Effectiveness of a smartphone-based virtual reality intervention on balance and functional mobility in children with acute lymphoblastic leukemia: A pre-post experimental study.

BACKGROUND: The odds of survival of children with acute lymphoblastic leukemia (ALL) has increased markedly owing to a better understanding of pathogenesis, adoption of risk stratification therapy, and availability of newer therapeutic agents. These drugs, however, may affect balance and functional mobility, leading to activity restrictions. Virtual reality (VR) is a promising rehabilitation program for motor difficulties. The study, therefore, aimed to determine the effect of a smartphone-based VR intervention on balance and functional mobility in children with ALL. METHODS: The pre-post experimental study included 32 children with ALL between 4 and 18 years of age. They received smartphone-based VR intervention every day for a period of 2 weeks, with each session lasting for 30 minutes. Each session included five VR games that were played by the child for 5 minutes each, with 1 minute rest between the games. Pre- and post-intervention, balance and functional mobility were evaluated using the balance subset of Bruininks Oseretsky Test of Motor Proficiency, second edition (BOT-2) and the Timed Up and Go (TUG) test, respectively. RESULTS: Children with ALL demonstrated a significant improvement in balance post-intervention, with a mean difference of 2.22 ± 1.75 (P < 0.0001). Functional mobility improved with a mean difference of 1.12 ± 1.09 (P < 0.0001). There was an improvement of 8.04% and 11.04% in balance and functional mobility, respectively. CONCLUSION: The study concluded that a 2-week smartphone-based VR intervention is effective in improving balance and functional mobility in children with ALL.

Impact of a Brief Healthcare-based Intervention to Support Early Childhood Development in India: A Pilot Randomized Controlled Trial.

OBJECTIVES: To study the impact of a brief early childhood develop-ment (ECD) intervention, Sit Down and Play (SDP), integrated within routine healthcare visits on parent and child outcomes. METHODS: Between April, 2018 and March, 2019, caregivers and their infants aged 5-6 months attending a well-baby clinic were enrolled and randomized to intervention (n=26) or control (n=26) groups. Intervention families received SDP at recruitment and two subsequent immunization visits (8 months and 10 months). Control families received usual care. ECD outcomes were assessed through in-person assessments at the age of 12 months using the Stim Q subscales to assess parenting behaviors, and the Developmental Assessment Scale for Indian Infants (DASII) for neurodevelopment. RESULTS: There was a significant improvement in parent-child stimulation activities and verbal interactions in the intervention group compared with the control group [6.1(1.4) vs 4.9 (1.3); P=0.002]. Infants in the intervention group had significantly higher DASII scores in multivariable analyses [108.0 (103.0-111.3) vs 102.0 (96.8-108.0); P=0.04]. CONCLUSION: Our findings suggest a brief healthcare intervention supports opportunities for early learning among caregivers and neurodevelopmental outcomes in their infants.

Warning Signs on Short Hammersmith Neonatal Neurological Examination and Correlation With Hammersmith Infant Neurological Examination Global Score in Preterm Infants: A Prospective Cohort Study.

OBJECTIVE: To describe the findings of short Hammersmith Neonatal Neurologic examination (HNNE) in preterm small for gestational age (SGA) and appropriate for gestational age (AGA) infants at term equivalent age (TEA) and to correlate it with the global score of Hammersmith Infant Neurologic Examination (HINE) performed at 4-6 months of corrected age. METHODS: This prospective cohort study was conducted at the high risk follow-up clinic of our center. 52 preterm infants born <35 weeks gestation were examined using HNNE at TEA and followed- up till 4-6 months of corrected age to estimate HINE. RESULTS: 20 infants (38.5%) had warning signs and 9 (17.3%) had abnormal signs on short HNNE. 12 (37.5%) AGA infants and 6 (30%) SGA infants had global score <65 at mean corrected age (SD) of 4.3 (0.7) weeks and 4.5 (0.8) weeks, respectively. Very preterm, birth weight <1000 g and SGA was significantly associated with global scores <65. CONCLUSION: Early identification of warning signs among SGA infants using Short HNNE screening at TEA can be useful to initiate early intervention. There was no statistically significant difference in global scores by HINE among AGA and SGA infants in early infancy.

Construction and validation of the Oxford Neurodevelopment Assessment (OX-NDA) in 1-year-old Brazilian children.

BACKGROUND: Over 250 million children under 5 years, globally, are at risk of developmental delay. Interventions during the first 2 years of life have enduring positive effects if children at risk are identified, using standardized assessments, within this window. However, identifying developmental delay during infancy is challenging and there are limited infant development assessments suitable for use in low- and middle-income (LMIC) settings. Here, we describe a new tool, the Oxford Neurodevelopment Assessment (OX-NDA), measuring cognition, language, motor, and behaviour, outcomes in 1-year-old children. We present the results of its evaluation against the Bayley Scales of Infant Development IIIrd edition (BSID-III) and its psychometric properties. METHODS: Sixteen international tools measuring infant development were analysed to inform the OX-NDA's construction. Its agreement with the BSID-III, for cognitive, motor and language domains, was evaluated using intra-class correlations (ICCs, for absolute agreement), Bland-Altman analyses (for bias and limits of agreement), and sensitivity and specificity analyses (for accuracy) in 104 Brazilian children, aged 12 months (SD 8.4 days), recruited from the 2015 Pelotas Birth Cohort Study. Behaviour was not evaluated, as the BSID-III's adaptive behaviour scale was not included in the cohort's protocol. Cohen's kappas and Cronbach's alphas were calculated to determine the OX-NDA's reliability and internal consistency respectively. RESULTS: Agreement was moderate for cognition and motor outcomes (ICCs 0.63 and 0.68, p < 0.001) and low for language outcomes (ICC 0.30, p < 0.04). Bland-Altman analysis showed little to no bias between measures across domains. The OX-NDA's sensitivity and specificity for predicting moderate-to-severe delay on the BSID-III was 76, 73 and 43% and 75, 80 and 33% for cognition, motor and language outcomes, respectively. Inter-rater (k = 0.80-0.96) and test-rest (k = 0.85-0.94) reliability was high for all domains. Administration time was < 20 minutes. CONCLUSION: The OX-NDA shows moderate agreement with the BSID-III for identifying infants at risk of cognitive and motor delay; agreement was low for language delay. It is a rapid, low-cost assessment constructed specifically for use in LMIC populations. Further work is needed to evaluate its use (i) across domains in populations beyond Brazil and (ii) to identify language delays in Brazilian children.

Association of orofacial dysfunction and sleep disordered breathing among Indian primary school children.

Introduction: Sleep-disordered breathing (SDB) ranges from partial obstruction of the upper airway resulting in snoring to total upper airway obstruction leading to obstructive sleep apnea. The impairment in the dynamics of the stomatognathic system is termed as orofacial dysfunction. This study investigates the prevalence of orofacial dysfunction and sleep-disordered breathing in primary school children and identifies their correlation. Methods: A total of 560 forms were distributed to 8 primary schools in Belagavi city. Among them, 482 parents responded (86% response rate), which included 239 boys (49.58%) and 243 girls (50.41%). All the participants were screened for orofacial dysfunction using Nordic Orofacial Dysfunction Test-screening (NOT-S) and sleep-disordered breathing using the Pediatric Sleep Questionnaire (PSQ). Result: A positive direct correlation of sleep-disordered breathing with orofacial dysfunction (r = 0.47; p ≤ 0.001) was noted. A total of 41(8.58%) children were found to be at risk of sleep-disordered breathing with a score less than or equal to eight, based on (PSQ) Pediatric Sleep Questionnaire, and 156 (32.6%) children showed symptoms of orofacial dysfunction based on Nordic Orofacial Test-Screening (NOT-S). Conclusion: The study demonstrates that around 32.6% of children had orofacial dysfunction symptoms, and 8.58% of children were at risk for sleep-disordered breathing, girls having a greater risk as compared to boys. There was a positive correlation between orofacial dysfunction and sleep-disordered breathing among children aged 6-12 years.

Implementing an early childhood development intervention with routine immunization visits in India: a feasibility trial.

Integrating an early childhood development (ECD) intervention within routine healthcare visits offers an important opportunity for a population-level approach to support ECD in low- and middle-income countries (LMICs) where 250 million children under the age of 5 years fail to reach their full developmental potential. This paper reports on the feasibility of integrating an adapted healthcare-based ECD intervention (Sit Down and Play) in primary health centers (PHCs) serving low-income rural communities in Karnataka, India, and its potential to support research-informed components needed to improve ECD (e.g., opportunities for learning). Using a prospective cluster nonrandomized pilot and feasibility trial, caregivers with infants 6-10 weeks of age were recruited from 2 PHCs: one which delivered the intervention at two subsequent immunization visits (n = 25) and the other as care as usual (n = 28). Feasibility was assessed using the following indicators: implementation, practicality, acceptability, demand, and limited efficacy. Quality of home stimulation and opportunities for learning were explored with key items from the UNICEF Multiple Cluster Index Surveys with generalized estimating equation models. While outcome measures were to be obtained from all participants 3-month post-enrollment, due to COVID19 restrictions, there was variability in timing of follow-up interviews; however, outcome data from all participants were obtained and no significant group differences existed in contact time. Results suggest the feasibility of delivery of SDP during routine immunization visits, high satisfaction with adapted content, and utility of developed training and fidelity measures. Though not powered for hypothesis testing, our exploratory analyses reveal the intervention group demonstrated greater improvements on quality of home stimulation over time than the control group. CONCLUSION: Our findings suggest integrating an ECD intervention with routine healthcare visits is a feasible and promising strategy for supporting ECD in India. Further studies are needed to determine the effectiveness of SDP on children's development. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04167254. WHAT IS KNOWN: • Interventions are increasingly being developed to target responsive caregiving and opportunities for learning because of their potential to support early childhood development (ECD) in low- and middle-income countries where 250 million children under the age of 5 years fail to reach their full developmental potential. • A critical issue in ECD intervention research is the gap between what is known to be effective treatment to protect healthy brain development and what is provided to millions of caregivers during routine care who live in low-income communities. WHAT IS NEW: • We adapted a brief, ECD intervention for use with routine healthcare visits in India as a population-level strategy to support ECD in LMICs. • Our results demonstrate feasibility, acceptability, and improvements in key parenting behaviors that promote ECD.

Effect of Maternal Docosahexaenoic Acid (DHA) Supplementation on Offspring Neurodevelopment at 12 Months in India: A Randomized Controlled Trial.

Intake of dietary docosahexaenoic acid (DHA 22:6n-3) is very low among Indian pregnant women. Maternal supplementation during pregnancy and lactation may benefit offspring neurodevelopment. We conducted a double-blind, randomized, placebo-controlled trial to test the effectiveness of supplementing pregnant Indian women (singleton gestation) from ≤20 weeks through 6 months postpartum with 400 mg/d algal DHA compared to placebo on neurodevelopment of their offspring at 12 months. Of 3379 women screened, 1131 were found eligible; 957 were randomized. The primary outcome was infant neurodevelopment at 12 months, assessed using the Development Assessment Scale for Indian Infants (DASII). Both groups were well balanced on sociodemographic variables at baseline. More than 72% of women took >90% of their assigned treatment. Twenty-five serious adverse events (SAEs), none related to the intervention, (DHA group = 16; placebo = 9) were noted. Of 902 live births, 878 were followed up to 12 months; the DASII was administered to 863 infants. At 12 months, the mean development quotient (DQ) scores in the DHA and placebo groups were not statistically significant (96.6 ± 12.2 vs. 97.1 ± 13.0, p = 0.60). Supplementing mothers through pregnancy and lactation with 400 mg/d DHA did not impact offspring neurodevelopment at 12 months of age in this setting.

Integrating an Adapted, Low-Intensity Program to Promote Early Childhood Development in Routine Health Visits in Rural India: A Feasibility Study.

OBJECTIVE: More than 200 million children younger than the age of 5 years fail to reach their full developmental potential in low- and middle-income countries (LMICs). The purpose of this study was to describe the feasibility of integrating a brief program to promote early childhood development within a health care setting serving a predominantly rural population in India. METHODS: We conducted a prospective, noncomparative, mixed-methods study. An adapted parent-directed program was administered to caregivers of 2- to 6-month-old children while waiting for their health care provider. Caregivers completed baseline and 4-week follow-up surveys. Thematic analyses and generalized equation estimates were used for analyses in the following feasibility indicators: acceptability, demand, implementation and practicality, and limited efficacy testing. RESULTS: Forty-seven caregivers were recruited; most were women (98%) and had equal to or less than 12 years of schooling (61%). Forty-six of 47 participants completed the follow-up at 1 month. Three administrators were trained to deliver the program over the course of 2 days. Caregivers perceived a need for the program and found the content and structure of the program useful. However, there were important suggestions for improvement, including greater visual content and dissemination to nonparental caregivers and fathers. Significant increases were seen on self-reported parenting behaviors regarding a child's caregiving environment. CONCLUSION: Our findings support the feasibility of integrating an adapted, low-intensity program in a primary care setting in India, but important adaptations and considerations will need to be addressed before effectiveness testing on a wider scale. We discussed implications for offering sustainable population-level interventions to promote early childhood development in LMICs.

Effect of Risperidone on the Motor and Functional Disability in Children With Choreoathetoid Cerebral Palsy.

BACKGROUND: Therapeutic options for management of choreoathetoid cerebral palsy, which is a permanent disorder, are limited. Available medications either have significant side effects or are unsuitable for long-term use. Risperidone has shown promise in the management of chorea and has been found to be safe in children less than five years. METHODS: Children with choreoathetoid cerebral palsy were enrolled after parental consent and given risperidone for six-month period along with standard care. The choreoathetoid movements were assessed using Abnormal Involuntary Movement Scale, the upper-limb functions were assessed using Quality of upper extremity skill tests, and the quality of life using Cerebral palsy-Quality of life. Side effects were monitored clinically, by biochemical tests and electrocardiogram. RESULTS: Of 42 children with choreoathetoid cerebral palsy who were screened over a period of one year, 35 subjects meeting the study criteria were enrolled. Thirty children completed six months of risperidone therapy, the remaining five subjects were excluded because of time missed due to intercurrent unrelated illnesses. Data of these 30 children were analyzed as per per-protocol analysis. Their mean age was 6.35 ± 3.17 years. Abnormal movements showed statistically significant decline after risperidone (19.7 vs 14.7, P < 0.0001). Functional ability of upper limbs and quality of life also showed improvement (37.0 vs 43.8, P < 0.0001 and 64.3 vs 70.0, P < 0.0001, respectively) after six months of risperidone therapy. Positive change in the behavior was also noted. It was well tolerated without significant side effects. CONCLUSION: Risperidone is a promising drug to manage children with choreoathetoid cerebral palsy and is well tolerated in children.

Comparison of non verbal learning difficulties in preschoolers born preterm with the term born peers.

OBJECTIVES: To identify the incidence and pattern of specific areas of non verbal learning deficits (NVLD) associated with preterm and term born peers and also to evaluate influence of gestational age on cognition, motor, language and behavior in preterm and term infants. METHODS: Children were screened for prematurity by giving parents a comprehensive questionnaire covering the family details, birth history, medical history and school performance. After finding their suitability, the children were picked randomly using the lottery method. Hundred children born moderately preterm were allocated in Group B and 100 term born children were recruited in Group A. Participants of both the groups were evaluated using the First STEP- screening test to evaluate preschoolers. RESULTS: This study revealed that there was significant difference between both the preterm and the control group in all the domains of First STEP and there was 10 % incidence of NVLD in preterm born preschoolers. CONCLUSIONS: Thus, the gestational age influences the cognitive, motor, behavior and academic performance in the preschoolers, thereby increasing the incidence of NVLD in preterm than the term born peers.

Movement assessment of infants as a predictor of one year neuromotor outcome in very low birth weight infants.

OBJECTIVE: To predict neuromotor outcome in Very Low Birth Weight infants at 1 year using Movement Assessment of Infants scale at 4 and 8 months of corrected age. METHODS: This hospital based prospective observational study consecutively recruited 45 infants with birth weight ≤ 1,500 g and admitted to neonatal intensive care unit. The infants were evaluated at 4 and 8 months of corrected age using Movement Assessment of Infants scale and then a follow up evaluation was done at 1 year of corrected age with a neuropschycological tool, Bayley Scale of Infant Development-II and psychomotor development index was calculated to identify the neuromotor outcome. RESULTS: For predicting neuromotor outcome on the Bayleys motor scale at 1 year, the sensitivity of Movement Assessment of Infants for 4-month was 70%, specificity 83.3%, positive predictive value 58.3% and negative predictive value was 89.3% for risk points ≥ 10. The sensitivity of Movement Assessment of Infants for 8-month was 80%, specificity 93.3%, positive predictive value 80% and negative predictive value was 93.3% for risk points ≥ 10 .The correlations of the Movement Assessment of Infants total risk scores and categorical risk scores for muscle tone, primitive reflex, automatic reactions and volitional movement at 4 and 8 months with Bayley motor scale at 1 year were highly significant (p < 0.0000). CONCLUSIONS: Movement Assessment of Infants is an effective clinical tool to identify neuromotor abnormalities, as the best predictive values for neuromotor outcome at 1 year in Very Low Birth Weight infants were obtained at 8-months and the 4-month Movement Assessment of Infants had high specificity and acceptable sensitivity.

Effectiveness of transcutaneous electrical nerve stimulation and microcurrent electrical nerve stimulation in bruxism associated with masticatory muscle pain--a comparative study.

OBJECTIVES: To compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) and microcurrent electrical nerve stimulation (MENS) on masticatory muscles pain bruxism patient. MATERIALS AND METHODS: A total of 60 subjects with the clinical diagnosis of bruxism were randomly allocated to two study groups. Group A received TENS (50 Hz, pulse width 0.5 mSec, intensity 0-60 mA for 20 minutes for a period of seven days) and Group B received MENS (0.5 Hz, intensity 1,000 muA for 20 minutes for a period of seven days). The outcome measures were assessed in term of Visual Analog Scale (VAS) and digital pressometer of 2 Kgf. RESULTS: The study showed significant change in intensity of pain as per VAS score ( P