Beverley J. Eldridge

A review of the effects of sleep position, play position, and equipment use on motor development in infants.

Since 1992, parents have been urged to place their infants on their back when asleep. The resulting lack of experience in a prone position appears to cause developmental delay in infants. Use of various infant equipment, except baby walkers, has not been examined thoroughly to establish their influence on the motor development of infants. The aim of this systematic review was to evaluate the effects of sleep and play positions, and use of infant equipment, on motor development. Nineteen studies with evidence at level II were selected against the selection criteria and scored against the Physiotherapy Evidence Database scale. Despite the generally poor methodological quality, the studies have consistently shown that there was transient delay in motor development for healthy term and low‐risk preterm infants who were not exposed to the prone position or who did not use infant equipment. However, most of these infants walked unaided within a normal time frame. Limited evidence was found for the effect on more vulnerable infants. More rigorous longitudinal studies using outcome measures focusing on movement quality are recommended to understand any long‐lasting influence on the motor skills in these infants.

Group-Based Task-Related Training for Children with Cerebral Palsy

This pilot study examined the feasibility of a 6-week group-based, task-related training program in children 6 to 14 years-old with spastic diplegia. Eight children were randomized to lower limb training and seven to an upper limb dexterity training program. There were no statistically significant differences in lower limb outcomes between children who received the lower limb training and children who received the upper limb dexterity training after completion of the interventions or at a 6-week follow-up. Children who received the upper limb training demonstrated a greater improvement on measures of manual dexterity compared with children who received the lower limb training program. Children who received the lower limb training demonstrated a trend toward walking a longer distance in 10 minutes immediately following intervention, that was not sustained at the 6-week followup. The group setting appeared to motivate the children and enhance their participation in the training programs. The pilot study provides data for the calculation of effect size and sample estimates for future studies.

Uptime normative values in children aged 8 to 15 years

The‘Uptimer’is a custom‐made lightweight battery‐operated remote activity monitor that records the amount of time an individual spends in the upright position, which is also known as‘uptime’. The aims of this study were to determine levels of uptime over 24 hours and the relation between uptime and a childs age, sex, height, weight, and body mass index (BMI). Uptime was recorded in 529 normally developing children (318 females, 211 males), aged between 8 and 15 years. All children wore an Uptimer continuously for a 24‐hour period that included a typical school day. Mean uptime for children in this study was 5.4 hours (SD 1.3; range 1.5 to 10.3 hours), over a 24‐hour period. Uptime followed approximately a normal distribution in this population and did not have a linear relation to age, height, weight, nor BMI. Results of this study may be used as a normative database for the evaluation of uptime in children with physical disabilities.

Performance of 2-year-old children after early surgery for congenital heart disease on the Bayley Scales of Infant and Toddler Development, Third Edition.

BACKGROUND Previous research on developmental outcomes of infants with congenital heart disease (CHD) has shown delays in both cognitive and motor skills. AIMS To describe outcomes on the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) for infants with CHD and to compare those findings to published results for similar samples of infants assessed on the 2nd edition of the Bayley Scales (BSID-II). STUDY DESIGN Prospective cohort. PARTICIPANTS AND OUTCOME MEASURES Of 50 infants with CHD who participated in this longitudinal study (2006-2008) at the Royal Childrens Hospital in Melbourne, Australia, 47 were assessed on the Bayley-III (median age=24.5 months), administered by a psychologist or neonatologist. Although neither assessor was blind to the CHD diagnosis, they were unaware of results of previous developmental assessments conducted in this longitudinal study. RESULTS For the Bayley-III cognitive composite score, 17.0% of infants showed mild delays (1-2 SD below the mean), 2.1% had moderate delays (2-3 SD below the mean), and none had severe delays (greater than 3 SD below the mean). Motor composite scores showed mild delays in 10.9% of infants and moderate delays in 2.2%; none had severe motor delays. These findings differ from study results using the BSID-II in similar infants. CONCLUSIONS The Bayley-III may underestimate developmental delay in 2-year-old children with CHD when compared to results of similar children tested at 12-36 months of age on the BSID-II.

Gross motor development is delayed following early cardiac surgery.

OBJECTIVE To describe the gross motor development of infants who had undergone cardiac surgery in the neonatal or early infant period. METHODS Gross motor performance was assessed when infants were 4, 8, 12, and 16 months of age with the Alberta Infant Motor Scale. This scale is a discriminative gross motor outcome measure that may be used to assess infants from birth to independent walking. Infants were videotaped during the assessment and were later evaluated by a senior paediatric physiotherapist who was blinded to each infants medical history, including previous clinical assessments. Demographic, diagnostic, surgical, critical care, and medical variables were considered with respect to gross motor outcomes. RESULTS A total of 50 infants who underwent elective or emergency cardiac surgery at less than or up to 8 weeks of age, between July 2006 and January 2008, were recruited to this study and were assessed at 4 months of age. Approximately, 92%, 84%, and 94% of study participants returned for assessment at 8, 12, and 16 months of age, respectively. Study participants had delayed gross motor development across all study time points; 62% of study participants did not have typical gross motor development during the first year of life. Hospital length of stay was associated with gross motor outcome across infancy. CONCLUSION Active gross motor surveillance of all infants undergoing early cardiac surgery is recommended. Further studies of larger congenital heart disease samples are required, as are longitudinal studies that determine the significance of these findings at school age and beyond.

Children with cerebral palsy and periventricular white matter injury: Does gestational age affect functional outcome?

This study aimed to determine differences in functional profiles and movement disorder patterns in children aged 4-12 years with cerebral palsy (CP) and periventricular white matter injury (PWMI) born >34 weeks gestation compared with those born earlier. Eligible children born between 1999 and 2006 were recruited through the Victorian CP register. Functional profiles were determined using the Gross Motor Function Classification System (GMFCS), Manual Abilities Classification System (MACS), Communication Function Classification System (CFCS), Functional Mobility Scale (FMS) and Bimanual Fine Motor Function (BFMF). Movement disorder and topography were classified using the Surveillance of Cerebral Palsy in Europe (SCPE) classification. 49 children born >34 weeks (65% males, mean age 8 y 9 mo [standard deviation (SD) 2 y 2 mo]) and 60 children born ≤ 34 weeks (62% males, mean age 8 y 2 mo [SD 2 y 2 mo]) were recruited. There was evidence of differences between the groups for the GMFCS (p=0.003), FMS 5, 50 and 500 (p=0.003, 0.002 and 0.012), MACS (p=0.04) and CFCS (p=0.035), with a greater number of children born ≤ 34 weeks more severely impaired compared with children born later. Children with CP and PWMI born >34 weeks gestation had milder limitations in gross motor function, mobility, manual ability and communication compared with those born earlier.

Variability in the measurement of uptime in children: a preliminary study

Objective: To examine variability in ‘uptime’ (the amount of time spent in the upright position). Design: An observational study. Setting: The community (i.e., homes and schools in the Melbourne metropolitan area). Subjects: Normal children between 8 and 15 years of age (18 girls and 8 boys). Equipment: An ‘uptimer’, a lightweight, battery-operated remote monitor, was used to record uptime. Procedure: Each child in the study wore the uptimer continuously over a 24-hour period, which included a typical day at school, on four separate occasions, one week apart. Results: The variability in repeated measures of uptime in the same child (standard deviation 0.8 hours in 24 hours) was lower than the variability between the children (standard deviation 1.1 hours in 24 hours). We estimate that a single uptime measurement has reliability given by an ICC of 0.65 (95% confidence interval 0.49–0.82), which is calculated by dividing the between-child variability by the total variability (within-child and between-child variability). There were no systematic differences in mean uptime between occasions of measurement. Conclusion: As an estimate of the time that a child spends in the upright position, a single 24-hour period of measurement of uptime may vary considerably from one occasion to the next. However, this within-child variability is less than the variability between children. In large-scale field studies a one-off measurement of uptime may be acceptable, but in small rehabilitation studies uptime should be measured on at least three occasions.

High-level mobility skills in children and adolescents with traumatic brain injury

Abstract Aim: To evaluate the reliability, validity and responsiveness of the High-level Mobility Assessment Tool (HiMAT) in children and adolescents with traumatic brain injury (TBI) and to compare the mobility skills of children with TBI to those of healthy peers. Method: The mobility skills of 52 children with moderate and severe TBI (36 males; mean age = 12 years, range = 6–17) were assessed using the HiMAT and the Pediatric Evaluation of Disability Inventory (PEDI). Inter-rater reliability, re-test reliability and responsiveness of the HiMAT were evaluated in sub-groups by comparing results scored at several time-points. The HiMAT scores of children with TBI were compared with those of a healthy comparative cohort. Results: The HiMAT demonstrated excellent inter-rater reliability (ICC = 0.93), re-test reliability (ICC = 0.98) and responsiveness to change (p = 0.002). The PEDI demonstrated a ceiling effect in mobility assessment of ambulant children with TBI. The HiMAT scores of children with TBI were lower than those of their healthy peers (p < 0.001). Interpretation: The HiMAT is a reliable, valid and sensitive measure of high-level mobility skills following childhood TBI. The high-level mobility skills of children with TBI are less proficient than their peers.

Motor skills of 5-year-old children who underwent early cardiac surgery.

UNLABELLED Aims To describe the motor proficiency of 5-year-old children who underwent early infant cardiac surgery and had atypical infant gross motor development. To identify risk factors for motor dysfunction at 5 years of age. METHODS A total of 33 children (80.5% participation rate) were re-assessed by a physiotherapist blinded to the diagnosis and previous clinical course, using standardised motor assessment tools. RESULTS Motor proficiency was categorised as below average or well below average in 41% of the study patients. Approximately 30% of the cohort had balance deficits. Motor abilities at 4 months and 2 years of age were associated with motor proficiency at age 5; however, atypical motor development in infancy was not predictive of below-average or well below-average scores at age 5. Risk factors associated with motor ability at age 5 included respiratory support and intensive care length of stay in the 1st year of life, asymmetrical crawling in infancy, and cyanotic CHD at age 5. CONCLUSIONS Despite differences from other reported studies in terms of cohort diagnoses and age at surgery, the rate of motor dysfunction was similar, with rates much higher than expected in typical children. Further assessment is needed in later childhood to determine the significance of these findings.