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Eto E, Maeda T, Kobayashi O, Ihara K. Intrauterine twin environment and genetic factors subliminally affecting general movements in preterm infants. Brain Dev 2024:S0387-7604(24)00072-X. [PMID: 38705801 DOI: 10.1016/j.braindev.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Understanding background factors is beneficial for interpreting general movements (GMs). This study examines the factors involved in preterm-writhing GMs by comparing twins and singletons. METHOD The subjects were 107 infants cared for at Oita University. The cohort consisted of very-low-birth-weight infants, including twins with a birth weight < 2000 g. The median gestational age (GA) was 29 weeks 1 day. The subjects consisted of 75 singletons, 32 twins (16 pairs), 20 monochorionic twins (M-twins), and 12 dichorionic twins (D-twins). GMs were scored according to the GMs optimality score (GMOS) and integrated into 6 items: the quality, neck-trunk and space, amplitude-speed, rotation, onset-offset and cramped, and tremulous score at 32-34 weeks, 35-36 weeks, and 37-42 weeks' GA. A hierarchical cluster analysis was performed using integrated GMOS, and the characteristics of clusters were examined according to clinical backgrounds. RESULTS Three clusters were identified. Cluster 1 was characterized by good-quality GMs, cluster 2 by a poor repertoire but optimal space and rotatory components, and cluster 3 by overall poor-quality GMs, respectively. The mean GMOSs were 36.6, 31.8 and 24.3 in clusters 1, 2, and 3, respectively. There were no marked differences in proportions within clusters with respect to sex and twins. Small-for-gestational age (SGA) was significantly more frequent in cluster 3 at 32-34 weeks' GA than in other clusters. Perinatal brain injury had a significantly lower proportion in cluster 1 and a higher proportion in cluster 3 at 35-36 weeks' GA and 37-42 weeks' GA. M-twin pairs tended to belong to the same clusters at 35-36 weeks' GA. CONCLUSION Preterm writhing GMs are associated with SGA and perinatal brain injury. Cluster matching in M-twins suggests that certain genetic factors may substantially influence GMs.
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Affiliation(s)
- Eriko Eto
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Tomoki Maeda
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan.
| | - Osamu Kobayashi
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Kenji Ihara
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
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Park MW, Shin HI, Bang MS, Kim DK, Shin SH, Kim EK, Lee ES, Shin HI, Lee WH. Reduction in limb-movement complexity at term-equivalent age is associated with motor developmental delay in very-preterm or very-low-birth-weight infants. Sci Rep 2024; 14:8432. [PMID: 38600352 PMCID: PMC11006919 DOI: 10.1038/s41598-024-59125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
Reduced complexity during the writhing period can be crucial in the spontaneous movements of high-risk infants for neurologic impairment. This study aimed to verify the association between quantified complexity of upper and lower-limb movements at term-equivalent age and motor development in very-preterm or very-low-birth-weight infants. Video images of spontaneous movements at term-equivalent age were collected from very-preterm or very-low-birth-weight infants. A pretrained pose-estimation model and sample entropy (SE) quantified the complexity of the upper- and lower-limb movements. Motor development was evaluated at 9 months of corrected age using Bayley Scales of Infant and Toddler Development, Third Edition. The SE measures were compared between infants with and without motor developmental delay (MDD). Among 90 infants, 11 exhibited MDD. SE measures at most of the upper and lower limbs were significantly reduced in infants with MDD compared to those without MDD (p < 0.05). Composite scores in the motor domain showed significant positive correlations with SE measures at most upper and lower limbs (p < 0.05). The results show that limb-movement complexity at term-equivalent age is reduced in infants with MDD at 9 months of corrected age. SE of limb movements can be a potentially useful kinematic parameter to detect high-risk infants for MDD.
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Affiliation(s)
- Myung Woo Park
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Don-Kyu Kim
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Sun Lee
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyun Iee Shin
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
- Biomedical Research Institute, Chung-Ang University Hospital, Seoul, Republic of Korea.
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Yardımcı-Lokmanoğlu BN, Demir N, Porsnok D, Sırtbaş-Işık G, Cengiz E, Serel-Arslan S, Mutlu A. Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes? A cohort study. Eur J Pediatr 2024; 183:1435-1446. [PMID: 38217695 PMCID: PMC10951042 DOI: 10.1007/s00431-024-05422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
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.
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Affiliation(s)
- Bilge N Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Numan Demir
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Swallowing Disorders Unit, Ankara, Türkiye
| | - Doğan Porsnok
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye
| | - Gülsen Sırtbaş-Işık
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye
| | - Emre Cengiz
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Swallowing Disorders Unit, Ankara, Türkiye
| | - Selen Serel-Arslan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Swallowing Disorders Unit, Ankara, Türkiye
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye
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Sırtbaş-Işık G, Porsnok D, Yardımcı-Lokmanoğlu BN, Mutlu A. Sleep characteristics, early spontaneous movements, and developmental functioning in preterm infants in the early postnatal period. Sleep Med 2024; 114:151-158. [PMID: 38184924 DOI: 10.1016/j.sleep.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
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.
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Affiliation(s)
- Gülsen Sırtbaş-Işık
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Doğan Porsnok
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Bilge Nur Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
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Shin HI, Park MW, Lee WH. Spontaneous movements as prognostic tool of neurodevelopmental outcomes in preterm infants: a narrative review. Clin Exp Pediatr 2023; 66:458-464. [PMID: 37202346 PMCID: PMC10626027 DOI: 10.3345/cep.2022.01235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023] Open
Abstract
An estimated 15 million infants are born prematurely each year. Although the survival rate of preterm infants has increased with advances in perinatal and neonatal care, many still experience various complications. Since improving the neurodevelopmental outcomes of preterm births is a crucial topic, accurate evaluations should be performed to detect infants at high risk of cerebral palsy. General movements are spontaneous movements involving the whole body as the expression of neural activity and can be an excellent biomarker of neural dysfunction caused by brain impairment in preterm infants. The predictive value of general movements with respect to cerebral palsy increases with continuous observation. Automated approaches to examining general movements based on machine learning can help overcome the limited utilization of assessment tools owing to their qualitative or semiquantitative nature and high dependence on assessor skills and experience. This review covers each of these topics by summarizing normal and abnormal general movements as well as recent advances in automatic approaches based on infantile spontaneous movements.
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Affiliation(s)
- Hyun Iee Shin
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myung Woo Park
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
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Topal Y, Yardımcı-Lokmanoğlu BN, Topuz S, Mutlu A. Early spontaneous movements and spatiotemporal gait characteristics in preterm children. Eur J Pediatr 2023:10.1007/s00431-023-04949-7. [PMID: 37060442 DOI: 10.1007/s00431-023-04949-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/16/2023]
Abstract
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.
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Affiliation(s)
- Yusuf Topal
- Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye.
| | - Bilge Nur Yardımcı-Lokmanoğlu
- Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Semra Topuz
- Gait Analysis Laboratory, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Akmer Mutlu
- Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
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Ferrari F, Bedetti L, Cavalleri F, Lucaccioni L, Bertoncelli N, Guidotti I, Lugli L, Roversi MF, Della Casa Muttini E, Pugliese M, Arpi E, D'Amico R, Berardi A. Therapeutic hypothermia is associated with changes in prognostic value of general movements. Eur J Paediatr Neurol 2023; 42:53-9. [PMID: 36563466 DOI: 10.1016/j.ejpn.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/15/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS General movements (GMs) have been recognized as the most accurate clinical tools for predicting cerebral palsy (CP). This study aimed to compare the type and prognostic value of abnormal GMs in infants with hypoxic ischemic encephalopathy treated or not with therapeutic hypothermia (TH). MATERIALS AND METHODS This was a single-center retrospective study. We compared GMs of 55 cooled term infants versus 30 non-cooled term infants with hypoxic ischemic encephalopathy (HIE) and their motor outcome at 24 months of age. We also included data regarding early brain MRI scans. RESULTS Rates of cerebral palsy was 5.4% and 46.7% in cooled and non-cooled infants respectively (p < 0.001). None of cooled infants showed cramped-synchronized GMs, whereas among non-cooled infants the cramped-synchronized pattern was present in 17.2% and 20% of infants at 1 and 3 months of age respectively. Hypokinesis was never seen in cooled infants and it was present in 23.3% of non-cooled ones. Absent fidgety correlated with CP in 14% and 73% of cooled and non-cooled infants respectively. At brain MRI cooled infants had fewer and less severe cerebral lesions compared to non-cooled infants (p = 0.003). CONCLUSIONS Abnormal GMs are reduced in infants treated with TH. Hypokinesis and cramped-synchronized GMs are not observed in cooled infants and the associations between absent fidgety movements and CP it is largely abolished. TH is associated with changes in prognostic value of GMs.
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Salavati S, den Heijer AE, Coenen MA, Bruggink JLM, Einspieler C, Bos AF, Spikman JM. The Early Motor Repertoire in Preterm Infancy and Cognition in Young Adulthood: Preliminary Findings. J Int Neuropsychol Soc 2023; 29:80-91. [PMID: 34974853 DOI: 10.1017/S1355617721001351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Preterm birth poses a risk to cognition during childhood. The resulting cognitive problems may persist into young adulthood. The early motor repertoire in infancy is predictive of neurocognitive development in childhood. Our present aim was to investigate whether it also predicts neurocognitive status in young adulthood. METHOD We conducted an explorative observational follow-up study in 37 young adults born at a gestational age of less than 35 weeks and/or with a birth weight below 1200 g. Between 1992 and 1997, these individuals were videotaped up until 3 months' corrected age to assess the quality of their early motor repertoire according to Prechtl. The assessment includes general movements, fidgety movements (FMs), and a motor optimality score (MOS). In young adulthood, the following cognitive domains were assessed: memory, speed of information processing, language, attention, and executive function. RESULTS Participants in whom FMs were absent in infancy obtained lower scores on memory, speed of information processing, and attention than those with normal FMs. Participants with aberrant FMs, that is, absent or abnormal, obtained poorer scores on memory, speed of information processing speed, attention, and executive function compared to peers who had normal FMs. A higher MOS was associated with better executive function. CONCLUSIONS The quality of the early motor repertoire is associated with performance in various cognitive domains in young adulthood. This knowledge may be applied to enable the timely recognition of preterm-born individuals at risk of cognitive dysfunctions.
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de Mendonça KT, Lanza FC, de Sousa Morais RL, Camargos ACR. Clinical factors associated with abnormal general movements of preterm newborns during hospitalization in a neonatal intensive care unit. Early Hum Dev 2022; 174:105682. [PMID: 36206619 DOI: 10.1016/j.earlhumdev.2022.105682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is no clarity about which clinical variables during hospitalization in the Neonatal Intensive Care Unit (NICU) are associated with abnormal General Movements (GMs). OBJECTIVE To describe the trajectory of GMs of preterm newborns and explore the association between clinical variables and the presence of abnormal GMs during the NICU stay. METHODS Fifty-eight preterm newborns (33 males), with a mean gestational age at birth of 31,93 week's postmenstrual age, were evaluated using the GMs assessment by Hadders-Algra method. Clinical variables recorded weekly throughout the hospitalization period. The weekly association between clinical variables and the presence of abnormal GMs was tested using the Generalized Estimating Equations (GEE) model. RESULTS Preterm infants were recorded for up to sixteen weeks and more than half of the infants (56.9 %) had abnormal movements in at least one week during hospitalization. The absence of peri-intraventricular hemorrhage (PIVH) grades I-II and non-invasive ventilatory support and/or oxygen therapy on the day of the evaluation reduced, respectively, by 77.3 % (OR = 0.23; p > 0.0001) and 64.3 % (OR = 0.36; p > 0.0001) the chance of having an abnormal classification. In addition, each day of increased invasive mechanical ventilation increased the chance of having an abnormal classification by 1.11 times (OR = 0.025; p > 0.0001). CONCLUSION PIVH grades I-II, longer durations of mechanical ventilation and the presence of non-invasive ventilatory support and/or oxygen therapy are associated with abnormal movements during stay in the neonatal period. The data suggest that development outcome of infants having these conditions should be closely monitored.
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Affiliation(s)
- Karoline Tury de Mendonça
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Córdoba Lanza
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosane Luzia de Sousa Morais
- Graduate Program in Health, Society and Environment and Department of Physiotherapy, Universidade Federal do Vale do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Ana Cristina Resende Camargos
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Porsnok D, Sırtbaş G, Yardımcı-Lokmanoğlu BN, Mutlu A. Early Spontaneous Movements and Postural Patterns in Infants With Extremely Low Birth Weight. Pediatr Neurol 2022; 129:55-61. [PMID: 35240363 DOI: 10.1016/j.pediatrneurol.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/20/2021] [Accepted: 01/26/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Extremely-low-birth-weight (ELBW) infants are at high risk of morbidity, mortality, and long-term neurodevelopmental disorders. Evaluating infants' early spontaneous movements and postural patterns could facilitate the early detection of neurological dysfunction. This study aimed to analyze the results of global-and detailed-General Movements Assessment (GMA) in ELBW infants at a corrected age of three to five months and to compare with normal-birth-weight (NBW) infants. METHODS Fifty-two ELBW infants (median birth weight = 915.5 g) and 50 NBW infants were included. All infants were assessed according to GMA using Motor Optimality Score for 3- to 5-Month-Old Infants-Revised score sheet (MOS-R). In addition, later diagnoses of ELBW infants with atypical development were presented. RESULTS Fidgety movements were observed in 36 (69.2%) of ELBW infants and all NBW infants. MOS-R scores were lower in the ELBW group (median = 24) compared with the NBW group (median = 26). The ELBW infants scored lower than NBW infants in all MOS-R subcategories. Twenty-three (44.2%) of ELBW infants were diagnosed as atypical in the later period, although all control infants had normal development. CONCLUSIONS The study indicated that ELBW might increase the risk of atypical development in infants. The MOS-R could help us to find the risk of atypical development in infants with ELBW.
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Tripathi T, Harrison TM, Simsic JM, Cabral TI, Heathcock JC. Screening and Evaluation of Neurodevelopmental Impairments in Infants Under 6 Months of Age with Congenital Heart Disease. Pediatr Cardiol 2022; 43:489-96. [PMID: 35190880 DOI: 10.1007/s00246-021-02745-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022]
Abstract
Clinical evaluation of neurodevelopmental impairments before 6 months of age is needed in congenital heart disease (CHD) to promote early referral to developmental interventions. The objective was to identify the risk of cerebral palsy (CP) and to compare neurodevelopment outcomes in infants with and without CHD. In a longitudinal study, 30 infants with CHD and 15 infants without CHD were assessed at 1 month, 3 months, and 6 months of age. Included measures were General Movement Assessment (GMA), Test of Infant Motor Performance (TIMP) and the Bayley Scale of Infant Development, third edition (Bayley-III), selected to identify the risk of CP, document neurodevelopmental impairments and infants' eligibility for early intervention services. Abnormal GMA categories were found in the CHD group where 48% had poor repertoire and 15% were at high risk of CP. At 3 months of age, CHD group had significantly lower TIMP scores compared to infants without CHD [t(41) = 6.57, p = 0.01]. All infants in the study had higher Bayley-III scores at 6 months than at 3 months of age. Infants with CHD had lower gross motor, fine motor and cognitive Bayley-III scores compared to their peers without CHD. Over time infants without CHD outperformed the CHD group in the gross motor skills [F(1,41) = 11.76, p = .001]. Higher prevalence of abnormal GMs, lower TIMP and Bayley-III were found in infants with single ventricle physiology compared to two-ventricle physiology. The risk of CP exists in infants with CHD, and these infants have worse outcomes compared to their peers without CHD. These differences are intensified in the single ventricle population.Clinical Trial Registration National Institute of Health, Unique identifier: NCT03104751; Date of registration-April 7, 2017.
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Kahraman A, Alkan H, Çelik HT, Mutlu A. The effect of hyperbilirubinemia on motor repertoire of infants between 3 and 5 months of age. Eur J Pediatr 2022; 181:99-105. [PMID: 34215927 DOI: 10.1007/s00431-021-04162-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/27/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
Jaundice is a common problem and occurs as a result of the increase in bilirubin level in infants. Infants may be adversely affected by this situation. The aim of this study is to determine whether neonatal jaundice affects the movements and postures of 3- to 5-month-old infants with hyperbilirubinemia and the correlation of motor repertoire at the same age with bilirubin levels. The study group included 30 infants (9 girls, 21 boys) with hyperbilirubinemia and a control group of 30 infants (11 girls, 19 boys) with typical development without hyperbilirubinemia. The motor repertoires of the infants were evaluated through detailed general movement (GM) analysis using video recordings made at 9-17 weeks post-term. The infants with hyperbilirubinemia had lower motor optimality score and subcategory scores (including observed movement patterns, age-adequate movement repertoire, observed postural patterns, and movement character) compared with the control group. The fidgety movement scores decreased as bilirubin value increased in infants.Conclusion: Infants with hyperbilirubinemia had poorer motor repertoire when compared to a control group. For this reason, detailed GM analysis of these infants will predict probable neurodevelopmental problems and infants with needs can begin individualized early intervention suitable for movement repertoire and posture at the earliest time. What is Known: • GMs of infants with hyperbilirubinemia were previously described. • However, the motor repertoires of infants with hyperbilirubinemia were not described in detail. What is New: • Infants with hyperbilirubinemia had poorer motor repertoire when compared to peers. • This is important in determining the need for individualized early intervention.
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Yardımcı-Lokmanoğlu BN, Mutlu A, Livanelioğlu A. The early spontaneous movements, and developmental functioning and sensory processing outcomes in toddlers born preterm: A prospective study. Early Hum Dev 2021; 163:105508. [PMID: 34798516 DOI: 10.1016/j.earlhumdev.2021.105508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/04/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Bilge Nur Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey.
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Ayşe Livanelioğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
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Ustad T, Fjørtoft T, Øberg GK. General movement optimality score and general movements trajectories following early parent-administrated physiotherapy in the neonatal intensive care unit. Early Hum Dev 2021; 163:105488. [PMID: 34695679 DOI: 10.1016/j.earlhumdev.2021.105488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Prechtl General Movement Assessment (GMA) is a reliable tool for the functional assessment of the young nervous system. It is based on a global assessment of the quality of infants' movements. In addition, detailed steps of assessment have been developed - one for preterm and term age, and one for use between 3 and 5 months. One potential benefit of such a detailed analysis is the documentation of subtle changes in the infants' spontaneous movements caused by early intervention. AIM To present detailed scores of the infants' general movements (GMs) at preterm age, and of the infants' motor repertoire at 3 months' postterm age (PTA), for infants having participated in a randomized controlled trial (RCT) of early intervention, and to examine possible group differences. In addition, the aim is also to present the GMA from preterm to 3 months' PTA, comparing the intervention and the control group. STUDY DESIGN A retrospective study on infants who had participated in an RCT of parent-administered early intervention. SUBJECTS 141 infants born very preterm. OUTCOME MEASURES GMA, "Detailed Assessment of General Movements During Preterm and Term Age" and "Assessment of Motor Repertoire at 3 to 5 months". RESULTS The GMA and the detailed assessments of GMs conducted at 36 weeks' post menstrual age (PMA) showed the same distribution of normal and abnormal movements in both the intervention and in the control group, as did the assessment of motor repertoire at 3 months' PTA. CONCLUSION Neither the GMA nor the detailed assessments of GMs at 36 weeks' PMA and of the motor repertoire at 13 weeks' PTA suggest that early intervention, performed before term, changes the GMs of very preterm-born infants.
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Affiliation(s)
- Tordis Ustad
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Toril Fjørtoft
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Section of Physiotherapy, University Hospital North Norway, Tromsø, Norway
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Apaydın U, Erol E, Yıldız A, Yıldız R, Acar ŞS, Gücüyener K, Elbasan B. The use of neuroimaging, Prechtl's general movement assessment and the Hammersmith infant neurological examination in determining the prognosis in 2-year-old infants with hypoxic ischemic encephalopathy who were treated with hypothermia. Early Hum Dev 2021; 163:105487. [PMID: 34673463 DOI: 10.1016/j.earlhumdev.2021.105487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of neuroimaging, the General Movement Assessment (GMA), and the Hammersmith Infant Neurological Examination (HINE) to identify the risk of neurodevelopmental delay in early infancy is recommended. AIM The aim of this study was to examine the predictive power of neuroimaging, GMA and HINE for neurodevelopmental delay and cerebral palsy (CP) in infants with hypoxic ischemic encephalopathy (HIE) who were treated with hypothermia. STUDY DESIGN Retrospective cohort. SUBJECTS AND OUTCOME MEASURES This retrospective study included 47 (18 female and 29 male) infants who were treated with hypothermia due to HIE. Neonates with a diagnosis of HIE were followed and assessed using neuroimaging, GMA, HINE and the Bayley Scales of Infant and Toddler Development-II (Bayley II) between 3 m and 2 years of age. RESULTS Out of the 47 infants with HIE, no fidgety movements were observed in 5 infants. The sensitivity and specificity in determining the psychomotor developmental index (PDI) score were 97% and 100%, respectively, for MRI; 92.9% and 100% for GMA; and 91.9% and 80% for the HINE. The sensitivity and specificity in determining the mental developmental index (MDI) score were 95% and 85.7%, respectively, for MRI; 90.5% and 80% for GMA; and 91.9% and 50% for HINE. The sensitivity and specificity in determining CP diagnosis at the age of 2 years were 83.3% and 95%, respectively, for MRI; 83.3% and 100% for GMA; and 83.3% and 87.8% for HINE. CONCLUSION The interpretation of MRI, GMA, and HINE that are performed within the early period of life may be the gold standard for the early detection of neurodevelopmental risks in 2-year-old infants with HIE. Clinical implementation of these methods in the early period in the follow-up of these infants offers useful information for the early identification of neurodevelopmental risk and for planning early intervention.
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Affiliation(s)
- Umut Apaydın
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06500 Ankara, Turkey.
| | - Erkan Erol
- Tokat Gaziosmanpaşa University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 60250 Tokat, Turkey
| | - Ayşe Yıldız
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06500 Ankara, Turkey
| | - Ramazan Yıldız
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06500 Ankara, Turkey
| | - Şebnem Soysal Acar
- Gazi University, Faculty of Medicine, Department of Pediatrics, Section of Pediatric Neurology, 06500 Ankara, Turkey
| | - Kıvılcım Gücüyener
- Gazi University, Faculty of Medicine, Department of Pediatrics, Section of Pediatric Neurology, 06500 Ankara, Turkey
| | - Bülent Elbasan
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06500 Ankara, Turkey.
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Robinson H, Hart D, Vollmer B. Predictive validity of a qualitative and quantitative Prechtl's General Movements Assessment at term age: Comparison between preterm infants and term infants with HIE. Early Hum Dev 2021; 161:105449. [PMID: 34481188 DOI: 10.1016/j.earlhumdev.2021.105449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/25/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
AIM To determine (1) if the General Movement Optimality Score (GMOS) at term age enhances prediction of motor impairment at 12 and 24 months of age in high-risk infants, when compared to a global General Movement Assessment (GMA), and (2) compare predictive validity for two high-risk populations: infants born preterm and infants born at term with hypoxic ischaemic encephalopathy who have received therapeutic hypothermia. METHODS Fifty-nine extremely preterm or term age infants with hypoxic ischaemic encephalopathy underwent term age GMA. A GMA score of normal or abnormal, and a comparative numerical General Movement Optimality Score (GMOS, total values 5-42) were assigned. Neurology and motor assessment were carried out at age 12 and 24 months using standardised assessments; Alberta Infant Motor Scale, Bayley Scales of Infant and Toddler Development or Ages and Stages Questionnaire. Outcomes were recorded as normal, motor delayed or cerebral palsy. Motor outcome prediction at 12 and 24 months of age was calculated using the GMA and, using ROC analysis, GMOS cut-off scores were determined. RESULTS At 12 and 24 months global GMA sensitivity for preterms was 80% and 100%, and for Term HIE was 100% at both ages. Specificity values for preterm infants at 12 and 24 months were 68.8% and 60% versus 28.8% and 21.4% for term HIE. Median GMOS scores were lower in the term HIE group than the preterm group in the normal and poor repertoire categories. Optimality cut off scores enhanced specificity, but values remained low. INTERPRETATION At term age, specificity for identification of infants with later normal motor outcome is low. The GMOS may assist identification of infants with the highest probability of motor impairment, enabling targeted intervention during critical periods for neuroplasticity.
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Affiliation(s)
- Helen Robinson
- Dept of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Physiotherapy Department, Musgrove Park Hospital, Taunton, UK.
| | - Denise Hart
- Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton, UK
| | - Brigitte Vollmer
- Dept of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton, UK
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Aizawa CYP, Einspieler C, Genovesi FF, Ibidi SM, Hasue RH. The general movement checklist: A guide to the assessment of general movements during preterm and term age. J Pediatr (Rio J) 2021; 97:445-452. [PMID: 33147443 PMCID: PMC9432338 DOI: 10.1016/j.jped.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. METHODS Three examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31-45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). RESULTS The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p<0.001). The checklist score also differentiated between poor-repertoire (median=13) and cramped-synchronized general movements (median=7; p=0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa=0.68-1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa=0.56-0.93); (iii) the checklist was good to excellent (ICC=0.77-0.96). CONCLUSION The general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.
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Affiliation(s)
- Carolina Yuri Panvequio Aizawa
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil.
| | | | - Fernanda Françoso Genovesi
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Silvia Maria Ibidi
- Universidade de São Paulo (USP), Hospital Universitário, Unidade de Neonatologia, Divisão de Clínica Pediátrica, São Paulo, SP, Brazil
| | - Renata Hydee Hasue
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
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Lucaccioni L, Bertoncelli N, Comini M, Martignoni L, Coscia A, Lugli L, Righi E, Iughetti L, Berardi A, Ferrari F. The ontogeny of limbs movements towards midline in healthy infants born at term. Early Hum Dev 2021; 155:105324. [PMID: 33581484 DOI: 10.1016/j.earlhumdev.2021.105324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/04/2021] [Accepted: 01/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Movements towards midline are part of the age-adequate motor repertoire of infants. They develop contemporaneously to general movements, changing from occasional simple contact to proper midline motor patterns. AIM The aim of this study is to describe the ontogeny of movements towards midline in full term healthy infants. STUDY DESIGN Parents were asked to record their infant every second week, from term age to 22 weeks post-term. SUBJECTS 25 healthy full-term infants. RESULTS Three main epochs of development were detected: in the first one, between birth and 4 weeks post-term, movements towards midline were occasional, apparently due to the dominant flexed posture of elbow and knees and the adducted posture of shoulders and hips. In the second epoch, from 4 to 8 weeks, the limbs movements towards midline markedly decreased. In the third one, after 8 weeks, movements towards midline increased again in frequency, first appearing in lower limbs then in upper limbs, first solely as contact and thereafter as manipulation. A temporal overlapping with the occurrence of intermittent or continual fidgety movements was detected. CONCLUSIONS Movements towards midline progressively change, through a defined timeline, in full term healthy infants. The increased knowledge about the normal age-adequate motor repertoire can help physicians in clinical assessment of high risk infants.
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Katušić A, Žunić Išasegi I, Radoš M, Raguž M, Grizelj R, Ferrari F, Kostović I. Transient structural MRI patterns correlate with the motor functions in preterm infants. Brain Dev 2021; 43:363-371. [PMID: 33239233 DOI: 10.1016/j.braindev.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
AIM To explore the relationships between transient structural brain patterns on MRI at preterm and at term-equivalent age (TEA) as a predictor of general movements (GMs) and motor development at 1-year corrected age (CA) in very preterm infants. METHODS In this prospective study, 30 very preterm infants (median = 28wks; 16 males) had structural magnetic resonance imaging (MRI) at preterm (median = 31wks + 6d) and at TEA (median = 40wks) and neuromotor assessments. The quality of GMs was assessed by Prechtl's general movements assessment and a detailed analysis of the motor repertoire was performed by calculating a motor optimality score (MOS), both at term age and at 3 months post-term. Motor development at 1-year CA was evaluated with the Infant Motor Profile (IMP). Associations between qualitative MRI findings and neuromotor scores were investigated. RESULTS Abnormal GMs and low motor performance at 1-year CA were associated with the poor visibility of transient structural pattern, that is with sagittal strata. INTERPRETATION Transient structural MRI pattern, sagittal strata, at preterm age is related to the quality of GMs and later motor development in preterm infants. This transient fetal brain compartment may be considered as a component of neurobiological basis for early neuromotor behavior, as expressed by GMs.
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Affiliation(s)
- Ana Katušić
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Croatia.
| | - Iris Žunić Išasegi
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Croatia
| | - Milan Radoš
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Croatia
| | - Marina Raguž
- University Hospital Dubrava, Department of Neurosurgery, University of Zagreb, School of Medicine, Croatia
| | - Ruža Grizelj
- Clinical Hospital Centre Zagreb, Department of Pediatrics, University of Zagreb, School of Medicine, Croatia
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Ivica Kostović
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Croatia
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20
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Silva N, Zhang D, Kulvicius T, Gail A, Barreiros C, Lindstaedt S, Kraft M, Bölte S, Poustka L, Nielsen-Saines K, Wörgötter F, Einspieler C, Marschik PB. The future of General Movement Assessment: The role of computer vision and machine learning - A scoping review. Res Dev Disabil 2021; 110:103854. [PMID: 33571849 PMCID: PMC7910279 DOI: 10.1016/j.ridd.2021.103854] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND The clinical and scientific value of Prechtl general movement assessment (GMA) has been increasingly recognised, which has extended beyond the detection of cerebral palsy throughout the years. With advancing computer science, a surging interest in developing automated GMA emerges. AIMS In this scoping review, we focused on video-based approaches, since it remains authentic to the non-intrusive principle of the classic GMA. Specifically, we aimed to provide an overview of recent video-based approaches targeting GMs; identify their techniques for movement detection and classification; examine if the technological solutions conform to the fundamental concepts of GMA; and discuss the challenges of developing automated GMA. METHODS AND PROCEDURES We performed a systematic search for computer vision-based studies on GMs. OUTCOMES AND RESULTS We identified 40 peer-reviewed articles, most (n = 30) were published between 2017 and 2020. A wide variety of sensing, tracking, detection, and classification tools for computer vision-based GMA were found. Only a small portion of these studies applied deep learning approaches. A comprehensive comparison between data acquisition and sensing setups across the reviewed studies, highlighting limitations and advantages of each modality in performing automated GMA is provided. CONCLUSIONS AND IMPLICATIONS A "method-of-choice" for automated GMA does not exist. Besides creating large datasets, understanding the fundamental concepts and prerequisites of GMA is necessary for developing automated solutions. Future research shall look beyond the narrow field of detecting cerebral palsy and open up to the full potential of applying GMA to enable an even broader application.
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Affiliation(s)
- Nelson Silva
- iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria; Know-Center GmbH, Graz, Austria
| | - Dajie Zhang
- iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria; Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany
| | - Tomas Kulvicius
- Department for Computational Neuroscience, Third Institute of Physics-Biophysics, Georg-August-University of Göttingen, Göttingen, Germany
| | - Alexander Gail
- Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany; German Primate Center - Leibniz Institute for Primate Research, Göttingen, Germany
| | - Carla Barreiros
- Know-Center GmbH, Graz, Austria; Institute of Interactive Systems and Data Science, Graz University of Technology, Graz, Austria
| | - Stefanie Lindstaedt
- Know-Center GmbH, Graz, Austria; Institute of Interactive Systems and Data Science, Graz University of Technology, Graz, Austria
| | - Marc Kraft
- Department of Medical Engineering, Technical University Berlin, Berlin, Germany
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Luise Poustka
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, David Geffen UCLA School of Medicine, USA
| | - Florentin Wörgötter
- Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany; Department for Computational Neuroscience, Third Institute of Physics-Biophysics, Georg-August-University of Göttingen, Göttingen, Germany; Institute of Physics, Department for Computational Neuroscience at the Bernstein Center Göttingen, Georg-August-University of Göttingen, Göttingen, Germany
| | - Christa Einspieler
- iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Peter B Marschik
- iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria; Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany; Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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21
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Lucaccioni L, Boncompagni A, Pugliese M, Talucci G, Della Casa E, Bertoncelli N, Coscia A, Bedetti L, Berardi A, Iughetti L, Ferrari F. Subtle impairment of neurodevelopment in infants with late fetal growth restriction. J Matern Fetal Neonatal Med 2021; 35:4927-4934. [PMID: 33455501 DOI: 10.1080/14767058.2021.1873267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Children with late fetal growth restriction (FGR) are at high risk of being born small for gestational age (SGA). These categories of newborns are at increased risk for neurodevelopment impairment. The general movements assessment, in particular at fidgety age, has been used to predict neurological dysfunctions. This study aimed to evaluate growth recovery, presence of fidgety movements at 3 months, and neurodevelopmental outcome at 2 years of age in term late FGR infants and adequate for gestational age (AGA) controls. METHODS Prospective clinical evaluation. At 3 months auxological parameters (AP) and neurological examination were evaluated while at 24 months neurodevelopment outcome by Griffiths Mental Development Scales (GMDS-R) was evaluated. RESULTS 38 late FGR and 20 AGA controls completed the study. Despite a significant catch up, at 3 months 13% of late FGR presented at least one auxological parameter <3° percentile. Moreover, 23.7% of late FGR infants did not show fidgety movements compared to 100% AGA controls (p < .001). Cranial circumference at birth resulted a positive predictive factor for FMs (p = .039). At 2 years of age, a difference statistically significant between late FGR and AGA was detected in GMDS-R. CONCLUSION Independently from growth recovery, fidgety movements resulted less expressed in late FGR infants, and at 2 years of age the neurodevelopmental assessment revealed differences in each domain of evaluation between late FGR and AGA infants, although within normal ranges.
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Affiliation(s)
- Laura Lucaccioni
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Boncompagni
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Marisa Pugliese
- Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanna Talucci
- Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Della Casa
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Luca Bedetti
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Kalteren WS, Mebius MJ, Verhagen EA, Tanis JC, Kooi EMW, Bos AF. Neonatal Hemoglobin Levels in Preterm Infants Are Associated with Early Neurological Functioning. Neonatology 2021; 118:593-599. [PMID: 34515185 DOI: 10.1159/000518655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonatal anemia may compromise oxygen transport to the brain. The effects of anemia and cerebral oxygenation on neurological functioning in the early neonatal period are largely unknown. OBJECTIVE This study aimed to determine the association between initial hemoglobin levels (Hb) and early neurological functioning in preterm infants by assessing their general movements (GMs). METHODS A retrospective analysis of prospectively collected data on preterm infants born before 32 weeks of gestation was conducted. We excluded infants with intraventricular hemorrhage > grade II. On day 8, we assessed infants' GMs, both generally as normal/abnormal and in detail using the general movement optimality score (GMOS). We measured cerebral tissue oxygen saturation (rcSO2) on day 1 using near-infrared spectroscopy. RESULTS We included 65 infants (median gestational age 29.9 weeks [IQR 28.2-31.0]; median birth weight 1,180 g [IQR 930-1,400]). Median Hb on day 1 was 10.3 mmol/L (range 4.2-13.7). Lower Hb on day 1 was associated with a higher risk of abnormal GMs (OR = 2.3, 95% CI: 1.3-4.1) and poorer GMOSs (B = 0.9, 95% CI: 0.2-1.7). Hemoglobin strongly correlated with rcSO2 (rho = 0.62, p < 0.01). Infants with lower rcSO2 values tended to have a higher risk of abnormal GMs (p = 0.06). After adjusting for confounders, Hb on day 1 explained 44% of the variance of normal/abnormal GMs and rcSO2 explained 17%. Regarding the explained variance of the GMOS, this was 25% and 16%, respectively. CONCLUSIONS In preterm infants, low Hb on day 1 is associated with impaired neurological functioning on day 8, which is partly explained by low cerebral oxygenation.
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Affiliation(s)
- Willemien S Kalteren
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mirthe J Mebius
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise A Verhagen
- Division of Neonatology, Department of Pediatrics, Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | - Jozien C Tanis
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth M W Kooi
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Barnes F, Graham L, Loganathan P, Nair V. General Movement Assessment Predicts Neuro-Developmental Outcome in Very Low Birth Weight Infants at Two Years - A Five-Year Observational Study. Indian J Pediatr 2021; 88:28-33. [PMID: 32488806 DOI: 10.1007/s12098-020-03365-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the value of general movements (GMs) in predicting the neurodevelopmental outcome using Bayley Scale of Infant Development III (BSID-III) at two years of age in very low birth weight (VLBW) infants. METHODS This is a five-year observational study (January 2012-June 2017). Two hundred twenty-seven VLBW infants were assessed in the neurodevelopmental clinic between Jan 2012 and June 2017. Of these 137 infants had GMs assessments at 3 mo post term (first visit to the clinic). RESULTS Absence of fidgety movements (FMs) at 3 mo post term had high specificity and negative predictive value for moderate to severe neurodevelopmental outcome in motor, cognition and language domains (composite score less than 70 in the Bayley III scales of Infant development scores). At 3 mo post term, absent FMs had high sensitivity, specificity and negative predictive value (NPV) for cerebral palsy (CP). CONCLUSIONS GMs assessment at 3 mo post term could be considered as an important screening tool for early identification of VLBW infants who are at risk of neurodevelopmental impairment/cerebral palsy.
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Fjørtoft T, Brandal M, Brubakk AM, Adde L, Ustad T, Vågen R, Evensen KAI. Maternal alcohol and drug use during pregnancy affects the motor behaviour and general movements of infants aged 3-4 months. Early Hum Dev 2020; 151:105171. [PMID: 32977207 DOI: 10.1016/j.earlhumdev.2020.105171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Exposure of alcohol and/or other addictive drugs in pregnancy is a documented risk factor for later neurological impairment. AIMS The aim of the study was to determine whether infants suffering from prenatal exposure to addictive drugs and alcohol develop an abnormal motor behaviour at three to four months of age. STUDY DESIGN Controlled cohort study of infants exposed to alcohol and/or other addictive drugs in pregnancy who were recruited from a hospital follow-up programme. The control group consisted of healthy, unexposed infants. SUBJECTS The study group of 108 infants exposed to alcohol and/or addictive drugs in pregnancy were enrolled based on referrals from primary health care. The control group included 106 infants who had not been exposed to the aforementioned substances. OUTCOME MEASURES We assessed the general movements (Prechtl's General-Movement-Assessment, GMA), the motor repertoire (Assessment-of-Motor-Repertoire, AMR), and the Alberta-Infant Motor-Scale (AIMS) in all infants at three to four months of age. RESULTS None of the infants in either group had absent fidgety movements (FMs). In the study group 5(5%) had exaggerated FMs and 5(5%) had sporadic FMs; and 68(63%) infants in the study group displayed an abnormal movement character, compared to 23(22%) in the control group (p<0.001). On the AIMS, 46(44%) infants in the study group scored below the 10th percentile, compared to 2(3%) controls (p< 0.001). CONCLUSION The study describes an abnormal movement character of infants exposed to alcohol and/or addictive drugs in pregnancy when their motor repertoire was assessed at three to four months of age. The AIMS also showed negative effects on their motor behaviour.
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Affiliation(s)
- T Fjørtoft
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - M Brandal
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A M Brubakk
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St. Olav's Hospital, Trondheim University Hospital, Norway
| | - L Adde
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - T Ustad
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - R Vågen
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - K A I Evensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway; Unit for Physiotherapy Services, Trondheim Municipality, Norway; Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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25
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Sokołów M, Adde L, Klimont L, Pilarska E, Einspieler C. Early intervention and its short-term effect on the temporal organization of fidgety movements. Early Hum Dev 2020; 151:105197. [PMID: 32979679 DOI: 10.1016/j.earlhumdev.2020.105197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Prechtl General Movement Assessment (GMA) predicts various neurological and developmental disorders while also documenting therapeutic effects. AIMS To describe the temporal organization of fidgety general movements in infants with mild to moderate postural asymmetries and/or tonus regulation problems, and to analyze to what extent the temporal organization of fidgety movements will change after physiotherapy. STUDY DESIGN Repeated measure design. PARTICIPANTS Twelve infants (five females) with mild to moderate postural asymmetries and/or tonus regulation problems were admitted for an early intervention program. The gestational age ranged from 27 to 40 weeks (Median, 36 weeks; nine infants born preterm) with birth weights ranging from 740 g to 3500 g (Median, 2590 g). MEASURES Fidgety movements and their temporal organization were measured using the Prechtl GMA at 9 to 19 weeks post term age (Median, 14 weeks) before and after an early motor training procedure. The movements of one of the infants were analysed using a computer-based approach, measuring the mean and standard deviation of quantity of motion, height of motion and width of motion. RESULTS Seven infants had sporadic fidgety movements, and five had intermittent fidgety movements. None had continual fidgety movements before the intervention was initiated. After intervention, the temporal organization of fidgety movements increased in all infants. The observations of these movements were supported by computer-based analysis. CONCLUSION The study indicates that early intervention increases the temporal organization of fidgety movements in infants with postural asymmetries and/or tonus regulation problems. The clinical significance of this finding needs to be further evaluated.
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Affiliation(s)
- Michal Sokołów
- Medical University of Gdańsk, Department of Physical Therapy, Dębinki 7, 80-211 Gdansk, Poland; Centre of Early Intervention in Gdańsk, Jagiellońska 11, 80-371 Gdańsk, Poland.
| | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Olav Kyrres gt. 11, 7491 Trondheim, Norway; Clinics of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Olav Kyrres gt. 17, 7006 Trondheim, Norway.
| | - Liliana Klimont
- Akershus University Hospital, Dept of Pediatric and Adolescent Rehabilitation, Postboks 1000, 1478 Lørenskog, Norway.
| | - Ewa Pilarska
- Medical University of Gdańsk, Department of Developmental Neurology, Dębinki 7, 80-211 Gdańsk, Poland.
| | - Christa Einspieler
- iDN interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Auenbruggerplatz 26, 8036 Graz, Austria.
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26
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Pascal A, Govaert P, Ortibus E, Naulaers G, Lars A, Fjørtoft T, Oostra A, Zecic A, Cools F, Cloet E, Casaer A, Cornette L, Laroche S, Samijn B, Van den Broeck C. Motor outcome after perinatal stroke and early prediction of unilateral spastic cerebral palsy. Eur J Paediatr Neurol 2020; 29:54-61. [PMID: 32988734 DOI: 10.1016/j.ejpn.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/11/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Unilateral spastic cerebral palsy (USCP) occurs in 30%-68% of infants with perinatal stroke. Early detection of USCP is essential for referring infants to early intervention. The aims of this study were to report motor outcomes after perinatal stroke, and to determine the predictive value of the General Movements Assessment (GMA) and Hand Assessment for Infants (HAI) for detection of USCP. MATERIALS AND METHODS This was a prospective observational study involving infants with perinatal stroke. GMA was conducted between 10 and 15 weeks post term-age (PTA). The HAI was performed between 3 and 5 months PTA. Motor outcome was collected between 12 and 36 months PTA. RESULTS The sample consisted of 46 infants. Fifteen children (32.6%) were diagnosed with CP, two children with bilateral CP and 13 with USCP. Abnormal GMA had a sensitivity of 85% (95% confidence interval [CI] 55-98%) and a specificity of 52% (95% CI 33-71%) to predict USCP. When asymmetrically presented FMs were also considered as abnormal, sensitivity increased to 100%, hence the specificity declined to 43%. A HAI asymmetry index cut-off of 23, had both a sensitivity and a specificity of 100% to detect USCP. CONCLUSION Using GMA and HAI can enable prediction of USCP before the age of 5 months in infants with perinatal stroke. Nevertheless, GMA must be interpreted with caution in this particular population. The HAI was found to be a very accurate screening tool for early detection of asymmetry and prediction of USCP.
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27
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Wu YC, Straathof EJM, Heineman KR, Hadders-Algra M. Typical general movements at 2 to 4 months: Movement complexity, fidgety movements, and their associations with risk factors and SINDA scores. Early Hum Dev 2020; 149:105135. [PMID: 32795785 DOI: 10.1016/j.earlhumdev.2020.105135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Movement complexity and the presence of fidgety movements (FMs) during general movements (GMs) both reflect aspects of neurological integrity in early infancy. AIM To assess interrelations between the degree of movement complexity and characteristics of FMs during typical GMs and to investigate associations between mildly impaired GMs and risk factors and neurodevelopmental condition. STUDY DESIGN Observational cohort study. SUBJECTS 283 infants (25 born preterm) at 2-4 months corrected age, representative of the general Dutch population. OUTCOME MEASURES GMs were classified in terms of GM-complexity (normal or mildly abnormal (MA)) and FMs (clearly present, sporadic, or exaggerated). Concurrent neurological, developmental and socio-emotional status were measured with the Standardized Infant NeuroDevelopmental Assessment (SINDA). RESULTS Infants with MA GM-complexity had a higher risk of having sporadic FMs and exaggerated FMs. Perinatal complications were not associated with mildly impaired GMs. MA GM-complexity was associated with advanced maternal age (adjusted OR = 2.29 [1.11, 4.76]) and having a non-native Dutch mother (adjusted OR = 2.93 [1.29, 6.64]). It was also associated with atypical neurological (OR = 7.62 [3.51, 16.54]) and developmental scores (OR = 2.38 [1.16, 4.88]). Sporadic and exaggerated FMs were associated with low-to-middle maternal education (adjusted OR = 2.88, [1.45, 5.72]) and having a non-native Dutch father (adjusted OR = 7.16 [1.41, 36.32]), respectively. However, neither sporadic nor exaggerated FMs were associated with the SINDA outcomes. CONCLUSIONS GM-complexity and FMs are two interrelated but different aspects of GMs. Mild impairments in GM-complexity and FMs share a non-optimal socio-economic background as risk factor, but only MA GM-complexity is associated with a concurrent non-optimal neurodevelopmental condition.
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Affiliation(s)
- Ying-Chin Wu
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands; Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Elisabeth J M Straathof
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
| | - Kirsten R Heineman
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands; SEIN, Stichting Epilepsie Instellingen Nederland, Zwolle, the Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.
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Skworc A, Marciniak S, Sławska H. Influence of infections on the quality of general movements in premature infants. Early Hum Dev 2020; 148:105118. [PMID: 32673903 DOI: 10.1016/j.earlhumdev.2020.105118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The task of contemporary neonatology is not only to save the lives of children born prematurely, but also to provide them with the highest possible quality of life. The Prechtl method, one of several methods of assessing the quality of general movement patterns, enables early identification of immaturity or damage to the central nervous system. AIM Dynamic assessment of the type and quality of general movement (GMs) in preterm infants to determine indications for early neurodevelopmental support and to identify the relationship between the occurrence of maternal and neonatal perinatal risk factors and the type and quality of general movements. MATERIAL AND METHOD 90 infants were assessed between 28 0/7 and 36 6/7 weeks gestational age. Dominant cases (57 cases) were infants born between 32 and 36 weeks GE. Most cases (48) received low Apgar score at 1 min (≤7), including two born in very severe condition. Neonatal infections were diagnosed in 26 infants. The study included three GM assessments: I - up to 14th day post-partum, II at term and III between 12 and 15 weeks corrected age. The analysis included gestational age, general condition of the newborn as per Apgar score as well as early and late infections. RESULTS Neonatal infections were found to show a close correlation with the occurrence of abnormal general movements. It was confirmed that gestational age and congenital infections are important variables affecting the occurrence of abnormal general movements.
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Affiliation(s)
- Aneta Skworc
- Department of Neonatology, Specialist Hospital No. 2, Bytom, Poland
| | - Sylwia Marciniak
- Department of Neonatology, Specialist Hospital No. 2, Bytom, Poland; Medical University of Silesia, Katowice, Poland.
| | - Helena Sławska
- Department of Neonatology, Specialist Hospital No. 2, Bytom, Poland; Medical University of Silesia, Katowice, Poland
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29
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Wang Y, Zhu P, Yang Z, Gu G. Establishing an early identification score system for cerebral palsy based on detailed assessment of general movements. J Int Med Res 2020; 48:300060520902579. [PMID: 32252569 PMCID: PMC7140202 DOI: 10.1177/0300060520902579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective This retrospective study aimed to establish an early identification
score system of cerebral palsy (CP) in the writhing movement
period of high-risk infants by detailed assessment of general
movements (GMs). Methods High-risk infants from our hospital during January 2016 to January
2017 were included. GMs were assessed and a detailed score was
calculated. The 52-neuromotor examination for 0- to 1-year-olds
was performed and follow-up outcome was determined at the 12th
month according to CP diagnostic criteria. An early
identification score of detailed assessment was established in
the writhing movement period of infants. Results The detailed score during the writhing movement period was
significantly different among the normal, poor repertoire, and
cramped-synchronized groups of GMs
(F = 208.186). Detailed scores were positively
related to 52-neuromotor examination scores, with a correlation
coefficient of 0.218. The predictive validity of the early
identification score was 92.11%, sensitivity was 100%,
specificity was 90.00%, the positive predictive value was
72.73%, the negative predictive value was 100%, the false
positive rate was 10, and the false negative rate was 0. Conclusion The detailed GM score in the writhing movement period is correlated
with 52-neuromotor examination results. The CP early
identification score could be useful in clinical practice.
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Affiliation(s)
- Yuqing Wang
- Department of Child Health, Xuzhou Children's Hospital, Xuzhou, China
| | - Ping Zhu
- Department of Child Health, Xuzhou Children's Hospital, Xuzhou, China
| | - Zhongxiu Yang
- Rehabilitation Department, Xuzhou Children's Hospital, Xuzhou, China
| | - Guixiong Gu
- Department of Child Health, Affiliated Children's Hospital of Soochow University, Suzhou, China
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30
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Soloveichick M, Marschik PB, Gover A, Molad M, Kessel I, Einspieler C. Movement Imitation Therapy for Preterm Babies (MIT-PB): a Novel Approach to Improve the Neurodevelopmental Outcome of Infants at High-Risk for Cerebral Palsy. J Dev Phys Disabil 2019; 32:587-598. [PMID: 32669775 PMCID: PMC7346982 DOI: 10.1007/s10882-019-09707-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To improve the neurodevelopmental outcome in infants with high grade intraventricular haemorrhage and cramped-synchronised (CS) general movements (GMs). Four very preterm infants with intraventricular haemorrhage grade III (n = 3) or intraventricular haemorrhage with apparent periventricular haemorrhagic infarction (n = 1) were diagnosed with CS GMs at 33 to 35 weeks postmenstrual age. A few days later MIT-PB [Movement Imitation Therapy for Preterm Babies], an early intervention programme, was commenced: the instant an infant showed CS movements, the therapist intervened by gently guiding the infant's limbs so as to manoeuvre and smoothen the movements, thereby imitating normal GM sequences as closely as possible (at least for 10 min, 5 times a day, with increasing frequency over a period of 10 to 12 weeks). After a period of consistent CS GMs, the movements improved. At 14 weeks postterm age, the age specific GM pattern, fidgety movements, were normal in three infants, one infant had abnormal fidgety movements. At preschool age, all participants had a normal neurodevelopmental outcome. This report on four cases demonstrates that mimicking normal and variable GM sequences might have a positive cascading effect on neurodevelopment. The results need to be interpreted with caution and replication studies on larger samples are warranted. Nonetheless, this innovative approach may represent a first step into a new intervention strategy.
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Affiliation(s)
- Marina Soloveichick
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Peter B. Marschik
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- Center of Neurodevelopmental Disorders (KIND), Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Ayala Gover
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Molad
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Irena Kessel
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Christa Einspieler
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
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31
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Marchi V, Hakala A, Knight A, D'Acunto F, Scattoni ML, Guzzetta A, Vanhatalo S. Automated pose estimation captures key aspects of General Movements at eight to 17 weeks from conventional videos. Acta Paediatr 2019; 108:1817-1824. [PMID: 30883894 DOI: 10.1111/apa.14781] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 11/27/2022]
Abstract
AIM General movement assessment requires substantial expertise for accurate visual interpretation. Our aim was to evaluate an automated pose estimation method, using conventional video records, to see if it could capture infant movements using objective biomarkers. METHODS We selected archived videos from 21 infants aged eight to 17 weeks who had taken part in studies at the IRCCS Fondazione Stella Maris (Italy), from 2011 to 2017. Of these, 14 presented with typical low-risk movements, while seven presented with atypical movements and were later diagnosed with cerebral palsy. Skeleton videos were produced using a computational pose estimation model adapted for infants and these were blindly assessed to see whether they contained the information needed for classification by human experts. Movements of skeletal key points were analysed using kinematic metrics to provide a biomarker to distinguish between groups. RESULTS The visual assessments of the skeleton videos were very accurate, with Cohen's K of 0.90 when compared with the classification of conventional videos. Quantitative analysis showed that arm movements were more variable in infants with typical movements. CONCLUSION It was possible to extract automated estimation of movement patterns from conventional video records and convert them to skeleton footage. This could allow quantitative analysis of existing footage.
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Affiliation(s)
- Viviana Marchi
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
- Department of Developmental Neuroscience IRCCS Fondazione Stella Maris Pisa Italy
| | - Anna Hakala
- Neuro Event Labs Oy (2712284‐1) Tampere Finland
| | | | - Federica D'Acunto
- Department of Developmental Neuroscience IRCCS Fondazione Stella Maris Pisa Italy
| | - Maria Luisa Scattoni
- Research Coordination and Support Service Istituto Superiore di Sanità Rome Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience IRCCS Fondazione Stella Maris Pisa Italy
- Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology Children′s Hospital University of Helsinki and Helsinki University Hospital (HUH) Helsinki Finland
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Maeda T, Iwata H, Sekiguchi K, Takahashi M, Ihara K. The association between brain morphological development and the quality of general movements. Brain Dev 2019; 41:490-500. [PMID: 30770148 DOI: 10.1016/j.braindev.2019.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/31/2018] [Accepted: 01/23/2019] [Indexed: 11/16/2022]
Abstract
AIM To clarify the morphologic characteristics of the brain, which are the foundation of the emergence of general movements (GMs) in very-low-birth-weight infants. STUDY DESIGN Prospective cohort study. GMs were scored according to a semiquantitative scoring system: the GMs optimality score (GMOS) at preterm and term ages. Brain magnetic resonance imaging (MRI) at term-equivalent age was scored using a validated scoring system (MRI score). We examined the relationship between the two scores by multiple regression analysis with relevant clinical background. SUBJECTS We included 50 very-low-birth-weight infants cared for at Oita University Hospital from August 2012 to August 2018 who underwent MRI and GMs assessment. Their median gestational age and birth weight were 29w2d and 1145 g, respectively. RESULTS The MRI score and systemic steroid administration were related to preterm GMOS, and the MRI score was related to term GMOS. The component cerebellum score and cortical grey matter score of the MRI score were associated with preterm GMOS, and the cerebellum and the cerebral white matter scores were associated with term GMOS. CONCLUSION The quality of GMs was associated with brain morphological development. The co-evaluation of GMs and brain morphology leads to accurate developmental prediction.
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Affiliation(s)
- Tomoki Maeda
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan.
| | - Hajime Iwata
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Kazuhito Sekiguchi
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Mizuho Takahashi
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Kenji Ihara
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
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Pansy J, Barones C, Urlesberger B, Pokorny FB, Bartl-Pokorny KD, Verheyen S, Marschik PB, Einspieler C. Early motor and pre-linguistic verbal development in Prader-Willi syndrome - A case report. Res Dev Disabil 2019; 88:16-21. [PMID: 30825843 DOI: 10.1016/j.ridd.2019.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/26/2018] [Accepted: 01/29/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare genetic disorder. Infants with PWS show a neurodevelopmental dysfunction which entails a delayed motor and language development, but studies on their spontaneous movements (i.e. general movements) or pre-linguistic speech-language development before 6 months of age are missing so far. AIM To describe early motor and pre-linguistic verbal development in an infant with PWS. METHODS AND PROCEDURES Prospective case report; in addition to the assessment of general movements and the concurrent movement repertoire, we report on early verbal forms, applying the Stark Assessment of Early Vocal Development-Revised. OUTCOMES AND RESULTS General movements were abnormal on days 8 and 15. No fidgety movements were observed at 11 weeks; they only emerged at 17 weeks and lasted until at least 27 weeks post-term. The movement character was monotonous, and early motor milestones were only achieved with a delay. At 27 weeks the infant produced age-adequate types of vocalisations. However, none of the canonical-syllable vocalisations that typically emerge at that age were observed. Early vocalisations appeared monotonous and with a peculiarly harmonic structure. CONCLUSIONS AND IMPLICATIONS Early motor and pre-linguistic verbal behaviours were monotonous in an infant with PWS throughout his first 6 months of life. This suggests that early signs of neurodevelopmental dysfunction (i.e. abnormal general movements) might already be diagnosed in infants with PWS during their first weeks of life, potentially enabling us to diagnose and intervene at an early stage.
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Affiliation(s)
- Jasmin Pansy
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
| | - Cornelia Barones
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Florian B Pokorny
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria; Machine Intelligence & Signal Processing Group, MMK, Technical University of Munich, Munich, Germany
| | - Katrin D Bartl-Pokorny
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Sarah Verheyen
- Institute of Human Genetics, Medical University of Graz, Graz, Austria
| | - Peter B Marschik
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria; Child and Adolescent Psychiatry and Psychotherapy, iDN - Interdisciplinary Developmental Neuroscience, University Medical Center Goettingen, Goettingen, Germany; Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Christa Einspieler
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
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Dostanic T, Sustersic B, Paro-Panjan D. Developmental outcome in a group of twins: Relation to perinatal factors and general movements. Eur J Paediatr Neurol 2018; 22:682-689. [PMID: 29709428 DOI: 10.1016/j.ejpn.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The quality of general movements (GMs) has proven to have predictive value for the developmental outcome, but this has not yet been studied in twins. AIMS Our aim was to analyse the quality of GMs and neurological and developmental outcome in relation to the gestational age (GA), mode of conception and other perinatal risk factors in a group of twins. STUDY DESIGN The documentation of twins referred for follow-up in the period from 1998 to 2016 was studied retrospectively. Data concerning the quality of GMs, perinatal risk factors and developmental outcome were analysed. SUBJECTS Eighty-nine twin pairs, GA from 24 to 38 weeks (median 35.0; IQR 3), birth weight 670 g-3820 g (median 2323; IQR 645) were included. OUTCOME MEASURES Results of neurological, psychological and speech/language development and school outcome were analysed. RESULTS GMs at term age and at three to four months postterm age did not differ with regard to the mode of conception. Preterm birth was significantly related to GMs at three to four months postterm age. At term age, GMs were significantly related to neurological outcome, while at three to four months postterm age, GMs were related to both the neurological and psychological outcome. Difficulties in speech/language development were diagnosed in almost half of the children, more frequently in boys and children with lower Apgar scores. CONCLUSION The study highlights the value of GMs for predicting the developmental outcome in twins and indicates the importance of developmental, especially speech/language, follow-up in twins.
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Affiliation(s)
- Tamara Dostanic
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Bohoriceva 20, 1000, Ljubljana, Slovenia
| | - Breda Sustersic
- Developmental Clinic, Health Centre Domzale, Mestni Trg 2, 1230, Domzale, Slovenia
| | - Darja Paro-Panjan
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Bohoriceva 20, 1000, Ljubljana, Slovenia.
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Hadders-Algra M. Early human motor development: From variation to the ability to vary and adapt. Neurosci Biobehav Rev 2018; 90:411-427. [PMID: 29752957 DOI: 10.1016/j.neubiorev.2018.05.009] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/17/2022]
Abstract
This review summarizes early human motor development. From early fetal age motor behavior is based on spontaneous neural activity: activity of networks in the brainstem and spinal cord that is modulated by supraspinal activity. The supraspinal activity, first primarily brought about by the cortical subplate, later by the cortical plate, induces movement variation. Initially, movement variation especially serves exploration; its associated afferent information is primarily used to sculpt the developing nervous system, and less to adapt motor behavior. In the next phase, beginning at function-specific ages, movement variation starts to serve adaptation. In sucking and swallowing, this phase emerges shortly before term age. In speech, gross and fine motor development, it emerges from 3 to 4 months post-term onwards, i.e., when developmental focus in the primary sensory and motor cortices has shifted to the permanent cortical circuitries. With increasing age and increasing trial-and-error exploration, the infant improves its ability to use adaptive and efficicient forms of upright gross motor behavior, manual activities and vocalizations belonging to the native language.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Dept. Pediatrics - Section Developmental Neurology, Groningen, The Netherlands.
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Tacke U, Weigand-Brunnhölzl H, Hilgendorff A, Giese RM, Flemmer AW, König H, Warken-Madelung B, Arens M, Hesse N, Schroeder AS. [Developmental neurology - networked medicine and new perspectives]. Nervenarzt 2017; 88:1395-1401. [PMID: 29101526 DOI: 10.1007/s00115-017-0436-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Developmental neurology is one of the major areas of neuropediatrics and is among other things (legally) responsible for monitoring the motor, cognitive and psychosocial development of all infants using standardized monitoring investigations. The special focus is on infants born at risk and/or due to premature birth before 32 weeks of gestation or a birth weight less than 1500 g. Early diagnosis of deviations from normal, age-related development is a prerequisite for early interventions, which may positively influence development and the long-term biopsychosocial prognosis of the patients. This article illustrates the available methods in developmental neurology with a focus on recent developments. Particular attention is paid to the predictive value of general movements (GM). The current development of markerless automated detection of spontaneous movements using conventional depth imaging cameras is demonstrated. Differences in spontaneous movements in infants at the age of 12 weeks are illustrated and discussed exemplified by three patients (healthy versus genetic syndrome versus cerebral palsy).
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Affiliation(s)
- U Tacke
- Abteilung für Neuropädiatrie und Entwicklung, Universitäts-Kinderspital beider Basel (UKBB), Spitalstraße 33, Postfach, 4031, Basel, Schweiz.
| | - H Weigand-Brunnhölzl
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
| | - A Hilgendorff
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland.,Institut für Lungenbiologie Comprehensive Pneumology Center (CPC), Helmholz-Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, München, Deutschland
| | - R M Giese
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
| | - A W Flemmer
- Neonatologie der Kinderklinik am Perinatalzentrum, Klinikum der LMU-München, Campus Großhadern, München, Deutschland
| | - H König
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
| | - B Warken-Madelung
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
| | - M Arens
- Fraunhofer Institut für Optronik, Systemtechnik und Bildauswertung (IOSB), Ettlingen, Deutschland
| | - N Hesse
- Fraunhofer Institut für Optronik, Systemtechnik und Bildauswertung (IOSB), Ettlingen, Deutschland
| | - A S Schroeder
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
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Fjørtoft T, Ustad T, Follestad T, Kaaresen PI, Øberg GK. Does a parent-administrated early motor intervention influence general movements and movement character at 3months of age in infants born preterm? Early Hum Dev 2017; 112:20-24. [PMID: 28672273 DOI: 10.1016/j.earlhumdev.2017.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/13/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies of preterm and term-born infants have shown absent fidgety movements and an abnormal movement character to be related to brain lesions and unfavourable neurological outcomes. AIMS The present study examines what effect a parent-administered early intervention program applied to preterm infants in a randomised control trial (RCT) between 34 and 36weeks gestational age has on their fidgety movements and overall movement character at three months of age. STUDY DESIGN The study was part of the RCT in an early intervention programme including preterm infants born between 2010 and 2014 at three Norwegian university hospitals. SUBJECTS 130 preterm infants participated in the study, with 59 of them in the control group and 71 in the intervention group. OUTCOME MEASURES Fidgety movements and overall movement character at three months corrected age. RESULTS No difference was found between the intervention group and the control group in terms of fidgety movements or movement character. Approximately half of the infants in both groups showed an abnormal movement character. CONCLUSION No evidence was found in this RCT to suggest that an intervention at 34 to 37weeks gestational age has a significant effect on the fidgety movements or overall movement character of preterm infants. This is in line with the assumption that absent fidgety movements and an abnormal movement character are due to permanent brain injury and are therefore good predictors for later neurological impairments.
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Affiliation(s)
- Toril Fjørtoft
- Clinics of Clinical services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Tordis Ustad
- Clinics of Clinical services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per Ivar Kaaresen
- Faculty of Clinical Medicine, University of Tromsø, The Arctic University of Norway, Norway; Pediatric and Adolescent Department, University Hospital North Norway, Tromsø, Norway
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Norway
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Salavati S, Einspieler C, Vagelli G, Zhang D, Pansy J, Burgerhof JGM, Marschik PB, Bos AF. The association between the early motor repertoire and language development in term children born after normal pregnancy. Early Hum Dev 2017; 111:30-35. [PMID: 28549271 PMCID: PMC5951278 DOI: 10.1016/j.earlhumdev.2017.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/03/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The assessment of the early motor repertoire is a widely used method for assessing the infant's neurological status. AIM To determine the association between the early motor repertoire and language development. STUDY DESIGN Prospective cohort study. SUBJECTS 22 term children born after normal pregnancy; video recorded for the assessment of the early motor repertoire including their motor optimality score (MOS), according to Prechtl, at 3 and 5months post term. OUTCOME MEASURES At 4years 7months and 10years 5months, we tested the children's language performance by administering three tests for expressive language and two for receptive language. RESULTS Smooth and fluent movements at 3months of age was associated with better expressive language outcome at both 4years 7months and 10years 5months (betas 0.363 and 0.628). A higher MOS at 5months was associated with better expressive language at both ages (betas 0.486 and 0.628). The item postural patterns at 5months was the only aspect associated with poorer expressive language outcome (beta -0.677). CONCLUSION Predominantly, qualitative aspects of the early motor repertoire at the age of 3 and 5months are associated with language development.
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Affiliation(s)
- Sahar Salavati
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria.
| | - Christa Einspieler
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria
| | - Giulia Vagelli
- SMILE Lab, Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Dajie Zhang
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter B Marschik
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria; Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Sanchez K, Morgan AT, Slattery JM, Olsen JE, Lee KJ, Anderson PJ, Thompson DK, Doyle LW, Cheong JLY, Spittle AJ. Neuropredictors of oromotor feeding impairment in 12month-old children. Early Hum Dev 2017; 111:49-55. [PMID: 28595097 DOI: 10.1016/j.earlhumdev.2017.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/07/2017] [Accepted: 05/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Feeding impairment is prevalent in children with neurodevelopmental issues. Neuroimaging and neurobehavioral outcomes at term are predictive of later neuromotor impairment, but it is unknown whether they predict feeding impairment. AIMS To determine whether neurobehavior and brain magnetic resonance imaging (MRI) at term predict oromotor feeding at 12 months in preterm and term-born children. STUDY DESIGN Prospective cohort study. SUBJECTS 248 infants (97 born <30 weeks and 151 born at term) recruited at birth. OUTCOME MEASURES Neurobehavioral assessments (General Movements (GMA), Hammersmith Neonatal Neurological Examination (HNNE), Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS)); and brain MRI were administered at term-equivalent age. Oromotor feeding was assessed at 12 months corrected age using the Schedule for Oral Motor Assessment. RESULTS 49/227 children had oromotor feeding impairment. Neurobehavior associated with later feeding impairment was: suboptimal NNNS stress (odds ratio [OR] 2.68; 95% confidence interval [CI] 1.20–6.01), non-optimal reflexes (OR 3.33; 95% CI 1.37–8.11) and arousal scales (OR 2.54; 95% CI 1.03–6.27); suboptimal HNNE total (OR 4.69; 95% CI 2.20–10.00), reflexes (OR 2.62; 95% CI 1.06–6.49), and tone scores (OR 3.87; 95% CI 1.45–10.35); and abnormal GMA (OR 2.60; 95% CI 1.21–5.57). Smaller biparietal diameter also predicted feeding impairment (OR 0.88; 95% CI 0.79–0.97). There was little evidence that relationships differed between birth groups. CONCLUSIONS Neurobehavior and biparietal diameter at term are associated with oromotor feeding at 12 months. These results may identify children at greatest risk of oromotor feeding impairment.
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Affiliation(s)
- Katherine Sanchez
- Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; University of Melbourne, Parkville, VIC 3052, Australia.
| | - Angela T Morgan
- Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; University of Melbourne, Parkville, VIC 3052, Australia; Royal Children's Hospital, Parkville, VIC 3052, Australia.
| | | | - Joy E Olsen
- Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; Royal Women's Hospital, Parkville, VIC 3052, Australia.
| | - Katherine J Lee
- Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; University of Melbourne, Parkville, VIC 3052, Australia.
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; University of Melbourne, Parkville, VIC 3052, Australia.
| | - Deanne K Thompson
- Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; University of Melbourne, Parkville, VIC 3052, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3052, Australia.
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; University of Melbourne, Parkville, VIC 3052, Australia; Royal Women's Hospital, Parkville, VIC 3052, Australia.
| | - Jeanie L Y Cheong
- Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; University of Melbourne, Parkville, VIC 3052, Australia; Royal Women's Hospital, Parkville, VIC 3052, Australia.
| | - Alicia J Spittle
- Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; University of Melbourne, Parkville, VIC 3052, Australia; Royal Women's Hospital, Parkville, VIC 3052, Australia.
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Crowle C, Walker K, Galea C, Novak I, Badawi N. General movement trajectories and neurodevelopment at 3months of age following neonatal surgery. Early Hum Dev 2017; 111:42-48. [PMID: 28577472 DOI: 10.1016/j.earlhumdev.2017.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/29/2017] [Accepted: 05/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonates who undergo major surgery are at risk of neurodevelopmental disability. The General Movements Assessment (GMA) is a valid and reliable method to predict neurodevelopment, however, there are minimal data on the applicability among infants post-surgery. AIM To describe GMs trajectories following neonatal surgery. STUDY DESIGN Prospective cohort study. SUBJECTS 217 infants following major cardiac and non-cardiac neonatal surgery. OUTCOME MEASURES Infants were assessed following surgery at term age (mean 40weeks, SD 2.3), and at 3months of age (mean 12weeks, SD 1.6) using the GMA and the Bayley Scales of Infant and Toddler Development III. GMA videos were independently scored by three advanced trained assessors, two blinded to infant details. RESULTS The most common result in the writhing period was 'poor repertoire' (n=117, 54%), however, 99 (84%) of these infants had normal fidgety movements. For infants with normal writhing (n=75, 34%), only four had absent fidgety movements. Cramped synchronised movements were seen in 10 infants, and three of these were rated as absent fidgety. There was no significant difference between the surgical groups. In total, 24 infants (11%) had absent fidgety movements and lower scores on average in all subtests of the BSID-III than those with normal fidgety movements. CONCLUSIONS This is the first report describing GMs trajectories in infants who have undergone neonatal surgery. Similar to other high risk infant populations, this group showed a high proportion of poor repertoire writhing movements, however, most infants demonstrated normal fidgety movements and development at 3months of age.
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Affiliation(s)
- Cathryn Crowle
- Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia; University of Sydney, Sydney, Australia; Cerebral Palsy Alliance Research Institute, Sydney, Australia.
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Sydney, Australia.
| | - Iona Novak
- University of Sydney, Sydney, Australia; Cerebral Palsy Alliance Research Institute, Sydney, Australia.
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia; University of Sydney, Sydney, Australia; Cerebral Palsy Alliance Research Institute, Sydney, Australia.
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Herrero D, Einspieler C, Panvequio Aizawa CY, Mutlu A, Yang H, Nogolová A, Pansy J, Nielsen-Saines K, Marschik PB. The motor repertoire in 3- to 5-month old infants with Down syndrome. Res Dev Disabil 2017; 67:1-8. [PMID: 28586709 PMCID: PMC5515547 DOI: 10.1016/j.ridd.2017.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/21/2017] [Accepted: 05/21/2017] [Indexed: 05/20/2023]
Abstract
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.
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Affiliation(s)
- Dafne Herrero
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Christa Einspieler
- Research Unit iDN, Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria.
| | - Carolina Y Panvequio Aizawa
- Department of Physical Therapy, Communication Science & Disorders and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Akmer Mutlu
- Developmental and Early Physiotherapy Unit, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Hong Yang
- Rehabilitation Department, Children's Hospital of Fudan University, Shanghai, China
| | - Alice Nogolová
- Children's Department, City Hospital of Ostrava, Ostrava, Czech Republic
| | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Karin Nielsen-Saines
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter B Marschik
- Research Unit iDN, Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria; Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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De Bock F, Will H, Behrenbeck U, Jarczok MN, Hadders-Algra M, Philippi H. Predictive value of General Movement Assessment for preterm infants' development at 2 years - implementation in clinical routine in a non-academic setting. Res Dev Disabil 2017; 62:69-80. [PMID: 28113095 DOI: 10.1016/j.ridd.2017.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 01/02/2017] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND General movements (GM) are used in academic settings to predict developmental outcome in infants born preterm. However, little is known about the implementation and predictive value of GM in non-academic settings. AIMS The aim of this study is twofold: To document the implementation of GM assessment (GMA) in a non-academic setting and to assess its predictive value in infants born preterm. METHODS AND PROCEDURES We documented the process of implementing GMA in a non-academic outpatient clinic. In addition, we assessed the predictive value of GMA at 1 and 3 months' corrected age for motor and cognitive development at 2 years in 122 children born <33 weeks' gestation. Outcome at two years was based upon the Bayley Scales of Infant Development-II (mental/psychomotor developmental index (MDI, PDI)) and a neurological examination. The infants' odds of atypical outcome (MDI or PDI ≤70 or diagnosis CP) and the predictive accuracy of abnormal GMA were calculated in a clinical routine scenario, which used all available GM information (primarily at 3 months or at 1 month, when 3 months were not available). In addition, separate analysis was undertaken for the samples of GMA at 1 and 3 months. OUTCOMES AND RESULTS Tips to facilitate GMA implementation are described. In our clinical routine scenario, children with definitely abnormal GM were more likely to have an atypical two-year outcome than children with normal GM (OR 13.2 (95% CI 1.56; 112.5); sensitivity 55.6%, specificity 82.1%). Definitely abnormal GM were associated with reduced MDI (-12.0, 95% CI -23.2; -0.87) and identified all children with cerebral palsy (CP) in the sample of GMA at 3 months only. CONCLUSIONS AND IMPLICATIONS GMA can be successfully implemented in a non-academic outpatient setting. In our clinical routine scenario, GMA allowed for adequate prediction of neurodevelopment in infants born preterm, thereby allaying concerns about diagnostic accuracy in non-academic settings.
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Affiliation(s)
- Freia De Bock
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Ludolf-Krehl Strasse 7-11, 68167 Mannheim, Germany; Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany.
| | - Heike Will
- Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany
| | - Ulrike Behrenbeck
- Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany
| | - Marc N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Ludolf-Krehl Strasse 7-11, 68167 Mannheim, Germany
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital - Institute of Developmental Neurology, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - Heike Philippi
- Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany
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Ferrari F, Frassoldati R, Berardi A, Di Palma F, Ori L, Lucaccioni L, Bertoncelli N, Einspieler C. The ontogeny of fidgety movements from 4 to 20weeks post-term age in healthy full-term infants. Early Hum Dev 2016; 103:219-224. [PMID: 27825041 DOI: 10.1016/j.earlhumdev.2016.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/04/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fidgety movements (FMs) are an early accurate marker for normal development. AIM The study assessed the ontogeny of normal FMs from 4 to 20weeks post-term age (PTA). STUDY DESIGN Longitudinal prospective study of healthy full-term infants video recorded every second week from birth to 20weeks PTA. SUBJECTS 21 full-term newborns were enrolled. OUTCOME MEASURES Temporal organization, amplitude, character, predominance in proximal and/or distal parts of the body and the presence of FMs in fingers and wrists were independently scored by three observers. RESULTS From 4 to 10weeks PTA, FMs were sporadic, becoming intermittent in 1-2weeks; they occurred in the proximal parts, with larger and jerkier movements in the following period. From 11 to 16weeks PTA FMs became smaller in amplitude and slower in speed, they were present in all body parts and were more continual than before. Rotational movements in wrists and ankles and finger movements with open hands appeared. From 17 to 20weeks PTA, FMs became more discontinuous and disappeared at 18-20weeks PTA. CONCLUSIONS Developmental course of FMs was seen between 4 and 20weeks PTA with changes in temporal organization, amplitude, speed and body parts involved. The best time for scoring FMs is between 12 and 16weeks PTA.
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Affiliation(s)
- Fabrizio Ferrari
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Rossella Frassoldati
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Di Palma
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | - Luca Ori
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Christa Einspieler
- Research Unit iDN - Interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria
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Adde L, Thomas N, John HB, Oommen S, Vågen RT, Fjørtoft T, Jensenius AR, Støen R. Early motor repertoire in very low birth weight infants in India is associated with motor development at one year. Eur J Paediatr Neurol 2016; 20:918-924. [PMID: 27524392 DOI: 10.1016/j.ejpn.2016.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/04/2016] [Accepted: 07/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most studies on Prechtl's method of assessing General Movements (GMA) in young infants originate in Europe. AIM To determine if motor behavior at an age of 3 months post term is associated with motor development at 12 months post age in VLBW infants in India. METHODS 243 VLBW infants (135 boys, 108 girls; median gestational age 31wks, range 26-39wks) were video-recorded at a median age of 11wks post term (range 9-16wks). Certified and experienced observers assessed the videos by the "Assessment of Motor Repertoire - 2-5 Months". Fidgety movements (FMs) were classified as abnormal if absent, sporadic or exaggerated, and as normal if intermittently or continually present. The motor behaviour was evaluated by repertoire of co-existent other movements (age-adequacy) and concurrent motor repertoire. In addition, videos of 215 infants were analyzed by computer and the variability of the spatial center of motion (CSD) was calculated. The Peabody Developmental Motor Scales was used to assess motor development at 12 months. RESULTS Abnormal FMs, reduced age adequacy, and an abnormal concurrent motor repertoire were significantly associated with lower Gross Motor and Total Motor Quotient (GMQ, TMQ) scores (p < 0.05). The CSD was higher in children with TMQ scores <90 (-1SD) than in children with higher TMQ scores (p = 0.002). CONCLUSION Normal FMs (assessed by Gestalt perception) and a low variability of the spatial center of motion (assessed by computer-based video analysis) predicted higher Peabody scores in 12-month-old infants born in India with a very low birth weight.
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Affiliation(s)
- Lars Adde
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway; Department of Physiotherapy, Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway.
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College, IDA Scudder Rd, Vellore, Tamil Nadu 632004, India.
| | - Hima B John
- Department of Neonatology, Christian Medical College, IDA Scudder Rd, Vellore, Tamil Nadu 632004, India.
| | - Samuel Oommen
- Department of Neonatology, Christian Medical College, IDA Scudder Rd, Vellore, Tamil Nadu 632004, India.
| | - Randi Tynes Vågen
- Department of Physiotherapy, Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway.
| | - Toril Fjørtoft
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway; Department of Physiotherapy, Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway.
| | | | - Ragnhild Støen
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway; Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway.
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Olsen JE, Brown NC, Eeles AL, Einspieler C, Lee KJ, Thompson DK, Anderson PJ, Cheong JLY, Doyle LW, Spittle AJ. Early general movements and brain magnetic resonance imaging at term-equivalent age in infants born <30weeks' gestation. Early Hum Dev 2016; 101:63-8. [PMID: 27411107 DOI: 10.1016/j.earlhumdev.2016.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/25/2016] [Accepted: 06/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neurodevelopmental assessments and brain magnetic resonance imaging (MRI) at term-equivalent age (TEA) predict developmental outcomes in preterm infants. However, the relationship between neurodevelopment prior to term and cerebral structure is currently unknown. AIMS To examine the relationships between General Movements (GMs) assessed from birth to TEA and brain MRI at TEA in infants born <30weeks' gestation. STUDY DESIGN Prospective cohort study. GMs (categorised as 'normal' or 'abnormal') were recorded weekly from birth to 32weeks, and at 34 and 36weeks' postmenstrual age. At TEA, GMs were assessed concurrently with brain MRI (using a validated scoring system). SUBJECTS 149 infants born <30weeks' gestation were recruited from a tertiary hospital. RESULTS 103 infants had MRI at TEA and GMs recorded. Abnormal GMs prior to term were associated with cortical grey matter abnormality (p<0.03), deep grey matter abnormality (p=0.02) and increased interhemispheric distance (p<0.02). Abnormal GMs at TEA (n=55/90) were associated with more global brain abnormality (p<0.01) and cortical grey matter abnormality (p=0.01), and decreased transcerebellar diameter (p=0.04) on concurrent brain MRI. CONCLUSIONS Abnormal GMs both prior to term and at TEA were associated with more marked brain abnormality, and smaller brains at TEA. Abnormal GMs are an early marker of brain abnormalities in very preterm infants.
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Affiliation(s)
- Joy E Olsen
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia.
| | - Nisha C Brown
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia
| | - Abbey L Eeles
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia
| | - Christa Einspieler
- Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Universitätsstrasse 15, 8010 Graz, Austria
| | - Katherine J Lee
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia; Physiotherapy Department, University of Melbourne, 7th Floor, Alan Gilbert Building, Grattan St, Parkville, Victoria 3052, Australia
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Zang FF, Yang H, Han Q, Cao JY, Tomantschger I, Krieber M, Shi W, Luo DD, Zhu M, Einspieler C. Very low birth weight infants in China: the predictive value of the motor repertoire at 3 to 5months for the motor performance at 12months. Early Hum Dev 2016; 100:27-32. [PMID: 27391870 PMCID: PMC5010039 DOI: 10.1016/j.earlhumdev.2016.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/05/2016] [Accepted: 03/18/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies on motor performance and its early markers are rare in China, especially in very low birth weight (VLBW) infants. OBJECTIVE Apart from the assessment of the inter-scorer agreement, we aimed to analyze to what extent the motor repertoire at 10 to 18weeks postterm was related to neonatal complications, and gross and fine motor performance at 12months after term. STUDY DESIGN Exploratory prospective study. SUBJECTS Seventy-four VLBW infants (58 males; mean gestational age=29weeks; mean birth weight=1252g). METHOD Five-minute video recordings were performed at 10 to 18weeks after term; fidgety movements and the concurrent motor patterns (resulting in a motor optimality score) were assessed according to the Prechtl general movements assessment (GMA). The gross and fine motor performance was assessed by means of the Peabody Developmental Motor Scales, second edition, at 12months. RESULTS Reliability was excellent. Pneumonia was associated with absent fidgety movements; the motor optimality score was lower in infants with pneumonia and/or bronchopulmonary dysplasia. Both absent fidgety movements and a lower motor optimality score were associated with a poor or very poor gross and fine motor performance at the 12-month-assessment. CONCLUSION Both the assessment of fidgety movements and the evaluation of the concurrent motor repertoire contribute significantly to an identification of VLBW children with a poor gross and fine motor outcome at 12months. The results of this study document the need for an early identification of infants at high risk for a poor motor performance.
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Affiliation(s)
- Fei-Fei Zang
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Qian Han
- Health Service Center, Meilong Community, Minhang District, Shanghai, PR China
| | - Jia-Yan Cao
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Iris Tomantschger
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
| | - Magdalena Krieber
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
| | - Wei Shi
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Dan-Dan Luo
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Mo Zhu
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Christa Einspieler
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China.
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Dimitrijević L, Bjelaković B, Čolović H, Mikov A, Živković V, Kocić M, Lukić S. Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants. Early Hum Dev 2016; 99:7-12. [PMID: 27372636 DOI: 10.1016/j.earlhumdev.2016.05.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) characteristics as well as with abnormal general movements (GMs) in the 1st month of life. AIMS To demonstrate to what extent GMs assessment can predict neurological outcome in preterm infants in our clinical setting; and to assess the clinical usefulness of time-domain indices of heart rate variability (HRV) in improving predictive value of poor repertoire (PR) GMs in writhing period. STUDY DESIGN Qualitative assessment of GMs at 1 and 3 months corrected age; 24h electrocardiography (ECG) recordings and analyzing HRV at 1 month corrected age. SUBJECTS Seventy nine premature infants at risk of neurodevelopmental impairments were included prospectively. OUTCOME MEASURES Neurodevelopmental outcome was assessed at the age of 2 years corrected. Children were classified as having normal neurodevelopmental status, minor neurologic dysfunction (MND), or cerebral palsy (CP). RESULTS We found that GMs in writhing period (1 month corrected age) predicted CP at 2 years with sensitivity of 100%, and specificity of 72.1%. Our results demonstrated the excellent predictive value of cramped synchronized (CS) GMs, but not of PR pattern. Analyzing separately a group of infants with PR GMs we found significantly lower values of HRV parameters in infants who later developed CP or MND vs. infants with PR GMs who had normal outcome. CONCLUSIONS The quality of GMs was predictive for neurodevelopmental outcome at 2 years. Prediction of PR GMs was significantly enhanced with analyzing HRV parameters.
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Affiliation(s)
- Lidija Dimitrijević
- Clinic of Physical medicine and Rehabilitation- Paediatric department, Clinical Centre, Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | - Bojko Bjelaković
- Faculty of Medicine, University of Niš, Serbia; Clinic of Pediatrics, Clinical Centre, Niš, Serbia
| | - Hristina Čolović
- Clinic of Physical medicine and Rehabilitation- Paediatric department, Clinical Centre, Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | - Aleksandra Mikov
- Clinic of Paediatric Rehabilitation, Institute for Children and Youth Health Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Serbia
| | - Vesna Živković
- Clinic of Physical medicine and Rehabilitation- Paediatric department, Clinical Centre, Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | - Mirjana Kocić
- Clinic of Physical medicine and Rehabilitation- Paediatric department, Clinical Centre, Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | - Stevo Lukić
- Faculty of Medicine, University of Novi Sad, Serbia; Clinic of Neurology, Clinical Centre, Niš, Serbia.
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Maeda T, Inoue M, Sekiguchi K, Ihara K. Aminophylline-associated irritable behaviour in preterm neonates. Early Hum Dev 2016; 99:37-41. [PMID: 27390110 DOI: 10.1016/j.earlhumdev.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
AIM This study investigated the effect of aminophylline on behaviour and autonomic function in the preterm period. METHOD Subjects were preterm infants cared for in the Oita University hospital from August 2012 to October 2014. The group that was administered aminophylline (Am+) and the group that received no aminophylline (Am-) included 11 cases that exhibited a mean gestational age of 28weeks 5days and a mean birth weight of 1109g and 8 cases that exhibited a mean gestational age of 30weeks 5days and a mean birth weight of 1223g, respectively. Intravenous aminophylline was administered continuously at a dose of 4-6mg/kg/day followed by oral therapy when the infant suffered repetitive apnoea. Two-hour video recordings were obtained every 2weeks, and electrocardiograms were performed simultaneously. Onset-offset and tremulous movements in general movement (GM) optimality list were used as indices of behaviour. Autonomic functions were investigated via heart-rate and heart-rate variability measurements using frequency domain spectral analysis and the MemCalc method. We compared indices in 4 periods: 30-31, 32-33, 34-35 and 36-37weeks gestation. RESULTS The Am+ group exhibited significantly low optimality of tremulous movements at 32-33weeks gestation. The autonomic parameters did not differ significantly between the Am+ and Am- groups. There was no significant correlation between GMs optimality score and serum theophylline concentration. CONCLUSION Aminophylline administration was associated with transient irritable behaviour without autonomic changes in the preterm period.
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Affiliation(s)
- Tomoki Maeda
- Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan.
| | - Masanori Inoue
- Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan
| | - Kazuhito Sekiguchi
- Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan
| | - Kenji Ihara
- Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan
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Abstract
OBJECTIVES To describe fidgety movements (FMs), i.e., the spontaneous movement pattern that typically occurs at 3-5 months after term age, and discuss its clinical relevance. SOURCES A comprehensive literature search was performed using the following databases: MEDLINE/PubMed, CINAHL, The Cochrane Library, Science Direct, PsycINFO, and EMBASE. The search strategy included the MeSH terms and search strings ('fidgety movement*') OR [('general movement*') AND ('three month*') OR ('3 month*')], as well as studies published on the General Movements Trust website (www.general-movements-trust.info). SUMMARY OF THE DATA Virtually all infants develop normally if FMs are present and normal, even if their brain ultrasound findings and/or clinical histories indicate a disposition to later neurological deficits. Conversely, almost all infants who never develop FMs have a high risk for neurological deficits such as cerebral palsy, and for genetic disorders with a late onset. If FMs are normal but concurrent postural patterns are not age-adequate or the overall movement character is monotonous, cognitive and/or language skills at school age will be suboptimal. Abnormal FMs are unspecific and have a low predictive power, but occur exceedingly in infants later diagnosed with autism. CONCLUSIONS Abnormal, absent, or sporadic FMs indicate an increased risk for later neurological dysfunction, whereas normal FMs are highly predictive of normal development, especially if they co-occur with other smooth and fluent movements. Early recognition of neurological signs facilitates early intervention. It is important to re-assure parents of infants with clinical risk factors that the neurological outcome will be adequate if FMs develop normally.
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Affiliation(s)
- Christa Einspieler
- Research Unit Interdisciplinary Developmental Neuroscience (iDN), Institute of Physiology, Medical University of Graz, Graz, Austria.
| | - Robert Peharz
- Research Unit Interdisciplinary Developmental Neuroscience (iDN), Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Peter B Marschik
- Research Unit Interdisciplinary Developmental Neuroscience (iDN), Institute of Physiology, Medical University of Graz, Graz, Austria
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Hamer EG, Bos AF, Hadders-Algra M. Specific characteristics of abnormal general movements are associated with functional outcome at school age. Early Hum Dev 2016; 95:9-13. [PMID: 26896696 DOI: 10.1016/j.earlhumdev.2016.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Assessing the quality of general movements (GMs) is a non-invasive tool to identify at early age infants at risk for developmental disorders. AIM To investigate whether specific characteristics of definitely abnormal GMs are associated with developmental outcome at school age. STUDY DESIGN Observational cohort study (long-term follow-up). SUBJECTS Parents of 40 children (median age 8.3 years, 20 girls) participated in this follow-up study. In infancy (median corrected age 10 weeks), the children (median gestational age 30.3 weeks; birth weight 1243 g) had shown definitely abnormal GMs according to Hadders-Algra (2004). Information on specific GM characteristics such as the presence of fidgety movements, degree of complexity and variation, and stiff movements, was available (see Hamer et al. 2011). OUTCOME MEASURES A standardised parental interview (presence of CP, attendance of school for special education, Vineland Adaptive Behavior Scale to determine functional performance) and questionnaires (Developmental Coordination Disorder Questionnaire [DCD-Q] to evaluate mobility and Child Behavior Checklist to assess behaviour) were used as outcome measures. RESULTS Six children had cerebral palsy (CP), ten children attended a school for special education, and eight children had behavioural problems. Both the absence of fidgety movements and the presence of stiff movements were associated with CP (p=0.001; p=0.003, respectively). Stiff movements were also related to the need of special education (p=0.009). A lack of movement complexity and variation was associated with behavioural problems (p=0.007). None of the GM characteristics were related to DCD-Q scores. CONCLUSIONS The evaluation of fidgety movements and movement stiffness may increase the predictive power of definitely abnormal GMs for motor outcome--in particular CP. This study endorses the notion that the quality of GMs reflects the integrity of the infant's brain, assisting prediction of long-term outcome.
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Affiliation(s)
- Elisa G Hamer
- Department of Pediatrics, Division of Developmental Neurology, University of Groningen, University Medical Center, Groningen, The Netherlands; Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend F Bos
- Department of Pediatrics, Division of Neonatology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Mijna Hadders-Algra
- Department of Pediatrics, Division of Developmental Neurology, University of Groningen, University Medical Center, Groningen, The Netherlands.
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