Influence of specific training on emergence of reaching in infants: randomized control clinical trial

• Grant number: 11/01543-2
• Support Opportunities: Scholarships in Brazil - Doctorate
• Start date: August 01, 2011
• End date: July 31, 2014
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Eloisa Tudella
• Grantee: Andréa Baraldi Cunha
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil
• Associated scholarship(s): 12/05684-2 - The influence of specific training on reaching in infants, BE.EP.DR

Abstract

Objectives: Part I) To verify the effect of short-term training on reaching behavior in fullterminfants at the onset of reaching. Part II) To know the behavior of reaching, thereaching training protocols in full-term and preterm infants and to adjust these training forchildren with cerebral palsy (CP). Methods: In Part I, it was conducted a randomizedcontrolled trial. 30 healthy infants at 3-4 months of age (M =14.0 ±1.6 weeks of age) wererandomly assigned to: 1) reaching training group; 2) social training group (control group).The infants were submitted into 3 assessments (kinematics and qualitative) at 45° reclinedposition (until 5 days after the onset of reaching): 1) Pre-training, before the first session oftraining; 2) Post-training 1, after the first session of training, at the same day; and 3) Posttraining2, after three sessions of training, at the following day. To perform the reachingtraining and social training, the infants were submitted into three short-term sessions oftraining, one performed on the first day and the two performed on the second day. Allinfants were seated reclined 45° in the researcher's lap. The infants of training groupreceived three activities of interaction with the object under serial practice (i.e.: ABC,ABC, ABC) in each session. The infants of social group received no reaching training orstimuli for their upper limbs of each session. The variables considered were: characterizingthe sample, the total reaching frequency, distal adjustments (hand orientation, handopening, and surface of the hand contact), and spatio-temporal variables (duration ofmovement, mean velocity, straightness index, deceleration index, and movement unit). InPart II, we performed a literature review on: the reaching behavior in infants with typicaldevelopmental, preterm infants and infants with CP from 0 to 2 years of age; the maintechniques of reaching assessment; models of reaching training protocols (immediate andshort-term effects) developed for full-term and preterm infants and; on a way of adjustingreaching training for children with CP in clinical practice. Results: In Part I, a trainingsession was effective in increasing the number of reaches and the percentage of reacheswith ventral hand, and decreasing the percentage of reaches with closed and dorsal hand. Inaddition, three training sessions resulted in changes in the spatio-temporal variables (withshorter and more fluent reachs) and increased the percentage of reaches with vertical hand.For Part II, it was highlighted the importance of determining immediate, short, medium andlong term goals, planning the therapeutic procedures directed to the goals. In addition, touse and adapt existing training protocols to intervene in infants at risk and / or diagnosis ofCP, and others. Conclusions: A few short training sessions under serial varied condictionwere effective in improving the reaching performance, such as changes in the number ofreaches, in distal adjustments and spatio-temporal reaching variables. These results reflectthe flexibility of the perceptual-motor skills development and the important role ofexperience in the improvement of motor behavior in infants. Furthermore, to direct theinterventions to the functional objectives and, to use and adapt existing training protocols,may provide to the professionals one more tool of intervention in infants at risk and / orestablished diagnosis of CP. (AU)