Effect of early postural management on gait development in preterm infants:a retrospective study

doi:10.21203/rs.3.rs-4867606/v1

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Effect of early postural management on gait development in preterm infants:a retrospective study

https://doi.org/10.21203/rs.3.rs-4867606/v1

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Background Independent walking is an important milestone in motor development and an important indicator of developmental follow-up in preterm infants. The aim of this study is to understand the effect of early postural management on gait development in preterm infants.

Methods A retrospective study was performed for the effect of early postural management on gait development in 622 preterm infants, there were 321 cases in the experimental group and 301 cases in the control group. Both groups underwent regular early exercise intervention and developmental evaluation, and the experimental group regularly visited the hospital for postural management guidance for 3 months after visiting the rehabilitation department. The sex, age, gestational age, and age of independent walking were collected in the two groups, at the same time, gait video observation and analysis results, Berg balance index and the gross motor function development quotient (DQ) score of GESELL test results in the two groups were recorded before and after 3 months.

Results There were no significant differences in sex, age, gestational age, and age of independent walking between the two groups (P>0.05). There were no significant differences in the ratio of ankle, knee, hip, pelvis, torso and upper limb swing control, Berg balance index and gross motor DQ score between the two groups before postural management (P>0.05). After postural management for 3 months, the ratio of ankle, knee, hip, pelvis, trunk and upper limb swing control were higher than those in the control group without posture management, and Berg balance index and the DQ score of gross movement in the experimental group were higher than those in the control group, and all the differences were statistically significant(P<0.05).

Conclusions Early postural management promotes the control of each joint during walking, balance function and gross motor development, thereby playing a positive role in the gait development of preterm infants.

Early postural management

Preterm infants

Gait development

Retrospective study

With the continuous advancement of medical technology, the survival rate of premature infants has increased significantly, but the incidence of movement disability, cognitive disability, language disability, intellectual disability and other disabilities has also increased^{1, 2}, they require long-term special monitoring and health management compared to generally healthy children^3,4,5. In the early stages of life, people pay great attention to the growth and development of preterm infants, especially the development of motor function. As an important milestone in motor development, independent walking has been valued by people, and it is also of vital significance to the future motor development of preterm infants⁶.

At present, many medical institutions have established developmental follow-up outpatient clinics for preterm infants to monitor the developmental level of preterm infants and provide early exercise intervention. Premature infants who visited regularly in the developmental follow-up outpatient clinic of the Rehabilitation Department of Chengdu Women's and Children's Central Hospital. In addition to regular monitoring of developmental levels and early exercise intervention, continuous postural management was also practiced for premature infants. At the time after 3 months of independent walking, the gait video observation and analysis of each child was routinely performed, then parents would be given specialized exercise intervention and postural management guidance based on the results. It is worth our attention that during the same time, some preterm infants who visited the outpatient clinic of the Rehabilitation Department due to "gait disorders" were referred from other medical institutions. In the early stages of developmental follow-up, these preterm infants received early exercise intervention and developmental evaluation regularly, but no early postural management.

Preterm infants in these two conditions have some differences in their gait development. Therefore, the aim of this retrospective study was to further clarify the effect of early postural management on gait development in preterm infants.

In this study, 622 preterm infants who visited the outpatient clinic of the Rehabilitation Department of Chengdu Women's and Children's Central Hospital from February 1, 2019 ~ January 31, 2022 and completed the gait video observation and analysis were retrospectively selected as the research subjects. According to the parents' willingness to come to the hospital to receive regular postural management guidance, they were divided into the experimental group and the control group, among them, 321 preterm infants who were accepted were classified as the experimental group, and 301 preterm infants who were rejected were classified as the control group.

Inclusion Criteria: ①Gestational age < 37 weeks, ②Hung on receiving early exercise intervention and developmental evaluation regularly, ③Had been walking independently for 3 months, ④Cooperated to complete the observation and analysis of gait video before and after 3 months, Berg balance function test and GESELL test, ⑤The parents or guardians in the experimental group followed the doctor's instructions to implement postural management opinions, ⑥The parents or guardians consented to anonymous data collection.

Exclusion Criteria: ①With progressive gait disorders, ②Ancillary examinations (brain MRI, X-ray, etc.) showed pathological gait disorders, ③Could not cooperate to complete the gait video observation and analysis, Berg balance function test and GESELL test, ④The parents or guardians in the experimental group did not follow the doctor's instructions to implement postural management opinions, ⑤The parents or guardians did not consent to the anonymous collection of data, ⑥Lost to follow-up in the later stage.

This study was approved by the Ethics Committee of Chengdu Women's and Children's Central Hospital, Ethics Approval No. 2022 (123).

All preterm infants in the two groups received regular early exercise intervention and developmental evaluation in the course of developmental follow-up. The experimental group received regular postural management guidance for 3 months after visiting the rehabilitation department.

The sex, age, gestational age, and age of independent walking were collected in the two groups, at the same time, gait video observation and analysis results, Berg balance index and the gross motor function development quotient (DQ) score of GESELL test results in the two groups were recorded before and after 3 months. The ankle, knee, hip, pelvis, torso, and upper limb swing in the gait video observation results were recorded as uncontrollable when the movement deviated from the normal range compared with the corresponding age during the walking cycle, while were recorded as controllable when within normal range.

Statistical analysis

The statistical analysis was performed using the IBM SPSS Statistics, Version 27.0. Armonk, NY: IBM Corp. The numerical data in this study were described by the number of cases, and the chi-square test was used for comparison of differences between groups. In this study, the Kolmogorov–Smirnov normality test was first performed for testing for normality.Non-normally distributed data was described by median (interquartile range), and the Mann-Whitney U test was used for comparison of differences between groups. Normally distributed data was expressed as mean ± standard deviation, and the T-test was used for comparison of differences between groups. A P value < 0.05 was considered statistically significant.

The age of preterm infants in the experimental group was 14.8–21.9 months, gestational age was 29.9–36.9 weeks, and the age of independent walking was 11.8–18.9 months. The age of preterm infants in the control group were aged 14.9–23.3 months, gestational age was 30.0-36.9 weeks, and the age of independent walking was 11.9–20.3 months. There was no significant difference in sex, age, gestational age and age of independent walking between the experimental group and the control group (P > 0.05) (Table 1).

Table 1

Comparison of general data
Group	Number	Sex		Age	Gestational age	Age of independent walking
Group	Number	Boys	Girls	(\(\:\stackrel{-}{\text{x}}\)±S, months)	(\(\:\stackrel{-}{\text{x}}\)±S, weeks)	(\(\:\stackrel{-}{\text{x}}\)±S, months)
Experimental group	321	168	153	18.29 ± 1.21	33.54 ± 1.21	15.29 ± 1.21
Control group	301	157	144	18.42 ± 1.48	33.41 ± 1.22	15.42 ± 1.48
P		0.965		0.232	0.194	0.232

Before postural management, the results of gait video observation and analysis were compared between the two groups. In the walking cycle, the ankle controllable ratio was 61.1% (196/321) in the experimental group, while 61.5% (185/301) in the control group; the knee controllable ratio was 56.7% (182/321) in the experimental group, while 56.5%(170/301) in the control group; the hip controllable ratio was 46.7%(150/321) in the experimental group, while 46.8%(141/301) in the control group; the pelvis controllable ratio was 44.5%(143/321) in the experimental group, while 44.5%(134/301) in the control group; the torso controllable ratio was 54.5%(175/321) in the experimental group, while 55.1%(166/301) in the control group; the upper limb swing controllable ratio was 62.0%(199/321) in the experimental group, while 62.5%(188/301) in the control group. There was no significant difference in all the above items (P > 0.05) (Table 2).

Berg balance index was 46.00(3.00) in the experimental group, while 45.59(3.00) in the control group. Gross motor DQ score was 80.00(5.00) in the experimental group, while 80.00(5.00) in the control group. There was no significant difference in all the above items (P > 0.05) (Table 3).

Table 2

Comparison of gait video observation and analysis before postural management
Group	Number	controllable Number(%)
Group	Number	ankle	knee	hip	pelvis	torso	upper limb swing
Experimental group	321	196 (61.1%)	182 (56.7%)	150 (46.7%)	143 (44.5%)	175 (54.5%)	199 (62.0%)
Control group	301	185 (61.5%)	170 (56.5%)	141 (46.8%)	134 (44.5%)	166 (55.1%)	188 (62.5%)
P		0.918	0.956	0.977	0.994	0.874	0.905

Table 3

Comparison of Berg balance index and gross motor DQ score before postural management
Group	Number	Berg balance index median (interquartile range)	gross motor DQ score median (interquartile range)
Experimental group	321	46.00(3.00)	80.00(5.00)
Control group	301	45.49(3.00)	80.00(5.00)
P		0.144	0.972

After posture management for 3 months, in the walking cycle, the ankle controllable ratio was 86.3% (277/321) in the experimental group, while 73.8% (222/301) in the control group; the knee controllable ratio was 82.2% (264/321) in the experimental group, while 68.4%(206/301) in the control group;the hip controllable ratio was 90.3%(290/321) in the experimental group, while 59.1%(178/301) in the control group; the pelvis controllable ratio was 88.5%(284/321) in the experimental group, while 59.5%(179/301) in the control group; the torso controllable ratio was 91.3%(293/321) in the experimental group, while 69.1%(208/301) in the control group; the upper limb swing controllable ratio was 91.9%(295/321) in the experimental group, while 73.8%(222/301) in the control group. The above ratios in the experimental group were higher than those in the control group. All the differences were statistically significant in all the above items(P<0.05) (Table 4).

Berg balance index was 49.00(3.00) in the experimental group, while 48.00(2.00) in the control group. Gross motor DQ score was 83.00(5.00) in the experimental group,while 82.00(5.00) in the control group. The above scores were higher in the experimental group than in the control group. All the differences were statistically significant in all the above items(P<0.05) (Table 5).

Table 4

Comparison of gait video observation and analysis after posture management
Group	Number	controllable Number(%)
Group	Number	ankle	knee		hip	pelvis	torso	upper limb swing
Experimental group	321	277 (86.3%)		264 (82.2%)	290 (90.3%)	284 (88.5%)	293 (91.3%)	295 (91.9%)
Control group	301	222 (73.8%)		206 (68.4%)	178 (59.1%)	179 (59.5%)	208 (69.1%)	222 (73.8%)
P		<0.001		<0.001	<0.001	<0.001	<0.001	<0.001

Table 5

Comparison of Berg balance index and gross motor DQ score after postural management
Group	Number	Berg balance index median (interquartile range)	gross motor DQ score median (interquartile range)
Experimental group	321	49.00(3.00)	83.00(5.00)
Control group	301	48.00(2.00)	82.00(5.00)
P		<0.001	<0.001

Due to the early birth of preterm infants, various organ systems are immature, and there may be varying degrees of sequelae, and active early intervention may greatly improve their prognosis^7,8,9. Early intervention can help promote the neurological development of preterm infants and improve their motor function^{10, 11}. Promote the development of gross and fine motor skills through targeted early motor training, so that premature infants can master basic movements such as sitting, crawling, walking, and so an earlier^{12, 13}. Independent walking is often valued as an important motor development milestone. Subsequent gait development still needs to go through a long-term process, that is, children need to go through the process of gradual development and perfection of walking posture and movement after learning to walk independently^14,15,16,17.

The study was retrospective. The sex, age, gestational age and age of independent walking in the experimental group and the control group were compared respectively, and there was no significant difference between two groups(P > 0.05). Before postural management, there was no significant difference between the two groups in terms of gait video observation and analysis, Berg balance index and gross motor DQ score (P > 0.05). The above situation was in line with the propensity score matching principle, interference factors were reduced and the reliability of the study results was improved. The results of the study showed that after 3 months of postural management, the controllable ratio of ankle, knee, hip, pelvis, trunk and upper limb swing were higher in experimental group than those in the control group, and Berg balance index and the DQ score of gross movement in the experimental group were higher than those in the control group, and all the differences were statistically significant(P < 0.05). These results suggest that postural management can significantly correct the abnormal walking posture of preterm infants, and improve their balance function and gross motor development, thereby playing a positive role in gait development.

This is because good postural management helps to establish the correct alignment of the body and joints, and postural management promotes the development of muscle balance¹⁸. In postural management, by maintaining the right position, the muscles of premature infants can be stimulated and exercised in a balanced manner, avoiding excessive tension or weakness of certain muscles, so as to ensure that the muscles can work in harmony during gait development to achieve a smooth and smooth walking movement^18,19,20. In addition, effective postural management also contributes to the normal development and function of the joints²¹. It keeps the joints moving in the correct position and range of motion, reducing the occurrence of joint deformities and limited mobility. This is essential for flexible flexion and extension of the joint and stable support in gait, helping to improve the efficiency and stability of walking. On the contrary, if the posture of premature infants is not properly managed, it may lead to asymmetrical development of the body, affecting the shift of the center of gravity and balance control, and then problems such as abnormal posture and poor balance function during gait development^22,23,24. Correct postural management can help preterm infants to form a good body posture perception in the early stage, and lay the foundation for subsequent gait development, which can reduce the formation of abnormal posture patterns and reduce the risk of gait disorders in the future²⁵. Therefore, postural management after independent walking is very important, and it is even necessary to pay attention to it before walking independently. In conclusion, early postural management of preterm infants is an important part of promoting the normal development of their gait, and it has a non-negligible role in improving the exercise ability and quality of life of preterm infants.

This study identified a significant positive effect of postural management on gait development in preterm infants. Through scientific and reasonable postural management intervention, it can effectively promote the normal development of gait and improve the gross motor development and balance function of preterm infants. It is an important part of the long-term monitoring of preterm infants, and it also lays a foundation for further in-depth research on the role of postural management in the development of preterm infants. Then early postural management which is a simple and easy to implement measure is recommended as part of primary child health care program for preterm infants. However, due to the young age of the patients, the gait analysis of the instrument is often not well coordinated, and the gait video observation method is used to analyze the natural state as much as possible, which makes the study have some limitations in the objective criteria. In addition, the sample size is relatively small and the observation time is limited. In the future, larger-scale and longer-term studies using more objective standards are needed to further verify and refine the research conclusions. In addition to paying attention to premature infants, early postural management can be extended to the primary child health care for normal children.

DQ Developmental quotient

Acknowledgements

We would like to thank the family and study individuals for their contribution.

Author contributions

YZ wrote the manuscript, QL analyzed the data, YY and XY collected relevant materials, and WZ provided the article ideas. Text revision was performed by all authors. All authors contributed to the article and approved the submitted version.

Funding

None.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Chengdu Women's and Children's Central Hospital, Ethics Approval No. 2022 (123). Informed consent was obtained by parents or guardians of the children enrolled in the study. All methods were carried out following the Declaration of Helsinki.

Consent for publication

Not applicable.

Conflict of interest

The authors have no conflict of interest to declare.

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You are reading this latest preprint version

Effect of early postural management on gait development in preterm infants:a retrospective study

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Abstract

Background

Methods

Statistical analysis

Results

Discussion

Conclusions

Abbreviations

Declarations

References

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