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Brain meets spine: the neural origin of toddler’s first steps

Periodic Reporting for period 2 - Learn2Walk (Brain meets spine: the neural origin of toddler’s first steps)

Reporting period: 2018-08-01 to 2020-01-31

Children have an instinct to walk from the moment they are born. If supported for about 70-80% of their weight, they instinctively ‘walk’ (stepping reflex) as their feet come into contact with a horizontal surface. In typically developing (TD) children we need then to wait about a year to be able to see the emergence of the independent walking. The first independent steps of a child represent a milestone of human growth that triggers several motor and cognitive developmental changes. Failing to reach the milestone of unsupported walking by an age of 18-20 months might be a sign of a possible developmental delay. Cerebral palsy (CP) – a neurodevelopmental disorder caused by (non-progressive) lesions in an immature brain – is the most frequent cause of motor disability amongst children in Europe. Although about 2/3 of children with CP manage to walk before the age of 5, they often exhibit hardly functional and unstable locomotion. Our project aims to characterize the emergence of independent walking in TD children and children with CP. It seeks to understand the interplay between brain and muscular activity in this crucial developmental phase in healthy children and in children with a visible lesion precisely in the brain; it aims to identify differences in the muscular and brain activation underlying the development of walking; it seeks to understand the effect of the current rehabilitation techniques performed in children with cerebral palsy in their neuromotor abilities, as a fundamental step for developing a testing a novel rehabilitation protocol to promote independent, functional, safe and efficient walking in children affected by CP.
In the first period of the project, we established the new recording platform proposed in the project that allowed recording of brain activity in conjunction with multi-muscles activity and whole-body kinematics. We tested the feasibility and started the data collection. A multi-centre collaboration has been established to perform the study on the emergence of walking in children with CP and evaluate the effects of current rehabilitation techniques performed in CP children in the movement pattern, muscular and brain activity. We proposed and validated a new methodological approach to study the entrainment of activity in primary motor cortex with the activity of groups of muscles involved in the locomotor task.
The longitudinal and cross-sectional data set collected in this project is unique and it allows to address fundamental questions on the emergence of walking from a novel perspective, in typically developing children and children with motor impairment. We developed a new methodological approach to study the cortico-spinal coherence and we will provide the software to analyse that during the development of walking in children. We will then provide a structural way to evaluate the effect of intervention therapies in the neuromotor outputs.