Sitting Postural Control Affects the Development of Focused Attention in Children with Cerebral Palsy Swati M. Surkar 1, Nicholas Stergiou 2, Sarah Berger 3, and Regina Harbourne 4 1. Munroe Meyer Institute of Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE 2. Nebraska Biomechanics Core Facility, University of Nebraska Omaha, Omaha, NE 3. Department of Psychology, College of Staten Island of City University of New York, Staten Island, NY4. John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA Purpose Conclusion As sitting postural control advanced from supported sitting to independent sitting, sustained attention during exploratory play increased. Longest FA on objects increased over time as sitting postural control developed. The total duration of FA and global FA increased in children who achieved independent sitting as well as mobility. However, in children who achieved mobility post-intervention, sustained attention on objects decreased and frequency of FA increased. Sitting postural control and the development of FA appear linked in children with CP suggesting a co-emergence of motor and cognitive functions. Participants Nineteen children (12 males and 7 females) with mild to moderate CP Data archived from previous studies Mean age of (SD = 10.54) months Inclusion criteria: 1. Children with a diagnosis of CP, a score of mild or moderate severity on CP severity rating scale. 2. The initial ability to sit with support. 3. Without known visual impairments. Exclusion criteria: 1. Children with a hip dislocation. 2. Neuromuscular diagnosis other than CP. 3. Severe cognitive deficits. 4. quadriplegic CP with severe upper limb dysfunction, which could affect object exploration during play assessment. Methods A trained Physical therapist performed sitting section of GMFM testing pre-intervention. Children sat with support for play assessment during pre-intervention session. We conducted a modified play based assessment (PBA), which consists of exploratory play using various toys for 10 minute period. PBA is a tool to facilitate and observe natural behavior in a standard manner, which is a reflection of cognitive skills. We coded all variables of FA, Global FA (GFA), total FA (TFA), longest FA (LFA), and frequency of FA using video segments from a modified PBA. A coder trained in coding of FA with the sequential data analysis software “OpenSHAPA” coded the segments of FA, with intrarater reliability of Children received various interventions to advance sitting postural control, which may have included perceptual-motor training, body weight supported treadmill training or a home program, which spanned a time period of two to three months. FA and GMFM sitting section was again administered post-intervention. Variety of Interventions (no comparison between interventions) Results Clinical Implications and Future Directions Interventions directed to improve motor function may have an effect on components of cognitive function. Since the development of early attention predicts later cognitive and behavioral functioning, early training of sitting postural control may be one influence on the development of attention in children with CP. Future research should examine the development of FA longitudinally with the development of gross motor skills such as sitting, crawling, and walking in both infants who are developing typically and infants with delays. Background Infant cognitive development occurs via perceptual-motor experience within a social and cultural context. 1 Early perceptual-motor experience gained after achieving independent motor skills such as sitting facilitates cognitive development. 2 Focused attention (FA) is a specific example of the interrelation between cognition and action. FA is the duration of concentrated examination of objects during independent play or object exploration. 3 Exploration and manipulation abilities facilitate the development of FA in children with typical development (TD). 4 However, impaired postural control in children with Cerebral Palsy (CP) affects eye-hand coordination and object exploration, which further contributes to delays in the development of object perception and early conceptual development. 5 Although we know about the relationship between cognition and action in children with TD, impaired sitting postural control in children with CP and its effect on the development of FA remains unexamined. To investigate whether FA changes as sitting postural control improves, and whether impairments in sitting postural control affects the development of FA in children with CP. Exploratory Play for Modified PBA and Coding of FA A Perceptual-motor Approach (PMA): PMA emphasized on child-directed, self- initiated functional movement with therapist’s suggestions and cues for variability. Body Weight Support Training (BWST): BWST emphasized assisting the child by lifting the body segments (trunk, legs) and initiating successful (normal) patterns of movement. Home Program: In the home program caregivers received written suggestions, individualized goals, and verbal instructions/demonstration. References 1.Lobo MA, Harbourne RT, Dusing SC, McCoy SW. Grounding early intervention: physical therapy cannot just be about motor skills anymore. Phys Ther. 2013;93(1): Campos JJ, David I, Anderson MA, et al. Travel broadens the mind. Infancy. 2000;1(2): Ruff HA, Capozzoli M, Saltarelli LM. Focused visual attentionand distractibility in 10-month-old infants. Infant Behav Dev. 1996;19(3): Gibson EJ. Exploratory behavior in the development of perceiving, acting, and the acquiring of knowledge. Ann Rev Psychol. 1988;39(1): Nelson CA. The ontogeny of human memory: a cognitive neuroscience perspective. Dev Psychol. 1995;31(5): Acknowledgement This work was supported by- 1. National Institute of Disability and Rehabilitation Research 2. Section on Pediatrics of the American Physical Therapy Association Several toys were presented to a child and a trained PT conducted modified PBA. We measured FA by timing periods of intense concentration on specific objects. 1.Global FA: A longer period of absorption and action on the objects with long episodes of FA and reduced extraneous behaviors. A child looking steadily at the toys with serious and intent expression and affect marked the beginning of FA, and a child looking away from the toys marked the end of FA. 2.Longest FA: The longest time period of sustained attention on the objects and measured for each of 3 toys within the 90 seconds of toy exposure. 3.Total FA: The duration of total time that the child concentrated on the objects and measured while the child explored the objects within the total play assessment of 270 seconds (90 seconds each for 3 toys). 1.Frequency of FA: The number of times the child was concentrating on each toy during the complete play session. Sitting, no mobility: Child can sit independently, reach and possibly transition in and out of sitting Mobile: Child can either crawl independently several feet, or scoot on bottom to reach objects at least six feet away Sitters vs. Mobile Children