Not just playing around: infants' behaviors with objects reflect ability, constraints, and object properties

Embedding Play to Enrich Physical Therapy

Play is an active process by which an individual is intrinsically motivated to explore the self, the environment, and/or interactions with another person. For infants and toddlers, engaging in play is essential to support development across multiple domains. Infants and toddlers with or at risk of motor delays may demonstrate differences in play or challenges with engaging in play activities compared to typically developing peers. Pediatric physical therapists often use play as a modality to engage children in therapeutic assessment and interventions. Careful consideration of the design and use of physical therapy that embeds play is needed. Following a 3-day consensus conference and review of the literature, we propose physical therapy that embeds play should consider three components; the child, the environment, and the family. First, engage the child by respecting the child's behavioral state and following the child's lead during play, respect the child's autonomous play initiatives and engagements, use activities across developmental domains, and adapt to the individual child's needs. Second, structure the environment including the toy selection to support using independent movements as a means to engage in play. Allow the child to initiate and sustain play activities. Third, engage families in play by respecting individual family cultures related to play, while also providing information on the value of play as a tool for learning. Partner with families to design an individualized physical therapy routine that scaffolds or advances play using newly emerging motor skills.

Exploring development of infant gaze, affect, and object exploration in a primarily Latino sample

Infants demonstrate rapid development across the first years of life, which underlies increased human interactions that promote social-emotional development. In particular, gaze, affect, and object exploration are early indicators of engagement and show rapid changes in the first year of life. However, current understanding on developmental trajectories during infancy often comes from majority white, non-Hispanic/Latino samples. This longitudinal study explored the development of infant gaze, affect, and object exploration across 2-18 months of age in a sample of primarily Latino infants drawn from a pediatric community clinic. Videos of mother-infant play when infants were 2, 6, 9, 12 and 18 months were coded for durations of three types of behaviors: gaze, affect, and object exploration. Additionally, mother-infant play videos when the infant was 24 months of age were coded for joint engagement. Descriptive statistics for the three behavior types were obtained at each timepoint, and repeated measures analysis of covariance investigated the development of behaviors from timepoint to timepoint. Latent growth curve analyses were conducted to analyze developmental trajectories of capacities across 2-18 months, as well as development in relation to joint engagement at 24 months. Results indicate an important development period from 2 to 6 months of infants' life, unique developmental patterns of specific behaviors, and heterogeneity in gaze development in the sample and across ages. Overall, this study provides an important description of development within mother-infant play in a primarily Latino sample.

Developing language in a developing body, revisited: The cascading effects of motor development on the acquisition of language

In the first years of life, infants rapidly acquire a series of new motor skills. They learn to sit independently, to walk with skill, and to engage in a wide variety of interactions with objects. Over these same years, infants also begin to develop language. These are not isolated events. In a complex developing system, even small changes in one domain can have far-reaching effects on development in other domains. This is the fundamental idea behind the rich framework known as the developmental cascades perspective. Here we employ this framework to show how early motor advances can exert downstream effects on the development of language. Focusing first on the emergence of independent sitting, then on the development of walking, and finally on changes in the ways in which infants act on and combine actions on objects, we describe how the nature and quality of infant actions change dramatically over the first few years and how this brings with it new possibilities for engaging the environment, more sophisticated ways of interacting with people, and significant alterations in communications directed by caregivers to the infant and coordinated with infant action in time and in meaning. The developmental cascades framework provides an approach for understanding how advances in motor skills influence communicative and language development, and more generally, for conceptualizing the constant, dynamic, and complex interplay between developing infants and their environments as it unfolds over time. This article is categorized under: Linguistics > Language Acquisition Psychology > Motor Skill and Performance Psychology > Development and Aging.

The Effect of START-Play Intervention on Reaching-Related Exploratory Behaviors in Children with Neuromotor Delays: A Secondary Analysis of a Randomized Controlled Trial

AIMS

Children with neuromotor delays are at risk for reaching and object exploration impairments, which may negatively affect their cognitive development and daily activity performance. This study evaluated the effectiveness of the Sitting Together And Reaching To Play (START-Play) intervention on reaching-related exploratory behaviors in children with neuromotor delays.

METHODS

In this randomized controlled clinical trial, 112 children (Mean = 10.80, SD = 2.59 months old at baseline) with motor delays were randomly assigned to receive START-Play intervention or usual care-early intervention. Performance for ten reaching-related exploratory behaviors was assessed at baseline and 1.5, 3, 6, 12 months post-baseline. Piecewise linear mixed-effects modeling was used to evaluate short- and long-term effects of the intervention.

RESULTS

Benefits of START-Play were observed for children with significant motor delays, but not for those with mild delays. START-Play was especially beneficial for children with significant motor delays who demonstrated early mastery in the reaching assessment (i.e., object contact ≥65% of the time within 3 months after baseline); these children showed greater improvements in manual, visual, and multimodal exploration, as well as intensity of exploration across time.

CONCLUSIONS

START-Play advanced the performance of reaching-related exploratory behaviors in children with significant motor delays.

Manual exploratory behaviors in six-month-old infants at environmental and biological risk

BACKGROUND

Exploratory behaviors are essential and may improve different skill development. Different risk factors may negatively impact neuromotor development, such as biological risk and environmental risk.

OBJECTIVE

Assess and discriminate exploratory behaviors of infants at environmental or biological risk and infants at non-risk.

METHODS

Sixty-four six-month-old infants were divided into three independent groups: Group 1 (G1), 28 healthy full-term infants; Group 2 (G2), 21 full-term infants of low socioeconomic status (SES); Group 3 (G3), 15 very preterm infants. Nine exploratory behaviors were assessed: fingering, mouthing, waving, tapping, banging, transferring, rotating, alternating, and squeezing.

RESULTS

For the malleable object, fingering (p = 0.005) and transferring (p = 0.046) behaviors were different between G2 and G3 whereas waving behavior (p = 0.041) differed between G1 and G3 and transferring (p = 0.003) between G1 and G2. For the rigid object, waving was different between G1 and G3 (p = 0.018) whereas transferring behavior differed between G2 and G3 (p = 0.019). Total number of behaviors was significantly different between G1 and G2 for malleable (p = 0.019) and rigid objects (p = 0.009). Intragroup analysis revealed differences between malleable and rigid objects for transferring (p = 0.013), squeezing (p < 0.0001), fingering (p < 0.0001), and banging (p = 0.013) behaviors in infants from G1. Fingering and squeezing (p < 0.0001) were different between malleable and rigid objects in G2 (p = 0.009 and p < 0.0001) and G3 (p = 0.004 and p < 0.0001).

CONCLUSION

Risk factors and object properties influence exploratory behaviors, mainly in low SES infants. Fingering and banging behaviors are favored by rigid objects, while squeezing is favored by malleable objects.

A model for using developmental science to create effective early intervention programs and technologies to improve children's developmental outcomes

Children born with a variety of environmental or medical risk factors may exhibit delays in global development. Very often, such delays are identified at preschool or school age, when children are severely overdue for effective early interventions that can alleviate the delays. This chapter proposes a conceptual model of child development to inform the creation of interventions and rehabilitative technologies that can be provided very early in development, throughout the first year of life, to optimize children's future developmental outcomes. The model suggests that early sensorimotor skills are antecedent and foundational for future motor, cognitive, language, and social development. As an example, this chapter describes how children's early postural control and exploratory movements facilitate the development of future object exploration behaviors that provide enhanced opportunities for learning and advance children's motor, cognitive, language, and social development. An understanding of the developmental pathways in the model can enable the design of effective intervention programs and rehabilitative technologies that target sensorimotor skills in the first year of life with the goal of minimizing or ameliorating the delays that are typically identified at preschool or school age. Specific examples of early interventions and rehabilitative technologies that have effectively advanced children's motor and cognitive development by targeting early sensorimotor skills and behaviors are provided.

Posture Matters: Object Manipulation During the Transition to Arms-Free Sitting in Infants at Elevated vs. Typical Likelihood for Autism Spectrum Disorder

Aims: We investigated how infants grasped and transferred toys over a four-week period as they transitioned to arms-free sitting. We compared object manipulation in infants with typical likelihood (TL) and elevated likelihood (EL) for autism spectrum disorder (ASD) as they sat with vs. without support.Methods: Eighteen infants (7 EL; 11 TL; 5-8 months of age at the start of the study) were observed during three sessions at home across the transition to arms-free sitting. At each session, toys were presented to the infants in two different postures: sitting with support from a boppy pillow and sitting independently. Mean percentage of time spent grasping and rates of transferring objects between two hands were calculated for each infant at each session.Results: Both grasping time and transfer rate increased across the transition to arms-free sitting. EL infants, but not TL infants, spent significantly less time grasping toys when sitting independently than when sitting with support.Conclusions: Sitting plays a significant role in the development of object manipulation skills. Our results reveal a need to examine object manipulation skills in multiple posture contexts, especially in infants who exhibit motor delays.

Early motor skills predict the developmental trajectory of problem solving in young children with motor delays

INTRODUCTION

The purpose of this study was to quantify the relationship between early motor skills, such as sitting, and the development of problem-solving skills in children with motor delays.

METHODS

Motor (Gross Motor Function Measure) and problem-solving (Assessment of Problem-Solving in Play) skills of 134 children 7-16 months adjusted age at baseline with motor delay were assessed up to 5 times over 12 months. Participants were divided into two groups: mild and significant motor delay.

RESULTS

Motor and problem-solving scores had large (r's = 0.53-0.67) and statistically significant (p's > .01) correlations at all visits. Baseline motor skills predicted baseline and change in problem solving over time. The associations between motor and problem-solving skills were moderated by level of motor delay, with children with significant motor delay generally having stronger associations compared to those with mild motor delay.

CONCLUSIONS

These findings suggest that overall baseline motor skills are predictive of current and future development of problem-solving skills and that children with significant motor delay have a stronger and more stable association between motor and problem-solving skills over time. This highlights that children with motor delays are at risk for secondary delays in problem solving, and this risk increases as degree of motor delay increases.

Does late preterm birth impact trunk control and early reaching behavior?

The aims of the study were to 1) verify the level of trunk control longitudinally and reaching behavior while sitting in two positions in late preterm (LPT) and full-term (FT) infants, 2) determine whether the level of trunk control relates to reaching outcomes. Twenty LPT infants and 36 infants born FT were assessed via three in-lab visits: at 6, 7, and 8 months. At each visit, the Segmental Assessment of Trunk Control (SATCo) and reaching assessment were performed, where the infants were positioned sitting in the ring and at 90° of flexion of hips, knees, and ankles. Accurate manual support to the trunk was provided in each visit. LPT infants presented a lower level of trunk control over time. LPT infants presented a higher percentage of unimanual reaches and successful grasping at 7 months' visit, and a higher number of reaches at 8 months' visit compared to FT infants. The sitting positions did not influence reaching performance. The level of trunk control relates to functional reaching strategies only in FT infants. This study might provide insights for clinicians for understanding the level of trunk control, the importance of reaching behaviors for exploration, and considering these behaviors as strategies for intervention.

Measuring Early Problem-Solving in Young Children with Motor Delays: A Validation Study

AIM

There is a lack of evidence-based tools for measuring problem-solving in young children with motor delays. The purpose of this study was to evaluate the construct validity and responsiveness of the Assessment of Problem-Solving in Play.

METHODS

125 young children (10.72, SD 2.62 months) with mild, moderate, and severe motor delays were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition Cognitive Scale and the Assessment of Problem-Solving in Play up to 4 times over 12 months. The baseline and change over time assessment scores were compared.

RESULTS

The Assessment of Problem-Solving in Play was strongly, positively correlated with the Bayley Scales of Infant and Toddler Development, Third Edition Cognitive Scale raw scores at baseline (r=.83, p<.001) and for changes in scores across time (r=.64, p<.001). On average, participants demonstrated positive change in problem-solving scores across time. Participants with severe motor delay scored lower at baseline and changed less as compared to other participants.

CONCLUSIONS

Results provide evidence for the construct validity and responsiveness of the Assessment of Problem-Solving in Play scores in quantifying problem-solving in young children with motor delays 7-27 months of age.

The positive influence of manual object exploration on predictive grasping for a moving object in 9-month-old infants

The present study examined whether infants' manual prediction ability is related to different types of their manual object exploration behavior. Thirty-two 9-month-old infants were tested in a manual prediction task, in which they were encouraged to reach for a temporarily occluded moving object. All infants also participated in a manual exploration task, in which they could freely explore five toy blocks. Infants with a high number of haptic scans in the manual exploration task showed a higher prediction rate in the manual prediction task compared to infants with a low haptic scan score. Reaction times of all infants decreased during the test blocks. However, the reaction time of infants with a high haptic scan score was faster in general. Our findings suggest that object experiences gathered by specific manual exploratory actions, such as haptic scans, are related to infants' predictive abilities when reaching and grasping for a temporarily occluded moving object.

Object interaction and walking: Integration of old and new skills in infant development

Manual skills such as reaching, grasping, and exploring objects appear months earlier in infancy than locomotor skills such as walking. To what extent do infants incorporate an old skill (manual actions on objects) into the development of a new skill (walking)? We video recorded 64 sessions of infants during free play in a laboratory playroom. Infants' age (12.7-19.5 months), walking experience (0.5-10.3 months), and walking proficiency (speed, step length, etc.) varied widely. We found that the earlier developing skills of holding and exploring objects are immediately incorporated into the later developing skill of walking. Although holding incurred a reliable cost to infants' gait patterns, holding and exploring objects in hand were relatively common activities, and did not change with development. Moreover, holding objects was equally common in standing and walking. However, infants did not interact with objects indiscriminately: Object exploration was more frequent while standing than walking, and infants selectively chose lighter objects to carry and explore. Findings suggest that the earlier appearance of some skills may serve to motivate and enrich later appearing skills.

Changes in Posture and Interactive Behaviors as Infants Progress From Sitting to Walking: A Longitudinal Study

This longitudinal study assessed how infants and mothers used different postures and modulated their interactions with their surroundings as the infants progressed from sitting to walking. Thirteen infants and their mothers were observed biweekly throughout this developmental period during 10 min laboratory free-play sessions. For every session, we tracked the range of postures mothers and infants produced (e.g., sitting, kneeling, and standing), we assessed the type of interactions they naturally engaged in (no interactions, passive involvement, fine motor manipulation, or gross motor activity), and documented all target transitions. During the crawling transition period, when infants used sitting postures, they engaged mainly in fine motor manipulations of targets and often maintained their activity on the same target. As infants became mobile, their rate of fine motor manipulation declined during sitting but increased while kneeling/squatting. During the walking transition, their interactions with targets became more passive, particularly when sitting and standing, but they also engaged in greater gross motor activity while continuing to use squatting/kneeling postures for fine motor manipulations. The walking period was also marked by an increase in target changes and more frequent posture changes during object interactions. Throughout this developmental period, mothers produced mainly no or passive activity during sitting, kneeling/squatting, and standing. As expected, during this developmental span, infants used their body in increasingly varied ways to explore and interact with their environment, but more importantly, progression in posture variations significantly altered how infants manually interacted with their surrounding world.

Differences in means-end exploration between infants at risk for autism and typically developing infants in the first 15 months of life

Our study compared means-end exploration in infants at risk (AR) for autism and typically developing (TD) infants using a nested box paradigm. Sixteen AR and 16 TD infants were observed at 9, 12, and 15 months with follow-up at 18 and 24 months. We collected video data on three tasks involving retrieval of a small toy by opening (a) an opaque box, (b) a transparent box, and (c) two nested boxes. Dependent variables included hand bias, time to completion, bilateral hand use, problem-solving strategies used, and tester assistance required. There were no group differences in terms of hand biases. Compared to TD infants, AR infants had lower bilateral hand use, poor problem solving skills, and required greater assistance. Both groups demonstrated age-related improvements in motor and cognitive skills. Means-end exploration provides a window into the bilateral coordination and motor planning/problem-solving abilities of young infants at risk for autism. Lastly, object retrieval tasks could serve as important learning contexts for at-risk infants.

Does early object exploration support gesture and language development in extremely preterm infants and full-term infants?

BACKGROUND

An increasing body of research on typically and atypically developing infants has shown that motor skills play an important role in language development. To date, however, the role of specific object exploration skills for early gesture and vocabulary development has not been investigated in extremely low gestational age infants (ELGA, GA < 28 weeks), who are at greater risk for motor and language delays than full-term (FT) infants.

PURPOSE

This longitudinal study examined relations between 6-month active exploratory behaviors and 12- month word comprehension, gestures and vocal production, controlling for cognitive performance and neonatal condition (ELGA vs FT).

METHODS

Forty infants, 20 ELGA and 20 FT, and their mothers participated in the study. Mother-infant play interaction was video-recorded at 6 and 12 months. Oral and manual object exploration at 6 months and spontaneous gestures and vocal production at 12 months were coded. Word comprehension was evaluated with the Italian version of the MacArthur-Bates CDI parent questionnaire at 12 months. Cognitive performance was examined with the Griffiths Mental Developmental Scales at 6 months and the Bayley-III Scales at 12 months.

RESULTS

Regression analyses showed that after accounting for cognitive performance and neonatal condition, oral exploration was related to word comprehension, and manual exploration to gestures and vocal production in the overall sample.

CONCLUSIONS

Cascading effects of specific object exploration skills on gestures and language comprehension and production in preterm infants and FT infants are discussed. Clinical implications for early assessment of and interventions involving object exploration skills, which may affect language development, are considered for the preterm population.

Sitting Together And Reaching To Play (START-Play): Protocol for a Multisite Randomized Controlled Efficacy Trial on Intervention for Infants With Neuromotor Disorders

BACKGROUND

There is limited research examining the efficacy of early physical therapy on infants with neuromotor dysfunction. In addition, most early motor interventions have not been directly linked to learning, despite the clear association between motor activity and cognition during infancy.

OBJECTIVE

The aim of this project is to evaluate the efficacy of Sitting Together And Reaching To Play (START-Play), an intervention designed to target sitting, reaching, and motor-based problem solving to advance global development in infants with motor delays or neuromotor dysfunction.

DESIGN

This study is a longitudinal multisite randomized controlled trial. Infants in the START-Play group are compared to infants receiving usual care in early intervention (EI).

SETTING

The research takes place in homes in Pennsylvania, Delaware, Washington, and Virginia.

PARTICIPANTS

There will be 140 infants with neuromotor dysfunction participating, beginning between 7 to 16 months of age. Infants will have motor delays and emerging sitting skill.

INTERVENTION

START-Play provides individualized twice-weekly home intervention for 12 weeks with families to enhance cognition through sitting, reaching, and problem-solving activities for infants. Ten interventionists provide the intervention, with each child assigned 1 therapist.

MEASUREMENTS

The primary outcome measure is the Bayley III Scales of Infant Development. Secondary measures include change in the Early Problem Solving Indicator, change in the Gross Motor Function Measure, and change in the type and duration of toy contacts during reaching. Additional measures include sitting posture control and parent-child interaction.

LIMITATIONS

Limitations include variability in usual EI care and the lack of blinding for interventionists and families.

CONCLUSIONS

This study describes usual care in EI across 4 US regions and compares outcomes of the START-Play intervention to usual care.

Cognition-Action Trade-Offs Reflect Organization of Attention in Infancy

This chapter discusses what cognition-action trade-offs in infancy reveal about the organization and developmental trajectory of attention. We focus on internal attention because this aspect is most relevant to the immediate concerns of infancy, such as fluctuating levels of expertise, balancing multiple taxing skills simultaneously, learning how to control attention under variable conditions, and coordinating distinct psychological domains. Cognition-action trade-offs observed across the life span include perseveration during skill emergence, errors and inefficient strategies during decision making, and the allocation of resources when attention is taxed. An embodied cognitive-load account interprets these behavioral patterns as a result of limited attentional resources allocated across simultaneous, taxing task demands. For populations where motor errors could be costly, like infants and the elderly, attention is typically devoted to motor demands with errors occurring in the cognitive domain. In contrast, healthy young adults tend to preserve their cognitive performance by modifying their actions.

Object exploration in extremely preterm infants between 6 and 9 months and relation to cognitive and language development at 24 months

Although early object exploration is considered a key ability for subsequent achievements, very few studies have analyzed its development in extremely low gestational age infants (ELGA- GA <28 weeks), whose early motor skills are delayed. Moreover, no studies have examined its developmental relationship with cognitive and language skills. The present study examined developmental change in Motor Object Exploration (MOE) and different types of MOE (Holding, Oral, Manual and Manual Rhythmic Exploration) in 20 ELGA and 20 full term (FT) infants observed during mother-infant play interaction at 6 and 9 months. It also explored whether specific types of MOE were longitudinally related to 24-month language and cognitive abilities (GMDS-R scores). ELGA infants increased MOE duration from 6 to 9 months, eliminating the initial difference with FT infants. In addition, ELGA infants showed a different pattern of Oral Exploration, that did not increase at 6 months and decrease at 9 months. Oral and Manual Exploration durations at 6 months were longitudinally related to 24-month GMDS-R language and cognitive performance scores respectively. We discuss the relevance of assessing early exploratory abilities in ELGA infants in order to implement customized intervention programs for supporting the development of these skills.

Predicting motor outcomes with 3 month prone hip angles in premature infants

PURPOSE

This study used kinematic analysis to identify a reliable and rapid assessment method for abnormal patterns of motor development in preterm infants.

METHODS

In a retrospective analysis, we examined video of n= 35 preterm infants at 3mo corrected age (CA) who had concurrent Test of Infant Motor Performance (TIMP) scores. Hyperflexion at the hip produces common gait anomalies seen in children with CP, therefore we analyzed hip angle in the prone head lift position at 3 months CA. Magnetic Resonance Spectroscopy (MRS) was performed at term equivalent (n= 23) and Bayley-III neurodevelopmental tests were performed at 1 year (n= 28). We correlated hip angles with TIMP and Bayley-III scores, and MRS neuronal metabolites.

RESULTS

Hip angle positively correlated with TIMP at 3 months (r= 0.642, p≤ 0.001), but not with Bayley-III at 1 year (r= 0.122, p= 0.529). Hip angle correlated negatively with myo-inositol (mI) ratios in frontal white matter tracts (mI/Cr r= -0.520, p= 0.011).

CONCLUSIONS

These results suggest prone hip angle may be a quantitative proxy for the 42-item TIMP at 3 months, and that hypertonicity in the hip flexor musculature is a manifestation of white matter metabolic abnormalities (elevated mI ratios) that may indicate occult white matter injury.

Associations between gross motor and communicative development in at-risk infants

Infants' advances in locomotion relate to advances in communicative development. However, little is known about these relations in infants at risk for delays in these domains and whether they may extend to earlier achievements in gross motor development in infancy. We examined whether advances in sitting and prone locomotion are related to communicative development in infants who have an older sibling with autism spectrum disorder (ASD) and are at risk for motor and communication delays (heightened-risk; HR). We conducted a longitudinal study with 37 HR infants who did not receive an ASD diagnosis at 36 months. Infants were observed monthly between the ages of 5 and 14 months. We assessed gross motor development using the Alberta Infant Motor Scales (AIMS) and recorded ages of onset of verbal and nonverbal communicative behaviors. Results indicated increased presence of early gross motor delay from 5 to 10 months. In addition, there were positive relations between sitting and gesture and babble onset and between prone development and gesture onset. Thus, links between gross motor development and communication extend to at-risk development and provide a starting point for future research on potential cascading consequences of motor advances on communication development.

Infant born preterm have delayed development of adaptive postural control in the first 5 months of life

Infants born preterm are at increased risk of developmental disabilities, that may be attributed to their early experiences and ability to learn. The purpose of this paper was to evaluate the ability of infants born preterm to adapt their postural control to changing task demands.

METHODS

This study included 18 infants born at 32 weeks of gestation or less whose posture was compared in supine under 2 conditions, with and without a visual stimulus presented. The postural variability, measured with root mean squared displacement of the center of pressure, and postural complexity, measured with the approximate entropy of the center of pressure displacement were measured longitudinally from 2.5 to 5 months of age.

RESULTS AND DISCUSSION

The infants looked at the toys in midline for several months prior to adapting their postural variability in a manner similar to full term infants. Only after postural variability was reduced in both the caudal cephalic and medial lateral direction in the toy condition did the infants learn to reach for the toy. Postural complexity did not vary between conditions. These findings suggest that infants used a variety of strategies to control their posture. In contrast to research with infants born full term, the infants born preterm in this study did not identify the successful strategy of reducing movement of the center of pressure until months after showing interest in the toy. This delayed adaptation may impact the infants ability to learn over time.

Feasibility and Effectiveness of a Novel Exoskeleton for an Infant With Arm Movement Impairments

PURPOSE

To determine whether a novel exoskeletal device (Pediatric-Wilmington Robotic Exoskeleton [P-WREX]) is feasible and effective for intervention to improve reaching and object interaction for an infant with arm movement impairments.

METHODS

An 8-month old infant with arthrogryposis was followed up every 2 weeks during a 1-month baseline, 3-month intervention, and 1-month postintervention. At each visit, reaching and looking behaviors were assessed.

RESULTS

Within sessions, the infant spent more time contacting objects across a larger space, contacting objects with both hands, and looking at objects when wearing the P-WREX. Throughout intervention, the infant increased time contacting objects both with and without the device and increased bilateral active shoulder flexion.

CONCLUSIONS

(1) It may be feasible for families to use exoskeletons for daily intervention, (2) exoskeletons facilitate immediate improvements in function for infants with impaired upper extremity mobility, and (3) interventions using exoskeletons can improve independent upper extremity function across time.

Assessment Position Affects Problem-Solving Behaviors in a Child With Motor Impairments

PURPOSE

The purpose of this report was to examine problem-solving behaviors of a child with significant motor impairments in positions she could maintain independently, in supine and prone positions, as well as a position that required support, sitting.

CASE DESCRIPTION

The child was a 22-month-old girl who could not sit independently and had limited independent mobility. Her problem-solving behaviors were assessed using the Early Problem Solving Indicator, while she was placed in supine or prone position, and again in manually supported sitting position.

RESULTS

In manually supported sitting position, the subject demonstrated a higher frequency of problem-solving behaviors and her most developmentally advanced problem-solving behavior.

CLINICAL IMPLICATIONS

Because a child's position may affect cognitive test results, position should be documented at the time of testing.

Characterization and intervention for upper extremity exploration & reaching behaviors in infancy

This article aims to: 1) highlight general exploration, reaching, and object exploration behaviors as key activities of daily living in infancy, 2) describe how knowledge of early warning signs for these behaviors may improve early assessment, and 3) discuss interventions that may advance performance of these behaviors. Early intervention should focus on improving performance of these behaviors because: a) these early, interrelated upper extremity behaviors serve an integral role in global learning and development in infancy, b) among at-risk populations, differences have been observed in the quantity and quality of performance of these behaviors and, in many cases, these differences are associated with related perceptual-motor and cognitive delays. This article highlights how early assessment and intervention can target these key early behaviors in populations at risk for upper extremity disabilities, such as those born preterm, with Down syndrome, brachial plexus palsy, or arthrogryposis multiplex congentia.

Independent development of the Reach and the Grasp in spontaneous self-touching by human infants in the first 6 months

The Dual Visuomotor Channel Theory proposes that visually guided reaching is a composite of two movements, a Reach that advances the hand to contact the target and a Grasp that shapes the digits for target purchase. The theory is supported by biometric analyses of adult reaching, evolutionary contrasts, and differential developmental patterns for the Reach and the Grasp in visually guided reaching in human infants. The present ethological study asked whether there is evidence for a dissociated development for the Reach and the Grasp in nonvisual hand use in very early infancy. The study documents a rich array of spontaneous self-touching behavior in infants during the first 6 months of life and subjected the Reach movements to an analysis in relation to body target, contact type, and Grasp. Video recordings were made of resting alert infants biweekly from birth to 6 months. In younger infants, self-touching targets included the head and trunk. As infants aged, targets became more caudal and included the hips, then legs, and eventually the feet. In younger infants hand contact was mainly made with the dorsum of the hand, but as infants aged, contacts included palmar contacts and eventually grasp and manipulation contacts with the body and clothes. The relative incidence of caudal contacts and palmar contacts increased concurrently and were significantly correlated throughout the period of study. Developmental increases in self-grasping contacts occurred a few weeks after the increase in caudal and palmar contacts. The behavioral and temporal pattern of these spontaneous self-touching movements suggest that the Reach, in which the hand extends to make a palmar self-contact, and the Grasp, in which the digits close and make manipulatory movements, have partially independent developmental profiles. The results additionally suggest that self-touching behavior is an important developmental phase that allows the coordination of the Reach and the Grasp prior to and concurrent with their use under visual guidance.

Infants born preterm demonstrate impaired object exploration behaviors throughout infancy and toddlerhood

BACKGROUND

Object exploration behaviors form the foundation for future global development, but little is known about how these behaviors are exhibited by infants born preterm.

OBJECTIVE

The study objective was to longitudinally compare a comprehensive set of object exploration behaviors in infants born preterm and infants born full-term from infancy into toddlerhood.

DESIGN

Twenty-two infants born full-term and 28 infants born preterm were monitored as they interacted with objects throughout their first 2 years.

METHODS

Infants were provided up to 30 seconds to interact with each of 7 objects across 9 visits. Experimenters coded videos of infants' behaviors. Growth modeling and t tests were used to compare how much infants exhibited behaviors and how well they matched their behaviors to the properties of objects.

RESULTS

Infants born preterm explored objects less in the first 6 months, exhibited less visual-haptic multimodal exploration, displayed reduced variability of exploratory behavior in a manner that reflected severity of risk, and were less able to match their behaviors to the properties of objects in a manner that reflected severity of risk. Infants born preterm with significant brain injury also had impaired bimanual abilities.

LIMITATIONS

There was a limited sample of infants born preterm with significant brain injury.

CONCLUSIONS

Infants born preterm have impaired abilities to interact with objects even in the first months of life. This impairment likely limits the knowledge they acquire about objects and about how they can act on them; this limited knowledge may, in turn, impair their early learning abilities. These results highlight the need for assessment and intervention tools specific for object exploration in young infants.