all preterm children whether or not they are at risk for neurodevelopmental disorder. Focusing attention on the use of sensory information for motor control in preterm children could also lead to more precise evaluations of motor abilities, which will then provide more detailed parameters for improved learning and rehabilitation programs.

A Mathematical Model to Examine Issues Associated With Using Portable Force-Measurement Technologies to Collect Infant Postural Data

Portable force-measurement technologies are becoming increasingly popular tools to examine the maturation of postural motor milestones, such as sitting and standing, in infants. These convenient, low-cost devices provide numerous opportunities to characterize postural development outside of the laboratory. However, it is important to understand the unique challenges and technical limitations associated with collecting center of pressure (CoP) data using portable force-measurement technologies in infant populations. This study uses a mathematical model to examine issues that emerge when using portable force-measurement technologies to collect sitting and standing postural data in infants. The results of our mathematical simulations demonstrate that the CoP errors from portable force-measurement technologies depend on the posture examined (e.g., sitting vs. standing), the anthropometrics of the person (e.g., height and weight), the frequency of body sway, and the experimental setup (e.g., an additional support surface being placed on top of the device). Recommendations are provided for developmental researchers interested in adopting these technologies in infant populations.

Body Posture Asymmetry in Prematurely Born Children at Six Years of Age

Aims

The purpose of the study was to assess body posture asymmetries in the standing and sitting position in prematurely born children at six years of age.

Study Design and Subjects

We measured trunk symmetry in coronal plane. The study was carried out in a group of 101 children, aged 6-7 years, mean age of 6.63, including 50 preterm children born at gestational age <32 weeks (preterm group) and 51 full-term children (control group).

Outcome Measures

Trunk symmetry in coronal plane was measured using photogrammetric technique with Mora 4G CQ Elektronik. The subjects were examined in standing and sitting position. Statistical analyses were carried out using Shapiro-Wilk W-test, Student's t-test, Mann–Whitney U test, and Pearson's chi-squared test. Statistical significance was assumed at p < 0.05.

Results

No significant differences were found between the groups in the asymmetries identified in the relevant anthropometric points, relative to the position assumed during the examination or to the subjects' sex.

Conclusions

There are no significant differences in body posture in the coronal plane, between preterm children and full-term children. Premature birth does not have adverse effects related to body posture asymmetry in preterm children at the age of six.