Motor Skill Development Alters Kinematics and Co-Activation between Flexors and Extensors of Limbs in Human Infant Crawling

Hands and knees crawling is an important motor developmental milestone but the current clinical measures of motor function during crawling stage are relatively subjective. Objective metrics using kinematics and electromyography (EMG) in infant crawling may provide more stable and accurate measures of such developmental milestone, demonstrating changes in locomotion during age span. The purpose of this paper was to determine whether joint kinematics and the underlying co-activation between flexor and extensor in infant crawling are different for arms and legs across the infant age span. Surface EMG of two pairs of flexors and extensors from arms and legs and the corresponding joint kinematic data were collected in twenty health infants (11 males and 9 females, range 8-15 months), while they were crawling on hands and knees. Co-activation index of averaged EMG was used to quantify the simultaneous contractions between flexor and extensor muscles. Coefficient of variation of joint's maximum vertical acceleration from multiple cycles was used to quantify the repeatability of kinematics during crawling. Our results indicated that the arm exhibited significantly higher co-activation and higher repeatability of joint movement than the leg, suggesting earlier development of arm compared to leg. Moreover, elder age groups, who had stronger walking ability developed, showed increased co-activation of the leg and significant increase in repeatability of the knee movement. These results were consistent with the rapid reinforcement of the leg during motor development from quadrupeds to bipedal walking. Furthermore, the EMG and kinematic parameters were significantly correlated with clinical variables. These results suggest that the EMG and kinematic analysis of infant crawling are useful in building effective assessment of infant's motor function before independent walking.