The TIMP has validity for assessing age-related development of functional motor skills in young infants and is sensitive to risk for poor developmental outcome.

Anticipatory postural adjustments (APAs) play an important role in the performance of many activities requiring the maintenance of vertical posture. However, little is known about how children utilize APAs during self-induced postural perturbations. A group of children, aged 7-16 years, with typical motor development, performed various arm movements while standing on a force platform. APAs were measured by recording the electromyographic activity of six trunk and leg muscles on both sides of the body and displacement of center of pressure (COP). Anticipatory bursts of activity in the dorsal muscle groups of the trunk and legs and suppression in the ventral muscle groups as well as posterior COP displacement were found during the performance of bilateral shoulder flexion. Conversely, during bilateral shoulder extension, the COP displacement was anterior, and APAs were reversed showing bursts of activity in the ventral muscle groups and suppression in the dorsal muscles. During right and left reciprocal arm movements, COP displacement was minimal and APAs were generated in the dorsal muscle groups on the side of the forward moving arm and in the ventral muscle groups on the side of the arm moving into extension. However this pattern reversed for lower leg muscles, where APAs were generated in the ventral muscles on the side of forward moving arm and in the dorsal muscle on the side of the arm moving into extension. The results of this study indicate that children with typical motor development are able to generate APAs, produce task-specific sequencing of muscle activity and differentiate between perturbations in the sagittal and transverse planes. The results of this study indicate that by at least age 7, children who are typically developing demonstrate the ability to generate patterns of anticipatory muscle activation and suppression, along with center of pressure changes, similar to those reported in healthy adults.

BackgroundKnowledge about early physiotherapy to preterm infants is sparse, given the risk of delayed motor development and cerebral palsy.Methods/DesignA pragmatic randomized controlled study has been designed to assess the effect of a preventative physiotherapy program carried out in the neonatal intensive care unit. Moreover, a qualitative study is carried out to assess the physiotherapy performance and parents' experiences with the intervention. The aim of the physiotherapy program is to improve motor development i.e. postural control and selective movements in these infants. 150 infants will be included and randomized to either intervention or standard follow-up. The infants in the intervention group will be given specific stimulation to facilitate movements based on the individual infant's development, behavior and needs. The physiotherapist teaches the parents how to do the intervention and the parents receive a booklet with photos and descriptions of the intervention. Intervention is carried out twice a day for three weeks (week 34, 35, 36 postmenstrual age). Standardized tests are carried out at baseline, term age and at three, six, 12 and 24 months corrected age. In addition eight triads (infant, parent and physiotherapist) are observed and videotaped in four clinical encounters each to assess the process of physiotherapy performance. The parents are also interviewed on their experiences with the intervention and how it influences on the parent-child relationship. Eight parents from the follow up group are interviewed about their experience. The interviews are performed according to the same schedule as the standardized measurements. Primary outcome is at two years corrected age.DiscussionThe paper presents the protocol for a randomized controlled trial designed to study the effect of physiotherapy to preterm infants at neonatal intensive care units. It also studies physiotherapy performance and the parent's experiences with the intervention.Trial registrationClinicalTrials.gov NCT01089296

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Anticipatory postural adjustments (APAs) in preparation for predictable externally induced loading perturbation were studied in children with typically development (TD), hemiplegic (HEMI), and diplegic (DIPL) cerebral palsy. Twenty-seven children (n = 9 in each group) were asked to stand and catch a load dropped from a pre-specified height. Electrical activity of the leg and trunk muscles and center of pressure (COP) displacements were recorded to quantify the APAs. All groups were able to generate APAs prior to the perturbation, but the magnitude was smaller and the onset was delayed in the dorsal (agonist) postural muscles in both HEMI and DIPL as compared to TD. HEMI and DIPL also generated APAs in the antagonist postural muscles. Anticipatory backward COP displacement was significantly different from the baseline value only in the TD and HEMI. HEMI and DIPL displayed a different postural control strategy; HEMI showed no difference in background postural activity from TD, but with diminished APAs in the agonist postural muscles compared to TD, while DIPL showed a higher background postural activity and diminished APAs in the agonist postural muscles compared to TD. These differences are important to consider when designing rehabilitation programs to improve posture and movement control in children with hemiplegic and diplegic cerebral palsy.

Change in theoretical framework over the last decades and recent research in pediatric physiotherapy, has created a debate surrounding therapeutic touch. What is the role of or is there a need for handling and hands-on facilitated guidance (facilitation)? Does it limit and/or interfere with children's learning and development? It is frequently argued that therapeutic touch represents a passive and/or static approach that restricts disabled children's participation during interaction and activity in clinical encounters leading to decreased home, school and community participation. Touch may even appear as coercive and controlling. In this context, therapeutic touch is largely associated with physical hands-on activities. However, therapeutic touch can also be understood as an intersubjective phenomenon that arises from a deep connection between movement, perception, and action. We believe the significance of therapeutic touch and its impact on physiotherapy for children has not been considered from this broader, holistic perspective. In this theoretical paper, we will apply enactive concepts of embodiment, sensory-motor agency, coordination, and emergence to explore the concept and importance of touch in physiotherapists‘ clinical face-to face encounters with children. We will frame the discussion within the context of the typical sensorimotor development of children from the fetal stage to birth on and into adulthood. Moreover, we will rely on biological, physiological, and phenomenological insights to provide an extended understanding of the importance of touch and the significance of touch in clinical practice.

Background. Hypothesis: neuromotor development correlates to body composition over the first year of life in prematurely born infants and can be influenced by enhancing motor activity. Methods. 46 female and 53 male infants [27±1.8(sd) weeks], randomized to comparison or exercise group (caregiver provided 15–20 minutes daily of developmentally appropriate motor activities) completed the yearlong study. Body composition [lean body and fat mass (LBM, FM)], growth/inflammation predictive biomarkers, and Alberta Infant Motor Scale (AIMS) were assessed. Results. AIMS at 1-year correlated with LBM (r=0.32, p<0.001) in the whole cohort. However, there was no effect of the intervention. LBM increased by ~3,685 g (p < 0.001)); insulin-like growth factor-1 (IGF-1) was correlated with LBM (r=0.36, p=0.002). IL-1RA (an inflammatory biomarker) decreased (−75%, p<0.0125). LBM and bone mineral density were significantly lower and IGF-1 higher in the females at 1-year. Conclusions. We found an association between neuromotor development and LBM suggesting that motor activity may influence LBM. Our particular intervention was ineffective. Whether activities provided largely by caregivers to enhance motor activity in prematurely born infants can affect the interrelated: 1) balance of growth and inflammation mediators; 2) neuromotor development; 3) sexual dimorphism; and/or 4) body composition early in life remains unknown.

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