Physical activity in non-ambulatory toddlers with cerebral palsy.
For toddlers with CP who cannot walk, leg movement during floor play gives no clue about their motor scores or family participation.
01Research in Context
What this study did
The team watched 20 toddlers with cerebral palsy who cannot walk. Each child wore a small movement meter on the thigh for three days at home. The meter counted every wiggle and kick during floor play.
Parents also filled out two checklists. One scored the child’s gross motor skills. The other rated how often the child joined family outings, playground trips, and play dates.
What they found
The meter showed wide differences: some toddlers moved a lot, some barely at all. Yet the movement numbers did not line up with motor scores or with how much the families joined activities. A quiet toddler on the mat could still have high family participation, and a busy kicker could still have low scores.
How this fits with other research
McIntyre et al. (2017) looked at both walkers and non-walkers and found that higher motor scores predicted more participation. The new study seems to disagree, but it focused only on toddlers who cannot walk and used a leg meter instead of parent surveys. The difference in age and method explains the clash.
Shikako-Dratsch et al. (2013) and Majnemer et al. (2015) followed older non-ambulatory youth and saw participation drop as kids became teens. Together these papers draw a timeline: movement counts at age two do not forecast involvement, but by adolescence lack of mobility starts to shrink social life.
Lauruschkus et al. (2013) used the same meter style in school-age children and added body weight and thinking skills as predictors. The toddler study keeps the meter method but shows that, at the earliest stage, even those extra factors do not help.
Why it matters
If you serve non-ambulatory toddlers, do not trust leg-worn data alone to judge how engaged the family is. Collect separate measures for motor skill, body functions, and real-life outings. Plan participation goals early, before the downward slide seen in older groups begins.
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02At a glance
03Original abstract
BACKGROUND: Children with cerebral palsy are less likely to be physically active than their peers, however there is limited evidence regarding self-initiated physical activity in toddlers who are not able, or who may never be able, to walk. AIMS: The aim of this study was to measure self-initiated physical activity and its relationship to gross motor function and participation in non-ambulatory toddlers with cerebral palsy. METHODS AND PROCEDURES: Participants were between the ages of 1-3 years. Physical activity during independent floor-play at home was recorded using a wearable tri-axial accelerometer worn on the child's thigh. The Gross Motor Function Measure-66 and the Child Engagement in Daily Life, a parent-reported questionnaire of participation, were administered. OUTCOMES AND RESULTS: Data were analyzed from the twenty participants who recorded at least 90 min of floor-play (mean: 229 min), resulting in 4598 total floor-play minutes. The relationship between physical activity and gross motor function was not statistically significant (r = 0.20; p = 0.39), nor were the relationships between physical activity and participation (r = 0.05-0.09; p = 0.71-0.84). CONCLUSIONS AND IMPLICATIONS: The results suggest physical activity during floor-play is not related to gross motor function or participation in non-ambulatory toddlers with cerebral palsy. Clinicians and researchers should independently measure physical activity, gross motor function, and participation.
Research in developmental disabilities, 2019 · doi:10.1016/j.ridd.2019.04.002