Marybeth Grant-Beuttler

Strength Training for a Child With Suspected Developmental Coordination Disorder

BACKGROUND Children with developmental coordination disorder (DCD) demonstrate difficulty with feedforward motor control and use varied compensatory strategies. PURPOSE To examine gross motor function changes following strength training in a child with motor control difficulties. CASE DESCRIPTION A girl aged 6 years 11 months, with apraxia and hypotonia, and demonstrating motor delays consistent with DCD. INTERVENTION Twenty-four strength training sessions were completed using a universal exercise unit. OUTCOMES Postintervention scores significantly improved on the Bruininks-Oseretsky test of motor proficiency, second edition, and the Canadian occupational performance measure scores and raised the developmental coordination disorder questionnaire, revised 2007, scores above the range where DCD is suspected. Nonsignificant changes in strength were observed. DISCUSSION Improved function and significant gains in manual coordination were observed following blocked practice of isolated, simple joint movements during strength training. Improved motor skills may be because of effective use of feedforward control and improved stabilization. Strength training does not rehearse skills using momentum, explaining nonsignificant changes in locomotor or locomotion areas.

Development of Fetal Movement between 26 and 36-Weeks’ Gestation in Response to Vibro-Acoustic Stimulation

Background: Ultrasound observation of fetal movement has documented general trends in motor development and fetal age when motor response to stimulation is observed. Evaluation of fetal movement quality, in addition to specific motor activity, may improve documentation of motor development and highlight specific motor responses to stimulation. Aim: The aim of this investigation was to assess fetal movement at 26 and 36-weeks gestation during three conditions (baseline, immediate response to vibro-acoustic stimulation (VAS), and post-response). Design: A prospective, longitudinal design was utilized. Subjects: Twelve normally developing fetuses, eight females and four males, were examined with continuous ultrasound imaging. Outcome Measures: The fetal neurobehavioral coding system (FENS) was used to evaluate the quality of motor activity during 10-s epochs over the three conditions. Results: Seventy-five percent of the fetuses at the 26-week assessment and 100% of the fetuses at the 36-week assessment responded with movement immediately following stimulation. Significant differences in head, fetal breathing, general, limb, and mouthing movements were detected between the 26 and 36-week assessments. Movement differences between conditions were detected in head, fetal breathing, limb, and mouthing movements. Conclusion: Smoother and more complex movement was observed with fetal maturation. Following VAS stimulation, an immediate increase of large, jerky movements suggests instability in fetal capabilities. Fetal movement quality changes over gestation may reflect sensorimotor synaptogenesis in the central nervous system, while observation of immature movement patterns following VAS stimulation may reflect movement pattern instability.

Gastrocnemius-Soleus Muscle Tendon Unit Changes Over the First 12 Weeks of Adjusted Age in Infants Born Preterm

Background and Purpose: Differences in the gastrocnemius-soleus muscle and tendon have been documented shortly after birth in infants born preterm compared with infants born at term. Knowledge of muscle tendon unit lengths at term age to 12 weeks of age in infants born preterm may be useful in understanding motor development. Participants and Method: Gastrocnemius-soleus muscle tendon unit lengths were compared at term age, at 6 weeks of age, and at 12 weeks of age (preterm adjusted age) in 20 infants born full term and 22 infants born preterm. Results: Significant differences were found between the 2 groups on taut tendon, relaxed muscle length (AO); taut tendon, stretched muscle length (AMax); and muscle stretch (AO to AMax). Infants born preterm demonstrated measures of AO and AMax in positions of greater plantar flexion compared with infants born full term. Significant differences in measurements of AO were found between term age and 12 weeks of age, indicating that the tendon lengthens during this period for both groups. Discussion and Conclusion: These results provide knowledge of musculoskeletal development of the gastrocnemius-soleus muscle and tendon. Differences in musculoskeletal measurements are consistent with uterine confinement in the last weeks of full-term gestation. These findings have implications when examining the musculoskeletal system in infants born preterm who are demonstrating functional changes.

Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis:

Context: Low back pain is common in golfers. The risk factors for golf-related low back pain are unclear but may include individual demographic, anthropometric, and practice factors as well as movement characteristics of the golf swing. Objective: The aims of this systematic review were to summarize and synthesize evidence for factors associated with low back pain in recreational and professional golfers. Data Sources: A systematic literature search was conducted using the PubMed, CINAHL, and SPORTDiscus electronic databases through September 2017. Study Selection: Studies were included if they quantified demographic, anthropometric, biomechanical, or practice variables in individuals with and without golf-related low back pain. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3. Data Extraction: Studies were independently reviewed for inclusion by 2 authors, and the following data were extracted: characterization of low back pain, participant demographics, anthropometrics, biomechanics, strength/flexibility, and practice characteristics. The methodological quality of studies was appraised by 3 authors using a previously published checklist. Where possible, individual and pooled effect sizes of select variables of interest were calculated for differences between golfers with and without pain. Results: The search retrieved 73 articles, 19 of which met the inclusion criteria (12 case-control studies, 5 cross-sectional studies, and 2 prospective longitudinal studies). Methodological quality scores ranged from 12.5% to 100.0%. Pooled analyses demonstrated a significant association between increased age and body mass and golf-related low back pain in cross-sectional/case-control studies. Prospective data indicated that previous history of back pain predicts future episodes of pain. Conclusion: Individual demographic and anthropometric characteristics may be associated with low back pain, but this does not support a relationship between swing characteristics and the development of golf-related pain. Additional high-quality prospective studies are needed to clarify risk factors for back pain in golfers.

Commentary on “Effects of a Program for Improving Biomechanical Characteristics During Walking and Running in Children Who Are Obese”

“How should I apply this information?” Addressing obesity is timely and appropriate, as pediatric therapists focus on promoting optimal physical function. The development of group programs similar to the ones in this study may provide an effective environment; however, reimbursement issues for delivery of group physical therapy sessions need to be addressed. This study provides positive evidence that a locomotor-emphasized intervention can decrease foot pressures with less conclusive temporal gait changes. Although use of a portable insole system may not be feasible in most clinics, foot contact area may be possible with a pedograph. Limitations in the specificity of time spent and intensity of exercises for both groups may hinder replication in the clinic; however, exercise focus for the locomotor emphasis was well outlined. Understanding the relationship between decreased foot pressure and changes in function and participation is important, as we consider the relevance of this information for children. The preventative effects of decreasing foot pressure are yet unknown but important on the basis of the long-term consequences of obesity, specifically in the lower extremities. “What should I be mindful about when applying this information?” This study did not measure outcomes, which can explain why or when foot pressure decreased. Changes in foot pressure may be explained by increased strength through muscle hypertrophy, improved coordination in gait patterns, or both. With limited measurements of locomotor coordination and no strength measures, no conclusions can be made as to the mechanisms for reported changes. Measurements preand postintervention also limit our understanding of when improvements occurred. Use of the locomotor-emphasis exercises may not need to occur for the entire 6 months. In addition, we need to investigate whether changes in foot pressure result in temporary or permanent increases in activity levels or improvements in long-term outcomes of function and participation.

Ankle Movements During Supine Kicking in Infants Born Preterm

Background: Knowledge of musculoskeletal factors that influence supine kicking of infants born preterm has implications for early intervention. Hypotheses: Differences exist between infants born preterm and full-term in ankle kinematics during supine kicking, which are attributable to passive measures of the gastrocnemius/soleus (g/s) muscle tendon unit (MTU). Subjects: Twenty infants born full-term and 22 born preterm were measured at term, 6 weeks, and 12 weeks of age. Outcome Measures: Ankle kinematics during supine kicking and g/s MTU length. Results: Infants born preterm demonstrated less dorsiflexion, more plantar flexion, and more total ankle range during supine kicking. Gestational age explained 69% to 85% of the variability in MTU length from term to 12 weeks of age. MTU lengths explained 0% to 42% of the variance in ankle kinematics. Conclusions: Passive measures of the g/s MTU may inform clinicians about ankle kinematics in newborns to 12-week infants during supine kicking.

Author Response to Invited Commentary by Heathcock

We thank Heathcock for taking the time to write her commentary1 regarding our study.2 Her comments are interesting, and our subsequent investigation into these ideas has led us to uncover some enlightening evidence in relation to the topics raised in the commentary. We will attempt to review each of the topics raised and the evidence associated with these topics. Heathcock1 suggests that “the measurements taken in this study were largely of the soleus muscle” secondary to knee contractures. There are 3 important issues to consider when contemplating this perspective. First, we measured infants born full term and infants born preterm over 3 different ages. In the infant born full term at the newborn measurement, knee extension is limited. During data collection, we were careful to ensure that we extended the knee as much as possible, but in the newborn infant born full term, the knee has a small flexion contracture that limits full extension. Although this muscle may not have been fully lengthened, it was lengthened as much as possible. This limitation to extension was not an issue at 6 or 12 weeks of age in the infants born full term or in the infants born preterm at any age. Second, we do not know which structures are limiting knee extension. If the gastrocnemius muscle was the structure limiting knee extension, then by extending the knee fully, we lengthened the muscle. Based on research by Brown and Swenson,3 the difference in ankle dorsiflexion in infants born full term at newborn age with the knee flexed to 90 degrees versus fully extended was 3 degrees in boys and 2 degrees in girls. This difference in ankle dorsiflexion with full extension and 90 degrees of knee flexion is small, and changes observed at the ankle with the small …