Principles of early intervention

Motor development of stable born healthy foals during the first 24 hours

The motor development of 14 healthy foals was observed using continuous video-recording from birth to 24 h of age. An ethogram was made of behaviours of interest with behaviour quantification using CowLog software. Behaviours were divided into six main classes: main activities, attempts to get up or lie down, nursing, playing and other skills, being helped by a human, and the foal not being visible. First-time behaviours (mean, range) of early motor development after birth included going into sternal position (5.4 min, 0-34.5 min), attempting to get up (7.6 min, 0.5-34.6 min), successfully getting up (56.4 min, 27.7 min - 1 h 43.3 min), walking (1 h 1.9 min, 28.1 min - 1 h 43.4 min), nursing (1 h 49.1 min, 1 h 10.3 min - 2 h 29.7 min), shaking (31.9 min, 0.2 min - 2 h 32.7 min), running (2 h 55.6 min, 1h 33.2 min - 6 h 12.1 min), walking backwards (4 h 12.8 min, 56.9 min - 12 h 50.6 min), frolicking (4 h 52.5 min, 2 h 3 min - 15 h 18.8 min), and autogrooming (7 h 30.3 min, 43.3 min - 14 h 40.1 min). All foals made several attempts before they were able to get up for the first time (61.9, 14-103). During the first 24 h the overall duration of lying down was highest, followed by standing and walking. This information adds to the basic information for assessing normal motor development in these animals, with the potential to identify delayed development.

Early Developmental Intervention and Enriched Environment in CDKL5 Developmental and Epileptic Encephalopathy: A Case Report

Objectives

CDKL5 developmental and epileptic encephalopathy (CDKL5-DEE) is a rare X-linked dominant genetic disorder. Family-centered Early Intervention (EI) programs, which promote axonal plasticity and synaptic reorganization through exposure to an enriched environment, should be integrated into clinical practice. However, there is presently a dearth of dedicated EI protocols for patients with CDKL5-DEE and cerebral visual impairment (CVI).

Methods

We present a girl with a deletion of the CDKL5 gene (MIM*300203). At the age of 2 months, the child presented with severe epilepsy. The neurologic examination was abnormal, and she had severe CVI. At the first assessment, at 5 months old, her Developmental Quotient (DQ) on the Griffiths Mental Developmental Scales III (GMDS-III) was equivalent to 3-month-old skills (95% CI). The child was enrolled in an EI program for 6 months.

Results

At 12 months of age, the DQ score was 91. There has been improvement in the neurovisual functions. The findings from the scales show a gradual improvement in neuromotor and psychomotor development, which is in contrast to the expected outcome of the disease.

Discussion

The case study shows that a family-centered EI and prompt assessment of CVI can promote and enhance neurodevelopment.

Motor-related health care for 5-year-old children born extremely preterm with movement impairments

AIM

To (1) determine the proportion of 5-year-old children born extremely preterm (EPT) with movement difficulties including cerebral palsy (CP) and the proportion of these children receiving motor-related health care (MRHC), and (2) describe factors associated with receiving MRHC.

METHOD

Children born before 28 weeks' gestation in 2011 to 2012 in 11 European countries were assessed with the Movement Assessment Battery for Children, Second Edition (MABC-2) at 5 years of age. Information on family characteristics, child health including CP diagnosis, and health care use were collected using parent-report questionnaires. MRHC was defined as visits in the previous year with health care providers (physical and occupational therapists) specialized in assessing/treating motor problems. We analysed receipt of MRHC and associated factors among children at risk of movement difficulties (MABC-2 score 6th-15th centiles), with significant movement difficulties (SMD; ≤5th centile) or with CP.

RESULTS

Of 807 children assessed at 5 years 7 months (SD 4 months; 4 years 7 months-7 years 1 month), 412 were males (51.1%), 170 (21.1%) were at risk of movement difficulties, 201 (24.9%) had SMD, and 92 (11.4%) had CP. Those who received MRHC comprised 89.1% of children with CP, 42.8% with SMD, and 25.9% at risk of movement difficulties. MRHC for children with SMD varied from 23.3% to 66.7% between countries. Children were more likely to receive MRHC if they had other developmental problems or socioemotional, conduct, or attention difficulties.

INTERPRETATION

Efforts are needed to increase MRHC for 5-year-old children born EPT with movement difficulties.

WHAT THIS PAPER ADDS

Children born extremely preterm without cerebral palsy frequently experienced motor difficulties. Most of these children were not receiving motor-related health care (MRHC). Large geographical differences throughout Europe were observed in receipt of MRHC. Socioemotional problems were related to MRHC use.