Michele A. Lobo

Grounding Early Intervention: Physical Therapy Cannot Just Be About Motor Skills Anymore

This perspective article provides support for 4 interrelated tenets: grounded perceptual-motor experience within cultural and social contexts forms cognition; exploration through early behaviors, such as object interaction, sitting, and locomotion, broadly facilitates development; infants and children with limited exploration are at risk for global developmental impairments; and early interventions targeting exploratory behaviors may be feasible and effective at advancing a range of abilities across developmental domains and time. These tenets emphasize that through the promotion of early perceptual-motor behaviors, broader, more global developmental advancements can be facilitated and future delays can be minimized across domains for infants and children with special needs. Researchers, educators, and clinicians should build on these tenets to further demonstrate the effectiveness of targeted early interventions. The goals of these interventions should be not only to advance targeted perceptual-motor skills in the moment but also to more broadly advance future abilities and meet the early intervention goal of maximizing childrens learning potential.

Movement Training Advances the Emergence of Reaching in Infants Born at Less Than 33 Weeks of Gestational Age: A Randomized Clinical Trial

Background and Purpose: This study had 2 purposes: (1) to compare the emergence of reaching in infants born full-term and infants born at less than 33 weeks of gestational age and (2) to evaluate the effectiveness of a movement training program on the emergence of reaching in this preterm population. Participants: Twenty-six infants born at less than 33 weeks of gestational age and with a birth weight less than 2,500 g were randomly assigned to receive 20 minutes of daily movement training (PT-M group) or daily social training (PT-S group) and were compared with 13 infants born full-term (FT-S group). Methods: Reaching and hand-object interactions were tested every other week for 8 weeks. At each visit, infants were allowed six 30-second opportunities to contact a midline toy. Results: The FT-S and PT-M groups reached earlier and more consistently than the PT-S group. Specifically, the subjects in the FT-S group contacted the toy for longer durations and with an open, ventral surface of their hand. The PT-M group demonstrated increases in the number of hand-object contacts, the number of consistent reaches, and the percentage of time interacting with the toy and the surface of hand-object contact. Discussion and Conclusion: This project demonstrates that there are early gross motor skill differences in infants born at less than 33 weeks of gestational age. A caregiver-based daily training program, however, is effective at lessening some, but not all, of these differences over the short term.

Assessment and stability of early learning abilities in preterm and full-term infants across the first two years of life.

Infants born preterm have increased risk for learning disabilities yet we lack assessments to successfully detect these disabilities in early life. We followed 23 full-term and 29 preterm infants from birth through 24 months to assess for differences in and stability of learning abilities across time. Measures included the Bayley-III cognitive subscale, the mobile paradigm assessment, and a means-end learning assessment. Preterm infants had poorer performance on measures of cognition and learning across the first two years of life. Learning performance at 3-4 months was consistent with learning performance at 12-24 months of age. At 3-4 months, the mobile paradigm had better sensitivity and predictive values for predicting 24-month cognitive delays on the Bayley-III than did the Bayley-III itself. At 12-18 months, the means-end learning assessment had better sensitivity than the Bayley-III for identifying 24-month cognitive delays on the Bayley-III. The results suggest that: (1) infants born preterm may demonstrate learning differences as early as the first few months of life, (2) learning differences identified in the first months of life are likely to persist throughout the second year of life, and (3) learning assessments that measure how infants and toddlers use their typical behaviors to problem-solve to control external events may be more effective than traditional standardized assessment tools for detecting early learning delays.

The onset of reaching significantly impacts how infants explore both objects and their bodies.

The purpose of this study was to describe how reaching onset affects the way infants explore objects and their own bodies. We followed typically developing infants longitudinally from 2 through 5 months of age. At each visit we coded the behaviors infants performed with their hand when an object was attached to it versus when the hand was bare. We found increases in the performance of most exploratory behaviors after the emergence of reaching. These increases occurred both with objects and with bare hands. However, when interacting with objects, infants performed the same behaviors they performed on their bare hands but they performed them more often and in unique combinations. The results support the tenets that: (1) the development of object exploration begins in the first months of life as infants learn to selectively perform exploratory behaviors on their bodies and objects, (2) the onset of reaching is accompanied by significant increases in exploration of both objects and ones own body, (3) infants adapt their self-exploratory behaviors by amplifying their performance and combining them in unique ways to interact with objects.

Enhanced Handling and Positioning in Early Infancy Advances Development Throughout the First Year

Behaviors emerge, in part, from the interplay of infant abilities and caregiver-infant interactions. Cross-cultural and developmental studies suggest caregiver handling and positioning influence infant development. In this prospective, longitudinal study, the effects of 3 weeks of enhanced handling and positioning experiences provided to 14 infants versus control experiences provided to 14 infants at 2 months of age were assessed with follow-up through 15 months of age. Behaviors in prone were immediately advanced. Short-term advancements occurred in multiple behaviors, including prone, head control, reaching, and sitting behaviors. Longer term advancements, up to 12 months after the experience period, occurred in object transfer, crawling and walking behaviors. This suggests broad and long-lasting changes can arise via brief periods of change in caregiver-infant interactions.

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.

Volumetric MRI and MRS and early motor development of infants born preterm.

Purpose: To investigate the relationship between volumetric magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in infants born less than 30 weeks gestation and early motor development at 6 months adjusted age. Methods: Twenty infants born preterm and 4 born at term (control) underwent MRI with volumetric analysis and MRS prior to neonatal intensive care unit discharge. Infants were assessed using the Bayley Scale of Infant Development at 6 months adjusted age. Results: At 6 months, infants born preterm with low motor scores had a reduction in their subcortical gray matter. No differences were detected in other brain structures. N-acetylaspartate/choline correlated with white matter (R = 0.45, P = .03), gray matter (R = 0.43, P = .04), and cerebellar volume (R = 0.6, P = .002) but not with 6-month motor performance. Conclusion: There is an association between diminished subcortical gray matter volume and low motor scores. Our data suggest that volumetric MRI performed prior to hospital discharge may have some role in counseling parents about potential motor delays.

Instability of delay classification and determination of early intervention eligibility in the first two years of life

The purpose of this study was to determine the effectiveness of the Bayley Scales of Infant Development, Third Edition (Bayley-III) to track development and classify delays in low- and high-risk infants across the first two years of life. We assessed cognitive, language, and motor development in 24 low-risk full-term and 30 high-risk preterm infants via seven assessments performed between 3 and 24 months corrected age. The Bayley-III resulted in highly unstable delay classifications, low sensitivities, and poor positive predictive values across time. The results highlight that early intervention professionals, researchers, and policy makers should: (1) emphasize clinical opinion and prevalence of risk factors rather than standardized assessment findings when classifying delays and determining eligibility for services, and (2) develop more effective developmental assessments for infants and young children.

Intervention in the first weeks of life for infants born late preterm: a case series.

&NA; Infants born late preterm (34–36 weeks of gestation) account for 350 000 US births per year, are at risk for developmental delays, and are rarely included in intervention studies. Purpose: To describe a novel parent-delivered movement intervention program for very young infants and outcomes following intervention and to evaluate the feasibility of using a comprehensive set of outcome measures. Summary of Key Points: Two infants born late preterm received intervention from 0.5 to 2.0 months of adjusted age. Development, postural control, reaching, and object exploration assessments were completed at 3 time points. The intervention was well tolerated by the family. Improvements in developmental outcomes, postural control, and object exploration are presented. Statement of Conclusion: Very early movement experience provided daily by parents may improve development. In combination, norm-referenced and behavioral measures appear sensitive to changes in infant behaviors.

Real-World Performance: Physical Activity, Play, and Object-Related Behaviors of Toddlers With and Without Disabilities

Purpose: To describe and compare the occurrence and co-occurrence of physical activity (PA), play, and object-related behaviors in toddlers with and without disabilities. Methods: Participants included 23 toddlers (21 with typical development (TD) and 2 with disabilities). Direct observation was used to describe the type and level of PA, play interactions, and object-related behaviors through video recordings. Results: Toddlers demonstrated high variability, occurrence, and co-occurrence of all behaviors. Toddlers with disabilities displayed less variability, occurrence, and co-occurrence of several behaviors. Conclusion: Toddlers with TD engage simultaneously in PA, play, and object-related behaviors for about 3 hours in a typical day. This same level of co-occurrence of behaviors may not be observed for children with disabilities. Intervention providers are encouraged to consider the behaviors of toddlers with TD, beyond the findings of this pilot study, as the reference standard when implementing technology and intervention strategies for children with disabilities.