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The Presentation of Maladaptive Postural Deviations in Young Children

Tara Fenamore, M.A.

Doctoral Candidate, 2021

Teachers College, Columbia University

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BACKGROUND

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RESEARCH PROPOSAL

Question

Do maturation and cognitive demand influence the presentation of forward head posture in children performing a graphomotor task?

Hypothesis

The occurrence of FHP will correlate positively with maturation and cognitive demand in typically developing subjects performing a graphomotor task.

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FORWARD HEAD POSTURE (FHP)

Anteriorization of the head and neck relative to the thoracic spine

Silva, A.G., Punt, T.D., Sharples, P., Vilas-Boas, J.P., & Johnson, M.I. (2009). Head posture and neck pain of chronic nontraumatic origin:

A comparison between patients and pain-free persons. Archives of Physical Medicine and Rehabilitation, 90(4), 669-674. https://doi.org/10.1016/j.apmr.2008.10.018.

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STUDY AIMS

Evaluate the validity and reliability of a Postural Deviation Rating Scale
Track the occurrence of forward head posture in a child population to isolate a critical period of musculoskeletal vulnerability to postural deviation
Identify variables that shift the musculoskeletal system into a deviant and maladaptive attractor state in early childhood (Thelen & Smith, 1994)
Observe changes in postural alignment that occur as children transition from an unstable behavioral pattern to a stable behavioral pattern (Thelen, 2005)

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QUALITATIVE MEASURE

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POSTURAL DEVIATION RATING SCALE

Rating	Sagittal Plane	Frontal Plane
0: None

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POSTURAL DEVIATION RATING SCALE

Rating	Sagittal Plane	Frontal Plane
1: Mild

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POSTURAL DEVIATION RATING SCALE

Rating	Sagittal Plane	Frontal Plane
2: Extreme

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PARTICIPANTS

Group	Age	N = 14
Group 1	3-4 years	7
Group 2	6-7 years	7

Table 1. The proposed study will employ a cross-sectional, within-subjects design. Participants will be assigned to groups according to age.

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EXPERIMENTAL CONDITIONS

Condition 1	Low Cognitive Demand self-directed drawing task
Condition 2	Medium Cognitive Demand NEPSY-II Visuomotor Precision Task
Condition 3	High Cognitive Demand NEPSY-II Design Copying Task

Table 2. The proposed study will use a 2x3 within-subjects factorial design. The three conditions would be assigned to all participants in a blocked, counterbalanced order.

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PSYCHOMETRIC MEASURE

NEPSY-II Selective Assessment Tool

Designed to assess neuropsychological development and cognitive ability of children aged 3-16
Evaluates child’s performance on tasks relative to age-mate peers

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NEPSY-II SELECTIVE ASSESSMENT TOOL

Sensorimotor Functioning Domain

Test: Visuomotor Precision Test

assesses graphomotor speed & accuracy

https://www.txasp.org/assets/conference-materials/2015/miller_nepsyii_tasp.pdf

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NEPSY-II SELECTIVE ASSESSMENT TOOL

Visuospatial Processing Domain

Test: Design Copying Task

Assesses motor and visual-perceptual

skills

https://www.txasp.org/assets/conference-materials/2015/miller_nepsyii_tasp.pdf

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METHODOLOGY

Children will perform all tasks on a height-adjustable easel
Two digital video cameras will be used to collect data in the sagittal and frontal planes
Three trained research assistants will analyze the recordings and report the frequency, magnitude, and duration of forward head posture during the first 30 seconds of each task
Test inter-rater reliability of Postural Deviation Rating Scale scores
Statistical analysis to test for significant differences in group means with respect to maturation, cognitive demand, and forward head posture

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FUTURE DIRECTIONS

Implementation of Postural Deviation Rating Scale in educational settings
Curriculum to guide the selection of adaptive psychomotor outcomes
Compare Postural Deviation Rating Scale scores with kinematic data using 3D Motion Capture technology

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REFERENCES

Alexander, F.M. (1969). Evolution of a technique. In Edward Maisel (ed.) The resurrection of the body: The writings of F. Matthias

Alexander (pp. 139-160). New York, NY: Delta Publishing Co., Inc. (Original work published in 1932).

Alexander, F.M. (1910). Man’s supreme inheritance. London, UK: MOURITZ.

Baer, J.L., Vasavada, A., & Cohen, R.G. (2019). Neck posture is influenced by anticipation of stepping. Human Movement Science, 64, 108-122. doi: https://doi.org/10.1016/j.humov.2019.01.010

Brattberg, G. (1994). The incidence of back pain and headache among swedish school children. Quality of Life Research, 3(1), 27-31. doi: 10.1007/BF00433372

Brooks, B., Sherman, E., & Strauss, E. (2010). NEPSY-II: A Developmental Neuropsychological Assessment, Second Edition. Child Neuropsychology, 16, 80–101. https://doi.org/10.1080/09297040903146966

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REFERENCES

Dimon, T. (2015). Neurodynamics: The Art of Mindfulness in Action. Berkeley, California: North Atlantic Books.

Dimon, T., & Brown, G.D. (2011). The body in motion: Its evolution and design. Berkeley, CA: North Atlantic Books.

Fiebert, I. M., Roach, K. E., Yang, S. S., Dierking, L. D., & Hart, F. E. (1999). Cervical range of motion and strength during resting and neutral head postures in healthy young adults. Journal of Back and Musculoskeletal Rehabilitation, 12(3), 165–178. https://doi.org/10.3233/BMR-1999-12304

Galbusera, F., & Wilke, H.J. (2018). Biomechanics of the spine: Basic concepts, spinal disorders and treatments. London, UK: Elsevier/Academic Press.

Haughie, L. J., Fiebert, I. M., & Roach, K. E. (1995). Relationship of Forward Head Posture and Cervical Backward Bending to Neck Pain. Journal of Manual & Manipulative Therapy, 3(3), 91–97. https://doi.org/10.1179/jmt.1995.3.3.91

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REFERENCES

Huguet, A., Tougas, M.E., Hayden, J., McGrath, P.J., Stinson, J.N., & Chambers, C.T. (2016). Systematic review with meta-analysis of childhood and adolescent risk and prognostic factors for musculoskeletal pain. Pain, 157, 2640-2656. Doi: 10.1097/j.pain.0000000000000685

Korkman, M., Kirk, U., & Kemp, S. (2007). NEPSY-II: Clinical and interpretive manual. San Antonio, TX: The Psychological Corporation.

Magill, R., & Anderson, A. (2016). Motor Learning and Control: Concepts and Applications. Dubuque: McGraw-Hill Education.

Miller, D.C. (2015, Oct. 9). How to administer and interpret the NEPSY-II - Part I [Conference Session]. TAPS 2015 Convention, San Antonio, TX. https://www.txasp.org/assets/conference-materials/2015/miller_nepsyii_tasp.pdf

Silva, A.G., Punt, T.D., Sharples, P., Vilas-Boas, J.P., & Johnson, M.I. (2009). Head posture and neck pain of chronic nontraumatic origin: A comparison between patients and pain-free persons. Archives of Physical Medicine and Rehabilitation, 90(4), 669-674. https://doi.org/10.1016/j.apmr.2008.10.018.

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REFERENCES

Thelen, E. (2005). Dynamical systems theory and the complexity of change. Psychoanalytic Dialogues, 15, 255-280.

doi: https://doi.org/10.1080/10481881509348831

Thelen, E., & Smith, L.B. (1994). A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge, Massachusetts: MIT Press/Bradford Books.