Commentary on "Sitting postural control affects the development of focused attention in children with cerebral palsy".

Abstract

“How could I apply this information?” This study provides initial evidence that focused attention on objects improves when independent sitting is achieved in young children with mild to moderate cerebral palsy (CP). The authors suggest that early physical therapy to train sitting may facilitate the development of focused attention in children with CP. Early intervention programs with a primary provider model should consider this information and assure that a physical therapist is involved when sitting is delayed. The study provides theoretical information regarding a linear relationship between motor and cognitive development in children with CP. “What should I be mindful of when applying this information?” Examining changes on the basis of global behavioral manifestations such as independent sitting may not be specific enough to delineate the variables necessary for treatment. The study would be strengthened by more specific measures of trunk control such as the Segmental Assessment of Trunk Control1 and by measuring more time points. With only 2 time points, a linear relationship between sitting ability and attention is all that could have been observed. Additional time points are needed to determine the true nature of this relationship.2 Manual skills and postural control are both linked to development of focused attention in infants who are typically developing3 and are likely to be an important factor in children with CP. No measures were completed regarding the manual exploration of objects by the children; therefore, it is not possible to differentiate between the influence of posture and manual skills on focused attention. Future studies should quantify manual skills and other variables that are known to affect the development of attention. The authors also interchanged the terms “focused attention” and “cognition”; however, more information is needed to confirm the appropriateness of interchanging these terms. Sandra Saavedra, MS, PT, PhD University of Hartford Hartford, Connecticut Danielle Bellows, PT, MHS, PCS Connecticut Children's Medical Center Hartford, Connecticut