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Gavazzi F, Vaia Y, Woidill S, Formanowski B, Peixoto de Barcelos I, Sevagamoorthy A, Modesti NB, Charlton L, Cusack SV, Vincent A, D'Aiello R, Jawad A, Galli J, Varesio C, Fazzi E, Orcesi S, Glanzman AM, Lorch S, DeMauro SB, Guez-Barber D, Waldman AT, Vanderver A, Adang LA. Nonverbal Cognitive Skills in Children With Aicardi Goutières Syndrome. Neurology 2024; 103:e209541. [PMID: 38857477 PMCID: PMC11226315 DOI: 10.1212/wnl.0000000000209541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/10/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Aicardi Goutières syndrome (AGS) is type I interferonopathy characterized by severe neurologic impairment. Although many children with AGS demonstrate motor and expressive language deficits, the magnitude of receptive language impairment is uncharacterized. We sought to characterize cognitive function in AGS-affected children using assessment tools with reduced dependence on motor abilities and compare cognitive testing outcomes with overall severity and parental assessment of adaptive behavior. METHODS We performed a cross-sectional study. Children were recruited as part of the Myelin Disorders Biorepository Project at the Children's Hospital of Philadelphia. We included individuals with a confirmed diagnosis of AGS. We administered the Leiter International Performance Scale, third edition (Leiter-3), and the Vineland Adaptive Behavior Scale, third edition (VABS-3), in the context of research encounters. Motor skills were categorized by AGS Severity Scale mobility levels. Descriptive statistics and Spearman's rank correlation were used to compare assessments. Mann-Whitney and Kruskal-Wallis tests with correction with Dunn's multiple comparison test were used to compare test performance between mobility groups. RESULTS Cognitive and adaptive behavior performance was captured in 57 children. The mean age at encounters was 8.51 (SD 5.15) years. The median (IQR) Leiter-3 score was 51 (interquartile range [IQR] 60), with administration failure in 20 of 57 (35%) individuals. On the VABS-3, the Motor Domain (median 29, IQR 36.25) was more impacted than the Communication (median 50, IQR 52), Daily Living Skills (median 52, IQR 31), and Socialization (median 54, IQR 40) Domains (p < 0.0001). The AGS Scale correlated with VABS-3 (r = 0.86, p < 0.0001) and Leiter-3 (r = 0.87, p < 0.0001). There was correlation between VABS-3 Domains and Leiter-3 (r-range 0.83-0.97). Gross motor and fine motor categories, respectively, correlated with VABS-3 (H = 39.37, p < 0.0001; U = 63, p < 0.0001) and Leiter-3 (H = 40.43, p < 0.0001; U = 66, p < 0.0001). Within each gross motor and fine motor category of the AGS Scale, a subset of children scored within normal IQ range. DISCUSSION Parental assessment of function by the VABS-3 correlated with directly assessed performance measures. Our data underscore the potential value of VABS-3 and Leiter-3 as tools to assess psychometric function in AGS. With a deeper understanding of our patients' abilities, we can better guide clinicians and families to provide appropriate support and personalized interventions to empower children with leukodystrophies to maximize their communication and educational potential.
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Affiliation(s)
- Francesco Gavazzi
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ylenia Vaia
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sarah Woidill
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brielle Formanowski
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Isabella Peixoto de Barcelos
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Anjana Sevagamoorthy
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nicholson B Modesti
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lauren Charlton
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Stacy V Cusack
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ariel Vincent
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Russell D'Aiello
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Abbas Jawad
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jessica Galli
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Costanza Varesio
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Elisa Fazzi
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Simona Orcesi
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Allan M Glanzman
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Scott Lorch
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sara B DeMauro
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Danielle Guez-Barber
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Amy T Waldman
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Adeline Vanderver
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Laura A Adang
- From the Divisions of Neurology (F.G., Y.V., S.W., I.P.d.B., A.S., N.B.M., L.C., D.G.-B., A.T.W., A. Vanderver, L.A.A.), and Neonatology (B.F., S.L., S.B.D.), and Departments of Occupational Therapy (S.V.C., A. Vincent), Biomedical & Health Informatics (R.D.A.), Pediatrics (A.J.), and Physical Therapy (A.M.G.), Children's Hospital of Philadelphia, PA; University of Milan (Y.V.); Department of Clinical and Experimental Sciences (J.G., E.F.), University of Brescia; Unit of Child Neurology and Psychiatry (J.G., E.F.), ASST Spedali Civili of Brescia; Unit of Child Neurology and Psychiatry (C.V., S.O.), Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia; Department of Brain and Behavioral Sciences (S.O.), University of Pavia, Italy; and Department of Neurology (D.G.-B., A.T.W., A. Vanderver, L.A.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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