Motor performance in the third, not the second month, predicts further motor development

Qualitative assessment in the third month of life allows for a better prognosis of the achievement of motor milestones versus assessment of pathological reflexes- prospective studies on Polish children

Introduction

The characteristic feature of primitive reflexes is that they occur early in development and must expire at a well-defined age. The study was conducted prospectively on a group of 107 children (74 boys). The study population included 83 infants born on time (weight 3,465 ± 395 g) and 24 born prematurely (weight 2,225 ± 793 g).

Methods

An analysis of motor development at 3 months of age consisting of a qualitative assessment (motor performance) and a check of reflexes was performed; at 9 months, the child was checked for crawling and sitting down, and at 16 months for walking.

Results

The more abnormal reflexes, the less likely it was to achieve the assessed milestones in time. It is possible to notice that the qualitative assessment is, in each case, a better predictor of the milestones than any of the reflexes, except for walking, where the Babkin reflex was strongly predictive. However, the qualitative assessment sum still occupies the second and third positions in prone and supine positions.

Discussion

The occurrence of Babkin's reflex at 3 months of age impacts the achievement of sitting down and walking functions. An abnormal Galant reflex was strongly associated with the lack of occurrence of crawling on time. At the same time, a high-quality score at 3 months of age guarantees the development of crawling on time, sitting down, and walking.

Impact of selected risk factors on motor performance in the third month of life and motor development in the ninth month

Background

Proper motor development can be influenced by a range of risk factors. The resulting motor performance can be assessed through quantitative and qualitative analysis of posture and movement patterns.

Methods

This study was designed as the cohort follow-up of the motor assessment and aimed to demonstrate, in a mathematical way, the impact of particular risk factors on elements of motor performance in the 3^rd month and the final motor performance in the 9^th month of life. Four hundred nineteen children were assessed (236 male and 183 female), including 129 born preterm. Each child aged 3 month underwent a physiotherapeutic assessment of the quantitative and qualitative development, in the prone and supine positions. The neurologist examined each child aged 9 month, referring to the Denver Development Screening Test II and assessing reflexes, muscle tone and symmetry. The following risk factors were analyzed after the neurological consultation: condition at birth (5^th min Apgar score), week of gestation at birth, intraventricular hemorrhage, respiratory distress syndrome, and the incidence of intrauterine hypotrophy and hyperbilirubinemia determined based on medical records.

Results

A combination of several risk factors affected motor development stronger than any one of them solely, with Apgar score, hyperbilirubinemia, and intraventricular hemorrhage exhibiting the most significant impact.

Conclusions

Premature birth on its own did not cause a substantial delay in motor development. Nonetheless, its co-occurrence with other risk factors, namely intraventricular hemorrhage, respiratory distress syndrome, and hyperbilirubinemia, notably worsened motor development prognosis. Moreover, improper position of the vertebral column, scapulae, shoulders, and pelvis in the third month of life may predict disturbances in further motor development.

Dynamics of changes in motor development depending on the quality in the 3rd month of life

The aim of the study was to show that the quantitative and qualitative motor development from the 3rd month of life is key to achieving milestones and that it may be an early warning signal in children at risk of cerebral palsy (CP). The study population included 93 children (69 born at term). Children were born at week 38 ± 4, the mean body weight was 3,102 ± 814 g. All children were evaluated after reaching the 3rd month of life (quantitative and qualitative assessment), and then the 4.5th, 7th, and 12th of life (quantitative assessment). In case of suspected CP, children were followed until the 18th month, when the diagnosis was confirmed. If at the age of 3 months, a child achieved a quadrangle of support and symmetrical support, then its development at the 4.5th month of life was correct, it would creep, and it would assume a crawl position, then in the final assessment (12th month of life), the child would start to walk. If a child failed to achieve a quadrangle of support and symmetrical support and the dynamics of its development were incorrect, the development would be delayed (12th month of life), or CP would develop. A correct qualitative assessment in the 3rd month of life with a high probability guarantees corrects quantitative development at the 4.5th, 7.5th, and 12th months of life. If the qualitative assessment in the 3rd month of life was very low the child would probably be diagnosed with CP at 18 months.

Crawl Position Depends on Specific Earlier Motor Skills

Early assessment of motor performance should allow not only the detection of disturbances but also create a starting point for the therapy. Unfortunately, a commonly recognised method that should combine these two aspects is still missing. The aim of the study is to analyse the relationship between the qualitative assessment of motor development at the age of 3 months and the acquisition of the crawl position in the 7th month of life. A total of 135 children were enrolled (66 females). The analysis was based on physiotherapeutic and neurological assessment and was performed in the 3rd, 7th and 9th months of life in children, who were classified according to whether they attained the crawl position or not in the 7th month. Children who did not attain the crawl position in the 7th month did not show distal elements of motor performance at the age of 3 months and thus achieved a lower sum in the qualitative assessment. Proper position of the pelvis at the age of 3 months proved to be very important for the achievement of the proper crawl position at the 7th month. Failure to attain the crawl position in the 7th month delays further motor development. The proximal-distal development must be achieved before a child is able to assume the crawl position. Supine position in the 3rd month seemed more strongly related to achieving the crawl position than assessment in the prone position.

How motor elements at 3 months influence motor performance at the age of 6 months

One of the most important achievements of infancy is mobility, through which the child gradually becomes independent and can discover new places and objects. One form of mobility that occurs in a child's development is rolling over from supine-to-prone.The assumption of the work was to check whether all particular motor elements from the 3rd month had a comparable effect on development in the 6th month of life.The study population included 119 children, 69 born at term, and 50 born preterm. Children were born at week 38 ± 3 (born at term 40  ± 1/preterm 34 ± 3), with a mean body weight of 3100 ± 814 g (born at term 3462 ± 505/ preterm 2282 ± 788). Pre-term children were assessed at the corrected age. The physiotherapeutic qualitative assessment at the age of 3 months was performed in the prone and supine positions, and the qualitative assessment included 15 elements in the prone position and 15 in the supine position. A detailed mathematical analysis was then performed. Values of Cramer's V coefficient with confidence range, Goodman-Kruskal's coefficient, and the values of the probability coefficient p were given.The position of the scapulae and pelvis (3rd month) had the strongest impact on achieving proper support on the upper extremities in the 6th month of life, while the supine position was most significantly affected by the position of the head, spine, and pelvis.

A multivariate discrete failure time model for the analysis of infant motor development

We develop a multivariate discrete failure time model for the analysis of infant motor development. We use the model to jointly evaluate the time (in months) to achievement of three well-established motor milestones: sitting up, crawling, and walking. The model includes a subject-specific latent factor that reflects underlying heterogeneity in the population and accounts for within-subject dependence across the milestones. The factor loadings and covariate effects are allowed to vary flexibly across milestones, and the milestones are permitted to have unique at-risk intervals corresponding to different developmental windows. We adopt a Bayesian inferential approach and develop a convenient data-augmented Gibbs sampler for posterior computation. We conduct simulation studies to illustrate key features of the model and use the model to analyze data from the Nurture study, a birth cohort examining infant health and development during the first year of life.

Socioeconomic diversities and infant development at 6 to 9 months in a poverty area of São Paulo, Brazil

Abstract Introduction The effects of socioeconomic disparities on cognitive development tend to emerge early in infancy and to widen throughout childhood, and may perpetuate later in life. Although the study of how poverty affects early childhood has increased in the last 20 years, many of the effects remain largely unknown, especially during the first year of life. Aim To investigate the influence of socioeconomic status (SES) and maternal education on infants’ language, motor and cognitive development. Methods The cognitive, language and motor skills of 444 infants aged 6 to 9 months selected from a poor neighborhood in São Paulo, Brazil, were evaluated using the Bayley Scales of Infant Development. A questionnaire on socioeconomic background was administered to the participants’ families. Results A positive association was found between SES and infants’ performance on language and motor scales. Additionally, higher maternal education was associated with higher language and cognitive scores. Conclusion Our findings indicate that SES effects are detectable very early in infancy. This result has implications for the timing of both screening and intervention efforts to help children overcome the consequences of living in poverty.

Position of pelvis in the 3rd month of life predicts further motor development

The aim of the study is to select elements of motor skills assessed at 3 months that provide the best predictive properties for motor development at 9 months. In all children a physiotherapeutic assessment of the quantitative and qualitative development at the age of 3 months was performed in the prone and supine positions, which was presented in previous papers as the quantitative and qualitative assessment sheet of motor development. The neurological examination at the age of 9 months was based on the Denver Development Screening Test II and the evaluation of reflexes, muscle tone (hypotony and hypertony), and symmetry. The particular elements of motor performance assessment were shown to have distinct predictive value for further motor development (as assessed at 9 months), and the pelvis position was the strongest predictive element. Irrespective of the symptomatic and anamnestic factors the inappropriate motor performance may already be detected in the 3rd month of life and is predictive for further motor development. The assessment of the motor performance should be performed in both supine and prone positions. The proper position of pelvis summarizes the proper positioning of the whole spine and ensures proper further motor development. To our knowledge, the presented motor development assessment sheet allows the earliest prediction of motor disturbances.

Predicting motor outcomes with 3 month prone hip angles in premature infants

PURPOSE

This study used kinematic analysis to identify a reliable and rapid assessment method for abnormal patterns of motor development in preterm infants.

METHODS

In a retrospective analysis, we examined video of n= 35 preterm infants at 3mo corrected age (CA) who had concurrent Test of Infant Motor Performance (TIMP) scores. Hyperflexion at the hip produces common gait anomalies seen in children with CP, therefore we analyzed hip angle in the prone head lift position at 3 months CA. Magnetic Resonance Spectroscopy (MRS) was performed at term equivalent (n= 23) and Bayley-III neurodevelopmental tests were performed at 1 year (n= 28). We correlated hip angles with TIMP and Bayley-III scores, and MRS neuronal metabolites.

RESULTS

Hip angle positively correlated with TIMP at 3 months (r= 0.642, p≤ 0.001), but not with Bayley-III at 1 year (r= 0.122, p= 0.529). Hip angle correlated negatively with myo-inositol (mI) ratios in frontal white matter tracts (mI/Cr r= -0.520, p= 0.011).

CONCLUSIONS

These results suggest prone hip angle may be a quantitative proxy for the 42-item TIMP at 3 months, and that hypertonicity in the hip flexor musculature is a manifestation of white matter metabolic abnormalities (elevated mI ratios) that may indicate occult white matter injury.

Qualitative elements of early motor development that influence reaching of the erect posture. A prospective cohort study

The proposed assessment sheet aims to show in detail, which qualitative elements of motor performance are performed correctly in the 2nd month of life by children who in the 9th month reached the erect posture. Similar analysis was performed for the qualitative assessment in the 6th month. The prospective investigation of motor development involved a group of 109 children (40 girls and 69 boys). The study was based on the previously described quantity and quality assessment sheet of motor performance, validated for the 2nd and 6th month. Final investigation took place in the 9th month of life and was based on a neurological assessment. It could be shown that a completely correct assessment at the age of 2 months precludes future severe motor development disorders, especially cerebral palsy, although it does not rule out a slight delay. Prematurity and the analyzed risk factors, particularly IVH, impair the motor performance. The absence of axial symmetry, the shoulders protraction and improper position of the pelvis are the most important alarming features at the 2nd month. Distal elements observed in the prone position at the 6th month show a good prognosis for the motor performance in the 9th month. Any abnormalities, mainly related to the body axis and symmetry observed at 2 months of age should encourage one to put a child under observation.