TY - JOUR
T1 - Early Development of Locomotor Patterns and Motor Control in Very Young Children at High Risk of Cerebral Palsy, a Longitudinal Case Series
AU - Bekius, Annike
AU - Bach, Margit M.
AU - van de Pol, Laura A.
AU - Harlaar, Jaap
AU - Daffertshofer, Andreas
AU - Dominici, Nadia
AU - Buizer, Annemieke I.
N1 - Funding Information: This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 Funding Information: We would like to thank the parents and children who participated in this study. We would like to express our appreciation for the support by the pediatric physiotherapists Danny Cornelissen, Eefje Muselaers and Emma Verwaaijen, and the researchers Marije Goudriaan, Marzieh Borhanazad, and Coen Zandvoort for their support during the experiments. Funding. This project has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement n. 715945 Learn2Walk) and from the Dutch Organization for Scientific Research (NWO) VIDI grant (grant agreement n. 016.156.346 FirSTeps). Publisher Copyright: © Copyright © 2021 Bekius, Bach, van de Pol, Harlaar, Daffertshofer, Dominici and Buizer.
PY - 2021/6/3
Y1 - 2021/6/3
N2 - The first years of life might be critical for encouraging independent walking in children with cerebral palsy (CP). We sought to identify mechanisms that may underlie the impaired development of walking in three young children with early brain lesions, at high risk of CP, via comprehensive instrumented longitudinal assessments of locomotor patterns and muscle activation during walking. We followed three children (P1–P3) with early brain lesions, at high risk of CP, during five consecutive gait analysis sessions covering a period of 1 to 2 years, starting before the onset of independent walking, and including the session during the first independent steps. In the course of the study, P1 did not develop CP, P2 was diagnosed with unilateral and P3 with bilateral CP. We monitored the early development of locomotor patterns over time via spatiotemporal gait parameters, intersegmental coordination (estimated via principal component analysis), electromyography activity, and muscle synergies (determined from 11 bilateral muscles via nonnegative matrix factorization). P1 and P2 started to walk independently at the corrected age of 14 and 22 months, respectively. In both of them, spatiotemporal gait parameters, intersegmental coordination, muscle activation patterns, and muscle synergy structure changed from supported to independent walking, although to a lesser extent when unilateral CP was diagnosed (P2), especially for the most affected leg. The child with bilateral CP (P3) did not develop independent walking, and all the parameters did not change over time. Our exploratory longitudinal study revealed differences in maturation of locomotor patterns between children with divergent developmental trajectories. We succeeded in identifying mechanisms that may underlie impaired walking development in very young children at high risk of CP. When verified in larger sample sizes, our approach may be considered a means to improve prognosis and to pinpoint possible targets for early intervention.
AB - The first years of life might be critical for encouraging independent walking in children with cerebral palsy (CP). We sought to identify mechanisms that may underlie the impaired development of walking in three young children with early brain lesions, at high risk of CP, via comprehensive instrumented longitudinal assessments of locomotor patterns and muscle activation during walking. We followed three children (P1–P3) with early brain lesions, at high risk of CP, during five consecutive gait analysis sessions covering a period of 1 to 2 years, starting before the onset of independent walking, and including the session during the first independent steps. In the course of the study, P1 did not develop CP, P2 was diagnosed with unilateral and P3 with bilateral CP. We monitored the early development of locomotor patterns over time via spatiotemporal gait parameters, intersegmental coordination (estimated via principal component analysis), electromyography activity, and muscle synergies (determined from 11 bilateral muscles via nonnegative matrix factorization). P1 and P2 started to walk independently at the corrected age of 14 and 22 months, respectively. In both of them, spatiotemporal gait parameters, intersegmental coordination, muscle activation patterns, and muscle synergy structure changed from supported to independent walking, although to a lesser extent when unilateral CP was diagnosed (P2), especially for the most affected leg. The child with bilateral CP (P3) did not develop independent walking, and all the parameters did not change over time. Our exploratory longitudinal study revealed differences in maturation of locomotor patterns between children with divergent developmental trajectories. We succeeded in identifying mechanisms that may underlie impaired walking development in very young children at high risk of CP. When verified in larger sample sizes, our approach may be considered a means to improve prognosis and to pinpoint possible targets for early intervention.
KW - development of walking
KW - early brain lesions
KW - electromyography
KW - intersegmental coordination
KW - muscle synergies
UR - http://www.scopus.com/inward/record.url?scp=85108168745&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fnhum.2021.659415
DO - https://doi.org/10.3389/fnhum.2021.659415
M3 - Article
C2 - 34149378
SN - 1662-5161
VL - 15
SP - 659415
JO - Frontiers in Human Neuroscience
JF - Frontiers in Human Neuroscience
M1 - 659415
ER -