Shifting of the body center of gravity in low-risk preterm infants: A video-pedoscope study.

AIM: To evaluate whether there is any developmental course of the shifting of the center of gravity (COG) in healthy preterm infants. METHODS: Eleven healthy preterm infants were assessed on a computerized pedoscope from early preterm to term age. Data from the pedoscope and the videorecorder were analyzed with a special software for the assessment of the COG shifting. Infants were placed on the pedoscope in supine position for 5 min. We scored the positions of the COG during its shifting, the body parts most frequently involved in its shifting and the shifting' amplitude at each epoch. We scored the frequency of the COG shifting in head, trunk and bottom, its direction and amplitude using a semi-quantitative scale. RESULTS: A developmental course of the COG shifting from preterm throughout post-term ages was demonstrated, with COG position displaced from head to bottom. The shifting amplitude decreased with increasing age. Lateral shifting were never observed. INTERPRETATION: The developmental course of the COG shifting suggests the maturation of postural behaviour in healthy preterm infants. The displacement of the COG from head to bottom and the reduced amplitude of the COG shifting from preterm to post-term age indicates a more stable body position.

Case report: Retracing atypical development: a preserved speech variant of Rett syndrome.

The subject of the present study is the development of a girl with the preserved speech variant of Rett disorder. Our data are based on detailed retrospective and prospective video analyses. Despite achieving developmental milestones, movement quality was already abnormal during the girl's first half year of life. In addition, early hand stereotypies, idiosyncratic vocalizations, asymmetric eye opening, and abnormal facial expressions are early signs proving that this variant of the Rett complex, too, manifests itself within the first months of life.

Quantitative aspects of the early motor repertoire in preterm infants: do they predict minor neurological dysfunction at school age?

BACKGROUND: Qualitative aspects of the motor repertoire, at 11-16 weeks post-term are predictive for minor neurological dysfunction (MND) at 7 to 11 years of age. Predictive value of quantitative aspects is unknown so far. AIM: To investigate whether quantitative aspects of the motor repertoire between 6 and 24 weeks post-term also have predictive value for neurological outcome at 7 to 11 years of age. STUDY DESIGN: Prospective cohort study. SUBJECTS: Preterm infants from whom several quantitative aspects of the motor repertoire were assessed between 6 and 24 weeks post-term. OUTCOME MEASURES: Neurological outcome at 7-11 years of age was assessed according to Touwens' neurological examination. Children were classified as neurologically normal, or as having complex MND or cerebral palsy (CP). RESULTS: Eighty-two children were included. At 7 to 11 years of age 15 children (18%) had developed CP, 49 (60%) were neurologically normal, and 18 (22%) had MND. Multiple logistic regression analysis showed that, when the qualitative aspects of the motor repertoire known to predict neurological outcome were taken into account, only the asymmetric tonic neck (ATN) posture provided additional predictive value. In case of normal fidgety movements (FMs) accompanied by an abnormal concurrent motor repertoire, the presence of an obligatory ATN increased the risk for developing complex MND to 75%; absence of an obligatory ATN reduced the risk to 15% (p<0.05). CONCLUSIONS: Quantitative aspects of the motor repertoire at 11-16 weeks post-term, in particular the presence of an obligatory ATN posture, contribute to the prediction of neurological outcome at 7 to 11 years of age.

From the reaching behavior at 5 months of age to hand preference at preschool age.

The aim of the study was to examine the reaching behavior at the age of 5 months, and to determine whether and to what extent there is a relationship between hand use at this age and manual laterality at preschool age. 20 participants (13 girls and 7 boys) were investigated on two occasions: At the age of 5 months we assessed the hand use for reaching for four different objects placed at the infant's body midline or in their right or left hemispaces, respectively. At the age of 5 years and 7 months, we assessed the hand use for 22 motor tasks. The handedness status was calculated in order to reflect the sinistrality-dextrality continuum. All but one infant were unimanual reachers at 5 months of age. Preferential reaching was space dependent rather than object dependent at this stage. Children reaching for objects in the right hemispace predominantly with their right hand showed a significantly greater right hand laterality at late preschool age than children who at the age of 5 months had shown inconsistent hand use (p < .05). Children who at the age of 5 months had reached for objects in the left hemispace with their left hand proved to be less lateralized in their right hand use approximately 5 years later (p < .05).

The quality of the early motor repertoire in preterm infants predicts minor neurologic dysfunction at school age.

OBJECTIVE: The quality of a child's motor repertoire at age 3 to 4 months postterm is predictive of later cerebral palsy (CP). Its predictive power for minor neurologic dysfunction (MND) is unclear. This study aimed to investigate the predictive value of the quality of the early motor repertoire for the development of MND at school age. STUDY DESIGN: We assessed the motor repertoire from video recordings made at 6 to 24 weeks postterm in 82 preterm infants (mean gestational age, 29.7 +/- 1.9 weeks; mean birth weight, 1183 +/- 302 g). At age 7 to 11 years, Touwen's neurologic examination was performed, and the children were classified as normal (n = 49; 60%), MND (n = 18; 22%), or CP (n = 15; 18%). RESULTS: Multiple logistic regression analysis showed that the quality of fidgety movements (FMs) and the quality of the concurrent motor repertoire had independent prognostic value for MND at school age. Abnormal FMs evolved into MND in 64% of the children. Nine of the 28 children with normal FMs and an abnormal concurrent motor repertoire developed abnormally (32%). Only 1 child of the 21 children with normal FMs and a normal concurrent motor repertoire developed MND (5%). CONCLUSIONS: Assessment of the quality of the early motor repertoire can accurately identify individual infants at high and low risk for MND at school age.

A longitudinal study on hand use while building a tower.

The aim of the study was to describe a developmental trend of hand use for picking up and stacking blocks from the age of 18 months to 7 years. A second aim was to determine whether there is a relationship between right-hand use while building a tower and manual laterality at school age. A total of 28 children were asked to build a tower at five longitudinal assessments. The use of the right hand fluctuated considerably with age (p<.05), but no age-related increase was observed. Right-hand use was rather prominent at 18 months, decreased significantly at 26 months, increased at age 4;7, decreased again at 5;7, and finally increased again at age 7. From age 4;7 onwards, the percentage of right-hand use for stacking the blocks was significantly (p<.05) related to the laterality quotient at school age.

Events at early development: are they associated with early word production and neurodevelopmental abilities at the preschool age?

BACKGROUND: Obstetrical and neonatal complications and/or an adverse parenting environment are risk factors for language impairment, but little is known about their effects on early word production (late talking). AIMS: To determine obstetrical and neonatal risk factors in children with delayed word production; to assess the influence of the parenting environment on word production; to determine whether the toddler's vocabulary competence is related to his/her social competence; to document the neurodevelopmental outcome at the late preschool age. STUDY DESIGN: Prospective follow-up study. Based on word production at 18 months, children were retrospectively classified into consistent or transient late talkers and controls. SUBJECTS: Full-term infants, N=30 (mean GA 40.3+/-1.1 weeks, mean birth weight 3577+/-267 g) were assessed at 18 and 24 months; and 5 years and 7 months. METHODS: Austrian Communicative Development Inventories; Bayley Scales of Infant Development; Griffiths Developmental Scales. OUTCOME MEASURES: Peabody Picture Vocabulary Test; Kaufman Assessment Battery for Children; Touwen's neurological examination. RESULTS AND CONCLUSIONS: Lower Apgar scores and the need for neonatal intensive care were associated with delayed word production. The parents' educational and vocational levels were lower in late talkers. Early vocabulary competence correlated with social competence. With regard to the prediction of lexical and cognitive outcomes, late talkers did not differ from controls. Minor neurological dysfunctions (MND) were seen in nearly half of the late talkers and indicate the necessity to follow these children into school age, when MND might become more obvious and literacy can be assessed.

Are abnormal fidgety movements an early marker for complex minor neurological dysfunction at puberty?

BACKGROUND: Prechtl's method on the qualitative assessment of general movements (GMs) is a powerful tool for early and specific prediction of cerebral palsy. However, it is uncertain whether the GM assessment can be used to predict mild neurological impairment. AIMS: To determine whether the quality of general movements (GMs) from the age of 3 to 5 months, i.e. fidgety movements, is related to the presence of complex minor neurological dysfunctions (MND) 13 to 15 years later. STUDY DESIGN: Prospectively collected data on the quality of GMs during infancy were retrospectively analysed on the basis of MND at puberty. SUBJECTS: Twenty-eight participants (14 girls and 14 boys) with a median gestational age of 40 weeks (range: 35 to 42 weeks) and an appropriate birth weight (median 3390 g; range 1900 to 4200 g). OUTCOME MEASURES: Touwen's neurological examination. RESULTS AND CONCLUSIONS: Abnormal fidgety movements were not related to later complex MND, but to fine manipulative disabilities (p<0.05). Normal fidgety movements, which are continually present in the whole body, might be required for optimal calibration of the proprioceptive system.

Does a detailed assessment of poor repertoire general movements help to identify those infants who will develop normally?

BACKGROUND: The assessment of the quality of general movements (GMs) in young infants is a reliable and valid diagnostic tool for detecting brain dysfunction early in life. Poor repertoire GMs are the most frequently observed abnormal GMs during the preterm, term and early postterm period. However, their predictive value for the neurological outcome is low. AIM: To find out whether a detailed scoring of poor repertoire GMs might lead to a better prediction of the neurological outcome. SUBJECTS: We studied 18 preterm infants who were repeatedly videoed from birth to 22 weeks postterm age, including several recordings assessed as poor repertoire GMs. At 8 to 10 years, six children were neurologically normal, six had mild neurological abnormalities, and the remaining six were classified as cerebral palsy. STUDY DESIGN: Each GM globally assessed as poor repertoire was scored in details according to several aspects of neck and trunk, arm and leg movements applying Prechtl's optimality concept. RESULTS: By and large, the detailed score of poor repertoire GMs was not related to the neurological outcome. CONCLUSION: For the clinical application of the GM assessment, it remains important to assess the fidgety movements of those infants with poor repertoire GM trajectories in order to predict their outcome.

Abnormal general movements in girls with Rett disorder: the first four months of life.

An apparently normal early development was one of the initial criteria for classical Rett syndrome. However, several investigators considered Rett syndrome to be a developmental disorder manifesting very soon after birth. Videos of 14 infants with Rett disorder were carefully assessed for their spontaneous movements, in particular general movements (GMs), during the first 4 months of life. A detailed analysis clearly demonstrated that none of the infants had normal GMs. However, a specific abnormal GM pattern could not be detected for Rett disorder. The abnormal GMs described here, and their individual developmental trajectories are different from the abnormal GMs described in infants with acquired brain lesion. Our study is the first to apply specific standardised measures of early spontaneous movements to infants with Rett syndrome, proving conclusively that the disorder is manifest within the first weeks of life.

Prechtl's assessment of general movements: a diagnostic tool for the functional assessment of the young nervous system.

General movements (GMs) are part of the spontaneous movement repertoire and are present from early fetal life onwards until the end of the first half a year of life. GMs are complex, occur frequently, and last long enough to be observed properly. They involve the whole body in a variable sequence of arm, leg, neck, and trunk movements. They wax and wane in intensity, force and speed, and they have a gradual beginning and end. Rotations along the axis of the limbs and slight changes in the direction of movements make them fluent and elegant and create the impression of complexity and variability. If the nervous system is impaired, GMs loose their complex and variable character and become monotonous and poor. Two specific abnormal GM patterns reliably predict later cerebral palsy: 1) a persistent pattern of cramped-synchronized GMs. The movements appear rigid and lack the normal smooth and fluent character. Limb and trunk muscles contract and relax almost simultaneously. 2) The absence of GMs of fidgety character. So-called fidgety movements are small movements of moderate speed with variable acceleration of neck, trunk, and limbs in all directions. Normally, they are the predominant movement pattern in an awake infant at 3 to 5 months. Beside a sensitivity and specificity of 95% each, the assessment of GMs is quick, noninvasive, even nonintrusive, and cost-effective compared with other techniques, e.g., magnetic resonance imaging, brain ultrasound, and traditional neurological examination.

Is the early development of girls with Rett disorder really normal?

An apparently normal early development was one of the initial criteria for classical Rett syndrome. However, several investigators considered Rett syndrome to be a developmental disorder manifesting very soon after birth. Videos of 22 Rett cases were assessed carefully for movements, posture, and behavior during the first 6 mo of life. All signs that deviated from the normal standard were recorded meticulously. Special attention was paid to the face, the hands, and body movements. A detailed analysis clearly demonstrated an abnormal quality of general movements (100%), tongue protrusion (62%), postural stiffness (58%), asymmetric eye opening and closing (56%), abnormal finger movements (52%), hand stereotypies (42%), bursts of abnormal facial expressions (42%), bizarre smile (32%), tremor (28%), and stereotyped body movements (15%). Our study is the first to apply specific standardized measures of early spontaneous movements to Rett infants, proving conclusively that the disorder is manifested within the first months of life. Although not necessarily specific, the signs that we have observed will be of value in alerting clinicians to the possibility of the diagnosis at an early stage, when intervention is likely to be most effective.

Cramped synchronized general movements in preterm infants as an early marker for cerebral palsy.

OBJECTIVE: To ascertain whether specific abnormalities (ie, cramped synchronized general movements [GMs]) can predict cerebral palsy and the severity of later motor impairment in preterm infants affected by brain lesions. DESIGN: Traditional neurological examination was performed, and GMs were serially videotaped and blindly observed for 84 preterm infants with ultrasound abnormalities from birth until 56 to 60 weeks' postmenstrual age. The developmental course of GM abnormalities was compared with brain ultrasound findings alone and with findings from neurological examination, in relation to the patient's outcome at age 2 to 3 years. RESULTS: Infants with consistent or predominant (33 cases) cramped synchronized GMs developed cerebral palsy. The earlier cramped synchronized GMs were observed, the worse was the neurological outcome. Transient cramped synchronized character GMs (8 cases) were followed by mild cerebral palsy (fidgety movements were absent) or normal development (fidgety movements were present). Consistently normal GMs (13 cases) and poor repertoire GMs (30 cases) either lead to normal outcomes (84%) or cerebral palsy with mild motor impairment (16%). Observation of GMs was 100% sensitive, and the specificity of the cramped synchronized GMs was 92.5% to 100% throughout the age range, which is much higher than the specificity of neurological examination. CONCLUSIONS: Consistent and predominant cramped synchronized GMs specifically predict cerebral palsy. The earlier this characteristic appears, the worse is the later impairment.