General movements in spinal muscular atrophy type 1

PURPOSE

To investigate the motor repertoire of infants diagnosed with spinal muscular atrophy Type I (SMA Type I) without administration of any disease-modifying agent.

METHODS

Motor Optimality Score-Revised (MOS-R) was calculated from videos recorded between post-term weeks 9-17 for 22 infants with SMA Type I. The MOS-R of infants with SMA Type I was compared with those of 22 infants with cerebral palsy (CP) and 22 infants with typical development.

RESULTS

Of the infants with SMA Type I, 17 had absent fidgety movements (FMs) and 5 had sporadic FMs. Age adequate movement repertoire was absent, and the variety of movements in infants was very low. Movements were symmetrical but movements of four limbs remained on the surface level. Antigravity movements were very rare. Movement characterization was monotonous, slow speed, and small amplitude. The MOS-R of infants with SMA Type I was lower than those of infants with typical development but similar to those of infants with CP.

CONCLUSIONS

Infants with SMA Type I had a motor repertoire similar to infants with CP, while they had a poorer motor repertoire than infants with typical development in the fidgety period as evidenced by MOS-R. Central nervous system involvement in these infants with SMA Type I with absent FMs and reduced MOS-R is unknown. Further studies are needed to determine the role of problems in the afferent and efferent pathways of spinal cord and muscle atrophy in the observation of normal FMs.

Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes? A cohort study

Sucking patterns and early spontaneous movements have an important role in the determination of later developmental problems, but the relationship of the two together with long-term outcomes has not been investigated. The objectives of this study were to (i) examine the relationship between sucking patterns using the Neonatal Oral Motor Assessment Scale (NOMAS) and fidgety movements and other movement patterns using detailed General Movements Assessment (GMA), and (ii) investigate the relationship between these early assessment methods and developmental functioning outcomes at later ages. We analyzed the NOMAS from 34 weeks' postmenstrual age up to 10 weeks post-term and GMA between 9 and 20 weeks post-term age, and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was applied for the developmental functioning outcomes to 62 infants (61%, 62/102) between 12 and 42 months of age. Among 102 infants at-risk, 70 (69%) showed a normal sucking pattern, and 85 (83%) had fidgety movements. The median Motor Optimality Score-Revised (MOS-R), as determined by GMA, of all infants was 24. The NOMAS was related to the MOS-R and its subcategories (p < 0.05) in all infants at-risk. The NOMAS, MOS-R and its subcategories were also related to cognitive, language, and motor development at later ages according to Bayley-III (p < 0.05).   Conclusion: This longitudinal study showed that the quality of sucking patterns, fidgety movements, and MOS-R were related to later developmental functioning, indicating that abnormal sucking patterns, aberrant fidgety movements, and lower MOS-R might predict developmental disorders. What is Known: • Sucking patterns and early spontaneous movements in which central pattern generators play an important role are related. • Sucking patterns and early spontaneous movements might be used separately to predict developmental outcomes. What is New: • Sucking patterns and early spontaneous movements, when used together, were related to later developmental functioning, including cognitive, language, and motor development in at-risk infants. • Predictive value of sucking patterns was lower for each developmental functioning outcome than early spontaneous movements.

Sleep characteristics, early spontaneous movements, and developmental functioning in preterm infants in the early postnatal period

OBJECTIVE

This study aimed to investigate the following: (i) sleep characteristics in preterm infants at 9-20 weeks of corrected age, and (ii) differences in early spontaneous movements and developmental functioning results between the groups based on some sleep characteristics.

METHODS

Seventy-four preterm infants (36 female) were included. Sleep characteristics were assessed according to the Brief Infant Sleep Questionnaire (BISQ). The infants were divided into two groups based on total sleep duration: less than 12 h (38 infants), and 12 h and more (36 infants). Video recordings were made for the General Movements Assessment (GMA) and evaluated using the Motor Optimality Score for 3- to 5-Month-Old-Infants-Revised (MOS). Cognitive, language, and motor development were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III).

RESULTS

The total sleep duration of all preterm infants (mean ± SD) was 11.8 ± 3.3 h. Infants who had absent fidgety movements slept less than 12 h, and fidgety movements differed between the groups (p = 0.012). Infants who slept 12 h or more had significantly higher MOS (p = 0.041), cognitive (p = 0.002), language (p < 0.001), and motor (p = 0.002) development results. Infants who snored had lower MOS (p = 0.001), cognitive (p = 0.004), language (p = 0.002), and motor (p = 0.001) development results. Infants with fewer than three nocturnal awakenings had significantly higher Bayley-III cognitive (p = 0.007), language (p = 0.032), and motor (p = 0.005) domain results. Prone and supine sleeping positions showed higher motor domain results than lateral positions (p = 0.001).

CONCLUSIONS

Sleep in preterm infants might be a key factor in early developmental functioning processes and nervous system integrity. Even in the first months of life, there are substantial differences in cognitive, language, and motor development in association with sleep characteristics.

Using the center of pressure movement analysis in evaluating spontaneous movements in infants: a comparative study with general movements assessment

BACKGROUND

Researchers have attempted to automate the spontaneous movement assessment and have sought quantitative and objective methods over the past decade. The purpose of the study was to present a quantitative assessment method of spontaneous movement using center-of-pressure (COP) movement analysis.

METHODS

A total of 101 infants were included in the study. The infants were placed in the supine position on the force plate with the cranial-caudal orientation. In this position, the recording of video and COP movement data were made simultaneously for 3 min. Video recordings were used to observe global and detailed general movement assessment (GMA), and COP time series data were used to obtain quantitative movement parameters.

RESULTS

According to the global GMA, 13 infants displayed absent fidgety movements (FMs) and 88 infants displayed normal FMs. The binary logistic regression model indicated significant association between global GMA and COP movement parameters (chi-square = 20.817, p < 0.001). The sensitivity, specificity, and overall accuracy of this model were 85% (95% CI: 55-98), 83% (95% CI: 73-90), and 83% (95% CI: 74-90), respectively. The multiple linear regression model showed a significant association between detailed GMA (motor optimality score-revised/MOS-R) and COP movement parameters (F = 10.349, p < 0.001). The MOS-R total score was predicted with a standard error of approximately 1.8 points (6%).

CONCLUSIONS

The present study demonstrated the possible avenues for using COP movement analysis to objectively detect the absent FMs and MOS-R total score in clinical settings. Although the method presented in this study requires further validation, it may complement observational GMA and be clinically useful for infant screening purposes, particularly in clinical settings where access to expertise in observational GMA is not available.

Assessing Joint Hypermobility, Proprioception, and Developmental Functioning in Toddlers Born Preterm

OBJECTIVE

The aims of this study were to explore (i) the joint hypermobility, proprioception, and developmental functioning in toddlers born preterm, (ii) differences in the proprioception and developmental functioning between toddlers with and without joint hypermobility, and (iii) the relationship between them.

MATERIALS AND METHODS

One hundred twelve toddlers born preterm between 24 and 42 months of age were included in this observational study. Beighton Score for joint hypermobility assess- ment and the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) for developmental functioning were applied in all toddlers born preterm; however, propriocep- tion assessment could be applied on 55 of 112 (49.11%) toddlers born preterm due to lack of cooperation.

RESULTS

Of 112 toddlers, 30 (26.79%) had joint hypermobility. There were no differences in coop- eration rate (P = .629) and success rate (P = .887) in the proprioception assessment between toddlers with and without joint hypermobility (55 toddlers born preterm), which is similar to the cognitive domain (P = .430), language domain (P = .062), and motor domain (P = .619) in the Bayley-III. Additionally, none of them were related to each other (P > .05).

CONCLUSION

Our study findings showed that joint hypermobility has no effect on propriocep- tion and motor development in toddlers born preterm between 24 and 42 months of age, and there is no relationship between them. The possibility of these results might be that movement repetition and not only proprioception but also other sensory systems could be important in this early period of life.

Early Spontaneous Movements and Sensory Processing in Preterm Infants

IMPORTANCE

Preterm infants are at higher risk of motor development abnormalities and sensory processing difficulties. Few studies have examined both movement development and sensory processing in the early months of life, and the results are controversial.

OBJECTIVE

In this cross-sectional study, we investigated (1) differences in early spontaneous movements and sensory processing between preterm infants born at <32 wk gestation and those born at 32 to 36 wk gestation when they reached corrected (postterm) age 3 to 5 mo and (2) the relationship between early spontaneous movements and sensory processing.

PARTICIPANTS

We included 50 preterm infants born at <32 wk gestation and 61 preterm infants born at 32 to 36 wk gestation.

OUTCOMES AND MEASURES

We assessed early spontaneous movements, including fidgety movements, using the General Movements Assessment (GMA), which provides the Motor Optimality Score (MOS), and sensory processing using the Infant Sensory Profile-2.

RESULTS

The preterm infants born at <32 wk gestation had lower MOS results (p = .035) and more sensory processing difficulties (p = .006) than those born at 32 to 36 wk gestation. We found no significant relationship between early spontaneous movements and sensory processing (p > .05).

CONCLUSIONS AND RELEVANCE

Preterm infants born at <32 wk gestation are at increased risk for motor development abnormalities and sensory processing difficulties. What This Article Adds: Assessment of both motor development and sensory processing can play a crucial role in identifying infants who need early intervention.

Early spontaneous movements and spatiotemporal gait characteristics in preterm children

This study aimed to analyze spatiotemporal gait characteristics of preterm children from 3 to 4 years of age according to different gestational age groups and to examine the relationship between the detailed general movements assessment and spatiotemporal gait characteristics. A total of 74 preterm children, 32 extremely preterm and very preterm (EP-VP, < 32 weeks gestational age) and 42 moderate to late preterm (MLP, 32 to < 37 weeks gestational age), were included in this prospective study, along with 38 term children. Early spontaneous movements of preterm children were assessed from videos at 9-20 weeks post-term according to the general movements assessment, which determines the Motor Optimality Score-Revised (MOS-R). The spatiotemporal gait characteristics of all children were evaluated using the GAITRite^®electronic walkway at self-selected walking speeds. EP-VP children walked with shorter step lengths (p = 0.039), and MLP children walked with greater step length variability (p = 0.003) than their term peers. The MOS-R results were related to step length (r = 0.36, p = 0.042), step length variability (r =  -0.56, p = 0.001), and base of support (r =  -0.37, p = 0.038) in EP-VP children. The MOS-R subcategories, age-adequate movement repertoire, and postural patterns were related to some of the spatiotemporal gait characteristics, including step length, step length variability, and base of support (p < 0.05).  Conclusion: EP-VP and MLP children might catch up to their term peers at 3 to 4 years of age in terms of most gait parameters. In addition to the MOS-R, age-adequate movement repertoire and postural patterns of preterm children without cerebral palsy in early life may be a marker of later neurodevelopmental dysfunction. What is Known: • Preterm children walk with a wider step width, a greater step length asymmetry and step time, and a shorter stride length at 18 to 22 months of age compared with term children at a self-selected speed, while these differences disappear in children 4.5-5 years old and older. What is New: • Early spontaneous movements were related to some spatiotemporal gait characteristics. • Preterm children might catch up to term children at 3-4 years of age in spatiotemporal gait characteristics while walking at a self-selected speed.

Sensory processing and sleep characteristics in preterm infants in the early period of life

OBJECTIVE

The present study aimed to investigate the following: (i) differences in sensory processing and sleep characteristics between preterm infants born at < 32 weeks', vs. those born at ≥ 32 weeks' gestation; (ii) differences in sleep characteristics between preterm infants with typical vs. atypical sensory processing; and (iii) relationship between sensory processing and sleep characteristics in preterm infants at 3 months of age.

METHODS

A total of 189 preterm infants, 54 born at < 32 weeks' gestation (26 females; mean gestational age [standard deviation (SD)], 30.1 [1.7] weeks), and 135 born at ≥ 32 weeks' gestation (78 females; mean gestational age [SD], 34.9 [0.9] weeks) were included in the present study. Sleep characteristics were evaluated using the Brief Infant Sleep Questionnaire, and sensory processing was assessed using the Infant Sensory Profile-2.

RESULTS

There were no significant differences in sensory processing (P > 0.05) or sleep characteristics (P > 0.05) between the preterm groups; however, more infants snored in the <32 weeks' gestation group (P = 0.035). Preterm infants with atypical sensory processing showed lower nighttime (P = 0.027) and total sleep durations (P = 0.032), and higher rates of nocturnal wakefulness (P = 0.038) and snoring (P = 0.001) than preterm infants with typical sensory processing. A significant relationship, therefore, was observed between sensory processing and sleep characteristics (P < 0.05).

CONCLUSIONS

Sensory processing patterns may play an important role in understanding sleep problems in preterm infants. The early detection of sleep problems and sensory processing difficulties are necessary for early intervention.

Assessment of spinal alignment in children with unilateral cerebral palsy

BACKGROUND

Children/youths with unilateral cerebral palsy are at high risk for the development of scoliosis and other postural deformities. The purpose of this study was to perform spinal assessment in the frontal and sagittal plane using Spinal Mouse® in children/youths with unilateral cerebral palsy and to compare their spinal shape and angles with typically developing children/youths.

METHODS

25 children/youths with unilateral cerebral palsy and 25 typical children/youths, aged 6-18 years, were included. The subject's frontal (scoliosis) and sagittal plane (kyphosis and lordosis) spinal curvatures were compared by assessing them with Spinal Mouse®.

FINDINGS

Scoliosis was detected in 40% of subjects in the unilateral cerebral palsy group and this rate was considerably higher than that in typical subjects (12%). The median angle of scoliosis was 8° in subjects with unilateral cerebral palsy and 5.3° in typical subjects. While the median angle of scoliosis was higher in subjects with unilateral cerebral palsy than typical subjects (p < 0.001), there was no significant difference in the angles of lordosis and kyphosis between both groups (p > 0.05). Curvature patterns of subjects with unilateral cerebral palsy differed from typical subjects.

INTERPRETATION

Our findings will allow children/youths with unilateral cerebral palsy, who are at risk of developing spinal deformity, to be identified earliest possible and included in the intervention. Children/youths with unilateral cerebral palsy have to be assessed in detail from the earliest period, especially when the possibility of an age-related increase in scoliosis is considered.

Gait characteristics and effects of early treadmill intervention in infants and toddlers with down syndrome: a systematic review

PURPOSE

The aim of this study was to evaluate gait characteristics, and the effectiveness of treadmill interventions on gait in infants and toddlers with Down syndrome (DS).

MATERIALS AND METHODS

A comprehensive search was performed on six databases for evidence published up to November 2020 for articles related to infants and toddlers with DS. The Clinical Appraisal Skills Programme Checklist assessed the methodological quality. Strength of evidence were evaluated Sackett's level.

RESULTS

Nine articles analyzing instrumental gait met the inclusion criteria. Of these, 4 compared DS and typically developing (TD), and 5 included treadmill training interventions for DS. Kinematic analysis was applied in 8 studies and all articles presented evaluations at different times according to the walking experience. Analysis with EMG was used in only one of the intervention articles and in 3 of the 4 comparative articles.

CONCLUSIONS

Although similar improvements are seen in spatiotemporal parameters for toddlers with typical development and those with DS, the decrease in step width is not similar for DS. Early treadmill training can have a positively effect on the gait characteristics of DS infants. Further research should focus on the acquisition of gait characteristics, long-term evaluations, kinetics and EMG data, for these children.Implications For RehabilitationToddlers with DS walked significantly slower, shorter stride length and less stride frequency.Treadmill training before 1-year old had positive effects on gait characteristics in infants and toddlers with DS.High-intensity treadmill training may provide early walking (2 months earlier) than the low-intensity group, therefore clinicians can add treadmill training programs in rehabilitation protocols of infants and toddlers with DS.Limited evidence for the effects of treadmill training on the kinematic and kinetic parameters of walking in DS infants and toddlers.

The PURPLE N study: objective and perceived nutritional status in children and adolescents with cerebral palsy

PURPOSE

To obtain information on characteristics, management, current objective nutritional status and perception of nutritional status of children with cerebral palsy (CP) from healthcare professionals (HCPs) and caregivers.

MATERIALS AND METHODS

A detailed survey of several items on eight main topics (general characteristics, motor function, comorbidities, therapies, anthropometry, feeding mode and problems and perceived nutritional status) was developed and tested for the study. Correlation between nutritional status and Gross Motor Function Classification System (GMFCS) levels was assessed using continuous variables (Z-scores for weight-for-age, height-for-age, weight-for-height, and body mass index-for-age), and categorical variables (being malnourished, stunted, or wasted). HCP and caregiver perceptions of the child's nutritional status as well as agreement between perceived and objective nutritional status and agreement between perceived nutritional status and concerns about the nutritional status were analyzed.

RESULTS

Data were available for 497 participants from eight European countries. Poorer nutritional status was associated with higher (more severe) GMFCS levels. There was minimal agreement between perceived and objective nutritional status, both for HCPs and caregivers. Agreement between HCP and caregiver perceptions of the child's nutritional status was weak (weighted kappa 0.56). However, the concerns about the nutritional status of the child were in line with the perceived nutritional status.

CONCLUSIONS

The risk of poor nutritional status is associated with more severe disability in children and adolescents with CP. There is a mismatch between HCP and caregiver perceptions of participants' nutritional status as well as between subjective and objective nutritional status. Our data warrant the use of a simple and objective screening tool in daily practice to determine nutritional status in children and adolescents with CP. Clinical trial registration: ClinicalTrials.gov Identifier: NCT03499288 (https://clinicaltrials.gov/ct2/show/NCT03499288). IMPLICATIONS FOR REHABILITATIONUse of the ESPGHAN recommendations and simple screening tools in daily practice is needed to improve nutritional care for individuals with CP.Attention should be paid to the differences in the perception of nutritional status of individuals with CP between professionals and caregivers to improve appropriate referral for nutritional support.Objective measures rather than the professional's perception need to be used to define the nutritional status of individuals with CP.

Preoperative anxiety and health literacy in patients applying to the anesthesia outpatient clinic

Background

Evaluation of preoperative anxiety and health literacy is important for healthcare professionals to understand the needs and expectations of patients and provide them with the necessary support. The study aimed to evaluate the preoperative anxiety levels of patients who applied to the anesthesia outpatient clinic and its relationship with health literacy.

Methods

A cross-sectional study was conducted on patients who applied to the anesthesia outpatient clinic of Eskişehir Osmangazi University Medical Faculty Hospital in March 2022. The questionnaire form, which was prepared by making use of the literature, was filled in by face-to-face interview method after obtaining the participants’ verbal consent. The 6 item Amsterdam Preoperative Anxiety and Information Scale (APAIS) in which the scores that can be taken range from 6 to 30 and higher score means higher anxiety was used to assess the level of anxiety, and the 16 item European Health Literacy Scale Short Form was used to assess health literacy. Descriptive statistics, Chi-Square test and Logistic Regression analysis were used to analyze the data.

Results

In the study group, 197 (50.3%) were female. Their ages ranged from 18 to 86, with a mean of 45.7 ± 17.2 years. The median (min-max) APAIS score was 15 (6-30). There was a moderate negative correlation between the scores obtained from the APAIS and the European Health Literacy Scale Short Form (r= -0.50, p &lt; 0.01). According to the logistic regression analysis, preoperative anxiety was found to be 1.53 (%95 CI; 1.01-2.30) times higher in women, 3.49 (%95 CI; 1.23-9.94) times higher in those with low family income, and 1.61 (%95 CI; 1.07-2.42) times higher in those with type A personality.

Conclusions

More than half of the patients had preoperative anxiety. The level of preoperative anxiety decreased as the health literacy level increased.

Key messages

Evaluation of Factors Associated with Dual Use of E-Cigarettes in University Students

Background

The World Health Organization defined smoking as the fastest spreading and longest lasting epidemic globally. It has been reported that two-thirds of all tobacco consumption in the world is in developing countries, and with today's technology, the use of electronic cigarettes (e-cigarettes) has increased rapidly among young people and adults, especially in recent years. The study aimed to evaluate the factors associated with dual use of e-cigarettes (e-cigarette plus one of the tobacco products) in university students.

Methods

This study was carried out with the participation of 2477 students at Eskişehir Osmangazi University in the 2019-2020 academic year, and it was designed as a nested case-control study from a study in which 49 were determined to be dual smokers. A randomized 1:3 for age and gender with 147 non-smokers (NS) and 147 classic cigarette smokers (CSS) selected by the propensity score matching method was performed, with the final sample consisting of 343 participants. Chi-square and multinomial logistic regression analyzes were used in the study.

Results

In the multinomial logistic regression, the belief that e-cigarettes do not help quit classical cigarette smoking was 4.0 (95% CI; 1.7 - 9.6) times higher in NS and 4.1 (1.6 - 10.0) times higher in CCS compared to dual smokers, while the belief that e-cigarettes may suppress the desire to smoke was 4.4 (1.7 - 11.2) times higher in NS and 6.8 (2.6 - 17.6) times higher in CCS.

Conclusions

The study determined that dual smokers were less likely to believe that e-cigarettes are more innocent than other tobacco products. While dual smokers believed that e-cigarettes might not suppress the desire to smoke, CCS believed e-cigarettes could even increase classical cigarette smoking.

Key messages

• Since the effects of e-cigarette use on human health are controversial, it is still a significant public health problem in developing countries.

• Although it was initially marketed to help quit or reduce the use of classical cigarettes, it should be noted that e-cigarettes are also a type of tobacco product addiction.

Evaluation of Telemedicine awareness, knowledge, attitude, skill levels of physicians and students

Background

The increase in the use of information and communication technologies around the world brings about developments and changes in the provision of health services. It is accepted that telemedicine applications will facilitate health services for patients and health personnel. This study aimed to evaluate the telemedicine awareness, knowledge, attitude and skill levels of physicians and medical school students.

Methods

This cross-sectional study was conducted between July and August 2021. A questionnaire form was prepared using the relevant literature then filled online by the participants. Telemedicine Awareness, Knowledge, Attitudes and Skills Questionnaire was used in the research. The universe of the research consisted of medical faculty students and physicians across Turkey. In the study, 933 people were reached by using the purposeful snowball sampling method, one of the non-probability sampling methods. Mann Whitney-U test, Kruskal Wallis test, Spearman correlation analysis and Multiple Linear Regression analysis were used.

Results

Of the participants, 442 (47.4%) were female, 497 (53.3%) were medical students, and 436 (46.7%) were physicians. Their ages ranged from 18 to 59, with a mean of 28.0±8.8 years. The median (min-max) scores obtained from the Telemedicine Awareness (TA) sub-section were 18(0-24), 51.3% of them had scores above the median score. TA sub-section had a moderate positive correlation (r = 0.559, p &lt; 0.001) with knowledge sub-section and a weak positive correlation (r = 0.208, p &lt; 0.001) with skill level sub-section. TA scores were higher among men, physicians and those who want to participate in a telemedicine training program. TA increased as the level of computer and internet knowledge increased (F = 29.171, R2=0.197, p &lt; 0.001).

Conclusions

It can be said that TA is at a moderate level among medical students and physicians in Turkey. TA increased as the level of computer and internet knowledge, telemedicine knowledge and skills increased.

Key messages

Early Spontaneous Movements and Upper Extremity Movement Score in Infants With all Narakas Types of Obstetric Brachial Plexus Palsy

BACKGROUND

Obstetric brachial plexus palsy (OBPP) is a birth injury that affects upper extremity performance. However, some children with OBPP might have central nervous system disorder or developmental disabilities. This study aimed to investigate (1) the early spontaneous movements using General Movements Assessment (GMA) in infants with OBPP according to the Narakas classification, (2) the differences from typical infants, and (3) the relationship between the GMA and the affected upper extremity movements score.

METHODS

Fifty-six infants with OBPP (39 females; median gestational age 40 weeks, range = 34 to 42) and 50 typical infants (20 females; median gestational age 38 weeks, range = 37 to 41) were assessed at age three to five months using the GMA, which is a determined Motor Optimality Score (MOS) for fidgety movements and concurrent motor repertoire, and using the Active Movement Scale (AMS) for affected upper extremity movements.

RESULTS

There were no differences in MOS and its subcategories between Narakas types in infants with OBPP (P > 0.05); however, infants with OBPP had a higher degree of aberrant fidgety movements and a lower score in MOS and its subcategories than typical infants (P < 0.05). There was no relationship between AMS scores, and MOS and its subcategories.

CONCLUSIONS

Infants with OBPP, except Narakas type I, might have an increased risk of central nervous disorder and developmental problems in addition to peripheral nerve injury. Each test, GMA and AMS, contributes to the identification of their own specific risk in these infants.

Developmental Functioning Outcomes in Infants With Cystic Fibrosis: A 24- to 36-Month Follow-Up Study

OBJECTIVE

This study aimed to examine early motor repertoire using Prechtl General Movement Assessment (GMA) and later developmental functioning of infants with cystic fibrosis (CF).

METHODS

Early motor repetoire was evaluated using Prechtl GMA, and developmental functioning was assessed using Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) in infants with CF and their peers who were neurotypical, as the control group.

RESULTS

Twelve infants with CF clinically stable and 12 infants who were neurotypical, with respective median post-term ages of 14 and 13 weeks, were assessed using GMA. At 24 to 36 months, the Bayley-III was applied to the CF group (median post-term age = 27.5 months) and the control group (median post-term age = 27.0 months). Fidgety movements were absent in 5 infants with CF, whereas all infants who were neurotypical had normal fidgety movements. The Motor Optimality Score was significantly lower in the CF group (median = 18.5) compared with the control group (median = 26). The CF group had significantly lower composite scores in the Bayley-III cognition, language, and motor domains compared with the control group.

CONCLUSION

Cognitive, language, and motor development was delayed in infants with CF. Developmental functioning of infants with CF should be assessed as early as possible and monitored, and age-specific early intervention programs should be considered when necessary.

IMPACT

Infants with CF may have motor, cognitive, and language developmental delays compared with peers who are neurotypical during early childhood, and hospitalization was negatively correlated with motor development at 24 to 36 months of age. This study highlights the importance of early assessment of developmental functioning and age-specific, early intervention programs when necessary in infants with CF.

LAY SUMMARY

It is important to assess developmental functioning as early as possible in infants with CF and to consider age-specific early intervention programs when necessary.

The early spontaneous movements, and developmental functioning and sensory processing outcomes in toddlers born preterm: A prospective study

BACKGROUND

Preterm infants may present sensory processing difficulties as well as developmental disorders. However, studies investigating both early spontaneous movements, and later sensory processing and development functioning are limited.

AIMS

To examine; (1) early spontaneous movements between the ages of 3 and 5 months, (2) the differences of sensory processing between the ages of 24 and 35 months in infants who had normal and aberrant fidgety movements between 3 and 5 months corrected age, and (3) the relationship between sensory processing and both early spontaneous movements and developmental functioning.

STUDY DESIGN

A prospective observational study design.

SUBJECTS

Eighty-eight preterm infants (median gestational age 32 weeks, range 23-36) were included.

OUTCOME MEASURES

Early spontaneous movements, including fidgety movements, were assessed according to the General Movements Assessment (GMA), which determines the Motor Optimality Score (MOS). Developmental functioning was assessed using the Bayley Scales of Infant and Toddler Development, Third-Edition (Bayley-III) and sensory processing was assessed with Toddler Sensory Profile-2 between the ages of 24 and 35 months.

RESULTS

Sixteen preterm infants (18.1%) displayed aberrant fidgety movements. Median MOS was 25. Infants who displayed aberrant fidgety movements had a lower Bayley-III score in cognitive, language, and motor domains (p = 0.001, p = 0.006, p < 0.001, respectively) and showed more atypical movement sensory processing (p = 0.016) and touch sensory processing (p = 0.018). Fidgety movements were related to typical/atypical movement processing (p = 0.004, r = 0.300).

CONCLUSION

In addition to motor assessment, sensory processing assessment in preterm infants might play a crucial role due to sensory processing difficulties from the early-period of life.

The Level of Cyber-Ostracism and Self-Esteem in Medical Faculty Students

Background

Social media, which has become an indispensable part of our lives in recent years, is important for young people to socialize in online groups and to develop their self-esteem (SE). One of the dangers of increased use of social media is cyber ostracism (CO), defined as not being able to join a group and being ignored on social media. In the study, it was aimed to evaluate the level of CO and SE in medical faculty students.

Methods

This is a cross-sectional study conducted on students of Eskişehir Osmangazi University Faculty of Medicine in 2021 spring semester. The questionnaire prepared based on the literature was filled out online by the participants. The study group consisted of 1092 (70% response rate) students who agreed to participate in the survey. The CO Scale was used to assess the level of CO, and the Rosenberg SE Scale was used for the assessment of SE. Mann Whitney-U test, Kruskal Wallis test, Spearman correlation analysis and Multiple Linear Regression analysis were used to analyze the data.

Results

In the study group; 593 (54.3%) were female. Their ages ranged from 17-27, with a mean of 21.6 ± 2.0 years. The scores obtained from the CO scale ranged from 14 to 70, with an average of 24.8 ± 9.9 points. A moderate positive correlation was found between the scores the students got from the CO Scale and the SE Scale (r: 0.49, p: 0.001). Multiple Linear Regression analysis showed that; living in an extended family, not sparing time for hobbies during the day, having a type-A personality, poor face-to-face communication with peers, negative evaluation of parental attitudes, age at first use of smartphone below years 12 or less, use of smartphones for 5 hours or more a day, and Creating membership in social media by hiding their identity was a predictor for CO (F: 30.338, R2: 0.212, p &lt; 0.001).

Conclusions

It can be said that CO is at a moderate level in medical faculty students. An inverse relationship between CO and SE was found in the study.

Key messages

İt’s recommended to plan more comprehensive studies on CO which is a new concept for digital health. Public health policies to reduce the level of CO may contribute to higher SE in future physicians.

The Effects of Different Exteroceptive Experiences on the Early Motor Repertoire in Infants With Down Syndrome

OBJECTIVE

Down syndrome is a chromosomal abnormality in which muscle tone, motor development, and sensory systems are affected. The objectives of this study were to examine the changes in movements and postures of 3- to 5-month-old infants with Down syndrome and infants who were neurotypical controls during exposure to a rough-textured surface and to compare the differences occurring before and during an exteroceptive condition that was different between the 2 groups.

METHODS

In this quasi-experimental study, participants were 20 infants with Down syndrome (8 female infants; age range = 10-18 weeks, mean [SD] = 12 weeks 2 days [2 weeks 2 days]) and 20 age-matched infants with typical development (8 female infants; age range = 9-17 weeks, mean (SD) = 12 weeks 6 days [1 week 5 days]). The movements and postures of the infants, including fidgety movements, were assessed according to the General Movements Assessment, which determines the Motor Optimality Score (MOS), on 2 surfaces.

RESULTS

The MOS outcomes of the infants with Down syndrome (median = 21.5, range = 6-28) were significantly lower than those of the infants who were neurotypical (median = 28, range = 23-28) on a standard mattress. The postures were found to be significantly better in infants with Down syndrome during exposure to a rough-textured surface. The MOS did not change due to the different exteroceptive experiences in infants with Down syndrome and infants who were neurotypical.

CONCLUSION

The different exteroceptive experiences caused only postural alterations, which might play a crucial role in early intervention programs for infants with Down syndrome.

IMPACT

This is the first study, to our knowledge, on the effects of different exteroceptive conditions, such as a coco coir mattress covered with muslin fabric, on the early motor repertoire in infants with Down syndrome. The findings showed that infants with Down syndrome had heterogeneity in their fidgety movements and large variability of the MOS, and the MOS results from infants with Down syndrome were lower than those of infants who were neurotypical. Fidgety movements and the MOS did not change due to the different exteroceptive experiences in either group. Significant improvements in posture were observed during exposure to a rough-textured surface. The improvement of posture is essential; clinicians might consider the positive effect of putting an infant with Down syndrome on a rough-textured surface and include this strategy in early intervention programs.

Developmental parameters and physical fitness in preschool children with Minor Neurological Dysfunction

BACKGROUND

The preschool years constitute a critical period during which significant changes are experienced in the acquisition of locomotor skills due to maturation of the nervous system. Our aim was to investigate the developmental parameters and physical fitness in preschool children with Minor Neurological Dysfunction (MND).

METHODS

The study was carried out in 212 preschool children without any known health problems. Sociodemographic characteristics of children were recorded. Denver Developmental Screening Test (DDST) II, Touwen Neurological Examination, and Preschool Physical Fitness (PREFIT) test battery were used to assess developmental parameters, neurological status, and physical fitness, respectively.

RESULTS

There was a statistical difference in the physical fitness and developmental parameters in preschool children with MND compared with healthy peers (p < 0.05). There was also a relationship between physical fitness and developmental parameters (p < 0.05).

CONCLUSIONS

Early identification of problems in developmental parameters and physical fitness in preschool children with MND might help to implement early supportive physiotherapy and rehabilitation.

The general movements assessment and effects of an early intervention in an infant with Cri du chat syndrome: a case report

BACKGROUND

Cri du chat syndrome (CdCS) is a rare orphan genetic disorder. Infants with CdCS have a neurodevelopmental dysfunction, but there are limited studies on their spontaneous movements or effect of the early interventions in children with CdCS. This study aimed to describe early spontaneous movements and investigate the effects of an early intervention in an infant with the CdCS.

CASE

We analyzed the detailed general movements assessment (GMA) of an infant with CdCS at 14 weeks, and the Bayley Scales of Infant and Toddler Development-third edition (Bayley-III) were used for the determining and the follow-up of developmental functioning at 14 weeks, 6 months and 12 months. The infant was included in an early intervention beginning from 14 weeks. Fidgety movements were absent. The motor repertoire appeared significantly reduced, and the movement character was monotonous at 14 weeks. Although the infant achieved some developmental milestones with the early intervention program, the improvements were not reflected in the Bayley-III composite score.

CONCLUSIONS

As a consequence, abnormal GMA results, including fidgety movements and concurrent movement patterns, seen in CdCS can be associated with early signs of neurodevelopmental dysfunction. Early intervention programs in infants with genetic disorders could help enable the early achievement of motor milestones.

Motor repertoire is age-inadequate in infants with cystic fibrosis

BACKGROUND

General movements (GMs) in infants occur as fidgety movements (FMs) between postterm 9 and 20 weeks. We aimed to evaluate FMs and motor repertoire in infants with cystic fibrosis (CF) and their relation with clinical findings.

METHODS

Demographic and clinical characteristics were recorded. FMs and motor repertoire were analyzed from a 5-min video recording of each infant. Videos were rated based on the Prechtl General Movement Assessment and motor optimality score (MOS) was calculated.

RESULTS

The analysis included 18 infants with CF and 20 healthy infants at postterm age of 3-5 months. MOS was significantly lower in the infants with CF compared to controls (p < 0.05). Fifty percent of the infants with CF had abnormal or absent/sporadic FMs. MOS was negatively associated with hospitalization duration (r = -0.378, p = 0.036); and positively associated with vitamin A level in CF infants (r = 0.665, p = 0.026).

CONCLUSIONS

Infants with genetically anticipated severe CF phenotype tended to have lower MOS. MOS may be used in addition to genetic testing to predict disease severity in infants with CF. Infants with CF, absent/sporadic FMs, and lower MOS could be considered for planning specific age-adequate early intervention programs.

IMPACT

Motor repertoire was age-inadequate in infants with cystic fibrosis (CF). 50% of infants with CF had abnormal or absent/sporadic fidgety movements (FMs). Motor optimality score (MOS) was positively associated with vitamin A level and negatively correlated with hospitalization duration in infants with CF. MOS tended to decrease as genetically anticipated disease severity increased; thus, MOS might enable us to predict disease severity in CF. The relationship between motor repertoire and phenotype and genotype is unclear and warrants further study. CF infants with absent/sporadic FMs, and lower MOS could be considered for planning early intervention.

General Movements and Developmental Functioning in an Individual with Rhizomelic Chondrodysplasia Punctata within the First Months of the Life: A Case Report

AIMS

Rhizomelic chondrodysplasia punctata (RCDP) is an autosomal recessive inherited disorder. Individuals with RCDP have a wide range of neurodevelopmental outcomes, but there are limited descriptions of their early motor development before 5 months of age. This study aimed to describe in detail the age-specific spontaneous movements and examine the developmental functioning in an individual with RCDP.

METHODS

A female infant (born at 39 weeks' gestation), diagnosed with RCDP at 3 weeks of age, was assessed at 4 and 16 weeks for general movements (GMs) and concurrent motor repertoire; the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was also applied at the same ages.

RESULTS

At 4 weeks, the infant showed poor repertoire GMs, with a detailed General Movement Optimality Score of 16/42. At 16 weeks, age-specific fidgety movements were absent, and the movement character was monotonous and stiff; the detailed Motor Optimality Score was severely reduced (7/28). All Bayley-III scores were <2 SD, that is <70 indicating severe developmental delay.

CONCLUSION

Functional assessments such as the GM assessment and age-specific detailed assessment could be complementary to neuroimaging assessments to predict the neurodevelopmental outcomes in infants with RCDP.

The Evaluation of Stigmatization and Related Factors in Students of Health-Related Faculties

Background

Individuals with disabilities are the people in which health inequalities are mostly experienced. Stigmatization of disabled people reduces their participation in society and causes insufficient health care. Not stigmatize disabled people by health care providers is important to eliminate this insufficiency. The aim of the study was to determine the stigmatization level and communication related factors of students educated in health-related faculties.

Methods

This cross-sectional study conducted in 873 university students who educated in health-related faculties. The level of stigmatization was measured with Disability Stigma Scale(DSS) including the items used in study performed by Mclaughlin et al. The questionnaire consists of sociodemographics and items of contact with disabled persons(CDP) scale.

Results

The mean age of study group was 20.19 ± 1.63, and the 71% were female. The prevelance of stigmatization for disabled people was 33.7%. Of 62.3% study group scored below the mean score from CDP scale. In univariate analysis, the prevelance of stigma was higher in the male group (p &lt; 0.001), low education level group (p &lt; 0.005) and low communication level group (p = 0.020). In multivariate analysis, the risk of stigma for disabled people increases 2.1 times (OR;95% CI, 1.53-2.85) in male group, reduces 0.70 times (0.53-0.93) in high education level parents group and reduces 0.98 times (0.97-0.99) in high communication level group.

Conclusions

It was concluded that stigmatization against disabled people is very important issue for investigation and intervention in males, parents with low education groups and low communication level groups.

Key messages

Communication with disabled people is a very important factor that could be modified and improved for reducing the stigmatization about disabled people. Intervention studies are needed for reducing stigmatization against disabled people in students educated in health-related faculties to eliminate inequalities in health.

Reliability and Validity of Disability Literacy Scale for Medical School Students

Background

Disability literacy is the ability to perceive definition of disabled person, their characteristics, difficulties in daily life and solution suggestions, their rights and false thoughts and orientations about them. The aim of the study was to develop the Disability Literacy Scale (DLS) to determine the disability literacy of medical school students with a high probability of encountering disabled people.

Methods

This study was conducted in 1110 medical school students in 2018-2019 academic year. By using literature 97 questions were collected. DLS was created with 22 questions by taking expert opinions. Correct answer was scored as 1, while wrong or ’do not know’ answer as 0. In order to evaluate the reliability of the scale, item total score correlation and internal consistency (Cronbach’s alpha) analyzes and exploratory and confirmatory factor analysis were used for construct validity.

Results

Of the 51.1% students were female and their age ranged from 17-40, the mean was 21.1±2.2. After the scale development study, the scale consisted of 14 items and 3 sub-dimensions. Scale items explain 43.21% of total variance and factor loadings ranged from 0.37-0.80. The Cronbach’s alpha coefficient was 0.61, 0.64, 0.51 for communication, health problems and social life sub-dimensions, and 0.68 for the whole scale. The fit of scale and the fit index were found to be acceptable after confirmatory factor analysis. In the last form of the scale, the score that can be taken from scale range 0-14. It was accepted that by increasing of the score, disability literacy level was increased. The mean score of students was 9.79±2.57 and the median was 10.0. The scores obtained from DLS were found to be lower in the first 3 grades (p &lt; 0.001), low level mother and father education (p &lt; 0.001/p=0.012) and who have not yet taken lesson about disability (p = 0.021).

Conclusions

DLS is a valid-reliable tool for assessing disability literacy levels of medical school students.

Key messages

It is essential to place disability related lessons from the earliest grades of medical school curriculum. In the literature, DLS seems the first scale about disability literacy and needs to be tested in large communities.

How do physical capacity, fatigue and performance differ in children with duchenne muscular dystrophy compared with their healthy peers?

Objectives:

To compare the fatigue levels and energy expenditure of children with Duchenne Muscular Dystrophy (DMD) at different functional levels with healthy children.

Methods:

The cross-sectional study was carried out in the Unit of Pediatric Neuromuscular Diseases in the Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Hacettepe University between March 2015 and January 2016. Fifty two children diagnosed with DMD in Level I-III according to the Brooke Functional Classification Scale and 17 healthy children were included in the study. The Six Minute Walk Test (6MWT), Northstar Ambulatory Assessment Scale (NSAA), Physiological

Cost Index (PCI), and Timed performance tests were used to assess the children.

Results:

Comparison in terms of PCI indicated a difference between Levels 2 and 3, and Levels 1 and 3 (p<0.0083). A difference was found in ascending and descending 4 stairs after 6MWT when fatigue after activity was evaluated.

Conclusion:

The walking distances, fatigue levels and energy expenditure of DMD patients were higher than the healthy peers. This difference was more prominent with decreasing functional level.

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3-5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant's later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.

The role of the family in early intervention of preterm infants with abnormal general movements

Objectives:

To determine the effect of family-based intervention on motor function in preterm infants.

Methods:

This study was designed as a randomized controlled trial between August 2015 and September 2016. Forty-two preterm infants were randomized and split equally between the family-based intervention group, composed of a physiotherapeutic and a familial component (8 males, 8 females; mean age 91±3.09 days), and the traditional early intervention group (8 females, 8 males, mean age: 91.06±2.4 days). Both groups received a treatment program based on a neurodevelopmental approach during 3- to 12-months-old. The groups were evaluated at corrected ages of the third, sixth, ninth, twelfth, and 24th months using the Bayley Scale of Infant and Toddler Development, Third Edition (Bayley-III).

Results:

Within-group changes over time were statistically significant using multivariate tests of fine motor (Multivariate analysis of variance (MANOVA); F=1515.27, p<0.001) and gross motor (MANOVA; F=1950.59, p=0.001) development. However, there was no interaction between groups in fine (MANOVA; F=0.027, p=0.872) and gross motor development (MANOVA; F=0.022, p=0.883).

Conclusion:

The early intervention approaches might support fine and gross motor function development in preterm infants in the first year of life.

Impairments, activity limitations, and participation restrictions of the international classification of functioning, disability, and health model in children with ambulatory cerebral palsy

Objectives:

To examine the impairments, activity limitations, and participation restrictions in children with spastic unilateral and bilateral cerebral palsy (CP). We investigated the relationship between these factors according to the international classification of functioning, disability, and health (ICF) model.

Methods:

This prospective cross sectional study included 60 children aged between 4-18 years with spastic CP (30 unilateral, 30 bilateral involvement) classified as Levels I and II on the gross motor function classification system. Children had been referred to the Pediatric Rehabilitation Unit in the Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey between March 2014 and March 2015. The Physician Rating scale was used to assess body functions and structures. The Gillette Functional Assessment Questionnaire 22-item skill set, Pediatric Functional Independence Measure, and Pediatric Outcomes Data Collection Instrument were used to assess activity and participation levels.

Results:

There was a significant positive correlation between impairments and activity limitations (r=0.558; p=0.000), as well as between activity limitations and participation restrictions (r=0.354, p=0.005).

Conclusion:

These results show that activity limitations in children with unilateral and bilateral ambulatory CP may be related to their impairments and participation restrictions, although the sample size of our study is not large enough for generalizations. Overall, our study highlights the need for up-to-date, practical evaluation methods according to the ICF model.

The motor repertoire in 3- to 5-month old infants with Down syndrome

BACKGROUND

Even though Down syndrome is the most common chromosomal cause of intellectual disability, studies on early development are scarce.

AIM

To describe movements and postures in 3- to 5-month-old infants with Down syndrome and assess the relation between pre- and perinatal risk factors and the eventual motor performance.

METHODS AND PROCEDURES

Exploratory study; 47 infants with Down syndrome (26 males, 27 infants born preterm, 22 infants with congenital heart disease) were videoed at 10-19 weeks post-term (median=14 weeks). We assessed their Motor Optimality Score (MOS) based on postures and movements (including fidgety movements) and compared it to that of 47 infants later diagnosed with cerebral palsy and 47 infants with a normal neurological outcome, matched for gestational and recording ages.

OUTCOMES AND RESULTS

The MOS (median=13, range 10-28) was significantly lower than in infants with a normal neurological outcome (median=26), but higher than in infants later diagnosed with cerebral palsy (median=6). Fourteen infants with Down syndrome showed normal fidgety movements, 13 no fidgety movements, and 20 exaggerated, too fast or too slow fidgety movements. A lack of movements to the midline and several atypical postures were observed. Neither preterm birth nor congenital heart disease was related to aberrant fidgety movements or reduced MOS.

CONCLUSIONS AND IMPLICATIONS

The heterogeneity in fidgety movements and MOS add to an understanding of the large variability of the early phenotype of Down syndrome. Studies on the predictive values of the early spontaneous motor repertoire, especially for the cognitive outcome, are warranted.

WHAT THIS PAPER ADDS

The significance of this exploratory study lies in its minute description of the motor repertoire of infants with Down syndrome aged 3-5 months. Thirty percent of infants with Down syndrome showed age-specific normal fidgety movements. The rate of abnormal fidgety movements (large amplitude, high/slow speed) or a lack of fidgety movements was exceedingly high. The motor optimality score of infants with Down syndrome was lower than in infants with normal neurological outcome but higher than in infants who were later diagnosed with cerebral palsy. Neither preterm birth nor congenital heart disease were related to the motor performance at 3-5 months.

Effects of functional level on balance in children with Duchenne Muscular Dystrophy

INTRODUCTION

This study was planned to compare the static and dynamic balance in children with Duchenne Muscular Dystrophy (DMD) at different functional levels with each other and with healthy peers.

MATERIAL AND METHODS

Sixty nine children between the ages of 6 and 11 were included in this study where 52 of them were diagnosed with DMD in Level I (18 patients), Level II (17 patients), and Level III (17 patients) according to Brooke Functional Classification Scale and 17 of them healthy peers were included. In order to assess static and dynamic balance pediatric functional reach test (PFRT) and timed up and go test (TUGT) were used.

RESULTS

When compared in terms of the TUGT, differences were found between all groups, i.e. Level 1 and 2, Level 2 and 3, Level 1 and 3, Healthy peers and Level 1, Healthy peers and Level 2, and Healthy peers and Level 3 (p < 0.0083). When compared in terms of the PFRT in the standing positions, there was difference between level 3 and healthy peers (p < 0.0083), but not between the other groups.

CONCLUSIONS

We found poor functional level in DMD to affect the dynamic and static balance parameters in this study. The dynamic balance of a child with DMD at Level 3 is decreased to a third of a healthy peer.

The effect of segmental weight of prosthesis on hemodynamic responses and energy expenditure of lower extremity amputees

[Purpose] The aim of this study was to investigate the effect of segmental weight of the prosthesis on hemodynamic responses and energy expenditure in lower extremity amputees. [Subjects and Methods] Thirteen patients with a mean age of 44 ± 15.84 years and with unilateral transtibial, transfemoral and Syme’s amputation were included to the study. The difference between the lightest and the heaviest prosthesis, 250 g used as the weight. All the patients completed the measurements first without weight and then with 250 g weight on the ankle joint. The blood pressure and heart rate of the patients were recorded before and after Six Minute Walk Test (6MWT) and 10 stairs up & down stairs test. Physiological Cost Index was used to calculate the energy expenditure. [Results] Heart rate and energy expenditure increased significantly when without weight and with weight results compared. [Conclusion] We conclude that the segmental weight of the prosthetic limb has a significant effect on the heart rate and energy expenditure but has no effect on the systolic and diastolic blood pressure of lower limb amputees. In order to generalize our results to lower limb amputees, more patients need to be included in future studies.

The effectiveness of taping on children with cerebral palsy: a systematic review

AIM

Taping is popular in a variety of paediatric clinical settings. The purpose of this study was to investigate the effectiveness of taping on the rehabilitation of children with cerebral palsy (CP).

METHOD

We used MEDLINE, Embase, PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials as the electronic databases for the review. We reviewed all relevant studies published up to May 2015. We also analysed pertinent secondary references. We used Sackett's Levels of Evidence and the guidelines for critical review of McMaster University to criticize the reviewed articles.

RESULTS

Nine papers met the inclusion criteria. Five of these were randomized controlled trials, three were case series, and one was a single case study. Four papers were high quality according to the methodological critical forms of this review, and two of these found that taping was effective in increasing activity in children with CP.

INTERPRETATION

Although benefits of taping were found in the population, and functional gains according to the International Classification of Functioning, Disability and Health were obtained, the evidence was not conclusive. Randomized controlled trials with larger sample sizes and with more specific taping procedures are required to strengthen the evidence for the effectiveness of taping on children with CP.

What do the relationships between functional classification systems of children with cerebral palsy tell us?

[Purpose] To examine the distribution of and relationship between the Gross Motor Function, Manual Ability, and Communication Function Classification Systems in different limbs of children with spastic cerebral palsy. We also investigated whether the four predicting variables of gender, age, manual ability, and gross motor classifications could significantly predict effective and non-effective communicator groups in communication function. [Subjects and Methods] This retrospective cross-sectional study included 327 children with a mean age of 10.13 ± 4.09 years. Classifications were performed by an experienced pediatric physiotherapist. [Results] Gross motor function levels showed a strong correlation with manual ability levels (r_s=0.78). Manual ability level was strongly correlated with communication function levels (r_s=0.73), particularly in quadriplegic children (r_s=0.78). Gross motor function levels were moderately correlated with communication function levels (r_s=0.71). Effective communicators in communication function showed more functional levels of manual ability and were determined by Gross Motor Function classifications. The variables were better at predicting ineffective communicators (91% correct) compared with effective communicators (85% correct). [Conclusion] Further studies are needed to relate these functional performance systems to the activity and participation levels as well as the quality of life, desires, and participation of the subjects.

Should botulinum toxin A injections be repeated in children with cerebral palsy? A systematic review

AIM

The aim of this study was to determine the effects of repeat botulinum toxin A (BoNT-A) injections in children with spastic cerebral palsy (CP) on the basis of a best evidence synthesis.

METHOD

This study included 13 original articles after searching the literature to retrieve information. We used the critical review form produced by McMaster University to determine the methodological quality of the studies, and then confirmed the levels of evidence from Sackett. The studies were also evaluated using the International Classification of Function, Disability and Health - Children and Youth Version (ICF-CY).

RESULTS

A total of 893 children with spastic CP who had been administered repeat BoNT-A injections were evaluated. The evidence level was II in four of the thirteen studies, III in four studies, and IV in five studies. The McMaster review form score was 14 in two studies, 13 in four studies, and 12 in seven studies. The results showed that repeat BoNT-A may be a safe and an effective approach. The first two injections/one repeat especially relieve spasticity and improve fine and gross motor activities.

INTERPRETATION

Future studies to investigate the effectiveness of repeat BoNT-A in children with spastic CP may be planned within the framework of the ICF-CY to include well-designed randomized controlled trials and those conducted on larger homogenous groups.

Systematic Review of Cerebral Palsy Registries/Surveillance Groups: Relationships between Registry Characteristics and Knowledge Dissemination

The aims of this study were to provide a comprehensive summary of the body of research disseminated by Cerebral Palsy (CP) registries and surveillance programs from January 2009 through May 2014 in order to describe the influence their results have on our overall understanding of CP. Secondly, registries/surveillance programs and the work they produced were evaluated and grouped using standardized definitions and classification systems.

METHOD

A systematic review search in PubMed, CINAH and Embase for original articles published from 1 January 2009 to 20 May 2014 originating from or supported by population based CP registries and surveillance programs or population based national registries including CP were included. Articles were grouped by 2009 World CP Registry Congress aim, registry/surveillance program classification, geographical region, and the International Classification of Function, Disability and Health (ICF) domain. Registry variables were assessed using the ICF-CY classification.

RESULTS

Literature searches returned 177 articles meeting inclusion criteria. The majority (69%) of registry/surveillance program productivity was related to contributions as a Resource for CP Research. Prevention (23%) and Surveillance (22%) articles were other areas of achievement, but fewer articles were published in the areas of Planning (17%) and Raising the Profile of CP (2%). There was a range of registry/surveillance program classifications contributing to this productivity, and representation from multiple areas of the globe, although most of the articles originated in Europe, Australia, and Canada. The domains of the ICF that were primarily covered included body structures and function at the early stages of life. Encouragingly, a variety of CP registry/surveillance program initiatives included additional ICF domains of participation and environmental and personal factors.

INTERPRETATION

CP registries and surveillance programs, including novel non-traditional ones, have significantly contributed to the understanding of how CP affects individuals, families and society. Moving forward, the global CP registry/surveillance program community should continue to strive for uniformity in CP definitions, variables collected and consistency with international initiatives like the ICF so that databases can be consolidated for research use. Adaptation to new technologies can improve access, reduce cost and facilitate information transfer between registrants, researchers and registries/surveillance programs. Finally, increased efforts in documenting variables of individuals with CP into adulthood should be made in order to expand our understanding of CP across the lifespan.

Improvements in children with cerebral palsy following intrathecal baclofen: use of the Rehabilitation Institute of Chicago Care and Comfort Caregiver Questionnaire (RIC CareQ)

Implantation of an intrathecal baclofen pump is recommended for children with cerebral palsy as a means to improve care and comfort when other options fail to control severe hypertonia. Making an assessment of a child's spasticity-related limitations in both routine care and activity is a necessary component of selection of intrathecal baclofen candidates. The Rehabilitation Institute of Chicago Care and Comfort Caregiver Questionnaire (RIC CareQ) is a validated, easy-to-use questionnaire that elicits information about the ease of daily activity and caregiving in patients with severe spasticity. Questionnaires completed by caregivers and patients at a pediatric physiatry spasticity clinic over an 11-year period were reviewed to evaluate whether the Rehabilitation Institute of Chicago Care and Comfort Caregiver Questionnaire captured improved caregiving and comfort of children with cerebral palsy and severe spasticity following intrathecal baclofen pump implantation. The Questionnaire scores showed improvement after intrathecal baclofen pump implantation, consistent with subjective reports of patient and caregiver satisfaction.

DTI findings during spontaneous migraine attacks

PURPOSE

Previous functional neuroimaging studies showed that the brainstem may have an important role in migraine and recently, DTI studies demonstrated that structural alterations in migraineurs may extend beyond the normal appearing brain tissue. The aim of our study was to find out if DTI may detect any abnormality during the spontaneous migraine attacks.

METHODS

The DTI images obtained in a 3T system during spontaneous migraine episodes. Patients with any systemic or metabolic disorder and abnormal signal intensity in conventional sequences were excluded. We measured the FA and ADC values of red nuclei, periaquaductal gray matter, thalami, posterior limbs of internal capsules and subcortical white matter. Fifteen healthy volunteers served as control group.

RESULTS

Fourteen patients enrolled in the study. The only site where we found an abnormality was the red nuclei, where the ADC values in migraineurs were statistically higher than in healthy volunteers. There was no statistical correlation between the DTI measurements and patients' ages, duration of disease, frequency of attacks and localization of pain.

CONCLUSION

Our findings supported the findings of previous functional neuroimaging studies, which concluded that the brainstem might have a role in the pathogenesis of a migraine episode. We think that the increase of ADC values in red nuclei may reflect vasogenic edema, which cannot be detected in conventional sequences. However, the exact underlying mechanism for this observation is unclear and we do not know whether these changes are responsible for triggering an attack or if they are the consequents of the attack itself.