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Commentary on “Approximate Entropy Values Demonstrate Neuromotor Control of Spontaneous Leg Activity in Infants With Myelomeningocele”

Capoun, Lynne PT, MS, PCS; Harbourne, Regina PT, PhD

Pediatric Physical Therapy: October 2011 - Volume 23 - Issue 3 - p 248
doi: 10.1097/PEP.0b013e318228c6bb
Clinical Bottom Line

University of Nebraska Medical Center, Omaha, Nebraska

University of Nebraska Medical Center, Omaha, Nebraska

The authors declare no conflict of interest.

“How should I apply this information?”

This study proposes that increases in active movement of the lower extremities of infants with myelomeningocele (MMC), encouraged from birth onward, should lead to optimal neuromotor control of the legs, greater movement complexity, and more organized movements. The potential of better long-term outcomes for individuals with MMC in the form of more energy-efficient walking is exciting given recent advances in the study of neuroplasticity, which support the idea of very early intervention and frequent practice of the activity of kicking. However, this study only allows us to speculate about this possibility and await verification with additional studies.

The data from this study indicate that there is a drop-off of both quantity and complexity of leg movements in infants with MMC by 3 months of age, which differs from infants with TD. The hope is that early intervention physical therapy services can take advantage of the neural plasticity of the infant through instruction given to parents and caregivers on how to increase kicking and movement practice. Specific ideas could include placing a toy bar by the infant's feet, placing soft rattles or socks with bells on the baby's feet, and even tying a ribbon from a mobile in the crib to the baby's ankle (with parent supervision). Considering the potential value of early activity for the future state of the child's mobility, this early and intensive investment of attention to early and variable movement entails minimal expense that could lead to a large reward in the child's future, even though there is no guarantee of a pay-off.

“What should I be mindful about in applying this information?”

There are some real-world obstacles to increasing kicking in the very young infant with MMC. For example, initial care (within the first few months) for many of these infants is complex and can require large changes in family routine (eg, catheterizing, wound care, etc). Many infants with MMC have casts or orthotics to correct bony deformity, which restrict movement. The need to create an active learning environment for kicking needs to be balanced with many other issues related to the early care of a child with some potentially major medical problems.

Lynne Capoun, PT, MS, PCS

University of Nebraska Medical Center, Omaha, Nebraska

Regina Harbourne, PT, PhD

University of Nebraska Medical Center, Omaha, Nebraska

Copyright © 2011 Academy of Pediatric Physical Therapy of the American Physical Therapy Association