Fields studying movement generation, including robotics, psychology, cognitive science, and neuroscience, utilize concepts and tools related to the pervasiveness of variability in biological systems. ...The concepts of variability and complexity and the nonlinear tools used to measure these concepts open new vistas for physical therapist practice and research in movement dysfunction of all types. Because mounting evidence supports the necessity of variability for health and functional movement, this perspective article argues for changes in the way therapists view variability, both in theory and in action. By providing clinical examples, as well as applying existing knowledge about complex systems, the aim of this article is to create a springboard for new directions in physical therapist research and practice.
Abstract
A critical factor to move the field of physical therapy forward is the measurement of fidelity during comparisons of interventions. Fidelity translates as “faithfulness”; thus, fidelity of ...intervention means faithful and correct implementation of the key components of a defined intervention. Fidelity measurement guards against deviations from, or drift in, the delivery of a targeted intervention, a process necessary for evaluating the efficacy of rehabilitation approaches. Importantly, attention to fidelity measurement differentiates rehabilitation approaches from each other. However, earlier research comparing physical therapist interventions often reported findings without careful attention to fidelity measurement. The purpose of this paper is 2-fold: (1) to support the development of intervention-specific fidelity measures in physical therapy research as the gold standard for translating research findings to clinical practice, and (2) to describe the process of creating a multi-dimensional fidelity measurement instrument in rehabilitation intervention. Improved attention to fidelity measurement will allow the rehabilitation field to communicate interventions clearly with a direct link to outcomes and target the implementation of our improved intervention for the right patient problem with the right dose and the right ingredients at the right time.
This perspective article provides support for 4 interrelated tenets: grounded perceptual-motor experience within cultural and social contexts forms cognition; exploration through early behaviors, ...such as object interaction, sitting, and locomotion, broadly facilitates development; infants and children with limited exploration are at risk for global developmental impairments; and early interventions targeting exploratory behaviors may be feasible and effective at advancing a range of abilities across developmental domains and time. These tenets emphasize that through the promotion of early perceptual-motor behaviors, broader, more global developmental advancements can be facilitated and future delays can be minimized across domains for infants and children with special needs. Researchers, educators, and clinicians should build on these tenets to further demonstrate the effectiveness of targeted early interventions. The goals of these interventions should be not only to advance targeted perceptual-motor skills in the moment but also to more broadly advance future abilities and meet the early intervention goal of maximizing children's learning potential.
Variability is a natural and important feature of human movement. Using existing theoretical frameworks as a foundation, we propose a new model to explain movement variability as it relates to motor ...learning and health. We contend that mature motor skills and healthy states are associated with an optimal amount of movement variability. This variability also has form and is characterized by a chaotic structure. Less than optimal movement variability characterizes biological systems that are overly rigid and unchanging, whereas greater than optimal variability characterizes systems that are noisy and unstable. Both situations characterize systems that are less adaptable to perturbations, such as those associated with abnormal motor development or unhealthy states. From our perspective, the goal of neurologic physical therapy should be to foster the development of this optimal amount of movement variability by incorporating a rich repertoire of movement strategies. The development of such a repertoire can be enhanced by incorporating a multitude of experiences within the therapeutic milieu. Promoting complex variation in human movement allows either motor development or the recovery of function after injury not to be hard coded, but determined instead by the active engagement of the individual within their environment. Measurement tools derived from nonlinear dynamics that characterize the complexity of movement variability provide useful means of testing these propositions. To illustrate, we present 2 clinical case studies, one pediatric and one adult, where we applied our theoretical framework to measuring change in postural control.
Each chapter in this volume supports the assumption that the quantity and quality of sleep is an essential building block for the architecture of learning in early life. Diverse areas affected by ...sleep include language, motor skills, problem solving, and memory, which show greater improvements when adequate and healthy sleep pervades a child's routine. Studies described in this volume expand our understanding of the impact of sleep both for short term skill improvement and for long-term developmental gains. The interdisciplinary content of this volume brings practical and translational information regarding sleep and learning in young children, including those with special challenges, such as children with Down syndrome, Williams syndrome, attention deficits, or cerebral palsy. In this concluding chapter, key knowledge gaps will be described with an eye toward areas of study that could further build strategies that support early learning and suggest attention to the role of sleep to enhance the effects of early intervention for children with developmental challenges.
Abstract
Background
Embodied cognition interests physical therapists because efforts to advance motor skills in young infants can affect learning. However, we do not know if simply advancing motor ...skill is enough to support advances in cognition.
Objective
The objective was to examine the effect of 2 interventions on the developing motor skill of sitting and problem solving and to describe the feasibility of using eye-tracking technology to explore visual and motor interaction.
Design
This was a longitudinal, randomized comparison of interventions.
Methods
Twenty infants with developmental delay and/or cerebral palsy, ranging in age from 8 to 34 months (mean SD = 15 6.9 months), participated in an intervention emphasizing motor-based problem solving, and an intervention focused on advancing motor skill through assistance for attaining optimal movement patterns. Outcome measures were the Gross Motor Function Measure sitting subsection and the Early Problem Solving for Infants test. Active touch and looks were measured with eye-tracking technology.
Results
Participants in both groups made significant motor gains from baseline, with no difference between intervention groups on Gross Motor Function Measure change scores. Participants in the problem-solving group showed significant gains in Early Problem Solving for Infants scores over the participants in the optimal movement patterns group. Overall, participants increased active touch of toys and increased concurrent looking with active touching.
Limitations
This exploratory study was small, with variation in participants’ skills. The sampled behaviors for analysis were a small portion of the overall function of the participant.
Conclusions
An intervention using motor-based problem solving could improve infants’ problem-solving skill. The use of eye-tracking could help to understand embodied cognition as infants develop, but the challenges of embedding the method in natural settings require further work.
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Variability is commonly considered a key to typical motor development. However, multiple definitions and quantification systems have limited the clinical interpretation of variability and the ...translation of developmental research to assessment and intervention. The purposes of this perspective article are to highlight the importance of statistical variability and complexity in postural control during development and to describe implications for assessment and intervention during infancy and early childhood. Five tenets are proposed describing the role of variability in postural control to support movement experiences, exploration, and global development. Evidence for assessment and intervention focused on variability in postural control are introduced.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
This study investigated the impact of postural control on infants’ Focused Attention (FA). Study 1 examined whether and how sitting independently versus with support impacted 6- to 8-month-old ...infants’ ability to focus attention during object exploration. FA measures did not depend on support condition. However, sitting experience was significantly negatively correlated with FA measures in the supported condition, suggesting that infants with more sitting experience performed fewer exploratory movements, possibly due to faster information processing ability compared to infants with less sitting experience. These unexpected findings prompted an exploration of more subtle looking behaviors during FA in Study 2—a case study of three infants who wore a head-mounted eye-tracker during an FA task. The ability to rapidly shift visual attention was key to gathering environmental information useful for problem solving—an interpretation that is supported by prior findings of the relationship between fast looks and faster information processing.
•Infants’ sitting experience was associated with fewer exploratory behaviors.•Sitting experience related to faster information processing during toy exploration.•Rapid shifting visual attention was key to gathering information for problem solving.•Eye-tracking allowed detailed inspection of infant gaze during skill acquisition.
Abstract
Objective
Our objective was to evaluate the efficacy of the Sitting Together and Reaching to Play (START-Play) intervention in young infants with neuromotor disorders.
Method
This randomized ...controlled trial compared usual care early intervention (UC-EI) with START-Play plus UC-EI. Analyses included 112 infants with motor delay (55 UC-EI, 57 START-Play) recruited at 7 to 16 months of age across 5 sites. START-Play included twice-weekly home visits with the infant and caregiver for 12 weeks provided by physical therapists trained in the START-Play intervention; UC-EI was not disrupted. Outcome measures were the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley); the Gross Motor Function Measure; reaching frequency; and the Assessment of Problem Solving in Play (APSP). Comparisons for the full group as well as separate comparisons for infants with mild motor delay and infants with significant motor delay were conducted. Piecewise linear mixed modeling estimated short- and long-term effects.
Results
For infants with significant motor delay, positive effects of START-Play were observed at 3 months for Bayley cognition, Bayley fine motor, and APSP and at 12 months for Bayley fine motor and reaching frequency outcomes. For infants with mild motor delay, positive effects of START-Play for the Bayley receptive communication outcome were found. For the UC-EI group, the only difference between groups was a positive effect for the APSP outcome, observed at 3 months.
Conclusion
START-Play may advance reaching, problem solving, cognitive, and fine motor skills for young infants with significant motor delay over UC-EI in the short term. START-Play in addition to UC-EI may not improve motor/cognitive outcomes for infants with milder motor delays over and above usual care.
Impact
Concepts of embodied cognition, applied to early intervention in the START-Play intervention, may serve to advance cognition and motor skills in young infants with significant motor delays over usual care early intervention.
Lay Summary
If you have a young infant with significant delays in motor skills, your physical therapist can work with you to develop play opportunities to enhance your child’s problem solving, such as that used in the START-Play intervention, in addition to usual care to help your child advance cognitive and motor skills.
Aim
To describe the development of an intervention‐specific fidelity measure and its utilization and to determine whether the newly developed Sitting Together and Reaching to Play (START‐Play) ...intervention was implemented as intended. Also, to quantify differences between START‐Play and usual early intervention (uEI) services.
Method
A fidelity measure for the START‐Play intervention was developed for children with neuromotor disorders by: (1) identifying key intervention components, (2) establishing a measurement coding system, and (3) testing the reliability of instrument scores. After establishing acceptable interrater reliability, 103 intervention videos from the START‐Play randomized controlled trial were coded and compared between the START‐Play and uEI groups to measure five dimensions of START‐Play fidelity, including adherence, dosage, quality of intervention, participant responsiveness, and program differentiation.
Results
Fifteen fidelity variables out of 17 had good to excellent interrater reliability evidence with intraclass correlation coefficients (ICCs) ranging from 0.77 to 0.95. The START‐Play therapists met the criteria for acceptable fidelity of the intervention (rates of START‐Play key component use ≥0.8; quality ratings ≥3 on a scale of 1–4). The START‐Play and uEI groups differed significantly in rates of START‐Play key component use and quality ratings.
Interpretation
The START‐Play fidelity measure successfully quantified key components of the START‐Play intervention, serving to differentiate START‐Play from uEI.
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