Pauline Watter

Motor coordination difficulties and physical fitness of extremely-low-birthweight children

Motor coordination difficulties and poor fitness exist in the extremely low birthweight (ELBW) population. This study investigated the relative impact of motor coordination on the fitness of ELBW children aged 11 to 13 years. One hundred and nine children were recruited to the study: 54 ELBW participants (mean age at assessment 12y 6mo; 31 male, 23 female; mean birthweight 769g, SD 148g; mean gestational age 26.6 weeks, SD 2.1 weeks) and 55 comparison children (mean age at assessment 12y 5mo; 28 males, 27 females; at least 37 weeks’ gestation). All children completed the Movement Assessment Battery for Children (MABC), functional tests of postural stability and strength, growth measures, and tests of respiratory function. Maximal oxygen uptake (VO2max) was calculated from a 20m shuttle run test as a measure of fitness. The ELBW group had greater problems with postural stability (p=0.001) and motor coordination (p=0.001), with 70% rated as having a definite motor problem on the MABC brackets (those who scored less than the 5th centile on the MABC). The ELBW was also less fit than the comparison group (p=0.001), with 45% below the 10th centile for VO2max. There were differences between the groups for growth, strength, and particularly respiratory function. However, respiratory function did not significantly correlate with VO2max in the ELBW group. Motor coordination was the most powerful predictor of VO2max in both the ELBW (p=0.001) and the comparison groups (p=0.001).

Movement Assessment Battery for Children (Movement ABC)

The Movement ABC (Henderson and Sugden 1992) is the most commonly reported norm-ranked assessment used to determine the presence of Developmental Co-ordination Disorder (DCD) in school-aged children. The assessment provides quantitative and qualitative data about a child’s performance of age-appropriate tasks within 3 subsections: Manual Dexterity, Ball Skills, and Static and Dynamic Balance. Performance is compared with established USA norms for children aged 4 to 12 years. The Movement ABC is a minimal task set designed to screen for motor impairment rather than provide a profile of a child’s motor performance. It takes approximately 30 minutes to administer and requires no special training.

IDENTIFICATION AND DEVELOPMENTAL ASSESSMENT OF CHILDREN WITH NEUROLOGICAL IMPAIRMENT1

During foetal life, at birth and in the first few post-natal months, the brain is particularly vulnerable to damage. It is at this time that there is rapid development of the central nervous system, a merging of early primitive responses with more complex and later, highly integrated and adaptive responses, and the development of purposeful physical activities.

Systematic review of early intervention programmes for children from birth to nine years who have a physical disability

AIM To systematically review the literature on the effectiveness of early intervention programmes for children with physical disabilities. METHODS Twelve electronic databases were searched for articles published between 1990 and April 2008. The quality of articles was appraised using an adapted version of the Checklist for the Evaluation of Research Articles and the Physiotherapy Evidence Database (PEDro) scale. RESULTS Ten studies were included in the review. Cross-sectional and interrupted time-series studies were of moderate methodological quality, whereas the non-randomised control trial was of moderate-to-high methodological quality. Studies differed considerably with respect to participants, types of intervention and outcomes measured. CONCLUSIONS Positive outcomes for both children and families have resulted from early intervention. However, methodological limitations hamper a more rigorous analysis of findings across studies.

A study of the effectiveness of physiotherapy in the management of young children with minimal cerebral dysfunction.

Minimal cerebral dysfunction (MCD) is one of many terms used to describe the syndrome exhibited by children who demonstrate mild abnormalities on clinical neurological assessment. The neurological signs of minimal cerebral dysfunction are manifested in the nature of the reflex and automatic sensory responses as well as in the motor responses to specific stimulations. Those reactions which persist beyond the normal age for their integration, together with other mild signs of neurological dysfunction are also symptomatic of minimal cerebral dysfunction.

Multidisciplinary Assessment of Children with Developmental Coordination Disorder: Using the ICF Framework to Inform Assessment

The aim of this study was to describe relationships in young children with motor coordination problems between measures of motor, functional, self-efficacy, and communication administered by a multidisciplinary team and the fit of these measures within the framework of the International Classification of Functioning, Disability and Health (ICF) (39). Sixty children, 40 males and 20 females, with mean age 72.5 months (SD = 11.4 months) referred to a university physiotherapy clinic met the inclusion criteria for developmental coordination disorder (DCD). Each measure provided a different perspective of performance when considered within the framework of the ICF. The findings suggest caution when using the Movement Assessment Battery for Children (M-ABC) for the purpose of diagnosis with young referred children, since 25 of the 60 children scored > 15th percentile, despite demonstrating motor deficits at home and school. Further research is needed to address assessment at the participation level. Viewing children from the multiple perspective of each discipline highlights the range of challenges faced by children with DCD.

Perinatal events and motor performance of children born with ELBW and nondisabled.

Purpose: To explore the relationship between perinatal variables and motor performance in children who were born with extremely low birth weight (ELBW) and were nondisabled at 1 and 4 years. Methods: Children without neurological or cognitive impairment (n = 48) born weighing less than 1000 g between 1992 and 1994 were assessed at 1 and 4 years corrected age using the Neurosensory Motor Developmental Assessment (NSMDA). Scores were used to categorize motor performance as normal or abnormal. Results: Chronic lung disease (CLD) of prematurity, necrotizing enterocolitis (NEC), and patent ductus arteriosus were associated with NSMDA category at 1 year. Chronic lung disease, male gender, and NEC were associated with NSMDA category at 4 years. Multiple regression analyses revealed that CLD and NEC were independently associated with abnormal motor outcomes at 1 year. Conclusions: Early assessment and motor therapy is recommended for infants with CLD, because of its effect on motor performance in this otherwise healthy group of children born with ELBW.

Identifying assessment measures and interventions reported for Thai children with cerebral palsy using the ICF-CY framework

Background: Cerebral palsy (CP) is the most common disability in childhood. The International Classification of Functioning, Disability and Health (ICF) provides a standard framework for classifying performance in people with disability, including children with CP. Linking measures actually reported with the ICF classification promotes best practice, especially pertinent in developing countries such as Thailand. This study aimed to explore the charted demographic data, assessment and intervention measures reported for children with CP in Central region of Thailand using the ICF for children and youths (ICF-CY) framework to clarify the scope of actual management practice in this population. Methods: Charts of children admitted to four public hospitals and two schools in 2007–2009 were age stratified, and approximately 48% audited (n = 269). Results: Contextual information was clearly reported, and measures could be classified across all components of the ICF, being mainly classified in Body Structures and Functions and to a lesser degree, in Activities and Participation. Our ability to compare across cultures was affected by poor recording practices limiting the amount and quality of data available. Conclusions: Classifying measures of children with CP in Thailand in terms of the ICF-CY framework demonstrates their holistic management as well as where gaps need to be addressed, and thus contributes to best practice. Implications for Rehabilitation Assessments and interventions reported for children with CP in Central region, Thailand cover all components of the ICF-CY, and describe the individual roles of the Inter-professional team members. Local health practitioners should consistently conform with internationally practice by using Standardized tools assessing all components of the ICF Consistent and uniform charting practices should be used to provide accurate interpretation of actual practice, as well as a clear pathway from assessment to intervention.

Health-related quality of life from the perspective of children with severe specific language impairment

BackgroundThis study aimed to evaluate the feasibility and reliability of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL™) for use by children with severe specific language impairment (SLI) and their parent, and to explore the health-related quality of life of children with severe SLI. We hypothesized that the PedsQL™ would be a suitable measure, and identify lower health-related quality of life compared to the healthy population sample, particularly in school and social functioning.MethodsForty-three out of 61 children with severe SLI enrolled at a dedicated school from February 2010 until September 2011 agreed to participate. Children and parents completed the PedsQL™ separately with support as required.ResultsThe PedsQL™ proved to be suitable for this cohort. Children perceived themselves to be at risk of impaired social and physical functioning, rendering the total score below the population mean. Parents rated social and emotional functioning at risk of impairment, with the psychosocial and total summary score consequently below the population mean. Physical functioning had the largest child/parent difference, with children rating themselves below the cut-off score, and parents rating their children above the cut-off score.ConclusionsThis measure can be used with this group. Our group of children with severe SLI reported lower health-related quality of life than the healthy population mean as perceived by both the child and the parent. Health professionals working with children who have SLI need to consider not only a child’s impairment, but also their wellbeing and participation by incorporating self- and proxy-reports into assessment in order to promote meaningful therapeutic outcomes that impact positively on a child’s life.

Patterns of improvement in neurological functioning of children with minimal cerebral dysfunction with physiotherapy intervention.

Sixty-four children with minimal cerebral dysfunction (MCD) were studied to evaluate the effectiveness of using a developmental physiotherapy approach to treatment. Assessments of the childrens performance in major areas of neurological development were made initially and after six months. In addition, a twelve months assessment allowed a determination of whether early progress was maintained after cessation of treatment. Analyses of results revealed that physiotherapy treatment does ameliorate the neuro-developmental problems seen in children with MCD, and that beneficial effects are well established after six months. On cessation of treatment, the children maintained the better level of functioning for a further six months in comparison to the control group. Resolution of neurological problems after a relatively brief period of physiotherapy justifies this form of intervention for children with MCD.