Jon Caflisch

Neuromotor development from 5 to 18 years. Part 2: associated movements.

Associated movements (AMs) are the most frequently assessed parameters of movement quality in children with motor dysfunctions. In this article, reference curves of duration and degree of AMs from 5 to 18 years are provided. In a cross-sectional study of non-disabled children (n=662) duration and degree of AMs were estimated at six specific ages while children performed repetitive finger, hand, and foot movements, alternating hand and foot movements, diadochokinesis, sequential finger movements, pegboard, stress gaits, and dynamic balance. Moderate-to-high intraobserver and interobserver reliability for the assessment of AMs were noted. Duration and degree of AMs displayed a non-linear developmental course that was a function of the motor tasks complexity. AMs decreased most with age in repetitive movements, less in alternating and sequential movements, and least in the pegboard and dynamic balance. Reference curves demonstrated large interindividual variations for duration and degree of AMs. Both the variable developmental course and large interindividual variation need to be taken into account in the assessment of movement quality of school-age children. In contrast to timed performance, considerable sex differences for AMs were observed.

Sleep Duration From Ages 1 to 10 Years: Variability and Stability in Comparison With Growth

OBJECTIVE. Our goal was to describe the variability of sleep duration (time in bed per 24 hours) in healthy children from 1 to 10 years of age in comparison with growth measures. METHODS. A total of 305 children were followed with structured sleep-related interviews and measurements of height and weight 12, 18, and 24 months after birth and then at annual intervals until 10 years of age. SD scores were calculated, and smooth curves were fitted by smoothing splines through the SD scores. The long-term variability channel within children (units SD score) was defined as the difference between the maximum and the minimum of the smooth curves and the short-term variability channel (units SD score) as the difference of the largest and the smallest deviations of the original SD scores from the smooth curve. RESULTS. Sleep duration remained within a long-term variability channel <0.5 SD score in 21% of the children (34% for height, 21% for weight). Nearly every second child (46%) stayed within a long-term variability channel <1.0 SD score (76% for height, 64% for weight). Sleep duration of ∼90% of all children ran within a long-term variability channel of <2.0 SD score (corresponding, eg, to the range between the 2nd and the 50th percentile). No single childs sleep duration remained within a short-term variability channel <0.5 SD score, indicating fluctuations from year to year (60% for height, 53% for weight). An association between aspects of sleep duration and somatic growth was not observed at any age. CONCLUSIONS. Sleep duration during early and middle childhood shows large variability among children, as well as trait-like long-term stability and state-like yearly fluctuations within children. An individual approach to the childs sleep behavior is needed; expectations in terms of appropriate sleep duration of the child should be adjusted to the individual sleep need.

Impaired motor performance and movement quality in very-low-birthweight children at 6 years of age

Motor performance and movement quality were quantitatively examined (Zurich Neuromotor Assessment: timed motor performances and associated movements) in 87 prospectively enrolled very-low-birthweight (VLBW; <1250g) children (38 males, 49 females; mean birthweight 1016.2g [SD 141.5]:, range 720-1240g; mean gestational age 28.7wks [SD 2], range 25.7-33.4wks) at 6 years of age. All motor tasks were below the reference population: pure motor (median z-score) -0.46; adaptive fine motor (pegboard) -0.99; adaptive gross motor -0.88; static balance -0.48; and associated movements -1.90. All tasks correlated with the degree of neurological abnormalities (p<or=0.004). VLBW children with no neurological abnormality also performed below the 10th centile and associated movements occurred more frequently than in the reference population (odds ratio 18, 95% confidence interval 6.7-47.9). Severity of periventricular leukomalacia and intraventricular haemorrhage assessed by ultrasound was associated with adaptive fine and gross motor tasks. We conclude that speed of motor performance and movement quality in particular were substantially impaired in VLBW children and are related to the degree of neurological abnormalities and neonatal cerebral injury.

Neurodevelopmental outcome, psychological adjustment, and quality of life in adolescents with congenital heart disease.

The aim of this study was to examine neurodevelopment, psychological adjustment, and health‐related quality of life (HRQoL) in adolescents after bypass surgery for congenital heart disease (CHD) during early childhood.

Long-Term Neurodevelopmental Outcome with Hypoxic-Ischemic Encephalopathy

OBJECTIVES To determine the long-term neurodevelopmental outcome for children after hypoxic-ischemic encephalopathy (HIE) without major disability, and to examine neonatal injury patterns detected on cerebral magnetic resonance imaging (MRI) in relation to later deficits. STUDY DESIGN Prospectively enrolled children with HIE and neonatal cerebral MRI data (n = 68) were examined at a mean age of 11.2 years (range, 8.2-15.7 years). Eleven children had a major disability (ie, cerebral palsy or mental retardation). Brain injury was scored according to the region and extent of injury. RESULTS Children without major disability (n = 57) had lower full-scale and performance IQ scores compared with norms (P = .02 and .01, respectively), and the proportion of children with an IQ <85 was higher than expected (P = .04). Motor performance on the Zurich Neuromotor Assessment was affected in the pure motor, adaptive fine motor, and gross motor domains, as well as in the movement quality domain (all P < .001). Watershed injury pattern on neonatal MRI correlated with full-scale and verbal IQ scores (P = .006 and <.001, respectively), but neonatal MRI pattern did not correlate with motor performance in children without major disability. CONCLUSION Children who sustained neonatal HIE without major disability are at increased risk for long-term intellectual, verbal, and motor deficits. The severity of watershed injury is correlated with later intellectual performance. Long-term follow-up examinations are necessary for early detection of neurodevelopmental impairment and early initiation of adequate therapies.

Development of motor speed and associated movements from 5 to 18 years

Aim  To study the development of motor speed and associated movements in participants aged 5 to 18 years for age, sex, and laterality.

Correlations Between Motor and Intellectual Functions in Normally Developing Children Between 7 and 18 Years

The relationship between motor and intellectual functions was examined in 252 healthy children from 7 to 18 years using the Zurich Neuromotor Assessment and standardized intelligence tests. The magnitude of Spearman correlations between neuromotor and intellectual scores was generally weak (r = 0.15–0.37). The strongest correlations were found between performance in the pegboard task and visuomotor intelligence (r = 0.35) and between contralateral associated movements and intelligence in boys (r = 0.37). We conclude that specific connections between motor and intellectual functions may exist. However, because the magnitude of correlations is generally weak, we suggest that motor and intellectual domains in healthy children are largely independent.

Neuromotor development in children. Part 3: motor performance in 3‐ to 5‐year‐olds

Aim  The aim of this cross‐sectional study was to provide normative data (ordinal scores and timed performances) for gross and fine motor tasks in typically developing children between 3 and 5 years of age using the Zurich Neuromotor Assessment (ZNA).

Quantitative reference curves for associated movements in children and adolescents

Intensity of contralateral associated movements (AMs) is a measure of movement quality assessed using frequency and degree of AMs. A sample of 593 right‐handed participants without disability (286 males, 307 females; aged 5y‐18y 6mo) was studied with the Zurich Neuromotor Assessment (ZNA). The ZNA is a standardized testing procedure which assesses performance on standardized motor tasks according to timed performance and frequency and degree of AMs. In contrast to frequency and degree, intensity of AMs allowed the calculation of centiles which were quasi‐continuous. Centile curves of contralateral AMs for the ZNA and data on inter‐ and intraobserver reliability are presented. The significance of age, sex, and side differences are discussed. Intensity of AMs offers clinical and scientific advantages for measurement of movement quality. There is a decrease of AMs with age depending on the complexity of tasks. Females showed consistently fewer AMs than males, whereas only minor side differences were shown.

Infant motor milestones: poor predictive value for outcome of healthy children

The acquisition of motor skills is among the most remarkable achievements in the first years of life. Motor milestones such as the emergence of sitting without support or the first independent steps provide a framework for developmental monitoring of children in health supervision visits because these milestones belong to the most salient and best demarcated markers of developmental processes that parents and healthcare professionals can observe. In clinical practice, general paediatricians, child neurologists and developmental paediatricians are often asked to predict future outcomes on the basis of early developmental milestones. While there is some evidence from the study of preterms or children who have experienced early brain injury that a delay in motor development is a predictor of subsequent motor and cognitive problems [see e.g. (1)], the association between infant motor milestones and later developmental outcome in normal healthy children without risks is less clear. Several papers have been recently published assessing this relationship in large-scale birth cohorts [e.g. 1946 National Survey of Health and Development in the United Kingdom (2) or Northern Finland 1966 Birth Cohort (3,4)]. Although these studies described an association between early motor milestones and later developmental outcome, the magnitude of the reported effects was generally small and the findings were questioned by others (5). In fact, infant milestone information in these studies was acquired either at age 12 months (before all children were able to walk independently) or at 24 months (past the time most children learned to sit without support or made their first steps), and later cognitive functions were not measured with existing standards (5). In our longitudinal study of normally developing children, milestones were recorded at a time point contemporaneous with the emergence of motor milestones and later outcomes were repeatedly assessed up to 18 years using standardized intelligence and neuromotor tests. Our cohort consisted of 222 healthy, term-born individuals [119 boys, 103 girls, median gestational age 40 weeks, MAD (median absolute deviation) 1.2 weeks, range 37– 44 weeks; median birth weight 3.26 kg, MAD 0.4 kg, range 2.37–4.57 kg] of the Zurich Generational Study [community sample of children born between 1978 and 1993 (6)]. Participants did not have mental retardation [full-scale intelligence quotient (IQ) < 70] or a motor disorder that required therapeutic interventions (physiotherapy, occupational therapy, etc.). The mean socioeconomic status (SES) according to Largo et al. (7) was 8 (range 3–12). Informed consent was obtained at birth from the parents. The institutional review board of the Canton Zurich confirmed that the study was performed according to the Declaration of Helsinki and conformed to legal and ethical norms. All children were followed with comprehensive neurodevelopmental assessments from birth to age 18 years by experienced developmental paediatricians (visits at the centre at ages 1, 3, 6, 9, 12, 18 and 24 months, and then in yearly intervals). Depending on the outcome variable considered, between 79% and 85% of children with a milestone record participated in the endpoint visit at age 18 years, and these children were representative of those included at baseline (i.e. same age distribution for milestones). Parents were asked to record the date when their child achieved motor milestones. At each visit, the