Longitudinal study of sleep behavior and motor development in low-birth-weight preterm children from infancy to preschool years

Abstract Objective: To verify the relationship between sleep characteristics and motor development in low-birth-weight preterm infants during infancy and preschool years. Method: Forty-one healthy preterm infants (<37 weeks' gestation) with low birth weight (≤1500 g) were assessed longitudinally at three different time points: at 6 months of corrected age, at 12 months of corrected age, and at 4-5 years of chronological age. At 6 and 12 months, motor development was assessed using the Denver Developmental Screening Test II and Alberta Infant Motor Scale, while sleep-related habits and disturbances were assessed using the Brief Infant Sleep Questionnaire. At 4-5 years, motor development was reassessed using the Pediatric Evaluation of Disability Inventory and sleep was reassessed using the Sleep Disturbance Scale for Children. Correlations were performed using sleep quality as the predictor variable and motor development as the outcome variable. Results: Most infants had suspected delay/atypical development at 6 and 12 months, with no difference between the scales (p = 1.000). Suspected delay/atypical development were associated with lateral sleep position (p = 0.004), greater number of nighttime awakenings (p = 0.008), and longer awake periods (p = 0.014) only at 6 months. At 4-5 years, the suspected delay/atypical development observed at 6 and 12 months disappeared. Conclusions: Sleep quality correlated with delayed/atypical motor development in healthy preterm infants with low birth weight only at 6 months of corrected age, which did not appear to affect later development of motor skills.

Longitudinal study of sleep behavior and motor development in low-birth-weight preterm children from infancy to preschool years.

OBJECTIVE: To verify the relationship between sleep characteristics and motor development in low-birth-weight preterm infants during infancy and preschool years. METHOD: Forty-one healthy preterm infants (<37 weeks' gestation) with low birth weight (≤1500 g) were assessed longitudinally at three different time points: at 6 months of corrected age, at 12 months of corrected age, and at 4-5 years of chronological age. At 6 and 12 months, motor development was assessed using the Denver Developmental Screening Test II and Alberta Infant Motor Scale, while sleep-related habits and disturbances were assessed using the Brief Infant Sleep Questionnaire. At 4-5 years, motor development was reassessed using the Pediatric Evaluation of Disability Inventory and sleep was reassessed using the Sleep Disturbance Scale for Children. Correlations were performed using sleep quality as the predictor variable and motor development as the outcome variable. RESULTS: Most infants had suspected delay/atypical development at 6 and 12 months, with no difference between the scales (p = 1.000). Suspected delay/atypical development were associated with lateral sleep position (p = 0.004), greater number of nighttime awakenings (p = 0.008), and longer awake periods (p = 0.014) only at 6 months. At 4-5 years, the suspected delay/atypical development observed at 6 and 12 months disappeared. CONCLUSIONS: Sleep quality correlated with delayed/atypical motor development in healthy preterm infants with low birth weight only at 6 months of corrected age, which did not appear to affect later development of motor skills.

Avaliação da capacidade funcional de crianças com paralisia cerebral / Evaluation of the functional capacity of children with cerebral palsy

Objetivo descrever a capacidade funcional de crianças com paralisia cerebral que realizavam atendimentos de Fisioterapia e Fisioterapia e Fonoaudiologia. Métodos estudo descritivo, de caráter transversal, composto por 14 crianças com PC do tipo quadriplegia espástica (6 realizavam Fisioterapia e 8 Fisioterapia e Fonoaudiologia). Foram utilizados para avaliação o Inventário de Avaliação Pediátrica de Incapacidade (PEDI) e o Sistema de Classificação da Função Motora Grossa (GMFCS). As associações entre as variáveis categóricas foram analisadas por meio do teste exato de Fisher. Comparações entre médias foram realizadas utilizando-se o teste t de Student. Resultados não se obteve melhora estatisticamente significante nas áreas de autocuidado, mobilidade e função social entre os dois grupos nos domínios de habilidade funcional e assistência ao cuidador. Conclusão as crianças do grupo Fisioterapia tiveram escores funcionais mais elevados que as do grupo Fisioterapia associado à Fonoaudiologia, mas não houve diferença estatisticamente significante entre os grupos. Isso se deu, provavelmente, devido ao reduzido número de participantes, à diversidade de quadros clínicos que a patologia pode apresentar e a possíveis diferenças na intervenção fisioterapêutica realizada nos dois estados, que possuem situações socioeconômicas bem diversas. .

Purpose to describe the functional capacity of children with cerebral palsy who performed the care of Physical Therapy Specialty and Speech, Language and Hearing Sciences. Methods a cross sectional observational study, comprising 14 children with spastic quadriplegic (6 performed Physiotherapy and 8 performed Physiotherapy and Speech therapy). The Pediatric Evaluation of Disability Inventory (PEDI) and the Manual Abilities Classification System (GMFCS) were used to evaluate them. The associations between categorical variables were analyzed using Fisher exact test. Comparisons between means were performed using the Student t test. Results we didn’t obtain statistically significant improvement in the areas of self-care, mobility and social function between the two groups in the fields of functional skills and caregiver assistance. Conclusion the Physiotherapy group of children had higher functional scores than those in the Physiotherapy group associated with Speech Therapy, but there was no statistically significant difference between the groups. This was probably due to the small number of participants, the diversity of clinical presentation and possible differences of Physical Therapy intervention conducted in two states with very different socioeconomic situations. .

Atividade eletromiográfica dos extensores de tronco durante manuseio pelo Método Neuroevolutivo Bobath / Electromyographic activity of trunk muscles during therapy using the Concept Bobath

INTRODUÇÃO: Paralisia cerebral é um distúrbio caracterizado por alterações no desenvolvimento da atividade, do movimento e da postura. O Conceito Neuroevolutivo Bobath é um método utilizado na reabilitação neuropediátrica, fundamentando-se na facilitação da aquisição de habilidades sensório-motoras de acordo com a sequência de desenvolvimento neuropsicomotor normal. OBJETIVO: Verificar atividade eletromiográfica de músculos envolvidos no controle cervical nos planos frontal, sagital e transverso, mediante manuseio em pontos-chave de controle, objetivando transferência de peso e estabilização corporal. MATERIAIS E MÉTODOS: Trata-se de uma avaliação quantitativa em um estudo de caso, no qual uma paciente de sete anos de idade, com diagnóstico clínico de paralisia cerebral e síndrome de West, foi submetida à análise eletromiográfica da musculatura envolvida no controle cervical, mediante manuseio em pontos-chave de controle. O registo ocorreu durante o manuseio utilizando postura de decúbito ventral sobre cunha e postura de decúbito lateral sobre o solo. RESULTADOS: O sinal eletromiográfico dos extensores e flexores na região cervical intensificou-se mediante manuseio para transferência de peso em ponto-chave de quadril em ambas as posturas. Embora o sinal de base tenha sido ampliado durante a transferência de peso para o quadril, o registro eletromiográfico nos segmentos musculares avaliados foi superior no decúbito lateral. CONCLUSÕES: Verificou-se que a transferência de peso para o quadril induziu facilitação do controle cervical e que o decúbito lateral de forma repetida e sustentada, mediante correto manuseio, alinhamento e transferência de peso, facilitou de forma mais pronunciada a atividade muscular na região cervical e de tronco superior do que o manuseio em decúbito ventral sobre a cunha.

INTRODUCTION: Cerebral palsy is a disorder characterized by an abnormal activity, movement and posture development. The Bobath concept is one of the most used methods for the neuropediatric rehabilitation and is based on the acquisition of sensorimotor skills according to the normal sequence of the psychomotor development. OBJECTIVE: In this study, we explore the relationship between electromyographic signal (EMG) in muscles involved in the cervical control in the frontal, sagittal and transversal planes and facilitation techniques using key points of control, which is part of the Bobath approach. MATERIALS AND METHODS: The methodology was quantitative applied in a case study of one child, seven years old, with Cerebral palsy and West syndrome diagnosis. The surface EMG activity of muscle groups involved in the cervical control (extensors, flexors and lateral flexors) was collected under therapeutic handling using key points of control in ventral decubitus on the wedge and in lateral decubitus along 5 seconds. RESULTS: The EMG signal from extensors and flexors muscles was augmented under therapeutic handling for weight bearing using the hip joint as key point of control in both decubitus. Although the EMG basal signal in the ventral position had been intensified during the weight bearing, the EMG activity was higher when the handling was performed using the lateral position. CONCLUSION: We concluded that the therapeutic handling for weigh bearing using the hip joint as key point of control induced the facilitation of cervical control. The use of the lateral position as well as the repetition of this position in a maintained way, since the correct alignment position is observed, should be able to induce higher facilitation of cervical control than weigh bearing in ventral position on the wedge.

Is it possible to predict the infant's neurodevelopmental outcome at 14 months of age by means of a single preterm assessment of General Movements?

BACKGROUND: It continues to be a challenge for clinicians to identify preterm infants likely to experience subsequent neurodevelopmental deficits. The Test of Infant Motor Performance (TIMP) and the assessment of spontaneous general movements (GMs) are the only reliable diagnostic and predictive tools for the functionality of the developing nervous system, if applied before term. AIM: To determine to what extent singular preterm assessments of motor performance can predict the neurodevelopmental outcome in 14-month olds. METHODS: Thirty-seven preterm infants born <34weeks gestational age were recruited for the study at the NICU of the São Lucas University Hospital, Porto Alegre, RS, Brazil. At 34weeks, their GMs were assessed; and the Test of Infant Motor Performance (TIMP) was applied. A prospective design was used to examine (A) the association between the GM assessment and the TIMP; and (B) the relation between GMs or the TIMP and the developmental status at 14months, assessed by means of Alberta Infant Motor Scales (AIMS) and the Pediatric Evaluation of Disability Inventory (PEDI). RESULTS: Nineteen infants (41%) had abnormal GMs; only one scored within the TIMP average range. Hence, GMs and TIMP were not related. Children with cramped-synchronized GMs at 34weeks preterm had a lower AIMS centile rank than those with poor repertoire or normal GMs. There was a marginal association between cramped-synchronized GMs and a lower PEDI mobility score. CONCLUSIONS: A single preterm GM assessment is only fairly to moderately associated with the 14-month motor development. The TIMP is not suitable as a complementary assessment tool at such a young age.

Avaliação do desempenho motor de prematuros nos primeiros meses de vida na Escala Motora Infantil de Alberta (AIMS) / Evaluation of motor performance of preterm newborns during the first months of life using the Alberta Infant Motor Scale (AIMS)

OBJETIVOS: Avaliar o desempenho motor de neonatos prematuros pela Escala Motora Infantil de Alberta (AIMS) e verificar a influência do peso de nascimento nas aquisições motoras. MÉTODOS: Foi realizado estudo transversal associado à coorte prospectiva, envolvendo 44 recém-nascidos prematuros com idade gestacional entre 32 e 34 semanas, sem distúrbios neurológicos, selecionados na unidade de terapia intensiva neonatal do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul. Os neonatos incluídos foram estratificados de acordo com o peso de nascimento e avaliados pela escala AIMS na 40ª semana de idade concepcional, aos 4 e 8 meses de idade corrigida. RESULTADOS: Os prematuros estudados apresentaram seqüência progressiva de aparecimento de habilidades motoras em todas as posturas estudadas (prono, supino, sentado, em pé), a qual ocorreu de forma variável, expressa pelo percentil médio de 43,2 a 45,7 por cento, mas dentro dos limites de normalidade previstos pela escala AIMS. Observou-se que houve um nítido aumento dos escores da AIMS ao longo dos três momentos de observação pós-natal. O ritmo de aumento nesses escores foi semelhante em ambos os grupos, independente do peso de nascimento (<1.750 g ou ³ 1.750 g). CONCLUSÕES: Na amostra estudada, o desempenho motor dos prematuros foi normal pela escala AIMS, assim como os escores da mesma não foram influenciados pelo peso de nascimento.

OBJECTIVES: To evaluate the motor performance of premature neonates using the Alberta Infant Motor Scale (AIMS) and to investigate the influence of birth weight on motor acquisition. METHODS: A cross-sectional study was carried out of a prospective cohort of 44 premature newborn infants with gestational ages from 32 to 34 weeks, without neurological disorders, selected from the neonatal intensive care unit at the Pontifícia Universidade Católica's Hospital São Lucas in Rio Grande do Sul, Brazil. The neonates studied were stratified by birth weight and assessed using the AIMS scale at the 40th week of postconceptional age, and at 4 and 8 months of corrected age. RESULTS: The preterm infants studied exhibited a progressive sequence of motor ability acquisition in all of the positions tested (prone, supine, sitting, standing), which occurred variable manner, expressed by the mean percentile of 43.2 to 45.7 percent, but within the limits of normality defined by the AIMS. It was observed that there was a clear increase in AIMS scores from the first to the last of the three postnatal observation points. The rate at which these scores increased was similar for both groups, irrespective of birth weight category (<1,750 g or ³1,750 g). CONCLUSIONS: The motor performance of the sample of premature infants studied here was normal according to the AIMS and their scores on that scale were not influenced by birth weight.

Evaluation of motor performance of preterm newborns during the first months of life using the Alberta Infant Motor Scale (AIMS).

OBJECTIVES: To evaluate the motor performance of premature neonates using the Alberta Infant Motor Scale (AIMS) and to investigate the influence of birth weight on motor acquisition. METHODS: A cross-sectional study was carried out of a prospective cohort of 44 premature newborn infants with gestational ages from 32 to 34 weeks, without neurological disorders, selected from the neonatal intensive care unit at the Pontifícia Universidade Católica's Hospital São Lucas in Rio Grande do Sul, Brazil. The neonates studied were stratified by birth weight and assessed using the AIMS scale at the 40th week of postconceptional age, and at 4 and 8 months of corrected age. RESULTS: The preterm infants studied exhibited a progressive sequence of motor ability acquisition in all of the positions tested (prone, supine, sitting, standing), which occurred variable manner, expressed by the mean percentile of 43.2 to 45.7%, but within the limits of normality defined by the AIMS. It was observed that there was a clear increase in AIMS scores from the first to the last of the three postnatal observation points. The rate at which these scores increased was similar for both groups, irrespective of birth weight category (<1,750 g or >or= 1,750 g). CONCLUSIONS: The motor performance of the sample of premature infants studied here was normal according to the AIMS and their scores on that scale were not influenced by birth weight.