Early Development of Locomotor Patterns and Motor Control in Very Young Children at High Risk of Cerebral Palsy, a Longitudinal Case Series

Annike Bekius, Margit M Bach, Laura A van de Pol, Jaap Harlaar, Andreas Daffertshofer, Nadia Dominici, Annemieke I Buizer

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

The first years of life might be critical for encouraging independent walking in children with cerebral palsy (CP). We sought to identify mechanisms that may underlie the impaired development of walking in three young children with early brain lesions, at high risk of CP, via comprehensive instrumented longitudinal assessments of locomotor patterns and muscle activation during walking. We followed three children (P1-P3) with early brain lesions, at high risk of CP, during five consecutive gait analysis sessions covering a period of 1 to 2 years, starting before the onset of independent walking, and including the session during the first independent steps. In the course of the study, P1 did not develop CP, P2 was diagnosed with unilateral and P3 with bilateral CP. We monitored the early development of locomotor patterns over time via spatiotemporal gait parameters, intersegmental coordination (estimated via principal component analysis), electromyography activity, and muscle synergies (determined from 11 bilateral muscles via nonnegative matrix factorization). P1 and P2 started to walk independently at the corrected age of 14 and 22 months, respectively. In both of them, spatiotemporal gait parameters, intersegmental coordination, muscle activation patterns, and muscle synergy structure changed from supported to independent walking, although to a lesser extent when unilateral CP was diagnosed (P2), especially for the most affected leg. The child with bilateral CP (P3) did not develop independent walking, and all the parameters did not change over time. Our exploratory longitudinal study revealed differences in maturation of locomotor patterns between children with divergent developmental trajectories. We succeeded in identifying mechanisms that may underlie impaired walking development in very young children at high risk of CP. When verified in larger sample sizes, our approach may be considered a means to improve prognosis and to pinpoint possible targets for early intervention.

Original languageEnglish
Article number659415
Pages (from-to)659415
JournalFrontiers in Human Neuroscience
Volume15
DOIs
Publication statusPublished - 2021

Funding

This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 We would like to thank the parents and children who participated in this study. We would like to express our appreciation for the support by the pediatric physiotherapists Danny Cornelissen, Eefje Muselaers and Emma Verwaaijen, and the researchers Marije Goudriaan, Marzieh Borhanazad, and Coen Zandvoort for their support during the experiments. Funding. This project has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement n. 715945 Learn2Walk) and from the Dutch Organization for Scientific Research (NWO) VIDI grant (grant agreement n. 016.156.346 FirSTeps).

FundersFunder number
Horizon 2020 Framework Programme
European Research Council
Nederlandse Organisatie voor Wetenschappelijk Onderzoek016.156.346 FirSTeps
Horizon 2020715945

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