Typical and atypical postural control in infancy

The study

During infancy postural control shows dramatic developmental changes. This is reflected by the fact that infants develop the ability to balance the head, to sit, to stand and to walk.

Postural control is well known for its complex organisation; it involves activity of virtually all parts of the nervous system. This is the main reason why in children with developmental disorders postural control is practically always impaired.

Current research

Background

Principles of postural control
In the control of postural two functional levels may be distinguished. The first and basic level consists of so-called direction-specificity. It means that the nervous system primarily recruits the muscles on the dorsal side of the body during a forward body sway, and primarily the muscles on the ventral body side during a backward body sway. At the second level of control the basic direction-specific postural activity is fine-tuned in order to adapt muscle activity to the specifics of the situation. The nervous system has many ways in which the adaptation may be organized. For example, adaptation may consist of a change in the recruitment order of the direction-specific muscles (e.g., from top-down to bottom-up recruitment) or it may consist of an adjustment of the degree of muscle contraction.
Development of postural control
Previous studies showed that the first level of postural control, the direction-specificity, already functions shortly after birth. This suggests that direction-specificity has an innate origin. Nevertheless, it takes some time before direction-specificity is fully expressed during reaching in sitting position. For instance, only about 40% of reaches of 4-month-old babies are accompanied by direction-specific postural adjustments. It takes until the age of 2 years before reaching movements are consistently accompanied by direction-specific postural activity.

The second level of postural control shows a protracted development. It starts between 3 and 6 months of age, but it takes until after puberty before the adult form of postural organization is achieved. This protracted development may be illustrated by the developmental changes in the recruitment order of the direction-specific muscles during reaching while sitting. In typically developing children recruitment order is characterized primarily by variation. Within the variation, young infants prefer a top-down recruitment. Around 18 months a preference exists for bottom-up, during preschool age recruitment is very variable, and only slowly thereafter, the adult consistent preference for top-down recruitment develops.

From the age of 9-10 months infants gradually learn to adapt the degree of muscle contraction to the specifics of the situation. The development of this precise type of fine-tuning of muscle activity is clearly experience dependent and continues until adolescence.
Postural control in infants at high risk for developmental disorders
Infants at risk for developmental disorders are in particular babies in whom perinatal and neonatal complications, such as preterm birth or asphyxia, resulted in a lesion of the brain or neurological dysfunction. It is important to realize that the majority of infants with perinatal and neonatal complications do nót suffer from a lesion of the brain or neurological dysfunction.


Resent research:

Recently we investigated the development of postural control
1. In infants who participated in the VIP project en who participate in LEARN2MOVE 0-2 years.
2. In typically developing infants when they learn to walk

We assessed the infants in particular during reaching for an object. Postural activity is recorded with surface EMG, video and kinematics.

The studies indicated that postural control develops at a slower pace in infants at very high risk for cerebral palsy. As a result their postural control differs at 18 months of age significantly from that of typically developing peers.
The studies also showed that the transition of not being able to sit without help to being able to sit independently is not associated with major changes in postural control. This holds true for typically and atypically developing infants. We therefore wondered whether learning to walk independently would be associated with clear changes in postural control. Indeed, we found that infants showed changes in postural control during the period in which they mastered the skill of walking independently. Interestingly, each infant showed his/her own developmental strategy to cope with postural control during the development of this major milestone.

Collaborators


Mijna Hadders-Algra, MD, PhD

Developmental Neurology

Lieke van Balen, MD, MSc

Developmental Neurology

Arend F Bos, MD, PhD
Neonatology, UMCG

Anke Boxum, MD, PhD
Developmental Neurology

Tineke Dirks, PT
Developmental Neurology

Linze J. Dijkstra
Developmental Neurology

Elisa G. Hamer, MD, PhD
Developmental Neurology

Tjitske Hielkema, MD, PhD
Centre for Rehabilitation, UMCG

Karel G.B. Maathuis, MD, PhD
Centre for Rehabilitation, UMCG

Key publications

  • Hadders-Algra M, Brogren E, Forssberg H. Ontogeny of postural adjustments during sitting in infancy: variation, selection and modulation. J Physiol 1996; 493: 273-88.
  • Hadders-Algra M, Brogren E, Forssberg H.  Training affects the development of postural adjustments in sitting infants. J Physiol 1996; 493: 289-98.
  • Hedberg Å, Forssberg H, Hadders-Algra M. Early development of postural adjustments in sitting position: evidence for the innate origin of direction specificity. Exp Brain Res 2004; 157: 10-7.
  • Hedberg Å, Schmitz C, Forssberg H, Hadders-Algra M. Early development of postural adjustment during standing, with and without support. Exp Brain Res 2007: 178: 439-49.
  • Van der Fits IBM, Otten E, Klip AWJ, Van Eykern LA, Hadders-Algra M. The development of postural adjustments during reaching in 6 to 18 months old infants: evidence for two transitions. Exp Brain Res 1999; 126: 517-28.
  • Van der Fits IBM, Flikweert ER, Stremmelaar EF, Martijn A, Hadders-Algra M. Development of postural adjustments during reaching in preterm infants. Pediatr Res 1999; 46: 1-7.
  • De Graaf-Peters VB, Bakker H, Van Eykern LA, Otten B, Hadders-Algra M.  Postural adjustments and reaching in 4- and 6-months-old infants: an EMG and kinematical study. Exp Brain Res 2007; 181: 647-56.
  • Van Balen LC, Dijkstra LJ, Hadders-Algra M. Development of postural adjustments during reaching in typically developing infants from 4 to 18 months. Exp Brain Res 2012; 220:109-19.
  • Hadders-Algra M, Van der Fits IBM, Stremmelaar EF, Touwen BCL. Development of postural adjustments during reaching in infants with cerebral palsy. Dev Med Child Neurol 1999; 41: 766-76.
  • Fallang B, Saugstad OD, Hadders-Algra M. Goal directed reaching and postural control in supine position in healthy infants. Behav Brain Res 2000; 115: 9-18.
  • Fallang B, Saugstad OD, Hadders-Algra M. Postural adjustments in preterm infants at 4 and 6 months post term age during voluntary reaching in supine position. Pediatr Res 2003; 54: 826-33.
  • Fallang B, Øien I, Hellem E, Saugstad OD, Hadders-Algra M. Quality of reaching and postural control in young preterm infants is related to neuromotor outcome at 6 years. Pediatr Res 2005; 58: 347-53.
  • Van Balen LC, Dijkstra LJ, Hadders-Algra M. Development of postural adjustments during reaching in typically developing infants from 4 to 18 months. Exp Brain Res 2012; 220:109-19.
  • Hadders-Algra M. Typical and atypical development of reaching and postural control in infancy. Dev Med Child Neurol 2013;55 (suppl 4):5-8.
  • Boxum AG, Van Balen LC, Dijktra LJ, Hamer EG, Hielkema T, Reinders-Messelink HA, Hadders-Algra M. Postural adjustments in infants at very high risk for cerebral palsy before and after developing the ability to sit independently. Early Hum Dev 2014;90:435-41.
  • Van Balen LC, Dijkstra LJ, Bos AF, Hadders-Algra M. Development of postural adjustments during reaching in infants at risk for cerebral palsy from 4 to 18 months. Dev Med Child Neurol, 2015 Jan 19. doi: 10.1111/dmcn.12699.
  • Van Balen LC, Boxum AG, Dijkstra LJ, Hamer EG, Hielkema T, Reinders-Messelink HA, Hadders-Algra M. Are postural adjustments during reaching related to walking development in typically developing infants and infants at risk of cerebral palsy? Infant Behav Dev. 2018; 50: 107-115.
  • Boxum AG, Dijkstra LJ, la Bastide-van Gemert S, Hamer EG, Hielkema T, Reinders-Messelink HA, Hadders-Algra M. Development of postural control in cerebral palsy and cystic periventricular leukomalacia in infancy. Res Dev Disabil, 2018, 78: 66-77.
  • Boxum AG, la Bastide-van Gemert S, Dijksta L, Furda A, Reinders-Messelink HA, Hadders-Algra M. Postural control during the development of walking in infancy. Dev Med Child Neurol 2019 61: 555-62.
  • Van Balen L, Dijkstra LJ, Dirks T, Bos AF, Hadders-Algra M. Early intervention and the development of postural adjustments during reaching in infants at risk of cerebral palsy. Pediatr Phys Ther. 2019; 31: 175-83.

Sponsors


Adriaanstichting

BCN

Johanna Kinderfonds

Nederlandse Vereniging van Revalidatieartsen

Phelps Stichting

Revalidatiefonds

Revalidatie Nederland

Stichting Fonds de Gavere Stichting Rotterdams Kinderrevalidatie Fonds

ZonMW

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