Clinical Bottom Line
Janjaap van der Net, PT, PhD, PCS
Maaike Sprong, PT, MSc, PCS
Child Development and Exercise Center, Division of Pediatrics, University Children's Hospital and Medical Center, Untrecht, The Netherlands
“How could I apply this information?”
This study describes a method of measuring postural control in infants with motor delays and motor impairments of known and unknown origins. The motor ability tested in this study was the ability to sit for a few seconds, with or without use of the arms without engaging in any other activity. Potentially, the method of measurement provides insight on the amount of variance in postural control in infants under controlled circumstances. In terms of the International Classification of Function Disability and Health, this study focuses primarily on the component of body function, that is, postural control, which is necessary for maintaining the sitting position. It does not measure the “activity” sitting. Currently, pediatric physical therapists are encouraged to focus on the activity/participation level of children such as sitting while playing. This is an important limitation of this study that makes it hard to apply the results in clinical practice.
Infants with developmental delay and infants with cerebral palsy show less variability in postural control while sitting. Motor variability has been regarded by many as a key sign of normal motor development; it therefore has become an important diagnostic entity to recognize children with potential motor impairment in pediatric physical therapy. At the same time, inducing motor variability has become an important aim in pediatric physical therapy treatment.
“What should I be mindful about in applying this information?”
It remains to be seen if a child in a more ecological environment (eg, during a play session) will show the same postural variability as in the test situation. It does not provide the observer information on the adaptability of the child to his or her environment (eg, while manipulating a toy). This is a significant limitation of this study.
Another concern is the large difference in age between the groups. Motor development of the different groups of children may be similar, but based on the difference in calendar age, one might expect that there is a difference in cognitive development between the different groups of children. It is unclear whether cognitive development influences adaptive motor strategies in sitting.