The long-term goal of this research is 1) to understand mechanisms used by typically developing (TD) infants in attaining head &trunk control for the development of sitting balance and associated reaching skills, and 2) to apply that knowledge to understanding and improving these skills in children with cerebral palsy (CP). While trunk postural control creates the basis for reaching skills, little is known about how spinal stability develops;in fact there are almost no clinical measures of intermediate stages of trunk stability. In the case of children with CP this lack of knowledge is critical. Our experiments address these limitations. Experiments will determine developmental changes in kinematics of head stability, trunk muscle activation patterns and patterns of reaching movements with different levels of trunk support in TD infants and children with CP.
Specific Aim 1 is a longitudinal study evaluating contributions of spinal segments to head stability and reaching skills in 3-9 month old TD infants as they gain sitting balance. We hypothesize: 1) head stability emerges first at higher levels of trunk support and stability progresses sequentially down the spine in a time dependent manner, associated with the rostro-caudal development of coordinated muscle response patterns during sitting;and 2) emergence of efficient reaching movements is associated with the mastery of postural control at a given level of trunk development.
Specific Aim 2 is a cross-sectional study evaluating contributions of spinal segments to trunk stability and reaching in children with moderate to severe CP. We hypothesize that 1) within children with various levels of severity of CP (Gross Motor Function Classification System levels III, IV, V) we will see arrested levels of spinal development along a continuum of that which is seen during sitting balance development in TD children;thus lack of sitting spinal control reflects deficits in coordination at a specific spinal level;2) reaching deficits will be associated with postural control deficits at specific spinal levels. The study of segmental contributions to spinal control is novel and challenges current clinical concepts for assessment and treatment of sitting development;thus it brings critical new information to our understanding of both typical development and constrained development in children with CP.

Public Health Relevance

Knowledge about progression of trunk control in TD infants and children with CP will provide important information for clinicians trying to help children with CP gain independent sitting and manipulation skills. This novel approach will be the basis for the development of new methods to assess and treat postural and reaching dysfunction. Unlike most previous research, this paradigm addresses the needs of those children with the most severe motor disabilities.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Musculoskeletal Rehabilitation Sciences Study Section (MRS)
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Cruz, Theresa
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University of Oregon
Other Basic Sciences
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United States
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Santamaria, Victor; Rachwani, Jaya; Saavedra, Sandra et al. (2016) Effect of Segmental Trunk Support on Posture and Reaching in Children With Cerebral Palsy. Pediatr Phys Ther 28:285-93
Saavedra, Sandra L; Woollacott, Marjorie H (2015) Segmental Contributions to Trunk Control in Children With Moderate-to-Severe Cerebral Palsy. Arch Phys Med Rehabil 96:1088-97
Pavão, Sílvia Leticia; dos Santos, Adriana Neves; Woollacott, Marjorie Hines et al. (2013) Assessment of postural control in children with cerebral palsy: a review. Res Dev Disabil 34:1367-75
Rachwani, Jaya; Santamaria, Victor; Saavedra, Sandra L et al. (2013) Segmental trunk control acquisition and reaching in typically developing infants. Exp Brain Res 228:131-9
Cunha, Andréa B; Woollacott, Marjorie; Tudella, Eloisa (2013) Influence of specific training on spatio-temporal parameters at the onset of goal-directed reaching in infants. Braz J Phys Ther 17:409-17
Saavedra, Sandra L; van Donkelaar, Paul; Woollacott, Marjorie H (2012) Learning about gravity: segmental assessment of upright control as infants develop independent sitting. J Neurophysiol 108:2215-29