Project Description:
Previously, children with spastic CP were not diagnosed until they failed to reach developmental milestones and/or developed spasticity. As infants at risk with CP can now be identified as early as 3months corrected age using the Generalized Movement Assessment, there is a need to develop improved motor assessments and targeted interventions for infants and toddler. With this grant funding, we developed a draft of an infant SMC evaluation to use as a working prototype. We recruited infants ages 3 months through 3 years of age including infants with typical development (TD) and those who have been identified as having cerebral palsy (CP) or being at risk for CP. After giving oral parental consent, these infants participate in a videotaped Zoom teleconference to record and observe lower extremity movement as well as providing medical history and participating in a gross motor evaluation using the Developmental Assessment of Infants and Young Children, second edition (DACY-2) Gross Motor subdomain. Families of 33 infants and children have consented to participate and 32 have participated in the data collection (video, medical history and DACY-2) as of 11-29-21. Ages range from 3 months to 46 months corrected or chronological age. (14 have identified CP or motor delay with risk for CP and 19 have TD). Families of all infants and toddlers have agreed to repeat these assessments periodically over the coming year and repeat evaluations have been completed for 12 participants making a total of 44 video sessions.
Review of videotapes and adjustments to draft of the infant SMC assessment tool are ongoing. Aspects include infant behavioral state, positioning, stimulus, response and potential quantification scales. A Demonstration poster explaining the importance of infant lower extremity SMC, the development of a tool and the implications for early intervention was presented at the 2021 Annual AACODM meeting. In addition, we have a family education component. We are coordinating efforts with the UCLA NICU Early Identification team, NICU follow-up clinic, Intervention Program (for infants and toddlers age 0-3 years), Center for CP clinic (Orthopedic Surgery and Physical Medicine), Department of Pediatric Neurology and Rehabilitation Services (Physical Therapy) to share information and improve the flow of referrals and service delivery.
In September, 2021 we added an intervention aspect to this program. Strategies to promote LE movement, specifically selective movement, have begun to be conceptualized and trialed during the weekly Parent and me Infant class generally serving children who are generally under age 18 months who are identified as having developmental delay. Many of these children have significant motor delay including CP or risk for CP or related disorders. We have begun to demonstrate ways to introduce dissociated hip and knee movement patterns during kicking, rolling and stepping to parents and caretakers during infant class free play time that can be carried over to home. We have also introduced positioning to assist in promotion and practice of intersegmental kicking and stepping including bean bag chairs, floor sitters (Tumble Form, Special Tomato), infant seats, Gait trainers, and Litegait with harness (overhead support). We are looking for positioning options using commercially available baby equipment in addition to using therapeutic equipment available at the program. Toys and materials are being collected and assessed for use in these tasks such as baby gym with suspended toys, ankle rattles, crinkle toys and musical toys.
Keyword(s):
Babies, Cerebral Palsy, Selected Motor Control, At Risk
Core Function(s):
Training Trainees, Performing Direct and/or Demonstration Services, Performing Research or Evaluation, Developing & Disseminating Information
Target Audience:
Students/Trainees (long or intermediate trainees), Professionals and Para-Professionals, Children/Adolescents with Disabilities/SHCN
