Postural Control Measurements to Predict Future Motor Impairment in Preterm Infants

Picture Reference: Dusing, Kyvelidou, Mercer, Stergiou, 2009

Author: Jennifer Bosserman, SPT
Advisor: Dana McCarty, PT, DPT
Committee Members: Jessica Cassidy, PT, DPT, PhD and Kristen Dragotta PT, DPT

Background

Prior to beginning PT school, I already knew that I had a passion for pediatric physical therapy. I was able to further pursue this passion through our DPT curriculum, my time with children in the community, shadowing with Dana McCarty, PT, DPT, and my clinical rotation in early intervention. During my time in the Neonatal Intensive Care Unit (NICU) with Dana, I was able to observe infants with a wide variety of diagnoses including premature birth which furthered my interest in neonatal physical therapy. This experience combined with my early intervention clinical rotation caused me to consider how we can improve prognostic measurements for children early in their life to prevent future disability.

When Dana presented this project to me in the early Fall of 2022, I was excited to have the opportunity to complete research and create a manuscript focused on improving prognosis and encouraging early treatment for children with potential motor impairments. Throughout the fall I created a focused research question, came up with inclusion and exclusion criteria, completed a thorough literature search, data extraction, and quality assessment for the chosen literature on this topic. I have been able to complete a manuscript as my capstone this semester that not only expanded my knowledge on postural control in preterm infants, but also describes how therapists can utilize this information to minimize motor impairment and disability in the future.

Statement of Need

There is a risk of motor impairment in all preterm infants born at <37 weeks gestation, however, the risk is highest in infants born moderately preterm (32-34 weeks gestation) at 20.6% and very preterm (<32 weeks gestation) at 36.1%.1,2 Risk of motor impairment in full-term infants ranges from 2-7% compared to 54-64% in preterm infants and there are notable differences in the movement patterns of preterm infants as compared to full-term infants.3 Further, preterm infants are more likely to display body and head asymmetry and show preference for extension patterns than full-term infants.6

Current evidence supports parent and therapist delivered motor intervention to improve motor and cognitive development and outcomes in preterm infants,18 and immediate, ongoing therapy services after hospital discharge to reduce the risk of developmental delays; however, there is often a delay in therapy services after NICU discharge,19,20 especially if no significant motor impairment or diagnosis is documented using a standardized or objective measure. The increased risk for developmental impairment in preterm infants demonstrates the need for a measure for future motor delay in order to provide timely, appropriate therapy services.

In the absence of extended time for clinicians to attend training programs and funding to pay for such programs, it is prudent to identify objective measures that indicate potential delay that can be used, assessed, and understood by a variety of clinicians and researchers. Quantitative measurements such as center of pressure (COP) and variability of movement have been shown to be predictive of motor impairment or delay in preterm infants,24 but these measures are not currently used in the clinical setting to identify infants at risk for movement delay.

Purpose

This study aimed to meet the needs listed above. The purpose of this manuscript was to evaluate the existing evidence regarding the use of pressure mats or force plates to measure postural control and movement in preterm infants. We also evaluated how those measures differ in preterm and full-term infants and how these differences may predict future motor impairment or disability in this population.

Products

To begin, I completed an initial keyword search which identified nine hundred articles. Full-text review for eligibility was completed for twenty-five full text studies, and eight met all eligibility criteria. I then used this literature to create my systematic review with Dana’s assistance which we will be submitting for publication to an academic journal. This manuscript discusses the use of pressure mats and force plates to assess postural control, and further utilize this information to determine likelihood of future motor impairment in preterm infants.

Manuscript

Evaluation and Self Reflection

Materials were delivered to all committee members and are being prepared to submit to an academic journal for publishing. I received feedback from my committee members who are pediatric physical therapists and also research specialists about the quality of my project. I feel as though I still have much progress to be made regarding my research skills but have met all of my learning objectives for this project. I have grown tremendously under the mentorship of my advisor Dana and also my committee members Kristen and Jessica. I plan to also submit and present this research at CSM in 2024 and have created an evaluation sheet to assess the understanding of the topic and also my presentation techniques.
Evaluation-Form-

Acknowledgements

To Dana McCarty, PT, DPT thank you so much for your support throughout this project and also my time here at UNC. You have not only been a great mentor in my journey of physical therapist, but you have also showed me what a great pediatric clinician looks like. Your passion and dedication for pediatrics is something that I hope to emulate within myself. You have been such an impact in helping me reach my goals as a pediatric physical therapist and I cannot thank you enough for that.

To Jessica Cassidy, PT, DPT, PhD, thank you for agreeing to be on my capstone committee and for all of your valuable feedback throughout this process. Your research experience and excellence was a large help while completing my manuscript. I am very appreciative of all of your assistance with this project but also throughout my journey here at UNC.

To Kristen Dragotta, PT, DPT, thank you for agreeing to serve on my capstone committee with all that you have going on with your life and career. I am very appreciative of the time you took to review my work and provide me with insightful feedback based on your experience in the NICU.

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