Motivating Selective Motor Control of Infants at High Risk of Cerebral Palsy Using an In-Home Kicking-Activated Mobile Task: A Pilot Study

Objective: Decreased selective motor control limits gait function of children with spastic cerebral palsy (CP). Infants at high risk of CP demonstrate decreased selective motor control by 1 month of age. To motivate more selective hip-knee control, infants at high risk of CP participated in an in-home kicking-activated mobile task. The purpose of this study was to determine whether infants at high risk of CP and infants with typical development (TD) demonstrated increased selective hip-knee control during 2-minute intervals of the mobile task when they demonstrated learning of the association between their leg movement and mobile activation vs during 2-minute intervals when they did not demonstrate learning.

Methods: Participants in this cohort study included 10 infants at high risk of CP based on neuroimaging and 11 infants with TD at 3.5 to 4.5 months of age. Each infant participated in the in-home kicking-activated mobile task for 8 to 10 min/d, 5 d/wk, for 6 weeks. Over 80,000 kicks were extracted and classified for each infant as occurring during 2-minute intervals of the task when the infant demonstrated learning vs not learning based on mobile activation time above baseline.

Results: Infants demonstrated kicks with more selective hip-knee control during 2-minute intervals of the mobile task when they demonstrated learning compared with when they did not demonstrate learning for 4 of 6 weeks in the cohort at high risk of CP and for 2 of 6 weeks in the cohort with TD.

Conclusion: Participation in the in-home kicking-activated mobile task may motivate more selective hip-knee control of infants at high risk of CP.

Impact: This study is a first step toward developing an intervention to promote selective hip-knee control of infants at high risk of CP, with the ultimate goal of optimizing future walking function.

Lay summary: This study showed that playing with an in-home infant kicking-activated mobile may motivate infants at high risk of CP to produce more age-appropriate leg movements.