Studying movement may move the needle for infants with Down syndrome

Interview by Noelle Toumey Reetz

Babies and young children with Down syndrome can often be late to reach early motor milestones. But Jerry Wu, a professor of kinesiology and health and department chair at Georgia State University, is working on research that could change that. Wu is collaborating with a cross-cutting team to discover interventions that may improve mobility, communication and quality of life for children with Down syndrome as they grow. It’s work he’s focused on for more than 20 years.

“Right now, we’re working with more than 40 families across metro Atlanta,” Wu said. “The idea is that as we provide more opportunities for these babies to explore their environment and interact with people, it may also improve their cognition and language development.”

Each year, about 5,700 babies born in the U.S. have Down syndrome, according to the Atlanta-based Centers for Disease Control and Prevention (CDC). Two studies led by Wu and funded by the National Institutes of Health are providing local families with training and tools they can use at home. The research aims to expand understanding of the connections between babies’ motor skills and other developmental progress. The final results are expected next summer. Here, Wu shares what they’re learning.

Physical abilities and motor skills are often the foundation for other skills as babies grow. Can you talk about the importance of early intervention for infants with Down syndrome? What do we know and what do we need to learn?

Evidence from research studies in the past few decades has shown that early intervention elicits significantly positive impact on the development of infants with Down syndrome in the motor, cognitive, language or social domains separately. However, limited studies have investigated the intercorrelations between domains for a given intervention modality. In other words, we do not know if and to what degree a motor intervention can impact cognitive and language development in infants with Down syndrome. Furthermore, participants in previous studies were predominantly white infants with Down syndrome. Therefore, the knowledge is lacking to understand the effectiveness of early intervention across different racial and ethnic groups. In addition, with rapid advances in science and technology, we need to continue to explore new ideas of early intervention to investigate its feasibility and impact on infant development across multiple domains.

How does this particular research look at the relationship between motor skills and cognitive and language development?

In our current study, we provide two early interventions to infants with Down syndrome. In the first, known as “sticky mittens” training, we recorded videos of infants using special Velcro mittens that provide them with opportunities to learn reaching and “grasping” and facilitate the emergence of true grasping and possibly gesturing for early communication. We also looked at bodyweight-supported treadmill stepping to evaluate the effect of training on motor skills. In addition to these interventions, we recorded 15 minutes of parent-infant interaction using a variety of books and toys. Then, psychologists on our research team used behavioral coding to understand the infants’ gesturing and language development. Biomechanists from our team used video analysis and biomechanical calculations to examine the infants’ motor pattern and strategy. Our team of physical therapists comprehensively assessed the infants’ motor, cognitive and language development. Our collaborator in the School of Public Health will use sophisticated statical models to explore interrelations of the data across multiple domains.

The families involved are a key aspect in this study. Can you share how their commitment plays a role?

Our “sticky mittens” training often lasts for two months. Our treadmill stepping training is typically 10 months. Those trainings needed to be implemented five days a week for eight minutes per day, so we taught the parents to administer the training at their homes. As a result, their commitment and involvement have been absolutely critical to the success of the study. We have been lucky to get overwhelming support from parents from the greater Atlanta area who have children with Down syndrome. We even have a family from Tennessee who travels four hours to Atlanta each month to allow our monthly video recording and assessment. We are so grateful for their help.

It's interesting that you also brought in psychology experts from the College of Arts & Sciences and physical therapy experts from the College of Nursing as part of the research team. How will this expand the impact of your findings?

It’s well known that child development is intertwined across multiple domains. This is more obvious in the first year of life in infants with and without Down syndrome. Traditionally, researchers conducted research projects and used their expertise to interpret the results from the perspective of their own field. However, as development emerges simultaneously across multiple domains, it is vital that an interdisciplinary approach is applied to understand it from multiple angles and explore the intercorrelations between domains. This will provide a better picture of how infants respond to early intervention and help reveal the underlying mechanisms of development across multiple fields.

Can you talk about how posture and even baby “babbling” sounds can be informative to your work?

Baby “babbling” is an important part of forming the foundation for speech and it’s one method to measure how a child’s language is developing. There is evidence that infant rhythmic arm movement in a sitting position, such as banging a toy, is correlated with the emergence of baby babbling in typically developing children. However, this knowledge is lacking in infants with Down syndrome. It is interesting to explore the relationship between these two domains, and hopefully apply the hidden connections to develop new intervention strategies to aid the development of infants with Down syndrome in multiple domains simultaneously.

You have another study in which your team will be using video and artificial intelligence (AI) to help gain insights from the research. Can you share more about that research?

For that work, we will record videos of infants with Down syndrome sitting and playing with toys. We will then use computer vision software such as OpenPose to extract the key movement patterns of rhythmic arm movements. Using this kind of AI will significantly reduce the time spent in manual video processing and analysis, and provide us with an alternative, effective tool to speed up the data analysis and result reporting. It could possibly help us reveal the hidden information embedded in the complex intercorrelation between rhythmic arm movement and the emergence of baby babbling.

Can you share any early results from your research?

Our preliminary results show that infants with Down syndrome improve the spatiotemporal pattern and joint angles steadily in the first five months of treadmill intervention. Also, the “sticky mittens” training may help infants with Down syndrome develop more efficient arm reaching, but different strategies may emerge to complete the reaching task. Further, our developmental assessment demonstrated a clear relationship between the development of motor and language skills in infants with Down syndrome. In addition, parents who have an infant with Down syndrome may use different strategies while reading a book or playing with a toy (e.g., a sorting or naming toy) with the infant to enhance parent-infant interaction.

What are you looking forward to building on or researching next? Where do you want to take your research results?

We will share our research findings with parents who have children with Down syndrome as well as researchers and clinicians via presentations at scientific conferences and publications in top-tier peer-reviewed journals. We want to continue to work with all stakeholders to improve medical services to children with Down syndrome. Our ultimate goal is enhancing the quality of life of individuals with Down syndrome as well as their families.

Visit the Biomechanics Lab website and Center for Movement and Rehabilitation Research to learn more about Wu’s work.

For more information about Georgia State Research, visit research.gsu.edu.