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 cerebral palsy (CP). To characterize how locomotor skill is learned (or not learned) during this critical period, the investigators will combine established protocols using robust, unbiased robotic and sensor technology to longitudinally study infant movement across three consecutive stages during the development of impaired human motor control - early spontaneous movement, prone locomotion (crawling), and upright locomotion (walking).
Early spontaneous leg movements will be measured monthly from 1-4 months of age. Infants who remain at high risk for CP by month 4 as measured by the General Movements Assessment and the Test of Infant Motor Performance (TIMP) at 4 months of age will continue to locomotor training phases. Prone locomotor training using the Self-Initiated Prone Progression Crawler (SIPPC) will be delivered from 5-9 months of age. Upright locomotor training with dynamic weight support (DWS) will be delivered from 9-18 months of age. Repeated assessments of locomotor skill, movement quality, training characteristics, and variables that may mediate locomotor learning will be collected at time points from 1 month to 18 months of post-term age. Investigators will examine the relationships between motor error and locomotor skill acquisition over time, anticipating that experiencing and correcting movement errors is critical to skill acquisition in infants at risk for CP; the contribution of other training characteristics (movement time, movement variability, and postural control) to locomotor learning; and how learning is mediated by neurobehavioral factors outside of training. Investigators will develop comprehensive models of training predictors and mediators for prone and upright locomotor learning.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
During the movement observation phase, infants will wear a wireless movement sensor at each ankle for two days. Research staff will show the caregivers how to place the sensors in the morning and charge them overnight. The training protocol for the prone training will consist of: 1) Warm-up. 2) Assisted movement of the arms and legs. 3) Calibration of the infant's arm and leg positions. 4) Self-initiated mobility for up to five minutes. For upright training, the environment will be arranged to encourage active motor exploration and variability in walking activities.The therapist will assist the child as needed to encourage upright locomotor activities, but only the minimum amount needed to perform the task. Weight assistance will be gradually reduced as postural control and coordination improve.
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Gross Motor Function Measure-66
The Gross Motor Function Measure-66 (GMFM-66) is a Rasch-analyzed measure of gross motor function designed for children with cerebral palsy (CP). Computation of the GMFM-66 score involves statistical weighting of the raw item scores for difficulty. Scores range from 0 to 100 with higher scores indicating more functional ability.
Time frame: Up to 18 months
Movement Observation Coding System
The Movement Observation Coding System will use video coding to assess postural control, arm and leg movements, and goal directed movement.
Time frame: Up to 18 months
Early spontaneous movement
Wearable sensor data will be analyzed to describe leg movements produced across in the natural environment.
Time frame: Up to 4 months
Error rate - prone
Error during prone locomotor training will measured using the Self-Initiated Prone Progression Crawler (SIPPC).
Time frame: Up to 18 months
Error rate - upright
Error during upright locomotor training will measured using the dynamic weight support (DWS) technology.
Time frame: Up to 18 months
Movement index
Movement index is the percent of time moving during each therapy session which will be recorded by sensors.
Time frame: Up to 18 months
Postural control
Postural control will be measured from video coding of therapy sessions.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
60
Time frame: Up to 18 months
Movement variability - prone
Movement variability during prone locomotor training will be measured using the Self-Initiated Prone Progression Crawler (SIPPC).
Time frame: Up to 18 months
Movement variability - upright
Movement variability during upright locomotor training will be measured by video coding.
Time frame: Up to 18 months