Modeling gross motor developmental curves of extremely and very preterm infants using the AIMS home-video method

BACKGROUND

Motor development is one of the first signals to identify whether an infant is developing well. For very preterm (VPT) infants without severe perinatal complications, little is known about their motor developmental curves.

AIMS

Explore gross motor developmental curves from 3 until 18 months corrected age (CA) of VPT infants, and related factors. Explore whether separate profiles can be distinguished and compare these to profiles of Dutch term-born infants.

STUDY DESIGN

Prospective cohort study with parents repeatedly recording their infant, using the Alberta Infant Motor Scale (AIMS) home-video method, from 3 to 18 months CA.

SUBJECTS

Forty-two Dutch infants born ≤32.0 weeks gestational age and/or with a birthweight (BW) of <1500 g without severe perinatal complications.

OUTCOME MEASURES

Gross motor development measured with the AIMS.

RESULTS

In total 208 assessments were analyzed, with 27 infants ≥five assessments, 12 with <four, and three with one assessment. Sigmoid-shaped gross motor curves show unidirectional growth and variability. No infant or parental factors significantly influenced motor development, although a trend was seen for the model where lower BW, five-minute Apgar score <7, and Dutch native-speaking parents were associated with slower motor development. Three motor developmental profiles of VPT infants were identified, early developers, gradual developers, and late bloomers, which until 12 months CA are comparable in shape and speed to profiles of Dutch term-born infants.

CONCLUSIONS

VPT infants show great intra- and interindividual variability in gross motor development, with three motor profiles being distinguished. From 12 months CA onwards, VPT infants appear to develop at a slower pace. With some caution, classifying infants into motor developmental profiles may assist clinical decision-making.

The AIMS home-video method: parental experiences and appraisal for use in neonatal follow-up clinics

Background

In The Netherlands, prematurely born infants and their parents are offered regular developmental check-ups in a hospital setting. In line with providing healthcare at distance, the use of video footage showing the infant’s behavior and movements, taken by parents at home and assessed by professionals online, might be a fruitful future practice. The focus of this study was to gain insight into parental experiences with the Alberta Infant Motor Scale home-video method and their appraisal of its applicability for use in an outpatient neonatal follow-up clinic.

Method

A qualitative descriptive study among parents of healthy extremely or very premature infants (GA 26.2–31.5 weeks) participating in a longitudinal study of motor development between 3–18 months corrected age. Ten semi-structured interviews were conducted and transcribed verbatim. Data was analyzed independently. Inductive content analysis was performed following the process of the AIMS home-video method.

Results

Parents appraised the AIMS home-video method as manageable and fun to do. Instructions, instruction film, and checklists were clear. Transferring the video footage from their phone to their computer and uploading it to the web portal was sometimes time-consuming. Parents gained a better awareness of their infant’s motor development and found the provided feedback a confirmation of what they already thought about their infant’s development and was reassuring that their child was doing well. First-time parents seemed more uncertain and had a greater need for information about (motor) development, but on the other hand, also had confidence in their child.

All parents thought that home-videos can be an addition to follow-up visits, but cannot replace (all) visits. It may be an opportunity to reduce the frequency of hospital visits, while still having their infant monitored.

Conclusion

Parents appraised the AIMS home-video method positively and are of the opinion that home-videos can be of added value in monitoring infants at risk in neonatal follow-up additional to hospital visits. In future research a user-friendly application and/or platform to exchange video footage safely between parents and professionals should be developed with all possible stakeholders involved and implementation should be explored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03398-9.

A home-video method to assess infant gross motor development: parent perspectives on feasibility

Background

Current use of smartphone cameras by parents create opportunities for longitudinal home-video-assessments to monitor infant development. We developed and validated a home-video method for parents, enabling Pediatric Physical Therapists to assess infants’ gross motor development with the Alberta Infant Motor Scale (AIMS). The objective of the present study was to investigate the feasibility of this home-video method from the parents’ perspective.

Methods

Parents of 59 typically developing infants (0–19 months) were recruited, 45 parents participated in the study. Information about dropout was collected. A sequential mixed methods design was used to examine feasibility, including questionnaires and semi-structured interviews. While the questionnaires inquired after the practical feasibility of the home-video method, the interviews also allowed parents to comment on their feelings and thoughts using the home-video method.

Results

Of 45 participating parents, 34 parents returned both questionnaires and eight parents agreed to an interview. Parent reported effort by the infants was very low: the home-video method is perceived as similar to the normal routine of playing. The parental effort level was acceptable. The main constraint parents reported was time planning. Parents noted it was sometimes difficult to find the right moment to record the infant’s motor behavior, that is, when parents were both at home and their baby was in the appropriate state. Technical problems with the web portal, reported by 28% of the parents were also experienced as a constraint. Positive factors mentioned by parents were: the belief that the home videos are valuable for family use, receiving feedback from a professional, the moments of one-on-one attention and interaction with their babies. Moreover, the process of recording the home videos resulted in an increased parental awareness of, and insight into, the gross motor development of their infant.

Conclusion

The AIMS home-video method is feasible for parents of typically developing children. Most constraints are of a practical nature that can be addressed in future applications. Future research is needed to show whether the home-video method is also applicable for parents with an infant at risk of motor development problems.

Information seeking by parents of children with physical disabilities: An exploratory qualitative study

BACKGROUND

Evidence suggests that parents of children with disabilities feel that not all their information needs are being met, but it remains unclear how parents try to fill these information gaps.

AIMS

The aim of this study is to describe how parents of children with physical disabilities search for and evaluate information.

METHODS

Qualitative semi-structured interviews were conducted with 15 parents of children with a disability, aged 1.5-21 years. Data were analysed using thematic analysis.

RESULTS

There was much variation in information needs between parents. Parents used different sources, depending on the type of information needed, the most important being healthcare professionals, peers, and websites. Peers played an important role in information provision and were the preferred source of experience-based knowledge and support. The Internet is a widely used medium to search for information and to access various sources. There was a general preference for closed Internet communities for peer contact. Information was commonly evaluated by comparing sources.

CONCLUSIONS AND IMPLICATIONS

Parents use different sources for different information needs, and evaluate information by comparing them. Healthcare professionals and parents can support each other in locating and evaluating information including experience-based knowledge. Healthcare professionals should guide parents in their search for information and experience-based knowledge from peers.

What do parents need to enhance participation of their school-aged child with a physical disability? A cross-sectional study in the Netherlands

BACKGROUND

The aim was to provide an overview of the number, domains and priority of needs as expressed by parents in supporting participation of their school-aged child with a physical disability. Additionally, this study investigated whether the number of needs within each domain is related to the child's gross motor function level, parent's perceived own general health, family socio-economic status and family type.

METHOD

A cross-sectional study with a total of 146 participants (84.9% mothers) who completed a survey including the Family Needs Inventory - Paediatric Rehabilitation, the Gross Motor Function Classification System Family Report Questionnaire, the General Health Questionnaire and a demographic questionnaire. A need has been operationalized as 'a family's, parent's or other family member's expressed desire for information, services and supports related to their family'. Descriptive statistics and correlation analysis were applied.

RESULTS

Parents (n = 146; response rate 27%) varied in the number of expressed needs (range 0-124; mean = 35.9; median = 30; SD = 25.6). Highest mean percentage scores were found for the domains 'Laws, regulations and fees' (36%), 'Leisure time' (35.6%) and 'Aids, adaptations, facilities and resources' (33.8%). Seven single needs were expressed by 50% or more of the parents. All domains of needs showed a positive correlation with perceived parental general health. The domains 'Laws, regulations and fees', 'Day care & school', 'Emotional and mental support' and 'Raising my child' correlated negatively with family socio-economic status; and child's gross motor function level correlated positively with the domains 'Aids, adaptations, facilities and resources', 'Practical support at home' and 'Leisure time'.

CONCLUSIONS

As parents have a major influence on participation of children with a physical disability, meeting their individual needs should become an objective for service providers and policy makers. Family-centred service might be more effective by putting a greater emphasis on changing the environment.

Parents' experiences with physical and occupational therapy for their young child with cerebral palsy: a mixed studies review

Understanding the experiences of parents with their child's intervention might help meet the needs of parents and, subsequently get them engaged in their child's intervention. As parents' early beliefs regarding their child's intervention has consequences for treatment participation, it is important to understand these parental perspectives. The aim of this mixed studies review was to give an overview of the experiences and related factors of parents of young children (0-5 years of age) with cerebral palsy in relation to the physical and/or occupational therapy of their child in a rehabilitation setting. The literature was searched systematically for qualitative and quantitative studies published between January 1990 and July 2011. Inclusion criteria were (1) the study population consisted of parents of children with cerebral palsy, with at least 25% of children under the age of five; (2) children had received physical and/or occupational therapy in a rehabilitation setting; and (3) the experiences of the parents with their child's therapy were addressed. Data were synthesized with the framework synthesis method resulting in a conceptual framework describing the factors that are related to the parents' experiences with their child's interventions. A total of 13 studies (eight qualitative and five quantitative) were included and evaluated. Parents expressed various aspects in context, process and outcomes when asked about their experiences with their child's intervention. They had different needs over time and needed time to build a collaborative relationship with their child's therapists. The proposed framework acknowledges the various aspects in context, process and outcomes that parents reported when asked about their experiences. Knowing this, the importance of the broader context of the child in a family should be acknowledged; realizing the impact that the demands of daily life, supports and resources provided to parents, attitudes in the community and culture have on parental experiences.

Assessment of family needs in children with physical disabilities: development of a family needs inventory

BACKGROUND

Valid tools to assess family needs for children with physical disabilities are needed to help tune paediatric rehabilitation care processes to individual needs of these families. To create such a family needs inventory, needs of families of children with a physical disability (age 0-18 years) were identified. We examined differences in the number and type of needs listed by families when asked for by means of an interview compared with using an inventory.

METHODS

Forty-nine families of children with a wide variety of physical disabilities (mean age 7.7 years; SD 4.6) participated in semi-structured interviews, focusing on family needs. They also checked an inventory of 99 items (based on a previously conducted literature review), regarding their family needs. In addition, individual interviews with healthcare professionals, and panel meetings with healthcare professionals and parents were held to further identify relevant family needs for the inventory.

RESULTS

The individual parent and healthcare professional interviews raised 41 needs that were not included in the original inventory of 99 items. Moreover, the panel meetings raised a further 49 needs. After restructuring and reformulating several items, a 187-item Family Needs Inventory - Paediatric Rehabilitation (FNI-PR) was created. The parent interviews revealed significantly less family needs (mean number of needs = 10.8; SD = 6.0) compared with using the inventory (mean number of needs = 31.7; SD = 19.7) (P < 0.0001). Most expressed family needs were related to both general and specific information concerning the child's development and treatment, aids and information about legislation and to rules relating to compensation of costs.

CONCLUSION

Based on responses of parents and healthcare professionals the FNI-PR has been developed, a comprehensive inventory for family needs that can be used in paediatric rehabilitation. An inventory checked by parents resulted in more family needs than a single open-ended question. The inventory may facilitate the implementation of family-centred care.

Do children participate in the activities they prefer? A comparison of children and youth with and without physical disabilities

Objective:

To assess the discrepancy between the leisure activities children prefer and the leisure activities they actually participate in, for children with and without a physical disability, and to explore how in both groups this is related to age and gender.

Design:

Cross-sectional comparison.

Subjects:

Children with and without physical disabilities that were recruited from schools for special education and regular schools in the Netherlands.

Main measures:

The Children’s Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC). A discrepancy score was calculated representing high preference but no participation in the activity in the past four months.

Results:

A total of 141 children (6–18 years) with a physical disability (mean age 12.5, 43% girls, 57% boys) and 156 children without physical disabilities (mean age 11.5, 55% girls,45% boys) were included in the study. There was no significant difference in discrepancy scores between children with and without physical disabilities (informal activities 9.8 ± 5.0 vs. 9.8 ± 4.6, formal activities 6.4 ± 3.4 vs. 6.6 ± 2.8). Discrepancy between preference and performance varied by age and gender for children without disabilities but not for children with disabilities.

Conclusions:

Both groups are equally able to participate in the activities they prefer. Age and gender had a significant effect on the discrepancy scores for children and adolescents without physical disabilities but not for children with physical disabilities.

Noonan syndrome: comparing mutation-positive with mutation-negative dutch patients

Noonan syndrome (NS) is an autosomal dominant disorder characterized by facial dysmorphisms, short stature and congenital heart defects. The disorder is genetically heterogeneous and shows clinical overlap with other RASopathies. These syndromes are caused by mutations in a variety of genes leading to dysregulation of the RAS-MAPK pathway: PTPN11, KRAS, SOS1, RAF1, CBL, SHOC2, NRAS, BRAF, MAP2K1, MAP2K2, HRAS, NF1 and SPRED1. In this study, we conduct a genotype-phenotype analysis of 33 patients with a clinical diagnosis of NS without a PTPN11 mutation. Mutation analysis of the genes involved in RASopathies was performed, except for NF1 and SPRED1. In 14 (42%) NS patients, a mutation was found, 7 (21%) had a mutation in SOS1, 3 (9%) in RAF1 and 1 (3%) in KRAS, MAP2K2, BRAF and SHOC2 each. The phenotype of these mutation-positive cases corresponded to that described in the literature. In the cases with a BRAF and MAP2K2 mutation, the diagnosis cardio-facio-cutaneous syndrome was made. The patient with the SHOC2 mutation had features compatible with 'Noonan-like syndrome with loose anagen hair'. Three major clinical features of NS - a typical face, short stature and a pulmonary valve stenosis - were less frequently present in the group without a mutation. Missense mutations in genes encoding proteins of the RAS-MAPK pathway cause NS. The 3 major clinical features of NS were less frequently present in the mutation-negative patients, which stresses the importance of the syndrome-specific symptoms of the face, heart and short stature in NS. However, all mutation-negative cases met the NS criteria, indicating that the involvement of novel genes is to be expected.

Predicting leisure participation of school-aged children with cerebral palsy: longitudinal evidence of child, family and environmental factors

OBJECTIVE

This longitudinal study aims to determine which child, family and environmental variables measured at 2 years of age predict leisure participation in formal and informal activities in school aged children with cerebral palsy (CP).

METHODS

Parents of 46 children with CP (mean age at baseline: 2 years 6 months, SD 0 years 1 month; at follow-up 6 years 7 months, SD 0 years 9 months; n = 26 boys, n = 20 girls; Gross Motor Classification System I = 30%, II = 7%, III = 28%, IV = 24%, V = 11%) completed the Children's Assessment of Participation and Enjoyment indicating their child's participation. Multivariate regression models were used to identify early predictors of participation.

RESULTS

Movement ability was a significant child-related predictor for formal activities (R(2) 17%, P < 0.05). Movement ability and social skills were most predictive (R(2) 62%, P < 0.00) for informal activities. The feeling of being restricted in family participation was the single most predictive factor for formal and informal activities at family level (R(2) 12%, P < 0.05, R(2) 25%, P < 0.05). Type of daycare was the only environmental variable that was predictive, and only for informal activities (R(2) 16%, P < 0.05). In the overall model movement ability was most predictive for leisure participation in formal activities (R(2) 17%, P < 0.05). Movement ability and social skills are the most important predictors for informal leisure participation (R(2) 62%, P < 0.01).

CONCLUSIONS

Several variables are found to be related to formal and informal participation at age 6. Movement ability and social skills at age 2 are most predictive of leisure participation when the child is 6 years old.

What influences participation in leisure activities of children and youth with physical disabilities? A systematic review

In 2001 the International Classification of Functioning (ICF) defined participation as 'someone's involvement in life situations'. Participation in leisure activities contributes to the development of children and their quality of life. Children with physical disabilities are known to be at risk for participation in fewer activities. The group of children with physical disabilities is highly heterogeneous consisting of children with different diagnosis and different ages. This systematic review aims to analyse the literature for the purpose of looking for variables involved in the frequency of participation in leisure activities for children and youth with different diagnoses and ages. Frequency of participation in leisure activities for children and youth with physical disabilities is associated with a variety of variables. Gross motor function, manual ability, cognitive ability, communicative skills, age and gender are the most important variables. The current evidence suggests that similar variables seem to apply to children with different diagnoses. Age is an important variable in participation of children and youth. However evidence about those variables associated with children at different ages is still lacking.

Development of non-verbal intellectual capacity in school-age children with cerebral palsy

BACKGROUND

Children with cerebral palsy (CP) are at greater risk for a limited intellectual development than typically developing children. Little information is available which children with CP are most at risk. This study aimed to describe the development of non-verbal intellectual capacity of school-age children with CP and to examine the association between the development of non-verbal intellectual capacity and the severity of CP.

METHODS

A longitudinal analysis in a cohort study was performed with a clinic-based sample of children with CP. Forty-two children were assessed at 5, 6 and 7 years of age, and 49 children were assessed at 7, 8 and 9 years of age. Non-verbal intellectual capacity was assessed by Raven's Coloured Progressive Matrices (RCPM). Severity of CP was classified by the Gross Motor Function Classification System, type of motor impairment and limb distribution. manova for repeated measurements was used to analyse time effects and time × group effects on both RCPM raw scores and RCPM intelligence quotient scores.

RESULTS

The development of non-verbal intellectual capacity was characterised by a statistically significant increase in RCPM raw scores but no significant change in RCPM intelligence quotient scores. The development of RCPM raw scores was significantly associated with the severity of CP. Children with higher levels of gross motor functioning and children with spastic CP showed greater increase in raw scores than children with lower levels of gross motor functioning and children with dyskinetic CP.

CONCLUSIONS

Children with CP aged between 5 and 9 years show different developmental trajectories for non-verbal intellectual capacity, which are associated with the severity of CP. The development of non-verbal intellectual capacity in children with less severe CP seems to resemble that of typically developing children, while children with more severe CP show a limited intellectual development compared to typically developing children.

Short-term changes in parents' resolution regarding their young child's diagnosis of cerebral palsy

OBJECTIVE

This study aimed to describe changes in parents' resolution regarding their young child's diagnosis of cerebral palsy over a period of 1 year, and to describe the changes in strategies of resolution.

METHODS

In this longitudinal study, 38 parents of children with cerebral palsy (mean age 18.4 months, SD = 1.1 at baseline) were followed with the Reaction to Diagnosis Interview, assessing their personal reactions to their child's diagnosis (i.e. resolution status). Changes at main and subclassification level of the Reaction to Diagnosis Interview were investigated using a binominal test.

RESULTS

Twenty-nine parents (76%) were found to be stable with respect to their main resolution status (i.e. 'resolved' or 'unresolved'), while 24% of the parents either had changed from 'unresolved' to 'resolved' or in the opposite way. Furthermore, of the 28 parents who were classified as 'resolved' at both times, 15 (54%) had changed at subclassification level with respect to the specific strategies used.

CONCLUSION

Resolution at a main level of parental reactions to their child's diagnosis was predominantly stable. Most parents were classified as 'resolved' at both baseline and follow-up assessment. However, more detailed analyses at subclassification level showed that most parents with a 'resolved' main status showed changing patterns of resolution strategies to their child's diagnosis, suggesting that resolution is an ongoing process.

Cross-cultural validation and psychometric evaluation of the Dutch language version of the Children’s Assessment of Participation and Enjoyment (CAPE) in children with and without physical disabilities

Objective: To assess construct validity, test—retest reliability and inter-interviewer reliability of the intensity dimension of the Children’s Assessment of Participation and Enjoyment (CAPE) for children with and without physical disabilities in the Netherlands.

Subjects: In total, 232 children aged 6—18 years (110 male, 122 female) participated. Seventy-four children with various physical disabilities and 158 without a disability.

Design: Participants completed the CAPE and the Peabody Picture Vocabulary Test. In addition, parents of 142 children were interviewed using the Vineland Adaptive Behavior Scales and the Family Environment Scale. For 71 children test— retest reliability and for 60 children inter-interviewer reliability were assessed. Validity was examined by assessing differences in participation intensity in children with disabilities versus without a physical disability, boys versus girls, and younger versus older children. In addition, 13 hypotheses regarding participation, child and family variables were examined.

Results: Validity of the CAPE was supported by significant differences in participation for subgroups. Participation differed significantly in children with and without disabilities. Girls participated more in all activities. Older children participated more in social activities and self-improvement activities, younger children participated more in recreational activities. Validity of the CAPE was further supported with significant correlation coefficients in 8 out of 13 hypotheses. Both test—retest and inter-interviewer reliability were good to excellent.

Conclusions: The findings indicate that the Dutch language version of the CAPE is a reliable and valid instrument to measure participation in recreation and leisure activities for children with and without physical disabilities aged 6—18 years.

Effectiveness of a computerised working memory training in adolescents with mild to borderline intellectual disabilities

BACKGROUND

The goal of this study is to evaluate the effectiveness of a computerised working memory (WM) training on memory, response inhibition, fluid intelligence, scholastic abilities and the recall of stories in adolescents with mild to borderline intellectual disabilities attending special education.

METHOD

A total of 95 adolescents with mild to borderline intellectual disabilities were randomly assigned to either a training adaptive to each child's progress in WM, a non-adaptive WM training, or to a control group.

RESULTS

Verbal short-term memory (STM) improved significantly from pre- to post-testing in the group who received the adaptive training compared with the control group. The beneficial effect on verbal STM was maintained at follow-up and other effects became clear at that time as well. Both the adaptive and non-adaptive WM training led to higher scores at follow-up than at post-intervention on visual STM, arithmetic and story recall compared with the control condition. In addition, the non-adaptive training group showed a significant increase in visuo-spatial WM capacity.

CONCLUSION

The current study provides the first demonstration that WM can be effectively trained in adolescents with mild to borderline intellectual disabilities.

Gross motor functional abilities in preterm-born children with cerebral palsy due to periventricular leukomalacia

To describe the impact of periventricular leukomalacia (PVL) on gross motor function, data on 59 children (37 males, 22 females) with a gestational age (GA) of 34 weeks or less with cerebral palsy (CP) due to PVL grade I (n=20), II (n=13), III (n=25), and IV (n=1) were studied; (mean GA 29 wk 4d [SD 4 wk 6d]; mean birthweight 1318 g [SD 342]). Two independent raters used the Gross Motor Function Classification System (GMFCS) at four time points: T1, mean corrected age (CA) 9 months 15 days (SD 2 mo 6d); T2, mean CA 16 months (SD 1 mo 27 d); T3, mean CA 24 months 27 days (SD 2 mo 3d); and T4, median age 7 years 6 months (range 2 y 2 mo-16 y 8 mo). Interrater reliability and stability across time with respect to the total cohort were kappa>or=0.86 and rho>or=0.74 respectively. The association between PVL and gross motor outcome at T4 was strong (positive and negative predictive values 0.92 and 0.85 respectively). The proportion of children who remained in the same GMFCS level increased from 27% (T1-T4) to 53% (T2-T4) and 72% (T3-T4). PVL grade I to II, as diagnosed in the neonatal period, has a better functional mobility prognosis than PVL grade III-IV. These findings have implications for habilitation counselling and intervention strategies.

Further delineation of Pitt-Hopkins syndrome: phenotypic and genotypic description of 16 novel patients

BACKGROUND

Haploinsufficiency of the gene encoding for transcription factor 4 (TCF4) was recently identified as the underlying cause of Pitt-Hopkins syndrome (PTHS), an underdiagnosed mental-retardation syndrome characterised by a distinct facial gestalt, breathing anomalies and severe mental retardation.

METHODS

TCF4 mutational analysis was performed in 117 patients with PTHS-like features.

RESULTS

In total, 16 novel mutations were identified. All of these proven patients were severely mentally retarded and showed a distinct facial gestalt. In addition, 56% had breathing anomalies, 56% had microcephaly, 38% had seizures and 44% had MRI anomalies.

CONCLUSION

This study provides further evidence of the mutational and clinical spectrum of PTHS and confirms its important role in the differential diagnosis of severe mental retardation.

Parents of children with cerebral palsy: a review of factors related to the process of adaptation

BACKGROUND

Little is known about the way parents adapt to the situation when their child is diagnosed with cerebral palsy.

METHODS

A literature search was performed to gain a deeper insight in the process of adaptation of parents with a child with cerebral palsy and on factors related to this process. The selected articles were examined with respect to (i) the type and purpose of the study, (ii) study sample, (iii) variables and instruments and (iv) results on adaptation and stress of the parents.

RESULTS

Twenty-two studies were found, which showed a large variety in research designs, instruments and populations. Despite methodological differences, it was possible to extract a number of factors related to resources of individual family members, the family unit as a whole and in the community, family appraisal and adaptive coping.

CONCLUSION

It is important to realize that parents' adaptation may change as a function of their child's development and changing stages of family life over time. Until now cross-sectional studies have dominated this area of research, but in order to understand the process of adaptation over time, longitudinal studies are needed.

Verbal working memory in children with mild intellectual disabilities

BACKGROUND

Previous research into working memory of individuals with intellectual disabilities (ID) has established clear deficits. The current study examined working memory in children with mild ID (IQ 55-85) within the framework of the Baddeley model, fractionating working memory into a central executive and two slave systems, the phonological loop and visuo-spatial sketchpad.

METHOD

Working memory was investigated in three groups: 50 children with mild ID (mean age 15 years 3 months), 25 chronological age-matched control children (mean age 15 years 3 months) and 25 mental age-matched control children (mean age 10 years 10 months). The groups were given multiple assessments of the phonological-loop and central-executive components.

RESULTS

The results showed that the children with mild ID had an intact automatic rehearsal, but performed poorly on phonological-loop capacity and central-executive tests when compared with children matched for chronological age, while there were only minimal differences relative to the performance of the children matched for mental age.

CONCLUSIONS

This overall pattern of results is consistent with a developmental delay account of mild ID. The finding of a phonological-loop capacity deficit has important implications for the remedial training of children with mild ID.

Rhythmic coordination of hand and foot in children with Developmental Coordination Disorder

BACKGROUND

Children with Developmental Coordination Disorder (DCD) have difficulties producing stable rhythmic bimanual coordination patterns in comparison with age-related peers. Rhythmic coordination of non-homologous limbs (e.g. hand and foot) is even more difficult to perform because of mechanical differences between the limbs. The aim of the present study is to investigate the stability of hand-foot coordination patterns of children with DCD.

METHODS

Ten children with DCD (mean age 7.0 years, SD 1.1 years) and 16 control children (mean age 7.4 years, SD 1.3 years) participated in the study. They were asked to perform in-phase or anti-phase tapping movements in three different interlimb coordination combinations: (1) hand-hand (homologous), (2) hand-foot same body side (ipsilateral), and (3) hand-foot different body side (contralateral). Coordination stability was measured by the variability of the relative phase between the limbs under a 'steady state' (preferred) frequency condition, and by the critical frequency (i.e. the point at which loss of pattern stability was observed) in a condition in which the movement frequency was 'scaled' up (only anti-phase tapping).

RESULTS

Coordination patterns of children in the DCD group were less stable in all three limb combinations compared with controls. Further, hand-foot coordination patterns were less stable than hand-hand coordination patterns. With regard to hand-foot coordination, ipsilateral patterns were equally stable compared with contralateral patterns in the in-phase task, but less stable in the anti-phase task. No differential effects were found between the DCD and control groups across the different limb combinations, except for steady-state anti-phase coordination in the ipsilateral limb condition. This effect was due to a relatively good performance of the control children in this condition in comparison with the other limb combination conditions.

CONCLUSIONS

Children with DCD have difficulties producing stable rhythmic hand-foot coordination patterns compared with control children.

Early gross motor development of preterm infants according to the Alberta Infant Motor Scale

OBJECTIVE

To systematically examine gross motor development in the first 18 months of life of preterm infants.

STUDY DESIGN

A total of 800 preterm infants (356 boys), ages between 1 and 18 months and corrected for degree of prematurity, were assessed with the use of the Alberta Infant Motor Scale.

RESULTS

Comparison of the mean Alberta Infant Motor Scale scores of the preterm infants with the norm-referenced values derived from term infants revealed that as a group, the preterm infants scored significantly lower at all age levels, even with full correction for degree of prematurity.

CONCLUSIONS

In general, preterm infants exhibit different gross motor developmental trajectories compared with term infants in the first 18 months of life. The gross motor developmental profile of preterm infants may reflect a variant of typical gross motor development, which seems most likely to be specific for this population. As a consequence, adjusted norms should be used for proper evaluation and clinical decision-making in relation to preterm infants.

Clinical and research diagnostic criteria for developmental coordination disorder: a review and discussion

The aim of this review was to investigate the selection criteria used in the past in studies of children with developmental motor problems (excluding those suffering from neurological dysfunctions such as cerebral palsy, muscular dystrophy, etc.). We therefore conducted an extensive analysis of 176 publications. First, an overview of the main characteristics of these studies (terminology, population, type and purpose) and the selection criteria that are reported in these publications are presented. Following this, the DSM-IV selection criteria for developmental coordination disorder (DCD) are contrasted with the selection criteria reported in 41 publications that have used this terminology to classify the children. The results of this comparison show that the inclusion criteria are largely followed, albeit with little consistency concerning selection instruments and quantitative cut-offs, while adherence to the exclusion criteria is not common practice. Strengths and weaknesses of the DSM-IV criteria, complementary to the previous discussion by Henderson and Barnett in the HMS special issue on DCD in 1998 on this same topic, are discussed. The results of the review also show that many studies have used additional selection criteria related to the specific research questions of the study concerned. In the broader context of clinical practice as well as basic research, the latter result suggests the usefulness of a distinction between Clinical Diagnostic Criteria and Research Diagnostic Criteria. This distinction helps to develop a unifying view on the use of diagnostic criteria for research and clinical practice. We conclude with a number of recommendations concerning the selection criteria for children with DCD.

Congenital hemiplegia in children at school age: assessment of hand function in the non-hemiplegic hand and correlation with MRI

The aim of this study was to evaluate whether children with congenital hemiplegia show abnormal hand function on the non-hemiplegic side and whether this, if present, can be related to the type and extent of brain lesions on MRI. Twenty-two children with congenital hemiplegia of age ranging between 4.8 and 12.3 years, were assessed with a clinical and MRI assessment. Clinical assessment included a structured neurological examination, assessment of hand grips and the Movement Assessment Battery for Children which also includes one item assessing speed and accuracy in each hand. The results showed that 64% of the children studied showed some degree of functional impairment of the non-hemiplegic hand. Manual dexterity 1 from the Movement ABC was, in our experience, a more sensitive tool to detect minor functional abnormalities than the evaluation of hand grips. The severity of the impairment on the non-hemiplegic side was not significantly related to the severity of impairment in the hemiplegic hand (p > 0.05). In contrast, a significant association was found with the site of lesions as hand function in the non-hemiplegic hand was always normal in children with unilateral lesion and abnormal in the ones with bilateral parenchymal lesions (p < 0.05). Children with predominantly unilateral lesions but with bilateral ventricular dilatation or periventricular changes showed more variable results.

Minor neurological signs and perceptual-motor difficulties in prematurely born children

AIM

To examine the spectrum of neurological dysfunction and perceptual-motor difficulties at school age in a cohort of prematurely born children, and the relation of these measures to neonatal brain lesions, intelligence quotient, and behavioural adjustment.

METHOD

One hundred and eighty three children were tested at the age of 6 years using Touwen's Examination of the Child with Minor Neurological Dysfunction, the Movement Assessment Battery for Children (Movement ABC), the Developmental Test of Visual-Motor Integration (VMI), British Ability Scales, and Rutter Scales.

RESULTS

Twenty six children had definite cerebral palsy and one was blind. Of the remaining 156, the proportions falling below the 15th centile point were 31% on Touwen's Examination, 44% on the Movement ABC, and 17% on the VMI. Forty two passed all three tests. No child with a normal ultrasound scan developed cerebral palsy, whereas nearly all those with major lesions did. Minor lesions, however, were not generally predictive of later outcome. Correlations between the tests were generally low.

CONCLUSIONS

These findings stress the need to assess neurological and perceptual motor functioning separately at school age and to monitor relationships with other aspects of development.

Evaluation of the corpus callosum in clumsy children born prematurely: a functional and morphological study

The aim of this study was to evaluate the incidence of functional and neuroradiological abnormalities of the corpus callosum in a group of 21 prematurely born children (GA < 34 weeks) who were found to be "clumsy" on the Movement Assessment Battery for Children at 6 years of age. All children underwent functional and morphological assessment of the corpus callosum. The functional assessment included tests of somesthesis, diadochokinesis and repetitive finger tapping. The morphology of the corpus callosum was evaluated on midsagittal MRI. Thirteen of the 21 clumsy children showed morphological abnormalities which were significantly associated with functional abnormalities. Morphological changes of the corpus callosum were also significantly associated with lesions on both neonatal ultrasound and late MRI. Our results support the view that morphological abnormalities of the corpus callosum are frequent in children born prematurely. The association between these abnormalities and lesions on US or MRI suggests that they are likely to be secondary to pre- or perinatal lesions.

Effect of cerebral lesions on continuous performance test responses of school age children born prematurely

Examined attention skills, as measured by the Continuous Performance Test (CPT), in a group of 64 children born premature and 40 full-term children, ages 6 to 8 years. Premature children were classified by neonatal cerebral lesions into no lesion, mild lesion, and severe lesion groups. It was predicted that severity of lesion would be associated with CPT performance. While mean differences among the groups of prematures did not reach significance, children with severe lesions made significantly more errors of omission and commission than the full-term comparison group. Children with mild lesions were poorer than full terms in errors of commission. Children with no lesions also made more errors of omission and commission than full terms, suggesting attention deficits secondary to prematurity even in the absence of identified brain lesion. With increasing severity of lesion, increasing percentages of each group were found to perform more than 2 SD below the mean in errors of commission. Results suggest that premature children, with and without identified lesions, are at risk for attention deficits.

Visual function of prematurely born children with and without perceptual-motor difficulties

The relationship between visual and perceptual-motor abilities at 6 years of age was investigated in a cohort of 141 prematurely born children without cerebral palsy. Visual acuity was assessed using the Sonksen-Silver Acuity System and stereopsis with the Titmus stereo test. Perceptual motor abilities were evaluated using the Movement Assessment Battery for Children and the Developmental Test of Visual-Motor Integration. The results showed a higher incidence of abnormalities both of linear acuity and stereopsis in the study group when compared to a group of reference children. Whereas abnormalities of linear acuity were not associated with perceptual-motor difficulties, abnormal stereopsis was significantly associated with poor performance on both perceptual-motor tests. Our results suggest that infants born preterm, even in the absence of other major neurological signs, are at risk for abnormal visual function and perceptual-motor difficulties. As these could interfere with everyday life and school performance, a longitudinal assessment of both areas of competencies is recommended so that diagnosis and possible intervention can take place as early as possible.

How local is the impact of a specific learning difficulty on premature children's evaluation of their own competence?

The aim of this study was to determine whether children's perceptions of their own competence levels reflected their actual strengths and weaknesses (Specificity Hypothesis) or transcended these (Generality Hypothesis). Harter and Pike's measure of self-perception was administered to 163 prematurely born 6-year-olds with or without motor co-ordination and/or reading problems. Associations between children's self-perceptions and their scores on standardised tests of motor co-ordination and reading were assessed in three distinct ways. These analyses produced converging results: self-perceptions of physical competence were associated specifically with performance on the Movement ABC Test, and self-perceptions of cognitive competence were associated specifically with performance on the BAS Word Reading Scale. Our results support the Specificity Hypothesis.

Minor neurological and perceptuo-motor deficits in children with congenital muscular dystrophy: correlation with brain MRI changes

Diffuse white matter changes on magnetic resonance imaging (MRI) have been a consistent feature in some children with the "pure" form of congenital muscular dystrophy (CMD) in which there are no structural changes in the brain or severe mental retardation. The aim of this study was to assess fine motor and perceptuo-motor abilities in children with CMD with and without MRI changes. Twenty-two children with "pure" CMD were investigated with a standard neurological examination and a battery of tests (Manual dexterity from the Movement ABC, test of visual-motor integration, Zurich Neuromotor test) which have already been used to detect minor neurological signs related to white matter changes. The cohort was then divided in two groups for analysis depending on the presence or the absence of diffuse white matter changes. A significant difference was found for all the tests between the group of the CMD children with normal MRI and the group with diffuse white matter changes. The manual dexterity and the Zurich Neuromotor tests showed a greater sensitivity than the test of visual-motor integration, which had some false negatives. It is of interest that in the group with diffuse white matter changes the presence of contractures or weakness did not seem to affect the quality of the performance; all these children scored abnormally on the test, irrespective of the severity or the extent of contractures and weakness. In contrast, in children with normal MRI severe contractures and weakness did affect the performances. Our results demonstrate that perceptuo-motor difficulties and minor neurological soft signs are a consistent feature in CMD children with diffuse MRI changes but not with normal MRI.(ABSTRACT TRUNCATED AT 250 WORDS)

Some aspects of the reliability of Touwen's examination of the child with minor neurological dysfunction

Three studies concerning the inter-rater and test-retest reliability of the Touwen examination are presented. The results of the first study showed that it was not possible to achieve acceptable levels of reliability using the manual as the only reference for instruction. Although the reliability estimates of the total scores were good, inter-rater reliability for the nine groups of items and the individual tasks within them was poor. When methodology and interpretation of performance was agreed between observers, a second study showed that these disagreements diminished. The third study demonstrated that the short-term stability of total scores is good, but reliability for group and individual item scores remained poor.

Duration of periventricular densities in preterm infants and neurological outcome at 6 years of age

Parenchymal echogenicities that break down into extensive cystic lesions are generally followed by severe motor deficit. However, the effect of echodensities in the periventricular white matter, so called 'flares', on later development is less well documented. The aim of the present study was to investigate the impact of neonatal flares in preterm infants on neurological status and motor competence at 6 years of age and to see to what extent outcome was related to duration of flares. Forty four children with flares, subdivided into three groups according to the duration of flares, and 62 children with normal scans were assessed on Touwen's neurological examination, the Movement ABC, and the British Ability Scales. No differences in cognitive abilities were found between the groups. The results of the motor assessments showed that performance decreased significantly with increasing duration of flares. In addition, there was a suggestion that this trend was stronger in measures assessing lower limb function than those of upper limb. Teachers were also able to identify differences between the groups of children on the basis of their motor performance in school.

Clumsiness in children--do they grow out of it? A 10-year follow-up study

The question of whether problems of motor co-ordination in early childhood recede with age has rarely been addressed. This paper reports the findings from a follow-up study of 17 children, identified by their teachers as having poor motor co-ordination at age six. Now age 16, these children and their matched controls completed a battery of assessments. The results suggest that the majority of children still have difficulties with motor co-ordination, have poor self-concept and are experiencing problems of various kinds in school. However, there are individual differences in the extent to which the children have learned to cope with their continuing difficulties over the years.

Antiperinuclear factor: indicator of more severe disease in seronegative rheumatoid arthritis

The specificity of antiperinuclear factor (APF) for patients with rheumatoid arthritis (RA) is well documented. It is unknown whether detection of these antibodies adds information to the detection of rheumatoid factor (RF). In a group of 132 patients with RA, 94 were RF positive. Of the 38 patients persistently negative for RF, 14 (37%) were positive for APF. These 14 proved to have a disease course similar to that of RF positive patients. This similarity was shown most impressively by radiological progression of the disease, and to a lesser extent, by the medication needed to control the disease and the number of extraarticular manifestations. No significant correlation was shown between APF and antinuclear antibodies. Among the RF positive patients with their generally poorer prognosis, APF identified the worst affected. Our study suggests that APF in serum of patients with RA is associated with a poor disease outcome, especially in RF negative patients.