Anna-Maria Johansson

Handedness in preterm born children: A systematic review and a meta-analysis

It has been proposed that left and/or non-right handedness (NRH) is over-represented in children with a history of preterm birth because such births are associated with a greater incidence of insult to the brain. We report an approximate two-fold increase in left and/or non-right handedness based on a systematic search of the literature from 1980 to September 2010 for English-language articles reporting handedness status in preterm children compared with fullterm controls either as a main focus of the study or as a secondary finding. In total, thirty articles met the inclusion criteria. However, there was a great variation between the included studies in terms of objectives, population characteristics, sample size and methodologies used. While the majority of studies reported a higher incidence of NRH in preterm than fullterm children, this was not a consistent finding. A quality assessment was made to explore the differences in overall study quality and handedness assessment methodology between studies. A random-effects model meta-analysis was then performed to estimate the accumulated effect of preterm birth on handedness (18 studies; 1947 cases and 8170 controls). Preterm children displayed a significantly higher occurrence of NRH than fullterm children (odds ratio [OR]: 2.12; 95% confidence interval [CI]: 1.59-2.78). Sources of heterogeneity were investigated by supplementary meta-analyses considering studies with high or low overall and handedness assessment quality. Publication bias was assessed by Eggers test of the intercept and Duvall and Tweedies trim-and-fill method. The outcomes of these procedures did not jeopardize the overall finding of reliably increased OR for NRH in preterm children. The present review suggests that a preterm birth is indeed associated with a greater than two-fold likelihood of NRH. Several studies also explored the relationship between handedness and neuropsychological functioning (cognition mainly) with an array of methods. Although not without disagreement, this association was found to be concordant. Studying handedness in preterm children, therefore, is a potentially important index of hemispheric organization and cognitive and sensory-motor functions following neurodevelopmental disturbance.

Long-term influences of a preterm birth on movement organization and side specialization in children at 4-8 years of age.

This study explored upper-limb and head kinematics during unimanual goal-directed movements in children born preterm (PT) and full-term (FT) aged 4-8 years. Further, functional lateralization was investigated through side-specific kinematics and hand preference observations. Altogether, 141 children were included, divided into three sub-groups based on gestation week at birth (GW). Children born FT (38-41 GW) and moderately PT (33-35 GW) showed faster, smoother, and shorter movement trajectories than children born very PT (V-PT < 33 GW). Only children born FT expressed evident side differences that were characterized by smoother movements with the preferred side. Regarding hand preference, the children born V-PT showed increased rates of non-right-handedness compared with the other groups. Regardless of hand preference, the children born V-PT showed less well organized movements compared with the other groups. These findings suggest that spatio-temporal movement organization and side specialization at pre-/early school-age are affected by a PT birth, and more frequently so for children born before 33 GWs, indicating long-lasting influences on neuromotor development and specialization.

Short- and long-term effects of synchronized metronome training in children with hemiplegic cerebral palsy: A two case study

Background: Children with cerebral palsy (CP) require individualized long-term management to maintain and improve motor functions. The objective of this study was to explore potential effects of synchronized metronome training (SMT) on movement kinematics in two children diagnosed with spastic hemiplegic CP (HCP). Method: Both children underwent 4-weeks/12 sessions of SMT by means of the Interactive Metronome (IM). Optoelectronic registrations of goal-directed uni- and bimanual upper-limb movements were made at three occasions; pre-training, post completed training and at 6-months post completed training. Results: Significant changes in kinematic outcomes following IM training were found for both cases. Findings included smoother and shorter movement trajectories in the bimanual condition, especially for the affected side. In the unimanual condition, Case I also showed increased smoothness of the non-affected side. Conclusions: The observed short- and long-term effects on the spatio-temporal organization of upper-limb movements need to be corroborated and extended by further case-control studies.

Relations among upper-limb movement organization and cognitive function at school age in children born preterm.

Objective: To explore relations between aspects of upper-body spatiotemporal movement organization and intelligence in children born preterm at school age. Methods: Three-dimensional (3D) kinematic recordings of arm and head movements during a unimanual precision task were related to performance on the Wechsler Intelligence Scale for Children, 4th edition, in a sample of 32 children born preterm (gestational age, mean: 31.5 weeks [range: 22–35 weeks]; birth weight, mean: 1699 g [range: 404–2962 g]) at 6 years to 8 years with no diagnosed cognitive, sensory, or motor impairments compared with 40 age-matched control children born fullterm. Results: In the children born preterm, upper-limb movement duration and segmentation of movement trajectories were significantly associated with full-scale intelligence quotient independent of gestational age (GA) and sex. These effects pertained to the preferred side, characterized by more effective movement organization being linked with increased intelligence scores. The same relations were not seen in the controls. Within the children born preterm, a significant effect of GA was also found for some aspects of upper-limb movement organization. Full-scale intelligence quotient was within normal limits for both groups but significantly lower in the preterm (mean: 94.5 [range: 72–120]) compared with the fullterm (mean: 101.7 [range: 76–119]) born children. Conclusions: The findings demonstrate that, independent of GA, the spatiotemporal organization of upper-limb movements is partly associated with cognitive performance in children born preterm.

Alterations in white matter microstructure are associated with goal-directed upper-limb movement segmentation in children born extremely preterm

Altered white matter microstructure is commonly found in children born preterm (PT), especially those born at an extremely low gestational age (GA). These children also commonly show disturbed motor function. This study explores the relation between white matter alterations and upper‐limb movement segmentation in 41 children born PT (19 girls), and 41 children born at term (18 girls) at 8 years. The PT group was subdivided into extremely PT (E‐PT; GA = 25–27 weeks, N = 10), very PT (V‐PT; GA = 28–32 weeks, N = 13), and moderately PT (M‐PT; GA = 33–35 weeks, N = 18). Arm/hand preference (preferred/non‐preferred) was determined through object interactions and the brain hemispheres were designated accordingly. White matter alterations were assessed using diffusion tensor imaging in nine areas, and movement segmentation of the body‐parts head, shoulder, elbow, and wrist were registered during a unimanual goal‐directed task. Increased movement segmentation was demonstrated consistently on the preferred side in the E‐PT group compared with the term born group. Also compared with the term born peers, the E‐PT group demonstrated reduced fractional anisotropy (FA) in the cerebral peduncle (targeting the corticospinal tract) in the hemisphere on the non‐preferred side and in the splenium of corpus callosum. In contrast, in the anterior internal capsule on the preferred side, the E‐PT group had increased FA. Lower FA in the cerebral peduncle, but higher FA in the anterior internal capsule, was associated with increased movement segmentation across body‐parts in a contralateral manner. The results suggest that impaired development of sensorimotor tracts in E‐PT children could explain a sub‐optimal spatiotemporal organization of upper‐limb movements. Hum Brain Mapp 38:5051–5068, 2017.

Timing Training in Three Children with Diplegic Cerebral Palsy: Short- and Long-Term Effects on Upper-Limb Movement Organization and Functioning

Despite the great need of interventions to maintain and improve motor functions in children with diplegic cerebral palsy (DCP), scientific evaluations of existing training methods are rare. This study aimed to explore individual effects of synchronized metronome training (SMT) on motor timing, spatio-temporal movement organization, and subjective experiences of changes in upper-limb functions in three children with DCP. All children participated in an individualized 4-week/12 session SMT training regime. Measurements before training (Pre), after training (Post1), and at 6 months post completed training (Post2) were made by the applied SMT training equipment, optoelectronic registrations of goal-directed upper-limb movements, and a questionnaire assessing subjective experiences of changes in upper-limb functions and usability. In general, the training regime was shown to have little effect on motor timing. However, some positive changes in spatio-temporal movement organization were found. Two children also reported substantial long-lasting positive changes in subjective experiences of hand/arm functionality in terms of increased movement control and reduced muscle tone. For these children, parallel kinematic findings also indicated smoother and faster movement trajectories that remained at Post2. Although highly individualized, the shown improvements in upper-limb kinematics and subjective experiences of improved functionality of the hands/arms for two of the cases warrant further explorations of SMT outcomes in children with DCP.

Developmental progression and side specialization in upper-limb movements from 4 to 8 years in children born preterm and fullterm

ABSTRACT This study investigated developmental changes and differences in upper-limb movement organization from 4 to 8 years of age in children born preterm (PT) and fullterm (FT). Kinematic recordings of precision-demanding unimanual movements and lateral assessments were carried out in 37 children (18 PT). All children, particularly children born PT, displayed considerable gain in movement kinematics. Contrary to controls, children born PT displayed persistently less-evident side preference. Gestational age (GA) contributed significantly to kinematic differences shown, with larger upper-limb deviances in the lowest GAs, in agreement with cross-sectional findings of altered hemispheric connections and delayed side-specialization among children born very PT.

Assessment of myelin and brain volumes at early school-age: long-term effects of a preterm birth

BackgroundStructural and functional alterations in white matter architecture are common described in children born preterm (PT) and associated to behavioral implications. Still, how critical gestat ...Introduction: The Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS) and the Communication Function Classification System (CFCS) have become important tools to describe motor function in children with cerebral palsy (CP). The aim of this study was to describe the relationship between activities of daily living, motor function, and communication in children with CP. Patients and method: Ninety-one children with hemiplegic CP, (age 8y 2.4y; 79% left hemiplegic CP) and between the years 2000–2015 who were accepted to therapy in the Department of Occupational Therapy in Hacettepe University were included in the study. GMFCS, MACS, CFCS, Pediatric Evaluation Disability Inventory (PEDI), and Functional Independence Measure for Children (WeeFIM) was evaluated by the child’s therapist. Results: There was a good overall correlation between gross motor function and manual ability (r=0.754), gross motor function and communication (r=0.649), and manual ability and communication (r=0.779, p<0.001). In addition, there was a similar relationship between these three classification and assessment of daily living activities (r= 0.414 to r= 0.716 for WeeFIM; r=0.354–0.766 for PEDI; p<0.001). Conclusion: When evaluating children with CP, all three approaches must be assessed before complete clinical status is determined. In this context, the GMFCS, MACS, and CFCS seem to be well informed about daily living activities, and population-based studies seem to be very useful for health records and clinical practice for children with hemiplegic CP.

Three dimensional kinematic analyses of finger movement control and association to brain activity responses – A pilot study on healthy individuals

Introduction: An increased knowledge of how the brain control finger movements give us keys to understand the recovery of motor function after a brain injury. This knowledge is crucial for the deve ...

Improved fine motor performance in children born preterm : a longitudinal study of upper-limb kinematics from 4 to 8 years

Introduction:Although children born preterm (PT) are at known risk for impaired neuromotor development, longitudinal studies using detailed measurements of motor performance are rare. This study in ...