A Preliminary Analysis of Spontaneous Kicking in Infants with Stroke: Do Toys Have an Impact?

Research Report
Population: Pediatric

Jill Heathcock, MPT, PhD, Assistant Professor, The Ohio State University jill.heathcock@osumc.edu

Emily Durbak, BS, BMS student, The Ohio State University durbak.@buckeyemail.osu.edu

Danielle Capitillo, SPT, Student Physical Therapist, The Ohio State University capetillo.3@buckeyemail.osu.edu

Keywords: Prediction, Stroke, Kicking, Assessment

Purpose/Hypothesis: Toys are widely used in clinical observation to elicit specific motor skills or test items on standardized assessment tools with infants. Typically the toys are used to encourage upper extremity movements, mobility, and visual tracking; or to provide reinforcement and opportunities to play.  Analysis of spontaneous movements of the lower extremities, or kicking movements, is also a commonly observed and measured infant skill. The impact of toys on the lower extremity, during kicking, has not been examined. The current study evaluates and describes changes in spontaneous kicking quantity and quality in infants with perinatal stroke (PS) compared to typically developing (TD) infants with and without toys over time. We investigated the hypothesis that the inclusion of toys would result in a decrease in kick quantity and quality.

Subjects: 24

Materials/Methods: This is a prospective and longitudinal study of 10 PS and 14 TD infants. Infants were recorded laying supine for 30-second trials within and without toys for 8 trials at 8 and 10 weeks of age. Kicks were analyzed for frequency and classified as alternating, parallel, or unilateral; parallel was defined as the most advanced. Quantity was defined as the total number of kicks and quality was defined as the total number of parallel kicks. Paired and independent t-tests were used for statistical analysis.

Results: Both groups demonstrated a decrease kick quantity (p=0.01 TD and p=0.05 PS) as well as a less advance kick quality (p=0.003 TD and p=0.02 PS) during the trials with toys. Within groups analysis suggests that changes in kicking over developmental time, which are expected, were only observed without toys. Similarly, group differences were observed only without toys. For example, without toys, the TD group averaged 11.41 more kicks 5.49 more parallel kicks than the PS group. With toys there was not difference between the groups for quantity and quality of kicks.

Conclusions: Infants with TD and PS decreased kicking quantity and quality when a toy was present. This decrease was maintained and steady over time.

Clinical Relevance: Infants with PS are at high risk for the development of hemiplegic cerebral palsy (CP) which affects one arm and leg. Currently, diagnosis of CP does not occur until 18 months of age or later. There is some indication that classification of spontaneous movements may improve our ability to predict impaired motor development and even cerebral palsy. Kicking movements of the legs can differentiate between typical and atypical development in other at-risk infant populations (e.g. preterm birth, Down syndrome, spine bifida). Evaluation of motor development in infants relies heavily on the use of toys to elicit positive interactions. However, these data suggests that a no toy period might be critical for effective analysis and differentiation of typical and atypical lower extremity movements.

Heathcock, Jill , MPT, PhD; Durbak, Emily , BS; Capitillo, Danielle , SPT. A Preliminary Analysis of Spontaneous Kicking in Infants with Stroke: Do Toys Have an Impact?. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/094_heathcock-et-al/