Yvonne Burns

Differences in postural control and movement performance during goal directed reaching in children with developmental coordination disorder

Poor upper-limb coordination is a common difficulty for children with developmental coordination disorder (DCD). One hypothesis is that deviant muscle timing in proximal muscle groups results in poor postural and movement control. The relationship between muscle timing, arm motion and childrens upper-limb coordination deficits has not previously been studied. The aim of this study was to investigate the relationship between functional difficulties with upper-limb motor skills and neuromuscular components of postural stability and coordination. Sixty-four children aged 8-10 years, 32 with DCD and 32 without DCD, participated in the study. The study investigated timing of muscle activity and resultant arm movement during a rapid, voluntary, goal-directed arm movement. Results showed that compared to children without DCD, children with DCD took significantly longer to respond to visual signals and longer to complete the goal-directed movement. Children with DCD also demonstrated altered activity in postural muscles. In particular, shoulder muscles, except for serratus anterior, and posterior trunk muscles demonstrated early activation. Further, anterior trunk muscles demonstrated delayed activation. In children with DCD, anticipatory function was not present in three of the four anterior trunk muscles. These differences support the hypothesis that in children with DCD, altered postural muscle activity may contribute to poor proximal stability and consequently poor arm movement control when performing goal-directed movement. These results have educational and functional implications for children at school and during activities of daily living and leisure activities and for clinicians assessing and treating children with DCD.

SCHOOL PERFORMANCE OF ELBW CHILDREN: A CONTROLLED STUDY

This paper examines the prevalence of learning difficulty in reading, spelling, mathematics and writing and the prevalence of attention deficit disorder (ADD) in extremely low‐birthweight (ELBW) children at school compared to their peers. Parents of 87 eligible ELBW children completed an educational questionnaire and questionnaire for ADD. Teachers of the ELBW children completed a detailed educational and ADD questionnaire for the study child and two control children in the same class, matched for âge and nearest in birth date to the study child.

The measurement of the medial longitudinal arch in children

Both feet of two hundred and seventy two children aged between five years six months and ten years and eleven months were studied using a footprint technique called the arch index (Al), and the vertical height of the navicular (NH) as non invasive techniques of objective measures of the medial longitudinal arch (MLA). In addition to age the study investigated the influence of gender, limb dominance, and body weight. The study found the existence of a relationship between the two measures of the MLA. There was no significant difference in NH measures between males and females and body weight did not affect the NH. The NH changed with age, suggesting it provides a useful, easily obtained clinical measure. The Al measures were slightly more reliable than the NH but showed less change with age.

Maternal hypertension and neurodevelopmental outcome in very preterm infants

AIM To determine the outcome of preterm infants born to mothers with hypertension during pregnancy, and preterm controls. METHODS 107 infants of 24–32 weeks gestation, born to hypertensive mothers, and 107 controls matched for gestational age, sex, and multiple pregnancy, born to normotensive mothers, were prospectively enrolled over 2 years. Information on maternal complications and medication was obtained and neonatal mortality and morbidities recorded. Survivors were followed up to at least 2 years, corrected for prematurity. RESULTS One third of the hypertensive mothers were treated with antihypertensive drugs, while 18% received convulsion prophylaxis with phenytoin. Magnesium sulphate was not prescribed. Both groups had a mean gestational age of 29.9 weeks, with the study infants having a significantly lower birthweight than the controls. Four study and three control infants died in the neonatal period. Cerebral palsy was not diagnosed in any infant of a hypertensive mother compared with five of the controls. The mean general quotient for the two groups was very similar and no difference in the incidence of minor neuromotor developmental problems was shown. CONCLUSIONS Maternal hypertension seems to protect against cerebral palsy in preterm infants without increasing the risk of cognitive impairment. This was independent of the use of maternally administered magnesium sulphate.

Perinatal hypoxic-ischaemic brain injury-prediction of outcome

Twenty‐sis term babies with hypoxic‐ischaemic brain injury were studied during the neonatal period to evaluate the prediction of outcome to at least one year of age by means of ultrasonography, CT scanning and Doppler ultrasound assessment of cerebral palsy blood flow velocity (CBFV). Adverse outcome was defined as the occurrence of cerebral palsy, developmental delay or death. At follow‐up, 17 infants had an adverse outcome (seven died, 10 had disability); the remainder had no detectable impairment. Abnormalities on cranial ultrasound were not, but generalised decreased tissue density on CT scan was, associated with adverse outcome. Abnormal mean CBFV in the middle cerebral artery had no association with outcome, but abnormal mean CBFV in the anterior cerebral artery and a low resistance index in both arteries were significantly associated with adverse outcome. Such information may be used for appropriate counselling of parents of asphyxiated infants.

Extremely low birth weight and control infants at 2 years corrected age: A comparison of intellectual abilities, motor performance, growth and health

A 2-year cohort of 63 surviving extremely low birth weight (ELBW) infants was prospectively studied and 60 of these infants, together with 44 normal birth weight control infants, were assessed at 2 years of age for intellectual abilities, motor skills, growth and health. The total ELBW group differed significantly from controls on overall Griffiths developmental quotient (99.3 vs. 103.8 P = 0.02) and in the personal/social subscale (100.7 vs. 106.7 P = 0.01). A subset of 43 of the ELBW infants was identified as low risk at discharge. No statistically significant differences were present between the low risk ELBW subset and controls in intellectual abilities though both the total ELBW group and the low risk ELBW subset differed from controls in fine and gross motor abilities, and in weight at 2 years. The total ELBW group also experienced more frequent ill health and hospital readmission.

Changing patterns of survival and outcome at 4 years of children who weighed 500–999 g at birth

To evaluate the impact of changing perinatal practices on survival rates and 4 year neurodevelopmental outcome for infants of birthweight 500–999 g.

The Neuro-sensory Motor Developmental Assessment Part 1: Development and Administration of the Test

The Neuro-sensory Motor Developmental Assessment (NSMDA) has been developed to meet the need for a progressive developmental assessment of infants and children. In this study a cohort of 148 preterm infants was assessed at 1, 4, 8, 12, and 24 months adjusted age. The results were used to classify the subjects as having normal, suspect or abnormal developmental status. The scores for each time were correlated with outcome scores at 24 months. Part One of this paper includes a description of the development and administration of the NSMDA. Longitudinal and cross correlations of scores were analysed and shown to be highly significant over the first two years of testing, thereby establishing the basis for validity and predictability of the NSMDA.

Neonatal cranial ultrasonography as predictor of 2 year outcome of very low birthweight infants

Abstract Real time ultrasound scans using an ATL 300C sector scanner with 5–7.5 MHz transducer were performed on days 1, 4, 7 and thereafter as clinically necessary on 153 consecutively discharged very low birthweight (VLBW) infants. One hundred and forty‐six long‐term survivors were assessed fully at 2 years. The prevalence of cerebroventricular haemorrhage (CVH) in these survivors was 34.2% (grade 1—21.2%; grade 2—4.8%; grade 3—3.4%; grade 4—4.8%), ventricular dilatation 19.9% (including 4.1% with ventriculoperitoneal shunt), and ischaemia 9%. Impairments at 2 years were classified as nil, mild, moderate, severe or multiply severe, based on the criteria of Kitchen et al.

Prevalence and aetiology of neurological impairment in extremely low birthweight infants

Objective: To determine the prevalence and perinatal predictors of cerebral palsy, intellectual impairment, visual impairment and deafness in a cohort of extremely low birthweight (ELBW) infants at two years of age.