Lynette S. Chandler

Predictive validity of the “movement assessment of infants”

Early identification of neuromotor deficits, cerebral palsy or other neurological handicaps, is a focus of concern for neurologists, pediatricians, and developmental therapists. Among infants at risk for developing these handicaps are those with low birthweight, idiopathic respiratory distress syndrome, and early central nervous system insults. The Movement Assessment of Infants (MAI), a neuromotor assessment tool, was developed for the purpose of evaluating high-risk infants participating in the University of Washingtons Neonatal Intensive Care Unit Followup Clinic. The predictive validity of the MAI was evaluated for 246 infants for whom assessments had been completed at four months and for whom at least one set of followup data was available at either one or two years of age. Correlations between the MAI total risk score and all five of the outcome measures at one and two years were highly significant. The clinical relevance of this study in the use of the MAI as an evaluation tool for identifying infants with neuromotor dysfunction is discussed.

Effects of prenatal tobacco, alcohol and marijuana exposure on processing speed, visual-motor coordination, and interhemispheric transfer.

Deficits in motor control are often reported in children with prenatal alcohol exposure (PAE). Less is known about the effects of prenatal tobacco exposure (PTE) and prenatal marijuana exposure (PME) on motor coordination, and previous studies have not considered whether PTE, PAE, and PME interact to affect motor control. This study investigated the effects of PTE, PAE, and PME as well as current drug use on speed of processing, visual-motor coordination, and interhemispheric transfer in 16-year-old adolescents. Data were collected as part of the Maternal Health Practices and Child Development Project. Adolescents (age 16, n=320) participating in a longitudinal study of the effects of prenatal substance exposure on developmental outcomes were evaluated in this study. The computerized Bimanual Coordination Test (BCT) was used to assess each domain of function. Other important variables, such as demographics, home environment, and psychological characteristics of the mother and adolescent were also considered in the analyses. There were significant and independent effects of PTE, PAE, and PME on processing speed and interhemispheric transfer of information. PTE and PME were associated with deficits in visual-motor coordination. There were no interactions between PAE, PTE, and PME. Current tobacco use predicted deficits in speed of processing. Current alcohol and marijuana use by the offspring were not associated with any measures of performance on the BCT.

Effects of a neurodevelopmental treatment-based trunk protocol for infants with posture and movement dysfunction.

Purpose: This study was used to evaluate the efficacy of a neurodevelopmental treatment (NDT)-based sequenced trunk activation protocol for change in gross motor function of infants aged 4 to 12 months with posture and movement dysfunction. Infants who received a dynamic co-activation trunk protocol were compared with a control group who received a parent-infant interaction and play protocol. Method: A repeated measures randomized block design was used. A masked reliable examiner assessed infants before, immediately after, and 3 weeks after intervention using the Gross Motor Function Measure (GMFM). Results: The NDT-based protocol group made significantly (P = 0.048) more progress than the control group from pretest to posttest. Conclusions: Cautious support was found for (1) sequenced, dynamic trunk co-activation intervention compared to generalized infant play; (2) high-frequency, short-term, task-specific intervention; and (3) direct service by NDT-trained pediatric therapists specializing in infant intervention.

A longitudinal study of outcome measures for children receiving early intervention services.

Purpose: The purpose of this study was to compare the Pediatric Evaluation of Disability Inventory (PEDI) and the Mullen Scales of Early Learning (MSEL) as measures of change in children who received early intervention services. Methods: Thirty-four children were stratified into 2 groups according to the presence of gross motor delay. The PEDI and MSEL were administered 3 times: at an average age of 18, 31, and 53 months of age. Data were analyzed using a repeated-measures multivariate analysis of variance. Results: The findings suggest that PEDI Functional Skills Scaled Scores were capable of measuring change in both groups of children. The standard scores on the PEDI Functional Skills Social Scale were found to be more sensitive to change than the MSEL Receptive and Expressive Language scores for children with motor delays. Conclusion: Using PEDI scaled scores may be an effective strategy for measuring change in children receiving early intervention services.

Identifying 4-month-old infants at risk in community screening.

Purpose: To validate a 2-step infant developmental screening protocol administered by nonphysician health professionals. Methods: The Parent Concerns Survey and the Meade Movement Checklist (MMCL) were administered during 5 community clinics. Infant scores at 4 months were compared with the Bayley Scales of Infant Development II and Movement Assessment of Infants at 6 months and to the Ages and Stages Questionnaires at 8 months. Results: Parents identified significantly more concerns on the Parent Concerns Survey (×2 = 6.43, p = 0.011) than parents not attending clinics. The correlation between infant MMCL scores at 4 months and Movement Assessment of Infants was r = 0.58 (p = 0.01) and r = −0.48 (p = 0.01) with Bayley Scales of Infant Development II scores at 6 months. The MMCL demonstrated 87.5% sensitivity, 91.4% specificity, and 70% positive predictive value. Conclusion: Combining parent concerns and observational screening effectively identified infants for further evaluation. This 2-step screening by nonphysician health professionals provides a valid, new perspective for screening young infants.

How Do Toddlers Increase Their Gait Velocity

This study examines the components of the development of velocity during early walking. Eight children with typical development were followed during their first 5 months of walking experience. Velocity, cadence, and step length were measured. Normalized step length did not change over this time, however, normalized cadence increased. This indicates that an increase in cadence is contributing to early increases in walking velocity.

The relationship between transitional motor skills and locomotion

This study explores whether transitional skills and sitting correlate with locomotion onset. The development of eight infants was followed. Most transitional skills correlated with locomotor skills. Sitting and rolling did not. Transitional skills may resemble the control needed for locomotion more closely than sitting.

Assessment of Sensory and Motor Function

The assessment of individuals with neurological deficits requires focused evaluation of the extent to which pathophysiology of cells or tissues is expressed as neurological impairment, as well as an understanding of the disabilities and limitations imposed by the sensory-motor losses (see Table 1) (National Institutes of Health, 1993; World Health Organization, 1980). This chapter provides an overview of the clinical evaluation of sensory motor system impairment and the pathology that points to the impairment underlying the disability. Furthermore, we discuss the combined effects of sensory-motor impairment on function as evaluated by gait. Limitations imposed by the environment are not the focus of this chapter.