Infant Neuromotor Development Research Articles

Evolution of a System to Monitor Infant Neuromotor Development in the Home: Lessons from COVID-19

In the nine months leading up to COVID-19, our biomedical engineering research group was in the very early stages of development and in-home testing of HUGS, the Hand Use and Grasp Sensor (HUGS) system. HUGS was conceived as a tool to allay parents' anxiety by empowering them to monitor their infants' neuromotor development at home. System focus was on the evolving patterns of hand grasp and general upper extremity movement, over time, in the naturalistic environment of the home, through analysis of data captured from force-sensor-embedded toys and 3D video as the baby played. By the end of March, 2020, as the COVID-19 pandemic accelerated and global lockdown ensued, home visits were no longer possible and HUGS system testing ground to an abrupt halt. In the spring of 2021, still under lockdown, we were able to resume recruitment and in-home testing with HUGS-2, a system whose key requirement was that it be contactless. Participating families managed the set up and use of HUGS-2, supported by a detailed library of video materials and virtual interaction with the HUGS team for training and troubleshooting over Zoom. Like the positive/negative poles of experience reported by new parents under the isolation mandated to combat the pandemic, HUGS research was both impeded and accelerated by having to rely solely on distance interactions to support parents, troubleshoot equipment, and securely transmit data. The objective of this current report is to chronicle the evolution of HUGS. We describe a system whose design and development straddle the pre- and post-pandemic worlds of family-centered health technology design. We identify and classify the clinical approaches to infant screening that predominated in the pre-COVID-19 milieu and describe how these procedural frameworks relate to the family-centered conceptualization of HUGS. We describe how working exclusively through the proxy of parents revealed the family's priorities and goals for child interaction and surfaced HUGS design shortcomings that were not evident in researcher-managed, in-home testing prior to the pandemic.

PreEMPT (Preterm Infant Early Intervention for Movement and Participation Trial): The Feasibility of a Novel, Participation-Focused Early Physiotherapy Intervention Supported by Telehealth in Regional Australia—A Protocol

Background: Early intervention is beneficial for improving preterm infant motor and cognitive outcomes in early childhood; however, little is known about whether early intervention can influence a preterm infant’s participation. Additionally, many studies investigating the impact of early intervention for preterm infants have been conducted in large metropolitan centres, leaving preterm infants who reside in regional areas underrepresented in the literature to date. Consequentially, it is not yet known whether there are service delivery models, such as using telehealth as an adjunct to face-to-face intervention, that might cater to the needs of preterm infants residing outside metropolitan centres. PreEMPT (Preterm infant Early intervention for Movement and Participation Trial) is a novel early physiotherapy intervention that has been designed to use a participation goal-directed intervention approach via a mixture of face-to-face clinic sessions and telehealth sessions to improve the motor and participation outcomes of preterm born infants. Methods: This study aims to evaluate the feasibility of PreEMPT using an assessor-blinded, randomised controlled trial to compare PreEMPT to Usual Physiotherapy Care (UPC) for preterm infants residing in a regional Australian hospital catchment area. Twenty-six preterm infants (≤34 + 6 weeks gestational age) will be recruited prior to term corrected age from the special care nursery of a regional hospital. Following informed consent and baseline assessments, infants will be randomly allocated to receive either PreEMPT, a novel participation-focused early physiotherapy intervention delivered weekly for 14 forty-five-minute sessions alternating face-to-face sessions with telehealth into the infant’s home, or UPC, two - three physiotherapy sessions in the 4-month intervention period. Outcome measures relating to infant neuromotor development, motor performance, general development, and parental mental health and well-being will be assessed at 4-, 6- and 8-months corrected age. Feasibility will be evaluated by acceptability (parental satisfaction), demand and practicality (recruitment rate and telehealth session implementation), implementation (attendance at assessment and treatment sessions), and limited efficacy testing (comparing outcomes listed above for infants in PreEMPT and UPC). Discussion: This study will be the first of its kind to use the participation of preterm infants in meaningful life situations as the foundation for intervention delivered via alternating face-to-face clinic sessions with telehealth into the home. The feasibility of this approach will be evaluated and used to inform future iterations of research about PreEMPT’s efficacy for improving preterm infant motor and participation outcomes.

Infant Neuromotor Development: An Early Indicator of Genetic Liability for Neurodevelopmental Disorders

Infant Neuromotor Development: An Early Indicator of Genetic Liability for Neurodevelopmental Disorders

Polygenic Risk Scores for Developmental Disorders, Neuromotor Functioning During Infancy, and Autistic Traits in Childhood

BackgroundImpaired neuromotor development is often one of the earliest observations in children with autism spectrum disorder (ASD). We investigated whether a genetic predisposition to developmental disorders was associated with nonoptimal neuromotor development during infancy and examined the genetic correlation between nonoptimal neuromotor development and autistic traits in the general population. MethodsIn a population-based cohort in The Netherlands (2002–2006), we calculated polygenic risk scores (PRSs) for ASD and attention-deficit/hyperactivity disorder (ADHD) using genome-wide association study summary statistics. In 1921 children with genetic data, parents rated autistic traits at 6 years of age. Among them, 1174 children (61.1%) underwent neuromotor examinations (tone, responses, senses, and other observations) during infancy (9–20 weeks of age). We used linear regressions to examine associations of PRSs with neuromotor scores and autistic traits. We performed a bivariate genome-based restricted maximum likelihood analysis to explore whether genetic susceptibility underlies the association between neuromotor development and autistic traits. ResultsHigher PRSs for ASD were associated with less optimal overall infant neuromotor development, in particular low muscle tone. Higher PRSs for ADHD were associated with less optimal senses. PRSs for ASD and those for ADHD both were associated with autistic traits. The single nucleotide polymorphism–based heritability of overall motor development was 20% (SE = .21) and of autistic traits was 68% (SE = .26). The genetic correlation between overall motor development and autistic traits was .35 (SE = .21, p < .001). ConclusionsWe found that genetic liabilities for ASD and ADHD covary with neuromotor development during infancy. Shared genetic liability might partly explain the association between nonoptimal neuromotor development during infancy and autistic traits in childhood.

Infants born to women with substance use: Exploring early neurobehavior with the Dubowitz neurological examination.

There is a special concern regarding substance using pregnant women due to the possible adverse effects on the infant. While the immediate effects of prenatal substance exposure are well known, the long-term data on the infants' neurodevelopment is inconclusive. The purpose of this study was to assess early neurobehavior of infants of mothers with substance use using the Dubowitz examination and to follow their neuromotor development until one year of age. Ninety-five pregnant women with a recent history of substance use were recruited and followed up at the maternity outpatient clinic. Follow-up data was collected from hospital records and maternal interviews. The Dubowitz neurological examination was performed to the 54 clinically healthy term infants. The results were converted into optimality scores and compared to normative values from clinically healthy term infants derived from a separate normative population. The infant's neuromotor development was followed up to one year of age. Only 7% of the infants born to women with recent or current substance use reached optimal scores (<30.5) in the Dubowitz neurological examination compared to 95% reported in normative population. Sixty-three percent of the newborns needed follow-up based on physiotherapeutic assessment of neurobehavior. By 12 months of age, the neuromotor status of 88% (n = 30) of these infants was found normal. A high percentage of infants of mothers who were referred prenatally to hospital due to substance use showed suboptimal neurological findings during their first days of life.

Infant Neuromotor Development and Childhood Problem Behavior.

Research of adults and school-aged children suggest a neurodevelopmental basis for psychiatric disorders. We examined whether infant neuromotor development predicted internalizing and externalizing problems in young children. In Generation R, a population-based cohort in the Netherlands (2002-2006), trained research assistants evaluated the neuromotor development of 4006 infants aged 2 to 5 months by using an adapted version of Touwen's Neurodevelopmental Examination (tone, responses, and senses and other observations). We defined nonoptimal neuromotor development as scores in the highest tertile. Mothers and fathers rated their children's behavior at ages 1.5, 3, 6, and 10 years with the Child Behavior Checklist (n = 3474, response: 86.7%). The associations were tested with generalized linear mixed models. Overall, neuromotor development predicted internalizing scores, but no association was observed with externalizing scores. Nonoptimal muscle tone was associated with higher internalizing scores (mothers' report: β = .07; 95% confidence interval [CI]: 0.01 to 0.13; fathers' report: β = .09, 95% CI: 0.00 to 0.16). In particular, nonoptimal low muscle tone was associated with higher internalizing scores (mothers' report: β = .11; 95% CI: 0.05 to 0.18; fathers' report: β = .13; 95% CI: 0.04 to 0.22). We also observed an association between senses and other observations with internalizing scores. There was no relationship between high muscle tone or reflexes and internalizing scores. Common emotional problems in childhood have a neurodevelopmental basis in infancy. Neuromotor assessment in infancy may help identify vulnerability to early internalizing symptoms and offer the opportunity for targeted interventions.

Association of Genetic Risk for Schizophrenia and Bipolar Disorder With Infant Neuromotor Development

Schizophrenia and bipolar disorder (BD) are heritable disorders with similarities in clinical symptoms and typical onset after puberty. While research shows that impaired motor coordination can have an associationwith schizophrenia, there are limited data on childhood development preceding BD. Murray et al proposed a developmental model for similarities and dissimilarities between schizophrenia and BD, but it remains unknown if dissimilarities exist in early infancy and if they covary with genetic liability for these disorders. Using polygenic risk scores (PRSs),we exploredwhether genetic risk for schizophrenia and genetic risk for BD are associated with neuromotor development in infancy.

Relation of infant motor development with nonverbal intelligence, language comprehension and neuropsychological functioning in childhood: a population-based study.

Within a population-based study of 3356 children, we investigated whether infant neuromotor development was associated with cognition in early childhood. Neuromotor development was examined with an adapted version of Touwen's Neurodevelopmental Examination between 9 and 20weeks. Parents rated their children's executive functioning at 4years. At age 6years, children performed intelligence and language comprehension tests, using Dutch test batteries. At age 6-9years, neuropsychological functioning was assessed in 486 children using the validated NEPSY-II-NL test battery. We showed that less optimal neurodevelopment in infancy may predict poor mental rotation, immediate memory, shifting, and planning; but not nonverbal intelligence or language comprehension.

The effect of maternal sleep-disordered breathing on the infant’s neurodevelopment

We sought to examine the effect of maternal sleep-disordered breathing (SDB) on infant general movements (GMs) and neurodevelopment. Pregnant women with uncomplicated full-term pregnancies and their offspring were prospectively recruited from a community and hospital low-risk obstetric surveillance. All participants completed a sleep questionnaire on second trimester and underwent ambulatory sleep evaluation (WatchPAT; Itamar Medical, Caesarea, Israel). They were categorized as SDB (apnea hypopnea index>5) and controls. Infant GMs were assessed in the first 48 hours and at 8-11 and 14-16 weeks of age. At 12 months of age the Infant Developmental Inventory and the Brief Infant Sleep Questionnaire were administered. In all, 74 women and their full-term infants were studied. Eighteen (24%) women had SDB. Mean birthweight was 3347.1±423.9 g. Median Apgar score at 5 minutes was 10 (range, 8-10). In adjusted comparisons, no differences were found between infants born to mothers with SDB and controls in GM scores in all 3 evaluations. Low social developmental score was detected at 12 months in 64% of infants born to SDB mothers compared to 25% of infants born to controls (adjusted P=.036; odds ratio, 16.7). Infant snoring was reported by 41.7% of mothers with SDB compared to 7.5% of controls (P=.004). Our preliminary results suggest that maternal SDB during pregnancy has no adverse effect on neonatal and infant neuromotor development but may affect social development at 1 year.

Early Infant Neuromotor Assessment is Associated with Language and Nonverbal Cognitive Function in Toddlers

Numerous studies in high-risk populations established that variations in infant neuromotor development predict poor cognitive function. It is unclear whether this association is found in the general population. Moreover, previous population-based studies mostly focused on motor milestone achievement. This study was embedded in the Generation R Study, a population-based cohort in Rotterdam, the Netherlands. Neuromotor development was assessed with an adapted version of Touwen's Neurodevelopmental Examination when infants (1205 males, 1278 females) were on average 12 weeks old (standard deviation 1, range, 9-15 weeks). To measure language function at age 1.5 years, the MacArthur Short Form Vocabulary Checklist was used. At 2.5 years, mothers completed the Language Development Survey and the Parent Report of Children's Abilities measuring language and nonverbal cognitive functioning, respectively. After adjustment for confounders, less optimal neuromotor development, that is, more low tone symptoms, was associated with a delay in receptive language at 1.5 years (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.05-1.34) and in expressive language at multiple time points (OR, 1.11; 95% CI, 1.02-1.21). Higher scores on overall neuromotor development, indicating a less optimal neuromotor development, was associated with an increased risk of a delay in nonverbal cognitive function at 2.5 years (OR, 1.19; 95% CI, 1.05-1.35). The results of this study suggest that infants with more low tone symptoms, indicating minor deviances from normal neuromotor development, are somewhat more vulnerable to language delays than those infants who do not have these symptoms.

Physical activity during pregnancy and infant's neuromotor development in the first 4 years of life*

Introduction: Physical activity (PA) during pregnancy is known to result in many health benefits. Evidence also shows that child may benefit from maternal exercise. However, similar to the general population, PA level during gestation is below the recommended by health guidelines. Many reasons are reported by women to not exercise, and even among those who were previously active, unexplained fear of harming herself or fetus is observed. The aim of this study was to evaluate if leisure-time PA during pregnancy in Brazilian women could alter offspring's neurodevelopment.

Fetal Programming of Infant Neuromotor Development: The Generation R Study

The objective of the study was to examine whether infant neuromotor development is determined by fetal size and body symmetry in the general population. This study was embedded within the Generation R Study, a population-based cohort in Rotterdam. In 2965 fetuses, growth parameters were measured in mid-pregnancy and late pregnancy. After birth, at age 9 to 15 wks, neuromotor development was assessed with an adapted version of Touwen's Neurodevelopmental Examination. Less optimal neuromotor development was defined as a score in the highest tertile. We found that higher fetal weight was beneficial to infant neurodevelopment. A fetus with a 1-SD score higher weight in mid-pregnancy had an 11% lower risk of less optimal neuromotor development (OR: 0.89; 95% CI: 0.82-0.97). Similarly, a fetus with a 1-SD score larger abdominal-to-head circumference (AC/HC) ratio had a 13% lower risk of less optimal neuromotor development (OR: 0.87; 95% CI: 0.79-0.96). These associations were also present in late pregnancy. Our findings show that fetal size and body symmetry in pregnancy are associated with infant neuromotor development. These results suggest that differences in infant neuromotor development, a marker of behavioral and cognitive problems, are at least partly caused by processes occurring early in fetal life.

Maternal Symptoms of Anxiety During Pregnancy Affect Infant Neuromotor Development: The Generation R Study

Several studies found that maternal symptoms of anxiety or depression are related to functioning and development of the offspring. Within a population-based study of 2,724 children, we investigated the effect of maternal anxiety or depression on infant neuromotor development. Symptoms of anxiety and depression were measured during pregnancy and after giving birth; infant neuromotor development was assessed by trained research nurses during a home visit at the age of 3 months. The current study showed that mothers who were anxious during pregnancy had an elevated risk of having an infant with non-optimal neuromotor development.

Does gestational duration within the normal range predict infant neuromotor development?

Aim To examine the extent to which infant neuromotor development is determined by gestational duration and birth weight within the normal range. Methods The study was embedded within the Generation R Study, a population-based cohort in Rotterdam, the Netherlands. An adapted version of Touwen's Neurodevelopmental Examination was used to assess 3224 infants (1576 males and 1648 females) at corrected ages between 9 and 15 weeks. Non-optimal neuromotor development was defined as a score in the highest tertile. Results Infant neuromotor development was significantly affected by gestational duration (odds ratio 0.8, 95% confidence interval 0.7;0.8). Adding a quadratic term of gestational duration to the model revealed a highly significant curvilinear association between gestational duration and neuromotor development; after adjusting for post-conceptional age this was still significant. Although babies with a 1 kg lower birth weight had a 30% higher risk of non-optimal neuromotor development, this association disappeared after adjustment for post-conceptional age. Conclusions Our findings indicate that differences in infant neuromotor development can be explained even by variations in gestational duration within the normal range. If an infant is found to have minor neuromotor delays, account should be taken of this.

Is Maternal Education Related to Infant Motor Development?

Because results of previous studies were inconclusive, our purpose was to examine the relationship between maternal education and infant neuromotor development in infants who are healthy and born at term. Secondary analysis of normative data derived through administration of the Harris Infant Neuromotor Test (HINT) to 412 Canadian infants was conducted. Infants were recruited from community-based infant programs, childcare facilities, and homes in five Canadian provinces. Inclusion criteria included: term birth (38-42 weeks), birth weight > or =2500 g, and no history of major prenatal, perinatal, or postnatal medical complications or maternal complications. Infants encompassed Canadian ethnic diversity as well as equal gender distribution at each of 10 monthly age intervals. The analysis demonstrated that maternal education was only minimally associated with infant neuromotor development as measured by HINT total scores. Our results confirmed other researchers' findings of no association between maternal education and infant motor development.

Early Neuromotor and Psychomotor Development of Infants with Chronic Lung Disease (CLD)

Early Neuromotor and Psychomotor Development of Infants with Chronic Lung Disease (CLD)

Neuromotor Development of Cocaine-exposed and control Infants from Birth Through 15 Months: Poor and Poorer Performance

The objective of this study is to describe the longitudinal course of motor development of a group of infants exposed to cocaine in utero and an unexposed control group. Subjects included 28 in utero-exposed infants and 22 unexposed infants matched for race, income of the family, and mother's educational level. Infants were evaluated at 1 month with the Alberta Infant Motor Scale (AIMS), at 4 months with the AIMS and Movement Assessment of Infants (MAI), at 7 months with the AIMS and MAI, and at 15 months with the Peabody Developmental Motor Scales (PDMS). At 4 months, compared with the unexposed infants, a significantly larger proportion of the exposed infants fell below the 50th percentile on the AIMS and had greater proportion of suspicious risk scores on the MAI. At 7 months infants in the exposed group had lower AIMS and MAI scores than the control group. There was no difference between groups on the motor scales at 1, 4, or 15 months. At all ages more infants in both groups scored significantly less than the expected norms on all scales. Performance was unrelated to a cumulative risk index made up of demographic, medical, and social factors. Almost all subjects had risk scores that placed them at extremely high levels of risk. Performance may have been related to a difference in weight between groups at 7 months and to decreasing weights for both groups by 15 months. In utero cocaine exposure has a significant, although relatively small, effect on infant motor performance late in infancy. However, regardless of exposure status, these infants had poor performance that may be accounted for by a heavy accumulation of risk factors associated with poverty.

Neuromotor Development of Preterm Infants Through the First Year of Life

Neuromotor Development of Preterm Infants Through the First Year of Life

Neuromotor Development of Preterm Infants Through the First Year of Life

Physical and occupational therapists monitor the development of preterm infants graduating form neonatal intensive care units and frequently use the neuromotor development of fullterm infants as the criterion against which normality is judged. Despite the methodological problems of comparison on non-homogeneous groups, poor matching, inadequate measurement tools, and expectancy bias, the literature suggests that preterm infants develop differently from full term infants. Neither the extent nor reasons for differences and suggestions for future research are proposed. Knowledge of the variability of preterm infant neuromotor behavior should be useful to pediatric therapists aiming to identify those infants who truly are developing abnormally.

Neuromotor development of preterm and full-term infants

The Neuromotor Behavioral Inventory (NBI), a 16-category measure of muscle tone, developmental motor abilities, quality of movement, neurological reflexes and reactions, and neuromotor outcome was used with 38 infants divided into three groups: healthy preterm (HPT), sick preterm (SPT), and healthy full-term (HFT) infants. Infants were tested at five time points: 40 weeks postconception (newborn) and 3, 6, 9 and 12 months of age post-term. The intent of the study was two-fold: to determine whether there are developmental differences among the groups of infants and whether the differences persist during the first year of life. Results indicate that HFT and HPT infants score higher than SPT infants in the neuromotor categories of: muscle tone, upper extremity development, head control, and neuromotor outcome rating. HFT infants scored higher than both preterm groups in: trunk rotation, reaction to movement, visual and auditory attention, and fixing. Differences persisted among the gorups during the first year of life in the following: the developmental motor ability of trunk rotation, fixing, adaptability, and the neuromotor outcome rating. It appears that neonatal health status is a contributing factor to infant neuromotor development, particularly in the quality of movement reactions.