Self-Sitting and Reaching in 5- to 8-Month-Old Infants: The Impact of Posture and Its Development on Early Eye-Hand Coordination

Early object skill supports growth in role-differentiated bimanual manipulation in infants

The ability to coordinate the hands together to act on objects where each hand does something different is known as role-differentiated bimanual manipulation (RDBM). This study investigated two motor skills that may support the development of RDBM: infants' early object skill and their early sitting skill. To evaluate these potential predictors of RDBM growth, 90 infants were examined in a lab-based longitudinal design over a 9-month period. Latent growth modeling was used to estimate RDBM growth trajectories over 9 to 14 months from infants' object and sitting skills at 6 months, controlling for infant's sex, mother's education, and family income. Higher object skill, controlling for sitting skill, was related to a higher increase in RDBM over time. Sitting did not predict infants' change in RDBM over time, controlling for object skill. The ability to manage multiple objects may support collaborative hand use by providing infants with opportunities to practice actions that will be needed later for RDBM. By comparison, sitting may free the hands in an unspecified manner for manipulation.

Biological and environmental factors may affect children's executive function through motor and sensorimotor development: Preterm birth and cerebral palsy

Disruptive biological and environmental factors may undermine the development of children's motor and sensorimotor skills. Since the development of cognitive skills, including executive function, is grounded in early motor and sensorimotor experiences, early delays or impairments in motor and sensorimotor processing often trigger dynamic developmental cascades that lead to suboptimal executive function outcomes. The purpose of this perspective paper is to link early differences in motor/sensorimotor processing to the development of executive function in children born preterm or with cerebral palsy. Uncovering such links in clinical populations would improve our understanding of developmental pathways and key motor and sensorimotor skills that are antecedent and foundational for the development of executive function. This knowledge will allow the refinement of early interventions targeting motor and sensorimotor skills with the goal of proactively improving executive function outcomes in at-risk populations.

Opportunities for learning and social interaction in infant sitting: Effects of sitting support, sitting skill, and gross motor delay

The development of independent sitting changes everyday opportunities for learning and has cascading effects on cognitive and language development. Prior to independent sitting, infants experience the sitting position with physical support from caregivers. Why does supported sitting not provide the same input for learning that is experienced in independent sitting? This question is especially relevant for infants with gross motor delay, who require support in sitting for many months after typically developing infants sit independently. We observed infants with typical development (n = 34, ages 4-7 months) and infants with gross motor delay (n = 128, ages 7-16 months) in early stages of sitting development, and their caregivers, in a dyadic play observation. We predicted that infants who required caregiver support for sitting would spend more time facing away from the caregiver and less time contacting objects than infants who could sit independently. We also predicted that caregivers of supported sitters would spend less time contacting objects because their hands would be full supporting their infants. Our first two hypotheses were confirmed; however, caregivers spent surprisingly little time using both hands to provide support, and caregivers of supported sitters spent more time contacting objects than caregivers of independent sitters. Similar patterns were seen in the group of typically developing infants and the infants with motor delay. Our findings suggest that independent sitting and supported sitting provide qualitatively distinct experiences with different implications for social interaction and learning opportunities. HIGHLIGHTS: During seated free play, supported sitters spent more time facing away from their caregivers and less time handling objects than independent sitters. Caregivers who spent more time supporting infants with both hands spent less time handling objects; however, caregivers mostly supported infants with one or no hands. A continuous measure of sitting skill did not uniquely contribute to these behaviors beyond the effect of binary sitting support (supported vs. independent sitter). The pattern of results was similar for typically developing infants and infants with gross motor delay, despite differences in age.

Motor Overflow during Reaching in Infancy: Quantification of Limb Movement Using Inertial Motion Units

Early in life, infants exhibit motor overflow, which can be defined as the generation of involuntary movements accompanying purposeful actions. We present the results of a quantitative study exploring motor overflow in 4-month-old infants. This is the first study quantifying motor overflow with high accuracy and precision provided by Inertial Motion Units. The study aimed to investigate the motor activity across the non-acting limbs during goal-directed action. To this end, we used wearable motion trackers to measure infant motor activity during a baby-gym task designed to capture overflow during reaching movements. The analysis was conducted on the subsample of participants (n = 20), who performed at least four reaches during the task. A series of Granger causality tests revealed that the activity differed depending on the non-acting limb and the type of the reaching movement. Importantly, on average, the non-acting arm preceded the activation of the acting arm. In contrast, the activity of the acting arm was followed by the activation of the legs. This may be caused by their distinct purposes in supporting postural stability and efficiency of movement execution. Finally, our findings demonstrate the utility of wearable motion trackers for precise measurement of infant movement dynamics.

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.

The Relationship between Trunk Control and Upper Extremity Function in Children with Obstetric Brachial Plexus Palsy

PURPOSE

This study aimed to assess sitting skills and trunk control in children with obstetric brachial plexus palsy (OBPP) and investigate the effect of these skills on upper extremity function.

METHODS

A total of 106 children with OBPP aged 10-18 months were included in this study. Injury severity was determined with Narakas Classification. The Gross Motor Function Measurement Sitting Sub-scale was used to assess sitting skills, while the Sitting Assessment Scale was used to evaluate the trunk control. The upper extremity functions were assessed with using the Active Movement Scale and the Modified Mallet Score.

RESULTS

As the severity of injury increased, sitting skills and trunk control values decreased (p = .0001). In addition, upper extremity function decreased with the decreasing sitting skills and trunk control (p = .0001).

CONCLUSION

Rehabilitation approaches should involve approaches that aim to increase trunk control in addition to programs targeting the extremity function in children with OBPP.

Object exploration during the transition to sitting: A study of infants at heightened risk for autism spectrum disorder

Learning to sit promotes infants' object exploration because it offers increased access to objects and an improved position for exploration (e.g., ). Infants at heightened risk (HR) for autism spectrum disorder (ASD) exhibit delays in sitting and differences in object exploration. However, little is known about the association between sitting and object exploration among HR infants. We examined changes in object exploration as HR infants (N = 19) and comparison infants with no family history of ASD (Low Risk; LR; N = 23) gained experience sitting independently. Infants were observed monthly from 2.5 months until 1 month after the onset of independent sitting. At 12, 18, 24, and 36 months, infants completed standardized developmental assessments, and HR infants were assessed for ASD symptoms at 36 months. Although HR infants began sitting later than LR infants, both groups increased time spent grasping, shaking, banging, and mouthing objects as they gained sitting experience. Groups only differed in time spent actively mouthing objects, with LR infants showing a greater increase in active mouthing than HR infants. Findings suggest that HR infants experience a similar progression of object exploration across sitting development, but on a delayed time scale.

What are Fundamental Motor Skills and What is Fundamental About Them?

A review and synthesis of the literature on the learning and development of motor skills supports the postulation that whether a motor skill can be deemed fundamental is dependent on the collective presence of three conditions: (i) uniqueness to the movement pattern and/or outcome; (ii) near universality of the functional outcome in the healthy population; (iii) capacity to act as an antecedent influence supporting generalization to a large and broad set of perceptual-motor skills. Within this framework, it is proposed that the infant motor development sequence underpinning upright posture (e.g., sitting, bipedal standing), locomotion (e.g., walking, running), and object-interaction (e.g., grasping) represents the minimum set of fundamental motor skills from which all other skills evolve with over the lifespan. This position is in contrast to the views of many students of motor development and learning who describe numerous skills that typically emerge in the ∼2- to 18-year-old range as fundamental but do not meet the criteria outlined here to be fundamental. It is proposed that these be labeled as core developmental activities having a more restricted but still practically relevant influence on the acquisition of and generalization to other motor skills.

Postural control during reaching while sitting and general motor behaviour when learning to walk

AIM

To study changes in muscular postural strategies and general motor behaviour during the transition to independent walking. Postural control was assessed at its two functional levels: (1) direction specificity, in which dorsal muscles are primarily activated when reaching forward; and (2) fine-tuning of direction specificity.

METHOD

In an explorative longitudinal study, surface electromyograms of the arm, trunk, and neck muscles of 28 typically developing infants were recorded during reaching while sitting. Each infant was assessed in three developmental phases: during pull-to-stand (T0), first independent steps (T1), and 1 month after T1 (T2). Motor behaviour was assessed using the Infant Motor Profile (IMP). The effect on developmental outcome measures (postural parameters and IMP) of the developmental phases (T0, T1, T2) was estimated using linear mixed-effects models.

RESULTS

None of the postural parameters changed significantly over time. However, individual developmental trajectories showed infant-specific postural reorganizational changes. Total IMP score decreased between T0 and T1 (mean IMP score 95% and 91% respectively; p<0.001); between T1 and T2 IMP scores did not change (91% and 93%; p=0.073).

INTERPRETATION

Typically developing infants do not show consistent patterns of postural reorganization but show individual muscular strategies during the transition to independent walking. However, signs of reorganization of general motor behaviour are present.

WHAT THIS PAPER ADDS

Infants show signs of reorganization of motor behaviour when learning to walk. Infants show individual strategies of postural reorganization when learning to walk.

The Role of Sound in Encouraging Infants with Congenital Blindness to Reach for Objects

Reaching for sound-producing and silent objects was assessed in seven infants who had been blind from birth. Objects were presented while they were in tactile contact with their bodies, immediately after withdrawal, or without prior contact. The study found that sound elicited reaching earlier than did antecedent tactile contact. These findings are compared with those of previous studies.

Sit Still and Pay Attention! Trunk Movement and Attentional Resources in Infants with Typical and Delayed Development

AIMS

(1) examine infant movement during an early posture (sitting) utilizing a novel video assessment technique; and (2) document the differences between infants with typical development (TD), premature infants with motor delay, and infants with cerebral palsy (CP) during focused and nonfocused attention (NFA).

METHODS

Infants were tested when they began to sit independently. We utilized Eulerian Video Magnification (EVM) to accentuate small trunk and pelvic movements for visual coding from video taken during a natural play task with and without focused attention (FA).

RESULTS

Trunk/pelvic movement varied as a function of both motor skill and attention. Infants with TD and CP made fewer trunk movements during periods of FA than NFA. Preterm infants exhibited more trunk/pelvic movement than the other groups and their movement did not differ based on attention type.

CONCLUSIONS

The EVM technique allowed for replicable coding of real-time "hidden" motor adjustments from video. The capacity to minimize extraneous movements in infants, or "sitting still" may allow greater attention to the task at hand, similar to older children and adults. Premature infants' excessive trunk/pelvic movement that did not adapt to task requirements could, in the long term, impact tasks requiring attentional resources.

Developing Hierarchical Schemas and Building Schema Chains Through Practice Play Behavior

Examining the different stages of learning through play in humans during early life has been a topic of interest for various scholars. Play evolves from practice to symbolic and then later to play with rules. During practice play, infants go through a process of developing knowledge while they interact with the surrounding objects, facilitating the creation of new knowledge about objects and object related behaviors. Such knowledge is used to form schemas in which the manifestation of sensorimotor experiences is captured. Through subsequent play, certain schemas are further combined to generate chains able to achieve behaviors that require multiple steps. The chains of schemas demonstrate the formation of higher level actions in a hierarchical structure. In this work we present a schema-based play generator for artificial agents, termed Dev-PSchema. With the help of experiments in a simulated environment and with the iCub robot, we demonstrate the ability of our system to create schemas of sensorimotor experiences from playful interaction with the environment. We show the creation of schema chains consisting of a sequence of actions that allow an agent to autonomously perform complex tasks. In addition to demonstrating the ability to learn through playful behavior, we demonstrate the capability of Dev-PSchema to simulate different infants with different preferences toward novel vs. familiar objects.

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.

Early human motor development: From variation to the ability to vary and adapt

This review summarizes early human motor development. From early fetal age motor behavior is based on spontaneous neural activity: activity of networks in the brainstem and spinal cord that is modulated by supraspinal activity. The supraspinal activity, first primarily brought about by the cortical subplate, later by the cortical plate, induces movement variation. Initially, movement variation especially serves exploration; its associated afferent information is primarily used to sculpt the developing nervous system, and less to adapt motor behavior. In the next phase, beginning at function-specific ages, movement variation starts to serve adaptation. In sucking and swallowing, this phase emerges shortly before term age. In speech, gross and fine motor development, it emerges from 3 to 4 months post-term onwards, i.e., when developmental focus in the primary sensory and motor cortices has shifted to the permanent cortical circuitries. With increasing age and increasing trial-and-error exploration, the infant improves its ability to use adaptive and efficicient forms of upright gross motor behavior, manual activities and vocalizations belonging to the native language.

The Diaper Change Play: Validation of a New Observational Assessment Tool for Early Triadic Family Interactions in the First Month Postpartum

The quality of family relations, observed during mother-father-infant triadic interactions, has been shown to be an important contributor to child social and affective development, beyond the quality of dyadic mother-child, father-child, and marital relationships. Triadic interactions have been well described in families with 3 month olds and older children using the Lausanne Trilogue Play (LTP). Little is known about the development of mother-father-baby interactions in the very 1st weeks postpartum, mostly because no specific observational setting or particular instrument had been designed to cover this age yet. To fill this gap, we adapted the LTP to create a new observational setting, namely the Diaper Change Play (DCP). Interactions are assessed using the Family Alliance Assessment Scales for DCP (FAAS-DCP). We present the validation of the DCP and its coding system, the FAAS-DCP. The three validation studies presented here (44 mother-father-child-triads) involve a sample of parents with 3-week-old infants recruited in two maternity wards (n = 32 and n = 12) in Switzerland. Infants from both sites were all healthy according to their APGAR scores, weight at birth, and scores on the NICU Network Neurobehavioral Scale (NNNS), which was additionally conducted on the twelve infants recruited in one of the maternity ward. Results showed that the "FAAS - DCP" coding system has good psychometric properties, with a good internal consistency and a satisfying reliability among the three independent raters. Finally, the "FAAS-DCP" scores on the interactive dimensions are comparable to the similar dimensions in the FAAS-LTP. The results showed that there is no statistically significant difference on scores between the "FAAS-DCP" and the "FAAS," which is consistent with previous studies underlying stability in triadic interaction patterns from pregnancy to 18 months. These first results indicated that the DCP is a promising observational setting, able to assess the development of the early family triadic functioning. The DCP and the FAAS-DCP offer to both clinicians and researchers a way to improve the understanding of the establishment of early family functioning as well as to study the young infant's triangular capacity. Perspectives for future research will be discussed.

Combining Recurrence Analysis and Automatic Movement Extraction from Video Recordings to Study Behavioral Coupling in Face-to-Face Parent-Child Interactions

The analysis of parent-child interactions is crucial for the understanding of early human development. Manual coding of interactions is a time-consuming task, which is a limitation in many projects. This becomes especially demanding if a frame-by-frame categorization of movement needs to be achieved. To overcome this, we present a computational approach for studying movement coupling in natural settings, which is a combination of a state-of-the-art automatic tracker, Tracking-Learning-Detection (TLD), and nonlinear time-series analysis, Cross-Recurrence Quantification Analysis (CRQA). We investigated the use of TLD to extract and automatically classify movement of each partner from 21 video recordings of interactions, where 5.5-month-old infants and mothers engaged in free play in laboratory settings. As a proof of concept, we focused on those face-to-face episodes, where the mother animated an object in front of the infant, in order to measure the coordination between the infants' head movement and the mothers' hand movement. We also tested the feasibility of using such movement data to study behavioral coupling between partners with CRQA. We demonstrate that movement can be extracted automatically from standard definition video recordings and used in subsequent CRQA to quantify the coupling between movement of the parent and the infant. Finally, we assess the quality of this coupling using an extension of CRQA called anisotropic CRQA and show asymmetric dynamics between the movement of the parent and the infant. When combined these methods allow automatic coding and classification of behaviors, which results in a more efficient manner of analyzing movements than manual coding.

A Developmental Approach to Machine Learning?

Visual learning depends on both the algorithms and the training material. This essay considers the natural statistics of infant- and toddler-egocentric vision. These natural training sets for human visual object recognition are very different from the training data fed into machine vision systems. Rather than equal experiences with all kinds of things, toddlers experience extremely skewed distributions with many repeated occurrences of a very few things. And though highly variable when considered as a whole, individual views of things are experienced in a specific order - with slow, smooth visual changes moment-to-moment, and developmentally ordered transitions in scene content. We propose that the skewed, ordered, biased visual experiences of infants and toddlers are the training data that allow human learners to develop a way to recognize everything, both the pervasively present entities and the rarely encountered ones. The joint consideration of real-world statistics for learning by researchers of human and machine learning seems likely to bring advances in both disciplines.

The potential of an automated system to identify the upper limb component of a controlled sitting posture

Full trunk control in sitting is demonstrated only when the head-trunk are aligned and upper limbs remain free of contact from mechanical support. These components represent a Controlled Kinetic Chain and can be evaluated in people with neuromotor disability using the Segmental Assessment of Trunk Control (SATCo) when a therapist provides manual trunk support at different segmental levels. However, the SATCo, as with other clinical assessments of control, is subjective. The SATCo was translated to objective rules relating the position of the hands and elbows to the head-trunk and then tested to determine the extent to which this automated objective method replicated the clinical judgement. Clinical evaluation used video to determine whether the upper limb was free of mechanical support while the objective evaluation used 3D motion capture of the trunk and upper limbs with a classification rule. The agreement between clinical and objective classification was calculated for three conditions of a distance-from-support-surface threshold parameter in five healthy adults and five children with cerebral palsy. The unfitted (zero-threshold values) method replicated the clinical judgement in part (68.26%±15.7, adults, 48.3%±33.9 children). The fitted (level-of-support determined) agreement showed that the process could be refined using trial specific parameters (88.32%±5.3 adults, 89.84%±10.2 children). The fixed-values agreement showed high values when using general group parameters (80.80%±3.1 adults, 74.31%±21.5 children). This objective classification of the upper limb component of trunk control largely captures the clinical evaluation. It provides the first stages in development of a clinically-friendly fully automated method.

Gait performance of children and adolescents with sensorineural hearing loss

BACKGROUND

Several studies have demonstrated that children with sensorineural hearing loss (SNHL) may exhibit balance disorders, which can compromise the gait performance of this population.

OBJECTIVE

Compare the gait performance of normal hearing (NH) children and those with SNHL, considering the sex and age range of the sample, and analyze gait performance according to degrees of hearing loss and etiological factors in the latter group.

METHOD

This is a cross-sectional study that assessed 96 students, 48 NH and 48 with SNHL, aged between 7 and 18 years. The Brazilian version of the Dynamic Gait Index (DGI) was used to analyze gait and the Mann-Whitney test for statistical analysis.

RESULTS

The group with SNHL obtained lower average gait performance compared to NH subjects (p=0.000). This was also observed when the children were grouped by sex female and male (p=0.000). The same difference occurred when the children were stratified by age group: 7-18 years (p=0.000). The group with severe and profound hearing loss exhibited worse gait performance than those with mild and moderate loss (p=0.048) and children with prematurity as an etiological factor demonstrated the worst gait performance.

CONCLUSION

The children with SNHL showed worse gait performance compared to NH of the same sex and age group. Those with severe and profound hearing loss and prematurity as an etiological factor demonstrated the worst gait performances.

Give Me a Hand: Adult Involvement During Object Exploration Affects Object Individuation in Infancy

The development of object individuation, a fundamental ability that supports identification and discrimination of objects across discrete encounters, has been examined extensively by researchers. There are significant advancements in infants' ability to individuate objects during the first year-and-a-half. Experimental work has established a timeline of object individuation abilities and revealed some mechanisms underlying this ability, however, the influence of adult assistance during object exploration has not yet been explored. The current study investigates the effect of adult involvement during object exploration on infants' object individuation abilities. In Experiment 1a and 1b, we examined 9.5-month-old infants' colour-based object individuation following adult-assisted multisensory object exploration. Two components of adult interaction were of particular interest: facilitation of object manipulation (grasping, rotating, and attention-getting behaviours) and social engagement (smiling, pointing, attention-getting verbalizations, and object-directed gaze). Experiment 2a and 2b assessed these components with 4.5-month-olds to examine their impact across development. The results showed that after adult-guided object exploration, both 9.5- and 4.5-month-old infants successfully individuated previously undifferentiated objects. Results of Experiments 1b and 2b provide implications for the mechanisms underlying the scaffolding influence of adult interaction during infant behaviours.

From faces to hands: Changing visual input in the first two years

Human development takes place in a social context. Two pervasive sources of social information are faces and hands. Here, we provide the first report of the visual frequency of faces and hands in the everyday scenes available to infants. These scenes were collected by having infants wear head cameras during unconstrained everyday activities. Our corpus of 143hours of infant-perspective scenes, collected from 34 infants aged 1month to 2years, was sampled for analysis at 1/5Hz. The major finding from this corpus is that the faces and hands of social partners are not equally available throughout the first two years of life. Instead, there is an earlier period of dense face input and a later period of dense hand input. At all ages, hands in these scenes were primarily in contact with objects and the spatio-temporal co-occurrence of hands and faces was greater than expected by chance. The orderliness of the shift from faces to hands suggests a principled transition in the contents of visual experiences and is discussed in terms of the role of developmental gates on the timing and statistics of visual experiences.

A Perceptual Motor Intervention Improves Play Behavior in Children with Moderate to Severe Cerebral Palsy

For children with moderate or severe cerebral palsy (CP), a foundational early goal is independent sitting. Sitting offers additional opportunities for object exploration, play and social engagement. The achievement of sitting coincides with important milestones in other developmental areas, such as social engagement with others, understanding of spatial relationships, and the use of both hands to explore objects. These milestones are essential skills necessary for play behavior. However, little is known about how sitting and play behavior might be affected by a physical therapy intervention in children with moderate or severe CP. Therefore, our overall purpose in this study was to determine if sitting skill could be advanced in children with moderate to severe CP using a perceptual motor intervention, and if play skills would change significantly as sitting advanced. Thirty children between the ages of 18 months and 6 years who were able to hold prop sitting for at least 10 s were recruited for this study. Outcome measures were the sitting subsection of the Gross Motor Function Measure (GMFM), and the Play Assessment of Children with Motor Impairment play assessment scale, which is a modified version of the Play in Early Childhood Evaluation System. Significant improvements in GMFM sitting scores (p < 0.001) and marginally significant improvement in play assessment scores (p = 0.067) were found from pre- to post-intervention. Sitting change explained a significant portion of the variance in play change for children over the age of 3 years, who were more severely affected by CP. The results of this study indicate that advances in sitting skill may be a factor in supporting improvements in functional play, along with age and severity of physical impairment.

Upper extremity function: What's posture got to do with it?

This perspective paper reviews the linkage between developing postural control and upper extremity function. We suggest updated principles for guiding clinical practice, based on current views from motor learning, motor development, and motor control research. Using three clinical examples, we illustrate principles focusing on the use of variability, the importance of errors in learning movement, task specific exploration and practice, and the critical timing necessary to build skill of the upper extremity in a variety of postures. These principles differ from historic approaches in therapeutic exercise, which treated posture as a separate system and a precursor for extremity skill building. We maintain that current movement science supports the tight interaction of posture and upper extremity function through developmental time and in real time, such that one system cannot be considered separate from the other. Specific suggestions for clinical practice flow from the guiding principles outlined in this paper.

Relations between infants' emerging reach-grasp competence and event-related desynchronization in EEG

Recent reports of similar patterns of brain electrical activity (electroencephalogram: EEG) during action execution and observation, recorded from scalp locations over motor-related regions in infants and adults, have raised the possibility that two foundational abilities--controlling one's own intentional actions and perceiving others' actions--may be integrally related during ontogeny. However, to our knowledge, there are no published reports of the relations between developments in motor skill (i.e. recording actual motor skill performance) and EEG during both action execution and action observation. In the present study we collected EEG from 21 9-month-olds who were given opportunities to reach for toys and who also observed an experimenter reach for toys. Event-related desynchronization (ERD) was computed from the EEG during the reaching events. We assessed infants' reaching-grasping competence, including reach latency, errors, preshaping of the hand, and bimanual reaches, and found that desynchronization recorded in scalp electrodes over motor-related regions during action observation was associated with action competence during execution. Infants who were more competent reachers, compared to less competent reachers, exhibited greater ERD while observing reaching-grasping. These results provide initial evidence for an early emerging neural system integrating one's own actions with the perception of others' actions.

Posture effects on spontaneous limb movements, alternated stepping, and the leg extension response in neonatal rats

The development of postural control is considered an important factor for the expression of coordinated behavior such as locomotion. In the natural setting of the nest, newborn rat pups adapt their posture to perform behaviors of ecological relevance such as those related to suckling. The current study explores the role of posture in the expression of three behaviors in the newborn rat: spontaneous limb activity, locomotor-like stepping behavior, and the leg extension response (LER). One-day-old rat pups were tested in one of two postures--prone or supine--on each of these behavioral measures. Results showed that pups expressed more spontaneous activity while supine, more stepping while prone, and no differences in LER expression between the two postures. Together these findings show that posture affects the expression of newborn behavior patterns in different ways, and suggest that posture may act as a facilitator or a limiting factor in the expression of different behaviors during early development.

Timing and Force Characteristics of Muscle Activity: Postural Control in Children with and Without Developmental Coordination Disorders

Setting appropriate timing and force parameters of muscle activity is a significant part of producing skillful movement behavior: Data reported here suggest that an important characteristic of children with developmental coordination disorders (DCD) is inconsistency and lack of precision in regulating timing and force characteristics of muscle activity to correct for perturbations to balance. Children with and without DCD stood on a moveable platform. Balance was perturbed under fully redundant sensory conditions and under conditions where vision was removed or vestibular input was modified. EMG activity in tibialis anterior and quadriceps leg muscles was recorded. Children with normal motor development produced less force than children with DCD. Children with DCD tended to rely on proximal muscle activity to respond to perturbations to balance and, in contrast to children with normal motor development, modified temporal but not force characteristics of muscle activity when the sensory framework for balance was modified.

Immediate Effect of Training at the Onset of Reaching in Preterm Infants: Randomized Clinical Trial

The authors' aim was to investigate the immediate effect of a single specific training session (serial varied practice), of short duration on the kinematic parameters of reaching, in the period of the emergence of the skill in preterm and low birth weight infants. The study included 16 infants of both sexes, born at a mean gestational age of 32.13 (±1.36) weeks and mean birth weight of 1720.94 (±358.46) g. The infants were randomly divided into 2 groups: experimental and control. The experimental group was given a 5-min training session in reaching, while the control group received no training. The results showed significant differences in peak velocity in the intra (Z = -2.10, p = .036) and intergroup (U = 9.00, p = .016) evaluations, which decreased in the experimental group after training. Cohen's d test for clinical relevance suggested that the specific, short duration training proved effective in promoting slower reaches, with greater adjustment and lower number of units of movement. These results are positive for preterm infants given that these parameters more closely resemble the typical development of mature reaching behaviors in term infants, which suggests that this protocol of reaching training (serial varied practice) could be used as an evidence-based intervention strategy.

Relation between hand function and gross motor function in full term infants aged 4 to 8 months

Background:

In children, reaching emerges around four months of age, which is followed by rapid changes in hand function and concomitant changes in gross motor function, including the acquisition of independent sitting. Although there is a close functional relationship between these domains, to date they have been investigated separately.

Objective:

To investigate the longitudinal profile of changes and the relationship between the development of hand function (i.e. reaching for and manipulating an object) and gross motor function in 13 normally developing children born at term who were evaluated every 15 days from 4 to 8 months of age.

Method:

The number of reaches and the period (i.e. time) of manipulation to an object were extracted from video synchronized with the Qualisys^(r) movement analysis system. Gross motor function was measured using the Alberta Infant Motor Scale. ANOVA for repeated measures was used to test the effect of age on the number of reaches, the time of manipulation and gross motor function. Hierarchical regression models were used to test the associations of reaching and manipulation with gross motor function.

Results:

Results revealed a significant increase in the number of reaches (p<0.001), the time of manipulation (p<0.001) and gross motor function (p<0.001) over time, as well as associations between reaching and gross motor function (R²=0.84; p<0.001) and manipulation and gross motor function (R²=0.13; p=0.02) from 4 to 6 months of age. Associations from 6 to 8 months of age were not significant.

Conclusion:

The relationship between hand function and gross motor function was not constant, and the age span from 4 to 6 months was a critical period of interdependency of hand function and gross motor function development.

Sitting postural control affects the development of focused attention in children with cerebral palsy

PURPOSE

To investigate whether focused attention (FA) changes over time as sitting postural control improves and whether an impairment in sitting postural control affects the development of FA in children with cerebral palsy (CP).

METHODS

Nineteen children with CP, mean ages 21.47 months, were assessed for FA and sitting scores pre- and postintervention.

RESULTS

Longest, total, and global FA increased and frequency of FA decreased in children who achieved independent sitting. However, children who achieved mobility postintervention exhibited a decrease in longest FA and an increase in frequency of FA.

CONCLUSION

Sitting postural control and the development of FA appear associated in children with CP. The increase in FA may signal a key opportunity for learning and attending to objects. However, the time of early mobility may interrupt these long periods of attention, resulting in less sustained attention to objects.

Differences between late preterm and full-term infants: comparing effects of a short bout of practice on early reaching behavior

This study compared the effects of a short bout of practice on reaching behavior between late preterm and full-term infants at the onset of goal-directed reaching. Twelve late preterm infants and twelve full-term infants received reaching practice based on a serial schedule. Late preterm and full-term infants were assessed in 3.3±1.4 and 2.6±1.0 days after the onset of goal-directed reaching in two measures in a single day: immediately before practice (pre-test) and immediately after practice (post-test). During the assessments, the infants were placed in a baby chair and a rubber toy was presented at their midline within reaching distance for 2 min. Between assessments, the infants received practice of toy-oriented reaching in 3 activities repeated for approximately 4 min. The activities were elicited in a pre-established serial sequence and were applied by a physical therapist. During the pre-test, late preterm infants presented lower range of proximal adjustments, greater proportion of reaches with semi-open hand, and greater proportion of reaches without grasping than the full-term infants. During the post-test, late preterm infants presented greater motor variability of proximal adjustments, but explored and selected distal control and grasping outcomes less compared to the full-term group. Differences in reaching and gross motor behavior between late preterm and full-term infants can be found at the age of reaching onset. Practice provided new opportunities for late preterm infants to improve perception-action coupling to reach; however, relative to full-terms, they seemed less advanced in benefiting from the experience for more refined manual tasks.

Brain reorganization as a function of walking experience in 12-month-old infants: implications for the development of manual laterality

Hand preference in infancy is marked by many developmental shifts in hand use and arm coupling as infants reach for and manipulate objects. Research has linked these early shifts in hand use to the emergence of fundamental postural-locomotor milestones. Specifically, it was found that bimanual reaching declines when infants learn to sit; increases if infants begin to scoot in a sitting posture; declines when infants begin to crawl on hands and knees; and increases again when infants start walking upright. Why such pattern fluctuations during periods of postural-locomotor learning? One proposed hypothesis is that arm use practiced for the specific purpose of controlling posture and achieving locomotion transfers to reaching via brain functional reorganization. There has been scientific support for functional cortical reorganization and change in neural connectivity in response to motor practice in adults and animals, and as a function of crawling experience in human infants. In this research, we examined whether changes in neural connectivity also occurred as infants coupled their arms when learning to walk and whether such coupling mapped onto reaching laterality. Electroencephalogram (EEG) coherence data were collected from 43 12-month-old infants with varied levels of walking experience. EEG was recorded during quiet, attentive baseline. Walking proficiency was laboratory assessed and reaching responses were captured using small toys presented at mid-line while infants were sitting. Results revealed greater EEG coherence at homologous prefrontal/central scalp locations for the novice walkers compared to the prewalkers or more experienced walkers. In addition, reaching laterality was low in prewalkers and early walkers but high in experienced walkers. These results are consistent with the interpretation that arm coupling practiced during early walking transferred to reaching via brain functional reorganization, leading to the observed developmental changes in manual laterality.

Sitting infants alter the magnitude and structure of postural sway when performing a manual goal-directed task

In typical daily life, adults routinely adapt posture so that balance can be maintained while other goal-directed activities are performed. Interestingly, newly standing infants also control posture based on the demands of a task. It is unknown if the ability to properly adapt postural movements as a goal-directed task is performed emerges soon after the acquisition of independent stance or if it is present at earlier key postural milestones, such as independent sitting. In this study, the postural sway patterns of independently sitting infants were compared while either holding or not holding a toy. Infants exhibited less postural sway when holding the toy. This reduction in sway allowed infants to look at and stabilize the toy in their hand. Thus, the ability to adjust postural movements while performing a concurrent goal-directed task emerges long before the acquisition of independent stance.

Postural position constrains multimodal object exploration in infants

Recent research has revealed the important role of multimodal object exploration in infants' cognitive and social development. Yet, the real time effects of postural position on infants' object exploration have been largely ignored. In the current study, 5- to 7-month-old infants (N = 29) handled objects while placed in supported sitting, supine, and prone postures, and their spontaneous exploratory behaviors were observed. Infants produced more manual, oral, and visual exploration in sitting compared to lying supine and prone. Moreover, while sitting, infants more often coupled manual exploration with mouthing and visual examination. Infants' opportunities for learning from object exploration are embedded within a real time postural context that constrains the quantity and quality of exploratory behavior.

Postural Evaluation of Vertebral Column in Children and Teenagers with Hearing Loss

Introduction: Posture is determined by the performance of the visual, somatosensory and vestibular systems. Children with hearing loss can present problems in their posture or postural control, enabling postural deviations and alterations to appear in their vertebral column, possibly provoked by a hypoactivity of the vestibular system as a result of deafness.

Objective: To evaluate the posture of the vertebral column in children and teenagers with hearing loss at school age, taking into consideration the sample gender and age.

Method: A descriptive and prospective study was performed at both Duque de Caxias School and Rotary Rehabilitation and Special Education Center in Caruaru – Pernambuco. 44 students aged between 7-17 years old, out of whom 22 were female and 22 were male, with hearing loss were evaluated. The study was developed by way of a postural evaluation, using a symmetrograph, marking specific anatomical points with stickers placed over polystyrene balls and fixed with double-sided adhesive tape.

Results: The results showed that all of the individuals evaluated in this study presented some kind of postural alteration in their vertebral column. Scoliosis was the most observed alteration among the students (84.1%), followed by thoracic hyperkyphosis (68.2%).

Conclusion: It has been concluded that children and teenagers with hearing loss are exposed to postural alteration in their vertebral column. Such a condition can be associated with a number of factors comprising unfavorable ergonomics of the school environment, bad postural habits and impairment of the vestibular system by virtue of the hearing loss.

Posture support improves object individuation in infants

A hierarchical progression in infants' ability to use surface features, such as color, as a basis for object individuation in the first year has been well established (Tremoulet, Leslie, & Hall, 2000; Wilcox, 1999). There is evidence, however, that infants' sensitivity to surface features can be increased through multisensory (i.e., visuohaptic) exploration of objects (Wilcox, Woods, Chapa, & McCurry, 2007). Three studies were conducted to investigate the effect of multisensory experience on infants' sensitivity to pattern information. Experiments 1 and 2 confirmed that 5.5- and 6.5-month-olds do not spontaneously use pattern differences to individuate objects and revealed that 6.5- but not 5.5-month-olds can be primed to attend to pattern differences if allowed multisensory experience with the objects prior to the individuation task. However, the 5.5-month-olds also had greater difficulty maintaining a self-sitting posture during the multisensory priming experience. In Experiment 3, 4.5- and 5.5-month-olds were given full postural support during the multisensory exploration period. In this situation, the 5.5-month-olds successfully individuated the objects, but even with full postural support, 4.5-month-old infants did not use the pattern differences to individuate the objects. These results demonstrate that multisensory priming is effective with infants as young as 5.5 months and extends multisensory priming to another surface feature, pattern. Furthermore, these results indicate that constraints are placed on the multisensory experience by the physical and motor development of the infant.

Sit happens: Does sitting development perturb reaching development, or vice versa?

The development of reaching and of sitting during the first year of life is typically studied as separate yet related behaviors. Interestingly, very soon after learning to reach, 4-7-month-old infants start coordinating their arms with their trunk and legs for sitting. In this longitudinal study, we focused, for the first time, on how infants learn to use their arms for the dual tasks of reaching for objects while providing arm support as they learn to sit. We hypothesized that the use of arms for support during sitting development would be a temporary perturbation to reaching and result in a nonlinear progression of reaching skill. Eleven infants were studied monthly from the time they began to prop sit to the time of sitting independence (5-8 months of age). Behavioral coding, kinematics, and electromyography (EMG) characterized reaching and posture while infants sat as independently as possible. Results revealed significant changes across time in trunk movement and hand use as infants transitioned through three stages of sitting: with arm support, sitting briefly without arm support, and sitting independently. Infants used their hands more for contacting objects and less for posture support linearly across time. In contrast, changes in posture control as indicated by pelvis and trunk movement demonstrated a U-shaped curve with more movement of these two body segments during the middle stage of sitting than in the first or last stage. During the middle stage of sitting infants reached persistently even though posture control, measured by pelvis and trunk movement, appeared to be significantly challenged. Muscle activation consisted of tonic and variable combinations of muscle pairings in early sitting. As infants progressed to sitting without hand support, variable but successful strategies utilizing lower extremity muscles in a tight linkage with reach onset emerged to provide prospective control for reaching. Our findings support the contention that reaching both drives the development of sitting in infancy as well as perturbs sitting posture, factoring into the assembly of the complex dual sit-reach behavior that supports and expands flexible interaction with the environment.

Effects of postural manipulations on head movements from birth to 4 months of age

The authors investigated the effects of postural manipulation on head movement control in infants from birth to 4 months of age. Eighteen full-term infants were presented with a card, which was moved from side to side before their eyes in 3 positions: unsupported supine, supported supine, and supported reclined. The results showed a higher proportion of initial position of head at midline and midline-to-side trajectory, improving the alignment of head and trunk; fewer movement units and movement units after peak velocity; lower mean angular velocity and peak velocity; and a broader rotation of the head in both supported positions. Thus, external support of the head promoted head and trunk alignment, improving stability and enabling the infant to execute better-controlled head movements. These findings may be helpful in early intervention and treatment of at-risk infants.

A Perspective on Human Movement Variability With Applications in Infancy Motor Development

Movement variability is considered essential to typical motor development. However, multiple theoretical perspectives and measurement tools have limited interpretation of the importance of movement variability in biological systems. The complementary use of linear and nonlinear measures have recently allowed for the evaluation of not only the magnitude of variability but also the temporal structure of variability. As a result, the theoretical model of optimal movement variability was introduced. The model suggests that the development of healthy and highly adaptable systems relies on the achievement of an optimal state of variability. Alternatively, abnormal development may be characterized by a narrow range of behaviors, some of which may be rigid, inflexible, and highly predictable or, on the contrary, random, unfocused, and unpredictable. In the present review, this theoretical model is described as it relates to motor development in infancy and specifically the development of sitting posture.

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.

How feasible is Baby-led Weaning as an approach to infant feeding? A review of the evidence

Baby-Led Weaning (BLW) is an alternative method for introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult. The BLW infant also shares family food and mealtimes and is offered milk (ideally breast milk) on demand until they self-wean. Anecdotal evidence suggests that many parents are choosing this method instead of conventional spoon-feeding of purées. Observational studies suggest that BLW may encourage improved eating patterns and lead to a healthier body weight, although it is not yet clear whether these associations are causal. This review evaluates the literature with respect to the prerequisites for BLW, which we have defined as beginning complementary foods at six months (for safety reasons), and exclusive breastfeeding to six months (to align with WHO infant feeding guidelines); the gross and oral motor skills required for successful and safe self-feeding of whole foods from six months; and the practicalities of family meals and continued breastfeeding on demand. Baby-Led Weaning will not suit all infants and families, but it is probably achievable for most. However, ultimately, the feasibility of BLW as an approach to infant feeding can only be determined in a randomized controlled trial. Given the popularity of BLW amongst parents, such a study is urgently needed.

Kicking performance in relation to balance ability over the support leg

Balance control is presumed to be a fundamental constraint on the organization of skilled movement. The current experiment explored whether single-leg balance ability predicted kicking performance on the other leg. Thirty-eight participants ranging widely in skill kicked a soccer ball with the right and left legs for maximum accuracy and velocity and performed single-leg balance on a force plate for 30 s with the right and left legs. Significant correlations between single-leg balance and kicking accuracy, but not velocity, were found. Left leg balance was more highly correlated than right leg balance with right (dominant) leg kicking accuracy. However, the same pattern of relations was not seen between single-leg balance and left (non-dominant) leg kicking accuracy. These findings provide preliminary support for the importance of balance ability in kicking performance. The importance of balance in the production of athletic skills is discussed and additional experimental paradigms are suggested that might further our knowledge in this area.

The control of posture in newly standing infants is task dependent

The postural sway patterns of newly standing infants were compared under two conditions: standing while holding a toy and standing while not holding a toy. Infants exhibited a lower magnitude of postural sway and more complex sway patterns when holding the toy. These changes suggest that infants adapt postural sway in a manner that facilitates visually fixating on and stabilizing the toy in their hand. When simply standing, infants exhibited postural sway patterns that appeared to be more exploratory in nature. Exploratory sway patterns may allow infants to learn the affordances of their new standing posture. These results demonstrate that newly standing infants are capable of task-dependent postural control.