Marybeth Grant-Beuttler

Children that are diagnosed with Idiopathic Toe walking (cITW) are characterized by persistent toe-to-toe contacts. The objective of this study was to explore whether typical foot contact dynamics during walking predisposes cITW to a higher risk of falling. Twenty cITW and age-matched controls performed typical and toe walking trials. The gait parameters related to foot contact dynamics, vertical force impulses during stance, slip, and trip risk were compared for both groups. We found that cITW manifest less stable gait and produced significantly higher force impulses during push-off. Additionally, we found that cITW had a higher slip-initiation risk that was associated with higher foot contact horizontal and vertical velocities in addition to lower transitional acceleration of center of mass. We found that cITW exhibited a higher trip risk with toe clearance being significantly lower when compared to healthy counterparts. This study allowed for a quantitative description of foot contact dynamics and delineated typical from toe walking among cITW. Overall, the results indicate that cITW are less stable during typical walking and are prone to a higher risk of slip and trip-like falls.

Background: Ultrasound observation of fetal movement has documented general trends in motor development and fetal age when motor response to stimulation is observed. Evaluation of fetal movement quality, in addition to specific motor activity, may improve documentation of motor development and highlight specific motor responses to stimulation. Aim: The aim of this investigation was to assess fetal movement at 26 and 36-weeks gestation during three conditions (baseline, immediate response to vibro-acoustic stimulation (VAS), and post-response). Design: A prospective, longitudinal design was utilized. Subjects: Twelve normally developing fetuses, eight females and four males, were examined with continuous ultrasound imaging. Outcome Measures: The fetal neurobehavioral coding system (FENS) was used to evaluate the quality of motor activity during 10-s epochs over the three conditions. Results: Seventy-five percent of the fetuses at the 26-week assessment and 100% of the fetuses at the 36-week assessment responded with movement immediately following stimulation. Significant differences in head, fetal breathing, general, limb, and mouthing movements were detected between the 26 and 36-week assessments. Movement differences between conditions were detected in head, fetal breathing, limb, and mouthing movements. Conclusion: Smoother and more complex movement was observed with fetal maturation. Following VAS stimulation, an immediate increase of large, jerky movements suggests instability in fetal capabilities. Fetal movement quality changes over gestation may reflect sensorimotor synaptogenesis in the central nervous system, while observation of immature movement patterns following VAS stimulation may reflect movement pattern instability.

Differences in the gastrocnemius-soleus muscle and tendon have been documented shortly after birth in infants born preterm compared with infants born at term. Knowledge of muscle tendon unit lengths at term age to 12 weeks of age in infants born preterm may be useful in understanding motor development. Gastrocnemius-soleus muscle tendon unit lengths were compared at term age, at 6 weeks of age, and at 12 weeks of age (preterm adjusted age) in 20 infants born full term and 22 infants born preterm. Significant differences were found between the 2 groups on taut tendon, relaxed muscle length (A_O); taut tendon, stretched muscle length (A_Max); and muscle stretch (A_O to A_Max). Infants born preterm demonstrated measures of A_O and A_Max in positions of greater plantar flexion compared with infants born full term. Significant differences in measurements of A_O were found between term age and 12 weeks of age, indicating that the tendon lengthens during this period for both groups. These results provide knowledge of musculoskeletal development of the gastrocnemius-soleus muscle and tendon. Differences in musculoskeletal measurements are consistent with uterine confinement in the last weeks of full-term gestation. These findings have implications when examining the musculoskeletal system in infants born preterm who are demonstrating functional changes.

This study assessed differences in measures of the muscle tendon unit between infants born preterm and infants born full-term. Twenty infants born between 26 and 36 weeks of gestation comprised the preterm group and 21 infants born between 38 and 42 weeks of gestation comprised the full-term group. Gastrocnemius-soleus measurements were obtained with a taut tendon and relaxed muscle belly (Ao), and with a taut tendon and elongated muscle belly (Amax). Muscle extensibility measurements were obtained with a goniometer. Ao to Amax was the difference between Ao and Amax measurements. Statistically significant differences were found for both measures of muscle extensibility, but not for the difference between these measures. The preterm group demonstrated measures of Ao and Amax in more extended ankle positions. Muscle length differences are present between infants born full-term and infants born preterm. These differences are most likely due to differences in tendon length.