Motor development and sensory processing: A comparative study between preterm and term infants

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Highlights

Abstract

Infants born preterm and/or with low birth weight may present a clinical condition of organic instability and usually face a long period of hospitalization in the Neonatal Intensive Care Units, being exposed to biopsychosocial risk factors to their development due to decreased spontaneous movement and excessive sensory stimuli. This study assumes that there are relationships between the integration of sensory information of preterm infants, motor development and their subsequent effects.

Objective

To evaluate the sensory processing and motor development in preterm infants aged 4–6 months and compare performance data with their peers born at term.

Method

This was a cross-sectional and comparative study consisting of a group of preterm infants (n = 15) and a group of term infants (n = 15), assessed using the Test of Sensory Functions in Infants (TSFI) and the Alberta Infant Motor Scale (AIMS).

Results

The results showed no significant association between motor performance on the AIMS scale (total score) and sensory processing in the TSFI (total score). However, all infants who scored abnormal in the total TSFI score, subdomain 1, and subdomain 5 presented motor performance at or below the 5th percentile on the AIMS scale.

Conclusion

Since all infants who presented definite alteration in tolerating tactile deep pressure and poor postural control are at risk of delayed gross motor development, there may be peculiarities not detected by the tests used that seem to establish some relationship between sensory processing and motor development.

Introduction

Sensory integration is the innate ability to process, organize and interpret sensations and respond appropriately to the environment, that is, the ability to organize sensory input, select the information that deserves attention or response and ignore what is not relevant for the moment (Magalhães, 2008). This theory examines how individuals develop the ability to organize sensations to perform self-directed and meaningful activities (Miller, 2006). It was based on the premise that higher cortical functions depend on adequate neural organization in the subcortical levels to explain the relationship between behavior and neural functioning (Ayres, 1972).

Thus, providing and controlling sensory input, especially in the vestibular, proprioceptive and tactile systems, is important for the development of adaptive responses that integrate these sensations that are essential for the control of posture, coordination of movement and the organization of mechanisms of alertness and orientation (Ayres, 1979). Improper processing of these data results in maladaptive responses, which may represent sensory processing disorders. The etiology of these disorders is unknown, but they are more common and evident in children born prematurely, with low birth weight and who experienced neonatal complications (Magalhães, 2008), conditions that constitute a biological risk to neurodevelopment and learning factors (Martins, Linhares, & Martinez, 2005).

Although the Neonatal Intensive Care Units (NICU) have contributed to decrease neonatal morbidity and mortality (Scochi, Riul, Garcia, Barradas & Pileggi, 2001), specialized care produces adverse factors which may have negative impact on infant's development in short and medium term (Grunau, 2006). The intense lighting, excessive noise and painful procedures are stressful (Ichisato & Scochi, 2006). Faced with this overload of sensory stimuli, the infant's physiological responses are altered and can culminate in behavioral changes such as decreased social interaction; altered state of rest and sleep, restlessness, irritability and crying, as well as overall reduction in auditory response and motor development (Darcy et al., 2008, Otenio et al., 2007). This is due to their lack of inhibitory control to process, organize and select the sensory input as a result of preterm's brain immaturity (Rodarte et al., 2005). The association between preterm birth and admission to NICU, therefore, establishes a chain of negative events that may trigger attention and learning difficulties, sensory and motor dysfunctions (Kakehashi, Pinheiro, Pizzarro & Guilherme, 2007). In this sense, a multiple risk condition is structured in which a risk factor potentiates another (Martins et al., 2005).

With regard to neurosensorimotor development, it was observed that there are differences in the rate of skill acquisition of preterm infants when compared to term infants (Raniero, Tudella, & Mattos, 2010). Pin, Darrer, Eldridge and Galea (2009) found that, although at 8 months of age preterm infants exhibit motor performance similar to term infants in the prone and supine postures, there was a significant difference between groups in the sitting and standing postures, which make greater demands on the antigravity musculature and on motor control. Moreover, even when monitored in follow-up programs, until 12 months of corrected age, preterm infants have lower scores in gross motor development (Formiga & Linhares, 2011).

Due to the health conditions at birth, preterm and/or low birth weight infants may require hospitalization in the Neonatal Intensive Care Unit (NICU) to ensure their survival (Als et al., 2004, Scochi et al., 2001). However, the hospital environment with intense lighting, excessive noise and the performance of painful procedures, is a constant source of stress (Charpak, Calume & Hamel, 1999). Thus, this environment of excessive and prolonged stimulation during brain development brings many consequences for the preterm infant, who may develop long-term attention and learning difficulties, difficulty remaining in an active or inactive behavioral state of alertness and in regulating sleep patterns (Bremmer, Byers, & Kiehl, 2003).

Thus, due to the diversity of risk factors in the development of preterm infants during the first year of life, it is necessary to use increasingly precise and accurate evaluations with high predictive value for alterations in the medium and long term. These evaluation allow the implementation of effective intervention programs (Spittle et al., 2013) to aid the development of basic motor skills related to postural control and mobility, which are essential to the interactions the child establishes with the environment (Evensen, Skranesa, Brubakka & Vik, 2009).

Furthermore, although alterations or delays in motor development diagnosed early may be transient and disappear with the maturation of the central nervous system (Bartlett and Jamie Fanning, 2003, Darrah et al., 1998), there are still no reports in the literature discussing the association of motor development with sensory processing. In this sense, preterm infants who required admission to the NICU are more prone to alterations in neurosensorimotor development. Inappropriate excessive stimulation and positioning in the incubator may impede spontaneous movement. Thus, it is important to check the impact of these early sensory experiences on motor development so that these infants can be referred to early intervention programs such as prevention strategies and the promotion of development.

Therefore, the aim of this study was to investigate the correlation between sensory processing and motor development in preterm infants aged 4–6 months and compare their performance data with their peers born at term. We hypothesize that preterm infants who present poor postural control and tactile defensiveness will present delay in the prone and sitting postures.

Section snippets

Participants

Taking part in this cross-sectional, comparative study, were 15 infants in the experimental group (8 female), born preterm, with a mean gestational age of 31.3 weeks (±1.8), mean birth weight of 1.506 g (±386.5), Apgar average of 6.9 (±1.6) and 8.7 (±1), in the first and fifth minutes, respectively, average length of hospital stay of 16.4 days (±13.0), with a mean age of 22.2 weeks (±3.89) at the time of assessment. The control group consisted of 15 term infants (7 female) with a mean

Results

In the comparison between the groups regarding motor development assessed by means of the AIMS scale, there was no significant difference in total score (p = 0.0922) and in the prone (p = 0.2738) and sitting posture (p = 0.0624), i.e., the groups are similar in terms of gross motor development.

With regard to sensory processing, there was a difference when comparing the preterm and term groups in the TSFI total score (p = 0.0113) and in subdomain 1 – reactivity to tactile deep pressure (p < 0.0001), i.e.,

Discussion

The aim of this study was to verify the correlation between motor development and sensory processing in preterm infants aged 4–6 months of corrected age and to compare the performance data with their peers born at term.

Although the statistical analysis points towards the groups exhibiting similar motor performance, the descriptive data reveal that the majority of preterm infants (53%) scored at or below the 5th percentile on the AIMS test, indicating risk of developmental delay (Piper & Darrah,

Conclusion

There may be some relationship between sensory processing and motor development since all the infants in this study that showed definite alteration in tolerating tactile deep pressure and poor postural control are at risk of delayed gross motor development. These results provide important information about the association between the impacts of sensory stimuli in early postnatal life on early motor development. Moreover, the results justify the practice of health professionals such as

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