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We investigated the role of rate limiting factors in development using walking as a model system. The achievement of bipedal posture and locomotion are among the most significant achievements in an infant's first year, with poor balance and weak muscles long proposed as the rate limiting factors. Compensating for either may reveal upright motor skill that has not yet emerged in the infant's natural repertoire. To probe this question, we unweighted prewalking infants and measured their performance in various standing and walking behaviors while unweighted compared to baseline. Our secondary objective was to determine if the influence of unweighting was related to infants' locomotor experience. Infants stood unsupported for longer durations with 20% or 40% unweighting. Infants took more independent steps and more steps with one hand held with 40% unweighting. No differences in transition to/from standing were observed. Locomotor experience was related to the influence of unweighting during cruising and walking with a push toy. This is the first report of more advanced motor skills—longer periods of unsupported standing and the emergence of independent walking—revealed by unweighting infants. We interpret our observations to suggest that the refinement of motor control needed to support bipedal posture and locomotion precedes the functional emergence of these skills in infants. In other words, the musculoskeletal components required for walking are slower to develop than the neurological factors – and consequently may be the rate limiters. We further suggest that training regimens including unweighting should be explored in infants with motor delays. [ABSTRACT FROM AUTHOR]

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 3 years of age. Methods: Forty‐one children with a mean age of 23.8 months participated in this study. The Family Empowerment Scale (FES) was completed by the participants' parents, whereas 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 to 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. [ABSTRACT FROM AUTHOR]

Aim: To compare the effect of iMOVE (Intensive Mobility training with Variability and Error) therapy with dose‐matched conventional therapy on gross motor development and secondary outcomes in young children with cerebral palsy. Method: This single‐blind, randomized controlled trial included repeated assessments of gross motor function (using the Gross Motor Function Measure) and secondary outcomes during a 12‐ to 24‐week intervention phase and at three follow‐up points after treatment. Treatment was delivered three times per week in both groups. Forty‐two children aged 12 to 36 months were stratified by age and motor function to ensure equivalence between groups at baseline. Results: Thirty‐six children completed treatment and follow‐up phases. Treatment fidelity was high and adherence was equivalent between groups (77.3% conventional therapy, 76.2% iMOVE). There were no group differences on the primary (gross motor function after 12 weeks p = 0.18; after 24 weeks p = 0.94) or any secondary (postural control p = 0.88, caregiver satisfaction p = 0.52, child engagement p = 0.98) measure after treatment or at the follow‐up points. However, one‐third of total participants exceeded predicted change after 12 weeks and 77% exceeded predicted change after 24 weeks of treatment. Interpretation: Our observations indicate a potential dose–response effect of rehabilitation therapy. We further demonstrated that individual therapeutic ingredients can be manipulated. When delivered consistently, both iMOVE and conventional therapy interventions might both be more effective than standard care. What this paper adds: Those receiving iMOVE therapy demonstrated more independent practice time, error, and child‐initiation than those receiving the dose‐matched control.iMOVE therapy was not superior to the control (conventional physical) therapy.Most participants exceeded predicted change after 24 weeks of treatment. [ABSTRACT FROM AUTHOR]

Background: Cerebral palsy (CP) is the most common cause of motor disability in children. A concept to consider in order to meet the needs of children with CP and their families is family empowerment. Family empowerment can be defined as the process by which families acquire the skills, knowledge and resources to allow them to gain control and improve the quality of their lives. The relationship between gross motor function and family empowerment may be important because children with CP vary so widely in their ability to perform motor skills, which may affect their family's levels of empowerment. The purpose of this research was to investigate the relationship between the Family Empowerment Scale (FES) and Gross Motor Function Measure‐66 (GMFM‐66) in children with CP who were under 3 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 or regular caregivers and includes a total score and subscales of empowerment in the family, in service situations and in community/political environments. The GMFM‐66 was administered by a physical therapist and consists of a total score of gross motor function (GMFM‐66) and subscores for Dimension B (sitting), Dimension C (crawling and kneeling), Dimension D (standing) and Dimension E (walking, running and jumping). Results: Statistically significant positive correlations were found between the FES total and GMFM (total score and Dimensions B–E) with coefficients varying from 0.43–0.62. Significant relationships were also found between most subscales of the FES and the GMFM‐66. Conclusions: This study provides evidence of a relationship between family empowerment and gross motor function in young children with CP and suggests that caregivers of children with higher gross motor function report higher levels of self‐efficacy. [ABSTRACT FROM AUTHOR]

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. 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. 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. Using DWS to incorporate principles of infant learning may have facilitated the development of gross motor skills in a child with diplegic CP. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this research was to investigate differences in Early Clinical Assessment of Balance (ECAB) scores within children with cerebral palsy (CP) with different Gross Motor Function Classification System (GMFCS) levels and between children with CP and typical development (TD) who are under three years of age. Methods: The ECAB was administered to fifty children (13 with TD, 16 with GMFCS level II, 11 with GMFCS level III, 10 with GMFCS level III). Results: The group of children of TD had significantly higher scores than all groups of children with CP. There were significant differences in ECAB within the groups of children with CP with different GMFCS levels. Conclusion: The results of this study support the construct validity of the ECAB as a measure of postural control in children under three years of age with CP. [ABSTRACT FROM AUTHOR]

Purpose: 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. Methods: Twenty seven children (mean age of 25 months) participated. Data were collected before and after 3 and 6 months of physical therapy. Responsiveness was calculated using standardized response means (SRM). Results: Significant relationships were observed between the ECAB, GMFM-66 score (r = 0.87), and GMFM subscales (r = 0.63–0.86). A moderate effect size (SRM = 0.62) and a large effect size (SRM = 0.92) for the ECAB were found over the 3- and 6-month intervention periods, respectively. Conclusion: These results support the validity and responsiveness of the ECAB in young children with CP. [ABSTRACT FROM AUTHOR]