Visual-motor, visual-perceptual, and fine motor outcomes in very-low-birthweight children at 5 years

Early Neurodevelopmental Assessments of Neonates Discharged From the Neonatal Intensive Care Unit: A Physiatrist's Perspective

The survival rate of children admitted in the neonatal intensive care unit (NICU) after birth is on the increase; hence, proper evaluation and care of their neurodevelopment has become an important issue. Neurodevelopmental assessments of individual domains regarding motor, language, cognition, and sensory perception are crucial in planning prompt interventions for neonates requiring immediate support and rehabilitation treatment. These assessments are essential for identifying areas of weakness and designing targeted interventions to improve future functional outcomes and the quality of lives for both the infants and their families. However, initial stratification of risk to select those who are in danger of neurodevelopmental disorders is also important in terms of cost-effectiveness. Efficient and robust functional evaluations to recognize early signs of developmental disorders will help NICU graduates receive interventions and enhance functional capabilities if needed. Several age-dependent, domain-specific neurodevelopmental assessment tools are available; therefore, this review summarizes the characteristics of these tools and aims to develop multidimensional, standardized, and regular follow-up plans for NICU graduates in Korea.

Visual-motor functions are affected in young adults who were born premature and screened for retinopathy of prematurity

AIM

To assess visual-motor integration in young adults previously included in a prospective study on the incidence of retinopathy of prematurity (ROP).

METHODS

The study encompassed 59 preterm individuals, born 1988-1990, with a birth weight ≤1500 g, and 44 full-term controls, aged 25-29 years. Ophthalmological examination, including visual acuity and contrast sensitivity, and the Beery Visual-Motor Integration (VMI) with supplemental tests of visual perception and motor coordination, were performed. A short questionnaire was filled in.

RESULTS

The preterm individuals had significantly lower scores than the controls in all VMI tests, median values and interquartile ranges: Beery VMI 87 (21) vs 103 (11), visual perception 97 (15) vs 101 (8) and motor coordination 97 (21) vs 102 (15), respectively. Within the preterm group, no correlations were found between the VMI tests and ROP, gestational age, birth weight or visual acuity. Contrast sensitivity was correlated to visual perception. Neurological complication at 2.5 years was a risk factor for lower scores on Beery VMI. The preterm subjects reported six times as many health problems as compared to the controls.

CONCLUSION

Being born preterm seemed to have life-long effects. This study shows that visual-motor integration was affected in young adults born preterm.

Impact of prematurity on neurodevelopment

The consequences of prematurity on brain functional development are numerous and diverse, and impact all brain functions at different levels. Prematurity occurs between 22 and 36 weeks of gestation. This period is marked by extreme dynamics in the physiologic maturation, structural, and functional processes. These different processes appear sequentially or simultaneously. They are dependent on genetic and/or environmental factors. Disturbance of these processes or of the fine-tuning between them, when caring for premature children, is likely to induce disturbances in the structural and functional development of the immature neural networks. These will appear as impairments in learning skills progress and are likely to have a lasting impact on the development of children born prematurely. The level of severity depends on the initial alteration, whether structural or functional. In this chapter, after having briefly reviewed the neurodevelopmental, structural, and functional processes, we describe, in a nonexhaustive manner, the impact of prematurity on the different brain, motor, sensory, and cognitive functions.

Impairment of cognitive function in ornithine transcarbamylase deficiency is global rather than domain-specific and is associated with disease onset, sex, maximum ammonium, and number of hyperammonemic events

Beginning in 2006, the Urea Cycle Disorders Consortium (UCDC) has conducted a longitudinal study of eight inherited deficiencies of enzymes and transporters of the urea cycle, including 444 individuals with ornithine transcarbamylase deficiency (OTCD), of whom 300 (67 males, 233 females) received psychological evaluation. In a cross-sectional study (age range, 3-71 years), analysis of covariance (ANCOVA) determined the association between outcomes in five cognitive domains (global intelligence, executive functions, memory, visuomotor integration, visual perception) and sex, age at testing and timing of disease onset defined as early onset (≤28 days; EO), late onset (LO), or asymptomatic (AS). The dataset of 183 subjects with complete datasets (31 males, 152 females) revealed underrepresentation of EO subjects (2 males, 4 females), who were excluded from the ANCOVA. Although mean scores of LO and AS individuals were within 1 SD of the population norm, AS subjects attained significantly higher scores than LO subjects and males higher scores than females. Correlations between cognitive domains were high, particularly intelligence proved to be a distinguished indicator for cognitive functioning. Maximum plasma ammonium concentration and intelligence correlated significantly higher in EO (r = -0.47) than in LO subjects (r = 0.04). Correlation between the number of hyperammonemic events and intelligence scores were similar for EO (r = -0.30) and LO (r = -0.26) individuals. The number of clinical symptoms was significantly associated with intelligence (r = -0.28) but not with scores in other domains. Results suggest that OTCD has a global impact on cognitive functioning rather than a specific effect on distinct cognitive domains.

National Registry Data from Korean Neonatal Network: Two-Year Outcomes of Korean Very Low Birth Weight Infants Born in 2013-2014

BACKGROUND

The aim of this study was to observe long-term outcomes of very low birth weight infants (VLBWIs) born between 2013 and 2014 in Korea, especially focusing on neurodevelopmental outcomes.

METHODS

The data were collected from Korean Neonatal Network (KNN) registry from 43 and 54 participating units in 2013 and 2014, respectively. A standardized electronic case report form containing 30 items related to long-term follow up was used after data validation.

RESULTS

Of 2,660 VLBWI, the mean gestational age and birth weight were 29^1/7 ± 2^6/7 weeks and 1,093 ± 268 g in 2013 and 29^2/7 ± 2^6/7 weeks and 1,125 ± 261 g in 2014, respectively. The post-discharge mortality rate was 1.2%-1.5%. Weight < 50th percentile was 46.5% in 2013 and 66.1% in 2014. The overall prevalence of cerebral palsy among the follow up infants was 6.2% in 2013 and 6.6% in 2014. The Bayley Scales of Infant Developmental Outcomes version II showed 14%-25% of infants had developmental delay and 3%-8% of infants in Bayley version III. For the Korean developmental screening test for infants and children, the area "Further evaluation needed" was 5%-12%. Blindness in both eyes was reported to be 0.2%-0.3%. For hearing impairment, 0.8%-1.9% showed bilateral hearing loss. Almost 50% were readmitted to hospital with respiratory illness as a leading cause.

CONCLUSION

The overall prevalence of long-term outcomes was not largely different among the VLBWI born between 2013 and 2014. This study is the first large national data study of long-term outcomes.

Visual-motor integration and fine motor skills at 6½ years of age and associations with neonatal brain volumes in children born extremely preterm in Sweden: a population-based cohort study

OBJECTIVES

This exploratory study aimed to investigate associations between neonatal brain volumes and visual-motor integration (VMI) and fine motor skills in children born extremely preterm (EPT) when they reached 6½ years of age.

SETTING

Prospective population-based cohort study in Stockholm, Sweden, during 3 years.

PARTICIPANTS

All children born before gestational age, 27 weeks, during 2004-2007 in Stockholm, without major morbidities and impairments, and who underwent MRI at term-equivalent age.

MAIN OUTCOME MEASURES

Brain volumes were calculated using morphometric analyses in regions known to be involved in VMI and fine motor functions. VMI was assessed with The Beery-Buktenica Developmental Test of Visual-Motor Integration-sixth edition and fine motor skills were assessed with the manual dexterity subtest from the Movement Assessment Battery for Children-second edition, at 6½ years. Associations between the brain volumes and VMI and fine motor skills were evaluated using partial correlation, adjusted for total cerebral parenchyma and sex.

RESULTS

Out of 107 children born at gestational age <27 weeks, 83 were assessed at 6½ years and 66/83 were without major brain lesions or cerebral palsy and included in the analyses. A representative subsample underwent morphometric analyses: automatic segmentation (n=34) and atlas-based segmentation (n=26). The precentral gyrus was associated with both VMI (r=0.54, P=0.007) and fine motor skills (r=0.54, P=0.01). Associations were also seen between fine motor skills and the volume of the cerebellum (r=0.42, P=0.02), brainstem (r=0.47, P=0.008) and grey matter (r=-0.38, P=0.04).

CONCLUSIONS

Neonatal brain volumes in areas known to be involved in VMI and fine motor skills were associated with scores for these two functions when children born EPT without major brain lesions or cerebral palsy were evaluated at 6½ years of age. Establishing clear associations between early brain volume alterations and later VMI and/or fine motor skills could make early interventions possible.

Enhancing sensory experiences for very preterm infants in the NICU: an integrative review

OBJECTIVE

Very preterm infants hospitalized in the neonatal intensive care unit (NICU) experience alterations in sensory experiences. Defining types, timing and frequency of sensory-based interventions that optimize outcomes can inform environmental modifications. The objective of this study was to conduct an integrative review on sensory-based interventions used with very preterm infants in the NICU to improve infant and parent outcomes.

STUDY DESIGN

The data sources include MEDLINE, CINAHL, Cochrane Library and Google Scholar. Studies were identified that used sensory-based interventions in the NICU with preterm infants born ⩽32 weeks gestation, were published in a peer-reviewed journal between 1995 and 2015, and measured outcomes related to infant and parent outcomes. Studies were extracted from electronic databases and hand-searched from identified reference lists.

RESULTS

Eighty-eight articles were identified (31 tactile, 12 auditory, 3 visual, 2 kinesthetic, 2 gustatory/olfactory and 37 multimodal). There was evidence to support the use of kangaroo care, music and language exposure, and multimodal interventions starting at 25 to 28 weeks postmenstrual age. These interventions were related to better infant development and lower maternal stress, but not all findings were consistent. Limitations included lack of consistent outcome measures, study quality and gaps in the literature.

CONCLUSIONS

Most research identified interventions that were done for short periods of time. It is unclear what the potential is for improving outcomes if positive sensory exposures occur consistently throughout NICU hospitalization. Until more research defines appropriate sensory-based interventions to use with infants born very preterm in the NICU, information from this review can be combined with expert opinion and parent/family values to determine best practice.

Do Mainstream Schoolchildren Who Were Born Preterm Have Motor Problems?

Children who are born preterm now have improved survival chances owing to major changes in obstetric and neonatal intensive care. Previous studies have indicated that such children who are attending mainstream school have an increased risk of long-term motor impairment when compared with those who were born at full term. The present study describes the motor outcome in a geographically defined population born at or below 32 weeks of gestational age, alongside a group of full-term children who were matched for age, gender and school. Motor skills were assessed using the Movement Assessment Battery for Children (Movement ABC) and the Developmental Test of Visual Motor Integration (VMI), in addition to a detailed perinatal history.

A total of 280 preterm children were assessed alongside 210 controls. There were highly statistically significant differences between the preterm and full-term cohorts on both the Movement ABC (p<0.001, Mann-Whitney U) and the VMI (p<0.001, independent sample t-test), with the preterm group performing considerably worse than their peers. Using the 5th percentile on the Movement ABC, 30.7% of the preterm group were impaired compared with 6.7% of the controls.

Occupational therapists may find increased referral levels of preterm children because of motor difficulties and associated functional problems.

Interlimb coordination and academic performance in elementary school children

BACKGROUND

The specific mechanisms linking motor ability and cognitive performance, especially academic achievement, are still unclear. Whereas the literature provides an abundance of information on fine and visual-motor skill and cognitive attributes, much less has been reported on gross motor ability. This study examined interlimb coordination and its relationship to academic performance in children aged 8-11 years.

METHODS

Motor and academic skills were examined in 100 Brazilian children using the Bruininks-Oseretsky Test of Motor Proficiency and the Academic Performance Test. Participants were grouped into low (<25%) and high (>75%) academic achievers.

RESULTS

There was a significant difference between groups for Total Motor Composite (P < 0.001) favoring the high group. On regression analysis there was a significant association between academic performance and Body Coordination. Of the subtests of Body Coordination (Bilateral Coordination and Balance), Bilateral Coordination accounted for the highest impact on academic performance. Of interest here, that subtest consists primarily of gross motor tasks involving interlimb coordination.

CONCLUSION

Overall, there was a positive relationship between motor behavior, in particular activities involving interlimb coordination, and academic performance. Application of these findings in the area of early assessment may be useful in the identification of later academic problems.

Premature birth as a risk factor for autism spectrum disorder

OBJECTIVE

Autism spectrum disorder (ASD) is common, life-long in nature, and can be very debilitating. Thus, an intensive search is on to identify the potential risk factors for the disorder. Premature birth has been identified as one potential factor that could influence potential symptoms of ASD.

METHOD

The sample for this study consisted of 1655 at risk children for developmental delays who were 17-37 months of age. Participants were divided into those diagnosed with ASD (n = 916) and children with atypical development only (n = 739).

RESULTS

Premature births were almost twice as common for the atypical development group versus the ASD group.

CONCLUSIONS

Implications of these data are discussed.

Visuo-manual coordination in preterm infants without neurological impairments

The extent of and reasons for visuo-manual coordination deficits in moderate and late preterm born infants without neurological impairments are not well known. This paper presents a longitudinal study on the visuo-manual development of twelve preterm infants, born after 33-36 weeks of gestation without neurological complications, between the ages of 6 and 12 months. Visuo-manual integration and grasping were assessed using the Peabody Developmental Motor Scales, along with bimanual coordination and handedness tests. Visual function was examined once prior to the beginning of the study. Gross motor development was also evaluated every month. Preterm infants were compared to a control group of ten full-term infants according to corrected age. Compared to full-terms, the visual perception of preterm infants was close to normal, with only a measure of visual fixation lower than in full-terms. In contrast, preterm infants had delayed development of visuo-manual integration, grasping, bimanual coordination, and handedness even when compared using corrected age. Tonicity and gestational age at birth were the main variables associated to the delays. These results are discussed in terms of the possible factors underlying such delays. They need to be confirmed on a larger sample of preterm born children, and to be correlated with later development. This would allow developing markers of future neuropsychological impairments during childhood.

Neurorehabilitation after neonatal intensive care: evidence and challenges

Neonatologists and paediatric providers of developmental care have documented poor neurodevelopmental outcomes of infants who have received neonatal intensive care due to prematurity, perinatal neurological insults such as asphyxia or congenital anomalies such as congenital heart disease. In parallel, developmental specialists have researched treatment options in these high-risk children. The goal of this review is connect the main categories of poor outcomes (sensory and motor function, cognition, communication, behaviour) studied by neonatal intensive care follow-up specialists to the research focused on improving these outcomes. We summarise challenges in designing diagnostic and interventional approaches in infants <2 years of age and review the evidence for existing therapies and future treatments aimed at improving functionality.

Test of visuospatial construction: Validity evidence in extremely low birth weight and late preterm children at early school age

The Test of Visuospatial Construction (TVSC), a measure of visuoconstruction that does not rely on upper extremity motor response or written production, was administered to extremely low birth weight (ELBW), late preterm (LPT), and term participants at preschool (n = 355) and kindergarten (n = 265) ages. TVSC showed statistically significant weak-to-moderate positive correlations (age 3: r = .118-.303; age 6: r = .138-.348) with Developmental VMI, Differential Ability Scales-II Copying, Matrices, and Pattern Construction subtests, Baron-Hopkins Board Test, and the Purdue Pegboard. One-way ANOVA indicated ELBW performed worse than Term (p = .044) on visuospatial construction at age 3 with a small-to-medium effect size (d = -0.43). No other statistically significant differences were found at age 3 on the TVSC (ELBW/LPT: p = .608, d = -0.17; LPT/Term: p = .116, d = -0.31). At age 6, ELBW participants performed worse than LPT participants (p = .027) and Term participants (p = .012); LPT participants did not differ from Term participants. Small effect sizes at age 3 (ELBW < LPT, d = -0.17; ELBW < Term, d = -0.43) were notably larger at age 6 (ELBW < LPT, d = -0.42; ELBW < Term, d = -0.53). Important practical differences showing LPT participants performed below Term participants (d = -0.31) at age 3 were no longer evident at age 6 (d = -0.097). These findings provide preliminary evidence of TVSC validity supporting its use to detect neuropsychological impairment and to recommend appropriate interventions in young preterm children.

The role of general dynamic coordination in the handwriting skills of children

Difficulties in handwriting are often reported in children with developmental coordination disorder, and they represent an important element in the diagnosis. The present study was aimed at investigating the relation between motor coordination and handwriting skills, and to identify differences in handwriting between children without and with coordination difficulties. In particular, we asked whether visual-spatial skills have a role as mediating variables between motor coordination and handwriting. We assessed motor coordination as well as graphic abilities in children aged 7-10 years. Moreover, we evaluated their visual-motor integration, visual-spatial skills, and other cognitive abilities (memory and planning). We found no relation between motor coordination and handwriting skills, while visual-spatial skills (measured by a visual-constructive task) were related with both. Our conclusion is that visual-spatial skills are involved both in general motor coordination and in handwriting, but the relationship involves different aspects in the two cases.

[Evaluation of isometric force in lower limbs and body composition in preterm infants]

INTRODUCTION

Strength is a physical quality with a clear influence on quality of life. It is determined by the structure of the musculoskeletal system, and depends on the muscular structure. It has been described that prematurity conditions both qualities. The aims of this study are to determine whether prematurity is associated with strength or body composition and evaluate the relationship between prematurity, strength and muscle mass.

MATERIAL AND METHODS

Case-control study. Participants were premature 7-to-11 year-old children and full-term birth controls. Strength was measured by a strength gauge and body composition from DEXA (duel-energy X-ray absorptiometry) scans. A total of 89 subjects were included and divided into three groups: 30 prematures with birth-weight ≤ 1500g, 29 prematures with birth-weight 1500-2000g, and 30 controls.

RESULTS

Weight and BMI z-score was lower in the premature group. No differences were found in muscular mass or strength between groups. A ratio was established between strength and weight or muscular mass. It was observed that it was possible for them to move four times their weight, without finding any differences between groups or a relationship with birth-weight.

CONCLUSIONS

Between 7 and 11 years of age, children who were premature have lower weight and BMI than the rest of the children. However, there were no differences in body composition or strength between preterm children and controls.

Visual-motor deficits relate to altered gray and white matter in young adults born preterm with very low birth weight

Individuals born preterm and at very low birth weight (birth weight ≤ 1500 g) are at an increased risk of perinatal brain injury and neurodevelopmental deficits over the long term. This study examined whether this clinical group has more problems with visual-motor integration, motor coordination, and visual perception compared to term-born controls, and related these findings to cortical surface area and thickness and white matter fractional anisotropy. Forty-seven preterm-born very low birth weight individuals and 56 term-born controls were examined at 18-22 years of age with a combined cognitive, morphometric MRI, and diffusion tensor imaging evaluation in Trondheim, Norway. Visual-motor skills were evaluated with the Beery-Buktenica Developmental Test of Visual-Motor Integration-V (VMI) copying test and its supplemental tests of motor coordination and visual perception. 3D T1-weighted MPRAGE images and diffusion tensor imaging were done at 1.5 T. Cortical reconstruction generated in FreeSurfer and voxelwise maps of fractional anisotropy calculated with Tract-Based Spatial Statistics were used to explore the relationship between MRI findings and cognitive results. Very low birth weight individuals had significantly lower scores on the copying and motor coordination tests compared with controls. In the very low birth weight group, VMI scores showed significant positive relationships with cortical surface area in widespread regions, with reductions of the superior temporal gyrus, insula, and medial occipital lobe in conjunction with the posterior ventral temporal lobe. Visual perception scores also showed positive relationships with cortical thickness in the very low birth weight group, primarily in the lateral occipito-temporo-parietal junction, the superior temporal gyrus, insula, and superior parietal regions. In the very low birth weight group, visual-motor performance correlated positively with fractional anisotropy especially in the corpus callosum, inferior fronto-occipital fasciculus bilaterally, and anterior thalamic radiation bilaterally, driven primarily by an increase in radial diffusivity. VMI scores did not demonstrate a significant relationship to cortical surface area, cortical thickness, or diffusion measures in the control group. Our results indicate that visual-motor integration problems persist into adulthood for very low birth weight individuals, which may be due to structural alterations in several specific gray-white matter networks. Visual-motor deficits appear related to reduced surface area of motor and visual cortices and disturbed connectivity in long association tracts containing visual and motor information. We conjecture that these outcomes may be due to perinatal brain injury or aberrant cortical development secondary to injury or due to very preterm birth.

Preterm children have unfavorable motor, cognitive, and functional performance when compared to term children of preschool age

OBJECTIVE

to compare the motor coordination, cognitive, and functional development of preterm and term children at the age of 4 years.

METHODS

this was a cross-sectional study of 124 four-year-old children, distributed in two different groups, according to gestational age and birth weight, paired by gender, age, and socioeconomic level. All children were evaluated by the Movement Assessment Battery for Children - second edition (MABC-2), the Pediatric Evaluation of Disability Inventory (PEDI), and the Columbia Mental Maturity Scale (CMMS).

RESULTS

preterm children had worse performance in all tests, and 29.1% of the preterm and 6.5% of term groups had scores on the MABC-2 indicative of motor coordination disorder (p=0.002). In the CMMS (p=0.034), the median of the standardized score for the preterm group was 99.0 (± 13.75) and 103.0 (± 12.25) for the term group; on the PEDI, preterm children showed more limited skill repertoire (p=0.001) and required more assistance from the caregiver (p=0.010) than term children.

CONCLUSION

this study reinforced the evidence that preterm children from different socioeconomic backgrounds are more likely to have motor, cognitive, and functional development impairment, detectable before school age, than their term peers.

Neurodevelopmental outcomes of infants born prematurely

Long-term follow-up of infants born prematurely is necessary to determine neurodevelopmental outcomes, particularly with the expansion of interest from major disabilities to high prevalence/low severity dysfunctions. Models of pathogenesis include changes due to developmental disruptions and to injury, the magnitude and type of change influenced by the infant's age, and central nervous system recovery and reorganization. Alterations in neurogenesis, migration, myelination, cell death, and synaptogenesis occur even in the absence of insult. Despite increased knowledge regarding these processes, the functional significance of brain abnormalities is unclear. Because of methodologic problems in follow-up studies, it is difficult to characterize outcome definitively. Nonetheless, an acceptable degree of agreement across studies is found with regard to specific neurodevelopmental outcomes: motor/neurologic function, visuomotor integrative skills, IQ, academic achievement, language, executive function, and attention-deficit hyperactivity disorder/behavioral issues. In general, children born prematurely have more problems in these areas than do their normal birth weight counterparts. Suggestions for improved analyses and clarification of outcomes include use of cluster analysis, structural equation modeling, growth curve analysis, developmental epidemiologic approaches, and better control of background variables using risk indexes and factor scores. Better assessment techniques measuring functions documented to be at higher risk of problems are discussed.

Motor impairment in very preterm-born children: links with other developmental deficits at 5 years of age

AIM

To elucidate the relation between motor impairment and other developmental deficits in very preterm-born children without disabling cerebral palsy and term-born comparison children at 5 years of (corrected) age.

METHOD

In a prospective cohort study, 165 children (81 very preterm-born and 84 term-born)were assessed with the Movement Assessment Battery for Children - 2nd edition, Touwen’s neurological examination, the Wechsler Preschool and Primary Scale of Intelligence, processing speed and visuomotor coordination tasks of the Amsterdam Neuropsychological Tasks, and the Strengths and Difficulties Questionnaire.

RESULTS

Motor impairment (≤15th centile) occurred in 32% of the very preterm-born children compared with 11% of their term-born peers (p=0.001). Of the very preterm-born children with motor impairment, 58% had complex minor neurological dysfunctions, 54% had low IQ, 69% had slow processing speed, 58% had visuomotor coordination problems, and 27%, 50%,and 46% had conduct, emotional, and hyperactivity problems respectively. Neurological outcome (odds ratio [OR]=41.7, 95% confidence intervals [CI] 7.5–232.5) and Full-scale IQ(OR=7.3, 95% CI 1.9–27.3) were significantly and independently associated with motor impairment. Processing speed (OR=4.6, 95% CI 1.8–11.6) and attention (OR=3.2, 95% CI1.3–7.9) were additional variables associated with impaired manual dexterity. These four developmental deficits mediated the relation between preterm birth and motor impairment.

INTERPRETATION

Complex minor neurological dysfunctions, low IQ, slow processing speed,and hyperactivity/inattention should be taken into account when very preterm-born children are referred for motor impairment.

Hand function and its prognostic factors of very low birth weight preterm children up to a corrected age of 24 months

A delay in functional hand performance broadly affects a child's successful participation in daily activities as well as later academic performance. Despite its high prevalence, hand function has received much less attention than other developmental domains, especially for young children. The aims of this study, therefore, were to examine hand function in preterm children up to a corrected age of 24 months; to establish predictive models for estimating preterm children's hand function; and to identify the contribution of early neuromotor assessments. This study included 230 preterm children (69, 76, and 85 children at corrected ages of 6-, 12-, and 24-months, respectively) who were recruited from the database of the preemie follow-up clinic at the National Cheng Kung University Hospital in Tainan, Taiwan. Hand function was evaluated using the Peabody Developmental Motor Scales II. Demographic information, birth history, and developmental documents were obtained from the medical records of routine preemie clinic follow-ups. Approximately half of healthy preterm children demonstrate hand function deficits at 12 and 24 months of corrected age. The Neonatal Medical Index, representing an infant's history of medical complication, was the best predictor of hand function at 12 and 24 months of corrected age. The social factor, represented by maternal educational year, was found to have influence on hand function only in preterm children at corrected age of 24 months old. Finally, early neuromotor performance demonstrated significant predictability of later hand function that supports the importance of continuous follow-up examinations in children with a history of prematurity. An understanding of a preterm child's early hand function as well as how its risk factors evolve helps clinicians both target children who might benefit from early intervention and ensure that children reach their full developmental potential.

Executive function and IQ predict mathematical and attention problems in very preterm children

Objective of this study was to examine the impact of executive function (EF) on mathematical and attention problems in very preterm (gestational age ≤ 30 weeks) children. Participants were 200 very preterm (mean age 8.2 ± 2.5 years) and 230 term children (mean age 8.3 ± 2.3 years) without severe disabilities, born between 1996 and 2004. EFs assessed included verbal fluency, verbal working memory, visuospatial span, planning, and impulse control. Mathematics was assessed with the Dutch Pupil Monitoring System and parents and teachers rated attention problems using standardized behavior questionnaires. The impact of EF was calculated over and above processing speed indices and IQ. Interactions with group (very preterm versus term birth status) were examined. Analyses were conducted separately for two subsamples: children in preschool and children in primary school. Very preterm children performed poorer on tests for mathematics and had more parent and teacher rated attention problems than term controls (ß(s)>.11, P(s)<.01). IQ contributed unique variance to mathematics in preschool and in primary school (ß(s)>.16, P(s)<.007). A significant interaction of group with IQ (ß = -. 24, P = .02) showed that IQ contributed unique variance to attention problems as rated by teachers, but that effects were stronger for very preterm than for term infants. Over and above IQ, EF contributed unique variance to mathematics in primary school (ß = .13, P<.001), to parent rated inattention in preschool and in primary school (ß(s)>-.16, P(s)<.04), and to teacher rated inattention in primary school (ß = -.19; ß = .19, P(s)<.009). In conclusion, impaired EF is, over and above impaired IQ, an important predictor for poor mathematics and attention problems following very preterm birth.

Are Motor-free Visual Perception Skill Constructs Predictive of Visual-motor Integration Skill Constructs?

Background

Theoretical perspectives vary in considering whether visual perceptual skills and visual-motor integration (VMI) skills are related, interdependent skill sets, or two discrete skill constructs.

Objective

This study investigated whether motor-reduced/free visual perceptual skill constructs were predictive of motor-enhanced VMI skill constructs.

Method

A total of 45 typically developing children aged 6–12 years completed the Developmental Test of Visual Perception-Second Edition (DTVP-2) and the Test of Visual Perceptual Skills-Third Edition (TVPS-3). Four multiple linear regression analyses were completed with the four DTVP-2 motor-enhanced VMI subscales being the dependent (criterion) variables and the seven TVPS-3 motor-reduced subscales being the independent variables.

Results

The total variance accounted for in the four DTVP-2 VMI skill constructs by all the seven TVPS-3 skill constructs ranged from 29.3% to 60.10%. In the first regression analysis, the TVPS-3 Visual Sequential Memory and TVPS-3 Visual FigureGround constructs explained 5.40% and 4.90%, respectively, of the variance in the DTVP-2 Eye Hand Coordination construct. In the second regression, the TVPS-3 Visual Sequential Memory and TVPS-3 Visual Figure–Ground constructs accounted for 5.60% and 3.10%, respectively, of the DTVP-2 Copying construct's variance. The third analysis revealed that the TVPS-3 Visual Memory and TVPS-3 Visual Form Constancy constructs represented 6.20% and 7.90%, respectively, of the DTVP-2 Spatial Relations construct's variance. In the fourth and final regression analysis, the TVPS-3 Visual Sequential Memory and TVPS-3 Visual Figure–Ground construct explained 14.60% and 4.90%, respectively, of the variance in the DTVP-2 Visual-Motor Speed construct.

Conclusion

In the four regression analyses, specific types of motor-reduced visual perception constructs were predictive of the four specific types of motor-enhanced VMI constructs. Visual Sequential Memory and Visual FigureGround, specific types of motor-reduced visual perceptual constructs, were frequent and significant predictors of VMI skill constructs in children. It would appear that motor-reduced visual perceptual skills and motor-enhanced VMI skills as theoretical constructs are related and dependent on one another.

Baixo peso ao nascer e proficiência motora em crianças: uma revisão sistemática

O objetivo deste trabalho foi analisar estudos que associam o baixo peso ao nascer e a proficiência motora em crianças com idade entre um e dez anos. A revisão sistemática da literatura foi realizada em base de dados eletrônica e lista de referência dos artigos publicados. Foram utilizados os seguintes descritores na língua inglesa: "infant low birth weight", "infant very low birth weight", "infant extremely low birth weight", "motor skills", "psychomotor performance", "child development", "human development", "growth & development", "growth" e "fetal development". A análise dos estudos envolveu leitura de títulos, resumos e textos completos. No total, 18 artigos foram lidos na íntegra; apenas dois estudos tiveram delineamento longitudinal; e os demais estudos eram transversais. As crianças avaliadas tinham idade entre 9 meses e 9 anos. Na avaliação do desenvolvimento motor, há ampla utilização de instrumentos já padronizados, que avaliam habilidades motoras grossas e finas de maneira quantitativa.Os resultados dos estudos apontam que crianças nascidas com peso abaixo de 2.500g apresentam algum tipo de deficit motor. As habilidades mais afetadas foram as habilidades motoras finas e o equilíbrio. O peso ao nascer é uma variável que deve ser considerada nos estudos sobre o desenvolvimento de habilidades motoras básicas das crianças.

Visual perception and visual-motor integration in very preterm and/or very low birth weight children: a meta-analysis

A range of neurobehavioral impairments, including impaired visual perception and visual-motor integration, are found in very preterm born children, but reported findings show great variability. We aimed to aggregate the existing literature using meta-analysis, in order to provide robust estimates of the effect of very preterm birth on visual perceptive and visual-motor integration abilities. Very preterm born children showed deficits in visual-spatial abilities (medium to large effect sizes) but not in visual closure perception. Tests reporting broad visual perceptive indices showed inconclusive results. In addition, impaired visual-motor integration was found (medium effect size), particularly in boys compared to girls. The observed visual-spatial and visual-motor integration deficits may arise from affected occipital-parietal-frontal neural circuitries.

Perinatal cerebellar injury in human and animal models

Cerebellar injury is increasingly recognized through advanced neonatal brain imaging as a complication of premature birth. Survivors of preterm birth demonstrate a constellation of long-term neurodevelopmental deficits, many of which are potentially referable to cerebellar injury, including impaired motor functions such as fine motor incoordination, impaired motor sequencing and also cognitive, behavioral dysfunction among older patients. This paper reviews the morphogenesis and histogenesis of the human and rodent developing cerebellum, and its more frequent injuries in preterm. Most cerebellar lesions are cerebellar hemorrhage and infarction usually leading to cerebellar abnormalities and/or atrophy, but the exact pathogenesis of lesions of the cerebellum is unknown. The different mechanisms involved have been investigated with animal models and are primarily hypoxia, ischemia, infection, and inflammation Exposure to drugs and undernutrition can also induce cerebellar abnormalities. Different models are detailed to analyze these various disturbances of cerebellar development around birth.

Development of the Affordances in the Home Environment for Motor Development-Infant Scale

BACKGROUND

The present study reports the development and application of the Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS), a parental self-report designed to assess the quantity and quality of affordances in the home environment that are conducive to motor development for infants aged 3-18 months.

METHODS

Steps in its development included use of expert feedback, establishment of construct validity, interrater and intrarater reliability, and predictive validity. With all phases of the project, 113 homes were involved.

RESULTS

Intraclass correlation coefficients for interrater and intrarater reliability for the total score were 1 and 0.94, respectively. In addition, results indicate that the test has the characteristic of differentiating a wide range of scores. Regression analysis for the AHEMD-IS and motor development using the Alberta Infant Motor Scale supports preliminary evidence for predictive validity.

CONCLUSION

Our findings suggest that the AHEMD-IS has sufficient reliability and validity as an instrument for assessing affordances in the home environment, with clinical and research applications.

Selective deficit in spatial location memory in extremely low birth weight children at age six: the PETIT study

Spatial location memory has rarely been assessed in young children due to a scarcity of developmentally appropriate tests. This study sought to compare nonverbal learning and recall in children born extremely low birth weight (ELBW; <1000 g) and less than 33 gestational weeks (GW) with term-born children at early school age using a recently developed and adapted test. We administered a modification of the Hopkins Board to 210 children at age six; 84 born ELBW (35 born < 26 GW; 49 born 26-33 GW) and 126 term-born. Six measures were obtained: naming, trials-to-criterion, errors-to-criterion, delayed item recall, delayed location recall, and percent retention. After age correction, ELBW children had worse general cognition, item naming, delayed item recall, delayed location recall, and percent retention than term-born children. Delayed item recall and percent retention performances of ELBW children remained worse after correction for general cognition. ELBW groups (< 26 GW and 26-33 GW) groups performed worse than term-born children in naming and delayed item recall with chronological age as covariate. Those born before 26 GW, but not 26-33 GW, performed worse than term-born children in delayed location recall and percent retention. Differences remained significant after controlling for gender, maternal education, and delivery type. All three groups' performance declined from final learning trial to delayed location recall, with a decline greater for less than 26 GW than term-born children. Extreme prematurity (< 26 GW) and ELBW are significant risk factors for spatial location memory deficit. The modified Hopkins Board discriminated high-risk preterm and term-born children at early school age and appears to be a useful test to measure this rarely studied cognitive capacity.

Sensorimotor skills associated with motor dysfunction in children born extremely preterm

BACKGROUND

Children born prematurely, despite being free of intellectual and sensorineural deficits, are at risk of motor dysfunction.

AIM

To investigate the association of sensorimotor processing skills and Developmental Coordination Disorder (DCD) in "apparently normal" extreme preterm children.

STUDY DESIGN

In a matched case-control study, 50 preterm children born less than 29 weeks or birthweight <1000 g, with an IQ>85 and no identified sensorineural disability, were assessed at 8 years of age along with 50 gender and birth date matched classroom controls born at full term. A battery of sensorimotor tests was administered, which examined visual-motor, visual perception, tactile perception, kinaesthesia, and praxis.

RESULTS

For preterm children with DCD (n=21), significantly lower scores were found for the visual processing and praxis tests, with the exception of verbal command, in comparison to those 29 preterm children without DCD and term controls (median visual perception scores were 92, 96 and 108 respectively; design copying was 0.07, 0.46 and 0.95; constructive praxis was 0.09, 0.27 and 0.63; and sequencing praxis was 0.14, 0.73 and 0.96). There were no difference on the tactile sensitivity and kinaesthetic processing tests.

CONCLUSIONS

Preterm children with DCD have difficulty with visual processing tasks. Praxis or motor planning poses a particular challenge for them. Motor dysfunction in extremely preterm children was related to poorer visual processing and motor planning and may relate to a cognitive processing problem.

Convergent Validity of Two Visual Motor Integration Tests

Background:

Occupational therapists often assess visual motor integration (VMI) skills. It is, therefore, imperative that therapists use VMI tests with robust measurement properties.

Objective:

This study examined the convergent validity of two VMI tests used to assess children, adolescents and adults.

Method:

Three groups of healthy participants (n = 153) completed the Beery-Buktenica Developmental Test of Visual-Motor Integration (DTVMI) and the Full Range Test of Visual Motor Integration (FRTVMI). Seventy-three children aged 5–10 years (37 males and 36 females; mean age 7.5 years, SD = 2.20), 19 adolescents aged 11–17 years (8 males and 11 females; 13.1 years, SD = 2.16), and 61 adults (18 males and 43 females; mean age 31.82 years, SD = 11.20) completed the DTVMI and the FRTVMI. Spearman rho correlation coefficients were used to investigate whether each pair of the VMI test scores for each of the three participant age groups were associated.

Results:

The Spearman rho correlation coefficients between all three versions of the DTVMI and FRTVMI were statistically significant. For the child group, the correlation coefficient was rho = 0.70 (p<0.000), while the correlation between the VMI scores obtained by the adolescent group on the two tests was rho = 0.77 (p<0.000). For the adult participant group, the correlation coefficient between the DTVMI and the FRTVMI was rho = 0.70 (p<0.000).

Conclusion:

The VMI scores obtained by the three participant age groups on the DTVMI and the FRTVMI were all significantly correlated with each other. Overall, the DTVMI and the FRTVMI exhibited large levels of convergent validity with each other, indicating that the two tests appear to measure similar visual-motor integration constructs.

Processing speed mediates executive function difficulties in very preterm children in middle childhood

Executive function and attention difficulties are reported in very preterm (VPT) children at school entry, but it is unclear if these remain at later ages and/or if these difficulties are mediated by more basic functions, such as processing speed. Processing speed has been shown to underlie academic and behavioral problems in VPT children in middle childhood (Mulder, Pitchford, & Marlow, 2010, 2011), so may also underpin executive function and attention difficulties. We investigated this by comparing VPT (gestational age <31 weeks; N = 56) to term children (N = 22) aged 9-10 years on a comprehensive battery of executive function and attention tasks from the Test of Everyday Attention for Children (Manly, Robertson, Anderson, & Nimmo-Smith, 1999) and NEPSY (Korkman, Kirk, & Kemp, 1998). Selective and sustained attention, inhibition, working memory, shifting, verbal fluency, planning, and processing speed were examined. Group differences favoring term children were shown on most executive function tasks (i.e., inhibition, working memory, verbal fluency, and shifting), all of which were mediated by slow processing speed in the VPT group, except response inhibition. Seemingly, processing speed is an important determinant underpinning many neuropsychological deficits seen in VPT children in middle childhood.

The motor development of orphaned children with and without HIV: Pilot exploration of foster care and residential placement

Background

The AIDS epidemic has lead to an increase in orphaned children who need residential care. It is known that HIV leads to delayed motor development. However, the impact of place of residence on motor function has not been investigated in the South African context. The aim of the study was therefore to establish if children in institutionalised settings performed better or worse in terms of gross motor function than their counterparts in foster care. A secondary objective was to compare the performance of children with HIV in these two settings with those of children who were HIV negative.

Methods

Forty-four children both with and without HIV, were recruited from institutions and foster care families in Cape Town. The Peabody Development Motor Scale (PDMS II) was used to calculate the total motor quotient (TMQ) at baseline and six months later. Comparisons of TMQ were made between residential settings and between children with and without HIV.

Results

Twenty-one children were infected with HIV and were significantly delayed compared to their healthy counterparts. Antiretroviral therapy was well managed among the group but did not appear to result in restoration of TMQ to normal over the study period. HIV status and place of residence emerged as a predictor of TMQ with children in residential care performing better than their counterparts in foster care. All children showed improvement over the six months of study.

Conclusions

Foster parents were well supported administratively in the community by social welfare services but their children might have lacked stimulation in comparison to those in institutional settings. This could have been due to a lack of resources and knowledge regarding child development. The assumption that foster homes provide a better alternative to institutions may not be correct in a resource poor community and needs to be examined further.

Cerebellar abnormalities following hypoxia alone compared to hypoxic-ischemic forebrain injury in the developing rat brain

Two-day-old (P2) rat pups were subjected to either a global hypoxia or to electrocoagulation of the right carotid artery followed by 2.5 h hypoxia. Cellular and regional injury in the cerebellum (CB) was studied at 1, 2 and 19 days using immunohistology. Following hypoxia and hypoxia-ischemia, all neuronal populations of the CB were damaged in a subset of Purkinje cells. The decrease in the number of interneurons, as well as the thickness of molecular and granular layers was significant following hypoxia. Diffuse white matter damage, with loss of preoligodendrocytes was more severe following hypoxia than hypoxia-ischemia. Global hypoxia in the rat at P2 produces extensive damage to many cell types in different areas of the CB. The addition of unilateral forebrain ischemia does not increase the severity of these changes. Our data provide insight into the mechanisms of the changes observed in the CB of premature newborns.

Interlimb coordination differentiates Brazilian children from two socioeconomic settings

BACKGROUND

The aim of the present study was to test the notion that Brazilian children entering private school have a motor function advantage over those entering their first year in public school.

METHODS

Four hundred and two children from the two cultural settings were examined for motor function in the first and 10th month of school (first grade). Participants were assessed based on age-level standards and by total score for all items for children 3 to 7 years of age.

RESULTS

The private school group outperformed their public setting peers on the first and second assessment; both groups improved over the school year. The most interesting outcome was the type of motor task that most clearly differentiated the groups: activities requiring gross motor (interlimb) coordination.

CONCLUSION

Among the recommendations given, it is suggested that motor skill activities, especially those involving interlimb coordination, be included with any type of motor programming for young children.

Representational momentum in children born preterm and at term

The term representational momentum (RM) refers to the idea that our memory representations for moving objects incorporate information about movement - a fact that can lead us to make errors when judging an object's location (the RM effect). In this study, we explored the RM effect in a sample of children born very prematurely and a sample born at term. Because preterm children are known to be at risk for problems with motion perception, we anticipated that they would show a weaker or absent RM effect. This prediction was confirmed. In addition, we found that, in both samples of children, 5-6year olds showed a reduced RM effect compared to 7-9year olds. These results demonstrate that the ability to represent motion information in memory shows continued development over this age range, and may help to elucidate factors contributing to problems with fine and gross motor planning and execution that have been observed in the preterm population. We propose that problems affecting the formation, maintenance, or use of predictive models, or motion extrapolation skills, may have cascading effects on the development of other abilities.

Growth mixture modeling of academic achievement in children of varying birth weight risk

The extremes of birth weight and preterm birth are known to result in a host of adverse outcomes, yet studies to date largely have used cross-sectional designs and variable-centered methods to understand long-term sequelae. Growth mixture modeling (GMM) that utilizes an integrated person- and variable-centered approach was applied to identify latent classes of achievement from a cohort of school-age children born at varying birth weights. GMM analyses revealed 2 latent achievement classes for calculation, problem-solving, and decoding abilities. The classes differed substantively and persistently in proficiency and in growth trajectories. Birth weight was a robust predictor of class membership for the 2 mathematics achievement outcomes and a marginal predictor of class membership for decoding. Neither visuospatial-motor skills nor environmental risk at study entry added to class prediction for any of the achievement skills. Among children born preterm, neonatal medical variables predicted class membership uniquely beyond birth weight. More generally, GMM is useful in revealing coherence in the developmental patterns of academic achievement in children of varying weight at birth and is well suited to investigations of sources of heterogeneity.

Magnetic resonance imaging--insights into brain injury and outcomes in premature infants

Preterm birth is a major public-health issue because of its increasing incidence combined with the frequent occurrence of subsequent behavioral, neurological, and psychiatric challenges faced by surviving infants. Approximately 10-15% of very preterm children (born<30 weeks gestational age) develop cerebral palsy, and 30-60% of them experience cognitive impairments. These adverse outcomes are related to a confluence of abnormal brain development along with white (WM) and gray matter (GM) injury sustained during the neonatal period. It is becoming apparent that the extra-uterine environment during this critical period (24-40 weeks gestation) in brain development has a profound and long lasting impact on the premature infant. Magnetic resonance imaging in the neonatal period and infancy provides a non-invasive, "in vivo" assessment of brain development and extent of brain injury. This not only helps understand the extent and timing of injury but also identifies infants who may benefit from early intervention to minimize the impact of the injury.

LEARNING OUTCOMES

Readers will be able to (1) appreciate the diverse impact of prematurity on neurodevelopmental outcome, (2) recognize the biological vulnerability of the developing brain in premature infants born between 24 and 40 weeks of gestation, (3) understand the role of magnetic resonance imaging (MRI) as a tool to detect abnormal development and brain injury in premature infants, and (4) see the potential role for novel MR imaging methods as biomarkers for brain development and injury in premature infants.

Early school-based learning difficulties in children born very preterm

BACKGROUND

Educational underachievement is a major morbidity associated with very preterm (VPT) birth. However, few studies have examined early school outcomes with most employing global, clinic based measures.

OBJECTIVE

To examine the early school achievement in a cohort of children born VPT and studied to age 6 years.

METHODS

A regional cohort of 102 VPT children (</=33 weeks GA) were followed prospectively alongside a comparison group of 108 full term (FT) children born during the same period (1998-2000). At 6 years corrected age, all children underwent a comprehensive neurodevelopmental evaluation that included the Woodcock-Johnson Tests of Achievement (WJ-III), teacher report and national numeracy and literacy test results. Rates of specific learning disabilities (LD) were also examined.

RESULTS

VPT children performed less well than FT children on WJ-III subtests (ps<.05), national tests (ps<.01), and in all curricular areas rated by teachers (ps<.01) except expressive language. Even VPT children without severe neurodevelopmental impairment scored lower on the WJ-III math, national tests (ps<.05) and were 2-3 times more likely to show delays (ps<.02) in math (43% vs. 19%), written language (36% vs. 22%), language comprehension (26% vs. 14%), handwriting (36% vs. 17%), spelling (38% vs. 30%) and physical education (33% vs. 11%). They were also twice as likely as FT children to have math LD (47% vs. 21%).

CONCLUSIONS

By age 6, a substantial proportion of VPT children are lagging behind their FT peers across multiple curriculum areas, with difficulties being most prominent in math. Findings highlight the need for early identification and educational supports to help maximise VPT children's learning opportunities during the transition to school.

Age-appropriate early school age neurobehavioral outcomes of extremely preterm birth without severe intraventricular hemorrhage: a single center experience

BACKGROUND

Extremely low birth weight (ELBW) is an established risk factor for poor neurocognitive outcome, particularly when severe intraventricular hemorrhage (IVH) complicates the neonatal course. Those born <26 weeks gestational age (GA) are at greatest risk, their outcomes poorer than later born ELBW children. Outcomes of GA subgroups of ELBW uncomplicated by severe IVH have not been well described.

AIM

To compare neurocognitive and behavioral outcomes of those born < and >or=26 weeks for an ELBW cohort treated in a single center with extremely low IVH incidence.

DESIGN

Single center retrospective observational cohort study of <or=1000 g survivors born between 1998-2000, using standardized tests of cognition, academic achievement, executive function, attention, language, memory, motor/visual-motor skill, parent and teacher behavioral questionnaires.

RESULTS

ELBW participants (mean age: 6.85+/-0.79) had a mean General Cognitive Ability of 101.4+/-13.05; no significant differences found between <26 weeks (98.19+/-12.48) and >or=26 weeks (102.97+/-13.21) subgroups. No neurocognitive, achievement, or behavioral score was impaired (>or=2 SDs below the normative mean). Subgroup comparisons were nonsignificant after controlling for BW and maternal education, except for >or=26 week advantage for phoneme analysis. Poorer, but low average, performances were found for motor dexterity/coordination, spatial working memory, and selective attention.

CONCLUSIONS

Age-appropriate neurocognitive and behavioral function of ELBW survivors suggests outcome may be predicted based on IVH incidence as opposed to birth weight or GA. Factors leading to decreased IVH incidence deserve further study, via single- and cross-center methodologies, to enhance decision-making regarding resuscitation and care of these highly at-risk neonates.

Construct validity of the Test of Visual-Motor Skills-Revised (TVMS-R): an evaluation using the Rasch Measurement Model

Construct validity of instruments, tests, and scales can be examined using the Rasch Measurement Model (RMM) during their initial construction and validation, or after they have been published. The aim of this study was to examine the construct validity of the Test of Visual-Motor Skills-Revised (TVMS-R) by applying the RMM to evaluate its scalability, dimensionality, differential item functioning, and hierarchical ordering. The participants included 400 children aged 5 to 12 years, recruited from six schools in the Melbourne metropolitan area, Victoria, Australia. Children completed the TVMS-R under the supervision of an occupational therapist. Overall, 39 out of 142 of the TVMS-R scale scoring accuracy classification criteria items exhibited poor measurement properties. As nearly one-third of the scoring classification criteria items were found to be problematic, the TVMS-R in its current form is not recommended for clinical use, as it is not consistent with the clinical demands expected of an instrument used to evaluate the visual motor integration skills of children.