Background Preterm infants with periventricular brain injury (PBI) have a high incidence of atypical development and leg movements. Objective Determine whether kicking and treadmill stepping intervention beginning at 2 months corrected age (CA) in children with PBI improves motor function at 12 months CA when compared with control subjects. Method In a multi-center pilot study for a controlled clinical trial, sixteen infants with PBI were randomly assigned to home exercise consisting of kicking and treadmill stepping or a no-training control condition. Development was assessed at 2, 4, 6, 10, and 12 months CA with the Alberta Infant Motor Scale (AIMS). At 12 months children were classified as normal, delayed, or with cerebral palsy (CP). Results At 12 months CA 3 of 7 (43%) of the exercise group children walked alone or with one hand held versus 1 of 9 (11%) in the control group (p=.262), but no significant differences in AIMS scores were found at any age. Half of the subjects had CP or delay; the outcomes of these infants were not improved by exercise. Compliance with the home program was lower than requested and may have affected results. Conclusion Although not statistically significant with a small sample size, self-produced kicking and treadmill exercise may lower age at walking in infants with normal development following PBI, but improvements of the protocol to increase and document compliance are needed before a larger study is implemented.

Means ranged from 49 (standard deviation = 15) at 34-35 weeks' postconceptional age through 120 (standard deviation = 16) at 16-17 weeks after term. High-risk infants scored significantly lower than other infants (beta = -0.133, P < 0.0001). Latino infants scored lower than infants of all other ethnicities (beta = -0.052, p < 0.006). Performance did not differ by sex. CONCLUSIONS/CLINICAL IMPLICATIONS: These standards for performance on the TIMP can be used to identify infants with delayed motor development.

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Purpose Describe behavior of children with periventricular brain injury (PBI) in a tethered-kicking intervention. Methods Sixteen infants with PBI were randomly assigned to exercise or no-training in a longitudinal pilot study. Frequency of leg movements and inter-limb coordination were described from videos at 2 and 4 months corrected age (CA). Results Eight of 13 children (62%) with longitudinal data increased the frequency of leg movements while tethered to a mobile between 2 and 4 months CA. Movement frequency was correlated with scores on the Test of Infant Motor Performance, but there were no differences between experimental groups. Children with typical development at 12 months CA increased the proportion of leg movements that were synchronous between 2 and 4 months as did a child with cerebral palsy in the experimental group. Conclusion The tethered-kicking intervention facilitates movement in infants with PBI but effects on development remain to be demonstrated.

Purpose To determine whether motor outcomes of an exercise intervention beginning at 2 months corrected age (CA) in children with periventricular brain injury (PBI) are correlated with fractional anisotropy (FA) measures derived from diffusion tensor imaging (DTI) at 12 months CA. Materials and Methods DTI was performed in eight infants with PBI who were randomly assigned to kicking and treadmill stepping exercise or a no-training condition. Development was assessed using the Alberta Infant Motor Scale (AIMS) and the Gross Motor Function Classification System (GMFCS). FA values were derived from regions of interest (ROI) in the middle third of the posterior limb of the internal capsule (PLIC) and the posterior thalamic radiation (PTR). Results Significant correlations were observed between motor development and FA measures. For PLIC, the correlation coefficients were 0.82 between FA and AIMS, and -0.92 between FA and GMFCS, while for PTR the corresponding correlation coefficients were 0.73 and -0.80, respectively. Conclusion Results of this study suggest that quantitative evaluation of white matter tracts using DTI at 12 months CA may be useful for assessment of brain plasticity in children.

Purpose Examine agreement between the Test of Infant Motor Performance (TIMP) and the Bayley III. Methods One-hundred, forty-five infants born at 29-34 weeks gestation with socioenvironmental risk factors were tested on the TIMP and Bayley III at 6 weeks corrected age (CA). Scores were correlated to assess convergence/divergence of content. Decision analysis using a cutoff of the mean on the Bayley Motor Composite and -.5 and -1 SD from the mean on the TIMP assessed agreement on delay/non-delay. Results The TIMP-Bayley Motor Composite correlation was .546, with Cognitive was .310, and with Language was .281. 9% of infants scored below −1.0 SD on the TIMP while no child performed below -1 SD on the Bayley Motor scale (sensitivity 31%). Conclusions Convergent validity between the TIMP and the Bayley Motor scale was demonstrated, but no infant showed delay on any Bayley scale. The TIMP is preferred for early assessment of infants.

A cutscore of -0.25 SD appears useful in predicting the best combination of false negatives (5.8%) and false positives (12.5%) with overall accuracy of classification of 81.7%.

The prevalence of prone sleeping has decreased dramatically since the American Academy of Pediatrics (AAP) published sleep position guidelines and launched the Back to Sleep Campaign in 1992. One aspect of the guidelines, which suggests placing infants in the prone position for supervised play time, is often overlooked. This review summarizes published articles related to the effects of sleep/play position on motor development and provides considerations for physical and occupational therapy practice in early infancy. The study results suggested that delays in the attainment of gross motor milestones in the prone position could be observed in infants whose predominant sleep position was supine, but the delays in motor development disappeared later in life. Some studies also found a reverse order of the rolling development. Therapists should educate parents about the less known advised rules of supervised play time in the prone position by the AAP, and include activities in the prone position as part of the home program in early infancy.