Early intervention and its short-term effect on the temporal organization of fidgety movements.

BACKGROUND: The Prechtl General Movement Assessment (GMA) predicts various neurological and developmental disorders while also documenting therapeutic effects. AIMS: To describe the temporal organization of fidgety general movements in infants with mild to moderate postural asymmetries and/or tonus regulation problems, and to analyze to what extent the temporal organization of fidgety movements will change after physiotherapy. STUDY DESIGN: Repeated measure design. PARTICIPANTS: Twelve infants (five females) with mild to moderate postural asymmetries and/or tonus regulation problems were admitted for an early intervention program. The gestational age ranged from 27 to 40 weeks (Median, 36 weeks; nine infants born preterm) with birth weights ranging from 740 g to 3500 g (Median, 2590 g). MEASURES: Fidgety movements and their temporal organization were measured using the Prechtl GMA at 9 to 19 weeks post term age (Median, 14 weeks) before and after an early motor training procedure. The movements of one of the infants were analysed using a computer-based approach, measuring the mean and standard deviation of quantity of motion, height of motion and width of motion. RESULTS: Seven infants had sporadic fidgety movements, and five had intermittent fidgety movements. None had continual fidgety movements before the intervention was initiated. After intervention, the temporal organization of fidgety movements increased in all infants. The observations of these movements were supported by computer-based analysis. CONCLUSION: The study indicates that early intervention increases the temporal organization of fidgety movements in infants with postural asymmetries and/or tonus regulation problems. The clinical significance of this finding needs to be further evaluated.

Arthrogryposis multiplex congenital - multidisciplinary care - including own experience.

Arthrogryposis multiplex congenital (AMC) is a heterogeneous disorder, characterized by nonprogressive multiple intra-articular contractures, which can be recognized at birth. The prevalence in Europe is estimated at about 1 per 12,000. Etiopathogenesis of arthrogryposis is multifactorial. Symptoms of some forms of arthrogryposis can be found in the clinical presentation of selected genetic disorders, e.g. Pena Shokeir syndrome. Arthrogryposis can also result from environmental factors such as medication, trauma or chronic illness during pregnancy, as well as from oligohydramnios or abnormal structure of the uterus. In this particular disorder prenatal diagnosis is crucial, because it determines the level of hospital reference during the delivery of the affected child. The highest reference degree hospital is preferential, with staff prepared for the multidisciplinary approach to the treatment of the newborn. The key to success is rehabilitation treatment and it should be initiated as soon as possible. In a substantial number of cases, physical therapy can replace invasive corrective surgery, but even when orthopedic treatment is required, it should always be preceded and followed by rehabilitation.

Early diagnosis and treatment of children with skull deformations. The challenge of modern medicine.

Skull deformations affect approximately 45% of newborn babies, the most common ones being: plagiocephaly, brachycephaly and scaphocephaly. The first symptoms can be observed 4 to 8 weeks after birth. The causes of skull deformation in newborns can be divided into congenital ones and those acquired after birth. An increase in the incidence of acquired head deformations can be attributed to the "BACK TO SLEEP" campaign, carried out in 1992 by the American Academy of Pediatrics (AAP), which was aimed to reduce the frequency of sudden infant death syndrome (SIDS) by placing babies to sleep in the supine position. By the year 2000, the number of SIDS incidents had been significantly lowered, however, it seems that this improvement was achieved at the cost of an increased number of head deformations [3, 4, 5, 34]. Skull deformations, if left untreated, may have consequences for the future. Plagiocephalic deformations may be associated with delayed intellectual and motor development [2]. Early recognition of the condition and the appropriate classification of each skull deformation are crucial for the success of the treatment [8]. Treatment choice depends on the etiology of the problem and its severity, as well as on the age of the infant. Available options include training for the parents/caregivers, physical therapy, custom head orthosis and surgical intervention.