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Li L, Zhang L, Cui H, Zhao Y, Zhu C, Fan Q, Li W. Gait and sEMG characteristics of lower limbs in children with unilateral spastic cerebral palsy during walking. Gait Posture 2024; 108:177-182. [PMID: 38100956 DOI: 10.1016/j.gaitpost.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/19/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Children with unilateral spastic cerebral palsy (USCP) have muscle hypertonia, balance, and coordination defects that affect gross motor skills, especially walking. Understanding the gait characteristics and lower limb muscle activation patterns of USCP children can provide an objective and quantitative basis for patient assessment and treatment plan formulation. OBJECTIVE This study compared the gait and lower limb muscle activation characteristics of children with USCP and with typical development (TD) during walking. METHODS We recorded gait and sEMG data of 20 children with USCP, and 20 with typical development. sEMG signals were acquired from the bilateral tibialis anterior (TA) and lateral gastrocnemius muscles (LG) during walking. The root mean square (RMS) value, integrated electromyographic (iEMG) value and co-contraction ratio (CR) were used to evaluate muscle activity. Student's t Test and non-parametric rank sum Test were used to compare the differences between the data groups (significance level of 0.05). RESULTS The stance time, step length, speed, single leg support time ratio, ground impact, pre-swing angle, and muscle strength of the affected side were significantly decreased compared to those of the unaffected side in children with USCP (P < 0.05), while the swing phase, muscle tonus of LG were significantly prolonged (P < 0.05). Compared with TD children, children with USCP exhibited reduced bilateral walking ability, particularly noticeable in their smaller pre-swing angle(P < 0.05), diminished muscle strength of the TA and LG, as well as LG spasms(P < 0.05). SIGNIFICANCE Children with USCP have decreased ambulatory gait stability. Step length, pull acceleration, pre-swing angle, and CR can be used as sensitive indicators for gait assessment. Strengthening the TA muscle and reducing ankle spasm may help improve gait and postural stability in children with USCP.
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Affiliation(s)
- Longfei Li
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong 264003, China
| | - Lina Zhang
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China
| | - Hongxing Cui
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China
| | - Yixuan Zhao
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong 264003, China
| | - Chuanhua Zhu
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China
| | - Qianqian Fan
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China.
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong 256603, China.
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Huisenga D, la Bastide-van Gemert S, Van Bergen AH, Sweeney JK, Hadders-Algra M. Motor development in infants with complex congenital heart disease: A longitudinal study. Dev Med Child Neurol 2023; 65:117-125. [PMID: 35665492 PMCID: PMC10084079 DOI: 10.1111/dmcn.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/31/2022]
Abstract
AIM To evaluate whether infants with complex congenital heart disease (CCHD) have an increased risk of impaired quality of motor behavior and delayed motor milestones. METHOD A cohort of 69 infants with CCHD (43 males, 26 females) were assessed with the Infant Motor Profile (IMP) at three time periods between 6 to 18 months, mean ages in months (SD): 6.4 (0.7); 12.7 (1.0); 18.5 (0.7) IMP data were available from a reference sample of 300 Dutch infants. Analyses included multivariable logistic regression analysis to estimate differences in IMP scores below the 15th centile between children with CCHD and the reference group, and linear mixed-effects models to assess the effect of ventricular physiology and systemic oxygen saturation (SpO2) of less than 90% on IMP outcomes. RESULTS Infants with CCHD had increased risks of total IMP scores below the 15th centile (lowest odds ratio [OR] at 18mo: 6.82 [95% confidence interval {CI} 2.87-16.19]), especially because of lower scores in the domains of variation, adaptability, and performance. Children with single ventricle CCHD scored consistently 3.03% (95% CI 1.00-5.07) lower than those with two ventricle physiology, mainly from contributions of the variation and performance domains. SpO2 of less than 90% was associated with 2.52% (95% CI 0.49-4.54) lower IMP scores. INTERPRETATION CCHD, especially single ventricle physiology, increases risk of impaired motor development. WHAT THIS PAPER ADDS Complex congenital heart disease (CCHD) substantially increases risk of impaired motor development. CCHD is associated with motor delay and reduced motor variation and adaptability. Single ventricle physiology increases the risk of impaired motor behavior.
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Affiliation(s)
- Darlene Huisenga
- Advocate Children's Hospital, Department of Pediatric Rehabilitation and Development, Oak Lawn, Illinois, USA.,University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
| | - Sacha la Bastide-van Gemert
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Andrew H Van Bergen
- Advocate Children's Hospital, Department of Pediatric Rehabilitation and Development, Oak Lawn, Illinois, USA.,Advocate Children's Hospital, Advocate Children's Heart Institute, Division of Pediatric Cardiac Critical Care, Oak Lawn, Illinois, USA
| | - Jane K Sweeney
- Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
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Coxon ML, Hoyt CR, Smith AE, Hadders-Algra M. Going Beyond Conventional Assessment of Developmental Motor Disorders: Exploring Video Methods for Early Identification Among Children 0 to 3 Years. ADVANCES IN REHABILITATION SCIENCE AND PRACTICE 2023; 12:27536351231207740. [PMID: 37928362 PMCID: PMC10621290 DOI: 10.1177/27536351231207740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
Motor skills and movement-related functioning significantly shape how children experience and interact with the world around them. Among infants and young children, developmental motor disorders contribute to delays with motor, cognitive, and psychosocial development. Early and accurate identification of these disorders is necessary to facilitate timely access to therapeutic interventions that minimize the long-term effects of disability on everyday activities and participation. In the United States, motor assessments commonly used among children 0 to 3 years focus on completion of specific motor skills at a single point in time, which provides only a part of the greater picture that is a child's motor and movement-related functioning. Video-capture methods, like the General Movements Assessment (GMA) and the Infant Motor Profile (IMP), offer greater accuracy and predictive power to (1) identify motor deficits in young children and (2) facilitate early access to supportive, therapeutic intervention.
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Affiliation(s)
- Maria Lopez Coxon
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine R Hoyt
- Departments of Neurology and Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Alyssa E Smith
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Centre Groningen, Department of Pediatrics, Division of Developmental Neurology, Groningen, the Netherlands
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Guy BJ, Morris A, Mirjalili SA. Toward Emulating Human Movement: Adopting a Data-Driven Bitmap-Based "Voxel" Multimaterial Workflow to Create a Flexible 3D Printed Neonatal Lower Limb. 3D PRINTING AND ADDITIVE MANUFACTURING 2022; 9:349-364. [PMID: 36660289 PMCID: PMC9831563 DOI: 10.1089/3dp.2021.0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
It is increasingly common to produce physical anatomical medical models using high-fidelity multiproperty 3D printing to assist doctor-patient communication, presurgical planning, and surgical simulation. Currently, most medical models are created using image thresholding and traditional mesh-based segmentation techniques to produce mono-material boundaries (STL file formats) of anatomical features. Existing medical modeling manufacturing methods restrict shape specification to one material or density, which result in anatomically simple 3D printed medical models with no gradated material qualities. Currently, available high-resolution functionally graded multimaterial 3D printed medical models are rigid and do not represent biomechanical movement. To bypass the identified limitations of current 3D printing medical modeling workflows, we present a bitmap-based "voxel" multimaterial additive manufacturing workflow for the production of highly realistic and flexible anatomical models of the neonatal lower limb using computed tomographic ("CT") data. By interpolating and re-slicing a biomedical volumetric data set at the native 3D printer z resolution of 27 μm and using CT scan attenuation properties (Hounsfield units) to guide material mixing ratios, producing highly realistic models of the neonatal lower limb at a significantly faster rate than other manufacturing methods. The presented medical modeling workflow has considerable potential to improve medical modeling manufacturing methods by translating medical data directly into 3D printing files aiding in anatomical education and surgical simulation practices, especially in neonatal research and clinical training.
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Affiliation(s)
- Bernard Joseph Guy
- Industrial Design Department, School of Design Innovation, Victoria University of Wellington, Wellington, New Zealand
| | - Ana Morris
- Industrial Design Department, School of Design Innovation, Victoria University of Wellington, Wellington, New Zealand
| | - Seyed Ali Mirjalili
- Anatomy and Medical Imaging Department, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Infant motor behaviour and functional and cognitive outcome at school-age: A follow-up study in very high-risk children. Early Hum Dev 2022; 170:105597. [PMID: 35689969 DOI: 10.1016/j.earlhumdev.2022.105597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/31/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Infant Motor Profile (IMP) is an appropriate tool to assess and monitor infant motor behaviour over time. Infants at very high risk (VHR) due to a lesion of the brain generally show impaired motor development. They may grow into or out of their neurodevelopmental deficit. AIMS Evaluate associations between IMP-trajectories, summarised by IMP-scores in early infancy and rates of change, and functional and cognitive outcome at school-age in VHR-children. STUDY DESIGN Longitudinal study. SUBJECTS 31 VHR-children, mainly due to a brain lesion, who had multiple IMP-assessments during infancy, were re-assessed at 7-10 years (school-age). OUTCOME MEASURES Functional outcome was assessed with the Vineland-II, cognition with RAKIT 2. Associations between IMP-trajectories and outcome were tested by multivariable linear regression analyses. RESULTS When corrected for sex, maternal education and follow-up age, initial scores of total IMP, variation and performance domains, as well as their rates of change were associated with better functional outcome (unstandardised coefficients [95% CI]): 36.44 [19.60-53.28], 33.46 [17.43-49.49], 16.52 [7.58-25.46], and 513.15 [262.51-763.79], 356.70 [148.24-565.15], and 269 [130.57-407.43], respectively. Positive rates of change in variation scores were associated with better cognition at school-age: 34.81 [16.58-53.03]. CONCLUSION Our study indicated that in VHR-children IMP-trajectories were associated with functional outcome at school-age, and to a minor extent also with cognition. Initial IMP-scores presumably reflect the effect of an early brain lesion on brain functioning, whereas IMP rate of change reflects whether infants are able to grow into or out of their initial neurodevelopmental deficit.
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Tveten KM, Strand LI, Riiser K, Nilsen RM, Dragesund T. The ability of the Ages and Stages Questionnaire (ASQ) to indicate motor difficulties in infants in primary care. Physiother Theory Pract 2022:1-7. [PMID: 35321635 DOI: 10.1080/09593985.2022.2056553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Delayed achievement of motor milestones may be an early indicator of motor difficulties. Parent-reported questionnaires may serve as an efficient, low-cost screening to identify infants in need of further clinical assessment, and thus be a helpful tool in busy health care centers. PURPOSE To examine the ability of the Ages and Stages Questionnaire, second edition (ASQ-2) to indicate motor difficulties in infants using the Infant Motor Profile (IMP) as the reference standard. METHODS A cross-sectional design was applied to examine the correlation between parent-reported data of the ASQ-2 and data from physiotherapist assessment using IMP. Included were 432 mainly low-risk infants aged 3-12 months from primary care. RESULTS Overall, ASQ-2 gross and fine motor scores did not correlate well with the IMP total or domain scores. The ASQ-2 gross motor cut point (> 2SD below the mean), showed 34.3% sensitivity and 96.7% specificity using the 15th percentile from IMP performance domain as reference standard. The positive predictive value to indicate motor difficulties was 48%. CONCLUSION The motor domains of ASQ-2 have poor ability to identify infants with motor difficulties as indicated by their IMP scores in low-risk infants.
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Affiliation(s)
- Kine Melfald Tveten
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kirsti Riiser
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Roy Miodini Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tove Dragesund
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Active head lifting from supine in infancy in the general population: Red flag or not? Early Hum Dev 2021; 163:105466. [PMID: 34543946 DOI: 10.1016/j.earlhumdev.2021.105466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Previously it had been had reported that active head lifting from supine (AHLS) in high-risk infants was associated with lower cognitive scores in the second year. AHLS was generally accompanied by stereotyped leg movements. AIMS To examine in a standardized way whether AHLS with or without stereotyped leg movements in the general population is associated with prenatal, perinatal, neonatal and socio-economic risk factors or with lower scores on concurrent infant tests. STUDY DESIGN Cross-sectional study SUBJECTS: 1700 infants aged 2-18 months representative of the Dutch population. OUTCOME MEASURES Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). Assessments were video-recorded and included at the youngest ages 3min of behaviour in supine. AHLS and the presence of stereotyped leg movements were recorded. Standardized information on early risk factors was available. RESULTS AHLS occurred at 4-9 months (prevalence per months: 1-14%; highest prevalence at 6 months). It was not associated with early risk factors or scores on infant tests. When AHLS was accompanied by stereotyped leg movements it was associated with a higher prevalence of an IMP-variation score < P15 (Odds Ratio (OR) 2.472 [95%CI 1.017; 6.006]). Stereotyped leg movements irrespective of AHLS were associated with more unfavourable total IMP scores and IMP performance scores (B coefficients -3.212 [-4.065; -2.360], -2.521 [-3.783; -1.259]) and IMP variation and SINDA neurological scores (ORs 5.432 [3.409; 8.655], 3.098 [1.548; 6.202]). CONCLUSIONS The data suggest that AHLS is not a red flag. Rather its co-occurring stereotyped leg movements may signal less favourable neurodevelopment.
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Menici V, Antonelli C, Beani E, Mattiola A, Giampietri M, Martini G, Rizzi R, Cecchi A, Cioni ML, Cioni G, Sgandurra G. Feasibility of Early Intervention Through Home-Based and Parent-Delivered Infant Massage in Infants at High Risk for Cerebral Palsy. Front Pediatr 2021; 9:673956. [PMID: 34350144 PMCID: PMC8328146 DOI: 10.3389/fped.2021.673956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
Infant massage (IM) can be considered an early intervention program that leads to the environmental enrichment framework. The effectiveness of IM to promote neurodevelopment in preterm infants has been proved, but studies on infants with early brain damage are still lacking. The main aim of this study was to assess the feasibility, acceptability and usability of IM, carried out by parents at home, on infants at high risk for Cerebral Palsy. An IM daily diary and an ad hoc questionnaire, called Infant Massage Questionnaire Parent-Infant Experiences (IMQPE), were developed. IMQPE consisted of a total of 30 questions, divided into 5 areas. The parents were trained to carry out the IM with a home-based course, conducted by an expert therapist. The intensive IM program was set according to a defined daily length of at least 20 min, with a frequency of at least 5 days per week for a total of 8 weeks. Data collection consisted in the selection of the variables around the characteristics, both of the infants and the mothers, IM dosage and frequency, different body parts of the infants involved and IMQPE scores. Variable selection was carried out by minimizing the Bayesian Information Criteria (BIC) over all possible variable subsets. Nineteen high-risk infants, aged 4.83 ± 1.22 months, received IM at home for 8 weeks. The massage was given by the infants' mothers with a mean daily session dose of 27.79 ± 7.88 min and a total of 21.04 ± 8.49 h. 89.74% and 100% of mothers performed the IM for the minimum daily dosage and the frequency recommended, respectively. All the families filled in the IMQPE, with a Total mean score of 79.59% and of 82.22% in General Information on IM, 76.30% in Infant's intervention-related changes, 76.85% in IM Suitability, 79.07% in Infant's acceptance and 83.52% in Time required for the training. Different best predictors in mothers and in infants have been found. These data provide evidence of the feasibility of performing IM at home on infants at high risk for CP. Study registration: www.clinicaltrial.com (NCT03211533 and NCT03234959).
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Affiliation(s)
- Valentina Menici
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Camilla Antonelli
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Tuscan Ph.D. Programme of Neuroscience, University of Florence, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Alessandra Mattiola
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Pisa, Italy
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Pisa, Italy
| | - Giada Martini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Riccardo Rizzi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Tuscan Ph.D. Programme of Neuroscience, University of Florence, Florence, Italy
| | - Alessandra Cecchi
- Division of Neonatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Maria Luce Cioni
- Neonatal Intensive Care Unit, Children's Hospital A. Meyer, Florence, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Akhbari Ziegler S, Rhein M, Meichtry A, Wirz M, Hielkema T, Hadders‐Algra M. The Coping with and Caring for Infants with Special Needs intervention was associated with improved motor development in preterm infants. Acta Paediatr 2021; 110:1189-1200. [PMID: 33047325 PMCID: PMC7984220 DOI: 10.1111/apa.15619] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022]
Abstract
AIM We compared the impact of standard infant physiotherapy and the family-centred programme, Coping with and Caring for Infants with Special Needs (COPCA), in infants born before 32 weeks without significant brain lesions. METHODS This randomised controlled trial was carried out in patients' homes and outpatient settings in Switzerland between January 2016 and October 2019. We used data from the national SwissNeoNet register and an assessment battery that included infant and family outcomes and video analyses of therapy sessions. The Infant Motor Profile was the primary outcome instrument. RESULTS The COPCA group comprised six boys and two girls with a median gestational age of 27 weeks (range 25-30), and the standard care group comprised seven boys and one girl with a median gestational age of 29.5 weeks (range 26-31). COPCA participants improved significantly more between baseline and 18 months in the IMP variation (9.0 percentage points, 95% confidence interval: 0.3-17.5) and performance (12.0 percentage points, 95% confidence interval: 4.1-20.6) domains than standard care participants. COPCA coaching was positively associated with IMP scores at 18 months, but some standard care actions were negatively associated. CONCLUSION COPCA was associated with better motor outcome in infants born before 32 weeks than standard infant physiotherapy.
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Affiliation(s)
- Schirin Akhbari Ziegler
- School of Health Professions Institute of Physiotherapy Zurich University of Applied Sciences ZHAW Winterthur Switzerland
| | - Michael Rhein
- Department of Pediatrics Kantonsspital Winterthur Winterthur Switzerland
- University Children`s Hospital Zurich Zurich Switzerland
| | - André Meichtry
- School of Health Professions Institute of Physiotherapy Zurich University of Applied Sciences ZHAW Winterthur Switzerland
| | - Markus Wirz
- School of Health Professions Institute of Physiotherapy Zurich University of Applied Sciences ZHAW Winterthur Switzerland
| | - Tjitske Hielkema
- Department of Pediatrics Division of Developmental Neurology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Mijna Hadders‐Algra
- University of Groningen University Medical Center Groningen Department of Pediatrics Division of Developmental Neurology Groningen The Netherlands
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Hadders-Algra M. Early Diagnostics and Early Intervention in Neurodevelopmental Disorders-Age-Dependent Challenges and Opportunities. J Clin Med 2021; 10:861. [PMID: 33669727 PMCID: PMC7922888 DOI: 10.3390/jcm10040861] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022] Open
Abstract
This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2-4 months and from 2-4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics-Section Developmental Neurology, 9713 GZ Groningen, The Netherlands
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Rizzi R, Menici V, Cioni ML, Cecchi A, Barzacchi V, Beani E, Giampietri M, Cioni G, Sgandurra G. Concurrent and predictive validity of the infant motor profile in infants at risk of neurodevelopmental disorders. BMC Pediatr 2021; 21:68. [PMID: 33549070 PMCID: PMC7866878 DOI: 10.1186/s12887-021-02522-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Preterm infants and infants with perinatal brain injury show a higher incidence of neurodevelopmental disorders (NDD). The Infant Motor Profile (IMP) is a clinical assessment which evaluates the complexity of early motor behaviour. More data are needed to confirm its predictive ability and concurrent validity with other common and valid assessments such as the Alberta Infant Motor Scale (AIMS) and Prechtl's General Movement Assessment (GMA). The present study aims to evaluate the concurrent validity of the IMP with the AIMS, to assess its association with the GMA, to evaluate how the IMP reflects the severity of the brain injury and to compare the ability of the IMP and the AIMS to predict an abnormal outcome in 5-month-old infants at risk of NDD. METHODS 86 infants at risk of NDD were retrospectively recruited among the participants of two clinical trials. Preterm infants with or without perinatal brain injury and term infants with brain injury were assessed at 3 months corrected age (CA) using the GMA and at 5 months CA using the IMP and the AIMS. The neurodevelopmental outcome was established at 18 months. RESULTS Results confirm a solid concurrent validity between the IMP Total Score and the AIMS (Spearman's ρ 0.76; p < .001) and a significant association between IMP Total Score and the GMA. Unlike the AIMS, the IMP Total score accurately reflects the severity of neonatal brain injury (p < .001) and proves to be the strongest predictor of NDD (p < .001). The comparison of areas under receiver operating characteristic curves (AUC) confirms that the IMP Total score has the highest diagnostic accuracy at 5 months (AUC 0.92). For an optimal IMP Total Score cut-off value of 70, the assessment shows high sensitivity (93%) and specificity (81%) (PPV 84%; NPV 90%). CONCLUSIONS Early motor behaviour assessed with the IMP is strongly associated with middle-term neurodevelopmental outcome. The present study confirms the concurrent validity of the IMP with the AIMS, its association with the GMA and its ability to reflect brain lesion load, hence contributing to the construct validity of the assessment. TRIAL REGISTRATION NCT01990183 and NCT03234959 (clinicaltrials.gov).
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Affiliation(s)
- Riccardo Rizzi
- Tuscan PhD Programme of Neuroscience, University of Florence, Pisa and Siena, Florence, Italy
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Valentina Menici
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Maria Luce Cioni
- Neonatal Intensive Care Unit, Children's Hospital A. Meyer, Florence, Italy
| | - Alessandra Cecchi
- Division of Neonatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Veronica Barzacchi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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Montgomery C, F. Kaul Y, Strand Brodd K, Persson K, Hellström‐Westas L. Structured Observation of Motor Performance in Infants: Level and quality associated with later motor development. Acta Paediatr 2021; 110:307-313. [PMID: 32474945 DOI: 10.1111/apa.15377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 01/22/2023]
Abstract
AIM The aim of this study was to investigate the level of motor development and the quality of motor performance during the first 10 months in relation to the Bayley Scales of Infant Development-third edition (Bayley-III) motor index at 2.5 years. METHODS Children born very preterm from a population-based study (n = 113) were assessed with the Structured Observation of Motor Performance in Infants (SOMP-I) at 2, 4, 6 and 10 months corrected age and the Bayley-III motor index at 2.5 years corrected age (n = 98). Logistic regressions were performed to investigate the independent association of each SOMP-I domain to Bayley-III motor index. RESULTS There were significant associations between the SOMP-I-scores and Bayley-III motor index per every assessment age. At 4 months, both level and quality were independently associated with a later motor outcome, OR for level was 1.26 (95% CI = 1.08-1.50, P = .002) and for quality, 0.75 (95% CI = 0.63-0.90, P = .002). Quality was independently associated with the Bayley-III motor index at 6 and 10 months: OR 0.080 (95% CI = 0.67-0.95 P = .010) and 0.79 (95% CI = 0.64-0.97, P = .026). CONCLUSION Both SOMP-I domains, level and quality, are markers to identify motor problems early. Quality became more important with age.
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Affiliation(s)
- Cecilia Montgomery
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - Ylva F. Kaul
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - Katarina Strand Brodd
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
- Centre for Clinical Research Sörmland Uppsala University Uppsala Sweden
| | - Kristina Persson
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
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Tveten KM, Hadders-Algra M, Strand LI, Van Iersel PAM, Rieber J, Dragesund T. Intra- and Inter-Rater Reliability of the Infant Motor Profile in Infants in Primary Health Care. Phys Occup Ther Pediatr 2020; 40:571-581. [PMID: 32003280 DOI: 10.1080/01942638.2020.1720331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To explore intra-rater and inter-rater reliability of the Infant Motor Profile (IMP). The IMP is a video-based method assessing movement quality (movement variation, adaptability, symmetry and fluency) and motor skills in infants aged 3 to 18 months. METHOD The IMP assessment was performed on 50 infants aged 3 to 12 months recruited in connection with health control in primary health care, mean gestational age at birth 39.4 weeks, mean birthweight 3462 g. Seven infants had a moderately increased risk of developmental disorders. Three pediatric physiotherapists performed independent rating of the video recordings. One rater assessed the video recordings twice with a four-week interval. RESULTS Intraclass correlation coefficient (ICC) for intra-rater reliability was found satisfactory for the total IMP score (ICC = 0.95), and the domains: performance (ICC = 0.98), variation (ICC = 0.74), adaptability (ICC = 0.93) and fluency (ICC = 0.86). The ICC value for symmetry was 0.65. For inter-rater reliability, ICC values were satisfactory for the total IMP score (ICC = 0.86-0.91), and the domains: performance (ICC = 0.98), variation (ICC = 0.71-0.82), adaptability (ICC = 0.99) and fluency (ICC = 0.82-0.81). The ICC values for symmetry varied between 0.13-0.35. CONCLUSION In this sample, including mostly low-risk infants, satisfactory intra- and inter-rater reliability for all domains were demonstrated, except for symmetry.
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Affiliation(s)
| | - Mijna Hadders-Algra
- University Medical Center Groningen Developmental Neurology, University of Groningen, Groningen, GZ, The Netherlands
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Jannike Rieber
- Children's Physiotherapy Center and Turbo, Bergen, Norway
| | - Tove Dragesund
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Heineman KR, Schendelaar P, Van den Heuvel ER, Hadders-Algra M. Motor development in infancy is related to cognitive function at 4 years of age. Dev Med Child Neurol 2018; 60:1149-1155. [PMID: 29633244 DOI: 10.1111/dmcn.13761] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 11/29/2022]
Abstract
AIM Evidence is accumulating that motor and cognitive development are interrelated. This study investigates associations between motor development in infancy and cognitive function at 4 years of age. METHOD This study is part of the Groningen prospective cohort study on the development of children born after assisted reproductive techniques such as in vitro fertilization. The study group consisted of 223 children (119 males, 104 females) born to subfertile couples (median gestational age 39.6wks, range 30-43wks). Motor behaviour was assessed with the Infant Motor Profile (IMP) at 4 months, 10 months, and 18 months. IQ was evaluated at 4 years with the Kaufman Assessment Battery for Children, Second Edition. Latent class growth modelling was used to analyse relations between IMP and IQ scores. RESULTS Infants with low total IMP scores had an IQ that was 8.9 points lower at 4 years than infants with typical IMP scores (95% confidence interval 3.6-14.1). Also, low scores in the domains of variation and performance were associated with a lower IQ at 4 years of age, by 6.1 points and 13.2 points respectively. INTERPRETATION Motor development in relatively low-risk infants is associated with cognition at 4 years of age. In particular, low motor variation and performance are associated with a lower IQ at 4 years of age. WHAT THIS PAPER ADDS Motor development in infancy is directly related to cognitive function at 4 years of age. This relationship is most pronounced for infant motor variation and performance. The size of the differences in IQ is clinically relevant.
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Affiliation(s)
- Kirsten R Heineman
- Division of Developmental Neurology, Department of Paediatrics, University Medical Center Groningen, Groningen, the Netherlands.,SEIN Centre of Excellence for Epilepsy and Sleep Medicine, Zwolle, the Netherlands
| | - Pamela Schendelaar
- Division of Developmental Neurology, Department of Paediatrics, University Medical Center Groningen, Groningen, the Netherlands
| | - Edwin R Van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Mijna Hadders-Algra
- Division of Developmental Neurology, Department of Paediatrics, University Medical Center Groningen, Groningen, the Netherlands
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Are postural adjustments during reaching related to walking development in typically developing infants and infants at risk of cerebral palsy? Infant Behav Dev 2017; 50:107-115. [PMID: 29268105 DOI: 10.1016/j.infbeh.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In typical development, postural adjustments during reaching change in the second half of infancy, including increasing rates of direction-specific adjustments. These changes are absent or different in infants at risk of cerebral palsy (CP). To discover whether these changes are related to acquisition of independent walking, we studied postural adjustments during reaching in infants before and after they learned to walk. METHODS Ten typically developing (TD) infants and 11 infants at very high risk (VHR) of CP were assessed before and after they learned to walk. Reaching movements were elicited during supported sitting, while surface electromyography was recorded of arm, neck, and trunk muscles. Percentages of direction-specific adjustments (first level of control), and recruitment patterns and anticipatory activation (second level of control) were calculated. RESULTS In both groups, postural adjustments during reaching were similar before and after acquisition of independent walking. Direction-specificity increased with age in typically developing infants but not in VHR-infants. CONCLUSION Increasing age rather than the transition to independent walking is associated with increasing direction-specificity of TD-infants during reaching while sitting, while infants at very high risk of CP show no increase in direction-specificity, suggesting that they gradually grow into a postural deficit.
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Di Rosa G, Cavallaro T, Alibrandi A, Marseglia L, Lamberti M, Giaimo E, Nicotera A, Bonsignore M, Gagliano A. Predictive role of early milestones-related psychomotor profiles and long-term neurodevelopmental pitfalls in preterm infants. Early Hum Dev 2016; 101:49-55. [PMID: 27405056 DOI: 10.1016/j.earlhumdev.2016.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/15/2016] [Accepted: 04/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Developmental milestones are useful signposts developed to assess the pace and the trajectory of maturation occurring during specific time-windows called critical periods. The predictive role of their clinical assessment in premature infants is challenging, however, it actually represents an easy and reliable tool at follow-up. AIM AND STUDY DESIGN Relying on a milestone-based neurological examination, we aimed to detect the interdependence between time of achievement of each milestone with long-term neuropsychological and neurodevelopmental outcomes. The influence of pre-perinatal events was also considered. PATIENTS & METHODS Two-hundred-eighty patients (53.2% M) were serially assessed by classic neurological examination during the first 18months and subsequently evaluated by Griffiths Developmental Mental Scale. Children were sorted by ranges of gestational age and compared according to their different profiles. RESULTS The Extremely PreTerms appeared to have a globally delayed development with subsequent attentional and behavioral troubles. Differently, the older peers, from Moderately to Full Term ones, although did not show significant differences in achievement of gross motor skills, had a stable delay of visual and social skills across the age ranges. This gap was not evidenced at the long-term evaluation, except for the Extremely PreTerm children. Pre-perinatal factors played a significant role on short and long term neurodevelopmental outcome. CONCLUSIONS Early assessed classic neurological examination might address neurodevelopmental trajectories in PreTerm children in which visual and social skills appear to be the mostly affected. It remains the easiest and most reliable tool of evaluation throughout the follow-up programs.
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Affiliation(s)
- Gabriella Di Rosa
- Department of Human Pathology of the Adult and Developmental Age, Unit of Child Neurology and Psychiatry, University Hospital of Messina, Messina, Italy.
| | - Tiziana Cavallaro
- Department of Human Pathology of the Adult and Developmental Age, Unit of Child Neurology and Psychiatry, University Hospital of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
| | - Lucia Marseglia
- Department of Human Pathology of the Adult and Developmental Age, Unit of Neonatal Intensive Care, University Hospital of Messina, Messina, Italy
| | - Marco Lamberti
- Department of Human Pathology of the Adult and Developmental Age, Unit of Child Neurology and Psychiatry, University Hospital of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Elisa Giaimo
- Department of Human Pathology of the Adult and Developmental Age, Unit of Child Neurology and Psychiatry, University Hospital of Messina, Messina, Italy
| | - Antonio Nicotera
- Department of Human Pathology of the Adult and Developmental Age, Unit of Child Neurology and Psychiatry, University Hospital of Messina, Messina, Italy
| | - Maria Bonsignore
- Department of Human Pathology of the Adult and Developmental Age, Unit of Child Neurology and Psychiatry, University Hospital of Messina, Messina, Italy
| | - Antonella Gagliano
- Department of Human Pathology of the Adult and Developmental Age, Unit of Child Neurology and Psychiatry, University Hospital of Messina, Messina, Italy
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Sgandurra G, Bartalena L, Cecchi F, Cioni G, Giampietri M, Greisen G, Herskind A, Inguaggiato E, Lorentzen J, Nielsen JB, Orlando M, Dario P. A pilot study on early home-based intervention through an intelligent baby gym (CareToy) in preterm infants. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 53-54:32-42. [PMID: 26851385 DOI: 10.1016/j.ridd.2016.01.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/09/2015] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND CareToy is an intelligent system, inspired by baby gyms, aimed to provide an intensive, individualized, home-based and family-centred early intervention (EI) program. AIMS A pilot study was carried out to explore the feasibility of CareToy intervention in preterm infants, aged 3-9 months of corrected age. METHODS Twenty low-risk preterm infants, without brain lesion or other clinical complications (14 allocated to CareToy intervention and 6 to Standard Care) were recruited. The Infant Motor Profile (IMP) was predefined as the primary outcome measure and Alberta Infant Motor Scale and Teller Acuity Cards as secondary measures. Moreover, 202 pre-programmed training scenarios were developed and instructions for the management of CareToy intervention were defined as general guidelines. OUTCOMES AND RESULTS All infants received 4 weeks of their allocated intervention and were evaluated with the selected tests before and immediately after the 4 weeks. The mean difference changes in IMP total score and Teller Acuity Cards over the intervention period were higher in the CareToy group than in the Standard Care group. CONCLUSIONS AND IMPLICATIONS CareToy seems a feasible device for providing EI. An adequately powered randomized clinical trial is warranted.
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Affiliation(s)
- Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy.
| | - Laura Bartalena
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Via Roma 67, 56126 Pisa, Italy.
| | - Francesca Cecchi
- The BioRobotics Institute, Polo Sant'Anna Valdera, Viale Rinaldo Piaggio 34, Pontedera, 56026 Pisa, Italy.
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy.
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Via Roma 67, 56126 Pisa, Italy.
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Anna Herskind
- Department of Neonatology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark; Helene Elsass Center, Charlottenlund, Denmark.
| | - Emanuela Inguaggiato
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy; Scuola Superiore Sant'Anna, Institute of Life of Sciences, Piazza Martiri delle Libertà, 1, 56127 Pisa, Italy.
| | - Jakob Lorentzen
- Helene Elsass Center, Charlottenlund, Denmark; Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark.
| | - Jens Bo Nielsen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark; Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark.
| | - Martina Orlando
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy.
| | - Paolo Dario
- The BioRobotics Institute, Polo Sant'Anna Valdera, Viale Rinaldo Piaggio 34, Pontedera, 56026 Pisa, Italy.
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Hadders-Algra M. Early diagnosis and early intervention in cerebral palsy. Front Neurol 2014; 5:185. [PMID: 25309506 PMCID: PMC4173665 DOI: 10.3389/fneur.2014.00185] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/09/2014] [Indexed: 01/06/2023] Open
Abstract
This paper reviews the opportunities and challenges for early diagnosis and early intervention in cerebral palsy (CP). CP describes a group of disorders of the development of movement and posture, causing activity limitation that is attributed to disturbances that occurred in the fetal or infant brain. Therefore, the paper starts with a summary of relevant information from developmental neuroscience. Most lesions underlying CP occur in the second half of gestation, when developmental activity in the brain reaches its summit. Variations in timing of the damage not only result in different lesions but also in different neuroplastic reactions and different associated neuropathologies. This turns CP into a heterogeneous entity. This may mean that the best early diagnostics and the best intervention methods may differ for various subgroups of children with CP. Next, the paper addresses possibilities for early diagnosis. It discusses the predictive value of neuromotor and neurological exams, neuroimaging techniques, and neurophysiological assessments. Prediction is best when complementary techniques are used in longitudinal series. Possibilities for early prediction of CP differ for infants admitted to neonatal intensive care and other infants. In the former group, best prediction is achieved with the combination of neuroimaging and the assessment of general movements, in the latter group, best prediction is based on carefully documented milestones and neurological assessment. The last part reviews early intervention in infants developing CP. Most knowledge on early intervention is based on studies in high-risk infants without CP. In these infants, early intervention programs promote cognitive development until preschool age; motor development profits less. The few studies on early intervention in infants developing CP suggest that programs that stimulate all aspects of infant development by means of family coaching are most promising. More research is urgently needed.
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Affiliation(s)
- Mijna Hadders-Algra
- Department of Pediatrics - Developmental Neurology, University Medical Center Groningen, University of Groningen , Groningen , Netherlands
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19
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Schendelaar P, Heineman KR, Heineman MJ, Jongbloed-Pereboom M, La Bastide-Van Gemert S, Middelburg KJ, Van den Heuvel ER, Hadders-Algra M. Movement variation in infants born following IVF/ICSI with and without ovarian hyperstimulation. Early Hum Dev 2013; 89:507-13. [PMID: 23582573 DOI: 10.1016/j.earlhumdev.2013.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 02/13/2013] [Accepted: 03/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The effect of in vitro fertilisation (IVF) on neurodevelopment is not fully understood. Probably, IVF does not affect traditional measures of neurodevelopment in infancy. Recently, an instrument, the Infant Motor Profile (IMP), was developed that evaluates the quality of motor behaviour. It includes the evaluation of movement variation (i.e. movement repertoire size), a parameter reflecting the integrity of cortical connectivity. AIM To evaluate the effect of ovarian hyperstimulation and the in vitro procedure on movement variation during infancy. STUDY DESIGN Prospective cohort study. SUBJECTS Singletons born following IVF or intracytoplasmic sperm injection (ICSI) with conventional controlled ovarian hyperstimulation (COH-IVF/ICSI, n=68), in a modified natural cycle (MNC-IVF/ICSI, n=57) and natural conception born to subfertile couples (Sub-NC, n=90). OUTCOME MEASURES Children were assessed with the IMP at 4, 10 and 18 months, resulting in a total IMP score and five domain scores: variation, variability, symmetry, fluency and performance. Primary outcome was the domain score variation. RESULTS A significant effect of study group was observed for the variation score up until 18 months of age (p=0.039). COH-IVF/ICSI children had a significantly lower mean variation score than MNC-IVF/ICSI children (mean difference [95% confidence interval] -1.010 [-1.766; -0.254]). Mean variation scores of COH-IVF/ICSI and Sub-NC children were similar; the same held true for the comparison between MNC-IVF/ICSI and Sub-NC. Total IMP scores and other domain scores of the three groups were similar. CONCLUSION The present study did not demonstrate a clear effect of ovarian hyperstimulation and the in vitro procedure on movement variation throughout infancy.
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Affiliation(s)
- Pamela Schendelaar
- Dept. of Paediatrics, Div. of Developmental Neurology-CA 85, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Heineman KR, Middelburg KJ, Bos AF, Eidhof L, La Bastide-Van Gemert S, Van Den Heuvel ER, Hadders-Algra M. Reliability and concurrent validity of the Infant Motor Profile. Dev Med Child Neurol 2013; 55:539-45. [PMID: 23480426 DOI: 10.1111/dmcn.12100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Abstract
AIM The Infant Motor Profile (IMP) is a qualitative assessment of motor behaviour in infancy. It consists of five domains: movement variation, variability, fluency, symmetry, and performance. The aim of this study was to assess interobserver reliability and concurrent validity of the IMP with the Alberta Infant Motor Scale (AIMS) and an age-specific neurological examination. METHOD Fifty-nine preterm infants (25 females, 34 males; median gestational age 29.7wks, median birthweight 1285g) and 146 term infants (74 females, 72 males; median gestational age 40.1wks, birthweight 3500g) were included. Assessments were performed at corrected ages of 4, 6, 10, 12, and 18 months and consisted of the IMP, AIMS, and an age-specific neurological examination. Interobserver reliability was investigated on a sample of 25 video recordings. Non-parametric statistics were used to analyse the data. RESULTS Interobserver reliability was high (intraclass correlation coefficient 0.95). At all ages, AIMS scores correlated weakly to fairly with total IMP scores (Spearman's ρ 0.36-0.55), but moderately to strongly with scores on the performance domain of the IMP (Spearman's ρ 0.47-0.84). A clear relation was found between total IMP score and outcome of the neurological examination (Kruskal-Wallis p<0.001 at all ages). INTERPRETATION Interobserver reliability of the IMP is good. Concurrent validity with the AIMS is best for the IMP performance domain. Concurrent validity with age-specific neurological examination is very good.
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Affiliation(s)
- Kirsten R Heineman
- Department of Paediatrics, Institute of Developmental Neurology, University Medical Center Groningen, Groningen, the Netherlands
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