To compare gross motor performance of children with Down syndrome (DS) and typical development (TD) at 2 to 4 months (Phase I) and at 2 years of age (Phase II) and to investigate the relation between early motor performance and later outcome. Seventeen infants (10 with TD and 7 with DS) were assessed in Phase I using the Test of Infant Motor Performance (TIMP); 25 children were assessed in Phase II using the gross motor scale of the Bayley Scales of Infant and Toddler Development (Bayley-III); 10 participants were enrolled in both phases. TIMP and Bayley-III scores were lower in the DS group. In both groups, TIMP z scores were predictive of Bayley-III scores. Children with DS show difficulties in early postural control and activities requiring speed, postural control, and balance. The finding that early performance relates to later outcome reinforces the relevance of early and task-specific intervention.

(2020). COVID-19 Pandemic: Is This a Good Time for Implementation of Home Programs for Children’s Rehabilitation in Low- and Middle-Income Countries?. Physical & Occupational Therapy In Pediatrics. Ahead of Print.

Functional reaching is impaired in dystonia. Here, we analyze upper extremity kinematics to quantify timing and coordination abnormalities during unimanual reach-to-grasp movements in individuals with childhood-onset unilateral wrist dystonia. Kinematics were measured during movements of both upper limbs in a patient group ( n = 11, age = 17.5 ±5 years), and a typically developing control group ( n = 9, age = 16.6 ±5 years). Hand aperture was computed to study the coordination of reach and grasp. Time-varying joint synergies within one upper limb were calculated using a novel technique based on principal component analysis to study intra-limb coordination. In the non-dominant arm, results indicate reduced coordination between reach and grasp in patients who could not lift the grasped object compared to those who could lift it. Lifters exhibit incoordination in distal upper extremity joints later in the movement and non-lifters lacked coordination throughout the movement and in the whole upper limb. The amount of atypical coordination correlates with dystonia severity in patients. Reduced coordination during movement may reflect deficits in the execution of simultaneous movements, motor planning, or muscle activation. Rehabilitation efforts can focus on particular time points when kinematic patterns deviate abnormally to improve functional reaching in individuals with childhood-onset dystonia.

Evaluation of task-evoked cortical responses during movement has been limited in individuals with bilateral cerebral palsy (CP), despite documented alterations in brain structure/function and deficits in motor control. To systematically evaluate cortical activity associated with lower extremity tasks, and relate activation parameters to clinical measures in CP. 28 ambulatory participants (14 with bilateral CP and 14 with typical development) completed five motor tasks (non-dominant ankle dorsiflexion, hip flexion and leg cycling as well as bilateral dorsiflexion and cycling) in a block design while their sensorimotor cortex was monitored using functional near infrared spectroscopy (fNIRS), in addition to laboratory and clinical measures of performance. Main effects for group and task were found for extent of fNIRS activation (number of active channels; p < 0.001 and p = 0.010, respectively), magnitude of activation (sum of beta values; p < 0.001 for both), and number of active muscles (p = 0.001 and p < 0.001, respectively), but no group by task interactions. Collectively, subgroups with CP and especially those with greater impairments, showed higher extent and magnitude of cortical sensorimotor activation as well as higher amounts of concurrent activity in muscles not required for task performance. Magnitude of fNIRS activation during non-dominant dorsiflexion correlated with validated measures of selective control (r = -0.60, p = 0.03), as well as mobility and daily activity (r = -0.55, p = 0.04 and r = -0.52, p = 0.05, respectively) and self-reported gait function (r = -0.68, p = 0.01) in those with CP. The association between higher activity in the sensorimotor cortex and decreased selectivity in cortical organization suggests a potential neural mechanism of motor deficits and target for intervention.