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Sırtbaş-Işık G, Porsnok D, Yardımcı-Lokmanoğlu BN, Mutlu A. Sleep characteristics, early spontaneous movements, and developmental functioning in preterm infants in the early postnatal period. Sleep Med 2024; 114:151-158. [PMID: 38184924 DOI: 10.1016/j.sleep.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE This study aimed to investigate the following: (i) sleep characteristics in preterm infants at 9-20 weeks of corrected age, and (ii) differences in early spontaneous movements and developmental functioning results between the groups based on some sleep characteristics. METHODS Seventy-four preterm infants (36 female) were included. Sleep characteristics were assessed according to the Brief Infant Sleep Questionnaire (BISQ). The infants were divided into two groups based on total sleep duration: less than 12 h (38 infants), and 12 h and more (36 infants). Video recordings were made for the General Movements Assessment (GMA) and evaluated using the Motor Optimality Score for 3- to 5-Month-Old-Infants-Revised (MOS). Cognitive, language, and motor development were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). RESULTS The total sleep duration of all preterm infants (mean ± SD) was 11.8 ± 3.3 h. Infants who had absent fidgety movements slept less than 12 h, and fidgety movements differed between the groups (p = 0.012). Infants who slept 12 h or more had significantly higher MOS (p = 0.041), cognitive (p = 0.002), language (p < 0.001), and motor (p = 0.002) development results. Infants who snored had lower MOS (p = 0.001), cognitive (p = 0.004), language (p = 0.002), and motor (p = 0.001) development results. Infants with fewer than three nocturnal awakenings had significantly higher Bayley-III cognitive (p = 0.007), language (p = 0.032), and motor (p = 0.005) domain results. Prone and supine sleeping positions showed higher motor domain results than lateral positions (p = 0.001). CONCLUSIONS Sleep in preterm infants might be a key factor in early developmental functioning processes and nervous system integrity. Even in the first months of life, there are substantial differences in cognitive, language, and motor development in association with sleep characteristics.
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Affiliation(s)
- Gülsen Sırtbaş-Işık
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Doğan Porsnok
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Bilge Nur Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
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The General Movements Motor Optimality Score in High-Risk Infants: A Systematic Scoping Review. Pediatr Phys Ther 2023; 35:2-26. [PMID: 36288244 DOI: 10.1097/pep.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this systematic scoping review was to explore the use of the motor optimality score in the fidgety movement period in clinical practice, and to investigate evidence for the motor optimality score in predicting neurodevelopmental outcomes. SUMMARY OF KEY POINTS Thirty-seven studies, with 3662 infants, were included. Studies were conceptualized and charted into 4 categories based on the motor optimality score: prediction, outcome measure, descriptive, or psychometric properties. The most represented populations were preterm or low-birth-weight infants (16 studies), infants with cerebral palsy or neurological concerns (5 studies), and healthy or term-born infants (4 studies). CONCLUSION The motor optimality score has the potential to add value to existing tools used to predict risk of adverse neurodevelopmental outcomes. Further research is needed regarding the reliability and validity of the motor optimality score to support increased use of this tool in clinical practice. What this adds to the evidence : The motor optimality score has potential to improve the prediction of adverse neurodevelopmental outcomes. Further research on validity and reliability of the motor optimality score is needed; however, a revised version, the motor optimality score-R (with accompanying manual) will likely contribute to more consistency in the reporting of the motor optimality score in future.
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Shahabi S, Kiekens C, Etemadi M, Mojgani P, Teymourlouei AA, Lankarani KB. Integrating rehabilitation services into primary health care: policy options for Iran. BMC Health Serv Res 2022; 22:1317. [PMCID: PMC9635163 DOI: 10.1186/s12913-022-08695-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background Providing rehabilitation services in primary health care (PHC) is associated with numerous health, social, and economic benefits. Therefore, low and middle-income countries, such as Iran, should benefit from the advantages of integrating rehabilitation services into PHC. We conducted a qualitative study to determine policy solutions that could facilitate the integration of rehabilitation services into Iran’s PHC network. Methods Semi-structured interviews were conducted with 38 participants, including health policymakers, rehabilitation managers, faculty members, and rehabilitation practitioners. Purposive and snowball sampling strategies were adopted to recruit participants. The WHO Health System building blocks framework analysis was applied to analyze the collected data. Results Participants’ perspectives and experiences outlined potential policy options including: (1) stewardship: increasing political support, strengthening the leadership of the rehabilitation sector, and promoting inter-sectoral collaborations; (2) service delivery: increasing the knowledge of healthcare professionals, using local volunteers, deploying mobile rehabilitation teams, using telerehabilitation, and improving referral pathways; (3) financing: increasing government funding, preparing a package of rehabilitation services, and using appropriate payment mechanisms; (4) human resources: expanding rehabilitation workforce, training rehabilitation assistants, and enhancing employment and social opportunities; (5) information systems: establishing a comprehensive information system and an effective surveillance system; and (6) technologies: facilitating access to a range of rehabilitation equipment and raw materials, especially for prosthetics and orthotics services. Conclusion Based on the WHO six building blocks framework, this study identified several policy options for integrating rehabilitation services into the Iranian PHC Network. Some of the policy options include increasing political support, promoting inter-sectoral collaborations, increasing the skills and knowledge of healthcare workers, establishing effective referral pathways, strengthening team-working, and increasing government funding.
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Affiliation(s)
- Saeed Shahabi
- grid.412571.40000 0000 8819 4698Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Manal Etemadi
- National Center for Health Insurance Research, Tehran, Iran
| | - Parviz Mojgani
- grid.444911.d0000 0004 0619 1231Iran-Helal Institute of Applied Science and Technology, Tehran, Iran ,Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | - Ahmad Ahmadi Teymourlouei
- grid.411746.10000 0004 4911 7066Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Bagheri Lankarani
- grid.412571.40000 0000 8819 4698Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Intervención temprana en la unidad de cuidado intensivo neonatal con seguimiento en casa dirigidas a las habilidades motoras de niños prematuros. MOVIMIENTO CIENTÍFICO 2022. [DOI: 10.33881/2011-7191.mct.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introducción: La prematurez es una importante causa de morbimortalidad perinatal asociado a un mayor riesgo neurológico esto debido a que entre las semanas 20 y 37 de gestación ocurre un rápido crecimiento cortical, particularmente de las áreas sensoriomotoras lo cual afecta potencialmente el neurodesarrollo. Desde diferentes campos se han propuesto estrategias que buscan prevenir que el cerebro sea lesionado por la estimulación intensa y dolorosa conocidas como “Cuidados centrados en el desarrollo”. Sin embargo, se reporta escasa literatura disponible a nivel nacional que proporcione evidencia de la efectividad de la intervención temprana que favorezca el desarrollo de las habilidades motoras de los bebés en la Unidad de Cuidado intensivo neonatal (UCIN). Por lo cual, el objetivo de este estudio es conocer las estrategias de intervención temprana utilizadas para mejorar las habilidades motoras en bebés prematuros según lo reportado en la literatura. Método: Se llevó a cabo una revisión de literatura en 3 bases de datos (Scopus, Clinicalkey y ScienceDirect) durante los años 2016 a 2020. Resultados: Se revisaron 7 artículos cuyo idioma prevalente es el inglés sobre estrategias de intervención que inician en la UCIN y continúan con seguimiento en el hogar. Conclusiones: En algunos estudios no se logra evidenciar claramente una dosificación de las intervenciones realizadas. A su vez, la participación activa de los padres es fundamental para la adquisición de habilidades motoras en esta población, donde el fisioterapeuta es primordial en el entrenamiento, guía y acompañamiento del proceso con la familia.
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Yin H, Wang X, Yang H, Zhu X, Wang J, Li Z. A pilot study of the General Movement Optimality Score detects early signs of motor disorder in neonates with arterial ischemic stroke. Early Hum Dev 2021; 163:105484. [PMID: 34655917 DOI: 10.1016/j.earlhumdev.2021.105484] [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] [Received: 12/10/2020] [Revised: 08/12/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
AIM To explore whether the General Movement Optimality Score (GMOS) could help to identify asymmetric movement in infants with neonatal arterial ischemic stroke (NAIS) in the early stage. METHOD Twenty-seven infants with NAIS (16 males, 11 females) were enrolled. The general movement video was recorded approximately one month after birth. The GMOS focused separately on the neck and trunk and the upper and lower extremities. The differences between the ipsilesional and contralesional limbs were analyzed. RESULTS Eight infants who developed cerebral palsy (CP) had middle cerebral artery (MCA) infarction involving the main branch. By GMOS evaluation, the scores of the contralesional upper and/or lower limbs were lower than those of the ipsilesional side (p < 0.05). In the contralesional limbs, the CP group had a lower GMOS than the non-CP group. Distal rotatory components of the contralesional upper limbs and tremulous movement of the lower limbs showed significant differences. INTERPRETATION The GMOS could help to quantitatively find and assess the asymmetric movement of global and contralesional limbs. Distal rotatory movement of the upper limbs could be an early sign of abnormal motor function in infants with NAIS.
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Affiliation(s)
- Huanhuan Yin
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xinrui Wang
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xiaoyun Zhu
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Jun Wang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China.
| | - Zhihua Li
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China.
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Khurana S, Rao BK, Lewis LE, Kumaran SD, Kamath A, Einspieler C, Dusing SC. Neonatal PT Improves Neurobehavior and General Movements in Moderate to Late Preterm Infants Born in India: An RCT. Pediatr Phys Ther 2021; 33:208-216. [PMID: 34618744 DOI: 10.1097/pep.0000000000000824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine whether a structured neonatal physical therapy program (SNP) improves neurobehavior and general movements in moderate to late preterm (MLP) infants. METHODS Sixty MLP infants participated in this clinical trial. After baseline assessment using the Neurobehavioral Assessment of Preterm Infant (NAPI) and Prechtl General Movements (GMs) Assessment, infants were randomly allocated to a usual care (n = 30) or an SNP group (n = 30) and continued receiving usual care. The SNP group received intervention for 90 minutes/day, 6 days/week until discharge. Changes in neurobehavior and GMs were assessed at hospital discharge. RESULTS Changes in scores on scarf sign and motor development and vigor clusters of NAPI document an improvement in the SNP group. The proportion of infants with poor repertoire GMs also decreased more in the SNP group than in the usual care group. CONCLUSION The SNP may be effective in improving some aspects of neurobehavior and quality of GMs in MLP infants. WHAT THIS ADDS TO THE EVIDENCE The addition of a structured neonatal physical therapy program to usual care can promote neurobehavioral organization and improve the quality of general movements in moderate and late preterm infants in India.
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Affiliation(s)
- Sonia Khurana
- Department of Physical Therapy (Dr Khurana), Motor Development Lab, Virginia Commonwealth University, Richmond, Virginia; Department of Physiotherapy (Drs Rao and Kumaran), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Department of Paediatrics (Drs Lewis), Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India; Department of Data Science (Dr Kamath), Manipal Academy of Higher Education, Manipal, Karnataka, India; Division of Phoniatrics (Dr Einspieler), Medical University of Graz, Graz, Austria; Division of Biokinesiology and Physical Therapy (Dr Dusing), University of Southern California, Los Angeles, California
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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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Soloveichick M, Marschik PB, Gover A, Molad M, Kessel I, Einspieler C. Movement Imitation Therapy for Preterm Babies (MIT-PB): a Novel Approach to Improve the Neurodevelopmental Outcome of Infants at High-Risk for Cerebral Palsy. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2019; 32:587-598. [PMID: 32669775 PMCID: PMC7346982 DOI: 10.1007/s10882-019-09707-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To improve the neurodevelopmental outcome in infants with high grade intraventricular haemorrhage and cramped-synchronised (CS) general movements (GMs). Four very preterm infants with intraventricular haemorrhage grade III (n = 3) or intraventricular haemorrhage with apparent periventricular haemorrhagic infarction (n = 1) were diagnosed with CS GMs at 33 to 35 weeks postmenstrual age. A few days later MIT-PB [Movement Imitation Therapy for Preterm Babies], an early intervention programme, was commenced: the instant an infant showed CS movements, the therapist intervened by gently guiding the infant's limbs so as to manoeuvre and smoothen the movements, thereby imitating normal GM sequences as closely as possible (at least for 10 min, 5 times a day, with increasing frequency over a period of 10 to 12 weeks). After a period of consistent CS GMs, the movements improved. At 14 weeks postterm age, the age specific GM pattern, fidgety movements, were normal in three infants, one infant had abnormal fidgety movements. At preschool age, all participants had a normal neurodevelopmental outcome. This report on four cases demonstrates that mimicking normal and variable GM sequences might have a positive cascading effect on neurodevelopment. The results need to be interpreted with caution and replication studies on larger samples are warranted. Nonetheless, this innovative approach may represent a first step into a new intervention strategy.
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Affiliation(s)
- Marina Soloveichick
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Peter B. Marschik
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- Center of Neurodevelopmental Disorders (KIND), Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Ayala Gover
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Molad
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Irena Kessel
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Christa Einspieler
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
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