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To investigate the relation between cognitive and motor development in preschool aged children with Dravet syndrome, in particular between the age of independent walking and cognitive development.Results of cognitive and motor developmental assessments and the age of independent walking were retrieved retrospectively from the medical records of 33 children (17 males, 16 females; mean age at last evaluation 33.2mo, SD 8.2mo, range 9-48mo) diagnosed with Dravet syndrome. Cognitive and motor developmental age, derived from the Bayley Scales of Infant Development or through standardized neurodevelopmental assessment, were converted into cognitive and motor developmental quotients. Multiple test scores per child were included.A strong positive relation was found between cognitive and motor developmental quotient (Pearson r=0.854; p0.001) in 20 children (slope=0.75; 95% CI: 0.54-0.95). A later age of independent walking was associated with a lower cognitive developmental quotient (28 children; p0.001; slope=-1.01; 95% CI: -1.53 to -0.49). A higher cognitive developmental quotient was seen in children with an age at testing younger than 24 months. The cognitive developmental quotient of children with a delay in independent walking (17.6mo) was significantly lower than those without a delay (p=0.006).A strong relation exists between cognitive and motor development. Furthermore, the age of independent walking might be an important indicator of the development of children with Dravet syndrome.Cognitive and motor development are strongly related in children with Dravet syndrome. Later age of independent walking is associated with worse cognitive development in children with Dravet syndrome.

Achievement of early motor milestones in infancy affords new opportunities for social interaction and communication. Research has shown that both motor and social deficits are observed in infants who later develop autism spectrum disorder (ASD). The current study examined associations between motor and social-communication skills in 12-month-old infant siblings of children with ASD who are at heightened risk for developmental delays (N=86) and low-risk, typically developing infants (N=113). Infants were classified into one of three groups based on their walking ability: walkers (walks independently), standers (stands independently), or pre-walkers (does not yet stand or walk independently). Social-communication and cognitive skills were assessed with two standardized assessments (Communication and Symbolic Behaviors Scales [CSBS] and Mullen Scales of Early Learning) and compared across the three walking groups. Results demonstrated that high-risk walkers showed superior social-communication skills, but commensurate cognitive skills, compared to high-risk pre-walkers. In contrast, social-communication and cognitive skills were largely comparable for low-risk infants, regardless of walking status. Findings suggest that for high-risk infants, who are already vulnerable to developmental delays and ASD, independent walking may facilitate the emergence of social-communication abilities. Pivotal motor milestones may serve as useful indicators of social-communication delays and targets for intervention.

Background: Gross motor development is usually assessed in terms of age of achievement of motor milestones. Although we generally have an impression that one developed faster, if one achieved younger milestone faster than usual; there are no longitudinal study about these association among each milestones especially in Japan. As a part of Japan Children's Study, we researched whether the achievement of gross motor milestones in infancy were related with the age of walking. Methods: This is a prospective cohort study of 290 healthy and term infants born in a district of Osaka City, Japan. Three milestones; rolling over, sitting and crawling were observed in laboratory at the age of 4 and 9 months by a pediatrician and a developmental psychologist, and the age of walking was confirmed in questionnaires filled in by the parents at the age of 18 and 27 months. Results: Whether or not roll over at 4 months, and sit and crawl at 9 months were related to the age of walking. About crawling and sitting, the age of walking varies not only able or unable but the variation of its form at the 9 month observation point. Multiple regression analysis revealed these three milestones were positively associated with walking; rolling over (β= 0.567), sitting (β= 1.973) and crawling (β= 1.473). Conclusion: The age and the patterns of sitting, crawling and rolling over were all related to the age of independent walking among Japanese infants. Consideration of milestone' definition and variations proves to be essential in medical check-up. Language: en

Aim The aim of this study was to assess the onset of forward parachute reaction (FPR) in infants with brain lesions and its correlation with age of walking. Method FPR was assessed at 6, 9, and 12 months in 140 infants with brain lesions (78 males, 62 females; mean gestational age 31wks; SD 3.6wks; mean birthweight 1450g, SD 252g). On cranial ultrasound 62 infants had mild and 78 had major abnormalities; 86 developed cerebral palsy. All were followed for 5 years, and the age at which each child achieved independent walking was recorded. Infants who had been born small for gestational age (weight

This research examined developmental continuity between “cruising” (moving sideways holding onto furniture for support) and walking. Because cruising and walking involve locomotion in an upright posture, researchers have assumed that cruising is functionally related to walking. Study 1 showed that most infants crawl and cruise concurrently prior to walking, amassing several weeks of experience with both skills. Study 2 showed that cruising infants perceive affordances for locomotion over an adjustable gap in a handrail used for manual support, but despite weeks of cruising experience, cruisers are largely oblivious to the dangers of gaps in the floor beneath their feet. Study 3 replicated the floor-gap findings for infants taking their first independent walking steps, and showed that new walkers also misperceive affordances for locomoting between gaps in a handrail. The findings suggest that weeks of cruising do not teach infants a basic fact about walking: the necessity of a floor to support their body. Moreover, this research demonstrated that developmental milestones that are temporally contiguous and structurally similar might have important functional discontinuities.

UMMARY Electromyographic and kinematic data were collected during treadmill locomotion by normal infants and infants with cerebral palsy. Locomotor patterns of the infants with cerebral palsy were similar to those of normal infants during the stage of supported locomotion, but as they matured, some of the characteristics of the infant stepping pattern, such as synchronous muscle activity with excessive muscular co-contraction and short-latency reflexes at foot contact, were retained. The normal plantigrade features of adult gait did not develop in these children. RESUME Le developpement de la marche independante chez les enfants I. M. C. Des donnees electromyographiques et d'etudes cinematiques ont ete relevees durant une marche en plan incline chez des enfants normaux et I. M. C. L'allure de la locomotion des enfants I. M. C. etait semblable a celle des enfants normaux durant le temps portant du deplacement. Avec la croissance, chez les enfants I. M. C., quelques caracteristiques de steppage telle qu'une activite synchrone musculaire avec co-contractions musculaires excessives etaient observees. L'allure plantigrade normale de la demarche d'un adulte n'apparaissait pas chez ces enfants. ZUSAMMENFASSUNG Entwicklung zum freien Laufen bei Kindern mit Cerebralparese Bei gesunden und cerebralparetischen Kindern wurden bei einer Tretmuhlenbewegung elektromyographische und kinematische Daten gewonnen. Im Stadium der unterstutzten Bewegung waren die Bewegungsmuster der cerebralparetischen und der gesunden Kinder ahnlich. Im spateren Entwicklungsverlauf blieben bei den Kindern mit Cerebralparese einige Charakteristika des kindlichen Laufschemas, wie synchrone Muskelaktivitat mit exzessiver muskularer Kokontraktion erhalten. Der normale Sohlengang des Erwachsenen entwickelte sich bei diesen Kindern nicht. RESUMEN Desarrollo de la marcha independiente en ninos con paralisis cerebral Se recogieron datos electromiograficos y cinematicos durante la locomocion en una cinta sin fin en lactantes normales y con paralisis cerebral. Los patrones locomotores de los ninos con paralisis cerebral eran similares a los de los ninos normales durante el estadio de locomocion sostenida. A medida que el nino con paralisis cerebral maduraba, algunas de las caracteristicas del patron de andadura, tales como la actividad muscular sincronica con una co-contraccion muscular excesiva, persistieron. En estos ninos no se desarrollo el tipo normal plantigrado tipico del adulto.

UMMARY Locomotor strategies used before the acquisition of independent walking were studied in 424 infants. 270 were survivors of neonatal intensive care (the index group); the other 154 (controls) had had no perintal complications. Five forms of locomotion were distinguished: crawling on hands and knees, creeping on the stomach, bottom-shuffling, other, and none before independent walking. Crawling was the most common form of locomotion in both groups. A higher percentage in the index group were late crawlers (> 10 months), but similar proportions in both groups were bottom-shufflers or simply stood up and walked. One of the most important factors influencing locomotor strategies was asymmetry. Analysis of the influence of locomotor strategies on psychomotor and linguistic outcome up to five years showed no significant relationships within the index group. However, within the control group, infants who crawled had a statistically greater incidence of later motor delay, which is in contrast to the findings of other studies RESUME Strategies locomotrices precedant la marche independante: etude prospective du developpement neurologique et du langage de 424 cas Les strategies locomotrices utilisees avant l'acquisition d'une marche independante ont ete etudiees chez 424 nourrissons. 270 etaient les survivants de soins intensifs neo-nataux (groupe index); les 154 autres (groupe controle) n'avaient pas presente de complications perinatales. Cinq formes de locomotion furent distinguees: la marche a quatre pattes, ramper sur le ventre, le glissement sur le siege, autres, et aucune avant la marche independante. La marche a quatre pattes fut la plus habituelle dans les deux groupes. Un retard dans ce type de marche (apparition a plus de 10 mois) fut plus frequent dans le groupe index mais le pourcentage des enfants qui ont utilises le glissement sur le siege et qui m'ont pas utilises aucunes autre formes de deplacement avant la marche debout, etait identique dans les deux groupes (index et controle). Un des facteurs les plus importants influencant les strategies etait l'assymetrie. L'analyse de l'influence des stragegies locomotrices sur le devenir psychomoteur et linguistique jusqu'a cinq ans ne revela aucune relation significative dans le groupe index. Cependant, dans le groupe controle, la marche a quatre pattes etait reliee statistiquement a un retard moteur ulterieur, ce qui est en contradiction avec les donnees d'autres etudes. ZUSAMMENFASSUNG Bewegungsstrategien vor dem Laufenlernen: eine prospektive Studie uber die neurologische und sprachliche Entwicklung von 424 Kindern Bei 424 Kindern wurden die Bewegungsstrategien vor dem Laufenlernen untersucht. 270 waren auf der Neugeborenenintensivstation gewesen (Index Gruppe), die anderen 154 (Kontrollen) hatten keine perinatalen Komplikationen gehabt. Es wurden funf verschiedene Fortbewegungsarten unterschieden: Krabbeln auf Handen und Knien, auf dem Bauch kriechen, auf dem Hosenboden rutschen, andere und keine vor dem Laufen. In beiden Gruppen war das Krabbeln die haufigste Form der Fortbewegung. In der Index Gruppe fand sich ein hoherer Prozentsatz spater Krabbler (> 10 Monate), aber in beiden Gruppen gab es ungefahr gleich viele Kinder, die auf dem Hosenboden rutschten oder einfach aufstanden und losliefen. Asymmetrie war der wichtigste Faktor, der die Bewegungsstrategien beeinfluβte. Eine Analyse des Einflusses von Bewegunsstrategien auf den psychomotorischen und sprachlichen Outcome bis zum Alter von funf Jahren zeigte keine signifikanten Relationen innerhalb der Index Gruppe. In der Kontrollgruppe jedoch fand sich, daβ die Kinder, die gekrabbelt sind, spater statistisch haufiger Verzogerungen in der motorischen Entwicklung aufwiesen, was im Gegensatz zu den Befunden anderer Studien steht. RESUMEN Estrategias locomotoras precediendo la marcha independiente: estudio prospectivo deel desarrollo neurologico y del lenguaje en 424 casos Se estudiaron las estrategias locomotoras utilizadas antes de la adquisicion de la marcha independiente en 424 lactantes. 270 eran supervivientes de una cura intensiva neonatal (grupo indice), los otros 154 (controles) no habian tenido ninguna complicacion perinatal. Se distinguieron cinco formas de locomocion antes de la marcha independiente: arrastrarse sobre manos y rodillas, arrastrarse sobre el estomago, desplazarse sobre el trasero, otra forma y ninguna. El desplazamiento sobre manos y rodillas era laforma de locomocion mas corriente en ambos grupos. Un porcentaje mayor en el grupo indice lo hacia mas tarde (> 10 meses), pero habia la misma proporcion en ambos grupos de los que se desplazaban sobre el trasero o simplemente se ponian de pie y echabana andar. Uno de los factores mas importantes que influia en las estrategias locomotorasera la asimetria. El analisis de la influencia de las estrategias locomotoras sobre el desarrollo psicomotor y linguistico hasta los cinco anos de edad, no mostro ninguna relacion significativa en el grupo indice. Sin embargo en el grupo control los ninos que se desplazaban sobre manos y rodillas tenian una mayor incidencia estadistica de retraso motor posterior, lo que contrasta con los hallazgos en otros estudios.

The aims of this study were to assess the characteristics of three-dimensional displacement of the centre of mass of the body (CMb) during walking in healthy children and to compare it with those of young adults. Twenty-one children (11 males, 10 females; age range 1 to 9 years) were recruited from the nursery and school attached to the Université catholique de Louvain, Brussels, Belgium; and three young adults (one male two females; mean age 26 years 4 months) were recruited from the Rehabilitation and Physical Medicine Unit of the same university. Displacement of CMb was assessed at different walking velocities in the children and adults by two successive mathematical integrations of ground reaction forces, measured by a large strain-gauge force platform. Displacement of CMb was controlled for leg length of the participant to eliminate the scaling effect that is dependent on growth. Results showed that vertical and lateral amplitudes of the CMb when controlled for leg length were greater for children before 4 years of age and that the forward amplitude when controlled for leg length was greater for children before 7 years of age. We conclude that the development of mature human CMb displacement during independent walking is a gradual neural process, evolving until the age of 7 years.

We report on seven children (five males, two females) who presented with marked, often asymmetrical, toe-walking from onset of independent walking, associated with abnormal foot postures and increased tone at the ankles with characteristics of dystonia. Most of the children had presented with unusual pre-walking locomotion and a mild delay in independent walking. They did not fit into the usual categories of 'habitual' toe-walking or congenital short tendo calcaneus but nor did they have the clinical signs of spastic diplegia or of a peripheral neuromuscular disease. Normalization occurred progressively in the second to fourth years of life. The children were re-examined several years later (1 to 11y) and were normal. We believe that their persistent toe-walking corresponded to a variant of 'transient focal dystonia of infancy'. Knowledge of its existence may justify a period of observation without special investigations, surgery, or casting.

The ability to integrate sensation with action is considered an important factor underlying the development of upright stance and locomotion. While many have studied sensory influences on posture, the nature of these influences and how they change with development have yet to be thoroughly characterized in infancy. Six infants were examined from 1 month prior to walk onset until 9 months of independent walking experience while standing quietly and touching either a static or a dynamic surface. Five adults were examined performing an analogous task. An event-related, time-frequency analysis was used to assess the relationship between postural sway and the motion of the somatosensory stimulus. Phase consistency between sway and stimulus was observed for both adults and infants, and with walking experience the infants increased their phase consistency rather than changing aspects of response amplitude. It is concluded that walking experience provides opportunities for an active tuning of sensorimotor relations for adequate estimation of body position in space and thus facilitates refined control over temporal aspects of postural sway.

Although ankle-foot orthoses (AFOs) are frequently prescribed to correct skeletal malalignment in children with spastic diplegia, their effect on standing balance abilities has not been documented. This study investigated balance differences related to the presence of pathology and orthotic conditions during conditions of unexpected stance perturbation by comparing four children aged between 3 1/2 and 15 years with spastic cerebral palsy and four control children matched for years of independent walking experience. Electromyographic and kinematic data were collected and compared between groups and in three orthotic conditions (no AFOs, solid AFOs, dynamic AFOs). Results revealed that balance responses of children with spasticity were characterized by: increased coactivation of muscles as opposed to distal to proximal recruitment, decreased presence of upright posture in stance, increased use of 'on-toes' strategies, and different sway characteristics compared with the typically developing children. In both groups of children, the use of solid AFOs during perturbed stance resulted in: decreased activation of gastrocnemius muscles, disorganized muscle-response patterns, decreased use of ankle strategies, and increased joint angular velocities at the knee compared with conditions without AFOs or with dynamic AFOs. These preliminary results support the use of dynamic AFOs to correct skeletal malalignment in children with spastic diplegia.

Background and Purpose Independent walking function is a highly desired goal amonst stroke victims, and has been well reported in Western literature. However, few studies have investigated the recovery of gait following stroke in Third World countries, where rehabilitation is often minimal or non-existent. Methods A descriptive survey, using a structured questionnaire, was conducted on stroke victims, 12–14 weeks post-discharge from the Chris Hani Baragwanath Hospital, Soweto, South Africa. Although the questionnaire included a number of aspects of impairment, disability and handicap, this paper only reports on the recovery of walking function. Results A total of 361 patients were screened initially. Only 54 fulfilled all inclusion criteria, 38 (70%) were over 50 years of age and 16 (30%) were aged under 50 years. The average length of stay in hospital of the older group was eight days, and in the younger group, 11.5 days. All 54 subjects interviewed were able to walk prior to their stroke. Twelve to fourteen weeks post-discharge, 23 (66%) subjects in the older group and all (100%) of the younger group said they could walk. Half of the older group and nearly all of the younger group could walk outside their homes, unassisted and without appliances. One-third of the subjects experienced knee pain during walking, but only a small percentage said that this pain prevented them from walking. The ability to catch a taxi in Soweto was used as a measurement of the handicap of gait. Twenty (54%) older group subjects and five (31%) of the younger group never caught a taxi. Conclusions Although the recovery of gait in these subjects appears to have been good, the results cannot be extrapolated to the stroke population in general due to the stringent selection criteria of the study. Further studies are required to acquire a broader cross-section of the stroke population, including longer follow-up periods to gain insight into the continuation of walking function. This information is necessary in order to plan effective and appropriate rehabilitation services. Copyright © 1998 Whurr Publishers Ltd.