BACKGROUND: Physical disability in individuals with cerebral palsy (CP) creates lifelong mobility challenges and healthcare costs. Despite this, very little is known about how infants at high risk for CP learn to move and acquire early locomotor skills, which set the foundation for lifelong mobility. The objective of this project is to characterize the evolution of locomotor learning over the first 18 months of life in infants at high risk for CP. To characterize how locomotor skill is learned, we will use robotic and sensor technology to provide intervention and longitudinally study infant movement across three stages of the development of human motor control: early spontaneous movement, prone locomotion (crawling), and upright locomotion (walking).

STUDY DESIGN: This longitudinal observational/intervention cohort study (ClinicalTrials.gov Identifier: NCT04561232) will enroll sixty participants who are at risk for CP due to a brain injury by one month post-term age. Study participation will be completed by 18 months of age. Early spontaneous leg movements will be measured monthly from 1 to 4 months of age using inertial sensors worn on the ankles for two full days each month. Infants who remain at high risk for CP at 4 months of age, as determined from clinical assessments of motor function and movement quality, will continue through two locomotor training phases. Prone locomotor training will be delivered from 5 to 9 months of age using a robotic crawl training device that responds to infant behavior in real-time. Upright locomotor training will be delivered from 9 to 18 months of age using a dynamic weight support system to allow participants to practice skills beyond their current level of function. Repeated assessments of locomotor skill, training characteristics (such as movement error, variability, movement time and postural control), and variables that may mediate locomotor learning will be collected every two months during prone training and every three months during upright training.

DISCUSSION: This study will develop predictive models of locomotor skill acquisition over time. We hypothesize that experiencing and correcting movement errors is critical to skill acquisition in infants at risk for CP and that locomotor learning is mediated by neurobehavioral factors outside of training. 1R01HD098364-01A1. NCT04561232.

BACKGROUND: Family empowerment in families of young children with cerebral palsy (CP) is an important consideration because the first few years of life can be overwhelming for parents. The purpose of this research was to investigate the relationship between family empowerment, fine motor (FM), gross motor (GM), and cognitive development in children with CP who were under three years of age.

METHODS: Forty-one children with a mean age of 23.8 months participated in this study. The FES was completed by the participants' parents while the FM, GM, and cognitive subscales of the Bayley Scales of Infant and Toddler Development Third edition (B-III) were administered by physical therapists.

RESULTS: Statistically significant positive correlations were found between the FES total and B-III raw scores for FM, GM, and cognitive subscales with coefficients ranging from 0.35-0.41. Significant relationships were also found between the FES Community subscale and the B-III FM, GM, and cognitive subscales.

CONCLUSIONS: This study provides evidence of a relationship between family empowerment and FM, GM, and cognitive abilities in young children with CP, with a greater severity of impairments related to lower levels of caregiver empowerment.

<p><strong>BACKGROUND: </strong>Leukodystrophies are a rare class of disorders characterized by severe neuromotor disability. There is a strong need for research regarding the functional status of people with leukodystrophy which is limited by the need for in-person assessments of mobility. The purpose of this study is to assess the reliability of the Gross Motor Function Measure-88 (GMFM-88) using telemedicine compared with standard in-person assessments in patients with leukodystrophy.</p>

<p><strong>METHODS: </strong>A total of 21 subjects with a diagnosis of leukodystrophy (age range&nbsp;= 1.79-52.82&nbsp;years) were evaluated by in-person and by telemedicine evaluations with the GMFM-88 by physical therapists. Inter-rater reliability was assessed through evaluation of the same subject by two independent raters within a three-week period (n&nbsp;=&nbsp;10 encounters), and intrarater reliability was assessed through blinded rescoring of video-recorded assessments after a one-week time interval (n&nbsp;=&nbsp;6 encounters).</p>

<p><strong>RESULTS: </strong>Remote assessments were performed by caregivers in all 21 subjects using resources found in the home with remote guidance. There was agreement between all paired in-person and remote measurements (Lin's concordance correlation ≥0.995). The Bland-Altman analysis indicated that the paired differences were within ±5%. Intrarater and inter-rater reliability demonstrated an intraclass correlation coefficient of &gt;0.90.</p>

<p><strong>CONCLUSIONS: </strong>These results support that remote application of the GMFM-88 is a feasible and reliable approach to assess individuals with leukodystrophy. Telemedicine application of outcome measures may be of particular value in rare diseases and those with severe neurologic disability that impacts the ability to travel.</p>

<p><strong>AIMS: </strong>Typical infant movement is characterized by a high degree of motor exploration, error, and variability. However, children with cerebral palsy (CP) often cannot create these experiences due to their neuromotor impairments. The purpose of this case study is to describe a 6-month course of physical therapy (PT) incorporating principles of infant motor learning using dynamic weight support (DWS) in a child with CP.</p>

<p><strong>METHODS: </strong>The child was a 27-month-old girl with diplegic CP who functioned at Gross Motor Function Classification System Level IV. The child received 68 PT sessions over a six-month period. DWS was used during therapy to encourage motor practice. The therapy area was arranged to encourage active exploration, motor variability, and error experience. Gross motor function, postural control, parent perception of performance, and parent satisfaction were measured before, during, and after the course of therapy.</p>

<p><strong>RESULTS: </strong>Gross motor function increased during the treatment beyond the level predicted from natural progression. Postural control fluctuated and demonstrated no appreciable improvement. Parent-perceived performance and satisfaction improved on three of four goals.</p>

<p><strong>CONCLUSIONS: </strong>Using DWS to incorporate principles of infant learning may have facilitated the development of gross motor skills in a child with diplegic CP.</p>

<p><strong>BACKGROUND: </strong>Early detection of delay or impairment in motor function is important to guide clinical management and inform prognosis during a critical window for the development of motor control in children. The purpose of this study was to investigate the ability of biomechanical measures of early postural control to distinguish infants with future impairment in motor control from their typically developing peers.</p>

<p><strong>METHODS: </strong>We recorded postural control from infants lying in supine in several conditions. We compared various center of pressure metrics between infants grouped by birth status (preterm and full term) and by future motor outcome (impaired motor control and typical motor control).</p>

<p><strong>RESULTS: </strong>One of the seven postural control metrics-path length-was consistently different between groups for both group classifications and for the majority of conditions.</p>

<p><strong>CONCLUSIONS: </strong>Quantitative measures of early spontaneous infant movement may have promise to distinguish early in life between infants who are at risk for motor impairment or physical disability and those who will demonstrate typical motor control. Our observation that center of pressure path length may be a potential early marker of postural instability and motor control impairment needs further confirmation and further investigation to elucidate the responsible neuromotor mechanisms.</p>

<p><strong>IMPACT: </strong>The key message of this article is that quantitative measures of infant postural control in supine may have promise to distinguish between infants who will demonstrate future motor impairment and those who will demonstrate typical motor control. One of seven postural control metrics-path length-was consistently different between groups. This metric may be an early marker of postural instability in infants at risk for physical disability.</p>

<p>An infant's risk of developing neuromotor impairment is primarily assessed through visual examination by specialized clinicians. Therefore, many infants at risk for impairment go undetected, particularly in under-resourced environments. There is thus a need to develop automated, clinical assessments based on quantitative measures from widely-available sources, such as videos recorded on a mobile device. Here, we automatically extract body poses and movement kinematics from the videos of at-risk infants (N = 19). For each infant, we calculate how much they deviate from a group of healthy infants (N = 85 online videos) using a Naïve Gaussian Bayesian Surprise metric. After pre-registering our Bayesian Surprise calculations, we find that infants who are at high risk for impairments deviate considerably from the healthy group. Our simple method, provided as an open-source toolkit, thus shows promise as the basis for an automated and low-cost assessment of risk based on video recordings.</p>

<p><strong>PURPOSE: </strong>The purpose of this study was to examine the relationship between spasticity and muscle volume in children with cerebral palsy (CP), using isokinetic dynamometry and magnetic resonance imaging.</p>

<p><strong>METHODS: </strong>A retrospective sample of 8 children with diplegic CP was analyzed. One set of 10 passive knee flexion movements was completed at a velocity of 180° per second with concurrent surface electromyography of the medial hamstrings (MH) and vastus lateralis (VL) to assess knee extensor spasticity. Magnetic resonance imaging was used to measure maximum cross-sectional area and muscle volume of the quadriceps femoris.</p>

<p><strong>RESULTS: </strong>The quadriceps femoris muscle volume was positively correlated with MH reflex activity, VL reflex activity, MH/VL co-contraction, and peak knee extensor passive torque (P &lt; .05).</p>

<p><strong>CONCLUSION: </strong>The present findings suggest that higher levels of knee extensor muscle spasticity are associated with greater quadriceps muscle volume in children with spastic diplegic CP.</p>

<p><strong>Purpose:</strong> The Early Clinical Assessment of Balance (ECAB) is a measure of postural stability for children with cerebral palsy (CP). The purpose of this research was to investigate the relationship between the ECAB and Gross Motor Function Measure-66 (GMFM-66) and to determine the responsiveness of the ECAB in children with CP under three years of age. <strong>Methods:</strong> Twenty seven children (mean age of 25&nbsp;months) participated. Data were collected before and after 3 and 6 months of physical therapy. Responsiveness was calculated using standardized response means (SRM). <strong>Results:</strong> Significant relationships were observed between the ECAB, GMFM-66 score (r&nbsp;=&nbsp;0.87), and GMFM subscales (r&nbsp;=&nbsp;0.63-0.86). A moderate effect size (SRM&nbsp;=&nbsp;0.62) and a large effect size (SRM&nbsp;=&nbsp;0.92) for the ECAB were found over the 3- and 6-month intervention periods, respectively. <strong>Conclusions:</strong> These results support the validity and responsiveness of the ECAB in young children with CP.</p>

<p><strong>BACKGROUND: </strong>Cerebral palsy (CP) is the most common cause of physical disability in children. The best opportunity to maximize lifelong independence is early in motor development when there is the most potential for neuroplastic change, but how best to optimize motor ability during this narrow window remains unknown. We have systematically developed and pilot-tested a novel intervention that incorporates overlapping principles of neurorehabilitation and infant motor learning in a context that promotes upright mobility skill and postural control development. The treatment, called iMOVE therapy, was designed to allow young children with CP to self-initiate motor learning experiences similar to their typically developing peers. This manuscript describes the protocol for a subsequent clinical trial to test the efficacy of iMOVE therapy compared to conventional therapy on gross motor development and other secondary outcomes in young children with CP.</p>

<p><strong>METHODS: </strong>The study is a single-blind randomized controlled trial. Forty-two participants with CP or suspected CP between the ages of 1-3&nbsp;years will be randomized to receive either the iMOVE or conventional therapy group. Distinguishing characteristics of each group are detailed. Repeated measures of gross motor function will be collected throughout the 12-24&nbsp;week intervention phase and at three follow-up points over one year post therapy. Secondary outcomes include measures of postural control, physical activity, participation and caregiver satisfaction.</p>

<p><strong>DISCUSSION: </strong>This clinical trial will add to a small, but growing, body of literature on early interventions to optimize the development of motor control in young children with CP. The information learned will inform clinical practice of early treatment strategies and may contribute to improving the trajectory of motor development and reducing lifelong physical disability in individuals with CP.</p>

<p><strong>TRIAL REGISTRATION: </strong>ClinicalTrials.gov identifier NCT02340026 . Registered January 16, 2015.</p>