Bjørg Fallang

Goal directed reaching and postural control in supine position in healthy infants

The present study focussed on the development and interaction of reaching and posture in supine position in young infants. The kinematics of goal directed reaches and the concurrent ground reaction forces of the total body centre of pressure (COP) in cranial-caudal and medial-lateral direction were recorded in twelve healthy fullterm infants at 4 and 6 months of age. From eight infants, data were available at both ages. The results indicated that between 4 and 6 months, postural stability during reaching in supine position increased, as the oscillatory COP displacement in the medial-lateral direction decreased significantly with increasing age. Concurrently, reaching performance improved, which was reflected by a decrease in the number of movement units (MU), the length of the displacement-path of the hand and an increase of the length and duration of the first MU. The kinematic data of the reaching movements and the COP data were correlated at both ages, but the nature of the relation changed. At 4 months of age, the number of MU was related to the number of COP oscillations in the cranial-caudal direction, whereas at 6 months the maximum velocity of the hand movement was related to the maximum velocity of COP displacement in cranial-caudal and medial-lateral direction. This change might point to the development of a more subtle control of postural adjustments during reaching movements in supine position.

Kinematic Quality of Reaching Movements in Preterm Infants

Many preterm infants may experience so-called minor developmental disorders; however, in general, the problems in motor behavior are not detected until school age. To introduce therapies aimed at the prevention of these problems, we need to increase our knowledge of motor function and dysfunction at early age. The present study focused on the organization of reaching movements in full-term and preterm infants without cerebral palsy. The reaching behavior of premature infants (n = 63) was assessed longitudinally at the corrected ages of 4 and 6 mo. Clinical assessments were made at 6 and 12 mo of age. On the basis of the infants morbidity during the early stay in the neonatal intensive care unit, the preterm infants were allocated into a high-risk and a low-risk group. Results from a previous study in full-term infants (n = 13) were included. Kinematics of reaching movements in supine position were measured, and the analysis focused on movement velocity and movement units. A compound parameter of kinematic variables was created, reflecting the quality of reaching movements. The present study showed that at the age of 4 mo, low-risk preterm infants showed more often optimal reaching behavior than full-term and preterm high-risk infants. This better reaching performance was related to a better general motor and behavioral development during the first year of life. At the age of 6 mo, the advantage of the low-risk group in reaching behavior had disappeared and a disadvantage in the form of nonoptimal reaching behavior of the high-risk group emerged.

Goal-oriented rehabilitation of preschoolers with cerebral palsy—a multi-case study of combined use of the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scaling (GAS)

Purpose: To explore setting and implementing goals as an ongoing process, using the COPM and the GAS in combination. Methods: Multi-case study of a goal-setting approach, involving parents and service providers of 13 children (aged 23–50 months) with mild-to-moderate CP enrolled in a 9-month rehabilitation programme consisting of two blocks of setting and implementing goals. The childrens COPM reports and GAS goals and information from a questionnaire about implementation were analysed. Results: In the initial assessment, most problems prioritized by the parents in the COPM were phrased in terms of activities. The priorities for intervention changed during the process of setting and implementing goals. GAS goals were frequently integrated in everyday activities both at home and in kindergarten based on decisions on how to implement the goals. Changes in the childrens performance were recognized by a high proportion of goal attainment and a small, but clear change in the parents’ perception of performance. Parents and service providers reported many gains working towards concrete and measurable goals, but also some challenges. Conclusion: By using the COPM and GAS in combination, a dynamic and interactive process of setting and implementing goals in the context of everyday activities emerged.

Postural Adjustments in Preterm Infants at 4 and 6 Months Post-Term During Voluntary Reaching in Supine Position

Gradually it is getting clear that motor development – in particular balance control – in so-called “low-risk” preterm infants often differs from that in full-term infants. However, little is known on the etiology and pathophysiology of these problems. The aim of this study was to evaluate postural behavior during reaching by means of kinetic and kinematic measurements. Preterm infants (n = 32) without cerebral palsy were investigated longitudinally at the corrected ages of 4 and 6 mo. Thirteen age-matched full-term infants served as controls. Cognitive and motor development were assessed by means of the quality of General Movements (GMs) at 4 mo and Bayley scales at 6 and 12 mo. The infants were lying supine on a forceplate reaching for a toy and the kinetics of the total bodys Center of Pressure (COP) was measured in cranial-caudal and medial-lateral direction. The analysis focused on COP displacement, Vmax and oscillatory changes of the COP displacement during reaching. The kinematic analysis of reaching focused on movement units, Vmax and a compound kinematic variable reflecting the quality of reaching. The results showed that preterm infants showed a remarkable “still” postural behavior, which differed significantly from the mobile COP behavior of the full-term infants. More “still” postural behavior at 6 mo was associated with a better quality of reaching movements and with normal GMs at 4 mo. We concluded that “still” postural behavior is an adequate postural strategy of preterm infants. But it might be that this postural behavior is an indicator of later dysfunction.

Quality of Reaching and Postural Control in Young Preterm Infants Is Related to Neuromotor Outcome at 6 Years

A substantial proportion of the “apparently normal” preterm infants exhibit minor and moderate dysfunctions in neuromotor outcome as they grow older. Birth characteristics, minor abnormalities on the neonatal ultrasound scan of the brain, and motor milestones have only limited value in the early detection of these children. The aim of the present study was to investigate whether nonoptimal reaching and relatively immobile postural behavior at an early age are associated with dysfunctional neuromotor and behavioural development at school age. The preterm children and full-term children of the present follow-up study participated in a previous study on the characteristics of reaching kinematics and the kinetics of posture at 4 and 6 mo corrected age. At the age of 6 y, the children were re-assessed by means of the Touwen neurologic assessment, the Movement ABC, and the Child Behavior Check List. The results demonstrated that in preterm children without cerebral palsy, a lack of successful reaching at 4 mo and a nonoptimal quality of reaching at 6 mo are related to the development of a complex form of minor neurologic dysfunction (MND) and fine manipulative disability at 6 y. Thus, these early signs indicate the presence of clinically significant brain dysfunction. A relatively immobile postural behavior at 4 mo was associated with simple MND, coordination problems, and at 6 mo with a worse score on the Movement ABC and internalizing behavior. This suggests that a relatively immobile postural behavior points to a mild form of brain dysfunction.

Postural Behavior in Children Born Preterm

The present paper presents clinical and neurophysiological data of postural behavior in preterm children without CP. Clinical followup studies of preterm infants until toddler and school age have reported that low-risk preterm infants may have atypical postural behavior in terms of reduced amount of rotation during crawling, delayed dynamic balance, delayed onset of and a poor quality of early walking behavior. At school age, dysfunctions such as problems in standing on one leg and poor hopping are reported. Neurophysiological data of postural control at early age indicated the presence of a dysfunction in the capacity to modulate postural activity, and the postural activity has been characterized by temporal disorganization of EMG responses. Postural responses to goal-directed reaching in supine lying have been recorded and analyzed in terms of the total body center of pressure. In this study, preterm infants show less mobile postural behavior compared with full-term infants. In infancy, the less mobile postural behavior seemed to be adequate as it was related to better goal-directed reaching quality, but the results indicated that the relatively immobile postural behavior during reaching in early age was related to less favorable neuromotor behavior in school-age.

Everyday use of assistive technology devices in school settings

Abstract Purpose: To gain more knowledge about ATDs as social–cultural objects in school settings, particularly from the children’s perspective. Methods: Nine children with cerebral palsy, aged five to six years, were observed 3 days in kindergarten and twice in the first year at primary school. At the primary school, we interviewed the children. During the interviews, the children were shown photos taken during the observations. In addition, dialogues with parents, therapists and school staff were carried out. Results and discussions: ATDs seem to have the potential both to exacerbate disability and to enhance selfhood, embodied capacities and participation. Through use, ATDs become social objects with symbolic values that influence their use. Devices corporally embedded into the child’s body schema appeared as facilitators for participation in culturally valued activities. In contrast, devices prescribed as medical interventions tended to be greeted with ambivalence by the children themselves, their parents and school staff. A device incorporated into one situation was not necessarily relevant for use in another. Conclusions: In recognizing the value of exploring children’s experiences, professionals are left with the challenge of creating space for children to reflect on the worthiness of an ATD across place, time and functionality. Implications for Rehabilitation Used in everyday life, ATDs become social objects with potential both to exacerbate disability and to enhance selfhood, embodied capacities and participation. The child’s everyday environment is a vulnerable setting for implementing rehabilitation interventions, such as ATDs. Creating space for children to reflect on the worthiness of an ATD, regarding place, time and functionality, may enhance their participation in everyday life.

Micro-processes in social and learning activities at school generate exclusions for children with disabilities

This study explores children’s everyday life activities in their first year at school, revealing a variety of situated activities that involved interactions between the child, peers and (para) professionals. We sought to examine how a child with a disability encounters opportunities and space for participation in these peer interactions and multi-professional encounters. We observed eight children with disabilities (six years of age) in a primary mainstream school and conducted interviews/dialogue with the children, professionals and paraprofessional assistants. Observation of a variety of activities revealed that seemingly insignificant processes of exclusion during the day could have implications far beyond the singular situations. Professional actions to support the child with a disability may produce micro-processes that hamper participation. The study’s key messages include the need to pay attention to how socio-material and pedagogical environments are organized and to use observational sensitivity to the micro-processes at play during the school day to improve the learning environment for all children.

Active Play in After-school Programmes: development of an intervention and description of a matched-pair cluster-randomised trial assessing physical activity play in after-school programmes

Introduction Interventions delivered in after-school programmes (ASPs) have the potential to become a means of ensuring adequate physical activity among schoolchildren. This requires a motivational climate, allowing for self-determined play. If trained, ASP staff may represent a valuable resource for supporting such play. Increasing knowledge and supportive skills among ASP staff may also potentially increase their motivation for work. The purpose of this article is to describe the development of the ‘Active Play in ASP’ intervention, which aims to promote physical activity among first graders attending ASP, and to present a protocol for a matched-pair cluster-randomised trial to evaluate the intervention. Methods and analysis Informed by experiences from practice, evidence-based knowledge and theory, the intervention was developed in a stepwise process including focus group meetings and a small-scale pilot test. The intervention contains a course programme for ASP staff to increase their skills in how to support physical activity through play. In a cluster randomised controlled trial, the ASPs will be matched and randomly allocated to receive the 7-month intervention or to a control group. Outcomes will be assessed at baseline, after 7 and 19 months. First graders attending the ASPs included are eligible. The primary outcome will be accelerometer-determined minutes in moderate to vigorous physical activity in the ASP. The study uses a mixed methods approach including observations and interviews to provide rich descriptions of the concept of childrens physical activity in ASP. Moreover, the trial will assess whether the ASP staff benefits from participation in the intervention in terms of increased work motivation. Lastly, process evaluations of programme fidelity, satisfaction and suggestions on improvement will be performed. Ethics and dissemination The study is approved by the Data Protection Official for Research (reference no 46008). Results will be presented in conferences and peer-reviewed journals. Trial registration number Clinical Trials (NCT02954614), pre-results.