Zhang X1,2
1Tongji University, Rehabilitation Science, Shanghai, China, 2University of Nebraska Medical Center, Physical Therapy, Omaha, United States
Background: Early movement skills have been implicated in early cognitive development, but the relationship is not well understood. In typically developing infants, crawling has been linked to the ability to perceive object permanence. However, no studies have specifically examined movement and the progression of cognitive skill in children with neuromotor disorders. The ability to learn about objects partly relies on motor abilities, and should be reflected in problem solving ability.
Purpose: The purpose of this pilot study was to compare the effects of a perceptual motor approach (PMA) and a body weight support (BWS) intervention in advancing postural transitions and problem solving skills in children with CP. The PMA, which focuses on enhancing complexity of movement variability, was shown to improve sitting control and play skills in a previous study.
Methods: Twelve children with mild to moderate CP, 6 in each therapy group Between the ages of 9 months to 3 years. Children entered the study when they were able to sit for one minute alone. Intervention was twice weekly for 12 weeks, for 60 minute sessions.
PMA emphasized child-directed, self-initiated movement in various sitting positions, with suggestions from the therapist for variability. BWS was provided by suspension system or by physical therapy assistance to maintain an erect body position for standing or walking.
Gross Motor Function Measure-88 (GMFM), sitting/ crawling/standing/walking dimensions. The Early Problem Solving Indicator (EPSI) was used to measure cognitive skill. The EPSI assessment includes play with 3 standard toys: pop-up pets, stacking cups, and gumball machine. Infants are offered those toys for 6 mins, 2 mins each. Manipulation events (look, explore, function and solution) are coded from videotaped sessions. Data collected pre-intervention and post-intervention.
Results: The GMFM in all dimensions significantly increased overall(P 0.05).
The change scores of the GMFM in crawling and walking dimensions in the BWS group are larger (19.67±18.11% and 5.67±5.47%, respectively) than the perceptual motor group (15.00± 22.19% and 3.17±5.38%).
The change scores in the sitting and standing dimensions are smaller in the BWS group (13.83±12.95% and 4.50±5.96%) than in the perceptual motor group (18.501±11.86% and 10.50±9.91%).
The scores of EPSI explores and functions decreased in BWS group (-0.50±.051, -0.83±10.72 and -1.5±5.71); conversely, the scores of explores and functions in the PMA group increased (3.00±10.56 and 7.17±11.44).
Conclusion(s): BWS training and perceptual motor approach are both useful in promoting gross motor skill advancement.
The descriptive data imply that BWS intervention was more helpful in advancing dynamic motor abilities, such as crawling and walking. In contrast, the perceptual motor approach was more beneficial in improving static posture control, such as sitting and standing.
Surprisingly, the BWS group decreased in problem solving skills from pre to post intervention, while the PMA group improved during the intervention.
Implications: Specificity of practice appeared to affect the skills expected for each intervention group; practicing walking and crawling advanced those skills, while practicing postural skills advanced sitting and standing. Problem solving skills appeared to improve only in the group focused on perceptual motor skill, and gaining controlled variability of sitting and standing skills.
Keywords: Problem Solving, Cerebral Palsy, perceptual motor
Funding acknowledgements: American Physical Therapy Association, Section on Pediatrics.
Purpose: The purpose of this pilot study was to compare the effects of a perceptual motor approach (PMA) and a body weight support (BWS) intervention in advancing postural transitions and problem solving skills in children with CP. The PMA, which focuses on enhancing complexity of movement variability, was shown to improve sitting control and play skills in a previous study.
Methods: Twelve children with mild to moderate CP, 6 in each therapy group Between the ages of 9 months to 3 years. Children entered the study when they were able to sit for one minute alone. Intervention was twice weekly for 12 weeks, for 60 minute sessions.
PMA emphasized child-directed, self-initiated movement in various sitting positions, with suggestions from the therapist for variability. BWS was provided by suspension system or by physical therapy assistance to maintain an erect body position for standing or walking.
Gross Motor Function Measure-88 (GMFM), sitting/ crawling/standing/walking dimensions. The Early Problem Solving Indicator (EPSI) was used to measure cognitive skill. The EPSI assessment includes play with 3 standard toys: pop-up pets, stacking cups, and gumball machine. Infants are offered those toys for 6 mins, 2 mins each. Manipulation events (look, explore, function and solution) are coded from videotaped sessions. Data collected pre-intervention and post-intervention.
Results: The GMFM in all dimensions significantly increased overall(P 0.05).
The change scores of the GMFM in crawling and walking dimensions in the BWS group are larger (19.67±18.11% and 5.67±5.47%, respectively) than the perceptual motor group (15.00± 22.19% and 3.17±5.38%).
The change scores in the sitting and standing dimensions are smaller in the BWS group (13.83±12.95% and 4.50±5.96%) than in the perceptual motor group (18.501±11.86% and 10.50±9.91%).
The scores of EPSI explores and functions decreased in BWS group (-0.50±.051, -0.83±10.72 and -1.5±5.71); conversely, the scores of explores and functions in the PMA group increased (3.00±10.56 and 7.17±11.44).
Conclusion(s): BWS training and perceptual motor approach are both useful in promoting gross motor skill advancement.
The descriptive data imply that BWS intervention was more helpful in advancing dynamic motor abilities, such as crawling and walking. In contrast, the perceptual motor approach was more beneficial in improving static posture control, such as sitting and standing.
Surprisingly, the BWS group decreased in problem solving skills from pre to post intervention, while the PMA group improved during the intervention.
Implications: Specificity of practice appeared to affect the skills expected for each intervention group; practicing walking and crawling advanced those skills, while practicing postural skills advanced sitting and standing. Problem solving skills appeared to improve only in the group focused on perceptual motor skill, and gaining controlled variability of sitting and standing skills.
Keywords: Problem Solving, Cerebral Palsy, perceptual motor
Funding acknowledgements: American Physical Therapy Association, Section on Pediatrics.
Topic: Paediatrics: cerebral palsy
Ethics approval required: Yes
Institution: University of Nebraska Medical Center
Ethics committee: Christopher J Kratochvil, Suzanne Haney, Andrew MacFadyen
Ethics number: 134-11-EP
All authors, affiliations and abstracts have been published as submitted.
