Social–Emotional Behaviors During the Development of Prone Locomotion in Infants at High and Low Risk for Cerebral Palsy

PURPOSE: Delays in the motor abilities of children with cerebral palsy (CP) often begin in infancy and affect other developmental domains. Research has suggested a connection between crawling, the first form of self-generated mobility, and cognitive, perceptual, and social–emotional (SE) development. The exact mechanisms and nature of the relationship are not known. The purpose of this study was to examine the relationship between SE and early motor development.

Hypotheses: (1) There is a positive correlation between an increase in frequency of certain SE behaviors and an increase in self-generated prone locomotion (SGPL), (2) correlations between SE behaviors and SGPL in infants who are low risk (LR) for CP will be higher than in infants at high risk (HR) for CP, and (3) infant SE behaviors will increase in frequency during the development of SGPL as a function of increased mobility (the increase in SGPL will precede the increase in SE behaviors.)

RATIONALE: The delay in meeting or inability to meet motor milestones likely affects children’s SE development. The cost associated with mobility constraints and societal consequences of limitations in social participation make this relationship an important area of investigation.

DESIGN: Longitudinal descriptive repeated-measures design with two groups defined by risk for CP. Quantitative data taken from video recordings of infants during attempts for prone locomotion.

PARTICIPANTS: Twenty-seven infants and their caregivers participated in a National Institutes of Health–funded study on the development of prone locomotion with and without robotic assistance for 12 wk. The infants, 6 at low risk and 21 at high risk for CP, were enrolled into the study at age 4.5 mo.

METHOD: We used an adapted motivation to move (MTM–a) scale and frequency counts of goal-directed behaviors (GDB) to code the video recordings and Movement Observation Coding System (MOCS) mastery and propulsion subscale to measure SPGL. The Bayley SE Scale was administered pre- and poststudy.

ANALYSIS: After computing composite scores for each 3-wk interval, we used Pearson r to test the first hypothesis, a paired-samples t test to test the second hypothesis, and repeated-measures analyses of variance to test the third hypothesis.

RESULTS: For the group with HR, correlation coefficients for the MOCS and MTM–a and the MOCS and GDB at each time interval ranged from .717 to .941 and were statistically significant (p = .01). For the group with LR, coefficients ranged from –.645 to .913 and were statistically significant only for MOCS and GDB during Wk 7–9 (p = .031).

These results support the first hypotheses for the group with HR. We also found statistically significant changes over time for both groups and indications that between the two groups SE and early motor skills developed differently.

DISCUSSION: A strong association between SPGL and SE behaviors for infants at HR for CP point to possible interplays between the two areas of development for these infants that was not observed in infants at LR. Differences observed in the timing of increases in SE and SPGL skills raise questions about the threshold at which motor may affect SE development in infants at risk for CP. Further and larger studies are needed to explore this relationship.

IMPACT: Associations between goal-directed actions/motivation to move with early prone mobility suggest therapists should consider infants with motor impairment as at risk for SE delays as well. This study supports early intervention to target both mobility and SE skills and suggests that interventions must target both areas to be effective.