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Approximate Entropy Values Demonstrate Impaired Neuromotor Control of Spontaneous Leg Activity in Infants With Myelomeningocele

Smith, Beth A. PT, DPT, PhD; Teulier, Caroline PhD; Sansom, Jennifer PT, MPT, MS; Stergiou, Nicholas PhD; Ulrich, Beverly D. PhD

doi: 10.1097/PEP.0b013e3182289ae4
Research Article

Purpose: One obstacle to providing early intervention to infants with myelomeningocele (MMC) is the challenge of quantifying impaired neuromotor control of movements early in life.

Methods: We used the nonlinear analysis tool Approximate Entropy (ApEn) to analyze periodicity and complexity of supine spontaneous lower extremity movements of infants with MMC and typical development (TD) at 1, 3, 6, and 9 months of age.

Results: Movements of infants with MMC were more regular and repeatable (lower ApEn values) than movements of infants with TD, indicating less adaptive and flexible movement patterns. For both groups ApEn values decreased with age, and the movements of infants with MMC were less complex than movements of infants with TD. Further, for infants with MMC, lesion level and age of walking onset correlated negatively with ApEn values.

Conclusions: Our study begins to demonstrate the feasibility of ApEn to identify impaired neuromotor control in infants with MMC.

Results of this study of the characteristics of spontaneous leg movements of infants with MMC and those typically developing imply that neuromotor control of leg movements in infants with MMC is fundamentally different than in infants with TD. The authors recommend further study of the development of leg movements in infants with MMC.

Balance Disorders Laboratory, Departments of Neurology and Behavioral Neuroscience, Oregon Health & Science University (Dr Smith), Portland, Oregon; Department of Physical Education and Sport Sciences, University of Limerick (Dr Tuelier), Limerick, Ireland; Developmental Neuromotor Control Laboratory, School of Kinesiology, University of Michigan (Ms Sansom and Dr Ulrich), Ann Arbor, Michigan; Nebraska Core Biomechanics Facility, University of Nebraska at Omaha and Department of Environmental, Agricultural, and Occupational Health Sciences, College of Public Health, University of Nebraska Medical Center (Dr Stergiou), Omaha, Nebraska.

Correspondence: Beth A. Smith, PT, DPT, PhD, Balance Disorders Laboratory, Oregon Health and Science University, W Campus, 505 NW 185th Ave, Beaverton, OR 97006 (

Grant Support: Funding for this study was provided by NIH NICHD R01 HD047567 awarded to Beverly D. Ulrich. In addition, Beth A. Smith is currently a postdoctoral fellow at Oregon Health and Science University, supported on NIH NIA Institutional Training Grant 2T32AG023477-06 to Henryk Urbanski (PI). During data collection for this project, Dr Smith was a PhD candidate in the Developmental Neuromotor Control Laboratory, School of Kinesiology at the University of Michigan, supported by grant H424C010067 from the US Office of Special Education and Rehabilitative Services to Dale Ulrich (PI).

The authors declare no conflict of interest.

© 2011 Lippincott Williams & Wilkins, Inc.