Moving Forward: Early Predictors of Crawling and Walking in Infants with DS - PROJECT SUMMARY Infants with Down syndrome (DS) typically have significant delays in motor development, which has cascading effects on language and cognition. Enabling earlier acquisition of motor skills for infants with DS has the potential to support development across domains and is a primary focus of the NIH’s INCLUDE project. However, limitations in resources prevent infants from getting the support they need to facilitate development. Moreover, as in many clinical populations, the age of attainment of motor skills in infants with DS is highly variable (e.g., walk onset delayed by 6 - 36 months), and resources need to be allocated differently for children based on their anticipated achievement of key motor milestones. There is a need to identify predictors of delays in independent mobility in order to individualize rehabilitation interventions and share resources. The Alberta Infant Motor Scale (AIMS), a routine clinical assessment of posture, and measures of spontaneous leg kicking (e.g., frequency and interlimb coordination) have been used to predict walk onset in other populations but not in DS. The lack of evaluation of these outcomes in DS raises the question: will these predictors of walk onset in other populations translate to infants with DS? However, even if they are successful predictors, the collection of these variables requires trained personnel. There is a need for alternative measures that address resource limitations and accessibility issues while still capturing the mechanisms reflected in AIMS scores and kicking variables. Ecological momentary assessment (EMA) and kinematic analysis of 2-D videos have recently emerged as fully remote, cost-effective solutions. This study aims to explore early indicators associated with crawling and walking milestone achievement in infants with DS. Fifty infants and caregivers will be recruited nationally to complete two weeks of EMA when infants are four and six months old, time points that are prior to independent mobility and match those of prior studies. A subset of 25 infants will complete a single, home-based data collection session immediately prior to each week of EMA assessments. Caregivers will also complete a monthly survey of motor skills until walk onset. At the end of this study, we will have identified and compared empirically supported and alternative, accessible predictors of independent mobility in infants with DS. This project is the first step in offering individualized rehabilitation paradigms to infants with DS while balancing the appropriate allocation of resources.
