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King AR, Machipisa C, Finlayson F, Fahey MC, Novak I, Malhotra A. Early detection of cerebral palsy in high-risk infants: Translation of evidence into practice in an Australian hospital. J Paediatr Child Health 2021; 57:246-250. [PMID: 32940939 DOI: 10.1111/jpc.15191] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022]
Abstract
AIM The early diagnosis of cerebral palsy (CP) allows children timely access to early intervention. In 2018, Monash Children's Hospital established an Early Neurodevelopment Clinic based upon evidence-based guidelines for the early diagnosis of CP in high-risk infants. In this study, we aimed to characterise the infants presenting to the clinic and determine the rate of CP diagnosis. METHODS This study analysed data from infants attending the Early Neurodevelopment Clinic between May 2019 and April 2020. Infants at high-risk for CP attended the clinic at 3 months corrected age. Neuroimaging reports were reviewed, and a Prechtl's General Movement Assessment and Hammersmith Infant Neurological Examination were performed. Infants were diagnosed as having typical development, delayed development, high-risk of CP or CP at the time of clinic attendance and referred on to the appropriate pathway. RESULTS Ninety-six high-risk infants attended the clinic over the 1 year study period. Sixty-eight (71%) infants were extremely preterm or extremely low birthweight, and 28 (29%) were infants at born at older gestation with evidence of moderate to severe brain injury. Nine (9.6%) infants received a CP diagnosis and 12 (12.5%) were considered high-risk of CP. All infants with CP or high-risk of CP were referred to the Victorian Paediatric Rehabilitation Service. CONCLUSIONS It is feasible to implement the early CP diagnosis guidelines into a high-risk infant follow-up clinic. Implementation of the guidelines allows for early diagnosis of CP and appropriate referral of high-risk infants.
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Affiliation(s)
- Arrabella R King
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Catherine Machipisa
- Allied Health Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Francyne Finlayson
- Allied Health Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
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602
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Aravamuthan BR, Fehlings D, Shetty S, Fahey M, Gilbert L, Tilton A, Kruer MC. Variability in Cerebral Palsy Diagnosis. Pediatrics 2021; 147:e2020010066. [PMID: 33402528 PMCID: PMC7906070 DOI: 10.1542/peds.2020-010066] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common childhood motor disability. The emergence of genetic CP etiologies, variable inclusion of hypotonic CP in international registries, and involvement of different medical disciplines in CP diagnosis can promote diagnostic variability. This variability could adversely affect patients' understanding of their symptoms and access to care. Therefore, we sought to determine the presence and extent of practice variability in CP diagnosis. METHODS We surveyed physicians in the United States and Canada interested in CP on the basis of membership in the American Academy of Cerebral Palsy and Developmental Medicine or the Child Neurology Society Neonatal Neurology, Movement Disorders, or Neurodevelopmental Disabilities Special Interest Groups. The survey included the 2007 consensus definition of CP and 4 hypothetical case scenarios. RESULTS Of 695 contacted physicians, 330 (47%) completed the survey. Two scenarios yielded consensus: (1) nonprogressive spastic diplegia after premature birth with periventricular leukomalacia on brain MRI (96% would diagnose CP) and (2) progressive spastic diplegia (92% would not diagnose CP). Scenarios featuring genetic etiologies or hypotonia as the cause of nonprogressive motor disability yielded variability: only 46% to 67% of practitioners would diagnose CP in these settings. CONCLUSIONS There is practice variability in whether a child with a nonprogressive motor disability due to a genetic etiology or generalized hypotonia will be diagnosed with CP. This variability occurred despite anchoring questions with the 2007 consensus definition of CP. On the basis of these results, we have suggested ways to reduce diagnostic variability, including clarification of the consensus definition.
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Affiliation(s)
- Bhooma R Aravamuthan
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri;
| | - Darcy Fehlings
- Department of Pediatrics, University of Toronto and Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Sheetal Shetty
- Departments of Child Health, Neurology, Genetics, and Cellular and Molecular Medicine, College of Medicine - Phoenix, University of Arizona and Cerebral Palsy and Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona
| | - Michael Fahey
- Department of Paediatrics, Monash University, Melbourne, Australia; and
| | - Laura Gilbert
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri
| | - Ann Tilton
- Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Michael C Kruer
- Departments of Child Health, Neurology, Genetics, and Cellular and Molecular Medicine, College of Medicine - Phoenix, University of Arizona and Cerebral Palsy and Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona
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603
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Badawi N, Mcintyre S, Hunt RW. Perinatal care with a view to preventing cerebral palsy. Dev Med Child Neurol 2021; 63:156-161. [PMID: 33251607 PMCID: PMC7839537 DOI: 10.1111/dmcn.14754] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 01/02/2023]
Abstract
Birth prevalence of cerebral palsy (CP) is declining in high-income countries, to as low as 1.4 per 1000 live births in the most recent international reports. This represents a 35% reduction in birth prevalence over a 15-year period. This reduction is underpinned by a heightened focus of attention towards all aspects of CP, including: increased awareness, better data collection, development of national networks and registries, an explosion of research in basic science, perinatal care, neonatal neurology, public health, early detection, and targeted early intervention. Quick uptake of evidence into practice has ensued and overall improvements in clinical care occurred concurrently. It is anticipated that with continued partnerships with families, ongoing research driving further clinical improvement and vice versa, birth prevalence and severity of CP will further decline and the focus will shift to prevention in low- and middle-income countries. WHAT THIS PAPER ADDS: Research in the field of perinatal care and cerebral palsy (CP) prevention has increased significantly. In high-income countries, increased awareness of CP and scientific advances have improved clinical care. Population-based registers have limitations but remain the best mechanism to quantify birth prevalence of CP and accurately track trends. There have been recent reductions in the birth prevalence of CP.
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Affiliation(s)
- Nadia Badawi
- Grace Centre for Newborn CareChildren's Hospital at Westmead Sydney Children's Hospital NetworkSydneyNSWAustralia,Cerebral Palsy Alliance Research InstituteSpecialty of Child & Adolescent HealthSydney Medical SchoolFaculty of Medicine & HealthThe University of SydneySydneyNSWAustralia
| | - Sarah Mcintyre
- Cerebral Palsy Alliance Research InstituteSpecialty of Child & Adolescent HealthSydney Medical SchoolFaculty of Medicine & HealthThe University of SydneySydneyNSWAustralia
| | - Rod W Hunt
- Department of PaediatricsMonash UniversityMelbourneVICAustralia,Neonatal ResearchClinical SciencesMurdoch Children's Research InstituteMelbourneVICAustralia,Monash NewbornMonash HealthMelbourneVICAustralia
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604
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Karim T, Dossetor R, Huong Giang NT, Dung TQ, Son TV, Hoa NX, Tuyet NH, Van Anh NT, Chau CM, Bang NV, Badawi N, Khandaker G, Elliott E. Data on cerebral palsy in Vietnam will inform clinical practice and policy in low and middle-income countries. Disabil Rehabil 2021; 44:3081-3088. [PMID: 33397164 DOI: 10.1080/09638288.2020.1854872] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To document known risk factors, clinical severity, associated impairments and rehabilitation status of children presenting with cerebral palsy (CP) to the National Children's Hospital (NCH) in Hanoi, Vietnam. MATERIALS AND METHODS Active prospective ascertainment of cases of CP presenting between June and November 2017 to the NCH using surveillance modelled on the Paediatric Active Enhanced Disease Surveillance system in Australia. RESULTS Data were collected on 765 children with CP (mean age: 2 years 7 months (SD 2 y 6 mo). Mean age at diagnosis was 1 year 8 months (SD 1 y 9 mo). Children predominantly had spastic CP (95.2%, n = 729), most were quadriplegic (69.6%, n = 532) and 60.3% (n = 454) were Gross Motor Functional Classification System level III-V. Of the children 76.2% (n = 583) had one/more associated impairments. 36.3% (n = 276) had presumed perinatal asphyxia, 26.5% (n = 202) were preterm. Physiotherapy (94.3%, n = 663) was the most common form of intervention used. Only 2.6% (n = 12) of the children who would have benefitted from assistive devices had wheelchairs. CONCLUSION We established hospital-based surveillance of CP in Hanoi and confirmed a high burden and severity of CP with potentially preventable risk factors. These data will inform clinician training and health policy and identify need for evidence-based care and assistive devices.IMPLICATIONS FOR REHABILITATIONWe identified a high number of children with severe forms of cerebral palsy (CP) in Hanoi, Vietnam through hospital-based surveillance.There is an urgent need for clinician training and access to and use of evidence-based interventions including assistive technology.This study will inform local capacity building and health policy for improved diagnosis and care of children with CP in Vietnam and other low and middle-income countries.
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Affiliation(s)
- Tasneem Karim
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Rachael Dossetor
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Trinh Quang Dung
- Rehabilitation Department, National Children's Hospital, Hanoi, Vietnam
| | - Tran Vinh Son
- Rehabilitation Department, National Children's Hospital, Hanoi, Vietnam
| | - Nguyen Xuan Hoa
- Rehabilitation Department, National Children's Hospital, Hanoi, Vietnam
| | - Nguyen Hong Tuyet
- Rehabilitation Department, National Children's Hospital, Hanoi, Vietnam
| | - Nguyen Thi Van Anh
- Medical Education and Skills-Lab Department, Hanoi Medical University, Hanoi, Vietnam
| | - Cao Minh Chau
- Rehabilitation Department, Hanoi Medical University (Bach Mai Hospital), Hanoi, Vietnam.,Faculty of Health Sciences, Phenikaa University, Hanoi, Vietnam
| | - Nguyen Van Bang
- Department of Paediatrics, Hanoi Medical University, Hanoi, Vietnam.,Faculty of Medicine, Hanoi University of Business and Technology, Hanoi, Vietnam
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Elizabeth Elliott
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Kid's Research, The Sydney Children's Hospitals Network (Westmead), Sydney, Australia
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605
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Use of Vitamin D Bolus in Fortified Juice for Improving Vitamin D Status in Children with Cerebral Palsy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1339:257-264. [DOI: 10.1007/978-3-030-78787-5_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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606
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Miller S, O'Donnell M, Mulpuri K. Physical Therapists Are Key to Hip Surveillance for Children with Cerebral Palsy: Evaluating the Effectiveness of Knowledge Translation to Support Program Implementation. Phys Occup Ther Pediatr 2021; 41:300-313. [PMID: 33280455 DOI: 10.1080/01942638.2020.1851337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS Physical and occupational therapists play a key role in the implementation of hip surveillance for children with cerebral palsy (CP) in British Columbia, Canada. We aimed to develop and assess a knowledge translation strategy to support the implementation of a provincial hip surveillance program. METHODS Pediatric therapists were invited to participate in an anonymous survey assessing hip surveillance knowledge and learning needs. Based on these results, educational materials were developed. Two years later, one year following the launch of the hip surveillance program, the survey was repeated to assess learning, knowledge use, and barriers to enrollment. RESULTS The initial survey was completed by 102 therapists; 74 therapists completed the second survey. Multifaceted educational strategies, including web-based learning, in-person education, email notifications, and print materials that targeted knowledge gaps were developed. Upon re-evaluation, knowledge increased on all questions. At follow-up, 45 therapists had enrolled a child, indicating knowledge use. Barriers to enrollment included lack of a CP diagnosis, parents or physicians not agreeing to enrollment, time requirements, and lack of space to complete the clinical exam. CONCLUSIONS Targeted knowledge translation strategies were successful in meeting the educational requirements of a large group of therapists in a vast geographic area.
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Affiliation(s)
- Stacey Miller
- BC Children's Hospital, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Maureen O'Donnell
- Sunny Hill Health Centre for Children, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kishore Mulpuri
- BC Children's Hospital, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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607
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Tann CJ, Kohli-Lynch M, Nalugya R, Sadoo S, Martin K, Lassman R, Nanyunja C, Musoke M, Sewagaba M, Nampijja M, Seeley J, Webb EL. Surviving and Thriving: Early Intervention for Neonatal Survivors With Developmental Disability in Uganda. INFANTS AND YOUNG CHILDREN 2021; 34:17-32. [PMID: 33790497 PMCID: PMC7983078 DOI: 10.1097/iyc.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Global attention on early child development, inclusive of those with disability, has the potential to translate into improved action for the millions of children with developmental disability living in low- and middle-income countries. Nurturing care is crucial for all children, arguably even more so for children with developmental disability. A high proportion of survivors of neonatal conditions such as prematurity and neonatal encephalopathy are affected by early child developmental disability. The first thousand days of life is a critical period for neuroplasticity and an important window of opportunity for interventions, which maximize developmental potential and other outcomes. Since 2010, our group has been examining predictors, outcomes, and experiences of neonatal encephalopathy in Uganda. The need for an early child intervention program to maximize participation and improve the quality of life for children and families became apparent. In response, the "ABAaNA early intervention program," (now re-branding as 'Baby Ubuntu') a group participatory early intervention program for young children with developmental disability and their families, was developed and piloted. Piloting has provided early evidence of feasibility, acceptability, and impact and a feasibility trial is underway. Future research aims to develop programmatic capacity across diverse settings and evaluate its impact at scale.
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Affiliation(s)
- Cally J. Tann
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Maya Kohli-Lynch
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Ruth Nalugya
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Samantha Sadoo
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Karen Martin
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Rachel Lassman
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Carol Nanyunja
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Margaret Musoke
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Margaret Sewagaba
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Margaret Nampijja
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Janet Seeley
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Emily L. Webb
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
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608
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Spatial, But Not Temporal, Kinematics of Spontaneous Upper Extremity Movements Are Related to Gross and Fine Motor Skill Attainment in Infancy. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2021. [DOI: 10.1123/jmld.2020-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Spontaneous upper extremity movements in infancy provide insight on neuromotor development. Spatiotemporal kinematics have been used to evaluate typical development of reaching, a foundational motor skill in infancy. This study evaluates the relationship between spontaneous upper extremity movements, not elicited by a toy, and motor skill attainment. Methods: N = 12 healthy infants (2–8 months) participated in this longitudinal study (one to four sessions). Motor skills were assessed with the Bayley Scales of Infant and Toddler Development, 3rd Edition: gross motor subtest (GM) and fine motor subtest. Spontaneous upper extremity movements were collected using 3D motion capture technology. Infants were placed in supine for three to twelve 30-s trials, and their movements were recorded. Repeated measure correlation coefficients (Rmcorr) were used to evaluate relationships between variables. Results: There were significant, moderate, positive relationships between the straight distance from start to end of a movement and (a) fine motor score (Rmcorr = .55, p = .03), (b) GM score (Rmcorr = .63, p = .01), and (c) age (Rmcorr = .56, p = .02). There was a significant, moderate, negative relationship between straightness ratio and GM score (Rmcorr = −.52, p = .047). Discussion: Fine and GM skills are related to the straight distance from start to end of a movement and the straightness ratio of underlying spontaneous upper extremity movements.
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609
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Ferrari F, Bedetti L, Bertoncelli N, Roversi MF, Della Casa E, Guidotti I, Ori L, D'Amico R, Valeri L, Lugli L, Lucaccioni L, Berardi A. Foot-to-Foot Contact Among Initial Goal-Directed Movements Supports the Prognostic Value of Fidgety Movements in HIE-Cooled Infants. Front Pediatr 2021; 9:731021. [PMID: 35071123 PMCID: PMC8767005 DOI: 10.3389/fped.2021.731021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Few studies conducted to date have observed general movements in infants affected by hypoxic-ischemic encephalopathy (HIE) who underwent therapeutic hypothermia. We investigated whether foot-to-foot contact (FF) could support the predictive value of fidgety movements (FMs) in infants affected by HIE and treated with brain cooling. Methods: Spontaneous motility was video recorded for 3-5 min at 12 weeks post-term age in 58 full-term newborn infants affected by perinatal asphyxia who were cooled due to moderate to severe HIE. FF and FMs were blindly scored by three independent observers. At 24 months, each patient underwent a neurological examination by Amiel-Tison and Grenier. Results: At 24 months, 47 infants had developed typically at neurological examination, eight had developed mild motor impairment, and three developed cerebral palsy (CP). At 12 weeks, 34 (58.6%) infants had shown normal FMs, four of whom developed mild motor impairment. Twenty-four infants (41.4%) exhibited abnormal or no FMs, four of whom developed mild motor impairment and three developed CP. FF was present in 20 infants (34.5%), two of whom developed mild motor impairment. FF was absent in 38 infants (65.5%), six of whom developed mild motor impairment and three developed CP. Both FMs and FF, considered separately, were 100% sensitive for predicting CP at 24 months, but only 61 and 36%, respectively, were specific. Summing the two patterns together, the specificity increases to 73%, considering only CP as an abnormal outcome, and increases to 74% when considering CP plus mild motor impairment. Unexpectedly, fidgety movements were absent in 24 infants with typical motor outcomes, 17 of whom showed a typical motor outcome. Conclusions: FF is already part of motor repertoire at 12 weeks and allows a comparison of spontaneous non-voluntary movements (FMs) to pre-voluntary movements (FF). FF supports FMs for both sensitivity and specificity. A second video recording at 16-18 weeks, when pedipulation is present in healthy infants, is suggested: it may better define the presence or absence of goal-directed motility.
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Affiliation(s)
- Fabrizio Ferrari
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Luca Bedetti
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Maria Federica Roversi
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Elisa Della Casa
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Isotta Guidotti
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Luca Ori
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Roberto D'Amico
- Unit of Statistics, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Lara Valeri
- Pediatric Post-graduate School, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Laura Lucaccioni
- Pediatrics, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
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610
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Peyton C, Sukal Moulton T, Carroll AJ, Anderson E, Brozek A, Davis MM, Horowitz J, Jayaraman A, O'Brien M, Patrick C, Pouppirt N, Villamar J, Xu S, Lieber RL, Wakschlag LS, Krogh-Jespersen S. Starting at Birth: An Integrative, State-of-the-Science Framework for Optimizing Infant Neuromotor Health. Front Pediatr 2021; 9:787196. [PMID: 35141178 PMCID: PMC8820372 DOI: 10.3389/fped.2021.787196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Numerous conditions and circumstances place infants at risk for poor neuromotor health, yet many are unable to receive treatment until a definitive diagnosis is made, sometimes several years later. In this integrative perspective, we describe an extensive team science effort to develop a transdiagnostic approach to neuromotor health interventions designed to leverage the heightened neuroplasticity of the first year of life. We undertook the following processes: (1) conducted a review of the literature to extract common principles and strategies underlying effective neuromotor health interventions; (2) hosted a series of expert scientific exchange panels to discuss common principles, as well as practical considerations and/or lessons learned from application in the field; and (3) gathered feedback and input from diverse stakeholders including infant caregivers and healthcare providers. The resultant framework was a pragmatic, evidence-based, transdiagnostic approach to optimize neuromotor health for high-risk infants based on four principles: (a) active learning, (b) environmental enrichment, (c) caregiver engagement, and (d) strength-based approaches. In this perspective paper, we delineate these principles and their potential applications. Innovations include: engagement of multiple caregivers as critical drivers of the intervention; promoting neuromotor health in the vulnerability phase, rather than waiting to treat neuromotor disease; integrating best practices from adjacent fields; and employing a strengths-based approach. This framework holds promise for implementation as it is scalable, pragmatic, and holistically addresses both the needs of the infant and their family.
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Affiliation(s)
- Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Theresa Sukal Moulton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Allison J Carroll
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Erica Anderson
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
| | - Alexandra Brozek
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Matthew M Davis
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Ann and Robert H. Lurie Children's Hospital, Stanley Manne Children's Research Institute, Chicago, IL, United States
| | - Jessica Horowitz
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | | | - Cheryl Patrick
- Division of Rehabilitative Services, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Nicole Pouppirt
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Juan Villamar
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheila Krogh-Jespersen
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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611
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Ribeiro MTC, Pfeifer LI. Intervention bimanual stimulates the abilities in infants with asymmetry. FISIOTERAPIA EM MOVIMENTO 2021. [DOI: 10.1590/fm.2021.34301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: The cerebral palsy and brachial plexus injury may cause asymmetry in the use of the upper limbs (UL). This condition requires early treatment to reduce the impact of the child's life; therefore, several proposed interventions aim to increase their functional independence. The Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Therapy (HABIT) have been widely considered effective interventions to improve hand function. Objective: Investigate the effects of an intervention protocol based on the CIMT and HABIT theoretical foundations in the stimulation of manual function in infants with the UL asymmetry. Methods: Five infants (6-24 months) participated in the study. To evaluate the motor function of infants we used Pediatric Motor Activity Log (PMAL-R) and Manual Function Evaluation (AMIGO), and to assess the caregiver's perception of the participation of the infant in daily tasks, we used the Pediatric Disability Assessment Inventory (PEDI). All evaluations occurred before, immediately after the intervention, and after four months for follow-up recording, and were analyzed descriptively by Jacobson- Truax method. Results: The results between evaluation and reevaluation demonstrated evolution in all aspects studied. In the PEDI self-care session, an average of 38.6 (±8.4) - 44.2 (±7.4); PEDI Mobility: 28.8 (±20.3) - 36.28 (±21.7); PEDI Social Function: 40.1 (±10.2) - 42.3 (±8.9). The PMAL-R quantity and quality results evidence a highly positive clinical significance in all infants. Conclusion: The application of the modified restriction intervention protocol resulted in reliable and clinically significant changes in all cases.
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612
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Yardımcı-Lokmanoğlu BN, Mutlu A, Livanelioğlu A. General Movements and Developmental Functioning in an Individual with Rhizomelic Chondrodysplasia Punctata within the First Months of the Life: A Case Report. Phys Occup Ther Pediatr 2021; 41:326-335. [PMID: 33161810 DOI: 10.1080/01942638.2020.1841870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Rhizomelic chondrodysplasia punctata (RCDP) is an autosomal recessive inherited disorder. Individuals with RCDP have a wide range of neurodevelopmental outcomes, but there are limited descriptions of their early motor development before 5 months of age. This study aimed to describe in detail the age-specific spontaneous movements and examine the developmental functioning in an individual with RCDP. METHODS A female infant (born at 39 weeks' gestation), diagnosed with RCDP at 3 weeks of age, was assessed at 4 and 16 weeks for general movements (GMs) and concurrent motor repertoire; the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was also applied at the same ages. RESULTS At 4 weeks, the infant showed poor repertoire GMs, with a detailed General Movement Optimality Score of 16/42. At 16 weeks, age-specific fidgety movements were absent, and the movement character was monotonous and stiff; the detailed Motor Optimality Score was severely reduced (7/28). All Bayley-III scores were <2 SD, that is <70 indicating severe developmental delay. CONCLUSION Functional assessments such as the GM assessment and age-specific detailed assessment could be complementary to neuroimaging assessments to predict the neurodevelopmental outcomes in infants with RCDP.
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Affiliation(s)
- Bilge Nur Yardımcı-Lokmanoğlu
- Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Hacettepe University, Ankara, Turkey
| | - Akmer Mutlu
- Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Hacettepe University, Ankara, Turkey
| | - Ayşe Livanelioğlu
- Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Hacettepe University, Ankara, Turkey
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613
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Einspieler C, Zhang D, Marschik PB. Die Bedeutung fötaler und neonataler Motorik für die kindliche Entwicklung und die Früherkennung von Entwicklungsstörungen. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die von Central Pattern Generators (CPGs) generierten Bewegungen des Neugeborenen und jungen Säuglings haben eine lange pränatale Vorgeschichte. Fragestellung: Welche Bedeutung hat die Analyse der CPG-Aktivität, besonders der General Movements (GMs) in der entwicklungsneurologischen Diagnostik? Methode: Unsere Übersichtsarbeit bezieht sich auf Prechtl’s General Movement Assessment (GMA), das ab dem Frühgeborenenalter bis zum Ende des 5. Monats nach einer Termingeburt anwendbar ist. Ergebnisse: Das GMA ermöglicht die Vorhersage einer Zerebralparese mit einer Sensitivität von 98 % und einer Spezifität von 91 %. Abnormale cramped-synchronized GMs sind ein früher Marker für spastische Zerebralparesen. Das Fehlen von Fidgety Movements (im 3.–5. Monat) weist auf alle Formen der Zerebralparese hin und kann auch bei bestimmten genetischen Erkrankungen auftreten. Zwei von drei Säuglingen mit einer späteren Diagnose Autismus haben atypische GMs und fallen vor allem durch ihre Monotonie in den Bewegungen auf. Diskussion und Schlussfolgerung: Mittels GMA lassen sich mit großer Treffsicherheit typische Entwicklungsverläufe vorhersagen oder aber ein Risiko für einen atypischen Verlauf erkennen und somit frühzeitige Interventionen einleiten.
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Affiliation(s)
- Christa Einspieler
- iDN – interdisciplinary Developmental Neuroscience, Klinische Abteilung für Phoniatrie, Medizinische Universität Graz
| | - Dajie Zhang
- iDN – interdisciplinary Developmental Neuroscience, Klinische Abteilung für Phoniatrie, Medizinische Universität Graz
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen
- Leibniz-WissenschaftsCampus Primatenkognition, Göttingen
| | - Peter B. Marschik
- iDN – interdisciplinary Developmental Neuroscience, Klinische Abteilung für Phoniatrie, Medizinische Universität Graz
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen
- Leibniz-WissenschaftsCampus Primatenkognition, Göttingen
- Center of Neurodevelopmental Disorders (KIND), Department of Women’s and Children’s Health, Karolinska Institutet Stockholm
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614
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Montgomery C, F. Kaul Y, Strand Brodd K, Persson K, Hellström‐Westas L. Structured Observation of Motor Performance in Infants: Level and quality associated with later motor development. Acta Paediatr 2021; 110:307-313. [PMID: 32474945 DOI: 10.1111/apa.15377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 01/22/2023]
Abstract
AIM The aim of this study was to investigate the level of motor development and the quality of motor performance during the first 10 months in relation to the Bayley Scales of Infant Development-third edition (Bayley-III) motor index at 2.5 years. METHODS Children born very preterm from a population-based study (n = 113) were assessed with the Structured Observation of Motor Performance in Infants (SOMP-I) at 2, 4, 6 and 10 months corrected age and the Bayley-III motor index at 2.5 years corrected age (n = 98). Logistic regressions were performed to investigate the independent association of each SOMP-I domain to Bayley-III motor index. RESULTS There were significant associations between the SOMP-I-scores and Bayley-III motor index per every assessment age. At 4 months, both level and quality were independently associated with a later motor outcome, OR for level was 1.26 (95% CI = 1.08-1.50, P = .002) and for quality, 0.75 (95% CI = 0.63-0.90, P = .002). Quality was independently associated with the Bayley-III motor index at 6 and 10 months: OR 0.080 (95% CI = 0.67-0.95 P = .010) and 0.79 (95% CI = 0.64-0.97, P = .026). CONCLUSION Both SOMP-I domains, level and quality, are markers to identify motor problems early. Quality became more important with age.
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Affiliation(s)
- Cecilia Montgomery
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - Ylva F. Kaul
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - Katarina Strand Brodd
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
- Centre for Clinical Research Sörmland Uppsala University Uppsala Sweden
| | - Kristina Persson
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
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615
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A dynamic era in cerebral palsy research. Eur J Paediatr Neurol 2021; 30:100. [PMID: 33556745 DOI: 10.1016/j.ejpn.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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616
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General Movement Assessment Predicts Neuro-Developmental Outcome in Very Low Birth Weight Infants at Two Years - A Five-Year Observational Study. Indian J Pediatr 2021; 88:28-33. [PMID: 32488806 DOI: 10.1007/s12098-020-03365-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the value of general movements (GMs) in predicting the neurodevelopmental outcome using Bayley Scale of Infant Development III (BSID-III) at two years of age in very low birth weight (VLBW) infants. METHODS This is a five-year observational study (January 2012-June 2017). Two hundred twenty-seven VLBW infants were assessed in the neurodevelopmental clinic between Jan 2012 and June 2017. Of these 137 infants had GMs assessments at 3 mo post term (first visit to the clinic). RESULTS Absence of fidgety movements (FMs) at 3 mo post term had high specificity and negative predictive value for moderate to severe neurodevelopmental outcome in motor, cognition and language domains (composite score less than 70 in the Bayley III scales of Infant development scores). At 3 mo post term, absent FMs had high sensitivity, specificity and negative predictive value (NPV) for cerebral palsy (CP). CONCLUSIONS GMs assessment at 3 mo post term could be considered as an important screening tool for early identification of VLBW infants who are at risk of neurodevelopmental impairment/cerebral palsy.
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617
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Mandich M, Scott K. Commentary on "Early Spontaneous Movements in Infants With Hypoxic-Ischemic Encephalopathy". Pediatr Phys Ther 2021; 33:23. [PMID: 33337770 DOI: 10.1097/pep.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- MaryBeth Mandich
- Division of Physical Therapy West Virginia University Morgantown, West Virginia
| | - Kimberley Scott
- School of Health and Rehabilitation Sciences The Ohio State University Columbus, Ohio
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618
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Abstract
OBJECTIVE The aim of this study was to determine motor repertoire at 3 to 5 months of age in infants with hypoxic-ischemic encephalopathy (HIE) and to examine changes according to HIE severity. METHODS Participants were 38 infants aged 3 to 5 months with HIE and 38 infants in the comparison group. The general movement assessment and the Motor Optimality Score (MOS) were used. RESULTS Infants in the HIE group had a significantly lower total MOS and scores for fidgety movements, age adequacy of motor repertoire, and quality of movement patterns compared with the comparison group. Infants with grade III HIE compared with grade I had a significantly lower MOS. CONCLUSIONS Infants with HIE had poorer motor repertoire at age 3 to 5 months when compared with peers. Motor repertoire deteriorated as HIE severity increased. Detecting potential developmental delays as early as possible allows for early intervention and rehabilitation in this population.
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619
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Kwong AKL, Eeles AL, Spittle AJ. Early neurodevelopmental screening: Parent perspectives from the neonatal intensive care unit. Acta Paediatr 2021; 110:359-360. [PMID: 33006152 DOI: 10.1111/apa.15563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amanda K. L. Kwong
- Murdoch Children’s Research Institute Parkville Vic Australia
- Department of Physiotherapy The University of Melbourne Melbourne Vic Australia
- The Royal Women’s Hospital Parkville Vic Australia
| | - Abbey L. Eeles
- Murdoch Children’s Research Institute Parkville Vic Australia
- Department of Physiotherapy The University of Melbourne Melbourne Vic Australia
- The Royal Women’s Hospital Parkville Vic Australia
- Department of Paediatrics Monash University Clayton Vic Australia
| | - Alicia J. Spittle
- Murdoch Children’s Research Institute Parkville Vic Australia
- Department of Physiotherapy The University of Melbourne Melbourne Vic Australia
- The Royal Women’s Hospital Parkville Vic Australia
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620
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Wu Y, Rijssen IM, Buurman MT, Dijkstra L, Hamer EG, Hadders‐Algra M. Temporal and spatial localisation of general movement complexity and variation-Why Gestalt assessment requires experience. Acta Paediatr 2021; 110:290-300. [PMID: 32274828 PMCID: PMC7818473 DOI: 10.1111/apa.15300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
Aim General movements’ assessment (GMA), based on Gestalt perception, identifies infants at risk of cerebral palsy. However, the requirement of ample experience to construct the assessor's inner criteria for abnormal movement hampers its widespread clinical use. This study aims to describe details of general movements (GMs) in various body parts and to investigate their association with GMA‐Gestalt. Methods Participants were 24 typically developing infants and 22 very‐high‐risk infants. GMs were assessed during the writhing (0‐8 weeks) and/or fidgety GM phase (2‐5 months) by GMA‐Gestalt and a semi‐quantification of the duration of simple movements and complex movements in various body parts. Results During both GM phases, the quality of movement often varied within a single assessment, but the degree of complexity and variation of movements in trunk, arms and legs were interrelated (ρ = 0.32‐0.84). Longer durations of complex movements in arms and legs (P < .042) were further associated with a better quality in GMA‐Gestalt. Head movement was associated with movements in other body parts only in the writhing phase and not associated with GMA‐Gestalt during both GM phases. Conclusion Infants did not show consistently over time and across body parts simple or complex movements. Detailed description of movement characteristics may facilitate the development of computer‐based GMA.
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Affiliation(s)
- Ying‐Chin Wu
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology Groningen The Netherlands
| | - Ilse M. Rijssen
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology Groningen The Netherlands
| | - Maria T. Buurman
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology Groningen The Netherlands
| | - Linze‐Jaap Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology Groningen The Netherlands
| | - Elisa G. Hamer
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology Groningen The Netherlands
- Department of Neurology Radboud University Medical Center Nijmegen The Netherlands
| | - Mijna Hadders‐Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology Groningen The Netherlands
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621
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Pavone P, Gulizia C, Le Pira A, Greco F, Parisi P, Di Cara G, Falsaperla R, Lubrano R, Minardi C, Spalice A, Ruggieri M. Cerebral Palsy and Epilepsy in Children: Clinical Perspectives on a Common Comorbidity. CHILDREN-BASEL 2020; 8:children8010016. [PMID: 33396243 PMCID: PMC7823826 DOI: 10.3390/children8010016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022]
Abstract
Cerebral palsy (CP) is a frequent cause of childhood disability often associated with a complex group of disorders, including epilepsy, which is reported to impact approximately 40% of affected individuals. This retrospective study involved a group of children affected by CP, some of whom also had comorbid epilepsy. The aim of this study was to report our experience of analyzing, in particular, (a) some of the clinical aspects of the different type of CP, and (b) the relationship between the clinical data of children affected by CP plus epilepsy and each type of CP. Methods: This retrospective single-center study was performed with 93 children admitted to the Pediatric Department of the University of Catania, Italy, affected by CP and distinguished according to the type of motor clinical presentation, with 46 showing epileptic seizures, compared to a control group of 136 children affected by epilepsy without other neurologic disorders. Results: Among the 93 CP children, 25 (27%) had spastic quadriplegia (plus one patient with dystonic quadriplegia), 39 (42%) had spastic hemiplegia, 11 (12%) had spastic diplegia (plus two with ataxia and one with dyskinetic CP), and 14 (15%) did not have a well-defined type of CP. The frequency of epilepsy was higher in affected CP children who showed major motor dysfunction (GMFCS IV–V types). As regards the 46 children with CP plus epilepsy, compared to the group of the control, the age of epilepsy onset was found to be statistically significant: 21 ± 35.1 months vs. 67 ± 39.7. Conclusions: Epilepsy represents one of the most frequent comorbidities of cerebral palsy. In children with CP, particular attention should be paid to the early identification and treatment of comorbid epilepsy.
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Affiliation(s)
- Piero Pavone
- Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, AOU "Policlinico", PO "G. Rodolico", University of Catania, 95123 Catania, Italy; (P.P.); (A.L.P.); (F.G.)
| | - Carmela Gulizia
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy;
| | - Alice Le Pira
- Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, AOU "Policlinico", PO "G. Rodolico", University of Catania, 95123 Catania, Italy; (P.P.); (A.L.P.); (F.G.)
| | - Filippo Greco
- Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, AOU "Policlinico", PO "G. Rodolico", University of Catania, 95123 Catania, Italy; (P.P.); (A.L.P.); (F.G.)
| | - Pasquale Parisi
- NESMOS Department of Pediatrics, Sapienza University of Rome, Sant’Andrea University Hospital, 00161 Rome, Italy;
| | - Giuseppe Di Cara
- Department of Pediatrics, University of Perugia, 06132 Perugia, Italy;
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit (NICU), Neonatal COVID-19 Center, AOU “Policlinico”, PO San Marco, University of Catania, 95123 Catania, Italy;
| | - Riccardo Lubrano
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria, Neonatologia, Ospedale Santa Maria Goretti, Polo di Latina, 04010 Latina, Italy;
| | - Carmelo Minardi
- Department of Anaesthesia and Intensive Care, University Hospital “G. Rodolico” of Catania, 95123 Catania, Italy;
| | - Alberto Spalice
- Child Neurology Division, Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy;
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, 95123 Catania, Italy
- Correspondence:
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622
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Mazzarella J, McNally M, Richie D, Chaudhari AMW, Buford JA, Pan X, Heathcock JC. 3D Motion Capture May Detect Spatiotemporal Changes in Pre-Reaching Upper Extremity Movements with and without a Real-Time Constraint Condition in Infants with Perinatal Stroke and Cerebral Palsy: A Longitudinal Case Series. SENSORS 2020; 20:s20247312. [PMID: 33352727 PMCID: PMC7766939 DOI: 10.3390/s20247312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/29/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
Perinatal stroke (PS), occurring between 20 weeks of gestation and 28 days of life, is a leading cause of hemiplegic cerebral palsy (HCP). Hallmarks of HCP are motor and sensory impairments on one side of the body—especially the arm and hand contralateral to the stroke (involved side). HCP is diagnosed months or years after the original brain injury. One effective early intervention for this population is constraint-induced movement therapy (CIMT), where the uninvolved arm is constrained by a mitt or cast, and therapeutic activities are performed with the involved arm. In this preliminary investigation, we used 3D motion capture to measure the spatiotemporal characteristics of pre-reaching upper extremity movements and any changes that occurred when constraint was applied in a real-time laboratory simulation. Participants were N = 14 full-term infants: N = six infants with typical development; and N = eight infants with PS (N = three infants with PS were later diagnosed with cerebral palsy (CP)) followed longitudinally from 2 to 6 months of age. We aimed to evaluate the feasibility of using 3D motion capture to identify the differences in the spatiotemporal characteristics of the pre-reaching upper extremity movements between the diagnosis group, involved versus uninvolved side, and with versus and without constraint applied in real time. This would be an excellent application of wearable sensors, allowing some of these measurements to be taken in a clinical or home setting.
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Affiliation(s)
- Julia Mazzarella
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
| | - Mike McNally
- Tampa Bay Rays, 1 Tropicana Dr., St. Petersburg, FL 33705, USA;
| | - Daniel Richie
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
| | - Ajit M. W. Chaudhari
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
- Department of Mechanical and Aerospace Engineering, College of Engineering, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA
| | - John A. Buford
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
| | - Xueliang Pan
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1800 Cannon Drive, Columbus, OH 43210, USA;
| | - Jill C. Heathcock
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
- Correspondence:
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623
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Beani E, Menici V, Cecchi A, Cioni ML, Giampietri M, Rizzi R, Sgandurra G, Cioni G. Feasibility Analysis of CareToy-Revised Early Intervention in Infants at High Risk for Cerebral Palsy. Front Neurol 2020; 11:601137. [PMID: 33391164 PMCID: PMC7772394 DOI: 10.3389/fneur.2020.601137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022] Open
Abstract
Infants with perinatal brain injury are at high risk for Cerebral Palsy (CP). Progresses in detection of early signs of brain injury and of CP allow early intervention (EI) programs for improving the outcome of these infants. CareToy system (CT), developed within a European project (Trial Registration: NCT01990183), allows providing, by means of tele-rehabilitation, a highly personalized, family-centered, home-based EI for young infants, remotely managed by clinicians. CareToy, already used with pre-terms without brain injury, has been adapted for high-risk infants in a project funded by the Italian Ministry of Health, and the CareToy-Revised (CareToy-R) has been realized (Trial registration: NCT03211533 and NCT03234959). Before assessing its efficacy, it was crucial to evaluate the acceptability, usability, and feasibility of CareToy-R EI. Nineteen high-risk infants with perinatal brain injury, aged 5.95 ± 2.13 months (range 3.12–10.78 months), carried out an 8-week training with CareToy-R at home, performing customized playful activities with their parents, tailored to their rehabilitative needs, remotely managed by clinicians. The feasibility of training and study procedures was assessed through criteria derived from literature; acceptability and usability have been analyzed from data about individual training and an ad hoc questionnaire. All CareToy-R trainings were planned by the clinical staff with a daily personalized use for each infant between 30 and 45 min (mean 34.37 min). The amount of executed training by the infants was very high (daily mean 30.30 min), with no differences related to infant age, sex, and gestational age. All the nine feasibility criteria were achieved, family compliance to the project was very good, data collection was completed and the CareToy-R system worked properly and easily for parents. The answers to the questionnaire had a total mean score of 84.49% and they ranged from a minimum of 81.05% (in “easy to use” area) to a maximum of 86.49% (“changes due to the training” area), with no differences related to nationality or familiarity with technology of the mothers. This study reports preliminary evidence to the feasibility of a home-based EI with CareToy-R system in infants at high risk for CP. Results of the RCT will provide data about the potential effectiveness of this approach.
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Affiliation(s)
- Elena Beani
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Valentina Menici
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Alessandra Cecchi
- Division of Neonatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Maria Luce Cioni
- Neonatal Intensive Care Unit, Children's Hospital A. Meyer, Florence, Italy
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Pisa, Italy
| | - Riccardo Rizzi
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Tuscan Ph.D. Programme of Neuroscience, University of Florence, Florence, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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624
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Saini L, Madaan P, Bhagwat C, Einspieler C. Home-Videos for Neurodevelopmental Follow-Up of High-Risk Infants during COVID-19 Pandemic: A Simple and Inexpensive Tool. J Trop Pediatr 2020; 67:6038980. [PMID: 33324988 PMCID: PMC7798623 DOI: 10.1093/tropej/fmaa088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lokesh Saini
- Correspondence: Lokesh Saini, Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Tel: +91-996-8859725, Fax: +91-172-2744401. E-mail: <>
| | - Priyanka Madaan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Chandana Bhagwat
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Christa Einspieler
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz 8036, Österreich
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625
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The quality of general movements in infants with complex congenital heart disease undergoing surgery in the neonatal period. Early Hum Dev 2020; 151:105167. [PMID: 32916592 DOI: 10.1016/j.earlhumdev.2020.105167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Advances in diagnostic technologies, surgical management, and perioperative care have increased survival for neonates with complex congenital heart disease (CCHD). The success of these advances exposed a heightened risk of brain injury and developmental disabilities. The General Movements Assessment, a non-invasive method, may detect early neurodevelopmental impairments in high-risk infants. AIMS To examine whether infants with CCHD undergoing neonatal surgery have higher prevalence of atypical general movements (GMs) than a reference group, and whether single ventricle physiology with systemic oxygen saturations <90% increases risk for atypical GMs. METHODS Serial General Movements Assessment (GMA) in a cohort of infants with CCHD (n = 74) at writhing (term-6 weeks) and fidgety (7-17 weeks) GM-age. GMA focused on the presence of definitely abnormal GM-complexity and absent fidgety movements. Single GMAs at 3 months were available from a reference sample of Dutch infants (n = 300). Regression analyses examined relationships between cardiac characteristics and definitely abnormal GM-complexity. RESULTS Higher prevalence of definitely abnormal GM-complexity in infants with CCHD compared to reference infants (adjusted OR 5.938, 95% CI 2.423-14.355), single ventricle CCHD increased the risk. Occurrence of absent fidgety movements was similar in infants with CCHD and reference infants (adjusted OR 0.475, 95% CI 0.058-3.876). Systemic postoperative oxygen saturations <90% was associated with higher risk of definitely abnormal GM-complexity at fidgety (adjusted OR 16.445 95% CI 1.149-235.281), not at writhing age. CONCLUSIONS Infants with CCHD, especially those with single ventricle CCHD, are at increased risk of definitely abnormal GM-complexity. GMA at fidgety age is recommended.
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626
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Wu Y, Bouwstra H, Heineman KR, Hadders‐Algra M. Atypical general movements in the general population: Prevalence over the last 15 years and associated factors. Acta Paediatr 2020; 109:2762-2769. [PMID: 32335944 PMCID: PMC7754433 DOI: 10.1111/apa.15329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/16/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
AIM To determine the prevalence of atypical general movements (GMs) in the general population, to examine its time trend and associated factors. METHODS Participants consisted of 300 infants born in 2016-2018 (current cohort; gestational age 39.4 weeks (27-42); 162 boys), representative of the Dutch population. GMs were assessed at 2-4 months corrected age in terms of GM-complexity (definitely abnormal (DA) or not) and fidgety movements (present or absent). GM-complexity data from a cohort of 455 Dutch infants born in 2001-2002 were used to investigate the time trend. RESULTS In the current cohort, 10 infants (3%) showed DA GM-complexity and 8 (3%) absent fidgety movements. Only one infant had both GM-impairments (0.3%). The prevalence of DA GM-complexity did not differ from that in the 2001-2002 cohort (adjusted odds ratio (OR) = 1.47 [0.53, 4.06]). DA GM-complexity was associated with maternal smoking (adjusted OR = 3.59 [1.56, 8.28]) and marginally with prematurity (adjusted OR = 2.78 [1.00, 7.74]); absence of fidgety movements was curvilinearly associated with assessment age only (OR = 1.06 [1.01, 1.12]). CONCLUSION In the general population, the prevalence of DA GM-complexity and absent fidgety movements is 3%. The finding that they rarely co-occur and are associated with different factors indicates that GM-assessment needs to address both aspects.
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Affiliation(s)
- Ying‐Chin Wu
- University of Groningen, University Medical Center GroningenDepartment of PaediatricsDivision of Developmental NeurologyGroningenThe Netherlands
| | - Hylco Bouwstra
- University of Groningen, University Medical Center GroningenDepartment of PaediatricsDivision of Developmental NeurologyGroningenThe Netherlands
- Department of General Practice and Elderly Care MedicineAmsterdam UMCAmsterdamThe Netherlands
| | - Kirsten R. Heineman
- University of Groningen, University Medical Center GroningenDepartment of PaediatricsDivision of Developmental NeurologyGroningenThe Netherlands
- SEIN Stichting Epilepsie Instellingen NederlandZwolleThe Netherlands
| | - Mijna Hadders‐Algra
- University of Groningen, University Medical Center GroningenDepartment of PaediatricsDivision of Developmental NeurologyGroningenThe Netherlands
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627
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Garcia-Alix A, Arnaez J. Neonatal neurology, a crucial discipline to enhance neurologic care of the newborn. Acta Paediatr 2020; 109:2451-2453. [PMID: 32181925 DOI: 10.1111/apa.15258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 01/24/2020] [Accepted: 03/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Alfredo Garcia-Alix
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Dèu, Barcelona, Spain.,Universidad de Barcelona, Barcelona, Spain.,Fundación NeNe, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - Juan Arnaez
- Fundación NeNe, Madrid, Spain.,Unidad de Neonatología, Hospital Universitario Burgos, Burgos, Spain
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628
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Fjørtoft T, Brandal M, Brubakk AM, Adde L, Ustad T, Vågen R, Evensen KAI. Maternal alcohol and drug use during pregnancy affects the motor behaviour and general movements of infants aged 3-4 months. Early Hum Dev 2020; 151:105171. [PMID: 32977207 DOI: 10.1016/j.earlhumdev.2020.105171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Exposure of alcohol and/or other addictive drugs in pregnancy is a documented risk factor for later neurological impairment. AIMS The aim of the study was to determine whether infants suffering from prenatal exposure to addictive drugs and alcohol develop an abnormal motor behaviour at three to four months of age. STUDY DESIGN Controlled cohort study of infants exposed to alcohol and/or other addictive drugs in pregnancy who were recruited from a hospital follow-up programme. The control group consisted of healthy, unexposed infants. SUBJECTS The study group of 108 infants exposed to alcohol and/or addictive drugs in pregnancy were enrolled based on referrals from primary health care. The control group included 106 infants who had not been exposed to the aforementioned substances. OUTCOME MEASURES We assessed the general movements (Prechtl's General-Movement-Assessment, GMA), the motor repertoire (Assessment-of-Motor-Repertoire, AMR), and the Alberta-Infant Motor-Scale (AIMS) in all infants at three to four months of age. RESULTS None of the infants in either group had absent fidgety movements (FMs). In the study group 5(5%) had exaggerated FMs and 5(5%) had sporadic FMs; and 68(63%) infants in the study group displayed an abnormal movement character, compared to 23(22%) in the control group (p<0.001). On the AIMS, 46(44%) infants in the study group scored below the 10th percentile, compared to 2(3%) controls (p< 0.001). CONCLUSION The study describes an abnormal movement character of infants exposed to alcohol and/or addictive drugs in pregnancy when their motor repertoire was assessed at three to four months of age. The AIMS also showed negative effects on their motor behaviour.
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Affiliation(s)
- T Fjørtoft
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - M Brandal
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A M Brubakk
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St. Olav's Hospital, Trondheim University Hospital, Norway
| | - L Adde
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - T Ustad
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - R Vågen
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - K A I Evensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway; Unit for Physiotherapy Services, Trondheim Municipality, Norway; Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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629
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Sokołów M, Adde L, Klimont L, Pilarska E, Einspieler C. Early intervention and its short-term effect on the temporal organization of fidgety movements. Early Hum Dev 2020; 151:105197. [PMID: 32979679 DOI: 10.1016/j.earlhumdev.2020.105197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Prechtl General Movement Assessment (GMA) predicts various neurological and developmental disorders while also documenting therapeutic effects. AIMS To describe the temporal organization of fidgety general movements in infants with mild to moderate postural asymmetries and/or tonus regulation problems, and to analyze to what extent the temporal organization of fidgety movements will change after physiotherapy. STUDY DESIGN Repeated measure design. PARTICIPANTS Twelve infants (five females) with mild to moderate postural asymmetries and/or tonus regulation problems were admitted for an early intervention program. The gestational age ranged from 27 to 40 weeks (Median, 36 weeks; nine infants born preterm) with birth weights ranging from 740 g to 3500 g (Median, 2590 g). MEASURES Fidgety movements and their temporal organization were measured using the Prechtl GMA at 9 to 19 weeks post term age (Median, 14 weeks) before and after an early motor training procedure. The movements of one of the infants were analysed using a computer-based approach, measuring the mean and standard deviation of quantity of motion, height of motion and width of motion. RESULTS Seven infants had sporadic fidgety movements, and five had intermittent fidgety movements. None had continual fidgety movements before the intervention was initiated. After intervention, the temporal organization of fidgety movements increased in all infants. The observations of these movements were supported by computer-based analysis. CONCLUSION The study indicates that early intervention increases the temporal organization of fidgety movements in infants with postural asymmetries and/or tonus regulation problems. The clinical significance of this finding needs to be further evaluated.
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Affiliation(s)
- Michal Sokołów
- Medical University of Gdańsk, Department of Physical Therapy, Dębinki 7, 80-211 Gdansk, Poland; Centre of Early Intervention in Gdańsk, Jagiellońska 11, 80-371 Gdańsk, Poland.
| | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gt. 11, 7491 Trondheim, Norway; Clinics of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Olav Kyrres gt. 17, 7006 Trondheim, Norway.
| | - Liliana Klimont
- Akershus University Hospital, Dept of Pediatric and Adolescent Rehabilitation, Postboks 1000, 1478 Lørenskog, Norway.
| | - Ewa Pilarska
- Medical University of Gdańsk, Department of Developmental Neurology, Dębinki 7, 80-211 Gdańsk, Poland.
| | - Christa Einspieler
- iDN interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Auenbruggerplatz 26, 8036 Graz, Austria.
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630
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Jahan I, Al Imam MH, Karim T, Muhit M, Hardianto D, Das MC, Smithers-Sheedy H, Badawi N, Khandaker G. Epidemiology of cerebral palsy in Sumba Island, Indonesia. Dev Med Child Neurol 2020; 62:1414-1422. [PMID: 32686098 DOI: 10.1111/dmcn.14616] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
Abstract
AIM To define the epidemiology, clinical characteristics, and rehabilitation status of children with cerebral palsy (CP) in Sumba Island, Indonesia. METHOD A community-based key informant method survey among children (aged <18y) with CP was conducted between March and August 2017. Children with suspected CP underwent detailed neurodevelopmental assessment by a multidisciplinary medical team. Socio-demographic characteristics, aetiology, motor type, motor severity, associated impairments, educational, and rehabilitation status were documented. RESULTS There were 130 children with clinically confirmed CP. The mean age at assessment was 8 years 11 months and 43.8% (n=57) of the children were female. The mean age at CP diagnosis was 6 years 5 months. Of these children, 46.9% (n=61) had post-neonatally acquired CP, most frequently because of vaccine-preventable infectious encephalopathy (73.8%, n=45). In total, 80.8% (n=105) had a predominantly spastic motor type of CP and 83.8% (n=109) were classified in Gross Motor Functional Classification System levels III to V. A total of 77.7% (n=101) had at least one associated impairment (speech 77.5%, intellectual 29.2%, visual 13.8%, hearing 20.0%, and epilepsy 13.5%). And 66.2% (n=86) had never received rehabilitation services. INTERPRETATION Post-neonatally acquired CP was common in this setting. Addressing preventable post-neonatally acquired risk factors for CP should be a public health priority. Earlier identification and diagnosis of CP would also provide new opportunities for early intervention and targeted rehabilitation services.
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Affiliation(s)
- Israt Jahan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Tasneem Karim
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | | | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Hayley Smithers-Sheedy
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Gulam Khandaker
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
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631
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Legros L, Zaczek S, Vaivre-Douret L, Mostaert A. Concurrent and predictive validity of the Motor Functional Development Scale for Young Children in preterm infants. Early Hum Dev 2020; 151:105240. [PMID: 33160163 DOI: 10.1016/j.earlhumdev.2020.105240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Motor Functional Development Scale for Young Children (DF-mot) is a developmental tool assessing both gross and fine motor skills in term infants. AIMS To examine the concurrent validity of the DF-mot with the Alberta Infants Motor Scale (AIMS) in preterm infants and compare their ability in predicting scores on the Bayley Scales of Infant-Toddler Development (Bayley-III) at 12 months. STUDY DESIGN Retrospective cohort study. SUBJECTS AND OUTCOME MEASURES Hundred and eleven infants born at less than 32 weeks' gestation or with a birthweight less than 1500 g were assessed simultaneously on the DF-mot and the AIMS at age 3-5 months. Correlation analysis was used to determine the strength of association between the DF-mot and the AIMS. Among these, 62 were reassessed on the Bayley-III at age 9-12 months. Clinimetric properties were calculated to evaluate their ability to predict motor delay on the Bayley-III. RESULTS The concurrent validity study found a good level of correlation between the two scales (r = 0.79). The predictive validity study showed good sensitivity and negative predictive value for the AIMS 25th centile and the DF-mot -1 standard deviation to predict motor delay at 12 months (respectively Se = 100% and 84%; NPV = 100% and 77.8%). CONCLUSIONS The DF-mot is a valid instrument with good predictive validity in preterm infants, suggesting it can be used as a clinical useful tool to assess motor development.
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Affiliation(s)
- Ludovic Legros
- Departement of Neonatal Intensive Care, CHR Sambre et Meuse, 5000 Namur, Belgium.
| | - Sophie Zaczek
- Follow-up Center for preterm infants, CHR Sambre et Meuse, 5000 Namur, Belgium
| | - Laurence Vaivre-Douret
- Faculty of Health, Division of Medicine Paris Descartes, Université de Paris, 75006 Paris, France; Inserm UMR 1018-CESP, University of Paris Sud-Paris Saclay, UVSQ, 94800 Villejuif, France; Department of Child Psychiatry, Necker - Enfants-Malades University Hospital, AP-HP, 75015 Paris, France; Department of Pediatrics, Paris Center Port Royal-Cochin Hospital, AP-HP, 75014 Paris, France; Institut Universitaire de France (IUF), 75005 Paris, France
| | - Anne Mostaert
- Departement of Neonatal Intensive Care, CHR Sambre et Meuse, 5000 Namur, Belgium; Follow-up Center for preterm infants, CHR Sambre et Meuse, 5000 Namur, Belgium
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632
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Toldo M, Varishthananda S, Einspieler C, Tripathi N, Singh A, Verma SK, Vishwakarma K, Zhang D, Dwivedi A, Gupta R, Karn S, Kerketta N, Narayan R, Nikam Singh K, Rani S, Singh A, Singh D, Singh KP, Singh N, Singh N, Singh R, Singh SP, Srivastava R, Srivastava S, Srivastava S, Yadav G, Yadav P, Yadav S, Yadav S, Marschik PB. Enhancing early detection of neurological and developmental disorders and provision of intervention in low-resource settings in Uttar Pradesh, India: study protocol of the G.A.N.E.S.H. programme. BMJ Open 2020; 10:e037335. [PMID: 33148727 PMCID: PMC7640505 DOI: 10.1136/bmjopen-2020-037335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Around 9% of India's children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is regarded as the best clinical tool to predict cerebral palsy in infants <5 months. In addition, children with developmental delay, intellectual disabilities, late detected genetic disorders or autism spectrum disorder show abnormal general movements (GMs) during infancy. General Movement Assessment in Neonates for Early Identification and Intervention, Social Support and Health Awareness (G.A.N.E.S.H.) aims to (1) provide evidence as to whether community health workers can support the identification of infants at high-risk for neurological and developmental disorders and disabilities, (2) monitor further development in those infants and (3) initiate early and targeted intervention procedures. METHODS This 3-year observational cohort study will comprise at least 2000 infants born across four districts of Uttar Pradesh, India. Community health workers, certified for GMA, video record and assess the infants' GMs twice, that is, within 2 months after birth and at 3-5 months. In case of abnormal GMs and/or reduced MOSs, infants are further examined by a paediatrician and a neurologist. If necessary, early intervention strategies (treatment as usual) are introduced. After paediatric and neurodevelopmental assessments at 12-24 months, outcomes are categorised as normal or neurological/developmental disorders. Research objective (1): to relate the GMA to the outcome at 12-24 months. Research objective (2): to investigate the impact of predefined exposures. Research objective (3): to evaluate the interscorer agreement of GMA. ETHICS AND DISSEMINATION G.A.N.E.S.H. received ethics approval from the Indian Government Chief Medical Officers of Varanasi and Mirzapur and from the Ramakrishna Mission Home of Service in Varanasi. GMA is a worldwide used diagnostic tool, approved by the Ethics Committee of the Medical University of Graz, Austria (27-388 ex 14/15). Apart from peer-reviewed publications, we are planning to deploy G.A.N.E.S.H. in other vulnerable settings.
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Affiliation(s)
- Moreno Toldo
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Swami Varishthananda
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Christa Einspieler
- Division of Phoniatrics, Research Unit iDN (Interdisciplinary Developmental Neuroscience), Medical University of Graz, Graz, Austria
| | - Neeraj Tripathi
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Anshu Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Surendra K Verma
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Kanchan Vishwakarma
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Dajie Zhang
- Division of Phoniatrics, Research Unit iDN (Interdisciplinary Developmental Neuroscience), Medical University of Graz, Graz, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
| | - Agyeya Dwivedi
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Ritika Gupta
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Sanjay Karn
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Nirmal Kerketta
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Ram Narayan
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | | | - Sumitra Rani
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Akanksha Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Divyanshu Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Krishna Pratap Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Navin Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Neeraj Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Rishi Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Shyam P Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Rakesh Srivastava
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Sandeep Srivastava
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Sanjeev Srivastava
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Gopal Yadav
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Preeti Yadav
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Sheshnath Yadav
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Sujata Yadav
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Peter B Marschik
- Division of Phoniatrics, Research Unit iDN (Interdisciplinary Developmental Neuroscience), Medical University of Graz, Graz, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
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633
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Conner BC, Remec NM, Orum EK, Frank EM, Lerner ZF. Wearable Adaptive Resistance Training Improves Ankle Strength, Walking Efficiency and Mobility in Cerebral Palsy: A Pilot Clinical Trial. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2020; 1:282-289. [PMID: 33251524 PMCID: PMC7694567 DOI: 10.1109/ojemb.2020.3035316] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/07/2022] Open
Abstract
GOAL To determine the efficacy of wearable adaptive resistance training for rapidly improving walking ability in children with cerebral palsy (CP). METHODS Six children with spastic CP (five males, one female; mean age 14y 11mo; three hemiplegic, three diplegic; Gross Motor Function Classification System [GMFCS] levels I and II) underwent ten, 20-minute training sessions over four weeks with a wearable adaptive resistance device. Strength, speed, walking efficiency, timed up and go (TUG), and six-minute walk test (6MWT) were used to measure training outcomes. RESULTS Participants showed increased average plantar flexor strength (17 ± 8%, p = 0.02), increased preferred walking speed on the treadmill (39 ± 25%, p = 0.04), improved metabolic cost of transport (33 ± 9%, p = 0.03), and enhanced performance on the timed up and go (11 ± 9%, p = 0.04) and six-minute walk test (13 ± 9%, p = 0.04). CONCLUSIONS The observed increase in preferred walking speed, reduction in metabolic cost of transport, and improved performance on clinical tests of mobility highlights the potentially transformative nature of this novel therapy; the rate at which this intervention elicited improved function was 3 - 6 times greater than what has been reported previously.
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Affiliation(s)
| | | | | | - Emily M. Frank
- College of Health SolutionsArizona State UniversityTempeAZ85281USA
| | - Zachary F. Lerner
- Mechanical Engineering DepartmentNorthern Arizona UniversityFlagstaffAZ86011USA
- Department of OrthopedicsUniversity of Arizona College of Medicine – PhoenixPhoenixAZ85004USA
- Department of Mechanical EngineeringNorthern Arizona UniversityFlagstaffAZ86011USA
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634
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Pannek K, George JM, Boyd RN, Colditz PB, Rose SE, Fripp J. Brain microstructure and morphology of very preterm-born infants at term equivalent age: Associations with motor and cognitive outcomes at 1 and 2 years. Neuroimage 2020; 221:117163. [DOI: 10.1016/j.neuroimage.2020.117163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 06/27/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
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635
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Motor outcome after perinatal stroke and early prediction of unilateral spastic cerebral palsy. Eur J Paediatr Neurol 2020; 29:54-61. [PMID: 32988734 DOI: 10.1016/j.ejpn.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/11/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Unilateral spastic cerebral palsy (USCP) occurs in 30%-68% of infants with perinatal stroke. Early detection of USCP is essential for referring infants to early intervention. The aims of this study were to report motor outcomes after perinatal stroke, and to determine the predictive value of the General Movements Assessment (GMA) and Hand Assessment for Infants (HAI) for detection of USCP. MATERIALS AND METHODS This was a prospective observational study involving infants with perinatal stroke. GMA was conducted between 10 and 15 weeks post term-age (PTA). The HAI was performed between 3 and 5 months PTA. Motor outcome was collected between 12 and 36 months PTA. RESULTS The sample consisted of 46 infants. Fifteen children (32.6%) were diagnosed with CP, two children with bilateral CP and 13 with USCP. Abnormal GMA had a sensitivity of 85% (95% confidence interval [CI] 55-98%) and a specificity of 52% (95% CI 33-71%) to predict USCP. When asymmetrically presented FMs were also considered as abnormal, sensitivity increased to 100%, hence the specificity declined to 43%. A HAI asymmetry index cut-off of 23, had both a sensitivity and a specificity of 100% to detect USCP. CONCLUSION Using GMA and HAI can enable prediction of USCP before the age of 5 months in infants with perinatal stroke. Nevertheless, GMA must be interpreted with caution in this particular population. The HAI was found to be a very accurate screening tool for early detection of asymmetry and prediction of USCP.
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636
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Cizmeci MN, Groenendaal F, Liem KD, van Haastert IC, Benavente-Fernández I, van Straaten HLM, Steggerda S, Smit BJ, Whitelaw A, Woerdeman P, Heep A, de Vries LS. Randomized Controlled Early versus Late Ventricular Intervention Study in Posthemorrhagic Ventricular Dilatation: Outcome at 2 Years. J Pediatr 2020; 226:28-35.e3. [PMID: 32800815 DOI: 10.1016/j.jpeds.2020.08.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/16/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the effect of intervention at low vs high threshold of ventriculomegaly in preterm infants with posthemorrhagic ventricular dilatation on death or severe neurodevelopmental disability. STUDY DESIGN This multicenter randomized controlled trial reviewed lumbar punctures initiated after either a low threshold (ventricular index of >p97 and anterior horn width of >6 mm) or high threshold (ventricular index of >p97 + 4 mm and anterior horn width of >10 mm). The composite adverse outcome was defined as death or cerebral palsy or Bayley composite cognitive/motor scores <-2 SDs at 24 months corrected age. RESULTS Outcomes were assessed in 113 of 126 infants. The composite adverse outcome was seen in 20 of 58 infants (35%) in the low threshold group and 28 of 55 (51%) in the high threshold (P = .07). The low threshold intervention was associated with a decreased risk of an adverse outcome after correcting for gestational age, severity of intraventricular hemorrhage, and cerebellar hemorrhage (aOR, 0.24; 95% CI, 0.07-0.87; P = .03). Infants with a favorable outcome had a smaller fronto-occipital horn ratio (crude mean difference, -0.06; 95% CI, -0.09 to -0.03; P < .001) at term-equivalent age. Infants in the low threshold group with a ventriculoperitoneal shunt, had cognitive and motor scores similar to those without (P = .3 for both), whereas in the high threshold group those with a ventriculoperitoneal shunt had significantly lower scores than those without a ventriculoperitoneal shunt (P = .01 and P = .004, respectively). CONCLUSIONS In a post hoc analysis, earlier intervention was associated with a lower odds of death or severe neurodevelopmental disability in preterm infants with progressive posthemorrhagic ventricular dilatation. TRIAL REGISTRATION ISRCTN43171322.
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Affiliation(s)
- Mehmet N Cizmeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center; Utrecht; University Medical Center Utrecht, Utrecht Brain Center, Utrecht, the Netherlands; Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center; Utrecht; University Medical Center Utrecht, Utrecht Brain Center, Utrecht, the Netherlands
| | - Kian D Liem
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid C van Haastert
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center; Utrecht; University Medical Center Utrecht, Utrecht Brain Center, Utrecht, the Netherlands
| | | | | | - Sylke Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bert J Smit
- Directorate Quality & Patient Care, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Andrew Whitelaw
- Neonatal Intensive Care Unit, Southmead Hospital and Neonatal Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Peter Woerdeman
- Division of Neuroscience, Department of Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Axel Heep
- Neonatal Intensive Care Unit, Southmead Hospital and Neonatal Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center; Utrecht; University Medical Center Utrecht, Utrecht Brain Center, Utrecht, the Netherlands.
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637
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Chambers C, Seethapathi N, Saluja R, Loeb H, Pierce SR, Bogen DK, Prosser L, Johnson MJ, Kording KP. Computer Vision to Automatically Assess Infant Neuromotor Risk. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2431-2442. [PMID: 33021933 DOI: 10.1101/756262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
An infant's risk of developing neuromotor impairment is primarily assessed through visual examination by specialized clinicians. Therefore, many infants at risk for impairment go undetected, particularly in under-resourced environments. There is thus a need to develop automated, clinical assessments based on quantitative measures from widely-available sources, such as videos recorded on a mobile device. Here, we automatically extract body poses and movement kinematics from the videos of at-risk infants (N = 19). For each infant, we calculate how much they deviate from a group of healthy infants (N = 85 online videos) using a Naïve Gaussian Bayesian Surprise metric. After pre-registering our Bayesian Surprise calculations, we find that infants who are at high risk for impairments deviate considerably from the healthy group. Our simple method, provided as an open-source toolkit, thus shows promise as the basis for an automated and low-cost assessment of risk based on video recordings.
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638
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Chambers C, Seethapathi N, Saluja R, Loeb H, Pierce SR, Bogen DK, Prosser L, Johnson MJ, Kording KP. Computer Vision to Automatically Assess Infant Neuromotor Risk. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2431-2442. [PMID: 33021933 PMCID: PMC8011647 DOI: 10.1109/tnsre.2020.3029121] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
An infant's risk of developing neuromotor impairment is primarily assessed through visual examination by specialized clinicians. Therefore, many infants at risk for impairment go undetected, particularly in under-resourced environments. There is thus a need to develop automated, clinical assessments based on quantitative measures from widely-available sources, such as videos recorded on a mobile device. Here, we automatically extract body poses and movement kinematics from the videos of at-risk infants (N = 19). For each infant, we calculate how much they deviate from a group of healthy infants (N = 85 online videos) using a Naïve Gaussian Bayesian Surprise metric. After pre-registering our Bayesian Surprise calculations, we find that infants who are at high risk for impairments deviate considerably from the healthy group. Our simple method, provided as an open-source toolkit, thus shows promise as the basis for an automated and low-cost assessment of risk based on video recordings.
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639
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Doroniewicz I, Ledwoń DJ, Affanasowicz A, Kieszczyńska K, Latos D, Matyja M, Mitas AW, Myśliwiec A. Writhing Movement Detection in Newborns on the Second and Third Day of Life Using Pose-Based Feature Machine Learning Classification. SENSORS 2020; 20:s20215986. [PMID: 33105787 PMCID: PMC7660095 DOI: 10.3390/s20215986] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
Observation of neuromotor development at an early stage of an infant’s life allows for early diagnosis of deficits and the beginning of the therapeutic process. General movement assessment is a method of spontaneous movement observation, which is the foundation for contemporary attempts at objectification and computer-aided diagnosis based on video recordings’ analysis. The present study attempts to automatically detect writhing movements, one of the normal general movement categories presented by newborns in the first weeks of life. A set of 31 recordings of newborns on the second and third day of life was divided by five experts into videos containing writhing movements (with occurrence time) and poor repertoire, characterized by a lower quality of movement in relation to the norm. Novel, objective pose-based features describing the scope, nature, and location of each limb’s movement are proposed. Three machine learning algorithms are evaluated in writhing movements’ detection in leave-one-out cross-validation for different feature extraction time windows and overlapping time. The experimental results make it possible to indicate the optimal parameters for which 80% accuracy was achieved. Based on automatically detected writhing movement percent in the video, infant movements are classified as writhing movements or poor repertoire with an area under the ROC (receiver operating characteristics) curve of 0.83.
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Affiliation(s)
- Iwona Doroniewicz
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, 40-065 Katowice, Poland; (I.D.); (A.A.); (K.K.); (D.L.); (M.M.); (A.M.)
| | - Daniel J. Ledwoń
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland;
- Correspondence:
| | - Alicja Affanasowicz
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, 40-065 Katowice, Poland; (I.D.); (A.A.); (K.K.); (D.L.); (M.M.); (A.M.)
| | - Katarzyna Kieszczyńska
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, 40-065 Katowice, Poland; (I.D.); (A.A.); (K.K.); (D.L.); (M.M.); (A.M.)
| | - Dominika Latos
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, 40-065 Katowice, Poland; (I.D.); (A.A.); (K.K.); (D.L.); (M.M.); (A.M.)
| | - Małgorzata Matyja
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, 40-065 Katowice, Poland; (I.D.); (A.A.); (K.K.); (D.L.); (M.M.); (A.M.)
| | - Andrzej W. Mitas
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland;
| | - Andrzej Myśliwiec
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, 40-065 Katowice, Poland; (I.D.); (A.A.); (K.K.); (D.L.); (M.M.); (A.M.)
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640
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Ikeudenta BA, Rutkofsky IH. Unmasking the Enigma of Cerebral Palsy: A Traditional Review. Cureus 2020; 12:e11004. [PMID: 33209560 PMCID: PMC7669254 DOI: 10.7759/cureus.11004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022] Open
Abstract
Cerebral palsy is a group of neuromuscular diseases that is primarily common in the pediatric population and is the most common cause of neurological and motor disability in children. Cerebral palsy is comprised of various subtypes with the most common type being spastic cerebral palsy. It is highly associated with prematurity and affects nerve function, motor function, and intellectual capacity. It is also associated with nutritional deficiencies and gastrointestinal dysfunction. Cerebral palsy is diagnosed via clinical evaluation and does not have specific laboratory or image findings, but certain imaging findings are positively correlated with it. There are numerous interventions and treatment modalities that are aimed at ensuring the highest quality of life for the patient and their families. This article was compiled with peer-reviewed publications from the PubMed database in which various keywords were utilized in the search engine. These peer-reviewed articles were selected without geographical restrictions and selected based on the use of the English language. These articles were also selected on the restriction of publication within the last 10 years. This review article on cerebral palsy will serve as a medium of education for the physician, healthcare team, and family involved in the management of children or adults with cerebral palsy. It is important because it discusses the possible etiologies, diagnostic and assessment techniques, prevention methods, and possible rehabilitation interventions. This article aims to broaden the reader's understanding of cerebral palsy and answer any questions that may arise during the management of this disease. The management of cerebral palsy is often plagued with frustration, depression, and anxiety. The main goal of treatment is to attain the highest quality of life for the family and the child.
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Affiliation(s)
- Bryan A Ikeudenta
- Psychiatry, Neuroscience, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ian H Rutkofsky
- Psychiatry, Neuroscience, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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641
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Riewruja K, Amarase C, Osateerakun P, Weerasopone S, Limpaphayom N, Honsawek S. Neutrophil-to-lymphocyte ratio predicts the severity of motor impairment in cerebral palsy children living at home and the rehabilitation center: A comparative study. Biomed Rep 2020; 13:63. [PMID: 33149907 DOI: 10.3892/br.2020.1370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the neutrophil-to-lymphocyte ratio (NLR) level in children with cerebral palsy (CP) living at home or the rehabilitation center. The correlation of NLR with different severities of motor impairment was assessed. This was a single-center, cross-sectional, observational study. A total of 80 CP children who were either living at home (n=34) or at the rehabilitation center (n=46) were included. Demographic characteristics, anthropometric parameters and complete blood counts were recorded, and the NLR values were calculated. The severity of motor impairment was evaluated and categorized according to the Gross Motor Functional Classification System (GMFCS) level. The mean age of CP participants was 8.52±1.92 years. The percentage of children with CP who were malnourished (underweight, stunted and wasted) was higher amongst those at the rehabilitation center compared with those living at home. The mean NLR of children with CP in the rehabilitation center was significantly higher compared with the patients living at home (P=0.003). Participants from the rehabilitation center had severe motor impairment (GMFCS levels IV-V) and significantly higher NLR values than those with mild motor impairments (GMFCS levels II-III; P=0.006). However, there were no differences in NLR values in relation to severity of motor impairment in CP children living at home. CP children had some degree of neuroinflammation and systemic inflammation. NLR may be a potential simple inflammatory parameter that may be used to predict the severity of the motor impairment, particularly in CP children living at a rehabilitation center.
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Affiliation(s)
- Kanyakorn Riewruja
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.,Department of Biochemistry, Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Chavarin Amarase
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Phatcharapa Osateerakun
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Soarawit Weerasopone
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Noppachart Limpaphayom
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Sittisak Honsawek
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.,Department of Biochemistry, Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
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Aravamuthan BR, Shevell M, Kim YM, Wilson JL, O'Malley JA, Pearson TS, Kruer MC, Fahey M, Waugh JL, Russman B, Shapiro B, Tilton A. Role of child neurologists and neurodevelopmentalists in the diagnosis of cerebral palsy: A survey study. Neurology 2020; 95:962-972. [PMID: 33046609 DOI: 10.1212/wnl.0000000000011036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To contextualize the role of child neurologists and neurodevelopmentalists (CNs/NDDs) in cerebral palsy (CP) care, we review the changing landscape of CP diagnosis and survey stakeholder CNs/NDDs regarding their roles in CP care. METHODS The optimal roles of the multiple specialties involved in CP care are currently unclear, particularly regarding CP diagnosis. We developed recommendations regarding the role of CNs/NDDs noting (1) increasing complexity of CP diagnosis given a growing number of genetic etiologies and treatable motor disorders that can be misdiagnosed as CP and (2) the views of a group of physician stakeholders (CNs/NDDs from the Child Neurology Society Cerebral Palsy Special Interest Group). RESULTS CNs/NDDs felt that they were optimally suited to diagnose CP. Many (76%) felt that CNs/NDDs should always be involved in CP diagnosis. However, 42% said that their patients with CP were typically not diagnosed by CNs/NDDs, and 18% did not receive referrals to establish the diagnosis of CP at all. CNs/NDDs identified areas of their expertise critical for CP diagnosis including knowledge of the neurologic examination across development and early identification of features atypical for CP. This contrasts with their views on CP management, where CNs/NDDs felt that they could contribute to the medical team, but were necessary primarily when neurologic coexisting conditions were present. DISCUSSION Given its increasing complexity, we recommend early referral for CP diagnosis to a CN/NDD or specialist with comparable expertise. This contrasts with current consensus guidelines, which either do not address or do not recommend specific specialist referral for CP diagnosis.
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Affiliation(s)
- Bhooma R Aravamuthan
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA.
| | - Michael Shevell
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Young-Min Kim
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Jenny L Wilson
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Jennifer A O'Malley
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Toni S Pearson
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Michael C Kruer
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Michael Fahey
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Jeff L Waugh
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Barry Russman
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Bruce Shapiro
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Ann Tilton
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
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643
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Whittingham K, Sheffield J, Mak C, Dickinson C, Boyd RN. Early Parenting Acceptance and Commitment Therapy 'Early PACT' for parents of infants with cerebral palsy: a study protocol of a randomised controlled trial. BMJ Open 2020; 10:e037033. [PMID: 33039994 PMCID: PMC7552872 DOI: 10.1136/bmjopen-2020-037033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION New international clinical practice guidelines exist for identifying infants at high risk of cerebral palsy (CP) earlier: between 12 to 24 weeks corrected age, significantly earlier than previous diagnosis windows in Australia at 19 months. The earlier detection of infants at high risk of CP creates an opportunity for earlier intervention. The quality of the parent-infant relationship impacts various child outcomes, and is leveraged in other forms of intervention. This paper presents the protocol of a randomised controlled trial of an online parent support programme, Early Parenting Acceptance and Commitment Therapy (Early PACT) for families of infants identified as at high risk of CP. We predict that participating in the Early PACT programme will be associated with improvements in the parent-infant relationship, in parent mental health and well-being as well as infant behaviour and quality of life. METHODS AND ANALYSIS This study aims to recruit 60 parents of infants (0 to 2 years old corrected age) diagnosed with CP or identified as at high risk of having CP. Participants will be randomly allocated to one of two groups: Early PACT or waitlist control (1:1). Early PACT is an online parent support programme grounded in Acceptance and Commitment Therapy (ACT). It is delivered as a course on an open source course management system called edX. Early PACT is designed to support parental adjustment and parent-infant relationship around the time of early diagnosis. Assessments will be conducted at baseline, following completion of Early PACT and at 6-month follow-up (retention). The primary outcome will be the quality of parent-child interactions as measured by the Emotional Availability Scale. Standard analysis methods for randomised controlled trial will be used to make comparisons between the two groups (Early PACT and waitlist control). Retention of effects will be examined at 6-month follow-up. ETHICS AND DISSEMINATION This study is approved through appropriate Australian and New Zealand ethics committees (see in text) with parents providing written informed consent. Findings from this trial will be disseminated through peer-reviewed journal publications and conference presentations. TRIAL REGISTRATION DETAILS This trial has been prospectively registered on 12 June 2018 to present (ongoing) with the Australian New Zealand Clinical Trials Registry (ACTRN12618000986279); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=3 74 896.
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Affiliation(s)
- Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre (CHRC), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jeanie Sheffield
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Catherine Mak
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre (CHRC), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Corrine Dickinson
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre (CHRC), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre (CHRC), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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644
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Shepherd E, Mcintyre S, Smithers-Sheedy H, Ashwood P, Sullivan TR, Te Velde A, Doyle LW, Makrides M, Middleton P, Crowther CA. Linking data from a large clinical trial with the Australian Cerebral Palsy Register. Dev Med Child Neurol 2020; 62:1170-1175. [PMID: 32383806 DOI: 10.1111/dmcn.14556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/27/2022]
Abstract
AIM To link data from a large maternal perinatal trial with the Australian Cerebral Palsy Register (ACPR) to identify children with cerebral palsy (CP). METHOD Deidentified data from the Australasian Collaborative Trial of Magnesium Sulphate (ACTOMgSO4 ) and the ACPR were linked. Children born from 1996 to 2000 at Australian hospitals who survived and had 2-year paediatric assessments were included. Children identified with CP in: (1) both the ACTOMgSO4 (2y) and the ACPR (5y), (2) the ACTOMgSO4 only, and (3) the ACPR only were compared. RESULTS We included 913 children (492 males, 421 females; mean gestational age at birth 27.8wks [standard deviation 2.1wks]; range 23.0-40.0wks). Eighty-four children received a CP diagnosis: 35 by the ACTOMgSO4 and the ACPR, 29 by the ACTOMgSO4 only, and 20 by the ACPR only. The ACTOMgSO4 diagnosed 76.2% (95% confidence interval [CI] 65.9-84.1) and the ACPR identified 65.5% (95% CI 54.7-74.9). Children born in states/territories with long-standing versus more recently established registers were more likely to be included on the ACPR (p<0.05). INTERPRETATION Linking deidentified perinatal trial data with the ACPR was achieved. Limitations of both strategies for identifying children with CP in this era (late 1990s and early 2000s) probably explain many of the differences observed, and inform future linkage studies and evaluations of CP-preventive interventions. WHAT THIS PAPER ADDS Randomized trial data were linked with the Australian Cerebral Palsy Register. Trial (2y) and register (up to 5y) diagnoses of cerebral palsy (CP) differed. States with long-standing registers were more likely to include children with CP.
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Affiliation(s)
- Emily Shepherd
- SA Health and Medical Research Institute, Adelaide, SA, Australia.,Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Sarah Mcintyre
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Pat Ashwood
- Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Thomas R Sullivan
- SA Health and Medical Research Institute, Adelaide, SA, Australia.,School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Anna Te Velde
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, The Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Neonatal Services, Royal Women's Hospital, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
| | - Maria Makrides
- SA Health and Medical Research Institute, Adelaide, SA, Australia.,Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Philippa Middleton
- SA Health and Medical Research Institute, Adelaide, SA, Australia.,Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Caroline A Crowther
- Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Liggins Institute, The University of Auckland, Auckland, New Zealand
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645
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Fluss J, Lidzba K. Cognitive and academic profiles in children with cerebral palsy: A narrative review. Ann Phys Rehabil Med 2020; 63:447-456. [DOI: 10.1016/j.rehab.2020.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/11/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
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646
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Wu YC, Straathof EJM, Heineman KR, Hadders-Algra M. Typical general movements at 2 to 4 months: Movement complexity, fidgety movements, and their associations with risk factors and SINDA scores. Early Hum Dev 2020; 149:105135. [PMID: 32795785 DOI: 10.1016/j.earlhumdev.2020.105135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Movement complexity and the presence of fidgety movements (FMs) during general movements (GMs) both reflect aspects of neurological integrity in early infancy. AIM To assess interrelations between the degree of movement complexity and characteristics of FMs during typical GMs and to investigate associations between mildly impaired GMs and risk factors and neurodevelopmental condition. STUDY DESIGN Observational cohort study. SUBJECTS 283 infants (25 born preterm) at 2-4 months corrected age, representative of the general Dutch population. OUTCOME MEASURES GMs were classified in terms of GM-complexity (normal or mildly abnormal (MA)) and FMs (clearly present, sporadic, or exaggerated). Concurrent neurological, developmental and socio-emotional status were measured with the Standardized Infant NeuroDevelopmental Assessment (SINDA). RESULTS Infants with MA GM-complexity had a higher risk of having sporadic FMs and exaggerated FMs. Perinatal complications were not associated with mildly impaired GMs. MA GM-complexity was associated with advanced maternal age (adjusted OR = 2.29 [1.11, 4.76]) and having a non-native Dutch mother (adjusted OR = 2.93 [1.29, 6.64]). It was also associated with atypical neurological (OR = 7.62 [3.51, 16.54]) and developmental scores (OR = 2.38 [1.16, 4.88]). Sporadic and exaggerated FMs were associated with low-to-middle maternal education (adjusted OR = 2.88, [1.45, 5.72]) and having a non-native Dutch father (adjusted OR = 7.16 [1.41, 36.32]), respectively. However, neither sporadic nor exaggerated FMs were associated with the SINDA outcomes. CONCLUSIONS GM-complexity and FMs are two interrelated but different aspects of GMs. Mild impairments in GM-complexity and FMs share a non-optimal socio-economic background as risk factor, but only MA GM-complexity is associated with a concurrent non-optimal neurodevelopmental condition.
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Affiliation(s)
- Ying-Chin Wu
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands; Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Elisabeth J M Straathof
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
| | - Kirsten R Heineman
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands; SEIN, Stichting Epilepsie Instellingen Nederland, Zwolle, the Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.
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647
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Bennett JF, Andrews M, Omura J. Cerebral Palsy. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xue J, Mo Y. Application of vocal organ correction combined with language training in the rehabilitation of children with cerebral palsy and language disorder. Transl Pediatr 2020; 9:645-652. [PMID: 33209727 PMCID: PMC7658770 DOI: 10.21037/tp-20-223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To explore the effect of vocal organ correction combined with language training on the rehabilitation of children with cerebral palsy (CP) and language disorder. METHODS A total of 98 children with CP and language disorder were divided into two groups (49 cases in each group) using a random number table: the control group and the test group. The control group was given language training alone, while the test group received vocal organ correction combined with language training. The changes in language function classification, efficacy, and family satisfaction before and after the treatments were compared. RESULTS A significant difference was identified in language function classification between the two groups before and after treatment (P<0.05). The language function classification of the two groups was also significantly different after treatment (P<0.05), as was the distribution of clinical efficacy between the two groups (P<0.05). The total effective rate for the test group was 91.84%, which was higher than the 73.47% for the control group (P<0.05). Family satisfaction between the two groups differed significantly (P<0.05), and the total satisfaction rate of families in the test group was 87.76%, which was higher than the 69.39% in the control group (P<0.05). CONCLUSIONS Vocal organ correction combined with language training can improve the language function of children with CP and language disorder, has ideal efficacy, and can also enhance family satisfaction during rehabilitation.
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Affiliation(s)
- Jinjun Xue
- Department of Paediatrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Youfang Mo
- Department of Rehabilitation, Tongde Hospital of Zhejiang Province, Hangzhou, China
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649
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From cerebral palsy to developmental coordination disorder: Development of preclinical rat models corresponding to recent epidemiological changes. Ann Phys Rehabil Med 2020; 63:422-430. [DOI: 10.1016/j.rehab.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023]
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650
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Test of Infant Motor Performance for Infants in Brazil: Unidimensional Model, Item Difficulty, and Motor Function. Pediatr Phys Ther 2020; 32:390-397. [PMID: 32991567 DOI: 10.1097/pep.0000000000000745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a need for appropriate tests to identify developmental delays early in life. OBJECTIVE This study investigates the Test of Infant Motor Performance (TIMP) unidimensional model and its ability to explain variance in items response, hierarchic order of the items, levels of difficulty, and the extent to which the items were appropriate to distinguish different levels of function for infants in Brazil. METHODS Six hundred fifty-five infants were assessed. Families provided sociodemographic information. RESULTS Appropriate items reliability (0.99), infit (mean = 0.99; SD = 0.46), outfit (mean = 1.34; SD = 1.58), and point-biserial correlations (-0.36 to 0.92) were obtained. The model explains 74.3% of the variance, and 76.2% of the items had adequate factor relationship. CONCLUSION The TIMP measures a single construct, has items with different levels of difficulty, and is sensitive to detect differences in the performance of distinct groups for infants in Brazil.
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