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Relationship Between Postural Control and Fine Motor Skills in Preterm

Infants at 6 and 12 Months Adjusted Age

Article  in  The American journal of occupational therapy.: official publication of the American Occupational Therapy Association · November 2011
DOI: 10.5014/ajot.2011.001503 · Source: PubMed

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Relationship Between Postural Control and Fine Motor
Skills in Preterm Infants at 6 and 12 Months
Adjusted Age
KEY WORDS
 child development
 infant
 infant, premature
 motor skills
 postural balance
Tien-Ni Wang, PhD, OT, is Assistant Professor, School
of Occupational Therapy, College of Medicine, National
Taiwan University, 17 Syujhou Road 4F, Taipei City 100,
Taiwan, Republic of China; tnwang@ntu.edu.tw
Tsu-Hsin Howe, PhD, OTR, is Assistant Professor,
Steinhardt School of Culture, Education, and Human
Development, New York University, New York.
Jim Hinojosa, PhD, OT, FAOTA, is Professor,
Steinhardt School of Culture, Education, and Human
Development, New York University, New York.
Sharon L. Weinberg, PhD, is Professor, Steinhardt
School of Culture, Education, and Human Development,
New York University, New York.
The American Journal of Occupational Therapy
Tien-Ni Wang, Tsu-Hsin Howe, Jim Hinojosa, Sharon L. Weinberg
We examined the relationship between postural control and fine motor skills of preterm infants at 6 and 12 mo
adjusted age. The Alberta Infant Motor Scale was used to measure postural control, and the Peabody De-
velopmental Motor Scales II was used to measure fine motor skills. The data analyzed were taken from 105
medical records from a preterm infant follow-up clinic at an urban academic medical center in south Taiwan.
Using multiple regression analyses, we found that the development of postural control is related to the
development of fine motor skills, especially in the group of preterm infants with delayed postural control.
This finding supports the theoretical assumption of proximal–distal development used by many occupational
therapists to guide intervention. Further research is suggested to corroborate findings.
Wang, T.-N., Howe, T.-H., Hinojosa, J., & Weinberg, S. L. (2011). Relationship between postural control and fine motor
skills in preterm infants at 6 and 12 months adjusted age. American Journal of Occupational Therapy, 65, 695–
701. doi: 10.5014/ajot.2011.001503
A dvances in medical technology have contributed to a significant increase in
the survival rates of preterm infants, who are at high risk for long-term
neurological, cognitive, and behavioral complications (Aylward, 2005). Among
these high-risk areas, motor development is reported to be more affected by
premature birth than are other developmental domains (Lorenz, Wooliever,
Jetton, & Paneth, 1998) and is therefore an important area to monitor in
preterm infants.
The relation between postural control and fine motor skills is the primary
focus of therapy when clinicians are working on young children’s motor ac-
quisition. Clinicians often base their therapeutic interventions on the proximal–
distal principle of normal motor development (Case-Smith, Fisher, & Bauer,
1989; Rosenblum & Josman, 2003). This principle suggests that motor
development initially occurs proximally (i.e., in the head and trunk) and
thereafter progresses outwardly toward the distal parts of the body (i.e., the
hands and feet; Case-Smith et al., 1989; Loria, 1980; Skinner, 1979). Postural
control, the ability to maintain the center body mass or a body part over a stable
or moving base of support (Massion, 1998; Shumway-Cook & Woollacott,
1995), is an example of a proximal motor function. Despite widespread ac-
ceptance of the proximal–distal principle, the evidence supporting this as-
sumption is limited (Case-Smith et al., 1989).
Both clinical and laboratory studies have examined the relationship between
proximal motor function (e.g., postural control) and distal motor function (e.g.,
fine motor skills) in the typically developing population at different age ranges
(Case-Smith et al., 1989; Fallang, Saugstad, & Hadders-Algra, 2000; Rochat,
1992; Rosenblum & Josman, 2003; Thelen & Spencer, 1998). These studies
collectively do not lend strong support for the proximal–distal principle,
695
however. Fallang and colleagues (2000) found a strong
association between the kinematics of reaching activities
as an indication of fine motor skills and postural control
in a laboratory setting using healthy infants ages 4 and 6
mo. Yet, in another sample of healthy infants ages 2–6
mo, Case-Smith et al. (1989) found a moderately low,
albeit statistically significant, correlation between postural
control and fine motor skills (rs 5 .31–.35, ps < .05) in
a clinical setting. In still another study of older children,
Rosenblum and Josman (2003) investigated the re-
lationship between postural control and fine motor skills
in 47 typically developing children at ages 5–6 yr and
found low to moderate, but statistically significant, cor-
relations between postural control and fine manual dex-
terity (rs 5 2.31 to 2.47, ps < .05). The findings of
these studies have low correlations that provide limited
information about the relationship between postural
control and fine motor skills.
The relationship between postural control and fine
motor skills also has been investigated in the preterm
infant population (de Groot, 2000; Fallang, Saugstad, &
Hadders-Algra, 2003; Plantinga, Perdock, & de Groot,
1997; Samsom & de Groot, 2000); in these studies,
however, only a single component of postural control was
investigated. Past studies of postural control in premature
infants (de Vries & de Groot, 2002; Fallang et al., 2003;
Plantinga et al., 1997) examined only specific positions in
the realm of possible postural control positions. For ex-
ample, when studying the relationship between postural
control and fine motor skills, Plantinga et al. (1997)
examined only the sitting position, de Vries and de Groot
(2002) examined only trunk rotation, and Fallang et al.
(2003) focused only on reaching in the supine position.
Because these researchers measured postural control dif-
ferently, using different dimensions of postural control as
indicators, drawing comparisons across studies and arriv-
ing at a conclusion about the relationship between postural
control, in general, and fine motor skills is difficult.
In addition, previous studies of the relationship be-
tween postural control and fine motor skills have been
limited in terms of the variety of preterm populations
studied (Plantinga et al., 1997; Samsom & de Groot,
2000). The results of these studies cannot be generalized to
other preterm infant populations. Samsom and de Groot
(2000), for example, investigated the relationship between
postural control and fine motor skills in high-risk preterm
infants. They defined high-risk infants as those <32 wk
gestational age, birth weight <1,500 g, and with at least
one medical complication. They did not include healthy
preterm infants without medical complications or preterm
infants between 33 and 36 wk gestational age.
696
The first purpose of our study was to examine the
general relationship between postural control and fine
motor skills in preterm infants at 6 and 12 mo adjusted
age. In addition, we examined the relationship between
postural control and fine motor skills, comparing groups
with different adjusted ages and groups with and without
motor delays separately.
Method
Research Design
We used a cross-sectional design (Portney & Watkins,
2009) to investigate the differences in postural control
and fine motor skills between preterm and full-term in-
fants at the adjusted ages of 6 and 12 mo. The institutional
review board of the National Cheng Kung University
Hospital and New York University Human Subjects Re-
view Board reviewed and approved the study procedures.
Participants
National Cheng Kung University Hospital in Taiwan
provided data from infants’ 6- and 12-mo preemie follow-
up visits between August 2008 and April 2009. All the
medical records reviewed met the following criteria: (1) the
preterm infant’s birth weight was £1,500 g; (2) the infant’s
gestational age was <37 wk; (3) the infant had no marked
neurological impairments, such as Grade III or IV in-
traventricular hemorrhage or periventricular leukomalacia;
and (4) the infant had no congenital impairment.
Tien-Ni Wang reviewed 133 medical records from the
preemie follow-up program recorded at National Cheng
Kung University Hospital in Taiwan. The preemie follow-
up team evaluated 71 boys and 62 girls between August
2008 and April 2009. On the basis of the inclusion criteria,
12 preterm infants (8 boys and 4 girls) who had in-
traventricular hemorrhage, Grade III and IV, or periven-
tricular leukomalacia were excluded. Because the data
collection period spanned longer than 6 mo, 16 preterm
infants (9 boys and 7 girls) were tested at both 6 and 12 mo
adjusted age. One of the two sets of data collected on these
16 preterm infants was eliminated to be consistent with
a cross-sectional design. Moreover, one set of data collected
at 6 mo adjusted age was eliminated to balance the sample
sizes for the two age groups. The final sample consisted of
105 participants: 54 preterm infants at 6 mo adjusted age
and 51 preterm infants at 12 mo adjusted age.
Instruments
We used two standardized assessments. Postural control
was measured with the Alberta Infant Motor Scale (AIMS;
November/December 2011, Volume 65, Number 6
Piper & Darrah, 1994), and fine motor skills were
measured by the Fine Motor scale of the Peabody
Developmental Motor Scales, 2nd edition (PDMS–2;
Folio & Fewell, 2000). The PDMS–2 measures in-
cluded the Composite Fine Motor score and the scores
of two subscales: Grasping and Visual–Motor Integration.
Alberta Infant Motor Scale. In this study, we used the
AIMS (Piper & Darrah, 1994), a standardized norm-
referenced observation- and performance-based test, to
measure postural control. The AIMS evaluates the sponta-
neous movement repertoires of infants from birth through
independent walking. It consists of 58 items assessing all
components of postural control, including antigravity
movements, body alignment, trunk rotation, and weight
shifting in different positions (i.e., supine, prone, sitting,
standing). The total raw score (sum of the positional item
scores) ranges from 0 to 58. The higher the score is, the
better the infant’s postural control.
Interrater reliability of the AIMS is reported to be
higher than .96, and test–retest reliability ranges from .86
to .99 at different ages (Liao & Campbell, 2004). Good
to excellent concurrent validity was found with other
standardized motor evaluations, including the PDMS–2
and the Bayley Scales of Infant Development I and II
(rs 5 .74–.89; Almeida, Dutra, Mello, Reis, & Martins,
2008; Piper & Darrah, 1994). The AIMS also demon-
strated good intrarater and interrater reliabilities (intra-
class correlation coefficients [ICCs] 5 .97–.99) as well as
excellent concurrent validity with the Bayley Scales of
Infant Development II (.78 at 6 mo and .90 at 12 mo)
when used in the Taiwanese preterm population (Jeng,
Yau, Chen, & Hsiao, 2000).
Peabody Developmental Motor Scales–2. The PDMS–2
is a standardized and norm-referenced test that consists of
a Gross Motor and a Fine Motor scale, each of which is
divided into skill categories. In this study, we used the
Fine Motor scale to measure fine motor skills. The Fine
Motor scale consists of test items measuring (1) con-
trolled use of the fingers and hands under the general
heading of Grasping (PDMS–G) and (2) Visual–Motor
Integration (PDMS–V) using test items such as reaching
for and grasping an object, building with blocks, and
copying designs. Test items reflect typical motor tasks
for each age, including drawing and manual dexterity
activities.
The test manual reported good reliability and validity,
as have other studies (Folio & Fewell, 2000; Provost et al.,
2004). Test–retest reliability values for the total motor
quotient for a group of infants between ages 2 and 17 mo
were .89–.96, those for PDMS–G for a group of infants
between ages 2 and 17 mo were .82–.91, and those
The American Journal of Occupational Therapy
for PDMS–V for a group of infants between ages 2
and 17 mo were .90–.95. The interrater reliability (r 5
.98) and test–retest reliability (ICC 5 .97) of the
PDMS–2 are both high (Folio & Fewell, 2000). The
concurrent validities of the Fine Motor Skill subscale of
the Bayley Scales of Infant Development II (Bayley,
1969) and PDMS–2 in infants at 12 mo were reported
to be between .78 and .90 (Provost et al., 2004). In
this study, we used the standard score of the PDMS–2
with a mean (M) 5 10 and a standard deviation (SD) 5
3 to represent the performance of preterm infants’ fine
motor skills.
Procedures
Infants with birth weight £1,500 g from six different
hospitals in the southern region of Taiwan are automat-
ically enrolled in the centralized preterm follow-up pro-
gram at National Cheng Kung University Hospital. A
follow-up team evaluates all premature infants at the
adjusted ages of 6 and 12 mo with a series of neuro-
logical, cognitive, and motor development tests. The
evaluation team administers the AIMS and PDMS–2
as part of the motor tests. Tien-Ni Wang, who was not
a member of the evaluation team, retrieved the infants’
demographic information, birth history, and results
from the motor skills assessments from the existing
medical records of the follow-up clinics. All members of
the evaluation team were blind to the purpose of this
study.
Data Analysis
We analyzed the data using SPSS-PC for Windows
Release 17.0 (SPSS Inc., Chicago). Initially, we used
descriptive statistics to examine the tenability of the
underlying assumptions of the tests of inference used
to answer the questions addressed. The underlying as-
sumptions for these tests, including linearity, normality,
and homoscedasticity, were found to be tenable. Ac-
cordingly, we conducted three regression analyses, one
on each of the three Fine Motor subscales of the PDMS–2
as dependent measures variables: the PDMS–G, the
PDMS–V, and the Composite Fine Motor score (PDMS–
F). Finally, we investigated the relationship between
postural control and fine motor skills for two groups of
preterm infants, those with and without motor delays at
6 and 12 mo adjusted age. In this study, we identified
preterm infants as being delayed in postural control if
their AIMS score was lower than the fifth percentile
ranking of the norm in their respective age group (Campos
et al., 2006; Piper & Darrah, 1994).
697
Results Table 1. Correlation Matrix Between All Pairs of Variables
Variable 1 2 3 4 5 6 7
Demographic Characteristics 1. BW —
The final sample consisted of 105 preterm infants (54 boys, 2. GA .578** —
3. Gender .155 2.067 —
51 girls). A total of 54 infants were at 6 mo adjusted age,
4. AIMS .058 2.088 2.166 —
and 51 were at 12 mo adjusted age. Birth weight of the 105 5. PDMS–G .268** .146 2.048 .431** —
participants ranged from 720 g to 1,496 g (M 5 1,178.50, 6. PDMS–V .200* .139 2.089 .355** .653** —
SD 5215.47), and gestational age ranged from 24 wk to 7. PDMS–F .265** .157 2.069 .440** .950** .856** —
36 wk (M 5 29.67, SD 5 2.57). We found no significant Note. N 5 105. — 5 not applicable; AIMS 5 Alberta Infant Motor Scale;
group differences between the 6- and 12-mo adjusted age BW 5 birth weight; GA 5 gestational age; PDMS 5 Peabody Developmental
Motor Scale–2; PDMS–F 5 PDMS Composite Fine Motor score; PDMS–G 5
groups in terms of birth weight (t 5 20.376, df 5 103, PDMS Grasping subscale; PDMS–V 5 PDMS Visual–Motor Integration
p 5 .708), gestational age (t 5 1.163, df 5 103, p 5 subscale.
*p 5 .05. **p 5 .01.
.247), or gender (x2 5 1.591, df 5 2, N 5 105, p 5
.244). Relationship Between Postural Control and
Fine Motor Skills After Controlling for
Postural Control and Fine Motor Skills in Demographic Variables
Preterm Infants
Because birth weight, gender, gestational age, and adjusted
To make scores comparable between different ages and age are known to correlate with fine motor skills, we
tests, we transformed all AIMS and PDMS–2 raw scores examined the relationship between postural control and
into standard scores. We used the standard scores printed fine motor skills after controlling for these demographics.
in the AIMS test manual, which are z scores (M 5 0, In this way, we could examine the unique contribution of
SD 5 1) and contingent on age (Piper & Darrah, 1994). postural control on fine motor skills over and above these
The z scores are based on a normative group of full-term demographic variables. The particular set of dependent
infants, which explains why the M for the AIMS has variables included the PDMS–G, the PDMS–V, and the
a negative value for this preterm population (M 5 20.56, PDMS–F, and the particular set of independent variables
SD 5 1.08). Fine motor skills included the PDMS–G, included postural control (as measured by the AIMS) and
PDMS–V, and PDMS–F standard scores with M 5 10 the demographic control variables gender, gestational age,
and SD 5 3. As with the AIMS, the standard scores of the birth weight, and adjusted age.
PDMS–G and PDMS–V are obtained from the PDMS–2 The findings showed that after accounting for the
test manual and are contingent on age (Folio & Fewell, effects of the control variables, postural control contributes
2000). The PDMS–F standard score is a summary value to fine motor skills as measured by the PDMS–F, PDMS–
of the PDMS–G and PDMS–V standard scores. These G, and PDMS–V (Table 2). The R2 values in the final
standard scores are based on a normative group of full- model of equations indicate that after controlling for
term infants, which again explains why the means for the gender, birth weight, gestational age, and adjusted age,
PDMS–G (M 5 9.44, SD 51.47) and PDMS–V (M 5 postural control uniquely explained 25.6% of the vari-
9.74, SD 5 0.89) are all less than the full-term mean ance in fine motor skills, 24.8% of the variance in
of 10. grasping fine motor skills, and 16.7% of the variance in
Table 1 presents the matrix of correlations between visual–motor integration skills.
all pairs of variables, including demographic variables
(i.e., birth weight, gestational age, and gender), pos- Table 2. Multiple Linear Regression Analyses Testing the Effects
tural control as measured by the AIMS, and fine motor of Postural Control on Fine Motor Skills in Preterm Infants
skills as measured by the PDMS–G, PDMS–V, and Control Variable Predictor
PDMS–F. On the basis of the correlational analyses, we Equation Intercept GA BW Gender AIMS F(4, 104) R2
found statistically significant associations between the
1. PDMS–F 15.414 .066 .002 2.097 .867** 8.606** .256**
fine motor skills variables and postural control (rs 5 2. PDMS–G 7.633 .036 .001 2.015 .580** 8.223** .248**
.355–.440, p < .05) when the effect of age was con- 3. PDMS–V 8.381 .030 .001 2.082 .287** 5.007** .167**
trolled. These results indicate that fine motor skills in Note. N 5 105. AIMS 5 Alberta Infant Motor Scale; BW 5 birth weight; GA 5
terms of grasping, visual–motor integration, and com- gestational age; PDMS 5 Peabody Developmental Motor Scale–2; PDMS–F 5
PDMS Composite Fine Motor score; PDMS–G 5 PDMS Grasping subscale;
posite scores of fine motor skills are associated with PDMS–V 5 PDMS Visual–Motor Integration subscale.
postural control. *p 5 .05. **p 5 .01.

698 November/December 2011, Volume 65, Number 6

Relationship Between Postural Control and Fine
Motor Skills in Different Age and Motor Subgroups
We further examined the relationship between postural
control and fine motor skills at two different adjusted ages:
6 mo (n 5 54) and 12 mo (n 5 51); we also looked at the
relationship for those with delayed postural control (n 5
12) and those without delayed postural control (n 5 93).
With respect to the demographics, we found no signifi-
cant differences in birth weight (p > .05) and gestational
age (p > .05) between the groups of infants with and
without delayed postural control or between the groups
of infants at 6 and 12 mo adjusted age (see Table 3).
Table 3 shows the correlation between postural
control as measured by the AIMS and fine motor skills as
measured by the PDMS–F in the different subgroups
defined by adjusted age and status of postural control.
Although the relationship between postural control and
fine motor skills is stronger in preterm infants at 6 mo
adjusted age than in those at 12 mo adjusted age, the
difference in the correlations is not large (.503 vs. .415).
When examining the correlation between postural con-
trol and fine motor skills in the groups with and without
delayed postural control, we found that infants without
delayed postural control did not have a significant asso-
ciation between postural control (AIMS) and fine motor
skills (PDMS–F; r 5 .139, p 5 .185), whereas those with
delayed postural control did (r 5 .671, p 5 .017).
Discussion
The findings of this study support postural control’s as-
sociation with fine motor skills in preterm infants. The
relationships between postural control and all fine motor
skills variables were low to moderately significantly pos-
itive (rs 5 .355–.440, p < .05). Analyses demonstrated
that preterm infants at 6 mo adjusted age (r 5 .503) tend
Table 3. Birth Weight, Gestational Age, and Relationship
Between Postural Control and Fine Motor Skills in Preterm
Infants in Different Subgroups
Birth Weight Gestational Age Relationship
Group M (SD) M (SD) Pearson r n
Infants with DPC 1,197.6 (210.0) 30.4 (3.3) .671*
Infants without DPC 1,176.0 (217.1) 29.6 (2.5) .139
6 mo AA 1,202.2 (210.8) 29.6 (2.2) .503**
12 mo AA 1,153.4 (219.6) 29.8 (2.9) .415**
Total 1,178.5 (215.5) 29.7 (2.6) .440**
Note. Postural control was measured by the Alberta Infant Motor Scale, and
fine motor skills were measured by the composite fine motor score of the
Peabody Developmental Motor Scale–2. AA 5 adjusted age; DPC 5 delayed
postural control; M 5 mean; SD 5 standard deviation.
*p 5 .05. **p 5 .01.
The American Journal of Occupational Therapy
to have a stronger association between postural control
and fine motor skills than those at 12 mo adjusted age
(r 5 .415). Moreover, we found a strong, significant
relationship between postural control and fine motor
skills in preterm infants with delayed postural control
(r 5 .671, p 5 .017), but not in those without delayed
postural control (r 5 .139, p 5 .185).
The results of this study demonstrated a significant
association between postural control and fine motor skills.
In this study, a higher percentage of variance in the fine
motor scores was explained by the scores of postural
control (16.7%–25.6%) than was explained in Case-
Smith et al.’s (1989) study (12%), which was based on
the typically developing population. These different
findings are likely the result of the different populations
studied. This study’s results indicate that postural control
and fine motor skills are more strongly associated in
preterm infants than in typically developing infants.
When we examined preterm infants in different age
groups, the study results indicated that descriptively
speaking, preterm infants at 6 mo adjusted age have
a stronger association between postural control and fine
motor skills (r 5 .503) than those at 12 mo adjusted age
(r 5 .415). Van der Fits, Otten, Klip, Van Eykern, and
Hadders-Algra (1999) offered an explanation of why the
relationship between postural control and fine motor
skills decreases with age. Van der Fits and his coauthors
investigated the developmental changes in postural con-
trol accompanying reaching movements in healthy in-
fants from 6 to 18 mo old. Their findings indicated that
once an infant is successful in reaching, postural control
and reaching develop relatively independently.
A unique aspect of this study was our examination of
postural control as a whole. The results of this study
expand the findings of previous studies that focused on
only a single component or position (de Vries & de
Groot, 2002; Fallang et al., 2003; Plantinga et al.,
1997). These findings provide further evidence to sup-
port the relationship between general postural control
and fine motor skills, including all of its components in
different positions. This result is especially important for
infant populations, because they develop their fine mo-
tor skills in different positions using various postural
12
components.
93
54
Moreover, we included a wider population of preterm
51 infants than did prior studies. This study’s population was
105 preterm infants born between 32 and 36 wk gestational
age and free of medical complications. During the past 2
decades, the number of preterm infants with younger
gestational age and lower birth weight has increased
dramatically; the results add to our theoretical knowledge
699
of the general relationship between postural control and
fine motor skills in this population.
Clinical Implications
Infants’ motor development is a major area of focus for
therapists working with children who have developmental
disabilities. To fulfill the need for practical applications,
we further analyzed the relationship between postural
control and fine motor skills. We compared the differ-
ences between two groups: (1) a group of preterm infants
without delayed postural control and (2) a group of
preterm infants with delayed postural control. The results
indicated that the relationship between postural control
and fine motor skills is strong and significant for preterm
infants with delayed postural control (r 5 .671, p 5
.017), although it is not significant for preterm infants
without delayed postural control. These findings further
echoed Van der Fits and colleagues’ (1999) conclusion
that postural control and fine motor skills are two in-
terdependent systems when the motor system is not
mature or is delayed.
On the basis of our findings, we argue that the
proximal–distal principle might be appropriately applied
to infants with motor delay. These results, however, are
different from Case-Smith’s (1989) study, in which she
found a low but significant distal–proximal relationship
in typically developing infants. Case-Smith suggested that
the proximal–distal principle may not be a valid postulate
on which to design treatment programs for infants. The
different population could also explain this conflict with
our own findings.
The results of this study should help therapists un-
derstand the general relationship between postural control
and fine motor skills in preterm infants. We demonstrated
a strong relationship between postural control and fine
motor skills in preterm infants with motor delay. We also
found a stronger relationship between postural control and
fine motor skills in younger preterm infants at 6 mo ad-
justed age than at 12 mo adjusted age. This finding suggests
that clinicians should consider postural control and fine
motor skills as two interdependent systems when treating
infants at a younger age or infants with motor delay. In
addition, we propose that therapists should treat infants’
difficulties in postural control and fine motor skills con-
currently until they have mastered postural control.
Limitations and Further Studies
This cross-sectional study focused on preterm infants age
1 yr or younger. Because delays in motor skills consis-
tently appear at a later age (Churcher et al., 1993; Darlow,
Horwood, Mogridge, & Clemett, 1997; Sullivan &
700
Msall, 2007), the performance of postural control and
fine motor skills and the relationship between them is
worth investigating in a wider age range. Moreover, in-
vestigating the developmental motor trajectory of preterm
infants using a longitudinal design is needed to verify our
findings. Retrospective data collection also has some in-
herent limitations, such as data integrity and the issue of
quality. For example, in our study, we did not establish
interrater reliability between two occupational therapists
on the team before administering AIMS and PDMS–2.
Conclusion
We investigated the relationship between postural control
and fine motor skills in preterm infants at 6 and 12 mo
adjusted age. We found that the development of postural
control is related to the development of fine motor skills,
especially in the group of preterm infants with delayed
postural control. Understanding that the relationship
between postural control and fine motor skills in infants
with delayed postural control is strong might offer insight
into helpful intervention strategies for preterm infants. s
Acknowledgments
This article is based on research conducted by Tien-Ni
Wang in partial fulfillment of the requirements for the
Doctor of Philosophy in Occupational Therapy degree at
the Steinhardt School of Culture, Education, and Human
Development, New York University. We thank the staffs
of the National Cheng Kung University Hospital preemie
follow-up clinic and the Premature Baby Foundation of
Taiwan for their assistance in data collection.
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